Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries.

BACKGROUND: The last 3 years have witnessed global health challenges, ranging from the pandemics of COVID-19 and mpox (monkeypox) to the Ebola epidemic in Uganda. Public health surveillance is critical for preventing these outbreaks, yet surveillance systems in resource-constrained contexts struggle to provide timely disease reporting. Although community health workers (CHWs) support health systems in low-income and middle-income countries (LMICs), very little has been written about their role in supporting public health surveillance. This review identified the roles, impacts and challenges CHWs face in public health surveillance in 25 LMICs. METHODS: We conducted a scoping review guided by Arksey and O'Malley's framework. We exported 1,156 peer-reviewed records from Embase, Global Health and PubMed databases. After multiple screenings, 29 articles were included in the final review. RESULTS: CHWs significantly contribute to public health surveillance in LMICs including through contact tracing and patient visitation to control major infectious diseases such as HIV/AIDS, malaria, tuberculosis, Ebola, neglected tropical diseases and COVID-19. Their public health surveillance roles typically fall into four main categories including community engagement; data gathering; screening, testing and treating; and health education and promotion. The use of CHWs in public health surveillance in LMICs has been impactful and often involves incorporation of various technologies leading to improved epidemic control and disease reporting. Nonetheless, use of CHWs can come with four main challenges including lack of education and training, lack of financial and other resources, logistical and infrastructural challenges as well as community engagement challenges. CONCLUSION: CHWs are important stakeholders in surveillance because they are closer to communities than other healthcare workers. Further integration and training of CHWs in public health surveillance would improve public health surveillance because CHWs can provide health data on 'hard-to-reach' populations. CHWs' work in public health surveillance would also be greatly enhanced by infrastructural investments.

Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

Les taux de fécondité restent élevés dans certains sous-groupes de la population, et les recherches sur les facteurs sociodémographiques influençant la fécondité sont limitées, en particulier à Eswatini où les femmes sont souvent considérées comme mineures. Cette étude vise à étudier les changements dans la fécondité au cours de la vie et les associations entre les facteurs sociodémographiques et la fécondité au cours de la vie chez les femmes déjà mariées. L'étude a utilisé des données transversales secondaires des enquêtes par grappes à indicateurs multiples (MICS) d'Eswatini de 2010 et 2014, avec un échantillon de 2 295 et 2 351 femmes, respectivement. Les données ont été analysées à l'aide de statistiques descriptives et d'une régression de Poisson multivariée. Les résultats ont montré que les taux de fécondité ont diminué de 3,47 à 3,21 enfants entre 2010 et 2014. L'étude a révélé que la perte d'enfants et l'âge (25 ans et plus) étaient des facteurs importants associés à une fécondité plus élevée, tandis qu'un âge plus tardif au mariage et aux débuts sexuels (20 ans et plus) ), au moins une éducation secondaire, et le fait d'être riche étaient de puissants prédicteurs de taux de fécondité plus faibles. L'étude recommande de sensibiliser et de renforcer les lois visant à abolir les premiers rapports sexuels et le mariage précoces. Il suggère également d'autonomiser les femmes grâce à l'éducation, d'encourager l'utilisation de contraceptifs et de fournir des services de santé maternelle et infantile dans les zones rurales où les taux de fécondité ont tendance à être plus élevés.

Folic Acid-Fortified Iodized Salt and Serum Folate Levels in Reproductive-Aged Women of Rural India: A Nonrandomized Controlled Trial.

Importance: India has a disproportionately high prevalence of neural tube defects, including spina bifida and anencephaly (SBA), causing a high number of stillbirths, elective pregnancy terminations, and child mortality; India contributes a large proportion of the global burden of SBA. Thirty years after folic acid was shown to be effective in reducing SBA prevalence, only about one-quarter of such births are prevented globally through cereal grain fortification. Objective: To determine the association of folic acid-fortified iodized salt with serum folate concentrations among nonpregnant and nonlactating women of reproductive age. Design, Setting, and Participants: This nonrandomized controlled trial using a preintervention and postintervention design was conducted in 4 rural villages in Southern India from July 1 to November 30, 2022. All households in the villages agreed to participate in the study. Preintervention and postintervention serum folate levels were analyzed among study participants at baseline and after 4 months, respectively. Intervention: Consumption of approximately 300 µg/d of folic acid using double fortified salt (folic acid plus iodine). Median serum folate concentrations were assessed at baseline and 4 months. Main Outcomes and Measures: Change in median serum folate levels between baseline and study end point as the primary outcome of the study. Results: A total of 83 nonpregnant nonlactating women aged 20 to 44 years (mean [SD] age, 30.9 [5.1] years) were eligible for the study and provided serum samples for analysis at baseline and the end point of the intervention. The median serum folate concentration increased from 14.6 (IQR, 11.2-20.6) nmol/L at baseline to 54.4 (IQR, 43.5-54.4) nmol/L at end of study, a 3.7-fold increase from baseline to study end point. Two-tailed Wilcoxon signed rank test showed the median difference in preintervention and postintervention serum folate concentrations to be highly significant (P < .001). The participants found the salt acceptable in color and taste. Conclusions and Relevance: Use of folic acid-fortified iodized salt was associated with increased serum folate concentrations in women of reproductive age. This novel evidence can inform public health policy to accelerate SBA prevention. Trial Registration: ClinicalTrials.gov Identifier: NCT06174883.

