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

{"title":"Corrigendum to Predictors of mortality among individuals with advanced HIV disease in a contemporary Brazilian cohort.","authors":"","doi":"10.26633/RPSP.2026.42","DOIUrl":"https://doi.org/10.26633/RPSP.2026.42","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.26633/RPSP.2025.36.].</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e42"},"PeriodicalIF":2.2,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499649","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":"Predictors of mortality among individuals with advanced HIV disease in a contemporary Brazilian cohort.","authors":"Nicole Reis, Omar Sued, Tarsila Vieceli, Diego R Falci, Larissa R Silva, Pedro M Fonseca, Renata B A Soares, Cassia S M Godoy, Marineide G Melo, Nayla A Hatem, Ana C G Castelo, Freddy Perez, Alessandro C Pasqualotto","doi":"10.26633/RPSP.2026.36","DOIUrl":"10.26633/RPSP.2026.36","url":null,"abstract":"<p><strong>Objective: </strong>To identify clinical characteristics and risk factors associated with mortality, with a focus on opportunistic infections (OIs), in patients with advanced HIV in Brazil.</p><p><strong>Methods: </strong>A prospective cohort study was conducted in five Brazilian tertiary hospitals, including 419 adults with advanced HIV. Baseline demographic and clinical data were collected during hospital admission, and participants were screened for tuberculosis, cryptococcosis, and histoplasmosis using rapid diagnostic tests. Participants were followed for 90 days to assess mortality, with causes of death classified using the Coding of Death in HIV (CoDe) protocol. Statistical analysis identified the variables associated with mortality.</p><p><strong>Results: </strong>The median CD4 count was 66 cells/mm³, and the median HIV viral load was 104 887 copies/mL. After 90 days, 18.1% of participants had died. ART-naive status, mental confusion, anemia, and elevated creatinine levels were strongly associated with mortality. OIs were diagnosed in 45.6% of participants, with severe histoplasmosis and cryptococcal meningitis significantly increasing the risk of mortality. Social determinants, such as sex, race, gender, and education level, did not have a significant impact on mortality, but socioeconomic factors influenced health care access.</p><p><strong>Conclusion: </strong>Early HIV diagnosis and continuous ART are essential to reduce mortality. Public health strategies should prioritize improving HIV testing, treatment adherence, and addressing social disparities to mitigate health care inequalities.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e36"},"PeriodicalIF":1.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499573","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":"Scoping review of evidence on front-of-pack warning labels and nutrition and health variables in Peru.","authors":"Gabriela V Proaño, Lorena Saavedra-Garcia, Mitsuo Teruya, Mayra Meza-Hernández, Rajiv Chowdhury, Cristina Palacios","doi":"10.26633/RPSP.2026.23","DOIUrl":"10.26633/RPSP.2026.23","url":null,"abstract":"<p><strong>Objective: </strong>Front-of-pack labeling (FOPL) was implemented in Peru as a national prevention strategy, but little is known about its evaluation, impact, or effectiveness in nutrition and health. This scoping review shows the evidence on front-of-pack warning labels and nutrition and health variables in Peru.</p><p><strong>Methods: </strong>The search was conducted (September 2024 and June 2025) through electronic databases (MEDLINE, SciELO, CAB abstracts, FSTA, Scopus) and gray literature (VHL Regional Portal, ProQuest) on any FOPL study (any study design and setting) in Peru, complemented by a hand search of local theses.</p><p><strong>Results: </strong>In total, 287 records were identified and 55 studies were included (15 peer-reviewed and 40 theses). Most studies were cross-sectional surveys among adults in Lima on FOPL awareness, attitudes, knowledge, purchase intention, and food consumption. A majority of studies reporting on attitudes (<i>n</i> = 20/24, 83%) and awareness (<i>n</i> = 10/13, 77%) found that most agreed that the policy is important and recognized it. Half of the studies reporting on knowledge and purchase intentions found that participants had a clear understanding of FOPL and used it to inform purchasing. Half of the studies that reported on dietary consumption (mostly theses) found that participants reported no change in FOPL product consumption.</p><p><strong>Conclusion: </strong>This review generally found high FOPL awareness and perceptions. Half of the studies showed a strong understanding and use of FOPL for purchasing decisions, and reported no change in the consumption of FOPL products in adults from Lima. More studies with stronger designs are needed to better understand the impact of FOPL on health outcomes.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e23"},"PeriodicalIF":1.