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The past half-century has seen enormous changes in the demographic makeup of Latin America and the Caribbean (LAC). In the 1950s, LAC had a small population of about 160 million people, less than today's population of Brazil. Two-thirds of Latin Americans lived in rural areas. Families were large and women had one of the highest fertility rates in the world, low levels of education, and few opportunities for work outside the household. Investments in health and education reached only a small fraction of the children, many of whom died before reaching age five. Since then, the size of the LAC population has tripled and the mostly rural population has been transformed into a largely urban population. There have been steep reductions in child mortality, and investments in health and education have increased, today reaching a majority of children. Fertility has been more than halved and the opportunities for women in education and for work outside the household have improved significantly. Life expectancy has grown by 22 years. Less obvious to the casual observer, but of significance for policy makers, a population with a large fraction of dependent children has evolved into a population with fewer dependents and a very large proportion of working-age adults. This overview seeks to introduce the reader to three groups of issues related to population aging in LAC. First is a group of issues related to the support of the aging and poverty in the life cycle. Second is the question of the health transition. Third is an understanding of the fiscal pressures that are likely to accompany population aging and to disentangle the role of demography from the role of policy in that process.

This volume examines crucial concerns in palliative care, including the proper balance between comfort and cure for the patient, the integration of spiritual well-being, and the challenges of providing care in the absence of basic medical services and supplies. In the first section, palliative-care pioneers Constance Dahlin, Eduardo Bruera, Neil MacDonald, and Declan Walsh recount the early history of the discipline. Part 2 discusses the role of poetry, prose, plays, and other aspects of the humanities in the practice of palliative care. Part 3 explores essential current issues in the field, including autonomy, the use of opioids, and the impact of artificial intelligence on the evolution of palliative care. The final section focuses on the spiritual dimensions of pain and suffering. Rich with anecdotes and personal stories and featuring contributions from pioneers and current practitioners, The Pursuit of Life is an essential assessment of the past, present, and future of palliative care. In addition to the editors, the contributors include W. Andrew Achenbaum, Stacy L. Auld, Elena Pagani Bagliacca, Costantino Benedetti, Courtenay Bruce, Eduardo Bruera, Joseph Calandrino, Jim Cleary, Constance Dahlin, Andrea Ferrari, Mauro Ferrari, Joseph J. Fins, Bettie Jo Tennon Hightower, Kathryn B. Kirkland, Robin W. Lovin, Neil MacDonald, Charles Millikan, Dominique J. Monlezun, Tullio Proserpio, Giovanna Sironi, Daniel P. Sulmasy, and Declan Walsh.

Since the beginning of the epidemic sex workers have experienced a heightened burden of HIV across settings, despite their higher levels of HIV protective behaviors (UNAIDS, 2009). Unfairly, sex workers have often been framed as 'vectors of disease' and 'core transmitters' rather than workers and human beings with rights in terms of HIV prevention and beyond. By gaining a deeper understanding of the epidemiologic and broader policy and social context within which sex work is set one begins to quickly gain a sense of the complex backdrop for increased risk to HIV among sex workers. This backdrop includes the critical role of stigma, discrimination and violence faced by sex workers, as well as, the importance of community empowerment and mobilization among sex workers to address these regressive forces. The eight country case studies work to highlight the experiences of diverse populations of and contexts for sex work across settings. Given the limited epidemiologic and intervention evaluation data available among male and transgender sex workers, however, our collaborative team (Johns Hopkins University, or JHU, World Bank, United Nations Population Fund (UNFPA), and Global Network of Sex Work Projects, or NSWP) determined that the systematic review, mathematical modeling and cost-effective analyses would focus on female sex workers. Throughout the process of this analysis as a whole, the participation of sex worker perspectives and sex worker organizations such as NSWP and their regional partners has been critical by providing documents and resources, input and consultation throughout the analytical process.

The treatment of endovascular leaks after endovascular abdominal aortic repair can be challenging, particularly in patients with a lack of vascular access. We describe the case of a critically ill elderly patient with an endoleak resulting from structural failure of an endograft years after endovascular abdominal aortic repair. The patient was treated with an aorto-uni-iliac endoprosthesis, but a few days later a new endoleak appeared and femoral or axillar access was not feasible. We successfully treated the endoleak using a novel technique via bilateral transradial access involving simultaneous insufflation of two peripheral low-profile balloons to achieve a diameter capable of improving the apposition of the stent graft. In selected cases, bilateral radial access allows procedures to be performed that would otherwise be impossible due to the inherent limitation in sheath size that can be used in the radial artery.The treatment of endovascular leaks after endovascular abdominal aortic repair can be challenging, particularly in patients with a lack of vascular access. We describe the case of a critically ill elderly patient with an endoleak resulting from structural failure of an endograft years after endovascular abdominal aortic repair. The patient was treated with an aorto-uni-iliac endoprosthesis, but a few days later a new endoleak appeared and femoral or axillar access was not feasible. We successfully treated the endoleak using a novel technique via bilateral transradial access involving simultaneous insufflation of two peripheral low-profile balloons to achieve a diameter capable of improving the apposition of the stent graft. In selected cases, bilateral radial access allows procedures to be performed that would otherwise be impossible due to the inherent limitation in sheath size that can be used in the radial artery.

