Genotype distribution of Group A rotavirus in children before and after massive vaccination in Latin America and the Caribbean: Systematic review

BackgroundDuring the last decade, most of Latin American and the Caribbean (LAC) countries have implemented oral live rotavirus vaccines in their national vaccination programs with remarkable results. However, it has been suggested that massive vaccination could lead to the replacement of circulating genotypes or the emergence of new variants or neutralizing antibodies escape mutants, which may reduce the effectiveness of the vaccine. The objective was to analyze the genetic diversity of Group A rotavirus before and after the introduction of universal vaccination in LAC.MethodsWe conducted a systematic review of studies published in PubMed, Scielo and LILACS. There were considered only LAC countries with rotavirus massive vaccination strategy which had described circulating genotypes data in children under 5 years of age, either for surveillance or vaccine effectiveness purposes, from 2001 to 2017. Systematic review stages were carried out following the recommendations of PRISMA.ResultsOf the 18 countries that included any of the two licensed rotavirus vaccines in their national schedules since 2006, only 7 (~39%) presented studies of RVA genetic diversity before and after implementation, and met the inclusion criteria. Four of them (Argentina, Brazil, Colombia and Nicaragua) experienced a rapid switch from Wa-like to DS-1-like strains. Also, G1P[8] association, considered the most predominant worldwide in the pre-vaccination era, decreased significantly and was only frequently detected in Venezuela and Nicaragua. No defined pattern of emergence at high frequencies of unusual associations was observed in the post vaccination period, except for some evidence of G9P[4] in Colombia, G3P[6] and G1P[4] in Nicaragua.ConclusionsEven though the evidence shows a DS-1-like change trend, data from studies conducted in Latin America and the Caribbean are diverse and still not sufficient to assess the impact of vaccines on viral ecology or if genetic diversity is influenced by natural mechanisms of fluctuation.     

Evaluation of Nutrient Intake and Food Consumption among Dutch Toddlers

Improving dietary habits at a young age could prevent adverse health outcomes. The aim was to gain insight into the adequacy of the dietary intake of Dutch toddlers, which may provide valuable information for preventive measures. Data obtained from the Dutch National Food Consumption Survey 2012–2016 were used, which included 672 children aged one to three years. Habitual intakes of nutrients were evaluated according to recommendations set by the Dutch Health Council. Specific food groups were evaluated according to the Dutch food-based dietary guidelines. For most nutrients, intakes were estimated to be adequate. High intakes were found for saturated fatty acids, retinol, iodine, copper, zinc, and sodium. No statement could be provided on the adequacy of intakes of alpha-linoleic acids, N-3 fish fatty acids, fiber, and iron. 74% of the toddlers used dietary supplements, and 59% used vitamin D supplements specifically. Total median intakes of vegetables, bread, and milk products were sufficient. Consumption of bread, potatoes and cereals, milk products, fats, and drinks consisted largely of unhealthy products. Consumption of unfavorable products may have been the cause of the observed high and low intakes of several nutrients. Shifting towards a healthier diet that is more in line with the guidelines may positively affect the dietary intake of Dutch toddlers and prevent negative health impacts, also later in life.     

Progress Toward Long-Term Care Protection in Latin America: A National Long-Term Care System in Costa Rica

The aging of the world's population is a reality. People are living longer, not just in high-income countries, but it remains unclear whether their extra years will be lived in better health. In fact, an increasing number of older adults will probably require help to perform activities of daily living. Within the framework of its Global Strategy and Action Plan on Ageing and Health, the World Health Organization has called on all countries to create suitable and equitable long-term care systems that meet the needs of older people. The challenge is particularly acute in Latin America. The region is aging faster than other areas in the world, and its less-prepared social protection systems suffer from limited economic resources.Costa Rica is one the first middle-income countries to create a national long-term care system. This article describes the main characteristics of this system and discusses it from an international perspective. The results show that it has been designed to prioritize severity of dependency and cost containment, and to reinforce the formalization of care. The outcome of its implementation will affect the decisions of neighboring countries and those with similar economic conditions concerning the development of their own long-term care systems.     

