1 00:00:05,760 --> 00:00:15,760 >>Chair Aviles-Santa: WELCOME. 2 00:00:15,760 --> 00:00:18,840 I AM LA REESE A AVILES-SANTA. 3 00:00:18,840 --> 00:00:22,880 GREETINGS FROM NIMHD. 4 00:00:22,880 --> 00:00:23,600 THE NATIONAL INSTITUTE OF 5 00:00:23,600 --> 00:00:25,120 MINORITY HEALTH AND HEALTH 6 00:00:25,120 --> 00:00:25,480 DISPARITIES. 7 00:00:25,480 --> 00:00:27,520 IT'S AN HONOR TO BE HERE 8 00:00:27,520 --> 00:00:31,080 SURROUNDED BY COLLEAGUES AND BY 9 00:00:31,080 --> 00:00:34,040 EXPERTS TO DISCUSS CRUCIAL 10 00:00:34,040 --> 00:00:35,480 TOPICS AND DIFFICULT TOPICS IN 11 00:00:35,480 --> 00:00:41,400 THIS UNIQUE WORKSHOP, LATINO 12 00:00:41,400 --> 00:00:42,800 AMERICA, SYNERGIESING RESEARCH 13 00:00:42,800 --> 00:00:45,880 ACROSS THE HEMISPHERE. 14 00:00:45,880 --> 00:00:51,320 TODAY AND TOMORROW, WE WILL HAVE 15 00:00:51,320 --> 00:00:53,920 36 EXPERTS FROM LATINO AMERICA, 16 00:00:53,920 --> 00:00:58,400 THE UNITED STATES AND AMERICA 17 00:00:58,400 --> 00:01:08,960 EUROPE DISCUSSING THE -- IN U.S. 18 00:01:23,680 --> 00:01:29,200 LATINO/HU.S./. 19 00:01:29,200 --> 00:01:31,480 >>THAT WILL BE OF MUTUAL 20 00:01:31,480 --> 00:01:34,880 INTEREST AND BENEFIT TO BOTH 21 00:01:34,880 --> 00:01:37,680 LATIN AMERICA AND THE U.S. 22 00:01:37,680 --> 00:01:38,440 LATINO COMMUNITIES. 23 00:01:38,440 --> 00:01:41,440 I WANT TO THANK ALL EXPERTS WHO 24 00:01:41,440 --> 00:01:43,600 HAVE ACCEPTED THE INVITATION TO 25 00:01:43,600 --> 00:01:46,120 PARTICIPATE IN OUR WORKSHOP. 26 00:01:46,120 --> 00:01:48,520 AND WHO HAVE SET ASIDE TIME TO 27 00:01:48,520 --> 00:01:50,560 REALLY SHARE THEIR KNOWLEDGE AND 28 00:01:50,560 --> 00:01:54,200 ENGAGE IN CRUCIAL AND RECENT 29 00:01:54,200 --> 00:01:54,520 CONVERSATIONS. 30 00:01:54,520 --> 00:01:57,960 I ALSO WANT TO THANK Dr. 31 00:01:57,960 --> 00:02:01,520 PEREZ-STABLE FOR SUPPORTING THIS 32 00:02:01,520 --> 00:02:01,760 WORKSHOP. 33 00:02:01,760 --> 00:02:05,040 I WANT TO THANK ALL OF YOU, IN 34 00:02:05,040 --> 00:02:07,160 LATIN AMERICA, AND IN THE U.S. 35 00:02:07,160 --> 00:02:10,960 WHO ARE TAKING TIME FROM THIS 36 00:02:10,960 --> 00:02:12,720 VERY SPECIAL DAY. 37 00:02:12,720 --> 00:02:14,720 TO BE HERE WITH US. 38 00:02:14,720 --> 00:02:17,200 WE KNOW THIS IS A MAJOR 39 00:02:17,200 --> 00:02:18,640 CELEBRATION ACROSS LATIN AMERICA 40 00:02:18,640 --> 00:02:22,280 AND WE ARE GRATEFUL FOR YOUR 41 00:02:22,280 --> 00:02:22,560 PRESENCE. 42 00:02:22,560 --> 00:02:25,280 AND NOW, I WANT TO PASS THE 43 00:02:25,280 --> 00:02:29,880 MICROPHONE TO OUR COLLEAGUE. 44 00:02:29,880 --> 00:02:30,840 >>THANK YOU. 45 00:02:30,840 --> 00:02:32,880 GOOD MORNING AND WELCOME, 46 00:02:32,880 --> 00:02:33,120 EVERYONE. 47 00:02:33,120 --> 00:02:35,600 I AM CONSTANZA, AN INVESTIGATOR 48 00:02:35,600 --> 00:02:37,680 IN THE DIVISION OF CANCER 49 00:02:37,680 --> 00:02:39,920 EPIDEMIOLOGY AND GENETICS AT THE 50 00:02:39,920 --> 00:02:41,160 NATIONAL CANCER INSTITUTE. 51 00:02:41,160 --> 00:02:42,680 IT'S AN HONOR TO BE PART OF THE 52 00:02:42,680 --> 00:02:45,160 ORGANIZING COMMITTEE OF THIS 53 00:02:45,160 --> 00:02:45,960 UNPRECEDENTED MEETING. 54 00:02:45,960 --> 00:02:48,400 WE HAVE A MOMENTUM AND A AGAIN 55 00:02:48,400 --> 00:02:50,600 DA AND A PROMISE FOR ADVANCING 56 00:02:50,600 --> 00:02:54,200 HEALTH IN HISPANIC LATINO 57 00:02:54,200 --> 00:02:55,280 POPULATIONS IN YEARS AHEAD OF 58 00:02:55,280 --> 00:02:56,800 THE I LOOK FORWARD TO LEARNING 59 00:02:56,800 --> 00:02:58,920 ABOUT THE BEST PRACTICES AND 60 00:02:58,920 --> 00:03:00,240 EMERGING RESEARCH OPPORTUNITIES 61 00:03:00,240 --> 00:03:02,600 TO BE DISCUSSED TODAY AND 62 00:03:02,600 --> 00:03:02,960 TOMORROW. 63 00:03:02,960 --> 00:03:05,600 NOW, I'M GOING TO TURN THE 64 00:03:05,600 --> 00:03:07,360 MICROPHONE OVER TO Dr. 65 00:03:07,360 --> 00:03:08,200 MICHELLE DOOSE. 66 00:03:08,200 --> 00:03:08,560 THANK YOU. 67 00:03:08,560 --> 00:03:12,000 >>THANK YOU. 68 00:03:12,000 --> 00:03:14,040 GREETINGS, I'M Dr. MICHELLE 69 00:03:14,040 --> 00:03:15,160 DOOSE A PROGRAM OFFICIAL AT THE 70 00:03:15,160 --> 00:03:16,840 NATIONAL INSTITUTE ON MINORITY 71 00:03:16,840 --> 00:03:18,360 HEALTH AND HEALTH DISPARITY. 72 00:03:18,360 --> 00:03:20,840 IT'S AN HONOR COULD BE A 73 00:03:20,840 --> 00:03:22,200 CO-CHAIR AND FOR THIS WORKSHOP 74 00:03:22,200 --> 00:03:23,600 TO ADVANCE THE SCIENCE TO 75 00:03:23,600 --> 00:03:26,680 IMPROVE THE HEALTH OF HISPANICS 76 00:03:26,680 --> 00:03:29,640 AND LATINOS AND REDUCE HEALTH 77 00:03:29,640 --> 00:03:31,040 DISPARITIES ACROSS THE 78 00:03:31,040 --> 00:03:31,520 HEMISPHERE. 79 00:03:31,520 --> 00:03:35,080 WHERE ARE YOU WATCHING FROM? 80 00:03:35,080 --> 00:03:41,080 SO PLEASE TAKE A MOMENT TO GO TO 81 00:03:41,080 --> 00:03:42,120 SLIDO.COM. 82 00:03:42,120 --> 00:03:43,840 VIA YOUR PHONE, COMPUTER OR 83 00:03:43,840 --> 00:03:46,960 TABLET AND TYPE IN LATAM. 84 00:03:46,960 --> 00:03:48,160 IT'S AN OPPORTUNITY TO SHARE 85 00:03:48,160 --> 00:03:52,000 WHERE YOU ARE WATCHING FROM 86 00:03:52,000 --> 00:03:54,120 TODAY AND SELECT WHAT COUNTRY 87 00:03:54,120 --> 00:03:55,400 YOU ARE ENJOYING US FROM. 88 00:03:55,400 --> 00:03:57,000 WE HOPE AT THE END, WE'LL BE 89 00:03:57,000 --> 00:03:58,320 ABLE TO SHARE A MAP WHERE 90 00:03:58,320 --> 00:04:04,640 EVERYBODY IS WATCHING US FROM 91 00:04:04,640 --> 00:04:05,000 TODAY. 92 00:04:05,000 --> 00:04:07,360 WE'LL SHOW THE SLIDE LATER, WE 93 00:04:07,360 --> 00:04:10,120 CAN DO IT DURING THE BREAK BUT 94 00:04:10,120 --> 00:04:11,200 PLEASE SHARE WHERE YOU ARE 95 00:04:11,200 --> 00:04:13,960 JOINING US FROM. 96 00:04:13,960 --> 00:04:16,600 NOW I WANT TO COVER A COUPLE 97 00:04:16,600 --> 00:04:17,560 HOUSEKEEPING ITEMS. 98 00:04:17,560 --> 00:04:19,440 ALL TOPIC PRESENTATIONS, EXCEPT 99 00:04:19,440 --> 00:04:21,040 FOR THE OPEN DISCUSSION, AT THE 100 00:04:21,040 --> 00:04:24,560 END OF DAY ONE, HAVE BEEN 101 00:04:24,560 --> 00:04:24,920 PRE-RECORDED. 102 00:04:24,920 --> 00:04:27,400 THEY WILL BE FOLLOWED BY A LIVE 103 00:04:27,400 --> 00:04:28,120 Q&A SESSION. 104 00:04:28,120 --> 00:04:29,880 PLEASE SUBMIT QUESTIONS VIA 105 00:04:29,880 --> 00:04:39,400 E-MAIL TO OUR WORKSHOP E-MAIL. 106 00:04:39,400 --> 00:04:41,680 LATAMWKSP@MAIL.COM. 107 00:04:41,680 --> 00:04:43,320 THE BEE OWES ARE AVAILABLE WHERE 108 00:04:43,320 --> 00:04:45,320 CAN YOU FIND MORE INFORMATION ON 109 00:04:45,320 --> 00:04:47,720 EACH SPEAKER'S AFFILIATION AND 110 00:04:47,720 --> 00:04:49,560 RESEARCH EXPERTISE. 111 00:04:49,560 --> 00:04:50,880 THE WORKSHOP IS BEING RECORDED 112 00:04:50,880 --> 00:04:52,640 AND IT WILL BE PUBLICLY 113 00:04:52,640 --> 00:04:57,560 AVAILABLE SHORTLY AFTER THE 114 00:04:57,560 --> 00:04:57,960 WORKSHOP. 115 00:04:57,960 --> 00:04:59,280 IT'S MY PRIVILEGE TO Dr. 116 00:04:59,280 --> 00:05:06,640 INTRODUCINTRODUCEDr. PEREZ-STABY 117 00:05:06,640 --> 00:05:13,000 START THE WORKSHOP WITH 118 00:05:13,000 --> 00:05:14,120 INOPENING REMARKS. 119 00:05:14,120 --> 00:05:17,480 >>WELCOME, MY NAME ISN'TLY SAY 120 00:05:17,480 --> 00:05:19,400 OWE PEREZ-STABLE AND I'M THE 121 00:05:19,400 --> 00:05:20,240 DIRECTOR OF THE NATIONAL 122 00:05:20,240 --> 00:05:21,760 INSTITUTE MINORITY HEALTH AND 123 00:05:21,760 --> 00:05:24,240 HEALTH DISPARITIES AND IT IS A 124 00:05:24,240 --> 00:05:27,560 REAL PLEASURE TO BE HOSTING THIS 125 00:05:27,560 --> 00:05:29,360 SCIENTIFIC WORKSHOP ON HEALTH 126 00:05:29,360 --> 00:05:31,560 RESEARCH IN LATIN AMERICA AND 127 00:05:31,560 --> 00:05:36,320 IT'S RELATIONSHIP TO U.S. HEALTH 128 00:05:36,320 --> 00:05:36,760 DISPARITIES. 129 00:05:36,760 --> 00:05:41,200 SO WHY LATIN AMERICA AT NIMHD. 130 00:05:41,200 --> 00:05:43,720 FIRST OF ALL, 19% OF THE U.S. 131 00:05:43,720 --> 00:05:45,320 POPULATION IN 2020 HAVE THEIR 132 00:05:45,320 --> 00:05:55,760 ORIGINS IN LATIN AMERICA. 133 00:05:56,280 --> 00:06:01,760 THIS WORKSHOP FOCUSES ON NON 134 00:06:01,760 --> 00:06:03,200 COMMUNICABLE CHRONIC DISEASES 135 00:06:03,200 --> 00:06:04,720 BECAUSE THE TRANSLATION OF 136 00:06:04,720 --> 00:06:06,480 POPULATION HEALTH IN LATIN 137 00:06:06,480 --> 00:06:13,360 AMERICA HAPPEN DECADES AGO FROM 138 00:06:13,360 --> 00:06:15,000 INFECTIOUS DISEASES TO 139 00:06:15,000 --> 00:06:16,640 MALNUTRITION, DIABETES AND OTHER 140 00:06:16,640 --> 00:06:18,560 CHRONIC DISEASES AS THE LEADING 141 00:06:18,560 --> 00:06:21,720 CAUSES OF DEATH. 142 00:06:21,720 --> 00:06:23,560 NIMHD HAS SUBSTANTIAL GRANTS IN 143 00:06:23,560 --> 00:06:24,960 PUERTO RICO LIEU THE RESEARCH 144 00:06:24,960 --> 00:06:27,440 CENTERS FOR MINORITY 145 00:06:27,440 --> 00:06:29,760 INSTITUTIONS, POSTMA REA, RO1s 146 00:06:29,760 --> 00:06:32,040 AS WELL AS SOME TRAINING GRANTS. 147 00:06:32,040 --> 00:06:33,560 AND WE ARE INTERESTED IN 148 00:06:33,560 --> 00:06:35,560 IMMIGRANTS IN THE U.S. SO THAT 149 00:06:35,560 --> 00:06:37,200 COMING FROM LATIN AMERICA. 150 00:06:37,200 --> 00:06:40,320 AND FINALLY, THE NIH HAS LARGELY 151 00:06:40,320 --> 00:06:42,200 IGNORED LATIN AMERICA AND THAT 152 00:06:42,200 --> 00:06:43,600 IS ANOTHER REASON TO HIGHLIGHT 153 00:06:43,600 --> 00:06:45,880 THIS WORKSHOP. 154 00:06:45,880 --> 00:06:47,200 SO OPPORTUNITIES FOR RESEARCH 155 00:06:47,200 --> 00:06:49,840 AND LATIN AMERICA FROM OUR 156 00:06:49,840 --> 00:06:52,160 PERSPECTIVE ARE NUMEROUS. 157 00:06:52,160 --> 00:06:54,680 COMPARISONS TO U.S. POPULATIONS. 158 00:06:54,680 --> 00:06:56,320 SO WHAT HAPPENS OVER TIME WITH 159 00:06:56,320 --> 00:06:57,160 IMMIGRANTS? 160 00:06:57,160 --> 00:06:58,240 WHAT ABOUT THOSE WHO DIDN'T 161 00:06:58,240 --> 00:06:58,680 MIGRATE? 162 00:06:58,680 --> 00:07:01,080 HOW DO THEY COMPARE TO THE 163 00:07:01,080 --> 00:07:02,600 POPULATIONS HERE? 164 00:07:02,600 --> 00:07:04,120 THERE ARE PRECIOUS FEW STUDIES 165 00:07:04,120 --> 00:07:04,840 IN THAT AREA. 166 00:07:04,840 --> 00:07:07,760 WHAT'S THE ROLE OF CULTURE AND 167 00:07:07,760 --> 00:07:08,920 ENVIRONMENT IN DEVELOPMENT AND 168 00:07:08,920 --> 00:07:12,080 EVOLUTION OF CHRONIC DISEASES 169 00:07:12,080 --> 00:07:13,800 INCLUDING ISSUES AROUND 170 00:07:13,800 --> 00:07:15,480 BEHAVIORAL HEALTH AND MENTAL 171 00:07:15,480 --> 00:07:15,880 HEALTH. 172 00:07:15,880 --> 00:07:19,160 WHAT'S THE ROLE OF RACISM, 173 00:07:19,160 --> 00:07:20,320 ETHNICITY AND SOCIAL CLASS IN 174 00:07:20,320 --> 00:07:22,480 THE LATIN AMERICAN CONTEXT? 175 00:07:22,480 --> 00:07:24,520 LATIN AMERICA AFTER ALL IS MIXED 176 00:07:24,520 --> 00:07:24,840 POPULATION. 177 00:07:24,840 --> 00:07:27,080 AND SO THIS IS VERY RELEVANT. 178 00:07:27,080 --> 00:07:28,800 WHAT ABOUT MODELS OF HEALTHCARE 179 00:07:28,800 --> 00:07:31,280 FOR CHRONIC DISEASES? 180 00:07:31,280 --> 00:07:36,920 DO SYSTEMS IN LANE AMERI LATIN A 181 00:07:36,920 --> 00:07:38,280 BETTER JOB IN SOME CASES THAN 182 00:07:38,280 --> 00:07:39,120 THE UNITED STATES. 183 00:07:39,120 --> 00:07:42,320 THE ROLE OF POPULATION MIXTURE, 184 00:07:42,320 --> 00:07:44,160 CANCER, METABOLIC DISORDERS, 185 00:07:44,160 --> 00:07:45,800 USING ANCESTORIAL MARKERS OR 186 00:07:45,800 --> 00:07:47,800 OTHER BIOLOGICAL MARKERS THAT 187 00:07:47,800 --> 00:07:50,720 WOULD BE OF INTEREST TO US AS 188 00:07:50,720 --> 00:07:50,920 WELL. 189 00:07:50,920 --> 00:07:53,720 A QUICK TOUR OF SOME OF THE 190 00:07:53,720 --> 00:07:55,640 PROFILE OF MORTALITY IN LATIN 191 00:07:55,640 --> 00:07:57,560 AMERICA SHOWS YOU SEE FROM THIS 192 00:07:57,560 --> 00:07:59,440 DATA FROM THE PAN AMERICAN 193 00:07:59,440 --> 00:08:00,720 HEALTH ORGANIZATION WERE THE 194 00:08:00,720 --> 00:08:04,280 UNITED STATES SITS AT 5.6 IN 195 00:08:04,280 --> 00:08:06,320 INFANT MORTALITY IN 2015 TO 196 00:08:06,320 --> 00:08:08,120 MEXICO AT 11.3. 197 00:08:08,120 --> 00:08:11,400 HIGHER BUT NOT DRAMATICALLY 198 00:08:11,400 --> 00:08:13,040 DIFFERENT AND IT WAS BETTER AT 199 00:08:13,040 --> 00:08:15,000 4.0 AND INTER PERSONAL VIOLENCE 200 00:08:15,000 --> 00:08:17,440 BEING A GREATER PROBLEM IN SOME 201 00:08:17,440 --> 00:08:19,160 LATIN AMERICA COUNTRIES AS WELL 202 00:08:19,160 --> 00:08:20,600 AS SELF-HARM BEING LESS OF A 203 00:08:20,600 --> 00:08:22,240 PROBLEM IN MOST LATIN AMERICAN 204 00:08:22,240 --> 00:08:28,360 COUNTRIES COMPARED TO THE U.S. 205 00:08:28,360 --> 00:08:31,040 LUNG CANCER MORTALITY IS TOBACCO 206 00:08:31,040 --> 00:08:32,720 USE AND WE'VE SEEN IT RISE AND 207 00:08:32,720 --> 00:08:35,200 FALL WITH THAT EPIDEMIC BEING 208 00:08:35,200 --> 00:08:37,040 MANAGED AND YOU SEE THERE'S A 209 00:08:37,040 --> 00:08:39,720 HIGHER MORTALITY FOR MEN WITH 210 00:08:39,720 --> 00:08:41,520 LUNG CANCER THAN YOU UNITED 211 00:08:41,520 --> 00:08:42,920 STATES OR CANADA WHICH IS A NEW 212 00:08:42,920 --> 00:08:46,840 DEVELOPMENT IN THE LAST DECADE 213 00:08:46,840 --> 00:08:50,360 MANY OF. 214 00:08:50,360 --> 00:08:53,000 YOU SEE MUCH LOWER RATES IN 215 00:08:53,000 --> 00:08:53,600 MEXICO. 216 00:08:53,600 --> 00:08:55,000 LOOKING AT THIS FROM DIFFERENT 217 00:08:55,000 --> 00:08:56,280 PERSPECTIVES WOULD BE OF 218 00:08:56,280 --> 00:09:01,680 INTEREST TO HEALTH IN THE UNITED 219 00:09:01,680 --> 00:09:02,040 STATES. 220 00:09:02,040 --> 00:09:04,880 AS MORTALITY RATES THAT WAS DONE 221 00:09:04,880 --> 00:09:07,840 BY AN INTRAMURAL GROUP HERE AT 222 00:09:07,840 --> 00:09:10,480 NIH, PUBLISHED A COUPLE OF YEARS 223 00:09:10,480 --> 00:09:12,480 AGO, AND THIS COMPARES AND THE 224 00:09:12,480 --> 00:09:14,880 RED BARS U.S., AFRICAN 225 00:09:14,880 --> 00:09:18,120 AMERICANS, U.S. WHITES, AND U.S. 226 00:09:18,120 --> 00:09:18,360 LATINOS. 227 00:09:18,360 --> 00:09:21,160 YOU SEE U.S. LATINOS DO WELL IN 228 00:09:21,160 --> 00:09:24,600 OVER ALL MORTALITY AMONG MEN 229 00:09:24,600 --> 00:09:26,280 COMPARED TO NOT ONLY LATIN 230 00:09:26,280 --> 00:09:27,600 AMERICA BUT ALSO WHITE AND 231 00:09:27,600 --> 00:09:29,400 AFRICAN AMERICAN COUNTERPARTS. 232 00:09:29,400 --> 00:09:32,360 YOU SEE THAT MOST LATIN AMERICAN 233 00:09:32,360 --> 00:09:34,040 COUNTRY WITH GOOD DATA ARE IN 234 00:09:34,040 --> 00:09:34,880 BETWEEN WHITES AND AFRICAN 235 00:09:34,880 --> 00:09:38,480 AMERICANS WITH A COUPLE DOING 236 00:09:38,480 --> 00:09:40,720 BETTER THAN EVEN U.S. WHITES. 237 00:09:40,720 --> 00:09:46,480 THIS INCLUDES NICARAGUA AND PERU 238 00:09:46,480 --> 00:09:47,440 AND PANAMA. 239 00:09:47,440 --> 00:09:52,160 THIS MIDDLE-INCOME PART OF THE 240 00:09:52,160 --> 00:09:53,360 CONTINENT IS DOING GOOD IN TERMS 241 00:09:53,360 --> 00:09:55,040 OF MORTALITY RATES AND THESE ARE 242 00:09:55,040 --> 00:10:02,800 RATES FOR WOMEN, SIMILAR 243 00:10:02,800 --> 00:10:04,840 RELATIONSHIPS, CARDIOVASCULAR 244 00:10:04,840 --> 00:10:06,640 AND ACCIDENTS AND RESPIRATORY 245 00:10:06,640 --> 00:10:08,440 DISEASE JUST TO GIVE YOU A 246 00:10:08,440 --> 00:10:09,640 FLAVOR OF WHAT THESE RESULTS 247 00:10:09,640 --> 00:10:09,840 WERE. 248 00:10:09,840 --> 00:10:11,720 I WANT TO THANK YOU FOR JOINING 249 00:10:11,720 --> 00:10:14,200 US TODAY AND THIS SCIENTIFIC 250 00:10:14,200 --> 00:10:14,720 WORKSHOP. 251 00:10:14,720 --> 00:10:17,200 I LOOK FORWARD TO THE EXCITING 252 00:10:17,200 --> 00:10:17,880 PRESENTATIONS PLANNED OVER THE 253 00:10:17,880 --> 00:10:19,960 NEXT TWO DAYS AND THANK YOU FOR 254 00:10:19,960 --> 00:10:22,840 ATTENDING AND I LOOK FORWARD FOR 255 00:10:22,840 --> 00:10:30,800 WHAT THIS WILL BE IN THE FUTURE. 256 00:10:30,800 --> 00:10:32,160 >>THANK YOU FOR SETTING THE 257 00:10:32,160 --> 00:10:33,480 STAGE FOR TODAY'S WORKSHOP AND 258 00:10:33,480 --> 00:10:35,280 YOUR REMARKS TO ADVANCE SCIENCE 259 00:10:35,280 --> 00:10:40,240 TO REDUCE HEALTH AND HEATH CARE 260 00:10:40,240 --> 00:10:44,760 DISPARITIES FOR U.S. LATINOS. 261 00:10:44,760 --> 00:10:46,760 IT'S MY HONOR TO OPEN THE 262 00:10:46,760 --> 00:10:50,840 OPENING SESSION, HEALTH PROFILE 263 00:10:50,840 --> 00:10:57,480 OF U.S. HISPANICS AND LATINOS IN 264 00:10:57,480 --> 00:10:58,520 LATIN AMERICA. 265 00:10:58,520 --> 00:11:01,920 >>Chair Aviles-Santa: GOOD 266 00:11:01,920 --> 00:11:02,960 MORNING. 267 00:11:02,960 --> 00:11:05,000 MY NAME IS LARISSA AVILES-SANTA 268 00:11:05,000 --> 00:11:06,640 AND I AM THE DIRECTOR OF THE 269 00:11:06,640 --> 00:11:08,440 DIVISION OF CLINICAL AND HEALTH 270 00:11:08,440 --> 00:11:11,480 SERVICES RESEARCH AT THE NIMHD. 271 00:11:11,480 --> 00:11:14,000 I'M HONORED TO SHARE SOME KEY 272 00:11:14,000 --> 00:11:16,640 THOUGHTS ABOUT U.S. HISPANIC 273 00:11:16,640 --> 00:11:18,560 LATINO HEALTH THAT WILL SERVE AS 274 00:11:18,560 --> 00:11:19,840 BACKGROUND TO THE DISCUSSIONS 275 00:11:19,840 --> 00:11:24,200 THAT WILL TAKE PLACE TODAY AND 276 00:11:24,200 --> 00:11:26,360 TOMORROW. 277 00:11:26,360 --> 00:11:28,360 IN 2020, 62.1 MILLION PERSONS 278 00:11:28,360 --> 00:11:31,320 LIVING IN 50 STATES THAT IS NOT 279 00:11:31,320 --> 00:11:32,360 INCLUDING PUERTO RICO AND THE 280 00:11:32,360 --> 00:11:34,840 OTHER TERRITORIES, 281 00:11:34,840 --> 00:11:38,160 SELF-IDENTIFIED AS HISPANIC OR 282 00:11:38,160 --> 00:11:39,080 LATINO. 283 00:11:39,080 --> 00:11:44,040 MAKING ALMOST 19% OF THE U.S. 284 00:11:44,040 --> 00:11:44,360 POPULATION. 285 00:11:44,360 --> 00:11:48,280 10 STATES HAVE THE HIGHEST 286 00:11:48,280 --> 00:11:51,920 CONCENTRATION OF HISPANIC OR 287 00:11:51,920 --> 00:11:53,120 ADEENE OWES AND ONE GROUP ARE 288 00:11:53,120 --> 00:11:55,160 THE SECOND LARGEST RACIAL OR 289 00:11:55,160 --> 00:11:58,000 ETHNIC GROUP IN THE U.S. AFTER 290 00:11:58,000 --> 00:12:01,200 NON HISPANIC WHITES. 291 00:12:01,200 --> 00:12:03,840 WITH THIS SIZE AND PRESENCE, IN 292 00:12:03,840 --> 00:12:07,760 ACROSS THE U.S., UNDERSTANDING 293 00:12:07,760 --> 00:12:12,400 THE HEALTH AND ADDRESSING THE 294 00:12:12,400 --> 00:12:14,320 HEALTH DISPARITIES BY THIS 295 00:12:14,320 --> 00:12:16,560 HEALTH POPULATION WOULD HAVE A 296 00:12:16,560 --> 00:12:17,840 CRUCIAL INFLUENCE ON MANY LIVES 297 00:12:17,840 --> 00:12:21,480 IN THE NATION. 298 00:12:21,480 --> 00:12:25,720 FOR INSTANCE, AS ONE GROUP, 299 00:12:25,720 --> 00:12:26,800 HISPANICS OR LATINOS LIVING IN 300 00:12:26,800 --> 00:12:29,760 THE U.S. EXPERIENCE THE LONGEST 301 00:12:29,760 --> 00:12:37,840 LIFE EXPECTANCY AFTER ASIANS. 302 00:12:37,840 --> 00:12:40,560 FURTHERMORE, ON AVERAGE, 303 00:12:40,560 --> 00:12:41,880 HISPANICS OR LATINOS LIVE TWO 304 00:12:41,880 --> 00:12:44,560 YEARS LONGER THAN NON-HISPANIC 305 00:12:44,560 --> 00:12:46,000 WHITES AND SEVEN YEARS LONGER AN 306 00:12:46,000 --> 00:12:48,080 AFRICAN AMERICANS. 307 00:12:48,080 --> 00:12:49,840 AND THE SAME TIME, THE 308 00:12:49,840 --> 00:12:52,000 PREVALENCE OF CHRONIC DISEASESES 309 00:12:52,000 --> 00:12:55,240 IN THIS POPULATION HAS BEEN 310 00:12:55,240 --> 00:12:56,880 CONSPICUOUSLY INCREASES WHERE AS 311 00:12:56,880 --> 00:12:59,880 THE AWARENESS, TREATMENT, AND 312 00:12:59,880 --> 00:13:05,680 CONTROL OF THIS CONDITIONS HAS 313 00:13:05,680 --> 00:13:08,320 REMAINED UNACCEPTABLY SUB 314 00:13:08,320 --> 00:13:08,720 OPTIMAL. 315 00:13:08,720 --> 00:13:10,000 VERY IMPORTANTLY, DIFFERENCES IN 316 00:13:10,000 --> 00:13:14,080 THE PREVALENCE OF CHRONIC 317 00:13:14,080 --> 00:13:22,120 DISEASES AMONG DIFFERENT 318 00:13:22,120 --> 00:13:23,600 HERITAGE GROUPS HAVE BEEN 319 00:13:23,600 --> 00:13:23,840 OPTIMAL. 320 00:13:23,840 --> 00:13:27,440 THE STUDY OF LATINOS, BOTH MEN 321 00:13:27,440 --> 00:13:30,120 AND WOMEN ARE SOUTH AMERICAN 322 00:13:30,120 --> 00:13:32,800 DISSENT HAD THE HIGHEST PERCENT 323 00:13:32,800 --> 00:13:36,680 OF PARTICIPANTS WITH NO 324 00:13:36,680 --> 00:13:39,360 CARDIOVASCULAR RISK FACTORS, 325 00:13:39,360 --> 00:13:41,520 HOWEVER, MEN AND WOMEN OF PUERTO 326 00:13:41,520 --> 00:13:43,520 RICAN DISSENT HAVE THE HIGHEST 327 00:13:43,520 --> 00:13:46,040 PERCENT OF PARTICIPANTS WITH 328 00:13:46,040 --> 00:13:48,560 THREE OR MORE CARDIOVASCULAR 329 00:13:48,560 --> 00:13:49,800 RISK FACTORS. 330 00:13:49,800 --> 00:13:53,440 IN THE SAME STUDY, AT SIX YEARS, 331 00:13:53,440 --> 00:13:56,640 AFTER BASELINE, THE INCIDENTS OF 332 00:13:56,640 --> 00:14:00,000 DIABETES WAS THE HIGHEST AMONG 333 00:14:00,000 --> 00:14:01,800 HISPANICS OR LATINOS OF MEXICAN, 334 00:14:01,800 --> 00:14:04,640 PUERTO RICAN AND DOMINICAN 335 00:14:04,640 --> 00:14:09,160 DISSENT AND THE PREVALENCE OF 336 00:14:09,160 --> 00:14:10,440 DIABETES WAS THE HIGHEST IN 337 00:14:10,440 --> 00:14:11,880 THESE POPULATIONS. 338 00:14:11,880 --> 00:14:14,040 OF NOTE, DIFFERENCES IN THE 339 00:14:14,040 --> 00:14:18,640 PREVALENCE OF DIABETES AMONG 340 00:14:18,640 --> 00:14:21,480 MEXICANS, PUERTO RICANS AND 341 00:14:21,480 --> 00:14:23,160 CUBANS HAVE BEEN DESCRIBED IN 342 00:14:23,160 --> 00:14:27,400 THE HISPANIC HEALTH EXAMINATION 343 00:14:27,400 --> 00:14:31,640 SURVEY IN THE 1980s. 344 00:14:31,640 --> 00:14:33,240 IN OTHER WORDS, DIFFERENCES IN 345 00:14:33,240 --> 00:14:37,160 THE PREVALENCE OF DIABETES AMONG 346 00:14:37,160 --> 00:14:39,560 HISPANIC GROUPS HAVE BEEN 347 00:14:39,560 --> 00:14:44,760 DOCUMENTED ALMOST 40 YEARS AGO. 348 00:14:44,760 --> 00:14:46,280 ALSO, IN THE STUDY, THE 349 00:14:46,280 --> 00:14:49,520 INCIDENTS OF CHRONIC KIDNEY 350 00:14:49,520 --> 00:14:50,840 DISEASE WAS SIGNIFICANTLY HIGHER 351 00:14:50,840 --> 00:14:52,600 AMONG PARTICIPANTS OF PUERTO 352 00:14:52,600 --> 00:14:57,400 RICAN DISSENT AT SIX YEARS OF 353 00:14:57,400 --> 00:14:58,720 FOLLOW-UP. 354 00:14:58,720 --> 00:15:00,280 THIS AND OTHER DIFFERENCES IN 355 00:15:00,280 --> 00:15:10,240 HEALTH OUTCOMES, LEAD US TO ASK, 356 00:15:10,240 --> 00:15:10,680 WHY? 357 00:15:10,680 --> 00:15:13,720 WHAT ARE THE MEDIATING FACTORS? 358 00:15:13,720 --> 00:15:17,120 WITH THESE QUESTIONS IN MIND, WE 359 00:15:17,120 --> 00:15:19,520 NEED TO REMEMBER THE DIVERSITY 360 00:15:19,520 --> 00:15:24,080 OF THE ORIGINS OF THE HISPANIC 361 00:15:24,080 --> 00:15:27,240 OR LATINO POPULATION. 362 00:15:27,240 --> 00:15:29,160 HISPANIC OR LATINOS OF MEXICAN 363 00:15:29,160 --> 00:15:33,560 DISSENT HAVE LIVED IN THIS LAND 364 00:15:33,560 --> 00:15:37,200 LONG BEFORE THIS COUNTRY BECAME 365 00:15:37,200 --> 00:15:41,600 TO BE KNOWN AS THE UNITED STATES 366 00:15:41,600 --> 00:15:43,040 OF AMERICA. 367 00:15:43,040 --> 00:15:44,320 THE EXPANSION TO THE WEST AND 368 00:15:44,320 --> 00:15:46,880 THE MEXICAN-AMERICAN WAR, A 369 00:15:46,880 --> 00:15:49,560 LARGE PORTION OF THE TERRITORY 370 00:15:49,560 --> 00:15:50,920 OF MEXICO BECAME PART OF THE 371 00:15:50,920 --> 00:15:58,560 UNITED STATES. 372 00:15:58,560 --> 00:16:01,360 IN 1998, THE SPANISH-AMERICAN 373 00:16:01,360 --> 00:16:02,960 WAR BROUGHT PUERTO RICO AS A 374 00:16:02,960 --> 00:16:06,840 U.S. TERRITORY. 375 00:16:06,840 --> 00:16:08,480 OTHER WORKFORCE RECRUITMENT 376 00:16:08,480 --> 00:16:10,320 PROGRAMS WROTE MEXICANS AND 377 00:16:10,320 --> 00:16:12,600 PUERTO RICANS TO WORK IN 378 00:16:12,600 --> 00:16:16,920 AGRICULTURE AND INDUSTRY. 379 00:16:16,920 --> 00:16:19,240 AND VARIOUS SOCIAL YO POLITICAL 380 00:16:19,240 --> 00:16:21,560 EVENTS IN LATIN AMERICAN HAVE 381 00:16:21,560 --> 00:16:23,200 TRIGGERED WAVES OF MIGRATION 382 00:16:23,200 --> 00:16:25,880 FROM THE CARIBBEAN CENTRAL AND 383 00:16:25,880 --> 00:16:32,120 SOUTH AMERICA. 384 00:16:32,120 --> 00:16:36,440 IT'S CLEAR THAT U.S. 385 00:16:36,440 --> 00:16:38,080 HISPANIC/LATINOS SHARE SOME 386 00:16:38,080 --> 00:16:39,320 COMMONALITIES IN LANGUAGE, 387 00:16:39,320 --> 00:16:42,520 CULTURE AND HISTORY. 388 00:16:42,520 --> 00:16:45,120 AND AT THE SAME TIME, THEY ARE 389 00:16:45,120 --> 00:16:47,440 ALSO LINGUISTICALLY HISTORICALLY 390 00:16:47,440 --> 00:16:51,040 AND CULTURALLY DIVERSE. 391 00:16:51,040 --> 00:16:56,560 IN FACT, A LARGE SIGNIFICANT 392 00:16:56,560 --> 00:16:57,960 PREPORTION OF HISPANICS OR 393 00:16:57,960 --> 00:16:59,480 LATINOS ARE BORN IN THE U.S. OR 394 00:16:59,480 --> 00:17:01,280 THEIR FAMILIES HAVE LIVED IN THE 395 00:17:01,280 --> 00:17:04,120 U.S. FOR GENERATIONS. 396 00:17:04,120 --> 00:17:06,320 THE DIVERSITY OF THE PLACES 397 00:17:06,320 --> 00:17:13,440 WHERE WE WORK, WHERE WE LIVE, 398 00:17:13,440 --> 00:17:14,640 ALSO HAVE SOME EXPERIENCES 399 00:17:14,640 --> 00:17:16,440 RELATED TO ENVIRONMENT, 400 00:17:16,440 --> 00:17:17,640 OCCUPATION, PUBLIC AND 401 00:17:17,640 --> 00:17:21,080 HEALTHCARE POLICIES, THAT 402 00:17:21,080 --> 00:17:23,640 CLEARLY WILL INFLUENCE OUR 403 00:17:23,640 --> 00:17:23,880 HEALTH. 404 00:17:23,880 --> 00:17:26,400 FOR INSTANCE, AS I MENTIONED 405 00:17:26,400 --> 00:17:27,560 BEFORE, 10 STATES HAVE THE 406 00:17:27,560 --> 00:17:31,000 HIGHEST CONCENTRATION OF U.S. 407 00:17:31,000 --> 00:17:32,120 HISPANIC LATINOS. 408 00:17:32,120 --> 00:17:37,320 WITHIN THE LAST DECADE, THE 409 00:17:37,320 --> 00:17:37,920 GROWTH OF THE TOTAL HISPANIC 410 00:17:37,920 --> 00:17:40,360 LATINOS POPULATION HAS BEEN 23% 411 00:17:40,360 --> 00:17:41,120 ON AVERAGE. 412 00:17:41,120 --> 00:17:43,720 BUT IT'S NOT ONLY IN THOSE 10 413 00:17:43,720 --> 00:17:48,320 STATES, IT'S ALSO IN OTHER NEW 414 00:17:48,320 --> 00:17:49,840 LOCATIONS. 415 00:17:49,840 --> 00:17:51,160 AND AT THE SAME TIME, ALTHOUGH 416 00:17:51,160 --> 00:17:53,440 MANY ADVANCES AND PROGRESS HAS 417 00:17:53,440 --> 00:17:56,640 BEEN MADE, IN THE PERCENT OF 418 00:17:56,640 --> 00:18:00,640 PEOPLE WITH HEALTH INSURANCE, 419 00:18:00,640 --> 00:18:02,400 THE NUMBER OF HISPANICS OR 420 00:18:02,400 --> 00:18:03,880 LATINOS WITHOUT HEALTH INSURANCE 421 00:18:03,880 --> 00:18:04,960 IS STILL HIGH. 422 00:18:04,960 --> 00:18:07,400 IN ADDITION, DISPARITIES HAVE 423 00:18:07,400 --> 00:18:08,960 BEEN DESCRIBED AMONG THOSE WITH 424 00:18:08,960 --> 00:18:11,320 INSURANCE AND ESPECIALLY 425 00:18:11,320 --> 00:18:13,720 MEDICARE AND ESPECIALLY 426 00:18:13,720 --> 00:18:20,400 DISPARITIES IN THE ATTAINMENT OF 427 00:18:20,400 --> 00:18:23,000 CARE AMONG BETWEEN MEDICARE 428 00:18:23,000 --> 00:18:26,600 ENROLL'S IN PUERTO RICO COMPARED 429 00:18:26,600 --> 00:18:30,000 TO LATINO/HISPANIC DISSENT IN 430 00:18:30,000 --> 00:18:30,720 THE MAINLAND. 431 00:18:30,720 --> 00:18:33,640 IN ADDITION, THE DIAGNOSIS OF 432 00:18:33,640 --> 00:18:37,200 CONCERN CONDITIONS, ESPECIALLY 433 00:18:37,200 --> 00:18:39,600 COGNITIVE DECLINE AND DEMENTIA, 434 00:18:39,600 --> 00:18:42,040 TENDS TO BE UNTIMELY. 435 00:18:42,040 --> 00:18:43,840 AND THE UTILIZATION OF 436 00:18:43,840 --> 00:18:48,320 SCREENING, TESTS, LESS THAN 437 00:18:48,320 --> 00:18:48,760 IDEAL. 438 00:18:48,760 --> 00:18:53,400 IT'S VERY IMPORTANT TO NOTE THAT 439 00:18:53,400 --> 00:18:54,240 MANY HISPANICS/LATINOS MAINTAIN 440 00:18:54,240 --> 00:18:55,680 CLOSE CONTACT WITH THE COUNTRY 441 00:18:55,680 --> 00:18:59,120 OF ORIGIN OR THE COUNTRY OF 442 00:18:59,120 --> 00:19:00,680 ORIGIN OF THEIR ANCESTORS AND 443 00:19:00,680 --> 00:19:03,520 FOR SOME, THIS CONTACT HAPPENS 444 00:19:03,520 --> 00:19:06,920 ON A DAILY BASIS. 445 00:19:06,920 --> 00:19:10,000 CONVERSELY, THE STUDY OF 446 00:19:10,000 --> 00:19:11,400 HISPANIC/LATINOS HEALTH TENDS TO 447 00:19:11,400 --> 00:19:14,280 HAPPEN WITHIN THE CONTEXT OF THE 448 00:19:14,280 --> 00:19:14,520 U.S. 449 00:19:14,520 --> 00:19:19,120 IT FOCUSES ON THE IMMEDIATE 450 00:19:19,120 --> 00:19:19,720 ENVIRONMENT. 451 00:19:19,720 --> 00:19:23,480 HOWEVER, IN THE SAME WAY, THAT 452 00:19:23,480 --> 00:19:24,880 DIFFERENCES IN THE PREVALENCE OF 453 00:19:24,880 --> 00:19:26,920 CHRONIC DISEASES AMONG THE 454 00:19:26,920 --> 00:19:32,200 DIFFERENT U.S. HISPANIC/LATINOS 455 00:19:32,200 --> 00:19:33,680 GROUPS HAVE BEEN DOCUMENTED, 456 00:19:33,680 --> 00:19:35,600 ALSO THOSE DIFFERENCES HAVE BEEN 457 00:19:35,600 --> 00:19:38,920 DOCUMENTED AMONG COUNTRIES IN 458 00:19:38,920 --> 00:19:40,320 LATIN AMERICA. 459 00:19:40,320 --> 00:19:46,680 LIKE OUR COLLEAGUES JAIME WILL 460 00:19:46,680 --> 00:19:46,960 DISCUSS. 461 00:19:46,960 --> 00:19:48,240 HEALTH RESEARCH PERFORMED IN 462 00:19:48,240 --> 00:19:50,920 LATIN AMERICA, PROVIDES A 463 00:19:50,920 --> 00:19:51,560 CRUCIAL OPPORTUNITY TO FURTHER 464 00:19:51,560 --> 00:19:56,520 OUR UNDERSTANDING OF U.S. 465 00:19:56,520 --> 00:19:58,080 HISPANIC-LATINO HEALTH THAT CAN 466 00:19:58,080 --> 00:19:59,840 BE SOLELY ACCOMPLISHED IN THE 467 00:19:59,840 --> 00:20:01,400 U.S. 468 00:20:01,400 --> 00:20:02,600 LESSON LEARNED AND BEST 469 00:20:02,600 --> 00:20:05,080 PRACTICES RELATED TO RESEARCH 470 00:20:05,080 --> 00:20:10,840 AND EMERGING HEALTH RESEARCH 471 00:20:10,840 --> 00:20:12,200 OPPORTUNITIES IN LATINO AMERICA 472 00:20:12,200 --> 00:20:15,240 WOULD RESYNERGIES OUR COMMON 473 00:20:15,240 --> 00:20:16,920 INTEREST IN IMPROVING HEALTH 474 00:20:16,920 --> 00:20:27,480 OUTCOMES ACROSS THE HEMISPHERE. 475 00:20:27,960 --> 00:20:28,960 >>THANK YOU FOR EVERYONE 476 00:20:28,960 --> 00:20:31,320 JOINING US TODAY AND TOMORROW 477 00:20:31,320 --> 00:20:33,280 AND WARPING IN VERY ENRICHING 478 00:20:33,280 --> 00:20:36,600 CONVERSATIONS. 479 00:20:36,600 --> 00:20:37,760 NOW, IRE COLLEAGUE JAIME MIRANDA 480 00:20:37,760 --> 00:20:41,040 WILL SHARE INSIGHTS ABOUT 481 00:20:41,040 --> 00:20:45,240 CHRONIC CONDITIONS IN LATIN 482 00:20:45,240 --> 00:20:45,480 AMERICA. 483 00:20:45,480 --> 00:20:46,880 THANK YOU. 484 00:20:46,880 --> 00:20:49,000 >>IT'S VERY NICE TO BE JOINING 485 00:20:49,000 --> 00:20:51,280 US ON THIS VIRTUAL HYBRID FORM 486 00:20:51,280 --> 00:20:53,320 TO THIS EVENT THAT IS VERY 487 00:20:53,320 --> 00:20:54,720 PROMISING AND I'M VERY PLEASED 488 00:20:54,720 --> 00:20:56,720 TO HAVE BOTH COMMUNITIES GETTING 489 00:20:56,720 --> 00:20:57,000 TOGETHER. 490 00:20:57,000 --> 00:20:58,960 AND THIS IS MY SLIDES OF 491 00:20:58,960 --> 00:21:01,440 DECLARATION OF CONFLICT OF 492 00:21:01,440 --> 00:21:02,800 INTEREST. 493 00:21:02,800 --> 00:21:04,760 AND AN ORIGINAL HAT I'M WEARING 494 00:21:04,760 --> 00:21:09,520 IS THE MEMBER OF THIS GROUP OF 495 00:21:09,520 --> 00:21:12,160 SCIENTISTS AND WE WERE 496 00:21:12,160 --> 00:21:13,800 DESCRIBING 2018 AS INTER 497 00:21:13,800 --> 00:21:15,920 DISCIPLINARY RESEARCH AND 498 00:21:15,920 --> 00:21:17,680 THERE'S A MANY PART OF THE WORLD 499 00:21:17,680 --> 00:21:19,240 AND I I SUPPOSE WE'RE DOING 500 00:21:19,240 --> 00:21:20,480 SOMETHING GOOD IS THAT WORTH 501 00:21:20,480 --> 00:21:22,920 SHARING WITH THE ENTIRE LATIN 502 00:21:22,920 --> 00:21:24,880 COMMUNITY IN THE REGION. 503 00:21:24,880 --> 00:21:26,640 I CANNOT DECIDE WITHOUT GIVING 504 00:21:26,640 --> 00:21:30,160 MY THANKS TO ALL OF YOU, WHERE 505 00:21:30,160 --> 00:21:31,640 YOU ARE WHERE YOU HAVE BEEN AND 506 00:21:31,640 --> 00:21:33,280 WHERE YOU CONTINUE TO BE, FOR 507 00:21:33,280 --> 00:21:36,800 YOUR EFFORTS AND WORK IN THE 508 00:21:36,800 --> 00:21:38,360 LAST YEARS. 509 00:21:38,360 --> 00:21:43,000 AND WHAT DO I THINK WHEN I HEAR 510 00:21:43,000 --> 00:21:44,800 THE WORD LATINO/AMERICAN. 511 00:21:44,800 --> 00:21:46,920 I AM FROM THE GENERATION OF THE 512 00:21:46,920 --> 00:21:51,960 MID 1970s, 1970s THIS GRAPH 513 00:21:51,960 --> 00:21:54,160 FROM 2000 ONWARDS AND WHAT I MAN 514 00:21:54,160 --> 00:21:57,480 BY LONG-TERM POPULATION HANDY 515 00:21:57,480 --> 00:21:58,800 CAPS THE RATES OF STANDING IN 516 00:21:58,800 --> 00:22:00,680 THE POPULATION, PARTICULARLY MY 517 00:22:00,680 --> 00:22:01,880 GENERATION, WE'RE VERY HIGH. 518 00:22:01,880 --> 00:22:03,640 I'VE SEEN BREAKERS AND I NEED TO 519 00:22:03,640 --> 00:22:06,600 DIG OUT MORE DETAILS BUT IT USED 520 00:22:06,600 --> 00:22:13,040 TO BE AS HIGH A 50%. 521 00:22:13,040 --> 00:22:16,800 1/2 HAVE SUFFERED THE EARLY 522 00:22:16,800 --> 00:22:18,600 IMPACTS OF CHILDHOOD SO THAT'S 523 00:22:18,600 --> 00:22:20,560 ONE BIOLOGICAL HANDICAP. 524 00:22:20,560 --> 00:22:23,120 THE SECOND THING IS, REGION OF 525 00:22:23,120 --> 00:22:24,240 MASSIVE RAPID CHANGES AND THIS 526 00:22:24,240 --> 00:22:26,080 IS A PICTURE OF URBANIZATION. 527 00:22:26,080 --> 00:22:29,680 WHERE YOU SEE IN THE AXIS 100 528 00:22:29,680 --> 00:22:30,720 YEARS BEING PLOTTED AND THE 529 00:22:30,720 --> 00:22:33,320 CURVE OF LATIN AMERICA IN THE 530 00:22:33,320 --> 00:22:36,120 LIGHT BLUE, SEE HOW RAPIDLY IT 531 00:22:36,120 --> 00:22:38,240 HAS OVER THE SCOPE OF A VERY FEW 532 00:22:38,240 --> 00:22:40,080 DECADES AND THOSE CHANGES ARE 533 00:22:40,080 --> 00:22:42,200 OBVIOUSLY GOING TO HAVE 534 00:22:42,200 --> 00:22:43,520 IMPLICATIONS. 535 00:22:43,520 --> 00:22:45,840 IMPLICATIONS THAT ARE 536 00:22:45,840 --> 00:22:48,560 CONTEXTUALIZED WITH SOCIAL 537 00:22:48,560 --> 00:22:51,720 STRUCTURES THAT ARE NOT 538 00:22:51,720 --> 00:22:58,520 CONDUCIVE TO HIGH LEVELS OF 539 00:22:58,520 --> 00:22:58,760 HEALTH. 540 00:22:58,760 --> 00:23:00,280 WITH THAT COMBINATIONS AND 541 00:23:00,280 --> 00:23:01,800 UNDERSTANDING BIOLOGY AND THE 542 00:23:01,800 --> 00:23:03,840 CONTEXT AND WERE IN THAT 543 00:23:03,840 --> 00:23:05,600 PUBLICATION WE PROPOSE THIS 544 00:23:05,600 --> 00:23:10,120 CAPACITY MODEL WHEREBY, THE 545 00:23:10,120 --> 00:23:11,280 BIOLOGICAL PICTURES AND 546 00:23:11,280 --> 00:23:12,720 CHARACTERISTICS OF PARTICULAR 547 00:23:12,720 --> 00:23:15,080 POPULATIONS BEING EXPOSED TO 548 00:23:15,080 --> 00:23:18,280 HARDSHIPS IN INFANCY ARE 549 00:23:18,280 --> 00:23:19,480 COMPOUNDED WITH ENVIRONMENT OF 550 00:23:19,480 --> 00:23:21,120 TODAY, RIGHT. 551 00:23:21,120 --> 00:23:22,640 LATIN AMERICA HAVE PARTICULAR 552 00:23:22,640 --> 00:23:25,400 UNIQUE COMBINATIONS OF THE 553 00:23:25,400 --> 00:23:26,200 STRESSES. 554 00:23:26,200 --> 00:23:28,040 AND THIS MATTERS BECAUSE 555 00:23:28,040 --> 00:23:29,960 ACHIEVING IN CHILDHOOD YOUR 556 00:23:29,960 --> 00:23:36,240 DEVELOPMENTAL POTENTIAL HAS AN 557 00:23:36,240 --> 00:23:36,920 IMPACT FOR LIFE. 558 00:23:36,920 --> 00:23:38,720 THIS IS THE PRICE OF CHILD 559 00:23:38,720 --> 00:23:39,080 SURVIVAL. 560 00:23:39,080 --> 00:23:41,280 HERE IS A PICTURE OF NEURONS, 561 00:23:41,280 --> 00:23:46,520 VERY DELICATE, FINE, VERY 562 00:23:46,520 --> 00:23:47,840 CROSS-COMMUNICATED BEAUTIFUL 563 00:23:47,840 --> 00:23:49,880 NEURONS AND THEN YOU HAVE NEXT 564 00:23:49,880 --> 00:23:53,320 TO IT THIS LIGHT A KID WHO 565 00:23:53,320 --> 00:23:54,680 SUFFERED SOMETHING AND YOU SEE 566 00:23:54,680 --> 00:23:58,480 THE DEVELOPMENT OF THEIR BRAIN 567 00:23:58,480 --> 00:24:03,960 IS LESS AWESOME, LESS GROTESQUE 568 00:24:03,960 --> 00:24:06,440 AND THIS IS THE ENDING THAT YOU 569 00:24:06,440 --> 00:24:09,400 CARRY ON INTO OTHER. 570 00:24:09,400 --> 00:24:11,560 IF WE HAVE STUNTED CHILDREN AND 571 00:24:11,560 --> 00:24:15,400 WE HAVE LARGE NUMBER OF COHORTS 572 00:24:15,400 --> 00:24:16,720 WHO SUFFER STUNTING. 573 00:24:16,720 --> 00:24:19,680 THEN WE CAN BE WITH THE STUNTED 574 00:24:19,680 --> 00:24:21,360 BRAINS THE QUESTION IS, WHAT 575 00:24:21,360 --> 00:24:23,000 ABOUT THE ORGANS? 576 00:24:23,000 --> 00:24:27,040 ARE WE COMING WITH THE ORGANS AS 577 00:24:27,040 --> 00:24:29,200 WELL? 578 00:24:29,200 --> 00:24:32,000 THIS REPLICATIONS THEN AND 579 00:24:32,000 --> 00:24:35,480 SOCIAL REPERCUSSIONS THAT HAVE 580 00:24:35,480 --> 00:24:36,560 BEEN UNRAVELED AND PUT TO THE 581 00:24:36,560 --> 00:24:37,840 FRONT DURING THE PANDEMIC. 582 00:24:37,840 --> 00:24:41,080 I ALWAYS WANTED TO SEE PERU ON 583 00:24:41,080 --> 00:24:42,400 THE FRONT PAGE OF THE "NEW YORK 584 00:24:42,400 --> 00:24:44,080 TIMES" BUT NOT WITH IMAGES LIKE 585 00:24:44,080 --> 00:24:44,400 THESE. 586 00:24:44,400 --> 00:24:45,440 THEY'RE FAMILIAR FOR MANY OF US 587 00:24:45,440 --> 00:24:48,160 AND MANY OF YOU, I SUPPOSE, AND 588 00:24:48,160 --> 00:24:49,040 WHEN PEOPLE TALK ABOUT THE 589 00:24:49,040 --> 00:24:55,160 HEALTH SITS TOM SYSTEM. 590 00:24:55,160 --> 00:24:57,160 THIS IS THE VIDEO I HAVE TODAY 591 00:24:57,160 --> 00:24:57,880 TRAVELING AROUND THE WORLD I 592 00:24:57,880 --> 00:24:59,240 HAVE SEEN HOW THINGS ARE 593 00:24:59,240 --> 00:25:00,960 OPERATING AND WORK BUT THIS IS A 594 00:25:00,960 --> 00:25:02,160 PICTURE THAT I HAVE ON MY MIND 595 00:25:02,160 --> 00:25:04,320 WHEN I HEAR ABOUT HEALTH 596 00:25:04,320 --> 00:25:04,560 SYSTEMS. 597 00:25:04,560 --> 00:25:08,040 WHERE DO WE GO FROM HERE? 598 00:25:08,040 --> 00:25:10,400 ONE REFLECTION IS UNDERSTANDING 599 00:25:10,400 --> 00:25:13,760 THIS TRANSITIONS AS A ENTIRE 600 00:25:13,760 --> 00:25:16,040 REGISTER ON SO THEY'RE 601 00:25:16,040 --> 00:25:17,320 TRANSITION THAT'S HAVE VERY 602 00:25:17,320 --> 00:25:19,840 STRONG SOCIOECONOMIC PATTERNING. 603 00:25:19,840 --> 00:25:24,520 WE DEMONSTRATED HOW THE OBESITY 604 00:25:24,520 --> 00:25:26,520 TRANSITION IS DEPICTED OR 605 00:25:26,520 --> 00:25:30,200 PICTURED OR ACCOMPANIED BY USING 606 00:25:30,200 --> 00:25:31,280 DIFFERENT INDICATORS SO THE 607 00:25:31,280 --> 00:25:32,680 MESSAGE IS THAT YOU DON'T HAVE 608 00:25:32,680 --> 00:25:36,800 TO WAIT FOR A VISIT TO SEE MOST 609 00:25:36,800 --> 00:25:38,240 DEPRIVED GROUPS TO TRY TO REACT 610 00:25:38,240 --> 00:25:40,000 TO IT SO THERE'S AN OPPORTUNITY 611 00:25:40,000 --> 00:25:41,520 THERE AND THEN ALSO THE 612 00:25:41,520 --> 00:25:43,520 TRANSITION TO DIFFERENT MULTIPLE 613 00:25:43,520 --> 00:25:45,000 COMMON RISK FACTORS FOR MANY OF 614 00:25:45,000 --> 00:25:50,560 THE NCBs AND HERE WE SAW OVER 615 00:25:50,560 --> 00:25:54,200 A STUDY PERIOD HOW THESE WERE 616 00:25:54,200 --> 00:25:55,440 GROUPING TOGETHER AND CHANGING 617 00:25:55,440 --> 00:25:57,320 RAPIDLY AND THEY'RE INSIGHTFUL 618 00:25:57,320 --> 00:26:01,520 OBSERVATIONS PARTICULARLY FOR 619 00:26:01,520 --> 00:26:03,840 THESE FEMALES. 620 00:26:03,840 --> 00:26:06,480 AND FROM HERE, I WANT TO JUMP 621 00:26:06,480 --> 00:26:08,360 INTO WHAT CAN WE LEARN? 622 00:26:08,360 --> 00:26:09,800 WHAT CAN WE LEARN MOVING FORWARD 623 00:26:09,800 --> 00:26:12,400 IN THESE TWO DAYS OF THIS EVENT. 624 00:26:12,400 --> 00:26:15,760 TAKING ADVANTAGE OF THIS STUDY, 625 00:26:15,760 --> 00:26:17,680 WE KNEW WHAT IS KNOWN FROM THE 626 00:26:17,680 --> 00:26:19,240 DIFFERENCES THE MIGRANTS SERVE 627 00:26:19,240 --> 00:26:21,280 AS A UNIQUE NATURAL EXPERIMENT, 628 00:26:21,280 --> 00:26:22,800 HOW DO THEY MOVE AROUND. 629 00:26:22,800 --> 00:26:25,760 WHEN WE DO THESE INTO A COHORT, 630 00:26:25,760 --> 00:26:28,120 WE SAW THAT THE MIGRANTS HAVE 631 00:26:28,120 --> 00:26:30,240 HIGHER INCIDENTS FOR OBESITY, 632 00:26:30,240 --> 00:26:32,560 THE RURAL GROUP HIGHER INCIDENTS 633 00:26:32,560 --> 00:26:35,080 FOR HYPERTENSION AND THE URBAN 634 00:26:35,080 --> 00:26:36,160 GROUP HIGHER INCIDENTS FOR 635 00:26:36,160 --> 00:26:37,960 DIABETES AND ANOTHER MESSAGE 636 00:26:37,960 --> 00:26:40,760 THAT NOT EVERYBODY IS THE SAME, 637 00:26:40,760 --> 00:26:41,720 IT'S CHALLENGES AND THE 638 00:26:41,720 --> 00:26:42,800 DIFFERENT DIRECTIONS BETWEEN 639 00:26:42,800 --> 00:26:44,280 HUMANS AND ENVIRONMENTS I'M 640 00:26:44,280 --> 00:26:46,840 GOING TO GIVE US ON SIZE AND 641 00:26:46,840 --> 00:26:48,160 VERY INFORMED RESPONSES. 642 00:26:48,160 --> 00:26:51,160 AND IN THIS TYPE OF MORE INTO 643 00:26:51,160 --> 00:26:54,080 INSIGHTS LATIN AMERICA IS A VERY 644 00:26:54,080 --> 00:26:56,080 PECULIAR AND PARTICULAR WITH ALL 645 00:26:56,080 --> 00:26:57,760 THESE GEOGRAPHIC DIVERSE TEASE 646 00:26:57,760 --> 00:27:02,720 AND HERE WE DID THIS STUDY AND 647 00:27:02,720 --> 00:27:05,200 PEOPLE IN URBAN AND RURAL POONA 648 00:27:05,200 --> 00:27:10,120 WHICH IS 4,000 METERS ABOVE SEA 649 00:27:10,120 --> 00:27:13,360 LEVEL AND ON THE BORDER WITH 650 00:27:13,360 --> 00:27:13,640 EQUADOR. 651 00:27:13,640 --> 00:27:15,760 THE PREVALENCE AND WEIGHT OF THE 652 00:27:15,760 --> 00:27:17,560 ARROWS AND THE COMMON CONDITIONS 653 00:27:17,560 --> 00:27:19,120 AND YOU SEE WHEN THE MESSAGE 654 00:27:19,120 --> 00:27:21,040 HERE IS THAT ONE SIZE DOES NOT 655 00:27:21,040 --> 00:27:22,640 FIT ALL. 656 00:27:22,640 --> 00:27:24,160 AND THIS IS PARTICULARLY FOR THE 657 00:27:24,160 --> 00:27:33,120 FIELD OF CARDIOVASCULAR. 658 00:27:33,120 --> 00:27:34,680 WHICH MANY OTHER PUBLISHED AND 659 00:27:34,680 --> 00:27:36,720 WHEN WE PLOTTED THOSE TOOLS, YOU 660 00:27:36,720 --> 00:27:38,720 KNOW, DIFFERENT ENVIRONMENT AND 661 00:27:38,720 --> 00:27:40,720 POPULATIONS WE SEE THEY PERFORM 662 00:27:40,720 --> 00:27:42,640 DIFFERENTLY SO NOW I SAY LOOK, 663 00:27:42,640 --> 00:27:44,680 WE NEED TO UNDERSTAND BETTER THE 664 00:27:44,680 --> 00:27:46,080 POPULATION BEHIND IT AND THE 665 00:27:46,080 --> 00:27:48,320 BASELINE LEVELS OF RISK FACTORS 666 00:27:48,320 --> 00:27:49,760 ARE COEXISTENCE OF RISK FACTORS 667 00:27:49,760 --> 00:27:51,160 IN THIS DIFFERENT POPULATIONS 668 00:27:51,160 --> 00:27:54,960 ACKNOWLEDGING THAT INCOMPETENTES 669 00:27:54,960 --> 00:27:56,520 ARE MULTIPLE AND DIVERSE. 670 00:27:56,520 --> 00:27:58,520 WHAT DOES IT MEAN IN TERMS OF 671 00:27:58,520 --> 00:27:59,680 INTERVENTION THIS IS WHAT CAN WE 672 00:27:59,680 --> 00:28:01,000 DO FROM HERE? 673 00:28:01,000 --> 00:28:03,480 NOW WITH THE PANDEMIC, WE HAVE 674 00:28:03,480 --> 00:28:06,360 ALL SUPPORTING A MOVEMENT 675 00:28:06,360 --> 00:28:08,280 TOWARDS TELEMEDICINE OR 676 00:28:08,280 --> 00:28:10,280 TELEHEALTH OPTIONS AND HERE WHAT 677 00:28:10,280 --> 00:28:13,240 WE'RE STUDYING WITH RIGHT BEFORE 678 00:28:13,240 --> 00:28:17,560 THE PANDEMIC AND HAD TO SO WE 679 00:28:17,560 --> 00:28:20,840 NEED A DOCTOR IT TELL YOU START 680 00:28:20,840 --> 00:28:22,480 WITH OBSERVATION WHEN YOU BECOME 681 00:28:22,480 --> 00:28:32,680 HYPHYPER TENSE I HAVE. 682 00:28:32,680 --> 00:28:37,240 WE CAN DEMONSTRATE IMPORTANT 683 00:28:37,240 --> 00:28:46,640 EFFECTS ON WEIGHT LOSS. 684 00:28:46,640 --> 00:28:49,880 ONE OF THE STUDIES THE USE OF 685 00:28:49,880 --> 00:28:51,440 FOOT THEY ARE MOM TREE AND WE 686 00:28:51,440 --> 00:28:54,360 DESIGNED THIS TO IMPROVE IT FROM 687 00:28:54,360 --> 00:28:56,600 A 30% ADHERENCE IN THE U.S. ON A 688 00:28:56,600 --> 00:29:00,800 U.S. SETTING, TO 50%. 689 00:29:00,800 --> 00:29:05,560 THE ACTUAL APPETITE WAS WELL 80% 690 00:29:05,560 --> 00:29:07,160 SO IT WAS A NEGATIVE STUDY FOR 691 00:29:07,160 --> 00:29:08,840 THE PROPOSED INTERVENTION BUT 692 00:29:08,840 --> 00:29:10,240 ALSO IT TAUGHT US A LOT THAT 693 00:29:10,240 --> 00:29:11,520 THERE WAS THESE WILLINGNESS OF 694 00:29:11,520 --> 00:29:13,280 PEOPLE TO RECEIVE SOMETHING OUT 695 00:29:13,280 --> 00:29:18,000 OF ASSISTANCE TO ANOTHER 696 00:29:18,000 --> 00:29:18,720 APPROACH. 697 00:29:18,720 --> 00:29:22,360 ALSO, YOU HERE TESTING WITH WHAT 698 00:29:22,360 --> 00:29:22,560 OUTCOME. 699 00:29:22,560 --> 00:29:27,800 THE OUTCOME FOR THESE RELEASING 700 00:29:27,800 --> 00:29:29,320 SODIUM AND WAS SALE SO AN 701 00:29:29,320 --> 00:29:30,880 INVITATION FOR US TO BE 702 00:29:30,880 --> 00:29:34,520 VERSATILE TO BE OPEN AND TO BE 703 00:29:34,520 --> 00:29:36,000 ADAPTIVE TO THE DIFFERENT NEEDS 704 00:29:36,000 --> 00:29:37,120 OF THE DIFFERENT GROUPS AND I'M 705 00:29:37,120 --> 00:29:40,040 GOING TO FINISH HERE WITH TWO 706 00:29:40,040 --> 00:29:40,240 STUDIES. 707 00:29:40,240 --> 00:29:42,960 THEY WILL TELL US ALSO HOW ON 708 00:29:42,960 --> 00:29:44,400 THE FOREFRONT OF HIGH-QUALITY 709 00:29:44,400 --> 00:29:46,960 RESEARCH THAT CAN BENEFIT THE 710 00:29:46,960 --> 00:29:48,400 LATINO COMMUNITY IN THE U.S. 711 00:29:48,400 --> 00:29:50,560 THIS IS USING SALT SUBSTITUTES 712 00:29:50,560 --> 00:29:52,480 WHERE PART OF THE SODIUM IS 713 00:29:52,480 --> 00:29:55,400 REPLACED BY POTASSIUM AND THEY 714 00:29:55,400 --> 00:29:56,760 ARE WORKING TOWARDS REDUCING 715 00:29:56,760 --> 00:29:57,840 BLOOD PRESSURE AND THE QUESTION 716 00:29:57,840 --> 00:30:00,480 IS HERE HOW TO SHAPE PRESSURE 717 00:30:00,480 --> 00:30:02,080 AND WORKING WITH THE GROUPS AT 718 00:30:02,080 --> 00:30:03,480 HIGH-RISK AND HOW CAN WE COVER 719 00:30:03,480 --> 00:30:06,080 THE ENTIRE GROUPS AND ENTIRE 720 00:30:06,080 --> 00:30:07,840 POPULATION AND WE 721 00:30:07,840 --> 00:30:09,480 DEMONSTRATESSED BENEFITS IN 722 00:30:09,480 --> 00:30:09,960 THERE. 723 00:30:09,960 --> 00:30:11,480 HERE IS ANOTHER ONE AND ANOTHER 724 00:30:11,480 --> 00:30:12,680 STUDY THAT WAS CONDUCTED IN 725 00:30:12,680 --> 00:30:23,200 BRAZIL AND PERU AND AGAIN, THE 726 00:30:27,360 --> 00:30:31,840 ONE IN PERU IS DIFFERENT AND 727 00:30:31,840 --> 00:30:34,680 THEY HAVE A ROLE IN REDUCING THE 728 00:30:34,680 --> 00:30:39,080 DEPRESSIVE SYMPTOMS IN PERU SO 729 00:30:39,080 --> 00:30:41,840 ANOTHER TO SHARE. 730 00:30:41,840 --> 00:30:43,040 PERSEVERANCE AND PERSEVERANCE 731 00:30:43,040 --> 00:30:44,920 AND I WANT THIS CONVERSATION WE 732 00:30:44,920 --> 00:30:45,800 START TODAY TO BE CONTINUED AND 733 00:30:45,800 --> 00:30:48,480 THANK YOU TO MY GROUP LIVING 734 00:30:48,480 --> 00:30:55,480 WITH AGAIN OWE RECEIPT TEE AND U 735 00:30:55,480 --> 00:30:57,120 VERY MUCH AND I WILL STOP HERE. 736 00:30:57,120 --> 00:31:03,680 BYE FOR NOW. 737 00:31:03,680 --> 00:31:04,360 >>Chair Aviles-Santa: THANK YOU 738 00:31:04,360 --> 00:31:05,960 FOR YOUR VERY INSIGHTFUL NOTE 739 00:31:05,960 --> 00:31:08,360 ABOUT LATIN AMERICA. 740 00:31:08,360 --> 00:31:11,440 THIS IS LARISSA AVILES-SANTA. 741 00:31:11,440 --> 00:31:13,760 AND NOW, WE WILL TRANSITION TO 742 00:31:13,760 --> 00:31:16,840 THE VERY FIRST TOPIC OF THE 743 00:31:16,840 --> 00:31:18,280 WORKSHOP. 744 00:31:18,280 --> 00:31:18,560 DIABETES. 745 00:31:18,560 --> 00:31:25,240 OUR PANELISTS ARE BA PABLO 746 00:31:25,240 --> 00:31:30,800 ASCHNER AND DID JUAN JOSE 747 00:31:30,800 --> 00:31:31,120 GAGLIARDINO. 748 00:31:31,120 --> 00:31:32,720 WE WILL HAVE A LIVE Q&A AFTER 749 00:31:32,720 --> 00:31:33,760 THE PRESENTATIONS. 750 00:31:33,760 --> 00:31:34,360 >>HELLO. 751 00:31:34,360 --> 00:31:36,120 THANK YOU FOR IN INVITING ME TO 752 00:31:36,120 --> 00:31:37,520 THIS VERY INTERESTING WORKSHOP. 753 00:31:37,520 --> 00:31:42,160 I'M GOING TO PRESENT HERE SOME 754 00:31:42,160 --> 00:31:45,920 EVIDENCE, REAL-WORLD EVIDENCE, 755 00:31:45,920 --> 00:31:48,440 IN PREVENTION OF TYPE-2 DIABETES 756 00:31:48,440 --> 00:31:51,120 WHICH WAS IN LATIN AMERICA 757 00:31:51,120 --> 00:31:53,160 SPECIFICALLY IN COLOMBIA. 758 00:31:53,160 --> 00:31:56,520 I WANT TO START BY SHOWING THE 759 00:31:56,520 --> 00:31:57,880 PREVALENCE OF THE TOLERANCE 760 00:31:57,880 --> 00:31:59,480 AROUND THE WORLD BECAUSE PEOPLE 761 00:31:59,480 --> 00:32:01,960 WITH IMPAIRED GLUCOSE TOLERANCE 762 00:32:01,960 --> 00:32:03,640 ARE THOSE AT HIGHER RISK OF 763 00:32:03,640 --> 00:32:04,520 DEVELOPING DIABETES. 764 00:32:04,520 --> 00:32:08,200 AND AS YOU CAN SEE, SOUTH 765 00:32:08,200 --> 00:32:10,080 AMERICA AND CENTRAL AND NORTH 766 00:32:10,080 --> 00:32:15,240 AMERICA ARE IN THE MEDIUM TO 767 00:32:15,240 --> 00:32:17,600 HIGH RANGE OF IGT PREVALENCE. 768 00:32:17,600 --> 00:32:21,840 WHEN WE LOOK AT THE THOSE WITH 769 00:32:21,840 --> 00:32:23,560 THE -- COUNTRIES WITH LOW INCOME 770 00:32:23,560 --> 00:32:25,880 ARE THOSE WITH THE HIGHEST 771 00:32:25,880 --> 00:32:28,880 PREVALENCE OF IGT ALTHOUGH THE 772 00:32:28,880 --> 00:32:30,760 NUMBER IS NOT AS HIGH AS IN THE 773 00:32:30,760 --> 00:32:33,120 OTHER COUNTRIES. 774 00:32:33,120 --> 00:32:34,680 AND WHEN WE COMPARE THE 775 00:32:34,680 --> 00:32:36,200 PREVALENCE OF IGT WITH THE 776 00:32:36,200 --> 00:32:39,120 PREVALENCE OF DIABETES, WE CAN 777 00:32:39,120 --> 00:32:40,840 SEE THAT IN ALL THE COUNTRIES OR 778 00:32:40,840 --> 00:32:44,520 IN MOST COUNTRIES, IGT 779 00:32:44,520 --> 00:32:47,200 PREVALENCE IS EQUAL OR HIGHER 780 00:32:47,200 --> 00:32:49,920 THAN THAT OF DIABETES, WHICH 781 00:32:49,920 --> 00:32:54,120 MEANS THAT THIS IS A BIG PROBLEM 782 00:32:54,120 --> 00:32:57,440 BECAUSE THESE PEOPLE ARE SO TO 783 00:32:57,440 --> 00:32:59,840 SPEAK, IN LINE TO DEVELOP 784 00:32:59,840 --> 00:33:02,760 DIABETES IN THE NEAR FUTURE AND 785 00:33:02,760 --> 00:33:07,600 ACTUALLY THE CONVERSION OF TWO 786 00:33:07,600 --> 00:33:09,720 DIABETES AND THE COMMUNITY OF 787 00:33:09,720 --> 00:33:13,280 INCIDENTS AT ONE YEAR IS 13% AND 788 00:33:13,280 --> 00:33:18,560 CAN BE AS HIGH AS 23% BUT 20 789 00:33:18,560 --> 00:33:23,520 YEARS, IT'S ALMOST 70% AND THERE 790 00:33:23,520 --> 00:33:26,280 HAVE BEEN STRATEGIES, SUCCESSFUL 791 00:33:26,280 --> 00:33:28,160 STRATEGIES TO PREVENT 792 00:33:28,160 --> 00:33:29,040 PROGRESSION TO DIABETES IN 793 00:33:29,040 --> 00:33:31,480 PEOPLE WITH IGT AND OTHER FORMS 794 00:33:31,480 --> 00:33:33,640 OF PRE DIABETES AND THIS IS A 795 00:33:33,640 --> 00:33:35,880 META ANALYSIS WHERE WE CAN SEE 796 00:33:35,880 --> 00:33:38,600 THAT THE BEST STRATEGY FOR THAT 797 00:33:38,600 --> 00:33:42,160 HAS BEEN THE BARIATRIC SURGERY 798 00:33:42,160 --> 00:33:44,520 AND WE KNOW THAT IS THE BEST 799 00:33:44,520 --> 00:33:47,480 STRATEGY ALSO TO LOSE WEIGHT 800 00:33:47,480 --> 00:33:49,840 WITHOUT RISK REDUCTION OF AROUND 801 00:33:49,840 --> 00:33:52,440 84% BUT I WANT TO EMPHASIS THIS 802 00:33:52,440 --> 00:33:55,640 STUDIES THAT HAVE BEEN DONE WITH 803 00:33:55,640 --> 00:33:58,520 CHANGES IN LIFESTYLE WHICH CAN 804 00:33:58,520 --> 00:34:02,320 OBTAIN A REDUCTION OF AROUND 50% 805 00:34:02,320 --> 00:34:07,040 OR MORE IN THE PROGRESSION TO 806 00:34:07,040 --> 00:34:07,280 DIABETES. 807 00:34:07,280 --> 00:34:08,920 AND WE WANTED TO SEE WHETHER 808 00:34:08,920 --> 00:34:11,560 THIS IS FEASIBLE IN REAL LIFE IN 809 00:34:11,560 --> 00:34:17,880 OUR COUNTRY IN COLOMBIA, SO THIS 810 00:34:17,880 --> 00:34:21,000 WAS DONE IN THE CARIBBEAN COAST 811 00:34:21,000 --> 00:34:25,160 WHERE MORE THAN 14,000 PEOPLE 812 00:34:25,160 --> 00:34:26,360 WERE SCREENED WITH A FIN RISK 813 00:34:26,360 --> 00:34:27,960 WHICH WAS DEVELOPED IN FINLAND 814 00:34:27,960 --> 00:34:35,280 AROUND THE THIRD HAD A FINDRISC 815 00:34:35,280 --> 00:34:37,000 OF 12 WHICH IS OUR CUT OFF OF 816 00:34:37,000 --> 00:34:40,080 PREDICTING THE PRESENCE OF 817 00:34:40,080 --> 00:34:42,720 DIABETES OR IN HYPER GLYCEMIA 818 00:34:42,720 --> 00:34:46,040 AND THEY WERE INVITE TODAY A 819 00:34:46,040 --> 00:34:50,640 OGTT AND 13% HAD ACTUALLY 820 00:34:50,640 --> 00:34:54,480 UNKNOWN TYPE-2 DIABETES AND 821 00:34:54,480 --> 00:34:56,920 AROUND 28% HAD ONE FORM OF PRE 822 00:34:56,920 --> 00:34:59,760 DIABETES EITHER IFG, IGT OR 823 00:34:59,760 --> 00:35:00,160 BOTH. 824 00:35:00,160 --> 00:35:01,320 AND THESE WERE THE PEOPLE THAT 825 00:35:01,320 --> 00:35:06,400 WERE INVITED TO THE STUDY AND 826 00:35:06,400 --> 00:35:09,480 THEY WERE RANDOMIZED TO 827 00:35:09,480 --> 00:35:10,920 LIFESTYLE INTERVENTION OR TO A 828 00:35:10,920 --> 00:35:12,040 CONTROL GROUP. 829 00:35:12,040 --> 00:35:13,880 THE LIFESTYLE INTERVENTION THERE 830 00:35:13,880 --> 00:35:15,480 WERE TWO GROUPS, ONE WHICH 831 00:35:15,480 --> 00:35:17,280 STARTED WITH NUTRITIONISTS 832 00:35:17,280 --> 00:35:19,160 INTERVENTION THE OTHER WITH 833 00:35:19,160 --> 00:35:21,120 EXERCISE AND THE SIX TO 12 834 00:35:21,120 --> 00:35:22,960 MONTHS BOTH GROUPS WERE DOING 835 00:35:22,960 --> 00:35:24,280 BOTH STRATEGIES. 836 00:35:24,280 --> 00:35:26,320 AND THE GOALS WERE SIMILAR TO 837 00:35:26,320 --> 00:35:29,000 THE DIABETES PREVENTION STUDY 838 00:35:29,000 --> 00:35:32,560 DONE IN FINLAND AND THE STUDY 839 00:35:32,560 --> 00:35:35,680 LED BY Dr. TOMMY LETO WHO WAS 840 00:35:35,680 --> 00:35:42,800 WAS A P.I. FOR THESE STUDY. 841 00:35:42,800 --> 00:35:44,200 AND AFTER TWO YEARS FOLLOW-UP 842 00:35:44,200 --> 00:35:45,560 THESE ARE THE PEOPLE REMAINING 843 00:35:45,560 --> 00:35:47,000 IN THE PROGRAM AND THERE WAS NO 844 00:35:47,000 --> 00:35:49,840 DIFFERENCE IN THE REVERSAL TO 845 00:35:49,840 --> 00:35:51,480 NORMAL GLUCOSE TOLERANCE BETWEEN 846 00:35:51,480 --> 00:35:53,520 THE GROUPS AND THERE WAS NO 847 00:35:53,520 --> 00:35:55,400 DIFFERENCE ALSO IN THE 848 00:35:55,400 --> 00:35:58,520 PROGRESSION TO DIABETES IN THE 849 00:35:58,520 --> 00:36:00,880 DIFFERENT GROUPS. 850 00:36:00,880 --> 00:36:04,360 BUT, THERE WAS A REDUCTION, A 851 00:36:04,360 --> 00:36:07,560 SIGNIFICANT REDUCTION IN THE 852 00:36:07,560 --> 00:36:10,320 BLOOD GLUCOSE POST GLUCOSE LOAD 853 00:36:10,320 --> 00:36:13,360 SUGGESTING SOME CONTAMINATION 854 00:36:13,360 --> 00:36:16,680 FROM THE CONTROL GROUPS POSITIVE 855 00:36:16,680 --> 00:36:17,400 CONTAMINATION PROBABLY BECAUSE 856 00:36:17,400 --> 00:36:21,040 THEY LIVE IN THE SAME AREA AND 857 00:36:21,040 --> 00:36:23,280 THEY MAY HAVE ADOPTED THE SAME 858 00:36:23,280 --> 00:36:25,880 CHANGES IN LIFESTYLE, ACTUALLY, 859 00:36:25,880 --> 00:36:28,880 THE CONVERSION TO DIABETES WAS 860 00:36:28,880 --> 00:36:31,480 AROUND 5% AND SO TO FURTHER 861 00:36:31,480 --> 00:36:37,360 EXPLORE THIS, WE DID THIS, WE 862 00:36:37,360 --> 00:36:42,120 ARE DOING THIS PROJECT WHICH IS 863 00:36:42,120 --> 00:36:44,240 JUST FINISHING IN OUR CAPITOL 864 00:36:44,240 --> 00:36:52,560 CITY AND IS IN ANDEAN REGION WE 865 00:36:52,560 --> 00:36:59,040 SCREENED 3,000 ALMOST 4,000 866 00:36:59,040 --> 00:37:03,000 PEOPLE APPROPRIATE FOR OUR 867 00:37:03,000 --> 00:37:05,040 POPULATIONS AND WE DID THE SAME 868 00:37:05,040 --> 00:37:09,120 AND OGTT ON THOSE WHICH HAD A 869 00:37:09,120 --> 00:37:13,480 HIGH FINDRISC AND WE HAD A LOWER 870 00:37:13,480 --> 00:37:16,560 PREVALENCE OF TYPE-2 DIABETES 871 00:37:16,560 --> 00:37:21,360 AND AROUND 5.5% AND AROUND 13 872 00:37:21,360 --> 00:37:23,600 ALMOST 14% HAD IGT WHICH IS THE 873 00:37:23,600 --> 00:37:28,000 GROUP WE CONSIDERED HIGH-RISK. 874 00:37:28,000 --> 00:37:31,160 THE REST WERE MODERATE RISK AND 875 00:37:31,160 --> 00:37:35,120 TYPE-2 DIABETES WAS REFERRED TO 876 00:37:35,120 --> 00:37:40,520 HEALTH SERVICE AND PEOPLE WITH 877 00:37:40,520 --> 00:37:42,320 IGT WERE INVITED TO JOIN A 878 00:37:42,320 --> 00:37:43,480 STRUCTURE PROGRAM THAT I WILL 879 00:37:43,480 --> 00:37:45,000 EXPLAIN LATER AND WE NEEDED A 880 00:37:45,000 --> 00:37:50,720 NUMBER OF 1 OTHER AND WE GOT 881 00:37:50,720 --> 00:37:52,360 THAT AND FOR THE MODERATE RISK, 882 00:37:52,360 --> 00:37:55,440 WE GAVE THEM GENERAL INFORMATION 883 00:37:55,440 --> 00:37:57,440 ON DIABETES PREVENTION AND 884 00:37:57,440 --> 00:37:58,840 CHANGES IN LIFESTYLE AND THOSE 885 00:37:58,840 --> 00:38:03,960 WHO HAVE THE LOW FINDRISC LESS 886 00:38:03,960 --> 00:38:05,640 EQUAL TO 12 THEY WERE LOW RISK 887 00:38:05,640 --> 00:38:08,200 AND THEY WERE INVOLVED IN A 888 00:38:08,200 --> 00:38:09,720 COMMUNITY PROGRAM BASED ON 889 00:38:09,720 --> 00:38:12,920 INTERVENTION MAPPING AND AT THE 890 00:38:12,920 --> 00:38:14,800 BEGINNING, THERE WAS A RANDOM 891 00:38:14,800 --> 00:38:19,040 SAMPLE AMONG THEM AND FOR SOME 892 00:38:19,040 --> 00:38:22,840 TESTS AND AFTER A YEAR, THE 893 00:38:22,840 --> 00:38:26,640 PEOPLE IN THE HIGH-RISK GROUP 894 00:38:26,640 --> 00:38:28,920 ARE AGAIN TESTED WITH AN OGTT 895 00:38:28,920 --> 00:38:31,280 AND THE MAIN OBJECTS, THE MAIN 896 00:38:31,280 --> 00:38:34,480 OUTCOMES WERE CHANGES IN WEIGHT 897 00:38:34,480 --> 00:38:39,200 AND GLYCEMIC STATUS AND THE REST 898 00:38:39,200 --> 00:38:43,520 WERE SELECTED AT RANDOM FOR A 899 00:38:43,520 --> 00:38:46,320 NEW TEST AND TO COMPARE CHANGES 900 00:38:46,320 --> 00:38:50,160 IN THE PARAMETER AND SO THE 901 00:38:50,160 --> 00:38:51,360 INTERVENTION OF THE HIGH-RISK 902 00:38:51,360 --> 00:38:53,920 GROUP WAS DONE BASED ON THE 903 00:38:53,920 --> 00:38:54,840 NATIONAL DIABETES PREVENTION 904 00:38:54,840 --> 00:38:57,000 PROGRAM IN THE U.S. WHICH IS 905 00:38:57,000 --> 00:38:59,000 COORDINATED BY THE CDC AND 906 00:38:59,000 --> 00:39:03,960 ADOPTED FOR HISPANICS. 907 00:39:03,960 --> 00:39:06,960 IT'S A 26-SESSION PROGRAM 908 00:39:06,960 --> 00:39:10,120 LASTING ONE YEAR AND WE THOUGHT 909 00:39:10,120 --> 00:39:13,760 THAT WAS TOO MUCH FOR OUR 910 00:39:13,760 --> 00:39:16,720 POPULATION SO WITH PERMISSION OF 911 00:39:16,720 --> 00:39:19,320 BETSY RODRIGUEZ, THE COORDINATOR 912 00:39:19,320 --> 00:39:23,960 OF THIS ADD APPLICATION, WE 913 00:39:23,960 --> 00:39:30,560 ADAPTED IT AGAIN TO THE ONLY 10 914 00:39:30,560 --> 00:39:33,400 GROUP SESSIONS COMPRISING 915 00:39:33,400 --> 00:39:36,840 NUTRITION AND PHYSICAL ACTIVITY 916 00:39:36,840 --> 00:39:40,760 WORKSHOPS OF 1.5 HOURS EACH AND 917 00:39:40,760 --> 00:39:42,920 SMALL GROUPS WORKSHOPS AND THIS 918 00:39:42,920 --> 00:39:45,280 SESSIONS WERE LED BY CULTURES 919 00:39:45,280 --> 00:39:47,760 FROM THE COMMUNITY WHICH THEY 920 00:39:47,760 --> 00:39:49,680 WERE PREVIOUS TRAINED BY 921 00:39:49,680 --> 00:39:50,920 RESEARCH GROUP AND SUPER ARE 922 00:39:50,920 --> 00:39:55,680 VICED BY A FIELD COORDINATOR AND 923 00:39:55,680 --> 00:39:57,200 WE USE TO CONDUCT THE PEOPLE 924 00:39:57,200 --> 00:40:03,960 WITH MOBILE PHONES. 925 00:40:03,960 --> 00:40:05,600 SO 87 SUBJECT AROUND 57% OF 926 00:40:05,600 --> 00:40:07,320 THOSE IN THE HIGH-RISK GROUP 927 00:40:07,320 --> 00:40:10,440 COMPLETED THIS STRUCTURED 928 00:40:10,440 --> 00:40:11,080 PREVENTION PROGRAM. 929 00:40:11,080 --> 00:40:12,600 THOSE ARE THE MAIN 930 00:40:12,600 --> 00:40:15,000 CHARACTERISTICS INCLUDING A BMI 931 00:40:15,000 --> 00:40:17,240 OF 31 KILOGRAMS SUPERVISOR 932 00:40:17,240 --> 00:40:21,560 SQUARE METER AND THERE WAS A 933 00:40:21,560 --> 00:40:23,560 MEDIUM CHANGE TO OUR BLOOD 934 00:40:23,560 --> 00:40:28,360 GLUCOSE AND IT WAS SIGNIFICANT 935 00:40:28,360 --> 00:40:29,880 AND THE WEIGHT CHANGE OF ONE 936 00:40:29,880 --> 00:40:33,840 YEAR WAS -2° .4 BUT 78% OF THE 937 00:40:33,840 --> 00:40:39,440 PEOPLE LOST WEIGHT AND WAS 938 00:40:39,440 --> 00:40:42,640 ALMOST FOUR KILOGRAMS AND THE 939 00:40:42,640 --> 00:40:45,400 GLYCEMIC STATUS 60% REVERSE TO 940 00:40:45,400 --> 00:40:50,520 NORMAL GLUCOSE TOLERANCE AND 1% 941 00:40:50,520 --> 00:41:00,920 PROGRESSES ONE OF THE MAIN 942 00:41:00,920 --> 00:41:03,320 DRIVING FACTORS IN THIS NETWORK 943 00:41:03,320 --> 00:41:08,240 OF STUDIES IN REAL LIFE, WE CAN 944 00:41:08,240 --> 00:41:11,400 SEE IN A MATTER THE WEIGHT LOSS 945 00:41:11,400 --> 00:41:13,960 WAS ASSOCIATED WITH A LOWER RISK 946 00:41:13,960 --> 00:41:16,800 OF DEVELOPING DIABETES, ONE 947 00:41:16,800 --> 00:41:20,280 KILOGRAM LOST ASSOCIATED WITH A 948 00:41:20,280 --> 00:41:23,760 43% LOWER RISK OF DEVELOPING 949 00:41:23,760 --> 00:41:24,480 DIABETES. 950 00:41:24,480 --> 00:41:27,520 SO, TO CONCLUDE, I BELIEVE THAT 951 00:41:27,520 --> 00:41:30,560 IT CAN BE DONE AND THE 952 00:41:30,560 --> 00:41:33,040 PREVENTION OF TYPE-2 DIABETES, 953 00:41:33,040 --> 00:41:36,360 WITH LIFESTYLE CHANGES AND EVEN 954 00:41:36,360 --> 00:41:38,360 IN COMMUNITIES SUCH AS OURS. 955 00:41:38,360 --> 00:41:42,960 THANK YOU, VERY MUCH. 956 00:41:42,960 --> 00:41:45,400 >>GOOD MORNING, AUDIENCE. 957 00:41:45,400 --> 00:41:50,000 I WOULD LIKE TO THANK THERESA 958 00:41:50,000 --> 00:41:51,640 AND HER TEAM TO PARTICIPATE IN 959 00:41:51,640 --> 00:42:01,040 THIS IMPORTANT OFTEN AND -- I WF 960 00:42:01,040 --> 00:42:05,200 ALL TO START WITH THE WE HAVE IN 961 00:42:05,200 --> 00:42:09,960 THE WORLD 537 MILLION HAVING 962 00:42:09,960 --> 00:42:10,960 DIABETES. 963 00:42:10,960 --> 00:42:12,360 32 MILLION OF THEM ARE LOCATED 964 00:42:12,360 --> 00:42:14,840 IN OUR SOUTH AMERICAN AND 965 00:42:14,840 --> 00:42:19,640 CENTRAL AMERICAN REGION. 966 00:42:19,640 --> 00:42:21,240 541 MILLION ADULTS HAVE 967 00:42:21,240 --> 00:42:22,440 PRE-DIABETES THAT MEANS THAT 968 00:42:22,440 --> 00:42:23,760 THEY HAVE HIGH-RISK OF 969 00:42:23,760 --> 00:42:26,000 DEVELOPING THE DISEASE. 970 00:42:26,000 --> 00:42:29,800 DIABETES ON THE OTHER SIDE HAVE 971 00:42:29,800 --> 00:42:31,120 PRODUCED 6.7 MILLION DEATHS IN 972 00:42:31,120 --> 00:42:34,440 THE LAST YEAR AND IS RESPONSIBLE 973 00:42:34,440 --> 00:42:38,520 OF PAY ATTENTION TO THIS DATA 974 00:42:38,520 --> 00:42:42,080 BECAUSE AROUND 966 BILLION 975 00:42:42,080 --> 00:42:44,520 AMERICAN DOLLARS EXPENDITURES 976 00:42:44,520 --> 00:42:47,160 RELATED TO THE TREATMENT AND AN 977 00:42:47,160 --> 00:42:49,640 INCREMENT THAT REPRESENTS 316% 978 00:42:49,640 --> 00:42:52,600 COMPARED TO THE LAST 15 YEARS. 979 00:42:52,600 --> 00:43:01,200 IN ADDITION, THE WHO HAVE MADE 980 00:43:01,200 --> 00:43:02,840 PROGNOSIS THE NEXT PANDEMIC IN 981 00:43:02,840 --> 00:43:04,240 THE 21st CENTURY IS GOING TO 982 00:43:04,240 --> 00:43:06,560 BE DIABETES AND OBESITY. 983 00:43:06,560 --> 00:43:08,680 THAT WAS A PROGNOSIS BUT NOW WE 984 00:43:08,680 --> 00:43:11,240 HAVE SOME COMPARISON AND 985 00:43:11,240 --> 00:43:14,120 SIGNIFICANT DATA TO COMPARE 986 00:43:14,120 --> 00:43:14,720 WITH. 987 00:43:14,720 --> 00:43:16,840 CORONAVIRUS HAS PRODUCED ONLY 988 00:43:16,840 --> 00:43:19,440 INFECTED PEOPLE 346 MILLION OF 989 00:43:19,440 --> 00:43:24,600 THEM AND PRODUCED 5.9 MILLION OF 990 00:43:24,600 --> 00:43:30,200 THIS AND THIS IS SIGNIFICANT AND 991 00:43:30,200 --> 00:43:32,840 THE PROGNOSIS IS THE WHO IS NOT 992 00:43:32,840 --> 00:43:38,120 THE PROGNOSIS IS A FACT AND AND 993 00:43:38,120 --> 00:43:44,240 NOW WE ARE GOING TO PRESENT AND 994 00:43:44,240 --> 00:43:54,760 AMERICAN AND IT'S LISTED HERE 995 00:43:56,480 --> 00:43:57,960 AND IF WE COMPARE WHAT HAPPENED 996 00:43:57,960 --> 00:44:05,280 WITH ONE OF THEM, DIABETES, FROM 997 00:44:05,280 --> 00:44:08,160 2005, AND 2018 YOU CAN SEE HERE 998 00:44:08,160 --> 00:44:13,000 THAT IT WENT TO 8.5 TO 12.7 999 00:44:13,000 --> 00:44:16,240 MEANING 51% INCREASE AND OBESITY 1000 00:44:16,240 --> 00:44:18,360 AT THE SAME TIME COULD HAVE 74% 1001 00:44:18,360 --> 00:44:21,360 AND IF WE DON'T TAKE CARE OF 1002 00:44:21,360 --> 00:44:23,960 HIGH CONSIDERATION ABOUT THESE 1003 00:44:23,960 --> 00:44:26,560 FIGURES, THESE THINGS, OBESITY 1004 00:44:26,560 --> 00:44:29,200 IS GOING TO BE SLOWLY COMING 1005 00:44:29,200 --> 00:44:31,360 DOWN TO DIABETES AND INCREASING 1006 00:44:31,360 --> 00:44:31,560 AGAIN. 1007 00:44:31,560 --> 00:44:33,760 WE ARE TALKING ABOUT ALL OF 1008 00:44:33,760 --> 00:44:36,960 DIABETES BUT WE DON'T HAVE PRE 1009 00:44:36,960 --> 00:44:37,240 DIABETES. 1010 00:44:37,240 --> 00:44:39,880 AND PRE DIABETES ARE COMING HERE 1011 00:44:39,880 --> 00:44:42,640 FROM ONE OF OUR STUDIES AND MAKE 1012 00:44:42,640 --> 00:44:46,520 IT PREVENTION STUDY ABOUT TYPE-2 1013 00:44:46,520 --> 00:44:48,880 DIABETES IS HEALTHY HABITS AND 1014 00:44:48,880 --> 00:44:53,000 WE HAVE A STUDY IN THE PROVINCE 1015 00:44:53,000 --> 00:44:57,440 AND TO INCLUDE THE POPULATION WE 1016 00:44:57,440 --> 00:45:01,800 APPLIED THE AND THE IT WAS ONE 1017 00:45:01,800 --> 00:45:06,400 OF OUR ADVISERS WHEN WE GO TO 1018 00:45:06,400 --> 00:45:10,320 FIELD RISK AND 13 POINTS WE HAVE 1019 00:45:10,320 --> 00:45:11,640 TO KNOW EXACTLY WHAT HAPPENED 1020 00:45:11,640 --> 00:45:14,160 WITH A NUMBER OF PRE DIABETES 1021 00:45:14,160 --> 00:45:18,120 AND FROM THIS CENTER, WE HAVE 1022 00:45:18,120 --> 00:45:21,080 41% PEOPLE WITH PRE DIABETES AND 1023 00:45:21,080 --> 00:45:24,920 ALSO, WE HAVE 5% AND DIAGNOSED 1024 00:45:24,920 --> 00:45:27,200 TYPE-2 DIABETES AND UNFORT THESE 1025 00:45:27,200 --> 00:45:28,440 ARE NOT TREATED. 1026 00:45:28,440 --> 00:45:33,360 WHAT ABOUT THE PEOPLE WITH PRE 1027 00:45:33,360 --> 00:45:35,880 DIABETES? 1028 00:45:35,880 --> 00:45:37,520 WE HAVE FASTING GLUCOSE AND THE 1029 00:45:37,520 --> 00:45:41,520 FIRST STAGE OF THE DISEASE AND 1030 00:45:41,520 --> 00:45:43,760 14% WITH IMPAIRED SECOND STATION 1031 00:45:43,760 --> 00:45:53,080 OVER THE DISEASES AND 17% OF 1032 00:45:53,080 --> 00:45:58,400 ALMOST -- 17% HAVE COMPARED 1033 00:45:58,400 --> 00:45:59,960 DISEASES AND WHY IS IT IMPORTANT 1034 00:45:59,960 --> 00:46:01,320 THIS KNOWLEDGE? 1035 00:46:01,320 --> 00:46:03,560 BECAUSE, THE ANNUAL TRANSITION 1036 00:46:03,560 --> 00:46:07,760 RATE OF DIABETES ACCORDING TO 1037 00:46:07,760 --> 00:46:13,000 THE METABOLIC DYSFUNCTION AND 1038 00:46:13,000 --> 00:46:15,520 THE, IF YOU COMPARE FASTING 1039 00:46:15,520 --> 00:46:19,040 GLUCOSE, THIS RATE IS 4.66 AND 1040 00:46:19,040 --> 00:46:23,600 IF YOU HAVE BOTH, YOU HAVE 12%. 1041 00:46:23,600 --> 00:46:27,080 IT MEANS THAT IF YOU ARE A 1042 00:46:27,080 --> 00:46:30,040 PERSON WITH PRE DIABETES AND THE 1043 00:46:30,040 --> 00:46:30,720 PHYSICIAN PAYS ATTENTION TO 1044 00:46:30,720 --> 00:46:34,040 THESE THINGS, WE'LL MAKE IT 1045 00:46:34,040 --> 00:46:37,320 HEALTHY HABITS TO PREVENT THE 1046 00:46:37,320 --> 00:46:41,280 TRANSITION RATE THAT IS SHOWN 1047 00:46:41,280 --> 00:46:41,840 HERE. 1048 00:46:41,840 --> 00:46:44,720 NOW, EVEN EXAMPLE OF DIRECT COST 1049 00:46:44,720 --> 00:46:46,280 THAT WE HAVE AN IMPACT ON THE 1050 00:46:46,280 --> 00:46:48,840 HEALTH SYSTEM, FROM THIS STUDY 1051 00:46:48,840 --> 00:46:51,360 THAT WE HAVE MENTIONED BEFORE. 