Mapping Human Resources to Guide Ophthalmology Capacity-Building Projects in Honduras: Sub-national Analyses of Physician Distribution and Surgical Practices.

Objective: To map ophthalmologist locations and surgical practices as they vary sub-nationally within Honduras to maximize the impact of efforts to develop cataract surgical capacity. Methods: An anonymous survey was sent to all Honduran ophthalmologists with questions on surgical volume, department-level location, type of facility in which they work, surgical methods, and age. Surgical volume, population, and poverty data sourced through the Oxford Poverty Human Development Initiative were mapped at the department level, and cataract surgical rates (CSR; surgeries per million population per year) were calculated and mapped. Results: Sixty-one of the 102 Honduran ophthalmologists contacted responded. Of those, 85% perform cataract surgery, and 49% work at least part time in a non-profit or governmental facility. Honduras has fewer surgical ophthalmologists per million than the global average, and though national CSR appears to be increasing, it varies significantly between departments. The correlation between CSR and poverty is complex, and outliers provide valuable insights. Conclusion: Mapping ophthalmological surgical practices as they relate to population and poverty at a sub-national level provides important insights into geographic trends in the need for and access to eye care. Such insights can be used to guide efficient and effective development of cataract surgical capacity.

Off-premises demand elasticities for pure alcohol in five Latin American countries: The case of Argentina, Chile, Costa Rica, Honduras, and Uruguay.

BACKGROUND AND AIMS: There is ample evidence from high-income countries that fiscal policies such as alcohol taxes can affect the consumption of alcohol by increasing alcohol prices. In the case of Latin American countries, much less is known about how sensitive alcohol demand is to alcohol price changes. This study aims to expand the evidence base on the sensitivity of off-premises pure alcohol demand to price and expenditure increases in five Latin American countries: Argentina, Chile, Costa Rica, Honduras, and Uruguay, which have different socioeconomic profiles and alcohol consumption patterns. DESIGN AND SETTING: Cross-sectional study MEASUREMENTS: The price and expenditure elasticities were estimated using an Almost Ideal Demand System (AIDS). Own price and expenditure elasticities for off-premises pure alcohol were estimated using representative household surveys, which collect data on households' expenses to construct the consumer basket of goods and services used to calculate the consumer price index (CPI) for the country. FINDINGS: Own price elasticities of off-premises pure alcohol for all countries were negative, inelastic, and significant at 1 %. They were -0.418 for Argentina; -0.656 for Chile; and for Costa Rica, Honduras, and Uruguay, they were equal to -0.608, -0.509, and -0.32, respectively. Expenditure elasticities were positive and significant at 1 %, except for Costa Rica, which was significant at 10 %. They were equal to 0.865 in Argentina; 0.943 in Chile; 1.182 in Costa Rica; 0.874 in Honduras; and 0.857 in Uruguay. Elasticities for Costa Rica should be interpreted cautiously, as there is insufficient geographical price variability to identify the demand correctly. CONCLUSIONS: Results were consistent with previous literature for countries from other regions. Governments should expand this study to measure total demand elasticities to improve the design of alcohol tax policies.

Moral reasoning about gang violence in context: A comparative study with children and adolescents exposed to maras in Honduras and not exposed in Nicaragua.

This study examined how youth morally deliberate about conditions of gang violence shaping their communities. Participants (N = 80; 10-11 and 14-15 years; 50% female) exposed to gangs (maras) in Honduras and not exposed to maras in Nicaragua evaluated hypothetical situations of physical harm in contexts of chronic gang violence. Results indicated that mara-exposed youth were more likely to endorse harming a rival gang member in some contexts, but not others. Moreover, in some contexts, males were more likely to endorse harming others as necessary. Few age differences emerged, suggesting comparability among children and adolescents. Discussion focuses on how children and adolescents coordinate different moral and social concepts and concerns pertaining to acts of physical harm in situations involving gangs.

One World Surgery: The Evolution of a Locally Run Surgical Mission in Honduras.

