COVID-19 in the US-affiliated Pacific Islands: A timeline of events and lessons learned from March 2020-November 2022.

The US-Affiliated Pacific Islands (USAPIs) experience many health disparities, including high rates of non-communicable disease and limited health resources, making them particularly vulnerable when SARS-CoV-2 began circulating globally in early 2020. Therefore, many USAPIs closed their borders early during the COVID-19 pandemic to give them more time to prepare for community transmission. Routine virtual meetings were established and maintained throughout the pandemic to support preparedness and response efforts and to share information among USAPIs and support partners. Data collected from these regular virtual meetings were gathered and disseminated through routine regional situational reports. These situational reports from March 27, 2020 to November 25, 2022 were reviewed to develop a quantitative dataset with qualitative notes that were used to summarize the COVID-19 response in the USAPIs. The initial surges of COVID-19 in the USAPIs ranged from August 2020 in Guam to August 2022 in the Federated States of Micronesia. This prolonged time between initial surges in the region was due to varying approaches regarding travel requirements, including fully closed borders, repatriation efforts requiring pre-travel quarantine and testing, quarantine requirements upon arrival only, and vaccine mandates. Delaying community transmission allowed USAPIs to establish testing capacity, immunize large proportions of their populations, and use novel COVID-19 therapeutics to reduce severe disease and mortality. Other essential components to support the USAPI regional COVID-19 response efforts included strong partnership and collaboration, regional information sharing and communication efforts, and trust in health leadership among community members. Valuable lessons learned from the USAPIs during the COVID-19 pandemic can be used to continue to strengthen systems within the region and better prepare for future public health emergencies.

The Importance of Partnership in the Rollout of Triple-Drug Therapy to Eliminate Lymphatic Filariasis in the Pacific.

We discuss the experience of some Pacific island countries in introducing the new WHO-recommended treatment protocol for lymphatic filariasis-a triple-drug therapy composed of ivermectin, diethylcarbamazine, and albendazole. The successful rollout of the new treatment protocol was dependent on strong partnerships among these countries' ministries of health, WHO, and other stakeholders. Effective communication among these partners allowed for lessons learned to cross borders and have a positive impact on the experiences of other countries. We also describe various challenges confronted during this process and the ways these countries overcame them.

'Hybrid Survey' approach to non-communicable disease surveillance in the US-Affiliated Pacific Islands.

In 2010 the US-Affiliated Pacific Islands (USAPI) declared a regional state of health emergency due to the epidemic of non-communicable disease (NCD) and an NCD monitoring and surveillance framework was developed that includes adult NCD risk factor and disease prevalence indicators to be collected every 5 years using a population-based survey. On evaluation of existing data from adult population-based NCD surveys, it was found that there was a lack of valid, available and consistently collected data. Therefore, a new model was developed to combine various indicators and survey tools from different partner agencies into one survey. After the report was endorsed by local health leadership, a dissemination workshop was conducted. In 2015 (baseline for Hybrid Survey implementation), three out of nine jurisdictions (33.3%) had completed a population-based survey in the past 5 years. Four (44.4%) had no adult prevalence data at all, two (22.2%) had data sets from their surveys and four (44.4%) had at least two surveys ever collected that could be used for comparison. As of 2020, all nine jurisdictions have, or are in the process of completing an adult population-based survey. Eight (88.9%) have data sets from their surveys, and five (55.6%) have at least two surveys collected that can be used for comparison. This Hybrid Survey model has helped to improve adult NCD surveillance in the USAPI by more efficiently using limited resources. This model could be considered in other small island nations, or rural areas where adult NCD surveillance is challenging.

The prevalence of overweight and obesity in children at a Health Maintenance Organization in Hawai'i.

In the past 20-30 years, the number of overweight children in the United States has doubled.1 Overweight children are acquiring conditions such as hypertension, type II diabetes, hypercholesterolemia, sleep apnea, and orthopedic problems. The purpose of this study was to explore the prevalence of and factors associated with at risk and overweight in children 2-10 years of age in a Health Maintenance Organization (HMO) in Hawai'i. This quantitative, retrospective cross-sectional study included a stratified random sample of 554 children ages 2-10 years who received a well child health care exam at a HMO in 2003. The prevalence of at risk and overweight were examined including the relationship between ethnicity, socioeconomic status, place of residence, and a child being overweight. Thirteen percent were at risk for overweight (BMI 85-95%) and 19% (BMI >95%) were overweight. In the 6-10 year age group, 42 % were overweight or at risk for being overweight. Boys had a higher incidence of being overweight (54%) than the girls (46%). Pacific Islanders had the highest incidence of overweight (40%), followed by the Hawaiian/Part Hawaiians (19%) and Filipinos (19%). Ethnicity and place of residence were significantly associated with being at risk or overweight. Pacific Islanders were 4 times more likely to be overweight/at risk for overweight and those residing in the West O'ahu, Honolulu, and Central O'ahu/North Shore areas were 2-3 times more likely to be at risk for overweight when compared to children living in the Windward side. With increased age, the prevalence of overweight increased. Findings suggest that targeted obesity prevention strategies need to be initiated early in life and geared for ethnically and geographically diverse children and their families.

