The Experience of Testing for Coronavirus Disease (COVID-19) at a Single Diagnostic Center in Paraguay before the Introduction of Vaccination.

Soon after the declaration of the COVID-19 pandemic, the Institute for Health Sciences Research (IICS) of the National University of Asunción, Paraguay became a testing laboratory (COVID-Lab) for SARS-CoV-2. The COVID-Lab testing performance was assessed from 1 April 2020 to 12 May 2021. The effect of the pandemic on the IICS and how the COVID-Lab contributed to the academic and research activities of the institute were also assessed. IICS researchers and staff adjusted their work schedules to support the COVID-Lab. Of the 13,082 nasopharyngeal/oropharyngeal swabs processed, 2704 (20.7%) tested positive for SARS-CoV-2 by RT-PCR. Of the individuals testing positive, 55.4% were female and 48.3% were aged 21-40 years. Challenges faced by the COVID-Lab were unstable reagent access and insufficient staff; shifting obligations regarding research, academic instruction, and grantsmanship; and the continuous demands from the public for information on COVID-19. The IICS provided essential testing and reported on the progress of the pandemic. IICS researchers gained better laboratory equipment and expertise in molecular SARS-CoV-2 testing but struggled to manage their conflicting educational and additional research obligations during the pandemic, which affected their productivity. Therefore, policies protecting the time and resources of the faculty and staff engaged in pandemic-related work or research are necessary components of healthcare emergency preparedness.

Self-report on COVID-19: a survey of paraguayan dentists / Autorreporte acerca del contagio de COVID-19: una encuesta a odontólogos paraguayos

Aim: To determine the frequency of signs and/or symptoms compatible with COVID-19 in Paraguayan dentists, as well as the possible source of contagion. Material and Methods: Online survey consisting of 13 questions, applied to all dentists in Paraguay from January 20 to February 15, 2021. Results: A total of 433 dentists participated in the survey; 47.5% displayed symptoms compatible with COVID-19 and 13.39% indicated that they had contracted the disease, providing confirmation via a positive test result. Headache, loss of smell, loss of taste, cough, and fatigue were the most prevalent symptoms among COVID-19 positive cases. The main source of contagion was the family nucleus. Only one participant reported having contracted the disease while providing dental care. Conclusion: Almost half of the dentists displayed symptoms compatible with COVID-19. Only 13.39% tested positive for COVID-19. Only one case of contagion was reported to have happened during the provision of dental care.

Computer Visual Syndrome in Medical Students From a Private University in Paraguay: A Survey Study.

Purpose: To determine the prevalence and factors associated with computer vision syndrome in medical students at a private university in Paraguay. Methods: A survey study was conducted in 2021 in a sample of 228 medical students from the Universidad del Pacífico, Paraguay. The dependent variable was CVS, measured with the Computer Visual Syndrome Questionnaire (CVS-Q). Its association with covariates (hours of daily use of notebook, smartphone, tablet and PC, taking breaks when using equipment, use of preventive visual measures, use of glasses, etc.) was examined. Results: The mean age was 22.3 years and 71.5% were women. CVS was present in 82.5% of participants. Higher prevalence of CVS was associated with wearing a framed lens (PR = 1.11, 95% CI: 1.03-1.20). In contrast, taking a break when using electronic equipment at least every 20 min and every 1 h reduced 7% (PR = 0.93, 95% CI: 0.87-0.99) and 6% (PR = 0.94, 95% CI: 0.89-0.99) the prevalence of CVS, respectively. Conclusion: Eight out of 10 students experienced CVS during the COVID-19 pandemic. The use of framed lenses increased the presence of CVS, while taking breaks when using electronic equipment at least every 20 min and every 1 h reduced CVS.

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial.

BACKGROUND: Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system. OBJECTIVES: The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay. METHOD: A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm). CONCLUSIONS: It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04659746.

Prevalence and Associated Factors of Depression, Anxiety, and Stress in University Students in Paraguay during the COVID-19 Pandemic.

