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.

The Effect of Sociodemographic Factors on COVID-19 Mortality in Costa Rica: A Geographic Approach

Introduction: The coronavirus disease (COVID-19) has spread among the population of Costa Rica and has had a great global impact. However, there are important geographic differences in mortality from COVID-19 among world regions and within Costa Rica.Objective: To explore the effect of some sociodemographic factors on COVID-19 mortality in the small geo-graphic divisions or cantons of Costa Rica.Methods: We used official records and applied a classical epidemiological Poisson regression model and a geographically weighted regression model.Results: We obtained a lower Akaike Information Criterion with the weighted regression (927.1 in Poisson regression versus 358.4 in weighted regression). The cantons with higher risk of mortality from COVID-19 had a denser population;higher material well-being;less population by health service units and are located near the Pacific coast.Conclusions: A specific COVID-19 intervention strategy should concentrate on Pacific coast areas with denser population, higher material well-being and less population by health service units.

A Lost Opportunity? Collective Demands and Migrant Farmworkers in Costa Rica during the Pandemic

The COVID-19 pandemic induced an overexposure of migrant farmworkers' poor working and living conditions in Costa Rica's northern border area and underscored the country's dependence on migrant labor. This created a unique opportunity to position pro-migrant concerns and demand actions from the state. In this article, we assess if and to what extent the actions of the Costa Rican state were influenced by migrant demands, or whether other priorities guided policy. Based on a novel database on protest and collective action (Protestas-IIS) that is fed with national and local newspaper articles, we analyze the demands made by migrants, the private sector and NIMBY movements, and state responses. Our findings suggest that the latter prioritized market concerns and antiimmigrant interests, thereby underscoring lessons from the literature that migrants are among the politically most disenfranchised in society. Their demands were only partially responded to by the state, and only concerning issues that aligned directly with public concerns, in this case related to health.

Costa Rican Sustainable Development Perspectives: The COVID-19 Pandemic as a Turning Point?

The effects of the COVID-19 pandemic have accentuated pleas worldwide for urgent action in social, political, and environmental matters. Many of these appeals portray the pandemic as a "wake-up call” to the many long-standing problems affecting societies worldwide, including social and economic inequality, political struggles, and climate change. Indeed, calls for urgent environmental action have predominated in the wake of the pandemic, on one hand by presenting contemporary human-environment interactions as a root cause, and on the other, by comparing the pandemic effects to what could possibly occur if effective remediating actions are not taken in the short term. In this chapter, we broadly examine some relevant perspectives on the pandemic-environment relationship in the Costa Rican institutional milieu with particular focus on those who envision the pandemic as a turning point towards a more environmentally-sound development model in a country commonly portrayed as "green” and highly dependent on nature-based tourism. In so doing, we seek to provoke discussions on how these perspectives that leverage on the pandemic crisis can lead to social and environmental change significant enough to effectively redirect development pathways toward sustainability. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

REPERTORIO DE POLÍTICAS PÚBLICAS EN EL CONGRESO PARA MITIGAR LAS CONSECUENCIAS DEL COVID-19 EN COSTA RICA

Este artículo es el resultado de un estudio de las propuestas de política pública presentados en el Congreso de Costa Rica para amortiguar o revertir los efectos socioeconómicos y de salud provocados por la pandemia del Covid-19. De todas las propuestas presentadas en los primeros seis meses de la declaratoria de emergencia ocasionada por el virus, en el año 2020, más de la mitad (194 en total) intentan mitigar uno o varios de los efectos de tal enfermedad infecciosa. Aún en la multiplicidad de protección a sectores específicos que se tratan de salvaguardar (33), hay una marcada tendencia en la regulación financiera-fiscal y de actuación en torno a la reactivación productiva. Pese a esto, una parte sustancial de las políticas planteadas para convertirse en leyes, no tienen un sustento financiero para ejecutarlas.Alternate :This article is the result of a study of the public policy proposals presented in the Costa Rican Congress to cushion or reverse the socioeconomic and health effects caused by the Covid-19 pandemic. Of all the proposals presented in the first six months of the emergency declaration caused by the virus, in the year 2020, more than half (194 total) try to mitigate one or more of the effects of such an infectious disease. Even in the multiplicity of protection for specific sectors that are sought to be safeguarded (33), there is a marked trend in financial-fiscal regulation and action around productive reactivation. Despite this, a substantial part of the policies proposed to become laws do not have financial support to execute them.

