Dino Sepúlveda

We examine how structural characteristics of health systems in Latin America and the Caribbean (LAC) shape access to innovative therapies, using emicizumab for hemophilia A as a case study. Although the therapy is available in the region, access remains uneven and constrained by high costs and fragmented health system arrangements. Using a descriptive structural approach, we characterize the health system configurations associated with financial coverage of emicizumab across 16 LAC countries, representing more than 85% of the regional population. Regulatory approval timelines and coverage status were described, and principal component analysis (PCA) was applied to synthesize multiple indicators into a Global Characteristics Index capturing five core health system functions: resource generation, financing, service delivery, general governance, and therapy-specific governance. Coverage is defined as formal access with explicit financial protection provided by the health system. Substantial heterogeneity was observed across countries. Regulatory approval was often achieved relatively rapidly, but this did not consistently translate into timely or comprehensive coverage. Countries with stronger structural characteristics—particularly in resource generation, service delivery, and governance—tended to achieve broader and more sustained coverage, although institutional capacity alone was not sufficient in all cases. Our results emphasize the need to strengthen health governance and adopt specific policies for rare diseases in the region.

Knowledge translation (KT) platforms (organisations that focus on supporting evidence-informed policy-making4) are widely used tools to implement evidence-informed decision-making at the policy level. In the Latin American Region, there are several types of health KT Platforms, located mainly within non-governmental organisations, universities3 5 and in the case of Chile6 and Brazil,7 8 placed within Ministries of Health. It is noteworthy that Brazil and Chile have shown a significant adherence to EVIPNet America efforts.9

INTRODUCCIÓN. La pandemia COVID-19 evidenció la necesidad de contar con estrategias de comunicación de riesgo efectivas y contextualizadas al territorio, para la toma de decisión informada de la comunidad. OBJETIVO. describir la construcción y validación por expertos de una Guía de Buenas Prácticas para Comunicación de Riesgo durante una crisis sanitaria (GBP-CR) en el contexto chileno. MATERIAL Y MÉTODOS. Estudio multi método y de validez de constructo para los elementos de evaluación de la guía. RESULTADOS. Se construyó una GBP-CR que aborda contenidos teóricos sobre comunicación de riesgo (CR), institucionalización de la estrategia, su enfoque y análisis del contexto de implementación. Incluye recomendaciones para construir, transmitir y evaluar el mensaje para una CR efectiva y rúbricas para valorar tres aspectos centrales de los comunicados. CONCLUSIÓN. Se construyó la primera Guía de Buenas Prácticas para la Comunicación de Riesgo durante una crisis sanitaria basada en evidencia y ajustada a la realidad local.

The Preferred Reporting Items for Overviews of Reviews (PRIOR) statement provides an evidence-based reporting guideline developed using established, rigorous methods that involved a four-stage process (project launch, evidence reviews, modified Delphi exercise, development of the reporting guideline) and an international stakeholder group representing varied experiences (e.g., authors, peer reviewers, editors, readers) and roles (e.g., patients/public, researchers, statisticians, librarians, healthcare professionals, policymakers).The PRIOR statement includes: a checklist with 27 main items that cover all steps and considerations involved in planning and conducting an overview of reviews of healthcare interventions; an explanation and elaboration document with rationale, essential elements, additional elements, and example for each item; and a flow diagram.The methods and results of the PRIOR guideline development, including the checklist and flow diagram, are reported separately. This document contains the explanation and elaboration for each checklist item.

