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1.
Rev. bioét. derecho ; (50): 221-237, nov. 2020.
Artigo em Espanhol | IBECS | ID: ibc-FGT-4644

RESUMO

Los avances de las Tecnologías de la Información y la Comunicación (TIC) permiten acceder en tiempo real a una cantidad ingente de datos, a través de los cuales es posible conocer el comportamiento de hechos sociales. En este escenario, la actual pandemia por SARS-CoV-2 ha permitido, bajo cuestionables criterios de inmediatez y urgencia, circular información que genera realidad e impacta en la toma de decisiones; y, además, ha favorecido la apropiación del dato, exponiendo a las personas a violaciones de sus derechos fundamentales. Ambos asuntos son sensibles para América Latina y el Caribe, región que hoy se presenta no sólo como el epicentro de la pandemia sino también de las desigualdades. La contribución que desde la reflexión y deliberación bioética puede realizarse en esta materia, adquiere especial relevancia con vistas a generar un nuevo pacto para el tratamiento de los datos


Advances in Information and Communication Technologies (ICT) provide real-time access to a vast amount of data, through which it is possible to know the behavior of social facts. In this scenario, the current SARS-CoV-2 pandemic has allowed, under questionable criteria of immediacy and urgency, to circulate information that generates reality and impacts on decision-making; and has also favored the appropriation of the data, exposing people to violations of their fundamental rights. Both issues are sensitive to Latin America and the Caribbean, a region that today is presented itself not only as the epicenter of the pandemic but also of inequalities. The contribution that bioethical reflection and deliberation can make in this matter, acquires special relevance with a view to generating a new covenant for the treatment of data


Els avenços de les Tecnologies de la Informació I la Comunicació (TIC) permeten accedir en temps real a una quantitat ingent de dades, a través dels quals és possible conèixer el comportament de fets socials. En aquest escenari, l'actual pandèmia per SARS-CoV-2 ha permès, sota qüestionables criteris d'immediatesa I urgència, circular informació que genera realitat I impacta en la presa de decisions; i, a més, ha afavorit l'apropiació de la dada, exposant a les persones a violacions dels seus drets fonamentals. Tots dos assumptes són sensibles per a Amèrica Llatina I el Carib, regió que avui es presenta no només com l'epicentre de la pandèmia sinó també de les desigualtats. La contribució que des de la reflexió I deliberació bioètica pot realitzarse en aquesta matèria, adquireix especial rellevància amb vistes a generar un nou pacte per al tractament de les dades


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Acesso à Internet , Tecnologia da Informação , América Latina/epidemiologia , Região do Caribe/epidemiologia
3.
Washington; Organización Panamericana de la Salud; jun. 15, 2020. 26 p.
Não convencional em Espanhol | LILACS | ID: biblio-1099999

RESUMO

La finalidad de este documento es brindar orientación a los países de América Latina y el Caribe a fin de mejorar la vigilancia de la mortalidad por COVID-19. En este documento se amplían los métodos deanálisis de la mortalidad por todas las causas como uno de los enfoques propuestos para contribuir a la evaluación de la magnitud real de la carga de la epidemia de COVID-19 en los países de América Latina y el Caribe. Este documento está dirigido a las autoridades nacionales de salud, incluidos los equipos de vigilancia epidemiológica y de emergencia de salud pública que participan en la respuesta a la epidemia de COVID-19, así como a otros profesionales o instituciones a cargo de la vigilancia (como los departamentos de epidemiología) y de seguimiento de la mortalidad (como los institutos nacionales de estadística).


Assuntos
Humanos , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/epidemiologia , Pandemias/prevenção & controle , Vigilância em Saúde Pública/métodos , Betacoronavirus/patogenicidade , Estatísticas Vitais , Região do Caribe/epidemiologia , Serviços Médicos de Emergência/organização & administração , Monitoramento Epidemiológico , América Latina/epidemiologia
4.
Recurso na Internet em Inglês, Espanhol | LIS - Localizador de Informação em Saúde | ID: lis-47549

RESUMO

El Reino Unido acordó contribuir con 3 millones de libras (unos 3,8 millones de dólares) a la Organización Panamericana de la Salud (OPS) para ayudar a ocho países del Caribe a contener la propagación de la pandemia por la nueva enfermedad por el coronavirus del 2019 (COVID-19) y mitigar su impacto. Los países beneficiarios son Antigua y Barbuda, Belice, Dominica, Granada, Guyana, Jamaica, Santa Lucía y San Vicente y las Granadinas.


