Genetic risk prediction in Hispanics/Latinos: milestones, challenges, and social-ethical considerations.

Genome-wide association studies (GWAS) have allowed the identification of disease-associated variants, which can be leveraged to build polygenic scores (PGSs). Even though PGSs can be a valuable tool in personalized medicine, their predictive power is limited in populations of non-European ancestry, particularly in admixed populations. Recent efforts have focused on increasing racial and ethnic diversity in GWAS, thus, addressing some of the limitations of genetic risk prediction in these populations. Even with these efforts, few studies focus exclusively on Hispanics/Latinos. Additionally, Hispanic/Latino populations are often considered a single population despite varying admixture proportions between and within ethnic groups, diverse genetic heterogeneity, and demographic history. Combined with highly heterogeneous environmental and socioeconomic exposures, this diversity can reduce the transferability of genetic risk prediction models. Given the recent increase of genomic studies that include Hispanics/Latinos, we review the milestones and efforts that focus on genetic risk prediction, summarize the potential for improving PGS transferability, and highlight the challenges yet to be addressed. Additionally, we summarize social-ethical considerations and provide ideas to promote genetic risk prediction models that can be implemented equitably.

Supportive relationships in childhood: Does it have a long Reach into health and depression outcomes for immigrants from Latin America?

This study examines how social support during childhood and adolescence is associated with self-rated good health and the incidence of depression among Latin American immigrants in the U.S. We focus on those who immigrated under age 18 (childhood arrivals) to understand the interplay between early social support and adult health outcomes. Data are from the 2012-2013 iteration of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), which included a sample of 3441 immigrant respondents born in Latin America. Multivariable binomial logistic regression analyses indicated that childhood and interpersonal support in adulthood were negatively associated with lifetime major depressive disorder (LMDD) episodes. These associations differed between childhood arrival and adult arrival immigration samples. Findings from this study highlight the role that social support in critical developmental periods has on immigrant health and depression outcomes. Continued and more nuanced investigations are warranted to examine social resources across lifespans and their roles in mitigating adverse health outcomes among immigrants from Latin America.

Clinical Evaluation and Experience in Treatments Performed with Fractional CO2 Laser on Latin American Skin: An Observational Retrospective Study.

Background: The carbon dioxide (CO2) laser is an ablative system that evaporates, remodels, and coagulates tissues, becoming therefore a gold standard piece of equipment for the treatment of dermatological pathologies and esthetic imperfections. Objective: To evaluate the efficacy and safety of CO2 laser treatments in different patients' skin pathologies. Methods: A total of 705 patients with an age range between 18 and 70 years, with phototypes on the Fitzpatrick scale III, IV, V, and VI, were enrolled from October 2021 to May 2022, and were treated using the CO2 laser system. Results: Ninety-six patients were treated with fractional CO2 laser, used for skin rejuvenation and stretch marks. One patient presented reactivation of herpes simplex, 10 postinflammatory hyperpigmentation that resolved after 3 months with depigmenting agents, 6 with persistent erythema. A total of 13 patients with rhinophyma were treated, and no complications were observed; a total of 64 patients with wrinkles were treated. They improved in 6 months. A total of 340 patients were treated for seborrheic keratosis, papulosa nigra dermatosis, fibropapillomas, sebaceous hyperplasias, verruca vulgaris, and condylomata acuminata. One patient presented with a complication hypopigmented macule. A total of 136 patients underwent treatment for laser ablation of intradermal nevi and verrucous epidermal nevi, without complications. A total of 56 patients were treated with keloids and hypertrophic scars. One patient presented with ulceration of a keloid that resolved with the application of clostridiopeptidase A and chloramphenicol after 2 weeks. Conclusions: The use of the CO2 laser in any phototype and race, which are factors with a high incidence in Latin America, provides a safe and effective result for different dermatological pathologies.

