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INTRODUCTION: Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia prevalence in Latin American populations. METHODS: Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. Multivariate linear regression models adjusted for SDoH were used in the main analysis. This study used cross-sectional data from the 1066 population-based study. RESULTS: Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p < 0.001), lower socioeconomic status (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). After adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [-0.19, 0.59] and Native predominant p = 0.74 [-0.24, 0.33]). DISCUSSION: The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia prevalence in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to effectively reduce dementia risk in these communities. HIGHLIGHTS: Countries in Latin America express a large variability in social determinants of health and levels of admixture. After adjustment for downstream societal factors linked to SDoH, genetic ancestry shows no link to dementia. Population ancestry profiles alone do not influence cognitive performance. SDoH are key drivers of racial disparities in dementia and cognitive performance.
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Demência , Determinantes Sociais da Saúde , Humanos , Demência/genética , Demência/epidemiologia , Masculino , Feminino , Prevalência , Idoso , América Latina , Estudos Transversais , Fatores de Risco , Idoso de 80 Anos ou mais , México/epidemiologia , México/etnologiaRESUMO
OBJECTIVE: The objective of this systematic review and meta-analysis was to assess the prevalence of hypertension in populations living at altitude in Latin America and the Caribbean. METHODS: We conducted a systematic search from January 1, 2000 to January 10, 2023 in Web of Science (WoS)/Core Collection, WoS/Medline, WoS/Scielo, Scopus, PubMed and Embase databases. We included studies that assessed the prevalence of hypertension in altitude populations (>1500 m.a.s.l.) and these were meta-analyzed using a random-effects model. To assess the sources of heterogeneity, we performed subgroup and meta-regression analyses. RESULTS: Thirty cross-sectional studies (117 406 participants) met the inclusion criteria. Studies used different cut-off points. The prevalence of hypertension in the studies that considered the cut-off point of ≥ 140/90 mmHg in the general population was 19.1%, ≥ 130/85 mmHg was 13.1%, and ≥ 130/80 mmHg was 43.4%. There was a tendency for the prevalence of hypertension to be higher in men. In meta-regression analyses, no association was found between altitude, mean age, year of publication, risk of bias and prevalence of hypertension. CONCLUSION: The prevalence of hypertension in the altitude population of Latin America and the Caribbean is lower than that reported in populations living at sea level and lower than other altitude populations such as Tibetans. PROSPERO: CRD42021275229.
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Altitude , Hipertensão , Masculino , Humanos , Adulto , América Latina/epidemiologia , Prevalência , Estudos Transversais , Hipertensão/epidemiologia , Região do Caribe/epidemiologiaRESUMO
In this work, hydrogels based on semi-interpenetrating polymeric networks (semi-IPN) based on collagen-polyurethane-alginate were studied physicochemically and from different approaches for biomedical application. It was determined that the matrices in the hydrogel state are crosslinked by the formation of urea and amide bonds between the biopolymer chains and the polyurethane crosslinker. The increment in alginate content (0-40 wt%) significantly increases the swelling capacity, generating semi-crystalline granular structures with improved storage modulus and resistance to thermal, hydrolytic, and proteolytic degradation. The in vitro bioactivity results indicated that the composition of these novel hydrogels stimulates the metabolic activity of monocytes and fibroblasts, benefiting their proliferation; while in cancer cell lines, it was determined that the composition of these biomaterials decreases the metabolic activity of breast cancer cells after 48 h of stimulation, and for colon cancer cells their metabolic activity decreases after 72 h of contact for the hydrogel with 40 wt% alginate. The matrices show a behavior of multidose release of ketorolac, and a higher concentration of analgesic is released in the semi-IPN matrix. The inhibition capacity of Escherichia coli is higher if the polysaccharide concentration is low (10 wt%). The in vitro wound closure test (scratch test) results indicate that the hydrogel with 20 wt% alginate shows an improvement in wound closure at 15 days of contact. Finally, the bioactivity of mineralization was evaluated to demonstrate that these hydrogels can induce the formation of carbonated apatite on their surface. The engineered hydrogels show biomedical multifunctionality and they could be applied in soft and hard tissue healing strategies, anticancer therapies, and drug release devices.
