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1.

Chronic kidney disease of non-traditional origin in Mesoamerica: a disease primarily driven by occupational heat stress

Wesseling, Catharina; Glaser, Jason; Rodríguez-Guzmán, Julieta; Weiss, Ilana; Lucas, Rebekah; Peraza, Sandra; Soares da Silva, Agnes; Hansson, Erik; Johnson, Richard J.; Hogstedt, Christer; Wegman, David H.; Jakobsson, Kristina
| Idioma(s): Inglés
[ABSTRACT]. The death toll of the epidemic of chronic kidney disease of nontraditional origin (CKDnt) in Mesoamerica runs into the tens of thousands, affecting mostly young men. There is no consensus on the etiology. Anecdotal evidence from the 1990s pointed to work in sugarcane; pesticides and heat stress were suspected. Subsequent population-based surveys supported an occupational origin with overall high male-female ratios in high-risk lowlands, but small sex differences within occupational categories, and low prevalence in non-workers. CKDnt was reported in sugarcane and other high-intensity agriculture, and in non-agricultural occupations with heavy manual labor in hot environments, but not among subsistence farmers. Recent studies with stronger designs have shown cross-shift changes in kidney function and hydration biomarkers and cross-harvest kidney function declines related to heat and workload. The implementation of a water-rest-shade intervention midharvest in El Salvador appeared to halt declining kidney function among cane cutters. In Nicaragua a water-rest-shade program appeared sufficient to prevent kidney damage among cane workers with low-moderate workload but not among cutters with heaviest workload. Studies on pesticides and infectious risk factors have been largely negative. Non-occupational risk factors do not explain the observed epidemiologic patterns. In conclusion, work is the main driver of the CKDnt epidemic in Mesoamerica, with occupational heat stress being the single uniting factor shown to lead to kidney dysfunction in affected populations. Sugarcane cutters with extreme heat stress could be viewed as a sentinel occupational population. Occupational heat stress prevention is critical, even more so in view of climate change. [RESUMEN]. La mortalidad por la epidemia de enfermedad renal crónica de origen no tradicional (ERCnt) en Mesoamérica asciende a decenas de miles de personas, principalmente hombres jóvenes. No existe consenso sobre su etiología. En la década de 1990, informes anecdóticos apuntaban como factor de riesgo al trabajo en plantaciones de caña de azúcar; se consideró como posibles causantes a los plaguicidas y el estrés térmico. Estudios de prevalencia de base poblacional subsiguientes apoyaron un origen ocupacional, con una proporción elevada de hombres respecto de las mujeres en las tierras bajas donde el riesgo era elevado, pero con pequeñas diferencias de sexo dentro de las categorías ocupacionales y baja prevalencia en el ámbito no laboral. Se reportó ERCnt en los trabajadores de la caña de azúcar y otros cultivos con alta exigencia física y en ocupaciones no agrícolas que implican trabajo manual intenso en ambientes calurosos, pero no entre los agricultores de subsistencia. Estudios recientes con diseños más sólidos han demostrado cambios en la función renal y en los biomarcadores de hidratación en el curso de los turnos laborales, y disminución de la función renal relacionada con el calor y la carga de trabajo en el curso de la cosecha. La implementación de una intervención basada en la provisión de agua, descanso y sombra a mitad de la cosecha en El Salvador detuvo la disminución de la función renal en los cortadores de caña. En Nicaragua, un programa de provisión de agua, descanso y sombra evitó la lesión renal en los trabajadores de la caña con una carga de trabajo baja y moderada, pero no entre los cortadores, quienes tienen la mayor carga de trabajo. Los estudios sobre plaguicidas y factores de riesgo infecciosos han sido en gran medida negativos. Los factores de riesgo no ocupacionales no explican los patrones epidemiológicos observados. En conclusión, el trabajo es el principal desencadenante de la epidemia de ERCnt en Mesoamérica, y el estrés térmico ocupacional es el único factor que consistentemente conduce a la disfunción renal en las poblaciones afectadas. Los cortadores que trabajan en los ingenios azucareros y están expuestos a un estrés térmico extremo podrían ser considerados una población ocupacional centinela. La prevención del estrés térmico ocupacional es crítica, más aún si se consideran los efectos del cambio climático. [RESUMO]. A mortalidade devida à epidemia de doença renal crônica de origem não tradicional (DRCnt) na Mesoamérica atinge dezenas de milhares de pessoas, principalmente homens jovens. Não há consenso sobre a sua etiologia. Na década de 1990, informações empíricas apontavam o trabalho em plantações de cana de açúcar como um fator de risco; pesticidas e estresse térmico também eram considerados causas possíveis. As pesquisas populacionais subsequentes sustentam uma origem ocupacional da doença, com uma elevada proporção de homens quando comparados à de mulheres, em areas de baixa altitude, onde o risco da doença é mais elevado, mas com pequenas diferenças de gênero quando se consideram as categorias ocupacionais e baixa prevalência no ambiente não-ocupacional. A DRCnt foi identificada em trabalhadores agrícolas da cana de açúcar e de outras culturas que exigem trabalho físico de alta intensidade e em ocupações não agrícolas envolvendo um trabalho manual intenso em ambientes quentes, mas não entre os agricultores de subsistência. Estudos recentes com desenhos mais robustos demonstraram mudanças na função renal e nos biomarcadores de hidratação ao longo dos turnos de trabalho, e diminuição da função renal relacionada à exposição ao calor e à carga de trabalho ao longo da colheita. A implementação de uma intervenção de água-descanso-sombra durante a colheita em El Salvador interrompeu o declínio da função renal em cortadores de cana. Na Nicarágua, intervenções água-descanso-sombra parecem ter sido suficientes para evitar lesões renais em trabalhadores canavieiros com cargas de trabalho baixa e moderada, mas não entre os cortadores de cana que têm carga de trabalho mais pesada. Estudos sobre exposição a pesticidas e a fatores de risco de origem infecciosa têm sido largamente negativos. Os fatores de risco não-ocupacionais não explicam os padrões epidemiológicos observados. Em conclusão, ocupação é o principal desencadeador da epidemia de DRCnt na Mesoamérica, e o estresse térmico ocupacional é o único fator comprovado que leva à disfunção renal nas populações afetadas. Os cortadores de cana que trabalham em engenhos de açúcar e expostos a um estresse térmico extremo podem ser considerados uma população ocupacional sentinela. A prevenção do estresse térmico ocupacional é crítica, especialmente considerando os efeitos das mudanças climáticas.
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2.

