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1.
Int J Hyg Environ Health ; 241: 113949, 2022 04.
Article in English | MEDLINE | ID: covidwho-1757396

ABSTRACT

Household air pollution from solid fuel combustion was estimated to cause 2.31 million deaths worldwide in 2019; cardiovascular disease is a substantial contributor to the global burden. We evaluated the cross-sectional association between household air pollution (24-h gravimetric kitchen and personal particulate matter (PM2.5) and black carbon (BC)) and C-reactive protein (CRP) measured in dried blood spots among 107 women in rural Honduras using wood-burning traditional or Justa (an engineered combustion chamber) stoves. A suite of 6 additional markers of systemic injury and inflammation were considered in secondary analyses. We adjusted for potential confounders and assessed effect modification of several cardiovascular-disease risk factors. The median (25th, 75th percentiles) 24-h-average personal PM2.5 concentration was 115 µg/m3 (65,154 µg/m3) for traditional stove users and 52 µg/m3 (39, 81 µg/m3) for Justa stove users; kitchen PM2.5 and BC had similar patterns. Higher concentrations of PM2.5 and BC were associated with higher levels of CRP (e.g., a 25% increase in personal PM2.5 was associated with a 10.5% increase in CRP [95% CI: 1.2-20.6]). In secondary analyses, results were generally consistent with a null association. Evidence for effect modification between pollutant measures and four different cardiovascular risk factors (e.g., high blood pressure) was inconsistent. These results support the growing evidence linking household air pollution and cardiovascular disease.


Subject(s)
Air Pollutants , Air Pollution, Indoor , Air Pollution , Air Pollutants/analysis , Air Pollution/analysis , Air Pollution, Indoor/analysis , C-Reactive Protein , Cooking/methods , Cross-Sectional Studies , Female , Honduras/epidemiology , Humans , Particulate Matter/analysis , Wood/analysis , Wood/chemistry
2.
Acta Trop ; 227: 106269, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1729465

ABSTRACT

Monte Verde, a peri­urban squatter community near San Pedro Sula, virtually eliminated Aedes aegypti production in all known larval habitats: wells; water storage containers including pilas (open concrete water tanks used for laundry), 200-liter drums, 1000-liter plastic "cisterns," buckets; and objects collecting rainwater. The project began in 2016 when Monte Verde was overrun with dengue, Zika, and chikungunya. During more than a year of experimentation, Monte Verde residents crafted an effective, sustainable, and environmentally friendly toolkit that was inexpensive but required full community participation. Biological control with copepods, turtles, and tilapia was at the core of the toolkit, along with a mix of other methods such as getting rid of unnecessary containers, scrubbing them to remove Ae. aegypti eggs, and covering them to exclude mosquitoes or rainwater. Environmentally friendly larvicides also had a limited but crucial role. Key design features: (1) toolkit components known to be nearly 100% effective at preventing Ae. aegypti production when fitted to appropriate larval habitats; (2) using Ae. aegypti larval habitats as a resource by transforming them into "egg sinks" to drive Ae. aegypti population decline; (3) dedicated community volunteers who worked with their neighbors, targeting 100% coverage of all known Ae. aegypti larval habitats with an appropriate control method; (4) monthly monitoring in which the volunteers visited every house to assess progress and improve coverage as an ongoing learning experience for both volunteers and residents. Taking pupae as an indicator of Ae. aegypti production, from September 2018 to the end of the record in December 2021 (except for a brief lapse during COVID lockdown in 2020), the monthly count of pupae fluctuated between zero and 0.6% of the 22,984 pupae counted in the baseline survey at the beginning of the project. Adult Ae. aegypti declined to low numbers but did not disappear completely. There were no recognizable cases of dengue, Zika, or chikungunya after June 2018, though the study design based on a single site did not provide a basis for rigorous confirmation that Monte Verde's Ae. aegypti control program was responsible. Nonetheless, Monte Verde's success at eliminating Ae. aegypti production can serve as a model for extending this approach to other communities. Key ingredients for success were outside stimulation and facilitation to foster shared community awareness and commitment regarding the problem and its solution, enduring commitment of local leadership, compatibility of the toolkit with the local community, overcoming social obstacles, rapid results with "success breeding success," and building resilience.


