Pediatric neurosurgical medulloblastoma outcomes in La Paz, Bolivia: How a Lower Middle-Income Country (LMIC) institution in South America compares to the United States.

BACKGROUND: How pediatric medulloblastoma patients fare in Lower Middle-Income Country (LMICs) in South America is not well understood. Correspondingly, the aim of this study was to summarize the pediatric neurosurgical experience of an institution in La Paz, and compare outcomes to that of a generalized High Income Country (HIC) United States (US) experience. METHODS: A retrospective review of all pediatric neurosurgical medulloblastoma patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria") between 2014 and 2023 was conducted and compared to a generalized US experience abstracted from the US National Cancer Database (NCDB) and National Inpatient Sample (NIS) databases. Categorical, continuous and survival data were statistically summarized and compared. RESULTS: A total of 24 pediatric medulloblastoma patients underwent neurosurgical treatment at the Hospital del Niño. In this La Paz cohort, there were 15 (63%) males and 9 (38%) females, with a mean age of 5.6 years old at diagnosis. The majority of patients underwent subtotal resection (STR, 79%), while the remaining patients underwent biopsy only. Ten (42%) patients expired during their hospitalization, and mean length of stay overall was 39 days. Only 8 (33%) patients received adjuvant treatment after surgery. Median overall survival from diagnosis in the La Paz cohort was 1.9 months. Compared to the US databases, the La Paz cohort experienced significantly more emergency room admissions for surgery, less gross total resection, more STR, more return to operating room for ventriculoperitoneal shunting, more bacteremia, more tracheostomy procedures, more percutaneous gastrostomy placements, longer lengths of stay, less adjuvant chemotherapy, less radiation therapy, shorter follow-up, and ultimately, significantly shorter overall survival (all P < 0.050). CONCLUSIONS: Pediatric neurosurgical medulloblastoma outcomes at the Children's Hospital of La Paz, Bolivia are significantly inferior to that of a generalized US experience. Future research is required to identify institution- and country-specific initiatives to improve discrepancies between institutions in LMICs in South America compared to HICs.

Human Pesticide Exposure in Bolivia: A Scoping Review of Current Knowledge, Future Challenges and Research Needs.

Numerous studies have shown that pesticide exposure is linked to adverse health outcomes. Nevertheless, in Bolivia, where there is an increasing use of pesticides, the literature is sparse. To address knowledge gaps and guide future research in Bolivia, we conducted a scoping review spanning 22 years (January 2000 to December 2022). Our search identified 39 peer-reviewed articles, 27 reports/documents on Bolivian regulations, and 12 other documents. Most studies focused on farmers and revealed high pesticide exposure levels, assessed through biomarkers of exposure, susceptibility, and effect. The literature explored a range of health effects due to pesticide exposure, spanning from acute to chronic conditions. Many studies highlighted the correlation between pesticide exposure and genotoxic damage, measured as DNA strand breaks and/or micronuclei formation. This was particularly observed in farmers without personal protection equipment (PPE), which increases the risk of developing chronic diseases, including cancer. Recent findings also showed the alarming use of banned or restricted pesticides in Bolivian crops. Despite existing Bolivian regulations, the uncontrolled use of pesticides persists, leading to harmful health effects on the population and increasing land and water pollution. This review underscores the need for the stringent enforcement of regulations and continued research efforts, and it provides a scientific foundation for decision-making by relevant authorities.

[Inequalities in time to diagnosis of Down Syndrome in Bolivia]. / Desigualdades en el tiempo hasta el diagnóstico del síndrome de Down en Bolivia.

Down Syndrome is the most common genetic condition and a leading cause of intellectual disability. Individuals in rural areas, particularly those with disabilities, often face disparities in healthcare access. Analyzing clinical records of patients diagnosed with Down Syndrome between 2013 and 2022 by the Institute of Genetics at the Universidad Mayor de San Andrés in La Paz, Bolivia, this study examined the time to diagnosis for 250 patients with Down Syndrome. The findings revealed that patients from rural areas with Down Syndrome take an average of five months to receive a diagnosis, compared to two months in urban areas (p<0.001). No significant differences were found in the time to diagnosis based on gender. However, a higher proportion of males from rural areas was observed (p=0.03). The results suggest that individuals in rural areas face challenges in receiving a timely diagnosis. On the other hand, women may not be brought to cities for proper diagnosis and treatment due to gender biases in certain communities. The importance of improving access to early diagnosis and treatment in rural areas is emphasized.

