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1.
Nutr. hosp ; 36(5): 1123-1132, sept.-oct. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184636

RESUMO

Introduction: the failure to eat breakfast has been associated with weight gain, a lower level of physical activity, and poor diet quality. Objective: to examine the frequency of skipping breakfast in an Ecuadorian population and its association with nutritional status and level of physical activity. Methods: a cross-sectional study of individuals who reported breakfast omission in a national survey. Nutritional status and physical activity were evaluated through anthropometric measures and the International Physical Activity Questionnaire, respectively. Results: the mean age of the study sample was 34.2 ± 14 years, 40% were aged 20 to 34 years, one half were women, 55% were living in the coastal region, and one half were classified as low socioeconomic status. Overall, 6.6% of participants did not mention breakfast in both recalls. Individuals who skipped breakfast were more likely to be aged 20 to 34 years (42.6% vs. 37.4%) and from the coastal region (61.1% vs. 51.8%) than those who ate breakfast. We did not find an association between skipping breakfast and being overweight or obese (35.2% vs. 36.1%), nor achieving a low level of physical activity (28.6% vs. 29.8%). In addition, breakfast consumers (vs. non-consumers) had higher intake of total energy, macronutrients (protein, carbohydrate, fat, and sugar), and micronutrients (fiber and calcium). Conclusions: in Ecuador, ~ 7% of the population skips breakfast. The nutritional status and level of physical activity did not differ between those who ate breakfast and those who did not. However, the long-term health consequences should be avoided by changing this eating habit


Introducción: la falta de no desayunar se ha asociado con el aumento de peso, un menor nivel de actividad física y una mala calidad de la dieta. Objetivo: evaluar la frecuencia de saltearse el desayuno en una población ecuatoriana y su asociación con el estado nutricional y el nivel de actividad física. Métodos: estudio de corte transversal de individuos que informaron la omisión del desayuno en una encuesta nacional. El estado nutricional y la actividad física se evaluaron mediante medidas antropométricas y el cuestionario Internacional de Actividad Física, respectivamente. Resultados: la edad media de la muestra del estudio fue de 34,2 ± 14 años, el 40% tenía entre 20 y 34 años, la mitad eran mujeres, el 55% vivía en la región costera y la otra mitad se clasificó de nivel socioeconómico bajo. En general, el 6,6% de los participantes no mencionó el desayuno en ambos recordatorios. Las personas que se saltearon el desayuno tenían más probabilidades de tener entre 20 y 34 años (42.6% vs. 37.4%) y ser de la región costera (61.1% vs. 51.8%) comparado con aquellos que si desayunaron. No se encontró una asociación entre saltarse el desayuno y tener sobrepeso u obesidad (35.2% vs. 36.1%), ni lograr un bajo nivel de actividad física (28.6% vs. 29.8%). Además, los consumidores de desayuno (vs. no consumidores) tuvieron una mayor ingesta de energía total, macronutrientes (proteínas, carbohidratos, grasas totales, y azúcares) y micronutrientes (fibra y calcio). Conclusiones: en Ecuador, ~ 7% de la población se salta el desayuno. El estado nutricional y el nivel de actividad física no difirieron entre quienes desayunaron y quienes no lo hicieron. Sin embargo, las consecuencias de salud a largo plazo deben evitarse cambiando este hábito alimentario


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Desjejum , Estado Nutricional , Atividade Motora , Obesidade/epidemiologia , América Latina/epidemiologia , Estudos Transversais , Inquéritos e Questionários , Antropometria
2.
Rev Assoc Med Bras (1992) ; 65(6): 914-921, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340325

