Latin Research Articles

COVID-19-related worries: A longitudinal study comparing migrants and non-migrants in Norway

Abstract Background Health- and economic-related worries during the COVID-19 pandemic contributed to worsening of mental health, particularly affecting migrants in vulnerable situations. However, this differential impact was only clear some months into the pandemic, and there is little evidence about any differences in health and economic worries between migrants and non-migrants as the pandemic developed. To close this knowledge gap, we assessed the changes in COVID-19-related worries reported by migrants compared to non-migrants in Norway throughout the pandemic. Methods Our study analyzed data from three time points (April-20, January-21, March-22) for 25,305 participants of the Bergen in Change study, including 509 (2%) migrants from Asia, Africa, or Latin America (LATAM), and 1250 (5%) migrants from other regions. Worries were assessed using questions on COVID-19 infection fear, job security, and economic stability. Analysis methods included descriptive analysis, chi-squared, Sankey plots, and logistic regression, adjusting for age, gender, education, and type of work. Results Migrants from Asia, Africa and LATAM reported health worries more often than non-migrants [OR (95%CI) 1.9 (1.3-2.8)] without clear changes over time, 0.9 (0.7-1.3). Migrants from Asia, Africa, and LATAM, as well as from other regions, also reported economic worries significantly more often than non-migrants [3.1 (2.5-3.9) and 2.1 (1.8-2.4) respectively] at baseline. Each additional year into the pandemic increased the odds of economic worries by a factor of 1.3 (1.0-1.6) for migrants from Asia, Africa, and LATAM compared to non-migrants. The odds ratio for migrants from other regions over time was stable, 1.0 (0.9-1.1). Conclusions Migrants, especially those from Asia, Africa, and LATAM, reported more pandemic- related worries than non-migrants, and this persisted over time. Identifying and understanding these worries could guide preventive measures to enhance mental health in migrant population. Key messages • Throughout the pandemic, migrants reported more COVID-19-related worries than non-migrants, a trend that persisted over time and was greater among migrants from Asia, Africa, and Latin America. • Identifying the differential impact of COVID-19 on migrants’ groups and understanding the factors involved is essential for guiding healthcare interventions to improve migrant health.

ICARUS registry: findings from the first 1595 cases of acute decompensated heart failure in a single center in a latin american country

Abstract Introduction Institutional aCute decompensAted HeaRt FailUre RegiStry (ICARUS) will provide information on clinical characteristics, medical practice, patterns of treatment, and outcomes of patients hospitalized with Acute Decompensated Heart Failure (ADHF) in a hospital in a middle-income country. Objective Describe the methodological aspects, sociodemographic, and clinical characteristics of patients hospitalized with ADHF and their short-term outcomes. Method Prospective cohort of patients with ADHF from the emergency service of a cardiovascular center. Descriptive statistics were used to synthesize sociodemographic characteristics, clinical characteristics during hospitalization, and outcomes. Results 1595 patients with ADHF. The median age was 68 years (Q1=58; Q3=76), and 69.28% were men. The median hospital stay was six days (Q1=4; Q3=11), with an accumulative incidence (AI) for rehospitalization at 30 days of 8.70 % (95% CI 7.18 to 10.40%), in-hospital mortality AI of 4.33% (95% CI 3.38 to 5.44%), and a median change in the quality-of-life score like Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 30 days of -20 points (Q1=-37; Q3=-5). At discharge, all patients had a percentage greater than 70% of the use of quadruple neurohormonal blockade therapy. Conclusions ICARUS is one of the first registries in Latin America since the indication of the use of SGLT2 inhibitors, evaluating the clinical and sociodemographic characteristics, treatment patterns, and outcomes of a preliminary cohort of 1595 patients hospitalized for ADHF. The results indicate that, at discharge, up to 82.79% of patients were receiving quadruple neurohormonal blockade therapy, which is considerably challenging to achieve in Latin America. Considering the results of the Safety, tolerability and efficacy of up-titration of Guideline-Directed Medical therapies for acute heart failure (STRONG-HF study), our study reinforces the benefit of discharge with Guideline-Directed Medical Therapy (GDMT) for heart failure from hospitalization. The use of GDMT for heart failure may have influenced our positive outcomes in terms of in-hospital mortality, improvement in quality of life, and the percentage of short-term rehospitalizations compared to similar cohorts.Proportion of HF drug group