1052 00:46:51,360 --> 00:46:54,000 AND WE HAVE INCLUDED IN THIS 1053 00:46:54,000 --> 00:46:55,200 TABLE, ALL THE THINGS THAT WE 1054 00:46:55,200 --> 00:46:57,480 HAVE CONSIDERED FROM THE POINT 1055 00:46:57,480 --> 00:46:59,840 OF VIEW OF COURSE AND WE HAVE 1056 00:46:59,840 --> 00:47:06,040 EXPRESSED A TOTAL COST BY AND 1057 00:47:06,040 --> 00:47:08,720 INDEPENDENT OF THE ARGENTINE AN 1058 00:47:08,720 --> 00:47:10,200 PESO THAT IS HERE YOU PAY 1059 00:47:10,200 --> 00:47:12,000 ATTENTION TO THE RATE OF 1060 00:47:12,000 --> 00:47:13,840 INCREASE AND IF YOU COMPARE THE 1061 00:47:13,840 --> 00:47:16,960 GROUP OF CONTROL, PEOPLE WITHOUT 1062 00:47:16,960 --> 00:47:18,840 DIABETES, AND PEOPLE WITH 1063 00:47:18,840 --> 00:47:20,640 DIABETES BUT WITHOUT 1064 00:47:20,640 --> 00:47:24,960 COMPLICATIONS, THIS INCREASE FOR 1065 00:47:24,960 --> 00:47:30,240 5.8 AND TO 9.04 MEANS 78% 1066 00:47:30,240 --> 00:47:33,320 INCREASE AND IF YOU HAVE ALREADY 1067 00:47:33,320 --> 00:47:35,800 DEVELOPED DIABETES 1068 00:47:35,800 --> 00:47:38,320 COMPLICATIONS, YOU GO FROM 5.8 1069 00:47:38,320 --> 00:47:43,600 IN A CONTROLLED TO 260 TIMES THE 1070 00:47:43,600 --> 00:47:44,560 INCREASING COST. 1071 00:47:44,560 --> 00:47:46,800 THAT MEANS THAT WE HAVE TO 1072 00:47:46,800 --> 00:47:48,120 PREVENT AT ANY PRICE, THE 1073 00:47:48,120 --> 00:47:49,880 DEVELOPMENT OF COMPLICATIONS TO 1074 00:47:49,880 --> 00:47:52,960 CUT DOWN THE COSTS. 1075 00:47:52,960 --> 00:47:57,000 NOW, THIS IS ONE SIDE OF THE 1076 00:47:57,000 --> 00:47:58,440 COIN, BECAUSE EVERYBODY KNOWS, 1077 00:47:58,440 --> 00:48:00,520 THAT YOU HAVE POVERTY ASSOCIATED 1078 00:48:00,520 --> 00:48:02,960 WITH LOW LEVEL OF EDUCATION, AND 1079 00:48:02,960 --> 00:48:05,680 YOU PROMOTE DIABETES. 1080 00:48:05,680 --> 00:48:08,520 NOW, WHAT IS THE IMPACT OF 1081 00:48:08,520 --> 00:48:11,920 DIABETES UPON THIS SOCIOCULTURAL 1082 00:48:11,920 --> 00:48:13,320 DEVELOPMENT AND THIS IS FROM A 1083 00:48:13,320 --> 00:48:17,720 STUDY THAT WE REPORTED FROM 1084 00:48:17,720 --> 00:48:19,240 2014, AND YOU HAVE SEEN FOR 1085 00:48:19,240 --> 00:48:21,000 EXAMPLE THE EDUCATION IN 1086 00:48:21,000 --> 00:48:22,560 ARGENTINA THE FORMAL EDUCATION 1087 00:48:22,560 --> 00:48:26,840 AND PRIMARY SCHOOL IS OBLIGATORY 1088 00:48:26,840 --> 00:48:30,000 AND YOU COME DOWN FROM ALMOST 1089 00:48:30,000 --> 00:48:33,840 14% IN THE CONTROL AND TO 12.2 1090 00:48:33,840 --> 00:48:37,600 IN THE TYPE-2 DIABETES WITH 1091 00:48:37,600 --> 00:48:38,200 COMPLICATIONS. 1092 00:48:38,200 --> 00:48:39,720 WHAT ABOUT UNIVERSITY ARE 1093 00:48:39,720 --> 00:48:40,000 COMPLETED. 1094 00:48:40,000 --> 00:48:41,920 THIS IS MORE IMPACTED AND YOU 1095 00:48:41,920 --> 00:48:47,440 HAVE COMING DOWN FROM 55% TO 43% 1096 00:48:47,440 --> 00:48:48,920 AND FROM THE POINT OF VIEW IF 1097 00:48:48,920 --> 00:48:52,280 YOU COMPARE FULL-TIME OR 1098 00:48:52,280 --> 00:48:54,400 PART-TIME JOBS YOU COME FROM 43% 1099 00:48:54,400 --> 00:48:57,200 IN THE CONTROL TO 27% IN THE 1100 00:48:57,200 --> 00:48:59,600 TYPE-2 DIABETESES WITH 1101 00:48:59,600 --> 00:49:01,040 COMPLICATIONS. 1102 00:49:01,040 --> 00:49:02,840 WHAT ABOUT THE MONTHLY INCOME? 1103 00:49:02,840 --> 00:49:07,600 THE MINIMAL SALARY COMING DOWN 1104 00:49:07,600 --> 00:49:11,160 FROM 53% IN CONTROL TO 25% IN 1105 00:49:11,160 --> 00:49:13,040 DIABETES WITH COMPLICATIONS BUT 1106 00:49:13,040 --> 00:49:16,800 IN ANY CONTROL, IN ANY CASE, IF 1107 00:49:16,800 --> 00:49:18,720 WE COMPARE MEN WITH WOMEN, YOU 1108 00:49:18,720 --> 00:49:20,520 SEE THE FIGURES ARE RESPONDING 1109 00:49:20,520 --> 00:49:22,920 TO THE WOMAN ARE MORE EFFECTIVE 1110 00:49:22,920 --> 00:49:23,840 THAN THE MALE. 1111 00:49:23,840 --> 00:49:29,280 THIS IS NOT AN ARGENTINIAN 1112 00:49:29,280 --> 00:49:31,280 PHENOMENON, IT'S WORLDWIDE, 1113 00:49:31,280 --> 00:49:32,360 UNFORTUNATELY IT'S ASSOCIATED 1114 00:49:32,360 --> 00:49:34,480 WITH THE GENDER. 1115 00:49:34,480 --> 00:49:37,120 NOW, BASED ON THAT DATA, WE 1116 00:49:37,120 --> 00:49:42,080 BELIEVE WE PROPOSE THAT THIS IS 1117 00:49:42,080 --> 00:49:44,840 GOING TO PROMOTE FROM POVERTY 1118 00:49:44,840 --> 00:49:48,120 AND EDUCATION DEFICIT AND TO 1119 00:49:48,120 --> 00:49:51,000 TYPE-2 DIABETES COMPLICATION AND 1120 00:49:51,000 --> 00:49:53,280 FROM THESE COMPLICATIONS YOU 1121 00:49:53,280 --> 00:49:57,160 HAVE A LOW SOCIOECONOMIC 1122 00:49:57,160 --> 00:49:58,760 DEVELOPMENT AND IT'S GOING AND 1123 00:49:58,760 --> 00:50:00,840 GOING AND EVEN IF YOU DON'T STOP 1124 00:50:00,840 --> 00:50:03,440 ANY TIME, IN ANY POINT, THIS IS 1125 00:50:03,440 --> 00:50:06,320 GOING TO BE WORSE AND WORSE AND 1126 00:50:06,320 --> 00:50:07,600 WORSE. 1127 00:50:07,600 --> 00:50:09,640 NOW, WHAT ABOUT QUALITY OF CARE 1128 00:50:09,640 --> 00:50:11,400 PROVIDED TO THE POPULATION THAT 1129 00:50:11,400 --> 00:50:15,280 IS IN OUR COUNTRY AND WE HAVE A 1130 00:50:15,280 --> 00:50:19,080 STUDY AND WITH 2,550 PATIENTS 1131 00:50:19,080 --> 00:50:20,680 WITH DIABETES 2 DIABETES AND 8% 1132 00:50:20,680 --> 00:50:28,680 OF THEM TREATED BY 1133 00:50:28,680 --> 00:50:31,160 DIABETOLOGISTS AND WE HAVE SEEN 1134 00:50:31,160 --> 00:50:33,040 THAT WHAT HAPPENED WITH THE 1135 00:50:33,040 --> 00:50:34,960 PATIENTS ACCORDING TO THE 1136 00:50:34,960 --> 00:50:45,480 DURATION OF THE EXPRESS IN YEARS 1137 00:50:47,160 --> 00:50:50,080 AND BELOW 7 AND WE HAVE 78% AS 1138 00:50:50,080 --> 00:50:55,520 SOON AS WE GET TREAT TREATED. 1139 00:50:55,520 --> 00:51:03,440 WE GET 61% ACTIVE 6% OR THE SIX 1140 00:51:03,440 --> 00:51:05,560 YEARS IN 10 YEARS AND YOU HAVE 1141 00:51:05,560 --> 00:51:10,280 MORE THAN 10 YEARS, YOU HAVE 54% 1142 00:51:10,280 --> 00:51:13,000 THAT MEANS THAT THESE ARE THE 1143 00:51:13,000 --> 00:51:16,920 PATIENCE THAT THEY WERE 1144 00:51:16,920 --> 00:51:21,440 CARDIOMETABOLIC AND GLUCOSE MA 1145 00:51:21,440 --> 00:51:22,520 LAB LIS HAVE REMAINED. 1146 00:51:22,520 --> 00:51:25,920 BUT AS SOON AS YOU REGRESS THE 1147 00:51:25,920 --> 00:51:28,920 CELLS REMAIN IN THE BODY AND BY 1148 00:51:28,920 --> 00:51:31,120 THE COMBINATION THEY DO IT OF 1149 00:51:31,120 --> 00:51:33,880 PATIENCE AND PHYSICIANS YOU CAN 1150 00:51:33,880 --> 00:51:38,480 DOWN THIS RULE OF 7% REALLY 1151 00:51:38,480 --> 00:51:40,800 DRAMATICALLY THAT MEANS THAT 1152 00:51:40,800 --> 00:51:43,680 EVEN A PERCENT YEARS AFTER THE 1153 00:51:43,680 --> 00:51:46,800 DISCOVERY, AND FACILITY THAT WE 1154 00:51:46,800 --> 00:51:48,160 HAVE WITH YOU STILL HAVE TO 1155 00:51:48,160 --> 00:51:54,560 LEARN HOW TO HANDLE THE THIS AND 1156 00:51:54,560 --> 00:51:54,840 TREATMENT. 1157 00:51:54,840 --> 00:51:56,360 THIS IS THE ONLY PROBLEM THAT WE 1158 00:51:56,360 --> 00:51:57,200 HAVE RIGHT NOW. 1159 00:51:57,200 --> 00:51:59,480 WE HAVE SOMETHING ELSE. 1160 00:51:59,480 --> 00:52:01,320 GLUCOSE LEVELS IS THE DIAGNOSIS 1161 00:52:01,320 --> 00:52:04,080 FOR DIABETES AND THE CONTROL 1162 00:52:04,080 --> 00:52:05,760 THAT WE HAVE. 1163 00:52:05,760 --> 00:52:08,760 BUT TYPE-2 DIABETES, THE MOST 1164 00:52:08,760 --> 00:52:12,160 FREQUENT VERSION OF THE DISEASE, 1165 00:52:12,160 --> 00:52:18,200 IS NOT ONLY GRO GLUCOSE IT'S 1166 00:52:18,200 --> 00:52:22,880 HYPERTENSION, OBESITY, AND THIS 1167 00:52:22,880 --> 00:52:24,440 EP DEEMIA AND TO DEMONSTRATE 1168 00:52:24,440 --> 00:52:25,880 THAT YOU HAVE TO TAKE CARE OF 1169 00:52:25,880 --> 00:52:29,480 THE WHOLE PICTURE TO HAVE A 1170 00:52:29,480 --> 00:52:32,000 PRIMARY PREVENTION OF THESE 1171 00:52:32,000 --> 00:52:35,280 THINGS AND WHAT HAPPENS IN OUR 1172 00:52:35,280 --> 00:52:37,680 CASE? 1173 00:52:37,680 --> 00:52:39,520 WE ATTAIN COMBINED GOALS. 1174 00:52:39,520 --> 00:52:47,440 IF YOU CONSIDER ORAL ANTIBIOTIC 1175 00:52:47,440 --> 00:52:52,000 BUT IF YOU GO TO SIN INSULIN YE 1176 00:52:52,000 --> 00:52:54,400 DOWN TO 2.7 AND PAY ATTENTION TO 1177 00:52:54,400 --> 00:52:56,040 THESE. 1178 00:52:56,040 --> 00:52:57,920 OAD THAT WE SUGGEST WE'VE TAKEN 1179 00:52:57,920 --> 00:53:00,280 ACTION NOW AND PAY ATTENTION TO 1180 00:53:00,280 --> 00:53:10,720 CUT DOWN THIS SITUATION. 1181 00:53:10,720 --> 00:53:12,040 >>GOOD MORNING, EVERYONE. 1182 00:53:12,040 --> 00:53:13,320 WE ARE BACK. 1183 00:53:13,320 --> 00:53:20,360 THANK YOU TO Dr. ASCHNER AND 1184 00:53:20,360 --> 00:53:23,720 Dr. GAGLIARDINO ABOUT DIABETES 1185 00:53:23,720 --> 00:53:25,600 AND PREVENTING DIABETES. 1186 00:53:25,600 --> 00:53:27,560 NOW WE START THE LIVE Q&A WITH 1187 00:53:27,560 --> 00:53:28,360 BOTH OF THEM. 1188 00:53:28,360 --> 00:53:29,920 SO I WOULD LIKE TO START WITH 1189 00:53:29,920 --> 00:53:31,440 THE FIRST QUESTION. 1190 00:53:31,440 --> 00:53:37,640 AND BY THE WAY, THIS Q&A WILL BE 1191 00:53:37,640 --> 00:53:38,480 ABOUT 19 MINUTES LONG AND WE 1192 00:53:38,480 --> 00:53:40,680 HAVE A BREAK AT 9:45A.M. 1193 00:53:40,680 --> 00:53:43,800 THE FIRST QUESTION IS FOR Dr. 1194 00:53:43,800 --> 00:53:46,160 ASCHNER, AND THE EXPLANATION OF 1195 00:53:46,160 --> 00:53:51,760 THE PREVENTION STUDY THAT WAS 1196 00:53:51,760 --> 00:53:59,040 PERFORMED, AND IS THE PREVENTION 1197 00:53:59,040 --> 00:54:01,000 STUDY GOING ON STILL AND ANY 1198 00:54:01,000 --> 00:54:02,040 FOLLOW-UP BEYOND 12 MONTHS? 1199 00:54:02,040 --> 00:54:04,040 IF YOU HAVE CONTINUED THE STUDY, 1200 00:54:04,040 --> 00:54:05,680 WE WOULD LIKE TO HEAR MORE ABOUT 1201 00:54:05,680 --> 00:54:08,080 WHAT HAS MADE IT SUCCESSFUL? 1202 00:54:08,080 --> 00:54:10,960 EITHER IN THE FIRST 12 MONTHS 1203 00:54:10,960 --> 00:54:13,760 AND LATER. 1204 00:54:13,760 --> 00:54:21,040 AND ALSO, ANY POTENTIAL OR PLANS 1205 00:54:21,040 --> 00:54:24,160 FOR SCALING IT UP? 1206 00:54:24,160 --> 00:54:26,640 >>WELL, THANK YOU LARISSA AND 1207 00:54:26,640 --> 00:54:28,720 THE ANSWER IS NO, WE HAVEN'T 1208 00:54:28,720 --> 00:54:29,760 FOLLOWED THE STUDY NOW. 1209 00:54:29,760 --> 00:54:32,280 IT WAS KIND OF A PROOF OF 1210 00:54:32,280 --> 00:54:32,600 CONCEPT. 1211 00:54:32,600 --> 00:54:35,000 WE WANTED TO SEE WHETHER IN REAL 1212 00:54:35,000 --> 00:54:37,760 LIFE WE COULD IMPLEMENT SUCH A 1213 00:54:37,760 --> 00:54:42,040 PROBLPROGRAM HAS THE ONE DONE IE 1214 00:54:42,040 --> 00:54:42,360 U.S. 1215 00:54:42,360 --> 00:54:44,560 AND BASICALLY, WE WANTED TO SEE 1216 00:54:44,560 --> 00:54:48,440 IF WE COULD SHORTEN IT WHICH WE 1217 00:54:48,440 --> 00:54:50,600 DID, AND WHETHER THAT WOULD WORK 1218 00:54:50,600 --> 00:54:53,800 BUT OUR MAIN OUTCOMES WAS NOT 1219 00:54:53,800 --> 00:54:55,120 THE REDUCTION IN THE INCIDENTS 1220 00:54:55,120 --> 00:54:57,360 OF DIABETES BUT ACTUALLY 1221 00:54:57,360 --> 00:54:58,840 REDUCTION IN WEIGHT BECAUSE IT 1222 00:54:58,840 --> 00:55:03,200 WAS A SHORT TIME TO DEMONSTRATE 1223 00:55:03,200 --> 00:55:07,200 ANY CHANGES IN DIABETES 1224 00:55:07,200 --> 00:55:07,880 INCIDENTS. 1225 00:55:07,880 --> 00:55:14,600 AND WE DID SHOW THAT LOSING 1226 00:55:14,600 --> 00:55:16,880 WEIGHT IS POSSIBLE BUT TO SEE A 1227 00:55:16,880 --> 00:55:20,040 LONG -- I MEAN, TO SEE RESULTS 1228 00:55:20,040 --> 00:55:24,720 AT THE LONGER TIME, WE HAVEN'T 1229 00:55:24,720 --> 00:55:26,760 FOLLOWED THEM BUT WE WOULD, I 1230 00:55:26,760 --> 00:55:30,880 WOULD SUGGEST AND THINK THAT THE 1231 00:55:30,880 --> 00:55:34,080 MAIN FACTOR TO SEE PROLONGED 1232 00:55:34,080 --> 00:55:38,320 EFFECT OF THE INTERVENTIONS, IS 1233 00:55:38,320 --> 00:55:43,120 TO THE WEIGHT LOST WITH NOT BE 1234 00:55:43,120 --> 00:55:44,040 INCREASING LATER ON. 1235 00:55:44,040 --> 00:55:47,600 SO I WOULD SAY THAT STRATEGIES 1236 00:55:47,600 --> 00:55:50,000 TO KEEP THE WEIGHT LOSS TO AVOID 1237 00:55:50,000 --> 00:55:51,880 WEIGHT GAIN AND TO CONTINUE 1238 00:55:51,880 --> 00:55:54,920 LOSING WEIGHT AND CHANGE A 1239 00:55:54,920 --> 00:55:58,320 LIFESTYLE HABITS, THE LIFESTYLE, 1240 00:55:58,320 --> 00:55:59,160 ARE ESSENTIAL. 1241 00:55:59,160 --> 00:56:03,480 WE WANTED TO HAVE THE LOW RISK 1242 00:56:03,480 --> 00:56:05,160 GROUP AS I MENTIONED AND THAT 1243 00:56:05,160 --> 00:56:07,640 WAS UNFORTUNATE BECAUSE WE HAD 1244 00:56:07,640 --> 00:56:08,480 THE PANDEMIC. 1245 00:56:08,480 --> 00:56:11,600 JUST WHEN WE STARTED THAT, THE 1246 00:56:11,600 --> 00:56:13,600 PANDEMIC CAME AND PEOPLE WERE 1247 00:56:13,600 --> 00:56:16,440 KEPT IN THEIR HOUSES AND AS WE 1248 00:56:16,440 --> 00:56:18,840 LEARNED FROM A QUESTIONNAIRE, WE 1249 00:56:18,840 --> 00:56:22,480 GAVE TO THEM AND THEY WORKED 1250 00:56:22,480 --> 00:56:26,520 MUCH LESS, THEY INCREASED THEIR 1251 00:56:26,520 --> 00:56:30,080 FOOD INTAKE OF STARCH MAINLY 1252 00:56:30,080 --> 00:56:31,600 ALTHOUGH THE GENERAL FOOD INTAKE 1253 00:56:31,600 --> 00:56:37,160 WAS DECREASED BECAUSE OF THE 1254 00:56:37,160 --> 00:56:38,560 UNAVAILABILITY AND THESE WERE 1255 00:56:38,560 --> 00:56:41,480 PEOPLE WITH LOW INCOME SO WE 1256 00:56:41,480 --> 00:56:44,920 HAVEN'T BEEN REALLY ABLE TO 1257 00:56:44,920 --> 00:56:47,280 CONCLUDE WHAT WE WANTED FROM THE 1258 00:56:47,280 --> 00:56:48,840 LOW RISK GROUP AND THAT IS WHAT 1259 00:56:48,840 --> 00:56:52,800 WE'RE DOING NOW. 1260 00:56:52,800 --> 00:56:53,480 TRYING TO UNDERSTAND WHAT 1261 00:56:53,480 --> 00:56:54,440 HAPPENED WITH THEM. 1262 00:56:54,440 --> 00:56:57,040 ABOUT SCALING, WELL,NESS, I 1263 00:56:57,040 --> 00:56:59,680 THINK THAT BEING ABLE TO LOWER 1264 00:56:59,680 --> 00:57:02,360 IT TO AROUND 10 SESSIONS, THAT'S 1265 00:57:02,360 --> 00:57:04,760 FEASIBLE AND THAT CAN BE SCALED 1266 00:57:04,760 --> 00:57:14,800 AND WE HOPE TO DO THAT IN THE 1267 00:57:14,800 --> 00:57:16,400 NEAR FUTURE. 1268 00:57:16,400 --> 00:57:17,240 >>Chair Aviles-Santa: THANK 1269 00:57:17,240 --> 00:57:17,400 YOU. 1270 00:57:17,400 --> 00:57:17,880 THANK YOU VERY MUCH. 1271 00:57:17,880 --> 00:57:19,920 WHAT ARE THE CHALLENGES RELATED 1272 00:57:19,920 --> 00:57:21,680 TO TIMELY SCREENING ASK 1273 00:57:21,680 --> 00:57:25,640 DIAGNOSIS OF DIABETES, 1274 00:57:25,640 --> 00:57:26,480 ESPECIALLY CONSIDERING THE 1275 00:57:26,480 --> 00:57:31,440 CONTEXT OF POVERTY OR EVEN LOW 1276 00:57:31,440 --> 00:57:32,400 RESOURCE SETTINGS? 1277 00:57:32,400 --> 00:57:34,760 AND NOT ADEQUATE ACCESS TO 1278 00:57:34,760 --> 00:57:36,800 MEDICAL CARE, WE HEARD OF YOUR 1279 00:57:36,800 --> 00:57:38,640 MODEL AND YOUR INTERVENTION AND 1280 00:57:38,640 --> 00:57:43,280 WE WOULD LIKE TO HEAR MORE ABOUT 1281 00:57:43,280 --> 00:57:46,120 THE SOCIAL CHALLENGES AND WHAT 1282 00:57:46,120 --> 00:57:49,920 ARE THE POTENTIAL SOLUTIONS TO 1283 00:57:49,920 --> 00:57:51,480 OVERCOME AND MAKE THIS 1284 00:57:51,480 --> 00:57:57,240 INTERVENTIONS MORE EFFECTIVE AT 1285 00:57:57,240 --> 00:57:58,360 COULD BE REACHED BY THE 1286 00:57:58,360 --> 00:57:58,640 POPULATION. 1287 00:57:58,640 --> 00:58:02,480 >>THANK YOU, LARISSA. 1288 00:58:02,480 --> 00:58:05,280 YES, THE QUESTION IS QUITE 1289 00:58:05,280 --> 00:58:05,520 CLEAR. 1290 00:58:05,520 --> 00:58:08,000 ON THE DIAGNOSIS FROM THE POINT 1291 00:58:08,000 --> 00:58:12,120 OF VIEW FROM THE COST, FOR US, 1292 00:58:12,120 --> 00:58:15,120 THE BEST IDEA IS TO COMBINE THE 1293 00:58:15,120 --> 00:58:17,120 FIELD RISK THAT IS ONLY PENCIL 1294 00:58:17,120 --> 00:58:20,520 AND PAPER NOT MORE ON THAT AND 1295 00:58:20,520 --> 00:58:23,920 JUST IN CASE THAT YOU HAVE A 1296 00:58:23,920 --> 00:58:30,160 SCORE OF 8 OR 13, WE PERFORM A 1297 00:58:30,160 --> 00:58:32,880 GLUCOSE TEST BECAUSE IT SEEMS 1298 00:58:32,880 --> 00:58:36,000 IT'S ONLY HAVE TO MEASURE BLOOD 1299 00:58:36,000 --> 00:58:39,080 GLUCOSE AND IT'S VERY SIMPLE, 1300 00:58:39,080 --> 00:58:42,160 IT'S QUITE WELL STANDARDIZED 1301 00:58:42,160 --> 00:58:42,720 ANYWHERE. 1302 00:58:42,720 --> 00:58:45,360 AND WITH THIS CONDITION, WE CAN 1303 00:58:45,360 --> 00:58:47,640 APPLY A PREVENTION STRATEGY 1304 00:58:47,640 --> 00:58:49,320 BASED ON EDUCATION AND EDUCATION 1305 00:58:49,320 --> 00:58:55,600 IS A GOOD WAY TO PROMOTE EARLY 1306 00:58:55,600 --> 00:58:57,160 REACTION AND EARLY TREATMENT FOR 1307 00:58:57,160 --> 00:58:59,720 THE PATIENT AND IN OUR CASE IT'S 1308 00:58:59,720 --> 00:59:01,720 THE BEST WAY AND THE MOST 1309 00:59:01,720 --> 00:59:03,720 EFFECTIVE WAY TO TREAT THE 1310 00:59:03,720 --> 00:59:05,120 PATIENTS AND TO AFTER THE 1311 00:59:05,120 --> 00:59:06,920 DIAGNOSIS HA I MENTIONED HOW TO 1312 00:59:06,920 --> 00:59:14,080 DO IT AND THANK YOU. 1313 00:59:14,080 --> 00:59:15,040 >>Chair Aviles-Santa: THANK 1314 00:59:15,040 --> 00:59:16,080 YOU, DOCTOR. 1315 00:59:16,080 --> 00:59:19,560 NOW, FOR Dr. ASCHNER, HAVE 1316 00:59:19,560 --> 00:59:21,000 DIABETES PREVENTION PROGRAMS 1317 00:59:21,000 --> 00:59:23,360 ALSO DEMONSTRATED THE PREVENTION 1318 00:59:23,360 --> 00:59:25,760 OF CARDIOVASCULAR DISEASE IN 1319 00:59:25,760 --> 00:59:27,640 LATIN AMERICA? 1320 00:59:27,640 --> 00:59:30,720 OR DO YOU THINK THAT WITHIN THE 1321 00:59:30,720 --> 00:59:33,880 CONTEXT OF DIABETES PREVENTION 1322 00:59:33,880 --> 00:59:35,040 PROGRAMS, OTHER PREVENTIONS 1323 00:59:35,040 --> 00:59:37,240 COULD BE INTEGRATED FOR OTHER 1324 00:59:37,240 --> 00:59:38,400 CHRONIC CONDITIONS COULD BE 1325 00:59:38,400 --> 00:59:40,640 INTEGRATED AND HOW? 1326 00:59:40,640 --> 00:59:45,560 >>THAT'S A VERY CHALLENGING 1327 00:59:45,560 --> 00:59:48,840 QUESTION BECAUSE, IT IS NOT EASY 1328 00:59:48,840 --> 00:59:51,240 TO DEMONSTRATE WHETHER THERE'S A 1329 00:59:51,240 --> 00:59:53,520 LOWER INCIDENTS OF 1330 00:59:53,520 --> 00:59:55,120 CARDIOVASCULAR DISEASE BY 1331 00:59:55,120 --> 00:59:56,640 PREVENTING DIABETES. 1332 00:59:56,640 --> 00:59:58,760 IT SEEMS TO BE FROM THE 1333 00:59:58,760 --> 01:00:00,360 THEORETICAL POINT OF VIEW IT 1334 01:00:00,360 --> 01:00:03,840 SEEMS TO BE THE CASE BUT WE 1335 01:00:03,840 --> 01:00:06,080 DON'T KNOW BECAUSE WE ARE ONLY 1336 01:00:06,080 --> 01:00:08,680 IF WE DO REALLY CHANGE THE 1337 01:00:08,680 --> 01:00:10,920 NATURAL HISTORY OF DIABETES, WE 1338 01:00:10,920 --> 01:00:13,760 WOULD EXPECT LESS CARDIOVASCULAR 1339 01:00:13,760 --> 01:00:15,760 DISEASE BUT CERTAINLY ANY 1340 01:00:15,760 --> 01:00:25,120 STRATEGY THAT UNCOVERS THE RISK 1341 01:00:25,120 --> 01:00:26,720 THAT CALLS FOR ACTION AND IF WE 1342 01:00:26,720 --> 01:00:29,600 ACTUALLY DO ACT IN TERMS OF 1343 01:00:29,600 --> 01:00:32,400 CHANGING LIFESTYLE WILL 1344 01:00:32,400 --> 01:00:35,040 CERTAINLY BE LESS CARDIOVASCULAR 1345 01:00:35,040 --> 01:00:37,600 IN THE INCIDENTS OF CARD YE 1346 01:00:37,600 --> 01:00:38,920 VASCULAR ACCIDENTS AND THAT 1347 01:00:38,920 --> 01:00:41,120 HASN'T BEEN PROVEN AND CERTAINLY 1348 01:00:41,120 --> 01:00:43,360 NOT IN LATIN AMERICA. 1349 01:00:43,360 --> 01:00:47,000 AND ON THE OTHER HAND, YOU ARE 1350 01:00:47,000 --> 01:00:49,880 RIGHT, THE STRATEGY SHOULD BE 1351 01:00:49,880 --> 01:00:52,800 COMPREHENSIVE AND NOT JUST 1352 01:00:52,800 --> 01:00:54,280 FOCUSING ON BLOOD GLUCOSE BUT 1353 01:00:54,280 --> 01:00:58,080 ALSO FOCUSING ON LIPIDS, 1354 01:00:58,080 --> 01:01:01,280 FOCUSING ON HYPERTENSION, AND 1355 01:01:01,280 --> 01:01:04,280 DEFINITELY FOCUSING ON OBESITY 1356 01:01:04,280 --> 01:01:08,480 AND THAT IS FUNDAMENTAL AND ALSO 1357 01:01:08,480 --> 01:01:10,600 OTHER BAD HABITS SO TO SPEAK AND 1358 01:01:10,600 --> 01:01:12,920 WE'RE ACTUALLY DOING THAT 1359 01:01:12,920 --> 01:01:14,800 BECAUSE STUDYING WHAT HAPPENED 1360 01:01:14,800 --> 01:01:16,800 WITH HIM BECAUSE WE ENDED UP 1361 01:01:16,800 --> 01:01:20,080 BEING EXPLORE THE RISK FACTORS 1362 01:01:20,080 --> 01:01:22,400 AND SEEING WHAT KIND OF CHANGES 1363 01:01:22,400 --> 01:01:26,480 WE WERE WELCOME BACK TO OBTAIN. 1364 01:01:26,480 --> 01:01:27,440 >>THANK YOU Dr. ASCHNER. 1365 01:01:27,440 --> 01:01:29,240 THANK YOU, VERY MUCH. 1366 01:01:29,240 --> 01:01:32,400 I HAVE A QUESTION FOR THE TWO OF 1367 01:01:32,400 --> 01:01:33,000 YOU. 1368 01:01:33,000 --> 01:01:34,200 ACTUALLY TWO QUESTIONS. 1369 01:01:34,200 --> 01:01:37,360 SO, ONE OF THEM IS, HOW WOULD 1370 01:01:37,360 --> 01:01:39,440 YOU DESCRIBE THE IDEAL IMAGE TO 1371 01:01:39,440 --> 01:01:41,040 PROMOTE DIABETES PREVENTION AND 1372 01:01:41,040 --> 01:01:44,680 ACROSS LATIN AMERICA AND U.S. 1373 01:01:44,680 --> 01:01:45,760 HISPANICS LATINOS. 1374 01:01:45,760 --> 01:01:49,480 WHAT COMPONENTS, WHO WOULD BE 1375 01:01:49,480 --> 01:01:53,600 THE MAIN PLAYERS, ACADEMIC 1376 01:01:53,600 --> 01:01:55,000 CENTERS AND COMMUNITIES AND 1377 01:01:55,000 --> 01:01:59,480 ORGANIZATIONS AND WHAT KIND OF 1378 01:01:59,480 --> 01:02:01,480 RESEARCH WOULD BE INVOLVED OR 1379 01:02:01,480 --> 01:02:06,960 EVEN RESEARCH CAPACITY? 1380 01:02:06,960 --> 01:02:08,840 >>GO AHEAD. 1381 01:02:08,840 --> 01:02:13,040 >>OK. 1382 01:02:13,040 --> 01:02:17,720 FROM MAYBE PROBLEM IS PROBLEM OF 1383 01:02:17,720 --> 01:02:21,000 FATE AND YOU BELIEVE IN THAT IF 1384 01:02:21,000 --> 01:02:23,000 YOU ADOPT HEALTHY HABITS, WE ARE 1385 01:02:23,000 --> 01:02:27,440 GOING TO PREVENT CARDIOVASCULAR 1386 01:02:27,440 --> 01:02:30,800 DIABETES AND IN OUR CASE, WE 1387 01:02:30,800 --> 01:02:32,240 STILL BELIEVE THAT THIS IS 1388 01:02:32,240 --> 01:02:34,480 REALLY TRUE AND AGAIN, FROM OUR 1389 01:02:34,480 --> 01:02:36,360 POINT OF VIEW, EDUCATION AT 1390 01:02:36,360 --> 01:02:40,200 EVERY LEVEL IS THE BEST WAY TO 1391 01:02:40,200 --> 01:02:43,120 OBTAIN PREVENTION AND PREVENTION 1392 01:02:43,120 --> 01:02:47,960 FIRST COST AND THE SECOND ONE IS 1393 01:02:47,960 --> 01:02:51,400 TREATMENT OF THE THREE THINGS 1394 01:02:51,400 --> 01:02:56,400 SUGGESTED BY THEM BY THE AIM 1395 01:02:56,400 --> 01:03:00,160 MEANS HYPERTENSION OBESITY AND 1396 01:03:00,160 --> 01:03:01,920 HYPER GLYCEMIA AND IF YOU GET 1397 01:03:01,920 --> 01:03:02,920 ALL THINGS TOGETHER YOU ARE 1398 01:03:02,920 --> 01:03:04,800 GOING TO BE PREVENT 1399 01:03:04,800 --> 01:03:06,480 COMPLICATIONS, FIRST OF ALL THE 1400 01:03:06,480 --> 01:03:11,120 DIABETES DISEASE AND SECOND THE 1401 01:03:11,120 --> 01:03:13,520 COMPLICATIONS THAT IS THE SIMPLE 1402 01:03:13,520 --> 01:03:16,360 RECIPE DIFFICULT TO GET IT AND 1403 01:03:16,360 --> 01:03:19,200 VERY, VERY COMPLICATE AND YOU 1404 01:03:19,200 --> 01:03:21,120 HAVE TO HAVE A VERY GOOD TEAM 1405 01:03:21,120 --> 01:03:22,560 READY TO ACT IMMEDIATELY AND AS 1406 01:03:22,560 --> 01:03:25,440 SOON AS POSSIBLE AND TO 1407 01:03:25,440 --> 01:03:27,000 TREATMENT ALL THE COMPLICATIONS 1408 01:03:27,000 --> 01:03:31,120 THAT YOU HAVE TO PREVENT. 1409 01:03:31,120 --> 01:03:34,360 THANK YOU. 1410 01:03:34,360 --> 01:03:36,160 >>I AGREE AND I WOULD SAY THIS 1411 01:03:36,160 --> 01:03:39,960 WOULD BE A PARALLEL STRATEGY AS 1412 01:03:39,960 --> 01:03:41,920 IN TERMS OF USING RESOURCES, FOR 1413 01:03:41,920 --> 01:03:43,280 EXAMPLE, WE CONDITION USE THE 1414 01:03:43,280 --> 01:03:46,680 RESOURCE THAT'S ARE NOW DESTINED 1415 01:03:46,680 --> 01:03:49,480 TO TREAT DIABETES AND WE SAW 1416 01:03:49,480 --> 01:03:52,680 FROM THE TALK AND HOW POORLY WE 1417 01:03:52,680 --> 01:03:54,240 ARE TREATED PEOPLE WITH DIABETES 1418 01:03:54,240 --> 01:03:56,240 WOULD KIND OF TAKE RESOURCES 1419 01:03:56,240 --> 01:04:02,360 HUMAN RESOURCES AND MONEY FROM 1420 01:04:02,360 --> 01:04:04,760 THE DIABETES TO PREVENT DIABETES 1421 01:04:04,760 --> 01:04:06,040 AND WE HAVE TO DO IT WITH 1422 01:04:06,040 --> 01:04:07,840 DIFFERENT RESOURCES AND ONE OF 1423 01:04:07,840 --> 01:04:10,080 THE MAIN RESULTS OF OUR STUDY 1424 01:04:10,080 --> 01:04:14,840 WAS THAT THIS CAN BE DONE WITH 1425 01:04:14,840 --> 01:04:16,200 PEOPLE FROM THE COMMUNITY. 1426 01:04:16,200 --> 01:04:17,040 WE DON'T NEED HEALTH 1427 01:04:17,040 --> 01:04:19,040 PROFESSIONALS WHO ARE ALREADY 1428 01:04:19,040 --> 01:04:21,680 HAVING A LOT OF WORK BY TREATING 1429 01:04:21,680 --> 01:04:23,160 PEOPLE WITH DIABETES AND WE CAN 1430 01:04:23,160 --> 01:04:27,560 DO IT WITH CULTURES, WELL 1431 01:04:27,560 --> 01:04:30,160 TRAINED, AND IN THAT WAY AND WE 1432 01:04:30,160 --> 01:04:32,800 ARE NOT CONSUMING THE RESOURCES 1433 01:04:32,800 --> 01:04:41,560 FOR DIABETES AND ALSO, IN TERMS 1434 01:04:41,560 --> 01:04:45,520 OF USING RESOURCES, WE HAVE TO 1435 01:04:45,520 --> 01:04:49,480 HAVE IN MIND THAT AS WE SCREEN 1436 01:04:49,480 --> 01:04:51,720 FOR PEOPLE WITH PRE DIABETES WE 1437 01:04:51,720 --> 01:04:54,200 WILL HAVE A HIGHER BURDEN ON 1438 01:04:54,200 --> 01:04:55,440 MONDAY THE HEALTH SERVICES IN 1439 01:04:55,440 --> 01:04:56,560 TREATING PEOPLE WITH DIABETES 1440 01:04:56,560 --> 01:04:58,560 AND WE MIGHT INCREASE THE NUMBER 1441 01:04:58,560 --> 01:05:01,520 OF DIABETES TWICE OR MORE, TWO 1442 01:05:01,520 --> 01:05:05,400 FOLDS OR MORE, SO WE HAVE TO BE 1443 01:05:05,400 --> 01:05:06,600 PREPARED FOR THAT I WOULD 1444 01:05:06,600 --> 01:05:08,680 SUGGEST WE SHOULD START BY DOING 1445 01:05:08,680 --> 01:05:12,440 IT IN THE OPPORTUNISTIC WAY THAT 1446 01:05:12,440 --> 01:05:14,800 MEANS INSIDE THE SYSTEM. 1447 01:05:14,800 --> 01:05:15,840 ARE THERE A LOT OF PEOPLE INSIDE 1448 01:05:15,840 --> 01:05:20,880 THE SYSTEM HAVING BEEN DIAGNOSED 1449 01:05:20,880 --> 01:05:26,080 PRE DIABETES AND NOT WITH 1450 01:05:26,080 --> 01:05:27,520 EMPHASIS BUT THEY HAVE GONE 1451 01:05:27,520 --> 01:05:29,880 THROUGH A OGPT OR WHATEVER AND 1452 01:05:29,880 --> 01:05:31,120 THEY'RE FLOATING AROUND AND THEY 1453 01:05:31,120 --> 01:05:35,960 HAVE NO TREATMENT AND THEY HAVE 1454 01:05:35,960 --> 01:05:37,400 NOT BEEN PROPERLY ADDRESS AND 1455 01:05:37,400 --> 01:05:39,000 THEY HAVEN'T BEEN INCORPORATED 1456 01:05:39,000 --> 01:05:41,000 INTO PREVENTION PROGRAMS AND SO 1457 01:05:41,000 --> 01:05:43,640 INSIDE THE SYSTEM WE SHOULD 1458 01:05:43,640 --> 01:05:45,880 START THERE BY SPOTTING THESE 1459 01:05:45,880 --> 01:05:49,880 PEOPLE WITH PRE DIABETES AND 1460 01:05:49,880 --> 01:05:53,120 SUGGESTING, AND INVISITING THEM 1461 01:05:53,120 --> 01:05:55,680 TO SPECIAL PROGRAMS WHERE WE 1462 01:05:55,680 --> 01:05:57,160 HAVE DIABETES SHOULD WE SHOULD 1463 01:05:57,160 --> 01:05:59,720 HAVE A PROGRAM FOR PREVENTING 1464 01:05:59,720 --> 01:06:02,000 DIABETES AND FOR PEOPLE WITH PRE 1465 01:06:02,000 --> 01:06:08,400 DIABETES SO THAT WE CAN ADDRESS 1466 01:06:08,400 --> 01:06:08,600 THAT. 1467 01:06:08,600 --> 01:06:10,040 >>THANK YOU Dr. ASCHNER. 1468 01:06:10,040 --> 01:06:12,640 SO I HAVE ONE MORE QUESTION AND 1469 01:06:12,640 --> 01:06:15,120 MOVING FROM PREVENTING DIABETES, 1470 01:06:15,120 --> 01:06:20,760 MOVING TO DIABETES, WHAT ARE THE 1471 01:06:20,760 --> 01:06:21,920 EMERGING OR OBVIOUS 1472 01:06:21,920 --> 01:06:23,880 OPPORTUNITIES FOR RESEARCH AND 1473 01:06:23,880 --> 01:06:26,280 RESEARCH QUESTIONS AND DIABETES 1474 01:06:26,280 --> 01:06:30,080 AND THAT YOU SEE THAT COULD BE 1475 01:06:30,080 --> 01:06:34,280 PROPOSED IN COLLABORATION ACROSS 1476 01:06:34,280 --> 01:06:35,720 COUNTRIES IN LATIN AMERICA AND 1477 01:06:35,720 --> 01:06:38,360 IT'S RELEVANT AND COULD BE A 1478 01:06:38,360 --> 01:06:40,240 COLLABORATION WITH INVESTIGATORS 1479 01:06:40,240 --> 01:06:44,120 THAT ARE INTERESTED AND THAT ARE 1480 01:06:44,120 --> 01:06:45,400 INTERESTED AND HISPANIC 1481 01:06:45,400 --> 01:06:50,160 POPULATION AND THIS IS ABOUT 1482 01:06:50,160 --> 01:06:50,440 DIABETES. 1483 01:06:50,440 --> 01:06:52,400 >>SORRY, PABLO. 1484 01:06:52,400 --> 01:06:54,520 I WILL TAKE ADVANTAGE OF YOUR 1485 01:06:54,520 --> 01:06:55,000 WORK. 1486 01:06:55,000 --> 01:06:58,080 YOU MENTIONED OPPORTUNISTIC 1487 01:06:58,080 --> 01:06:59,640 APPROACH AND THIS MEANS THAT YOU 1488 01:06:59,640 --> 01:07:03,400 HAVE TO GO TO PRIMARY CARE LEVEL 1489 01:07:03,400 --> 01:07:04,960 AND THIS IS THE FIRST CONTACT 1490 01:07:04,960 --> 01:07:06,920 THAT THE PEOPLE HAVE WITH THE 1491 01:07:06,920 --> 01:07:10,160 HEALTH SYSTEM AND THEN IF YOU 1492 01:07:10,160 --> 01:07:11,440 HAVE THIS OPPORTUNITIES APPROACH 1493 01:07:11,440 --> 01:07:14,560 YOU ARE TAKING CARE OF THE FOR 1494 01:07:14,560 --> 01:07:16,200 EXAMPLE THE FIELD RISK AND THE 1495 01:07:16,200 --> 01:07:19,200 ORAL GLUCOSE COLORRANCE AND NO 1496 01:07:19,200 --> 01:07:20,960 MATTER THE PATIENTS COMES TO SEE 1497 01:07:20,960 --> 01:07:24,240 THE APPOINTMENT FOR ANYTHING AND 1498 01:07:24,240 --> 01:07:26,040 ANYTHING ELSE YOU MADE THESE 1499 01:07:26,040 --> 01:07:28,600 THINGS AND THIS IS THE 1500 01:07:28,600 --> 01:07:29,320 OPPORTUNITY APPROACH AND YOU 1501 01:07:29,320 --> 01:07:32,320 HAVE A LARGE POPULATION AND YOU 1502 01:07:32,320 --> 01:07:34,560 CAN MAKE AN EARLY DIAGNOSTIC OF 1503 01:07:34,560 --> 01:07:35,760 DIABETES AND EARLY TREATMENT 1504 01:07:35,760 --> 01:07:39,640 THAT MEANS THAT YOU ARE GOING IN 1505 01:07:39,640 --> 01:07:41,520 THE BEST WAY TO PREVENT THE 1506 01:07:41,520 --> 01:07:42,920 DEVELOPMENT OF THE DISEASE AND 1507 01:07:42,920 --> 01:07:46,360 THE DEVELOPMENT OF THE 1508 01:07:46,360 --> 01:07:46,680 COMPLICATIONS. 1509 01:07:46,680 --> 01:07:48,000 THIS IS A WAY WE ARE USING THIS 1510 01:07:48,000 --> 01:07:49,440 AND THIS IS THE BEST RESULT 1511 01:07:49,440 --> 01:07:53,200 THAT'S WE HAVE OBTAINED IN OUR 1512 01:07:53,200 --> 01:07:53,760 POPULATION. 1513 01:07:53,760 --> 01:07:56,880 PERHAPS PABLO HAS SIMILAR 1514 01:07:56,880 --> 01:07:58,560 EXPERIENCES AND I WOULD LIKE TO 1515 01:07:58,560 --> 01:08:00,600 SEE WHAT IS THERE IN THE 1516 01:08:00,600 --> 01:08:03,640 POSITION THAT HE HAS. 1517 01:08:03,640 --> 01:08:04,880 >>Dr. ASCHNER. 1518 01:08:04,880 --> 01:08:08,160 >>WELL, THIS IS ALWAYS A 1519 01:08:08,160 --> 01:08:12,560 DISCUSSION AMONG EPIDEMIOLOGISTS 1520 01:08:12,560 --> 01:08:14,880 WHETHER TO ADDRESS OUR EFFORTS 1521 01:08:14,880 --> 01:08:18,560 TO THE POPULATION AND HAVE A 1522 01:08:18,560 --> 01:08:23,200 LITTLE IMPACT IN A LOT OF PEOPLE 1523 01:08:23,200 --> 01:08:24,960 OR ADDRESS TO PEOPLE WITH HIGH 1524 01:08:24,960 --> 01:08:29,400 PICK AND HAVE A BIG IMPACT ON A 1525 01:08:29,400 --> 01:08:30,480 SMALL AMOUNT OF PEOPLE AND I 1526 01:08:30,480 --> 01:08:32,400 THINK WE HAVE TO DO BOTH BUT IT 1527 01:08:32,400 --> 01:08:35,920 DEPENDS ON THE RESOURCE AND WE 1528 01:08:35,920 --> 01:08:37,560 HAVE TO BE PREPARED TO HANDLE 1529 01:08:37,560 --> 01:08:42,360 WHATEVER WE DO, WHATEVER WE TRY 1530 01:08:42,360 --> 01:08:47,200 AND ABOUT YOUR QUESTION, LARI 1531 01:08:47,200 --> 01:08:51,360 LARISSA, I THERE ARE MANY, MANY 1532 01:08:51,360 --> 01:08:53,960 ISSUES THAT HAVEN'T BEEN 1533 01:08:53,960 --> 01:08:56,240 PROPERLY ADDRESSED. 1534 01:08:56,240 --> 01:08:59,480 I WOULD SAY ONE MAIN ISSUE IS 1535 01:08:59,480 --> 01:09:02,800 THE FACT THAT ALTHOUGH THAT WAS 1536 01:09:02,800 --> 01:09:06,280 SHOWN, WE HAVE A LOT OF TOOLS TO 1537 01:09:06,280 --> 01:09:07,120 TREAT DIABETES. 1538 01:09:07,120 --> 01:09:09,880 WE STILL HAVE A VERY POOR 1539 01:09:09,880 --> 01:09:12,880 PERFORMANCE IN TERMS OF HAVING 1540 01:09:12,880 --> 01:09:15,680 PEOPLE THAT GO AND IT SEEMS THAT 1541 01:09:15,680 --> 01:09:19,560 EVEN WHEN YOU ADD INSULIN, IT'S 1542 01:09:19,560 --> 01:09:20,760 EVEN WORSE. 1543 01:09:20,760 --> 01:09:24,840 IF INSULIN WAS A TREATMENT FOR 1544 01:09:24,840 --> 01:09:27,480 FAILURE AND IT ALL HAS TO DO 1545 01:09:27,480 --> 01:09:30,400 WITH INERTIA AND SO WE HAVE TO 1546 01:09:30,400 --> 01:09:33,040 STUDY WHAT IS GOING ON WITH 1547 01:09:33,040 --> 01:09:33,400 INERTIA. 1548 01:09:33,400 --> 01:09:39,160 WHAT ARE THE MAIN OBSTACLES THAT 1549 01:09:39,160 --> 01:09:40,760 PRODUCE INERTIA IN THE TREATMENT 1550 01:09:40,760 --> 01:09:42,440 OF DIABETES AND I WOULD START BY 1551 01:09:42,440 --> 01:09:45,040 THE BIGGEST INERTIA OF ALL WHICH 1552 01:09:45,040 --> 01:09:48,280 IS LOSING WEIGHT. 1553 01:09:48,280 --> 01:09:52,600 WE HAVEN'T BEEN SUCCESSFUL IN 1554 01:09:52,600 --> 01:09:54,920 GETTING OUR PATIENCE WITH TYPE 1555 01:09:54,920 --> 01:09:57,920 TWO DIABETES AT THE BEGINNING TO 1556 01:09:57,920 --> 01:09:58,560 LOSE WEIGHT. 1557 01:09:58,560 --> 01:10:00,120 WE KNOW FROM STUDIES LIKE THE 1558 01:10:00,120 --> 01:10:01,880 DIRECT STUDY IF YOU START EARLY, 1559 01:10:01,880 --> 01:10:04,400 AND YOU HAVE A REAL GOOD RESULT, 1560 01:10:04,400 --> 01:10:08,400 YOU CAN EVEN GET REMISSION OF 1561 01:10:08,400 --> 01:10:08,760 DIABETES. 1562 01:10:08,760 --> 01:10:14,520 AND I APPLAUD THE NEW STATEMENT 1563 01:10:14,520 --> 01:10:17,600 OF THE ASD WHERE THEY PUT THE 1564 01:10:17,600 --> 01:10:21,880 TREATMENT OF OBESITY IN THE 1565 01:10:21,880 --> 01:10:24,320 HIGHEST PLACE EQUAL TO THE 1566 01:10:24,320 --> 01:10:25,880 TREATMENT OF OF BLOOD GLUCOSE 1567 01:10:25,880 --> 01:10:27,800 AND OTHER RISK FACTORS SO 1568 01:10:27,800 --> 01:10:30,280 INERTIA I WOULD SAY MEANS MORE 1569 01:10:30,280 --> 01:10:31,960 ATTENTION EXPLORING WHAT IS 1570 01:10:31,960 --> 01:10:35,000 HAPPENING AND PROBABLY THAT HAS 1571 01:10:35,000 --> 01:10:37,160 TO DO WITH A LOT OF VARIABLES 1572 01:10:37,160 --> 01:10:40,400 THAT ARE DIFFERENT IN DIFFERENT 1573 01:10:40,400 --> 01:10:41,840 REGIONS AND PROBABLY DIFFERENT 1574 01:10:41,840 --> 01:10:44,640 EVEN IN DIFFERENT COUNTRIES IN 1575 01:10:44,640 --> 01:10:45,280 LATIN AMERICA. 1576 01:10:45,280 --> 01:10:47,440 AND IN THE U.S. WITH THE 1577 01:10:47,440 --> 01:10:49,560 HISPANIC POPULATION BUT WE COULD 1578 01:10:49,560 --> 01:10:52,280 LEARN FROM THAT COMPARING THAT 1579 01:10:52,280 --> 01:10:56,840 THE DIFFERENT ASPECTS OF THAT 1580 01:10:56,840 --> 01:10:57,080 PROBLEM. 1581 01:10:57,080 --> 01:11:01,760 >>THANK YOU Dr. ASCHNER. 1582 01:11:01,760 --> 01:11:05,960 ANY QUESTIONS FROM THE SPEAKERS. 1583 01:11:05,960 --> 01:11:08,840 I DON'T SEE ANY QUESTIONS POSTED 1584 01:11:08,840 --> 01:11:12,320 IN THE CHAT. 1585 01:11:12,320 --> 01:11:13,800 WE ARE FOUR MINUTES AWAY FROM 1586 01:11:13,800 --> 01:11:14,440 THE BREAK. 1587 01:11:14,440 --> 01:11:15,880 I WANT TO GIVE AN OPPORTUNITY 1588 01:11:15,880 --> 01:11:19,440 FOR ANY OF THE SPEAKERS TO ASK 1589 01:11:19,440 --> 01:11:23,200 ANY QUESTIONS OR, OR Dr. 1590 01:11:23,200 --> 01:11:27,480 ASCHNER AND Dr. GAGLIARDINO -- 1591 01:11:27,480 --> 01:11:28,160 ONE SECOND. 1592 01:11:28,160 --> 01:11:30,720 I SEE ONE. 1593 01:11:30,720 --> 01:11:33,200 THERE'S A QUESTION. 1594 01:11:33,200 --> 01:11:34,360 CAN THE CURRENT SPEAKER ADDRESS 1595 01:11:34,360 --> 01:11:36,120 THE RELATIONSHIP WITH 1596 01:11:36,120 --> 01:11:38,280 INCORPORATE INFLUENCE THAT IS 1597 01:11:38,280 --> 01:11:46,080 PUT IN THE INCREASE IN DIABETES. 1598 01:11:46,080 --> 01:11:49,760 >>WELL, THE FOOD INDUSTRY IS 1599 01:11:49,760 --> 01:11:52,360 ALWAYS THE CULPRIT, ISN'T IT. 1600 01:11:52,360 --> 01:11:56,240 AND I'M NOT SURE THAT IT'S ONLY 1601 01:11:56,240 --> 01:11:57,840 THEIR FAULT BECAUSE WE ARE THE 1602 01:11:57,840 --> 01:12:02,040 ONES WHO CHOSE FOODS AND I 1603 01:12:02,040 --> 01:12:04,440 REMEMBER, I WENT TO CONGRESS IN 1604 01:12:04,440 --> 01:12:06,840 CHILE OBESITY CONGRESS AND ONE 1605 01:12:06,840 --> 01:12:11,160 OF THE STANDS WAS MCDONALD'S AND 1606 01:12:11,160 --> 01:12:13,920 I WAS SURPRISED AND ASKED THEM, 1607 01:12:13,920 --> 01:12:16,080 WELL, IT'S INTERESTING TO SEE 1608 01:12:16,080 --> 01:12:18,200 YOU IN THIS CONFERENCE AND WE 1609 01:12:18,200 --> 01:12:20,480 SAID WE WANT TO SHOW WE HAVE 1610 01:12:20,480 --> 01:12:21,520 HEALTHY FOOD TO OFFER. 1611 01:12:21,520 --> 01:12:25,040 WE DO HAVE HEALTHY FOOD BUT 1612 01:12:25,040 --> 01:12:26,120 PEOPLE JUST DON'T BUY IT. 1613 01:12:26,120 --> 01:12:28,480 THEY DON'T GO TO MCDONALD'S TO 1614 01:12:28,480 --> 01:12:32,600 HAVE HEALTHY FOOD AND IT'S A 1615 01:12:32,600 --> 01:12:35,240 QUESTION OF NOT JUST WHAT THEY 1616 01:12:35,240 --> 01:12:39,040 PRODUCE, BUT HOW WE CONSUME IT. 1617 01:12:39,040 --> 01:12:41,280 I AGREE THAT AND IN OUR 1618 01:12:41,280 --> 01:12:42,520 COUNTRIES, ACTUALLY IN COLOMBIA, 1619 01:12:42,520 --> 01:12:46,560 WE HAVE JUST RECENTLY APPROVED 1620 01:12:46,560 --> 01:12:49,800 THE LABELS ON THE FOOD SHOWING 1621 01:12:49,800 --> 01:12:52,160 WHICH ARE MORE HARMFUL THAN 1622 01:12:52,160 --> 01:12:55,120 OTHERS AND CERTAINLY, THAT HELPS 1623 01:12:55,120 --> 01:12:57,880 AND PEOPLE CHOOSING, BETTER 1624 01:12:57,880 --> 01:13:02,440 HAVING BETTER CHOICES NOT 1625 01:13:02,440 --> 01:13:04,280 NECESSARILY CHOICES THAT WILL 1626 01:13:04,280 --> 01:13:06,440 REDUCE WEIGHT WHICH IS ONE OF 1627 01:13:06,440 --> 01:13:10,440 THE MAIN DRIVERS OF DIABETES AND 1628 01:13:10,440 --> 01:13:12,680 STILL IT IS HAPPENING AND IT'S 1629 01:13:12,680 --> 01:13:17,960 CHANGING AND I WOULD SAY IT 1630 01:13:17,960 --> 01:13:19,960 STARTS WITH SCHOOLS. 1631 01:13:19,960 --> 01:13:21,600 CHILDREN DO HAVE TO LEARN WHAT 1632 01:13:21,600 --> 01:13:23,760 WE EAT AND EVEN INFLUENCE THEIR 1633 01:13:23,760 --> 01:13:26,960 PARENTS AND THEIR FAMILIES AND 1634 01:13:26,960 --> 01:13:31,320 HAVE A BETTER CONSUMPTION OF 1635 01:13:31,320 --> 01:13:31,520 FOOD. 1636 01:13:31,520 --> 01:13:35,760 >>YES, I MEAN AND THE PROBLEM 1637 01:13:35,760 --> 01:13:40,000 REASON THAT OBESITY IS NOT JUST 1638 01:13:40,000 --> 01:13:44,560 PROBLEM HEALTH SYSTEM AND WE 1639 01:13:44,560 --> 01:13:47,160 NEED A ROUND CABLE IS POVERTY 1640 01:13:47,160 --> 01:13:50,400 AND POVERTY IS NOT A PROBLEM AND 1641 01:13:50,400 --> 01:13:53,360 SYSTEM IT'S A PROBLEM OF 1642 01:13:53,360 --> 01:13:53,560 ECONOMY. 1643 01:13:53,560 --> 01:13:55,360 AND LOW EDUCATION IS NOT THE 1644 01:13:55,360 --> 01:14:01,200 PROBLEM OF DIABETES ON THE 1645 01:14:01,200 --> 01:14:04,120 HEALTH SYHEALTH SYSTEM. 1646 01:14:04,120 --> 01:14:06,440 MASS MEDIA IS PROMOTING ALWAYS 1647 01:14:06,440 --> 01:14:08,720 THE HEALTHY HABITS AND THEN WE 1648 01:14:08,720 --> 01:14:11,880 NEED THESE THINGS AND YOU NEED 1649 01:14:11,880 --> 01:14:15,080 THE POPULATION AND EDUCATION AND 1650 01:14:15,080 --> 01:14:17,520 THROUGH THIS SYSTEM AND ALL 1651 01:14:17,520 --> 01:14:19,920 TOGETHER, IS GOING LIKE A AND 1652 01:14:19,920 --> 01:14:21,520 WE'RE GOING TO NOTICE. 1653 01:14:21,520 --> 01:14:23,680 YOU ARE ONLY MISSENNING AND THEY 1654 01:14:23,680 --> 01:14:25,560 MADE THEIR AGREEMENT BETWEEN 1655 01:14:25,560 --> 01:14:26,640 DIFFERENT INSTRUMENTS AND AS 1656 01:14:26,640 --> 01:14:28,680 SOON AS YOU GET THE SECOND 1657 01:14:28,680 --> 01:14:30,200 DIRECTOR YOU HAVE THE AGREEMENT 1658 01:14:30,200 --> 01:14:32,080 AND YOU GET THE MEL BEE AND WE 1659 01:14:32,080 --> 01:14:35,960 HAVE TO GET THE MELODY WORKING 1660 01:14:35,960 --> 01:14:37,880 ALL TOGETHER IN COORDINATING WAY 1661 01:14:37,880 --> 01:14:41,040 AND THAT IS THE ONLY WAY THAT 1662 01:14:41,040 --> 01:14:42,600 MAKES THE SOLUTION FOR THE 1663 01:14:42,600 --> 01:14:43,400 PROBLEM. 1664 01:14:43,400 --> 01:14:46,840 OTHERWISE, WE ARE GOING TO GET 1665 01:14:46,840 --> 01:14:47,040 LOST. 1666 01:14:47,040 --> 01:14:48,640 >>THANK YOU Dr. ASCHNER AND 1667 01:14:48,640 --> 01:14:57,080 THANK YOU Dr. GAGLAIARINO. 1668 01:14:57,080 --> 01:14:58,760 WE'RE GOING TO A BREAK NOW, 1669 01:14:58,760 --> 01:15:01,240 AFTER THE BREAK, WE WILL BE BACK 1670 01:15:01,240 --> 01:15:06,440 WITH ANOTHER SESSION. 1671 01:15:06,440 --> 01:15:06,960 >>THANK YOU. 1672 01:15:06,960 --> 01:15:09,840 >>THANK YOU TO EVERYBODY AND 1673 01:15:09,840 --> 01:15:11,880 PABLO AND LARISSA AS WELL. 1674 01:15:11,880 --> 01:15:12,120 BYE-BYE. 1675 01:15:12,120 --> 01:15:12,640 >>YES. 1676 01:15:12,640 --> 01:15:22,880 >>BYE-BYE. 1677 01:24:41,480 --> 01:24:42,640 >>WELCOME BACK FROM THE BREAK. 1678 01:24:42,640 --> 01:24:44,760 I WANT TO REITERATE, SEND IN 1679 01:24:44,760 --> 01:24:46,200 YOUR QUESTIONS FOR ANY OF THE 1680 01:24:46,200 --> 01:24:47,640 SPEAKERS AND SO WE CAN ADDRESS 1681 01:24:47,640 --> 01:24:50,640 THEM DURING THE LIVE Q&A 1682 01:24:50,640 --> 01:24:51,040 SESSION. 1683 01:24:51,040 --> 01:24:57,680 YOU CAN E-MAIL IT. 1684 01:24:57,680 --> 01:25:01,560 AND AGAIN, PLEASE COMPLETE THE 1685 01:25:01,560 --> 01:25:05,240 SLIDE POLL AT SLIDEO.COM AND 1686 01:25:05,240 --> 01:25:08,640 TYPE IN LATAM SO THAT WE KNOW 1687 01:25:08,640 --> 01:25:10,040 WHERE YOU ARE JOINING FROM 1688 01:25:10,040 --> 01:25:10,280 TODAY. 1689 01:25:10,280 --> 01:25:11,680 SO NOW WE'RE GOING TO GET 1690 01:25:11,680 --> 01:25:13,240 STARTED AND RESUME THE 1691 01:25:13,240 --> 01:25:14,200 PROCEEDINGS RIGHT AWAY. 1692 01:25:14,200 --> 01:25:15,720 I WILL NOW TURN THINGS OVER TO 1693 01:25:15,720 --> 01:25:17,520 THE MODERATOR FOR THE NEXT 1694 01:25:17,520 --> 01:25:19,840 SESSION, Dr. LARISSA 1695 01:25:19,840 --> 01:25:20,160 AVILES-SANTA. 1696 01:25:20,160 --> 01:25:24,720 THANK YOU. 1697 01:25:24,720 --> 01:25:28,120 >>Chair Aviles-Santa: GOOD 1698 01:25:28,120 --> 01:25:29,080 MORNING, AGAIN. 1699 01:25:29,080 --> 01:25:31,440 MY NAME IS LARISSA AVILES-SANTA. 1700 01:25:31,440 --> 01:25:33,600 I AM THE MODERATOR OF THE SECOND 1701 01:25:33,600 --> 01:25:36,880 TOPIC OF THE OUR WORKSHOP, CAR 1702 01:25:36,880 --> 01:25:38,800 YO VASCULAR DISEASES AND RISK 1703 01:25:38,800 --> 01:25:39,040 FACTORS. 1704 01:25:39,040 --> 01:25:43,440 OUR ANNALISTS ARE Dr. FERNANDO 1705 01:25:43,440 --> 01:25:47,480 LANAS ZANETTI AND Dr. PATRICIO 1706 01:25:47,480 --> 01:25:49,600 LOPEZ JARAMILLO. 1707 01:25:49,600 --> 01:25:51,280 WE WILL HAVE A LIVE Q&A AFTER 1708 01:25:51,280 --> 01:25:56,640 THE PRESENTATIONS, LET'S BEGIN. 1709 01:25:56,640 --> 01:25:59,120 >>GOOD MORNING, I WOULD LIKE 1710 01:25:59,120 --> 01:26:00,120 FIRST TO THANK THE OPPORTUNITIES 1711 01:26:00,120 --> 01:26:02,920 TO BE PART OF THIS IMPORTANT 1712 01:26:02,920 --> 01:26:03,160 WORKSHOP. 1713 01:26:03,160 --> 01:26:08,160 AND SECOND TO APOLOGIZE FOR MY 1714 01:26:08,160 --> 01:26:12,400 VOICE BUT I AM IN THE MIDDLE OF 1715 01:26:12,400 --> 01:26:12,760 A SEVERE CORD. 1716 01:26:12,760 --> 01:26:16,600 IF WE LOOK AT THE CARDIOVASCULAR 1717 01:26:16,600 --> 01:26:18,000 DISEASE IN LATIN AMERICA AND 1718 01:26:18,000 --> 01:26:21,960 IT'S AROUND A MILLION DEATHS A 1719 01:26:21,960 --> 01:26:24,000 YEAR, HEART DISEASE IS THE MOST 1720 01:26:24,000 --> 01:26:28,080 IMPORTANT WITH THE FULLY 2% OF 1721 01:26:28,080 --> 01:26:33,400 THE TOTAL, WE STUDIED A CAUSES 1722 01:26:33,400 --> 01:26:34,920 OF MIO CARDIA IN FUNCTION IN 1723 01:26:34,920 --> 01:26:38,680 CASE CONTROL STUDY NAMED INTER 1724 01:26:38,680 --> 01:26:42,160 HEART, AND YOU CAN SEE FROM OUR 1725 01:26:42,160 --> 01:26:44,040 REGION, OBESITY IS THE RISK 1726 01:26:44,040 --> 01:26:46,440 FACTORS WITH THE GREATER 1727 01:26:46,440 --> 01:26:48,840 POPULATION ACHIEVABLE RISK FOR 1728 01:26:48,840 --> 01:26:52,880 LOW DIABETES EP DEEMIA AND 1729 01:26:52,880 --> 01:26:53,680 HYPERTENSION. 1730 01:26:53,680 --> 01:26:56,280 THE SECOND CAUSE OF 1731 01:26:56,280 --> 01:26:57,920 CARDIOVASCULAR DISEASE IS 1732 01:26:57,920 --> 01:27:02,440 STROKE, THAT IS RESPONSIBLE FOR 1733 01:27:02,440 --> 01:27:06,920 29% OF THE MORTALITY AND WE 1734 01:27:06,920 --> 01:27:08,720 STUDY THE CAUSES FOR STROKE IN 1735 01:27:08,720 --> 01:27:12,240 ANOTHER CASE CONTROL STUDY NAMED 1736 01:27:12,240 --> 01:27:18,520 INTER TR STROKE AND HYPERTENSION 1737 01:27:18,520 --> 01:27:26,640 WAS THE MAIN RISK OF 50% FOR 1738 01:27:26,640 --> 01:27:31,560 THAT IS DIET AND ABDOMINAL OBESE 1739 01:27:31,560 --> 01:27:34,480 TEASE SO YOU CAN SEE THAT FOR 1740 01:27:34,480 --> 01:27:37,720 BOTH, DISEASES, THE RISK FACTORS 1741 01:27:37,720 --> 01:27:40,320 REALLY ARE THE SAME IF YOU HAVE 1742 01:27:40,320 --> 01:27:43,400 HYPERTENSION, YOU HAVE MORE THAN 1743 01:27:43,400 --> 01:27:45,200 80% OF THE CAUSES OF DEATH IN 1744 01:27:45,200 --> 01:27:49,800 THE REGION. 1745 01:27:49,800 --> 01:27:51,560 THERE ARE SOME DIFFERENCES 1746 01:27:51,560 --> 01:27:53,360 BETWEEN LATIN AMERICA AND THE 1747 01:27:53,360 --> 01:27:57,600 REST OF THE WORLD IN THE 1748 01:27:57,600 --> 01:28:00,440 POPULATION OF RISK. 1749 01:28:00,440 --> 01:28:06,120 FOR OUR REGION, WAYS TO HIT 1750 01:28:06,120 --> 01:28:08,400 RATIO AS MEASUREMENT OF OBESITY 1751 01:28:08,400 --> 01:28:11,480 IT'S THE MOST IMPORTANT, WE 1752 01:28:11,480 --> 01:28:14,920 DON'T HAVE MUCH DIFFERENCE IN 1753 01:28:14,920 --> 01:28:18,280 TERM OF THE TOBACCO ASSOCIATED 1754 01:28:18,280 --> 01:28:21,760 WITH RISK AND ALSO IN 1755 01:28:21,760 --> 01:28:23,200 HYPERTENSION AND STRESS SEEMS TO 1756 01:28:23,200 --> 01:28:31,880 BE MORE IMPORTANT IN OUR REGION. 1757 01:28:31,880 --> 01:28:34,480 IN THE FEW THAT IT IS BIG COVER 1758 01:28:34,480 --> 01:28:39,080 THE STUDY THAT INCLUDES FROM 1759 01:28:39,080 --> 01:28:41,240 LATIN AMERICA AND ARGENTINA, 1760 01:28:41,240 --> 01:28:43,600 BRAZIL AND COLOMBIA AND CHILE, 1761 01:28:43,600 --> 01:28:47,200 WE WERE ABLE TO CONFIRM OUR 1762 01:28:47,200 --> 01:28:51,560 RESULTS AND THE POPULATION 1763 01:28:51,560 --> 01:28:55,600 ACHIEVED A FRACTION FOR CARD YE 1764 01:28:55,600 --> 01:28:57,200 VASCULAR DISEASE FOR 1765 01:28:57,200 --> 01:29:04,480 HYPERTENSION IS 22% FOR TOBACCO 1766 01:29:04,480 --> 01:29:09,440 15% AND ABDOMINAL OBESITY 14%. 1767 01:29:09,440 --> 01:29:12,760 THAT IS THE FACT AOR WENT TO 1768 01:29:12,760 --> 01:29:16,200 IMPROVE THE PROGNOSIS OF 1769 01:29:16,200 --> 01:29:19,920 CARDIOVASCULAR DISEASE IN THE 1770 01:29:19,920 --> 01:29:25,160 REGION AND ALSO DIABETES IS 1771 01:29:25,160 --> 01:29:26,680 IMPORTANT AND YOU CAN SEE THE 1772 01:29:26,680 --> 01:29:27,760 DIFFERENCE BETWEEN REGIONS ARE 1773 01:29:27,760 --> 01:29:33,520 QUITE MARKED. 1774 01:29:33,520 --> 01:29:35,400 IF WE GO TO HYPERTENSION THE 1775 01:29:35,400 --> 01:29:41,200 MAIN RISK FACTORS IN TWO COHORTS 1776 01:29:41,200 --> 01:29:45,960 IN LATIN AMERICA AND INCLUDES 1777 01:29:45,960 --> 01:29:48,320 SUBJECTS FROM ARGENTINA ALL THE 1778 01:29:48,320 --> 01:29:51,720 WAY AND CHILE AND WE CAN 1779 01:29:51,720 --> 01:29:54,520 SUMMARIZE THE RESULTS SAYING 1780 01:29:54,520 --> 01:29:56,320 THAT FOR EACH HYPERTENSION I 1781 01:29:56,320 --> 01:29:58,720 HAVES IN THE REGION, FOUR FOUR 1782 01:29:58,720 --> 01:30:02,080 ARE NOT AWARE OF IT AND SO THOSE 1783 01:30:02,080 --> 01:30:06,360 ARE THE PERSON WHO ARRIVED WITH 1784 01:30:06,360 --> 01:30:11,000 THE STROKE OR HEART FAILURE AND 1785 01:30:11,000 --> 01:30:14,000 THEY NEVER KNOW THEY ARE 1786 01:30:14,000 --> 01:30:14,480 HYPERTENSIVE. 1787 01:30:14,480 --> 01:30:16,440 FROM THOSE TREATED THAT HALF OF 1788 01:30:16,440 --> 01:30:20,080 THE HYPERTENSIVES IN OUR SAMPLE, 1789 01:30:20,080 --> 01:30:22,360 THREE OF THEM DOES NOT HAVE 1790 01:30:22,360 --> 01:30:26,240 BLOOD PRESSURE CONTROL AND SO I 1791 01:30:26,240 --> 01:30:30,520 THINK THAT THE RESEARCH ON 1792 01:30:30,520 --> 01:30:39,000 SURVEYS TO BLOOD PRESSURE 1793 01:30:39,000 --> 01:30:43,920 CONTROL ARE IMPORTANT RESEARCH 1794 01:30:43,920 --> 01:30:44,160 AREAS. 1795 01:30:44,160 --> 01:30:48,200 SO SECOND, I WOULD LIKE TO SPEAK 1796 01:30:48,200 --> 01:30:52,840 ABOUT SECONDARY PREVENTION IT'S 1797 01:30:52,840 --> 01:30:55,040 CONSIDERED A LOW-HANGING FRUIT 1798 01:30:55,040 --> 01:30:56,480 BECAUSE IT'S WITH A NEED TO 1799 01:30:56,480 --> 01:31:01,800 SCREEN AND WE ALREADY KNOW THAT 1800 01:31:01,800 --> 01:31:03,440 WE HAVE THE DISEASE AND SIMPLE 1801 01:31:03,440 --> 01:31:09,040 TREATMENT CAN REDUCE THE RATE BY 1802 01:31:09,040 --> 01:31:14,680 TWO-THIRDS. 1803 01:31:14,680 --> 01:31:16,360 AND THOSE ARE THE RESULTS FROM 1804 01:31:16,360 --> 01:31:20,120 THOSE LOOK AT HEALTHY LIFESTYLE 1805 01:31:20,120 --> 01:31:22,040 BEHAVIOR AND THAT MEANS THOSE 1806 01:31:22,040 --> 01:31:26,160 WHO FOLLOW DIET, RECOMMENDATIONS 1807 01:31:26,160 --> 01:31:30,480 WHO DO EXERCISE AND DO NOT 1808 01:31:30,480 --> 01:31:31,080 SMOKE. 1809 01:31:31,080 --> 01:31:33,080 DO WE HAVE THE RESULTS FROM 1810 01:31:33,080 --> 01:31:36,960 SOUTH AMERICA? 1811 01:31:36,960 --> 01:31:41,160 THIS IS MORE CLEAR BUT REPRESENT 1812 01:31:41,160 --> 01:31:44,680 THOSE THAT HAVE A MAJOR EVENT IN 1813 01:31:44,680 --> 01:31:48,800 MY STROKE AND CONTINUOUS SMOKING 1814 01:31:48,800 --> 01:31:52,080 AND DO NOT FOLLOW DIET, AND DO 1815 01:31:52,080 --> 01:31:55,760 NOT DO EXERCISES AND THEY ARE AT 1816 01:31:55,760 --> 01:31:59,480 20% AND THERE'S MORE AND IT'S 1817 01:31:59,480 --> 01:32:03,520 THE PREPORTION OF THOSE WHO HAVE 1818 01:32:03,520 --> 01:32:05,440 A HEALTHY LIFESTYLE IN OUR 1819 01:32:05,440 --> 01:32:14,560 REGION AFTER A MAJOR EVENT. 1820 01:32:14,560 --> 01:32:19,680 WE CAN SEE A CERTAIN OF THEM 1821 01:32:19,680 --> 01:32:25,200 RECEIVED ANTI-PLATELETS AN AND 1822 01:32:25,200 --> 01:32:26,960 LEAVING THEM ONE OF THE FIVE 1823 01:32:26,960 --> 01:32:30,360 STUDIES AND THIS IS RESULTS ARE 1824 01:32:30,360 --> 01:32:37,280 VALID AND HOWEVER, UNFORTUNA 1825 01:32:37,280 --> 01:32:47,800 UNFORTUNATELY, THREE TIMES THE 1826 01:33:28,760 --> 01:33:29,760 MORTALITY IN HIGH INCOME 1827 01:33:29,760 --> 01:33:31,200 COUNTRIES AND THAT IS HAPPENING 1828 01:33:31,200 --> 01:33:35,240 FOR TOTAL MORTALITY. 1829 01:33:35,240 --> 01:33:37,160 AND THIS ILLUSTRATED THE 1830 01:33:37,160 --> 01:33:40,880 WEAKNESS OF OUR HEALTH SYSTEM 1831 01:33:40,880 --> 01:33:44,920 AND AGAIN, MORE AREAS FOR 1832 01:33:44,920 --> 01:33:46,120 RESEARCH. 1833 01:33:46,120 --> 01:33:50,120 RECENTLY WE PUBLISHED THE 1834 01:33:50,120 --> 01:33:58,120 TRANSFER H -- AND IT HAS DECREAD 1835 01:33:58,120 --> 01:34:01,480 IN THE 1% CHANGE OF 2.5% AND 1836 01:34:01,480 --> 01:34:05,480 IT'S QUITE DIFFERENT IN 1837 01:34:05,480 --> 01:34:10,280 DIFFERENT REGIONS SEW IN NORTH 1838 01:34:10,280 --> 01:34:14,640 AMERICA WE HAVE A ADEQUATE 1839 01:34:14,640 --> 01:34:25,160 REDUCTION OF MORTALITY AND IN 1840 01:34:27,320 --> 01:34:30,640 THE CENTRAL AMERICA, MEXICO AND 1841 01:34:30,640 --> 01:34:37,280 WE ARE LEADING THE MORTALITY 1842 01:34:37,280 --> 01:34:39,640 HASN'T BEEN REDUCED IN THE LAST 1843 01:34:39,640 --> 01:34:40,720 20 YEARS. 1844 01:34:40,720 --> 01:34:44,040 FINALLY, I WOULD LIKE TO SHOW 1845 01:34:44,040 --> 01:34:47,440 THAT HEALTH POLICY CHANGE IS 1846 01:34:47,440 --> 01:34:49,440 IMPACTING CARDIOVASCULAR DISEASE 1847 01:34:49,440 --> 01:34:54,720 AND IT'S THE CASE OF CHILE AND 1848 01:34:54,720 --> 01:34:57,240 SINCE 2004, THEY PROVIDE A GUN 1849 01:34:57,240 --> 01:35:00,440 TEE TO ACCESS OPPORTUNITIES AND 1850 01:35:00,440 --> 01:35:04,520 PROTECTION AND QUALITY AND TO 85 1851 01:35:04,520 --> 01:35:10,760 HEALTH CONDITIONS WHERE IMPLEME. 1852 01:35:10,760 --> 01:35:16,120 BY LOW WE MUST PROVIDE ANGIE 1853 01:35:16,120 --> 01:35:17,920 OWEPLASTY TO INDIVIDUALS WHO ARE 1854 01:35:17,920 --> 01:35:19,440 ATTENDING ANY HOSPITAL OR CLINIC 1855 01:35:19,440 --> 01:35:20,880 IN THE COUNTRY. 1856 01:35:20,880 --> 01:35:23,080 AND ALSO, SECONDARY PREVENTION 1857 01:35:23,080 --> 01:35:28,000 IS INCLUDED. 1858 01:35:28,000 --> 01:35:30,600 AND WE HAD STROKE HYPERTENSION 1859 01:35:30,600 --> 01:35:34,920 AND DIABETES AND YOU CAN SEE HOW 1860 01:35:34,920 --> 01:35:39,920 MUCH THE DROP IN ADJUSTED 1861 01:35:39,920 --> 01:35:44,280 MORTALITY FOR HEART DISEASE IS 1862 01:35:44,280 --> 01:35:54,800 FOR MALE AND FEMALE AND SO IN 1863 01:35:58,320 --> 01:36:00,960 MUM REAND IN LATIN AMERICA 1864 01:36:00,960 --> 01:36:05,160 THEY'RE FREQUENT AND EASY TO 1865 01:36:05,160 --> 01:36:15,640 IDENTIFY AND WE ALL KNOW THE 1866 01:36:20,840 --> 01:36:25,000 RICH FACTOR FOR CARDIO AND 1867 01:36:25,000 --> 01:36:27,360 ASSOCIATED AND WITH POVERTY, LOW 1868 01:36:27,360 --> 01:36:29,360 EDUCATION AND LEVEL OF 1869 01:36:29,360 --> 01:36:31,680 MINORITIES AND WE MAY NOT BE 1870 01:36:31,680 --> 01:36:33,920 MORE ON THIS RISK FACTOR 1871 01:36:33,920 --> 01:36:37,520 PREVALENCE AND DISTRIBUTION BUT, 1872 01:36:37,520 --> 01:36:39,640 WHAT WE ALL NEED IS INFORMATION 1873 01:36:39,640 --> 01:36:42,160 ABOUT THE IMPLEMENTATION OF 1874 01:36:42,160 --> 01:36:45,160 EFFECTIVE INTERVENTION AND 1875 01:36:45,160 --> 01:36:49,960 ESPECIALLY IN LOW RESOURCE 1876 01:36:49,960 --> 01:36:50,200 SETTINGS. 1877 01:36:50,200 --> 01:36:50,720 THANK YOU. 1878 01:36:50,720 --> 01:36:55,880 >>GOOD MORNING, I AM Dr. 1879 01:36:55,880 --> 01:36:56,840 JARAMILLO FROM COLOMBIA. 1880 01:36:56,840 --> 01:36:59,880 FIRST OF ALL, I WOULD LIKE TO 1881 01:36:59,880 --> 01:37:02,480 SAY THANK YOU FOR THE KIND 1882 01:37:02,480 --> 01:37:03,760 INVITATION TO PARTICIPATE OF 1883 01:37:03,760 --> 01:37:11,000 THIS IMPORTANT ACTIVITY. 1884 01:37:11,000 --> 01:37:14,120 IN SOUTH AMERICA, THE PRINCIPLE 1885 01:37:14,120 --> 01:37:19,800 CAUSE OF MORTALITY IS 1886 01:37:19,800 --> 01:37:22,000 CARDIOVASCULAR DISEASE AND THAT 1887 01:37:22,000 --> 01:37:25,640 THE PRINCIPLE RISK FACT OR ARE 1888 01:37:25,640 --> 01:37:33,040 HYPERTENSION, OBESITY, SMOKING, 1889 01:37:33,040 --> 01:37:37,320 DIABETES, AND LOW -- THIS IS 1890 01:37:37,320 --> 01:37:40,120 PARTICULARLY IMPORTANT TO 1891 01:37:40,120 --> 01:37:51,480 EXPLAIN THE PARTIC PARTICULAR AN 1892 01:37:59,080 --> 01:37:59,280 DISEASES. 1893 01:37:59,280 --> 01:38:01,520 AND AS WAS PRESENTED ALREADY, 1894 01:38:01,520 --> 01:38:05,000 THESE ARE THE RISK FACTORS 1895 01:38:05,000 --> 01:38:07,560 ASSOCIATED TO DIABETES GLOBALLY 1896 01:38:07,560 --> 01:38:12,160 AND AND DIABETES AND WAIT TO AND 1897 01:38:12,160 --> 01:38:14,680 ARE THE PRINCIPLE BUT ONE SCENE 1898 01:38:14,680 --> 01:38:22,600 THAT IS IMPORTANT, IS TO SHOW 1899 01:38:22,600 --> 01:38:26,200 THAT OF DIABETESS DEPENDING OF 1900 01:38:26,200 --> 01:38:36,640 THE INCOME OF THE COUNTRIES. 1901 01:38:38,080 --> 01:38:39,840 FROM LOW INCOME COUNTRIES 1902 01:38:39,840 --> 01:38:43,240 PRESENT AND INCREASE OF ALMOST 1903 01:38:43,240 --> 01:38:47,360 SIX TIMES HIGHER PREVALENCE OF 1904 01:38:47,360 --> 01:38:47,920 DIABETES. 1905 01:38:47,920 --> 01:38:52,760 IT'S THE SAME WHEN YOU EVALUATE 1906 01:38:52,760 --> 01:38:55,360 WAYS TO SIN CREASE ALMOST FOUR 1907 01:38:55,360 --> 01:38:57,240 TIMES HIGHER PREVALENCE OF 1908 01:38:57,240 --> 01:38:59,280 DIABETES IN PEOPLE WITH THE 1909 01:38:59,280 --> 01:39:01,600 LOWER LEVELS OF ABDOMINAL 1910 01:39:01,600 --> 01:39:02,520 OBESITY. 1911 01:39:02,520 --> 01:39:04,800 WHY IS THE REASON? 1912 01:39:04,800 --> 01:39:07,080 AS WE HAVE PROPOSED SOME TIME 1913 01:39:07,080 --> 01:39:10,160 AGO, IS THAT ALL POPULATIONS 1914 01:39:10,160 --> 01:39:13,280 PRESENT AN INCREASE OF 1915 01:39:13,280 --> 01:39:14,840 SENSITIVITY TO DEVELOP LOW 1916 01:39:14,840 --> 01:39:18,720 DEGREE INFLAMMATION AND INSULIN 1917 01:39:18,720 --> 01:39:24,040 RESISTANT TO LOW LEVELS OF THIS 1918 01:39:24,040 --> 01:39:30,000 IS CERTAINLY ASSOCIATED WITH NO 1919 01:39:30,000 --> 01:39:34,400 SO THE METABOLIC SYNDROME 1920 01:39:34,400 --> 01:39:36,480 PROBABLY HAVE AS ONE OF THE 1921 01:39:36,480 --> 01:39:42,240 PRINCIPLE MECHANISMS THE 1922 01:39:42,240 --> 01:39:46,920 RELATION BETWEEN OBESITY AND 1923 01:39:46,920 --> 01:39:48,760 MUSS LIEU CAR STRENGTH AND THIS 1924 01:39:48,760 --> 01:39:51,720 IS PRODUCING INSULIN REDUCE TEE, 1925 01:39:51,720 --> 01:39:53,160 LOW AGREE INFLAMMATION AND OF 1926 01:39:53,160 --> 01:39:56,000 COURSE AN INCREASE RISK OF 1927 01:39:56,000 --> 01:39:57,960 DIABETES TYPE 2 AND CARD YE 1928 01:39:57,960 --> 01:40:00,120 VASCULAR DISEASE AND LET'S GO TO 1929 01:40:00,120 --> 01:40:02,640 SHOW SOME EVIDENCE THAT SUPPORTS 1930 01:40:02,640 --> 01:40:08,400 THESE PROPOSALS. 1931 01:40:08,400 --> 01:40:12,960 FIRST, WE EVER USE. 1932 01:40:12,960 --> 01:40:15,840 AND INDICATER OF MUSS LIEU CAR 1933 01:40:15,840 --> 01:40:21,400 STRENGTH AND AS THIS SHOWS, THIS 1934 01:40:21,400 --> 01:40:23,200 GRAPHS SHOW THE MUSCULAR 1935 01:40:23,200 --> 01:40:26,600 STRENGTH IS DEPENDING OF THE 1936 01:40:26,600 --> 01:40:28,960 COUNTRIES YOU SEE FOR INSTANCE, 1937 01:40:28,960 --> 01:40:31,120 PAKISTAN, A LOW INCOME COUNTRY, 1938 01:40:31,120 --> 01:40:36,520 FEMALE AND MALES HAVE A 1939 01:40:36,520 --> 01:40:38,160 SIGNIFICANTLY LOWER STRENGTH OF 1940 01:40:38,160 --> 01:40:43,480 POPULATION OF RISK CON TREES AS 1941 01:40:43,480 --> 01:40:45,160 CANADA AND SWEDEN AND THIS IS 1942 01:40:45,160 --> 01:40:49,720 RELATED NOT ONLY WITH THE 1943 01:40:49,720 --> 01:40:52,880 PARTICULAR ETHNIA AND THE 1944 01:40:52,880 --> 01:40:58,840 PROGRAMMING THAT IS THE 1945 01:40:58,840 --> 01:41:05,680 DETERMINATED THAT YOU HAVE LOW 1946 01:41:05,680 --> 01:41:07,360 MUSCULAR STRENGTH. 1947 01:41:07,360 --> 01:41:10,080 MUSCULAR STRENGTH IS IMPORTANT 1948 01:41:10,080 --> 01:41:12,880 PREDICT OR OF MORTALITY. 1949 01:41:12,880 --> 01:41:16,360 WE ARE SHOWING IN THIS TABLE AS 1950 01:41:16,360 --> 01:41:19,160 BY 5-KILOGRAM OR REDUCING TO 1951 01:41:19,160 --> 01:41:24,440 HAVE AN INCREASE MORTALITY MORE 1952 01:41:24,440 --> 01:41:27,200 CARDIOVASCULAR MORTALITY AND 1953 01:41:27,200 --> 01:41:29,080 IT'S DIABETES. 1954 01:41:29,080 --> 01:41:31,720 SO, IT IS IMPORTANT TO 1955 01:41:31,720 --> 01:41:36,080 UNDERSTAND THAT THERE IS NOT 1956 01:41:36,080 --> 01:41:39,200 ONLY ALSO THE MUSCULAR MASS AND 1957 01:41:39,200 --> 01:41:42,520 THE MUSCULAR STRENGTH THAT ARE 1958 01:41:42,520 --> 01:41:45,840 IN THE WAYS TO PRESENT 1959 01:41:45,840 --> 01:41:48,200 CARDIOMETABOLIC DISEASES AND NOT 1960 01:41:48,200 --> 01:41:52,440 ONLY THAT, BUT ALSO THE RATE OF 1961 01:41:52,440 --> 01:41:55,360 CASE MORTALITY IS INCREASING IN 1962 01:41:55,360 --> 01:41:59,840 PEOPLE THAT HAVE THE LOWER TECH 1963 01:41:59,840 --> 01:42:01,040 TILE. 1964 01:42:01,040 --> 01:42:03,480 YOU DID SEE IT STROKE PEOPLE 1965 01:42:03,480 --> 01:42:06,120 THAT HAVE THESE PRESENT A HIGHER 1966 01:42:06,120 --> 01:42:10,480 RISK OF DEATH IF THEY HAVE A LOW 1967 01:42:10,480 --> 01:42:13,360 HAND GRIP SO MUSCULAR STRENGTH 1968 01:42:13,360 --> 01:42:16,280 IS AN IMPORTANT FACTOR THAT WE 1969 01:42:16,280 --> 01:42:19,480 NEED TO CONSIDER IT WHEN WE ARE 1970 01:42:19,480 --> 01:42:21,280 TALKING ABOUT THE MANAGEMENT THE 1971 01:42:21,280 --> 01:42:23,880 RISK OF CARDIOVASCULAR DISEASE 1972 01:42:23,880 --> 01:42:26,160 IN COUNTRIES AT THE LATIN 1973 01:42:26,160 --> 01:42:28,200 AMERICA AND ONE OF THE PEOPLE AS 1974 01:42:28,200 --> 01:42:31,440 THE LATINA AMERICAN LIVING IN 1975 01:42:31,440 --> 01:42:33,160 THE UNITED STATES THAT PRESENT 1976 01:42:33,160 --> 01:42:36,440 AN INCREASE RATES TO THEIR RATE 1977 01:42:36,440 --> 01:42:39,240 OF DIABETES AND CARDIOVASCULAR 1978 01:42:39,240 --> 01:42:39,480 DISEASE. 1979 01:42:39,480 --> 01:42:43,800 WE HAVE SHOWN EARLY, SOME YEARS 1980 01:42:43,800 --> 01:42:45,920 AGO, THAT ANY INCREASE OF ONE 1981 01:42:45,920 --> 01:42:48,560 KILOGRAM OF MUSCULAR STRENGTH OF 1982 01:42:48,560 --> 01:42:51,720 GRIP IS ASSOCIATED WITH A LOWER 1983 01:42:51,720 --> 01:42:57,200 RISK OF CARDIOVASCULAR AND MIO 1984 01:42:57,200 --> 01:43:00,640 CARTAL AND A MORTALITY OF ALL 1985 01:43:00,640 --> 01:43:02,760 CAUSE IF YOU HAVE ONLY AN 1986 01:43:02,760 --> 01:43:04,920 INCREASE OF ONE KILOGRAM SO, 1987 01:43:04,920 --> 01:43:08,800 THIS IS SUPPORTING THAT NEEDED 1988 01:43:08,800 --> 01:43:13,600 THAT WE HAVE TO IMPROVE OR 1989 01:43:13,600 --> 01:43:16,160 ACKNOWLEDGE ABOUT MUSCULAR 1990 01:43:16,160 --> 01:43:17,840 ASSOCIATED WITH CHRONIC DISEASES 1991 01:43:17,840 --> 01:43:19,960 THAT IS INTERESTING THAT THE IN 1992 01:43:19,960 --> 01:43:23,880 YOUR REGION, MEDICAL DOCTORS AND 1993 01:43:23,880 --> 01:43:27,200 THE TEAM OF OCCURRED HEALTH TEAL 1994 01:43:27,200 --> 01:43:29,920 HAVE VERY LOW KNOWLEDGE ABOUT 1995 01:43:29,920 --> 01:43:32,440 THE IMPORTANCE OF MUSCULAR 1996 01:43:32,440 --> 01:43:39,440 STRENGTH IN THE AREAS OF 1997 01:43:39,440 --> 01:43:41,400 DISEASES AND THE PROPOSAL IS 1998 01:43:41,400 --> 01:43:42,920 THIS ONE YOU HAVE IN MORE 1999 01:43:42,920 --> 01:43:45,200 COUNTRIES A HIGH PERCENT OF 2000 01:43:45,200 --> 01:43:54,720 WOMEN THAT HAVE NOT PREGNANCY 2001 01:43:54,720 --> 01:43:58,800 AND NEW BIRTH WEIGHT AND THIS 2002 01:43:58,800 --> 01:44:03,520 LOW BIRTH WEIGHT THAT IS EXPOSED 2003 01:44:03,520 --> 01:44:06,360 CHANGING THEIR LIFESTYLE OF 2004 01:44:06,360 --> 01:44:09,840 PHYSICAL INACTIVE TEE AND STRESS 2005 01:44:09,840 --> 01:44:12,920 AND LESS TO AN IMBALANCE BETWEEN 2006 01:44:12,920 --> 01:44:16,240 INFLAMMATION AND 2007 01:44:16,240 --> 01:44:18,640 ANTI-INFLAMMATION AND LOW MUSCLE 2008 01:44:18,640 --> 01:44:21,720 AND HIGH PRODUCED AN INCREASE OF 2009 01:44:21,720 --> 01:44:25,320 INFLAMMATION IF YOU CHANGE IT BY 2010 01:44:25,320 --> 01:44:31,360 GOOD MUTATION AND STRAINING YOU 2011 01:44:31,360 --> 01:44:33,200 WILL HAVE A BETTER MESS KULAR 2012 01:44:33,200 --> 01:44:35,560 MASS AND THIS DIS BALANCE 2013 01:44:35,560 --> 01:44:37,800 BETWEEN INFLAMMATION AND 2014 01:44:37,800 --> 01:44:38,200 ANTI-INFLAMMATION. 2015 01:44:38,200 --> 01:44:40,640 I WOULD LIKE TO FINISH HERE AND 2016 01:44:40,640 --> 01:44:44,560 I OPEN TO ANY QUESTIONS TO 2017 01:44:44,560 --> 01:44:48,920 DISCUSSION ABOUT THE ETH NIA NEW 2018 01:44:48,920 --> 01:44:50,000 POSSIBILITY THAT'S WE HAVE TO 2019 01:44:50,000 --> 01:45:00,520 CHANGE THE LIFESTYLE, CHANGING 2020 01:45:00,760 --> 01:45:02,000 TOE GOOD TO IMPROVE CONDITIONS 2021 01:45:02,000 --> 01:45:03,960 THE SITUATION OF CARD YE 2022 01:45:03,960 --> 01:45:06,760 VASCULAR DISEASES IN LATIN 2023 01:45:06,760 --> 01:45:07,000 AMERICA. 2024 01:45:07,000 --> 01:45:17,480 THANK YOU FOR YOUR ATTENTION. 2025 01:45:18,960 --> 01:45:20,920 >>FOR THOSE JOIN USs NOW WE 2026 01:45:20,920 --> 01:45:25,240 ARE IN THE LIVE Q&A AND THE 2027 01:45:25,240 --> 01:45:27,120 PRESENTATION OF THE SECOND TOPIC 2028 01:45:27,120 --> 01:45:31,480 OF THE WORKSHOP CARDIOVASCULAR 2029 01:45:31,480 --> 01:45:32,960 DISEASES AND RISK FACTORS IN 2030 01:45:32,960 --> 01:45:36,400 LATIN AMERICA SO WELCOME TO 2031 01:45:36,400 --> 01:45:36,680 EVERYONE. 2032 01:45:36,680 --> 01:45:37,960 WE HAVE SEVERAL QUESTIONS AND 2033 01:45:37,960 --> 01:45:43,200 THIS Q&A WILL LAST 20 MINUTES 2034 01:45:43,200 --> 01:45:45,280 AND TO 10:35 WE ARE SHIFTING TO 2035 01:45:45,280 --> 01:45:47,560 ANOTHER PRESENTATION. 2036 01:45:47,560 --> 01:45:52,080 AND SO THE FIRST VERY IS FOR 2037 01:45:52,080 --> 01:45:54,120 Dr. LANAS. 2038 01:45:54,120 --> 01:45:55,600 YOU OBSERVED THE AWARENESS, 2039 01:45:55,600 --> 01:45:56,960 TREATMENT AND CONTROL OF 2040 01:45:56,960 --> 01:45:58,520 HYPERTENSION AND OTHER 2041 01:45:58,520 --> 01:46:00,600 CARDIOVASCULAR RISK FACTORS AND 2042 01:46:00,600 --> 01:46:02,400 MEDICATION INTAKE, FOR SECONDARY 2043 01:46:02,400 --> 01:46:05,000 PREVENTION OF CARDIOVASCULAR 2044 01:46:05,000 --> 01:46:07,360 DISEASE HAS BEEN SELF-OPTIMAL IN 2045 01:46:07,360 --> 01:46:07,960 LATIN AMERICA. 2046 01:46:07,960 --> 01:46:09,640 WHAT ARE THE POTENTIAL 2047 01:46:09,640 --> 01:46:11,640 STRATEGIES TO ADDRESS THESE AND 2048 01:46:11,640 --> 01:46:13,600 WHAT HAS WORKED OR WHAT IS BEING 2049 01:46:13,600 --> 01:46:16,240 DONE RIGHT NOW. 2050 01:46:16,240 --> 01:46:24,400 >>LET ME START FIRST BY 2051 01:46:24,400 --> 01:46:28,520 SPEAKING ABOUT THE AWARENESS OF 2052 01:46:28,520 --> 01:46:30,080 HYPERTENSION AND ONE INITIATIVE 2053 01:46:30,080 --> 01:46:32,920 THAT MANY COUNTRIES IN LATIN 2054 01:46:32,920 --> 01:46:38,520 AMERICA HAS JOINED IS THE MMM 2055 01:46:38,520 --> 01:46:45,520 INITIATIVE FROM THE NOT NATIONAF 2056 01:46:45,520 --> 01:46:53,680 HYPERTENSION -- IS TO HAVE ONE 2057 01:46:53,680 --> 01:46:57,360 DAY TO RAISE THE CONCERNS ABOUT 2058 01:46:57,360 --> 01:46:58,920 HYPERTENSION IN THE WORLD IS TO 2059 01:46:58,920 --> 01:47:01,880 HAVE A FULL MONTH DEDICATED TO 2060 01:47:01,880 --> 01:47:04,560 THE ACTIVITIES SO THIS HAS TWO 2061 01:47:04,560 --> 01:47:05,920 BRANCHES REALLY. 2062 01:47:05,920 --> 01:47:12,080 ONE, IT'S TO RELATE WITH THE 2063 01:47:12,080 --> 01:47:13,000 COMMUNICATIONS ABOUT THE 2064 01:47:13,000 --> 01:47:14,320 IMPORTANCE OF HYPERTENSION TO 2065 01:47:14,320 --> 01:47:16,640 THE COMMUNITY AND IT'S STARTING 2066 01:47:16,640 --> 01:47:21,840 IN THE MEDIA AND TV AND RADIO, 2067 01:47:21,840 --> 01:47:25,840 NEWSPAPERS, AND ON THE OTHER 2068 01:47:25,840 --> 01:47:28,680 HAND, SCREENING ACTIVITIES THAT 2069 01:47:28,680 --> 01:47:34,080 TAKE PLACE IN MANY LOCATIONS IN 2070 01:47:34,080 --> 01:47:37,680 THE COUNTRIES LIKE THE HEALTH 2071 01:47:37,680 --> 01:47:42,840 SYSTEM FACILITIES, THE 2072 01:47:42,840 --> 01:47:44,960 UNIVERSITIES, THE MORGUE AND IN 2073 01:47:44,960 --> 01:47:46,720 CHILE THIS RAISES THE INTEREST 2074 01:47:46,720 --> 01:47:50,720 OF MINISTER OF HEALTH SO THE MAY 2075 01:47:50,720 --> 01:47:53,040 MONTH MEASUREMENT IS PART OF THE 2076 01:47:53,040 --> 01:47:54,720 OFFICIAL ACTIVITIES OF THE 2077 01:47:54,720 --> 01:47:58,880 MINISTRY OF HEALTH AND TO 2078 01:47:58,880 --> 01:48:01,040 IMPROVE THE KNOWLEDGE OF 2079 01:48:01,040 --> 01:48:02,720 HYPERTENSION AND THE SECOND 2080 01:48:02,720 --> 01:48:06,480 THING WE HAVE REGARDING 2081 01:48:06,480 --> 01:48:10,080 IDENTIFYING WITH A POTENTIAL IS 2082 01:48:10,080 --> 01:48:15,400 THAT IF HEALTH FACILITY MUST DO 2083 01:48:15,400 --> 01:48:18,480 GENERAL SURVEY TO THE POPULATION 2084 01:48:18,480 --> 01:48:26,000 UNDER THEIR CARE, TO ASSESS RISK 2085 01:48:26,000 --> 01:48:28,120 FACTORS WITH TOBACCO, 2086 01:48:28,120 --> 01:48:29,080 HYPERTENSION AND CHOLESTEROL AND 2087 01:48:29,080 --> 01:48:32,760 THE PREPORTION IT'S AT, EVERY 2088 01:48:32,760 --> 01:48:32,960 YEAR. 2089 01:48:32,960 --> 01:48:36,960 WITH THIS MEASUREMENTS, THE 2090 01:48:36,960 --> 01:48:39,480 KNOWLEDGE OF HYPERTENSION IN THE 2091 01:48:39,480 --> 01:48:44,080 COMMUNITY HAS RAISED FROM 23% TO 2092 01:48:44,080 --> 01:48:45,520 73% IN THE POPULATION THAT IS 2093 01:48:45,520 --> 01:48:48,720 NOT VERY HIGH BUT IT'S SOME 2094 01:48:48,720 --> 01:48:49,080 IMPROVEMENT. 