RESUMO

OBJECTIVE: The objective of this review was to investigate the epidemiology of Fulminant Acute Hepatitis in Latin America and the Caribbean and identify possible measures aimed at a better understanding and improvement of patient support. METHODS: We used 3 different researchers to investigate the topic of Fulminant Acute Hepatitis in pediatrics in papers published by Latin American and Caribbean authors in the PubMed and SciELO databases from 2000 to 2016. RESULTS: We found 2,879 articles in the databases searched. After selecting and excluding articles according to the study protocol, 68 remaining studies were obtained for analysis. A total of 1,265 cases of acute fulminant hepatitis were detected, with a predominance of females (42.9%), followed by males (39.4%), with no description of sex in 17.7% of the cases. The main cause was viral hepatitis, representing 45.1% of the cases. The hepatitis A virus was responsible for 34.7% of the total cases and 76.9% of the infectious causes. Of the total number of patients, 26.9% were described as idiopathic, and 11.5% had no cause. CONCLUSION: The preventable causes of Fulminant Acute Hepatitis include hepatitis viruses - primarily the hepatitis A virus - and poisoning. Active vaccination, basic sanitation, and public awareness can reduce the number of patients and, consequently, the costs of liver transplantation due to these causes.


Assuntos
Hepatite/epidemiologia , Falência Hepática Aguda/epidemiologia , Região do Caribe/epidemiologia , Feminino , Humanos , América Latina/epidemiologia , Masculino
3.
Rev Esp Salud Publica ; 932019 Jul 22.
Artigo em Espanhol | MEDLINE | ID: mdl-31328723

RESUMO

OBJECTIVE: Mortality from oral cancer, the prevalence of the main risk factors and the implementation of policies to control current trends and the distribution of data among the countries of Latin America. The objective of this study was to describe the trends of mortality from oral cancer between 2000 and 2017, by sex, in 20 countries in Latin America, and to know the effect of measures to control tobacco consumption and alcohol consumption on the Mortality from oral cancer. METHODS: Ecological study that evaluates the relationship between the rates standardized by the age of cancer by oral sex, the prevalence of tobacco consumption and alcohol consumption, and the implementation of control policies. To calculate the annual percentage change of the rates, the Prais-Winsten regression was used; and the effect of measures of control of risk factors on oral cancer mortality is assessed by Spearman correlations. RESULTS: The greatest decreases in oral cancer mortality were in men in Brazil (APC -7.83, -14.25,-0.93). Mortality from cancer the oral relationship between men and the prevalence of tobacco consumption and alcohol consumption (r = 0.358, r 0.537) (p <0.01), and between the non-implementation of control policies of smoking (r = 0.738) (p= 0.003), the restrictions on the hours and days of sale of alcohol (r = 0.777, p = 0.001), and the states on sponsorship and promotion of alcohol sales (r =0.739 , p =0.040). CONCLUSIONS: The effect of the implementation of control policies is evidenced by a greater relationship with oral cancer mortality in the countries with the least progress in their execution.


Assuntos
Consumo de Bebidas Alcoólicas/prevenção & controle , Carcinoma de Células Escamosas/mortalidade , Política de Saúde , Promoção da Saúde , Neoplasias Bucais/mortalidade , Prevenção do Hábito de Fumar , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/prevenção & controle , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/etiologia , Neoplasias Bucais/prevenção & controle , Prevalência , Fatores de Risco , Fumar/epidemiologia , Espanha
4.
Nurs Clin North Am ; 54(3): 449-456, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31331630

RESUMO

There are roughly 600 million people in the Latin America and the Caribbean region, of whom approximately 36% are living at or below the poverty line. According to this, neurologic injury disorders disproportionately affect this population, which faces not only most risk factors, but also has less developed health systems to deal with illness recovery. Further, most of the risk factors can be attributed to classic preventable cardiovascular risk factors, although there are important differences in demographics, socioeconomic status, and injury mechanisms that may influence the patient's outcome.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Pobreza , Fatores Socioeconômicos , Cuidado Transicional/normas , Região do Caribe/epidemiologia , Países em Desenvolvimento , Humanos , Internacionalidade , América Latina/epidemiologia , Doenças do Sistema Nervoso/epidemiologia
6.
J. Hypertens ; 37(9): 1813-1821, Jul., 31, 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1015823

RESUMO

OBJECTIVES: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. METHODS: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay)were included. HTN was defined as self-reported HTN on blood pressure (BP)medication or average BP over 140/90 mmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90 mmHg. RESULTS: Mean age was 52 years,60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%)58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90 mmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN. CONCLUSION: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is na urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.(AU)


