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1.
Washington, D.C.; PAHO; 2022-01-11.
en Inglés, Español | PAHO-IRIS | ID: phr-55594

RESUMEN

[WEEKLY SUMMARY]. North America: Overall, influenza activity remained low but increasing. In Canada, influenza A and B virus co-circulated with influenza A(H3N2) and A(H1N1)pdm09 among samples where subtyping was performed; SARS-CoV-2 activity slightly increased. In Mexico, influenza A(H3N2) prevailed, with B co-circulating and SARS-CoV-2 activity increased. In the United States, influenza A(H3N2) predominated, with SARS-CoV-2 activity increasing, hospitalizations and deaths remained elevated. Respiratory syncytial virus activity remained high in Canada. Caribbean: Influenza remained at low activity levels. Haiti reported a few detections in recent weeks with the predominance of influenza B/Victoria and A(H1N1)pdm09. In Suriname, SARS-CoV-2 and SARI activity decreased to low levels. Central America: Influenza activity continued low and SARS-CoV-2 activity decreased to low levels overall. In Guatemala, influenza activity decreased with the predominance of influenza A(H3N2) in the previous week, while influenza A(H3N2) circulation increased in Honduras with low SARI and ILI activity. Andean: Overall, influenza activity remained low; however, Bolivia, Ecuador, and Peru reported increased influenza activity associated with A(H3N2) detections. SARS-CoV-2 activity stands elevated in Bolivia and Ecuador; and in Bolivia, SARI activity continued at extraordinary levels. Brazil and Southern Cone: Influenza activity increased to pre-pandemic levels, and SARS-CoV-2 activity continues at low levels, except in Argentina. Influenza A(H3N2) detections continue to rise in Brazil, Chile, Paraguay, and Uruguay. Most activity and increasing A(H3N2) detections are recorded in Brazil and Uruguay. Global: In the temperate zones of the northern hemisphere, influenza activity, although still low, appeared to increase in some countries with detections of mainly influenza A(H3N2) and B Victoria lineage (mainly in China). In Europe, influenza activity continued to increase. Influenza A(H3N2) predominated. In East Asia, influenza activity continued rising in China, while influenza illness indicators and activity remained low in the rest of the subregion. Influenza B/Victoria viruses predominated. In tropical Africa, overall influenza activity continued decreasing, with both influenza A and B detected. In Southern Asia, influenza virus detections of predominately influenza A(H3N2) increased overall, although reducing in a few countries. In South-East Asia, sporadic influenza detections were reported in the Philippines. However, in the temperate zones of the southern hemisphere, influenza activity remained low overall. SARS-CoV-2 percent positivity from sentinel surveillance increased to approximately 30%. Activity remained under 10% positivity in the Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO. In the other WHO Regions, an increasing trend in positivity was observed in recent weeks. Overall positivity from non-sentinel sites also increased and was at 25%.


