Search

Primary health care (PHC) has increased in global relevance as it has been demonstrated to be a useful strategy to promote community access to health services. Multilateral organizations and national governments have reached a consensus regarding the basic principles of PHC, but the application of these varies from country to country due to the particularities of local health systems. This article aims to review and summarize PHC strategies and the configuration of health networks in Latin American and Caribbean countries. The review was carried out using keywords in at least 9 databases. Papers in languages other than English, Portuguese, and Spanish were excluded, while non-refereed articles and regional gray literature were incorporated. As a result, 1,146 papers were identified. After three instances of analysis, 142 articles were selected for this investigation. Data were analyzed according to an analysis by theme. The evidence collected on health reforms in the region reflects the need to intensify care strategies supported by PHC and care networks. These must be resilient to changes in the population's needs and must be able to adapt to contexts of epidemiological accumulation. [ABSTRACT FROM AUTHOR]

Background: Scientific journals play a critical role in research validation and dissemination and are increasingly vocal about the identification of research priorities and the targeting of research results to key audiences. No new journals specialising in health policy and systems research (HPSR) and focusing in the developing world or in a specific developing world region have been established since the early 1980s. This paper compares the growth of publications on HPSR across Latin America and the world and explores the potential, feasibility and challenges of innovative publication strategies.Methods: A bibliometric analysis was undertaken using HPSR MeSH terms with journals indexed in Medline. A survey was undertaken among 2500 authors publishing on HPSR in Latin America (LA) through an online survey, with a 13.1% response rate. Aggregate indicators were constructed and validated, and two-way ANOVA tests were performed on key variables.Results: HPSR publications on LA observed an average annual growth of 27.5% from the years 2000 to 2018, as against 11.4% worldwide and yet a lag on papers published per capita. A total of 48 journals with an Impact Factor publish HPSR on LA, of which 5 non-specialised journals are published in the region and are ranked in the bottom quintile of Impact Factor. While the majority of HPSR papers worldwide is published in specialised HPSR journals, in LA this is the minority. Very few researchers from LA sit in the Editorial Board of international journals. Researchers highly support strengthening quality HPSR publications through publishing in open access, on-line journals with a focus on the LA region and with peer reviewers specialized on the region. Researchers would support a new open access journal specializing in the LA region and in HPSR, publishing in English. Open access up-front costs and disincentives while waiting for an Impact Factor can be overcome.Conclusion: Researchers publishing on HPSR in LA widely support the launching of a new specialised journal for the region with a vigorous editorial policy focusing on regional and country priorities. Strategies should be in place to support English-language publishing and to develop a community of practice around the publication process. In the first years, special issues should be promoted through a priority-setting process to attract prominent authors, develop the audience and attain an Impact Factor. [ABSTRACT FROM AUTHOR]

Background: Claims of inconsistency in epidemiological data have emerged for both developed and developing countries during the COVID-19 pandemic. Methods: In this paper, we apply first-digit Newcomb-Benford Law (NBL) and Kullback-Leibler Divergence (KLD) to evaluate COVID-19 records reliability in all 20 Latin American countries. We replicate country-level aggregate information from Our World in Data. Results: We find that official reports do not follow NBL's theoretical expectations (n = 978; chi-square = 78.95; KS = 4.33, MD = 2.18; mantissa =.54; MAD =.02; DF = 12.75). KLD estimates indicate high divergence among countries, including some outliers. Conclusions: This paper provides evidence that recorded COVID-19 cases in Latin America do not conform overall to NBL, which is a useful tool for detecting data manipulation. Our study suggests that further investigations should be made into surveillance systems that exhibit higher deviation from the theoretical distribution and divergence from other similar countries. [ABSTRACT FROM AUTHOR]