COVID-19 Waves and Politics in Costa Rica

In 2018, the government that came to power in Costa Rica quickly began to promote socially regressive policies, which directly favored the oligarchic groups, at the expense of the working classes and the middle sectors. The COVID-19 pandemic, instead of stopping this process, accentuated it. After a very moderate first wave of infections (March-May 2020), the disease spread steadily during a second wave (June 2020-February 2021). A third wave (so far May-June 2021) has brought the public health system to the brink of collapse. With the social protests neutralized by health measures to contain COVID-19, authorities took advantage of this situation to promote new reforms that deteriorate labor rights, reduce wages and deepen inequalities. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

How COVID-19 worsened the mental health problems of incarcerated youth

The COVID-19 pandemic of 2020 transformed daily life worldwide. To minimize the spread of the virus, many governments imposed a lockdown and physical distancing measures. Schools, universities, restaurants, shops, and businesses all closed. Research has shown that the mandatory stay-at-home orders associated with the COVID-19 pandemic adversely affected the mental health of parents, children, and youth. This chapter considers how the COVID-19 pandemic has affected the mental health of youth behind bars in the United States and in other countries. The longstanding impression of prisons is that the people in custody are violent, dangerous, and deserve to be incarcerated. Even incarcerated youth are viewed by many in society as super-predators. Most incarcerated youth have significant mental health needs. Incarcerated youth often suffer from a variety of mental health conditions including anxiety, depression, Post Traumatic Stress Disorder, substance abuse, and suicidal ideation. When incarcerated youth show symptoms of COVID-19 or are diagnosed with it, juvenile correctional facilities are faced with few options for quarantine that do not resemble solitary confinement. Because of concern regarding the high transmissibility of COVID-19 in juvenile prisons, most prison administrators suspend visitors or greatly restrict the number of people entering the facilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

[Management and impact of interventions to reduce COVID-19 cases in Costa RicaGestão e impacto das medidas de intervenção para reduzir os casos de COVID-19 na Costa Rica]. / Gestión e impacto de las medidas de intervención para la reducción de casos por COVID-19 en Costa Rica.

Objective: Assess the impact of interventions introduced in Costa Rica during 2020 and 2021 to control the COVID-19 pandemic. Methods: A Bayesian Poisson regression model was used, incorporating control or intervention measures as independent variables in the changes in reported case numbers per epidemiological week. Results: The results showed the relative and combined impact of containment policies and measures on the reduction of cases: mainly vehicular traffic restrictions, use of masks, and implementation of health guidelines and protocols. Evidence of impact was optimized and made available for decision-making by the country's health and emergency authorities. Several iterations were generated for constant monitoring of variations in impact at four different moments in the pandemic's spread. Conclusion: The simultaneous implementation of different mitigation measures in Costa Rica has been a driving force in reducing the number of COVID-19 cases.

Objetivo: Avaliar o impacto das intervenções realizadas na Costa Rica durante 2020 e 2021 para o controle da pandemia de COVID-19. Método: Foi utilizado um modelo Bayesiano de regressão de Poisson que incorporou as medidas de controle ou intervenção como variáveis independentes sobre a variação do número de casos por semana epidemiológica. Resultados: Os resultados evidenciaram o efeito relativo e conjunto que as políticas ou medidas de contenção tiveram na redução de casos, principalmente as restrições a veículos, o uso de máscaras e a implementação de diretrizes e protocolos de saúde. As evidências dos efeitos foram otimizadas e disponibilizadas às autoridades sanitárias e de emergência do país para auxiliar na tomada de decisão. Diversas iterações foram geradas para o monitoramento constante da variação nos efeitos em quatro momentos distintos do avanço da pandemia. Conclusão: A aplicação simultânea de diferentes medidas de mitigação na Costa Rica tem sido um agente promotor da diminuição de casos de COVID-19.

