Methodology for the Differential Classification of Dengue and Chikungunya According to the PAHO 2022 Diagnostic Guide.

Arboviruses such as dengue, Zika, and chikungunya present similar symptoms in the early stages, which complicates their differential and timely diagnosis. In 2022, the PAHO published a guide to address this challenge. This study proposes a methodological framework that transforms qualitative information into quantitative information, establishing differential weights in relation to symptoms according to the medical evidence and the GRADE scale based on recommendation 1 of the said guide. To achieve this, common variables from the dataset were identified using the PAHO guide, and quality rules were established. A linear interpolation function was then parameterised to assign weights to the symptoms according to the evidence. Machine learning was used to compare the different models, achieving 99% accuracy compared with 79% without the methodology. This proposal represents a significant advancement, allowing the direct application of the PAHO recommendations to the dataset and improving the differential classification of arboviruses.

COVID-19 and zoonoses in Brazil: Environmental scan of one health preparedness and response.

The emergence of the COVID-19 pandemic reinforced the central role of the One Health (OH) approach, as a multisectoral and multidisciplinary perspective, to tackle health threats at the human-animal-environment interface. This study assessed Brazilian preparedness and response to COVID-19 and zoonoses with a focus on the OH approach and equity dimensions. We conducted an environmental scan using a protocol developed as part of a multi-country study. The article selection process resulted in 45 documents: 79 files and 112 references on OH; 41 files and 81 references on equity. The OH and equity aspects are poorly represented in the official documents regarding the COVID-19 response, either at the federal and state levels. Brazil has a governance infrastructure that allows for the response to infectious diseases, including zoonoses, as well as the fight against antimicrobial resistance through the OH approach. However, the response to the pandemic did not fully utilize the resources of the Brazilian state, due to the lack of central coordination and articulation among the sectors involved. Brazil is considered an area of high risk for emergence of zoonoses mainly due to climate change, large-scale deforestation and urbanization, high wildlife biodiversity, wide dry frontier, and poor control of wild animals' traffic. Therefore, encouraging existing mechanisms for collaboration across sectors and disciplines, with the inclusion of vulnerable populations, is required for making a multisectoral OH approach successful in the country.

Ultra-processed food consumption in Barbados: evidence from a nationally representative, cross-sectional study.

Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012-13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25-64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25-44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45-64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25-44 years) compared with the older (45-64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1-3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.

Comparative performances of seven quantitative Reverse-Transcription Polymerase Chain Reaction assays (RT-qPCR) for detecting SARS-CoV-2 infection in samples from individuals suspected of COVID-19 in São Paulo, Brazil.

Introduction: Brazil is the second largest country with COVID-19 positive cases worldwide. Due to the potent spread of the virus and the scarcity of kits and supplies, the Brazilian Ministry of Health has granted authorization for the use of kits available during this emergency, without an accurate evaluation of their performance. This study compared the performance and cost-effectiveness of seven molecular assays/kits available in São Paulo, Brazil, for SARS-CoV-2 diagnosis. Materials and methods: A total of 205 nasopharyngeal/oropharyngeal samples from suspected cases of COVID-19, were tested using the following assays: (i) GeneFinder COVID-19 plus RealAmp kit; (ii) 2019-nCoV RNA PCR-Fluorescence Probing, Da An Gene Co.; (iii) in-house RT-qPCR SARS-CoV-2 IAL; (iv) 2019-nCoV kit, IDT; (v) molecular SARS-CoV-2 (E) kit, Bio-Manguinhos; (vi) Allplex 2019-nCoV modified Assay, Seegene Inc, and (vii) Biomol one-step COVID-19 kit, IBMP. The criteria for determining a SARS-CoV-2 true positive result included the cycle threshold cut-off values, the characteristics of exponential/linear curves, the gene target diversity, and a positive result in at least two assays. Results: The overall sensitivity of the assays listed were GeneFinder 83.6%, Da An Gene 100.0%, IAL 90.4%, IDT 94.6%, Bio-Manguinhos 87.7%, Allplex 97.3%, and IBMP 87.7%. The minor sensitive gene target was RdRP. Although all assays had a Cohen's Kappa index ≥0.893, the best tests used multiplex assays identifying N-gene and/or E-gene targets. Conclusion: All assays tested accurate for diagnosis, but considering cost-effectiveness (cost, time consumption, number of samples tested, and performance), the in-house IAL assay was ideal for COVID-19 diagnosis in São Paulo, Brazil.

