Search Results (59)

Group A rotaviruses (RVAs) remain the leading cause of acute gastroenteritis (AGE) in young children in low- and middle-income countries. In Brazil, the oral attenuated RVA vaccine (Rotarix^®), monovalent genotype G1P[8], is distributed by the national immunization program and has drastically reduced morbidity and mortality associated with RVA etiology. In this study, Rotarix^® G1P[8] was detected using specific qRT-PCR from the fecal shedding of children living in the Amazon region, and 18.3% (29/158) were positive and 75.8% (22/29) presented with AGE. The VP4 (VP8*) gene of these sheddings, submitted to Sanger nucleotide sequencing, showed an occurrence of mutations, including the silent mutation at 144C > G (one child) and the following missense mutations— 499T > C (F167L) (two children), 644G > C (C215S) (one child), and 787G > A (E263K) (one child). These mutations had no impact on the protein model structure in silico deduced from the VP4 (VP8*) mutants. The in silico protein model deduced from the VP4 (VP8*) nucleotide sequences, bound to type 1H sugar antigens (H1) and its precursor Lac-para-N-biose (LNB), had a stronger binding to the G1P[8] genotype, when compared to G3P[8]. Rotarix^® shedding was higher in HBGA secretors than in non-secretors (79.3%; 23/29). A total of 11.4% (18/158) of children with Rotarix^® G1P[8] shedding were unvaccinated, indicating the occurrence of indirect protection. Stability evidence of Rotarix^® VP4 (VP8*) spike protein from samples collected in vivo is presented. Full article

Objective: To provide a narrative overview of the scientific knowledge on Last Aid Courses and experiences from different countries. Background: The levels of death literacy, grief literacy, and knowledge about palliative care are low in many countries around the world. For many people, dying, death, and grief are still a taboo. Public Palliative Care Education (PPCE), the public knowledge approach, and the Last Aid Course (LAC) aim to increase death literacy, grief literacy, and public knowledge about palliative care. Methods: A literature search in the databases PubMed/Medline, CINAHL, and PsycInfo was undertaken. Other additional sources were found by hand searching, books, reference lists, and the internet. A narrative overview of the existing literature on LAC and Public Palliative Care Education (PPCE) is provided. Experiences with PPCE and LAC from different countries are presented. Based on the findings, a future agenda for research on PPCE and LAC is presented. Results and Discussion: PPCE and LAC have been introduced in 23 countries. A total of 17 articles and reviews on Last Aid were included. Research on the effects of LAC in different countries and cultural issues connected to LAC are ongoing. Conclusions: Since 2015, LACs have been introduced in 23 different countries. The LAC, the LAC-KT, and PPCE may enhance the public debate on dying, death, grief, and palliative care and may empower people to contribute to end-of-life care in the community. Future research on PPCE, the LAC, and the LAC-KT should focus on retention over time and the long-term effects of the courses. Full article

Our research explores the dynamic relationship between CO₂ emissions and four major influencing factors: foreign direct investment (FDI), economic growth (GDP), renewable energy consumption (REN) and population (POP) in the Association of Southeast Asian Nations (ASEAN) and three large Asian countries—China, India and Pakistan, collectively referred to as LACs (larger Asian countries), from 1990 to 2022. The study has three main objectives: (1) to assess the short-run and long-run effects of GDP, FDI, REN and POP on CO₂ emissions; (2) to compare the adjustment speeds and environmental policy responsiveness between ASEAN and LAC regions; and (3) to evaluate the role of renewable energy in mitigating environmental degradation. Against the backdrop of increasing environmental challenges and divergent development paths in Asia, this research contributes to the literature by applying a dynamic heterogeneous panel autoregressive distributed lag (panel ARDL) model. Unlike traditional static panel models, the panel ARDL model captures both long-run equilibrium relationships and short-run adjustments, allowing for country-specific dynamics. The results reveal a significant long-run cointegration among the variables. The error correction term (ECT) indicates a faster adjustment to equilibrium in LACs (−1.18) than ASEAN (−0.37), suggesting LACs respond more swiftly to long-run disequilibria in emissions-related dynamics. This may reflect more responsive policy mechanisms, stronger institutional capacities or more aggressive environmental interventions in LACs. In contrast, the slower adjustment in ASEAN highlights potential structural rigidities or delays in implementing effective policy responses, emphasizing the need for enhanced regulatory frameworks and targeted climate strategies to improve policy intervention efficiency. Results show that GDP and FDI increase emissions in both regions, while REN reduces them. POP is insignificant in ASEAN but increases emissions in LACs. These results provide insights into the relative effectiveness of policy instruments in accelerating the transition to a low-carbon economy, highlighting the need for differentiated strategies that align with each country’s institutional capacity, development stage and energy structure. Full article