2095 01:48:49,080 --> 01:48:51,800 AND IN THE AREA OF TREATMENT, 2096 01:48:51,800 --> 01:48:53,600 AGAIN, CHILE AND OTHER 2097 01:48:53,600 --> 01:48:54,760 COUNTRIES, IN THE REGISTER ON 2098 01:48:54,760 --> 01:48:57,360 HAVE JOINED THE HEART INITIATIVE 2099 01:48:57,360 --> 01:49:00,240 AND THAT IT IS FOR THOSE WHO MAY 2100 01:49:00,240 --> 01:49:03,320 NOT KNOW, IT'S A SET OF 2101 01:49:03,320 --> 01:49:07,000 ACTIVITIES THAT INCLUDES SIMPLE 2102 01:49:07,000 --> 01:49:12,520 PROTOCOLS STANDARDIZED TO MAKE 2103 01:49:12,520 --> 01:49:17,840 MEDICATION AVAILABLE FOR THE 2104 01:49:17,840 --> 01:49:19,880 HYPERTENSIVE TRIED TO USE 2105 01:49:19,880 --> 01:49:25,320 LONG-TERM MEDICATIONS AND IT 2106 01:49:25,320 --> 01:49:29,000 ALSO HAS BEEN SUCCESSFUL SO 2107 01:49:29,000 --> 01:49:35,040 PEOPLE WHO IN THE CARDIOVASCULAR 2108 01:49:35,040 --> 01:49:36,800 PROGRAM IN CHILE THE 2109 01:49:36,800 --> 01:49:40,960 HYPERTENSION IS ABOUT 66% SO, 2110 01:49:40,960 --> 01:49:44,440 TWO-THIRDS OF THE INDIVIDUALS 2111 01:49:44,440 --> 01:49:47,280 WHO HAVE BEEN SUITED FOR HYPE 2112 01:49:47,280 --> 01:49:49,400 ARE TENSION IN THE COUNTRY STILL 2113 01:49:49,400 --> 01:49:51,160 HAS NORMAL BLOOD PRESSURE BUT 2114 01:49:51,160 --> 01:49:52,920 WITH THE TWO MILLION THAT ARE 2115 01:49:52,920 --> 01:49:54,600 NOT AWARE OF BEING HYPERTENSION 2116 01:49:54,600 --> 01:49:58,080 I HAVE AND SO, WE HAVE A LOW WAY 2117 01:49:58,080 --> 01:50:02,360 TO IMPROVING OUR CARE. 2118 01:50:02,360 --> 01:50:03,000 >>Chair Aviles-Santa: THANK 2119 01:50:03,000 --> 01:50:04,400 YOU, Dr. LANAS. 2120 01:50:04,400 --> 01:50:09,160 THE NEXT QUESTION IS FOR Dr. 2121 01:50:09,160 --> 01:50:10,000 LOPEZ-JARAMILL-O ARE YOU WORKING 2122 01:50:10,000 --> 01:50:11,760 ON MUSCLE STRENGTHENING 2123 01:50:11,760 --> 01:50:13,200 INTERVENTIONS AND IF SO, COULD 2124 01:50:13,200 --> 01:50:17,840 YOU SHARE SOME OBSERVATIONS OR 2125 01:50:17,840 --> 01:50:21,280 FINDINGS? 2126 01:50:21,280 --> 01:50:23,880 >>THANK YOU. 2127 01:50:23,880 --> 01:50:26,920 WE HAVE SOME RESULTS AND 2128 01:50:26,920 --> 01:50:32,080 CLINICAL TRIALS AND USING 2129 01:50:32,080 --> 01:50:35,720 ESPECIALLY IN RESISTANT EXERCISE 2130 01:50:35,720 --> 01:50:40,640 ON THESE RESISTANT EXERCISES 2131 01:50:40,640 --> 01:50:42,280 ESPECIALLY ONCE PRODUCE A 2132 01:50:42,280 --> 01:50:46,880 REDUCTION IN HYPERTENSION 2133 01:50:46,880 --> 01:50:51,240 PATIENTS OF ABOUT (INAUDIBLE). 2134 01:50:51,240 --> 01:50:54,280 THE RESULTS OF THE STUDY FOR 2135 01:50:54,280 --> 01:50:56,920 INSTANCE WHERE WE USED TWO 2136 01:50:56,920 --> 01:50:59,080 HYPERTENSIVE MEDICATION AND 2137 01:50:59,080 --> 01:51:01,000 PRODUCE OUR REDUCE OF 6 MILLION 2138 01:51:01,000 --> 01:51:08,200 SO IT IS INCREASING AND IT IS 2139 01:51:08,200 --> 01:51:12,800 ONLY THREE TIMES A WEEK AND 2140 01:51:12,800 --> 01:51:14,320 APPROXIMATELY EIGHT MINUTES OF 2141 01:51:14,320 --> 01:51:18,280 EXERCISE TWO MINUTES OF EXERCISE 2142 01:51:18,280 --> 01:51:19,960 WE DO THE REST THREE TIMES A 2143 01:51:19,960 --> 01:51:22,680 WEEK WITH THESE IMPORTANT 2144 01:51:22,680 --> 01:51:25,560 REDUCTIONS AND THE OTHER HAND, 2145 01:51:25,560 --> 01:51:27,280 JUST NOW, WE ARE ORGANIZING AND 2146 01:51:27,280 --> 01:51:31,480 WE WOULD LIKE TO INVITE TO THE 2147 01:51:31,480 --> 01:51:33,920 SITES TO PARTICIPATE OF A 2148 01:51:33,920 --> 01:51:39,480 CLINICAL TRIAL WITH A TO SHOW IF 2149 01:51:39,480 --> 01:51:42,120 ONE STRENGTH AND PRODUCED THE 2150 01:51:42,120 --> 01:51:45,760 SAME RESULTS BECAUSE FOR YOU 2151 01:51:45,760 --> 01:51:51,640 NEED TO HAVE THE MOMENTS AND OR 2152 01:51:51,640 --> 01:51:54,880 TO SEE THE AND I DON'T SAY 2153 01:51:54,880 --> 01:52:00,040 EXACTLY AS YOU SAY IN THE EAST, 2154 01:52:00,040 --> 01:52:04,360 NOT NEED OF ANY INSTRUMENTS. 2155 01:52:04,360 --> 01:52:06,000 >>THANK YOU, DOCTOR. 2156 01:52:06,000 --> 01:52:12,640 IN FACT, THERE'S A QUESTION IN 2157 01:52:12,640 --> 01:52:16,920 THE CHAT PRECISELY ABOUT MUSCLE 2158 01:52:16,920 --> 01:52:20,120 STRENGTH AND IT'S RELATED TO IF 2159 01:52:20,120 --> 01:52:24,240 A PERSON ALREADY HAS A LOWER 2160 01:52:24,240 --> 01:52:27,200 HAND GRIP STRENGTH OR IT IS AN 2161 01:52:27,200 --> 01:52:30,840 INDICATE ERROR IT COULD BE AN 2162 01:52:30,840 --> 01:52:33,200 INDICATE OR OF VERY CHRONIC 2163 01:52:33,200 --> 01:52:37,760 DAMAGE OR THE DEFICIENCIES AND 2164 01:52:37,760 --> 01:52:39,200 HOW EFFECTIVE COULD THIS WORK IN 2165 01:52:39,200 --> 01:52:40,360 A PERSON LIKE THAT? 2166 01:52:40,360 --> 01:52:44,600 IS THERE A RECOVERY? 2167 01:52:44,600 --> 01:52:46,960 >>YES, THANK YOU FOR THAT 2168 01:52:46,960 --> 01:52:47,960 QUESTION. 2169 01:52:47,960 --> 01:52:50,920 REALLY, WE ARE TALKING ABOUT 2170 01:52:50,920 --> 01:52:51,920 PRECISION MEDICINE AND WHEN THE 2171 01:52:51,920 --> 01:52:54,840 FIRST THING IS TO HAVE 2172 01:52:54,840 --> 01:52:57,800 PREDICTION OF RISK AND IF YOU 2173 01:52:57,800 --> 01:53:01,440 HAVE A NEW CHILD AND WITH A LOW 2174 01:53:01,440 --> 01:53:05,400 BIRTH WEIGHT, IT'S REASON TO 2175 01:53:05,400 --> 01:53:06,960 DEVELOP CARDIOMETABOLIC DISEASE 2176 01:53:06,960 --> 01:53:10,760 SO YOU CAN START WITH THIS 2177 01:53:10,760 --> 01:53:13,080 PREDICTION OF RISK AND INCLUDE 2178 01:53:13,080 --> 01:53:16,160 PRE TENSION AND PREVENTION IS TO 2179 01:53:16,160 --> 01:53:20,840 IMPROVE THE QUALITY OF BODY 2180 01:53:20,840 --> 01:53:24,040 COMPOSITION THAT MEANS 2181 01:53:24,040 --> 01:53:27,160 INCREASING MUSCULAR MASS AND IT 2182 01:53:27,160 --> 01:53:31,400 STOPS THE INCREASE OF FATTY 2183 01:53:31,400 --> 01:53:33,760 TISSUE AND THIS MEANS GOOD 2184 01:53:33,760 --> 01:53:36,760 PHYSICAL ACTIVITY AND THIS MEANS 2185 01:53:36,760 --> 01:53:40,760 GOOD NUTRITION. 2186 01:53:40,760 --> 01:53:42,680 SO, EARLY IN LIFE YOU START THE 2187 01:53:42,680 --> 01:53:50,560 PREVENTION AND ALSO, IN LIFE, 2188 01:53:50,560 --> 01:53:53,160 YOU INTRODUCE SOME INTERVENTION 2189 01:53:53,160 --> 01:53:54,960 AS FOR INSTANCE ICE OWE METRIC 2190 01:53:54,960 --> 01:53:57,160 EXERCISE IN THE PLACE OF THE 2191 01:53:57,160 --> 01:53:58,840 WORLD THAT THIS IS THE MOST 2192 01:53:58,840 --> 01:53:59,800 INTERESTING THING, YOU DO NEED 2193 01:53:59,800 --> 01:54:03,840 TO GO TO THE GYM, DUE NEED TO 2194 01:54:03,840 --> 01:54:05,520 LIVE AT YOUR PLACE OF WORK TO DO 2195 01:54:05,520 --> 01:54:09,240 ICE OWE METRIC EXERCISES. 2196 01:54:09,240 --> 01:54:13,040 IT'S IMPROVING INSULIN 2197 01:54:13,040 --> 01:54:15,360 SENSITIVITY AND IMPROVING LOW 2198 01:54:15,360 --> 01:54:16,680 DEGREE INFLAMMATION THAT ARE THE 2199 01:54:16,680 --> 01:54:19,320 TWO MECHANISMS THAT ARE RELATED 2200 01:54:19,320 --> 01:54:21,320 WITH A CLARITY SO IT'S POSSIBLY 2201 01:54:21,320 --> 01:54:31,800 IN ADULTS, SO WE HAVE A VERY 2202 01:54:34,160 --> 01:54:38,120 SMALL REASON WE NEED IT INCLUDES 2203 01:54:38,120 --> 01:54:40,560 MORE PEOPLE AT THE MOMENT, IN 2204 01:54:40,560 --> 01:54:42,800 SOME LATINO AMERICAN COUNTRIES 2205 01:54:42,800 --> 01:54:46,080 IN COORDINATION WITH PEOPLE OF 2206 01:54:46,080 --> 01:54:49,880 SPAIN WE HAVE ORGANIZING A 2207 01:54:49,880 --> 01:54:54,320 NETWORK TO START A STUDY 2208 01:54:54,320 --> 01:54:55,560 INCLUDING MORE PEOPLE SO I WOULD 2209 01:54:55,560 --> 01:54:59,560 LIKE TO TAKE CARE ADVANTAGE OF 2210 01:54:59,560 --> 01:55:01,600 THESE MEETINGS TO INVITE THE 2211 01:55:01,600 --> 01:55:04,360 PEOPLE TO HAVE INTERESTED TO 2212 01:55:04,360 --> 01:55:09,600 PARTICIPATE TO JOIN US. 2213 01:55:09,600 --> 01:55:12,240 >>Chair Aviles-Santa: THANK 2214 01:55:12,240 --> 01:55:12,440 YOU. 2215 01:55:12,440 --> 01:55:13,440 I HAVE ANOTHER QUESTION FOR 2216 01:55:13,440 --> 01:55:15,440 Dr. LANAS. 2217 01:55:15,440 --> 01:55:17,440 YOU ILLUSTRATED THE RELATIONSHIP 2218 01:55:17,440 --> 01:55:20,360 BETWEEN SOCIOECONOMIC STATUS AND 2219 01:55:20,360 --> 01:55:21,800 CARDIOVASCULAR MORTALITY AND 2220 01:55:21,800 --> 01:55:23,080 WE'VE SEEN IN THIS RELATIONSHIP 2221 01:55:23,080 --> 01:55:31,200 FOR OTHER CHRONIC DISEASES ABOUT 2222 01:55:31,200 --> 01:55:33,480 WHAT COULD BE THE MOST IMPACTFUL 2223 01:55:33,480 --> 01:55:37,720 AND REALISTIC INTERVENTIONS TO 2224 01:55:37,720 --> 01:55:42,240 ADDRESS THIS DISPARITY AND WHAT 2225 01:55:42,240 --> 01:55:44,680 WOULD BE THE IMPLICATIONS OF 2226 01:55:44,680 --> 01:55:51,560 SUCH INTERVENTIONS FOR U.S. 2227 01:55:51,560 --> 01:55:52,320 HISPANICS AND LATINOS. 2228 01:55:52,320 --> 01:55:55,080 >>THANK YOU FOR THE QUESTION. 2229 01:55:55,080 --> 01:55:56,680 THIS IS A ISSUE THAT WORRIES ME 2230 01:55:56,680 --> 01:55:58,600 AND A LOT OF PEOPLE REALLY. 2231 01:55:58,600 --> 01:56:03,600 IN PER EYE, PERU, WE HAVE DOCUMF 2232 01:56:03,600 --> 01:56:05,480 YOU ARE FROM A LOW INCOME 2233 01:56:05,480 --> 01:56:07,640 COUNTRY AND YOU HAVE A INCOME 2234 01:56:07,640 --> 01:56:09,520 COUNTRIES AND YOU ARE POOR OR 2235 01:56:09,520 --> 01:56:12,480 LESS EDUCATED OR YOU LIVE IN A 2236 01:56:12,480 --> 01:56:16,520 RURAL AREA, YOU HAVE MORE RISK 2237 01:56:16,520 --> 01:56:18,040 FACTORS THAN SOMEONE FROM HIGH 2238 01:56:18,040 --> 01:56:22,240 INCOME COUNTRIES AND YOU HAVE A 2239 01:56:22,240 --> 01:56:30,480 MORE CARDIOVASCULAR EVENTS AND 2240 01:56:30,480 --> 01:56:31,720 MORE GENERAL MORTALITY. 2241 01:56:31,720 --> 01:56:39,320 THIS IS A FACT TO SHOW THAT HOW 2242 01:56:39,320 --> 01:56:44,000 WE CAN IMPROVE THAT ANDER 2243 01:56:44,000 --> 01:56:46,880 FINDING A SOLUTION TO THIS MAJOR 2244 01:56:46,880 --> 01:56:48,920 INEQUITY AND I DON'T REALLY 2245 01:56:48,920 --> 01:56:54,400 THINK THAT AN ISOLATED AND IT 2246 01:56:54,400 --> 01:56:56,320 WILL BE SUCCESSFUL AND OF 2247 01:56:56,320 --> 01:56:57,400 COURSE, OF COURSE THERE'S AN 2248 01:56:57,400 --> 01:57:00,680 NEED THE COUNTRIES FOCUS THE 2249 01:57:00,680 --> 01:57:03,400 INVESTMENT IN HEALTH AND IN TOES 2250 01:57:03,400 --> 01:57:08,200 WHO ARE AT INDICTS ADVANTAGE AND 2251 01:57:08,200 --> 01:57:10,480 THE THEY GO FAR HEALTH AND IT'S 2252 01:57:10,480 --> 01:57:12,320 AN ISSUE OF EDUCATION AND 2253 01:57:12,320 --> 01:57:17,360 SECURITY HOUSING AND ENVIRONMENT 2254 01:57:17,360 --> 01:57:18,760 AND THE PRIV OF THE HEALTHY FOOD 2255 01:57:18,760 --> 01:57:24,520 AND MANY OTHERS AND SO WE ARE, 2256 01:57:24,520 --> 01:57:30,960 WE NEED TO TROY TO MOVE THE 2257 01:57:30,960 --> 01:57:33,280 GOVERNMENT AND THE HEALTH SYSTEM 2258 01:57:33,280 --> 01:57:38,720 TO PROVIDE MORE CARE FOR THOSE 2259 01:57:38,720 --> 01:57:43,120 WHO ARE LESS RESOURCES AND IN 2260 01:57:43,120 --> 01:57:47,240 SOME WAY AND THE REGIONAL 2261 01:57:47,240 --> 01:57:51,640 CARDIOLOGY OF SCIENTISTS AND 2262 01:57:51,640 --> 01:57:53,280 PUTTING THIS SOCIAL DISADVANTAGE 2263 01:57:53,280 --> 01:57:58,120 AND ONE MAJOR RISK FACTOR SO 2264 01:57:58,120 --> 01:58:00,920 DEAL WITH THE MORE TURN AND WE 2265 01:58:00,920 --> 01:58:03,520 ALL KNOW THAT IT'S IN A 2266 01:58:03,520 --> 01:58:07,880 HIGH-RISK OF CARDIOVASCULAR 2267 01:58:07,880 --> 01:58:18,400 PROBLEMS AND WE DEVELOP WHAT WE 2268 01:58:19,040 --> 01:58:21,760 CALL ROAD MAPS AND IT'S STUDY 2269 01:58:21,760 --> 01:58:25,800 TIME PROVE THE BARRIERS AND FOR 2270 01:58:25,800 --> 01:58:29,040 GOOD CARE AND WE HAVE THE 2271 01:58:29,040 --> 01:58:31,880 SCIENTIFIC SOCIETIES AND THE 2272 01:58:31,880 --> 01:58:34,440 HEALTH PROVIDERS THAT MINISTRY 2273 01:58:34,440 --> 01:58:38,440 OF HEALTH AND IN ORDER TO AGAIN 2274 01:58:38,440 --> 01:58:42,920 RAIL A NATIONAL STRATEGY AND AND 2275 01:58:42,920 --> 01:58:47,760 IT'S A VERY DIFFICULT AFFECT I'M 2276 01:58:47,760 --> 01:58:47,960 SURE. 2277 01:58:47,960 --> 01:58:49,440 >>THANK YOU. 2278 01:58:49,440 --> 01:58:51,480 I HAVE TO TWO MORE QUESTIONS AND 2279 01:58:51,480 --> 01:58:54,160 THESE TWO QUESTIONS ARE FOR THE 2280 01:58:54,160 --> 01:58:56,280 TWO OF YOU. 2281 01:58:56,280 --> 01:58:58,160 WHAT WOULD THE STUDY OF PRIMARY 2282 01:58:58,160 --> 01:59:01,600 OR SECONDARY PREVENTION OF 2283 01:59:01,600 --> 01:59:03,600 CARDIOVASCULAR DISEASES 2284 01:59:03,600 --> 01:59:04,000 CONTRIBUTE? 2285 01:59:04,000 --> 01:59:10,120 TO THE REDUCTION OF SCARED YO 2286 01:59:10,120 --> 01:59:12,080 WORTH WHILE AND U.S. HISPANIC 2287 01:59:12,080 --> 01:59:16,880 AND LATINOS? 2288 01:59:16,880 --> 01:59:21,520 >>OK, I WILL START. 2289 01:59:21,520 --> 01:59:26,080 WE HAVE TWO HOPE THREE AND FOUR 2290 01:59:26,080 --> 01:59:32,880 THAT SHOWS AT REDUCTIONS OF 40% 2291 01:59:32,880 --> 01:59:35,480 OF CARDIO AND STROKE AND THAT 2292 01:59:35,480 --> 01:59:39,600 WAS COMPOSED OF OUTCOME WITH THE 2293 01:59:39,600 --> 01:59:41,880 USE OF TWO HYPERTENSIVE AND ONE 2294 01:59:41,880 --> 01:59:44,240 SETTING IN PEOPLE WITH 2295 01:59:44,240 --> 01:59:47,120 HYPERTENSION. 2296 01:59:47,120 --> 01:59:49,800 HYPERTENSION THAT MEANS HIGHER 2297 01:59:49,800 --> 01:59:52,680 THAN 140 MILLIONS AND AFTER 2298 01:59:52,680 --> 01:59:57,040 THESE WE SHOW A IT'S CHANGE IN 2299 01:59:57,040 --> 02:00:01,600 THE STRATEGY OF CONTROL OF 2300 02:00:01,600 --> 02:00:05,920 CARDIOVASCULAR RISK FACTOR AND 2301 02:00:05,920 --> 02:00:09,840 IT'S USE AND IT'S NOT MEDICAL 2302 02:00:09,840 --> 02:00:12,040 HEALTH WORKERS DOING THE 2303 02:00:12,040 --> 02:00:16,480 TREATMENT AT HOME AND IDENTIFY 2304 02:00:16,480 --> 02:00:21,000 THE PEOPLE AND PROVIDING FREE 2305 02:00:21,000 --> 02:00:26,320 ACCESS MEDICATIONS TO 2306 02:00:26,320 --> 02:00:30,720 ANTIHYPERTENSIVE AND STUDY A 2307 02:00:30,720 --> 02:00:33,240 REDUCTION WITH THE WE DISCOVER 2308 02:00:33,240 --> 02:00:40,120 OF 11 POINTS SO, IT'S VERY CLEAR 2309 02:00:40,120 --> 02:00:42,800 WE NEED SOME STYLES AND IN THIS 2310 02:00:42,800 --> 02:00:47,240 WAY THE USE OF SOME INTER 2311 02:00:47,240 --> 02:00:49,040 TENSION TO IMPROVE MUSCULAR 2312 02:00:49,040 --> 02:00:50,840 STRENGTH IS SO IMPORTANT AND 2313 02:00:50,840 --> 02:00:54,080 ALSO WE HAVE SO THAT 2314 02:00:54,080 --> 02:00:58,680 INTERVENTION WITH MEDICATION IS 2315 02:00:58,680 --> 02:01:02,640 PARTICULARLY AND IT'S A GOOD 2316 02:01:02,640 --> 02:01:13,120 APPROACH TO THE AND WE HAVE 2317 02:01:37,800 --> 02:01:48,240 STUDY AND WE MUST COMPARE WITH 2318 02:01:52,120 --> 02:01:54,880 TWO GROUPS WITH TRADITIONAL 2319 02:01:54,880 --> 02:02:01,400 HYPERTENSION AND AND IT WAS A 2320 02:02:01,400 --> 02:02:08,240 HUGE INCREASE AND COMPLY IN THE 2321 02:02:08,240 --> 02:02:13,800 NEW ONES SO, MORE BROAD IN THE 2322 02:02:13,800 --> 02:02:16,880 REGION WITH MORE SIDES AND IN 2323 02:02:16,880 --> 02:02:19,080 HYPERTENSION OR IN SECONDARY 2324 02:02:19,080 --> 02:02:25,720 PREVENTION AND IT COULD BE QUITE 2325 02:02:25,720 --> 02:02:26,000 IMPORTANT. 2326 02:02:26,000 --> 02:02:28,320 >>THANK YOU Dr. LANAS. 2327 02:02:28,320 --> 02:02:29,760 I HAVE ONE MORE QUESTION FOR THE 2328 02:02:29,760 --> 02:02:36,880 TWO OF YOU AND WE HAVE THREE 2329 02:02:36,880 --> 02:02:38,040 MINUTES TO SHARE THE ANSWER FOR 2330 02:02:38,040 --> 02:02:38,680 THIS QUESTION. 2331 02:02:38,680 --> 02:02:42,400 WHAT ARE SOME POTENTIAL RESEARCH 2332 02:02:42,400 --> 02:02:46,480 OPPORTUNITIES AND YOU COULD 2333 02:02:46,480 --> 02:02:49,080 ELABORATE ON KEY RESEARCH 2334 02:02:49,080 --> 02:02:50,440 STUDIES IN LATIN AMERICA AND 2335 02:02:50,440 --> 02:02:52,280 THAT COULD ALSO HAVE AN IMPACT 2336 02:02:52,280 --> 02:02:58,040 IN THE STUDY AND IN THE CARE OF 2337 02:02:58,040 --> 02:02:58,640 DISEASE INCLUDING STROKES AND 2338 02:02:58,640 --> 02:03:00,840 RISK FACTORS AND U.S. HISS PAN 2339 02:03:00,840 --> 02:03:09,120 PICK AND LATINO POPULATIONS. 2340 02:03:09,120 --> 02:03:15,480 >>LET ME GO FIRST. 2341 02:03:15,480 --> 02:03:18,840 THE AND DISEASE AND MIO CARDIAL 2342 02:03:18,840 --> 02:03:23,040 AND SO WE HAVE MAJOR PROBLEMS IN 2343 02:03:23,040 --> 02:03:24,800 OUR CONTROL OF HEART FAILURE AND 2344 02:03:24,800 --> 02:03:28,840 WE HAVE DOCUMENTED THAT AND IN 2345 02:03:28,840 --> 02:03:32,800 RELATIONS AND SO I THINK WE NEED 2346 02:03:32,800 --> 02:03:37,400 SOME SIMPLE STUDIES WITH THE 2347 02:03:37,400 --> 02:03:41,600 SOMEWAY TO SCREEN POPULATION AND 2348 02:03:41,600 --> 02:03:45,440 SIMPLE TREATMENT AND TO DO IT 2349 02:03:45,440 --> 02:03:49,560 WITH THE COST EFFECTIVENESS AND 2350 02:03:49,560 --> 02:03:51,920 PART OF THE STUDY SO WE CAN 2351 02:03:51,920 --> 02:03:57,960 CONVINCE THE AUTHORITIES TO SO 2352 02:03:57,960 --> 02:04:02,800 THEY DECIDE TO INVEST IN THAT 2353 02:04:02,800 --> 02:04:03,120 AND SO. 2354 02:04:03,120 --> 02:04:12,080 >>Dr. LOPEZ-JARAMILLO. 2355 02:04:12,080 --> 02:04:14,480 >>I'M REALLY INTERESTED IN 2356 02:04:14,480 --> 02:04:21,040 AGING HEALTHY. 2357 02:04:21,040 --> 02:04:25,800 WITH THIS COMING THE BIG PROBLEM 2358 02:04:25,800 --> 02:04:28,040 OF THE KNOWLEDGE MATURATION SO I 2359 02:04:28,040 --> 02:04:31,760 THINK THAT IT'S IMPORTANT THAT 2360 02:04:31,760 --> 02:04:35,200 WE STARTED TO IDENTIFY WHY SOME 2361 02:04:35,200 --> 02:04:39,000 PEOPLE AND MYSELF THAT WE ARE 2362 02:04:39,000 --> 02:04:40,880 OLDER THAN 70 YEARS AND STILL WE 2363 02:04:40,880 --> 02:04:45,720 ARE VERY ACTIVE AND PHYSICAL 2364 02:04:45,720 --> 02:04:47,160 ACTIVE AND ANOTHER PEOPLE WITH 2365 02:04:47,160 --> 02:04:50,680 THE SAME AGE, ARE REALLY DOING 2366 02:04:50,680 --> 02:04:52,240 NOTHING AND WE NEED TO IDENTIFY 2367 02:04:52,240 --> 02:04:56,040 ONE OF THE RISKS FOR THIS 2368 02:04:56,040 --> 02:04:58,640 DIFFERENCE AND WE HAVE CLEARLY 2369 02:04:58,640 --> 02:05:00,680 OF COURSE, TAKEN PROGRAMMING AND 2370 02:05:00,680 --> 02:05:04,720 MUSCULAR STRENGTH AND LOW DEGREE 2371 02:05:04,720 --> 02:05:06,120 INFLAMMATION ARE SO IN THE 2372 02:05:06,120 --> 02:05:09,960 PROBLEM OF DEMENTIA AND A 2373 02:05:09,960 --> 02:05:12,200 PROBLEMS RELATED WITH THESE SO, 2374 02:05:12,200 --> 02:05:15,960 I THINK THAT IT IS AN AREA THAT 2375 02:05:15,960 --> 02:05:19,400 WE NEED TO START TO THINK ABOUT 2376 02:05:19,400 --> 02:05:21,760 DEVELOP INTERNATIONAL STOPS AND 2377 02:05:21,760 --> 02:05:24,760 ALSO, I THINK THAT IT'S SO 2378 02:05:24,760 --> 02:05:28,720 IMPORTANT NOW TO DEFINE IF 2379 02:05:28,720 --> 02:05:33,920 REALLY THE POLICY AND THE AND 2380 02:05:33,920 --> 02:05:37,400 YOU HAVE USING SOME CLINICAL 2381 02:05:37,400 --> 02:05:41,200 TRIALS AND IS THAT IT WORK IN 2382 02:05:41,200 --> 02:05:43,040 OUR COUNTRIES. 2383 02:05:43,040 --> 02:05:43,720 >>Chair Aviles-Santa: THANK YOU 2384 02:05:43,720 --> 02:05:45,920 DOCTORS FOR YOUR PRESENTATIONS 2385 02:05:45,920 --> 02:05:48,640 AND FOR THIS VERY INTERESTING IN 2386 02:05:48,640 --> 02:05:53,480 Q&A AND NOW WE MOVE INTO THE 2387 02:05:53,480 --> 02:05:55,120 PRESENTATIONS FOR THE THIRD 2388 02:05:55,120 --> 02:05:55,640 TOPIC. 2389 02:05:55,640 --> 02:06:06,760 WORKSHOP WHICH IS CAN SEPTE CAN. 2390 02:06:06,760 --> 02:06:07,000 >>SEE YOU. 2391 02:06:07,000 --> 02:06:07,800 >>BYE-BYE. 2392 02:06:07,800 --> 02:06:14,520 >>BYE-BYE. 2393 02:06:14,520 --> 02:06:16,720 >>I'M INVESTIGATOR AT THE 2394 02:06:16,720 --> 02:06:18,760 NATIONAL CANCER INSTITUTE AND 2395 02:06:18,760 --> 02:06:21,120 MODERATOR FOR TODAY'S SESSION OF 2396 02:06:21,120 --> 02:06:21,360 CANCER. 2397 02:06:21,360 --> 02:06:23,760 YOU WILL HEAR TWO PRESENTATIONS. 2398 02:06:23,760 --> 02:06:25,760 FIRST ON CANCER BURDEN AND 2399 02:06:25,760 --> 02:06:31,360 CONTROL BY Dr. SUYAPA BERARANO 2400 02:06:31,360 --> 02:06:37,840 AND SECOND BY Dr. GUSTAVO 2401 02:06:37,840 --> 02:06:38,200 WERUTSKY. 2402 02:06:38,200 --> 02:06:39,120 THEM TAKE QUESTIONS LIVE AFTER 2403 02:06:39,120 --> 02:06:40,160 THE PRESENTATIONS. 2404 02:06:40,160 --> 02:06:43,280 >>GOOD MORNING, EVERYONE, I AM 2405 02:06:43,280 --> 02:06:52,920 A ONCOLOGIST AND WORK AS A PEDRO 2406 02:06:52,920 --> 02:06:54,240 SULA, HONDURAS. 2407 02:06:54,240 --> 02:06:55,640 THANK YOU FOR PUTTING TOGETHER 2408 02:06:55,640 --> 02:06:57,520 THESE SELECTED GROUP OF 2409 02:06:57,520 --> 02:06:59,480 PROFESSIONALS AND INVITING ME TO 2410 02:06:59,480 --> 02:07:02,240 JOIN THIS I WANT TO ADDRESS TO 2411 02:07:02,240 --> 02:07:06,560 YOU THIS MORNING AND COMMENT A 2412 02:07:06,560 --> 02:07:09,000 LITTLE BIT OF REGARDING THE 2413 02:07:09,000 --> 02:07:10,560 CANCER BURDEN LATIN AMERICA AND 2414 02:07:10,560 --> 02:07:15,120 THE CARIBBEAN AND SOME RISK 2415 02:07:15,120 --> 02:07:20,320 FACTORS AND WHAT WE HAVE TO FACE 2416 02:07:20,320 --> 02:07:23,400 WHAT DO WE KNOW IS IT'S A VAST 2417 02:07:23,400 --> 02:07:25,800 REGION AND THAT ACCOUNT FOR 20 2418 02:07:25,800 --> 02:07:28,400 COUNTRIES AND 14 DEPENDENCIES 2419 02:07:28,400 --> 02:07:31,200 AND WE HAVE A POPULATION AMONG 2420 02:07:31,200 --> 02:07:35,200 THE COUNTRIES FROM GENETIC 2421 02:07:35,200 --> 02:07:38,080 BACKGROUNDS FROM ETHNIC GROUPS 2422 02:07:38,080 --> 02:07:39,040 AND FROM DIFFERENT LANGUAGES 2423 02:07:39,040 --> 02:07:40,640 WHERE SPANISH AND PORTUGUESE ARE 2424 02:07:40,640 --> 02:07:42,760 BEING THE MAIN LANGUAGES AND 80% 2425 02:07:42,760 --> 02:07:47,360 OF OUR POPULATION LIVE IN URBAN 2426 02:07:47,360 --> 02:07:52,520 AREAS AND THERE'S 2019 G.D.P. 2427 02:07:52,520 --> 02:07:58,400 REPORTED OF $5.6 TRILLION BUT IF 2428 02:07:58,400 --> 02:08:00,680 WE SEE MORE DEEP INTO THESE 2429 02:08:00,680 --> 02:08:02,880 NUMBERS AND WE SEE IT PROJECTED 2430 02:08:02,880 --> 02:08:08,400 WE CAN SEE A HIGH VARIETY FROM 2431 02:08:08,400 --> 02:08:10,280 $1,000 TO $30,000 IN DIFFERENT 2432 02:08:10,280 --> 02:08:10,680 COUNTRIES. 2433 02:08:10,680 --> 02:08:12,360 WHY IS THIS IMPORTANT? 2434 02:08:12,360 --> 02:08:15,160 BECAUSE THE POPULATION, THE 2435 02:08:15,160 --> 02:08:16,720 DOUGH MET TICK BACKGROUND AND 2436 02:08:16,720 --> 02:08:19,440 THE SOCIOECONOMIC CONDITION THAT 2437 02:08:19,440 --> 02:08:22,440 POSES EXPOSURES TO THOSE 2438 02:08:22,440 --> 02:08:23,280 SPECIFIC POPULATION COULD 2439 02:08:23,280 --> 02:08:24,880 EXPLAIN THE CANCER BURDEN THAT 2440 02:08:24,880 --> 02:08:26,440 WE'RE FACING TODAY IN LATIN 2441 02:08:26,440 --> 02:08:28,200 AMERICA AND THE CARIBBEAN. 2442 02:08:28,200 --> 02:08:32,800 AS WE SEE IN THIS GRAPH, WE HAVE 2443 02:08:32,800 --> 02:08:36,760 COUNTRIES WITH HIGH INCIDENTS OF 2444 02:08:36,760 --> 02:08:41,000 CANCER LIKE URUGUAY WITH 257,000 2445 02:08:41,000 --> 02:08:43,480 INHABITS AND COUNTRIES AS 2446 02:08:43,480 --> 02:08:45,480 CENTRAL AMERICA IN CENTRAL 2447 02:08:45,480 --> 02:08:49,320 AMERICA, THAT ARE LESS THAN 111 2448 02:08:49,320 --> 02:08:49,560 WORLDWIDE. 2449 02:08:49,560 --> 02:08:52,120 AND AS I MENTIONED BEFORE, THE 2450 02:08:52,120 --> 02:08:53,800 HUMAN LEVEL OF THE INDEX HAS 2451 02:08:53,800 --> 02:08:58,600 BEEN PREDICTED OF CANCER BY 2452 02:08:58,600 --> 02:09:05,800 DISEASE AND WITH SPECIFIC BURDEN 2453 02:09:05,800 --> 02:09:08,840 OF CANCER WITH COLORECTAL, 2454 02:09:08,840 --> 02:09:11,000 BREAST AND CERVIC AND LIVER 2455 02:09:11,000 --> 02:09:14,800 CANCER WHILE THE VERY HIGH HDI 2456 02:09:14,800 --> 02:09:16,600 COUNTRIES HAVE MORE LONG BREAST, 2457 02:09:16,600 --> 02:09:24,520 COCOCOLORECTAL AND PROSTATE. 2458 02:09:24,520 --> 02:09:26,960 WE CAN SEE WHAT I'M TALKING 2459 02:09:26,960 --> 02:09:28,480 ABOUT THIS. 2460 02:09:28,480 --> 02:09:30,960 WE STILL HAVE BREAST AND 2461 02:09:30,960 --> 02:09:32,160 COLORECTAL AS THE MAIN INCIDENTS 2462 02:09:32,160 --> 02:09:35,160 THROUGH THE COUNTRIES BUT WE 2463 02:09:35,160 --> 02:09:36,400 ALSO SEE COUNTRIES LIKE BOLIVIA 2464 02:09:36,400 --> 02:09:37,880 WHERE CERVICAL CANCER IS THE 2465 02:09:37,880 --> 02:09:40,920 FIRST CANCER OF INCIDENTS AND 2466 02:09:40,920 --> 02:09:42,600 THEN WE HAVE OTHER WHERE STOMACH 2467 02:09:42,600 --> 02:09:47,040 CANCER AND CERVICAL CANCER AND 2468 02:09:47,040 --> 02:09:48,480 BLADDER RELATED TO SEDENTARY 2469 02:09:48,480 --> 02:09:50,120 CONDITIONS AND INFECTIONS AND 2470 02:09:50,120 --> 02:09:52,800 THEY ARE IN THE MAIN TYPES OF 2471 02:09:52,800 --> 02:09:53,280 CANCER. 2472 02:09:53,280 --> 02:09:55,240 SO, THERE'S A DIFFERENCE BETWEEN 2473 02:09:55,240 --> 02:09:56,760 THE COUNTRIES AND THE DIFFERENCE 2474 02:09:56,760 --> 02:09:58,640 OF THE RISK FACTORS PRESENTED IN 2475 02:09:58,640 --> 02:10:02,160 THESE POPULATIONS WHICH MAKES IT 2476 02:10:02,160 --> 02:10:04,720 DIFFICULT TO ADDRESS FROM A 2477 02:10:04,720 --> 02:10:06,000 UNIFORM WAY THE CANCER CONTROL 2478 02:10:06,000 --> 02:10:08,400 IN THE REGION. 2479 02:10:08,400 --> 02:10:10,040 AND THE IMPORTANT ISSUE THAT WE 2480 02:10:10,040 --> 02:10:13,080 HAVE A VERY YOUNG POPULATION AND 2481 02:10:13,080 --> 02:10:15,480 WITH THE AGE OF 31 YEARS AND 2482 02:10:15,480 --> 02:10:19,640 THERE IS A EXPECTED RISE IN THE 2483 02:10:19,640 --> 02:10:21,840 HDI IN THE FOLLOWING DECADES AND 2484 02:10:21,840 --> 02:10:25,280 ALSO, A RISE IN THE INCIDENTS OF 2485 02:10:25,280 --> 02:10:29,360 CANCER AND IT'S CURIOUS TO SEE 2486 02:10:29,360 --> 02:10:33,760 THAT THE EXTRAPOLATED DATA THE 2487 02:10:33,760 --> 02:10:35,000 REGIONS OF THE HIGHEST INCREASE 2488 02:10:35,000 --> 02:10:38,080 IN CANCER RATES IN THE NEXT 2489 02:10:38,080 --> 02:10:38,560 DECADES. 2490 02:10:38,560 --> 02:10:40,640 SO, IN THIS VERY DIFFICULT FOR 2491 02:10:40,640 --> 02:10:42,800 US TO ADDRESS THE PROBLEM OF 2492 02:10:42,800 --> 02:10:44,600 CANCER, KNOWING THAT WE HAVE A 2493 02:10:44,600 --> 02:10:46,040 VARIETY OF SITUATIONS LIKE 2494 02:10:46,040 --> 02:10:48,800 THESE, MOST OF OUR INFORMATIONS 2495 02:10:48,800 --> 02:10:53,640 ARE RELYING ON MORTALITY BECAUSE 2496 02:10:53,640 --> 02:10:55,160 THERE'S NOT ENOUGH POPULATION 2497 02:10:55,160 --> 02:10:58,480 BASED CANCER REGISTRY WORKING 2498 02:10:58,480 --> 02:11:02,320 PROPERLY IN THE REGION. 2499 02:11:02,320 --> 02:11:03,800 THESE FACTORS THAT WE HAVE 2500 02:11:03,800 --> 02:11:04,160 IDENTIFIED. 2501 02:11:04,160 --> 02:11:06,520 WE CAN SEE THAT THE DISTRIBUTION 2502 02:11:06,520 --> 02:11:10,680 OF THIS RISK FACTORS IN THE 2503 02:11:10,680 --> 02:11:12,760 INFECTIONS AND ALCOHOL DRINKING 2504 02:11:12,760 --> 02:11:15,160 AND IT'S RELATED TO THEM AND 2505 02:11:15,160 --> 02:11:18,920 WHICH WE ALSO SEE THAT ARE 2506 02:11:18,920 --> 02:11:21,680 RELATED WITH HDI, HIGHER HDI AND 2507 02:11:21,680 --> 02:11:23,920 COLOR ALCOHOL CONSUMPTION AND 2508 02:11:23,920 --> 02:11:26,280 HAS A HIGHER BODY MASS INDEX BUT 2509 02:11:26,280 --> 02:11:30,440 ALSO WE CAN SEE THAT INFECTIONS 2510 02:11:30,440 --> 02:11:35,160 IN THE LOWER HDI ONE OF THE MAIN 2511 02:11:35,160 --> 02:11:37,200 CONTINUED STUDY AND IT'S 2512 02:11:37,200 --> 02:11:39,200 STANDARDIZED RATES OF CANCER. 2513 02:11:39,200 --> 02:11:41,840 AND SO VERY IMPORTANT POINT 2514 02:11:41,840 --> 02:11:43,000 REGARDING THE LIFESTYLES IS 2515 02:11:43,000 --> 02:11:46,280 THERE'S INSUFFICIENT PHYSICAL 2516 02:11:46,280 --> 02:11:47,840 ACTIVITY IN THROUGH LATIN 2517 02:11:47,840 --> 02:11:49,400 AMERICA OF IMPORTANT DIFFERENCE 2518 02:11:49,400 --> 02:11:52,560 WITHIN MEN AND WOMEN BOTH OVER 2519 02:11:52,560 --> 02:11:54,040 ALL WE HAVE INSUFFICIENT 2520 02:11:54,040 --> 02:11:55,600 PHYSICAL ACTIVITIES REPORTED TO 2521 02:11:55,600 --> 02:11:59,600 THE COUNTRIES. 2522 02:11:59,600 --> 02:12:02,080 REGARDING THE ALCOHOL EXPOSURE, 2523 02:12:02,080 --> 02:12:04,240 WE WOULD EXPECT THAT WITH ALL 2524 02:12:04,240 --> 02:12:05,760 THE CAMPAIGNS THAT WE HAVE BEEN 2525 02:12:05,760 --> 02:12:07,680 DOING THROUGH THE YEARS AGAIN, 2526 02:12:07,680 --> 02:12:09,680 LEARNING ABOUT THE CANCER RISK 2527 02:12:09,680 --> 02:12:12,920 AND LEARNING OF OTHER DISEASES 2528 02:12:12,920 --> 02:12:14,960 RELATED TO TOBACCO SMOKING AND 2529 02:12:14,960 --> 02:12:17,280 OTHER FORMS OF THE TOBACCO, WE 2530 02:12:17,280 --> 02:12:20,600 HAVE SEEN THE REDUCTION LESS 2531 02:12:20,600 --> 02:12:22,600 THAN 10% IN THE LAST DECADE AND 2532 02:12:22,600 --> 02:12:24,080 ALSO THE COUNTRIES WITH THE 2533 02:12:24,080 --> 02:12:27,680 HIGHER HDI HAS THE HIGHER 2534 02:12:27,680 --> 02:12:31,680 CONSUMPTION OF ALCOHOL CONSUMING 2535 02:12:31,680 --> 02:12:32,280 TOBACCO. 2536 02:12:32,280 --> 02:12:35,280 AND FROM 2018 AND ANOTHER 2537 02:12:35,280 --> 02:12:36,680 IMPORTANT FACTOR THAT WE HAVE 2538 02:12:36,680 --> 02:12:38,680 IDENTIFIED, REGARDING THE 2539 02:12:38,680 --> 02:12:40,600 INCIDENTS OF CANCER LIKE GASTRIC 2540 02:12:40,600 --> 02:12:43,120 CANCER IS THE SODIUM INTAKE. 2541 02:12:43,120 --> 02:12:45,080 AS WE SEE IN THIS GRAPH THROUGH 2542 02:12:45,080 --> 02:12:47,760 ALL THAT IN AMERICA, THERE'S A 2543 02:12:47,760 --> 02:12:50,240 HIGHER INTAKE OF SODIUM RELATED 2544 02:12:50,240 --> 02:12:52,040 TO THE RECOMMENDATION OF THE 2545 02:12:52,040 --> 02:12:53,680 AMERICAN HEART ASSOCIATION WHICH 2546 02:12:53,680 --> 02:12:56,320 IS ASSOCIATED WITH A SIGNIFICANT 2547 02:12:56,320 --> 02:12:59,920 RISK OF GASTRIC CANCER. 2548 02:12:59,920 --> 02:13:01,440 THERE IS INTERESTING PHENOMENON 2549 02:13:01,440 --> 02:13:04,080 HAVE JUST EMERGED IS THAT IT HAS 2550 02:13:04,080 --> 02:13:07,040 BEEN THAT IN CERTAIN COUNTRY, 2551 02:13:07,040 --> 02:13:09,160 THE LIGHT INCREASE IN MORTALITY 2552 02:13:09,160 --> 02:13:11,680 OF CANCER FOR GASTRIC CANCER IN 2553 02:13:11,680 --> 02:13:14,680 YOUNGER AGES, RELATED TO OR 2554 02:13:14,680 --> 02:13:16,720 OTHER COUNTRIES AND OTHER AGES 2555 02:13:16,720 --> 02:13:18,320 AND THIS IS A PHENOMENON THAT 2556 02:13:18,320 --> 02:13:20,200 NEEDS TO BE RESEARCH AND NEEDS 2557 02:13:20,200 --> 02:13:22,040 TO BE CHANGED TO KNOW WHAT IS 2558 02:13:22,040 --> 02:13:25,760 THE CAUSE OF THIS BEHAVIOR. 2559 02:13:25,760 --> 02:13:28,880 AND THEN WE HAVE THE INDIGENOUS 2560 02:13:28,880 --> 02:13:31,480 PEOPLE, WE HAVE A RICH VARIETY 2561 02:13:31,480 --> 02:13:32,560 OF ETHNIC GROUPS IN LATIN 2562 02:13:32,560 --> 02:13:34,640 AMERICA WHICH ARE HE IS POSED TO 2563 02:13:34,640 --> 02:13:41,880 CARCINOMCARCINOGENS AND SANITARY 2564 02:13:41,880 --> 02:13:44,800 CONDITIONS AND POOR 2565 02:13:44,800 --> 02:13:46,320 SOCIOECONOMIC OUTCOME THAT POSES 2566 02:13:46,320 --> 02:13:48,520 A CANCER RISK DIFFERENT THAN 2567 02:13:48,520 --> 02:13:51,360 FROM OTHER POPULATIONS AND THESE 2568 02:13:51,360 --> 02:13:55,800 POPULATIONS ARE ALWAYS OR 2569 02:13:55,800 --> 02:14:00,880 USUALLY FAR FROM ANTI-WAIT POINT 2570 02:14:00,880 --> 02:14:04,280 OF CARE AND THERE ARE INEQUITIES 2571 02:14:04,280 --> 02:14:07,440 AMONG THE EDUCATION AND AMONG 2572 02:14:07,440 --> 02:14:09,240 THE HETERO SERVICES THEY 2573 02:14:09,240 --> 02:14:10,400 RECEIVED AND WE HAVE TO ADDRESS 2574 02:14:10,400 --> 02:14:14,120 THIS POPULATIONS IN CULTURALLY 2575 02:14:14,120 --> 02:14:17,520 CORRECT WAY SO THERE IS ALSO 2576 02:14:17,520 --> 02:14:21,080 ANOTHER WAY AND ANOTHER FORM OF 2577 02:14:21,080 --> 02:14:23,120 INTEREST THAT WE CAN DEVELOP IN 2578 02:14:23,120 --> 02:14:26,600 RESEARCH AND IN THIS SPECIFIC 2579 02:14:26,600 --> 02:14:26,920 POPULATIONS. 2580 02:14:26,920 --> 02:14:30,960 AND OVER ALL, THERE IS POOR 2581 02:14:30,960 --> 02:14:32,160 AVAILABILITY FOR HIGH-QUALITY 2582 02:14:32,160 --> 02:14:33,720 HEALTHCARE IN LATIN AMERICA FOR 2583 02:14:33,720 --> 02:14:35,000 MANY REASONS. 2584 02:14:35,000 --> 02:14:37,360 THE UNIVERSAL HEALTH COVERAGE IS 2585 02:14:37,360 --> 02:14:41,160 OVER 70% IN MOST COUNTRIES BUT 2586 02:14:41,160 --> 02:14:44,240 STILL, MORE THAN 58% OF THE 2587 02:14:44,240 --> 02:14:46,240 CANCER CARE COME OUT OF THE 2588 02:14:46,240 --> 02:14:48,000 POCKET EXPENDITURE AND AS I 2589 02:14:48,000 --> 02:14:49,280 MENTIONED BEFORE, WE DON'T HAVE 2590 02:14:49,280 --> 02:14:51,080 ENOUGH CANCER IN POPULATION 2591 02:14:51,080 --> 02:14:53,000 BASED CANCER REGISTRY THAT HELP 2592 02:14:53,000 --> 02:14:55,120 US AND NO ABOUT WHAT IS THE REAL 2593 02:14:55,120 --> 02:14:56,640 INCIDENTS OF MORTALITY OF CANCER 2594 02:14:56,640 --> 02:14:59,160 IN THE REGION AND ONLY NINE OF 2595 02:14:59,160 --> 02:15:02,440 THE 20 COUNTRIES HAVE CANCER 2596 02:15:02,440 --> 02:15:04,160 CONTROL PLANS. 2597 02:15:04,160 --> 02:15:05,720 THERE'S INSUFFICIENT SPECIALISTS 2598 02:15:05,720 --> 02:15:09,600 FOR CANCER CARE AND IN LATIN 2599 02:15:09,600 --> 02:15:10,760 AMERICA THERE ARE DIFFERENCES IN 2600 02:15:10,760 --> 02:15:12,320 AMONG THE COUNTRIES BUT OVER 2601 02:15:12,320 --> 02:15:17,040 ALL, THE AMOUNT OF ONCOLOGISTS 2602 02:15:17,040 --> 02:15:19,200 ARE LOWER THAN THE POPULATIONS, 2603 02:15:19,200 --> 02:15:22,560 AS WE SEE, LATIN AMERICA IS AN 2604 02:15:22,560 --> 02:15:24,480 INTERESTING AREA IN THE REGION 2605 02:15:24,480 --> 02:15:26,720 AND WE HAVE OPPORTUNITIES AND 2606 02:15:26,720 --> 02:15:30,160 THREATS THAT CAN BE OVERCOME IF 2607 02:15:30,160 --> 02:15:32,920 WE INCREASE CANCER RESEARCH, IF 2608 02:15:32,920 --> 02:15:34,720 WE INCREASE THE TECH TRANSFER 2609 02:15:34,720 --> 02:15:37,760 AND WE INCREASE FUNDING SO WE 2610 02:15:37,760 --> 02:15:39,960 CAN UNDERSTAND OUR SITUATIONS OF 2611 02:15:39,960 --> 02:15:43,040 THE IMPORTANCE OF CANCER AND 2612 02:15:43,040 --> 02:15:43,760 HAVE OUT OWN RESEARCH AND 2613 02:15:43,760 --> 02:15:48,240 UNDERSTAND WHAT IS THE 2614 02:15:48,240 --> 02:15:50,320 CONDITIONS THAT CAN HELP US 2615 02:15:50,320 --> 02:15:51,760 REDUCE THE INCIDENTS AND 2616 02:15:51,760 --> 02:15:53,680 MORTALITY OF CANCER IN LATIN 2617 02:15:53,680 --> 02:15:55,360 AMERICA AND THE CARIBBEAN. 2618 02:15:55,360 --> 02:15:56,520 THANK YOU FOR YOUR ATTENTION AND 2619 02:15:56,520 --> 02:15:58,040 I WILL BE LOOKING FORWARD TO 2620 02:15:58,040 --> 02:16:02,720 YOUR QUESTIONS AND COMMENTS. 2621 02:16:02,720 --> 02:16:09,440 >>HELLO I'M GUSTAVO WERUTSKY 2622 02:16:09,440 --> 02:16:13,360 AND CHAIR FROM THE LATINO ON COL 2623 02:16:13,360 --> 02:16:14,520 GOUGH GROUP IN BRAZIL AND I WILL 2624 02:16:14,520 --> 02:16:15,600 PRESENT TO YOU TODAY THE 2625 02:16:15,600 --> 02:16:19,920 CLINICAL RESEARCH FOR CONTROL IN 2626 02:16:19,920 --> 02:16:21,720 AMERICAN AND THE CARIBBEAN. 2627 02:16:21,720 --> 02:16:23,720 I WORK FOR CLINICAL RESEARCH 2628 02:16:23,720 --> 02:16:25,880 ESPECIALLY IN BREAST CANCER IN 2629 02:16:25,880 --> 02:16:26,280 MY INSTITUTION. 2630 02:16:26,280 --> 02:16:28,120 SO IN THE THE LAST 20 OR 30 2631 02:16:28,120 --> 02:16:29,920 YEARS, WE SAW A GLOBAL MIGRATION 2632 02:16:29,920 --> 02:16:33,440 OF CLINICAL TRIALS COMING AND 2633 02:16:33,440 --> 02:16:35,120 THE MAJORITY COMING TO ASIA AND 2634 02:16:35,120 --> 02:16:36,960 AS WELL TO LATIN AMERICA AND 2635 02:16:36,960 --> 02:16:38,440 OTHER DEVELOPING COUNTRIES AND 2636 02:16:38,440 --> 02:16:42,200 AS YOU CAN SEE IN THE GRAPH, THE 2637 02:16:42,200 --> 02:16:44,880 PREPORTION OF UPPER MIDDLE AND 2638 02:16:44,880 --> 02:16:46,560 LOWER MIDDLE INCOME COUNTRIES 2639 02:16:46,560 --> 02:16:49,760 THAT ARE PARTICIPATING IN 2640 02:16:49,760 --> 02:16:51,000 REGISTRATION TRIALS IN CLINICAL 2641 02:16:51,000 --> 02:16:53,440 TRIALS THAT ARE increasing over 2642 02:16:53,440 --> 02:16:55,440 the years, if you look to phase 2643 02:16:55,440 --> 02:16:58,080 1 to clinical trials on going 2644 02:16:58,080 --> 02:17:01,720 open foray cruel in the clinical 2645 02:17:01,720 --> 02:17:04,120 trials, we see that Latina 2646 02:17:04,120 --> 02:17:06,680 America participate in around 5% 2647 02:17:06,680 --> 02:17:10,240 of the studies and Latin America 2648 02:17:10,240 --> 02:17:11,720 sites participate in clinical 2649 02:17:11,720 --> 02:17:13,520 trials we see that we don't have 2650 02:17:13,520 --> 02:17:15,640 a huge number of sites but that 2651 02:17:15,640 --> 02:17:18,760 a few number of sites we've high 2652 02:17:18,760 --> 02:17:20,640 amount of patients to we include 2653 02:17:20,640 --> 02:17:23,880 several patients in the single 2654 02:17:23,880 --> 02:17:24,400 enters Tuesday. 2655 02:17:24,400 --> 02:17:30,040 THIS IS WINSTITUTION. 2656 02:17:30,040 --> 02:17:32,040 WHEN WE PARTICIPATE IN THE 2657 02:17:32,040 --> 02:17:32,760 CLINICAL TRIALS. 2658 02:17:32,760 --> 02:17:34,720 IF WE LOOK AT PROFILE OF 2659 02:17:34,720 --> 02:17:37,080 CLINICAL TRIALS THAT HAVE BEEN 2660 02:17:37,080 --> 02:17:38,920 DOING IN LATIN AMERICA, WE SEE 2661 02:17:38,920 --> 02:17:43,920 THAT THE 95% OF THE STUDIES ARE 2662 02:17:43,920 --> 02:17:46,040 CONDUCTED BY PHARMA SPONSORS SO 2663 02:17:46,040 --> 02:17:48,000 BASICALLY WE PARTICIPATE IN 2664 02:17:48,000 --> 02:17:49,280 CLINICAL TRIAL ININCLUDED 2665 02:17:49,280 --> 02:17:50,360 PATIENTS. 2666 02:17:50,360 --> 02:17:54,360 WE DON'T HAVE IN LATIN AMERICA 2667 02:17:54,360 --> 02:17:56,680 THAT RECOGNIZE THE ACADEMIC 2668 02:17:56,680 --> 02:17:57,720 CLINICAL RESEARCH. 2669 02:17:57,720 --> 02:18:00,640 SO IT MEANS THAT WE NEED TO RELY 2670 02:18:00,640 --> 02:18:04,000 ON THE SAME CLINICAL PHARMA 2671 02:18:04,000 --> 02:18:06,680 INDUSTRIES TO DEVELOP OUR 2672 02:18:06,680 --> 02:18:07,720 INVESTIGATIVE TRIALS AND IT 2673 02:18:07,720 --> 02:18:10,800 MEANS THAT WE NEED TO COVER ALL 2674 02:18:10,800 --> 02:18:12,280 THE CARE OF PATIENTS SO THIS IS 2675 02:18:12,280 --> 02:18:15,120 VERY EXPENSIVE TO DEVELOP THE 2676 02:18:15,120 --> 02:18:18,080 TRIALS IF WE NEED TO RESPONSE 2677 02:18:18,080 --> 02:18:19,920 AND COVER ALL THE CARE AND THIS 2678 02:18:19,920 --> 02:18:21,560 IS WHY WE DON'T HAVE A HUGE 2679 02:18:21,560 --> 02:18:23,880 NUMBER OF INITIATIVES 2680 02:18:23,880 --> 02:18:25,080 INVESTIGATIVE TRIALS IN THE 2681 02:18:25,080 --> 02:18:27,080 REGION AS WE SEE HERE IN THIS 2682 02:18:27,080 --> 02:18:29,200 PICTURE, WE SEE THAT LATIN 2683 02:18:29,200 --> 02:18:31,800 AMERICA GOVERNMENTS, THEY DON'T 2684 02:18:31,800 --> 02:18:33,320 INVEST A LOT IN RESEARCH AND 2685 02:18:33,320 --> 02:18:37,480 DEVELOPMENT AND EVEN THE 2686 02:18:37,480 --> 02:18:46,280 NATIONAL COMPANIES THAT O WE SEE 2687 02:18:46,280 --> 02:18:51,920 BRAZIL HAS GDP DEVELOPMENT AND 2688 02:18:51,920 --> 02:18:53,840 IF YOU COMPARE AND TWO TIMES 2689 02:18:53,840 --> 02:18:56,200 MORE SO BASICALLY, LATIN AMERICA 2690 02:18:56,200 --> 02:18:57,760 RELIES A LOT IN THE PUBLIC 2691 02:18:57,760 --> 02:18:59,800 FUNDING AND IN THE RIGHTS YOU 2692 02:18:59,800 --> 02:19:02,000 CAN SEE THAT WHEN WE HAVE 2693 02:19:02,000 --> 02:19:04,080 ECONOMIC CRISIS AS THIS IS AN 2694 02:19:04,080 --> 02:19:05,440 EXAMPLE FROM BRAZIL, FOR 2695 02:19:05,440 --> 02:19:07,160 EXAMPLE, AND THE GOVERNMENT THE 2696 02:19:07,160 --> 02:19:08,840 FIRST THING THE GOVERNMENT DOES 2697 02:19:08,840 --> 02:19:13,040 IT INVESTMENT IN RESEARCH SO 2698 02:19:13,040 --> 02:19:17,480 THIS IS WHY WHOA NEED TO SHIFT D 2699 02:19:17,480 --> 02:19:18,680 MAKE AN ENVIRONMENT THAT IS 2700 02:19:18,680 --> 02:19:21,320 FRIENDLY AND EASY TO DEVELOP AND 2701 02:19:21,320 --> 02:19:23,080 INVEST IN CLINICAL TRIALS IN OUR 2702 02:19:23,080 --> 02:19:25,760 REGION SO WHEN WE LOOK AT THE 2703 02:19:25,760 --> 02:19:28,040 TIME TO APPROVAL OF CLINICAL 2704 02:19:28,040 --> 02:19:30,080 TRIALS THIS IS AN EXAMPLE FROM 2705 02:19:30,080 --> 02:19:31,040 AFFINITY TRIAL IN BREAST CANCER 2706 02:19:31,040 --> 02:19:32,560 AND WE SEE THAT FOR EXAMPLE, 2707 02:19:32,560 --> 02:19:36,400 NORTH AMERICA THE TIME IN DAYS 2708 02:19:36,400 --> 02:19:38,560 TO REGULATORY APPROVAL IS AROUND 2709 02:19:38,560 --> 02:19:42,160 30 DAYS COMPARED TO LATIN 2710 02:19:42,160 --> 02:19:46,840 AMERICA IT'S AROUND 53 OR 55 2711 02:19:46,840 --> 02:19:48,000 DAYS SO IT'S BASICALLY DOUBLE 2712 02:19:48,000 --> 02:19:50,000 TIME FOR REGULATORY APPROVAL. 2713 02:19:50,000 --> 02:19:53,080 WHEN WE SEE ALSO THE COUNTRIES 2714 02:19:53,080 --> 02:19:55,720 BY INCOME WE SEE THE UPPER 2715 02:19:55,720 --> 02:19:56,520 MIDDLE I OBJECT COME TAKES MORE 2716 02:19:56,520 --> 02:20:00,560 TIME THAN THE HIGH INCOME TO 2717 02:20:00,560 --> 02:20:05,040 APPROVE A PROTOCOL SO WHEN WE 2718 02:20:05,040 --> 02:20:06,600 ASK THE PATIENTS AROUND THE 2719 02:20:06,600 --> 02:20:08,360 WORLD IF THEY PARTICIPATE, 93% 2720 02:20:08,360 --> 02:20:10,640 OF THE PATIENTS IN NORTH AMERICA 2721 02:20:10,640 --> 02:20:12,600 THEY ARE WANTING TO PARTICIPATE 2722 02:20:12,600 --> 02:20:14,120 BUT EVEN IN SOUTH AMERICA ABOUT 2723 02:20:14,120 --> 02:20:16,000 THE MAJORITY OF PATIENTS ARE 2724 02:20:16,000 --> 02:20:17,040 WANTING TO PARTICIPATE IN 2725 02:20:17,040 --> 02:20:18,360 CLINICAL TRIALS AND THE PROBLEM 2726 02:20:18,360 --> 02:20:20,480 HERE IS THAT WE DON'T HAVE A 2727 02:20:20,480 --> 02:20:22,360 EDUCATION AND WE DON'T HAVE 2728 02:20:22,360 --> 02:20:24,520 EDUCATION FOR OUR PATIENTS TO 2729 02:20:24,520 --> 02:20:26,280 UNDERSTAND THE CLINICAL TRIALS 2730 02:20:26,280 --> 02:20:27,840 SO THERE'S NO INFORMATION FROM 2731 02:20:27,840 --> 02:20:31,240 THE MINISTER OF HEALTH AND 2732 02:20:31,240 --> 02:20:33,960 NATIONAL INSTITUTES AND OTHER 2733 02:20:33,960 --> 02:20:35,880 PATIENTS AND ADVOCACY GROUPS 2734 02:20:35,880 --> 02:20:37,280 INVOLVED CLINICAL TRIALS AND WHY 2735 02:20:37,280 --> 02:20:39,280 IT'S IMPORTANT TO PARTICIPATE IN 2736 02:20:39,280 --> 02:20:41,400 THIS STUDY SO I REALLY FEEL WE 2737 02:20:41,400 --> 02:20:42,960 NEED TO HAVE MORE EDUCATIONAL 2738 02:20:42,960 --> 02:20:44,760 INFORMATION FOR THE PATIENTS IN 2739 02:20:44,760 --> 02:20:52,160 THE REGION. 2740 02:20:52,160 --> 02:20:57,400 THIS IS A INITIATIVE FROM 2741 02:20:57,400 --> 02:20:59,760 FUNDRAISING INITIATIVE TO INVEST 2742 02:20:59,760 --> 02:21:05,320 IN AK A TEMPERATURE I CAN ACADEN 2743 02:21:05,320 --> 02:21:06,520 LATIN AMERICA. 2744 02:21:06,520 --> 02:21:08,080 THIS WAS MEETING WITH PATIENTS 2745 02:21:08,080 --> 02:21:10,960 AND PATIENT ADVOCACY GROUPS TO 2746 02:21:10,960 --> 02:21:12,520 EXPLAIN WHAT THIS CONCEPT AND 2747 02:21:12,520 --> 02:21:14,200 WHY IT'S IMPORTANT THIS CLINICAL 2748 02:21:14,200 --> 02:21:16,080 TRIALS AND CONCEPTS SO THIS IS A 2749 02:21:16,080 --> 02:21:18,920 VERY GOOD INITIATIVE THAT MAY 2750 02:21:18,920 --> 02:21:20,800 ATTRACT A PATIENT ADVOCACY 2751 02:21:20,800 --> 02:21:22,440 GROUPS AND CLINICAL TRIALS AND 2752 02:21:22,440 --> 02:21:24,760 TO GIVE MORE INFORMATION TO 2753 02:21:24,760 --> 02:21:26,680 PEOPLE IN THIS MEETING WAS 2754 02:21:26,680 --> 02:21:34,240 BROADCASTS SO, THEN WE CAN REACH 2755 02:21:34,240 --> 02:21:44,760 MANY, MANY WE ARE LEARNING ABOUT 2756 02:21:48,920 --> 02:21:50,600 THE CLINICAL TRIALS AS THEY 2757 02:21:50,600 --> 02:21:51,800 CENTRALIZE THE CLINICAL TRIALS 2758 02:21:51,800 --> 02:21:53,840 THAT WOULD BE I THINK FROM LATIN 2759 02:21:53,840 --> 02:21:57,840 AMERICA AND WITH THE HUGE HEAD 2760 02:21:57,840 --> 02:22:08,320 GEOGRAPHY OF THE COUNTRIES AND 2761 02:22:12,320 --> 02:22:13,880 BECAUSE YOU HAVE THE COST OF IS 2762 02:22:13,880 --> 02:22:15,440 THIS SET THAT YOU REQUEST THE 2763 02:22:15,440 --> 02:22:18,000 RECRUITMENT IN DIVERSITY OF THE 2764 02:22:18,000 --> 02:22:19,680 POPULATION THAT THE PATIENT 2765 02:22:19,680 --> 02:22:22,640 DON'T NEED TO CENTER FOR 2766 02:22:22,640 --> 02:22:24,080 SOMETIMES IT'S 200 KILOMETRES 2767 02:22:24,080 --> 02:22:27,080 FROM THE AND FOR EXAMPLE WE CAN 2768 02:22:27,080 --> 02:22:33,640 GENERATE A LOT OF DATA SO THAT 2769 02:22:33,640 --> 02:22:35,680 AND ESPECIALLY I AM NOT FEED THE 2770 02:22:35,680 --> 02:22:39,680 DEVASTATION PROCESS OF THIS 2771 02:22:39,680 --> 02:22:42,600 STUDIES IN THE IT WAS GOING TO 2772 02:22:42,600 --> 02:22:45,720 SPEAK ABOUT THE THE LA TEENY 2773 02:22:45,720 --> 02:22:46,440 AMERICAN CO-OPERATIVE GROUP AND 2774 02:22:46,440 --> 02:22:48,680 THIS IS A RESEARCH GROUP AND 2775 02:22:48,680 --> 02:22:50,640 THIS IS NOT A NON-PROFIT 2776 02:22:50,640 --> 02:22:56,880 ORGANIZATION THAT WAS VIEWED TO 2777 02:22:56,880 --> 02:23:02,480 THE WE HAVE ABOUT 427 MEMBERS IN 2778 02:23:02,480 --> 02:23:04,200 16 COUNTRIES IN LATIN AMERICA 2779 02:23:04,200 --> 02:23:06,000 AND THEY COVER AROUND 200 2780 02:23:06,000 --> 02:23:10,880 HOSPITALS AND WE DID AROUND THE 2781 02:23:10,880 --> 02:23:15,360 59 EPIDEMIOLOGICAL WITH MORE 2782 02:23:15,360 --> 02:23:16,760 THAN 10,000 PATIENTS IN THIS 2783 02:23:16,760 --> 02:23:27,320 SERVICE AND WE PRODUCE MORE THAN 2784 02:23:29,120 --> 02:23:31,760 AND SEVERAL IN DIFFERENT TUMOR 2785 02:23:31,760 --> 02:23:39,640 TYPES AND SO, IN 202020, THERE 2786 02:23:39,640 --> 02:23:41,200 WAS A BIG ACHIEVEMENT TO OUR 2787 02:23:41,200 --> 02:23:45,080 GROUP THAT WAS THE FIRST 2788 02:23:45,080 --> 02:23:48,680 CLINICAL TRIAL INVESTIGATED THAT 2789 02:23:48,680 --> 02:23:50,800 CAUSE CONDUCTED AND PRESENTED AS 2790 02:23:50,800 --> 02:23:54,120 A PRESENTATION AND IN 2020 AND 2791 02:23:54,120 --> 02:23:56,960 THIS WAS A STUDY IN PROSTATE 2792 02:23:56,960 --> 02:23:58,880 CONCERN AND TODAY, THEY HAVE 2793 02:23:58,880 --> 02:24:01,800 SEVERAL PARTNERS AND WE 2794 02:24:01,800 --> 02:24:02,800 PARTNERSHIP WITH SEVERAL 2795 02:24:02,800 --> 02:24:05,120 NATIONAL GROUPS AND BRAZIL AND 2796 02:24:05,120 --> 02:24:13,640 ALSO FROM LATIN AMERICA AND 2797 02:24:13,640 --> 02:24:15,280 GROUPS FROM YOU'RE UP AND HOW DO 2798 02:24:15,280 --> 02:24:22,160 WE FOSTER CLUB CLIN CLINICAL TR. 2799 02:24:22,160 --> 02:24:24,880 WE NEED TO DECENTRALIZE THE 2800 02:24:24,880 --> 02:24:34,000 COMMUNITY IN A ROLE FOR EXAMPLE 2801 02:24:34,000 --> 02:24:37,560 NA BRAZIL WE NEED TO OPEN 10 2802 02:24:37,560 --> 02:24:40,000 SITES AND SO THIS PROCESS IS 2803 02:24:40,000 --> 02:24:41,520 VERY AT LENGTH SO IT'S A LONG 2804 02:24:41,520 --> 02:24:45,440 PROCESS AND IT'S DELAYED THE 2805 02:24:45,440 --> 02:24:49,480 STARTING OF THE CRISIS SO WE CAN 2806 02:24:49,480 --> 02:24:50,400 TREATMENT LINE THE INTERNAL 2807 02:24:50,400 --> 02:24:52,480 PROCESS FOR REGULATORY AND ALSO 2808 02:24:52,480 --> 02:24:53,920 THE CONTACT APPROVAL THAT IS 2809 02:24:53,920 --> 02:24:55,240 IMPORTANT AND SOMETIMES IT'S TWO 2810 02:24:55,240 --> 02:24:56,520 OR THROW MONTHS OR FOUR MONTHS 2811 02:24:56,520 --> 02:24:59,160 IN CONTRACTS AND APPROVALS SO 2812 02:24:59,160 --> 02:24:59,800 THIS WOULD BE CERTAINLY 2813 02:24:59,800 --> 02:25:02,040 SOMETHING TO IMPROVE INSIDE THE 2814 02:25:02,040 --> 02:25:04,080 CENTERS AND ALSO THE INDUCE 2815 02:25:04,080 --> 02:25:04,920 TREMENDOUS AROUND THE SPONSOR 2816 02:25:04,920 --> 02:25:07,000 AND THEY NEED TO INCORPORATE 2817 02:25:07,000 --> 02:25:09,480 DIGITAL TECHNOLOGIES AND IN 2818 02:25:09,480 --> 02:25:12,800 CLINICAL TRIALS FOR EXAMPLE 2819 02:25:12,800 --> 02:25:14,640 CONSENT AND MONITORING AND ALSO 2820 02:25:14,640 --> 02:25:17,680 ALL THE POSSIBILITIES THAT IS 2821 02:25:17,680 --> 02:25:19,480 STREAMLINE THE PROCESS INSIDE 2822 02:25:19,480 --> 02:25:21,240 THE CENTER AND FACILITATE THE 2823 02:25:21,240 --> 02:25:23,600 WORK AND FOR PATIENTS AND 2824 02:25:23,600 --> 02:25:25,040 RECRUITMENT I THINK THAT WE NEED 2825 02:25:25,040 --> 02:25:30,000 TO STIMULATE MORE THE USE 2826 02:25:30,000 --> 02:25:31,320 PROMOTING CLINICAL TRIALS AND WE 2827 02:25:31,320 --> 02:25:33,760 NEED TO ENGAGE AS WELL THE 2828 02:25:33,760 --> 02:25:37,160 PATIENTS AND ADVOCACY GROUPS TO 2829 02:25:37,160 --> 02:25:39,080 KNOW ABOUT THESE STUDIES BECAUSE 2830 02:25:39,080 --> 02:25:40,760 TODAY, THE PATIENTS AND THE 2831 02:25:40,760 --> 02:25:42,400 POPULATION JUST DON'T KNOW WHERE 2832 02:25:42,400 --> 02:25:46,160 THEY STUDIES ARE OPEN FOR RULE. 2833 02:25:46,160 --> 02:25:47,200 THERE'S NO INFORMATION ON THE 2834 02:25:47,200 --> 02:25:49,480 INTERNET AND EVEN IN SOCIAL 2835 02:25:49,480 --> 02:25:50,880 MEDIA AND LASTLY THE TRANSLATION 2836 02:25:50,880 --> 02:25:53,600 OF RESEARCH WE NEED TO STIMULATE 2837 02:25:53,600 --> 02:25:55,760 THE FUNDING FOR TRANSLATIONAL SO 2838 02:25:55,760 --> 02:25:58,880 WE RELY BASICALLY IN LATIN 2839 02:25:58,880 --> 02:26:00,640 AMERICA PUBLIC FUNDING FOR 2840 02:26:00,640 --> 02:26:04,280 RESEARCH AND PH.D, BUT WE NEVER 2841 02:26:04,280 --> 02:26:08,240 IN LATIN AMERICA MAKE A DEVICE 2842 02:26:08,240 --> 02:26:12,240 OR A NEW DRUG APPROVAL FROM THIS 2843 02:26:12,240 --> 02:26:14,400 INVESTMENT AND THEY WILL WILL 2844 02:26:14,400 --> 02:26:16,520 DOR FOR SEVERAL DECADES SO THAT 2845 02:26:16,520 --> 02:26:18,800 IS VERY IMPORTANT TO FACILITATE 2846 02:26:18,800 --> 02:26:20,600 THE REBATE FUNDING FOR THOSE 2847 02:26:20,600 --> 02:26:22,240 NATIONS AND RESEARCH ESPECIALLY 2848 02:26:22,240 --> 02:26:30,040 FOR ACADEMIC INITIATED CLINICAL 2849 02:26:30,040 --> 02:26:32,120 TRIALS. 2850 02:26:32,120 --> 02:26:34,080 THANK YOU, VERY MUCH. 2851 02:26:34,080 --> 02:26:39,000 >>GOOD MORNING, EVERYONE, 2852 02:26:39,000 --> 02:26:39,240 WELCOME. 2853 02:26:39,240 --> 02:26:41,000 THANK YOU FOR YOUR EXCELLENT AND 2854 02:26:41,000 --> 02:26:42,440 INFORMATIVE PRESENTATION AND I'M 2855 02:26:42,440 --> 02:26:44,760 DELIGHTED TO MODERATE YOUR 2856 02:26:44,760 --> 02:26:45,440 CONVERSATION. 2857 02:26:45,440 --> 02:26:49,440 MY FIRST QUESTION FROM THE 2858 02:26:49,440 --> 02:26:53,240 AUDIENCE FOR Dr. BEJARANO. 2859 02:26:53,240 --> 02:26:54,400 WOULD YOU PLEASE DESCRIBE THE 2860 02:26:54,400 --> 02:26:56,280 CURRENT EVENTS TO FACILITATE AND 2861 02:26:56,280 --> 02:27:00,200 PROMOTE RESEARCH IN CENTRAL 2862 02:27:00,200 --> 02:27:01,840 AMERICA? 2863 02:27:01,840 --> 02:27:05,040 >>GOOD MORNING, WE HAVE SOME 2864 02:27:05,040 --> 02:27:09,160 MANY OPPORTUNITIES AS Dr. 2865 02:27:09,160 --> 02:27:10,720 WERUTSKY JUST MENTIONED, ONE IS 2866 02:27:10,720 --> 02:27:11,440 IN AMERICA. 2867 02:27:11,440 --> 02:27:14,600 ONE YOU CAN SEE THERE'S A 2868 02:27:14,600 --> 02:27:16,840 NETWORK OF COMMITTEES AND THIS 2869 02:27:16,840 --> 02:27:19,600 IS FROM VERY RECENT CREATION AND 2870 02:27:19,600 --> 02:27:21,080 IT'S HELPING OUT TO IDENTIFY 2871 02:27:21,080 --> 02:27:23,200 MORE THAN 1500 ETHICS COMMITTEE 2872 02:27:23,200 --> 02:27:24,400 AND THIS MEANS THAT THERE'S A 2873 02:27:24,400 --> 02:27:26,640 LOT OF PEOPLE INTERESTED IN 2874 02:27:26,640 --> 02:27:37,160 RESEARCH AND TRYING TO ACQUIRE 2875 02:27:40,080 --> 02:27:41,320 BETTER QUALITY CLINICAL TRIALS. 2876 02:27:41,320 --> 02:27:46,680 TO EMPOWER THIS NEW RESEARCHERS, 2877 02:27:46,680 --> 02:27:51,560 PROMOTE THE ACQUISITION OF THIS 2878 02:27:51,560 --> 02:27:55,600 TOOLS THAT WE ENABLE THEM TO 2879 02:27:55,600 --> 02:27:57,000 PERFORM ADEQUATELY RESEARCH IN 2880 02:27:57,000 --> 02:28:01,840 THE REGION. 2881 02:28:01,840 --> 02:28:02,640 >>THANK YOU. 2882 02:28:02,640 --> 02:28:07,120 THE NEXT QUESTION IS FOR Dr. 2883 02:28:07,120 --> 02:28:07,720 WERUTSKY. 2884 02:28:07,720 --> 02:28:08,960 WHAT MAKES IT SUCCESSFUL? 2885 02:28:08,960 --> 02:28:10,120 WHAT LESSONS LEARNED CAN YOU 2886 02:28:10,120 --> 02:28:12,640 SHARE WITH US THAT WILL NEED TO 2887 02:28:12,640 --> 02:28:15,960 BE CONSIDERED FOR AN IDEAL 2888 02:28:15,960 --> 02:28:16,920 U.S.-LATIN AMERICA 2889 02:28:16,920 --> 02:28:17,280 COLLABORATION? 2890 02:28:17,280 --> 02:28:22,240 >>SO, I THINK PART BASICALLY IT 2891 02:28:22,240 --> 02:28:25,480 WAS IN THE BEGINNING NETWORK OF 2892 02:28:25,480 --> 02:28:28,440 INVESTIGATORS AND SO THERE WAS A 2893 02:28:28,440 --> 02:28:31,400 WAY TO START TO PERFORM, 2894 02:28:31,400 --> 02:28:38,480 INVESTIGATE AND STUDIES IN THE 2895 02:28:38,480 --> 02:28:40,640 REGION. 2896 02:28:40,640 --> 02:28:41,880 AT THAT TIME, WE HAD PEOPLE 2897 02:28:41,880 --> 02:28:43,440 WORKING AND GETTING ALL THE 2898 02:28:43,440 --> 02:28:47,840 IDEAS FROM THE INVESTIGATORS AND 2899 02:28:47,840 --> 02:28:48,320 MEETING THESE IDEAS TO 2900 02:28:48,320 --> 02:28:49,600 ESPECIALLY IN THE CLINICAL 2901 02:28:49,600 --> 02:28:52,040 TRIALS TO PHARMA, TO SEE IF THEY 2902 02:28:52,040 --> 02:28:54,560 HAVE INTEREST TO DEVELOP THIS 2903 02:28:54,560 --> 02:28:56,560 PROPOSALS IN THE REGION BUT AS 2904 02:28:56,560 --> 02:28:59,320 WELL, WE SENT PROPOSALS FOR THE 2905 02:28:59,320 --> 02:29:01,280 GOVERNMENT AND ESPECIALLY TO 2906 02:29:01,280 --> 02:29:03,200 GENERATE THE REEVOLVING DATA 2907 02:29:03,200 --> 02:29:05,000 THAT WE GENERATE IN SEVERAL 2908 02:29:05,000 --> 02:29:07,240 HUMOR TYPES AND THIS STEPS US A 2909 02:29:07,240 --> 02:29:14,240 LOT TO UNDERSTAND THE REALITY OF 2910 02:29:14,240 --> 02:29:24,760 OUR WE SAW INVESTIGATORS BECAUSE 2911 02:29:27,760 --> 02:29:29,680 WE STARTED TO PUBLISH OUR RESULT 2912 02:29:29,680 --> 02:29:33,280 AND THIS GENERATES A LOT OF 2913 02:29:33,280 --> 02:29:34,800 CREDIBILITY INTERNATIONALLY AND 2914 02:29:34,800 --> 02:29:36,400 NOW WE'RE IN THE NEXT STEP. 2915 02:29:36,400 --> 02:29:39,560 NOW WE HAVE PARTICIPATING MORE 2916 02:29:39,560 --> 02:29:41,600 MORE IN INTRA GROUP STUDIES AND 2917 02:29:41,600 --> 02:29:47,320 GROUPS FROM U.S. AND EUROPE IN 2918 02:29:47,320 --> 02:29:48,480 PHASE 3 REGISTRATION PRICE SO 2919 02:29:48,480 --> 02:29:50,120 DOING ACTIVITIES HERE IN BRAZIL 2920 02:29:50,120 --> 02:29:51,880 AND LATIN AMERICA WITH 2921 02:29:51,880 --> 02:29:53,320 MONITORING PAYMENTS, CONTRACTS 2922 02:29:53,320 --> 02:29:57,400 AND EVERYTHING SO, THIS IS A 2923 02:29:57,400 --> 02:30:00,120 HISTORY NA THIS SHOWS THAT IT IS 2924 02:30:00,120 --> 02:30:01,560 POSSIBLE TO DO OK, WHAT I THINK 2925 02:30:01,560 --> 02:30:04,000 IS IMPORTANT IS THAT I BELIEVE 2926 02:30:04,000 --> 02:30:06,520 WE CAN, WE HAVE A VERY PROMISING 2927 02:30:06,520 --> 02:30:08,200 POSSIBILITY TO INTERACT MORE 2928 02:30:08,200 --> 02:30:11,240 WITH THE U.S. AND U.S. GROUPS 2929 02:30:11,240 --> 02:30:13,960 AND THE MODEL OF GROUP STUDIES 2930 02:30:13,960 --> 02:30:15,880 WE NEED TO EVALUATE BECAUSE 2931 02:30:15,880 --> 02:30:18,440 THERE IS ALSO MANY BAD YEARS IN 2932 02:30:18,440 --> 02:30:21,840 TERMS OF NCI HOW THE NCI WORKS 2933 02:30:21,840 --> 02:30:24,080 WITH GROUPS OUTSIDE THE, S. THAT 2934 02:30:24,080 --> 02:30:25,720 WE NEED MAYBE TO BE MORE 2935 02:30:25,720 --> 02:30:27,720 FLEXIBILITY BECAUSE LATIN 2936 02:30:27,720 --> 02:30:30,360 AMERICA HAS SEVERAL REGULATORY 2937 02:30:30,360 --> 02:30:34,040 TYPES OF SUBMISSIONS AND ALSO 2938 02:30:34,040 --> 02:30:36,160 INSURANCE FOR THE INVESTIGATORS 2939 02:30:36,160 --> 02:30:38,080 AND PAYMENTS OF THE SYSTEM OF 2940 02:30:38,080 --> 02:30:40,680 CARE SO WE NEED A BIT MORE 2941 02:30:40,680 --> 02:30:42,800 COMMUNICATION TO TRY TO 2942 02:30:42,800 --> 02:30:44,120 STREAMLINE OUR PARTNERSHIP WITH 2943 02:30:44,120 --> 02:30:47,400 THE U.S. 2944 02:30:47,400 --> 02:30:49,240 >>THANK YOU, CONGRATULATIONS ON 2945 02:30:49,240 --> 02:30:50,640 THE GREAT INITIATIVE. 2946 02:30:50,640 --> 02:30:57,040 WE'RE GOING BACK TO Dr. 2947 02:30:57,040 --> 02:30:57,480 BEJARANO. 2948 02:30:57,480 --> 02:30:59,200 HOW DO YOU INCREASE HUMAN 2949 02:30:59,200 --> 02:31:02,120 RESOURCES IN CANCER HEALTHCARE? 2950 02:31:02,120 --> 02:31:03,960 ARE THERE ANY INTERVENTIONS OR 2951 02:31:03,960 --> 02:31:06,080 POLICIES IN PLACE IN THE REGION? 2952 02:31:06,080 --> 02:31:08,680 >>IT'S A VERY IMPORTANT 2953 02:31:08,680 --> 02:31:09,160 QUESTION. 2954 02:31:09,160 --> 02:31:12,760 NOT MANY COUNTRIES HAVE CANCER 2955 02:31:12,760 --> 02:31:14,680 POLICIES SO THE RESULT IS THAT 2956 02:31:14,680 --> 02:31:17,880 THERE'S NO PLANS FOR SCHOOLS FOR 2957 02:31:17,880 --> 02:31:21,080 ONCOLOGY TRAINING AND ONE OF MY 2958 02:31:21,080 --> 02:31:22,400 PROPOSALS FROM A GROUP THAT 2959 02:31:22,400 --> 02:31:24,440 WE'VE BEEN TALKING ABOUT WITH 2960 02:31:24,440 --> 02:31:29,200 OUR COLLEAGUES IS TO PROMOTE THE 2961 02:31:29,200 --> 02:31:30,720 OPENING OF THESE CANCER 2962 02:31:30,720 --> 02:31:32,760 TRAININGS SCHOOLS NOT ONLY FOR 2963 02:31:32,760 --> 02:31:34,720 PHYSICIANS BUT ALSO FOR NURSES 2964 02:31:34,720 --> 02:31:37,320 AND TECHNICIANS AND SO MANY WAYS 2965 02:31:37,320 --> 02:31:39,880 PSYCHOLOGY AND SPECIALIZING IN 2966 02:31:39,880 --> 02:31:42,800 CANCER CARE BECAUSE IT'S ANOTHER 2967 02:31:42,800 --> 02:31:44,720 PART OF THE MANAGEMENT OF CANCER 2968 02:31:44,720 --> 02:31:46,760 PATIENTS THAT IS VERY IMPORTANT 2969 02:31:46,760 --> 02:31:50,520 TO ADDRESS SO ONE OF THE 2970 02:31:50,520 --> 02:31:54,240 RECOMMENDATIONS WOULD BE TO 2971 02:31:54,240 --> 02:31:57,680 EMPOWER OR PROMOTE LOCAL 2972 02:31:57,680 --> 02:31:59,240 TRAINING CENTERS IN COUNTRIES 2973 02:31:59,240 --> 02:32:03,240 WHO DOESN'T HAVE AND FOR IN 2974 02:32:03,240 --> 02:32:05,080 CENTRAL AMERICA, COSTA RICA HAS 2975 02:32:05,080 --> 02:32:08,120 A VERY SOLID ONCOLOGY TRAINING 2976 02:32:08,120 --> 02:32:10,200 PROGRAM BUT IT'S NOT OPEN TO 2977 02:32:10,200 --> 02:32:12,120 FOREIGNERS SO ONLY FOR COAST A 2978 02:32:12,120 --> 02:32:15,680 REEKANCE SO MAYBE WE CAN HAVE A 2979 02:32:15,680 --> 02:32:17,400 NETWORK THAT WE CAN CHAIR AND WE 2980 02:32:17,400 --> 02:32:19,760 HAVE ACCESS FOR ALL THE PERSONS 2981 02:32:19,760 --> 02:32:20,560 WHO ARE INTERESTED. 2982 02:32:20,560 --> 02:32:22,240 BUT THE OTHER HAND, THERE'S 2983 02:32:22,240 --> 02:32:23,800 STILL THE PROBLEM OF THE 2984 02:32:23,800 --> 02:32:28,320 GOVERNMENTS BECAUSE WE NEED A 2985 02:32:28,320 --> 02:32:29,520 LOT OF PROFESSIONAL AND 2986 02:32:29,520 --> 02:32:31,400 SOMETIMES MOST OF THE TIMES 2987 02:32:31,400 --> 02:32:34,880 THERE'S NOT A BUDGET TO HIRE 2988 02:32:34,880 --> 02:32:36,240 THEM SO IT'S AN ISSUE. 2989 02:32:36,240 --> 02:32:38,520 THIS IS A LOCAL ISSUE BUT WE CAN 2990 02:32:38,520 --> 02:32:43,760 ADDRESS IT AS A GROUP AND 2991 02:32:43,760 --> 02:32:44,000 PROMOTE. 2992 02:32:44,000 --> 02:32:44,880 >>THANK YOU. 2993 02:32:44,880 --> 02:32:52,160 I THINK THE ORGANIZED REGION ARE 2994 02:32:52,160 --> 02:32:52,360 KEY. 2995 02:32:52,360 --> 02:32:54,000 YOU MENTIONED LIMITATIONS ABOUT 2996 02:32:54,000 --> 02:32:56,240 FUNDING, WHAT IS THE BEST WAY TO 2997 02:32:56,240 --> 02:33:00,480 SUPPORT CANCER RESEARCH IN 2998 02:33:00,480 --> 02:33:01,880 LATINO AMERICAN AND 2999 02:33:01,880 --> 02:33:03,960 INVESTIGATORS INITIATED STYLES? 3000 02:33:03,960 --> 02:33:07,640 >>SO, I THINK IT'S IMPORTANT TO 3001 02:33:07,640 --> 02:33:08,960 RECOGNIZE, FOR EXAMPLE, IN 3002 02:33:08,960 --> 02:33:12,040 BRAZIL WHEN LATIN AMERICA IS THE 3003 02:33:12,040 --> 02:33:15,120 SAME THAT PHARMA SPONSORED 3004 02:33:15,120 --> 02:33:16,760 TRIALS IN OUR HOSPITALS HAVE 3005 02:33:16,760 --> 02:33:20,440 BEEN DONE IN THE LAST 20 TO 25 3006 02:33:20,440 --> 02:33:23,360 YEARS AND THIS BRINGS TO OUR 3007 02:33:23,360 --> 02:33:25,880 CONSCIOUS A LOT OF INVESTMENTS. 3008 02:33:25,880 --> 02:33:26,720 OK. 3009 02:33:26,720 --> 02:33:30,600 THESE ALSO HAVE INDIRECTLY WHY 3010 02:33:30,600 --> 02:33:32,000 DO WE SAY THAT? 3011 02:33:32,000 --> 02:33:35,160 BECAUSE IN OUR HOSPITALS, THAT 3012 02:33:35,160 --> 02:33:36,600 PARTICIPATE IN CLINICAL TRIALS 3013 02:33:36,600 --> 02:33:39,200 THEY NEED TO CHANGE THE PRACTICE 3014 02:33:39,200 --> 02:33:40,720 AND IN TERMS OF QUALITY FOR 3015 02:33:40,720 --> 02:33:47,080 EXAMPLE, IN THE SURGERY, IN 3016 02:33:47,080 --> 02:33:49,120 PATHOLOGY, THE HYDROLOGIST NEEDS 3017 02:33:49,120 --> 02:33:50,360 TO UNDERSTAND AND LEARN ABOUT 3018 02:33:50,360 --> 02:33:53,080 THE RISKS AND THIS IS WILL 3019 02:33:53,080 --> 02:33:54,640 IMPACT ALL THE PATIENTS WE SEE, 3020 02:33:54,640 --> 02:33:55,440 OK. 3021 02:33:55,440 --> 02:33:57,160 SO THE INVESTMENT THAT INDUSTRY 3022 02:33:57,160 --> 02:33:58,800 DID IN THE LAST 20 YEARS WAS 3023 02:33:58,800 --> 02:34:02,920 VERY IMPORTANT TO BECAUSE THERE 3024 02:34:02,920 --> 02:34:05,000 WAS AT INTERESTS INSIDE THE 3025 02:34:05,000 --> 02:34:05,840 HOSPITALS, OK. 3026 02:34:05,840 --> 02:34:09,400 BUT WE NEED GO TO THE NEXT STEP. 3027 02:34:09,400 --> 02:34:12,160 THE NEXT STEP IS INNOVATION. 3028 02:34:12,160 --> 02:34:16,560 FOR IN OVATION, FOR EXAMPLE, THE 3029 02:34:16,560 --> 02:34:18,840 ORGANIZATION BASICALLY RELY ON 3030 02:34:18,840 --> 02:34:21,200 PROJECTS THAT WE DO WITH PHARMA 3031 02:34:21,200 --> 02:34:23,640 AS THEY DO AROUND THE WORLD AS 3032 02:34:23,640 --> 02:34:25,040 WE INVESTIGATE THE STUDIES WE 3033 02:34:25,040 --> 02:34:26,920 DON'T HAVE ANY SUPPORT FROM THE 3034 02:34:26,920 --> 02:34:28,440 GOVERNMENT AND I THINK THAT 3035 02:34:28,440 --> 02:34:33,120 THERE'S A VERY NICE INTERESTING 3036 02:34:33,120 --> 02:34:34,680 PROGRAM FROM THE GOVERNMENT IN 3037 02:34:34,680 --> 02:34:38,520 BRAZIL THE LAST YEARS THAT THE 3038 02:34:38,520 --> 02:34:41,680 PEOPLE AND THE COMPANIES CAN 3039 02:34:41,680 --> 02:34:47,760 INVEST OR CAN DONATE MONEY FOR 3040 02:34:47,760 --> 02:34:50,960 RESEARCH PROJECTS AND SO IT'S A 3041 02:34:50,960 --> 02:34:52,480 PROJECT THAT PEOPLE AND 3042 02:34:52,480 --> 02:34:54,880 COMPANIES CAN DONATE FOR ITS 3043 02:34:54,880 --> 02:34:57,920 RESEARCH PROJECTS AND THEN THEY 3044 02:34:57,920 --> 02:35:03,800 CAN DO IT AS A DONATION IN THE. 3045 02:35:03,800 --> 02:35:09,320 SO THIS MAKES A LOT OF NEW 3046 02:35:09,320 --> 02:35:10,400 POSSIBILITIES FOR PEOPLE AND 3047 02:35:10,400 --> 02:35:12,240 COMPANIES TO INVEST IN CLINICAL 3048 02:35:12,240 --> 02:35:16,120 RESEARCH AND THIS IS A WAY TO 3049 02:35:16,120 --> 02:35:18,440 PREVENT COMPANIES FROM BRINGING 3050 02:35:18,440 --> 02:35:23,440 PEOPLE ALSO TO SUPPORT 3051 02:35:23,440 --> 02:35:33,920 INVESTIGATIVE AND PRICE AND. 3052 02:35:38,800 --> 02:35:41,480 >>YOU SHOW US HOW SOMETIMES 3053 02:35:41,480 --> 02:35:45,800 MORE RATES ALIGN WITH INCIDENTS 3054 02:35:45,800 --> 02:35:48,160 AND AND THEY ARE DIAGNOSED AT 3055 02:35:48,160 --> 02:35:50,040 LATE STAGES AND HOW TO IMPROVE 3056 02:35:50,040 --> 02:35:52,200 CANCER PREVENTION AND IN LATIN 3057 02:35:52,200 --> 02:35:56,680 AMERICA AND THE CANADIAN. 3058 02:35:56,680 --> 02:35:59,320 >>WE HAVE THE PROBLEM THAT IT'S 3059 02:35:59,320 --> 02:36:01,600 A DIVERSITY OF PRIMARY CANCERS 3060 02:36:01,600 --> 02:36:03,120 IN LATIN AMERICA AND THE POINT 3061 02:36:03,120 --> 02:36:05,320 THAT IS COME TO ALL OF THEM, IS 3062 02:36:05,320 --> 02:36:08,760 THAT WE CAN DETECT EARLY CANCERS 3063 02:36:08,760 --> 02:36:12,480 AND WE UNDERSTAND HOW CAN WE 3064 02:36:12,480 --> 02:36:13,080 DETECT EARLY CANCERS VIA 3065 02:36:13,080 --> 02:36:15,160 SCREENING OR VIA EARLY DETECTION 3066 02:36:15,160 --> 02:36:20,400 AND WE CAN MAKE AN IMPACT ON 3067 02:36:20,400 --> 02:36:22,360 MORTALITY NOT ONLY IN LATIN 3068 02:36:22,360 --> 02:36:24,080 AMERICA BUT FOR PATIENTS THAT 3069 02:36:24,080 --> 02:36:26,240 MIGRATE TO OTHER COUNTRIES 3070 02:36:26,240 --> 02:36:29,480 BECAUSE THEY ARE ALREADY HAVE 3071 02:36:29,480 --> 02:36:32,760 DISEASES THAT ARE CARRYING FROM 3072 02:36:32,760 --> 02:36:35,560 THEIR ORIGINAL REGIONS SO 3073 02:36:35,560 --> 02:36:37,120 UNDERSTANDING THE EMERGING 3074 02:36:37,120 --> 02:36:39,520 CANCER LIKE LIVER CANCER FOR 3075 02:36:39,520 --> 02:36:40,920 EXAMPLE, LIKE GASTRIC CANCER AND 3076 02:36:40,920 --> 02:36:43,560 MORTALITY AND IT WILL ONLYING 3077 02:36:43,560 --> 02:36:45,360 EXPLAINED IF WE DO RESEARCH IN 3078 02:36:45,360 --> 02:36:47,800 THESE EARLY STAGES AND WE 3079 02:36:47,800 --> 02:36:54,200 ENFORCE EARLY DETECTION IN EARLY 3080 02:36:54,200 --> 02:36:54,400 CANCERS. 3081 02:36:54,400 --> 02:36:57,640 >>THANK YOU. 3082 02:36:57,640 --> 02:37:01,960 >>Dr. VERUTSKY CAN YOU TALK 3083 02:37:01,960 --> 02:37:03,600 ABOUT AMERICA AND THE KA RAIN 3084 02:37:03,600 --> 02:37:06,320 YAN, WE SEE THE LACK OF LATIN 3085 02:37:06,320 --> 02:37:07,840 AMERICA, THE LACK OF 3086 02:37:07,840 --> 02:37:11,880 PRECIPITATION IN SOME KEY PAP 3087 02:37:11,880 --> 02:37:18,080 PRECIPITATPARTICIPATION.WHAT ISO 3088 02:37:18,080 --> 02:37:18,360 BANKS? 3089 02:37:18,360 --> 02:37:18,680 THANK YOU. 3090 02:37:18,680 --> 02:37:22,480 >>YES, SO, BIOBANKING IN LATIN 3091 02:37:22,480 --> 02:37:24,520 AMERICA IS PERFORMING BASICALLY 3092 02:37:24,520 --> 02:37:29,200 BY A FEW INSTITUTIONS. 3093 02:37:29,200 --> 02:37:29,560 OK. 3094 02:37:29,560 --> 02:37:33,480 AND WE DON'T HAVE, FOR EXAMPLE, 3095 02:37:33,480 --> 02:37:38,520 OUR NATIONAL BIOBANK AND THAT IS 3096 02:37:38,520 --> 02:37:41,760 ALL DECIDE ON THAT AND SO, WE 3097 02:37:41,760 --> 02:37:44,400 DON'T HAVE IN THIS WAY A SUPPORT 3098 02:37:44,400 --> 02:37:46,320 TO THE INSTITUTIONS FROM THE 3099 02:37:46,320 --> 02:37:48,560 GOVERNMENT FOR EXAMPLE, TWO 3100 02:37:48,560 --> 02:37:52,520 PERFORM AND VIEW BIO BLANK SET 3101 02:37:52,520 --> 02:37:53,760 SO IT'S DIFFICULT FOR 3102 02:37:53,760 --> 02:37:56,040 UNIVERSITIES AND HOSPITALS TO 3103 02:37:56,040 --> 02:38:02,760 VIEW THE BEE O BIO BANKING SO WD 3104 02:38:02,760 --> 02:38:05,520 TO ORGANIZE AND INCENTIVIZE AND 3105 02:38:05,520 --> 02:38:08,240 IT WOULD BE VERY IMPORTANT THAT 3106 02:38:08,240 --> 02:38:10,240 THE GOVERNMENT BE INVOLVED IN 3107 02:38:10,240 --> 02:38:12,120 THAT TO THE BIOBANK AND THE 3108 02:38:12,120 --> 02:38:13,920 SECOND THING THAT IS VERY 3109 02:38:13,920 --> 02:38:16,520 IMPORTANT, OK, FOR EXAMPLE, IN 3110 02:38:16,520 --> 02:38:18,600 BRAZIL, THE REGULATION OF 3111 02:38:18,600 --> 02:38:20,000 BIOBANKING DOESN'T ALLOW THE 3112 02:38:20,000 --> 02:38:26,960 PATIENT TO DONATE THE SAMPLES 3113 02:38:26,960 --> 02:38:29,320 AND SO THEY WILL CONTRIBUTE TO 3114 02:38:29,320 --> 02:38:32,680 THE NATIONAL AND INTERNATIONAL 3115 02:38:32,680 --> 02:38:35,520 BIOBANKING BECAUSE THEY DID NOT 3116 02:38:35,520 --> 02:38:37,800 DONATE THIS OK AND THE THIRD 3117 02:38:37,800 --> 02:38:39,560 THING IS IMPOSSIBLE IN BRAZIL 3118 02:38:39,560 --> 02:38:46,080 AND REGULATION FOR EXAMPLE, TO 3119 02:38:46,080 --> 02:38:49,080 MAKE AND IT'S NOT POSSIBLE TO 3120 02:38:49,080 --> 02:38:51,880 PATENT NEW TESTS OR DEVICES 3121 02:38:51,880 --> 02:38:54,840 USING SAMPLE COMMUTATIONS SO 3122 02:38:54,840 --> 02:38:57,240 SOMETIMES, IT'S VERY IMPORTANT 3123 02:38:57,240 --> 02:39:00,440 FOR THE PROBLEM IS OUR 3124 02:39:00,440 --> 02:39:02,120 REGULATIONS THAT MAKE IT HERE 3125 02:39:02,120 --> 02:39:05,200 FOR THE ALLOT THE AND NOT THE 3126 02:39:05,200 --> 02:39:06,880 PROBLEM OF THE PEOPLE THAT DON'T 3127 02:39:06,880 --> 02:39:12,600 WANT TO CONTRIBUTE, OK, SO IN 3128 02:39:12,600 --> 02:39:15,560 THIS WAY I RECOMMEND THAT FOR 3129 02:39:15,560 --> 02:39:16,920 EXAMPLE, INSTITUTIONS FROM U.S. 3130 02:39:16,920 --> 02:39:21,000 AND THE U.S. GOVERNMENT WHO 3131 02:39:21,000 --> 02:39:23,520 MAYBE HAVE A JOINT EFFORT WITH 3132 02:39:23,520 --> 02:39:32,560 LATIN AMERICA TO HELP TO BAYS WE 3133 02:39:32,560 --> 02:39:34,440 FIELD THE INSTITUTION 0 BRAZIL 3134 02:39:34,440 --> 02:39:36,800 AND THE REGULATORY THEY NEED TO 3135 02:39:36,800 --> 02:39:38,840 HELP IN UNDERSTAND WHAT IS 3136 02:39:38,840 --> 02:39:46,280 POSSIBLE TO DO AND SO I THINK IT 3137 02:39:46,280 --> 02:39:48,880 NEEDS TO MAKE AN CHANGE OUR 3138 02:39:48,880 --> 02:39:54,080 REGULATION TO FACILITATE THE 3139 02:39:54,080 --> 02:39:58,960 COLLABORATIONS CONNECTION. 