Migration process of Venezuelan women to Brazil: living conditions and use of health services in Manaus and Boa Vista, 2018-2021.

BACKGROUND: The last decade saw the emergence of a new significant migration corridor due to the mass migration of Venezuelans to neighboring countries in South America. Since 2018, Brazil became the third host country of Venezuelan displaced populations. Little is known about how migratory processes affect needs, access to social programs, and public health services of migrant women. The goal of this study is to shed light on the socio-economic profile, living conditions, and use of health services of Venezuelan migrant women in two main reception cities in Brazil. METHODS: A survey was conducted using respondent-driven sampling (RDS) in the cities of Boa Vista (Roraima), and Manaus (Amazonas). The study included 2012 Venezuelan migrant women aged between 15 and 49 years old who migrated from Venezuela to Brazil between 2018 and 2021. Relative prevalence was calculated, and the χ2 test was used to analyse the homogeneity of proportions. All analyses considered the complex sampling. RESULTS: The main reasons for migrating relate to difficulties obtaining food (54%) and accessing health services (37.8%) in their country of origin. They were young and mixed race (65.7%) and had high school education (69.9%). In Manaus, 3.7% of the interviewees declared that they had no family income in the last month, while in Boa Vista, it was higher (66.2%) (p-value < 0.001). Almost one-third of them sought health care in the last 15 days, and 95% of them received care. The residents of Boa Vista arrived more recently and family income and access to paid work improved with time of residence in Brazil. CONCLUSIONS: Given the increasing flow of Venezuelan migrants crossing to Brazil, a reception system was established for the provision of food, shelter, access to health services, and income transfer programs to migrants. This was the case despite high unemployment and poverty levels and income inequality, particularly in the city of Boa Vista. However, the majority had legal migrant status and had access to the public and universal healthcare system in Brazil (SUS). The use of the SUS was similar in both cities, acting as a buffer for the differences in opportunities offered.

Persistent Food Insecurity and Material Hardships: A Latent Class Analysis of Experiences among Venezuelan Refugees and Migrants in Urban Colombia.

The causes and conditions of displacement often increase the vulnerability of migrant and refugee populations to food insecurity, alongside other material hardships. We aimed to examine the multidimensional aspects and patterns of food insecurity and other material hardships in a cross-sectional sample of 6221 Venezuelan refugees and migrants in urban Colombia using a latent class analysis. Using multinomial and logistic regression models, we investigated the demographic and migratory experiences associated with identified classes and how class membership is associated with multiple health outcomes among Venezuelan refugees and migrants, respectively. Approximately two thirds of the sample was comprised cisgender women, and the participants had a median age of 32 years (IQR: 26-41). Four heterogeneous classes of food insecurity and material hardships emerged: Class 1-low food insecurity and material hardship; Class 2-high food insecurity and material hardship; Class 3-high income hardship with insufficient food intake; and Class 4-income hardship with food affordability challenges. Class 2 reflected the most severe food insecurity and material hardships and had the highest class membership; Venezuelans with an irregular migration status were almost 1.5 times more likely to belong to this class. Food insecurity and material hardship class membership was independently associated with self-rated health, mental health symptoms, and recent violence victimization and marginally associated with infectious disease outcomes (laboratory-confirmed HIV and/or syphilis infection). Social safety nets, social protection, and other interventions that reduce and prevent material hardships and food insecurity among refugees and migrants, alongside the host community, may improve public health, support development, and reduce healthcare costs. In the long term, regularization and social policies for migrants aimed at enhancing refugees' and migrants' social and economic inclusion may contribute to improving food security in this population.

Comparative reproductive ecology of Old and New World Trogons, an order in decline across the world.

Many tropical species show declining populations. The pantropical order Trogoniformes has 76% of its species ranked as declining, reflecting a worldwide problem. Here, we report on the reproductive ecology and life history traits of the declining and near-threatened old world Whitehead's Trogon (Harpactes whiteheadi), the declining new world Collared Trogon (Trogon collaris), and the stable Masked Trogon (T. personatus). We also reviewed the literature on reproductive ecology and life history traits of trogons to assess possible commonalities that might help explain population declines. We found that the declining Whitehead's and Collared Trogons had reasonable nest success (32% and 25%, respectively), while the stable Masked Trogon had poor reproductive success (9%), all contrary to population trends. However, the limited literature data suggested that poor reproductive success may be common among trogons, which may contribute to population declines. Parents fed young at a low rate and had long on-bouts for incubation and nestling warming that reduced activity at the nest, as favored by high nest predation risk over evolutionary time. We found that young fledged from the nest with poorly developed wings, as also favored by high nest predation risk. Evolved nestling periods among trogon species suggests that poor wing development is likely common. Wing development has been shown to affect juvenile survival after leaving the nest. The poor wing development may be an important contributor to population declines that deserves more attention. Evolved life history traits are important to recognize as creating population vulnerabilities in a changing world.

Understanding the factors associated with COVID-19 vaccine hesitancy in Venezuela.