A Framework for Evaluating Local Adaptive Capacity to Health Impacts of Climate Change: Use of Kenya's County-Level Integrated Development Plans.

Background: Health National Adaptation Plans were developed to increase the capacity of low- and middle-income countries (LMICs) to adapt to the impacts of climate change on the health sector. Climate and its health impacts vary locally, yet frameworks for evaluating the adaptive capacity of health systems on the subnational scale are lacking. In Kenya, counties prepare county integrated development plans (CIDPs), which contain information that might support evaluations of the extent to which counties are planning climate change adaptation for health. Objectives: To develop and apply a framework for evaluating CIDPs to assess the extent to which Kenya's counties are addressing the health sector's adaptive capacity to climate change. Methods: CIDPs were analyzed based on the extent to which they addressed climate change in their description of county health status, whether health is noted in their descriptions of climate change, and whether they mention plans for developing climate and health programs. Based on these and other data points, composite climate and health adaptation (CHA) scores were calculated. Associations between CHA scores and poverty rates were analyzed. Findings: CHA scores varied widely and were not associated with county-level poverty. Nearly all CIDPs noted climate change, approximately half mentioned health in the context of climate change and only 16 (34%) noted one or more specific climate-sensitive health conditions. Twelve (25%) had plans for a sub-program in both adaptive capacity and environmental health. Among the 24 counties with plans to develop climate-related programs in health programs, all specified capacity building, and 20% specified integrating health into disaster risk reduction. Conclusion: Analyses of county planning documents provide insights into the extent to which the impacts of climate change on health are being addressed at the subnational level in Kenya. This approach may support governments elsewhere in evaluating climate change adaptation for health by subnational governments.

To social distance or to not social distance? COVID-19 social impact and safety profiles, social determinants, and mental health of Black adults.

The impact of COVID-19 on Black adults' social networks and their perceptions of the safety of social gatherings are intertwined. Yet, we know little about the role of this intersection and social determinants on Black adults' mental health. The goal of this study was to examine profiles of COVID-19 impact and safety for Black adults in the United States, their association with mental health, and the role of sociodemographic, health, and employment social determinants. We used latent class analysis and data from Black adults from the nationally representative survey of the Understanding Coronavirus in America Study (January-February 2021; N = 593) to construct profiles and test associations between profiles, social determinants, and mental health. Black adults in the low visitation safety profile had worse mental health than those in the high home safety profile. Older, retired, and insured Black adults were less likely to be impacted by COVID-19. Both the impact of COVID-19 on social networks and perceptions of safety of engaging with others are important for Black adults' mental health. Age, retirement, and health insurance play a role. Reducing distress and social isolation from COVID-19 impact and safety fears may bolster the mental health of Black adults. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chinese Railroad Workers, the Transcontinental Railroad, and the Indispensability of Immigration to America.

Asian migration to America began with Chinese railroad workers on the transcontinental railroad (1862-1869). Their labor saved the foundering Central Pacific Railroad, challenged by building a rail line through the Sierra Nevada. By mid-1864 only 50 miles of track had been laid, grueling work that dissuaded its white workforce from going any further. To save the railroad 50 Cantonese workers were hired in early 1864 from neighboring mines to lay rail through forests, canyons, and granite mountains. High explosives, rockslides, cave-ins, and winter avalanches were constant dangers. The trial worked so well that thousands of Chinese joined the effort, many from the rural districts surrounding Guangzhou (Canton). The wages, less than half of that paid to white workers, were beyond the imaginations of subsistence farmers escaping abject poverty, plague, and famine. A good proportion of their earnings were remitted to families back home. As many as 20,000 may have worked on the railway. The death toll was staggering, estimated in the thousands. After Promontory Summit in 1869, Chinese were in great demand, building scores of rail lines throughout the country and Canada. Just 13 years later rising anti-Asian sentiment led to the passage of the Chinese Restriction Act of 1882 that for the first time barred a racial group from American shores. But they opened America to Asian immigrants that includes today's Asian surgical community, which owes its present-day success to the hardworking forebears that created a global country with ribbons of steel rail.

Disentangling the link between social determinants of health and child survival in Nigeria during the Sustainable Development Goals era: a hierarchical path analysis of time-to-event outcome.

While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20-34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.

Decoupling livestock and poultry pollution emissions from industrial development: A step towards reducing environmental emissions.

China has implemented policies like Leading areas for Agricultural Green Development (LAGD) to mitigate livestock and poultry farming pollution while promoting industry growth. However, it remains uncertain whether LAGDs have successfully balanced emission reduction with stable development. This study examines 165 LAGDs to analyze changes in emissions, assess the decoupling of emission reduction from output value, and identify influencing factors. Findings reveal that emissions from livestock and poultry in LAGDs initially increased and then decreased between 2010 and 2019. Cattle were responsible for over 40% of fecal emissions, and pigs for more than 20%. Additionally, pigs contributed to over 61% of urine emissions. From 2010 to 2014, increases in chemical oxygen demand were mainly due to pigs and cattle. Total nitrogen levels were significantly impacted by cattle, while pigs were affected by total phosphorus. From 2014 to 2019, reductions in emissions were largely attributed to a decrease in pig-related pollutants. The decoupling status shifted from strong to weak and then back to strong between 2014 and 2019. Production efficiency played a crucial role in reducing emissions, while changes in industrial structure moved from supporting to hindering this reduction. Economic development was a primary factor in driving these changes. Standard emissions in Chinese regions showed a rising and then declining trend from 2010 to 2019. The Northeast and Northwest regions of China demonstrated emission trends that were in sync with the growth in rural income. This study offers insights into the successes and challenges of LAGDs in achieving a balance between reduced emissions and development, using quantitative analysis. The findings are instrumental in informing policies for a sustainable livestock and poultry industry. Recommendations include evaluating coordinated approaches to pollution reduction and industrial growth, setting decoupling goals, designing policies based on influential factors, conducting regional assessments of livestock and poultry demand, and implementing region-specific strategies.