The publication of systematic reviews has rapidly increased making it challenging to remain apprised of and interpret evidence from their growing number. A newer form of evidence synthesis, overview of reviews, synthesizes evidence from multiple systematic reviews. Authors would benefit from evidence- and consensus-based guidance for the complete and transparent reporting of overviews of reviews; in turn this will improve their reproducibility, trustworthiness, and usefulness for readers and end users (e.g., healthcare providers, healthcare decision-makers, policy-makers, patients/public).The PRIOR statement provides an evidence-based reporting guideline developed using established, rigorous methods that involved a four-stage process (project launch, evidence reviews, modified Delphi exercise, development of the reporting guideline) and an international stakeholder group representing varied experiences (e.g., authors, peer reviewers, editors, readers) and roles (e.g., patients/public, researchers, statisticians, librarians, healthcare professionals, policymakers). The PRIOR statement includes: a checklist with 27 main items that cover all steps and considerations involved in planning and conducting an overview of reviews of healthcare interventions; an explanation and elaboration document with rationale, essential elements, additional elements, and example for each item; and a flow diagram.

Purpose: Drug utilization research (DUR) contributes to inform policymaking and to strengthen health systems. The availability of data sources is the first step for conducting DUR. However, documents that systematize these data sources in Latin American (LatAm) countries are not known. We compiled the potential data sources for DUR in the LatAm region.Methods: A network of DUR experts from nine LatAm countries was assembled and experts conducted: (i) a website search of the government, academic, and private health institutions; (ii) screening of eligible data sources, and (iii) liaising with national experts in pharmacoepidemiology (via an online survey). The data sources were characterized by accessibility, geographic granularity, setting, sector of the data, sources and type of the data. Descriptive analyses were performed.Results: We identified 125 data sources for DUR in nine LatAm countries. Thirty‐eight (30%) of them were publicly and conveniently available; 89 (71%) were accessible with limitations, and 18 (14%) were not accessible or lacked clear rules for data access. From the 125 data sources, 76 (61%) were from the public sector only; 46 (37%) were from pharmacy records; 43 (34%) came from ambulatory settings and; 85 (68%) gave access to individual patient‐level data.Conclusions: Although multiple sources for DUR are available in LatAm countries, the accessibility is a major challenge. The procedures for accessing DUR data should be transparent, feasible, affordable, and protocol‐driven. This inventory could permit a comparison of drug utilization between countries identifying potential medication‐related problems that need further exploration.