Depression and anxiety in peruvian military personnel during the pandemic context: a cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, increased workload and stress could have increased mental health problems (anxiety and depression) in military personnel. However, the number of studies in military members is scarce, especially in regard to mental health. The objective of this study was determine the prevalence and factors associated with depression and anxiety in Peruvian military personnel. METHODS: We undertook an analytical cross-sectional study. The survey was distributed face to face between November 02 and 09, 2021, during the second wave of the COVID-19 pandemic among the military personnel. We used some instruments to measure depression (Patient Health Questionnaire, PHQ-9), anxiety (Generalized Anxiety Disorder, GAD-7), insomnia (Insomnia Severity Index, ISI), food insecurity (Household Food Insecurity Access Scale, HFIAS), physical activity (International Physical Activity Questionnaires, IPAQ-S), resilience (abbreviated CD-RISC), and fear of COVID-19 scale. The exclusion criteria included those who did not completely fill out the evaluation instruments. RESULTS: We analyzed the data of 615 military personnel that participated in the survey. Of them, 93.7% were male and the median age was 22 years old. There was a prevalence of 29.9% and 22.0% in regard to depression and anxiety symptoms, respectively. In addition, it was found that being married (PR: 0.63; 95% IC: 0.42-0.94), having a relative with mental health problems (PR: 2.16), having experienced food insecurity (PR: 1.48), insomnia (PR: 2.71), fear of COVID-19 (PR: 1.48), and a high level of resilience (PR: 0.65) were factors associated with depression. In regard to anxiety, the factors associated were working for more than 18 months since the beginning of the COVID-19 pandemic (PR: 0.52), a high level of resilience (PR: 0.50; 95% IC: 0.33-0.77), insomnia (PR: 3.32), fear of COVID-19 (PR: 2.43). CONCLUSION: We found a prevalence of symptoms of depression and anxiety of 29.9% and 22.0%, respectively. In regard to the factors that attenuate depression, we can mention being married and having resilience; and among the aggravating factors, having a relative with mental health problems, food insecurity, insomnia, and fear of COVID-19. Finally, anxiety increased through working time, insomnia, and fear of COVID-19.

"Ancestral recipes": a mixed-methods analysis of MyPlate-based recipe dissemination for Latinos in rural communities.

BACKGROUND: The Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs. METHODS: Diverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants' motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation. RESULTS: A total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings. CONCLUSION: This study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation.

Disentangling Signatures of Selection Before and After European Colonization in Latin Americans.

Throughout human evolutionary history, large-scale migrations have led to intermixing (i.e., admixture) between previously separated human groups. Although classical and recent work have shown that studying admixture can yield novel historical insights, the extent to which this process contributed to adaptation remains underexplored. Here, we introduce a novel statistical model, specific to admixed populations, that identifies loci under selection while determining whether the selection likely occurred post-admixture or prior to admixture in one of the ancestral source populations. Through extensive simulations, we show that this method is able to detect selection, even in recently formed admixed populations, and to accurately differentiate between selection occurring in the ancestral or admixed population. We apply this method to genome-wide SNP data of ∼4,000 individuals in five admixed Latin American cohorts from Brazil, Chile, Colombia, Mexico, and Peru. Our approach replicates previous reports of selection in the human leukocyte antigen region that are consistent with selection post-admixture. We also report novel signals of selection in genomic regions spanning 47 genes, reinforcing many of these signals with an alternative, commonly used local-ancestry-inference approach. These signals include several genes involved in immunity, which may reflect responses to endemic pathogens of the Americas and to the challenge of infectious disease brought by European contact. In addition, some of the strongest signals inferred to be under selection in the Native American ancestral groups of modern Latin Americans overlap with genes implicated in energy metabolism phenotypes, plausibly reflecting adaptations to novel dietary sources available in the Americas.

Food Sources of Shortfall Nutrients among Latin Americans: Results from the Latin American Study of Health and Nutrition (ELANS).

