From national and regional commitments to global impact: artificial intelligence for equitable public health at the G20

Artificial intelligence (AI) is rapidly transforming numerous sectors and public health is no exception. As a powerful tool for modernizing health systems and services, AI promises to improve health outcomes, enhance efficiency and ensure innovation in public health practices. The G20, representing the world’s largest economies, plays a crucial role in shaping global health policies and driving forward initiatives that leverage AI for public health (1). Through its influential platform, this political body has the capacity to foster international collaboration, share knowledge, and recommend and support global standards that prioritize AI integration into public health. Health equity remains a fundamental principle of global public health goals, emphasizing the need for universal access to quality health care services regardless of geographical, economic or social barriers. AI holds immense potential to bridge health disparities, particularly for underserved populations. The G20’s commitment to embrace AI in public health underscores a collective effort to address these disparities, ensuring that technological advancements do not leave anyone behind.

Investigating under-reported human papillomavirus genotypes in Grenadian women through self-sampling for cervical cancer screening / Investigación de los genotipos de virus del papiloma humano infranotificados en mujeres de Granada mediante automuestreo para el tamizaje del cáncer cervicouterino / Investigação de genótipos subnotificados de papilomavírus humano em mulheres de Granada por meio de autoamostragem para rastreamento de câncer do colo do útero

[ABSTRACT]. Objective. To compare the adequacy, agreement, and acceptability of Papanicolaou testing (cytology) for cervical cancer screening using self-collected samples compared to physician-collected samples in Grenada in the Caribbean. Furthermore, the study identifies the human papillomavirus (HPV) genotypes present among asymptomatic women testing positive for HPV, the etiologic cause of cervical cancer. Methods. Participants were divided into two groups and two cervical samples were collected from the women in each group: a self-collected sample and a physician-collected sample. Cervical specimens were tested for cytology and HPV. HPV genotyping was performed on positive specimens. Results. Self-collected samples were adequate and in agreement with physician-collected samples, showing no difference between the two sampling methods. Oncogenic high-risk HPV genotypes were identified in cervical samples which were positive for atypical squamous cells and low-grade squamous intraepithelial lesions. The high-risk HPV genotypes found, notably HPV 45 and 53, differed from those most commonly reported. Although the commonly reported high-risk genotypes HPV 16 and 18 were found, so were 31, 33, 35, 52, 66, 68, and 82. Conclusions. Using self-collection facilitated the discovery of unexpected HPV genotypes among asymptomatic women in Grenada. These findings add new information to the literature regarding cervical cancer and neoplasia screening and HPV genotypes in the Caribbean. This genotype information may impact surveillance of women with low-grade lesions, HPV vaccine selection, and possibly further vaccine research. Research regarding HPV in Caribbean pathology samples of cervical neoplasia and cancer is needed.

[RESUMEN]. Objetivo. Comparar la idoneidad, concordancia y aceptabilidad de la prueba de Papanicolaou (citología) para el tamizaje del cáncer cervicouterino mediante la comparación de muestras obtenidas con automuestreo y muestras tomadas por personal médico en Granada, en el Caribe. Asimismo, en el estudio se identifican los genotipos del virus del papiloma humano (VPH) existentes en las mujeres asintomáticas con un resultado positivo en las pruebas del VPH, la causa etiológica del cáncer cervicouterino. Métodos. Las participantes se dividieron en dos grupos y se tomaron dos muestras cervicouterinas de las mujeres de cada grupo: una muestra tomada por la propia paciente y una muestra tomada por personal médico. Se realizó un examen citológico y una prueba de detección del VPH en las muestras. En las muestras positivas, se determinó el genotipo del VPH. Resultados. Las muestras tomadas por las propias pacientes fueron adecuadas y concordaron con las obtenidas por el personal médico, sin que se observaran diferencias entre ambos métodos de muestreo. Se identificaron genotipos de VPH de alto riesgo oncogénico en muestras cervicouterinas positivas para células escamosas atípicas y lesiones intraepiteliales escamosas de grado bajo. Los genotipos de VPH de alto riesgo encontrados, en especial VPH 45 y 53, diferían de los notificados con mayor frecuencia. Aunque se encontraron los genotipos de alto riesgo habituales 16 y 18 del VPH, también se encontraron los genotipos 31, 33, 35, 52, 66, 68 y 82. Conclusiones. El uso del automuestreo facilitó la detección de genotipos inesperados del VPH en mujeres asintomáticas de Granada. Estos resultados agregan nueva información a la bibliografía sobre el tamizaje de las neoplasias y el cáncer cervicouterino, así como sobre los genotipos del VPH, en el Caribe. Esta información sobre el genotipo puede repercutir en la vigilancia de las mujeres con lesiones de bajo grado, en la elección de la vacuna contra el VPH y, posiblemente, en las ulteriores investigaciones sobre vacunas. Es necesario investigar la presencia del VPH en muestras anatomopatológicas de neoplasias y cánceres cervicouterinos en el Caribe.