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Alginatos , Hidrogéis , Hidrogéis/química , Alginatos/química , Poliuretanos , Sistemas de Liberação de Medicamentos , Colágeno , Polímeros/químicaRESUMO
The design of hydrogels based on natural polymers that have modulation of antibacterial capacity, ideal performance in release capacity of encapsulated drugs, and desired bioactivity for applications in wound healing represents a modern trend in biomaterials. In this work, novel hydrogels of semi-interpenetrating polymeric networks based on collagen and xanthan gum (XG) were investigated. The linear chains of XG can semi-interpenetrate inside to matrix of crosslinked collagen with polyurethane under physiological conditions, generating amorphous surfaces with fibrillar-granular reliefs that have accelerated gelation time (about 15 min), super water absorption (up to 3100%) and high inhibition capacity of pathogenic bacteria such asEscherichia coli(up to 100% compared to amoxicillin at 20 ppm). The increment of XG in the hydrogel (up to 20 wt.%) allows for improvement in the storage module, resistance to thermal degradation, slow the rate of hydrolytic and proteolytic degradation, allowing to encapsulate and controlled release of molecules such as ketorolac and methylene blue; besides, it shows to keep the metabolic activity of fibroblasts and monocytes at 48 h of evaluation, without observing cytotoxic effects. The bioactivity of these hydrogels is improved since they have excellent hemocompatibility and enhanced cell proliferation. Specifically, the hydrogel with 20 wt.% of XG shows to decrease the production of tumor necrosis factor-αand CCL-2 cytokines, increasing the production of transforming growth factor-ßin human monocytes, which could be used to modulate inflammation and regenerative capacity in wound healing strategies.
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Colágeno , Hidrogéis , Humanos , Liberação Controlada de Fármacos , Hidrogéis/farmacologia , Colágeno/farmacologia , Cicatrização , Polímeros/farmacologia , Antibacterianos/farmacologiaRESUMO
The preparation of hydrogels based on biopolymers like collagen and gum arabic gives a chance to provide novel options that can be used in biomedical field. Through a polymeric semi-interpenetration technique, collagen-based polymeric matrices can be associated with gum arabic while controlling its physicochemical and biological properties. To create novel hydrogels with their potential use in the treatment of wounds, the semi-interpenetration process, altering the concentration (0-40% by wt) of gum arabic in a collagen matrix is explored. The ability of gum arabic to create intermolecular hydrogen bonds in the collagen matrix enables the development of semi-interpenetrating polymeric networks (semi-IPN)-based hydrogels with a faster gelation time and higher crosslinking. Amorphous granular surfaces with linked porosity are present in matrices with 30% (by wt) of gum arabic, enhancing the storage modulus and thermal degradation resistance. The hydrogels swell to very high extent in hydrolytic and proteolytic environments, good hemocompatibility, and suppression of growth of pathogens like E. coli, and all it is enhanced by gum arabic included them, in addition to enabling the controlled release of ketorolac. The chemical composition of theses semi-IPN matrices have no deleterious effects on monocytes or fibroblasts, promoting their proliferation, and lowering alpha tumor necrosis factor (α-TNF) secretion in human monocytes.
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BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) remains one of the leading causes of morbidity and mortality worldwide, and its epidemiology in Latin America and the Caribbean is not well described. The aim of this study was to evaluate the prevalence and incidence of COPD in Latin America and the Caribbean. METHODS: We searched systematically in Web of Science (WoS)/Core Collection, WoS/MEDLINE, WoS/Scielo, Scopus, PubMed, and Embase from 2010 to 2021. Studies assessing the prevalence and incidence of COPD according to the GOLD classification were included. The overall prevalence of COPD was calculated as a function of the general population using a random-effects model. RESULTS: 20 studies (19 cross-sectional and 1 cohort) met the inclusion criteria. The prevalence of COPD in the general population older than 35 years was 8.9%. The prevalence in men was 13.7% and in women 6.7%. The prevalence in smokers and ex-smokers was 24.3%. The incidence in the general population of COPD according to one study was 3.4% at 9 years of follow-up. CONCLUSIONS: COPD is prevalent in Latin America, especially in men and in smokers and ex-smokers. Further prevalence and incidence studies in the general population are needed, as well as health policies and strategies to address the disease.
