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

{"title":"Global Initiative for Childhood Cancer: progress and challenges in Panama.","authors":"Karina Quintero, Iveth Berrio, Elsa Arenas, Soad Fuentes-Alabí, Liliana Vásquez, Sandra Luna-Fineman, Jorge Victoria, Modesta Houghton","doi":"10.26633/RPSP.2023.154","DOIUrl":"10.26633/RPSP.2023.154","url":null,"abstract":"<p><p>Despite being classified as a high-income country, Panama still faces challenges in providing care for children and adolescents with cancer. Annually, 170 new cases of childhood cancer are diagnosed in Panama, and the survival rate is around 60%. To improve this, the establishment of a Pediatric Cancer Commission comprised of healthcare professionals and nonprofit organizations has been a critical step toward the objectives outlined in the Cure<i>All</i> framework of the World Health Organization Global Initiative for Childhood Cancer (GICC). To improve childhood cancer care in Panama, a workshop for cancer in children and adolescents was conducted with the support of St. Jude Children's Research Hospital, Children's Hospital Colorado, the Ministry of Health of Panama, and the Pan American Health Organization. The commissions established were on: Nursing, Palliative Care, Psychosocial, Hospital Registry, Early Diagnosis, and Health Services. Each commission has a specific project to be implemented in the period 2021-2029 to continue the progress toward improving childhood cancer care. Since the start of implementation of the GICC in Panama, important achievements have included the launch in 2021 of the Guide for the Diagnosis of Cancer in Children and Adolescents, and training programs for primary care health personnel. Through these programs, more than 1 000 health professionals have been trained on diagnosis of cancer in childhood and adolescence. Challenges remain, such as access to quality care, and it is essential to continue efforts to improve childhood cancer care.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e154"},"PeriodicalIF":2.0,"publicationDate":"2023-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/66/e2/rpsp-47-e154.PMC10580196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49681803","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":"[Core competencies for public health teaching: regional framework for the AmericasCompetências essenciais para a docência em saúde pública: um marco regional para as Américas].","authors":"Juana Elvira Suárez Conejero,&nbsp;Gabriel Listovsky,&nbsp;Laura Magaña Valladares,&nbsp;María Isabel Duré,&nbsp;José Francisco García Gutiérrez,&nbsp;Marcela van Olphen","doi":"10.26633/RPSP.2023.137","DOIUrl":"10.26633/RPSP.2023.137","url":null,"abstract":"<p><strong>Objective: </strong>To present the Regional Core Competency Framework for Public Health (RCCFPH) and the methodology used for its development.</p><p><strong>Methods: </strong>A participatory methodology was used for this descriptive study, using techniques such as questionnaires, discussions, pair work, extreme cases, jigsaw, data evaluation matrices, iterative reviews, and comparative analyses. The study was carried out over nine stages, bringing together experts from public health institutions and schools, as well as primary health care professionals in the Americas.</p><p><strong>Results: </strong>The primary result is the RCCFPH, which is organized around 10 competency domains, all favoring comprehensive teaching. The primary focus is on the disciplinary domain, along with the educational domain. The remaining domains are common to the teaching of any discipline, but each competence was formulated for use within the field of public health, which is what differentiates this framework from others. It is proposed as a regional tool for use from multiple perspectives.</p><p><strong>Conclusion: </strong>The domains and competencies encourage a new perspective on comprehensive teacher training in public health. The RCCFPH can be used as a tool to assess teaching skills and improve the quality of teaching in the Region. It can foster cooperation among educational institutions and is proposed as a facilitator for a Latin American community of practice to address new challenges in public health.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e137"},"PeriodicalIF":2.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/e2/rpsp-47-e137.PMC10566529.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211101","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 call to action: strengthening services to improve childhood cancer survival in Latin America and the Caribbean.","authors":"Jarbas Barbosa da Silva","doi":"10.26633/RPSP.2023.157","DOIUrl":"10.26633/RPSP.2023.157","url":null,"abstract":"","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e157"},"PeriodicalIF":2.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/86/rpsp-47-e157.PMC10566528.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211104","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":"[Evidence of effectiveness of hospital transition care in the elderly: rapid systematic reviewEvidencia de la eficacia de la atención transitoria prestada a las personas mayores después de la hospitalización: revisión sistemática rápida].","authors":"Liza Yurie Teruya Uchimura,&nbsp;Mabel Fernandes Figueiró,&nbsp;Denila Bueno Silva,&nbsp;Laís Komatsu de Paiva,&nbsp;Pedro Paulo Magalhães Chrispim,&nbsp;Tatiana Yonekura","doi":"10.26633/RPSP.2023.143","DOIUrl":"10.26633/RPSP.2023.143","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize the evidence on the effectiveness of hospital transition care in the elderly to support decision-making.