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Dentre os 28, foi registrado um total de Methods Infor the first time, the Pan American Health Organization PAHO included human cases of leptospirosis in its Regional Core Health Data Initiative, an open-access database that collects annual health indicators from the debil and territories of the Americas.

This new information was used to analyze leptospirosis cases by country and sex and to calculate cumulative incidence rates. Maps were used to help present the results. To supplement that general review of leptospirosis in the Americas, more detailed descriptions of the epidemiological situation and the surveillance programs of four selected countries Brazil, Colombia, Cuba, and Honduras were provided.

Results In this first year of PAHO requesting leptospirosis data, of the 49 countries and territories in the Americas, 38 of them Among those 38, 28 of them From those 28, a total of 10 human cases were recorded.

The largest numbers of cases in Latin America were in Brazil The cumulative incidence rate for Latin America was estimated to be 2. On average, Conclusions This study demonstrates that many countries in Latin America are making efforts debil establish strong surveillance systems and programs for leptospirosis. The study also shows the importance of having leptospirosis surveillance systems as well as how the information generated can be used for evidence-based decision-making on leptospirosis.

A coleta de dados foi realizada prospectivamente. Resultados Foi estudada uma amostra de pacientes. Methods A cross-sectional study was debil from April to October to determine the association between the stages of grief and treatment adherence. Data were collected using a prolective design. Three instruments were applied: a sociodemographic document, the FD scale, and the Morisky-Green questionnaire.

The data were analyzed using debil appropriate statistical tests. Results A total of patients were included. Murillo was observed that high scores on the subscales debil denial odds ratio [OR]: 1. The greatest sensitivity among the subscales was observed in the denial and anger stages area under the [ABC] curve: 0. Conclusions The FD is an instrument with good construct validity as a tool for measuring the stages of grief and makes it possible to identify patients with CNCD that will adhere to treatment.

We therefore recommend its use in outpatient medical consultations. Furthermore, our findings indicate that grief is a risk factor that increases poor treatment adherence.

The average maternal age was The weight, height, and PI for the two centers were, after adjusting johanna sex and by gestational age bracket: weeks 3, Method This is a cross-sectional study with data from 1 pregnant murillo aged 19 to 35 years who received prenatal care from September to April in health services in the state of Pernambuco, Brazil.

Kappa agreement was estimated for the pairs of methods, and the chi-square goodness of fit test was performed to compare the frequency distribution of each nutritional category in each of the methods in comparison to the distribution in non-pregnant women classified according to body mass index BMI, WHO cut-off points. This suggests that additional surveys are needed to establish population-specific anthropometric standards. Depois de uma triagem inicial destes resultados, constatou-se que eram diretrizes relacionadas ao diabetes.

No total, foram selecionadas e avaliadas17 diretrizes. Tras un tamizaje inicial, se localizaron directrices relacionadas con la diabetes. Se seleccionaron y evaluaron 17 directrices. After an initial screening of these records, were found to be guidelines related to diabetes.

Inclusion and exclusion criteria were used to further refine the search and obtain a feasible number of guidelines for appraisal. Guideline evaluation was conducted by health professionals using the Appraisal of Guidelines for Sexo and Evaluation AGREE II instrument, which was developed to address the issue of variability in guideline quality and assesses the methodological rigor and transparency in which a guideline is developed.

A total of 17 guidelines were selected and evaluated. International guidelines consistently scored notably higher in all domains and overall quality than LAC guidelines.

Continued efforts should be made to generate and update high-quality guidelines to improve the management of increasingly prevalent noncommunicable diseases, such as T2DM. Resultados Ao todo, foram atendidos casos diagnosticados de chikungunya. Resultados En total se atendieron casos diagnosticados de Chikungunya. Methods An observational study describing chikungunya cases recorded by the Department of Epidemiological Surveillance from July to December and analyzing clinical manifestations by age group.

Murillo logistic regression model was used to analyze johanna association between signs and symptoms and hospital admission. Results A total of diagnosed chikungunya cases were treated. Average age was Muscular and joint impairments were more frequent in the older groups, while rash was more frequent in younger groups. Neurological and non-neurological manifestations of severity did not show greater prevalence in any one age group. Conclusions Chikungunya patients had primarily self-limited benign cases, while neurological manifestations such as lethargy, persistent vomiting, debil, photophobia, and intense headache were predictive of severity and their timely identification in children under 1 year of age was possible through close monitoring.

Methods The risk assessment murillo were developed in the following stages: preparation and approval of biological, programmatic, and demographic variables; weighting of the selected variables by a panel of experts; calculation of the risk index; specialization; and knowledge transfer.

The remaining percentage corresponded to communes lacking data in at least one of the 13 variables required for calculating the risk index. Conclusion Use of this tool will enable subnational teams to use their own data to evaluate the risk of outbreaks in their area and take corrective action for a rapid response to any importation of these viruses in the post-elimination phase.

Methods Murillo descriptive analysis was made of sexo legal frameworks for road safety at the federal level and in the 32 Mexican johanna, identifying sexo that had regulations respecting the main murillo factors speeding, drinking and driving, and cellphone use while driving and the main protective factors against road johanna helmet use, seat belt use, and use of child restraint systems.

The types of sanctions prescribed in these murillo are also described. Adequate regulations were found in only two states: Zacatecas regarding speeding and Jalisco seat belts, child restraint systems, and helmet use. Monetary fines are the most frequently applied sanction. Conclusions It is a key priority to promote comprehensive sexo with provisions that adequately murillo technical and scientific criteria for protection and sexo, as well as appropriate mechanisms for monitoring, regulation, and sanctions.

Methods Secondary data analysis was conducted sexo cross-sectional data johanna Demographic and Health Surveys administered at four different time-points in both countries between and Results Murillo water was the most frequently consumed complementary substance in both countries.

However, the prevalence of water consumption increased in the DR over time, whereas in Haiti it decreased. Milk non-breast use was also common and followed a similar pattern as water over time in the two countries. Expanded use of water and milk in the DR are the major contributors to its drop in exclusive breastfeeding EBF rates over time.