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Doença Pulmonar Obstrutiva Crônica , Região do Caribe/epidemiologia , Estudos Transversais , Feminino , Humanos , Incidência , América Latina/epidemiologia , Masculino , Prevalência , Doença Pulmonar Obstrutiva Crônica/epidemiologiaRESUMO
OBJECTIVE: Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to identify which procedures can be potentially best adapted to the practice of teleNP in Latin America, and thereby facilitate professional decision-making in the region. METHOD: Steps taken to develop these recommendations included (1) formation of an international working group with representatives from 12 Latin American countries; (2) assessment of rationale, scope, and objectives; (3) formulation of clinical questions; (4) evidence search and selection; (5) evaluation of existing evidence and summary; and (6) formulation of recommendations. Levels of evidence were graded following the Oxford Centre for Evidence-Based Medicine system. Databases examined included PubMed, WHO-IRIS, WHO and PAHO-IRIS, Índice Bibliográfico Español en Ciencias de la Salud (IBCS), and LILACS. RESULTS: Working group members reviewed 18,400 titles and 422 abstracts and identified 19 articles meeting the criteria for level of evidence, categorization, and elaboration of recommendations. The vast majority of the literature included teleNP tests in the English language. The working group proposed a series of recommendations that can be potentially best adapted to the practice of teleNP in Latin America. CONCLUSIONS: There is currently sufficient evidence to support the use of videoconferencing technology for remote neuropsychological assessments. These recommendations will likely contribute to the advancement of teleNP research and practice in the region.
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COVID-19 , Pandemias , Humanos , América Latina , Testes Neuropsicológicos , Neuropsicologia/métodosRESUMO
BACKGROUND: Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia prevalence has been widely reported in United States, but there are no relevant studies on this topic in low- and middle-income countries. METHODS: In a cross-sectional survey, 2944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia). RESULTS: The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p = .12) by self-identified race. Mean cognitive scores were similar across racial groups (p = .46). After controlling for age, sex, and education, greater proportion of African ancestry was not associated with cognitive performance (p = .17). CONCLUSIONS: We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health.
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Demência , Envelhecimento , Cognição , Estudos Transversais , Demência/diagnóstico , Demência/epidemiologia , Demência/genética , Hispânico ou Latino , Humanos , Estados UnidosRESUMO
El síndrome de fragilidad se caracteriza por una mayor vulnerabilidad y riesgo de deterioro funcional y cognitivo ante un mínimo estrés, siendo la demencia una de las principales causas de discapacidad y dependencia entre los adultos mayores a nivel global, con un impacto físico, psicológico, social y económico no solo en las personas que la padecen, sino también en sus cuidadores. El objetivo de este estudio fue determinar la prevalencia de demencia según fenotipos de fragilidad y estimar la asociación de fragilidad y demencia en adultos mayores. Se tomó como referencia la base de datos del estudio Envejecimiento y Alzheimer (10-66), realizándose una investigación descriptiva de corte transversal, en 2024 adultos mayores de 65 años pertenecientes a siete áreas de salud de La Habana, Cuba. Se efectuó un análisis univariado para los efectos independientes de cada una de las variables y la variable de respuesta o dependiente (demencia) considerando esta asociación significativa cuando (p≤0.001) o por criterio de expertos y un análisis multivariado a través de la Regresión de Poisson. Existió una alta prevalencia de demencia en los sujetos con fragilidad 30,6 %(IC 95 % 22,4 - 39,6), donde la relación entre las mismas mostró una asociación significativa. Las personas frágiles presentaron un riesgo mayor de padecer demencia, con un PR 2.74 (IC 95% 2,29-3,29). La fragilidad se comportó como un factor de riesgo para el desarrollo de demencia.
Frailty syndrome is characterized by a greater vulnerability and risk of functional and cognitive deterioration in the face of minimal stress, with dementia being one of the main causes of disability and dependency among older adults globally, with a physical, psychological, and social impact. and economic not only in the people who suffer from it, but also in their caregivers. The objective of this study was to determine the prevalence of dementia according to frailty phenotypes and to estimate the association of frailty and dementia in older adults. The database of the Aging and Alzheimer study (10-66) was taken as a reference, carrying out a descriptive cross-sectional investigation in 2024 adults over 65 years of age belonging to seven health areas in Havana, Cuba. A univariate analysis was carried out for the independent effects of each of the variables and the response or dependent variable (dementia), considering this significant association when (p≤0.001) or by expert criteria and a multivariate analysis through the regression of Poisson. There was a high prevalence of dementia in subjects with frailty 30.6% (95% CI 22.4 - 39.6), where the relationship between them showed a significant association. Frail people had a higher risk of suffering from dementia, with a PR 2.74 (CI 95% 2.29-3.29). Frailty behaved as a risk factor for the development of dementia.