ABSTRACT: One World Surgery (OWS) is a medical mission organization that treats a variety of orthopaedic conditions and focuses on local partnerships, education, capacity-building, and high-quality care. OWS runs a Honduran ambulatory surgery center (ASC) with >50 full-time local staff; it operates year-round and accommodates visiting surgical teams bimonthly. Across its 12-year history, 8,703 surgical procedures have been performed and 54,940 total consults have been completed, with increasing autonomy of the local medical staff. From 2009 through 2021, OWS has provided 74 million U.S. dollars in surgical and consult patient care. By addressing global surgical disparities via life-enhancing surgical care in low- and middle-income country (LMIC) settings, the OWS ASC mission model may be a useful blueprint for other medical missions.

Frequency of strongyloidiasis and associated factors: Analysis of 13 years of laboratory results in a tertiary referral hospital in Honduras, 2010-2022. / Frecuencia de estrongiloidiasis y factores asociados: análisis de 13 años de resultados de laboratorio en un hospital de tercer nivel de Honduras, 2010-2022

INTRODUCTION: The frequency of detected strongyloidiasis is affected by the selected laboratory method in the studied population. Considering that Honduras has few community-based studies, the analysis of the laboratory record data can provide information helping to understand this parasitosis. OBJECTIVE: To estimate the frequency and to identify the factors associated with strongyloidiasis, analyzing the laboratory records of the Servicio de Parasitología at Hospital Escuela in Tegucigalpa (Honduras) between 2010 and 2022. MATERIALS AND METHODS: We carried out a descriptive, cross-sectional, analytical study. The laboratory diagnosis consisted of stool samples' examination by direct smear and modified Baermann technique. We estimated frequencies and percentages. The statistical association was calculated with prevalence ratios and a 95% confidence interval. Software R, version 4.2.0, and epiR package, version 2.0.46, were used to perform the analysis. RESULTS: The frequency of strongyloidiasis was 0.29% (112/38,085). It was higher with the modified Baermann technique (0.87%; 40/4,575) among male patients (0.44%; 70/15,758). Regarding the age, strongyloidiasis was higher in the 20-40 years old group (0.41%; 28/6,886) with direct smear and 41-61 years old (1.14%; 14/1,232) group with the modified Baermann technique. Among the factors associated with strongyloidiasis were age between 20 and 61 years old (PR=2.26, CI 95%=1.53-3.31), male patients (PR=2.34, CI 95%=1.60­3.44), mucus (PR=1.86, CI 95%=1.22-2.83) and Charcot-Leyden crystals in stool (PR=8.47, CI 95%=5.14-13.96); watery stool (PR=2.39, CI 95%=1.55-3.68), and other helminthiases (PR=6.73, CI 95%=3.98-11.38). Associated factors to cases detected with the modified Baermann technique were outpatient consultation (PR=4.21, CI 95%=1.91-9.28) and formed stools (PR=3.99, CI 95%=1.94-8.19). CONCLUSIONS: The modified Baermann technique increased the detection of strongyloidiasis almost four times. Most cases were distributed among male adults. The cases diagnosed exclusively with the modified Baermann technique have differences from those with observed larvae in the direct smear. It is necessary to develop community-based population studies.

Introducción: La detección de estrongiloidiasis depende del método de diagnóstico utilizado y la población estudiada. Dado que en Honduras hay pocos estudios poblacionales, el análisis de los datos de laboratorio puede generar información que ayude a entender esta parasitosis. Objetivo: Estimar la frecuencia e identificar los factores asociados a la estrongiloidiasis mediante el análisis de los registros de laboratorio del Servicio de Parasitología del Hospital Escuela en Tegucigalpa (Honduras) durante el periodo 2010-2022. Materiales y métodos: Se llevó a cabo un estudio descriptivo, transversal y analítico. El diagnóstico de laboratorio consistió en el análisis de muestras de heces con los métodos directo y Baermann modificado. Se estimaron frecuencias y porcentajes, y la asociación estadística se calculó con razón de prevalencia e intervalos de confianza del 95 %. Se utilizaron los programas R, versión 4.2.0, y el paquete epiR, versión 2.0.46, para ejecutar los análisis estadísticos. Resultados: La frecuencia general de estrongiloidiasis fue 0,29 % (112/38.085). Dicha frecuencia de detección fue mayor con el método de Baermann modificado (0,87 %; 40/4.575), entre pacientes masculinos (0,44 %; 70/15.758). También fue mayor en el rango de edad 20-40 años (0,41%; 28/6.886) por examen directo y entre los 41-61 años (1,14%; 14/1.232) con el método de Baermann modificado. Entre los factores asociados con la estrongiloidiasis se encontraron: edad entre los 20 y los 61 años (RP=2,26; IC 95%=1,53-3,31), sexo masculino (RP=2,34; IC 95% =1,60-3.44), moco (RP=1,86; IC 95%=1,22-2,83) y cristales de Charcot-Leyden en heces (RP=8,47, IC 95%=5,14-13,96), heces líquidas (RP=2,39, IC 95%=1,55-3,68) y otras helmintiasis (RP=6,73, IC 95%=3,98-11,38). Como factores asociados a los casos detectados con el método de Baermann modificado están consulta externa (RP=4,21, IC 95%=1,91-9,28) y heces formadas (RP=3,99, IC 95%=1,94-8,19). Conclusiones: El método de Baermann modificado aumentó la frecuencia de detección de estrongiloidiasis casi cuatro veces. La mayoría de los casos se distribuyeron entre pacientes masculinos adultos. Los casos diagnosticados exclusivamente con el método de Baermann modificado tuvieron diferencias con los casos diagnosticados por examen directo. Es necesario realizar estudios poblacionales.

