Latin American Sites Research Articles

An impact evaluation of conservation investments targeting long-distance migratory species.

We evaluated the impact of a philanthropic program investing in the conservation of sites along the Pacific Americas Flyway, which spans >16,000km of coastline and is used by millions of shorebirds. Using a quasi-experimental, mixed methods approach, we estimated what would have happened to shorebird populations at 17 wintering sites without the sustained and additional investment they received. We modeled shorebird populations across the entire flyway and at sites with and without investment. Combining shorebird abundance estimates with a land-cover classification model, we used the synthetic control method to create counterfactuals for shorebird trends at the treatment sites. We found no evidence of an overall effect across three outcome variables. Species- and site-level treatment effects were heterogeneous, with a few cases showing evidence of a positive effect, including a site with a high level of overall investment. Results suggest six shorebirds declined across the entire flyway, including at many Latin American sites. However, the percentage of flyway populations present at the sites remained stable, and the percentage at the treatment sites was higher (i.e., investment sites) than at control sites. Multiple mechanisms behind our results are possible, including that investments have yet to mitigate impacts and negative impacts at other sites are driving declines at the treatment sites. A limitation of our evaluation is the sole focus on shorebird abundance and the lack of data that prohibits the inclusion of other outcome variables. Monitoring infrastructure is now in place to design a more robust and a priori shorebird evaluation framework across the entire flyway. With this framework, it will prove easier to prioritize limited dollars to result in the most positive conservation outcomes.

Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (inArgentina, Bolivia,Brazil, Chile,Colombia, Ecuador, Hondurasand Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sexand weight, scan factors (tube current and potential), volumeCT dose index (CTDIvol) and dose lengthproduct (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data toimprove scan protocols and perform a follow-up CTstudy to establish DRLs and ADs based on clinical indications.

Behavior of Adult Aedes aegypti and Aedes albopictus in Kinshasa, DRC, and the Implications for Control

Yellow fever and chikungunya outbreaks-and a few dengue cases-have been reported in the Democratic Republic of the Congo (DRC) in recent years. However, little is known about the ecology and behavior of the adult disease vector species, Aedes aegypti and Aedes albopictus, in DRC. Preliminary studies showed important differences in Aedes behavior in DRC and Latin-American sites. Therefore, this study aimed to assess the host-seeking and resting behaviors of female Ae. aegypti and Ae. albopictus, and their densities in four communes of Kinshasa (Kalamu, Lingwala, Mont Ngafula and Ndjili). Two cross-sectional surveys were carried out, one in the dry season (July 2019) and one in the rainy season (February 2020). We used three different adult vector collection methods: BG-Sentinel 2, BG-GAT, and prokopack. Both Aedes species were clearly exophagic, exophilic, and sought breeding sites outdoors. The adult house index for Ae. aegypti exceeded 55% in all communes except Lingwala, where it was only 27%. The Adult Breteau Index (ABI) for Ae. aegypti was 190.77 mosquitoes per 100 houses inspected in the rainy season and 6.03 in the dry season. For Ae. albopictus, the ABI was 11.79 and 3.52 in the rainy and dry seasons, respectively. Aedes aegypti showed unimodal host-seeking activity between 6 h and 21 h. The exophagic and exophilic behaviors of both species point to the need to target adult mosquitoes outdoors when implementing vector control.

Wordplay in Spanish advertising discourse

The article comprehensively studies such a stylistic device as wordplay in advertising discourse on the example of the Spanish language. The main purpose of the study was to study the wordplay techniques in the Internet advertising banners, which in recent years have gained most popularity among potential consumers compared with other types of advertising, as well as to identify those that are most frequently used. The objectives of the study were to find, systematize and classify examples of wordplay, determine the frequency of their use, as well as their compatibility and reinforcement potential in conjunction with visual means. To achieve the goals set, a significant layer of Spanish-language advertising on the Internet was analyzed from both Spanish and Latin American sites; the most striking and illustrative examples were selected and classified, and ranked according to the frequency of their use. In many advertising banners on the Internet was revealed a reference to the cultural and social realities of Spanish-speaking countries, their national color, features, which allows one not only to better understand the realities of Spanish-speaking countries, but also the value orientations of local goods and services consumers. On the basis of the conducted research, it was found that the most striking and most commonly used wordplay techniques are dilogy and pun, whereas paronomasia, diaphora and folding word are less common. Quite rare in advertising are antimetaboles and acrostics, as well as palindrome, which is explained by their least expressiveness and attractiveness to the consumer. The material has proved that wordplay in the language of advertising is one of the key aspects in creating advertising texts on the Internet, since, in combination with visual means, this technique creates a strong emotional impact, draws the consumer's attention to the advertised product and contributes to its better implementation, which is the advertisers’ goal.

