Latin American Settings Research Articles

Performance of a household tuberculosis exposure survey among children in a Latin American setting.

OBJECTIVE: To evaluate the performance of a survey that quantifies the intensity of household tuberculosis (TB) exposure among children.METHODS: Children aged 0-14 years in Lima, Peru, with ≥1 signs and/or symptoms of TB and a history of contact with an adult TB patient were included. The 10-question survey was administered to caregivers and addressed sleep proximity, frequency of exposure, and infectiousness of the contact. Infection status was determined using tuberculin skin tests (TSTs). The exposure scale was evaluated for association with TST positivity using mixed-effects regression analyses.RESULTS: The exposure score was significantly associated with TST positivity (age-adjusted odds ratio [aOR] 1.14, 95%CI 1.02-1.28). We observed a stronger association with TST positivity in children aged ≤5 years; (aOR 1.23, 95%CI 1.07-1.41) and no association in children 6-14 years of age (aOR 0.99, 95%CI 0.82-1.20).CONCLUSION: This survey was easy to use and modestly successful in predicting TST positivity in children aged ≤5 years. It may be a useful resource for clinicians for diagnosing TB in children, and for national TB programs aiming to scale up preventive therapy initiatives.

Toxicity of chemotherapy in patients with colorectal cancer: The role of age in the Latin American setting.

e15095 Background: The incidence of colorectal cancer (CRC) in Peru has increased in the last decades. In our country, the toxicities of systemic treatment have not been analyzed in a large population in the different disease settings. Numerous clinical studies have shown an association between toxicities and age, type of chemotherapy, number of courses, and others. Our objective was to explore the toxicities presented in our population and find if any variables could help us predict these toxicities. Methods: We retrospectively reviewed the electronic medical records of 371 patients with CRC from one specialized Peruvian cancer center between 2006 and 2016. Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. The primary outcome measure was if the patient developed toxicity ≥3 assessed with multiple variables: age, sex, tumor location, NLR, PLR, pathological stage group (PSG), type of chemotherapy (CT), liver metastases, metastasectomy performed, albumin level, CEA, nodal involvement, time to CT, number of CT courses. Multivariable analysis in logistic regression model was adjusted for the factors statistically significant in the univariable analysis. Results: A total of 371 patients were included, of which 95 (25.6%) developed a ≥3 grade toxicity. The more frequent toxicity was neuropathy (30.5%). Univariate logistic regression analysis showed that age, albumin level, PSG, time to CT, number of CT courses, type of chemotherapy (CT), tumor location and liver metastases were associated with a ≥3 grade toxicity. Furthermore, multivariate regression analysis demonstrated that stage IV [OR, 0.012; 95% CI, 0.002-0.078; p < 0.001], age ≥70 [OR, 3.475; 95% CI,1.818-6.643; p < 0.001], number of courses [OR, 0.839; 95% CI, 0.763-0.922; p < 0.001] and albumin levels [OR, 0.391; 95% CI,0.257-0.596; p < 0.001]were independently risk factors for ≥3 grade toxicity. Conclusions: Stage IV, age ≥70, a greater number of CT courses and lower albumin levels were independently associated with a ≥3 grade toxicity.

Validation of a scale to measure perceived residential environment quality in a Latin American setting / Validación de una escala para medir la percepción de la calidad del entorno residencial en un contexto latinoamericano

This article presents the findings of a research project that aimed to validate, in a Latin American setting, a scale to measure perceived residential environment quality (PREQ), developed principally on the basis of several studies conducted in different Italian cities in the 1990s. The instrument, a questionnaire comprising 19 sub-scales, was completed by 394 residents of Flores, in the canton of Heredia, Costa Rica. The scales were validated using Confirmatory Factor Analysis (CFA). The results confirm reliability and validity for the majority of the 12 factors examined, in spite of geographical, morphological and socio-cultural dissimilarities between the different urban contexts where the studies were conducted. The scales for which a favourable result was not obtained were reconfigured and yielded good fit indices, also managing to reduce the number of factors to 11 ((1) Architecture and Urban Space; (2) Mobility, Transport and Connectivity; (3) Green Areas; (4) Socio-Relational Features; (5) Social Care; (6) Recreational Services; (7) Commercial Services; (8) Pace of Life; (9) Environmental Health; (10) Upkeep; (11) Place Attachment) along with the total number of items included on the instrument.