Honduras HIV cohort: HLA class I and CCR5-Δ32 profiles and their associations with HIV disease outcome.

IMPORTANCE: We identify both canonical and novel human leukocyte antigen (HLA)-HIV associations, providing a first step toward improved understanding of HIV immune control among the understudied Honduras Mestizo population. Our results are relevant to understanding the protective or detrimental effects of HLA subtypes in Latin America because their unique HLA diversity poses challenges for designing vaccines against HIV and interpreting results from such vaccine trials. Likewise, the description of the HLA profile in an understudied population that shows a unique HLA immunogenetic background is not only relevant for HIV immunology but also relevant in population genetics, molecular anthropology, susceptibility to other infections, autoimmune diseases, and allograft transplantation.

The enmity paradox.

The "friendship paradox" of social networks states that, on average, "your friends have more friends than you do". Here, we theoretically and empirically explore a related and overlooked paradox we refer to as the "enmity paradox". We use empirical data from 24,678 people living in 176 villages in rural Honduras. We empirically show that, for a real negative undirected network (created by symmetrizing antagonistic interactions), the paradox exists as it does in the positive world. Specifically, a person's enemies have more enemies, on average, than a person does. Furthermore, in a mixed world of positive and negative ties, we study the conditions for the existence of the paradox, which we refer to as the "mixed-world paradox", both theoretically and empirically, finding that, for instance, a person's friends typically have more enemies than a person does. We also confirm the "generalized" enmity paradox for non-topological attributes in real data, analogous to the generalized friendship paradox (e.g., the claim that a person's enemies are richer, on average, than a person is). As a consequence, the naturally occurring variance in the degree distribution of both friendship and antagonism in social networks can skew people's perceptions of the social world.

Presence, Co-Occurrence, and Daily Intake Estimates of Aflatoxins and Fumonisins in Maize Consumed in Food-Insecure Regions of Western Honduras.

Foodborne mycotoxins are a significant food safety risk in developing countries. Our objective was to determine the occurrence of and exposure levels to aflatoxins (AFs) and fumonisins (FBs) in maize intended for human and animal consumption in food-insecure regions of western Honduras. Total AFs and FBs were quantified with a monoclonal antibody-based affinity spectrofluorimetric method. FBs were detected in 614/631 samples of maize destined for human consumption at 0.3 to 41 mg/kg (mean, 2.7 mg/kg). Of the 614 positive samples, 147 had FB levels exceeding the U.S. Food and Drug Administration (FDA) advisory threshold of 4.0 mg/kg. AFs were detected in 109/631 samples of maize for human consumption with concentrations between 1.0 and 490 µg/kg (mean, 10 µg/kg). AF levels in 34 samples exceeded the FDA regulatory limit (i.e., 20 µg/kg). The average probable daily intake of AFs in western Honduras ranged from 0 to 260 ng/kg body weight/day, and for FBs, the average probable daily intake ranged from 17 to 53 µg/kg body weight/day. AFs and FBs co-occurred in 106/631 samples with 60 samples containing both toxins at levels greater than the FDA regulatory levels. Samples of maize intended for animal feed had significantly higher AF (mean, 22 µg/kg) and FB (mean, 7.6 mg/kg) contamination levels than those observed in samples destined for human consumption. Thus, the maize supply chain in western Honduras is contaminated with mycotoxins at levels that pose health risks to both humans and livestock. More effective mycotoxin surveillance and implementation of effective mitigation strategies are needed to reduce mycotoxin contamination and exposure.

