Starting a peritoneal carcinomatosis treatment program in a developing country: A prospective analysis.

BACKGROUND: Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has become a valuable treatment strategy for selected patients with peritoneal carcinomatosis (PC). In Chile, it is an emerging technique. The aim of this study is to describe our protocol and report our perioperative results. METHODS: A prospectively maintained database for patients undergoing exploratory surgery for PC was reviewed. Eligible patients were selected using the peritoneal cancer index in correlation with the primary tumor. Patients underwent HIPEC using mitomycin C. Clinical data and postoperative results were analyzed. RESULTS: Seventy-six patients underwent exploratory surgery. Most patients were female (55%) with a median age of 62 years (range, 25-83). Complete CRS and HIPEC were achieved in 53 patients. The most frequent primary tumor site was colon-rectum (49%). The median number of resected organs was 4 (range, 1-13). Overall 90-day incidence of major complications was 26%. After a median follow-up of 26 months, 44 patients (83%) in the resected group were alive with no evidence of disease. CONCLUSIONS: The PC treatment program at our institution has been established in a safe manner, with acceptable morbidity comparable to high-volume centers. A comprehensive preoperative evaluation, careful patient selection, and a cohesive team are necessary for successful results.

The COVID-19 pandemic and organisational commitment of senior hotel managers.

The COVID-19 pandemic will reduce the attractiveness of hospitality occupations. This particularly concerns senior management positions whose holders may substitute hospitality jobs with more secure and rewarding employment in other economic sectors. Organisational resilience of hospitality businesses, including their response to COVID-19, and corporate social responsibility (CSR) practices may, however, affect perceived job security of senior managers and, thus, influence their commitment to remain in their host organisations. This paper quantitatively tests the inter-linkages between the above variables on a sample of senior managers in hotels in Spain. It finds that the levels of organisational resilience and the extent of CSR practices reinforce perceived job security of managers which, in turn, determines their organisational commitment. Organisational response to COVID-19 affects perceived job security and enhances managers' organisational commitment. To retain senior management teams in light of future disastrous events, hotels should, therefore, strengthen their organisational resilience and invest in CSR.

Prevalence of cleft lip and cleft palate in rural north-central guatemala.

OBJECTIVE: To estimate the number of new cases of cleft lip and cleft palate in the department (state) of Alta Verapaz, Guatemala, in 2012. DESIGN: Cross-sectional survey of midwives from communities identified through a two-stage cluster-sampling process. Midwives were asked how many babies they had delivered in the past year and how many of those newborns had various types of birth defects, as illustrated in pictures. SETTING: Indigenous Mayan communities in rural north-central Guatemala. PARTICIPANTS: Midwives (n = 129) who had delivered babies in the previous year. MAIN OUTCOME MEASURE: Reports of babies born with cleft lip and cleft palate. RESULTS: A 1-year prevalence rate of 18.9 per 10,000 for cleft lip and 4.7 per 10,000 for cleft palate was estimated for Alta Verapaz. None of the cases of cleft lip also had cleft palate. CONCLUSION: The indigenous communities in north-central Guatemala might have a relatively high cleft lip prevalence rate compared with the global average.

Dietary, socioeconomic, and maize handling practices associated with aflatoxin and fumonisin exposure among women tortilla makers in 5 departments in Guatemala.

Previous research has demonstrated human exposure to mycotoxins among Guatemalans, with high levels of mycotoxins being found in blood and urine samples as well as in maize for human consumption. Mishandling of crops such as maize during pre- and post-harvest has been associated with mycotoxin contamination. The overarching goal of this study was to identify risk factors for aflatoxin and fumonisin exposure in Guatemala. A cross-sectional survey of 141 women tortilla makers was conducted in the departments of Guatemala, Sololá, Suchitepéquez, Izabal, and Zacapa in February 2022. Maize and tortilla samples were collected and analyzed for aflatoxin B1 (AFB1) and fumonisin B1, B2, and B3 contamination (FB1, FB2, FB3). Urine samples were collected and analyzed for urinary FB1 (uFB1) contamination. A questionnaire was administered to collect data on sociodemographic characteristics, dietary intake of maize-based foods the week prior to the study, and maize handling practices. Descriptive statistics were used to describe common maize handling practices. A univariable analysis was conducted to identify predictors of low/high AFB1, total fumonisins, and uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). During tortilla processing, a reduction in the AFB1 and total fumonisin levels was observed. The presence of AFB1 in maize was associated with department and mean total fumonisin level in maize (OR: 1.705, 95% CI: 1.113-2.613). The department where the tortilleria was located was significantly associated with the presence of fumonisins in tortillas. Increased consumption of Tortrix was significantly associated with the presence of FB1 in urine (OR: 1.652, 95% CI: 1.072-2.546). Results of this study can be used in the development and implementation of supply chain management practices that mitigate mycotoxin production, reduce food waste and economic loss, and promote food security.