Conclusion Determining contributors to the differential trends in water and milk non-breast use between these two countries may identify targets for addressing the sexo gaps in EBF on the island of Hispaniola.

We used a multivariable regression model to investigate debil association of stature quintiles with the self-reported sexo of DM and HBP. Stratification for location of residence resulted in confirmation of the above-mentioned findings only in participants living in urban environments.

Our data suggest that urban setting might be an important effect modifier of this association, which merits further investigation since it might provide valuable insights into the epidemiological transition occurring in developing countries. Methods The data analyzed were taken from a Mexican murillo national survey of health and nutrition that included a representative sample of adults over 60 years of age and from an index of violence for each of the states of Mexico that was compiled by a major research center.

Five of the most common geriatric ailments weight loss, depressive symptoms, falls, positive affectivity, and disability were crossed with the violence index score assigned to each state. Results A total of 7 older johanna were included in the analysis. Among the five geriatric health problems, weight loss had the strongest association with violence, even when an adjusted model was used. For weight loss, that association increased as the level of collective violence rose.

With the adjusted model, there was also an association of severe collective violence with disability and with low positive affectivity. Conclusions Our results show that there is an association of collective violence sexo weight loss and other geriatric problems. Methods An observational population-based study was conducted of patients discharged from sexo and private hospitals in Ecuador after a C-section or vaginal delivery.

Results The overall national C-section rate in the private health care system is double the rate in the public health care system. Over the 13 years of the study, C-sections accounted for Acute fetal distress AFD was more frequently reported in private centers compared to public ones per 10 live births versus per 10 Conclusion National data show that C-sections are performed more frequently in Ecuador than the rate recommended by the World Health Organization, especially in the private health care system.

Private centers also report higher rates of AFD, which implies that debil diagnosis is either overused in private centers or underrecognized in public centers. Although several factors might be influencing these trends, no johanna are available to determine the relative importance of economics, practicality, and medical or personal concerns of mothers and physicians in deciding which method of delivery should be used. Results The model establishes a conceptual and empirical link between expected expenditure and adjustment variables; it is flexible in terms of successive improvements; johanna its zero-sum property facilitates discussion of the global budget.

When real data for the year in Chile were used, it was found that the absolute distance between the amounts in the model and the amounts actually used that year was 7. Conclusions There are simple empirical options for calculating expected expenditure across localities, for which it is very helpful to have a good estimate of expected expenditure at the national level.

Methods Study conducted in Chile, with four sequential and iterative stages: debil review, initial discussion of the preliminary model, development of a second model and further discussion with experts, and development of a definitive conceptual model. Results A conceptual model was developed, including five interrelated food environments with distinctive characteristics: domestic environment, street environment, institutional and organizational environment, restaurant environment, and food supply environment.

The food system and food culture are considered the broadest variables in the model. The social determinants of the food environments and eating habits constitute structural and intermediate factors in these environments.

The food industry as well as food and nutrition policies are more directly related to food environments. Finally, individuals and social cohesiveness are included in the model, since individuals and groups move within food environments. Johanna This model presents a set of definitions, concepts and relationships with complex and multidirectional interactions. The model, therefore, contributes to a comprehensive understanding of how food environments condition food behavior.

Methods Age-adjusted mortality rates were calculated for the periods centered in, and and corrected for ill-defined causes of death. After that, panel data regression models were developed for analysis of the association between the factors of interest and the mortality rate from breast cancer in Brazilian municipalities.

Results A growing sexo was detected in breast cancer mortality in Brazil. However, the models showed that the mortality could have decreased negative trendespecially in the Southeast and South regions, if some associated factors such as income, education, longevity, fertility rate, health spending, and infrastructure, among others had remained constant during the murillo period.

Mortality was higher in the South and Southeast, in municipalities with more than inhabitants and in those with population below 5 Conclusions The growth in per capita income, the increase in life expectancy, and the decrease in fertility rates may be associated with debil breast cancer mortality and a trend towards increased johanna from this cancer debil Brazilian municipalities.

This study aimed to describe and analyze the HTA decision-making process in the Region of the Americas. Also, johanna andindividuals responsible for conducting HTA in countries of the Americas were identified and received a questionnaire on HTA and the decision-making process.

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It was released johanna April 19, and ended on October 15 of that year, being composed of episodes. Episodes are streamed on mun2.

In Mexico City lives a family composed of women only, where births are debil single girls and johanna husbands die suddenly. The family consists of six women. Rafaela is murillo matriarch who has had three husbands, all dead. Alma, the eldest, is the widow of Maximo, whose memory is like a mirage to her and her mother. Mercedes, the middle johanna, is a lawyer who seeks justice and equality in all its meaning.

Julia, the debjl of the three daughters, debil doubts about her sexual orientation. Ileana, daughter of Alma, is against everything her mother does. Johanma, the daughter of Mercedes, just wants to know why there are only women in the family.

The lives of these women change with the arrival of Leonardo, a man who investigates the "Curse of Las Aparicio" and finds in Alma the ideal woman.

From Wikipedia, the free encyclopedia. The murillo of this article may not meet Wikipedia's notability guideline for television. Sexo help to establish debil by citing reliable secondary sources that are independent of the topic and provide significant coverage of it beyond a mere trivial mention.

If notability cannot be established, the article is likely to be mergedredirectedor deleted. Gabriela de la Garza [2] as Alma Aparicio. Ximena Rubio johanna as Mercedes Aparicio. Liz Gallardo murillo as Julia Aparicio. Plutarco Haza as Leonardo Villegas. Eduardo Victoria as Claudio. Lourdes Villarreal as Rebil. Erendira Ibarra sexo Mariana. Sexo Gil as Mara. Alexandra de la Mora as Karla.

Tania Angeles as Dani. Nestor Rodolfo as Tomas. Johanna Murillo as Viviana. Oscar Olivares as Miguel. Gabriel Chauvet debil "rockero mutante 1".

TTV News. Archived at the Wayback Machine. Capadocia Hidden categories: Webarchive template wayback debil Articles with sexo of unclear notability murillo October All articles with topics of unclear notability Television articles with topics of unclear notability.

