Assistência pré-natal às usuárias de substâncias psicoativas: dificuldades elencadas pelos profissionais da saúde / Prenatal care for users of psychoactive substances: difficulties listed by health professionals / Atención prenatal a consumidoras de sustancias psicoactivas: dificultades mencionadas por los profesionales de la salud

Objetivo: conhecer as dificuldades elencadas pelos profissionais de saúde na assistência pré-natal às usuárias de substâncias psicoativas. Método: estudo qualitativo, exploratório-descritivo, realizado nas mídias sociais, com profissionais da área da saúde que realizam atendimento pré-natal. A coleta de dados ocorreu de novembro de 2022 a janeiro de 2023 por meio de questionário eletrônico. Os dados foram analisados por meio da análise temática. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados: os profissionais destacam o déficit de conhecimento para abordar este público em específico. A abordagem superficial e condenatória do uso de substâncias pelas políticas públicas corrobora para que os profissionais se sintam preparados em parte para atender essas gestantes. Considerações finais: a capacitação dos profissionais é necessária para superar práticas condenatórias e retrógradas de cuidado que focam unicamente a abstinência; como também, o investimento na capacitação acerca da rede de atenção à saúde, buscando ampliar sua visibilidade e utilização.

Objective: understanding the difficulties listed by health professionals in prenatal care for users of psychoactive substances. Method: this is a qualitative, exploratory-descriptive study carried out on social media with health professionals who provide prenatal care. Data was collected from November 2022 to January 2023 using an electronic questionnaire. The data was analyzed using thematic analysis. Protocol approved by the Research Ethics Committee. Results: the professionals highlight the lack of knowledge to deal with this specific public. The superficial and condemnatory approach to substance use by public policies contributes to making professionals feel partly prepared to deal with these pregnant women. Final considerations: the training of professionals is necessary to overcome condemnatory and retrograde care practices that focus solely on abstinence; and investment in training about the health care network, seeking to increase its visibility and use.

Objetivo: conocer las dificultades mencionadas por los profesionales de la salud en la atención prenatal de las consumidoras de sustancias psicoactivas. Método: estudio cualitativo, exploratorio-descriptivo, realizado en redes sociales, con profesionales de la salud que brindan atención prenatal. La recolección de datos se llevó a cabo de noviembre de 2022 a enero de 2023 a través de un cuestionario electrónico. Los datos se analizaron mediante análisis temático. El protocolo fue aprobado por el Comité de Ética en Investigación. Resultados: los profesionales destacan que les falta el conocimiento para atender a este público específico. El abordaje superficial y condenatorio del consumo de sustancias por parte de las políticas públicas contribuye a que los profesionales se sientan parcialmente preparados para atender a esas gestantes. Consideraciones finales: es necesario capacitar a los profesionales para superar las prácticas asistenciales condenatorias y retrógradas que se centran únicamente en evitar el consumo; e invertir en capacitación sobre la red de atención de salud, para ampliar su visibilidad y uso.

Percepções e ações da equipe multiprofissional em saúde sobre a medicina tradicional indígena / Perceptions and actions of the multi-professional health team on traditional indigenous medicine / Percepciones y acciones del equipo multidisciplinario de salud sobre la medicina tradicional indígena

Objetivo: compreender as percepções e as ações de uma equipe multiprofissional em saúde quanto à prática da medicina tradicional indígena em uma Casa de Atenção à Saúde Indígena. Método: estudo qualitativo descritivo, realizado em uma de Casa de Apoio à Saúde Indígena em um município do Pará, que incluiu oito profissionais de uma equipe multiprofissional. A coleta de dados foi realizada no ano de 2018 e estes foram examinados pelo método da análise de conteúdo. Resultados: inserção e prática do cristianismo; ritos e lideranças xamânicas; e postura da equipe de multidisciplinar foram as categorias elencadas, que apontam os entendimentos e atuações da equipe multiprofissional e da organização espacial da Casa de Saúde do município. Considerações finais: há novos costumes e valores entre as etnias, em virtude da aproximação de grupos religiosos, cujas ações foram registradas e apreendidas pela equipe de trabalhadores em saúde.

Objective: understanding the perceptions and actions of a multi-professional health team regarding the practice of traditional indigenous medicine in an Indigenous Health Care Center. Method: this is a descriptive qualitative study carried out in an Indigenous Health Support Center in a municipality in the state of Pará, which included eight professionals from a multi-professional team. Data was collected in 2018 and examined using the content analysis method. Results: insertion and practice of Christianity; shamanic rites and leadership; and the attitude of the multidisciplinary team were the categories listed, which point to the understandings and actions of the multi-professional team and the spatial organization of the Health Center in the municipality. Final considerations: there are new customs and values among ethnic groups, due to the approach of religious groups, whose actions were recorded and apprehended by the team of health workers.

Objetivo: comprender las percepciones y acciones de un equipo multidisciplinario de salud sobre la práctica de la medicina tradicional indígena en una Casa de Atención para la Salud Indígena. Método: estudio descriptivo cualitativo, realizado en una Casa de Apoyo a la Salud Indígena de un municipio de Pará, que incluyó ocho profesionales de un equipo multidisciplinario. La recolección de datos se realizó en 2018 y los datos fueron sometidos al método de análisis de contenido. Resultados: inserción y práctica del cristianismo; ritos y líderes chamánicos; y actitud del equipo multidisciplinario fueron las categorías enumeradas, que indican la percepción y las acciones del equipo multidisciplinario y la organización espacial de la Casa de Salud del municipio. Consideraciones finales: existen nuevas costumbres y valores entre las etnias, debido a la presencia de grupos religiosos, el equipo de los trabajadores de la salud registró y aprendió las acciones de los indígenas.

