Cervical intraepithelial neoplasia (CIN) is a premalignant lesion that may exist at any one of three stages: CIN1, CIN2, or CIN3. If left untreated, CIN2 or CIN3 (collectively referred to as CIN2+) can progress to cervical cancer. Instead of screening and diagnosis by the standard sequence of cytolo...gy, colposcopy, biopsy, and histological confirmation of CIN, an alternative method is to use a ‘screen-and-treat’ approach in which the treatment decision is based on a screening test and treatment is provided soon or, ideally, immediately after a positive screening test. This guideline provides recommendations for strategies for a screen-and-treat programme
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Constituting the fourth part of the World Drug Report 2022, this booklet focuses on the market dynamics of various stimulants – cocaine, amphetamines and “ecstasy” – and of NPS.
The first chapter contains an analysis of the global market for cocaine, starting with a review of cocaine supply..., including trends in the cultivation of coca bush and in the manufacture of and trafficking in cocaine at the global level and in the various regions. An analysis of different eradication strategies is included, as well as of the role of women in the cocaine supply chain. The chapter also presents the latest estimates of and trends in cocaine use, including a brief introduction to the various cocaine consumer products. Finally, it reviews the trends in the use of cocaine and the impact of the coronavirus disease (COVID-19) pandemic in different regions
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The Guidelines on promotive and preventive mental health interventions for adolescents - Helping Adolescents thrive (HAT), provide evidence-informed recommendations on psychosocial interventions to promote mental health, prevent mental disorders, and reduce self-harm and other risk behaviours among ...adolescents.
The HAT Guidelines aims to inform policy development, service planning and the strengthening of health and education systems, and facilitate mainstreaming of adolescent mental health promotion and prevention strategies across sectors and delivery platforms.
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The purpose of this guide is to offer recommendations for improving the implementation of non‑pharmacological public health measures during the COVID-19 response and compliance with these measures by population groups in situations of vulnerability. This requires determining the main barriers to i...mplementing these measures so that we can identify the groups and territories most affected during the different phases of the pandemic. With this objective in mind––and within the framework of an equity, human rights, and diversity approach––, policies, strategies, and interventions to accompany the implementation and flexibilization of the measures are recommended to ensure that no one is left behind.
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El documento "Lista de productos sanitarios prioritarios para la respuesta a COVID-19 y especificaciones técnicas asociadas" complementa esta directriz.
Este documento proporciona una orientación provisional sobre la calidad, las características de rendimiento y las normas conexas de los equi...pos de protección personal (EPP) que se utilizarán en el contexto de COVID-19. Esto incluye los productos sanitarios prioritarios de la OMS, concretamente: mascarillas quirúrgicas, mascarillas no quirúrgicas, guantes, gafas, protectores faciales, batas y mascarillas N95. Está dirigido a los organismos de adquisición, los departamentos de salud laboral, los departamentos o puntos focales de prevención y control de infecciones, los administradores de los centros de salud, la ingeniería biomédica y de materiales, los fabricantes de EPI y las autoridades de salud pública, tanto a nivel nacional como de los centros.
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A module from the suite of health service capacity assessments in the context of the COVID-19 pandemicINTERIM GUIDANCE5 February2021
The Community needs, perceptions and demand: community assessment toolcan be used by countries to conduct a rapid pulse survey of community health needs and perceptio...ns around effective use of essential health services during the COVID-19 outbreak. The assessment helps to establish an early warning system on the need to implement coping strategies to continue to respond to communities’ health needs throughout the course of the pandemic. This assessment tool is informed by WHO and partner tools and guidance on community health needs, continuity of essential health services and readiness planning for COVID-19
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El documento WHO Guidance on community mental health services: Promoción de enfoques centrados en la persona y basados en los derechos humanos forma parte del conjunto de publicaciones de la OMS Orientación y paquetes técnicos sobre servicios comunitarios de salud mental. Ofrece una descripción ...detallada de los enfoques de salud mental centrados en la persona y basados en los derechos humanos, así como ejemplos resumidos de servicios de buenas prácticas en todo el mundo. Describe los vínculos necesarios con los sectores de la vivienda, la educación, el empleo y la protección social, y presenta ejemplos de redes regionales y nacionales integradas de servicios comunitarios de salud mental. Se presentan recomendaciones específicas y pasos de acción para desarrollar servicios de salud mental comunitarios que respeten los derechos humanos y se centren en la recuperación. Este exhaustivo documento va acompañado de un conjunto de siete paquetes técnicos centrados en categorías específicas de servicios de salud mental y de orientaciones para la creación de nuevos servicios.
