Central American Countries Research Articles

Epidemiological Characteristics of Road Traffic Injuries Involving Children in Three Central American Countries, 2012–2015

Although motor vehicle collisions (MVCs) are a worldwide public health concern due to their high injury, mortality, and fatality rates, few studies have addressed the epidemiologic behavior of MVCs in Latin American youth. Thus, this study was aimed at describing and comparing the characteristics of MVCs involving 0 to 14-year-olds in Costa Rica, Guatemala, and Panama. A secondary aim was to estimate the crude MVC-related injury, fatality, and mortality rates and their trends over time. We conducted a descriptive, retrospective study using publicly available data for Costa Rica, Panama, and Guatemala between 2012 and 2015. We examined the reported MVC cases and calculated the crude injury, fatality, and mortality rates and their trends over time (α = 0.05). Publicly available data reported 12,020 MVC-related injuries and 431 MVC-related deaths involving 0 to 14-year-olds. The most frequent mechanisms involved 0 to 14-year-olds as passengers or pedestrians in MVCs (>85% of all cases). The highest crude MVC-related injury and mortality rates were reported for Panama (119.35 and 2.14 per 100,000 population, respectively, in 0 to 14-years-olds), while Guatemala had the highest median MVC-related fatality rate (8.84 per 100,000 events; χ2 [2] = 377.8; p < 0.001) with a statistically significant trend increasing over time (r = 0.947; p = 0.027). Although several factors play a role in the prevention of MVCs among 0 to 14-year-olds, we found that Costa Rica was the only country that implemented a policy on child restraint systems resulting in the lowest rates of MVC-related injury, mortality, and fatality. These results could be used by decision makers from the aforementioned Central American countries to develop adequate policies addressing MVC preventative strategies to protect Central American infants and children.

“Ni vivo, ni muerto”

The battles of memory that take place in Central America in order to establish the truth about past armed conflicts are also “a war of figures”, as stated by the historian Arturo Taracena, who was part of the team of researchers of the Commission for Historical Clarification (CEH) in Guatemala. Indeed, the number of victims can only be established based on estimates and projections due to the implementation of forced disappearance of people and collective massacres which were strategies of the State terrorism practiced in the region.Unlike Argentina and Chile who, at different times during their transition, promoted state-funded memory policies aimed at searching for and identifying the disappeared, the exhumation process in Central American countries directly affected by armed conflicts is in charge of family members, associations of victims and NGOs. In other words, the missing person in Central America still has no place in the Archive –in the sense of the law of what is possible to say given by Michel Foucault. How to represent this gap around which present and past, absence and presence converge? Whereas the literature of the Southern Cone provided several answers to this question, Central American production is still scarcely doing so. We deal here to analyse some novels and artistic works of the region that place the missing person at the centre of the plot, giving him a discursive place that he still lacks at the official level. In this way, we highlight the different strategies that make the disappeared visible as a way to fight against institutionalized forgetfulness.

Ageing well in a foreign land: group memberships protect older immigrants’ wellbeing through enabling social support and integration

AbstractDespite the numerous challenges of ageing in a foreign land, many older immigrants are fairly resilient and report experiencing good wellbeing. The key question that the present paper addresses is how this is achieved. Drawing on frameworks from cross-cultural and social identity literatures, the present study proposes and tests a model of serial multiple mediation that identifies possible mechanisms supporting the wellbeing of older immigrants who have resided in the host country for some time. In this model, it is predicted that new group memberships acquired post-migration enable access to social support that in turn provides the basis for perceived integration, which enhances wellbeing. This model was tested in a survey study with 102 older people, whose mean age was 80.3 years and who had migrated to Australia from Asian, European, and Central and South American countries on average 36 years previously. The survey assessed cultural identity, social group memberships acquired post-migration, perceived social support, perceived integration and wellbeing. Results supported the hypothesised model, indicating that joining new heritage culture and wider groups in Australia post-migration provided a platform for social support and integration, which enhanced life satisfaction and reduced loneliness. The implications of these findings for theory and adapting successfully to both migration and ageing are discussed.

