Abundance and Leishmania infection patterns of the sand fly Psathyromyia cratifer in Southern Mexico.

BACKGROUND: Localized cutaneous leishmaniasis (LCL) is a serious public health problem in Southern Mexico. Six species of Phlebotominae (Diptera: Psychodidae) have been found to be infected with Leishmania (Leishmania) mexicana, the causative agent of LCL in the region. However, little is known about the biology and potential participation of Psathyromyia cratifer in the Leishmania transmission cycle in Mexico, and the Americas. The present study provides evidence of temporal infection caused by Leishmania in Psathyromyia cratifer as well as data on its population dynamics in a LCL endemic area during the well-known transmission cycle of Leishmania in Southern Mexico. METHODOLOGY/PRINCIPAL FINDINGS: Individual specimens of Psathyromyia cratifer were collected in four sites over the course of five months (from November 2020 through March 2021) using animal-baited, human-baited, and light traps. The temporal activity pattern (month + hour) of Psathyromyia cratifer was assessed along with its relationship with environmental variables. Moreover, Leishmania DNA and blood meals were analyzed and detected in female sand flies. This evidenced an infection rate ranging from 8% to 83%, and the record of Homo sapiens and Ototylomys phyllotis as blood hosts of this sand fly species. High abundances of these sand flies in human-baited traps were recorded which revealed the marked anthropophilic behavior of Psathyromyia cratifer. As regards the transmission dynamics of the parasite within the region, it was observed that the potential highest epidemiological risk for Leishmania transmission by Psathyromyia cratifer occurred during the months of January and March. CONCLUSION: This is the first contribution ever made to both the population dynamic and the temporal Leishmania prevalence patterns in Psathyromyia cratifer. The resulting findings suggest that this sand fly specimen is the sixth potential vector of L. (L.) mexicana in Southern Mexico. Nonetheless, various biology, behavior, and ecology strands are yet to be addressed. The latter, to determine the role it plays in the transmission dynamics of the parasite within the region, and other areas of the country.

Obesity Is Associated With Increased Pediatric Dengue Virus Infection and Disease: A 9-Year Cohort Study in Managua, Nicaragua.

BACKGROUND: Obesity is on the rise globally in adults and children, including in tropical areas where diseases such as dengue have a substantial burden, particularly in children. Obesity impacts risk of severe dengue disease; however, the impact on dengue virus (DENV) infection and dengue cases remains an open question. METHODS: We used 9 years of data from 5940 children in the Pediatric Dengue Cohort Study in Nicaragua to determine whether pediatric obesity is associated with increased susceptibility to DENV infection and symptomatic presentation. Analysis was performed using generalized estimating equations adjusted for age, sex, and preinfection DENV antibody titers. RESULTS: From 2011 to 2019, children contributed 26 273 person-years of observation, and we observed an increase in prevalence of overweight (from 12% to 17%) and obesity (from 7% to 13%). There were 1682 DENV infections and 476 dengue cases in the study population. Compared with participants with normal weight, participants with obesity had higher odds of DENV infection (adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI]: 1.03-1.42) and higher odds of dengue in DENV-infected individuals (aOR, 1.59; 95% CI: 1.15-2.19). Children with obesity infected with DENV showed increased odds of presenting fever (aOR, 1.46; 95% CI: 1.05-2.02), headache (aOR, 1.51; 95% CI: 1.07-2.14), and rash (aOR, 2.26; 95% CI: 1.49-3.44) when compared with children with normal weight. CONCLUSIONS: Our results indicate that obesity is associated with increased susceptibility to DENV infection and dengue cases in children, independent of age, sex, and preinfection DENV antibody titers.

Obesity is associated with increased pediatric dengue virus infection and disease: A 9-year cohort study in Managua, Nicaragua.

