For the 24th consecutive year, PAHO has published the report Health Situation in the Americas: Core Indicators featuring the latest information on key indicators for the Region of the Americas. This 2018 edition includes data on the 82 core indicators for the countries, territories, and sub regions ...of the Americas, grouped into the following categories: demographic-socioeconomic, health status, risk factors, service coverage, and health systems. Information is also presented on 22 indicators of the Sustainable Development Goals (SDGs).
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This paper showed a large positive correlation coefficient between psychosocial health problems and dysfunctional abilities among rural community members
Chagas disease is currently endemic and also predicted to be at increased transmission risk under future climate change scenarios. Similarly, an expansion of areas in the United States at increased risk for Chagas disease transmission is also expected over the next several decades under climate chan...ge scenarios. Of particular interest is the predicted northern shift of triatomine species to central regions of the United States with historically unsuitable climates for T. cruzi vectors. The weight of evidence regarding the influences climate change may pose on T. cruzi vector species distributions demonstrates the sensitivity of Chagas disease transmission to future climate variability. In order to advance forecasts for the impact climate change may have on Chagas disease transmission in the Americas, it is imperative to
further develop, utilize, and perhaps combine predictive species distribution modeling approaches that integrate accurate, long term data on climate variables, vector species distributions, Chagas disease incidence, as well as other socio-ecological variables.
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2nd edition. These guidelines include several notable changes from the first edition. For cutaneous leishmaniasis, ketoconazole has been removed from the list of treatment options; the number of Leishmania species for which there is strong evidence for the efficacy of miltefosine has increased from ...two to four; and the recommendation for intralesional antimonials is now strong. For mucosal leishmaniasis there is now a strong recommendation for use of pentavalent antimonials with or without oral pentoxifylline. For visceral leishmaniasis, the strong recommendations for use of pentavalent antimonials and amphotericin B deoxycholate are now conditional.
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The burden of diabetes is enormous, positioning it as one of the main challenges facing public health today. Currently, it is estimated that 62 million people are living with diabetes in the Region of the Americas and projections show its prevalence will continue rising over the following years. The... Region shows the highest number of years of healthy life lost (through either disability or premature death) due to diabetes worldwide. The high costs associated with its treatment produce a heavy economic burden. Its complications can seriously affect the quality of life of people living with diabetes, their families, and society and overload health systems. This report shows the latest internationally comparable data on diabetes and its main risk factors by year, country, and sex. It also includes a summary of the countries health systems’ response to diabetes, including national plans, targets, surveillance, guidelines, and access to essential drugs and technologies, and synthesizes information about diabetes-related complications and the close relationship between diabetes and other pathologies, such as cardiovascular diseases, tuberculosis, and COVID-19. The data presented here reveal that, despite advances in national responses, diabetes continues to expand, and our response remains insufficient. This report aims to draw attention to the urgent need to strengthen efforts to prevent, diagnose, and control diabetes in the Region of the Americas.
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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operational guidance on further integrating CVD management
• technical guidance on evaluating the impact of... CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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The COVID-19 HEalth caRe wOrkErs Study (HEROES): Regional Report from the Americas is a multicenter prospective cohort study to assess the impact of the COVID-19 pandemic on the mental health of health care workers in 26 countries on four continents and how it is affected by several factors at diffe...rent interrelated levels: individual, family, occupational, and social. This brief report presents the evidence generated from the baseline survey of 11 participating countries in the Region of the Americas. Using validated scales, the findings show high rates of depressive symptoms, suicidal ideation, and psychological distress in several countries of the Region. The spirit of the project is not only to generate quality scientific evidence on the mental health of health care workers, but also to help develop interventions (both individual and institutional) and policies to address the negative impacts of the COVID-19 pandemic on mental health.
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In the Region of the Americas, the leishmaniases are a group of diseases caused by various species of Leishmania, which cause a set of clinical syndromes in infected humans that can involve the skin, mucosa, and visceral organs. The spectrum of clinical disease is varied and depends on the interacti...on of several factors related to the parasite, the vector, and the host. Cutaneous leishmaniasis is the form most frequently reported in the Region and nearly 90% of cases present single or multiple localized lesions. Other cutaneous clinical forms, such as disseminated and diffuse cutaneous leishmaniasis, are more difficult to treat and relapses are common. The mucosal form is serious because it can cause disfigurement and severe disability if not diagnosed and treated early on. Visceral leishmaniasis is the most severe form, as it can cause death in up to 90% of untreated people.
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Key Messages and Recommendations.
The Report, Todos y todas sin excepción, produced by the Global Education Monitoring (GEM) Report and the Regional Bureau for Education in Latin America and the Caribbean (OREALC /UNESCO Santiago), along with the Laboratory of Education, Research and Innovation in... Latin America and the Caribbean (SUMMA) shows that, prior to the pandemic, in 21 countries, children from the richest households were five times as likely as the poorest to complete upper secondary school.
Learning outcomes were low before COVID-19. Only half of 15-year-olds achieved minimum proficiency in reading. In Guatemala and Panama, barely 10 disadvantaged 15-year-old students master basic mathematics skills for every 100 of their better-off peers. Indigenous people and Afro-descendants also have lower attainment and literacy rates.
