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1.
BMJ Open ; 13(1): e056913, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609334

RESUMO

OBJECTIVE: The burden of diabetes mellitus is increasing in low-income and middle-income countries (LMICs). Few studies have explored pathways to care among individuals with diabetes in LMICs. This study evaluates care trajectories among adults with diabetes in rural Guatemala. DESIGN: A qualitative investigation was conducted as part of a population-based study assessing incidence and risk factors for chronic kidney disease in two rural sites in Guatemala. A random sample of 807 individuals had haemoglobin A1c (HbA1c) screening for diabetes in both sites. Based on results from the first 6 months of the population study, semistructured interviews were performed with 29 adults found to have an HbA1c≥6.5% and who reported a previous diagnosis of diabetes. Interviews explored pathways to and experiences of diabetes care. Detailed interview notes were coded using NVivo and used to construct diagrams depicting each participant's pathway to care and use of distinct healthcare sectors. RESULTS: Participants experienced fragmented care across multiple health sectors (97%), including government, private and non-governmental sectors. The majority of participants sought care with multiple providers for diabetes (90%), at times simultaneously and at times sequentially, and did not have longitudinal continuity of care with a single provider. Many participants experienced financial burden from out-of-pocket costs associated with diabetes care (66%) despite availability of free government sector care. Participants perceived government diabetes care as low-quality due to resource limitations and poor communication with providers, leading some to seek care in other health sectors. CONCLUSIONS: This study highlights the fragmented, discontinuous nature of diabetes care in Guatemala across public, private and non-governmental health sectors. Strategies to improve diabetes care access in Guatemala and other LMICs should be multisectorial and occur through strengthened government primary care and innovative private and non-governmental organisation care models.


Assuntos
Diabetes Mellitus , Humanos , Adulto , Guatemala/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Fatores de Risco , Pesquisa Qualitativa
2.
Sci Rep ; 12(1): 20928, 2022 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-36463285

RESUMO

Domestic dogs can affect human health through bites and pathogen transmission, particularly in resource-poor countries where dogs, including owned ones, predominantly roam freely. Habitat and resource selection analysis methods are commonplace in wildlife studies but have not been used to investigate the environmental resource use of free-roaming domestic dogs (FRDD). The present study implements GPS devices to investigate habitat selection by FRDD from an urban site and a rural site in Indonesia, and one urban and two rural sites in Guatemala (N = 321 dogs). Spatial mixed effects logistic regression models, accounting for heterogeneous distribution of the resources, showed that patterns of habitat selection by FRDD were similar across study sites. The most preferred resources were anthropogenic, being buildings and roads, which implies selection for human proximity. Vegetation and open fields were less preferred and steep terrain was avoided, indicating that FRDD were synanthropic and that their space patterns likely optimised energy use. Results presented here provide novel data on FRDD habitat selection patterns, while improving our understanding of dog roaming behaviour. These findings provide insights into possible high-risk locations for pathogen transmission for diseases such as rabies, and can assist management authorities in the planning and deployment of efficient disease control campaigns, including oral vaccination.


Assuntos
Raiva , Humanos , Cães , Animais , Raiva/epidemiologia , Raiva/prevenção & controle , Raiva/veterinária , Animais Selvagens , Guatemala/epidemiologia , Indonésia , Ecossistema
3.
BMJ Open ; 12(12): e066365, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36523220

