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Resumen Introducción: El concepto de salud pública aparece con frecuencia en las prácticas disciplinares de las ciencias de la salud, sociales y humanas. Sin embargo, la salud pública es objeto de debate debido a su naturaleza multifacética e interdisciplinaria. Esta variabilidad se atribuye a las diferencias en cómo cada disciplina interpreta y aplica el concepto, basándose en su propia comprensión de las problemáticas que buscan intervenir. Objetivo: Analizar críticamente el concepto de salud pública y su objeto de estudio a partir de su relación y diferenciación con distintos enfoques en psicología y medicina. Método: Se trató de un estudio de reflexión y análisis crítico de las diferentes conceptualizaciones y aplicaciones de la salud pública. Reflexión: Se abordaron tres debates relevantes: los vínculos de la salud pública con la psicología y la medicina (1), el objeto de estudio de la salud pública (2) y los retos para abordar problemas sociales y de salud actuales (3). Se discute la evolución histórica del concepto de salud pública, su carácter interdisciplinar y su adaptabilidad a los contextos sociopolíticos y a las emergentes problemáticas sociales contemporáneas. Conclusión: Se destaca la interdisciplinariedad para atender los retos emergentes, centrando esfuerzos en mitigar factores multidimensionales asociados con la salud y el bienestar global, así como la relevancia de fortalecer las estructuras organizativas, desarrollar políticas adecuadas y contar con sistemas epidemiológicos robustos para enfrentar desafíos actuales y futuros.

Abstract Introduction: The concept of public health appears frequently in the disciplinary practices of health, social, and human sciences. However, the concept of public health is controversial because of its multifaceted and interdisciplinary nature. This happens because its meaning, theorization, and application vary according to how each discipline understands the issues it seeks to address. Objective: To critically analyze the concept of public health and its object of study, based on its relationship and differentiation with different approaches in psychology and medicine. Methodology: This was a study of reflection and critical analysis of the different conceptualizations and applications of public health. Reflection: Three relevant debates have been addressed: the links of public health with psychology and medicine (1), the object of study of public health (2), and the challenges to address current social and health problems (3). The historical evolution of the concept of public health, its interdisciplinary nature, and its adaptability to sociopolitical contexts and emerging contemporary social issues are discussed. Conclusion: Interdisciplinarity is emphasized to address emerging challenges, focusing efforts on mitigating multidimensional factors associated with global health and well-being, as well as the importance of strengthening organizational structures, developing appropriate policies, and having robust epidemiological systems to face current and future challenges.

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Enteroparasitosis are diseases caused by parasitic agents present in the environment and in the gastrointestinal tract of living beings. In addition, they are still considered neglected diseases, but of great importance for public health, especially when they are related to secondary infections and currently their co-infection profile with COVID-19. The interaction of protozoa and/or helminths with the SARS-CoV-2 virus is timely and its signs and symptoms are confused with other pathogen relationships. In this way, this study aims to correlate the incidence of enteroparasitosis and COVID-19, in the pandemic period from 2020 to April 2022. This is a documentary and exploratory study of secondary data from laboratory tests of patients who were treated and diagnosed with COVID-19 and enteroparasitosis at Hospital Doutor Cloves Bezerra Cavalcante, Municipal Hospital of Bananeiras, Paraíba, Brazil. In the analysis of the database, a significant increase of approximately 48.85% in the incidence of COVID-19 cases from 2020 to 2021 stands out, remaining high until 2022. In contrast, cases of enteroparasites peaked at 48.74% in 2021, followed by an average reduction of 23.12%, with a deviation of 1.49%, in relation to the years 2020 and 2022. It was concluded that COVID-19 is predominantly associated with an increase in secondary infections, highlighting the crucial need to promote health education, improve basic sanitation and guarantee access to health services as essential components in combating the increase in parasitic infections, especially those related to viral pathologies.

