The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact.

Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.

Availability of substance use disorder treatment in Spanish: Associations with state-level proportions of Spanish speakers and treatment facility characteristics in the United States.

BACKGROUND AND OBJECTIVES: Spanish is the second most spoken language in the United States. Not all substance use disorder (SUD) treatment facilities provide treatment in Spanish. This study examined factors associated with SUD treatment facilities having counselors that provide treatment in Spanish. METHODS: State-level estimates of Spanish-speaking individuals were derived from the American Community Survey 2019. SUD treatment facility characteristics were captured from the National Survey of Substance Abuse Treatment Services 2020. We examined a sample of 15,246 facilities which included 12,798 outpatient, 3554 nonhospital residential, and 1106 with both outpatient and residential programs. Binary logistic regression models were used to observe state-level proportions of Spanish speakers and facility-level characteristics as factors associated with a facility having counselors that provide treatment in Spanish. RESULTS: Approximately 23.3% of facilities had counselors able to provide treatment in Spanish. Among outpatient or nonhospital residential SUD facilities, those in a state with a larger proportion of Spanish-speaking individuals, facilities with pay assistance, facilities that accept Medicaid, and facilities that engage in community outreach had higher odds of having counselors that provide treatment in Spanish. CONCLUSIONS: Considering that less than a quarter of facilities provide treatment in Spanish, increasing the availability of linguistically appropriate and culturally responsive services for SUD is imperative. SCIENTIFIC SIGNIFICANCE: This national study is the first of its kind to examine associations between estimates of Spanish speakers and treatment facility characteristics associated with counselors that provide treatment in Spanish in outpatient and nonhospital residential SUD treatment.

Addressing Neurocognitive Disorders, Dementias, and Alzheimer's Disease in Colonias of the Lower Rio Grande Valley: Establishing a Research Foundation Using Promotores.

Several Texas communities along the Mexican border, including the Lower Rio Grande Valley (LRGV), are home to low-income Hispanic populations, many of whom live in underserved communities known as colonias. These areas have high incidences of neurocognitive disorders, dementia, and Alzheimer's disease (AD); health care strategies that are culturally and linguistically appropriate for the area are needed. We aim to build capacity to reduce risk, facilitate treatment, and provide caregiver support for affected individuals. However, gaining trust of communities and presenting information about research studies in a way that is culturally appropriate is critical for engagement of underserved communities. This brief report examines our work with local community health workers.(CHWs), promotores in Spanish, to establish contact with, engage, mobilize, and educate the Hispanic communities of the LGRV. Lessons from the succesful experience of training promotores in autism spectrum disorder in the LRGV highlight the importance of specifically addressing outreach in health fairs, clinic vists and referral as well as adequate selection, training, management, and support of the promotores as critical aspects. To initiate and sustain recruitment of older adults and care partners in research studies of AD and other dementias in the RGV, we have incorporated these aspects as components of the promotores training and engagement model, which has been developed and implemented by researchers and their colleagues at the School of Medicine at the University of Texas Rio Grande Valley.

Organic Compounds Detected in Deciduous Teeth: A Replication Study from Children with Autism in Two Samples.

Biological samples are an important part of investigating toxic exposures and disease outcomes. However, blood, urine, saliva, or hair can only reflect relatively recent exposures. Alternatively, deciduous teeth have served as a biomarker of early developmental exposure to heavy metals, but little has been done to assess organic toxic exposures such as pesticides, plastics, or medications. The purpose of our study was to determine if organic chemicals previously detected in a sample of typically developing children could be detected in teeth from a sample of children with autism. Eighty-three deciduous teeth from children with autism spectrum disorders (ASD) were chosen from our tooth repository. Organic compounds were assessed using liquid chromatography tandem mass spectrometry and gas chromatography methods. Consistent with a prior report from Camann et al., (2013), we have demonstrated that specific semivolatile organic chemicals relevant to autism etiology can be detected in deciduous teeth. This report provides evidence that teeth can be useful biomarkers of early life exposure for use in epidemiologic case-control studies seeking to identify differential unbiased exposures during development between those with and without specific disorders such as autism.

Human papillomavirus infection and P53 codon 72 genotypes in a Hispanic population at high-risk for cervical cancer.