Background: Obesity is on the rise globally in adults and children, including in tropical areas where diseases such as dengue have a substantial burden, particularly in children. Obesity impacts the risk of severe dengue disease; however, the impact on dengue virus (DENV) infection and dengue cases remains an open question. Methods: We used 9 years of data from 5,940 children in the Pediatric Dengue Cohort Study in Nicaragua to examine whether pediatric obesity is associated with increased susceptibility to DENV infection and symptomatic presentation. Analysis was performed using Generalized Estimating Equations adjusted for age, sex, and pre-infection DENV antibody titers. Results: From 2011 to 2019, children contributed 26,273 person-years of observation, and we observed an increase in the prevalence of overweight (from 12% to 17%) and obesity (from 7% to 13%). There were 1,682 DENV infections and 476 dengue cases in the study population. Compared to participants with normal weight, participants with obesity had higher odds of DENV infection (Adjusted Odds Ratio [aOR] 1.21, 95% confidence interval [CI] 1.03-1.42) and higher odds of dengue disease given infection (aOR 1.59, 95% CI 1.15-2.19). Children with obesity infected with DENV showed increased odds of presenting fever (aOR 1.46, 95% CI 1.05-2.02), headache (aOR 1.51, 95% CI 1.07-2.14), and rash (aOR 2.26, 95% CI 1.49-3.44) when compared with children with normal weight. Conclusions: Our results indicate that obesity is associated with increased susceptibility to DENV infection and dengue cases in children, independently of age, sex, and pre-infection DENV antibody titers.

Personal protective equipment: Analysis of supply among midwives during the COVID-19 pandemic in Peru.

OBJECTIVE: To report the details of provision of personal protective equipment to midwives during the COVID-19 pandemic in Peru METHODS: This is a non-experimental, descriptive, cross-sectional study. An online survey of 679 midwives working at public healthcare centres was conducted via questionnaires. The following aspects were outlined: method of supply and frequency of delivery of personal protective equipment, type of personal protective equipment provided by the institution, and self-purchase. Furthermore, features of the midwives' workplace were described. For statistical analysis, absolute frequencies and relative proportions were used for categorical variables, and mean and standard deviation were used for numerical variables. MEASUREMENTS AND FINDINGS: The most important finding of this study is that a large proportion of midwives (66.6%) did not receive new personal protective equipment for each shift; 41.9% of midwives who received personal protective equipment during each shift exclusively provided services in the COVID-19 ward, whereas 27.6% did not. The least received supplies were of N95 respirator masks (41.7%) and disposable isolation suit gown (50.5%). Only a certain proportion of midwives (38.6%) were trained by their own institutions on the use of personal protective equipment. KEY CONCLUSIONS: The provision of personal protective equipment to midwives and training on personal protective equipment were insufficient at all workplaces. Therefore, measures must be taken to increase the supply of this material to midwives who are essential workers in reproductive health.

The Nicaraguan Pediatric Influenza Cohort Study, 2011-2019: Influenza Incidence, Seasonality, and Transmission.

BACKGROUND: Children account for a large portion of global influenza burden and transmission, and a better understanding of influenza in children is needed to improve prevention and control strategies. METHODS: To examine the incidence and transmission of influenza we conducted a prospective community-based study of children aged 0-14 years in Managua, Nicaragua, between 2011 and 2019. Participants were provided with medical care through study physicians and symptomatic influenza was confirmed by reverse-transcription polymerase chain reaction (RT-PCR). Wavelet analyses were used to examine seasonality. Generalized growth models (GGMs) were used to estimate effective reproduction numbers. RESULTS: From 2011 to 2019, 3016 children participated, with an average of ∼1800 participants per year and median follow-up time of 5 years per child, and 48.3% of the cohort in 2019 had been enrolled their entire lives. The overall incidence rates per 100 person-years were 14.5 symptomatic influenza cases (95% confidence interval [CI]: 13.9-15.1) and 1.0 influenza-associated acute lower respiratory infection (ALRI) case (95% CI: .8-1.1). Symptomatic influenza incidence peaked at age 9-11 months. Infants born during peak influenza circulation had lower incidence in the first year of their lives. The mean effective reproduction number was 1.2 (range 1.02-1.49), and we observed significant annual patterns for influenza and influenza A, and a 2.5-year period for influenza B. CONCLUSIONS: This study provides important information for understanding influenza epidemiology and informing influenza vaccine policy. These results will aid in informing strategies to reduce the burden of influenza.

Pediatric burden and seasonality of human metapneumovirus over 5 years in Managua, Nicaragua.

