War, armed conflict, forced displacement, and climate change are increasingly interconnected determinants of mental health. A geopsychiatric perspective situates their effects within the interacting geographic, geopolitical, environmental, cultural, economic, and institutional conditions that shape exposure, vulnerability, protection, and care. In conflict-affected and climate-vulnerable settings, mental health consequences extend beyond direct trauma and arise through cumulative disruptions to safety, livelihoods, social and cultural continuity, health systems, and adaptive capacity. This critical narrative and conceptual review uses geopsychiatry as its organizing framework to examine the mental health consequences of war and armed conflict within the climate–conflict polycrisis. Drawing on evidence from conflict psychiatry, displacement studies, climate and mental health research, and humanitarian mental health, it shows that war generates a broad and heterogeneous burden encompassing common and severe mental disorders, non-diagnostic forms of suffering, disability, and intergenerational effects. Risk is unequally distributed according to displacement status, social and clinical vulnerability, and access to protection and care. Climate change can act as a threat multiplier by intensifying resource insecurity, livelihood disruption, forced migration, institutional fragility, and pressure on health systems. The framework connects macro-level climate and geopolitical forces with meso-level systems and micro-level vulnerabilities and protective resources. It also emphasizes reciprocal, context-dependent pathways and the potential for adaptation, recovery, and collective resilience. Geopsychiatry provides an integrative basis for understanding the mental health effects of the climate–conflict polycrisis and for aligning clinical, humanitarian, and policy responses. Mental health should therefore be embedded in integrated policies for climate adaptation, conflict prevention, humanitarian response, and recovery.

A licensed chikungunya vaccine now exists; however, it remains unclear whether it could be deployed during outbreaks to reduce the health burden. We used an epidemic in Paraguay as a case study. We conducted a seroprevalence study and used models to reconstruct epidemic transmission dynamics, providing a framework to assess the theoretical impact of a vaccine had it been available. We estimated that 33.0% (95% confidence interval (CI) 30.1-36.0%) of the population became infected during the outbreak. Of these individuals, 6.3% (95% CI 5.8-6.9%) were detected by the surveillance system, with a mean infection fatality ratio of 0.013% (95% CI 0.012-0.014%). A disease-blocking vaccine with 75% efficacy deployed in 40% of individuals aged ≥12 years over a 3-month period would have prevented 34,200 (95% CI 30,900-38,000) cases, representing 23% of all cases, and 73 (95% CI 66-81) deaths. If the vaccine also leads to infection blocking, 88% of cases would have been averted. These findings suggest that the vaccine is an important new tool to control outbreaks.

Estimado editor: El pasado 7 de agosto de 2025, la Dirección General de Vigilancia de la Salud del Ministerio de Salud Pública de Paraguay emitió una alerta epidemiológica por sarampión, tras la confirmación de cuatro casos en el departamento de San Pedro, todos ellos sin antecedentes de vacunación documentada (1). El último brote con transmisión autóctona en el país se registró en 1998. Más recientemente, en 2023, se notificó un caso confirmado de fuente de infección desconocida, que no generó casos secundarios (1). Esta señal de alarma no es un hecho aislado: se enmarca en un contexto global de reemergencia del virus, favorecido por las brechas en la cobertura vacunal, la circulación internacional de personas y la complacencia que a veces se instala cuando una enfermedad ha sido declarada eliminada en un país. La rápida diseminación y el riesgo de brotes secundarios en comunidades vulnerables invitan a replantear una pregunta que, pese a décadas de evidencia científica, sigue sin recibir suficiente atención en el discurso público: ¿continuamos subestimando al sarampión como una enfermedad meramente febril y exantemática?

Introduction: COVID-19, a respiratory infection caused by SARS-CoV-2, has demonstrated varying severity across populations, with approximately 20% of patients developing complications and less than 5% experiencing severe disease requiring hospitalization. The impact of chronic diseases on COVID-19 outcomes remains particularly relevant in developing countries, where healthcare resources and population characteristics differ from well-studied settings. Objective: Describe the clinical and epidemiological characteristics of patients hospitalized with COVID-19 during the first seven months of the pandemic in Paraguay, analyzing how chronic non-communicable diseases (NCDs) influenced disease progression and outcomes. Material and Methods: We conducted a cross-sectional analytical study examining medical records from patients hospitalized with confirmed SARS-CoV-2 infection across five major referral hospitals in Paraguay from March to September 2020. Using bivariate and multivariate logistic regression analyses with likelihood ratio criterion, we identified factors associated with ICU admission and mortality, considering p<0.05 statistically significant. Results: Among 1,690 hospitalized patients, 797 (47.2%) met inclusion criteria, with a median age of 51 years and male predominance (53.8%). Chronic diseases were present in 61.9% of patients, with hypertension (29.6%) and diabetes (25.6%) being most prevalent. Multivariate analysis revealed that age over 80 years (OR=7.70), presence of COPD (OR=2.58), and having three or more NCDs (OR=2.78) significantly increased mortality risk. ICU admission was required for 29.6% of patients, with an overall mortality rate of 29.1%. Conclusion: The severity of COVID-19 outcomes among hospitalized patients in Paraguay showed strong associations with advanced age, multiple chronic conditions, and specific comorbidities like COPD. These findings emphasize the need for targeted preventive strategies and enhanced monitoring of high-risk patients, particularly those with multiple NCDs.

established in 1988, the number of wild poliovirus (WPV) been declared eradicated (1). By the end of 2022, WPV type 1 cally linked to Pakistan (4,5), and circulating vaccine-derived poliovirus (cVDPV) outbreaks were detected in 42 countries (6). cVDPVs are oral poliovirus vaccine-derived viruses that can emerge after prolonged circulation in populations with low immunity allowing reversion to neurovirulence and can cause paralysis. Polioviruses are detected primarily through surveillance for acute flaccid paralysis (AFP), and poliovirus

Background: Paraguay has recently experienced an exponential increase in chikungunya cases, leading to psychological distress, particularly anxiety. Aim: To develop and validate the Chikungunya Anxiety Scale (CHIKAS). Materials and Methods: An initial scale of 18 items was used, which was subjected to validation by expert judgment to obtain 14 items. To determine construct validity, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have been employed, and internal and convergent validity were determined. Demographic, socioeconomic, and health status data were also collected. Results: The study included 974 participants. The final scale consisted of 12 items with evidence of a two-factor model (psychological and physical). The internal validity was good (McDonald's omega = 0.882). The CFA showed good adjustment indices. Regarding participant characteristics, a relationship was found between anxiety due to chikungunya and gender, employment, mental diagnosis, medication use, and chikungunya infection. Conclusion: The final 12-item CHIKAS had strong psychometric properties and was a two-factor model.