El síndrome de Down es la condición genética más común y una causa principal de discapacidad intelectual. Las personas en áreas rurales, especialmente aquellas con discapacidades, a menudo enfrentan desigualdades en el acceso a la salud. A partir de los registros clínicos de pacientes con diagnóstico confirmado de síndrome de Down entre 2013 y 2022, por el Instituto de Genética de la Universidad Mayor de San Andrés, La Paz, Bolivia, se analizó, analizó el tiempo hasta el diagnóstico de 250 pacientes con síndrome de Down, mostró que los pacientes procedentes de áreas rurales con síndrome de Down tardan cinco meses en promedio en recibir un diagnóstico, comparado a los dos meses en zonas urbanas (p<0,001). No se encontraron diferencias significativas en el tiempo hasta el diagnostico según el sexo. Sin embargo, se evidenció una mayor proporción de varones provenientes de áreas rurales (p=0,03). Los hallazgos sugieren que los individuos de áreas rurales enfrentan dificultades para recibir el diagnóstico. Por otro lado, las mujeres quizás no sean llevadas a ciudades para un diagnóstico y tratamiento adecuado debido a sesgos de género en ciertas comunidades. Se subraya la importancia de mejorar el acceso a diagnósticos y tratamientos tempranos en áreas rurales.

Genotoxicity in humans exposed to arsenic, lithium, and boron in drinking water in the Bolivian Andes-A cross sectional study.

Elevated concentrations of arsenic, lithium and boron in drinking water have already been reported in Bolivia. Arsenic is known to cause genotoxicity but that caused by lithium and boron is less well known. The aim of the present cross-sectional study was to evaluate potential genotoxic effects of exposure to arsenic, while considering exposure to lithium and boron and genetic susceptibility. Women (n = 230) were recruited in villages located around Lake Poopó. Exposure to arsenic was determined as the sum of concentrations of arsenic metabolites inorganic arsenic, monomethylarsonic acid (MMA), and dimethylarsinic acid (DMA) in urine. Exposure to lithium and boron was determined based on their concentrations in urine. Genetic susceptibility was determined by GSTM1 (glutathione S-transferase-mu-1) and GSTT1 (glutathione S-transferase-theta-1) null genotypes and AS3MT (Arsenite Methyltransferase) rs3740393. Genotoxicity was measured in peripheral blood leukocytes using the comet assay. The geometric means of arsenic, lithium, and boron concentrations were 68, 897, and 3972 µg/L, respectively. GSTM1 and GSTT1 null carriers had more DNA strand breaks than gene carriers (p = .008, p = .005). We found no correlation between urinary arsenic and DNA strand breaks (rS = .03, p = .64), and only a weak non-significant positive association in the adjusted multivariate analysis (ß = .09 [-.03; .22], p = .14). Surprisingly, increasing concentrations of lithium in urine were negatively correlated with DNA strand breaks (rS = -.24, p = .0006), and the association persisted in multivariate analysis after adjusting for arsenic (ß = -.22 [-.36; -.08], p = .003). We found no association between boron and DNA strand breaks. The apparent protective effect of lithium merits further investigation.

First molecular evidence of lichen-inhabiting Acrospermum and new insights into the evolution of lifestyles of Acrospermales (Dothideomycetes).

Acrospermales represent one of the least studied lineages of Dothideomycetes and are characterized by diverse ecological strategies, including saprotrophic, epiphytic, fungicolous, lichenicolous, and bryophilous lifestyles. The order is composed of two teleomorphic genera, Acrospermum and Oomyces, and five anamorphic genera of unclear relationships. The objectives of the study were to establish the phylogenetic position of Acrospermum species collected from lichens in the tropical forest of Bolivia and to infer the evolution of the lichenicolous lifestyle in Acrospermales. Our results reveal that the examined specimens from Bolivia represent a new species, A. bolivianum, which is well characterized by its phylogenetic distinctness, morphological characteristics, and host selection. The new species is the first lichenicolous member of Acrospermum and forms a well-supported clade sister to the bryophilous Acrospermum adeanum. The evolution of lifestyles, concluded by phylogenetic analyses and ancestral state reconstructions, indicated that the saprotrophic lifestyle is ancestral to Acrospermales. This corresponds to their close relationship to other saprotrophic lineages of Dothideomycetes and indicates that the wide spectrum of nutritional strategies, currently observed in Acrospermales, may be a result of more recent shifts in their ecology. Our results also suggest that the lichenicolous lifestyle in Acrospermales appeared independently at least two times. Lichenicolous species are represented in our data set by Acrospermum bolivianum and Gonatophragmium physciae, which evolved from lichenicolous and plant-parasite ancestors, respectively. The genus Oomyces, represented by O. carneoalbus, was included for the first time in the phylogenetic analysis and showed a sister relationship to the remaining taxa of Acrospermales.

