Revista Panamericana De Salud Publica-pan American Journal of Public Health最新文献

{"title":"Using data systems to conduct health research in the Caribbean: challenges during the COVID-19 pandemic.","authors":"Marshall Kerr Tulloch-Reid, Jacqueline Duncan, Keri-Ann Facey, Akil Williams, Marsha Ivey, Shelly-Ann Hunte, Eden Agustus, Simon Anderson, Maria Jackson","doi":"10.26633/RPSP.2025.29","DOIUrl":"https://doi.org/10.26633/RPSP.2025.29","url":null,"abstract":"<p><p>We aimed to assess how control measures during the coronavirus disease 2019 (COVID-19) pandemic affected the metabolic health of people with noncommunicable diseases when severe restrictions on movement and safety concerns prevented the use of traditional methods of health data collection. To identify study participants, we attempted to use hospital laboratory databases in Jamaica, Barbados, and Trinidad and Tobago. We planned to contact participants by telephone for verbal consent to complete a questionnaire and to extract health information (blood pressure and anthropometric data) from their medical records. In this article, we describe the challenges of collecting data from hospital systems to conduct this research during COVID-19. Only one of the four hospitals selected had dedicated information technology personnel able to access laboratory data systems for sampling. When laboratory data were obtained through the commercial vendor, the lack of unique identifiers made it difficult to link these reports to medical records containing contact information. Outdated telephone contact information limited our ability to recruit potential participants identified by this method. Three of four hospitals used paper records requiring manual chart review. There was inconsistent recording of biomedical data on medical record abstraction. As restrictions lifted, we resorted to traditional methods of recruitment to complete data collection. Strengthening routine data collection and implementing standardized, accessible, electronic data systems are essential to generate actionable health data in the Caribbean.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e29"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vaccine-associated poliomyelitis: safety of the oral poliovirus vaccine, Brazil, 2013-2023Poliomielitis asociada a poliovirus derivados de la vacuna: seguridad de la vacuna oral contra la poliomielitis en Brasil, 2013-2023].","authors":"Roberta Mendes Abreu Silva, Carla Dinamerica Kobayashi, Adriano Ferreira Martins, Victor Bertollo Gomes Porto, Ana Catarina de Melo Araujo, Paulo Henrique Santos Andrade, Martha Elizabeth Brasil da Nóbrega, Cibelle Mendes Cabral, Mônica Brauner de Moraes, Greice Madeleine Ikeda do Carmo, Felipe Daniel Cardoso, Guilherme Alves de Siqueira, Zirlei Maria de Matos, Jadher Percio, Eder Gatti Fernandes","doi":"10.26633/RPSP.2025.27","DOIUrl":"https://doi.org/10.26633/RPSP.2025.27","url":null,"abstract":"<p><strong>Objective: </strong>To quantify the occurrence of vaccine-associated paralytic poliomyelitis (VAPP) cases in Brazil from January 2013 to May 2023.</p><p><strong>Methods: </strong>A descriptive study was conducted on VAPP cases reported as events supposedly attributable to vaccination or immunization (ESAVI) following oral poliovirus vaccine (OPV) administration. VAPP cases were defined as acute flaccid paralysis (AFP) with isolation of vaccine-derived poliovirus in stool samples and persistence of motor deficits after 60 days.</p><p><strong>Results: </strong>A total of 200 suspected cases were identified, with two confirmed as VAPP (<1 case per 10 million doses administered) based on the isolation of the vaccine virus. Risk factors associated with VAPP included incomplete vaccination schedules, malnutrition, and/or immunodeficiency.</p><p><strong>Conclusions: </strong>VAPP occurrence was rare and aligned with expected values. Continued surveillance of ESAVI and suspected VAPP cases is essential to support poliomyelitis eradication efforts and ensure vaccine safety.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e27"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regulation and performance of health systems: a review of analytical frameworks.","authors":"Ernesto Báscolo, David Debrott Sánchez, Natalia Houghton, Carina Vance","doi":"10.26633/RPSP.2025.34","DOIUrl":"https://doi.org/10.26633/RPSP.2025.34","url":null,"abstract":"<p><p>The private health sector has expanded significantly in recent decades, both in Latin America and other regions. Governments and international organizations have dealt with this process in a heterogeneous manner. A policy approach and, above all, a regulatory framework, are required in order to put health objectives and the right to health above the profit