As part of the MASCOT/WOTRO multinational team conducting the maternal health literature mapping, four Latin American researchers were particularly interested in analysing information specific to their region. The mapping started with 45,959 papers uploaded from MEDLINE, CINAHL, Embase, LILACAS, PopLINE, PsycINFO and Web of Knowledge. From these, 4175 full texts were reviewed and 2295 papers were subsequently included. Latin America experienced an average maternal mortality decline of 40% between 1990 and 2013. Nevertheless, the region's performance was below the global average and short of the 75% reduction set in Millennium Development Goal 5 for 2015. The main outcomes show that research on maternal health in the countries where the most impoverished populations of the world are living is not always aligned with their compelling needs. From another perspective, the review made it possible to recognize that research funding as well as the amount of scientific literature produced concentrate on issues that are not necessarily among the main causes of maternal deaths. Even though research on maternal health in Latin America has grown from an average of 92.5 publications per year in 2000-2003 to 236.7 between 2008 and 2012, it's not satisfactorily keeping pace with other regions. In conclusion, it is critical to effectively orient research funding and production to respond to the health needs of the population. At the same time, there is a need for innovative mechanisms to strengthen the production and uptake of scientific evidence that can properly inform public health decision making. [ABSTRACT FROM AUTHOR]

Background: During the first decade of the current century, Latin American countries have shown high and consistent economic growth rates, increasing per capita GDP and reducing poverty. Social indicators improved in even the poorest and least equitable countries in the region. In terms of health care results, marked advances were made in infant mortality rates. Objective: The aim of this paper is to identify if decreasing poverty rates in Latin America and the Caribbean during the first decade of the century have had an effect on health inequality, specifically by reducing the health care equity gap and, if so, whether that trend and its effects were distributed evenly at the sub-national level. Methods: Basic statistical tools were applied to national and sub-national administrative data for eleven Latin American countries (Argentina, Belize, Bolivia, Brazil, Colombia, Dominican Republic, El Salvador, Mexico, Nicaragua, Peru, and Uruguay) to compare the evolution of a set of social determinants with a classic health care outcome, such infant mortality) during the period 1995–2012. This document proposes a set of indicators to analyze relative evolution of results and convergence to equity, and to discuss general trends in health care reforms across the region. Results: The document shows a correspondence between poverty reduction, and improvement of health care indicators at a regional level, though national differences persist. In some cases, like Brazil and Peru, the reduction in infant mortality rates is coupled with significant movements towards health equity. This trend is different in Bolivia, where the drop in poverty is not followed by better outcomes in poor departments. At the same, results are not necessarily linked to health systems organization and/or specific reforms. For instance, both Brazil and Peru pursue in applying decentralized solutions, although the incentive mechanisms are quite different: the former has a supply side structure at the public provision level while the latter has implemented mixed payment systems. Conclusion: While some of the same instruments and measures of effectiveness in health care reforms appear across the region, specific impact evaluations should be performed. To reduce the equity gap in Latin America requires not only major improvements in social determinants but also the design and implementation of sound institutional policy and more robust regulatory frameworks (institutional determinants) so that more resources yield better practices. [ABSTRACT FROM AUTHOR]

