Cohort Profile: The Cohorts Consortium of Latin America and the Caribbean (CC-LAC).
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ABSTRACT:
SUBMITTER: Cohorts Consortium of Latin America and the Caribbean (CC-LAC)
PROVIDER: S-EPMC7746413 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Publications
Cohort Profile: The Cohorts Consortium of Latin America and the Caribbean (CC-LAC).
International journal of epidemiology 20201001 5
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Project description:To assess scientific publication and map research gaps on access to medicines (ATM) in Latin American and the Caribbean low-income and middle-income countries (LMIC). Scoping review. Two independent reviewers assessed studies for inclusion and extracted data from each study. Search strategies were developed and the following databases were searched: MEDLINE, ISI, SCOPUS and Lilacs, from 2000 to 2010. Research articles and reviews published in English, Spanish and Portuguese were included. Studies including only high-income countries were excluded, as well as those carried out in very limited settings and discussion papers. The 77 articles retained were categorised through consensus among the research team according to the level of the health system addressed, ATM domain and research issues covered. Publications on ATM have increased over time during the study period (r 0.93, p=0.00; R(2) 0.85). The top five countries covered were Brazil (68.8%), Mexico (15.6%), Colombia (11.7%), Argentina (10.4%) and Peru (10.4%). 'Health services delivery' and 'patients, household and communities' were the health system levels most frequently covered. The ATM domains 'leadership and governance', 'sustainable financing, affordability and price of medicines', 'medicines selection and use' and 'availability of medicines' were the top four explored. There are research gaps in important areas such as 'human resources for health', 'global policies and human rights', 'production of medicines' and 'traditional medicine'. The upward trend on scientific publication reflects a growing research capacity in the region, which is concentrated on research teams in selected countries. The gaps on research capacity could be overcome through research collaboration among countries. It is important to strengthen these collaborations, assuring that interests and needs from the LMIC are addressed and local capacity building is promoted.
| S-EPMC3646181 | biostudies-literature
Project description:BackgroundRisk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations.MethodsWe developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory-based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell's C-statistic and calibration slopes.FindingsThe C-statistic for the laboratory-based model was 72% (70-74%), the calibration slope was 0.994 (0.934-1.055) among men and 0.852 (0.761-0.942) among women; for the office-based model the C-statistic was 71% (69-72%) and the calibration slope was 1.028 (0.980-1.076) among men and 0.811 (0.663-0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%.InterpretationThe cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC.FundingWellcome Trust (214185/Z/18/Z).
| S-EPMC9107390 | biostudies-literature
Project description:BACKGROUND:The European Commission (EC) Horizon 2020 (H2020)-funded ZIKAlliance Consortium designed a multicentre study including pregnant women (PW), children (CH) and natural history (NH) cohorts. Clinical sites were selected over a wide geographic range within Latin America and the Caribbean, taking into account the dynamic course of the ZIKV epidemic. METHODS:Recruitment to the PW cohort will take place in antenatal care clinics. PW will be enrolled regardless of symptoms and followed over the course of pregnancy, approximately every 4 weeks. PW will be revisited at delivery (or after miscarriage/abortion) to assess birth outcomes, including microcephaly and other congenital abnormalities according to the evolving definition of congenital Zika syndrome (CZS). After birth, children will be followed for 2 years in the CH cohort. Follow-up visits are scheduled at ages 1-3, 4-6, 12, and 24 months to assess neurocognitive and developmental milestones. In addition, a NH cohort for the characterization of symptomatic rash/fever illness was designed, including follow-up to capture persisting health problems. Blood, urine, and other biological materials will be collected, and tested for ZIKV and other relevant arboviral diseases (dengue, chikungunya, yellow fever) using RT-PCR or serological methods. A virtual, decentralized biobank will be created. Reciprocal clinical monitoring has been established between partner sites. Substudies of ZIKV seroprevalence, transmission clustering, disabilities and health economics, viral kinetics, the potential role of antibody enhancement, and co-infections will be linked to the cohort studies. DISCUSSION:Results of these large cohort studies will provide better risk estimates for birth defects and other developmental abnormalities associated with ZIKV infection including possible co-factors for the variability of risk estimates between other countries and regions. Additional outcomes include incidence and transmission estimates of ZIKV during and after pregnancy, characterization of short and long-term clinical course following infection and viral kinetics of ZIKV. STUDY REGISTRATIONS: clinicaltrials.gov NCT03188731 (PW cohort), June 15, 2017; clinicaltrials.gov NCT03393286 (CH cohort), January 8, 2018; clinicaltrials.gov NCT03204409 (NH cohort), July 2, 2017.
