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Objectives: Distinct diseases prevent endangered huemul deer (Hippocamelus bisulcus) recovery. Fundamental etiological factors include nutriments, a mayor component of habitat quality. Undernutrition affects growth, skeletal development, osteopathology, reproduction and immunocompetence: this paper amplifies data corroborating micro-nutrient deficiencies among huemul. Results: In Argentina, 57% huemul cadavers exhibited osteopathology, with new cases reported here. Recently, 86% live huemul had osteopathology: cranial lesions involved antemortem tooth loss, reducing feeding efficiency and body condition, with starvation deaths. This population had tissues well deficient compared to other cervids, averaging 0.28 ppm selenium, 4.98 ppm copper, whereas for manganese 55% were deficient (2.52 ppm) and 45% adequate (42.79 ppm). Recently, lesions in one Chilean huemul were interpreted to stem from parapoxvirus. That population also has cases with cranial osteopathologies, high disease susceptibility (parapoxvirus, parasitism, foot lesions), crippled antlers, and low density, indicative of marginal habitat and primary etiological factors like undernutrition and immunosuppression. The reported atypical symptoms attributed to parapoxvirus may relate to probable diagnostic limitations, but does support presence of nutritional deficiencies. Patagonia has selenium deficient plants and livestock, including severe muscular dystrophy, and soil levels in extant huemul areas considered very deficient. Moreover, 73% of Chilean huemul were selenium deficient and 64% severely deficient with concomitant cranial osteopathology. [ABSTRACT FROM AUTHOR]

Background: The 'Sponsoring National Processes for Evidence-Informed Policy Making in the Health Sector of Developing Countries' program was launched by the Alliance for Health Policy and Systems Research, WHO, in July 2008. The program aimed to catalyse the use of evidence generated through health policy and systems research in policymaking processes through (1) promoting researchers and policy advocates to present their evidence in a manner that is easy for policymakers to understand and use, (2) creating mechanisms to spur the demand for and application of research evidence in policymaking, and (3) increased interaction between researchers, policy advocates, and policymakers. Grants ran for three years and five projects were supported in Argentina, Bangladesh, Cameroon, Nigeria and Zambia. This paper seeks to understand why projects in some settings were perceived by the key stakeholders involved to have made progress towards their goals, whereas others were perceived to have not done so well. Additionally, by comparing experiences across five countries, we seek to illustrate general learnings to inform future evidence-to-policy efforts in low- and middle-income countries.Methods: We adopted the theory of knowledge translation developed by Jacobson et al. (J Health Serv Res Policy 8(2):94-9, 2003) as a framing device to reflect on project experiences across the five cases. Using data from the projects' external evaluation reports, which included information from semi-structured interviews and quantitative evaluation surveys of those involved in projects, and supplemented by information from the projects' individual technical reports, we applied the theoretical framework with a partially grounded approach to analyse each of the cases and make comparisons.Results and Conclusion: There was wide variation across projects in the type of activities carried out as well as their intensity. Based on our findings, we can conclude that projects perceived as having made progress towards their goals were characterized by the coming together of a number of domains identified by the theory. The domains of Jacobson's theoretical framework, initially developed for high-income settings, are of relevance to the low- and middle-income country context, but may need modification to be fully applicable to these settings. Specifically, the relative fragility of institutions and the concomitantly more significant role of individual leaders point to the need to look at leadership as an additional domain influencing the evidence-to-policy process. [ABSTRACT FROM AUTHOR]

Background: The 2021 World Health Organization (WHO) guidelines on cervical cancer screening and treatment provide countries with evidence-based recommendations to accelerate disease elimination. However, evidence shows that health providers' adherence to screening guidelines is low. We conducted a study in Argentina to analyze health providers' knowledge and perceptions regarding the 2021 WHO Guidelines. Methods: A qualitative study was conducted based on individual, semi-structured interviews with health providers specializing in gynecology (n = 15). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research. Results: Although health providers perceive WHO as a reliable institution, they do not know the 2021 guidelines, its supporting evidence, and its elaboration process. Their clinical practice is mainly guided by local recommendations developed by national professional medical associations (PMAs). For interviewees, WHO guidelines should be disseminated through health authorities and national PMAs, mainly through in-service training. Health providers had a positive assessment regarding WHO Recommendation 1 (screen, triage, and treatment for women aged 30 + with HPV-testing every 5 to 10 years) and perceived a favorable climate for its implementation. HPV-testing followed by triage was considered a low-complexity practice, enabling a better detection of HPV, a better selection of the patients who will need diagnosis and treatment, and a more efficient use of health system resources. However, they suggested adapting this recommendation by removing screening interval beyond 5 years. WHO Recommendation 2 (screen-and-treat approach with HPV-testing for women aged 30 + every 5 to 10 years) was predominantly rejected by interviewees, was considered an algorithm that did not respond to women's needs, and was not adequate for the Argentinean context. Regarding the HPV-test modality, clinician-collected tests were the preferred mode. Health providers considered that HPV self-collection should be used primarily among socially vulnerable women to increase screening coverage. Conclusion: WHO guidelines should be widely disseminated among health providers, especially in settings that could benefit from a screen-and-treat approach. Identifying areas of partnership and collaboration with PMAs in implementing WHO guidelines is essential. [ABSTRACT FROM AUTHOR]

Background: Mosquito-borne diseases (e.g., transmitted by Aedes aegypti) affect almost 700 million people each year and result in the deaths of more than 1 million people annually. Methods: We examined research undertaken during the period 1951–2020 on the effects of temperature and climate change on Ae. aegypti, and also considered research location and between-country collaborations. Results: The frequency of publications on the effects of climate change on Ae. aegypti increased over the period examined, and this topic received more attention than the effects of temperature alone on this species. The USA, UK, Australia, Brazil, and Argentina were the dominant research hubs, while other countries fell behind with respect to number of scientific publications and/or collaborations. The occurrence of Ae. aegypti and number of related dengue cases in the latter are very high, and climate change scenarios predict changes in the range expansion and/or occurrence of this species in these countries. Conclusions: We conclude that some of the countries at risk of expanding Ae. aegypti populations have poor research networks that need to be strengthened. A number of mechanisms can be considered for the improvement of international collaboration, representativity and diversity, such as research networks, internationalization programs, and programs that enhance representativity. These types of collaboration are considered important to expand the relevant knowledge of these countries and for the development of management strategies in response to climate change scenarios. [ABSTRACT FROM AUTHOR]

Background: To evaluate the optical performance and safety of a new multifocal lens with a novel optical design featuring two additional foci (or intensifiers) in patients with cataract and presbyopia. Methods: In this single-center, non-randomized prospective observational study, 31 patients underwent implantation of the new multifocal IOL between March 2020 and November 2021 at a tertiary clinical center in Buenos Aires and Ramos Mejia, Argentina. Postoperative examinations with emphasis on uncorrected and corrected visual acuity at distance and near and at two different intermediate distances (80 cm and 60 cm) were performed during the 3 postoperative months. Results: Of the 31 patients who underwent implantation of the new IOL, 30 underwent bilateral surgery (61 eyes in total). At 3 months, all 61 eyes had an uncorrected distance visual acuity (UCDVA) of at least 0.15 logMAR; 57 eyes (93%) had an uncorrected distance visual acuity (UCDVA) of 0.1 logMAR and 27 eyes (44%) had an UCDVA of 0.0 logMAR. At 80 cm, 60 eyes (98%) had an uncorrected intermediate visual acuity (UCIVA) of at least 0.1 log MAR and 48 eyes (79%) had an UCIVA of 0.0 logMAR. Conclusion: The new multifocal IOL with a novel optical concept (5 foci) showed a wide range of visual acuity especially at intermediate and near distances in patients undergoing cataract surgery. Uncorrected visual acuity was excellent at all tested distances, monocularly and binocularly, spectacle independence and patient satisfaction were high. [ABSTRACT FROM AUTHOR]

Background: Eco-anxiety is increasingly recognized as a shared experience by many people internationally, encompassing fear of environmental catastrophe and anxiety about ecological crises. Despite its importance in the context of the changing climate, measures for this construct are still being developed in languages other than English. Methods: To contribute to global eco-anxiety research, we translated the Hogg Eco-Anxiety Scale (HEAS) into Spanish, creating the HEAS-SP. We validated this measure in samples from both Argentina (n = 990) and Spain (n = 548), performing measurement invariance and confirmatory factor analyses. Internal consistency of the scale and score stability over time were investigated through reliability analyses. Differences in eco-anxiety across sociodemographic variables were explored through Student's t-tests and Pearson's r tests. Results: The four-factor model of the HEAS-SP comprising affective and behavioural symptoms, rumination, and anxiety about personal impact demonstrated excellent model fit. We found good internal consistency for each subscale, and established measurement invariance between Spanish and Argentine samples, as well as across genders and participants' age. Spanish participants reported higher scores on the affective symptoms and personal impact anxiety factors compared to the Argentinian sample. Also, men reported lower levels than women on the subscales of affective symptoms, rumination, and personal impact anxiety. It was found that the relationship between both age and personal impact anxiety and age and affective symptoms varies significantly depending on the gender of the individuals. Younger participants tended to report higher scores on most dimensions of eco-anxiety. Conclusions: These findings enhance the global initiative to investigate, explore and therefore comprehend eco-anxiety by introducing the first valid and reliable Spanish-language version of this psychometric instrument for its use within Spanish and Argentinian populations. This study augments the body of evidence supporting the robust psychometric properties of the HEAS, as demonstrated in prior validations for Australian, Turkish, Portuguese, German, French, and Italian populations. [ABSTRACT FROM AUTHOR]