BACKGROUND: Human metapneumovirus (hMPV) is an important cause of pediatric respiratory infection. We leveraged the Nicaraguan Pediatric Influenza Cohort Study (NPICS) to assess the burden and seasonality of symptomatic hMPV infection in children. METHODS: NPICS is an ongoing prospective study of children in Managua, Nicaragua. We assessed children for hMPV infection via real-time reverse-transcription polymerase chain reaction (RT-PCR). We used classical additive decomposition analysis to assess the temporal trends, and generalized growth models (GGMs) were used to estimate effective reproduction numbers. RESULTS: From 2011 to 2016, there were 564 hMPV symptomatic infections, yielding an incidence rate of 5.74 cases per 100 person-years (95% CI 5.3, 6.2). Children experienced 3509 acute lower respiratory infections (ALRIs), of which 160 (4.6%) were associated with hMPV infection. Children under the age of one had 55% of all symptomatic hMPV infections (62/112) develop into hMPV-associated ALRIs and were five times as likely as children over one to have an hMPV-associated ALRI (rate ratio 5.5 95% CI 4.1, 7.4 p < 0.001). Additionally, symptomatic reinfection with hMPV was common. In total, 87 (15%) of all observed symptomatic infections were detected reinfections. The seasonality of symptomatic hMPV outbreaks varied considerably. From 2011 to 2016, four epidemic periods were observed, following a biennial seasonal pattern. The mean ascending phase of the epidemic periods were 7.7 weeks, with an overall mean estimated reproductive number of 1.2 (95% CI 1.1, 1.4). CONCLUSIONS: Symptomatic hMPV infection was associated with substantial burden among children in the first year of life. Timing and frequency of symptomatic hMPV incidence followed biennial patterns.

Homotypic protection against influenza in a pediatric cohort in Managua, Nicaragua.

The period of protection from repeat infection following symptomatic influenza is not well established due to limited availability of longitudinal data. Using data from a pediatric cohort in Managua, Nicaragua, we examine the effects of natural influenza virus infection on subsequent infection with the same influenza virus subtype/lineage across multiple seasons, totaling 2,170 RT-PCR-confirmed symptomatic influenza infections. Logistic regression models assessed whether infection in the prior influenza season protected against homologous reinfection. We sequenced viruses from 2011-2019 identifying dominant clades and measuring antigenic distances between hemagglutinin clades. We observe homotypic protection from repeat infection in children infected with influenza A/H1N1pdm (OR 0.12, CI 0.02-0.88), A/H3N2 (OR 0.41, CI 0.24-0.73), and B/Victoria (OR 0.00, CI 0.00-0.14), but not with B/Yamagata viruses (OR 0.60, CI 0.09-2.10). Overall, protection wanes as time or antigenic distance increases. Individuals infected with one subtype or lineage of influenza virus have significantly lower odds of homologous reinfection for the following one to two years; after two years this protection wanes. This protection is demonstrated across multiple seasons, subtypes, and lineages among children.

Proceso de enfermería a adulto mayor con Diabetes tipo 2 hospitalizado por COVID-19 / Nursing process for an elderly person with type 2 Diabetes hospitalized

Introducción: el Síndrome Respiratorio Agudo Severo Coronavirus 2 es el agente causal de la COVID-19, una enfermedad emergente pandémica que requiere cuidados de enfermería basados en el proceso de enfermería desde el autocuidado. Objetivo: Aplicar el proceso de enfermería desde la perspectiva teórica del autocuidado a un adulto mayor con diagnóstico de diabetes tipo 2 hospitalizado por complicaciones de la COVID-19. Métodos: estudio de caso con Proceso de Enfermería a adulto mayor con COVID-19, para valoración se utilizó una cédula basada en conceptos de la Teoría General del Déficit de autocuidado de Orem, escala de ansiedad de Halminton y escala de riesgo de caídas, para la deducción diagnóstica, resultados e intervenciones se utilizó la taxonomía NANDA 2018-2020, clasificación de Resultados NOC, guías de práctica clínica y la clasificación de intervenciones NIC, respectivamente. Resultados: se identificaron 8 diagnósticos de enfermería, de los cuales, 4 son reales, 3 de riesgo, 1 de promoción a la salud. Se elaboraron 8 planes de cuidados con enfoque de educación para la salud e intervenciones con criterios de resultados del NOc e intervenciones de enfermería basadas en NIC y 4 Guías de práctica clínica sobre las respuestas humanas prioritarias; deterioro del intercambio de gases, diarrea, ansiedad y riesgo de glicemia inestable. Conclusiones: el Proceso de Enfermería vinculado con la teoría de Dorothea Orem permitió mejorar las prácticas de autocuidado y por consiguiente el autocontrol de la enfermedad respiratoria y metabólica en el adulto mayor[AU]