Teens' satisfaction with virtual classes in Costa Rica

During the COVID-19 pandemic the Costa Rican educational system has adapted classes to a virtual model;furthermore, evidence has supported the existence of technological, digital, and educational gaps among students. The aim of the present study is to identify sociodemographic, psychosocial, technological, and digital characteristics associated with the adolescents' satisfaction with virtual classes during the pandemic. Using a cross-sectional de- sign, an online questionnaire was filled out by 14- to 18-year-old adolescents (n = 128, 63.3% girls, Mage = 16.2, SDage = 0.593) from public and private high schools. Results showed that only perceived support, self-efficacy, and socioeconomic status (SES) were significantly (positively) correlated with satisfaction with virtual classes. Also, it was found that a model that accounts for satisfaction in terms of perceived support and self-efficacy is better than one that includes SES as another explanatory variable. These results show some insights for making virtual learning a more satisfying experience for adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Spanish) Durante la pandemia por COVID-19, el sistema educativo costarricense ha adaptado las clases a una modalidad virtual;ademas, hay evidencia de brechas tecnologicas, digitales y educativas entre la poblacion estudiantil. El objetivo del presente estudio fue identificar las caracteristicas sociodemograficas, psicosociales, tecnologicas y digitales asociadas al nivel de satisfaccion de adolescentes en Costa Rica con las clases virtuales durante la pandemia. Se empleo un diseno transversal y se aplico un cuestionario en linea a adolescentes de entre 14 y 18 anos (n = 128, 63.3% mujeres, M edad = 16.2, DEedad = 0.593) de colegios publicos y privados. Se encontro que solo el apoyo percibido, la autoeficacia hacia las clases virtuales y el nivel socioeconomico (NSE) se correlacionan significativamente (de forma positiva) con la satisfaccion con las clases virtuales. Ademas, se hallo que un modelo que explica la variabilidad en la satisfaccion a partir del apoyo percibido y la autoeficacia hacia las clases virtuales es mejor que uno que tambien incluya el NSE como variable predictora. Los resultados muestran indicios sobre la forma de hacer mas satisfactoria la experiencia de las personas adolescentes en el contexto de clases virtuales. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

La pandemia de enfermedad por coronavirus (COVID-19) y las narrativas de la política social en Costa Rica: historia de una (breve) oportunidad

La pandemia de enfermedad por coronavirus (COVID-19), ¿potenció ideas favorables a la política social inclusiva en América Latina? Este artículo aborda esta pregunta a través de un análisis del programa de transferencias monetarias de emergencia implementado durante 2020 en Costa Rica. A partir de debates legislativos y entrevistas a jerarcas y analistas, mostramos la presencia, muy acotada en el tiempo, de ideas favorables a extender la protección social no contributiva. El nuevo programa se vio rápidamente limitado por un discurso que asimilaba la responsabilidad fiscal a la reducción del gasto social, antes que a la ampliación de los ingresos. Evitando generalizaciones simplistas, los hallazgos invitan al análisis contextualizado del impacto de la pandemia en procesos específicos de formación de política y a considerar el papel de las ideas en los debates sobre la política social. Si existe un riesgo para la política social inclusiva, este es el discurso dominante de austeridad.

Purchase of food by ecommerce in Costa Rica during COVID-19

Introduction: The influence of electronic commerce (EC) on people's food purchasing decisions has been relevant during the COVID-19 pandemic. In Costa Rica, there is no information available on how this medium has modified the food purchasing and consumption behaviors in Costa Rican families during this health emergency. Background: To analyze changes in the food purchase and consumption patterns of Costa Ricans that were influenced by the EC during the pandemic. Materials and methods: An online survey using the snowball methodology was carried out in June 2021 in different social networks groups in Costa Rica. Structural equation modeling was used to establish the causes associated with endogenous (trust, convenience, hedonic impulses) and exogenous variables (socioeconomic status, purchase decisions due to COVID-19) that outlined the changes in purchasing habits. The stimuli generated from EC that influenced these purchase decisions were reviewed according to the specific food group. Results: A strong causality was found from the latent variable convenience (beta=0.89;p<0.01) for the purchase of food by EC, in addition to little impact (beta=-0.35;p<0.01) on food consumption habits, generated by the measures defined to contain the pandemic. The sanitary measures established by the authorities show causality in the general response of the food consumer by EC (NORM_1<0.8;p<0.01), which was low if its estimated value is compared with other motivators in purchase decisions such as convenience due to improvements in quality of life (CO10.8;p<0.01) or even trust due to the commitment to quality offered by the website (CF30.6;p<0.01). Conclusions: The pandemic promoted an improvement in consumer perception regarding advantageous situations of employing EC to make food purchases.