motive that drives private sector participation. This paper reviews frameworks for analyzing the performance of health systems and the regulation of financing and service provision, primarily (but not exclusively) in the private sector. This review covers the output of the main international health agencies (Pan American Health Organization and World Health Organization), international development agencies (World Bank and Organization for Economic Cooperation and Development), and academics involved in international health policy debates. Common aspects of the different frameworks are identified, as well as substantive divergences. The purpose of this article, which is part of a larger project, is to contribute to discussions on the regulation of health systems in the Region of the Americas, consider their particularities, and describe the current context.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e34"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Critical factors for institutionalizing evidence-informed decision-making in healthcare organizationsFactores críticos para la institucionalización de la toma de decisiones basada en la evidencia en las organizaciones de salud].","authors":"Tereza Setsuko Toma, Jorge Otávio Maia Barreto, Romeu Gomes, Maria Lúcia Teixeira Machado, Rachel Riera, Isabela Porto de Toledo, Silvio Fernandes da Silva","doi":"10.26633/RPSP.2025.33","DOIUrl":"https://doi.org/10.26633/RPSP.2025.33","url":null,"abstract":"<p><strong>Objective: </strong>To map critical factors for sustainable processes in the institutionalization of evidence-informed decision-making in public health organizations.</p><p><strong>Method: </strong>A rapid critical interpretative synthesis was carried out based on searches conducted in databases, websites, and reference lists, with findings categorized into an appropriate framework.</p><p><strong>Results: </strong>Twenty studies were analyzed and six dimensions of critical factors were addressed: 1) governance, aimed at dealing with difficulties in the organizational context and motivation for change, together with a management style that has a long-term vision and invests in communication tools; 2) standardized routine processes, involving the characteristics of information that facilitate its incorporation into organizational practices; 3) leadership and commitment, revealing the importance of identifying and engaging leaders who can influence the adoption of evidence-informed policies in organizations; 4) resources, which correspond to the need for training programs that ensure the availability of a team with the skills needed to identify research evidence within a supportive organizational infrastructure; 5) partnerships, collective action, and support, which show the importance of involving stakeholders in collaborative processes, using exchange structures; and 6) culture, related to efforts to bring research and policy closer together, so that they are more receptive to organizational changes.</p><p><strong>Conclusion: </strong>The identified critical factors can provide a reference framework to support improvement planning and the institutionalization of evidence use. The results are applicable to organizations that formulate and implement public health policies and other social policies.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e33"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrated serological surveillance of communicable diseases in the Paraguayan Chaco, 2019.","authors":"Patricia Galeano, Claudia Huber, Violeta Ortiz, Soraya Araya, Vilma Teresa Pérez, Guillermo Sequera, María Paz Ade, Gloria Rey-Benito, Pamela Bravo, Ana Luciañez, Romeo Montoya, Silvia Giselle Ibarra-Ozcariz, Viviana De Egea, Águeda Cabello, Ana Morice, Martha Idalí Saboyá-Díaz, E Brook Goodhew, Gretchen Cooley, Diana Martin","doi":"10.26633/RPSP.2025.25","DOIUrl":"https://doi.org/10.26633/RPSP.2025.25","url":null,"abstract":"<p><strong>Objective: </strong>To establish baseline seroprevalence of soil-borne, waterborne, and foodborne diseases and to monitor diseases that are eliminated or on the path to elimination in the Paraguayan Chaco.</p><p><strong>Methods: </strong>A total of 1 100 school-age children (6-15 years) were tested in urban and rural schools selected for a cross-cutting population-based survey using a two-stage probabilistic sample design in the three departments of the Paraguayan Chaco. Blood samples were taken on filter paper to measure IgG antibodies using a multiplex bead assay. Data collection was carried out through interviews with parents and caregivers. Access to basic sanitation and improved water was assessed. Differences in pathogen seropositivity and seroprotection were estimated by urban and rural areas.