Increased consumption of energy-dense, nutrient-poor foods can lead to inadequate intakes of shortfall nutrients, including vitamin A, D, C, and E, dietary folate, calcium, iron, magnesium, potassium, and fiber. The objective was to examine the prevalence of inadequate intake of shortfall nutrients and identify food sources of shortfall nutrients in eight Latin American countries. Data from ELANS, a multi-country, population-based study of 9218 adolescents and adults were used. Dietary intake was collected through two 24 h Recalls from participants living in urban areas of Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Venezuela. Foods and beverages were classified using the adapted version of the NHANES "What We Eat in America" system. Nutrients inadequacy was estimated using the Institute of Medicine recommendations and descriptive statistics were calculated. Prevalence of inadequacy was above 50% for most of the nutrients, which the exception of vitamin C with a prevalence of inadequacy of 39%. Milk, cheese, seafoods, breads, and fruit juices/drinks were among the top 5 sources for each of the 10 shortfall nutrients examined. Many food categories were top contributors to more than one dietary component examined. Understanding the nutrient intake and food sources can help inform dietary guidance and intervention approaches.

Contribution of food groups to energy, grams and nutrients-to-limit: the Latin American Study of Nutrition and Health/Estudio Latino Americano de Nutrición y Salud (ELANS).

OBJECTIVE: To quantify the energy, nutrients-to-limit and total gram amount consumed and identify their top food sources consumed by Latin Americans. DESIGN: Data from the Latin American Study of Nutrition and Health (ELANS). SETTING: ELANS is a cross-sectional study representative of eight Latin American countries: Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Peru and Venezuela. PARTICIPANTS: Two 24-h dietary recalls on non-consecutive days were used to estimate usual dietary intake of 9218 participants with ages between 15-65 years. 'What We Eat in America' food classification system developed by United States Department of Agriculture was adapted and used to classify all food items consumed by the ELANS population. Food sources of energy, added sugars, SFA, Na and total gram amount consumed were identified and ranked based on percentage of contribution to intake of total amount. RESULTS: Three-highest ranked food categories of total energy consumed were: rice (10·3%), yeast breads (6·9%), and turnovers and other grain-based items (6·8 %). Highest ranked food sources of total gram amount consumed were fruit drinks (9·6%), other 100% juice (9·3%) and rice (8·3%). Three highest ranked sources for added sugars were other 100% juice (24·1 %), fruit drinks (16·5%), and sugar and honey (12·4%). SFA ranked foods were turnovers and other grain-based (12·6 %), cheese (11·9%), and pizza (10·3%). Three top sources of Na were rice (13·9%), soups (9·1 %) and rice mixed dishes (7·3 %). CONCLUSION: Identification of top sources of energy and nutrients-to-limit among Latin Americans is critical for designing strategies to help them meet nutrient recommendations within energy needs.

Prediction of eye, hair and skin colour in Latin Americans.

Here we evaluate the accuracy of prediction for eye, hair and skin pigmentation in a dataset of > 6500 individuals from Mexico, Colombia, Peru, Chile and Brazil (including genome-wide SNP data and quantitative/categorical pigmentation phenotypes - the CANDELA dataset CAN). We evaluated accuracy in relation to different analytical methods and various phenotypic predictors. As expected from statistical principles, we observe that quantitative traits are more sensitive to changes in the prediction models than categorical traits. We find that Random Forest or Linear Regression are generally the best performing methods. We also compare the prediction accuracy of SNP sets defined in the CAN dataset (including 56, 101 and 120 SNPs for eye, hair and skin colour prediction, respectively) to the well-established HIrisPlex-S SNP set (including 6, 22 and 36 SNPs for eye, hair and skin colour prediction respectively). When training prediction models on the CAN data, we observe remarkably similar performances for HIrisPlex-S and the larger CAN SNP sets for the prediction of hair (categorical) and eye (both categorical and quantitative), while the CAN sets outperform HIrisPlex-S for quantitative, but not for categorical skin pigmentation prediction. The performance of HIrisPlex-S, when models are trained in a world-wide sample (although consisting of 80% Europeans, https://hirisplex.erasmusmc.nl), is lower relative to training in the CAN data (particularly for hair and skin colour). Altogether, our observations are consistent with common variation of eye and hair colour having a relatively simple genetic architecture, which is well captured by HIrisPlex-S, even in admixed Latin Americans (with partial European ancestry). By contrast, since skin pigmentation is a more polygenic trait, accuracy is more sensitive to prediction SNP set size, although here this effect was only apparent for a quantitative measure of skin pigmentation. Our results support the use of HIrisPlex-S in the prediction of categorical pigmentation traits for forensic purposes in Latin America, while illustrating the impact of training datasets on its accuracy.

