Pan American Health Organization Research Articles

Assault on salt Intake

Assault on salt Intake

Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study

Colposcopy, currently included in WHO recommendations as an option to triage human papillomavirus (HPV)-positive women, remains as the reference standard to guide both biopsy for confirmation of cervical precancer and cancer and treatment approaches. We aim to evaluate the performance of colposcopy to detect cervical precancer and cancer for triage in HPV-positive women. This cross-sectional, multicentric screening study was conducted at 12 centres (including primary and secondary care centres, hospitals, laboratories, and universities) in Latin America (Argentina, Bolivia, Colombia, Costa Rica, Honduras, Mexico, Paraguay, Peru, and Uruguay). Eligible women were aged 30-64 years, sexually active, did not have a history of cervical cancer or treatment for cervical precancer or a hysterectomy, and were not planning to move outside of the study area. Women were screened with HPV DNA testing and cytology. HPV-positive women were referred to colposcopy using a standardised protocol, including biopsy collection of observed lesions, endocervical sampling for transformation zone (TZ) type 3, and treatment as needed. Women with initial normal colposcopy or no high-grade cervical lesions on histology (less than cervical intraepithelial neoplasia [CIN] grade 2) were recalled after 18 months for another HPV test to complete disease ascertainment; HPV-positive women were referred for a second colposcopy with biopsy and treatment as needed. Diagnostic accuracy of colposcopy was assessed by considering a positive test result when the colposcopic impression at the initial colposcopy was positive minor, positive major, or suspected cancer, and was considered negative otherwise. The main study outcome was histologically confirmed CIN3+ (defined as grade 3 or worse) detected at the initial visit or 18-month visit. Between Dec 12, 2012, and Dec 3, 2021, 42 502 women were recruited, and 5985 (14·1%) tested positive for HPV. 4499 participants with complete disease ascertainment and follow-up were included in the analysis, with a median age of 40·6 years (IQR 34·7-49·9). CIN3+ was detected in 669 (14·9%) of 4499 women at the initial visit or 18-month visit (3530 [78·5%] negative or CIN1, 300 [6·7%] CIN2, 616 [13·7%] CIN3, and 53 [1·2%] cancers). Sensitivity was 91·2% (95% CI 88·9-93·2) for CIN3+, whereas specificity was 50·1% (48·5-51·8) for less than CIN2 and 47·1% (45·5-48·7) for less than CIN3. Sensitivity for CIN3+ significantly decreased in older women (93·5% [95% CI 91·3-95·3] in those aged 30-49 years vs 77·6% [68·6-85·0] in those aged 50-65 years; p<0·0001), whereas specificity for less than CIN2 significantly increased (45·7% [43·8-47·6] vs 61·8% [58·7-64·8]; p<0·0001). Sensitivity for CIN3+ was also significantly lower in women with negative cytology than in those with abnormal cytology (p<0·0001). Colposcopy is accurate for CIN3+ detection in HPV-positive women. These results reflect ESTAMPA efforts in an 18-month follow-up strategy to maximise disease detection with an internationally validated clinical management protocol and regular training, including quality improvement practices. We showed that colposcopy can be optimised with proper standardisation to be used as triage in HPV-positive women. WHO; Pan American Health Organization; Union for International Cancer Control; National Cancer Institute (NCI); NCI Center for Global Health; National Agency for the Promotion of Research, Technological Development, and Innovation; NCI of Argentina and Colombia; Caja Costarricense de Seguro Social; National Council for Science and Technology of Paraguay; International Agency for Research on Cancer; and all local collaborative institutions.

Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology AssessmentSíntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina

This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

Organization of healthcare systems to confront COVID-19: a scoping reviewOrganización de los sistemas de salud para hacer frente a la COVID-19: revisión del alcance

To identify evidence in the literature on the response of managers regarding the organization of global healthcare systems to face the COVID-19 pandemic. For this scoping review, searches were performed in 11 databases accessible through the Virtual Health Library. Eleven studies, published in 2019 and 2020, were selected based on the following guiding question: "How did managers act to organize healthcare systems to face the coronavirus pandemic?". The results were organized in terms of the categories outlined in the Pan-American Health Organization's Framework for the response of Integrated Health Service Delivery Networks to COVID-19: governance; model of care; organizational and management; financial allocations. Managers in countries that invested and articulated actions in the categories of the Reference Framework, with coordination of care at the primary healthcare level, achieved better outcomes in coping with the COVID-19 pandemic. Situating the coordination of healthcare systems at the primary care level, preparing managers and ensuring the continued allocation of financial resources to healthcare are important factors to secure a satisfactory response to crises such as the covid-19 pandemic.

Follow-up on Women with Abnormal Findings of Cervical Cancer Screening in “The Americas” Region:

The Americas region ranks third in the world in incidence and mortality from cervical cancer among World Health Organization (WHO) regions. Several studies analyze screening coverage and accuracy of screening tests as the main reasons for lack of effectiveness; however, reports on follow-up of positive-screened women are scarce. Aim: To synthesize the existing knowledge about compliance with follow-up recommendations after an abnormal result of cervical cancer screening. Methods: We will search the PubMed via Medline and LILACS databases, with additional searches of grey literature. Inclusion criteria comprise studies on adult women from the Pan American Health Organization (PAHO) affiliated countries, with full text available and with specified data on follow-up outcomes. There are no language or publication date restrictions. Studies on special populations or including only women under age 25 will be excluded. Two reviewers will screen titles and abstracts independently, and two researchers will assess the methodological quality and risk of bias by using validated tools according to type of study. Disagreements will be solved by consensus. Discussion: This systematic review will provide information on differences and determinants of effective follow-up of positive-screened women in cervical cancer screening. The use of a Latin American database, the review of grey literature, and the inclusion of studies in all languages will allow us to identify more reports that might be relevant for low and middle income countries (LMIC) accounting with a high burden of disease.

The Post Pandemic Future: Nursing in the Region of the Americas and Mental Health

The transformative and impactful role of nurses has been highlighted throughout the COVID-19 pandemic. The health workforce has endured many particularly difficult challenges during this time, both professionally and in their personal lives, in the effort to respond to the needs of communities, patients, and families. As a result, many nurses and other providers are facing their own mental health challenges due to the prolonged response to address pandemic challenges. In the Region of the Americas, several areas have faced inequities and greater challenge, especially in countries that are low- and middle income. There is a tremendous gap between the number of people who need mental healthcare and those who receive it, even with the current health workforce. Increasing national investments in nursing in the Region of the Americas is necessary and has been addressed by the Pan American Health Organization. A strategic regional focus has been placed to empower healthcare professionals to achieve the levels of education necessary to improve working conditions and to have leadership roles supported and recognized in a model of resilient health systems. Protecting mental health of providers has become an important lesson of the pandemic and an essential and permanent component in the management of health systems and services. This article offers a summary of challenges in the Region of the America as leaders consider the best strategies to support a positive relationship that features resilience, adequate working conditions, and investments in the nursing profession for a post-COVID-19 future that protects workers’ mental health.

A novel food processing-based nutrition classification scheme for guiding policy actions applied to the Australian food supply.

