Migração e mortalidade por câncer entre os migrantes colombianos nos EUA: um estudo com dados de declaração de óbito / Migration and cancer mortality among Colombian migrants in the USA: a death certification study

Resumo Este estudo teve como objetivo comparar padrões de mortalidade por câncer entre os imigrantes colombianos nos EUA e colombianos em sua terra natal. Dados de 2008 a 2012 foram coletados, e foram calculadas taxas de mortalidade por câncer de colombianos residindo em seu país natal e colombianos residindo em Califórnia, Flórida e Nova York, bem como taxas específicas de mortalidade por idade e sexo por cada 100.000 pessoas. Para comparar as duas populações, tanto antes como após a correção pela escolaridade, as razões de taxas de mortalidade (MRR) foram estimadas por modelo de regressão binomial negativa. Foi descoberto que colombianos em sua terra natal apresentam taxas de mortalidade por câncer mais altas quando comparados aos que residem nos EUA (MRR masculino 1,4 (IC 95%: 1,2-1,5), MRR feminino 1,5 (IC 95%: 1,3-1,7)). Essas diferenças persistem para a maioria dos tipos de câncer, mesmo após correção pela escolaridade. Os colombianos em sua terra natal apresentaram taxa de mortalidade por câncer gástrico (MRR masculino 2,6; feminino 2,8) e cervical (MRR 5,0) significativamente mais alta em comparação com os que residem nos EUA. As desigualdades educacionais na mortalidade por câncer foram mais acentuadas para aqueles que moram em sua terra natal. A menor taxa de mortalidade por câncer observada entre os colombianos nos EUA, porém, não pode ser atribuída às diferenças de escolaridade, um indicador de status socioeconômico. Em vez disso, provavelmente ocorre devido à maior acessibilidade aos serviços de saúde preventivos e curativos nos EUA.

Abstract We aim to compare cancer mortality rates of USA Colombian migrants (USA Colombians) to Colombians in their country of origin (CO Colombians). Using Colombian national mortality data and data on cancer deaths among Colombians residing in the states of California, Florida, and New York (USA Colombians) for the period 2008-2012, we estimated sex-specific and age-standardized mortality rates (ASMR), expressed per 100,000 persons. For comparisons between the two populations before and after adjustment for educational level, negative binomial regression models were used to compute Mortality Rate Ratios (MRR). CO Colombians had higher cancer mortality rates compared with USA Colombians (male MRR 1.4 [95%CI: 1.2-1.5], female MRR 1.5 [95%CI: 1.3-1.7]). These differences persisted for most cancers even after adjustment for education. CO Colombians had significantly higher mortality from gastric (MRR 2.6 in males and 2.8 in females) and cervical cancer (MRR 5.0) compared with US Colombians. Educational inequalities in cancer mortality were more pronounced among CO Colombians than among USA Colombians. Lower cancer mortality observed among USA Colombians cannot be attributed to differences in education, an indicator of socio-economic status. Rather, it is likely due to better access to preventive and curative healthcare in the USA.

An excerpt of AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis （2023） / 临床肝胆病杂志

This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension （PH）， for prevention of initial hepatic decompensation， for the management of acute variceal hemorrhage （AVH）， and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease， codification of methodology to use noninvasive assessments to identify clinically significant PH （CSPH）， and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH， clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH， discusses more recent data related to the management of cardiofundal varices， and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.

El orden de nacimiento como factor de riesgo para ser víctima de trata sexual en el triángulo norte de Centroamérica / Birth order as a risk factor for being victim of sex trafficking in the northern triangle of Central America

RESUMEN Las redes de tráfico humano para la prostitución captan a menores vulnerables, en especial, a quienes consideran no les queda otra opción que emigrar al norte para hacer frente a problemas económicos graves. El objetivo del presente trabajo fue establecer si el orden de nacimiento representó un factor de riesgo, asociado a la vulnerabilidad para la trata sexual de menores centroamericanas, traficadas a Estados Unidos. Las entrevistadas mostraban vulnerabilidades vinculadas con estructuras sociales y conductas individuales. Por una parte, todas crecieron en hogares caracterizados por la pobreza extrema. Por otra parte, también presentaban vulnerabilidades relacionadas con el embarazo adolescente, la falta de educación, la disfuncionalidad familiar y la participación en mercados ilegales. Ocupar el primer lugar en orden de nacimiento eleva la vulnerabilidad de las menores a ser traficadas a Estados Unidos para el comercio sexual. Por el contrario, ocupar el último lugar disminuye este riesgo.

