Ciber violencia contra la pareja en universitarios de España y Latinoamérica / Cyber violence against the couple in university students in Spain and Latin America

El objetivo de la investigación fue estudiar la presencia de ciber violencia contra la pareja en estudiantes universitarios de España y Latinoamérica, así como como analizar su relación con los mitos románticos y el sexismo ambivalente. La investigación tiene un diseño transversal. La muestra estaba formada por 2.798 estudiantes de siete países hispanohablantes: España, El Salvador, Nicaragua, Colombia, Chile, Argentina y México. Los resultados muestran pocas diferencias de medias entre hombres y mujeres; sin embargo, las diferencias entre países son considerables, sobre todo en la perpetración de agresiones directas y control. Las distintas formas de ciber violencia contra la pareja tienden a correlacionar, en una dirección positiva, con las actitudes sexistas y las creencias distorsionadas sobre el amor romántico. En conclusión, los programas de prevención deberían tener en cuenta las nuevas manifestaciones de la violencia que están apareciendo en los espacios virtuales.(AU)

The objective of the research was to study the presence of cyber violenceagainst partners in university students in Spain and Latin America, as well as toanalyze its relationship with romantic myths and ambivalent sexism. The researchhas a cross-sectional design. The sample was made up of 2,798 students fromseven Spanish-speaking countries: Spain, El Salvador, Nicaragua, Colombia, Chile,Argentina, and Mexico. The results show few differences in means between menand women; However, the differences between countries are considerable,especially in the perpetration of direct attacks and control. The different forms ofcyber violence against a partner tend to correlate, in a positive direction, with sexistattitudes and distorted beliefs about romantic love. In conclusion, preventionprograms should take into account the new manifestations of violence that areappearing in virtual spaces.(AU)

Longitudinal analysis of post-acute chikungunya-associated arthralgia in children and adults: A prospective cohort study in Managua, Nicaragua (2014-2018).

Chikungunya can result in debilitating arthralgia, often presenting as acute, self-limited pain, but occasionally manifesting chronically. Little is known about differences in chikungunya-associated arthralgia comparing children to adults over time. To characterize long-term chikungunya-associated arthralgia, we recruited 770 patients (105 0-4 years old [y/o], 200 5-9 y/o, 307 10-15 y/o, and 158 16+ y/o) with symptomatic chikungunya virus infections in Managua, Nicaragua, during two consecutive chikungunya epidemics (2014-2015). Participants were assessed at ~15 days and 1, 3, 6, 12, and 18 months post-fever onset. Following clinical guidelines, we defined participants by their last reported instance of arthralgia as acute (≤10 days post-fever onset), interim (>10 and <90 days), or chronic (≥90 days) cases. We observed a high prevalence of arthralgia (80-95%) across all ages over the study period. Overall, the odds of acute arthralgia increased in an age-dependent manner, with the lowest odds of arthralgia in the 0-4 y/o group (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.14-0.51) and the highest odds of arthralgia in the 16+ y/o participants (OR: 4.91, 95% CI: 1.42-30.95) relative to 10-15 y/o participants. Females had higher odds of acute arthralgia than males (OR: 1.63, 95% CI: 1.01-2.65) across all ages. We found that 23-36% of pediatric and 53% of adult participants reported an instance of post-acute arthralgia. Children exhibited the highest prevalence of post-acute polyarthralgia in their legs, followed by the hands and torso - a pattern not seen among adult participants. Further, we observed pediatric chikungunya presenting in two distinct phases: the acute phase and the subsequent interim/chronic phases. Thus, differences in the presentation of arthralgia were observed across age, sex, and disease phase in this longitudinal chikungunya cohort. Our results elucidate the long-term burden of chikungunya-associated arthralgia among pediatric and adult populations.

Impact of heat and a rest-shade-hydration intervention program on productivity of piece-paid industrial agricultural workers at risk of chronic kidney disease of nontraditional origin.