The need for culture in tegumentary leishmaniasis diagnosis in Bolivia: A comparative evaluation of four parasitological techniques using two sampling methods.

Leishmaniases are zoonotic diseases caused by protozoa of the genus Leishmania. In Bolivia, leishmaniasis occurs mainly in the cutaneous form (CL) followed by the mucosal or mucocutaneous form (ML or MCL), grouped as tegumentary leishmaniosis (TL), while cases of visceral leishmaniasis (VL) are rare. The cases of TL are routinely diagnosed by parasitological methods: Direct Parasitological Exam (DPE) and axenic culture, the latter being performed only by specialized laboratories. The aim of the present study was to optimize the parasitological diagnosis of TL in Bolivia, using two sampling methods. Samples from 117 patients with suspected TL, obtained by aspiration (n = 121) and scraping (n = 121) of the edge of the lesion were tested by: direct parasitological exam, culture in TSTB medium, and miniculture and microculture in Schneider's medium. A positive laboratory result by any of the four techniques evaluated using either of the two sampling methods was considered the gold standard. Of the 117 suspected patients included, TL was confirmed in 96 (82 %), corresponding 79 of the confirmed cases (82.3 %) to CL and 16 (16.7 %) to ML. Parasitological techniques specificity was 100 % and their analytical sensitivity was greater with scraping samples in TSTB culture (98 %). Scraping samples in TSTB and miniculture correlated well with the reference (Cohen's kappa coefficient=0.88) and showed good reliability (Cronbach's alpha coefficient ≥0.91). Microculture provided positive results earlier than the other culture methods (mean day 4.5). By day 14, 98 % of positive cultures had been detected. Scraping sampling and miniculture were associated with higher culture contamination (6 % and 17 %, respectively). Bacterial contamination predominated, regardless of the sampling and culture method, while filamentous fungi and mixed contamination were more frequently observed in cultures from scraping samples. In conclusion: (i) scraping samples proved more suitable for the diagnosis of TL as they increased analytical sensitivity, are less traumatic for the patient and are safer for laboratory personnel than aspirates; (ii) culture, mainly in TSBT medium, should be used for the diagnosis of TL due to its high sensitivity (doubling the number of cases diagnosed by DPE) and its low cost compared to other culture media.

Addressing the Publication Gap in the Tropical Andes: Unveiling Challenges and Implementing Solutions / Abordando la brecha de publicaciones en los Andes Tropicales: revelando desafíos e implementando soluciones / Abordando a lacuna de publicação nos Andes tropicais: revelando desafios e implementando soluções

Biodiversity and conservation research play a pivotal role in advancing knowledge and addressing global challenges. Yet, a striking gap in the publication of research between the Tropical Andes and other regions. To address this disparity, a comprehensive strategy was employed, encompassing a three-day workshop aimed at addressing research publication challenges in the Tropical Andes region, as well as a sequence of surveys. The registration survey, distributed to over 500 potential participants, examined the demographics, perceptions of factors impacting lower publication rates, personal barriers to publishing, and proposed strategies for overcoming these obstacles. Additionally, a pre-workshop survey delved into selected participants' specific interests, obstacles they aimed to overcome, and their preferences for workshop content. Subsequently, the post-workshop survey assessed the workshop's impact, participant satisfaction, valuable session topics, and recommendations for future workshops. The survey revealed a range of challenges, including limited training in publishing, cultural factors, language barriers, restricted resources, and financial limitations, all contributing to the publication gap. Surprisingly, workshop interest was primarily from experienced professionals, indicating that the challenge isn't due to a lack of skills but rather the struggle to convert their expertise into published work. Moreover, about two-thirds of participants had ready-to-publish materials, showcasing an untapped knowledge reservoir. A major personal barrier identified was understanding the publication process, surpassing even language concerns, highlighting the need to clarify this process. Other findings underscored the pivotal role of self-confidence, with self-doubt, fears of rejection, and confidence issues acting as main personal limitations. The study highlights the importance of addressing challenges faced by experienced professionals in the Tropical Andes by understanding individual needs, fostering support, and demystifying the publication process. This offers a promising path to close the publication gap while preserving the region's rich biodiversity and valuable scientific contributions.