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499599","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 of health care financing and delivery: analytic contributions from the perspective of industrial organization and the selection dilemmaRegulação do financiamento e da oferta de serviços de saúde: contribuições analíticas a partir da perspectiva da organização industrial e o dilema da seleção].","authors":"Ernesto Bascolo, Natalia Houghton, David Debrott Sanchez, Carla Castillo-Laborde, Annie Sylvain","doi":"10.26633/RPSP.2026.22","DOIUrl":"10.26633/RPSP.2026.22","url":null,"abstract":"<p><p>This article proposes an analytical framework to reinterpret the segmentation and fragmentation of health systems in Latin America and the Caribbean, focusing on the asymmetric relationships between actors as a structural cause of inefficiencies and inequities. In contrast to the traditional approach, which attributes these problems to the mere coexistence of multiple financing and delivery schemes, the present proposal combines the structure-behavior-performance (SBP) paradigm from industrial economics with an analysis of the selection dilemma to explain how strategic incentives and power dynamics shape the functioning of the system.The framework shows that the expansion of the private sector in the region has accentuated asymmetries among insurers, providers, and the population, giving rise to practices such as population skimming and the prioritization of profitable services. These strategic behaviors, when interacting with segmented and fragmented market structures and weak regulatory frameworks, deepen inequalities and reduce the system's allocative efficiency.Effective regulation must go beyond institutional control: it must intervene in the strategic relationships between actors and modify both structures and behaviors. The framework identifies critical points for regulatory intervention and proposes tools to align incentives with equity and efficiency objectives. Finally, it should be noted that integrating systems institutionally is not enough if the relationships between actors are not regulated and the structural asymmetries that underlie the problems of access, quality, and sustainability in health are not addressed. This perspective offers a useful guide for redesigning more effective public policies in the region.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e22"},"PeriodicalIF":1.7,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13001681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499603","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":"[Substandard and falsified medical products: 25 years of successful network collaboration among regulatory authorities in the AmericasProdutos médicos de qualidade inferior e falsificados: 25 anos de colaboração bem-sucedida em rede entre autoridades reguladoras da Região das Américas].","authors":"Juanita Vahos Zambrano, Gabriela Carrasco, Robin Rojas-Cortés, María José Alfonso, Romina Viñas, Maximiliano Derecho, Miriam Munguía, Danini Marin, José Luis Castro, María Luz Pombo-Castro","doi":"10.26633/RPSP.2026.32","DOIUrl":"10.26633/RPSP.2026.32","url":null,"abstract":"<p><strong>Objective: </strong>To present the background, results, contributions, challenges, future prospects of the Regional Network of Focal Points for Prevention, Detection, and Response to Substandard and Falsified Medical Products (SF Network) in the Americas during the two decades of its existence.</p><p><strong>Method: </strong>A documentary review was conducted to identify the background, results, and future prospects of the SF Network. The time horizon considered was 1999 -2025. The data are presented in narrative form.</p><p><strong>Results: </strong>At present, 28 countries in the Region of the Americas have active participation in the initiative. This has made it possible to: exchange information on nearly 650 incidents over the past 10 years; publish 12 technical documents on this subject; and convene 14 national meetings and workshops in the Region. The three key achievements of the initiative are collaborative work, the strengthening of market surveillance and control capacities among members, and the sustainability strategy.</p><p><strong>Conclusions: </strong>The achievements, experiences, and actions of the SF Network represent a success story that demonstrates the value and necessity of using models that facilitate exchange and collaboration between countries. The future of the SF Network should focus on new forms of member participation that strengthen the development of solutions and strategies, in relation to both known issues and emerging regional and global challenges.