Imputation Performance in Latin American Populations: Improving Rare Variants Representation With the Inclusion of Native American Genomes.

Current Genome-Wide Association Studies (GWAS) rely on genotype imputation to increase statistical power, improve fine-mapping of association signals, and facilitate meta-analyses. Due to the complex demographic history of Latin America and the lack of balanced representation of Native American genomes in current imputation panels, the discovery of locally relevant disease variants is likely to be missed, limiting the scope and impact of biomedical research in these populations. Therefore, the necessity of better diversity representation in genomic databases is a scientific imperative. Here, we expand the 1,000 Genomes reference panel (1KGP) with 134 Native American genomes (1KGP + NAT) to assess imputation performance in Latin American individuals of mixed ancestry. Our panel increased the number of SNPs above the GWAS quality threshold, thus improving statistical power for association studies in the region. It also increased imputation accuracy, particularly in low-frequency variants segregating in Native American ancestry tracts. The improvement is subtle but consistent across countries and proportional to the number of genomes added from local source populations. To project the potential improvement with a higher number of reference genomes, we performed simulations and found that at least 3,000 Native American genomes are needed to equal the imputation performance of variants in European ancestry tracts. This reflects the concerning imbalance of diversity in current references and highlights the contribution of our work to reducing it while complementing efforts to improve global equity in genomic research.

Differences in Eye Health, Access to Eye Care Specialists and Use of Lenses among Immigrant and Native-Born Workers in Spain.

Latin American immigrants make up 49% of the total immigrant population in Spain, yet little is known about their eye health. The aim of this study is to determine if there are differences in self-perceived eye health, access to eye care specialists, and use of lenses between a sample of Latin American immigrant workers from Colombia and Ecuador, and native-born workers in Spain. We used data from the PELFI cohort (Project for Longitudinal Studies of Immigrant Families). The sample consisted of 179 immigrant workers born in Colombia or Ecuador, and 83 Spanish-born workers. The outcome variables were self-perceived eye health, access to eye specialists, and use of lenses. A descriptive analysis of the sample was carried out, and the prevalence of the three outcome variables in immigrants and natives was calculated and adjusted for explanatory variables. Random effects logistic regression models examined eye health outcomes by workers' country of birth. Immigrants are less likely to report poor self-perceived eye health than native-born (ORc 0.46; CI 95%, 0.22-0.96). Furthermore, they have less access to specialists (ORc 2.61; CI 95%, 1.32-5.15) and a higher probability of needing lenses but not having them (ORc 14.14; CI 95%, 1.77-112.69). This latter variable remained statistically significant after adjusting for covariates (ORa 34.05; CI 95%, 1.59-729.04). Latin American immigrants may not value the use of lenses, despite eye care specialists indicating that they need them. Eye health education is required to recognize the importance of using lenses according to their visual needs.

Attitudes of Latin American Immigrants Resident in Florida (United States) Toward Related Living Kidney Donation.

INTRODUCTION: Latin American immigrants comprise an important population group in the United States. The purpose of this study was to analyze the attitude toward living kidney donation found among Latin American citizens who are residents in Florida and to identify the psychosocial variables affecting their attitude. MATERIAL AND METHODS: A sample of Latin American residents in the state of Florida was randomly obtained and stratified by nationality, age, and sex (n = 1524). Attitude was assessed through a validated questionnaire that was self-administered and completed anonymously. Descriptive, Student t test and the χ2 test were used to analyze findings. RESULTS: The questionnaire completion rate was 94% (N = 1433), with 59% (n = 845) in favor of related living donation, 40% (n = 571) were opposed to donation, with the remaining 1% (n = 17) undecided. The following variables were related to attitude toward living donation: country of origin (P < .001), marital status (P < .001), having descendants (P = .004), educational background (P < 0.001), having had previous experience of donation and transplantation (P < .001), attitude toward deceased donation (P < .001), considering the possibility of needing a transplant (P < .001), the respondent's partner's opinion (P < .001), having considered the subject with one's family (P < .001), having carried out prosocial type activities (P < .001), the respondent's religion (P < .001), knowing that one's religion is in favor of this therapy (P < .001), concern about mutilation after donation (P < .001), and considerations of the risks of living donation (P < .001). CONCLUSIONS: The attitude toward related living kidney donation of Latin American residents in Florida is not very favorable (only 59%).