[RESUMO]. Objetivo. Comparar a adequação, o nível de concordância e a aceitabilidade do exame de Papanicolau (citologia) para o rastreamento do câncer do colo do útero usando amostras autocoletadas em comparação com amostras coletadas por médicos em Granada, no Caribe. Além disso, o estudo identifica os genótipos de papilomavírus humano (HPV) presentes entre as mulheres assintomáticas com resultado positivo para HPV, a causa etiológica do câncer do colo do útero. Métodos. As participantes foram divididas em dois grupos, e duas amostras cervicais foram coletadas das mulheres de cada grupo: uma amostra autocoletada e uma amostra coletada por um médico. As amostras cervicais foram submetidas a exames citológicos e de HPV. A genotipagem do HPV foi realizada nas amostras positivas. Resultados. As amostras autocoletadas eram adequadas e compatíveis com as amostras coletadas por médicos, não havendo diferença entre os dois métodos de amostragem. Foram identificados genótipos de HPV de alto risco oncogênico em amostras cervicais positivas para células escamosas atípicas e lesões intraepiteliais escamosas de baixo grau. Os genótipos de HPV de alto risco encontrados, principalmente HPV 45 e 53, não correspondiam aos genótipos registrados com mais frequência na literatura. Embora os genótipos de alto risco HPV 16 e 18, que são frequentemente registrados, tenham sido observados, também foram detectados os genótipos 31, 33, 35, 52, 66, 68 e 82. Conclusões. O uso da autocoleta facilitou a detecção de genótipos inesperados de HPV entre mulheres assintomáticas em Granada. Esses achados adicionaram novas informações à literatura sobre o rastreamento de neoplasias e câncer do colo do útero e sobre os genótipos de HPV no Caribe. Essas informações genotípicas podem afetar a vigilância de mulheres com lesões de baixo grau, a seleção da vacina contra o HPV e, possivelmente, futuras pesquisas sobre vacinas. É necessário pesquisar o HPV em amostras patológicas de neoplasias cervicais e câncer do colo do útero no Caribe.

Introducing the concept of digitally smart health facilities: a vision for the future

The adoption of the digitally smart health facilities (DSHFs) concept introduces a new paradigm in today’s public health environment, potentially opening possibilities for addressing many challenges. This editorial explores the concept, emphasizing its potential to revolutionize the health care landscape by integrating digital infrastructure, tools, services and digital literacy within the planning and construction or renovation of health facilities at all levels of care. This innovative concept could pave the way for transformative changes in health care delivery, and improve patients’ outcomes and operational efficiencies, bringing health care closer to patients not only during day-to-day operations but also during health emergencies and disasters. This editorial highlights the significant contributions made by digital health solutions to the safe hospitals initiative led by the Pan American Health Organization (PAHO), emphasizing the role of information and communication technologies in enhancing access to care.

Culturally adapted mobile application for optimizing metabolic control in type 1 diabetes: a pilot study / Aplicación móvil adaptada desde el punto de vista cultural para optimizar el control metabólico en la diabetes tipo 1: estudio piloto / Aplicativo móvel culturalmente adaptado para otimizar o controle metabólico do diabetes tipo 1: estudo-piloto

[ABSTRACT]. Objective. To evaluate whether use of a culturally adapted mobile application (app) for adolescents with type 1 diabetes is associated with improved metabolic control. Methods. The Dominican Republic’s National Institute of Diabetes, Endocrinology, and Nutrition and the Learning to Live clinic recruited 23 pediatric participants for the study. Blood tests were performed before and after use of the app for a period of 3 months. Based on the user profile, participants were encouraged to use the app’s bolus insulin calculator after each meal. The app included a list of regionally and culturally specific foods, color-coded to indicate a high glycemic index (GI) as red; medium GI as yellow; and low GI as green. The color-coding was designed to assist participants in making healthier eating choices. Results. There were statistically significant improvements in lipid profile. Mean high-density lipoprotein values rose to acceptable levels, while low-density lipoproteins and triglyceride levels fell to the recommended values. The overall quality of life increased, although glycated hemoglobin levels showed no statistically significant changes. Conclusion. The findings of this study suggest that using this culturally tailored app can help young patients with type 1 diabetes to improve metabolic health.