Indigenous Peoples and Social Protection: The Case of the Peruvian Amazon

The persistence of indigenous poverty and exclusion is one of the main challenges for social policy in Latin America. Social protection programmes, in particular conditional cash transfers, have been among the main instruments used by governments over the past two decades to respond to the high incidence of poverty in indigenous contexts. The inclusion of indigenous peoples as social protection beneficiaries remains a largely unexplored topic, despite its relevance to understand social policy trajectories in the global South. This article discusses the expansion of poverty alleviation social programmes in the Peruvian Amazon. Although the expansion of these programmes increased the state’s capacity to deliver welfare services in historically excluded areas, it also revealed the limitations of existing social protection instruments to effectively respond to indigenous poverty and vulnerability. Addressing this challenge constitutes a key opportunity to promote transformative approaches in social protection systems in Latin America.

Latin American networking and cooperative struggles in Argentina: A conversation with the Movimiento de Ocupantes e Inquilinos (MOI)

This conversation examines the Movimiento de Ocupantes e Inquilinos (MOI) in Argentina, a grassroots organization promoting cooperative, self-managed housing for over 30 years. Based on a conversation with Néstor Jeifetz, the article traces the origins of the MOI from the 1980s building occupations in Buenos Aires, through its connection to the broader Latin American cooperative housing movement, including the creation of the Latin American Secretariat for Popular Housing and Habitat (SELVIHP). The article explores how MOI’s efforts to reclaim vacant urban properties—such as the La Fábrica cooperative housing project—address the critical need for secure, affordable housing in a context of neoliberal economic policies and external debt crises. Jeifetz discusses the political ramifications of recent far-right victories in Argentina, which threaten hard-won social rights and self-managed housing initiatives, as well as the MOI’s role in resisting these policies through a framework of collective ownership, democratic decision-making, and mutual aid. By highlighting the intersections of housing with education, health, and labor, and situating the MOI’s work within a larger history of land and building occupations across Abya-Yala, this article provides a nuanced understanding of the ongoing struggles for housing justice in the face of both local and global neoliberal forces.

Prevalence of transthyretin amyloid cardiomyopathy in patients hospitalised for heart failure with preserved ejection fraction in an LATAM center

Abstract Introduction Transthyretin Amyloid cardiomyopathy (ATTR-CM) usually presents as heart failure with preserved ejection fraction (HFpEF). Its diagnosis has a significant clinical impact, as specific treatment is currently available. Purpose To assess the prevalence of ATTR-CM in patients hospitalised for HFpEF and increased septal thickness in our institution of general community hospital in Latin America (LATAM). Methods Cross-sectional study. Patients hospitalised for HFpEF (>50%) and septal thickness ≥ 12 mm during the period from 8/2019 to 1/2023 were prospectively included. Patients with pacemaker, significant left valve disease and end-stage renal failure (creatinine clearance < 30 ml/min/BSA) were excluded. A pyrophosphate bone scintigraphy (PYP) was planned to be performed in order to assess ATTR-CM. The prevalence of ATTR-CM and its 95% confidence interval were calculated. Results A PYP was performed in 59/82 patients hospitalised for HFpEF. Median age was 85 [IQR 78-88] years, and 54% were women. At admission, 61% (n=36) had atrial fibrillation and the median NT Pro-Bnp was 3536 [1700-7748] pg/mL. The mean left ventricle ejection fraction was 57% (+/- 5%). The prevalence of ATTR-CM diagnosed by PYP was 19% (95% CI 9.7-30.1, n=11). There were no significant clinical differences between patients who performed a PYP and did not. Patients with ATTR-CM had lower blood pressure and higher septal thickness, NT Pro-Bnp and troponin levels compared to patients without ATTR-CM (TABLE). Conclusion In patients admitted for HFpEF and increased septal thickness, the diagnosis of ATTR-CM was relatively common (one of five had ATTR-CM) in our region (LATAM). We believe that systemic assessment with PYP should be performed in patients hospitalised with HFpEF and increased wall thickness.