Religious values and social distance as activators of norms to reduce food waste when dining out.

Empirical research is required to identify psychological and psychographic factors which can activate or amplify norms of foodservice customers towards food waste reduction. By surveying 446 foodservice customers in Poland, a country with a large population of religion followers, this study examines the influence of religious values on personal norms and explores the moderating effect of social distance on injunctive norms. The results indicate that religious values do not activate personal norms directly but affect them indirectly via such mediating factors as the feeling of compassion and family upbringing. Close encounters, such as family and friends, amplify the effect of injunctive norms while distant encounters, such as fellow countrymen, do not. This suggests that measures for food waste reduction should be designed to appeal to the foodservice customers' feeling of compassion. The measures should also remind foodservice customers that their (grand)parents and friends would disprove food waste.

Dietary and socioeconomic risk factors for fumonisin exposure among women of reproductive age in 18 municipalities in Guatemala from 2013 to 2014.

Fumonisin exposure is common in populations where maize is a dietary staple, such as in Guatemala, and has been associated with negative health outcomes including neural tube defects. The objective of this study was to estimate fumonisin B1 (FB1) exposure among Guatemalan reproductive-age women and develop a better understanding of the dietary and sociodemographic risk factors for exposure. A cross-sectional study in 18 municipalities in Guatemala was conducted. Midwives and study nurses enrolled consenting women and collected individual and household demographic and socioeconomic data. A food frequency questionnaire was administered to estimate quantity and types of food products consumed. A urine sample was collected and urinary fumonisin B1 (uFB1) concentration was measured. A univariable analysis was conducted to identify predictors of low/high uFB1. Multivariable logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). In total, 775 women had analyzable urine samples. Higher uFB1 levels were associated with speaking Mayan (OR = 2.33, 95% CI:1.44-3.77), less than high school education (OR = 1.61, 95% CI:1.12-2.30), increasing dietary proportion of maize-based foods (OR = 1.02, 95% CI:1.01-1.03), and consumption of tostadas (fried tortillas) (OR = 1.11, 95% CI:1.02-1.22). Lower uFB1 levels were associated with consumption of highly processed maize-based foods (OR = 0.93, 95% CI:0.87-0.99). Tortillas were the most frequently consumed maize-based food among study participants and significantly associated with high uFB1 exposure in the univariable but not multivariable analysis. Consumption of >4,750 grams/week of maize-based foods, >5,184 g/week of locally produced maize-based foods, and >110 servings/week of tortillas were also significantly associated with high uFB1 exposure in univariable analysis. Populations with low socioeconomic status/education levels and high consumption of maize-based foods had higher fumonisin exposure. Interventions aimed at reducing the risk of exposure to mycotoxins through maize in Guatemala, including the increased consumption of non-maize-based foods, should be further explored.

Assessing the scale of adoption of sustainability practices by community pharmacies in Spain in the time of COVID-19.

Community pharmacies play a critical societal role and are well placed to enable the progress of national health systems towards sustainability. Nevertheless, there is a dearth of research which has been set up to understand sustainability practices adopted by community pharmacies and evaluate the drivers behind their adoption. This study undertook an exploratory analysis of 95 community pharmacies in Spain, measured their engagement with sustainability practices and assessed these practices in light of the COVID-19 pandemic. The results demonstrated the room for improvement in the adoption of green procurement practices in pharmacies and in their engagement with the community. Moreover, the study showcased that, during the COVID-19 crisis, the pharmacies with the largest extent of adoption of sustainability practices implemented preventative measures against the pandemic in a more diverse number during the first weeks of the lockdown, compared to their less sustainable counterparts. This indicates that, to build resilience to future (health) crises, the implementation of sustainable practices in community pharmacies should be encouraged by both policy makers and pharmaceutical firms.