</p><p><strong>Method: </strong>This rapid systematic review followed the recommendations of the Cochrane Rapid Reviews Methods Group. Studies were selected from the PubMed, EMBASE, Cochrane Library, and Virtual Health Library (BVS) databases using the following criteria: focus on the elderly as population; provision of hospital transition care as intervention; care as usual (non-transition care) as comparator; and effectiveness of the presence vs. absence of transition care as the outcome, with effectiveness defined as improvement in any evaluated parameter. Systematic reviews published in Portuguese, English, or Spanish, with or without meta-analysis, that assessed hospital transition care in elderly individuals were included. Studies lacking a description of the intervention and target population were excluded.</p><p><strong>Results: </strong>Of the 207 identified reviews, 18 were included. The studies were conducted in 21 countries, with 10 studies conducted in Europe and one in Brazil. The effectiveness of care for the elderly was demonstrated through increased adherence to medication regimens, reduced adverse events and medication-related errors, improved functional status, reduced falls, and reduced healthcare costs.</p><p><strong>Conclusions: </strong>Despite the evidence indicating the effectiveness of hospital transition care, further research is needed to develop more robust indicators of clinical improvement and integration into healthcare systems.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e143"},"PeriodicalIF":2.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/df/rpsp-47-e143.PMC10566530.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211102","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":"[Health expenditure and health outcomes in Latin America and the CaribbeanGastos em saúde e resultados de saúde na América Latina e no Caribe].","authors":"Sebastian Rolando Ayala-Beas,&nbsp;Yony Edwin Rodriguez Minaya","doi":"10.26633/RPSP.2023.136","DOIUrl":"10.26633/RPSP.2023.136","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effect of public and private health expenditure on health outcomes in Latin American and Caribbean countries from 2000 to 2019.</p><p><strong>Methods: </strong>A health production function was used, wherein life expectancy at birth and infant mortality rate were considered as indicators of health outcomes. Panel data econometrics were applied, using data from a 33-country sample for the period from 2000 to 2019.</p><p><strong>Results: </strong>According to estimates, a 1% increase in public health expenditure is associated with a 0.019% increase in life expectancy, and a 1% increase in private health expenditure increases life expectancy by 0.023%. At the same time, a 1% increase in public health expenditure reduces the infant mortality rate by -0.168%, whereas the effect of private health expenditure on infant mortality is not statistically significant.</p><p><strong>Conclusions: </strong>The results provide evidence of the effect of public health expenditure in reducing infant mortality and increasing life expectancy, while private health expenditure has a positive effect only on the latter metric. The findings have important political implications for the countries of the Region in the post-pandemic context of limited fiscal space.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e136"},"PeriodicalIF":2.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/bf/rpsp-47-e136.PMC10566531.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211103","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":"Storytelling workshop to encourage stakeholder engagement with the Global Initiative for Childhood Cancer.","authors":"Soad Fuentes-Alabí,&nbsp;Kendall Carpenter,&nbsp;Meghan Shea,&nbsp;Liliana Vásquez,&nbsp;Sara Benitez Majano,&nbsp;Mauricio Maza,&nbsp;Silvana Luciani,&nbsp;Irini Albanti","doi":"10.26633/RPSP.2023.148","DOIUrl":"https://doi.org/10.26633/RPSP.2023.148","url":null,"abstract":"<p><p>Storytelling can enhance stakeholder engagement and support the implementation of the World Health Organization and Pan American Health Organization's (PAHO) Global Initiative for Childhood Cancer, which aims to improve care globally for children with cancer. The Initiative aligns with the United Nations Sustainable Development Goals, addressing health, education, inequalities and international collaboration. This report describes the design and implementation of a workshop that used storytelling through film to encourage stakeholders in national cancer control plans to engage with the Initiative in its focal countries in Central America, the Dominican Republic and Haiti. A six-step process was used to develop the virtual workshop hosted by PAHO: (i) define the audience; (ii) define the goals of storytelling; (iii) build an appropriate storyline, including choosing a platform and content, and addressing group dynamics and the length of the film; (iv) guide the workshop's design and implementation with current theoretical frameworks, including the Socioecological Model of Health and the Theory of Change; (v) design interactive group exercises; and (vi) disseminate workshop results. The skills-building component of the