Authors:Abraham Valles Abstract: Systematic review of teen pregnancy prevention programs using websites and chatbotsAbraham Valles14 Apr 2025 Librado González ObjectiveTo evaluate the effectiveness of artificial intelligence (AI)-based chatbots in preventing teenage pregnancy compared with traditional methods of sex education or no intervention. Materials and methodsA systematic review of original studies published between January 2010 and December 2024 was conducted based on the PRISMA guidelines and the population, intervention, comparator, outcome, time, and data (PICOT-D) question formulation strategy. Databases such as PubMed, the Cochrane Library, Embase, and Scopus were searched; DeCS and MeSH descriptors were used. Data were managed in Rayyan® and in an Excel® spreadsheet. The protocol was registered in PROSPERO (CRD42024580136). ResultsWe analyzed 14 studies involving 10,018 participants (71.1% were women). Chatbots demonstrated high usability (SUS score of 77.7, 82nd percentile). Of the total users, 83% interacted with the chatbot, 46% initiated hormonal contraceptives, and 56.8% rated the chatbot as easy to understand. A significant increase was seen in the use of contraceptives (adjusted odds ratio [aOR] = 1.60); p = 0.02) and condoms (aOR = 1.48; p <0.001). There were also improvements in knowledge of emergency contraception (57.3% vs. 47.5%; p <0.01) and access to contraceptive services (95.6% versus 91.8%; p = 0.01). ConclusionAI-based chatbots are effective in preventing teenage pregnancy and can be a key complement to traditional sex education methods. Article's language Spanish https://doi.org/10.26633/RPSP.2025.22 Review PubDate: Mon, 14 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: AI’s ongoing impact: Implications of AI’s effects on health equity for women’s healthcare providersAbraham Valles11 Apr 2025 Vadlamani et al. ObjectiveTo assess the effects of the current use of artificial intelligence (AI) in women’s health on health equity, specifically in primary and secondary prevention efforts among women. MethodsTwo databases, Scopus and PubMed, were used to conduct this narrative review. The keywords included “artificial intelligence,” “machine learning,” “women’s health,” “screen,” “risk factor,” and “prevent,” and papers were filtered only to include those about AI models that general practitioners may use. ResultsOf the 18 articles reviewed, 8 articles focused on risk factor modeling under primary prevention, and 10 articles focused on screening tools under secondary prevention. Gaps were found in the ability of AI models to train using large, diverse datasets that were reflective of the population it is intended for. Lack of these datasets was frequently identified as a limitation in the papers reviewed (n = 7). ConclusionsMinority, low-income women have poor access to health care and are, therefore, not well represented in the datasets AI uses to train, which risks introducing bias in its output. To mitigate this, more datasets should be developed to validate AI models, and AI in women’s health should expand to include conditions that affect men and women to provide a gendered lens on these conditions. Public health, medical, and technology entities need to collaborate to regulate the development and use of AI in health care at a standard that reduces bias. Article's language English https://doi.org/10.26633/RPSP.2025.19 Special report PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Regulation and performance of health systems: a review of analytical frameworksAbraham Valles11 Apr 2025 Báscolo et al. The private health sector has expanded significantly in recent decades, both in Latin America and other regions. Governments and international organizations have dealt with this process in a heterogeneous manner. A policy approach and, above all, a regulatory framework, are required in order to put health objectives and the right to health above the profit motive that drives private sector participation. This paper reviews frameworks for analyzing the performance of health systems and the regulation of financing and service provision, primarily (but not exclusively) in the private sector. This review covers the output of the main international health agencies (Pan American Health Organization and World Health Organization), international development agencies (World Bank and Organization for Economic Cooperation and Development), and academics involved in international health policy debates. Common aspects of the different frameworks are identified, as well as substantive divergences. The purpose of this article, which is part of a larger project, is to contribute to discussions on the regulation of health systems in the Region of the Americas, consider their particularities, and describe the current context. Article's language English https://doi.org/10.26633/RPSP.2025.34 Review PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Critical factors for institutionalizing evidence-informed decision-making in healthcare organizationsAbraham Valles11 Apr 2025 Toma et al. ObjectiveTo map critical factors for sustainable processes in the institutionalization of evidence-informed decision-making in public health