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)

Recent progress in immunoprophylaxis of severe acute respiratory syndrome coronavirus 2 in children younger than 5 years.

Immunoprophylaxis refers to the strategy to enhance specific immunity of the body through artificial methods, which can be divided into active immunization (mainly vaccination) and passive immunization (including maternal vaccination). Vaccination is the most cost - effective measure to prevent and control the novel coronavirus disease 2019 (COVID -19). Recently, the United States, Costa Rica and Australia have authorized use of the COVID - 19 vaccine for children down to 6 months of age. In real - world evaluation, maternal vaccination was associated with a substantial reduction in incidence of severe acute respiratory syndrome coronavirus 2 (SARS - CoV - 2) infection, the risk of COVID - 19 related hospitalization and critical illness among infants younger than 6 months of age. Coupled with these advances in young children, it is possible to achieve the whole population coverage of SARS - CoV - 2 mmune prevention.Copyright © 2022 Chinese Journal of Applied Clinical Pediatrics. All rights reserved.

FINUT 2022 Conference Abstracts

The proceedings contain 343 papers. The topics discussed include: alterations in the gut microbiota associated with obesity and metabolic disease: cause or consequence?;childhood obesity in the community context;big data and machine learning as tools for the biomedical field;thermogenesis and adipose tissue: effect of genistein;pediatric obesity and comorbidities: a question of time and genetics? the Portuguese experience;nutrigenomics of inflammation;environmental factors associated with school children's excess of weight in communities of Costa Rica;dietary consumption: guided by a focus of nutrient adequacy or selection of foodstuffs?;functional foods as key regulators of gut microbiota in the SARS-CoV-2 infection;immunomodulatory properties of human milk;vitamin d in childhood and adolescent obesity;and new sources of vitamin D and E supplementation during pregnancy.

Covid-19 en América Latina y México: brechas del bienestar

Este trabajo aborda empíricamente las brechas estructurales del bienestar reveladas por la epidemia de Covid-19 en cuatro países de América Latina: Argentina, Costa Rica, México y Panamá. Para ello, aborda diversos ámbitos: el sanitario, el económico, el del empleo y el de la protección social, particularmente en el ámbito de la afiliación a los sistemas de pensiones, la mayor o menor incidencia de la crisis en el ascenso de la pobreza y la pobreza extrema y la capacidad para responder a ese repunte, la agudización de las desigualdades de género y el surgimiento de brechas que magnifican las desigualdades educativas.Alternate abstract:This article empirically addresses structural welfare gaps revealed by the Covid-19 epidemic in four Latin American countries: Argentina, Costa Rica, Mexico, and Panama. To do this, it examines various areas: healthcare, the economy, employment, social protection, particularly in the field of affiliation to pension systems, the greater or lesser incidence of the crisis in the growth of poverty and extreme poverty and the ability of each state to respond to that rise, the worsening of gender inequalities, and the emergence of gaps that magnify educational inequalities.

