BACKGROUND & AIMS: :Trypanosoma cruzi, the causative agent of Chagas disease, exhibits a high genetic variability and has been classified into six discrete typing units (DTUs) named TcI through TcVI. This genetic diversity is believed to be associated with clinical characteristics and outcomes, but evidence supporting such associations has been limited. Herein, we performed a phylogenetic analysis of T. cruzi sequences of the mini-exon intergenic region obtained from a large cohort of pregnant women and newborns from Argentina, Honduras, and Mexico, to assess parasite genetic diversity and possible associations with congenital transmission. Analysis of 105 samples (including five paired samples) from maternal and umbilical cord blood indicated that T. cruzi DTU distribution was similar among pregnant women and newborns from these three countries, with a high frequency of TcII-TcV-TcVI DTUs, including mixed infections with TcI. However, phylogenetic analysis revealed that although the same parasite haplotypes circulated in these three countries, they were present at different frequencies, leading to significant geographic differences. Of importance, a strong association was observed between parasite haplotypes and congenital infection of newborns. Thus, the identification of parasite haplotypes in pregnant women, but not of parasite DTUs, may help predict congenital transmission of T. cruzi.

背景与目标： ：恰加斯氏锥虫（Trypanosoma cruzi）是恰加斯病的病原体，具有很高的遗传变异性，已被分类为六个离散的打字单位（DTU），称为TcI至TcVI。人们认为这种遗传多样性与临床特征和结果有关，但是支持这种关联的证据有限。本文中，我们对从阿根廷，洪都拉斯和墨西哥的大量孕妇和新生儿中获得的迷你外显子基因间区域的克鲁氏梭菌序列进行了系统发育分析，以评估寄生虫的遗传多样性以及与先天性传播的可能关联。对来自母体和脐带血的105个样本（包括五个配对样本）进行的分析表明，这三个国家的孕妇和新生儿的克鲁氏锥虫DTU分布相似，TcII-TcV-TcVI DTU的发生频率较高，包括混合感染与TcI。但是，系统发育分析表明，尽管在这三个国家中传播相同的寄生虫单倍型，但它们以不同的频率出现，从而导致明显的地理差异。重要的是，观察到寄生虫单倍型与新生儿先天性感染之间有很强的联系。因此，鉴定孕妇中的寄生虫单倍型，而不鉴定寄生虫的DTU，可能有助于预测克鲁格氏菌的先天性传播。

BACKGROUND & AIMS: :In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

背景与目标： ：2006年，我们在洪都拉斯的三个城市实施了针对女性性工作者（FSW）的艾滋病毒和性传播感染（STI）预防计划。所有在STI诊所就诊的FSW均接受定期检查和STI测试。每次访问时都会收集与不同伙伴使用安全套的信息。三年后，我们发现梅毒的患病率从第一次筛查时的2.3％下降到第三次筛查时的0.0％（P = 0.05），衣原体感染率从6.1％下降到3.3％（P = 0.01）。淋病或滴虫病的发生率未见变化。累积的艾滋病毒感染率保持不变（P = 0.44）。与客户一起使用安全套的报告从93.8％增加到98.9％（P <0.001）。在FSW中实施的HIV / STI预防计划已有助于增加与客户的安全套使用量，并降低了梅毒和衣原体感染率。应当加强干预，并将其视为国家卫生政策战略的一部分。