RESUMO

OBJECTIVES: To evaluate the impact of culturally and linguistically tailored informational videos delivered via social media campaigns on COVID-19 vaccine uptake in Indigenous Maya communities in Guatemala. METHODS: Our team designed a series of videos utilising community input and evaluated the impact using a pre-post intervention design. In-person preintervention surveys were collected from a sample of respondents in four rural municipalities in Guatemala in March 2022. Facebook, Instagram and browser ads were flooded with COVID-19 vaccine informational videos in Spanish, Kaqchikel and Kiche for 3 weeks. Postintervention surveys were conducted by telephone among the same participants in April 2022. Logistic regression models were used to estimate the OR of COVID-19 vaccine uptake following exposure to the intervention videos. RESULTS: Preintervention and postintervention surveys were collected from 1572 participants. The median age was 28 years; 63% (N=998) identified as women, and 36% spoke an Indigenous Mayan language. Twenty-one per cent of participants (N=327) reported watching the intervention content on social media. At baseline, 89% (N=1402) of participants reported having at least one COVID-19 vaccine, compared with 97% (N=1507) in the follow-up. Those who reported watching the videos had 1.78 times the odds (95% CI 1.14 to 2.77) of getting vaccinated after watching the videos compared with those who did not see the videos when adjusted by age, community, sex and language. CONCLUSION: Our findings suggest that culturally and linguistically tailored videos addressing COVID-19 vaccine misinformation deployed over social media can increase vaccinations in a rural, indigenous population in Guatemala, implying that social media content can influence vaccination uptake. Providing accurate, culturally sensitive information in local languages from trusted sources may help increase vaccine uptake in historically marginalised populations.


Assuntos
COVID-19 , Mídias Sociais , Feminino , Humanos , Adulto , Vacinas contra COVID-19 , Guatemala , COVID-19/prevenção & controle , Povos Indígenas
4.
Glob Heart ; 17(1): 82, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36578912

RESUMO

Background: Nearly 50% of Guatemalans are Indigenous Maya, yet few studies have examined the prevalence of modifiable cardiovascular disease (CVD) risk factors in Indigenous Maya populations. Therefore, we sought to estimate the prevalence of modifiable CVD risk factors in two Indigenous Maya areas in Guatemala. Methods: We conducted, between June 2018 and October 2019, a population-representative survey of adults aged 18 years and older in two rural Indigenous Maya municipalities in Guatemala. Our primary outcomes were five modifiable CVD risk factors: diabetes, hypertension, obesity, smoking, and alcohol use. We estimated the crude and age-standardized prevalence of each outcome. We also constructed multivariable logistic regression models to assess prevalence over covariates including age, sex, education level, ethnicity, and poverty. Sampling weights adjusted for nonresponse, and appropriate survey commands were used in all analyses. Results: The crude prevalence of diabetes was 12.5% (95% confidence Interval [CI] 9.6% to 16.1%), hypertension 20.3% (95% CI 17.1% to 23.9%), obesity 23.7% (95% CI 19.4% to 28.6%), smoking 10.7% (95% CI 7.8% to 14.5%), and high alcohol use 0.9% (95% CI 0.5% to 1.6%). Age-standardized prevalence of each outcome was similar to the crude prevalence. The prevalence of multiple CVD risk factors increased between the age groups 18-29 years and 50-59 years before decreasing among older age groups. Men had twenty-fold higher smoking prevalence than women (20.5% vs. 1.2%, respectively) and women had nearly double the age-adjusted prevalence of obesity as men (30.1% vs. 17.0%, respectively). Conclusion: There is a substantial prevalence of modifiable CVD risk factors in rural, Indigenous populations in Guatemala, in particular hypertension, diabetes, obesity (among women), and smoking (among men). These findings can help catalyze policy and clinical investments to improve the prevention, management, and control of CVD risk factors in these historically marginalized communities.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus , Hipertensão , Adulto , Masculino , Humanos , Feminino , Idoso , Adolescente , Adulto Jovem , Doenças Cardiovasculares/epidemiologia , Fatores de Risco , Cidades , Prevalência , Guatemala/epidemiologia , Hipertensão/epidemiologia , Diabetes Mellitus/epidemiologia , Obesidade/epidemiologia
5.
Glob Heart ; 17(1): 84, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36578915

RESUMO

Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.


Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Adulto , Feminino , Humanos , Masculino , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/terapia , Angina Instável/terapia , Angina Instável/tratamento farmacológico , Atenção à Saúde , Guatemala/epidemiologia , Estudos Prospectivos , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Resultado do Tratamento
6.
BMC Public Health ; 22(1): 2320, 2022 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-36510216

RESUMO

BACKGROUND: Uncontrolled hypertension is a major public health burden and the most common preventable risk factor for cardiovascular diseases in Guatemala and other low- and middle-income countries. Prior to an initial trial that evaluated a hypertension intervention in rural Guatemala, we collected qualitative information on the needs and knowledge gaps of hypertension care within Guatemala's public healthcare system. This analysis applied Kleinman's Explanatory Models of Illness to capture how patients, family members, community-, district-, and provincial-level health care providers and administrators, and national-level health system stakeholders understand hypertension.  METHODS: We conducted in-depth interviews with three types of participants: 1) national-level health system stakeholders (n = 17), 2) local health providers and administrators from district, and health post levels (25), and 3) patients and family members (19) in the departments of Sololá and Zacapa in Guatemala. All interviews were conducted in Spanish except for 6 Maya-Kaqchikel interviews. We also conducted focus group discussions with auxiliary nurses (3) and patients (3), one in Maya-Tz'utujil and the rest in Spanish. Through framework and matrix analysis, we compared understandings of hypertension by participant type using the Explanatory Model of Illness domains -etiology, symptoms, pathophysiology, course of illness, and treatment. RESULTS: Health providers and administrators, and patients described hypertension as an illness that spurs from emotional states like sadness, anger, and worry; is inherited and related to advanced age; and produces symptoms that include a weakened body, nerves, pain, and headaches. Patients expressed concerns about hypertension treatment's long-term consequences, despite trying to comply with treatment. Patients stated that they combine biomedical treatment (when available) with natural remedies (teas and plants). Health providers and administrators and family members stated that once patients feel better, they often disengage from treatment. National-level health system stakeholders referred to lifestyle factors as important causes, considered patients to typically be non-compliant, and identified budget limitations as a key barrier to hypertension care. The three groups of participants identified structural barriers to limited hypertension care (e.g., limited access to healthy food and unaffordability of medications). CONCLUSION: As understandings of hypertension vary between types of participants, it is important to describe their similarities and differences considering the role each has in the health system. Considering different perceptions of hypertension will enable better informed program planning and implementation efforts.


Assuntos
Hipertensão , Humanos , Hipertensão/terapia , Família , Pessoal de Saúde , Pessoal Administrativo , Programas Governamentais , Guatemala , Pesquisa Qualitativa
7.
PLoS Negl Trop Dis ; 16(11): e0010480, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36383617

RESUMO

During the course of the 2015-2017 outbreak of Zika virus (ZIKV) in the Americas, the emerging virus was recognized as a congenital infection that could damage the developing brain. As the Latin American ZIKV outbreak advanced, the scientific and public health community questioned if this newly recognized neurotropic flavivirus could affect the developing brain of infants and young children infected after birth. We report here the study design, methods and the challenges and lessons learned from the rapid operationalization of a prospective natural history cohort study aimed at evaluating the potential neurological and neurodevelopmental effects of postnatal ZIKV infection in infants and young children, which had become epidemic in Central America. This study enrolled a cohort of 500 mothers and their infants, along with nearly 400 children 1.5-3.5 years of age who were born during the initial phase of the ZIKV epidemic in a rural area of Guatemala. Our solutions and lessons learned while tackling real-life challenges may serve as a guide to other researchers carrying out studies of emerging infectious diseases of public health priority in resource-constrained settings.