An integrated approach to improve maternal and perinatal outcomes in rural Guatemala: A stepped-wedge cluster randomized trial.

OBJECTIVE: To evaluate the impact of an intervention package on maternal and newborn health indicators. METHODS: A randomized stepped-wedge non-blind trial was conducted across six subdistricts within two districts in Guatemala from January 2014 to January 2017. Data on outcomes were collected on all deliveries in all 33 health centers. The intervention package included distribution of promotional materials encouraging health center delivery; education for traditional birth attendants about the importance of health center delivery; and provider capacity building using simulation training. Main outcomes were number of health center deliveries, maternal morbidity, and perinatal morbidity and mortality. RESULTS: Overall, there were 24 412 deliveries. Health center deliveries per 1000 live births showed an overall increase, although after adjustment for secular trends and clustering, the relative risk for the treatment effect was not statistically significant (aRR, 1.04; 95% confidence interval [CI], 0.97-1.11, P=0.242). Although not statistically significant, maternal morbidity (aRR, 0.78; 95% CI, 0.60-1.02; P=0.068) and perinatal morbidity (aRR, 0.84; 95% CI, 0.68-1.05; P=0.133) showed a tendency toward a decrease. CONCLUSION: The present study represents one of the few randomized evaluations of an integrated approach to improve birth outcomes in a low-income setting. ClinicalTrials.gov: NCT0315107.

Bringing a health systems modelling approach to complex evaluations: multicountry applications in HIV, TB and malaria.

INTRODUCTION: Understanding how to deliver interventions more effectively is a growing emphasis in Global Health. Simultaneously, health system strengthening is a key component to improving delivery. As a result, it is challenging to evaluate programme implementation while reflecting real-world complexity. We present our experience in using a health systems modelling approach as part of a mixed-methods evaluation and describe applications of these models. METHODS: We developed a framework for how health systems translate financial inputs into health outcomes, with in-country and international experts. We collated available data to measure framework indicators and developed models for malaria in Democratic Republic of the Congo (DRC), and tuberculosis in Guatemala and Senegal using Bayesian structural equation modelling. We conducted several postmodelling analyses: measuring efficiency, assessing bottlenecks, understanding mediation, analysing the cascade of care and measuring subnational effectiveness. RESULTS: The DRC model indicated a strong relationship between shipment of commodities and utilisation thereof. In Guatemala, the strongest model coefficients were more evenly distributed. Results in Senegal varied most, but pathways related to community care had the strongest relationships. In DRC, we used model results to estimate the end-to-end cost of delivering commodities. In Guatemala, we used model results to identify potential bottlenecks and understand mediation. In Senegal, we used model results to identify potential weak links in the cascade of care, and explore subnationally. CONCLUSION: This study demonstrates a complementary modelling approach to traditional evaluation methods. Although these models have limitations, they can be applied in a variety of ways to gain greater insight into implementation and functioning of health service delivery.

Evidence for fumonisin inhibition of ceramide synthase in humans consuming maize-based foods and living in high exposure communities in Guatemala.

SCOPE: Fumonisin (FB) occurs in maize and is an inhibitor of ceramide synthase (CerS). We determined the urinary FB1 (UFB1 ) and sphingoid base 1-phosphate levels in blood from women consuming maize in high and low FB exposure communities in Guatemala. METHODS AND RESULTS: FB1 intake was estimated using the UFB1 . Sphinganine 1-phosphate (Sa 1-P), sphingosine 1-phosphate (So 1-P), and the Sa 1-P/So 1-P ratio were determined in blood spots collected on absorbent paper at the same time as urine collection. In the first study, blood spots and urine were collected every 3 months (March 2011 to February 2012) from women living in low (Chimaltenango and Escuintla) and high (Jutiapa) FB exposure communities (1240 total recruits). The UFB1 , Sa 1-P/So 1-P ratio, and Sa 1-P/mL in blood spots were significantly higher in the high FB1 intake community compared to the low FB1 intake communities. The results were confirmed in a follow-up study (February 2013) involving 299 women living in low (Sacatepéquez) and high (Santa Rosa and Chiquimula) FB exposure communities. CONCLUSIONS: High levels of FB1 intake are correlated with changes in Sa 1-P and the Sa 1-P/So 1-P ratio in human blood in a manner consistent with FB1 inhibition of CerS.