[RESUMEN SEMANAL] América del Norte: en general, la actividad de la influenza se mantuvo baja pero en aumento. En Canadá, el virus de la influenza A y B circularon concurrentemente con los virus influenza A(H3N2) y A(H1N1)pdm09 en las muestras a las que se les determinó el subtipo; la actividad del SARS-CoV-2 aumentó ligeramente. En México, predominó el virus influenza A(H3N2), con la circulación concurrente de B, y la actividad del SARS-CoV-2 aumentó. En los Estados Unidos, predominó la influenza A(H3N2), con un aumento de la actividad del SARS-CoV-2, las hospitalizaciones y muertes se mantuvieron elevadas. La actividad del virus respiratorio sincitial se mantuvo alta en Canadá. Caribe: la influenza se mantuvo en niveles bajos de actividad. Haití reportó algunas detecciones en las últimas semanas con predominio de influenza B/Victoria y A(H1N1)pdm09. En Surinam, la actividad del SARS-CoV-2 e IRAG disminuyó a niveles bajos. América Central: la actividad de la influenza continuó baja y la actividad del SARS-CoV-2 disminuyó a niveles bajos en general. En Guatemala, la actividad de la influenza disminuyó con el predominio de la influenza A(H3N2) en semanas previa, mientras que la circulación de la influenza A(H3N2) aumentó en Honduras con baja actividad de IRAG y ETI. Andina: en general, la actividad de la influenza se mantuvo baja; sin embargo, Bolivia, Ecuador y Perú informaron un aumento de la actividad de la influenza asociada con las detecciones de A(H3N2). La actividad de SARS-CoV-2 se mantiene elevada en Bolivia y Ecuador; y en Bolivia, la actividad de la IRAG continuó en niveles extraordinarios. Brasil y Cono Sur: la actividad de la influenza aumentó a niveles prepandémicos y la actividad del SARS-CoV-2 continúa en niveles bajos, excepto en Argentina. Las detecciones de influenza A(H3N2) continúan aumentando en Brasil, Chile, Paraguay y Uruguay. La mayor parte de la actividad y las detecciones crecientes de A(H3N2) se registran en Brasil y en Uruguay. Global: en las zonas templadas del hemisferio norte, la actividad de la influenza, aunque todavía baja, pareció aumentar en algunos países con detecciones de influenza principalmente A(H3N2) y B linaje Victoria (principalmente en China). En Europa, la actividad gripal siguió aumentando. Predominó influenza A(H3N2). En el este de Asia, la actividad de la influenza siguió aumentando en China, mientras que los indicadores y la actividad de la enfermedad por influenza se mantuvieron bajos en el resto de la subregión. Predominaron los virus influenza B linaje Victoria. En África tropical, la actividad general de la influenza continuó disminuyendo y se detectaron tanto la influenza A como la B. En el sur de Asia, en general, las detecciones de los virus de la influenza predominantemente A(H3N2) aumentaron, aunque disminuyeron en algunos países. En el sudeste asiático, en Filipinas se informaron detecciones esporádicas de influenza. Sin embargo, en las zonas templadas del hemisferio sur, la actividad de influenza se mantuvo baja en general. El porcentaje de positividad de SARS-CoV-2 de la vigilancia centinela aumentó a aproximadamente el 30%. La actividad se mantuvo por debajo del 10 % de positividad en las Regiones del Mediterráneo Oriental, Asia Sudoriental y el Pacífico Occidental. En las otras Regiones, se observó una tendencia creciente en la positividad en las últimas semanas. La positividad general de los sitios no centinela también aumentó y fue del 25%.


Asunto(s)
Gripe Humana , COVID-19 , SARS-CoV-2 , Betacoronavirus , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe , Gripe Humana , Reglamento Sanitario Internacional , Urgencias Médicas , Américas , Región del Caribe
2.
AIDS Behav ; 2022 Jan 04.
Artículo en Inglés | MEDLINE | ID: mdl-34982320

RESUMEN

The goal of this paper is to determine the association between traveling to engage in sex work in another country and recent access to HIV testing among substance-using female sex workers (FSWs) in the Mexico-Guatemala border region. From 2012 to 2015, through modified time-location sampling and peer referral, 255 FSWs were recruited at Mexico's southern border. Participants completed questionnaires on sociodemographics, migration and mobility experiences, work environment factors, and substance use. A conceptual framework, as depicted by a directed acyclic graph (DAG), guided our analysis. Crude and adjusted logistic regression models were used to evaluate the relationships between mobility experiences and HIV testing in the past year. Overall HIV testing was low (41%); after considering relevant covariates (i.e., interaction with health services and organizations, and sex work characteristics) traveling to engage in sex work in another country was found to be positively associated with HIV testing in the past year. Future efforts need to consider voluntary and non-stigmatizing prevention HIV services and focus on reaching out to less mobile women.