Unhealthy diets are a leading risk factor for non-communicable diseases and negatively impact environmental sustainability. Policy actions recommended to address dietary risk factors, such as restrictions on marketing and front-of-pack labelling, are informed by nutrition classification schemes (NCSs). Ultra-processed foods are associated with adverse population and planetary health outcomes, yet the concept is rarely incorporated in nutrition classification schemes for policy actions. This study aims to develop a novel food processing-based nutrition classification scheme for guiding policy actions. A secondary aim is to validate the scheme by classifying food and beverage items in the Australian food supply (face validity) and comparing them to the classifications of existing NCSs (convergent validity). Two versions of a model were developed, classifying foods and beverages in two steps, first using the NOVA classification system and secondly by applying upper thresholds for added free sugars and sodium, producing a binary output of either healthy or unhealthy. All food and beverage items (n = 7,322) in a dataset combining the Australian Food Composition Database (AUSNUT 2011-2013) and Mintel's Global New Product Database (2014-2019) were classified using the two models. The same dataset was also classified by the Health Star Rating system (HSR), The Australian Dietary Guidelines (ADGs), The Pan American Health Organization's Nutrient Profile Model (PAHO NPM), and the NOVA classification scheme, and pairwise agreement between all NCSs and the two models was determined (using Cohen's Kappa coefficient). A higher proportion of food categories consistent with dietary patterns that are associated with positive health outcomes, such and fruits, vegetables, and eggs were classified as healthy. And the clear majority of food categories consistent with dietary patterns associated with adverse health outcomes, such as confectionery, snack foods, and convenience foods were classified as unhealthy. The two versions of the model showed substantial agreement with NOVA and the PAHO NPM, fair agreement with the ADGs and slight to moderate agreement with the HSR system. A model NCS combining level of processing and nutrient criteria presents a valid alternative to existing methods to classify the health potential of individual foods for policy purposes.

GENEVA DECLARATION 2021 ON SELF-CARE, INTER-CARE, AND WELL-BEING IN PANDEMIC TIMES

Emerging from the 13th Geneva Conference on Person Centered Medicine organized as a virtual event on 5–7 April 2021 by the International College of Person-Centered Medicine (ICPCM) in collaboration with the World Medical Association, the International Council of Nurses, and the Pan-American Health Organization.

Development and validation of a clinical rule for the diagnosis of chikungunya fever in a dengue-endemic area.

Rio de Janeiro is a dengue-endemic city that experienced Zika and chikungunya epidemics between 2015 and 2019. Differential diagnosis is crucial for indicating adequate treatment and assessing prognosis and risk of death. This study aims to derive and validate a clinical rule for diagnosing chikungunya based on 3,214 suspected cases consecutively treated at primary and secondary health units of the sentinel surveillance system (up to 7 days from onset of symptoms) in Rio de Janeiro, Brazil. Of the total sample, 624 were chikungunya, 88 Zika, 51 dengue, and 2,451 were negative for all these arboviruses according to real-time polymerase chain reaction (RT-qPCR). The derived rule included fever (1 point), exanthema (1 point), myalgia (2 points), arthralgia or arthritis (2 points), and joint edema (2 points), providing an AUC (area under the receiver operator curve) = 0.695 (95% CI: 0.662-0.725). Scores of 4 points or more (validation sample) showed 74.3% sensitivity (69.0% - 79.2%) and 51.5% specificity (48.8% - 54.3%). Adding more symptoms improved the specificity at the expense of a lower sensitivity compared to definitions proposed by government agencies based on fever alone (European Center for Disease Control) or in combination with arthralgia (World Health Organization) or arthritis (Pan American Health Organization, Brazilian Ministry of Health). The proposed clinical rule offers a rapid, low-cost, easy-to-apply strategy to differentiate chikungunya fever from other arbovirus infections during epidemics.

Coexistence of high content of critical nutrients and claims in food products targeted at Brazilian children.