BACKGROUND & AIMS: BACKGROUND:Growing evidence links household air pollution exposure from biomass-burning cookstoves to cardiometabolic disease risk. Few randomized controlled interventions of cookstoves (biomass or otherwise) have quantitatively characterized changes in exposure and indicators of cardiometabolic health, a growing and understudied burden in low- and middle-income countries (LMICs). Ideally, the solution is to transition households to clean cooking, such as with electric or liquefied petroleum gas stoves; however, those unable to afford or to access these options will continue to burn biomass for the foreseeable future. Wood-burning cookstove designs such as the Justa (incorporating an engineered combustion zone and chimney) have the potential to substantially reduce air pollution exposures. Previous cookstove intervention studies have been limited by stove types that did not substantially reduce exposures and/or by low cookstove adoption and sustained use, and few studies have incorporated community-engaged approaches to enhance the intervention. METHODS/DESIGN:We conducted an individual-level, stepped-wedge randomized controlled trial with the Justa cookstove intervention in rural Honduras. We enrolled 230 female primary cooks who were not pregnant, non-smoking, aged 24-59 years old, and used traditional wood-burning cookstoves at baseline. A community advisory board guided survey development and communication with participants, including recruitment and retention strategies. Over a 3-year study period, participants completed 6 study visits approximately 6 months apart. Half of the women received the Justa after visit 2 and half after visit 4. At each visit, we measured 24-h gravimetric personal and kitchen fine particulate matter (PM2.5) concentrations, qualitative and quantitative cookstove use and adoption metrics, and indicators of cardiometabolic health. The primary health endpoints were blood pressure, C-reactive protein, and glycated hemoglobin. Overall study goals are to explore barriers and enablers of new cookstove adoption and sustained use, compare health endpoints by assigned cookstove type, and explore the exposure-response associations between PM2.5 and indicators of cardiometabolic health. DISCUSSION:This trial, utilizing an economically feasible, community-vetted cookstove and evaluating endpoints relevant for the major causes of morbidity and mortality in LMICs, will provide critical information for household air pollution stakeholders globally. TRIAL REGISTRATION:ClinicalTrials.gov Identifier NCT02658383 , posted January 18, 2016, field work completed May 2018. Official title, "Community-Based Participatory Research: A Tool to Advance Cookstove Interventions." Principal Investigator Maggie L. Clark, Ph.D. Last update posted July 12, 2018.

背景与目标： 摘要背景：越来越多的证据表明，从燃烧生物质的炉灶暴露的家庭空气污染与心脏代谢疾病的风险有关。很少有炊具（生物质或其他生物）的随机对照干预措施能够定量地描述暴露量的变化和心脏代谢健康指标，这是低收入和中等收入国家（LMIC）日益增加且研究不足的负担。理想的解决方案是使家庭过渡到清洁的烹饪方式，例如使用电或液化石油气炉灶。但是，那些无力负担或无法获得这些选择的人将在可预见的未来继续燃烧生物质。诸如Justa（结合工程燃烧区和烟囱）的燃木灶具设计具有显着减少空气污染暴露的潜力。以前的炉灶干预研究受到炉灶类型的限制，而炉灶类型并未显着减少暴露量和/或受炉灶的采用和持续使用率低，很少有研究采用社区参与的方法来增强干预措施。
方法/设计：我们在洪都拉斯农村地区进行了Justa Cookstove干预的个体水平，楔入式随机对照试验。我们招募了230名未怀孕，不吸烟，年龄为24-59岁的女性初级厨师，他们在基线时使用传统的燃木炊具。社区顾问委员会指导调查的发展和与参与者的沟通，包括招募和保留策略。在为期3年的研究期内，参与者完成了6次研究访问，相隔约6个月。一半的妇女在探访2和探访4之后都接受了Justa。在每次探访中，我们测量了24小时体重个人和厨房细颗粒物（PM2.5）的浓度，定性和定量炊具的使用和采用指标以及指标代谢健康。主要的健康终点是血压，C反应蛋白和糖化血红蛋白。总体研究目标是探索采用和持续使用新灶具的障碍和促成因素，按分配的灶具类型比较健康终点，并探讨PM2.5与心脏代谢健康指标之间的暴露-反应关联。
讨论：该试验利用经济可行，社区审查的炉灶并评估与LMIC发病率和死亡率的主要原因相关的终点，将为全球家庭空气污染利益相关者提供重要信息。
试验注册：ClinicalTrials.gov标识符NCT02658383，于2016年1月18日发布，现场工作于2018年5月完成。官方标题为“基于社区的参与性研究：推进Cookstove干预的工具”。首席研究员玛吉·克拉克（Maggie L. Clark）博士最新更新发布于2018年7月12日。