Vaccination Week in the Americas: An Ongoing Initiative to Strengthen and Sustain Measles and Rubella Elimination in the Region.

Vaccination Week in the Americas (VWA) is a yearly regional initiative that promotes the benefits of vaccination to all persons in the region. In its 22-year history, more than 1.15 billion people have been reached under the framework of VWA across more than 40 countries and territories. This review examines multiple PAHO and WHO data points, documents and reports related to measles/rubella vaccination coverage and VWA since its inception. Its goal is to document the impact that the VWA has had in maintaining and accelerating measles and rubella disease elimination, in the context of PAHO's Disease Elimination Initiative. The results suggest that VWA's contributions to measles and rubella elimination have been substantial. Every year, VWA promotes (a) renewed political commitment to the immunization program from the highest political authorities of Member States; (b) vaccination operations to close immunity gaps, recover under-vaccinated persons, and reach chronically underserved populations; and (c) the dissemination of messages on the benefits of vaccination through regional and national communications campaigns. VWA will continue to be an important contributor to disease elimination efforts in the Americas, even as new targets are set in response to the evolving epidemiological landscape.

[Hegemonies, subalternities, and possible counter-hegemonies: The case of traditional medicine of Indigenous peoples in Mexico]. / De hegemonías, subalternidades y posibles contrahegemonías: El caso de la medicina tradicional de los pueblos indígenas de México.

A whole series of processes lead to the decrease in the use of traditional medicine by the indigenous peoples of Mexico, including the reduction in the number of traditional healers and the direct and indirect expansion of biomedicine. This essay addresses the central role these processes play in the relations of hegemony/subalternity that occur in different fields of reality, and especially in the health-illness-care-prevention processes, given that counter-hegemonic processes are not generated, or those that do arise have been ineffective in confronting social hegemony in general and biomedical hegemony in particular.

Toda una serie de procesos conducen a la disminución del uso de la medicina tradicional por los pueblos indígenas de México, incluyendo la reducción del número de curadores tradicionales y la expansión directa e indirecta de la biomedicina. En este ensayo se aborda el papel nuclear que tienen estos procesos en las relaciones de hegemonía/subaltenidad que se dan en los diferentes campos de la realidad y, especialmente, en los procesos de salud-enfermedad-atención-prevención, dado que no se generan procesos contrahegemónicos o, los que surgen, han sido ineficaces para enfrentar la hegemonía social en general y biomédica en particular.

Systematic Review of Prevalence of Histoplasma Antigenuria in Persons with HIV in Latin America and Africa.

Histoplasmosis is a fungal disease associated with substantial mortality rates among persons with advanced HIV disease. Our systematic review synthesized data on the global prevalence of Histoplasma--caused antigenuria in persons with HIV. We searched PubMed/Medline, Embase, and Scopus databases on January 3, 2023, to identify cross-sectional and cohort studies evaluating Histoplasma antigenuria prevalence among adults with HIV infection. We calculated point estimates and 95% CIs to summarize prevalence. Of 1,294 studies screened, we included 15. We found Histoplasma antigenuria among 581/5,096 (11%; 95% CI 11%-12%) persons with HIV and 483/3,789 persons with advanced HIV disease (13%; 95% CI 12%-14%). Among persons with HIV and symptoms consistent with histoplasmosis, Histoplasma antigenuria prevalence was 14% (95% CI 13%-15%; 502/3,631 participants). We determined that persons with advanced HIV disease, inpatients, and symptomatic persons might benefit from a systematic approach to early detection of histoplasmosis using urine antigen testing.

Sustaining the Elimination of Measles, Rubella and Congenital Rubella Syndrome in the Americas, 2019-2023: From Challenges to Opportunities.

This report reviews national data from all Member States on measles, rubella, and congenital rubella syndrome (CRS) elimination in the Region of the Americas during 2019-2023. It includes an analysis of compliance with vaccination coverage, surveillance indicators, and measles outbreaks, as well as an analysis of the response capacity of the laboratory network and a country case study that meets all indicators. The sources of information were the integrated epidemiological surveillance system for measles and rubella of the Pan American Health Organization (PAHO)/World Health Organization (WHO) and the Joint Reporting Form (eJRF), among others. From 2020 to 2022, regional coverage with first (MMR-1) and second doses (MMR-2) decreased to rates below 90%. The regional suspected case notification rate was maintained above the minimum expected 2.0 suspect cases per 100,000 population, except in 2021. During 2019 to 2023, 18 countries experienced outbreaks, with two of the outbreaks resulting in re-established endemic transmission. In conclusion, two countries in the Americas have not maintained measles elimination, but by the end of 2023 no country showed endemic measles transmission. One of the countries that lost its certification of elimination in 2018 managed to be reverified in 2023; the other is pending reverification. All countries maintained rubella elimination. Despite these challenges, the sustainability of the elimination of these diseases remains a health priority in the Region.

[Evidence synthesis and recommendations: clinical practice guidelines on drug treatment for hypertension in pregnancySíntese de evidências e recomendações: diretrizes de prática clínica para o tratamento farmacológico da hipertensão arterial na gravidez]. / Síntesis de evidencia y recomendaciones: guías de práctica clínica para el tratamiento farmacológico de la hipertensión arterial en el embarazo.

