Achieving co-presence when together and apart: Hybrid engagements and multi-modal collaborative research with urban indigenous youth

This article reflects on collaborative research carried out during the COVID-19 pandemic involving indigenous youth co-investigators from different urban settings in Bolivia and a UK- and Bolivia-based research coordination team. Unlike previous studies that highlight the potential of generating a shared co-presence via virtual engagements and digital methods when face-to-face interactions seem less desirable, this article offers a more cautious account. We question the existence of a shared co-presence and, instead, posit co-presence as fragmented and not necessarily mutual, requiring careful engagement with power imbalances, distinct socio-economic and space-time positionings, and diverse priorities around knowledge generation among team members. These considerations led us to iteratively configure a hybrid research approach that combines synchronous and asynchronous virtual and face-to-face interactions with multi-modal methods. We demonstrate how this approach enabled us to generate a sense of co-presence in a context where collaborator access to a shared space-time was limited, differentiated, or displaced. [ FROM AUTHOR] Copyright of Qualitative Research is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Declaration of Cuernavaca

The National Public Health Institutes (NPHI), members of the Latin American Regional Network of the International Association of National Institutes of Public Health, met face to face at the headquarters of the National Institute of Public Health of Mexico, in the City of Cuernavaca, from October 5 to 7, 2022, with the participation of the directors or their representatives of the NPHIs of Bolivia, Brazil, Colombia, Costa Rica, El Salvador, Mexico, Peru and Suriname and representatives of the South American Sub regional Program (SAM), and the Central American Sub regional Program (CAM) of the Pan American Health Organization (PAHO), the Organization of the Amazon Cooperation Treaty (OTCA), the Andean Health Agency/Hipolito Unanue Agreement (ORAS/CONHU) and the Central American Integration System (SICA/COMISCA), analyzing the role of the NPHI in combating health inequities;in confronting the global climate and environmental crisis;combating hunger, food insecurity and malnutrition;successes and challenges in responding to the Covid-19 pandemic;strengthening and continuous improvement of integrated disease surveillance and preparedness for health emergencies;as well as the various existing regional and sub-regional health cooperation programs, noticing that: 1. In the current scenario, the dominating development model is a generator of growing social inequalities, which determine serious inequities in the health conditions of our peoples. 2. Likewise, the current model of production and consumption, adopted at the global level, has increased hunger, food insecurity and malnutrition that possibly constitute nowadays the main health problem in our region. 3. The environmental crisis, which is also a product of the current global development model, has a significant impact on human and animal health and the interaction between both. 4. The NPHIs have played a role of major relevance in confronting the Covid-19 pandemic, not fully applying, however, their full potential for research and for proposing national plans for the disease control. 5. Health surveillance systems, in most of our countries, suffer from significant fragmentation between various sectors and within the health sector itself, implying, in any case, reactive actions that do not allow for anticipating the emergence of new pathologies or health emergencies. 6. The various regional and sub regional cooperation agencies and programs offer an enormous capacity for synergies and mutual cooperation.

Assessing the Impact of COVID-19 on Indigenous Peoples in Latin America: Towards Effective Post-Pandemic Policies

