Public Health, Visual Rhetoric, and Latin America: Steinbeck's The Forgotten Village.

This essay analyzes the visualization of Euro-American medicine and indigenous healing in John Steinbeck's 1941 documentary-drama The Forgotten Village. The movie juxtaposes film and medical discourse as exemplifications of modern, visual culture by showing excerpts from hygiene films and foregrounding medical imagery (e.g., bacteria cultures). The film displaces indigenous medicine by privileging a Euro-American medical model, and the gaze of oppression is perpetuated through humanitarian medical intervention. In short, disease is not simply a material fact but embedded in discourses about community identity, moral values, and politics.

[On specialized oversights: biomedicine as an intrinsic part of life for indigenous peoples]. / De omisiones especializadas: la biomedicina como parte intrínseca de la vida de los pueblos originarios.

The vast majority of studies on traditional medicine disregard the existence of biomedicine and alternative and complementary medicines in the lives of the indigenous peoples of Mexico and Latin America in general, despite the fact that these populations increasingly make use of biomedical knowledge more and more intensively. In this text I have attempted to elucidate this expansion of biomedicine and the decline of traditional medicine, through ethnographic information related to different indigenous groups. This expansion of biomedicine takes place despite the various negative consequences it generates due to different factors such as its comparative effectiveness, which is evidenced in the use of and demand for pharmaceuticals, biomedical services, and in particular the construction of hospitals in their communities. The indigenous population combines the uses of traditional medicine and biomedicine with a tendency to increasingly utilize biomedicine, even on the part of traditional healers.

La gran mayoría de los estudios de la medicina tradicional excluyen la existencia de la biomedicina y de las medicinas alternativas y complementarias en la vida de los pueblos indígenas de México y de Latinoamérica en general, pese a que estos pueblos utilizan la biomedicina en forma creciente e intensa. En este texto, he tratado de poner de manifiesto este proceso de expansión biomédica y de declive de la medicina tradicional, a través de información etnográfica referida a distintos pueblos originarios. Esta expansión biomédica se desarrolla a pesar de las varias consecuencias negativas que genera, debido a diversos factores, entre ellos, su eficacia comparativa, que se expresa a través de los usos y la demanda de fármacos, de los servicios biomédicos y, en particular, de la instalación de hospitales en sus comunidades. La población indígena articula los usos de la medicina tradicional y de la biomedicina con la tendencia a utilizar cada vez más la biomedicina, incluso por parte de los curadores tradicionales.

Anthropogenic pollen indicators: Global food plants and Latin American human indicators in the pollen record.

Pollen-based evidence of human presence is crucial for reconstructing human history. However, information on the morphology of pollen grains of global food plants and regional pollen-based human indicators is scattered in the literature, leading to the risk of overlooking important evidence of human presence. To address this issue, we first compiled a comprehensive overview of 354 major food plants worldwide, creating a paleoecology-friendly format that includes their family, vernacular name, earliest known use, environmental preference, and geographical region. Moreover, we identified the sources of illustrations of their pollen grains for 209 out of 273 different genera of globally relevant food plants in 10 selected pollen atlases. Secondly, we compiled all human indicators from pollen-based paleoecological literature in Latin America (based on 750 references), providing an overview of 212 single-pollen type indicators and identified 95 crucial combinations of pollen types as "human indices", and their corresponding references. Our review datasets aids in distilling human evidence from numerous fossil pollen records worldwide.

A declaration on the value of experiential measures of food and water insecurity to improve science and policies in Latin America and the Caribbean.