Assuntos
Humanos , Hipertensão/epidemiologia , América Latina/epidemiologia
7.
Int J Infect Dis ; 86: 157-166, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229613

RESUMO

BACKGROUND AND AIMS: Experience in the region shows that in some countries there is very good surveillance of Healthcare-associated infections (HAIs) in health services, but there is no national data consistently in all countries. Therefore, we set to estimate the total burden of HAIs and antimicrobial use in acute care hospitals in Brazil, Venezuela, Mexico, and Colombia using the one-day point prevalence methodology. METHODS: The survey was conducted between June and July 2016. In each ward or unit, HAIs and antimicrobial use data were collected on a single day by a trained team of researchers. Also, for each patient, we collected data on risk factors for infections. RESULTS: One out of ten individuals surveyed had at least one healthcare-associated infection (HAI). Pneumonia and surgical site infections were the most relevant among the surveyed countries. Most of the surveyed participants, regardless of their HAI status, received antibiotics except the individuals managed in Brazil. Carbapenems and third-generation Cephalosporins were among the most frequently used antibiotics. CONCLUSION: Our results add to WHO's recent efforts to understand HAIs prevalence and antibiotic consumption in low and middle-income countries, of which we studied three that were not included in their last report.


Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/epidemiologia , Adulto , Infecção Hospitalar/etiologia , Revisão de Uso de Medicamentos , Métodos Epidemiológicos , Feminino , Hospitais/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Inquéritos e Questionários
8.
BMC Public Health ; 19(1): 826, 2019 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-31242875

RESUMO

BACKGROUND: Varicella is a highly contagious childhood disease. Generally benign, serious complications necessitating antibiotic use may occur. The objective of this study was to characterize the rate, appropriateness and patterns of real-world antibiotic prescribing for management of varicella-associated complications, prior to universal varicella vaccination (UVV) implementation. METHODS: Pooled, post-hoc analysis of 5 international, multicenter, retrospective chart reviews studies (Argentina, Hungary, Mexico, Peru, Poland). Inpatient and outpatient primary pediatric (1-14 years) varicella cases, diagnosed between 2009 and 2016, were eligible. Outcomes, assessed descriptively, included varicella-associated complications and antibiotic use. Three antibiotic prescribing scenarios were defined based on complication profile in chart: evidence of microbiologically confirmed bacterial infection (Scenario A); insufficient evidence confirming microbiological confirmation (Scenario B); no evidence of microbiological confirmation (Scenario C). Stratification was performed by patient status (inpatient vs. outpatient) and country. RESULTS: Four hundred one outpatients and 386 inpatients were included. Mean (SD) outpatient age was 3.6 (2.8) years; inpatient age was 3.1 (2.8) years. Male gender was predominant. Overall, 12.2% outpatients reported ≥1 infectious complication, 3.7% ≥1 bacterial infection, and 0.5% ≥1 microbiologically confirmed infection; inpatient complication rates were 78.8, 33.2 and 16.6%, respectively. Antibiotics were prescribed to 12.7% of outpatients and 68.9% of inpatients. Among users, ß-lactamases (class), and clindamycin (agent), dominated prescriptions. Scenario A was assigned to 3.9% (outpatients) vs 13.2% (inpatients); Scenario B: 2.0% vs. 6.0%; Scenario C: 94.1% vs. 80.8%. CONCLUSIONS: High rates of infectious complications and antibiotic use are reported, with low rates of microbiological confirmation suggesting possible antibiotic misuse for management of varicella complications.


Assuntos
Antibacterianos/uso terapêutico , Varicela/tratamento farmacológico , Assistência à Saúde/normas , Prescrições de Medicamentos/estatística & dados numéricos , Adolescente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Varicela/epidemiologia , Varicela/virologia , Criança , Pré-Escolar , Clindamicina/uso terapêutico , Europa (Continente)/epidemiologia , Feminino , Hospitalização , Humanos , Lactente , Pacientes Internados , América Latina/epidemiologia , Masculino , Pacientes Ambulatoriais , Estudos Retrospectivos , beta-Lactamases/uso terapêutico
9.
Int J Infect Dis ; 85: 37-48, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31085314