Social isolation during the COVID-19 pandemic is associated with the decline in cognitive functioning in young adults.

Coronaviruses have caused widespread disease and death worldwide, leading to the implementation of lockdown measures and the closure of educational institutions in various countries. This research aims to investigate the impact of social isolation on the cognitive functioning of young students. The study included 84 subjects, with 48 being socially isolated and 36 non-isolated individuals. The participants' mental health was assessed using the Mini-Mental State Examination (MMSE), while cognitive functions were evaluated through attention-switching tasks (AST), pattern recognition memory (PRM), and choice reaction time (CRT) tests utilizing the Cambridge Neuropsychological Automated Battery (CANTAB) software. The socially isolated group had an average age of 21.3 ± 1.1 years, whereas the non-isolated group had an average age of 22.8 ± 2.0 years. The MMSE scores were 25.8 ± 1.6 for the socially isolated group and 28.6 ± 1.3 for the non-isolated group. In terms of cognitive functioning, there were significant differences (p = 0.000) observed in the values of AST correct latency for non-switching blocks (blocks 3 and 5) between the socially isolated group (608.1 ± 139.2) and the non-isolated group (499.5 ± 67.8). Similarly, the AST mean correct latency for switching blocks (block 7) was significantly different (p = 0.012) between the socially isolated group (784.4 ± 212.5) and the non-isolated group (671.8 ± 175.6). The socially isolated group exhibited significantly higher values in AST correct mean latency, AST congruent mean latency, AST incongruent mean latency, and AST percent mean correct trials compared to the non-isolated group. Additionally, the PRM mean percent correct significantly differed (p = 0.000) between the isolated group (81.3 ± 12.0) and the non-isolated group (91.9 ± 9.2). The isolated group also showed a higher CRT correct mean latency (482.4 ± 128.9) than the non-isolated group (451.0 ± 59.0), however the difference was not significant. In conclusion, social isolation during the COVID-19 pandemic has resulted in a decline in the cognitive functioning of young students.

Trastornos psicóticos en Paraguay: ¿existen diferencias significativas entre zonas urbanas y rurales? / Psychotic disorders in Paraguay: Are there any significant differences between urban and rural areas?

Actualmente existe una tendencia mundial de desplazamiento de la población rural hacia áreas cada vez más urbanizadas. Existe evidencia que informa que el desarrollo de las enfermedades mentales tiene relación importante con factores tanto internos (por ejemplo, genéticos) y externos (el ambiente, entre otros). Con respecto a esto último, la manera en la que el entorno afecta a la salud mental es un objeto de estudio de interés global y se ha reportado que las áreas urbanas presentan mayores tasas de trastornos mentales comunes en comparación con las rurales. En el caso de la psicosis, por más de que el factor genético sea el más demostrado (y estudiado en los últimos años), el factor ambiental representando por el ambiente urbano ya ha sido analizado por investigadores a inicios del siglo 20. Desde allí, a lo largo de los años se obtuvo evidencia repetida que lo respalda como un factor de riesgo. Se ha encontrado que, además, existe relación con el grado de exposición, lo que hace pensar que la causa no solamente se limita a la transición del área rural al área urbana, sino que están involucrados factores sociales, económicos y medioambientales más profundos como la disparidad social, inseguridad, contaminación, entre otros 1. Ya en las últimas décadas del siglo 20, investigadores informaron de un aumento de la incidencia de esquizofrenia de 1,65 en hombres que vivían ciudades sobre sus contrapartes de origen rural. Años después, otros estudios han reportado esta variación en la incidencia de primeros episodios psicóticos a través del gradiente social urbano-rural, así como una relación entre el aumento de hospitalización por esquizofrenia con el grado de urbanización.

Assessing the extent and impacts of linear infrastructure on Sri Lanka's natural and protected areas: Implications for future development planning.

Linear infrastructure (LI) has varying effects on landscapes depending on different ecosystems' sensitivity and threat levels. Economically developing tropical countries are particularly at risk from LI. Therefore, understanding a country's current LI network and planning future developments to avoid further fragmentation and disturbance is crucial. This study aimed to assess the extent of Sri Lanka's LI network (i.e., roads, railroads, and powerlines), given that it is both a biodiversity hotspot and an economically developing country in the tropics. First, we calculated the average normalized difference vegetation index (NDVI) and normalized difference built-up index (NDBI) indices and examined their spatial autocorrelation per divisional secretariat division. Then a multivariate cluster analysis was used to determine clusters of natural and protected areas that may receive similar impacts from different LI and their combinations. Results indicated that roads are the most widespread LI type in Sri Lanka, followed by powerlines and railroads. Over 80% of Sri Lanka's total land area falls within 1 km of either a national or a provincial/local road. Areas with high NDVI were primarily manmade habitats, with less than 20% contribution from protected areas. Over 50% of the total protected area of Sri Lanka is being impacted by all three types of LI. Powerlines were the most common LI type in protected areas in proportion to their total network lengths. To minimize environmental impact while achieving development goals, future LI development activities should use a landscape approach to identify development needs and strategies informed by these findings.