Background: Exposure to potentially traumatic events increases the risk of a person developing a mental disorder. Training community members to offer support to a person during and after a traumatic situation may help lower this risk. This study reports on the cultural adaptation of Australian mental health first aid guidelines for individuals exposed to a potentially traumatic event to the Chilean and Argentinian context. Methods: A Delphi expert consensus study was conducted with two panels of experts, one of people with lived experience of trauma (either their own or as a carer; n = 26) and another one of health professionals (n = 41). A total of 158 items, drawn from guidelines developed by Australian experts in 2019, were translated to Spanish and evaluated in a two-round survey process. The panellists were asked to rate each item on a five-point Likert scale; statements were included in the final guidelines if 80% of both panels endorsed the item as "essential" or "important". Results: Consensus was achieved on 142 statements over two survey rounds. A total of 102 statements were included from the English-language guidelines, and 40 locally generated statements were accepted in the second round. Local experts endorsed a larger number of items compared to their counterparts in Australia and emphasised the importance of acknowledging the first aider's limitations, both personally and as part of their helping role. Additional items about working as a team with other first responders and considering helping the person's significant others were endorsed by the local panellists. Conclusions: The study showed a high level of acceptance of the original actions suggested for inclusion in the guidelines for Australia, but also a significant number of new statements that highlight the importance of the adaptation process. Further research on the dissemination of these guidelines into a Mental Health First Aid training course for Chile and Argentina is still required. [ABSTRACT FROM AUTHOR]

Background: Self-collection has been proposed as a strategy to increase cervical screening coverage among hard-to-reach women. However, evaluations of the implementation of this strategy on a large scale are scarce. This paper describes the process and measurement of the scaling-up of self-collection offered by community health workers during home visits as a strategy to reach under-screened women aged 30+ with public health coverage, defined as the target women.Methods: We used an adaptation of the Health System Framework to analyze key drivers of scaling-up. A content analysis approach was used to collect and analyze information from different sources. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) model was used to evaluate the impact of the strategy.Results: HPV self-collection was scaled-up in the province of Jujuy in 2014 after a RCT (Self-collection Modality Trial, initials EMA in Spanish) was carried out locally in 2012 and demonstrated effectiveness of the strategy to increase screening uptake. Facilitators of scaling-up were the organizational capacity of the provincial health system, sustainable funding for HPV testing, and local consensus about the value of the technology. Reach: In 2014, 9% (2983/33,245) of target women were screened through self-collection in the Jujuy public health sector. Effectiveness: In 2014, 17% (n = 5657/33,245) of target women were screened with any HPV test (self-collected and clinician-collected tests) vs. 11.7% (4579/38,981) in 2013, the pre-scaling-up period (p < 0.0001).Implementation: Training about the strategy was provided to 84.2% (n = 609/723) of total community health workers (CHWs). Of 414 HPV+ women, 77.5% (n = 320) had follow-up procedures. Of 113 women with positive triage, 66.4% (n = 75) had colposcopic diagnosis. Treatment was provided to 80.7% of CIN2+ women (n = 21/26). Adoption: Of trained CHWs, 69.3% (n = 422/609) had at least one woman with self-collection; 85.2% (n = 315/368) of CHWs who responded to an evaluation survey were satisfied with self-collection strategy. Maintenance: During 2015, 100.0% (723/723) CHWs were operational and 63.8% (461/723) had at least one woman with self-collection.Conclusions: The strategy was successfully scaled-up, with a high level of adoption among CHWs, which resulted in increased screening among socially vulnerable under-screened women. [ABSTRACT FROM AUTHOR]

Background: Understanding how people interpret environmental change and develop practices in response to such change is essential to comprehend human resource use. In the cosmology of the American indigenous peoples, as among the Mapuche people, freshwater systems are considered a living entity, where animals have an enormous role to play in the universe of meaning. However, human adaptive responses to freshwater system dynamics are scarcely examined. In this work a survey is carried out in three Mapuche communities of Argentine Patagonia to assess their traditional knowledge of the fishes and other non-human living beings that inhabit lakes and rivers. Both material and symbolic aspects are included, as are the differences in knowledge and use of the fishes between past and present times. Methods: Our methods were based on a quali-quantitative fieldwork approach. In-depth interviews were carried out with 36 individuals from three rural Mapuche populations in Neuquén province (Patagonia, Argentina). Free listing was used for inquiring about fish knowledge and use. Fishes were identified scientifically and ethnotaxonomically. In-depth analysis of the discourses was conducted, documenting the recognition, perception, and cultural significance of fluvial environments and their inhabitants. Quantitative survey results were analyzed with categorical statistical methods. Results: The body of knowledge of the communities studied reflects the socio-environmental changes experienced by Patagonian freshwater bodies. According to local perception, non-human beings live in these water bodies, guarding the environment, and they should not be disturbed. At present, five different fish species are identified, three of which are exotic, having been introduced at the beginning of the 20th century by the white man. These exotic trout (Oncorhynchus mykiss and Salvelinus fontinalis) are considered ill omens, indicators of the white man's presence, and therefore their appearance presages negative events for the families. In addition, we found that Mapuche people differentiate fish species mainly by morphological, organoleptic and ecological attributes. Current consumption of fish by Mapuche communities is sporadic, in accordance with bibliography and ancient tales. Several fishing tools are used, including modern elements. Conclusions: Our data enable us to characterise dynamic traditional knowledge in these communities, which is flexible in nature and adaptable to new situations, demonstrated by the incorporation not only of new species but also new fishing tools. It also seems that new significances become absorbed in synchrony with the advance or arrival of exotic and invasive species. For the Mapuche, the presence of the white man heralded by exotic trouts speaks of how a recent event, such as the introduction of the salmonids, is already incorporated into Mapuche symbolism. Mapuche traditional knowledge and cosmovision on the use of fish and waters, a vision which promotes respect and the avoidance of actions that could disturb the beings (animals and sacred or mythological characters) that inhabit and take care of them should be fostered as part of management plans of regional natural resources. This paper contributes to the broader literature on freshwater resource management by providing empirical evidence of the critical role of local perceptions in promoting the sustainable management of natural resources. [ABSTRACT FROM AUTHOR]

Despite a global need for the use of medication during pregnancy, the medical research community lacks robust evidence for safety and efficacy of treatments and preventives often taken by pregnant women. Given the biological differences between pregnant women and the rest of the population, the need to gather data on the ways in which medications behave in the pregnant body is critical to the health of pregnant women and their offspring. Three ethical reasons are central to this need: 1. Pregnant women deserve access to effective treatment, 2. Pregnant women deserve access to safe treatment, and 3. Pregnant women deserve equitable access to trials carrying the prospect of direct benefit. In this paper, we introduce and frame this Supplement Issue, which presents important conference proceedings of the 2016 Global Forum on Bioethics in Research meeting held in Buenos Aires, Argentina, on the 3rd and 4th of November. [ABSTRACT FROM AUTHOR]

Background: Not long ago Eugene Hunn suggested using a combination of cognitive, linguistic, ecological and evolutionary theories in order to account for the dynamic character of ethnoecology in the study of folk classification systems. In this way he intended to question certain homogeneity in folk classifications models and deepen in the analysis and interpretation of variability in folk classifications. This paper studies how a rural culturally mixed population of the Atlantic Forest of Misiones (Argentina) classified honey-producing stingless bees according to the linguistic, cognitive and ecological dimensions of folk classification. We also analyze the socio-ecological meaning of binomialization in naming and the meaning of general local variability in the appointment of stingless bees. Methods: We used three different approaches: the classical approach developed by Brent Berlin which relies heavily on linguistic criteria, the approach developed by Eleonor Rosch which relies on psychological (cognitive) principles of categorization and finally we have captured the ecological dimension of folk classification in local narratives. For the second approximation, we developed ways of measuring the degree of prototypicality based on a total of 107 comparisons of the type "X is similar to Y" identified in personal narratives. Results: Various logical and grouping strategies coexist and were identified as: graded of lateral linkage, hierarchical and functional. Similarity judgments among folk taxa resulted in an implicit logic of classification graded according to taxa's prototypicality. While there is a high agreement on naming stingless bees with monomial names, a considerable number of underrepresented binomial names and lack of names were observed. Two possible explanations about reported local naming variability are presented. Conclusions: We support the multidimensionality of folk classification systems. This confirms the specificity of local classification systems but also reflects the use of grouping strategies and mechanisms commonly observed in other cultural groups, such as the use of similarity judgments between more or less prototypical organisms. Also we support the idea that alternative naming results from a process of fragmentation of knowledge or incomplete transmission of knowledge. These processes lean on the facts that culturally based knowledge, on the one hand, and biologic knowledge of nature on the other, can be acquired through different learning pathways. [ABSTRACT FROM AUTHOR]

Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we describe variation in prescribing style within and across groups of GPs from six countries. Methods: Cross-sectional study with the inclusion of 457 GPs and 6394 sore throat patients. We describe variation in prescribing antibiotics for sore throat patients across six countries and assess whether variation in “prescribing style” - understood as a subjective tendency to prescribe - has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation of the random effect variance onto an odds ratio; Thus, MOR = 1 means similar odds or strict homogeneity between GPs' prescribing style, while a MOR higher than 1 denotes heterogeneity in prescribing style. Results: In all countries some GPs always prescribed antibiotics to all their patients, while other GPs never did. After adjusting for patient and GP characteristics, prescribing style in the group of GPs from Russia was about three times more heterogeneous than the prescribing style in the group of GPs from Denmark - Median Odds Ratio (6.8, 95% CI 3.1;8.8) and (2.6, 95% CI 2.2;4.4) respectively. Conclusion: Prescribing style is an important source of variation in prescription of antibiotics within and across countries, even after adjusting for patient and GP characteristics. Interventions aimed at influencing the prescribing style of GPs must encompass context-specific actions at the policy-making level alongside GP-targeted interventions to enable GPs to react more objectively to the external demands that are in place when making the decision of prescribing antibiotics or not. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is emerging as an important reproductive rights issue in the care of trans and gender nonconforming people. This study sought to understand the tools available to professionals working in the field of trans health to help trans women induce lactation and explore the concept of unmet need. Methods: In November 2018, we conducted a cross-sectional study which surveyed attendees at the World Professional Association for Transgender Health (WPATH) symposium in Buenos Aires, Argentina. Eligible participants were 18 + years old, had professional experience with transgender populations, were able to complete a survey in English, and were conference attendees. Descriptive data were collected using a 14-item written survey encompassing demographic characteristics, experience in transgender health, and lactation induction in trans women. Results: We surveyed 82 respondents (response rate 10.5%), the majority of whom were healthcare professionals (84%). Average age of respondents was 42.3 years old. They represented 11 countries and averaged 8.8 years of work at 21.3 h/week with trans populations. Healthcare professionals in this sample primarily specialized in general/internal medicine, psychology, endocrinology, and obstetrics/gynecology. One-third of respondents (34%) stated that they have met trans women who expressed interest in inducing lactation. Seventeen respondents (21%) knew of providers, clinics, or programs that facilitated the induction of lactation through medication or other means. Seven respondents (9%) have helped trans women induce lactation with an average of 1.9 trans women in the previous year. Two protocols for lactation induction were mentioned in free text responses and 91% believe there is a need for specialized protocols for trans women. Conclusion: This exploratory study demonstrates healthcare professionals' interest in breastfeeding protocols for lactation induction in trans women. Additional studies are needed to capture insights from breastfeeding specialists, e.g. lactation consultants and peripartum nurses, and to understand patients' perspectives on this service. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has shown how intraurban inequalities are likely to reinforce health and social inequalities. Studies at small area level help to visualize social inequialities hidden in large areas as cities or regions. Aim: To describe the spatial patterning of COVID-19 death rates in neighborhoods of the medium-sized city of Bariloche, Argentina, and to explore its relationship with the socioeconomic characteristics of neighborhoods. Methods: We conducted an ecological study in Bariloche, Argentina. The outcome was counts of COVID-19 deaths between June 2020 and May 2022 obtained from the surveillance system and georeferenced to neighborhoods. We estimated crude- and age-adjusted death rates by neighborhood using a Bayesian approach through a Poisson regression that accounts for spatial-autocorrelation via Conditional Autoregressive (CAR) structure. We also analyzed associations of age-adjusted death rates with area-level socioeconomic indicators. Results: Median COVID-19 death rate across neighborhoods was 17.9 (10th/90th percentile of 6.3/35.2) per 10,000 inhabitants. We found lower age-adjusted rates in the city core and western part of the city. The age-adjusted death rate in the most deprived areas was almost double than in the least deprived areas, with an education-related relative index of inequality (RII) of 2.14 (95% CI 1.55 to 2.96). Conclusion: We found spatial heterogeneity and intraurban variability in age-adjusted COVID-19 death rates, with a clear social gradient, and a higher burden in already deprived areas. This highlights the importance of studying inequalities in health outcomes across small areas to inform placed-based interventions. [ABSTRACT FROM AUTHOR]

Background: Whether women should be able to decide on mode of birth in healthcare settings has been a topic of debate in the last few decades. In the context of a marked increase in global caesarean section rates, a central dilemma is whether pregnant women should be able to request this procedure without medical indication. Since 2015, Law 25,929 of Humanised Birth is in place in Argentina. This study aims at understanding the power relations between healthcare providers, pregnant women, and labour companions regarding decision-making on mode of birth in this new legal context. To do so, central concepts of power theory are used. Methods: This study uses a qualitative design. Twenty-six semi-structured interviews with healthcare providers were conducted in five maternity wards in different regions of Argentina. Participants were purposively selected using heterogeneity sampling and included obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. Reflexive thematic analysis was used to inductively develop themes and categories. Results: Three themes were developed: (1) Healthcare providers reconceptualize decision-making processes of mode of birth to make women's voices matter; (2) Healthcare providers feel powerless against women's request to choose mode of birth; (3) Healthcare providers struggle to redirect women's decision regarding mode of birth. An overarching theme was built to explain the power relations between healthcare providers, women and labour companions: Healthcare providers' loss of beneficial power in decision-making on mode of birth. Conclusions: Our analysis highlights the complexity of the healthcare provider-woman interaction in a context in which women are, in practice, allowed to choose mode of birth. Even though healthcare providers claim to welcome women being an active part of the decision-making processes, they feel powerless when women make autonomous decisions regarding mode of birth. They perceive themselves to be losing beneficial power in the eyes of patients and consider fruitful communication on risks and benefits of each mode of birth to not always be possible. At the same time, providers perform an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place. Plain Language Summary: In the last few decades, there has been a debate on whether women should be able to choose if they haver a vaginal birth or a caesarean section. This debate has been framed by the fact that an increasing number of caesarean sections are being performed. Since 2015, Argentina has a Law of Humanised Birth. We conducted a study to understand the power relations between healthcare providers, pregnant women and labour companions in decision making on mode of birth in this new legal context. To do so, we used central concepts of power theory. We conducted 26 semi-structured interviews with healthcare providers in five maternity wards of Argentina. The interviewees were obstetrician/gynaecologists (heads of department, specialists working in 24-h shifts, and residents) and midwives where available. We used thematic analysis to build themes from the data. We discovered that healthcare providers perceive themselves to be losing beneficial power in decision-making on mode of birth. Even though they claim to want women to make autonomous decisions, they feel frustrated when this happens. They also perceive it to be more difficult to communicate with patients regarding the risks and benefits of vaginal birth and caesarean section. At the same time, providers carry out an increasing number of CSs without medical indication when it is convenient for them, which suggests that paternalistic practices are still in place. [ABSTRACT FROM AUTHOR]

Background: Although most Latin American and the Caribbean (LAC) countries made important progress in maternal and child health indicators from the 1990s up to 2010, little is known about such progress in the last decade. This study aims at documenting progress for each country as a whole, and to assess how within-country socioeconomic inequalities are evolving over time. Methods: We identified LAC countries for which a national survey was available between 2011–2015 and a second comparable survey in 2018–2020. These included Argentina, Costa Rica, Cuba, the Dominican Republic, Guyana, Honduras, Peru, and Suriname. The 16 surveys included in the analysis collected nationally representative data on 221,989 women and 152,983 children using multistage sampling. Twelve health-related outcomes were studied, seven of which related to intervention coverage: the composite coverage index, demand for family planning satisfied with modern methods, antenatal care (four or more visits and eight or more visits), skilled attendant at birth, postnatal care for the mother and full immunization coverage. Five additional impact indicators were also investigated: stunting prevalence among under-five children, tobacco use by women, adolescent fertility rate, and under-five and neonatal mortality rates. For each of these indicators, average annual relative change rates were calculated between the baseline and endline national level estimates, and changes in socioeconomic inequalities over time were assessed using the slope index of inequality. Results: Progress over time and the magnitude of inequalities varied according to country and indicator. For countries and indicators where baseline levels were high, as Argentina, Costa Rica and Cuba, progress was slow and inequalities small for most indicators. Countries that still have room for improvements, such as Guyana, Honduras, Peru and Suriname, showed faster progress for some but not all indicators, although also had wider inequalities. Among the countries studied, Peru was the top performer in terms of increasing coverage and reducing inequalities over time, followed by Honduras. Declines in family planning and immunization coverage were observed in some countries, and the widest inequalities were present for adolescent fertility and antenatal care coverage with eight or more visits. Conclusions: Although LAC countries are well placed in terms of current levels of health indicators compared to most low- and middle-income countries, important inequalities remain, and reversals are being observed in some areas. More targeted efforts and actions are needed in order to leave no one behind. Monitoring progress with an equity lens is essential, but this will require further investment in conducting surveys routinely. [ABSTRACT FROM AUTHOR]

Background: Low adherence to triage after positive screening is a widespread problem for cervical cancer screening programs in Low- and Middle-income Countries. Adherence to cytology-based triage can be challenging, especially among women with self-collected tests. SMS-based interventions are accepted by women and can increase screening uptake. The ATICA study was an effectiveness-implementation hybrid type I trial, combining a cluster randomized controlled trial (RCT) with a mixed-methods implementation evaluation involving quantitative and qualitative methods. Although the RCT provided evidence regarding the effectiveness of the SMS-based intervention, less is known about its acceptability, relevance, and usefulness from the women´s perspective. Methods: We carried out a cross-sectional study based on a structured questionnaire among HPV-positive women who were enrolled in ATICA's intervention group. We measured acceptability, appropriateness, and message content comprehension. Also, we evaluated if the SMS message was considered a cue to encourage women to pick up their HPV test results and promote the triage. Results: We interviewed 370 HPV-positive women. Acceptability of SMS messages among women who had received at least one message was high (97%). We found high levels of agreement in all appropriateness dimensions. More than 77% of women showed high comprehension of the content. Among women who received at least one SMS message, 76% went to the health center to pick up their results. Among those who got their results, 90% reported that the SMS message had influenced them to go. We found no significant differences in acceptability, appropriateness or message comprehension between women who adhered to triage and those who did not adhere after receiving the SMS messages. Conclusion: The intervention was highly acceptable, and women reported SMS was an appropriate channel to be informed about HPV test results availability. SMS was also a useful cue to go to the health center to pick up results. The implementation did not encounter barriers associated with the SMS message itself, suggesting the existence of other obstacles to triage adherence. Our results support the RCT findings that scaling up SMS is a highly acceptable intervention to promote cervical screening triage adherence. [ABSTRACT FROM AUTHOR]

Background: The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage. Methods: A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants' roles, methods) and associated difficulties, coordination problems and interventions selected. Results: LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200–479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals' time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected. Conclusions: As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts. [ABSTRACT FROM AUTHOR]