Introduction: Hypertensive disorders during pregnancy are a major cause of severe morbidity, long-term disability, and death. Appropriate pharmacological treatment is essential in the management of these disorders. Objectives: Synthesize the recommendations developed by the World Health Organization (WHO) to improve the quality of care and health outcomes of adults with high blood pressure, and address aspects of how to implement these recommendations. Methods: A synthesis was conducted of WHO recommendations: drug treatment for severe hypertension in pregnancy and WHO recommendations: drug treatment for non-severe hypertension in pregnancy. The WHO recommendations follow the GRADE methodology (Grading of Recommendations, Assessment, Development, and Evaluation) for the preparation of guidelines, as described in the WHO Handbook for Guideline Development. In addition, a systematic search for studies carried out in the Region of the Americas was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature to identify barriers, facilitators, and implementation strategies. Results: Four recommendations were formulated for women with hypertensive disorders. Implementation barriers and facilitators were identified, and indicators were created to assess adherence and outcomes. Conclusions: The formulated recommendations provide guidance on how to approach drug treatment of hypertension in pregnancy, with considerations for implementation in Latin America and the Caribbean.

Introdução: Os distúrbios hipertensivos na gravidez são uma das principais causas do alto índice de morbidade grave, morte e incapacidade de longo prazo. Um dos principais procedimentos para manejo desses distúrbios é o tratamento farmacológico adequado. Objetivos: Apresentar uma síntese das recomendações elaboradas pela Organização Mundial da Saúde (OMS) para melhorar a qualidade da atenção e dos desfechos de saúde em gestantes com distúrbios hipertensivos e abordar aspectos da implementação dessas recomendações. Métodos: Foi elaborado um resumo das recomendações feitas em duas diretrizes da OMS (uma para tratamento farmacológico da hipertensão grave na gestação e outra para tratamento farmacológico da hipertensão não grave na gestação). As diretrizes elaboradas pela OMS seguem os métodos de elaboração da Classificação de Análise, Desenvolvimento e Avaliação de Recomendações (GRADE, na sigla em inglês) do manual de elaboração de diretrizes da OMS. Além disso, foi realizada uma busca sistemática de estudos desenvolvidos na Região das Américas nas bases de dados PubMed, LILACS, Health Systems Evidence e Epistemonikos e na literatura cinzenta, a fim de identificar barreiras, facilitadores e estratégias de implementação, bem como indicadores. Resultados: Foram formuladas quatro recomendações para mulheres com distúrbios hipertensivos. Identificaram-se barreiras e facilitadores para a implementação e criaram-se indicadores de adesão e de resultados. Conclusões: As recomendações formuladas visam orientar a abordagem do tratamento farmacológico da hipertensão na gestação e incluem considerações de implementação na América Latina e no Caribe.

Income inequality as a determinant of neonatal mortality in the Americas during 2000-2019: implications for the attainment of Sustainable Development Goal target 3.2.

BACKGROUND: The work of the WHO Commission on the Social Determinants of Health has been fundamental to provide a conceptual framework of the social determinants of health. Based on this framework, this study assesses the relationship of income inequality as a determinant of neonatal mortality in the Americas and relates it to the achievement of the Sustainable Development Goal target 3.2 (reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births). The rationale is to evaluate if income inequality may be considered a social factor that influences neonatal mortality in the Americas. METHODS: Yearly data from 35 countries in the Americas during 2000-2019 was collected. Data sources include the United Nations Inter-agency Group for Child Mortality Estimation for the neonatal mortality rate (measured as neonatal deaths per 1,000 live births) and the United Nations University World Institute for Development Economics Research for the Gini index (measured in a scale from 0 to 100). This is an ecological study that employs a linear regression model that relates the neonatal mortality rate (dependent variable) to the Gini index (independent variable), while controlling for other factors that influence neonatal mortality. Coefficient estimates and their robust standard errors were obtained using panel data techniques. RESULTS: A positive relationship between income inequality and neonatal mortality is found in countries in the Americas during the period studied. In particular, the analysis suggests that a unit increase in a country's Gini index during 2000-2019 is associated with a 0.27 (95% CI [- 0.04, 0.57], P =.09) increase in the neonatal mortality rate. CONCLUSION: The analysis suggests that income inequality may be positively associated with the neonatal mortality rate in the Americas. Nonetheless, given the modest magnitude of the estimates and Gini values and trends during 2000-2019, the findings suggest a potential limited scope for redistributive policies to support reductions in neonatal mortality in the region. Thus, policies and interventions that address higher coverage and quality of services provided by national health systems and reductions in socio-economic inequalities in health are of utmost importance.

[Strengthening leadership for educational management in the Americas: an action research strategyFortalecimento da liderança para a gestão educacional na Região das Américas: uma estratégia de pesquisa-ação]. / Fortalecimiento del liderazgo para la gestión educativa en las Américas: una estrategia de investigación-acción.

The training of human resources for health (HRH) is a recurring concern. The Virtual Campus for Public Health (VCPH) - the educational platform of the Pan American Health Organization (PAHO) - seeks to improve access to public health education, emphasizing leadership training for teams that plan, implement, and evaluate policies and educational initiatives.The objective of this work is to present the results of a consultation with experts on the virtual course "Leadership for Educational Management in Health Organizations", as part of a PAHO/VCPH strategy to strengthen leadership capacities for educational management in the Americas.A qualitative action-research study was carried out using the Delphi method with two iterations of consultations (one virtual and one in person) with experts in educational management in health organizations.The results show the importance of eight dimensions of analysis: recipient profiles, competencies, approach and contents, activities, evaluation of and for learning, adaptability, implementation, and monitoring during and after the course.The participation of actors from different geopolitical spheres in the design and implementation of a regional educational initiative fosters adaptations in the context of its implementation and improves the likelihood it will be adopted. This course can play a strategic role as a catalyst in the formation and consolidation of an integrated network of organizations that strengthen educational leadership in the Americas. This study also highlights the value of the methodological strategy used to improve the quality of HRH training.