BACKGROUND: Despite nearly a quarter of Venezuelans remaining unvaccinated against coronavirus disease 2019 (COVID-19), the factors contributing to vaccine hesitancy in the country have not been thoroughly investigated. METHODS: A cross-sectional study was conducted from October 15th to 30th, 2022, using a knowledge, attitudes, and practices (KAP) survey to identify factors associated with COVID-19 vaccine hesitancy. RESULTS: The study analyzed data from 1,930 participants from all 24 states of Venezuela. The majority (93.4%) were vaccinated. The mean age was 40 years, predominantly female (67.3%), and held a university degree (70.6%). The mean KAP score was significantly higher among vaccinated individuals compared to unvaccinated ones (7.79 vs. 3.94 points for knowledge, 40 vs. 24 points for attitudes, and 16 vs. 10 points for practices, all p < 0.001). Increases in the scores for KAP were associated with increased odds of being vaccinated (84.6%, 25.6%, and 33% respectively for each one-point increase, all p < 0.001). Certain demographic factors such as marital status, occupation, religious beliefs, monthly income, and location influence COVID-19 vaccine knowledge. Higher income and certain occupations decrease the odds of low knowledge, while residing in specific states increases it. Attitudes towards the COVID-19 vaccine are influenced by age, health status, vaccination status, and location. Higher income and absence of certain health conditions decrease the odds of negative attitudes. Lastly, age, occupation, monthly income, and location affect vaccine practices. Advanced age and higher income decrease the odds of inappropriate practices, while residing in La Guaira state increases them. CONCLUSION: Factors such as age, education level, occupation, monthly income, and location were found to be associated with knowledge and attitudes towards COVID-19 vaccine among the surveyed Venezuelans.

Syphilis prevalence and correlates of infection among Venezuelan refugees and migrants in Colombia: findings of a cross-sectional biobehavioral survey.

Background: Population-based estimates of syphilis prevalence are critical to informing public health response. We aimed to measure syphilis prevalence among Venezuelan refugees and migrants in Colombia to inform public health programming. Methods: Between July 2021 and February 2022, we surveyed 6221 adult Venezuelan refugees and migrants in four cities in Colombia using respondent-driven sampling (RDS). Participants completed a survey and dual-rapid HIV/treponemal syphilis screening. Confirmatory laboratory-based rapid plasma reagin testing was conducted on whole blood samples. Active syphilis infection was defined as RPR titer ≥ 1:8 and no self-reported syphilis treatment. We used multivariable regression models to identify associations with active syphilis infection among subgroups by gender and history of pregnancy (cisgender men n = 2123, cisgender women n = 4044, transgender/nonbinary people n = 47, pregnant women n = 150). Findings: Population (RDS-weighted) prevalence of laboratory-confirmed syphilis was 5.1% (95% CI: 4.6-5.6). Syphilis prevalence was 5.8% (weighted) among men; lifetime sexually transmitted infections (STI) diagnosis, same-sex relationships, HIV infection, and partner number were independently associated with syphilis infection. Syphilis prevalence was 4.6% (weighted) in women; correlates of infection included: lifetime STI diagnosis, food insecurity, current engagement in sex work, current pregnancy, any unsafe night in Colombia, irregular migration status, and no healthcare utilization in Colombia. 14.9% (unweighted) of transgender participants had syphilis infection; correlates of infection included partner number and HIV infection. The prevalence of syphilis was 9.0% (weighted) among pregnant women, which was associated with lifetime STI diagnosis. Interpretation: Syphilis among Venezuelans in Colombia is high. Correlates of infection are distinct among demographic groups, spanning sexual and social vulnerabilities, suggesting tailored public health strategies. Funding: US President's Emergency Plan for AIDS Relief through the U.S. Centers for Disease Control and Prevention.

Access to HIV/STI testing among male and female Venezuelan migrants in Peru: evidence from a nationwide survey.

BACKGROUND: Human immunodeficiency virus (HIV) infection and sexually transmitted infections (STIs) are major global public health issues. Migrants represent a vulnerable group that faces multiple barriers to access to healthcare services, including HIV/STI testing. This study aimed to assess the factors associated with access to HIV/STI testing in male and female Venezuelan migrants in Peru. METHODS: This was a cross-sectional study involving secondary data analysis of the 2022 Venezuelan Population Residing in Peru Survey. The study was conducted in the eight most populated cities inhabited by Venezuelan migrants and refugees. For each city, the sampling design was probabilistic, stratified, and independent. The outcome variable was whether participants had access to HIV or other STI testing during their stay in Peru. Statistical analysis was stratified by sex owing to potential effect modification. Crude and adjusted prevalence ratios were calculated using generalized linear models Poisson family with log link function. Confidence intervals were calculated to 95%. RESULTS: A total of 3,723 male and 3,984 female migrants were included. Access to HIV/STI testing among male and female migrants was 19.85% and 25.16%, respectively. Among male migrants, being LGBTI, health insured, and married or cohabiting were associated with increased access to HIV/STI testing. Among females, those aged 18-44 years, those who were married or cohabiting and were health insured, and those residing for more than 1 year in Peru were significantly more likely to have access to HIV/STI testing. Moreover, physical/mental disability and unemployed status were associated with a lower probability of HIV/STI testing in females. CONCLUSIONS: Only two in ten Venezuelan migrants and refugees in Peru were screened for HIV/STI, with fewer males than females. Sex-specific sociodemographic, health-related, and migration-related variables were independently associated with access to HIV/STI testing.