BACKGROUND & AIMS: Objective:To assess maternal health training priorities for primary care human resources for health (HRH) in nursing and allied health workers in Colombia, Honduras, and Nicaragua, to inform maternal care HRH strategic planning efforts. Methods:This Washington, D.C.-based study utilized cross-sectional survey methodology to collect country-level data. From October 2016 to March 2017, a needs assessment tool was developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) and PAHO/WHO Collaborating Centers. Data collection was completed by PAHO/WHO country offices, in collaboration with national health authorities and other high-level government personnel. The collected data included information on the composition, capacities, and training priorities of traditional birth attendants (TBAs), community health workers (CHWs), registered nurses (RNs), and auxiliary nurses in the three study countries; the findings were summarized in a report. Results:Data on the health workforce composition in the three countries indicated reliance on HRH with low levels of education and training, with limited integration of TBAs. In all three countries, management of obstetric emergencies was a training priority for RNs, and identification of danger signs was a priority for CHWs and TBAs. Training priorities for auxiliary nurses varied widely across the three countries and included health promotion, preconception and prenatal care, and obstetric emergencies. There was also a wide range in the total number of HRH across the three countries. Conclusions:Reliance on health workers with low levels of training is concerning but can be mitigated through in-service training. Training priorities are consistent with the major causes of maternal mortality, and Latin America and Caribbean region training programs show promise for improving quality of care. In the long term, planning for maternal care HRH should seek to increase the concentration of health professionals that are more highly skilled. Objetivo:Evaluar las prioridades de capacitación en el ámbito de la salud materna de los recursos humanos de enfermería y otros trabajadores de atención primaria en Colombia, Honduras y Nicaragua, y fundamentar los esfuerzos de planificación estratégica de los recursos humanos para la salud dedicados a la atención materna. Métodos:En este estudio, con sede en Washington, D. C., se empleó una metodología de encuesta transversal para recopilar datos a nivel de país. Entre los meses de octubre del 2016 y marzo del 2017, la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y sus centros colaboradores elaboraron una herramienta para la evaluación de las necesidades. Las representaciones de la OPS/OMS, en colaboración con las autoridades nacionales de salud y otros funcionarios gubernamentales de alto nivel, realizaron la recopilación de datos. Los datos reunidos incluyeron información sobre la composición, las aptitudes y las prioridades de capacitación de las parteras tradicionales, los agentes comunitarios de salud, las enfermeras tituladas y las enfermeras auxiliares en los tres países del estudio. Los resultados se resumieron en un informe. Resultados:Los datos sobre la composición del personal de salud en los tres países indicaron que se depende de recursos humanos para la salud que presentan escasos niveles de educación y formación, y que la integración de las parteras tradicionales es limitada. En los tres países, el tratamiento de las urgencias obstétricas constituyó una prioridad de capacitación para las enfermeras tituladas, y la detección de los signos de peligro fue una prioridad en el caso de los agentes comunitarios de salud y las parteras tradicionales. Las prioridades de formación para las enfermeras auxiliares variaron sustancialmente entre los tres países y entrañaron la promoción de la salud, la atención pregestacional y prenatal, y las urgencias obstétricas. Asimismo, el número total de recursos humanos para la salud varió considerablemente entre los países. Conclusiones:Depender de personal de salud de escaso nivel formativo es motivo de preocupación, si bien la capacitación en el servicio puede mitigar este problema. Las prioridades de capacitación están en consonancia con las principales causas de mortalidad materna y los programas formativos de América Latina y el Caribe resultan prometedores para mejorar la calidad de la atención. A largo plazo, la planificación de los recursos humanos para la salud dedicados a la atención materna deberá procurar aumentar la concentración de profesionales de salud más capacitados. Objetivo:Avaliar as prioridades de formação em saúde materna dos recursos humanos na área de atenção primária à saúde entre profissionais de enfermagem e outros profissionais da saúde na Colômbia, Honduras e Nicarágua, a fim de subsidiar os esforços de planejamento estratégico de recursos humanos para saúde materna. Métodos:Foi conduzido um estudo transversal, sediado em Washington, D.C., para coletar dados ao nível nacional. Uma ferramenta de avaliação das necessidades foi desenvolvida, de outubro de 2016 a março de 2017, pela Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e Centros Colaboradores da OPAS/OMS. A coleta de dados foi concluída pelas representações da OPAS/OMS nos países, em colaboração com autoridades sanitárias nacionais e pessoal de alto escalão do governo. Foram coletados dados sobre a composição, as competências e as prioridades de formação de parteiras tradicionais, agentes comunitários de saúde, enfermeiros licenciados e assistentes de enfermagem nos três países de estudo. Os resultados foram compilados em um relatório. Resultados:Os dados relativos à composição da força de trabalho em saúde nos três países indicaram que eles contam com pessoal com baixo nível de instrução e formação, com integração limitada das parteiras tradicionais. Observou-se, nos três países, que a atuação em emergências obstétricas era uma prioridade de formação para enfermeiros licenciados e a identificação de sinais de perigo era uma prioridade para agentes comunitários de saúde e parteiras tradicionais. As prioridades de formação para os assistentes de enfermagem foram bastante distintas entre os países: promoção da saúde, cuidados pré-concepcionais e assistência pré-natal e emergências obstétricas. O número total de recursos humanos para a saúde também variou nos três países. Conclusões:É motivo de preocupação ter de contar com profissionais da saúde com baixo nível de formação, porém este problema pode ser reduzido com a capacitação no próprio serviço. As prioridades de formação nos países estudados são condizentes com as principais causas de mortalidade materna e os programas de formação profissional da Região da América Latina e Caribe têm potencial para melhorar a qualidade da atenção. O planejamento dos recursos humanos para saúde materna deve visar a longo prazo aumentar a concentração de profissionais que são mais capacitados.