A formação de recursos humanos em saúde é uma preocupação recorrente. O Campus Virtual de Saúde Pública (CVSP) é a plataforma educacional da Organização Pan-Americana da Saúde (OPAS), que busca melhorar a acessibilidade à educação em saúde pública, com ênfase na formação de lideranças educacionais voltadas para o planejamento, a implementação e a avaliação de políticas e ações educacionais.O objetivo deste documento é apresentar os resultados de uma consulta com especialistas sobre o curso virtual "Liderazgo para la Gestión Educativa en Organizaciones de Salud" [Liderança para a Gestão Educacional em Organizações de Saúde], como parte de uma estratégia para fortalecer as capacidades de liderança para gestão educacional na Região das Américas proposta pelo CVPS/OPAS.Foi realizado um estudo qualitativo de pesquisa-ação utilizando o método Delphi com duas rodadas de consultas, uma virtual e outra presencial, a especialistas em gestão educacional em organizações de saúde.Os resultados mostram a relevância de oito dimensões de análise: perfil do público-alvo; competências; abordagem e conteúdo; atividades; avaliação de e para as aprendizagens; adaptabilidade; implementação; e acompanhamento durante e após o curso.A participação de atores de diferentes esferas geopolíticas no delineamento e na implementação de uma proposta educacional regional promove a transformação do contexto de aplicação e aumenta seu potencial de adoção. Destaca-se o posicionamento estratégico do curso como catalisador na criação e consolidação de uma rede integrada de organizações para fortalecer a liderança educacional na Região das Américas e a adequação da estratégia metodológica empregada para melhorar a qualidade da formação de recursos humanos em saúde.

The antiquity and ancestral origin of humans in the americas: a five hundred year inquiry from a biological anthropology perspective.

The questions -When did humans arrive in the Americas? Who were they, or from where did they come from? -are enduring and fascinating inquiries that have been approached from different perspectives, thanks to the contributions of archaeology, biological anthropology, and linguistics, among other disciplines. As a result, and after several centuries of studies, this body of research inspired several proposed models on the peopling of the Americas. These models are not only equally unique from each other but also distinct from the current themes in recent literature. However, there is a limited and occasionally inaccurate reference to the knowledge produced in the peripheral countries. This may be attributed to differences in language, academic traditions, as well as the consequences of geopolitics and neocolonialism in science. By reviewing both the old and recent literature, my aim is to present a historical account of how biological evidence has contributed to supporting and discussing some of the broad models that were proposed to explain the peopling of the Americas. Instead of providing an exhaustive account on the models, herein I focus on critically linking evidence and discussions ranging from the early skeletal discoveries at Lagoa Santa in Brazil in the 1830s to the current challenges of integrating a large amount of disparate data and collaborating with indigenous communities in the "omics" era. Far from being fully understood, investigations into the antiquity and the ancestral origin of Native Americans are revealing that these complex questions should be addressed by combining diverse data, articulating information at finer and larger grain scales, and adopting a sensitive and respectful approach by engaging with the views of indigenous communities.

Building Capacity and Advancing Regulatory Measures to Improve Food Environments in the Region of the Americas.

Noncommunicable diseases (NCDs) are the main cause of death globally (70%) and in the Region of the Americas (80%), and poor diets are a leading driver of NCDs. In response, the Pan American Health Organization (PAHO)/World Health Organization (WHO) introduced a set of evidence-based regulatory measures to help countries improve diets through the reduced consumption of processed and ultra-processed foods. This paper aims to describe the needs of and propose actions for key actors to advance these measures. A workshop was designed to assess member states' regulatory capacity. A thematic analysis was conducted to analyze regional needs, successes and challenges. Thereafter, the Government Capacity-Building Framework for the prevention and control of NCDs was used to examine findings. The findings were organized in two sets: (i) PAHO/WHO actions to support member states and (ii) key actors' actions to advance regulatory policies. The results show notable regulatory progress across the Region of the Americas. However, progress differs between countries, with opportunities to strengthen measures in most countries, mainly in conflict of interest management. The results identified important actions to strengthen the regulatory capacity of PAHO/WHO member states. To maximize momentum for these actions, timelines must be identified, and political commitment can be boosted by applying human rights-based and food system-wide approaches.

Canine leishmaniasis in the Americas: etiology, distribution, and clinical and zoonotic importance.

Canine leishmaniasis is a widespread disease on the American continent, with cases reported from Uruguay to the USA and Canada. While numerous Leishmania spp. have been reported in dogs in this region, Leishmania infantum and Leishmania braziliensis are the most common etiological agents of canine leishmaniasis from a continental perspective. Nonetheless, other species may predominate locally in some countries. The participation of dogs in the transmission cycle of various Leishmania spp. has long been speculated, but evidence indicates that their role as reservoirs of species other than L. infantum is negligible. Various native wildlife (e.g., small rodents, marsupials, sloths, and monkeys) are, in fact, the primary hosts of Leishmania spp. in the Americas. In this review, an updated list of Leishmania spp. infecting dogs in the Americas is presented, along with their distribution and clinical and zoonotic importance.

Maintaining the Region of the Americas free of polio: best practices for incident management support teams.