A distinctive new species of the coral shrimp genus Microprosthema Stimpson, 1860 from the Atlantic coast of Florida and Honduras (Decapoda: Stenopodidea: Spongicolidae).

A new species of the spongicolid coral shrimp genus Microprosthema Stimpson, 1860 is described on the basis of three specimens collected by hand while scuba diving off the Atlantic coast of southern Florida, with additional photographic records from Roatan, Honduras. Microprosthema dimitrisorum sp. nov. can be separated from all presently known species of the genus by a unique combination of morphological characters, and most easily, by its highly diagnostic and conspicuous colour pattern consisting of large red spots on most of the body and appendages.

Trans-Holocene Bayesian chronology for tree and field crop use from El Gigante rockshelter, Honduras.

El Gigante rockshelter in western Honduras provides a deeply stratified archaeological record of human-environment interaction spanning the entirety of the Holocene. Botanical materials are remarkably well preserved and include important tree (e.g., ciruela (Spondias), avocado (Persea americana)) and field (maize (Zea mays), beans (Phaseolus), and squash (Cucurbita)) crops. Here we provide a major update to the chronology of tree and field crop use evident in the sequence. We report 375 radiocarbon dates, a majority of which are for short-lived botanical macrofossils (e.g., maize cobs, avocado seeds, or rinds). Radiocarbon dates were used in combination with stratigraphic details to establish a Bayesian chronology for ~9,800 identified botanical samples spanning the last 11,000 years. We estimate that at least 16 discrete intervals of use occurred during this time, separated by gaps of ~100-2,000 years. The longest hiatus in rockshelter occupation was between ~6,400 and 4,400 years ago and the deposition of botanical remains peaked at ~2,000 calendar years before present (cal BP). Tree fruits and squash appeared early in the occupational sequence (~11,000 cal BP) with most other field crops appearing later in time (e.g., maize at ~4,400 cal BP; beans at ~2,200 cal BP). The early focus on tree fruits and squash is consistent with early coevolutionary partnering with humans as seed dispersers in the wake of megafaunal extinction in Mesoamerica. Tree crops predominated through much of the Holocene, and there was an overall shift to field crops after 4,000 cal BP that was largely driven by increased reliance on maize farming.

Accuracy of Dengue, Chikungunya, and Zika diagnoses by primary healthcare physicians in Tegucigalpa, Honduras.

BACKGROUND: Dengue, Chikungunya, and Zika are co-endemic in Honduras and are often misdiagnosed due to similar clinical and epidemiological behavior. Most arboviral infections reported in primary care are based on clinical diagnoses without laboratory confirmation. Therefore, the accuracy of physicians' diagnoses and the factors that affect them needs to be evaluated. METHODS: A cross-sectional study with convenience sampling at primary healthcare centers was conducted from June to September 2016 and 2017. Clinical data and dried blood spots on Whatman 903 filter paper from 415 arboviral cases and 248 non-arboviral febrile cases were collected. Viral RNA was extracted from a 6-mm DBS paper disc and confirmed by RT-qPCR and sequencing. RESULTS: Only 30.84% of diagnostic accuracy was observed in physicians in primary care when comparing arboviral clinical diagnosis with RT-qPCR detection. Moreover, in Dengue and Zika clinical cases, only 8.23% and 27.08% were RT-qPCR confirmed, respectively. No Chikungunya cases were confirmed. In 2017, 20.96% of febrile cases were RT-qPCR confirmed arboviral infections. The symptoms of 45.5% of arboviral cases can fit more than one case definition for arboviruses. The "symptom compliance" and "patient with suspected close contact" were the criteria most utilized by physicians for arboviral diagnosis. The pattern of the epidemiological curves of the arboviral clinical cases didn't match the one of the RT-qPCR confirmed cases. CONCLUSIONS: Low diagnostic accuracy for overall and individual arboviral infections was observed in physicians. Unspecific symptomatology, overlapping case definitions, and reported close contact to an arboviral patient might contribute to misdiagnosis. Without laboratory confirmation, surveillance data may not reflect the real behavior of these diseases and could impact health interventions.