ABSTRACT Human trafficking networks for prostitution recruit vulnerable underage girls, especially those who are considered with no choice but to migrate north to cope with serious economic problems. The aim of this work was to determine if birth order represented a risk factor associated to the vulnerability for sex trafficking of Central American female minors. The interviewees presented vulnerabilities associated to social structures and individual behaviors. On the one hand, all of them grew up in house holds characterized by extreme poverty. On the other hand, they also had vulnerabilities related to teenage pregnancy, lack of education, family dysfunction and participation in illegal markets. Findings suggest that occupying the first place in the order of birth raises the vulnerability of minors to being trafficked to the United States for sex trade. On the contrary, occupying the last place decreases this risk.

Research on Ethical Governance of "BRAIN Initiative" in the United States / 中国医学伦理学

With the implementation of the "BRAIN initiative" in various countries, neuroethical governance has become an important concern of the international community. After ten years of development, the "BRAIN initiative" in the United States has formed a relatively complete ethical governance system. By interpreting the strategic report of the "BRAIN initiative" in the United States, analyzing its basic framework of ethical governance, dissecting its governance practice mechanism, and conducting research from the aspects of top-level design and construction, regulatory model innovation, promoting public participation, enhancing international dialogue, and improving soft and hard regulations, this paper provided some reference and thoughts for the ethical governance of the "BRAIN initiative" in China.

The introduction to and inspiration from FDA Guidance: alternative procedures for the manufacture of cold-stored platelets intended for the treatment of active bleeding when conventional platelets are not available or their use is not practical / 中国输血杂志

U.S. Food and Drug Administration recently issued a guidance on alternative procedures for the manufacture of cold-stored platelets intended for the treatment of active bleeding when conventional platelets are not available or their use is not practical. It was allowed to use platelets stored at 1 ℃ to 6 ℃, with a storage period of up to 14 days from the date of collection.The validation and quality monitoring of platelet manufacture retained pH items testing at the end of the storage, and platelet count and actual plasma volume testing items were not required. The guidance provided the recommendations and considerations for the manufacture, labeling, storage, transportation, bacterial contamination control, process validation, and quality monitoring sampling of cold-stored platelets, as well as the further research needs for its efficacy, particularly when conventional platelets are available and their use is practical. The scientific and regulatory considerations on cold-stored platelets in the guidance would be informative and instructive to the development of blood regulation and standards related with urgent transfusion in China.

The experience and enlightenment of American home-school-community partnership to promote physical activity of school age children for overweight and obesity prevention / 中国学校卫生

Abstract@#The study elaborates on the historical development of the home-school-community partnership in the United States, as well as physical activity strategies to prevent overweight and obesity in school age children. Feasible suggestions are proposed for implementing the home-school-community collaboration in China. The finding suggests that in addition to cooperation with schools, families and communities need to take initiatives to actively support children s participation in various physical activities and provide facilities and guarantees. Schools should also do a top level design that links with families and communities, and incorporate their participation into long term physical education planning, making them an integral part of a closely interconnected collaborative network to further prevent overweight and obesity in school age children.

Overview on haemovigilance about delayed transfusions in the UK and blood shortage in the USA / 中国输血杂志

Serious hazards of transfusion(SHOT)in the United Kingdom has been received reporting of the adverse events of delayed transfusion for more than ten years. Hemovigilance Module Surveillance Protocol in Biovigilance Component in National Healthcare Safety Network in the United States updated the incident codes to include under-transfusion with the creation of a new process code: no blood (NB) and four incident codes in October 2022. This review introduces the monitoring practice of delayed transfusion/under-transfusion in the UK and the USA, makes a suggestion to incorporate delayed transfusion/under-transfusion due to blood shortage into the national health standard on the classification of transfusion reactions and haemovigilance protocol in China, and to do a national survey as well, therefore the real world data and evidences would be obtained and used for further policy making.

