Panel sobre personas “sin religión” en América Latina

Background: The current magnitude of folate and vitamin B12 deficiency in Latin America and the Caribbean is uncertain. To summarize data on plasma or serum vitamin B12 and folate concentrations in Latin America and the Caribbean reported since 1990, a period that covers the era before and after the introduction of folic acid fortification. A systematic review was conducted in 2012 and updated in 2014. Studies and surveys using biochemical biomarkers and conducted in apparently healthy individuals were identified. Folate deficiency in Latin America and the Caribbean appears not to be a public health problem (prevalence < 5%) after the introduction of folic acid fortification. However, there is some indication that high rates of low or marginal vitamin B12 status remain in most locations and across population groups. Adding vitamin B12 as a fortificant with folic acid may be the best strategy in areas where vitamin B12 deficiency is an established concern.

Malnutrition, an illness which can easily be prevented and cured with existing resources and technology, is perhaps the most widespread disease in Latin America. However, it is unrecognized as such, and those population groups that suffer most from it are most prone to have their sufferings unrecorded. Two factors contribute to this: (a) the inaccuracy and incomplete coverage of vital statistics, as reflected by underregistration of deaths, insufficient medical certification of registered deaths, and biases both among certifying physicians and in the International Classification of Diseases; and (b) low population coverage by the health care systems and thus by the statistics which they generate. These factors are related to the ideological bias of those statistical systems and to the concepts of causality which they use. Through a review and analysis of "ad hoc" studies on the frequency of malnutrition in Latin America and its incidence in relation to morbidity and mortality, an estimation is made of malnutrition-caused deaths, which would amount to almost one-fifth of deaths from all causes. As overall availability of food in Latin America is adequate, it is held that this continent ultimately has the level of malnutrition that it wishes to have.

Magnus Mörner (1924–2012)

Representative sampling and analysis in HIV molecular epidemiology studies

Numerous epidemiological factors affect the probability of developing breast or ovarian cancer, but no predictor is as determinant as inheriting a mutation in BRCA1 or BRCA2. The concept of the founder effect explains the reduced genetic variability in some populations, according to the theory that new populations can be formed from a reduced number of individuals, so the new population would carry only a small fraction of the genetic variability of the original population. The main purpose of this review is to provide an update on the state of the art in founder mutations and some recurrent mutations that have recently been described in Latin America. A literature search was performed in the electronic databases of PUBMED, EMBASE, LILACS, and BIREME using the terms BRCA1, BRCA2, founder mutation, Latin American population, and Hispanic. Sixty-two papers were identified, of which 38 were considered relevant for this review. Each result is shown per country. In Latin America, clear founder effects have been reported in Mexico (BRCA1 del exons 9-12), Brazil (BRCA1 5382insC and BRCA2 c.156_157insAlu), and Colombia (BRCA1 3450del4, A1708E, and BRCA2 3034del4) and in Latinas residing in Southern California (BRCA1 185delAG, IVS5+1G>A, S955x, and R1443x). Of these, mutation BRCA1 3450del4 has also been reported in Brazil and Chile, whereas mutation BRCA2 3034del4 has been reported in Argentina and Peru. These data support the idea that although most Hispanic populations are the result of a mixture between Europeans, Africans, and Amerindians, the relative proportion of each genetic component varies throughout the Hispanic populations, making it necessary to identify the mutations characteristic of each population to generate mutation profiles adjusted to each one of them. In Latin American countries, and even among regions of the same country, there is great heterogeneity of ancestors. Therefore, Latinas should not be analyzed like other population groups without taking into account their genetic ancestry. The presence of founder mutations in specific population groups represents a cost-effective analysis. The importance of determining the founder mutations lies mainly in the decrease in costs. If we manage to decrease costs, screenings could be offered more widely and cover a larger number of women. Hispanic and African-American populations are four to five times less likely than other populations worldwide to receive screening for BRCA mutations, a main reason being the high costs of these tools. The present study seeks to identify the prevalent mutations and the founder effect in the BRCA gene in the Hispanic population to address specific panels for this population group in the future and develop strategies for population screening.

