Implementing community based inclusive development for people with disability in Latin America: a mixed methods perspective on prioritized needs and lessons learned.

BACKGROUND: Research on the needs of people with disability is scarce, which promotes inadequate programs. Community Based Inclusive Development interventions aim to promote rights but demand a high level of community participation. This study aimed to identify prioritized needs as well as lessons learned for successful project implementation in different Latin American communities. METHODS: This study was based on a Community Based Inclusive Development project conducted from 2018 to 2021 led by a Columbian team in Columbia, Brazil and Bolivia. Within a sequential mixed methods design, we first retrospectively analyzed the project baseline data and then conducted Focus Group Discussions, together with ratings of community participation levels. Quantitative descriptive and between group analysis of the baseline survey were used to identify and compare sociodemographic characteristics and prioritized needs of participating communities. We conducted qualitative thematic analysis on Focus Group Discussions, using deductive main categories for triangulation: 1) prioritized needs and 2) lessons learned, with subcategories project impact, facilitators, barriers and community participation. Community participation was assessed via spidergrams. Key findings were compared with triangulation protocols. RESULTS: A total of 348 people with disability from 6 urban settings participated in the baseline survey, with a mean age of 37.6 years (SD 23.8). Out of these, 18 participated within the four Focus Group Discussions. Less than half of the survey participants were able to read and calculate (42.0%) and reported knowledge on health care routes (46.0%). Unemployment (87.9%) and inadequate housing (57.8%) were other prioritized needs across countries. Focus Group Discussions revealed needs within health, education, livelihood, social and empowerment domains. Participants highlighted positive project impact in work inclusion, self-esteem and ability for self-advocacy. Facilitators included individual leadership, community networks and previous reputation of participating organizations. Barriers against successful project implementation were inadequate contextualization, lack of resources and on-site support, mostly due to the COVID-19 pandemic. The overall level of community participation was high (mean score 4.0/5) with lower levels in Brazil (3.8/5) and Bolivia (3.2/5). CONCLUSION: People with disability still face significant needs. Community Based Inclusive Development can initiate positive changes, but adequate contextualization and on-site support should be assured.

Comportamiento epidemiológico de la lepra en varios países de América Latina, 2011-2020

[RESUMEN]. Objetivo. Describir el comportamiento epidemiológico de la lepra en varios países latinoamericanos durante 2011-2020, tomando como base los indicadores de la Organización Mundial de la Salud (OMS). Método. Estudio transversal, descriptivo y cuantitativo con datos oficiales sobre incidencia y prevalencia en la población en general, niños, forma clínica y casos de discapacidad de grado 2 registrados por la OMS entre 2011 y 2020. Se seleccionaron los ocho países latinoamericanos con más casos y se realizaron análisis de estadística descriptiva simple y comparativa entre las variables. Resultados. Entre 2011-2020 se reportaron 301 312 casos de lepra en los países seleccionados: Argentina, Brasil, Colombia, Cuba, México, Paraguay, República Dominicana y Venezuela. Brasil fue el único con una prevalencia mayor a 1 por 10 000 habitantes y representó 93,77% de casos. En Brasil y República Dominicana se observó un aumento de la prevalencia durante 2011-2019, mientras que en los demás países esta tendió a disminuir. La enfermedad fue más frecuente en hombres, y los casos multibacilares superaron significativamente a los paucibacilares. En Brasil se encontraron las mayores incidencias de casos de lepra infantil y discapacidad de grado 2 durante el período evaluado. Conclusión. A pesar de que en América Latina la lepra solo es considerada un problema de salud pública en Brasil, la mayoría de los países de la región continúa reportando casos cada año, lo que revela una falta de atención médica adecuada. El estudio confirmó la importancia de la vigilancia activa, el diagnóstico temprano y la planificación de acciones contra la enfermedad en todos los países evaluados, con el propósito de disminuir o detener su transmisión.