OBJECTIVES: Assess the impact of environmental heat and a rest-shade-hydration (RSH) intervention against heat stress on productivity of piece-paid Mesoamerican sugarcane cutters. These workers are at a high risk of chronic kidney disease of non-traditional origin (CKDnt), from the severe heat stress they experience due to heavy work under hot conditions. RSH interventions in these populations improve kidney health outcomes, but their impact on productivity has yet to be examined. METHODS: We accessed routine productivity data from seed (SC, N = 749) and burned (BCC, N = 535) sugarcane cutters observed over five harvest seasons with increasing RSH intervention at a large Nicaraguan sugarcane mill. Hourly field-site wet-bulb globe temperature (WBGT) was recorded by mill staff and summarized as a daily mean. Mixed linear regression was used to model daily productivity, adjusting for age (18-29, 30-44, and >45 years), sex, WBGT (<28, 28-29, 29-30, 30-31, and >31 °C) on the same and preceding day, harvest season (2017-18 to 2021-22), month, and acclimatization status (<1, 1-2, and >2 weeks). RESULTS: There was an inverse dose-response relationship between SC productivity and WBGT on the same and preceding days, decreasing by approximately 3%/°C WBGT. Productivity increased during the study period, i.e. coinciding with RSH scale-up, by approximately 19% in SC and 9% in BCC. CONCLUSION: Agricultural worker productivity was expected lower on hotter days, strengthening the interest in all stakeholders to mitigate increasing global temperatures and their impact. Despite decreasing the total time allocated for work each day, an RSH intervention appears to result in increased productivity and no apparent loss in productivity.

Analysis of recent land management initiatives in Nicaragua from the perspective of the "ecosystem approach".

In the world there are approximately 608 million farms, of which 84% are small farms and produce 35% of the food of the world population. Training programs have been promoted by different organizations to achieve a more sustainable and efficient agricultural practice. Within this context, this article has classified a set of smallholders located in central Nicaragua with regard to how they apply Land Use Management Initiatives (LUMI). The aim is to outline their weaknesses and strengths and thus identify key elements that can contribute to improving soil resource management. We focus on the LUMI carried out in Nicaragua in the municipalities of El Tuma-La Dalia, El Cuá and Waslala between 1992 and 2022. To conduct this study, eight LUMI were identified and analysed, and 25 indicators linked to the Malawi Principles were extracted and selected for the design of a survey in order to collect land use management information from 455 farms in the study area. Simple random sampling was used to select the farms. Subsequently, the collected data were analysed using descriptive statistics and Multivariate Analysis techniques. The results reveal that in the study area, the LUMI incorporate between one and five Malawi Principles. The multivariate analysis techniques employed identified three clusters of farms, with either Active, Moderate or Improvable ecosystem management. The study area as a whole displays strengths in social participation, local capacity building, soil and environmental conservation practices, with the farm as the main source of income. Weaknesses lie in the fact that indicators referring to household income and productivity are less frequent. In terms of farm management, the results revealed that combined male and female management was similar in percentage to male-only management. The results highlight the need to continue with the implementation of environmental goals linked to the design of initiatives that promote productivity, income and gender equity in farm management in an integrated manner. At the same time, existing local capacities for sustainable soil and ecosystem management should be brought together and strengthened.

Transmission Patterns of Norovirus From Infected Children to Household Members in León, Nicaragua.

Norovirus is a common and highly transmissible gastrointestinal pathogen. Among 34 Nicaraguan households with a norovirus-infected child, 48% experienced norovirus transmission within 1 week, infecting 18% of household members; GII norovirus was more commonly transmitted than GI. Pediatric norovirus vaccines could prevent both index cases and transmission to close contacts.

Moral reasoning about gang violence in context: A comparative study with children and adolescents exposed to maras in Honduras and not exposed in Nicaragua.

This study examined how youth morally deliberate about conditions of gang violence shaping their communities. Participants (N = 80; 10-11 and 14-15 years; 50% female) exposed to gangs (maras) in Honduras and not exposed to maras in Nicaragua evaluated hypothetical situations of physical harm in contexts of chronic gang violence. Results indicated that mara-exposed youth were more likely to endorse harming a rival gang member in some contexts, but not others. Moreover, in some contexts, males were more likely to endorse harming others as necessary. Few age differences emerged, suggesting comparability among children and adolescents. Discussion focuses on how children and adolescents coordinate different moral and social concepts and concerns pertaining to acts of physical harm in situations involving gangs.

Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study.

BACKGROUND: Psychosocial and physical trauma are known risk factors for irritable bowel syndrome (IBS), including in war veterans, whereas war exposure in civilians is unclear. Nicaragua experienced two wars, 1970-1990: The Sandinistas Revolution (1970s) and The Contra War (1980s). Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system (11000 households). AIM: To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua. METHODS: We conducted a nested population-based, cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria. 1617 adults were randomly selected. The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua. War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects. Multiple exposures were defined by ≥ 3 measures. RESULTS: The prevalence of IBS was 15.2% [Female (F) 17.1%, Male (M) 12.0%], war exposure 19.3% (F 9.3%, M 36.7%), and post-traumatic stress disorder (PTSD) 5.6% (F 6.4%, M 4.3%). Significant associations with IBS in the civilian population were observed (adjusted by gender, age, socioeconomic status, education): physical and psychological abuse [adjusted odds ratio (aOR): 2.25; 95% confidence interval: 1.1-4.5], witnessed execution (aOR: 2.4; 1.1-5.2), family member death (aOR: 2.2; 1.2-4.2), and multiple exposures (aOR: 2.7; 1.4-5.1). PTSD was independently associated with IBS (aOR: 2.6; 1.2-5.7). CONCLUSION: An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS. Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.

Kidney disease characteristics, prevalence, and risk factors in León, Nicaragua: a population-based study.

BACKGROUND: CKD of unknown etiology (CKDu) disproportionately affects young people in Central America who lack traditional CKD risk factors (diabetes and hypertension) and has instead been variably linked to heat stress, occupational and environmental exposures, nephrotoxic medications, and/or genetic susceptibility. This study aimed to estimate the prevalence of CKD and identify risk factors for traditional CKD and CKDu in Nicaragua. METHODS: Surveys and assessment for CKD markers in urine and serum were performed in 15-59 year olds in households of the León municipality of Nicaragua. The survey included questions on demographics, health behaviors, occupation, and medical history. Participants with CKD were subdivided into traditional CKD and suspected CKDu based on history of diabetes, hypertension, or other specified conditions. A multinomial logistic regression model was used to identify factors associated with traditional CKD and suspected CKDu, compared to the non-CKD reference group. RESULTS: In 1795 study participants, CKD prevalence was 8.6%. Prevalence in males was twofold higher than females (12% vs 6%). Of those with CKD, 35% had suspected CKDu. Both traditional CKD and CKDu were associated with male sex and increasing age. Traditional CKD was associated with a family history of CKD, history of urinary tract infections, and lower socioeconomic status, while CKDu was associated with drinking well water and a lower body mass index. CONCLUSIONS: Both traditional CKD and CKDu are significant burdens in this region. Our study supports previous hypotheses of CKDu etiology and emphasizes the importance of CKD screening.

Developing the agroecological niche in Nicaragua: The roles of knowledge flows and intermediaries.

Supporting transitions to sustainable, resilient agri-food systems is important to ensure stable food supply in the face of growing climate extremes. Agroecology, or diversified farming systems based on ecological principles, can contribute to such systems. Based on a qualitative case study of Nicaragua, a forerunner in agroecology, this paper unpacks an ongoing transition to agroecology, focusing on how the transition has been shaped by knowledge flows and intermediary actors. Using a niche development framework based on knowledge processes, we analyze the growth of the agroecological niche in Nicaragua over three phases of niche development. The findings show how knowledge processes' emphases have shifted over time, as have functions enacted by intermediaries. Dedicated, diversified intermediaries have been key in creating momentum for agroecology, as have individual actors moving between niche and regime. Agency in niche development has come from both niche and regime actors. Finally, we find that Nicaragua's transition to agroecology has been ambiguous: While the niche has succeeded in changing the mainstream selection environment to its favor in some arenas, transition dynamics lag in others. Drawing lessons from this ambiguity, we suggest entry points for broader systems change, such as market stimulation, value chain development, phase-out policies, and supportive policy in related arenas. We also point out possible actions for niche actors such as integration of financial and commercial actors into niches and creation of dedicated market-focused intermediaries. Our results provide evidence of an ongoing transition and action points for supporting niche development in (sustainable agri-food) transitions around the globe.