Background:A growing body of evidence suggests that depression is related to dementia in older adults. Previous research has been done in high-income countries and there is a lack of studies in low- and middle income countries (LMICs).Objective:To examine the relationship between depressive symptoms and incidence of dementia in a population-based study of older adults in Latin America.Methods:The study is a part of the 10/66 Dementia Research Group’s population survey and includes 11,472 older adults (baseline mean age 74 years) from Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. The baseline examinations were done in 2003-2007 and the follow-up examinations 4 years later. Semi-structured psychiatric interviews gave information about ICD-10 depression and sub-syndromal depression (i.e., ≥4 depressive symptoms) at baseline. Information on dementia were collected at the follow-up examination. Competing risk models analyzed the associations between depression and incidence of dementia and the final model were adjusted for age, sex, education, stroke, and diabetes. Separate analyses were conducted for each site and then meta-analyzed by means of fixed effect models.Results:At baseline, the prevalence of depression was 26.0% (n = 2,980): 5.4% had ICD-10 depression and 20.6% sub-syndromal depression. During the follow-up period, 9.3% (n = 862) developed dementia and 14.3% (n = 1,329) deceased. In the pooled analyses, both ICD-10 depression (adjusted sub-hazard ratio (sHR) 1.63, 95% confidence interval (CI) 1.26–2.11) and sub-syndromal depression (adjusted sHR 1.28, 95% CI: 1.09–1.51) were associated with increased incidence of dementia. The Higging I2 tests showed a moderate heterogeneity across the study sites.Conclusion:Our findings suggest that late-life depression is associated with the incidence of dementia in LMICs in Latin America, which support results from earlier studies conducted in high-income countries.

Not all Korean immigrants in the U.S. originated from South Korea; instead, some are secondary migrants from various places in Latin America. These individuals often arrived in the U.S. with more diverse cultural and linguistic backgrounds than those who came directly from Korea. Based on extensive interview data from 102 people of Korean descent from Latin America currently residing in the New York metropolitan area, this article examines how Latin American language abilities among Korean remigrants have impacted their resettlement processes, concentrating on their workplace experiences. The article contextualizes Korean‐Latino interracial relations within the diverse economic environment of the city. Building on previous literature mainly addressing Korean‐Latino relations focusing only on Korean businesses, this study sheds light on how Korean remigrants contribute to New York’s general economy by interacting with Latino groups. In addition, this article emphasizes Latino immigrants both as employees of and consumers for Korean businesses and demonstrates that Korean remigrants have served as critical intermediaries, for example, by running employment agencies that connect Korean employers with Latino employees. This study of intraethnic and interethnic relations among Koreans from Latin America and other groups of Latino populations testifies to a surprising degree of diversity within the seemingly homogenous Korean population in the U.S., and demonstrates the unacknowledged pluralism of linguistic and cultural differences among them. I expect that it will serve as a launching point to further discuss diverse linkages between two of the largest immigrant groups in the U.S.: Asian and Latino communities, which are likely to have multiple, but less acknowledged, ethnic backgrounds.

The presence of acrylamide in foods such as coffee can pose risks to human health. Coffee consumption and production in Latin America have increased in recent years. According to the FAO, world coffee consumption is divided into five groups of countries according to average yearly per capita consumption: (i) between 8.0 kg and 12 kg; (ii) between 4.1 kg and 8.0 kg; (iii) between 2.4 kg and 4.5 kg; (iv) between 0.8 kg and 2.4 kg; and (v) less than 0.8 kg. In this work, the countries of Latin America are divided into three groups according to annual per capita coffee consumption: group 1: between 4.1 kg and 8.0 kg (Brazil, Argentina, Colombia and Costa Rica); group 2: between 2.4 kg and 4.5 kg (Guyana, French Guyana, Honduras, Suriname, Uruguay and Venezuela); and group 3: between 0.8 kg and 2.4 kg (Bolivia, Chile, Cuba, El Salvador, Ecuador, Guatemala, Haiti, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Puerto Rico and Dominican Republic). There are great differences in the consumption of acrylamide-forming foods among populations from different countries. The literature shows a range from 0.5 to 4.21 µg of acrylamide per 300 mL of coffee and the World Health Organization recommends a maximum daily limit for acrylamide intake of 1 µg/kg bw. Thus, coffee is a beverage that contributes greatly to acrylamide intake in almost all population groups. From the calculated data on acrylamide intake in Latin America, it was possible to estimate the daily intake in the region’s countries. According to the maximum limit set by the WHO of 1 µg acrylamide per day per bw, for people in the countries of group 1, coffee makes a large contribution to the intake of acrylamide. Thus, there should be focus on reducing the levels of acrylamide in foods, since they are the predominant sources of this substance for some populations.