| S-EPMC6933915 | biostudies-literature
Project description:BackgroundSchool milk programs have a long history in Latin America and the Caribbean. In recent decades, the region has undergone a nutrition transition characterized by a rise in children's overweight/obesity, which adds new challenges for school-based programs.ObjectivesThis article aimed to unpack how school milk programs in the region have fared as of 2022 and what drives their success (or lack thereof).MethodsData from the Global Survey of School Meal Programs were analyzed descriptively to broadly summarize the current state of school feeding programs in Latin America and the Caribbean. To probe the status of school milk programs, key informant interviews were conducted with school milk stakeholders in 7 countries (Brazil, Chile, Colombia, the Dominican Republic, Ecuador, Guatemala, and Honduras), and these interviews were analyzed for thematic elements.ResultsFive countries were found to have operational school milk programs, whereas the programs in Guatemala and Honduras have not (thus far) endured. Programs often prioritized and took pride in local milk procurement, although there was sometimes incongruity between objectives to improve children's diets and stimulate local agricultural development. Program implementers grapple with the taste, texture, and safety of milk, and it can be challenging to reconcile concerns over child obesity and the need to ensure the milk is appealing and accepted.ConclusionsIn conclusion, programs seek creatively to overcome the aformentioned challenges wherever there is fiscal capacity and political will.
| S-EPMC11795587 | biostudies-literature
Project description:BackgroundLatin America and the Caribbean (LAC) is the world's most inequitable region in terms of wealth distribution. The full scale of social inequalities in health has been hidden by the lack of reliable data. This study aimed to measure and compare health inequalities in the working population within and between 15 countries of LAC.MethodsA sample of 180,163 workers aged 18 years and older was drawn from the most recent national surveys of working conditions or health in 15 LAC countries. Poor self-perceived health (P-SPH) was used as a health indicator, and age, education level, and occupational category as inequality stratifiers. We calculated four measures: absolute and relative population-attributable risks, the Kuznets and weighted Keppel indexes.ResultsP-SPH prevalence ranged from 9% in men from Uruguay to 50% in women from Nicaragua. It was higher in women than in men in most countries. A clear gradient was shown, in which young people in non-manual skilled jobs and high education had the lowest prevalence. Nearly 45% of cases that reported P-SPH among men and 35% among women could be avoided if all the groups received a higher level of education. Also, approximately 42% of P-SPH reported by men and 31% by women could be avoided if they all shared the working and employment conditions of non-manual skilled jobs.ConclusionsWide health inequalities were found between occupational and educational groups in LAC. However, country borders appear to be an even more important stratifier in the production of health inequalities. Urgent interventions to improve worker's health are needed in countries where prevalence of poor self-perceived health is high. Strengthening occupational health surveillance system in LAC countries should become a priority, in order to track the interventions to reduce occupational health inequity.