The impact of the COVID-19 pandemic on people living with HIV: a cross-sectional study in Caracas, Venezuela.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted multiple health services, including human immunodeficiency virus (HIV) testing, care, and treatment services, jeopardizing the achievement of the Joint United Nations Programme on HIV/AIDS 90-90-90 global target. While there are limited studies assessing the impact of the COVID-19 pandemic on people living with HIV (PLHIV) in Latin America, there are none, to our knowledge, in Venezuela. This study aims to assess the impact of the COVID-19 pandemic among PLHIV seen at the outpatient clinic of a reference hospital in Venezuela. METHODS: We conducted a cross-sectional study among PLHIV aged 18 years and over seen at the Infectious Diseases Department of the University Hospital of Caracas, Venezuela between March 2021 and February 2022. RESULTS: A total of 238 PLHIV were included in the study. The median age was 43 (IQR 31-55) years, and the majority were male (68.9%). Most patients (88.2%, n = 210) came for routine check-ups, while 28 (11.3%) were newly diagnosed. The majority of patients (96.1%) were on antiretroviral therapy (ART), but only 67.8% had a viral load test, with almost all (95.6%) being undetectable. Among those who attended regular appointments, 11.9% reported missing at least one medical consultation, and 3.3% reported an interruption in their ART refill. More than half of the patients (55.5%) had received at least one dose of the COVID-19 vaccine, while the rest expressed hesitancy to get vaccinated. Most patients with COVID-19 vaccine hesitancy were male (65.1%), younger than 44 years (57.5%), employed (47.2%), and had been diagnosed with HIV for less than one year (33%). However, no statistically significant differences were found between vaccinated patients and those with COVID-19 vaccine hesitancy. Older age was a risk factor for missing consultations, while not having an alcoholic habit was identified as a protective factor against missing consultations. CONCLUSION: This study found that the COVID-19 pandemic had a limited impact on adherence to medical consultations and interruptions in ART among PLHIV seen at the University Hospital of Caracas, Venezuela.

Forced displacement and the health workforce crisis: Venezuelan healthcare workers in Peru.

The migration of health workforces tends to be economically based benefiting high-income countries, while draining lower-income countries of workers and skills However, national instability or civil conflict may also have the effect of forcing out health workers. However, few articles focus on the experiences of these types of migrants. Peru has become the second largest Latin American destination for Venezuelan forced displaced migrants, a number of which are health workers. While the exact numbers of these workers is unknown, it is estimated that 4000 and 3000 doctors and about 2500 nurses and health technicians from Venezuela reside in Peru. These workers find entry into the heath system difficult due to bureaucratic and costly registration and qualification validation procedures. However, during Covid-19 these conditions were relaxed, and a large number of these heath workers entered the heath workforce. These workers were primarily doctors and worked in urban medical facilities, though there was some distribution across the country's departments. This avenue to the health workforce allowed the mobilisation of dormant health skills and lifted workforce density numbers. Nonetheless, it is too early to see if there have been sustainable improvements, and it remains uncertain how these policies have contributed to the country's UHC goals. Peru's experiences raise the issue of how to mobilise dormant displaced health worker migrants.

Pilgrimage for an autism diagnosis: A study of Venezuelan parents' experiences.

It cannot be assumed that the experience of having an autistic child is the same across countries since demographic and systemic factors are as diverse as the manifestation of ASD symptomatology. This study explores the lived experiences of 20 Venezuelan parents after receiving an autism diagnosis for their child. Applied thematic analysis was used to analyze parental attitudes, challenges in identifying their child's delay, access to diagnostic services, beliefs towards autism, professional evaluations, family support, and perceptions toward health and educational services for autistic children. Venezuelan parents reported a generalized lack of autism awareness, an unsupportive school system, and judgment from their extended family. Despite the universal health coverage in the country, Venezuelan parents commented on the scarcity of services, as well as the lengthy and costly processes to receive an ASD diagnosis. The results support previous research findings showing that socioeconomic factors influence how parents experience the process of obtaining an autism diagnosis for their children. For most Venezuelan parents, it might imply a long journey in which limited resources and knowledge about autism will determine its route and length. For parents, cultural values and spiritual and religious beliefs will serve as both coping mechanisms and barriers to accessing services.

Echinorhinus brucus (Bonnaterre, 1788) in the Caribbean Sea: A recurrent visitor, or are the artisanal fisheries exploiting deeper waters?

Documentation of Echinorhinus brucus, (Bonnaterre, 1788) in the western Atlantic primarily relies on chance observations. Georeferenced records in this area remain notably scarce. This study contributes the second Venezuelan and seventh Caribbean Sea specimens, increasing the western Atlantic count to 15 individuals. All specimens gathered here were sexually mature, with a slight dominance of females. Our bramble shark record appears to be driven more by the interplay of its biology and environmental factors than being a deliberate deep-sea fishery activity, which likely occurs in the Southern Caribbean area.

