Los caminos del enfermo en una comunidad K’iche’de Guatemala: una contribución del análisis de redes al estudio de los comportamientos de búsqueda de atención en salud

Introducción: El objetivo de este estudio fue ampliar la comprensión sobre los comportamientos de búsqueda de atención a través del análisis de las transiciones que las personas hacen entre distintas alternativas terapéuticas. Metodología: Una encuesta de prevalencia de enfermedad en 229 unidades domésticas de la comunidad, detectó 92 personas con algún padecimiento agudo, a quienes se entrevistó para establecer las acciones que tomaron respecto a la enfermedad. Las acciones correspondieron a una de las siguientes categorías: esperar, remedios caseros, compra de medicinas, o uso de profesionales (tradicionales, biomedicina o sanación divina). Estas categorías terapéuticas se tabularon en una matriz idéntica unidireccional. Se usó el programa NetDraw para representar gráficamente la red de transiciones entre categorías terapéuticas. Se usó el programa UCINET para calcular la densidad de la red, el grado de centralidad y de intermediación de cada categoría de tratamiento. Resultados: La densidad de la red fue de 98%. Para toda la red, el grado de centralidad hacia fuera y hacia dentro fue de 35 y 27%, respectivamente. El grado de intermediación estuvo entre 1% para terapeutas tradicionales y 26% para terapeutas de la biomedicina. Conclusiones: Las decisiones de iniciar un nuevo tratamiento se ven influidas por los tratamientos previos. Esperar sin tratamiento y usar tratamientos caseros es frecuente en diferentes momentos del episodio de enfermedad. Usar profesionales de la biomedicina está seguido frecuentemente por la búsqueda de otros tratamientos. Usar terapeutas tradicionales y profesionales de la sanación divina está seguido frecuentemente del final del episodio.Introduction: The aim of this study was to broaden understanding about careseeking behavior through the analysis of the transitions people make between different forms of treatment. Methodology: A survey of disease prevalence in 229 households from the community identified 92 people with severe illnesses, who were interviewed to establish the actions they took regarding the enferemdad. The actions correspond to one of the following categories: waiting, home remedies, purchase of medicine, or professional use (traditional, biomedical or divine healing). These therapeutic categories were tabulated in an array the same way. Netdraw program was used to plot the network of transitions between therapeutic categories. UCINET was used to calculate the density of the network, the degree of centrality and brokerage for each treatment category. Results: The network density was 98%. For the entire network, the degree of centrality outward and inward was 35 and 27% respectively. The degree of interference was between 1% to traditional healers and 26% for practitioners of biomedicine. Conclusions: The decision to start a new treatment is influenced by previous treatments. To wait without treatment and home treatment is often used at different times of illness episode. Using biomedical professionals is often followed by the search for other treatments. Using traditional healers and practitioners of divine healing is often followed for the end of the episode

Neocolonial epidemiology

The relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country’s economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call ‘neocolonial epidemiology’, and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level

Environmental and Social Factors Associated with High Chronic Kidney Disease Mortality Rates in Municipalities of Guatemala: An Ecological Study of Municipal-Level Mortality Data

The purpose of this study was to determine the association between social and environmental indicators and high mortality rates from chronic kidney disease (CKD) in municipalities of Guatemala. An ecological study of municipal-level factors associated with CKD mortality in Guatemala was conducted. Crude mortality rates were calculated for the 2009–2019 period for each of the country’s 340 municipalities, by gender and age groups. Municipal-level social and environmental indicators were used as independent variables. Linear regression was used for bivariate and multivariate analysis. A total of 28,723 deaths from CKD were documented for the 2009–2019 period. Average crude mortality rate for all ages for the country’s 340 municipalities was 70.66 per 100,000 [0–502.99]. Very highly positive associations with high mortality rates were found in two agrarian territories where land use is mainly for permanent crops (e.g., sugar cane, coffee, rubber, banana, plantain, African palm) and pastures for cattle, with very low percentages of land covered by forests or protected areas. Social factors related to poverty and environmental factors related to agricultural use of land may play a role in the high CKD mortality rates documented in a cluster of municipalities of Guatemala