Associations between active commuting to school, sleep duration, and breakfast consumption in Ecuadorian young people.

BACKGROUND: Daily behaviours such as active commuting to school (ACS) could be a source of physical activity, contributing to the improvement of youth cardiovascular health, however, the relationship between ACS and other aspects of a youth's health, such as sleep duration and breakfast consumption, require further clarification. The aims of this study were therefore: 1) to analyse the prevalence of modes of commuting to school, sleep duration, and breakfast consumption by age groups and gender, and 2) to analyse the association between ACS, sleep duration recommendations, and breakfast consumption by age groups and gender. METHOD: This cross-sectional study included 732 school-aged students of low-middle socioeconomic status, categorised into children (10-12 yr), young adolescents (13-15 yr), and older adolescents (16-18 yr). Modes of commuting to/from school, sleep duration, and breakfast consumption were self-reported. Logistic regression models were fitted to examine the association between ACS, sleep duration and breakfast consumption, analysed according to age groups and gender. RESULTS: The percentage of students meeting sleep duration and daily breakfast recommendations was lowest in older adolescents, and highest in children (6.3% versus 50.8% p < 0.001, and 62.1%, versus 76.8%, p = 0.001, respectively). Young adolescents and girls who met the sleep duration recommendations were more likely to be active commuters than their counterparts (OR = 4.25; 95% CI = 1.81 to 9.92, p = 0.001 and OR = 2.89; 95%CI = 1.01 to 8.27, p = 0.04, respectively). CONCLUSION: Young adolescents (13-15 yr) and girls who met the sleep duration recommendations during school days displayed a positive association with ACS. There was no association between ACS and breakfast consumption for any of the age groups or gender. Children (10-12 yr) were those that best meet with the adequate sleep duration and breakfast consumption recommendations.

Interethnic Variability in CYP2D6, CYP2C9, and CYP2C19 Genes and Predicted Drug Metabolism Phenotypes Among 6060 Ibero- and Native Americans: RIBEF-CEIBA Consortium Report on Population Pharmacogenomics.

Pharmacogenetic variation in Latin Americans is understudied, which sets a barrier for the goal of global precision medicine. The RIBEF-CEIBA Network Consortium was established to characterize interindividual and between population variations in CYP2D6, CYP2C9, and CYP2C19 drug metabolizing enzyme genotypes, which were subsequently utilized to catalog their "predicted drug metabolism phenotypes" across Native American and Ibero American populations. Importantly, we report in this study, a total of 6060 healthy individuals from Ibero-America who were classified according to their self-reported ancestry: 1395 Native Americans, 2571 Admixed Latin Americans, 96 Afro-Latin Americans, 287 white Latin Americans (from Cuba), 1537 Iberians, and 174 Argentinean Ashkenazi Jews. Moreover, Native Americans were grouped into North-, Central-, and South Amerindians (from Mexico, Costa Rica, and Peru, respectively). All subjects were studied for the most common and functional CYP2D6, CYP2C9, and CYP2C19 allelic variants, and grouped as genotype-predicted poor or ultrarapid metabolizer phenotypes (gPMs and gUMs, respectively). Native Americans showed differences from each ethnic group in at least two alleles of CYP2D6, CYP2C9, and CYP2C19. Native Americans had higher frequencies of wild-type alleles for all genes, and lower frequency of CYP2D6*41, CYP2C9*2, and CYP2C19*17 (p < 0.05). Native Americans also showed less CYP2C19 gUMs than the rest of the population sample. In addition, differences within Native Americans (mostly North vs. South) were also found. The interethnic differences described supports the need for population-specific personalized and precision medicine programs for Native Americans. To the best of our knowledge, this is the largest study carried out in Native Americans and other Ibero-American populations analyzing CYP2D6, CYP2C9, and CYP2C19 genetic polymorphisms. Population pharmacogenomics is a nascent field of global health and warrants further research and education.