Parasitological and molecular characterization of Trypanosoma cruzi of triatomines and mammals from endemic areas for Chagas disease in Venezuela.

It is estimated that 6-7 million people worldwide are infected with Trypanosoma cruzi, the parasite that causes Chagas disease. In Venezuela, Chagas disease remains a public health problem. In this work, T. cruzi isolates from six species of triatomines and mammals of the orders Didelphimorphia and Xenarthra, captured in rural communities of Monagas, underwent parasitological and molecular characterization. A total of 471 triatomines and 17 mammals were captured, with a natural infection rate of 41.4% and 70.6%, respectively. In the male NMRI mouse model used for parasitological characterization (prepatent period, parasitemia curve, mouse mortality, and tissular parasitism), T. cruzi isolates exhibited high lethality due to their pronounced virulence, irrespective of the parasite load in each mouse, resulting in a mortality rate of 75%. Among the vector isolates, in the mouse model, only 2 out of 6 remained alive, while the rest perished during the evaluation. Conversely, the isolates from mammals proved fatal for all the inoculated mice. All isolates were identified as belonging to DTU TcI, based on the molecular markers such as the intergenic region of the miniexon, D7 divergent domain of the 24Sα rDNA, size-variable domain of the 18S rDNA, and hsp60-PCR-RFLP-EcoRV. This study demonstrates the presence of vectors and mammalian reservoirs naturally infected with T. cruzi in communities of Monagas, the 9th largest and 9th most populous state in Venezuela. This situation represents a neglected epidemiological problem demanding urgent attention and imperative health care intervention.

Precisión diagnóstica de la circunferencia de cuello para la predicción de sobrepeso y obesidad en estudiantes universitarios mexicanos / Diagnostic accuracy of neck circumference for the prediction of overweight and obesity in Mexican university students

Introducción. La circunferencia de cuello es una medida de fácil acceso y bajo costo, que podría ayudar a la identificación del sobrepeso u obesidad. Objetivo. Determinar la precisión diagnóstica de la circunferencia de cuello para la predicción de sobrepeso y obesidad en estudiantes universitarios mexicanos y analizar la correlación entre la circunferencia de cuello con otros indicadores antropométricos y la presión arterial como factor de riesgo cardiovascular. Materiales y métodos. Estudio transversal, analítico en 236 universitarios. Se realizaron mediciones antropométricas y presión arterial. Se realizaron análisis de las curvas ROC para obtener la sensibilidad y especificidad de los puntos de corte para la predicción de sobrepeso u obesidad y correlaciones de Pearson de circunferencia de cuello vs variables antropométricas. Resultados. Se observó, en hombres y mujeres, una correlación fuerte entre circunferencia de cuello y peso [r= 0,74 y r= 0,82 (p<0,01), respectivamente], seguida por IMC [r= 0,77 y r= 0,75 (p<0,01), respectivamente], circunferencia de cintura [r= 0,73 y r= 0,77 (p<0,01), respectivamente] e ICT [r= 0,71 y r= 0,73 (p<0,01), respectivamente]; se encontraron correlaciones moderadas para porcentaje de masa grasa y tensión arterial. La circunferencia de cuello vs circunferencia de cintura fue la mejor prueba de predicción para asociar el sobrepeso u obesidad tanto en hombres (AUC= 0,93; 89,3% sensibilidad y 82,3% especificidad) como mujeres (AUC= 0,95: 94,3% sensibilidad y 82,3% especificidad). Conclusiones. Los puntos de corte de la circunferencia de cuello presentan una adecuada capacidad para predecir el sobrepeso y obesidad en jóvenes adultos mexicanos(AU)

Introduction. Neck circumference is an easily accessible and low-cost measure, which could help in the identification of overweight or obesity. Objective. To determine the diagnostic accuracy of neck circumference for the prediction of overweight and obesity in Mexican university students and to analyze the correlation between neck circumference and other anthropometric indicators and blood pressure as a cardiovascular risk factor. Materials and methods. Cross-sectional, analytical study in 236 university students. Anthropometric and blood pressure measurements were taken. ROC curve analysis was performed to obtain the sensitivity and specificity of the cut-off points for the prediction of overweight or obesity and Pearson correlations of neck circumference vs anthropometric variables. Results. A strong correlation was observed, in men and women, between neck circumference and weight [r= 0.74 and r= 0.82 (p<0.01), respectively], followed by BMI [r= 0.77 and r= 0.75 (p<0.01), respectively], waist circumference [r= 0.73 and r= 0.77 (p<0.01), respectively] and ICT [r= 0.71 and r= 0.73 (p<0.01), respectively]; moderate correlations were found for percent fat mass and blood pressure. Neck circumference vs waist circumference was the best predictive test for associating overweight or obesity in both men (AUC= 0.93; 89.3% sensitivity and 82.3% specificity) and women (AUC= 0.95: 94.3% sensitivity and 82.3% specificity). Conclusions. Neck circumference cut-off points present adequate ability to predict overweight and obesity in Mexican young adults(AU)