Background: The huillín (Lontra provocax, Thomas 1908) is an otter, endemic to southern Argentina and Chile. It is in danger of extinction. In the Nahuel Huapi National Park and surroundings is the only freshwater, known and stable population of huillín in Argentina. In this park, several urban and rural centers coexist with this species. The main objective of our work was to answer: How does the local zoological knowledge (LZK) vary about the huillín, particularly its identification and sighting, among people from different social groups, with different ages and gender, who live in the rural or urban environment and with different periods of permanence in the place? Methods: Ninety-six written interviews were conducted using visual stimuli to ensure that interviewees refer to the huillín. In addition, we also inquire about the LZK of other species with which it can be confused. Additional open interviews were conducted with participants who observed the huillín to determine the georeferencing of the reported sites and include them on a final map. Results: 95% of people identified the huillín and this was confused with the coipo in 3% and with the american mink, in 5%. The results show that, in general, the LZK did not vary significantly with the sociocultural characteristics of the participants, showing a remarkable homogeneity. However, people in rural areas are more likely to observe the species than people in urban areas. Moreover, people between 20 and 40 years of age are more likely to observe the huillín. The LZK mapping has identified areas that are consistent with and/or adjacent to official source records. Other areas have also been identified that may provide new information. Conclusion: With this participatory work, we realize that the species is recognized by urban and rural inhabitants and very few confused it. The homogeneity in the LZK found constitutes a kick for the realization of other participatory studies that promote lines of research, action and management that improve the quality of the environments where the only freshwater, known and stable population of the huillín in Argentina lives. [ABSTRACT FROM AUTHOR]

Objective: Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. Methods: Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. Findings: Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. Interpretation: The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective. [ABSTRACT FROM AUTHOR]

Background: In yellow fever (YF) endemic areas, measles, mumps, and rubella (MMR), and YF vaccines are often co-administered in childhood vaccination schedules. Because these are live vaccines, we assessed potential immune interference that could result from co-administration. Methods: We conducted an open-label, randomized non-inferiority trial among healthy 1-year-olds in Misiones Province, Argentina. Children were randomized to one of three groups (1:1:1): Co-administration of MMR and YF vaccines (MMR1YF1), MMR followed by YF vaccine four weeks later (MMR1YF2), or YF followed by MMR vaccine four weeks later (YF1MMR2). Blood samples obtained pre-vaccination and 28 days post-vaccination were tested for immunoglobulin G antibodies against measles, mumps, and rubella, and for YF virus-specific neutralizing antibodies. Non-inferiority in seroconversion was assessed using a -5% non-inferiority margin. Antibody concentrations were compared with Kruskal-Wallis tests. Results: Of 851 randomized children, 738 were correctly vaccinated, had ≥ 1 follow-up sample, and were included in the intention-to-treat population. Non-inferior seroconversion was observed for all antigens (measles seroconversion: 97.9% in the MMR1YF1 group versus 96.3% in the MMR1YF2 group, a difference of 1.6% [90% CI -1.5, 4.7]; rubella: 97.9% MMR1YF1 versus 94.7% MMR1YF2, a difference of 3.3% [-0.1, 6.7]; mumps: 96.7% MMR1YF1 versus 97.9% MMR1YF2, a difference of -1.3% [-4.1, 1.5]; and YF: 96.3% MMR1YF1 versus 97.5% YF1MMR2, a difference of -1.2% [-4.2, 1.7]). Rubella antibody concentrations and YF titers were significantly lower following co-administration; measles and mumps concentrations were not impacted. Conclusion: Effective seroconversion was achieved and was not impacted by the co-administration, although antibody levels for two antigens were lower. The impact of lower antibody levels needs to be weighed against missed opportunities for vaccination to determine optimal timing for MMR and YF vaccine administration. Trial Registration: The study was retrospectively registered in ClinicalTrials.gov (NCT03368495) on 11/12/2017. [ABSTRACT FROM AUTHOR]

Background: Depression is one of the most common mental health problems worldwide and, while prevalence rates in Latin America are relatively high, most people who meet the criteria for diagnosis do not receive treatment. Family and friends of a person with depression can play an important role in supporting a person to seek and engage with treatment. However, many people do not have the necessary skills or confidence to help. English-language mental health first aid guidelines have been developed to support people to provide such help. The aim of this study was to culturally adapt these guidelines for Chile and Argentina. Methods: A Delphi expert consensus study was conducted with two expert panels, one of people with lived experience of depression (either their own or as a carer; n = 26) and one of health professionals (n = 29). Overall, 172 statements from the English-language guidelines were translated and compiled into a questionnaire. Participants were asked to rate statements based on how essential or important those statements were for Chile and Argentina and to suggest new statements if necessary. Results: Data were obtained over two survey rounds. Consensus was achieved on 172 statements. A total of 137 statements were adopted from the English-language guidelines, whereas 35 new endorsed statements were generated from panel suggestions. There were similarities between the English-language guidelines and those for Chile and Argentina. The adapted guidelines did not include some of the items from the English-language guidelines related to commenting on a person's strengths or making judgements about their character, and also incorporated new items related to the incorporation of sociocultural considerations as causes of depression and attention to inequities in mental health. Conclusions: The significant number of new items underscores the importance of undertaking a careful process of cultural adaptation. Further research on dissemination and incorporation of the guidelines into the Mental Health First Aid training course for Chile and Argentina is still required. [ABSTRACT FROM AUTHOR]

The aims of this research were (i) to study with a sample of Argentine consumers the representations of traditional gastronomy through the free listing method; (ii) to identify consumers' typologies according to their representation of traditional gastronomy; and (iii) to establish some methodological implications using the free listing in the study of the gastronomic field. A survey was conducted in which 249 Argentines from the Littoral area were recruited. Through a free listing task, participants were asked to mention the main foods or dishes of Argentina's gastronomy. Twenty-eight foods, dishes or food categories were obtained that are part of the representations of Argentina's gastronomy. The results showed a strong connection between gastronomy and the representations of the consumers with the "Asado" (CSI = 0.289, Smith = 0.613), the traditional and characteristic food of Argentine gastronomy. Three groups of consumers were identified, presenting differences in the representation of traditional gastronomy (p < 0.05). This work is pioneering for studying gastronomy representations from the consumers' language through the free listing method using the case of traditional Argentine gastronomy. Future directions of free listing in the gastronomic field are identified and discussed. [ABSTRACT FROM AUTHOR]

Background: The ATICA study was a Hybrid I type randomized effectiveness-implementation trial that demonstrated effectiveness of a multicomponent mHealth intervention (Up to four SMS messages sent to HPV-positive women, and one SMS message to CHWs to prompt a visit of women with no triage Pap 60 days after a positive-test), to increase adherence to triage of HPV positive women (ATICA Study). We report data on perceptions of health decision-makers and health-care providers regarding the intervention implementation and scaling-up. Methods: A qualitative study was carried out based on individual, semi-structured interviews with health decision-makers (n = 10) and health-care providers (n = 10). The themes explored were selected and analyzed using domains and constructs of the Consolidated Framework for Implementation Research (CFIR) and the maintenance dimension of the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: Both health-care providers and decision-makers had a positive assessment of the intervention through most included constructs: knowledge of the intervention, intervention source, design quality, adaptability, compatibility, access to knowledge and information, relative advantage, women's needs, and relative priority. However, some potential barriers were also identified including: complexity, leadership engagement, external policies, economic cost, women needs and maintenance. Stakeholders conditioned the strategy's sustainability to the political commitment of national and provincial health authorities to prioritize cervical cancer prevention, and to the establishment of the ATICA strategy as a programmatic line of work by health authorities. They also highlighted the need to ensure, above all, that there was staff to take Pap tests and carry out the HPV-lab work, and to guarantee a constant provision of HPV-tests. Conclusion: Health decision-makers and health-care providers had a positive perception regarding implementation of the multicomponent mHealth intervention designed to increase adherence to triage among women with HPV self-collected tests. This increases the potential for a successful scaling-up of the intervention, with great implications not only for Argentina but also for middle and low-income countries considering using mHealth interventions to enhance the cervical screening/follow-up/treatment process. [ABSTRACT FROM AUTHOR]

Background: Wheat stripe rust, caused by Puccinia striiformis f. sp. tritici (Pst), is one of the most devastating diseases of the wheat crop. It causes significant reductions in both grain yield and grain quality. In recent years, new and more virulent races have overcome many of the known resistance genes in Argentinian germplasm. In order to identify loci conferring resistance to the local races of Pst for effective utilization in future breeding programs, a genome-wide association study (GWAS) was performed using a collection of 245 bread wheat lines genotyped with 90 K SNPs. Results: To search for adult plant resistance (APR) the panel was evaluated for disease severity (DS) and area under disease progress curve (AUDPC) in field trials during two years under natural infection conditions. To look for seedling or all-stage resistance (ASR) the panel was evaluated to determine infection type (IT) under greenhouse conditions against two prevalent races in Argentina. The phenotypic data showed that the panel possessed enough genetic variability for searching for sources of resistance to Pst. Significant correlations between years were observed for Pst response in the field and high heritability values were found for DS (H2 = 0.89) and AUDPC (H2 = 0.93). Based on GWAS, eight markers associated with Pst resistance (FDR < 0.01) were identified, of these, five were associated with ASR (on chromosomes 1B, 2A, 3A and 5B) and three with APR (on chromosomes 3B and 7A). These markers explained between 2% and 32.62% of the phenotypic variation. Five of the markers corresponded with previously reported Yr genes/QTL, while the other three (QYr.Bce.1B.sd.1, QYr.Bce.3A.sd and QYr.Bce.3B.APR.2) might be novel resistance loci. Conclusion: Our results revealed high genetic variation for resistance to Argentinian stripe rust races in the germplasm used here. It constitutes a very promising step towards the improvement of Pst resistance of bread wheat in Argentina. Also, the identification of new resistance loci would represent a substantial advance for diversifying the current set of resistance genes and to advance in the improvement of the durable resistance to the disease. [ABSTRACT FROM AUTHOR]