Cervical cancer mortality is high in Texas, especially among Hispanic women living in south Texas and adjacent Mexico. Though human papillomavirus (HPV) infection has a causal role in the development of cervical cancer, there are no published data on the prevalence of HPV genotypes in this underscreened region. We studied 398 Hispanic women on both sides of the border along the lower Rio Grande River to determine the prevalence of HPV genotypes and risk factors for cervical cancer. Using a nested PCR system HPV was detected in 62% of cervical specimens, including all the known high-risk HPV genotypes, with HPV16 and HPV18 the most frequent (30.6% and 23.0%, respectively). Multiple infections were common (29.4% of the infected specimens), and where this occurred we were more likely to find high-risk HPV genotypes. We examined host p53 codon 72 genotype frequencies and found that patients with cervical abnormalities and women with HPV16 and HPV18 infections had a lower genotype frequency of the homozygous (AA) previously reported to be associated with cervical cancer, than uninfected women with no abnormalities. In this US/Mexico border population high rates of potentially oncogenic HPV viruses and multiple infections are consistent with observed elevated cervical cancer rates. These data are further evidence that in this underserved population HPV infections are associated with high rates of malignancy, but that host p53 genotypic variations are unlikely to be primary factors in oncogenesis.

Uso de suplementador y sacapezones como métodos efectivos que fomentan la lactancia materna / Use as a suplementer and nipple as efective methods to encourage the breast feeding

Aunque la mayoría de las mujeres están capacitadas para ofrecer seno materno a sus hijos, existen ocasiones en las que hay necesidad de suplementar al recién nacido mientras se instala una producción materna en las primeras horas de vida; otras mujeres requieren apoyo para corregir sus pezones planos o invertidos. Estas dos situaciones constituyen obstáculos para el éxito de la lactancia causando ansiedad en la madre que se siente incapaz de amamantar a su hijo, decidiéndose por la utilización de biberones causando un destete precoz. Objetivo. Evaluar la efectividad del suplementador y el sacapezones en el fomento a la lactancia. Material y métodos. El estudio se realizó en el Hospital General de Cerralvo, de 2o. nivel de la SSA, certificando como Hospital Amigo del Niño y de la Madre, en forma prospectiva, observacional, captándose 83 recién nacidos de término, neurológicamente íntegros con reflejos de succión, rotación y apertura presentes y normales, en alojamiento conjunto. Resultados. En 24 casos se utilizó suplementador, de estos 18 se colocaron por producción insuficiente de leche, 4 fueron por aumento en la demanda (2 macrosómicos) y una pareja de gemelos. En 10 pacientes se utilizó sacapezones, 9 de ellas por pezón plano y una por pezón invertido. Aunque existen en el mercado utilizamos para su fabricación en el suplementador una jeringa de plástico, desechable de 20 ml. sin émbolo y sin aguja, conectada a una sonda de alimentación 5 French sin punta, la cual se colocaba en la línea media tórax por debajo del nivel de los pezones, la punta de la sonda terminaba en el pezón, todo con el fin de ejercer la salida de leche por succión y no por gravedad; en el sacapezones se utilizó un jeringa de 20 ml. de plástico sin émbolo y sin aguja conectada por un trozo de sonda de Foley No. 14, a una jeringa de 10 cc con la que se ejercía la succión del pezón. Se valoraron al nacimiento, 5 y 10 días con utilización de estos métodos de 12 a 72 horas, observándose en sus citas de seguimiento 100 por ciento de lactancia materna exclusiva. Concluyéndose que ambos métodos son efectivos al mantener la succión directa del seno materno para lograr una lactancia materna exclusiva

Fomento de la lactancia materna mediante un sencillo ®suplementador¼ y ®sacapezones¼ / The effectivity of the supplier in the maternal lactancy keeping the physiology mechanisms of breast feeding

Objetivo. Probar la efectividad de un ®suplementador¼ para fomentar la lactancia materna, en vez de utilizar biberón. Material y métodos. Entre 83 niños recién nacidos y sus madres, se dio apoyo, con el sacapezones, a ocho mujeres por tener pezón plano y a una por presentar pezón invertido. El suplementador se utilizó en 24 niños. El material utilizado para la elaboración del sacapezones y el suplementador fueron, jeringas, sondas de alimentación y trozos de sondas de Foley o de venoclisis. Resultados. Al quinto y décimo día, todas las madres alimentaban al seno a sus hijos, sin utilizar biberones. Conclusiones. Los dos procedimientos usados fomentan la lactancia materna al mantener el mecanismo fisiológico de amamantamiento