Assuntos
Complicações Infecciosas na Gravidez , Infecção por Zika virus , Zika virus , Lactente , Criança , Feminino , Humanos , Pré-Escolar , Gravidez , Estudos de Coortes , Estudos Prospectivos , Guatemala/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-36360942

RESUMO

Women and children in rural regions of low-income countries are exposed to high levels of household air pollution (HAP) as they traditionally tend to household chores such as cooking with biomass fuels. Early life exposure to air pollution is associated with aeroallergen sensitization and developing allergic diseases at older ages. This prospective cohort study assigned HAP-reducing chimney stoves to 557 households in rural Guatemala at different ages of the study children. The children's air pollution exposure was measured using personal CO diffusion tubes. Allergic outcomes at 4-5 years old were assessed using skin prick tests and International Study of Asthma and Allergies in Childhood (ISAAC)-based questionnaires. Children assigned to improved stoves before 6 months old had the lowest HAP exposure compared to the other groups. Longer exposure to the unimproved stoves was associated with higher risks of maternal-reported allergic asthma (OR = 2.42, 95% CI: 1.11-5.48) and rhinitis symptoms (OR = 2.01, 95% CI: 1.13-3.58). No significant association was found for sensitization to common allergens such as dust mites and cockroaches based on skin prick tests. Reducing HAP by improving biomass burning conditions might be beneficial in preventing allergic diseases among children in rural low-income populations.


Assuntos
Poluição do Ar em Ambientes Fechados , Asma , Hipersensibilidade , Criança , Humanos , Feminino , Pré-Escolar , Lactente , Poluição do Ar em Ambientes Fechados/efeitos adversos , Poluição do Ar em Ambientes Fechados/análise , Biomassa , Estudos Prospectivos , Guatemala/epidemiologia , Culinária , Alérgenos , Asma/epidemiologia , Asma/etiologia , Fumaça/efeitos adversos
9.
An Acad Bras Cienc ; 94(suppl 4): e20210445, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36449856

RESUMO

From a standpoint of phytosociological research, little is known about the phytocoenosis found on the volcanoes of Central America. This paper analyses the distribution of the vegetation on the volcano of San Pedro in terms of its species-richness, composition, structure and abundance, and the possible relationships between these components and the changes in elevation and orientation that occur there. We divided the study area into three altitudinal belts between 2,400 and 3,020 m a.s.l. where carried out 36 inventories, each one in an area of 0.1 ha. We then applied multivariate analysis to classify and order the data in the matrix obtained from the frequency of the sampled plants. Our results lead us to propose two mixed cloud-forest associations within the class Alnetea acuminatae. The first, Saurauio oreophilae-Alnetum acuminatae ass. nova, is found on the more humid western side, while the second, Adianto andicolae-Quercetum peduncularis ass. nova, appears in sunnier and less shady sites, mainly on the east face. As part of this latter association, we also identified the new subassociation festucetosum amplissimae subass. nova. These syntaxa are part of the alliance Oreopanacion xalapensis all. nova, which we have created to embrace the mesophytic montane forests dominated by broad-leaved species.


Assuntos
Florestas , Registros , Animais , Guatemala , Análise Multivariada , Equidae
10.
Guatemala; OPS; 2022-11-21. (OPS/GTM/22-0001).
Não convencional em Espanhol | PAHO-IRIS | ID: phr2-56335

RESUMO

En el 2022 se celebra el 120.º aniversario de la Organización Panamericana de la Salud (OPS). En calidad de organismo independiente especializado en salud del sistema interamericano, la OPS brinda cooperación técnica a sus Estados Miembros para abordar las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, como Oficina Regional de la Organización Mundial de la Salud para la Región de las Américas, participa en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible a nivel de país. A nivel subregional, la OPS trabaja con los mecanismos de integración para que la salud y sus determinantes tengan un lugar en la agenda política. En el informe anual correspondiente al 2021 se presenta la cooperación técnica de la OPS en los países y territorios en este período, con la aplicación de las estrategias de cooperación en los países, la respuesta a sus necesidades y prioridades, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la OPS y los Objetivos de Desarrollo Sostenible. En consonancia con el tema general de "responder a la COVID-19 y prepararse para el futuro", se ponen de relieve las medidas que ha adoptado la OPS con respecto a la pandemia de COVID-19 y sus esfuerzos continuos en áreas prioritarias como las emergencias de salud, los sistemas y servicios de salud, las enfermedades transmisibles, las enfermedades no transmisibles y la salud mental, la salud a lo largo del curso de vida y la equidad en la salud. También se presenta un resumen financiero del bienio 2020-2021.