Prevalence and Factors Associated with Subjective Memory Complaint in a Semi-Rural Community in Chile.

BACKGROUND: Subjective memory complaints (SMC) are commonly studied in older adults and have been identified as potentially prodromal to dementia and Alzheimer's disease. Studies among younger adults from South America are lacking. OBJECTIVE: To estimate the prevalence of SMC and the factors associated with it among Maule Cohort (MAUCO) participants. METHODS: We performed a cross-sectional analysis to estimate the prevalence of SMC and investigated its associated factors from MAUCO baseline data (N = 6,687). Within groups defined by age (38-59, 60-74) and global cognition (Mini-Mental State Examination: ≥26, 25-22, ≤21), multinomial logistic regression models evaluated risk factors for SMC (Yes, Sometimes, No). RESULTS: Overall, SMC prevalence was 16.4%; 15.9% (95% CI 14.9-16.9%) among younger and 17.6% (15.8-19.4%) among older participants. Female sex, comorbidities, and bad/fair self-reported health status (SRHS) were generally associated with higher odds of SMC. CONCLUSION: Overall prevalence of SMC was 16%. Different factors were associated with the odds of SMC depending on age and global cognitive status. Future SMC studies should include sex-specific assessments, evaluate SRHS as a moderator of SMC reporting, and the influence of the SARS-CoV-2 pandemic on SMC reporting.

Differences in the evolution of urban and rural surface thermal environment and their responses to urban renewal in Shanghai, China.

The rapid and extensive urbanization has profound impacts on urban thermal environment. It is of great significance to comprehensively understand how urbanization affects the evolution of urban thermal environment for urban ecological safety, environmental quality, and residents' health. Based on daily land surface temperature (LST) products of MODIS Aqua satellite in the summer of 2002-2020, we investigated the evolution of urban-rural differences in surface summer thermal environment in Shanghai during 2002-2020 and its response to urban spatial renewal. We used normalized land surface temperature (NLST) and urban heat island ratio index (URI) as the surface thermal environment measurement indicators, by combining vegetation index and impervious surface cove-rage, and used M-K trend analysis and interpretation analysis. The results showed that the linear growth rate of LST in Shanghai was 0.09 ℃·a-1 (2002-2020), and that URI showed a trend of first increasing (2002-2010) and then decreasing (2010-2020). The mean summer LST was generally in the order of urban core>suburban>rural. 1.6% of the areas showed a significant cooling trend, of which 54.0% were distributed in the urban core. 39.5% of the regions showed a significant warming trend, of which 77.6% were distributed in the suburban. In general, there were concentrated significant cooling areas in the highly urbanized urban areas, while there was a significant warming trend in the suburban. The transformation from urban expansion to urban renewal was the main reason for the emergence of concentrated and significant cooling areas in the urban. Nearly 20% of the urban area showed a signi-ficant increase of vegetation coverage. Urban renewal projects such as gathering vegetation or dispersing impervious surfaces in highly urbanized areas are important ways to effectively improve the urban residential thermal environment.

Performance patterns of primary health care in the face of COVID-19 in Brazil: characteristics and contrasts. / Padrões de desempenho da atenção primária à saúde diante da COVID-19 no Brasil: características e contrastes.

The adequate fight against pandemics requires effective coordination between primary health care (PHC) and health surveillance, guaranteed attention to acute and chronic demands, and a bond with the community dimension in the scope of basic health units (UBS, acronym in Portuguese). This study aims to contrast two extreme standards of PHC performance in the fight against COVID-19 in Brazil, comparing them with the profiles of the corresponding municipalities and characteristics of the organization of services. Based on the results of a cross-sectional national survey with a representative sample of UBSs, we created a synthetic index to evaluate how PHC performs against COVID-19 called CPI, composed of axes of health surveillance and social support (collective dimension) and of COVID-19 care and continuity of care (individual dimension). Of the 907 surveyed UBSs, 120 were selected, half of which had the highest indexes (complete standard) and the other half, the lowest ones (restricted standard). The municipalities of the UBSs with a complete standard are predominantly rural, have low Municipal Health Development Index (MHDI), high Family Health Strategy (FHS) coverage, and stand out in the collective dimension, whereas the UBSs in urban municipalities with this same standard have high MHDI, low FHS coverage, and an emphasis on the individual dimension. In the restricted standard, we highlight community health workers' reduced work in the territory. In the Brazilian Northeast, UBSs with complete standard predominate, whereas, in its Southeast, UBSs with restricted standard predominate. The study poses questions that refer to the role and organization of PHC in the health care network under situations that require prompt response to health issues and indicates the greater potential capacity of the FHS program in such situations.