Coronavirus Disease (COVID-19) Pandemic: The Psychological Well-Being in a Cohort of Workers of a Multinational Company

BackgroundThe aim of the present study was to evaluate the psychological well-being (PWB) during the coronavirus disease (COVID-19) pandemic in workers of a multinational company. MethodsEmployees (aged ≥18 years) were recruited from Latin American, North American, New Zealand, and European sites of a multinational company operative during all the pandemic period. The self-reported Psychological General Well-Being Index was used to assess the global PWB and the effects on six subdomains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. The influencing role of age, gender, geographical location, COVID-19 epidemiology, and restrictive measures adopted to control the pandemic was explored. ResultsA total of 1335 workers completed the survey. The aggregate median PWB global score was in a positive range, with significantly better outcomes detected in the Mexican and Colombian Latin American sites compared with the other worldwide countries (p < 0.001). Among the European locations, a significantly higher PWB score was determined in Spain compared with the German and French sites (p < 0.05). Comparable geographical trends were demonstrated for all the PWB subdomains. Male workers had a significantly better PWB compared with females (p < 0.05), whereas a negative correlation emerged with aging (p = 0.01). COVID-19 epidemiology and pandemic control measures had no clear effects on PWB. ConclusionMonitoring PWB and the impact of individual and pandemic-related variables may be helpful to clarify the mental health effects of pandemic, define targeted psychological-supporting measures, also in the workplace, to face such a complex situation in a more constructive way.

Cesarean birth in the Global Network for Women\u2019s and Children\u2019s Health Research: trends in utilization, risk factors, and subgroups with high cesarean birth rates

BackgroundThe objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women’s and Children’s Health Research (Global Network).MethodsThis is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites.ResultsCesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p < 0.001. For multiparous women with a history of prior cesarean birth, rates of vaginal birth after cesarean were about 20% in the Latin American and Southeast Asian sites and about 84% at the sub-Saharan African sites. In the African sites, proportions of cesarean birth in the study were highest among women without a prior cesarean and a single, cephalic, term pregnancy. In the non-African sites, groups with the greatest proportion of cesarean births were nulliparous women with a single, cephalic, term pregnancy and all multiparous women with at least one previous uterine scar with a term, cephalic pregnancy.ConclusionCesarean birth rates continue to rise within the Global Network. The proportions of cesarean birth are higher among women with no history of cesarean birth in the African sites and among women with primary elective cesarean, primary cesarean after induction, and repeat cesarean in the non-African sites.

Global cognition predicts the incidence of poor physical performance among older adults: A cross-national study.

The relationship between physical performance and cognition is well established. However, findings on the relationship between global cognition and the incidence of functional disability has been inconsistent. Using data from the International Mobility in Aging Study, we investigated the relationship between baseline cognitive function and the incidence of poor physical performance 2 years later. A total of 1071 community-dwelling participants (aged 64-75 years) from four sites in Canada and Latin America, with a Short Physical Performance Battery score ≥9 at baseline (good performance) were included. We carried out two sets of analyses, measuring cognition with either the Leganés Cognitive Test or the Montreal Cognitive Assessment. We used three logistic regression models, controlling for either no confounders, sociodemographic confounders or sociodemographic and health confounders. The full model was also stratified by site. A score <9 on the Short Physical Performance Battery indicated poor physical performance. In the fully adjusted model, each 1-point increase in the baseline Leganés Cognitive Test score (range 0-32) was associated with a 10% decrease in the odds of incidence of poor physical performance at the 2-year follow-up (P = 0.019). Likewise, each 1-point increase in the baseline Montreal Cognitive Assessment score (range 0-30) was associated with a 16% decrease in the odds of developing poor physical performance (P = 0.005). When stratified by site, the results were significant at the Latin American sites (P = 0.02), but not at the Canadian sites (P = 0.08). Poor baseline cognition is associated with the incidence of poor physical performance in community-dwelling older adults. To prevent physical disability, interventions addressing both cognitive and physical performance are required. Geriatr Gerontol Int 2020; ••: ••-••.

Colonization Factors in Enterotoxigenic Escherichia coli Strains in Travelers to Mexico, Guatemala, and India Compared with Children in Houston, Texas.