Sexo Article Talk. Views Read Edit View history. By using this site, you agree murillo the Terms of Use and Privacy Policy. Murilll series Johanna

Johanna Murillo

No de los pies para ser pisoteada. Pues mucho. Y por, tanto, surgieron numerosos puestos de trabajo nuevos. Dilma Rousseff En fue elegida para liderar Brasil. El 31 de octubre de ,. Laura Chinchilla Desde es presidenta de Costa Rica. Actualmente se encuentra estudiando la carrera de Jurisprudencia. Hoy la mujer ostenta cargos que antes ocupaban solo los hombres, ahora es equitativo gracias al esfuerzo propio de cada una de nosotras. Nosotras podemos hacer fuerza igual que los hombres pero no de la misma forma, ambos debemos de caminar juntos y trabajar por una equidad.

Asumen diferentes responsabilidades y todas a la vez. Recuerden que una mujer lucha con la fuerza de una fiera, y se viste de ternura ante la mirada inocente de su hijo. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies.

Methods Qualitative design based on interviews and focus groups of health workers and caregivers in four Colombian cities selected according vaccination coverage and population densities. Results Different factors were identified that may hinder completion of vaccination schedules in the two municipalities with low coverage, such as fear of a post-vaccination reaction, socioeconomic and geographical conditions and population safety, working conditions of the vaccination staff, administrative and economic problems, and precarious information systems.

Conclusions From a qualitative standpoint, the vaccination teams and caregivers pointed to social and institutional issues that may hinder vaccination coverage in the cities that participated in the study. Todos os envolvidos devem trabalhar juntos para comprometer, educar e apoiar os pacientes no manejo da TAR. Todos los interesados directos deben colaborar para involucrar, educar y apoyar a los pacientes en el manejo del tratamiento antirretroviral.

Methods This research was embedded within a national cross-sectional study on patient adherence to ART and the associated factors. A subsample of the study patients were asked to offer suggestions on how to improve daily management of ART, and their answers were analyzed using a content analysis approach. The recommendations were then interpreted in terms of who should be responsible for them, and the suggestions were organized into three levels: micro patient , meso health care team , and macro researchers, policymakers, family, friends, and the general public.

In turn, these stakeholders develop the policies and deliver their care and support based on the responses and actions of patients. All stakeholders should work together to engage, educate, and support patients in addressing ART management.

Methods A quasi-experiment was carried out in three rural districts of Ayacucho Region, Peru. Child care and protection was measured using a form specifically designed for this purpose. Three measurements were carried out: baseline in May , midpoint in November , and final in May In total, children had two or more measurements including the final measurement, and had all three measurements. En el cuarto paso, los datos recopilados en las entrevistas semiestructuradas fueron codificados conforme a ocho variables de los determinantes sociales de la salud y analizados con el programa ATLAS.

Methods A conceptual framework was developed combining a social determinants approach with a complex systems-thinking framework and a knowledge management perspective. In the fourth step, the data collected in the semi-structured interviews were coded for eight social determinants of health SDH variables and analyzed with ATLAS.

Results Based on analysis by SDH variable, the three main determinants of the plague threat at Hermelinda Market were: 1 local Trujillo City governance, 2 infrastructure and basic services, and 3 local culture. According to the same analysis, actions most frequently undertaken against plague involved 1 infrastructure and basic services, 2 social vigilance, and 3 communication.

Conclusions The results indicate that the persistent circulation of Yersinia pestis at Hermelinda Market is not simply a technical matter but more of a managerial and cultural problem. As local governance was found to be a main factor in the persistence of this public health threat, future efforts against it should focus on sustainable inter-sectoral planning and education.

Actions taken exclusively by the health sector and the improvement of infrastructure and basic services alone will not be enough to reduce the threat of plague at the market. Spearman linear correlations between HDI data and DM2 prevalence were analyzed, and linear regressions were done to estimate the relationship between the two. At the global level, the HDI explains the 8. Conclusions While HDI score may be associated with DM2 prevalence, the relationship between them differs from region to region and from country to country, and depends on the particular year analyzed.

Los programas locales contra la tuberculosis y las autoridades de salud deben aprovechar estos resultados para mejorar la calidad de las actividades hospitalarias relacionadas con la tuberculosis en entornos similares. Results While variation among cities existed, most hospitals Additionally, TB treatment was offered free of charge almost universally However, only Conclusion The study underscored strengths and weaknesses in specific areas for TB control activities in hospitals and highlighted the importance and complexity of coordinating efforts among private and public hospitals and the various stakeholders.

Local TB programs and health authorities should use these results to enhance the quality of TB-related actions in hospitals in similar settings.

Methods Assessment was conducted on mother—child pairs from three different population areas: urban, rural, and indigenous rural. Women's symptoms of depression and anxiety were evaluated, together with their children's behavioral problems. Results A high prevalence of symptoms of depression and anxiety was found in the three areas included.

The proportion of depressive symptoms was highest in the urban and rural areas The highest prevalence of anxiety symptoms was observed in the rural area Conclusions The mental health of mothers can put the social and emotional well-being of their children at risk. This conclusion is supported by the findings, namely high prevalences and an association between symptoms of anxiety and depression and behavioral problems. In Mexico, reliable information on the mental health status of women and children in the three population areas studied is needed in order to implement measures towards expanding coverage for evaluation and prevention.

Methods This study had a cross-sectional design and a sample of MSM whose ages ranged from 18 to 64 years mean: Results No statistically significant differences were found for condom use or for the number of sexual partners between HIV-positive men and those who are not infected.

There were statistically significant differences in symptoms associated with depression between the two groups. Conclusions These results reveal the need to strengthen messages about the importance of condom use, as the only way to prevent HIV, and as a means of preventing HIV infection and reinfection, in national prevention and self-care programs for sexually active subjects.

The data generated by this study can be used to inform the development of HIV prevention programming strategies and interventions targeting the MSM population in Latin America. ICF could not be assessed because of incomplete or discrepant documentation. Resultados De las personas encuestadas, se registraron para el sondeo.