introduction: the Severe Acute Respiratory Syndrome Coronavirus 2 is the causal agent of COVID-19, an emerging pandemic disease that requires nursing care based on the nursing process from self-care. Objective: to apply the nursing process from the theoretical perspective of self-care to an older adult diagnosed with type 2 diabetes hospitalized for complications of COVID-19. Methods: case study with the Nursing Process of an elderly person with COVID-19, for assessment a card based on concepts of the General Theory of Deficit of Orem's self-care deficit, Halminton anxiety scale and risk of falls scale was used. For the diagnostic deduction, results and interventions, the 2018-2020NANDA taxonomy, NOC Results classification, clinical practice guidelines and the NIC intervention classification were used, respectively. Results: Eight nursing diagnoses were identified, of which 4 are real, 3 of risk, 1 of health promotion. 8 care plans were developed with a focus on health education and interventions with NOCresults criteria and NIC-based nursing interventions and 4 clinical practice guidelines on priority human responses; impaired gas exchange, diarrhea, anxiety and risk of unstable blood glucose. Conclusions: the Nursing Process linked to Dorothea Orem's theory allowed to improve self-care practices and consequently the self-control of respiratory and metabolic disease in the elderly[AU]

a Síndrome Respiratória Aguda Grave Coronavírus 2 é o agente causal da COVID-19, uma doença pandêmica emergente que requer cuidados de enfermagem baseados no processo de enfermagem a partir do autocuidado. Objetivo: aplicar o processo de enfermagem na perspectiva teórica do autocuidado a um idoso com diagnóstico de diabetes tipo 2 internado por complicações do COVID-19. Métodos: estudo de caso com o Processo de Enfermagem de uma pessoa idosa com COVID-19, para avaliação de uma ficha baseada nos conceitos da Teoria Geral do Déficit do Déficit de Autocuidado de Orem, Escala de Ansiedade Halminton e Escala de Risco de Quedas. Dedução diagnóstica, resultados e intervenções, a taxonomia NANDA2018-2020, classificação de resultados NOC, diretrizes de prática clínica e a classificação de intervenção NIC foram usados, respectivamente. Resultados: foram identificados 8 diagnósticos de enfermagem, sendo 4 reais, 3 de risco, 1 de promoção da saúde. 8 planos de cuidados foram desenvolvidos com foco em educação em saúde e intervenções com critérios de resultados NIC e intervenções de enfermagem baseadas em NIC e 4 diretrizes de prática clínica em respostas humanas prioritárias; alteração das trocas gasosas, diarreia, ansiedade e risco de glicose sanguínea instável. Conclusões: o Processo de Enfermagem atrelado à teoria de Dorothea Orem permitiu aprimorar as práticas de autocuidado e consequentemente o autocontrole das doenças respiratórias e metabólicas em idosos[AU]

Text segmentation ability predicts future reading efficiency in Spanish-speaking children.

Can the ability to parse unspaced texts (measured by a Text Segmentation Task, TST) index and predict reading efficiency in Spanish-speaking children? A sample of 1112 children (1st to 6th grade) was assessed. Additionally, two subsamples (51 children of 4th-5th grades and 71 children of 1st grade) were followed up. Our results indicate that the TST: a) reflects the acquisition of reading over primary school grades; b) reflects the teacher's judgment about the child's reading development; c) accurately predicts oral reading efficiency one and four years later year, in the former case even after removing the contributions of the IQ and oral reading speed. These results indicate that TST can be used to both index present -and predict future- reading achievements.