Migratory destinations and spatial structuring of humpback whales (Megaptera novaeangliae) wintering off Nicaragua.

Understanding the migratory patterns of large whales is of conservation importance, especially in identifying threats to specific populations. Migration ecology, including migratory destinations, movements and site fidelity for humpback whales (Megaptera novaeangliae) remain poorly studied in parts of the range of the Central America population, considered endangered under the United States Endangered Species Act. This study aimed to investigate the migratory destinations of humpback whales sighted at two study sites in Nicaragua, which are part of the Central America population. A ten-year photographic database of humpback whales observed off Nicaragua was combined with citizen science contributions and sightings from dedicated research programs. The resulting image collection was compared with available historical photo identifications and databases using an automated image recognition algorithm. This approach yielded 36 years of photographic identification totaling 431 recaptures in Nicaragua (2006-2008 and 2016-2021) and 2539 recaptures (1986-2020) in both feeding and breeding grounds of 176 unique individuals sighted in Nicaragua. Our results showed that photo-identified whales were recaptured between October and April in breeding grounds and year-round in feeding grounds between British Columbia and California, with peak recaptures between June and October. Our study provided first-time evidence on fine-scale site affinity of individual humpback whales within Nicaraguan waters and to other breeding and feeding grounds.

Household environment and animal fecal contamination are critical modifiers of the gut microbiome and resistome in young children from rural Nicaragua.

BACKGROUND: Early life plays a vital role in the development of the gut microbiome and subsequent health. While many factors that shape the gut microbiome have been described, including delivery mode, breastfeeding, and antibiotic use, the role of household environments is still unclear. Furthermore, the development of the gut antimicrobial resistome and its role in health and disease is not well characterized, particularly in settings with water insecurity and less sanitation infrastructure. RESULTS: This study investigated the gut microbiome and resistome of infants and young children (ages 4 days-6 years) in rural Nicaragua using Oxford Nanopore Technology's MinION long-read sequencing. Differences in gut microbiome diversity and antibiotic resistance gene (ARG) abundance were examined for associations with host factors (age, sex, height for age z-score, weight for height z-score, delivery mode, breastfeeding habits) and household environmental factors (animals inside the home, coliforms in drinking water, enteric pathogens in household floors, fecal microbial source tracking markers in household floors). We identified anticipated associations of higher gut microbiome diversity with participant age and vaginal delivery. However, novel to this study were the significant, positive associations between ruminant and dog fecal contamination of household floors and gut microbiome diversity. We also identified greater abundance of potential pathogens in the gut microbiomes of participants with higher fecal contamination on their household floors. Path analysis revealed that water quality and household floor contamination independently and significantly influenced gut microbiome diversity when controlling for age. These gut microbiome contained diverse resistome, dominated by multidrug, tetracycline, macrolide/lincosamide/streptogramin, and beta-lactam resistance. We found that the abundance of ARGs in the gut decreased with age. The bacterial hosts of ARGs were mainly from the family Enterobacteriaceae, particularly Escherichia coli. CONCLUSIONS: This study identified the role of household environmental contamination in the developing gut microbiome and resistome of young children and infants with a One Health perspective. We found significant relationships between host age, gut microbiome diversity, and the resistome. Understanding the impact of the household environment on the development of the resistome and microbiome in early life is essential to optimize the relationship between environmental exposure and human health. Video Abstract.

Phylodynamics of dengue virus 2 in Nicaragua leading up to the 2019 epidemic reveals a role for lineage turnover.