The fiscal cost of the provision of basic public services, subsidies for expenditure on food and basic citizen income per household in Costa Rica, Guatemala and El Salvador during the COVID-19 pandemic: An expenditure analysis

The objective of this article is to estimate the fiscal costs, using income and expenditure surveys, of the provision of basic public services (electricity, water, telephone and internet) for the 40% of the population with the lowest incomes, the provision of a subsidy of 50% of actual food expenditure for the 40% of the population with the lowest incomes and the provision of a basic income per household equivalent to the value of the poverty line for households under the poverty line in Costa Rica, Guatemala and El Salvador during the COVID-19 pandemic. These fiscal options are a fundamental component of any public health strategy against the COVID-19 considering they give economic viability to the population during the isolation and mobility restrictions period and financial support during the economic and social emergency. The results show that the fiscal costs of the provision of basic public services to 40% of the population with the lowest incomes or other fiscal measures considering less ambitious targets are heterogeneous between these Central American countries because of previous conditions and public policies but are reasonable and possible to cover under the actual circumstances.

Development of the Global Network for Women\u2019s and Children\u2019s Health Research\u2019s socioeconomic status index for use in the network\u2019s sites in low and lower middle-income countries

BackgroundSocioeconomic status (SES) is an important determinant of health globally and an important explanatory variable to assess causality in epidemiological research. The 10th Sustainable Development Goal is to reduce disparities in SES that impact health outcomes globally. It is easier to study SES in high-income countries because household income is representative of the SES. However, it is well recognized that income is poorly reported in low- and middle- income countries (LMIC) and is an unreliable indicator of SES. Therefore, there is a need for a robust index that will help to discriminate the SES of rural households in a pooled dataset from LMIC.MethodsThe study was nested in the population-based Maternal and Neonatal Health Registry of the Global Network for Women’s and Children’s Health Research which has 7 rural sites in 6 Asian, sub-Saharan African and Central American countries. Pregnant women enrolling in the Registry were asked questions about items such as housing conditions and household assets. The characteristics of the candidate items were evaluated using confirmatory factor analyses and item response theory analyses. Based on the results of these analyses, a final set of items were selected for the SES index.ResultsUsing data from 49,536 households of pregnant women, we reduced the data collected to a 10-item index. The 10 items were feasible to administer, covered the SES continuum and had good internal reliability and validity. We developed a sum score-based Item Response Theory scoring algorithm which is easy to compute and is highly correlated with scores based on response patterns (r = 0.97), suggesting minimal loss of information with the simplified approach. Scores varied significantly by site (p < 0.001). African sites had lower mean SES scores than the Asian and Central American sites. The SES index demonstrated good internal consistency reliability (Cronbach’s alpha = 0.81). Higher SES scores were significantly associated with formal education, more education, having received antenatal care, and facility delivery (p < 0.001).ConclusionsWhile measuring SES in LMIC is challenging, we have developed a Global Network Socioeconomic Status Index which may be useful for comparisons of SES within and between locations. Next steps include understanding how the index is associated with maternal, perinatal and neonatal mortality.Trial Registration NCT01073475Plain English summarySocioeconomic status (SES) is an important determinant of health globally, and improving SES is important to reduce disparities in health outcomes. It is easier to study SES in high-income countries because it can be measured by income and what income is spent on, but this concept does not translate easily to low and middle income countries. We developed a questionnaire that includes 10 items to determine SES in low-resource settings that was added to an ongoing Maternal and Neonatal Health Registry that is funded by the National Institutes of Child Health and Human Development’s Global Network. The Registry includes sites that collect outcomes of pregnancies in women and their babies in rural areas in 6 countries in South Asia, sub-Saharan Africa and Central America. The Registry is population based and tracks women from early in pregnancy to day 42 post-partum. The questionnaire is easy to administer and has good reliability and validity. Next steps include understanding how the index is associated with maternal, fetal and neonatal mortality.