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e32"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463674","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":"[Intra- and after-action reviews of public health emergencies: report of the Brazilian experience and achievements, 2023 to 2025Evaluación durante y después de una emergencia de salud pública: experiencia y avances de Brasil entre el 2023 y el 2025].","authors":"Raquel Proença, José Lucas Pinho da Fonseca, Rafaela Dos Santos Ferreira, Vinicius de Souza Casaroto, Verônica Maria do Nascimento Machado Fernandes, Fatima Sonally Sousa Gondim, Taynná Vernalha Rocha Almeida, Edenilo Baltazar Barreira Filho","doi":"10.26633/RPSP.2026.18","DOIUrl":"10.26633/RPSP.2026.18","url":null,"abstract":"<p><p>Intra and after action reviews (IARs and AARs) are essential for the management of public health emergencies. This article reports on the experience of developing an IAR and AAR method by the Ministry of Health in Brazil, highlighting its conceptual and organizational foundations and its application in different public health emergency contexts from 2023 to 2025, a period during which 10 evaluations were conducted nationwide. The method was developed through a participatory process, based on a literature review and consultations with national and international experts, and was validated by consensus. The reviews were carried out in partnership with state health departments, using methodologies such as in-person workshops, structured debriefings, response action assessment tools, and individual instruments, often in combination. The number of participants ranged from 40 to 80 professionals, including managers, technical staff, and representatives from multiple sectors. The duration of activities ranged from meetings lasting a few hours to 2-day workshops. The reviews revealed good practices, challenges, and next steps that informed the updating of contingency plans and the incorporation of lessons learned into national and subnational policies and guidelines, synthesized in a Guide for After Action Review of Public Health Emergencies published by the Ministry of Health. This experience underscores the importance of incorporating IARs and AARs as strategic components of public health emergency preparedness and response. The process strengthens organizational learning, enhances the legitimacy of actions, and contributes to building a culture of continuous monitoring.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e18"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463649","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":"[HEARTS quality: a policy framework to strengthen hypertension and cardiovascular risk management in primary healthcare - insights from HEARTS in the AmericasQualidade da iniciativa HEARTS: marco de políticas para fortalecer o manejo da hipertensão e do risco cardiovascular na atenção primária à saúde. Perspectivas da iniciativa HEARTS nas Américas].","authors":"Esteban Londoño, Reena Gupta, Patrick Van der Stuyft, Martin Heine, Gloria Giraldo, Grace Marie Ku, Jeffrey Brettler, Andrés Rosende, Vilma Irazola, Jerry Toelsie, Carolina Neira, Teresa Aumala, Yamilé Valdés, Eric Zúñiga, Libardo Rodríguez, Matías Villatoro, María Cristina Escobar, Vivian Pérez, Alied Bencomo, Michael Pereira, Andelys de la Rosa, Pedro Ordunez","doi":"10.26633/RPSP.2026.24","DOIUrl":"10.26633/RPSP.2026.24","url":null,"abstract":"<p><p>HEARTS in the Americas is the largest-scale implementation of the WHO's global initiative, with 33 countries participating, 28 having adopted standardized clinical pathways, and about 10 000 primary healthcare facilities engaged. Despite progress, fragmented care, limited availability of validated blood pressure devices, restricted access to essential medicines, and weak quality assurance systems continue to hinder hypertension control and cardiovascular risk management. In response, PAHO and participating countries co-developed the HEARTS Quality Framework. Grounded in regional implementation, this model synthesizes global evidence and lessons from Latin America and the Caribbean. Co-designed by Ministries of Health, care providers, and international experts, it translates HEARTS strategies into actionable system-level objectives. Clearly defined outcome indicators and implementation targets promote institutionalization, quality improvement, and primary healthcare strengthening- supporting HEARTS scale-up and equitable outcomes. With appropriate contextualization, the HEARTS Quality Framework provides a practical roadmap for countries beyond the Region to advance primary healthcare-based chronic disease care.