Subject(s)
Aedes , COVID-19 , Copepoda , Dengue , Tilapia , Turtles , Zika Virus Infection , Zika Virus , Aedes/physiology , Animals , Communicable Disease Control , Community Participation , Dengue/epidemiology , Dengue/prevention & control , Honduras , Humans , Larva , Mosquito Control/methods , SARS-CoV-2
3.
BMC Pregnancy Childbirth ; 22(1): 5, 2022 Jan 03.
Article in English | MEDLINE | ID: covidwho-1605314

ABSTRACT

BACKGROUND: The Salud Mesoamérica Initiative (SMI) is a public-private collaboration aimed to improve maternal and child health conditions in the poorest populations of Mesoamerica through a results-based aid mechanism. We assess the impact of SMI on the staffing and availability of equipment and supplies for delivery care, the proportion of institutional deliveries, and the proportion of women who choose a facility other than the one closest to their locality of residence for delivery. METHODS: We used a quasi-experimental design, including baseline and follow-up measurements between 2013 and 2018 in intervention and comparison areas of Guatemala, Nicaragua, and Honduras. We collected information on 8754 births linked to the health facility closest to the mother's locality of residence and the facility where the delivery took place (if attended in a health facility). We fit difference-in-difference models, adjusting for women's characteristics (age, parity, education), household characteristics, exposure to health promotion interventions, health facility level, and country. RESULTS: Equipment, inputs, and staffing of facilities improved after the Initiative in both intervention and comparison areas. After adjustment for covariates, institutional delivery increased between baseline and follow-up by 3.1 percentage points (ß = 0.031, 95% CI -0.03, 0.09) more in intervention areas than in comparison areas. The proportion of women in intervention areas who chose a facility other than their closest one to attend the delivery decreased between baseline and follow-up by 13 percentage points (ß = - 0.130, 95% CI -0.23, - 0.03) more than in the comparison group. CONCLUSIONS: Results indicate that women in intervention areas of SMI are more likely to go to their closest facility to attend delivery after the Initiative has improved facilities' capacity, suggesting that results-based aid initiatives targeting poor populations, like SMI, can increase the use of facilities closest to the place of residence for delivery care services. This should be considered in the design of interventions after the COVID-19 pandemic may have changed health and social conditions.


Subject(s)
Delivery, Obstetric , Health Promotion , Health Services Accessibility , Maternal Health Services , Prenatal Care , Adolescent , Adult , Female , Guatemala , Health Facilities , Honduras , Humans , Middle Aged , Nicaragua , Pregnancy , Pregnancy Outcome , Young Adult
5.
Hisp Health Care Int ; 19(4): 230-238, 2021 12.
Article in English | MEDLINE | ID: covidwho-1473601

ABSTRACT

The purpose of the current study was to determine the influence of moral injury and Light Triad (LT) personality traits on anxiety and depression symptoms of health-care personnel during the coronavirus-2019 pandemic. A quantitative, cross-sectional research design was used, the study included a sample of 169 health-care workers from Honduras. Data was gathered through the Moral Injury Symptom Scale for Health Professionals (MISS-HP), Light Triad Scale (LTS), the Generalized Anxiety Disorder-7, and the Patient-Health Questionnaire-9. Results suggest that almost 9 out of 10 respondents experienced at least one potentially morally injurious event, 45.6% were at significant risk of impairment related to moral injury. Working with limited staff and resources, and the implications of it, was the most common potentially morally injurious situation reported by the respondents. Results suggest that MISS-HP Mistrust has significant negative correlations with LT traits. A hierarchical regression model determined that Moral Injury, but not LT traits, significantly affected depression symptoms. On the other hand, anxiety symptoms were significantly predicted by Moral Injury, as did LTS-Humanism. The results were discussed according to their implications for public health policy in Latin America.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Anxiety/epidemiology , Anxiety/etiology , Anxiety Disorders/epidemiology , Anxiety Disorders/etiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Health Personnel , Honduras/epidemiology , Humans , Pandemics , Surveys and Questionnaires
8.
Soc Sci Med ; 281: 114040, 2021 07.
Article in English | MEDLINE | ID: covidwho-1243229