A Qualitative Assessment of Social Norms Related to Seeking Help for Intimate Partner Violence in Honduras.

Intimate partner violence (IPV) is a major public health issue in Honduras and other low- and middle-income countries, with few victims seeking help. While structural factors, such as lack of services and economic barriers, are often cited as reasons for not seeking help, social and cultural factors may also play a role. This study aims to describe the normative social environment that may hinder women's help-seeking behaviors for IPV. Thematic analysis was conducted on data from four focus group discussions with 30 women at a busy health center in urban Tegucigalpa, Honduras. Data were coded inductively and themes were identified deductively using the theory of normative social behavior and its components (descriptive and injunctive social norms, expected outcomes, and groups of reference). Four themes emerged: social norms and expected outcomes that discourage IPV help-seeking; factors that determine the direction of a social norm, either discouraging or encouraging help-seeking; groups of reference for IPV victims; and society sets women up for failure. Social norms, expected outcomes, and groups of reference hinder women's help-seeking behavior after IPV. These findings have significant implications for designing effective interventions and policies to support women and their families affected by IPV.

Trophic state resilience to hurricane disturbance of Lake Yojoa, Honduras.

Cyclones are a poorly described disturbance in tropical lakes, with the potential to alter ecosystems and compromise the services they provide. In November 2020, Hurricanes Eta and Iota made landfall near the Nicaragua-Honduras border, inundating the region with a large amount of late-season precipitation. To understand the impact of these storms on Lake Yojoa, Honduras, we compared 2020 and 2021 conditions using continuous (every 16 days) data collected from five pelagic locations. The storms resulted in increased Secchi depth and decreased algal abundance in December 2020, and January and February 2021, and lower-than-average accumulation of hypolimnetic nutrients from the onset of stratification (April 2021) until mixus in November 2021. Despite the reduced hypolimnetic nutrient concentrations, epilimnetic nutrient concentrations returned to (and in some cases exceeded) pre-hurricane levels following annual water column turnover in 2021. This response suggests that Lake Yojoa's trophic state had only an ephemeral response to the disturbance imposed by the two hurricanes, likely due to internal input of sediment derived nutrients. These aseasonal storms acted as a large-scale experiment that resulted in nutrient dilution and demonstrated the resilience of Lake Yojoa's trophic state to temporary nutrient reductions.

Can domestic dogs be considered a good reservoir of Leishmania (L.) infantum chagasi in an endemic area of nonulcerated cutaneous leishmaniasis in Southern Honduras?

Dogs are considered to be the main domestic reservoir associated with the transmission of Leishmania (L.) infantum chagasi to humans in endemic areas of visceral leishmaniasis in America. However, little is known about the role of canines as a source of infection in endemic areas of nonulcerated cutaneous leishmaniasis (NUCL). Therefore, the objective of the present study was to investigate the role of dogs as a possible reservoir of the parasite in Southern Honduras. Dogs (n = 107) living with individuals affected by NUCL were clinically examined and biological material was collected for parasitological and immunological diagnosis. Most animals showed a healthy appearance and a few presented slight weight loss (64%), alopecia (7%), onychogryphosis (5%) and skin lesions (1%). The overall seroprevalence of Leishmania infection based on the DDP ® quick test and/or in-house ELISA serological test was 41%. The presence of the parasite's DNA was confirmed in 94% of the dogs; however, the average parasite load in the buffy coat was low at 6.09 parasites/µL, ranging between 0.221 and 50.2. The skin of seropositive dogs examined by histopathology using paraffin sections stained by hematoxylin and immunohistochemistry did not show cutaneous lesions or parasite amastigotes. Based on the absence of parasites in the skin and the low parasite load detected in the buffy coat, it seems that the dog does not represent a good source of infection for the vector in the endemic area of NUCL transmission in Southern Honduras. Other domestic and/or wild animals should be investigated.

The Honduran diaspora and infectious diseases: An urgent need for action.

Recently, there has been a significant increase in irregular migration from Central America's northern triangle (Honduras, Guatemala and El Salvador). Hondurans who migrate to North America face numerous risks to their lives and health. Infectious diseases are one of the most serious threats to migrants both during the migration process and once they arrive in the host country. The major infectious diseases affecting both migrants and the health services in non-endemic countries that care for these migrants are discussed.