</p><p><strong>Results: </strong>Seroprotection against measles was 62.9% and against rubella was 78.2%. Minimal diphtheria and tetanus seroprotection (≥0.01 IU/ml) was 92.9% and 98.3%, respectively. Seroprotective levels against these four vaccine-preventable diseases significantly decreased with increasing age (<i>p</i> < 0.05). The following pathogens and respective antigens showed significantly higher seroprevalence (<i>p</i> < 0.05) in rural areas compared with urban areas: <i>Cryptosporidium parvum</i> Cp17: 80.4% vs 64.6%, and Cp23: 60.6% vs 44.8%; <i>Giardia lamblia</i> VSP3: 26.9% vs 16.6%; <i>Strongyloides stercoralis</i> NIE: 11.5% vs 4.1%; and <i>Taenia solium</i> T24H: 7.1% vs 1.6%. Seroprevalence for these pathogens was also higher in Indigenous population when compared to non-Indigenous. Basic sanitation conditions showed significant differences (<i>p</i> < 0.05) between rural and urban areas: adobe and soil dwelling floor (65.3% vs 30.2%), use of pit latrine (90.3% vs 44.2%), availability of drainage or septic tank (8.7% vs 55.2%), access to safe water (19.7% vs 44.9%), and water treatment (6.8% vs 32.3%).</p><p><strong>Conclusions: </strong>We identified high exposure to soil-borne, waterborne, and foodborne diseases in rural areas and Indigenous population in the Paraguayan Chaco. Low seroprotection against measles and rubella alerts about the risk of immunity gaps to maintain elimination targets.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e25"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol use, heavy episodic drinking, and associated cardiovascular risk in Guyana.","authors":"M Shastri Motilal, Reeta Gobin, Raveed Khan, Rohan G Maharaj","doi":"10.26633/RPSP.2025.30","DOIUrl":"https://doi.org/10.26633/RPSP.2025.30","url":null,"abstract":"<p><strong>Objective: </strong>To determine associations between demographic characteristics, alcohol use, heavy episodic drinking (HED), and cardiovascular risk factors using the 2016 Guyana World Health Organization (WHO) STEPwise noncommunicable diseases risk factor survey.</p><p><strong>Methods: </strong>A weighted sample was used in a secondary analysis of data obtained from an online database. Descriptive statistics, binary logistic regression, and linear regression models were applied to identify which subpopulations were at highest risk of HED or cardiovascular disease.</p><p><strong>Results: </strong>Data from 2 662 individuals (77% response rate) were analyzed. In the unweighted sample, females made up 59.9% (95% CI [58.04, 61.76]) of the respondents and the average age was 40.7 years. Indo-Guyanese comprised 39.4% (95% CI [37.54, 41.26]) of the sample. The maximum educational level completed was primary level in 44.5% (95% CI [42.61, 46.39]) and secondary in 32.5% (95% CI [30.72, 34.28]). Of those who had ever drunk, 80.1% (95% CI [78.30, 81.90]) confirmed alcohol use in the past 12 months. Younger males were significantly more likely to consume alcohol. Using the weighted sample, Amerindian individuals had lower odds of alcohol use (odds ratio [OR] 0.36; 95% CI [0.25, 0.51]) compared to Indo-Guyanese. Residents of the Demerara-Mahaica region had the highest use at 86.1% (OR 4.74; 95% CI [2.86, 7.86]). Regarding HED, 16.4% (95% CI [14.73, 18.07]) of the entire sample, and 41.1% (95% CI [38.88, 43.32]) of those who drank in the past 30 days, reported having at least six drinks (defined as HED) in one sitting. The 25-29 age group showed an increase in odds for HED (OR 2.09; 95% CI [1.13, 3.89]). Men were more likely to engage in HED than women (OR 6.13; 95% CI [4.73, 7.95]). People of African (OR 0.78; 95% CI [0.61, 1.00]) and Amerindian descent (OR 0.48; 95% CI [0.31, 0.73]) had lower odds of HED than Indo-Guyanese. In the adjusted models, HED was positively correlated with elevated blood pressure (adjusted OR [aOR] 1.40; 95% CI [1.05, 1.88]), obesity (aOR 1.49; 95% CI [1.13, 1.95]), and elevated triglycerides (<i>β</i> coefficient 28.38, <i>p</i> = 0.004). For each OR and aOR above, <i>p</i> ≤ 0.05.</p><p><strong>Conclusions: </strong>This secondary analysis identifies that the population along the central and eastern coastal regions, young males, and those of Indo-Guyanese descent might benefit from focused public health interventions on alcohol and cardiovascular risk in Guyana.