The Evaluation of a Low-Cost Colorimeter for Glucose Detection in Salivary Samples.

Given the limited access to healthcare resources, low-income settings require the development of affordable technology. Here we present the design and evaluation of a low-cost colorimeter applied to the non-invasive monitoring of Diabetes Mellitus through the detection of glucose in salival fluid. Samples were processed by the glucose oxidase-peroxidase enzymatic system and analyzed with the development equipment. A light emission diode of 532.5 nm was used as an excitation source and a RGB module was used as a receptor. A calibration curve to quantify the concentration of salivary glucose (0 to 18 mg/dL) was carried out by relating the RGB components registered with glucose concentrations, achieving a limit of detection of 0.17 mg/dL with a CV of 5% (n = 3). Salivary samples of diabetic and healthy volunteers were processed with the equipment showing an average concentration of 1.5519 ± 0.4511 mg/dL for the first and 4.0479 ± 1.6103 mg/dL for the last, allowing a discrimination between both groups. Results were validated against a UV-Vis-NIR spectrophotometer with a correspondence of R² of 0.98194 between both instruments. Results suggest the potential application of the developed device to the sensitive detection of relevant analytes with a low-cost, user-friendly, low-power and portable instrumentation.

Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings.

BACKGROUND: Health has improved markedly in Mesoamerica, the region consisting of southern Mexico and Central America, over the past decade. Despite this progress, there remain substantial inequalities in health outcomes, access, and quality of medical care between and within countries. Poor, indigenous, and rural populations have considerably worse health indicators than national or regional averages. In an effort to address these health inequalities, the Salud Mesoamérica 2015 Initiative (SM2015), a results-based financing initiative, was established. METHODS: For each of the eight participating countries, health targets were set to measure the progress of improvements in maternal and child health produced by the Initiative. To establish a baseline, we conducted censuses of 90,000 households, completed 20,225 household interviews, and surveyed 479 health facilities in the poorest areas of Mesoamerica. Pairing health facility and household surveys allows us to link barriers to care and health outcomes with health system infrastructure components and quality of health services. RESULTS: Indicators varied significantly within and between countries. Anemia was most prevalent in Panama and least prevalent in Honduras. Anemia varied by age, with the highest levels observed among children aged 0 to 11 months in all settings. Belize had the highest proportion of institutional deliveries (99%), while Guatemala had the lowest (24%). The proportion of women with four antenatal care visits with a skilled attendant was highest in El Salvador (90%) and the lowest in Guatemala (20%). Availability of contraceptives also varied. The availability of condoms ranged from 83% in Nicaragua to 97% in Honduras. Oral contraceptive pills and injectable contraceptives were available in just 75% of facilities in Panama. IUDs were observed in only 21.5% of facilities surveyed in El Salvador. CONCLUSIONS: These data provide a baseline of much-needed information for evidence-based action on health throughout Mesoamerica. Our baseline estimates reflect large disparities in health indicators within and between countries and will facilitate the evaluation of interventions and investments deployed in the region over the next three to five years. SM2015's innovative monitoring and evaluation framework will allow health officials with limited resources to identify and target areas of greatest need.

Sexual onset and contraceptive use among adolescents from poor neighbourhoods in Managua, Nicaragua.

BACKGROUND AND OBJECTIVES: The prevalence of teenage pregnancies in Nicaragua is the highest in Latin-America. This study aimed to gain insight into factors which determine the sexual behaviours concerned. METHODS: From July until August 2011, a door-to-door survey was conducted among adolescents living in randomly selected poor neighbourhoods of Managua. Logistic regression was used to analyse factors related to sexual onset and contraceptive use. RESULTS: Data from 2803 adolescents were analysed. Of the 475 and 299 sexually active boys and girls, 43% and 54%, respectively, reported contraceptive use. Sexual onset was positively related to increasing age, male sex, alcohol consumption and not living with the parents. Catholic boys and boys never feeling peer pressure to have sexual intercourse were more likely to report consistent condom use. Having a partner and feeling comfortable talking about sexuality with the partner were associated with hormonal contraception. CONCLUSIONS: Our data identified associates of adolescents' sexual behaviour related to personal characteristics (sex and alcohol use), to the interaction with significant others (parents, partners, peers) and to the environment (housing condition, religion). We interpreted those associates within the context of the rapidly changing society and the recently implemented health system reform in Nicaragua.