Neumonía y síndrome de insuficiencia respiratoria progresiva aguda por SARS-CoV-2 en la Ciudad de México / Pneumonia and SARS-CoV-2 Acute Respiratory Distress Syndrome in Mexico City / Pneumonia e Síndrome da Insuficiencia Respiratória Progressiva Aguda devido à SARS-CoV-2 na Cidade do México

Resumen: Durante la pandemia de SARS-CoV-2 se presenta el caso clínico de un hombre joven de 43 años, sin comorbilidades, quien asiste a un concierto en la Ciudad de México y seis días después inicia con un cuadro infeccioso de vías respiratorias altas que evoluciona en seis días a una neumonía con síndrome de insuficiencia respiratoria progresiva aguda (SIRPA) grave. Se confirma infección por SARS-CoV-2 y sobreinfección bacteriana por Staphylococcus aureus meticilino resistente, requiriendo asistencia ventilatoria invasiva y cuidados en la Unidad de Terapia Intensiva del Hospital Bité Medica de la Ciudad de México por un grupo interdisciplinario. El paciente evoluciona favorablemente con hidroxicloroquina y lopinavir/ritonavir, esteroide sistémico, linezolid, estrategias ventilatorias de protección pulmonar y cuidados críticos generales sin desarrollar falla de otros órganos o sistemas.

Abstract: During the SARS-CoV-2 Pandemic, a clinical case of a 43-year-old young man is presented, who after six days of attending a concert in Mexico City developed an infectious of the upper respiratory tract that evolved to a pneumonia with severe acute respiratory distress syndrome (ARDS), confirming SARS CoV2 infection and bacterial superinfection with resistant methicillin Staphylococcus aureus, requiring invasive ventilatory assistance and care in the Intensive Care Unit of the Hospital Bité Medica, Mexico City by an interdisciplinary group. The patient improved with hydroxychloroquine and lopinavir/ritonavir, systemic steroid, linezolid, ventilatory strategies for pulmonary protection, and general critical care without developing failure of other organs or systems.

Resumo: Durante a pandemia de SARS CoV 2, é apresentado o caso clínico de um jovem de 43 anos que assiste a um concerto na Cidade do México e seis dias depois começa com um quadro infeccioso do trato respiratório superior que evolui em seis dias para pneumonia com síndrome do desconforto respiratório agudo grave, confirmando infecção por SARS CoV2 e superinfecção bacteriana com meticilina resistente Staphylococcus aureus, exigindo assistência ventilatória invasiva e cuidados na Unidade de Terapia Intensiva do Hospital Bitémedica, Cidade do México por um grupo interdisciplinar. O paciente progride para melhora com hidroxicloroquina e lopinavir/ritonavir, esteróide sistêmico, linezolida, estratégias ventilatórias para proteção pulmonar e cuidados críticos em geral, sem desenvolver falha de outros órgãos ou sistemas.

Grado de conocimiento de los residentes de la especialidad de medicina pediátrica en el Hospital Nacional de Niños Benjamín Bloom sobre el concepto del dolor en pediatría y su tratamiento en el periodo de 1 de Agosto al 30 de Agosto del 2019 / Degree of knowledge of the residents of the pediatric medicine specialty at the Benjamin Bloom National Children's Hospital about the concept of pain in pediatrics and its treatment in the period from August 1 to August 30, 2019

El dolor en pediatría es un síntoma que acompaña a múltiples enfermedades y por consiguiente es un motivo frecuente de consulta en pediatría; actualmente hay un creciente interés en el manejo del dolor pediátrico, pero a pesar de estos avances aún hay muchos niños que sufren innecesariamente por falta de un adecuado tratamiento. El control del dolor es parte fundamental de una buena práctica médica y de una atención de alta calidad. La prevención y un buen manejo del dolor son prioridades cuando se trabaja con niños; por tanto es importante en la formación médica adquirir conocimiento sobre la definición y el tratamiento del dolor en ellos; este estudio evaluó el conocimiento de los médicos residentes de Medicina Pediátrica del Hospital Nacional de Niños Benjamín Bloom a través de un instrumento de investigación auto administrado, diseñado específicamente para esta investigación.

Prior dengue virus infection and risk of Zika: A pediatric cohort in Nicaragua.