The Pan American Health Organization (PAHO) and its Member States have been leading the efforts to eradicate wild poliovirus in the Region of Americas since smallpox's successful elimination in 1971. The region became the first to be certified free of wild poliovirus in 1994. However, in July 2022, an unvaccinated patient with no recent travel history was diagnosed with poliomyelitis in the United States of America. In response to the emergence of a circulating vaccine-derived poliovirus in the United States, PAHO established the Polio Incident Management Support Team. This team has been coordinating response efforts, focusing on: coordination, planning, and monitoring; risk communication and community engagement; surveillance and case investigation; vaccination; and rapid response. In this paper, we identified and documented best practices observed following establishment of the Incident Management Support Team (September 2022-2023) through a comprehensive review and analysis of various data sources and country-specific data from the polio surveillance dashboard. The aim was to share these best practices, highlighting technical support and implementation of polio measures by Member States. Despite several challenges, the Americas region remains polio-free. Polio risk is declining, with a July 2023 assessment showing fewer countries at medium, high, and very high risk. This progress reflects improved immunization coverage, surveillance, containment, health determinants, and outbreak preparedness and response. The PAHO Polio Incident Management Support Team has played a key role in supporting these efforts.

La Organización Panamericana de la Salud (OPS) y sus Estados Miembros han liderado los esfuerzos para erradicar el poliovirus salvaje en la Región de las Américas desde la eliminación exitosa de la viruela en 1971. En 1994, la Región fue la primera en obtener la certificación de libre del poliovirus salvaje. Sin embargo, en julio del 2022, se diagnosticó poliomielitis a un paciente de Estados Unidos de América no vacunado y sin antecedentes de viajes recientes. Para responder a la aparición de un poliovirus circulante derivado de la vacuna en ese país, la OPS creó el equipo de apoyo a la gestión de incidentes de poliomielitis. Este equipo ha asumido la coordinación de los esfuerzos de respuesta y se ha centrado en la coordinación, la planificación y seguimiento; la comunicación de riesgos y la participación de la comunidad; la vigilancia e investigación de casos; la vacunación; y la respuesta rápida. En este artículo, se determinan y documentan las mejores prácticas observadas después de la creación del equipo de apoyo a la gestión de incidentes (septiembre del 2022-2023) mediante una revisión y un análisis pormenorizados de datos procedentes de diversas fuentes y de datos específicos de los países del panel de vigilancia de la poliomielitis. El objetivo fue poner en común estas mejores prácticas y resaltar el apoyo técnico y la aplicación de medidas contra la poliomielitis por parte de los Estados Miembros. A pesar de los diversos desafíos, la Región de las Américas se mantiene libre de poliomielitis. El riesgo de esta enfermedad es cada vez menor, y la evaluación de julio del 2023 muestra una disminución del número de países con un riesgo medio, alto o muy alto. Este progreso refleja la mejora de la cobertura de inmunización, la vigilancia, la contención, los determinantes de la salud y la preparación y respuesta ante brotes. El equipo de apoyo a la gestión de incidentes relacionados con la poliomielitis de la OPS ha desempeñado un papel fundamental para brindar apoyo a estas iniciativas.

Desde a eliminação bem-sucedida da varíola em 1971, a Organização Pan-Americana da Saúde (OPAS) e seus Estados Membros têm estado à frente de iniciativas para erradicar o poliovírus selvagem na Região das Américas. Em 1994, a região foi a primeira do mundo a ser certificada como livre do poliovírus selvagem. Entretanto, em julho de 2022, um paciente não vacinado e sem histórico de viagens recentes foi diagnosticado com poliomielite nos Estados Unidos da América. Em resposta ao surgimento de um poliovírus derivado de vacina circulante nos Estados Unidos, a OPAS criou a Equipe de Apoio à Gestão de Incidentes de Poliomielite. A equipe vem administrando os esforços de resposta, concentrando-se em: coordenação, planejamento e monitoramento; comunicação de risco e envolvimento da comunidade; vigilância e investigação de casos; vacinação; e resposta rápida. Neste documento, identificamos e documentamos as melhores práticas observadas após a criação da Equipe de Apoio à Gestão de Incidentes (setembro de 2022 a 2023) por meio de uma revisão e análise abrangentes de diversas fontes de dados e dados específicos de cada país fornecidos por meio do painel de vigilância da poliomielite. O objetivo foi compartilhar essas melhores práticas, destacando o apoio técnico e a implementação de medidas contra a poliomielite pelos Estados Membros. Apesar de vários desafios, a Região das Américas continua livre da poliomielite. Um levantamento de julho de 2023 demonstrou que o risco da poliomielite vem diminuindo, com menos países com risco médio, alto ou muito alto. Essa evolução é resultado de melhoras na cobertura vacinal, vigilância, contenção, preparação, determinantes de saúde e resposta a surtos. A Equipe de Apoio à Gestão de Incidentes de Poliomielite da OPAS foi fundamental para apoiar esses esforços.

Founder effects identify languages of the earliest Americans.

The known languages of the Americas comprise nearly half of the world's language families and a wide range of structural types, a level of diversity that required considerable time to develop. This paper proposes a model of settlement and expansion designed to integrate current linguistic analysis with other prehistoric research on the earliest episodes in the peopling of the Americas. Diagnostic structural features from phonology and morphology are compared across 60 North American languages chosen for coverage of geography and language families and adequacy of description. Frequency comparison and graphic cluster analysis are applied to assess the fit of linguistic types and families with late Pleistocene time windows when entry from Siberia to North America was possible. The linguistic evidence is consistent with two population strata defined by early coastal entries ~24,000 and ~15,000 years ago, then an inland entry stream beginning ~14,000 ff. and mixed coastal/inland ~12,000 ff. The dominant structural properties among the founder languages are still reflected in the modern linguistic populations. The modern linguistic geography is still shaped by the extent of glaciation during the entry windows. Structural profiles imply that two linguistically distinct and internally diverse ancient Siberian linguistic populations provided the founding American populations. OBJECTIVES: Describe early North American linguistic population structure and chronology; align distribution of structural types with archeological and paleoclimatological evidence on the earliest settlements. Propose an improved model of early settlement and expansion and pose some priority research questions. MATERIALS AND METHODS: Classification of languages based on a tripartite geolinguistic division based on geographical and linguistic evidence. Survey of phonological and morphological patterns of 60 languages representing the structural, geographical, and genealogical diversity of North America. Survey of 16 morphological and phonological features of known or likely high stability and family-identifying value across those languages. Frequency comparison and cluster analysis to elucidate the tripartite analysis and compare to the chronology and geolinguistics implied by paleoclimatological and archeological work. RESULTS: There is enough evidence (linguistic, archeological, genetic, and geological) to indicate four glacial-age openings allowing entries to North America: coastal c. 24,000 and 15,000 years ago; inland c. 14,000 years ago and continuing; and coastal c. 12,000 years ago and continuing. Geographical distribution of modern languages reflects the geography and chronology of the openings and the two human and linguistic population strata they formed, and plausibly also the structural types of the founding languages. DISCUSSION: Improved model of North American settlement (two chronological strata, four entries); comparison to other proposed models. Further questions and research issues for linguistic, genetic, and archeological research.