Enlightenment of the DRG payment reform in the United States on the reform of China′s medical insurance payment methods / 中华医院管理杂志

In order to curb the excessive growth of medical expenses, the United States has initiated payment reform of diagnosis-related groups (DRG) since 1983, and developed a series of complementary measures to address issues such as overcoding and declining healthcare service quality which were exposed during the reform. The authors discussed the implementation of DRG payment reform in the United States, namely the case-mix specialization of medical institutions and the reduction of costs, as well as the relationship between the two. On this basis, the authors suggested that when implementing reforms to the medical insurance payment system in China, it is imperative to avoid such loopholes as overcoding by medical institutions and excessive pursuit of efficiency at the expense of quality control, as well as the decline of comprehensive rescue capability and quality of care incurred by the exacerbated specialization.

Research on the appointment system of universities to promote interdisciplinary research from the perspective of comparison between China and the United States / 中华医学科研管理杂志

Objective:This paper focused on the research of the appointment system in interdisciplinary research institutions of world-class universities in China and the United States. The positive effects of different employment and evaluation systems as well as existing problems were sorted out and analyzed, and some suggestions were put forward to optimize and innovate the teacher appointment system and promote the interdisciplinary construction of Chinese universities.Methods:This paper focused on the new teacher appointment system adopted by representative universities in China and the United States to promote the development of interdisciplinary research and used the methods of literature research, questionnaire survey, case analysis, and in-depth interview to sort out and analyze the different systems.Results:Based on the broad perspective of the ″new concept-(artificial) selection-stabilization″ system change, the implementation of an interdisciplinary joint appointment in our country has experienced a stage of ″new concept generation″ at present, but it is still in the stage of ″institution establishment and stabilization″. The personnel management system for teachers engaged in interdisciplinary research still needs to be improved, and there are still outstanding problems in the areas of evaluation and promotion pressure, financial resources guarantee, teachers′ sense of belonging, administrative costs, etc.Conclusions:Referring to the advanced experience at home and abroad, Chinese universities should focus on breaking the barriers of distributing the interests of results, improving interdisciplinary talent evaluation mechanisms, adopting a variety of flexible appointment systems depending on demands, and building a benign flow ecology of interdisciplinary human resources. Apart from these, urgent attention should be paid to improving the administrative work system and interdisciplinary cultural system construction.

Review of the competitive generic drug incentive system in the United States and its enlightenment to China / 中国药房

OBJECTIVE To provide ideas and inspiration for promoting the development of the generic drug industry and legal system of China. METHODS With text analysis， empirical research and other methods， the competitive generic drug incentive system in the United States was combed， its implementation effect and successful experience were analyzed， and the reference was provided for the implementation of relevant systems in China. RESULTS The competitive generic drug incentive system in the United States had achieved a satisfactory effect in three aspects： encouraging generic drug applications， accelerating the listing of generic drugs， and promoting drug price reduction， which was ultimately conducive to improving drug accessibility by publishing List of Off-Patent，Off-Exclusivity Drugs without an Approved Generic， while accelerating the development and review of generic drugs with insufficient competition and giving market exclusivity periods. CONCLUSIONS China’s reference to the competitive generic drug incentive system in the United States meets the needs of the current situation of domestic drug supply and also has the basis for industry practice. Therefore， we can refer to it， improve the system of releasing the catalog of encouraged generic drugs to be imitated， optimize the approval process for them， and authorize the exclusive period incentive to them.

Investigation on medical practice of overseas acupuncturists based on the top 5 general hospitals in the United States of America and the inspiration / 国际中医中药杂志

This study selected the top five general hospitals in the United States of America, collected the practice information of acupuncturists through the official website, and analyzed the professional department, expertise, professional title, education background, residency, fellowship, board certification, etc. of these acupuncturists to understand the practice situation of acupuncturists in the hospitals. The results of the study showed the practice of acupuncturists in the United States of America is improving. With further localization, locally trained acupuncturists have gradually become the main body of acupuncturists; acupuncture treatment is still mainly for analgesia, but the scope of treatment continues to expand, and departments that accept acupuncturists are gradually increasing. However, the group of licensed acupuncturists is still a minority in the group of acupuncturists in the United States of America. Native American physicians still use acupuncture as an alternative option and neglect to obtain a license. The entry barrier for acupuncturists still needs to be raised.