3.
PLoS One ; 17(1): e0261161, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35025914

RESUMEN

BACKGROUND: The coverage for reproductive care continuum is a growing concern for communities in low- income economies. Adolescents (15-19 years) are often at higher odds of maternal morbidity and mortality due to other underlying factors including biological immaturity, social, and economic differences. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20-49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive care-seeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design. METHODS: In each country, communities in two districts/sub-districts received timed community health worker (CHW) household health promotion and social accountability interventions with community scorecards. Two matched districts/sub-districts were selected for comparison and received routine healthcare services. RESULTS: Results from the final evaluation showed that there were no significant differences in the care continuum for adolescents and adults except for Kenya (26.1% vs 18.8%, p<0.05). SBA was significantly higher for adolescents compared to adult women for Guatemala (64% vs 55.5%, p<0.05). Adolescents in the intervention sites showed significantly higher ANC utilization for Kenya (95.3% vs 84.8%, p<0.01) and Zambia (87% vs 72.7%, p<0.05), ANC4 for Cambodia (83.7% vs 43.2%, p<0.001) and Kenya (65.9% vs 48.1%, p<0.05), SBA for Cambodia (100% vs 88.9%, p<0.05), early PNC for Cambodia (91.8% vs 72.8%, p<0.01) and Zambia (56.5% vs 16.9%, p<0.001) compared to the comparison sites. However, the findings from Guatemala illustrated significantly lower care continuum for intervention sites (aOR:0.34, 95% CI 0.28-0.42, p<0.001). The study provides some evidence on the potential of multilevel community-oriented interventions to improve adolescent healthcare seeking in rural contexts. The predictors of care continuum varied across countries, indicating the importance of contextual factors in designing interventions.

4.
Transcult Psychiatry ; : 13634615211067357, 2022 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-35018876

RESUMEN

This study sought to understand interpretations of interconnections between historical trauma, contemporary violence, and resilience in a Maya Achi community currently engaged in promoting peace and social change through popular education. In particular, the ways in which participants drew upon identity and memory in articulating characteristics of community distress and resilience are discussed. The research is informed by liberation psychology and critical perspectives of mental health, particularly considering the challenges inherent in the promotion of collective memory of trauma and resistance in contexts of violence and humanitarian settings. Participant reflections on historical and contemporary violence highlight elements of collective distress, connecting identity and memory with acts of both oppression and resistance. Education and development are signaled as possible sites of resilience but also experienced as sites of power upholding the status quo. Diverse experiences and applications of identity and memory provide insight into the ways in which community organizations working in contexts of political violence might navigate polarizing and paradoxical discourses in order to subvert, co-opt, or adapt to hegemonic cultural, political, and economic power relations in the process of transformation for collective resilience.

5.
BMC Pregnancy Childbirth ; 22(1): 5, 2022 Jan 03.
Artículo en Inglés | MEDLINE | ID: mdl-34979990

RESUMEN

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.


Asunto(s)
Parto Obstétrico , Promoción de la Salud , Accesibilidad a los Servicios de Salud , Servicios de Salud Materna , Atención Prenatal , Adolescente , Adulto , Femenino , Guatemala , Instituciones de Salud , Honduras , Humanos , Persona de Mediana Edad , Nicaragua , Embarazo , Resultado del Embarazo , Adulto Joven
6.
J Ethnopharmacol ; 283: 114710, 2022 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-34626780