Assuntos
Infecções por Coronavirus , Região do Caribe/epidemiologia , Betacoronavirus
6.
J Relig Health ; 59(1): 40-58, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31020490

RESUMO

This study examined the relationships of perceived discrimination and religious coping with hypertension in a sample of Black and White Seventh-day Adventists. Data come from a community-based sample of 6128 White American, 2253 African American and 927 Caribbean American adults (67% women; mean age = 62.9 years). Results indicate lifetime unfair treatment was significantly associated with hypertension regardless of race/ethnicity. Positive religious coping was associated with lower odds of hypertension and did not interact with unfair treatment. Both positive and negative religious coping were indirectly associated with increased hypertension risk through an increase in perceived discrimination.


Assuntos
Adaptação Psicológica , Afro-Americanos/psicologia , Discriminação Psicológica , Grupo com Ancestrais do Continente Europeu/psicologia , Hipertensão/psicologia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Região do Caribe/epidemiologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Hipertensão/etnologia , Hipertensão/terapia , Masculino , Pessoa de Meia-Idade
7.
BMC Infect Dis ; 19(1): 1081, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878895

RESUMO

BACKGROUND: The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. METHODS: Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1-3, 4-6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems. Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites. Substudies of ZIKV seroprevalence, transmission clustering, disabilities and health economics, viral kinetics, the potential role of antibody enhancement, and co-infections will be linked to the cohort studies. DISCUSSION: Results of these large cohort studies will provide better risk estimates for birth defects and other developmental abnormalities associated with ZIKV infection including possible co-factors for the variability of risk estimates between other countries and regions. Additional outcomes include incidence and transmission estimates of ZIKV during and after pregnancy, characterization of short and long-term clinical course following infection and viral kinetics of ZIKV. STUDY REGISTRATIONS: clinicaltrials.gov NCT03188731 (PW cohort), June 15, 2017; clinicaltrials.gov NCT03393286 (CH cohort), January 8, 2018; clinicaltrials.gov NCT03204409 (NH cohort), July 2, 2017.


Assuntos
Arbovirus/isolamento & purificação , Microcefalia/complicações , Complicações Infecciosas na Gravidez/epidemiologia , Infecção por Zika virus/epidemiologia , Zika virus/imunologia , Adulto , Arbovirus/genética , Região do Caribe/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção , Feminino , Seguimentos , Humanos , Lactente , América Latina/epidemiologia , Microcefalia/epidemiologia , Microcefalia/virologia , Gravidez , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal , Estudos Prospectivos , Risco , Estudos Soroepidemiológicos , Zika virus/isolamento & purificação , Infecção por Zika virus/transmissão , Infecção por Zika virus/virologia
8.
PLoS One ; 14(11): e0224655, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31725746

RESUMO

INTRODUCTION: Epidemiology of acute kidney injury (AKI) is highly dependent on patient characteristics, context and geography. Considering the limited information in Latin America and the Caribbean, we performed a study with the aim to contribute to improve its better understanding. METHODS: Observational, prospective, longitudinal, multinational cohort study addressed to determine risk factors, clinical profile, process of care and outcomes of AKI in the region. Patients meeting KDIGO AKI definition were included over a 9-month period and designated community or hospital-acquired. De-identified clinical and lab data were entered in a specifically designed on-line platform. Co-variables potentially linked to AKI onset, in-hospital and 90-days mortality, were recorded and correlated using a multiple logistic regression model. RESULTS: Fifty-seven physicians from 15 countries provided data on 905 patients, most with acceptable basic needs coverage. Median age 64 (50-74) yrs; most of them were male (61%) and mestizos (42%). Comorbidities were present in 77%. AKI was community-acquired in 62%. Dehydration, shock and nephrotoxic drugs were the commonest causes. During their process of care, 77% of patients were assessed by nephrologists. Kidney replacement therapy (KRT) was performed in 29% of cases. In-hospital mortality was 26.5% and independently associated to older age, chronic liver disease, hypotension, shock, cardiac disturbances, hospital-acquired sepsis, KRT and mechanical ventilation. At 90-days follow up partial or complete renal recovery was 81% and mortality 24%. CONCLUSIONS: AKI was mainly community-acquired, in patients with comorbidities and linked to fluid loss and nephrotoxic drugs. Mortality was high and long-term follow up poor. Notwithstanding, the study shows partially the situation in the participant countries rather than the actual epidemiology of AKI in Latin America and Caribbean, a pending and needed task.