Neocolonial Epidemiology: Public Health Practice and the Right to Health in Guatemala

The relationship between public health practice and the fulfilment of the right to health is often assumed to be synergistic. With the goal of understanding how exactly this relationship happens, I studied the everyday practice of epidemiology in Guatemala, seeking to understand how it shapes and is shaped by the notion of health as a human right. Here I present findings from my ethnographic investigation of the Guatemalan Centro Nacional de Epidemiología (National Epidemiology Center), created in 2004 with the explicit mission of contributing to fulfilling the right to health for the inhabitants of Guatemala. While the relationship between epidemiological practice and the right to health is influenced by the specific configuration of local and transnational flows (bureaucratic, economic, ideological, political, scientific, social, and symbolic), epidemiologists also play an important mediating role. There are four intermediate social mechanisms that shape the relevance of epidemiological practice to fulfilling the right to health in Guatemala. Given how the country’s economic and social inequalities translate into enormous health inequities, an epidemiological practice committed to the right to health should aspire to transform, rather than reproduce, the social hierarchies underlying such inequalities. The mechanisms I identified shape how epidemiological practice contributes to the reproduction or transformation of such hierarchies. These mechanisms shape what I call ‘neocolonial epidemiology’, and include: institutional chaos, disciplinary conformism, global health international relations, and social relations at the national level

Sanitary Cordons in COVID-19: Experience and the Object of Epidemiological Interventions

What is the object of epidemiological interventions during an epidemic? Is it the virus, the disease, the fear, the chaos, or the threat to security? And what is the objective of those interventions? Is it to eliminate the virus, to mitigate the effects of the disease, to calm the fear, to control the chaos, or to defeat the threat

La nueva provincia: (re)poblamiento de los territorios agrarios. Chile 1982-2002

En este ensayo se propone que, en Chile, desde los años 70, en el contexto del desarrollo de la nueva agricultura exportadora, está ocurriendo un repoblamiento de los territorios o zonas agrarias. En particular, se propone que dicho repoblamiento es, ahora y en diferencia a los campos tradicionales, a) predominantemente urbano en el hábitat, y b) "procesador" o industrial en lo productivo

Role of stress-responsive genes in the molt cycle of decapod crustaceans

2019 Fall.Includes bibliographical references.The main objective of this study was to understand the molecular mechanisms underlying the inhibition of molting by environmental stress in decapods. The general hypothesis describes that environmental stressors inhibit synthesis and secretion of molting hormones (ecdysteroids) by the molting gland, or Y-organ (YO), through stress response signaling genes in the mTOR signaling pathway. It is predicted that premolt animals of Gecarcinus lateralis will be more sensitive to thermal stress compared to those in intermolt stages, and that G. lateralis will be more sensitive to environmental stresses such as temperature or desiccation than Carcinus maenas. The aims of this study were to review of state of the art on molting in decapods, regulation of molt cycle by environmental stress, design of model of stress response in decapods (Chapter 1), Isolate, identify and characterize cDNAs encoding stress response genes in G. lateralis and C. maenas (Chapter 2), Quantify the effects of acute thermal stress on the Y-organ of Multiple Leg Autotomy (MLA) and Eyestalk Ablated (ESA) intermolt, premolt, and postmolt G. lateralis (Chapter 3), and Quantify the effects of desiccation on gene expression and mTOR activity in intermolt animals of C. maenas (Chapter 4)

Towards Effective English Teaching

In view of the increasing need for learning English in a more and more demanding society, the present study aims to evaluate the effectiveness of the teaching of English in Spanish schools. The investigation has been carried out in four schools which follow two different teaching methodologies. This has enabled us to analyze how the use of a certain teaching methodology or strategy influences the communicative competence in English and the ease with which the language is spoken. The analysis of the data gathered has led us to the proposal of improvements to make the teaching of English more effective

Los caminos del enfermo en una comunidad K’iche’ de Guatemala: una contribución del análisis de redes al estudio de los comportamientos de búsqueda de atención en salud

