Telemedicine consultation for emergency patients' attention: a clinical experience from a high complex university hospital from Latin America.

INTRODUCTION: As a result of the new coronavirus pandemic, a highly complex academic hospital in Latin America implemented a telemedicine service for the care of obstetric, pediatric, and adult patients. In 2020, regional emergency services collapsed due to the increase in demand for care, generating the need to open expansion services and seek strategies to provide timely care to consulting patients. OBJECTIVE: We retrospectively describe the clinical experience of patients who consulted the emergency department via telemedicine across a videoconference tool using digital platforms. METHODS: A descriptive study with retrospective data collection was conducted to describe the implementation of the teleconsultation care model for patients. We constructed the clinical process indicators to evaluate the model. RESULTS: A total of 4652 teleconsultations were registered. Telemedicine consultation was above 50% in the country and department and above 90% in Cali city. The average waiting time for care was estimated to be 1:59:52 h. A total of 275 patients were transferred to the emergency room after consultation. The principal reasons for consultation in the institutional telemedicine program were respiratory and gastrointestinal symptoms. Teleconsultations related to SARS-COV 2 infections reported 3775 patients (3127 with unidentified virus and 648 with the identified virus). CONCLUSIONS: Telemedicine is a tool that provides support and guidance to patients who consult emergency departments, reducing barriers to access health care and decreasing emergency department collapse.

Who wears the face mask? Preventive measures against COVID-19 in Latin America before vaccination.

OBJECTIVES: We analyze the profile of adults who used a mask in the context of the COVID-19 pandemic in Latin America, between October and November 2020, right before the mass vaccination campaigns. STUDY DESIGN: Based on the Latinobarometer 2020 data, we assess the individual, regional, cultural and political factors of people who used a mask in the context of the COVID-19 pandemic in 18 countries of Latin America. METHODS: We applied a logistic regression to model the probability of using the mask regularly to avoid being infected with the COVID-19 virus. RESULTS: Women, older people, those with higher education, those being employed and not working in temporarily jobs, retirees, students, people with a centrist political ideology, and Catholics had a higher chance of using a face mask on a regular basis. People living in Venezuela, Chile, Costa Rica and Brazil were the most likely to use face masks. CONCLUSION: These results highlight the need to understand the social forces behind the willingness to adopt non-pharmacological preventive measures to make them more effective in health crisis emergencies.

[Heterogeneous governmental responses in confronting the COVID-19 pandemic in Latin American countries]. / Respostas governamentais heterogêneas no enfrentamento da pandemia da COVID-19 por países da América Latina.

The study analyzes the development of responses to address the COVID-19 pandemic in Latin America. It is a descriptive study based on an analysis of documents, data, and policy measures adopted or announced between March and December 2020 in 14 Latin American countries. The analysis included assessment of the content, tenor, and scope of policy measures for containment and mitigation, health care, and reorganization of health services identified on government websites. In addition, quantitative demographic indicators were included, as well as those related to the epidemiological situation and the result of the Stringency index. In general, the responses of Latin American countries were heterogeneous, albeit multisectoral, characterizing the complexity and diversity of decision making when confronting a pandemic. The conclusion drawn is that there is still a great deal to reflect upon with respect to the consequences of regulatory weaknesses for the achievement of multidimensional demands during health crises.

O estudo analisa a elaboração de respostas para o enfrentamento da pandemia da COVID-19 na América Latina. Trata-se de um estudo descritivo com base em análise de documentos, dados e medidas políticas adotadas ou anunciadas entre março e dezembro de 2020 em 14 países latino-americanos. A análise compreendeu a apreciação de teor, conteúdo e abrangência das medidas políticas para contenção e mitigação sanitárias e para a reorganização dos serviços de saúde identificadas nos sites governamentais. Complementarmente, incluiu-se indicadores quantitativos demográficos e relativos à situação epidemiológica e resultado do Sringency index. No geral, as respostas dos países latino-americanos foram heterogêneas, apesar de multisetoriais, caracterizando a complexidade e diversidade decisória frente à pandemia. Conclui-se que ainda há muito a refletir sobre as consequências das fragilidades normativas para a consecução das necessidades multidimensionais durante crises sanitárias.

Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

Nephrologists' perspectives on the impact of COVID-19 on caring for patients undergoing dialysis in Latin America: a qualitative study.

OBJECTIVE: To describe the experiences of nephrologists on caring for patients undergoing in-centre haemodialysis during the COVID-19 pandemic in Latin America. DESIGN: Twenty-five semistructured interviews were conducted by Zoom videoconference in English and Spanish languages during 2020 until data saturation. Using thematic analysis, we conducted line-by-line coding to inductively identify themes. SETTING: 25 centres across nine countries in Latin America. PARTICIPANTS: Nephrologists (17 male and 8 female) were purposively sampled to include diverse demographic characteristics and clinical experience. RESULTS: We identified five themes: shock and immediate mobilisation for preparedness (overwhelmed and distressed, expanding responsibilities to manage COVID-19 infection and united for workforce resilience); personal vulnerability (being infected with COVID-19 and fear of transmitting COVID-19 to family); infrastructural susceptibility of dialysis units (lacking resources and facilities for quarantine, struggling to prevent cross-contamination, and depletion of personal protective equipment and cleaning supplies); helplessness and moral distress (being forced to ration life-sustaining equipment and care, being concerned about delayed and shortened dialysis sessions, patient hesitancy to attend to dialysis sessions, being grieved by socioeconomic disparities, deterioration of patients with COVID-19, harms of isolation and inability to provide kidney replacement therapy); and fostering innovative delivery of care (expanding use of telehealth, increasing uptake of PD and shifting focus on preventing syndemics). CONCLUSION: Nephrologists felt personally and professionally vulnerable and reported feeling helpless and morally distressed because they doubted their capacity to provide safe care for patients undergoing dialysis. Better availability and mobilisation of resources and capacities to adapt models of care, including telehealth and home-based dialysis, are urgently needed.

[COVID-19 and its socio-cultural imagery in Latin America: a tool for public health]. / COVID-19 y sus imaginarios socioculturales en Latinoamérica: una herramienta para la salud pública.

OBJECTIVE: Identify the content and organization of social representations (SR) against COVID-19 in urban population of three cities in Latin America, 2020. MATERIALS AND METHODS: Qualitative study from cognitive anthropology through the structural analysis of SR. Free listing and pair comparison techniques were used from February-April 2020, in Pereira (Colombia), Guadalajara Metropolitan Area (ZMG)-(Mexico), León (Mexico). 97 participants were included in the first phase and 71 in the second phase, of both sexes, of legal age, whose occupation and profession had no relation to the health area; non-probability-purposeful sampling was performed. RESULTS: The socio-cultural imaginary is associated with terms such as contagion, pandemic, but highlighting the terms related to disease prevention. CONCLUSIONS: The knowledge of the population about COVID-19 privileges clinical and epidemiological aspects, as well as containment and mitigation measures.

OBJETIVO: Identificar el contenido y organización de las representaciones sociales que tiene la población urbana de tres ciudades de América Latina sobre el COVID-19. MATERIALES Y MÉTODOS: Estudio cualitativo hecho desde la antropología cognitiva a través del análisis estructural de las representaciones sociales. Se utilizaron técnicas de listados libres y comparación de pares de febrero a abril de 2020 en Pereira (Colombia), en la zona metropolitana de Guadalajara (México) y en León (también en México). Participaron 97 personas de ambos sexos (97 en la primera fase y 71 en la segunda), mayores de edad y que su ocupación o profesión no tuvieran relación con el área de salud; se realizó muestreo no probabilístico-propositivo. RESULTADOS: El imaginario sociocultural está asociado con términos como contagio y pandemia, con énfasis en los términos relacionados con la prevención de la enfermedad. CONCLUSIONES: Los saberes de la población sobre el COVID-19 privilegian aspectos clínicos y epidemiológicos, así como las medidas de contención y mitigación.