O enfrentamento adequado de pandemias requer forte articulação entre atenção primária à saúde (APS) e vigilância em saúde, atenção garantida às demandas agudas e crônicas e vinculação com a dimensão comunitária no âmbito das unidades básicas de saúde (UBS). O objetivo deste artigo é contrastar dois padrões extremos de desempenho da APS no enfrentamento da COVID-19 no Brasil, cotejando-os com os perfis dos respectivos municípios e características da organização dos serviços. A partir dos resultados de inquérito nacional transversal com amostra representativa das UBS, foi criado um índice sintético de desempenho da APS em relação à COVID-19, denominado CPI, composto pelos eixos de vigilância e apoio social (dimensão coletiva) e de atendimento ao paciente com COVID-19 e continuidade do cuidado (dimensão individual). Das 907 UBS pesquisadas, foram selecionadas 120, sendo a metade com os maiores índices encontrados (padrão completo) e a outra com os menores (padrão restrito). Os municípios das UBS com padrão completo são preponderantemente rurais, com baixo Índice de Desenvolvimento Humano Municipal (IDHM), alta cobertura da Estratégia Saúde da Família (ESF) e destacam-se na dimensão coletiva, enquanto as UBS nesse mesmo padrão situadas em municípios urbanos apresentam alto IDHM, baixa cobertura de ESF, com ênfase na dimensão individual. No padrão restrito, destaca-se a reduzida atuação de agentes comunitários de saúde no território. Na Região Nordeste, predominam UBS com padrão completo, enquanto na Sudeste preponderam UBS com padrão restrito. O estudo apresenta questões que remetem ao papel e à organização da APS na rede de cuidados em situações que requerem pronta resposta aos agravos de saúde e indica maior capacidade potencial da ESF em tais situações.

El enfrentamiento adecuado de las pandemias requiere una fuerte articulación entre atención primaria de salud (APS) y la vigilancia en salud, una atención garantizada a las demandas agudas y crónicas y la vinculación con la dimensión comunitaria en el ámbito de las unidades básicas de salud (UBS). El objetivo de este artículo es contrastar dos patrones extremos de desempeño de la APS en el enfrentamiento del COVID-19 en Brasil, comparándolos con los perfiles de los respectivos municipios y características de la organización de los servicios. A partir de los resultados de una encuesta nacional transversal con una muestra representativa de las UBS fue creado un índice sintético de desempeño de la APS frente al COVID-19, denominado CPI, compuesto por los ejes de vigilancia y apoyo social (dimensión colectiva) y de atención al COVID-19 y continuidad de la atención (dimensión individual). De las 907 UBS investigadas, se seleccionaron 120, siendo la mitad con los índices más grandes encontrados (estándar completo) y la otra con los más bajos (estándar estricto). Los municipios de las UBS con estándar completo son preponderantemente rurales, con bajo índice de desarrollo humano municipal (IDHM), alta cobertura de la Estrategia Salud de la Familia (ESF) y se destacan en la dimensión colectiva, mientras que las UBS en este mismo estándar situadas en municipios urbanos presentan alto IDHM, baja cobertura de ESF, con énfasis en la dimensión individual. En el estándar estricto, se destaca la reducida actuación de los agentes comunitarios de salud en el territorio. En la región Nordeste predominan las UBS con estándar completo, mientras que en el Sureste predominan las UBS con un estándar estricto. El estudio aporta cuestiones que remiten al papel y organización de la APS en la red de atención en situaciones que requieren respuesta rápida a los problemas de salud e indica una mayor capacidad potencial de la ESF en tales situaciones.

Relationship between aging population, birth rate and disposable income per capita in the context of COVID-19.

The outbreak of the COVID-19 in early 2020 and the recurring epidemic in later years have disturbed China's economy. Moreover, China's demographic dividend has been disappearing due to its fastest aging population and declining birth rate. The birth rates in eastern provinces of China are much lower than those of the western provinces. Considering the impacts of the COVID-19 and aging population, this paper focused on the relationship between birth rate and the disposable income and tried to find effective measures to raise China's birth rate. We discovered through regression analysis that the link between per capita disposable income and birth rate is initially "reverse J" and later "inverted J", indicating that per capita disposable income will influence the birth rate. Women's employment rate and educational level are negatively correlated with the birth rate. To raise the fertility rate in China, it is necessary to increase the marriage rate and the willingness to have children by raising the per capita disposable income and introducing effective tax relief policies.

Covid-19 e o uso de tecnologias informacionais e de comunicação por pessoas idosas: revisão integrativa / Covid-19 and the use of information and communication technologies by older people: integrative review / Covid-19 y el uso de tecnologías de la información y la comunicación por parte de las personas mayores: revisión integradora

Acrise sanitária ocasionada pela COVID-19 fomentou o desenvolvimento e uso das plataformas digitais e, consequentemente, a população idosa precisou se adaptar ao uso desses recursos. Objetivo:Investigar o uso das tecnologias digitais pela população idosa durante o contexto da pandemia da COVID-19. Metodologia:Revisão integrativa realizada entre os meses de janeiro a março de 2022, de artigos publicados na íntegra em português e inglês, disponíveis na Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS), National Library of Medicine (NLM-PubMed) e PubMed. Foram utilizados os descritores "aged/elderly" AND "covid-19/sars-cov-2/coronavírus" AND "information and communication technology", sendo selecionados e analisados nove estudos. Resultados:a população idosa utilizou diversos recursos tecnológicos durante a pandemia, com intuito de auxiliar o processo de comunicação, proporcionar distração e lazer, e obter auxílio e atendimento de saúde. Conclusões:Durante o isolamento social, o uso de tecnologias pela população idosa possibilitou interação social e acesso aos mais diversos recursos para busca de informações, além de amenizar a solidão e reduzir a exposição ao risco de infecção pelo vírus SARS-CoV-2 (AU).