背景与目标： 目的：评估哥伦比亚，洪都拉斯和尼加拉瓜的护理人员和相关卫生工作者的初级保健卫生人力资源（HRH）的孕产妇保健培训优先事项，以为孕产妇保健HRH战略规划工作提供信息。
方法：这项基于华盛顿特区的研究利用横断面调查方法来收集国家/地区数据。从2016年10月到2017年3月，泛美卫生组织/世界卫生组织（PAHO / WHO）和PAHO / WHO合作中心开发了需求评估工具。泛美卫生组织/世卫组织国家办事处与国家卫生当局和其他高级政府人员合作完成了数据收集。收集的数据包括三个研究国家中传统接生员（TBA），社区卫生工作者（CHWs），注册护士（RNs）和辅助护士的组成，能力和培训重点的信息；报告中总结了这些发现。
结果：这三个国家的卫生人力构成数据表明，他们对HRH的依赖程度较低，其教育和培训水平较低，而TBA整合程度有限。在这三个国家中，产科急诊管理都是RN的培训重点，而危险标志的识别则是CHW和TBA的重点。在这三个国家中，辅助护士的培训重点各不相同，包括健康促进，孕前和产前护理以及产科急诊。在这三个国家中，卫生人力资源的总数也很大。
结论：对培训程度较低的卫生工作者的依赖令人担忧，但可以通过在职培训来减轻。培训重点与孕产妇死亡的主要原因是一致的，拉丁美洲和加勒比地区的培训计划显示出改善护理质量的希望。从长远来看，HRH的产妇护理计划应设法提高技术熟练的医疗专业人员的集中度。
哥伦比亚：哥伦比亚，洪都拉斯和尼加拉瓜，拉丁美洲和加勒比人民共和国Materna航空公司。
注释：在华盛顿特区的estéstudio，横向和横向都可以看到。在2016年10月至2017年3月之间的Entre los meses de octubre或2017年3月3日在Salud的OrganizaciónPanamericana de la Salud的组织（OPS / OMS）和colaboradores elaboraron una herramienta para lavalusciciónde las necesidades的组织。 OPS / OMS上的Las代表处，在Alto Nivel上的国营银行和自动售货公司进行合作，并在datos处进行实物转售。daccess-ods.un.org daccess-ods.un.org daccess-ods.un.org Loss datos reunidos incluyeron sopar lacomposición，las aptitudes y lasparteras tradicas tradicionales，los agentes comunitarios de salud，las enfermeras tituladas y las enfermeras aux los en tres studios。信息丢失的结果。
结果：在印第安纳州洛斯达托斯州的个人综合研究机构获得了永久性的人权证明书，并在有限责任公司获得了综合赔偿。失去优先权的反垄断法，无权转让的优先权，无权转让的优先权和无偿担保权的优先权。产前预防法和辅助治疗法，产前预防法，产前预防法和产前预防法。阿西米斯莫，人文共和体，人类发展史。
结论：从业人员的个人敬业精神，有能力地解决了因地制宜的服务问题。拉丁美洲和加勒比海地区优先机构的先验资本能力证书，拉丁美洲和加勒比海地区的抵押贷款担保人资格证书，在拉丁美洲的加利福利亚州的中美洲法拉利获得了批准。一份以人为主体的Largo Plazo，以人为主体的人际关系的法律，以人为本的专业知识的原则。
Objetivo：作为先贤先贤的先贤，先后获得人道专业人士的先验资格，再到先后获得人事担保人的专业资格，再到尼加拉瓜的人际合作Materna。
Métodos：Foi conduzido um estudo transverse，华盛顿特区的sediado，国家参议员。乌干达乌拉·费拉门塔（Uma ferramenta deavaliaçãodas necessidades foi desenvolvida），2016年3月至2017年3月，泛美洲萨达德（PauOrganização），南美萨达（OrganizaçãoMundial daSaúde）（OPAS / OMS）和Centros Colaboradores da OPAS / OMS。哥斯达黎加州立大学的果岭分校代表OPAS / OMS nospaíses，这是共和式自动清洁卫生院。孔雀石竹是一种具有竞争力的产品，它既是传统工艺的先验优势，又是传统的合作社，竞争的先驱，又是竞争的先天之举。daccess-ods.un.org daccess-ods.un.org daccess-ods.un.org daccess-ods.un.org daccess-ods.un.org结果汇总表。
结果：dárásrelativosàcomposiçãodaforçade trabalho emsaúdenostrêspaísesindicaram que eles contam compespesal com baixoníveldeinstruçãoeformação，comintegraçaislimitada das parteira。观察到的东西，在某种形式的历史上获得了优先权，而在永久性的基础上又得到了普遍的认同。作为最佳形式的辅助手段，有以下几种形式：促销，促销，产假和产科辅助服务。促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动促销活动人性总动员手册
结论：从事专业生产工作的专业人士，需要解决的问题是提供服务的能力。作为专业资格的优先事项，作为专业的拉丁美洲，加勒比和拉丁美洲地区的永久性的基本原则，美国的永久性的资格证书就应运而生。飞机维修人员的基本人身权利和专业能力被集中。