day-long workshop included 80 representatives from eight countries in the Region of the Americas, with participants representing pediatric oncology, hospital administration, ministries of health, nonprofit foundations, the scientific community and public health organizations. Outputs from the workshop included (i) a summary report, (ii) an empathy word cloud with live reactions from participants, (iii) qualitative responses (i.e. quotes from participants), (iv) stakeholders' analyses and (v) a prioritization matrix for country-level strategic activities that could be undertaken to strengthen health systems when caring for children with cancer. The workshop used storytelling through film to try to reduce health inequalities and have a regional impact. Combining art, public health and medicine, the workshop created positive change by sharing real-life experiences. Commitment was fostered among stakeholders through their engagement with the workshop, which aimed to increase their awareness of the need and advocacy to improve health systems and enhance access to health care for this vulnerable population.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e148"},"PeriodicalIF":2.6,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/a1/rpsp-47-e148.PMC10561658.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211106","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":"Collaborative effort to catalyze the implementation of the Global Initiative for Childhood Cancer in the Central American subregion.","authors":"Maria de Los Angeles Campos,&nbsp;Katiuska E Alvayero,&nbsp;Soad Fuentes-Alabi","doi":"10.26633/RPSP.2023.145","DOIUrl":"10.26633/RPSP.2023.145","url":null,"abstract":"<p><p>In Central America, childhood cancer is one of the leading causes of death. It is also a significant disease burden to health systems, with social and economic implications for families. The World Health Organization (WHO), the Executive Secretary of the Council of Ministers of Health of Central America and the Dominican Republic (SE-COMISCA), the Pan American Health Organization (PAHO), and St Jude Children's Research Hospital are working collaboratively to strengthen the health system's response to childhood cancer in Central America and the Dominican Republic. This collaboration's primary objective is to support the development of national pediatric cancer plans for each country in the subregion and improve overall survival rates and quality of care for children with cancer through a more comprehensive universal health coverage package. This collaborative effort has led to: (i) the development of childhood cancer national action plans; (ii) the launch of awareness and promotion campaigns; (iii) the design of childhood cancer educational material for children and their families; and (iv) a platform for professionals working in childhood cancer to share good practices and successful experiences. The countries of the subregion together with PAHO and St Jude Children's Research Hospital are working to develop standardized evidence-based clinical practice guidelines on childhood cancer for the region. This brief communication reports on this collaborative work.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e145"},"PeriodicalIF":2.6,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/01/rpsp-47-e145.PMC10561657.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41211105","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 multimodal strategy to improve health care for pediatric patients with cancer and fever in Peru.","authors":"Ana Mendieta, Ligia Rios Lopez, Maria Vargas Arteaga, Essy Maradiegue, Walter Delgadillo Arone, Carlos Rueda Bazalar, Alexis Holguin, Carlos Santillan Salas, Ivan Maza, Maysam Homsi, Frankly Farias Barrios, Claudia Assayag, Liliana Vásquez, Claudia Pascual, Miguela Caniza","doi":"10.26633/RPSP.2023.140","DOIUrl":"10.26633/RPSP.2023.140","url":null,"abstract":"<p><strong>Objective: </strong>The DoTT (Decreasing Time to Therapy) project aimed to minimize the interval between fever onset and medical interventions for children with febrile neutropenia. The objective of this study was to determine the effect of implementing the DoTT project on the hospital time to antibiotic (TTA) and patient time to arrival (PTA) at the hospital in children with febrile neutropenia admitted to the emergency department.</p><p><strong>Methods: </strong>The DoTT project was implemented at a Peruvian hospital and followed the World Health Organization (WHO) multimodal improvement strategy model. Components included creating a healthcare delivery bundle and antibiotic selection pathways, training users of the bundle and pathways, monitoring patient outcomes and obtaining user feedback, encouraging use of the new system, and promoting the integration of DoTT into the institutional culture. Emergency room providers were trained in the care delivery for children with cancer and fever and taught to use the bundle and pathways. DoTT was promoted via pamphlets and posters, with a view to institutionalizing the concept and disseminating it to other hospital services.</p><p><strong>Results: </strong>Admission data for 129 eligible patients in our registry were analyzed. The TTA and PTA were compared before and after the DoTT intervention. The median TTA was 146 minutes (interquartile range [IQR] 97-265 minutes) before the intervention in 99 patients, and 69 minutes (IQR 50-120 minutes) afterwards in 30 patients (<i>p</i> < 0.01). The median PTA was reduced from 1 483 minutes at baseline to 660 minutes after the intervention (<i>p</i> < 0.01).