Intake of Vitamin E and C in Women of Reproductive Age: Results from the Latin American Study of Nutrition and Health (ELANS)

Vitamin E was identified as a lipophilic compound essential to maintain rat pregnancy. Low vitamin E intake during early pregnancy associates with congenital malformations and embryonic loss in animals and with miscarriage and intrauterine growth restriction in humans. Vitamin E protects cell membranes from lipoperoxidation and exerts non-antioxidant activities. Its function can be restored by vitamin C; thus, intake and circulating levels of both micronutrients are frequently analyzed together. Although substantial vitamin E inadequacy was reported worldwide, its consumption in Latin America (LatAm) is mostly unknown. Using data from the Latin American Study of Nutrition and Health (Estudio Latinoamericano de Nutrición y Salud, ELANS), we evaluated vitamin E and C intake in women of reproductive age (WRA) from eight LatAm countries and identified their main food sources. Two non-consecutive 24-h dietary recalls in 3704 women aged from 15 to 49 years and living in urban locations showed low average intake of vitamin E (7.9 mg/day vs. estimated average requirement (EAR) of 12 mg/day) and adequate overall vitamin C consumption (95.5 mg/day vs. EAR of 60 mg/day). The mean regional inadequacy was 89.6% for vitamin E and 36.3% for vitamin C. The primary food sources of vitamin E were fats and oils, as well as vegetables. Vitamin C intake was explained mainly by the consumption of fruit juices, fruits, and vegetables. Combined deficient intake of both vitamins was observed in 33.7% of LatAm women. Although the implications of low antioxidant vitamins’ consumption in WRA are still unclear, the combined deficient intake of both vitamins observed in one-third of ELANS participants underscores the need for further research on this topic.     

Factors Associated with Food Insecurity in Latin America and the Caribbean Countries: A Cross-Sectional Analysis of 13 Countries

It is estimated that Latin America and the Caribbean (LAC) is the region with the second highest figures for food insecurity (FI) globally, with a prevalence of 40.9% in the entire region. This cross-sectional study analyzes the household factors associated with FI across 13 LAC countries. We used data from the first round of high-frequency phone surveys, conducted by the World Bank. Approximately 4 out of 10 people in LAC experienced FI during the first phase of the COVID-19 pandemic. FI was positively associated with the number of individuals aged from 5 to 18 years, the number of men, the illness, accident, or death of an income-earning household member, and health expenditure due to COVID-19 or other illnesses, as well as the increase in food prices, reduced family income, and job loss by a member of the household. On the other hand, households located in capital cities and those with more bedrooms were less likely to have experienced FI. The design of social policies must focus on the economic deficiencies experienced by the LAC population, with unemployment, reduced income, and high food costs being the main factors that must be addressed to ensure adequate nutrition.     

The reality of disability: Multidimensional poverty of people with disability and their families in Latin America

Background

Disability and poverty are interconnected and although this relationship has been recognised, there is a lack of empirical evidence to support any possible causal relationship in this topic, particularly in the context of Latin America (LA).

中国医疗器械在拉丁美洲三国的进出口分析

拉丁美洲的市场,是中国医疗器械进出口很重要的市场。对中国诊断医疗产品在巴西,墨西哥和阿根廷市场的进出口分析会对中国产品进入这一市场提供理论和实践的参考依据。北美自由贸易协议和政府采购对墨西哥的市场影响很大。巴西和阿根廷的当地医疗器械制造商较弱,进入壁垒适中,中国产品有较大的竞争优势。     

Development of a Cultural Awareness Scale for Occupational Therapy Students in Latin America: A Qualitative Delphi Study

Cultural awareness is a key issue in healthcare worldwide. Valid and reliable assessments are needed to assess cultural awareness for occupational therapy students. The purpose of this study was to develop a scale to assess cultural awareness for Latin American occupational therapy students. A Delphi design was implemented considering four rounds with experts from four countries. A 30‐item scale in Spanish was developed to assess three categories of items: personal, therapeutic strategies and persons' cultures. The experts highlighted local features for professional practice as a key aspect of the scale. Local differences in practice were considered with the profession's traditions and prevailing knowledge across the scale. A participatory strategy and an international group of experts enriched the cultural relevance. A subsequent study of statistical reliability is required (the scale is not presented in an extended version here). Further research should consider the application of the scale and strategies to improve cultural awareness across the curricula. Copyright © 2016 John Wiley & Sons, Ltd.     

The tobacco epidemic in Latin America and the Caribbean: A snapshot

The tobacco epidemic continues to spread through Latin America and the Caribbean. Philip Morris and British American Tobacco Company control the market through their subsidiaries. In the past, governments in this region have shown little or no commitment to tobacco control. This, however, has changed in recent years as the World Health Organization (WHO) Framework Convention on Tobacco Control has been signed by most and ratified by several countries in the region. Non-governmental organizations, sometimes rallied by the InterAmerican Heart Foundation, have played a crucial role in supporting Treaty ratification. Latin America and the Caribbean have the momentum to move forward in tobacco control and also the support to approve the necessary legislation to halt the tobacco epidemic.     