BACKGROUND & AIMS: :A carbapenem-resistant Acinetobacter baumannii strain was isolated from the peritoneal fluid of a patient with complicated intra-abdominal infection and evaluated at the Multidrug-resistant Organism Repository and Surveillance Network by whole-genome sequencing and real-time PCR. The isolate was sequence type 25 and susceptible to colistin and minocycline, with low MICs of tigecycline. blaNDM-1 was located on a plasmid with >99% homology to pNDM-BJ02. The isolate carried numerous other antibiotic resistance genes, including the 16S methylase gene, armA.

背景与目标： ：从一名复杂的腹腔内感染患者的腹膜液中分离出一个耐碳青霉烯的鲍曼不动杆菌菌株，并通过全基因组测序和实时PCR在耐多药生物体库和监测网络中进行了评估。分离株的序列类型为25，对大肠菌素和美满霉素敏感，而替加环素的MIC较低。 blaNDM-1位于与pNDM-BJ02具有> 99％同源性的质粒上。分离株携带许多其他抗生素抗性基因，包括16S甲基化酶基因armA。

BACKGROUND & AIMS: :The State of Honduras instituted its technical advisory committee on immunization in response to recommendations made by the Pan-American Health Organization (PAHO) and the National Extended Program of Immunization (EPI). On 9 October 1999, the "National Consultative Council of Immunization" (NCCI) was established to provide support and recommendations to the EPI program for the eradication, elimination and control of vaccine-preventable diseases. The seven permanent members of the Council are all paediatricians. Additionally, there are liaison members (from PAHO, the national EPI team, and others) who participate in NCCI meetings when required. Meetings take place three times per year. The high quality of Council recommendations is demonstrated by the fact that the health authorities have adopted all of them.