BACKGROUND: Water security is necessary for good health, nutrition, and wellbeing, but experiences with water have not typically been measured. Given that measurement of experiences with food access, use, acceptability, and reliability (stability) has greatly expanded our ability to promote food security, there is an urgent need to similarly improve the measurement of water security. The Water InSecurity Experiences (WISE) Scales show promise in doing so because they capture user-side experiences with water in a more holistic and precise way than traditional supply- side indicators. Early use of the WISE Scales in Latin American & the Caribbean (LAC) has revealed great promise, although representative data are lacking for most of the region. Concurrent measurement of experiential food and water insecurity has the potential to inform the development of better-targeted interventions that can advance human and planetary health. MAIN TEXT: On April 20-21, 2023, policymakers, community organizers, and researchers convened at Universidad Iberoamericana in Mexico City to discuss lessons learned from using experiential measures of food and water insecurity in LAC. At the meeting's close, organizers read a Declaration that incorporated key meeting messages. The Declaration recognizes the magnitude and severity of the water crisis in the region as well as globally. It acknowledges that traditional measurement tools do not capture many salient water access, use, and reliability challenges. It recognizes that the WISE Scales have the potential to assess the magnitude of water insecurity more comprehensively and accurately at community, state, and national levels, as well as its (inequitable) relationship with poverty, poor health. As such, WISE data can play an important role in ensuring more accountability and strengthening water systems governance through improved public policies and programs. Declaration signatories express their willingness to promote the widespread use of the WISE Scales to understand the prevalence of water insecurity, guide investment decisions, measure the impacts of interventions and natural shocks, and improve public health. CONCLUSIONS: Fifty-three attendees endorsed the Declaration - available in English, Spanish and Portuguese- as an important step to making progress towards Sustainable Development Goal 6, "Clean Water and Sanitation for All", and towards the realization of the human right to water.

Patient-doctor interactions around alternative and complementary medicine in the context of oncology care in a Latin American country.

OBJECTIVE: To characterize doctor-patient communication patterns around the use of complementary and alternative medicines (CAM) in the context of oncology care in Colombia. METHODS: A qualitative study was conducted using snowball sampling until data saturation was reached. We included oncology specialists and cancer patients who were in active treatment. Semi-structured interviews were conducted following a guide designed for each group of participants. An analysis based on open coding was performed to identify thematic areas. The coherence of emerging categories was verified by contrasting the data set within the content of the participants' reports and existing literature. RESULTS: In total, 10 oncologists and 16 cancer patients were included, representing diverse professional fields and cancer diagnoses, respectively. Communication patterns comprise themes regarding the beginning of the interaction (i.e., patient's anticipations), the patient-doctor relationship (i.e., confidence), the characteristics of the message (i.e., synthetic vs explanatory), the communication styles (i.e., confrontational vs conciliatory), and the closing of the interaction (i.e., continuity vs. end of communication). In addition, extrinsic factors influencing communication were found to be related to participants (i.e., knowledge, cultural background) and context (i.e., institutional procedures). CONCLUSIONS: The low frequency of communication contrasts to the increasing use of CAM. Divergent perspectives between doctors and patients could limit shared decision-making on the use of CAM. Enhanced knowledge and education on CAM for both actors is fundamental to improve their interaction and to move away from paternalistic and confrontational communication, particularly in a world region with cultural backgrounds that influence the use of CAM.

Characterization of Latin American migrants at risk for Trypanosoma cruzi infection in a non-endemic setting. Insights into initial evaluation of cardiac and digestive involvement.

BACKGROUND: Trypanosoma cruzi causes Chagas disease (CD), a potentially fatal disease characterized by cardiac disorders and digestive, neurological or mixed alterations. T. cruzi is transmitted to humans by the bite of triatomine vectors; both the parasite and disease are endemic in Latin America and the United States. In the last decades, population migration has changed the classic epidemiology of T. cruzi, contributing to its global spread to traditionally non-endemic countries. Screening is recommended for Latin American populations residing in non-endemic countries. METHODS: The present study analyzes the epidemiological characteristics of 2,820 Latin American individuals who attended the International Health Service (IHS) of the Hospital Clinic de Barcelona between 2002 and 2019. The initial assessment of organ damage among positive cases of T. cruzi infection was analyzed, including the results of electrocardiogram (ECG), echocardiogram, barium enema and esophagogram. RESULTS: Among all the screened individuals attending the clinic, 2,441 (86.6%) were born in Bolivia and 1,993 (70.7%) were female. Of individuals, 1,517 (81.5%) reported previous exposure to the vector, which is a strong risk factor associated with T. cruzi infection; 1,382 individuals were positive for T. cruzi infection. The first evaluation of individuals with confirmed T. cruzi infection, showed 148 (17.1%) individuals with Chagasic cardiomyopathy, the main diagnostic method being an ECG and the right bundle branch block (RBBB) for the most frequent disorder; 16 (10.8%) individuals had a normal ECG and were diagnosed of Chagasic cardiomyopathy by echocardiogram. CONCLUSIONS: We still observe many Latin American individuals who were at risk of T. cruzi infection in highly endemic areas in their countries of origin, and who have not been previously tested for T. cruzi infection. In fact, even in Spain, a country with one of the highest proportion of diagnosis of Latin American populations, T. cruzi infection remains underdiagnosed. The screening of Latin American populations presenting with a similar profile as reported here should be promoted. ECG is considered necessary to assess Chagasic cardiomyopathy in positive individuals, but echocardiograms should also be considered as a diagnostic approach given that it can detect cardiac abnormalities when the ECG is normal.