A blood spot method for detecting fumonisin-induced changes in putative sphingolipid biomarkers in LM/Bc mice and humans.

Fumonisins (FB) are mycotoxins found in maize. They are hypothesised risk factors for neural tube defects (NTDs) in humans living where maize is a dietary staple. In LM/Bc mice, FB1-treatment of pregnant dams induces NTDs and results in increased levels of sphingoid base 1-phosphates in blood and tissues. The increased level of sphingoid base 1-phosphates in blood is a putative biomarker for FB1 inhibition of ceramide synthase in humans. Collection of blood spots on paper from finger sticks is a relatively non-invasive way to obtain blood for biomarker analysis. The objective of this study was to develop and validate in an animal model, and ultimately in humans, a method to estimate the volume of blood collected as blood spots on absorbent paper so as to allow quantification of the molar concentration of sphingoid base 1-phosphates in blood. To accomplish this objective, blood was collected from unexposed male LM/Bc and FB1-exposed pregnant LM/Bc mice and humans and applied to two types of absorbent paper. The sphingoid base 1-phosphates, absorbance at 270 nm (A270), and total protein content (Bradford) were determined in the acetonitrile:water 5% formic acid extracts from the dried blood spots. The results show that in both mouse and human the A270, total protein, and blood volume were closely correlated and the volume of blood spotted was accurately estimated using only the A270 of the extracts. In mouse blood spots, as in tissues and embryos, the FB1-induced changes in sphingolipids were correlated with urinary FB1. The half-life of FB1 in the urine was short (<24 h) and the elevation in sphingoid base 1-phosphates in blood was also short, although more persistent than the urinary FB1.

Urinary fumonisin B1 and estimated fumonisin intake in women from high- and low-exposure communities in Guatemala.

SCOPE: Fumonisin (FB) intake can be high when maize is a dietary staple. We determined (i) urinary FB (UFB) in women consuming maize in high- and low-exposure communities in Guatemala, (ii) the FB levels in maize, (iii) the relationship between UFB and FB intake, and (iv) the relative excretion of UFB1 , UFB2 , and UFB3 . METHODS AND RESULTS: Urine and maize were analyzed for FB for 1 year in three departments. Maize consumption was estimated by an interview questionnaire. Fumonisin B1 , B2 , and B3 (FB1 , FB2 and FB3 ), were detected in 100% of maize samples. FB1 in maize and urine was significantly higher in Jutiapa compared to Chimaltenango or Escuintla. The FB intake paralleled UFB1 in a dose-dependent manner but UFB1 was present in much higher levels than UFB2 or UFB3 compared to maize. CONCLUSION: In Jutiapa, agroecological conditions favored FB production. UFB1 mirrored the estimated FB intake. UFB1 > 0.1 ng/mL resulted in a dose-dependent increase in the risk of exceeding FB intake of 2 µg/kg b.w./day compared to women with no detectable UFB1 . More than 50% exceeded 2 µg/kg b.w./day when UFB1 was >0.5 ng/mL. UFB2 and UFB3 were rarely detected confirming that FB1 is either absorbed better or preferentially excreted in urine.

The kinetics of urinary fumonisin B1 excretion in humans consuming maize-based diets.

SCOPE: Fumonisins (FB) are mycotoxins found in maize. The purpose of this study was to (i) determine the relationship between FB(1) , FB(2) , and FB(3) intake and urinary excretion in humans, (ii) validate a method to isolate urinary FB on C(18) -SPE cartridges for international shipment, and (iii) test the method using samples from Guatemala. METHODS AND RESULTS: Volunteers (n = 10) consumed 206 grams/day of tortillas and biscuits prepared from masa flour and a product containing maize flour. Volunteers estimated their daily urine output and samples were analyzed for FB(1) , FB(2) , and FB(3) and hydrolyzed FB(1) . Only FB(1) was detected in urine suggesting lower absorption of FB(2) and FB(3) . Excretion was highly variable peaking soon after consumption began and decreasing rapidly after consumption stopped. Within 5 days after consumption ended, FB(1) was not detected in urine. In a study with eight volunteers, the average total urinary FB(1) was 0.5% of the intake. FB(1) was detected in 61% (107/177) of the samples collected in Guatemala. CONCLUSION: The results support the use of urinary FB(1) to assess ongoing exposure in population-based studies. However, relating the FB(1) concentration in urine to dietary intake of FB by individual subjects will be complicated due to interindividual variability and the rapidity of clearance.