Enterotoxigenic Escherichia coli (ETEC) can be attributed to around 200 million diarrheal episodes and 380,000 deaths in the developing regions. Travelers' diarrhea occurs in 15-40% of travelers to developing regions with ETEC being the most important etiologic agent. This study aims to describe the distribution of enterotoxins and colonization factor (CF) profiles of ETEC isolates from stool samples of adult travelers acquiring diarrhea in Mexico, Guatemala, and India and a group of children with acute diarrhea in Houston, TX, between 2007 and 2012. The heat-labile/heat-stable (LT/ST) enterotoxins and CFs from 252 patients were determined using polymerase chain reaction assay. Among the 252 ETEC isolates, 15% were LT-only, 58% were ST-only, and 28% produced both LT and ST. The distribution of LT-only (12-15%) and ST-only (55-56%) isolates was similar between Latin American and Indian sites. The most prevalent CF was CS21, expressed in 65% of the isolates followed by CS6 (25%) and CS3 (17%). Among the international travelers, 64% of the ETEC isolates expressed CS21. CS21 was expressed in 46% of isolates from Latin America compared with 96% of isolates from India (P < 0.0001). CS21 was expressed in 85% isolates from Houston children. CS21 was increasingly found in ST-only (P = 0.003) and ST/LT (P = 0.026) ETEC compared with LT-only ETEC. High frequency of finding CS21 among recent isolates of ETEC over a wide geographic distribution warrants additional studies on this CF. Highly conserved CS21 is an important target for potential multivalent ETEC vaccines.

The Prevalence, Correlates, Detection and Control of Diabetes among Older People in Low and Middle Income Countries. A 10/66 Dementia Research Group Population-Based Survey.

BackgroundLittle is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria.MethodsCross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7mmol/L).ResultsTotal diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes.ConclusionsDiabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.

Social differences associated with the use of psychotropic drugs among men and women aged 65 to 74 years living in the community: the International Mobility in Aging Study (IMIAS).

BackgroundElderly persons make greater use of psychotropic drugs, but there are few international studies on social differences in the use of these medications. The aim of this study is to examine social differences in the use of psychotropic drugs among persons aged 65–74 years in the International Mobility in Aging Study (IMIAS).MethodsThe sample consisted of 1,995 participants in the IMIAS 2012 baseline study in Saint-Hyacinthe (Canada), Kingston (Canada), Tirana (Albania), Manizales (Colombia), and Natal (Brazil). During home visits, all medication taken by the participants in the previous 15 days was recorded. We then used the Anatomical Therapeutic Chemical classification system to code psychotropic drugs as anxiolytics, sedatives, hypnotics (ASH); antidepressants (ADP); or analgesics, antiepileptics, or antiparkinsonians (AEP). Prevalence ratios for psychotropic drug use according to sex, education, income, and occupation were estimated by fitting a Poisson regression and controlling for demographic and health covariates.ResultsPsychotropic drug use was higher among Canadian participants than among those living outside Canada. Prevalence of AEP drug use was higher for women than men in the Canadian and Latin American sites. In Tirana, antidepressant drugs were rarely used. Socioeconomic differences varied among sites. In the Canadian cities, low socioeconomic standing was associated with higher frequency of psychotropic drug use. In the Latin American cities, elderly people with high education and income levels showed a higher level of antidepressant drug use, while people with manual occupations had a higher use of AEP drugs. In Tirana, ASH drug use was higher among those with low income.ConclusionAn inverse association was observed between socioeconomic standing and psychotropic drug use in Canada, while the opposite was true in Latin America. Albania was notable for an absence of antidepressant use and greater use of ASH drugs among low-income groups.

Toward Measuring Schistosoma Response to Praziquantel Treatment with Appropriate Descriptors of Egg Excretion.