背景与目标： ：洪都拉斯州根据泛美卫生组织（PAHO）和国家免疫规划署（EPI）的建议，成立了免疫技术咨询委员会。 1999年10月9日，成立了“全国免疫咨询协商委员会”（NCCI），以向EPI计划提供根除，消除和控制疫苗可预防疾病的支持和建议。安理会的七个常任理事国都是儿科医生。此外，在需要时，还有联络成员（来自泛美卫生组织，国家EPI团队和其他机构）参加NCCI会议。每年召开三次会议。卫生当局已经采纳了所有建议，这证明了理事会建议的高质量。

BACKGROUND & AIMS: Grains of two improved maicillo hybrids (Sorghum bicolor (L) Moench) and their criollo (Landrace) counterparts grown at two farmsites in Honduras were lime-cooked and processed into table tortillas. Kernels from the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos were less dense and softer than kernels from the improved cultivars. The improved maicillos had straw or red plant and glume colors while the criollos had purple colored plants with black or purple glumes. The soft textured criollo kernels required less cooking than their harder improved counterparts. Nixtamals cooked to contain 53-55% moisture were the most suitable for processing into tortillas. Both improved maicillos compared favorably with Sureño (used as positive control during processing). The criollos produced darker, less acceptable tortillas. Masa and tortillas from criollos darkened during lime-cooking especially during baking. All sorghums and their respective tortillas had similar chemical composition. The improved maicillos bred in Honduras have a significantly improved plant and glume color with white pericarp. The sorghum improvement was also observed in the overall tortilla quality.

背景与目标： 将两种改良的maicillo杂种（高粱双色（L）Moench）和它们的criollo（Landrace）对应物的谷物在洪都拉斯的两个农场种植，用石灰煮熟并加工成餐桌玉米饼。 criollos的籽粒比改良品种的籽粒密度更小，更柔软。改良的麦可斯草具有稻草或红色的植物和淡紫色的颜色，而criollos的密度和柔软性均低于改良品种的谷粒。改良的细毛had草具有稻草或红色的植物和颖片的颜色，而criollos具有紫色的植物，具有黑色或紫色的颖片。软质感的克里奥洛仁比较硬的改良仁更少。煮熟的水分含量为53-55％的尼克松最适合加工成玉米饼。与Sureño（在加工过程中用作阳性对照）相比，两者均改善了肉馅。 criollos产生了较暗，不太可接受的玉米饼。 criollos制成的Masa和玉米饼在煮石灰时特别是在烘烤过程中变黑。所有高粱及其各自的玉米饼具有相似的化学组成。在洪都拉斯繁殖的改良的细鳞动物具有明显改善的植物和颖果颜色，并带有白色果皮。高粱的整体玉米饼品质也得到了改善。

BACKGROUND & AIMS: OBJECTIVES:Numerous studies link low objective and subjective socioeconomic status (SES) to chronic activation of the hypothalamic pituitary adrenal (HPA) axis. Here, we examine associations between objective and subjective SES and diurnal salivary cortisol, a primary HPA component, as well as demographic and ecological predictors associated with SES perceptions and changes in diurnal cortisol. METHODS:Participants were residents (age 18-79, n = 61) of Utila, a Honduran island where economic disparities are overt and geographically contained. Objective SES was measured as a composite of income, education, and occupation. Subjective SES was measured with a MacArthur ladder and a perceived lifestyle discrepancy (PLD) scale. Salivary cortisol was collected three times per day for two days. Questions addressing demographic, social, and household characteristics were assessed as predictors of PLD. RESULTS:Assessed independently, objective SES (P = .06) and PLD (P = .003) were associated with the steepness of diurnal cortisol changes, while PLD was also associated with higher cortisol area under the curve (AUC) (P = .036). Modeled together, only PLD predicted diurnal slope and AUC. PLD was associated with household sanitation, immigration status, food scarcity, objective SES, and owing money. Only access to sanitation and owing money had direct associations with cortisol that were not mediated by PLD. CONCLUSIONS:For adults on Utila, perceptions of unmet need outweigh other social and economic status factors in predicting cortisol AUC and slope. In addition, the unmediated effects of access to sanitation and owing money on cortisol suggest that these distinct aspects of inequality are important to consider when seeking to understand how inequality can impact HPA function.