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: Snakebite envenoming is a public health problem of high impact in Central America. Bothrops asper, known as barba amarilla, terciopelo, and equis, is the snake species responsible for most snakebites in Central America. In this region, there is a long-standing tradition on the use of plants in the management of snakebites, especially in indigenous communities. Ethnomedical use of Eryngium foetidum L., Neurolaena lobata (L.) Cass. and Pimenta dioica (L.) Merr. to treat snakebite envenoming has been reported in Belice, Guatemala, Nicaragua, and Costa Rica. Extracts of the leaves of these plants have shown anti-venom activities in in vitro assays in previous studies. AIM OF THE STUDY: To assess the ability of organic fractions from these three plants to inhibit enzymatic activities associated with toxicity of the venom of B. asper, and to study, by docking analysis, the interaction of metalloproteinase and phospholipases A2 (PLA2) from B. asper venom with secondary metabolites previously described in these plants. MATERIALS AND METHODS: Organic fractions were obtained from these three plant species and their ability to neutralize proteolytic, PLA2 and in vitro coagulant activities of B. asper venom was assessed. A phytochemical analysis was carried out in these fractions. The interaction of secondary metabolites previously described in these plants with three toxins from B. asper venom (a metalloproteinase, a PLA2 and a PLA2 homologue) was investigated by docking analysis. RESULTS: The inhibitory activity of plants was mainly concentrated in their polar fractions. Acetonic fraction from P. dioica was the most active against PLA2 activity, while the acetonic fraction of E. foetidum completely inhibited the proteolytic activity of the venom. Coagulant activity was partially inhibited only by the acetone and ethyl acetate fractions of P. dioica. Phytochemical analysis of the most bioactive fractions identified flavonoids, saponins, essential oils, coumarins, alkaloids, tannins and sesquiterpene lactones. Docking analysis revealed high affinity interactions of several secondary metabolites of these plants with residues in the vicinity of the catalytic site of these enzymes and, in the case of PLA2 homologue myotoxin II, in the hydrophobic channel. CONCLUSIONS: Various fractions from these plants have inhibitory activity against enzymatic actions of B. asper venom which are directly associated with toxicological effects. Docking analysis showed structural evidence of the interaction of secondary metabolites with three toxins. These observations provide support to the potential of these plants to inhibit relevant toxic components of this snake venom.

7.
Violence Against Women ; 28(1): 150-168, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33471626

RESUMEN

Over a third of women in Guatemala are subjected to intimate partner violence (IPV). Indigenous Mayan women are particularly vulnerable, due to the intersection of race, gender, and poverty. However, no research exists into the causes of IPV among this group. Our pioneering study addresses this knowledge gap. Our results from in-depth interviews with service providers in Sololá highlight four interlinked causes of IPV: rigid gender roles, lack of awareness of women's rights, use of alcohol by men, and poor reproductive health. From these, we draw implications for service provision to victims of IPV.

8.
Acta Trop ; 225: 106157, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34634265

RESUMEN

The Pan American Health Organization (PAHO) has defined Chagas Disease hotspots in Central America associated with the vector Triatoma spp. Triatoma dimidiata is a native vector adapted to multiple environments, including intra-domestic and peri-domestic habitats. A multi-institutional project named "Alliances for the elimination of Chagas in Central America" was created to help reduce the incidence of the disease in the region. Activities performed in the field as part of the project included aspects of vector surveillance and control, improvement of houses, diagnosis and treatment of individuals, health promotion, training of human resources and identification of access barriers to diagnosis and treatment. As a base line study, eleven villages, comprised of 1,572 households, were entomologically evaluated (83.4% overall participation); five were found to have very high infestation rates (>20%), three had high infestation rates (8-20%) and three had low-infestation rates (<8%), coinciding with the category of infestation-risk of the houses within each village. Serological tests were carried out in 812 people (>80% participation) in two of the 11 villages and none of the 128 children tested, less than 5 years of age, were positive for Trypanosoma cruzi infection. Community participation in all the activities was high (>70%). The collaboration between several subnational, national, and international institutions, each with specific roles, promoted community participation in the activities of vector control and patient care, thus, establishing a baseline to continue implementing and monitoring project progress.