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e30"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Political support and micro-planning as success factors in a high-quality follow-up vaccination campaign in Ecuador, 2023Apoio político e microplanejamento como fatores de sucesso em uma campanha de vacinação de seguimento de alta qualidade no Equador em 2023].","authors":"Gabriela Aguinaga-Romero, Cristina Jacome, Jonathan Márquez, Jackeline Pinos, Ania Carmenates, Daniel Simancas-Racines, Juan Marcos Parise-Vasco, Andrés Viteri-García, Álvaro Withembury, Yndira Anchayhua, Regina Durón","doi":"10.26633/RPSP.2025.32","DOIUrl":"https://doi.org/10.26633/RPSP.2025.32","url":null,"abstract":"<p><strong>Objective: </strong>To describe the results, achievements, and lessons learned through administrative coverage and rapid monitoring of a follow-up vaccination campaign, in the context of political prioritization and micro-planning as determining factors in the different stages of follow-up campaigns, and the application of these good practices to strengthen the National Immunization Program.</p><p><strong>Method: </strong>This is a special descriptive epidemiological report on a high-quality follow-up vaccination campaign in Ecuador. The sources of information used were: population estimates from the 2010 and 2022 censuses carried out by the National Institute of Statistics and Census; calculation of the susceptible cohort for vaccination with the bivalent vaccine (measles and rubella) and with the oral and injectable polio vaccines; definition of vaccination strategies and tactics, and vaccine scheduling by type and age group; and macro- and micro-planning instruments generated at the local level, which involve quantitative variables related to human, material, logistic, and financial resources. Achievement of high-quality criteria and indicators for follow-up vaccination campaigns were also assessed, including effectiveness, homogeneity, timeliness, simultaneity, efficiency, and rapid monitoring.</p><p><strong>Results: </strong>The micro-planning process was fully implemented nationwide in 95% of health facilities (1879) four weeks prior to implementation of the follow-up campaign. High-quality follow-up was conducted over 14 weeks: 3 395 716 children aged 1-12 years were vaccinated and 99% administrative coverage was achieved, with 71% of provinces (17) reaching ≥95% coverage. In the remaining 29% of provinces (7), coverage rates were between 90% and 94%, with a total of 5 556 128 doses of bivalent vaccine and oral or injectable polio vaccine. Based on the quality criteria, the country achieved 95% of the targeted results.</p><p><strong>Conclusions: </strong>Political support and prioritization, together with the implementation of high-quality micro-planning of the follow-up vaccination campaign generated at the local level, enabled the achievement of targets and results at ≥95% coverage. This is an innovative and successful public health experience that has strengthened the National Immunization Program in Ecuador and other countries in the Region of the Americas. Local health teams conducted micro-planning adapted to the local context, using the methodology and instruments to identify areas of responsibility in orderly, systematic intramural and extramural vaccination campaigns.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e32"},"PeriodicalIF":2.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Lessons learned in the implementation of measles and rubella vaccination campaigns in the AmericasLições aprendidas com a implementação de campanhas de vacinação contra sarampo e rubéola na Região das Américas].","authors":"Regina Durón, Desirée Pastor, Álvaro Whittembury, Daniele Rocha Queiroz Lemos","doi":"10.26633/RPSP.2025.24","DOIUrl":"10.26633/RPSP.2025.24","url":null,"abstract":"<p><strong>Objective: </strong>To systematize and share knowledge and lessons learned from the implementation of follow-up vaccination campaigns in the Region of the Americas between 2003 and 2023.</p><p><strong>Methods: </strong>Descriptive report with a quantitative and qualitative analysis of the achievement of targets and lessons learned in 20 years of follow-up vaccination campaigns. The sources consulted were joint reports to WHO and the United Nations Children's Fund on vaccination data and reports to the Regional Commission for Monitoring and Re-Verification of the Elimination of Measles, Rubella and Congenital Rubella Syndrome.</p><p><strong>Results: </strong>During the period from 2003 to 2023, 68 follow-up campaigns were implemented in 20 countries in the Region of the Americas. Of these, 50.0% (34/68) achieved the minimum expected target of ≥ 95%. In the first decade, from 2003 to 2012, 49.0% (33/68) of the follow-up campaigns were implemented; of those, 54.5% (18/33) achieved ≥ 95%. In the second decade, from 2013 to 2023, 51.0% (35/68) were implemented, with 45.7% (16/35) reaching the ≥ 95% target. The COVID-19 pandemic negatively impacted achievement of the targets in the second decade. During the COVID-19 pandemic, 12 follow-up campaigns were carried out; of these, 58.3% (7/12) did not reach at least 95% of the target population.