[...]a broad and inclusive approach to post-pandemic policy-making—one that considers Indigenous forms of knowledge whilst fostering appreciation for their cultures and lives—is needed to adequately assist Indigenous peoples in repairing the harm they have suffered as a result of COVID-19.3 COVID-19 and its deadly impact on Indigenous communities There are no less than eight hundred distinct Indigenous communities across Latin America, each with its own unique identity, culture, and [End Page 169] history. In Bolivia, for example, where Indigenous groups comprise a significant portion of the electorate (between 41 and 62 percent of the population), Latin America's first Indigenous political executive was elected in 2006.4 In most instances, however, Indigenous peoples make up only a small proportion of Latin American country populations (generally ranging from 0.5–15 percent), one factor ensuring limited political influence and the widespread marginalization of their interests.5 As a consequence, Indigenous peoples across the region entered the pandemic whilst already suffering from a range of serious economic and socio-cultural inequalities.6 Inadequate access to medical care, chronic poverty and economic marginalization, racism and prejudice, and inadequate access to education are common issues that exacerbated the impact of the pandemic.7 The World Health Organization confirmed the arrival of the pandemic in the region on February 26, 2020. [...]Indigenous mortality rates were 4.03 percent in Brazil and 19.9 percent in Mexico—significantly higher than 2.2 percent and 5.7 percent overall mortality rates in each country respectively.9 Unfortunately, the lack of regional data on, and deliberate under-reporting of, Indigenous mortality rates across much of Latin America has problematized many of the available datasets.10 In Brazil, for example, organizations such as The Articulation of Indigenous Peoples (APIB), have shown that the total number of recognized Indigenous deaths (902 persons as of April 7, 2022), undercounts the actual figure by at least 31 percent.11 Other sources, such as the Special Secretariat for Indigenous Health (SESAI), which is responsible for Indigenous medical care, also provides incomplete data on Brazilian Indigenous mortality by failing to count Indigenous urban dwellers or those who live outside of recognized government-controlled territories in their data sets.12 Such groups are among some of the most vulnerable Indigenous communities in the country, receiving little, if any, support from government agencies charged with supporting Indigenous communities.13 As a result, the scale and scope of COVID-19's impact on Indigenous Brazilians is, and for the foreseeable future will likely remain, unknowable.14 Despite a lack of adequate data across much of Latin America, a growing body of evidence indicates that Indigenous peoples were particularly vulnerable to COVID-19, and that they likely died or suffered long-term health issues in disproportionate numbers.15 In a study of Indigenous peoples in Chile, for instance, regions with larger Indigenous populations recorded a noticeable increase in overall mortality.16 Where direct data do not exist, emerging studies suggest that the medical impact of COVID-19 was likely compounded by a range of structural inequalities and environmental factors.17 Many Indigenous peoples lack access to adequate medical care. [...]disproportionate exposure to pesticides—used extensively in agricultural industries in which many Indigenous people find employment, as well as exposure to smoke inhalation—caused by out-of-control forest fires across Latin America—likely exacerbated the repertory symptoms caused by COVID-19.18 As a consequence, Indigenous peoples had to face COVID-19 not only with fewer resources, but with greater exposure to the types of pre-existing conditions known to aggravate the impact of the disease.19 Particularly high mortality rates among Indigenous elders, who act as stores of traditional knowledge, affected cultural continuity and community cohesion.20 To better understand this we spoke with a representative of the Indigenous Kaingang people, Duko Vãgfy, who explained that "[t]he worst losses [we suffered] were the elders, because they held so much knowledge about [our] people.

Hybrid Immunity for COVID-19 in Bolivian Healthcare Workers.

Introduction Vaccination is one of the pillars for the prevention of COVID-19 in healthcare workers (HCWs). The present study aims to determine the effectiveness of vaccination for COVID-19 as well as hybrid immunity in previously infected HCWs in a hospital in a developing country. Methods An observational study was carried out on health personnel with a complete COVID-19 vaccination schedule according to their previous infection status, with a follow-up period of 15 months. Results In this study, 335 subjects were enrolled, of which 32.8% had a previous infection with COVID-19. The safety of vaccines was determined by estimating the presence of adverse effects of vaccination and immunization (AEVI), with the first and second doses showing an incidence of 8.2% and 9.5% respectively, during the second and third waves. Around 5.7% of immunized personnel were sick and 8.4% in the fourth wave; the serum value of neutralizing antibodies was normal at 60.2% with no differences between vaccines (p=0.164). However, in personnel with hybrid immunity, there were normal levels of antibodies in 81.8% of cases (p= 0.023), fewer days of medical leave (6.4 days (standard deviation=1.4) (p=0.067)), higher immunoglobin values ​​(p=0.011) and an insignificantly (p=0.248) lower rate of COVID-19 presentation. Conclusion Vaccination, when applied to people who previously acquired natural immunity, generates a hybrid immunity that is robust, and could have a longer duration, as well as greater efficacy for new COVID-19 variants of concern.

