ABSTRACT
BACKGROUND: Risk factors for mortality and MDR-TB in Guatemala are poorly understood. We aimed to identify risk factors to assist in targeting public health interventions. METHODS: We performed a retrospective study of adults with pulmonary TB reported to the Guatemalan TB Program between January 1, 2016 and December 31, 2017. The primary objective was to determine risk factors for mortality in pulmonary TB. The secondary objective was to determine risk factors associated with MDR-TB. RESULTS: Among 3,945 patients with pulmonary TB, median age was 39 years (IQR 25-54), 59% were male, 25% of indigenous ethnicity, 1.1% had MDR-TB and 3.9% died. On multivariable analysis, previous TB treatment (odds ratio [OR] 3.57, CI 2.24-5.68 [p < 0.001]), living with HIV (OR 3.98, CI 2.4-6.17 [p < 0.001]), unknown HIV diagnosis (OR 2.65, CI 1.68-4.18 [p < 0.001]), indigenous ethnicity (OR 1.79, CI 1.18-2.7 [p = 0.005]), malnutrition (OR 7.33, CI 3.24-16.59 [p < 0.001]), and lower educational attainment (OR 2.86, CI 1.43-5.88 [p = 0.003]) were associated with mortality. Prior treatment (OR 53.76, CI 25.04-115.43 [p < 0.001]), diabetes (OR 4.13, CI 2.04-8.35 [p < 0.001]), and indigenous ethnicity (OR 11.83, CI 1.46-95.73 [p = 0.02]) were associated with MDR-TB. CONCLUSIONS: In Guatemala, both previous TB treatment and indigenous ethnicity were associated with higher TB mortality and MDR-TB risk among patients with pulmonary TB.
ABSTRACT
OBJECTIVE: Examine effectiveness of a state's Youth Expanded Food and Nutrition Education Program (EFNEP) and assess the validity of the federal impact indicator method for reporting program outcomes. DESIGN: A randomized, controlled field trial of 229 groups with 5,111 youth, 9-12 years old, in community settings. INTERVENTION: 6- to 8- hour, 7-lesson education experience with food preparation and tasting, an education experience typical of EFNEP in California. OUTCOME MEASURES: US Department of Agriculture (USDA) impact indicators: nutrition knowledge, eating a variety of foods, food selection, and food preparation and safety practices. ANALYSIS: Analysis of covariance model controlling for pretest, gender, age, and ethnicity, with group nested in condition. RESULTS: Organizing responses by impact indicators, treatment participants made significant gains on the posttest compared to controls for 3 of 4 indicators (P < .008 to P < .0001). Gains were made by 34 to 68% of youth participants for 4 indicators. The impact indicator method for federal reporting compared favorably with results from a randomized controlled trial with groups nested in conditions. CONCLUSION AND IMPLICATIONS: This is the first report in the literature of (1) a large evaluation study of Youth EFNEP and (2) an estimate of the validity of the USDA impact indicator method for reporting program outcomes.
Subject(s)
Child Nutrition Sciences/education , Health Education , Poverty , Program Evaluation/methods , United States Department of Agriculture , Age Distribution , Analysis of Variance , California , Child , Food Handling/methods , Humans , Poverty/ethnology , Reproducibility of Results , Sex Distribution , Surveys and Questionnaires , United StatesABSTRACT
Fueron interrogados 100 pacientes de ambos sexos, mayores de 60 años, con el objeto de identificar los alcances terapéuticos que ha tenido la odontología institucional y/o privada en relación al tipo de tratamiento que ha recibido este grupo de estudio, conocer la importancia que el paciente geriátrico le da al tratamiento odontológico integral y los factores que influyen en ello. El 52 por ciento de la muestra estudiada nunca recibió información sobre los problemas que pueden tener en la boca y el 66 por ciento no fue informado sobre las necesidades de tratamiento. Las principales actividades terapéuticas que recibieron fueron exodoncia, operatoria y periofoncia (profilaxis). El 45 por ciento de los pacientes mayores de 60 años acude solamente por presentar dolor. Declararon no asistir al odontólogo por carecer de recursos económicos, por no tener dolor, y por considerarlo un lujo o tener miedo