BACKGROUND: Dengue is a mosquito-borne viral disease posing a significant threat to public health. Dengue virus (DENV) evolution is often characterized by lineage turnover, which, along with ecological and immunological factors, has been linked to changes in dengue phenotype affecting epidemic dynamics. Utilizing epidemiologic and virologic data from long-term population-based studies (the Nicaraguan Pediatric Dengue Cohort Study and Nicaraguan Dengue Hospital-based Study), we describe a lineage turnover of DENV serotype 2 (DENV-2) prior to a large dengue epidemic in 2019. Prior to this epidemic, Nicaragua had experienced relatively low levels of DENV transmission from 2014 to 2019, a period dominated by chikungunya in 2014/15 and Zika in 2016. RESULTS: Our phylogenetic analyses confirmed that all Nicaraguan DENV-2 isolates from 2018 to 2019 formed their own clade within the Nicaraguan lineage of the Asian/American genotype. The emergence of the new DENV-2 lineage reflects a replacement of the formerly dominant clade presiding from 2005 to 2009, a lineage turnover marked by several shared derived amino acid substitutions throughout the genome. To elucidate evolutionary drivers of lineage turnover, we performed selection pressure analysis and reconstructed the demographic history of DENV-2. We found evidence of adaptive evolution by natural selection at the codon level as well as in branch formation. CONCLUSIONS: The timing of its emergence, along with a statistical signal of adaptive evolution and distinctive amino acid substitutions, the latest in the NS5 gene, suggest that this lineage may have increased fitness relative to the prior dominant DENV-2 strains. This may have contributed to the intensity of the 2019 DENV-2 epidemic, in addition to previously identified immunological factors associated with pre-existing Zika virus immunity.

Perfil de carga de enfermedad por diabetes 2023: Nicaragua

El propósito fundamental de esta serie de perfiles nacionales de la carga de enfermedad por diabetes y de enfermedad renal crónica debida a diabetes es apoyar a los países de la Región de las Américas en el seguimiento de las estrategias puestas en marcha para enfrentar la diabetes. Esta primera versión de los perfiles, que abarca el período comprendido entre el 2000 y el 2019, muestra la tendencia de la mortalidad, los años de vida perdidos por muerte prematura, los años vividos con discapacidad y los años de vida ajustados por discapacidad de ambas enfermedad. Se han elaborado con los últimos datos disponibles de las estimaciones mundiales de salud de la Organización Mundial de la Salud y tiene como objetivo convertirse en una herramienta útil para llevar a cabo el monitoreo de las estrategias conexas.

Effectiveness of Home Gardening in Improving Food Security and Health in Chacraseca, Nicaragua: A Pilot Study.

We studied the usefulness of home gardening in improving food security and health. One hundred participants were randomized into the control and intervention group of which the intervention group received training in home gardening. Results showed that the percentage of participants with normal body mass index decreased from 24.4% to 20% in the control group whereas it remained unchanged in the intervention group. The number of participants in the very low food security category decreased from 66% (n=33) to 54% (n=27) in the intervention group whereas it increased from 68.8% (n=33) to 70.8% (n=34) in the control group. Results from the present study may be used to guide policymakers in designing or modifying home gardening interventions.

Prevalencia del segundo conducto en dientes anteroinferiores usando Tomografía Computadorizada Cone Beam / Second root canal prevalence in lower anterior teeth using Cone Beam Computed Tomography