School Feeding Programs in the United States during 1853-2010 / 中国学校卫生

Abstract@#The Children s Aid Society of New York has been providing free food to students at local vocational schools since 1853. It wasn t until 1975 that the school lunch program was permanently mandated by Congress. The National School Lunch Program in America has gone through a historic process from its inception and establishment to its development. The continued interest and oversight of the American people, public opinion guidance by progressive people like nutrition reformers, home economics and other are external factors in the continued development of this program. The timely enactment of the bill by the federal government and the high concern of senior leaders on this project is an important prerequisite for continued development. Integrating this program into the national agricultural development strategy and realizing the overall development philosophy is the key to the sustainability of this program. Paying attention to children s physical health is the core reason why American School Feeding Programs focus on children s diet quantity to children s nutritional quality. All of these factors contribute to the development of this project.

The Study of Factors Affecting Oral Health in a Sample from NHANES Survey in the United States

Aims: Oral health problems include dental caries, gum diseases, loss of natural teeth, and other mucosal diseases. The present research aimed to study the factors affecting periodontal health in the residents of the United States of America. This study examined if there were significant differences in the health of teeth and gums with respect to last visit to the dentist, intake of fluoride drops or tablets, gender, and educational level. Materials & Methods: The study analyzed secondary data from the National Health and Nutrition Examination Survey 2017-18. This study examined a population of 9,254 residents aged 1 and older. The Chi-Square Test of Independence was used to test significance among the variables of last visit to the dentist, received fluoride drops or tablets, gender, and educational level. Results: The study found no statistically significant differences in health of teeth and gums with respect to intake of fluoride drops or tablets, gender, and educational level. However, the study did find a statistically significant difference in the health of teeth and gums with regard to the last visit to the dentist among residents of the US. Individuals who have visited the dentist in the last six months have rated their health of teeth and gums as excellent as compared to those who did not visit the dentist in the last six months. Conclusions: Future studies should review other factors affecting oral health such as high sugar intake, diabetes, chronic diseases, and genetics. Emphasis should be given to the identification of inequities associated with periodontal health among various cultural and ethnic groups in the United States of America.

Objetivos: Los problemas de salud oral incluyen la caries dental, las enfermedades de las encías, la pérdida de los dientes naturales y otras enfermedades de las mucosas. El presente estudio tuvo como objetivo examinar los factores que afectan la salud periodontal en los residentes de los Estados Unidos de América. Este estudio examinó si había diferencias significativas en la salud de los dientes y de las encías con respecto a la última visita al dentista, ingesta de gotas o tabletas de flúor, género y nivel educativo. Materiales y Métodos: El estudio se analizó con datos provenientes de la Encuesta y Examinación Nacional de Salud y Nutrición NHANES del 2017-2018. Este estudio examinó una población de 9.254 residentes de 1 año o de mayor edad. Se usó la prueba de independencia Chi-Cuadrado para probar la significancia entre variables como la última visita al dentista, ingesta de gotas o tabletas de flúor, sexo y nivel educativo. Resultados: El estudio no encontró diferencias estadísticamente significativas en la salud de los dientes y de las encías con respecto a la ingesta de gotas o tabletas de flúor, sexo y nivel educativo. Sin embargo, el estudio encontró una diferencia estadísticamente significativa en la salud de los dientes y de las encías con respecto a la última visita al dentista entre los residentes de los Estados Unidos. Las personas que visitaron al dentista en los últimos seis meses calificaron la salud de sus dientes y encías como excelente en comparación con quienes no visitaron al dentista en los últimos 6 meses. Conclusiones: Los estudios futuros deberían revisar otros factores que afectan la salud bucal como la ingesta de alto contenido de azúcar, la diabetes, al igual que las enfermedades crónicas y factores de genética. Se debe hacer énfasis en la identificación de inequidades asociadas con la salud periodontal entre diversas culturas y grupos étnicos en los Estados Unidos.

Updated key points of chronic hepatitis B virus infection: developing drugs for treatment issued by the U.S. food and drug administration(clinical part) / 临床肝胆病杂志