Assuntos
COVID-19 , Emergências , Sistemas de Saúde , Serviços de Saúde , Doenças Transmissíveis , Equidade , Equidade de Gênero , Diversidade Cultural , Cooperação Técnica , América , Guatemala
11.
Nutrients ; 14(19)2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36235598

RESUMO

(1) Background: Guatemala is the Latin American country with the highest prevalence of childhood stunting. Short height can bias the diagnosis of wasting when using the weight-for-height indicator. The aim of this study was to evaluate the diagnostic concordance of the anthropometric indicators of wasting and the relationship between wasting and stunting in children from highly vulnerable communities in Guatemala. (2) Methods: The sample consisted of 13,031 anthropometric records of children under five years of age (49.5% girls, average age of 27.9 months), including weight, height, and mid-upper arm circumference (MUAC), collected in March-August 2019. The proportions of stunting, underweight, and wasting, assessed by three different indicators, as well as their concurrence through the Composite Index of Anthropometric Failure were calculated. (3) Results: Stunting affected 73% of the sample, and 74.2% showed anthropometric failure. Wasting varied by indicator (weight-for-height: 2.8%; MUAC: 4.4%; MUAC-for-age: 10.6%). Concordance between MUAC and weight-for-height was very low (Kappa: 0.310; sensitivity: 40.9%). MUAC identified more wasted children in the stunted group (53.6% vs. 26.5%), while the opposite occurred in the non-stunted group (34.8% vs. 46.7%). (4) Conclusion: The presence of stunting affected the diagnosis of wasting, and both indicators should be included as diagnostic criteria for screening campaigns and in the treatment of moderate to acute wasting in vulnerable populations affected by multiple forms of undernutrition.


Assuntos
Desnutrição , Saúde Pública , Estatura , Caquexia , Criança , Pré-Escolar , Feminino , Transtornos do Crescimento/diagnóstico , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Guatemala/epidemiologia , Humanos , Lactente , Masculino , Desnutrição/diagnóstico , Desnutrição/epidemiologia
12.
Trials ; 23(1): 891, 2022 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-36273180

RESUMO

BACKGROUND: Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. METHODS: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. DISCUSSION: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04277325. Registered on February 20, 2020.


Assuntos
Terapia de Casal , Terapia Focada em Emoções , Humanos , Terapia de Casal/métodos , Idioma , México , Espanha , Argentina , Costa Rica , Guatemala , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Multicêntricos como Assunto
13.
Am J Trop Med Hyg ; 107(5): 1099-1106, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36252798

RESUMO

Although Central America is largely dengue virus (DENV)-endemic, the 2015-2016 Zika virus (ZIKV) pandemic brought new urgency to develop surveillance approaches capable of characterizing the rapidly changing disease burden in resource-limited settings. We conducted a pediatric DENV surveillance study in rural Guatemala, including serial cross-sectional surveys from April through September 2015 (Survey 1), in October-November 2015 (Survey 2), and January-February 2016 (Survey 3). Serum underwent DENV IgM MAC ELISA and polymerase chain reaction testing. Using banked specimens from Surveys 2 and 3, we expanded testing to include DENV 1-4 and ZIKV microneutralization (MN50), DENV NS1 IgG ELISA, and ZIKV anti-NS1 antibody Blockage of Binding (BoB) ELISA testing. Demographic risk factors for ZIKV BoB positivity were explored using multivariable generalized linear regression models. Of Survey 2 and 3 samples available (N = 382), DENV seroprevalence slightly increased (+1%-10% depending on the assay) during the surveillance period and increased with age. In contrast, ZIKV seroprevalence consistently increased over the 3-month period, including from 6% to 34% (P < 0.0001) and 10%-37% (P < 0.0001) using the MN50 ≥100 and BoB ELISA assays, respectively. Independent risk factors for ZIKV seropositivity included older age (prevalence ratio (PR)/year = 1.12, 95% confidence interval (CI) = 1.07-1.17) and primary caregiver literacy (PR = 2.80, CI = 1.30-6.06). Rapid active surveillance (RAS) surveys demonstrated a nearly 30% increase in ZIKV prevalence and a slight (≤ 10%) increase in DENV seroprevalence from October to November 2015 to January to February 2016 in rural southwest Guatemala, regardless of serologic assay used. RAS surveys may be a useful "off-the-shelf" tool to characterize arboviruses and other emerging pathogens rapidly in resource-limited settings.