Using photovoice to explore Bolivian children's experiences of COVID-19.

Our capacity to facilitate the empowerment of children is dependent on our ability to understand their values and experiences. This study aimed to explore Bolivian children's experiences of COVID-19. This study used a participatory action research method, photovoice, which involved focus groups, individual interviews and the use of cameras by participants to capture their reality and express their ideas through photographs. Ten participants aged 12-15 years were recruited from a school in the municipality of Mecapaca in Bolivia. Thematic analysis was used to identify and report response patterns. Four themes were developed through analysis: (i) sadness and fear of getting sick, (ii) the challenges of online learning, (iii) the tension between traditional knowledge and modern medicine, and (iv) the role of nature and culture in supporting well-being-natural and cultural capital. The narratives and choice of images by the children illustrate some issues and experiences. These findings also highlighted the importance of considering and exploring how children's experiences and interactions with their habitat, nature and their physical environment impacts on their health and well-being.

Satisfacción laboral del personal de salud durante la emergencia sanitaria en Latinoamérica

El Covid-19 puso a prueba al sistema sanitario a nivel mundial y mostró la relevancia del personal de salud, pero también las debilidades del sistema para dar soporte a su desempeño. En Latinoamérica, la situación fue caótica tanto para el usuario como para el personal de salud. Estos últimos sometidos a interminables y estresantes jornadas laborales con recursos limitados en la mayoría de los casos, lo que influyó en su nivel de satisfacción laboral. Por ello, la investigación se planteó explicar la satisfacción laboral en el personal de salud de Perú, Bolivia y Brasil durante la pandemia, considerando como determinantes la motivación, condiciones laborales y burnout. Se aplicó el enfoque cuantitativo, no experimental, transversal y ex post facto. Los resultados mostraron la correlación entre las determinantes y la satisfacción laboral. En el caso de Brasil y Perú el nivel de satisfacción tiende a ser mayor lo cual es explicado por las condiciones laborales, motivación y el burnout sostenido por la resiliencia;mientras que en el caso de Bolivia la satisfacción laboral es la más baja, pero responde igualmente a valores negativos en las determinantes. Adicionalmente, se encontró que existen otras variables que podrían influir en el nivel de satisfacción laboral.Alternate abstract:Covid-19 put the healthcare system to the test worldwide and showed the relevance of health personnel, but also the weaknesses of the system to support their performance. In Latin America, the situation was chaotic for both the user and the health personnel. The latter were subjected to endless and stressful working hours with limited resources in most cases, which influenced their level of job satisfaction. Therefore, the research aimed to explain job satisfaction among health personnel in Peru, Bolivia and Brazil during the pandemic, considering motivation, working conditions and burnout as determinants. A quantitative, nonexperimental, cross-sectional and ex post facto approach was applied. The results showed the correlation between the determinants and job satisfaction. In the case of Brazil and Peru, the level of satisfaction tends to be higher, which is explained by positive working conditions, motivation and burnout, while in the case of Bolivia, job satisfaction is the lowest but also responds to negative values in the determinants. Additionally, it was found that there are other variables that could influence the level of job satisfaction.

CITIZENS OF BOLIVIA, COLOMBIA, ECUADOR AND PERU HAVE ADDITIONAL RIGHTS TO THOSE OF THEIR COUNTRY OF BIRTH, WHICH ARE EFFECTIVE THROUGHOUT THE TERRITORY OF THE ANDEAN COMMUNITY. CONCEPT NOT APPLICABLE TO HEALTH PERSONNEL IN THE CASE OF AN OCCUPATIONAL BIOHAZARD EVENT.