Introducción: El objetivo de este estudio fue ampliar la comprensión sobre los comportamientos de búsqueda de atención a través del análisis de las transiciones que las personas hacen entre distintas alternativas terapéuticas. Metodología: Una encuesta de prevalencia de enfermedad en 229 unidades domésticas de la comunidad, detectó 92 personas con algún padecimiento agudo, a quienes se entrevistó para establecer las acciones que tomaron respecto a la enfermedad. Las acciones correspondieron a una de las siguientes categorías: esperar, remedios caseros, compra de medicinas, o uso de profesionales (tradicionales, biomedicina o sanación divina). Estas categorías terapéuticas se tabularon en una matriz idéntica unidireccional. Se usó el programa NetDraw para representar gráficamente la red de transiciones entre categorías terapéuticas. Se usó el programa UCINET para calcular la densidad de la red, el grado de centralidad y de intermediación de cada categoría de tratamiento. Resultados: La densidad de la red fue de 98%. Para toda la red, el grado de centralidad hacia fuera y hacia dentro fue de 35 y 27%, respectivamente. El grado de intermediación estuvo entre 1% para terapeutas tradicionales y 26% para terapeutas de la biomedicina. Conclusiones: Las decisiones de iniciar un nuevo tratamiento se ven influidas por los tratamientos previos. Esperar sin tratamiento y usar tratamientos caseros es frecuente en diferentes momentos del episodio de enfermedad. Usar profesionales de la biomedicina está seguido frecuentemente por la búsqueda de otros tratamientos. Usar terapeutas tradicionales y profesionales de la sanación divina está seguido frecuentemente del final del episodio.   Abstract:   Introduction: The aim of this study was to broaden understanding about care-seeking behavior through the analysis of the transitions people make between different forms of treatment. Methodology: A survey of disease prevalence in 229 households from the community identified 92 people with severe illnesses, who were interviewed to establish the actions they took regarding the enferemdad. The actions correspond to one of the following categories: waiting, home remedies, purchase of medicine, or professional use (traditional, biomedical or divine healing). These therapeutic categories were tabulated in an array the same way. Netdraw program was used to plot the network of transitions between therapeutic categories. UCINET was used to calculate the density of the network, the degree of centrality and brokerage for each treatment category. Results: The network density was 98%. For the entire network, the degree of centrality outward and inward was 35 and 27% respectively. The degree of interference was between 1% to traditional healers and 26% for practitioners of biomedicine. Conclusions: The decision to start a new treatment is influenced by previous treatments. To wait without treatment and home treatment is often used at different times of illness episode. Using biomedical professionals is often followed by the search for other treatments. Using traditional healers and practitioners of divine healing is often followed for the end of the episode

La determinación social de la enfermedad renal crónica de causas no tradicionales (ERCnT) en Guatemala

La Enfermedad Renal Crónica de Causas no Tradicionales (ERCnT) ha aumentado en los últimos veinte años, convirtiéndose en un problema de salud pública importante que se observa principalmente en países de Centroamérica y Asia, afectando principalmente a trabajadores agrícolas jóvenes. La presencia de factores de riesgo relacionados con toxinas, medio ambiente y condiciones laborales sugiere una causa multifactorial, la cual puede que involucre la exposición a agroquímicos, contaminantes ambientales, y episodios repetidos de deshidratación. La comprensión de las condiciones sociales que unen estos factores en grupos específicos de población es fundamental para el desarrollo de programas de salud pública tendientes a la prevención de esta epidemia devastadora. Luego de presentar brevemente los antecedentes, este ensayo discute el paradigma de causalidad de la enfermedad implícito en la literatura disponible sobre ERCnT, concretamente la “multicausalidad”, sitúa el enfoque en su contexto histórico, y presenta sus fortalezas y limitaciones. Luego, el ensayo presenta dos paradigmas de causalidad que podrían ayudar a avanzar en la investigación sobre las causas de la enfermedad, específicamente los enfoques socioecológico y de determinación social de la salud. El ensayo concluye con recomendaciones para una agenda de investigación e intervención que enfoque en explicar las causas de la ERCnT