Perinatal hypoxia increases susceptibility to high-altitude polycythemia and attendant pulmonary vascular dysfunction.

Perinatal exposures exert a profound influence on physiological function, including developmental processes vital for efficient pulmonary gas transfer throughout the lifespan. We extend the concept of developmental programming to chronic mountain sickness (CMS), a debilitating syndrome marked by polycythemia, ventilatory impairment, and pulmonary hypertension that affects ∼10% of male high-altitude residents. We hypothesized that adverse perinatal oxygenation caused abnormalities of ventilatory and/or pulmonary vascular function that increased susceptibility to CMS in adulthood. Subjects were 67 male high-altitude (3,600-4,100 m) residents aged 18-25 yr with excessive erythrocytosis (EE, Hb concentration ≥18.3 g/dl), a preclinical form of CMS, and 66 controls identified from a community-based survey (n = 981). EE subjects not only had higher Hb concentrations and erythrocyte counts, but also lower alveolar ventilation, impaired pulmonary diffusion capacity, higher systolic pulmonary artery pressure, lower pulmonary artery acceleration time, and more frequent right ventricular hypertrophy, than controls. Compared with controls, EE subjects were more often born to mothers experiencing hypertensive complications of pregnancy and hypoxia during the perinatal period, with each increasing the risk of developing EE (odds ratio = 5.25, P = 0.05 and odds ratio = 6.44, P = 0.04, respectively) after other factors known to influence EE status were taken into account. Adverse perinatal oxygenation is associated with increased susceptibility to EE accompanied by modest abnormalities of the pulmonary circulation that are independent of increased blood viscosity. The association between perinatal hypoxia and EE may be due to disrupted alveolarization and microvascular development, leading to impaired gas exchange and/or pulmonary hypertension.

Factors Influencing the Use of Biomedical Health Care by Rural Bolivian Anemic Women: Structural Barriers, Reproductive Status, Gender Roles, and Concepts of Anemia.

METHODS: Non-pregnant women from a rural town and its surrounding region were tested for anemia. During phase 1 (n = 181), anemic women received a written recommendation for low-cost purchase of iron pills at the nearest health center. They were subsequently interviewed on their actions and experiences. RESULTS: Estimated anemia prevalence among these non-pregnant women was 50% higher than the national average. Despite holding conceptualizations of anemia generally aligned with biomedical concepts, only 40% of anemic women attempted to obtain iron supplements from the health center. Town residents were about twice as likely to attempt to purchase pills as outside-town residents. Town women who were concurrently breastfeeding and menstruating, considered anemia most serious for women, and considered family health the shared responsibility of spouses were most likely to decide to purchase iron pills. Age, education, or native language did not negatively influence this health care behavior. CONCLUSIONS: Securing iron supplements involves individual trade-offs in the allocation of time, cost and effort. Nonetheless, suitably tailored programs can potentially harness local perceptions in the service of reducing anemia. Because of their comparatively high motivation to obtain iron supplements, targeting concurrently breastfeeding and menstruating women could have a positive cascade effect such that these women continue attending to their iron needs once they stop breastfeeding and if they become pregnant again. Because a sense of shared responsibility for family health appears to encourage women to attend to their own health, programs for women could involve their spouses. Complementing centralized availability, biomedical and traditional healers could distribute iron supplements on rotating visits to outlying areas and/or at highly attended weekly markets.

Role of genetic and environmental factors in the increased blood pressures of Bolivian blacks.

The tendency toward hypertension or higher blood pressure is more common in blacks than whites. The factors that account for these differences are attributed to both environmental and genetic factors. To clarify this issue, an anthropological study of black and nonblack populations in the lowland village of Chicaloma, northeastern Bolivia at a midaltitude of 1,800 m was conducted. The study included 159 subjects, of which 79 were black and 80 were nonblack, 17-78 years. The study suggests the following: (1) the socioeconomic status of blacks as measured by an ownership index is greater than that of nonblacks, (2) blacks had higher average systolic and diastolic blood pressures than nonblacks and showed an age-associated increase in blood pressures, (3) the prevalence of hypertension was higher for blacks (7-6%) than nonblacks (1.3%), but three times lower than among blacks in the United States, (4) skin reflectance is inversely related to blood pressures so that contrary to what has been suggested the darker the skin color, the higher the blood pressures even at comparable levels of affluence. These findings together suggest that genetic factors predispose black individuals to increased blood pressures, but the expression of clinical hypertension is influenced by adverse unaccounted environmental factors. Am. J. Hum. Biol. 11:489-498, 1999. Copyright 1999 Wiley-Liss, Inc.

Influencia de ciertas moléculas en la renovación parcial de fosfolípidos plaquetarios en Aymarás, Quechuas y europeos / Effects of certain molecules on the partial renewal of phospholipids in the platelets of Aymarás, Quechua and european population

La hipoagregabilidad plaquetaria en presencia de ciertos inductores de la agregación, hipolipidemia, hipoglicemia, la relativa disminución de magnesio y la poca predisposición a las trombosis arteriales de aymarás y quechuas, habitantes de grande alturas parecen estar relacionadas con el metabolismo fosfolipídico. En este trabajo se realizaron estudios comparativos (composición fosfolipídica e intercambio de biomoléculas polares fosfolipídicas con sus homólogas de su medio ambiente) en plaquetas de aymarás, quechuas y europeos. En efecto, se evidenció que los principales fosfolípidos se encuentran en cantidades similares en las plaquetas de estas tres poblaciones; sin embargo, la lisofosfatidilcolina está en concentraciones mayores y la esfingomielina en concentraciones menores en aymarás y quechuas en relación a las poblaciones europeas. Las moléculas marcadas colina, serina y etanolamina intercambian con sus homólogas que se encuentran en los fosfolípidos en proporciones semejantes en las tres poblaciones; la fosfatidilcolina intercambia su base con la homóloga del medio externo en mayor porcentaje que la fosfatidiletanolamina y esta última en mayor porcentaje que la fosfatidilserina. El calcio y magnesio favorecen el intercambio de moléculas fosfolipídicas incrementándose más esta renovación con el calcio que con el magnesio; el ácido etilendiamino-tetraacético, glucosa y cianuro de potasio inhiben parcialmente esta renovación