This study reports on community surveys of 160 representative Latino adults in Hartford, CT, Edinburg, TX, Guadalajara, Mexico; and in rural Guatemala. A 142-item questionnaire covered asthma beliefs and practices (e.g., causes, symptoms, and treatments). The cultural consensus model was used to analyze the agreement among respondents within each sample and to describe beliefs. Beliefs were then compared across the four samples. Analysis of the questionnaire data shows that there was overall consistency or consensus regarding beliefs and practices among individuals at each site (intraculturally) and to a lesser extent across respondents of all four different Latino cultural groups (i.e., interculturally). This pattern of response is indicative of a shared belief system among the four groups with regard to asthma. Within this shared belief system though, there is systematic variation between groups in causes, symptoms, and treatments for asthma. The most widely recognized and shared beliefs concerned causes of asthma. Notable differences were present between samples in terms of differences in beliefs about symptoms and treatments. The biomedical model is shown to be a part of the explanatory model at all sites; in addition to the biomedical model, ethnocultural beliefs such as the humoral ("hot/cold") aspects and the importance of balance are also evident. The Connecticut Puerto Ricans had a greater degree of shared beliefs about asthma than did the other three samples (p < 0.00005). It was concluded that the four Latino groups studied share an overall belief system regarding asthma, including many aspects of the biomedical model of asthma. In addition, traditional Latino ethnomedical beliefs are present, especially concerning the importance of balance in health and illness. Many beliefs and practices are site-specific, and caution should be used when using inclusive terms such as "Hispanic" or "Latino," since there is variation as well as commonality among different ethnic groups with regard to health beliefs and practices.

The cultural consensus model facilitated assessment of cultural beliefs regarding diabetes and diabetes management. Overall, Latino cultural beliefs about diabetes were concordant with the biomedical model. Variation in responses tended to characterize less knowledge or experience with diabetes and not different beliefs.

Rationale: Gastrointestinal fistulas (GIF) represent a severe and potentially lethal complication in hospital surgical patients. However, evidences are lacking about prognosis and outcomes of GIF in Latin America (LATAM) hospitals. Objective: To describe the prognosis and outcomes GIF in LATAM hospitals. Study design: Prospective, longitudinal, cohort-type study. The cohort fostered three cross-sectional examinations: First examination: On admission of the patient in the study; Second examination: Thirty days later; and Third (and last) examination: Sixty days after patient's admission. Study serie: One hundred seventy-seven patients (Males: 58.2 %; Average age: 51.0 ± 16.7 years; Ages ≥ 60 years: 36.2 %) diagnosed with, and assisted for, GIF (ECF: Enterocutaneous: 64.9 % vs. EAF: Enteroathmospheric: 35.1 %) in 76 LATAM (13 countries) and Europe (4) hospitals. Methods: Condition (Alive vs. Deceased) and hospital status (Hospitalized vs. Discharged) of the patient, and the GFI patency (Closed vs. Non closed) were recorded in each of the cohort's examination. Indicators of GFI prognosis thus constructed were correlated demographical, sanitary, surgical and nutritional characteristics of the patients. Results: On conclusion of the study indicators of GIF prognosis behaved as follows: Mortality: 14.7 %; Prolonged hospitalization: 46.3 %; Spontaneous closure of GIF: 36.2 %. Only the type of GIF influenced upon patient's survival: ECF: 87.0 % vs. EAF: 82.3 % (Δ = +4.7 %; χ2 = 6.787; p < 0.05). Similarly, in each examination of the cohort, the number of surviving subjects was always greater among those with ECF: After 30 days: ECF: 92.1 % vs. EAF: 83.9 % (Δ = +8.2 %); After 60 days: ECF: 98.1 % vs. EAF: 90.4 % (Δ = +7.7 %; χ2 = 13.764; p < 0.05). Conclusions: Currently, only the type of GIF influences upon survival of the patient.

SUMMARYRationalePrognosis and outcomes of gastrointestinal fistulas (GIF) might depend upon the operational characteristics of the hospital containing and caring for the patients.ObjectiveTo assess how selected operational characteristics of the hospital participating in the exercises of the “Fistula Day” Project (FDP) influence upon prognosis and outcomes of GIF.Study designCohort-type study. Enrolled patients were followed for 60 days. Three cross-sectional examinations were made during the completion of the exercises of the FDP, namely, upon admission of the patient in the study, and 30 and 60 days after admission.Study serieSeventy-six hospitals of Latin America (13 countries) and Europe (4).MethodsAssociations between survival of the patient, prolongation of hospital stay, and (likely) spontaneous closure of the fistula, on one hand; and selected operational characteristics of the participating hospital, on the other; were assessed.ResultsSpecialties hospitals prevailed. Most of the hospitals assisted between 1 – 2 GIF patients a month. Participating hospitals distributed evenly regarding the number of beds. Most of the hospitals had an intensive care unit. Similarly, three-quarters of the hospitals had a multidisciplinary unit dedicated to clinical and hospital nutrition. However, a unit dedicated to the management of intestinal failure and/or postoperative fistulas was present only in a fifth of them. Experience of the physician attending GIF was rated between “Expert” and “High” in one third of the hospitals. Number of hospitals beds associated with increased survival of GIF patients (χ2 = 5.997; p = 0.092), prolonged hospital stay (χ2 = 7.885; p < 0.05), and higher rate of spontaneous closure of the fistula (χ2 = 11.947; p < 0.05). In addition, rate of spontaneous closure of the fistula was (marginally) higher among patients assisted by a hospital unit specialized on intestinal failure (χ2 = 3.610; p = 0.0574). On the other hand, survival of the patient was dependent (also marginally) upon the number of patients assisted in a month (χ2 = 5.934; p = 0.0514).ConclusionsIt is likely number of hospital beds to determine prognosis and outcomes of GIF. Other operational characteristics of the hospital might exert a marginal influence upon survival of the patient and the likely spontaneous closure of the fistula.

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We investigate whether age profiles of ethnobiological knowledge developmentare consistent with predictions derived from life history theory about the timing ofproductivity and reproduction. Life history models predict complementary knowledgeprofiles developing across the lifespan for women and men as they experiencechanges in embodied capital and the needs of dependent offspring. We evaluatethese predictions using an ethnobiological knowledge assessment tool developedfor an off-grid pastoralist population known as Choyeros, from Baja California Sur,Mexico. Our results indicate that while individuals acquire knowledge of most dangerousitems and edible resources by early adulthood, knowledge of plants and animalsrelevant to the age and sex divided labor domains and ecologies (e.g., women’shouse gardens, men’s herding activities in the wilderness) continues to develop intomiddle adulthood but to different degrees and at different rates for men and women.As the demands of offspring on parents accumulate with age, reproductive-agedadults continue to develop their knowledge to meet their children’s needs. After controllingfor vision, our analysis indicates that many post-reproductive adults showthe greatest ethnobiological knowledge. These findings extend our understanding ofthe evolved human life history by illustrating how changes in embodied capital andthe needs of dependent offspring predict the development of men’s and women’sethnobiological knowledge across the lifespan.

Aims.-To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. Methods.-Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. Results.-1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m 2 , HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP

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