Increasing awareness of danger signs in pregnancy through community- and clinic-based education in Guatemala.

OBJECTIVE: This study evaluates the effectiveness of a set of information, education, and communication (IEC) strategies designed to increase the awareness of danger signs in pregnancy, delivery, or the postpartum period among pregnant or recently pregnant women. METHODS: Three IEC programs were implemented in 4 regions of southwestern Guatemala between April 1997 and May 1998: (1) a clinic-based program involving the training of health providers in prenatal counseling and the provision of educational media to clients; (2) a community-based strategy consisting of radio messages regarding obstetric complications; and (3) educational sessions conducted through women's groups. Three surveys were conducted. In 1997, 637 pregnant women were interviewed at clinics where the interventions had been implemented. In 1998, 163 pregnant women using a subset of the same health clinics were interviewed. In 1999, a population-based survey of 638 pregnant and postpartum women was conducted. Using logistic regression, we model awareness of danger signs as a function of sociodemographic characteristics, prenatal care utilization, and IEC interventions. RESULTS: Among women using health clinics, the likelihood of having heard of danger signs nearly tripled between 1997 and 1998, when the clinic interventions were fully implemented. In 1999, those who had heard radio messages or participated in women's groups were, respectively, 3 times and 5 times more likely to have heard of danger signs in pregnancy. CONCLUSIONS: Safe motherhood programs can effectively increase knowledge of danger signs through clinic- and community-based educational strategies.

Estandarización de personal en diagnóstico clínico de bocio: ¿Cómo evaluar la concordancia entre examinadores de la tiroides? / Personnel standarization in clinical diagnosis of goiter: ¿How to evaluate concordance between thyroid examiners?

El uso de las pruebas t de Student y Cochran para evaluar medidas de tendencia central, así como la prueba de F para evaluar la variabilidad, y el análisis de correlación, han sido usados en forma equivocada para evaluar concordancia entre examinadores del tiroides. En el presente artículo se presenta la prueba de Kappa intraclase (Bloch y Kraemer, 1989), así como la experiencia de su uso en Centroamérica para estandarizar a los examinadores del tiroides que participaron en las encuestas nacionales para determinar prevalencia de bocio en 1990

Elaboración de harinas procesadas de semilla de gandul / Preparation of flour processed with pigeon pea seed

Pigeon pea is a legume grain of good production capacity and of a relatively high nutritive value, which has not been used in Latin America on the basis of the potential it offers. In this study experiments were conducted to learn about the possibility of processing pigeon pea to yield an intermediate flour with good functional characteristics for food product development. The intermediate pigeon pea flour was produced through a selection of a process to efficiently dehull the grain followed by a thermic process to improve its functional properties and nutritive value. The best dehulling process was subjecting the grain to a vapor treatment for five minutes, followed by a 2-hour dehydration of surface moisture with air at 60 degrees and dehulling with an 8-disc dehuller for 10 minutes. Yield was 84 per cent with 70.7 per cent dehulling efficiency. Pigeon pea flours were prepared by three thermic processes: pressure cooking at 15 lb (121 degrees C) for 5 and 10 minutes as a reference product; cooking and drying with a drum dryer at 120 degrees C and 4 rpm and by extrusion-cooking with the material with 18 and 21 per cent moisture at 270 and 300 degrees F, respectively. Process selection was based on the functional properties such as water absorption index, water solubility index, soluble nitrogen and viscosity, through chemical analysis of protein, available lysine and methionine and residual trypsin inhibitors, and through a biological evaluation of protein digestibility and quality. Both pressure cooking products had similar functional and chemical characteristics, however, the 5-minute cooked product has higher protein quality than the 10-minute product.(ABSTRACT TRUNCATED AT 250 WORDS)