Background: Chagas is a public health problem, especially in Latin America, exacerbated by migratory movements and increasing urbanization. Argentina is among the countries with the highest estimated prevalence in the region, with 1,500,000 people infected, with mother to child as the main mode of transmission. Vertical transmission has been signifcantly reduced by treating women of childbearing age; several guidelines in the region recommend treat- ment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment. The objective of this research was to design an implementation strategy to improve using Chagas guidelines focused on attending women of childbearing age and children at the primary healthcare level and pilot it in three primary health care centers in Argentina. Methods: We conducted a pilot feasibility study using the Consolidated Framework for Implementation Research. A qualitative process evaluation was conducted using semi-structured interviews with health care providers and obser- vations in primary health care centers. Results: We developed a multifaceted implementation strategy including training, fowcharts and reminders, a register of suspected and confrmed cases, and the selection of a management facilitator. The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components, being the facilitating factors, the simplicity of the intervention, professionals' willingness to expand the indication of serologic tests, and staf commitment to the adoption of intervention components. The main barriers found were the change of authorities at the local level, some professionals´ reluctance to administer etiological treat- ment, staf shortages, lack of diagnostic supplies, and the health emergency caused by the COVID-19 pandemic. Conclusions: Behavioral change strategies should be applied to improve implementation to address some of the main barriers, including support actions ofered by opinion leaders, medical experts, and local health authorities. Rapid diagnostic tests should be readily available to maintain behavior changes. We suggest further refnement of the strategy and its implementation in more centers to assess outcomes prospectively with a hybrid implementation research design. [ABSTRACT FROM AUTHOR]

Background: Hormonal therapy is an integral component for breast cancer treatment in women with oestrogen receptor positive tumours in early-stage and advanced cases of the disease. Little is known about what factors influence oncologists' prescribing practices, especially non-biological factors, although this information may have important implications for understanding inequalities in health care quality and outcomes. This paper presents findings from research on factors influencing oncologists' prescribing hormonal therapy for women with early and advanced cases of breast cancer in the city of Córdoba, Argentina. Methods: A qualitative study using in-depth, semi-structured interviews with 16 oncologists was conducted. A stratified purposive sampling was used to recruit female and male participants and working at 3 health subsystems (private, social security, public). Data was analysed using the Framework approach. Results: According to the respondents, factors influencing prescribing practices of hormonal therapy are varied. Women's socio-economic status (poverty and wealth) and their level of health literacy can affect oncologists' prescribing practices. Overall, in comparison to male, female oncologists reported more awareness of patients' needs, more involvement in communicating drug side-effects, and in offering treatment options in private health settings. The 3 health subsystems provided a differential access to drugs and lines of hormonal treatment, which ranged from a limited availability in the public sector, to administrative restrictions imposed by the social security system, and to a lesser extent, the private sector. This happened in the backdrop of national legislation covering oncological treatments and drugs free of charge. Conclusions: Addressing prescribing practices for hormonal therapy as a distinct type of breast cancer treatment (chronic care) is fundamental in the understanding of breast cancer care and can shed light on inequalities in treatments. Identifying the underlying care gaps in the prescription of hormonal therapy can help in the design of tailored interventions. [ABSTRACT FROM AUTHOR]

Background: The SARS-CoV-2 virus is responsible for the COVID-19 pandemic. To better understand the evolution of SARS-CoV-2 early in the pandemic in the Province of Cordoba, Argentina, we performed a comparative genomic analysis of SARS-CoV-2 strains detected in survivors and non-survivors of COVID-19. We also carried out an epidemiological study to find a possible association between the symptoms and comorbidities of these patients with their clinical outcomes. Results: A representative sampling was performed in different cities in the Province of Cordoba. Ten and nine complete SARS-CoV-2 genomes were obtained by next-generation sequencing of nasopharyngeal specimens from non-survivors and survivors, respectively. Phylogenetic and phylodynamic analyses revealed multiple introductions of the most common lineages in South America, including B.1, B.1.1.1, B.1.499, and N.3. Fifty-six mutations were identified, with 14% of those in common between the non-survivor and survivor groups. Specific SARS-CoV-2 mutations for survivors constituted 25% whereas for non-survivors they were 41% of the repertoire, indicating partial selectivity. The non-survivors' variants showed higher diversity in 9 genes, with a majority in Nsp3, while the survivors' variants were detected in 5 genes, with a higher incidence in the Spike protein. At least one comorbidity was present in 60% of non-survivor patients and 33% of survivors. Age 75–85 years (p = 0.018) and hospitalization (p = 0.019) were associated with non-survivor patients. Related to the most common symptoms, the prevalence of fever was similar in both groups, while dyspnea was more frequent among non-survivors and cough among survivors. Conclusions: This study describes the association of clinical characteristics with the clinical outcomes of survivors and non-survivors of COVID-19 patients, and the specific mutations found in the genome sequences of SARS-CoV-2 in each patient group. Future research on the functional characterization of novel mutations should be performed to understand the role of these variations in SARS-CoV-2 pathogenesis and COVID-19 disease outcomes. These results add new genomic data to better understand the evolution of the SARS-CoV-2 variants that spread in Argentina during the first wave of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Shigella specie is a globally important intestinal pathogen disseminated all over the world. In this study we analyzed the genome and the proteomic component of two Shigella flexneri 2a clinical isolates, collected from pediatric patients with gastroenteritis of the Northwest region of Argentina (NWA) in two periods of time, with four years of difference. Our goal was to determine putative changes at molecular levels occurred during these four years, that could explain the presence of this Shigella's serovar as the prevalent pathogen in the population under study. Results: As previously reported, our findings support the idea of Shigella has a conserved "core" genome, since comparative studies of CI133 and CI172 genomes performed against 80 genomes obtained from the NCBI database, showed that there is a large number of genes shared among all of them. However, we observed that CI133 and CI172 harbors a small number of strain-specific genes, several of them present in mobile genetic elements, supporting the hypothesis that these isolates were established in the population by horizontal acquisition of genes. These differences were also observed at proteomic level, where it was possible to detect the presence of certain secreted proteins in a culture medium that simulates the host environment. Conclusion: Great similarities were observed between the CI133 and CI172 strains, confirming the high percentage of genes constituting the "core" genome of S. flexneri 2. However, numerous strain specific genes were also determined. The presence of the here identified molecular elements into other strain of our culture collation, is currently used to develop characteristic markers of local pathogens. In addition, the most outstanding result of this study was the first description of a S. flexneri 2 producing Colicin E, as one of the characteristics that allows S. flexneri 2 to persist in the microbial community. These findings could also contribute to clarify the mechanism and the evolution strategy used by this pathogen to specifically colonize, survive, and cause infection within the NWA population. [ABSTRACT FROM AUTHOR]

Background: In the last American Joint Committee on Cancer/Tumor, Node, Metastasis (AJCC/TNM) 8th edition (TNM8), several changes were introduced to this risk stratification system to improve the prognosis of differentiated thyroid cancer (DTC). Aim: To validate the impact of TNM8 vs. TNM 7th edition (TNM7) in DTC in terms of predictive value in two hospitals from Buenos Aires, Argentina. Methods: Retrospective study of DTC patients from two institutions. Reclassification from TNM7 to TNM8, disease-specific survival (DSS), and final clinical outcomes at the end of follow-up (recurrent/persistent structural disease) (median 5 years) were analyzed. The proportion of variation explained (PVE) was used to compare the predictive capability of DSS of both classification systems. Results: Reclassification of 245 patients, aged (mean ± SD) 55 ± 15.36 years, 91% women, to TNM8 from TNM7 showed: 82% vs 57% stage I (SI), 10% vs 8.5% SII, 5% vs 22% SIII, 3% vs 12% SIV (p < 0.01). Forty percent of the population was downstaged with TNM8. Ten-year DSS rates for SI, SII, SIII and SIV in TNM7 were 100, 100, 100 and 74%, respectively and in TNM8: 97.6, 100, 100 and 37.5%, respectively. Out of 4 disease-specific deaths in SIV TNM7, one was subclassified to SI TNM8, corresponding to a 53-year-old patient with structural persistence. PVE for TNM8 (29%) was more than twice that of TNM7 (13%). Conclusion: In this Argentinian DTC patients sample, it was confirmed that the new TNM8 classification is more accurate in predicting survival attributable to cancer than its previous version. [ABSTRACT FROM AUTHOR]