Background: Increasing vaccination coverage was key to curbing the COVID-19 pandemic globally. However, lack of trust in the vaccine and fear of side effects in regions like the Caribbean resulted in a low uptake despite enough vaccine supply. Methods: We conducted two correlational analyses and one experiment between five sequential behaviorally informed Facebook campaigns, social media performance outcomes, and district-level vaccination data. First, we ran multivariate linear regression models to estimate the mean differences between the campaigns in (i) social media performance ("Clicks" and "Engagement") and (ii) COVID-19 vaccination uptake at the district level. "Clicks" were measured by the number of people who clicked on the respective Facebook advert and visited the official vaccination site. "Engagements" were the number of people interacting with the advert through likes and emojis. Second, we took advantage of the experimental design during one of the campaigns to analyze the differential effect of messages conveying information about the number of people reporting vaccination side effects using words ("Few"/ "Majority) and numbers ("3 out of 100 ") on social media performance. Results: The correlational analysis showed that the number of "Clicks" and "Engagement" was similar among campaigns, except for the campaign focusing on vaccines' effectiveness, which had 14.65 less clicks and 19.52 less engagements per advert (including controls and district-fixed effects) compared to the base "It's safe" campaign. Vaccination rates were highest at times coinciding with campaigns focusing on vaccination safety and effectiveness. Our experimental results showed that informational messages related to side effects that were framed using words ("Majority did not report discomfort"/ "Few persons reported discomfort") were better at generating "Clicks" compared to those using numbers ("3 out of 100 reported discomforts"). Conclusions: Facebook adverts highlighting vaccine safety had a similar level of social media performance as other campaigns, except for adverts focusing on vaccine efficacy, which performed worse. Communicating side-effect information with words instead of numbers can expand social media interest in low-uptake regions like the Caribbean. Our results serve as preliminary evidence for public health officials to encourage vaccine uptake in high-hesitancy contexts. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has spread through pre-existing fault lines in societies, deepening structural barriers faced by precarious workers, low-income populations, and racialized communities in lower income sub-city units. Many studies have quantified the magnitude of inequalities in COVID-19 distribution within cities, but few have taken an international comparative approach to draw inferences on the ways urban epidemics are shaped by social determinants of health. Methods: Guided by critical epidemiology, this study quantifies sub-city unit-level COVID-19 inequalities across eight of the largest metropolitan areas of Latin America and Canada. Leveraging new open-data sources, we use concentration indices to quantify income- and vulnerability-related inequalities in incidence, test positivity, and deaths over the first 125 weeks of the pandemic between January 2020 and May 2022. Results: Our findings demonstrate that incidence, deaths, and test positivity are all less concentrated in low-income sub-city units than would be expected, with incidence ranging concentration in lower income neighbourhoods in Toronto (CI = -0.07) to concentration in higher income neighbourhoods in Mexico City (CI = 0.33). Drawing on relevant studies and evaluations of data reliability, we conclude that the best available public surveillance data for the largest cities in Latin America are likely not reliable measures of the true COVID-19 disease burden. We also identify recurring trends in the evolution of inequalities across most cities, concluding that higher income sub-city units were frequent early epicentres of COVID-19 transmission across the Latin America and Canada. Conclusions: Just as critical epidemiology points to individuals biologically embodying the material and social conditions in which we live, it may be just as useful to think of cities reifying their material and social inequities in the form of sub-city unit-level infectious disease inequities. By shifting away from a typical vulnerability-based social determinants of health frame, policymakers could act to redress and reduce externalities stemming from sub-city unit-level income inequality through redistributive and equity-promoting policies to shift the centre of gravity of urban health inequalities before the next infectious disease epidemic occurs. [ABSTRACT FROM AUTHOR]

Background: Latin America (LATAM) encompasses a vast region with diverse populations. Despite publicly funded health care systems providing universal coverage, significant socioeconomic and ethno-racial disparities persist in health care access across the region. Breast cancer (BC) incidence and mortality rates in Brazil are comparable to those in other LATAM countries, supporting the relevance of Brazilian data, with Brazil's health care policies and expenditures often serving as models for neighboring countries. We evaluated the impact of mobility on oncological outcomes in LATAM by analyzing studies of patients with BC reporting commuting routes or travel distances to receive treatment or diagnosis. Methods: We searched MEDLINE (PubMed), Embase, Cochrane CENTRAL, LILACS, and Google Scholar databases. Studies eligible for inclusion were randomized controlled trials and observational studies of patients with BC published in English, Portuguese, or Spanish and conducted in LATAM. The primary outcome was the impact of mobility or travel distance on oncological outcomes. Secondary outcomes included factors related to mobility barriers and access to health services. For studies meeting eligibility, relevant data were extracted using standardized forms. Risk of bias was assessed using the Newcastle-Ottawa Scale. Quantitative and qualitative evidence synthesis focused on estimating travel distances based on available data. Heterogeneity across distance traveled or travel time was addressed by converting reported travel time to kilometers traveled and estimating distances for unspecified locations. Results: Of 1142 records identified, 14 were included (12 from Brazil, 1 from Mexico, and 1 from Argentina). Meta-analysis revealed an average travel distance of 77.8 km (95% CI, 49.1-106.48) to access BC-related diagnostic or therapeutic resources. Nonetheless, this average fails to precisely encapsulate the distinct characteristics of each region, where notable variations persist in travel distance, ranging from 88 km in the South to 448 km in the North. Conclusion: The influence of mobility and travel distance on access to BC care is multifaceted and should consider the complex interplay of geographic barriers, sociodemographic factors, health system issues, and policy-related challenges. Further research is needed to comprehensively understand the variables impacting access to health services, particularly in LATAM countries, where the challenges women face during treatment remain understudied. Trial registration: CRD42023446936. [ABSTRACT FROM AUTHOR]