As enteroparasitoses são enfermidades originadas por agentes parasitários presentes no meio ambiente e no trato gastrointestinal dos seres vivos. Ademais, ainda são consideradas doenças negligenciadas, porém de grande importância para a saúde pública, em especial, quando estão relacionadas com infecções secundárias e atualmente seu perfil de coinfecção com a COVID-19. A interação de protozoários e/ou helmintos com o vírus SARS-CoV-2 é oportuna e seus sinais e sintomas são confundidos com outras relações de patógenos. Desta maneira, este estudo visa correlacionar a incidência de enteroparasitoses e COVID-19, no período pandêmico de 2020 a abril de 2022. Trata--se de uma pesquisa documental e exploratória, de dados secundários dos exames laboratoriais de pacientes que foram atendidos e diagnosticados com COVID-19 e enteroparasitoses no Hospital Doutor Cloves Bezerra Cavalcante, Hospital Municipal de Bananeiras, Paraíba, Brasil. Na análise da base de dados, destaca-se um aumento significativo de aproximadamente 48,85% na incidência de casos de COVID-19 de 2020 a 2021, mantendo-se elevado até 2022. Em contraste, os casos de enteroparasitas atingiram um pico de 48,74% em 2021, seguido por uma redução média de 23,12%, com um desvio de 1,49%, em relação aos anos de 2020 e 2022. Conclui-se que a COVID-19 está predominantemente associada ao aumento de infecções secundárias, destacando a necessidade crucial de promover a educação em saúde, melhorar o saneamento básico e garantir o acesso aos serviços de saúde como componentes essenciais no combate ao aumento de infecções parasitárias, especialmente aquelas relacionadas a patologias virais.

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BACKGROUND: Telomere length has been investigated as a biomarker of biological aging and is associated with several diseases, lifestyle, and socioeconomic factors. OBJECTIVE: This study aimed to verify whether food insecurity is associated with shorter telomere length in older people. METHODS: This is a cross-sectional study carried out in a municipality in the interior of Brazil, with a sample of 440 older people from the community. For telomere length analysis, a blood sample was obtained from each participant, followed by real-time qPCR, and sociodemographic and health information was collected through interviews. Food security/insecurity was measured using the reduced version of the Brazilian Food Insecurity Scale. Descriptive analysis and multiple logistic regression were performed to analyze the factors associated with shorter telomere length, adopting a significance level of 5%. RESULTS: We found that food insecurity was significantly associated with shorter telomere length, regardless of age group, skin color, tabagism, physical activity, milk and dairy consumption, living arrangement, and basic activities of daily life. CONCLUSION: The findings show the importance of ensuring full access to adequate nutrition for the older population, who are physiologically and socially vulnerable.

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Abstract Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

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INTRODUCTION: Sporotrichosis is a chronic infectious mycosis caused by traumatic implantation of Sporothrix spp., which poses a significant challenge to public health because of its zoonotic nature. It affects humans and other animals, particularly cats. This study investigated epidemiological trends and spatial distribution of feline sporotrichosis in Espírito Santo between 2017 and 2022. METHODS: This study collected diagnostic data on sporotrichosis from the Veterinary Pathology Laboratory and Center for Infectious Diseases in Espírito Santo from 2017 to 2022. Statistical analyses were performed using STATA and spatial analyses were performed using ArcGIS software to create maps and identify hotspots. Kernel density estimation and directional mean statistics were applied to visualise the disease concentration and transmission trends. RESULTS: The results showed a significant increase in feline sporotrichosis cases in Espírito Santo from 2017 to 2022, with hotspots identified in urban and densely populated areas. Anchieta, Aracruz and Vila Velha reported the highest numbers of cases. Spatial analysis indicated a spread towards the central and northern coastal regions. CONCLUSION: This study highlights the growing threat of feline sporotrichosis in Espírito Santo, Brazil, particularly in densely populated urban areas. This underscores the urgent need for comprehensive public health strategies that address urbanisation, human-animal interactions and managing stray cat populations. Effective control measures and enhanced surveillance are crucial to mitigate the spread of this zoonotic disease. Importantly, this study provides valuable insights into the epidemiology of sporotrichosis in Brazil and offers a framework for other regions identified as emerging hotspots that face similar challenges.