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of invasive meningococcal disease (IMD), meningococcal meningitis, and Neisseria meningitidis carriers in Latin America. METHODS: A systematic review was conducted to identify and analyze studies published in 2008-2018. Incidence rates, case fatality rates (CFRs), and the relative distribution of cases per serogroup by country were assessed. RESULTS: Meningococcal surveillance in Latin America differs among countries, and most systems are based on passive sentinel surveillance. Thirty-nine studies were selected. In 2006, the incidence rate of IMD per 100 000 inhabitants was highest in Brazil (1.9), followed by Uruguay (1.3), Chile (0.8), Argentina (0.7), Colombia and Venezuela (0.3 each), and Mexico (0.06). Brazil reported the highest CFR (20%), followed by Uruguay (15%), Chile (11%), and Venezuela and Argentina (10% each). In 2012, the CFR in Chile increased to approximately 27%. The most frequent serogroups among IMD cases were C in Brazil (2007-2010) and Mexico (2005-2016), W in Chile (2012-2018), and B in Argentina (2012-2015). However, the true burden of IMD in Latin America is probably underestimated due to underreporting of cases. CONCLUSIONS: Improvements in IMD notification, IMD registration, national surveillance programs (including active surveillance systems), diagnostic tools, and characterization of isolates may better elucidate the true epidemiological burden of IMD in Latin America.


Assuntos
Infecções Meningocócicas/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , Meningite Meningocócica/epidemiologia , Infecções Meningocócicas/economia , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Neisseria meningitidis/isolamento & purificação , Neisseria meningitidis/fisiologia
10.
BMC Public Health ; 19(1): 528, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31068173

RESUMO

BACKGROUND: Varicella is typically mild and self-limiting, but can be associated with complications and even death. The limited data available on varicella in Latin America and the Caribbean (LAC) indicate substantial burden in countries where varicella vaccine is not part of publicly funded childhood national immunization programs. METHODS: A systematic literature review of published studies was complemented by "gray" literature on varicella incidence, complications, mortality, and economic consequences, in the absence and presence of universal varicella vaccination (UVV) in LAC. RESULTS: Seroprevalence data indicate that varicella is usually a disease of childhood in LAC. Varicella incidence rates, while unreliable in the absence of mandatory reporting, show a trend to increased incidence due to greater urbanization and population density. The introduction of UVV in national immunization programs has led to significant reductions in varicella incidence in these areas. CONCLUSIONS: Varicella continues to pose a substantial healthcare burden in LAC. The future introduction of UVV in additional countries is predicted to provide substantial reductions in cases, with important economic benefits. For countries that have already implemented UVV, the challenge is to maintain high rates of coverage and, where relevant, consider inclusion of a second dose to reduce breakthrough cases. Given the significant proportion of the region now implementing UVV, a regional recommendation in order to prevent any potential for age-shifts in varicella infection might be considered.


Assuntos
Vacina contra Varicela/administração & dosagem , Varicela/epidemiologia , Efeitos Psicossociais da Doença , Vacinação/estatística & dados numéricos , Região do Caribe/epidemiologia , Varicela/prevenção & controle , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Programas de Imunização/estatística & dados numéricos , Incidência , América Latina/epidemiologia , Notificação de Abuso , Estudos Soroepidemiológicos , Resultado do Tratamento
11.
BMC Public Health ; 19(1): 530, 2019 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-31072386