Asunto(s)
Enfermedad de Chagas , Triatoma , Trypanosoma cruzi , Animales , Enfermedad de Chagas/diagnóstico , Enfermedad de Chagas/epidemiología , Enfermedad de Chagas/prevención & control , Niño , Guatemala/epidemiología , Humanos , Control de Insectos , Insectos Vectores , Salud Pública
9.
Vaccine ; 40(3): 450-458, 2022 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-34949496

RESUMEN

AIM: There are few reliable estimates of the half-lives of maternal antibodies to the antigens found in the primary series vaccines. We aimed to calculate the half-lives of passively acquired diphtheria, tetanus and pertussis (DTP) antibodies in infants. We aimed to determine whether decay rates varied according to country, maternal age, gestational age, birthweight, World Bank income classifications, or vaccine received by the mother during pregnancy. METHODS: De-identified data from infants born to women taking part in 10 studies, in 9 countries (UK, Belgium, Thailand, Vietnam, Canada, Pakistan, USA, Guatemala and the Netherlands) were combined in an individual participant data meta-analysis. Blood samples were taken at two timepoints before any DTP-containing vaccines were received by the infant: at birth and at 2-months of age. Decay rates for each antigen were log2-transformed and a mixed effects model was applied. Half-lives were calculated by taking the reciprocal of the absolute value of the mean decay rates. RESULTS: Data from 1426 mother-infant pairs were included in the analysis. The half-lives of the 6 antigen-specific maternal antibodies of interest were similar, with point estimates ranging from 28.7 (95% CI: 24.4 - 35) days for tetanus toxoid antibodies to 35.1 (95% CI: 30.7 - 41.1) days for pertactin antibodies. The decay of maternal antibodies did not significantly differ by maternal age, gestational age, birthweight, maternal vaccination status or type of vaccine administered. CONCLUSION: Maternal antibodies decay at different rates for the different antigens; however, the magnitude of the difference is small. Decay rates are not modified by key demographic or vaccine characteristics.

10.
Multimedia | Recursos Multimedia | ID: multimedia-9529

RESUMEN

Webinar realizado el 31 de marzo de 2020, organizado por la Red Centroamericana de Informática en Salud, con la participación de Aline Jiménez (México), Guiselle Barrantes (Costa Rica), Isabel Lobos (Guatemala), Myrna Marti (Argentina) y Sonia Viana (El Salvador), y moderado por Joseline Carías (RECAINSA).


Asunto(s)
División del Trabajo basado en el Género , Informática Médica , Sistemas de Información en Salud , Estrategias de eSalud , Mujeres Trabajadoras
11.
Front Med (Lausanne) ; 8: 768376, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34888329

RESUMEN

In recent years, post-approval changes (PACs) for medicinal products have increased faster than the national regulatory agencies can attend to without causing any negative impact. This study presents a proposal for regulatory management based on our analysis of the data available from the national regulatory agencies of Latin America on the total post-approval changes evaluated, and the time spent in the process. A retrospective search on the official websites of competent national regulatory authorities (NRAs) of 14 Latin American countries (México, Guatemala, Nicaragua, Honduras, El Salvador, Panamá, Costa Rica, Venezuela, Colombia, Ecuador, Peru, Argentina, Chile and Brazil) was conducted to collect data on post-approval changes in the last 4-6 years, up to January 2021. The NRAs considered were Brazil, México, Colombia, and Costa Rica. Our analysis was focused on the post-approval changes that required approval before implementation, those that were submitted, and those that were submitted and approved for small molecules, biologics, and biotechnological products. The results indicated differences in the regulatory processes and procedures applied by the different agencies. We also found that the implementation of the PACs was directly impacted by limited resources, which puts the medication supply for chronic treatments at risk resulting in serious consequences for patients. For local decision-making, Latin American NRAs should implement regulatory pathways already made by regulatory agencies included in the World Health Organization Listed Authorities on PAC approval to optimize their resources and to ensure the continuity of medicine supply for their patients.