Introduction: The studies of comparative law are used as a methodology of legal analysis based on the comparison of different applications and interpretations for similar cases, the interest in comparative law lies in that it nourishes and broadens the vision for international understanding, which makes us understand the rationale of the rules in different states, Of our interest is the concept of the Andean citizen and the migratory statute that defines that migrant workers from Bolivia, Colombia, Peru and Ecuador have additional rights, guarantees and duties to those of their country of birth, these new social rights are those granted since August 11, 2021 by decision 878 of the Andean migratory statute. When analyzing whether the health workers who attended the COVID-19, exposure to occupational biological risk was considered in each of their countries as of occupational origin, since the objective of the community is to standardize and normalize concepts and regulations and thus allow inferring whether they are entitled to the assistance and economic benefits covered to the worker Objective:To compare the legislation issued by the health authorities of the member countries of the Andean Community of Nations on COVID-19, and if this was configured as an Occupational Disease in health workers who attended the Pandemic. Material(s) and Method(s): An exhaustive review was carried out in the official communication channels of the health authorities of Colombia, Ecuador, Peru and Bolivia, CAN member countries, filtering the information on how they developed COVID-19 as an Occupational Disease in their internal regulations, identifying guarantees and protections provided by the countries to the health workers who have been in charge of the integral attention of this contingency. Descriptive study that included a search from April to December 2021. Result(s):After the review,COVID-19 was recognized as an Occupational Disease in health workers, in 3 of the 4 Countries, 1 of the Countries determined it as a Public Health problem, likewise it was found that each Country, approaches Occupational Risks differently, translating into the fact that Health Workers of the CAN, did not have guarantees and protections proper to the Occupational Risks system. Conclusion(s): There is a lack of development on the part of all the Countries that make up the CAN, with regard to aligning their regulations on labor risks, in such a way that they guarantee access to the Andean Citizen to enjoy the guarantees provided by social security in accordance with the supra-national regulation, Decision 584 which approves an instrument that establishes the fundamental rules on occupational safety and health, as a basis for the gradual and progressive harmonization of the laws and regulations governing the particular situations of the labor activities developed in each of the Member Countries, which are not fully developed by all the member countries, generating legal insecurity and uncertainty for the migrant worker.Copyright © 2022, Accion Medica S.A.. All rights reserved.

The impact of the COVID-19 on the tourist industry of Bolivia and strategies to exit the crisis

Covid-19 has not only affected the health of the population but has also deteriorated the economies and industries of the countries;one of them, which is the most affected, is undoubtedly tourism. The impact of the Covid-19 on the Bolivian tourism industry warned that about 3,020 million BOB$ would be lost in 2020. The main receptive inbound markets in Bolivia drastically decreased their trips and the impact derived from the absence of tourism caused more than 140 thousand people to lose their job source. Undoubtedly, the tourism micro entrepreneur was the one who received the greatest impact, since nearly 50% of the productive units closed operations in the months following the start of the pandemic. However, Bolivian entrepreneurs saw in this interruption an opportunity to think and reinvent themselves by migrating to the computer world.

Are societies in conflict more susceptible to believe in COVID-19 conspiracy theories? A 66 nation study

Conspiracy theories widely influence our social and political lives. A recent example is the broad impact such theories had on government's efforts to halt the spread of the COVID-19 pandemic. In that context, public's compliance and willingness to get vaccinated was found to be substantially and negatively affected by the belief in conspiracy theories, among various factors. In the present study, we tested whether some countries are more susceptible to conspiracy theories than others. We examined, for the first time, the idea that the degree of intensity of conflict predicts the degree of belief in COVID-19 conspiracy theories. A multilevel analysis across 66 countries (N = 46,450) demonstrated that people living in countries with higher conflict intensity tended to be more susceptible to COVID-19 conspiracy beliefs. These findings are the first large-scale comparative evidence of the profound psychological effects of conflicts on the involved societies. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Impact Statement The belief in COVID-19 conspiracy theories has severe implications on public's health. Thus, it is important to better understand the reasons behind such beliefs. The present study provides new information which helps to better understand the contexts in which conspiracy belief thrive. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Kidney Replacement Therapy in Latin America, 2020 Data