Fat-to-Muscle Ratio: A New Anthropometric Indicator as a Screening Tool for Metabolic Syndrome in Young Colombian People.

Fat-to-muscle ratio has been proposed as an alternative approach for assessing body fat. The objective of this study was to explore fat-to-muscle ratio thresholds in metabolic syndrome (MetS) diagnosis; it was hypothesised that the fat-to-muscle ratio is a good predictive indicator of MetS in a large population of young Colombian adults. For this purpose, a cross-sectional study was conducted on 1416 subjects (66.6% female), aged from 18.1 to 25.1. As part of the study, measurements of the subjects' anthropometric indicators, serum lipid indices, blood pressure, and fasting plasma glucose were taken. Body composition was measured through bioelectrical impedance analysis (BIA). A new variable (ratio of fat mass to muscle mass, in kg) was calculated. Following the International Diabetes Federation (IDF) definition, MetS includes three or more metabolic abnormalities. Receiver operating characteristic (ROC) curves and logistic regression determined the discriminatory ability of the fat-to-muscle ratio to predict MetS. According to the IDF, the best fat-to-muscle ratio cut-off point for detecting MetS in men was 0.225 kg, with an area under the curve (AUC) of 0.83, sensitivity of 80%, and specificity of 70%. For women, the fat-to-muscle ratio cut-off point was 0.495 kg, the AUC was 0.88, and the sensitivity and specificity were 82% and 80%, respectively. In conclusion, our results showed that the fat-to-muscle ratio cut-off points from ROC analyses demonstrate good discriminatory power for detecting MetS in young Colombian adults.

Aculturación, involucramiento parental y autoeficacia materna: Un estudio cualitativo con mujeres latinoamericanas en los Estados Unidos / Acculturation, parental involvement, and maternal self-efficacy: A qualitative study among Latin American women in the United States

La inmigración a los Estados Unidos conlleva para las familias latinoamericanas una serie de desafíos y adversidades así como múltiples oportunidades y beneficios. Desde esta perspectiva, el objetivo de la investigación que se informa fue analizar el impacto que tiene este proceso de adaptación en el involucramiento parental y la autoeficacia materna de las mujeres inmigrantes latinoamericanas que residen en los Estados Unidos. En este estudio participaron 14 mujeres provenientes de cinco países latinoamericanos. Los principales hallazgos muestran que las participantes tuvieron que adaptarse a las tradiciones, leyes y normas de convivencia imperantes en los Estados Unidos. Con respecto a sus expectativas, las participantes describieron el deseo de obtener un trabajo bien remunerado para poder satisfacer las necesidades básicas de su familia así como proveer a sus hijos de una buena educación. Entre las principales adversidades se encuentran el idioma, el estatus migratorio y la separación de sus familiares. En contraste, diversos beneficios tales como la educación de los hijos y la información profesional que recibieron han sido determinantes en su involucramiento parental. De la misma manera, las participantes enfatizaron la importancia de diversos recursos que han encontrado en el país de residencia entre los que se encuentran el apoyo recibido del gobierno norteamericano, los cursos en los que han participado y el apoyo social brindado por otras familias latinoamericanas. Los resultados de la investigación permiten concluir que a pesar de los muchos obstáculos a los que se enfrentan, todas las participantes mencionaron contundentemente que el haber inmigrado a los Estados Unidos ha enriquecido su experiencia como madres.