Hábitos alimentarios asociados a la emergencia sanitaria Covid-19 en adultos chilenos / Eating habits associated with the Covid-19 health emergency in Chilean adults

Introducción. El brote de COVID-19 generó cambios significativos en los hábitos alimentarios asociados a las medidas de confinamiento y distanciamiento social. Objetivo. Evaluar los hábitos alimentarios asociados a la emergencia sanitaria COVID-19 en adultos chilenos durante el año 2020. Materiales y Métodos. Se realizó un estudio observacional, descriptivo y transversal en adultos chilenos seleccionados mediante muestreo no probabilístico por conveniencia. Se utilizó una encuesta validada por juicio de expertos, que incluyó preguntas sobre características sociodemográficas, ingesta habitual de alimentos y percepción de cambios de hábitos alimentarios durante el confinamiento. Resultados. Participaron 4.346 adultos chilenos con una edad promedio de 35,8 ± 13,9 años, predominantemente residentes urbanos (94,3%) y mujeres (75,1%). Se observó un aumento en el abastecimiento de alimentos en los hogares durante el confinamiento. La mayoría de los participantes manifestó que mantuvo o aumentó el consumo de verduras, frutas, lácteos, pescado y legumbres. Sin embargo, la ingesta de alimentos saludables no alcanzó las recomendaciones nutricionales establecidas. Adicionalmente, se encontró un aumento en el consumo de dulces. Conclusiones. Este estudio revela los efectos del confinamiento por la pandemia de COVID-19 en los hábitos alimentarios de los adultos chilenos, donde un porcentaje considerable de la población no cumplió con las recomendaciones de una dieta equilibrada según las guías alimentarias chilenas. El aumento en el consumo de algunos alimentos poco saludables puede tener implicaciones en la salud y el estado nutricional. Es necesario fomentar una alimentación equilibrada durante situaciones de crisis como esta pandemia(AU)

Introduction. The COVID-19 outbreak has led to significant changes in dietary habits due to confinement and social distancing measures. Objective. To assess the dietary habits associated with the COVID-19 health emergency among Chilean adults during the year 2020. Materials and methods. An observational, descriptive, and cross- sectional study was conducted on Chilean adults selected through non-probabilistic convenience sampling. A survey validated by expert judgment was used, including questions on sociodemographic characteristics, usual food intake, and perceived changes in dietary habits during confinement. Results. A total of 4,346 Chilean adults participated in the study, with an average age of 35.8 ± 13.9 years, predominantly urban residents (94.3%), and female (75.1%). An increase in household food supplies during confinement was observed. Most participants reported maintaining or increasing their consumption of vegetables, fruits, dairy, fish, and legumes. However, the intake of healthy foods did not meet the established nutritional recommendations. Additionally, there was an increase in the consumption of sweets. Conclusions. This study reveals the effects of COVID-19 confinement on the dietary habits of Chilean adults, where a considerable percentage of the population did not comply with the recommended balanced diet according to Chilean dietary guidelines. The increased consumption of some unhealthy foods may have implications for health and nutritional status. It is essential to promote balanced eating during crisis situations like this pandemic(AU)

Comparación entre la morbilidad y la mortalidad por COVID-19, asociada a factores de riesgo metabólicos en población no indígena e indígena de México / Comparison between morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico

Introducción. La investigación sobre la pandemia de COVID-19, se ha estudiado en tiempo real, ha sido y sigue siendo reveladora. Objetivo. Analizar la morbilidad y la mortalidad por COVID-19, asociadas a factores de riesgo metabólicos en población no indígena e indígena de México. Materiales y métodos. Utilizamos la Base Nacional de Datos COVID-19, durante los años críticos 2020-2021- 2022. Se trabajó con 5.380.247 casos que representaron la población total de positivos al SARS-CoV-2. Se analizaron las discrepancias entre las prevalencias de población no indígena, población indígena, defunción y no defunción. Se definió población indígena, con la clasificación oficial de auto-identificación. Se aplicó el modelo de regresión logística para determinar el riesgo de morir para cada variable: enfermedades cardiovasculares, hipertensión, diabetes, obesidad, sexo, edad y condición indígena. El análisis de multicolinealidad se analizó a través de la prueba de asociación Phi para variables dicotómicas y a través del ajuste de Nagelkerke. Resultados. En los positivos totales 99,2% fue población no indígena y 0,8% indígenas, mientras su porcentaje de letalidad fue de 5,8% y 11,1% respectivamente. En ambos grupos, murieron más hombres (61,5%) que mujeres (38,5%) y las edades de mayor defunción fueron 60 a 79 años. La mortalidad por enfermedades cardiovasculares fue la de mayor incidencia, 26,6% en población general y 32,3% en indígena; por diabetes 22,1% y 27,9%; hipertensión 20,0% y 26,7%y la obesidad 11, 3% y 17,4% respectivamente. Los análisis de regresión logística se ajustaron por sexo, edad y condición indígena. El condicionante de mayor riesgo de muerte, fueron las comorbilidades metabólicas y el de menor riesgo, la condición indígena. Conclusiones. El impacto de la pandemia por COVID-19 fue más grave cuando hubo padecimientos metabólicos tanto en la población no indígena como en la indígena(AU)