Background: To identify the prevalence and sociodemographic correlates of different domains of physical activity (PA) and higher sitting time among South American adolescents. Methods: Data from national surveys of 11 South American countries were analyzed, and comprised information on 166,901 adolescents. PA (≥ 60 min/day of moderate-vigorous PA), physical education classes (PEC) (≥ 3 classes/wk), active commuting to school (≥ 1 d/wk), and higher sitting time (≥ 3 h/d) were self-reported. Sociodemographic correlates, such as gender, age, and food security status were explored using a random effect meta-analysis for logistic parameters. Results: Recommended PA ranged between 7.5% (Brazil) and 19.0% (Suriname). Peru (2.2%) and Guyana (43.1%) presented the lowest prevalence of PEC and active commuting to school, respectively. Higher sitting time was less prevalent in Bolivia (24.6%) and more prevalent in Argentina (55.6%). Compared to girls, boys were more prone to reach recommendations for PA [OR = 1.94(1.65;2.28)]; to reach ≥ 3 PEC [OR = 1.17(1.04;1.33)] and to be active in commuting to school [(OR = 1.14(1.06;1.23)], but less prone to higher sitting time [OR = 0.89(0.82;0.96)]. Older adolescents had less odds of reach PA guidelines [OR = 0.86(0.77; 0.97)] and accumulated higher sitting time [OR = 1.27(1.14;1.41)]. Adolescents with food insecurity reported more PEC [OR = 1.12(1.04;1.21)] and active commuting to school [OR = 1.12(1.02;1.22)] but had less higher sitting time than their food security pairs [OR = 0.89(0.81;0.98)]. Conclusions: Few adolescents reach the PA recommendation. Actions aiming the promotion of PA and the reduction of sitting time must consider girls and older adolescents as target groups, as well as the specifics of each country. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about how people who have abortions describe high-quality interpersonal care in Argentina. This qualitative study aimed to understand preferences and priorities in their interactions with providers. Study design: We conducted 24 in-depth interviews with people who obtained abortions at a comprehensive reproductive health clinic or with support from a feminist accompaniment group in Buenos Aires and Neuquén, Argentina. We iteratively coded transcripts using a thematic analysis approach based on interpersonal domains present in current quality of care frameworks. Results: Participants described high-quality abortion care as feeling acompañamiento and contención from their providers – terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortion. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. Conclusions: People obtaining abortions in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people's perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion. Plain language summary: Little is known about how people who have abortions perceive the quality of the care they receive and what aspects of interpersonal interactions with providers matter to them. This qualitative study aimed to understand preferences of people who had abortions at both a reproductive health clinic and with an accompaniment group in Argentina. We interviewed 24 people who obtained abortion care in Buenos Aires and Neuquén, Argentina. We asked them about their preferences for and experiences of abortion care. Then we analyzed the interviews, specifically assessing aspects of interpersonal care based on quality of care frameworks from the literature. Participants described high-quality abortion care as feeling acompañamiento and contención from their providers—terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortions. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. In conclusion, people obtaining abortions in two distinct models of care in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people's perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion. [ABSTRACT FROM AUTHOR]

Background: The order Hymenoptera comprises melliferous insects (bees, wasps and bumblebees); among them, stingless bees comprise a diverse group of eusocial insects present in tropical and subtropical areas. Of a total of approximately 500 species, 400 are found in the Neotropics. On the continent of America, before the introduction of Apis mellifera, these insects represented the main source of honey and wax. In Argentina, ethnobiological investigations had been carried out on this group of insects, principally in the Atlantic Forest and Chaco regions. Out of a total of 33 species, only 14 were recorded for use or breeding. In the Yungas, however, there are no ethnobiological studies analyzing this group of species, although the use of their products is mentioned in different ethnobotanical works. This paper studies the knowledge and uses of melliferous insects by the inhabitants of the village of Baritú and surrounding. Method: Information on location, management and duties assigned (e.g., preparation and administration) to deal with bee products like honey, pollen, wax and propolis was obtained through semi-structured interviews. Besides, reference material was collected to identify melliferous insects known and used in the region. Results: Fifteen ethnospecies were identified and grouped locally according to their defensive behavior. The culturally most important species is the stingless bee Plebeia sp. nov.—mansita-, in terms of frequency of citations and diversity of uses, and among those that sting, the honeybee Apis mellifera—extranjera-. Honey, pollen, wax, and propolis of Plebeia sp. nov. had the highest current frequency of use. Honey is used in food (incorporated at pure state, as a complement and in drinks), as nutraceutical food and in medicinal preparations. In addition, it is an important resource for marketing during the warm season, infusions being the main mode of administration. Pollen is used as a supplement for food and alcoholic drinks, wax mainly in candle making, and propolis. Conclusion: The data obtained in this study complements the information available in ethnobotanical studies carried out in the region. The present study is the first on melliferous insects in the area. A new species of stingless bee the genus Plebeia was registered, and it was observed that the known distribution of others has increased. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 disease has changed people's work and income. While recent evidence has documented the adverse impact of these changes on mental health outcomes, most research is focused on frontline healthcare workers and the reported association between income loss and mental health comes from high-income countries. In this study we examine the impact of changes in working conditions and income loss related to the COVID-19 lockdown on workers' mental health in Argentina. We also explore the role of psychological detachment from work and work-family interaction in mental health. Methods: A total of 1049 participants aged between 18 and 65 who were working before the national lockdown in March 2020 were recruited using a national random telephone survey. Work conditions included: working at the usual workplace during the pandemic, working from home with flexible or fixed schedules, and being unemployed or unable to work due to the pandemic. Measures of financial hardship included income loss and self-reported financial problems related to the outbreak. Work-family interface included measures of work-family conflict (WFC) and family-work conflict (FWC). Mental health outcomes included burnout, life satisfaction, anxiety and depressive symptoms. Data were collected in October 2020. Results: Home-based telework under fixed schedules and unemployment impact negatively on mental health. Income loss and particularly self-reported financial problems were also associated with deterioration of mental health. More than half of the participants reported financial problems, and those who became unemployed during the pandemic experienced more often financial problems. Finally, psychological detachment from work positively influenced mental health; WFC and FWC were found to negatively impact on mental health. Conclusions: Countries' policies should focus on supporting workers facing economic hardships and unemployment to ameliorate the COVID-19' negative impact on mental health. Organisations can protect employees' mental health by actively encouraging psychological detachment from work and by help managing work-family interface. Longitudinal studies are needed to more thoroughly assess the long-term impact of the COVID-19-related changes in work and economic turndown on mental health issues. [ABSTRACT FROM AUTHOR]

Background: Among all psychoactive substances, alcohol consumption presents the most significant public health problem and is a leading risk factor for overall disease burden in Latin America. However, most people who meet criteria for a substance use disorder do not receive treatment in primary or secondary care sources. Community members can play a role in helping people to seek help as they are likely to encounter people experiencing problem drinking and recognize the signs. However, many do not have adequate mental health first aid knowledge or skills to provide help. We aimed to culturally adapt the existing English-language mental health first aid guidelines for helping someone with problem drinking for Argentina and Chile. Methods: The Delphi consensus method was used to determine the importance of helping actions translated from the English-language guidelines and to add new actions suggested by expert panellists. The importance of each statement was rated by two expert panels. Panel one included people with lived experience (either their own or as a support person, n = 23) recruited in Argentina and panel two included health professionals (n = 31) recruited in Argentina and Chile. Results: Overall, 165 helping actions were endorsed by panellists across two consecutive survey rounds. Endorsed items included 132 of the 182 items translated into Spanish from the English-language guidelines and 33 of the 61 new items generated from panellists' comments in the first survey round. Conclusions: While there were some similarities in recommended helping actions between English-speaking countries, and Argentina and Chile, key differences were seen in attitudes to low-risk drinking. While there was a relatively high level of agreement between health professionals and people with lived experience, some divergence of opinion was seen, particularly in the area of commitment to recovery as a condition for help. Future research should explore the implementation of the guidelines. [ABSTRACT FROM AUTHOR]

Background: The distribution of parasite load across hosts may modify the transmission dynamics of infectious diseases. Chagas disease is caused by a multi-host protozoan, Trypanosoma cruzi, but the association between host parasitemia and infectiousness to the vector has not been studied in sylvatic mammalian hosts. We quantified T. cruzi parasite load in sylvatic mammals, modeled the association of the parasite load with infectiousness to the vector and compared these results with previous ones for local domestic hosts. Methods: The bloodstream parasite load in each of 28 naturally infected sylvatic mammals from six species captured in northern Argentina was assessed by quantitative PCR, and its association with infectiousness to the triatomine Triatoma infestans was evaluated, as determined by natural or artificial xenodiagnosis. These results were compared with our previous results for 88 humans, 70 dogs and 13 cats, and the degree of parasite over-dispersion was quantified and non-linear models fitted to data on host infectiousness and bloodstream parasite load. Results: The parasite loads of Didelphis albiventris (white-eared opossum) and Dasypus novemcinctus (nine-banded armadillo) were directly and significantly associated with infectiousness of the host and were up to 190-fold higher than those in domestic hosts. Parasite load was aggregated across host species, as measured by the negative binomial parameter, k, and found to be substantially higher in white-eared opossums, cats, dogs and nine-banded armadillos (range: k = 0.3–0.5) than in humans (k = 5.1). The distribution of bloodstream parasite load closely followed the "80–20 rule" in every host species examined. However, the 20% of human hosts, domestic mammals or sylvatic mammals exhibiting the highest parasite load accounted for 49, 25 and 33% of the infected triatomines, respectively. Conclusions: Our results support the use of bloodstream parasite load as a proxy of reservoir host competence and individual transmissibility. The over-dispersed distribution of T. cruzi bloodstream load implies the existence of a fraction of highly infectious hosts that could be targeted to improve vector-borne transmission control efforts toward interruption transmission. Combined strategies that decrease the parasitemia and/or host–vector contact with these hosts would disproportionally contribute to T. cruzi transmission control. [ABSTRACT FROM AUTHOR]

Background: Dengue is one of the most important re-emerging viral diseases and the most common human arthropod-borne viral infection worldwide. Any of the four Dengue virus serotypes (DENV-1 to 4) can cause asymptomatic infections or clinical manifestations that range in severity from a mild, self-limited illness, to a severe disease characterized by a shock syndrome that can lead to death. Paraguay suffers periodic epidemic outbreaks of dengue since 1988 when the DENV-1 was introduced in the country. Epidemics caused by all four serotypes have been reported and the country. Although dengue is endemic in Paraguay, few studies have described the molecular epidemiology of DENV in the country, which is important to understand the local and global spread, as well as the evolution of this pathogen.Methods: This was a cross-sectional study of a convenience sample. Suspected dengue patients of any age were recruited from the Emergency Laboratory of the Central Hospital of the Institute of Social Welfare, Asuncion, Paraguay, from February to June of 2011. A DENV antigen test was used to confirm the infection. The protein E gene sequences of isolated viruses were sequenced for phylogenetic analysis.Results: Dengue was confirmed in 55.1% of the participants (n = 98/178). The most frequent clinical findings were fever, headache, and myalgia. Identity analyses of the protein E gene sequence of 56 viruses isolated showed the circulation of DENV-1 (n = 45) and DENV-2 (n = 11) in the Asuncion metropolitan area in 2011. Molecular epidemiology analyses suggest that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages.Conclusions: We have analyzed the molecular epidemiology of DENV-1 and DENV-2 isolated in Paraguay in 2011. We found strong evidence that DENV-1 was introduced into Paraguay from Argentina, while the DENV-2 from Brazil, replacing previous virus lineages. Molecular epidemiology studies are of great interest to analyze the dynamic of DENV spread, which are useful for early implementation of containment measures to reduce the risk of explosive epidemics caused by this virus. [ABSTRACT FROM AUTHOR]