Assuntos
Vírus da Dengue , Dengue , Infecção por Zika virus , Zika virus , Criança , Humanos , Estudos Soroepidemiológicos , Estudos Transversais , Guatemala/epidemiologia , Anticorpos Antivirais , Ensaio de Imunoadsorção Enzimática , Reações Cruzadas
14.
West J Emerg Med ; 23(5): 746-753, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36205672

RESUMO

INTRODUCTION: Access to emergency care is an essential part of the health system. Improving access to emergency services in low- and middle-income countries (LMIC) decreases mortality and reduces global disparities; however, few studies have assessed emergency services resources in LMICs. To guide future improvements in care, we performed a comprehensive assessment of the emergency services capacity of a rural community in Guatemala serving a mostly indigenous population. METHODS: We performed an exhaustively sampled cross-sectional survey of all healthcare facilities providing urgent and emergent care in the four largest cities surrounding Lake Atitlán using the Emergency Services Resource Assessment Tool (ESRAT). RESULTS: Of 17 identified facilities, 16 agreed to participate and were surveyed: nine private hospitals; four public clinics; and three public hospitals, including the region's public departmental hospital. All facilities provided emergency services 24/7, and a dedicated emergency unit was available at 67% of hospitals and 75% of clinics. A dedicated physician was present in the emergency unit during the day at 67% of hospitals and 75% of clinics. Hospitals had a significantly higher percentage of available equipment compared to clinics (85% vs 54%, mean difference 31%; 95% confidence interval (CI) 23-37%; P = 0.004). There was no difference in availability of laboratory tests between public and private hospitals or between cities. Private hospitals had access to a significantly higher percentage of medications compared to clinics (56% vs 27%, mean difference 29%; 95% CI 9-49%; P = 0.024). CONCLUSION: We found a high availability of emergency services and universal availability of personal protective equipment but a severe shortage of critical medications in clinics, and widespread shortage of pediatric equipment.


Assuntos
Serviços Médicos de Emergência , População Rural , Criança , Estudos Transversais , Guatemala , Acesso aos Serviços de Saúde , Hospitais Públicos , Humanos
15.
Proc Natl Acad Sci U S A ; 119(40): e2121821119, 2022 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-36161917

RESUMO

Cacao seeds, Theobroma cacao, provide the basis for a ceremonially important Mesoamerican food. Past efforts to identify cacao in ceramics focused on highly decorative vessel forms associated with elite ceremonial contexts, creating assumptions as to how cacao was distributed and who could access it. This study examines 54 archaeological ceramic sherds from El Pilar (Belize/Guatemala) of Late Classic (600 to 900 CE) residential and civic contexts representing a cross-section of ancient Maya inhabitants. Identification of cacao in ancient sherds has depended on the general presence of theobromine; we used the discrete presence of theophylline, a unique key biomarker for cacao in the region. Analysis was done by grinding off all outside surfaces to reduce contamination, pulverizing the inner clay matrix, extracting absorbed molecules, and concentrating the extractions. In order to obtain especially high selectivity and low limits of detection, our study utilized the technique of resonance-enhanced multiphoton ionization coupled with laser-desorption jet-cooling mass spectrometry. This technique isolates molecules in the cold gas phase where they can be selectively ionized through a resonant two-photon process. Of the sherds analyzed, 30 samples (56%) were found to contain significant amounts of theophylline and thus test positive for cacao. Importantly, cacao is present in all contexts, common to all Maya residents near and far from centers.


