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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Cette publication présente le Programme sur la santé, l’environnement et les changements climatiques pour les Amériques 2021-2030. Le Programme est un appel à l’action au secteur de la santé pour qu’il prenne l’initiative d’agir sur les déterminants environnementaux de la santé dans... les Amériques. L’Organisation panaméricaine de la Santé (OPS) travaillera avec les États Membres pour atteindre son but et son objectif, qui consistent à permettre à tous de vivre en bonne santé et à promouvoir le bien-être de tous à tout âge, en employant une approche durable et équitable qui accorde la priorité à la réduction des iniquités en matière de santé. Le programme a été élaboré sous l’égide de la Stratégie mondiale de l’OMS sur la santé, l’environnement et les changements climatiques et s’appuie sur les engagements énoncés dans le Programme d’action sanitaire durable pour les Amériques 2018-2030 et le Plan stratégique de l’OPS 2020-2025. Le programme a été élaboré en consultation avec le groupe consultatif technique et par un processus décisionnel consensuel avec les États Membres au cours de la période 2019-2020. En vue de la réalisation de l’objectif de développement durable 3, le programme se concentre sur l’amélioration de la performance des programmes et des institutions de santé publique environnementale, la promotion de systèmes de santé résilients et durables sur le plan environnemental et la promotion de villes et de communautés saines et résilientes sur le plan environnemental. Sa mise en œuvre sera adaptée au contexte, en fonction des besoins et des réalités des pays. Il profitera aux pays et aux territoires en encourageant les pratiques de bonne gouvernance, en renforçant les rôles de leadership et de coordination du secteur de la santé, en favorisant l’action intersectorielle, en se concentrant sur la prévention primaire et en améliorant les données probantes et la communication. Il facilitera l’accès aux ressources humaines, techniques et financières nécessaires pour agir sur les déterminants environnementaux de la santé et fera en sorte que la Région soit pleinement engagée dans les processus et les accords mondiaux en matière de santé, d’environnement et de changements climatiques.
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Some observers have described the coronavirus pandemic as an 'Anthropocene disease,' thereby highlighting its connection with this new ecological era that is characterised by the considerable pressure human activities are exerting on ecosystems and the consequences on public health, society and the ...environment. This article focuses on the recent emergence of the 'Planetary Health' paradigm. Launched by the Rockefeller Foundation and the medical journal The Lancet, Planetary Health is one of the most ambitious attempts in recent years to systematize global health in the Anthropocene. While recognising the interest and necessity of reflecting on human health and the health of the planet, this article aims to show, however, that the Planetary Health paradigm is problematic and aporetic for two reasons. First, because it is based on a scientistic and depoliticised conception of the Anthropocene, which obscures capitalism's responsibility for the contemporary global and, especially, ecological crisis. Second, because this conception leads to a promotion of solutions that are essentially based on the financialization and technoscientific management of the living world - precisely the underlying cause of the degradation of ecosystems and living conditions that created the Anthropocene in the first place. A different kind of 'planetary health' remains possible and desirable.
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Our target end-users are those with limited literacy. It is a challenging task to achieve success in this group as so much of what is "obvious" to those of us with good literacy skills is totally obscure to those who have never had the opportunity to learn the meaning of e.g. an arrow shape and what... it is meant to represent. Our pictograms have been tested mainly in our local Xhosa population, so we cannot guarantee universal generalisability (as is the case for any other pictograms). Categories in the database include Dosage and frequency; Route of administration; Additional medicine instructions; Side effects or indications; Storage of medicines; Tablets, capsules, bottles, droppers; Miscellaneous; TB-related pictograms
A common application relates to their use with medicines where they may serve to convey instructions, precautions, storage requirements, warnings, as well as medicine indication or side effects to patients or consumers. Many examples of diverse application of pictograms in the health literature have been described including health promotion materials, wound care instructions, asthma prevention and treatment, injury prevention, discharge instructions, self-care guidance, paediatric anaphylaxis plan, organ and body donation, CT scan risks and benefits, driving risks, safety symbols, decision aids for treatment, and patient-reported outcomes dashboards, amongst others.
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Introduction: Considering the global prevalence of coronavirus disease 2019 (COVID-19), a vaccine is being developed to control the disease as a complementary solution to hygiene measures—and better, in social terms, than social distancing. Given that a vaccine will eventually be produced, informa...tion will be needed to support a potential campaign to promote vaccination.
Objective: The aim of this study was to determine the variables affecting the likelihood of refusal and indecision toward a vaccine against COVID-19 and to determine the acceptance of the vaccine for different scenarios of effectiveness and side effects.