[RESUMEN]. Objetivo. Evaluar si el uso de una aplicación móvil (app) para adolescentes con diabetes tipo 1, adaptada desde el punto de vista cultural, se asocia a una mejora del control metabólico. Métodos. El Instituto Nacional de Diabetes, Endocrinología y Nutrición de República Dominicana y Learning to Live Clinic reclutaron a 23 participantes pediátricos para el estudio. Se realizaron análisis de sangre antes y después de utilizar la aplicación durante un período de 3 meses. En función del perfil de usuario, se alentó a los participantes a utilizar la calculadora del bolo de insulina de la aplicación después de cada comida. La aplicación incluía una lista de alimentos propios de la región y la cultura, codificados por colores para indicar un índice glucémico (IG) alto (rojo), medio (amarillo) o bajo (verde). El código de colores se diseñó para ayudar a los participantes a adoptar opciones de alimentación más saludables. Resultados. Se observaron mejoras estadísticamente significativas en el perfil lipídico. Los valores medios de las lipoproteínas de alta densidad aumentaron hasta niveles aceptables, mientras que los niveles de las lipoproteínas de baja densidad y los triglicéridos descendieron hasta los valores recomendados. Se observó una mejora en la calidad de vida general, si bien no se observaron cambios estadísticamente significativos en los niveles de hemoglobina glucosilada. Conclusiones. Los resultados de este estudio sugieren que el uso de esta aplicación adaptada desde el punto de vista cultural puede ayudar a los pacientes jóvenes con diabetes mellitus tipo 1 a mejorar su salud metabólica.

[RESUMO]. Objetivo. Avaliar se o uso de um aplicativo móvel culturalmente adaptado para adolescentes com diabetes tipo 1 está associado a um melhor controle metabólico. Métodos. O Instituto Nacional de Diabetes, Endocrinologia e Nutrição da República Dominicana e a clínica Learning to Live recrutaram 23 participantes pediátricos para o estudo. Foram realizados exames de sangue antes e depois do uso do aplicativo por um período de 3 meses. Com base no perfil de usuário, os participantes foram incentivados a usar a calculadora de bolus de insulina do aplicativo após cada refeição. O aplicativo incluía uma lista de alimentos específicos da região e da cultura, codificados por cores para indicar índices glicêmicos (IG) altos em vermelho; IG médios em amarelo; e IG baixos em verde. O código de cores foi criado para ajudar os participantes a fazer escolhas alimentares mais saudáveis. Resultados. Houve melhoras estatisticamente significantes no perfil lipídico. Os valores médios de lipoproteínas de alta densidade subiram para níveis aceitáveis, e os níveis de lipoproteínas de baixa densidade e de triglicerídeos caíram para os valores recomendados. A qualidade de vida geral aumentou, embora os níveis de hemoglobina glicada não tenham apresentado alterações estatisticamente significantes. Conclusão. Os resultados deste estudo sugerem que o uso desse aplicativo culturalmente adaptado pode ajudar pacientes jovens com diabetes tipo 1 a melhorar sua saúde metabólica.

No seguir ciegos a la equidad: lecciones por aprender de la pandemia de COVID-19 en las Américas / We must not remain blind to equity: lessons to be learned from the COVID-19 pandemic in the Americas / Deixar de ignorar a equidade: lições a aprender com a pandemia de COVID-19 nas Américas

[RESUMEN]. La Región de las Américas ha experimentado históricamente desigualdades sociales enraizadas en el colonialismo, las cuales se reflejan y reproducen en el ámbito de la salud. La incursión de la pandemia de COVID-19 afectó a toda la Región, pero golpeó con mayor fuerza a los grupos socialmente más desaventajados, y agravó las inequidades en salud. Bajo la premisa que las pandemias no son fenómenos socialmente neutrales, en este informe especial se analizan los impactos desiguales de la pandemia desde distintas perspectivas –histórica, epidemiológica, política, social, económica, ambiental y poblacional. Se ofrecen aquí reflexiones críticas sobre las implicaciones negativas de las desigualdades para el bienestar, no solo de las poblaciones más afectadas, sino de la sociedad en su conjunto. Se concluye con recomendaciones estratégicas para progresar hacia la equidad en salud en el escenario pospandémico. Se destaca la importancia de avanzar en la madurez de los sistemas de información para el monitoreo de la equidad en salud, la resiliencia de los sistemas de salud, y la implementación de políticas y prácticas explícitas dirigidas a eliminar las inequidades en salud. Se espera que todo lo anterior allane el camino hacia la prosperidad y el desarrollo sostenible en la Región.