This study examines the impact of financial inclusion (FI) on reducing poverty and income inequality in Latin America and the Caribbean (LAC), using panel data from 15 countries for the period 2004–2021. System GMM with robust errors was used to address endogeneity issues, and FI was assessed in terms of access to and use of the financial system. The results indicate that increased FI contributes to reducing poverty and income inequality in LAC. While access to financial services plays a crucial role in poverty reduction, the utilization of financial services has a more profound impact on combating income inequality. These results underscore the importance of policies designed to improve financial access and promote the use of financial products and services. It is recommended to expand the banking infrastructure, facilitate the provision of low-cost accounts, and strengthen financial education programs. Full article

Background/Objectives: Respiratory infections impact older adults due to immunosenescence and comorbidities, resulting in increased healthcare costs and mortality. While vaccination is a critical preventive measure, research on respiratory vaccines in older adults in Latin America and the Caribbean (LAC) remains underexplored. This study aims to map the research landscape and identify emerging themes to guide future studies. Methods: A bibliometric analysis was conducted using the Web of Science database, focusing on publications up to 2023 related to respiratory vaccines in LAC’s older adult population. PRISMA-ScR guidelines were followed for data extraction and analysis, with performance metrics and scientometric mapping conducted using Biblioshiny 4.1 and VOSviewer. Results: Ninety-nine studies spanning forty-one journals and 575 authors were included. Brazil contributed 70% of publications, followed by Mexico and Argentina. Influenza and pneumococcal vaccines were the most studied, focusing on coverage, acceptance, and cost-effectiveness. Emerging themes included COVID-19 vaccine effectiveness and vaccination-associated factors. Brazil was identified as the primary hub for collaboration across the region, while other countries made limited contributions. Conclusions: The findings highlight disparities in research output, with Brazil dominating and significant gaps in other LAC countries. Future research should prioritize genomic studies, vaccine efficacy in comorbid populations, and adaptive immunization strategies. Building research capacity and fostering international collaborations are essential for improving vaccination outcomes in older adults across LAC. Full article

Background/Objectives: A heart transplantation (HT) is the definitive treatment for heart failure. There is a difference in the success between national HT programs in developed countries and those in Central America, South America, and the Caribbean (LAC), and social determinants of health (SDHs) can directly influence this. The objectives of this study were to describe the survival since the beginning of the HT program of a national pediatric institute in Mexico City and to compare it with the results of a systematic review of LAC. Methods: A cohort study of a pediatric hospital (which performed 42% of the pediatric HTs in Mexico) was performed since the beginning of the HTs program in 2001. Clinical variables related to the transplants were identified, and the SDHs were divided into three categories: personal, family, and community. A systematic literature review was performed using keywords and a search in the medical indexes of LAC countries. The statistical analysis included descriptive statistics and a bivariate survival analysis. A risk calculation was estimated using the hazard ratio (HR) of the SDHs. Results: A total of 38 HTs were performed, the median age was 7 (4–16) years, and 22 (58%) were men. The leading cause was cardiomyopathy in 20 (53%) cases. The first-year survival rate was 76.3 per 100 HTs. The SDHs that increased the risk of death were suboptimal immunosuppression, the persistence of malnutrition, parental education, the distance from the center, the socioeconomic level, and the absence of transitional care. Conclusions: This cohort of pediatric patients with HTs resulted in the identification of risk variables of personal and community SDHs for mortality in the first and fifth years. Chronic rejection occurred in 50%, and the absence of transitional care to adulthood was the variable with the highest risk. The systematic review identified Mexico as the country with the second-highest frequency of HTs, and our cohort represented 42% of the total number of transplants in the country. Numerically, LAC has a lower frequency of transplants and survival in the first year compared to other developed countries, possibly due to a gap associated with organizational justice. Full article