We aimed to determine the prevalence of depression, anxiety, and stress in university students in Paraguay during the COVID-19 pandemic. A cross-sectional study was conducted among 293 students from four universities in Paraguay in 2021. The DASS-21 mental health scale was used to measure the outcomes (depression, anxiety, and stress) and evaluate their association with socio-educational variables. A total of 77.1% of the participants were women and 136 (46.4%) were between 21 and 25 years old. The prevalence of depression, anxiety, and stress was 74.7%, 87.4%, and 57%, respectively. We found that being a woman and studying at a public university was positively associated with depression, anxiety, and stress. Receiving COVID-19 training increases the prevalence of mental health problems. In conclusion, high levels of anxiety, depression, and stress were found in university students during the COVID-19 pandemic. Being a woman, studying at a public university, and receiving training on COVID-19 were factors associated with a higher prevalence of presenting all the mental health problems evaluated. Furthermore, students aged 31 and over had a higher prevalence of depression and stress.

Technostress, anxiety, and depression among university students: A report from Paraguay.

BACKGROUND: Although technologies (including information, e-learning, and communication) have been daily employed by University students in the last years, the COVID-19 pandemic has led to a considerable increase in their use. Technostress is a modern term referring to levels of stress caused by the prolonged exposure to technology. AIM: The aim of this study is to assess the technostress and related anxiety and depression among Paraguayan University students, describing their sociodemographic characteristics and relevant associations. METHODS: A cross-sectional and descriptive study has been conducted. Participants were recruited through an Internet-based survey. Technostress, anxiety, and depression have been assessed with the Technostress Questionnaire (TechQ), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and the Patient Health Questionnaire-2 (PHQ-2), respectively. RESULTS: A total of 378 participants were included, 74.1% of whom were women. According to the TechQ scores, 47.4% of the participants reported a low/moderate level of technostress whereas 5.2% showed severe scores. About 58.5% of participants reported a GAD-7 score ⩾10, meeting diagnostic criteria for generalized anxiety. About 60.3% scored ⩾3 at the PHQ-2 reporting significant levels of depression. Technostress has been significantly associated with levels of anxiety (p < .001) as well as depression (p < .001). CONCLUSION: Our results suggest further research regarding the implications of technostress on the well-being of University students. Specific measures aimed to improve students' coping with the challenges of technology and technostress should be promoted.

[Endocervical swabbing in women with COVID-19 symptoms from departments of Paraguay]. / Hisopado endocervical en mujeres con síntomas de COVID-19 provenientes de departamentos del Paraguay.

BACKGROUND: COVID-19 is an eminently respiratory transmissible infection of respiratory initiation, the existence of other sources of contagion is discussed. The ACE2 viral receptor has also been detected in the uterus and vagina; Hence, the involvement of the SARS-CoV-2 virus on the genitourinary system and its possible repercussions on pregnancy has been raised. AIM: To determine the presence of SARS-CoV-2 in endocervical samples of women with COVID-19 in the departments of Paraguay. METHODS: Designed as a prospective observational of transverse cohort. Two hundred women were recruited from August 2020 to February 2021, with no more than 48/72 hours of a previous positive nasopharyngeal swab result for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (rt-RT-PCR) and who agreed to participate in the study. A clinical epidemiological questionnaire was completed. The samples were taken in health services of the MSPYBS (Public Ministry of Health and Social Welfare), homes and shelters in the different departments of Paraguay. Each patient underwent a swab (dacron swabs) or endocervical cytobrush for the detection of SARS-CoV-2 by rt-RT-PCR. RESULTS: Women recruited had a mean age of 46.5 years (95% CI 31,562.5). They reported contagion with SARS-CoV-2: 75.5% in the community, 13.5% at home, 8.5% in the place of work and 1.5% abroad. The clinical manifestations were: 30% flu syndrome, 22.5% fever, 20% cough, 15.5% anosmia, 15.5% digestive disorders, among other symptoms. The swabs or endocervical cytobrush samples subjected to rt-RT-PCR for the detection of SARS-CoV-2 were negative in the 200 study women. DISCUSSION: It should be noted that the vaginal samples were taken within 24-72 hours after obtaining a positive result for SARS-CoV-2 in the nasopharyngeal swab and that 62.5% of the women were hospitalized in respiratory modules. The reason for the negativity of the exams and their significance are discussed. Conclusión: No SARS Cov-2 infection was detected in the endocervical region of 200 women with clinical manifestations of COVID 19 and evaluated within 48/72 hours of a positive nasopharyngeal result for SARS Cov-2. The results in the study population agree with the findings of other studies reported in the literature.