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Background: Countries of the Caribbean Community signed the Declaration of Port of Spain in 2007 with the vision to stop the epidemic of non-communicable diseases (NCDs). The adoption of the Declaration by member states represented a regional effort, challenging governments, the private sector, and civil society to act together. Multisectoral actions in Guyana aimed at achieving this goal are the focus of this article, demonstrating the work of different actors in addressing the burden of NCDs in the country. Objective: To analyze multisectoral actions developed among five ministries for the implementation of the Declaration of Port of Spain 2007 in Guyana. Methods: This qualitative study was guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist and conducted in five ministries (Agriculture, Education, Finance, Health, and Trade) in Georgetown, Guyana. The thematic analysis was guided by a framework consisting of four elements: context (why the policy is needed), content (what the policy is mainly about), process (how the policy was brought forward and implemented), and actors (who participates in and influences the formulation and implementation of the policy). The framework considers how these elements interconnect to shape policy development and implementation processes. Findings: Data analysis provided the researchers with insights into possible topic areas and codes for consideration during the analysis, hence a deductive approach to data analysis was used. The results highlighted the importance of coordination among government entities, national and international agencies, private actors, industry players, and civil society. Participants did not mention the use of responsibility metrics but cited mechanisms that facilitated collaboration. Conclusion: The results showed limitations in transforming multisectoral initiatives into intersectoral collaboration to achieve real integration among the different actors involved, considering the actual context and content. Actions could be more effectively implemented with significant outcomes for NCD control in Guyana.

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Introduction: Prevalence of oral, metabolic, circulatory, and nutritional diseases has tended to increase globally. As these diseases have common contributing factors, such as unhealthy diets, evaluating their epidemiological trends and the relation between them is relevant. In Colombia, the Ministry of Health records the frequency of consultation for these diseases through the Integrated Social Protection Information System. It facilitates the evaluation of their epidemiological behavior at the population level. Aim: To analyze and correlate the burden of oral diseases (caries and periodontitis) with respect to nutritional, circulatory and metabolic pathologies, as well as their relationships with socioeconomic indices in Colombian regions from 2016 to 2023. Methods: This study analyzes retrospective data collected between 2016 and 2023 by the National Health Registry in Colombia (SISPRO) according to the ICD-10. Sociodemographic data and the number of disease consultations were extracted. The number of consultations for oral diseases was correlated with systemic pathologies, socioeconomic indices through the Spearman test. Associations were explored via multiple linear regressions. A Principal Component Analyses (PCA) was conducted to identify patterns between socioeconomic, oral and systemic disease variables, as well as to reduce the complexity of the analysis by creating clusters that capture the greatest possible variability in the data. Results: The average number of consultations per biennium was 24.550.435 being the highest number for 2018-2019. The highest percentage of consultations was related to extensive caries, followed by chronic gingivitis. Moreover, consultations for oral diseases were found to correlate with systemic pathologies. All socioeconomic indices were associated with caries and/or periodontal diseases. This study is the first in Colombia that uses national data on diagnoses assigned to medical and dental consultations. PCA revealed a clustering pattern of pathologies suggesting that they are highly associated one to each other. Conclusion: Correlations between consultations for oral and systemic diseases stratified by life cycle and socioeconomic indices highlight the importance of conducting epidemiological and public health characterizations and their associations. Identifying these factors is imperative in the prevention and management of both diseases.

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INTRODUCTION: Health technology assessment (HTA) is a standardized methodology that allows the assessment technologies' value. By incorporating the perspective of stakeholders in a public consultation process, transparency and quality of decisions can be improved. OBJECTIVE: To describe the active stakeholder consultation process for rapid HTAs in an Argentinean, independent, academic, non-profit HTA agency, assessing its initial five years. METHODS: Since 2017, we have been conducting an active public consultation process for rapid HTA documents, inviting producers, healthcare professionals, and patient organizations to provide comments, and their input may lead to changes in the HTA documents. Changes were classified as major (changes to the coverage recommendation), intermediate (changes in efficacy, net benefit, or cost-effectiveness that did not change coverage recommendations), and minor modifications (other changes). RESULTS: From May 2017-August 2022, 308 rapid HTA (rHTA) reports were published, and 3,438 invitations were sent. 140 rHTA (45.5%) received a total of 228 comments. Comments came from producers in 53% (n = 112) and healthcare professional organizations in 31.2% (n = 66). Technologies evaluated were drugs in 37% (n = 114), procedures in 35.5% (n = 109), diagnostic methods in 15.3% (n = 47), and devices in 12.2% (n = 38). Out of 308 rHTA documents, 120 (39%) were modified-mostly minor adjustments (n = 100; 80%), followed by major (n = 12; 10%) and intermediate modifications (n = 8; 6.4%). CONCLUSION: Implementing an active stakeholder involvement process in HTA is feasible in a low- to middle-income country context and strengthens and improves the HTA process.