The American Cherimoya Genome Reveals Insights into the Intra-Specific Divergence, the Evolution of Magnoliales, and a Putative Gene Cluster for Acetogenin Biosynthesis.

Annona cherimola (cherimoya) is a species renowned for its delectable fruit and medicinal properties. In this study, we developed a chromosome-level genome assembly for the cherimoya 'Booth' cultivar from the United States. The genome assembly has a size of 794 Mb with a N50 = 97.59 Mb. The seven longest scaffolds account for 87.6% of the total genome length, which corresponds to the seven pseudo-chromosomes. A total of 45,272 protein-coding genes (≥30 aa) were predicted with 92.9% gene content completeness. No recent whole genome duplications were identified by an intra-genome collinearity analysis. Phylogenetic analysis supports that eudicots and magnoliids are more closely related to each other than to monocots. Moreover, the Magnoliales was found to be more closely related to the Laurales than the Piperales. Genome comparison revealed that the 'Booth' cultivar has 200 Mb less repeats than the Spanish cultivar 'Fino de Jete', despite their highly similar (>99%) genome sequence identity and collinearity. These two cultivars were diverged during the early Pleistocene (1.93 Mya), which suggests a different origin and domestication of the cherimoya. Terpene/terpenoid metabolism functions were found to be enriched in Magnoliales, while TNL (Toll/Interleukin-1-NBS-LRR) disease resistance gene has been lost in Magnoliales during evolution. We have also identified a gene cluster that is potentially responsible for the biosynthesis of acetogenins, a class of natural products found exclusively in Annonaceae. The cherimoya genome provides an invaluable resource for supporting characterization, conservation, and utilization of Annona genetic resources.

[HEARTS in the Americas: targeting health system change to improve population hypertension controlHEARTS nas Américas: impulsionar mudanças no sistema de saúde para melhorar o controle da hipertensão arterial na população]. / HEARTS en las Américas: impulsar el cambio en el sistema de salud para mejorar el control de la hipertensión en la población.

Purpose of review: HEARTS in the Americas is the regional adaptation of Global Hearts, the World Health Organization initiative for cardiovascular disease (CVD) prevention and control. Its overarching goal is to drive health services to change managerial and clinical practice in primary care settings to improve hypertension control and CVD risk management. This review describes the HEARTS in the Americas initiative. First, the regional epidemiological situation of CVD mortality and population hypertension control trends are summarized; then the rationale for its main intervention components: the primary care-oriented management system and the HEARTS Clinical Pathway are described. Finally, the key factors for accelerating the expansion of HEARTS are examined: medicines, team-based care, and a system for monitoring and evaluation. Recent findings: Thus far, 33 countries in Latin America and the Caribbean have committed to integrating this program across their primary healthcare network by 2025. The increase in hypertension coverage and control in primary health care settings compared with the traditional model is promising and confirms that the interventions under the HEARTS umbrella are feasible and acceptable to communities, patients, providers, decision-makers, and funders. This review highlights some cases of successful implementation. Summary: Scaling up effective treatment for hypertension and optimization of CVD risk management is a pragmatic way to accelerate the reduction of CVD mortality while strengthening primary healthcare systems to respond effectively, with quality, and equitably, to the challenge of non-communicable diseases, not only in low-middle income countries but in all communities globally.

Propósito da revisão: HEARTS nas Américas é uma adaptação regional da iniciativa mundial HEARTS, da Organização Mundial da Saúde, voltada para prevenção e controle das doenças cardiovasculares (DCV) na Região das Américas. Seu objetivo geral é promover mudanças na prática clínica e na gestão da atenção primária pelos serviços de saúde a fim de melhorar o controle da hipertensão arterial e reduzir o risco de DCV. Esta revisão descreve a iniciativa HEARTS nas Américas. Primeiro, é apresentado um resumo da situação epidemiológica regional relativa à mortalidade por DCV e das tendências no controle da hipertensão arterial em nível populacional. Em seguida, são explicados os motivos por trás dos principais componentes da intervenção: o sistema de manejo focado na atenção primária e o componente clínico da HEARTS. Por fim, são examinados os principais fatores para acelerar a ampliação da HEARTS: medicamentos, atenção baseada no trabalho em equipe e um sistema de monitoramento e avaliação. Resultados recentes: Até o momento, 33 países e territórios da América Latina e do Caribe se comprometeram a integrar esse programa em toda sua rede de atenção primária à saúde até 2025. Comparado com o modelo tradicional, o aumento da cobertura e do controle da hipertensão arterial nos ambientes de atenção primária à saúde é promissor e confirma que as intervenções promovidas pela HEARTS são exequíveis e aceitas por comunidades, pacientes, prestadores de serviços de saúde, tomadores de decisão e financiadores. Nesta revisão, destacamos alguns casos nos quais a implementação foi satisfatória. Conclusões: Ampliar a aplicação de um tratamento eficaz contra a hipertensão arterial e otimizar o controle do risco de DCV são medidas pragmáticas para acelerar a redução da mortalidade por DCV e, ao mesmo tempo, fortalecer os sistemas de atenção primária à saúde para responder com qualidade, eficácia e equidade ao desafio apresentado pelas doenças não transmissíveis, não apenas nos países de baixa ou média renda, mas no mundo todo.