Proceedings of a workshop to discuss the epidemiology of invasive Haemophilus influenzae disease with emphasis on serotype a and b in the Americas, 2019.

On March 9, 2019, a one-day workshop titled "The current epidemiology of invasive Haemophilus influenzae disease in the Americas", jointly organized by the Public Health Agency of Canada (PHAC), the Canadian Institute of Health Research (CIHR), and the National Research Council Canada (NRC), brought together experts in the epidemiology and surveillance of invasive Haemophilus influenzae (Hi) disease from the Pan American Health Organization (PAHO) and its five regional reference laboratories in South America, USA, and Canada in Ottawa, Ontario, Canada. This workshop built upon recommendations of previous related workshops and incorporated updated data.

It Takes More than Two to Tango with COVID-19: Analyzing Argentina's Early Pandemic Response (Jan 2020-April 2020).

In November 2019, the world was introduced to a new coronavirus that has since ravaged it. Argentina began to see an increase of COVID-19 quickly in the new year and as of April 2020 the country was still being burdened by the transmission of the virus. With the progression of the epidemic turning into a pandemic, health authorities constantly updated health prevention strategies and responses to the novel coronavirus in its first wave. The Center for Disease Control and Prevention (CDC) issued a level three warning for international travel to/from Argentina because of COVID-19's rapid transmission. With Argentina's already fragile economy, health systems had to meet the challenge of being able to treat the infected. This case presentation aims to provide an overview of Argentina's earliest epidemiological situation of the COVID-19 pandemic. The data provided in this study concern Argentina's COVID-19 situation during the period of January 2020-April 2020. Mathematical modeling was used to forecast COVID-19 transmission after the first wave, specifically focusing on Buenos Aires. The country's demographics and an impression of its health systems will be analyzed in this case presentation for preparedness. The case study concludes in depicting Argentina's current and anticipated economic, social, and political disruptions because of the first wave of the pandemic.

An analysis of stakeholder networks to support the breastfeeding scale-up environment in Mexico.

Little information exists on how to garner political commitment to strengthen large-scale breastfeeding policies and programmes by targeting key decision makers. The present study aims to map and describe the influence of stakeholders involved in breastfeeding policy and programming and identify opportunities to strengthen the breastfeeding-friendly environment in Mexico. A total of nine key informants from seventeen stakeholder organisations were selected based on their in-depth knowledge of the breastfeeding environment in Mexico and were individually interviewed using Net-Map methodology. This participatory interview technique combines stakeholder mapping, social network analysis and influence mapping to identify relevant stakeholders. Participants identified a total of fifty-five stakeholders shaping breastfeeding programmes and policies through four domains of influence: commands (n 32 stakeholders), dissemination (n 40), funding (n 35) and technical assistance (n 37). The Federal Ministry of Health emerged as the most influential stakeholder of breastfeeding policy and programming decisions in Mexico among all domains of influence. The Ministry of Finance and Public Credit as well as the National Institute of Public Health were identified as additional key stakeholders providing funding and technical assistance to the Federal Ministry of Health, respectively. Engaging identified key stakeholders can generate a multisectoral commitment to breastfeeding and strengthen the breastfeeding-friendly environment in Mexico.

Comparative Analysis of the Classification of Food Products in the Mexican Market According to Seven Different Nutrient Profiling Systems.