[ABSTRACT]. Objective. To describe the epidemiological behavior of leprosy in several Latin American countries during 2011-2020, based on World Health Organization (WHO) indicators. Methods. Cross-sectional, descriptive and quantitative study with official data on incidence and prevalence in the general population, children, clinical form and cases with grade 2 disability from WHO records between 2011 and 2020. The eight countries in Latin America that reported most cases were selected and analyses were carried out using simple descriptive and comparative statistics between different variables. Results. During the study period, 301 312 cases of leprosy were reported in the selected countries: Argentina, Brazil, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, and Venezuela. Brazil is the only country in the region with a prevalence greater than 1 per 10 000, representing 93.77% of all cases. Brazil and the Dominican Republic showed an increase in prevalence during 2011-2019, while in other countries the trend was decreasing. The disease is more frequent in men, and multibacillary cases significantly exceed paucibacillary ones. Brazil showed the highest incidences of cases of childhood leprosy and grade 2 disability during the evaluated period. Conclusion. In Latin America, leprosy is only considered a public health problem in Brazil; however, most countries in the region continue to report cases annually, revealing a lack of adequate medical care. This study confirmed the importance of active surveillance, early diagnosis and planning of actions against the disease in all the countries evaluated with the aim of reducing its transmission.

[RESUMO]. Objetivo. Descrever o comportamento epidemiológico da hanseníase em vários países de América Latina durante 2011-2020, tomando como base os indicadores da Organização Mundial da Saúde (OMS). Método. Estudo transversal, descritivo e quantitativo com dados oficiais de incidência e prevalência na população geral, em crianças, forma clínica e casos com incapacidade de grau 2 nos registros da OMS entre 2011 e 2020. Se selecionaram os oito países da América Latina que relataram a maioria dos casos e as análises foram avaliadas por meio de estatísticas descritivas e comparativas simples entre as variáveis. Resultados. No período, foram notificados 301 312 casos de hanseníase nos países selecionados: Argentina, Brasil, Colômbia, Cuba, México, Paraguai, República Dominicana e Venezuela. O Brasil é o único país da região com prevalência maior que 1 por 10 000 habitantes, representando 93,77% do total de casos. O Brasil e a República Dominicana mostraram um aumento na variação da prevalência durante 2011-2019, enquanto nos demais a tendência foi decrescente. A doença é mais frequente em homens e os casos multibacilares superam significativamente os paucibacilares. O Brasil apresentou as maiores incidências de hanseníase infantil e incapacidade de grau 2 durante o período avaliado. Conclusão. Na América Latina, a hanseníase só é considerada um problema de saúde pública no Brasil; no entanto, a maioria dos países da região continua notificando casos anualmente, revelando falta de assistência médica adequada. O presente estudo confirmou a importância da vigilância ativa, do diagnóstico precoce e do planejamento de ações contra a doença em todos os países avaliados, com o objetivo de reduzir e interromper a sua transmissão.

Chromoblastomycosis in Latin America and the Caribbean: Epidemiology over the past 50 years.

Chromoblastomycosis is a chronic disease caused by melanized fungi that mainly affect individuals performing soil-related labor. The objective of this study was to analyze the epidemiological and clinical characteristics of chromoblastomycosis in Latin America and the Caribbean by an extensive literature review. An integrative review was performed of English, French, Portuguese, and Spanish publications in LILACS, SciELO, PubMed, SCOPUS and Web of Science databases covering the period 1969-2019. A total of 1211 articles were identified, of which 132 were included in the review, covering 2081 patients, 80.3% were males, the mean age was 56.1 years. The mean duration of the disease was 10.8 years. The lesions were mainly described in the lower limbs (60%). The most frequent clinical forms were verrucous (46.4%) and tumorous (21.7%). Major disease symptoms and signs consisted of itching and pain. Bacterial infection and functional limitation were important complications. Immunosuppression post-kidney transplantation was the most frequent comorbidity while leprosy was the main concomitant infectious disease. Fonsecaea pedrosoi and Cladophialophora carrionii were the predominant etiological agents. Majority of the cured cases were treated with itraconazole as monotherapy or in combination with other antifungals, surgery or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Latin America and the Caribbean, causing disability and personal, family and economic losses. It is important to prioritize epidemiological surveillance and early diagnosis of this disease in order to reveal its real prevalence and direct resources to preventive actions, diagnosis and early treatment. LAY SUMMARY: Chromoblastomycosis is a slowly progressing chronic disease caused by melanized fungi. We collected data from South America and the Caribbean covering 1969-2019, the 132 articles included 2081 patients, mean disease duration was 10.8 years. Fonsecaea pedrosoi and Cladophialophora carrionii predominated.

