Dinámica sociodemográfica de los pueblos rurales de la linea sur rionegrina.

Desde hace décadas, mucho se ha hablado acerca del despoblamiento delcampo. Si bien los datos censales muestran que la población rural total y dispersa ha disminuido en el último período intercensal, la población rural agrupada, aumentó.Este proceso se traduce en pérdida absoluta y relativa de habitantes de algunosparajes y localidades, y en el crecimiento inusual de otros. En este sentido, pueden identificarse dinámicas diferenciales de pueblos rurales con desigual evolución demográfica de acuerdo a las características de los sistemas productivos y las posibilidades de trabajo no agrario.Surge así la necesidad de explorar qué ocurre con los pueblos y la población ruralen un extenso territorio rionegrino, la Línea Sur. El significado social que adquieren estos pueblos y parajes rurales, permitió definir el foco de análisis de esta ponencia: comprender los cambios que están atravesando estas comunidades y la población rural, indagando tendencias diferenciales que den cuenta del crecimiento o del decrecimiento de pueblos y parajes rurales. Pensamos que la categoría pueblo rural representa una categoría suficientemente persistente como para hacer significativo su estudio. Esto nos lleva a intentar acercarnos al mundo sociodemográfico de los pueblos rurales de esa región rionegrina que, durante décadas, se caracterizó por la pérdida de población o por un bajo crecimiento demográfico ligado a las crisis de la principal actividad, la ganadería extensiva.Desde el punto de vista metodológico se trabaja con fuentes de datos secundarias -información censal, bibliografía y artículos periodísticos- y primarias - entrevistas a pobladores e informantes calificados

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

Sem informação113478788

Acceptability of Human Papillomavirus Self-Sampling for Cervical Cancer Screening in an Indigenous Community in Guatemala

Purpose: Cervical cancer rates in Latin America are higher than those in developed countries, likely because of the lower prevalence of screening. Specifically, less than 40% of women in Guatemala are regularly screened and even fewer women are screened in indigenous communities. Current screening strategies—Pap smears and visual inspection with acetic acid—might not be the most effective methods for controlling cancer in these settings. We thus investigated the potential of self-collection of cervical samples with testing for human papillomavirus (HPV) to help prevent cervical cancer in an indigenous community in Guatemala. Patients and Methods: A community representative random sample of 202 indigenous women age 18 to 60 years residing in Santiago Atitlan, Guatemala, were surveyed to assess knowledge of and risk factors for HPV and cervical cancer. Women were then invited to self-collect a cervical sample using HerSwab collection kits to assess the prevalence of HPV and the acceptability of self-sampling. Results: Of 202 women who completed the survey, 178 (89%) provided a self-sample. In all, 79% of these women found the test comfortable, 91% found the test easy to use, and 100% reported they were willing to perform the test periodically as a screening method. Thirty-one samples (17%) were positive for at least one of 13 high-risk HPV types, and eight (4.5%) were positive for HPV 16/18. Conclusion: HPV testing by using self-collected samples was well accepted, suggesting that it is a plausible modality for cervical cancer screening in indigenous communities. Further studies are needed to assess rates of follow-up after a positive test and to determine whether these findings extend to other indigenous and nonindigenous communities in Guatemala and Latin America

DINÁMICA SOCIODEMOGRÁFICA DE LOS PUEBLOS RURALES DE LA LINEA SUR RIONEGRINA.

Desde hace décadas, mucho se ha hablado acerca del despoblamiento del campo. Si bien los datos censales muestran que la población rural total y dispersa ha disminuido en el último período intercensal, la población rural agrupada, aumentó. Este proceso se traduce en pérdida absoluta y relativa de habitantes de algunos parajes y localidades, y en el crecimiento inusual de otros. En este sentido, pueden identificarse dinámicas diferenciales de pueblos rurales con desigual evolución demográfica de acuerdo a las características de los sistemas productivos y las posibilidades de trabajo no agrario. Surge así la necesidad de explorar qué ocurre con los pueblos y la población rural en un extenso territorio rionegrino, la Línea Sur. El significado social que adquieren estos pueblos y parajes rurales, permitió definir el foco de análisis de esta ponencia: comprender los cambios que están atravesando estas comunidades y la población rural, indagando tendencias diferenciales que den cuenta del crecimiento o del decrecimiento de pueblos y parajes rurales. Pensamos que la categoría pueblo rural representa una categoría suficientemente persistente como para hacer significativo su estudio. Esto nos lleva a intentar acercarnos al mundo sociodemográfico de los pueblos rurales de esa región rionegrina que, durante décadas, se caracterizó por la pérdida de población o por un bajo crecimiento demográfico ligado a las crisis de la principal actividad, la ganadería extensiva. Desde el punto de vista metodológico se trabaja con fuentes de datos secundarias -información censal, bibliografía y artículos periodísticos- y primarias - entrevistas a pobladores e informantes calificados