El aporte de la investigación sobre la conservación de la biodiversidad en el avance del conocimiento y la respuesta a los desafíos globales es fundamental. Sin embargo, aún existe una brecha sorprendente entre los Andes Tropicales y otras regiones en relación a la publicación de investigaciones científicas. Para comprender esta disparidad, se empleó una estrategia integral, que abarcó un taller de tres días destinado a abordar los principales desafíos que enfrentan los investigadores en la región de los Andes Tropicales, así como una serie de encuestas. La encuesta de inscripción, distribuida a más de 500 participantes potenciales, examinó la demografía, las percepciones de los factores que impactan las tasas de publicación más bajas, las barreras personales para la publicación y propuso estrategias para superar estos obstáculos. Esta fue seguida por una encuesta previa al taller, en la que se profundizó en los intereses específicos de los participantes seleccionados, los obstáculos que pretendían superar y sus preferencias por el contenido del taller. Por último, la encuesta a posteriori, en la que se evaluó el impacto del taller, la satisfacción de los participantes, los temas de interés en las sesiones y las recomendaciones para futuros talleres. La encuesta descubrió varios desafíos, como la capacitación limitada en publicaciones, factores culturales, barreras idiomáticas, recursos restringidos y limitaciones financieras, todos los cuales contribuyen a la brecha en las publicaciones. Sorprendentemente, el interés en el taller provino principalmente de profesionales experimentados, lo que indica que el desafío no se debe a la falta de habilidades sino más bien a la lucha por convertir su experiencia en un trabajo publicado. Además, alrededor de dos tercios de los participantes tenían materiales listos para publicar, lo que mostraba una reserva de conocimientos sin explotar. Una barrera importante identificada fue la limitada comprensión del proceso de publicación, superando incluso a la barrera del  idioma, destacando la necesidad de aclarar este proceso. Otros hallazgos subrayan el papel fundamental de la confianza en uno mismo, siendo las dudas sobre uno mismo, el miedo al rechazo y los problemas de confianza las principales limitaciones personales. El estudio destaca la importancia de abordar los desafíos que enfrentan los profesionales experimentados en los Andes Tropicales al comprender las necesidades individuales, fomentar el apoyo y desmitificar el proceso de publicación. Esto ofrece un camino prometedor para cerrar la brecha de publicaciones y lograr que la ciencia producida en esta región se documente y amplifique aportando al conocimiento que ayude a   preservar la rica biodiversidad de esta región.  

A pesquisa em biodiversidade e conservação desempenha um papel fundamental no avanço do conhecimento e na solução de desafios globais. No entanto, há uma lacuna evidente na publicação de pesquisas entre os Andes Tropicais e outras regiões. Para enfrentar essa disparidade, foi empregada uma estratégia abrangente, incluindo um workshop de três dias com o objetivo de abordar os desafios na publicação de pesquisas na região dos Andes Tropicais, além de uma série de pesquisas. A pesquisa de registro, distribuída para mais de 500 potenciais participantes, examinou a demografia, percepções de fatores que impactam as baixas taxas de publicação, barreiras pessoais para publicar e estratégias propostas para superar esses obstáculos. Além disso, uma pesquisa pré-workshop explorou interesses específicos dos participantes selecionados, obstáculos que pretendiam superar e suas preferências para o conteúdo do workshop. Posteriormente, a pesquisa pós-workshop avaliou o impacto do workshop, a satisfação dos participantes, tópicos de sessões valiosas e recomendações para futuros workshops. A pesquisa revelou uma série de desafios, incluindo treinamento limitado em publicação, fatores culturais, barreiras linguísticas, recursos restritos e limitações financeiras, todos contribuindo para a lacuna na publicação. Surpreendentemente, o interesse no workshop veio principalmente de profissionais experientes, indicando que o desafio não está na falta de habilidades, mas sim na luta para converter sua experiência em trabalhos publicados. Além disso, cerca de dois terços dos participantes tinham materiais prontos para publicação, mostrando um reservatório de conhecimento não utilizado. Uma grande barreira pessoal identificada foi entender o processo de publicação, ultrapassando até mesmo as preocupações com o idioma, destacando a necessidade de esclarecer esse processo. Outros achados destacaram o papel fundamental da autoconfiança, com auto-dúvida, medo de rejeição e questões de confiança atuando como principais limitações pessoais. O estudo destaca a importância de enfrentar os desafios enfrentados por profissionais experientes nos Andes Tropicais, compreendendo as necessidades individuais, promovendo apoio e desmistificando o processo de publicação. Isso oferece um caminho promissor para fechar a lacuna na publicação, ao mesmo tempo em que preserva a rica biodiversidade da região e valiosas contribuições científicas.