Introduction: The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. The main goals of the LADRTR is to promote the development of national registries, consolidate a data system for KRT in Latin America (LA), return the data provided by nephrologist to the different stakeholders that participate in the decision making process, while contributing to the universal knowledge of prevention, incidence and evolution of the disease in the region. This summarizes the registry data for 2020. Method(s): Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2020 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB. Result(s): On 31 December 2020 the prevalence of KRT in LA was 848 per million population (pmp), which shows a drop in the rate compared to the previous year (Figure 1). The prevalence ranged from 2129 pmp in Puerto Rico to 111 pmp in Nicaragua. Eight countries had a rate >700 pmp (Argentina, Brazil, Chile, Colombia, Ecuador, Panama, Puerto Rico and Uruguay). The states of Mexico, Jalisco and Aguas Calientes, also had a rate >700 pmp (Figure 2). Regarding treatment modality, 67,0% of the prevalent patients were treated with HD (n= 290 099) and 9.3% with PD (n= 40 450) while 23,6% of the patients had an LFG (n= 102772). The total unadjusted incidence rate of patients that started KRT was 158 pmp. The majority of the patients started KRT with HD modality, while only 6,08% used PD, varying the rate of incidence from 477 pmp in Jalisco and Aguas Calientes to 2 pmp in Bolivia. The kidney transplant rate in the region was 15 pmp, showing a drop from the previous year, and 89% of KT were from a deceased donor (Figure 3). The total prevalence of KRT correlated positively with GDP per capita (r 2 = 0.6, P < 0.01) and LEB (r 2 = 0.27, P < 0.05). The overall unadjusted mortality rate was 18%, cardiac disease was the leading cause of death (31%), followed by infectious diseases (21%) and other causes (16%). [Formula presented] [Formula presented] [Formula presented] Conclusion(s): For the first time in the last decade the overall prevalence and kidney transplant rate decreased, being this associated with COVID-19 pandemic. Although the incidence and prevalence of KRT in the LA region have increased over the years, there is still a need to improve accessibility to KRT, develop programs that facilitate better control of risk factors, early diagnosis and the treatment of chronic kidney disease, as well as the implementation of an effective kidney transplant program, to reduce the gap that exists between the countries of LA. No conflict of interestCopyright © 2023

El apoyo mutuo y la respuesta urbana a la pandemia de Covid-19

En Bolivia, el apoyo mutuo a través de redes barriales ha sido una estrategia exitosa -aunque poco visibilizada- de respuesta a la pandemia de Covid-19. Esta experiencia ha movilizado a miles de personas alrededor del mundo y ha logrado salvar una serie de vicisitudes generadas por el virus y por la forma de respuesta de los gobiernos. Este artículo, resultado de un estudio desarrollado en el área metropolitana de Cochabamba durante la primera etapa de la pandemia, presta atención y expone formas notables de gestión de la pandemia y estrategias solidarias desarrolladas por barrios caracterizados por el trabajo mancomunado.Alternate :In Bolivia, mutual support through neighborhood networks has been a successful - albeit little publicized- strategy in response to the Covid-19 pandemic. This experience has mobilized thousands of people around the world and has managed to overcome a series of vicissitudes generated by the virus and by the response of governments. This article, the result of a study conducted in the metropolitan area of Cochabamba during the first stage of the pandemic, focuses on the remarkable forms of pandemic management and solidarity strategies developed in neighborhoods where joint work is common.