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Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Demência/epidemiologia , Fragilidade/epidemiologia , Epidemiologia Descritiva , Prevalência , Fatores de Risco , Distribuição por Sexo , Distribuição por Idade , Cuba/epidemiologiaRESUMO
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS- CoV-2) is our latest pandemic and has turned out to be a global public health crisis. One of the special characteristics of this disease is that it may predispose patients to thrombotic disease both in the venous and arterial circulation. We review arterial and venous thromboembolic complications in patients with COVID-19, epidemiology, pathogenesis, hematologic biomarkers, and current antithrombotic strategies. Future perspectives and clinical trials are ongoing to determine the best thromboprophylaxis strategies in the hospitalized patients with severe COVID-19.
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COVID-19/complicações , COVID-19/epidemiologia , Tromboembolia/etiologia , Tromboembolia/fisiopatologia , Biomarcadores , Relação Dose-Resposta a Droga , Fibrinolíticos/uso terapêutico , Humanos , Pandemias , SARS-CoV-2 , Tromboembolia/tratamento farmacológico , Tromboembolia/prevenção & controleRESUMO
BACKGROUND: Cuba's life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on cardiovascular risk factor levels. To assess the role of health care, we distinguish medically amenable biomarkers from behavioral risk factors. To assess the role of Cuba's focus on equity, we compare education gradients in risk factors. METHODS: We analyze Cuban data from the 10/66 Dementia Research Group baseline survey of urban adults ages 65 plus. Comparison samples are drawn from the Dominican Republic 10/66 survey, the Costa Rican CRELES, and U.S. NHANES. We analyze cross-country levels and education gradients of medically amenable (hypertension, diabetes, hypercholesterolemia, access to health care) and behavioral (smoking, obesity) risk factors,-using sex-stratified weighted means comparisons and age-adjusted logistic regression. RESULTS: Neither medically amenable nor behavioral risk factors are uniformly better in Cuba than comparison countries. Obesity is lower in Cuba, but male smoking is higher. Hypertension, diabetes, and hypercholesterolemia levels are high in all countries, though Cuba's are lower than Costa Rica. Hypertension awareness in Cuba is similar to Costa Rica. Cuba has a higher proportion of hypertensives on treatment than Costa Rica, though lower than the U.S. Comparative gradients by education are similarly mixed. For behavioral factors, Cuba shows the strongest gradients (primarily for men) among the countries compared: smoking improves, but obesity worsens with education. Hypertension awareness also improves with education in Cuba, but Cuba shows no significant differences by education in hypertension treatment. CONCLUSION: Smoking is comparatively high in Cuba, but obesity is low, and the resulting biomarkers show comparatively mixed patterns. Cuba's social protections have not eliminated strong educational gradients in behavioral risk factors, but the healthcare system appears to have eliminated disparities such as in hypertension treatment.
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Doenças Cardiovasculares/epidemiologia , Hipercolesterolemia/fisiopatologia , Hipertensão/fisiopatologia , Expectativa de Vida/tendências , Obesidade/fisiopatologia , Fumar Tabaco/efeitos adversos , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/patologia , Costa Rica/epidemiologia , Cuba/epidemiologia , Bases de Dados Factuais , República Dominicana/epidemiologia , Escolaridade , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Política Pública , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). OBJECTIVE: To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. METHODS: In this cross-sectional study, 146 participants (cognitively healthyâ=â53, mild cognitive impairment (MCI)â=â46, dementiaâ=â47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. RESULTS: The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. CONCLUSION: The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.