Introducción: Es un error común pensar que los dientes anteroinferiores, por lo general, tienen un solo conducto radicular con una sola raíz. Sin embargo, un estudio realizado por Vertucci et. al., (1974), mostraron una alta prevalencia (13%) de dos conductos radiculares en los dientes anteroinferiores, lo que estimuló más investigaciones. Objetivo: El propósito de este estudio fue determinar la prevalencia del segundo conducto radicular en los dientes anteroinferiores en una población nicaragüense, estos fueron detectados por medio de tomografía computadorizada (Cone Beam). Materiales y Métodos: En el estudio se analizaron 293 piezas dentales, de canino a canino de la arcada inferior. Para realizar el análisis se utilizó el software libre Radiant DICOM Viewer 2021.2.2, se realizaron cortes sagitales, axiales y coronales para ver la prevalencia del segundo conducto radicular. Resultados: De las 293 piezas dentarias analizadas se encontró que 259 presentaban un solo conducto que correspondía al 88.4% y 34 dientes presentaban dos conductos que correspondían al 11.6%. De acuerdo con el análisis tomográfico, se encontró que en los cortes axiales y sagitales fue donde se observó la presencia del segundo conducto. Con respecto a la presencia del segundo conducto de acuerdo al tercio del canal radicular se identificó que la mayoría se presentó en el tercio medio (52.94%), seguido por coronal (29.41%) y por último el tercio apical (17.65%). De acuerdo con la clasificación de Vertucci se encontró que se presenta un mayor porcentaje del tipo I con 88.40%, seguido por el tipo III con 4.44%, después el tipo V con 3.41%, y el tipo II con 2.39%. El de menor porcentaje fue el tipo VI con 1.37%, mientras que, en las piezas analizadas, no se encontraron los tipos IV, VII y VIII. Conclusión: Basados en los resultados obtenidos en este estudio, la prevalencia de un segundo conducto en dientes anteroinferiores fue de 11.6%.

Title The prevalence of a second root canal in mandibular anterior teeth using Cone Beam Computed Tomography. Abstract Introduction: It is a common misconception that the mandibular anterior teeth usually have a single root canal with a single root. However, a study by Vertucci et. al., (1974), showed a high prevalence (13%) of two root canals in the lower anterior teeth, which stimulated further investigations. Objective: The purpose of this study was to determine the prevalence of the second root canal in the mandibular anterior teeth in a Nicaraguan population, these were detected by means of computed tomography (Cone Beam). Materials and methods: In the study, 293 teeth were analyzed, from canine to canine of the mandibular teeth. To perform the analysis, the free software Radiant DICOM Viewer 2021.2.2 was used, sagittal, axial and coronal views were made to see the prevalence of the second root canal. Results: Of the 293 teeth analyzed, it was found that 259 had a single root canal corresponding to 88.4%, and 34 teeth had two root canals corresponding to 11.6%. According to the tomographic analysis, it was found that the presence of the second root canal was observed only in the axial and sagittal views. Regarding the presence of the second canal according to the third of the root canal, it was identified that the majority presented in the middle third (52.94%), followed by coronal (29.41%) and finally the apical third (17.65%). According to the Vertucci classification, it was found that there is a higher percentage of type I with 88.40%, followed by type III with 4.44%, then type V with 3.41%, and type II with 2.39%. The one with the lowest percentage was type VI with 1.37%, while in the pieces analyzed, types IV, VII and VIII were not found. Conclusion: Based on the results obtained in this study, the prevalence of a second root canal in lower anterior teeth was 11.6%.

By youth for youth: Empowering youth experiencing homelessness in Managua, Nicaragua.

There is a dearth of effective, evidence-based programming to support youth experiencing homelessness, particularly in low- and middle-income countries where the majority of these young people live. Programs focused on youth engagement and leadership appear to be promising means to effectively engage and promote positive outcomes in this population. By Youth for Youth (BYFY) is a peer-led youth leadership framework developed to promote youth engagement, empowerment, and skill development. To date, BYFY has been successfully implemented with promising process and outcome indicators for youth experiencing homelessness, both in Toronto and with Indigenous youth in Thunder Bay. In this article, we present the application of BYFY with 30 street-involved youth in Managua, Nicaragua. We highlight the key implementation factors leading to BYFY's success in Nicaragua as perceived by facilitators from the implementing organization, Covenant House International, and youth leaders. Using a General Inductive analysis of interview data, field notes, and artistic output generated by the project (rap video, graffiti art, street theater), we identify the processes that appeared to underlie positive outcomes observed in participants, including creating a sense of safety and providing opportunities to challenge negative self-perceptions. This article provides evidence for a scaleable model for youth engagement and empowerment that (a) is practical to implement in low-resource settings and (b) is effective at engaging street-involved youth across diverse cultures and contexts. We summarize practical implications and actionable measures that can be taken by stakeholders to capitalize on these findings. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Visual findings in children exposed to Zika in utero in Nicaragua.