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OBJECTIVE: To provide local policymakers with a guideline of potential actions to prevent the high consumption of Non-Nutritive Sweeteners (NNS) among children and adolescents observed in Chile, given the potential health problems related to NNS intake. DESIGN: The Delphi method was used for the evaluation of twenty-one recommendations to decrease the intake of NNS in paediatric population, with the participation of a panel of relevant actors. SETTING: The proposed recommendations were developed by the research team using the NOURISHING framework; potential actions were based on the increase in the use and intake of NNS by Chilean children, current local food regulations, recommendations of health organisations and foreign policy experiences. PARTICIPANTS: Twenty-five relevant actors related to NNS, nutrition, food technology and paediatrics (out of thirty-nine invitations made to scholars, professional institutions and civil society's organisations) participated in the Delphi study. RESULTS: A consensus was reached on nine recommendations regarding relevance and feasibility to be part of the guideline. Recommendations involved measures mostly related to improving the delivery of information (food content and potential health effects of NNS), supporting the generation of more evidence of NNS health effects and substitutes, and marketing restrictions when targeted to children. CONCLUSIONS: The process produced a nine-action guideline to reduce the excessive NNS consumption among Chilean children and adolescents. Developed through a consensus-driven approach among key stakeholders, this guideline provides policymakers with a framework to adopt a precautionary stance, particularly concerning vulnerable populations, given the currently inconclusive evidence on the long-term health effects of NNS consumption.

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BACKGROUND: Eating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals. METHODS: Qualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software. RESULTS: 40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient's ego-syntonic behaviors. The main facilitators were patients' and relatives' psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment. CONCLUSIONS: This study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions. Eating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED's duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.

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Environmental monitoring of protozoa, with the potential to trigger diseases, is essential for decision-making by managing authorities and for the control of water surveillance. This study aimed to detect and quantify Cryptosporidium oocysts and Giardia cysts in surface water for drinking water supply and treated sewage for reuse in the city of São Paulo. Samples collected bimonthly for one year were concentrated using the USEPA 1623.1 and 1693 methods for surface water and treated effluents, respectively. Immunofluorescence and nucleic acid amplification techniques were used to detect and quantify (oo)cysts. The cloning technique followed by sequencing and phylogenetic analyses were performed to characterize species and genotypes. The immunofluorescence detected Cryptosporidium spp. and Giardia spp. in 69.2% (9/13) and 100% (13/13) of the surface water samples (0.1-41 oocysts/L and 7.2-354 cysts/L, respectively). In the reuse samples, 85.7% (12/14) were positive for both protozoa and the concentrations varied from 0.4 to 100.6 oocysts/L and 1.2 and 93.5 cysts/L. qPCR assays showed that 100% of surface water (0.1-14.6 oocysts/L and 0.3-639.8 cysts/L) and reused samples (0.1-26.6 oocysts/L and 0.3-92.5 cysts/L) were positive for both protozoa. Species C. parvum, C. hominis, and C. muris were identified using the 18S rRNA gene, demonstrating anthroponotic and zoonotic species in the samples. Multilocus SSU rRNAanalyses of the SSU rRNA, tpi, and gdh genes from Giardia intestinalis identified the AII, BII, and BIV assemblages, revealing that contamination in the different matrices comes from human isolates. The study showed the circulation of these protozoa in the São Paulo city area and the impairment of surface water supply in metropolitan regions impacted by the discharge of untreated or inadequately treated sewage regarding the removal of protozoa, emphasizing the need to implement policies for water safety, to prevent the spread of these protozoa in the population.