The report includes a set of key recommendations for the next decade, which will help countries achieve the objectives of the 2030 Agenda and calls for schools to be more inclusive, which many still are not.
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The COVID-19 pandemic is having a major impact on the mental health of populations in the Americas. Studies
show high rates of depression and anxiety, among other psychological symptoms, particularly among women, young
people, those with pre-existing mental health conditions, health workers, and p...ersons living in vulnerable condi-
tions. Mental health systems and services have also been severely disrupted. A lack of financial and human resource
investments in mental health services, limited implementation of the decentralized community-based care approach
and policies to address the mental health gap prior to the pandemic, have all contributed to the current crisis. Coun-
tries must urgently strengthen their mental health responses to COVID-19 by taking actions to scale up mental
health and psychosocial support services for all, reach marginalized and at-risk populations, and build back better
mental health systems and services for the future.
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Global asymmetries influence policies for recovery in Latin America and the Caribbean. Nearly 30 years after the Earth Summit and the global adoption of an international development agenda, in practical terms the environmental pillar of the 2030 Agenda for Sustainable Development has not been taken ...into consideration in recovery policies in the region. This has created major problems in terms of the medium- and long-term direction of regional economies.
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Unmet mental health needs in the Region of the Americas are a leading source of morbidity and mortality, which result in tremendous health, social, and economic consequences. The COVID-19 pandemic has exacerbated the mental health crisis in the Region, necessitating urgent action at the highest leve...ls of government and across sectors to build back better mental health now and for the future. This landmark report is the result of the PAHO High-Level Commission on Mental Health and COVID-19. It provides an analysis of the mental health situation in the Region, followed by a series of recommendations and corresponding actions to support countries in the Americas to prioritize and advance mental health using human rights- and equity-based approaches.
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In the last quarter century, several projects emerged to reform mental health services in Latin American and Caribbean countries. Some did not survive the difficulties that inevitably arise in processes of change, and ended up disappearing before the intended changes could be introduced. Others, how...ever, as shown in this publication, were able to overcome difficulties and meet intended objectives, effectively transforming the structure and quality of services. All these projects, including the many that did not survive, were part of one of the richest experiences in the transformation of mental health care worldwide - the experience of mental health reform in Latin America and the Caribbean
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The cardiovascular disease continuum begins with risk factors such as diabetes mellitus (DM), progresses to vasculopathy and myocardial dysfunction, and finally ends with cardiovascular death. Diabetes is associated with a 2- to 4-fold increased risk for heart failure (HF). Moreover, HF patients wit...h DM have a worse prognosis than those without DM. Diabetes can cause myocardial ischemia via micro- and macrovasculopathy and can directly exert deleterious effects on the myocardium. Hyperglycemia, hyperinsulinemia, and insulin resistance can cause alterations in vascular homeostasis. Then, reduced nitric oxide and increased reactive oxygen species levels favor inflammation leading to atherothrombotic progression and myocardial dysfunction. The classification, diagnosis, and treatment of HF for a patient with and without DM remain the same. Until now, drugs targeting neurohumoral and metabolic pathways improved mortality and morbidity in HF with reduced ejection fraction (HFrEF). Therefore, all HFrEF patients should receive guideline-directed medical therapy. By contrast, drugs modulating neurohumoral activity did not improve survival in HF with preserved ejection fraction (HFpEF) patients. Trials investigating whether sodium-glucose cotransporter-2 inhibitors are effective in HFpEF are on-going. This review will summarize the epidemiology, pathophysiology, and treatment of HF in diabetes.
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The chapter Dementia in Latin America and the Caribbean: Prevalence, Incidence, Impact, and Trends over Time, is part of the publication series titled “Decade of Healthy Aging: situation and challenges”. This document aims to provide an outline of the current situation in Latin America and the C...aribbean in respect of the prevalence and incidence of dementia and its impact on the health status of older people. As dementia is a significant global health problem which also has social and economic impacts this document highlights the importance of monitoring dementia in the region. The document evidences that dementia is one of the main contributors to dependence and disability in older people in Latin America and the Caribbean and, although its prevalence and incidence increase exponentially with age, it is not part of normal aging. Alzheimer’s disease is the most common dementia, and there is no cure for this condition, but with timely diagnosis is possible to ameliorate symptoms. It is important to assess what are the needs of people leaving with dementia and their families and to integrate dementia risk reduction strategies in pre-existing strategies for other non-communicable diseases. As shown in the report, despite the huge burden dementia is still underdiagnosed, and it is fundamental to better monitor its prevalence, incidence and the different societal impact that dementia can have. For that, it is crucial to promote the use of harmonized methodologies to address this information in a broader number of studies and countries in the region. This can contribute to the generation of direct actions to decrease dementia risk and lead to healthier lives for people with dementia and their families.
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Why a 4°C warmer world must be avoided
Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (...SES).
Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.
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New and updated information.
Adverse health effects of hot weather and heat-waves are largely preventable. Prevention requires a portfolio of actions at different levels:from health system preparedness, coordinated with meteorological early warning systems, to timely public ... and medical advice andimprovements to housing and urban planning. This publication offers detailed information for various target audiences, and on medicaladvice and treatment practices
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