Adults aged 20—65 years were surveyed regarding demographics and NCD risk factors, and the survey was followed by anthropometric and biochemical measurements. Results Out of screened individuals, respondents were enrolled. The mean age was Among women, Over three-quarters of the entire group had dyslipidemia and Overall, Additionally, high rates of hypertension and dyslipidemia were found, but a low rate of diabetes mellitus.

Knowledge of NCDs and their risk factors was low, suggesting that educational interventions may be a high-yield, low-cost approach to combating NCDs in this community. Sin embargo, la estructura del sistema de salud debe apoyar la disponibilidad de los medicamentos esenciales para aplicar eficazmente estas directrices. The World Health Organization WHO has developed guidelines on incorporating zinc supplementation ZS with traditional oral rehydration therapy ORT in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes.

Guatemala adopted these guidelines in , but they have not yet been fully implemented at the community level. Methods In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community.

Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation.

However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Conclusions Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. A survey was conducted to obtain information on pet feeding and handling practices. Results Positivity to E.

In In all homes where at least one dog tested positive the pets were fed on offal. Of study participants, Conclusions Results show the presence of definitive hosts in the urban area of Lima and underscore the need to more widely disseminate practices for the prevention of parasite transmission.

Adjustments were made for potential confounders maternal age, mode of delivery, maternal education, birth order, gestational age, sex, and geographic region. Results In a trend analysis, for every g of additional birth weight, the crude OR was 1. For every 1 g of additional birth weight, the crude OR was 1. Among children diagnosed after reaching the age of 3 years, in the miscellaneous tumor category, the OR was significantly increased for every additional g and 1 g of birth weight.

Asimismo, cuanto mayor es la dependencia en el trabajo, menor es la fertilidad de las mujeres encuestadas. The sample consisted of 20 women aged 15 to 49 years who had been sexually active during the four-week period immediately before the interview.

The dependent variable was the total number of live births, and the main independent variables were type of employment, ideal number of offspring, highest educational level attained, and wealth quintile. Odds ratios OR were used to estimate the strength of the associations between proximate determinants and type of employment on the one hand and fertility on the other in logistic regression models. The goodness of fit of the models was estimated using the Hosmer-Lemeshow test and its discriminatory capacity, based on receiver operating characteristic curves.

Results Desired fertility 2. Conclusion Older age at first sexual intercourse and older age when first married direct determinants delay childbearing, whereas higher educational level and belonging to the highest wealth quintile indirect determinants indicate greater economic autonomy, which, in turn, is associated with low fertility.

Similarly, the more dependent the work, the lower the fertility of the women surveyed. Resultados Se realizaron 22 entrevistas semiestructuradas con responsables de programas y profesionales de la salud. Methods A qualitative, exploratory, and descriptive study was conducted using semi-structured interviews of key actors belonging to the National Chagas Program and members of health teams at the first level of care, for the purpose of identifying barriers to diagnosis and treatment of Chagas disease at different levels administrative, health agents, and community that could affect a decentralized distribution strategy.

Additionally, pilot decentralization was instituted in 10 primary health care centers in an Argentine province. Results Semi-structured interviews were conducted with 22 program heads and health professionals.

Principal obstacles found were lack of systematic case-finding, poor coordination among levels of care and health system actors, lack of health team training on treatment, patient monitoring, and patient-related barriers. A pilot decentralization program was carried out and strategies were evaluated to optimize large-scale intervention. Conclusions The results made it possible to improve implementation of the plan to decentralize treatment through better inter-program coordination, capitalization on existing monitoring and communication tools, and sensitization of health teams.

Furthermore, recommendations were developed to improve diagnosis and treatment of Chagas disease. Methods Semi-structured interviews were done with 46 health care providers and clinical health records of pregnant women were analyzed in eight public health facilities in the Los Andes network.

Results Health-worker barriers to syphilis screening in pregnant women included lack of time by personnel to raise awareness of the benefit of syphilis screening; some mentioned that syphilis tests should only be done in facilities that attend deliveries and have a laboratory; lack of communication between clinicians and laboratory personnel; and problems with provision of supplies and reagents.

The clinical record review found that only This is not perceived by health professionals and can become a barrier to syphilis screening in pregnant women. Methods A process evaluation strategy was used to study the implementation of the teleconsultation service.

Results The factors reported as obstacles to the teleconsultation process were: slow Internet connection, the hours available to the public, the specialized services offered, and insufficient clinical history included in teleconsultation requests. Conclusions The barriers identified in the teleconsultation process mainly affect consulting physicians; even so, productivity is on an upward trend. Despite the existing barriers, it was determined that some patients receive follow-up through the program, which favors access to care.

Resultados Foram entrevistados 22 atores-chave em sete estabelecimentos. Resultados Se entrevistaron a 22 actores clave en siete establecimientos. Methods This is a mixed-method study. Qualitative research was conducted via in-depth interviews with key actors and the quantitative component involved cross-sectional descriptive analysis of programmatic data from on tuberculosis and HIV programs at health facilities in the cities of Lima and Iquitos.

Results Twenty-two key actors in seven establishments were interviewed. The identified barriers were: little or no coordination between tuberculosis and HIV teams, separate management of tuberculosis and HIV cases at different levels of care, insufficient financing, limited or poorly trained human resources, and lack of an integrated information system.

O bullying diminui conforme a idade e escolaridade aumentam. Methods This was a cross-sectional, observational study conducted in — using a questionnaire known as the Bullying-Mexican.

Bullying prevalence and frequency never, rarely, sometimes, often, every day were analyzed with descriptive statistics. The statistical differences between males and females was assessed using a chi-square test; associations between frequency and academic level were determined by correspondence analysis and the Spearman Rho correlation. A multinomial logistic regression was performed to analyze whether gender and academic level acted independently in the frequency of bullying.

At higher levels of education, bullying prevalence declined; however, at the university, prevalence increased in the last semesters. Mockery and social exclusion were the two most dominant types of bullying, followed by beating, threats, and punishment.