The health crisis brought about by COVID-19 prompted the development and use of digital platforms and, consequently, theneed for theelderly population to adapt to the use of these resources. Objective:to investigate the use of digital technologies by older peopleduring the context of the COVID-19 pandemic. Method:This is an integrative review carried out between January and March 2022 of articles published in Portuguese and English, available in full in the Latin American and Caribbean Health Sciences Literature (LILACS), National Library of Medicine (NLM-PubMed) and PubMed. The descriptors "aged/elderly" AND "covid-19/sars-cov-2/coronavirus" AND "information and communication technology" were used, and nine studies were selected and analyzed. Results:The elderly population used various technological resources during the pandemic to assist in theircommunication process, provide distraction and leisure, and get help and health care. Conclusion:During social distancing, the use of technologies by the elderly population allowed social interaction and access to the most diverse resources for searching for information, in addition to alleviating loneliness and reducing exposure to the risk of infection by the SARS-CoV-2 virus (AU).

La crisis sanitaria provocada por el COVID-19 fomentó el desarrollo y uso de plataformas digitales y, en consecuencia, la población anciana necesitó adaptarse al uso de estos recursos. Objetivo:Investigar el uso de las tecnologías digitales por parte delas personas mayores durante el contexto de la pandemia de COVID-19. Metodología:Revisión integradora realizada entre enero y marzo de 2022 de artículos publicados en portugués e inglés, disponibles íntegramente en la Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Biblioteca Nacional de Medicina (NLM-PubMed) y PubMed. Se utilizaron los descriptores "aged/elderly" AND "covid-19/sars-cov-2/coronavírus" AND "information and communication technology", y se seleccionaron y analizaron nueve estudios. Resultados:Se identificó el uso de diversos recursos tecnológicos en la vida cotidiana de los ancianos, especialmente para ayudar en el proceso de comunicación, proporcionar distracción y ocio, así como para obtener asistencia y cuidadossanitarios. Conclusiones: Durante el aislamiento social, el uso de la tecnología por las personas mayorespermitió la interacción social y el acceso a una amplia gama de recursos de búsqueda de información, además de aliviar la soledad sin favorecer la exposición al riesgo de infección por SARS-CoV-2 (AU).

A busca por um fazer costurado de possibilidades e desafios: a atuação do sanitarista na atenção primária à saúde do campo / The search for making a summaryof possibilities and challenges: The performance of the sanitarian in Primary Health carein the field / La búsqueda por un hacer sembrado de posibilidades y desafíos: la actuación del prestador sanitario en la atención primaria de salud en el campo

As práticas de trabalho em saúde têm historicamente passado por transformações principalmente a partir dos processos de formação dos profissionais da saúde. O profissional sanitarista, ou bacharel em saúde coletiva vem somando esforços e ocupando espaços de trabalho multiprofissionais fortalecendo a perspectiva transversal do cuidado em saúde em diversos campos de atuação. Objetivo:Este estudo objetiva relatar a experiência de construção do processo de trabalho de um bacharel em Saúde Coletiva na Atenção Primária à Saúde do Campo em meio a pandemia de Covid-19. Metodologia:O período de abrangência foi de 2020 a 2022, ocorrendo no município de Caruaru, Pernambuco. A atuação do bacharel em Saúde Coletiva se deu na perspectiva do Núcleo de Apoio àsaúde da famíliae atenção básica,atuando junto a duas equipes de saúde da família de territórios rurais. Resultados: O processo de trabalho se desenvolveu em três principais frentes, sendo elas: 1) Atenção à saúde com base territorial; 2) Articulação com redes intra e intersetoriais; 3) Reorganização do trabalho multiprofissional na Atenção Primária à Saúde. Conclusões: Sendo assim, é possível constatar que o processo de trabalho do bacharel em Saúde Coletiva está em constante movimento, delimitando as suas possibilidades de atuação, bem como os seus limites quanto a um fazer ainda desconhecido em realidades como a Atenção Primária. O avanço da discussão ocorre em paralelo a formação e inserção destes profissionais nos mais diversos contextos a exemplo da saúde do campo. Nota-se a necessidade de desenvolver novos estudos e experiências formativas de bacharéise saúde coletiva conectados aos territórios do campo, apostando na capilarização e ampliação da presença deste profissional nas realidades singulares do Sistema Único de Saúde (AU).

Health work practices have historically undergone transformations, mainly from the training processes of health professionals. The sanitary professional, or bachelor in public health, has been joining efforts and occupying multidisciplinary workspaces, strengthening the transversal perspective of health care in different fields. Objective:This study aims to report the experience of building the work process of a Bachelor of Public Health in Primary Health Care in the Countryside in the midst of the Covid-19 pandemic. Methodology: The coverage period was from 2020 to 2022, taking place in the municipality of Caruaru, Pernambuco. The performance of the bachelor in Collective Health took place from the perspective of the Support Center for family health and primary care, working with two family health teams from rural territories. Results:The work process was developed on three main fronts, namely: 1) Health care based on territory; 2) Articulation with intra and intersectoral networks; 3) Reorganization of multidisciplinary work in Primary Health Care.Conclusions:Therefore, it is possible to verify that the work process of the bachelor in Collective Health is in constant movement, delimiting their possibilities of action, as well as their limits regarding an action still unknown in realities such as Primary attention The advancement of the discussion occurs in parallel with the training and insertion of these professionals in the most diverse contexts, such as rural health. There is a need to develop new studies and training experiences for bachelors and collective health connected to rural territories, focusing on the capillarization and expansion of the presence of this professional in the unique realities of the Unified Health System (SUS) (AU).

