Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021.

BACKGROUND: Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES's implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. METHODS: Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. RESULTS: From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). CONCLUSIONS: Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.

A comprehensive and healthcare equity promoting response by a civil society-public partnership to COVID-19 in Chiapas, Mexico.

Following the first COVID-19 case in Chiapas, Mexico in March 2020, the non-governmental organisation Compañeros En Salud (CES) and the state's Ministry of Health (MOH) decided to join forces to respond to the global pandemic. The collaboration was built over 8 years of partnership to bring healthcare to underserved populations in the Sierra Madre region. The response consisted of a comprehensive SARS-CoV-2 infection prevention and control programme, which included prevention through communication campaigns to combat misinformation and stigma related to COVID-19, contact tracing of suspected and confirmed COVID-19 cases and their contacts, outpatient and inpatient care for patients with respiratory symptoms, and CES-MOH collaboration on anti-COVID-19 immunisation campaigns. In this article, we describe these interventions and their principal outcomes, as well as reflect on notable pitfalls identified during the collaboration, and we suggest a series of recommendations to prevent and mitigate their occurrence. As with many cities and towns across the globe, the poor preparedness of the local health system for a pandemic and pandemic response led to the collapse of the medical supply chain, the saturation of public medical facilities and the exhaustion of healthcare personnel, which had to be overcome through adaptation, collaboration and innovation. For our programme in particular, the lack of a formal definition of roles and clear lines of communication between CES and the MOH; thoughtful planning, monitoring and evaluation and active engagement of the communities served in the design and implementation of health interventions affected the outcomes of our efforts.

Assessment of knowledge of oral cancer in dentists in the Los Ríos region, Chile, in 2017 / Evaluación del conocimiento del cáncer oral en dentistas en la región de Los Ríos, Chile, en 2017

Objective: To determine the level of knowledge of Oral Cancer (OC) of dental surgeons in Los Rios Region in the year 2017. Materials and methods: A descriptive, cross-sectional study consisting of a survey containing 24 multiple-choice questions was conducted and applied in person to 102 public practice dentists of Los Ríos Region, between March-July 2017. Participants were previously informed that the survey was voluntary, anonymous and confidential. Characterization data from the population was collected and the variable "Knowledge of Oral Cancer" along with its subsections on OC epidemiology, etiopathogenesis, diagnosis, treatment/complications and prognosis/prevention were measured. Tabulated data were analyzed through descriptive statistics. Results were presented through a passing percentage (60% minimum for approval). Results: 100 surveys were answered (with a 98% response rate). Knowledge of OC averaged a 77% passing rate among the participants: 63% for the epidemiology section, 78% for etiopathogenesis, 86.5% for diagnosis, 64% for treatment/complications, while OC prevention resulted in a 75% passing rate. Conclusion: A high percentage of dental surgeons in Los Rios Region demonstrated a satisfactory knowledge of the etiopathogenesis, diagnosis and prevention of OC. However, a low percentage responded correctly regarding the epidemiological factors, treatment and complications. It is highly recommended to follow the same research methodology in other regions across Chile in order to analyze results at a national level with a new approach, so as to properly guide future professional training programs.

Objetivo: Determinar los conocimientos acerca de cáncer oral (CO) que poseen los odontólogos de la Región de los Ríos en el año 2017. Material y métodos: Se realizó un estudio descriptivo mediante encuestas de preguntas de selección múltiple aplicadas a 102 odontólogos de práctica pública de la Región de los Ríos. Se informó previamente a los participantes el carácter voluntario, anónimo y confidencial de la encuesta y se entregó un consentimiento informado. Se recopilaron datos de caracterización de la población y se midió la variable "Conocimientos acerca del Cáncer Oral" en sus dimensiones de epidemiología, etiopatogenia, diagnóstico, tratamiento/complicaciones y pronóstico/prevención. A los datos tabulados se les realizó estadística descriptiva. Los resultados se presentaron mediante porcentaje de aprobación y nota equivalente al 60% en escala continua. Resultados: Se respondieron 100 encuestas (tasa de respuesta del 98%). El Conocimiento acerca de CO promedió una aprobación de 77% entre los participantes, equivalente a una nota 5,29. La dimensión de epidemiología alcanzó un 63%, etiopatogenia un 78%, diagnóstico un 86,5%, tratamiento/complicaciones un 64% y prevención 75% de aprobación. Conclusión: Un alto porcentaje de los cirujanos dentistas de la Región de los Ríos demostró conocimientos adecuados acerca de la etiopatogenia, diagnóstico y prevención del CO. Sin embargo, un bajo porcentaje respondió asertivamente en lo que respecta a factores epidemiológicos, tratamiento y complicaciones. Se sugiere seguir la misma línea investigativa en otras regiones, para analizar resultados a nivel nacional y orientar, con un nuevo enfoque, los programas educativos para profesionales.

Avanço maxilomandibular no tratamento da Síndrome da Apneia e Hipopneia Obstrutiva do Sono / Maxillomandibular advancement in the treatment of Obstructive Sleep Apnea and Hypopnea Syndrome

Introdução: A Síndrome da Apneia e Hipopneia obstrutiva do Sono é uma doença, que gera grandes transtornos ao paciente e diversos tipos de tratamento a serem realizados lhe são propostos desde procedimentos clínicos a cirúrgicos que envolvem ora somente oro-nasofaringe ora a face como um todo. objetivo: Relato de caso clínico de paciente portador da Síndrome, classificado como grave, tratado cirurgicamente com avanço maxilomandibular. Relato de caso clínico: P.C.C.S, gênero masculino, leucoderma, 46 anos, com Índice de Massa Corporal 29,37 procurou atendimento odontológico referindo-se à ocorrência de apneias durante o sono. Ao exame polissonográfico, foi constatada a ocorrência de 151 apneias/hora de sono, 71 hipopneias/hora de sono. A radiografia cefalométrica de perfil revelou um estreitamento das vias áreas superiores, e o procedimento cirúrgico de avanço bimaxilar associadoà mentoplastia para aumento da volumetria das vias aéreas foi realizado. o paciente evoluiu com melhora do quadro de apneia. Conclusão: Apesar de a uvulopalatofaringoplastia ser a técnica cirúrgica mais antiga e mais utilizada para o tratamento da Síndrome da Apneia e Hipopneia do Sono, o avanço maxilomandibular tem-se mostrado mais eficaz e definitivo para os pacientes por ela afetados.

Introduction: obstructive sleep apnea and hypopnea syndrome is a disease that causes great incon-venience to the patient. Several types of treatment have been proposed, ranging from clinical to surgical procedures involving either the oro-nasopharynx alone or the face as a whole. objective: Case report of a patient with the syndrome, classified as severe, surgically treated with maxillomandibular advancement. Case report: The patient, P.C.C.S, male, Caucasian, 46 years old, body mass index 29.37, sought dental treatment, reporting the occurrence of apneas during sleep. Polysomnography revealed the incidence of 151 apneas / hour of sleep, 71 hypopneas / hour of sleep; the profile cephalometric radiograph revealed a narrowing of the upper airways and bimaxillary advancement surgery to increase the volumetric airway was performed. The patient had an improvement in the apnea. Conclusion: Although uvulopalatopharyngoplasty is thefioldest and most widely used surgical technique for the treatment of sleep apnea and hypopnea syndrome, maxillomandibular advancement has been more effective and definitive final for patients affected by the condition.