RESUMO

BACKGROUND: The recent Zika virus (ZIKAV) epidemics disclosed a major public health threat and a scientific and technological (S&T) challenge. The lessons learned from the S&T response of Latin America and the Caribbean (LAC) countries are critical to inform further research and guide scientific investments. The present study aimed to assess how new S&T knowledge produced and disseminated regionally can contribute to address global health challenges. METHODS: Scientometric and social network analysis methods were used to assess the LAC scientific contribution and potential technological development on ZIKAV up to December 2017. ZIKAV-related publications were retrieved from the Web of Science, Scopus, and PubMed databases. Regionally published articles were obtained from SciELO (Scientific Electronic Library Online) and LILACS (Literature in the Health Sciences in Latin America and the Caribbean) databases. Patent registries were retrieved using Orbit Intelligence and Derwent Innovation. Records from each database were individually downloaded, integrated, standardized and analyzed. RESULTS: We retrieved 5421 ZIKAV-related publications, revealing a sharp increase from 2015 onwards. LAC countries accounted for 20% of all publications and Brazil was among the top three most central countries in the global network for ZIKAV research. A total of 274 patent families backed up by experimental evidence were retrieved. Only 5% were filed by LAC assignees, all of them based in Brazil. The largest contribution of LAC research was on the clinical manifestations of the ZIKAV infection, along with vector control, which was also the main focus of patents. CONCLUSIONS: Our analysis offered a comprehensive overview of ZIKAV's research and development and showed that (i) LAC countries had a key role in generating and disseminating scientific knowledge on ZIKAV; (ii) LAC countries have expressively contributed to research on ZIKAV clinical manifestations; (iii) the Brazilian scientific community was potentially very effective in knowledge sharing and diffusion in the ZIKAV research network; (iv) Brazil was the single LAC country filing patents, mostly represented by independent inventors and low-tech patents. The paper advocates the need for a continued interdisciplinary approach to improve LAC countries ability to prevent, prepare for and control future outbreaks.


Assuntos
Pesquisa Biomédica/tendências , Epidemias/estatística & dados numéricos , Infecção por Zika virus/epidemiologia , Zika virus , Brasil , Região do Caribe/epidemiologia , Surtos de Doenças , Saúde Global , Humanos , América Latina/epidemiologia , Saúde Pública/tendências , Fatores Socioeconômicos , Infecção por Zika virus/prevenção & controle
12.
BMC Public Health ; 19(1): 581, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096940

RESUMO

BACKGROUND: The inadequate management of solid waste impacts populations' health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. METHODS: This is a cross-sectional study, based on survey design in an area of extreme social vulnerability - the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. RESULTS: One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36-45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). CONCLUSIONS: This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Resíduos de Alimentos , Doenças Profissionais/epidemiologia , Resíduos Sólidos , Adulto , Pré-Escolar , Estudos Transversais , Países em Desenvolvimento , Projetos de Pesquisa Epidemiológica , Feminino , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/etiologia , Qualidade de Vida , Medição de Risco
13.
BMC Public Health ; 19(1): 585, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096943

RESUMO

BACKGROUND: In an ageing world facing an epidemic of chronic diseases, there is great interest in the burden of multimorbidity on individuals and caregivers, yet no studies have examined the longitudinal association between multimorbidity and care dependence in low and middle income countries. Mental and cognitive disorders are associated with dependence but little is known about their role in the pathway to dependence in the context of multimorbidity. This study aims to determine (1) the association of multimorbidity with the onset of care dependence in older adults, accounting for mortality and controlling for sociodemographic factors, and (2) the independent effects of physical multimorbidity, mental and cognitive disorders. METHODS: A population-based cohort study of people aged 65 years and older in six countries in Latin America, and China. Data on chronic conditions and sociodemographic factors were collected at baseline. Multimorbidity was ascertained as a count of up to 15 mental, cognitive and physical health conditions. Dependence was ascertained through informant interviews at baseline and follow-up. We used competing risk regression to assess the association between multimorbidity and the onset of care dependence, acknowledging the possibility of dependence-free death. We also assessed the independent effects of physical multimorbidity and depression, anxiety and dementia individually. RESULTS: 12,965 participants, with no needs for care at baseline, were followed up for a median of 3.0-4.9 years. Each unit increase in multimorbidity count increased the cumulative risk of dependence by 20% in the fully adjusted model. Age was the only variable to confound this relationship. Physical multimorbidity was associated with only a modest increased risk of care dependence. Dementia, depression and anxiety were independently associated with incident care dependence at every level of physical multimorbidity, and depression and anxiety attenuated the effect of physical multimorbidity. CONCLUSION: Multimorbidity consistently predicts care dependence with little variation between countries. Physical multimorbidity imparts a lower risk than multimorbidity with mental and cognitive disorders included. Mental and cognitive disorders independently increase the risk of care dependence. Comprehensive and holistic assessment of disorders of body, brain and mind can help to identify older people at high risk of care dependence.