12.
J Clin Tuberc Other Mycobact Dis ; 25: 100287, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34849409

RESUMEN

Background: Risk factors for mortality and MDR-TB in Guatemala are poorly understood. We aimed to identify risk factors to assist in targeting public health interventions. Methods: We performed a retrospective study of adults with pulmonary TB reported to the Guatemalan TB Program between January 1, 2016 and December 31, 2017. The primary objective was to determine risk factors for mortality in pulmonary TB. The secondary objective was to determine risk factors associated with MDR-TB. Results: Among 3,945 patients with pulmonary TB, median age was 39 years (IQR 25-54), 59% were male, 25% of indigenous ethnicity, 1.1% had MDR-TB and 3.9% died. On multivariable analysis, previous TB treatment (odds ratio [OR] 3.57, CI 2.24-5.68 [p < 0.001]), living with HIV (OR 3.98, CI 2.4-6.17 [p < 0.001]), unknown HIV diagnosis (OR 2.65, CI 1.68-4.18 [p < 0.001]), indigenous ethnicity (OR 1.79, CI 1.18-2.7 [p = 0.005]), malnutrition (OR 7.33, CI 3.24-16.59 [p < 0.001]), and lower educational attainment (OR 2.86, CI 1.43-5.88 [p = 0.003]) were associated with mortality. Prior treatment (OR 53.76, CI 25.04-115.43 [p < 0.001]), diabetes (OR 4.13, CI 2.04-8.35 [p < 0.001]), and indigenous ethnicity (OR 11.83, CI 1.46-95.73 [p = 0.02]) were associated with MDR-TB. Conclusions: In Guatemala, both previous TB treatment and indigenous ethnicity were associated with higher TB mortality and MDR-TB risk among patients with pulmonary TB.

13.
Health Promot Int ; 2021 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-34849870

RESUMEN

Mental health problems, including anxiety and depression, are a common comorbidity among gay, bisexual and other men who have sex with men (GBMSM) living with HIV. Informed by social support theory, health navigation is a strengths-based intervention that has been demonstrated to improve HIV care outcomes. The purpose of this study was to explore how health navigation influences the mental health of GBMSM living with HIV. We analyzed longitudinal qualitative in-depth interviews conducted with GBMSM (n = 29) in a 12-month multi-component intervention to improve HIV care outcomes, including health navigation. We used narrative and thematic analytic approaches to identify salient themes, including if and how themes changed over time. Participants described that navigator support helped them maintain good mental health, prevent crises and respond to crises. Navigator support included providing motivational messaging, facilitating participants' control over their health and improving access to care, which aided with supporting mental health. Navigators also responded to acute crises by providing guidance for those newly diagnosed with HIV and support for those experiencing critical life events. Participants emphasized the importance of feeling heard and valued by their navigators and gaining hope for the future as key to their wellbeing. In conclusion, health navigation may be an effective intervention for promoting mental health among GBMSM living with HIV. Additional research is needed to examine mediating pathways between navigation and mental health, including informational support, or if navigator support moderates the relationship between stressors and mental health outcomes for GBMSM.

14.
Ann N Y Acad Sci ; 2021 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-34850396

RESUMEN

A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population-specific food-based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual-level 24-h recalls (24HRs). The 24HR data from 12- to 23-month-old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES- and 24HR-defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food-group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77-100% agreement), food sources of nutrients (71-100% agreement), and FBRs (80-100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12- to 23-month-old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.