In November 2018, the U.S. food and drug administration (FDA) issued guidance for the development of drugs for chronic hepatitis B virus infection (draft for comments) (hereinafter referred to as draft for comments), and in April 2022, the FDA issued Chronic Hepatitis B Virus Infection: Developing Drugs for Treatment, which has been updated with some details based on the Draft for Comments. This guidance further emphasizes the importance of HBsAg clearance in clinical trials, and classifies chronic suppressive therapy into two categories, namely noninferiority (NI) (or superiority) test with nucleos(t)ide analogues as control and add-on superiority trial with nucleos(t)ide analogues as control, and as for the latter, HBV DNA is no longer recommended as a primary endpoint of the trial, which poses a huge challenge to the development of innovative drugs targeting HBV DNA. The new finite duration therapy should aim to eliminate HBsAg and reduce virologic relapse and the risk of liver disease progression during treatment cessation. Reduction in HBsAg from baseline is not recommended as a primary endpoint for phase Ⅲ clinical trials, since the correlation between such reduction and clinical response remains unclear. In addition, this guidance also specifies the duration of treatment cessation and treatment consolidation period and the criteria for withdrawal of nucleos(t)ide analogues.

Grouping rules and implications of MS-DRG in the United States / 中华医院管理杂志

The United States is the first country to implement DRG payment in the world, and its MS-DRG(medical severity DRG)version has been used for reference by many countries and regions. In order to ensure the universal applicability of DRG grouping scheme and adapt to the clinical reality, the MS-DRG grouping scheme should follow such grouping rules as similarity of resource consumption, clinical similarity and easy management of DRG groups. This paper presented the evolution of MS-DRG and expounded on its grouping rules in detail, for reference in the amendment and improvement of grouping rules in CHS-DRG.

The Anesthesiology Milestones 2.0 an competency-based assessment for residency training in the United States: an interpretation / 中华麻醉学杂志

From a time-based to a competency-based medical education, the evolution of residency training began nearly 30 years ago, the development of valid and reproducible assessment tools faces challenges.Medical educators across specialties remain motivated to develop a relevant, generalizable, and measurable system.The Accreditation Council for Graduate Medical Education (ACGME) in the United States commits to the responsibility by assuring that the process and outcome of graduate medical education (GME) in the national residency programs produce competent, safe, and compassionate doctors.The Milestones Project is the ACGME′s evolution to a competency-based system, which allows each specialty to develop its own subcompetencies and 5-level progression of Milestones, along a continuum of novice to expert.Milestones 1.0 provided important foundational information and insights for the education community, that has had nearly 5 years of experience for residency training in Anesthesiology, needs to be improved.Milestones 1.0 highlighted challenges with assessment and evaluation of residents, some mismatch between subcompetencies and current and future clinical practices in Anesthesiology, and the need for faculty development tools.The ACGME assembled representatives from stakeholder groups using an iterative process within the Anesthesiology community to develop the second generation of Milestones in 2021.This article describes Milestones 2.0 for residency training in Anesthesiology in the United States, emphasizing the rationality and practicability, to provide evidence for residency training in Anesthesiology in China.There is a lack of systematic, cooperative and continuous research on medical education in Anesthesiology in China, and a lack of competency-based and milestone-based residency training in Anesthesiology.It is urgent to narrow the gap between developed countries and China to improve medical education and training in Anesthesiology.

Human parasitism by the exotic tick Dermacentor variabilis (Parasitiformes: Ixodida) in Brazil: report of an imported case / Parasitismo humano pelo carrapato exótico Dermacentor variabilis (Parasitiformes: Ixodida) no Brasil: relato de um caso importado

Abstract In June 2012, a tick was found parasitizing a man in the city of São Paulo, who had recently returned from a visit to Pennsylvania, in the northeast of the United States. The tick was removed and sent to the São Paulo State Department of Health, where it was identified as a male of the species Dermacentor variabilis (Say, 1821), according to the literature and taxonomic keys. The tick was subjected to a PCR test to search for rickettsiae, but the result was negative. The fact that a human entered Brazilian territory unaware that he was parasitized by a hard tick not belonging to the national tick fauna is significant because of the possibility that an exotic species could be introduced and take hold in this country. Another major risk to public health is that this arthropod could be infected with the bacterium Rickettsia rickettsii, as this ectoparasite is the main vector of Spotted Fever on the East Coast of North America.