Background: The aim of our study was to determine through a systematic review and meta-analysis the incubation period of COVID-19. It was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Criteria for eligibility were all published population-based primary literature in PubMed interface and the Science Direct, dealing with incubation period of COVID-19, written in English, since December 2019 to December 2020. We estimated the mean of the incubation period using meta-analysis, taking into account between-study heterogeneity, and the analysis with moderator variables. Results: This review included 42 studies done predominantly in China. The mean and median incubation period were of maximum 8 days and 12 days respectively. In various parametric models, the 95th percentiles were in the range 10.3–16 days. The highest 99th percentile would be as long as 20.4 days. Out of the 10 included studies in the meta-analysis, 8 were conducted in China, 1 in Singapore, and 1 in Argentina. The pooled mean incubation period was 6.2 (95% CI 5.4, 7.0) days. The heterogeneity (I2 77.1%; p < 0.001) was decreased when we included the study quality and the method of calculation used as moderator variables (I2 0%). The mean incubation period ranged from 5.2 (95% CI 4.4 to 5.9) to 6.65 days (95% CI 6.0 to 7.2). Conclusions: This work provides additional evidence of incubation period for COVID-19 and showed that it is prudent not to dismiss the possibility of incubation periods up to 14 days at this stage of the epidemic. [ABSTRACT FROM AUTHOR]

Background: Wheat straw, one of the most abundant agricultural residues worldwide, can be used to produce biogas, which is considered one of the most efficiently produced renewable energies. Wheat grown with the dual-purpose of producing food and biogas should display simultaneously high grain and straw yields, low lodging susceptibility and high conversion efficiency of straw into biogas. The aims of this study were to determine the best food-fuel dual-purpose wheat candidates among 36 wheat genotypes—including French, CIMMYT and local (Criollo) germplasm—used in breeding programs in Argentina and to gain some insights into the relationships between key traits relevant for dual-purpose wheat genotypes. Results: High variability in individual key traits for dual-purpose wheat ideotype has been found. Genotypes of French origin displayed the highest grain yield, and those of CIMMYT origin, the lowest straw yield. Genotypes of Criollo origin showed the highest lodging susceptibility, and French ones, the lowest. Straw yield was positively correlated with grain yield in all genotypes, and negatively correlated with plant height in genotypes of Criollo origin. Straw conversion into biogas was measured in terms of the biogas potential production and kinetic parameters Bmax (maximum specific biogas production) and k (first-order kinetic constant) were analyzed. All key traits were analyzed together by a principal component analysis. Baguette 31 and SNR Nogal, two genotypes of French origin, showed high grain yield, high-to-very high straw yield, low lodging susceptibility, and moderate-to-high Bmax and k. Buck Guapo and Buck Baqueano, two genotypes of Criollo origin, displayed good values for grain yield, straw yield and Bmax and k. However, their high lodging susceptibility precludes their production in shallow soils or high-input systems. Lastly, some old genotypes (e.g. Klein Atlas) harbored a good combination of all key traits and could prove valuable to be included in future breeding programs for dual-purpose wheat. Conclusions: While none of the genotypes excelled in every key trait, a few candidates showed potential for dual-purpose ideotype, particularly Baguette 31 and SNR Nogal. The challenge lays in gathering all attributes for food and 2G fuel in the same genotype. [ABSTRACT FROM AUTHOR]

Background: The increase of excess weight around the world is progressive and sustained in children. This is the most prevalent form of malnutrition in this population and they represent the major public health problem in developed and developing countries. The aim of this study was to analyze the magnitude of change in thinness and excess weight prevalence in 4-7 years-old schoolchildren from Jujuy (Argentina), between 1996 and 2015 and to examine the association according to sex and school location.Methods: Cross-sectional study. Data was obtained from databases of School Health programs and it is representative of the city school population. For the analysis, 31,014 schoolchildren between 4 and 7 years old were evaluated, 20,224 from the first period (1996-2001) and 10,790 from the second (2010-2015). The city was partitioned in three different areas determined by the rivers that cross it. Nutritional status was determined by BMI for age with the criteria suggested by the International Obesity Task Force. The percentage of malnutrition change between periods was calculated and a binomial regression model was adjusted.Results: Between periods, a significant (p-value< 0.0001) increase in the prevalence of overweight from 15.1% (CI 14.6-15.6%) to 18.1% (CI 17.4-18.8%) and obesity from 5% (CI 4.7-5.3) to 10.7% (CI 10.1-11.3%), and a decrease of thinness prevalence from 6.3% (CI 6.0-6.7%) to 4.7% (CI 4.3-5.1%) were observed. The percentage of change in the prevalence of obesity was very high in all areas and in both sexes (103.5% girls; 125.6% in boys), being higher in the south for girls (122.4%) and in the north for boys (158.8%). Besides, being a boy was inversely associated with the presence of excess weight and, as the age increases, the presence of obesity does it too. By analyzing the effect of the school location, the south and north zones had an inverse association with the presence of obesity. The period has a direct association with the presence of excess weight.Conclusion: The study contributes with valuable information on the magnitude of the increase in obesity in schoolchildren and suggests a possible correlation with sex and spatial distribution in the capital city of Jujuy. [ABSTRACT FROM AUTHOR]

Objective: To describe the calcium concentration of tap and bottled waters from Argentina and to estimate the contribution of drinking water to calcium recommendations. Results: Calcium concentrations provided by water authorities ranged from 6 to 105 mg/L. The mean calcium level of samples analysed at the Laboratorio de Ingeniería Sanitaria, National University of La Plata was 15.8 (SD ± 13.2) mg/L and at the Bone Biology Laboratory of the National University of Rosario was 13.1 (± 10.0) mg/L. Calcium values of samples from supply systems and private wells was similar. Most bottled waters had calcium levels well below 50 mg/L. The intake of one litre of drinking water from Argentina could represent in average between 1.2 and 8.0% of the calcium daily values for an adult. [ABSTRACT FROM AUTHOR]

Background: In South America, cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL) are emerging diseases, expanding in the border area of Argentina, Brazil and Paraguay. Outbreaks of CL were reported since the 1990s, with Nyssomyia whitmani as the main vector in this region. Regarding VL, urban reports started in 2010 with Lutzomyia longipalpis as the main vector. The aim of this study was to evaluate environmental determinants related to the main vectors of leishmaniasis, to contribute to the prevention and control response to the emergence of VL and CL in the Argentina-Brazil-Paraguay border region. Methods: The cross-sectional survey includes two cities and two close rural areas in the Argentinean Northeast Region, between November 2014 and January 2015, with a total of 95 sampling sites. REDILA-BL traps were set for three consecutive nights, and a total of 68 meso- and microscale environmental and landscape characteristics were surveyed. The association between vector abundance with different variables was evaluated using a generalized linear model with zero-inflated negative binomial distribution. We analyzed females for detection of Leishmania DNA. Results: The analysis for Lu. longipalpis indicates an excess of absences when the mean NDWI around the sites were higher. The abundance of Lu. longipalpis at mesoscale level was higher when more urban services were present, and when blood sources such as chickens or dogs at the microscale level were present. For Ny. whitmani, no variable was found to be associated with the absences, while its abundance increased in association with the following variables: percentage of tree cover, presence of garbage collection service, hosted people and, at microscale, the presence of poultry. Leshmania infantum DNA was detected in 2/49 (4%) Lu. longipalpis. Conclusions: The abundance of both species is influenced by variables at different scales, their influence probably has a hierarchy and they are acting on different aspects of the biology of these vectors. The urban spatial segregation of Lu. longipalpis and the peri-urban and rural segregation of N. whitmani increase the risk of VL and CL. The selection of the better variables for each scale will allow the design of appropriate control strategies depending on species. [ABSTRACT FROM AUTHOR]

Background: Disabled people are particularly exposed to the risks of COVID-19, as well as to the measures taken to address it, and their impact. The aim of the study was to examine the disability-inclusiveness of government responses to COVID-19 in four South American Countries: Argentina, Brazil, Chile, and Peru. Methods: We conducted documentary research, using framework analysis to analyse reports, legislation, decrees, and other official documents that communicated measures taken in response to the pandemic, published from February 1st until May 22nd, 2020. We included documents reporting measures that affected disabled people either directly (measures specifically designed for disabled people) or indirectly (measures for the general population). We developed an analytical framework based on recommendations for disability-inclusive response to COVID-19 published by the Economic Commission for Latin America and the Carribean, the World Health Organisation, and other international organisations. Results: We analysed 72 documents. The findings highlight that while some positive measures were taken, the needs of disabled people were not fully considered. Several countries published recommendations for a disability-inclusive response to COVID-19, without ensuring their translation to practice. All countries took at least some steps to ensure access to financial support, health, and education for disabled people, but at the same time they also implemented policies that had a detrimental impact on disabled people. The populations that are most exposed to the impacts of COVID-19, including disabled people living in institutional care, were protected in several cases only by recommendations rather by legislation. Conclusions: This study illustrates how the official government responses taken by four countries in the region – while positive, in several aspects – do not fully address the needs of disabled people, thus further disadvantaging them. In order to ensure response to COVID − 19 is disability inclusive, it is necessary to translate recommendations to practice, consider disabled people both in mainstream policy and in disability-specific measures, and focus on the long-term reconstruction phase. [ABSTRACT FROM AUTHOR]