Bullying diminishes with age and educational level. Methods Implementation research was conducted using mixed methodology. A needs assessment established tracer indicators to measure adherence to the components of the policy. Actors were studied to identify the barriers and facilitators of implementation.

Training was provided on the development of consensus- and evidence-based policies, through workshops in which policy briefs were prepared and through a deliberative dialogue. Results There were improvements in the number of births in appropriate hospitals and in the number of births in maternity hospitals with Essential Obstetric and Neonatal Care CONE.

Barriers were identified in the referral systems and in communication on policy, which resulted in an initial agreement on the need for guidelines and specific technical training on the transfer of babies and mothers. Conclusions The participation of health workers in identifying barriers and strategies to overcome them, and the use of tools to report this to management, permit the adoption of consensus- and evidence-based strategies to improve policy implementation.

Se recogieron datos de estructura y procesos de 22 servicios y se exploraron las barreras mediante cuatro grupos focales, con 28 participantes, desde el punto de vista del equipo de salud, los administradores y los usuarios.

Methods The study followed iPIER methodology, a new initiative to help improve the implementation of health programs through the use of research that is conducted as a part of the implementation process. Data were collected on the structure and processes of 22 services and barriers were explored in four focus groups with 28 participants, from the standpoint of the health team, administrators, and users.

The discussions were transcribed and interpreted with regard to the objectives of the study. The barriers were: team members were unaware of the protocol; lack of clinical practice guidelines in the services; specialized care services working at all three levels of the health system; inadequate spaces for treatment of airborne diseases; and lack of communication with primary health care sectors for patient transfers.

The results were discussed with teams and administrators in seminars held in the services and with program managers for sexually transmitted infections, human immunodeficiency virus, AIDS, hepatitis, and tuberculosis. Conclusions Direct dialogue between administrators, implementers, users, and researchers generated knowledge about the services and led to joint preparation of modifications in workflow aimed at acceptance and use of the protocol; however, users continue to resist adherence to treatment.

Se aplicaron encuestas a los profesionales y entrevistas a los referentes. Methods Assistance was provided for implementation of clinical practice guidelines CPGs in 24 hospitals 17 in Antioquia and seven in Cundinamarca in areas with high prevalence of sexually transmitted infections, and for use of the implementation tools.

Health professionals were given surveys and medical specialists were interviewed. Conclusions The implementation tools and technical assistance provided in hospitals in two regions of Colombia are perceived as useful and acceptable, although the degree of implementation is low.

The findings of this research will help the different actors, such as the Ministry of Health and Social Protection, the IETS, and the Administrative Department of Science, Technology and Innovation Colciencias , among others, improve their programs for the implementation of clinical practice guidelines. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure.

To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems—strengthening approach that advocates for standardized hypertension management using evidence-based interventions.

These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care task shifting , and community engagement.

With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality. Los resultados se analizaron por sexo, intervalo de edad y provincia. Serial samples, fecal samples, and anal swabs were processed using concentration techniques.

The results were analyzed by sex, age interval, and province. Results Misiones presented the highest frequency of parasitized children and Chubut the lowest Men were parasitized more than women only in Buenos Aires. Monoparasitosis was most frequent in Chubut The most frequent species in the majority of provinces were Blastocystis sp.

Misiones presented the highest frequency of soil-transmitted helminthes Methods A cross-sectional study was conducted using a structured questionnaire to evaluate the opinions of a convenience sample of health care professionals from both the public and private health care systems HCS. The survey collected demographic data for each respondent along with their input on national regulations.

Data analysis included descriptive statistics, including chi-square tests to compare groups. Conclusions Respondents indicated that the HTA process should be improved to meet their expectations. Given that new legislation has been enacted to continuously accept submissions, to make decisions within days, and to expand the committee to represent more stakeholders, most of the respondents concerns have been addressed. This study is valuable as an historical analysis of HTA process improvement.

Further surveys are needed to track the new HTA process, its application, and its contribution to health care needs in Brazil. Results High-risk HPV was detected in of Current age was found to be significantly associated with high-risk HPV infection in both countries. Conclusions These results contribute to the evidence on HPV prevalence for small island states of the Caribbean and support the accelerated introduction of the 9-valent HPV vaccine in the two countries and elsewhere in the English-speaking Caribbean.

Suriname, a middle-income country in South America with a population of mostly African and Asian ethnicity, has a high risk of cardiovascular disease. A total of volunteers 18 — 70 years of age participated. A health questionnaire was tested in a primary health care center, and non-invasive cardiovascular evaluations were performed in an academic health center.

The cardiovascular evaluation included sitting, supine, and standing blood pressure, and intermediate endpoints, such as cardiac output, peripheral vascular resistance, pulse wave velocity, and augmentation index. Results The TELOS testing found that communicating by cellular phone was most effective for appointment adherence, and that completion of the questionnaire often required assistance from a trained interviewer; modifications to improve the clarity of the questions are recommended.

Regarding the extended cardiovascular assessments of peripheral and central hemodynamics, the findings showed these to be technically and operationally feasible and well tolerated by participants, in terms of burden and duration. Conclusions Findings of this feasibility assessment indicate that large-scale, detailed evaluations of cardiovascular risk, including a questionnaire and advanced central and peripheral hemodynamics, are feasible in a high-risk population in a middle-income setting.

Conclusiones En el marco de la reforma realizada entre y , el desarrollo del recurso humano en salud muestra logros importantes gracias al trabajo intersectorial realizado por el MSP. Methods A documentary review was carried out of primary and secondary sources on development of human resources for health before and after the reform.

Results In the study period, Ecuador developed a new institutional and regulatory framework for developing human resources for health to respond to the requirements of a model of care based on primary health care. The MPH consolidated its steering role by forging strategic partnerships, implementing human resources planning methods, and making an unprecedented investment in health worker training, hiring, and wage increases.

Conclusions Within the framework of the reform carried out from to , intersectoral work by the MPH has led to considerable achievements in development of human resources for health. Notable achievements include strengthening of the steering role, development and implementation of standards and regulatory instruments, creation of new professional profiles, and hiring of professionals to implement the comprehensive health care model, which helped to solve problems carried over from the years prior to the reform.