Resumo Em junho de 2012, foi enviado ao serviço da Secretaria de Estado da Saúde de São Paulo um carrapato que foi encontrado em parasitismo sobre um homem adulto na cidade de São Paulo, que havia chegado recentemente de uma viagem de turismo aos Estados Unidos, onde visitou o estado da Pensilvânia, situado na região Nordeste Americana. O carrapato foi identificado como um macho da espécie Dermacentor variabilis, (Say, 1821), de acordo com a literatura e chaves taxonômicas, sendo submetido ao teste da PCR para pesquisa de riquétsias, porém o resultado foi negativo. O fato de um ser humano ter cruzado a fronteira do Brasil, parasitado, sem o seu prévio conhecimento, por um carrapato duro, não pertencente à ixodofauna nacional, é de grande importância pela chance de introdução e estabelecimento no território brasileiro de uma espécie exótica. Outro grande risco para a saúde pública é que esse artrópode poderia estar infectado com a bactéria Rickettsia rickettsii, pois esse ectoparasito é o principal vetor da Febre Maculosa na costa Leste Norte Americana.

Analysis of physical therapy education programs in universities of United States / 中国康复理论与实践

@#Objective To analyze the educational characteristics of physical therapy in universities of United States, and provide reference for the international development of rehabilitation therapy education in China.Methods Based on the data collected from the official websites of three universities in the United States and the databases at home and abroad, combined with the author's learning experience, the characteristics of physical therapy education in universities of United States in detail was analyzed.Results Characteristics of physical therapy education in universities of United States had strict accreditation system, course objectives oriented by practicing competence, comprehensive curriculum plan, educational concept of student-centered, high level of teaching informatization, diversified teaching and learning evaluation system, which conformed to the goal of rehabilitation competency of World Health Organization.Conclusion Physical therapy education in United States has remarkable characteristics and a well-developed system, which has certain reference value for China.

Application status and thinking of acupuncture and moxibustion therapy for assisted reproductive field in the United States / 中国针灸

The application status of acupuncture and moxibustion therapy for assisted reproductive field in the United States was analyzed, and the existing problems and future development directions were discussed. According to the survey on the 456 websites of assisted reproductive clinic in the United States mentioned in the report of U.S. Centers for Disease Control and Prevention (CDC), 111 clinics among 456 assisted reproductive clinics recommend and used acupuncture and moxibustion therapy, accounting for 24.3%. Acupuncture and moxibustion therapy had obvious effect, good safety and low cost, and the assisted reproductive institutions in the United States had a high degree of application and recognition to acupuncture and moxibustion therapy. However, some problems, such as immature treatment scheme, unclear mechanism and imperfect insurance policies, still existed. In the future, the advantages of Chinese traditional acupuncture and moxibustion should combine with international modern assisted reproductive technology, and multi-center and large-sample clinical randomized controlled trials and basic experimental research on the mechanism of acupuncture and moxibustion for assisted reproduction should be carried out.

United States Food and Drug Administration's authorization of reduced exposure claims for IQOS®: implications for regulation in Latin America / Autorización de la Administración de Alimentos y Medicamentos de Estados Unidos de declaraciones sobre exposición reducida respecto de IQOS: implicaciones para la regulación en América Latina / Autorização pela Administração de Alimentos e Fármacos dos Estados Unidos de alegações de exposição reduzida para os produtos IQOS: implicações para a regulamentação na América Latina

ABSTRACT Philip Morris International has used the July 7, 2020 United States Food and Drug Administration's (US FDA) modified risk tobacco product order for IQOS®, which authorized certain reduced exposure marketing claims, as a corporate strategy to promote and normalize its heated tobacco products in Latin America. The modified risk tobacco product orders are based on the US's unique regulatory system that is not, and should not be, replicated anywhere else in the world. Philip Morris International's global public relations campaign largely ignored the FDA's rejection of reduced risk claims for IQOS and other key FDA findings that are important for policy-makers, regulators, and consumers - including tobacco users and Philip Morris International's customers - to understand the risks associated with the product. In Latin America in particular, Philip Morris International has used media outlets to promote this misleading information to the public. This company has also used the FDA ruling to lobby regulators in Latin America to relax regulations on IQOS in the region. As tobacco companies rapidly introduce new tobacco products in low- and middle-income countries, public health advocates and Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) should take measures to prevent the promotion of misleading statements about heated tobacco products, including IQOS. As Latin American countries are at different stages in their regulation of heated tobacco products, governments should adhere to their WHO FCTC obligations and the recommendations of the Conference of the Parties by entirely prohibiting the sale of heated tobacco products or strictly applying to heated tobacco products all the relevant tobacco demand-reduction policies based on the WHO FCTC (making sure to capture both heated cigarettes and heating devices).