The CILAD, a model of an international dermatologic society, united by geographic, linguistic, and cultural nexus.

The Ibero Latin American College of Dermatology, CILAD, the largest dermatologic organization in the region, was established in 1948 during the course of the V International Congress of Leprosy held in Havana, Cuba. Constituted in its beginning with fewer than 100 dermatologists from nine countries, its growth has been exponential, reaching now around 4000 members spread throughout Latin America, the Iberian Peninsula, and other regions of the world. In recent years, academic activity has been intense, such as the development of several institutional programs, like its community health care program, designed for geographic areas lacking dermatologic care in the Latin American region. This contribution presents a review of its history, noting the dermatologists and personalities who ennoble the institution. The multiple areas of interest of this growing dermatologic organization are described, and the projections toward the future are discussed.

Social determinants, their relationship with leprosy risk and temporal trends in a tri-border region in Latin America.

BACKGROUND: Brazil is the only country in Latin America that has adopted a national health system. This causes differences in access to health among Latin American countries and induces noticeable migration to Brazilian regions to seek healthcare. This phenomenon has led to difficulties in the control and elimination of diseases related to poverty, such as leprosy. The aim of this study was to evaluate social determinants and their relationship with the risk of leprosy, as well as to examine the temporal trend of its occurrence in a Brazilian municipality located on the tri-border area between Brazil, Paraguay and Argentina. METHODS: This ecological study investigated newly-diagnosed cases of leprosy between 2003 and 2015. Exploratory analysis of the data was performed through descriptive statistics. For spatial analysis, geocoding of the data was performed using spatial scan statistic techniques to obtain the Relative Risk (RR) for each census tract, with their respective 95% confidence intervals calculated. The Bivariate Moran I test, Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were applied to analyze the spatial relationships of social determinants and leprosy risk. The temporal trend of the annual coefficient of new cases was obtained through the Prais-Winsten regression. A standard error of 5% was considered statistically significant (p < 0.05). RESULTS: Of the 840 new cases identified in the study, there was a predominance of females (n = 427, 50.8%), of white race/color (n = 685, 81.6%), age range 15 to 59 years (n = 624, 74.3%), and incomplete elementary education (n = 504, 60.0%). The results obtained from multivariate analysis revealed that the proportion of households with monthly nominal household income per capita greater than 1 minimum wage (ß = 0.025, p = 0.036) and people of brown race (ß = -0.101, p = 0.024) were statistically-significantly associated with risk of illness due to leprosy. These results also confirmed that social determinants and risk of leprosy were significantly spatially non-stationary. Regarding the temporal trend, a decrease of 4% (95% CI [-0.053, -0.033], p = 0.000) per year was observed in the rate of detection of new cases of leprosy. CONCLUSION: The social determinants income and race/color were associated with the risk of leprosy. The study's highlighting of these social determinants can contribute to the development of public policies directed toward the elimination of leprosy in the border region.

Impact of TNF -308 G>A (rs1800629) gene polymorphism in modulation of leprosy risk: a reappraise meta-analysis of 14 case-control studies.