| S-EPMC7329389 | biostudies-literature
Project description:Introduction:The homicide rates among young men in Latin America and the Caribbean (LAC) are the highest in the world. It is not clear how this has impacted the life expectancy in these countries. This research has two purposes: (1) to quantify the impact of homicides on the mortality gap between LAC and high-income countries over recent years and (2) to assess the changes in homicide impact in overall survival over time. Methods:Causes of death data were extracted for 23 countries in the LAC and 15 European countries (average European union-15 [EU-15]), using UN, UNODC, WHO, HMD and IHME databases for the period 2005-2014. The contribution by homicide deaths to the change in life expectancy, over time and as a difference between two populations, was quantified using decomposition methods. Results:The contribution by homicide mortality to changes in life expectancy levels differed widely across the examined LAC countries. In Honduras, homicide mortality accounted for 1.75 (95% CI 1.64 to 1.86) and 6.30 (95% CI 6.07 to 6.53) years lower life expectancy than in the EU-15 countries for women and men, respectively. Contrary to this, homicide was just accountable for less than a couple of months of life expectancy differences between Chile and EU-15. Jamaica had the largest reduction in homicides and its impact increased life expectancy over time by almost half a year for men. However, Mexican men and Honduran women have experienced increases in mortality by homicide, which decreased their life expectancy by more than a quarter of a year between 2005 and 2014. Conclusions:Excess mortality related to homicides in young people accounted for major changes in life expectancy in the LAC region. Furthermore, reducing excess mortality due to homicides is a crucial goal to further increase longevity towards levels of low-mortality countries. These reductions might prevent homicides spreading to other parts of Latin America. Decision and policy-makers in LAC need to address this immediately, and investing in the young population needs to be given a high priority.
| S-EPMC6509612 | biostudies-other
Project description:This article delves into the complex relationship between climate change, migration patterns, and health outcomes in Latin America and the Caribbean (LAC). While the severe impact of climate change on health in LAC is widely acknowledged, the article sheds light on the often-overlooked multiple effects on migration and the well-being of migrants. These impacts encompass poverty, food and water insecurity, and adverse physical and mental health outcomes. Our paper, guided by a rights-based framework, aims to identify key trends, challenges, and opportunities that can contribute to enhanced knowledge and generate questions to support future research. By emphasizing the need for collaborative efforts across sectors, including public and private entities, civil society, and academic institutions, we aim to address the nuanced intersections of climate change, migration, and health impacts in the region. This approach prioritises the needs of the most vulnerable, including migrants, establishing a framework for mitigation and adaptation that ensures equitable outcomes.
| S-EPMC11703577 | biostudies-literature
Project description:To identify measures that mitigate the impact of influenza in Latin America and the Caribbean, we compared the burden and detection capacity in humans and animals after the 2009 pandemic. The incidence rate in people was higher in Chile (23.72 per 100,000 people), but the impact was greater for Guatemala (503.78 disability-adjusted life years per 100,000 people). Brazil, Peru, Argentina, and Mexico built better medical testing, with typing being less frequent in Chile and Argentina, where costs for medical care were higher. The positivity rate among avian and nonhuman mammals was 5.8%, with more cases in Mexico, but constant testing in Chile. H5N1, H5N2, and H7N6 are deadly to poultry, whereas H1N1 is common in swine, and H3N8 in equines. By June 2023, H5N1 had caused severe influenza in two persons and killed millions of birds and hundreds of mammals with aquatic lifestyles. An analysis of the efforts in response to this outbreak revealed that handling of outbreaks in animals needs homogeneity and reinforcement of vaccination. Surveillance in exposed individuals requires articulation of medical and animal health authorities, and the region also demands decentralized typing and networks for genomic characterization.
| S-EPMC11861997 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic.ObjectiveThis study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics.MethodsThrough a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020.ResultsThe LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of -0.31, all of which decreased in the subsequent week to 9.04, -0.81, and -0.03, respectively.ConclusionsMetrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks.
| S-EPMC8083950 | biostudies-literature
Project description:Understanding the fine scale spatial distribution of births and pregnancies is crucial for informing planning decisions related to public health. This is especially important in lower income countries where infectious disease is a major concern for pregnant women and new-borns, as highlighted by the recent Zika virus epidemic. Despite this, the spatial detail of basic data on the numbers and distribution of births and pregnancies is often of a coarse resolution and difficult to obtain, with no co-ordination between countries and organisations to create one consistent set of subnational estimates. To begin to address this issue, under the framework of the WorldPop program, an open access archive of high resolution gridded birth and pregnancy distribution datasets for all African, Latin America and Caribbean countries has been created. Datasets were produced using the most recent and finest level census and official population estimate data available and are at a resolution of 30 arc seconds (approximately 1 km at the equator). All products are available through WorldPop.
| S-EPMC5963337 | biostudies-literature