BACKGROUND: Zika virus (ZIKV) emerged in northeast Brazil in 2015 and spread rapidly across the Americas, in populations that have been largely exposed to dengue virus (DENV). The impact of prior DENV infection on ZIKV infection outcome remains unclear. To study this potential impact, we analyzed the large 2016 Zika epidemic in Managua, Nicaragua, in a pediatric cohort with well-characterized DENV infection histories. METHODS AND FINDINGS: Symptomatic ZIKV infections (Zika cases) were identified by real-time reverse transcription PCR and serology in a community-based cohort study that follows approximately 3,700 children aged 2-14 years old. Annual blood samples were used to identify clinically inapparent ZIKV infections using a novel, well-characterized serological assay. Multivariable Poisson regression was used to examine the relation between prior DENV infection and incidence of symptomatic and inapparent ZIKV infection. The generalized-growth method was used to estimate the effective reproduction number. From January 1, 2016, to February 28, 2017, 560 symptomatic ZIKV infections and 1,356 total ZIKV infections (symptomatic and inapparent) were identified, for an overall incidence of 14.0 symptomatic infections (95% CI: 12.9, 15.2) and 36.5 total infections (95% CI: 34.7, 38.6) per 100 person-years. Effective reproduction number estimates ranged from 3.3 to 3.4, depending on the ascending wave period. Incidence of symptomatic and total ZIKV infections was higher in females and older children. Analysis of the effect of prior DENV infection was performed on 3,027 participants with documented DENV infection histories, of which 743 (24.5%) had experienced at least 1 prior DENV infection during cohort follow-up. Prior DENV infection was inversely associated with risk of symptomatic ZIKV infection in the total cohort population (incidence rate ratio [IRR]: 0.63; 95% CI: 0.48, 0.81; p < 0.005) and with risk of symptomatic presentation given ZIKV infection (IRR: 0.62; 95% CI: 0.44, 0.86) when adjusted for age, sex, and recent DENV infection (1-2 years before ZIKV infection). Recent DENV infection was significantly associated with decreased risk of symptomatic ZIKV infection when adjusted for age and sex, but not when adjusted for prior DENV infection. Prior or recent DENV infection did not affect the rate of total ZIKV infections. Our findings are limited to a pediatric population and constrained by the epidemiology of the site. CONCLUSIONS: These findings support that prior DENV infection may protect individuals from symptomatic Zika. More research is needed to address the possible immunological mechanism(s) of cross-protection between ZIKV and DENV and whether DENV immunity also modulates other ZIKV infection outcomes such as neurological or congenital syndromes.

Seroprevalence, risk factor, and spatial analyses of Zika virus infection after the 2016 epidemic in Managua, Nicaragua.

In 2015, a Zika epidemic in Brazil began spreading throughout the Americas. Zika virus (ZIKV) entered Managua, Nicaragua, in January 2016 and caused an epidemic that peaked in July-September 2016. ZIKV seropositivity was estimated among participants of pediatric (n = 3,740) and household (n = 2,147) cohort studies, including an adult-only subset from the household cohort (n = 1,074), in Managua. Seropositivity was based on a highly sensitive and specific assay, the Zika NS1 blockade-of-binding ELISA, which can be used in dengue-endemic populations. Overall seropositivity for the pediatric (ages 2-14), household (ages 2-80), and adult (ages 15-80) cohorts was 36, 46, and 56%, respectively. Trend, risk factor, and contour mapping analyses demonstrated that ZIKV seroprevalence increased nonlinearly with age and that body surface area was statistically associated with increasing seroprevalence in children. ZIKV seropositivity was higher in females than in males across almost all ages, with adjusted prevalence ratios in children and adults of 1.11 (95% CI: 1.02-1.21) and 1.14 (95% CI: 1.01-1.28), respectively. No household-level risk factors were statistically significant in multivariate analyses. A spatial analysis revealed a 10-15% difference in the risk of ZIKV infections across our 3-km-wide study site, suggesting that ZIKV infection risk varies at small spatial scales. To our knowledge, this is the largest ZIKV seroprevalence study reported in the Americas, and the only one in Central America and in children to date. It reveals a high level of immunity against ZIKV in Managua as a result of the 2016 epidemic, making a second large Zika epidemic unlikely in the near future.

Influenza transmission during extreme indoor conditions in a low-resource tropical setting.