ABSTRACT

RATIONALE: Stress process theory considers that actual and perceived isolation, caused by mobility restrictions from attempted containment of the COVID-19 pandemic, deteriorates mental health. OBJECTIVE: We examine the relationship between the COVID-19 lockdowns and mental health-related Google searches in 11 Latin American countries. We include the following countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Uruguay. We also explore how changes in search patterns relate to income support policies and to COVID-19 death rates. METHOD: Using Google Trends data and an event-study design, as well as a difference-in-differences analysis, we investigate the association between country specific stay-at-home orders and internet searches including the following words: insomnia, stress, anxiety, sadness, depression, and suicide. RESULTS: We find three main patterns. First, searches for insomnia peak but then decline. Second, searches for stress, anxiety, and sadness increase and remain high throughout the lockdown. Third, there is no substantial change in depression-related or suicide-related searches after the lockdown. In terms of potential mechanisms, our results suggest that searches declined for suicide and insomnia following the passage of each country's income support, while in countries with higher COVID-19-related death rates, searches for insomnia, stress, and anxiety increased by more. CONCLUSIONS: Our results suggest that, in Latin America, Google searches for words associated with mild mental health disorders increased during the COVID-19 stay-at-home orders. Nonetheless, these conclusions should not be construed as a general population mental health deterioration, as we cannot verify that search indicators are accurately related to the users' current feelings and behaviors, and as internet users may not be representative of the population in this region.


Subject(s)
COVID-19 , Mental Health , Search Engine , Argentina , Bolivia , Chile , Colombia , Communicable Disease Control , Ecuador , Guatemala , Honduras , Humans , Latin America/epidemiology , Mexico , Pandemics , Peru , SARS-CoV-2 , Uruguay
9.
Clin Infect Dis ; 72(10): e476-e483, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1232182

ABSTRACT

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused substantial morbidity and mortality worldwide. Few reports exist in Latin America, a current epicenter of transmission. Here, we aim to describe the epidemiology and outcomes associated with coronavirus disease 2019 (COVID-19) in Honduras. METHODS: Baseline clinical and epidemiological information of SARS-CoV-2 reverse transcriptase polymerase chain reaction-confirmed cases detected between 17 March-4 May in the San Pedro Sula Metropolitan area was collected; for hospitalized cases, clinical data were abstracted. Logistic regression models were fit to determine the factors associated with hospitalization. RESULTS: We identified 877 COVID-19 cases, of which 25% (n = 220) were hospitalized. The 19-44-year age group (57.8%) and males (61.3%) were predominant in overall COVID-19 cases. Of the cases, 34% (n = 299) had at least 1 preexisting medical condition. Individuals aged 45-69 years (adjusted odds ratio [aOR] = 4.05; 95% confidence interval [CI], 2.85-5.76) or ≥70 years (aOR = 9.12; 95% CI, 5.24-15.86), of male sex (aOR = 1.72; 95% CI, 1.21-2.44), and those with a preexisting condition (aOR = 2.12; 95% CI, 1.43-3.14) had higher odds of hospitalization. Of inpatients, 50% were hospitalized more than 7 days. The median length of hospitalization was 13 days (interquartile range [IQR], 8-29) among individuals aged 19-44 years, and 17 days (IQR, 11-24.6) among those aged 45-69. Of the fatal cases, 42% occurred among adults under 60 years old. CONCLUSIONS: Our findings show that a high proportion of COVID-19 cases in Honduras occurred among younger adults, who also constituted a significant proportion of severe and fatal cases. Preexisting conditions were associated with severe outcomes independently from age and were highly prevalent in Honduran COVID-19 cases.