Abstract P3-08-17: Evaluation of Oncotype DX testing and subsequent treatment choices in the Latin American setting

Abstract Background: The gene expression profiling assay OncotypeDx (ODx) prognosticates the risk of estrogen receptor positive (ER+) breast cancer (BC) recurrence and assesses the likely benefit from adjuvant chemotherapy in addition to endocrine therapy. Numerous clinical utility studies have shown that acknowledging the RS impacts on clinical decision making, leading to a decrease in chemotherapy (CT) use. However, the cost of the assay limits it widespread use, especially in low and middle-income countries. Our objective was to determine the patterns of use of ODx, its results and the subsequent treatment choices in a large Latin American cohort. Methods: We retrospectively reviewed the electronic medical records of patients with early-stage ER+ BC for whom ODx recurrence score (RS) was available. Patients were diagnosed and treated at 3 specialized Peruvian cancer centers between 2007 and 2017. Descriptive results for numeric variables were presented as means with standard deviation (SD) or medians with interquartile range (IQR), depending on their distributions; otherwise, we expressed the qualitative variables as numbers with percentages. We evaluated the association between ODx RS category and treatment using the Chi-squared test. Results: A total of 551 patients were included. Patients had a mean age of 56.2 ± 11.9 (SD) (range: 26-89). 9.6% (n=53) of patients were ≤40 years old. The size of the tumors ranged from 0.1 cm to 7.2 cm (median = 1.5 cm; IQR 1.0-2.2cm). 36 (6.5%) patients had tumors ≤ 0.5cm and 7 (1%) had tumors > 5cm. A minority of patients had lymph node involvement (5.8%, n=32). ODx was ordered in 55 cases (10%) of lobular carcinoma and in 23 cases (4%) of favorable histology tumors (19 mucinous, 4 tubular). Most tumors exhibited an intermediate histological grade (71.6%, n=386). Ki67 was available in 58.8% patients (n= 324), with a median Ki67 of 20 (IQR 10-30). Using commercial cutoffs RS was distributed as follows: low (0–17) = 316 (57.4%), intermediate (18–30) = 177 (32.1%), and high (≥31) = 58 (10.5%). In general, 57.5% (n=317) of patients received endocrine therapy (ET) as their only systemic treatment and 42.5% (n=234), also received CT (ET + CT). In the low-risk category, 87.3% (n=276) of patients received ET and 12.7% (n=40), ET + CT. Within the intermediate-risk category, most patients received ET + CT (77.4%, n=137). Only one patient in the high-risk category did not receive CT. There was a significant association between the RS group and treatment choice (p<0.001). Impact of ODx RS results on treatment recommendations Oncotype risk categories LowIntermediateHighp valueTreatmentn%n%n%<0.001Endocrine therapy27687.34022.611.7 Chemotherapy + Endocrine therapy4012.713777.45798.3 Conclusion: ODx significantly influenced treatment decisions in our cohort, however an overutilization of CT was found in low-risk patients. Further data analysis is needed to explain the higher than expected use of CT. Also, there is room for improvement in the selection of cases that undergo ODx testing. Citation Format: Ruiz R, Morante Z, Namuche F, Urrunaga D, Aguilar A, Schwarz J, Leon M, Ziegler G, Chavez Mac Gregor M, Gomez H. Evaluation of Oncotype DX testing and subsequent treatment choices in the Latin American setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-08-17.

Factors and policies explaining the emergence of the bicycle commuter in Bogotá

The capital of Colombia, Bogotá, managed to include the bicycle in its recent sustainable transportation efforts attaining a remarkable increase in bike ridership. The bicycle is one of the three general strategies that the city has recently implemented, along with car use reduction and transit prioritization. What is the story behind the urban cycling process in Bogotá? What were the actions and policies that led to an increase in the cycling share from 0.58% in 1996 to 9.10% in 2017? Through interviews with different actors that have operated in close relation to this process (officials, transportation experts, advocates, academics, and bicycle practitioners), we identify and analyze the key factors that influenced Bogotá’s increased bicycle use in recent years. Clear policies in mayors’ planning documents, a latent bicycle culture, advocacy groups, and continuity in effective local policies produced a series of processes that led the city to achieve high levels of bike ridership. In Latin American cities various successful cases promoting urban cycling have been undervalued and given little attention. Results can be relevant for other cities, especially in Colombian and Latin American settings, to promote the bicycle as a better sustainable transportation within the urban context.