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e24"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463683","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":"No time to wait: A regional model for inter-epidemic vector-borne disease preparedness in the Caribbean.","authors":"Willy Dunbar, Jenna Indarsingh, Rajesh Ragoo, LaDonna Gulston, Dana Gomez, Charmaine Blades, Anselmo Matthew, Alan Wheeler, Horace Cox","doi":"10.26633/RPSP.2026.26","DOIUrl":"10.26633/RPSP.2026.26","url":null,"abstract":"<p><p>Vector-borne diseases continue to pose significant and evolving public health threats in the Caribbean. The compounded effects of human travel and migration, climate variability, ecological change, and structural vulnerabilities are intensifying transmission risks. However, preparedness efforts across the region remain largely reactive, with limited investment during the inter-epidemic periods, the interval between recognized outbreak waves when risk drivers persist but attention often declines, despite their potential as a strategic window for resilience-building. This Opinion and Analysis article, informed by deliberations during the 2025 Annual Meeting of the Caribbean Vector-Borne Disease Network, argues for a redefinition of the inter-epidemic phase as the operational core of vector-borne disease preparedness and resilience. Drawing on structured technical discussions within the Network's technical working groups and regional stakeholders, the article presents three strategic pillars: integrated surveillance that brings together epidemiological surveillance, integrated vector management, and innovations such as entomo-virological and wastewater monitoring; strong coalitions with sustained community engagement and stakeholder co-ownership of prevention and response; and the alignment of research with policy through a regionally developed research agenda. Each pillar is examined alongside implementation considerations, enabling conditions, and constraints relevant to small island health systems. The Caribbean Vector-Borne Disease Network is presented as a regional innovation platform whose transdisciplinary, multilingual, and equity-focused approach may offer transferable lessons for climate-vulnerable settings across the Americas, subject to contextual adaptation. Its outputs, including tools, protocols, and implementation resources, are being piloted and adapted across Member States through network-supported exchange and coordination. This framing supports a shift from episodic crisis response toward sustained inter-epidemic governance.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e26"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463667","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":"[Ageism in health care and suicide risk in older adults: a challenge for public health in Latin AmericaIdadismo no âmbito da saúde e risco de suicídio em pessoas idosas: um desafio para a saúde pública na América Latina].","authors":"Agnieszka Bozanic, Tomas León, Francisca Acevedo, Elisa de la Maza, Paula Ulloa","doi":"10.26633/RPSP.2026.17","DOIUrl":"10.26633/RPSP.2026.17","url":null,"abstract":"<p><p>Older people have the highest suicide rates in several countries in Latin America and the Caribbean. However, policies and prevention strategies continue to neglect social and structural factors specific to aging. In this context, ageism in health care acts as a critical barrier that affects access to and the quality and relevance of mental health care and influences the risk of suicide in old age. This article aims to analyze ageism in health as a critical social determinant of suicide risk among older adults in Latin America. It analyzes the structural, interpersonal, and internalized expressions of ageism, as well as its impact on mental health, with emphasis on the Chilean context. A thematic narrative analysis was conducted based on the scientific literature published in Spanish between 2020 and 2025 and retrieved from biomedical and regional databases. The analysis was complemented with epidemiological data, technical documents from international organizations, and current Chilean regulations on mental health, suicide prevention, and aging. Recognition of ageism as a structural determinant of suicide risk broadens the traditional biomedical approach and incorporates political, cultural, and social dimensions into the prevention of suicide in old age. The article proposes guidelines for public policies, health programs, and professional training with a focus on rights, critical gerontology, and public health, aimed at strengthening relevant and sustained prevention responses for older adults in Chile and Latin America.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e17"},"PeriodicalIF":1.7,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12983929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147463685","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":"Inicio temprano de la gripe estacional y actividad emergente del virus respiratorio sincitial: Consecuencias para los sistemas de salud.","authors":"","doi":"10.26633/RPSP.2026.28","DOIUrl":"https://doi.org/10.26633/RPSP.2026.28","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"50 ","pages":"e28"},"PeriodicalIF":2.2,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147434938","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}