COVID-19 Disruption and Meaningful Work: The Mediating Role of Family–Work Conflict

Work overload and the alteration in family dynamics caused by the COVID-19 pandemic crisis may be increasing family–work conflict, leading to the consequent decrease in meaningful work. Using the structural equation modeling of covariance, this research determines the impact of the pandemic disruption on meaningful work as mediated through family–work conflict. The sample comes from 534 men and 257 women that are full-time employees of seven public manufacturing companies in Bolivia;they were surveyed by filling out a self-report questionnaire at the companies' locations. Although no significant direct effects were found between COVID-19 disruption and meaningful work (standardized beta = 0.038, Z = 0.756, p = 0.450), there is an indirect effect when the relationship is measured through the family–work life conflict variable (standardized beta = −0.138, Z = −6.119, p < 0.001). Implications for business management are discussed. © 2023 by the authors.

Everyday urbanisms in the pandemic city: a feminist comparative study of the gendered experiences of Covid-19 in Southern cities

Drawing on GenUrb's comparative research undertaken in mid-2020 with communities in five cities—Cochabamba, Bolivia, Delhi, India, Georgetown, Guyana, Ibadan, Nigeria, and Shanghai, China—we engage in an intersectional analysis of the gendered impacts of the Covid-19 pandemic in women's everyday lives. Our research employs a variety of context-specific methods, including virtual methods, phone interviews, and socially-distanced interviews to engage women living in neighbourhoods characterized by underdevelopment and economic insecurity. While existing conditions of precarity trouble the before-and-after terminology of Covid-19, across the five cities the narratives of women's everyday lives reveal shifts in spatial-temporal orders that have deepened gendered and racial exclusions. We find that limited mobilities and the different and changing dimensions of production and social reproduction have led to increased care work, violence, and strained mental health. Finally, we also find that social reproduction solidarities, constituting old and new circuits of care, have been reinforced during the pandemic.

High SARS-CoV-2 Prevalence among Healthcare Workers in Cochabamba, Bolivia.

Healthcare workers (HCWs) are at increased risk of SARS-CoV-2 infection. The aim of the study was to estimate the SARS-CoV-2 seroprevalence among HCWs in Cochabamba, Bolivia and to determine the potential risk factors. In January 2021, a cross-sectional SARS-CoV-2 seroprevalence study was conducted in 783 volunteer clinical and non-clinical HCWs in tertiary care facilities. It was based on IgG detection using ELISA, chemiluminiscence, and seroneutralisation tests from dried blood spots. Analysis revealed a high seroprevalence (43.4%) of SARS-CoV-2 IgG antibodies. The combination of anosmia and ageusia (OR: 68.11; 95%-CI 24.83-186.80) was predictive of seropositivity. Belonging to the cleaning staff (OR: 1.94; 95%-CI 1.09-3.45), having more than two children in the same house (OR: 1.74; 95%-CI 1.12-2.71), and having been in contact with a close relative with COVID-19 (OR: 3.53; 95%-CI 2.24-5.58) were identified as risk factors for seropositivity in a multivariate analysis. A total of 47.5% of participants had received medication for COVID-19 treatment or prevention, and only ~50% of symptomatic subjects accessed PCR or antigenic testing. This study confirms a massive SARS-CoV-2 attack rate among HCWs in Cochabamba by the end of January 2021. The main risk factors identified are having a low-skilled job, living with children, and having been in contact with an infected relative in the household.

An epidemiological evaluation of COVID-19 in La paz, Bolivia.