Background: This paper analyzes the strategies used by activist health professionals in Argentina who justify providing abortion despite legal restrictions on the procedure. These "insider activists" make a case for abortion rights by linking pregnancy termination to a woman's ability to exert agency at a key point in her reproductive life, and argue that refusing women access to the procedure constitutes a grievous health risk. This argument frames pregnancy termination as an issue of empowerment and also as a medical necessity.Methods: This article is based on ethnographic research conducted in Argentina in 2013 and 2015, which includes in-depth interviews with abortion activists and health professionals and ethnographic observation at activist events and in clinics.Results: During the period of my field research, the medical staff in one clinic shifted from abortion counseling, based on a harm reduction model, to legal pregnancy termination, a new mode of abortion provision where they directly provided abortions based on the legal health exception. These insider activists formalized the latter approach by creating a diagnostic instrument that frames women's "bio-psycho-social" reasons for wishing to terminate a pregnancy as medically justified.Conclusions: The clinical practice analyzed in this article raises important questions about the potential for health professionals to take on an activist role by making safe abortion accessible, even in a context where the procedure is highly restricted. [ABSTRACT FROM AUTHOR]

Introduction: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. Methods: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2–3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. Results: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. Conclusion: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability. [ABSTRACT FROM AUTHOR]

Background: Digital technologies have positively impacted the availability and usability of clinical algorithms through the advancement in mobile health. Therefore, this study aimed to determine if a web-based algorithm designed to support the decision-making process of cancer care providers (CCPs) differentially impacted their self-reported self-efficacy and practices for providing smoking prevention and cessation services in Peru and Colombia. Methods: A simple decision-making tree algorithm was built in REDCap using information from an extensive review of the currently available smoking prevention and cessation resources. We employed a pre-post study design with a mixed-methods approach among 53 CCPs in Peru and Colombia for pilot-testing the web-based algorithm during a 3-month period. Wilcoxon signed-rank test was used to compare the CCPs' self-efficacy and practices before and after using the web-based algorithm. The usability of the web-based algorithm was quantitatively measured with the system usability scale (SUS), as well as qualitatively through the analysis of four focus groups conducted among the participating CCPs. Results: The pre-post assessments indicated that the CCPs significantly improved their self-efficacy and practices toward smoking prevention and cessation services after using the web-based algorithm. The overall average SUS score obtained among study participants was 82.9 (± 9.33) [Peru 81.5; Colombia 84.1]. After completing the qualitative analysis of the focus groups transcripts, four themes emerged: limited resources currently available for smoking prevention and cessation in oncology settings, merits of the web-based algorithm, challenges with the web-based algorithm, and suggestions for improving this web-based decision-making tool. Conclusion: The web-based algorithm showed high usability and was well-received by the CCPs in Colombia and Peru, promoting a preliminary improvement in their smoking prevention and cessation self-efficacy and practices. [ABSTRACT FROM AUTHOR]

Background: Thriving from Work is a construct that has been highlighted as an important integrative positive worker well-being indicator that can be used in both research and practice. Recent public discourse emphasizes the important contributions that work should have on workers' lives in positive and meaningful ways and the importance of valid and reliable instruments to measure worker well-being. The Thriving from Work Questionnaire measures how workers' experiences of their work and conditions of work contributes in positive ways to their thriving both at and outside of work. Methods: The purpose of this study was to translate the Thriving from Work Questionnaire from English to Spanish, and then validate the translated questionnaire in a sample of 8,795 finance workers in Peru and Mexico. We used item response theory models replicating methods that were used for the original validation studies. We conducted a differential item functioning analysis to evaluate any differences in the performance of models between Peru and Mexico. We evaluated criterion validity with organizational leadership, flourishing, vitality, community well-being, and worker's home location socio-economic position. Results: The current study demonstrates that the Spanish (Peru/Mexico) questionnaire was found to be a reliable and valid measure of workers' thriving from work. One item was dropped from the long-form version of the original U.S. questionnaire. Both the long and short form versions of the questionnaire had similar psychometric properties. Empirical reliability was high. Criterion validity was established as hypothesized relationships between constructs was supported. There were no differences in the performance of the model between countries suggesting utility across Latin American countries. Conclusions: The current study demonstrated that the Spanish (Peru and Mexico) version of the questionnaire is both a reliable and valid measure of worker well-being in Latin America. Specific recommendations are made for the adaptation of the questionnaire and directions of future research. [ABSTRACT FROM AUTHOR]

