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Introduction: Implementation of evidence-based care for heavy drinking and depression remains low in global health systems. We tested the impact of providing community support, training, and clinical packages of varied intensity on depression screening and management for heavy drinking patients in Latin American primary healthcare. Materials and methods: Quasi-experimental study involving 58 primary healthcare units in Colombia, Mexico and Peru randomized to receive: (1) usual care (control); (2) training using a brief clinical package; (3) community support plus training using a brief clinical package; (4) community support plus training using a standard clinical package. Outcomes were proportion of: (1) heavy drinking patients screened for depression; (2) screen-positive patients receiving appropriate support; (3) all consulting patients screened for depression, irrespective of drinking status. Results: 550/615 identified heavy drinkers were screened for depression (89.4%). 147/230 patients screening positive for depression received appropriate support (64%). Amongst identified heavy drinkers, adjusting for country, sex, age and provider profession, provision of community support and training had no impact on depression activity rates. Intensity of clinical package also did not affect delivery rates, with comparable performance for brief and standard versions. However, amongst all consulting patients, training providers resulted in significantly higher rates of alcohol measurement and in turn higher depression screening rates; 2.7 times higher compared to those not trained. Conclusions: Training using a brief clinical package increased depression screening rates in Latin American primary healthcare. It is not possible to determine the effectiveness of community support on depression activity rates due to the impact of COVID-19. [ABSTRACT FROM AUTHOR]

• Standards of care play an important role in the clinical course of bacteraemia. • Definitive antibiotic treatment must be tailored according to susceptibility. • Timely CVC removal reduces mortality in bacteraemia. • ID consultations might enhance adherence to standards of care and improve quality of care. Despite high mortality rates, physicians can alter the course of the Staphylococcus aureus bacteraemia (SAB) by following recommended standards of care. We aim to assess the adherence of these guidelines and their impact on mortality. Substudy from a prospective cohort of hospitalized patients with SAB from three hospitals from Peru. Hazard ratios were calculated using Cox proportional regression to evaluate the association between 30-day mortality and the performance of standards of care: removal of central venous catheters (CVC), follow-up blood cultures, echocardiography, correct duration, and appropriate definitive antibiotic therapy. 150 cases of SAB were evaluated; 61.33% were MRSA. 30-day attributable mortality was 22.39%. CVC removal was done in 42.86% of patients. Follow-up blood cultures and echocardiograms were performed in 8% and 29.33% of cases, respectively. 81.33% of cases had appropriate empirical treatment, however, only 22.41% of MSSA cases were given appropriate definitive treatment, compared to 93.47% of MRSA. The adjusted regression for all-cause mortality found a substantial decrease in hazards when removing CVC (aHR 0.28, 95% CI: 0.10 - 0.74) and instituting appropriate definitive treatment (aHR 0.27, 95% CI: 0.08 - 0.86), while adjusting for standards of care, qPitt bacteraemia score, comorbidities, and methicillin susceptibility; similar results were found in the attributable mortality model (aHR 0.24, 95% CI: 0.08 - 0.70 and aHR 0.21, 95% CI: 0.06 - 0.71, respectively). Deficient adherence to standards of care was observed, especially definitive treatment for MSSA. CVC removal and the use of appropriate definitive antibiotic therapy reduced the hazard mortality of SAB. [ABSTRACT FROM AUTHOR]

Over the past two decades, practices of accountability have acquired a new presence in neoliberal governance and resource extraction in Peru. In the context of mining activity, generally refers to public mechanisms of evaluation and record-keeping through which citizens can make corporations and governments answerable to them. However, I argue that these practices often prioritize mining interests by enabling corporations to define and ultimately enforce standards of performance. This article focuses on a key process in the making of social and environmental accountability in mining projects: Environmental Impact Assessment (EIA). I show that the of the documents produced for the EIA (i.e., their required components, as established in legal frameworks) and the of making them public (participatory meetings and public forums) can take precedence over their content. I examine two aspects of the EIA that make this possible. First, the risks that are identified in the EIA are those that a company deems to be technically manageable based on the solutions and interventions that it has to offer. Second, the participatory process of the EIA creates collaborative relationships among state agents, corporations, NGOs, and communities that strengthen the EIA's claims of accountability while circumscribing the spaces for opposition to a proposed project. [ABSTRACT FROM AUTHOR]