Air quality modeling intercomparison and multiscale ensemble chain for Latin America

Abstract. A multiscale modeling ensemble chain has been assembled as a first step towards an air quality analysis and forecasting (AQF) system for Latin America. Two global and three regional models were tested and compared in retrospective mode over a shared domain (120–28° W, 60° S–30° N) for the months of January and July 2015. The objective of this experiment was to understand their performance and characterize their errors. Observations from local air quality monitoring networks in Colombia, Chile, Brazil, Mexico, Ecuador and Peru were used for model evaluation. The models generally agreed with observations in large cities such as Mexico City and São Paulo, whereas representing smaller urban areas, such as Bogotá and Santiago, was more challenging. For instance, in Santiago during wintertime, the simulations showed large discrepancies with observations. No single model demonstrated superior performance over others or among pollutants and sites available. In general, ozone and NO2 exhibited the lowest bias and errors, especially in São Paulo and Mexico City. For SO2, the bias and error were close to 200 %, except for Bogotá. The ensemble, created from the median value of all models, was evaluated as well. In some cases, the ensemble outperformed the individual models and mitigated extreme over- or underestimation. However, more research is needed before concluding that the ensemble is the path for an AQF system in Latin America. This study identified certain limitations in the models and global emission inventories, which should be addressed with the involvement and experience of local researchers.

Complementarities in R&D and Innovation Decisions: An Enquiry on an Extensive Sample of Latin American Companies

This study uses an extensive sample of company data referring to seven Latin American countries to analyze the potential influence of simultaneity and heterogeneity in determining decisions to commit to R&D and innovation outputs. First, the analysis focuses on the decisions about spending on in-house and external research. Second, the outcomes of three different innovations: process, product, and organizational. Choices were considered simultaneously by employing a multivariate probit estimation model. In so doing, the enquiry considered the possible systematic interdependencies among the decisions. The results indicate that the two R&D decisions are interdependent. However, a different picture emerged in relation to innovation outputs, in which the correlations coefficients were small with unexpected signs. This may indicate a structural weakness of the technological production system in Latin America, wherein the synergies, complementarities, and complex relationships usually involved in the process of innovation are not fully developed.

Estimation of individual lifetime cardiovascular disease risk and treatment benefit in patients with established atherosclerotic cardiovascular disease: the updated SMART-REACH2 model

Abstract Background The 2021 ESC Guidelines on Cardiovascular Disease (CVD) Prevention in Clinical Practice recommend using (lifetime) risk to guide preventive treatment intensification. Purpose Updating and systematically recalibrating the SMART-REACH lifetime prediction model for the estimation of lifetime risk of recurrent CVD in patients with established atherosclerotic CVD (ASCVD) to various European and international risk regions. Methods The updated SMART-REACH (i.e., SMART-REACH2) model was derived using data from 9,477 individuals between 40-90 years with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms included in the UCC-SMART cohort in whom 2,090 ASCVD events were observed during a median follow-up of 8.9 years (interquartile range 4.5–14.1). Coefficients for type of CVD, estimated glomerular filtration rate, non-high density lipoprotein cholesterol, systolic blood pressure, duration of CVD, C-reactive protein, current smoking, and presence of diabetes were derived using sex-stratified cause-specific Cox models with age as the time axis, adjusted for the competing risk of non-CVD mortality. Lifetables were used to estimate 10-year and lifetime CVD-risk and CVD-free life expectancy. The SMART-REACH2 model was externally validated in 121,701 patients from the NOR-COR, Nor-COAST, HUNT3, SWEDEHEART, Bialystok PLUS/Polaspire, REACH-EU, and REACH non-EU (Asia, Japan, Latin America, North America) covering 43 countries. The model was recalibrated to specific risk regions based on the expected-observed ratios from representative cohorts. Performance was assessed by calibration of predicted and observed risk and Harrel’s C-statistic for discrimination. Results 16,689ASCVD events were observed in the external validation cohorts. The model was visually well calibrated for the various risk regions. The pooled C-statistic across risk regions was 0.665 [95% confidence interval 0.640-0.691], with adequate performance in the separate regions (Figure 1). Using SMART-REACH2 to estimate potential gain in CVD-free life expectancy upon treatment initiation showed varying projections. For example, two comparable 55-year-old males from the low-risk region and very high-risk region would gain an estimated 2.2 and 3.9 CVD-free life years as a result of smoking cessation (Figure 2). Conclusion(s) By using larger and more contemporary data sources, considering geographical differences, and extending the age range, the updated SMART-REACH2 model provides an improved algorithm for the estimation of lifetime risk and CVD-free life expectancy for individuals with established ASCVD, facilitating shared decision-making for cardiovascular prevention as recommended by the 2021 ESC Prevention of CVD guidelines.C-statistics across global risk regionsCase vignette