West and North Germanic language varieties have been part of the Latin American language ecology since the middle of the 19th century, when European mass migration created Germanic-speaking immigrant communities in North, Central, and South America. The subsequent fate of the Germanic immigrant varieties in Latin America varied greatly in terms of how long intergenerational transfer has been maintained, if and to what degree language maintenance has been supported by linguistic codification and language teaching, and the degree of contact with the surrounding majority population. Some languages like the Mennonite Low German varieties have been quite repellent with regard to language change induced by contact with the majority languages Portuguese and/or Spanish, other (Germanic) immigrant varieties, and indigenous languages. However, contact with the majority population and other (immigrant) ethnic groups, bilingualism, and, accordingly, the influence of Spanish and/or Portuguese has been growing for most Germanic immigrant varieties at least since the 1950s. The long-standing German dialectological research tradition into extra-territorial Germanic language islands has led to detailed accounts of many German varieties in Latin America. Accounts of other Germanic varieties are much more restricted, both in numbers and in extent: Some like Argentine Danish or Patagonian Afrikaans have been described only recently; others, like Swedish in Brazil and Argentine Dutch, hardly at all. In all cases, the accounts differ greatly regarding if, and to what extent, language contact is included as a cause of language change. Based on the scholarly coverage, the extent of contact-induced change in the Germanic varieties in Latin America appears to vary greatly, but whether this impression is due to the varying degrees of attention that the accounts devote to the effects of language contact or to particular sociolinguistic circumstances preventing or promoting language contact cannot be established. Still, contact linguistic profiles of many Germanic immigrant varieties in Latin America present themselves as a promising terra incognita for future research. From a bird’s-eye perspective, we may in general terms conclude that the Germanic varieties in Latin America are characterized by lexical borrowing, at least for cultural loans and discourse-structuring elements, as well as ad hoc code-switching. Interestingly, a number of varieties show a similar pattern of integrating Spanish or Portuguese verb stems of verbs ending in -ir and -ar into a very similar inflectional Germanic paradigm (Misiones Swedish -era, Argentine Danish -is(ere), Riograndenser Hunsrückisch -ieren, Volga German -i(:)ere). In general, syntactical restructurings seem to be restricted, with the notable exception of standard deviant omission of mainly pronominal subjects and, partly, pronominal objects. Other developments are specific, applying only to individual varieties.

.Endemic transmission of measles has been reestablished in Venezuela, and outbreaks of diphtheria remain ongoing across Latin America (LA). Hence, a large cross-sectional population-based serosurveillance study was conducted on Bonaire, one of the Dutch Leeward Antilles, to assess specific age and population groups at risk. Participants (aged 0–90 years) donated a blood sample and completed a questionnaire (n = 1,129). Antibodies against measles and diphtheria were tested using bead-based multiplex immunoassays. Our data revealed that immunity against measles is suboptimal, especially for those aged less than 5 years from Suriname, Aruba, and former Dutch Antilles (SADA), and adolescents from LA; and against diphtheria for persons aged more than 30 years, particularly among females and residents from SADA and LA. As refugees arrive persistently, health authorities on the Dutch Leeward Antilles should be on alert to detect early cases and prevent subsequent transmission. Ultimately, there is an urgent need for serosurveillance studies in the Caribbean region.

Therapeutic recommendations in this report are based heavily on evidence from controlled clinical trials. Nonetheless, randomized clinical trials have not been carried out to address all therapeutic questions pertaining to all age groups, both sexes, and different racial/ethnic groups. Consequently, ATP III recommendations for various groups often must be made by combining what has been learned from clinical trials with other lines of evidence such as epidemiological findings. Fortunately, a large number of clinical trials have produced a very large set of consistent results that allow for considerable confidence in projections of benefits and drawbacks of cholesterol-lowering therapy in groups that have not been subject to clinical trials. In the discussion to follow, the ATP III panel has crafted its recommendations for different population groups from general evidence statements and general recommendations developed in previous sections. No attempt will be made to grade the category and strength of evidence for all recommendations made in this section. Men of middle-age (35-65 years) are at increasing risk for CHD as they progressively age. Up to one-third of all new CHD events and about one-fourth of all CHD deaths occur in middle-aged men.1017 Most of the excess risk for CHD morbidity and mortality in middle-aged men can be explained by the major risk factors—cholesterol disorders, hypertension, and cigarette smoking.10,11 Men are predisposed to abdominal obesity, which makes them particularly susceptible to the metabolic syndrome. Consequently, metabolic risk factors (elevated cholesterol and triglycerides, low HDL cholesterol, and elevated blood pressure) appear earlier in men than women. Table VIII.1-1 summarizes factors to consider when applying ATP III guidelines to middle-aged men. View this table: Table VIII.1-1. Special Considerations for Cholesterol Management in Middle-Aged Men CHD is a major cause of death in women as well as men and it ultimately kills as many women as men.1017 However, …