This study aimed to evaluate food labels targeted at children and identify the concomitant presence of claims and high levels of critical nutrients and/or the presence of sweeteners. Asa secondary objective, it aimed to list different types of claims and check which marketing strategies are most used. We collected 409 products, from 8 popular food groups targeted at children, in Brazilian market (i.e., fruit drinks, dairy drinks, sandwich cookies, cakes, breakfast cereals, jellies, corn snacks, and yogurts). The contents of critical nutrients (e.g., sugar, total fat, saturated fat, and trans-fat, and sodium) and presence/absence of sweetener were calculated, considering Pan American Health Organization (PAHO) parameters. Then,we verified the presence and types of claims in these products. Overall, 265 (64.7%) labels presented claims. In three of the eight categories (i.e., breakfast cereals, dairy drinks, and yogurt), all products with claims (50, 34, and 34 products, respectively) had one or more nutrients in harmful concentrations (critical nutrients above PAHO's nutritional profile and/or presence of sweeteners). In the other categories, only one product (of 63 sandwich cookies and 26 breakfast cereals with claims) and three products (of 22 cakes and 28 jellies with claims) had no nutrient in critical concentration. The presence of claims, like "rich/source" of micronutrient, was predominant in seven of the eight food groups. In the present study, there was a high presence of claims, of different types, in foods targeted at children, which, for the most part, also have excess of at least one critical nutrient, according to PAHO.

Telemedicine ready or not? A cross-sectional assessment of telemedicine maturity of federally funded tertiary health institutions in Nigeria.

Telemedicine has reinforced its position as a means for the continuity of healthcare services and a cost-effective approach to improving health equity as demonstrated during the COVID-19 pandemic. The preparedness of health systems for telemedicine is an indicator of the scalability of their services, especially during catastrophes. We aimed to assess the maturity and preparedness of federally funded tertiary health institutions in Nigeria, to deploy telemedicine as such data are currently lacking and are required to drive improvements in health services delivery. We conducted a cross-sectional survey of thirty randomly selected federally funded tertiary health institutions in Nigeria using the Pan American Health Organization's tool for assessing the maturity level of health institutions to implement telemedicine between 17 September 2020 and 1 September 2021. Descriptive statistics were used for overall maturity levels and non-parametric tests to compare scores for overall maturity and specific Pan American Health Organization domains per region. The level of significance was set at p-value <0.05. The response rate was 77.4% (24 of 30 randomly polled federally funded tertiary health institutions responded). Overall, the median telemedicine maturity level was 2.0 (1.75) indicating a beginner level. No significant inter-zonal difference in the median overall maturity level (p = 0.87). The median maturity levels for telemedicine readiness in specific domains were organizational readiness - 2.0 (2.0), processes 1.0 (1.0), digital environment 2.0 (3.0), human resources 2.0 (1.0), regulatory issues - 1.5 (1.0) and expertise 2.0 (2.0); mostly at beginner level, with no inter-zonal differences. Most participating institutions had no initiatives in place for domains of processes and regulatory issues. The current telemedicine maturity level of federally funded tertiary health institutions in Nigeria is at the beginner level. This behoves policy-makers to advance the implementation and deployment of telemedicine nationwide as part of digital quality healthcare, to improve health equity and to ensure continuity of healthcare services in the event of another pandemic.

ASSISTÊNCIA DE ENFERMAGEM À SAÚDE DAS POPULAÇÕES INDÍGENAS: REVISÃO DE ESCOPO

ABSTRACT Objective: to identify in the literature the nursing care actions for the health of indigenous populations. Method: this is a scoping review, whose search was conducted in September 2022 in the following databases: Nursing Database (BDENF), CAPES Theses and Dissertations Catalog, Google Scholar, Latin American and Caribbean Literature on Health Sciences (LILACS), Pan American Health Organization (PAHO), National Library of Medicine and National Institutes of Health (PUBMED) and Scientific Electronic Library Online (SCIELO). The results were evaluated by summarizing the selected articles. Results: the main actions directed to the indigenous population were nursing consultations and health promotion and prevention activities. The main difficulty encountered in relation to indigenous peoples is the language barrier. Conclusion: the nursing team encounters difficulties, such as: the difficult location of the villages; high work overload due to the lack of medical professionals; language barrier; and inadequate conditions.

Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review.