3140 02:39:58,960 --> 02:40:02,160 WE WILL BE ABLE TO TRANSFER IN 3141 02:40:02,160 --> 02:40:04,720 SAMPLES TOO OTHER, TO THE 3142 02:40:04,720 --> 02:40:06,720 COLLABORATIVE EFFORTS AND THE 3143 02:40:06,720 --> 02:40:07,680 INTERNATIONAL ONES AND THIS 3144 02:40:07,680 --> 02:40:12,320 QUESTION APPLIED TO BOTH YOU. 3145 02:40:12,320 --> 02:40:13,880 WOULD YOU PLEASE SUGGEST A 3146 02:40:13,880 --> 02:40:14,800 POTENTIAL RESEARCH OPPORTUNITY 3147 02:40:14,800 --> 02:40:17,200 IT COULD BE A RESEARCH QUESTION 3148 02:40:17,200 --> 02:40:19,520 AND A SPECIFIC STUDY AND 3149 02:40:19,520 --> 02:40:21,280 INTERVENTION AND THAT COULD BE 3150 02:40:21,280 --> 02:40:24,040 IN LATIN AMERICAN POPULATIONS TO 3151 02:40:24,040 --> 02:40:26,280 REDUCE THE DISPARITIES AMONG 3152 02:40:26,280 --> 02:40:27,760 HISPANIC LATINO POPULATIONS IN 3153 02:40:27,760 --> 02:40:29,080 THE U.S.? 3154 02:40:29,080 --> 02:40:30,720 THIS QUESTION COULD BE ALSO SEEN 3155 02:40:30,720 --> 02:40:34,800 AS WHAT SHOULD BE THE KEY TOPICS 3156 02:40:34,800 --> 02:40:36,600 OF COLLABORATION BETWEEN THE 3157 02:40:36,600 --> 02:40:41,520 U.S. AND LATIN AMERICAN AND THE 3158 02:40:41,520 --> 02:40:48,800 CARIBBEAN. 3159 02:40:48,800 --> 02:40:50,800 AS I MENTIONED BEFORE, EMERGING 3160 02:40:50,800 --> 02:40:54,880 COUNCILS IN POPULATION AND 3161 02:40:54,880 --> 02:40:55,640 CANCER LIKE GASTRIC AND LIVER 3162 02:40:55,640 --> 02:40:57,240 CANCER WOULD BE TOPIC OF 3163 02:40:57,240 --> 02:40:58,800 INTEREST AND THIS MORNING AND 3164 02:40:58,800 --> 02:41:00,680 MOST OF THE PEOPLE THAT MIGRATE 3165 02:41:00,680 --> 02:41:03,000 TO THE UNITED STATES ONCE THAT 3166 02:41:03,000 --> 02:41:08,120 LIVE IN THE UNITED STATES, HAVE 3167 02:41:08,120 --> 02:41:09,800 THE SAME BEHAVIOR WHEN THEY GIVE 3168 02:41:09,800 --> 02:41:12,120 IN THEIR OWN COUNTRIES AND THEIR 3169 02:41:12,120 --> 02:41:18,320 LATE DIAGNOSIS, HIGH MORTALITY 3170 02:41:18,320 --> 02:41:21,040 AND ADDRESSING THESE KEY POINTS 3171 02:41:21,040 --> 02:41:23,880 WOULD BE IMPORTANT FOR CANCER 3172 02:41:23,880 --> 02:41:25,640 WHICH ARE PREVALENT IN THE 3173 02:41:25,640 --> 02:41:27,080 POPULATION OF LATIN AMERICA AND 3174 02:41:27,080 --> 02:41:29,000 THE UNITED STATES. 3175 02:41:29,000 --> 02:41:33,400 SO, THIS WOULD BE MY POINT OF 3176 02:41:33,400 --> 02:41:36,720 VIEW REGARDING OF IMMEDIATE 3177 02:41:36,720 --> 02:41:38,960 RESEARCH QUESTION IS ABOUT THIS 3178 02:41:38,960 --> 02:41:40,600 CANCER WHICH ARE EMERGING AND 3179 02:41:40,600 --> 02:41:42,720 ARE VERY PREVALENT IN THE 3180 02:41:42,720 --> 02:41:43,000 POPULATION. 3181 02:41:43,000 --> 02:41:43,920 >>THANK YOU. 3182 02:41:43,920 --> 02:41:46,440 Dr. WERUTSKY. 3183 02:41:46,440 --> 02:41:50,800 >>I THINK THAT WE NEED TO 3184 02:41:50,800 --> 02:41:54,520 UNDERSTAND MUCH MORE THE 3185 02:41:54,520 --> 02:41:56,600 GENETICS RISK OF OUR HISS PAN 3186 02:41:56,600 --> 02:41:59,120 PICK AND LATINO POPULATION IN 3187 02:41:59,120 --> 02:42:03,360 TERMS OF SOME TYPES AND ALSO THE 3188 02:42:03,360 --> 02:42:08,040 MOLECULAR OF ALSO IN SOME TUMOR 3189 02:42:08,040 --> 02:42:10,720 TYPES SO WE KNOW IN BRAZIL AND 3190 02:42:10,720 --> 02:42:14,520 THE RISK AND SOME PARTICULAR 3191 02:42:14,520 --> 02:42:16,760 IT'S OFF VARIANTS AND NO YOU GO 3192 02:42:16,760 --> 02:42:18,520 GENE VARIANTS AND THIS IMPACT 3193 02:42:18,520 --> 02:42:20,440 THE DIAGNOSIS OF RECOMMENDATION 3194 02:42:20,440 --> 02:42:24,400 AND THIS IS A CASE FOR EXAMPLE 3195 02:42:24,400 --> 02:42:27,960 WE BUT ALSO A LOT OF HIGH 3196 02:42:27,960 --> 02:42:29,720 INCIDENTS FOR THE CARCINOMA AND 3197 02:42:29,720 --> 02:42:34,800 IT'S SO MUCH CARCINOMA AND 3198 02:42:34,800 --> 02:42:37,080 CARCINOMA IN BRAZIL THAT SOME OF 3199 02:42:37,080 --> 02:42:39,800 THE TOP IN THE WORLD SO WHY 3200 02:42:39,800 --> 02:42:42,760 THESE PATIENTS, WHY THIS DISEASE 3201 02:42:42,760 --> 02:42:43,880 IS SO PREVALENT. 3202 02:42:43,880 --> 02:42:45,880 SO WE HAVE A GOOD OPPORTUNITIES 3203 02:42:45,880 --> 02:42:48,840 HERE TO UNDERSTAND MORE OF THE 3204 02:42:48,840 --> 02:42:51,120 GENETIC RISK BUT ALSO VERY 3205 02:42:51,120 --> 02:42:52,760 IMPORTANT FOR SOME TUMOR TYPES, 3206 02:42:52,760 --> 02:42:56,080 FOR EXAMPLE, ARE USED AND LUNG 3207 02:42:56,080 --> 02:42:58,680 CANCER AND EACH OF THE MUTATION 3208 02:42:58,680 --> 02:43:06,360 IS VERY HIGH IN THE PACIFIC 3209 02:43:06,360 --> 02:43:16,480 COAST. 3210 02:44:05,200 --> 02:44:07,000 >>AND FIND THE STUDY LIKE IN 3211 02:44:07,000 --> 02:44:08,840 AMERICAN TO HELP PATIENTS TO 3212 02:44:08,840 --> 02:44:15,400 HAVE A MORE HAPPILY DIAGNOSIS OF 3213 02:44:15,400 --> 02:44:15,640 CONCEPT. 3214 02:44:15,640 --> 02:44:17,040 >>THANK YOU TO BOTH. 3215 02:44:17,040 --> 02:44:18,680 I APPRECIATE YOUR COMMENTS AND 3216 02:44:18,680 --> 02:44:20,800 INSIGHTS AND THANK YOU TO THE 3217 02:44:20,800 --> 02:44:23,480 AUDIENCE FOR THE QUESTIONS AND 3218 02:44:23,480 --> 02:44:24,760 BECAUSE OF THE INTEREST OF TIME, 3219 02:44:24,760 --> 02:44:26,760 I WILL NOW TURN THINGS OVER TO 3220 02:44:26,760 --> 02:44:32,800 THE MODERATOR OF THE NEXT 3221 02:44:32,800 --> 02:44:34,320 SESSION, Dr. DOOSE. 3222 02:44:34,320 --> 02:44:34,640 >>THANK YOU. 3223 02:44:34,640 --> 02:44:37,600 >>THANK YOU. 3224 02:44:37,600 --> 02:44:43,440 >>GREETINGS. 3225 02:44:43,440 --> 02:44:45,800 I'M THE MODERATOR OF PULMONARY 3226 02:44:45,800 --> 02:44:46,760 DISEASE AND ENVIRONMENT HEALTH. 3227 02:44:46,760 --> 02:44:51,240 BEFORE THE LIVE Q&A SESSION, YOU 3228 02:44:51,240 --> 02:44:52,960 WILL HEAR PRESENTATIONS FROM 3229 02:44:52,960 --> 02:44:57,120 Dr. ROGELIO PEREZ-PADILLA AND 3230 02:44:57,120 --> 02:45:03,480 FOLLOWED BY Dr. ANADIEXROUX. 3231 02:45:03,480 --> 02:45:06,800 >>FROM THE NATIONAL INSTITUTE 3232 02:45:06,800 --> 02:45:08,960 INSTITUTE OF RESPIRATORY 3233 02:45:08,960 --> 02:45:10,000 DISEASES IN MEXICO. 3234 02:45:10,000 --> 02:45:11,440 NO CONFLICTS AND I'M GOING TO 3235 02:45:11,440 --> 02:45:14,240 TALK MAINLY ABOUT COPD AND THE 3236 02:45:14,240 --> 02:45:18,240 RISK FACTORS FOR COPD, 3237 02:45:18,240 --> 02:45:20,640 ESPECIALLY THE EXPOSURE TO 3238 02:45:20,640 --> 02:45:21,760 SMOKING IN RURAL YEARS AND JUST 3239 02:45:21,760 --> 02:45:27,280 A FEW WORDS ABOUT HAVING NOT 3240 02:45:27,280 --> 02:45:31,120 INTRA GRAY TIVE PROGRAM FOR COPD 3241 02:45:31,120 --> 02:45:37,160 AND I WORD ON PREVENTION. 3242 02:45:37,160 --> 02:45:39,160 COPD HAS BEEN INCREASING IN 3243 02:45:39,160 --> 02:45:40,960 MEXICO AND ALSO THE DEATH RATE 3244 02:45:40,960 --> 02:45:44,120 FOR COPD IN DISEASES FROM GLOBAL 3245 02:45:44,120 --> 02:45:48,960 IMPORTANCE OF DISEASES AND IN 3246 02:45:48,960 --> 02:45:51,480 2019 AND YOU CAN IS HE MEXICO 3247 02:45:51,480 --> 02:45:54,840 HAS GONE UP AND OTHER COUNTRY IN 3248 02:45:54,840 --> 02:45:56,160 LATIN AMERICA AS WELL. 3249 02:45:56,160 --> 02:46:01,320 LATIN AMERICA IS A VAST COUNTRY 3250 02:46:01,320 --> 02:46:05,560 OR AREA WITH A MANY HEALTH 3251 02:46:05,560 --> 02:46:10,360 ISSUES AND YOU CAN SEE HERE, 3252 02:46:10,360 --> 02:46:16,000 THAT AS RATE OF COPD AND WE HAVE 3253 02:46:16,000 --> 02:46:17,920 OTHER RATES OF HEINE INCOME 3254 02:46:17,920 --> 02:46:20,240 COUNTRIES AND OTHER COUNTRIES 3255 02:46:20,240 --> 02:46:25,920 WITH VERY LOW ESTIMATED DEATH 3256 02:46:25,920 --> 02:46:29,600 RATE AND YOU CAN SEE THE RISK 3257 02:46:29,600 --> 02:46:36,440 FACTORS AND WHY IT'S MAINLY DUE 3258 02:46:36,440 --> 02:46:46,160 TO SMOKING TOBACCO AND WE ALSO 3259 02:46:46,160 --> 02:46:49,560 HAVE SOME COUNTRIES WITH RED AND 3260 02:46:49,560 --> 02:46:51,080 EXPOSURE TO HOUSEHOLD AREAS. 3261 02:46:51,080 --> 02:46:54,280 RISK FACTORS AND THE PREVALENCE 3262 02:46:54,280 --> 02:47:00,520 OF COPD ALSO CHANGES A LOT HERE 3263 02:47:00,520 --> 02:47:02,480 AND THERE ARE SURVEYS POPULATION 3264 02:47:02,480 --> 02:47:02,800 BASED? 3265 02:47:02,800 --> 02:47:05,160 CITIES AND YOU CAN SEE THAT WE 3266 02:47:05,160 --> 02:47:10,480 HAVE SOME CITIES WITHOUT 3267 02:47:10,480 --> 02:47:10,760 PREVALENCE. 3268 02:47:10,760 --> 02:47:12,800 CLOSE TO 15% OF THOSE OLDER THAN 3269 02:47:12,800 --> 02:47:14,320 40 YEARS OF AGE BUT YOU HAVE 3270 02:47:14,320 --> 02:47:18,320 MEXICO CITY WITH A MUCH LOWER 3271 02:47:18,320 --> 02:47:23,400 PREVALENCE OF COPD AND THIS HAS 3272 02:47:23,400 --> 02:47:25,960 TO DO MAINLY WITH TOBACCO 3273 02:47:25,960 --> 02:47:26,200 SMOKING. 3274 02:47:26,200 --> 02:47:30,320 AS YOU CAN SEE HERE, CHILE HAS A 3275 02:47:30,320 --> 02:47:32,640 VERY HIGH PREVALENCE OF SMOKERS 3276 02:47:32,640 --> 02:47:40,480 AND PANAMA HAS LESS THAN 10% IN 3277 02:47:40,480 --> 02:47:41,120 SOME GROUPS. 3278 02:47:41,120 --> 02:47:43,480 THERE ARE OTHER FACTORS AND 3279 02:47:43,480 --> 02:47:48,240 EXPOSURE AND PROBABLY 3280 02:47:48,240 --> 02:47:48,560 SUSCEPTIBLE. 3281 02:47:48,560 --> 02:47:52,360 THIS FROM MEXICO AND I SHOW THE 3282 02:47:52,360 --> 02:47:56,200 DECREASE IN SMOKING, MEXICO HAS 3283 02:47:56,200 --> 02:47:59,560 A PLATEAU THAT WE HAVE TO 3284 02:47:59,560 --> 02:48:04,040 OVERCOME AND SMOKING HAS BEEN 3285 02:48:04,040 --> 02:48:04,320 IMPROVING. 3286 02:48:04,320 --> 02:48:08,200 OF COURSE, BIO MASS IS SMALL HAS 3287 02:48:08,200 --> 02:48:11,280 A COMPANION DEMAND FOR THOUSANDS 3288 02:48:11,280 --> 02:48:16,840 OF YEARS AND MANY GENERATIONS 3289 02:48:16,840 --> 02:48:25,760 AND STILL IS IT'S HIGH IN WOMEN 3290 02:48:25,760 --> 02:48:36,320 AND THIS THE STATE OF AND MEXICO 3291 02:48:36,640 --> 02:48:40,840 AND MORE THAN HALF OF HOUSE 3292 02:48:40,840 --> 02:48:43,920 CLOUDS AND UTILIZING FUEL AND 3293 02:48:43,920 --> 02:48:51,720 OTHER CITIES WITH ALMOST NON AND 3294 02:48:51,720 --> 02:48:54,120 IN CENTERS AND YOU ANALYZE THE 3295 02:48:54,120 --> 02:48:57,680 DATA OF COPD, MOST ARE SMOKERS 3296 02:48:57,680 --> 02:49:00,320 AND BUT ABOUT A FOURTH AT LEAST 3297 02:49:00,320 --> 02:49:10,840 THIS HAPPENS HERE BUT AND ONLY 3298 02:49:12,120 --> 02:49:16,640 EXPOSURE AND THEY WERE NEVER 3299 02:49:16,640 --> 02:49:22,720 SMOKERS AND THEY LOOK THE SAME 3300 02:49:22,720 --> 02:49:27,640 WITH A LOT OF CARBON AND IN 3301 02:49:27,640 --> 02:49:32,400 PATHOLOGY, SMOKERS HAVE MORE 3302 02:49:32,400 --> 02:49:36,200 EMPHYSEMA AND THOSE EXPOSED TO 3303 02:49:36,200 --> 02:49:39,360 BIO MASS MORE SMALLER WITH 3304 02:49:39,360 --> 02:49:43,520 FIBROSIS AND THICKNESS OF THE 3305 02:49:43,520 --> 02:49:47,160 ARTERIES AND THIS IS THE SAME 3306 02:49:47,160 --> 02:49:49,680 CITIES SCANING AND MOREEN NAZEM 3307 02:49:49,680 --> 02:49:53,680 A AND MORE TRAPPING IN BIOMASS 3308 02:49:53,680 --> 02:49:59,520 GROUP AND THAT ALSO HAS MORE 3309 02:49:59,520 --> 02:50:02,880 HYPER RESPONSENESS AND OF COURSE 3310 02:50:02,880 --> 02:50:05,480 EXPOSURE IS DIFFERENT AND 3311 02:50:05,480 --> 02:50:11,400 BIOMASS OF SMOKE IS MAINLY AND 3312 02:50:11,400 --> 02:50:16,360 IN THE SMOKERS IS ORAL AND 3313 02:50:16,360 --> 02:50:19,160 DEEPER INHALLTATIONS AND THE 3314 02:50:19,160 --> 02:50:21,840 POSITION IS ALSO MORE PRE FOUND 3315 02:50:21,840 --> 02:50:25,280 AND MORE IMPORTANT THAN THOSE 3316 02:50:25,280 --> 02:50:32,640 EXPOSED TO BIO MASS ABOUT BUT IT 3317 02:50:32,640 --> 02:50:34,080 OVERLAPS IN BOTH GROUPS AND WHEN 3318 02:50:34,080 --> 02:50:40,720 YOU ADJUST FOR A ONE AND SO IT'S 3319 02:50:40,720 --> 02:50:45,320 A BAD DISEASE AS WELL AND THAT 3320 02:50:45,320 --> 02:50:49,880 PRODUCING WOMEN EXPOSED TO BIO 3321 02:50:49,880 --> 02:50:54,200 MASS OR EVEN THOUGH THE 3322 02:50:54,200 --> 02:50:57,080 DECLINING LUNG FUNCTION IS 3323 02:50:57,080 --> 02:50:59,240 NORMAL IN THE BUY EMAS GROUP AND 3324 02:50:59,240 --> 02:51:01,720 YOU CAN SEE HERE HOW WITH A 3325 02:51:01,720 --> 02:51:10,080 HIGHER SLOPE IN THE SMOKERS AND 3326 02:51:10,080 --> 02:51:13,920 SO THIS GROUP OF MARKERS WITH 3327 02:51:13,920 --> 02:51:17,440 COPD AND SOME HAVE A FROM A 3328 02:51:17,440 --> 02:51:20,320 STUDY AND SOME HAVE PREVIOUSLY 3329 02:51:20,320 --> 02:51:27,240 TB WHICH IS AN IMPORTANT ISSUE 3330 02:51:27,240 --> 02:51:29,440 AND IT HAS TO BE TREATED 3331 02:51:29,440 --> 02:51:34,600 CORRECTLY SINCE INFANCY TO AVOID 3332 02:51:34,600 --> 02:51:37,320 PERMANENT DAMAGE AND THIS IS 3333 02:51:37,320 --> 02:51:43,760 FROM FROM PLATINO STUDY WITH 3334 02:51:43,760 --> 02:51:46,360 HAVING A PREVIOUSLY STATEMENT OR 3335 02:51:46,360 --> 02:51:48,440 PREVIOUS CLOSE THIS IS MORE A 3336 02:51:48,440 --> 02:51:51,560 FLOW OF STRUCTURE AND THAT IS 3337 02:51:51,560 --> 02:51:53,000 BECAUSE OF THIS SCARRING AND 3338 02:51:53,000 --> 02:51:57,280 THAT IS MOR IMPORTANT IN DRUG 3339 02:51:57,280 --> 02:51:58,000 RESISTANT TUBERCULOSIS AND 3340 02:51:58,000 --> 02:52:01,200 ANOTHER IMPORTANT ISSUE IS THE 3341 02:52:01,200 --> 02:52:05,040 DISEASE THAT DEVELOPS IN SMOKERS 3342 02:52:05,040 --> 02:52:07,080 PEOPLE EXPOSED TO BIO MASS BUT 3343 02:52:07,080 --> 02:52:08,880 NOT WITH AIR FLOW INSTRUCTION 3344 02:52:08,880 --> 02:52:10,960 THEY DON'T HAVE COPD BUT THE 3345 02:52:10,960 --> 02:52:13,760 PRESENCE OF SYMPTOMS INCREASES 3346 02:52:13,760 --> 02:52:17,920 THE MORTALITY AND THIS IS FROM 3347 02:52:17,920 --> 02:52:20,080 LATINO STUDY AND ALSO, 3348 02:52:20,080 --> 02:52:22,680 INCREASING THE LONG FUNCTION 3349 02:52:22,680 --> 02:52:25,880 DECLINE AND IS AN IMPORTANT 3350 02:52:25,880 --> 02:52:28,560 ISSUE AND OF COURSE, WE SHOULD 3351 02:52:28,560 --> 02:52:39,080 NOT HAVE A ONE THIS INCLUDING 3352 02:52:40,400 --> 02:52:42,160 COPD AND WE NEED TO REDUCE 3353 02:52:42,160 --> 02:52:45,520 SMOKING, IMPROVE AIR QUALITY AND 3354 02:52:45,520 --> 02:52:48,680 OF COURSE HAVING PROGRAMS FROM 3355 02:52:48,680 --> 02:52:52,560 PRIMARY CARE AND FROM REFERRALS 3356 02:52:52,560 --> 02:52:55,160 CENTERS WITH TEACHING AND 3357 02:52:55,160 --> 02:53:00,200 PREVENTION IS KIND OF DIFFICULT 3358 02:53:00,200 --> 02:53:02,200 BECAUSE EXPOSURE TO BIO MASS IS 3359 02:53:02,200 --> 02:53:05,440 ASSOCIATED WITH POVERTY AND IN 3360 02:53:05,440 --> 02:53:09,320 THIS PROGRAM IN CHINA, THEY WERE 3361 02:53:09,320 --> 02:53:12,600 VERY EFFECTIVE PREVENTING COPD 3362 02:53:12,600 --> 02:53:14,720 JUST WITH A ACHIEVEMENT BUT IN 3363 02:53:14,720 --> 02:53:17,120 MEXICO AND ON ANOTHER COUNTRIES, 3364 02:53:17,120 --> 02:53:20,720 THIS IS CALLED EXPOSURE TO CALL 3365 02:53:20,720 --> 02:53:25,080 NOT TO CHARCOAL AND SO, THIS IS 3366 02:53:25,080 --> 02:53:27,600 A LITTLE DIFFERENT AND ADHERENCE 3367 02:53:27,600 --> 02:53:30,840 TO THE IMPROVE IT HAS BEEN VERY 3368 02:53:30,840 --> 02:53:32,520 POOR AND OF COURSE, THERE ARE 3369 02:53:32,520 --> 02:53:34,960 QUESTIONS TO BE ANSWERED AND FOR 3370 02:53:34,960 --> 02:53:45,480 EXAMPLE, THERE ARE ANCESTRY IS 3371 02:53:56,360 --> 02:54:00,120 CENTER IN THE USER AND TRYING TO 3372 02:54:00,120 --> 02:54:02,000 AVOID OPEN FIRES BECAUSE 3373 02:54:02,000 --> 02:54:06,680 SOMETIMES THEY COMBINE DIFFERENT 3374 02:54:06,680 --> 02:54:17,200 STOVES AND BEFORE IMPLEMENTING 3375 02:54:17,600 --> 02:54:19,680 WIDELY IMPROVE 3376 02:54:19,680 --> 02:54:21,280 LONG-TERM ADHERENCE. 3377 02:54:21,280 --> 02:54:22,960 ANOTHER KIND OF QUESTION WE HAVE 3378 02:54:22,960 --> 02:54:31,080 TO ANSWER IS, FOR EXAMPLE, IF 3379 02:54:31,080 --> 02:54:32,880 STEROIDS WORK BETTER IN COPD 3380 02:54:32,880 --> 02:54:35,880 THAN BIOMASS BECAUSE THE REPORTS 3381 02:54:35,880 --> 02:54:40,040 ON BRONCHIAL HYPER 3382 02:54:40,040 --> 02:54:42,120 RESPONSIVENESS AND THE MAIN 3383 02:54:42,120 --> 02:54:46,880 ISSUE WE EXTRAPOLATE TREATMENTS 3384 02:54:46,880 --> 02:54:49,880 TO THIS FROM SMOKER STUDY AND WE 3385 02:54:49,880 --> 02:54:51,800 NEED STUDIES DONE IN THIS TYPE 3386 02:54:51,800 --> 02:54:57,200 OF PATIENTS AND IT'S PHENOTYPE A 3387 02:54:57,200 --> 02:54:58,680 DIFFERENT PHENOTYPE AND OF 3388 02:54:58,680 --> 02:55:01,320 COURSE WE NEED TREATMENT FOR 3389 02:55:01,320 --> 02:55:05,240 PATIENTS WITH SYMPTOMS AND 3390 02:55:05,240 --> 02:55:08,960 CHRONIC BRONCHITIS TO KNOW THE 3391 02:55:08,960 --> 02:55:11,280 IMPORTANCE OF THIS CHRONIC 3392 02:55:11,280 --> 02:55:12,720 BRONCHITIS AND SYMPTOMS IN 3393 02:55:12,720 --> 02:55:15,040 PATIENTS EXPOSED TO BIO MASS. 3394 02:55:15,040 --> 02:55:18,320 THANK YOU VERY MUCH FOR YOUR 3395 02:55:18,320 --> 02:55:18,600 ATTENTION. 3396 02:55:18,600 --> 02:55:21,040 >>GOOD MORNING, THANK YOU FOR 3397 02:55:21,040 --> 02:55:23,160 THE OPPORTUNITY TO SHARE WITH 3398 02:55:23,160 --> 02:55:26,960 YOU SOME DATA AND SOME 3399 02:55:26,960 --> 02:55:27,520 REFLECTIONS ON CERTAINLY AND 3400 02:55:27,520 --> 02:55:35,320 ENVIROSOCIAL ANDDETERMINANTS OFS 3401 02:55:35,320 --> 02:55:39,640 LATIN AMERICAN CITIES. 3402 02:55:39,640 --> 02:55:42,800 I'M DOING WORK AND THIS IS A 3403 02:55:42,800 --> 02:55:47,320 PROJECT LED BY THE DREXEL AND 14 3404 02:55:47,320 --> 02:55:48,880 PARTNERS BASED IN LATIN AMERICA 3405 02:55:48,880 --> 02:55:51,000 AND THE PROJECT WAS LAUNCH 3406 02:55:51,000 --> 02:55:53,400 INSIDE 2017 SO YOU CAN SEE THAT 3407 02:55:53,400 --> 02:55:57,120 OUR PARTNERS ALL OVER THE 3408 02:55:57,120 --> 02:55:57,520 REGION. 3409 02:55:57,520 --> 02:55:59,400 THE PROJECT HAS FOUR AIMS, AIM 3410 02:55:59,400 --> 02:56:00,920 ONE IS TO IDENTIFY CITY AND 3411 02:56:00,920 --> 02:56:01,960 NEIGHBORHOOD DRIVERS OF HEALTH 3412 02:56:01,960 --> 02:56:03,920 AND HEALTH INEQUALITIES AMONG 3413 02:56:03,920 --> 02:56:06,520 AND WITHIN CITIES. 3414 02:56:06,520 --> 02:56:11,240 TIME AIM TO AND AIM THREE IS TO 3415 02:56:11,240 --> 02:56:12,760 EMPLOY SYSTEMS THINKING AND 3416 02:56:12,760 --> 02:56:14,400 SIMULATION MODEL TO EVALUATE 3417 02:56:14,400 --> 02:56:16,240 URBAN HEALTH ENVIRONMENTAL LINKS 3418 02:56:16,240 --> 02:56:17,880 AND PLAUSIBLE POLICY IMPACTS AND 3419 02:56:17,880 --> 02:56:19,720 ENGAGE THE SCIENTIFIC COMMUNITY 3420 02:56:19,720 --> 02:56:22,160 THE PUBLIC AND POLICYMAKERS TO 3421 02:56:22,160 --> 02:56:23,520 TRANSLATE FINDINGS SO TODAY I'M 3422 02:56:23,520 --> 02:56:25,440 GOING TO FOCUS PRIMARILY ON 3423 02:56:25,440 --> 02:56:26,080 RESULT DEASE ARRIVED FROM AIM 3424 02:56:26,080 --> 02:56:27,640 ONE BUT THE STUDY IS VERY RICH 3425 02:56:27,640 --> 02:56:30,200 SO I WANTED TO SHARE THE OTHER 3426 02:56:30,200 --> 02:56:32,200 AIMS WITH YOU AS WELL. 3427 02:56:32,200 --> 02:56:34,680 AS YOU KNOW, SOCIAL BUILT AND 3428 02:56:34,680 --> 02:56:36,200 PHYSICAL ENVIRONMENTS ARE KEY 3429 02:56:36,200 --> 02:56:38,160 DETERMINANTS OF HEALTH AND ONE 3430 02:56:38,160 --> 02:56:40,360 CAN ARGUE NON COMMUNICABLE 3431 02:56:40,360 --> 02:56:40,760 DISEASES. 3432 02:56:40,760 --> 02:56:42,520 SO SHOW ONE ILLUSTRATION OF 3433 02:56:42,520 --> 02:56:43,160 THIS, ECONOMIC AND I EQUALITY 3434 02:56:43,160 --> 02:56:45,320 AND RACISM, CONTRIBUTE TO 3435 02:56:45,320 --> 02:56:47,480 RESIDENTIAL SEGREGATION WHICH IN 3436 02:56:47,480 --> 02:56:50,080 TURN CREATES AND REINFORCES 3437 02:56:50,080 --> 02:56:51,160 INEQUALITY THIS IS POWER AND 3438 02:56:51,160 --> 02:56:53,280 RESOURCE DISTRIBUTION AND THIS 3439 02:56:53,280 --> 02:56:55,840 DYNAMIC CREATES DIFFERENCES, 3440 02:56:55,840 --> 02:56:56,360 ACROSS NEIGHBORHOODS AND 3441 02:56:56,360 --> 02:56:57,840 NEIGHBORHOOD PHYSICAL 3442 02:56:57,840 --> 02:56:58,800 ENVIRONMENTS AND IN NEIGHBORHOOD 3443 02:56:58,800 --> 02:57:09,240 SOCIAL ENVIRONMENTS AND -- 3444 02:57:20,320 --> 02:57:21,920 SPECIFICALLY, URBAN 3445 02:57:21,920 --> 02:57:24,520 ENVIRONMENTS, IN PARTICULAR, CAN 3446 02:57:24,520 --> 02:57:27,480 HAVE A NEGATIVE IMPACT ON NON 3447 02:57:27,480 --> 02:57:29,160 COMMUNICABLE DISEASES THROUGH 3448 02:57:29,160 --> 02:57:30,920 THE PROMOTION OF SEDENTARY 3449 02:57:30,920 --> 02:57:35,640 LIFESTYLE BECAUSE OF MOBILITY ON 3450 02:57:35,640 --> 02:57:36,640 ABLE TRANSPORTATION AND 3451 02:57:36,640 --> 02:57:37,440 SEDENTARY WORK. 3452 02:57:37,440 --> 02:57:39,080 THEY CAN ALSO INCREASE ACCESS TO 3453 02:57:39,080 --> 02:57:40,720 AND PROMOTION OF PROCESSED 3454 02:57:40,720 --> 02:57:42,400 FOODS, INCREASED FOOD 3455 02:57:42,400 --> 02:57:43,360 CONSUMPTION OUTSIDE THE HOME, 3456 02:57:43,360 --> 02:57:45,000 AND ALSO INCREASE EXPOSURE TO 3457 02:57:45,000 --> 02:57:46,520 AIR POLLUTION BECAUSE URBAN 3458 02:57:46,520 --> 02:57:48,520 AREAS HAVE HIGHER LEVELS OF AIR 3459 02:57:48,520 --> 02:57:48,920 POLLUTION. 3460 02:57:48,920 --> 02:57:50,400 BUT THERE ARE ALSO WAYS IN WHICH 3461 02:57:50,400 --> 02:57:51,960 URBAN ENVIRONMENTS CAN HAVE 3462 02:57:51,960 --> 02:57:55,480 POSITIVE EFFECTS AND REDUCE NON 3463 02:57:55,480 --> 02:57:57,240 COMMUNICABLE DISEASE RISK AND 3464 02:57:57,240 --> 02:57:59,200 THEY PROMOTE MIXED LAND USE, 3465 02:57:59,200 --> 02:58:00,600 PEDESTRIAN FRIENDLY ENVIRONMENTS 3466 02:58:00,600 --> 02:58:02,960 AND HIGH POPULATION DENSITY AND 3467 02:58:02,960 --> 02:58:05,880 THEY CAN CREATE OPPORTUNITIES 3468 02:58:05,880 --> 02:58:07,200 FOR PROMOTION OF HEALTHY EATING 3469 02:58:07,200 --> 02:58:08,480 AND FOOD AND ADVERTISING 3470 02:58:08,480 --> 02:58:09,560 RESTRICTIONS ON PROCESSED FOODS 3471 02:58:09,560 --> 02:58:11,440 AND TOBACCO PRODUCTS AND THEY 3472 02:58:11,440 --> 02:58:15,920 CAN ALSO REDUCE AIR POLLUTION 3473 02:58:15,920 --> 02:58:17,160 EXPOSURE AND SO THERE'S NO 3474 02:58:17,160 --> 02:58:19,040 SINGLE WAY IN WHICH URBAN 3475 02:58:19,040 --> 02:58:20,760 ENVIRONMENTS AFFECT NON COM 3476 02:58:20,760 --> 02:58:22,040 UNIKE ABLE DISEASE DEPENDS ON 3477 02:58:22,040 --> 02:58:24,160 THE FORM IN WHICH URBANIZATION 3478 02:58:24,160 --> 02:58:25,560 TAKES AND HOW IT'S MANAGE AND 3479 02:58:25,560 --> 02:58:27,120 HOW CITIES ARE GOVERNED AND THIS 3480 02:58:27,120 --> 02:58:28,760 IS TRUE IN LATIN AMERICA AND 3481 02:58:28,760 --> 02:58:32,120 ALSO OF COURSE IN THE U.S. 3482 02:58:32,120 --> 02:58:34,160 AND NOW NON COMMUNICABLE 3483 02:58:34,160 --> 02:58:35,920 DISEASES, AS YOU KNOW, ARE A 3484 02:58:35,920 --> 02:58:39,840 MAJOR CAUSE OF MOR BILL TEE AND 3485 02:58:39,840 --> 02:58:41,280 MORTALITY BUT THEY HAVE HIT YO 3486 02:58:41,280 --> 02:58:53,040 AGAIN A THETEROGENEITY.THESE AR0 3487 02:58:53,920 --> 02:58:55,720 PEOPLE MOR MORE IN ALL THE 3488 02:58:55,720 --> 02:59:05,240 COUNTRIES INCLUDED IN OUR STUDY. 3489 02:59:05,240 --> 02:59:06,760 THE CITIES ARE ORDER BY DEATH 3490 02:59:06,760 --> 02:59:09,120 DUE TO VIOLENT INJURIES BUT I 3491 02:59:09,120 --> 02:59:10,640 WANT TO HIGHLIGHT THE ORIGINAL 3492 02:59:10,640 --> 02:59:12,600 AND THE RED WHICH AS YOU CAN SEE 3493 02:59:12,600 --> 02:59:14,040 IT'S A SIGNIFICANT PREPORTION 3494 02:59:14,040 --> 02:59:16,120 BUT IT'S ALSO VARIABLE ACROSS 3495 02:59:16,120 --> 02:59:18,440 THE CITIES AND IN FACT, IF WE 3496 02:59:18,440 --> 02:59:20,240 SORT THE CITIES ACCORDING TO THE 3497 02:59:20,240 --> 02:59:22,000 PREPORTION OF THE DEATH THAT ARE 3498 02:59:22,000 --> 02:59:25,520 BY NON COMMUNICABLE DISEASES WE 3499 02:59:25,520 --> 02:59:32,960 SEE HETERO AGAIN EIG HETEROGENE. 3500 02:59:32,960 --> 02:59:34,360 WHAT CITY LEVEL OR OTHER FACTORS 3501 02:59:34,360 --> 02:59:36,400 ARE RELATED TO THESE DIFFERENCES 3502 02:59:36,400 --> 02:59:40,760 AND THIS IS NOT ATTRIBUTABLE TO 3503 02:59:40,760 --> 02:59:42,080 COUNTRIES IT'S CITIES WITHIN A 3504 02:59:42,080 --> 02:59:44,440 COUNTRY PRIMARILY. 3505 02:59:44,440 --> 02:59:46,240 WE HAVE LOOKED AT SOME FACTORS 3506 02:59:46,240 --> 02:59:47,640 INCLUDING SOCIAL ENVIRONMENT 3507 02:59:47,640 --> 02:59:49,000 FACTORS TO EXPLAIN THIS AND AS 3508 02:59:49,000 --> 02:59:52,360 I'LL SHOW IN THE NEXT FEW 3509 02:59:52,360 --> 02:59:53,440 SLIDES, THEY ARE LINKED TO 3510 02:59:53,440 --> 02:59:55,080 SOCIAL CONDITIONS AT THE LEVELS 3511 02:59:55,080 --> 02:59:57,120 OF CITIES, NEIGHBORHOODS AND 3512 02:59:57,120 --> 02:59:57,400 INDIVIDUALS. 3513 02:59:57,400 --> 03:00:00,520 THIS FIRST EXAMPLE SHOWS 3514 03:00:00,520 --> 03:00:01,480 PATTERNS ACROSS CITIES. 3515 03:00:01,480 --> 03:00:03,000 IF WE LOOK AT THE RELATIONSHIP 3516 03:00:03,000 --> 03:00:04,760 BETWEEN THE PREPORTION OF 3517 03:00:04,760 --> 03:00:07,480 MORTALITY FOR VARIOUS CAUSES OF 3518 03:00:07,480 --> 03:00:09,840 DEATH AND THE INDEX WHICH IS A 3519 03:00:09,840 --> 03:00:11,480 COMPOSITE OF CITY LEVEL 3520 03:00:11,480 --> 03:00:14,800 EDUCATION OVER CROWD WATER AND 3521 03:00:14,800 --> 03:00:16,000 SANITATION AND BETTER SOCIAL 3522 03:00:16,000 --> 03:00:17,320 CONDITIONS WE SEE THE PREPORTION 3523 03:00:17,320 --> 03:00:19,440 OF DEATHS DUE TO NON SCHOOL 3524 03:00:19,440 --> 03:00:26,080 UNIKECOMMUNICABLE AND THIS BEGIO 3525 03:00:26,080 --> 03:00:28,480 DECREASE AND WHEREAS FOR A 3526 03:00:28,480 --> 03:00:29,840 CANCER THERE'S A CLEAR INCREASE 3527 03:00:29,840 --> 03:00:31,800 IN PREPORTION AS THE CITY SOCIAL 3528 03:00:31,800 --> 03:00:34,080 ENVIRONMENTAL INDEX INCREASES. 3529 03:00:34,080 --> 03:00:36,440 AND IF WE LOOK WITHIN CITIES, WE 3530 03:00:36,440 --> 03:00:39,040 ALSO SEE SIGNIFICANT PATTERNING 3531 03:00:39,040 --> 03:00:39,440 IN NEIGHBORHOODS. 3532 03:00:39,440 --> 03:00:41,240 THIS IS DATA HAVE A STUDY WE 3533 03:00:41,240 --> 03:00:43,080 PUBLISHED A YEAR OF YEARS AGO 3534 03:00:43,080 --> 03:00:45,200 SHOWING AGE ADJUSTED 3535 03:00:45,200 --> 03:00:49,400 CARDIOVASCULAR MORTALITY ACCUSED 3536 03:00:49,400 --> 03:00:53,280 THE CITY OF AND THERE'S A STRONG 3537 03:00:53,280 --> 03:00:55,160 ASSOCIATION WITH RESIDENTS 3538 03:00:55,160 --> 03:00:56,760 WITHIN COMPLETE SECONDARY 3539 03:00:56,760 --> 03:00:59,600 EDUCATION AND THE RISK OF TOTAL 3540 03:00:59,600 --> 03:01:04,160 DEATHS BUT ALSO CARDIOVASCULAR 3541 03:01:04,160 --> 03:01:04,400 DEATHS. 3542 03:01:04,400 --> 03:01:07,160 IN ADDITION TO THIS PATTERNING 3543 03:01:07,160 --> 03:01:08,560 BY NEIGHBORHOODS, WE ALSO SEE 3544 03:01:08,560 --> 03:01:10,080 SOCIAL PATTERNING ACROSS 3545 03:01:10,080 --> 03:01:11,760 INDIVIDUALS AND THIS IS DATA 3546 03:01:11,760 --> 03:01:16,480 COMPILED AND HARMONIZED OVER 3547 03:01:16,480 --> 03:01:19,600 100,000 SURVEY RESPONSES AND 3548 03:01:19,600 --> 03:01:22,200 ACROSS OUR 232 CITIES AND WE 3549 03:01:22,200 --> 03:01:28,040 ESTIMATED ADJUSTED PREVALENCE OF 3550 03:01:28,040 --> 03:01:28,920 DIABETES AND FOUND THAT IN 3551 03:01:28,920 --> 03:01:30,720 GENERAL IN WOMEN, THERE WAS THE 3552 03:01:30,720 --> 03:01:33,280 EXPECTED INVERSE ASSOCIATION, 3553 03:01:33,280 --> 03:01:34,720 HIGHER EDUCATION, LESS DIABETES 3554 03:01:34,720 --> 03:01:37,080 BUT IN MEN THERE WAS QUITE A BIT 3555 03:01:37,080 --> 03:01:38,280 OF HIT PRO AGAIN A TEE AND SOME 3556 03:01:38,280 --> 03:01:43,960 THERE WAS AN INVERSE AND HIGHER 3557 03:01:43,960 --> 03:01:45,320 EDUCATION AND MORE DIABETES AND 3558 03:01:45,320 --> 03:01:53,720 SOME OF THIS HETERO INGAY TEE HS 3559 03:01:53,720 --> 03:01:54,360 ACROSS DIFFERENT GROWTHS AND WE 3560 03:01:54,360 --> 03:01:55,520 CAN TALK ABOUT THAT LATER. 3561 03:01:55,520 --> 03:01:57,640 WE HAD ALSO SEEN IN A PREVIOUS 3562 03:01:57,640 --> 03:01:59,600 STUDY THAT THE INVERSE GRADIENT 3563 03:01:59,600 --> 03:02:01,080 OF ASSOCIATED WITH INDIVIDUALS 3564 03:02:01,080 --> 03:02:04,480 LEVEL EDUCATION, EMERGED AS 3565 03:02:04,480 --> 03:02:11,160 URBANNATION INCREASED. 3566 03:02:11,160 --> 03:02:13,720 SO HE IS ARE IN BMI AND 3567 03:02:13,720 --> 03:02:14,720 HYPERTENSION ASSOCIATED WITH 3568 03:02:14,720 --> 03:02:25,280 HIGHER EDUCATION AND THE INVERSE 3569 03:02:32,440 --> 03:02:34,440 SO SOCIAL GRADIENTS AS WELL. 3570 03:02:34,440 --> 03:02:36,200 NOW THERE ARE IMPORTANT 3571 03:02:36,200 --> 03:02:37,240 ENVIRONMENTAL EXPOSURES LINKED 3572 03:02:37,240 --> 03:02:40,440 TO NON COMMUNICABLE DISEASE AND 3573 03:02:40,440 --> 03:02:42,440 I'M GOING TO FOCUS ON AIR 3574 03:02:42,440 --> 03:02:42,680 POLLUTION. 3575 03:02:42,680 --> 03:02:45,360 THIS IS DATA FROM THE STUDY 3576 03:02:45,360 --> 03:02:47,960 DESCRIBING LEVELS OF PM2.5, IT'S 3577 03:02:47,960 --> 03:02:50,800 BEEN RELATED TO CARDIOVASCULAR 3578 03:02:50,800 --> 03:02:52,600 DISEASE ACROSS THE CITIES IN OUR 3579 03:02:52,600 --> 03:02:54,000 SAMPLE AND THE DOTTED LINE IS 3580 03:02:54,000 --> 03:02:56,280 THE WHO STANDARD, IT'S EVEN 3581 03:02:56,280 --> 03:02:57,400 LOWER THAN THAT NOW THIS IS 3582 03:02:57,400 --> 03:03:00,480 BEFORE THE REDUCED THE STANDARD 3583 03:03:00,480 --> 03:03:01,840 RECENTLY AND A HIGH PREPORTION 3584 03:03:01,840 --> 03:03:04,000 OF THE CITIES HAVE LEVELS ABOVE 3585 03:03:04,000 --> 03:03:07,120 THE W.H.O. STANDARD AND IN FACT, 3586 03:03:07,120 --> 03:03:09,120 SIGNIFICANT PREPORTIONS OF THE 3587 03:03:09,120 --> 03:03:12,480 POPULATION IN MANY OF OUR 3588 03:03:12,480 --> 03:03:14,000 COUNTRIES LIVE IN AREAS WHERE 3589 03:03:14,000 --> 03:03:17,480 THE MEAN PM2.5 IS ABOVE THE WHO 3590 03:03:17,480 --> 03:03:19,000 STANDARD AND SO THIS OBVIOUSLY 3591 03:03:19,000 --> 03:03:24,080 HAS IMPLICATIONS FOR NON COM UNI 3592 03:03:24,080 --> 03:03:25,880 CAN ABLE DISEASE RATES AND THESE 3593 03:03:25,880 --> 03:03:28,000 LEVELS ARE RELATED TO CITY 3594 03:03:28,000 --> 03:03:28,840 CHARACTERISTICS AND I DON'T HAVE 3595 03:03:28,840 --> 03:03:30,520 TIME TO GO INTO THE DETAILS ON 3596 03:03:30,520 --> 03:03:31,960 THIS FIGURE IN THIS TABLE BUT 3597 03:03:31,960 --> 03:03:35,000 THINGS LIKE, MASS TRANSIT, 3598 03:03:35,000 --> 03:03:37,600 RELATED TO LOWER LEVELS OF AIR 3599 03:03:37,600 --> 03:03:38,960 POLLUTION, HAVING MORE 3600 03:03:38,960 --> 03:03:41,200 CONGESTION, HIGHER LEVELS, MORE 3601 03:03:41,200 --> 03:03:41,880 MOTORIZATION, HIGHER LEVELS AS 3602 03:03:41,880 --> 03:03:43,280 WELL SO SOME OF THE THINGS YOU 3603 03:03:43,280 --> 03:03:44,720 EXPECT BUT WHAT THIS ILLUSTRATES 3604 03:03:44,720 --> 03:03:46,160 IS THAT THEIR POLICIES THAT 3605 03:03:46,160 --> 03:03:47,680 CITIES KIM NOTMENT TO REDUCE 3606 03:03:47,680 --> 03:03:49,240 THESE AIR POLLUTION LEVELS WHICH 3607 03:03:49,240 --> 03:03:50,640 WILL ALSO HAVE BENEFICIAL 3608 03:03:50,640 --> 03:03:53,720 EFFECTS FOR NON COMMUNICABLE 3609 03:03:53,720 --> 03:03:53,960 DISEASES. 3610 03:03:53,960 --> 03:03:55,320 THE LAST THING I WANT TO FOCUS 3611 03:03:55,320 --> 03:03:56,640 ON IS THE IMPACT OF CLIMATE 3612 03:03:56,640 --> 03:03:59,000 CHANGE AS AN EMERGING THREAT TO 3613 03:03:59,000 --> 03:04:01,000 NON COMMUNICABLE DISEASES IN THE 3614 03:04:01,000 --> 03:04:02,200 REGION AND THIS IS DATA FROM A 3615 03:04:02,200 --> 03:04:03,840 PAPER WE JUST PUBLISHED IN 3616 03:04:03,840 --> 03:04:05,280 NATURE MEDICINE LOOKING AT THE 3617 03:04:05,280 --> 03:04:05,880 RELATIONSHIP BETWEEN 3618 03:04:05,880 --> 03:04:09,080 TEMPERATURES AND MORTALITY AND 3619 03:04:09,080 --> 03:04:10,640 326 LATIN AMERICAN CITIES AND 3620 03:04:10,640 --> 03:04:11,760 THESE FIGURES SHOW THE SHAPE OF 3621 03:04:11,760 --> 03:04:13,720 THE MORTALITY TEMPERATURE 3622 03:04:13,720 --> 03:04:15,840 RELATIONSHIP AS WELL AS THE 3623 03:04:15,840 --> 03:04:16,880 DISTRIBUTION OF TEMPERATURES IN 3624 03:04:16,880 --> 03:04:19,280 DIFFERENT CITIES ACROSS THE 3625 03:04:19,280 --> 03:04:19,800 REGION. 3626 03:04:19,800 --> 03:04:21,400 AND WHAT WE FOUND, THIS IS VERY 3627 03:04:21,400 --> 03:04:23,040 SIMILAR TO WHAT STUDIES IN OTHER 3628 03:04:23,040 --> 03:04:25,400 REGIONS HAVE FOUND, IS THAT 3629 03:04:25,400 --> 03:04:29,560 ABOUT 0.7%, 0.7, 0.8% OF DEATHS 3630 03:04:29,560 --> 03:04:31,360 ARE ATTRIBUTABLE TO HIGH 3631 03:04:31,360 --> 03:04:33,120 TEMPERATURES AND FIVE TO SIX 3632 03:04:33,120 --> 03:04:34,400 PERCENT OF DEATHS TO LOW 3633 03:04:34,400 --> 03:04:35,760 TEMPERATURES AND YOU MAY THINK 3634 03:04:35,760 --> 03:04:37,720 WELL THAT MEANS THAT HEAT IS NOT 3635 03:04:37,720 --> 03:04:39,000 IMPORTANT, THIS IS A LITTLE BIT 3636 03:04:39,000 --> 03:04:39,960 MISLEADING BECAUSE AS I SHOWED 3637 03:04:39,960 --> 03:04:41,760 YOU IN THE PREVIOUS FIGURE, THE 3638 03:04:41,760 --> 03:04:43,440 NUMBER OF DAYS AT LOW 3639 03:04:43,440 --> 03:04:44,640 TEMPERATURES IS GENERALLY LARGER 3640 03:04:44,640 --> 03:04:46,520 THAN THE NUMBER OF DAYS AT HIGH 3641 03:04:46,520 --> 03:04:51,840 TEMPERATURES AND SO WHEN WE 3642 03:04:51,840 --> 03:04:53,640 LOOKED AT THE SLOPE, THE 3643 03:04:53,640 --> 03:04:55,520 STEEPNESS IS PRONOUNCED FOR HEAT 3644 03:04:55,520 --> 03:04:57,080 THAN IT IS FOR COLD AND IT 3645 03:04:57,080 --> 03:04:58,520 SUGGESTS THAT AS WE SLIDE THE 3646 03:04:58,520 --> 03:04:59,600 CURVE TOWARDS HIGHER 3647 03:04:59,600 --> 03:05:00,560 TEMPERATURES, WE WILL SEE 3648 03:05:00,560 --> 03:05:03,880 IMPORTANT INCREASE THIS IS THE 3649 03:05:03,880 --> 03:05:04,720 NUMBER OF DEATHS. 3650 03:05:04,720 --> 03:05:06,480 THIS IS OBSERVED FOR ALL DEATHS 3651 03:05:06,480 --> 03:05:08,360 BUT IT'S PRESENT FOR 3652 03:05:08,360 --> 03:05:10,000 CARDIOVASCULAR AND RESPIRATORY 3653 03:05:10,000 --> 03:05:11,120 DISEASE BECAUSE THESE CAUSES OF 3654 03:05:11,120 --> 03:05:14,800 DEATH ARE ALSO EFFECTED BY 3655 03:05:14,800 --> 03:05:15,120 TEMPERATURE. 3656 03:05:15,120 --> 03:05:19,400 I ALSO WANTED VERY BRIEFLY NOTE 3657 03:05:19,400 --> 03:05:20,920 THE FACT THAT SIGNIFICANT 3658 03:05:20,920 --> 03:05:22,240 PREPORTION OF GREENHOUSE GAS 3659 03:05:22,240 --> 03:05:24,360 EMISSIONS ARE LINKED TO OUR 3660 03:05:24,360 --> 03:05:25,920 DIETS AND MANY COUNTRIES IN THE 3661 03:05:25,920 --> 03:05:28,760 REGION OF LATIN AMERICA ARE 3662 03:05:28,760 --> 03:05:29,840 UNDERGOING A NUTRITION 3663 03:05:29,840 --> 03:05:31,560 TRANSITION WITH IMPORTANT 3664 03:05:31,560 --> 03:05:32,520 IMPLICATIONS FOR FOOD SYSTEMS 3665 03:05:32,520 --> 03:05:35,480 AND ENVIRONMENTAL IMPACT AND THE 3666 03:05:35,480 --> 03:05:37,560 SAME DIETS BAD FOR GREENHOUSE 3667 03:05:37,560 --> 03:05:38,640 GHAZI MISSIONS SO WE HAVE A 3668 03:05:38,640 --> 03:05:41,000 PERFECT EXAMPLE OF THE CROW 3669 03:05:41,000 --> 03:05:43,520 BENEFITS OF A POLICY THAT COULD 3670 03:05:43,520 --> 03:05:45,280 SIMULTANEOUSLY IMPROVE HEALTH 3671 03:05:45,280 --> 03:05:47,240 AND SUSTAINABILITY. 3672 03:05:47,240 --> 03:05:50,680 SO IN SUMMARY, THEY ARE MAJOR 3673 03:05:50,680 --> 03:05:53,200 CAUSE OF MORTALITY ACROSS LATIN 3674 03:05:53,200 --> 03:05:55,920 AMERICA CITIES AND THERE'S 3675 03:05:55,920 --> 03:05:58,080 HETEROGENEITY ACROSS CITIES ASK 3676 03:05:58,080 --> 03:05:58,880 NEIGHBORHOODS WITHIN CITIES AND 3677 03:05:58,880 --> 03:06:00,040 SOCIAL ENVIRONMENTAL FACTORS ARE 3678 03:06:00,040 --> 03:06:01,720 KEY BUT REMAIN UNDER EXPLORED IN 3679 03:06:01,720 --> 03:06:03,240 THE REGION IN PARTICULAR AND 3680 03:06:03,240 --> 03:06:04,760 THERE'S SIGNIFICANT POLICY 3681 03:06:04,760 --> 03:06:06,000 IMPLICATIONS BEYOND HEALTHCARE 3682 03:06:06,000 --> 03:06:08,920 AT THE NEED FOR COORDINATED 3683 03:06:08,920 --> 03:06:10,720 EFFORTS ACROSS THE REGION AND 3684 03:06:10,720 --> 03:06:12,600 ALSO, REGIONAL CAPACITY 3685 03:06:12,600 --> 03:06:14,160 STRENGTHEN TO COLLECT AND 3686 03:06:14,160 --> 03:06:17,400 ANALYZE DATA AS WE WERE DOING IS 3687 03:06:17,400 --> 03:06:19,160 FUNDAMENTAL TO GENERATING 3688 03:06:19,160 --> 03:06:22,320 LOCALLY RELEVANT EVIDENCE BOTH 3689 03:06:22,320 --> 03:06:24,920 ACROSS ALL OF THE AMERICAS. 3690 03:06:24,920 --> 03:06:27,320 LAST BUT NOT LEAST, HERE IS OUR 3691 03:06:27,320 --> 03:06:28,560 CONTACT INFORMATION IF YOU WANT 3692 03:06:28,560 --> 03:06:29,240 TO LEARN MORE. 3693 03:06:29,240 --> 03:06:39,640 THANK YOU FOR HAVING ME. 3694 03:06:40,120 --> 03:06:42,760 >>WELCOME TO THE LIVE Q&A 3695 03:06:42,760 --> 03:06:43,120 SESSION. 3696 03:06:43,120 --> 03:06:45,520 YOU BOTH HIGHLIGHTED IN YOUR 3697 03:06:45,520 --> 03:06:47,240 PRESENTATIONS THE HETERO AGAIN 3698 03:06:47,240 --> 03:06:48,960 EIGHT TEE OF ENVIRONMENTAL RISK 3699 03:06:48,960 --> 03:06:53,080 FACTORS AT THE COUNTRY AND CITY 3700 03:06:53,080 --> 03:06:54,560 LEVEL WITHIN LATIN AMERICA. 3701 03:06:54,560 --> 03:06:57,560 THIS IS TRUE FOR AMONG LATINOS 3702 03:06:57,560 --> 03:06:59,640 AND HISPANICS IN THE U.S. WHICH 3703 03:06:59,640 --> 03:07:01,440 MAY BE ONE GROUP. 3704 03:07:01,440 --> 03:07:06,680 FOR EXAMPLE, Dr. PEREZ HE 3705 03:07:06,680 --> 03:07:09,680 HIGHLIGHTED COPD IS 50% AND 3706 03:07:09,680 --> 03:07:14,120 ESTIMATED TO BE 7.6% AMONG 3707 03:07:14,120 --> 03:07:14,880 U.S.-LED FEMALES. 3708 03:07:14,880 --> 03:07:17,000 LIKEWISE SMOKING RATES AMONG 3709 03:07:17,000 --> 03:07:20,440 HISPANIC LATINOS IN THE U.S. IS 3710 03:07:20,440 --> 03:07:23,280 8% AND 40% IN CHILE SO GIVEN 3711 03:07:23,280 --> 03:07:24,600 THIS BETWEEN CITIES AND 3712 03:07:24,600 --> 03:07:26,520 COUNTRIES AND ACROSS THE 3713 03:07:26,520 --> 03:07:27,920 HEMISPHERE, I WANTED TO START BY 3714 03:07:27,920 --> 03:07:31,160 ASKING YOU, Dr. PEREZ, WHAT 3715 03:07:31,160 --> 03:07:33,000 WOULD A NATIONAL OR REGIONAL 3716 03:07:33,000 --> 03:07:36,480 PROGRAM TO PREVENT AND TREAT 3717 03:07:36,480 --> 03:07:38,640 RESPIRATORY DISEASES LIKE LIKE 3718 03:07:38,640 --> 03:07:41,480 AND WHAT ARE THE MOST URGENT 3719 03:07:41,480 --> 03:07:42,760 QUESTIONS THAT SUCH A PROGRAM 3720 03:07:42,760 --> 03:07:45,800 WOULD ANSWER? 3721 03:07:45,800 --> 03:07:56,280 >>I THINK WHAT Dr. ANA DIEZ 3722 03:07:59,600 --> 03:08:02,480 ROUX IS PUBLIC-HEALTH, REDUCING 3723 03:08:02,480 --> 03:08:04,000 AIR POLLUTION AT ALL LEVELS. 3724 03:08:04,000 --> 03:08:08,840 I MENTIONED MAINLY SMOKING AND 3725 03:08:08,840 --> 03:08:12,040 BIOMASS POLLUTION BUT CITIES ARE 3726 03:08:12,040 --> 03:08:14,680 POLLUTED, WORKS ARE POLLUTED SO 3727 03:08:14,680 --> 03:08:19,720 WE HAVE TO CLEAN THE AIR IN ALL 3728 03:08:19,720 --> 03:08:21,320 THE AREAS FROM THE PREVENTATIVE 3729 03:08:21,320 --> 03:08:22,400 POINT OF VIEW. 3730 03:08:22,400 --> 03:08:24,920 FROM A CLINICAL POINT OF VIEW, 3731 03:08:24,920 --> 03:08:28,120 WE WANT TO DO SOMETHING QUICKLY 3732 03:08:28,120 --> 03:08:33,480 OR QUICKER AND WE HAVE TO FOCUS 3733 03:08:33,480 --> 03:08:36,480 ON TOBACCO AND HOUSEHOLD AIR 3734 03:08:36,480 --> 03:08:38,120 POLLUTION. 3735 03:08:38,120 --> 03:08:42,680 SO THERE ARE COMPLIMENT EACH 3736 03:08:42,680 --> 03:08:43,040 OTHER. 3737 03:08:43,040 --> 03:08:45,080 AND TAKING CARE OF PATIENTS ALSO 3738 03:08:45,080 --> 03:08:48,880 IS VERY IMPORTANT AND I 3739 03:08:48,880 --> 03:08:53,080 MENTIONED SOMETHING ABOUT THAT. 3740 03:08:53,080 --> 03:08:55,120 >>THERE'S SOME URGENT QUESTIONS 3741 03:08:55,120 --> 03:08:56,520 THAT YOU THINK THAT WE NEED TO 3742 03:08:56,520 --> 03:09:00,400 BE ANSWERED NOW AS IT RELATES TO 3743 03:09:00,400 --> 03:09:03,960 CREATING OUR RESPIRATORY 3744 03:09:03,960 --> 03:09:04,320 PROGRAM? 3745 03:09:04,320 --> 03:09:08,280 >>FEW COUNTRIES HAVE A 3746 03:09:08,280 --> 03:09:09,760 RESPIRATORY PROGRAM. 3747 03:09:09,760 --> 03:09:12,680 USUALLY, WE HAVE A PROGRAM FOR 3748 03:09:12,680 --> 03:09:14,160 TUBERCULOSIS AND SOME COUNTRIES 3749 03:09:14,160 --> 03:09:17,360 FOR ACUTE RESPIRATORY INFECTIONS 3750 03:09:17,360 --> 03:09:21,080 AND FOR CHRONIC DISEASES, AND 3751 03:09:21,080 --> 03:09:27,640 ESPECIALLY NOT E ENTA GRAY TIVE 3752 03:09:27,640 --> 03:09:29,320 PROGRAMS TO GIVE ACCESS TO 3753 03:09:29,320 --> 03:09:30,600 DIAGNOSIS AND MEDICATIONS THAT 3754 03:09:30,600 --> 03:09:32,880 ARE REQUIRED FOR ASTHMA, FOR 3755 03:09:32,880 --> 03:09:35,600 COPD AND SO, THAT IS AMAZING IN 3756 03:09:35,600 --> 03:09:38,000 MOST COUNTRIES AND MISSING IN 3757 03:09:38,000 --> 03:09:43,200 MEXICO NOW AND SO BASICALLY IT'S 3758 03:09:43,200 --> 03:09:45,000 INEXIST ANT AND ONE OF THE 3759 03:09:45,000 --> 03:09:47,160 PROPOSALS THAT I THINK IS VERY 3760 03:09:47,160 --> 03:09:52,280 IMPORTANT IS TO GROW FROM THE 3761 03:09:52,280 --> 03:09:52,880 TUBERCULOSIS PROGRAM THAT IS ALL 3762 03:09:52,880 --> 03:09:59,240 OVER THE COUNTRIES AND EVEN ALL 3763 03:09:59,240 --> 03:10:01,720 PRIMARY CARE CAN DO TREATMENT 3764 03:10:01,720 --> 03:10:05,840 ASK DIAGNOSIS OF TUBERCULOSIS SO 3765 03:10:05,840 --> 03:10:07,480 GROWING FROM THE SERVICES OF 3766 03:10:07,480 --> 03:10:08,960 TUBERCULOSIS IS ONE OF THE 3767 03:10:08,960 --> 03:10:13,600 PROPOSALS THAT I THINK CAN WORK. 3768 03:10:13,600 --> 03:10:14,400 >>GREAT. 3769 03:10:14,400 --> 03:10:15,840 THANK YOU. 3770 03:10:15,840 --> 03:10:19,680 SO Dr. DIEZ ROUX I'M EXCITED 3771 03:10:19,680 --> 03:10:21,320 FROM THE RESEARCH EMERGING BUT 3772 03:10:21,320 --> 03:10:23,080 AS YOU STATED SOCIAL AND 3773 03:10:23,080 --> 03:10:24,720 ENVIRONMENTAL FACTORS REMAIN 3774 03:10:24,720 --> 03:10:26,240 UNDER EXPLORE. 3775 03:10:26,240 --> 03:10:28,080 COULD YOU ELABORATE MORE ON THIS 3776 03:10:28,080 --> 03:10:30,200 AND SUCH AS WHAT ARE THE 3777 03:10:30,200 --> 03:10:32,920 RESEARCH GAP AND OPPORTUNITIES? 3778 03:10:32,920 --> 03:10:36,720 >>SURE. 3779 03:10:36,720 --> 03:10:38,280 SO, I THINK SOCIAL AND 3780 03:10:38,280 --> 03:10:44,800 ENVIROMENTAL FACTORS ARE 3781 03:10:44,800 --> 03:10:46,400 PROBABLY PORT UNDERSTAND 3782 03:10:46,400 --> 03:10:48,160 UNDERSTAND THE HETEROGENEITY AND 3783 03:10:48,160 --> 03:10:49,600 THERE WILL BE CLINICAL FACTORS 3784 03:10:49,600 --> 03:10:52,360 THAT AN INDIVIDUAL FACTOR THAT 3785 03:10:52,360 --> 03:10:54,240 CONTRIBUTE TO THE HETEROGENEITY 3786 03:10:54,240 --> 03:10:55,800 BUT MANY ARE AFFECTED BY SOCIAL 3787 03:10:55,800 --> 03:11:00,080 AND ENVIRONMENTAL DETERMINANTS 3788 03:11:00,080 --> 03:11:02,320 SO CHARACTERIZING THAT BETTER TO 3789 03:11:02,320 --> 03:11:03,160 UNDERSTAND WHAT IS HAPPENING IN 3790 03:11:03,160 --> 03:11:05,200 THE REGION WHAT ARE THE KEY 3791 03:11:05,200 --> 03:11:06,320 ENVIRONMENTAL FACTORS THAT ARE 3792 03:11:06,320 --> 03:11:08,920 IMPORTANT AND THAT'S NOT, I 3793 03:11:08,920 --> 03:11:11,360 FOCUSED ON AIR POLUTION BUT IT 3794 03:11:11,360 --> 03:11:12,720 INCLUDES BUILT ENVIRONMENTS THAT 3795 03:11:12,720 --> 03:11:14,240 ARE RELATED TO PHYSICAL ACTIVITY 3796 03:11:14,240 --> 03:11:16,000 AND DIET. 3797 03:11:16,000 --> 03:11:17,960 AND ALSO, BETTER CHARACTERIZING 3798 03:11:17,960 --> 03:11:19,160 THE SOCIAL PATTERNING AND HOW 3799 03:11:19,160 --> 03:11:20,800 IT'S CHANGING AND EVOLVING OVER 3800 03:11:20,800 --> 03:11:23,280 TIME BECAUSE IT'S NOT BY ANY 3801 03:11:23,280 --> 03:11:23,920 MEANS INGVAR' APARTMENT. 3802 03:11:23,920 --> 03:11:27,400 IT'S REALLY IMPORTANT JUST FROM 3803 03:11:27,400 --> 03:11:28,920 THE DESCRIPTIVE POINT OF VIEW. 3804 03:11:28,920 --> 03:11:32,680 I THINK THAT IN ADDITION AN 3805 03:11:32,680 --> 03:11:36,440 IMPORTANT AREA FOR RESEARCH IS 3806 03:11:36,440 --> 03:11:37,640 TO UNDERSTAND WHAT BUILT AND 3807 03:11:37,640 --> 03:11:38,840 SOCIAL ENVIRONMENT FACTORS ARE 3808 03:11:38,840 --> 03:11:39,920 PARTICULARLY RELEVANT IN THE 3809 03:11:39,920 --> 03:11:42,920 LATIN AMERICAN REGION BECAUSE WE 3810 03:11:42,920 --> 03:11:44,000 TEND TO EXTRAPOLATE RESEARCH 3811 03:11:44,000 --> 03:11:46,560 FROM THE U.S. AND EUROPE AND 3812 03:11:46,560 --> 03:11:47,920 IT'S SOMETIMES VALID BUT 3813 03:11:47,920 --> 03:11:49,360 SOMETIMES PARTICULARLY FOR MORE 3814 03:11:49,360 --> 03:11:50,920 SOCIAL AND ENVIRONMENTAL THINGS, 3815 03:11:50,920 --> 03:11:53,280 THERE MAY BE NUANCES FOR ASPECTS 3816 03:11:53,280 --> 03:11:56,560 OF IT THAT NEED LOCAL RESEARCH 3817 03:11:56,560 --> 03:11:58,000 AND THEN THE LAST THING I'LL SAY 3818 03:11:58,000 --> 03:12:00,360 IN TERMS OF RESEARCH 3819 03:12:00,360 --> 03:12:02,240 OPPORTUNITIES, I THINK MANY 3820 03:12:02,240 --> 03:12:03,680 COUNTRIES AND CITIES HAVE 3821 03:12:03,680 --> 03:12:06,280 IMPLEMENTED POLICIES AT THE 3822 03:12:06,280 --> 03:12:07,480 POPULATION LEVEL AND I MEAN 3823 03:12:07,480 --> 03:12:08,520 THERE ARE MANY EXAMPLES ACROSS 3824 03:12:08,520 --> 03:12:10,320 THE REGION. 3825 03:12:10,320 --> 03:12:15,120 MENU LABELING, TOBACCO 3826 03:12:15,120 --> 03:12:18,120 REDESCRIPTIONS, MANY, EVEN NEW 3827 03:12:18,120 --> 03:12:19,840 TRANSPORTATION INITIATIVES 3828 03:12:19,840 --> 03:12:22,040 REDUCTIONS IN CAR USE, POLICIES 3829 03:12:22,040 --> 03:12:26,880 TO REDUCE CAR BUSE AND 3830 03:12:26,880 --> 03:12:28,320 CONGESTION AND THERE'S A 3831 03:12:28,320 --> 03:12:29,760 OPPORTUNITY FOR EVALUATE THE 3832 03:12:29,760 --> 03:12:31,520 BENEFITS OF THOSE POLICIES AND I 3833 03:12:31,520 --> 03:12:35,040 THINK THAT WOULD BE VERY 3834 03:12:35,040 --> 03:12:35,760 POWERFUL EVIDENCE AND WOULD 3835 03:12:35,760 --> 03:12:39,080 TEACH US ABOUT THE CAUSES OF NON 3836 03:12:39,080 --> 03:12:41,120 CON UNICH ABLE DISEASE AND WHAT 3837 03:12:41,120 --> 03:12:42,560 POLICIES MIGHT BE MOST EFFECTIVE 3838 03:12:42,560 --> 03:12:44,560 AND ARE ACTUALLY FEASIBLE ACROSS 3839 03:12:44,560 --> 03:12:48,560 THREGION. 3840 03:12:48,560 --> 03:12:51,160 >>THANK YOU FOR HIGHLIGHT TAG 3841 03:12:51,160 --> 03:12:52,560 AND I KNOW WE HAVE A SESSION TO 3842 03:12:52,560 --> 03:12:54,800 TALK ABOUT PUBLIC POLICY IN MORE 3843 03:12:54,800 --> 03:12:56,000 DEPTH LATER ON. 3844 03:12:56,000 --> 03:12:58,960 ANOTHER QUESTION I WANTED TO ASK 3845 03:12:58,960 --> 03:13:00,480 YOU, WHAT RESEARCH EFFORTS ARE 3846 03:13:00,480 --> 03:13:01,800 NEEDED TO BETTER CAPTURE 3847 03:13:01,800 --> 03:13:08,120 ENVIRONMENVIRONMENVIRONMENTAL EE 3848 03:13:08,120 --> 03:13:09,560 LIFE FEAR AND IN LATIN AMERICA 3849 03:13:09,560 --> 03:13:13,200 AND U.S. AND THOSE WHO HAVE 3850 03:13:13,200 --> 03:13:15,920 EMIGRATED, AS YOU SAID, Dr. 3851 03:13:15,920 --> 03:13:19,320 DIAZ ROUX WE NEED THE LATIN 3852 03:13:19,320 --> 03:13:20,760 AMERICA CONTEXT AND WHAT DOES IT 3853 03:13:20,760 --> 03:13:22,680 MEAN OVER THE LIFE COURSE AND 3854 03:13:22,680 --> 03:13:24,680 GENERATION AND BOTH ACROSS THE 3855 03:13:24,680 --> 03:13:24,960 HEMISPHERE? 3856 03:13:24,960 --> 03:13:26,240 COULD YOU COMMENT ON THAT? 3857 03:13:26,240 --> 03:13:29,400 IT'S OPEN FOR BOTH OF YOU TO 3858 03:13:29,400 --> 03:13:29,640 ANSWER. 3859 03:13:29,640 --> 03:13:33,320 >>WELL, ONE ISSUE THAT I 3860 03:13:33,320 --> 03:13:37,640 CONSIDER VERY IMPORTANT IS THE 3861 03:13:37,640 --> 03:13:45,080 CONTRIBUTION OF MEASURE I HAD AD 3862 03:13:45,080 --> 03:13:47,520 THERE ARE SOME INFORMATION ABOUT 3863 03:13:47,520 --> 03:13:49,760 THESE BUT THERE IS ALSO, I 3864 03:13:49,760 --> 03:13:51,920 THINK, IT'S GOING TO BE 3865 03:13:51,920 --> 03:13:53,440 IMPORTANT TO EXPLAIN SOME OF 3866 03:13:53,440 --> 03:13:57,160 THESE VARIATIONS AND MEXICO MAY 3867 03:13:57,160 --> 03:14:00,560 BE ONE EXAMPLE BECAUSE SMOKING 3868 03:14:00,560 --> 03:14:06,400 IS NOT AS HEAVY HERE AS IN OTHER 3869 03:14:06,400 --> 03:14:09,800 COUNTRIES AND THE PREVALENCE OF 3870 03:14:09,800 --> 03:14:12,240 COPD IS MUCH LOWER THAN YOU 3871 03:14:12,240 --> 03:14:22,760 COULD EXPECT AND SO I THINK THAT 3872 03:14:25,600 --> 03:14:29,080 IT COULD BE WIDESPREAD COLLATION 3873 03:14:29,080 --> 03:14:31,360 SITUATION AND SEVERAL 3874 03:14:31,360 --> 03:14:33,880 PERSPECTIVES AND AND I THINK 3875 03:14:33,880 --> 03:14:36,720 THAT THE ALTITUDE OF OC LEVEL 3876 03:14:36,720 --> 03:14:47,120 AND IT'S A REALITY AND, 3877 03:14:57,040 --> 03:14:58,120 INCREASES A LOT IN CITIES LIKE 3878 03:14:58,120 --> 03:15:08,720 MEXICO CITY AND ET CETERA MAY BE 3879 03:15:12,240 --> 03:15:14,080 IMPACTS TO AIR POLLUTION AT THE 3880 03:15:14,080 --> 03:15:16,280 SAME CONCENTRATION AND YOU 3881 03:15:16,280 --> 03:15:18,200 BREATH AND MORE IN MEXICO CITY 3882 03:15:18,200 --> 03:15:20,480 THAN AT SEA LEVEL SO THE 3883 03:15:20,480 --> 03:15:28,120 EXPOSURE IS HIGHER. 3884 03:15:28,120 --> 03:15:36,360 I WOULD JUST ADD BUILDING ON ONE 3885 03:15:36,360 --> 03:15:38,760 THING IS THE LIMITED AMOUNT OF 3886 03:15:38,760 --> 03:15:40,280 DATA THAT WE COLLECT IN LATIN 3887 03:15:40,280 --> 03:15:41,800 AMERICA ON RACE AND ETHNIC 3888 03:15:41,800 --> 03:15:47,400 ORIGIN IN MANY OF OUR, VITAL 3889 03:15:47,400 --> 03:15:49,520 STATISTICS AND THE SURVEYS, THE 3890 03:15:49,520 --> 03:15:50,440 SURVEILLANCE SURVEYS THAT ARE 3891 03:15:50,440 --> 03:15:53,920 DONE AND IT'S AN AREA THAT IS 3892 03:15:53,920 --> 03:15:55,680 REALLY IMPORTANT TO EXPLORE 3893 03:15:55,680 --> 03:15:57,400 FURTHER TO UNDERSTAND INEQUITIES 3894 03:15:57,400 --> 03:16:00,080 SO LOOKING AT SOCIOECONOMIC AND 3895 03:16:00,080 --> 03:16:06,600 RACE AND ETHNIC AND DIFFERENCES 3896 03:16:06,600 --> 03:16:08,000 ACROSS THESE GROUPS AND EMERGE 3897 03:16:08,000 --> 03:16:10,560 AND MANY NOT RELATED TO GENETICS 3898 03:16:10,560 --> 03:16:11,720 AND SOCIAL CIRCUMSTANCES AND 3899 03:16:11,720 --> 03:16:15,520 HISTORY BUT IT'S IMPORTANT TO 3900 03:16:15,520 --> 03:16:16,080 UNDERSTAND THOSE AS WELL AND 3901 03:16:16,080 --> 03:16:18,960 WITH RESPECT TO YOUR QUESTIONS, 3902 03:16:18,960 --> 03:16:25,520 MICHELLE, I THINK THAT LATINOS 3903 03:16:25,520 --> 03:16:27,640 CARRY WITH THEM THE RISK THEY 3904 03:16:27,640 --> 03:16:30,880 EXPERIENCE EARLY IN LIFE AND 3905 03:16:30,880 --> 03:16:31,840 ALSO, THEIR EXPERIENCE PARENTED 3906 03:16:31,840 --> 03:16:33,600 BECAUSE WE KNOW SOME OF THESE 3907 03:16:33,600 --> 03:16:35,000 THINGS TRAVEL ACROSS GENERATION 3908 03:16:35,000 --> 03:16:38,480 AND SO I THINK THAT AN 3909 03:16:38,480 --> 03:16:39,680 UNDERSTANDING THE HEALTH OF 3910 03:16:39,680 --> 03:16:41,720 LATINOS AND THE U.S., 3911 03:16:41,720 --> 03:16:43,000 UNDERSTANDING THEIR HISTORY AND 3912 03:16:43,000 --> 03:16:44,160 IMMIGRATION HISTORY AND THE 3913 03:16:44,160 --> 03:16:45,200 ENVIRONMENTS IN WHICH THEY GREW 3914 03:16:45,200 --> 03:16:47,800 UP IS VERY IMPORTANT AND I THINK 3915 03:16:47,800 --> 03:16:55,040 THERE ARE A LOT OF COMMONALITIES 3916 03:16:55,040 --> 03:17:00,640 BETWEEN IN LATIN AMERICA AND 3917 03:17:00,640 --> 03:17:01,720 CITIES IN THE U.S. 3918 03:17:01,720 --> 03:17:03,040 THERE'S WAYS WE CAN LEVERAGE 3919 03:17:03,040 --> 03:17:04,920 ACROSS THE REGION OF THE AMERICA 3920 03:17:04,920 --> 03:17:06,560 TO BETTER UNDERSTAND THE DRIVERS 3921 03:17:06,560 --> 03:17:09,080 OF NON COM UNIKE ABLE DISEASE 3922 03:17:09,080 --> 03:17:10,600 AND ITS AND HOW THEY EVOLVE AND 3923 03:17:10,600 --> 03:17:11,880 CHANGE OVER TIME AND WHAT THAT 3924 03:17:11,880 --> 03:17:20,760 MEANS FOR POLICY BUT ALSO FOR 3925 03:17:20,760 --> 03:17:21,000 CLINICAL. 3926 03:17:21,000 --> 03:17:22,200 >> 3927 03:17:22,200 --> 03:17:32,520 >>CAN I COMMENT. 3928 03:17:36,680 --> 03:17:38,520 IT'S FROM BEFORE BIRTH AND IT'S 3929 03:17:38,520 --> 03:17:41,240 TRUE FOR SMOKING OR AIR 3930 03:17:41,240 --> 03:17:45,120 POLLUTION IN THE CITIES SO, BY 3931 03:17:45,120 --> 03:17:48,000 ADOLESCENCE, MOST OF THE DAMAGE 3932 03:17:48,000 --> 03:17:50,640 IS PROBABLY DONE SO THE GROWTH 3933 03:17:50,640 --> 03:17:53,680 OF THE RESPIRATORY SYSTEM AND 3934 03:17:53,680 --> 03:17:58,000 IT'S EFFECTIVE SO, BY THE TIME 3935 03:17:58,000 --> 03:18:00,240 THEY IMMIGRANT, MOST OF THE 3936 03:18:00,240 --> 03:18:03,640 PEOPLE DO UNITED STATES AND THEY 3937 03:18:03,640 --> 03:18:09,840 ALREADY HAVE THESE ADVANTAGES 3938 03:18:09,840 --> 03:18:11,680 >>HIGHLIGHTING CAPTURING THAT 3939 03:18:11,680 --> 03:18:13,880 DATA AND I WANT TO TO SAY WE 3940 03:18:13,880 --> 03:18:19,840 HAVE A SESSION LATER ON THIS 3941 03:18:19,840 --> 03:18:21,360 AFTERNOON, RACE AND ETHNICITY IN 3942 03:18:21,360 --> 03:18:23,960 LATIN AMERICA, IT'S ACTUALLY 3943 03:18:23,960 --> 03:18:24,240 TOMORROW. 3944 03:18:24,240 --> 03:18:26,280 >>THAT'S GREAT. 3945 03:18:26,280 --> 03:18:26,480 YEAH. 3946 03:18:26,480 --> 03:18:29,280 >>STAY TUNED FOR THAT. 3947 03:18:29,280 --> 03:18:30,480 ANOTHER QUESTION I WANT TO ASK 3948 03:18:30,480 --> 03:18:33,520 FROM THE AUDIENCE AND THIS IS 3949 03:18:33,520 --> 03:18:36,560 FOR YOU, HOW CAN COUNTRY SWITCH 3950 03:18:36,560 --> 03:18:38,840 RURAL POPULATIONS FROM USING 3951 03:18:38,840 --> 03:18:41,280 WOOD, COAL, CHARCOAL INDOORS. 3952 03:18:41,280 --> 03:18:43,240 ARE THERE INTERVENTION THAT'S 3953 03:18:43,240 --> 03:18:53,640 WORKED IN THIS REGARD? 3954 03:18:56,440 --> 03:18:58,720 >>IT IMPROVES STOPPING AND WORK 3955 03:18:58,720 --> 03:19:02,520 WELL IN THE LABORATORIES BUT 3956 03:19:02,520 --> 03:19:05,680 THEY ARE NOT USED FOR A LONG 3957 03:19:05,680 --> 03:19:10,840 TIME SO THERE'S NO ADHERENCE TO 3958 03:19:10,840 --> 03:19:16,600 THESE PROGRAMS AND SO PEOPLE 3959 03:19:16,600 --> 03:19:19,840 KEEP USING OPEN FIRES WITH A BIG 3960 03:19:19,840 --> 03:19:23,560 COMMAND TO DO MANY THINGS AT THE 3961 03:19:23,560 --> 03:19:24,320 SAME TIME. 3962 03:19:24,320 --> 03:19:26,880 SO THERE ARE NO, FROM MY POINT 3963 03:19:26,880 --> 03:19:36,320 OF VIEW, A GOOD PROGRAM THAT CAN 3964 03:19:36,320 --> 03:19:47,000 USE SO UNFORTUNATELY THERE ARE 3965 03:19:47,000 --> 03:19:51,040 MANY THOUSANDS OF STOPS THAT ARE 3966 03:19:51,040 --> 03:19:52,880 WORRYING AND THE IMPACT HAS BEEN 3967 03:19:52,880 --> 03:19:55,120 VERY POOR AND ALMOST FROM THE 3968 03:19:55,120 --> 03:20:00,440 HEALTH POINT OF VIEW. 3969 03:20:00,440 --> 03:20:02,480 >>THANK YOU SO MUCH FOR COMING 3970 03:20:02,480 --> 03:20:04,480 ON THAT IT'S AN IMPORTANT AREA 3971 03:20:04,480 --> 03:20:07,320 OF RESEARCH AS IT IMPACTS RURAL 3972 03:20:07,320 --> 03:20:08,240 POPULATION AND WOMEN AND 3973 03:20:08,240 --> 03:20:09,640 CHILDREN AND I ALSO WANT TO ASK 3974 03:20:09,640 --> 03:20:11,960 YOU TO GIVE ME YOUR EXPERIENCE 3975 03:20:11,960 --> 03:20:14,920 WITH THE TRANS NATIONAL RESEARCH 3976 03:20:14,920 --> 03:20:15,920 AND COLLABORATION. 3977 03:20:15,920 --> 03:20:19,800 YOU KNOW, WHAT ARE EXAMPLES 3978 03:20:19,800 --> 03:20:21,360 OF -- ABOUT WHAT ARE SOME OF THE 3979 03:20:21,360 --> 03:20:23,160 CHALLENGES IN THESE RESEARCH 3980 03:20:23,160 --> 03:20:24,600 COLLABORATION AND HOW HAVE YOU 3981 03:20:24,600 --> 03:20:30,200 OVERCOME THEM IN YOUR RESEARCH? 3982 03:20:30,200 --> 03:20:32,560 >>I MEAN, I CAN TAKE A STAB OF 3983 03:20:32,560 --> 03:20:32,920 THAT. 3984 03:20:32,920 --> 03:20:35,320 I THINK, YOU KNOW, THE 3985 03:20:35,320 --> 03:20:37,680 EXPERIENCE OF HAS BEEN REALLY 3986 03:20:37,680 --> 03:20:40,960 INCREDIBLE AND I MEAN, BECAUSE 3987 03:20:40,960 --> 03:20:45,560 WE HAVE BEEN ABLE TO CREATE A 3988 03:20:45,560 --> 03:20:48,280 REALLY MULTI-NATIONAL TEAM 3989 03:20:48,280 --> 03:20:50,520 ACROSS THE AMERICAS REALLY AND 3990 03:20:50,520 --> 03:20:52,440 IT'S BEEN JUST AMAZING TO SEE 3991 03:20:52,440 --> 03:20:55,400 WHAT'S POSSIBLE. 3992 03:20:55,400 --> 03:20:56,760 THIS REQUIRES, YOU KNOW, A 3993 03:20:56,760 --> 03:20:58,240 SIGNIFICANT FUNDING AND WE WERE 3994 03:20:58,240 --> 03:21:00,040 FORTUNATE TO GET FUNDING FROM A 3995 03:21:00,040 --> 03:21:02,800 FOUNDATION TO WELCOME TRUST TO 3996 03:21:02,800 --> 03:21:04,440 REALLY CREATE THE RESEARCH 3997 03:21:04,440 --> 03:21:06,560 PLATFORM WHICH MEANS, ESTABLISH 3998 03:21:06,560 --> 03:21:07,960 MECHANISMS FOR COLLABORATIONS SO 3999 03:21:07,960 --> 03:21:09,720 WE HAVE A WHOLE STRUCTURE THAT 4000 03:21:09,720 --> 03:21:11,360 INVOLVES A GOVERNANCE STRUCTURE 4001 03:21:11,360 --> 03:21:15,960 FOR THE PROJECT AND WORKING 4002 03:21:15,960 --> 03:21:18,080 GROUPS AND COORS OF PROCESS FOR 4003 03:21:18,080 --> 03:21:19,880 REVIEW OF PUBLICATION COMMITTEE 4004 03:21:19,880 --> 03:21:21,400 TO ENGAGE JUNIOR INVESTIGATORS 4005 03:21:21,400 --> 03:21:24,120 AND TRAINEES SO A SYSTEM, A DATA 4006 03:21:24,120 --> 03:21:25,760 PLATFORM THAT WE'VE DEVELOPED SO 4007 03:21:25,760 --> 03:21:29,280 IT'S A REAL SYSTEM TO CREATE A 4008 03:21:29,280 --> 03:21:32,280 CULTURE OF COLLABORATION THAT IS 4009 03:21:32,280 --> 03:21:34,120 REALLY ABOUT SUPPORTING 4010 03:21:34,120 --> 03:21:36,480 INVESTIGATORS IN THE REGION AND 4011 03:21:36,480 --> 03:21:40,400 NOT AND EXTRACTING DATA AND AN 4012 03:21:40,400 --> 03:21:44,240 EYES SOMEWHERE ELSE AND THAT 4013 03:21:44,240 --> 03:21:44,840 REALLY TIRES INVESTMENTS AND 4014 03:21:44,840 --> 03:21:47,320 SUPPORT FOR THIS KIND OF WORK 4015 03:21:47,320 --> 03:21:49,560 AND THERE'S AN INCREDIBLE 4016 03:21:49,560 --> 03:21:52,640 RICHNESS CAPACITY IN THE REGION 4017 03:21:52,640 --> 03:21:56,240 TO BE LEVERAGED TO REALLY LEARN 4018 03:21:56,240 --> 03:21:58,600 MORE AND USE IT. 4019 03:21:58,600 --> 03:22:01,000 SO, YOU KNOW, I'M VERY POSITIVE 4020 03:22:01,000 --> 03:22:07,040 ABOUT THE POSSIBILITIES BUT IT 4021 03:22:07,040 --> 03:22:10,080 REQUIRES INVESTMENTS. 4022 03:22:10,080 --> 03:22:12,280 >>WHAT ARE THE KEY PLAYERS AND 4023 03:22:12,280 --> 03:22:14,600 TO DO THIS TYPE OF 4024 03:22:14,600 --> 03:22:16,240 TRANS-NATIONAL RESEARCH 4025 03:22:16,240 --> 03:22:16,600 COLLABORATIONS? 4026 03:22:16,600 --> 03:22:21,760 >>WELL, WE HAVE A TEAM, WE HAVE 4027 03:22:21,760 --> 03:22:24,480 MULTIPLE INSTITUTIONS AND 4028 03:22:24,480 --> 03:22:24,960 RESEARCH CENTERS AND 4029 03:22:24,960 --> 03:22:27,000 UNIVERSITIES ACROSS THE REGION 4030 03:22:27,000 --> 03:22:28,680 AND THEY HAVE EACH SENIOR AND 4031 03:22:28,680 --> 03:22:30,920 JUNIOR PEOPLE AND IT'S VERY 4032 03:22:30,920 --> 03:22:32,920 INTER DISCIPLINARY WITH 4033 03:22:32,920 --> 03:22:35,280 PHYSICIANS, EPIDEMIOLOGISTS AND 4034 03:22:35,280 --> 03:22:37,680 SOCIOLOGISTS AND URBAN PLANNERS, 4035 03:22:37,680 --> 03:22:38,960 AIR POLLUTION EXPERTS AND WE 4036 03:22:38,960 --> 03:22:40,960 HAVE A BIG POLICY MAKER 4037 03:22:40,960 --> 03:22:42,440 ENGAGEMENT COMPONENT TO THE 4038 03:22:42,440 --> 03:22:44,200 PROJECT SO WE DO DISSEMINATION 4039 03:22:44,200 --> 03:22:50,040 EFFORTS TO REALLY GET THE WORD 4040 03:22:50,040 --> 03:22:52,240 OUT AND GET INPUT ON WHAT WE 4041 03:22:52,240 --> 03:22:53,680 SHOULD LOOK AT SO MANY DIFFERENT 4042 03:22:53,680 --> 03:22:55,360 KINDS OF STAKEHOLDERS AND WE 4043 03:22:55,360 --> 03:23:00,200 ALSO WORK WITH NON PROFITS TO 4044 03:23:00,200 --> 03:23:01,720 DISSEMINATE THE FINDINGS FOCUSED 4045 03:23:01,720 --> 03:23:08,840 ON URBAN ISSUES AND PAN AMERICAN 4046 03:23:08,840 --> 03:23:10,400 HAS BEEN A PARTNER AS WELL SO 4047 03:23:10,400 --> 03:23:12,440 IT'S A MULTI-DISCIPLINARY TEAM 4048 03:23:12,440 --> 03:23:18,160 WITH MANY DIFFERENT PLAYERS IN 4049 03:23:18,160 --> 03:23:18,320 IT. 4050 03:23:18,320 --> 03:23:19,720 >>WOULD YOU LIKE TO COMMENT 4051 03:23:19,720 --> 03:23:20,120 ALSO? 4052 03:23:20,120 --> 03:23:23,120 YOUR WORK IN LATIN AMERICA, HOW 4053 03:23:23,120 --> 03:23:24,840 ARE YOU BEEN ABLE TO ADVANCE THE 4054 03:23:24,840 --> 03:23:27,800 RESEARCH AND DO THIS 4055 03:23:27,800 --> 03:23:28,440 COLLABORATION IF. 4056 03:23:28,440 --> 03:23:33,000 >>I AGREE COMPLETELY WITH ANNA. 4057 03:23:33,000 --> 03:23:35,000 FUNDING HAS BEEN BOTTLENECK. 4058 03:23:35,000 --> 03:23:45,480 THERE ARE GROUPS INTERESTED IN 4059 03:23:46,720 --> 03:23:48,400 BUT AT THIS MOMENT, WE WERE ABLE 4060 03:23:48,400 --> 03:23:52,560 TO DO SOME THINGS IN 4061 03:23:52,560 --> 03:23:54,240 COLLABORATION WITH OIR CITIES IN 4062 03:23:54,240 --> 03:23:57,080 LATIN AMERICA BUT WE HAVE BEEN 4063 03:23:57,080 --> 03:24:00,840 HAVING A LOT OF TROUBLE GETTING 4064 03:24:00,840 --> 03:24:02,880 FUNDING AND ESPECIALLY FUNDING 4065 03:24:02,880 --> 03:24:09,920 FOR LATIN AMERICA AND IT'S VERY 4066 03:24:09,920 --> 03:24:14,080 DIFFICULT AND IT NEEDS TO BE 4067 03:24:14,080 --> 03:24:18,520 IMPROVED AND YOU KNOW, IF THESE 4068 03:24:18,520 --> 03:24:20,560 GROUPS DEVELOP AND VERY 4069 03:24:20,560 --> 03:24:22,440 IMPORTANT QUESTIONS CAN BE 4070 03:24:22,440 --> 03:24:27,480 ANSWERED AS ANNA HAS MENTIONED. 4071 03:24:27,480 --> 03:24:28,720 >>THANK YOU TWO SO MUCH. 4072 03:24:28,720 --> 03:24:29,400 WE ARE AT TIME. 4073 03:24:29,400 --> 03:24:31,200 THIS IS BEEN A WONDERFUL 4074 03:24:31,200 --> 03:24:32,280 DISCUSSION AND JUST REALLY 4075 03:24:32,280 --> 03:24:35,160 THOUGHT PROVOKING AND DISCUSSION 4076 03:24:35,160 --> 03:24:36,960 AND IDEAS AND AN OPPORTUNITY FOR 4077 03:24:36,960 --> 03:24:38,560 ADVANCING THE RESEARCH IN THIS 4078 03:24:38,560 --> 03:24:40,240 AREA AND I NOW WANT TO LET YOU 4079 03:24:40,240 --> 03:24:41,760 ALL KNOW WE'RE TAKING A BREAK 4080 03:24:41,760 --> 03:24:44,840 FOR LUNCH AND PLEASE COME BACK 4081 03:24:44,840 --> 03:24:46,160 AT 12:55. 4082 03:24:46,160 --> 03:24:48,000 WE STILL HAVE SOME WONDERFUL 4083 03:24:48,000 --> 03:24:49,160 PRESENTATIONS THIS AFTERNOON AND 4084 03:24:49,160 --> 03:24:54,200 LIVE Q&A SESSIONS SO AGAIN, 4085 03:24:54,200 --> 03:24:55,480 THANK YOU Dr. DIEZ ROUX AND 4086 03:24:55,480 --> 03:25:00,240 Dr. PER HE'S PEREZ FOR A GREAT 4087 03:25:00,240 --> 03:25:01,800 DISCUSSION AND PRESENTATION. 4088 03:25:01,800 --> 03:25:02,640 THANK YOU. 4089 03:25:02,640 --> 03:25:03,600 >>WELCOME BACK FROM BREAK. 4090 03:25:03,600 --> 03:25:05,360 IN THE INTEREST OF TIME WE'RE 4091 03:25:05,360 --> 03:25:07,720 GOING RESUME THE PROCEEDINGS 4092 03:25:07,720 --> 03:25:08,640 RIGHT AWAY. 4093 03:25:08,640 --> 03:25:14,080 I'M NOW TURN THINGS OVER TO THE 4094 03:25:14,080 --> 03:25:23,880 MODERATOR FOR THE NEXT SESSION, 4095 03:25:23,880 --> 03:25:28,520 DR. DOOS. 4096 03:25:28,520 --> 03:25:30,600 >>WE HAVE THREE PRESENTATIONS 4097 03:25:30,600 --> 03:25:34,120 FROM DOCTOR. 4098 03:25:34,120 --> 03:25:42,400 LET'S START. 4099 03:25:42,400 --> 03:25:44,200 >>GOOD AFTERNOON AND THANK YOU 4100 03:25:44,200 --> 03:25:46,080 FOR JOINING THE SESSION I'LL 4101 03:25:46,080 --> 03:25:50,480 TALK MAINLY BE THE LATINO 4102 03:25:50,480 --> 03:25:55,480 COMMUNITY AND ON DEMENTIA IN 4103 03:25:55,480 --> 03:25:56,200 LATIN AMERICA AND THE PROBLEMS 4104 03:25:56,200 --> 03:26:05,480 THERE AND IN THE U.S. 4105 03:26:05,480 --> 03:26:07,680 FIRST I'D LIKE TO TALK ABOUT WHY 4106 03:26:07,680 --> 03:26:09,840 WE'RE TALKING ABOUT DEMENTIA IN 4107 03:26:09,840 --> 03:26:11,560 THE LATINO COMMUNITY OR 4108 03:26:11,560 --> 03:26:12,280 POPULATION. 4109 03:26:12,280 --> 03:26:17,080 FOR LATIN AMERICA, IN THE NEXT 4110 03:26:17,080 --> 03:26:19,520 TWO DECADES DEMENTIA WILL DOUBLE 4111 03:26:19,520 --> 03:26:20,640 IN LATIN AMERICA COUNTRIES. 4112 03:26:20,640 --> 03:26:22,640 THIS IS RELEVANT BECAUSE THIS 4113 03:26:22,640 --> 03:26:27,440 PROCESS TOOK ALMOST FOUR DECADES 4114 03:26:27,440 --> 03:26:28,760 IN WESTERN EUROPE AND NORTH 4115 03:26:28,760 --> 03:26:29,080 AMERICA. 4116 03:26:29,080 --> 03:26:31,000 THE PROCESS THAT TOOK FOUR 4117 03:26:31,000 --> 03:26:32,480 DECADES WILL TAKE ONLY TWO 4118 03:26:32,480 --> 03:26:34,920 DECADES IN LATIN AMERICA. 4119 03:26:34,920 --> 03:26:36,760 THIS IS RELEVANT BECAUSE IN OUR 4120 03:26:36,760 --> 03:26:39,120 POPULATION THERE IS LITTLE 4121 03:26:39,120 --> 03:26:40,080 AWARENESS ABOUT ALZHEIMER'S 4122 03:26:40,080 --> 03:26:42,640 DISEASE AND RELATED DEMENTIA. 4123 03:26:42,640 --> 03:26:46,320 WE DON'T HAVE ENOUGH RESEARCH IN 4124 03:26:46,320 --> 03:26:47,160 THE LATINO COMMUNITY. 4125 03:26:47,160 --> 03:26:52,800 LESS THAN 5% OF ALL GENETIC 4126 03:26:52,800 --> 03:26:54,480 STUDIES DONE OR ALZHEIMER'S 4127 03:26:54,480 --> 03:26:56,080 DISEASE IS DONE IN HISPANIC 4128 03:26:56,080 --> 03:26:58,440 POPULATION AND THERE'S POOR 4129 03:26:58,440 --> 03:27:02,080 UNDERSTANDING ABOUT THE DISEASE 4130 03:27:02,080 --> 03:27:05,680 TRAJECTORY IN OUR POPULATION. 4131 03:27:05,680 --> 03:27:07,200 THERE'S RESEARCH IN THE MAIN 4132 03:27:07,200 --> 03:27:09,800 INTERACTION BETWEEN GENETIC AND 4133 03:27:09,800 --> 03:27:10,440 THE DIFFERENT ENVIRONMENT IN OUR 4134 03:27:10,440 --> 03:27:12,360 POPULATION. 4135 03:27:12,360 --> 03:27:14,360 LET ME BRING THAT TO CONTEXT TO 4136 03:27:14,360 --> 03:27:16,280 ONE OF OUR COMMUNITIES. 4137 03:27:16,280 --> 03:27:24,080 I WILL START WITH THE CASE OF A 4138 03:27:24,080 --> 03:27:26,080 76-YEAR-OLD WOMAN LIVING IN THIS 4139 03:27:26,080 --> 03:27:31,440 PERIOD AND FOR HER COMMUNITY AND 4140 03:27:31,440 --> 03:27:35,320 GREGORIA THERE'S NEUROLOGY OR 4141 03:27:35,320 --> 03:27:37,440 HEALTH OR CARDIOVASCULAR FACTORS 4142 03:27:37,440 --> 03:27:40,280 ARE NOT KNOWN TO THE COMMUNITY 4143 03:27:40,280 --> 03:27:41,400 AND HAVE NO ACCESS TO HEALTH 4144 03:27:41,400 --> 03:27:41,600 CARE. 4145 03:27:41,600 --> 03:27:45,360 THIS IS WHAT WE SEE IN SEVERAL 4146 03:27:45,360 --> 03:27:47,480 COMMUNITIES IN LATIN AMERICA. 