Rethinking the Coloniality of Race: Blood Purity and the Politics of Periodization

The coloniality of power stands as a major framework for theorizing race within the context of Latin America, providing an influential account of the origin of race in the Spanish colonization of the Americas. Without abandoning the task of theorizing the ways in which race functions in Latin America, this article asks: what is obscured by an insistence on 1492 as the moment when race emerged, and what different understandings of race can be made available by connecting the colonization of the Americas to a different set of temporal and spatial referents? Specifically, I develop a “prismatic” approach to analyze the impact of fifteenth-century Iberian blood purity statutes on the development of race without positing these as the new, singular origin of race. This article thus suggests an alternative genealogy of racialization while providing a critical engagement with the coloniality of power’s account of race.

Education and the Own Economy: What is Colombia Doing to Promote Economic Autonomy within the Framework of the Sdgs?

Objectives: The study establishes an analysis of the relationship between education and the economy as a starting point for addressing the SDGs. Theoretical Framework: In Latin America, despite the predominance of capitalism, alternative economic systems adapted to local contexts coexist. These economies stand out for the cooperation in communities to face specific challenges, respecting cultural traditions, the environment, and their own needs. They focus on collectivism and reciprocity, seeking not only survival, but also the preservation of values and ways of life. Adapting symbiotically to capitalism, these economies do not lose their essence and are characterized by their focus on the reproduction of life, community solidarity and the search for autonomy. Method: This document of reflection and documentary analysis reports the qualitative results of a research project on the teaching of Indigenous Economy in Latin American contexts. To obtain documents, a systemic literature review was proposed. However, given the complexity and novelty of the subject, a manual search of documents was necessary where specialized academic databases such as Scopus, Web of Science and Google Scholar were used. Results and Discussion: Education is key to preserving knowledge and practices of one's own economies over time, being essential to integrate the principles of alternative economies in school curricula as territorial knowledge necessary to strengthen. This facilitates the long-term sustainability of these economies and promotes more equitable and environmentally friendly development. Research Implications: This reflection article focuses on the bibliographic review and analysis of the contributions of Latin American authors on their own economies, emphasizing how these types of alternative economies are taught and the authors' perspectives in this regard. Originality/Value of the Research: The study is a fundamental contribution to research in terms of one's own economies, perspectives of economic autonomy and its relationship with education.

The cardiovascular polypill strategy (acetyl salicylic acid, atorvastatin, ramipril) as baseline treatment after a cardiovascular event supported by compelling evidence: a global expert consensus

Abstract Background The SECURE trial demonstrated that the CV-polypill strategy (acetylsalicylic acid [ASA]+atorvastatin+ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction (MI) compared to standard care over 3 years (median). The 2023 ACS ESC Guidelines recommend the polypill strategy to improve outcomes and treatment adherence. The CV-polypill inclusion in the 2023 World Health Organization's essential medicines list signifies its effective and affordable response to a global secondary prevention healthcare requirement. Purpose To reach consensus among medical experts from various countries regarding key implementation aspects of the CV-polypill strategy (ASA+atorvastatin+ramipril) as baseline preventive treatment after a CV event (CVe) in routine clinical practice. Methods A two-round modified Delphi method was employed. A questionnaire consisting of 30 evidence-based statements was developed and validated with input from 8 distinguished cardiologists. The Delphi panel, 50 physicians from 19 countries across Europe, Latin America, and Asia, used a three-point Likert scale to establish their agreement and perceived importance of the statements. Consensus was reached when ≥80% agreed or deemed statements 'very important' or 'important. Statements without consensus in the first round underwent refinement based on evidence and panellists’ feedback in the second round. Persistent disagreements were resolved in a face-to-face meeting with experts. Descriptive statistics were applied. Results 38/50 panellists participated in round 1, and 37/50 in round 2. 31/38 were cardiologists. 28/38 routinely prescribed the CV-polypill strategy. 97.4% of panellists believed that the 24% relative risk reduction in major CVe over 3 years (median), attained with the CV-polypill strategy (ASA+atorvastatin+ramipril) compared to standard care could replicate in clinical practice while maintaining equal safety (97.4%). Unanimous consensus (100%) supported initiating the CV-polypill strategy as baseline preventive treatment upon hospital discharge or at first follow-up. Its efficacy and safety were also acknowledged for stroke (94.7%), peripheral artery disease (92.1%), and both genders (84.2%). 89.5% supported CV-polypill affordability for preventing CHD events and strokes. Algorithms for initiation (97.3%) and transition (97.4%) to the CV-polypill strategy from cardioprotective drugs, considering patient preferences (97.5%), were confirmed. A unanimous consensus (100%) affirmed the positive impact of the simplified CV-polypill treatment on patient satisfaction, with 94.7% recognizing its convenience (Figure 1). Conclusions Skilled medical experts across continents reached consensus on critical implementation aspects and strongly endorse the early use of the CV-polypill strategy (ASA+atorvastatin+ramipril). This adoption aims to reduce CVD recurrence, improve prognosis, and potentially enhance affordability in CVD treatment after a CVe.Consensus on CV polypill implementation