背景与目标： 目的：许多研究将低客观和主观的社会经济地位（SES）与下丘脑垂体肾上腺（HPA）轴的慢性激活联系起来。在这里，我们研究了客观和主观SES与昼夜唾液皮质醇（HPA的主要成分）之间的关联，以及与SES感知和昼夜皮质醇变化相关的人口和生态预测因子。
方法：参与者是洪都拉斯岛乌蒂拉岛（Utila）的居民（年龄18-79岁，n =）61），那里的经济差异明显且地理分布有限。客观SES是收入，教育和职业的综合指标。使用MacArthur阶梯和感知的生活方式差异（PLD）量表测量主观SES。每天两次收集唾液皮质醇，持续两天。解决人口，社会和家庭特征的问题被评估为PLD的预测因素。
结果：独立评估，客观SES（P = .06）和PLD（P = .003）与昼夜皮质醇变化的陡度有关，而PLD也与曲线下的高皮质醇面积（AUC）有关（P =）。 036）。一起建模，只有PLD预测日斜率和AUC。 PLD与家庭卫生，移民状况，食物短缺，客观的SES和欠款有关。只有获得卫生条件和欠款才与皮质醇有直接联系，而这种联系不是由PLD调解的。
结论：对于Utila地区的成年人来说，在预测皮质醇AUC和坡度时，未满足需求的感知要超过其他社会和经济状况因素。此外，获得卫生设施和欠款对皮质醇的无中介影响表明，在试图了解不平等如何影响HPA功能时，应考虑到不平等的这些不同方面。

BACKGROUND & AIMS: :The first phase of the PROALMA project in Honduras resulted in changed hospital breastfeeding practices within as little as 2 years. These changes affected the community, lengthening the duration of exclusive breastfeeding to 1-2 months and the duration of any breastfeeding to 12 months. The second phase of the project sought to extend the program nationwide. One of the original pilot hospitals in San Pedro Sula was well along in breastfeeding promotion but felt there were still problems in breastfeeding education and the integration with family planning services. Following retraining of staff and the opening of a Breastfeeding Clinic and a Temporary Methods Family Planning Clinic, there have been improvements in both areas.

背景与目标： ：洪都拉斯PROALMA项目的第一阶段在短短2年内改变了医院的母乳喂养习惯。这些变化影响了社区，将纯母乳喂养的时间延长到1-2个月，任何母乳喂养的时间延长到12个月。该项目的第二阶段试图将该计划扩展到全国。圣佩德罗苏拉（San Pedro Sula）最初的一家试点医院在促进母乳喂养方面进展良好，但认为母乳喂养教育以及与计划生育服务的融合仍然存在问题。在对工作人员进行再培训以及开设母乳喂养诊所和临时方法计划生育诊所之后，这两个领域都得到了改善。

BACKGROUND & AIMS: INTRODUCTION:Hurricane Mitch was an event described as one of the most damaging recent natural disasters in our hemisphere. This study examined its effects on a community of 5,000 residents in northern Honduras. METHODS:Survey responses of 110 attendants at an ambulatory clinic 4 months after the event were analyzed. Correlates were established between demographic and housing characteristics and morbidity and mortality. RESULTS:The availability of food, water, and medical care decreased significantly immediately after the hurricane, but by four months afterward returned to baseline values. Residents reported emotional distress correlated with the loss of a house or intrafamilial illness or mortality. Diarrheal illnesses more commonly were found in households with poor chronic access to medical care. The use of cement block housing correlated with availability of food or running water, with access to medical care and vaccinations, and with a reduced frequency of diarrhea or headaches in the immediate post-hurricane phase. CONCLUSIONS:Improvements in housing construction appear to be the most effective preventive measure for withstanding the effects of future hurricanes in tropical regions similar to northern Honduras.