Risk factors for COVID-19 mortality in hospitalized patients in Bolivia.

Objectives: This study aimed to ascertain which factors are associated with higher risk of mortality among hospitalized COVID-19 Bolivian patients. Methods: This retrospective observational study assessed risk factors associated with mortality in patients (n = 549) hospitalized for SARS-CoV-2 infection in a Bolivian hospital between April 6, 2020, and August 18, 2022. Results: The results provide evidence of association between male sex (odds ratio [OR] = 1.6, 95% confidence interval [CI] 1.06-2.6), older age, 51-61 years-old (OR = 5.2, 95% CI 2.2-12.6), 62-70 years-old (OR = 8.7, 95% CI 3.7-20.5), >70 years-old (OR = 16.9, 95% CI 7.1-39.9), and blood group A (OR = 1.9, 95% CI: 1.1-3.4) with higher mortality risk. The strong association between mortality and relatively young age, may be due to high frequency of undiagnosed comorbidities. Vaccination was associated with a reduction in mortality only when time period of hospitalization was not adjusted for. Conclusion: Among hospitalized patients in Bolivia male sex, older age, and blood group A are associated with higher mortality risk. Mortality risk increased markedly from a relatively young age and decreased in parallel to the uptake of the vaccination program. However, the gradual reduction in mortality can also be due to improved patient management and changes in natural immunity and virulence of circulating strains as the pandemic progressed.

A scoping review of the health co-benefits of climate mitigation strategies in South America.

The accelerated production of greenhouse gases (GHG) due to human activity has led to unprecedented global warming, making climate mitigation strategies crucial for minimizing its impacts. South America, a region highly vulnerable to climate change, stands to benefit from implementing such strategies to reduce future risks and generate health co-benefits. This scoping review, aimed to assess the existing evidence on the health benefits of climate mitigation strategies in South American countries. PubMed, Web of Science, and LILACS databases were searched until June 15, 2023. Nine studies published between 2001 and 2021 were analyzed, focusing on Brazil, Chile, and Bolivia. All the studies identified in this review used scenario modeling. They evaluated various GHG emission mitigation strategies, including land management, reducing livestock production, biofuel production, increased active transportation, renewable energy, and waste reduction. Only one study looked at GHG capture and sequestration through afforestation. Given the limited information available, there is a pressing need for more research on the region's potential health, environmental, and economic co-benefits. This review serves as a starting point and suggests that climate mitigation can offer a range of positive co-benefits, such as improved air quality and increased resilience to climate impacts, thereby advancing public health initiatives. Funding: MYG was supported by the Wellcome Trust (grant number 209734/Z/17/Z). The other authors did not receive financial support for their research or authorship. The publication of this article was financially supported by Universidad Peruana Cayetano Heredia.

Divergent Genotype of Hepatitis A Virus in Alpacas, Bolivia, 2019.

Hepatitis A virus (HAV) is a common human pathogen found exclusively in primates. In a molecular and serologic study of 64 alpacas in Bolivia, we detected RNA of distinct HAV in ≈9% of animals and HAV antibodies in ≈64%. Complete-genome analysis suggests a long association of HAV with alpacas.

Violence Exposure Among Women in the Sex Industry and Their Children in El Alto, Bolivia: A Comparative Cross-Sectional Study.

We conducted a comparative cross-sectional study to compare the prevalence of exposure to workplace violence and intimate partner violence (IPV) in 125 female sex workers (FSWs) and 125 age-matched control women working in other professions (non-FSWs) and their children in El Alto, Bolivia. Violence exposure was assessed using the Demographic Health Survey Domestic Violence Module. To determine associations between work type and violence exposure, we conducted multivariate logistic regression. One-third of working mothers experienced sexual IPV, regardless of their profession. FSWs experienced higher rates of severe physical IPV and workplace violence. Children of FSWs were approximately three times more likely to be exposed to violence in the workplace. In Bolivia, strategies to reduce exposure to violence within the home and in FSW workplaces are paramount to minimizing negative impacts on women and their children. These findings have implications for policies to improve education, living wages, and social interventions to prevent and mitigate violence against women and children.