Ready‐to‐Eat Cereal Consumption and the School Breakfast Program: Relationship to Nutrient Intake and Weight

BACKGROUND: Children in the United States exhibit high rates of nutrient inadequacy and overweight/obesity; other international studies report similar associations. The School Breakfast Program (SBP) may help alleviate these conditions for youth in the United States. This research examined the association of ready‐to‐eat (RTE) breakfast cereal consumption with students' (SBP participants and nonparticipants) dietary nutrient intake and weight status. METHODS: Data were from the third School Nutrition Dietary Assessment Study (SNDA‐III), conducted in 2004‐2005. Analyses included all 2298 SNDA‐III participants (ages 5‐18 years), who completed a dietary recall and whose parents completed an interview. Students were categorized as skipping versus eating breakfast; students eating breakfast were categorized by SBP participation (SBP participant vs nonparticipant) and breakfast type (with vs without RTE cereal). Analyses estimated the association of these categorizations with total daily nutrient intake and weight‐related measures, after adjusting for covariates. RESULTS: RTE cereal breakfast consumers (regardless of SBP participation) had greater intake of vitamin A, iron, and whole grain, compared with noncereal breakfast eaters. Breakfast consumers (regardless of SBP participation and type) had greater intake of vitamins A and C, calcium, iron, dietary fiber, and whole grain, relative to breakfast skippers. CONCLUSIONS: The SBP increases opportunity for improved nutrient intake and healthier body weight through breakfast consumption, especially whole grain RTE cereals, as recommended by the Dietary Guidelines 2010.     

Food Group Intake and Micronutrient Adequacy in Adolescent Girls

This study explores the contribution of food group intakes to micronutrient adequacy among 2379 girls in the National Growth and Health Study during three age periods (9–13, 14–18, and 19–20 years). Data on food and nutrient intakes from 3-day diet records over 10 years were used to estimate mean intakes and percent meeting Dietary Guidelines (DGA) recommendations for food intakes and Institute of Medicine’s recommendations for vitamins and minerals. More than 90% of girls failed to consume the recommended amounts of fruit, vegetables and dairy; 75% consumed less than the recommended amounts in the “meat” group. The vast majority of girls of all ages had inadequate intakes of calcium, magnesium, potassium, and vitamins D and E. In contrast, they consumed >750 kcal/day (~40% of total energy) from the DGA category of solid fat and added sugars, about five times the recommended maximum intakes. This study shows the importance of consuming a variety of foods in all five food groups, including those that are more energy dense such as dairy and meats, in order to meet a broad range of nutrient guidelines. Diet patterns that combined intakes across food groups led to greater improvements in overall nutritional adequacy.     

Social inequities and contemporary struggles for collective health in Latin America

ABSTRACT

As part of a planned series from Global Public Health aimed at exploring both the epistemological and political differences in diverse public health approaches across different geographic and cultural regions, this special issue assembles papers that consider the legacy of the Latin American Social Medicine and Collective Health (LASM-CH) movements, as well as additional examples of contemporary social action for collective health from the region. In this introduction, we review the historical roots of LASM-CH and the movement’s primary contributions to research, activism and policy-making over the latter-half of the twentieth century. We also introduce the special issue’s contents. Spanning 19 papers, the articles in this special issue offer critical insight into efforts to create more equitable, participatory health regimes in the context of significant social and political change that many of the countries in the region have experienced in recent decades. We argue that as global health worldwide has been pushed to adopt increasingly conservative agendas, recognition of and attention to the legacies of Latin America’s epistemological innovations and social movement action in the domain of public health are especially warranted.     

National working conditions surveys in Latin America: comparison of methodological characteristics

Background:

High-quality and comparable data to monitor working conditions and health in Latin America are not currently available. In 2007, multiple Latin American countries started implementing national working conditions surveys. However, little is known about their methodological characteristics.

Objective:

To identify commonalities and differences in the methodologies of working conditions surveys (WCSs) conducted in Latin America through 2013.

Methods:

The study critically examined WCSs in Latin America between 2007 and 2013. Sampling design, data collection, and questionnaire content were compared.

Results:

Two types of surveys were identified: (1) surveys covering the entire working population and administered at the respondent''s home and (2) surveys administered at the workplace. There was considerable overlap in the topics covered by the dimensions of employment and working conditions measured, but less overlap in terms of health outcomes, prevention resources, and activities.

Conclusions:

Although WCSs from Latin America are similar, there was heterogeneity across surveyed populations and location of the interview. Reducing differences in surveys between countries will increase comparability and allow for a more comprehensive understanding of occupational health in the region.     