Influence of charge carrier mobility and morphology on solar cell parameters in devices of mono- and bis-fullerene adducts.

Herein, we analyze charge carrier mobility and morphology of the active blend layer in thin film organic solar cells and correlate them with device parameters. A low band gap donor-acceptor copolymer in combination with phenyl-C61-butyric acid methyl ester (PCBM) or two bis-adduct fullerenes, bis-PCBM and bis-o-quino-dimethane C60 (bis-oQDMC), is investigated. We study the charge transport of polymer:fullerene blends in hole- and electron-only devices using the space-charge limited current method. Lower electron mobilities are observed in both bis-adduct fullerene blends. Hole mobility, however, is decreased only in the blend containing bis-oQDMC. Both bis-adduct fullerene blends show very high open circuit voltage in solar cell devices, but poor photocurrent compared to the standard PCBM blend for an active layer thickness of 200 nm. Therefore, a higher short circuit current is feasible for the polymer:bis-PCBM blend by reducing the active layer thickness in order to compensate for the low electron mobility, which results in a PCE of 4.3%. For the polymer:bis-oQDMC blend, no such improvement is achieved due to an unfavorable morphology in this particular blend system. The results are supported by external quantum efficiency measurements, atomic force microscopy, transmission electron microscopy and UV/vis spectroscopy. Based on these results, the investigations presented herein give a more scientific basis for the optimization of solar cells.

Community embedded reproductive health interventions for adolescents in Latin America: development and evaluation of a complex multi-centre intervention.

BACKGROUND: Adolescents in Latin America are at high risk for unwanted and unplanned pregnancies, which often result in unsafe abortions or poor maternal health outcomes. Both young men and women in the region face an increased risk of sexually transmitted infections due to inadequate sexual and reproductive health information, services and counselling. To date, many adolescent health programmes have targeted a single determinant of sexual and reproductive health. However, recent evidence suggests that the complexity of sexual and reproductive health issues demands an equally multi-layered and comprehensive approach. METHODS: This article describes the development, implementation and evaluation design of the community-embedded reproductive health care for adolescents (CERCA) study in three Latin American cities: Cochabamba (Bolivia), Cuenca (Ecuador) and Managua (Nicaragua). Project CERCA's research methodology builds on existing methodological frameworks, namely: action research, community based participatory research and intervention-mapping.The interventions in each country address distinct target groups (adolescents, parents, local authorities and health providers) and seek improvement of the following sexual health behaviours: communication about sexuality, sexual and reproductive health information-seeking, access to sexual and reproductive health care and safe sexual relationships.In Managua, we implemented a randomised controlled study, and in Cochabamba and Cuenca we adopted a non-randomised controlled study to evaluate the effectiveness of Project CERCA interventions, in addition to a process evaluation. DISCUSSION: This research will result in a methodological framework that will contribute to the improved design and implementation of future adolescent sexual and reproductive health interventions. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01722084).

Spectroscopic investigation of the electronic and excited state properties of para-substituted tetraphenyl porphyrins and their electrochemically generated ions.