Background: The high fragmentation and decentralization in the provision of health care services that characterizes Argentina's health system, as well as the economic and social inequalities, challenge the achievement of the Universal Health Coverage (UHC). The objective of this study is to measure socioeconomic-related inequality and horizontal inequity in the use of health care services in Argentina as well as identify the factors that contribute to these disparities. Methods: The 2013 National Risk Factor Survey, developed by the Ministry of Health of Argentina, was used to measure socioeconomic-related inequality and inequity in the use of health care services through concentration curves, the Erreygers concentration index, and the index of horizontal inequity. Econometric micro-decomposition was applied to estimate the contribution of each determining factor to inequality in the use of health care services. Results: The Erreygers concentration index for the use of health care services was 0.1223, evidencing pro-rich inequalities. By adding variables of health care needs, the horizontal inequity index was 0.1296. Non-need factors such as education and health coverage with social security increase pro-rich inequality. Conclusions: The Argentine health system shows pro-rich inequality in the use of health care services. It is necessary to design strategies to improve articulation between the three coverage subsectors and national, provincial, and municipal governments to keep the commitment of "not leaving anyone behind." The results showed here could provide lessons for countries with similar contexts and challenges in public health. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for cardiovascular disease (CVD). Despite advances in hypertension prevention and treatment, the proportion of patients who are aware, treated and controlled is low, particularly in low-income and middle-income countries (LMICs). We will evaluate an adapted version of a multilevel and multicomponent hypertension control program in Guatemala, previously proven effective and feasible in Argentina. The program components are: protocol-based hypertension treatment using a standardized algorithm; team-based collaborative care; health provider education; health coaching sessions; home blood pressure monitoring; blood pressure audit; and feedback.Methods: Using a hybrid type 2 effectiveness-implementation design, we will evaluate clinical and implementation outcomes of the multicomponent program in Guatemala over an 18-month period. Through a cluster randomized trial, we will randomly assign 18 health districts to the intervention arm and 18 to enhanced usual care across five departments, enrolling 44 participants per health district and 1584 participants in total. The clinical outcomes are (1) the difference in the proportion of patients with controlled hypertension (< 130/80 mmHg) between the intervention and control groups at 18 months and (2) the net change in systolic and diastolic blood pressure from baseline to 18 months. The context-enhanced Reach, Efficacy, Adoption, Implementation, Maintenance (RE-AIM)/Practical Robust Implementation and Sustainability Model (PRISM) framework will guide the evaluation of the implementation at the level of the patient, provider, and health system. Using a mixed-methods approach, we will evaluate the following implementation outcomes: acceptability, adoption, feasibility, fidelity, adaptation, reach, sustainability, and cost-effectiveness.Discussion: We will disseminate the study findings, and promote scale up and scale out of the program, if proven effective. This study will generate urgently needed data on effective, adoptable, and sustainable interventions and implementation strategies to improve hypertension control in Guatemala and other LMICs.Trial Registration: ClinicalTrials.gov: NCT03504124. Registered on 20 April 2018. [ABSTRACT FROM AUTHOR]

Background: Traditionally part of the human diet, plants with edible fleshy fruits (PEFF) contain bioactive components that may exert physiological effects beyond nutrition, promoting human health and well-being. Focusing on their food-medicine functionality, different ways of using PEFF were studied in a cross-sectional way using two approaches: a bibliographical survey and an ethnobotanical case study in a rural community of Patagonia, Argentina. Methods: A total of 42 studies were selected for the bibliographical review. The case study was carried out with 80% of the families inhabiting the rural community of Cuyín Manzano, using free listing, interviews, and participant observation. In both cases we analyzed species richness and use patterns through the edible consensus and functional consensus indices. Local foods, ailments, medicines and drug plants were also registered. Results: The review identified 73 PEFF, the majority of which (78%) were native species, some with the highest use consensus. PEFF were used in 162 different local foods, but mainly as fresh fruit. Of the total, 42% were used in a functional way, in 54 different medicines. The principal functional native species identified in the review were Aristotelia chilensis and Berberis microphylla. In the case study 20 PEFF were in current use (50% were native), and consensus values were similar for native and exotic species. These were used in 44 different local foods, mainly as fresh fruit. Only 30% were recognized for their functional value by inhabitants (mainly as gastrointestinal and respiratory treatments). The species with the highest functional consensus were the exotic Sambucus nigra and Rosa rubiginosa, followed by the native A. chilensis, Ribes magellanicum and B. microphylla. Infusions also constituted important local functional foods. Conclusions: This survey highlights the importance of studying the different local functional foods to depict the biocultural diversity of a human society. The preparation of different beverages and herbal medicines was relevant, and would be a promising subject to investigate in the future. The living heritage of PEFF appears to have undergone hybridization processes, such that exotic species play an increasingly significant role. [ABSTRACT FROM AUTHOR]

Background: Chagas disease (CD) continues to be a neglected infectious disease with one of the largest burdens globally. Despite the modest cure rates in adult chronic patients and its safety profile, benznidazole (BNZ) is still the drug of choice. Its current recommended dose is based on nonrandomized studies, and efficacy and safety of the optimal dose of BNZ have been scarcely analyzed in clinical trials.Methods/design: MULTIBENZ is a phase II, randomized, noninferiority, double-blind, multicenter international clinical trial. A total of 240 patients with Trypanosoma CD in the chronic phase will be recruited in four different countries (Argentina, Brazil, Colombia, and Spain). Patients will be randomized to receive BNZ 150 mg/day for 60 days, 400 mg/day for 15 days, or 300 mg/day for 60 days (comparator arm). The primary outcome is the efficacy of three different BNZ therapeutic schemes in terms of dose and duration. Efficacy will be assessed according to the proportion of patients with sustained parasitic load suppression in peripheral blood measured by polymerase chain reaction. The secondary outcomes are related to pharmacokinetics and drug tolerability. The follow-up will be 12 months from randomization to end of study participation. Recruitment was started in April 2018.Conclusion: This is a clinical trial conducted for the assessment of different dose schemes of BNZ compared with the standard treatment regimen for the treatment of CD in the chronic phase. MULTIBENZ may help to clarify which is the most adequate BNZ regimen in terms of efficacy and safety, predicated on sustained parasitic load suppression in peripheral blood.Trial Registration: ClinicalTrials.gov, NCT03191162. Registered on 19 June 2017. [ABSTRACT FROM AUTHOR]

Background: There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico). Methods: The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed. Discussion: The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries. Trial registration: Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019. [ABSTRACT FROM AUTHOR]

Patients with rare diseases across the world struggle to access timely diagnosis and state-of-the-art treatment and management of their conditions. Several recently published reviews highlight the importance of country efforts to address rare diseases and orphan drugs policy comprehensively. However, many of these reviews lack depth and detail at the local level, which we believe is necessary for rare disease advocates to identify and prioritize opportunities for strengthening each country's policy framework.We asked leading patient advocates from civil society organizations their views on rare disease public policy in Argentina, Brazil, Chile, Colombia, Mexico, and Peru with a focus on whether specific laws and regulations in these six Latin American countries have been promulgated. From December 2018 to March 2019 we supplemented their perspectives with evidence from accessible literature using key search terms. For each country, we prepared a detailed analysis on how laws or other policy initiatives took shape and the steps taken since to implement them. This allowed us to identify five broad policy categories for subsequent analysis: national laws, national regulations, health system incorporation of rare disease treatments, care delivery, and patient engagement.By describing the different approaches, challenges and timelines across six countries, our research demonstrates that strengthening rare disease policy first requires a common understanding and local consensus of each country's recent past and current situation. Subsequent analysis based on a set of common policy dimensions led us to where we believe salient opportunities lie for each of these countries to strengthen their overall policy framework for rare disease patients. [ABSTRACT FROM AUTHOR]

Background: Melanic (dark) morphs have been barely reported in peridomestic and sylvatic conditions for Triatoma infestans, the most important vector of Chagas disease in the Southern Cone of South America. Adults with dark and small yellow markings on the connexivum were collected after manual searches conducted by technical personnel in 62 domiciliary units in Cruz del Eje, Córdoba Province, Argentina. The last community-wide insecticide spraying campaign before the study had been conducted three years earlier. We investigated if there was a measurable color morph variation (melanic and non-melanic) in wings and connexivum; we determined infestation, distribution of melanic and non-melanic forms, and correspondence of colorimetric variation with variations in morphology (wing size and shape and body length), development (wing fluctuating asymmetry), physiology (nutritional status) or behaviour (flight initiation). Results: Forty-nine females, 54 males and 217 nymphs were collected in 24 domiciliary units. House infestation and colonization were 53% and 47%, respectively. Most of the T. infestans individuals (83.2%) were collected in chicken coops; intradomicile infestation was recorded in only one case. The chromatic cluster analysis showed two well-defined groups: melanic and non-melanic. The melanic group included 17 (35%) females and 25 (46%) males. Peridomestic infestation was lower for melanic than for non-melanic adults. Melanic morphs were collected in houses from several localities. Sexual dimorphisms were confirmed by morphometric measurements. Body length was large in melanic adults (P < 0.01 only for males). Differences between groups were significant for wing size and shape, but not for weight or weight/body length ratio. Melanic females and males showed significantly higher fluctuating asymmetry (FA) indices than their non-melanic counterparts. Conclusions: This is the second report of melanic forms of T. infestans in domestic and peridomestic habitats in the Dry Chaco region of Argentina. Although non-melanic adults exhibited a higher infestation rate, melanic adults were widespread in the area and were collected in the infested domicile and in most types of peridomestic annexes. Differences in morphometric variables between groups might be due to different ecological adaptations. The higher FA levels observed in melanic individuals suggest a higher developmental instability and a selective advantage of non-melanic individuals in domestic and peridomestic habitats. [ABSTRACT FROM AUTHOR]