[COVID-19 in Latin America: a systematic review and bibliometric analysis]. / COVID-19 en Latinoamérica: una revisión sistemática de la literatura y análisis bibliométrico.

OBJECTIVE: Describe and analyze scientific activity on COVID-19 in Latin America. MATERIALS AND METHODS: Through a systematic review of the literature in PubMed, LILACS, and the preprinted repositories BioRxiv and medRxiv, all available documents on COVID-19 in Latin America from January 1 to April 24, 2020, were retrieved for review and bibliometric analysis. RESULTS: A total of 29 publications were included in the analysis. The country with the most scientific production was Brazil (10/29; 34,4%) followed by Colombia (6/29; 20,6%) and Mexico (6/29; 20,6%). The university with the most articles was the Technological University of Pereira, Colombia (5/29; 17,2%). 41,3% of the publications were preprinted documents. Most of the excluded studies were editorial comments or expert opinions. Three out of four investigations had an epidemiological focus (21/29; 72,4%); Limited studies on diagnosis (5/29; 17,24%), pathophysiology (2/29, 2,8%) and therapeutic. CONCLUSION: Despite the exponential growth of publications in the world, there is a limited amount of information on the behavior of this infection in Latin America. The publication of studies with high methodological quality is required, which provide knowledge of the impact of the pandemic in the region.

[Morbidity and mortality due to COVID-19 in latin america: study of three countries - february to july 2020]. / Morbilidad y mortalidad por COVID-19 en Latinoamérica: estudio en tres países - febrero a julio de 2020.

BACKGROUND: On March 11, 2020 the WHO declared the state of pandemic by COVID-19. As of July 29, 2020, 17 106 007 cases and 668 910 deaths have been reported globally. The region of the Americas has reported 9 152 173 cases (53%) and 351 121 deaths (52,2%), so the aggregate analysis of the data in countries in this region is of interest. Argentina, Chile and Colombia, due to their demographic and economic characteristics, are countries that can be studied. OBJETIVE: Analyze variables related to health systems and epidemiological data of SARS-CoV-2 virus disease in Argentina, Chile and Colombia. METHODS: A descriptive study of variables reported by the official organisms of each state was used. RESULTS: There is an important difference in active cases and mortality among the three countries; the Autonomous City of Buenos Aires has the highest number of active cases as of July 2020. Colombia has the highest numbers of deaths confirmed by COVID-19 in the months of February to July 2020. We suggest the unification of an information system for Latin America that allows a comprehensive monitoring of variables, improves the qua-lity of data and unifies the technical language.

Telehealth and Telemedicine in Latin American Rheumatology, a New Era After COVID-19.

ABSTRACT: Telemedicine is the delivery of health care services by health care professionals using information and communication technologies to exchange valid information for the diagnosis, treatment, and prevention of diseases. Telemedicine was further developed in Latin America during the COVID-19 (coronavirus disease 2019) pandemic, becoming the first line of defense for health professionals to stop the spread of infections and allow them to continue the care of their patients. During the pandemic, 79% of rheumatologists in Latin America reported the use of remote communication, the most frequent being the use of phone calls and WhatsApp voice messages. In contrast, 84% of the patients reported that telemedicine was appropriate for them during the pandemic, but only 54% considered telemedicine to be a valid option for rheumatic health care after the pandemic. Telemedicine and telehealth have advantages such as lower costs, improved access in rural areas, shortage of care providers, and reduction in waiting time for appointments. However, it also has some challenges, such as legal, technological, and organizational barriers. In this review, we explore the current state of telemedicine in Latin America and discuss its future.

Overview of the SARS-CoV-2 genotypes circulating in Latin America during 2021.