The purpose of this study is to examine the economic and sectoral convergence of 32 countries in Latin America and the Caribbean (LAC) region from 1980 to 2022. The economic convergence hypothesis suggests that two economies with similar structural characteristics but different per capita income levels can tend to equalize in terms of income level in the long run. Confirming economic convergence has led to the development of various methodologies, among which dynamic and static disparity measures stand out. To achieve the objective of this research, both types of measures were calculated, determining beta and sigma convergence for dynamic disparity and gamma convergence for static disparity. This was accomplished by adopting the methodological approaches proposed by Sala-I-Martin and Marchante, Ortega, and Sánchez. The results show a gradual but steady evolution towards economic and sectoral convergence in LAC region during the 1980–2022 period. However, inequalities and divergences persist, requiring less developed countries to strengthen their institutions, implement sound macroeconomic policies, and diversify their economies. These measures are essential to driving economic growth and fostering more balanced and sustainable development across the region. Full article

Background. International public health agencies recommend policies to improve diets and promote healthy eating, but implementation often falters due to varying contextual factors across regions. Objectives. This study evaluates the relevance and applicability of these policies in urban areas of Latin America and the Caribbean (LAC). Methods. Using the Delphi technique, we convened a panel of 21 experts from 13 LAC countries, representing public policy, research, social action, and healthcare. Over two consultation rounds, the panel assessed 21 potential actions that local actors could implement to promote healthy eating by altering the physical and social environments. Data analysis led to a consensus on classifying these actions as high priority, low priority, or debatable. Results. The panel highlighted several contextual factors affecting policy implementation in the LAC region. For example, the informal nature (such as informal street vending) of many food establishments in the LAC region complicates zoning policies, such as restrictions in areas near schools, making them difficult to enforce and likely to face resistance. Conclusions. The panel identified eight actions as high priority, eight as low priority, and five as debatable for implementation at local level in the LAC region. Full article

One Health (OH) is an integrative approach to human, animal, and environmental health and can be used as a comprehensive indicator for comparative purposes. Although an OH index has been proposed for comparing cities, states, and countries, to date, no practical study has compared countries using this approach. Accordingly, this study aimed to assess OH initiatives using a survey with a veterinary public health focus. The questionnaire contained 104 quantitative questions and was sent to representatives of governmental institutions of 32 countries in the Americas. After exclusion criteria were considered, a total of 35 questionnaires from 17 countries were analyzed, with country names remaining undisclosed during the statistical analyses to protect potentially sensitive information. Principal component analysis (PCA) of health parameters in Latin America and the Caribbean (LAC) as a function of country perception (self-vector) showed that food safety was ranked higher than public policies (p = 0.009), and that both (p = 0.003) were ranked higher than institutional routines related to zoonosis programs. National policies in accordance with international standards, regulations, recommendations, and guidelines was considered the standout topic for public policy, with higher-ranking topics including standard. Meanwhile, challenging topics included tools, preparedness, governance, and research. Food safety showed both strengths and challenges in the coordination of its activities with other sectors. Food safety communication was scored as a strength, while foodborne diseases prevention was ranked as a challenge. Institutional routines for zoonosis maintained both strong and challenging topics in the execution and implementation of attributions and daily routine. Thus, the survey showed that topics such as access to and compliance with international guidelines and intercountry integration were ranked higher than in-country articulation, particularly among food safety, zoonoses, and environmental institutions. Full article