Assuntos
Lesão Renal Aguda/mortalidade , Mortalidade Hospitalar , Terapia de Substituição Renal , Lesão Renal Aguda/terapia , Adolescente , Adulto , Idoso , Região do Caribe/epidemiologia , Intervalo Livre de Doença , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida
9.
BMC Oral Health ; 19(1): 234, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675959

RESUMO

BACKGROUND: Good oral health has been associated with better quality of life and general health. In the Caribbean, there have been no studies regarding the association between oral health conditions and the quality of life of the population. The main purpose of this study was to investigate the association between gingival parameters and oral health-related quality of life (OHRQoL) in Caribbean adults. A secondary aim of the study was to gain more information on factors that impact OHRQoL in this population. METHODS: This cross-sectional, epidemiological, population-based study was conducted in community settings. After the participants with missing Oral Health Impact Profile (OHIP) data were excluded, the sample size was 1821 (weighted according to the age and gender distribution in each target population). OHIP-14 standardized questionnaires were used to collect information. In addition, a medical/oral health questionnaire including sociodemographics, general health, dental visits, oral hygiene habits and knowledge, the frequency of dental visits, prosthesis use/hygiene, and smoking was administered. A multivariate model included predictors that showed significant associations in the univariate models. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported; statistical significance was set at 0.05. RESULTS: In the multivariate analysis, current smokers (OR = 2.34, 95% CI: 1.74-3.14 vs. never smokers), those who visited the dentist only when problems arose (OR = 1.65, 95% CI: 1.13-2.40 vs. those visiting once a year), and participants with any chronic disease/condition (OR = 1.38, 95% CI: 1.06-1.78) had higher odds of being in the highest tertile for OHIP score (poorer health). CONCLUSIONS: The present multicenter study identified potential modifiable risk factors for poor OHRQoL among adults in three Caribbean cities.


Assuntos
Doenças da Gengiva/epidemiologia , Saúde Bucal , Higiene Bucal , Vigilância da População/métodos , Qualidade de Vida , Adolescente , Adulto , Idoso , Região do Caribe/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice Periodontal , Inquéritos e Questionários , Adulto Jovem
10.
J Parasitol ; 105(5): 697-703, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31580786

RESUMO

Snappers from the southern Gulf of Mexico (SGM) and Mexican Caribbean (CAR) were examined for parasitic nematodes to determine their richness, composition, and infection parameters (prevalence and mean intensity). From February 2016 to March 2018, 431 individuals of 8 snapper species were collected in 6 localities. In all, these fishes were parasitized by 2,275 individual nematodes belonging to 13 taxa: Terranova sp. was found in 7 of 8 host species and showed the highest prevalence (23%), while the rest had lower values (<10%). Lutjanus griseus (Linnaeus) harbored the highest species richness (10 species), followed by Lutjanus apodus (Walbaum) (8 species). Most localities were similar in terms of species richness but differed in the specific composition. Eight nematode taxa represent new host records for the family Lutjanidae (Gill), thus increasing to 22 the nematode taxa in the SGM and CAR. There is a potential risk to public health due to the presence of nematodes with zoonotic potential (as Anisakis sp.) and the habit in the region of eating raw fish (cebiche).


Assuntos
Doenças dos Peixes/parasitologia , Nematoides/classificação , Infecções por Nematoides/veterinária , Perciformes/parasitologia , Animais , Região do Caribe/epidemiologia , Doenças dos Peixes/epidemiologia , Golfo do México/epidemiologia , Humanos , México/epidemiologia , Nematoides/isolamento & purificação , Infecções por Nematoides/epidemiologia , Infecções por Nematoides/parasitologia , Infecções por Nematoides/transmissão , Prevalência , Alimentos Crus/parasitologia , Zoonoses
11.
Cardiovasc Ultrasound ; 17(1): 20, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31630681