Assuntos
Cacau , Belize , Cacau/anatomia & histologia , Cacau/história , Argila , Guatemala , História Antiga , Sementes/química , Teobromina/análise , Teobromina/história , Teofilina/análise , Teofilina/história
16.
JCO Glob Oncol ; 8: e2200124, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36179269

RESUMO

PURPOSE: Surveys to assess patient and family experiences of pediatric cancer care have been primarily developed and validated in high-income Western settings with English-speaking participants. However, 90% of children with cancer live in low- and middle-income countries. We sought to develop a survey focused on pediatric cancer communication for use in a low-literacy population in Guatemala, including adaptation of many previously validated items. METHODS: A multidisciplinary team developed a quantitative survey on the basis of a theoretical model of important components and influences on pediatric cancer communication. The original survey included established items previously used in high-income settings and novel questions designed for this study. The survey was translated into Spanish and pilot tested with parents of children receiving treatment at Unidad Nacional de Oncologia Pediatrica in Guatemala City, Guatemala, from April-June 2019. Cognitive interviews were used during pilot testing, and the survey was iteratively revised throughout this process. RESULTS: Early in testing, Guatemalan parents tended to choose answers at the extreme ends of response categories and socially desirable responses. Ultimately, a visual aid was developed to accompany three-item Likert scale response options. This allowed for successful administration of the survey instrument, resulting in moderate variation of response options and similar proportions to those generated when the original five-item responses were used in parent populations from the United States. CONCLUSION: Appropriately adapted surveys are necessary to understand patient-centered communication among pediatric oncology populations in low- and middle-income countries. Eventual validation of such tools will enable cross-cultural studies and comparative analysis of results.


Assuntos
Neoplasias , Pais , Criança , Comunicação , Guatemala , Humanos , Neoplasias/diagnóstico , Neoplasias/terapia , Pais/psicologia , Assistência Centrada no Paciente , Estados Unidos
17.
Public Health Nutr ; 25(11): 3252-3264, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35993181

RESUMO

OBJECTIVE: To identify the corporate political activity (CPA) strategies used by food industry actors during the development of two public health nutrition policies in Central America: Law #570 (taxation of sugar-sweetened beverages) in Panama and Bill #5504 (labelling and food marketing regulations) in Guatemala. DESIGN: We triangulated data from publicly available information from 2018 to 2020, (e.g. industry and government materials; social media material) with semi-structured interviews with key stakeholders. SETTING: Guatemala and Panama. PARTICIPANTS: Government, academia and international organisations workers in health and nutrition. DESIGN: CPA strategies were categorised according to an existing internationally used taxonomy into action-based, instrumental strategies (coalition management, information management, direct involvement and influence in policy, legal action) and discursive strategies. RESULTS: Instrumental strategies included the establishment of relationships with policymakers and direct lobbying against the proposed public policies. Discursive strategies were mainly criticising on the unfounded ground that they lacked evidence of effectiveness and will imply negative impacts on the economy. The industry pointed at individuals for making their own food choices, in order to shift the focus away from the role of its products in contributing to ill health. CONCLUSION: We provide evidence of the political practices used by the food industry to interfere with the development and implementation of public health nutrition policies to improve diets in Central America. Policymakers, public health advocates and the public should be informed about those practices and develop counterstrategies and arguments to protect the public and policies from the vested interests of the food industry.


Assuntos
Indústria Alimentícia , Saúde Pública , Guatemala , Humanos , Manobras Políticas , Política Nutricional
18.
Int J STD AIDS ; 33(11): 987-994, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35978450

RESUMO

BACKGROUND: People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala. METHODS: Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression. RESULTS: Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4+ T cell count < 200 cells/mm3 (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome. CONCLUSIONS: Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.