Materials and Methods: A multinomial logistic regression method based on the Health Belief Model was used to estimate the current methodology, using data obtained by an online anonymous survey of 370 respondents in Chile.
Results: The results indicate that 49% of respondents were willing to be vaccinated, with 28% undecided or 77% of individuals who would potentially be willing to be inoculated. The main variables that explained the probability of rejection or indecision were associated with the severity of COVID-19, such as, the side effects and effectiveness of the vaccine; perceived benefits, including immunity, decreased fear of contagion, and the protection of oneself and the environment; action signals, such as, responses from ones' family and the government, available information, and specialists' recommendations; and susceptibility, including the contagion rate per 1,000 inhabitants and relatives with COVID-19, among others. Our analysis of hypothetical vaccine scenarios revealed that individuals preferred less risky vaccines in terms of fewer side effects, rather than effectiveness. Additionally, the variables that explained the indecision toward or rejection of a potential COVID-19 vaccine could be used in designing public health policies.
Conclusions: We discovered that it is necessary to formulate specific, differentiated vaccination-promotion strategies for the anti-vaccine and undecided groups based on the factors that explain the probability of individuals refusing or expressing hesitation toward vaccination.
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Cholera is a transmissible diarrhoeal infection caused by Vibrio cholerae. Endemic and/or epidemic in over 40 countries (mainly in Africa and Asia), cholera continues to be a major global public health issue.
The World Health Organization (WHO) estimates that the number of cases reported worldwid...e represents in reality only 5 to 10% of actual cases.
This guide is intended for medical and non-medical staff responding to a cholera outbreak. It attempts to provide concrete answers to the questions and problems faced by staff, based on the recommendations of reference organisations, such as WHO and UNICEF, as well as Médecins Sans Frontières’ experience in the field.
It is divided into 8 chapters. Chapter 1, Cholera overview, outlines the epidemiological and clinical features of cholera. Chapter 2, Outbreak investigation, explains the method and stages of a field investigation, from the alert to implementation of initial activities. Chapter 3, Cholera control measures, details measures and tools to prevent and/or control cholera transmission and mortality in populations affected, or at risk of being affected, by an epidemic (curative care, prevention means and health promotion activities). Chapter 4, Strategies for epidemic response, addresses the roll-out strategies of the measures described in Chapter 3 which depend on context (e.g. urban, rural, endemic, non-endemic setting, etc.), resources and particular constraints. Chapter 5, Cholera case management, details the different stages of cholera treatment, from diagnosis through to cure.
Chapter 6, Setting up cholera treatment facilities, focuses on the installation of treatment facilities that vary in size and complexity according to operational requirements (treatment centres and units and oral rehydration points). Chapter 7, Organisation of cholera treatment facilities, describes the organisation of these specialized facilities in terms of human resources, supply, water, hygiene and sanitation, etc. Chapter 8, Monitoring and evaluation, presents the key data to be collected and analysed during an epidemic to facilitate a tailored response and evaluate its quality and effectiveness.
The guide includes various practical tools in the appendices to facilitate activities (e.g. water quality tests, job descriptions, documents, etc.). Moreover, the toolbox also contains additional tools in editable formats (individual patient file, cholera case register, pictograms).
Despite all efforts, it is possible that certain errors may have been overlooked in this guide. Please inform the authors of any errors detected.
To ensure that this guide continues to evolve while remaining adapted to field realities, please send any comments or suggestions.
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The burden of diabetes is high and increasing globally, and in developing economies like India, mainly fueled by the increasing prevalence of overweight/obesity and unhealthy lifestyles. The estimates in 2019 showed that 77 million individuals had diabetes in India, which is expected to rise to over... 134 million by 2045. Approximately 57% of these individuals remain undiagnosed. Type 2 diabetes, which accounts for majority of the cases, can lead to multiorgan complications, broadly divided into microvascular and macrovascular complications. These complications are a significant cause for increased premature morbidity and mortality among individuals with diabetes, leading to reduced life expectancy and financial and other costs of diabetes leading to profound economic burden on the Indian health care system. The risk for diabetes is largely influence by ethnicity, age, obesity and physical inactivity, unhealthy diet, and behavioral habits in addition to genetics and family history. Good control of blood sugar blood pressure and blood lipid levels can prevent and/or delay the onset of diabetes complications. The prevention and management of diabetes and associated complications is a huge challenge in India due to several issues and barriers, including lack of multisectoral approach, surveillance data, awareness regarding diabetes, its risk factors and complications, access to health care settings, access to affordable medicines, etc. Thus, effective health promotion and primary prevention, at both, individual and population levels are the need of the hour to curb the diabetes epidemic and reduce diabetes-related complications in India
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The document "J-esyon ak bon manipilasyon manje yo" focuses on proper food handling and hygiene practices to prevent contamination and foodborne illnesses. It provides comprehensive guidelines for individuals and communities, emphasizing the importance of food safety. Key recommendations include kee...ping raw and cooked foods separate, ensuring thorough cooking of perishable items like meat and fish, and checking canned goods for damage or expiration before use. It stresses the need to use treated or boiled water for cooking, drinking, and washing food, as contaminated water can lead to diseases such as diarrhea, typhoid, and skin infections.