Prevalencia, tipos de violencia y repercusiones de la misma en adolescentes que acudieron a la Defensoría de la Niñez y Adolescencia (Comuna Adela Zamudio, gestión 2007) / Prevalence rates of violence and the impact of adolescents who attended the Defense of Children and Adolescents (Commune Adela Zamudio, management 2007)

Los adolescentes que viven en violencia podrían correr el riesgo de experimentar problemas en su desarrollo físico, psicológico y social, hecho que puede repercutir en sus vidas debido a la frecuencia con que ocurre. Esta realidad se ha convertido en un problema de salud pública muy alarmante ya que incluso puede incidir en la mortalidad del adolescente.El objetivo planteado para el trabajo de investigación realizado es aportar conocimiento acerca de la salud mental en adolescentes que viven en violencia que acudieron a la Defensoría de la Niñez y la Adolescencia û Comuna Adela Zamudio durante la gestión 2007; con el fin de identificar las repercusiones psicológicas en el adolescente. Así mismo, describir las causas que llevan a la violencia y los tipos de violencia más frecuentes.La investigación se realizó con un enfoque cuantitativo para medir la prevalencia, identificar el tipo de violencia más frecuente. La población en estudio fue de 692 adolescentes que presentaron denuncia por violencia. También se recurrió al enfoque cualitativo para investigar las repercusiones psicológicas de la violencia, que prioriza la visión de adolescentes que viven en violencia y busca la información con detalle y en profundidad.Las principales conclusiones fueron las siguientes: los tipos de violencia más frecuentes que sufren los adolescentes son la violencia física y la violencia psicológica, ya que este tipo de violencia es la que deja mayores consecuencias negativas en el desarrollo emocional, social e intelectual del y la adolescente. Las repercusiones psicológicas de la violencia en adolescentes determina un sentimiento de miedo hacia su agresor y la sociedad, muchos de éstos adolescentes toman decisiones que pueden llevar a consecuencias desfavorables para su salud física y psicológica, inclusive poniendo su vida en riesgo.

Incidencia de Amenaza de Parto Pretérmino en el Hospital de Quillacollo, durante los meses de Marzo, Abril y Mayo de la gestión 2009 (Hospital de Quillacollo - Villa Moderna) / Incidence of preterm labor in Quillacollo Hospital during the months of March, April and May 2009 management (Quillacollo Hospital - Villa Moderna)

Durante los meses mencionados asistieron 268 pacientes con complicaciones durante el embarazo de los cuales el 69,9% corresponde a hemorragias de la primera mitad, un 5,2% eclampsia û preeclampsia. Las complicaciones de la segunda mitad del embarazo: Placenta previa con 7,4%, desprendimiento de placenta y otros con 3,7%. Pacientes con Amenaza de Parto Pretérmino en un porcentaje de 10,8 representando a 29 pacientes; es la población que se estudió con mayor detalle.De un total de 29 pacientes registradas con Amenaza de Parto Pretérmino en el hospital de Quillacollo, en el gráfico # 2 se observa que el mes de marzo hubo una incidencia de 13,7% y el mes de mayo 51,6%, estos porcentajes muestran que fue aumentando gradualmente la incidencia. Estas pacientes asistieron al hospital de Quillacollo por diferentes circunstancias como ser referidas de los diferentes centros de salud que pertenecen a la Red de Quillacollo y algunas por presentar sintomatología de Amenaza de Parto Pretérmino.Se puede observar que el porcentaje mayor de la población de mujeres que asistieron al servicio de dilatantes corresponde al grupo de 21 a 25 años de edad con 34,4%, con un porcentaje de 6,8% las mujeres de 31 a 35 años.

Conforme va avanzando la edad va disminuyendo el porcentaje de Amenaza de Parto Pretérmino. La mayor incidencia de Amenaza de Parto Pretérmino ocurre en primigestas con un porcentaje de 41,3% y en mujeres con 4º gestas con 13,7%. Estos datos coinciden con las causas, que la mayoría de las mujeres padecen de infección del tracto urinario, ya que durante la gestación la mujer es más suceptible a contraer las mismas por diferentes causas.Se observa que el 58,6% de mujeres con Amenaza de Parto Pretérmino realizaron de 1 a 3 controles prenatales y algunas pacientes realizaron 7 a 8 controles prenatales en un porcentaje de 13,7%. Tomando en cuenta que toda mujer durante su gestación (nueve meses) debe realizar cuatro controles prenatales, más aun si es un embarazo de alto riesgo. Se observó que el 62% de mujeres con Amenaza de Parto Pretérmino se presenta durante las 31 a 37 semansa gestacionales, en pacientes con 22 a 25 semanas gestacionales un 17,2%. En muchos de estos casos se logra evitar el parto pretérmino con las medidas de prevención que se realiza en el hospital de Quillacollo.La causa principal para la Amenaza de Parto Pretérmino es la infección del tracto urinario alta con un porcentaje de 34,4%, seguida de infecciones del tracto urinario baja con un 24,1%, en muchas ocasiones con dos causas como ser ruptura prematura de membranas y oligohidramnios con 20,6%; en un porcentaje de 10,3% pacientes con ruptura prematura de membranas, de igual forma con polihidramnios. Como ya se mencionó anteriormente la causa con mayor porcentaje son las infecciones del tracto urinario durante el embarazo, lo cual nos concientiza para educar a la población sobre los cuidados durante el embarazo y cuan importantes son los controles prenatales.

Se observa que las pacientes internadas con Amenaza de Parto Pretérmino en el servicio de obstetricia del hospital de Quillacollo se quedaron entre 1 a 3 dias en un porcentaje de 68,9% y un 10,3% por 6 días o más; la mayoría de éstas dejaron el servicio por alta médica y algunas referidas a tercer nivel. Durante su permanencia en el hospital de las mantuvo en reposo absoluto, con úteroinhibición, maduración fetal, monitoreando constantemente la frecuencia cardiaca materna y fetal, la dinámica uterina y el sangrado transvaginal.