Clima organizacional del centro de investigaciones y estudios de la salud, CIES - UNAN ­ Managua, febrero 2019/ Organizational climate of the Center for Health Research and Studies, CIES - UNAN - Managua, February 2019

Figueroa Meza, José Ernesto
| Idioma(s): Español
OBJETIVO: Determinar el clima organizacional existente en el CIES UNANManagua, Nicaragua, febrero 2019. METODOLOGÍA: Estudio descriptivo de corte transversal, universo constituido por 31 colaboradores administrativos, docentes y de proyecto. La fuente de información fue primaria, la muestra fue de 21 colaboradores. Se utilizó el instrumento de medición propuesto por la OPS para medir Clima Organizacional, los datos se procesaron en Microsoft Excel 2019. RESULTADOS: Se caracterizó sociolaboralmente al personal, los resultados muestran que la edad promedio se encuentra entre los 41 a 60 años esto representa 13 (72.2%), en cuanto al sexo, predominan los hombres con el 10 (56%), y 8 (44%) son mujeres, se observa que el nivel de escolaridad presenta un promedio de 50% con titulos de maestría por la experiencia y experticia en la docencia a esto se le suman los años de antiguedad en la institución con un promedio de 8 (44.5%).el 8 (44%) de los colaboradores son administrativos y 6 (33.3%) de los encuestados son docentes. Los principales resultados del estudio apuntan hacia la existencia de dificultades en las cuatro variables liderazgo, motivación, reciprocidad y participación lo que incide desfavorablemente en el clima organizacional, con un promedio general de 57%. CONCLUSIÓNES: El clima organizacional no es satisfactorio, El personal considera que las autoridades no contribuyen en la realización personal y profesional, así como no existe retribución por parte de las autoridades a sus actividades laborales además de la inexistencia del reconocimiento por el buen desempeño
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3.