Latin America is one of the regions in which the COVID-19 pandemic has a stronger impact, with more than 72 million reported infections and 1.6 million deaths until June 2022. Since this region is ecologically diverse and is affected by enormous social inequalities, efforts to identify genomic patterns of the circulating SARS-CoV-2 genotypes are necessary for the suitable management of the pandemic. To contribute to the genomic surveillance of the SARS-CoV-2 in Latin America, we extended the number of SARS-CoV-2 genomes available from the region by sequencing and analyzing the viral genome from COVID-19 patients from seven countries (Argentina, Brazil, Costa Rica, Colombia, Mexico, Bolivia, and Peru). Subsequently, we analyzed the genomes circulating mainly during 2021 including records from GISAID database from Latin America. A total of 1,534 genome sequences were generated from seven countries, demonstrating the laboratory and bioinformatics capabilities for genomic surveillance of pathogens that have been developed locally. For Latin America, patterns regarding several variants associated with multiple re-introductions, a relatively low percentage of sequenced samples, as well as an increment in the mutation frequency since the beginning of the pandemic, are in line with worldwide data. Besides, some variants of concern (VOC) and variants of interest (VOI) such as Gamma, Mu and Lambda, and at least 83 other lineages have predominated locally with a country-specific enrichments. This work has contributed to the understanding of the dynamics of the pandemic in Latin America as part of the local and international efforts to achieve timely genomic surveillance of SARS-CoV-2.

COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries.

BACKGROUND: The COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC). METHODS: We sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness. RESULTS: Planning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability. CONCLUSION: Countries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.

Is the meaning of subjective well-being similar in Latin American countries? A cross-cultural measurement invariance study of the WHO-5 well-being index during the COVID-19 pandemic.

BACKGROUND: There is an urgent need to assess changes in well-being on a multinational scale during the COVID-19 pandemic, thus culturally valid scales must be available. METHODS: With this in mind, this study examined the invariance of the WHO well-being index (WHO-5) among a sample of 5183 people from 12 Latin Americans countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay). RESULTS: The results of the present study indicate that the WHO-5 is strictly invariant across samples from different Latin American countries. Furthermore, the results of the IRT analysis indicate that all items of the WHO-5 were highly discriminative and that the difficulty required to respond to each of the five items is ascending. Additionally, the results indicated the presence of moderate and small size differences in subjective well-being among most countries. CONCLUSION: The WHO-5 is useful for assessing subjective well-being in 12 Latin American countries during the COVID-19 pandemic, since the differences between scores can be attributed to differences in well-being and not in other characteristics of the scale.

Telemedicine for the management of diabetic patients in a high-complexity Latin American hospital.

BACKGROUND: Noncommunicable diseases such as diabetes mellitus (DM) have gained attention worldwide. Latin America experienced a rise in rates of DM. During the COVID-19 pandemic, a telemedicine program was implemented in a quaternary care academic complex in Latin America to continue the follow-up of patients with diabetes. OBJECTIVE: The aim of this study is to describe the clinical experience of DM patient management through telemedicine and the HbA1c behavior of patients followed-up through this modality. MATERIALS AND METHODS: We conducted a retrospective cohort study including all patients with type 1 or 2 diabetes who were treated via telemedicine from March to December 2020. A Wilcoxon statistical test was used to compare the changes in glycosylated hemoglobin between the first teleconsultation and after 6 months of telemedicine follow-up. RESULTS: A total of 663 patients were included, 17.65% (117) of whom had type 1 diabetes and 82.35% (546) of whom had type 2 diabetes. Patients with both types of diabetes, presented with stable HbA1c values regardless of the length of follow-up. CONCLUSION: The use of telemedicine can be a helpful tool for both patients and health care providers to support the continuity of care to maintain acceptable control levels within glycemic control goals.

COVID-19 impacts on household solid waste generation in six Latin American countries: a participatory approach.