Porphyrins play pivotal roles in many crucial biological processes including photosynthesis. However, there is still a knowledge gap in understanding electronic and excited state implications associated with functionalization of the porphyrin ring system. These effects can have electrochemical and spectroscopic signatures that reveal the complex nature of these somewhat minor substitutions, beyond simple inductive or electronic effect correlations. To obtain a deeper insight into the influences of porphyrin functionalization, four free-base, meso-substituted porphyrins: tetraphenyl porphyrin (TPP), tetra(4-hydroxyphenyl) porphyrin (THPP), tetra(4-carboxyphenyl) porphyrin (TCPP), and tetra(4-nitrophenyl) porphyrin (TNPP), were synthesized, characterized, and investigated. The influence of various substituents, (-hydroxy,-carboxy, and -nitro) in the para position of the meso-substituted phenyl moieties were evaluated by spectroelectrochemical techniques (absorption and fluorescence), femtosecond transient absorption spectroscopy, cyclic and differential pulse voltammetry, ultraviolet photoelectron spectroscopy (UPS), and time-dependent density functional theory (TD-DFT). Spectral features were evaluated for the neutral porphyrins and differences observed among the various porphyrins were further explained using rendered frontier molecular orbitals pertaining to the relevant transitions. Electrochemically generated anionic and cationic porphyrin species indicate similar absorbance spectroscopic signatures attributed to a red-shift in the Soret band. Emissive behavior reveals the emergence of one new fluorescence decay pathway for the ionic porphyrin, distinct from the neutral macrocycle. Femtosecond transient absorption spectroscopy analysis provided further analysis of the implications on the excited-state as a function of the para substituent of the free-base meso-substituted tetraphenyl porphyrins. Herein, we provide an in-depth and comprehensive analysis of the electronic and excited state effects associated with systematically varying the induced dipole at the methine bridge of the free-base porphyrin macrocycle and the spectroscopic signatures related to the neutral, anionic, and cationic species of these porphyrins.

Closo-Borate Gel Polymer Electrolyte with Remarkable Electrochemical Stability and a Wide Operating Temperature Window.

A major challenge in the pursuit of higher-energy-density lithium batteries for carbon-neutral-mobility is electrolyte compatibility with a lithium metal electrode. This study demonstrates the robust and stable nature of a closo-borate based gel polymer electrolyte (GPE), which enables outstanding electrochemical stability and capacity retention upon extensive cycling. The GPE developed herein has an ionic conductivity of 7.3 × 10-4  S cm-2 at room temperature and stability over a wide temperature range from -35 to 80 °C with a high lithium transference number ( tLi+$t_{{\rm{Li}}}^ + $ = 0.51). Multinuclear nuclear magnetic resonance and Fourier transform infrared are used to understand the solvation environment and interaction between the GPE components. Density functional theory calculations are leveraged to gain additional insight into the coordination environment and support spectroscopic interpretations. The GPE is also established to be a suitable electrolyte for extended cycling with four different active electrode materials when paired with a lithium metal electrode. The GPE can also be incorporated into a flexible battery that is capable of being cut and still functional. The incorporation of a closo-borate into a gel polymer matrix represents a new direction for enhancing the electrochemical and physical properties of this class of materials.

Using Systems Dynamics for Capturing the Multicausality of Factors Affecting Health System Capacity in Latin America while Responding to the COVID-19 Pandemic.

Similar interventions to stop the spread of COVID-19 led to different outcomes in Latin American countries. This study aimed to capture the multicausality of factors affecting HS-capacity that could help plan a more effective response, considering health as well as social aspects. A facilitated GMB was constructed by experts and validated with a survey from a wider population. Statistical analyses estimated the impact of the main factors to the HS-capacity and revealed the differences in its mechanisms. The results show a similar four-factor structure in all countries that includes public administration, preparedness, information, and collective self-efficacy. The factors are correlated and have mediating effects with HS-capacity; this is the base for differences among countries. HS-capacity has a strong relation with public administration in Bolivia, while in Nicaragua and Uruguay it is related through preparedness. Nicaragua lacks information as a mediation effect with HS-capacity whereas Bolivia and Uruguay have, respectively, small and large mediation effects with it. These outcomes increase the understanding of the pandemic based on country-specific context and can aid policymaking in low-and middle-income countries by including these factors in future pandemic response models.

Mediterranean spotted fever with encephalitis.