Cervical cancer knowledge and barriers and facilitators to screening among women in two rural communities in Guatemala: a qualitative study

Background Approximately 80% of deaths due to cervical cancer occur in low- and middle-income countries. In Guatemala, limited access to effective screening and treatment has resulted in alarmingly high cervical cancer incidence and mortality rates. Despite access to free-of-cost screening, women continue to face significant barriers in obtaining screening for cervical cancer. Methods In-depth interviews (N = 21) were conducted among women in two rural communities in Guatemala. Interviews followed a semi-structured guide to explore knowledge related to cervical cancer and barriers and facilitators to cervical cancer screening. Results Cervical cancer knowledge was variable across sites and across women. Women reported barriers to screening including ancillary costs, control by male partners, poor provider communication and systems-level resource constraints. Facilitators to screening included a desire to know one’s own health status, conversations with other women, including community health workers, and extra-governmental health campaigns. Conclusions Findings speak to the many challenges women face in obtaining screening for cervical cancer in their communities as well as existing facilitators. Future interventions must focus on improving cervical cancer-related knowledge as well as mitigating barriers and leveraging facilitators to promote screening.Medicine, Faculty ofNon UBCReviewedFacultyResearche

Dinámica sociodemográfica de los pueblos rurales de la linea sur rionegrina

Desde hace décadas, mucho se ha hablado acerca del despoblamiento delcampo. Si bien los datos censales muestran que la población rural total y dispersa ha disminuido en el último período intercensal, la población rural agrupada, aumentó.Este proceso se traduce en pérdida absoluta y relativa de habitantes de algunosparajes y localidades, y en el crecimiento inusual de otros. En este sentido, pueden identificarse dinámicas diferenciales de pueblos rurales con desigual evolución demográfica de acuerdo a las características de los sistemas productivos y las posibilidades de trabajo no agrario.Surge así la necesidad de explorar qué ocurre con los pueblos y la población ruralen un extenso territorio rionegrino, la Línea Sur. El significado social que adquieren estos pueblos y parajes rurales, permitió definir el foco de análisis de esta ponencia: comprender los cambios que están atravesando estas comunidades y la población rural, indagando tendencias diferenciales que den cuenta del crecimiento o del decrecimiento de pueblos y parajes rurales. Pensamos que la categoría pueblo rural representa una categoría suficientemente persistente como para hacer significativo su estudio. Esto nos lleva a intentar acercarnos al mundo sociodemográfico de los pueblos rurales de esa región rionegrina que, durante décadas, se caracterizó por la pérdida de población o por un bajo crecimiento demográfico ligado a las crisis de la principal actividad, la ganadería extensiva.Desde el punto de vista metodológico se trabaja con fuentes de datos secundarias -información censal, bibliografía y artículos periodísticos- y primarias - entrevistas a pobladores e informantes calificados

Using self-collection HPV testing to increase engagement in cervical cancer screening programs in rural Guatemala: a longitudinal analysis

Abstract Background Cervical cancer is a leading cause of death in low- and middle-income countries. Self-collection testing for human papillomavirus (HPV) is an alternative form of cervical cancer screening that can be completed privately and at home. Understanding how the use of HPV testing influences follow-up care in low-resourced settings is crucial before broad implementation. This study aimed to identify if access to self-collection HPV testing impacts participation in established cervical cancer screening programs among women in two rural communities in Guatemala. Methods A cohort of 956 women was recruited in 2016 and followed for 2 years for the HPV Multiethnic Study (HPV MES). At baseline, women answered a questionnaire assessing cervical cancer screening history and were offered self-collection HPV testing. Women were re-contacted yearly to determine receipt of additional screening. Statistical changes in screening behavior before and throughout study participation, stratified by self-collection status, were assessed using McNemar pair tests for proportions. Alluvial plots were constructed to depict changes in individual screening behavior. The odds of changes in Pap-compliance (screened in past 3 years), given collection status, were assessed using multivariate logistic regressions. Results Reported screening rates increased 2 years after enrollment compared to rates reported for the 3 years before study entry among women who collected a sample (19.1% increase, p < 0.05), received results of their test (22.1% increase, p < 0.05), and received positive (24.2% increase, p < 0.1) or negative results (21.7% increase, p < 0.05). However, most increases came from one community, with minimal changes in the other. The adjusted odds of becoming Pap compliant were higher for women who collected a sample vs. did not (OR: 1.48, 95% CI: 0.64, 3.40), received their result vs. did not (OR: 1.29, 95% CI: 0.52, 3.02), and received a positive result vs. negative (OR: 2.43, 95% CI: 0.63, 16.10). Conclusions Participation in self-collection HPV testing campaigns may increase likelihood of involvement in screening programs. However, results varied between communities, and reporting of screening histories was inconsistent. Future work should identify what community-specific factors promote success in HPV testing programs and focus on improving education on existing cervical cancer interventions.http://deepblue.lib.umich.edu/bitstream/2027.42/173485/1/12889_2020_Article_9478.pd