Background: The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanisms in the field of sexual and reproductive health (SRH) outside North American or European contexts. This paper seeks to give an overview of the existing knowledge on this topic as well as to document practical challenges and remedies from the perspectives of researchers involved in four SRH research consortium projects in Latin America, sub-Saharan Africa, China and India. Methods: A literature review and relevant project documents were used to develop an interview guide through which researchers could reflect on their experiences in engaging with policy-makers, and particularly on the obstacles met and the strategies deployed by the four project consortia to circumvent them. Results: Our findings confirm current recommendations on an early and steady involvement of policy-makers, however they also suggest that local barriers between researchers and policy-making spheres and individuals can represent major hindrances to the realization of translation objectives. Although many of the challenges might be common to different contexts, creating locally-adapted responses is deemed key to overcome them. Researchers' experiences also indicate that - although inevitable - recognizing and addressing these challenges is a difficult, time- and energy-consuming process for all partners involved. Despite a lack of existing knowledge on translation efforts in SRH research outside North American or European contexts, and more particularly in low and middle-income countries, it is clear that existing pressure on health and policy systems in these settings further complicates them. Conclusions: This article brings together literature findings and researchers' own experiences in translating research results into policy and highlights the major challenges research conducted on sexual and reproductive health outside North American or European contexts can meet. Future SRH projects should be particularly attentive to these potential obstacles in order to tailor appropriate and consistent strategies within their existing resources. [ABSTRACT FROM AUTHOR]

Background: Poor glycemic control in patients with type 2 diabetes is commonly recorded worldwide; Latin America (LA) is not an exception. Barriers to intensifying insulin therapy and which barriers are most likely to negatively impact outcomes are not completely known. The objective was to identify barriers to insulin progression in individuals with type 2 diabetes mellitus (T2DM) in LA countries (Mexico, Brazil, and Argentina). Methods: MOSAIc is a multinational, non-interventional, prospective, observational study aiming to identify the patient-, physician-, and healthcare-based factors affecting insulin intensification. Eligible patients were ≥18 years, had T2DM, and were treated with insulin for ≥3 months with/without oral antidiabetic drugs (OADs). Demographic, clinical, and psychosocial data were collected at baseline and regular intervals during the 24-month follow-up period. This paper however, focuses on baseline data analysis. The association between glycated hemoglobin (HbA1c) and selected covariates was assessed. Results: A trend toward a higher level of HbA1c was observed in the LA versus non-LA population (8.40 ± 2.79 versus 8.18 ± 2.28; p ≤ 0.069). Significant differences were observed in clinical parameters, treatment patterns, and patient-reported outcomes in LA compared with the rest of the cohorts and between Mexico, Brazil, and Argentina. Higher number of insulin injections and lower number of OADs were used, whereas a lower level of knowledge and a higher level of diabetes-related distress were reported in LA. Covariates associated with HbA1c levels included age (-0.0129; p < 0.0001), number of OADs (0.0835; p = 0.0264), higher education level (-0.2261; p = 0.0101), healthy diet (-0.0555; p = 0.0083), self-monitoring blood glucose (-0.0512; p = 0.0033), hurried communication style in the process of care (0.1295; p = 0.0208), number of insulin injections (0.1616; p = 0.0088), adherence (-0.1939; p ≤ 0.0104), and not filling insulin prescription due to associated cost (0.2651; p = 0.0198). Conclusion: MOSAIc baseline data showed that insulin intensification in LA is not optimal and identified several conditions that significantly affect attaining appropriate HbA1c values. Tailored public health strategies, including education, should be developed to overcome such barriers. [ABSTRACT FROM AUTHOR]