Influenza transmission occurs throughout the planet across wide-ranging environmental conditions. However, our understanding of the environmental factors mediating transmission is evaluated using outdoor environmental measurements, which may not be representative of the indoor conditions where influenza is transmitted. In this study, we examined the relationship between indoor environment and influenza transmission in a low-resource tropical population. We used a case-based ascertainment design to enroll 34 households with a suspected influenza case and then monitored households for influenza, while recording indoor temperature and humidity data in each household. We show that the indoor environment is not commensurate with outdoor conditions and that the relationship between indoor and outdoor conditions varies significantly across homes. We also show evidence of influenza transmission in extreme indoor environments. Specifically, our data suggests that indoor environments averaged 29 °C, 18 g/kg specific humidity, and 68 % relative humidity across 15 transmission events observed. These indoor settings also exhibited significant temporal variability with temperatures as high as 39 °C and specific and relative humidity increasing to 22 g/kg and 85 %, respectively, during some transmission events. However, we were unable to detect differences in the transmission efficiency by indoor temperature or humidity conditions. Overall, these results indicate that laboratory studies investigating influenza transmission and virus survival should increase the range of environmental conditions that they assess and that observational studies investigating the relationship between environment and influenza activity should use caution using outdoor environmental measurements since they can be imprecise estimates of the conditions that mediate transmission indoors.

The Nicaraguan pediatric influenza cohort study: design, methods, use of technology, and compliance.

BACKGROUND: Influenza causes substantial morbidity and mortality worldwide, yet few data exist on influenza infection rates in tropical, developing countries. In 2011, we established the Nicaraguan Pediatric Influenza Cohort Study (NPICS) to study the burden and seasonality of influenza in Nicaraguan children. Here we describe the study design, methods, and participation data of the NPICS for 2011-2013. METHODS/DESIGN: A total of 1532 children aged 0 to 12 years were enrolled into the study in 2011, and an additional 401 children were enrolled between 2012 and 2013. Children were provided with all of their medical care through the study, and data on medical visits were recorded systematically. A number of surveys were conducted together with a blood sample annually, including a height and weight measurement, a socio-economic status and risk factor survey, and a breastfeeding survey. DISCUSSION: Unique features of our study include the customized low-cost, open-source informatics system as well as the development of methods to leverage infrastructure and resources by conducting multiple studies in the same setting while maximizing protocol adherence and quality control. These methods should be useful to others conducting large cohort studies, particularly in low-resource settings.

TV food advertisements' effect on food consumption and adiposity among women and children in Mexico.

BACKGROUND: The objective of the study was to assess the association between TV foods advertisements and the ones consumed by mothers and children, and the body weight of both mother and child, among population from different SES in two Mexican cities. METHODS: During June through October 2011 in Tijuana and Tuxtla Gutierrez, two national broadcasted channels were recorded during a period of 5 h in the afternoon on working days. Direct interviews were conducted to explore the foods consumed by mothers and their children from January to July 2012. To identify the difference in the number of hours of TV watching, number of TV sets, and the number of advertisements they recalled, a one-way ANOVA was used. RESULTS: An association was observed between the consumption of advertised foods by mothers and the frequency of broadcasted advertising. It was also observed that there was an association between the hours watching TV and BMI of the mothers and BMI Z-score of their children. CONCLUSIONS: There was an association between BMI of the mothers and their children and time spent watching TV. The high exposure to TV food advertisements in Mexico may increase the odds for having childhood obesity.

Antecedentes: El objetivo de este estudio fue valorar la asociación entre los anuncios de alimentos en TV, los alimentos consumidos por las madres y los niños, y el peso corporal de madres y niños entre población con diferentes niveles socioeconómicos. Métodos: De junio a octubre de 2011 en Tijuana y Tuxtla Gutiérrez, se grabaron los programas de dos canales nacionales durante un período de cinco horas, cinco días laborables. Se realizaron entrevistas a las madres de enero a julio de 2012, para explorar los alimentos consumidos por las madres y los niños. Para identificar las diferencias entre el número de horas de TV, el número de unidades de TV, y el número de anuncios que recordaban se realizó análisis de una vía de ANOVA. Resultados: Se observó una asociación entre el consumo de los alimentos anunciados y la frecuencia en la que se anuncian en la TV. También se observó una asociación entre las horas de televisión, el IMC de las madres y el puntaje Z-score de los niños. Conclusiones: Se observó una asociación entre las horas de televisión y los indicadores de adiposidad en las madres y los niños. El mayor aumento en la exposición a la TV puede incrementar el riesgo de obesidad infantil.