RESUMO

BACKGROUND: Cardiac adaptation to intense physical training is determined by many factors including age, gender, body size, load training and ethnicity. Despite the wide availability of ECG analysis, with a higher presence of abnormalities in different races, echocardiographic studies on young Afro-Caribean (AA) and Caucasian athletes (CA) are lacking in literature. We aimed to assess the effect in the secondary LV remodelling of load training in young AA players compared to matched CA players. METHOD: Seventy-seven AA and 53 CA matched soccer players (mean age 17.35 ± 0.50 and 18.25 ± 0.77 y) were enrolled. They were evaluated with echocardiography. A subgroup of 30 AA and 27 CA were followed up for a period of 4 years. The myocardial contractile function was evaluated by speckle-tracking echocardiographic global longitudinal strain (GLS). RESULTS: No significant differences were found in weight and height and in blood pressure response to maximal ergometer test in either group. In AA a higher level of LV remodelling, consisting in higher LV wall thickness, higher interventricular septum (IVS) and posterior wall (PW) thickness were found (IVS: 10.04 ± 0.14 and 9.35 ± 0.10 in AA and CA respectively, p < 0.001. PW: 9.70 ± 0.20 and 9.19 ± 0.10 mm in AA and CA respectively, p < 0.05). Strain data showed no significant differences between the two groups (22.35 ± 0.48 and 23.38 ± 0.69 in AA (n = 27) and CA (n = 25), respectively). At the beginning of the follow-up study AA showed a significantly higher left ventricular remodelling (IVS = 9.29 ± 0.3 and 8.53 ± 0.12 mm in AA and CA respectively, p < 0.002. PW = 9.01 ± 0.2 and 8.40 ± 0.20 in AA and CA respectively, p = 0.1). During the next four years of follow-up we observed a regular parallel increase in LV wall thickness and chamber diameters in both groups, proportionally to the increase in body size and LV mass. (IVS = 10.52 ± 0.17 and 9.03 ± 0.22 mm in AA and CA respectively, p < 0.001. PW: 10.06 ± 0.17 and 8.26 ± 0.19 mm in AA and CA respectively, p < 0.001). CONCLUSION: The study shows that the ventricular remodelling observed in AA appears to be a specific phenotype already present in pre-adolescence. These data also suggest that genetic/ethnic factors play a central role in left ventricular remodelling during the first years of life in elite athletes.


Assuntos
Afro-Americanos , Atletas , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular/fisiologia , Adolescente , Região do Caribe/epidemiologia , Eletrocardiografia , Ventrículos do Coração/fisiopatologia , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/fisiopatologia , Incidência , Masculino , Contração Miocárdica/fisiologia
12.
PLoS One ; 14(10): e0224012, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618268

RESUMO

BACKGROUND: Female breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries. METHODS: We searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493. RESULTS: For pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2 = 99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study. CONCLUSIONS: LAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Região do Caribe/epidemiologia , Feminino , Humanos , Incidência , América Latina/epidemiologia , Estadiamento de Neoplasias , Análise de Sobrevida
13.
PLoS One ; 14(10): e0222835, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31574098

RESUMO

BACKGROUND: Guyana expanded its HIV response in 2005 but the epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections has not been characterized. METHODS: The 2011 Seroprevalence and Behavioral Epidemiology Risk Survey for HIV and STIs collected biologic specimens with demographic and behavioral data from a representative sample of Guyana military personnel. Diagnostics included commercial serum: HIV antibody; total antibody to hepatitis B core (anti-HBc); IgM anti-HBc; hepatitis B surface antigen (HBsAg); anti-HBs; antibody to HCV with confirmatory testing; and HBV DNA sequencing with S gene fragment phylogenetic analysis. Chi-square, p-values and prevalence ratios determined statistical significance. RESULTS: Among 480 participants providing serologic specimens, 176 (36.7%) tested anti-HBc-positive. Overall, 19 (4.0%) participants tested HBsAg-positive; 17 (89.5%) of the HBsAg-positive participants also had detectable anti-HBc, including 1 (5.3%) IgM anti-HBc-positive male. Four (6.8%) females with available HBV testing were HBsAg-positive, all aged 23-29 years. Sixteen (16, 84.2%) HBsAg-positive participants had sufficient specimen for DNA testing. All 16 had detectable HBV DNA, 4 with viral load >2x104IU/ml. Sequencing found: 12 genotype (gt) A1 with 99.9% genetic identity between 1 IgM anti-HBc-positive and 1 anti-HBc-negative; 2 gtD1; and 2 with insufficient specimen. No statistically significant associations between risk factors and HBV infection were identified. CONCLUSIONS: Integrated HIV surveillance identified likely recent adult HBV transmission, current HBV infection among females of reproductive age, moderate HBV infection prevalence (all gtA1 and D1), no HCV infections and low HIV frequency among Guyana military personnel. Integrated HIV surveillance helped characterize HBV and HCV epidemiology, including probable recent transmission, prompting targeted responses to control ongoing HBV transmission and examination of hepatitis B vaccine policies.