The COVID-19 pandemic has greatly impacted the Americas, the continent with the highest number of COVID-related deaths according to WHO statistics. In Latin America, strict confinement conditions at the beginning of the pandemic put recycling activity to a halt and augmented the consumption of plastic as a barrier to stop the spread of the virus. The lack of data to understand waste management dynamics complicates waste management strategy adjustments aimed at coping with COVID-19. As a novel contribution to the waste management data gap for Latin America, this study uses a virtual and participatory methodology that collects and generates information on household solid waste generation and composition. Data was collected between June and November 2021 in six countries in Latin America, with a total of 503 participants. Participants indicated that the pandemic motivated them to initiate or increase waste reduction (41%), waste separation (40%), and waste recovery (33%) activities. Forty-three percent of participants perceived an increase in total volume of their waste; however, the quantitative data showed a decrease in household waste generation in Peru (-31%), Honduras (-25%), and Venezuela (-82%). No changes in waste composition were observed. Despite the limited sample size, this data provides a much-needed approximation of household waste generation and composition in the pandemic situation during 2021.

What is post-COVID-19 syndrome? Definition and update.

This work addresses the origin and development of post-COVID-19 syndrome, which consists of the persistence of different symptoms over time as a consequence of SARS-CoV-2 infection. Based on a narrative review of the scientific literature, a brief analysis of the new term is made, specifying the conceptual definition, characteristic symptoms, the various implications for people's health, and the responses to specific care measures that have been implemented. It concludes with a wake-up call to the governments of Latin America and the Caribbean in order for care and surveillance to be provided to this public health problem.

Este trabajo aborda el origen y el desarrollo del síndrome pos-COVID-19, el cual consiste en la persistencia a través del tiempo de diferentes síntomas como consecuencia de la infección por SARS-CoV-2. A partir de una revisión narrativa de la literatura científica, se realiza un breve recorrido sobre el nuevo término y se precisa la definición conceptual, los síntomas característicos, las diversas implicaciones en la salud de las personas y las respuestas de atención específica que se han implementado. Se concluye con una llamada de atención a los gobiernos de América Latina y el Caribe para dar tratamiento y seguimiento a este problema de salud pública.

Post-COVID-19 syndrome in a sample of climacteric women living in Latin America.

OBJECTIVE: The aim of this study was to assess resilience, fear of COVID-19, sleep disorders, and menopause-related symptoms after the acute phase of COVID-19 in middle-aged women with positive reverse transcription-polymerase chain reaction and noninfected women. METHODS: This is a cross-sectional, analytical study of climacteric women from 9 Latin American countries, aged 40-64 years, attending a routine health checkup. We evaluated clinical characteristics and used the Connor-Davidson Resilience Scale, the Fear of COVID-19 Scale, the Jenkins Sleep Scale, and the Menopause Rating Scale to evaluate their health. RESULTS: A total of 1,238 women were studied, including 304 who were positive for COVID-19 reverse transcription-polymerase chain reaction. The median (interquartile range) age was 53 (12) years; years of studies, 16 (6); body mass index, 25.6 (5.1) kg/m 2 ; and time since first COVID-19 symptom, 8 (6) months. COVID-19 patients reported fatigability (18.8%), joint and muscular discomfort (14.1%), and anosmia (9.5%). They had a significantly lower resilience score (26.87 ± 8.94 vs 29.94 ± 6.65), higher Fear of COVID-19 score (17.55 ± 7.44 vs 15.61 ± 6.34), and a higher Jenkins Scale score (6.10 ± 5.70 vs 5.09 ± 5.32) compared with control women. A logistic regression model confirmed these results. There was not a significant difference in the total Menopause Rating Scale score, although the odds ratios for both severe menopausal symptoms (1.34; 95% confidence interval, 1.02-1.76) and the use of hypnotics were higher in women with COVID-19 (1.80; 95% confidence interval, 1.29-2.50) compared with those without infection. We found no decrease in studied outcomes between the initial 7 months versus those reported after 8 to 18 months since first COVID-19 symptoms. CONCLUSIONS: COVID-19 climacteric women have sleep disorders, lower resilience and higher fear of COVID-19.