15.
BMC Pediatr ; 21(1): 534, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34852795

RESUMEN

BACKGROUND: Intrapartum-related hypoxic events, or birth asphyxia, causes one-fourth of neonatal deaths globally and in Mesoamerica. Multidimensional care for asphyxia must be implemented to ensure timely and effective care of newborns. Salud Mesoamérica Initiative (SMI) is a performance-based program seeking to improve maternal and child health for low-income areas of Central America. Our objective was to assess the impact of SMI on neonatal asphyxia care in health centers and hospitals in the region. METHODS: A pre-post design. Two hundred forty-eight cases of asphyxia were randomly selected from medical records at baseline (2011-2013) and at second-phase follow-up (2017-2018) in Mexico (state of Chiapas), Honduras, Nicaragua, and Guatemala as part of the SMI Initiative evaluation. A facility survey was conducted to assess quality of health care and the management of asphyxia. The primary outcome was coverage of multidimensional care for the management of asphyxia, consisting of a skilled provider presence at birth, immediate assessment, initial stabilization, and appropriate resuscitation measures of the newborn. Data were analyzed using multivariable logistic regression. RESULTS: Management of asphyxia improved significantly after SMI. Proper care of asphyxia in intervention areas was better (OR = 2.4; 95% CI = 1.3-4.6) compared to baseline. Additionally, multidimensional care was significantly higher in Honduras (OR = 4.0; 95% CI = 1.4-12.0) than in Mexico. Of the four multidimensional care components, resuscitation showed the greatest progress by follow-up (65.7%) compared to baseline (38.7%). CONCLUSION: SMI improved the care for neonatal asphyxia management across all levels of health care in all countries. Our findings show that proper training and adequate supplies can improve health outcomes in low-income communities. SMI provides a model for improving health care in other settings.

16.
Artículo en Inglés | MEDLINE | ID: mdl-34866040

RESUMEN

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

17.
Front Psychol ; 12: 763993, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34867664

RESUMEN

The invariance of the Preventive COVID-19 Infection Behaviors Scale (PCIBS) was evaluated in 12 Latin American countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay). A total of 5183 people from the aforementioned countries participated, selected using the snowball sampling method. Measurement invariance was assessed by multigroup confirmatory factor analysis (MG-CFA) and Multi-Group Factor Analysis Alignment (CFA-MIAL). In addition, item characteristics were assessed based on Item Response Theory. The results indicate that the original five-item version of the PCIBS is not adequate; whereas a four-item version of the PCIBS (PCIBS-4) showed a good fit in all countries. Thus, using the MG-CFA method, the PCIBS-4 achieved metric invariance, while the CFA-MIAL method indicated that the PCIBS-4 shows metric and scalar invariance. Likewise, the four items present increasing difficulties and high values in the discrimination parameters. The comparison of means of the PCIBS-4 reported irrelevant differences between countries; however, Mexico and Peru presented the highest frequency of preventive behaviors related to COVID-19. It is concluded that the PCIBS-4 is a unidimensional self-report measure which is reliable and invariant across the twelve participating Latin American countries. It is expected that the findings will be of interest to social and health scientists, as well as those professionals directly involved in public health decision making.

18.
Prev Chronic Dis ; 18: E100, 2021 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-34882536

RESUMEN

INTRODUCTION: To address the global diabetes epidemic, lifestyle counseling on diet, physical activity, and weight loss is essential. This study assessed the implementation of a diabetes self-management education and support (DSMES) intervention using a mixed-methods evaluation framework. METHODS: We implemented a culturally adapted, home-based DSMES intervention in rural Indigenous Maya towns in Guatemala from 2018 through 2020. We used a pretest-posttest design and a mixed-methods evaluation approach guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative data included baseline characteristics, implementation metrics, effectiveness outcomes, and costs. Qualitative data consisted of semistructured interviews with 3 groups of stakeholders. RESULTS: Of 738 participants screened, 627 participants were enrolled, and 478 participants completed the study. Adjusted mean change in glycated hemoglobin A1c was -0.4% (95% CI, -0.6% to -0.3%; P < .001), change in systolic blood pressure was -5.0 mm Hg (95% CI, -6.4 to -3.7 mm Hg; P < .001), change in diastolic blood pressure was -2.6 mm Hg (95% CI, -3.4 to -1.9 mm Hg; P < .001), and change in body mass index was 0.5 (95% CI, 0.3 to 0.6; P < .001). We observed improvements in diabetes knowledge, distress, and most self-care activities. Key implementation factors included 1) recruitment barriers for men, 2) importance of patient-centered care, 3) role of research staff in catalyzing health worker involvement, 4) tradeoffs between home and telephone visits, and 5) sustainability challenges. CONCLUSION: A community health worker-led DSMES intervention was successfully implemented in the public health system in rural Guatemala and resulted in significant improvements in most clinical and psychometric outcomes. Scaling up sustainable DSMES in health systems in rural settings requires careful consideration of local barriers and facilitators.