The fiscal cost of the provision of basic public services, subsidies for expenditure on food and basic citizen income per household during the COVID-19 pandemic: An expenditure analysis

The objective of this article is to estimate the fiscal costs, using income and expenditure surveys, of the provision of basic public services (electricity, water, telephone and internet) for the 40% of the population with the lowest incomes, the provision of a subsidy of 50% of actual food expenditure for the 40% of the population with the lowest incomes and the provision of a basic income per household equivalent to the value of the poverty line for households under the poverty line in Costa Rica, Guatemala and El Salvador during the COVID-19 pandemic. These fiscal options are a fundamental component of any public health strategy against the COVID-19 considering they give economic viability to the population during the isolation and mobility restrictions period and financial support during the economic and social emergency. The results show that the fiscal costs of the provision of basic public services to 40% of the population with the lowest incomes or other fiscal measures considering less ambitious targets are heterogeneous between these Central American countries because of previous conditions and public policies but are reasonable and possible to cover under the actual circumstances.

Changes in the dynamics of dengue incidence in South and Central America are possibly due to cross-population immunity after Zika virus epidemics.

We tested the hypothesis that Zika virus (ZIKV) immunity may protect against dengue virus (DENV) infection, disease severity or human amplification, based on analysis of epidemiological data from our long-term surveillance study (2009-2016) in the city of Salvador, Brazil, that indicated a substantial reduction in the frequency of laboratory-confirmed dengue cases following the Zika outbreak. To assess whether similar patterns were observed across the Americas, we did a broader explorative investigation of historical series (2004 to 2019) of suspected cases of dengue fever, covering 20 DENV-endemic South and Central American countries. We used segmented linear regressions of single group interrupted time series (ITS) analysis to evaluate whether the Zika epidemic had a statistical effect on the trends of annual dengue incidence. We observed in our 16-year historical series that in all countries, the incidence of dengue exhibited periodic oscillations over time, with a general trend of statistically significant increase during the pre-Zika period overall and for 11 of the 20 countries. Following the peak of the first population exposure to ZIKV in the Americas, in 2016, the overall rate of reported dengue cases in 2017 and 2018 in the countries under study sharply dropped (P<0.05) and was the lowest reported since 2005. Individually in each country, a statistically significant reduction in the annual dengue incidence beginning in 2016 or in 2017-2018 occurred in 13 of the 20 studied countries. However, in 2019, reports of suspected dengue cases increased across the Americas. In Brazil, Dominican Republic, Guatemala and Honduras, dengue incidence was >5 times higher in 2019 than in 2017 and 2018, and, in 2019, they had the greater dengue incidence than in all previous years throughout the historical series. The widespread decline in suspected dengue cases recorded in 2017 and 2018 lends further support to our previous epidemiological hypothesis of ZIKV-induced cross-species immunity to DENV. However, the cross-protection appears to be transient (around 2years). Long-term, prospective follow-ups of dengue reports are needed to confirm (or refute) these findings, which could have significant public health implications, in particular regarding DENV vaccine development and application.

Extreme Natural Events Mitigation: An Analysis of the National Disaster Funds in Latin America

This paper reviews, compares, and analyzes the legal and institutional framework of Latin American government insurance systems for disaster risk. Data and information are obtained through an intense examination of disasters database, the scientific literature and legal framework of administrative and operational procedures, and mainly sources of financial funds related to disaster risk management. The results demonstrate that all countries, with the exception of Ecuador and Chile, legally establish some form of fund by their own legislation and regulation, as a total or partial form of financing the management of natural disasters, particularly those classified as post-disaster recuperation and reconstruction practices. North and Central American countries have more complex and well-structured funds, presumably based on their history of natural disasters and high social vulnerability. The funds are composed of initial values defined by law, annual contributions of general budgets, donations, and the financial gains of resources deposited into bank accounts. The paper concludes that the unavailability of required resources in an emergency situation has led Latin American countries to choose disaster funds as a primary disaster risk management financing strategy. However, the uncertainty of natural disaster occurrence is one of the main obstacles to the use of public financial resources in prevention and preparedness strategies and actions, increasing even more with the inclusion of climate change uncertainties.

Otosclerosis in an Urban Population.

