Latin American Settings Research Articles

A Medical Informatics Distance-learning Course for Latin America

There is a growing need and interest worldwide for healthcare and information technology professionals trained in medical informatics. Distance learning technologies are increasingly used to deliver such education, but have mainly been limited to the English language. Describe the implementation and student satisfaction of a medical informatics course delivered in Spanish for a Latin American audience. The course was based on the 10 x 10 program of the American Medical Informatics Association and Oregon Health & Science University that was translated and adapted to the Latin American setting. The initial course consisted of ten one-week units, currently the course has 15 modules that are delivered in 16 weeks with topics that address the needs of medical informatics in the region. We also administered an anonymous questionnaire of student satisfaction. A total of 499 individuals have enrolled in the course, and 70% have completed it. Most of the students have been healthcare professionals (86%), with the largest proportion from Argentina. Student satisfaction with all aspects of the course was high. After the initial experience and feedback from the students, the course has been adapted to better meet regional needs. The initial experience obtained in training healthcare professionals in medical informatics in Latin America in their own language demonstrated that it could be used across the region, and this could represent a model for disseminating knowledge of medical informatics across other languages and cultures.

Physical Activity and Public Health in Latin America—Moving Forward

Physical inactivity is a global health concern and, according to the World Health Organization (WHO), is the fourth leading contributor to deaths, ahead of those attributable to obesity and with greater contributions to deaths in middlethan high-income countries. Therefore, developing solutions to increasing activity rates is of international interest. Much of the evidence base for physical activity (PA) and health, and reporting interventions to decrease inactivity, come from the developed world, although the risks from noncommunicable disease (NCD) are increasing rapidly in many transitional nations. What is needed is an evidence base for action from population studies and public health interventions in developing countries. This supplement provides excellent examples of the breadth and innovation in PA research being conducted in Colombia and Brazil, 2 large nations in Latin America. The funding provided through GUIA is unique, as it develops research capacity and fosters research partnerships that provide in-country opportunities to evaluate innovative and inspirational public health interventions. To major examples are the social movement that was catalyzed by the groundbreaking Project Agita in Brazil, and the unthinkable task of shifting a whole urban transport system toward a more sustainable and more active one in Bogota, Colombia. These projects are aspirational for PA advocates in developed countries, but in these Latin American settings innovation is partnered with technical expertise to attempt real public health change, using good population samples and research methods to develop the evidence base for action. Encouragingly, many of the findings in this supplement are similar to those observed in developed countries. For example, the surveillance instrument, IPAQ, is widely used and has modest but acceptable measurement properties, but some problems remain with its administration. The observed relationships between the built

The Impact of Globalization on the Poor in Latin America

This paper consists of four parts following an introduction. Section 2 analyzes and describes the main channels (transmission mechanisms) through which the process of globalization affects poverty directly and indirectly. Section 3 reviews the major effects of globalization on the Latin American economy - keeping in mind that few generalizations can be made with much assurance. Section 4 focuses on 13 case studies of the impact of globalization within different Latin American settings undertaken under the auspices of a UNU/ WIDER project directed by the authors. These case studies reveal clearly how the effects of different manifestations of globalization on poverty tend to be context-specific. In general, the main globalization channels appeared not to have been able to reduce overall poverty in the region. Between 1981 and 2004 growth was anemic and its pattern was not pro-poor, instead bringing about greater income inequality. The transfer of technology tended to benefit the skilled workers and hurt the unskilled. The one ray of hope in an otherwise bleak picture consists of the safety nets and social protection schemes implemented in an innovative fashion by some of the larger countries in the region.

Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomised, double-blind, placebo-controlled phase III study

Peak incidence of rotavirus gastroenteritis is seen in infants between 6 and 24 months of age. We therefore aimed to assess the 2-year efficacy and safety of an oral live attenuated human rotavirus vaccine for prevention of severe gastroenteritis in infants. 15 183 healthy infants aged 6-13 weeks from ten Latin American countries randomly assigned in a 1 to 1 ratio to receive two oral doses of RIX4414 or placebo at about 2 and 4 months of age in a double-blind, placebo-controlled phase III study were followed up until about 2 years of age. Primary endpoint was vaccine efficacy from 2 weeks after dose two until 1 year of age. Treatment allocation was concealed from investigators and parents of participating infants. Efficacy follow-up for gastroenteritis episodes was undertaken from 2 weeks after dose two until about 2 years of age. Analysis was according to protocol. This study is registered with ClinicalTrials.gov, number NCT00140673 (eTrack444563-023). 897 infants were excluded from the according-to-protocol analysis. Fewer cases (p<0.0001) of severe rotavirus gastroenteritis were recorded for the combined 2-year period in the RIX4414 group (32 [0.4%] of 7205; 95% CI 0.3-0.6) than in the placebo group (161 [2.3%] of 7081; 1.9-2.6), resulting in a vaccine efficacy of 80.5% (71.3-87.1) to 82.1% (64.6-91.9) against wild-type G1, 77.5% (64.7-86.2) against pooled non-G1 strains, and 80.5% (67.9-88.8) against pooled non-G1 P[8] strains. Vaccine efficacy for hospital admission for rotavirus gastroenteritis was 83.0% (73.1-89.7) and for admission for diarrhoea of any cause was 39.3% (29.1-48.1). No cases of intussusception were reported during the second year of follow-up. Two doses of RIX4414 were effective against severe rotavirus gastroenteritis during the first 2 years of life in a Latin American setting. Inclusion of RIX4414 in routine paediatric immunisations should reduce the burden of rotavirus gastroenteritis worldwide.