China, Egypt, India, Italy, Thailand & US: Birla – carbon black

Although cash management has been extensively studied, the cash policies of multinational corporations (MNCs) outside of the U.S. market have been underexplored. We fill this gap in the literature by comparing the cash policies of MNCs to those of non-MNCs in a Latin American setting (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Using different proxies for multinationality, we find evidence that the cash holdings of multilatinas are significantly higher than those of their domestic counterparts. Overall, given that foreign markets may offer the best investment opportunities for many MNCs, our results are consistent with the argument that multilatinas maintain higher cash levels to take advantage of the greater growth opportunities abroad. We contribute to the literature on cash management and international business by expanding knowledge regarding the efforts of MNCs in emerging markets. Our results hold following a series of robustness checks and endogeneity concerns.

Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru.

Diagnosis of tuberculous meningitis (TM) is a challenge in countries with a high burden of the disease and constrained resources and clinical prediction rules (CPRs) could be of assistance. We aimed at developing a CPR for diagnosis of TM in a Latin American setting with high tuberculosis incidence and a concentrated HIV epidemic. We enrolled adult patients with clinical suspicion of TM attending two hospitals in Lima, Peru. We obtained information on potential anamnestic, clinical and laboratory predictive findings that are easy to collect and promptly available. We independently diagnosed TM according to a composite reference standard that included a series of microbiological tests. We performed bivariate analysis and constructed a logistic regression model to select the predictive findings associated with TM. With the selected predictors included in the model, we developed a score-based CPR. We assessed its internal validity and diagnostic performance. Of 155 analysed patients, 59 (38%) had TM. The CPR we derived includes three predictors: cough for 14 days or more, 10-500 cells in CSF and adenosine deaminase ≥ 6 U/l in CSF. It classifies patients into high-, moderate- or low-score groups and has an overall area under the ROC curve of 0.87. 59% of patients were assigned to either the high- or the low-score group, permitting prompt decision-making. In patients in the high-score group, it attains a positive likelihood ratio for TM of 10.6 and in patients with low scores, a negative likelihood ratio of 0.10. Bootstrap analysis indicated high internal validity. This CPR could support decision-making in patients with clinical suspicion of TM. External validation and further assessment of its clinical impact are necessary before application in other settings.

Cathay extends scope of distributorship of Chidley & Peto

Although cash management has been extensively studied, the cash policies of multinational corporations (MNCs) outside of the U.S. market have been underexplored. We fill this gap in the literature by comparing the cash policies of MNCs to those of non-MNCs in a Latin American setting (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Using different proxies for multinationality, we find evidence that the cash holdings of multilatinas are significantly higher than those of their domestic counterparts. Overall, given that foreign markets may offer the best investment opportunities for many MNCs, our results are consistent with the argument that multilatinas maintain higher cash levels to take advantage of the greater growth opportunities abroad. We contribute to the literature on cash management and international business by expanding knowledge regarding the efforts of MNCs in emerging markets. Our results hold following a series of robustness checks and endogeneity concerns.

China: Haining Caiyuan – masterbatch.

Although cash management has been extensively studied, the cash policies of multinational corporations (MNCs) outside of the U.S. market have been underexplored. We fill this gap in the literature by comparing the cash policies of MNCs to those of non-MNCs in a Latin American setting (Argentina, Brazil, Chile, Colombia, Mexico and Peru). Using different proxies for multinationality, we find evidence that the cash holdings of multilatinas are significantly higher than those of their domestic counterparts. Overall, given that foreign markets may offer the best investment opportunities for many MNCs, our results are consistent with the argument that multilatinas maintain higher cash levels to take advantage of the greater growth opportunities abroad. We contribute to the literature on cash management and international business by expanding knowledge regarding the efforts of MNCs in emerging markets. Our results hold following a series of robustness checks and endogeneity concerns.