Nutrient profiling systems (NPS) are used around the world. In some countries, the food industry participates in the design of these systems. We aimed to compare the ability of various NPS to identify processed and ultra-processed Mexican products containing excessive amounts of critical nutrients. A sample of 2544 foods and beverages available in the Mexican market were classified as compliant and non-compliant according to seven NPS: the Pan American Health Organization (PAHO) model, which served as our reference, the Nutrient Profiling Scoring Criterion (NPSC), the Mexican Committee of Nutrition Experts (MCNE), the Health Star Rating (HSR), the Mexican Nutritional Seal (MNS), the Chilean Warning Octagons (CWO) 2016, 2018 and 2019 criteria, and Ecuador's Multiple Traffic Light (MTL). Overall, the proportion of foods classified as compliant by the HSR, MTL and MCNE models was similar to the PAHO model. In contrast, the NPSC, the MNS and the CWO-2016 classified a higher amount of foods as compliant. Larger differences between NPS classification were observed across food categories. Results support the notion that models developed with the involvement of food manufacturers are more permissive than those based on scientific evidence. Results highlight the importance of thoroughly evaluating the underlying criteria of a model.

Taking innovative vector control interventions in urban Latin America to scale: lessons learnt from multi-country implementation research.

Prior to the current public health emergency following the emergence of chikungunya and Zika Virus Disease in the Americas during 2014 and 2015, multi-country research investigated between 2011 and 2013 the efficacy of novel Aedes aegypti intervention packages through cluster randomised controlled trials in four Latin-American cities: Fortaleza (Brazil); Girardot (Colombia), Acapulco (Mexico) and Salto (Uruguay). Results from the trials led to a scaling up effort of the interventions at city levels. Scaling up refers to deliberate efforts to increase the impact of successfully tested health interventions to benefit more people and foster policy and program development in a sustainable way. The different scenarios represent examples for  a 'vertical approach' and a 'horizontal approach'. This paper presents the analysis of a preliminary process evaluation of the scaling up efforts in the mentioned cites, with a focus on challenges and enabling factors encountered by the research teams, analysing the main social, political, administrative, financial and acceptance factors.

Escala diagnóstica de Thwaites: experiencia en el Hospital Carlos Andrade Marín (Quito-Ecuador) / Thwaites diagnostic scale: experience in the Carlos Andrade Marin Hospital (Quito-Ecuador)

Introducción: La tuberculosis es un problema de salud pública. La escala diagnóstica de Thwaites es una herramienta usada para diferenciar la meningitis tuberculosa de otros tipos de meningitis bacterianas. Materiales y métodos: Estudio retrospectivo en pacientes con sospecha de meningitis bacteriana realizado en el Hospital Carlos Anadrade Marín con la información de los registros médicos del sistema informático AS-400. Resultados: Estudiamos 41 casos de meningitis bacteriana no tuberculosa y 7 casos confirmados de tuberculosis. Los resultados del uso de la escala fueron: sensibilidad 88% y especificidad 88%. Razón de Verosimilitud positiva: 7.33 y Razón de Verosimilitud negativa: 0.14. Discusión: La escala de Thwaites podría ser útil para diferenciar la meningitis bacteriana piógena de la tuberculosa. Palabras clave: OMS-OPS; thwaites; LCR; Meningitis, Tuberculosis.

Introduction: tuberculous meningitis is one of the most common public health problems worldwide. Thwaites diagnostic scale is a tool used to differentiate tuberculous meningitis from other types of bacterial meningitis. Methods: This is a retrospective study carried out in patients diagnosed of bacterial meningitis developed at Carlos Andrade Marin Hospital. Information was taken from the medical records stored in the AS400 system. Results: Of 48 patients studied, 41 had bacterial meningitis and seven tuberculous meningitis. The sensitivity and the specificity of Thwaites' diagnostic score were 88%. The LR+ and LR- were 7.33 y 0.14 respectively. Discusion: Thwaites' diagnostic score was found to be a useful tool to differentiate bacterial from tuberculous meningitis.

Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital.

BACKGROUND: Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. METHODS: The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. RESULTS: The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation. CONCLUSIONS: Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates of critically ill children suggest that ETAT-based triage systems have the potential to greatly improve patient care in Latin America.