Assuntos
Infecções por HIV/sangue , HIV-1/isolamento & purificação , Hepatite B/sangue , Hepatite C/sangue , Adolescente , Adulto , Região do Caribe/epidemiologia , Feminino , Guiana/epidemiologia , Anticorpos Anti-HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-1/patogenicidade , Hepatite B/epidemiologia , Hepatite B/transmissão , Hepatite B/virologia , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/patogenicidade , Hepatite C/epidemiologia , Hepatite C/transmissão , Hepatite C/virologia , Humanos , Masculino , Militares , Fatores de Risco , Estudos Soroepidemiológicos , Carga Viral , Adulto Jovem
14.
Glob Public Health ; 14(11): 1547-1556, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31537195

RESUMO

This introduction presents a special issue of Global Public Health with a collection of articles that offer multidisciplinary perspectives on HIV/AIDS in the Caribbean. Since the 1990s, poverty, marginalisation, and social stigma have been strong foci of much social science research on HIV/AIDS in the region. These three interrelated phenomena have been offered as explanatory factors contributing to the high prevalence of cases observed in this region. Contributors to this special issue take these emphases in new directions, asking multi-level questions that require unique combinations of epidemiological, social scientific, theoretical, and policy-oriented perspectives and methodologies. Together, they identify several topical areas that intend to create dialogue across disciplines and dialectics, with the fundamental principle that the factors relevant to HIV/AIDS are broad and require intersectional lenses. The articles in this issue offer multi-level interventions into HIV/AIDS in the region, from the varied social circumstances that shape heightened risk factors to patient adherence programmes, with emphases on structural, social, and policy-level approaches. Collectively, this special issue establishes the importance of transdisciplinary approaches to HIV/AIDS that are macro-level in scope, but simultaneously attend to how large-scale dynamics are inflected in situated contexts and histories.


Assuntos
Infecções por HIV/epidemiologia , Região do Caribe/epidemiologia , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Prevalência , Marginalização Social , Estigma Social , Estados Unidos
16.
Int. microbiol ; 22(3): 337-342, sept. 2019.
Artigo em Inglês | IBECS | ID: ibc-184840

RESUMO

Malaria is one of the most important human diseases throughout tropical and sub-tropical regions of the world. Global distribution and ample host range have contributed to the genetic diversity of the etiological agent, Plasmodium. Phylogeographical analyses demonstrated that Plasmodium falciparum and Plasmodium vivax follow an Out of Africa (OOA) expansion, having a higher genetic diversity in African populations and a low genetic diversity in South American populations. Modeling the evolutionary rate of conserved genes for both P. falciparum and P. vivax determined the approximate arrival of human malaria in South America. Bayesian computational methods suggest that P. falciparum originated in Africa and arrived in South America through multiple independent introductions by the transatlantic African slave trade; however, in South America, P. vivax could have been introduced through an alternate migratory route. Alignments of P. vivax mitogenomes have revealed low genetic variation between the South American and Southeast Asian populations suggesting introduction through either pre-Columbian human migration or post-colonization events. To confirm the findings of these phylogeographical analyses, molecular methods were used to diagnose malaria infection in archeological remains of pre-Columbian ethnic groups. Immunohistochemistry tests were used and identified P. vivax but not P. falciparum in histologically prepared tissues from pre-Columbian Peruvian mummies, whereas shotgun metagenomics sequencing of DNA isolated from pre-Columbian Caribbean coprolites revealed Plasmodium-homologous reads; current evidence suggests that only P. vivax might have been present in pre-Columbian South America


No disponible


Assuntos
Humanos , Malária Vivax/parasitologia , Epidemiologia Molecular , Filogeografia , Plasmodium vivax/classificação , Plasmodium vivax/genética , Região do Caribe/epidemiologia , América do Sul/epidemiologia
17.
PLoS Negl Trop Dis ; 13(8): e0007622, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31449532