BackgroundThe control of schistosomiasis emphasizes preventive chemotherapy with praziquantel, which aims at decreasing infection intensity and thus morbidity in individuals, as well as transmission in communities. Standardizing methods to assess treatment efficacy is important to compare trial outcomes across settings, and to monitor program effectiveness consistently. We compared customary methods and looked at possible complementary approaches in order to derive suggestions for standardizing outcome measures.Methodology/Principal FindingsWe analyzed data from 24 studies conducted at African, Asian, and Latin American sites, enrolling overall 4,740 individuals infected with Schistosoma mansoni, S. haematobium, or S. japonicum, and treated with praziquantel at doses of 40–80 mg/kg. We found that group-based arithmetic and geometric means can be used interchangeably to express egg reduction rates (ERR) only if treatment efficacy is high (>95%). For lower levels of efficacy, ERR estimates are higher with geometric than arithmetic means. Using the distribution of individual responses in egg excretion, 6.3%, 1.7% and 4.3% of the subjects treated for S. haematobium, S. japonicum and S. mansoni infection, respectively, had no reduction in their egg counts (ERR = 0). The 5th, 10th, and 25th centiles of the subjects treated for S. haematobium had individual ERRs of 0%, 49.3%, and 96.5%; the corresponding values for S. japonicum were 75%, 99%, and 99%; and for S. mansoni 18.2%, 65.3%, and 99.8%. Using a single rather than quadruplicate Kato-Katz thick smear excluded 19% of S. mansoni-infected individuals. Whilst the effect on estimating ERR was negligible by individual studies, ERR estimates by arithmetic means were 8% lower with a single measurement.Conclusions/SignificanceArithmetic mean calculations of Schistosoma ERR are more sensitive and therefore more appropriate to monitor drug performance than geometric means. However, neither are satisfactory to identify poor responders. Group-based response estimated by arithmetic mean and the distribution of individual ERRs are correlated, but the latter appears to be more apt to detect the presence and to quantitate the magnitude of suboptimal responses to praziquantel.

The mobility gap between older men and women: The embodiment of gender

ObjectivesTo present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. MethodsData are from surveys on random samples of people aged 65–74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. ResultsAge-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DiscussionResults provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis.

BackgroundBecause large, prospective, population-based data sets describing maternal outcomes are typically not available in low- and middle-income countries, it is difficult to monitor maternal mortality rates over time and to identify factors associated with maternal mortality. Early identification of risk factors is essential to develop comprehensive intervention strategies preventing pregnancy-related complications. Our objective was to describe maternal mortality rates in a large, multi-country dataset and to determine maternal, pregnancy-related, delivery and postpartum characteristics that are associated with maternal mortality.MethodsWe collected data describing all pregnancies from 2010 to 2013 among women enrolled in the multi-national Global Network for Women’s and Children’s Health Research Maternal and Neonatal Health Registry (MNHR). We reported the proportion of mothers who died per pregnancy and the maternal mortality ratio (MMR). Generalized linear models were used to evaluate the relationship of potential medical and social factors and maternal mortality and to develop point and interval estimates of relative risk associated with these factors. Generalized estimating equations were used to account for the correlation of outcomes within cluster to develop appropriate confidence intervals.ResultsWe recorded 277,736 pregnancies and 402 maternal deaths for an MMR of 153/100,000 live births. We observed an improvement in the total MMR from 166 in 2010 to 126 in 2013. The MMR in Latin American sites (91) was lower than the MMR in Asian (178) and African sites (125). When adjusted for study site and the other variables, no formal education (RR 3.2 [1.5, 6.9]), primary education only (RR 3.4 [1.6, 7.5]), secondary education only (RR 2.5 [1.1, 5.7]), lack of antenatal care (RR 1.8 [1.2, 2.5]), caesarean section delivery (RR 1.9 [1.3, 2.8]), hemorrhage (RR 3.3 [2.2, 5.1]), and hypertensive disorders (RR 7.4 [5.2, 10.4]) were associated with higher risks of death.ConclusionsThe MNHR identified preventable causes of maternal mortality in diverse settings in low- and middle-income countries. The MNHR can be used to monitor public health strategies and determine their association with reducing maternal mortality.Trial Registrationclinicaltrials.gov NCT01073475

A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia.