Assuntos
Cuidadores/estatística & dados numéricos , Doença Crônica/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Multimorbidade , Pobreza/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , China/epidemiologia , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Demência/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Renda , América Latina/epidemiologia , Estudos Longitudinais , Masculino , Análise de Regressão
14.
Am Soc Clin Oncol Educ Book ; 39: e45-e52, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099692

RESUMO

HPV vaccine programs in Latin America run the risk of repeating the problems associated with Papanicolaou (Pap) test programs, an efficient, life-saving tool that is unfortunately underutilized for cancer prevention, in low- and middle-income countries. There is a great need for vigilance in the ongoing implementation of the HPV vaccine in Latin America.


Assuntos
Neoplasias/epidemiologia , Neoplasias/prevenção & controle , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus , Estudos de Viabilidade , Saúde Global , Política de Saúde , Humanos , América Latina/epidemiologia , Neoplasias/etiologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/administração & dosagem , Vacinas contra Papillomavirus/imunologia , Vigilância em Saúde Pública , Vacinação
15.
Lupus ; 28(6): 740-747, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31018759

RESUMO

OBJECTIVE: The aim of this study is to determine whether the functional interferon regulatory factor 5 ( IRF5) polymorphism rs2004640 is associated with susceptibility to systemic lupus erythematosus (SLE) in multiple ethnic populations. METHODS: A meta-analysis was conducted on the T allele of the IRF5 rs2004640 polymorphism in all study participants as well as each ethnic population. RESULTS: Twenty research articles that included 28 comparative studies of 20,892 patients and 24,930 controls were included in the meta-analysis. The Asian population had a much lower prevalence of the T allele than any other study population at 28%, and the European population had the highest prevalence of the T allele at 52%. Meta-analysis showed an association between the IRF5 rs2004640 polymorphism and SLE in all participants (odds ratio = 1.472, 95% confidence interval = 1.370-1.582, p < 0.001). Analysis after stratification by ethnicity indicated that the IRF5 rs2004640 T allele is significantly associated with SLE in Europeans, Asians, Latin Americans and Arabs. CONCLUSIONS: This meta-analysis confirms that the IRF5 rs2004640 polymorphism is associated with SLE susceptibility in different ethnic groups, and that its prevalence is ethnicity dependent.


Assuntos
Fatores Reguladores de Interferon/genética , Lúpus Eritematoso Sistêmico/genética , Polimorfismo Genético , Alelos , Ásia/epidemiologia , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Grupos Étnicos/genética , Europa (Continente)/epidemiologia , Grupo com Ancestrais do Continente Europeu/genética , Frequência do Gene , Predisposição Genética para Doença , Humanos , América Latina/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Prevalência
16.
Pediatr Hematol Oncol ; 36(2): 55-72, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31014139

RESUMO

Retinoblastoma (RB) is the most common intraocular tumor of childhood. In low income countries, Time to diagnosis (TTD: interval between first symptom and diagnosis) has been associated with extraocular disease, metastasis and mortality. However, the relationship between TTD and prognosis is complex and not simply a linear correlation, particularly if TTD is <6 months. This systematic review aims to identify studies reporting TTD of retinoblastoma in Latin America, highlighting factors affecting TTD, alongside proposals and initiatives to obtain shorter intervals. The review also aims to discuss the methodology linked to cancer pathways studies. The study respected PRISMA recommendations, was registered on Prospero, an international database for systematic review registries under number CRD42017076777. MEDLINE/PUBMED, LILACS and SCIELO databases were searched. Studies from Latin America and the Caribbean, published between 1997 and 2017, reporting TTD and age at diagnosis of patients with retinoblastoma were selected. Nine studies were selected, concerning 1560 patients from Argentina, Brazil, Chile, Honduras, Mexico and Peru. The median TTD ranged from 3 to 5 months and the median age at diagnosis ranged from 16.5 to 22.2 months. A prolonged TTD was observed and was associated to damaging results on retinoblastoma outcomes, particularly increasing extraocular disease, and mortality rates. Methodological heterogeneity was observed and reiterates the importance of standardization of TTD studies, allowing more reliable comparisons and greater knowledge about retinoblastoma pathways before diagnosis. Reports on successful initiatives against delayed diagnosis were scarce, emphasizing a need for further studies.