Introduction. Research on the COVID-19 pandemic, studied in real time, has been and continues to be revealing. Objective. To analyze morbidity and mortality from COVID-19, associated with metabolic risk factors in non-indigenous and indigenous populations of Mexico. Materials and methods. We use the National COVID-19 Database, during the critical years 2020-2021-2022. We worked with 5,380,247 cases that represented the total population of SARS-CoV-2 positives. The discrepancies between the prevalence of non-indigenous population, indigenous population, death and non-death were analyzed. The indigenous population was defined, with the official self-identification classification. The logistic regression model was applied to determine the risk of dying for each variable: cardiovascular diseases, hypertension, diabetes, obesity, sex, age and indigenous status. The multicollinearity analysis was analyzed through the Phi association test for dichotomous variables and through the Nagelkerke adjustment. Results. Of the total positives, 99.2% were non-indigenous people and 0.8% were indigenous, while their fatality percentage was 5.8% and 11.1% respectively. In both groups, more men (61.5%) than women (38.5%) died and the ages of greatest death were 60 to 79 years. Mortality from cardiovascular diseases was the one with the highest incidence, 26.6% in the general population and 32.3% in the indigenous population; due to diabetes 22.1% and 27.9%; hypertension 20.0% and 26.7% and obesity 11.3% and 17.4% respectively. Logistic regression analyzes were adjusted for sex, age, and indigenous status. The condition with the highest risk of death was metabolic comorbidities and the lowest risk was indigenous status. Conclusions. The impact of the COVID-19 pandemic was more serious when there were metabolic disorders in both the non-indigenous and indigenous populations(AU)

Un programa informático en la web para la evaluación dietética en Costa Rica / A web-based software for dietary assessment in Costa Rica

Introducción. La medición del consumo de alimentos es un importante indicador del estado nutricional de las personas; sin embargo, el proceso no es fácil y puede tener un nivel de error inaceptable. La incorporación de nuevas tecnologías pueden facilitar el proceso y minimizar el error. Objetivo. Desarrollar un programa informático en la web para nutricionistas que permita el ingreso de datos de consumo de alimentos con un recordatorio de 24 horas o de los 7 días anteriores, el análisis de la ingesta de energía y nutrientes y su comparación con las ingestas recomendadas; con el fin de minimizar el error en la recopilación y análisis de los datos. Materiales y métodos. Primero, se determinaron las características importantes que debe tener el programa, el cual fue elaborado posteriormente con los lenguajes de programación de Python y Javascript y con un patrón de diseño modelo-vista-controlador. Simultáneamente se crearon tres bases de datos, uno con el valor nutritivo de los alimentos, otro con datos de tamaños de porción de los mismos y otro con las recomendaciones nutricionales. Una vez elaborado, el programa fue sometido a una serie de pruebas para evaluar tanto su facilidad de uso como la exactitud de los cálculos. Resultados. Se describen las 9 etapas del programa y se justifica su diseño con evidencias de la literatura científica. Conclusiones. Se desarrolló el programa en la web, 'Dietnóstico', que permite la recolección y análisis de datos de consumo de alimentos. Una vez validado, el programa estará disponible para nutricionistas a usar en la atención nutricional y la investigación(AU)

Introduction. Assessment of food consumption is an important indicator of a person's nutritional status; however, it is not a simple process and can involve an unacceptable level of error. The application of new technologies in this process can lead to improvements and the minimization of error. Objective. To develop a computer program in the web, for nutritionists that allows the input of food consumption data using a 24- hour recall or a recall of food consumption during the 7 previous days, the analysis of energy and nutrient intake and its comparison with recommended intakes with the aim of minimizing the error involved in the collection and analysis of food consumption data. Materials and methods. The first stage was to define important characteristics to include in the programme which was developed using the programming languages of Python and Javascript and using a model-view-controller design pattern. At the same time, three databases were created: one with the nutritional value of foods, another with portion sizes of the foods and a third with the nutritional recommendations. Once created, several trials were conducted on the programme to test the operations from a user point of view, and the accuracy of the calculations. Results. The 9 stages of the software are described and its design is justified with evidence from the scientific literature. Conclusions. The program 'Dietnóstico' for use in the web, allows the collection and analysis of food consumption data. Once validated, it will be available for nutritionists involved in nutrition counselling and research(AU)

The Regulatory Status of Functional Foods in the Economic Integration Organizations of Latin America and the Caribbean / El Estatus Regulatorio de los Alimentos Funcionales en las Organizaciones de Integración Económica de Latinoamérica y el Caribe