BackgroundThe Global Network for Women’s and Children’s Health Research is one of the largest international networks for testing and generating evidence-based recommendations for improvement of maternal-child health in resource-limited settings. Since 2009, Global Network sites in six low and middle-income countries have collected information on antenatal care practices, which are important as indicators of care and have implications for programs to improve maternal and child health. We sought to: (1) describe the quantity of antenatal care attendance over a four-year period; and (2) explore the quality of coverage for selected preventative, screening, and birth preparedness components.MethodsThe Maternal Newborn Health Registry (MNHR) is a prospective, population-based birth and pregnancy outcomes registry in Global Network sites, including: Argentina, Guatemala, India (Belgaum and Nagpur), Kenya, Pakistan, and Zambia. MNHR data from these sites were prospectively collected from January 1, 2010 – December 31, 2013 and analyzed for indicators related to quantity and patterns of ANC and coverage of key elements of recommended focused antenatal care. Descriptive statistics were generated overall by global region (Africa, Asia, and Latin America), and for each individual site.ResultsOverall, 96% of women reported at least one antenatal care visit. Indian sites demonstrated the highest percentage of women who initiated antenatal care during the first trimester. Women from the Latin American and Indian sites reported the highest number of at least 4 visits. Overall, 88% of women received tetanus toxoid. Only about half of all women reported having been screened for syphilis (49%) or anemia (50%). Rates of HIV testing were above 95% in the Argentina, African, and Indian sites. The Pakistan site demonstrated relatively high rates for birth preparation, but for most other preventative and screening interventions, posted lower coverage rates as compared to other Global Network sites.ConclusionsResults from our large, prospective, population-based observational study contribute important insight into regional and site-specific patterns for antenatal care access and coverage. Our findings indicate a quality and coverage gap in antenatal care services, particularly in regards to syphilis and hemoglobin screening. We have identified site-specific gaps in access to, and delivery of, antenatal care services that can be targeted for improvement in future research and implementation efforts.Trial registrationRegistration at Clinicaltrials.gov (ID# NCT01073475)

Psychometric properties of EURO-D, a geriatric depression scale: a cross-cultural validation study.

BackgroundMany of the assessment tools used to study depression among older people are adaptations of instruments developed in other cultural setting. There is a need to validate those instruments in low and middle income countries (LMIC).MethodsA one-phase cross-sectional survey of people aged [greater than or equal to] 65 years from LMIC. EURO-D was checked for psychometric properties. Calibration with clinical diagnosis was made using ICD-10. Optimal cutpoint was determined. Concurrent validity was assessed measuring correlations with WHODAS 2.0.Results17,852 interviews were completed in 13 sites from nine countries. EURO-D constituted a hierarchical scale in most sites. The most commonly endorsed symptom in Latin American sites was depression; in China was sleep disturbance and tearfulness; in India, irritability and fatigue and in Nigeria loss of enjoyment. Two factor structure (affective and motivation) were demonstrated. Measurement invariance was demonstrated among Latin American and Indian sites being less evident in China and Nigeria. At the 4/5 cutpoint, sensitivity for ICD-10 depressive episode was 86% or higher in all sites and specificity exceeded 84% in all Latin America and Chinese sites. Concurrent validity was supported, at least for Latin American and Indian sites.ConclusionsThere is evidence for the cross-cultural validity of the EURO-D scale at Latin American and Indian settings and its potential applicability in comparative epidemiological studies.

Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002–2009

ObjectiveTo describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. MethodsA prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. ResultsAntiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P<0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P<0.001). The proportion of women with viral loads below 1000copies/mL at hospital discharge after delivery (HD) increased over time (P=0.0031). Median CD4 lymphocyte counts also rose at HD, from 441cell/mm3 to 515cells/mm3 (P<0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P=0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). ConclusionThe results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region.

Assessment of obstetric and neonatal health services in developing country health facilities.

To describe the staffing and availability of medical equipment and medications and the performance of procedures at health facilities providing maternal and neonatal care at African, Asian, and Latin American sites participating in a multicenter trial to improve emergency obstetric/neonatal care in communities with high maternal and perinatal mortality. In 2009, prior to intervention, we surveyed 136 hospitals and 228 clinics in 7 sites in Africa, Asia, and Latin America regarding staffing, availability of equipment/medications, and procedures including cesarean section. The coverage of physicians and nurses/midwives was poor in Africa and Latin America. In Africa, only 20% of hospitals had full-time physicians. Only 70% of hospitals in Africa and Asia had performed cesarean sections in the last 6 months. Oxygen was unavailable in 40% of African hospitals and 17% of Asian hospitals. Blood was unavailable in 80% of African and Asian hospitals. Assuming that adequate facility services are necessary to improve pregnancy outcomes, it is not surprising that maternal and perinatal mortality rates in the areas surveyed are high. The data presented emphasize that to reduce mortality in these areas, resources that result in improved staffing and sufficient equipment, supplies, and medication, along with training, are required.