INTRODUCTION: The Plurinational State of Bolivia (Bolivia) has experienced four major waves of coronavirus disease 2019 (COVID-19) so far. Although the ministry of health has been tracking morbidity and mortality through each wave, epidemiology of COVID-19 in Bolivia is not well defined, despite a need for more accurate measurement of the number of cases and deaths to allow for forecasting of the pandemic. This study examined prevalence of COVID-19 at community level, determinants of its occurrence and vaccine effectiveness. METHODS: We conducted a cross-sectional study in La Paz city on 2,775 individuals between March 2020 and February 2022. A structured questionnaire was used to collect data on COVID-19 morbidity, mortality and vaccination status. RESULTS: Of the 2,775 participants, 1,586 (57.1%) were infected with COVID-19, and 187 (6.7%) were suspected cases. The mortality rate was 2.9%. Sinopharm, Johnson & Johnson, Gamaleya, Pfizer-BioNtech, Moderna and AstraZeneka vaccines are in use, and all vaccines have demonstrated effectiveness in reducing the risk of onset. Risk for mortality was significantly lower in the vaccinated group with an odds ratio of 0.037 (95％ confidential interval: 0.01-0.10, p-value: <0.001). CONCLUSIONS: Actual prevalence of COVID-19 in La Paz (the prevalence rate: 63.8%, including suspected case) was higher than that reported by the Ministry of Health and Sports in Bolivia (7.5%). In addition, vaccination has contributed significantly to the control of the COVID-19 epidemic in Bolivia. We believe that our report will be useful for COVID-19 prevention strategies in Bolivia for the future.

Achieving the Sustainable Development Goals through the Power of Play

As we work to educate our children in effective ways, supporting their efforts to make a positive difference reaps benefits for both students and society.

El impacto de la COVID-19 en la industria turística de Bolivia y estrategias para salir de la crisis

La COV ID-19 no solo ha afectado la salud de la población, sino también ha deteriorado las economías y las industrias de los países, una de ellas y la más afectada es, sin duda, el turismo. El impacto de la COV ID-19 en la industria turística boliviana alertó que se perderían cerca de 3.020 millones de bolivianos en la gestión de 2020. Los principales mercados de turismo receptivo de Bolivia disminuyeron drásticamente sus viajes y el impacto derivado de la ausencia de turismo provocó que más de 140.000 personas perdieran su fuente de empleo. Pero, sin duda, el microempresario de turismo fue quien recibió el mayor impacto, ya que cerca del 50 % de las unidades productivas cerraron operaciones en los meses siguientes al inicio de la pandemia. Sin embargo, los empresarios bolivianos vieron en la paralización una oportunidad para pensar y reinventarse a partir de la migración al mundo informático.Alternate :Covid-19 has not only affected the health of the population but has also deteriorated the economies and industries of the countries;one of them, which is the most affected, is undoubtedly tourism. The impact of the Covid-19 on the Bolivian tourism industry warned that about 3,020 million BOB $ would be lost in 2020. The main receptive inbound markets in Bolivia drastically decreased their trips and the impact derived from the absence of tourism caused more than 140 thousand people to lose their job source. Undoubtedly, the tourism micro entrepreneur was the one who received the greatest impact, since nearly 50% of the productive units closed operations in the months following the start of the pandemic. However, Bolivian entrepreneurs saw in this interruption an opportunity to think and reinvent themselves by migrating to the computer world.

Sustainable Futures for Bolivia

In this chapter, the reality of Bolivia's current situation is presented, including details regarding the country's political, economic and environmental context. Then, alternate possible future scenarios are presented, developed by four different types of stakeholders in Bolivian society during four workshops that produced various suggestions on how to recover from the effects of the COVID-19 pandemic using a sustainable approach. Several findings are incorporated into these scenarios, including potential risks, public policy recommendations and structural changes required to attain the best possible post-pandemic scenario for Bolivia, including the achievement of several Sustainable Development Goals (SDGs) from the 2030 Agenda, especially SDGs 8, 13 and 17. © 2022 Emerald Publishing Limited.