PURPOSE: Earlier studies have shown that tumor necrosis factor (TNF) -308 G>A (rs1800629) gene polymorphism is implicated in the susceptibility to leprosy, but results were inconsistent. METHODS: A meta-analysis of 14 studies involving 3327 leprosy cases and 3203 controls was performed to appraise the association of TNF -308 G>A polymorphism with leprosy using MEDLINE (PUBMED), EMBASE, and Google Scholar web databases. RESULTS: Overall, no significant association was observed in allelic (A vs. G: P=0.068; OR = 0.836, 95% CI = 0.689-1.013), homozygous (AA vs. GG: P=0.394; OR = 0.810, 95% CI = 0.499-1.315), heterozygous (GA vs. GG: P=0.059; OR = 0.780, 95% CI = 0.603-1.010), dominant (AA + GA vs. GG: P=0.067; OR = 0.797, 95% CI = 0.625-1.016), and recessive (AA vs. GG + GA: P=0.594; OR = 0.877, 95% CI = 0.542- 1.420) genetic models. Subgroup analysis showed no association in Asians. Whereas, reduced risk was found in allelic contrast (A vs. G: P=0.014; OR = 0.832, 95% CI = 0.718-0.963) and dominant models (AA + GA vs. GG: P=0.004; OR = 0.790, 95% CI = 0.673-0.928) of the mixed population. CONCLUSIONS: TNF -308 G>A polymorphism is not associated with leprosy risk in the overall population. However, subgroup analysis demonstrated protective effect of the said polymorphism in leprosy risk in the Latin American population, but showed no association in the Asians.

Lepra en América Latina / No disponible

No disponible

[The road to elimination: an overview of neglected infectious diseases in Latin America and the Caribbean]. / El camino a la eliminación: un panorama de las enfermedades infecciosas desatendidas en América Latina y el Caribe.

Neglected infectious diseases (NID) affect mainly isolated populations living in isolation and in poor socioeconomic conditions. These diseases, by their chronic and silent nature, often affect communities with a weak political voice. This translates into very little attention or political priority; which is reflected in minimal and insufficient preventive measures, monitoring and control. However, there is evidence this situation is changing favorably in some countries of the Americas. In recent years, several resolutions (official agreement of the member countries of the Pan American Health Organization / World Health Organization-PAHO / WHO), regional and global agreements on public health; with a greater commitment from the pharmaceutical industry, and other donors and international partners in combination with the development and use of integrated action plans have allowed countries to intensify public interventions to control these diseases and thus achieve target elimination of NID. Onchocerciasis, lymphatic filariasis, Chagas disease, leprosy and trachoma blindness, among others, have been eliminated in several countries and endemic areas, regardless of the level of development of the country or geographical area where they are located. The political decision reflected in adequate financial resources in the next decade will be crucial to achieving the goals of elimination of NID (regional and national).

El camino a la eliminación: un panorama de las enfermedades infecciosas desatendidas en América Latina y el Caribe / The road to elimination: an overview of neglected infectious diseases in Latin America and the Caribbean

Las enfermedades infecciosas desatendidas (EID) afectan, principalmente, a las poblaciones que viven en condiciones aisladas y socioeconómicas de pobreza. Estas enfermedades, por su naturaleza crónica y silenciosa, aquejan con frecuencia a comunidades con voz política débil. Lo anterior se traduce en muy poca atención o prioridad política; lo que se refleja en mínimas e insuficientes acciones de prevención, vigilancia y control. Sin embargo, hay evidencia de que la situación está cambiando favorablemente en algunos países de las Américas. En los últimos años, varias resoluciones (acuerdos oficiales de los países miembros de la Organización Panamericana de la Salud/Organización Mundial de la Salud- OPS/OMS), convenios regionales y mundiales en materia de salud pública, junto a un mayor compromiso por parte de la industria farmacéutica, y otros donantes y socios internacionales, en combinación con el desarrollo y uso de los planes de acción integrados, han permitido que los países intensifiquen las intervenciones públicas hacia el control de estas enfermedades y así alcanzar los objetivos de eliminación de las EID. La oncocercosis, la filariasis linfática, la enfermedad de Chagas, la lepra y la ceguera por tracoma, entre otras, han sido eliminadas en varios países o zonas endémicas, sin importar el nivel de desarrollo del país o área geográfica donde se localizan. La voluntad política reflejada en los recursos financieros suficientes en la próxima década, serán determinantes para lograr los objetivos regionales y nacionales de eliminación de las EID...