Quality of life, self-reported outcomes and impact of education among people with moderate and severe hemophilia A: An integrated perspective from a Latin American country.

Collecting and interpreting self-reported outcomes among people with hemophilia A supports the understanding of the burden of the disease and its treatment to improve holistic care. However, in Colombia, this information is limited. Therefore, this study aimed to describe the knowledge, perception and burden of hemophilia A from the patients' perspective. A cross-sectional study was conducted in the context of a hemophilia educational bootcamp held from November 29th to December 1st, 2019, in Medellin, Colombia. The bootcamp was organized by a hemophilia patient association responsible for contacting and inviting patients with hemophilia A (PwHA). Information on patients' health beliefs, treatment experiences, and health-related quality of life (HRQoL) was obtained through focus groups, individual interviews and the Patient Reported Outcomes, Burdens and Experiences (PROBE) questionnaire. A total of 25 moderate or severe PwHA were enrolled in this study and completed the PROBE questionnaire. Acute pain was the most frequently reported symptom, with 88% of the patients reporting the use of pain medication. Difficulty with activities of daily living was reported by 48%. Furthermore, 52% reported having more than 2 spontaneous bleeding events in the last year. Treatment was administered at home for 72% of patients, with regular prophylaxis as the most common treatment regimen. In terms of overall HRQoL, the median EQ-5D VAS score was 80 (IQR: 50-100). PwHA in Colombia still suffer from disease complications related to bleeding events, pain and disability that affect their HRQoL, which highlights the need to develop patient-centered initiatives to improve the wellness of this population.

Structural competency, Latin American social medicine, and collective health: Exploring shared lessons through the work of Jaime Breilh.

ABSTRACTStructural competency is a recent framework for understanding and addressing the structural drivers of disease. Latin American Social Medicine and Collective Health is a decades-long movement similarly concerned with the study and transformation of social structures to achieve health equity. In this paper, we put insights from Latin American Social Medicine and Collective Health into conversation with the developing structural competency framework. We focus specifically on insights from Jaime Breilh's new article summarising his theoretical work on medical ethics and rights in this special issue and his new book, Critical Epidemiology and the People's Health. This paper is comprised of three parts. Part 1 provides an introduction to the structural competency framework. Part 2 provides an overview of the Latin American Social Medicine and Collective Health movement, along with a summary of the social determination of health paradigm. Part 3 places insights from these works into conversation with structural competency and considers ways in which Latin American Social Medicine and Collective Health might inform the further development of structural competency, and potentially vice versa. The paper closes by calling for greater attention to Latin American Social Medicine and Collective Health among those committed to health equity within the anglophone world.

Continuity of maternal and infant care through integrated health service delivery networks in Latin America: a scoping review.

Latin America has experienced substantial development over the last three decades; however, development has been uneven with persistent inequalities, especially in the areas of maternal and child health. Since the early 1990s, most Latin American health-care systems have undergone a series of reforms to improve access to services, with the most recent being the implementation of integrated health service delivery networks (IHSDNs). This model posits that patients will receive better continuity of care and higher-quality health services and avoid duplicated efforts. While decreased maternal and infant mortality rates have been observed in the region since IHSDN implementation, there is limited evidence on this model's implications for maternal and infant care. The purpose of this study is to explore how IHSDNs affect access to and continuity of maternal and infant care in Latin America, according to the peer-reviewed literature. A scoping review was conducted systematically to identify peer-reviewed articles published since 2007 on studies that took place in Latin America, include IHSDNs, focus on the antenatal and/or postnatal period, include women and/or infants under 2 years of age and are written in English, Spanish or Portuguese. Seven studies (n = 7) met the inclusion criteria for this review. Barriers identified were related to person-centred care (n = 5) and logistical challenges (n = 5). The most cited facilitator encompassed social support for women when accessing care (n = 3). Potential solutions to improve care access included an improvement in the network structure and a greater focus on care provision, rather than regulations and compliance. Findings from this study suggest that the IHSDN model has the potential to improve care for women during pregnancy and post-birth if the model is implemented to its full extent. However, implementation of the model in Latin America is still weak, creating barriers for women when seeking care, particularly for disparate populations and those residing in rural areas.