Estilos de vida de profesionales de la salud que laboran en el Centro de Salud Roberto Herrera Ríos, Managua, Nicaragua, Febrero del 2019/ Lifestyles of health professionals working at the Roberto Herrera Ríos Health Center, Managua, Nicaragua, February 2019

Calero Reyes, Johanna del Carmen
| Idioma(s): Español
Estudio descriptivo, transversal, con universo 89 trabajadores profesionales de la salud: Médicos, Enfermeras Auxiliar de Enfermerías, muestra 40 que cumplían con los criterios de inclusión y exclusión con representación 44.9%, fuente de información fue primaria recolectada a través de una encuesta. El 47.5% fue de edad de 20 a 30 años, el 75%fue sexo mujer, el 45% fueron médicos, el 45% soltero(a), el 47.5% de religión católicos. Los hábitos de consumo de sustancias toxicas el 55% a veces ingieren alcohol, el 75% nunca fuman, el 85% nunca usan ansiolíticos, el 85% nunca usan analgésicos opioides. Los hábitos alimenticios el 67.5% a veces ingieren gaseosas, el 42.5% consumen < de 1 litro de agua al día, el 50% a veces consumen alimentos ricos en fibras, el 52.5% a veces reduce el consumo de grasas, el 50% a veces consume vegetales, el 55% a veces consume frutas, el 50% a veces consume cereales, el 47,5% casi siempre consume proteínas, el 72.5% a veces consume comidas chatarras, el 45% a veces consumen lácteos. En cuanto al tipo de actividades el 47.5% siempre caminan, el 57.5% nunca corren, el 55 % a veces suben y bajan escaleras, el 50 % a veces bailan, el 62.5% nunca andan en bicicletas, el 65% nunca nadan, el 57% siempre realizan tareas domésticas. La edad más frecuente fue de 20 a 30 años, médicos, solteros, a veces ingieren Licor, a veces ingieren gaseosas, consumen < de 1 litro de agua al día, a veces consumen comidas chatarras, a veces consumen frutas, casi siempre consumen lácteos, siempre corren, a veces bailan y siempre realizan tareas domésticas.
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4.

Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries.

McNellan, Claire R; Dansereau, Emily; Wallace, Marielle C G; Colombara, Danny V; Palmisano, Erin B; Johanns, Casey K; Schaefer, Alexandra; Ríos-Zertuche, Diego; Zúñiga-Brenes, Paola; Hernandez, Bernardo; Iriarte, Emma; Mokdad, Ali H
| Idioma(s): Inglés
BACKGROUND: Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). METHODS: We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. RESULTS: Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62-7.69]; Mexico OR = 5.00 [95% CI: 3.41-7.32]; Honduras OR = 2.60 [95% CI: 1.42-4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21-7.23]; Mexico OR = 4.02 [95% CI: 2.77-5.82]; Honduras OR = 2.14 [95% CI: 1.26-3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. CONCLUSIONS: Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women's uptake of health care services.
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5.

Condiciones de vida y el bienestar subjetivo de los adultos mayores del distrito I y VI de Managua, Nicaragua, de noviembre 2018 - enero 2019/ Living conditions and subjective well-being of the elderly in district I and VI of Managua, Nicaragua, from November 2018 - January 2019