Global health diplomacy (GHD) has become an important field of investigation due to health concerns increasingly entering the foreign policy domain. Much of the existing academic writing focuses on North-South cooperation in global health, and emphasizes the role of security and economic interests by Northern countries as drivers of GHD. Chile presents a favourable environment for an expanded involvement in future GHD activities. However, there is little knowledge about what has been driving Chile’s integration of health into foreign policy, and little effort to appropriate knowledge from international relations theories to better theoretically grasp the emergence of GHD. To fill this knowledge gap, we conducted a narrative literature review of the driving forces behind Chile’s integration of health into foreign policy. Drawing on a popular analytical framework used in international relations scholarship, we identified driving forces of the integration of health into Chile foreign policy at three levels of analysis. At the international/global level of analysis, the main driving forces were related to national security concerns and compliance with regulations of international organizations. At the regional level, GHD was driven by a commitment to regional solidarity through mutually beneficial cooperation in response to neoliberal reforms; health coordination in emergencies; and protection of indigenous peoples. Finally, at the domestic level, drivers identified include economic interests of various productive sectors and how health regulations might impact those; the high degree of social inequity which impacts on access to healthcare; and management of natural disasters. Health actions in the context of international relations in Chile are still mainly motivated by more traditional foreign policy interests rather than by a desire to satisfy health needs per se. This seems to conform with findings of existing GHD scholarship that emphasize the importance of security and economic interests as driving forces of GHD, and how health is often appropriated instrumentally within foreign policy settings to achieve other goals. But the review also reveals that in the context of South-South cooperation (and regional health diplomacy), solidarity and normative considerations can be important driving forces as well. Finally, the review demonstrates that there has been an evolution from chiefly domestically focused health policies (e.g. maternal and child nutrition treatment) towards internationally inspired integrated policies (e.g. maternal and child nutrition promotion aligned with international guidelines). La diplomacia en salud global (DSG) se ha convertido en un importante campo de investigación debido a que los problemas de salud son cada vez más considerados en el ámbito de la política exterior. Gran parte de la literatura existente se centra en la cooperación Norte-Sur en salud global, y enfatiza el papel de la seguridad e intereses económicos por parte de los países del Norte como impulsores de la DSG. Chile presenta un escenario favorable para una mayor participación en actividades de DSG. Sin embargo, existe poco conocimiento sobre lo que ha estado impulsando la integración de la salud de Chile en la política exterior, y pocos esfuerzos por usar los elementos de las relaciones internacionales y las teorías de la política exterior para entender mejor el surgimiento de DSG. Para llenar este vacío de conocimiento, realizamos una revisión narrativa de la literatura. Basándonos en un popular marco analítico utilizado en estudios sobre relaciones internacionales, identificamos las fuerzas que impulsan la integración de la salud en la política exterior de Chile en tres niveles de análisis. En el nivel de análisis internacional / mundial, las principales fuerzas motrices se relacionaron con las preocupaciones de seguridad nacional y el cumplimiento de las reglamentaciones de las organizaciones internacionales. A nivel regional, la DSG se ha impulsado por: un compromiso con la solidaridad regional a través de la mutua cooperación en respuesta a las reformas neoliberales; una necesidad de coordinación de salud en emergencias; y la protección de pueblos indígenas. Finalmente, a nivel doméstico, los factores identificados incluyen los intereses económicos de varios sectores productivos (y cómo las reglamentaciones sanitarias podrían afectarlos); el alto grado de inequidad social que impacta en el acceso a la atención médica; y el manejo de desastres naturales. Las acciones de salud en el contexto de las relaciones internacionales en Chile siguen estando motivadas principalmente por intereses de política exterior tradicionales, más que por el deseo de satisfacer las necesidades de salud per se. Esto parece concordar con hallazgos previos, que enfatizan la importancia de la seguridad y los intereses económicos como fuerzas impulsoras de la DSG, y cómo el tema de salud suele ser apropiado instrumentalmente dentro de la política exterior para lograr otros objetivos. Sin embargo, la revisión también revela que, en el contexto de la cooperación Sur-Sur (y la diplomacia regional de salud), la solidaridad y las consideraciones normativas también pueden ser importantes fuerzas impulsoras. Finalmente, ha existido una evolución de las políticas de salud centradas principalmente en el ámbito interno (p. Ej, el tratamiento de nutrición materno-infantil) hacia políticas integradas inspiradas a nivel internacional (p. Ej., la promoción de la nutrición materno-infantil se alinea con las directrices internacionales).

Introducción: Sarocladium kiliense es un hongo saprófito que puede generar infecciones oportunistas asociadas a procedimientos invasores. Se informa un brote multicéntrico nosocomial de fungemias de fuente común por este agente. Luego del reporte de cinco casos en pacientes en tres hospitales al Programa de Control de Infecciones del Ministerio de Salud de Chile en julio de 2013, se estudiaron a nivel nacional todos los pacientes con hemocultivo positivo para este agente. Se trató de cuadros clínicos leves a moderados, sin muertes atribuibles. El estudio identificó 65 casos en 8 hospitales, en su mayoría pacientes pediátricos en quimioterapia. Estudios iniciales de 94 muestras de cuatro fármacos y dispositivos usados en todos los casos resultaron negativas hasta que, en un segundo análisis de lotes seleccionados por criterios epidemiológicos y su matriz farmacéutica, se identificó la contaminación intrínseca de ampollas de ondansetrón de un productor específico, que se usó en todos los casos. Se realizó un retiro nacional de las ampollas de los tres lotes contaminados del fármaco, después de lo cual se contuvo el brote. La vigilancia de infecciones en los hospitales y el programa nacional coordinado con los laboratorios de microbiología fueron claves para identificar un brote multicéntrico de fuente común por contaminación de un fármaco por un hongo inusual.

1. ¿Cómo interpretar una recomendación formulada con sistema GRADE?