背景与目标： 简介：米奇飓风是被描述为我们半球最近最具破坏性的自然灾害之一。这项研究检查了其对洪都拉斯北部5000名居民社区的影响。
方法：对事件发生后4个月在门诊诊所的110名服务员的调查反应进行了分析。在人口和住房特征以及发病率和死亡率之间建立了相关性。
结果：飓风过后，食物，水和医疗的可利用性显着下降，但到四个月后恢复到基准值。居民报告称情绪困扰与房屋损失或家庭内疾病或死亡相关。腹泻病多见于长期无法获得医疗服务的家庭。水泥砌块房屋的使用与食物或自来水的供应量，获得医疗护理和疫苗接种以及飓风过后立即减少的腹泻或头痛频率有关。
结论：住房建设的改善似乎是抵御类似于洪都拉斯北部的热带地区未来飓风的影响的最有效的预防措施。

BACKGROUND & AIMS: BACKGROUND:Monitoring infectivity markers in multi-transfused patients is an important indicator of the efficiency and quality of testing in blood centers. This study is part of a regional initiative to bring both national and regional attention to the problem of hepatitis C, compare the threat of HCV to that of HBV and HIV; assess the risks for viral infection of using different blood products and implementing different transfusion practices, and contribute to a better understanding of the state of blood safety in the region. STUDY DESIGN AND METHODS:A cross sectional study was conducted from September 2002 to August 2003 and included multi-transfused patients from eight private, public and Social Security hospitals from Tegucigalpa and San Pedro Sula, Honduras. A survey was completed for each patient which included demographic and clinical data. Patients were tested for HBsAg, anti-HBc, anti-HIV and anti-HCV Effects of the exposure to blood products, to whole blood; to lyophilized factor VIII in patients living with hemophilia on the prevalence of HBV, HCV and HIV infection were evaluated. RESULTS:Five hundred and two patients were enrolled in the study; 11% were positive for HBsAg; 27% for anti-HBc; 7% for HCV and 1% for HIV One point six percent of hemophilia patients were positive for HBsAg; 38% were positive for anti-HBc and 26.9% for HCV A dose effect between the exposure to blood products and prevalence of HCV was found (p < 0.05). It was not possible to show a dose effect between the exposure to blood products and prevalence of either HBV or HIV in any of the subpopulations studied. CONCLUSIONS:The transfusion of blood products seems to be the main factor for HCV seropositivity in the subpopulation of patients studied. Additional work is needed to elucidate the risk factors associated with HBV infection in Honduras.

背景与目标： 背景：监测多次输血患者的感染性标志物是血液中心检测效率和质量的重要指标。这项研究是一项地区计划的一部分，旨在使国家和地区都关注丙型肝炎问题，将HCV的威胁与HBV和HIV的威胁进行比较；评估使用不同血液制品和实施不同输血方法引起的病毒感染风险，并有助于更好地了解该地区的血液安全状况。
研究设计和方法：2002年9月至2003年8月进行了一项横断面研究，纳入了来自洪都拉斯特古西加尔巴和圣佩德罗苏拉的八家私立，公立和社会保障医院的多次输血患者。已完成对每位患者的调查，其中包括人口统计学和临床​​数据。对患者进行了HBsAg，抗HBc，抗HIV和抗HCV检测。评估血友病患者冻干因子VIII对HBV，HCV和HIV感染的患病率。
结果：本研究共纳入502例患者。 HBsAg阳性的占11％；抗HBc的27％； HCV为7％，HIV为1％。6％的血友病患者HBsAg阳性。抗HBc阳性38％，HCV阳性26.9％。发现从血液制品接触到HCV流行之间存在剂量效应（p <0.05）。在所研究的任何亚人群中，都不可能显示出暴露于血液制品与HBV或HIV患病率之间的剂量效应。
结论：输血似乎是所研究患者亚群中HCV血清阳性的主要因素。需要进一步的工作来阐明洪都拉斯与HBV感染相关的危险因素。