Assuntos
Neoplasias Oculares/diagnóstico , Retinoblastoma/diagnóstico , Fatores Etários , Pré-Escolar , Diagnóstico Tardio , Detecção Precoce de Câncer , Diagnóstico Precoce , Neoplasias Oculares/epidemiologia , Humanos , Lactente , Recém-Nascido , América Latina/epidemiologia , Prognóstico , Retinoblastoma/epidemiologia , Fatores Socioeconômicos , Fatores de Tempo
17.
Emergencias (Sant Vicenç dels Horts) ; 31(2): 123-135, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182530

RESUMO

En los servicios de urgencias hospitalarios (SUH), la incidencia y la prevalencia de la sepsis dependen de las definiciones y registros que se utilicen. Además, en general existe un infradiagnostico. Un grupo internacional de expertos y representantes de sociedades y asociaciones latinoamericanas de urgencias y emergencias ha revisado y analizado las coincidencias y diferencias en la situación actual epidemiológica, así como los problemas y puntos clave (con sus similitudes y diferencias según el entorno geográfico) en relación a: la detección inmediata del paciente con infección grave-sepsis, los criterios para su definición, la administración de la antibioterapia y fluidoterapia precoces y adecuadas, y el papel que juegan los sistemas de triaje, las unidades multidisciplinares de sepsis (conocidas como "código sepsis") o los biomarcadores en esta enfermedad tiempo-dependiente. Además, señalan algunos puntos clave y estrategias de mejora para el diagnóstico, pronóstico y atención en los SUH de estos pacientes


Although infection rates and the impact of infection on hospital emergency departments (EDs) are known or can be reliably estimated, the incidence and prevalence of sepsis vary in relation to which definitions or registers used. Sepsis is also well known to be under-diagnosed by physicians in general and by ED physicians in particular. Over half of sepsis cases are community-acquired, and 50% to 60% of patients in intensive care units (ICUs) with sepsis or septic shock are admitted directly from the ED. Pneumonia and urinary tract infections are the most common points of focus in sepsis, septic shock, bacteremia, and ED admissions to the ICU for infectious processes. For this article a multinational group of experts representing Latin American emergency medicine associations reviewed and analyzed similarities and differences in the epidemiology of sepsis in different geographic locations. We consider key aspects and geographic similarities and differences in the early identification of patients with severe sepsis; criteria that define the diagnosis; appropriate early antibiotic and fluid therapy; the roles of triage systems and multidisciplinary sepsis code units; and the use of biological markers in this time-dependent disease. We also discuss key points and strategies for improving the diagnosis, prognosis, and care of sepsis patients in the ED


Assuntos
Humanos , Consenso , Sepse/epidemiologia , Serviço Hospitalar de Emergência , Biomarcadores , Prognóstico , América Latina/epidemiologia , Infecção Hospitalar/epidemiologia , Diagnóstico Precoce
18.
Trop Anim Health Prod ; 51(5): 1033-1048, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877525

RESUMO

Newcastle disease (ND) infects wild birds and poultry species worldwide, severely impacting the economics of the poultry industry. ND is especially problematic in Latin America (Mexico, Colombia, Venezuela, and Peru) where it is either endemic or re-emerging. The disease is caused by infections with one of the different strains of virulent avian Newcastle disease virus (NDV), recently renamed Avian avulavirus 1. Here, we describe the molecular epidemiology of Latin American NDVs, current control and prevention methods, including vaccines and vaccination protocols, as well as future strategies for control of ND. Because the productive, cultural, economic, social, and ecological conditions that facilitate poultry endemicity in South America are similar to those in the developing world, most of the problems and control strategies described here are applicable to other continents.