RESUMO

BACKGROUND: A severe neurological disorder, Guillain-Barré syndrome (GBS) is the leading cause of acute flaccid paralysis. Enhanced surveillance of GBS in Latin America and the Caribbean (LAC) following the 2015-2016 Zika virus (ZIKV) epidemic presents an opportunity to estimate, for the first time, the regional incidence of GBS. METHODS AND FINDINGS: For this systematic review and meta-analysis, we searched nine scientific databases and grey literature from January 1, 1980 to October 1, 2018. Sources with primary data on incident GBS cases in LAC within a well-defined population and timeframe, published in English, Spanish, Portuguese, or French, were included. We calculated the annual GBS incidence rates (IRs) and 95% confidence intervals (CIs) for each source based on published data. Following an assessment of heterogeneity, we used random-effects meta-analysis to calculate the pooled annual IR of GBS. The study is registered with PROSPERO, number CRD42018086659. Of the 6568 initial citation hits, 31 were eligible for inclusion. Background annual GBS IRs in Latin America ranged from 0.40 in Brazil to 2.12/100,000 in Chile. The pooled annual IR in the Caribbean was 1.64 (95% CI 1.29-2.12, I2<0.01, p = 0.44). During the ZIKV epidemic, GBS IRs ranged from 0.62 in Mexico to 9.35/100,000 in Martinique. GBS increased 2.6 (95% CI 2.3-2.9) times during ZIKV and 1.9 (95% CI 1.1-3.4) times during chikungunya outbreaks over background rates. A limitation of this review is that the studies included employed different methodologies to find and ascertain cases of GBS, which could contribute to IR heterogeneity. In addition, it is important to consider that data on GBS are lacking for many countries in the region. CONCLUSIONS: Background IRs of GBS appear to peak during arboviral disease outbreaks. The current review contributes to an understanding of the epidemiology of GBS in the LAC region, which can inform healthcare system planning and preparedness, particularly during arboviral epidemics. TRIAL REGISTRATION: Registered with PROSPERO: CRD42018086659.


Assuntos
Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/epidemiologia , Região do Caribe/epidemiologia , Febre de Chikungunya/epidemiologia , Bases de Dados Factuais , Epidemias , Feminino , Humanos , Incidência , América Latina/epidemiologia , Masculino , Martinica/epidemiologia , Zika virus
18.
PLoS One ; 14(8): e0219595, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31393886

RESUMO

OBJECTIVE: There are limited published data about the circulation of influenza B/Victoria and B/Yamagata in Latin America and the Caribbean (LAC) and most countries have a vaccine policy that includes the use of the trivalent influenza vaccine. We analyzed influenza surveillance data to inform decision-making in LAC about prevention strategies, such as the use of the quadrivalent influenza vaccine. METHODS: There are a total of 28 reference laboratories and National Influenza Centers in LAC that conduct influenza virologic surveillance according to global standards, and on a weekly basis upload their surveillance data to the open-access World Health Organization (WHO) platform FluNet. These data include the number of specimens tested for influenza and the number of specimens positive for influenza by type, subtype and lineage, all by the epidemiologic week of specimen collection. We invited these laboratories to provide additional epidemiologic data about the hospitalized influenza B cases. We conducted descriptive analyses of patterns of influenza circulation and characteristics of hospitalized cases. We compared the predominant B lineage each season to the lineage in the vaccine applied, to determine vaccine mismatch. A Chi-square and Wilcoxan statistic were used to assess the statistical significance of differences in proportions and medians at the P<0.05 level. FINDINGS: During 2010-2017, the annual number of influenza B cases in LAC was ~4500 to 7000 cases. Since 2011, among the LAC-laboratories reporting influenza B lineage using molecular methods, both B/Victoria and B/Yamagata were detected annually. Among the hospitalized influenza B cases, there were statistically significant differences observed between B/Victoria and B/Yamagata cases when comparing age and the proportion with underlying co-morbid conditions and with history of oseltamivir treatment (P<0.001). The proportion deceased among B/Victoria and B/Yamagata hospitalized cases did not differ significantly. When comparing the predominant influenza B lineage detected, as part of surveillance activities during 63 seasons among 19 countries, to the lineage of the influenza B virus included in the trivalent influenza vaccine used during that season, there was a vaccine mismatch noted during 32% of the seasons analyzed. CONCLUSIONS: Influenza B is important in LAC with both B/Victoria and B/Yamagata circulating annually in all sub regions. During approximately one-third of the seasons, an influenza B vaccine mismatch was identified. Further analyses are needed to better characterize the medical and economic burden of each influenza B lineage, to examine the potential cross-protection of one vaccine lineage against the other circulating virus lineage, and to determine the potential impact and cost-effectiveness of using the quadrivalent vaccine rather than the trivalent influenza vaccine.


Assuntos
Vírus da Influenza B/imunologia , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Região do Caribe/epidemiologia , Proteção Cruzada/imunologia , Humanos , Vírus da Influenza B/patogenicidade , América Latina/epidemiologia , Estações do Ano , Vacinação/métodos
19.
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
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