The document also highlights critical hygiene practices, such as washing hands with soap and treated water before handling food or eating, and thoroughly cleaning food preparation areas. Proper storage of food at suitable temperatures to prevent spoilage is another key focus, along with protecting food from animals, insects, and other sources of contamination. Overall, the manual emphasizes that maintaining proper hygiene and safe food handling practices is vital for preventing illnesses and promoting public health, making it a valuable resource for educating communities on food safety.
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The document focuses on household water treatment methods to ensure access to safe drinking water, particularly in areas with limited access to clean water sources. It highlights the importance of safe water, noting that contaminated water is a major cause of waterborne diseases such as diarrhea and... cholera. Treating water at the household level is emphasized as an effective way to reduce health risks.
The document outlines several treatment methods, including boiling, which kills most pathogens; chlorination, which disinfects water by adding chlorine; filtration, which removes dirt and certain microbes using simple or advanced filters; and solar disinfection (SODIS), which involves exposing water in clear plastic bottles to sunlight for several hours to kill microbes. Additionally, it stresses the importance of safe water storage, such as using clean and covered containers to prevent recontamination, and practicing good hygiene, including regular handwashing and maintaining cleanliness around water sources.
By promoting these methods, the document aims to raise awareness and provide practical solutions for improving water quality at the household level, thereby reducing the spread of diseases and enhancing public health.
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Esta publicação apresenta a Agenda para as Américas sobre Saúde, Meio Ambiente e Mudança Climática 2021–2030 (a Agenda). Esta Agenda é um apelo ao setor da saúde para que se posicione na vanguarda da abordagem aos determinantes ambientais da saúde nas Américas. A Organização Pan-Americ...ana da Saúde (OPAS) trabalhará com os Estados Membros para alcançar a meta e objetivo desta agenda: assegurar uma vida saudável e promover o bem-estar para todos, em todas as idades, usando um enfoque sustentável e equitativo que priorize a redução das iniquidades em saúde. A Agenda foi desenvolvido sob a égide da Estratégia Mundial da Organização Mundial da Saúde (OMS) sobre a Saúde, o Meio Ambiente e a Mudança Climática e se baseia nos compromissos estabelecidos na Agenda de Saúde Sustentável para as Américas 2018–2030 e no Plano Estratégico da OPAS 2020–2025. A Agenda foi desenvolvida em consulta com o Grupo Técnico Assessor (GTA), por meio de um processo decisório consensual com os Estados Membros, durante os anos de 2019 e 2020. Para alcançar o Objetivo de Desenvolvimento Sustentável 3, a Agenda enfoca: melhoria do desempenho dos programas e instituições de saúde pública ambiental; promoção de sistemas de saúde ambientalmente resilientes e sustentáveis; e promoção de cidades e comunidades ambientalmente saudáveis e resilientes. A implementação da Agenda deverá ser contextual, com base nas necessidades e realidades de cada país. Ela beneficiará países e territórios ao promover boas práticas de governança; fortalecer as funções de liderança e coordenação do setor da saúde; favorecer ações intersetoriais; focar na prevenção primária; e melhorar as evidências e a comunicação. Facilitará o acesso aos recursos humanos, técnicos e financeiros necessários para abordar os determinantes ambientais da saúde e garantir que a Região esteja totalmente engajada nos processos e acordos globais de saúde, meio ambiente e mudança climática. O objetivo desta Agenda é fortalecer a capacidade dos atores da saúde, tanto no setor da saúde quanto em outros setores, para abordarem e se adaptarem aos determinantes ambientais da saúde (DAS), priorizando as populações que vivem em condições de vulnerabilidade, a fim de atingir o Resultado Intermediário 18 do Plano Estratégico da OPAS 2020–2025, diretamente, e vários outros resultados do Plano, indiretamente. Para enfrentar e se adaptar aos desafios dos DEA na Região, será necessária uma abordagem integrada e baseada em evidências dentro do setor da saúde e entre os setores, possibilitada e favorecida por boas práticas de governança, mecanismos de gestão adequados, vontade política de alto nível e dotação adequada de recursos humanos, técnicos, tecnológicos e financeiros.