Assuntos
Galinhas , Doença de Newcastle , Vírus da Doença de Newcastle/imunologia , Doenças das Aves Domésticas , Vacinação/veterinária , Vacinas Virais/administração & dosagem , Animais , América Latina/epidemiologia , Doença de Newcastle/epidemiologia , Doença de Newcastle/prevenção & controle , Doenças das Aves Domésticas/epidemiologia , Doenças das Aves Domésticas/prevenção & controle
19.
BMC Int Health Hum Rights ; 19(1): 9, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30832664

RESUMO

BACKGROUND: Female sex workers, MSM, and transgender women-collectively referred to as key populations (KPs)-are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs' human rights. METHODS: Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis. RESULTS: Nearly all participants experienced some form of GBV. Emotional and economic GBV were the most commonly reported but approximately three-quarters of participants reported sexual and physical GBV and other human rights violations. The most common settings for GBV were at home, locations where sex work took place such as brothels, bars and on the street; public spaces such as parks, streets and public transport, health care centers, police stations and-for transgender women and MSM-religious settings and schools. The most common perpetrators of violence included: family, friends, peers and neighbors, strangers, intimate partners, sex work clients and other sex workers, health care workers, police, religious leaders and teachers. Consequences included emotional, physical, and sexual trauma; lack of access to legal, health, and other social services; and loss of income, employment, housing, and educational opportunities. Though many participants disclosed experiences of GBV to friends, colleagues and family, they rarely sought services following violence. Furthermore, less than a quarter of participants believed that GBV put them at risk of HIV. CONCLUSIONS: Our study found that across the four study countries, FSWs, MSM, and transgender women experienced GBV from state and non-state actors throughout their lives, and much of this violence was directly connected to rigid and harmful gender norms. Through coordinated interventions that address both HIV and GBV, this region has the opportunity to reduce the national burden of HIV while also promoting key populations' human rights.


Assuntos
Violência de Gênero , Infecções por HIV/epidemiologia , Profissionais do Sexo/psicologia , Minorias Sexuais e de Gênero/estatística & dados numéricos , Estigma Social , Adulto , Região do Caribe/epidemiologia , Feminino , Direitos Humanos , Humanos , Entrevistas como Assunto , América Latina/epidemiologia , Masculino , Pesquisa Qualitativa
20.
Clin Rheumatol ; 38(5): 1485-1496, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30915652

RESUMO

INTRODUCTION: Biologics have improved the treatment of rheumatic diseases, resulting in better outcomes. However, their high cost limits access for many patients in both North America and Latin America. Following patent expiration for biologicals, the availability of biosimilars, which typically are less expensive due to lower development costs, provides additional treatment options for patients with rheumatic diseases. The availability of biosimilars in North American and Latin American countries is evolving, with differing regulations and clinical indications. OBJECTIVE: The objective of the study was to present the consensus statement on biosimilars in rheumatology developed by Pan American League of Associations for Rheumatology (PANLAR). METHODS: Using a modified Delphi process approach, the following topics were addressed: regulation, efficacy and safety, extrapolation of indications, interchangeability, automatic substitution, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. Consensus was achieved when there was agreement among 80% or more of the panel members. Three Delphi rounds were conducted to reach consensus. Questionnaires were sent electronically to panel members and comments about each question were solicited. RESULTS: Eight recommendations were formulated regarding regulation, pharmacovigilance, risk management, naming, traceability, registries, economic aspects, and biomimics. CONCLUSION: The recommendations highlighted that, after receiving regulatory approval, pharmacovigilance is a fundamental strategy to ensure safety of all medications. Registries should be employed to monitor use of biosimilars and to identify potential adverse effects. The price of biosimilars should be significantly lower than that of reference products to enhance patient access. Biomimics are not biosimilars and, if they are to be marketed, they must first be evaluated and approved according to established regulatory pathways for novel biopharmaceuticals. KEY POINTS: • Biologics have improved the treatment of rheumatic diseases. • Their high cost limits access for many patients in both North America and Latin America. • Biosimilars typically are less expensive, providing additional treatment options for patients with rheumatic diseases. • PANLAR presents its consensus on biosimilars in rheumatology.


Assuntos
Medicamentos Biossimilares/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Medicamentos Biossimilares/efeitos adversos , Consenso , Medicina Baseada em Evidências , Humanos , América Latina/epidemiologia , América do Norte , Guias de Prática Clínica como Assunto , Reumatologia , Sociedades Médicas
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