Subject(s)
COVID-19 , Adult , Aged , Honduras/epidemiology , Hospitalization , Humans , Male , Middle Aged , Pandemics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Young Adult
10.
Soc Sci Med ; 277: 113933, 2021 05.
Article in English | MEDLINE | ID: covidwho-1189014

ABSTRACT

RATIONALE: The purpose of the current study was to analyze the influence of coronavirus awareness, psychological stress responses, and sociodemographic variables on mental health indicators (somatization, depression, and anxiety) in residents of Honduras, Chile, Costa Rica, Mexico, and Spain. METHODS: The study used a quantitative, cross-sectional approach. Data was collected online using the Brief Symptom Inventory-18 (BSI-18); the Coronavirus Awareness Scale-6 (CAS-6) and a questionnaire that included psychological and sociodemographic questions. The total sample size consisted of 1559 respondents from Honduras (34%), Chile (29%), Costa Rica (17%), Mexico (11%), and Spain (9%). RESULTS: The most common stress domains correspond to family (22.97%), financial (22.53%), academic (16.47%), leisure time constraints (14.23%), health (12.48%), peer group (7.63%), and religious concerns (3.69%). These domains are significantly associated with the respondent's country, sex, employment status, and being or not a health worker. Respondents who reported confinement stress also reported higher scores in anxiety, depression, and somatization. The Global Severity Index was significantly predicted by confinement stress, health, academic, and leisure time-related stress, sex, age, being a health worker, COVID-19 Personal Concern, and Perceived Seriousness. Non-significant predictors were employment status, the number of people at home, presence of older adults and children at home, financial, peer group, family, and religious concerns; the regression model had an R2 of 0.26. Similar analyses were conducted for somatization, depression, and anxiety subscales. CONCLUSIONS: The COVID-19 pandemic has adverse effects on the mental health of the general population, particularly regarding anxiety, depression, and somatization. Specific populations, such as women and healthcare workers, are at particular risk of suffering a deterioration in mental wellbeing. The implications of the study for public policy are discussed.


Subject(s)
COVID-19 , Mental Health , Aged , Anxiety/epidemiology , Child , Chile , Costa Rica/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Female , Honduras/epidemiology , Humans , Mexico/epidemiology , Pandemics , SARS-CoV-2 , Spain , Stress, Psychological/epidemiology , Surveys and Questionnaires
12.
J Public Health (Oxf) ; 43(2): e358-e359, 2021 06 07.
Article in English | MEDLINE | ID: covidwho-1123356

ABSTRACT

A recent correspondence discussed that in trying times, technology can help be applied toward epidemiology to benefit communities by building a basic surveillance system. This suggested development in Honduras can be utilized in the Philippines to improve the State's handling of health emergencies. With this, this paper accentuates the importance of prevention and planning to ensure public health in the Philippines, especially during the COVID-19 pandemic.


Subject(s)
COVID-19 , Cyclonic Storms , Dengue , Honduras , Humans , Pandemics/prevention & control , Philippines/epidemiology , Public Health , SARS-CoV-2
13.
Int J Cancer ; 149(1): 97-107, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1086364

ABSTRACT

We conducted a study to document the impact of COVID-19 pandemic on cancer screening continuum in selected low- and middle-income countries (LMICs). LMICs having an operational cancer control plan committed to screen eligible individuals were selected. Managers/supervisors of cancer screening programs were invited to participate in an online survey and subsequent in-depth interview. Managers/supervisors from 18 programs in 17 countries participated. Lockdown was imposed in all countries except Brazil. Screening was suspended for at least 30 days in 13 countries, while diagnostic-services for screen-positives were suspended in 9 countries. All countries except Cameroon, Bangladesh, India, Honduras and China managed to continue with cancer treatment throughout the outbreak. The participants rated service availability compared to pre-COVID days on a scale of 0 (no activities) to 100 (same as before). A rating of ≤50 was given for screening services by 61.1%, diagnostic services by 44.4% and treatment services by 22.2% participants. At least 70% participants strongly agreed that increased noncompliance of screen-positive individuals and staff being overloaded or overwhelmed with backlogs would deeply impact screening programs in the next 6 months at least. Although many of the LMICs were deficient in following the "best practices" to minimize service disruptions, at least some of them made significant efforts to improve screening participation, treatment compliance and program organization. A well-coordinated effort is needed to reinitiate screening services in the LMICs, starting with a situational analysis. Innovative strategies adopted by the programs to keep services on-track should be mutually shared.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control/methods , Early Detection of Cancer/statistics & numerical data , Neoplasms/diagnosis , SARS-CoV-2/isolation & purification , Surveys and Questionnaires/statistics & numerical data , Bangladesh , Brazil , COVID-19/epidemiology , COVID-19/virology , Cameroon , China , Cross-Sectional Studies , Developing Countries , Early Detection of Cancer/methods , Honduras , Humans , India , Neoplasms/therapy , Pandemics , SARS-CoV-2/physiology
15.
PLoS One ; 16(1): e0245025, 2021.
Article in English | MEDLINE | ID: covidwho-1060203

ABSTRACT

PURPOSE: COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. MATERIALS AND METHODS: Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. RESULTS: Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. CONCLUSION: The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.