Background: Free trade agreements (FTAs) can affect food environments and non-communicable disease risks through altering the availability of highly-processed foods. Few studies have quantified such effects. Using a natural experiment this paper quantifies changes in Peru's soft-drink market before/after entry into the US-Peru FTA, compared with Bolivia, a county with no such agreement.Methods: Difference-in-difference models were used to test for between country differences in the rate of per capita foreign direct investment (FDI) inflows, soft-drink imports, the volumes of various soft-drinks sold, and the volumes of sugar from soft-drinks before/after FTA ratification (2006) and enforcement (2009).Results: In Peru average per capita FDI-inflows rose from US$103.11 in the pre-ratification period to US$269.79 post-ratification, with little change in Bolivia. This corresponded with a 122 % increase in Peruvian soft-drink production. There was a significant between-country difference in FDI-inflows pre-/post-ratification (DID:1.07, 95 % CI:0.19-1.96; p = 0.01). Despite little difference in total per capita soft-drink sales volumes there was a significant between-country difference in per capita sugar from soft-drinks pre-/post enforcement (DID:-0.99, 95 % CI: -1.91-0.06; p = 0.03) with stagnated growth in Peru and continued growth in Bolivia. This resulted from stagnated sugar sweetened carbonates growth and increased bottled water, juice and sports & energy drinks growth in Peru, with continued carbonates growth in Bolivia. There was a significant between-country difference in per capita carbonates (DID: -1.44, 95 % CI: -2.52-0.36, p = 0.01) and bottled water (DID:0.63; 95 % CI: -0.01-1.26; p = 0.04) sales volumes.Conclusions: The FTA may have resulted in increased FDI-inflows and soft-drink production and also contributed to the diversification of soft drinks produced and sold in Peru with some positive (stagnated carbonates and increased bottled water) and some negative (increased juice and sports & energy drinks) implications for nutrition. These changes were not evident in Bolivia. These results should be interpreted cautiously given the study design limitations. [ABSTRACT FROM AUTHOR]

Copyright of Reproductive Health is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reproductive Health is the property of BioMed Central and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Data audits are often evaluated soon after completion, even though the identification of systematic issues may lead to additional data quality improvements in the future. In this study, we assess the impact of the entire data audit process on subsequent statistical analyses.Methods: We conducted on-site audits of datasets from nine international HIV care sites. Error rates were quantified for key demographic and clinical variables among a subset of records randomly selected for auditing. Based on audit results, some sites were tasked with targeted validation of high-error-rate variables resulting in a post-audit dataset. We estimated the times from antiretroviral therapy initiation until death and first AIDS-defining event using the pre-audit data, the audit data, and the post-audit data.Results: The overall discrepancy rate between pre-audit and audit data (n = 250) across all audited variables was 17.1%. The estimated probability of mortality and an AIDS-defining event over time was higher in the audited data relative to the pre-audit data. Among patients represented in both the post-audit and pre-audit cohorts (n = 18,999), AIDS and mortality estimates also were higher in the post-audit data.Conclusion: Though some changes may have occurred independently, our findings suggest that improved data quality following the audit may impact epidemiological inferences. [ABSTRACT FROM AUTHOR]

Background: Latin America has among the highest rates of intimate partner violence. While there is increasing evidence that intimate partner violence is associated with mental health problems, there is little such research for developing countries. The purpose of this paper is to examine the relationship between Bolivian women's experiences with physical, psychological, and sexual intimate partner violence and mental health outcomes. Methods: This study analyzes data from the 2008 Bolivia Demographic and Health Survey. 10,119 married or cohabiting women ages 15-49 are included in the analysis. Probit regression models are used to assess the association between intimate partner violence and mental health, after controlling for other demographic factors and partner characteristics. The questionnaire uses selected questions from the SRQ-20 to measure symptoms of mental health problems. Results: Intimate partner violence is common in Bolivia, with 47% of women experiencing some type of spousal abuse in the 12 months before the survey. Women exposed to physical spousal violence in the past year are more likely to experience symptoms of depression, anxiety, psychogenic non-epileptic seizures, and psychotic disorders, after controlling for other demographic and partner characteristics. Women who experienced sexual abuse by a partner are most likely to suffer from all mental health issues. Psychological abuse is also associated with an increased risk of experiencing symptoms of depression, anxiety, and psychogenic seizures. Women who experienced only psychological abuse report mental health problems similar to those who were physically abused. Conclusion: This study demonstrates an urgent need for research on the prevalence and health consequences of psychological abuse in developing countries. Our findings highlight the need for mental health services for victims of intimate partner violence. Because physical and psychological violence are often experienced concurrently, it is recommended that health providers who are treating victims of physical intimate partner violence also screen them for symptoms of potential mental health problems and refer them to appropriate mental health services. [ABSTRACT FROM AUTHOR]