Aflatoxin and viral hepatitis exposures in Guatemala: Molecular biomarkers reveal a unique profile of risk factors in a region of high liver cancer incidence.

Liver cancer is an emerging global health issue, with rising incidence in both the United States and the economically developing world. Although Guatemala experiences the highest rates of this disease in the Western hemisphere and a unique 1:1 distribution in men and women, few studies have focused on this population. Thus, we determined the prevalence and correlates of aflatoxin B1 (AFB1) exposure and hepatitis virus infection in Guatemalan adults. Healthy men and women aged ≥40 years (n = 461), residing in five departments of Guatemala, were enrolled in a cross-sectional study from May-October of 2016. Serum AFB1-albumin adducts were quantified using isotope dilution mass spectrometry. Multivariate linear regression was used to assess relationships between AFB1-albumin adduct levels and demographic factors. Biomarkers of hepatitis B virus and hepatitis C virus infection were assessed by immunoassay and analyzed by Fisher's exact test. AFB1-albumin adducts were detected in 100% of participants, with a median of 8.4 pg/mg albumin (range, 0.2-814.8). Exposure was significantly higher (p<0.05) in male, rural, low-income, and less-educated participants than in female, urban, and higher socioeconomic status participants. Hepatitis B and C seropositivity was low (0.9% and 0.5%, respectively). Substantial AFB1 exposure exists in Guatemalan adults, concurrent with low prevalence of hepatitis virus seropositivity. Quantitatively, AFB1 exposures are similar to those previously found to increase risk for liver cancer in Asia and Africa. Mitigation of AFB1 exposure may reduce liver cancer incidence and mortality in Guatemala, warranting further investigation

Assessing the Validity of Normalizing Aflatoxin B₁-Lysine Albumin Adduct Biomarker Measurements to Total Serum Albumin Concentration across Multiple Human Population Studies

The assessment of aflatoxin B1 (AFB1) exposure using isotope-dilution liquid chromatography-mass spectrometry (LCMS) of AFB1-lysine adducts in human serum albumin (HSA) has proven to be a highly productive strategy for the biomonitoring of AFB1 exposure. To compare samples across different individuals and settings, the conventional practice has involved the normalization of raw AFB1-lysine adduct concentrations (e.g., pg/mL serum or plasma) to the total circulating HSA concentration (e.g., pg/mg HSA). It is hypothesized that this practice corrects for technical error, between-person variance in HSA synthesis or AFB1 metabolism, and other factors. However, the validity of this hypothesis has been largely unexamined by empirical analysis. The objective of this work was to test the concept that HSA normalization of AFB1-lysine adduct concentrations effectively adjusts for biological and technical variance and improves AFB1 internal dose estimates. Using data from AFB1-lysine and HSA measurements in 763 subjects, in combination with regression and Monte Carlo simulation techniques, we found that HSA accounts for essentially none of the between-person variance in HSA-normalized (R2 = 0.04) or raw AFB1-lysine measurements (R2 = 0.0001), and that HSA normalization of AFB1-lysine levels with empirical HSA values does not reduce measurement error any better than does the use of simulated data (n = 20,000). These findings were robust across diverse populations (Guatemala, China, Chile), AFB1 exposures (105 range), HSA assays (dye-binding and immunoassay), and disease states (healthy, gallstones, and gallbladder cancer). HSA normalization results in arithmetic transformation with the addition of technical error from the measurement of HSA. Combined with the added analysis time, cost, and sample consumption, these results suggest that it may be prudent to abandon the practice of normalizing adducts to HSA concentration when measuring any HSA adducts—not only AFB1-lys adducts—when using LCMS in serum/plasma