Introduction. The legal declarations on functional foods of the four main economic integration organizations in Latin America and the Caribbean (LAC) ­ Pacific Alliance (PA), Caribbean Community (CARICOM), Southern Common Market (MERCOSUR) and Central American Integration System (SICA) - are based on the Codex Alimentarius system and do not regulate functional foods. The use of Codex in food marketing is an insufficient condition for its application in functional foods. Regulation based on scientific and technology results are required to be used in the economic integration organizations of LAC. Objective. The objective is to analyze the theoretical framework of the legal foundations that could govern the commercialization processes of functional foods, whose research advances have currently only been manifested in nutritional health. This article also seeks to address this gap through a systematic analysis of international regulations. Materials and methods. For this, a review of the literature emanating from two databases from 2018-2023 is carried by applying the legal-economic research method of documentary content analysis, applied to three general food marketing regulations: food safety declarations, regulations for inspections, food manufacturing and food labeling. Results. The results reveal the absence of specific legislation for functional foods in LAC economic integration organizations. Conclusions. The legal principle of marketing based on peremptory norm (also called jus cogens) can be facilitated through side letters, included in the contents of international contracts. along with the registration requirements of industrial property rights of the member countries associations(AU)

Introducción. Las declaraciones legales sobre alimentos funcionales de las cuatro principales organizaciones de integración económica de América Latina y el Caribe (ALC) ­ Alianza del Pacífico (AP), Comunidad del Caribe (CARICOM), Mercado Común del Sur (MERCOSUR) y Sistema de Integración Centroamericana (SICA) - se basan en el sistema del Codex Alimentarius y no regulan los alimentos funcionales. El uso del Codex en la comercialización de alimentos es condición insuficiente para su aplicación en alimentos funcionales. Se requiere que las regulaciones basadas en resultados científicos y tecnológicos sean utilizadas en los organismos de integración económica de ALC. Objetivo. Analizar el marco teórico de los fundamentos legales que podrían regir los procesos de comercialización de alimentos funcionales, cuyos avances en investigación actualmente solo se han manifestado en salud nutricional. Este artículo también busca abordar esta brecha a través de un análisis sistemático de las regulaciones internacionales. Materiales y métodos. Se realiza una revisión de la literatura emanada de dos bases de datos del período 2018-2023 aplicando el método de investigación jurídico- económica de análisis de contenido documental, aplicado a tres normas generales de comercialización de alimentos: declaraciones de seguridad alimentaria, normas para inspecciones, fabricación de alimentos y etiquetado de alimentos. Resultados. Los resultados revelan la ausencia de legislación específica para alimentos funcionales en las asociaciones comerciales de ALC. Conclusiones. El principio jurídico de comercialización basado en norma imperativa (también llamado jus cogens) puede facilitarse a través de cartas complementarias, incluidas en el contenido de los contratos internacionales. junto con los requisitos de registro de los derechos de propiedad industrial de las asociaciones de los países miembros(AU)

Bacterias resistentes a los antibióticos en alimentos de origen animal. Revisión sistemática / Antibiotic-resistant bacteria in foods of animal origin. Systematic review

Introducción. La problemática alrededor de la resistencia a los antibióticos se intensifica por la presencia de patógenos resistentes en alimentos de origen animal. Objetivo. Presentar el estado de la prevalencia de bacterias resistentes a antibióticos (BRA) y los principales genes de resistencia a antibióticos (GRAs) que se reportan en alimentos de origen animal y en animales destinados al consumo humano. Materiales y métodos. Se realizó una revisión sistemática basada en la guía PRISMA, empleando las bases de datos: Science Direct, Redalyc, Scopus, Hinari, Scielo, Dialnet, PLOS, ProQuest, Taylor, Lilacs y PubMed/ Medline con estudios originales realizados entre enero de 2017 y abril 2023. Resultados. Un total de 2620 estudios fueron identificados y 71 estudios cumplieron los criterios de inclusión. La carne de res, leche cruda/productos lácteos no pasteurizados y las heces de animales de granja fueron las muestras más estudiadas. Las BRAs más frecuentes fueron Escherichia coli productora de ß-lactamasas de espectro extendido (BLEE), Salmonella spp. resistente a múltiples fármacos (MDR) y Stahylococcus aureus resistente a meticilina (SARM). Los GRAs más reportados fueron bla, tet y sul mediados por plásmidos e integrones, principalmente. Conclusiones. En esta revisión sistemática se encontró, que los aislamientos de E. coli, Salmonella spp. y S. aureus son los que más frecuentemente presentaron resistencia a la tetraciclina ampicilina y el sulfametoxazol/ trimetoprima con el predominio de los genes bla, tet y sul, que están siendo diseminados por elementos genéticos móviles entre bacterias y a humanos a través de clones zoonóticos con una alta estabilidad en el tiempo(AU)

Introduction. The problem around antibiotic resistance is intensified by the presence of resistant pathogens in foods of animal origin. Objective. Present the state of the prevalence of antibiotic resistant bacteria (ARB) and the main antibiotic resistance genes (AGRs) that are reported in foods of animal origin and in animals intended for human consumption. Materials and methods. A systematic review was carried out based on the PRISMA guide, from the Science Direct, Redalyc, Scopus, Hinari, Scielo, Dialnet, PLOS, ProQuest, Taylor, Lilacs and PubMed/Medline databases with original studies carried out between January 2017 and April of 2023. Results. A total of 2620 studies were identified, and 71 studies met the inclusion criteria. Beef, raw milk/unpasteurized dairy products, and farm animal feces were the most studied samples. The most common resistant bacteria were extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli, Salmonella spp. multidrug resistant (MDR) and methicillin resistant Stahylococcus aureus (MRSA). The AGRs most reported were bla, tet and sul, mediated mainly through plasmids and integrons. Conclusions. In this systematic review it was found that the isolates of E. coli, Salmonella spp. and S. aureus are the ones that most frequently presented resistance to tetracycline ampicillin and sulfamethoxazole/ trimethoprim with a predominance of the bla, tet and sul genes, which are being disseminated by mobile genetic elements between bacteria and humans through zoonotic clones with high stability over time(AU)