Background: Food insecurity (FI) remains a global public health problem. FI is more prevalent in low-and middle-income countries than high-income countries. FI is related with worse cognitive outcomes including cognitive function, cognitive decline, and cognitive impairment. Few studies have sought to identify how patterns of FI relate with cognitive function in old age and the potential mechanisms underlying this association. Methods: Data from the 2015 and 2018 waves of the Mexican Health and Aging Study (n = 9,654, age 50+) were used in this study. Reports of FI in 2015 and 2018 were combined to create four patterns of FI groups: "persistently food secure", "became food secure", "became food insecure", and "persistently food insecure". Linear regression was used to estimate associations between patterns of FI and cognitive task performance. The mediating roles of depressive symptoms, body mass index, and chronic conditions were tested using Karlson, Holm, and Breen methodology. Results: Approximately half of the sample were persistently food secure, 17% became food secure, 14% became FI, and 15% experienced persistent FI. When adjusting for demographic/socioeconomic confounders, persistent FI related with worse Verbal Learning, Verbal Recall, Visual Scanning, and Verbal Fluency performance compared to the persistently food secure. Becoming FI related with worse Verbal Learning, Visual Scanning, and Verbal Fluency. Mediation analyses provided support for depressive symptoms mediating associations between FI and poorer cognition, where 48% of the association between persistent FI and worse Verbal Recall performance was attributed to higher depressive symptoms. Becoming food secure was not associated with cognitive performance compared to the persistently food secure. Conclusions: FI may represent an important modifiable risk factor for poorer cognitive outcomes among older adults. Public health efforts should focus on providing stable food access to older adults, especially those living in poverty. [ABSTRACT FROM AUTHOR]

Dengue continues to be a major public health concern in Latin America and the Caribbean with many countries in the region having experienced drastic increases in the incidence of dengue over the past few years. Dengue virus is predominantly transmitted by the bite of an infected female Aedes aegypti mosquito via a process called horizontal transmission. However, the virus may also be transmitted from an infected female mosquito to her offspring by vertical transmission, which occurs via viral invasion of the ovary either at the time of fertilization or during oviposition. In this way, mosquitoes may become dengue virus infected before ever encountering a human host. While some researchers have reported this phenomenon and suggested it may serve as a reservoir for the dengue virus in nature, others have questioned its epidemiological significance because of the low frequency at which it has been observed. Several researchers have either altogether failed to detect it or observed its occurrence at low frequencies. However, some studies have attributed these failures to small sample sizes as well as poor sensitivities of screening methods employed. Therefore, an overview of the occurrence, significance and limitations of detection of vertical transmission of dengue virus in Aedes mosquitoes in nature within Latin America and the Caribbean will be the focus of this review. [ABSTRACT FROM AUTHOR]

Background: Given the physiological changes during pregnancy, pregnant women are likely to develop recurrent urinary tract infections (UTIs) and pyelonephritis, which may result in adverse obstetric outcomes, including prematurity and low birth weight preeclampsia. However, data on UTI prevalence and bacterial profile in Latin American pregnant women remain scarce, necessitating the present systematic review to address this issue. Methods: To identify eligible observational studies published up to September 2022, keywords were systematically searched in Medline/PubMed, Cochrane Library, Embase, Web of Science, and Bireme/Lilacs electronic databases and Google Scholar. The systematic review with meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of studies was classified according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The meta-analysis employed a random-effects method with double-arcsine transformation in the R software. Results: Database and manual searches identified 253,550 citations published until September 2022. Among the identified citations, 67 met the inclusion criteria and were included in the systematic review, corresponding to a sample of 111,249 pregnant women from nine Latin American countries. Among Latin American pregnant women, the prevalence rates of asymptomatic bacteriuria, lower UTI, and pyelonephritis were estimated at 18.45% (95% confidence interval [CI]: 15.45–21.53), 7.54% (95% CI: 4.76–10.87), and 2.34% (95% CI: 0.68–4.85), respectively. Some regional differences were also detected. Among the included studies, Escherichia coli (70%) was identified as the most frequently isolated bacterial species, followed by Klebsiella sp. (6.8%). Conclusion: Pregnant women in Latin America exhibit a higher prevalence of bacteriuria, UTI, and pyelonephritis than pregnant women globally. This scenario reinforces the importance of universal screening with urine culture during early prenatal care to ensure improved outcomes. Future investigations should assess the microbial susceptibility profiles of uropathogens isolated from pregnant women in Latin America. Trial registration: This research was registered at PROSPERO (No. CRD42020212601). [ABSTRACT FROM AUTHOR]