Genomic characterisation of the population structure and antibiotic resistance of Salmonella enterica serovar Infantis in Chile, 2009-2022.

Background: Multidrug-resistant (MDR) Salmonella Infantis has disseminated worldwide, mainly linked to the consumption of poultry products. Evidence shows dissemination of this pathogen in Chile; however, studies are primarily limited to phenotypic data or involve few isolates. As human cases of Salmonella Infantis infections have substantially increased in recent years, this study aimed to characterise the genomic epidemiology and antimicrobial-resistance profiles of isolates obtained from different sources, aiming to inform effective surveillance and control measures. Methods: We sequenced 396 Salmonella Infantis genomes and analysed them with all publicly available genomes of this pathogen from Chile (440 genomes in total), representing isolates from environmental, food, animal, and human sources obtained from 2009 to 2022. Based on bioinformatic and phenotypic methods, we assessed the population structure, dissemination among different niches, and antimicrobial resistance (AMR) profiles of Salmonella Infantis in the country. Findings: The genomic and phylogenetic analyses showed that Salmonella Infantis from Chile comprised several clusters of highly related isolates dominated by sequence type 32. The HC20_343 cluster grouped an important proportion of all isolates. This was the only cluster associated with pESI-like megaplasmids, and up to 12 acquired AMR genes/mutations predicted to result in an MDR phenotype. Accordingly, antimicrobial-susceptibility testing revealed a strong concordance between the AMR genetic determinants and their matching phenotypic expression, indicating that a significant proportion of HC20_343 isolates produce extended-spectrum ß-lactamases and have intermediate fluoroquinolone resistance. HC20_343 Salmonella Infantis were spread among environmental, animal, food, and human niches, showing a close relationship between isolates from different years and sources, and a low intra-source genomic diversity. Interpretation: Our findings show a widespread dissemination of MDR Salmonella Infantis from the HC20_343 cluster in Chile. The high proportion of isolates with resistance to first-line antibiotics and the evidence of active transmission between the environment, animals, food, and humans highlight the urgency of improved surveillance and control measures in the country. As HC20_343 isolates predominate in the Americas, our results suggest a high prevalence of ESBL-producing Salmonella Infantis with intermediate fluoroquinolone resistance in the continent. Funding: Partially supported by the Food and Drug Administration (FDA) of the U.S. Department of Health and Human Services as part of an award, FDU001818, with 30% percent funded by FDA/HHS; and by Agencia de Investigación y Desarrollo de Chile (ANID) through FONDECYT de Postdoctorado Folio 3230796 and Folio 3210317, FONDECYT Regular Folio 1231082, and ANID-Millennium Science Initiative Program-ICN2021_044.

Cervical cancer screening coverage in the Americas region: a synthetic analysis.

Background: The Americas region has the lowest (North America) and the second highest (Latin America and Caribbean) cervical cancer (CC) mortality worldwide. The lack of reliable data on screening coverage in the region hinders proper monitoring of the World Health Organization (WHO) CC elimination initiative. Methods: For this synthetic analysis, we searched data on CC screening coverage from official sources and national health surveys, supplemented with a formal WHO country consultation. Context data were obtained from official sources (income, health expenditure, inequality-adjusted human development index -IHDI-, universal health coverage, CC incidence/mortality). Country age-specific coverages for 2019 by screening interval were computed. Missing data were imputed through a multi-step algorithm. Beta-regression and Poisson-regression models were used to analyse associations between context variables, screening coverage, and CC mortality. Findings: We included data from 37 countries in the Americas. Data on coverage of HPV testing was scarce, and for many countries only Pap-smear coverage data was available. Overall, 78%, 34%, 60%, and 67% of women aged 25-65 years have been screened ever in their lifetime, and in the previous year, 3 years, and 5 years, respectively. By sub-region, 3-year coverage ranges from 48% (South America) to 72% (North America). Twenty-four countries showed screening coverage below 70%. Income and health system type were associated with screening coverage, but coverage was not associated with CC mortality. Interpretation: In the Americas region 35.1% and 56.8% of countries report 3-year and 5-year coverage over 70%, respectively. Inequalities remain a major challenge for screening programs in the region. The elimination campaign should reinforce the transition to HPV testing and strengthen surveillance systems. Funding: Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.

[Health alerts for substandard, falsified, and unregistered medical products at the onset of the COVID-19 pandemic in the AmericasAlertas de saúde para produtos médicos abaixo do padrão, falsificados e não registrados no início da pandemia de COVID-19 nas Américas]. / Alertas sanitarias de productos médicos subestándares, falsificados y no registrados al inicio de la pandemia de COVID-19 en las Américas.