4147 03:27:47,480 --> 03:27:51,360 APPROXIMATELY THERE'S MORE THAN 4148 03:27:51,360 --> 03:27:54,480 30 MILLION CASES LIKE HERS IN 4149 03:27:54,480 --> 03:27:56,320 LATIN AMERICA AND LOW-INCOME 4150 03:27:56,320 --> 03:27:56,600 COUNTRIES. 4151 03:27:56,600 --> 03:27:59,600 SOME OF HE STORIES HAVE HELPED 4152 03:27:59,600 --> 03:28:01,760 TO HAVE UNDERSTANDING OF THE 4153 03:28:01,760 --> 03:28:02,920 MAIN RISK FACTORS FOR DEMENTIA 4154 03:28:02,920 --> 03:28:07,720 IN COMMUNITIES LIKE THE ONES 4155 03:28:07,720 --> 03:28:08,680 WHERE GREGORIA LIVES. 4156 03:28:08,680 --> 03:28:10,840 I'M GOING BRIEFLY SUMMARIZE THE 4157 03:28:10,840 --> 03:28:14,880 STUDY HERE AND IT STARTED IN 4158 03:28:14,880 --> 03:28:17,920 2000 WITH THE FIRST WAVE IN 4159 03:28:17,920 --> 03:28:19,520 DEMENTIA FOLLOWING BY THE 4160 03:28:19,520 --> 03:28:22,960 INCIDENT WAVE AND NOW WE JUST 4161 03:28:22,960 --> 03:28:25,680 CONCLUDED THE PREVALENCE WAVE 4162 03:28:25,680 --> 03:28:27,920 AND SECOND INCIDENCE WAVE. 4163 03:28:27,920 --> 03:28:30,080 THE MAIN GOAL HAS BEEN TRYING TO 4164 03:28:30,080 --> 03:28:35,040 ESTABLISH WHAT ARE THE MAIN RISK 4165 03:28:35,040 --> 03:28:39,360 FACTORS FOR DEMENTIA AND IT'S A 4166 03:28:39,360 --> 03:28:40,320 POPULATION-BASED STUDY WITH MORE 4167 03:28:40,320 --> 03:28:46,080 THAN 4,000 PATIENTS IN MORE THAN 4168 03:28:46,080 --> 03:28:48,280 SEVEN COUNTRIES AND OTHER 4169 03:28:48,280 --> 03:28:49,920 COUNTRIES SO THEY HAVE ALWAYS 4170 03:28:49,920 --> 03:28:54,400 USED THE SAME ACROSS-CULTURAL 4171 03:28:54,400 --> 03:28:55,080 VALIDATED ASSESSMENT FOR 4172 03:28:55,080 --> 03:28:55,520 DEMENTIA DIAGNOSIS. 4173 03:28:55,520 --> 03:28:58,080 WHAT WE KNOW SO FAR. 4174 03:28:58,080 --> 03:29:04,800 NUMBER ONE, WE BELIEVE THERE'S 7 4175 03:29:04,800 --> 03:29:08,440 MILLION PEOPLE LIVING WITH 4176 03:29:08,440 --> 03:29:12,080 DEMENTIA 70% OF THOSE CARING FOR 4177 03:29:12,080 --> 03:29:14,560 THOSE PEOPLES ARE UNPAID CARE 4178 03:29:14,560 --> 03:29:15,880 AND WHERE SHOULD RESEARCH BE 4179 03:29:15,880 --> 03:29:18,920 GOING ESPECIALLY IN LATIN 4180 03:29:18,920 --> 03:29:21,040 AMERICA WE HAVE UNDERSTANDING OF 4181 03:29:21,040 --> 03:29:23,240 THE DEMENTIA PREVALENCE, HOW DO 4182 03:29:23,240 --> 03:29:24,600 WE PREPARE THE HEALTH CARE 4183 03:29:24,600 --> 03:29:28,200 SYSTEM OR CONTINUE TO VALIDATE 4184 03:29:28,200 --> 03:29:30,080 KNOWN BIOMARKERS AND GENETIC 4185 03:29:30,080 --> 03:29:32,240 RISK FACTORS AND HOW DO WE 4186 03:29:32,240 --> 03:29:34,880 VALIDATE THOSE OR FIND NEW 4187 03:29:34,880 --> 03:29:38,080 BIOMARKERS OR GENETIC RISK 4188 03:29:38,080 --> 03:29:40,680 FACTORS IN OUR POPULATION? 4189 03:29:40,680 --> 03:29:41,600 ALSO, LET ME CHANGE A LITTLE BIT 4190 03:29:41,600 --> 03:29:46,000 AND TALK ABOUT WHAT ARE THE NEW 4191 03:29:46,000 --> 03:29:48,080 TRENDS THAT WE ARE SEEING IN THE 4192 03:29:48,080 --> 03:29:50,080 STUDY? 4193 03:29:50,080 --> 03:29:52,760 FIRST I'M GOING TO TO PUT IT IN 4194 03:29:52,760 --> 03:29:54,760 CONTEXT AND SHOW WHAT IS GOING 4195 03:29:54,760 --> 03:29:56,920 IN MOST THE HIGH-INCOME 4196 03:29:56,920 --> 03:30:00,120 COUNTRIES WE'RE SEEING EITHER 4197 03:30:00,120 --> 03:30:01,400 STABLE OR DECREASING DEMENTIA 4198 03:30:01,400 --> 03:30:03,720 PREVALENCE IN HIGH-INCOME 4199 03:30:03,720 --> 03:30:04,160 COUNTRIES. 4200 03:30:04,160 --> 03:30:07,200 THE DEMENTIA PREVALENCE IS GOING 4201 03:30:07,200 --> 03:30:08,400 DOWN COMPARED TO PREVIOUS YEARS. 4202 03:30:08,400 --> 03:30:13,080 HOWEVER, THIS IS NOT THE CASE IN 4203 03:30:13,080 --> 03:30:13,400 LATIN AMERICA. 4204 03:30:13,400 --> 03:30:18,280 FOR MOST OF COUNTRIES INCLUDING 4205 03:30:18,280 --> 03:30:22,000 PERU AND MEXICO WE'RE MISSING 4206 03:30:22,000 --> 03:30:26,080 DATA FROM PUERTO RICO AND 4207 03:30:26,080 --> 03:30:29,320 VENEZUELA SO FAR WE ARE SEEING 4208 03:30:29,320 --> 03:30:32,520 THE PREVALENCE WAVE FROM 2006 4209 03:30:32,520 --> 03:30:33,760 WE'RE SEEING INCREASES IN 4210 03:30:33,760 --> 03:30:37,080 DEMENTIA INCIDENTS IN LATIN 4211 03:30:37,080 --> 03:30:39,520 AMERICA IN THE NEW WAVE AND IN 4212 03:30:39,520 --> 03:30:42,320 COUNTRIES LIKE PERU AND MEXICO 4213 03:30:42,320 --> 03:30:45,880 IT'S ALMOST DOUBLED RELATIVE TO 4214 03:30:45,880 --> 03:30:46,920 THE WAVE FROM 2006. 4215 03:30:46,920 --> 03:30:50,080 THERE'S A FEW FACTORS WE BELIEVE 4216 03:30:50,080 --> 03:30:51,040 MAY EXPLAIN THE INCREASE IN 4217 03:30:51,040 --> 03:30:54,080 DEMENTIA PREVALENCE AND THOSE 4218 03:30:54,080 --> 03:30:56,840 ARE MAINLY CARDIOVASCULAR RISK 4219 03:30:56,840 --> 03:30:57,240 FACTORS. 4220 03:30:57,240 --> 03:30:59,240 THIS TABLE KIND OF SUMMARIZES A 4221 03:30:59,240 --> 03:31:04,240 FEW OF THE MAIN RISK FACTORS IN 4222 03:31:04,240 --> 03:31:07,680 THE FIRST WAVE HIGHLIGHTING IN 4223 03:31:07,680 --> 03:31:09,880 BLUE THE ONE THAT WERE 4224 03:31:09,880 --> 03:31:13,120 SIGNIFICANT BUT ALSO IN MANY 4225 03:31:13,120 --> 03:31:14,640 WAYS HELP TO DECREASE DEMENTIA 4226 03:31:14,640 --> 03:31:17,360 PREVALENCE AND THOSE ARE AN 4227 03:31:17,360 --> 03:31:20,560 INCREASE IN EDUCATION IN MOST OF 4228 03:31:20,560 --> 03:31:22,680 OUR COUNTRIES AND WE'RE SEEING 4229 03:31:22,680 --> 03:31:26,040 COUNTRIES LIKE CUBA WE'RE SEEING 4230 03:31:26,040 --> 03:31:28,080 BETTER CONTROLS OF HYPERTENSION 4231 03:31:28,080 --> 03:31:30,680 AND LOWER RATES OF SMOKING. 4232 03:31:30,680 --> 03:31:31,440 HOWEVER, IN SOME EUROPEAN 4233 03:31:31,440 --> 03:31:33,000 COUNTRIES WE'RE SEEING AN 4234 03:31:33,000 --> 03:31:36,480 INCREASE IN DEMENTIA PREVALENCE 4235 03:31:36,480 --> 03:31:39,200 AND SEEING INCREASED 4236 03:31:39,200 --> 03:31:43,560 CARDIOVASCULAR RISK FACTORS AND 4237 03:31:43,560 --> 03:31:45,560 HYPERTENSION INCREASING IN PERU 4238 03:31:45,560 --> 03:31:51,600 AND MEXICO AND THE PREVALENCE OF 4239 03:31:51,600 --> 03:31:57,240 DIABETES AND INCREASE IN THE 4240 03:31:57,240 --> 03:31:59,440 DOMINICAN REPUBLIC AND PERU AND 4241 03:31:59,440 --> 03:32:02,080 WE SEE THIS DRIVING THE INCREASE 4242 03:32:02,080 --> 03:32:03,040 IN DEMENTIA PREVALENCE. 4243 03:32:03,040 --> 03:32:08,120 TO PUT IT IN CONTEXT 4244 03:32:08,120 --> 03:32:10,400 APPROXIMATELY ONLY 10% OF OUR 4245 03:32:10,400 --> 03:32:20,560 POPULATION IN LATIN AMERICA HAS 4246 03:32:20,560 --> 03:32:26,080 HAS INHERITED CARDIOVASCULAR 4247 03:32:26,080 --> 03:32:28,440 HEALTH AND WE'RE SEEING THOSE 4248 03:32:28,440 --> 03:32:32,920 WITH HIGHER VASCULAR BURDEN HAVE 4249 03:32:32,920 --> 03:32:38,000 HIGHER RATES OF DEMENTIA. 4250 03:32:38,000 --> 03:32:40,880 ALSO NOW GOING BACK TO DEMENTIA 4251 03:32:40,880 --> 03:32:44,120 IN LATIN AMERICA I WANT TO 4252 03:32:44,120 --> 03:32:44,840 HIGHLIGHT THAT HISPANIC 4253 03:32:44,840 --> 03:32:47,840 COMMUNITIES ARE NOT A MINORITY 4254 03:32:47,840 --> 03:32:49,920 GROUP EVEN WHEN OUR RESEARCH 4255 03:32:49,920 --> 03:32:51,560 ESPECIALLY IN THE U.S. WE PUT 4256 03:32:51,560 --> 03:32:54,160 THE HISPANIC GROUP AS A UNIQUE 4257 03:32:54,160 --> 03:32:54,520 GROUP. 4258 03:32:54,520 --> 03:32:57,280 IT'S NOT A MONOLITHIC GROUP AND 4259 03:32:57,280 --> 03:32:59,440 HERE IT'S SHOWN ACROSS THE 4260 03:32:59,440 --> 03:33:00,200 COUNTRIES WHERE WE'RE SEEING 4261 03:33:00,200 --> 03:33:03,320 DEMENTIA PREVALENCE IS HIGHER IN 4262 03:33:03,320 --> 03:33:05,600 THE CARIBBEAN POPULATIONS AND 4263 03:33:05,600 --> 03:33:08,560 THERE ARE MANY FACTORS THAT MAY 4264 03:33:08,560 --> 03:33:10,080 DRIVE LIKE LIKE DIFFERENCE 4265 03:33:10,080 --> 03:33:15,920 INDICT AND LIFESTYLE AND GENETIC 4266 03:33:15,920 --> 03:33:22,480 RISK FACTOR. 4267 03:33:22,480 --> 03:33:26,560 AND THERE'S GENETIC ORIGINS AND 4268 03:33:26,560 --> 03:33:31,640 HISPANIC POPULATIONS FROM THE 4269 03:33:31,640 --> 03:33:35,480 CARIBBEAN INCLUDE EUROPEAN 4270 03:33:35,480 --> 03:33:37,040 ANCESTRY AND FROM SOUTH AMERICA 4271 03:33:37,040 --> 03:33:40,640 AND PERU IT'S NATIVE AMERICAN 4272 03:33:40,640 --> 03:33:42,080 AND EUROPEAN CONTRIBUTION AND 4273 03:33:42,080 --> 03:33:45,520 THIS PRETTY MUCH DRIVES 4274 03:33:45,520 --> 03:33:47,080 DIFFERENCE IN WHAT COULD BE 4275 03:33:47,080 --> 03:33:48,880 GENETIC RISK FACTORS IN OUR 4276 03:33:48,880 --> 03:33:49,160 POPULATION. 4277 03:33:49,160 --> 03:33:51,680 AS YOU'LL NOTE ONE OF THE MAIN 4278 03:33:51,680 --> 03:33:54,080 DRIVERS OR ONE OF THE MAIN 4279 03:33:54,080 --> 03:33:59,560 GENETIC RISK FACTORS FOR 4280 03:33:59,560 --> 03:34:01,160 ALZHEIMER'S DISEASE IF YOU HAVE 4281 03:34:01,160 --> 03:34:03,960 THESE YOU'RE TWO TIMES MORE 4282 03:34:03,960 --> 03:34:05,600 LIKELY TO HAVE ALZHEIMER'S 4283 03:34:05,600 --> 03:34:07,840 DISEASE AROUND THERE'S A RISK IN 4284 03:34:07,840 --> 03:34:10,080 HISPANIC AND CARIBBEAN HAVING 4285 03:34:10,080 --> 03:34:14,640 THE LOWEST RISK TO DEVELOP 4286 03:34:14,640 --> 03:34:20,640 ALZHEIMER'S DISEASE IF YOU HAVE 4287 03:34:20,640 --> 03:34:22,800 APOE4 AND IT'S HIGHER IN 4288 03:34:22,800 --> 03:34:24,120 POPULATION THAT RANGES FROM FIVE 4289 03:34:24,120 --> 03:34:28,240 TO SEVEN TIMES MORE LIKELY TO 4290 03:34:28,240 --> 03:34:30,760 DEVELOP DEMENTIA AND IN HISPANIC 4291 03:34:30,760 --> 03:34:34,080 POPULATION IT SEEMS IT'S LOWER 4292 03:34:34,080 --> 03:34:37,120 THAN WHEN YOU COMPARE WITH 4293 03:34:37,120 --> 03:34:41,080 CAUCASIAN POPULATION AND THIS IS 4294 03:34:41,080 --> 03:34:43,960 WHAT UNDERSTAND ABOUT DEMENTIA 4295 03:34:43,960 --> 03:34:45,840 IN LATIN AMERICA AND UNDERSTAND 4296 03:34:45,840 --> 03:34:46,840 THE HISPANIC COMMUNITY IN THE 4297 03:34:46,840 --> 03:34:47,320 U.S. 4298 03:34:47,320 --> 03:34:49,480 IF THE RISK FACTORS ARE THE SAME 4299 03:34:49,480 --> 03:34:51,200 OR NOT AND IF THOSE ARE 4300 03:34:51,200 --> 03:34:53,360 DIFFERENT WHAT ARE THE 4301 03:34:53,360 --> 03:34:54,280 DIFFERENTIAL AFFECTS OF 4302 03:34:54,280 --> 03:34:56,440 DIFFERENT RISK FACTORS IN OUR 4303 03:34:56,440 --> 03:34:57,640 COMMUNITY LIVING IN LATIN 4304 03:34:57,640 --> 03:35:00,680 AMERICA AND IN THE U.S. AND THIS 4305 03:35:00,680 --> 03:35:02,560 ONE OF STUDIES THAT I BELIEVE 4306 03:35:02,560 --> 03:35:03,840 WILL HELP ANSWER SOME QUESTIONS 4307 03:35:03,840 --> 03:35:05,960 IS A STUDY WHERE THE MAIN GOAL 4308 03:35:05,960 --> 03:35:08,560 IS TO STUDY THE MAIN RISK 4309 03:35:08,560 --> 03:35:10,640 FACTORS OF POPULATIONS IN LATIN 4310 03:35:10,640 --> 03:35:13,200 AMERICA AND COMPARE THOSE WITH 4311 03:35:13,200 --> 03:35:18,120 SIMILAR POPULATIONS LIVING IN 4312 03:35:18,120 --> 03:35:21,720 U.S. USING HRS DATA AND LET'S 4313 03:35:21,720 --> 03:35:25,040 SEE DATA WE WANT TO FOCUS. 4314 03:35:25,040 --> 03:35:25,160 . 4315 03:35:25,160 --> 03:35:26,600 THIS DATA COMES FROM THE H ARE 4316 03:35:26,600 --> 03:35:30,080 RS AND HIGHLIGHTING THE 4317 03:35:30,080 --> 03:35:31,600 PREVALENCE OF DEMENTIA. 4318 03:35:31,600 --> 03:35:36,200 PEOPLE WITH MEXICAN ORIGIN OR 4319 03:35:36,200 --> 03:35:38,680 NON-HISPANICS WITH NON-MEXICAN 4320 03:35:38,680 --> 03:35:41,800 ORIENT HAVE THE PREVALENCE OF 4321 03:35:41,800 --> 03:35:45,040 DEMENTIA THAT IS HIGHER THAN THE 4322 03:35:45,040 --> 03:35:47,200 ONE WE DESCRIBED IN STUDIES IN 4323 03:35:47,200 --> 03:35:48,920 SIMILAR COMMUNITIES. 4324 03:35:48,920 --> 03:35:51,480 SO IT'S SIGNIFICANTLY HIGHER IN 4325 03:35:51,480 --> 03:35:52,440 MEXICANS LIVING IN THE 4326 03:35:52,440 --> 03:35:53,680 U.S. COMPARED TO MEXICANS LIVING 4327 03:35:53,680 --> 03:35:56,440 IN MEXICO AND WITH CARIBBEAN 4328 03:35:56,440 --> 03:35:57,720 AMERICANS LIVING IN THE 4329 03:35:57,720 --> 03:35:58,440 CARIBBEAN AND CARIBBEAN 4330 03:35:58,440 --> 03:36:01,000 AMERICANS LIVING IN THE U.S. AND 4331 03:36:01,000 --> 03:36:04,240 SIGNIFICANTLY HIGHER THAN THOSE 4332 03:36:04,240 --> 03:36:05,680 LIVING IN OTHER AREAS AND WHAT 4333 03:36:05,680 --> 03:36:07,800 ARE THE CAUSES OF PREVALENCE? 4334 03:36:07,800 --> 03:36:13,440 THOSE ARE THINGS WE NEED TO GET 4335 03:36:13,440 --> 03:36:14,600 BETTER AND GET GLOBAL RESEARCH. 4336 03:36:14,600 --> 03:36:16,800 WITH THAT I'D LIKE TO FINISH AND 4337 03:36:16,800 --> 03:36:19,000 LEAVE YOU WITH A FEW TAKE-HOME 4338 03:36:19,000 --> 03:36:19,400 MESSAGES. 4339 03:36:19,400 --> 03:36:22,440 FIRST, WHAT I THINK IS MORE 4340 03:36:22,440 --> 03:36:23,200 IMPORTANT CARDIOVASCULAR RISK 4341 03:36:23,200 --> 03:36:25,840 FACTORS I BELIEVE ARE ONE OF THE 4342 03:36:25,840 --> 03:36:28,760 MAJOR TRIGGERS OF DEMENTIA IN 4343 03:36:28,760 --> 03:36:29,760 LATIN AMERICA AND IN A WAY GIVES 4344 03:36:29,760 --> 03:36:32,560 ROOM FOR PREVENTION OF SOME OF 4345 03:36:32,560 --> 03:36:33,560 THE FACTORS. 4346 03:36:33,560 --> 03:36:36,280 WITH THAT, OF COURSE THANKS TO 4347 03:36:36,280 --> 03:36:41,400 ALL MY ALBERTAERS AND I'LL I'LL 4348 03:36:41,400 --> 03:36:43,160 TAKE QUESTIONS AND TALK WITH YOU 4349 03:36:43,160 --> 03:36:44,560 MORE ABOUT OUR RESEARCH. 4350 03:36:44,560 --> 03:36:48,920 THANK YOU VERY MUCH FOR THAT. 4351 03:36:48,920 --> 03:36:50,400 >>GOOD DAY TO YOU ALL. 4352 03:36:50,400 --> 03:36:53,720 I'M GOING TO START WITH MY 4353 03:36:53,720 --> 03:36:54,040 PRESENTATION. 4354 03:36:54,040 --> 03:36:57,800 THIS IS THE OUTLINE I WILL 4355 03:36:57,800 --> 03:36:58,040 FOLLOW. 4356 03:36:58,040 --> 03:36:59,320 HEALTH DISPARITY INS OLD AGE 4357 03:36:59,320 --> 03:37:01,280 RESULT FROM A LIFE TIME OF 4358 03:37:01,280 --> 03:37:04,240 UNEQUAL EXPOSURES AND 4359 03:37:04,240 --> 03:37:04,840 EXPERIENCES. 4360 03:37:04,840 --> 03:37:07,280 I HOPE TO PRESENT EVIDENCE USING 4361 03:37:07,280 --> 03:37:08,920 LONGITUDINAL COHORTS OF MEXICAN 4362 03:37:08,920 --> 03:37:10,000 OLDER ADULTS WE HAVE FOLLOWED IN 4363 03:37:10,000 --> 03:37:16,320 MEXICO. 4364 03:37:16,320 --> 03:37:16,520 . 4365 03:37:16,520 --> 03:37:18,160 I'LL FOCUS ON FUNCTIONALITY AND 4366 03:37:18,160 --> 03:37:21,480 FISCAL FUNCTION AND LIMITATIONS 4367 03:37:21,480 --> 03:37:24,560 AND IN THE MAIN LIFE COURSE 4368 03:37:24,560 --> 03:37:26,000 EXPERIENCES CHILDHOOD 4369 03:37:26,000 --> 03:37:27,360 EXPERIENCES, MAIN OCCUPATION AND 4370 03:37:27,360 --> 03:37:28,840 THE DAILY LIFE ENVIRONMENT. 4371 03:37:28,840 --> 03:37:32,960 AND FINALLY, I WILL CLOSE WITH 4372 03:37:32,960 --> 03:37:33,840 OPPORTUNITIES FOR RESEARCH AND 4373 03:37:33,840 --> 03:37:35,320 HEALTH DISPARITIES BASED ON THE 4374 03:37:35,320 --> 03:37:43,920 RESULTS IN THE UNITED STATES. 4375 03:37:43,920 --> 03:37:46,840 JUST TO SET THE STAGE I'LL FOCUS 4376 03:37:46,840 --> 03:37:48,600 ON PHYSICAL FUNCTION AND MIDDLE 4377 03:37:48,600 --> 03:37:52,760 AND OLD AGE FOR THE BRINGS 4378 03:37:52,760 --> 03:37:53,160 PRESENTATION. 4379 03:37:53,160 --> 03:37:57,560 THESE ARE ACTIVITIES SUCH AS 4380 03:37:57,560 --> 03:38:02,480 BATHING, EATING, DRESSING, USING 4381 03:38:02,480 --> 03:38:05,840 THE TOILET AND THESE ARE 4382 03:38:05,840 --> 03:38:06,120 IMPORTANT. 4383 03:38:06,120 --> 03:38:08,920 THE DATA USED BY RESEARCHERS 4384 03:38:08,920 --> 03:38:11,040 CAME FROM THE MEXICAN HEALTHY 4385 03:38:11,040 --> 03:38:13,080 AGING STUDY A LONGITUDINAL STUDY 4386 03:38:13,080 --> 03:38:16,400 THAT STARTED FOLLOWING ADULTS 4387 03:38:16,400 --> 03:38:20,320 AGE 50 AND OVER IN 2001 IN 4388 03:38:20,320 --> 03:38:22,120 REPRESENTATIVE SAMPLES OF URBAN 4389 03:38:22,120 --> 03:38:25,640 AND RURAL AREAS OF MEXICO. 4390 03:38:25,640 --> 03:38:28,480 MEXICO UNDERWENT FAST AGING 4391 03:38:28,480 --> 03:38:30,840 SURVIVAL IN PARTICULAR STARTING 4392 03:38:30,840 --> 03:38:34,120 IN 1950 AND THE RESEARCH AGENDA 4393 03:38:34,120 --> 03:38:38,080 HERE TRIES TO RESPOND TO THE 4394 03:38:38,080 --> 03:38:40,160 QUESTION, HOW DO SURVIVORS FARE 4395 03:38:40,160 --> 03:38:43,280 WITH RESPECT TO PHYSICAL 4396 03:38:43,280 --> 03:38:45,840 FUNCTION IN OLD AGE UNDER 4397 03:38:45,840 --> 03:38:47,520 CONDITIONS OF FAST SURVIVAL. 4398 03:38:47,520 --> 03:38:54,560 ADULTS AGE 50 IN MEX CROW -- 4399 03:38:54,560 --> 03:38:56,600 MEXICO ARE EXPECTED TO LIVE 4400 03:38:56,600 --> 03:38:59,000 ALMOST 30 YEARS THEN 4401 03:38:59,000 --> 03:39:02,040 TRAJECTORIES OF ADL DISABILITY 4402 03:39:02,040 --> 03:39:03,320 IS WORSE FOR WOMEN THAN FOR MEN. 4403 03:39:03,320 --> 03:39:06,000 THE PREVALENCE OF ADL DISABILITY 4404 03:39:06,000 --> 03:39:08,120 IS APPROXIMATELY TWICE FOR WOMEN 4405 03:39:08,120 --> 03:39:14,080 THAN FOR MEN, 17% COMPARED TO 8% 4406 03:39:14,080 --> 03:39:18,200 AMONG ADULTS 55 TO 74 YEARS OLD. 4407 03:39:18,200 --> 03:39:22,000 THE QUESTION IS OF THAT LIFE 4408 03:39:22,000 --> 03:39:25,480 EXPECTANCY HOW MANY YEARS ARE 4409 03:39:25,480 --> 03:39:26,840 EXPECTED TO BE IN WITH 4410 03:39:26,840 --> 03:39:27,200 DISABILITY. 4411 03:39:27,200 --> 03:39:28,400 AND ANOTHER QUESTION IS WHETHER 4412 03:39:28,400 --> 03:39:31,240 THE COHORTS ARE CHANGING. 4413 03:39:31,240 --> 03:39:34,560 THAT IS, IS IT IMPROVING OR 4414 03:39:34,560 --> 03:39:35,640 WORSENING AS SUCCESSIVE 4415 03:39:35,640 --> 03:39:38,240 GENERATIONS ARE COMING INTO OLD 4416 03:39:38,240 --> 03:39:38,560 AGE. 4417 03:39:38,560 --> 03:39:39,920 THIS RESEARCH COMPARES GROUPS OF 4418 03:39:39,920 --> 03:39:44,120 OLDER ADULTS WHO ARE 10 YEARS A 4419 03:39:44,120 --> 03:39:44,320 PART. 4420 03:39:44,320 --> 03:39:46,000 YOU CAN SEE NO DIFFERENCE IN 4421 03:39:46,000 --> 03:39:48,920 LIFE EXPECTANCY BUT FIND THE 4422 03:39:48,920 --> 03:39:51,080 MORE RECENT COHORTS ARE SPANNING 4423 03:39:51,080 --> 03:39:52,760 A LARGER FRACTION OF THEIR LIFE 4424 03:39:52,760 --> 03:39:56,680 WITH PHYSICAL IMPAIRMENTS BUT 4425 03:39:56,680 --> 03:39:58,080 IT'S EVIDENCE OF EXPANSION OF 4426 03:39:58,080 --> 03:40:00,280 DISABILITY. 4427 03:40:00,280 --> 03:40:03,360 A LARGER FRACTION AT EACH AGE, 4428 03:40:03,360 --> 03:40:08,000 50, 59, 60, 69 AND 70 AND 79. 4429 03:40:08,000 --> 03:40:10,040 THIS EXPANSION OF DISABILITY IS 4430 03:40:10,040 --> 03:40:12,960 MORE PRONOUNCED AMONG WOMEN THAN 4431 03:40:12,960 --> 03:40:13,160 MEN. 4432 03:40:13,160 --> 03:40:14,960 THOUGH THE MORE RECENT COHORTS 4433 03:40:14,960 --> 03:40:20,520 ARE MORE EDUCATED, THEY TEND TO 4434 03:40:20,520 --> 03:40:21,720 HAVE HIGHER DIABETES IN THIS 4435 03:40:21,720 --> 03:40:22,360 COULD BE THE REASON NOR 4436 03:40:22,360 --> 03:40:25,800 EXPANSION OF DISABILITY. 4437 03:40:25,800 --> 03:40:26,320 INSTEAD OF COMPRESSION OF 4438 03:40:26,320 --> 03:40:30,720 DISABILITY. 4439 03:40:30,720 --> 03:40:34,760 OTHER RESEARCHERS HAVE SHOWN 4440 03:40:34,760 --> 03:40:37,000 THAT THE LIFE COURSE INFLUENCES 4441 03:40:37,000 --> 03:40:38,120 OLD AGE FUNCTION AND THE 4442 03:40:38,120 --> 03:40:40,360 QUESTION FOR THEM IS HOW LONG IS 4443 03:40:40,360 --> 03:40:42,200 THIS ARM OF CHILDHOOD 4444 03:40:42,200 --> 03:40:44,400 CONDITIONS, WHAT IS THE REACH OF 4445 03:40:44,400 --> 03:40:46,400 THOSE CONDITIONS IN CHILDHOOD? 4446 03:40:46,400 --> 03:40:51,120 FOR THIS, THEY COMPARED PHYSICAL 4447 03:40:51,120 --> 03:40:53,440 IMPAIRMENT IN ALL AGE AND HOW 4448 03:40:53,440 --> 03:40:54,400 IT'S ASSOCIATED WITH SOCIO 4449 03:40:54,400 --> 03:40:57,200 ECONOMIC LEVELS IN CHILDHOOD, 4450 03:40:57,200 --> 03:40:59,160 ADULTHOOD AND OLD AGE 4451 03:40:59,160 --> 03:41:01,880 CONTRASTING ACROSS LIFE AND FIND 4452 03:41:01,880 --> 03:41:06,680 LOW SES IN CHILDHOOD EVEN AFTER 4453 03:41:06,680 --> 03:41:07,720 CONSIDERING THIS SOCIO ECONOMIC 4454 03:41:07,720 --> 03:41:08,720 STATUS IN THE OTHER STAGES OF 4455 03:41:08,720 --> 03:41:09,720 THE LIFE COURSE. 4456 03:41:09,720 --> 03:41:13,600 THAT IS, THE PERSISTENT EFFECT 4457 03:41:13,600 --> 03:41:15,400 OF CHILDHOOD CONDITIONS AND THE 4458 03:41:15,400 --> 03:41:18,560 AFFECTS VARY FOR MEN AND WOMEN 4459 03:41:18,560 --> 03:41:21,640 AND RURAL AND URBAN RESIDENTS 4460 03:41:21,640 --> 03:41:23,240 BUT CONSISTENTLY FAIR. 4461 03:41:23,240 --> 03:41:25,720 UNLIKE IN THE UNITED STATES, 4462 03:41:25,720 --> 03:41:27,640 THESE RESEARCH FINDS NO AFFECT 4463 03:41:27,640 --> 03:41:29,800 OF CHILDHOOD SES CHANGING WITH 4464 03:41:29,800 --> 03:41:31,000 OLDER AGE. 4465 03:41:31,000 --> 03:41:33,760 THERE'S NO SIGN OF DIMINISHING 4466 03:41:33,760 --> 03:41:36,480 THE EFFECT AND THE RESEARCHERS 4467 03:41:36,480 --> 03:41:37,720 SPECULATE THIS COULD BE BECAUSE 4468 03:41:37,720 --> 03:41:40,440 OF THE COUNTER-INFLUENCE OF 4469 03:41:40,440 --> 03:41:41,680 SOCIAL PROTECTION SUCH AS 4470 03:41:41,680 --> 03:41:43,520 MEDICARE AND MEDICAID IN OLD 4471 03:41:43,520 --> 03:41:44,120 AGE. 4472 03:41:44,120 --> 03:41:49,280 THAT IS ABLE TO COUNTER ACT THE 4473 03:41:49,280 --> 03:41:50,560 AFFECTS OF CHILDHOOD AS MORE 4474 03:41:50,560 --> 03:41:51,680 OLDER ADULTS LIVE LONGER. 4475 03:41:51,680 --> 03:42:02,240 THIS IS NOT THE CASE IN MEXICO. 4476 03:42:04,680 --> 03:42:08,800 ANOTHER GROUP IS LOOKING AT 4477 03:42:08,800 --> 03:42:17,000 OCCUPATION AL AND FIND IT'S 4478 03:42:17,000 --> 03:42:19,480 DICTATED BY THE FISCAL INTENSITY 4479 03:42:19,480 --> 03:42:21,840 OF THE PRIMARY OCCUPATION THEY 4480 03:42:21,840 --> 03:42:25,000 HELD OVER THEIR LIFE COURSE. 4481 03:42:25,000 --> 03:42:28,520 THE MOST IN CARE HAD THE MOST 4482 03:42:28,520 --> 03:42:30,040 WORK INJURIES OR WITH MORE 4483 03:42:30,040 --> 03:42:35,280 PHYSICAL WEAR AND TEAR OR 4484 03:42:35,280 --> 03:42:36,200 REPETITIVE MOTION FOR WORKERS IN 4485 03:42:36,200 --> 03:42:40,000 THE PRODUCTION OF FOOD AND 4486 03:42:40,000 --> 03:42:42,760 TOBACCO FOR MEN AND THAT MEANS 4487 03:42:42,760 --> 03:42:45,920 THE PATTERNS HOLD FOR MEN AND 4488 03:42:45,920 --> 03:42:50,680 WOMEN WHEREAS THEY FIND THE 4489 03:42:50,680 --> 03:42:52,520 EDUCATIONAL EXPERIENCE IS INDEED 4490 03:42:52,520 --> 03:42:54,400 A NOTICEABLE MARKER OF PHYSICAL 4491 03:42:54,400 --> 03:42:58,800 LIMITATIONS IN OLD AGE. 4492 03:42:58,800 --> 03:43:01,760 ANOTHER BODY OF RESEARCH LOOKS 4493 03:43:01,760 --> 03:43:03,440 AT THE ENVIRONMENT EXPOSURES IN 4494 03:43:03,440 --> 03:43:05,040 THE CONTEXT OF THE DAILY LIFE. 4495 03:43:05,040 --> 03:43:09,200 THEY LOOK AT THE USE OF UNCLEAN 4496 03:43:09,200 --> 03:43:10,800 FUEL FOR COOKING OR HEATING. 4497 03:43:10,800 --> 03:43:13,440 IN THIS CASE, WOOD OR CHARCOAL 4498 03:43:13,440 --> 03:43:15,520 IN MEXICO. 4499 03:43:15,520 --> 03:43:19,280 THIS IS PREVALENT IN AROUND 70% 4500 03:43:19,280 --> 03:43:21,760 IN ADULTS 70 AND UP TO 30% IN 4501 03:43:21,760 --> 03:43:22,800 RURAL AREAS. 4502 03:43:22,800 --> 03:43:25,280 THEY LOOK AT THE AFFECT OF USING 4503 03:43:25,280 --> 03:43:28,280 THIS KIND OF COOKING OR HEATING 4504 03:43:28,280 --> 03:43:29,880 FUEL ON COGNITIVE FUNCTION IN 4505 03:43:29,880 --> 03:43:31,320 OLD AGE AND THEY FIND THAT 4506 03:43:31,320 --> 03:43:33,720 INDEED THE AFFECT IS NEGATIVE 4507 03:43:33,720 --> 03:43:35,440 AND ROBUST AFTER ADJUSTMENT FOR 4508 03:43:35,440 --> 03:43:38,640 SOCIO ECONOMIC INDICATORS. 4509 03:43:38,640 --> 03:43:40,840 THE AFFECT OF USING THIS KIND OF 4510 03:43:40,840 --> 03:43:43,280 FUEL ON COGNITION IS EQUIVALENT 4511 03:43:43,280 --> 03:43:45,600 TO BEING THREE YEARS OLDER AND 4512 03:43:45,600 --> 03:43:48,560 SO IT'S A MEANINGFUL AFFECT THAT 4513 03:43:48,560 --> 03:43:53,600 IS THE USE OF THE FUELS. 4514 03:43:53,600 --> 03:43:55,680 THE LONG-TERM EXPOSURES RESULT 4515 03:43:55,680 --> 03:44:02,080 IN THE IMMEASURABLE IMPAIRMENTS 4516 03:44:02,080 --> 03:44:05,080 AND IN THE DAILY LIFE IN MEXICO. 4517 03:44:05,080 --> 03:44:06,840 AS A CONCLUSION THEY ASKED ME TO 4518 03:44:06,840 --> 03:44:09,960 LINK THE WORK WE'VE DONE IN 4519 03:44:09,960 --> 03:44:11,040 MEXICO TO RESEARCH IN THE UNITED 4520 03:44:11,040 --> 03:44:12,600 STATES REGARDING GROUPS WITH 4521 03:44:12,600 --> 03:44:15,080 HIGH BURDEN OF LIFE COURSE 4522 03:44:15,080 --> 03:44:15,840 EXPOSURES. 4523 03:44:15,840 --> 03:44:18,800 HOPEFULLY I'VE MOTIVATED THAT 4524 03:44:18,800 --> 03:44:19,480 INDEED THIS EXPOSURES OVER THE 4525 03:44:19,480 --> 03:44:22,320 LIFE COURSE HAVE AN IMPACT ON 4526 03:44:22,320 --> 03:44:23,120 OLD AGE FUNCTION. 4527 03:44:23,120 --> 03:44:24,880 THE SOURCES OF HEALTH 4528 03:44:24,880 --> 03:44:27,280 DISPARITIES AND OLD AGE IN THE 4529 03:44:27,280 --> 03:44:29,560 UNITED STATES ARE OF COURSE ALSO 4530 03:44:29,560 --> 03:44:32,240 RURAL RESIDENTS, LACK OF HEALTH 4531 03:44:32,240 --> 03:44:35,080 INSURANCE, HAVING LOW INCOME OR 4532 03:44:35,080 --> 03:44:36,840 MEDICAL DEBT OR OTHER DEBTS. 4533 03:44:36,840 --> 03:44:39,920 THIS IS NOT THE CASE FOR MEXICO 4534 03:44:39,920 --> 03:44:42,240 ONLY BECAUSE PROBABLY BECAUSE 4535 03:44:42,240 --> 03:44:45,240 THERE ARE NOT HIGH FUNCTIONALING 4536 03:44:45,240 --> 03:44:47,760 OF THESE TIMES OF MARKETS AND 4537 03:44:47,760 --> 03:44:49,800 THE LACK OF EDUCATION IN MEXICO 4538 03:44:49,800 --> 03:44:51,640 AND THE UNITED STATES AND THE 4539 03:44:51,640 --> 03:44:52,760 LIFE OF PRIMARY EDUCATION MARKS 4540 03:44:52,760 --> 03:44:57,360 THE DIFFERENCE IN CONTRAST IN 4541 03:44:57,360 --> 03:44:57,960 UNEQUAL OUTCOMES. 4542 03:44:57,960 --> 03:45:01,080 THE EVIDENCE WE NEED TO HAVE TO 4543 03:45:01,080 --> 03:45:03,400 CONDUCT THIS RESEARCH HAS TO BE 4544 03:45:03,400 --> 03:45:04,160 REPRESENTATIVE OF THE GROUPS FOR 4545 03:45:04,160 --> 03:45:08,080 WHOM WE WANT TO PROMOTE EQUITY. 4546 03:45:08,080 --> 03:45:11,600 THIS IS PERHAPS THE MAJOR 4547 03:45:11,600 --> 03:45:12,600 BARRIER IN RESEARCH ACROSS THE 4548 03:45:12,600 --> 03:45:15,040 UNITED STATES TO TRY TO STUDY 4549 03:45:15,040 --> 03:45:18,080 THE LIFE COURSE EXPOSURES OF 4550 03:45:18,080 --> 03:45:18,560 DIFFERENT GROUPS. 4551 03:45:18,560 --> 03:45:21,640 WE DON'T HAVE THE STATISTICAL 4552 03:45:21,640 --> 03:45:23,520 POWER TO CONTRAST AND COMPARE 4553 03:45:23,520 --> 03:45:27,880 ACROSS GROUPS AND PRODUCE THE 4554 03:45:27,880 --> 03:45:28,160 EVIDENCE. 4555 03:45:28,160 --> 03:45:29,680 THE TYPE OF RESEARCH WE PROBABLY 4556 03:45:29,680 --> 03:45:31,120 NEED TO INFORM THE PATH TO 4557 03:45:31,120 --> 03:45:32,520 EQUITY ACCORDING TO WHAT I SEE 4558 03:45:32,520 --> 03:45:33,920 IN THE RESULTS FROM MEXICO IS 4559 03:45:33,920 --> 03:45:36,240 THAT WE WOULD LIKE TO KNOW WHAT 4560 03:45:36,240 --> 03:45:39,000 ARE THE MIDDLE AGE OR OLD AGE 4561 03:45:39,000 --> 03:45:41,280 POLICIES AND PROGRAMS THAT CAN 4562 03:45:41,280 --> 03:45:44,560 HELP OVERCOME THE AFFECTS OF 4563 03:45:44,560 --> 03:45:49,640 EARLIER LIFE COURSE EXPOSURES. 4564 03:45:49,640 --> 03:45:51,400 WHICH POLICIES AND PROGRAMS WORK 4565 03:45:51,400 --> 03:45:53,440 FOR WHICH GROUPS AND HAVE TO BE 4566 03:45:53,440 --> 03:45:54,800 PROGRAM SPECIFIC AND GROUP 4567 03:45:54,800 --> 03:45:55,080 SPECIFIC. 4568 03:45:55,080 --> 03:45:56,160 ANOTHER TYPE OF RESEARCH COULD 4569 03:45:56,160 --> 03:45:59,480 BE WHAT ARE THE MARKERS OF 4570 03:45:59,480 --> 03:46:01,280 RESILIENCE AMONG OLDER ADULTS, 4571 03:46:01,280 --> 03:46:03,960 THAT IS WHO ARE THOSE STRONGER 4572 03:46:03,960 --> 03:46:08,360 AND BETTER CAPABLE OF OVERCOMING 4573 03:46:08,360 --> 03:46:10,600 SETBACKS THAN THEIR LIFE COURSE 4574 03:46:10,600 --> 03:46:11,800 DISADVANTAGE WOULD INDICATE. 4575 03:46:11,800 --> 03:46:15,320 WE CAN LEARN A LOT FROM THESE 4576 03:46:15,320 --> 03:46:17,280 RESILIENT OLDER ADULTS. 4577 03:46:17,280 --> 03:46:18,800 ANOTHER POSSIBILITY WE NEED TO 4578 03:46:18,800 --> 03:46:22,440 STUDY MORE IS FINDING CONSISTENT 4579 03:46:22,440 --> 03:46:23,720 DESPAIRS AMONG MEN AND WOMEN AND 4580 03:46:23,720 --> 03:46:26,120 OUTCOMES AND THE AFFECT AND HOW 4581 03:46:26,120 --> 03:46:29,480 PROGRAMS AND EXPOSURES WORK. 4582 03:46:29,480 --> 03:46:32,280 WHAT OCCUPATIONAL AND WHAT 4583 03:46:32,280 --> 03:46:34,080 DOMESTIC LIFE EXPOSURES SHOULD 4584 03:46:34,080 --> 03:46:36,080 BE TARGETED. 4585 03:46:36,080 --> 03:46:38,560 THINK THAT'S A PRIORITY RESEARCH 4586 03:46:38,560 --> 03:46:39,920 QUESTION. 4587 03:46:39,920 --> 03:46:41,840 THANK YOU VERY MUCH FOR THE 4588 03:46:41,840 --> 03:46:42,720 OPPORTUNITY TO ADDRESS YOU IN A 4589 03:46:42,720 --> 03:46:48,520 SHORT PRESENTATION. 4590 03:46:48,520 --> 03:46:50,080 >>HI. 4591 03:46:50,080 --> 03:46:54,080 I'M MARICRUZ RIVERA HERNANDEZ 4592 03:46:54,080 --> 03:46:55,880 AND MY PRESENTATION IS OUTCOMES 4593 03:46:55,880 --> 03:46:57,640 AND QUALITY OF CARE AMONG 4594 03:46:57,640 --> 03:47:00,000 MEDICARE ENROLLEES IN PUERTO 4595 03:47:00,000 --> 03:47:00,200 RICO. 4596 03:47:00,200 --> 03:47:05,480 I'M FUNDED BY THE NIA AND NIMHD. 4597 03:47:05,480 --> 03:47:09,200 I DON'T HAVE ANY OTHER CONFLICTS 4598 03:47:09,200 --> 03:47:11,560 OF INTEREST WITH THE REPRESENTED 4599 03:47:11,560 --> 03:47:13,160 MATERIAL. 4600 03:47:13,160 --> 03:47:14,840 I'M GOING TO TALK ABOUT 4601 03:47:14,840 --> 03:47:18,960 POPULATION AGING AND HEALTH 4602 03:47:18,960 --> 03:47:19,720 DISPARITIES AND MEDICARE 4603 03:47:19,720 --> 03:47:22,080 ADVANTAGE AND THE IMPACT OF 4604 03:47:22,080 --> 03:47:23,280 HURRICANE MARIA ON VULNERABLE 4605 03:47:23,280 --> 03:47:24,480 PATIENTS AND THE OVERLAPPING 4606 03:47:24,480 --> 03:47:28,920 THEMES IN THE STUDIES. 4607 03:47:28,920 --> 03:47:31,520 ASSESSING QUALITY OF CARE AND 4608 03:47:31,520 --> 03:47:34,040 OUTCOMES FOR MEDICARE 4609 03:47:34,040 --> 03:47:38,240 BENEFICIARIES IN PUERTO RICO IS 4610 03:47:38,240 --> 03:47:40,200 IMPORTANT FOR A NUMBER OF 4611 03:47:40,200 --> 03:47:40,480 REASONS. 4612 03:47:40,480 --> 03:47:47,120 FIRST I'LL PROVIDE CONTEXT IN 4613 03:47:47,120 --> 03:47:47,440 PUERTO RICO. 4614 03:47:47,440 --> 03:47:48,160 THE ISLAND'S POPULATION HAS 4615 03:47:48,160 --> 03:47:55,000 GROWN OLDER AND THE POPULATION 4616 03:47:55,000 --> 03:47:55,840 HAS CHANGED AND THE PERCENTAGE 4617 03:47:55,840 --> 03:47:58,800 OF ALL THE ADULTS 65 AND OLDER 4618 03:47:58,800 --> 03:48:02,520 IN THE U.S. WAS 17% IN 2021. 4619 03:48:02,520 --> 03:48:05,760 I'M GOING TO USE U.S. TO REFER 4620 03:48:05,760 --> 03:48:08,760 TO THE U.S. MAIN LAND. 4621 03:48:08,760 --> 03:48:14,720 PUERTO RICO CHANGES DUE TO LIFE 4622 03:48:14,720 --> 03:48:18,880 EXPECTANCY AND WORKING AGE 4623 03:48:18,880 --> 03:48:20,120 ADULTS. 4624 03:48:20,120 --> 03:48:21,400 IT'S BEEN DESCRIBED AS AN ISLAND 4625 03:48:21,400 --> 03:48:23,520 IN CRISIS WITH HIGH POVERTY RATE 4626 03:48:23,520 --> 03:48:29,600 AND STRAINED HEALTH CARE SYSTEM. 4627 03:48:29,600 --> 03:48:32,080 THE U.S. NATIONAL POVERTY RATE 4628 03:48:32,080 --> 03:48:37,120 IS ABOUT 13% IN 2021 AND THE 4629 03:48:37,120 --> 03:48:38,560 MEDIAN INCOME IN PUERTO RICO IS 4630 03:48:38,560 --> 03:48:41,000 30% OF THAT OF THE UNITED 4631 03:48:41,000 --> 03:48:41,240 STATES. 4632 03:48:41,240 --> 03:48:43,320 ABOUT $22,000 COMPARED TO 4633 03:48:43,320 --> 03:48:45,880 $70,000 AND THE RATE OF 4634 03:48:45,880 --> 03:48:47,600 EMPLOYMENT IS LOWER THAN THE 4635 03:48:47,600 --> 03:48:51,440 RATE OF EMPLOYMENT IN THE U.S. 4636 03:48:51,440 --> 03:48:52,880 FINALLY, PEOPLE IN PUERTO RICO 4637 03:48:52,880 --> 03:48:56,520 ARE LESS LIKELY TO HAVE 4638 03:48:56,520 --> 03:48:57,160 BACHELOR'S DEGREE COMPARED TO 4639 03:48:57,160 --> 03:48:58,480 THE U.S. 4640 03:48:58,480 --> 03:49:01,720 IN ADDITION, PUERTO RICO HAS 4641 03:49:01,720 --> 03:49:03,160 BEEN FACING A CRISIS. 4642 03:49:03,160 --> 03:49:04,920 AND DUE TO THESE ECONOMIC 4643 03:49:04,920 --> 03:49:05,640 CONSTRAINTS IT FACE AS A NUMBER 4644 03:49:05,640 --> 03:49:11,920 OF CHALLENGES REGARDING THE 4645 03:49:11,920 --> 03:49:12,440 HEALTH CARE SYSTEM AND 4646 03:49:12,440 --> 03:49:14,520 ADDRESSING HEALTH CARE NEEDS. 4647 03:49:14,520 --> 03:49:16,680 THERE'S A HIGH PREVALENCE OF 4648 03:49:16,680 --> 03:49:18,080 CHRONIC CONDITIONS WITH HIGH 4649 03:49:18,080 --> 03:49:19,240 RATES OF DISABILITY IN PUERTO 4650 03:49:19,240 --> 03:49:21,920 RICO THAN IN THE U.S. 4651 03:49:21,920 --> 03:49:25,720 THE TABLE DESCRIBES THE CHRONIC 4652 03:49:25,720 --> 03:49:26,760 CONDITIONS IN PUERTO RICO AND IN 4653 03:49:26,760 --> 03:49:30,040 THE U.S. 4654 03:49:30,040 --> 03:49:30,720 MEDICARE BENEFICIARIES IN PUERTO 4655 03:49:30,720 --> 03:49:34,000 RICO ARE MORE LIKELY TO HAVE 4656 03:49:34,000 --> 03:49:36,000 ALZHEIMER'S DISEASE AND RELATED 4657 03:49:36,000 --> 03:49:38,040 DEMENTIAS, CHRONIC KIDNEY 4658 03:49:38,040 --> 03:49:40,280 DISEASE, DIABETES, HEART FAILURE 4659 03:49:40,280 --> 03:49:42,480 AND HYPERTENSION COMPARED TO 4660 03:49:42,480 --> 03:49:43,640 MEDICARE BENEFICIARIES IN THE 4661 03:49:43,640 --> 03:49:43,840 U.S. 4662 03:49:43,840 --> 03:49:46,520 IN ADDITION, OLDER ADULTS IN 4663 03:49:46,520 --> 03:49:49,360 PUERTO RICO ARE MORE LIKELY TO 4664 03:49:49,360 --> 03:49:50,640 HAVE DIFFICULTIES WITH 4665 03:49:50,640 --> 03:49:53,280 ACTIVITIES OF DAILY LIVING AND 4666 03:49:53,280 --> 03:49:56,320 POOR HEALTH COMPARED TO OLDER 4667 03:49:56,320 --> 03:49:56,720 ADULTS IN THE U.S. 4668 03:49:56,720 --> 03:50:00,720 NOW I'M GOING TO TALK ABOUT 4669 03:50:00,720 --> 03:50:05,120 MEDICARE ADVANTAGE BENEFICIARIES 4670 03:50:05,120 --> 03:50:06,000 FROM THE ARTICLE MY COLLEAGUES 4671 03:50:06,000 --> 03:50:08,440 AND I PUBLISHED. 4672 03:50:08,440 --> 03:50:09,640 THE MEDICARE ADVANTAGE PROGRAM 4673 03:50:09,640 --> 03:50:14,000 PLAYS A CRITICAL ROLE IN 4674 03:50:14,000 --> 03:50:15,520 DELIVERING HEALTH CARE IN PUERTO 4675 03:50:15,520 --> 03:50:15,920 RICO. 4676 03:50:15,920 --> 03:50:22,680 OF THE 6,000 BENEFICIARIES IN , 4677 03:50:22,680 --> 03:50:24,840 93% ARE ENROLLED THE HIGHEST OF 4678 03:50:24,840 --> 03:50:27,480 ANY STATE OR TERRITORY. 4679 03:50:27,480 --> 03:50:29,280 MEDICARE ADVANTAGE PLANS IN 4680 03:50:29,280 --> 03:50:32,080 PUERTO RICO SIMILAR TO MA PLANS 4681 03:50:32,080 --> 03:50:33,520 OFTEN HAVE LOWER COST SHARING 4682 03:50:33,520 --> 03:50:35,360 THAN THAT OF TRADITIONAL 4683 03:50:35,360 --> 03:50:40,400 MEDICARE OR MEDICARE FEE FOR 4684 03:50:40,400 --> 03:50:41,320 SERVICE. 4685 03:50:41,320 --> 03:50:43,400 PUERTO RICANS HAVE TRADITIONALLY 4686 03:50:43,400 --> 03:50:46,080 RECEIVED LOWER PAYMENT THAN 4687 03:50:46,080 --> 03:50:46,760 U.S. MA PLANS. 4688 03:50:46,760 --> 03:50:50,080 RATES ARE BASED ON EXPENDITURES 4689 03:50:50,080 --> 03:50:52,560 MEDICARE FEE FOR SERVICE OR THE 4690 03:50:52,560 --> 03:50:53,880 MEDICARE POPULATION. 4691 03:50:53,880 --> 03:50:59,120 IN 2022 MA PLANS IN PUERTO RICO 4692 03:50:59,120 --> 03:51:01,080 RECEIVED 40% LOWER PER CAPITA 4693 03:51:01,080 --> 03:51:01,720 PAYMENTS COMPARED TO PLANS IN 4694 03:51:01,720 --> 03:51:06,120 THE SIXU.S. 4695 03:51:06,120 --> 03:51:09,760 FUNDING FOR MEDICAID IS MORE 4696 03:51:09,760 --> 03:51:11,320 CONSTRAINED THAN ANY STATE THIS 4697 03:51:11,320 --> 03:51:14,160 IS IMPORTANT BECAUSE THERE'S 4698 03:51:14,160 --> 03:51:17,840 MEDICAID AND MEDICARE DUAL 4699 03:51:17,840 --> 03:51:19,880 BENEFICIARIES AND THEY PROVIDE 4700 03:51:19,880 --> 03:51:21,240 ASSISTANCE FOR MEDICARE 4701 03:51:21,240 --> 03:51:23,440 COPAYMENTS AND DEDUCTIBLES FOR 4702 03:51:23,440 --> 03:51:25,800 BENEFICIARIES WITH LOW INCOMES. 4703 03:51:25,800 --> 03:51:27,920 THE LACK OF FUNDING FOR MEDICARE 4704 03:51:27,920 --> 03:51:30,800 AND MEDICAID HAS RESULTED IN 4705 03:51:30,800 --> 03:51:33,520 PHYSICIAN SHORTAGES, POORLY 4706 03:51:33,520 --> 03:51:34,840 COORDINATED CARE AND LONG WAIT 4707 03:51:34,840 --> 03:51:35,520 TIMES. 4708 03:51:35,520 --> 03:51:38,640 ACCORDING TO DATA FROM PUERTO 4709 03:51:38,640 --> 03:51:40,600 RICO THERE'S ABOUT 11,000 TO 4710 03:51:40,600 --> 03:51:46,360 SERVE THE POPULATION OF 3.2 4711 03:51:46,360 --> 03:51:48,200 MILLION AND SPECIALTY CARE IS 4712 03:51:48,200 --> 03:51:48,560 MINIMIZED. 4713 03:51:48,560 --> 03:51:51,160 MOST THE STUDIES THAT LOOKED AT 4714 03:51:51,160 --> 03:51:53,600 THE QUALITY OF CARE AND OUTCOMES 4715 03:51:53,600 --> 03:51:55,240 OFTEN EXCLUDE BENEFICIARIES FROM 4716 03:51:55,240 --> 03:51:56,560 PUERTO RICO. 4717 03:51:56,560 --> 03:51:59,840 IN THIS STUDY WE'RE STUDYING THE 4718 03:51:59,840 --> 03:52:01,240 QUALITY OF CARE AND OUTCOMES 4719 03:52:01,240 --> 03:52:03,440 AMONG BENEFICIARIES IN PUERTO 4720 03:52:03,440 --> 03:52:05,920 RICO AND USED DATA FROM MEDICARE 4721 03:52:05,920 --> 03:52:07,480 FROM 2011. 4722 03:52:07,480 --> 03:52:10,080 THIS TABLE SHOWS THE ADJUSTED 4723 03:52:10,080 --> 03:52:13,360 ABSOLUTE DIFFERENCES IN 4724 03:52:13,360 --> 03:52:14,560 PERFORMANCE RATES BETWEEN 4725 03:52:14,560 --> 03:52:16,360 U.S. HISPANIC AND PUERTO RICAN 4726 03:52:16,360 --> 03:52:19,960 HISPANIC MA ENROLLEES. 4727 03:52:19,960 --> 03:52:22,480 THIS LEFT SIDE SHOWS ADJUSTED 4728 03:52:22,480 --> 03:52:25,800 DIFFERENCES BY AGE AND SEX AND 4729 03:52:25,800 --> 03:52:28,280 THIS RIGHT SIDE SHOWS ADJUSTED 4730 03:52:28,280 --> 03:52:30,840 DIFFERENCES BY AGE, SEX AND 4731 03:52:30,840 --> 03:52:31,960 POVERTY. 4732 03:52:31,960 --> 03:52:34,040 WE FOUND THAT COMPARED TO 4733 03:52:34,040 --> 03:52:36,280 MEDICARE BENEFICIARIES IN THE 4734 03:52:36,280 --> 03:52:38,360 U.S. HISPANIC MEDICARE 4735 03:52:38,360 --> 03:52:39,480 BENEFICIARIES IN PUERTO RICO 4736 03:52:39,480 --> 03:52:41,840 RECEIVED LOWER QUALITY OF CARE 4737 03:52:41,840 --> 03:52:42,880 FROM CHRONIC CONDITIONS 4738 03:52:42,880 --> 03:52:46,600 INCLUDING WORSE CONTROL OF 4739 03:52:46,600 --> 03:52:49,560 DIABETES, HYPERLIPIDEMIA AND 4740 03:52:49,560 --> 03:52:52,560 LOWER USE OF EFFECTIVE 4741 03:52:52,560 --> 03:52:55,280 MEDICATION IN RHEUMATOID 4742 03:52:55,280 --> 03:52:56,560 ARTHRITIS AND COPD. 4743 03:52:56,560 --> 03:52:59,160 SOME DIFFERENCES WERE HIGHER 4744 03:52:59,160 --> 03:53:00,840 THAN 20 PERCENTAGE POINTS. 4745 03:53:00,840 --> 03:53:03,600 NOW I'LL TALK ABOUT THE IMPACT 4746 03:53:03,600 --> 03:53:06,920 OF HURRICANE MARIA AMONG 4747 03:53:06,920 --> 03:53:08,840 VULNERABLE PATIENTS IN PUERTO 4748 03:53:08,840 --> 03:53:09,080 RICO. 4749 03:53:09,080 --> 03:53:11,280 MY COLLEAGUES AND I RECENTLY 4750 03:53:11,280 --> 03:53:13,480 PUBLISHED THIS PAPER IN JAMA AND 4751 03:53:13,480 --> 03:53:15,720 EXPLORED THE CHANGES IN 4752 03:53:15,720 --> 03:53:17,320 MIGRATION AND MORTALITY AMONG 4753 03:53:17,320 --> 03:53:19,720 PATIENT WITH KIDNEY FAILURE IN 4754 03:53:19,720 --> 03:53:20,320 PUERTO RICO AFTER HURRICANE 4755 03:53:20,320 --> 03:53:22,520 MARIA. 4756 03:53:22,520 --> 03:53:25,280 HURRICANE MARIA IS CONSIDERED 4757 03:53:25,280 --> 03:53:27,240 ONE OF THE HISTORIC HURRICANES 4758 03:53:27,240 --> 03:53:28,400 IN U.S. HISTORY. 4759 03:53:28,400 --> 03:53:32,560 ON SEPTEMBER 20 OF 2017, 4760 03:53:32,560 --> 03:53:36,000 HURRICANE MARIA MADE LANDFALL IN 4761 03:53:36,000 --> 03:53:36,280 PUERTO RICO. 4762 03:53:36,280 --> 03:53:38,040 IT CAUSED DAMAGE TOTALLING MORE 4763 03:53:38,040 --> 03:53:42,280 THAN $100 MILLION THE THIRD 4764 03:53:42,280 --> 03:53:44,000 COSTLY HURRICANE IN THE U.S. 4765 03:53:44,000 --> 03:53:46,240 IT DESTROYED PUERTO RICO'S 4766 03:53:46,240 --> 03:53:48,640 ELECTRIC GRID CAUSING ONE OF THE 4767 03:53:48,640 --> 03:53:54,720 MOST EXTENSIVE POWER OUTAGES IN 4768 03:53:54,720 --> 03:53:57,080 U.S. HISTORY AND IT INTERRUPTED 4769 03:53:57,080 --> 03:53:57,960 SANITATION SERVICES IN DIFFERENT 4770 03:53:57,960 --> 03:54:06,480 AREAS ACROSS PUERTO RICO. 4771 03:54:06,480 --> 03:54:08,520 LIMITED WATER AFFECTED HOSPITALS 4772 03:54:08,520 --> 03:54:12,640 AND HEALTH CARE FACILITIES AND 4773 03:54:12,640 --> 03:54:16,480 THEY STRUGGLED AND IT AFFECTED 4774 03:54:16,480 --> 03:54:18,600 POPULATIONS RELIANT ON HEALTH 4775 03:54:18,600 --> 03:54:18,840 CARE. 4776 03:54:18,840 --> 03:54:20,440 FOR INSTANCE, A REPORT SUGGESTS 4777 03:54:20,440 --> 03:54:24,280 MANY PERSONS WITH KIDNEY FAILURE 4778 03:54:24,280 --> 03:54:26,320 LEFT PUERTO RICO TO RECEIVE 4779 03:54:26,320 --> 03:54:28,320 DIALYSIS CARE SOMEWHERE ELSE. 4780 03:54:28,320 --> 03:54:35,160 GIVEN THE IMPACT OF MARIA IN 4781 03:54:35,160 --> 03:54:37,560 PUERTO RICO, WE ASSESSED 4782 03:54:37,560 --> 03:54:40,200 PATIENTS WITH KIDNEY FAILURE AND 4783 03:54:40,200 --> 03:54:42,240 USED DATA AND THE RENAL 4784 03:54:42,240 --> 03:54:42,840 MANAGEMENT INFORMATION SYSTEM 4785 03:54:42,840 --> 03:54:46,200 FROM 2012 TO 2020. 4786 03:54:46,200 --> 03:54:49,400 WE USED INTERRUPTED TIME SERIES 4787 03:54:49,400 --> 03:54:50,800 DESIGN. 4788 03:54:50,800 --> 03:54:53,400 WE FOUND THEY WERE SUBSTANTIAL 4789 03:54:53,400 --> 03:54:54,560 DIFFERENCES IN THE NUMBER OF 4790 03:54:54,560 --> 03:54:56,360 PERSONS UNDERGOING DIALYSIS IN 4791 03:54:56,360 --> 03:54:59,200 PUERTO RICO BEFORE AND AFTER 4792 03:54:59,200 --> 03:55:01,040 MARIA. 4793 03:55:01,040 --> 03:55:04,360 BEFORE MARIA, THE MAIN NUMBER OF 4794 03:55:04,360 --> 03:55:05,760 UNIQUE PERSONS IN PUERTO RICO 4795 03:55:05,760 --> 03:55:08,920 WAS A LITTLE OVER 2800 PEOPLE. 4796 03:55:08,920 --> 03:55:14,200 AFTER MARIA, IT DROPPED BY 261 4797 03:55:14,200 --> 03:55:14,560 PEOPLE. 4798 03:55:14,560 --> 03:55:15,760 WE ALSO FOUND THE PERCENTAGE OF 4799 03:55:15,760 --> 03:55:18,480 PEOPLE WHO RECEIVED DIALYSIS AT 4800 03:55:18,480 --> 03:55:22,080 DIFFERENT FACILITIES OUTSIDE OF 4801 03:55:22,080 --> 03:55:23,880 PUERTO RICO INCREASED 4802 03:55:23,880 --> 03:55:25,280 IMMEDIATELY AFTER MARIA 4803 03:55:25,280 --> 03:55:29,080 INDICATING MIGRATION OF PEOPLE 4804 03:55:29,080 --> 03:55:30,720 WITH KIDNEY FAILURE TO THE 4805 03:55:30,720 --> 03:55:35,520 MAINLAND. 4806 03:55:35,520 --> 03:55:38,200 PRE-MARIA IT WAS 7.1%. 4807 03:55:38,200 --> 03:55:40,960 THERE WAS AN INCREASE AFTER 4808 03:55:40,960 --> 03:55:44,000 MARIA OF 5.8%. 4809 03:55:44,000 --> 03:55:45,280 FINALLY, I'M GOING BRIEFLY 4810 03:55:45,280 --> 03:55:46,840 DISCUSS THE OVERLAPPING THEMES 4811 03:55:46,840 --> 03:55:51,440 ACROSS THE DIFFERENT STUDIES. 4812 03:55:51,440 --> 03:55:52,960 THERE'S SIGNIFICANT ECONOMIC 4813 03:55:52,960 --> 03:55:54,240 CHALLENGE IN PUERTO RICO. 4814 03:55:54,240 --> 03:55:56,280 THE ISLAND'S ECONOMY HAS LED 4815 03:55:56,280 --> 03:56:00,280 MEASURES AND POLICIES THAT 4816 03:56:00,280 --> 03:56:01,520 NEGATIVELY IMPACT SOCIAL HEALTH 4817 03:56:01,520 --> 03:56:02,920 CARE SERVICES AND IN ADDITION TO 4818 03:56:02,920 --> 03:56:05,000 LOWER FUNDING FOR MEDICARE AND 4819 03:56:05,000 --> 03:56:06,920 MEDICAID, IN APRIL OF THIS YEAR 4820 03:56:06,920 --> 03:56:08,560 THE SUPREME COURT OF THE UNITED 4821 03:56:08,560 --> 03:56:12,960 STATES RULED CONGRESS CAN 4822 03:56:12,960 --> 03:56:18,080 CONTINUE TO EXCLUDE THEM FROM 4823 03:56:18,080 --> 03:56:20,000 THE SUPPLEMENTAL SECURITY AND 4824 03:56:20,000 --> 03:56:21,160 PHYSICIANS HAVE DESCRIBED IT AS 4825 03:56:21,160 --> 03:56:22,880 A PROBLEM FOR THE HEALTH CARE 4826 03:56:22,880 --> 03:56:25,240 SYSTEM AND A HUMANITARIAN CRISIS 4827 03:56:25,240 --> 03:56:28,120 THAT MAY IMPACT QUALITY OF CARE 4828 03:56:28,120 --> 03:56:31,040 AMONG MEDICARE BENEFICIARIES AND 4829 03:56:31,040 --> 03:56:36,040 OLDER ADULTS. 4830 03:56:36,040 --> 03:56:39,640 IN FACT WE SHOWED THEY RECEIVE 4831 03:56:39,640 --> 03:56:42,800 LOWER QUALITY OF CARE AND WE SAW 4832 03:56:42,800 --> 03:56:43,800 VULNERABLE PATIENTS INCLUDING 4833 03:56:43,800 --> 03:56:45,760 OLDER ADULTS MIGRATING TO THE 4834 03:56:45,760 --> 03:56:48,200 U.S. TO SEEK SPECIALIZED CARE 4835 03:56:48,200 --> 03:56:51,520 ESPECIALLY AFTER DISRUPTIONS OF 4836 03:56:51,520 --> 03:56:54,160 CARE DUE TO NATURAL DISASTERS. 4837 03:56:54,160 --> 03:56:55,880 AND CONSIDERED IMPLEMENTING 4838 03:56:55,880 --> 03:56:58,960 CHANGES TO ENSURE OLDER ADULT IN 4839 03:56:58,960 --> 03:56:59,640 PUERTO RICO RECEIVE APPROPRIATE 4840 03:56:59,640 --> 03:57:01,920 CARE AND DO NOT HAVE TO LEAVE 4841 03:57:01,920 --> 03:57:02,800 THEIR HOMES. 4842 03:57:02,800 --> 03:57:03,720 THANK YOU AND I'M HAPPY TO 4843 03:57:03,720 --> 03:57:14,120 ANSWER ANY QUESTIONS. 4844 03:57:18,120 --> 03:57:21,000 >>WELCOME TO THE LIVE Q&A 4845 03:57:21,000 --> 03:57:22,320 SESSION FOR SUCH AN IMPORTANT 4846 03:57:22,320 --> 03:57:23,440 DISCUSSION ON THE HEALTH OF 4847 03:57:23,440 --> 03:57:25,200 OLDER ADULTS. 4848 03:57:25,200 --> 03:57:28,320 HISPANIC AND LATINO ADULTS WILL 4849 03:57:28,320 --> 03:57:30,000 REPRESENT THE LARGEST SEGMENT OF 4850 03:57:30,000 --> 03:57:32,840 OLDER ADULTS BY 1960 WITH AN 4851 03:57:32,840 --> 03:57:36,280 INCREASE OF 9% TO 21%. 4852 03:57:36,280 --> 03:57:39,920 THE PREVALENCE INCIDENTS OF 4853 03:57:39,920 --> 03:57:42,280 DEMENTIA AS WELL AS OTHER 4854 03:57:42,280 --> 03:57:43,720 NON-COMMUNICABLE DISEASES WHICH 4855 03:57:43,720 --> 03:57:46,520 ARE RISK FACTORS FOR DEMENTIA 4856 03:57:46,520 --> 03:57:48,400 ARE INCREASING AMONG LATIN 4857 03:57:48,400 --> 03:57:50,080 AMERICA AND IN THE U.S. AND 4858 03:57:50,080 --> 03:57:52,000 HEALTH DISPARITIES AND OLDER AGE 4859 03:57:52,000 --> 03:57:53,360 AND HOW DISABILITIES INCREASE 4860 03:57:53,360 --> 03:57:57,200 MORE RECENT COHORTS OF OLDER 4861 03:57:57,200 --> 03:57:57,560 ADULTS. 4862 03:57:57,560 --> 03:58:00,240 AND DR. RIVERA HERNANDEZ 4863 03:58:00,240 --> 03:58:01,720 HIGHLIGHTED THE ACCESS TO HEALTH 4864 03:58:01,720 --> 03:58:05,640 CARE AND HEALTH CARE FUNDING FOR 4865 03:58:05,640 --> 03:58:07,560 OLDER ADULTS IN PUERTO RICO. 4866 03:58:07,560 --> 03:58:09,560 DR. WONG EFFORTS ARE NEEDED TO 4867 03:58:09,560 --> 03:58:11,480 ADVANCE RESEARCH TO IMPROVE THE 4868 03:58:11,480 --> 03:58:16,760 HEALTH AND HEALTH CARE OF OLDER 4869 03:58:16,760 --> 03:58:20,280 ADULTS BOTH LATIN AMERICANS AND 4870 03:58:20,280 --> 03:58:21,760 FOR LATINOS AND HISPANICS IN THE 4871 03:58:21,760 --> 03:58:22,000 U.S.? 4872 03:58:22,000 --> 03:58:23,680 >>THANK YOU, MICHELLE. 4873 03:58:23,680 --> 03:58:25,560 I APPRECIATE AGAIN THE 4874 03:58:25,560 --> 03:58:27,320 INVITATION AND BEING ON THIS 4875 03:58:27,320 --> 03:58:27,960 DISTINCT PANEL. 4876 03:58:27,960 --> 03:58:30,800 I WAS THINKING ABOUT THE WAY 4877 03:58:30,800 --> 03:58:38,080 THAT WE DO THIS RESEARCH IS IN 4878 03:58:38,080 --> 03:58:39,880 POPULATION-BASED TEND TO BE 4879 03:58:39,880 --> 03:58:43,080 LONGITUDINAL SAMPLES AND STUDIES 4880 03:58:43,080 --> 03:58:44,400 TO EXAMINING THE TRAJECTORY OF 4881 03:58:44,400 --> 03:58:46,200 AGING OF POPULATIONS. 4882 03:58:46,200 --> 03:58:50,120 SO IN THE U.S. I THINK THAT WE 4883 03:58:50,120 --> 03:58:52,320 NEED TO BUY IN TO EXISTING 4884 03:58:52,320 --> 03:58:56,240 COHORTS BECAUSE IT WOULD BE VERY 4885 03:58:56,240 --> 03:58:57,800 COSTLY TO LAUNCH REPRESENTATIVE 4886 03:58:57,800 --> 03:58:59,640 COHORTS FOR ALL THE GROUPS WE 4887 03:58:59,640 --> 03:59:00,400 NEED TO REPRESENT. 4888 03:59:00,400 --> 03:59:08,000 THESE COHORTS TEND TO BE 4889 03:59:08,000 --> 03:59:09,240 FOLLOWED OVER TIME 4890 03:59:09,240 --> 03:59:09,840 PROSPECTIVELY. 4891 03:59:09,840 --> 03:59:11,120 THERE'S STUDIES LIKE THAT BUT 4892 03:59:11,120 --> 03:59:12,040 DON'T HAVE THE REPRESENTATION OF 4893 03:59:12,040 --> 03:59:14,280 THE GROUPS THAT WE WANT TO 4894 03:59:14,280 --> 03:59:15,200 REPRESENT. 4895 03:59:15,200 --> 03:59:16,960 IT WOULD GOOD-BYE TO ADD AND 4896 03:59:16,960 --> 03:59:19,600 SUPPLEMENT THESE STUDIES AND I 4897 03:59:19,600 --> 03:59:21,440 KNOW THAT'S A WAY MANY ARE 4898 03:59:21,440 --> 03:59:22,360 THINKING ABOUT IT. 4899 03:59:22,360 --> 03:59:26,440 AND THEN IN ADDITION, WE NEED TO 4900 03:59:26,440 --> 03:59:28,440 PARTNER THE STUDIES AS A DATA 4901 03:59:28,440 --> 03:59:28,880 PRODUCER NOW. 4902 03:59:28,880 --> 03:59:31,560 WE NEED TO THINK ABOUT 4903 03:59:31,560 --> 03:59:32,400 PARTNERING WITH SOMEONE OR 4904 03:59:32,400 --> 03:59:38,080 GROUPS THAT CAN HELP US RECRUIT 4905 03:59:38,080 --> 03:59:40,800 THESE PARTICIPANTS OR GROUPS WE 4906 03:59:40,800 --> 03:59:42,120 WANT TO REPRESENT IN THE UNITED 4907 03:59:42,120 --> 03:59:43,440 STATES, SOCIAL MEDIA, ETCETERA. 4908 03:59:43,440 --> 03:59:46,920 FINALLY I WANTED TO ADD A PITCH 4909 03:59:46,920 --> 03:59:48,360 FOR HUMAN CAPITAL IN LATIN 4910 03:59:48,360 --> 03:59:48,640 AMERICA. 4911 03:59:48,640 --> 03:59:53,680 I THINK THE U.S. PARTNER WITH 4912 03:59:53,680 --> 03:59:54,680 INSTITUTIONS IN LATIN AMERICA 4913 03:59:54,680 --> 03:59:55,920 AND RESEARCH INSTITUTIONS, GRAD 4914 03:59:55,920 --> 04:00:00,320 SCHOOLS AND PUBLIC HEALTH TO 4915 04:00:00,320 --> 04:00:02,560 GATHER IN AND USE THE DATA AND 4916 04:00:02,560 --> 04:00:05,840 BE ABLE TO PARTNER WITH THE 4917 04:00:05,840 --> 04:00:08,280 INSTITUTIONS TO HIGHER BACK 4918 04:00:08,280 --> 04:00:10,600 GRADUATES GRADUATING FROM THE 4919 04:00:10,600 --> 04:00:11,520 UNITED STATES AND GO BACK TO 4920 04:00:11,520 --> 04:00:14,080 THEIR COUNTRIES TO HAVE A 4921 04:00:14,080 --> 04:00:14,720 CONTINUED COLLABORATION WITH 4922 04:00:14,720 --> 04:00:15,040 U.S. PARTNERS. 4923 04:00:15,040 --> 04:00:18,560 THANK YOU. 4924 04:00:18,560 --> 04:00:19,720 >>THANK YOU FOR GETTING US 4925 04:00:19,720 --> 04:00:19,960 STARTED. 4926 04:00:19,960 --> 04:00:22,200 I WANT TO BUILD ON WHAT YOU 4927 04:00:22,200 --> 04:00:25,080 SAID, DR. WONG. 4928 04:00:25,080 --> 04:00:26,920 DR. RIVERA HERNANDEZ, CAN YOU 4929 04:00:26,920 --> 04:00:28,160 TALK MORE ABOUT THE DATA SOURCES 4930 04:00:28,160 --> 04:00:31,120 NEEDED TO STUDY QUALITY OF CARE 4931 04:00:31,120 --> 04:00:33,000 AND OUTCOMES AMONG OLDER ADULTS 4932 04:00:33,000 --> 04:00:35,520 IN PUERTO RICO AND PUERTO RICANS 4933 04:00:35,520 --> 04:00:37,200 AND THE U.S. MAINLAND. 4934 04:00:37,200 --> 04:00:42,600 >>YES, FIRST I WANT TO MENTION 4935 04:00:42,600 --> 04:00:47,000 IT'S PUBLICLY AVAILABLE THROUGH 4936 04:00:47,000 --> 04:00:49,680 CMS TO TRACK LIKE THE COMPARE 4937 04:00:49,680 --> 04:00:53,920 SITE THAT TRACKS QUALITY OF CARE 4938 04:00:53,920 --> 04:00:57,360 OF HOSPITALIZATIONS AND 4939 04:00:57,360 --> 04:00:57,680 FACILITIES. 4940 04:00:57,680 --> 04:00:59,480 AND WE HAVE USED SOME OF THE 4941 04:00:59,480 --> 04:01:03,560 DATA FOR DIFFERENT PROJECTS 4942 04:01:03,560 --> 04:01:05,680 HOWEVER, IN TERMS OF THE DATA, 4943 04:01:05,680 --> 04:01:10,560 MEDICARE BENEFICIARIES ARE UNDER 4944 04:01:10,560 --> 04:01:13,040 REPRESENTED AND AS MENTIONED A 4945 04:01:13,040 --> 04:01:17,080 LOT OF MEDICARE ENROLLEES IN 4946 04:01:17,080 --> 04:01:21,680 PUERTO RICO ARE MEDICARE 4947 04:01:21,680 --> 04:01:22,440 BENEFICIARIES. 4948 04:01:22,440 --> 04:01:25,320 WE NEED TO TRACK THE HEALTH CARE 4949 04:01:25,320 --> 04:01:28,880 OUTCOMES AMONG PEOPLE FROM 4950 04:01:28,880 --> 04:01:29,480 PUERTO RICO. 4951 04:01:29,480 --> 04:01:31,440 I HAVE GRANTS UNDER REVIEW TO 4952 04:01:31,440 --> 04:01:34,080 CONTINUE WORKING ON A DESIGN 4953 04:01:34,080 --> 04:01:36,160 WITH BENEFICIARIES IN PUERTO 4954 04:01:36,160 --> 04:01:37,800 RICO AND TRACK OUTCOMES FOR 4955 04:01:37,800 --> 04:01:39,320 THESE POPULATIONS. 4956 04:01:39,320 --> 04:01:44,320 THIS WILL HELP ME TO CONTINUE TO 4957 04:01:44,320 --> 04:01:45,200 IDENTIFY COLLABORATORS AND BUILD 4958 04:01:45,200 --> 04:01:47,520 DATA SETS AND TRACK OUTCOMES FOR 4959 04:01:47,520 --> 04:01:49,280 MEDICARE ENROLLEES IN PUERTO 4960 04:01:49,280 --> 04:01:49,480 RICO. 4961 04:01:49,480 --> 04:01:52,600 >>THANK YOU. 4962 04:01:52,600 --> 04:01:56,560 AND ADDING TO OUR DISCUSSION ON 4963 04:01:56,560 --> 04:01:59,280 DATA, DR. LLIBRE-GUERRA, WHAT 4964 04:01:59,280 --> 04:02:02,880 EFFORTS ARE NEEDED TO ADVANCE 4965 04:02:02,880 --> 04:02:04,280 PHENOTYPES OF DEMENTIA TO 4966 04:02:04,280 --> 04:02:06,080 CONTRIBUTE TO THE PROMPT 4967 04:02:06,080 --> 04:02:06,720 PREVENTION OR DELAY ITS NATURE 4968 04:02:06,720 --> 04:02:10,800 COURSE? 4969 04:02:10,800 --> 04:02:11,880 -- NATURAL COURSE. 4970 04:02:11,880 --> 04:02:13,640 >>THANK YOU FOR THE INVITATION. 4971 04:02:13,640 --> 04:02:15,040 THERE'S THINGS WE NEED TO TAKE 4972 04:02:15,040 --> 04:02:17,960 INTO CONSIDERATION. 4973 04:02:17,960 --> 04:02:18,640 ONE, INTERVENTIONS AT THE 4974 04:02:18,640 --> 04:02:20,080 POPULATION LEVEL AND 4975 04:02:20,080 --> 04:02:21,560 INTERVENTIONS THAT WE SHOULD DO 4976 04:02:21,560 --> 04:02:23,880 IN OUR HEALTH CARE SYSTEM AND AT 4977 04:02:23,880 --> 04:02:26,760 POPULATION LEVEL I THINK WE 4978 04:02:26,760 --> 04:02:28,840 STILL NEED TO WORK TO BRING 4979 04:02:28,840 --> 04:02:31,200 AWARENESS TO ALZHEIMER'S DISEASE 4980 04:02:31,200 --> 04:02:32,280 IN THE HISPANIC POPULATION AND 4981 04:02:32,280 --> 04:02:33,960 FOR MANY YEARS THE HISPANIC 4982 04:02:33,960 --> 04:02:36,000 POPULATION HAVE CONSIDERED 4983 04:02:36,000 --> 04:02:37,560 MEMORY IMPAIRMENT AND DEMENTIA 4984 04:02:37,560 --> 04:02:41,080 AS PART OF NORMAL AGING. 4985 04:02:41,080 --> 04:02:44,480 THAT'S CHANGING AND THE OTHER 4986 04:02:44,480 --> 04:02:46,320 THING IN TERMS OF PHENOTYPING 4987 04:02:46,320 --> 04:02:51,240 AND EARLY DIAGNOSIS, I THINK WE 4988 04:02:51,240 --> 04:02:55,880 HAVE TO ASSESS PEOPLE WITH THIS 4989 04:02:55,880 --> 04:02:57,640 AND THAT REQUIRES CAPACITY 4990 04:02:57,640 --> 04:03:00,280 BUILDING AND TRAINING AND LASTLY 4991 04:03:00,280 --> 04:03:06,000 I THINK IN TERMS OF PHENOTYPING, 4992 04:03:06,000 --> 04:03:11,080 WE HAVE VALIDATE THE GENETICS 4993 04:03:11,080 --> 04:03:13,800 AND THE BIOMARKERS THAT WE ARE 4994 04:03:13,800 --> 04:03:19,040 NOW FINDING IN THE POPULATION. 4995 04:03:19,040 --> 04:03:22,320 WE CANNOT ASSUME THE POPULATION 4996 04:03:22,320 --> 04:03:23,760 THAT WAS THE SAME IN LATIN 4997 04:03:23,760 --> 04:03:24,040 AMERICA. 4998 04:03:24,040 --> 04:03:28,400 WE KNOW LESS THAN 5% OF GENETIC 4999 04:03:28,400 --> 04:03:29,440 STUDIES IN ALZHEIMER'S DISEASE 5000 04:03:29,440 --> 04:03:32,800 ARE DONE AND THAT'S A GAP WE 5001 04:03:32,800 --> 04:03:34,160 NEED AND BIOMARKERS. 5002 04:03:34,160 --> 04:03:37,080 WE HAVE THE RARE UNDERSTANDING 5003 04:03:37,080 --> 04:03:42,440 OF BLOOD-BASED BIOMARKERS THOSE 5004 04:03:42,440 --> 04:03:45,000 ARE NOT BEING SYSTEMATICALLY 5005 04:03:45,000 --> 04:03:45,560 VALIDATED IN THE HISPANIC 5006 04:03:45,560 --> 04:03:46,520 POPULATION WHICH IS THE NEXT 5007 04:03:46,520 --> 04:03:50,080 STEP FOR OUR REGION AND 5008 04:03:50,080 --> 04:03:55,080 POPULATIONS IN THE U.S. 5009 04:03:55,080 --> 04:03:56,160 >>THANK YOU. 5010 04:03:56,160 --> 04:03:58,320 ARE THERE FINDINGS ABOUT THE 5011 04:03:58,320 --> 04:04:00,280 EFFECTIVENESS OF CURRENT 5012 04:04:00,280 --> 04:04:02,080 TREATMENT FOR DEMENTIA AMONG 5013 04:04:02,080 --> 04:04:08,120 HISPANIC LATINOS OR IN LATIN 5014 04:04:08,120 --> 04:04:08,400 AMERICANS? 5015 04:04:08,400 --> 04:04:10,880 >>AS WE SAW IN SOME 5016 04:04:10,880 --> 04:04:11,520 REPRESENTATIONS IN THE MORNING 5017 04:04:11,520 --> 04:04:13,480 AND ALSO IN THE AFTERNOON, 5018 04:04:13,480 --> 04:04:19,440 CARDIOVASCULAR RISK FACTORS ARE 5019 04:04:19,440 --> 04:04:21,200 THE MAIN CONTRIBUTOR TO THIS AND 5020 04:04:21,200 --> 04:04:24,520 IN HISPANICS LIVING IN THE U.S. 5021 04:04:24,520 --> 04:04:26,200 EARLY INTERVENTION AND 5022 04:04:26,200 --> 04:04:27,480 PREVENTION OF CARDIOVASCULAR 5023 04:04:27,480 --> 04:04:31,200 RISK FACTOR WILL HELP DECREASE 5024 04:04:31,200 --> 04:04:33,720 THIS PREVALENCE IN THE HISPANIC 5025 04:04:33,720 --> 04:04:38,400 COMMUNITY AND BY INTERVENING WE 5026 04:04:38,400 --> 04:04:46,080 CAN REDUCE 30% OF DEMENTIA 5027 04:04:46,080 --> 04:04:47,000 CASES. 5028 04:04:47,000 --> 04:04:48,960 THREES NOT ENOUGH OF OUR 5029 04:04:48,960 --> 04:04:50,360 COMMUNITY REPRESENTED AND WE'RE 5030 04:04:50,360 --> 04:04:52,280 NOW SEEING THE FIRST DATA COMING 5031 04:04:52,280 --> 04:04:54,840 TO THE FIELD SHOWING 5032 04:04:54,840 --> 04:04:57,920 EFFECTIVENESS IN TERMS OF THE 5033 04:04:57,920 --> 04:04:58,480 DECLINE WITH THE EFFECT ON 5034 04:04:58,480 --> 04:05:06,560 BIOMARKERS. 5035 04:05:06,560 --> 04:05:08,800 NOW WE NEED TO MOVE MORE OF THIS 5036 04:05:08,800 --> 04:05:11,600 POPULATION TO THESE TRIALS. 5037 04:05:11,600 --> 04:05:12,920 >>WHAT ARE POTENTIAL 5038 04:05:12,920 --> 04:05:14,280 STRATEGIES, INTERVENTION AND 5039 04:05:14,280 --> 04:05:18,560 POLICIES NEEDED TO PREPARE OUR 5040 04:05:18,560 --> 04:05:19,200 HEALTH CARE SYSTEM AND WORKFORCE 5041 04:05:19,200 --> 04:05:21,240 AND FAMILY MEMBERS AND 5042 04:05:21,240 --> 04:05:24,320 CAREGIVERS WHO CARE FOR OLDER 5043 04:05:24,320 --> 04:05:25,880 ADULTS WITH CHRONIC DISEASE AND 5044 04:05:25,880 --> 04:05:26,480 DISABILITY IN LATIN AMERICA AND 5045 04:05:26,480 --> 04:05:36,720 IN THE U.S.? 5046 04:05:38,680 --> 04:05:41,160 >>THINKING THAT WE CAN DO IT 5047 04:05:41,160 --> 04:05:43,520 FROM THE HEALTH CARE SYSTEM NOT 5048 04:05:43,520 --> 04:05:43,800 REALISTIC. 5049 04:05:43,800 --> 04:05:46,600 WE NEED TO THINK OF FORMAL 5050 04:05:46,600 --> 04:05:48,200 STRATEGIES OR FAMILIES. 5051 04:05:48,200 --> 04:05:55,960 WE CAN THINK ABOUT HOW TO TRAIN 5052 04:05:55,960 --> 04:05:58,080 AND HOW TO HAVE A FAST WAY OF 5053 04:05:58,080 --> 04:06:01,200 TRAINING THE CAREGIVERS AND 5054 04:06:01,200 --> 04:06:04,320 TAKING CARE OF THEMSELVES. 5055 04:06:04,320 --> 04:06:08,120 SELF CARE CAREGIVERS IS AN 5056 04:06:08,120 --> 04:06:09,160 EMPOWERING WAY OF SAYING WE'RE 5057 04:06:09,160 --> 04:06:10,960 THINKING OF YOU. 5058 04:06:10,960 --> 04:06:12,760 WE WANT TO HELP YOU AND WANT TO 5059 04:06:12,760 --> 04:06:17,800 HELP YOU TO PROVIDE CARE AND 5060 04:06:17,800 --> 04:06:21,240 TAKE CARE OF YOURSELF AND THE 5061 04:06:21,240 --> 04:06:24,080 CARE GIVING RESPONSIBILITIES AND 5062 04:06:24,080 --> 04:06:27,280 THE WOMEN WHO ARE MOTHERS TAKING 5063 04:06:27,280 --> 04:06:28,160 CARE OF OTHERS. 5064 04:06:28,160 --> 04:06:30,840 AND THE STRATEGY OF HAVING TO 5065 04:06:30,840 --> 04:06:32,080 JUGGLE AS WELL AS HAVING TO TAKE 5066 04:06:32,080 --> 04:06:32,480 CARE OF THEMSELVES. 5067 04:06:32,480 --> 04:06:42,680 THANK YOU. 5068 04:06:52,960 --> 04:06:54,360 >>PUERTO RICO IS A 5069 04:06:54,360 --> 04:06:55,200 U.S. TERRITORY. 5070 04:06:55,200 --> 04:06:58,680 THEIR FUNDING MECHANISMS THAT 5071 04:06:58,680 --> 04:07:03,040 ALIGN TO THE U.S. IN MEDICARE OR 5072 04:07:03,040 --> 04:07:05,480 MEDICAID HOWEVER THERE'S LOWER 5073 04:07:05,480 --> 04:07:09,840 FUNDING TO PUERTO RICO. 5074 04:07:09,840 --> 04:07:12,920 WE'VE SEEN THOSE WITH COMPLEX 5075 04:07:12,920 --> 04:07:14,920 CONDITIONS MAY LEAVE THE ISLAND 5076 04:07:14,920 --> 04:07:18,120 AND COME TO THE U.S. TO SEEK 5077 04:07:18,120 --> 04:07:20,440 CARE THAT IS HARD TO GET IN 5078 04:07:20,440 --> 04:07:20,760 PUERTO RICO. 5079 04:07:20,760 --> 04:07:24,600 FROM THAT POINT OF VIEW I DO 5080 04:07:24,600 --> 04:07:26,960 BELIEVE WE SHOULD IMPLEMENT SOME 5081 04:07:26,960 --> 04:07:30,840 INTERVENTION TO HELP CAREGIVERS 5082 04:07:30,840 --> 04:07:32,760 WHO DON'T WANT TO LEAVE THE 5083 04:07:32,760 --> 04:07:35,040 ISLAND AND CONTINUE TO ABLE AT 5084 04:07:35,040 --> 04:07:40,800 HOME AND NOT HAVE TO MIGRATE. 5085 04:07:40,800 --> 04:07:44,520 AND THERE'S MANY BENEFITS AND 5086 04:07:44,520 --> 04:07:46,320 FUNDING IN PUERTO RICO AND THINK 5087 04:07:46,320 --> 04:07:48,960 OF PROVIDING INCENTIVES TO HAVE 5088 04:07:48,960 --> 04:07:53,880 SPECIALIZED CARE IN PUERTO RICO 5089 04:07:53,880 --> 04:07:59,720 AS WE'VE SEEN THEY'RE NOT 5090 04:07:59,720 --> 04:08:00,960 PROVIDING SPECIALTY CARE IN 5091 04:08:00,960 --> 04:08:03,240 PUERTO RICO. 5092 04:08:03,240 --> 04:08:06,600 >>I WANT TO TALK ABOUT THE 5093 04:08:06,600 --> 04:08:08,600 HEALTH CARE SYSTEM THAT IS NOT 5094 04:08:08,600 --> 04:08:09,880 READY YET TO DEAL WITH THIS AND 5095 04:08:09,880 --> 04:08:16,280 WE STILL NEED TO THINK HOW DO WE 5096 04:08:16,280 --> 04:08:22,200 ADDRESS THIS IN PRIMARY CARE AND 5097 04:08:22,200 --> 04:08:28,320 IT'S A NOT UNIQUE AND HAVE 5098 04:08:28,320 --> 04:08:30,080 PROVIDERS TO ASSESS PEOPLE IN 5099 04:08:30,080 --> 04:08:40,440 THEIR FIRST LANGUAGE. 5100 04:09:03,520 --> 04:09:04,800 >>AND LOOKING AT OUR WORKFORCE 5101 04:09:04,800 --> 04:09:08,000 AND MAKING SURE CLINICIANS AND 5102 04:09:08,000 --> 04:09:09,000 THE HEALTH CARE SYSTEM IS 5103 04:09:09,000 --> 04:09:10,160 DELIVERING CARE IN A RESPONSIVE 5104 04:09:10,160 --> 04:09:13,040 WAY TO THE CULTURE OF THE 5105 04:09:13,040 --> 04:09:15,040 HISPANIC LATINOS AND THE 5106 04:09:15,040 --> 04:09:16,880 LANGUAGE THEY WANT ARE IMPORTANT 5107 04:09:16,880 --> 04:09:20,280 POINTS YOU ALL HAVE BROUGHT UP. 5108 04:09:20,280 --> 04:09:24,240 I HAVE A COUPLE MORE QUESTIONS 5109 04:09:24,240 --> 04:09:26,720 THAT CAME OUT AND I ENJOYED YOUR 5110 04:09:26,720 --> 04:09:27,080 PRESENTATIONS. 5111 04:09:27,080 --> 04:09:28,680 DR. WONG, ONE QUESTION I 5112 04:09:28,680 --> 04:09:35,640 RECEIVED, IS OLDER ADULTS ABUSE 5113 04:09:35,640 --> 04:09:37,280 IDENTIFIED IN YOUR RESEARCH AND 5114 04:09:37,280 --> 04:09:40,800 HOW'S IT MANIFEST AND ARE THERE 5115 04:09:40,800 --> 04:09:42,720 EFFECTIVES TO ADDRESS THAT? 5116 04:09:42,720 --> 04:09:53,200 >>IN OUR STUDY WE SELECTED 5117 04:09:53,200 --> 04:09:56,120 AREAS IN MEXICO AND QUESTIONS OF 5118 04:09:56,120 --> 04:09:58,560 VIOLENCE AND DOMESTIC VIOLENCE 5119 04:09:58,560 --> 04:10:02,120 ARE VERY DELICATE BECAUSE WE 5120 04:10:02,120 --> 04:10:03,280 HAVE TO REPORT SOMEBODY IN THE 5121 04:10:03,280 --> 04:10:05,400 HOUSEHOLD IS ABUSING THEM. 5122 04:10:05,400 --> 04:10:06,680 SO WE HAVE NOT ASKED THOSE 5123 04:10:06,680 --> 04:10:09,240 QUESTIONS FROM OLDER ADULTS 5124 04:10:09,240 --> 04:10:12,440 THOUGH WE PILOT ED HOW TO DO IT, 5125 04:10:12,440 --> 04:10:13,720 IT WASN'T POSSIBLE TO IMPLEMENT 5126 04:10:13,720 --> 04:10:17,400 SO WE DON'T HAVE THAT IN OUR 5127 04:10:17,400 --> 04:10:20,440 STUDIES BUT IN SMALLER SAMPLES 5128 04:10:20,440 --> 04:10:22,680 THERE'S EVIDENCE OF ABUSE THAT 5129 04:10:22,680 --> 04:10:25,160 IS THEN HANDLED USUALLY BY 5130 04:10:25,160 --> 04:10:26,600 RELATIVES THAT REPORT OR PROTECT 5131 04:10:26,600 --> 04:10:31,320 THE OLDER ADULT OR THE 5132 04:10:31,320 --> 04:10:32,800 CAREGIVER, THE HEALTH CARE 5133 04:10:32,800 --> 04:10:33,200 PROVIDER. 5134 04:10:33,200 --> 04:10:37,560 >>DO YOU THINK IT'S STILL MAYBE 5135 04:10:37,560 --> 04:10:41,120 TABOO TO DISCUSS IN LATIN 5136 04:10:41,120 --> 04:10:42,280 AMERICA AND AMONG LATINOS IN THE 5137 04:10:42,280 --> 04:10:43,800 U.S. 5138 04:10:43,800 --> 04:10:47,000 >>IT WAS VERY HARD TO ASK THE 5139 04:10:47,000 --> 04:10:47,720 QUESTION. 5140 04:10:47,720 --> 04:10:50,600 YOU ALMOST HAVE TO ASK WITHOUT 5141 04:10:50,600 --> 04:10:52,560 ASKING CAN YOU REPORT IT AND SAY 5142 04:10:52,560 --> 04:10:54,520 YES, NO. 5143 04:10:54,520 --> 04:10:57,720 IT'S DIFFICULT IF YOU CAN'T READ 5144 04:10:57,720 --> 04:11:03,040 AND SO THERE'S BEEN DIFFERENT 5145 04:11:03,040 --> 04:11:05,720 ATTEMPTS BUT IT'S A TABOO TOPIC 5146 04:11:05,720 --> 04:11:07,320 AND WHY WE CAN'T MEASURE IT 5147 04:11:07,320 --> 04:11:09,760 AMONG ALL THE THINGS WE MEASURE 5148 04:11:09,760 --> 04:11:11,320 IN THE LAST 20 YEARS WE EVENT 5149 04:11:11,320 --> 04:11:14,440 GOTTEN TO THAT VERY IMPORTANT 5150 04:11:14,440 --> 04:11:15,000 AREA . 5151 04:11:15,000 --> 04:11:18,360 >>THANK YOU FOR SHARING. 5152 04:11:18,360 --> 04:11:20,560 FOR DR. RIVERA HERNANDEZ, I WANT 5153 04:11:20,560 --> 04:11:24,400 TO ASK ABOUT YOUR WORK IN PUERTO 5154 04:11:24,400 --> 04:11:24,640 RICO. 5155 04:11:24,640 --> 04:11:26,600 HAVE YOU EXPLORED MIGRATION 5156 04:11:26,600 --> 04:11:28,360 PATTERNS AMONG BENEFICIARIES 5157 04:11:28,360 --> 04:11:30,280 WITH OTHER COMPLEX CONDITIONS IN 5158 04:11:30,280 --> 04:11:32,480 PUERTO RICO AND HOW DO YOU DEAL 5159 04:11:32,480 --> 04:11:33,960 WITH CARE CONTINUITY MAKING SURE 5160 04:11:33,960 --> 04:11:36,360 THAT IF THEY GO BACK TO THE MAIN 5161 04:11:36,360 --> 04:11:38,560 LAND AND THE INFORMATION IS 5162 04:11:38,560 --> 04:11:41,240 BEING COMMUNICATED TO THEIR NEW 5163 04:11:41,240 --> 04:11:41,560 CLINICIANS? 5164 04:11:41,560 --> 04:11:45,840 CAN YOU TALK MORE ABOUT THAT? 5165 04:11:45,840 --> 04:11:48,320 >>GREAT QUESTION. 5166 04:11:48,320 --> 04:11:50,640 IN ONE OF THE GRANTS I JUST 5167 04:11:50,640 --> 04:11:52,280 RECEIVED FUNDING WE'RE GOING TO 5168 04:11:52,280 --> 04:11:53,680 TRACK MIGRATION AMONG PEOPLE 5169 04:11:53,680 --> 04:11:59,240 WITH KIDNEY FAILURE WHICH 5170 04:11:59,240 --> 04:12:01,960 INCLUDES PEOPLE WITH COMPLEX 5171 04:12:01,960 --> 04:12:03,040 CONDITIONS IS TRACKING WHERE 5172 04:12:03,040 --> 04:12:06,680 THEY RECEIVE CARE AND IF THEY'RE 5173 04:12:06,680 --> 04:12:08,040 OKAY IN PUERTO RICO THEY'RE 5174 04:12:08,040 --> 04:12:10,120 RECEIVING CARE AND IF THE 5175 04:12:10,120 --> 04:12:12,480 FACILITIES ARE IN THE U.S. MAIN 5176 04:12:12,480 --> 04:12:14,920 LAND IT MEANS THEY HAVE MOVED TO 5177 04:12:14,920 --> 04:12:16,080 COMMON AREAS LIKE FLORIDA, NEW 5178 04:12:16,080 --> 04:12:18,360 YORK AND ETCETERA. 5179 04:12:18,360 --> 04:12:21,320 WE'RE ABLE TO TRACK WHERE THEY 5180 04:12:21,320 --> 04:12:24,800 RECEIVE CARE AND SEE THE 5181 04:12:24,800 --> 04:12:26,080 PATTERNS ACROSS PUERTO RICO AND 5182 04:12:26,080 --> 04:12:26,800 THE U.S. 5183 04:12:26,800 --> 04:12:35,240 TO THE DATA SETS, THEY OFTEN 5184 04:12:35,240 --> 04:12:36,000 HAVE TO SUBMIT CLINICAL 5185 04:12:36,000 --> 04:12:38,880 INFORMATION WHICH MAKES IT 5186 04:12:38,880 --> 04:12:40,680 EASIER TO TRACK NOT ONLY WHERE 5187 04:12:40,680 --> 04:12:43,400 THEY'RE RECEIVING CARE BUT 5188 04:12:43,400 --> 04:12:44,600 OUTCOMES AMONG CLINICIANS AND 5189 04:12:44,600 --> 04:12:49,320 PROVIDERS. 