Background: Women living in indigenous communities in Peru currently experience extremely high rates of intimate partner violence (IPV). Over the past 10 years, there has been a large multi-sectoral initiative to establish a national network of Centros de Emergencia de la Mujer (Women's Emergency Centres) that integrate health and police services, and substantial increase in efforts from non-governmental organisations in supporting survivors of violence. However, there is currently little evidence on how existing services meet the needs of indigenous women experiencing violence in Peru. Methods: As part of a broader mixed-methods participatory VAWG prevention study, we assessed existing service provision for women experiencing violence in an indigenous Quechua community from Amantaní, Peru. This involved 17 key informant interviews with legal, government, police, and civil society representatives. We used the UN Women Essential Services Package for Women and Girls Subject to Violence framework to guide our analysis. Results: Participants identified major gaps in existing services for indigenous women survivors of violence in Peru. They discussed survivors and perpetrators not being identified by the health system, a lack of IPV response training for health professionals, IPV not being prioritised as a health concern, and a lack of health services that are culturally appropriate for indigenous populations. Survivors who report to police are often treated poorly and discriminated against. Legal systems were perceived as insufficient and ineffective, with inadequate legal measures for perpetrators. While legal and policy frameworks exist, they are often not applied in practice. Service provision in this region needs to adopt an intercultural, rights based, gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations. Conclusion: The role of structural violence in perpetuating indigenous women's experiences of violence and undermining their access to services must be central to designing and implementing appropriate policies and services if they are to meet the needs of indigenous women in Peru. Key messages: - Intimate partner violence is a serious health and human rights issue affecting women who have been traditionally discriminated against and excluded from support services in the Andes - Services available in the region need to adopt an intercultural, rights based and gendered approach to IPV response and prevention, considering cultural and linguistic relevance for indigenous populations in Peru - Structural violence needs to be considered in assessing indigenous women's experiences of violence and their access to services [ABSTRACT FROM AUTHOR]

Background: Globalization and population migration have led to increasingly culturally diverse societies, which has made nursing education in cultural competence and transcultural care a priority. This includes the ability to provide person-centered and culturally congruent care, even within one's own culture. However, this sort of training has been developed and implemented in practice comparatively more by English-speaking societies. Therefore, the aim of this study was to identify the existing educational initiatives for nurses and future ones in cultural competence and transcultural care in Spanish and explore their didactic characteristics in terms of teaching and learning formats, contents, skills, and evaluation methods at different academic levels. Methods: A scoping review was carried out by following the specific PRISMA recommendations and those of the Joanna Briggs Institute guidance throughout PudMed, Web of Science, Embase, Google Scholar, and Cinahl databases and also gray literature in the form of official documentation that later was complemented with a gap analysis including training programs published by Spanish and Latin-American educational institutions and the approaches of key academic informants. Results: The published evidence on nursing training in cultural competence or related topics in Spanish-speaking higher education for nurses is limited. Specific nursing programs in Spanish-speaking universities are primarily found in Spain, with fewer options available in Latin America. These contents are offered either as optional subjects or immersed in other courses and mainly taught in theoretical sessions. Practice in real contexts is supposed to be evaluated transversally under the cultural scope according to national educational recommendations though barely visible in students' evaluation reports. Even though postgraduate training dedicated to these issues exists, it is still limited, mixed with other contents, and generally depends on a few researchers investigating and publishing on the topic from very specific universities. Conclusions: It is essential to establish a common global strategy including Spanish-speaking countries in nurses' higher education and professional training on topics focused on cultural competence as well as the provision of nurses' social and cultural sensitivity towards their own culture and to define whether those that currently exist are effective. It is also crucial that this training was evaluated in practice in order to achieve enough impact on students, health organizations, and population health. [ABSTRACT FROM AUTHOR]