Leytón, Ivonne Dessireé
| Idioma(s): Español
OBJETIVO: Determinar las condiciones de vida y bienestar subjetivo de los adultos mayores del distrito I y VI de Managua, Nicaragua, de noviembre 2018 - enero 2019. DISEÑO METODOLÓGICO: Estudio descriptivo, de corte transversal. La muestra estuvo constituida por 96 adultos mayores de los distritos I y VI de la ciudad de Managua, Nicaragua, la técnica de recolección fue la entrevista, se diseñó un instrumento de 2 secciones, en la primera sección se registraron las características sociodemográficas de la población en estudio y condiciones de vida, la segunda parte estuvo conformada por el test de Diener et al. (2002) para medir el nivel de bienestar subjetivo. RESULTADOS: El 37.5%(36) tenía de 60 a 65 años, el 65.6%(63) eran mujeres y el 34.4%(33) eran hombres. El 25%(24) reportó primaria incompleta, el 43.8%(42) era casado. El 76%(73) no trabaja. El 53.1%(51) reportaron ingresos mensuales menores de C$ 5 000. El 100% tenían acceso a agua potable y luz eléctrica, el 85.4%(82) cuentan con servicio de alcantarillado. El 14.6%(14) viven solos, el 39.6%(38) de la población expresó estar totalmente de acuerdo acerca del acceso a la atención médica, el 50%(48) padecía de hipertensión arterial y el 26%(25) de diabetes mellitus. El 59.4%(57) recibe apoyo de la familia mientras que el 28.1% (27) no tiene redes de apoyo. Las principales actividades recreativas fueron: reunión con amigos, 26%(25). El 28.1%(27) está altamente satisfecho, el 18.8%(18) de las mujeres se sienten altamente satisfechas, el 26%(25) de los adultos mayores altamente satisfechos y satisfechos con su vida no viven solos. CONCLUSIONES: El grupo etario que predominó fue el de 60 a 65 años, la mayoría de la población eran mujeres con baja escolaridad, casadas, no trabajan y tiene ingresos menores a C$ 5 000 córdobas, con acceso a agua potable, luz eléctrica, servicio de alcantarillado. Los adultos mayores vivían acompañados, consideran que tienen acceso a atención médica, la enfermedad crónica más frecuente fue la hipertensión arterial, la principal red de apoyo es la familia y la actividad recreativa preferida fue la reunión con amigos. El nivel de bienestar subjetivo que predominó fue el altamente satisfecho
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6.

Reinforcing marginality? Maternal health interventions in rural Nicaragua.

Kvernflaten, Birgit
| Idioma(s): Inglés
To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth.
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7.

'Live Beautiful, Live Well' ('Vivir Bonito, Vivir Bien') in Nicaragua: Environmental health citizenship in a post-neoliberal context.

Hartmann, Chris
| Idioma(s): Inglés
The concepts Vivir Bien and Buen Vivir, often translated as 'living well' or 'collective well-being,' are central to contemporary social medicine reforms in Latin America. Owing to increasing social inequalities, notably in the public healthcare sector, Vivir Bien has regional significance as it redefines the neoliberal development goals from economic improvement to so-called post-neoliberal social goals of harmonious co-existence between society and the physical environment. To examine how this abstract concept is conceptualised, is incorporated into, and shapes state-sponsored public health strategies, I analyze the 'Vivir Limpio, Vivir Sano, Vivir Bonito, Vivir Bien … !' ('Live Clean, Live Healthy, Live Beautiful, Live Well … !') national campaign in Nicaragua that began in 2013. The campaign promotes normative socio-political ideals around environmental health citizenship, including the adoption of indigenous grammars and solidarity. However, analyses of dozens of interviews and 143 household surveys in four historically impoverished, untidy, and unhygienic communities suggest that the campaign's discourses do not resonate with citizens or their socio-economic contexts. In highlighting discrepancies between state-sponsored normative sociopolitical ideals and citizens' lived realities and perspectives, this paper introduces the term 'post-neoliberal citizenship' to reflect contemporary - and changing - conceptualizations of health, wellbeing, and citizenship in post-neoliberal Latin America.
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8.

Prospective biomonitor and sentinel bivalve species for pollution monitoring and ecosystem health disturbance assessment in mangrove-lined Nicaraguan coasts.