19.
Artículo en Inglés | MEDLINE | ID: mdl-34886133

RESUMEN

Single-visit "screen-and-treat" strategies using visual inspection with acetic acid (VIA) and cryotherapy (liquid nitrous oxide ablation) in low-resource settings are commonly used to detect and treat precancerous lesions for cervical cancer prevention. This study compared VIA sensitivity and specificity in rural indigenous Guatemalan communities, to that of oncogenic human papillomavirus (HPV) testing for detection of precancerous changes, using cytology as the reference standard. Between 3-8 September 2017, trained nurses examined 222 women aged 23-58 years with VIA. Specimens for liquid-based cytology and HPV testing were obtained prior to VIA with a cytobrush and transported in PreservCyt to a US clinical laboratory. VIA and HPV test sensitivities were assessed as proportions of women with abnormal cytology that had abnormal VIA or HPV results, respectively, and specificities, as proportions with normal cytology with normal VIA or negative HPV tests. Of 222 women, 18 (8.1%) had abnormal cytology (1 carcinoma in a participant who received VIA-based cryotherapy in 2015, 4 high- and 5 low-grade squamous intraepithelial lesions, and 8 atypical squamous cells of undetermined significance (ASCUS)). Excluding ASCUS, sensitivities of VIA and HPV were 20.0% and 100%, respectively. VIA-based screening may not be acceptable for detecting precancerous lesions, and field cryotherapy for preventing malignancy. The World Health Organization recommended in 2021 "…using HPV DNA detection as the primary screening test rather than VIA or cytology".

20.
Artículo en Inglés | MEDLINE | ID: mdl-34886324

RESUMEN

BACKGROUND: Clean cookstove interventions can theoretically reduce exposure to household air pollution and benefit health, but this requires near-exclusive use of these types of stoves with the simultaneous disuse of traditional stoves. Previous cookstove trials have reported low adoption of new stoves and/or extensive continued traditional stove use. METHODS: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3195 pregnant women in Guatemala, India, Peru, and Rwanda to either a liquefied petroleum gas (LPG) stove and fuel intervention (n = 1590) or to a control (n = 1605). The intervention consisted of an LPG stove and two initial cylinders of LPG, free fuel refills delivered to the home, and regular behavioral messaging. We assessed intervention fidelity (delivery of the intervention as intended) and adherence (intervention use) through to the end of gestation, as relevant to the first primary health outcome of the trial: infant birth weight. Fidelity and adherence were evaluated using stove and fuel delivery records, questionnaires, visual observations, and temperature-logging stove use monitors (SUMs). RESULTS: 1585 women received the intervention at a median (interquartile range) of 8.0 (5.0-15.0) days post-randomization and had a gestational age of 17.9 (15.4-20.6) weeks. Over 96% reported cooking exclusively with LPG at two follow-up visits during pregnancy. Less than 4% reported ever running out of LPG. Complete abandonment of traditional stove cooking was observed in over 67% of the intervention households. Of the intervention households, 31.4% removed their traditional stoves upon receipt of the intervention; among those who retained traditional stoves, the majority did not use them: traditional stove use was detected via SUMs on a median (interquartile range) of 0.0% (0.0%, 1.6%) of follow-up days (median follow-up = 134 days). CONCLUSIONS: The fidelity of the HAPIN intervention, as measured by stove installation, timely ongoing fuel deliveries, and behavioral reinforcement as needed, was high. Exclusive use of the intervention during pregnancy was also high.

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