Exploring the Role of Technology through Collaborative Learning in Ecuadorian Language Education

In order to resemble the real world outside the classroom, more and more institutions find it essential to implement technology into their teaching practices as learners make great use of it in their daily lives and are expected to use it in their future careers. As a consequence, the role of technology in second language education has become the focus of several studies in the last years. These studies have resulted in the finding of multiple benefits such as the increase of learners™ motivation, an approach to authentic and meaningful communication, among others. Unfortunately, most of the studies on the use of technology in second language education have been performed in developed countries (e.g. Japan, Australia, USA), which become the perfect scenario to conduct a sound research due to all of the elements these settings count on. Therefore, it becomes essential to determine whether these models can be implemented in Latin American settings and how feasible these will be due to the limited resources which public institutions usually rely on. Â This paper aims to review past research on the implementation of technology of EFL classrooms. Due to the broad scope, the use of technology implies and reluctance of more traditional instructors to include it, this literature-based research was limited to studies combining a technological feature with collaborative learning, another strong teaching approach in second language education. As a result, many advantages were found to the potential replication of these models in the Ecuadorian EFL classroom. Similarly, some criteria were developed to properly assess their feasibility for a more accurate outcome of the potential effectiveness of these models in the Ecuadorian EFL classrooms. Gruba and Hinkelman™s (2012) four considerations in the development of blended approaches to language learning were used as a reference to evaluate previous studies according to our needs. To conclude, some recommendations were made for future research on the topic.

OP29.10: Simulation in amniocentesis using a training model in a Latin American setting

OP29.10: Simulation in amniocentesis using a training model in a Latin American setting

Aproximaciones Psicosociales a la Corrupción: Una Revisión Teórica

La corrupción es una práctica extendida en las sociedades actuales que, a pesar de su relevancia social, se ha estudiado desde postulados mayoritariamente economicistas. Se revisó y analizó de manera crítica este fenómeno desde distintos aportes de la psicología social, tanto en el ámbito anglófono como latinoamericano. En el primer caso, se destaca la in-fluencia del comportamiento de los iguales y las normas sociales, las percepciones de riesgo, el papel de las emociones, la ética comportamental y la relación de la corrupción con el poder. Por su parte, los modelos latinoamericanos centran su interés en la influencia de las estructuras supraindividuales, como los valores éticos y las instituciones, en la conducta de los individuos. Se propone que la investigación apunte hacia el estudio de los principales factores psicosociales de manera sistemática y hacia la formulación de marcos teóricos específicos que expliquen este fenómeno social.

Buccal vs. sublingual misoprostol alone for early pregnancy termination in two Latin American settings: a randomized trial

Introduction: The main objectives of this study were to examine the efficacy, safety/side effects and acceptability of two misoprostol-only regimens that are commonly used for early pregnancy termination in settings where mifepristone is unavailable.

Exploring the Concept of Degrees of Maternal Morbidity as a Tool for Surveillance of Maternal Health in Latin American and Caribbean Settings.

Objectives To assess a birth registry to explore maternal mortality and morbidity and their association with other factors. Study Design Exploratory multicentre cross-sectional analysis with over 700 thousand childbirths from twelve Latin American and Caribbean countries between 2009 and 2012. The WHO criteria for maternal morbidity were employed to split women, following a gradient of severity of conditions, into (1) maternal death (MD); (2) maternal near miss (MNM); (3) potentially life-threatening conditions (PLTC); (4) less severe maternal morbidity (LSMM); (5) any maternal morbidity; and (6) women with no maternal morbidity. Their prevalence and estimated risks of adverse maternal outcomes were assessed. Results 712,081 childbirths had a prevalence of MD and MNM of 0.14% and 3.1%, respectively, while 38% of women had experienced morbidity. Previous maternal morbidity was associated with higher risk of adverse maternal outcomes and also the extremes of reproductive ages, nonwhite ethnicity, no stable partner, no prenatal care, smoking, drug and alcohol use, elective C-section, or induction of labour. Poorer perinatal outcomes were proportional to the severity of maternal outcomes. Conclusions The findings corroborate WHO concept regarding continuum of maternal morbidity, reinforcing its importance in preventing adverse maternal outcomes and improving maternal healthcare in different settings.

Validation of trauma scales: ISS, NISS, RTS and TRISS for predicting mortality in a Colombian population.