Aquí en el Ghetto: Hip-hop in Colombia, Cuba, and Mexico

AbstractHip-hop music has become an important tool worldwide for poor, marginalized youth to reflect on their lived experiences. This article traces the genre's production from its spontaneous origins in the urban ghettos of New York to its commoditization for global consumption and its evolution in three different Latin American settings: Colombia, Cuba, and Mexico. The article explores how hip-hop has been appropriated in each country and has been used to express the performers’ reflections on social, political, and economic problems. It also looks at the interplay between the homogenizing tendencies of global hip-hop and its local reception.

Rotarix™ (RIX4414): an oral human rotavirus vaccine

Rotavirus is the most common cause of severe gastroenteritis in children younger than 3 years of age worldwide. New rotavirus vaccine candidates were required to confer early protection against the most common rotavirus serotypes and to be well tolerated and not associated with intussusception. RIX4414 is a human-attenuated G1(P8) oral rotavirus vaccine administered in two doses at approximately 6–24 weeks of age. The first dose may be administered from the age of 6 weeks. There should be an interval of at least 4 weeks between doses and the vaccination course should preferably be given before 16 weeks of age and must be completed, according to the manufacturer, by the age of 24 weeks. In a worldwide development program involving more than 70,000 children in six Phase I–III field trials, this vaccine proved to be nonreactogenic, well tolerated and not associated with intussusception. The vaccine provides over 85–96% protection against moderate-to-severe gastroenteritis caused by G1 and non-G1 serotypes, as demonstrated in Latin American and European clinical trial settings, respectively; and reduces gastroenteritis-related hospitalizations by more than 40% in Latin America and by 75% in European settings.

Metabolic syndrome in young adults from two socioeconomic Latin American settings

Background and aim Since little information on the metabolic syndrome (MS) is available in Latin America, the aim of this study was to explore whether and to what extent differing socioeconomic conditions influence the prevalence of MS and its associated factors among young adults from two towns in Latin America: semi-rural Limache (L), Chile, and urban Ribeirão Preto (RP), Brazil. Methods and results A cross-sectional study based on two independent investigations of 22- to 28 year-old subjects using a common methodology. The prevalence of MS (according to the US National Cholesterol Education Program) and its risk factors (smoking habit, alcohol and caloric intake, obesity, physical activity and socioeconomic conditions) were assessed. The prevalence of MS was 10% in L and in RP men, but was lower (4.8%) in RP women. Hyperglycemia was very low (0.8% in L and 1.1% in RP), while the prevalence of low HDL cholesterol levels was high (66.7% and 42.2%, respectively). Intermediate prevalences of hypertriglyceridemia (17.9% and 12.9%), elevated blood pressure (15.5% and 23.1%) and abdominal obesity (19.3% versus 12.7%) were detected. RP subjects had a higher educational level and more qualified jobs, came from smaller families, and a higher proportion were car owners. In L, the smoking habit was more frequent, subjects had higher excess weight and caloric intake, and lower levels of physical activity. Conclusions Metabolic changes possibly leading to cardiovascular diseases in later life were present in both populations at an early age, but were higher in the rural and less developed county. Our findings point to the existence of a cultural, educational and socioeconomic phenomenon that possibly influences the prevalence of the diagnostic components of MS through differences in lifestyles.

Evaluación de un programa para fortalecer a los cuidadores familiares de enfermos crónicos

The study evaluated the effectiveness of the "Caring for the caregivers" programme which was designed to strength family caregivers' ability to care for people suffering from chronic disease. The study used a quasi-experimental design, having study and control groups, and measured caring ability before and after the intervention. 250 family caregivers were included in the study. The results included a description of the caregiver groups in terms of gender, age, family relationship, caring time and care receiver's dependence level. They also included initial and final levels regarding caring ability in each group, as well as comparing them to each other. Similarities were found in gender and responsibility for caring for younger people; differences were found in the service of origin, care-receiver functionality, accumulated experience and age. Caring ability was homogeneous in groups before the intervention but different in total level and patience following the programme. The findings agreed with the literature in terms of gender distribution, age, home assistance and caregivers' low levels of ability in terms of taking care of a family member suffering from chronic disease. The results suggested that the "Caring for the caregivers" programme has helped to increase caregivers' caring abilities and in doing so provided an option regarding the chronically ill which must be further explored within a Latin-American setting.

