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Local therapies are increasingly used for ocular preservation in retinoblastoma. In middle-income countries, these techniques pose specific challenges mostly related to more advanced disease at diagnosis. The Grupo de America Latina de Oncología Pediátrica (GALOP) developed a consensus document for the management of conservative therapy for retinoblastoma. Intra-arterial chemotherapy (OAC) is the preferred therapy, except for those with less advanced disease or age younger than 6 months. OAC allowed for a reduction in the use of external beam radiotherapy in our setting. Intravitreal chemotherapy is the preferred treatment for vitreous seeding. Enucleation is the treatment of choice for eyes with advanced disease.

Given the potential of institutional approaches to health promotion, this study sought to identify the countries on the American continent which have national physical activity (PA) guidelines approved by their national health agencies. A scoping review was conducted in May 2019, with a search conducted in five electronic databases, national health agency websites and contacts with members of the Physical Activity Network of the Americas. In all, national PA guidelines were found in ten of the 36 countries surveyed (27.8%), published between 2011 and 2018, the majority being in South American countries (n = 6). All guidelines presented \"approaches and strategies for primary health care,\" \"PA recommendations for health,\" and the \"involvement of different PA domains,\" however, few guidelines addressed \"constructed environment and infrastructure\" (n = 3), as well as \"monitoring and surveillance actions\" (n = 5). The conclusion can be drawn that, although few countries on the American continent have guidelines for PA and that the majority of those available address PA in a limited way, new national guidelines, based on the complexity of the determinants, monitoring and consequences of PA are needed to guide and foster policies to promote PA within the population.
Visto o potencial das abordagens institucionais à promoção da saúde, o presente estudo buscou identificar os países do continente americano que possuem diretrizes nacionais de atividade física (AF) chanceladas por órgãos nacionais de saúde. Em maio de 2019 realizou-se uma revisão de escopo, com buscas em cinco bases de dados eletrônicas, sítios eletrônicos dos órgãos nacionais de saúde e contato com integrantes da Rede de Atividade Física das Américas. Foram encontradas diretrizes nacionais de AF em dez dos 36 países pesquisados (27,8%), publicadas entre 2011 e 2018, com maioria nos países da América do Sul (n=6). Todas as diretrizes apresentaram “abordagens e estratégias para a atenção primária em saúde”, “recomendações de AF para a saúde” e o “envolvimento de distintos domínios da AF”, contudo, poucas diretrizes abordaram o “ambiente construído e infraestrutura” (n=3), assim como “ações de monitoramento e vigilância” (n=5). Pode-se concluir que, ao passo que poucos países do continente americano dispõem de diretrizes para a AF e, que boa parte das disponíveis aborda a AF de maneira limitada, novas diretrizes nacionais, fundamentadas na complexidade dos determinantes, monitoramento e consequências da AF são necessárias para a orientação e incentivo de políticas de promoção da AF no contexto populacional.

BACKGROUND: Plasmodium vivax malaria represents a major public health problem. This study presents the quality assessment of clinical practice guidelines for the management of P. vivax malaria.
METHODS: A systematic review was conducted in PubMed, SciELO, and Google Scholar. Additionally, five guidelines were assessed with the AGREE (Appraisal of Guidelines Research and Evaluation) II protocol.
RESULTS: The general performance on the domains of stakeholder involvement, development rigor, and editorial independence was low.
CONCLUSIONS: Most guidelines lack a solid research methodology, which implies ambiguous accuracy. Much needs to be done in the area of therapeutics and quality of policies.

Recreational water epidemiology studies are rare in settings with minimal wastewater treatment where risk may be highest, and in tropical settings where warmer temperature influences the ecology of fecal indicator bacteria commonly used to monitor recreational waters. One exception is a 1999 study conducted in São Paulo Brazil. We compared the risk and exposure characteristics of these data with those conducted in the United Kingdom (UK) in the early 1990s that are the basis of the World Health Organization\'s (WHO) guidelines on recreational water risks. We then developed adjusted risk difference models (excess gastrointestinal illness per swimming event) for children (<10 years of age) and non-children (≥10 years of age) across five Brazil beaches. We used these models along with beach water quality data from 2004 to 2015 to assess spatial and temporal trends in water quality and human risk. Risk models indicate that children in Brazil have as much as two times the risk of gastrointestinal illness than non-children. In Brazil, 11.8% of the weekly water samples from 2004 to 2015 exceeded 158 enterococci CFU/100 ml, the highest level of fecal streptococci concentration measured in the UK study. Risks associated with these elevated levels equated to median NEEAR-Gastrointestinal Illness (NGI) risks of 53 and 96 excess cases per 1000 swimmers in non-children and children, respectively. Two of the five beaches appear to drive the overall elevated NGI risks seen during this study. Distinct enteric pathogen profiles that exist in tropical settings as well as in settings with minimal wastewater treatment highlight the importance of regionally specific guideline development.