Orientaciones de la OMS sobre los servicios comunitarios de salud mental: Promover enfoques centrados en la persona y basados en los derechos es un conjunto de publicaciones que proporciona información y apoyo a todas las partes interesadas que deseen desarrollar o transformar su sistema y servicios de salud mental para que se ajusten a las normas internacionales de derechos humanos, incluida la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad.
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Este documento de referência foi preparado pelo Grupo de Trabalho sobre Vacinas contra COVID-19 do Grupo Consultivo Estratégico de Especialistas em Imunização (SAGE) para orientar as discussões do SAGE em sua reunião extraordinária de 8 de fevereiro de 2021, que resultou na publicação do do...cumento da OMS de 10 de fevereiro de 2021 Recomendações provisórias para o uso da vacina AZD1222 [ChAdOx1-S (recombinante)] contra COVID-19 desenvolvida pela Universidade de Oxford e pela AstraZeneca. Os dois documentos estão disponíveis na página sobre COVID-19 do SAGE: https://www.who.int/groups/strategic-advisory-group-of-experts-on-immunization/covid-19-materials. Têm sido usados vetores de adenovírus deficientes na replicação contendo um transgene específico do patógeno como novas vacinas devido à sua capacidade de induzir respostas humorais e celulares fortes.
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This publication presents the Agenda for the Americas on Health, Environment, and Climate Change 2021–2030 (the Agenda). The Agenda is a call to action to the health sector to lead the charge to address environmental determinants of health in the Americas. The Pan American Health Organization (PAH...O) will work with Member States to achieve its goal and objective to ensure healthy lives and promote well-being for all at all ages using a sustainable and equitable approach that places a priority on reducing health inequity. The Agenda has been developed under the umbrella of the WHO Global Strategy on Health, Environment, and Climate Change, and builds upon the commitments set forth in the Sustainable Health Agenda for the Americas 2018–2030 and the PAHO Strategic Plan 2020–2025. The Agenda was developed in consultation with the Technical Advisory Group and through a consensus-driven decision-making process with Member States during the 2019–2020 period. Looking toward the achievement of Sustainable Development Goal 3, the Agenda focuses on: improving the performance of environmental public health programs and institutions; fostering environmentally resilient and sustainable health systems; and promoting environmentally healthy and resilient cities and communities. Its implementation will be context-specific, based on the needs and realities of the countries. It will benefit countries and territories by promoting good governance practices, strengthening the leadership and coordination roles of the health sector, fostering cross-sectoral action, focusing on primary prevention, and enhancing evidence and communication. It will facilitate access to human, technical, and financial resources necessary to address environmental determinants of health and ensure that the Region is fully engaged in global health, environment, and climate change processes and agreements. The objective of the Agenda is to strengthen the capacity of health actors in the health and non-health sectors to address and adapt to environmental determinants of health (EDHs), prioritizing populations living in conditions of vulnerability, in order to meet Outcome 18 of the PAHO Strategic Plan 2020–2025 directly and several other outcomes of the Plan indirectly. To address and adapt to the challenges of EDHs in the Region, an integrated and evidence-informed approach within the health sector and across sectors will be needed, one enabled, and supported by good governance practices, adequate management mechanisms, high-level political will, and adequate human, technical, technological, and financial resources.
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Checklist to support the reopening of schools and preparation for resurgences of COVID-19 or similar public health crises.