O SUS visto pela OPAS: notícias sobre o Sistema Único de Saúde (SUS) no ano de 2013 / The SUS seen by PAHO: news about the Unified Health System (SUS) in the year 2013

Fruto de cooperação entre os governos brasileiro e cubano, mediado pela Organização Pan-Americana da Saúde (OPAS), o Programa Mais Médicos foi implantado no Brasil em agosto de 2013 e é visto como uma iniciativa inovadora para o fortalecimento da Atenção Básica no Sistema Único de Saúde (SUS). Neste sentido, este trablho se propôs a conhecer a visão da OPAS sobre o Mais Médicos, por meio da análise de conteúdo das notícias publicadas em seu site no ano de 2013. Das matérias selecionadas, os termos Cooperação e Estratégia são mais citados pela OPAS, aliando-se às atuais condições do SUS que opera por meio de entes cooperados, desenvolvendo estratégias para superar negligências históricas, mas ainda com o desafio de ofertar um sistema universal de saúde que efetivamente atenda todos os brasileiros e brasileiras, dos meios urbanos ou rurais, sem distinção de cor, raça, etnia ou gênero.(AU)

The result of cooperation between Brazilian and Cuban governments, mediated by the Pan American Health Organization (PAHO), the Mais Médicos Program was implemented in Brazil in August 2013 and is seen as an innovative initiative to strengthen primary health care in the Sistema Único de Saúde (SUS). In this sense, the article has an objective to meet the vision of PAHO abou the Mais Médicos, through the content analysis published on its website in 2013. Of the selected materials , the terms of cooperation and strategy are cited more often by PAHO , allying itself to current SUS conditions that operates through loved members, developing strategies to overcome historical negligence , but also with the challenge of offering a universal health system that effectively meets all Brazilians , urban or rural areas, without distinction of color , race, ethnicity or gender.(AU)

Review on the worldwide regulatory framework for biosimilars focusing on the Mexican case as an emerging market in Latin America.

The global biopharmaceutical market is worth over $100 billion USD. Nearly 90% of these products will lose their patent in the next ten years, leading to the commercialization of their subsequent versions, known as 'biosimilars'. Biosimilars are much more complex molecules than chemically synthesized generics in terms of size, structure, stability, microheterogeneity, manufacture, etc. Therefore, a specific regulatory framework is needed in order to demonstrate their comparability with innovative products, as well as their quality, safety and efficacy. The EU published the first regulatory pathway in 2005 and has approved 14 biosimilars. Mexico has recently developed a clear regulatory pathway for these products. Their legal basis was established in Article 222 Bis of General Law of Health in 2009, clear specifications in the Regulation for Health Goods in 2011, and further requirements in the Mexican Official Norm NOM-EM-001-SSA1-2012. The aim of this review is to summarize the regulatory pathways for biosimilars in the world with a special focus on Mexican experience, so as contribute to the development of regulations in other countries.

A saúde na proposta de desenvolvimento da Comissão Econômica para a América Latina e o Caribe (CEPAL)/Organização Pan-Americana da Saúde (OPAS) / Health in the development proposal of the Economic Commission for Latin America and the Caribbean (ECLAC) / Pan American Health Organization (PAHO)

Este trabalho de natureza documental buscou identificar as razões para a incorporação da saúde no projeto de desenvolvimento para os países da América Latina elaborado pela Comissão Econômica para a América Latina e o Caribe (CEPAL) no início da década de 1990, e o papel atribuído ao setor saúde na proposta construída em conjunto com a Organização Pan-Americana de Saúde (OPAS), intitulada Salud, equidad y transformación productiva en América Latina y el Caribe. Foram utilizados como fontes documentos elaborados pela CEPAL e publicações conjuntas com com a OPAS. Dentre os resultados, destacam-se a visão da saúde como fator de desenvolvimento econômico e social, e a noção de enfoque integrado como principal argumento para a incorporação da saúde no novo marco de desenvolvimento regional, além da centralidade das categorias de equidade e produtividade nas referidas propostas.

This work of documentary nature sought to identify the reasons for the incorporation of health in the development project for the Latin American countries prepared by the Economic Commission for Latin America and the Caribbean (ECLAC) in the early 1990s, and the role assigned to the health sector in the built proposition in conjunction with the Pan American Health Organization (PAHO), entitled Salud, equidad y transformación productiva en América Latina y el Caribe. It was used as source documents prepared by ECLAC and in combination with PAHO. Among the results, we highlight the view of health as a factor of economic and social development, besides the notion of integrated approach as the main argument for the incorporation of health in the new framework of regional development, and the centrality of the categories of equity and productivity in these referred proposals.