Characterizing Therapeutic Pluralism Policies in Latin America: A Qualitative Content Analysis.

Introduction: The 1978 Alma Ata Declaration initiated international recognition of non-biomedical healing systems and their relevance for primary health. World Health Assembly (WHA) resolutions have called for the study and inclusion of traditional and complementary medicine (T&CM) into national health systems through policy development. The increased public, political, and scholarly attention given to T&CM has focused on clinical efficacy, cost-effectiveness, mechanisms of action, consumer demand, and supply-side regulation. Although >50% of WHO member states have T&CM policies, scant research has focused on these policies and their public health implications. This paper defines a novel term "therapeutic pluralism," and it aims at characterizing related policies in Latin America. Methods: A qualitative content analysis of Latin American therapeutic pluralism policies was performed. Policies' characteristics and the reported social, political, and economic forces that have made possible their development were assessed. Pre-defined policy features were categorized on an MS-Excel; in-depth text analyses were conducted in NVivo. Analyses followed the steps described by Bengtsson: decontextualization, recontextualization, categorization, and compilation. Results: Seventy-four (74) policy documents from 16 of the 20 sovereign Latin American countries were included. Mechanisms for policy enactment included: Constitution, National Law, National Policy, National Healthcare Model, National Program Guideline, Specific Regulatory Norms, and Supporting Legislation, Policies, and Norms. We propose a four-category typology of policy approaches in Latin America: Health Services-centered, Model of Care-based, Participatory, and Indigenous People-focused. Common themes countries used when justifying developing these policies included: benefits to the health system, legal and political mandates, supply and demand, and culture and identity. Social forces these policies referenced as influencing their development included: pluralism, self-determination and autonomy, anticapitalism and decolonization, safeguarding cultural identity, bridging cultural barriers, and sustainability. Conclusion: Policy approaches to therapeutic pluralism in Latin America go beyond integrating non-biomedical interventions into health services; they offer perspectives for transforming health systems. Characterizing these approaches has implications for policy development, implementation, evaluation, international collaboration, the development of technical cooperation tools and frameworks, and research.

Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis.

BACKGROUND: Data-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels. METHODS: The raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries. RESULTS: The performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity. CONCLUSIONS: The GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.

Consensus on complementary feeding from the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition: COCO 2023.

Complementary feeding (CF) is defined as the feeding of infants that complements breastfeeding, or alternatively, feeding with a breast milk substitute, and is a process that is more than simply a guide as to what and how to introduce foods. The information provided by healthcare professionals must be up-to-date and evidence-based. Most of the recommendations that appear in the different international guidelines and position papers are widely applicable, but some must be regionalized or adapted to fit the conditions and reality of each geographic zone. The Nutrition Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) summoned a group of experts from each of the society's member countries, to develop a consensus on CF, incorporating, whenever possible, local information adapted to the reality of the region. The aim of the present document is to show the results of that endeavor. Utilizing the Delphi method, a total of 34 statements on relevant aspects of CF were evaluated, discussed, and voted upon.

Spirituality in Critical Care: An Observational Study of the Perceptions of Professionals, Patients and Families, in Spain and Latin America.

This research aims to describe the perspectives of health care professionals, patients, and family members regarding spiritual care options in intensive care units (ICUs). Participants were recruited consecutively from January to August 2019, during which time data collection was conducted. A total of 1211 Spanish-language questionnaires were collected from 41 ICUs in Spain and Latin America. Approximately 655 participants worked as ICU professionals (74.5% of these participants were women, and 47.5% were nurses). Additionally, 340 questionnaires were sent to patients' families, and patients completed 216 questionnaires; 59.7% of these participants were men, and their mean age was 59.4 years. Most (69.7%) of the critical care professionals considered this type of care to be a part of their profession, 50.1% did not feel competent to provide this type of care, and 83.4% felt that training in this area was necessary. Most families (71.7%) and patients (60.2%) felt that spiritual suffering occurred during their stay in the ICU. The results of this study suggest a perceived deficit in spiritual care in ICUs.