Las prácticas del trabajo en salud históricamente han sufrido transformaciones, principalmente a partir de los procesos de formación de los profesionales de la salud. El profesional sanitario, o licenciado en salud pública, viene sumando esfuerzos y ocupando espacios de trabajo multidisciplinarios, fortaleciendo la perspectiva transversal del cuidado de la salud en diferentes campos. Objetivo: Este estudio tiene como objetivo relatar la experiencia de construcción del proceso de trabajo de un Licenciado en Salud Pública en la Atención Primaria de Salud en el Campo en medio de la pandemia de la Covid-19. Metodología: El período de cobertura fue de 2020 a 2022, ocurriendo en el municipio de Caruaru, Pernambuco. La actuación de la licenciatura en Salud Colectiva se dio en la perspectiva del Centro de Apoyo a la salud de lafamilia y atención primaria, trabajando con dos equipos de salud de la familia de territorios rurales. Resultados: El proceso de trabajo se desarrolló en tres frentes principales, a saber: 1) Atención de la salud con base en el territorio; 2) Articulación con redes intra e intersectoriales; 3) Reorganización del trabajo multidisciplinario en la Atención Primaria de Salud. Conclusiones: Por tanto, es posible constatar que el proceso de trabajo del licenciado en Salud Colectiva está en constante movimiento, delimitando sus posibilidades de actuación, así como sus límites frente a un actuar aún desconocido en realidades como la Atención primaria. El avance de la discusión ocurre en paralelo con la formación e inserción de estos profesionales en los más diversos contextos, como la salud rural. Existe la necesidad de desarrollar nuevos estudios y experiencias de formación para licenciaturas y salud colectiva vinculadas a los territorios rurales, con foco en la capilarización y ampliación de la presencia de ese profesional en las realidades singulares del Sistema Único de Salud (SUS) (AU).

Análise de casos e óbitos relacionados à esquistossomose no Brasil: padrões epidemiológicos e distribuição espaçotemporal, 2010-2022 / Analysis of schistosomiasis cases and deaths in Brazil: epidemiologic patterns and spatio-temporal distribution, 2010-2022 / Análisis de los casos y muertes relacionados con la esquistosomiasis en Brasil: patrones epidemiológión espaciotemporal, 2010-2022cos y distribuci

A esquistossomose é uma infecção parasitária causada por um grupo de vermes chatos chamados Schistosoma. A doença encontra-se, sobretudo, nos países em desenvolvimento, especialmente nas zonas rurais com más condições de saneamento e acesso limitado à água potável. A esquistossomose é transmitida através do contato com água doce contaminada, como de rios, lagos e lagoas em que vivem as larvas dos parasitas. O objetivo deste artigo foi analisar as variáveis epidemiológicas dos casos (2010-2022) e dos óbitos (2010-2020) por esquistossomose no Brasil. Trata-se de um estudo epidemiológico transversal, descritivo e quantitativo. A estratégia metodológica envolveu análise dos boletins epidemiológicos disponibilizados pelo Sistema de Informação de Agravos de Notificação (Sinan) e pelo Sistema de Informação sobre Mortalidade (SIM) no período de 2010 a 2022. Foram notificados 93.521 casos de esquistossomose e 5.495 óbitos devido a complicações dessa infecção. A forma intestinal foi a mais identificada. Minas Gerais, São Paulo, Bahia e Espírito Santo foram os estados com maior prevalência da doença. Constatou-se que homens pardos com idade entre 20 e 39 anos e com baixo nível de escolaridade são os mais afetados. Identificaram-se 732 casos da infecção em gestantes. Ademais, 62,56% dos casos evoluíram para cura e 5,88% para óbito pelo agravo notificado. Em conclusão, é crucial adotar medidas de prevenção e acesso à educação para combater efetivamente a esquistossomose.

Schistosomiasis is a parasitic infection caused by a group of flatworms called Schistosoma. The disease is primarily found in developing countries, especially in rural areas with poor sanitation and limited access to clean water. Schistosomiasis is transmitted by contact with contaminated freshwater, such as rivers, lakes, and ponds, where the parasites' larvae live. The aim of this article was to analyze the epidemiological variables of schistosomiasis cases (2010-2022) and deaths (2010-2020) in Brazil. This is a cross-sectional, descriptive, and quantitative epidemiologic study. The methodological strategy involved the analysis of epidemiological bulletins provided by the Sistema de Informação de Agravos de Notificação (SINAN) and the Sistema de Informação sobre Mortalidade (SIM) from 2010 to 2022. There were 93.521 reported cases of schistosomiasis and 5.495 deaths due to complications of this infection. The intestinal form was the most identified. Minas Gerais, São Paulo, Bahia, and Espírito Santo were the states with the highest prevalence of the disease. Males, of mixed race, aged between 20 and 39 years, and with a low level of education were the most affected. There were 732 cases of infection in pregnant women. Furthermore, 62.56% of the cases evolved to cure and 5.88% evolved to death by the notified disease. In conclusion, it is crucial to adopt prevention measures and access to education to effectively combat schistosomiasis.