Influencia del empoderamiento y la comunicación con la pareja en la planificación familiar en mujeres unidas de 18 a 24 años en el Hospital Nacional Docente Madre Niño San Bartolomé de Noviembre a Diciembre 2012 / Influence of empowerment and couple communication on family planning among cohabiting or married women from 18-24 years old at the Teaching National Hospital Mother Child San Bartolome during the period from November to December 2012

Objetivos: Determinar la influencia del empoderamiento y la comunicación con la pareja en el uso de un servicio de planificación familiar en mujeres unidas, de 18 a 24 años, que asisten al Servicio de Ginecología y Obstetricia del Hospital Nacional Docente Madre Niño San Bartolomé durante noviembre y diciembre del año 2012. Diseño: El presente estudio es de tipo analítico, cuantitativo de corte transversal. Material y métodos: La muestra se conformó por 326 mujeres de 18 a 24 años casadas o convivientes, por un periodo mínimo de 6 meses. Se aplicó el método de la encuesta y la técnica de la entrevista estructurada. El empoderamiento femenino se midió a través de 5 índices: poder de decisión, apoyo para el uso de métodos anticonceptivos, rechazo a la violencia, equidad de género y autonomía en las relaciones sexuales, las cuales se clasificaron en 3 niveles: alto, medio y bajo. La comunicación en pareja se evaluó a través de la probable respuesta frente a diversas situaciones de conflicto de pareja planteadas, se puntuó de 1 (Muy improbable) a 9 (Muy probable), según la probabilidad que dicha respuesta se ajuste ante una determinada situación. Además de realizaron 5 preguntas vinculadas directamente a la planificación familiar: 2 de ellas ligadas al empoderamiento femenino y 3 a la comunicación de pareja. Para el análisis de datos se utilizó estadística descriptiva y prueba chi cuadrado con nivel de siqnificancia estadística de 0.05 (p1 o asociación negativa: RP<1. Resultados: Se observó que la mayoría de mujeres tenía entre 22 y 24 años (69.4 por ciento), grado de instrucción secundaria (59.2 por ciento), eran convivientes (84.4 por ciento). Asimismo, predominó la edad de inicio de vida sexual entre los 13 y 18 años (70.6 por ciento), la mayoría de mujeres tenían entre 1 y 2 hijos vivos (70.9 por ciento) y convivían con...

Objectives: To determinate influence of empowerment and couple communication on family planning among cohabiting or married women from 18 to 24 years old who were attended in Teaching National Hospital Mother Child San Bartolome during the period from November 2012 to December 2012. Methodology: Analytical, quantitative and transversal study. The sample was constituted by 326 women from 18 to 24 years old, who were married or cohabiting for a period not less than 6 months. We applied the method of the survey and structured interview technique. Women's empowerment was measured by 5 indices: power to make decisions, support for the use of contraceptive methods, rejection of violence, gender equity and sexual autonomy, which were classified into 3 levels: high, medium and low. Couple communication was assessed using the likely response to various situations of couple conflict raised, was scored from 1 (very unlikely) to 9 (very likely), according to the likelihood that the response will fit in a given situation. In addition to this, a total of 5 questions were made, related directly to family planning: 2 are linked to women's empowerment and 3 to couple communication. For data analysis we use descriptive statistics and chi-square test with statistical significance level of 0.05 (p 1 or negative association: RP<1. Results: It was observed that most women were between 22 and 24 years (69.4 per cent), secondary education level (59.2 per cent) were cohabiting (84.4 per cent). Beside this, age at first sexual intercourse between 13 and 18 years was prevailing (70.6 per cent), most women had between 1 and 2 living children (70.9 per cent) and were living with their partner for a period not less than one year (78.8 per cent). In addition, 58.6 per cent did not attend family planning services in the last year, and 56.1 per cent had not...