Managua, Nicaragua

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PubMed | University of Managua, Sustainable science Institute of Nicaragua, Hospital Dr Roberto Calderon Gutierrez and Emory University
Type: Journal Article | Journal: Journal of the International Association of Providers of AIDS Care | Year: 2014

Adverse drug reactions (ADRs) to antiretroviral therapy (ART) are an important cause of hospitalization, treatment discontinuation, and regimen changes in both developed and developing countries. This study is the first to examine and understand ADRs in HIV-infected patients in Nicaragua.A retrospective descriptive study was conducted from May 2010 to March 2011, in a cohort of HIV-infected patients receiving ART at the largest public hospital in Managua, Nicaragua. Patients were identified based on ADRs reporting on a standardized antiretroviral pharmacotherapy form. Subsequently, chart reviews of these patients were performed in order to document the specific ADRs.Six hundred ninety-two patients on ART were included. The incidence of ADRs was 6.4% (95% confidence interval [CI] 4.5-8.2). Females demonstrated a higher incidence, that is, 10.2% (95% CI 5.3-15.1, P = .020). Patients treated with combinations of zidovudine (ZDV)/lamivudine (3TC) and emtricitabine (FTC)/tenofovir (TDF) had fewer ADRs (P < .01) than those using other combinations. Five patients were hospitalized or had a prolonged hospitalization secondary to ADRs, with no mortality attributed to ADR. The most common manifestations of ADRs were central nervous system (20 of 44), gastrointestinal (12 of 44), and dermatologic (8 of 44) reactions. Adverse drug reactions were classified as likely ADRs (25 of 44) and possible ADRs (19 of 44). No ADRs were preventable.Adverse drug reactions most frequently affected the central nervous system. No ADR was life threatening. The frequency of ADRs in this Nicaraguan patient population was less than that reported from other studies in resource-limited settings.


PubMed | University of Managua and Johns Hopkins University
Type: | Journal: Frontiers in public health | Year: 2016

HIV in Nicaragua is concentrated among key populations (KPs) - men who have sex with men, female sex workers, and female transgender - in whom prevalence is 600-4,000 times higher than the general population. The United States Agency for International Development PrevenSida project is aimed at increasing healthy behavior among KPs and people with HIV and improving testing, counseling, and continuity of prevention and treatment by building capacity and improving performance of non-governmental organizations (NGOs) providing services to KPs. We evaluated the cost-effectiveness of PrevenSidas activities.This retrospective observational evaluation used individuals in KPs covered by NGOs receiving assistance from PrevenSida from 2012 to 2014. Cost-effectiveness analysis compared PrevenSidas intervention with business-as-usual. Model inputs were generated from epidemiological modeling and PrevenSidas records.By 2014, 24 NGOs received grants and technical assistance from PrevenSida with 72,955 people in KPs served at $11.32/person ($9.39-$16.55/person, depending on region). The estimated incremental cost-effectiveness ratio was $50,700/HIV case averted or $2,600/Disability-adjusted Life Year (DALY) averted (95% CI: $1,000-$99,000 and $50-$5,100, respectively).PrevenSida distributed about $600,000 in grants and used $230,000 to support 24 NGOs in 2014. Cost-effectiveness from the program perspective compared to no program was slightly over half of GDP per capita per DALY averted, considered highly cost-effective by WHO criteria. Cost and efficiency varied by region, reflecting the number of people in KPs receiving services. Cost-sharing by NGOs improved cost-effectiveness from the program perspective and likely promotes sustainability. Focused interventions for KP service provision organizations can be acceptably efficient in this setting.


Broughton E.I.,Bethesda University | Gomez I.,University of Managua | Sanchez N.,Hospital Bertha Calderon | Vindell C.,Hospital Bertha Calderon
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2013