Local Area Coordination (LAC) roles have been implemented in disability services in many countries, supporting people living with disability to connect with formal and informal support in the community. Embedded in the National Disability Insurance Scheme in Australia, the aspiration is that this LAC role will connect people with disability to supports and enable the generation of greater community capacity and inclusion. Yet, with only a limited evidence base that demonstrates the impact of this approach, a clear measurement framework is needed to provide evidence of the realization of this aspiration. We propose that this impact could be demonstrated by applying a Community Capitals Framework (CCF) as the theoretical base for the LAC role and other community capacity initiatives, such as service navigation within disability reform of disability services. The CCF is premised on seven ‘capitals’—social, natural, cultural, human, political, financial and built that intersect and interact with each other to create positive spirals of change in communities. In this critical literature review, we apply the CCF to map and synthesize existing research on the LAC’s role in building community capital and examine the utility of the CCF as a map for LAC and service navigation practices to enhance community inclusion. For this review, we analyzed peer-reviewed journal papers and grey literature that focused on LAC community capacity building for people with disability in a disability service context published between 2000 and August 2023. Of the 17 publications that met the inclusion criteria, there was no published evidence that comprehensively examined or measured community capacity building consistent with the tenets of the CCF. However, our analysis showed that all capitals, with the exception of natural capital, had been considered, with some indication that investment in these capitals (particularly social capital) could be connected in the positive spiraling way suggested by the CCF. Given the paucity of existing evidence to inform the LAC aspiration for community capacity building, research informed by consumer priorities is needed to inform LAC and service navigation practices to address community needs. The CCF has the potential to develop our understanding of LAC and other community capacity-building initiatives through the measurement of LAC and service navigation services and consumer outcomes, as well as by informing investment to target growth capitals in communities. Full article

Soil-transmitted helminths (STHs) are a group of parasites that are globally distributed and are the most prevalent neglected disease (NTD) in Latin America and the Caribbean (LAC); their presence is associated with health and development problems. In Argentina, their distribution is heterogenous, and there are highly endemic areas in the north of the country. The World Health Organization (WHO) recommends the mass deworming of children as a first-line strategy for the prevention and control of STHs and recently also encourage the development of more sensitive diagnostic tests. The aim of this study was to determine the prevalence of STHs in Tartagal (Salta, Argentina) after four years of deworming interruption with albendazole and ivermectin. A total of 437 fecal samples were analyzed using standard coprological techniques, a subset of which were selected to molecularly typify protozoan parasites; 257 blood samples were analyzed for the presence of specific antibodies to the STH Strongyloides stercoralis. The most prevalent protozoan species were G. intestinalis (19.6–49.2%) and B. hominis (19.1–38.5%). Molecular characterization allowed us to evidence possible zoonotic or human-to-human transmission pathways for Giardia intestinalis or Blastocystis spp., while serology for S. stercoralis proved to be a useful screening tool for monitoring this parasite after treatment. In general, a decrease in the prevalence of STHs was observed in the area, from 60% to 2.9–20% for hookworms and from 51% to 1–9.3% for S. stercoralis four years after treatment, demonstrating the effectiveness and duration of anthelmintic treatment with these two drugs. Full article