Objective: Identify and analyze incidents of substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic. Methods: Detailed search of the websites of regulatory authorities in the Americas. Identification of incidents of substandard, falsified, unregistered, and stolen medicines and medical devices (including in vitro diagnostics). The types of products were determined, as were the stages in the supply chain where they were detected, and the actions taken by authorities. Results: A total of 1 273 incidents were identified in 15 countries (1 087 substandard, 44 falsified, 123 unregistered, and 19 stolen products). The largest number of incidents involved medical devices, disinfectants, and antiseptics. The most frequently reported point in the supply chain was online purchasing. The principal measures taken by the regulatory authorities were: alerts, prohibition of use, prohibition of advertising and manufacture, recall, and monitoring of adverse events. Conclusions: A substantial number of incidents involving substandard, falsified, unregistered, and stolen medical products at the onset of the COVID-19 pandemic were identified. Shortages of supplies, easing of regulatory requirements, and increased demand are factors that may have led to an increase in the number of incidents. The national regulatory authorities of reference reported more frequent detection of incidents and more frequent application of health measures. A regulatory strategy is needed in order to address online sales and ensure the safe distribution of medical products.

Objetivo: Identificar e analisar incidentes de produtos médicos abaixo do padrão, falsificados, não registrados e roubados no início da pandemia de COVID-19. Métodos: Foi realizada uma busca detalhada nos sites das autoridades reguladoras das Américas. Foram identificados incidentes envolvendo medicamentos e dispositivos médicos (incluindo para diagnóstico in vitro) abaixo do padrão, falsificados, não registrados e roubados. Foram determinados os tipos de produtos, os estágios da cadeia de abastecimento em que foram detectados e as medidas tomadas pelas autoridades. Resultados: Foram identificados 1 273 incidentes em 15 países (1 087 produtos abaixo do padrão, 44 falsificados, 123 não registrados e 19 roubados). O maior número de incidentes estava relacionado a dispositivos médicos, desinfetantes e antissépticos. O ponto na cadeia de abastecimento com a maior frequência de relatos foi a de aquisição pela internet. As medidas tomadas pelas autoridades reguladoras foram principalmente alertas, proibições de uso, proibições de publicidade e fabricação, recolhimento de produtos do mercado e monitoramento de eventos adversos. Conclusões: Houve um número significativo de incidentes envolvendo produtos médicos abaixo do padrão falsificados, não registrados e roubados no início da pandemia de COVID-19. A escassez de insumos, a flexibilização das exigências regulatórias e o aumento da demanda são fatores que podem levar a um maior número de incidentes. As autoridades reguladoras nacionais de referência informaram um aumento na frequência de detecção de incidentes e implementação de medidas sanitárias. O canal de vendas pela internet precisa ser abordado com alguma estratégia regulatória para garantir a distribuição segura de produtos médicos.

[Concordance between essential medicines lists and diabetes guidelines in Latin America and the CaribbeanConcordância entre as listas de medicamentos essenciais e diretrizes para diabetes na América Latina e no Caribe]. / Concordancia entre las listas de medicamentos esenciales y las guías para diabetes en América Latina y el Caribe.

Objective: Conduct an analysis to determine the existence and updating of national essential medicines lists (EMLs) and clinical practice guidelines (CPGs) for the treatment of diabetes in Latin America and the Caribbean (LAC); and compare the medicines included in each country's list and guidelines both with each other and with those of the World Health Organization (WHO). Methods: Cross-sectional study. EMLs and CPGs for diabetes were found on the websites of the Pan American Health Organization and national health authorities. Medicines were noted and analyzed according to pharmacological group, based on the fourth level of nomenclature of the Anatomical Therapeutic Chemical (ATC) classification system. F1 scoring was used to assess the proximity of EMLs to the WHO Model List of Essential Medicines (MLEM). Results: Of the total number of countries, 87.2% have EMLs, and 91% have CPGs (78% and 45% updated in the last five years, respectively). Compared to the six hypoglycemic groups of the MLEM, the EMLs had a median (range) of 6 (4-13) and an F1 score of 0.80; This indicates proper alignment. CPGs had a median (range) of 12 (1-12) hypoglycemic drugs compared to eight in the WHO guidelines. CPGs had a median of 15 more drugs than their respective EMLs. Conclusions: While most LAC countries have EMLs and CPGs for diabetes, the lack of concordance among them limits their effectiveness. It is necessary to align the processes and criteria for the development of these two tools for policymaking on medicines.

Objetivos: Analisar a existência e a atualização das listas nacionais de medicamentos (LNMs) e guias de prática clínica (GPCs) para o tratamento do diabetes na América Latina e no Caribe (ALC). Comparar os medicamentos incluídos nas listas e nas diretrizes de cada país entre si e com as da Organização Mundial da Saúde (OMS). Métodos: Estudo transversal. Foram identificadas LMNs e GPCs para o diabetes nos sites da Organização Pan-Americana da Saúde e das autoridades sanitárias nacionais. Os medicamentos foram pesquisados e analisados por grupo farmacológico de acordo com o quarto nível da classificação ATC. A pontuação F1 foi utilizada para avaliar o grau de proximidade das LMNs com a lista-modelo de medicamentos essenciais (LMME) da OMS. Resultados: Do total de países, 87,2% dispõem de uma LNM e 91%, de GPCs (78% e 45%, respectivamente, atualizadas nos últimos 5 anos). Em comparação com os seis grupos de agentes hipoglicemiantes da LMME, as LMNs tinham uma mediana (intervalo) de 6 (4 a 13) e uma pontuação F1 de 0,80, o que indica uma conformidade adequada. As GPCs tinham uma mediana (intervalo) de 12 (1 a 12) agentes hipoglicemiantes, em comparação com 8 nos guias da OMS. As GPCs tinham uma mediana de 15 medicamentos a mais do que as respectivas LNMs. Conclusões: Embora a maioria dos países da América Latina e do Caribe disponha de LNMs e GPCs para o diabetes, a falta de concordância entre elas limita sua eficácia. É necessário alinhar os processos e os critérios de desenvolvimento dessas duas ferramentas da política de medicamentos.