Cost-effectiveness analysis of Chagas disease screening in pregnant women and their infants in Italy

Abstract Background Currently, Chagas disease (CD) is widespread in European nations that host notable populations from Latin America. Vertical transmission is a pathway for the spread of the disease in countries where it is not endemic. Due to socio-economic disparities, CD is a public health concern in non-endemic regions, raised by migration phenomena in vulnerable population groups who face similar hindrances as those most at risk in endemic areas. The aim is to evaluate the cost-effectiveness of CD screening versus no screening in pregnant women and their infants in Italy. Methods A Bayesian Markov model was employed to compare the CD screening versus the no screening alternative. Model parameters were sourced from pertinent scientific literature. A lifetime perspective was adopted, aligning with the perspective of the Italian National Health Service. The Eurozone threshold was applied. Costs and benefits were discounted at a rate of 3%. Gibbs sampling served as the algorithm for Bayesian inference. Uncertainty was addressed through a probabilistic sensitivity analysis (PSA) and a value of information analysis (VOI), depicted via the Cost-Effectiveness Acceptability Curve (CEAC) and Expected Value of Perfect Information (EVPI). Results were presented as the Incremental Cost-Effectiveness Ratio (ICER). Results The base case results showed that CD screening was cost-effective, with an ICER of €5,112 [€1,850 - €10,043]. Furthermore, according to the CEAC, the screening option exhibited the greatest probability of being cost-effective across all thresholds. Additionally, the EVPI per mother was €818 based on a threshold of €50,000/diagnosis. Conclusions Implementing a structured CD screening program also in non-endemic countries has the potential for early detection and treatment. This contributes to SDG 3 by improving access to healthcare, preventing transmission, and reducing the disease burden as well as informing public health policies for marginalised populations. Key messages • This study proves that screening for CD in pregnant women and their infants in a non-endemic area is a cost-effective strategy and possibly cost-saving in the long term. • Study findings could support a wider implementation of CD screening in Italy by informing health policy-makers in their decision-making process.

Clinical coordination in cancer diagnosis: healthcare stakeholders’ viewpoints in Latin America

Abstract Background Delays in diagnosis contribute to increasing cancer mortality rates in Latin American countries due to, among others, highly fragmented healthcare systems. The objective of this study, part of a larger research project (EquityCancer-LA), was to analyze cross-level coordination during cancer diagnosis and factors influencing it from healthcare stakeholders’ perspectives in Chile, Colombia, and Ecuador. Methods This descriptive-interpretative qualitative study was based on 114 semi-structured individual interviews in 2022-23 using a criterion sample of health professionals from primary care (PC) (n = 40) and secondary care (SC) (n = 44) as well as managers and policy makers (n = 30) from two public healthcare networks in each country. Sample reached saturation. A thematic analysis was conducted first by country and then comparatively, guided by the theoretical framework of clinical coordination. Results In all countries, informants highlighted limited cross-level exchange of information and limited coordination of clinical management, delays in referral, and long waiting times after referral, leading to diagnostic delays. Factors hindering coordination differed across countries: structural (insufficient personnel, access to diagnostic tests in PC); organizational (limited/inadequate coordination mechanisms, e.g. shared clinical records; poor working conditions); and health professional characteristics (limited knowledge and skills among PC doctors). Direct feedback was emphasized to facilitate coordination of cancer diagnosis: virtual joint clinical conferences in Chile, co-location of PC and SC in Colombia, and informal networks (based on personal contacts) in Ecuador. Conclusions The findings underscore the critical coordination problems contributing to delays in cancer diagnosis. Addressing these challenges requires strategic interventions aimed at strengthening primary care and fostering cross-level coordination. Key messages • Cancer diagnosis in Latin America suffers from coordination deficits due to structural, organizational, and professional factors. • Strengthening primary care and cross-level coordination is needed.