Pandemic populism and permanent campaigning: How Central American presidents build political legitimacy on Facebook

This article examines how Carlos Alvarado and Nayib Bukele, presidents of Costa Rica and El Salvador, respectively, employed Facebook throughout 2020 to communicate about the COVID-19 pandemic. The study draws on content analysis of 1584 posts made by both presidents on Facebook throughout 2020. The article argues that Alvarado and Bukele turned the pandemic into a means to build political legitimacy in their specific political context through two main strategies: populist communication and permanent campaigning. Whereas Alvarado relied on these strategies to demonstrate that he was in control of the country amid mounting backlash, Bukele infused both strategies with a religious imaginary to attack political opponents and perform the role of El Salvador's messiah. This analysis broadens the understanding of the relationship between populist communication and permanent campaigning in two main ways. First, by employing a comparative approach to identify singularities and differences in the ways that presidents built political legitimacy during the pandemic in a largely under-examined region (Central America). Second, by situating findings within a wide temporal perspective that included posts in an entire calendar year and comparisons with Alvarado's and Bukele's presidential campaigns. © The Author(s) 2022.

HACIA UN NUEVO ORDEN MUNDIAL 1

Pero para entender este esperanzador gesto de resonancia planetaria, es necesario tener presente como trasfondo, el deplorable panorama que nos arroja la actualidad política mundial. Hechos recientes que han sacudido la escena de la política mundial, tales como el asalto al Capitolio de Washington por hordas azuzadas por el candidato perdedor y presidente en ejercicio, Donald Trump;los efectos deletéreos en vidas humanas de la pandemia provocada por el Covid-19;las grandes catástrofes climáticas;y, de manera particularmente dramática, la aberrante guerra en Ucrania, que tiene a la humanidad en vilo ante la amenaza de una conflagración termonuclear, entre otros muchos conflictos que azotan al mundo entero, nos hace pensar que estamos ante el mayor y más trascendente cambio en la historia de la humanidad, desde que Occidente accediera a la cúspide de la historia a partir de que en el siglo VI antes de nuestra era, la Liga de Atenas derrotara al último gran imperio de Oriente liderado, en este caso, por los persas. Ese espacio lo suministrará el Océano Atlántico, lo que acarreará la conquista colonial por parte de la corona inglesa de América del Norte en el siglo XVII y, al expandir su poderío imperial, de la India en el siglo XVIII. La gran derrotada y humillada de esa guerra fue la Alemania hegemonizada por la familia imperial de Prusia, lo cual provoca el colapso mayor de la cultura occidental: el nazifascismo, cuyo desenlace es la Segunda Guerra Mundial.

Excess mortality from COVID 19 in Costa Rica: a registry based study using Poisson regression.

Background: Official death toll related to COVID-19 has been considerably underestimated in reports from some Latin American countries. This study aimed to analyze the mortality associated with the COVID-19 pandemic in Costa Rica between March 2020 and December 2021. Methods: A registry based study based on 2017-2021 data from the National Institute of Statistics and Census was designed (N = 128,106). Excess deaths were defined by the WHO as "the difference in the total number of deaths in a crisis compared to those expected under normal conditions"; and were estimated using a Poisson regression, and mortality and years of potential life lost (YPLL) rates were calculated. Findings: The COVID-19 pandemic represented 15% of the deaths in Costa Rica between March 2020 and December 2021. The mortality rate related to COVID-19 was 83 per 100,000 person-years. Between March and July 2020 (low-incidence period), observed number of deaths was 9%-lower than expected, whereas it was 15% and 24% higher than expected between July 2020 and March 2021 (high incidence period - no vaccination), and between March 2021 and December 2021 (high incidence period - progressive vaccination) respectively. Between July 2020 and December 2021, excess deaths observed and COVID-19 deaths reported were comparable (7461 and 7620 respectively). Nevertheless, there were more deaths than expected for conditions that predispose to COVID-19 deaths. YPLL and mortality rates increased with age, but significant excess deaths were observed in all age-groups older than 30-39 years. No large differences were noted by districts' socioeconomic characteristics although excess death rate was lower in rural compared to urban areas. Interpretation: Reporting of deaths was only slightly underestimated. In the pre-vaccination period, mortality rate and YPLL rates increased with age, being highest in people aged 60 years or older and justifying the decision to initially prioritize vaccination of older individuals. Funding: The study was supported by the University of Costa Rica and the Agencia Costarricense de Investigaciones Biomédicas - Fundación Inciensa.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020.

OBJECTIVES: To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS: We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS: We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS: Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.