Plan estratégico 2023-2030 del Organismo Andino de Salud - Convenio Hipólito Unanue (ORAS-CONHU) / Strategic Plan 2023-2030 of the Andean Health Agency - Hipólito Unanue Agreement (ORAS-CONHU)

El Plan Estratégico al 2030, aprobado por Resolución REMSAA Ext. XXXVI/2, constituye la hoja de ruta para afianzar la integración regional y el abordaje de una agenda en común de las prioridades en salud pública de los seis países andinos. Incluye cinco líneas estratégicas: 1. Posicionamiento de la salud como eje central del desarrollo humano, 2. Promoción del derecho a la salud con justicia social y ambiental, 3. Reducción de las desigualdades e inequidades en salud, 4. Integración y cooperación regional, 5. Fortalecimiento institucional. El Plan, parte de un diagnóstico que muestra cómo la pandemia afectó la garantía del derecho a la vida, la salud y el bienestar, pero aclarando que los efectos de dicha pandemia fueron más funestos donde la estructura de desigualdades exacerbó el riesgo de enfermar. Por ello, los datos muestran que los países con alta desigualdad y sistemas de protección débiles han tenido altos índices de contagios y letalidad.

Tailoring evidence into action: using a codesign approach for biodiversity information in the Tropical Andes / Toma de decisiones basadas en la evidencia: un enfoque de codiseño para la información sobre biodiversidad en los Andes tropicales / Tomada de decisão baseada em evidências: uma abordagem de co-design para informações sobre biodiversidade nos Andes tropicais

Biodiversity conservation is a complex and transdisciplinary problem that requires engagement and cooperation among scientific, societal, economic, and political institutions. However, historical approaches have often failed to bring together and address the needs of all relevant stakeholders in decision­making processes. The Tropical Andes, a biodiversity hotspot where conservation efforts often conflict with socioeconomic issues and policies that prioritize economic development, provides an ideal model to develop and implement more effective approaches. In this study, we present a co­design approach that mainstreams and improves the flow of biodiversity information in the Tropical Andes, while creating tailored outputs that meet the needs of economic and societal stakeholders. We employed a consultative process that brought together biodiversity information users and producers at the local, national, and regional levels through a combination of surveys and workshops. This approach identified priority needs and limitations of the flow of biodiversity information in the region, which led to the co­design of user­relevant biodiversity indicators. By leveraging the existing capacities of biodiversity information users and producers, we were able to co­design multiple biodiversity indicators and prioritize two for full implementation ensuring that the data was findable, accessible, interoperable, and reusable based on the FAIR principles. This approach helped address limitations that were identified in the stakeholder engagement process, including gaps in data availability and the need for more accessible biodiversity information. Additionally, capacity­building workshops were incorporated for all producers of biodiversity information involved, which aimed to not only improve the current flow of biodiversity information in the region but also facilitate its future sustainability. Our approach can serve as a valuable blueprint for mainstreaming biodiversity information and making it more inclusive in the future, especially considering the diverse worldviews, values, and knowledge systems between science, policy, and practice.

La conservación de la biodiversidad es un problema complejo y transdisciplinario que requiere el compromiso y la cooperación entre instituciones científicas, sociales, económicas y políticas. Sin embargo, los enfoques tradicionales/convencionales  a menudo no logran  reunir y abordar las necesidades de todos los actores relevantes en los procesos de toma de decisiones. Los Andes tropicales, un área clave  de biodiversidad donde los esfuerzos de conservación a menudo entran en conflicto con cuestiones socioeconómicas y políticas que priorizan el desarrollo económico, proporcionan un modelo ideal para desarrollar e implementar enfoques más efectivos. En este estudio, presentamos un enfoque co-diseño que integra y mejora el flujo de información sobre biodiversidad en los Andes tropicales, creando resultados personalizados que satisfacen las necesidades, tanto económicas como sociales, de las partes interesadas. Empleamos un proceso de consulta que reunió a usuarios y productores de información sobre biodiversidad a nivel local, nacional y regional, a través de encuestas y talleres. Este enfoque ha permitido identificar necesidades prioritarias y limitaciones del flujo de información sobre biodiversidad en la región; lo cual llevó al codiseño de indicadores de biodiversidad relevantes para los usuarios. Aprovechando las capacidades existentes de los usuarios y productores de información sobre biodiversidad, pudimos co-diseñar múltiples indicadores de biodiversidad y priorizar dos de estos para su implementación completa, asegurando que los datos sean localizables, accesibles, interoperables y reutilizables, según los principios FAIR. Este enfoque ayudó a abordar las limitaciones que se identificaron en el proceso de participación de las partes interesadas; incluidas las brechas en la disponibilidad de datos y la necesidad de información sobre biodiversidad más accesible. Además, se incorporaron talleres de desarrollo de capacidades para todos los productores de información sobre biodiversidad involucrados, los cuales apuntaron no sólo a mejorar el flujo actual de información sobre biodiversidad en la región, sino también facilitar su sostenibilidad futura. Nuestro enfoque puede servir como un modelo valioso para incorporar la información sobre biodiversidad y hacerla más inclusiva en el futuro; especialmente si consideramos las diversas perspectivas globales, valores y sistemas de conocimiento implicados en las interacciones entre  la ciencia, la política y su aplicación práctica.