Neglected infectious diseases (NID) affect mainly isolated populations living in isolation and in poor socioeconomic conditions. These diseases, by their chronic and silent nature, often affect communities with a weak political voice. This translates into very little attention or political priority; which is reflected in minimal and insufficient preventive measures, monitoring and control. However, there is evidence this situation is changing favorably in some countries of the Americas. In recent years, several resolutions (official agreement of the member countries of the Pan American Health Organization / World Health Organization-PAHO / WHO), regional and global agreements on public health; with a greater commitment from the pharmaceutical industry, and other donors and international partners in combination with the development and use of integrated action plans have allowed countries to intensify public interventions to control these diseases and thus achieve target elimination of NID. Onchocerciasis, lymphatic filariasis, Chagas disease, leprosy and trachoma blindness, among others, have been eliminated in several countries and endemic areas, regardless of the level of development of the country or geographical area where they are located. The political decision reflected in adequate financial resources in the next decade will be crucial to achieving the goals of elimination of NID (regional and national)...

Plasmacytoid dendritic cells in cutaneous lesions of patients with chromoblastomycosis, lacaziosis, and paracoccidioidomycosis: a comparative analysis.

Plasmacytoid dendritic cells (pDCs) are characterized by expression of CD123 and BDCA-2 (Blood Dendritic Cell Antigen 2) (CD303) molecules, which are important in innate and adaptive immunity. Chromoblastomycosis (CBM), lacaziosis or Jorge Lobo's disease (JLD), and paracoccidioidomycosis (PCM), are noteworthy in Latin America due to the large number of reported cases. The severity of lesions is mainly determined by the host's immune status and in situ responses. The dendritic cells studied in these fungal diseases are of myeloid origin, such as Langerhans cells and dermal dendrocytes; to our knowledge, there are no data for pDCs. Forty-three biopsies from patients with CBM, 42 from those with JLD and 46 diagnosed with PCM, were evaluated by immunohistochemistry. Plasmacytoid cells immunostained with anti-CD123 and anti-CD303 were detected in 16 cases of CBM; in those stained with anti-CD123, 24 specimens were obtained from PCM. We did not detect the presence of pDCs in any specimen using either antibody in JLD. We believe that, albeit a secondary immune response in PCM and CBM, pDCs could act as a secondary source of important cytokines. The BDCA-2 (CD303) is a c-type lectin receptor involved in cell adhesion, capture, and processing of antigens. Through the expression of the c-lectin receptor, there could be an interaction with fungi, similar to other receptors of this type, namely, CD207 in PCM and CD205 and CD209 in other fungal infections. In JLD, the absence of expression of CD123 and CD303 seems to indicate that pDCs are not involved in the immune response.

[Bibliographic production about adherence/non-adherence to therapy]. / Produção bibliográfica sobre adesão/não-adesão de pessoas ao tratamento de saúde.

Critical analysis of the Latin American bibliographical production over the last 10 years regarding the adherence/non-adherence to treatment of people with chronic health problems: leprosy, tuberculosis, hypertension, diabetes and AIDS. Thirty six articles were analyzed identifying the variables: year of publication, publication area and kind of study. Most of the articles (27) were produced by professionals of the medical area, in epidemiological studies, and of the nursing area (7) in qualitative and quanti-qualitative studies. The scientific production on the subject increased until 2002, when it began to drop. The authors repeatedly defended the idea that the role of the patient is to follow the recommendations of the health professional and that the patient is free to follow or not the treatment, the professional however being exempt from the responsibility for the consequences of this decision. The greater part of factors pointed out by the authors as contributing to non-adherence relates to the patient, showing that the major responsibility for the adherence / non-adherence to treatment is conferred upon him. The measures the authors indicate for solving the problem point to responsibility of professionals, health services, governments and teaching institutions.