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. In Brazil, TB is a public health problem, and the treatment dropout rate contributes to it. This systematic review investigated the factors associated with TB treatment dropout in Brazil using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The databases used were Bireme, Scopus, PubMed, Medline, Pan-American Health Organization (PAHO), and Latin-American and Caribbean Literature on Health Sciences (LILACS). The search was conducted on May 16, 2021. Nine articles were reviewed, and all were published within the last 5 years in English, Spanish, or Portuguese. The sample sizes in the studies ranged from 148 to 77,212 individuals, and the studies enrolled only adult patients (aged 18-59 years) in Brazil. Evidence suggests that the significant risk factors associated with TB treatment dropout are male sex, black race/ethnicity, age between 19 and 49 years, human immunodeficiency virus (HIV) co-infection, low education (<8 years), use of alcohol and illicit drugs, and unsupervised treatment. This study's limitations were the small number of articles published on this topic with stronger study designs, use of secondary data sources in most articles, and a moderate to high risk of bias in most papers. There was a significant association between abandonment of TB treatment and HIV/acquired immunodeficiency syndrome co-infection; socioeconomic factors (low education and homelessness); use of alcohol, tobacco, and illicit drugs; and failure to use directly observed treatment. These results can guide more efficient measures to prevent dropout.

Late-onset neonatal infections and bacterial multidrug resistance

This study aims to describe bacterial and antimicrobial sensibilities in late-onset healthcare-associated infections (HAIs) with laboratory confirmation in a Neonatal Intensive Care Unit (NICU) of a public hospital in Ceará. This was a cross-sectional study conducted from January 2013 to December 2017. The bacterial types involved in late-onset HAIs, their sensitivity to antimicrobials, and their multidrug resistance were evaluated. The latter was classified according to the criteria revised by the Pan-American Health Organization as multidrug resistance (MDR), extended drug resistance (XDR), or pandrug resistance (PDR). The description of the variables was performed through proportions and frequency distribution depicted in tables. Of the 427 patients with late-onset HAIs, 47 (11.0%) had bacterial infections confirmed by blood cultures, and 7 (14.9%) had infections caused by MDR bacteria. Among the types of bacteria, 26 (55.3%) were Gram-negative bacteria, and 21 (44.7%) were Gram-positive bacteria. Among the Gram-negative bacteria, 92.3% (n=24) showed resistance to more than one antimicrobial, especially to ampicillin (81.2%), cefepime (33.1%), gentamicin (19.4%), and piperacillin/tazobactam (17.2%). Among the MDR ones, three cases had Klebsiella pneumoniae, and three had Pseudomonas aeruginosa, classified as two MDR and one XDR, and three XDR, respectively. Gram-positive resistance to penicillin was the most common one (80.0%), and approximately half of the strains being resistant to oxacillin. Susceptibility was high to vancomycin (97.5%), but one microorganism was resistant to oxacillin and vancomycin. The emergence of MDR strains is a reality in NICUs, carrying the risk of therapeutic failure and requiring continuous prevention protocols aimed at minimizing the risks of contamination by bacteria with high morbidity and mortality.

Pontos de corte de índice de massa corporal e suas relações com doenças crônicas não transmissíveis em idosos

Abstract Objective To determine the association between nutritional status according to different cutoff points for body mass index (BMI) and the occurrence of noncommunicable chronic diseases (NCD) in older people. Methods A cross-sectional study of 365 older people was conducted using a questionnaire collecting information on health variables, body weight and height measurements. The association between classification of nutritional status using BMI and occurrence of NCD was estimated by the Odds Ratio (OR) and 95% Confidence Intervals (95%CI). Results As measured by the different BMI classification criteria, nutritional status varied: for normal weight (24.9-32.3%), excess weight (57.3-73.2%) and for underweight (1.9-15.3%). According to the Lipschitz classification, underweight was associated with lower occurrence of osteoarticular diseases (OR=0.38; 95%CI: 0.15-0.93) and cardiometabolic diseases (OR=0.42; 95%CI: 0.19- 0.94); while overweight was associated with higher occurrence of cardiometabolic diseases (OR=2.26; 95%CI: 1.30-3.93). According to the World Health Organization criteria, underweight was associated with lower occurrence of cardiometabolic diseases (OR=0.09; 95%CI: 0.01-0.61), overweight with lower occurrence of neuropsychological diseases (OR=0. 47; 95%CI: 0.26-0.87), while obese status was associated with higher occurrence of osteoarticular (OR=1.95; 95%CI: 1.08-3.52) and cardiometabolic (OR=3.02; 95%CI: 1.54-5.93) diseases. According to the Pan American Health Organization criteria, underweight was associated with lower occurrence of cardiometabolic diseases (OR=0.45; 95%CI: 0.22-0.91) and obese status with higher occurrence of osteoarticular (OR=1, 91; 95%CI: 1.16-3.15), cardiometabolic (OR=2.58; 95%CI: 1.36-4.85) and respiratory (OR=1.96; 95%CI: 1.16-3.16) diseases. Conclusion The classification criteria for BMI were negatively (underweight) and positively (excess weight) associated with the occurrence of NCD, exhibiting a stronger association when the overweight classification was differentiated from the obese classification.