Aguirre-Rubí, Javier R; Ortiz-Zarragoitia, Maren; Izagirre, Urtzi; Etxebarria, Nestor; Espinoza, Felix; Marigómez, Ionan
| Idioma(s): Inglés
This research aims at contributing to the use of Polymesoda arctata, Anadara tuberculosa, and Larkinia grandis as prospective biomonitors and sentinels, surrogate of Crassostrea rhizophorae for pollution biomonitoring in mangrove-lined coastal systems. Localities were selected along the Nicaraguan coastline in the rainy and dry seasons during 2012-2013: A. tuberculosa and L. grandis were collected in the Pacific, and P. arctata in the Caribbean. The tissue concentration of metals, polycyclic aromatic hydrocarbons (PAHs) and persistent organic pollutants (POPs) were integrated into pollution indices (chemical pollution index -CPI- and pollution load index -PLI-) and biological endpoints (flesh-condition, reproduction, histopathology and stress-on-stress) were determined as biomarkers of ecosystem health disturbance. In the Caribbean, contaminant tissue concentration was low in P. arctata, with some exceptions. Ag, As, Cd, Hg, Ni and V were mainly recorded during dry season, and PAHs and POPs (HCHs, DDTs, AHTN, PCBs and BDE85) during rainy season. Metals and PAHs were not a major threat in the study area; in contrast, high levels of HCHs and DDTs and low-to-moderate levels of musk fragrances and PBDEs were recorded. Minor differences were found in biological parameters albeit during the rainy season the LT50 values were low and seemingly associated to high PLI and CPI values. In the Pacific, the main pollutants recorded in A. tuberculosa and L. grandis were HCHs, DDTs, AHTN and PDBEs in rainy season and Cd in dry season. Although basic research is needed to understand the general biology, ecology and diseases in these Pacific species, biological endpoints comparable to those used in other sentinel bivalves are seemingly suitable biomarkers of health disturbance. Overall, Caribbean P. arctata and Pacific A. tuberculosa and L. grandis seem to be potential target species for pollution monitoring and ecosystem health disturbance assessment in mangrove-lined Nicaraguan coastal systems. Their use together with C. rhizophorae would provide opportunities for common approaches to be applied in inter-ocean countries of the Mesoamerican region.
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9.

Influenza Transmission Dynamics in Urban Households, Managua, Nicaragua, 2012-2014.

Gordon, Aubree; Tsang, Tim K; Cowling, Benjamin J; Kuan, Guillermina; Ojeda, Sergio; Sanchez, Nery; Gresh, Lionel; Lopez, Roger; Balmaseda, Angel; Harris, Eva
| Idioma(s): Inglés
During August 2012-November 2014, we conducted a case ascertainment study to investigate household transmission of influenza virus in Managua, Nicaragua. We collected up to 5 respiratory swab samples from each of 536 household contacts of 133 influenza virus-infected persons and assessed for evidence of influenza virus transmission. The overall risk for influenza virus infection of household contacts was 15.7% (95% CI 12.7%-19.0%). Oseltamivir treatment of index patients did not appear to reduce household transmission. The mean serial interval for within-household transmission was 3.1 (95% CI 1.6-8.4) days. We found the transmissibility of influenza B virus to be higher than that of influenza A virus among children. Compared with households with <4 household contacts, those with >4 household contacts appeared to have a reduced risk for infection. Further research is needed to model household influenza virus transmission and design interventions for these settings.
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10.

'"For a better life …" A study on migration and health in Nicaragua'.

Gustafsson, Cecilia
| Idioma(s): Inglés
BACKGROUND: Nicaraguans have migrated internally and internationally for centuries due to economic, political and sociocultural factors. Deficiencies in the country's health care system have produced inequities in people's access to health care and medicines. Remittances have become an important source of income, partly invested in health. OBJECTIVES: The overall aim of the study was to analyse migration-health relations in contemporary Nicaragua within a broader context of socio-economic transformations. METHODS: The study uses a mixed-methods approach, combining qualitative interview data and quantitative survey data. RESULTS: The findings show that migration is commonly practised as a strategy for making a living and is related to the struggle for a better life. Health concerns are indirectly embedded in people's mobile livelihoods, but also directly influence migration motives. Furthermore, migration involves both advantages and disadvantages for health. Physical and sexual violence can come to an end for migrating women, health care and medicine can become more accessible for internal migrants, and vulnerabilities caused by environmental disasters can be avoided by moving. Moreover, remittances can improve people's everyday life and health. Yet migration can also be a stressful and health-damaging event. International migrants, particularly the undocumented, can have problems accessing health care, and also experience much danger at border crossings. Transnational families can suffer emotionally as well as physically due to separation. Findings from the survey show that family members of migrants do not rate their physical health as good as often as non-migrating families. CONCLUSIONS: The Nicaraguan population is not guaranteed its social rights of citizenship. This results in mobile livelihoods and the need for translocal social support (e.g. remittances). Migration can have both positive and negative effects on health for migrants and their family members; geographical distance and social differences are key to the outcome.
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