Knowledge regarding the frequency of ocular abnormalities and abnormal visual function in children exposed to Zika virus (ZIKV) in utero but born without congenital Zika syndrome (CZS) is limited. We hypothesized that children exposed to ZIKV in utero born without CZS may have visual impairments in early childhood. We performed ophthalmic examination between 16 and 21 months of age and neurodevelopment assessment at 24 months of age with the Mullen Scales of Early Learning test (MSEL) on children enrolled in a cohort born to women pregnant during and shortly after the ZIKV epidemic in Nicaragua (2016-2017). ZIKV exposure status was defined based on maternal and infant serological testing. Visual impairment was defined as abnormal if the child had an abnormal ophthalmic exam and/or low visual reception score in the MSEL assessment. Of 124 children included in the analysis, 24 (19.4%) were classified as ZIKV-exposed and 100 (80.6%) unexposed according to maternal or cord blood serology. Ophthalmic examination showed that visual acuity did not differ significantly between groups, thus, 17.4% of ZIKV-exposed and 5.2% of unexposed had abnormal visual function (p = 0.07) and 12.5% of the ZIKV-exposed and 2% of the unexposed had abnormal contrast testing (p = 0.05). Low MSEL visual reception score was 3.2-fold higher in ZIKV-exposed than unexposed children, but not statistically significant (OR 3.2, CI: 0.8-14.0; p = 0.10). Visual impairment (a composite measure of visual function or low MESL visual reception score) was present in more ZIKV-exposed than in unexposed children (OR 3.7, CI: 1.2, 11.0; p = 0.02). However, the limited sample size warrants future investigations to fully assess the impact of in utero ZIKV exposure on ocular structures and visual function in early childhood, even in apparently healthy children.

Heat stress and heat strain among outdoor workers in El Salvador and Nicaragua.

BACKGROUND: There is growing attention on occupational heat stress in Central America, as workers in this region are affected by a unique form of chronic kidney disease. Previous studies have examined wet bulb globe temperatures and estimated metabolic rates to assess heat stress, but there are limited data characterizing heat strain among these workers. OBJECTIVE: The aims were to characterize heat stress and heat strain and examine whether job task, break duration, hydration practices, and kidney function were associated with heat strain. METHODS: We used data from the MesoAmerican Nephropathy Occupational Study, a cohort of 569 outdoor workers in El Salvador and Nicaragua who underwent workplace exposure monitoring, including continuous measurement of core body temperature (Tc), heart rate (HR), physical activity, and wet bulb globe temperature (WBGT), over the course of three days in January 2018 - May 2018. Participants represented five industries: sugarcane, corn, plantain, brickmaking, and construction. RESULTS: Median WBGTs were relatively high (>27 °C) at most sites, particularly when work shifts spanned the afternoon hours (e.g., 29.2 °C among plantain workers). Sugarcane workers, especially cane cutters in both countries and Nicaraguan agrichemical applicators, had the highest estimated metabolic rates (medians: 299-318 kcal/hr). Most workers spent little time on break (<10% of the shift), as determined by physical activity data. Overall, sugarcane workers-particularly those in Nicaragua-experienced the highest Tc and HR values. However, a few workers in other industries reached high Tc (>39 °C) as well. Impaired kidney function (estimated glomerular filtration rate <90 mL/min/1.73 m2) was associated with higher Tc and HR values, even after adjustment. SIGNIFICANCE: This is the largest study to-date examining heat stress and strain among outdoor workers in Central America. Workers at sugar companies regularly experienced Tc > 38°C (76.9% of monitored person-days at Nicaraguan companies; 46.5% at Salvadoran companies). Workers with impaired kidney function had higher measures of Tc and HR. IMPACT STATEMENT: This study examined levels of occupational heat stress and heat strain experienced among outdoor workers in five industries in El Salvador and Nicaragua. We characterized heat stress using wet bulb globe temperatures and estimated metabolic rate and heat strain using core body temperature and heart rate. Sugarcane workers, particularly cane cutters and Nicaraguan agrichemical applicators, performed more strenuous work and experienced greater levels of heat strain. Impaired kidney function was associated with higher heart rates and core body temperatures.