5190 04:12:49,320 --> 04:12:51,800 >>UNDERSTANDING I GUESS THE 5191 04:12:51,800 --> 04:12:52,760 COMPLEXITY OF THE HEALTH CARE 5192 04:12:52,760 --> 04:12:56,040 SYSTEM AND FUNDING IN PUERTO 5193 04:12:56,040 --> 04:12:59,680 RICO, CONSIDER WHERE IS MA OR 5194 04:12:59,680 --> 04:13:01,440 MEDICARE PARTICIPATION RATES SO 5195 04:13:01,440 --> 04:13:03,960 HIGH IN PUERTO RICO? 5196 04:13:03,960 --> 04:13:10,080 I THINK 93% WERE REPRESENTED AND 5197 04:13:10,080 --> 04:13:11,120 IN THE OTHER STATES AS HIGH AS 5198 04:13:11,120 --> 04:13:13,680 24% AND WHY IS FEE FOR SERVICE A 5199 04:13:13,680 --> 04:13:14,680 BIG PARTICIPATION IN PUERTO 5200 04:13:14,680 --> 04:13:15,160 RICO? 5201 04:13:15,160 --> 04:13:18,000 >>IF WE LOOK AT THE OVER ALL 5202 04:13:18,000 --> 04:13:23,840 TRENDS IN THE U.S. AS WELL AS, 5203 04:13:23,840 --> 04:13:28,240 HISPANIC AND LATIN AMERICANS 5204 04:13:28,240 --> 04:13:30,000 HAVE HIGHER PARTICIPATION 5205 04:13:30,000 --> 04:13:32,760 BECAUSE THEY'RE LOWER 5206 04:13:32,760 --> 04:13:37,520 OUT-OF-POCKET COSTS AND MAKE THE 5207 04:13:37,520 --> 04:13:41,960 PLANS ATTRACTIVE TO PEOPLE WITH 5208 04:13:41,960 --> 04:13:43,040 LOWER INCOMES. 5209 04:13:43,040 --> 04:13:45,080 IN PUERTO RICO THERE IS A 5210 04:13:45,080 --> 04:13:48,680 PREFERENCE TO ENROLLING AN IN 5211 04:13:48,680 --> 04:13:53,760 HMO PLAN THAN FEE OR SERVICE 5212 04:13:53,760 --> 04:13:54,080 ALTERNATIVE. 5213 04:13:54,080 --> 04:13:57,400 ONE OF THE ISSUES AS PEOPLE MAY 5214 04:13:57,400 --> 04:13:59,920 SEE IS MOVING TO THE U.S. MAIN 5215 04:13:59,920 --> 04:14:02,240 LAND AND THE HEALTH CARE MAY NOT 5216 04:14:02,240 --> 04:14:12,000 BE TRANSFERABLE AND WHAT THE 5217 04:14:12,000 --> 04:14:14,040 CONSEQUENCES OF SWITCHING THAT 5218 04:14:14,040 --> 04:14:20,680 COULD CORRELATE WITH MIGRATION. 5219 04:14:20,680 --> 04:14:24,560 >>VERY IMPORTANT WORK. 5220 04:14:24,560 --> 04:14:30,120 DR. LLIBRE-GUERRA YOU PRESENTED 5221 04:14:30,120 --> 04:14:32,560 WORK AMONG LATINOS IN U.S. AND 5222 04:14:32,560 --> 04:14:33,560 WHAT FURTHER COLLABORATION NEEDS 5223 04:14:33,560 --> 04:14:35,280 TO BE DONE IN THE U.S. AND LATIN 5224 04:14:35,280 --> 04:14:36,360 AMERICA AND WHAT ARE THE 5225 04:14:36,360 --> 04:14:38,120 CHALLENGES TO FORMING THE 5226 04:14:38,120 --> 04:14:38,720 RESEARCH COLLABORATION TRANS 5227 04:14:38,720 --> 04:14:42,160 NATIONALLY? 5228 04:14:42,160 --> 04:14:44,880 >>I THINK NUMBER ONE IN 5229 04:14:44,880 --> 04:14:50,560 MATERIALS OF PARTNERSHIP IT 5230 04:14:50,560 --> 04:15:01,040 SHOULD WAY AND NEEDS TO BE 5231 04:15:05,120 --> 04:15:08,200 ADDRESSED MOTORCYCLELY AND 5232 04:15:10,480 --> 04:15:14,080 AND IT'S BEING TRANSLATED TO THE 5233 04:15:14,080 --> 04:15:24,160 U.S. 5234 04:15:36,760 --> 04:15:37,800 AND ALZHEIMER'S RESEARCH IS THE 5235 04:15:37,800 --> 04:15:39,160 BEST WAY TO MOVE FORWARD IN 5236 04:15:39,160 --> 04:15:42,640 TERMS OF THE COLLABORATIONS. 5237 04:15:42,640 --> 04:15:47,880 >>CAN YOU SHARE WHY YOU'RE 5238 04:15:47,880 --> 04:15:49,480 SUCCESSFUL AT PARTICIPATION 5239 04:15:49,480 --> 04:15:50,480 RATION OR STRATEGIES WE CAN 5240 04:15:50,480 --> 04:16:01,040 LEARN TO IMPLEMENT IN THE U.S.? 5241 04:16:03,440 --> 04:16:06,080 AND WE HAD CLOSE TO 75% IN SOME 5242 04:16:06,080 --> 04:16:11,360 COUNTRIES AND 90% IN OTHER 5243 04:16:11,360 --> 04:16:13,200 COUNTRIES WHICH HIGH WITH 5244 04:16:13,200 --> 04:16:14,440 U.S. RESPONSE RATE IN OUR 5245 04:16:14,440 --> 04:16:24,240 COMMUNITY. 5246 04:16:24,240 --> 04:16:26,200 AND GOING TO THE COMMUNITY AND 5247 04:16:26,200 --> 04:16:27,400 TALKING ABOUT RESEARCH STUDIES 5248 04:16:27,400 --> 04:16:37,920 AND TALKING ABOUT THE DISEASE. 5249 04:16:38,560 --> 04:16:39,360 AND IT'S BEEN SUCCESSFUL IN OUR 5250 04:16:39,360 --> 04:16:49,560 RESEARCH. 5251 04:17:06,480 --> 04:17:08,880 >>THE TECHNICAL CAPACITY IS IN 5252 04:17:08,880 --> 04:17:09,880 LATIN AMERICA AND SOMEONE 5253 04:17:09,880 --> 04:17:12,960 MENTIONED THE CAPACITY IS THERE. 5254 04:17:12,960 --> 04:17:15,520 AND WE JUST NEED TO TAKE 5255 04:17:15,520 --> 04:17:18,480 ADVANTAGE AND SAYING IF WE CAN 5256 04:17:18,480 --> 04:17:19,560 COLLABORATE WITH THEM IT 5257 04:17:19,560 --> 04:17:20,760 PROVIDES AN INCENTIVE FOR THEM 5258 04:17:20,760 --> 04:17:23,240 TO BE MOTIVATED AND CHALLENGED 5259 04:17:23,240 --> 04:17:26,000 AND CONTINUE TO WORK AND STAY IN 5260 04:17:26,000 --> 04:17:27,640 THE RESEARCH INSTITUTIONS TO 5261 04:17:27,640 --> 04:17:30,040 WORK WITH AMONG THEMSELVES AND 5262 04:17:30,040 --> 04:17:35,760 WITH US. 5263 04:17:35,760 --> 04:17:37,960 AND IN TRYING TO ESTABLISH A 5264 04:17:37,960 --> 04:17:39,640 PROGRAM IS LANGUAGE. 5265 04:17:39,640 --> 04:17:41,720 THEY CAN SPEAK THE SCIENTIFIC 5266 04:17:41,720 --> 04:17:43,640 LANGUAGE IN ENGLISH BUT NOT THE 5267 04:17:43,640 --> 04:17:45,800 EVERYDAY LANGUAGE AS WELL. 5268 04:17:45,800 --> 04:17:50,000 SO TRYING TO REACH OUT AND WORK 5269 04:17:50,000 --> 04:17:51,560 FOR US TO WORK IN SPANISH 5270 04:17:51,560 --> 04:17:54,600 DOESN'T HAVE TO BE JUST ONE WAY. 5271 04:17:54,600 --> 04:17:56,760 LIKE SAYING THEY HAVE TO KNOW 5272 04:17:56,760 --> 04:17:58,800 ENGLISH AND HAVING MANY WHO CAN 5273 04:17:58,800 --> 04:17:59,480 SPEAK SPANISH. 5274 04:17:59,480 --> 04:18:00,120 THE OTHER THING IS THE POLITICAL 5275 04:18:00,120 --> 04:18:10,240 WILL. 5276 04:18:10,240 --> 04:18:12,440 IF WE'RE OUTSIDE THE UNITED 5277 04:18:12,440 --> 04:18:13,360 STATES WE'RE FIGHTING A 5278 04:18:13,360 --> 04:18:15,840 POLITICAL WILL AND HAVING A 5279 04:18:15,840 --> 04:18:16,960 PARTNER WITH A LARGE ROLE HAS 5280 04:18:16,960 --> 04:18:20,840 BEEN IMPORTANT FROM THE 5281 04:18:20,840 --> 04:18:23,480 BEGINNING TO SUSTAIN A STUDY FOR 5282 04:18:23,480 --> 04:18:26,120 20 YEARS WAS IMPORTANT TO STUDY 5283 04:18:26,120 --> 04:18:30,480 POLITICAL WILL AND NOW IT'S VERY 5284 04:18:30,480 --> 04:18:31,680 TRUST -- TRUST HAS CONTINUALLY 5285 04:18:31,680 --> 04:18:36,120 BEEN ACCUMULATED BECAUSE PEOPLE 5286 04:18:36,120 --> 04:18:37,880 CHANGE SO WE HAVE TO 5287 04:18:37,880 --> 04:18:38,600 RE-ESTABLISH THE TRUST. 5288 04:18:38,600 --> 04:18:43,200 THE OTHER THING I THINK WE 5289 04:18:43,200 --> 04:18:45,000 SHOULD THINK ABOUT IS THAT QUE 5290 04:18:45,000 --> 04:18:49,080 NEED TO BE MORE AWARE OF HOW WE 5291 04:18:49,080 --> 04:18:51,720 CAN MAKE THE NIH TYPE OF 5292 04:18:51,720 --> 04:19:01,080 COLLABORATIONS LESS DIFFICULT. 5293 04:19:01,080 --> 04:19:07,520 A 5294 04:19:07,520 --> 04:19:09,800 AND IF WE WANT TO HAVE MORE OF A 5295 04:19:09,800 --> 04:19:11,200 GLOBAL PRESENTATION IN THE SENSE 5296 04:19:11,200 --> 04:19:12,440 OF COLLABORATION, WE NEED TO 5297 04:19:12,440 --> 04:19:15,920 TAKE A HARD LOOK AT HOW THE NIH 5298 04:19:15,920 --> 04:19:18,080 CAN BECOME LESS COMPLEX AS A 5299 04:19:18,080 --> 04:19:24,480 FUNDER. 5300 04:19:24,480 --> 04:19:27,600 >>I APPRECIATE THE COMMENTS. 5301 04:19:27,600 --> 04:19:33,440 AND DR. RIVERA HERNANDEZ DID YOU 5302 04:19:33,440 --> 04:19:34,960 WANT TO ADD ANYTHING ABOUT THE 5303 04:19:34,960 --> 04:19:36,520 RESEARCH COLLABORATION IN PUERTO 5304 04:19:36,520 --> 04:19:38,840 RICO AND HAVE YOU OVERCOME ANY 5305 04:19:38,840 --> 04:19:42,160 BARRIERS OR EVEN OPPORTUNITIES 5306 04:19:42,160 --> 04:19:43,800 AS WELL. 5307 04:19:43,800 --> 04:19:46,280 >>I HAVE NOT FACED THE BARRIERS 5308 04:19:46,280 --> 04:19:48,040 MY COLLEAGUES HAVE MENTIONED. 5309 04:19:48,040 --> 04:19:55,920 I'M THANKFUL WE'RE RECEIVING 5310 04:19:55,920 --> 04:19:57,520 FUNDING AS WELL AS PUBLISHING 5311 04:19:57,520 --> 04:20:00,000 WORK THAT MAY BE RELATED TO WHAT 5312 04:20:00,000 --> 04:20:01,360 I'M DOING. 5313 04:20:01,360 --> 04:20:04,320 I'VE BEEN THANKFUL AND 5314 04:20:04,320 --> 04:20:06,080 SUCCESSFUL BY DOING A LOT OF 5315 04:20:06,080 --> 04:20:08,560 REACHING OUT AND NETWORKING TO 5316 04:20:08,560 --> 04:20:09,320 DIFFERENT WORKSHOPS. 5317 04:20:09,320 --> 04:20:11,160 IT'S A GREAT OPPORTUNITY TO SEE 5318 04:20:11,160 --> 04:20:12,400 WHAT THEY'RE DOING IN PUERTO 5319 04:20:12,400 --> 04:20:13,800 RICO AND OTHER AREAS AND TO 5320 04:20:13,800 --> 04:20:15,200 START THE COLLABORATIONS AND 5321 04:20:15,200 --> 04:20:17,640 REACHING OUT TO RESEARCHERS AND 5322 04:20:17,640 --> 04:20:19,480 SHARE OF THE IDEAS I HAVE. 5323 04:20:19,480 --> 04:20:22,200 AND MOST OF THE TIME THEY HAVE 5324 04:20:22,200 --> 04:20:27,760 BEEN VERY INTERESTING AND I HAVE 5325 04:20:27,760 --> 04:20:29,920 FOUND RESEARCHERS THAT WANT TO 5326 04:20:29,920 --> 04:20:34,080 BE CO-INVESTIGATORS AND I'M 5327 04:20:34,080 --> 04:20:35,560 THANKFUL AND I HAVE FOUND IT'S 5328 04:20:35,560 --> 04:20:38,120 BEEN SUCCESSFUL. 5329 04:20:38,120 --> 04:20:39,760 >>THANK YOU, THANK YOU. 5330 04:20:39,760 --> 04:20:41,360 SO ONE QUESTION THAT I RECEIVED 5331 04:20:41,360 --> 04:20:44,000 FROM THE AUDIENCE IS FOR 5332 04:20:44,000 --> 04:20:50,680 DR. WONG, HOW DO WE NOT 5333 04:20:50,680 --> 04:20:53,080 [INDISCERNIBLE] DUE TO THE 5334 04:20:53,080 --> 04:20:56,080 INCREASE IN VISIBILITY AND WHERE 5335 04:20:56,080 --> 04:20:57,400 WE SEEING THIS AMONG THE MEXICAN 5336 04:20:57,400 --> 04:21:00,680 HEALTH AND AGING STUDY? 5337 04:21:00,680 --> 04:21:04,320 >>I THINK THAT THE AUTHORS THAT 5338 04:21:04,320 --> 04:21:07,320 LOOKED AT THE TWO COHORTS 5339 04:21:07,320 --> 04:21:09,440 SEPARATED BY 10 YEARS AND 5340 04:21:09,440 --> 04:21:12,160 LOOKING AT HOW THE MORE RECENT 5341 04:21:12,160 --> 04:21:14,320 COHORTS BORN IN THE '50s OPPOSED 5342 04:21:14,320 --> 04:21:20,600 TO THE '40s SEEM MORE DISABLED. 5343 04:21:20,600 --> 04:21:22,000 IT'S MOSTLY BECAUSE OF THE 5344 04:21:22,000 --> 04:21:26,360 ABILITY TO SURVIVE LONGER WHICH 5345 04:21:26,360 --> 04:21:28,760 AN INCREASED SURVIVAL AND THE 5346 04:21:28,760 --> 04:21:30,520 IDEA IS YOU MAY SURVIVE TRAVEL 5347 04:21:30,520 --> 04:21:31,920 CONDITIONS PREVIOUS COHORTS 5348 04:21:31,920 --> 04:21:33,680 COULDN'T SURVIVE AND NOW THIS 5349 04:21:33,680 --> 04:21:38,080 COHORT CAN SURVIVE AND MAY 5350 04:21:38,080 --> 04:21:40,320 ARRIVE IN OLD AGE WEAKER BUT 5351 04:21:40,320 --> 04:21:43,720 MORE RECENT COHORTS ARE ARRIVING 5352 04:21:43,720 --> 04:21:50,240 WITH HIGHER OBESITY AND DIABETES 5353 04:21:50,240 --> 04:21:53,920 AND WE'RE SEEING IT ON THE 5354 04:21:53,920 --> 04:21:56,600 POPULATION ENTERING OLD AGE MORE 5355 04:21:56,600 --> 04:21:57,320 DISABLED. 5356 04:21:57,320 --> 04:21:59,240 >>THANK YOU FOR SHARING THAT. 5357 04:21:59,240 --> 04:22:02,120 WE HAVE ANOTHER QUESTION FOR THE 5358 04:22:02,120 --> 04:22:03,840 AUDIENCE FOR DR. LLIBRE-GUERRA, 5359 04:22:03,840 --> 04:22:06,440 WHAT NEEDS TO BE DOWN TO 5360 04:22:06,440 --> 04:22:13,840 IDENTIFY DEMENTIA EARLY OR RISK 5361 04:22:13,840 --> 04:22:14,400 OF DEVELOPING DEMENTIAING 5362 04:22:14,400 --> 04:22:16,720 AMONGST LATINOS AND HISPANIC 5363 04:22:16,720 --> 04:22:16,960 AMERICANS. 5364 04:22:16,960 --> 04:22:18,560 >>RAISE AWARENESS IN OUR 5365 04:22:18,560 --> 04:22:20,360 COMMUNITY. 5366 04:22:20,360 --> 04:22:21,560 WE KNOW HISPANIC COMMUNITY 5367 04:22:21,560 --> 04:22:24,120 USUALLY GO LATER ESPECIALLY WHEN 5368 04:22:24,120 --> 04:22:25,400 THEY START SEEING SYMPTOMS 5369 04:22:25,400 --> 04:22:28,640 THAT'S WHEN THEY GO TO THEIR 5370 04:22:28,640 --> 04:22:30,400 PHYSICIAN AND WHEN THEY SEE 5371 04:22:30,400 --> 04:22:31,880 EARLY MEMORY IMPAIRMENT. 5372 04:22:31,880 --> 04:22:34,200 THAT'S ONE STEP AND THE OTHER 5373 04:22:34,200 --> 04:22:36,480 THING I THINK IS GET A BETTER 5374 04:22:36,480 --> 04:22:38,840 UNDERSTANDING OF THE RISK 5375 04:22:38,840 --> 04:22:39,480 FACTORS FOR DEMENTIA IN THE 5376 04:22:39,480 --> 04:22:40,480 HISPANIC COMMUNITY. 5377 04:22:40,480 --> 04:22:42,640 IF YOU HAVE BETTER UNDERSTANDING 5378 04:22:42,640 --> 04:22:44,800 OF DEMENTIA ONCE YOU GO TO THE 5379 04:22:44,800 --> 04:22:46,760 PRIMARY CARE EVENT AND IT COULD 5380 04:22:46,760 --> 04:22:48,640 INCLUDE AS PART OF THE REGULAR 5381 04:22:48,640 --> 04:22:50,600 SHAPE AND ACCORDING TO THE 5382 04:22:50,600 --> 04:22:53,240 SCREENING I THINK THAT WOULD BE 5383 04:22:53,240 --> 04:22:56,080 SOME ELEMENTS I THINK WOULD BE 5384 04:22:56,080 --> 04:22:59,800 KEY FOR THE EARLY DIAGNOSIS. 5385 04:22:59,800 --> 04:23:01,560 >>WE HAVE ANOTHER QUESTION ALSO 5386 04:23:01,560 --> 04:23:04,160 FOR YOU, DO WE HAVE EXAMPLES IN 5387 04:23:04,160 --> 04:23:06,280 LATIN AMERICA ABOUT EFFECTIVE 5388 04:23:06,280 --> 04:23:08,320 OUTREACH AND EARLY DIAGNOSIS FOR 5389 04:23:08,320 --> 04:23:10,040 EXAMPLE, DEMENTIA TO BE ABLE TO 5390 04:23:10,040 --> 04:23:11,680 INTERVENE EARLIER? 5391 04:23:11,680 --> 04:23:14,360 >>SO I THINK THERE ARE A FEW 5392 04:23:14,360 --> 04:23:16,960 EXAMPLES WE COULD TRY TO SEE 5393 04:23:16,960 --> 04:23:20,920 MORE BUT IN TERMS OF EARLY 5394 04:23:20,920 --> 04:23:26,840 INTERVENTION, THERE'S NOW GOING 5395 04:23:26,840 --> 04:23:31,320 IN LATIN AMERICA A STUDY OF 5396 04:23:31,320 --> 04:23:36,960 PHYSICAL ACTIVITY DIAD 5397 04:23:36,960 --> 04:23:39,600 INTERVENTION AND IN TERMS OF 5398 04:23:39,600 --> 04:23:40,680 RECRUITMENT WE'RE STILL SEEING 5399 04:23:40,680 --> 04:23:46,000 THE RESULT ONGOING AND WE'RE 5400 04:23:46,000 --> 04:23:51,040 SEEING CLINICAL TRIALS AND 5401 04:23:51,040 --> 04:23:53,760 STARTING TO DO PRIMARY VERY 5402 04:23:53,760 --> 04:23:56,400 VENTION AND SECONDARY PREVENTION 5403 04:23:56,400 --> 04:23:59,920 STUDIES AND THOSE ARE A FEW IN 5404 04:23:59,920 --> 04:24:01,920 CHILE AND ARGENTINA AND I THINK 5405 04:24:01,920 --> 04:24:03,960 WE'LL START SEEING A FEW OF 5406 04:24:03,960 --> 04:24:04,600 THOSE ALREADY. 5407 04:24:04,600 --> 04:24:05,600 >>GREAT. 5408 04:24:05,600 --> 04:24:08,200 WE HAVE A COUPLE SECONDS. 5409 04:24:08,200 --> 04:24:10,080 ANYTHING ELSE ANYBODY WANTS IT 5410 04:24:10,080 --> 04:24:11,600 ADD BEFORE WE CLOSE? 5411 04:24:11,600 --> 04:24:12,760 WELL, THANK YOU SO MUCH. 5412 04:24:12,760 --> 04:24:14,600 IT'S BEEN A WONDERFUL 5413 04:24:14,600 --> 04:24:16,640 DISCUSSION, PRESENTATION. 5414 04:24:16,640 --> 04:24:18,400 I APPRECIATE SHARING YOUR 5415 04:24:18,400 --> 04:24:22,120 COMMENTS AND EXPERTISE AND FOR A 5416 04:24:22,120 --> 04:24:22,800 THOUGHT-PROVOKING DISCUSSION ON 5417 04:24:22,800 --> 04:24:25,160 THE HEALTH OF OLDER ADULTS AND 5418 04:24:25,160 --> 04:24:26,600 NOW WE'LL MOVE TO OUR NEXT 5419 04:24:26,600 --> 04:24:32,400 SESSION MODERATED BY DR. LARISSA 5420 04:24:32,400 --> 04:24:32,760 AVILES-SANTA. 5421 04:24:32,760 --> 04:24:39,320 THANK YOU. 5422 04:24:39,320 --> 04:24:41,000 >>GOOD AFTERNOON. 5423 04:24:41,000 --> 04:24:44,080 MY NAME IS LARISSA AVILES-SANTA. 5424 04:24:44,080 --> 04:24:50,080 I'M THE MODERATOR OF TOPIC 6, 5425 04:24:50,080 --> 04:24:52,080 BEST PRACTICES AND LESSONS 5426 04:24:52,080 --> 04:24:54,400 LEARNED IN RESEARCH. 5427 04:24:54,400 --> 04:25:01,600 OUR PANELISTS ARE DR. JUAN JOSÉ 5428 04:25:01,600 --> 04:25:03,760 GAGLIARDINO AND DR. HOORAY LIB 5429 04:25:03,760 --> 04:25:06,720 GUBE GUR GUR AND AFTER WE'LL 5430 04:25:06,720 --> 04:25:10,080 HAVE A LIVE Q&A. 5431 04:25:10,080 --> 04:25:11,200 >>HELLO. 5432 04:25:11,200 --> 04:25:13,080 WE'RE GOING AGAIN TOGETHER AND 5433 04:25:13,080 --> 04:25:17,280 THIS TIME I'M GOING TO BE MORE 5434 04:25:17,280 --> 04:25:18,200 OPTIMIST BECAUSE WE'RE TALKING 5435 04:25:18,200 --> 04:25:23,520 QUALITY AT THE PRIMARY CARE 5436 04:25:23,520 --> 04:25:29,000 LEVEL THIS REPRESENTS WHAT 5437 04:25:29,000 --> 04:25:32,600 HAPPENED USUALLY WHEN YOU MAKE A 5438 04:25:32,600 --> 04:25:35,200 MISTAKE AND IMMEDIATELY YOU HAVE 5439 04:25:35,200 --> 04:25:35,720 THIS. 5440 04:25:35,720 --> 04:25:38,360 THIS IS WHAT THE ANIMAL IS 5441 04:25:38,360 --> 04:25:38,600 DOING. 5442 04:25:38,600 --> 04:25:42,200 IT'S NOT THE TIME TO CHANGE 5443 04:25:42,200 --> 04:25:44,880 MEDICAL CARE AND WHAT IS THE 5444 04:25:44,880 --> 04:25:49,680 CARE PARITY IS LIKE A PYRAMID. 5445 04:25:49,680 --> 04:25:54,840 IN THE TOP YOU HAVE THE 5446 04:25:54,840 --> 04:26:05,320 PATHOLOGIST AND OTHER PEOPLE AND 5447 04:26:05,320 --> 04:26:06,840 UNFORTUNATELY, MOST OF THE 5448 04:26:06,840 --> 04:26:08,560 PATIENTS ARE NOT ATTENDED BY TO 5449 04:26:08,560 --> 04:26:09,520 THE SPECIALIST. 5450 04:26:09,520 --> 04:26:16,600 MOST THE PATIENTS HAVE THE 5451 04:26:16,600 --> 04:26:17,240 PRIMARY CARE LEVEL AND THEY'RE 5452 04:26:17,240 --> 04:26:20,200 NOT THE BEST PREPARED FOR THE 5453 04:26:20,200 --> 04:26:22,680 JOB BUT AT THE LONGER PATIENTS 5454 04:26:22,680 --> 04:26:24,680 BECAUSE IT'S THE FIRST BETWEEN 5455 04:26:24,680 --> 04:26:27,440 THE HEALTH CARE SYSTEM AND THE 5456 04:26:27,440 --> 04:26:27,720 POPULATION. 5457 04:26:27,720 --> 04:26:32,640 AND IF ARE LUCKY YOUR PRIMARY 5458 04:26:32,640 --> 04:26:35,240 CARE UNIT HAVE YOU THE PHYSICIAN 5459 04:26:35,240 --> 04:26:36,520 AND NUTRITIONIST AND NURSE. 5460 04:26:36,520 --> 04:26:41,720 AND ALSO YOU HAVE TO HAVE THE 5461 04:26:41,720 --> 04:26:50,080 CONTROL AT LEAST OF THE 5462 04:26:50,080 --> 04:26:53,240 CARDIOVASCULAR AND THE EASIEST 5463 04:26:53,240 --> 04:26:54,840 WAY TO DEVELOPING OF 5464 04:26:54,840 --> 04:26:56,400 COMPLICATIONS AND TO PUT 5465 04:26:56,400 --> 04:26:59,720 TOGETHER THE SYSTEM HAVE YOU 5466 04:26:59,720 --> 04:27:00,120 EDUCATION. 5467 04:27:00,120 --> 04:27:05,520 AND NOW I'LL EXPLAIN WHY I SAY 5468 04:27:05,520 --> 04:27:06,320 THAT. 5469 04:27:06,320 --> 04:27:07,600 WE MAKE AN EXPERIMENT AND REPORT 5470 04:27:07,600 --> 04:27:14,040 THE RESULT AND WE HAVE SELECTED 5471 04:27:14,040 --> 04:27:22,240 ARGENTINA AND WITHIN BUNOS AIRES 5472 04:27:22,240 --> 04:27:26,120 AND THE LOWEST LEVEL OF 5473 04:27:26,120 --> 04:27:30,000 EDUCATION AND THE HIGHER 5474 04:27:30,000 --> 04:27:30,440 MORTALITY. 5475 04:27:30,440 --> 04:27:32,560 WE'RE GOING FACE SEVERAL 5476 04:27:32,560 --> 04:27:34,840 DIFFICULTIES AND THE SUPPORT AND 5477 04:27:34,840 --> 04:27:36,880 THE ECONOMIC SUPPORT TO MAKE 5478 04:27:36,880 --> 04:27:37,480 THIS DEVELOPMENT WAS BASED ON 5479 04:27:37,480 --> 04:27:47,600 THAT. 5480 04:27:48,520 --> 04:27:53,160 WE HAVE AT THE GOVERNMENTAL AREA 5481 04:27:53,160 --> 04:27:55,520 THE PRIMARY CARE UNIT AND WE 5482 04:27:55,520 --> 04:27:58,280 HAVE RANDOMLY SELECTED OUT OF 5483 04:27:58,280 --> 04:28:03,280 THIS 40 WE HAVE 30 OF THEM. 5484 04:28:03,280 --> 04:28:06,280 IN EACH ONE WE HAVE THE 5485 04:28:06,280 --> 04:28:08,640 PHYSICIAN AND NURSES AND WE 5486 04:28:08,640 --> 04:28:12,640 RANDOMLY SELECTED ALF OF THEM 5487 04:28:12,640 --> 04:28:18,360 PRIMARY CARE UNIT WITH THE CARE 5488 04:28:18,360 --> 04:28:20,840 AND THE NURSES AND THEY'RE GOING 5489 04:28:20,840 --> 04:28:22,600 NOT TO DO ANY CHANGE. 5490 04:28:22,600 --> 04:28:27,200 WE'LL KEEP DOING WHAT THEY DO AS 5491 04:28:27,200 --> 04:28:32,440 WELL AS TO HAVE A CONTROL. 5492 04:28:32,440 --> 04:28:38,960 AND INVENTION WE HAVEN'T 5493 04:28:38,960 --> 04:28:40,840 INTRODUCED EDUCATION WE FOLLOWED 5494 04:28:40,840 --> 04:28:43,880 THE PATIENTS ONE YEAR AND ONE 5495 04:28:43,880 --> 04:28:47,800 CONTROL AND ONE OF THE SIGNALS 5496 04:28:47,800 --> 04:28:51,600 AND IN EACH APPOINTMENT THEY 5497 04:28:51,600 --> 04:28:57,840 HAVE TO FILL A FORM AND RECORD 5498 04:28:57,840 --> 04:29:00,600 JUST TO HAVE THE CLINICAL 5499 04:29:00,600 --> 04:29:05,400 BACKGROUND AND METABOLIC DATA 5500 04:29:05,400 --> 04:29:09,240 AND THERAPY AND THEN WE HAVE 5501 04:29:09,240 --> 04:29:10,800 INCORPORATED IN THE DATABASE AND 5502 04:29:10,800 --> 04:29:13,360 WE HAVE A GOOD RECORD OF THE 5503 04:29:13,360 --> 04:29:18,960 STAGE. 5504 04:29:18,960 --> 04:29:23,600 WE HAVE INTRODUCED AN EDUCATION 5505 04:29:23,600 --> 04:29:30,080 PROGRAM AT THE LEVEL OF DOCTORS 5506 04:29:30,080 --> 04:29:37,880 AND MANY HAVE BEEN EVALUATED BY 5507 04:29:37,880 --> 04:29:39,280 THE END OF THE COURSE. 5508 04:29:39,280 --> 04:29:43,240 WE HAVE THE SAME CONCEPT BUT 5509 04:29:43,240 --> 04:29:45,840 WITH DIFFERENT COMPLEXITY WHEN 5510 04:29:45,840 --> 04:29:47,120 DEVOTED TO PHYSICIAN AND NURSES. 5511 04:29:47,120 --> 04:29:51,200 IN ADDITION, WE ALSO HAVE A 5512 04:29:51,200 --> 04:29:53,520 MANUAL FOR THE PATIENTS. 5513 04:29:53,520 --> 04:30:02,080 WE MAKE A FOCUS ON THE PHYSICAL 5514 04:30:02,080 --> 04:30:04,200 ACTIVITY REGULARLY PRACTICED AND 5515 04:30:04,200 --> 04:30:08,560 MEAL PLAN IN OPTIMAL CONDITION 5516 04:30:08,560 --> 04:30:09,640 MEANS HEALTHY HABITS WITH MOST 5517 04:30:09,640 --> 04:30:15,800 THEM. 5518 04:30:15,800 --> 04:30:23,720 NOW, WE HAVE A RECORD THE 5519 04:30:23,720 --> 04:30:24,960 QUALITY OF RECORD AND CLINICAL 5520 04:30:24,960 --> 04:30:28,880 DATA AND METABOLIC DATA AND SOME 5521 04:30:28,880 --> 04:30:30,520 ON EDUCATION THE PATIENT HAS 5522 04:30:30,520 --> 04:30:32,960 RECEIVED AND IF THEY'VE HAD A 5523 04:30:32,960 --> 04:30:34,080 HOSPITALIZATION IT'S RECORDED 5524 04:30:34,080 --> 04:30:40,720 THERE AND YOU HAVE THE TREATMENT 5525 04:30:40,720 --> 04:30:46,080 AND THE TREATMENT AND MEDICAL 5526 04:30:46,080 --> 04:30:56,640 TREATMENT AND THE FIRST TIME YOU 5527 04:31:06,440 --> 04:31:07,680 COME TO THE APPOINTMENT AND IT'S 5528 04:31:07,680 --> 04:31:10,400 LOADED IN THE DATABASE AND THE 5529 04:31:10,400 --> 04:31:12,040 SECOND TIME YOU CAN COMPARE WHAT 5530 04:31:12,040 --> 04:31:14,080 HAPPENED THE LAST TIME AND THIS 5531 04:31:14,080 --> 04:31:24,200 TIME. 5532 04:31:30,240 --> 04:31:34,080 AND THERE'S PATIENTS AND GROUPS 5533 04:31:34,080 --> 04:31:38,080 AND DISAGREEMENT MEANS THE 5534 04:31:38,080 --> 04:31:46,360 PATIENT DID NOT IMPROVE AND FOR 5535 04:31:46,360 --> 04:31:53,600 EXAMPLE THE LAST APPOINTMENT WAS 5536 04:31:53,600 --> 04:31:57,200 10% AND THIS TIME COMES WITH THE 5537 04:31:57,200 --> 04:32:01,560 SAME SCORE AND THAT MEANS THAT 5538 04:32:01,560 --> 04:32:06,080 HE'S GOING RECEIVE THIS AND THIS 5539 04:32:06,080 --> 04:32:16,360 IS NOT DOING THAT. 5540 04:32:22,960 --> 04:32:25,120 YOU CAN COMPARE THE PATIENTS 5541 04:32:25,120 --> 04:32:27,680 TOGETHER AND THEY CONTROL WHAT 5542 04:32:27,680 --> 04:32:32,040 HAPPENED AND IN THIS WAY THEY 5543 04:32:32,040 --> 04:32:38,280 HAVE A HELP FOR THE PHYSICIAN TO 5544 04:32:38,280 --> 04:32:41,040 RECOGNIZE AND IN ADDITION WE GOT 5545 04:32:41,040 --> 04:32:41,720 THE APPOINTMENT BETWEEN THREE 5546 04:32:41,720 --> 04:32:42,800 DIFFERENT COMPONENTS. 5547 04:32:42,800 --> 04:32:45,560 LIKE I MENTIONED THE 5548 04:32:45,560 --> 04:32:47,480 RECEPTIONIST AND WE DON'T HAVE A 5549 04:32:47,480 --> 04:32:50,520 NUTRITIONIST AND HAVE TO REPLACE 5550 04:32:50,520 --> 04:32:51,600 IT AND TAKE THE DIFFERENT 5551 04:32:51,600 --> 04:32:54,880 GENERAL THINGS ABOUT THE PATIENT 5552 04:32:54,880 --> 04:32:59,200 AND NOT MEDICAL THINGS BUT HE'S 5553 04:32:59,200 --> 04:33:00,600 WRITING AND GIVES THE WRITING TO 5554 04:33:00,600 --> 04:33:04,320 THE NURSE AND THE NURSE TAKES 5555 04:33:04,320 --> 04:33:06,560 CARE OF THE BLOOD PRESSURE AND 5556 04:33:06,560 --> 04:33:10,520 FOOD CARE AND HE'S WRITING THERE 5557 04:33:10,520 --> 04:33:12,720 AND GIVES TO THE DOCTOR AND 5558 04:33:12,720 --> 04:33:14,360 PHYSICIAN AND TAKE A LOOK AT THE 5559 04:33:14,360 --> 04:33:17,560 THINGS THEY HAVE WRITTEN BEFORE 5560 04:33:17,560 --> 04:33:19,800 AND IF THEY SEE SOMETHING THAT 5561 04:33:19,800 --> 04:33:24,120 IS UNCLEAR FOR HIM, HE REPEAT IT 5562 04:33:24,120 --> 04:33:25,600 AND HAVE A DESCRIPTION. 5563 04:33:25,600 --> 04:33:28,480 IN THIS WAY WE HAVE OPTIMIZED 5564 04:33:28,480 --> 04:33:35,640 THE TIME BECAUSE EACH HAVE 10 5565 04:33:35,640 --> 04:33:36,560 MINUTES BUT TOGETHER THEY HAVE 5566 04:33:36,560 --> 04:33:38,280 30 MINUTES DEVOTED TO A PATIENT. 5567 04:33:38,280 --> 04:33:41,120 THAT'S LONGER THAN THE ONE TIME 5568 04:33:41,120 --> 04:33:42,160 THEY REGULARLY PAY ATTENTION TO 5569 04:33:42,160 --> 04:33:45,720 EACH PATIENT. 5570 04:33:45,720 --> 04:33:47,360 NOW, WHILE THE PATIENT IS IN THE 5571 04:33:47,360 --> 04:33:54,720 WAITING ROOM WAITING FOR THIS, 5572 04:33:54,720 --> 04:33:58,680 THERE IS NO MATTER FOR WHAT KIND 5573 04:33:58,680 --> 04:34:00,560 OF THING IN THE PRIMARY CARE 5574 04:34:00,560 --> 04:34:00,760 UNIT. 5575 04:34:00,760 --> 04:34:02,760 THEY HAVE A SYSTEMATIC SURVEY OF 5576 04:34:02,760 --> 04:34:09,040 PEOPLE AT RISK FOR DEVELOPING 5577 04:34:09,040 --> 04:34:10,240 TYPE II DIABETES. 5578 04:34:10,240 --> 04:34:16,640 AND IN CASE YOU HAVE THE TIME 5579 04:34:16,640 --> 04:34:18,560 POINTS IN THE TO PERFORM SURVEYS 5580 04:34:18,560 --> 04:34:20,480 AND THEN HAVE YOU A CLEAR DOVE 5581 04:34:20,480 --> 04:34:22,560 MISSION ABOUT THE STAGE. 5582 04:34:22,560 --> 04:34:24,840 AND IN ADDITION IN CASES. 5583 04:34:24,840 --> 04:34:28,320 PEOPLE WITH DIABETES AND 5584 04:34:28,320 --> 04:34:29,720 PRE-DIABETES THEY GET MEDICAL 5585 04:34:29,720 --> 04:34:31,320 FOLLOW-UP CONTROL APPOINTMENT 5586 04:34:31,320 --> 04:34:35,760 ONE WEEK AHEAD VIA A CALL CENTER 5587 04:34:35,760 --> 04:34:37,120 AND MAKE THE PHONE CALL AND 5588 04:34:37,120 --> 04:34:39,600 REMIND HIM OF THESE THINGS. 5589 04:34:39,600 --> 04:34:42,160 AND WHAT IS THE RESULT WE HAVE 5590 04:34:42,160 --> 04:34:43,160 OBTAINED USING THIS? 5591 04:34:43,160 --> 04:34:45,720 FROM THE POINT OF VIEW OF THE 5592 04:34:45,720 --> 04:34:48,440 SURGEON, WE GOT A 48% USUALLY 5593 04:34:48,440 --> 04:34:50,040 ABOUT 50% IN THE PRIMARY CARE 5594 04:34:50,040 --> 04:34:56,640 UNIT. 5595 04:34:56,640 --> 04:34:59,320 IN THE INTERVENTION, THIS CUTS 5596 04:34:59,320 --> 04:35:04,080 DOWN TO 28% AND IT'S A CLEAR 5597 04:35:04,080 --> 04:35:04,360 IMPROVEMENT. 5598 04:35:04,360 --> 04:35:09,560 AND WITHIN THE CONSULTATION, AT 5599 04:35:09,560 --> 04:35:14,440 LEAST ONCE A YEAR AT LEAST 70% 5600 04:35:14,440 --> 04:35:16,800 IN THE CONTROL GROUP AND THIS 5601 04:35:16,800 --> 04:35:20,640 WENT OUT TO 100% IN THE CASE OF 5602 04:35:20,640 --> 04:35:23,640 THE INTERVENTION GROUP. 5603 04:35:23,640 --> 04:35:25,120 OTHERWISE WHAT ABOUT THE 5604 04:35:25,120 --> 04:35:25,360 RESULTS? 5605 04:35:25,360 --> 04:35:28,400 HERE WE HAVE LISTED WHAT THE 5606 04:35:28,400 --> 04:35:31,080 DIFFERENT PARAMETERS WE HAVE 5607 04:35:31,080 --> 04:35:31,360 CONTROL. 5608 04:35:31,360 --> 04:35:32,680 AND OF COURSE WE DIDN'T EXPECT 5609 04:35:32,680 --> 04:35:37,240 TO HAVE ANY CHANGE IN THE 5610 04:35:37,240 --> 04:35:38,240 CONTROL GROUP BECAUSE THEY KEPT 5611 04:35:38,240 --> 04:35:39,600 DOING THE SAME AS THE BEFORE AND 5612 04:35:39,600 --> 04:35:45,320 WHY ARE THEY GOING CHANGE? 5613 04:35:45,320 --> 04:35:48,480 AND FOR EXAMPLE THIS VALUE COMES 5614 04:35:48,480 --> 04:35:50,960 DOWN AFTER SIX MONTHS BUT COMES 5615 04:35:50,960 --> 04:35:56,240 DOWN AGAIN ALMOST THE SAME AS 5616 04:35:56,240 --> 04:35:57,920 THE BEGINNING OF 12 MONTHS AND 5617 04:35:57,920 --> 04:36:00,640 SAME WITH THE INTERVENTION GROUP 5618 04:36:00,640 --> 04:36:05,200 AND YOU CAN SEE ALL THE ONES WE 5619 04:36:05,200 --> 04:36:09,840 HAVE AND THE BLOOD PRESSURE 5620 04:36:09,840 --> 04:36:12,160 GROUP AND YOU CAN SEE LIPIDS AND 5621 04:36:12,160 --> 04:36:13,960 SO ON AND IN ALMOST EVERY CASE 5622 04:36:13,960 --> 04:36:24,480 WE DEFINED THE GOAL AND SO ON. 5623 04:36:26,680 --> 04:36:29,040 AND NOW IF WE COMPARE THE RESULT 5624 04:36:29,040 --> 04:36:35,040 WE HAVE OBTAINED WITH THE 5625 04:36:35,040 --> 04:36:45,720 INTERNATIONAL REPORTS, PRODUCED 5626 04:36:48,920 --> 04:36:51,520 IF WE COMPARE THE META-ANALYSIS 5627 04:36:51,520 --> 04:36:59,040 AND YOU SEE IT GOES 3 5628 04:36:59,040 --> 04:37:03,480 MILLIMETERS WE HAVE RESULTS OF 5629 04:37:03,480 --> 04:37:06,080 THE META-ANALYSIS AND THEN WHAT 5630 04:37:06,080 --> 04:37:06,880 ABOUT THE COST? 5631 04:37:06,880 --> 04:37:09,680 AND THIS COST WE COMPARED THE 5632 04:37:09,680 --> 04:37:12,680 PEOPLE THAT HAVE LESS THAN 7% 5633 04:37:12,680 --> 04:37:20,640 AND PEOPLE WHO HAVE MORE THAN 7% 5634 04:37:20,640 --> 04:37:26,400 AND FROM THE POINT OF VIEW IT 5635 04:37:26,400 --> 04:37:29,200 GOES TO 715 IN THIS ONE IT MEANS 5636 04:37:29,200 --> 04:37:32,960 A SIGNIFICANT DECREASE AND THIS 5637 04:37:32,960 --> 04:37:37,160 IS ABOUT 175%. 5638 04:37:37,160 --> 04:37:43,160 IF YOU COMPARE THE THERAPY YOU 5639 04:37:43,160 --> 04:37:48,400 HAVE THIS SIGNIFICANT DECREASE 5640 04:37:48,400 --> 04:37:49,720 AND THE SAME THING. 5641 04:37:49,720 --> 04:37:52,880 IN ANY CASE YOU HAVE A 5642 04:37:52,880 --> 04:37:54,680 SIGNIFICANT DIFFERENCE MEANS 5643 04:37:54,680 --> 04:37:56,640 IMPROVING THE CARE PROVISION YOU 5644 04:37:56,640 --> 04:38:02,160 DECREASE THE COST. 5645 04:38:02,160 --> 04:38:12,480 NOW, WITH WHAT WE RECOMMEND IS 5646 04:38:12,480 --> 04:38:17,440 PRIMARY PREVENTION AND WE CAN 5647 04:38:17,440 --> 04:38:20,560 ADOPT HEALTHY LIFE AND NOW 5648 04:38:20,560 --> 04:38:25,560 SECONDARY WE START TO TREAT 5649 04:38:25,560 --> 04:38:30,080 DIABETES PATIENT, EARLY 5650 04:38:30,080 --> 04:38:33,240 TREATMENT AND FINALLY SYSTEMATIC 5651 04:38:33,240 --> 04:38:36,200 RECORDS OF DATA ARE REMINDERS WE 5652 04:38:36,200 --> 04:38:39,440 HAVE SEEN THE RESULTS IN A GOOD 5653 04:38:39,440 --> 04:38:42,640 IMPROVEMENT AND WHEN WE HAVE A 5654 04:38:42,640 --> 04:38:47,680 GOOD RECORD DATA TO FOLLOW-UP 5655 04:38:47,680 --> 04:38:50,080 THE INTERVENTION THAT WE POINT 5656 04:38:50,080 --> 04:38:50,280 FORWARD. 5657 04:38:50,280 --> 04:38:52,920 KNOW, WHAT ARE THE LEVELS WE ARE 5658 04:38:52,920 --> 04:38:53,880 PUTTING TOGETHER? 5659 04:38:53,880 --> 04:38:57,440 PRIMARY CARE LEVEL AND 5660 04:38:57,440 --> 04:38:59,960 ESPECIALLY CARE AT ANY TIME IF 5661 04:38:59,960 --> 04:39:04,600 WE THAT THE PATIENT HAS NOT 5662 04:39:04,600 --> 04:39:07,600 ENOUGH CARE CONTROL WE HAVE 5663 04:39:07,600 --> 04:39:14,640 SWITCHED TO SPECIALIST CARE AND 5664 04:39:14,640 --> 04:39:21,720 WE HAVE DIFFERENT ACTSORS. 5665 04:39:21,720 --> 04:39:25,760 THEY HAVE TO BELIEVE IN THESE 5666 04:39:25,760 --> 04:39:26,040 THING. 5667 04:39:26,040 --> 04:39:31,120 SECOND, THE PUBLIC HEALTH SYSTEM 5668 04:39:31,120 --> 04:39:37,440 AND THE SOCIAL SECURITY SYSTEM 5669 04:39:37,440 --> 04:39:39,760 AND WE HAVE THE MEDICAL SCHOOLS. 5670 04:39:39,760 --> 04:39:43,360 WHAT KIND OF LEARNING, WHAT KIND 5671 04:39:43,360 --> 04:39:45,840 OF TEACHING THINGS ARE PROVIDED 5672 04:39:45,840 --> 04:39:51,080 TO THE FUTURE DOCTORS TO SUPPORT 5673 04:39:51,080 --> 04:39:53,440 THE POPULATION CONSULTATION AND 5674 04:39:53,440 --> 04:39:55,800 FINALLY THE TOOLS. 5675 04:39:55,800 --> 04:39:58,600 WE HAVE WE HAVE TO IMPLEMENT 5676 04:39:58,600 --> 04:40:00,800 EDUCATION AT EVERY LEVEL AND 5677 04:40:00,800 --> 04:40:03,240 THINK ABOUT THIS IS AN EASY 5678 04:40:03,240 --> 04:40:03,840 TASK, NO. 5679 04:40:03,840 --> 04:40:06,240 WE DON'T BELIEVE IT'S EASY BUT 5680 04:40:06,240 --> 04:40:09,640 WE CAN DO WHAT PEOPLE SAY. 5681 04:40:09,640 --> 04:40:14,880 FOR EXAMPLE, DON'T GIVE UP ON 5682 04:40:14,880 --> 04:40:15,440 YOUR DREAMS. 5683 04:40:15,440 --> 04:40:18,600 AND SOMETIMES YOU HAVE TO PICK 5684 04:40:18,600 --> 04:40:21,880 UP YOURSELF AND CARRY ON AND 5685 04:40:21,880 --> 04:40:28,280 THANK YOU FOR YOUR ATTENTION. 5686 04:40:28,280 --> 04:40:30,080 >>THANK YOU, FOR JOINING YOU 5687 04:40:30,080 --> 04:40:31,080 ARE SESSION TODAY. 5688 04:40:31,080 --> 04:40:34,080 THIS TIME I'M GOING TO FOCUS ON 5689 04:40:34,080 --> 04:40:35,960 CLINICAL TRIALS AND 5690 04:40:35,960 --> 04:40:36,800 IMPLEMENTATION IN LATIN AMERICA 5691 04:40:36,800 --> 04:40:39,640 AND ESPECIALLY HIGHLIGHT A FEW 5692 04:40:39,640 --> 04:40:42,560 EXPERIENCE ABOUT OVERCOMING 5693 04:40:42,560 --> 04:40:44,440 BARRIERS FOR CLINICAL TRIAL 5694 04:40:44,440 --> 04:40:45,840 IMPLEMENTATION IN LATIN AMERICA. 5695 04:40:45,840 --> 04:40:47,160 THESE ARE MY DISCLOSURES. 5696 04:40:47,160 --> 04:40:50,840 FIRST I'D LIKE TO SHARE A FEW 5697 04:40:50,840 --> 04:40:52,520 IDEAS TO GIVE A PERSPECTIVE OF 5698 04:40:52,520 --> 04:40:54,800 THE NEED OF IMPLEMENTATION OF 5699 04:40:54,800 --> 04:40:55,360 CLINICAL TRIALS IN HISPANIC 5700 04:40:55,360 --> 04:40:58,680 POPULATION AND IN LATIN AMERICA. 5701 04:40:58,680 --> 04:41:02,640 FIRST, I BELIEVE THAT IN 1906 5702 04:41:02,640 --> 04:41:05,720 WAS A KEY MOMENT OF ALZHEIMER'S 5703 04:41:05,720 --> 04:41:09,080 DISEASE AND AFTER THAT WE HAVE 5704 04:41:09,080 --> 04:41:11,160 BEEN SEEING KEY ELEMENTS OF 5705 04:41:11,160 --> 04:41:13,560 SUCCESS IN ORDER TO BETTER 5706 04:41:13,560 --> 04:41:14,560 UNDERSTAND ALZHEIMER'S DISEASE 5707 04:41:14,560 --> 04:41:20,000 AND RELATED DEMENTIA. 5708 04:41:20,000 --> 04:41:24,680 ESPECIALLY IN 2022 WE SAW THE 5709 04:41:24,680 --> 04:41:31,800 FIRST TIME AMYLOID REMOVAL FOR 5710 04:41:31,800 --> 04:41:33,160 CLINICAL IMPROVED OUTCOME. 5711 04:41:33,160 --> 04:41:34,560 WE'VE SEEN THIS THROUGH 5712 04:41:34,560 --> 04:41:37,080 IMPLEMENTATION OF DIFFERENT 5713 04:41:37,080 --> 04:41:42,640 CLINICAL TRIALS BUT HOWEVER, 5714 04:41:42,640 --> 04:41:44,400 THEY'VE TAKEN PLACE IN 5715 04:41:44,400 --> 04:41:45,960 HIGH-INCOME COUNTRIES AND MORE 5716 04:41:45,960 --> 04:41:47,320 THAN 90% OF CLINICAL TRIALS ARE 5717 04:41:47,320 --> 04:41:50,080 IN HIGH-INCOME COUNTRIES AN ONLY 5718 04:41:50,080 --> 04:41:53,200 10% ARE CONDUCTED IN EMERGING 5719 04:41:53,200 --> 04:41:53,480 ECONOMIES. 5720 04:41:53,480 --> 04:41:55,400 THAT'S BEEN THE TREND OVER THE 5721 04:41:55,400 --> 04:41:57,680 LAST TWO DECADES. 5722 04:41:57,680 --> 04:42:03,200 WE'RE SEEING THAT SHOWN HERE IN 5723 04:42:03,200 --> 04:42:06,160 THIS WHERE THE CLINICAL TRIALS 5724 04:42:06,160 --> 04:42:08,560 ARE IMPLEMENTED IN HIGH-INCOME 5725 04:42:08,560 --> 04:42:08,960 COUNTRIES. 5726 04:42:08,960 --> 04:42:12,120 THIS IS ALSO THE TREND WE SEE 5727 04:42:12,120 --> 04:42:14,000 WHERE 80% OF ALL CLINICAL TRIALS 5728 04:42:14,000 --> 04:42:20,080 ARE IMPLEMENTED EITHER IN U.S., 5729 04:42:20,080 --> 04:42:21,480 CANADA OR EUROPE. 5730 04:42:21,480 --> 04:42:25,800 AND THEY'RE FOCUSSED ON THE TWO 5731 04:42:25,800 --> 04:42:27,880 REGIONS AND IT'S ON LATIN 5732 04:42:27,880 --> 04:42:30,240 AMERICA AND AFRICA ARE THE ONES 5733 04:42:30,240 --> 04:42:35,160 WITH THE LOWER DENSITY OF 5734 04:42:35,160 --> 04:42:35,880 CLINICAL TRIALS. 5735 04:42:35,880 --> 04:42:37,280 IT'S CAUGHT THE ATTENTION ABOUT 5736 04:42:37,280 --> 04:42:40,680 THE NEED FOR GLOBALIZATION OF 5737 04:42:40,680 --> 04:42:42,480 CLINICAL TRIALS IN ALZHEIMER'S 5738 04:42:42,480 --> 04:42:44,880 DISEASE AND RELATED DEMENTIA. 5739 04:42:44,880 --> 04:42:50,480 WHY WE NEED TO EXPAND CLINICAL 5740 04:42:50,480 --> 04:42:52,360 TRIALS TO LOOK AT CLINICAL 5741 04:42:52,360 --> 04:42:54,040 TRIALS MORE DIVERSE AND INCLUDE 5742 04:42:54,040 --> 04:42:56,280 OTHER COUNTRIES? 5743 04:42:56,280 --> 04:42:59,200 NUMBER ONE, WE KNOW THE 5744 04:42:59,200 --> 04:43:00,560 DEMOGRAPHICS AND RISK FACTORS 5745 04:43:00,560 --> 04:43:02,600 THAT CANNOT BE EXTRAPOLATED FROM 5746 04:43:02,600 --> 04:43:05,280 ONE POPULATION TO THE OTHER AND 5747 04:43:05,280 --> 04:43:11,240 THAT'S PART OF THE EDUCATION AND 5748 04:43:11,240 --> 04:43:14,160 CARDIOVASCULAR RISK FACTORS AND 5749 04:43:14,160 --> 04:43:18,080 AND WE NEED TO HAVE BETTER 5750 04:43:18,080 --> 04:43:21,560 UNDERSTANDING AND MORE SEEKING 5751 04:43:21,560 --> 04:43:22,440 TREATMENT ON DIAGNOSIS. 5752 04:43:22,440 --> 04:43:24,440 THAT MAY BE THE POPULATION-BASED 5753 04:43:24,440 --> 04:43:28,160 DIFFERENCE BASED ON THE GENETICS 5754 04:43:28,160 --> 04:43:30,640 IF WE DON'T EXPAND OUR CLINICAL 5755 04:43:30,640 --> 04:43:32,560 TRIALS AND HAVE A MORE DIVERSE 5756 04:43:32,560 --> 04:43:35,040 GROUP AND THE OTHER ELEMENTS THE 5757 04:43:35,040 --> 04:43:40,960 POPULATION FACTORS THAT MAY 5758 04:43:40,960 --> 04:43:42,680 AFFECT BIOLOGY AND THESE ARE 5759 04:43:42,680 --> 04:43:47,880 FACTORS AMONG OTHERS THAT MAY 5760 04:43:47,880 --> 04:43:49,720 HAPPEN IN THE DISEASE. 5761 04:43:49,720 --> 04:43:54,200 AND IN TERMS OF THE DOSE WE 5762 04:43:54,200 --> 04:43:59,640 SHOULD BE USING FREQUENCY AND 5763 04:43:59,640 --> 04:44:01,440 THIS IS DATA WHY WE NEED 5764 04:44:01,440 --> 04:44:01,960 CLINICAL TRIALS. 5765 04:44:01,960 --> 04:44:04,360 STOPPING THERE I'D LIKE TO 5766 04:44:04,360 --> 04:44:06,960 CHANGE AND TALK ABOUT OUR 5767 04:44:06,960 --> 04:44:09,040 EXPERIENCE IN IMPLEMENTING 5768 04:44:09,040 --> 04:44:09,720 CLINICAL TRIALS IN LATIN AMERICA 5769 04:44:09,720 --> 04:44:10,520 AND DIFFERENT SITES. 5770 04:44:10,520 --> 04:44:15,040 FOR THAT, I THINK THE USE OF THE 5771 04:44:15,040 --> 04:44:17,040 NETWORK ARE KEY FOR SUCCESS IN 5772 04:44:17,040 --> 04:44:17,640 THIS IMPLEMENTATION. 5773 04:44:17,640 --> 04:44:21,520 I'M GOING USE THE EXAMPLE OF 5774 04:44:21,520 --> 04:44:23,040 SOMETHING WE'VE BEEN DOING IN 5775 04:44:23,040 --> 04:44:27,680 THE ALZHEIMER'S TRIAL UNITS. 5776 04:44:27,680 --> 04:44:29,640 THIS IS A TRIAL UNIT WITH THE 5777 04:44:29,640 --> 04:44:32,520 MAIN GOAL TO IMPLEMENT SAFE 5778 04:44:32,520 --> 04:44:36,600 EFFECTIVE CLINICAL TRIALS IN 5779 04:44:36,600 --> 04:44:37,160 POPULATION WITH ALZHEIMER'S 5780 04:44:37,160 --> 04:44:37,400 DISEASE. 5781 04:44:37,400 --> 04:44:41,880 AND I WILL SAY IN THE FIRST 5782 04:44:41,880 --> 04:44:46,880 TRIALS OF THE NETWORK ESPECIALLY 5783 04:44:46,880 --> 04:44:52,200 THOSE INCLUDING THIS MOST OF OUR 5784 04:44:52,200 --> 04:44:54,720 SITES WERE INCLUDED WERE IN 5785 04:44:54,720 --> 04:44:55,680 EUROPE AND U.S. 5786 04:44:55,680 --> 04:44:58,080 ONE OF OUR GOALS WAS TO 5787 04:44:58,080 --> 04:44:59,760 IMPLEMENT NEW TRIALS AND HAVE 5788 04:44:59,760 --> 04:45:01,600 THE NEW SITE READY FOR UPCOMING 5789 04:45:01,600 --> 04:45:02,920 TRIALS TO THE PLATFORM. 5790 04:45:02,920 --> 04:45:05,720 WITH THAT, WE STARTED THE 5791 04:45:05,720 --> 04:45:08,160 INITIATIVE WHERE THE MAIN GOAL 5792 04:45:08,160 --> 04:45:13,400 WAS TO EXPAND CLINICAL TRIALS 5793 04:45:13,400 --> 04:45:15,240 AND CREATE THIS IN LATIN AMERICA 5794 04:45:15,240 --> 04:45:17,280 AND THE INITIAL GOAL WAS TO HAVE 5795 04:45:17,280 --> 04:45:22,680 SITES IN MEXICO, ALSO COLUMBIA, 5796 04:45:22,680 --> 04:45:25,160 SAU PABLO AND ARGENTINA AND SOME 5797 04:45:25,160 --> 04:45:33,000 SITES IN THE REGION. 5798 04:45:33,000 --> 04:45:34,880 HOW DO WE PREPARE FOR THE 5799 04:45:34,880 --> 04:45:35,240 CLINICAL TRIALS? 5800 04:45:35,240 --> 04:45:36,920 WE WANTED TO GET AN 5801 04:45:36,920 --> 04:45:38,240 UNDERSTANDING ON THE FREQUENCY 5802 04:45:38,240 --> 04:45:40,240 AND PREVALENCE OF THE 5803 04:45:40,240 --> 04:45:43,960 ALZHEIMER'S DISEASE IN LATIN 5804 04:45:43,960 --> 04:45:49,480 AMERICA TO HAVE A REGISTER OF 5805 04:45:49,480 --> 04:45:52,760 THIS AND ONE GOAL WAS TO COMPARE 5806 04:45:52,760 --> 04:45:55,240 THE BIOMARKERS OF THE 5807 04:45:55,240 --> 04:45:56,680 ALZHEIMER'S DISEASE IN HISPANICS 5808 04:45:56,680 --> 04:45:58,800 IN THE HISPANIC POPULATION AND 5809 04:45:58,800 --> 04:46:04,440 AT THE SAME TIME TRY TO IDENTIFY 5810 04:46:04,440 --> 04:46:06,000 NOVEL VARIANTS AND AGE OF ONSET 5811 04:46:06,000 --> 04:46:06,720 IN THE FAMILIES. 5812 04:46:06,720 --> 04:46:09,520 AT THE SAME TIME, HOW TO BETTER 5813 04:46:09,520 --> 04:46:20,040 UNDERSTAND WHAT IS THE AFFECT OF 5814 04:46:25,400 --> 04:46:25,640 A 5815 04:46:25,640 --> 04:46:26,240 FACTORS AND THOUGHT THIS NEEDED 5816 04:46:26,240 --> 04:46:26,840 TO START BEING EXPLORED AND 5817 04:46:26,840 --> 04:46:28,880 COLLABORATION WITH OUR PARTNERS 5818 04:46:28,880 --> 04:46:34,480 AND TO IDENTIFY THE COHORT READY 5819 04:46:34,480 --> 04:46:40,120 POPULATION TO BE ENROLLED IN THE 5820 04:46:40,120 --> 04:46:42,160 PLATFORM. 5821 04:46:42,160 --> 04:46:43,320 AND ONE OF THE STEPS WAS HAVING 5822 04:46:43,320 --> 04:46:47,560 A BETTER UNDERSTANDING OF WHAT 5823 04:46:47,560 --> 04:46:48,240 IS IN LATIN AMERICA AND WHERE 5824 04:46:48,240 --> 04:46:50,360 THE FAMILY IS LIVING AND WHAT'S 5825 04:46:50,360 --> 04:46:53,600 THE DISTRIBUTION AND THE MAIN 5826 04:46:53,600 --> 04:46:54,200 GENETIC VARIANTS. 5827 04:46:54,200 --> 04:46:57,320 IN COLLABORATION WITH OUR P.I.s 5828 04:46:57,320 --> 04:46:59,680 WE STARTED SCREENING FAMILIES 5829 04:46:59,680 --> 04:47:00,920 FOR ALZHEIMER'S DISEASE AND THIS 5830 04:47:00,920 --> 04:47:06,080 IS ONE OF THE EXAMPLES OF A 5831 04:47:06,080 --> 04:47:08,920 RURAL POPULATION DESCRIBED BY 5832 04:47:08,920 --> 04:47:12,920 OUR COLLABORATORS IN ARGENTINA 5833 04:47:12,920 --> 04:47:15,520 AND A POPULATION IN THIS AREA 5834 04:47:15,520 --> 04:47:20,160 AND THIS IS HOW WE IMPLEMENTED 5835 04:47:20,160 --> 04:47:21,880 THEM THROUGH THE NETWORK AND 5836 04:47:21,880 --> 04:47:23,240 THERE'S ABLE EXAMPLE HERE AND 5837 04:47:23,240 --> 04:47:26,040 THERE'S A SIMILAR EXPERIENCE 5838 04:47:26,040 --> 04:47:30,080 WITH MEXICO, BRAZIL, CHILE AND 5839 04:47:30,080 --> 04:47:31,320 OTHER COUNTRIES. 5840 04:47:31,320 --> 04:47:36,920 TO SUMMARIZE THE DISTRIBUTION OF 5841 04:47:36,920 --> 04:47:39,280 DIFFERENT VARIANTS CAUSING 5842 04:47:39,280 --> 04:47:40,920 ALZHEIMER'S DISEASE IN LATIN 5843 04:47:40,920 --> 04:47:50,080 AMERICA AND YOU CAN SEE THE 5844 04:47:50,080 --> 04:47:51,240 DISPARITIES IN BRAZIL AND 5845 04:47:51,240 --> 04:47:54,080 COLOMBIA AND SOME DESCRIBED BY 5846 04:47:54,080 --> 04:47:58,080 THE GROUP OF AND WE ALSO 5847 04:47:58,080 --> 04:48:00,720 DESCRIBED NEW VARIANTS IN 5848 04:48:00,720 --> 04:48:02,680 BRAZIL, MEXICO AND ARGENTINA. 5849 04:48:02,680 --> 04:48:05,320 AT THE SAME TIME WE GET A BETTER 5850 04:48:05,320 --> 04:48:09,480 UNDERSTANDING OF THE DIFFERENT 5851 04:48:09,480 --> 04:48:10,920 REPORTS IN LATIN AMERICA AND YOU 5852 04:48:10,920 --> 04:48:14,080 MAY SEE THERE'S A FEW WHERE WE 5853 04:48:14,080 --> 04:48:17,800 DON'T HAVE REPORTS BUT THIS ALSO 5854 04:48:17,800 --> 04:48:20,000 HIGHLIGHTS A LACK OF ACCESS TO 5855 04:48:20,000 --> 04:48:21,640 GENETIC TESTING AND COUNSELLING 5856 04:48:21,640 --> 04:48:26,080 WE'RE ALSO TRYING TO WORK ON. 5857 04:48:26,080 --> 04:48:27,080 THE OTHER ELEMENT THAT WAS 5858 04:48:27,080 --> 04:48:28,720 INTERESTING IN THE DISCOVERY WAS 5859 04:48:28,720 --> 04:48:31,720 THE DISTRIBUTION OF GENETIC 5860 04:48:31,720 --> 04:48:36,800 ANCESTRY FOR SOME OF THE 5861 04:48:36,800 --> 04:48:44,680 ALZHEIMER'S DISEASE AND WE ALSO 5862 04:48:44,680 --> 04:48:48,400 HAD VARIANTS WITH AFRICAN 5863 04:48:48,400 --> 04:48:54,280 ABSCAB -- 5864 04:48:54,280 --> 04:48:56,640 ANCESTRY AND OTHERS FROM BRAZIL 5865 04:48:56,640 --> 04:49:00,040 AND IT HIGHLIGHTS THE 5866 04:49:00,040 --> 04:49:01,080 DISTRIBUTION OF THE UNITS OF 5867 04:49:01,080 --> 04:49:04,960 SOME OF THESE VARIANTS. 5868 04:49:04,960 --> 04:49:07,240 AS WE START THINKING OF 5869 04:49:07,240 --> 04:49:08,200 IMPLEMENTING TRIALS IN 5870 04:49:08,200 --> 04:49:09,400 ALZHEIMER'S DISEASE ONE KEY 5871 04:49:09,400 --> 04:49:12,440 ELEMENT WE NEED TO HAVE READY IS 5872 04:49:12,440 --> 04:49:15,800 PROGRAMS ON GENETIC TESTING AND 5873 04:49:15,800 --> 04:49:16,040 CONSULT. 5874 04:49:16,040 --> 04:49:18,760 THOUGH MANY HAVE BEEN TESTED IN 5875 04:49:18,760 --> 04:49:20,240 HIGH-INCOME COUNTRIES INCLUDING 5876 04:49:20,240 --> 04:49:22,960 THE U.S. AND EUROPE THERE'S 5877 04:49:22,960 --> 04:49:24,160 DIFFERENT LEVELS AND STIGMA 5878 04:49:24,160 --> 04:49:30,080 AROUND DISEASE AND OTHER ELEMENT 5879 04:49:30,080 --> 04:49:35,280 S HIGHLIGHTING THE NEED FOR 5880 04:49:35,280 --> 04:49:39,400 TESTING IN OUR STUDY. 5881 04:49:39,400 --> 04:49:42,200 WE DEVELOPED THIS WHERE PEOPLE 5882 04:49:42,200 --> 04:49:43,600 WITH ALZHEIMER'S DISEASE WILL GO 5883 04:49:43,600 --> 04:49:49,040 THROUGH GENETIC TESTING AND 5884 04:49:49,040 --> 04:49:50,840 COUNSELLING AND WILL HAVE 5885 04:49:50,840 --> 04:49:53,480 CONTROL AND WE'LL HAVE 5886 04:49:53,480 --> 04:49:54,560 ADDITIONAL ASSESSMENT AND THREE 5887 04:49:54,560 --> 04:49:56,680 MONTHS FOLLOW-UP ASSESSMENT 5888 04:49:56,680 --> 04:49:59,640 AFTER LEARNING THEIR GENETICS. 5889 04:49:59,640 --> 04:50:03,720 WHERE WE'VE COME SORE FAR IS THE 5890 04:50:03,720 --> 04:50:06,600 ACTIVITY IN EUROPE AND GENETIC 5891 04:50:06,600 --> 04:50:13,000 COUNSELLING IS SAFE AND THOSE 5892 04:50:13,000 --> 04:50:14,400 RECEIVING A POSITIVE 5893 04:50:14,400 --> 04:50:17,720 CONFIRMATION OF THE VARIANTS DID 5894 04:50:17,720 --> 04:50:20,240 NOT DEFER FROM THE ONE THAT 5895 04:50:20,240 --> 04:50:22,800 SHOWED THE IDENTITY STATUS WHICH 5896 04:50:22,800 --> 04:50:25,280 IS HARD TO LOCK AT THE RELEVANCE 5897 04:50:25,280 --> 04:50:32,760 OF GENETIC TESTING AND IN TERMS 5898 04:50:32,760 --> 04:50:35,480 OF EXPLAINING THE ELEMENTS. 5899 04:50:35,480 --> 04:50:38,520 WITH THAT I THINK THAT'S HOW WE 5900 04:50:38,520 --> 04:50:40,480 ARE TODAY. 5901 04:50:40,480 --> 04:50:42,200 RIGHT NOW WE HAVE THREE SIDES 5902 04:50:42,200 --> 04:50:45,400 THAT ARE ACTIVE IN LATIN AMERICA 5903 04:50:45,400 --> 04:50:46,920 AND READY FOR CLINICAL TRIALS 5904 04:50:46,920 --> 04:50:50,720 AND OBSERVATIONAL STUDIES AND 5905 04:50:50,720 --> 04:50:54,880 THESE ARE LOCATED IN MEXICO, 5906 04:50:54,880 --> 04:50:58,440 COLOMBIA AND IN ARGENTINA. 5907 04:50:58,440 --> 04:51:04,480 WE HAVE TWO IN ACTIVATION. 5908 04:51:04,480 --> 04:51:14,960 ONE ROY -- GUARALAJARA AND 5909 04:51:19,240 --> 04:51:20,160 OTHER SITES IN LATIN AMERICA. 5910 04:51:20,160 --> 04:51:25,000 THE OTHER ELEMENTS WE WANT TO 5911 04:51:25,000 --> 04:51:26,600 HIGHLIGHT AFTER TESTING AND MANY 5912 04:51:26,600 --> 04:51:32,400 SITES HAVE ONGOING TESTING AND 5913 04:51:32,400 --> 04:51:34,080 GIVE FAMILIES ACCESS TO THE 5914 04:51:34,080 --> 04:51:35,840 PROGRAM AND SOMETHING WE NEEDED 5915 04:51:35,840 --> 04:51:38,160 TO HELP BUILD WAS LOCAL 5916 04:51:38,160 --> 04:51:38,440 RESOURCES. 5917 04:51:38,440 --> 04:51:44,080 AND THIS WAS MAINLY FOCUSSING ON 5918 04:51:44,080 --> 04:51:46,480 IMPLEMENTATION FOR SOME OF THE 5919 04:51:46,480 --> 04:51:51,520 CLINICAL TRIALS WE NEED TO USE 5920 04:51:51,520 --> 04:51:53,440 DIFFERENT TRACERS AND SOME OF 5921 04:51:53,440 --> 04:51:57,840 THE IMPORTANCE OF OUR CLINICAL 5922 04:51:57,840 --> 04:51:58,080 TRIALS. 5923 04:51:58,080 --> 04:52:01,280 IMPLEMENTING THE CENTER AND 5924 04:52:01,280 --> 04:52:02,960 HELPING DEVELOP THE RESOURCE WAS 5925 04:52:02,960 --> 04:52:06,480 KEY TO THE IMPLEMENTATION. 5926 04:52:06,480 --> 04:52:11,440 OUR FRESH APPROACH WAS TO CREATE 5927 04:52:11,440 --> 04:52:15,920 THIS ACROSS THE NETWORK TO 5928 04:52:15,920 --> 04:52:17,360 SUPPORT SITES THAT DON'T HAVE 5929 04:52:17,360 --> 04:52:21,480 THAT RESOURCE RIGHT NOW. 5930 04:52:21,480 --> 04:52:24,520 WE HELP MEXICO TO HELP BUILD 5931 04:52:24,520 --> 04:52:26,760 WITH TRAINING AN CAPACITY 5932 04:52:26,760 --> 04:52:31,720 BILLING TO PRODUCE SOME CENTERS 5933 04:52:31,720 --> 04:52:34,320 AND PEOPLE FROM COLOMBIA WILL 5934 04:52:34,320 --> 04:52:44,720 GET THEIR IMAGING AND IN 5935 04:52:44,720 --> 04:52:46,320 ARGENTINA WE HELPED WITH THE 5936 04:52:46,320 --> 04:52:50,600 PRODUCTION OF SOME OF THE 5937 04:52:50,600 --> 04:52:55,000 TRACERS AND WE'LL TRAVEL FROM 5938 04:52:55,000 --> 04:53:01,360 ARGENTINA AND OTHER PARTS AND TO 5939 04:53:01,360 --> 04:53:05,520 BUENOS AIRES. 5940 04:53:05,520 --> 04:53:09,080 AND THE GROUP FOR COLOMBIA ALSO 5941 04:53:09,080 --> 04:53:10,760 TRAVELED TO ARGENTINA. 5942 04:53:10,760 --> 04:53:13,960 WITH THAT IS HOW WE HELPED TO 5943 04:53:13,960 --> 04:53:19,840 GET THE NETWORK READY OR SITES 5944 04:53:19,840 --> 04:53:22,520 READY FOR LATIN AMERICA. 5945 04:53:22,520 --> 04:53:24,960 AND THEY ARE NOW STARTING TO 5946 04:53:24,960 --> 04:53:29,920 ENROLL AND FAMILY MEMBERS FROM 5947 04:53:29,920 --> 04:53:32,400 LATIN AMERICA WILL BE ENROLLING 5948 04:53:32,400 --> 04:53:36,760 OUR TWO MAIN ARMS FOR THE 5949 04:53:36,760 --> 04:53:39,440 CLINICAL INTERVENTION TRIAL AND 5950 04:53:39,440 --> 04:53:41,400 A COMBINATION TRIAL BETWEEN 5951 04:53:41,400 --> 04:53:47,040 THESE TWO AND THE MAP AND WILL 5952 04:53:47,040 --> 04:53:52,600 ENROLL UP TO 160 PARTICIPANTS 5953 04:53:52,600 --> 04:53:56,840 AND IT'S A PRIMARY PREVENTION 5954 04:53:56,840 --> 04:53:59,040 TRIAL IN THE FIELD AND WE'LL 5955 04:53:59,040 --> 04:54:00,760 ENROLL PARTICIPANTS IN LATIN 5956 04:54:00,760 --> 04:54:01,040 AMERICA. 5957 04:54:01,040 --> 04:54:03,280 NOW, I ALSO WANT TO HIGHLIGHT 5958 04:54:03,280 --> 04:54:04,920 THERE'S STILL EXISTING BARRIERS 5959 04:54:04,920 --> 04:54:06,800 BUT THOSE BARRIERS COULD BE 5960 04:54:06,800 --> 04:54:08,400 OVERCOME HERE AND I WANT TO 5961 04:54:08,400 --> 04:54:12,440 SHARE SOME OF THE BARRIERS WE 5962 04:54:12,440 --> 04:54:13,040 ENCOUN 5963 04:54:13,040 --> 04:54:13,360 ENCOUNTERED. 5964 04:54:13,360 --> 04:54:15,920 SOME WERE ORIGINAL BARRIERS 5965 04:54:15,920 --> 04:54:17,600 INCLUDING HAVING A SYSTEM THAT 5966 04:54:17,600 --> 04:54:20,120 WAS NOT SUPPORT I ENOUGH FOR OUR 5967 04:54:20,120 --> 04:54:24,280 P.I.s TO MOVE FORWARD WITH OTHER 5968 04:54:24,280 --> 04:54:29,640 REGULATORY VIEWS NEEDED TO BRING 5969 04:54:29,640 --> 04:54:36,960 WHAT IS READY AND HAVE DELAYS 5970 04:54:36,960 --> 04:54:42,400 AND TRYING TO OVERCOME AND MOST 5971 04:54:42,400 --> 04:54:44,400 OF OUR LACK OF FUNDING IS 5972 04:54:44,400 --> 04:54:46,640 SOMETHING WE ENCOUNTERED IN 5973 04:54:46,640 --> 04:54:51,760 MULTIPLE SITES IN LATIN AMERICA. 5974 04:54:51,760 --> 04:54:54,320 HOWEVER, A SUCCESSFUL 5975 04:54:54,320 --> 04:54:55,360 PARTNERSHIP MAY HELP OVERCOME 5976 04:54:55,360 --> 04:54:59,520 THE LACK OF FUNDING WE SEE IN 5977 04:54:59,520 --> 04:55:00,000 OUR SITES. 5978 04:55:00,000 --> 04:55:03,680 AND WITH POPULATION-RELATED 5979 04:55:03,680 --> 04:55:05,040 INDIVIDUAL RELATED 5980 04:55:05,040 --> 04:55:07,000 IMPLEMENTATION AND WE LOOK AT 5981 04:55:07,000 --> 04:55:08,640 LACK OF AWARENESS AND LACK OF 5982 04:55:08,640 --> 04:55:10,480 TRUST IN SCIENCE AND THESE WERE 5983 04:55:10,480 --> 04:55:13,160 ELEMENTS WE WERE ABLE TO 5984 04:55:13,160 --> 04:55:15,920 OVERCOME BY HAVING MEET IN THE 5985 04:55:15,920 --> 04:55:17,600 REGION AND TALKING WITH FAMILIES 5986 04:55:17,600 --> 04:55:20,040 ABOUT THEIR NEEDS AND SOME OF 5987 04:55:20,040 --> 04:55:22,160 OUR CONCERNS OF OUR TRIALS. 5988 04:55:22,160 --> 04:55:27,880 WITH THAT I'D LIKE TO STOP HERE 5989 04:55:27,880 --> 04:55:33,240 AND LEAVE A FEW TAKE-HOME 5990 04:55:33,240 --> 04:55:34,720 MESSAGES AND HIGH-INCOME 5991 04:55:34,720 --> 04:55:36,680 COUNTRIES HAVE PARTICIPATED IN 5992 04:55:36,680 --> 04:55:41,840 OVER 90% OF THE TRIALS AND WE 5993 04:55:41,840 --> 04:55:47,960 NEED TO IMPLEMENT MORE TRIALS IN 5994 04:55:47,960 --> 04:55:49,920 POPULATIONS WITHIN LOW-INCOME 5995 04:55:49,920 --> 04:55:53,000 COUNTRIES AND WE NEED 5996 04:55:53,000 --> 04:55:55,000 COLLABORATION BETWEEN HIGH AND 5997 04:55:55,000 --> 04:55:55,720 LOW-INCOME COUNTRIES IS 5998 04:55:55,720 --> 04:55:57,600 ESSENTIAL TO IMPLEMENTATION. 5999 04:55:57,600 --> 04:56:02,480 I JUST SHARED A FEW EXPERIENCES 6000 04:56:02,480 --> 04:56:09,520 WE HAD WE WERE ABLE TO IMPLEMENT 6001 04:56:09,520 --> 04:56:15,200 PLANS IN LATIN AMERICA AND THESE 6002 04:56:15,200 --> 04:56:17,760 IS FEASIBLE AND THERE'S OTHERS 6003 04:56:17,760 --> 04:56:23,120 LIKE THE ONGOING TRIAL THAT JUST 6004 04:56:23,120 --> 04:56:25,720 FINISHED AND THE OTHER TRIAL 6005 04:56:25,720 --> 04:56:26,280 STILL ONGOING. 6006 04:56:26,280 --> 04:56:28,760 AND WITH THAT I'LL STOP HERE AND 6007 04:56:28,760 --> 04:56:30,880 I'LL BE LOOKING FORWARD TO THE 6008 04:56:30,880 --> 04:56:34,200 QUESTIONS AT THE END OF THIS 6009 04:56:34,200 --> 04:56:34,600 SESSION. 6010 04:56:34,600 --> 04:56:35,480 ONCE AGAIN, THANK YOU FOR 6011 04:56:35,480 --> 04:56:39,480 JOINING US TODAY. 6012 04:56:39,480 --> 04:56:42,520 >>HI, THIS IS CLAUDIA BAMBS 6013 04:56:42,520 --> 04:56:46,080 FROM THE DEPARTMENT OF 6014 04:56:46,080 --> 04:56:55,480 DEPARTMENT HEALTH AND ADVANCED 6015 04:56:55,480 --> 04:56:58,000 CENTER FOR CHRONIC DISEASES. 6016 04:56:58,000 --> 04:57:01,160 I'M HERE TO TALK ABOUT PROMOTING 6017 04:57:01,160 --> 04:57:04,120 CESSATION OF SMOKING OF WOMEN IN 6018 04:57:04,120 --> 04:57:05,080 LATIN AMERICA AND I'LL SHARE 6019 04:57:05,080 --> 04:57:08,760 SOME RESULTS OF THE STUDY IN 6020 04:57:08,760 --> 04:57:18,920 PARALLEL. 6021 04:57:21,040 --> 04:57:27,160 MAYBE YOU HAVE HEARD THE 6022 04:57:27,160 --> 04:57:30,280 REPRODUCTIVE AGE OF THESE WOMEN 6023 04:57:30,280 --> 04:57:32,120 SMOKING IS HIGH AND SUPPORT FOR 6024 04:57:32,120 --> 04:57:35,160 SMOKING CESSATION SADLY IS A 6025 04:57:35,160 --> 04:57:35,840 TOBACCO CONTROLLED MEASURE WITH 6026 04:57:35,840 --> 04:57:36,360 THE LEAST PROGRESS IN OUR 6027 04:57:36,360 --> 04:57:39,040 COUNTRY. 6028 04:57:39,040 --> 04:57:41,720 ON THE OTHER HAND, MOBILE 6029 04:57:41,720 --> 04:57:46,240 PHONE-BASED INTERVENTIONS HAVE 6030 04:57:46,240 --> 04:57:47,360 PROVEN EFFECTIVE IN COUNTRIES 6031 04:57:47,360 --> 04:57:50,760 AND IN OUR POPULATION THERE'S A 6032 04:57:50,760 --> 04:57:51,240 MASSIVE USE OF MOBILE 6033 04:57:51,240 --> 04:57:56,640 TELEPHONES. 6034 04:57:56,640 --> 04:58:01,800 ALSO, THE EVIDENCE MOSTLY FROM 6035 04:58:01,800 --> 04:58:03,280 DEVELOPED COUNTRIES SHOWS 6036 04:58:03,280 --> 04:58:04,120 MOBILE-PHONE BASED INTERVENTIONS 6037 04:58:04,120 --> 04:58:06,040 ARE VERY EFFECTIVE FOR SMOKING 6038 04:58:06,040 --> 04:58:09,560 CESSATION. 6039 04:58:09,560 --> 04:58:16,480 HOWEVER, MOST STUDIES INCLUDED 6040 04:58:16,480 --> 04:58:18,240 IN REVIEWS AND SYSTEMATIC 6041 04:58:18,240 --> 04:58:19,400 REVIEWS AND META-ANALYSIS ARE 6042 04:58:19,400 --> 04:58:21,600 BASED ON TEXT-MESSAGE 6043 04:58:21,600 --> 04:58:22,200 INTERVENTIONS IN HIGH-INCOME 6044 04:58:22,200 --> 04:58:25,240 COUNTRIES. 6045 04:58:25,240 --> 04:58:25,480 . 6046 04:58:25,480 --> 04:58:30,800 THAT IS NOT THE CASE IN CHILE. 6047 04:58:30,800 --> 04:58:35,600 IN TERMS OF OUR CONTEXT, FOR 6048 04:58:35,600 --> 04:58:38,480 EXAMPLE, IN CHILE, FEWER AND 6049 04:58:38,480 --> 04:58:39,760 FEWER PEOPLE USE TEXT MESSAGES 6050 04:58:39,760 --> 04:58:47,440 AS A WAY OF DAILY COMMUNICATION. 6051 04:58:47,440 --> 04:58:49,280 THEREFORE THE GOAL OF THE STUDY 6052 04:58:49,280 --> 04:58:51,880 WAS TO EVALUATE THE 6053 04:58:51,880 --> 04:58:54,720 EFFECTIVENESS OF AN INTERVENTION 6054 04:58:54,720 --> 04:58:57,720 BASED ON THE DESIGN OF MOBILE 6055 04:58:57,720 --> 04:59:00,920 PHONE APPLICATION TO SUPPORT 6056 04:59:00,920 --> 04:59:05,880 SMOKING CESSATION IN CHILEAN 6057 04:59:05,880 --> 04:59:06,120 WOMEN. 6058 04:59:06,120 --> 04:59:10,360 APPS ARE VERY POPULAR AND WIDELY 6059 04:59:10,360 --> 04:59:11,600 USED AMONG OUR POPULATION. 6060 04:59:11,600 --> 04:59:15,440 WE DESIGN THE MOBILE APPLICATION 6061 04:59:15,440 --> 04:59:22,240 FOR ANDROID SYSTEM WORKING WITH 6062 04:59:22,240 --> 04:59:24,160 BOTH EXPERTS IN DESIGN OF THIS 6063 04:59:24,160 --> 04:59:27,160 KIND OF MOBILE APPLICATIONS ALSO 6064 04:59:27,160 --> 04:59:29,920 WE HAD A QUALITATIVE STAGE WITH 6065 04:59:29,920 --> 04:59:34,000 WOMEN SMOKERS FROM THE COMMUNITY 6066 04:59:34,000 --> 04:59:37,960 THAT WAS VERY INFORMATIVE FOR 6067 04:59:37,960 --> 04:59:39,640 THE DESIGN OF THE APPLICATION. 6068 04:59:39,640 --> 04:59:44,000 THEN, WE CONDUCTED A RANDOMIZED 6069 04:59:44,000 --> 04:59:46,360 CLINICAL TRIAL TO ASSESS THE 6070 04:59:46,360 --> 04:59:47,160 EFFECTIVENESS AND SAFETY OF THIS 6071 04:59:47,160 --> 04:59:50,480 APPLICATION. 6072 04:59:50,480 --> 04:59:56,480 THIS WAS A SINGLE BLIND STUDY 6073 04:59:56,480 --> 05:00:03,120 AND OUR GOAL WAS TO RECRUIT 6074 05:00:03,120 --> 05:00:09,240 WOMEN WHO WANT QUIT SMOKING. 6075 05:00:09,240 --> 05:00:14,880 THEY WERE FROM MIDDLE TO 6076 05:00:14,880 --> 05:00:19,720 LOW-INCOME DISTRICTS. 6077 05:00:19,720 --> 05:00:24,040 THIS STUDY WAS FUNDED BY THE 6078 05:00:24,040 --> 05:00:27,840 AGENCY FOR RESEARCH AND 6079 05:00:27,840 --> 05:00:32,800 DEVELOPMENT IN CHILE. 6080 05:00:32,800 --> 05:00:34,880 WE DESIGN FOLLOW-UP STRATEGY AT 6081 05:00:34,880 --> 05:00:39,280 FOUR WEEKS, THREE MONTHS AND SIX 6082 05:00:39,280 --> 05:00:43,880 MONTHS TO ELECTRONIC 6083 05:00:43,880 --> 05:00:47,280 QUESTIONNAIRES PARTICIPATING 6084 05:00:47,280 --> 05:00:50,360 WOMEN SELF-REPORTED SEVERAL 6085 05:00:50,360 --> 05:00:52,320 OUTCOMES ABOUT ABSTINENCE, 6086 05:00:52,320 --> 05:00:54,600 NUMBER OF QUICK ATTEMPTS, ALSO 6087 05:00:54,600 --> 05:00:57,560 THE NUMBER OF DAILY OR WEEKLY 6088 05:00:57,560 --> 05:00:59,520 CIGARETTES AMONG THOSE WOMEN WHO 6089 05:00:59,520 --> 05:01:02,240 DO NOT ACHIEVE COMPLETE 6090 05:01:02,240 --> 05:01:04,680 ABSTINENCE. 6091 05:01:04,680 --> 05:01:06,040 WE ALSO ASKED THE PARTICIPANTS 6092 05:01:06,040 --> 05:01:08,240 TO REPORT THE USE OF OTHER 6093 05:01:08,240 --> 05:01:10,200 TREATMENT OR CESSATION SERVICES 6094 05:01:10,200 --> 05:01:15,880 AS CO-INTERVENTIONS. 6095 05:01:15,880 --> 05:01:18,640 THEY ALSO REPORTED ANY ADVERSE 6096 05:01:18,640 --> 05:01:22,920 AFFECT SPECIFICALLY WE WERE 6097 05:01:22,920 --> 05:01:27,640 INTERESTED IN KNOWING IF OUR 6098 05:01:27,640 --> 05:01:28,280 PARTICIPANTS HAD BEEN INVOLVED 6099 05:01:28,280 --> 05:01:30,440 ANY TRAFFIC ACCIDENTS OR IF THEY 6100 05:01:30,440 --> 05:01:34,880 HAD ANY INJURIES OF THE HANDS 6101 05:01:34,880 --> 05:01:38,240 POTENTIALLY LINKED TO THE USE OR 6102 05:01:38,240 --> 05:01:45,160 FREQUENT USE OF THE TELEPHONE. 6103 05:01:45,160 --> 05:01:47,400 WHAT I WILL SHOW YOU NOW ARE THE 6104 05:01:47,400 --> 05:01:50,800 RESULTS OF THE FIRST STAGE OF 6105 05:01:50,800 --> 05:01:54,480 OUR STUDY WHICH WAS BASED IN 6106 05:01:54,480 --> 05:01:57,800 FOCUS GROUPS WITH WOMEN FROM 18 6107 05:01:57,800 --> 05:02:00,760 TO 44 YEARS OLD FROM THE COUNTY 6108 05:02:00,760 --> 05:02:05,440 OF PUENTE ALTO IN THE 6109 05:02:05,440 --> 05:02:08,520 METROPOLITAN REGION OF SANTIAGO. 6110 05:02:08,520 --> 05:02:10,600 THE FOCUS GROUP WOMEN SHARED 6111 05:02:10,600 --> 05:02:13,880 WITH US THEIR EXPECTATIONS AND 6112 05:02:13,880 --> 05:02:16,840 PREFERENCES REGARDING THE 6113 05:02:16,840 --> 05:02:19,800 CONTENT AND THE DESIGN OF A 6114 05:02:19,800 --> 05:02:23,960 POTENTIAL APPLICATION, MOBILE 6115 05:02:23,960 --> 05:02:27,640 APPLICATION TO SUPPORT QUITTING 6116 05:02:27,640 --> 05:02:28,200 SMOKING. 6117 05:02:28,200 --> 05:02:32,920 YOU MAY SEE IN THE LIST OF 6118 05:02:32,920 --> 05:02:34,920 CONTENTS WHAT THE WOMEN SAID. 6119 05:02:34,920 --> 05:02:38,640 THEY WANTED THE APP TO BE 6120 05:02:38,640 --> 05:02:39,000 PERSONALIZED. 6121 05:02:39,000 --> 05:02:41,840 SOMETHING CLOSE LIKE THE VOICE 6122 05:02:41,840 --> 05:02:48,880 OF THE CONSCIENCE THEY SAID. 6123 05:02:48,880 --> 05:02:51,480 THEY SAID WOMEN NEED SOMETHING 6124 05:02:51,480 --> 05:02:57,560 FAST AND THEY WANTED -- THE APP 6125 05:02:57,560 --> 05:03:02,080 MAY REPLACE SOME BORING TIMES 6126 05:03:02,080 --> 05:03:03,880 BECAUSE SAID WHEN IT'S NOT BUSY 6127 05:03:03,880 --> 05:03:08,040 OR SMOKING AND SAID KEEP IT 6128 05:03:08,040 --> 05:03:13,880 SIMPLE BUT ATTRACTIVE. 6129 05:03:13,880 --> 05:03:15,960 AND THE SAME AND CONTENT SHOULD 6130 05:03:15,960 --> 05:03:20,800 BE IN A STUDY AND THEY ALSO 6131 05:03:20,800 --> 05:03:25,720 REQUEST THAT WE HAD A PANIC 6132 05:03:25,720 --> 05:03:26,120 BUTTON. 6133 05:03:26,120 --> 05:03:32,000 SOMETHING THAT WOMEN COULD PRESS 6134 05:03:32,000 --> 05:03:35,320 AND WHEN THEY HAVE CRAVINGS OR 6135 05:03:35,320 --> 05:03:38,440 IF THEY HAD ALREADY HAD RELAXED 6136 05:03:38,440 --> 05:03:39,720 THE SMOKING. 6137 05:03:39,720 --> 05:03:42,960 THEY WANTED THE APP HAS A 6138 05:03:42,960 --> 05:03:44,400 PERSONAL GOAL AND THEY LOOK LIKE 6139 05:03:44,400 --> 05:03:49,680 A GAME. 6140 05:03:49,680 --> 05:03:52,280 YOU MAY FIND THE FULL TEXT 6141 05:03:52,280 --> 05:03:53,280 DESCRIPTION OF THIS QUALITATIVE 6142 05:03:53,280 --> 05:03:58,120 STAGE OF THE STUDY WHICH IS 6143 05:03:58,120 --> 05:03:59,040 ALREADY PUBLISHED. 6144 05:03:59,040 --> 05:04:03,440 I WANT TO SHOW YOU NOW SOME 6145 05:04:03,440 --> 05:04:06,040 IMAGES THAT REFLECT THE DESIGN, 6146 05:04:06,040 --> 05:04:09,720 THE NAME AND LOGO OF THE STUDY 6147 05:04:09,720 --> 05:04:11,040 AND THE DISSEMINATION STRATEGY 6148 05:04:11,040 --> 05:04:20,360 WE USED FOR THEIR RECRUITMENT. 6149 05:04:20,360 --> 05:04:25,720 PLEASE PAY ATTENTION TO THE 6150 05:04:25,720 --> 05:04:30,320 IMAGES LOOK AT THE AGE OF THE 6151 05:04:30,320 --> 05:04:32,920 WOMEN IN THE IMAGES AND THE 6152 05:04:32,920 --> 05:04:35,680 ACTIVITIES. 6153 05:04:35,680 --> 05:04:40,480 WE ADVERTISED THIS STUDY THROUGH 6154 05:04:40,480 --> 05:04:41,400 FOSTERS IN HEALTH CARE CENTERS 6155 05:04:41,400 --> 05:04:45,680 AND PUBLIC SPACES AND SUPER 6156 05:04:45,680 --> 05:04:46,720 MARKETS IN MALLS AND IN SOCIAL 6157 05:04:46,720 --> 05:04:56,880 NETWORKS. 6158 05:05:17,440 --> 05:05:22,520 WHEN WE HAD THE DESIGN OF THE 6159 05:05:22,520 --> 05:05:28,400 APP WE MADE IT AVAILABLE ON THE 6160 05:05:28,400 --> 05:05:31,480 GOOGLE PLAY STORE AND THE 6161 05:05:31,480 --> 05:05:37,280 PARTICIPANTS OF THE STUDY HAD AN 6162 05:05:37,280 --> 05:05:39,680 EXCLUSIVE ACCESS DURING THE 6163 05:05:39,680 --> 05:05:45,040 EXPERIMENTAL PHASE OF THE STUDY. 6164 05:05:45,040 --> 05:05:53,600 YOU MAY STATE HERE HOW THE APP 6165 05:05:53,600 --> 05:05:58,800 LOOKED BY THE WOMEN IN THE STAGE 6166 05:05:58,800 --> 05:06:02,880 OF THE STUDY INCLUDING THE PANIC 6167 05:06:02,880 --> 05:06:06,800 BUTTONS THEY WANTED US TO 6168 05:06:06,800 --> 05:06:07,040 INCLUDE. 6169 05:06:07,040 --> 05:06:10,680 ONE WAS LIKE A CRAVING BUTTON I 6170 05:06:10,680 --> 05:06:12,680 WANT TO SMOKE AND THE OTHER IS 6171 05:06:12,680 --> 05:06:14,840 WHEN THE WOMAN SAID I WENT BACK 6172 05:06:14,840 --> 05:06:21,600 TO SMOKING AND WHEN THEY AND THE 6173 05:06:21,600 --> 05:06:25,720 APP DISPLAYED A LIST OF 6174 05:06:25,720 --> 05:06:31,200 DIFFERENT MESSAGES TO INCREASE 6175 05:06:31,200 --> 05:06:32,240 MOTIVATION AND TO REMIND WOMEN 6176 05:06:34,480 --> 05:06:38,880 OF THE ORIGINAL GOALS THEY HAD 6177 05:06:38,880 --> 05:06:44,280 AND HOW TO DEAL WITH STRESS AND 6178 05:06:44,280 --> 05:06:49,360 SOME OTHER TECHNIQUES THAT 6179 05:06:49,360 --> 05:06:54,280 AREN'T WIDELY KNOWN IN SMOKING 6180 05:06:54,280 --> 05:06:57,680 CESSATION. 6181 05:06:57,680 --> 05:06:59,200 IN THIS PRESENTATION I HAVE 6182 05:06:59,200 --> 05:07:02,840 SHARED WITH YOU MOSTLY SOME 6183 05:07:02,840 --> 05:07:06,680 INFORMATION ABOUT THE 6184 05:07:06,680 --> 05:07:07,920 QUALITATIVE PART OF THE STUDY 6185 05:07:07,920 --> 05:07:12,560 WHICH IS ALREADY PUBLISHED. 6186 05:07:12,560 --> 05:07:14,120 THE RESULT OF THE CLINICAL TRIAL 6187 05:07:14,120 --> 05:07:21,920 ARE CURRENTLY BEING REVIEWED FOR 6188 05:07:21,920 --> 05:07:24,040 PUBLICATION BUT WE STILL MAY 6189 05:07:24,040 --> 05:07:30,120 HAVE SOME CONCLUSIONS. 6190 05:07:30,120 --> 05:07:32,840 WE MAY SAY THE DESIGN CONSIDERED 6191 05:07:32,840 --> 05:07:35,920 THE INITIAL QUALITATIVE STABLE 6192 05:07:35,920 --> 05:07:37,120 AND THERE'S AN APP WHO'S CONTENT 6193 05:07:37,120 --> 05:07:40,360 AND LANGUAGE ARE CULTURALLY 6194 05:07:40,360 --> 05:07:45,680 APPROPRIATE FOR THE TARGET 6195 05:07:45,680 --> 05:07:46,000 POPULATION. 6196 05:07:46,000 --> 05:07:53,440 WE BELIEVE AND WE HAVE POTENTIAL 6197 05:07:53,440 --> 05:07:56,560 USERS AND THE COMMUNITY AIMS TO 6198 05:07:56,560 --> 05:07:58,480 INCORPORATE THEIR VISION IN THE 6199 05:07:58,480 --> 05:08:01,640 DESIGN OF THE INTERVENTION. 6200 05:08:01,640 --> 05:08:06,120 AND THIS MAY CONTRIBUTE TO ITS 6201 05:08:06,120 --> 05:08:15,640 ACCEPTANCE AND THE APP IS AN 6202 05:08:15,640 --> 05:08:18,040 EFFECTIVE AND SAFE TOOL TO 6203 05:08:18,040 --> 05:08:20,000 SUPPORT THE SMOKING CESSATION IN 6204 05:08:20,000 --> 05:08:25,400 YOUNG WOMEN AND I CAN SHARE WITH 6205 05:08:25,400 --> 05:08:26,360 YOU THE CLINICAL TRIAL SHOWED 6206 05:08:26,360 --> 05:08:29,360 THAT PARTICIPANTS IN THE 6207 05:08:29,360 --> 05:08:30,400 INTERVENTION ARM ALMOST TRIPLED 6208 05:08:30,400 --> 05:08:33,840 THE CHANCE OF SMOKING ABSTINENCE 6209 05:08:33,840 --> 05:08:36,480 BOTH AT SIX WEEKS AND SIX MONTHS 6210 05:08:36,480 --> 05:08:38,320 FOLLOW-UP COMPARED TO THE 6211 05:08:38,320 --> 05:08:44,440 CONTROL PART OF THE STUDY. 6212 05:08:44,440 --> 05:08:46,240 WHILE THIS APP HAS ADVANTAGED 6213 05:08:46,240 --> 05:08:48,640 THAT ARE COMMON TO HEALTH 6214 05:08:48,640 --> 05:08:54,120 INTERVENTIONS BUT THIS IS 6215 05:08:54,120 --> 05:08:56,280 PARTICULARLY IMPORTANT FOR LATIN 6216 05:08:56,280 --> 05:08:57,560 AMERICA COUNTRIES AND LATINO 6217 05:08:57,560 --> 05:09:00,080 WOMEN AND THESE HEALTH 6218 05:09:00,080 --> 05:09:02,880 INTERVENTION USUALLY LOW COST 6219 05:09:02,880 --> 05:09:06,120 WITH A GREAT POTENTIAL FOR 6220 05:09:06,120 --> 05:09:06,520 SCALABILITY. 6221 05:09:06,520 --> 05:09:08,880 WOMEN WHO WANT TO QUIT SMOKING 6222 05:09:08,880 --> 05:09:13,880 HAVE A STRATEGY THAT WORKS 6223 05:09:13,880 --> 05:09:22,520 THROUGH THEIR MOBILE PHONES AND 6224 05:09:22,520 --> 05:09:26,880 TAKING THIS ASPECT INTO ACCOUNT 6225 05:09:26,880 --> 05:09:27,720 CAN BE VERY IMPORTANT FOR WOMEN 6226 05:09:27,720 --> 05:09:37,120 IN OUR TIMES. 