Objective. To examine the costs of implementing kangaroo mother care (KMC) in a referral hospital in Nicaragua, including training, implementation, and ongoing operating costs, and to estimate the economic impact on the Nicaraguan health system if KMC were implemented in other maternity hospitals in the country. Methods. After receiving clinical training in KMC, the implementation team trained their colleagues, wrote guidelines for clinicians and education material for parents, and ensured adherence to the new guidelines. The intervention began September 2010. The study compared data on infant weight, medication use, formula consumption, incubator use, and hospitalization for six months before and after implementation. Cost data were collected from accounting records of the implementers and health ministry formularies. Results. A total of 46 randomly selected infants before implementation were compared to 52 after implementation. Controlling for confounders, neonates after implementation had lower lengths of hospitalization by 4.64 days (p = 0.017) and 71% were exclusively breastfed (p < 0.001). The intervention cost US$ 23 113 but the money saved with shorter hospitalization, elimination of incubator use, and lower antibiotic and infant formula costs made up for this expense in 1-2 months. Extending KMC to 12 other facilities in Nicaragua is projected to save approximately US$ 166 000 (based on the referral hospital incubator use estimate) or US$ 233 000 after one year (based on the more conservative incubator use estimate). Conclusions. Treating premature and low-birth-weight infants in Nicaragua with KMC implemented as a quality improvement program saves money within a short period even without considering the beneficial health effects of KMC. Implementation in more facilities is strongly recommended.


PubMed | University of Managua and Bethesda University
Type: | Journal: Nursing research and practice | Year: 2014

Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We evaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and retention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+ mothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinating multidisciplinary care. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and after implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital teams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementers perspective. Results. Opportunistic infections decreased by 24% (95% CI: 14%-34%) and 11.3% of patients improved in CDC clinical stage. Average per-patient costs decreased by $133/patient/year (95% CI: $29-$249). The intervention, compared to business-as-usual strategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible patients to receive therapy. We recommended the intervention be implemented in all HIV service facilities in Nicaragua.


The recent food price crisis has been used by public and private investors to justify land grabbing in sub-Saharan Africa. At the same time, it has reopened the debate on agricultural development models and drawn attention to the differences between small-scale and largescale farming. After reviewing the public debate around these issues-one that has featured many sensationalist announcements about land grabbing, but very little concrete evidence about the scope and magnitude of thisphenomenon-thispaper offers newinsights into the debate about the advantages and disadvantages of different agricultural development models. Family farms are the dominant type of agriculture worldwide, and their diversity expresses a « continuum » of stages that reflects the shape of agrarian systems and markets. The resilience of family farms can be explained by their many advantageswhen compared to large-scale corporate farms, and agricultural history has shown their outstanding capacity for innovation, largely determined by economic and institutional conditions. In Africa, where most family farmers are poor, the lack of technical and financial assets, exacerbated by adverse environmental conditions, is the source of strong constraints that inhibit productivity growth in the small-scale farming sector. In such a context, large-scale corporate agriculture might appear to be an attractive alternative, but abandonment of family farms is not a feasible option. Continuing support of family farms, at least for the foreseeable future, is dictated by the structure of African economies, most of which are characterized by a lack of economic diversification and the considerable weight of agriculture in the labor force.


Avellan D.R.,University of Managua | Avellan D.R.,National Autonomous University of Mexico | Macias J.L.,National Autonomous University of Mexico | Pardo N.,Massey University | And 2 more authors.
Journal of Volcanology and Geothermal Research | Year: 2012

The Nejapa Volcanic Field (NVF) is located on the western outskirts of Managua, Nicaragua. It consists of at least 30 volcanic structures emplaced along the N-S Nejapa fault, which represents the western active edge of the Managua Graben. The study area covers the central and southern parts of the volcanic field. We document the basic geomorphology, stratigraphy, chemistry and evolution of 17 monogenetic volcanic structures: Ticomo (A, B, C, D and E); Altos de Ticomo; Nejapa; San Patricio; Nejapa-Norte; Motastepe; El Hormigón; La Embajada; Asososca; Satélite; Refinería; and Cuesta El Plomo (A and B). Stratigraphy aided by radiocarbon dating suggests that 23 eruptions have occurred in the area during the past ~. 34,000. years. Fifteen of these eruptions originated in the volcanic field between ~. 28,500 and 2,130. yr BP with recurrence intervals varying from 400 to 7,000. yr. Most of these eruptions were phreatomagmatic with minor strombolian and fissural lava flow events. A future eruption along the fault might be of a phreatomagmatic type posing a serious threat to the more than 500,000 inhabitants in western Managua. © 2011 Elsevier B.V.