Subject(s)
COVID-19/therapy , Intensive Care Units , Length of Stay , Adult , Aged , Aged, 80 and over , COVID-19/drug therapy , COVID-19/epidemiology , Female , Honduras/epidemiology , Humans , Immunologic Factors/administration & dosage , Male , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Retrospective Studies , Treatment Outcome
16.
J Public Health (Oxf) ; 43(2): e297-e298, 2021 06 07.
Article in English | MEDLINE | ID: covidwho-1054331

ABSTRACT

A recently published article of this journal stated that informatics solutions can guide better public health decision-making during the COVID 19 (Coronavirus Disease 2019) pandemic. Honduras is a country facing the COVID-19 pandemic with a weak health surveillance system while also fighting a dengue epidemic and the aftermath of two hurricanes that struck its territory in November 2020. In response, we as academics started a COVID-19 and Dengue Observatory combining several technological platforms and developing multidisciplinary research to help the country navigate the crisis. Mapping the pandemic and the natural disasters showed us that technology can be applied toward epidemiology to benefit communities in a time of need by quickly building a basic digital health surveillance system for Honduras.


Subject(s)
COVID-19 , Cyclonic Storms , Dengue , Dengue/epidemiology , Honduras/epidemiology , Humans , Pandemics , SARS-CoV-2
17.
PLoS One ; 16(1): e0245025, 2021.
Article in English | MEDLINE | ID: covidwho-1013223

ABSTRACT

PURPOSE: COVID-19 pandemic has multifaceted presentations with rising evidence of immune-mediated mechanisms underplay. We sought to explore the outcomes of severe COVID-19 patients treated with a multi-mechanism approach (MMA) in addition to standard-of-care (SC) versus patients who only received SC treatment. MATERIALS AND METHODS: Data were collected retrospectively for patients admitted to the intensive care unit (ICU). This observational cohort study was performed at five institutions, 3 in the United States and 2 in Honduras. Patients were stratified for MMA vs. SC treatment during ICU stay. MMA treatment consists of widely available medications started immediately upon hospitalization. These interventions target immunomodulation, anticoagulation, viral suppression, and oxygenation. Primary outcomes included in-hospital mortality and length of stay (LOS) for the index hospitalization and were measured using logistic regression. RESULTS: Of 86 patients admitted, 65 (76%) who had severe COVID-19 were included in the study; 30 (46%) patients were in SC group, compared with 35 (54%) patients treated with MMA group. Twelve (40%) patients in the SC group died, compared with 5 (14%) in the MMA group (p-value = 0.01, Chi squared test). After adjustment for gender, age, treatment group, Q-SOFA score, the MMA group had a mean length of stay 8.15 days, when compared with SC group with 13.55 days. ICU length of stay was reduced by a mean of 5.4 days (adjusted for a mean age of 54 years, p-value 0.03) and up to 9 days (unadjusted for mean age), with no significant reduction in overall adjusted mortality rate, where the strongest predictor of mortality was the use of mechanical ventilation. CONCLUSION: The finding that MMA decreases the average ICU length of stay by 5.4 days and up to 9 days in older patients suggests that implementation of this treatment protocol could allow a healthcare system to manage 60% more COVID-19 patients with the same number of ICU beds.


Subject(s)
COVID-19/therapy , Intensive Care Units , Length of Stay , Adult , Aged , Aged, 80 and over , COVID-19/drug therapy , COVID-19/epidemiology , Female , Honduras/epidemiology , Humans , Immunologic Factors/administration & dosage , Male , Middle Aged , Respiration, Artificial , Respiratory Distress Syndrome/therapy , Retrospective Studies , Treatment Outcome
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