Antenatal care is associated with adherence to iron supplementation among pregnant women in selected low-middle-income-countries of Asia, Africa, and Latin America & the Caribbean regions: Insights from Demographic and Health Surveys.

Anaemia is a global public health problem affecting 800 million women and children globally. Anaemia is associated with perinatal mortality, child morbidity and mortality, mental development, immune competence, susceptibility to lead poisoning and performance at work. The objective of this article is to identify whether antenatal care-seeking was associated with the uptake of iron supplementation among pregnant women, adjusting for a range of covariates. This article used data from the cross-sectional recent Demographic and Health Surveys (DHS) of 12 countries in Asia, Africa and Latin America & the Caribbean regions. The individual-level data from 273,144 women of reproductive age (15-49 years) were analysed from multi-country DHS. Multiple Logistic regression analyses were conducted using Predictive Analytics Software for Windows (PASW), Release 18.0. Receiving at least four antenatal care visits was significantly associated with the consumption of 90 or more iron-containing supplements in 12 low and middle income countries across three regions after adjusting for different household and respondent characteristics, while mass media exposure was found to be a significant predictor in India and Indonesia. Antenatal care seems to be the most important predictor of adherence to iron intake in the selected countries across Africa, Asia, Latin America and Caribbean regions.

The development of interprofessional education and collaborative practice in Latin America and the Caribbean: preliminary observations.

The Pan-American Health Organization (PAHO) and World Health Organization have encouraged countries across Latin America and the Caribbean (LAC) to incorporate interprofessional education and collaborative practice (IPECP) into policies on the health workforce, and support policymakers in expanding its use. PAHO recommend countries to promote the development of interprofessional teams in integrated health services networks using IPECP. The creation of the Regional Network for Interprofessional Education in the Americas, the mobilization of a series of IPECP regional meetings, and the development of national IPECP action plans are the most promising results achieved thus far. This report describes the process of implementing IPECP in LAC countries as an innovative initiative in interprofessional health policy.

Micronutrient Deficiency Pre- and Post-bariatric Metabolic Surgery in Latin America: a Systematic Review.

BACKGROUND: Persons submitted to bariatric metabolic surgery present micronutrient deficiency before and after surgery, due to the lack of proper supplementation. The aim of this study is to establish the prevalence of micronutrient deficiency in people before and after bariatric metabolic surgery in Latin America. METHODS: This review was conducted in accordance with the 2020 PRISMA Guidelines. RESULTS: Twenty-seven studies and 2135 participants were included. The highest prevalence of deficiency before surgery was reported for vitamin D (74%), zinc (71%), and hemoglobin (62%); after surgery, they were vitamin A (90.6%), vitamin D (90%), and zinc (68%). CONCLUSIONS: There is a high prevalence of micronutrient deficiency before and after bariatric metabolic surgery from Latin American persons; the micronutrients with the highest deficiency prevalence were vitamin D before and vitamin A after bariatric metabolic surgery.

Conductas alimentarias y actividad física asociadas a estrés, ansiedad y depresión durante la pandemia COVID-19 / Eating Behaviors and Physical Activity Associated With Stress, Anxiety, and Depression During the COVID-19 Pandemic

Resumen Introducción. Como medida preventiva para limitar el contagio ante la pandemia por COVID-19, se implementó el confinamiento. Este evento limitó la disponibilidad de alimentos y favoreció el consumo de alimentos procesados y no perecederos, menos saludables; estas conductas que se pueden ver relacionadas con trastornos de la salud mental como estrés, ansiedad y depresión. Métodos. Estudio cuantitativo, descriptivo, transversal, con muestreo no probabilístico por conveniencia realizado entre agosto-octubre, 2020, con una participación de 1657 personas latinoamericanas de población general. Se aplicó el cuestionario Depression, Anxiety and Stress Scales-21 y el de conductas alimentarias asociadas a estrés, ansiedad y depresión-17. Se empleó regresión logística ordinal para valorar la asociación entre variables. Resultados. El 62 % presentó algún grado de depresión, 55.9 % ansiedad y 55.2 % estrés. Se encontró asociación entre estrés con actividad física (p 0.048), consumo de pescado (p 0.041), agua (p 0.003), panes/postres (p 0.005), comidas rápidas (p <0.001), bebidas azucaradas (p 0.035), té e infusiones (p 0.023) y cacao y sus derivados (p 0.018). Ansiedad con actividad física (p 0.006), ingesta de verduras (p 0.022), pescado (p 0.031), aceites (p 0.008), panes/postres (p 0.026), comidas rápidas (p <0.001), té e infusiones (p 0.018), cacao y derivados (p 0.038) y suplementos vitamínicos (p 0.016). Depresión con la actividad física (p 0.037), consumo de frutas (p 0.012), agua (p 0.012), café (p 0.045), panes/postres (p 0.003), comidas rápidas (p <0.001). Conclusiones. Se encontró asociación entre el consumo de ciertos alimentos y los elevados niveles de estrés, ansiedad y depresión.