RESUMEN Philip Morris International ha empleado el dictamen que la Administración de Alimentos y Medicamentos (FDA) de Estados Unidos emitió el 7 de julio del 2020 sobre IQOS como producto de tabaco de riesgo modificado —que la autorizó a usar ciertas declaraciones relativas a una exposición reducida al comercializar el producto— como estrategia corporativa para promover y normalizar sus productos de tabaco calentado en América Latina. Los dictámenes sobre productos de tabaco de riesgo modificado se fundamentan en el sistema regulatorio único de Estados Unidos, que no se replica ni debería ser replicado en ningún otro lugar del mundo. La campaña mundial de relaciones públicas de Philip Morris International omitió en gran medida que la FDA rechazó los argumentos de que IQOS implica un riesgo reducido y otros hallazgos clave de la FDA que son importantes para que los responsables de las políticas, los reguladores y los consumidores, incluidos los consumidores de tabaco y los clientes de Philip Morris International, comprendan los riesgos asociados con el producto. En América Latina en particular, Philip Morris International ha utilizado los medios de comunicación para difundir esta información engañosa. Esta compañía también ha utilizado el fallo de la FDA para presionar a los reguladores en América Latina con el objetivo de que flexibilicen las regulaciones sobre IQOS en la Región. A medida que las compañías tabacaleras introducen con celeridad nuevos productos de tabaco en países de ingresos bajos y medianos, los defensores de la salud pública y los Estados Parte del Convenio Marco para el Control del Tabaco de la Organización Mundial de la Salud (CMCT de la OMS) deben tomar medidas para evitar la difusión de declaraciones engañosas sobre los productos de tabaco calentado, como IQOS. Dado que los países latinoamericanos se encuentran en diferentes etapas en la regulación de los productos de tabaco calentado, los gobiernos deben cumplir con sus obligaciones estipuladas en el CMCT de la OMS y las recomendaciones de la Conferencia de las Partes mediante la prohibición total de la venta de productos de tabaco calentado o la aplicación estricta a los productos de tabaco calentado de todas las políticas pertinentes sobre la reducción de la demanda de tabaco basadas en el CMCT de la OMS (y asegurarse de abarcar tanto los cigarrillos calentados como los dispositivos de calentamiento).

RESUMO A Philip Morris International utilizou a decisão de 7 de julho de 2020 da Administração de Alimentos e Fármacos dos Estados Unidos (United States Food and Drug Administration, FDA), que caracterizou o IQOS como produto de tabaco com risco modificado e que permitiu o uso de determinadas alegações de exposição reduzida no marketing do produto, como estratégia corporativa para promover e normalizar seus produtos de tabaco aquecido na América Latina. As decisões relativas aos produtos de tabaco com risco modificado se baseiam no singular sistema regulatório dos EUA, que não é e não deve ser reproduzido em nenhum outro lugar do mundo. A campanha global de relações públicas da Philip Morris International ignorou em grande parte a rejeição da FDA às afirmações de risco reduzido do IQOS e outros achados fundamentais da FDA, que são informações importantes para formuladores de políticas, órgãos regulamentadores e consumidores - incluindo usuários de tabaco e clientes da Philip Morris International - entenderem os riscos associados ao produto. A Philip Morris International tem usado a mídia para veicular essa informação enganosa ao público, principalmente na América Latina. A empresa também usou a decisão da FDA para pressionar órgãos regulamentadores na América Latina a flexibilizarem a regulamentação do IQOS na região. Conforme as empresas de tabaco introduzem rapidamente novos produtos em países de baixa e média renda, os ativistas de saúde pública e as Partes da Convenção-Quadro para Controle do Tabaco (CQCT) da Organização Mundial da Saúde (OMS) devem tomar providências para prevenir a promoção de alegações enganosas sobre produtos de tabaco aquecido, incluindo o IQOS. Como os países da América Latina estão em diferentes estágios da regulamentação de produtos de tabaco aquecido, os governos devem cumprir suas obrigações com a CQCT da OMS e seguir as recomendações da Conferência das Partes, proibindo totalmente a venda de produtos de tabaco aquecido ou aplicando rigorosamente aos produtos de tabaco aquecido todas as políticas relevantes de redução da demanda por tabaco, com base na CQCT da OMS (certificando-se de abranger tanto os cigarros aquecidos quanto os dispositivos de aquecimento).