Produção bibliográfica sobre adesão/não-adesão de pessoas ao tratamento de saúde / Bibliographic production about adherence/non-adherence to therapy

Análise crítica da produção bibliográfica latino-americana dos últimos dez anos, acerca da adesão/não-adesão ao tratamento de pessoas portadoras de problemas crônicos de saúde: hanseníase, tuberculose, hipertensão, diabetes e aids. Foram analisados 36 artigos, identificando-se as variáveis: ano de publicação, área de publicação e tipo de estudo. A maior parte dos artigos (27) foi produzida por profissionais da área de Medicina em estudos epidemiológicos e da área de Enfermagem (7) em estudos qualitativos e quanti-qualitativos. A produção científica sobre o assunto cresceu até 2002, caindo a partir desse ano. Nas definições descritas pelos autores, a idéia recorrente foi a de que o papel do paciente é o de ser submisso às recomendações dos profissionais de saúde e que ele tem autonomia para seguir ou não o tratamento, mas o profissional exime-se da responsabilidade sobre as conseqüências dessa decisão. A maioria dos fatores apontados pelos autores como contribuintes para a não-adesão está relacionada ao paciente, mostrando que a maior carga de responsabilidade pela adesão/não-adesão é conferida a ele. As medidas assinaladas pelos autores para a resolução do problema permitem a identificação da responsabilidade dos profissionais, serviços de saúde, governos e instituições de ensino.

Critical analysis of the Latin American bibliographical production over the last 10 years regarding the adherence / non-adherence to treatment of people with chronic health problems: leprosy, tuberculosis, hypertension, diabetes and AIDS. Thirty six articles were analyzed identifying the variables: year of publication, publication area and kind of study. Most of the articles (27) were produced by professionals of the medical area, in epidemiological studies, and of the nursing area (7) in qualitative and quanti-qualitative studies. The scientific production on the subject increased until 2002, when it began to drop. The authors repeatedly defended the idea that the role of the patient is to follow the recommendations of the health professional and that the patient is free to follow or not the treatment, the professional however being exempt from the responsibility for the consequences of this decision. The greater part of factors pointed out by the authors as contributing to non-adherence relates to the patient, showing that the major responsibility for the adherence / non-adherence to treatment is conferred upon him. The measures the authors indicate for solving the problem point to responsibility of professionals, health services, governments and teaching institutions.

The neglected tropical diseases of Latin America and the Caribbean: a review of disease burden and distribution and a roadmap for control and elimination.

The neglected tropical diseases (NTDs) represent some of the most common infections of the poorest people living in the Latin American and Caribbean region (LAC). Because they primarily afflict the disenfranchised poor as well as selected indigenous populations and people of African descent, the NTDs in LAC are largely forgotten diseases even though their collective disease burden may exceed better known conditions such as of HIV/AIDS, tuberculosis, or malaria. Based on their prevalence and healthy life years lost from disability, hookworm infection, other soil-transmitted helminth infections, and Chagas disease are the most important NTDs in LAC, followed by dengue, schistosomiasis, leishmaniasis, trachoma, leprosy, and lymphatic filariasis. On the other hand, for some important NTDs, such as leptospirosis and cysticercosis, complete disease burden estimates are not available. The NTDs in LAC geographically concentrate in 11 different sub-regions, each with a distinctive human and environmental ecology. In the coming years, schistosomiasis could be eliminated in the Caribbean and transmission of lymphatic filariasis and onchocerciasis could be eliminated in Latin America. However, the highest disease burden NTDs, such as Chagas disease, soil-transmitted helminth infections, and hookworm and schistosomiasis co-infections, may first require scale-up of existing resources or the development of new control tools in order to achieve control or elimination. Ultimately, the roadmap for the control and elimination of the more widespread NTDs will require an inter-sectoral approach that bridges public health, social services, and environmental interventions.

[The League of Nations Health Organization and the rise of Latin American participation, 1920-40]. / As origens da participação da América Latina na Organização de Saúde de Liga das Nações, 1920 a 1940.