A conservação da biodiversidade é um problema complexo e transdisciplinar que requer compromisso e cooperação entre instituições científicas, sociais, económicas e políticas. No entanto, as abordagens tradicionais/convencionais muitas vezes não conseguem reunir e responder às necessidades de todos os intervenientes relevantes nos processos de tomada de decisão. Os Andes tropicais, uma área chave para a biodiversidade onde os esforços de conservação entram frequentemente em conflito com questões socioeconómicas e políticas que dão prioridade ao desenvolvimento económico, fornecem um modelo ideal para desenvolver e implementar abordagens mais eficazes. Neste estudo, apresentamos uma abordagem de co-design que integra e melhora o fluxo de informações sobre biodiversidade nos Andes tropicais, criando resultados personalizados que atendem às necessidades, tanto econômicas quanto sociais, das partes interessadas. Empregamos um processo de consulta que reuniu usuários e produtores de informações sobre biodiversidade nos níveis local, nacional e regional, por meio de pesquisas e workshops. Esta abordagem permitiu identificar necessidades prioritárias e limitações do fluxo de informação sobre a biodiversidade na região; o que levou à concepção conjunta de indicadores de biodiversidade relevantes para os utilizadores. Aproveitando as capacidades existentes dos utilizadores e produtores de informação sobre biodiversidade, fomos capazes de conceber em conjunto vários indicadores de biodiversidade e priorizar dois deles para implementação total, garantindo que os dados sejam localizáveis, acessíveis, interoperáveis ​​e reutilizáveis, de acordo com os princípios FAIR. Esta abordagem ajudou a resolver as limitações identificadas no processo de envolvimento das partes interessadas; incluindo lacunas na disponibilidade de dados e a necessidade de informações mais acessíveis sobre biodiversidade. Além disso, foram incorporados workshops de capacitação para todos os produtores de informação sobre biodiversidade envolvidos, que visaram não só melhorar o fluxo actual de informação sobre biodiversidade na região, mas também facilitar a sua sustentabilidade futura. A nossa abordagem pode servir como um modelo valioso para incorporar informações sobre biodiversidade e torná-las mais inclusivas no futuro; especialmente se considerarmos as diversas perspectivas globais, valores e sistemas de conhecimento envolvidos nas interações entre ciência, política e sua aplicação prática.

Circulation of enterotoxigenic Escherichia coli (ETEC) isolates expressing CS23 from the environment to clinical settings.

IMPORTANCE: The importance of clean water cannot be overstated. It is a vital resource for maintaining health and well-being. Unfortunately, water sources contaminated with fecal discharges from animal and human origin due to a lack of wastewater management pose a significant risk to communities, as they can become a means of transmission of pathogenic bacteria like enterotoxigenic E. coli (ETEC). ETEC is frequently found in polluted water in countries with a high prevalence of diarrheal diseases, such as Bolivia. This study provides novel insights into the circulation of ETEC between diarrheal cases and polluted water sources in areas with high rates of diarrheal disease. These findings highlight the Choqueyapu River as a potential reservoir for emerging pathogens carrying antibiotic-resistance genes, making it a crucial area for monitoring and intervention. Furthermore, the results demonstrate the feasibility of a low-cost, high-throughput method for tracking bacterial pathogens in low- and middle-income countries, making it a valuable tool for One Health monitoring efforts.

Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory.

The COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as "interlocutors" between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.

Neotypification for five names linked to Arenaria (Caryophyllaceae) for the endemic flora of Peru and Bolivia.