To investigate the evolving prevalence of otosclerosis in a large urban population. A retrospective review of patients in a large, urban, public health system was conducted from January 2010 to August 2019 to identify subjects with otosclerosis. Diagnostic testing included audiometry and computed tomography scans. Sex, age at diagnosis, treatment received, race, ethnicity, and country of birth were analyzed for each subject and compared with all eligible patients in the reference population. A total of 134 patients from a reference population of 672,839 were diagnosed with otosclerosis and analyzed. The otosclerosis patients were predominantly Hispanic (73%), of which the majority were foreign born (87%). The average age at onset was 46 years and 59% were women. The overall prevalence of otosclerosis was 20 of 100,000 patients. The crude prevalence of otosclerosis by ethnicity was 43 of 100,000 for Hispanics, 12.6 of 100,000 for Caucasians, and 3 of 100,000 for African Americans. Within the Hispanic population, the prevalence of otosclerosis was 60 of 100,000 for foreign-born individuals and 16 of 100,000 for those born in the USA (odds ratio [OR] = 3.69, [95% confidence interval [CI], 2.02-6.76], p < 0.0001). Prevalence was not significantly different among Caucasians and US-born Hispanics. Otosclerosis in the studied population was most common among Hispanic patients, though it was strongly influenced by country of birth. The "imported" otosclerosis cases are best explained by environmental influence rather than ethnic susceptibility. This discrepancy is likely due to variance in measles immunization rates among North and Central American countries before 1990.

MALDI-TOF MS and genomic analysis can make the difference in the clarification of canine brucellosis outbreaks

Brucellosis is one of the most common bacterial zoonoses worldwide affecting not only livestock and wildlife but also pets. Canine brucellosis is characterized by reproductive failure in dogs. Human Brucella canis infections are rarely reported but probably underestimated due to insufficient diagnostic surveillance. To improve diagnostics, we investigated dogs in a breeding kennel that showed clinical manifestations of brucellosis and revealed positive blood cultures. As an alternative to the time-consuming and hazardous classical identification procedures, a newly developed species-specific intact-cell matrix-assisted laser desorption/ionization–time of flight mass spectrometry analysis was applied, which allowed for rapid identification of B. canis and differentiation from closely related B. suis biovar 1. High-throughput sequencing and comparative genomics using single nucleotide polymorphism analysis clustered our isolates together with canine and human strains from various Central and South American countries in a distinct sub-lineage. Hence, molecular epidemiology clearly defined the outbreak cluster and demonstrated the endemic situation in South America. Our study illustrates that MALDI-TOF MS analysis using a validated in-house reference database facilitates rapid B. canis identification at species level. Additional whole genome sequencing provides more detailed outbreak information and leads to a deeper understanding of the epidemiology of canine brucellosis.

Latino and Central American Asylum Seekers in the United States of America During the Trump Administration

The purpose of the article was to examine the Trump administration's asylum policy applied to Central American and Latino applicants. The United States has grappled with refugee problems in recent decades, and in 2018 Trump signed an executive order to detain families seeking to immigrate to the United States without separating from one another. With this decree, a new approach was formed in the policy of the United States government, which emphasizes the severe restrictions on the entry of asylum seekers and immigrants. In the methodological, it is a documentary research close to hermeneutics. It is concluded that, although the United States government has cited security concerns as an excuse to restrict the entry of asylum seekers, especially Latinos from Central American countries, this political approach is in conflict with the national legislation of the United States that stipulates that any citizen Foreigner arriving at any point along the US border, or at official exit points, has the right to apply for asylum. Furthermore, the implementation of such a policy is contrary to the end of the 1951 Convention, which focuses on the protection of refugees without distinction.

Reflection of Epidemiological Impact on Burden of Injury in Tertiary Care Centre, Pre-COVID and COVID Era: "Lockdown, a Good Fortune for Saving Life and Limb".