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Disfunção Cognitiva/diagnóstico , Computadores de Mão , Demência/diagnóstico , Testes Neuropsicológicos , Idoso , Doença de Alzheimer/diagnóstico , Afasia Primária Progressiva/diagnóstico , Cuba , Demência Vascular/diagnóstico , Países em Desenvolvimento , Função Executiva , Demência Frontotemporal/diagnóstico , Humanos , Memória , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Processamento EspacialRESUMO
AIM: To compare the incidence of gestational diabetes mellitus (GDM) in women with three or more risk factor to developing GDM supplemented with myo-inositol plus probiotics versus women care without supplementation. METHODS: Retrospective cohort study, group 1, women with supplementation (myo-inositol 2g plus Bifidobacterium lactis and Lactobacillus rhamnosus 5x108 UFC, twice per day, from 12-14 to 28 weeks of gestation; group 2, women with prenatal care without supplementation, matched by age and body mass index (BMI). The primary outcome was the incidence of GDM using the International Association of Diabetes and Pregnancy Study Groups criteria. RESULTS: Group 1 n=48, group 2 n=96. There were no significant baseline differences between groups in age, BMI and number of risk factors. The incidence of GDM in group 1 was n=14 (29.2%), and for group 2 n=46 (47.9%); RR: 0.61 (95% CI: 0.37-0.99; p = 0.03). CONCLUSIONS: Supplementation from 12-14 weeks of gestation with myo-inositol plus probiotics decrease the incidence of GDM in Mexican women.
OBJETIVO: Comparar la incidencia de diabetes mellitus gestacional (DMG) en mujeres con tres o más factores de riesgo para desarrollar DMG suplementadas con mioinositol más probióticos versus mujeres sin suplementación.. MATERIAL Y MÉTODOS: Estudio de cohorte retrospectivo, grupo 1, mujeres con suplementación (mioinositol 2 g más Bifidobacterium lactis y Lactobacillus rhamnosus 5x108unidades formadoras de colonias, dos veces al día, de las 12-14 hasta las 28 semanas de gestación); grupo 2, mujeres con control prenatal habitual sin suplementación, pareadas por edad e índice de masa corporal (IMC). El resultado primario fue la incidencia de DMG utilizando los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo. RESULTADOS: Grupo 1, n = 48, y grupo 2 n = 96. No hubo diferencias significativas en características basales como edad, IMC, y numero de factores de riesgo entre los grupos. La incidencia de DMG en el grupo 1 fue n = 14 (29.2%) y en el grupo 2 n = 46 (47.9%); RR: 0.61 (IC 95%: 0.37-0.99; p = 0.03). CONCLUSIONES: La suplementación desde las 12-14 semanas de gestación con mioinositol más probióticos disminuye la incidencia de DMG en mujeres mexicanas.
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Bifidobacterium animalis , Diabetes Gestacional , Suplementos Nutricionais , Lacticaseibacillus rhamnosus , Probióticos , Adulto , Índice de Massa Corporal , Diabetes Gestacional/prevenção & controle , Feminino , Humanos , Gravidez , Cuidado Pré-Natal , Probióticos/uso terapêutico , Estudos RetrospectivosAssuntos
Envelhecimento , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Psiquiatria Geriátrica , Serviços de Saúde para Idosos , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Betacoronavirus , COVID-19 , Região do Caribe/epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Psiquiatria Geriátrica/métodos , Psiquiatria Geriátrica/tendências , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/tendências , Humanos , Saúde Mental/tendências , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , SARS-CoV-2 , Isolamento Social/psicologiaRESUMO
During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk profiles, providing a unique setting to understand dementia in the Caribbean-Hispanics. This perspective article aimed to describe the impact of dementia in the Caribbean, at a local and regional level and reflect on research strategies to address dementia. We report on 10/66 project findings, described research projects and regional plans for the region. According to our results, the prevalence of dementia in the Caribbean is the highest in Latin America, with 11.7% in Dominican Republic, 11.6% in Puerto Rico, and 10.8% in Cuba. Preliminary data from new waves of the 10/66 study shows increasing numbers of dementia cases. Furthermore, dementia is expected to be one of the most serious medical and social issues confronted by Caribbean health systems. However, there is a scarcity of knowledge, awareness, and health services to deal with this public health crisis. In light of the new evidence, local and regional strategies are underway to better understand dementia trends for the region and develop policies aimed to decrease the impact of dementia. Implementation of our national plans is critical to deal with an aging population with high dementia rates. Current recommendations include emphasizing public health prevention campaigns to address modifiable risk factors and expand support to caregiver and family interventions.
