MS in Latin America

During the last few years, there has been an increasing desire to study and expand current knowledge about the different aspects of Multiple Sclerosis (MS) in Latin America (LATAM). This report analyzes epidemiological data and specific aspects of MS in this region and aims to describe the current situation, based on the very few scientific publications that contain reliable information. Everything seems to indicate that MS in LATAM has some special characteristics that makes it different from what has been described in other areas of the world. Nevertheless, more thorough research has to be carried out in order to obtain conclusive data regarding the behaviour of the disease in LATAM.     

Movement disorders in Latin America

The authors review some particularities of movement disorders (MDs) in the ethnically diverse population of Latin America. Although idiopathic diseases are evenly prevalent, access to treatment encounters difficulties that are worth discussing. Infectious-parasitic diseases observed throughout the continent occasionally present as MDs, and will be individually reviewed. Inherited MDs with regional foci of increased prevalence, particularly spinocerebellar ataxias, will also be considered. Whereas there is no treatment for genetic disorders, most of the other conditions are preventable or amenable to adequate treatment. Hope for better health standards for the Latin American population lies in profound social and political changes that are still to come.     

Crossroads: Identity struggles in Latin America and Latin American psychiatry

Identity can be defined from different perspectives such as those from philosophy, social sciences and phenomenology. The latter entails sameness, uniqueness, distinctiveness, continuity, diversity, universality and equality connotations to define characteristics of the existence and action of individuals, institutions, entities, organizations and collectivities. In order to elaborate on the identity of Latin American Psychiatry, this chapter deals first with the identity of the Latin American continent, the result of a ‘collision of cultures’ with mestizaje as its most prominent collective contribution. In turn, the Latin American population (and its ‘Hispanic’ equivalent in other countries and regions of the world) has been the subject of a pluralistic search, and played a combined role of hope and conflict, advances and setbacks in a fascinating historical process. In such context, Latin American psychiatry offers a mixed identity, resulting from a succession of mythic–religious, moral, phenomenologico-existential, biological and social/community-based routes. Each of them are assessed, and the contributions of two eponymous figures, Honorio Delgado and Gregorio Bermann, are duly delineated. Current realities in Latin American psychiatry and mental health in socio-political, conceptual, professional, ideological, academic and heuristic areas, are examined. The chapter ends with considerations of the future of psychiatry in the continent, the postulation of a ‘new synthesis’ embracing the essence of contemporary neurobiological knowledge and a new, revitalized humanism in the context of a healthy eclecticism, progressive educational training and didactic programmes, and concrete contributions embodying the promise of well justified expectations.     

International developments in behavior therapy in Latin America

The development of behavior therapy in Latin America is presented, beginning with the work of Keller and Bijou in Brazil and Mexico respectively. In the decade of the 70's the experimental analysis of behavior and interventions to change undesired behavior were considered scientific and professional alternatives to psychoanalysis. Psychologists trained in objective methodology began work on clinical problems, and were followed by psychiatrists not satisfied with traditional approaches. Today behavior therapy and behavior modification are known and practiced in the majority of the Latin American countries. Important basic research is in progress.     

Stroke epidemiology, prevention, and management strategies at a regional level: Latin America and the Caribbean

Stroke is a major health problem in Latin American and Caribbean countries. In this paper, we review the epidemiology, aetiology, and management of stroke in the region based on a systematic search of articles published in Spanish, Portuguese, and English. Stroke mortality is higher than in developed countries but rates are declining. Population-based studies show variations in incidence of strokes: lower rates of ischaemic stroke and similar rates of intracranial haemorrhages, compared with other regions. A significant proportion of strokes in these populations can be attributed to a few preventable risk factors. Some countries have published national clinical guidelines, although much needs to be done in the organisation of care and rehabilitation. Even though the burden of stroke is high, there is a paucity of information for implementing evidence-based management. The Global Stroke Initiative, the WHO STEPS Stroke surveillance, and WHO-PREMISE projects provide opportunities for surveillance at institutional and community levels.     