Clinical correlates and prognostic impact of cognitive decline in patients with heart failure and preserved ejection fraction: insights from PARAGON-HF

Abstract Background Cognitive decline is common in patients with heart failure (HF), but its clinical correlates and prognostic impact are not well understood in this population. Purpose To examine the baseline variables associated with cognitive decline and the associations between cognitive decline and HF outcomes in patients with heart failure and preserved ejection fraction (HFpEF). Methods We analyzed cognitive function, as measured by the Mini-Mental State Examination (MMSE), in 2895 patients with HFpEF enrolled in a pre-specified sub-study of PARAGON-HF. Logistic regression analysis was performed to determine the factors associated with cognitive decline i.e., a decrease in MMSE score of ≥3 points by 48 weeks. Time-updated Cox proportional hazards regressions and semiparametric proportional rates models were used to examine the subsequent risk of clinical outcomes after a decline in MMSE scores of ≥1-, 2- and 3-points during follow-up respectively, adjusted for known prognostic variables including NT-proBNP and baseline MMSE. Results A total of 450 (15.5% of the population) patients experienced a decrease in MMSE score of ≥3 points from baseline, at any follow-up visit. The corresponding number for a decrease in MMSE score of ≥2 points and ≥1 point was 755 (26.1%) and 1231 (42.5%), respectively. Independent predictors of cognitive decline at 48 weeks included older age, living in Latin America or the Asia/Pacific region, ischemic etiology, prior HF hospitalization, history of stroke/TIA, and lower serum albumin level (Figure 1). There was a graded relationship between the size of the decrease in MMSE score from baseline and the subsequent risk of mortality. Notably, a decrease of ≥3 points was associated with a 50% increase in the subsequent risk of death from any cause (adjusted HR 1.53, 95% CI 1.10-2.11) and a 90% elevation in risk of death from cardiovascular causes (1.89, 1.25-2.86), respectively, after extensive adjustment for known prognostic variables and baseline MMSE score. By contrast, cognitive decline during follow-up was not associated with a higher risk of HF hospitalization or the composite of HF hospitalization or CV death (Figure 2). Conclusions In patients with HFpEF, a decline in MMSE score during follow-up is independently associated with a graded increase in the risk for mortality, but not of HF hospitalization.The predictors for cognitive declineRisk of outcomes after a decline in MMSE

The Longlasting Program Keluarga Harapan as Conditional Cash Transfer in Indonesia: The Existing Problems and the Policy Recommendations

Program Keluarga Harapan (PKH) is a conditional cash transfer program in Indonesia that requires beneficiaries to meet certain requirements such as school attendance and health checks. Adopted from similar models in Latin America, PKH aims to reduce short-term poverty and invest in the health and education of future generations. Since its launch in 2007, PKH has operated in various regions with different poverty and infrastructure issues. PKH faces several challenges, including mistargeting of beneficiaries and burdensome bureaucracy for the poor. To address this, improvements to the targeting system and simplification of document procedures are recommended. The program has also contributed to reducing stunting through improved nutrition and health education, although health facilities need to be improved. In the education sector, PKH has succeeded in increasing school enrollment and attendance, but has not significantly reduced child labor. In terms of livelihoods, PKH encourages beneficiaries to shift to non-agricultural jobs, although often only casual labor. This study uses descriptive and explanatory designs to describe and explain the evolution of the PKH policy from 2007. Descriptive design is used to describe policy changes that occurred during the period, while explanatory design is used to explain the factors that influence policy changes and their impact on program effectiveness. The results found that there were problems with PKH facilitators including insufficient numbers, high workloads, and low salaries, which affected their effectiveness. To improve the performance of facilitators, new recruitment, regular training, and increased salaries and working conditions are recommended.