6227 05:09:37,120 --> 05:09:40,080 AND THERE'S SMOKING CESSATION 6228 05:09:40,080 --> 05:09:44,600 AND WE HOPE THIS APPLICATION 6229 05:09:44,600 --> 05:09:49,280 CONTINUE TO IMPROVE HEALTH AMONG 6230 05:09:49,280 --> 05:09:50,120 LATINA WOMEN. 6231 05:09:50,120 --> 05:09:51,560 THANK YOU FOR YOUR ATTENTION AND 6232 05:09:51,560 --> 05:09:54,280 I'LL BE VERY HAPPY TO HAVE YOUR 6233 05:09:54,280 --> 05:09:54,880 QUESTIONS AND COMMENTS IN THE 6234 05:09:54,880 --> 05:10:04,000 PANEL. 6235 05:10:04,000 --> 05:10:12,800 >>HI, I'M CARMEN ZORRILLA AT 6236 05:10:12,800 --> 05:10:15,320 THE PUERTO RICO MEDICAL SCIENCES 6237 05:10:15,320 --> 05:10:18,080 CAMPUS AND THANK YOU FOR INV 6238 05:10:18,080 --> 05:10:19,960 INVITING US RELATING TO OUR 6239 05:10:19,960 --> 05:10:22,280 EXPERIENCES IN ENROLLING AND 6240 05:10:22,280 --> 05:10:26,480 RECRUITING AND RETAINING 6241 05:10:26,480 --> 05:10:27,320 SPECIFIC GROUPS FOR CLINICAL 6242 05:10:27,320 --> 05:10:29,680 TRIALS OR STUDIES. 6243 05:10:29,680 --> 05:10:31,200 I'LL SHARE SOME OF OUR 6244 05:10:31,200 --> 05:10:32,240 EXPERIENCES WITH DIVERSE STUDIES 6245 05:10:32,240 --> 05:10:32,880 THROUGHOUT THE TIME. 6246 05:10:32,880 --> 05:10:35,600 I WANT TO READ FIRST A QUOTE 6247 05:10:35,600 --> 05:10:38,280 FROM ONE OF MY FAVORITE AUTHORS 6248 05:10:38,280 --> 05:10:40,120 AND HE WROTE THE REWARD OF OUR 6249 05:10:40,120 --> 05:10:41,520 WORK IS NOT WHAT WE GET BUT WHAT 6250 05:10:41,520 --> 05:10:48,200 WE BECOME. 6251 05:10:48,200 --> 05:10:50,000 I'LL USE A TERM SUCH AS TARGET 6252 05:10:50,000 --> 05:10:51,280 POPULATION TO REFER TO GROUPS 6253 05:10:51,280 --> 05:10:56,240 WHERE WE OFFER PARTICIPATION AND 6254 05:10:56,240 --> 05:10:57,200 STUDIES BASED ON EXCLUSION 6255 05:10:57,200 --> 05:11:01,880 CRITERIA AND MAY BE PEOPLE OF A 6256 05:11:01,880 --> 05:11:06,400 CERTAIN AGE OR GEOGRAPHIC 6257 05:11:06,400 --> 05:11:08,320 LOCATIONS AND SOME RECEIVE 6258 05:11:08,320 --> 05:11:11,720 SERVICES LIKE FAMILY PLANNING, 6259 05:11:11,720 --> 05:11:13,680 PRENATAL CARE AND HIV CARE AND 6260 05:11:13,680 --> 05:11:14,640 DIABETES OR CANCER TREATMENT. 6261 05:11:14,640 --> 05:11:17,680 THIS IS NOT INTENDED TO BE 6262 05:11:17,680 --> 05:11:20,040 STIGMATIZING BUT IT'S ONE WAY TO 6263 05:11:20,040 --> 05:11:21,440 DEFINE THE POPULATIONS THAT WILL 6264 05:11:21,440 --> 05:11:26,080 BE ENROLLED OR ARE TARGET TO 6265 05:11:26,080 --> 05:11:31,480 PARTICIPATING IN THE STUDY. 6266 05:11:31,480 --> 05:11:32,760 AND TO STUDY SPECIFIC DISEASES 6267 05:11:32,760 --> 05:11:36,080 OR CONDITIONS SUCH AS THE ONES 6268 05:11:36,080 --> 05:11:38,280 MENTIONED WE'LL NEED DIVERSE 6269 05:11:38,280 --> 05:11:39,720 STRATEGIES DEPENDING ON THE AIMS 6270 05:11:39,720 --> 05:11:41,280 OF THE STUDY AND TYPES OF 6271 05:11:41,280 --> 05:11:42,160 POPULATION AN LOCATIONS AND 6272 05:11:42,160 --> 05:11:51,800 DURATION OF THE STUDY. 6273 05:11:51,800 --> 05:11:53,000 THERE'S LOCATIONS AND STORAGE 6274 05:11:53,000 --> 05:11:54,400 AREA AND INFRASTRUCTURE TO BE 6275 05:11:54,400 --> 05:11:56,880 ABLE TO ENROLL PATIENTS 6276 05:11:56,880 --> 05:11:58,880 RECEIVING SERVICES, DATA ACCESS 6277 05:11:58,880 --> 05:12:02,440 AND REGULATORY COMMUNITIES, 6278 05:12:02,440 --> 05:12:03,920 LABORATORY AND SAMPLE SHIPPING 6279 05:12:03,920 --> 05:12:07,480 AGREEMENTS AND SO ON. 6280 05:12:07,480 --> 05:12:08,600 SCREENING, DIAGNOSIS AND 6281 05:12:08,600 --> 05:12:10,080 MONITORING CAPABILITIES FOR THE 6282 05:12:10,080 --> 05:12:11,200 SPECIFIC CONDITIONS YOU WANT TO 6283 05:12:11,200 --> 05:12:12,080 STUDY IS IMPORTANT. 6284 05:12:12,080 --> 05:12:17,560 FOR DIABETES YOU NEED TO BE ABLE 6285 05:12:17,560 --> 05:12:23,240 TO HAVE SCREENING AND CAPACITY 6286 05:12:23,240 --> 05:12:28,400 IN PLACE AT THE CLINIC TO SCREEN 6287 05:12:28,400 --> 05:12:33,800 PARTICIPANTS AND FOLLOW NEM AND 6288 05:12:33,800 --> 05:12:39,120 THERE'S CONDITIONS THAT AND 6289 05:12:39,120 --> 05:12:40,360 SCREENING WAS COMPLICATED 6290 05:12:40,360 --> 05:12:42,280 SOMETIMES AND THAT WAS AN ISSUE 6291 05:12:42,280 --> 05:12:46,880 SOMETIMES WHEN WE WERE ENROLLING 6292 05:12:46,880 --> 05:12:50,320 PARTICIPANTS. 6293 05:12:50,320 --> 05:12:52,040 COMMUNITY INVOLVEMENT IS 6294 05:12:52,040 --> 05:12:57,360 ESSENTIAL INVESTIGATORS IS 6295 05:12:57,360 --> 05:12:59,160 IMPORTANT AND STRATEGIES ARE 6296 05:12:59,160 --> 05:12:59,680 NEEDED. 6297 05:12:59,680 --> 05:13:00,840 PLANNING AND LEARNING WITH THE 6298 05:13:00,840 --> 05:13:03,120 TARGET POPULATION DEPENDS ON THE 6299 05:13:03,120 --> 05:13:05,200 TYPE OF STUDY DISEASE, DURATION 6300 05:13:05,200 --> 05:13:07,040 OF INTERVENTION AND PERCEIVED 6301 05:13:07,040 --> 05:13:08,880 NEEDS OF THE COMMUNITY AMONG 6302 05:13:08,880 --> 05:13:11,040 OTHER ISSUES. 6303 05:13:11,040 --> 05:13:12,520 AND WE SEARCHED PASSION AND 6304 05:13:12,520 --> 05:13:14,960 ALLOW THE VOLUNTEERS TO ACCESS 6305 05:13:14,960 --> 05:13:18,080 SPECIFIC TESTS OR DIAGNOSIS AND 6306 05:13:18,080 --> 05:13:21,520 INTERACT WITH HEALTH CARE 6307 05:13:21,520 --> 05:13:23,320 PROFESSIONALS AND LEARN ABOUT 6308 05:13:23,320 --> 05:13:24,840 SPECIFIC CONDITIONS AND THEIR 6309 05:13:24,840 --> 05:13:28,920 PREVENTION, OBTAIN SERVICES, 6310 05:13:28,920 --> 05:13:30,240 RETAIN STRATEGIES AND DEVELOP A 6311 05:13:30,240 --> 05:13:32,560 SENSE OF COMMUNITY WITH OTHER 6312 05:13:32,560 --> 05:13:34,000 AFFECTS OR PARTICIPATING 6313 05:13:34,000 --> 05:13:34,320 INDIVIDUALS. 6314 05:13:34,320 --> 05:13:39,800 IN GENERAL, WE RECRUITERS NEED 6315 05:13:39,800 --> 05:13:41,520 TO BE SELECTED FROM THE SAME 6316 05:13:41,520 --> 05:13:42,120 TARGET POPULATION WHO HAVE 6317 05:13:42,120 --> 05:13:42,920 DIRECT KNOWLEDGE AND CAN CONNECT 6318 05:13:42,920 --> 05:13:45,760 WITH THEM. 6319 05:13:45,760 --> 05:13:47,600 I'M GOING TO MENTION SOME OF THE 6320 05:13:47,600 --> 05:13:52,120 SPECIFIC TARGET GROUPS WE HAVE 6321 05:13:52,120 --> 05:13:54,400 ENROLLED FOR STUDIES. 6322 05:13:54,400 --> 05:13:55,800 FOR EXAMPLE, AT HIGH RISK OR 6323 05:13:55,800 --> 05:13:58,120 DIFFICULT TO ACCESS POPULATIONS 6324 05:13:58,120 --> 05:14:02,880 WE'VE DONE HIV PREVENTION, 6325 05:14:02,880 --> 05:14:12,600 VACCINE PREPAREDNESS STUDIES AND 6326 05:14:12,600 --> 05:14:13,160 PARTNERED WITH COMMUNITY 6327 05:14:13,160 --> 05:14:14,120 ORGANIZATION THAT PROVIDE 6328 05:14:14,120 --> 05:14:18,800 SERVICES TO THE WORKER AND 6329 05:14:18,800 --> 05:14:21,200 CONTRACTED THEIR STAFF AS 6330 05:14:21,200 --> 05:14:21,680 RECRUITERS TO PROVIDE 6331 05:14:21,680 --> 05:14:25,960 TRANSPORTATION OR TO CARRY OUT 6332 05:14:25,960 --> 05:14:27,040 HOME VISITS. 6333 05:14:27,040 --> 05:14:28,960 WE THEN LOCATED WHERE A 6334 05:14:28,960 --> 05:14:33,640 PARTICIPANT AND WHAT TO DO IF 6335 05:14:33,640 --> 05:14:35,320 THEY WERE UNDER THE INFLUENCE 6336 05:14:35,320 --> 05:14:38,120 WHEN THEY CAME TO THE 6337 05:14:38,120 --> 05:14:40,160 APPOINTMENT OR WERE SUPPOSED TO 6338 05:14:40,160 --> 05:14:41,520 HAVE THE VISIT AND SAFETY 6339 05:14:41,520 --> 05:14:42,920 PRECAUTIONS AND WHAT TO DO WITH 6340 05:14:42,920 --> 05:14:45,440 MONETARY INCENTIVES AND ONE 6341 05:14:45,440 --> 05:14:48,400 EXAMPLE IS WE TELL EVERYBODY WE 6342 05:14:48,400 --> 05:14:52,160 DON'T HAVE CASH IN OUR CLINIC 6343 05:14:52,160 --> 05:14:55,160 AND WHENEVER WE NEED TO PAY 6344 05:14:55,160 --> 05:14:57,080 PEOPLE FOR VISITS, OUR STAFF 6345 05:14:57,080 --> 05:14:59,000 NEED TO GO TO THE CAMPUS 6346 05:14:59,000 --> 05:15:01,240 BUILDING TO GET THE MONEY. 6347 05:15:01,240 --> 05:15:02,320 PEOPLE DON'T UNDERSTAND THERE'S 6348 05:15:02,320 --> 05:15:04,160 NO MONEY AT THE CLINIC THEREFORE 6349 05:15:04,160 --> 05:15:09,200 TO REDUCE THE RISK OF INCIDENTS. 6350 05:15:09,200 --> 05:15:16,280 FOR PREVENTION STUDY OF TO TEST 6351 05:15:16,280 --> 05:15:20,280 AND TREAT FOR HIV WE ACQUIRED 6352 05:15:20,280 --> 05:15:24,040 TWO MOBILE UNITS TO COVER 6353 05:15:24,040 --> 05:15:24,880 DIVERSE GEOGRAPHIC AREAS AND 6354 05:15:24,880 --> 05:15:25,960 IMPLEMENT THE STUDY. 6355 05:15:25,960 --> 05:15:29,960 THE MOBILE UNITS WERE MANAGED BY 6356 05:15:29,960 --> 05:15:33,280 A CVO STAFF AND MOST THE STUDY 6357 05:15:33,280 --> 05:15:38,160 PROCEDURES INCLUDING SAMPLING 6358 05:15:38,160 --> 05:15:42,200 QUESTIONNAIRES AND STUDY VISITS 6359 05:15:42,200 --> 05:15:43,320 WERE CARRIED OUT USING THE 6360 05:15:43,320 --> 05:15:44,560 MOBILE UNITS. 6361 05:15:44,560 --> 05:15:47,040 THESE ARE EXAMPLES OF THE 6362 05:15:47,040 --> 05:15:48,240 PUBLICATIONS ADDRESSING THE 6363 05:15:48,240 --> 05:15:50,880 POPULATIONS AND I'M GOING 6364 05:15:50,880 --> 05:15:53,640 MENTION AN EXAMPLE ON THE 6365 05:15:53,640 --> 05:15:57,120 PARTICULAR STUDY ON RECRUITMENT 6366 05:15:57,120 --> 05:16:00,000 OF WORKERS IN THE CARIBBEAN. 6367 05:16:00,000 --> 05:16:03,760 IN THIS STUDY IT WAS HAITI, 6368 05:16:03,760 --> 05:16:06,360 JAMAICA AND PUERTO RICO 6369 05:16:06,360 --> 05:16:07,240 PARTICIPATED FOR THE VACCINE 6370 05:16:07,240 --> 05:16:08,160 TRIALS NETWORK. 6371 05:16:08,160 --> 05:16:11,280 SOME OF THE COUNTRIES TARGETED 6372 05:16:11,280 --> 05:16:13,720 WOMEN WHO WERE COMMERCIAL SEX 6373 05:16:13,720 --> 05:16:16,360 WORKERS BECAUSE OF THEIR 6374 05:16:16,360 --> 05:16:19,680 HIGH-RISK OF STREET SEX WORKERS 6375 05:16:19,680 --> 05:16:20,520 WE TARGETED WOMEN WHO WERE 6376 05:16:20,520 --> 05:16:22,360 STREET SEX WORKERS AND WE 6377 05:16:22,360 --> 05:16:23,320 PARTNERED WITH COMMUNITY-BASED 6378 05:16:23,320 --> 05:16:24,360 ORGANIZATION WHO WERE THE ONES 6379 05:16:24,360 --> 05:16:28,440 WHO WERE IN CONTACT WITH THEM 6380 05:16:28,440 --> 05:16:29,360 AND ACTUALLY GAVE THEM 6381 05:16:29,360 --> 05:16:32,080 TRANSPORTATION FOR THE STUDY 6382 05:16:32,080 --> 05:16:33,680 VISITS AT THE CLINIC. 6383 05:16:33,680 --> 05:16:36,600 ONE INTERESTING ISSUE THAT 6384 05:16:36,600 --> 05:16:40,440 EMERGED WAS THE PARTICIPANTS THE 6385 05:16:40,440 --> 05:16:42,200 CVO STAFF PROPOSED TOOLS WE 6386 05:16:42,200 --> 05:16:45,760 NEEDED TO HAVE LIKE A PHOTO I.D. 6387 05:16:45,760 --> 05:16:48,960 OF PARTICIPATION IN THE STUDY 6388 05:16:48,960 --> 05:16:51,200 AND FELT IT WAS A GREAT IDEA 6389 05:16:51,200 --> 05:16:52,880 BECAUSE WE WANTED A PHOTO THEIR 6390 05:16:52,880 --> 05:16:54,680 PARTICIPANT SO IT WOULD CHANGE 6391 05:16:54,680 --> 05:16:57,400 APPEARANCE AS THEY OFTEN DO 6392 05:16:57,400 --> 05:16:58,240 ESPECIALLY PEOPLE ON THE STREETS 6393 05:16:58,240 --> 05:16:59,800 WE WOULD BE ABLE TO IDENTIFY 6394 05:16:59,800 --> 05:17:02,480 THEM FOR STUDY VISITS. 6395 05:17:02,480 --> 05:17:04,840 AND IT SO HAPPENED THE 6396 05:17:04,840 --> 05:17:07,000 PARTICIPANTS ENROLLED IN THE 6397 05:17:07,000 --> 05:17:08,000 STUDY LOVED THE PHOTO I.D. 6398 05:17:08,000 --> 05:17:13,320 BECAUSE IT GAVE THEM SORT OF 6399 05:17:13,320 --> 05:17:15,120 LIKE INE IDEA SAYING I'M 6400 05:17:15,120 --> 05:17:16,080 PARTICIPATING IN THE HIV 6401 05:17:16,080 --> 05:17:17,200 PREVENTION STUDY THAT REQUIRES 6402 05:17:17,200 --> 05:17:18,920 ME TO BE HIV NEGATIVE SO THEY 6403 05:17:18,920 --> 05:17:21,720 WOULD SHOW THE I.D. TO THEIR 6404 05:17:21,720 --> 05:17:22,960 FRIENDS AND CLIENTS. 6405 05:17:22,960 --> 05:17:26,440 AND THIS WAS NOT A GOVERNMENT 6406 05:17:26,440 --> 05:17:29,160 ISSUE I.D. BUT THEY WERE HAPPY 6407 05:17:29,160 --> 05:17:33,200 TO HAVE THAT AND REUSED IT AS A 6408 05:17:33,200 --> 05:17:37,600 STRATEGY IN THAT STUDY. 6409 05:17:37,600 --> 05:17:38,120 PREGNANT POPULATIONS WE 6410 05:17:38,120 --> 05:17:42,040 CERTAINLY ENROLLED THEM IN THE 6411 05:17:42,040 --> 05:17:43,680 PRENATAL CARE CLINIC. 6412 05:17:43,680 --> 05:17:46,400 FOR EXAMPLE, WE HAD A 6413 05:17:46,400 --> 05:17:47,920 PROSPECTIVE STUDY IN PREGNANCY 6414 05:17:47,920 --> 05:17:51,800 AND WE ENROLLED WOMEN FROM THE 6415 05:17:51,800 --> 05:17:52,920 PRENATAL CLINIC IN OUR HOSPITAL 6416 05:17:52,920 --> 05:17:56,120 FOR ANOTHER STUDY SPONSORED BY 6417 05:17:56,120 --> 05:18:00,360 THE CDC ON ZIKA EXPOSED INFANTS 6418 05:18:00,360 --> 05:18:05,400 WE RECEIVED WOMEN DIAGNOSED BY 6419 05:18:05,400 --> 05:18:08,800 PROVIDERS AND THE SECOND STUDY 6420 05:18:08,800 --> 05:18:09,760 DIDN'T REQUIRE SPECIFIC 6421 05:18:09,760 --> 05:18:10,640 GESTATIONAL AGE FOR PARTICIPANTS 6422 05:18:10,640 --> 05:18:16,400 BUT THE FIRST STUDY NEEDED WOMEN 6423 05:18:16,400 --> 05:18:18,840 WHO WERE WITHIN THE FIRST OR 6424 05:18:18,840 --> 05:18:20,920 SECOND TRIMESTER. 6425 05:18:20,920 --> 05:18:24,240 WE NEEDED TO HAVE STAFF AT THE 6426 05:18:24,240 --> 05:18:26,120 CLINIC TO BE ABLE TO IDENTIFY 6427 05:18:26,120 --> 05:18:27,480 PARTICIPANTS ACCORDING TO THE 6428 05:18:27,480 --> 05:18:29,240 GESTATIONAL AGE AND OTHER 6429 05:18:29,240 --> 05:18:31,440 CRITERIA AND OFFER PARTICIPATION 6430 05:18:31,440 --> 05:18:32,960 AND COORDINATE THE APPOINTMENTS. 6431 05:18:32,960 --> 05:18:36,720 ANOTHER STUDY WE DID ON CARE 6432 05:18:36,720 --> 05:18:39,040 SAME THING WE NEEDED TO HAVE 6433 05:18:39,040 --> 05:18:40,600 STAFF AT THE CLINIC TO BE ABLE 6434 05:18:40,600 --> 05:18:42,160 TO OFFER THE PARTICIPATION TO 6435 05:18:42,160 --> 05:18:43,640 THE PATIENTS. 6436 05:18:43,640 --> 05:18:48,040 CLINIC STAFF IS USUALLY BUSY AND 6437 05:18:48,040 --> 05:18:49,400 UNINTERESTED IN RECRUITING 6438 05:18:49,400 --> 05:18:50,080 PARTICIPANTS THEREFORE THIS IS 6439 05:18:50,080 --> 05:18:53,760 WHY WE NEED TO HAVE STUDY STAFF 6440 05:18:53,760 --> 05:18:55,520 LOCATED AT THE CLINICS WHEN THEY 6441 05:18:55,520 --> 05:18:59,840 ARE WORKING SO WE ARE ABLE TO 6442 05:18:59,840 --> 05:19:02,600 ENROLL AND THIS IS A STRATEGY 6443 05:19:02,600 --> 05:19:03,640 HIGHLY SUCCESSFUL. 6444 05:19:03,640 --> 05:19:06,200 AND THESE ARE SOME PUBLICATIONS 6445 05:19:06,200 --> 05:19:08,920 OF THE STUDY. 6446 05:19:08,920 --> 05:19:10,760 ONE OF THE COGNITIVE ASSESSMENTS 6447 05:19:10,760 --> 05:19:16,280 ON THE INFANTS OF ZIKA-EXPOSED 6448 05:19:16,280 --> 05:19:17,760 INFANTS. 6449 05:19:17,760 --> 05:19:23,080 AND FROM THOSE POPULATIONS SOME 6450 05:19:23,080 --> 05:19:27,520 TIME AFTER THE STUDY AND WE HAD 6451 05:19:27,520 --> 05:19:32,080 HALF THE COHORT HAD DELIVERED BY 6452 05:19:32,080 --> 05:19:33,120 HURRICANE MARIA AND HALF WERE 6453 05:19:33,120 --> 05:19:35,400 STILL PREGNANT. 6454 05:19:35,400 --> 05:19:37,680 WE WESTBOUND ABLE TO DEVELOP 6455 05:19:37,680 --> 05:19:44,600 ANOTHER STUDY ON EXPERIENCES AND 6456 05:19:44,600 --> 05:19:46,640 WE USE THE SAME STRATEGIES TO 6457 05:19:46,640 --> 05:19:48,640 ENROLL AND TO MAINTAIN AND THEY 6458 05:19:48,640 --> 05:19:51,280 HAD THE OPPORTUNITY OF 6459 05:19:51,280 --> 05:19:52,440 PARTICIPATING INTO OTHER STUDIES 6460 05:19:52,440 --> 05:19:55,280 BECAUSE WE INCLUDED IN THE 6461 05:19:55,280 --> 05:19:57,640 CONSENT FORM SENTENCES THAT WE 6462 05:19:57,640 --> 05:20:04,200 COULD CONTACT THEM FOR 6463 05:20:04,200 --> 05:20:05,360 PARTICIPATION IN ADDITIONAL 6464 05:20:05,360 --> 05:20:12,600 STUDIES FOR THEM OR THE INFANLT 6465 05:20:12,880 --> 05:20:15,960 -- INFANTS AND THE ELIMINATION 6466 05:20:15,960 --> 05:20:19,400 OF PRE NATAL TRANSMISSION. 6467 05:20:19,400 --> 05:20:22,240 THIS IS WHERE WE STARTED 6468 05:20:22,240 --> 05:20:27,000 PRENATAL SCREENING YEARS BEFORE 6469 05:20:27,000 --> 05:20:32,360 THE CDC RECOMMEND ED HIV 6470 05:20:32,360 --> 05:20:35,240 SCREENING AND AFTER WE HAD A 6471 05:20:35,240 --> 05:20:37,720 LONGITUDINAL FOLLOW-UP OF THE 6472 05:20:37,720 --> 05:20:38,920 PREGNANT PERSONS AND WE HAD 6473 05:20:38,920 --> 05:20:44,920 ACCESS TO A POPULATION OF WOMEN 6474 05:20:44,920 --> 05:20:48,400 OF REPRODUCTIVE AGE OF WOMEN 6475 05:20:48,400 --> 05:20:49,520 LIVING WITH HIV. 6476 05:20:49,520 --> 05:20:52,560 WOMEN OF REPRODUCTIVE AGE NOT 6477 05:20:52,560 --> 05:20:54,440 PREGNANT ARE ALSO TARGETED FOR 6478 05:20:54,440 --> 05:20:57,440 SPECIFIC STUDIES SUCH AS DRUG 6479 05:20:57,440 --> 05:20:58,080 CLINICAL TRIALS. 6480 05:20:58,080 --> 05:21:04,480 ONE STUDY ON PREVALENCE OF HPV 6481 05:21:04,480 --> 05:21:07,440 AMONG WOMEN LIVING WITH HIV OR 6482 05:21:07,440 --> 05:21:11,760 OTHER PREVENTION TRIAL. 6483 05:21:11,760 --> 05:21:13,320 FOR THIS TRIAL WE OFFERED THE 6484 05:21:13,320 --> 05:21:15,960 PARTICIPATION AT A 6485 05:21:15,960 --> 05:21:16,760 FAMILY-PLANNING CLINIC. 6486 05:21:16,760 --> 05:21:19,360 WE HAD STAFF AT THE CLINIC WHO 6487 05:21:19,360 --> 05:21:22,400 CONNECTED WITH THE PATIENTS AND 6488 05:21:22,400 --> 05:21:26,120 ALL THE STUDY PROCEDURES WERE 6489 05:21:26,120 --> 05:21:27,640 CARRIED OUT AT THE CLINIC. 6490 05:21:27,640 --> 05:21:31,440 SOME OF THE PUBLICATIONS OF THE 6491 05:21:31,440 --> 05:21:37,000 STUDIES OF NON-PREGNANT WOMEN 6492 05:21:37,000 --> 05:21:38,680 CLINICAL TRIALS, HPV PREVALENCE 6493 05:21:38,680 --> 05:21:44,720 AND DRUG INTERACTIONS. 6494 05:21:44,720 --> 05:21:46,480 FINALLY I WANT TO MENTION OUR 6495 05:21:46,480 --> 05:21:49,960 EXPERIENCE WITH ENROLLING 6496 05:21:49,960 --> 05:21:53,720 GENERAL POPULATION OF WOMEN FROM 6497 05:21:53,720 --> 05:21:58,800 21 TO PLUS FOR A VACCINE STUDY A 6498 05:21:58,800 --> 05:21:59,840 COVID VACCINE STUDY. 6499 05:21:59,840 --> 05:22:04,840 AT THIS TIME THIS WAS AN NOVAVAC 6500 05:22:04,840 --> 05:22:05,040 STUDY. 6501 05:22:05,040 --> 05:22:06,640 AT THE TIME VACCINES WERE NOT 6502 05:22:06,640 --> 05:22:08,280 AVAILABLE FOR THE GENERAL PUBLIC 6503 05:22:08,280 --> 05:22:10,040 AND PEOPLE WERE REALLY WILLING 6504 05:22:10,040 --> 05:22:14,320 TO PARTICIPATE IN A TRIAL IN 6505 05:22:14,320 --> 05:22:17,120 ORDER TO GET THE VACCINE OR 6506 05:22:17,120 --> 05:22:18,760 POTENTIAL USEFUL VACCINE. 6507 05:22:18,760 --> 05:22:24,160 THE STUDY HAD A 2:1 RATIO 6508 05:22:24,160 --> 05:22:27,320 VACCINE TO PLACEBO AND WITHIN 6509 05:22:27,320 --> 05:22:30,720 SIX MONTHS ALL PARTICIPANTS 6510 05:22:30,720 --> 05:22:32,200 WOULD HAVE RECEIVED THE VACCINE 6511 05:22:32,200 --> 05:22:34,800 AND THIS WAS ATTRACTIVE IN THIS 6512 05:22:34,800 --> 05:22:35,000 STUDY. 6513 05:22:35,000 --> 05:22:36,600 WE ENROLLED PEOPLE FROM ALL 6514 05:22:36,600 --> 05:22:42,480 WALKS OF LIFE FROM PEOPLE WHO 6515 05:22:42,480 --> 05:22:46,120 HAD BEEN HOMELESS TO 6516 05:22:46,120 --> 05:22:47,040 MILLIONAIRES AND DURING THE 6517 05:22:47,040 --> 05:22:50,920 SCREENING PHASE AND EVALUATIONS 6518 05:22:50,920 --> 05:22:53,160 FOR PREEXISTING CONDITIONS WE 6519 05:22:53,160 --> 05:22:54,520 DIAGNOSED A LOT OF PEOPLE WITH 6520 05:22:54,520 --> 05:22:55,800 HYPERTENSION AND DIABETES AND WE 6521 05:22:55,800 --> 05:22:58,560 HAD TO REFER THEM FOR MANAGEMENT 6522 05:22:58,560 --> 05:23:01,000 SO THIS WAS SOMETHING THAT THEY 6523 05:23:01,000 --> 05:23:03,200 GAINED FROM THE SCREENING WAS TO 6524 05:23:03,200 --> 05:23:07,440 BE ABLE TO HAVE A CONDITION THAT 6525 05:23:07,440 --> 05:23:10,040 WAS UNSUSPECTED, DIAGNOSED AND 6526 05:23:10,040 --> 05:23:10,240 MANAGED. 6527 05:23:10,240 --> 05:23:12,440 IT WAS A GREAT EXPERIENCE FOR 6528 05:23:12,440 --> 05:23:14,280 STAFF AND FOR ME BECAUSE THIS IS 6529 05:23:14,280 --> 05:23:16,440 AN UNUSUAL GROUP OF PEOPLE FROM 6530 05:23:16,440 --> 05:23:18,200 ALL WALKS OF LIFE. 6531 05:23:18,200 --> 05:23:22,480 WE HAD AND LAWYERS AND WE HAD 6532 05:23:22,480 --> 05:23:23,720 PEOPLE WHO WERE REQUIRED AND 6533 05:23:23,720 --> 05:23:26,120 THEY WERE ALL REALLY VERY 6534 05:23:26,120 --> 05:23:27,760 WILLING TO PARTICIPATE IN THE 6535 05:23:27,760 --> 05:23:29,960 TRIAL AND WE STILL GET CALLED 6536 05:23:29,960 --> 05:23:36,880 WHEN THEY GET SYMPTOMS OF COVID 6537 05:23:36,880 --> 05:23:38,080 AND WE FELT WE NEEDED TO MANAGE 6538 05:23:38,080 --> 05:23:40,840 THEM WITH PRESCRIPTIONS AND 6539 05:23:40,840 --> 05:23:42,200 WHATEVER THEY NEEDED AND THOUGH 6540 05:23:42,200 --> 05:23:47,920 THE STUDY ENDED WE'RE STILL 6541 05:23:47,920 --> 05:23:49,480 EVALUATING LONG-TERM OUTCOMES 6542 05:23:49,480 --> 05:23:51,080 AND POTENTIAL COVID-19 6543 05:23:51,080 --> 05:23:54,080 INVECTIONS FOR THE GROUP OF 6544 05:23:54,080 --> 05:23:54,840 PARTICIPANTS. 6545 05:23:54,840 --> 05:23:59,280 WE'RE NOW IMPLEMENT STUDY OF 6546 05:23:59,280 --> 05:24:03,840 INJECTABLE PREVENTION DRUG FOR 6547 05:24:03,840 --> 05:24:11,400 LGBTQI PLUS POPULATIONS AND WE 6548 05:24:11,400 --> 05:24:12,400 CREATED AN ADVISORY BOARD OF 6549 05:24:12,400 --> 05:24:15,600 PEOPLE WHO HAVE A SIGNIFICANT 6550 05:24:15,600 --> 05:24:17,680 SOCIAL MEDIA AND REPRESENT THE 6551 05:24:17,680 --> 05:24:20,040 COMMUNITY INCLUDING TRANS 6552 05:24:20,040 --> 05:24:26,880 PERSONS AND OTHER SELF-REPORTED 6553 05:24:26,880 --> 05:24:30,120 PEOPLE AND THEY'RE WILLING TO 6554 05:24:30,120 --> 05:24:31,560 DISSEMINATE THEIR ADS IN THEIR 6555 05:24:31,560 --> 05:24:32,360 OWN SOCIAL MEDIA. 6556 05:24:32,360 --> 05:24:34,760 THIS IS GOING TO BE OUR STRATEGY 6557 05:24:34,760 --> 05:24:39,600 FOR ENROLLMENT. 6558 05:24:39,600 --> 05:24:43,640 FOR ANOTHER MICROBIALCYTE 6559 05:24:43,640 --> 05:24:49,080 STUDIES WE HAD A YOUNG MAN FROM 6560 05:24:49,080 --> 05:24:50,960 THE COMMUNITY AND HE WAS 6561 05:24:50,960 --> 05:24:54,080 INVOLVED IN SOCIAL MEDIA AND 6562 05:24:54,080 --> 05:24:54,640 COMMUNITY INTERVENTIONS 6563 05:24:54,640 --> 05:24:56,760 INCLUDING VISITING BARS AND 6564 05:24:56,760 --> 05:24:59,360 OTHER MEETING PLACES AND EVENTS. 6565 05:24:59,360 --> 05:25:01,720 FINAL THOUGHTS, INVESTIGATORS 6566 05:25:01,720 --> 05:25:03,720 NEED TO BE HIGHLY MOTIVATED. 6567 05:25:03,720 --> 05:25:06,120 RESOURCES NEED TO BE AVAILABLE 6568 05:25:06,120 --> 05:25:08,920 AND RETENTION STRATEGIES CAN 6569 05:25:08,920 --> 05:25:13,080 INCLUDE LABORATORIES, MONETARY 6570 05:25:13,080 --> 05:25:14,360 INCENTIVES, GASOLINE OR FOOD 6571 05:25:14,360 --> 05:25:14,560 CARDS. 6572 05:25:14,560 --> 05:25:16,440 STAFF NEEDS TO BE FRIENDLY AND 6573 05:25:16,440 --> 05:25:18,720 SENSITIVE ABOUT THE NEEDS OF THE 6574 05:25:18,720 --> 05:25:20,080 POPULATION AND CONSTANT 6575 05:25:20,080 --> 05:25:21,320 COMMUNICATION IS ESSENTIAL TO 6576 05:25:21,320 --> 05:25:22,480 MAKE THEM FEEL THE STUDY BELONGS 6577 05:25:22,480 --> 05:25:25,160 TO THEM AND IS AN IMPORTANT 6578 05:25:25,160 --> 05:25:26,760 CONTRIBUTION FROM THE COMMUNITY 6579 05:25:26,760 --> 05:25:28,320 TO SCIENCE AND TO THE REST OF 6580 05:25:28,320 --> 05:25:30,440 THE COMMUNITY. 6581 05:25:30,440 --> 05:25:32,240 I'D LIKE TO CHOOSE STUDIES AND 6582 05:25:32,240 --> 05:25:34,400 PROJECTS I THINK WILL IMPACT 6583 05:25:34,400 --> 05:25:38,400 PEOPLE EVEN IF ONLY ONE AT A 6584 05:25:38,400 --> 05:25:38,920 TIME. 6585 05:25:38,920 --> 05:25:41,520 AND FINALLY I'LL READ A QUOTE 6586 05:25:41,520 --> 05:25:43,480 FROM MY FAVORITE AUTHOR AN HE 6587 05:25:43,480 --> 05:25:45,760 WROTE BEFORE MAKING AN IMPORTANT 6588 05:25:45,760 --> 05:25:47,520 DECISION LIKE DECLARING A WAR OR 6589 05:25:47,520 --> 05:25:52,160 MOVING TO OTHER PLANES OAR WHERE 6590 05:25:52,160 --> 05:25:55,040 TO PLANT A WARRIOR ASKS HOW WILL 6591 05:25:55,040 --> 05:26:00,000 THIS AFFECT MY DESCENDENTS. 6592 05:26:00,000 --> 05:26:04,480 THE WARRIOR KNOWS THAT EVERY 6593 05:26:04,480 --> 05:26:06,640 ACTION HAS A LONG-TERM 6594 05:26:06,640 --> 05:26:07,960 CONSEQUENCES AND NEEDS TO 6595 05:26:07,960 --> 05:26:09,080 UNDERSTAND WHAT KIND OF WORLD HE 6596 05:26:09,080 --> 05:26:10,320 IS LEAVING FOR THAT FIFTH 6597 05:26:10,320 --> 05:26:14,120 GENERATION. 6598 05:26:14,120 --> 05:26:15,320 THANK YOU VERY MUCH. 6599 05:26:15,320 --> 05:26:16,040 >>GOOD AFTERNOON. 6600 05:26:16,040 --> 05:26:19,840 THANK YOU FOR THE IN THE 6601 05:26:19,840 --> 05:26:21,880 INVITATION TO PARTICIPATE. 6602 05:26:21,880 --> 05:26:23,600 SO IMPORTANT FOR OUR REGION. 6603 05:26:23,600 --> 05:26:24,800 TODAY WE'LL TALK ABOUT THE ROLE 6604 05:26:24,800 --> 05:26:26,800 OF IMPLEMENTATION SCIENCE TO 6605 05:26:26,800 --> 05:26:30,080 ADVANCE THE IMPACT OF RESEARCH 6606 05:26:30,080 --> 05:26:33,640 IN PUBLIC HEALTH. 6607 05:26:33,640 --> 05:26:38,040 LET ME START BY REFLECTING ON 6608 05:26:38,040 --> 05:26:40,880 THE KNOWLEDGE THAT WE ALREADY 6609 05:26:40,880 --> 05:26:43,360 HAVE IN HEALTH SCIENCE. 6610 05:26:43,360 --> 05:26:45,760 THERE ARE MANY INTERVENTIONS, 6611 05:26:45,760 --> 05:26:50,160 TREATMENTS, STRATEGIES THAT HAVE 6612 05:26:50,160 --> 05:26:51,960 BEEN PROVEN EFFECTIVE IN 6613 05:26:51,960 --> 05:26:54,000 CONTROLLED RESEARCH SETTINGS. 6614 05:26:54,000 --> 05:26:59,160 THE PROBLEM IS THAT THOSE PROVEN 6615 05:26:59,160 --> 05:27:00,000 EFFECTIVE, EVIDENCE-BASED 6616 05:27:00,000 --> 05:27:02,400 INTERVENTIONS ARE NOT 6617 05:27:02,400 --> 05:27:06,080 IMPLEMENTED IN HEALTH CARE 6618 05:27:06,080 --> 05:27:08,280 SERVICES AND IT TAKES A LONG 6619 05:27:08,280 --> 05:27:10,600 TIME TO REACH EFFECTIVE 6620 05:27:10,600 --> 05:27:14,080 IMPLEMENTATION. 6621 05:27:14,080 --> 05:27:15,320 SO THERE IS A GAP BETWEEN WHAT 6622 05:27:15,320 --> 05:27:18,120 WE KNOW AND WHAT WE DO IN 6623 05:27:18,120 --> 05:27:20,320 PRACTICE. 6624 05:27:20,320 --> 05:27:22,280 THE AIM OF THE IMPLEMENTATION 6625 05:27:22,280 --> 05:27:25,640 RESEARCH IS TO BRIDGE THIS GAP. 6626 05:27:25,640 --> 05:27:26,360 TO CONTRIBUTE TO REDUCE THIS 6627 05:27:26,360 --> 05:27:32,200 GAP. 6628 05:27:32,200 --> 05:27:36,120 WE CAN DEFINE IMPLEMENTATION 6629 05:27:36,120 --> 05:27:39,000 SCIENCE AS THE STUDY OF METHODS 6630 05:27:39,000 --> 05:27:43,840 TO PROMOTE THE UPTAKE AND 6631 05:27:43,840 --> 05:27:46,080 INTEGRATION OF EVIDENCE-BASED 6632 05:27:46,080 --> 05:27:48,400 PRACTICES, INTERVENTIONS AND 6633 05:27:48,400 --> 05:27:50,400 POLICIES IN ROUTINE HEALTH CARE 6634 05:27:50,400 --> 05:27:55,360 AND PUBLIC HEALTH SETTINGS TO 6635 05:27:55,360 --> 05:27:57,360 IMPROVE THE IMPACT OF POPULATION 6636 05:27:57,360 --> 05:27:58,080 HEALTH. 6637 05:27:58,080 --> 05:28:02,920 AND AN IMPORTANT CONCEPT HERE IS 6638 05:28:02,920 --> 05:28:07,000 THAT IN IMPLEMENTATION SCIENCE 6639 05:28:07,000 --> 05:28:09,520 WE WORK IN COMPLEXITY. 6640 05:28:09,520 --> 05:28:14,080 THE PROJECTS TAKE PLACE ALWAYS 6641 05:28:14,080 --> 05:28:16,480 IN COMPLEX REALITIES. 6642 05:28:16,480 --> 05:28:19,480 FIRST, WE DEAL WITH COMPLEX 6643 05:28:19,480 --> 05:28:22,520 PROBLEMS WITH MULTIPLE CAUSES, 6644 05:28:22,520 --> 05:28:25,320 FEEDBACK LOOPS, MEDIATORS, 6645 05:28:25,320 --> 05:28:32,440 MODERATORS, FACTORS WE CANNOT 6646 05:28:32,440 --> 05:28:43,120 MEASURE OR WE DID NOT KNOW ABOUT 6647 05:28:43,120 --> 05:28:46,840 AND WE DESIGN COMPLEX 6648 05:28:46,840 --> 05:28:47,680 INTERVENTIONS AND ADDRESSING 6649 05:28:47,680 --> 05:28:49,880 DIFFERENT BARRIERS AND ASPECTS 6650 05:28:49,880 --> 05:28:53,320 OF THE PROBLEM. 6651 05:28:53,320 --> 05:28:57,000 WORKING AT DIFFERENT LEVELS, THE 6652 05:28:57,000 --> 05:29:00,240 SYSTEM LEVEL, THE PROVIDE LEVEL 6653 05:29:00,240 --> 05:29:01,520 AND PATIENT LEVEL AND COMMUNITY 6654 05:29:01,520 --> 05:29:03,960 AND WE USUALLY APPROACH 6655 05:29:03,960 --> 05:29:06,000 DIFFERENT BEHAVIORS. 6656 05:29:06,000 --> 05:29:14,440 THE CONTEXT IS ALSO COMPLEX 6657 05:29:14,440 --> 05:29:16,520 DYNAMIC AND MULTI-DIMENSIONAL. 6658 05:29:16,520 --> 05:29:17,800 THERE'S BARRIERS AND 6659 05:29:17,800 --> 05:29:18,960 FACILITATORS WE NEED TO 6660 05:29:18,960 --> 05:29:19,240 IDENTIFY. 6661 05:29:19,240 --> 05:29:23,760 THE PROCESS OF IMPLEMENTATION IS 6662 05:29:23,760 --> 05:29:28,000 COMPLEX AND INCLUDES MULTIPLE 6663 05:29:28,000 --> 05:29:32,680 STRATEGIES AND MANY ACT ORS, 6664 05:29:32,680 --> 05:29:34,440 IMPLEMENTERS, DECISION MAKERS, 6665 05:29:34,440 --> 05:29:37,160 CIVIL SOCIETY, STAKEHOLDERS WITH 6666 05:29:37,160 --> 05:29:38,280 DIFFERENT LEVELS OF POWER, 6667 05:29:38,280 --> 05:29:42,360 INFLUENCE AND INTEREST. 6668 05:29:42,360 --> 05:29:46,520 FINALLY, POPULATIONS ARE 6669 05:29:46,520 --> 05:29:46,760 COMPLEX. 6670 05:29:46,760 --> 05:29:48,280 DIFFERENT GROUPS AND SUB GROUPS 6671 05:29:48,280 --> 05:29:50,080 WITH DIFFERENT CHARACTERISTICS, 6672 05:29:50,080 --> 05:30:00,440 RESOURCES AND NEEDS. 6673 05:30:06,600 --> 05:30:11,200 LET ME BRIEFLY TELL YOU ABOUT AN 6674 05:30:11,200 --> 05:30:15,000 IMPLEMENTATION SCIENCE STUDY TO 6675 05:30:15,000 --> 05:30:17,400 TEST A COMPREHENSIVE 6676 05:30:17,400 --> 05:30:18,600 INTERVENTION TO IMPROVE 6677 05:30:18,600 --> 05:30:20,520 HYPERTENSION CONTROL IN 6678 05:30:20,520 --> 05:30:24,960 VULNERABLE POPULATION IN THE 6679 05:30:24,960 --> 05:30:26,560 PRIMARY CARE SETTING IN FIVE 6680 05:30:26,560 --> 05:30:31,280 PROVINCES IN ARGENTINA. 6681 05:30:31,280 --> 05:30:33,920 WE CONDUCTED A NEEDS ASSESSMENT 6682 05:30:33,920 --> 05:30:35,440 TO UNDERSTAND THE LOCAL NEEDS 6683 05:30:35,440 --> 05:30:38,520 AND PRIORITIES AND BARRIERS, 6684 05:30:38,520 --> 05:30:40,080 FACILITATORS FOR HYPERTENSION 6685 05:30:40,080 --> 05:30:44,160 MANAGEMENT AT THE PRIMARY CARE 6686 05:30:44,160 --> 05:30:47,840 LEVEL IN THE PROVINCES FROM 6687 05:30:47,840 --> 05:30:49,040 DIFFERENT PERSPECTIVES, FOR 6688 05:30:49,040 --> 05:30:49,760 EXAMPLE, HEALTH CARE PROVIDERS, 6689 05:30:49,760 --> 05:30:56,840 PATIENTS AND THEIR FAMILIES. 6690 05:30:56,840 --> 05:31:01,680 WITH ALSO CONDUCTED STAKE 6691 05:31:01,680 --> 05:31:02,280 HEADLHOLDER 6692 05:31:02,280 --> 05:31:03,520 MAPPING AND LOOKED AT THE 6693 05:31:03,520 --> 05:31:06,080 DESIGN, CO-CREATION AND 6694 05:31:06,080 --> 05:31:09,800 IMPLEMENTATION OF THE 6695 05:31:09,800 --> 05:31:10,120 INTERVENTION. 6696 05:31:10,120 --> 05:31:14,800 WE USED PARTICIPATORY RESEARCH 6697 05:31:14,800 --> 05:31:16,400 METHODS WITH THE COMMUNITY AS 6698 05:31:16,400 --> 05:31:18,920 WELL AND THIS IN A SHELL ARE THE 6699 05:31:18,920 --> 05:31:20,600 FINAL COMPONENTS OF THE 6700 05:31:20,600 --> 05:31:22,080 INTERVENTION. 6701 05:31:22,080 --> 05:31:26,080 WE HAVE THREE COMPONENTS. 6702 05:31:26,080 --> 05:31:27,240 THE FIRST WAS LED BY COMMUNITY 6703 05:31:27,240 --> 05:31:37,280 HEALTH WORKERS WHO VISITED MO 6704 05:31:37,280 --> 05:31:37,920 MONTHLY OR BIMONTHLY THE HOMES 6705 05:31:37,920 --> 05:31:42,400 AND PROVIDED PATIENTS WITH 6706 05:31:42,400 --> 05:31:47,480 TRAINING TO SELF-MONITOR THEIR 6707 05:31:47,480 --> 05:31:49,960 BLOOD PRESSURE AND GAVE 6708 05:31:49,960 --> 05:31:51,320 COUNSELLING ON HEALTHY HABITS 6709 05:31:51,320 --> 05:31:54,880 AND ADHERENCE TO MEDICATION. 6710 05:31:54,880 --> 05:31:57,320 THE SECOND COMPONENT WAS A 6711 05:31:57,320 --> 05:31:59,600 DIGITAL COMPONENT, PATIENTS 6712 05:31:59,600 --> 05:32:03,320 RECEIVED WEEKLY TEXT MESSAGES 6713 05:32:03,320 --> 05:32:07,560 FOCUSSED ON HEALTHY HABITS AND 6714 05:32:07,560 --> 05:32:12,200 HYPERTENSION TREATMENT 6715 05:32:12,200 --> 05:32:12,480 ADHERENCE. 6716 05:32:12,480 --> 05:32:15,800 THE THIRD COMPONENT WAS CAPACITY 6717 05:32:15,800 --> 05:32:16,440 BUILDING CONSISTENT WITH 6718 05:32:16,440 --> 05:32:20,320 TRAINING THE PRIMARY CARE TEAM 6719 05:32:20,320 --> 05:32:24,400 AND DOCTORS AND NURSES AND 6720 05:32:24,400 --> 05:32:25,840 COMMUNITY HEALTH WORKERS IN THE 6721 05:32:25,840 --> 05:32:28,480 USE OF HYPERTENSION GUIDELINES 6722 05:32:28,480 --> 05:32:33,280 AND MEETING AT THE PRIMARY CARE 6723 05:32:33,280 --> 05:32:38,080 CENTER TO DISCUSS CASES AND 6724 05:32:38,080 --> 05:32:48,400 RECEIVE FEEDBACK. 6725 05:33:24,920 --> 05:33:28,360 THE PRIMARY OUTCOMES WERE 6726 05:33:28,360 --> 05:33:32,640 CHANGES IN SYSTOLIC AND 6727 05:33:32,640 --> 05:33:37,840 DIASTOLIC BLOOD PRESSURE AND 6728 05:33:37,840 --> 05:33:38,320 HYPERTENSION CONTROL. 6729 05:33:38,320 --> 05:33:40,040 THESE ARE THE MAIN RESULTS. 6730 05:33:40,040 --> 05:33:42,200 A SUMMARY OF THE MAIN RESULTS OF 6731 05:33:42,200 --> 05:33:43,040 THE STUDY. 6732 05:33:43,040 --> 05:33:48,600 THIS IS THE EFFECT OF THE 6733 05:33:48,600 --> 05:33:52,480 INTERVENTION ON SYSTOLIC BLOOD 6734 05:33:52,480 --> 05:33:52,760 PRESSURE. 6735 05:33:52,760 --> 05:33:57,320 WE CAN SEE SYSTOLIC BLOOD 6736 05:33:57,320 --> 05:33:59,240 PRESSURE WAS REDUCED IN THE 6737 05:33:59,240 --> 05:34:00,120 INTERVENTION GROUP COMPARED TO 6738 05:34:00,120 --> 05:34:01,640 THE CONTROL GROUP AT 6, 12 AND 6739 05:34:01,640 --> 05:34:10,280 18 MONTHS. 6740 05:34:10,280 --> 05:34:14,720 THE SAME HAPPENED WITH 6, 12 AND 6741 05:34:14,720 --> 05:34:16,600 18 MONTHS IN DIASTOLIC AND WE 6742 05:34:16,600 --> 05:34:20,640 FOUND AN IMPROVEMENT IN THE 6743 05:34:20,640 --> 05:34:26,280 PROPORTION OF PATIENTS WITH 6744 05:34:26,280 --> 05:34:27,960 BLOODS PRESSURE CONTROL AND 6745 05:34:27,960 --> 05:34:30,000 IMPROVED AT 6, 12 AND 18 MONTHS 6746 05:34:30,000 --> 05:34:38,480 OF FOLLOW-UP. 6747 05:34:38,480 --> 05:34:42,240 WHAT HAPPENED TO ADHERENCE TO 6748 05:34:42,240 --> 05:34:43,600 MEDICATION IT IMPROVED IN THE 6749 05:34:43,600 --> 05:34:46,160 INTERVENTION GROUP COMPARED TO 6750 05:34:46,160 --> 05:34:54,040 THE CONTROL GROUP AND THE SAME 6751 05:34:54,040 --> 05:34:55,920 HAPPENED WITH TREATMENT AND 6752 05:34:55,920 --> 05:34:57,640 ATTACHMENT BY THE PRIMARY CARE 6753 05:34:57,640 --> 05:35:00,520 TEAM. 6754 05:35:00,520 --> 05:35:02,400 WELL, NOW THE QUESTION IS WHAT 6755 05:35:02,400 --> 05:35:03,360 HAPPENED NEXT? 6756 05:35:03,360 --> 05:35:06,840 FIRST, THIS IS ONE OF THE 6757 05:35:06,840 --> 05:35:08,600 PROVINCES WHERE THE STUDY WAS 6758 05:35:08,600 --> 05:35:09,320 CONDUCTED. 6759 05:35:09,320 --> 05:35:13,520 AS PART OF THE STUDY, WE 6760 05:35:13,520 --> 05:35:15,800 IMPLEMENTED THE INTERVENTION IN 6761 05:35:15,800 --> 05:35:18,200 THREE DISTRICTS IN THIS 6762 05:35:18,200 --> 05:35:18,440 PROVINCE. 6763 05:35:18,440 --> 05:35:21,840 BASED ON THE RESULT OF THE 6764 05:35:21,840 --> 05:35:23,640 STUDY, THE PROVINCIAL SECRETARY 6765 05:35:23,640 --> 05:35:28,280 OF HEALTH DECIDED TO EXPAND 6766 05:35:28,280 --> 05:35:29,520 PROGRESSIVELY THE INTERVENTION 6767 05:35:29,520 --> 05:35:31,400 TO OTHER DISTRICTS IN THE 6768 05:35:31,400 --> 05:35:32,280 PROVINCE. 6769 05:35:32,280 --> 05:35:35,280 AT THE SAME TIME, WE WERE 6770 05:35:35,280 --> 05:35:37,320 WORKING WITH THE NATIONAL 6771 05:35:37,320 --> 05:35:39,520 MINISTRY OF HEALTH TO 6772 05:35:39,520 --> 05:35:43,800 INCORPORATE OUR FINDINGS TO THE 6773 05:35:43,800 --> 05:35:45,360 NATIONAL HYPERTENSION PROGRAM 6774 05:35:45,360 --> 05:35:46,760 WHICH WAS BEING DEVELOPED AT 6775 05:35:46,760 --> 05:35:53,000 THAT VERY MOMENT. 6776 05:35:53,000 --> 05:35:54,680 AND SOMETHING HAPPENED. 6777 05:35:54,680 --> 05:35:58,800 ARGENTINA WAS INVITED TO 6778 05:35:58,800 --> 05:36:00,680 PARTICIPATE IN THE INITIATIVE 6779 05:36:00,680 --> 05:36:02,000 FOR THE AMERICAS. 6780 05:36:02,000 --> 05:36:05,880 FOR THOSE WHO MAY NOT BE 6781 05:36:05,880 --> 05:36:13,000 FAMILIAR WITH THIS INITIATIVE 6782 05:36:13,000 --> 05:36:16,000 HERTS HAS A FOCUS ON ME CONTROL 6783 05:36:16,000 --> 05:36:17,720 OF HYPERTENSION. 6784 05:36:17,720 --> 05:36:20,880 AND IT'S BASED ON SIX PILLARS 6785 05:36:20,880 --> 05:36:25,600 WHICH ARE STANDARDIZED TREATMENT 6786 05:36:25,600 --> 05:36:27,560 AND SIMPLIFIED PROTOCOLS, BLOOD 6787 05:36:27,560 --> 05:36:30,200 PRESSURE MEASUREMENTS WITH 6788 05:36:30,200 --> 05:36:32,600 VALIDATED DEVICES, CAPACITY 6789 05:36:32,600 --> 05:36:36,080 BUILDING AND TRAINING FOR THE 6790 05:36:36,080 --> 05:36:40,120 PRIMARY CARE TEAM, DATA 6791 05:36:40,120 --> 05:36:43,200 STANDARDIZATION AND USE OF 6792 05:36:43,200 --> 05:36:46,520 OUTCOME AND PROCESS INDICATORS, 6793 05:36:46,520 --> 05:36:48,520 IMPLEMENTATION RESEARCH AND 6794 05:36:48,520 --> 05:36:53,000 PROGRAM EVALUATION AND 6795 05:36:53,000 --> 05:36:54,760 TEAM-BASED AVERAGE. 6796 05:36:54,760 --> 05:36:56,800 WE STRONGLY SUPPORT AND ADVOCATE 6797 05:36:56,800 --> 05:37:00,400 FOR THESE RELEVANT INITIATIVES 6798 05:37:00,400 --> 05:37:04,040 IN THE REGION AND ALL THE 6799 05:37:04,040 --> 05:37:06,720 EXPERIENCE AND LESSONS LEARNED 6800 05:37:06,720 --> 05:37:10,280 AND MATERIALS DEVELOPED IN OUR 6801 05:37:10,280 --> 05:37:12,760 STUDY WERE SHARED AND USED TO 6802 05:37:12,760 --> 05:37:14,600 HELP THE PROCESS OF ADAPTATION 6803 05:37:14,600 --> 05:37:17,480 AND IMPLEMENTATION OF THE HEARTS 6804 05:37:17,480 --> 05:37:24,560 INITIATIVE IN OUR COUNTRY. 6805 05:37:24,560 --> 05:37:25,680 FINALLY, LET ME SHARE 6806 05:37:25,680 --> 05:37:28,760 REFLECTIONS AND LESSONS LEARNED. 6807 05:37:28,760 --> 05:37:32,680 FIRST, I'D LIKE TO SAY THAT 6808 05:37:32,680 --> 05:37:35,880 IMPLEMENTATION SCIENCE IS KEY TO 6809 05:37:35,880 --> 05:37:37,440 ADVANCE RESEARCH AND MORE 6810 05:37:37,440 --> 05:37:39,280 IMPORTANT TRANSLATION OF 6811 05:37:39,280 --> 05:37:44,560 RESEARCH FINDINGS INTO HEALTH 6812 05:37:44,560 --> 05:37:45,760 CARE SERVICES AND POLICIES IN 6813 05:37:45,760 --> 05:37:47,480 OUR REGION. 6814 05:37:47,480 --> 05:37:49,520 INTERVENTION STRATEGIES AND 6815 05:37:49,520 --> 05:37:52,440 PRACTICES HAVE TO BE ADOPTED TO 6816 05:37:52,440 --> 05:37:54,720 THE LOCAL CONTEXT TO PROMOTE 6817 05:37:54,720 --> 05:37:58,720 ADOPTION AND ACCEPTABILITY. 6818 05:37:58,720 --> 05:37:59,920 STAKEHOLDER ENGAGEMENT AND 6819 05:37:59,920 --> 05:38:04,560 INVOLVEMENT FROM THE VERY 6820 05:38:04,560 --> 05:38:05,600 BEGINNING AND THROUGHOUT THE 6821 05:38:05,600 --> 05:38:10,480 DESIGN AND IMPLEMENTATION 6822 05:38:10,480 --> 05:38:13,640 PROCESS IS KEY FOR 6823 05:38:13,640 --> 05:38:16,680 SUSTAINABILITY AND MONITORING 6824 05:38:16,680 --> 05:38:22,800 HELP US DECIDE USEFUL ADAPT 6825 05:38:22,800 --> 05:38:23,520 ADAPTATIONS. 6826 05:38:23,520 --> 05:38:24,880 STRONG LEADERSHIP AND GOVERNANCE 6827 05:38:24,880 --> 05:38:26,920 AND OWNERSHIP ARE INSTRUMENTAL 6828 05:38:26,920 --> 05:38:29,600 FOR SCALING UP AND THE IMPORTANT 6829 05:38:29,600 --> 05:38:35,920 WE NEED TO BE OPEN TO EMERGING 6830 05:38:35,920 --> 05:38:38,200 OPPORTUNITIES, SYNERGIES AND 6831 05:38:38,200 --> 05:38:42,240 PROACTIVE COLLABORATIONS TO BE 6832 05:38:42,240 --> 05:38:47,240 ABLE TO CONTRIBUTE TO BRIDGE TO 6833 05:38:47,240 --> 05:38:48,640 REDUCE THE GAP. 6834 05:38:48,640 --> 05:38:49,240 THANK YOU VERY MUCH FOR YOUR 6835 05:38:49,240 --> 05:38:59,400 ATTENTION. 6836 05:39:04,240 --> 05:39:06,680 >>GOOD AFTERNOON, EVERYONE. 6837 05:39:06,680 --> 05:39:09,240 AND THANK YOU TO ALL THE 6838 05:39:09,240 --> 05:39:14,600 SPEAKERS FOR ALL THOSE VERY 6839 05:39:14,600 --> 05:39:16,880 COMPREHENSIVE PRESENTATIONS AND 6840 05:39:16,880 --> 05:39:17,440 THE INFORMATION THEY HAVE 6841 05:39:17,440 --> 05:39:27,720 PROVIDED TO US. 6842 05:39:30,920 --> 05:39:41,240 AND WE HAVE DR. BAMBS, 6843 05:39:42,240 --> 05:39:48,400 DR. ZORRILLA AND DR. IRAZOLA AND 6844 05:39:48,400 --> 05:39:50,680 THE Q&A WILL END AT 3:50. 6845 05:39:50,680 --> 05:39:53,520 WE HAVE A BREAK. 6846 05:39:53,520 --> 05:39:55,000 SO IT'S 3:10 AND THANK YOU. 6847 05:39:55,000 --> 05:40:05,520 THE FIRST QUESTION IS FOR DR 6848 05:40:06,160 --> 05:40:08,320 DR. GAGLIARDINO. 6849 05:40:08,320 --> 05:40:11,640 WHAT ARE THE RESULTS BEYOND A 6850 05:40:11,640 --> 05:40:13,240 YEAR AND CAN THEY BE SUSTAINED 6851 05:40:13,240 --> 05:40:19,800 AND DO YOU INTEGRATE CARE FOR 6852 05:40:19,800 --> 05:40:20,320 OTH 6853 05:40:20,320 --> 05:40:20,800 OTHERS IN THIS MODEL. 6854 05:40:20,800 --> 05:40:29,880 THANK YOU. 6855 05:40:29,880 --> 05:40:33,560 >>WE'RE COLLECTING THE DATA AND 6856 05:40:33,560 --> 05:40:38,560 PERSEVERING WITH THIS STUDY WE 6857 05:40:38,560 --> 05:40:42,240 PERFORM WE'RE SEEING RESULTS AT 6858 05:40:42,240 --> 05:40:48,680 THE MOMENT WE'RE PRODUCED THESE 6859 05:40:48,680 --> 05:40:53,840 THINGS IN THE COUNTRY AND WE 6860 05:40:53,840 --> 05:40:56,440 CONTROL WHAT'S GOING ON IN 6861 05:40:56,440 --> 05:41:01,760 ADDITION IN 14 PROVINCES THAT IS 6862 05:41:01,760 --> 05:41:08,880 MORE OR LESS CONTROL AND WE 6863 05:41:08,880 --> 05:41:14,120 DON'T HAVE AND WE HAVE RESEARCH 6864 05:41:14,120 --> 05:41:16,520 AND HOPEFULLY WE'RE GOING 6865 05:41:16,520 --> 05:41:17,920 PRODUCE AND TO CHANGE THE 6866 05:41:17,920 --> 05:41:19,480 QUALITY OF CARE PROVIDED TO 6867 05:41:19,480 --> 05:41:22,400 PEOPLE WITH DIABETES IS THE MAIN 6868 05:41:22,400 --> 05:41:26,080 ISSUE WE ARE DEALING WITH. 6869 05:41:26,080 --> 05:41:32,800 OF COURSE DIABETES HAVE THE MOST 6870 05:41:32,800 --> 05:41:38,960 COMMON AND SO FAR WE GET PEOPLE 6871 05:41:38,960 --> 05:41:40,880 AT THE PRIMARY CARE LEVEL 6872 05:41:40,880 --> 05:41:44,520 BECAUSE AS USUAL WE BELIEVE MOST 6873 05:41:44,520 --> 05:41:50,120 OF PATIENTS ARE AT THE LEVEL AND 6874 05:41:50,120 --> 05:41:51,160 A MINIMAL AMOUNT GOES TO THE 6875 05:41:51,160 --> 05:41:52,960 SPECIALIST. 6876 05:41:52,960 --> 05:41:54,360 AGAIN, WE'RE WORKING WITH BOTH 6877 05:41:54,360 --> 05:41:59,440 SYSTEMS THE PRIMARY CARE LEVEL 6878 05:41:59,440 --> 05:42:04,480 AND THE SPECIALIST BECAUSE SOME 6879 05:42:04,480 --> 05:42:07,240 CANNOT WORK ON THE PRIMARY CARE 6880 05:42:07,240 --> 05:42:10,080 THEY HAVE TO GO TO THE 6881 05:42:10,080 --> 05:42:14,080 SPECIALIST AND IT'S A MOMENT TO 6882 05:42:14,080 --> 05:42:15,560 BE SURE EVERYBODY RECEIVE THE 6883 05:42:15,560 --> 05:42:18,120 QUALITY OF CARE THEY NEEDED. 6884 05:42:18,120 --> 05:42:24,160 >>THANK YOU. 6885 05:42:24,160 --> 05:42:27,360 WHAT ARE KEY FACTORS THAT 6886 05:42:27,360 --> 05:42:30,400 EXPLAIN THE SUCCESS OF THE 6887 05:42:30,400 --> 05:42:32,880 NETWORK WITH LATIN AMERICA. 6888 05:42:32,880 --> 05:42:35,400 YOU HAVE THE NETWORKS OF TRIAL 6889 05:42:35,400 --> 05:42:38,120 UNITS AND THEN EXPAND IT INTO 6890 05:42:38,120 --> 05:42:38,480 LATIN AMERICA. 6891 05:42:38,480 --> 05:42:41,480 WHAT ARE THE KEY FACTORS THAT 6892 05:42:41,480 --> 05:42:44,320 ASSURE THE SUCCESS AND WHAT ARE 6893 05:42:44,320 --> 05:42:45,680 THE IMPLICATIONS OF THE STUDY 6894 05:42:45,680 --> 05:42:54,600 FINDINGS. 6895 05:42:54,600 --> 05:42:56,320 ARE THE INTERVENTIONS PLANNED 6896 05:42:56,320 --> 05:43:00,080 AND ARE THEY INTEGRATED INTO 6897 05:43:00,080 --> 05:43:00,560 CLINICAL CARE. 6898 05:43:00,560 --> 05:43:01,800 >>LOTS OF QUESTIONS. 6899 05:43:01,800 --> 05:43:08,960 NUMBER ONE, I THINK IN TERMS OF 6900 05:43:08,960 --> 05:43:16,080 SUCCESS I WOULD SAY HAVING A 6901 05:43:16,080 --> 05:43:18,120 STUDY TEAM IN LATIN AMERICA AND 6902 05:43:18,120 --> 05:43:20,560 I THINK WE HAVE THE HUMAN 6903 05:43:20,560 --> 05:43:22,400 CAPITAL TO BRING THIS TO LATIN 6904 05:43:22,400 --> 05:43:26,120 AMERICA IN MANY SENSE. 6905 05:43:26,120 --> 05:43:27,280 I THINK THAT'S ONE. 6906 05:43:27,280 --> 05:43:28,880 THE SECOND IS TO A CONVERSATION 6907 05:43:28,880 --> 05:43:30,840 WITH THE P.I.s AND STUDY TEAMS 6908 05:43:30,840 --> 05:43:35,120 ON WHAT WAS NEEDED BEYOND THE 6909 05:43:35,120 --> 05:43:36,200 TRIAL. 6910 05:43:36,200 --> 05:43:38,960 WHAT DO WE NEED TO GET READY FOR 6911 05:43:38,960 --> 05:43:41,200 THE TRIAL AND THERE WERE THINGS 6912 05:43:41,200 --> 05:43:47,200 IN THE POPULATIONS AND ALSO WITH 6913 05:43:47,200 --> 05:43:49,560 RESOURCES NEEDED AND TRYING TO 6914 05:43:49,560 --> 05:43:54,640 BUILD THE RESOURCE LOCALLY WAS 6915 05:43:54,640 --> 05:43:57,280 ALSO KEY AND HAVING FUNDERS THAT 6916 05:43:57,280 --> 05:44:00,680 UNDERSTAND THE RELEVANCE OF 6917 05:44:00,680 --> 05:44:02,360 GLOBAL HEALTH AND HAVING THOSE 6918 05:44:02,360 --> 05:44:02,960 PARTNERSHIPS. 6919 05:44:02,960 --> 05:44:08,360 I THINK THOSE WILL BE THE THREE 6920 05:44:08,360 --> 05:44:14,320 MAIN KEY ELEMENTS AND WILL BE A 6921 05:44:14,320 --> 05:44:16,200 DIFFERENCE I THINK NOW IN TERMS 6922 05:44:16,200 --> 05:44:18,040 OF HOW TO INTEGRATE THE 6923 05:44:18,040 --> 05:44:21,360 LEARNINGS, NUMBER ONE I THINK WE 6924 05:44:21,360 --> 05:44:24,520 HAVE NOW REALLY COMPREHENSIVE 6925 05:44:24,520 --> 05:44:27,520 GENETIC TESTING AND COUNSELLING 6926 05:44:27,520 --> 05:44:32,000 FOR FAMILIAL ALZHEIMER'S DISEASE 6927 05:44:32,000 --> 05:44:34,400 AND THAT CAN GO TO DISEASES WITH 6928 05:44:34,400 --> 05:44:36,480 A GENETIC COMPONENT AND THIS IS 6929 05:44:36,480 --> 05:44:40,560 EXTREMELY RELEVANT BECAUSE WE 6930 05:44:40,560 --> 05:44:44,040 CAN ASSUME HOW WE DO IT WILL BE 6931 05:44:44,040 --> 05:44:45,800 THE SAME AND THEY'RE DIFFERENT 6932 05:44:45,800 --> 05:44:48,200 IN TERMS OF EDUCATIONAL LEVEL 6933 05:44:48,200 --> 05:44:53,680 AND THERE'S A STIGMA AROUND 6934 05:44:53,680 --> 05:44:56,400 GENETIC DISEASES AND WE WE HOPE 6935 05:44:56,400 --> 05:44:59,320 THAT NOW THE PROGRAM WILL BE 6936 05:44:59,320 --> 05:45:02,200 APPLIED TO OR INTEGRATED IN 6937 05:45:02,200 --> 05:45:06,920 CLINICAL CARE. 6938 05:45:06,920 --> 05:45:09,960 THAT'S OUR HOPE AND THING NOW 6939 05:45:09,960 --> 05:45:12,480 WE'RE GOING AND STARTING IN 6940 05:45:12,480 --> 05:45:13,680 CLINICAL TRIALS TWO OF OUR SITES 6941 05:45:13,680 --> 05:45:14,920 ARE READY TO IMPLEMENT. 6942 05:45:14,920 --> 05:45:18,080 I THINK WE'RE DOING GOOD IN 6943 05:45:18,080 --> 05:45:23,440 TERMS OF INTERVENTION WE PLAN. 6944 05:45:23,440 --> 05:45:24,640 >>THANK YOU. 6945 05:45:24,640 --> 05:45:28,880 WHAT MADE YOUR INTERVENTION 6946 05:45:28,880 --> 05:45:30,920 SUCCESSFUL AND I HAVE A SECOND 6947 05:45:30,920 --> 05:45:36,440 QUESTION, DO YOU THINK THE APP 6948 05:45:36,440 --> 05:45:38,480 COULD BE APPLIED TO OTHER 6949 05:45:38,480 --> 05:45:39,920 CHRONIC CONDITIONS? 6950 05:45:39,920 --> 05:45:45,680 DO YOU SEE IT BEING USED FOR 6951 05:45:45,680 --> 05:45:46,960 OTHER CONDITIONS OR WE WANT TO 6952 05:45:46,960 --> 05:45:55,960 HEAR YOUR THOUGHTS ON THAT. 6953 05:45:55,960 --> 05:46:01,640 >>I THINK ONE KEY FACTORS THAT 6954 05:46:01,640 --> 05:46:04,880 MADE THIS APP SUCCESSFUL WAS THE 6955 05:46:04,880 --> 05:46:07,160 EARLY INVOLVEMENT OF POTENTIAL 6956 05:46:07,160 --> 05:46:08,680 PARTICIPANTS IN THE DESIGN OF 6957 05:46:08,680 --> 05:46:14,120 THE APPLICATION ITSELF. 6958 05:46:14,120 --> 05:46:18,920 THE FINAL APP WAS SOMETHING THAT 6959 05:46:18,920 --> 05:46:20,680 CHILEAN WOMEN REALLY LIKED AND 6960 05:46:20,680 --> 05:46:27,720 EVEN TRYING TO KEEM IT SIMPLE WE 6961 05:46:27,720 --> 05:46:33,680 TRIED TO INCORPORATE MOST THE 6962 05:46:33,680 --> 05:46:38,480 SUGGESTIONS AND ALL THE 6963 05:46:38,480 --> 05:46:39,080 MATERIALS AND PROCESS OF THE 6964 05:46:39,080 --> 05:46:44,400 DESIGN WE CONDUCTED IS AVAILABLE 6965 05:46:44,400 --> 05:46:49,720 AND COULD BE USED AS A TEMPLATE 6966 05:46:49,720 --> 05:46:50,920 TO PERHAPS DESIGN INTERVENTIONS 6967 05:46:50,920 --> 05:46:52,080 FOR OTHER POPULATIONS. 6968 05:46:52,080 --> 05:46:53,840 FOR INSTANCE, THERE'S A GAP IN 6969 05:46:53,840 --> 05:46:59,800 TERMS OF INTERVENTIONS FOR 6970 05:46:59,800 --> 05:47:05,240 PREGNANT WOMEN STUDY DID NOT 6971 05:47:05,240 --> 05:47:10,080 COVER PREGNANT WOMEN AND 6972 05:47:10,080 --> 05:47:13,040 ADOLESCENTS AND WE HAD AN 6973 05:47:13,040 --> 05:47:18,280 INTEREST IN YOUNG WOMEN AND 6974 05:47:18,280 --> 05:47:24,120 LIMITED RESEARCH WE LAD TO 6975 05:47:24,120 --> 05:47:31,960 CHOOSE AND OUR GOAL IS TO HAVE 6976 05:47:31,960 --> 05:47:34,080 THESE MATERIALS AND THE LESSONS 6977 05:47:34,080 --> 05:47:34,640 LEARNED AVAILABLE FOR OTHER 6978 05:47:34,640 --> 05:47:34,960 RESEARCHERS. 6979 05:47:34,960 --> 05:47:44,000 >>THANK YOU. 6980 05:47:44,000 --> 05:47:48,560 FOR DR. ZORRILLA. 6981 05:47:48,560 --> 05:47:51,240 YOU REACH OUT TO PARTICIPANTS 6982 05:47:51,240 --> 05:47:52,840 WERE AND THE STRATEGIES WERE 6983 05:47:52,840 --> 05:47:55,320 BUILT UP AROUND WHERE WE CAN 6984 05:47:55,320 --> 05:48:00,360 FIND THEM AND CONNECT WITH THEM. 6985 05:48:00,360 --> 05:48:02,120 AT THE SAME TIME, WHAT IS THE 6986 05:48:02,120 --> 05:48:06,840 ROLE OF THE RECRUITERS IN BRAIN 6987 05:48:06,840 --> 05:48:08,720 STORMING ABOUT THIS AND 6988 05:48:08,720 --> 05:48:11,880 IMPLEMENTING THE RECRUITMENT AND 6989 05:48:11,880 --> 05:48:14,160 THE IMPRESSION OR THE ATTITUDES 6990 05:48:14,160 --> 05:48:17,600 OR EVEN CONCERNS OF PARTICIPANTS 6991 05:48:17,600 --> 05:48:19,000 AND MOTIVATION TO PARTICIPATE. 6992 05:48:19,000 --> 05:48:20,680 YOU MENTIONED A FEW THINGS. 6993 05:48:20,680 --> 05:48:26,920 WE WANT TO KNOW A LITTLE BIT 6994 05:48:26,920 --> 05:48:28,560 DEEPER ABOUT SPECIFICALLY THE 6995 05:48:28,560 --> 05:48:30,120 VACCINE TRIALS AND WHAT 6996 05:48:30,120 --> 05:48:31,920 MOTIVATED THE PARTICIPANTS TO 6997 05:48:31,920 --> 05:48:33,280 PARTICIPATE AND HOW THEY BECAME 6998 05:48:33,280 --> 05:48:33,960 ENGAGED AND THE ROLE OF THE 6999 05:48:33,960 --> 05:48:34,920 RECRUITERS. 7000 05:48:34,920 --> 05:48:39,080 >>SHUSH. 7001 05:48:39,080 --> 05:48:40,040 -- SURE. 7002 05:48:40,040 --> 05:48:41,640 FOR SPECIFIC TRIALS WE 7003 05:48:41,640 --> 05:48:42,680 APPROACHED COMMUNITY 7004 05:48:42,680 --> 05:48:44,760 ORGANIZATIONS THAT WORK WITH 7005 05:48:44,760 --> 05:48:46,560 SPECIFIC GROUPS, FOR EXAMPLE, 7006 05:48:46,560 --> 05:48:48,760 STREET SEX WORKERS WHICH ARE 7007 05:48:48,760 --> 05:48:54,400 REALLY DIFFICULT TO ENROLL. 7008 05:48:54,400 --> 05:48:57,680 ALSO WE HAVE TO WORK WITHIN THE 7009 05:48:57,680 --> 05:49:02,720 LEGAL CONSIDERATIONS AND WE CAN 7010 05:49:02,720 --> 05:49:05,520 NO LONGER HAVE FOOD VOUCHERS 7011 05:49:05,520 --> 05:49:06,400 BECAUSE THERE'S LAWS IN PUERTO 7012 05:49:06,400 --> 05:49:07,840 RICO THAT DON'T ALLOW YOU TO DO 7013 05:49:07,840 --> 05:49:08,040 THAT. 7014 05:49:08,040 --> 05:49:18,600 WITHIN THE CONSTRAINTS OF THE WE 7015 05:49:20,000 --> 05:49:22,440 HAD FOR THE VACCINE TRIAL THERE 7016 05:49:22,440 --> 05:49:24,360 WERE LOTS -- I'VE NEVER SEEN A 7017 05:49:24,360 --> 05:49:25,880 STUDY WHERE PEOPLE WERE SO MUCH 7018 05:49:25,880 --> 05:49:31,240 INTERESTED BECAUSE I THINK IT 7019 05:49:31,240 --> 05:49:34,120 WAS BECAUSE THERE WAS A NEED AND 7020 05:49:34,120 --> 05:49:38,400 THEY WANT THE VACCINE AS SOON AS 7021 05:49:38,400 --> 05:49:43,520 POSSIBLE AND WE LAD -- HAD TO 7022 05:49:43,520 --> 05:49:48,600 DEAL WITH VOLUMES OF PEOPLE 7023 05:49:48,600 --> 05:49:49,200 PARTICIPATING. 7024 05:49:49,200 --> 05:49:51,720 ONE PERSON HAD ACCESS TO PRIVATE 7025 05:49:51,720 --> 05:49:53,880 PLANES WE TOLD THEM WE CANNOT 7026 05:49:53,880 --> 05:49:54,760 ENROLL YOU BECAUSE IF YOU'RE 7027 05:49:54,760 --> 05:49:56,800 SICK AND SOME PLACE ELSE, WE 7028 05:49:56,800 --> 05:49:59,800 NEED TO EXAMINE YOU AND MAKE 7029 05:49:59,800 --> 05:50:01,880 SURE YOU HAVE BLOOD DRAW TO MAKE 7030 05:50:01,880 --> 05:50:03,040 SURE IT'S COVID OR NOT. 7031 05:50:03,040 --> 05:50:06,120 THEY SAID, DON'T WORRY, I HAVE A 7032 05:50:06,120 --> 05:50:08,120 PRIVATE PLANE AND I CAN GET 7033 05:50:08,120 --> 05:50:10,120 WHEREVER OR HAVE YOUR STAFF COME 7034 05:50:10,120 --> 05:50:10,960 TO WHERE I AM. 7035 05:50:10,960 --> 05:50:17,280 THAT WAS SURPRISING TO ME WE DID 7036 05:50:17,280 --> 05:50:19,400 NOT ENROLL THIS PARTICIPANT IN 7037 05:50:19,400 --> 05:50:24,840 PARTICULAR BUT IT TOLD ME A LOT 7038 05:50:24,840 --> 05:50:28,800 ABOUT THE PEOPLE INTERESTED IN 7039 05:50:28,800 --> 05:50:29,400 PARTICIPATING IN THE VACCINE 7040 05:50:29,400 --> 05:50:30,960 TRIAL AND OTHER THAN HAVING THE 7041 05:50:30,960 --> 05:50:37,040 PRODUCT EARLY ON, THERE WAS 7042 05:50:37,040 --> 05:50:39,520 THERE IS THE ALTRUISM. 7043 05:50:39,520 --> 05:50:48,120 A RETIRED POLICEMAN IN HIS 7 7044 05:50:48,120 --> 05:50:50,680 70s -- DECIDED HE WANTED TO BE 7045 05:50:50,680 --> 05:50:54,080 PART OF THE STUDY AND BY TO THE 7046 05:50:54,080 --> 05:50:56,960 TIME THERE WERE VACCINES FOR 7047 05:50:56,960 --> 05:50:59,200 PEOPLE 65 HE WANTED TO FINISH 7048 05:50:59,200 --> 05:51:00,320 WHAT HE STARTED. 7049 05:51:00,320 --> 05:51:05,440 THAT TO ME WAS INCREDIBLE IN 7050 05:51:05,440 --> 05:51:07,960 TERMS OF THE CONNECTION OF 7051 05:51:07,960 --> 05:51:09,520 VOLUNTEERS WITH STUDY STAFF. 7052 05:51:09,520 --> 05:51:18,120 >>VERY INSIGHTFUL. 7053 05:51:18,120 --> 05:51:26,080 DR 7054 05:51:26,080 --> 05:51:32,080 >>DR. IRAZOLA WHAT HAPPENED TO 7055 05:51:32,080 --> 05:51:33,800 THE STUDY? 7056 05:51:33,800 --> 05:51:38,080 IF YOUR STUDY WAS GOING TO BE 7057 05:51:38,080 --> 05:51:45,200 SCALED UP, WHAT HAVE YOU HAVE 7058 05:51:45,200 --> 05:51:50,200 DONE? 7059 05:51:50,200 --> 05:51:53,720 >>THE FIRST REFLECTION ON THAT 7060 05:51:53,720 --> 05:51:58,000 IS THAT AS YOU SAID ARE THE 7061 05:51:58,000 --> 05:52:00,480 LESSONS LEARNED TRAINING 7062 05:52:00,480 --> 05:52:04,640 MATERIALS FOR PARTICIPANTS AND 7063 05:52:04,640 --> 05:52:07,240 WHAT USED TO FIT IN OUR COUNTRY 7064 05:52:07,240 --> 05:52:13,200 AND AS RESEARCHERS, WE ARE SO 7065 05:52:13,200 --> 05:52:14,920 HAPPY ABOUT THAT BECAUSE WE FELT 7066 05:52:14,920 --> 05:52:18,360 OUR PROJECT HAD THE OPPORTUNITY 7067 05:52:18,360 --> 05:52:21,000 TO MERGE WITH SOMETHING BIGGER 7068 05:52:21,000 --> 05:52:24,720 WHICH IS THE HEART INITIATIVE. 7069 05:52:24,720 --> 05:52:26,960 IN TERMS AND NOW WHAT IS 7070 05:52:26,960 --> 05:52:27,600 HAPPENING WITH THE HEART 7071 05:52:27,600 --> 05:52:32,960 INITIATIVE IN OUR COUNTRY, WE 7072 05:52:32,960 --> 05:52:36,720 ARE JUST RECOVERING RECOVERING 7073 05:52:36,720 --> 05:52:39,400 AFTER THE PANDEMIC SO THAT'S A 7074 05:52:39,400 --> 05:52:40,040 CHALLENGE THAT WE ARE DEALING 7075 05:52:40,040 --> 05:52:46,080 WITH AT THE MOMENT AND ALSO 7076 05:52:46,080 --> 05:52:49,080 WE'RE WORK ON AN EVALUATION PLAN 7077 05:52:49,080 --> 05:52:51,720 WITH KEY IMPLEMENTATION OUTCOMES 7078 05:52:51,720 --> 05:52:59,960 WITH QUALITY OF CARE OUTCOMES I 7079 05:52:59,960 --> 05:53:10,480 THINK THE HEART INITIATIVE IS 7080 05:53:11,680 --> 05:53:14,080 THE BEST WE COULD IMAGINE, 7081 05:53:14,080 --> 05:53:14,320 REALLY. 7082 05:53:14,320 --> 05:53:21,440 >>THANK YOU. 7083 05:53:21,440 --> 05:53:26,120 DR. GAGLIARDINO HOW WILL THE 7084 05:53:26,120 --> 05:53:29,440 COORDINATION OF CARE AND THE 7085 05:53:29,440 --> 05:53:31,600 FOLLOW-UP YOU HAVE PRESENTED AND 7086 05:53:31,600 --> 05:53:36,400 IS PERFORMED, WHAT WOULD BE 7087 05:53:36,400 --> 05:53:38,080 REALISTIC STRATEGY TO IMPLEMENT 7088 05:53:38,080 --> 05:53:45,680 A PROGRAM LIKE THAT WITH FEWER 7089 05:53:45,680 --> 05:53:46,520 RESOURCES? 7090 05:53:46,520 --> 05:53:56,600 >> 7091 05:54:01,360 --> 05:54:07,200 >>THIS WAS SUPPORTED BY THE 7092 05:54:07,200 --> 05:54:12,800 FOUNDATION AND THEY SAID, DO IT 7093 05:54:12,800 --> 05:54:17,840 IN A PLACE THAT YOU HAVE HIGH 7094 05:54:17,840 --> 05:54:18,840 DEFICIENCIES BECAUSE IF YOU CAN 7095 05:54:18,840 --> 05:54:23,040 DO IT LATER, LATER ON YOU WON'T 7096 05:54:23,040 --> 05:54:26,080 HAVE ANY PROBLEM IN DIFFICULT 7097 05:54:26,080 --> 05:54:33,120 AREAS AND WE DID IT. 7098 05:54:33,120 --> 05:54:35,880 WHERE WE IMPLEMENTED THE STUDY 7099 05:54:35,880 --> 05:54:42,560 WAS THE HIGHEST POPULATION PER 7100 05:54:42,560 --> 05:54:43,480 SQUARE KILOMETER AND POVERTY OF 7101 05:54:43,480 --> 05:54:49,000 THE LARGEST PERCENTAGE AND IN 7102 05:54:49,000 --> 05:54:54,080 ADDITION THE HIGHEST MORTALITY 7103 05:54:54,080 --> 05:54:56,480 MEANING WE THINK IT'S A 7104 05:54:56,480 --> 05:54:58,880 POPULATION STUDY THAT CAN BE 7105 05:54:58,880 --> 05:55:00,000 DONE WITHOUT MANY DIFFICULTIES. 7106 05:55:00,000 --> 05:55:02,080 THE MAIN THING IS THE EDUCATION. 7107 05:55:02,080 --> 05:55:08,920 THAT'S THE TOOL. 7108 05:55:08,920 --> 05:55:11,400 NOT JUST ANY TOOL BUT WE HAVE IT 7109 05:55:11,400 --> 05:55:13,760 THROUGH THE UNIVERSITY STUDIES 7110 05:55:13,760 --> 05:55:19,120 AND EVALUATION OF THE OUTREACH 7111 05:55:19,120 --> 05:55:23,040 AND SCALE AND WE HAVE AN 7112 05:55:23,040 --> 05:55:29,000 EVALUATION FROM THE CLINICAL AND 7113 05:55:29,000 --> 05:55:29,960 METABOLIC POINT OF VIEW AND IT'S 7114 05:55:29,960 --> 05:55:40,120 AN INTEGRATED PROGRAM AND IT'S 7115 05:55:40,120 --> 05:55:46,920 HARD TO I MPLEMENT AND YOU NEED 7116 05:55:46,920 --> 05:55:49,000 TO MOTIVATE THE PEOPLE YOU HAVE 7117 05:55:49,000 --> 05:55:55,200 TO DECIDE TO BE EVALUATED AND 7118 05:55:55,200 --> 05:55:57,840 THEN HAVE RECORD OF THE DATA 7119 05:55:57,840 --> 05:55:58,440 OTHERWISE YOU NEVER COME THROUGH 7120 05:55:58,440 --> 05:56:01,280 WHAT HAPPENED. 7121 05:56:01,280 --> 05:56:03,720 THIS IS ONE OF THE 7122 05:56:03,720 --> 05:56:04,160 RECOMMENDATION. 7123 05:56:04,160 --> 05:56:05,480 EDUCATION, EVALUATION AND IMPACT 7124 05:56:05,480 --> 05:56:10,720 OF THE PROVISION OF THE 7125 05:56:10,720 --> 05:56:11,000 INFORMATION. 7126 05:56:11,000 --> 05:56:13,080 THAT'S MY SUGGESTION. 7127 05:56:13,080 --> 05:56:16,040 >>THANK YOU. 7128 05:56:16,040 --> 05:56:24,760 THERE'S SOME ECHO. 7129 05:56:24,760 --> 05:56:33,040 YOU MENTIONED THE RECRUITMENT OF 7130 05:56:33,040 --> 05:56:36,240 COUNTRIES WITH COHORTS AND WHAT 7131 05:56:36,240 --> 05:56:38,760 ARE THE MAIN SOLUTIONS FOR 7132 05:56:38,760 --> 05:56:39,360 IMPLEMENTING TRIALS THOSE 7133 05:56:39,360 --> 05:56:44,680 REQUIRING GENETIC TESTING? 7134 05:56:44,680 --> 05:56:46,760 CAN YOU MENTION IF ANY ARE 7135 05:56:46,760 --> 05:56:49,880 RELATED TO CAPACITY BUILDING, 7136 05:56:49,880 --> 05:56:51,680 TRAINING OR THE INFRASTRUCTURE 7137 05:56:51,680 --> 05:56:56,160 AND AGAIN WHAT ARE THE POTENTIAL 7138 05:56:56,160 --> 05:57:01,440 SOLUTIONS FOR HOW WOULD YOU -- 7139 05:57:01,440 --> 05:57:08,640 WORK THROUGH THOSE IMPLEMENT 7140 05:57:08,640 --> 05:57:10,640 STUDY LIKE THIS. 7141 05:57:10,640 --> 05:57:16,080 >>IT'S NOT ONE BUT A 7142 05:57:16,080 --> 05:57:18,840 COMBINATION OF GETTING LOCAL 7143 05:57:18,840 --> 05:57:24,080 RESOURCES AND TRAINING TO USE 7144 05:57:24,080 --> 05:57:25,800 THOSE RESOURCES. 7145 05:57:25,800 --> 05:57:29,800 ONE EXPERIENCE WE'RE GETTING IN 7146 05:57:29,800 --> 05:57:32,400 THE REGION WE COULD CONCENTRATE 7147 05:57:32,400 --> 05:57:34,200 RESOURCES TO SUPPORT THE REST OF 7148 05:57:34,200 --> 05:57:41,240 THE NETWORK AND IDEALLY IT'S A 7149 05:57:41,240 --> 05:57:43,400 DYNAMIC PROCESS AND IT WILL 7150 05:57:43,400 --> 05:57:44,840 SUPPORT THE NETWORK AND ONCE 7151 05:57:44,840 --> 05:57:50,120 HAVE YOU THE SIDE FUNCTIONING 7152 05:57:50,120 --> 05:57:55,200 YOU GET TO WHERE THE RESOURCES 7153 05:57:55,200 --> 05:57:58,640 ARE NEEDED AND WE START 7154 05:57:58,640 --> 05:58:02,000 EXPLORING SITES TO GET NEW SITES 7155 05:58:02,000 --> 05:58:03,320 READY AND THE OTHER THING THAT 7156 05:58:03,320 --> 05:58:06,800 IS POSITIVE IS THOUGH OUR TRIALS 7157 05:58:06,800 --> 05:58:09,560 ARE MAINLY FOCUSSED ON 7158 05:58:09,560 --> 05:58:18,080 ALZHEIMER'S DISEASE A GENETIC 7159 05:58:18,080 --> 05:58:21,560 FORM OF ALZHEIMER'S DISEASE YOU 7160 05:58:21,560 --> 05:58:25,640 CAN BRING THE TRIALS TO YOUR 7161 05:58:25,640 --> 05:58:26,200 SIDE. 7162 05:58:26,200 --> 05:58:28,560 I THINK THAT'S HOW WE DEFINE 7163 05:58:28,560 --> 05:58:33,880 MOST OF OUR SITES AND NOW MOVE 7164 05:58:33,880 --> 05:58:44,360 TO NEW SITES IN THE REGION. 7165 05:58:44,760 --> 05:58:50,080 AND NOT SEEING WE HAVE TO HAVE 7166 05:58:50,080 --> 05:58:59,600 THE SAME SAFETY STANDARD AND 7167 05:58:59,600 --> 05:59:06,960 HAVE DIFFERENT COMMITTEES AND 7168 05:59:06,960 --> 05:59:09,440 ALL THE COMMITTEES ARE THE SAME 7169 05:59:09,440 --> 05:59:10,680 AND HAVE TO GET THROUGH THE 7170 05:59:10,680 --> 05:59:16,000 COMMITTEE SO WHY NOT JUST ONE 7171 05:59:16,000 --> 05:59:20,000 THAT'S THE TYPE OF SYSTEM 7172 05:59:20,000 --> 05:59:22,640 SOMETIMES NOT EFFICIENT ENOUGH 7173 05:59:22,640 --> 05:59:24,120 AND NEED TO WORK IN PARTNERSHIP 7174 05:59:24,120 --> 05:59:26,560 AND THE OTHER IS FUNDING. 7175 05:59:26,560 --> 05:59:36,960 THERE'S A LIMITATION. 7176 05:59:37,800 --> 05:59:41,400 >>I HAVE A QUESTION ABOUT THE 7177 05:59:41,400 --> 05:59:44,360 APP AND THE USE OF DIGITAL 7178 05:59:44,360 --> 05:59:47,600 TECHNOLOGY HELPING INFORMATION 7179 05:59:47,600 --> 05:59:47,920 TECHNOLOGY. 7180 05:59:47,920 --> 05:59:52,120 HOW DO YOU SEE APPS LIKE THE ONE 7181 05:59:52,120 --> 05:59:54,080 BUILT FOR THE INTERVENTION IN 7182 05:59:54,080 --> 05:59:58,920 YOUR STUDY OR ANY OTHER APP 7183 05:59:58,920 --> 06:00:00,440 ADVANCING OR BEING MORE COMMON 7184 06:00:00,440 --> 06:00:03,080 AND INTEGRATED INTO CLINICAL 7185 06:00:03,080 --> 06:00:04,360 CARE. 7186 06:00:04,360 --> 06:00:10,960 WHAT WOULD IT TAKE AND IS IT 7187 06:00:10,960 --> 06:00:14,640 POSITIVE WOULD THERE BE USEFUL? 7188 06:00:14,640 --> 06:00:15,000 PLEASE COMMENT. 7189 06:00:15,000 --> 06:00:18,520 >>THANK YOU FOR THE QUESTION. 7190 06:00:18,520 --> 06:00:19,680 I THINK THERE ARE MANY APPS OUT 7191 06:00:19,680 --> 06:00:25,440 THERE BUT THE PROBLEM WITH THE 7192 06:00:25,440 --> 06:00:33,640 APP IS WE NEED AN EVALUATION AND 7193 06:00:33,640 --> 06:00:40,600 IN THIS CASE WE ARE ABLE TO 7194 06:00:40,600 --> 06:00:43,400 DEMONSTRATE IT IS SAFE AND 7195 06:00:43,400 --> 06:00:43,680 EFFECTIVE. 7196 06:00:43,680 --> 06:00:53,600 LIKE STEP ONE, NOW WE NEED TO 7197 06:00:53,600 --> 06:01:01,600 MOVE TO INTERVENTION AND MAKE IT 7198 06:01:01,600 --> 06:01:02,040 AVAILABLE TO THE 7199 06:01:02,040 --> 06:01:03,880 COMMUNICATION COMMUNITY AND WITH 7200 06:01:03,880 --> 06:01:05,320 MOBILE APPS IN GENERAL I WOULD 7201 06:01:05,320 --> 06:01:06,680 SAY THAT'S THE PROBLEM. 7202 06:01:06,680 --> 06:01:12,320 NOT ALL THE APPS ARE EFFECTIVE 7203 06:01:12,320 --> 06:01:18,880 AND WE NEED TO BE CAREFUL AT 7204 06:01:18,880 --> 06:01:19,640 WHAT MATERIALS AND INFORMATION 7205 06:01:19,640 --> 06:01:24,560 WE DISCUSS WITH OUR PATIENTS BUT 7206 06:01:24,560 --> 06:01:30,560 WHEN WE HAVE TOOLS THAT ARE 7207 06:01:30,560 --> 06:01:33,000 EFFECTIVE I THINK WE CAN DISCUSS 7208 06:01:33,000 --> 06:01:38,920 THEM AND ICE THEM AAS -- AS A 7209 06:01:38,920 --> 06:01:40,800 TOOL IN CLINICAL SETTING BUT 7210 06:01:40,800 --> 06:01:42,400 DOING THAT TAKES WORK AND 7211 06:01:42,400 --> 06:01:43,640 RESOURCES AND THE IMPLEMENTATION 7212 06:01:43,640 --> 06:01:49,320 IS NOT EASY AT ALL. 7213 06:01:49,320 --> 06:01:53,960 WE'RE HAPPY TO SHARE THAT WITH 7214 06:01:53,960 --> 06:01:55,240 THE COLLEAGUES HERE AND OTHER 7215 06:01:55,240 --> 06:01:55,520 COUNTRIES. 7216 06:01:55,520 --> 06:02:00,880 >>THANK YOU. 7217 06:02:00,880 --> 06:02:01,760 I'M GOING MOVE INTO TWO QUESTION 7218 06:02:01,760 --> 06:02:06,640 FOR EVERY ONE OF YOU TO ANSWER. 7219 06:02:06,640 --> 06:02:08,120 ONE, WHAT ARE THE KEY LESSONS 7220 06:02:08,120 --> 06:02:12,240 LEARNED YOU WOULD LIKE TO SHARE 7221 06:02:12,240 --> 06:02:16,200 WITH INVESTIGATORS PERFORMING 7222 06:02:16,200 --> 06:02:17,120 CLINICAL RESEARCH RELATING TO 7223 06:02:17,120 --> 06:02:18,120 HISPANIC LATINO HEALTH IN THE 7224 06:02:18,120 --> 06:02:25,240 U.S.? 7225 06:02:25,240 --> 06:02:27,400 WHAT ARE THE KEY LESSONS LEARNED 7226 06:02:27,400 --> 06:02:29,560 YOU'D LIKE TO SHARE WITH 7227 06:02:29,560 --> 06:02:30,400 INVESTIGATORS PERFORMING 7228 06:02:30,400 --> 06:02:32,000 CLINICAL RESEARCH INVOLVING OR 7229 06:02:32,000 --> 06:02:32,600 RELATED TO HISPANIC LATINO 7230 06:02:32,600 --> 06:02:42,920 HEALTH IN THE U.S.? 7231 06:02:44,480 --> 06:02:49,360 >>YES, DR. ZORRILLA. 7232 06:02:49,360 --> 06:02:50,720 >>SORRY FOR THE NOISE. 7233 06:02:50,720 --> 06:02:54,000 I'M AT A PLACE WITH BACKGROUND 7234 06:02:54,000 --> 06:02:55,200 NOISE. 7235 06:02:55,200 --> 06:02:56,280 REGARDING RESEARCH WITH SPECIFIC 7236 06:02:56,280 --> 06:02:58,080 POPULATIONS MAY THEM BE 7237 06:02:58,080 --> 06:03:02,240 HISPANICS OR ANY PARTICULAR 7238 06:03:02,240 --> 06:03:04,080 GROUP, YOU NEED TO BE COMMITTED 7239 06:03:04,080 --> 06:03:09,320 TO THE GROUP AND THEY NEED TO 7240 06:03:09,320 --> 06:03:10,600 UNDERSTAND YOU'RE INTERESTED IN 7241 06:03:10,600 --> 06:03:12,720 WORKING WITH THEM AND IF YOU 7242 06:03:12,720 --> 06:03:13,760 DON'T KNOW THEM AND THEY DON'T 7243 06:03:13,760 --> 06:03:18,000 KNOW YOU NEED PEOPLE WHO ARE THE 7244 06:03:18,000 --> 06:03:18,840 BRIDGES BETWEEN YOU AND THAT 7245 06:03:18,840 --> 06:03:20,480 GROUP SO YOU CAN START THE 7246 06:03:20,480 --> 06:03:20,840 COMMUNICATION. 7247 06:03:20,840 --> 06:03:24,520 YOU DON'T NEED TO HAVE YEARS OF 7248 06:03:24,520 --> 06:03:25,320 INTERACTION TO BE ABLE TO 7249 06:03:25,320 --> 06:03:27,840 IMPLEMENT THE STUDY. 7250 06:03:27,840 --> 06:03:30,000 AS LONG AS YOU HAVE AND 7251 06:03:30,000 --> 06:03:33,080 DEMONSTRATE THE INTEREST IN 7252 06:03:33,080 --> 06:03:39,720 MAKING SURE THAT THE STUDY 7253 06:03:39,720 --> 06:03:41,200 REPRESENTS THAT COMMUNITY THE 7254 06:03:41,200 --> 06:03:43,440 STUDY WILL TREAT THEM 7255 06:03:43,440 --> 06:03:44,480 ACCORDINGLY AND RESPECT THEM AND 7256 06:03:44,480 --> 06:03:47,240 YOU'LL HAVE RESULTS AFTERWARDS 7257 06:03:47,240 --> 06:03:49,640 AND YOU'LL CONSIDER 7258 06:03:49,640 --> 06:03:50,240 MODIFICATIONS, SOMETIMES YOU 7259 06:03:50,240 --> 06:03:53,040 MIGHT CONSIDER MODIFICATIONS 7260 06:03:53,040 --> 06:03:54,760 BASED ON THE COMMUNITY RESPONSES 7261 06:03:54,760 --> 06:03:56,240 AND THIS IS MY STRATEGY WHEN I 7262 06:03:56,240 --> 06:04:02,720 WANT TO MODIFY A PROTOCOL THAT 7263 06:04:02,720 --> 06:04:07,760 CONSTRUCTS SOMEBODY ELSE I HAVE 7264 06:04:07,760 --> 06:04:08,760 A COMMUNITY ADVISORY BOARD AND 7265 06:04:08,760 --> 06:04:11,080 IF IT TELLS ME THE INCLUSION 7266 06:04:11,080 --> 06:04:13,240 CRITERIA NEEDS TO BE MODIFIED OR 7267 06:04:13,240 --> 06:04:15,280 YOU NEED TO DO WHATEVER, IT 7268 06:04:15,280 --> 06:04:20,600 COMES FROM THE COMMUNITY 7269 06:04:20,600 --> 06:04:23,480 ADVISORY BOARD AND HAS TO BE AT 7270 06:04:23,480 --> 06:04:24,840 LEAST CONSIDERED. 