O objetivo desta lista de verificação é reforçar a conformidade e a adesão às medidas de saúde pública delineadas no documento recentemente atualizado Considerations fo...r school-related public health measures in the context of COVID-19 [Considerações para medidas de saúde pública relacionadas a escolas no contexto da COVID-19], considerando-se principalmente as crianças menores de 18 anos em contextos educacionais e em escolas com recursos limitados. A lista de verificação foi elaborada de acordo com os princípios e as abordagens das escolas promotoras de saúde.7,8 Este documento destaca a importância da coordenação multinível (ou seja, nos níveis escolar, subnacional e nacional) e de abordagens participativas e cocriadas pelas várias partes interessadas (por exemplo, trabalhadores das escolas, professores, alunos e pais). Esta abordagem visa a otimizar o cumprimento das medidas sociais e de saúde pública baseadas nos contextos sociais e culturais, conforme descrito no documento Considerations for implementing and adjusting public health and social measures in the context of COVID-19 [Considerações para a implementação e ajuste de medidas sociais e de saúde pública no contexto da COVID-19].
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The marathon to eradicate polio is on its final lap: the world is more than 99% of the way to success. After millennia of living with poliovirus and suffering the paralysis it causes, today nearly all the world’s people live in polio-free countries; two of the three strains of wild poliovirus (WPV...) have been eradicated. Some 20 million people are walking who would have been paralysed had it not been for the efforts of national governments and health workers. If eradicating polio has been a marathon, the finishing line is in sight.
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La presente guía tiene además como objetivo, ser un respaldo y no una camisa de fuerza para los médicos, pues pretendemos con ella proveer evidencia sólida respecto a los riesgos, beneficios o consecuencias que puede generar la toma de una decisión en pacientes con tuberculosis. Como lo propone... el Ministerio Nacional de Salud en sus normas técnicas, se busca un manejo integral del niño con tuberculosis pulmonar, asegurando la oportunidad, la eficiencia y la calidad de la atención.
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Despite the continuing war in Ukraine, the Government is preparing for the country’s recovery and reconstruction. Given the magnitude of the attacks on the health infrastructure and consequent disruption to health system functioning, reconstruction of the health system is integral to the country...s recovery. The immediate priorities are to restore essential services, respond to new physical and mental health needs, protect public health, and provide a secure and attractive environment for the return of both health professionals and the general population. This policy note identifies strategic directions for post-war health system recovery in the short and longer terms, while sustaining essential health services during the ongoing invasion
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Las infecciones del sitio quirúrgico (ISQ) constituyen una de las Infecciones Asociadas al Cuidado de la Salud (IACS) más frecuentes que ponen en riesgo a los pacientes llevando muchas veces al fracaso del procedimiento quirúrgico. Con una incidencia mucho mayor en países de medianos y bajos ing...resos, representa un desafío de la práctica médica cotidiana que compromete la salud y la seguridad de los pacientes. La indicación de profilaxis primaria con antibióticos en relación a los procedimientos invasivos, tiene como objetivo disminuir la incidencia de infecciones con la consecuente disminución de la morbimortalidad debiendo utilizarse únicamente en aquellos procedimientos en los que hay evidencia de efectividad. Cabe destacar que la indicación inadecuada, tiene potenciales efectos adversos tales como infecciones por Clostridium difficile, emergencia de resistencia
bacteriana, reacciones adversas a drogas e incremento de los costos en salud.
La profilaxis antibiótica como complemento de una buena técnica quirúrgica, es una medida costo efectiva de prevención de las ISQ representando alrededor del 30% de la indicación de antibióticos entre los pacientes hospitalizados. Dado que en algunos estudios el uso inapropiado de antibióticos se ve reflejado en el 40 al
80% de las indicaciones médicas, desde la Comisión de Infecciones Asociadas al Cuidado de la Salud y Seguridad del Paciente de SADI hemos realizado una actualización de la evidencia disponible. Este documento es una acción complementaria al consenso “Prevención de Infección del Sitio Quirúrgico” realizado entre SADI y el Instituto Nacional de Epidemiología “J. Jara” durante el Congreso de SADI 2015.
La posibilidad de contar con una guía actualizada de profilaxis quirúrgica adaptada a nuestro medio, constituye una herramienta de uso cotidiano por parte de los profesionales del equipo quirúrgico que permite la optimización de la utilización de fármacos restringiendo así la emergencia y diseminación de la resistencia bacteriana. Sin duda esperamos que pueda ser de utilidad para el equipo de salud.