This publication addresses research questions related to an increase in the levels of access and utilization for four key interventions that have the potential to significantly reduce HIV infections among People Who Inject Drugs (PWID) and their sexual and injecting partners, and hence morbidity and mortality in low and middle-income countries (LMIC). These interventions are drawn from nine consensus interventions that comprise a 'comprehensive package' for PWID. The four interventions are: Needle and Syringe Programs (NSP), Medically Assisted Therapy (MAT), HIV Counseling and Testing (HCT), and Antiretroviral Therapy (ART). The book summarizes the results from several recent reviews of studies related to the effectiveness of the four key interventions in reducing risky behaviors in the context of transmitting or acquiring HIV infection. Overall, the four key interventions have strong effects on the risk of HIV infection among PWID via different pathways, and this determination is included in the documents proposing the comprehensive package of interventions. In order to attain the greatest effect from these interventions, structural issues must be addressed, especially the removal of punitive policies targeting PWID in many countries. The scientific evidence presented here, the public health rationale, and the human rights imperatives are all in accord: we can and must do better for PWID. The available tools are evidence-based, right affirming, and cost effective. What are required now are political will and a global consensus that this critical component of global HIV can no longer be ignored and under-resourced.

Desde la perspectiva de la epidemiología sociocultural, se analiza cómo en Ocotepec, Chiapas, los saberes maternos sobre las enfermedades diarreicas y las infecciones respiratorias agudas, estudiados a partir de las representaciones sociales y prácticas de atención, inciden en la búsqueda de atención apropiada. Los resultados demuestran que no hay un reconocimiento de los signos de alarma de deshidratación y neumonía, las complicaciones más graves, lo que causa defunciones en niños menores de cinco años que pudieron evitarse con tratamientos adecuados, que no fueron accesibles debido a los procesos de medicalización y mercantilización de las prácticas médicas locales, y la falta de acceso a los servicios públicos de salud.

Empowering Women in Vanuatu: Analyzing Challenges to Economic Participation Women in Vanuatu examines the barriers hindering women's full economic participation in this traditional, patriarchal society.Despite increasing involvement in the private sector, women face limited government support and discriminatory legal frameworks.

Fifty years ago, health outcomes in the countries of Eastern Europe and Central Asia were not far behind those in Western Europe and well ahead of most other regions of the world. But progress since then has been slow. While life expectancy in the ECA region today is close to the global average, the gap with its western neighbors has doubled, and other middle-income regions have all surpassed ECA. Some countries in the region are doing better, but full convergence with the world’s most advanced health systems is still a long way off. At the same time, survey evidence suggests that the health sector is the top priority for additional investment among populations across the region. The experience of high-income countries also suggests that popular demand for strong and accessible health systems will only grow over time. Yet these aspirations must be reconciled with current fiscal realities. In brief, health sector issues are a challenge here to stay for policy-makers across the ECA region. This report draws on new evidence to explore the development challenge facing health sectors in ECA, and highlights three key agendas to help policy-makers seeking to achieve more rapid convergence with the world’s best performing health systems. The first is the health agenda, where the task is to strengthen public health and primary care interventions to help launch the \"cardiovascular revolution\" that has taken place in the West in recent decades. The second is the financing agenda, in which growing demand for medical care must be satisfied without imposing undue burden on households or government budgets. The third agenda relates to broader institutional arrangements. Here there are some key reform ingredients common to most advanced health systems that are still missing in many ECA countries. A common theme in each of these three agendas is the emphasis on improving outcomes, or \"Getting Better\".

A critical analysis of the World Bank's strategy to combat HIV/AIDS in Africa. The World Bank's Commitment to HIV/AIDS in Africa examines the development challenges posed by HIV/AIDS in Sub-Saharan Africa and outlines a comprehensive agenda for action. This report reaffirms the World Bank's dedication to supporting African countries in achieving their Universal Access targets, integrating AIDS into national development plans, and strengthening national systems. This agenda provides a roadmap for policymakers, development practitioners, and researchers seeking to understand and address the complexities of the HIV/AIDS epidemic in Africa. Discover how the World Bank is working with partners to: * Provide sustainable funding for HIV/AIDS programs * Promote evidence-based strategies for prevention and treatment * Strengthen governance and accountability * Build capacity in key sectors This report is essential reading for anyone committed to global health and development in Africa.

Drawing on an eclectic array of research and evaluative studies culled from a mix of sources, this volume analyzes Brazilian hospital performance along several policy dimensions including resource allocation and use within hospitals, hospital payment mechanisms, organizational and governance arrangements, management practices, and regulation and quality. An agenda for hospital reform is proposed which synthesizes priorities that are integral to improving hospital performance—and which should be considered for implementation in the near and medium term.