Measuring road safety advance by IW-EDAS-KNN: A case study for OAS countries

Road Safety is an important aspect when considering the public health of a nation. Road Safety is becoming an increasing concern among nations, and road safety hazards remained a huge problem in some nations, causing financial loss and fatalities. Estimated results demonstrates that road traffic injuries cost the government approximately 3% of GDP, and up to 5% in low- and middle-income countries [1]. Since the road traffic incidence created substantial financial burden, it is necessary to control risk factors and improve the road safety advance. By evaluating the road safety conditions of each individual states, or by comparing the road safety status of a group of states, we can identify the potential strengths and weaknesses of each state hence give suggestions for future improvements. This paper looks at a ten-year data (2009-2019), source from the World Health Organization, the Pan American Health Organization, and the Traffic Safety Data and Analysis Group. The aim of this research is to evaluate and benchmark the road safety conditions of the members states of the Organization of American States by applying Evaluation Based on Distance from Average Solution, a Multi-Criteria Decision-Making (MCDM) technique for classification; identify the continuity in development and advancement of road safety conditions for each state; group the member states of OAS into classes by applying K-Nearest Neighbor Analysis, an algorithm for classification and regression that group objects into classes based on its k nearest neighbors; and make suggestion for future improvements for each member states with respect to their group members. It is concluded that certain indicators are underperformed by a majority of OAS members, which allowed policymakers to identify the potential weakness in road safety performance and offer effective intervention. Additionally, suggestions are made for under-performing countries of the OAS to refer to the road safety procedure from the best-performing nations for future road safety advances.

Management of domestic solid waste in rural communities – a case study of the Río Blanco community, Ecuador

The current study focused on the proposal of a comprehensive management system for domestic solid waste in the rural community of Río Blanco belonging to the indigenous Ecuadorian Kichwa nationality. In this community, the burning of domestic solid waste is the only management strategy commonly used, which has generated various environmental and health impacts on the population. Therefore, here we focused on diagnosing the socio-environmental condition of the community through surveys in order to determine the average daily per capita production of domestic solid waste. This occurred through a characterization applying the methodology of the Pan American Health Organization (PAHO) and in the development of a proposal for a management model appropriate to the present demographic characteristics, from environmental education to its final disposal. The results obtained determined that the average DPCP of the community is 0.205 kg/person/day and the predominant category was the organic fraction with 45.84% of a total of 23.62 kg of solid waste produced. Finally, as appropriate management and use initiatives, we proposed the adaptation of an area for the generation of compost and a recycling system that allows obtaining economic resources for the benefit of the population.

Content of potentially toxic elements (PTEs) in various animal meats: a meta-analysis study, systematic review, and health risk assessment.