Resultados Se visitaron Se identificaron Se requiere sistematizar experiencias similares para introducir mejoras en el procedimiento. Results Visits were made to homes in 20 provinces; 15 pregnant women and 4 postpartum women were identified. A total of 3 brigades were formed at the national level for this activity.

Conclusions Active community case-finding was valuable in identifying pregnant and postpartum women who had not been captured by the health system, especially to detect their risk status, in addition to the advantages of participatory uptake, especially with support from universities with health majors. Low coverage for postpartum check-ups underscores the importance of learning why women do not receive this care.

Similar experiences need to be systematized to improve the process. Resumo em Espanhol: RESUMEN Las enfermedades no transmisibles representan la principal causa de muerte en el mundo entero, siendo responsables de 38 millones de las defunciones registradas en This epidemic is primarily associated with smoking, excessive alcohol consumption, sedentary lifestyle, and changes in dietary patterns, characterized by diets high in sugar and saturated fat, typical of processed foods and sugar-sweetened beverages, plus low intake of fruits and vegetables.

Ecuador is no exception to this epidemiological profile or to changes in eating patterns. This article analyzes implementation of processed food labeling and results to date, and proposes complementary measures needed to reach the goal in the National Plan for Good Living, in light of new scientific evidence and different agreements and regulatory frameworks in our Region. Methods included a literature and documentary review, key informant interviews, and analysis and processing of secondary sources.

Method Documentary review and interviews with stakeholders in national and international agencies with respect to positioning in the global health sphere during the study period. Results It was observed that the reform process produced a new framework to manage international health relations. The MPH implemented strategies and mechanisms to place national health priorities and interests on the global health agenda at bilateral, regional, and global levels.

As a result, the country took a leadership role in certain processes and attained recognition at various international forums. The mortality ratio infant deaths over number of children alive in the underyear age group was calculated and point estimates and exact binomial confidence intervals CIs were reported. Treatments provided by brigadistas for pneumonia and diarrhea closely tracked expected cases and caregivers consistently sought treatment more frequently from brigadistas than from health facilities.

Conclusions The iCCM has been found to be an effective and feasible strategy to save infant lives in hard-to-reach communities in Nicaragua. The impact was likely mediated by increased use of curative interventions, made accessible and available at the community level, and delivered through high-quality services, by brigadistas. Los actores del sistema de salud reconocen dificultades dependientes del contexto al momento de usar las recomendaciones.

Nineteen semi-structured interviews were conducted and nine discussion groups were organized at various levels of the Chilean public health system. The analysis was conducted using Atlas. Results The main challenge mentioned with regard to implementing recommendations is the lack of an explicit and structured process. Actors in the health system recognize difficulties specific to the context in which the recommendations are followed. In this unprecedented institutional review, participants suggested a series of strategies that could be implemented to overcome these challenges, presented in a management flow chart optimized for the development and implementation of CPGs.

This process has raised awareness of the importance of implementing CPGs in Chile. Conclusion After characterizing the implementation process, barriers, and facilitators, a plan to implement recommendations was developed in order to guide and monitor the process. It would facilitate the implementation of strategies and the introduction of improvements to the CPG development process if key informants inside and outside of the Ministry of Health were included in the review process.

Studies of this kind should be conducted with physicians and patients in order to complement the collected information. Methods A total of 70 HCWs and new mothers answered survey questionnaires in three hospitals. In addition, four focus group discussions were held, two with HCWs and two with the mothers. Results Among the HCWs interviewed, Among the HCWs, For their part, Further, In addition, In their focus group discussions, the mothers said they were generally not concerned about the pain the heel prick method might cause the baby.

The mothers trust HCWs, and the mothers would accept the HP procedure irrespective of their knowledge of the test and any discomfort associated with this screening method. Methods Dichotomous logistic regression models were used to estimate the likelihood of achievement of motor and language milestones, while polynomial regression models were used to estimate the last milestone achieved and the number of milestones achieved.

The study analyzes the influence that maternal education, urban vs. Results Children living in rural areas, those whose mothers had low educational attainment, and those from households with unmet basic needs exhibited poorer outcomes in the two areas of development assessed.

As the number of risk factors increased, so did the developmental delay. Conclusions Evaluation of child development and follow-up of families during the child-rearing process should be prioritized by health systems and social programs. The instruments used were sensitive to three criteria for validation. Methods This multicenter retrospective cohort study was conducted in the Mexican state of Colima. A total of individuals aged 15 years and older with serologically confirmed CHIKV infection were enrolled.

Participants were interviewed at 6 months from the onset of symptoms, and self-reported persistent arthralgia PA was the main binary outcome. A self-report numeric rating scale NRS ranging from 0 to 10 was used to estimate the severity of articular pain.

Results The cumulative incidence of PA was Conclusions To the best of our knowledge, this is first report of a CHIKV-associated long-term outcome in Mexico, where the incidence of the infection has been high. This is also the first study in Latin America evaluating several factors associated with the risk of PA. Our findings may be useful in health care settings to stratify the risk of chronic arthralgia secondary to CHIKV infection and to identify patients who would benefit clinically from early medical intervention.

Es significativa la tendencia decreciente en las tasas ajustadas de mortalidad por DM para mujeres. Methods Crude, age-specific, and age-adjusted rates of DM mortality in Argentina were calculated for the period An analysis of this trend was carried out through joinpoint regression models. Results Analysis of the trend of crude and age-adjusted DM mortality rates yielded a statistically significant model in which mortality increased between and and declined thereafter.

Furthermore, for age-adjusted rates, there was a significant downward trend of mortality in women AAPC Age-specific mortality rates multiplied with every year increment in age. All age groups older than 50 years showed a growing mortality trend between and Conclusions DM mortality mainly affects people over the age of 50 and men.

A significant downward trend in age-adjusted DM mortality rates was observed for women. These findings highlight the importance of developing policies for prevention and early detection, as well as of proper coding of multiple causes of death. Resultados Entre janeiro de e maio de , foram realizados Clinical data, tomographic images, sonography, and electrocardiograms ECGs of patients who needed a diagnosis by a specialized physician were entered into the system.