Singh P.,Villanova University | Klingler J.,Villanova University | Dougherty E.,Villanova University | Moncada M.V.,University of Managua
ASEE Annual Conference and Exposition, Conference Proceedings | Year: 2015

The entrepreneurial mindset has a number of attributes including curiosity about the world around you, discovery of opportunities, prototyping and vetting technology/business solutions and then executing on the venture. International development projects offer many possibilities to learn about an environment that students are not used to seeing and through observation, see opportunities for technology-based solutions to developing world problems. We have used this methodology for several senior design projects in the past and more recently have developed courses specifically to develop these attributes in electrical and computer engineering students. A two course sequence has been piloted for the first time this year. In the first course, taken by students in their junior year, the students are given the cultural context in a developing country (in particular, the present course's focus has been on Nicaragua). This topic is followed by a Spring break trip to Nicaragua and the students live out in rural communities to discover potential projects that have technical merit and offer potential business opportunities. The project proposals are then developed by students from a US university and a Nicaraguan university. In the second course, in parallel with the actual project design, the students take a business model development course to understand business models and how to produce them. They then use this knowledge to develop a business model for their particular projects. In the paper, details of the two courses will be presented along with student outcomes being measured in terms of how well the entrepreneurial mindset is being instilled. © American Society for Engineering Education, 2015.


Garache M.S.,University of Managua
Proceedings of the 2014 IEEE Central America and Panama Convention, CONCAPAN 2014 | Year: 2014

Multi-carrier High Speed Downlink Packet Access (HSDPA) technology, in Universal Mobile Telecommunications Service Cellular Networks (UMTS), allows efficient Radio Resource Management (RRM) of spreading codes, transmission power, and interference rise per carrier. However, poor radio network planning and configuration parameters can limit HSDPA system capacity, measured in terms of average user throughput. In this paper, we analyze the downlink throughput degradation problem that can occur as the traffic increases from low to moderate levels. A real network is studied and, in order to increase the capacity, we reduce the other-to-own-interference by optimizing antenna tilts and power optimization of physical channels. The results show that proper network planning significantly improves the average user throughput (up to 55% improvement) and contributes to the system RRM to exploit high spectral efficiency per carrier. © 2014 IEEE.


Santos-Cluters S.,University of Managua | Villanueva-Ortiz J.,University of Managua | Munguia-Mena M.,University of Managua
Proceedings of the 2014 IEEE Central America and Panama Convention, CONCAPAN 2014 | Year: 2014

In this paper, the method proposed in ¡Error No se encuentra el origen de la referencia. was extended by introducing two new features: Fm and Bm. These features use time scaling to take into account all the beat morphology and to compensate due to the differences in heart rates from patient to patient. The database consists of before and after angioplasty recordings as well as reference recordings. The assessment of the new features was carried out at two levels: intra-patient (by patient), and inter-patients (all patients). Moreover, the performances of the new features were compared to the feature proposed in ¡Error No se encuentra el origen de la referencia. The results at the intra-patient level showed that the accuracy of SVM classifier for Fm and Bm parameters, on average, increased by 4.2% and 4% respectively. At the inter-patients level the increase was 10% for Fm and 6% for Bm when before angioplasty and reference recordings were compared. In addition, statistical significance was obtained for first principal component analysis coefficient. © 2014 IEEE.


PubMed | University of Managua and Federal University of Pelotas
Type: Journal Article | Journal: Brazilian oral research | Year: 2016

The aim of this study was to assess the prevalence of black stains (BS) and factors associated with their occurrence and to investigate the association of BS with caries experience after adjusting for other risk indicators. A school-based, cross-sectional study using multistage sampling of children aged 10-12 years from 20 private and public schools in Pelotas/Southern Brazil was conducted (n = 706). Children were evaluated for BS and dental caries (DMFT/dmft index) and socioeconomic information was collected by questionnaire. Univariate and multivariate Poisson regressions were used to assess variables associated with the prevalence of BS and with caries experience. The prevalence of BS was 5.81%. The mean DMFT/dmft was 1.54 (1.91), with a maximum value of 10. Among the children with BS, mean dmft/DMFT was 1.22 (SD 1.68), with a maximum value of 6. After adjustments for demographics and socioeconomic variables, dental plaque and tooth brushing habits, prevalence of BS was associated with lower caries experience (RR 0.67; 95%CI 0.49-0.92). In conclusion, the presence of BS showed an association with lower dental caries experience in the evaluated population. Future studies should investigate the mechanisms behind this association.

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