Meat comprises the main part of the diet in many countries around the world. The present study aimed to assess potentially toxic elements (PTEs) lead (Pb), arsenic (As), cadmium (Cd), copper (Cu), nickel (Ni), zinc (Zn), and iron (Fe) in various meats (camel, chicken, cow, pork, birds, seafood (fish and crab), and sheep). The present study was performed on the concentration of PTEs in various meats by different databases including Scopus, PubMed, and Web of Science along with a meta-analysis. Additionally, the non-carcinogenic risk was assessed by calculating the total hazard quotient (TTHQ). According to findings, the highest concentration of Cd was related to sea (0.460mg/kg). The highest concentrations of Cd and As were reported in camel meat (1.965 and 1.503mg/kg, respectively). Regarding trace elements, the highest concentrations of Zn, Fe, Cu, and Ni were observed in seafood (fish and crab), cow meat, and bird's meat (71.159mg/kg, 36.608mg/kg, 8.680mg/kg, and 1.592mg/kg, respectively). Moreover, considering the type of continents based on the concentration of PTEs in various meats, the highest concentrations of As (0.792mg/kg), Cd (0.315mg/kg), Pb (1.049mg/kg), Fe (44.088mg/kg), and Ni (1.113mg/kg) were related to Eastern Mediterranean region (EMRO), African Region (AFRO), EMRO, the Pan American Health Organization (PAHO), and EMRO, respectively. However, the highest concentrations of Cu (4.846mg/kg) and Zn (60.742mg/kg) were related to European Region (EURO) and AFRO, respectively. On the other hand, the result of the risk assessment indicated that the risk pattern was different among countries.

Ranking of immunization programs in Latin America, 2019Ranking dos programas de imunização na América Latina, 2019

To establish a ranking of national immunization programs in Latin America that compares the various realities, identifies challenges and unachieved goals, and encourages countries to search for strategies to overcome the obstacles they face. Ten countries with the most innovative national vaccination schedules (NVCs) were selected. Information published on official websites of ministries of health, the World Health Organization (WHO), the Pan American Health Organization (PAHO), and the United Nations Children's Fund (UNICEF) were used, as well as interviews with experts from each country. A ranking was constructed, based on domains linked to the 2019 NVC (vaccinations given at different life stages, influenza vaccination, and vaccination in special situations); vaccination coverage in 2018; and programmatic aspects. The general ranking is led by Chile and Panama, due to vaccination in the first and second year of life. They are followed by Argentina, Uruguay, and Costa Rica, which stand out for vaccination of other groups, influenza vaccination, and programmatic aspects. Brazil, Colombia, and Mexico have more delays in their NVCs, as well as programmatic gaps and lower vaccination coverages. Finally, Paraguay and Peru have similar deficiencies and bigger information gaps. However, when the domains are analyzed individually, the ranking changes and the same pattern is not repeated. This is the first ranking of national immunization programs in Latin America that highlights strengths and weaknesses in each country. The periodicity of this exercise will be key when comparing the evolution and positioning of these programs over time.

The Actual Situation of Covid-19 Infection at High Altitudes in Perú

This study aimed to reveal the evolution and characteristics of the COVID-19 pandemic in high-altitude areas of Perú. An observational, descriptive, retrospective and longitudinal study based on information from the Peruvian Ministry of Health, COVID-19 Situational Room, warning from the National Epidemiology Center, Prevention and Disease Control, and the Panamerican Health Organization (PAHO) was conducted to analyze the occurrence of the COVID-19 pandemic in Perú from the beginning of the pandemic until March 7, 2022. In this period, 31,635,319 people were examined, 3,637,529 were infected, and 213,551 died from the disease, with a lethality index of 5.87%. Perú is now the country most affected by the pandemic in South America. The data showed heterogeneity in prevalence across the country, with higher altitudes having lower prevalence than coastal and jungle areas, which was related to climatic circumstances and social factors. The situation was complicated by the severe spread of the pandemia, which caused a surge in demand for health services and intensive care units, loss of workplaces and increased levels of poverty. A notable result was a decrease in the prevalence and mortality of the COVID-19 pandemic at high altitudes in Perú compared to the coastal and jungle areas.