Distribución de patrones PRA en aislamientos clínicos del complejo Mycobacterium avium procedentes de España y Suramérica.

Mycobacterium avium complex (MAC) infections are the most frequent systemic infections associated with advanced AIDS. DNA probes for accurate identification of mycobacteria are available but are very expensive in many Latin American settings. Consequently, most Latin American diagnostic laboratories employ inaccurate and outdated tests for mycobacteria identification. Therefore, PCR restriction analysis (PRA) of the hsp65 gene was evaluated for the identification of 163 MAC human isolates originated from Spain and South America. The predominant PRA type in each country was: M. avium type I in Argentina (23/42, 55%) and Brazil (48/72, 67%), M. avium type II in Spain (18/26, 69%) and M. avium type III in Colombia (10/23, 43%). The Colombia frequency is noteworthy, since the PRA type III was quite infrequent in the other three countries. Furthermore, its presence has not been reported outside the Americas. The advantages and disadvantages of PRA in diagnostic mycobacteriology are discussed.

Risk factors for adult male criminality in Colombia.

OBJECTIVES: This study sought to establish, in Colombia, the importance of factors alleged to be causes or correlates of adult criminality according to the published literature from other countries. METHODS: A comparison was made of arrested male offenders from ages 18 to 30 (n = 223) and similar community controls (n = 222) selected from five cities in Colombia as to their family background, exposure to abuse, family stressors, perceived care and history of childhood disruptive behaviour problems. RESULTS: Compared with neighbourhood controls from similar social classes, offenders were significantly more likely to report having had parents with less education, a mother under the age of 18 or over the age of 35 at time of birth, family members involved in crime, experiencing extreme economic deprivation, parental absence, family conflict, severe punishments, physical abuse, and maternal unavailability, rejection and lack of supervision. Prevalence of childhood disruptive behaviour problems was similar among offenders and controls. These findings appear to be independent of economic status, family size or type, birth order, or primary caregiver. Although the independent contribution of most of these factors is small, once all others have been controlled for, their cumulative effect is strong. CONCLUSIONS: The findings obtained in this Latin American setting do not support the generalized view that adult antisocial behaviour is necessarily preceded by a history of childhood behaviour problems. However, they do add evidence for the importance of family factors in the risk for adult criminality.

MEANING AND JOY IN LATIN AMERICAN SPORTS

Drawing on recent scholarship, this overview discusses the adoption of modern sports in several Latin American settings and their evolving cultural meaning. Examples include soccer in Argentina, baseball in Cuba, baseball along the United States-Mexican border and cricket in the West Indies. Discussion focuses upon the reasons why particular sports are adopted within a culture and assume import to a people within a specific geographical area. Ineffable aspects of these pastimes, such as the aesthetics and the emotion of sport, are acknowledged, in the light of a recognition of the continuing distinction between the intrinsic and the extrinsic qualities of sports.

A Place Unbecoming: The Coffee Farm of Northern Latin America

This article examines recent transformations of the coffee landscape of northern Latin America through the optic of “place as process.” As coffee became the most important regional export crop, its “place” evolved. Coffee lands in northern Latin America now embrace 3.1 million hectares, often contiguous across international borders. Like many agricultural systems, coffee has succumbed to intensification, a process termed “technification” in the Latin American setting. The result is a landscape mosaic in which a traditional agro‐forest coffee system coexists with coffee lands transformed by modernization. The institutional forces behind this process, as well as some of its social and ecological consequences, are discussed.

Gorgeous Pedagogy

Elena Poniatowska's recent Luz y luna, Ias lunitas immediately impresses the reader with its beauty; it is akin to a "coffee table book" in its sheer gorgeousness. I intend to explore the question of how to read the gorgeous object within the context of Poniatowska's oeuvre and within the frame of a pedagogical endeavor. Poniatowska, of course, represents the epitome of the elite but socially conscious Latin American author. As in certain of her other works (but perhaps more obviously here, because of the very nature of this book), the mix of elitism and social consciousness undergoes a multiple displacement. Like her other works, Luz y Iuna constitutes a palimpsest of discourses, seems to partake more of the modern semi-autobiographical gender essay than of the traditional (male) essay, and explicitly addresses the challenge of feminism in a Latin American setting. Nevertheless, this social consciousness enters into an implicit conflict with two of the book's other fundamental qualities: its polished and lyrical approach to the people and landscape of Mexico, and its utopian nostalgia, especially with respect to Mexico's indigenous cultures. In essence, then, this paper will explore how—more clearly than in her less overtly polished works—the problem of a pedagogical model drawn from Poniatowska is highlighted in this text.