organizations. MethodA rapid critical interpretative synthesis was carried out based on searches conducted in databases, websites, and reference lists, with findings categorized into an appropriate framework. ResultsTwenty studies were analyzed and six dimensions of critical factors were addressed: 1) governance, aimed at dealing with difficulties in the organizational context and motivation for change, together with a management style that has a long-term vision and invests in communication tools; 2) standardized routine processes, involving the characteristics of information that facilitate its incorporation into organizational practices; 3) leadership and commitment, revealing the importance of identifying and engaging leaders who can influence the adoption of evidence-informed policies in organizations; 4) resources, which correspond to the need for training programs that ensure the availability of a team with the skills needed to identify research evidence within a supportive organizational infrastructure; 5) partnerships, collective action, and support, which show the importance of involving stakeholders in collaborative processes, using exchange structures; and 6) culture, related to efforts to bring research and policy closer together, so that they are more receptive to organizational changes. ConclusionThe identified critical factors can provide a reference framework to support improvement planning and the institutionalization of evidence use. The results are applicable to organizations that formulate and implement public health policies and other social policies. Article's language Portuguese https://doi.org/10.26633/RPSP.2025.33 Review PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Political support and micro-planning as success factors in a high-quality follow-up vaccination campaign in Ecuador, 2023Abraham Valles11 Apr 2025 Aguinaga-Romero et al. ObjectiveTo describe the results, achievements, and lessons learned through administrative coverage and rapid monitoring of a follow-up vaccination campaign, in the context of political prioritization and micro-planning as determining factors in the different stages of follow-up campaigns, and the application of these good practices to strengthen the National Immunization Program. MethodThis is a special descriptive epidemiological report on a high-quality follow-up vaccination campaign in Ecuador. The sources of information used were: population estimates from the 2010 and 2022 censuses carried out by the National Institute of Statistics and Census; calculation of the susceptible cohort for vaccination with the bivalent vaccine (measles and rubella) and with the oral and injectable polio vaccines; definition of vaccination strategies and tactics, and vaccine scheduling by type and age group; and macro- and micro-planning instruments generated at the local level, which involve quantitative variables related to human, material, logistic, and financial resources. Achievement of high-quality criteria and indicators for follow-up vaccination campaigns were also assessed, including effectiveness, homogeneity, timeliness, simultaneity, efficiency, and rapid monitoring. ResultsThe micro-planning process was fully implemented nationwide in 95% of health facilities (1879) four weeks prior to implementation of the follow-up campaign. High-quality follow-up was conducted over 14 weeks: 3 395 716 children aged 1-12 years were vaccinated and 99% administrative coverage was achieved, with 71% of provinces (17) reaching ≥95% coverage. In the remaining 29% of provinces (7), coverage rates were between 90% and 94%, with a total of 5 556 128 doses of bivalent vaccine and oral or injectable polio vaccine. Based on the quality criteria, the country achieved 95% of the targeted results. ConclusionsPolitical support and prioritization, together with the implementation of high-quality micro-planning of the follow-up vaccination campaign generated at the local level, enabled the achievement of targets and results at ≥95% coverage. This is an innovative and successful public health experience that has strengthened the National Immunization Program in Ecuador and other countries in the Region of the Americas. Local health teams conducted micro-planning adapted to the local context, using the methodology and instruments to identify areas of responsibility in orderly, systematic intramural and extramural vaccination campaigns. Article's language Spanish https://doi.org/10.26633/RPSP.2025.32 Special report PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Alcohol use, heavy episodic drinking, and associated cardiovascular risk in GuyanaAbraham Valles11 Apr 2025 Motilal et al. ObjectiveTo determine associations between demographic characteristics, alcohol use, heavy episodic drinking (HED), and cardiovascular risk factors using the 2016 Guyana World Health Organization (WHO) STEPwise noncommunicable diseases risk factor survey. MethodsA weighted sample was used in a secondary analysis of data obtained from an online database. Descriptive statistics, binary logistic regression, and linear regression models were applied to identify which subpopulations were at highest risk of HED or cardiovascular disease. ResultsData