Determinants of health status and the influence of primary health care services in Latin America, 1990-98

Primary health care (PHC) services have been advocated as a means by which less developed countries may improve the health of their populations even in the face of poverty, low levels of literacy, poor nutrition and other factors that negatively influence health status. Using aggregated data from the World Bank and UNICEF this study examined which factors, both within the health care system and outside of it, are associated with under-5 mortality rates in 22 countries of Latin America and the Caribbean during the 1990s. In a multivariate analysis using generalized estimating equations for repeated measures, five factors were found to be independent predictors of lower under-5 mortality rates (U5MRs). These were vaccination levels, female literacy, the use of oral rehydration therapy, access to safe water and GNP per capita. When the magnitude of these associations were assessed, higher levels of GNP per capita was found to be very weakly associated with lower U5MRs, compared with female literacy and vaccination rates. These findings suggest that government policies which focus only on promoting economic growth, while not making important investments in PHC services, female education and access to safe water are unlikely to see large improvements in health status.     

Theoretical underpinnings of state institutionalisation of inclusion and struggles in collective health in Latin America

ABSTRACT

Community participation as a strategy in health aims to increase the role of citizens in health decision-making which are contextualised within the institutions of democracy. Electoral representation as the dominant model of democracy globally is based on the elite theory of democracy that sees political decision-making a prerogative of political elites. Such political elitism is counter to the idea of democratic participation. Neoliberalism together with elitism in political sphere have worsened social inequities by undermining working class interests. Latin America has seen adverse consequences of these social inequities. In response, social movements representing collective struggles of organised citizens arose in the region. This paper explores the theoretical underpinnings of democratic participation in contemporary Latin American context at the nexus of emerging social movement activism and policy responses. The paper will use empirical examples to highlight how such democratic practices at the societal level evolved while demanding political inclusion. These societal democratic practices in Latin America are redefining democracy, which continues to be seen in the political sphere only. Health reforms promoting participatory democracy in several Latin American countries have demonstrated that establishing institutions and mechanisms of democratic participation facilitate collective participation by the organised citizenry in state affairs.     

Breakfast and the diets of Australian adults: An analysis of data from the 1995 National Nutrition Survey

The aim of this study was to describe the nutrients provided to Australian adults by the breakfast meal and to compare the food and nutrient intakes and health of regular breakfast eaters and breakfast skippers. The Australian Bureau of Statistics was commissioned to undertake additional analysis of data collected in the 1995 Australian National Nutrition Survey (NNS). The survey included 24-h recalls, physical measurements and a food habits questionnaire collected during the period February 1995–March 1996, with a nationally representative sample of 10,851 Australians aged 19 years and older. The median nutrient intakes at breakfast and the proportion of the daily total contributed by breakfast were calculated. Differences between regular breakfast eaters and breakfast skippers in terms of nutrient intake, body mass index and health status were compared using Student t-tests. The findings show the typical Australian breakfast was low in fat, high in carbohydrate and a good source of thiamin, riboflavin, niacin, calcium and magnesium. In the NNS regular breakfast eaters had more adequate diets overall, particularly those aged 65+ years. People who did not eat breakfast cereal were much more likely to have inadequate nutrient intakes, especially of thiamin, riboflavin, calcium, magnesium and iron. Regular breakfast eaters were more likely to rate their health as excellent or good than those who skip breakfast, but there was no difference between the fat intake or the body mass index of regular breakfast eaters compared with breakfast skippers. Regular breakfast consumption is associated with better diets for adults overall.     

Standardization of the Food Composition Database Used in the Latin American Nutrition and Health Study (ELANS)

Between-country comparisons of estimated dietary intake are particularly prone to error when different food composition tables are used. The objective of this study was to describe our procedures and rationale for the selection and adaptation of available food composition to a single database to enable cross-country nutritional intake comparisons. Latin American Study of Nutrition and Health (ELANS) is a multicenter cross-sectional study of representative samples from eight Latin American countries. A standard study protocol was designed to investigate dietary intake of 9000 participants enrolled. Two 24-h recalls using the Multiple Pass Method were applied among the individuals of all countries. Data from 24-h dietary recalls were entered into the Nutrition Data System for Research (NDS-R) program after a harmonization process between countries to include local foods and appropriately adapt the NDS-R database. A food matching standardized procedure involving nutritional equivalency of local food reported by the study participants with foods available in the NDS-R database was strictly conducted by each country. Standardization of food and nutrient assessments has the potential to minimize systematic and random errors in nutrient intake estimations in the ELANS project. This study is expected to result in a unique dataset for Latin America, enabling cross-country comparisons of energy, macro- and micro-nutrient intake within this region.