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Congenital heart diseases are the most common congenital malformations worldwide and represent one of the leading causes of neonatal death, in addition to the significant use of human and financial resources by health systems. The purpose of this document is to support the implementation of neonatal screening for critical congenital heart diseases using pulse oximetry according to the different geographical altitudes of Peru. This technology is widely used worldwide and has high sensitivity, specificity, and cost-effectiveness. At many latitudes, it has led to better survival in this group of patients and in the neonatal population in general since its use in the early detection of sepsis, pneumonia, and other conditions that affect the oxygenation of the newborn. Neonatal screening for critical congenital heart disease is applicable at all levels of healthcare at a national level, and its implementation must be a priority to improve neonatal health.

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OBJECTIVE: Mining activity represents one of the most hazardous occupations related to health, with 8% of fatal injuries concentrated in this sector worldwide. Thus, it is crucial to timely identify the factors involved in such injuries. We aimed to explore the sociodemographic and occupational/organisational factors associated with injuries, causative agents and subsequent disabilities and fatality of workers exposed to occupational injuries in the mining sector. DESIGN: A secondary scoping review was conducted following the Joanna Briggs Institute guidelines. DATA SOURCES: Scopus, Embase, Virtual Health Library, SciELO and PubMed databases were searched in February 2022 and updated in October 2023. The protocol was developed in April 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included observational studies published within the last 13 years (2010-2022) which provided information on injuries of the mining workers and reported associated factors as well as health consequences. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers examined the eligibility criteria, screened and coded the extracted information using prevalidated data extraction tools, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews reporting guidelines. RESULTS: A total of 123 studies were found, of which nine were selected for inclusion in this review. Participants were between 15 and 80 years old, and the rate of injuries ranged from 4.4% to 10.6% of reported cases. Among the total selected studies, mechanical agents were identified as the leading cause of injuries in six studies. The factors associated with injuries included age, gender (female) and biochemical characteristics. On the other hand, occupational and organisational factors encompassed work shift, outsourcing (contractors) and less than 2 years of experience in the sector. CONCLUSION: This review emphasises that both work-related and individual characteristics are significantly related factors of injuries. Moreover, commonly reported health consequences of injuries encompass mortality, average days lost and permanent, partial or total disability.

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BACKGROUND: Violence against people with intellectual disabilities is unfortunately a reality all over the world, as they are one of the populations most vulnerable to various forms of aggression. Assertive prevention and control measures are crucial to tackle and reduce this problem. The aim of this study was to map and summarize the main measures for preventing and controlling domestic violence against people with intellectual disabilities.  METHODS: This was a scoping review conducted in accordance with the JBI guidelines. The databases consulted were: National Library of Medicine (PubMed); Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science; Excerpta Medica DataBASE (EMBASE); Latin American and Caribbean Health Sciences Literature (LILACS) and SCOPUS. Studies included in this review reported on strategies to address domestic violence against people with intellectual disabilities, published in  the last ten years, in Portuguese, Spanish or English. RESULTS: A total of 11 studies were included in this review. Six studies had high methodological quality and five had moderate. Cognitive-behavioral intervention programs, educational  technologies and/or auxiliary tools, along with the full participation of people with intellectual disabilities in domestic violence prevention measures are appropriate strategies for dealing with this issue. CONCLUSION: Domestic violence against people with intellectual disabilities is relatively unexplored in the health-field scientific literature. Prevention and control measures should be developed with the active involvement of people with intellectual disabilities, generating engagement and knowledge. Preventive measures should be adapted to the personal context and conditions of individuals with special needs, such as those with persistent or chronic mental disorders.