Road traffic injuries continue to be a major public health concern and are a leading cause of death and injury across the world. Road transport remains the most favoured mode of transport for both freight and passenger movement in India. As per the World Health Organization, approximately 1.35 million people die annually on the world’s roads, and another 20 to 50 million sustain nonfatal injuries as a result of road traffic crashes. These injuries and deaths have an immeasurable impact on the families affected, whose lives are often changed irrevocably by these tragedies, and on the communities in which these people lived and worked. India ranks 1 in the total number of traffic-related deaths across the 199 countries reported in the World Road Statistics, 2018, followed by China and the USA due to its large population (India, 21.7, and China, 18.6, fatalities per 100,000), although several Central American and African countries have higher fatality rates. During COVID-19 (coronavirus disease-19) pandemic, a national lockdown was implemented by Government of India from 24 March to 31 May 2020, in four phases to control the spread of SARS CoV-2 (severe acute respiratory syndrome coronavirus-2) infection. In our observational study, we compared the epidemiology of trauma patients of two periods from 1 April to 31 May 2019 and 24 March to 31 May 2020 and found out that unique concept of lockdown with stringent implementation of discipline, alcohol ban, behavioural change in visiting family and friends as minimum as possible, promoting work from home and digital classes for school and colleges lead to phenomenal decrease in traffic-related injuries and fatality. The lockdown has grossly decreased ‘disability-adjusted life year’(DALY), an outcome indicator for cost-effective analysis, which is calculated as the value of future years of healthy life lost to morbidity/disability and future years of life lost to premature mortality.

Exploring the relationship between KIBS co-location and the innovativeness of the manufacturing firms in Latin America

Literature has provided empirical evidence showing the importance of location for understanding KIBS effective service provision. According to territorial servitization postulates KIBS are also fundamental for the development of the manufacturing firms. Despite KIBS can be an important source of innovation, limited attention is paid of KIBS in Latin America region. The purpose of this research is analysing the relationship between KIBS co-location and innovativeness of the manufacturing firms. Drawing on the World Bank Enterprise Survey 2017 for Latin-American countries, authors analyse 3,029 manufacturing firms using OLS method. Findings indicate that manufacturing firms’ location based on KIBS proximity is a critical determinant of innovativeness. This relationship is considerably stronger in Central American countries, where according to our data there is KIBS scarcity.

Genomic Diversification, Structural Plasticity, and Hybridization in Leishmania (Viannia) braziliensis.

Leishmania (Viannia) braziliensis is an important Leishmania species circulating in several Central and South American countries. Among Leishmania species circulating in Brazil, Argentina and Colombia, L. braziliensis has the highest genomic variability. However, genomic variability at the whole genome level has been only studied in Brazilian and Peruvian isolates; to date, no Colombian isolates have been studied. Considering that in Colombia, L. braziliensis is a species with great clinical and therapeutic relevance, as well as the role of genetic variability in the epidemiology of leishmaniasis, we analyzed and evaluated intraspecific genomic variability of L. braziliensis from Colombian and Bolivian isolates and compared them with Brazilian isolates. Twenty-one genomes were analyzed, six from Colombian patients, one from a Bolivian patient, and 14 Brazilian isolates downloaded from public databases. The results obtained of Phylogenomic analysis showed the existence of four well-supported clades, which evidenced intraspecific variability. The whole-genome analysis revealed structural variations in the somy, mainly in the Brazilian genomes (clade 1 and clade 3), low copy number variations, and a moderate number of single-nucleotide polymorphisms (SNPs) in all genomes analyzed. Interestingly, the genomes belonging to clades 2 and 3 from Colombia and Brazil, respectively, were characterized by low heterozygosity (~90% of SNP loci were homozygous) and regions suggestive of loss of heterozygosity (LOH). Additionally, we observed the drastic whole genome loss of heterozygosity and possible hybridization events in one genome belonging to clade 4. Unique/shared SNPs between and within the four clades were identified, revealing the importance of some of them in biological processes of L. braziliensis. Our analyses demonstrate high genomic variability of L. braziliensis in different regions of South America, mainly in Colombia and suggest that this species exhibits striking genomic diversity and a capacity of genomic hybridization; additionally, this is the first study to report whole-genome sequences of Colombian L. braziliensis isolates.

Psychometry and estimation of cutoff points of Jefferson Scale of empathy in dental students.