from 2 662 individuals (77% response rate) were analyzed. In the unweighted sample, females made up 59.9% (95% CI [58.04, 61.76]) of the respondents and the average age was 40.7 years. Indo-Guyanese comprised 39.4% (95% CI [37.54, 41.26]) of the sample. The maximum educational level completed was primary level in 44.5% (95% CI [42.61, 46.39]) and secondary in 32.5% (95% CI [30.72, 34.28]). Of those who had ever drunk, 80.1% (95% CI [78.30, 81.90]) confirmed alcohol use in the past 12 months. Younger males were significantly more likely to consume alcohol. Using the weighted sample, Amerindian individuals had lower odds of alcohol use (odds ratio [OR] 0.36; 95% CI [0.25, 0.51]) compared to Indo-Guyanese. Residents of the Demerara-Mahaica region had the highest use at 86.1% (OR 4.74; 95% CI [2.86, 7.86]). Regarding HED, 16.4% (95% CI [14.73, 18.07]) of the entire sample, and 41.1% (95% CI [38.88, 43.32]) of those who drank in the past 30 days, reported having at least six drinks (defined as HED) in one sitting. The 25–29 age group showed an increase in odds for HED (OR 2.09; 95% CI [1.13, 3.89]). Men were more likely to engage in HED than women (OR 6.13; 95% CI [4.73, 7.95]). People of African (OR 0.78; 95% CI [0.61, 1.00]) and Amerindian descent (OR 0.48; 95% CI [0.31, 0.73]) had lower odds of HED than Indo-Guyanese. In the adjusted models, HED was positively correlated with elevated blood pressure (adjusted OR [aOR] 1.40; 95% CI [1.05, 1.88]), obesity (aOR 1.49; 95% CI [1.13, 1.95]), and elevated triglycerides (β coefficient 28.38, p = 0.004). For each OR and aOR above, p ≤ 0.05. ConclusionsThis secondary analysis identifies that the population along the central and eastern coastal regions, young males, and those of Indo-Guyanese descent might benefit from focused public health interventions on alcohol and cardiovascular risk in Guyana. Article's language English https://doi.org/10.26633/RPSP.2025.30 Original research PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Using data systems to conduct health research in the Caribbean: challenges during the COVID-19 pandemicAbraham Valles11 Apr 2025 Tulloch-Reid et al. We aimed to assess how control measures during the coronavirus disease 2019 (COVID-19) pandemic affected the metabolic health of people with noncommunicable diseases when severe restrictions on movement and safety concerns prevented the use of traditional methods of health data collection. To identify study participants, we attempted to use hospital laboratory databases in Jamaica, Barbados, and Trinidad and Tobago. We planned to contact participants by telephone for verbal consent to complete a questionnaire and to extract health information (blood pressure and anthropometric data) from their medical records. In this article, we describe the challenges of collecting data from hospital systems to conduct this research during COVID-19. Only one of the four hospitals selected had dedicated information technology personnel able to access laboratory data systems for sampling. When laboratory data were obtained through the commercial vendor, the lack of unique identifiers made it difficult to link these reports to medical records containing contact information. Outdated telephone contact information limited our ability to recruit potential participants identified by this method. Three of four hospitals used paper records requiring manual chart review. There was inconsistent recording of biomedical data on medical record abstraction. As restrictions lifted, we resorted to traditional methods of recruitment to complete data collection. Strengthening routine data collection and implementing standardized, accessible, electronic data systems are essential to generate actionable health data in the Caribbean. Article's language English https://doi.org/10.26633/RPSP.2025.29 Opinion and analysis PubDate: Fri, 11 Apr 2025 13:00:00 +000
Authors:Abraham Valles Abstract: Vaccine-associated poliomyelitis: safety of the oral poliovirus vaccine, Brazil, 2013–2023Abraham Valles11 Apr 2025 Silva et al. ObjectiveTo quantify the occurrence of vaccine-associated paralytic poliomyelitis (VAPP) cases in Brazil from January 2013 to May 2023. MethodsA descriptive study was conducted on VAPP cases reported as events supposedly attributable to vaccination or immunization (ESAVI) following oral poliovirus vaccine (OPV) administration. VAPP cases were defined as acute flaccid paralysis (AFP) with isolation of vaccine-derived poliovirus in stool samples and persistence of motor deficits after 60 days. ResultsA total of 200 suspected cases were identified, with two confirmed as VAPP (<1 case per 10 million doses administered) based on the isolation of the vaccine virus. Risk factors associated with VAPP included incomplete vaccination schedules, malnutrition, and/or immunodeficiency. ConclusionsVAPP occurrence was rare and aligned with expected values. Continued surveillance of ESAVI and suspected VAPP cases is essential to support poliomyelitis eradication efforts and ensure vaccine safety. Article's language Portuguese https://doi.org/10.26633/RPSP.2025.27 Original research PubDate: Fri, 11 Apr 2025 13:00:00 +000
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