[ABSTRACT]. The Region of the Americas has historically experienced social inequalities rooted in colonialism, which are reflected and reproduced in the area of health. The COVID-19 pandemic affected the entire Region, but the most socially disadvantaged groups were hit hardest, intensifying health inequities. Under the premise that pandemics are not socially neutral phenomena, this special report analyzes the unequal impacts of the pandemic from different perspectives: historical, epidemiological, political, social, economic, environmental, and population-related. Critical reflections are offered here on the negative impacts of inequalities on well-being, not only in the most affected populations, but across society as a whole. Strategic recommendations are made for progress toward health equity in the post-pandemic context. This report highlights the importance of advancing toward mature information systems to monitor health equity, developing more resilient health systems, and implementing explicit policies and practices aimed at eliminating health inequities. All of this should pave the way for prosperity and sustainable development in the Region.

[RESUMO]. Historicamente, a Região das Américas vivencia desigualdades sociais enraizadas no colonialismo, que estão refletidas e se reproduzem no campo da saúde. A pandemia de COVID-19 afetou toda a Região, mas atingiu com mais força os grupos mais desfavorecidos do ponto de vista social, agravando as iniquidades em saúde. Sob a premissa de que as pandemias não são fenômenos neutros em termos sociais, este relatório especial analisa os impactos desiguais da pandemia a partir de diferentes perspectivas: histórica, epidemiológica, política, social, econômica, ambiental e populacional. São apresentadas reflexões críticas sobre as implicações negativas das desigualdades para o bem-estar, não apenas das populações mais afetadas, mas da sociedade como um todo. Conclui-se com recomendações estratégicas para avançar em direção à equidade em saúde no cenário pós-pandemia. Destaca-se a importância de avançar na maturidade dos sistemas de informação para monitorar a equidade em saúde, a resiliência dos sistemas de saúde e a implementação de políticas e práticas explícitas voltadas para a eliminação das iniquidades em saúde. Espera-se que os pontos mencionados abram caminho para a prosperidade e o desenvolvimento sustentável na Região.

Together towards tomorrow: partnerships powering the digital transformation of the health sector

This editorial presents a collective vision of unity, innovation and collaboration, and a shared desire for resilient and more equitable health systems worldwide, urging the global health community to harness the collective strength of alliances and international collaboration to guide the health sector into a new era of digital transformation and innovation.

Salud pública abierta: el camino para no dejar a nadie atrás

[RESUMEN]. En el contexto de la globalización, la salud pública requiere una cooperación continua entre todos los actores y un flujo de datos e información que facilite y apalanque esa cooperación. Sin embargo, existen aún diversas restricciones que limitan o imposibilitan el acceso a ella y su uso en beneficio de las sociedades. Debido a esto, se propone la adopción de la salud pública abierta y se exploran sus implicaciones y alcances. Se entiende por salud pública abierta los datos, la información y el conocimiento dirigidos a mejorar la salud pública, que se comparten y desarrollan a través de redes colaborativas sin restricciones de acceso y uso y con protección continua de la privacidad, seguridad y confidencialidad de los datos sensibles o que requieran especial protección.

[ABSTRACT]. In the context of globalization, public health requires continuous cooperation among all actors and a flow of data and information that facilitates and leverages that cooperation. However, there are still barriers that limit or prevent access to and use of public health for the benefit of societies. In this context, the adoption of open public health is proposed and its implications and scope are explored. Open public health is understood as data, information and knowledge aimed at improving public health, which are shared and developed through collaborative networks without restrictions on access and use and with continuous protection of privacy, security and confidentiality of sensitive data or data requiring special protection.

[RESUMO]. No contexto da globalização, a saúde pública requer a cooperação contínua entre todos os atores e um fluxo de dados e informações que facilite e aproveite da melhor forma essa cooperação. No entanto, ainda existem muitas restrições que limitam ou impedem o acesso à saúde pública e a sua utilização em benefício das sociedades. Por isso, propomos aqui a adoção da saúde pública aberta, explorando as suas implicações e possibilidades. A saúde pública aberta é entendida como o uso de dados, informações e conhecimentos para melhorar a saúde pública, compartilhados e desenvolvidos através de redes colaborativas, sem restrições de acesso ou utilização e com proteção contínua da privacidade, segurança e confidencialidade de dados sensíveis ou que precisem de proteção especial.