Our purpose was to validate the performance of the ISS, NISS, RTS and TRISS scales as predictors of mortality in a population of trauma patients in a Latin American setting. Subjects older than 15years with diagnosis of trauma, lesions in two or more body areas according to the AIS and whose initial attention was at the hospital in the first 24h were included. The main outcome was inpatient mortality. Secondary outcomes were admission to the intensive care unit, requirement of mechanical ventilation and length of stay. A logistic regression model for hospital mortality was fitted with each of the scales as an independent variable, and its predictive accuracy was evaluated through discrimination and calibration statistics. Between January 2007 and July 2015, 4085 subjects were enrolled in the study. 84.2% (n=3442) were male, the mean age was 36years (SD=16), and the most common trauma mechanism was blunt type (80.1%; n=3273). The medians of ISS, NISS, TRISS and RTS were: 14 (IQR=10-21), 17 (IQR=11-27), 4.21 (IQR=2.95-5.05) and 7.84 (IQR=6.90-7.84), respectively. Mortality was 9.3%, and the discrimination for ISS, NISS, TRISS and RTS was: AUC 0.85, 0.89, 0.86 and 0.92, respectively. No one scale had appropriate calibration. Determining the severity of trauma is an essential tool to guide treatment and establish the necessary resources for attention. In a Colombian population from a capital city, trauma scales have adequate performance for the prediction of mortality in patients with trauma.

Abusive head trauma in Spanish language medical literature

Anecdotal experiences raise concerns that abusive head trauma (AHT) is significantly underdiagnosed and perhaps poorly recognized in Latin American settings. With increasing interest in international collaboration in pediatrics, differences in perspectives regarding complex diagnoses should be explored to facilitate a productive exchange of knowledge and ideas. The purpose of this study was to describe the medical literature pertaining to AHT available to physicians who read only in Spanish. In this review, LILACS, SciELO (major Spanish language databases) and Pubmed were searched with appropriate terms and filters in English, Spanish, and Portuguese for Spanish language articles on AHT. Identified articles’ reference lists were then examined for possible additional articles on AHT. All relevant articles were sorted by country and examined for article type and content. Thirty-four unique articles were located for review from 8 of 21 countries. Most of the articles identified were case reports, case series, or educational, and there were no studies regarding overall incidence or prevalence of AHT. Some scientific information contained in the articles varied considerably from that in the English language literature in the areas of etiology and preventive strategies. This survey highlights that the Spanish language literature regarding AHT is sparse and variable. This must be considered when working collaboratively in a global setting. Additionally, identification of this gap presents an opportunity for education and information exchange among global medical communities.

Prevalence of Hispanic BRCA1 and BRCA2 mutations among hereditary breast and ovarian cancer patients from Brazil reveals differences among Latin American populations

Germline mutations in BRCA1 or BRCA2 (BRCA) are responsible for 5-15% of breast (BC) and ovarian cancers (OC), predisposing to the development of early onset and often multiple primary tumors. Since mutation carriers can benefit from risk-reducing interventions, the identification of individuals with hereditary breast and ovarian cancer (HBOC) syndrome has a significant clinical impact. We assessed whether a panel assay for recurrent Hispanic BRCA mutations (HISPANEL) has an adequate breadth of coverage to be suitable as a cost effective screening tool for HBOC in a cohort of patients from Southern Brazil. A multiplex, PCR-based panel was used to genotype 232 unrelated patients for 114 germline BRCA mutations, finding deleterious mutations in 3.5% of them. This mutation prevalence is within the range detected by the HISPANEL among BC patients unselected for family history in other Latin American settings. The HISPANEL would have accounted for 27% of the BRCA mutations detected by complete sequencing in a comparison cohort (n = 193). This prevalence may be region-specific since significant differences in population structure exist in Brazil. Comprehensive analysis of BRCA in a larger set of HBOC patients from different Brazilian regions is warranted, and the results could inform customization of the HISPANEL as an affordable mutation screening tool.

Q Fever in French Guiana: Tip of the Iceberg or Epidemiological Exception?