Background: Routine vaccination coverage in Latin America and the Caribbean declined prior to and during the coronavirus pandemic. We assessed the pandemic’s impact on national coverage levels and analyzed whether financial and inequality indicators, immunization policies, and pandemic policies were associated with changes in national and regional coverage levels. Methodology: We compared first- and third-dose coverage of diphtheria–pertussis–tetanus-containing vaccine (DTPcv) with predicted coverages using time series forecast modeling for 39 LAC countries and territories. Data were from the PAHO/WHO/UNICEF Joint Reporting Form. A secondary analysis of factors hypothesized to affect coverages during the pandemic was also performed. Results: In total, 31 of 39 countries and territories (79%) had greater-than-predicted declines in DTPcv1 and DTPcv3 coverage during the pandemic, with 9 and 12 of these, respectively, falling outside the 95% confidence interval. Within-country income inequality (i.e., Gini coefficient) was associated with significant declines in DTPcv1 coverage, and cross-country income inequality was associated with declines in DTPcv1 and DTPcv3 coverages. Observed absolute and relative inequality gaps in DTPcv1 and DTPcv3 coverage between extreme country quintiles of income inequality (i.e., Q1 vs. Q5) were accentuated in 2021, as compared with the 2019 observed and 2021 predicted values. We also observed a trend between school closures and greater-than-predicted declines in DTPcv3 coverage that approached statistical significance (p = 0.06). Conclusion: The pandemic exposed vaccination inequities in LAC and significantly impacted coverage levels in many countries. New strategies are needed to reattain high coverage levels. Full article

Food-based dietary guidelines (FBDGs) are tools for promoting healthy eating habits. For the population of children under two years old in Latin America and the Caribbean (LAC), there is a lack of reviews analyzing the quality of these guidelines. The objective of this systematic review is to evaluate publicly available FBDGs for the population under two years old in LAC until mid-2023. Guidelines aimed at caregivers of children were included, sourced from government websites in LAC countries and the Food and Agriculture Organization (FAO) portal. Documents targeted at healthcare professionals were excluded. For qualitative analysis, the Agree II guidelines assessment tool and the FAO guide principles for developing healthy and sustainable diets were used. The results showed that more recently released and revised FBDGs with a greater number of pages obtained better scores in both assessments. Additionally, out of the 32 LAC countries, only 13 had these FBDGs available on websites for public access. As a limitation, this study faced challenges in standardizing the searches on government websites. The authors emphasize the need to develop FBDGs for the population under two years old that align with current health and sustainability needs and promote health education. Full article

Background: Last Aid Courses (LAC) for adults have been established in 21 countries in Europe, Australia and America to improve the public discussion about death and dying and to empower people to participate in end-of-life care provision. In 2018, the first Last Aid Courses for kids and teens (LAC-KT) were introduced. The aim of the study was to explore the views and experiences of the course participants and Last Aid Course instructors on the LAC-KT. Methods: A mixed-methods approach was used. The views of the LAC-KT participants, aged 7 to 17 years, on the LAC-KT were collected using a questionnaire. In addition, the experiences of the Last Aid Course instructors were explored in focus group interviews. Results: The results show that 84% of the participants had experiences with death and dying and 91% found the LAC-KT helpful for everyone. The majority of the participants appreciate the opportunity to talk and learn about death, dying, grief and palliative care. Conclusions: The LAC-KT is feasible, very well accepted and a welcome opportunity for exchanging and obtaining information about dying, grief and palliative care. The findings of the study indicate that the LAC-KT should be offered to all interested children and teenagers and included in the school curriculum. Full article

Forecasting extreme precipitation is one of the basic actions of warning systems in Latin America and the Caribbean (LAC). With thousands of economic losses and severe damage caused by floods in urban areas, hydrometeorological monitoring is a priority in most countries in the LAC region. The monitoring of convective precipitation, cold fronts, and hurricane tracks are the most demanded technological developments for early warning systems in the region. However, predicting and forecasting the onset time of extreme precipitation is a subject of life-saving scientific research. Developed in 2019, the CRHUDA (Crossing HUmidity, Dew point, and Atmospheric pressure) model provides insight into the onset of precipitation from the Clausius–Clapeyron relationship. With access to a historical database of more than 600 storms, the CRHUDA model provides a prediction with a precision of six to eight hours in advance of storm onset. However, the calibration is complex given the addition of ARMA(p,q)-type models for real-time forecasting. This paper presents the calibration of the joint CRHUDA+ARMA(p,q) model. It is concluded that CRHUDA is significantly more suitable and relevant for the forecast of precipitation and a possible future development for an early warning system (EWS). Full article