PCR-RFLP assays for the identification of Anopheles (Diptera: Culicidae) species circulating in Honduras.

BACKGROUND: Vector populations are a key target for malaria control and elimination. In Honduras, there are at least 12 reported anopheline species, however, the definitive number of species remains uncertain. Due to the inherent limitations of morphological identification of Anopheles species, molecular approaches have been developed to provide accurate identification and robust surveillance of local malaria vectors. The aim of this study was to design and assess three PCR-RFLP assays to identify anopheline species known to presently occur in Honduras. METHODS: Mosquitoes captured between 2018 and 2022 in seven malaria-endemic and non-endemic departments in Honduras were analysed. The ITS2 ribosomal region and three restriction enzyme-based assays were evaluated in silico and experimentally. RESULTS: A total of 132 sequences from 12 anopheline species were analysed. The ITS2 marker showed length polymorphisms that generated products between 388 and 592 bp and no relevant intraspecies polymorphisms were found. Furthermore, the three PCR-RFLP assays were able to differentiate 11 species with sufficient precision and resolution. CONCLUSION: The ITS2 region was shown to be a useful molecular marker for identifying local Anopheles species. In addition, the PCR-RFLP assays evaluated here proved to be capable of discriminating most of the anopheline species present in Honduras. These methods provide alternatives to improve entomological surveillance of Anopheles in Honduras and other Mesoamerican countries.

Evaluating Team Characteristics for Health Engagements in Three Countries in Central America: 2012-2017.

BACKGROUND: The U.S. DoD is a multidimensional agency of the government that employs health engagement activities within partner nations for medical operations, humanitarian assistance, threat reduction, and improved health outcomes toward sustainable global health and security. The composition and size of a health engagement team is critical for effective implementation; however, an ideal team makeup to achieve optimal operational readiness, health outcomes, and security cooperation objectives has not been established. This study was conducted to retrospectively describe and analyze medical mission activities in relation to ideal team characteristics in El-Salvador, Guatemala, and Honduras between 2012 and 2017. METHODS: A retrospective analysis was conducted on data from unclassified versions of the Global-Theater Security Cooperation Management Information System), Overseas Humanitarian Assistance Shared Information System databases, and mission files provided by U. S. Southern Command and its component commands. Data included 565 mission activities carried out by U.S. Military health teams in the selected host nations between 2012 and 2017. The mission activities were stratified and coded into nine distinct analyzable categories with subelements including but not limited to year, country, mission type, mission duration, team size, team language capability, team joint representation, and team member skillset. The analysis identifies mission objectives in the three subcategories of operational readiness, security cooperation, and health outcomes although the analysis did not include measurement of those objectives. Global Health Engagement mission types were broken down into five categories: direct care, health project, education & training (E&T), engineering, veterinary, or a combination. Data were analyzed using Excel. RESULTS: A total of 414 health engagement activities were found in the data analyzed during 2012 and 2017 accounting for duplication among the sources. Team size was documented in 23.4% (n = 97); team skillset makeup in 17.1% (n = 71); 2.7% (n = 11) showed that at least one team member had language capability for the country visited; and 3.6% (n = 15) documented that professional interpretation was available. The types of health engagement activities were broken down as follows: 64.3% were direct care, 12.2% were health projects, 10.9% were engineering, 9.1% were E&T, and 1.3% were veterinary. Overall, only 20.8% (n = 86) of the missions had a clear mission objective from the three categories of security cooperation, operational readiness, and health outcomes objectives. Individually, each category of objective was noted with the following: 74 with security cooperation (17.9%), 82 with operational readiness (19.8%), and 71 with health outcome objectives (17.1%). CONCLUSION: Findings from this study reveal a broad spectrum of health and medical missions conducted in El Salvador, Guatemala, and Honduras between 2012 and 2017 by DoD. Critical elements indicative of overall team capability for successful engagement such as team size, team member skillset, global health expertise, and appropriate language capability were rarely documented. Team characteristics could not be well-correlated with the Global Health Engagement type or desired mission outcomes. In the future, deliberate crafting and preparation of health engagement teams aimed at attaining desired security cooperation impact, operational readiness development, and positive health outcomes is essential for more effective Global Health Engagement.