Detecting prediabetes among Hispanics/Latinos from diverse heritage groups: Does the test matter? Findings from the Hispanic Community Health Study/Study of Latinos

The objectives of this analysis were to compare the ability of fasting plasma glucose (FPG), post oral load plasma glucose (2hPG), and hemoglobin A1c (HbA1c) to identify U.S. Hispanic/Latino individuals with prediabetes, and to assess its cardiovascular risk factor correlates

Limitaciones del desarrollo turístico sostenible: caso de dos ecolodges en la Amazonía ecuatoriana

El ecoturismo tiene una perspectiva interesante en el marco de la industria del turismo, que considera el bienestar de la población local del lugar de destino, que garantiza una experiencia nueva a los turistas y contribuye a mantener un medio ambiente perdurable. Abordar el turismo en términos de sostenibilidad nos permite orientarnos hacia la protección y la perennidad de los recursos medioambientales. Por lo tanto, para garantizar el desarrollo de un sitio o de un destino es importante constituir una gestión a favor de la conservación, donde se involucre la participación de los diferentes actores. Sin embargo, el turismo sostenible también puede tener limitaciones tales como la oferta de biodiversidad y la implicación de la comunidad. Es por esto que la elaboración de esta investigación se realizó en el ámbito de los desafíos y límites del desarrollo sostenible en la Amazonía ecuatoriana

Lineamientos para la aplicación de la herramienta city branding en la gestión de las ciudades destinos

En 30 años las ciudades serán los lugares más poblados del mundo, por lo que encontrar buenas herramientas de gestión urbana que contribuyan al turismo para crear el posicionamiento es fundamental. Debido a los efectos de la globalización desde la década de los 90, las ciudades se convierten en territorios cada vez más similares en las que se ve amenazado lo particular. Esta investigación presenta al city branding como una herramienta de gestión del turismo que pueda dar una respuesta local a la globalización y que contribuya a la creación de ventajas competitivas frente a otras ciudades. El city branding identifica los valores de la ciudad particular y el fortalecimiento de la identidad en combinación con el aspecto físico, creando una imagen particular y de gran alcance. Esto es evidente en estrategias de marca de ciudad desarrolladas con éxito en Amsterdam y Hong Kong. El documento concluye con una reflexión sobre la comercialización de la ciudad, su relación con la imagen de la ciudad por medio del análisis alcanzado de los casos de estudio presentados, lo que en consecuencia permite la formulación de lineamientos que pueden servir para la generación de políticas turísticas para la gestión de destinos urbanos

Attitudes towards HPV and COVID school-entry policies among adults living in Puerto Rico

Prior to the COVID pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. The COVID pandemic and administration of COVID vaccines might have impacted attitudes toward HPV vaccination. This study compared attitudes toward HPV and COVID vaccines with respect to school-entry policies among adults living in PR. A convenience sample of 222 adults (≥21 years old) completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID vaccines, attitudes toward vaccination policies for school-entry, and perceptions of sources of information. We assessed the magnitude of association between the agreement of school-entry policies for COVID and HPV vaccination by estimating the prevalence ratio (PRadjusted) with 95% Confidence Intervals (95% CI). The most trusted source of information for HPV and COVID vaccines were healthcare providers (42% and 17%, respectively) and the CDC (35% and 55%, respectively), while the least trusted were social media (40% and 39%, respectively), and friends and family (23% n = 47, and 17% n = 33, respectively). Most participants agreed that HPV (76% n = 156) and COVID vaccines (69% n = 136) should be a school-entry requirement. Agreement with school policy requiring COVID vaccination was significantly associated with agreement of school policy requiring HPV vaccination (PRadjusted:1.96; 95% CI:1.48–2.61) after controlling for potential confounders. Adults living in PR have an overall positive attitude about mandatory HPV and COVID vaccination school-entry policies, which are interrelated. Further research should elucidate the implications of the COVID pandemic on HPV vaccine attitudes and adherence rates

Implementation of the human papillomavirus school-entry requirement in Puerto Rico: barriers and facilitators using the consolidated framework for implementation research

In 2018, Puerto Rico (PR) enacted a Human papillomavirus (HPV) vaccine school-entry requirement for students ages 11 to 12. Using the Consolidated Framework for Implementation Research (CFIR), we aimed to identify potential barriers and facilitators of this implementation. We conducted 38 qualitative interviews with stakeholders in PR from different organizations (Department of Health, Schools, Healthcare Providers, and Community organizations). We evaluated construct rating variability between the organizations to determine barriers and facilitators. The strongest facilitator determined was stakeholder’s awareness of the parent’s and student’s needs to meet the HPV school-entry requirement. Other facilitators included initiatives for school-entry policies and the relative advantage of this requirement over different strategies. The strongest barriers included was the cost for private providers to administer the HPV vaccine, the negative influence of social media about the vaccine, which affected parents’ acceptance, and the lack of school nurses as available staff resources for the school entry requirement. Findings from this study can be used to improve implementation (adaptations/modifications) and inform other states and countries in earlier stages of consideration of the adoption of similar immunization policies. Most barriers can be modifiable with the implementation of educational programs/training across schools, considering that they are the first line of response to parents of this school entry requirement

Effect of Hurricane Maria on HPV, Tdap, and meningococcal conjugate vaccination rates in Puerto Rico, 2015–2019

In September 2017, Hurricane Maria devastated the Caribbean region, among them the US territory of Puerto Rico (PR). Vaccination distribution and uptake suffered from the impact. This study evaluated the trends in monthly vaccination initiation rates for human papilloma virus (HPV), Tdap and meningococcal conjugate (MenACWY) adolescent vaccines from 2015 to 2019, during which it was possible to observe and analyze the impact of Hurricane Maria on vaccine initiation. Monthly initiation rates were estimated. Age-standardized initiation rate ratio (SRR) and 95% CI were estimated. The analysis included 85,340 adolescents; 52.3% were male, and 47.7% were females. September 2017 showed HPV vaccine initiation had the lower rates of all the studied vaccines, with a rate of 75% after the disaster (from a rate of almost 90% in July 2017). Tdap and MenACWY vaccines rates remained above 90% in the same period. The SRR of HPV vaccine for September and October 2017 showed an estimated reduction of 5% and 8% in vaccine initiation rates, respectively for each month, when 2016 was the reference year (p > .05). The SRR of Tdap and MenACWY vaccines for November 2017 showed significant reductions when 2015 and 2016 were reference years (p < .05). HPV vaccine initiation rate was the most severely affected by the Hurricane Maria. Post-natural disaster protocols should strengthen existing programs for facilitate immunization access

Age-standardized rates (ASR) (per 100) and standardized rate ratio (SRR) for HPV vaccine initiation among adolescents 11–17 years old in Puerto Rico (2008–2019).

Age-standardized rates (ASR) (per 100) and standardized rate ratio (SRR) for HPV vaccine initiation among adolescents 11–17 years old in Puerto Rico (2008–2019).</p

Age-standardized rates (ASR) (per 100) and standardized rate ratio (SRR) for HPV vaccine UTD among adolescents 11–17 years old in Puerto Rico (2008–2019).

Age-standardized rates (ASR) (per 100) and standardized rate ratio (SRR) for HPV vaccine UTD among adolescents 11–17 years old in Puerto Rico (2008–2019).</p

HPV vaccine coverage rates stratified by age group and sex from 2008 to 2019.

(A) HPV Vaccine Initiation Coverage Rates, (B) HPV Vaccine UTD Coverage Rates.</p