Q fever is a cosmopolitan zoonosis caused by an intracellular bacterium, Coxiella burnetii. Since its discovery in 1935 in Australia, its presence has been reported almost worldwide in animals and humans [1]. In most developed countries, this infection has been widely described, and its life cycle, exposure factors, and clinical and biological pictures are well known. The incidence of Q fever is generally quite low, and most of the cases are diagnosed during short outbreaks related to direct or indirect contact of humans with cattle, sheep, or goats, which are the main reservoirs. In developing countries, information on endemicity is generally scarce and limited to seroprevalence studies in exposed populations or case reports. This presumably reflects misdiagnosis, rather than lower incidence. The diagnosis of acute Q fever mostly relies on the elevation of anti-C. burnetii antibodies by 15 to 21 days after the onset of the symptoms, detected by Immunofluorescence Assay, which is the gold standard for C. burnetii detection. However, these diagnostic techniques are often not available in tropical areas and, apparently, in numerous Latin American settings. Indeed, an exhaustive review of the literature in English, French, Spanish, and Portuguese showed that publications on Q fever in Latin America are scarce despite the worldwide presence of the disease (Table 1). Seven countries have never reported any cases of Q fever according to the available literature (Belize, Costa Rica, Guatemala, Guyana, Honduras, Paraguay, Suriname); three haven't reported any since 1990, but some older studies do exist (Bolivia, Pan-ama, Venezuela); seven countries reported one or two publications since 1990 (Argentina, Chile, Ecuador, El Salvador, Peru, Trinidad, Uruguay); and Colombia, Mexico, and Brazil published several publications, including mostly case reports of chronic Q fever, one case of acute Q fever, several seroprevalence studies in exposed populations, and some studies based on an acute febrile or acute respiratory syndrome approach. Recently, Q fever was confirmed in patients and animals in parts of the Brazilian Atlantic Forest. Thus, there are no publications on Q fever in the Amazon region except in French Guiana and Ecuador.

The Relationship Between Socioeconomic Status and CV Risk Factors: The CRONICAS Cohort Study of Peruvian Adults.

BackgroundVariations in the distribution of cardiovascular disease and risk factors by socioeconomic status (SES) have been described in affluent societies, yet a better understanding of these patterns is needed for most low- and middle-income countries.ObjectiveThis study sought to describe the relationship between cardiovascular risk factors and SES using monthly family income, educational attainment, and assets index, in 4 Peruvian sites.MethodsBaseline data from an age- and sex-stratified random sample of participants, ages ≥35 years, from 4 Peruvian sites (CRONICAS Cohort Study, 2010) were used. The SES indicators considered were monthly family income (n = 3,220), educational attainment (n = 3,598), and assets index (n = 3,601). Behavioral risk factors included current tobacco use, alcohol drinking, physical activity, daily intake of fruits and vegetables, and no control of salt intake. Cardiometabolic risk factors included obesity, elevated waist circumference, hypertension, insulin resistance, diabetes mellitus, low high-density lipoprotein cholesterol, and high triglyceride levels.ResultsIn the overall population, 41.6% reported a monthly family income <US$198, and 45.6% had none or primary education. Important differences were noted between the socioeconomic indicators: for example, higher income and higher scores on an asset index were associated with greater risk of obesity, whereas higher levels of education were associated with lower risk of obesity. In contrast, higher SES according to all 3 indicators was associated with higher levels of triglycerides.ConclusionsThe association between SES and cardiometabolic risk factors varies depending on the SES indicator used. These results highlight the need to contextualize risk factors by socioeconomic groups in Latin American settings.

The Contextual Value of Social Capital for Subsistence Entrepreneur Mobility

Close-knit relationships are a distinctive facet of subsistence living, in which survival mode entrepreneurship is a way of life. These relationships fuel “bonding social capital” within informal economies as people rely on others to work, consume, and cope with scarce resources. At the same time, policy agendas encourage business growth and social mobility by shifting informal microenterprises into the formal economy. However, success in formalized contexts requires a different form of social capital—that is, “bridging social capital” with people outside one's immediate social network and across institutional structures. Yet policy programs often stop short of addressing how subsistence entrepreneurs manage the inherent tensions across these forms of social capital. As such, this study unpacks the contextual value of social capital using data collected with street vendors in an urban Latin American setting. The analysis identifies four entrepreneurial paths pursued by street vendors and articulates the relative value of bonding and bridging social capital across different economic and social positions. The findings advance insights for a community-centric public policy approach and offer guidance for segmentation and value proposition development within subsistence entrepreneurship programs.