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AIM: To examine melanoma mortality trends in Spanish Autonomous Communities from 1999 to 2022, focusing on gender and age differences. METHODS: Data from the National Statistics Institute were used to calculate age-standardized mortality rates (ASMRs). Joinpoint regression identified trend changes. RESULTS: Melanoma mortality varied significantly by region, gender, and age. Eastern Spain had higher male mortality, while western regions had lower rates. Asturias had higher female mortality, with lower rates in Andalusia, Extremadura, and Castilla-La Mancha. Men generally exhibited higher ASMRs than women, with variations across regions. While ASMRs remained stable in most areas, Madrid experienced a notable decline (AAPC: - 1.3%). A national trend reversal occurred in 2014 (AAPC: - 1.3%). For individuals aged 45-74 years, Catalonia saw a significant decrease (AAPC: - 1.1%, p < 0.05), whereas Andalusia experienced an increase (APC: 2.1% since 2007). Nationally, ASMRs for this age group declined (AAPC: - 0.7%). Among those aged 75 years and over, ASMRs varied considerably, with increases observed in Andalusia and Aragon. Nationally, male ASMRs rose (AAPC: 1.6% per year), while female rates were stable. Regional disparities were evident, with higher female mortality in the Balearic Islands and fluctuating rates in the Community of Madrid (an increase followed by a decrease after 2015). The gender gap in mortality varied across regions, with some areas showing a narrowing gap and others widening disparities. CONCLUSION: Continuous monitoring of melanoma mortality, especially among men and older adults, is crucial. Public health efforts should address regional disparities, improve early detection, and enhance treatment access to optimize outcomes nationwide.

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Introduction Virologic failure due to antiretroviral drug resistance is a threat to efforts to control the human immunodeficiency virus (HIV) epidemic. Understanding the factors that influence the genetic and clinical expression of drug resistance is fundamental for infection control. Methods A nested case-control study was conducted on a cohort of adult HIV patients between 2016 and 2022. The cases were defined as patients with a confirmed diagnosis of virologic failure due to drug resistance, as indicated by a viral genotype result. The control group consisted of patients who had not experienced virologic failure or undergone any documented changes to their antiretroviral treatment. The incidence of virologic failure over a defined period was calculated. The characteristics of each group were documented in frequency tables and measures of central tendency. To identify risk factors, multiple logistic regression models were employed, and post hoc tests were conducted. All calculations were performed with 95% confidence intervals, and p-values less than 0.05 were considered significant. Results The incidence of virologic failure over the seven-year study period was 9.2% (95% CI: 7.5-11.2%). Low CD4 T-lymphocyte count (≤200 cells/mm³) at diagnosis (adjOR 14.2, 95% CI: 3.1-64.5), history of opportunistic infections (adjOR 3.5, 95% CI: 1.9-6.4), and late enrollment into an HIV program after diagnosis (>1 year) (adjOR 9.2, 95% CI: 3.8-22.2) were identified as independent predictors of virologic failure. The drugs with the highest rates of resistance were nevirapine (84.6%), efavirenz (82.4%), emtricitabine (81.3%), lamivudine (81.3%), and atazanavir (6.6%). The most prevalent major mutations identified were K103N, M184V, and M46I/M. Approximately 50% of the secondary mutations were identified in protease regions. Conclusions The incidence of virologic failure was low in the study population. The identified risk characteristics allow for the prediction of the profile of patients susceptible to failure and for the early optimization of treatment regimens.

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BACKGROUND: Uncorrected refractive errors and amblyopia are reported as the two main causes of childhood visual impairment and blindness worldwide. Our purpose was to evaluate refractive status, ocular alignment and effective refractive error coverage (eREC) of school-aged children from low-income areas of Sao Paulo city, Brazil. METHODS: Data from the "Ver na Escola" Project were used for the current study. Children enrolled in the selected schools had an ophthalmic exam including eye alignment assessed by cover test, automatized and subjective dynamic and static refraction. The associations of demographic variables with occurrence and magnitude of refractive errors and eREC were investigated by multiple logistic regressions and multilevel mixed effect models. RESULTS: A total of 17,973 children (51.12% females) with mean ± sd age 8.24 ± 3.54 years old examined from July 2018 to July 2019, were included in the study. Most of the participants (73%) showed orthoposition of the visual axis for both distance and near. Heterophoria was found in about 25% of participants (N = 4,498), with 71.7% of them (N= 3,222) classified as exophoria. Less than 2% (N = 232) showed strabismus, most of them (N = 160) esotropia. Overall, 1,370 (7.70%) of participants had myopia and 577 (3.24%) had hyperopia. Age was found to be significantly associated with increasing static subjective refraction spherical equivalent (Coefficient: -0.18; 95% Confidence Interval (CI): -0.21 to -0.16; p < 0.001). Female sex (Odds Ratio (OR) = 1.13; 95%CI: 1.01-1.27; p = 0.027) and older age (OR = 1.17; 95%CI: 1.16-1.19; p < 0,001) were significantly associated with myopia diagnosis. Older age decreased the odds of hyperopia (OR = 0.95; 95%CI: 0.93-0.98; p < 0.001). The overall effective refractive coverage was 51.76% and was significantly associated with age group, ranging from 32.25% in children aged 3 to 7 years to 61.35% in children aged 8 to 12 years. CONCLUSIONS: Most children have shown eye alignment for both distance and near assessments and no refractive error. Myopia was observed in 7.70% of the population and it was associated with older age and female sex. Hyperopia was observed in 3.24% and was associated with younger age. The overall eREC was 51.76%, significantly associated with age.

