PurposeCervical cancer is an important cause of mortality in low- and middle-income countries. Although screening technologies continue to improve, systems of care remain fragmented. It is important to better understand factors that affect use of screening services and loss to follow-up along the care continuum.MethodsWe conducted a mixed-methods study of a cytology-based screening program in rural Guatemala. A retrospective electronic chart review was performed on data from all patients from 2013 to 2014. We analyzed progression through care and calculated loss–to–follow-up rates. We also analyzed the prior experiences of patients with cervical cancer screening on the basis of self-reported historical data available in the chart review. Structured interviews with a subset of individuals to explore social supports and barriers to screening and engagement in care were conducted at the time of screening.ResultsThe analysis included 515 women (median age, 36 years). Cytologic screening showed concern for neoplastic changes in 0.83%; half resulted in biopsy-proven cervical intraepithelial neoplasia. An additional 9.9% showed severe inflammation. The rate of loss to follow–up was 11.3%. All losses to follow-up occurred for severe inflammation, not for cervical intraepithelial neoplasia. Historical data showed that 73% of the cohort had previously been screened and had high levels of loss to follow-up (57.4%). Qualitative interviews revealed factors that promoted loss to follow-up; these included cost, lack of social supports, transportation, distrust in public facilities, long turn-around times, and failure to return test results or offer follow-up treatments.ConclusionsTaken together, these quantitative and qualitative results highlight the need for cervical cancer screening programs in Guatemala to improve uptake of screening services by eligible women and to improve follow-up after a first abnormal screen.

Continuous glucose monitoring (CGM) systems have been explored in a few studies for non-intensive care unit (ICU) patients (1-3). During the coronavirus disease 2019 (COVID-19) pandemic, shortage of personal protective equipment (PPE) became a concern. On 1 April 2020, the U.S. Food and Drug Administration announced it would not object to the use of CGM systems to assist with COVID-19 patient monitoring (4). This study was conducted to explore the feasibility of using CGM in noncritically ill patients hospitalized with COVID-19. Non-ICU adult COVID-19-positive patients receiving subcutaneous insulin injection and point of care (POC) glucose testing (Accu-Chek Inform II) were eligible to participate. Exclusion criteria included unstable glucose levels (POC glucose ,70 or .350 mg/dL) at entry, hypotension, significant edema, being on dialysis, being postsurgical or with planned surgery/computed tomography/ MRI, and taking hydroxyurea, ascorbic acid, or acetaminophen .1 g every 6 h. Participants gave informed consent. The protocol was approved by the Institutional Review Board at the University of Illinois at Chicago.

Guatemala has one of the highest rates of child stunting in the world; the indigenous Maya population, who constitute a majority, are disproportionately affected in comparison to the general population. Nevertheless, research on the social dynamics of malnutrition in Maya communities is lacking. To address this deficiency, we present here an ethnographic study of caregivers' experiences of child malnutrition in two rural indigenous towns, supplemented by quantitative data collection on rates of child malnutrition in both study sites. Our research documents the ways in which child malnutrition is a "normalized" total experience for communities and caregivers, heavily influenced by local and structural inequalities, and we explore the policy implications of our findings for effective child nutrition programming.

Background and Aims: Guatemala has one of the highest rates of child stunting in the world, which especially impacts rural indigenous agricultural communities. Despite decades of intensive nutrition research and interventions, only rarely have nutrition programs successfully lowered the rate of stunting in these settings. The bulk of nutritional interventions in Guatemala are targeted at the education of female caregivers. However, women's ability to implement best practices in infant breastfeeding and complementary feeding are often constrained by external factors. This study evaluated the knowledge, beliefs, and practices of female caregivers, as well as the attitudes of fathers, toward breastfeeding and infant feeding in a rural Guatemalan village. Methods: Clinical work, participant-observation, surveys, interviews, and focus groups were conducted in a rural Guatemalan village in conjunction with a child feeding program from August 2008 to January 2011. Results: Male employment status, mental health, and attitudes towards child rearing and parenting responsibilities are often principal factors in infant growth failure. Conclusions: Successful child feeding programs must include educational elements for men and should consider structural elements that provide a safety net for unexpected changes in domestic finances.