"Coronaphobia" in Paraguay: Spanish Validation of the COVID-19 Phobia Scale.

BACKGROUND: The COVID-19 is a highly transmissible disease caused by a new zoonotic coronavirus called SARS-CoV-2 that has led to several health, social, and economic issues worldwide. Anxiety and stress are predominant symptoms in the population during the quarantine; also, levels of fear or phobia have been reported. SUBJECTS AND METHODS: This study validate the Spanish version of the COVID-19 Phobia Scale (C19P-S). Participants were recruited using an Internet-based survey. The survey was open from July 20 to July 31, 2021 and 1079 subjects were included. RESULTS: Kaiser-Meyer-Olkin test was adequate (KMO=0.956) and sphericity tested significantly (p<0.0001). The model of adjustment was good as shown by fit indices (S-B χ2=351.67, df=164, p>0.05; RMSEA=0.033; SRMSR=0.042; CFI=0.995, NFI=0.990). CONCLUSIONS: This confirms that the model of the Spanish version of the C19P-S may reproduce the same four-factors model from the original version of the scale and all items of these factors reported standardized loadings higher than 0.40 (p<0.001).

SARS-CoV-2 Variants in Paraguay: Detection and Surveillance with an Economical and Scalable Molecular Protocol.

SARS-CoV-2 variant detection relies on resource-intensive whole-genome sequencing methods. We sought to develop a scalable protocol for variant detection and surveillance in Paraguay, pairing rRT-PCR for spike mutations with Nanopore sequencing. A total of 201 acute-phase nasopharyngeal samples were included. Samples were positive for the SARS-CoV-2 N2 target and tested with the Spike SNP assay to detect mutations associated with the following variants: alpha (501Y), beta/gamma (417variant/484K/501Y), delta (452R/478K), and lambda (452Q/490S). Spike SNP calls were confirmed using amplicon (Sanger) sequencing and whole-genome (Nanopore) sequencing on a subset of samples with confirmed variant lineages. Samples had a mean N2 Ct of 20.8 (SD 5.6); 198/201 samples (98.5%) tested positive in the Spike SNP assay. The most common genotype was 417variant/484K/501Y, detected in 102/198 samples (51.5%), which was consistent with the P.1 lineage (gamma variant) in Paraguay. No mutations (K417 only) were found in 64/198 (32.3%), and K417/484K was identified in 22/198 (11.1%), consistent with P.2 (zeta). Seven samples (3.5%) tested positive for 452R without 478K, and one sample with genotype K417/501Y was confirmed as B.1.1.7 (alpha). The results were confirmed using Sanger sequencing in 181/181 samples, and variant calls were consistent with Nanopore sequencing in 29/29 samples. The Spike SNP assay could improve population-level surveillance for mutations associated with SARS-CoV-2 variants and inform the judicious use of sequencing resources.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Depression in public officials during the COVID-19 pandemic in Paraguay: a web-based study.

BACKGROUND: According to the World Health Organization, the coronavirus disease 2019 (COVID-19) pandemic has created situations that have a negative effect on people and threaten their mental health. Paraguay announced the Estado de Emergencia Sanitaria (Presidential Decree No. 3456) on March 16, 2020, which was followed by the imposition of a 24-h restriction on movement order on March 21. Self-quarantine at home may have been the most effective method of preventing the spread of infectious diseases; however, with the global pandemic becoming more prolonged and the consequent lengthening of the 24-h self-quarantine period, it is highly probable that both physical and psychological problems will arise. METHODS: In this study, a web-based cross-sectional method was used to analyze the factors influencing COVID-19-induced depressive feelings in Paraguayan public officials. RESULTS: Public officials reported a high level of depressive symptoms with a high level of apprehension in early stage of COVID-19. In addition, this study identified that when the self-quarantine period increased, levels of depressive feelings also increased. Since self-quarantine is characterized by the requirement that individuals endure an undetermined period within a confined area, it may have caused stress and anxiety, as well as the consequent experience of depressive feelings. CONCLUSIONS: Paraguayan government should develop a program for the delivery of mental health care and services to public officials in COVID-19 Pandemic period. Moreover, a program is required for people facing deteriorating mental health due to social isolation and loneliness caused by social distancing during the prolonged period of self-quarantine. Finally, mental health care programs should be organized in a community-focused way by utilizing online systems to enhance the effectiveness of mental health recovery.