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In the face of rapid increases in the number of hospitalizations due to COVID-19 in Latin America and the Caribbean, coupled with shortages of human and material resources, including medical equipment and gases, there is a need to redesign models of care in the Region to optimize available resources... and ensure that more patients receive the quantity and quality of oxygen they need. Oxygen is included in the World Health Organization’s list of essential medicines and is used to care for patients at all levels of integrated health services networks. The efficacy of oxygen use in the treatment of patients with respiratory conditions caused by COVID-19 has been demonstrated, but there is great opportunity to improve the effectiveness of its use if it is used in a rational, sustainable, and safe way. Bearing in mind that the efficacy of a health technology is measured by its benefit under actual conditions of use, practical actions can be taken to improve the use of medical oxygen and avoid oxygen shortages. A drug is considered to be used rationally when patients receive it according to their clinical needs, in doses appropriate to their individual needs, for an appropriate period, and at a low cost to them and their community. By providing instruction on the rational use of oxygen and promoting it, negative repercussions can be avoided, such as loss of efficacy as a result of activities related to oxygen storage, distribution, and administration. Rational use of oxygen also involves controlling waste due to leaks in storage and distribution systems, use of gas at incorrect pressures, use of incorrectly adjusted flowmeters, and disconnections, among other problems. Another aspect to consider is the provision of adequate technical support for all oxygen production systems, in terms of maintenance and calibration, availability of electrical energy, and specific knowledge about these systems. For these reasons, a set of guidelines has been put together for the development of an efficient management system to deal with situations of oxygen scarcity, both now and in the future.
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Background
The core clinical symptoms of addiction include an enhanced incentive for drug taking (craving), impaired self-control (impulsivity and compulsivity), emotional dysregulation (negative mood) and increased stress reactivity. Symptoms related to impaired self-control involve reduced activi...ty in anterior cingulate cortex (ACC), adjacent prefrontal cortex (mPFC) and other brain areas. Behavioral training such as mindfulness meditation can increase the function of control networks including those leading to improved emotion regulation and thus may be a promising approach for the treatment of addiction.
Methods
In a series of randomized controlled trials (RCTs), we tested whether increased ACC/mPFC activity is related to better self-control abilities in executive functions, emotion regulation and stress response in healthy and addicted populations. After a brief mindfulness training (Integrative Body-Mind Training, IBMT), we used the Positive and Negative Affect Schedule (PANAS) and Profile of Mood States (POMS) to measure emotion regulation, salivary cortisol for the stress response and fMRI for brain functional and DTI structural changes. Relaxation training was used to serve as an active control.
Results
In both smokers and nonsmokers, improved self-control abilities in emotion regulation and stress reduction were found after training and these changes were related to increased ACC/mPFC activity following training. Compared with nonsmokers, smokers showed reduced ACC/mPFC activity in the self-control network before training, and these deficits were ameliorated after training.
Conclusions
These results indicate that promoting emotion regulation and improving ACC/mPFC brain activity can help for addiction prevention and treatment.
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In Latin America and the Caribbean (LAC), one maternal death was registered every hour in 2020. That same year, the trend in the maternal mortality ratio (MMR) for the Region of the Americas regressed alarmingly and unprecedentedly to the levels seen two decades ago. In addition to indicating a wors...ening of health outcomes, these figures also signal a deepening of inequalities, representing thousands of individual, unacceptable tragedies that in most cases could have been preventable. Maternal death is the result of a multifactorial process in which structural elements such as the economic system, environmental conditions, and culture interact. Other factors related to social inequality are also present, such as racism, poverty, gender inequality, and lack of access to the education system. The current situation calls for urgent mobilization of the health systems of LAC countries in order to strengthen efforts to combat maternal mortality, especially in countries that are still far from achieving the SHAA2030 regional target. For this reason, a preventive, health-promoting, life-course-based approach is needed, with models of care centered on women, families, and the community Scientific evidence shows that health systems with a solid foundation in primary health care (PHC) achieve better outcomes, greater equity, and reduced health expenditures. To address this, PAHO proposes a strategy, aimed primarily at women who are in the most vulnerable situation, who are the ones who represent the greatest burden of maternal mortality, to accelerate the reduction of maternal mortality in the Region of the Americas, based on the expansion and strengthening of PHC.
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Advancing Health, Learning and Equity through WASH in Schools