The process of immigration involves multiple challenges and barriers as well as benefits and opportunities. Each year, innumerable Latin American families immigrate to the United States of America seeking employment, medical care, or education for their children. The purpose of this qualitative research was to explore the effects of the process of acculturation in the parental involvement and maternal self-efficacy among Latin American immigrant mothers living in the United States. In order to achieve this objective, four research questions were formulated: (1) Whatis the description that Latin American immigrant women express about their own process of acculturation? (2) What are the changes these women have experienced during their acculturation process to the United States of America? (3) How Latin American immigrant mothers are involved in the academic, emotional, social, and behavioral development of their children (4) What are the perceptions that Latin American immigrant women have about their abilities and resources as mothers? In the present study, 14 women from five different Latin American countries participated in qualitative interviews. Participants' narratives were analyzed using the Consensual Qualitative Research method proposed by Hill, Thompson and Williams. After having analyzed all transcripts, five main themes were identified: (1) Adaptation, (2) Expectations, (3) Challenges, (4) Benefits, and (5) Resources. Results shows that participants had to adapt their behavior and ideas to the current American traditions, laws, and norms. Regarding participants' expectations, they talked about how one of their main expectations was to obtain an employment with which they could satisfy their basic needs and provide a good educational level to their children. Immigrants experience multiple obstacles; for instance, lack of employment and health services, legal status, changes in family functioning, separation from family, discrimination, fear of deportation, intergenerational conflicts, and language proficiency. Besides these external barriers and challenges, Latin American immigrants are affected by internal challenges with possible negative consequences, such as intimate partner violence, despondent moods, loneliness, feeling of inadequacy, gender inequality, stress, anxiety, and alcoholism. In this study, the main barriers these participants had to cope were their immigration status, separation from their families, and language proficiency. In contrast, these participants had several benefits as a result of their decision to immigrate to the United States of America such as economic resources, their children's education, and professional information they received that helped them improve their maternal skills. In consequence, they have been able to develop their maternal skills and spend quality time with their children. All participants in this research emphasized that these benefits have been determinant for their parental involvement. The last factor related to their maternal experience was the resources they have found in the United States of American. Participants talked about the support they have received from the American government, formal and informal knowledge about how to become a better mother, and the social support provided by other Latin American families. In general terms, immigrants experience better life conditions when they have a network of relatives and friends previously established in the receiving country. Consequently, they have more opportunities for a successful relocation in the new region. The importance of social support is related to the presence of these networks which provide any kind of support when necessary. In particular, due to this support, these participants have had a better adaptation to their new life. In conclusion, this research reveals that in spite of multiple challenges Latin American immigrants have to cope, all participants concluded that after immigrating to the United States of America their competence and involvement as mothers have increased.

Palliative Care Needs in an Acute Internal Medicine Ward in Mexico.

BACKGROUND: Palliative care is an evolving but underdeveloped practice in Mexico. OBJECTIVE: The primary end point of this prospective observational study was to identify internal medicine inpatients fulfilling advanced criteria within a second-level hospital. Secondary end points were symptom burden, treatment, resource utilization, and one-year survival. DESIGN AND MEASUREMENTS: The 390-sample size calculation was based on previous studies where 15% of inpatients fulfilled palliative care needs. Consecutive admissions were assessed to identify patients with any of the following: cancer, cardiac, renal, hepatic insufficiency, COPD, AIDS, stroke, or fragility until sample size was completed. After obtaining informed consent, interview to patient, attending physician, and chart review was completed to identify any of the following advanced disease criteria in each patient: (1) Surprise question to attending physician of the possibility of the patient dying in the following year, (2) Palliative Performance Scale (PPS) <50, and (3) Advanced disease specific criteria. Interview also included presence of symptoms, functional capacity, and previous resource utilization. Treatment offered was analyzed only on day of admission. One-year follow-up to assess survival was done through the state death certificates. RESULTS: Out of 390 patients, 131 (34%) had any of the diseases studied. Out of 131 patients, 86 (66%) had at least one of the three inclusion criteria for advanced disease. Out of 86 patients, 70 (81%) advanced disease patients died after one-year follow-up. Comparison between patients with no advanced disease (no criteria) versus advanced disease (at least one criteria) showed a significant difference in mean PPS, nutrition status, survival days, inhospital death, weight loss, dependency on activities of daily living, and previous multiple emergency room visits. Advanced disease patients with no death at one year follow-up had significantly more new admissions to that hospital. CONCLUSIONS: The number of patients requiring palliative care in internal medicine wards may be excessive to the current palliative care structures available.