THE «INVENTION» OF AMERICA: ENCOUNTER SETTINGS ON THE LATIN AMERICAN LYRIC STAGE

The basis for interpretation of Latin American settings of encounter sub jects for the lyric stage must differ fundamentally from interpretations of European settings, with the possible exception of Spain and Portu gal, which were culturally engaged in the Conquest. For Latin America, the Conquest remains an event of apocalyptic proportions that changed the core of its historical being. I could not possibly approach my sub ject by analyzing libretti from the standpoint of dramaturgical conven tion (as J?rgen Maehder has brilliantly done for Italian, French, and German settings).1 Where I to do so, I would be placing the Latin Ame rican settings as brands of European exoticism, thereby dismissing their cultural significance. Within European exoticism, the choice of exotic subjects remains a matter of cultural indifference, swapping heroes on the lyric stage as if they were cardboard pieces on a chessboard. From Maehder's study of European settings, and up to 1900, one may con clude that the intensification of ?otherness? as dramatic device may have dictated the choice of American subjects. For Latin American set tings, an interpretation requires the framework of history and an under standing of how Europe conjured up its image of America; how ?for Eu rope? America became a fictive place; and what were the consequences of this fiction for the inner cultural dynamics within America, as it be came itself. In the myth-making scheme of history, reenactments of the Conquest in Latin America become part of the process of understand ing, parts of an inevitable cultural catharsis at specific historical times and places ? the late 18th and 19th centuries in Mexico and Peru ?

Coronelismo, Caciquismo, and Oyabun-Kobun Bonds: Divergent Implications of Hierarchical Trust in Brazil, Mexico and Japan

The present study analyses the character of hierarchical relations of personal dependence in Brazil, Mexico, andJapan, in an attempt to reveal their differences and implications, and, indirectly, to explain the lack of recourse to such relationships for purposes of modernization in the Latin American settings, in contradistinction toJapan. The detailed analysis shows that whereas in Japan hierarchical personalized trust contributed to societal trust, in Latin America it recreated existing uncertainties and weakened broader institutional trust. The combined perspectives of macroand micro-analysis shed light on the comparative brittleness of hierarchical trust in Latin America. The analysis suggests that the interpersonal tendencies characteristic of each setting are related both to institutional frameworks and to images of self-fulfilment peculiar to the societies in question. It is argued that it is the fragility of hierarchical trust in Mexico and Brazil that has contributed to the reformulation of patron-client relations following processes of change, i.e., industrialization, capitalistic penetration, and political

The Combined Naval Commercial Port (CNCP) in a Latin American setting

Inadequate ports are a major problem in many less developed countries (LDCS). In an era in which international trade involving developing countries is growing rapidly, decisions must be made to provide the necessary infrastructure and superstructure to facilitate the movement of cargo from ship to shore and vice versa. In LDCS, the phenonmenon of the Combined Naval-Commercial Port (CNCP) has not undergone scrutiny. This paper is concerned with describing the nature of the Latin American CNCP. The hypothesis is that commercial port interests have been adversely affected by coexistence. The results of an unquiry comprise the main body of this research.

A Preliminary Test of the Theory of Dependency

A Preliminary Test of Dependency This article reports the results of a preliminary test of based on a statistical comparison of seventeen Latin American countries. The concept of dependency has been applied with increasing frequency to the development problems of Latin America and Africa, and a considerable amount of data related to the subject has been amassed from United Nations sources and from historical case studies.' For the most part, however, these data have previously been used to build and illustrate dependency theory, rather than to subject it to the possibility of disproof.2 In this study, we have attempted to cull from the burgeoning theoretical literature a variety of disprovable, bivariate propositions which we operationalized and tested in the Latin American setting.

Ecological Variables in the Cross-Cultural Study of Delinquency

Students of delinquency, preoccupied with subcultural and value conflict theories, have recently produced fewer ecological studies. However, for the much-needed task of assessing the cross-cultural applicability of contemporary delinquency theories, ecological studies need to be conducted in other cultures to indicate where delinquency occurs and among whom. Ecological data are presented on juvenile offenders and their offenses from Cordoba, Argentina. These are discussed against a background of United States studies and implications are drawn concerning delinquency theory. In general, the ecology of delinquency in this Latin-American urban setting shows characteristics precluding the uncritical application of current delinquency