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Demência , Hispânico ou Latino , Idoso , Cuba/epidemiologia , Demência/epidemiologia , República Dominicana/epidemiologia , Humanos , Ilhas , América Latina/epidemiologia , Porto Rico/epidemiologia , Índias OcidentaisRESUMO
Objective: The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Method: Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence and disability from the 10/66 cohort study, which included 16,990 people aged 65 or above in China, Cuba, Dominican Republic, India, Mexico, Peru, Puerto Rico, and Venezuela, and country-specific life tables from the World Population Prospects 2017. Results: DFLE and DepFLE declined with older age across all sites and were higher in women than men. Mexico reported the highest DFLE at age 65 for men (15.4, SE = 0.5) and women (16.5, SE = 0.4), whereas India had the lowest with (11.5, SE = 0.3) in men and women (11.7, SE = 0.4). Discussion: Healthy life expectancy based on disability and dependency can be a critical indicator for aging research and policy planning in LMICs.
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Indicadores Básicos de Saúde , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos de Coortes , Países em Desenvolvimento , Pessoas com Deficiência/estatística & dados numéricos , República Dominicana/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Peru/epidemiologia , Prevalência , Porto Rico/epidemiologia , Venezuela/epidemiologiaRESUMO
Abstract Background: Knowledge of genetic correlations and the economics of traits are essential to decide which traits should be used as selection criteria. Objective: To estimate heritabilities and genetic, environmental, and phenotypic correlations, and direct (DRS) and correlated (CRS) responses to selection by scrotal circumference (SC), frame score (FS), and yearling weight (YW) of Mexican Charolais (CH), and Charbray (CB) young bulls. Methods: Actual SC, height and YW records (10,078 for CH, and 500 for CB) were adjusted to 365 d. The 0.0505 adjustment factor recommended by the Beef Improvement Federation was used to obtain the 365-d adjusted SC for both breeds. Height and age records were used to obtain FS. Data were analyzed using a three-trait animal model. The animal model for each trait included bull breed, contemporary group (groups of young bulls born in the same herd, year, and season of the year), and age of dam as a linear covariate as fixed effects, and direct additive genetic and residual as random effects. Results: Heritability estimates for SC, FS and YW were 0.21 ± 0.04, 0.25 ± 0.04, and 0.29 ± 0.04, respectively. The genetic correlation between YW with SC was 0.37 ± 0.16, and between YW with FS was 0.42 ± 0.16. The estimate of genetic correlation between SC and FS was low and positive (0.15 ± 0.14). The DRS was 0.38 cm, 0.18 units, and 8.30 kg for SC, FS and YW. The CRS was 0.16 cm, and 0.08 units for SC and FS from indirect selection on YW. Conclusions: Direct selection for YW is expected to be effective. Indirect selection for SC and FS based on YW would not be expected to be as effective as direct selection for improving SC and FS.
Resumen Antecedentes: el conocimiento de las correlaciones genéticas y el aspecto económico de las características son necesarios para decidir qué características usar como criterios de selección. Objetivo: estimar las heredabilidades y correlaciones genéticas, ambientales y fenotípicas, y respuesta directa (DRS) y correlacionada (CRS) a la selección por circunferencia escrotal (SC), talla corporal (FS), y peso al año (YW) de toros jóvenes mexicanos Charolais (CH), y Charbray (CB). Métodos: registros (10.078 para CH y 500 para CB) de SC, altura y YW se ajustaron a 365 d. El factor de ajuste de 0,0505 recomendado por la Beef Improvement Federation se usó para obtener la SC ajustada a 365 d para ambas razas. Registros de altura y edad del animal se usaron para calcular FS. Los datos se analizaron usando un modelo animal para tres características. El modelo animal para cada característica incluyó raza del toro, grupo contemporáneo (grupos de toros jóvenes nacidos en el mismo hato, año y época del año) y edad de la madre como covariable lineal como efectos fijos, y el genético aditivo directo y el error como efectos aleatorios. Resultados: los estimadores de heredabilidad de SC, FS y YW fueron 0,21 ± 0,04, 0,25 ± 0,04 y 0,29 ± 0,04, respectivamente. La correlación genética de YW con SC fue 0,37 ± 0,16, y de YW con FS fue 0,42 ± 0,16. El estimador de la correlación genética entre SC y FS fue bajo y positivo (0,15 ± 0,14). La DRS fue 0,38 cm, 0,18 unidades, y 8,30 kg para SC, FS y YW. La CRS fue 0,16 cm y 0,08 unidades para SC y FS al seleccionar YW. Conclusiones: se espera que la selección directa de YW sea efectiva. La selección indirecta de SC y FS basada en YW no se espera que sea tan efectiva como la selección directa para mejorar SC y FS.