The names Arenariamattfeldii, A.pallens, A.peruviana, A.pintaudii, and A.stuebelii (Caryophyllaceae, Arenarieae) from Peru and Bolivia were studied and neotypified based on specimens preserved at B and P.

Canada and the pharmaceutical industry in the time of COVID-19.

The COVID-19 pandemic showed the close relationship between the Canadian government and the pharmaceutical industry when it came to both domestic and international issues. Domestically, the government chose to prioritize advice about vaccine acquisition from a panel of heavily conflicted people; it signed contracts worth billions of dollars with companies for vaccines but the contents of contracts were largely kept secret. The government also committed over CAD$1 billion in funding for research on COVID-19 but without any requirement that any forthcoming intellectual property or diagnostic and therapeutic products had to be accessible and affordable in low- and middle-income countries (LMICs). On the international stage, Canada did not support the COVID-19 Technology Access Pool that aimed to provide a one-stop shop for scientific knowledge, data, and intellectual property to be shared equitably by the global community. It delayed donating vaccines to LMICs and bought vaccines from a facility designed mainly to provide vaccines to that group of countries. The government did not dismantle roadblocks that prevented a Canadian company from sending vaccines to Bolivia. Finally, it was ambiguous about whether it supported a patent waiver for COVID-19 technologies at the World Trade Organization.

Development and validation of a perceived abortion self-efficacy scale: results from Bolivia, Nepal and Nigeria.

The objective of this research was to develop and assess the validity of a scale to measure perceived abortion self-efficacy (PASE). Perceived abortion self-efficacy is defined as an individual's perceived confidence in their ability to carry out the tasks necessary to end a pregnancy safely and successfully. During the first phase of this study between February and April 2018, we conducted qualitative research using in-depth interviews and focus group discussions with women in Bolivia, Nepal, and Nigeria to explore domains of PASE. Using the qualitative data, we prepared a draft set of measures with 31 items. In October and November 2018, the second phase of the study included field testing 31 draft items with a convenience sample of approximately 1200 women across the three study countries. Exploratory factor analysis was conducted to identify an appropriate scale structure, resulting in a 15-item, 3-factor model. The three factors represent the concepts of enlisting social resources, accessing information and care, and resilience. In the third and final phase in September and October 2019, the validity of the 15 scale items was assessed. The scale was administered to a new sample of approximately 400 women in each country. Confirmatory factor analyses were conducted to test model fit for the scale structure identified during the second phase. The results from this study suggest that the final PASE scale has considerable potential to be a valid measure of PASE. The new 15-item PASE scale presented in this paper can be used to evaluate programmes or interventions designed to improve women's PASE and to assess the state of PASE in populations.

Intimate Partner Violence Against Women and Workplace Productivity in the Financial Sector of Two Latin American Societies.

This research determines the prevalence of intimate partner violence against women (IPVAW) and its impact on labor productivity in the financial sector of two Latin American countries. Nine financial institutions participated in this study with surveys of 892 female employees in Bolivia and 393 in Paraguay. The results revealed that 40.1% in Bolivia and 18.7% in Paraguay experienced IPVAW. In Bolivia, this resulted in 6.686 lost workdays per year due to absenteeism and 7.640 workdays per year due to presenteeism (present but distracted). In Paraguay, 12.035 days were lost to absenteeism and 12.037 to presenteeism. This pioneering research highlights the significant influence of IPVAW on financial sector productivity and its broader economic implications.

Cognitive evaluation and rehabilitation in high- and low-income countries.

Starting from her own personal experience, in the First Part of the article, the author reconstructs how the specialized sectors of cognitive evaluation and rehabilitation evolved in Western countries (Europe, the United States, Canada, and Australia, in particular) during the second half of the last century and the first decades of this century. In the Second Part, she describes her personal experience in setting up a rehabilitation centre dedicated to traumatic brain-injured subjects and her commitment to international cooperation (Bolivia, Rwanda, Myanmar, Tanzania) in the field of cognitive evaluation and rehabilitation in favour of people with congenital and acquired cerebral pathology, especially in the paediatric age, since there is an almost total lack of diagnostic, but above all, rehabilitative procedures for cognitive functions in low-middle income countries. In the Third Part of the article, the author carries out an extensive review of the international literature on the differences in access to cognitive diagnostic evaluation and cognitive rehabilitation in middle- and low-income countries - but not only - underlining the urgent need to launch a major international collaborative effort to reduce and eliminate these discrepancies.