Abstract Introduction. Confinement was implemented as a preventive measure to limit contagion in the face of the COVID-19 pandemic. This measure limited food availability and favored the consumption of less healthy processed and non-perishable foods. These behaviors can be seen as related to mental health disorders, such as stress, anxiety, and depression. Methods. It is a quantitative, descriptive, cross-sectional study with non-probabilistic convenience sampling carried out between August-October 2020, with the participation of 1657 Latin American people from the general population. The Depression, Anxiety and Stress Scales-21 questionnaire and the eating behaviors questionnaire associated with stress, anxiety, and depression-17 were applied. Ordinal logistic regression was used to assess the association between variables. Results. The 62% of participants presented some degree of depression; 55.9%, anxiety; and 55.2%, stress. An association was found between stress with physical activity (p 0.048) and consumption of fish (p 0.041), water (p 0.003), breads / desserts (p 0.005), fast foods (p <0.001), sugary drinks (p 0.035), tea and infusions (p 0.023), and cocoa and its derivatives (p 0.018). Another association was also found between anxiety with physical activity (p 0.006) and intake of vegetables (p 0.022), fish (p 0.031), oils (p 0.008), breads / desserts (p 0.026), fast foods (p <0.001), tea and infusions (p 0.018), cocoa and derivatives (p 0.038), and vitamin supplements (p 0.016). Depression was also found as associated with physical activity (p 0.037) and consumption of fruits (p 0.012), water (p 0.012), coffee (p 0.045), breads / desserts (p 0.003), and fast foods (p <0.001). Conclusions. An association was found between consuming certain foods and high levels of stress, anxiety, and depression.

Resumo Introdução. Como medida preventiva para limitar o contágio em face da pandemia COVID-19, o confinamento foi implementado. Esse evento limitou a disponibilidade de alimentos e favoreceu o consumo de alimentos industrializados menos saudáveis e não perecíveis, comportamentos que podem ser vistos relacionados a transtornos mentais como estresse, ansiedade e depressão. Métodos. Estudo quantitativo, descritivo, transversal, com amostragem não probabilística por conveniência, realizado no período de agosto a outubro de 2020 com a participação de 1.657 latino-americanos da população geral. Foram aplicados o questionário Depression, Anxiety and Stress Scales-21 e o questionário de comportamentos alimentares associados ao estresse, ansiedade e depressão-17. A regressão logística ordinal foi utilizada para avaliar a associação entre as variáveis. Resultados. 62% apresentavam algum grau de depressão, 55,9% ansiedade e 55,2% estresse. Foi encontrada associação entre estresse com atividade física (p 0,048), consumo de peixe (p 0,041), água (p 0,003), pães / sobremesas (p 0,005), fast food (p <0,001), bebidas açucaradas (p 0,035), chá e infusões (p 0,023) e cacau e seus derivados (p 0,018); ansiedade com atividade física (p 0,006), ingestão de vegetais (p 0,022), peixes (p 0,031), óleos (p 0,008), pães / sobremesas (p 0,026), fast food (p <0,001), chá e infusões (p 0,018), cacau e derivados (p 0,038) e suplementos vitamínicos (p 0,016); depressão com atividade física (p 0,037), consumo de frutas (p 0,012), água (p 0,012), café (p 0,045), pães / sobremesas (p 0,003), fast food (p <0,001). Conclusões. Foi encontrada associação entre o consumo de determinados alimentos e altos níveis de estresse, ansiedade e depressão.

Competencies for quality spiritual care in palliative care in Latin America: from the Spirituality Commission of the Latin American Association for Palliative Care.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.