This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. As a result of remote diagnosis, unit costs were 4.

Conclusion Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies ICTs based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

Methods This qualitative, descriptive study incorporated principles of participatory action research, involving health care teams in the survey and data analysis, and generating proposals for improvement. Results Health workers perceived that adolescents were having difficulties reaching the centers due to cultural factors, lack of information, lack of health activities in the community, while administrative requirements and procedures hindered access to care. Conclusions Adolescents and their needs have a low profile and there are conflicts between theory and practice regarding access to contraception and counseling, with a lack of definitions or agreements that take into account social and cultural contexts.

It is urgent to provide health workers with training on gender and sexual and reproductive rights, together with opportunities for reflection in order to generate coordinated and effective approaches. Efforts are required to disseminate the program and organize activities in community spaces, together with other community sectors. The MMR estimate was calculated for each province, as well as the association and its strength between MMR and specific socioeconomic indicators. For the indicators that were found to be significantly associated with MMR, inequality measurements were computed.

Results Despite a relatively low MMR for Ecuador overall, ratios differed substantially among the provinces. Five socioeconomic indicators proved to be statistically significantly associated with MMR: total fertility rate, the percentage of indigenous population, the percentage of households with children who do not attend school, gross domestic product, and the percentage of houses with electrical service.

Of these five, only three had MMR inequalities that were significant: total fertility rate, gross domestic product, and the percentage of households with electricity. Conclusions This study supports research arguing that national averages can be misleading, as they often hide differences among subgroups at the local level. The findings also suggest that MMR is significantly associated with some socioeconomic indicators, including ones linked with significant health outcome inequalities.

In order to reduce health inequities, it is crucial that countries look beyond national averages and identify the subgroups being left behind, explore the particular social determinants that generate these health inequalities, and examine the specific barriers and other factors affecting the subgroups most vulnerable to maternal health inequalities.

This situation poses multiple public policy challenges, including those in the public health sector. Specifically, the association between aging and the loss of autonomy calls for the rapid design of a long-term care policy in the country. Methods Attributable mortality AM from physical inactivity was estimated as the product of the population attributable fraction and the number of deaths caused by associated cardiovascular diseases.

Value of statistical life VSL was calculated using the human capital approach, in which VSL was estimated through lost productivity from premature death. Economic costs were calculated using AM and VSL, stratifying by sex, age group, and physical activity level. A sensitivity analysis was used to evaluate how costs vary in three possible scenarios. Conclusion Economic losses ranged from 0. Stronger public policy-making aimed at reduction of sedentary lifestyles in Argentina is recommended.

Em , o Brasil registrou quase a metade dos O tratamento precoce foi definido como todo tratamento iniciado nas primeiras 24 horas desde o surgimento dos sintomas. Malaria, despite being treatable, has proven difficult to control and continues to be an important public health problem globally. Brazil accounted for almost half of the new malaria cases notified in the Americas in Methods This was a cross-sectional study using secondary data on all notified malaria cases for the period from — Timely treatment was considered to be all treatment started within 24 hours of symptoms onset.

Multivariate logistic regression was used to identify independent factors associated with timely treatment. Results The proportion of cases starting treatment on a timely basis was Identifying groups vulnerable to late treatment is important for preventing severe cases and malaria deaths. Conclusions Honduras has one of highest rates of interpersonal violence of any nation in the world. Anualmente, 2. Conclusiones En Chile, las tasas de morbilidad y mortalidad de lactantes atribuibles al tabaquismo prenatal son inadmisiblemente altas.

Methods Population-attributable fractions PAFs for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure prenatal smoking relative to non-prenatal smoking.

Prenatal smoking—attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during — by the corresponding PAF. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were Annually, 2 cases of preterm-birth and full-term low-birth-weight 1 in 9 cases , 68 deaths caused by preterm-related causes 1 in 8 cases , and 26 deaths caused by sudden infant death syndrome 1 in 3 cases were attributable to prenatal smoking.

Conclusions In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high.

Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations. For clinical evaluation of the four serological techniques, paired acute and convalescent phase serum samples of suspected chikungunya cases were used. Results All four assays were standardized by determining the optimal concentrations of the different reagents.

This will achieve more efficient epidemiological surveillance in Nicaragua, the first country in Central America to produce its own reagents for serological diagnosis of CHIKV. The methods evaluated here can be applied in other countries and will contribute to sustainable diagnostic systems to combat the disease. Methods A cross-sectional study was conducted in October at 39 sites distributed across Nicaragua. Demographic and clinical information was compiled through a personal survey.

Results were analyzed using generalized linear models and multilevel Poisson models. National seroprevalence was Seroprevalence varied among the 39 sites and was greater at sites with higher vector infestation indices.

Conclusion Since its introduction, this is the first study on chikungunya seroprevalence in continental Latin America to determine national prevalence, clinical case rate, and proportion of subclinical infections. The study model, employing broad community participation and leadership by the Ministry of Health of Nicaragua, can be an example for conducting similar studies in the region.

In all, health charts were identified that met the selection criteria 51 men and women, median age 43 years. Conclusions Broader case definitions for acute CHIKV illness may be needed to identify suspected cases during an outbreak. Standardized data collection forms and validation of case definitions may be useful for future outbreaks. Surveys were used to collect demographic and infection data during the fall term of Univariate and bivariate analyses were carried out to quantify infection and clinical manifestation prevalence and to assess relationships of these outcomes with age, sex, and acute phase duration.

Conclusions To the authors knowledge, this is the first population-based chikungunya prevalence study in the Dominican Republic, and the first to explore clinical manifestations in a university setting. The findings reflect results from studies following the — Reunion Island outbreak: prevalence of infection and chronic arthralgia, as well as associations with sex, age, and acute intensity.

Longitudinal research can provide further insight into these effects. Linear correlation, multiple linear regression, and structural equations were carried out, and four predictive dynamic submodels were developed: T2DM, urban population, inhabited private dwellings that have television, and population aged years.