The objective of this study was to determine the psychometric properties of the 3-dimensional latent model of empathy on the Jefferson Scale of Physician Empathy instrument (version S), and to verify the existence of cutoff points capable of differentiating empathy measures classified as: "high," "medium," and "low" using data collected from observations of students from 11 dental faculties of 5 Central American and Caribbean countries (n = 3082) between 2015 and 2019. This is an exploratory, "a posteriori," and non-experimental study. Factor structure and factor invariance by country and gender were analyzed. Hierarchical cluster analysis and bifactorial analysis were applied, and the data were normalized by cluster and by percentiles within them. Confirmatory factor analysis showed that the original model was replicable and fit the data, while multigroup analysis allowed assuming an invariant factor structure by country and by gender. There is reliability in the measurement made by the scale and its dimensions. The instrument has adequate psychometric properties, and cutoff values obtained allow people with lower or higher levels of empathy and its components to be classified. Therefore, these results solve the problem of comparing the scores and observed levels of empathy between dental schools within and between countries and between genders. Such comparisons were only possible since the original data of each study were made available for traditional statistical methods.

Assessing the Effects of COVID-19 in Prisons in the Northern Triangle of Central America

ABSTRACT This article examines the impact of COVID-19 on penitentiary systems in the Central American countries of Honduras, El Salvador, and Guatemala (the Northern Triangle). Despite similar conditions in terms of crowding, lack of personal protective equipment, and infrastructure deficiencies, the neighboring countries have implemented distinctly different approaches to managing their incarcerated populations. In Honduras, in recognition of the elevated risks to certain inmates, nearly 2,000 prisoners were released in the early stages of the contagion. In El Salvador, President Bukele capitalized on the COVID crisis to implement curfews and national lockdowns to ensure conditions approaching martial law, declaring extreme security steps to address gang violence, while claiming incarcerated gang leaders were behind the increased violence. In Guatemala, the President Giammattei, a medical doctor, recognized prisons as epicenters of focus for reducing transmission rates and quickly advanced plans to contain a much larger outbreak. Using data collected from public media sources and in-depth qualitative interviews with prison administrators and staff, we provide a descriptive overview of the COVID impacts in these countries and consider possible longer-term prison policy implications.

Mesoamerican Nephropathy (MeN): What We Know so Far.

In 2002, a report from El Salvador described a high incidence of chronic kidney disease (CKD) of unknown cause, mostly in young males from specific coastal areas. Similar situations were observed along the Pacific Ocean coastline of other Central American countries and southern Mexico (Mesoamerica). This new form of CKD has been denominated Mesoamerican endemic nephropathy (MeN). The typical presentation of MeN is a young male from an endemic area with a family history of CKD, low eGFR, high serum creatinine, low level of albuminuria, hypokalemia, hyperuricemia, and urine urate crystals. Kidney biopsy demonstrating tubulointerstitial nephritis remains the gold standard for diagnosis but is available only for a minority. Commonly proposed causes include thermal stress/dehydration and/or exposure to environmental pollutants. However, likely, a third factor, which could be genetic or epigenetic, could contribute to the cause and development of the disease, along with social determinants. Currently, preventive measures focus on minimizing workers exposure to thermal stress/dehydration. There are many research opportunities and priorities should include clinical trials to evaluate the efficacy and safety of the current treatment protocols, along with etiological and genetic studies, and the development of kidney disease data systems. Although there is scant and controversial literature with regard s to the etiology, diagnosis and management of the disease, our aim is to provide the reader a vision of the disease based on our experience.

Creating an Outpatient-Specific Antibiogram to Guide Treatment for Urinary Tract Infections