Strengthening vaccination policies in Latin America: an evidence-based approach.

Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public-private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the long term. These reforms are now crucial, particularly as vaccines for previously neglected, developing-world diseases become available. In summary, a regionally-coordinated health policy will reduce vaccination inequality in Latin America.

Histórico del proceso de creación de la Escuela de Odontología de la Universidad del Valle: primera acción investigativa de base: estudio de recursos Odontológicos en el Área sur-occidental de Colombia / Historical review of the process of creation of the Dental School of the Universidad del Valle: first base action of investigation: study of dentistry resources in the southwestern area of Colombia

Se presenta el resultado de la única Investigación Epidemiológica Cuantitativo–Cualitativa Regional e Interinstitucional que se ha realizado en América Latina como base para la fundación de una Facultad de Odontología. En 1.969, por acción integrada de la Sección de Odontología Sanitaria del Departamento de Medicina Preventiva y de Salud Publica de la Universidad del Valle y del Programa de Especialización en Odontología Sanitaria y de Salud Pública de la Escuela de Salud Pública de la Universidad de Antioquia, con la Asesoría de la Organización Panamericana de la Salud “OPS”, se llevó a cabo una investigación de campo en Odontología cuyos métodos y resultados generales, algunos de cuyos hallazgos se presentan en este manuscrito, se utilizaron como fundamento para la toma de decisiones curriculares por parte del Comité Universitario Pro Facultad de Odontología de la Universidad del Valle, “CUPFO” y por el Consejo Directivo de la Universidad para aprobar, en Junio de 1.970, la creación del Departamento de Estomatología de la División de Salud (por la Reforma Administrativa llevada a cabo en 1.968, las Facultades de disciplinas afines se agruparon en unos nuevos entes administrativos: las Divisiones. Dentro de estas, las antiguas y las nuevas Facultades pasaron a ser Departamentos) en la mencionada Alma Mater. La investigación incluyó algunos aspectos que no fueron tomados en cuenta en el Estudio de Recursos Humanos para la Salud que formó parte de la Encuesta Nacional de Morbilidad realizada en 1.965, aspectos que si se incluyeron en el Estudio de Recursos Odontológicos llevado a cabo por el Instituto Nacional para Programas Especiales de Salud, del cual el autor de la Reseña que aquí se presenta fue Asesor - Consultor y Odontólogo de trabajo de Campo en las Unidades de Cali, Santa Rosa de Cabal y Quibdó.

Results of the unique Epidemiological Quantitative - Qualitative Regional and Interinstitutional Research performed at Latin America as essential base to found a new Dental School are presented trough this paper. In 1969 by a cooperative work between the Universidad del Valle, Cali, Colombia and the Antioquia University Public Health and Sanitarian Dentistry Program, on the advice of the Pan American Health Dental Health (PAHO) it was carried out a field research to establish the dental health practice conditions and the data obtained were used as a baseline of curricular determination by the Pro Dental Scholl Committee at the Universidad del Valle “CUPFO”. The study took on accountsome aspects that have been neglected on the National Health Human Resources Research as part of the National Morbidity Research Study realized on 1965 but included in the Dental Health Resources Research performed by the National Special Health Resources Institute. It is necessary to clarify that the author of the present paper participated as a special member of the advisors committee and as field dentist of the Dental Health Resources Research realized by theNational Special Health Resources Institute in 1.965.

Informação científica, educação médica e políticas de saúde: a Organização Pan-Americana da Saúde e a criação da Biblioteca Regional de Medicina - Bireme / Scientific information, medical education and health policies: the Pan-American Health Organization and the creation of the Regional Library of Medicine - Bireme