The League of Nations Health Organization collaborated with Latin American specialists in public health and infectious diseases from the early 1920s to the outbreak of the Second World War. The League developed studies of infant health and nutrition, and leprosy. The approach was expert-oriented, and designed to develop public health on a scientific basis. There were conferences, tours and reports in Latin America. This paper demonstrates that the Latin American collaboration with the Health Organization was extensive and multi-faceted.

As origens da participaçäo da América Latina na Organizaçäo de Saúde da Liga das Nações, 1920 a 1940 / The League of Nations Health Organization and the rise of Latin American participation, 1920-40

A Organizaçäo de Saúde da Liga das Nações colaborou com especialistas latino-americanos em saúde pública e doenças infecciosas desde o início da década de 1920 e até a eclosäo da Segunda Guerra Mundial. Desenvolveu estudos sobre saúde e nutriçäo infantil e sobre a lepra. A abordagem foi orientada por especialistas, tendo em mira o desenvolvimento da saúde pública em bases científicas. Houve conferências, visitas e relatórios sobre a América Latina. O artigo demonstra que a colaboraçäo da América Latina com aquela organizaçäo internacional de saúde foi ampla e multifacetada.(AU)The League of Nations Health Organization collaborated with Latin American specialists in public health and infectious diseases from the early 1920s to the outbreak of the Second World War. The League developed studies of infant health and nutrition, and leprosy. The approach was expert-oriented, and designed to develop public health on a scientific basis. There were conferences, tours and reports in Latin America. This paper demonstrates that the Latin American collaboration with the Health Organization was extensive and multi-faceted.(AU)

As origens da participação da América Latina na Organização de Saúde da Liga das Nações, 1920 a 1940 / The League of Nations Health Organization and the rise of Latin American participation, 1920-40

A Organização de Saúde da Liga das Nações colaborou com especialistas latino-americanos em saúde pública e doenças infecciosas desde o início da década de 1920 e até a eclosão da Segunda Guerra Mundial. Desenvolveu estudos sobre saúde e nutrição infantil e sobre a lepra. A abordagem foi orientada por especialistas, tendo em mira o desenvolvimento da saúde pública em bases científicas. Houve conferências, visitas e relatórios sobre a América Latina. O artigo demonstra que a colaboração da América Latina com aquela organização internacional de saúde foi ampla e multifacetada.

The League of Nations Health Organization collaborated with Latin American specialists in public health and infectious diseases from the early 1920s to the outbreak of the Second World War. The League developed studies of infant health and nutrition, and leprosy. The approach was expert-oriented, and designed to develop public health on a scientific basis. There were conferences, tours and reports in Latin America. This paper demonstrates that the Latin American collaboration with the Health Organization was extensive and multi-faceted.

Biology-based mapping of vector-borne parasites by geographic information systems and remote sensing.

Application of growing degree day-water budget analysis and satellite climatology to vector-borne parasites will be reviewed to demonstrate the value of using the unique thermal-hydrological preferences and limits of tolerance of individual parasite-vector systems to define the environmental niche of disease agents in the landscape by modern geospatial analysis methods. Applications of geospatial modeling will be illustrated by examples on fascioliasis, malaria, leprosy and leishmaniasis.

Consideraciones histórico-epidemiológicas de la lepra en América / History and epidemiology of leprosy in America

Se realiza un recorrido histórico del origen de la Lepra en América, con el descubrimiento y colonización por españoles y portugueses, y la posterior expansión por el tráfico de esclavos africanos. Su inicio en las Antillas y después a América Central, del Sur y Norteamérica e igualmente los eventos científicos más importantes y figuras destacadas, y por último la situación epidemiológica actual

An historical development of the origin pof the leprosy in American since the colonization by the Spanish and Portuguese peoplesand the post extension through the african slaves traffi c is reported. First, in the Antillas and then to Central and South America the leprosy was expanded also in North America. A review of the most important scientifi c events and leprologists; finally the epidemiological situation is considered