Multiple Sclerosis in Latin Americans: Genetic Aspects.

Latin Americans (LA) are a heterogeneous, multiethnic group of individuals who inhabit the continental countries in Latin America (LATAM), Caribbean islands and constitute the largest ethnic minority in the USA. Commonly used terminology and ethno racial classifications to define these groups may not be accurate. Risk for multiple sclerosis (MS) among LA is generally low to medium but frequencies are increasing in the American hemisphere. Genome-Wide Association Studies (GWAS) in LA show diverse variants and genetic proportions among Mestizos, the most representative ethnic population, who themselves are the product of centuries of interracial mixing between Native Americans (or Amerindians), White Caucasian Europeans, and Black Africans. Genetic distribution diversity appears to be related to migratory and historical and socio-political factors in LATAM. Epidemiologic studies show an extremely low prevalence of MS among non-mixed Amerindians; this has been attributed to protective ancestral Asian genetics and possibly, environmental factors. Mestizos and biracial LA of African ancestry have more susceptibility to MS apparently due to the historical introduction of the European HLA-DRB1*1501 gene. Contribution from HLA typing, GWAS, and ancestry informative markers (AIMs) has been determinant in the current LA genetic understanding but more regional studies are needed. The relationship between genetics and disease regional distribution is emphasized.

The attitude of Latin American immigrants in Florida (USA) towards deceased organ donation - a cross section cohort study.

The Latin American (LA) population resident in the USA is a growing subgroup of the population. To find out the structure of attitude towards organ donation in the LA population resident in Florida (USA). A sample was taken of LA residents in Florida, randomized and stratified by nationality, age and sex (n = 1524). Attitude was assessed using a validated questionnaire (PCID-DTO Rios) that was self-completed anonymously. The survey completion rate was 95% (n = 1450). Attitude was favourable in 33% of respondents (n = 485), against in 40% (n = 575) and undecided in 27% (n = 390). The following variables were associated with a favourable attitude: country of origin (Dominican Republic; P = 0.038); sex (female; P < 0.001); marital status (married; P < 0.001); level of education (university; P < 0.001); previous experience of the subject (P < 0.001); considering the need for a transplant in the future (P < 0.001); understanding the concept of brain death (P = 0.003); attitude towards donating a family member's organs (P < 0.001); having discussed organ donation and transplantation with one's family (P < 0.001) or with one's partner (P < 0.001); participation in pro-social type activities (P < 0.001); the respondent's religion (atheist-agnostic; P < 0.001); a respondent's knowledge of the attitude of his or her religion towards organ donation (P < 0.001); no concern about mutilation after donation (P < 0.001); acceptance of cremation (P < 0.001); burial (P < 0.001); and an autopsy if one were needed (P < 0.001). The attitude towards donation of LA in Florida is worse than that reported in the native population and is associated with certain psychosocial factors.

Identity management strategies among HIV-positive Colombian gay men in London.

This study set out to explore the social-psychological aspects of living with HIV among a group of HIV-positive Colombian gay men in London, and the strategies that they deployed to manage ensuing threats to their identities. Focus group and individual interview data were collected from 14 Colombian gay men living with HIV, and were analysed using qualitative thematic analysis and identity process theory. The following themes are discussed: (1) identity struggles and conflicts in Colombia, (2), managing multiple layers of social stigma in England, and (3) changing interpersonal and intergroup dynamics, which highlight the inter-connections between sexual prejudice, sexual risk-taking and HIV stigma. Identity may be chronically threatened due to the multiple layers of stigma, which can limit the coping strategies available to individuals. Findings strongly support the need for action and programmes to highlight and tackle both racism and HIV stigma on the gay scene and to fund more specific resources for sub-communities of gay, bisexual and other men who have sex with men, which employ appropriately trained and culturally competent staff.