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Background: Previously, a study conducted by UNICEF found that malnutrition affects approximately 80% of the indigenous children in Guatemala. Objective: Identify prevalence and risk factors for stunted growth in communities surrounding Lake Atitlán, Guatemala. Methods: Height-forage measurements of children under the age of five, N = 84, determined stunting prevalence and presumed burden of malnutrition in this region of the Guatemalan highlands. Mothers of a subset of this sample, N = 29, were interviewed to assess factors contributing to stunting. Analysis assessed the following risk factors: inadequate nutrition, increased infectious disease risk, high rate selfreport illness, inadequate breastfeeding, and inadequate utilization of prenatal care. Findings: The majority of children under the age of five were stunted (65.6%) and likely malnourished. ANOVA analysis showed significant differences in mean height-forage Z scores (HAZs) between groups with and without adequate nutrition (F = 7.069, p = 0.013), as well has with and without high rates of self-report illness (F = 6.894, p = 0.014). Both groups with inadequate nutrition (mean HAZs =-2.9, 95% CI = [-3.58,-2.24]) and high rates of self-report illness (mean HAZs =-2.8, 95% CI = [-3.13,-2.38]) had mean HAZs that are indicative of stunting. No other risk factors were associated with stunting. Conclusion: These pilot study results offer methods by which to obtain baseline data for assessing nutritional and public health interventions to improve stunting and malnutrition status as well as the health outcomes of children in rural, indigenous communities.

Background: Electromagnetic navigational bronchoscopy (ENB) has been shown to have variable diagnostic accuracy for the assessment of peripheral pulmonary nodules. This may be because of discrepancies between the preplanned computed tomography of chest target lesion location versus actual target location (computed tomography-to-body divergence), and the lack of a continuous navigational image. The ILLUMISITE (Medtronic, Minneapolis, MN) is a newly developed ENB platform that utilizes tomosynthesis, an imaging technology that can visualize the target location using fluoroscopy (F-ENB). This new system also allows for intraprocedural positional correction and continuous navigation guidance during sampling to overcome these limitations and improve diagnostic yield. We report our first experience in a single center, single proceduralist using this new technology. Methods: We conducted a retrospective, single center, single operator study reviewing 72 consecutive patients (78 nodules) over a 3-month period. We investigated the overall diagnostic yield and diagnostic yield by nodule location, size, and sedation type using this new F-ENB system. Results: The overall diagnostic yield was 87% and pnemothoraces occurred in 2/78 procedures. We did not find any statistically significant difference when comparing pulmonary nodule location, size or sedation method utilized ( P =0.231, 0.338, and 0.112, respectively). Sixty-nine percent of the pulmonary nodules biopsied were 2 to 3 cm in size. The average distance corrected after tomosynthesis visualization was 15.4 mm (0.4 to 29.8 mm). Conclusion: We report our initial experience with the ILLUMISITE system using fluoroscopic tomosynthesis-assisted visualization with continuous navigational guidance at our institution. This new technology allows the operator to correct for better target lesion alignment and real time positional correction and may improve diagnostic yields with minimal complications for evaluation of peripheral pulmonary nodules.

Mindfulness is a skill of intentionally directing one's attention to emotions, thoughts, or physical sensations with an open-minded, non-judgmental attitude. Mindfulness can enable a person to experience challenging feelings or situations without reacting impulsively or automatically. Mindfulness training may be provided to smokers to help them manage smoking triggers, urges, stress, or negative emotions without smoking. Randomized controlled trials have now shown that mindfulness training for smokers (MTS) yields smoking abstinence rates that are equal to or higher than matched behavioral treatments. We describe a comparative observational study on MTS within an ongoing clinical program. The study was conducted with a naturalistic design and utilized no procedures or evaluations beyond those already employed in clinical practice. All participants were advised to use FDA-approved smoking cessation medications and were provided with a choice of two behavioral treatments-MTS (selfpay) or the Wisconsin Tobacco Quit Line (WTQL) (free). Over a 12-month study period, 181 clinic patients enrolled; 65.75% (119) choose MTS and 34.25% (62) choose WTQL. MTS compared to WTQL treatment initiators showed significantly higher biochemically confirmed 7-day point prevalence smoking abstinence at 2 weeks postquit attempt (MTS = 47.00%, QL = 24.52%, p = .011, OR = 2.71). Intent-to-treat analysis showed similar outcomes (p = .019, OR = 2.45). The study provides evidence that MTS provided within clinical program leads to similar outcomes as found in randomized controlled trials. The strategic use of MTS within a smoking cessation program is discussed.

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Utilizing the Framework Method, qualitative research determined the effects of potential barriers to healthcare access faced by 15 self-selected, consenting Indigenous women living in three different communities in the Guatemalan highlands. The women were actively involved in the nutritional recuperation program of the Community Organization, a non-profit clinic. Data collection involved recorded interviews based on a questionnaire designed to ensure culture competency. Responses were grouped into categories based on their relation to potential barriers to healthcare access and were then coded based on impacts on healthcare seeking behaviours. Intercoder reliability was measured and negotiated agreement of results was conducted to reach 100% agreement.  Analyses of coded responses compared results between communities and between available sectors of healthcare (folk, public, and non-profit). Inductive reasoning was used to determine the effect of beliefs related to illness on healthcare seeking behaviour. Analyses showed significant differences in the impact of geographical barriers to healthcare access among communities across public and non-profit sectors of healthcare, p < 0.05, and demonstrated categorization of disease states and influence of beliefs related to illness on healthcare seeking behaviour. Results demonstrated a hierarchy of barriers, with barriers such as cost, perceived quality of care, trust of medical provider, and available time only showing a negative effect once the barrier of geography was overcome. Despite the sample bias, these results give insight into factors affecting healthcare seeking behaviours that could contribute to the low utilization of healthcare seen in this population.

The original publication is missing the following funding statement. "The study was funded by NIDA grant number P50DA027840." Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.