Mortalidad Materna en Venezuela: aspectos médicos y Políticas (1940 - 2016) / Materna Mortality in Venezuela: medical issues and Public Policy (1940 - 2016)

En la actualidad Venezuela se encuentra en una crisis social y económica sin precedentes. La mortalidad materna(MM) es un indicador en salud importante, debido a que permite tener idea de la atención médica de un país; se mide a través de dos indicadores: Razón de Mortalidad Materna (RMM) y Tasa de Mortalidad Materna (TMM). Objetivo: Revisar y compararla evolución de ambos indicadores de MM desde la década de 1930 hasta la década 2000. Métodos: Se realizó una revisión de la literatura y de informes técnicos de organismos gubernamentales y no gubernamentales para el análisis de la situación previa y reciente de esta situación en Venezuela. Los resultados señalan que existe una notable disminución de las cifras de MM como ha de esperarse con el mejoramiento de la tecnología desde la década de 1930 hasta el año 2000; posteriormente ocurre un retroceso de la sanidad pública con cifras comparables a la década de 1960. Concluimos que la MM ha sido desde tiempos pasados un problema constante en la salud pública; al pasar los años y gobiernos, se han implementado numerosas políticas públicas para mejorar esta situación, muchas de estas estrategias han sido fallidas debido a la falta de su continuidad y de su cumplimiento pleno.

Venezuela is currently in an unprecedented socialand economic crisis. Maternal mortality is an important health indicator because it provides an idea of a country's medical care. Maternal mortality is usually measured through two indicators: Maternal Mortality Ratio (MMR) and Maternal Mortality Rate. Objective: Review and compare the evolution of both healthindicators from the 1930s to 2016. Methods: A review of the literature and technical reports from governmental andnon-governmental organizations was carried out to analyze theprevious and recent situation. of this situation in Venezuela. Theresults indicate that there is a notable decrease in the figures ofmaternal mortality, as should be expected with the improvementof technology from the 1930s to the year 2000. Subsequently, there is a decline in public health with figures comparable to the1960s. We conclude that maternal mortality has been a constant problem in public health since ancient times. Over the years and governments, numerous public policies have been implementedto improve this situation. Many of these strategies have beenfailed due to lack of continuity and in the absence of its full compliance.

Enfoque hacia el uso de energías alternativas en establecimientos de atención médica / Approach to the use of alternative energies in medical care facilities

Introducción: El tema del cambio climático y sus efectos, en la salud, educación y transporte, es un tema emergente, que pretende la optimización del consumo y la eficiencia energética. Esta investigación se plantea como objetivo,la caracterización del uso y aprovechamiento de energías, en establecimientos de atención médica de la región capital durante el año 2022, considerando la distribución energética, eficiencia y fuentes primarias de energía utilizadas en este país. Métodos: Se trata de una investigación descriptiva, transversal y prospectiva,a través del análisis cuali-cuantitativo, con el uso de informantes clave quienes consideran importante la iluminación natural en los espacios y el mayor aprovechamiento energético en áreas como la quirúrgica y consulta externa. Resultados: Surge el uso de la energía solar, eólica e hidráulica como recursos energéticos aprovechables, así como la sostenibilidad y la mantenibilidad en el diseño y rediseño de infraestructuras hospitalarias. Los tipos de energías utilizados en Venezuela, siguen correspondiendo ala hidráulica y combustibles fósiles, se conoce la tecnología e implementación de paneles solares para la mejoría del cambio climático, la huella del carbono, el uso de energías verdes y reducción de combustibles fósiles. Su aceptación depende de regulaciones y la concientización energética como elementos fundamentales para el cambio.

Introduction: The issue of climate change and itseffects, in health, education and transportation, is an emergingissue, which aims at the optimization of energy consumption andefficiency. e objective of this research is to characterize the useand exploitation of energy in health care facilities in the capitalregion during the year 2022, considering the energy distribution,efficiency and primary energy sources used in this country.Methods: This is a descriptive, cross-sectional and prospectiveresearch, through qualitative-quantitative analysis, with the useof key informants who consider important the natural lightingin the spaces and the greater use of energy in areas such assurgery and outpatient care. Results: The use of solar, windand hydraulic energy emerged as usable energy resources, aswell as sustainability and maintainability in the design andredesign of hospital infrastructures. The types of energy used inVenezuela continue to correspond to hydraulics and fossil fuels; the technology and implementation of solar panels is known forthe improvement of climate change, the carbon footprint, theuse of green energy and reduction of fossil fuels. Their acceptancedepends on regulations and energy awareness as fundamental elements for change.