Record-breaking wildfires in the world's largest continuous tropical wetland: Integrative fire management is urgently needed for both biodiversity and humans.

In the Brazilian Pantanal, wildfire occurrence has increased, reaching record highs of over 40,000 km2 in 2020. Smoke from wildfires worsened the situation of isolated, as well as urban communities, already under an increasing toll of COVID-19. Here we review the impacts and the possible causes of the 2020 mega-fires and recommend improvements for public policies and fire management in this wetland. We calculated the amount of area burnt annually since 2003 and describe patterns in precipitation and water level measurements of the Paraguay River. Our analyses revealed that the 2020 wildfires were historically unprecedented, as 43% of the area (over 17,200 km2) had not been burnt previously in the last two decades. The extent of area affected in 2020 represents a 376% increase compared to the annual average of the area burnt annually in the last two decades, double than the value in 2019. Potential factors responsible for this increase are (i) severe drought decreased water levels, (ii) the fire corridor was located in the Paraguay River flood zone, (iii) constraints on firefighters, (iv) insufficient fire prevention strategy and agency budget reductions, and (v) recent landscape changes. Climate and land use change will further increase the frequency of these extreme events. To make fire management more efficient and cost-effective, we recommend the implementation of an Integrated Fire Management program in the Pantanal. Stakeholders should use existing traditional, local ecological, and scientific knowledge to form a collective strategy with clear, achievable, measurable goals, considering the socio-ecological context. Permanent fire brigades, including indigenous members, should conduct year-round fire management. Communities should cooperate to create a collaborative network for wildfire prevention, the location and characteristics (including flammability) of infrastructures should be (re)planned in fire-prone environments considering and managing fire-catalysed transitions, and depending on the severity of wildfires. The 2020 wildfires were tackled in an ad-hoc fashion and prioritisation of areas for urgent financial investment, management, protection, and restoration is necessary to prevent this catastrophe from happening again.

The obscurance of the greatest sylvatic yellow fever epidemic and the cooperation of the Pan American Health Organization during the COVID-19 pandemic.

INTRODUCTION: Since 2016, Brazil has been in the midst of its largest sylvatic yellow fever epidemic ever, found predominantly outside the Amazon region. Cases originating from Brazil have been reported in France, the Netherlands, Romania, Switzerland, Argentina, and Chile. The epidemic began in the Central-West region of Brazil in 2014, spreading into the Southern region, with significant non-human primate transmission continuing towards Paraguay and Argentina. METHODS: This report is an integrative review of Pan American Health Organization cooperation during a sylvatic yellow fever epidemic. RESULTS: The Pan American Health Organization has played a central role in handling the yellow fever emergency, collaborating with the Ministry of Health and various research groups in supporting interventions of different response areas. The Pan American Health Organization's technical cooperation included: training and workshops to exchange experiences, carrying out technical cooperation in patient management and epidemiological, entomological, laboratory, and epizootic surveillance, organizing the assistance network, and acquiring strategic inputs. The Pan American Health Organization's technical cooperation supported the Ministry of Health's decision to adopt a single-dose vaccine and use fractional doses to support the vaccination needs of more than 39,000,000 people. The coronavirus disease 2019 pandemic contributed to the failure of reaching the yellow fever vaccination goals and made it difficult to integrate the yellow fever vaccine into recommended areas. CONCLUSIONS: Given the ongoing coronavirus disease 2019 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of yellow fever with multilateral cooperation between countries.