In Latin America, pulse consumption ranges from 1 kg/capita per year (Argentina) to 25 kg/capita per year (Nicaragua). Common beans account for 87 % of the total. The differences between countries, regions or groups of population within the same country can be explained by the following factors: (1) beans are very nutritious; (2) beans and maize are traditional foods and the habit of consuming them is deeply rooted in many people and communities; (3) the rural population eats more pulses than the urban population, due to geographical constraints that limit exchanges and favour consumption of locally produced foods; (4) income level, beans are still the poor man's meat; and (5) other factors, such as consumers' taste, the constraints on cooking beans, etc. The evolution of the consumption level in the future will depend on the urbanization of the population, access to processed foods and income level. Health issues would be an argument for maintaining or increasing the current consumption level.

Rethinking anaemia surveillance

Since the 1990s, many European and Latin American countries have changed their laws to permit the acquisition of dual citizenship. This shift has accompanied the increase in Latin American migration to Europe and poses new challenges for studies on migrants’ integration, which are often based on nationality. We investigate the labour market incorporation of the Latin American-born population in Switzerland and compare the position of different groups of Latin American-born populations according to their nationality (Latin American, EU27 or Swiss). To do so, we assess the rate of overqualification for each group, separate by sex, and we implement logistic models to evaluate the impact of sociodemographic covariates on the likelihood of being overqualified. The results reflect the Swiss labour market segmentation by both nationality and sex, as the influence of the reason for migration on the labour market incorporation of these groups.

AimTo determine whether intermediate hyperglycaemia, defined by fasting plasma glucose and HbA1c criteria, is associated with mortality in a 10‐year cohort of people in a Latin American country.MethodsAnalysis of the PERU MIGRANT Study was conducted in three different population groups (rural, rural‐to‐urban migrant, and urban). The baseline assessment was conducted in 2007/2008, with follow‐up assessment in 2018. The outcome was all‐cause mortality, and the exposure was intermediate hyperglycaemia, using three definitions: (1) impaired fasting glucose, defined according to American Diabetes Association criteria [fasting plasma glucose 5.6–6.9 mmol/l (100–125 mg/dl)]; (2) intermediate hyperglycaemia defined according to American Diabetes Association criteria [HbA1c levels 39–46 mmol/mol (5.7–6.4%)]; and (3) intermediate hyperglycaemia defined according to the International Expert Committee criteria [HbA1c levels 42–46 mmol/mol (6.0–6.4%)]. Crude and adjusted hazard ratios and 95% CIs were estimated using Cox proportional hazard models.ResultsAt baseline, the mean (sd) age of the study population was 47.8 (11.9) years and 52.5% of the cohort were women. The study cohort was divided into population groups as follows: 207 people (20.0%) in the rural population group, 583 (59.7%) in the rural‐to‐urban migrant group and 198 (20.3%) in the urban population group. The prevalence of intermediate hyperglycaemia was: 6%, 12.9% and 38.5% according to the American Diabetes Association impaired fasting glucose definition, the International Expert Committee HbA1c‐based definition and the American Diabetes Association HbA1c‐based definition, respectively, and the mortality rate after 10 years was 63/976 (7%). Intermediate hyperglycaemia was associated with all‐cause mortality using the HbA1c‐based definitions in the crude models [hazard ratios 2.82 (95% CI 1.59–4.99) according to the American Diabetes Association and 2.92 (95% CI 1.62–5.28) according to the International Expert Committee], whereas American Diabetes Association‐defined impaired fasting glucose was not [hazard ratio 0.84 (95% CI 0.26–2.68)]. In the adjusted model, however, only the American Diabetes Association HbA1c‐based definition was associated with all‐cause mortality [hazard ratio 1.91 (95% CI 1.03–3.53)], whereas the International Expert Committee HbA1c‐based and American Diabetes Association impaired fasting glucose‐based definitions were not [hazard ratios 1.42 (95% CI 0.75–2.68) and 1.09 (95% CI 0.33–3.63), respectively].ConclusionsIntermediate hyperglycaemia defined using the American Diabetes Association HbA1c criteria was associated with an elevated mortality rate after 10 years in a cohort from Peru. HbA1c appears to be a factor associated with mortality in this Peruvian population.