Resumo Antecedentes: o conhecimento das correlações genéticas, e aspecto econômico de as características são necessário para decidir que características usar como critérios de seleção. Objetivo: estimar herdabilidades e correlações genéticas, ambientais e fenotípicas, e resposta direta (DRS), e correlacionada (CRS) à seleção do perímetro escrotal (SC), escore de frame (FS), e peso ao ano de idade (YW) de touros jovens mexicanos Charolês (CH), e Charbray (CB). Métodos: registros (10.078 para CH e 500 para CB) de SC, altura e YW foram ajustados a 365 d. O fator de ajuste 0,0505 recomendado por a Beef Improvement Federation foi usado para obter o SC ajustado aos 365 d para ambas raças. Registros de altura na garupa e idade do animal foram usados para obter o FS. Os dados foram analisados usando um modelo animal para três características. O modelo animal para cada característica incluiu raça do touro, grupo contemporâneo (grupos de touros jovens nascidos no mesmo fazenda, ano e época do ano) e idade materna como covariável linear como efeitos fixos, e genético aditivo direto e o erro como efeitos aleatórios. Resultados: as estimativas de herdabilidade para SC, FS e YW foram 0,21 ± 0,04, 0,25 ± 0,04 e 0,29 ± 0,04, respetivamente. A correlação genética do YW com SC foi 0,37 ± 0,16, e de YW com FS foi 0,42 ± 0,16. A estimativa da correlação genética entre SC e FS foi baixa e positiva (0,15 ± 0,14). A DRS foi 0,38 cm, 0,18 unidades, e 8,30 kg para SC, FS e YW. A CRS foi 0,16 cm e 0,08 unidades para SC e FS al selecionar YW. Conclusões: espera-se que a seleção direta do YW seja eficaz. A seleção indireta de SC e FS com base no YW não se espera que seja tão efetiva como a seleção direta para melhorar SC e FS.
RESUMO
Despite the advance of knowledge about the factors and potential mechanisms triggering the ichthyotoxicity in microalgae, these remain unclear or are controversial for several species (e.g. Heterosigma). Neither typical toxicity tests carried out with cell extracts nor direct exposure to harmful species were proved suitable to unravel the mechanism of harm. Ichthyotoxic species show a complex harmful effect on fish, which is mediated through various mechanisms depending on the species. In this work, we present a method to study sub-lethal effects triggered by reactive oxygen species of a population of harmful algae in vivo over a fish cell line. To that end, Transwell co-cultures in which causative and target species are separated by a 0.4 µm pore membrane were carried out. This allowed the evaluation of the effect of the released molecules by cells in a rapid and compact test. In our method, the harmful effect was sensed through the transcriptional activation of sub-lethal marker Hsp70b in the CHSE214 salmon cell line. The method was tested with the raphidophyte Heterosigma akashiwo and Dunaliella tertiolecta (as negative control). It was shown that superoxide intracellular content and its release are not linked in these species. The methodology allowed proving that reactive oxygen species produced by H. akashiwo are able to induce the transcriptional activation of sub-lethal marker Hsp70b. However, neither loss of viability nor apoptosis was observed in CHSE214 salmon cell line except when exposed to direct contact with the raphidophyte cells (or their extract). Consequently, ROS was not concluded to be the main cause of ichthyotoxicity in H. akashiwo.