Cooperativism as pedagogy: Conversation with Gustavo Machado a lecturer and researcher from Facultad de Ciencias Sociales de la Universidad de la República

This conversation with Gustavo Machado discusses the role of cooperativism as a pedagogical process in Uruguay. Machado emphasizes how cooperatives serve as models for housing production and transformative social learning processes, embedding collective action and mutual aid into daily life. He distinguishes between housing, habitat, and inhabitation, advocating for a broader understanding of living that transcends physical structures and integrates social, cultural, and communal dimensions. Our conversation delves into the political significance of cooperatives in the face of neoliberalism, positioning them as alternatives to market-based housing models. Machado discusses the challenges cooperatives face, such as state regulation and the need for flexibility in adapting to changing life circumstances. He also reflects on his personal experiences growing up in a cooperative during Uruguay's dictatorship, which shaped his political and professional views. The article highlights the intersection of cooperativism with broader social movements, such as gender equality and mental health, and the importance of international dialogue in expanding cooperative housing models across Latin America.

Long-term prognosis and predictors of death in chronic Chagas cardiomyopathy in women and men

Abstract Background Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of heart failure (HF) in Latin America and carries high morbidity and mortality. Previous studies showed conflicting results in epidemiological and clinical evidence of a gender-associated risk of death in patients with HF due to CCC. Purpose This study analysed the long-term prognosis and the main predictors of death in women and men with HF due to CCC. Methods From March 2009 to January 2023, we followed a cohort of outpatients with HF due to CCC. Specific serological tests diagnosed Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed using the Kaplan-Meier (K-M) method to analyse time-to-event data and Cox proportional hazards methods to search for predictors of death. Results We studied 739 patients, with a mean age of 57.0 ± 12.1 years, 387 (52%) male. Women had a higher mean age (58.4 ± 11.7 vs. 55.8 ± 12.3 years; p=0.001), had a higher mean baseline left ventricular ejection fraction (LVEF) (44.3±14.5 % vs. 37.0±14.5%; p<0.001) and a smaller left ventricular diastolic diameter (LVDD) (56.8±8.9 vs. 62.5±9.4 mm; p<0.001). Over a median follow-up period of 10 years, 213 (56%) men and 169 (44%) women died (K-M: log-rank p=0.043; Figure). Men received more beta-blocker therapy (52.4% vs. 47.6%; p=0.040) and had a higher prevalence of chronic kidney disease (CKD) (p=0.003) and stroke (p=0.007). HFpEF was more prevalent in women and HFrEF in men (p<0.001). Device implantation and transplant were similar between women and men. Cox regression analysis for death adjusted for age, sex, myocardial infarction, diabetes, CKD, stroke, atrial fibrillation (AF), and LVEF showed LVEF (HR= 0.98;95%CL:0.97-0.98), age (HR=1.03;95%CL1.02-1.04) and CKD (HR= 1.32;95%CL:1.10-1.64) as the main predictors of death. In men, the main predictors were age (HR=1.02;95%CL:1.01-1.04), CKD (HR=1.409;95%CL:1.07-1.86), and LVEF (HR=0.98;95%CL:0.97-0.99), and in women AF (HR=1.41;95%CL:1.03-1.91), age (HR=1.03;95%CL:1.01-1.04), and LVEF (HR=0.97;95%CL:0.96 -0.98). Conclusion women had a better prognosis than men, but gender was not an independent predictor of death. Prevention of comorbidities, especially CKD in men and AF in women, and higher beta-blocker therapy can significantly reduce the death rate in women and men with HF from CCC.

Comparative analysis of a novel preoperative stratification method versus traditional scores in patients with severe aortic stenosis undergoing aortic valve surgery