A Nobel Score to Predict Pediatric Covid-19 Severity in Low and Middle Income Countries

BACKGROUND AND AIM: COVID-19 affects children less seriously than adults;however, severe cases and deaths are documented. This study objective is to determine sociodemographic, clinical and laboratory indicators associated with severe pediatric COVID-19 and mortality at hospital entrance. METHOD(S): A multicenter, retrospective, cross-sectional study was performed in 13 tertiary hospitals in Bolivia. Clinical records were collected retrospectively from patients less than 18 years of age and positive for SARS-CoV-2 infection. All variables were measured at hospital entrance;outcomes of interest were ICU admission and death. A score for disease severity was developed using a logistic regression model. RESULT(S): 209 patients were included in the analysis. By the end of the study, 43 (20.6%) of children were admitted to the Intensive care unit (ICU), and 17 (8.1%) died. Five indicators were independently predictive of COVID-19 severity: age below 10 years OR: 3.3 (CI95%: 1.1 - 10.4), days with symptoms to medical care OR: 2.8 (CI95%: 1.2 - 6.5), breathing difficulty OR: 3.4 (CI95%: 1.4 - 8.2), vomiting OR: 3.3 (CI95%: 1.4 - 7.4), cutaneous lesions OR: 5.6 (CI95%: 1.9 - 16.6). Presence of three or more of these risk factors at hospital entrance predicted severe disease in COVID-19 positive children. Age, presence of underlying illness, male sex, breathing difficulty, and dehydration were predictive of death in COVID-19 children. CONCLUSION(S): Our study identifies several predictors of severe pediatric COVID-19 and death. Incorporating these predictors, we developed a tool that clinicians can use to identify children at high risk of severe COVID-19 in limited resource settings.

Antibiotic Consumption in a Healthcare System in Bolivia During the First Wave of COVID-19 Pandemic

Background. Several countries in Latin America reported an increase in antibiotic use during the first wave of the COVID-19 Pandemic. Methods. We retrospectively evaluated antibiotic use among 10,752 members of a private healthcare system in Santa Cruz de la Sierra, Bolivia, between Jan-Dec 2019 (pre-pandemic) and Jan-Aug 2020 (pandemic). Antibiotic use was calculated as daily defined doses (DDD) per 1,000 member-days, per 100 ambulatory visits, and per 100 inpatient-days, and categorized using the World Health Organization classification (Access, Watch, and Reserve), based on the impact of different antibiotics on antimicrobial resistance. In April 2020, the antibiotic stewardship team developed COVID-19 treatment guidelines for ambulatory and hospitalized patients and provided recommendations on all patients hospitalized due to COVID-19. Due to the nature of the network, guideline use is usually high. During the pandemic period and due to local restrictions, patient interactions were mostly limited to COVID-19 presentations. Differences with 95% confidence intervals (CI) between groups were estimated. Results. Pandemic and pre-pandemic antibiotic use in DDD/1,000 member-days was 8.48 and 18.37, respectively (diff. -8.89, 95%CI -10.11 to -9.67). Outpatient DDD/100 ambulatory visits was 67.68 vs. 86.20 (diff. -18.52, 95%CI -19.94 to - 17.1), and hospital DDD/per 100 inpatient-days was 39.79 vs. 61.71 (diff. -21.92, 95%CI -26.2 to -17.68) for pandemic and pre-pandemic periods, respectively. During the pandemic period, an overall reduction in macrolides use was also observed (-3.13 DDD/100 ambulatory visits, 95%CI -3.84 to -2.44, and -2.05 DDD/per 100 inpatient-days, 95%CI -2.88 to -1.26). Additionally, an increase in Access antimicrobials (83.3% vs. 79.5%;diff. 3.8%, 95%CI 0.3% to 7.4%) and a reduction in the Watch group (16.7% vs. 20.5%;diff. -3.7%, 95%CI -7.4% to -0.1%) were observed for pandemic and pre-pandemic periods, respectively. Conclusion. In this closed network, we observed a reduction in antibiotic use both in ambulatory and inpatient settings. Although, multifactorial, we believe the enhanced antibiotic stewardship approach on COVID-19 patients played a role in limiting antimicrobial use in this private healthcare system.