The US National Institutes of Mental Health Research Domain Criteria (RDoC) seek to stimulate research into biologically validated neuropsychological dimensions across mental illness symptoms and diagnoses. The RDoC framework comprises 39 functional constructs designed to be revised and refined, with the overall goal of improving diagnostic validity and treatments. This study aimed to reach a consensus among experts in the addiction field on the \'primary\' RDoC constructs most relevant to substance and behavioural addictions.
Forty-four addiction experts were recruited from Australia, Asia, Europe and the Americas. The Delphi technique was used to determine a consensus as to the degree of importance of each construct in understanding the essential dimensions underpinning addictive behaviours. Expert opinions were canvassed online over three rounds (97% completion rate), with each consecutive round offering feedback for experts to review their opinions.
Seven constructs were endorsed by ≥ 80% of experts as \'primary\' to the understanding of addictive behaviour: five from the Positive Valence System (reward valuation, expectancy, action selection, reward learning, habit); one from the Cognitive Control System (response selection/inhibition); and one expert-initiated construct (compulsivity). These constructs were rated to be related differentially to stages of the addiction cycle, with some linked more closely to addiction onset and others more to chronicity. Experts agreed that these neuropsychological dimensions apply across a range of addictions.
The study offers a novel and neuropsychologically informed theoretical framework, as well as a cogent step forward to test transdiagnostic concepts in addiction research, with direct implications for assessment, diagnosis, staging of disorder, and treatment.

The prevention and control of mosquito-borne diseases, such as malaria, are important health issues in tropical areas. Malaria transmission is a multi-scale process strongly controlled by environmental factors, and the use of remote-sensing data is suitable for the characterization of its spatial and temporal dynamics. Synthetic aperture radar (SAR) is well-adapted to tropical areas, since it is capable of imaging independent of light and weather conditions. In this study, we highlight the contribution of SAR sensors in the assessment of the relationship between vectors, malaria and the environment in the Amazon region. More specifically, we focus on the SAR-based characterization of potential breeding sites of mosquito larvae, such as man-made water collections and natural wetlands, providing guidelines for the use of SAR capabilities and techniques in order to optimize vector control and malaria surveillance. In light of these guidelines, we propose a framework for the production of spatialized indicators and malaria risk maps based on the combination of SAR, entomological and epidemiological data to support malaria risk prevention and control actions in the field.

Atrial fibrillation (AF) is a prominent risk factor for stroke and a leading cause of death and disability throughout Latin America. Contemporary evidence-based guidelines for the management of AF and stroke incorporate the use of practical and relatively simple scoring methods to estimate both stroke and bleeding risk, in order to assist in matching patients with appropriate interventions. This review examines consistencies and differences among guidelines for reducing stroke risk in patients with AF, assessing the role of user-friendly scoring methods to determine appropriate patients for anticoagulation and other treatment options. Current options include warfarin and direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban. These agents have been found to be superior or noninferior to standard vitamin K antagonist anticoagulation in large randomized trials. Potential benefits of these agents mainly include lower ischemic stroke rates, reduced intracranial bleeding, no need for regular monitoring, and fewer drug-drug and drug-food interactions. Expert opinions regarding clinical situations for which data are presently lacking, such as emergency bleeding and stroke in anticoagulated patients, are also provided. Enhanced attention and adherence to evidence-based guidelines are essential components for a strategy to reduce stroke morbidity and mortality across Latin America.

Food-based dietary guidelines (FBDGs) are regularly updated educational documents that provide scientific information on nutritional needs and food composition to the general population. The aim of this study was to review the FBDGs of countries in the Americas and compare them based on their pictorial representation, food grouping, and associated messages on healthy eating and behavior, considering intercultural differences. FBDGs from 30 countries in the Americas were collected, representing 97% of the entire North and South American population. Of these FBDGs, 93% (28 of 30) have adopted a food guide illustration shape that conveys local traditions and classifies foods into six or seven groups. The main food groups are vegetables, fruits, cereals, starchy vegetables and fruits, legumes, milk and dairy, protein-rich foods, oils and fats, and sugar and sweeteners. Some differences include single food classifications. Despite the dietary pattern resulting from geographic conditions and cultural heritages, the main nutritional keypoints are similar among the different American FBDGs as follows: (1) Consume large amounts of fruits, vegetables, and cereals; and (2) limit intake of fat, simple sugars, and salt. Although there is general agreement on the basic nutritional messages, FBDGs remain insufficient regarding food groups and the identification of subgroup population nutritional requirements, particularly in countries where both excess and deficit malnutrition are present.

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