</p><p><strong>Conclusions: </strong>Follow-up vaccination campaigns are a fundamental tool for sustaining measles and rubella elimination in the Americas, making it possible to update children's immunization schedules and strengthen the routine program.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e24"},"PeriodicalIF":2.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review and analysis of a series of country experiences to inform the Chilean health financing reform.","authors":"Sebastián Villarroel, Mauricio Osorio, Vivienne C Bachelet","doi":"10.26633/RPSP.2025.26","DOIUrl":"10.26633/RPSP.2025.26","url":null,"abstract":"<p><strong>Objective: </strong>To analyze international health reform experiences to inform Chile's health financing reform efforts.</p><p><strong>Methods: </strong>A scoping review methodology was used. Six countries that met inclusion criteria were used for the comparative analysis: Canada, Denmark, Estonia, France, Slovenia, and Spain. A profile was prepared for each country describing the financing system, the structures in charge of managing the public health insurance system, and the institution responsible for financing and its attributions regarding healthcare providers.</p><p><strong>Results: </strong>The search identified 188 records, from which the country profiles were created. We narratively analyze the findings, focusing on a) financing (revenue collection and pooling), b) purchaser-provider relationship and payment mechanisms, c) governance of institutional capacities and policies for reform, and d) voluntary private health insurance. For each of these dimensions, we make focused recommendations that could aid the ongoing effort on healthcare reform in Chile to move toward universal public insurance with a mixed payment mechanism for public and private providers. We also discuss the type of institutional governance required and the transition from mandatory to complementary private insurance.</p><p><strong>Conclusions: </strong>Our analysis and underlying assumptions allow us to provide recommendations for the current reform process in Chile, focusing on the advancement of universal public insurance with a mixed payment mechanism for public and private providers, the type of institutional governance to be developed to achieve it, and the transition from the current mandatory private insurance to complementary private insurance.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e26"},"PeriodicalIF":2.0,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The role of the Pan American Committee for Safe Vaccination (COPAVASE) in strengthening safe vaccination in the AmericasO papel do Comitê Pan-Americano de Vacinação Segura (COPAVASE) no fortalecimento da vacinação segura nas Américas].","authors":"Ángela Gentile, Verónica Vergara, Herminio Hernández, Gloria Giraldo, Tracy Evans-Gilbert, Alejandro Cravioto, María Teresa Valenzuela, Peter Figueroa, Noni MacDonald, Jorge Alberto Cortés, Helvert Felipe Molina-León","doi":"10.26633/RPSP.2025.18","DOIUrl":"https://doi.org/10.26633/RPSP.2025.18","url":null,"abstract":"<p><p>The <i>Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas</i> represented one of the first steps toward building the regional system for surveillance of events supposedly attributable to vaccination or immunization (ESAVIs) and adverse events of special interest (AESIs). This manual establishes that, after notification and investigation of an event, a national committee of experts should classify the event in accordance with the World Health Organization (WHO) causality classification. The Pan American Committee for Safe Vaccination (COPAVASE) was created in response to the introduction of the new COVID-19 vaccines to support causality analysis of complex regional ESAVI cases and to advise the Pan American Health Organization (PAHO) on strategies for developing safety information and implementing risk mitigation measures. As part of this work, two strategic planning exercises were carried out, one with Committee members and PAHO staff and another that included national authorities and committee members, who contributed ideas on how to strengthen the work both at the regional level and in countries' surveillance systems.Suggested areas of work included definition of clear guidelines, development of model terms of reference and case presentation guidelines, training, and strategies to ensure committee sustainability.With the strategies identified, PAHO expects to be able to continue strengthening national safe vaccination committees as key institutions for maintaining public trust.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"49 ","pages":"e18"},"PeriodicalIF":2.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}