Assuntos
Infecções por HIV , Hiperuricemia , Síndrome Metabólica , Adulto , Alcinos , Benzoxazinas , Estudos Transversais , Ciclopropanos , Feminino , Guatemala/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Prevalência , Fatores de Risco
19.
Acta Trop ; 235: 106655, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35977598

RESUMO

Triatoma dimidiata is the main vector of Chagas disease in southern Mexico, Central America and northern South America. As a native vector, it moves readily among domestic, peri­domestic and sylvatic environments, making it difficult to control only using insecticide as this requires regular application, and re-infestation frequently occurs. Other social innovation alternatives such as those based on Ecohealth principles can be used to tackle the dynamics of the disease in an integral way. We asked whether an Ecohealth intervention, implemented beginning in 2001 in a highly infested village, 41.8%, in southeastern Guatemala, was sustainable in the long term. This intervention included initial insecticide treatments, followed by making low-cost house improvements to eliminate transmission risk factors such as repairing cracked walls, covering dirt floors with a cement-like substance and moving domestic animals outside. We assessed the long-term sustainability through entomological and house condition surveys, as well as an analysis of community satisfaction. We found over a 19-year period, infestation with T. dimidiata was reduced to 2.2% and maintained at a level below the level (8%) where vector transmission is unlikely. This long-term maintenance of low infestation coincided with a large proportion of villagers (88.6%) improving their houses and completing other aspects of the Ecohealth approach to maintain the village at low risk for Chagas transmission. There was unanimous satisfaction among the villagers with their houses, following improvements using the Ecohealth method, which likely played a role in the long-term persistence of the modifications. Although the infestation has remained low, 11 years following the last intervention and as the population grew there has been an increase in the proportion of "at-risk" houses, to 33%, pointing out the necessity of maintaining vigilance. The Ecohealth approach is a low-cost, sustainable approach for the long-term control of vector-borne Chagas disease. We recommend this approach including ongoing community monitoring and institutional response for the long-term, integrated control of Chagas disease.


Assuntos
Doença de Chagas , Inseticidas , Triatoma , Animais , Doença de Chagas/prevenção & controle , Guatemala/epidemiologia , Habitação , Controle de Insetos/métodos , Insetos Vetores/fisiologia , Triatoma/fisiologia
20.
BMC Nephrol ; 23(1): 282, 2022 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-35962338

RESUMO

BACKGROUND: Community engagement is essential for effective research when addressing issues important to both the community and researchers. Despite its effectiveness, there is limited published evidence concerning the evaluation of community engagement in research projects, especially in the area of nephrology. METHODS: We developed a community engagement program in Guatemala to address the role of hydration in chronic kidney disease of unknown origin, using five key engagement principles: 1. Local relevance and determinants of health. 2. Acknowledgment of the community. 3. Dissemination of findings and knowledge gained to all partners. 4. Usage of community partners' input. 5. Involvement of a cyclical and iterative process in the pursuit of goals. The effectiveness of community engagement was measured by a structured questionnaire on a 5-point likert scale. This measure determined how well and how often the research team adhered to the five engagement principles. We assessed internal consistency for each set of the engagement items through Omega coefficient. RESULTS: Sixty-two community leaders completed the questionnaire. Seventy-five percent were female, with a mean age of 37 years. All 5 engagement principles scored highly on the 5-point likert scale. Every item set corresponding to an engagement principles evaluation had a Omega coefficient > 0.80, indicating a firm internal consistency for all question groups on both qualitative and quantitative scales. CONCLUSION: Engagement of the community in the kidney research provides sustainability of the efforts and facilitates the achievements of the goals. Community leaders and researchers became a team and develop a relationship in which commitment and empowerment facilitated the participation in all aspects of the research process. This initiative could be a useful tool for researchers, especially in low-middle income countries, to start research in a community, achieve objectives in a viable form, and open opportunities to further studies.


Assuntos
Empoderamento , Hispânico ou Latino , Adulto , Feminino , Guatemala , Humanos , Rim , Masculino , Inquéritos e Questionários
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