Rickettsia conorii infection is endemic in the Mediterranean basin, where it is known as Mediterranean spotted fever, also known as Boutonneuse fever and Marseilles fever. We report the case of a 66-year-old diabetic man who presented a severe form of the disease, complicated by acute renal failure, thrombocytopenia and encephalitis. Diagnosis was confirmed by indirect immunofluorescence assay. Despite appropriate treatment, severe neurological sequelae have remained. Medical literature on encephalitis caused by R. conorii is also reviewed.

Construction and validation of a model to predict nonadherence to guidelines for prescribing antiplatelet therapy to hypertensive patients.

OBJECTIVE: To construct and validate a model to predict nonadherence to guidelines for prescribing antiplatelet therapy (NGAT) to hypertensive patients. METHODS: This 3 month prospective study was undertaken in 2007-2009 to determine whether 712 hypertensive patients were or were not being prescribed antiplatelet therapy. OUTCOME: NGAT according to clinical guidelines (just for patients in secondary prevention or with Systematic COronary Risk Evaluation (SCORE) ≥10%). Secondary variables: Duration of hypertension (years), blood pressure (BP), age, gender, smoking, diabetes, dyslipidemia, cardiovascular disease, lipid parameters, SCORE. Of the whole sample 80% was used to construct the model and 20% to validate it. To construct the model, we performed a multivariate logistic regression model which was adapted to be a scoring system with risk groups. The adjusted odds ratios (ORs) were obtained through the model. To validate the model we calculated the area under the ROC curve (AUC) and then compared the expected and the observed NGAT. The final model was adapted for use as a mobile application. RESULTS: NGAT: 18.5%, construction; 17.9%, validation. FACTORS: higher duration of hypertension diagnosis, higher systolic BP, older age, male gender, smoking, diabetes, dyslipidemia and cardiovascular disease. VALIDATION: AUC = 0.82 (95% CI: 0.74-0.90, p < 0.001), with no differences between the observed and the expected NGAT (p = 0.334). CONCLUSION: A tool was constructed and validated to predict NGAT. The associated factors were related with a greater cardiovascular risk. The scoring system has to be validated in other areas.

La virtualización en programas de postgrado: experiencia del CIES UNAN MANAGUA 2010-2017 / Virtualization in postgraduate programs: experience of CIES UNAN MANAGUA 2010-2017

El CIES-UNAN Managua ha desarrollado una tendencia hacia la virtualización de los Programas de Estudios de Postgrado en Salud Pública (5 programas de Maestría -Salud Pública, Administración de la Salud, Epidemiología, Salud Ocupacional, Economía de la Salud- y uno de Doctorado en Ciencias de la Salud) en el último decenio de sus 35 años de servicio. Motivado en las necesidades de sus usuarios (Profesionales de la Salud de la Región Meso Americana, especialmente de Nicaragua, Honduras y El Salvador), surgidas de factores que impulsan un cambio permanente en sus necesidades, ha ido incorporando la Tecnología y la Metodología necesaria para que esta evolución sea siempre en función de las necesidades de los usuarios. Esto ha sido mediado a través de Modalidades mixtas. Los avances evidenciados en este estudio parten del diagnóstico sobre el uso de la tecnología de los estudiantes activos en los programas académicos de Postgrado, llegando a una valoración de los espacios virtuales de aprendizaje a partir de criterios presentes en la literatura existente sobre el tema. Se evidencia la satisfacción de los Estudiantes específicamente en los elementos de virtualización que han sido implementados. El conocimiento previo de la tecnología por su parte permite una mejor utilización de las Plataformas. También es notoria la Evolución satisfactoria de los hábitos de búsqueda de Información de los Estudiantes en Internet, acompañado con el desarrollo de competencias con el aprovechamiento de la Tecnología, lo que les ha permitido emigrar hacia Plataformas y Sitios más reconocidos y más confiables