La esquistosomiasis es una enfermedad parasitaria causada por un grupo de platelmintos conocidos como Schistosoma. La enfermedad es más frecuente sobre todo en países en desarrollo, especialmente en zonas rurales con saneamiento deficiente y acceso limitado al agua potable. La transmisión de la esquistosomiasis se da por el contacto con agua dulce contaminada, como ríos, lagos y lagunas donde viven las larvas de los parásitos. El objetivo de este artículo fue analizar las variables epidemiológicas de los casos (2010-2022) y muertes (2010-2020) por esquistosomiasis en Brasil. Se trata de un estudio epidemiológico transversal, descriptivo y cuantitativo. La estrategia metodológica contó con el análisis de los informes epidemiológicos que pone a disposición el Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan) y el Sistema de Información sobre Mortalidad (SIM) en el período de 2010 a 2022. Se notificaron 93.521 casos de esquistosomiasis y 5.495 muertes por complicaciones de esta infección. La forma intestinal fue la más identificada. Minas Gerais, São Paulo, Bahia y Espírito Santo fueron los estados con mayor prevalencia de la enfermedad. Se constató que hombres pardos, de edad entre 20 y 39 años, y bajo nivel de escolaridad son los más afectados. Se identificaron 732 casos de infección en mujeres embarazadas. El 62,56% de los casos evolucionaron a cura; y el 5,88% tuvieron muerte confirmada por el agravio notificado. Se concluye con la necesidad de adoptar medidas de prevención y acceso a la educación para combatir eficazmente la esquistosomiasis.

Adolescent childbirth and mobility disability among women ages 15-49: an analysis of population health surveys from 14 low-income and middle-income countries.

OBJECTIVES: Adolescent childbirth is associated with older adult adverse health outcomes that negatively affect mobility function, but these associations have not been studied globally in large samples of reproductive-age women. This study examines the association between age at first childbirth and mobility disability in national surveys from low-income and middle-income countries, and hypotheses that adolescent childbirth is associated with mobility disability. DESIGN: Cross-sectional analysis. SETTING: Population health surveys from 2013 to 2018 containing mobility disability measures among ever-pregnant women ages 15-49. These included 13 Demographic Health Surveys from Haiti, Pakistan, Uganda, Cambodia, Colombia, South Africa, Timor-Leste, Albania, Gambia, Maldives, Peru, Senegal and Yemen and 1 Maternal Health Survey from Ghana. PARTICIPANTS: The sample included 157 988 women ages 15-49 years. PRIMARY OUTCOME MEASURE: Adolescent childbirth was defined as 10-19 years of age. Poisson regression models were used to estimate prevalence ratios (PRs) of mobility disability among women who first gave birth during adolescence and in adult life (ages 20-45 years) in each country and across the whole sample. Countries were also analysed according to the use of standard and non-standard mobility disability measures. Covariates included current age, urban/rural residence, education and household wealth. RESULTS: Prevalence of adolescent childbirth (17.5%-66.2%) and mobility disability (0.32%-21.45%) varied widely across countries. Adolescent childbirth was significantly (p<0.05) associated with greater mobility disability in six of eight countries using standard disability measures. Among the six countries that did not use standard disability measures, none showed a statistically significant association between adolescent childbirth and mobility disability. Considering the whole sample and adjusting for all covariates, women who gave birth during adolescence had greater prevalence of mobility disability (pooled PR 1.19, 95% CI 1.06-1.31). CONCLUSIONS: This analysis suggests a moderate and consistent association of adolescent childbearing with subsequent mobility disability.

Promoting early childhood development in Viet Nam: cost-effectiveness analysis alongside a cluster-randomised trial.

BACKGROUND: Economic evaluations are critical to ensure effective resource use to implement and scale up child development interventions. This study aimed to estimate the cost-effectiveness of a multicomponent early childhood development intervention in rural Viet Nam. METHODS: We did a cost-effectiveness study alongside a cluster-randomised trial with a 30-month time horizon. The study included 669 mothers from 42 communes in the intervention group, and 576 mothers from 42 communes in the control group. Mothers in the intervention group attended Learning Clubs sessions from mid-pregnancy to 12 months after delivery. The primary outcomes were child cognitive, language, motor, and social-emotional development at age 2 years. In this analysis, we estimated the incremental cost-effectiveness ratios (ICERs) of the intervention compared with the usual standard of care from the service provider and household perspectives. We used non-parametric bootstrapping to examine uncertainty, and applied a 3% discount rate. FINDINGS: The total intervention cost was US$169 898 (start-up cost $133 692 and recurrent cost $36 206). The recurrent cost per child was $58 (1 341 741 Vietnamese dong). Considering the recurrent cost alone, the base-case ICER was $14 and mean ICER of 1000 bootstrap samples was $14 (95% CI -0·48 to 30) per cognitive development score gained with a 3% discount rate to costs. The ICER per language and motor development score gained was $22 and $20, respectively, with a 3% discount rate to costs. INTERPRETATION: The intervention was cost-effective: the ICER per child cognitive development score gained was 0·5% of Viet Nam's gross domestic product per capita, alongside other benefits in language and motor development. This finding supports the scaling up of this intervention in similar socioeconomic settings. FUNDING: Australian National Health and Medical Research Council and Grand Challenges Canada. TRANSLATION: For the Vietnamese translation of the abstract see Supplementary Materials section.