Research in the Field of Prevention in Latin America

International Journal of Mental Health and Addiction -     

Influenza vaccination status in multiple sclerosis patients from Latin America

Journal of NeuroVirology - The objective of the present study was to identify the frequency of MS patients in Latin America (LATAM) that received the influenza vaccine during the most recent season...     

Sociocultural domains of depression among indigenous populations in Latin America

Not enough research has been carried out on depression up to now in Latin America. The knowledge that has resulted from research activities in the USA or Europe offers limited generalizability to other regions of the world, including Latin America. In the Andean highlands of Ecuador, we found very high rates of moderate and severe depressive symptoms, a finding that must be interpreted within its cultural context. Somatic manifestations of depression predominated over cognitive manifestations, and higher education level was protective against depression. These findings call for an appreciation of culturally specific manifestations of depression and the social factors that influence them. These factors must be further studied in order to give them the deserved priority, allocate resources appropriately, and formulate innovative psychosocial interventions.     

Addressing psychiatric education in Latin America: Challenges and opportunities

This article is about the psychiatric educational components in the field of psychiatry. Currently the training and educational objectives focus on five major areas: undergraduate education (medical students); graduate education (psychiatric residents); psychiatric education for primary care physicians, as well as physicians in other medical specializations (psychosomatic training); public health and public education at large, and patient and family education, and the promotion of ‘mental health’ at a community level. Given the strong globalization process observed in all regions of the world in the past two or three decades, it is very important for Latin America to constantly review and update its psychiatric and behavioural sciences curriculum across all medical institutions and universities of the continent. New methods of teaching and novel approaches to education in the field of psychiatry are currently based on models that are also in use in other parts of the world, especially in the USA. Boards of certification for psychiatrists are being implemented all over the continent. Sound certification guarantees that the professional has followed and passed an educational training plan to make him/her qualified to start practising the profession. The future of psychiatric training will be closely bound to the future of the practice of psychiatry, and will have to get ahead of the challenges the specialism will face during the next decades.     

Response to the Psychological Consequences of Disasters in Latin America

The ongoing Israeli-Palestinian conflict has taken its toll on both sides. Prominent among peace building initiatives is the Parents Circle-Families Forum, a cross-community peace building project of bereaved families. We examine the grieving process and emotional well-being of a sample of 21 Israeli Jews and Palestinians living in the West Bank, who have lost their loved ones in the context of ongoing war and armed conflict. We also investigate whether the positive attitudes and emotions toward the opposing groups can serve as protective factors associated with prolonged grief disorder (PGD). The most prominent finding of our study is that some attitudes (e.g., a positive attitude toward peace, being hopeful about the future, the ability to forgive the opposing group) can be considered protective factors associated with PGD. People-to-people peace building initiatives, such as the Parents Circle-Families Forum, reinforce these factors. Furthermore, they provide their members with social support and a strong sense of mutual commitment and responsibility, facilitating their grieving process, and emotional well-being.     

Prevalence and clinical features of multiple sclerosis in Latin America

Multiple sclerosis (MS) in Latin America (LA) is considered to have a low to medium prevalence. However, accurate information on MS in LA is scarce. The aim of this study was to compare clinical characteristics among LA patients through a systematic review of the literature. A systematic search (Spanish, Portuguese and English) was done for all clinical studies of MS in humans (MEDLINE, PubMed, Scielo, BIREME, EMBASE and LILACS) up to May 2011 being focused on a well-defined Latin American population (peer-reviewed journal) following the MOOSE guidelines. The search strategy included combinations of different Mesh terms (two independent researchers). Classification of each article by using the Oxford Centre for Evidence-based Medicine – Levels of Evidence was done. The total number of patients per country for each specific characteristic was compiled. Chi-square test was used to compare the characteristics in the studies retrieved per country. There were 38 articles fulfilling the inclusion criteria, accounting for 4524 patients. Relapsing-remitting form was the most frequent in LA patients and the main initial symptom was motor, followed by optic neuritis and sensorial. A mild expanded disability status scale was the most prevalent in all LA countries. Factors accounting for differences in distribution and clinical course across LA countries include genetics, environment, diagnostic techniques, socioeconomic structure and medical facilities.