Alimentos orgánicos disminuyen la incidencia de cáncer / Organic foods reduce the incidence of cancer

En todo el mundo, el número de casos nuevos de cáncer se estimó en 2012 en más de 14 millones,1,2 y el cáncer sigue siendo una de las principales causas de mortalidad en Francia. Entre los factores de riesgo ambientales para el cáncer, existen preocupaciones sobre la exposición a diferentes clases de pesticidas, en particular a través de la exposición ocupacional.3 Una revisión reciente4 concluyó que el papel de los pesticidas para el riesgo de cáncer no podía ponerse en duda dado el creciente cuerpo de evidencia que vincula el desarrollo del cáncer a la exposición a plaguicidas. Si bien las respuestas a dosis de tales moléculas o los posibles efectos de coctel no se conocen bien, se ha sugerido un aumento de los efectos tóxicos, incluso a bajas concentraciones de mezclas de pesticidas.5

Worldwide, the number of new cases of cancer was estimated in 2012 at more than 14 million, 1,2 and cancer remains one of the leading causes of death in France. Among the environmental risk factors for cancer, there are concerns about exposure to different kinds of pesticides, particularly through occupational exposure.3 A recent review4 concluded that the role of pesticides in cancer risk could not be put in place. doubt given the growing body of evidence linking the development of cancer to exposure to pesticides. While responses to doses of such molecules or possible cocktail effects are not well known, an increase in toxic effects has been suggested, even at low concentrations of pesticide mixtures.5

Genetic variants associated with poor responsiveness to sulfonylureas in Filipinos with type 2 diabetes mellitus / Journal of the ASEAN Federation of Endocrine Societies

Introduction@# Sulfonylureas (SUs) are commonly used drugs for type 2 diabetes mellitus (T2DM) in the Philippines. This study aimed to associate genetic variants with poor response to gliclazide and glimepiride among Filipinos.@*Methodology@#Two independent, dichotomous longitudinal substudies enrolled 139 and 113 participants in the gliclazide and glimepiride substudies, respectively. DNA from blood samples underwent customized genotyping for candidate genes using microarray. Allelic and genotypic features and clinical associations were determined using exact statistical methods.@*Results@#Three months after sulfonylurea monotherapy, 18 (13%) were found to be poorly responsive to gliclazide, while 7 (6%) had poor response to glimepiride. Seven genetic variants were nominally associated (p<0.05) with poor gliclazide response, while three variants were nominally associated with poor glimepiride response. For gliclazide response, carboxypeptidase-associated variants (rs319952 and rs393994 of AGBL4 and rs2229437 of PRCP) had the highest genotypic association; other variants include rs9806699, rs7119, rs6465084 and rs1234315. For glimepiride response, 2 variants were nominally associated: CLCN6-NPPA-MTHFR gene cluster – rs5063 and rs17367504 – and rs2299267 from the PON2 loci.@*Conclusion@#Genetic variants were found to have a nominal association with sulfonylurea response among Filipinos. These findings can guide for future study directions on pharmacotherapeutic applications for sulfonylurea treatment in this population.

Philippine pediatric COVID-19 living clinical practice guidelines as of March 2022

Executive Summary@#The Coronavirus disease 2019 (COVID-19) pandemic has triggered a global crisis and has affected millions of people worldwide. With the evolution of the different variants of concern, the incidence of COVID- 19 in the pediatric population has risen. The Surveillance and Analysis of COVID-19 in Children Nationwide (SALVACION) Registry, developed by the Pediatric Infectious Disease Society of the Philippines (PIDSP) and the Philippine Pediatric Society (PPS), has reported 3,221 cases as of March 31, 2022, with 90.4% requiring hospitalization and 36.2% with moderate to critical disease severity. Given the magnitude of the impact of COVID-19, with most of the clinical recommendations available designed towards adult patients, there was an urgent need for clinicians, public health officials and the government to also prioritize evidence-based clinical practice guidelines for the pediatric population. Hence, the development of the Philippine Pediatric COVID-19 Living Clinical Practice Guidelines was conceptualized. This independent project, funded and supported by the PPS and PIDSP, aimed to formulate up-to-date, evidence-based recommendations on the treatment, diagnosis, infection prevention and control of COVID-19 in children. Following the standard CPG development process outlined in the DOH Manual for CPG Development and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, 15 evidence summaries and 24 recommendations were generated by 12 consensus panelists representing their specific health organizations and institutions.