Abstract Introduction It is crucial to consider factors that complicate the indication of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS), such as narrow valve ring, extensive calcification or inadequate vascular access. (1-4) Thus, aortic valve replacement surgery (SAVR) remains a recommended indication, with its pre-surgical stratification being a challenge. (1-3) Despite the widespread use of scores like the STS and EuroSCORE II, they exhibit limitations, being validated primarily for populations outside Latin America and focusing predominantly on individual factors while often neglecting structural parameters like left ventricular hypertrophy, diastolic dysfunction, or left atrium volume. (3-5) Purpose This study aimed to assess whether a novel modified Généreux stratification method offers superior predictive value for postoperative mortality in AS patients compared to traditional scoring systems. Methods We conducted a retrospective, single-center study involving patients with confirmed severe AS who underwent aortic valve replacement surgery between January 2017 and December 2021. The new stratification method categorized patients into three stages based on echocardiographic parameters (see Figure 1). Univariate and multivariate Cox regression analyses were conducted to identify predictors of mortality, with survival analysis performed using Kaplan-Meier curves. A p-value <0.05 was considered statistically significant. Results A total of 508 patients were included in the study. Stage 1 patients had a lower median age (62 years vs. 67 years in stages 2 and 3). The median EuroSCORE and STS were 2.75 and 2.62%, respectively, with stage 3 showing significantly higher scores (p ≤0.001). Over a median follow-up of 81 months, 56 deaths occurred (11%). Kaplan-Meier curve analysis revealed significant differences in all-cause mortality among the three groups (HR 4.073, log-rank p≤0.001), as illustrated in Figure 1. Multivariate analysis identified the three preoperative stages (HR 3.22, [95% CI 1.44-7.20], p=0.004) and mean transaortic gradient (HR 0.96, [95% CI 0.92-0.99], p=0.021) as independent predictors of mortality. The new stages demonstrated a superior area under the ROC curve of 0.758 compared to traditional scores (see Figure 1). Conclusions The novel three-stage preoperative classification and low transaortic gradient serve as significant predictors of mortality in patients undergoing SAVR. These stages exhibit robust predictive capability for mortality compared to EuroSCORE II and STS.Baseline and multivariate analysisKaplan-meier and ROC curve

Performance of the 2020 ACC/AHA and 2023 ESC risk stratification scales for primary prevention of sudden cardiac death in a Latin American population with hypertrophic cardiomyopathy

Abstract Background Identifying patients with hypertrophic cardiomyopathy (HCM) who are at high risk of sudden cardiac death (SCD) is essential for managing this condition. The American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) guidelines help assess and stratify the risk of determining which patients would benefit from primary prevention with an implantable cardioverter-defibrillator (ICD). Objective The study aims to evaluate the performance of the 2020 AHA/ACC and 2023 ESC risk stratification scales (AHA/ACC-rss; ESC-rss) for the primary prevention of SCD in Latin-American patients diagnosed with HCM. Methods A retrospective cohort of HCM from a single-center was analyzed. The inclusion criteria were individuals aged 16 years or older, without a history of SCD, and who had not undergone any treatment such as myomectomy or septal ablation with alcohol (Figure 1). The primary outcome was the identification of SCD or an equivalent event (successful resuscitation after cardiac arrest or appropriate therapy from the ICD). Results One hundred twenty patients were included (mean age 46.2 years old) and the mean follow-up duration was 61.1 months. From the total sample, 10 patients (8.3%) experienced an equivalent SCD event; 7 patients (5.8%) were ICD-protected and 3 (2.5%) required external defibrillation. The ESC-rss showed a greater area under the ROC curve (AUC, 0.79; 95% CI 0.62-0.94 vs AUC, 0.63; 95% CI 0.49-0.78) and specificity (85%; 95% CI 63-92 vs 51%; 95% CI 37.3-64.5). Sensitivity was similar between both scales (AHA/ACC-rss: 77%; 95% CI 50-100 vs ESC-rss: 73%; 95% CI 43-100). Remarkably, 2.5% of the patients who experienced an equivalent of SCD were incorrectly identified as low-risk individuals by either the AHA/ACC-rss, ESC-rss, or both (Table 1). Conclusion The SCD risk stratification recommended by the ESC-rss demonstrated a more effective identification of Latin American patients with HCM for ICD placement because the area under the curve was more significant than those of the AHA/ACC-rss. This single-center study highlights the need for a multicenter prospective study in Latin America.

Por las puertas de la apercepción: Acercamientos a la filosofía de Francisco Gavidia

In the following paper, the author points out some of the aspects of the philosophical project of the Salvadoran writer Francisco Gavidia. One important contribution is that the author reflects on whether a Latin American philosophy is possible, long before the philosophical debates regarding this matter during the 1960s. Gavidia maintained that this philosophy must overcome the limitations of positivism and provide a perspective of reality rooted both on scientific reason and poetic intuition, given the particularities of Latin American identity. That is what the author calls “apperception”, which he considers as the foundation of his philosophical and cultural project for El Salvador. Nevertheless, Gavidia thought has both the scope and limitations of a philosophy rooted in the 19th century intellectual context but focused on the 20th century problems. Realidad, Revista de Ciencias Sociales y Humanidades, No. 164, 2024: 89-136.