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In 1997, the Fiftieth World Health Assembly adopted resolution WHA50.29 on the elimination of
lymphatic filariasis as a public health problem. Preliminary guidance from WHO printed in 2011 referred to “verification” as the official process by which the achievements of the Global Programme to El...iminate Lymphatic Filariasis (GPELF) would be confirmed. For the sake of harmonization, the terminology now used for elimination of lymphatic filariasis as a public health problem is “validation”. In 2015, the WHO Strategic and Technical Advisory Group for Neglected Tropical Diseases endorsed standardized processes for confirming and acknowledging success for all neglected tropical diseases targeted for eradication, elimination of transmission, or elimination as a public health problem.
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As countries aim to progress towards the Sustainable Development Goals (SDGs) and achieving universal health coverage, health inequities driven by racial discrimination and intersecting factors remain pervasive. Inequities experienced by indigenous peoples as well as people of African descent, Roma ...and other ethnic minorities are of concern globally; they are unjust, preventable and remediable.
Health systems themselves are important determinants of health and health equity. They can perpetuate health inequities by reflecting structural racism and discriminatory practices of wider society. For instance, systemic racism, implicit bias, misinformed clinical practice, or discrimination by health professionals contributes to health inequities. However, health systems can also be a leading force for tackling the inequities faced by populations experiencing racial discrimination.
Primary health care (PHC) is the essential strategy for reorientating health systems and societies to become healthier, equitable, effective and sustainable. In 2018, on the 40th anniversary of the Declaration of Alma-Ata, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) renewed the emphasis on PHC with their strategy,
WHO outlines 14 strategic and operational levers for policy-makers to strengthen PHC. Within each lever, there are multiple potential entry points for targeted actions to address racial discrimination, foster intercultural care, and reduce health inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities.
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Population movements have turned Chagas disease (CD) into a global public health problem. Despite the successful implementation of subregional initiatives to control vectorial and transfusional Trypanosoma cruzi transmission in Latin American settings where the disease is endemic, congenital CD (cCD...) remains a significant challenge. In countries where the disease is not endemic, vertical transmission plays a key role in CD expansion and is the main focus of its control. Although several health organizations provide general protocols for cCD control, its management in each geopolitical region depends on local authorities, which has resulted in a multitude of approaches. The aims of this review are to (i) describe the current global situation in CD management, with emphasis on congenital infection, and (ii) summarize the spectrum of available strategies, both official and unofficial, for cCD prevention and control in countries of endemicity and nonendemicity. From an economic point of view, the early detection and treatment of cCD are cost-effective. However, in countries where the disease is not endemic, national health policies for cCD control are nonexistent, and official regional protocols are scarce and restricted to Europe. Countries of endemicity have more protocols in place, but the implementation of diagnostic methods is hampered by economic constraints. Moreover, most protocols in both countries where the disease is endemic and those where it is not endemic have yet to incorporate recently developed technologies. The wide methodological diversity in cCD diagnostic algorithms reflects the lack of a consensus. This review may represent a first step toward the development of a common strategy, which will require the collaboration of health organizations, governments, and experts in the field.
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The waves of yellow fever transmission in the Region of the Americas in 2016–2018 involved the largest number of human and epizootic cases to be reported in several decades. Yellow fever is a serious viral hemorrhagic disease that poses a challenge for health professionals. It requires early recog...nition of signs and symptoms, which are often nonspecific, and it can mimic other acute febrile syndromes. Early detection of suspected or confirmed cases, monitoring of vital signs, life support measures, and treatment of acute kidney failure continue to be the recommended strategies for case management. This report is the result of discussions among experienced specialists in the Americas on the clinical management of yellow fever patients, especially during outbreaks and epidemics, in the context of current medical and scientific evidence and taking into account the technical guidelines already available in the countries of the Region. It includes flowcharts for initially addressing patients with clinical suspicion of yellow fever and proposes a minimum package of laboratory tests that may be useful in contexts where resources are limited. In addition, it considers aspects of health system organization for dealing with yellow fever outbreaks and epidemics.
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