O artigo examina a gênese e os primeiros anos de funcionamento da Biblioteca Regional de Medicina (Bireme - OPAS), hoje Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde, no período compreendido entre 1963 e 1982. Ao fazê-lo, caracteriza a Bireme, simultaneamente, como aparato e como arena de negociação, inscrita nos processos mais gerais do desenvolvimento, da cooperação internacional, da informação em C&T, das políticas de saúde e do movimento de expansão e reforma do ensino médico. A narrativa tem como marco inicial a concepção de uma biblioteca regional de medicina para a América Latina, segundo um modelo proposto pela National Library of Medicine. Em seguida, o artigo caracteriza a trajetória inicial da Bireme como sendo a história da recepção deste modelo, percurso que refletiu os processos de crítica, no período, às formas pelas quais se davam a organização de serviços de atenção à saúde e a formação de seus recursos humanos. Indica que, a partir de 1976, um novo modelo resultou em efetiva modificação da agenda programática da Bireme, implicando aportes radicalmente distintos ao funcionamento do regime de informação em ciências da saúde vigente no Brasil e na América Latina.

This article examines the creation and the first years of functioning of the Regional Library of Medicine (Biblioteca Regional de Medicina - Bireme - PAHO), today Latin-American Center for Information in Health Sciences, during 1963-1982. In the course of this analysis, Bireme is being characterized as both an apparatus and an arena for negotiation present in the most general processes of development expressed in international cooperation, information in science and technology, health policies and in the movement for expansion and reform of medical teaching. The narrative has as initial landmark the conception of a regional library of medicine for Latin America according to a model proposed by the National Library of Medicine. The article qualifies the first years of Bireme's existence as the history of the reception of this model, a trajectory that reflected the criticism of that time against the way the health care services were organized and their human resources were educated. Finally, beginning in 1976, a new model resulted in a real modification of Bireme's programmatic agenda, implying in very distinct contributions for the functioning of the regime of information in health sciences in force in Brazil and Latin America.

Rehistoriar la bioética en Latinoamérica: la contribución de James Drane / Remakin bioethiccs' history in Latin America: James Drane's contribution / Re-historiar a bioética na América Latina: a contribuição de James Drane

Este artículo presenta la persona y la obra de James Drane en su relación con la bioética en Latinoamérica. Tras un breve examen de su carrera y publicaciones, se destaca la creación de un centro de estudios en Edinboro University of Pennsylvania, legado de la filantropía de Russell B. Roth y su familia, que perpetuará el espíritu de interrogación libre y lealtad a sus principios que Drane ha mantenido a lo largo de su vida.

This article presents the person and work of James Drane in their relation to bioethics in Latin America. After a brief analysis of his career and publications, the establishment of a study center at the Edinboro University of Pennsylvania is underscored, a legacy of the late Russell B. Roth and his family, which will perpetuate the spirit of free inquiry and loyalty to his principles that Drane has kept throughout his life.

Este artigo apresenta a pessoa e a obra de James Drane relacionada com a bioética na América Latina. Após um breve exame de sua carreira e publicações, destaca-se a criação de um centro de estudo na Edinboro Univerisity na Pensilvânia (EUA), legado da filantropia de Russell B. Roth e sua família. Este centro perpetuará o espírito de livre pensador e lealdade aos seus princípios que Drane tem defendido ao longo de sua vida.

Sylvatic yellow fever outbreak in Bolivia.

PIP: In the past 10 years, Bolivia has reported more than 400 cases of yellow fever, representing 30% of all cases reported in the region in the same period. In January 1999, Bolivia notified a sylvatic yellow fever outbreak. A provisional total of 29 cases have been reported nationally since the beginning of the year, all occurring in rural settings of the Department of Santa Cruz. The area reporting the most cases is localized 120-200 km south of the city of Santa Cruz de la Sierra between the provinces of Cordillera and Vallegrande. 23 cases were male and 6 female. 82% of cases were over age 15 years, 11% were aged 10-15 years, and 7% were under age 10 years. 27 cases were not vaccinated against yellow fever and 2 had an unverified history of vaccination. There were 10 deaths as of mid-February. A mass immunization campaign of all age groups living in outbreak areas was implemented immediately after the first cases were confirmed. In the Department of Santa Cruz, 30,000 vaccinations have thus far been given in municipalities surrounding the outbreak, increasing the vaccination coverage to higher than 90% in those counties. Recent cases present a similar epidemiologic profile to those in previous yellow fever outbreaks. PAHO recommendations to prevent and control yellow fever are presented.^ieng