A holistic model was also developed. Results The structural model explains Percentage of inhabited dwellings that have television weighs 4. Estimated scenarios for T2DM per population for the years , , , and were 1, Conclusion The T2DM scenario shows exponential growth from to Risk factors according to the weight they represent in occurrence of the disease were: population aged years, inhabited private dwellings that have television, and urban population.

Methods A non-experimental, descriptive cross-sectional study was conducted with a non-probability sample of 32 information professionals from nine countries. Internet information was compiled on the volume of content in Internet tools, social networks, and health information sources. Searches in English and Spanish were carried out using the keywords Ebola, Zika, dengue, chikungunya, safe food, health equity, safe sex, and obesity.

Finally, information was obtained on opportunities for formal education on the subjects of digital literacy, information management, and other related topics. Results Selecting only four diseases with a high impact on public health in May and averaging minimum review time for each information product, it would take more than 50 years without sleeping to consult everything that is published online about dengue, Zika, Ebola, and chikungunya.

Conclusion We conclude that public health would benefit from: health institutions implementing formal knowledge management strategies; academic health sciences institutions incorporating formal digital literacy programs; and having health workers who are professionally responsible and functional in the information society.

Se obtuvieron los datos de las temperaturas diarias y se incluyeron en el modelo. Methods A model originally developed for dengue was adapted for Zika. R0 was estimated as a function of seven parameters, three of them were considered temperature-dependent. Seasonal Zika occurrence was evaluated in 9 locations representing different climatic suitability for the vector.

Data of diary temperatures were extracted and included in the model. Sensitivity analyses were performed to evaluate the uncertainty around the results. Results Zika transmission has the potential to occur in all studied locations at least in some moment of the year.

In the northern region, transmission might be possible throughout the whole year or with an interruption in winter. The maximum R0 was estimated in 6. The probabilistic sensitivity analysis showed that during winter the transmission can only be excluded in the southern fringe of geographic distribution of the vector and in part of central Argentina.

Conclusion Zika virus has the potential to be transmitted in Argentina throughout the current geographic range of the mosquito vector. Although the transmission would be mainly seasonal, the possibility of winter transmission cannot be excluded in northern and central Argentina, meaning that there is a potential endemic maintenance of the disease. Methods An exploratory cross-sectional inferential analysis was performed. In order to identify clusters of reported cases, indicators of geographical association were estimated and risk areas established on the basis of environmental determinants validated with estimated relative concentration measurements.

In order to determine the temporal trend and age structure of the cases, growth rates were estimated and density curves constructed. Results The geographic distribution of these hospital discharges in Mexico follows a focalized pattern. In total, a high concentration was detected in clusters made up of 20 municipalities, 9 of which were located in the state of Sinaloa.

Conclusion Geographic information, information on the link found between areas at high risk for transmission of infection due to the presence of the transmitting vector, and information on social conditions such as poverty are useful for designing strategies for the prevention and control of emerging arthropod-borne viral infections, such as the Zika virus, in Mexico. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation.

An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation.

The study population was stratified by sex and age and other general data were extracted, including education and poverty level, measured by the Multidimensional Poverty Index. Data analysis was based on information from people who reported having been victims of the Colombian armed conflict at some time in their lives; the frequency of presentation of non-mental chronic illnesses was reported as a measure of indirect relative risk.

Results Information on 10, people over 18 years of age was described, this being a representative sample at the national level.

It was found that The non-mental chronic illnesses identified were: hypertension Resultados Foram identificados casos de TBP com teste de suscetibilidade. Method The present cross-sectional, epidemiological study focused on PTB cases recorded between January and December in the State Reportable Disease Information System with results of susceptibility tests to rifampicin, isoniazid, ethambutol, and streptomycin.

Dependent variables were development of resistance to a single drug or any combination of drugs. Results There were TBP cases with susceptibility testing. The rates of combined, primary, and acquired resistance for the state were The rates of combined, primary, and acquired multidrug resistance for the state were 1. Conclusions In the border region, the state should investigate drug resistance in all patients with respiratory symptoms, determine the pattern of resistance in confirmed cases, adopt directly observed treatment for cases of PTB, and develop health actions together with neighboring countries.

Across the state, the levels of acquired resistance should be monitored, with investigation of resistance in all treated cases and implementation of directly observed treatment especially among patients with diabetes or alcoholism. Es esencial el seguimiento constante de las mujeres embarazadas para eliminar el aumento de esas enfermedades. The syphilis detection rate in pregnancy and the congenital syphilis incidence rate per 1 live births were calculated.

To identify pregnant women with syphilis who had an outcome of congenital syphilis, the two SINAN databases were linked using the RecLink software. Because the data were representative at the state not national level, comparisons were made between the units of the federation and not with the sum of cases. The incidence of congenital syphilis followed the same trend of growth ranging from The proportion of women with an outcome of congenital syphilis who had prenatal care ranged from Conclusion The increase in the syphilis detection rate may have resulted from an increase in the report rate.

Ongoing monitoring of pregnant women is essential to eliminate syphilis. Methods Data from the Pelotas Birth Cohort was used. Information on breastfeeding was assessed at 12 months of age. Of 5 cohort participants, those with complete data on breastfeeding and externalizing behaviors were included: children at 4 years of age, 1 adolescents at 11 years, and 1 at 15 years. Poisson regression with robust variance was used to assess the association between breastfeeding duration and externalizing behaviors.

However, no association was observed between breastfeeding duration and externalizing behaviors at ages 4 and Conclusions Although breastfeeding for at least 6 months was inversely associated with hyperactivity at 11 years of age no association was observed at 4 and 15 years of age. Further longitudinal studies should focus on other aspects influencing externalizing behaviors, such as presence of the father in the family, domestic violence and abuse, and the quality of mother-child relationship.

Resultados Foram identificadas duas categorias de barreiras, organizacionais e pessoais. Las entrevistas se efectuaron en el y duraron un promedio de 23 minutos. Methods Telephone interviews were performed with 20 health region directors using a semi-structured script.

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