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OBJECTIVE: To assess the current Na levels in a variety of processed food groups and categories available in the Argentinean market to monitor compliance with the National Law and to compare the current Na content levels with the updated Pan American Health Organisation (PAHO) regional targets. DESIGN: Observational cross-sectional study. SETTING AND PARTICIPANTS: Argentina. Data were collected during March 2022 in the city of Buenos Aires in two of the main supermarket chains. We carried out a systematic survey of pre-packaged food products available in the food supply assessing Na content as reported in nutrition information panels. RESULTS: We surveyed 3997 food products, and the Na content of 760 and 2511 of them was compared with the maximum levels according to the Argentinean law and the regional targets, respectively. All food categories presented high variability of Na content. More than 90 % of the products included in the National Sodium Reduction Law were found to be compliant. Food groups with high median Na, such as meat and fish condiments, leavening flour and appetisers are not included in the National Law. In turn, comparisons with PAHO regional targets indicated that more than 50 % of the products were found to exceed the regional targets for Na. CONCLUSIONS: This evidence suggests that it is imperative to update the National Sodium Reduction Law based on regional public health standards, adding new food groups and setting more stringent legal targets.

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BACKGROUND: The Mpox, a zoonotic viral disease that has historically affected Central and West Africa, has been declared a Public Health Emergency of International Concern by the World Health Organization. Rapid transmission and recent dissemination in Africa may imply significant challenges to global health, including mental health. METHODS: We reviewed the mental health implications of the Mpox outbreak according to the published literature. We also discussed the psychological effects of the global spreading of this infection and public health preparedness strategies. Key areas of intervention may include the epidemiological surveillance, vaccine development, and mental health strategies. COMMENTS: The Mpox outbreak calls for a robust global preparedness to address potential health emergencies. Strengthening epidemiological surveillance, ensuring equitable vaccine distribution, and building resilient public health infrastructure are crucial. Additionally, addressing mental health consequences may require immediate, intermediate, and long-term strategies, including telepsychiatry, stress management training, and the integration of mental health into primary care.

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The Oropouche virus (OROV) is emerging as a major public health threat worldwide, yet for the Americas, it raises complex challenges that intersect with other existing arboviral threats such as Zika (ZIKV), dengue (DENV) and Chikungunya (CHIKV) viruses. Originating from Trinidad and Tobago in 1955, it has spread across the Amazonian Basin and more recently into the Caribbean (Cuba and Haiti) and Europe, highlighting the importance of air travel in its dissemination. OROV and the less studied Melao virus (MELV), pose significant laboratory diagnostic challenges particularly in regions co-endemic with other arboviral diseases, such as dengue and Zika fever. The effects of climate change, particularly in the Caribbean, may exacerbate the transmission of these viruses by exposing human exposure risk to vectors. Public health systems in the Americas are under strain due to complex clinical management of these infections necessitating enhanced surveillance, clinical vigilance, diagnostics and vector control. Vulnerable populations, including pregnant women, elderly, and young children, are at a heightened risk, which raises concerns about the impact on medical tourism in the region. To mitigate the spread and impact of OROV and MELV, recommendations include increased clinical surveillance, improved laboratory diagnostics, public health communication, and strengthened vector controls. Robust research and capacity building (including training and education) efforts are essential to address knowledge gaps and effectively manage future OROV and MELV outbreaks in the Americas.