Background: Outpatients with uncomplicated urinary tract infections (UTIs) are often treated empirically without culture, whereas urine cultures are typically collected from patients with complicated UTI. Susceptibilities for fosfomycin (a first-line agent) are not routinely performed or reported in the antibiogram. Understanding the prevalence of antibiotic resistance for UTI is critical for empiric treatment and antibiotic stewardship in primary care. Methods: We developed a UTI-focused antibiogram from a prospective sample of outpatients (women and men) with UTIs from 2 public family medicine clinics in an urban area with a diverse, international population (November 2018 to present). During the study period, providers ordered a urine culture for any adult patient presenting with UTI symptoms, including uncomplicated and complicated infections. We estimated the prevalence of resistance to UTI-relevant antibiotics in the overall study population and compared it between patients born in the United States and other countries. Results: We collected 678 urine cultures from 644 unique patients (79% female). Of these cultures, 158 (23.3%) had no growth, 330 (48.7%) grew mixed urogenital flora, and 190 (28.0%) were positive (&gt;10,000 CFU/mL). Patients with positive cultures were mostly female (88.2%), and their mean age was 46.6 ± 14.8 years. Among patients with positive cultures, 42.7% were born in the United States and 57.3% were born Mexico or Central America. Escherichia coli was the most commonly isolated organism (Fig. 1). Susceptibility results for E. coli and all gram-negative organisms combined are presented in Fig. 2. Susceptibility of uropathogens to TMP-SMX was significantly higher in patients born in the United States compared to patients from Mexico or Central America (82% vs 61%; P = .03). Susceptibility to ciprofloxacin was similar in patients born in the United States and other countries (79% vs 72%; P = .50). Of 77 E. coli isolates, 11 (14%) were positive for extended-spectrum β-lactamase production, including 8 isolates from patients whose country of origin was Mexico or a Central American country. Conclusions: More than 20% of outpatients presenting with UTI symptoms had a negative urine culture. Among outpatients with uncomplicated and complicated UTI, uropathogens had a high prevalence of resistance to ciprofloxacin and TMP-SMX, but susceptibility to fosfomycin (restricted in our system) was 100%. Resistance rates for TMP-SMX were higher in patients from Mexico and Central America. Our findings question whether TMP-SMX should remain a first-line agent in US primary-care settings.Funding: This project was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI104681.Disclosures: None

Onchocerciasis Elimination: Progress and Challenges.

Onchocerciasis is a parasitic infection caused by the filarial nematode Onchocerca volvulus and transmitted through the bites of black flies of the genus Similium that breed in rivers and streams. The impact of mass treatment with ivermectin and supplemented by vector control in some countries has changed the global scene of onchocerciasis. There has been reported progress made in elimination of onchocerciasis in central and southern American countries and in some localities in Africa. The target for elimination in the Americas has been set at 2022 while for 12 countries in Africa this is expected in 2030. This review was conducted to examine the current status of onchocerciasis elimination at the global level and report on progress made. Literature searches were made through PubMed, articles in English or English abstracts, reports and any other relevant articles related to the subject. The global burden of onchocerciasis is progressively reducing and is no longer a public health problem in some regions. However, programs are challenged with a range of issues: cross-border transmission, diagnostic tools, Loa loa co-endemicity, limited workforce in entomology and maintaining enthusiasm among community drug distributors. More concerted effort using appropriate tools is required to overcome the challenges.

Service encounters across the lifespan in individuals with autism spectrum disorders: Results from a multisite study in Latin America

BackgroundCore symptoms of Autism Spectrum Disorder (ASD) continue to affect everyday life as children grow and transition into adulthood. That way, different services may be needed at various stages of their lifetimes. This study aimed to describe service encounters and hours of service per week for individuals with ASD in Latin American countries and compare the data from three age groups (preschoolers, school-aged, and adolescents). MethodsThe data were obtained from an online survey adapted by Red Espectro Autista Latinoamerica (REAL) in 6 different South & Central American countries. The total sample was composed of 2520 caregivers of children and adolescents with ASD. ResultsService encounters for Speech, Occupational, and Behavioral Therapies decreased with patient age, while medication increased. Regardless of the age group, a large proportion of individuals (19–37 %) were not receiving treatment, and those receiving treatment got fewer hours than best practice recommendations. For adolescents, the gaps in treatment are even greater and less consistent. DiscussionFailure to offer timely identification and intervention for ASD will result in more impairment of the individual and the family burden. Although there are several initiatives to develop more resources for this population in Latin-America, the provision of services for ASD is still undervalued. Many such individuals might not be receiving the services they need, while most children are mainly receiving therapies with low to moderate evidence at a frequency below the recommended standards.