The CIES-UNAN Managua has developed a trend towards the virtualization of the Postgraduate Studies Programs in Public Health (5 Master's programs - Public Health, Health Administration, Epidemiology, Occupational Health, Health Economics - and one Doctorate in Health Sciences) in the last decade of his 35 years of service. Motivated in the needs of its users (Health Professionals of the Meso-American Region, especially in Nicaragua, Honduras and El Salvador), arising from factors that drive a permanent change in their needs, it has incorporated the Technology and Methodology necessary to that this evolution is always based on the needs of users. This has been mediated through mixed Modalities. The advances evidenced in this study are based on the diagnosis of the use of technology by active students in postgraduate academic programs, reaching an assessment of virtual learning spaces based on criteria present in the existing literature on the subject. The satisfaction of the Students is evidenced specifically in the elements of virtualization that have been implemented. The prior knowledge of the technology allows a better use of the Platforms. It is also notorious the satisfactory evolution of student's information search habits on Internet, accompanied by the development of skills on the use of technology, which has allowed them to migrate to more recognized and reliable platforms and sites.

Factorial validation of the Attitudes toward Women Scale for Adolescents (AWSA) in assessing sexual behaviour patterns in Bolivian and Ecuadorian adolescents.

BACKGROUND: Adolescents' health is greatly influenced by social determinants, including gender norms. Although research has shown that there is an association between gender attitudes and adolescents' sexual behaviour, few studies have assessed this relationship carefully. The Attitudes toward Women Scale for Adolescents (AWSA) is widely used to assess gender attitudes among adolescents; however, to our knowledge it has not been applied in Latin America. OBJECTIVE: To apply AWSA in Latin America for the first time, to perform a factorial validation of this scale and to assess the relationship of gender attitudes and sexual behaviour in Bolivian and Ecuadorian adolescents. DESIGN: This cross-sectional study was carried out in 2011 among 14-18 year olds in 20 high schools in Cochabamba (Bolivia) and six in Cuenca (Ecuador) as a part of a larger project. Schools were purposively selected. A Spanish version of the 12-item AWSA was employed for this study. The assessed aspects of adolescent sexual behaviour were: reported sexual intercourse, reported positive experience during last sexual intercourse and reported current use of contraception. The psychometric properties of AWSA were investigated, and both explanatory and confirmatory factorial analyses were performed. RESULTS: The number of questionnaires included in the analysis was 3,518 in Bolivia and 2,401 in Ecuador. A factorial analysis of AWSA resulted in three factors: power dimension (PD), equality dimension (ED) and behavioural dimension (BD). ED showed the highest correlates with adolescent sexual behaviour. Higher scores of this dimension were associated with a more positive experience of sexual relationships, a higher current use of modern contraception and greater sexual activity among girls. CONCLUSIONS: This study revealed a three-factorial structure of AWSA and demonstrated that by employing factors, the sensitivity of AWSA increases as compared to using the scale as a whole to assess sexual behaviour. This could have important implications for future research on gender and the sexual experiences of adolescents.

Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua.

OBJECTIVES: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved. METHODS: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology. RESULTS: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers' awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become 'gate-openers' to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts. CONCLUSIONS: To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

Nevus conjuntivo / Connective nevus

Se agrega a las anteriores comunicaciones un nuevo caso de nevus conectivos cutáneo puro con alteraciones cuantitativas de las fibras colágenas en un niño de 9 años de edad, único portador en su familia de dicha enfermedad. Se efectuaron los estudios correspondentes, de los que se descartan compromisos generales. Los exámenes radiográficos nos mostraron signos de osteospoiquilosis, con las típicas imágenes lenticulares de condensación ósea

Nevus conjuntivo / Connective nevus

Se agrega a las anteriores comunicaciones un nuevo caso de nevus conectivos cutáneo puro con alteraciones cuantitativas de las fibras colágenas en un niño de 9 años de edad, único portador en su familia de dicha enfermedad. Se efectuaron los estudios correspondentes, de los que se descartan compromisos generales. Los exámenes radiográficos nos mostraron signos de osteospoiquilosis, con las típicas imágenes lenticulares de condensación ósea (AU)