</p><p><strong>Conclusions: </strong>Applying the WHO multimodal improvement strategy model to the care of children with febrile neutropenia arriving at the hospital had a positive impact on the PTA and TTA, thus potentially increasing the survival of these patients.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e140"},"PeriodicalIF":2.6,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/43/rpsp-47-e140.PMC10548892.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41157688","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":"Collaboration for success: the Global Initiative for Childhood Cancer in Latin America.","authors":"Liliana Vásquez, Soad Fuentes-Alabi, Sara Benitez-Majano, Karina Braga Ribeiro, Monnie Abraham, Asya Agulnik, Justin N Baker, Daniel Bastardo Blanco, Miguela A Caniza, Adolfo Cardenas-Aguirre, Carmen Salaverria, Courtney E Sullivan, Erika Damasco-Avila, Ximena García-Quintero, Patricia Loggetto, Michael J McNeil, Sandra Luna-Fineman, Nuria Rossell, Regina Aparecida Garcia de Lima, Regina Holanda de Mendonca, Viviana Trigoso, Lorena Segovia, Roberto Vasquez, Florencia Moreno, Paola Friedrich, Silvana Luciani, Catherine Lam, Monika L Metzger, Carlos Rodríguez-Galindo, Mauricio Maza","doi":"10.26633/RPSP.2023.144","DOIUrl":"10.26633/RPSP.2023.144","url":null,"abstract":"<p><p>The Global Initiative for Childhood Cancer (GICC) aims to increase the cure rate for children with cancer globally by improving healthcare access and quality. The Pan American Health Organization (PAHO), St. Jude Children's Research Hospital (St. Jude), and collaborators have joined efforts to improve outcomes of children with cancer in Latin America and the Caribbean (LAC) using the Cure<i>All</i> framework. In this article, we describe the process of developing regional resources aimed at accelerating the GICC implementation in LAC. In March 2021, PAHO formed regional working groups to develop core projects aligned with Cure<i>All</i> pillars and enablers. Seven working groups emerged from regional dialogues: early detection, nursing, psychosocial, nutrition, supportive care, treatment abandonment, and palliative care. PAHO arranged regular online meetings under the mentorship and support of St. Jude regional/transversal programs and international mentors. Between April and December 2021, 202 multidisciplinary experts attended 43 online meetings to promote the dialogue between stakeholders to improve childhood cancer outcomes. Fourteen technical outputs were produced: four regional snapshots, four technical documents, two virtual courses, one set of epidemiological country profiles, one educational content series for parents/caregivers, and two communication campaigns. The ongoing dialogue and commitment of PAHO, St. Jude, LAC working committees, and international collaborators are essential foundations to successfully accelerate GICC implementation. This is achievable through the development of materials of regional and global relevance. Further research and evaluation are needed to determine the impact of these strategies and resources on childhood cancer outcomes in LAC and other regions.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e144"},"PeriodicalIF":2.6,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/ac/rpsp-47-e144.PMC10548891.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41149187","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 importance of a gender focus in building resilient, equitable, and universal health systemsA importância da abordagem de gênero no desenvolvimento de sistemas de saúde resilientes, equitativos e universais].","authors":"James Fitzgerald,&nbsp;Jessie Schutt-Aine,&nbsp;Natalia Houghton,&nbsp;Silvia Helena De Bortoli Cassiani,&nbsp;Ernesto Báscolo,&nbsp;Gisela Alarcón,&nbsp;Ana Gabriela Nascimento Sena","doi":"10.26633/RPSP.2023.135","DOIUrl":"https://doi.org/10.26633/RPSP.2023.135","url":null,"abstract":"<p><p>The coronavirus disease 2019 (COVID-19) pandemic demonstrated the need to strengthen the focus on gender from an integrative and multisectoral perspective to address health care problems. This article seeks to highlight the importance of incorporating and strengthening the gender focus in policies for building resilient, equitable, and universal health care systems. With this objective in mind, the role of women in the health sector is addressed from two directions. The first examines women's conditions of access to health systems in the Region of the Americas and highlights the need to overcome the obstacles that prevent the full realization of their right to health care. The second discusses the preponderant role of women in the health labor market, and the need to expand their leadership in decision-making in the sector. Finally, an appeal is made for progress in the implementation of recommendations to strengthen the focus on gender and the role of women in health policies and systems.</p>","PeriodicalId":21264,"journal":{"name":"Revista Panamericana De Salud Publica-pan American Journal of Public Health","volume":"47 ","pages":"e135"},"PeriodicalIF":2.6,"publicationDate":"2023-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/8b/rpsp-47-e135.PMC10521582.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41150677","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}