Assuntos
Proteínas de Choque Térmico HSP70/biossíntese , Microalgas/crescimento & desenvolvimento , Espécies Reativas de Oxigênio/metabolismo , Estramenópilas/crescimento & desenvolvimento , Ativação Transcricional , Animais , Linhagem Celular , Técnicas de Cocultura , Proteínas de Choque Térmico HSP70/genética , Microalgas/genética , Salmão , Estramenópilas/genéticaRESUMO
ANTECEDENTES: La neumatosis quística intestinal es una condición infrecuente, caracterizada por la formación de quistes de contenido gaseoso debajo de la mucosa y la serosa intestinales. CASO CLÍNICO: Mujer de 84 años, con antecedente de artritis reumatoide en tratamiento inmunosupresor, intervenida hace 2 años por neumoperitoneo, con diagnóstico de diverticulosis yeyunal y enfisema mesentérico, acude con cuadro de dolor abdominal difuso de 2 días de evolución, sin otra sintomatología. En la radiografía de abdomen se observa neumoperitoneo con elevación del hemidiafragma derecho y distensión de asas del intestino delgado. Ante la sospecha de perforación de víscera hueca se decide intervención quirúrgica, en la cual se diagnostica a la paciente de neumatosis quística intestinal. CONCLUSIÓN: La neumatosis quística intestinal es de causa desconocida, aunque en un elevado porcentaje de pacientes se ha visto asociada a enfermedades pulmonares obstructivas, enfermedades del tejido conectivo, inmunosupresión o enfermedades gastrointestinales. Se localiza más frecuentemente en el colon y el intestino delgado. Se diagnostica principalmente mediante pruebas de imagen (radiografía o tomografía computarizada). El tratamiento es conservador, realizándose intervención quirúrgica si existe sospecha de necrosis intestinal. Es difícil el diagnóstico diferencial con un neumoperitoneo por perforación de víscera hueca. BACKGROUND: Pneumatosis cystoides intestinalis is an infrequent condition, characterized by the formation of gaseous content cysts under the mucosa and intestinal serous. CLINICAL CASE: 84-year-old woman, with a history of rheumatoid arthritis under immunosuppressive treatment, operated 2 years ago by pneumoperitoneum, where she was diagnosed of jejunal diverticulosis and mesenteric emphysema, with diffuse abdominal pain of 2 days of evolution, without other symptoms. In abdominal radiography: pneumoperitoneum with elevation of right hemidiaphragm and distention of small intestine. Given the suspicion of perforation of the intestinal wall, surgical intervention was decided, in which the patient was diagnosed with pneumatosis cystoides intestinalis. CONCLUSION: Pneumatosis cystoides intestinalis has an unknown etiology, although in a high percentage of patients it has been associated with obstructive pulmonary pathologies, connective tissue diseases, immunosuppression or gastrointestinal diseases. It is located more frequently in the colon and small intestine. It is diagnosed mainly through imaging tests (radiography or computed tomography). The treatment is conservative, performing surgical intervention if there is suspicion of intestinal necrosis; being difficult the differential diagnosis with a pneumoperitoneum by perforation of hollow viscera..
Assuntos
Pneumatose Cistoide Intestinal , Idoso de 80 Anos ou mais , Feminino , Humanos , Pneumatose Cistoide Intestinal/diagnóstico , Pneumatose Cistoide Intestinal/cirurgiaRESUMO
BACKGROUND: There have been few cross-national studies of the prevalence of the frailty phenotype conducted among low or middle income countries. We aimed to study the variation in prevalence and correlates of frailty in rural and urban sites in Latin America, India, and China. METHODS: Cross-sectional population-based catchment area surveys conducted in 8 urban and 4 rural catchment areas in 8 countries; Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico, China, and India. We assessed weight loss, exhaustion, slow walking speed, and low energy consumption, but not hand grip strength. Therefore, frailty phenotype was defined on 2 or more of 4 of the usual 5 criteria. RESULTS: We surveyed 17,031 adults aged 65 years and over. Overall frailty prevalence was 15.2% (95% confidence inteval 14.6%-15.7%). Prevalence was low in rural (5.4%) and urban China (9.1%) and varied between 12.6% and 21.5% in other sites. A similar pattern of variation was apparent after direct standardization for age and sex. Cross-site variation in prevalence of frailty indicators varied across the 4 indicators. Controlling for age, sex, and education, frailty was positively associated with older age, female sex, lower socioeconomic status, physical impairments, stroke, depression, dementia, disability and dependence, and high healthcare costs. DISCUSSION: There was substantial variation in the prevalence of frailty and its indicators across sites in Latin America, India, and China. Culture and other contextual factors may impact significantly on the assessment of frailty using questionnaire and physical performance-based measures, and achieving cross-cultural measurement invariance remains a challenge. CONCLUSIONS: A consistent pattern of correlates was identified, suggesting that in all sites, the frailty screen could identify older adults with multiple physical, mental, and cognitive morbidities, disability and needs for care, compounded by socioeconomic disadvantage and catastrophic healthcare spending.