From the Editor

From the Editor David J. Robinson As has now become almost routine, this edition of JLAG contains a highly differentiated collection of articles. The first takes us to one of the world’s best preserved wilderness areas --the Baja California peninsula. The authors insist that given the potential risks of poorly-controlled development a detailed physical geographical regionalization was urgently needed based on biotic richness and endemism. Their detailed analysis provides clear evidence that around thirty percent of the peninsula is still inadequately protected. Such conservation gaps have to be urgently assessed and remedied if the peninsula is to maintain its unique identity. The next article examines, with much-underused IRS data, the pattern of not only circular migration of Puerto Ricans, especially through the newly-emerging hub of Orlando, Florida, but also the income characteristics of the migrants. Though within Puerto Rico no data is available at the level of US counties, on the mainland the authors provide us with new maps of the county destinations of Puerto Rican migrants in the late 1990s and the early 2000s. In the next paper the focus switches to northern Peru, to the city of Cajamarca, to examine a critical factor in the city’s development: an adequate water supply. A team of German colleagues provide us with a detailed analysis of the water storage volume of a key watershed serving the city. Much has been published recently of Latin American water issues but here we are taken underground to appreciate the relevance of hydro-geological structures. Statistical analysis allows us to see that not only is soil conservation essential to preserve the stored water source, but attention must be paid to subsurface water paths. We next move from Peru to Brazil to read of a process associated with the private sector: ‘land-grabbing’ by national and multinational corporations. But here the story is quite distinctive given the fact that most of the grabbing of land is not only tolerated but actually assisted by the State. Under the blanket of the Growth Acceleration Program both state and federal governments have initiated private/public partnerships for implementing mega-projects, and if and when land is needed for their implementation by the various corporations the Constitution and relevant laws are conveniently set aside. Those who suffer are landowners and squatters, targets of eviction and clear victims of the Brazilian rush to develop at any cost. Morelia, Mexico, presents a much less radical context for the next paper that asks key questions that are relatively scarce in the published literature: what do residents of this city think of their ‘historic center’? One often forgets that in spite of the prestige afforded cities bestowed with entry on the World Heritage List (in this case since 1991), people have to live with the everyday consequences of such a citation. Security, parking, public transport, rising housing costs---the list of perceived issues is a familiar one, but one that visitors especially need to appreciate. Heritage for some often means daily inconvenience for many others. [End Page 3] Our next move is to Guatemala, to the Sierra de las Minas and the mountain community of Santa Rosalía, to read an analysis of yet another common question: why do people continue to live, apparently illogically, in zones that are sites of frequent natural physical hazards—in this case landslides? We learn from interview data and cartographic analysis that the diversified economic livelihoods provide cultural rootedness that defies re-location given the various hazards. Moving would be far more costly in cultural terms that merely persistently coping and rebuilding. From real physical hazards we next turn to the electronic world of the Internet. Though one might think, given the frequency of the word ‘globalized’ in so many contexts, that anybody can get in touch from one (real) place with anyone else (in another real place) via the Internet, Gustavo Buzai’s analysis of connections between Buenos Aires and neighboring cities, such as Asunción and Santiago de Chile, demonstrates just how dependent Latin American sites are on connections that go not directly from Argentina to Uruguay, but rather Argentina to the USA, and then back to Uruguay! Real geographic proximity...

Institutional prevention policies and rates of Group B Streptococcus infection among HIV-infected pregnant women and their infants in Latin America

ObjectiveTo describe Group B Streptococcus (GBS) prevention policies at 12 Latin American sites participating in the NICHD (Eunice Kennedy Shriver National Institute of Child Health and Human Development) International Site Development Initiative (NISDI) Longitudinal Study in Latin American Countries (LILAC) and to determine rates of rectovaginal colonization and GBS-related disease among HIV-infected pregnant women and their infants. MethodsSite surveys were used to assess prevention policies and practices administered cross-sectionally during 2010. Data collected in NISDI from 2008 to 2010 regarding HIV-infected pregnant women were used to determine rates of colonization and GBS-related disease. ResultsOf the 9 sites with a GBS prevention policy, 7 performed routine rectovaginal screening for GBS. Of the 401 women included in the NISDI study, 56.9% were at sites that screened. The GBS colonization rate was 8.3% (19/228 women; 95% confidence interval [CI], 5.1%–12.7%). Disease related to GBS occurred in 0.5% of the participants (2/401 women; 95% CI, 0.1%–1.8%); however, no GBS-related disease was reported among the 398 infants (95% CI, 0.0%–0.9%). ConclusionImproved efforts to implement prevention policies and continued surveillance for GBS are needed to understand the impact of GBS among HIV-infected pregnant women and their infants in Latin America.

Su1673 H. pylori Recurrence One Year After Eradication Treatment in a Population Randomized Trial (SWOG S0701) in Seven Latin American Sites

Su1673 H. pylori Recurrence One Year After Eradication Treatment in a Population Randomized Trial (SWOG S0701) in Seven Latin American Sites