7271 06:04:24,840 --> 06:04:25,320 HEAVILY CONSIDERED. 7272 06:04:25,320 --> 06:04:27,520 THAT'S MY STRATEGY OF MAKING 7273 06:04:27,520 --> 06:04:29,960 SURE THE VOICES OF MY COMMUNITY 7274 06:04:29,960 --> 06:04:30,920 ARE HEARD INCLUDING THE DESIGN 7275 06:04:30,920 --> 06:04:41,440 EVEN IF IT'S ALREADY IN PLACE. 7276 06:04:43,160 --> 06:04:49,840 >>VERY BRIEFLY, I AGREE WITH 7277 06:04:49,840 --> 06:04:50,080 CARMEN. 7278 06:04:50,080 --> 06:05:00,640 I WOULD SAY KEEPING MY IDENT 7279 06:05:01,200 --> 06:05:09,560 IDENTIFYING OF LOCAL LEADERS AND 7280 06:05:09,560 --> 06:05:18,400 THAT'S MY VERY BRIEF REFLECTION. 7281 06:05:18,400 --> 06:05:21,120 >>AND ALSO IN TERMS OF DOING 7282 06:05:21,120 --> 06:05:25,000 RESEARCH WITH HISPANIC 7283 06:05:25,000 --> 06:05:26,640 POPULATION IN THE U.S. WE HAVE 7284 06:05:26,640 --> 06:05:35,440 TO BE MORE PRESENT WHEN WE REACH 7285 06:05:35,440 --> 06:05:40,680 OUT TO THE COMMUNITY OR DO 7286 06:05:40,680 --> 06:05:44,080 ACTIVITIES IT'S USUALLY THE P.I. 7287 06:05:44,080 --> 06:05:45,280 THAT EXPLAINS THE TRIAL AND WHAT 7288 06:05:45,280 --> 06:05:46,400 WE WANT TO ACHIEVE. 7289 06:05:46,400 --> 06:05:51,480 I THINK THAT'S SOMETHING WE 7290 06:05:51,480 --> 06:05:54,080 START THINKING IN THE U.S 7291 06:05:54,080 --> 06:05:57,360 U.S. LOOKING AT THAT WITH THE 7292 06:05:57,360 --> 06:06:00,840 COMMUNITY AND NOT ONLY THAT BUT 7293 06:06:00,840 --> 06:06:04,400 HAVING OUR P.I.s AND TALKING TO 7294 06:06:04,400 --> 06:06:05,280 WITH THE COMMUNITY AND WHY WE 7295 06:06:05,280 --> 06:06:10,080 NEED THE INFORMATION. 7296 06:06:10,080 --> 06:06:11,800 I HAVE THE EXPERIENCE ONCE YOU 7297 06:06:11,800 --> 06:06:13,480 GO WITH THE COMMUNITY AND TELL 7298 06:06:13,480 --> 06:06:15,760 THE POPULATION WHY WE NEED THEM 7299 06:06:15,760 --> 06:06:20,880 INVOLVED IN RESEARCH, HOW WE 7300 06:06:20,880 --> 06:06:26,200 COULD LEARN FROM OUR EXPERIENCE 7301 06:06:26,200 --> 06:06:27,960 AND IT CHANGE THE RESPONSE RATE 7302 06:06:27,960 --> 06:06:29,160 AND IN TERMS OF HOW THEY 7303 06:06:29,160 --> 06:06:31,960 PERCEIVE AND HOW THEY WANT TO 7304 06:06:31,960 --> 06:06:34,560 WORK WITH YOU IN THE RESEARCH 7305 06:06:34,560 --> 06:06:36,400 AND ONCE YOU REACH OUT YOU START 7306 06:06:36,400 --> 06:06:37,720 RECEIVING REQUESTS FOR DOING 7307 06:06:37,720 --> 06:06:39,200 MORE RESEARCH ACTIVITIES WITHIN 7308 06:06:39,200 --> 06:06:42,160 THE COMMUNITY. 7309 06:06:42,160 --> 06:06:45,120 I THINK THAT'S THE TAKE HOME 7310 06:06:45,120 --> 06:06:46,600 MESSAGE FOR RESEARCHERS DOING 7311 06:06:46,600 --> 06:06:53,160 RESEARCH HERE IN THE U.S. 7312 06:06:53,160 --> 06:06:56,000 >>I WOULD LIKE TO SAY I BELIEVE 7313 06:06:56,000 --> 06:06:59,880 CARMEN ZORRILLA HAS CLEARLY 7314 06:06:59,880 --> 06:07:01,960 DEMONSTRATED THE MANY POINTS YOU 7315 06:07:01,960 --> 06:07:03,640 HAVE TO CONSIDER. 7316 06:07:03,640 --> 06:07:07,760 ONE THING THAT YOU CANNOT AVOID 7317 06:07:07,760 --> 06:07:11,200 IS YOU HAVE TO DEMONSTRATE. 7318 06:07:11,200 --> 06:07:12,760 YOU CAN'T COMPROMISE BECAUSE 7319 06:07:12,760 --> 06:07:16,600 YOU'RE THE MODEL AND IF YOU 7320 06:07:16,600 --> 06:07:18,120 DON'T TRANSMIT THIS IMPORTANT 7321 06:07:18,120 --> 06:07:19,800 THINGS YOU ARE NOT GOING TO GET 7322 06:07:19,800 --> 06:07:21,120 IT AND YOU HAVE TO BE CONVINCED 7323 06:07:21,120 --> 06:07:24,400 THIS IS IMPORTANT AND THE PEOPLE 7324 06:07:24,400 --> 06:07:26,760 HAVE TO FEEL THEY'RE GOING TO 7325 06:07:26,760 --> 06:07:28,120 RECEIVE THE BENEFIT BECAUSE IT'S 7326 06:07:28,120 --> 06:07:37,280 NOT ONLY FOR HER OR HIM IT'S 7327 06:07:37,280 --> 06:07:37,640 FO 7328 06:07:37,640 --> 06:07:38,640 FOR EVERYBODY AND WHAT I'D LIKE 7329 06:07:38,640 --> 06:07:39,240 TO GET FROM THE PRESENTATIONS 7330 06:07:39,240 --> 06:07:47,680 HERE. 7331 06:07:47,680 --> 06:07:48,280 >>THANK YOU. 7332 06:07:48,280 --> 06:07:51,080 >>IN TERMS OF LESSONS LEARNED, 7333 06:07:51,080 --> 06:07:54,960 I HAVE TWO LESSONS. 7334 06:07:54,960 --> 06:07:57,360 ONE IS RECRUITMENT AND FOLLOW-UP 7335 06:07:57,360 --> 06:07:59,120 ARE GETTING REALLY HARD EVEN IN 7336 06:07:59,120 --> 06:08:00,280 THE GENERAL POPULATION I WOULD 7337 06:08:00,280 --> 06:08:10,000 SAY AT LEAST IN MY COUNTRY NOT 7338 06:08:10,000 --> 06:08:11,840 TO EASY TO GET PEOPLE INVOLVED 7339 06:08:11,840 --> 06:08:16,400 FOR LONG-TERM STUDIES. 7340 06:08:16,400 --> 06:08:20,520 THE LESSON FOR RESEARCHERS HERE 7341 06:08:20,520 --> 06:08:24,520 IS THAT WE NEED TO APPLY SCIENCE 7342 06:08:24,520 --> 06:08:26,160 TO THE PROCESS AS WELL AND TO 7343 06:08:26,160 --> 06:08:30,880 TRY TO UNDERSTAND FACTORS 7344 06:08:30,880 --> 06:08:33,960 ASSOCIATED TO STUDY ADHERENCE, 7345 06:08:33,960 --> 06:08:35,240 RETENTION, ATTRITION AND WHAT 7346 06:08:35,240 --> 06:08:41,800 KIND OF FACTORS ARE ASSOCIATED 7347 06:08:41,800 --> 06:08:46,640 WITH THIS DIFFERENT SCENARIO. 7348 06:08:46,640 --> 06:08:54,560 I THINK THERE ARE A FEW STUDIES 7349 06:08:54,560 --> 06:08:59,720 TRYING TO UNDERSTAND THAT AT 7350 06:08:59,720 --> 06:09:03,920 LEAST IN CHILE AND APPLY SCIENCE 7351 06:09:03,920 --> 06:09:06,080 TO THE RETENTION, ATTRITION AND 7352 06:09:06,080 --> 06:09:09,560 ADHERENCE AND TRYING TO 7353 06:09:09,560 --> 06:09:14,920 UNDERSTAND THE METHOD WE ALL 7354 06:09:14,920 --> 06:09:17,680 KNOW AND THE OTHER LESSON HAS TO 7355 06:09:17,680 --> 06:09:18,840 BE WITH IMPLEMENTATION. 7356 06:09:18,840 --> 06:09:21,240 NOW THAT WE HAVE THIS APP IN 7357 06:09:21,240 --> 06:09:26,320 CHILE AND WE HAVE PROVEN IT'S 7358 06:09:26,320 --> 06:09:28,080 EFFECTIVE BUT NOW WE ARE FACING 7359 06:09:28,080 --> 06:09:33,520 PROBLEMS WITH THE FOLLOW-UP AND 7360 06:09:33,520 --> 06:09:35,320 MAINTENANCE OF THE APP AND 7361 06:09:35,320 --> 06:09:36,760 GETTING SUPPORT AND UPDATE TO 7362 06:09:36,760 --> 06:09:41,360 THE APP OVER TIME. 7363 06:09:41,360 --> 06:09:46,960 AND SO WHAT MY COLLEAGUES SAID, 7364 06:09:46,960 --> 06:09:48,040 WE ARE NOW HAVING THIS GAP. 7365 06:09:48,040 --> 06:09:50,120 WE HAVE THE INTERVENTION. 7366 06:09:50,120 --> 06:09:53,040 WE KNOW IT'S EFFECTIVE 7367 06:09:53,040 --> 06:09:54,960 CULTURALLY APPROPRIATE BUT WE 7368 06:09:54,960 --> 06:09:55,880 HAVE PROBLEMS WITH IT. 7369 06:09:55,880 --> 06:09:59,080 WHO IS GOING TO TAKE CARE OF 7370 06:09:59,080 --> 06:10:00,960 THIS APP THAT WE DESIGN AND 7371 06:10:00,960 --> 06:10:04,320 MAKING THE UPDATES OVER TIME AND 7372 06:10:04,320 --> 06:10:07,760 MAKING AVAILABLE FOR COMMUNITY, 7373 06:10:07,760 --> 06:10:08,040 ETCETERA. 7374 06:10:08,040 --> 06:10:08,960 THOSE ARE SOME THOUGHTS I'D LIKE 7375 06:10:08,960 --> 06:10:10,600 TO SHARE WITH MY COLLEAGUES 7376 06:10:10,600 --> 06:10:10,800 HERE. 7377 06:10:10,800 --> 06:10:13,160 THANK YOU. 7378 06:10:13,160 --> 06:10:17,360 >>THANK YOU, DR. BAMBS. 7379 06:10:17,360 --> 06:10:22,800 WE HAVE ONE MORE QUESTION IN THE 7380 06:10:22,800 --> 06:10:23,400 CHAT. 7381 06:10:23,400 --> 06:10:26,040 HOW HAS MISTRUST AND 7382 06:10:26,040 --> 06:10:29,320 MISINFORMATION IMPACTED CLINICAL 7383 06:10:29,320 --> 06:10:31,080 RESEARCH IN LATIN AMERICA. 7384 06:10:31,080 --> 06:10:36,080 HOW HAS MISTRUST AND 7385 06:10:36,080 --> 06:10:36,680 MISINFORMATION IMPACTED CLINICAL 7386 06:10:36,680 --> 06:10:42,480 RESEARCH IN LATIN AMERICA? 7387 06:10:42,480 --> 06:10:49,000 >>THAT'S A GREAT QUESTION. 7388 06:10:49,000 --> 06:10:52,080 IT'S DIFFICULT TO APPROACH 7389 06:10:52,080 --> 06:10:55,560 BECAUSE MISINFORMATION IS A NEW 7390 06:10:55,560 --> 06:10:57,040 DETERMINATE OF HEALTH. 7391 06:10:57,040 --> 06:10:58,080 YOU HAVE SOCIAL DETERMINATES OF 7392 06:10:58,080 --> 06:11:03,280 HEALTH AND NOW WE HAVE 7393 06:11:03,280 --> 06:11:10,080 MISINFORMATION AND WE HAVE 7394 06:11:10,080 --> 06:11:13,760 DIFFERENT SOURCES WHERE NICK CAN 7395 06:11:13,760 --> 06:11:19,240 SAY ANYTHING AND IT'S DIFFICULT 7396 06:11:19,240 --> 06:11:27,080 FOR ALL OF US TO UNDERSTAND THE 7397 06:11:27,080 --> 06:11:33,200 AUTHORITY ANY OF US HAVE. 7398 06:11:33,200 --> 06:11:39,360 I WOULD SAY GLOBALLY WITH 7399 06:11:39,360 --> 06:11:40,760 MISINFORMATION AN REALIZE 7400 06:11:40,760 --> 06:11:43,400 THERE'S GROUPS TRYING TO PROPOSE 7401 06:11:43,400 --> 06:11:47,360 THE APPROACH TO THIS NEW SOCIAL 7402 06:11:47,360 --> 06:11:48,560 DETERMINATE OF HEALTH. 7403 06:11:48,560 --> 06:11:52,960 I THINK WE STILL DON'T HAVE THE 7404 06:11:52,960 --> 06:11:53,480 RIGHT ANSWERS. 7405 06:11:53,480 --> 06:11:54,080 >>THANK YOU. 7406 06:11:54,080 --> 06:11:57,080 ANYONE ELSE WHO WOULD LIKE TO 7407 06:11:57,080 --> 06:11:58,520 OFFER A COMMENT AROUND THE 7408 06:11:58,520 --> 06:12:00,240 QUESTION AROUND MISTRUST AND 7409 06:12:00,240 --> 06:12:01,720 MISINFORMATION AND HOW IT 7410 06:12:01,720 --> 06:12:07,080 IMPACTS CLINICAL RESEARCH? 7411 06:12:07,080 --> 06:12:08,960 >>WE NEED TO LOOK AT HOW TO 7412 06:12:08,960 --> 06:12:11,560 OVERCOME THOSE AND WHEN WE SEE 7413 06:12:11,560 --> 06:12:14,720 MISINFORMATION THERE'S KEY 7414 06:12:14,720 --> 06:12:19,600 ELEMENTS THAT HELPS INFORMATION 7415 06:12:19,600 --> 06:12:24,560 THROUGH THE POPULATION. 7416 06:12:24,560 --> 06:12:26,120 WE SEE COMPLEX TERMS AND THINGS 7417 06:12:26,120 --> 06:12:29,040 NOT SUPPORTED WITH SCIENCE COME 7418 06:12:29,040 --> 06:12:39,600 WITH CRAZY CONSPIRACY THEORIES. 7419 06:12:42,280 --> 06:12:52,760 WE NEED TO SEND OUR TERM THAT A 7420 06:12:57,200 --> 06:13:07,760 POPULATION WOULD UNDERSTAND. 7421 06:13:07,760 --> 06:13:09,400 >>I WOULD LIKE TO SAY THIS 7422 06:13:09,400 --> 06:13:13,200 MEETING HAS AN IMPORTANT THEME. 7423 06:13:13,200 --> 06:13:15,240 YOU HAVE TO PUT TOGETHER 7424 06:13:15,240 --> 06:13:17,280 RESEARCH AND CLINICAL PRACTICE 7425 06:13:17,280 --> 06:13:22,480 AND QUALITY OF PEOPLE NO MATTER 7426 06:13:22,480 --> 06:13:26,120 THE DISEASE. 7427 06:13:26,120 --> 06:13:28,200 PEOPLE CAN SEE HOW MUCH IS 7428 06:13:28,200 --> 06:13:29,680 IMPORTANT DEDICATED RESEARCH TO 7429 06:13:29,680 --> 06:13:30,920 THE QUALITY OF LIFE OF PEOPLE 7430 06:13:30,920 --> 06:13:34,400 AND THIS IS GOING TO BE A GREAT 7431 06:13:34,400 --> 06:13:36,640 IMPROVEMENT AND GREAT MESSAGE 7432 06:13:36,640 --> 06:13:39,720 AND NOT ONLY FOR LATIN AMERICA I 7433 06:13:39,720 --> 06:13:45,360 THINK FOR EVERY PART OF THE 7434 06:13:45,360 --> 06:13:47,640 WORLD AND THAT'S THANK YOU TO 7435 06:13:47,640 --> 06:13:50,080 YOU AND THE NIH FOR THE 7436 06:13:50,080 --> 06:13:51,000 OPPORTUNITY AND THANK YOU 7437 06:13:51,000 --> 06:13:51,520 EVERYBODY FOR THE CLEAR 7438 06:13:51,520 --> 06:13:51,880 PRESENTATIONS. 7439 06:13:51,880 --> 06:13:56,680 THANK YOU. 7440 06:13:56,680 --> 06:13:59,400 >>THANK YOU, DR. GAGLIARDINO. 7441 06:13:59,400 --> 06:13:59,920 OTHER COMMENTS? 7442 06:13:59,920 --> 06:14:08,040 WE HAVE ONE MORE QUESTION. 7443 06:14:08,040 --> 06:14:12,600 HOW WOULD YOU DESCRIBE A 7444 06:14:12,600 --> 06:14:14,120 SUCCESSFUL COLLABORATION WITH 7445 06:14:14,120 --> 06:14:19,680 LATINOS AND HISPANIC HOW WOULD 7446 06:14:19,680 --> 06:14:22,880 YOU DESCRIBE A SUCCESSFUL 7447 06:14:22,880 --> 06:14:24,880 COLLABORATION INVOLVING LATINOS 7448 06:14:24,880 --> 06:14:26,680 AND HISPANIC AND WHAT WOULD IT 7449 06:14:26,680 --> 06:14:27,200 LOOK LIKE. 7450 06:14:27,200 --> 06:14:30,400 I UNDER DIFFERENT DISCIPLINES 7451 06:14:30,400 --> 06:14:32,920 LIKE DR. GAGLIARDINO MENTIONED. 7452 06:14:32,920 --> 06:14:37,440 EACH HAS APPROACHED A SPECIFIC 7453 06:14:37,440 --> 06:14:41,200 CONDITION OR SPECIFIC POPULATION 7454 06:14:41,200 --> 06:14:45,920 BUT IF THERE IS A COMMON 7455 06:14:45,920 --> 06:14:46,160 MESSAGE? 7456 06:14:46,160 --> 06:14:56,560 WHO WOULD LIKE TO START? 7457 06:14:59,080 --> 06:15:00,480 >>ADDRESSING HISPANICS IN THE 7458 06:15:00,480 --> 06:15:02,080 MAIN LAND U.S. RIGHT NOW BECAUSE 7459 06:15:02,080 --> 06:15:04,840 OF THE POLITICAL ENVIRONMENT AND 7460 06:15:04,840 --> 06:15:08,600 THE DIVISION IN THE COUNTRY IS A 7461 06:15:08,600 --> 06:15:11,960 VERY DIFFICULT PROCESS AND WORK. 7462 06:15:11,960 --> 06:15:15,680 POPULATIONS ARE AFRAID OF BEING 7463 06:15:15,680 --> 06:15:21,360 MISTREATED NOT JUST DEPORTED, 7464 06:15:21,360 --> 06:15:22,800 MISTREATED AND MISUNDERSTOOD I 7465 06:15:22,800 --> 06:15:24,360 THINK PEOPLE WORKING RIGHT NOW 7466 06:15:24,360 --> 06:15:27,640 WITH HISPANIC POPULATIONS IN THE 7467 06:15:27,640 --> 06:15:31,960 MAINLAND HAVE A TOUGH JOB MAKING 7468 06:15:31,960 --> 06:15:33,120 SURE THE INFORMATION IS 7469 06:15:33,120 --> 06:15:36,080 AVAILABLE THAT THE STUDIES WILL 7470 06:15:36,080 --> 06:15:37,720 MAKE SURE THAT PEOPLE ARE 7471 06:15:37,720 --> 06:15:39,720 TREATED ADEQUATELY THAT THEY 7472 06:15:39,720 --> 06:15:41,320 WILL NOT -- THEIR INFORMATION 7473 06:15:41,320 --> 06:15:51,800 WILL NOT BE DISCLOSED TO OTHER 7474 06:15:51,800 --> 06:15:54,080 STUDIES AND NOW HAVE BETTER WAYS 7475 06:15:54,080 --> 06:15:58,080 OF TRANSLATIONS. 7476 06:15:58,080 --> 06:16:00,760 YOU DON'T NEED EVEN PREVIOUS 7477 06:16:00,760 --> 06:16:02,600 YEARS YOU HAD THE CHILDREN OF 7478 06:16:02,600 --> 06:16:03,120 THE PARTICIPANTS GETTING 7479 06:16:03,120 --> 06:16:05,080 INVOLVED IN ANSWERING THE 7480 06:16:05,080 --> 06:16:07,640 QUESTIONS WHICH AFFECTED THE 7481 06:16:07,640 --> 06:16:08,600 DEGREE OF CERTAINTY OF THE 7482 06:16:08,600 --> 06:16:11,560 ANSWERS BECAUSE YOU HAVE A CHILD 7483 06:16:11,560 --> 06:16:13,320 RESPONDING FOR THEIR PARENTS. 7484 06:16:13,320 --> 06:16:16,520 SO I THINK WE ARE IN A DIFFERENT 7485 06:16:16,520 --> 06:16:16,720 TIME. 7486 06:16:16,720 --> 06:16:19,560 THINGS ARE GOOD FOR THE USE OF 7487 06:16:19,560 --> 06:16:24,920 TECHNOLOGY, WHICH ALLOW PEOPLE 7488 06:16:24,920 --> 06:16:31,200 TO BE IN A PRIVATE SPACE AND 7489 06:16:31,200 --> 06:16:32,840 HAVE PROTOCOLS WHERE A LOT OF 7490 06:16:32,840 --> 06:16:34,120 THINGS CAN HAPPEN ONLINE AND 7491 06:16:34,120 --> 06:16:37,880 THINGS CAN HAPPEN AT A CLINIC OR 7492 06:16:37,880 --> 06:16:39,880 LABORATORY AND YOU TAKE TO THE 7493 06:16:39,880 --> 06:16:42,960 COMMUNITY EITHER THE SAMPLING 7494 06:16:42,960 --> 06:16:48,000 PROCESSES OR THE EXAMS OR 7495 06:16:48,000 --> 06:16:49,320 SOMETHING LIKE THAT. 7496 06:16:49,320 --> 06:16:51,160 IN LATIN AMERICA I WOULD NOT 7497 06:16:51,160 --> 06:16:52,360 DARE TO SAY BUT IN THE 7498 06:16:52,360 --> 06:16:54,360 U.S. MAINLAND, THINGS CAN BE 7499 06:16:54,360 --> 06:16:57,120 DIFFICULT AND WE NEED TO MAKE 7500 06:16:57,120 --> 06:16:59,960 THAT WE STRENGTHEN THE CAPACITY 7501 06:16:59,960 --> 06:17:02,680 AND THE RESOURCES OF PEOPLE WHO 7502 06:17:02,680 --> 06:17:03,440 ARE GOING TO BE STUDYING THE 7503 06:17:03,440 --> 06:17:07,440 POPULATIONS. 7504 06:17:07,440 --> 06:17:11,840 >>THANK YOU, DR. ZORRILLA. 7505 06:17:11,840 --> 06:17:14,080 DR. BAMBS, YOU HAVE YOUR HAND 7506 06:17:14,080 --> 06:17:14,840 RAISED? 7507 06:17:14,840 --> 06:17:15,360 >>YEAH. 7508 06:17:15,360 --> 06:17:21,280 I THINK SUCCESSFUL COLLABORATION 7509 06:17:21,280 --> 06:17:27,840 BETWEEN RESEARCHERS AND THOSE 7510 06:17:27,840 --> 06:17:30,800 WHO WORK IN POPULATIONS IN THE 7511 06:17:30,800 --> 06:17:33,120 U.S. IS IMPORTANT TO CONSIDER 7512 06:17:33,120 --> 06:17:36,280 PRINCIPLES OF COLLABORATION 7513 06:17:36,280 --> 06:17:41,400 BETWEEN PEERS AND SEEING EACH 7514 06:17:41,400 --> 06:17:46,320 OTHER AND GROUPS AND THAT MEANS 7515 06:17:46,320 --> 06:17:51,960 TO TRY TO IDENTIFY SOME RESEARCH 7516 06:17:51,960 --> 06:17:53,920 QUESTIONS THAT ARE IN IMPORTANT 7517 06:17:53,920 --> 06:17:55,520 AND DO THAT IN COMMON AND DESIGN 7518 06:17:55,520 --> 06:18:00,800 THE PROTOCOLS TOGETHER AND THEN 7519 06:18:00,800 --> 06:18:02,240 IMPLEMENT WHATEVER WE DECIDED TO 7520 06:18:02,240 --> 06:18:06,800 DO TOGETHER. 7521 06:18:06,800 --> 06:18:12,680 SOMETIMES WHAT HAS HAPPENED IN 7522 06:18:12,680 --> 06:18:15,280 THE PAST IS SOME SOUTH AMERICAN 7523 06:18:15,280 --> 06:18:16,920 COUNTRIES WORKED WITH PROTOCOLS 7524 06:18:16,920 --> 06:18:18,280 DEVELOPED AND WE FOLLOWED THE 7525 06:18:18,280 --> 06:18:21,760 DIRECTION AND I THINK NOW WE'RE 7526 06:18:21,760 --> 06:18:24,600 IN A DIFFERENT ERA AND WE COULD 7527 06:18:24,600 --> 06:18:26,520 WORK TOGETHER KNOWING THAT WE IN 7528 06:18:26,520 --> 06:18:29,560 OUR COUNTRIES WE HAVE KNOWLEDGE 7529 06:18:29,560 --> 06:18:33,680 THAT IS IMPORTANT THAT IS SOLID 7530 06:18:33,680 --> 06:18:36,440 AND WE CAN COLLABORATE IN A MORE 7531 06:18:36,440 --> 06:18:39,000 HORIZONTAL WAY AND THAT CAN 7532 06:18:39,000 --> 06:18:42,320 BENEFIT A LOT THE SUCCESS OF OUR 7533 06:18:42,320 --> 06:18:46,080 RESEARCH NETWORKS. 7534 06:18:46,080 --> 06:18:48,640 >>THANK YOU, DR. BAMBS. 7535 06:18:48,640 --> 06:18:49,600 VERY INSIGHTFUL. 7536 06:18:49,600 --> 06:18:51,120 ANY OTHER? 7537 06:18:51,120 --> 06:19:00,480 WE HAVE ONE MINUTE. 7538 06:19:00,480 --> 06:19:02,160 >>I AGREE WITH CLAUDIA'S 7539 06:19:02,160 --> 06:19:02,400 COMMENT. 7540 06:19:02,400 --> 06:19:04,360 TO FOLLOW-UP ON THAT, I THINK 7541 06:19:04,360 --> 06:19:11,160 THAT KEY CONCEPTS ARE EQUITY, 7542 06:19:11,160 --> 06:19:12,240 POWER BALANCE, HAVE GREAT 7543 06:19:12,240 --> 06:19:13,120 COLLABORATION WITH RESEARCHERS 7544 06:19:13,120 --> 06:19:17,120 FROM HIGH-INCOME COUNTRIES AND 7545 06:19:17,120 --> 06:19:18,120 IN PARTICULAR THE 7546 06:19:18,120 --> 06:19:19,680 U.S. RESEARCHERS. 7547 06:19:19,680 --> 06:19:25,640 TO ME THOSE ARE THE MAIN POINTS 7548 06:19:25,640 --> 06:19:26,800 IN THIS COLLABORATION WHERE WE 7549 06:19:26,800 --> 06:19:30,080 LEARN FROM EACH OTHER. 7550 06:19:30,080 --> 06:19:32,680 >>EXCELLENT. 7551 06:19:32,680 --> 06:19:43,080 THANK YOU, DR. IRAZOLA. 7552 06:19:44,360 --> 06:19:46,080 IT'S NOW ALMOST 3:50 AND WE'RE 7553 06:19:46,080 --> 06:19:49,400 GOING TO BREAK. 7554 06:19:49,400 --> 06:19:50,400 THANK YOU FOR WATCHING OUR 7555 06:19:50,400 --> 06:19:52,360 WORKSHOP AND GOOD-BYE FOR NOW. 7556 06:19:52,360 --> 06:19:57,280 SEE YOU AT 4:00 P.M. 7557 06:19:57,280 --> 06:19:58,920 >>GOOD AFTERNOON, EVERYONE. 7558 06:19:58,920 --> 06:20:00,320 IT'S 4:00 P.M. 7559 06:20:00,320 --> 06:20:08,400 IT'S TIME TO COME BACK. 7560 06:20:08,400 --> 06:20:12,760 WE'RE ABOUT TO START TOPIC 7 OF 7561 06:20:12,760 --> 06:20:14,880 OUR WORKSHOP. 7562 06:20:14,880 --> 06:20:15,520 THANK YOU FOR JOINING SINCE 7563 06:20:15,520 --> 06:20:19,800 EARLY THIS MORNING. 7564 06:20:19,800 --> 06:20:21,760 THE TOPIC IS PART OF THE 7565 06:20:21,760 --> 06:20:22,480 OVERVIEW OF HEALTH CARE SYSTEMS 7566 06:20:22,480 --> 06:20:23,920 AND HEALTH CARE. 7567 06:20:23,920 --> 06:20:27,360 WE HAVE THREE SPEAKERS AND THE 7568 06:20:27,360 --> 06:20:32,320 MODERATOR IS DR. MICHELLE DOOSE. 7569 06:20:32,320 --> 06:20:41,320 LET'S BEGIN. 7570 06:20:41,320 --> 06:20:44,160 >>I'LL BE THE MODERATOR. 7571 06:20:44,160 --> 06:20:45,840 BEFORE THE LIVE Q&A SESSION WE 7572 06:20:45,840 --> 06:20:50,600 HAVE THREE PRESENTATIONS FROM 7573 06:20:50,600 --> 06:20:54,800 DOCTORS ERNESTO BASCOLO AND 7574 06:20:54,800 --> 06:20:58,000 FRANCISCO BECERRA POSADA AND 7575 06:20:58,000 --> 06:21:00,760 DR. ALEX ORTEGA. 7576 06:21:00,760 --> 06:21:02,960 >>I'M ERNESTO BASCOLO. 7577 06:21:02,960 --> 06:21:05,120 THE ACT BEING UNIT CHIEF OF THE 7578 06:21:05,120 --> 06:21:08,560 HEALTH SYSTEM UNITS AT THE PAN 7579 06:21:08,560 --> 06:21:17,200 AMERICAN HEALTH ORGANIZATION. 7580 06:21:17,200 --> 06:21:18,760 PUBLIC HEALTH HAS SEEN 7581 06:21:18,760 --> 06:21:21,560 IMPROVEMENT IN THE REGION OF ME. 7582 06:21:21,560 --> 06:21:23,240 THERE'S SIGNIFICANT CHALLENGES 7583 06:21:23,240 --> 06:21:27,800 WE NEED TO ADDRESS TO IMPROVE 7584 06:21:27,800 --> 06:21:29,520 THE HEALTH OF OUR POPULATION WE 7585 06:21:29,520 --> 06:21:34,520 LIVE IN A REGION WHERE THE 7586 06:21:34,520 --> 06:21:35,400 INFLUENCE OF THE SOCIAL 7587 06:21:35,400 --> 06:21:37,000 DETERMINATES OF HEALTH, THE 7588 06:21:37,000 --> 06:21:40,720 CIRCUMSTANCES IN WHICH PEOPLE 7589 06:21:40,720 --> 06:21:43,840 ARE BORN, GROW UP, WORK, LIVE 7590 06:21:43,840 --> 06:21:48,200 AND AGE AND WHICH HAVE THE 7591 06:21:48,200 --> 06:21:53,280 IMPACT ON THE DAILY LIVING 7592 06:21:53,280 --> 06:21:55,360 CONDITIONS AND HEALTH OF 7593 06:21:55,360 --> 06:22:00,600 INDIVIDUALS IS BECOMING EVIDENT. 7594 06:22:00,600 --> 06:22:07,400 WE LIVE IN AN AGING SOCIETY 7595 06:22:07,400 --> 06:22:11,280 WHERE PHENOMENON ARE OCCURRING 7596 06:22:11,280 --> 06:22:16,360 IN COUNTRIES AND WE MUST HAVE 7597 06:22:16,360 --> 06:22:17,160 ADDRESS CLIMATE CHANGE AND 7598 06:22:17,160 --> 06:22:19,120 DEMOGRAPHIC TRANSITIONS AND THE 7599 06:22:19,120 --> 06:22:21,640 PRESENCE OF EMERGING AND 7600 06:22:21,640 --> 06:22:24,480 RE-EMERGING DISEASES AND THE 7601 06:22:24,480 --> 06:22:28,360 COVID-19 PANDEMIC TOGETHER WITH 7602 06:22:28,360 --> 06:22:29,480 NON-COMMUNICABLE DISEASES. 7603 06:22:29,480 --> 06:22:31,880 THESE CHALLENGES ARE THEN TAKING 7604 06:22:31,880 --> 06:22:35,480 PLACE IN THE CONTEXT OF 7605 06:22:35,480 --> 06:22:39,560 POLITICAL CRISES, CONFLICT IN 7606 06:22:39,560 --> 06:22:43,320 SEVERAL COUNTRIES. 7607 06:22:43,320 --> 06:22:48,840 WHICH WE CAN LOOK AT STEWARDSHIP 7608 06:22:48,840 --> 06:22:50,680 AND GOVERNANCE AND INCREASE 7609 06:22:50,680 --> 06:22:51,720 INEQUITY IN ACCESS TO HEALTH 7610 06:22:51,720 --> 06:23:01,920 SERVICES. 7611 06:23:11,480 --> 06:23:17,080 AND THERE'S A FUNCTIONAL 7612 06:23:17,080 --> 06:23:19,160 RELATIONSHIP AND SUPPLY AND 7613 06:23:19,160 --> 06:23:23,720 DEMAND AND CONDITION IN THE 7614 06:23:23,720 --> 06:23:30,720 CAPACITY TO FACILITATE OR LIMIT 7615 06:23:30,720 --> 06:23:33,840 BARRIERS OR ACCESS WHEN THE 7616 06:23:33,840 --> 06:23:35,400 POPULATION NEEDS THEM BASED ON 7617 06:23:35,400 --> 06:23:39,600 THE 17 COUNTRIES IN THE REGIONS 7618 06:23:39,600 --> 06:23:44,160 ABOUT 34% OF THE POPULATION 7619 06:23:44,160 --> 06:23:48,320 EXPERIENCES UNMET NEEDS DUE TO 7620 06:23:48,320 --> 06:23:52,680 MULTIPLE ACCESS BARRIERS WITH 7621 06:23:52,680 --> 06:23:55,480 FINANCIAL AVAILABILITY AND 7622 06:23:55,480 --> 06:23:57,120 ADMINISTRATIVE BARRIERS BEING ON 7623 06:23:57,120 --> 06:24:00,600 AVERAGE THE MOST COMMON REASONS 7624 06:24:00,600 --> 06:24:04,520 FOR UNMET CARE NEEDS. 7625 06:24:04,520 --> 06:24:06,560 ADDITIONALLY, THE PERCENTAGE OF 7626 06:24:06,560 --> 06:24:08,560 UNMET NEEDS WAS HIGHER ON 7627 06:24:08,560 --> 06:24:13,600 AVERAGE AMONG INDIVIDUALS IN THE 7628 06:24:13,600 --> 06:24:20,320 POOREST INCOME QUARTILE AND 7629 06:24:20,320 --> 06:24:23,560 THOSE WERE MOST LIKELY TO 7630 06:24:23,560 --> 06:24:26,880 EXPERIENCE BARRIERS RELATED TO 7631 06:24:26,880 --> 06:24:30,520 ISSUES AND FINANCIAL AND 7632 06:24:30,520 --> 06:24:31,640 GEOGRAPHICAL ACCESS OR 7633 06:24:31,640 --> 06:24:33,320 AVAILABILITY OF RESOURCES 7634 06:24:33,320 --> 06:24:39,040 HIGHLIGHTING THE NEED FOR 7635 06:24:39,040 --> 06:24:41,360 INTEGRATIVE MULTI-SECTORIAL 7636 06:24:41,360 --> 06:24:43,880 APPROACHES AND PRODUCE BARRIERS 7637 06:24:43,880 --> 06:24:51,120 TO ACCESS HEALTH SERVICES. 7638 06:24:51,120 --> 06:24:53,200 THERE HAS ALSO BEEN A DEFICIT OF 7639 06:24:53,200 --> 06:24:55,560 HUMAN RESOURCES FOR HEALTH THAT 7640 06:24:55,560 --> 06:25:01,400 HAS REMAINED HIGH DESPITE 7641 06:25:01,400 --> 06:25:05,920 EFFORTS FOR IMPROVEMENT BETWEEN 7642 06:25:05,920 --> 06:25:15,520 66 AND 94% OF THE LATIN AMERICAN 7643 06:25:15,520 --> 06:25:16,680 COUNTRIES AND MEETING THE 7644 06:25:16,680 --> 06:25:18,400 THRESHOLD IN 2019 AND HERE WE 7645 06:25:18,400 --> 06:25:24,800 CAN SEE THE NUMBER OF COUNTRIES 7646 06:25:24,800 --> 06:25:29,520 WITH THE SUM OF TYPES OF CRUCIAL 7647 06:25:29,520 --> 06:25:33,480 HUMAN RESOURCES FOR HEALTH 7648 06:25:33,480 --> 06:25:37,200 INCLUDE PHYSICIANS, NURSES, 7649 06:25:37,200 --> 06:25:39,720 MID-WIVES, DENTISTRY PERSONNEL 7650 06:25:39,720 --> 06:25:42,200 AND PHARMACEUTICAL PERSONNEL. 7651 06:25:42,200 --> 06:25:48,360 THIS NUMBER HIGHLIGHTS THE NEED 7652 06:25:48,360 --> 06:25:50,080 FOR INCREASED INVESTMENT IN 7653 06:25:50,080 --> 06:25:50,800 EDUCATION AND EMPLOYMENT 7654 06:25:50,800 --> 06:25:54,360 CONDITIONS OF HUMAN RESOURCES 7655 06:25:54,360 --> 06:25:58,240 FOR HEALTH TO ACHIEVE UNIVERSAL 7656 06:25:58,240 --> 06:25:58,760 HEALTH AND GLOBAL HEALTH 7657 06:25:58,760 --> 06:26:05,440 SECURITY. 7658 06:26:05,440 --> 06:26:08,440 THE COVID-19 PANDEMIC HAS 7659 06:26:08,440 --> 06:26:11,280 AMPLIFIED THESE EXISTING 7660 06:26:11,280 --> 06:26:16,360 CHALLENGES PARTICULARLY AMONG 7661 06:26:16,360 --> 06:26:24,200 VULNERABLE COMMUNITIES THIS 7662 06:26:24,200 --> 06:26:27,560 GRAPH SHOWS THE PERCENTAGE WITH 7663 06:26:27,560 --> 06:26:30,160 ESSENTIAL HEALTH SERVICES BY 7664 06:26:30,160 --> 06:26:33,400 SERVICE DELIVERY CHANNELS AND 7665 06:26:33,400 --> 06:26:35,560 PRIORITY HEALTH AREAS 7666 06:26:35,560 --> 06:26:35,880 PROSPECTIVELY. 7667 06:26:35,880 --> 06:26:44,720 AT THE END OF 2021, THEDISRUPTI 7668 06:26:44,720 --> 06:26:46,160 WERE REPORTED ACROSS ALL 7669 06:26:46,160 --> 06:26:47,320 DELIVERY PLATFORMS AND THE FIRST 7670 06:26:47,320 --> 06:26:48,880 LEVEL OF CARE AND 7671 06:26:48,880 --> 06:26:50,480 COMMUNITY-BASED CARE SERVICES 7672 06:26:50,480 --> 06:26:56,360 AMONG THE MOST AFFECTED AREAS. 7673 06:26:56,360 --> 06:26:58,680 ADDITIONALLY, COUNTRIES CONTINUE 7674 06:26:58,680 --> 06:27:02,000 TO REPORT THIS ACROSS ALL 7675 06:27:02,000 --> 06:27:07,440 PRIORITY HEALTH AREAS WITH MORE 7676 06:27:07,440 --> 06:27:12,160 THAN HALF OF COUNTRIES REPORTING 7677 06:27:12,160 --> 06:27:13,960 DISRUPTIONS TO IMMUNIZATION AND 7678 06:27:13,960 --> 06:27:15,600 CARE FOR OTHER PEOPLE AND CANCER 7679 06:27:15,600 --> 06:27:18,920 CARE. 7680 06:27:18,920 --> 06:27:21,440 EVEN BEFORE THE PANDEMIC THERE 7681 06:27:21,440 --> 06:27:25,160 WERE DIFFERENT TYPES OF REFORMS 7682 06:27:25,160 --> 06:27:25,880 IN OUR HEALTH SYSTEMS. 7683 06:27:25,880 --> 06:27:28,360 THE REFORMS CAN BE DESCRIBED IN 7684 06:27:28,360 --> 06:27:32,440 TERMS OF TYPE OF REFORMS AND 7685 06:27:32,440 --> 06:27:35,280 REFORM THAT FOCUS ON EXPANDED 7686 06:27:35,280 --> 06:27:37,080 INSURANCE COVERAGE AND REFORM 7687 06:27:37,080 --> 06:27:40,280 THAT PRIORITIZES CHALLENGES IN 7688 06:27:40,280 --> 06:27:42,000 THE ORGANIZATION OF HEALTH 7689 06:27:42,000 --> 06:27:42,240 SERVICES. 7690 06:27:42,240 --> 06:27:45,520 HERE ARE SOME KEY ELEMENTS TO 7691 06:27:45,520 --> 06:27:48,320 CONSIDER AS COMPONENTS OF THOSE 7692 06:27:48,320 --> 06:27:53,000 DIFFERENT TYPES OF HEALTH 7693 06:27:53,000 --> 06:27:56,760 SYSTEMS RE FOFORMS THE RELATIONP 7694 06:27:56,760 --> 06:28:01,040 BETWEEN THE STATE AND MARK AND 7695 06:28:01,040 --> 06:28:06,120 SOCIO PROTECTION AND MARKET 7696 06:28:06,120 --> 06:28:08,760 REGULATION CONSIDERED AND 7697 06:28:08,760 --> 06:28:11,440 CONCEPTION BEHIND THOSE 7698 06:28:11,440 --> 06:28:12,680 INITIATIVES AND INSTITUTIONAL 7699 06:28:12,680 --> 06:28:14,800 AND POLITICAL PROCESSES. 7700 06:28:14,800 --> 06:28:16,920 WHAT ARE THE DRIVERS OF THE 7701 06:28:16,920 --> 06:28:17,720 CHALLENGES. 7702 06:28:17,720 --> 06:28:20,560 WHAT ARE THE STRATEGIES OF THOSE 7703 06:28:20,560 --> 06:28:25,520 REFORMS. 7704 06:28:25,520 --> 06:28:30,160 LET'S LOOK IN MORE DETAIL AT 7705 06:28:30,160 --> 06:28:32,600 THESE TWO REFORM PROCESSES. 7706 06:28:32,600 --> 06:28:38,160 THE FIRST REFORM PROCESS 7707 06:28:38,160 --> 06:28:40,920 PROMOTES REFORM ON INNOVATION IN 7708 06:28:40,920 --> 06:28:44,400 INSURANCE MODELS AS STRATEGY FOR 7709 06:28:44,400 --> 06:28:48,600 REFORMING THE HEALTH SYSTEM AND 7710 06:28:48,600 --> 06:28:52,640 EXPANDING COVERAGE TO ASSURE THE 7711 06:28:52,640 --> 06:28:54,000 POPULATION IS FINANCIALLY 7712 06:28:54,000 --> 06:28:56,280 PROTECTED. 7713 06:28:56,280 --> 06:28:59,840 COUNTRIES THAT FOCUS ON REFORMS 7714 06:28:59,840 --> 06:29:03,160 TO INSURANCE IMPROVE FINANCIAL 7715 06:29:03,160 --> 06:29:05,800 PROTECTION BUT NOT NECESSARILY 7716 06:29:05,800 --> 06:29:08,360 WITH RESULT IN POSSIBLE CHANGES 7717 06:29:08,360 --> 06:29:17,800 IN ACCESS. 7718 06:29:17,800 --> 06:29:23,000 THE SECOND REFORM PROCESS 7719 06:29:23,000 --> 06:29:32,520 FOCUSSED ON ORGANIZING HEALTH 7720 06:29:32,520 --> 06:29:34,080 SERVICES TO ADDRESS THE 7721 06:29:34,080 --> 06:29:36,080 STRUCTURAL FRAGMENTATION OF 7722 06:29:36,080 --> 06:29:38,120 HEALTH SYSTEMS AND THIS REFORM 7723 06:29:38,120 --> 06:29:43,720 PROCESS LEADS TO IMPROVED ACCESS 7724 06:29:43,720 --> 06:29:46,520 YET A LARGE PROPORTION OF THE 7725 06:29:46,520 --> 06:29:47,840 POPULATION CONTINUES TO REPORT 7726 06:29:47,840 --> 06:29:52,440 BARRIERS TO ACCESS IN THE 7727 06:29:52,440 --> 06:29:55,880 COUNTRYIES STUDIED. 7728 06:29:55,880 --> 06:29:57,960 FOR BOTH IMPROVING SOCIAL 7729 06:29:57,960 --> 06:29:58,640 CONDITIONS OF THE POPULATION AND 7730 06:29:58,640 --> 06:30:03,600 ESTABLISH POLICIES ARE NEEDED TO 7731 06:30:03,600 --> 06:30:04,120 ACHIEVE MORE SIGNIFICANT 7732 06:30:04,120 --> 06:30:09,960 PROGRESS. 7733 06:30:09,960 --> 06:30:16,000 AND IN 2020 THE RENEWED 7734 06:30:16,000 --> 06:30:18,760 ESSENTIAL PUBLIC HEALTH WHICH 7735 06:30:18,760 --> 06:30:26,200 WERE SUPPORTED BY MEMBER STATES 7736 06:30:26,200 --> 06:30:32,640 IN THE SEPTEMBER 2021 RESOLUTION 7737 06:30:32,640 --> 06:30:36,600 AND THE STRATEGY FOR BUILDING 7738 06:30:36,600 --> 06:30:38,160 RESILIENT HEALTH SYSTEM IN 7739 06:30:38,160 --> 06:30:44,000 COVID-19 RECOVERY TO SUSTAIN AND 7740 06:30:44,000 --> 06:30:47,680 PROTECT PUBLIC HEALTH GAINS AND 7741 06:30:47,680 --> 06:30:49,080 STRENGTHENING OF STEWARDSHIP AND 7742 06:30:49,080 --> 06:30:55,600 GOVERNANCE THAT GOES FROM THE 7743 06:30:55,600 --> 06:30:58,000 LIMIT OF HEALTH SERVICE TO 7744 06:30:58,000 --> 06:31:03,200 IMPROVING THE CAPACITY OF THE 7745 06:31:03,200 --> 06:31:07,440 HEALTH SYSTEM TO RESPOND WITH AN 7746 06:31:07,440 --> 06:31:09,840 INTERSECTIONAL APPROACH TO THE 7747 06:31:09,840 --> 06:31:12,400 FACTORS AND SOCIAL DETERMINATES 7748 06:31:12,400 --> 06:31:16,640 WAS DEFINED AS A KEY STRATEGY 7749 06:31:16,640 --> 06:31:18,160 LINE OF ACTION. 7750 06:31:18,160 --> 06:31:19,800 >>GOOD AFTERNOON. 7751 06:31:19,800 --> 06:31:24,280 I'M HAPPY TO BE HERE AND THE 7752 06:31:24,280 --> 06:31:28,800 ORGANIZERS FOR THE INTER -- 7753 06:31:28,800 --> 06:31:34,200 INVITATION ON THE SEMINAR ON KEY 7754 06:31:34,200 --> 06:31:35,160 ISSUES LATIN AMERICA AND SOME OF 7755 06:31:35,160 --> 06:31:37,880 THE INFORMATION I'LL BE 7756 06:31:37,880 --> 06:31:40,360 PRESENTING WAS ALIGNED WITH 7757 06:31:40,360 --> 06:31:44,120 HEALTH POLICIES AND SYSTEMS 7758 06:31:44,120 --> 06:31:44,400 RESEARCH. 7759 06:31:44,400 --> 06:31:46,880 THE CHALLENGES IS PRETTY MUCH 7760 06:31:46,880 --> 06:31:47,920 THE SAME ALL OVER LATIN AMERICA 7761 06:31:47,920 --> 06:31:53,400 AND THERE'S A LOT OF EMERGING 7762 06:31:53,400 --> 06:31:58,560 DEMANDS THAT CLISHZ WITH SYSTEMS 7763 06:31:58,560 --> 06:32:01,840 LIMITA 7764 06:32:01,840 --> 06:32:04,240 -- CLASHES WITH SYSTEMS AND WE 7765 06:32:04,240 --> 06:32:06,640 DEAL WITH IMPROVEMENTS AND 7766 06:32:06,640 --> 06:32:08,120 SOCIETY AND DISEASE AND 7767 06:32:08,120 --> 06:32:11,960 AWARENESS IS NOT ENOUGH AND IT'S 7768 06:32:11,960 --> 06:32:20,320 A NOT ALWAYS AS TRANSPARENT AS 7769 06:32:20,320 --> 06:32:27,200 WE WISH AND WE NEED A WORKFORCE 7770 06:32:27,200 --> 06:32:30,880 AND ACTION AND ALL THIS IS A 7771 06:32:30,880 --> 06:32:31,720 PERFECT WAVE AGAINST WHAT WE 7772 06:32:31,720 --> 06:32:34,200 REALLY WANT TO ACHIEVE IN 7773 06:32:34,200 --> 06:32:36,320 UNIVERSAL HEALTH COVERAGE AND 7774 06:32:36,320 --> 06:32:37,720 MOVE FORWARD. 7775 06:32:37,720 --> 06:32:39,040 YOU HAVE SEEN INFORMATION OF THE 7776 06:32:39,040 --> 06:32:40,240 REGION AND FOR THOSE JOINING THE 7777 06:32:40,240 --> 06:32:41,720 SESSION FOR THE FIRST TIME OF 7778 06:32:41,720 --> 06:32:46,280 THE SEMINAR, THIS IS A VERY 7779 06:32:46,280 --> 06:32:47,840 QUICK LANDSCAPE OF WHAT'S GOING 7780 06:32:47,840 --> 06:32:52,320 ON IN TERMS OF DISEASES AND THIS 7781 06:32:52,320 --> 06:32:53,840 IS PROBABLY THE LARGEST AMOUNT 7782 06:32:53,840 --> 06:32:56,360 OF DISEASES AND BURDEN OF 7783 06:32:56,360 --> 06:33:01,240 DISEASE IN THE REGION. 7784 06:33:01,240 --> 06:33:03,800 WITH INFECTIOUS DISEASES AND OF 7785 06:33:03,800 --> 06:33:04,680 COURSE VIOLENCE IN THE REGION IS 7786 06:33:04,680 --> 06:33:11,960 VERY HIGH. 7787 06:33:11,960 --> 06:33:13,600 YOU CAN SEE HOW DIFFERENT 7788 06:33:13,600 --> 06:33:17,680 COUNTRIES HAVE HIGHER RATES OF 7789 06:33:17,680 --> 06:33:20,680 CANCERS IN TERMS OF THE KEY ONES 7790 06:33:20,680 --> 06:33:25,760 AND IT'S ESTIMATED ABOUT 1.3 7791 06:33:25,760 --> 06:33:31,160 MILLION CASES AND YOU CAN SEE 7792 06:33:31,160 --> 06:33:33,640 THE NUMBER OF CANCERS THERE'S 7793 06:33:33,640 --> 06:33:34,960 STRONG SPECIFICALLY IN SOME 7794 06:33:34,960 --> 06:33:36,360 COUNTRIES LIKE YOU CAN SEE ON 7795 06:33:36,360 --> 06:33:40,800 THE RIGHT. 7796 06:33:40,800 --> 06:33:44,800 WHEN WE SEE THIS WE HAVE ALSO 7797 06:33:44,800 --> 06:33:46,280 PROBLEMS WITH CHILDREN, YOUTH 7798 06:33:46,280 --> 06:33:48,600 AND WOMEN AND HOW IT'S AFFECTING 7799 06:33:48,600 --> 06:33:51,200 THE PANDEMIC WITH HIGH NUMBER OF 7800 06:33:51,200 --> 06:33:52,200 ORPHANS, SCHOOL DROPOUTS. 7801 06:33:52,200 --> 06:33:55,560 WE HAVE A PANDEMIC FOR THE 7802 06:33:55,560 --> 06:33:59,200 COUNTRIES AND THAT'S GOING TO 7803 06:33:59,200 --> 06:34:01,320 TAKE A TOLL AS WELL IN THE 7804 06:34:01,320 --> 06:34:06,680 ECONOMIC AND CULTURAL GAINS. 7805 06:34:06,680 --> 06:34:13,360 AND THERE'LL BE A LACK OF 7806 06:34:13,360 --> 06:34:14,280 EMERGENCY CARE. 7807 06:34:14,280 --> 06:34:18,560 THIS IS A CONTRAST TO WHAT WE'RE 7808 06:34:18,560 --> 06:34:20,720 SEEING IN OTHER PLACES AND WE 7809 06:34:20,720 --> 06:34:24,440 HAVE AN AGING REGION AND IT'S 7810 06:34:24,440 --> 06:34:27,080 GOING TO TAKE A TOLL ON HEALTH 7811 06:34:27,080 --> 06:34:28,240 CARE AND SOCIAL SERVICES BECAUSE 7812 06:34:28,240 --> 06:34:32,320 WE'RE MOVING FORWARD TO A 7813 06:34:32,320 --> 06:34:36,120 PERFECT STORM. 7814 06:34:36,120 --> 06:34:38,120 WE MAY HAVE STEWARDSHIP AND 7815 06:34:38,120 --> 06:34:42,240 GOVERNANCE AND LEGAL FRAMEWORKS 7816 06:34:42,240 --> 06:34:47,640 THAT MORE OR LESS WORK IN SOME 7817 06:34:47,640 --> 06:34:53,560 COUNTRIES AND THE KEY ONE FOR 7818 06:34:53,560 --> 06:34:56,320 ALL OF THEM IS THE CENTER 7819 06:34:56,320 --> 06:35:01,040 BECAUSE IF WE DON'T HAVE ENOUGH 7820 06:35:01,040 --> 06:35:03,520 WE'LL DEAL WITH INSUFFICIENT 7821 06:35:03,520 --> 06:35:08,440 INFRASTRUCTURE AND PERSONNEL AND 7822 06:35:08,440 --> 06:35:09,640 THE ADMINISTRATION WILL BE 7823 06:35:09,640 --> 06:35:13,400 SUFFERING THERE WILL NOT BE 7824 06:35:13,400 --> 06:35:15,680 ENOUGH SUPPLIES AND SURVEILLANCE 7825 06:35:15,680 --> 06:35:16,800 WILL BE AFFECTED AND THE MODEL 7826 06:35:16,800 --> 06:35:18,280 OF CARE. 7827 06:35:18,280 --> 06:35:23,800 ALL THIS HAS TO BE WELL BALANCED 7828 06:35:23,800 --> 06:35:26,880 AND WE'RE SEEING IT'S NOT 7829 06:35:26,880 --> 06:35:29,400 WORKING TO MANY PLACE AND I'LL 7830 06:35:29,400 --> 06:35:30,680 PRESENT BRIEFLY THE EXAMPLE OF 7831 06:35:30,680 --> 06:35:32,840 MEXICO BEING MY COUNTRY. 7832 06:35:32,840 --> 06:35:34,200 I CAN SPEAK FREELY. 7833 06:35:34,200 --> 06:35:38,520 YOU CAN SEE HOW FRAGMENTS IT IS 7834 06:35:38,520 --> 06:35:42,520 IN TERMS OF FUNDING AND YOU HAVE 7835 06:35:42,520 --> 06:35:46,320 FEDERAL GOVERNMENT, EMPLOYEES 7836 06:35:46,320 --> 06:35:50,960 AND FEDERAL FUNDING AND THIS IS 7837 06:35:50,960 --> 06:35:56,000 THE PRIVATE SECTOR INSURANCE. 7838 06:35:56,000 --> 06:35:57,680 YOU HAVE ALL THE SOCIAL SECURITY 7839 06:35:57,680 --> 06:35:58,680 INSTITUTIONS AND THE OPEN 7840 06:35:58,680 --> 06:36:03,360 POPULATION WHICH IS THOSE WHO 7841 06:36:03,360 --> 06:36:07,880 ARE UNINSURED AND THE PRIVATE 7842 06:36:07,880 --> 06:36:08,280 SECTOR. 7843 06:36:08,280 --> 06:36:09,720 THERE'S INSTITUTES THAT WORK 7844 06:36:09,720 --> 06:36:12,400 WITHIN THEIR OWN HOSPITALS. 7845 06:36:12,400 --> 06:36:19,680 EACH HAS THEIR OWN NETWORK AND 7846 06:36:19,680 --> 06:36:22,160 YOU HAVE THESE USERS. 7847 06:36:22,160 --> 06:36:26,600 THIS IS COMPLEX AND VERY 7848 06:36:26,600 --> 06:36:27,200 DUPLIC 7849 06:36:27,200 --> 06:36:36,200 DUPLICATED PROCESS IN MEXICO. 7850 06:36:36,200 --> 06:36:40,920 AND WE HAVE FRAGMENTATION AND 7851 06:36:40,920 --> 06:36:43,360 HEALTH SYSTEMS IS THE NORM. 7852 06:36:43,360 --> 06:36:48,960 AND PUBLIC INVESTMENT IS NOT 7853 06:36:48,960 --> 06:36:55,280 CONSIDERED OUT OF POCKET AND THE 7854 06:36:55,280 --> 06:36:56,680 PANDEMIC HIGHLIGHTED FRAGILE 7855 06:36:56,680 --> 06:36:58,440 SYSTEMS AND SOMETHING WE'VE SEEN 7856 06:36:58,440 --> 06:36:59,920 NOT ONLY IN LATIN AMERICA BUT 7857 06:36:59,920 --> 06:37:01,560 ALL OVER THE WORLD AND IT'S 7858 06:37:01,560 --> 06:37:08,840 TAKEN A TOLL INTO HOW TO MAKE 7859 06:37:08,840 --> 06:37:12,440 HEALTH SYSTEMS RESILIENT TO 7860 06:37:12,440 --> 06:37:15,280 ACHIEVE UNIVERSAL HEALTH 7861 06:37:15,280 --> 06:37:15,560 COVERAGE. 7862 06:37:15,560 --> 06:37:16,880 SOCIAL SECURITY ARE HIGHER ALL 7863 06:37:16,880 --> 06:37:26,000 THE TIME IN OTHER COUNTRIES AND 7864 06:37:26,000 --> 06:37:28,320 IT'S A REAL THING IN TERMS OF 7865 06:37:28,320 --> 06:37:33,400 INSTITUTIONS HAVING HIGHER PER 7866 06:37:33,400 --> 06:37:36,720 CAPITA THAN OTHER COUNTRIES. 7867 06:37:36,720 --> 06:37:42,040 AGING IS GOING TO BE AN ISSUE IT 7868 06:37:42,040 --> 06:37:45,280 WILL BE TAKEN A BURDEN ON THE 7869 06:37:45,280 --> 06:37:46,880 SYSTEMS AND IF WE DON'T HAVE 7870 06:37:46,880 --> 06:37:49,120 ENOUGH FUNDING OR PREPAREDNESS 7871 06:37:49,120 --> 06:37:49,760 WE'LL SEE A LOT OF PROBLEMS IN 7872 06:37:49,760 --> 06:37:52,520 THE FUTURE. 7873 06:37:52,520 --> 06:37:54,080 THE ECONOMIC SCENARIO IS NOT 7874 06:37:54,080 --> 06:37:54,960 HELPING BECAUSE INFLATION RATES 7875 06:37:54,960 --> 06:37:55,960 ARE HIGH. 7876 06:37:55,960 --> 06:37:58,280 IN TERMS OF FUNDING AND THE 7877 06:37:58,280 --> 06:38:06,080 OTHER PARTIED -- PART, I'D LIKE 7878 06:38:06,080 --> 06:38:08,320 TO TOUCH AND SOME COUNTRIES 7879 06:38:08,320 --> 06:38:15,680 DEPEND ON LOCATION ON THE BUDGET 7880 06:38:15,680 --> 06:38:25,520 S AND RESEARCH FALLS AND SOME 7881 06:38:25,520 --> 06:38:31,040 COUNTRIES HAVE DROPPED AND 7882 06:38:31,040 --> 06:38:32,280 DISAPPEARED SCHEMES AND WHICH 7883 06:38:32,280 --> 06:38:34,640 WERE WORKING AND LIKE IN MEXICO 7884 06:38:34,640 --> 06:38:39,280 OTHERS LIKE COLOMBIA AND 7885 06:38:39,280 --> 06:38:41,000 ARGENTINA ARE NOW ADOPTING THIS 7886 06:38:41,000 --> 06:38:42,120 AND HOPEFULLY ALL COUNTRIES WILL 7887 06:38:42,120 --> 06:38:52,680 SHARE MORE FUNDING FOR RESEARCH. 7888 06:38:53,840 --> 06:38:58,640 TO THE FINANCIAL SITUATION PLAYS 7889 06:38:58,640 --> 06:39:09,160 A ROLE AND ACADEMIA AND WE'RE 7890 06:39:11,640 --> 06:39:13,520 LOOKING FOR MONIES OUTSIDE THE 7891 06:39:13,520 --> 06:39:15,440 COUNTRY BECAUSE IT'S THE ONLY 7892 06:39:15,440 --> 06:39:16,840 REAL FUNDING THEY CAN HAVE AND 7893 06:39:16,840 --> 06:39:27,360 NIH IS ONE OF THE MAIN FUNDERS. 7894 06:39:35,280 --> 06:39:41,440 AND WE HAVE LOOKED AT REDUCED 7895 06:39:41,440 --> 06:39:42,160 FUNDING FOR TECHNOLOGY AND 7896 06:39:42,160 --> 06:39:47,320 SOMETHING IS SOMETHING WE HAVE 7897 06:39:47,320 --> 06:39:56,080 TO LOOK BECAUSE THIS IS AN ISSUE 7898 06:39:56,080 --> 06:39:58,200 HOW RESEARCH IS BEING FUNDED IN 7899 06:39:58,200 --> 06:40:00,600 THE REGION SO LET'S SEE AND HOPE 7900 06:40:00,600 --> 06:40:07,320 IT CAN BE RESERVED AT SOME 7901 06:40:07,320 --> 06:40:09,680 POINT. 7902 06:40:09,680 --> 06:40:10,960 SOME COUNTRIES HAVE A UNIFIED 7903 06:40:10,960 --> 06:40:12,520 HEALTH SYSTEM AND SOME ARE 7904 06:40:12,520 --> 06:40:20,320 FRAGMENTED. 7905 06:40:20,320 --> 06:40:26,240 AND THERE'S ALWAYS 7906 06:40:26,240 --> 06:40:27,320 FRAGMENTATIONS AND THERE'S AN 7907 06:40:27,320 --> 06:40:33,200 ISSUE WE'LL BE SEEING AND 7908 06:40:33,200 --> 06:40:40,600 COMORBIDITY CAUSED HIGH 7909 06:40:40,600 --> 06:40:49,200 MORTALITY AND THE SCIENCE AND 7910 06:40:49,200 --> 06:40:50,640 TECHNOLOGY SECTOR IS NOT WELL 7911 06:40:50,640 --> 06:40:50,880 FUNDED. 7912 06:40:50,880 --> 06:40:56,200 EACH COUNTRY HAS A DIFFERENT WAY 7913 06:40:56,200 --> 06:41:03,680 OF SUPPORTING RESEARCH AND IN 7914 06:41:03,680 --> 06:41:05,360 THE CARIBBEAN FUNDING WAS FOR 7915 06:41:05,360 --> 06:41:10,040 THE UNIVERSITIES THEMSELVES. 7916 06:41:10,040 --> 06:41:17,520 BRAZIL, MEXICO, ARGENTINA AND 7917 06:41:17,520 --> 06:41:19,160 PERU CONTRIBUTE AND CARIBBEAN 7918 06:41:19,160 --> 06:41:21,360 COUNTRIES ARE IN THE TOP 25. 7919 06:41:21,360 --> 06:41:24,400 THIS IS IMPORTANT OF COURSE 7920 06:41:24,400 --> 06:41:26,480 BRAZIL IS THE HIGHEST NUMBER OF 7921 06:41:26,480 --> 06:41:31,560 PUBLICATIONS AND THAT PUSHES ALL 7922 06:41:31,560 --> 06:41:34,520 THE LATIN AMERICA MEDIA 7923 06:41:34,520 --> 06:41:34,920 PUBLICATIONS. 7924 06:41:34,920 --> 06:41:40,000 IF WE TAKE BRAZIL OUT IT DROPS 7925 06:41:40,000 --> 06:41:44,120 DRAMATICALLY BUT GOOD QUALITY OF 7926 06:41:44,120 --> 06:41:45,240 THE COUNTRIES AND MOST WITH 7927 06:41:45,240 --> 06:41:45,560 COLLABORATION. 7928 06:41:45,560 --> 06:41:46,760 THANK YOU SO MUCH AND YOU CAN 7929 06:41:46,760 --> 06:41:49,400 HAVE ACCESS TO THE PAPER ON THE 7930 06:41:49,400 --> 06:41:51,680 LEFT AND TO THE SERIES ON THE 7931 06:41:51,680 --> 06:41:51,880 RIGHT. 7932 06:41:51,880 --> 06:41:53,960 THANK YOU. 7933 06:41:53,960 --> 06:41:57,360 >>I'M ALEX ORTEGA A DIRECTOR OF 7934 06:41:57,360 --> 06:42:01,000 THE CENTER FOR POPULATION HEALTH 7935 06:42:01,000 --> 06:42:06,200 AND COMMUNITY IMPACT IN THE 7936 06:42:06,200 --> 06:42:08,680 DORNSIFE SCHOOL OF. 7937 06:42:08,680 --> 06:42:10,600 LICK HEALTH. 7938 06:42:10,600 --> 06:42:12,680 AT DREXEL UNIVERSITY. 7939 06:42:12,680 --> 06:42:15,840 I'M THE INVESTIGATOR OF TWO RO1 7940 06:42:15,840 --> 06:42:17,720 STUDIES BASED IN PUERTO RICO 7941 06:42:17,720 --> 06:42:20,080 BOTH FUNDED BY THE NATIONAL 7942 06:42:20,080 --> 06:42:21,720 INSTITUTE ON MINORITY HEALTH AND 7943 06:42:21,720 --> 06:42:23,760 HEALTH DISPARITY. 7944 06:42:23,760 --> 06:42:25,520 ONE IS OF ISLAND PUERTO RICANS 7945 06:42:25,520 --> 06:42:28,600 AND THEIR MENTAL HEALTH BEFORE 7946 06:42:28,600 --> 06:42:30,040 HURRICANES IVAN AND MARIA AND 7947 06:42:30,040 --> 06:42:33,720 THE SECOND STUDY FOCUSES ON THE 7948 06:42:33,720 --> 06:42:36,120 PUERTO RICAN HEALTH CARE SYSTEM 7949 06:42:36,120 --> 06:42:40,840 BEFORE AND AFTER RECENT PUBLIC 7950 06:42:40,840 --> 06:42:43,560 HEALTH EMERGENCIES AFTER DISEASE 7951 06:42:43,560 --> 06:42:48,560 OUTBREAKS AND TROPICAL DISEASE 7952 06:42:48,560 --> 06:42:49,200 OUTBRA 7953 06:42:49,200 --> 06:42:51,720 OUTBREAKS RELATED TO CLIMATE 7954 06:42:51,720 --> 06:42:52,120 CHANGE. 7955 06:42:52,120 --> 06:42:53,160 I'M FORCE ON PUBLIC HEALTH 7956 06:42:53,160 --> 06:42:53,760 DISASTERS. 7957 06:42:53,760 --> 06:42:56,120 OUR STUDY WAS FUNDED IN MAY SO 7958 06:42:56,120 --> 06:42:56,880 WE'RE JUST GETTING IN THE FIELD 7959 06:42:56,880 --> 06:43:01,280 SO I DO NOT HAVE RESULTS OF OUR 7960 06:43:01,280 --> 06:43:06,440 WORK TO SHARE BUT WOULD LIKE TO 7961 06:43:06,440 --> 06:43:07,600 HIGHLIGHT THE IMPETUS. 7962 06:43:07,600 --> 06:43:11,640 THE IMPACT MUST BE UNDERSTOOD IN 7963 06:43:11,640 --> 06:43:14,240 A LONGITUDINAL CONTEXT. 7964 06:43:14,240 --> 06:43:15,480 INCREASING NATURAL DISASTERS AND 7965 06:43:15,480 --> 06:43:16,800 TROPICAL CYCLONES, HURRICANES, 7966 06:43:16,800 --> 06:43:20,320 FLOODS AND EARTHQUAKES HAVE 7967 06:43:20,320 --> 06:43:22,240 BECOME MORE COMMON AND MORE 7968 06:43:22,240 --> 06:43:23,680 CLOSELY SPACED COMPARED TO ANY 7969 06:43:23,680 --> 06:43:27,720 OTHER TIME PERIOD GOING BACK TO 7970 06:43:27,720 --> 06:43:30,440 1960. 7971 06:43:30,440 --> 06:43:32,800 SUPER IMPOSING INFECTIOUS 7972 06:43:32,800 --> 06:43:35,520 DISEASE DEMONSTRATES INCREASING 7973 06:43:35,520 --> 06:43:40,040 STRESS ON PUERTO RICO'S SYSTEMS 7974 06:43:40,040 --> 06:43:41,160 PRIOR TO THE PANDEMIC. 7975 06:43:41,160 --> 06:43:41,960 PUERTO RICO HAS FACED 7976 06:43:41,960 --> 06:43:44,320 SIGNIFICANT CHALLENGES OVER THE 7977 06:43:44,320 --> 06:43:47,280 PAST FEW YEARS AS IT RECOVERS 7978 06:43:47,280 --> 06:43:52,320 FROM FOUR SEPARATE, BACK TO BACK 7979 06:43:52,320 --> 06:44:00,360 PUBLIC HEALTH EMERGENCIES AND 7980 06:44:00,360 --> 06:44:02,720 NATURAL DISASTERS AND THE 7981 06:44:02,720 --> 06:44:08,360 HURRICANES AND EARTHQUAKE AND 7982 06:44:08,360 --> 06:44:09,720 THE COVID-19 PANDEMIC ALL OF 7983 06:44:09,720 --> 06:44:14,200 WHICH DISASTERS HAVE IMPACTED 7984 06:44:14,200 --> 06:44:15,680 PUERTO RICO'S STRUGGLING ECONOMY 7985 06:44:15,680 --> 06:44:18,040 AND HIGH UNEMPLOYMENT. 7986 06:44:18,040 --> 06:44:18,960 PUERTO RICO HAS 50 GENERAL 7987 06:44:18,960 --> 06:44:24,320 HOSPITALS MOSTLY LOCATED IN SAN 7988 06:44:24,320 --> 06:44:27,680 JUAN AND OTHER REGIONS AND 7989 06:44:27,680 --> 06:44:31,240 HEALTH CENTERS PROVIDING PRIMARY 7990 06:44:31,240 --> 06:44:34,720 AND PREVENTIVE CARE. 7991 06:44:34,720 --> 06:44:35,400 THE MAJOR METEOROLOGIST AREAS 7992 06:44:35,400 --> 06:44:36,720 THERE ARE 35 PRIVATE HOSPITALS 7993 06:44:36,720 --> 06:44:37,840 AND 11 PUBLIC HOSPITALS. 7994 06:44:37,840 --> 06:44:43,960 ONLY A FEW HOSPITALS SERVE AN 7995 06:44:43,960 --> 06:44:45,520 EXTENSIVE RURAL POPULATION ALL 7996 06:44:45,520 --> 06:44:48,160 THE HEALTH CARE FACILITIES 7997 06:44:48,160 --> 06:44:49,440 EXPERIENCED MAJOR DEVASTATION 7998 06:44:49,440 --> 06:44:53,000 AFTER THE DISASTERS AND ONE LOST 7999 06:44:53,000 --> 06:44:55,520 ITS ONLY OPERATING HOSPITAL 8000 06:44:55,520 --> 06:44:57,680 AFTER HURRICANES IRMA AND MARIA. 8001 06:44:57,680 --> 06:45:01,800 FROM 1930 TO 1970, AMERICA'S 8002 06:45:01,800 --> 06:45:04,440 HEALTH CARE SYSTEM RESEMBLED THE 8003 06:45:04,440 --> 06:45:06,960 LATIN AMERICA SOCIALIZED SYSTEM 8004 06:45:06,960 --> 06:45:08,400 WHERE EACH MUNICIPALITY HAD A 8005 06:45:08,400 --> 06:45:10,240 HOSPITAL AND HEALTH CARE 8006 06:45:10,240 --> 06:45:13,360 PROVIDERS WERE EMPLOYED BY THE 8007 06:45:13,360 --> 06:45:13,640 GOVERNMENT. 8008 06:45:13,640 --> 06:45:14,400 GROWTH IN PRIVATE HEALTH CARE 8009 06:45:14,400 --> 06:45:20,960 CHANGED THE SYSTEM AND IN 1993 8010 06:45:20,960 --> 06:45:25,040 PUERTO RICO PUT CONSTRAINTS ON 8011 06:45:25,040 --> 06:45:26,680 THE PRIVATIZATION AND PHYSICIANS 8012 06:45:26,680 --> 06:45:29,840 WERE INCENTIVIZED TO CONTRACT 8013 06:45:29,840 --> 06:45:32,800 WITH MEDICARE AND MEDICAID AND 8014 06:45:32,800 --> 06:45:35,240 THE MUNICIPALITIES HAVE REMAIN 8015 06:45:35,240 --> 06:45:36,040 LARGELY UNCHANGE. 8016 06:45:36,040 --> 06:45:38,520 PUERTO RICO IS LARGELY DEPENDENT 8017 06:45:38,520 --> 06:45:41,000 ON MEDICAID AND MEDICARE FOR THE 8018 06:45:41,000 --> 06:45:43,360 PUBLIC HEALTH SYSTEM FORMALLY 8019 06:45:43,360 --> 06:45:51,360 KNOWN AS LA REFORMA. 8020 06:45:51,360 --> 06:45:54,360 49% OF RESIDENTS RECEIVE CHIP. 8021 06:45:54,360 --> 06:46:00,240 11% RECEIVE MEDICARE AND 35% 8022 06:46:00,240 --> 06:46:01,640 EMPLOYER-BASED COVERAGE AND 6% 8023 06:46:01,640 --> 06:46:04,280 ARE UNINSURED AND PEOPLE IN 8024 06:46:04,280 --> 06:46:06,040 PUERTO RICO ARE MORE LIKELY TO 8025 06:46:06,040 --> 06:46:08,720 REPORT POORER HEALTH THAN THE 8026 06:46:08,720 --> 06:46:09,320 MAINLAND. 8027 06:46:09,320 --> 06:46:11,760 POVERTY IS HIGHER IN AMERICA AT 8028 06:46:11,760 --> 06:46:14,440 41% VERSUS 12% RESPECTIVELY AND 8029 06:46:14,440 --> 06:46:16,480 57% OF YOUNG PEOPLE LIVE UNDER 8030 06:46:16,480 --> 06:46:17,720 THE FEDERAL POVERTY LEVEL. 8031 06:46:17,720 --> 06:46:19,640 THIS IS ALL DIRECTLY RELATED TO 8032 06:46:19,640 --> 06:46:22,560 THE HIGH PROPORTION ON MEDICAID 8033 06:46:22,560 --> 06:46:25,360 OR CHIP IN PUERTO RICO. 8034 06:46:25,360 --> 06:46:27,680 IN ORDER TO QUALIFY A FAMILY OF 8035 06:46:27,680 --> 06:46:29,440 FOUR CAN EARN NO MORE THAN $850 8036 06:46:29,440 --> 06:46:35,400 A MONTH. 8037 06:46:35,400 --> 06:46:37,680 MEDICAID FUNDING HAS A MATCH GAP 8038 06:46:37,680 --> 06:46:40,120 OF 50% YIELD MEDICAID 8039 06:46:40,120 --> 06:46:41,680 REIMBURSEMENT LOWER THAN THE 8040 06:46:41,680 --> 06:46:43,400 STATES AND U.S. MAINLAND. 8041 06:46:43,400 --> 06:46:45,400 THE SIGNIFICANT MEDICAL NEED AND 8042 06:46:45,400 --> 06:46:47,520 POVERTY ON THE ISLAND HAS PUT A 8043 06:46:47,520 --> 06:46:49,600 MAJOR TOLL ON CARE DELIVERY AND 8044 06:46:49,600 --> 06:46:51,640 CONTINUES TO EXACERBATE HEALTH 8045 06:46:51,640 --> 06:46:53,960 CARE DISPARITIES. 8046 06:46:53,960 --> 06:46:56,400 THE U.S. GOVERNMENT TYPICALLY 8047 06:46:56,400 --> 06:47:01,880 COVERS 55% OF THE MEDICATE 8048 06:47:01,880 --> 06:47:03,840 EXPENDITURES AND AS A RESULT THE 8049 06:47:03,840 --> 06:47:06,520 PROGRAM HAS HISTORICALLY USED A 8050 06:47:06,520 --> 06:47:08,600 LOWER ELIGIBLE THRESHOLD AND 8051 06:47:08,600 --> 06:47:09,840 COVERED FEWER BENEFITS COMPARED 8052 06:47:09,840 --> 06:47:12,480 TO MEDICAID IN THE STATES. 8053 06:47:12,480 --> 06:47:14,400 MEDICAID IN PUERTO RICO ALSO 8054 06:47:14,400 --> 06:47:18,400 REIMBURSES AT A LOWER LEVEL THAN 8055 06:47:18,400 --> 06:47:21,720 THE MAINLAND AND THE EXECUTIVE 8056 06:47:21,720 --> 06:47:23,320 SESSION AND DISASTERS AFFECTED 8057 06:47:23,320 --> 06:47:25,520 THE NEEDS TO COVER THE NEEDS OF 8058 06:47:25,520 --> 06:47:36,200 1.6 POLITICAL -- 1.6 POLITICAL 8059 06:47:40,440 --> 06:47:40,800 ONPUERTO RICANS. 8060 06:47:40,800 --> 06:47:43,400 LESS THAN 30 YEARS AGO, PUERTO 8061 06:47:43,400 --> 06:47:45,240 RICO HEALTH CARE WAS EXCLUSIVELY 8062 06:47:45,240 --> 06:47:47,400 RUN BY THE LOCAL GOVERNMENT. 8063 06:47:47,400 --> 06:47:48,360 WHILE THIS PROVIDED MORE 8064 06:47:48,360 --> 06:47:51,520 EQUITABLE ACCESS TO CARE AND 8065 06:47:51,520 --> 06:47:54,960 BROADER EDUCATIONAL FACILITIES 8066 06:47:54,960 --> 06:47:57,000 IT RESULTED IN SUBSTANTIAL COST 8067 06:47:57,000 --> 06:48:01,200 TO THE GOVERNMENT AND UNDER PAID 8068 06:48:01,200 --> 06:48:01,480 PROVIDERS. 8069 06:48:01,480 --> 06:48:04,120 WITH THE PRIVATIZATION OF THE 8070 06:48:04,120 --> 06:48:05,680 HEALTH SYSTEM CAME CAPITATION 8071 06:48:05,680 --> 06:48:06,920 PAYMENTS, SELLING OF PUBLIC 8072 06:48:06,920 --> 06:48:08,000 HOSPITALS AND HEALTH CENTERS AND 8073 06:48:08,000 --> 06:48:10,320 THE INTRODUCTION OF MEDICAID 8074 06:48:10,320 --> 06:48:12,240 FUNDS FROM THE FEDERAL 8075 06:48:12,240 --> 06:48:12,840 GOVERNMENT. 8076 06:48:12,840 --> 06:48:14,160 MEDICARE AND MEDICAID ARE 8077 06:48:14,160 --> 06:48:16,320 PRIMARILY RUN BY A FEW MANAGED 8078 06:48:16,320 --> 06:48:20,320 CARE ORGANIZATIONS THROUGH THE 8079 06:48:20,320 --> 06:48:22,720 PUERTO RICO HEALTH INSURANCE 8080 06:48:22,720 --> 06:48:23,080 ADMINISTRATION. 8081 06:48:23,080 --> 06:48:26,320 THE HEALTH OF DEATH HAS A 8082 06:48:26,320 --> 06:48:28,440 COOPERATIVE AGREEMENT WHICH 8083 06:48:28,440 --> 06:48:31,360 IMPLEMENTS AND ADMINISTERED THE 8084 06:48:31,360 --> 06:48:32,800 HEALTH INSURANCE SYSTEM. 8085 06:48:32,800 --> 06:48:36,360 THE PRIVATIZATION OF HEALTH CARE 8086 06:48:36,360 --> 06:48:37,720 IN PUERTO RICO HAS BROUGHT OTHER 8087 06:48:37,720 --> 06:48:39,560 QUALITY CONCERNS FOR HEALTH 8088 06:48:39,560 --> 06:48:41,040 SERVICES SUCH AS OVERCROWDED 8089 06:48:41,040 --> 06:48:42,760 MEDICAL CENTERS, OVER WORKED 8090 06:48:42,760 --> 06:48:44,120 PERSONNEL AND PROLONGED WAIT 8091 06:48:44,120 --> 06:48:47,520 TIMES AND A LOSS OF ACADEMIC 8092 06:48:47,520 --> 06:48:56,080 CENTERS FOR HEALTH CARE 8093 06:48:56,080 --> 06:48:57,400 PROVIDERS. 8094 06:48:57,400 --> 06:48:59,400 72 OF THE MUNICIPALITIES HAS 8095 06:48:59,400 --> 06:49:01,360 BEEN IDENTIFIED AS MEDICALLY 8096 06:49:01,360 --> 06:49:07,320 UNDER SERVED AREAS. 8097 06:49:07,320 --> 06:49:10,600 PRIOR TO THE ONSET OF THE PUBLIC 8098 06:49:10,600 --> 06:49:15,000 HEALTH EMERGENCIES NEARLY HALF 8099 06:49:15,000 --> 06:49:18,240 THE POPULATION WAS LIVING IN A 8100 06:49:18,240 --> 06:49:21,080 PROVIDER SHORTAGE AND THEY EARN 8101 06:49:21,080 --> 06:49:24,280 LESS THAN HALF THE MEDIAN WAGE 8102 06:49:24,280 --> 06:49:25,520 OF THE PROVIDERS ON THE MAINLAND 8103 06:49:25,520 --> 06:49:30,120 AND REIMBURSED LOWER THAN THOSE 8104 06:49:30,120 --> 06:49:32,280 COMPARED TO THE 50 U.S. STATES. 8105 06:49:32,280 --> 06:49:35,440 THE MASS EXODUS OF PROVIDERS TO 8106 06:49:35,440 --> 06:49:37,880 THE U.S. MAINLAND IN SEARCH OF 8107 06:49:37,880 --> 06:49:39,360 BETTER WORKING CONDITIONS AND 8108 06:49:39,360 --> 06:49:41,640 HIGHER PAY HAS ONLY INCREASED 8109 06:49:41,640 --> 06:49:43,440 THE ECONOMIC CRISIS. 8110 06:49:43,440 --> 06:49:44,200 MOREOVER, PUERTO RICO HAS ONE OF 8111 06:49:44,200 --> 06:49:46,000 THE LOWEST RETENTION RATES IN 8112 06:49:46,000 --> 06:49:50,480 THE U.S. FOR LOCALLY TRAINED 8113 06:49:50,480 --> 06:49:53,240 PRACTITIONERS AN THIS OVER 8114 06:49:53,240 --> 06:49:54,360 BURDENED PROVIDERS IN PUERTO 8115 06:49:54,360 --> 06:49:55,720 RICO AND LEAVES THEM WITH A 8116 06:49:55,720 --> 06:49:57,760 DEARTH OF RESOURCES AND 8117 06:49:57,760 --> 06:50:01,680 DIFFICULT RESOURCES. 8118 06:50:01,680 --> 06:50:03,600 THIS ALSO AGGREGATES EXTENSIVE 8119 06:50:03,600 --> 06:50:06,040 WAIT TIMES, LIMITED APPOINTMENT 8120 06:50:06,040 --> 06:50:06,720 AVAILABILITY AND LONGER 8121 06:50:06,720 --> 06:50:12,000 DISTANCES TO RECEIVE CARE. 8122 06:50:12,000 --> 06:50:13,400 HERE ARE SHORT-TERM 8123 06:50:13,400 --> 06:50:14,200 RECOMMENDATIONS TO IMPROVE 8124 06:50:14,200 --> 06:50:15,600 KNOWLEDGE AND TO IMPROVE 8125 06:50:15,600 --> 06:50:17,600 POPULATION HEALTH ON THE ISLAND. 8126 06:50:17,600 --> 06:50:20,000 IN ORDER TO IDENTIFY AND 8127 06:50:20,000 --> 06:50:21,760 IMPLEMENT STRATEGIES TO IMPROVE 8128 06:50:21,760 --> 06:50:22,960 HEALTH CARE OUTCOMES OF 8129 06:50:22,960 --> 06:50:25,800 RESIDENTS OF PUERTO RICO, VALID 8130 06:50:25,800 --> 06:50:28,160 REPRESENTATIVE DATA ARE NEEDED. 8131 06:50:28,160 --> 06:50:29,760 AS IT STANDS, ISLAND PUERTO 8132 06:50:29,760 --> 06:50:32,240 RICANS ARE LARGELY EMITTED FROM 8133 06:50:32,240 --> 06:50:35,480 HEALTH MONITORING AND SFLS 8134 06:50:35,480 --> 06:50:36,840 SYSTEMS SUCH AS THE SURVEY AND 8135 06:50:36,840 --> 06:50:38,600 THE AND A HALF HEALTH AND 8136 06:50:38,600 --> 06:50:39,720 NUTRITION SURVEY DISPIED BEING 8137 06:50:39,720 --> 06:50:44,760 CITIZENS. 8138 06:50:44,760 --> 06:50:48,720 THE SURVEILLANCE SYSTEM KNOWN BY 8139 06:50:48,720 --> 06:50:51,280 THE CDC IS ONE OF THE FEW 8140 06:50:51,280 --> 06:51:00,800 PROBABILITY-BASED SERVURVEYS LOD 8141 06:51:00,800 --> 06:51:02,440 AT CITIZEN AND CARE BEYOND COST 8142 06:51:02,440 --> 06:51:06,440 AND QUALITY OF HEALTH CARE. 8143 06:51:06,440 --> 06:51:11,480 EXPANDING DATA COLLECTION 8144 06:51:11,480 --> 06:51:13,440 EFFORTS TO INCLUDE PUERTO RICO 8145 06:51:13,440 --> 06:51:19,040 WILL IMPROVE KNOWLEDGE AND 8146 06:51:19,040 --> 06:51:20,040 IMPROVE OUTCOMES. 8147 06:51:20,040 --> 06:51:21,440 THIS IS TO UNDERSTAND THE 8148 06:51:21,440 --> 06:51:22,320 BASELINE UNDERSTANDING OF 8149 06:51:22,320 --> 06:51:23,440 POPULATION HEALTH OUTCOMES AND 8150 06:51:23,440 --> 06:51:25,440 DEVELOP HOW SERVICES AND POLICY 8151 06:51:25,440 --> 06:51:26,240 INTERVENTIONS TO IMPROVE HEALTH 8152 06:51:26,240 --> 06:51:29,840 AND WELL BEING OF PUERTO RICO. 8153 06:51:29,840 --> 06:51:31,000 PRIOR TO STUDYING THE 8154 06:51:31,000 --> 06:51:33,960 IMPLICATIONS OF THE BLOCK GRANT 8155 06:51:33,960 --> 06:51:36,440 FOR U.S. TERRITORIES HAS 8156 06:51:36,440 --> 06:51:38,480 RECOMMENDED ELIMINATING OR 8157 06:51:38,480 --> 06:51:39,840 MODIFYING THE FEDERAL FUNDING 8158 06:51:39,840 --> 06:51:42,360 STRUCTURE TO IMPROVE PROGRAM 8159 06:51:42,360 --> 06:51:44,880 QUALITY, EXPAND ELIGIBILITY AND 8160 06:51:44,880 --> 06:51:48,600 EXTEND COVERED BENEFITS. 8161 06:51:48,600 --> 06:51:49,560 TAKING INTO CONSIDERATION THE 8162 06:51:49,560 --> 06:51:52,360 FREQUENCY AND INTENSITY OF 8163 06:51:52,360 --> 06:51:54,760 DISASTERS IN PUERTO RICO, THE 8164 06:51:54,760 --> 06:51:56,360 BLOCK GRANT STRUCTURE AND 8165 06:51:56,360 --> 06:51:57,720 COLLAPSING PUBLIC HEALTH SYSTEM 8166 06:51:57,720 --> 06:52:01,680 FAILED TO ACCOUNT FOR THE HEALTH 8167 06:52:01,680 --> 06:52:03,440 CARE IMPACT OF THESE 8168 06:52:03,440 --> 06:52:05,560 UNPREDICTABLE EVENTS. 8169 06:52:05,560 --> 06:52:15,080 WITH THAT I THANK YOU VERY MUCH. 8170 06:52:15,080 --> 06:52:17,240 >>WELCOME TO THE LAST SESSION 8171 06:52:17,240 --> 06:52:18,880 FOR AN IMPORTANT DISCUSSION ON 8172 06:52:18,880 --> 06:52:19,720 HEALTH CARE SYSTEM AND HEALTH 8173 06:52:19,720 --> 06:52:29,960 CARE AND I WANT TO WELCOME OUR 8174 06:52:29,960 --> 06:52:30,200 SPEAKERS. 8175 06:52:30,200 --> 06:52:30,800 WOULD YOU LIKE TO INTRODUCE 8176 06:52:30,800 --> 06:52:40,200 YOURSELF? 8177 06:52:40,200 --> 06:52:50,520 WE CAN'T HEAR YOU. 8178 06:52:52,200 --> 06:52:54,040 >>SORRY, I'M CONNECTED FROM AN 8179 06:52:54,040 --> 06:52:55,120 AIRPORT BUT I'M TRYING TO HAVE 8180 06:52:55,120 --> 06:52:57,280 THE BEST CONDITIONS TO BE ABLE 8181 06:52:57,280 --> 06:53:00,320 TO PARTICIPATE. 8182 06:53:00,320 --> 06:53:04,320 I'M AN INTERNATIONAL CONSULTANT 8183 06:53:04,320 --> 06:53:07,520 WORKING WITH ERNESTO BASCOLO THE 8184 06:53:07,520 --> 06:53:14,840 FORMER MINISTER OF HEALTH OF 8185 06:53:14,840 --> 06:53:22,280 ECUADOR. 8186 06:53:22,280 --> 06:53:23,280 >>I NOTICED A COMMON THREAD IN 8187 06:53:23,280 --> 06:53:26,480 THE PRESENTATION IS THE LACK OF 8188 06:53:26,480 --> 06:53:28,360 INTEGRATION OF SYSTEMS. 8189 06:53:28,360 --> 06:53:31,520 PUBLIC HEALTH AND SOCIAL 8190 06:53:31,520 --> 06:53:32,520 SERVICES IN LATIN AMERICA 8191 06:53:32,520 --> 06:53:33,880 INCLUDING PUERTO RICO. 8192 06:53:33,880 --> 06:53:38,800 AND HEALTH SYSTEM INTEGRATION IS 8193 06:53:38,800 --> 06:53:40,880 A PROBLEM IN THE U.S. WITH HALF 8194 06:53:40,880 --> 06:53:42,160 THE U.S. POPULATION NOT HAVING 8195 06:53:42,160 --> 06:53:44,240 ACCESS AND ALMOST A QUARTER OF 8196 06:53:44,240 --> 06:53:45,880 HISPANIC AND LATINOS NOT HAVING 8197 06:53:45,880 --> 06:53:47,600 ACCESS TO HEALTH CARE. 8198 06:53:47,600 --> 06:53:50,080 STARTING WITH YOU, KARINA, I 8199 06:53:50,080 --> 06:53:52,240 WANTED TO ASK WHAT ARE 8200 06:53:52,240 --> 06:53:53,600 STRATEGIES, BEST PRACTICES OR 8201 06:53:53,600 --> 06:53:56,240 MODELS EMERGING FROM LATIN 8202 06:53:56,240 --> 06:54:05,120 AMERICA STRENGTHENING THE 8203 06:54:05,120 --> 06:54:11,400 INTEGRATION OF PUBLIC HEALTH AND 8204 06:54:11,400 --> 06:54:12,200 HEALTH CARE SYSTEMS. 8205 06:54:12,200 --> 06:54:17,040 >>I'LL TALK ABOUT THE 8206 06:54:17,040 --> 06:54:17,720 IMPLEMENTATION OF THE PUBLIC 8207 06:54:17,720 --> 06:54:19,400 HEALTH FUNCTION AND WHAT WE HAVE 8208 06:54:19,400 --> 06:54:25,320 IN TERMS OF ACCESS AND ALSO 8209 06:54:25,320 --> 06:54:30,440 POPULATION-LEVEL SERVICES AND 8210 06:54:30,440 --> 06:54:31,360 THINK 8211 06:54:31,360 --> 06:54:37,920 THINKING HOW THE AUTHORITIES CAN 8212 06:54:37,920 --> 06:54:40,360 IMPLEMENT POLICIES AS A STRATEGY 8213 06:54:40,360 --> 06:54:48,560 TO ACHIEVE THAT. 8214 06:54:48,560 --> 06:54:57,040 THE FUNCTIONS LAUNCHED IN 2020 8215 06:54:57,040 --> 06:54:58,080 HAVE BEEN SUPPORTED IN THE 8216 06:54:58,080 --> 06:55:00,320 COUNTRIES OF THE AMERICAS AND 8217 06:55:00,320 --> 06:55:04,040 THE LAST OCCASION WAS LAST YEAR 8218 06:55:04,040 --> 06:55:06,440 IN SEPTEMBER OF 2021 WHEN A 8219 06:55:06,440 --> 06:55:08,320 UNANIMOUS RESOLUTION WAS PASSED 8220 06:55:08,320 --> 06:55:17,160 BY MEMBER STATES. 8221 06:55:17,160 --> 06:55:19,960 ASKING THEY EXERCISE THE FUNDING 8222 06:55:19,960 --> 06:55:26,720 AND THIS IS PART OF THE POLICY 8223 06:55:26,720 --> 06:55:29,760 CYCLE A STRATEGY WE'RE USING HOW 8224 06:55:29,760 --> 06:55:32,120 WE VIEW THE PUBLIC HEALTH 8225 06:55:32,120 --> 06:55:32,400 FUNCTIONS. 8226 06:55:32,400 --> 06:55:37,720 PART OF THE POLICY CYCLE IS 8227 06:55:37,720 --> 06:55:48,240 EVALUATION AND WE FOCUSSED ON 8228 06:55:48,760 --> 06:55:52,320 FORMAL CAPACITY THAT IS WHAT ARE 8229 06:55:52,320 --> 06:55:57,280 THE CHARACTERISTICS OF THE LEGAL 8230 06:55:57,280 --> 06:55:57,840 FRAMEWORK AND FROM THE 8231 06:55:57,840 --> 06:55:59,960 PERSPECTIVE OF ACCESS AND 8232 06:55:59,960 --> 06:56:03,000 ACHIEVING UNIVERSAL ACCESS AND 8233 06:56:03,000 --> 06:56:08,320 HEALTH COVERAGE AS WELL AS THE 8234 06:56:08,320 --> 06:56:09,800 IMPLEMENTATION OF MODELS BASED 8235 06:56:09,800 --> 06:56:14,680 IN PRIMARY HEALTH CARE. 8236 06:56:14,680 --> 06:56:15,800 FORMAL CAPACITY IS ONE WE FOCUS 8237 06:56:15,800 --> 06:56:18,960 ON. 8238 06:56:18,960 --> 06:56:20,760 THE OTHER IS STRUCTURAL CAPACITY 8239 06:56:20,760 --> 06:56:23,000 AND NOT ONLY THINKING ECO 8240 06:56:23,000 --> 06:56:24,600 FRIENDLY BUT WHAT ARE THE 8241 06:56:24,600 --> 06:56:25,640 INSTITUTIONAL ARRANGEMENTS THAT 8242 06:56:25,640 --> 06:56:32,440 CAN BE HELPFUL IN ACHIEVING 8243 06:56:32,440 --> 06:56:33,840 UNIVERSAL HEALTH AND THE 8244 06:56:33,840 --> 06:56:39,240 INSTITUTIONAL ARRANGEMENT, 8245 06:56:39,240 --> 06:56:40,400 COORDINATION BETWEEN DIFFERENT 8246 06:56:40,400 --> 06:56:46,200 PUBLIC SECTORS AND PRIVATE 8247 06:56:46,200 --> 06:56:49,920 SECTOR AND UNIVERSITIES CIVIL 8248 06:56:49,920 --> 06:56:52,160 SOCIETY. 8249 06:56:52,160 --> 06:56:54,760 THE OTHER CAPACITY IS THE 8250 06:56:54,760 --> 06:56:56,360 SUPERVISORY CAPACITY. 8251 06:56:56,360 --> 06:57:02,000 WITH THE STEWARDSHIP OF THE 8252 06:57:02,000 --> 06:57:03,200 NATIONAL HEALTH AUTHORITY, WHAT 8253 06:57:03,200 --> 06:57:05,640 IS BEING DONE IN TERMS OF 8254 06:57:05,640 --> 06:57:08,360 CONTROLLING AND SUPERVISING 8255 06:57:08,360 --> 06:57:17,520 THINGS ARE WORKING AND FINALLY 8256 06:57:17,520 --> 06:57:21,400 WE FOCUS ON CAPACITY AND THE 8257 06:57:21,400 --> 06:57:26,160 ABILITIES OR CAPACITY TO 8258 06:57:26,160 --> 06:57:26,960 IMPLEMENT POLICIES TO HAVE THE 8259 06:57:26,960 --> 06:57:30,880 RESOURCES NEEDED TO IMPLEMENT 8260 06:57:30,880 --> 06:57:31,440 POLICY. 8261 06:57:31,440 --> 06:57:34,600 THERE'S FOCUSES ON HUMAN AND 8262 06:57:34,600 --> 06:57:37,160 FINANCIAL RESOURCES AND YOU MAY 8263 06:57:37,160 --> 06:57:38,240 KNOW REGIONALLY AND 8264 06:57:38,240 --> 06:57:42,960 INTERNATIONALLY NOW IT'S GAINING 8265 06:57:42,960 --> 06:57:44,920 GROUND THE IDEA OF PUBLIC HEALTH 8266 06:57:44,920 --> 06:57:50,560 EXPENDITURE BEING AT LEAST 6% OF 8267 06:57:50,560 --> 06:57:51,000 GDP. 8268 06:57:51,000 --> 06:57:51,720 THAT'S SOMETHING THAT'S BEEN A 8269 06:57:51,720 --> 06:57:53,280 FEW YEARS WE SET THE GOAL AND 8270 06:57:53,280 --> 06:57:58,360 IT'S IMPORTANT WE ACCOMPLISH IT 8271 06:57:58,360 --> 06:58:03,080 BUT WE'RE FAR AND STILL TRYING 8272 06:58:03,080 --> 06:58:07,840 TO ACCOMPLISH THE STANDARD WE 8273 06:58:07,840 --> 06:58:09,680 HAD PREVIOUSLY BUT SOMETHING 8274 06:58:09,680 --> 06:58:11,040 THAT HAS CHANGE. 8275 06:58:11,040 --> 06:58:13,840 ONE INNOVATION OF TERMS OF THE 8276 06:58:13,840 --> 06:58:14,960 PUBLIC HEALTH FUNCTION BASED ON 8277 06:58:14,960 --> 06:58:17,600 THE HISTORY OF LATIN AMERICA AND 8278 06:58:17,600 --> 06:58:22,400 HOW THE HEALTH SYSTEMS IN LATIN 8279 06:58:22,400 --> 06:58:28,360 AMERICA HAVE BEEN DEVELOPED IS 8280 06:58:28,360 --> 06:58:30,480 SOCIAL PARTICIPATION AND I'D 8281 06:58:30,480 --> 06:58:32,160 LIKE TO HIGHLIGHT THAT'S ONE OF 8282 06:58:32,160 --> 06:58:32,680 THE IMPORTANT CHANGES IN 8283 06:58:32,680 --> 06:58:37,800 FUNCTIONS. 8284 06:58:37,800 --> 06:58:39,880 NOT ONLY IN TERMS OF HEALTH 8285 06:58:39,880 --> 06:58:40,800 PROMOTION BUT IN MATERIALS OF 8286 06:58:40,800 --> 06:58:44,960 POLICY DESIGN AND IMPLEMENTATION 8287 06:58:44,960 --> 06:58:45,720 AS WELL. 8288 06:58:45,720 --> 06:58:48,600 GOING FROM A MORE DECORATIVE 8289 06:58:48,600 --> 06:58:52,480 PARTICIPATION TO A SOCIAL 8290 06:58:52,480 --> 06:58:53,920 PARTICIPATION THAT IS TRULY 8291 06:58:53,920 --> 06:58:55,560 WORKING WITH THE GOVERNMENT, 8292 06:58:55,560 --> 06:58:58,840 WORKING WITH THE NATIONAL HEALTH 8293 06:58:58,840 --> 06:59:00,720 AUTHORITY AND THE DIFFERENT ACTS 8294 06:59:00,720 --> 06:59:05,840 IN THE HEALTH SYSTEM TO BE ABLE 8295 06:59:05,840 --> 06:59:12,480 TO ACCOMPLISH THAT COMMON GOAL 8296 06:59:12,480 --> 06:59:13,000 THANK YOU. 8297 06:59:13,000 --> 06:59:19,240 >>CAN YOU TALK MORE ABOUT WHERE 8298 06:59:19,240 --> 06:59:22,320 THE POTENTIAL HEALTH CARE SYSTEM 8299 06:59:22,320 --> 06:59:26,880 SOLUTIONS IN MEXICO. 8300 06:59:26,880 --> 06:59:28,320 >>THANK YOU. 8301 06:59:28,320 --> 06:59:32,280 I'D LIKE TO SAY HELLO TO CARINA 8302 06:59:32,280 --> 06:59:39,640 AND TO MY CO-PANELIST, ALEX. 8303 06:59:39,640 --> 06:59:41,320 I THINK THIS IS SOMETHING WE 8304 06:59:41,320 --> 06:59:42,760 HAVE TO UNDERSTAND EACH COUNTRY 8305 06:59:42,760 --> 06:59:51,840 HAS THEIR OWN MODEL OF CARE. 8306 06:59:51,840 --> 06:59:53,040 HOWEVER, THERE'S A LOT OF 8307 06:59:53,040 --> 06:59:58,200 FRAGMENTATION AND INSTITUTIONS 8308 06:59:58,200 --> 07:00:00,000 WORKING TOGETHER AND YOU HAVE 8309 07:00:00,000 --> 07:00:05,800 DIFFERENTIAL HEALTH CARE BECAUSE 8310 07:00:05,800 --> 07:00:13,080 WHEN YOU SEE WHAT SHE SOCIAL 8311 07:00:13,080 --> 07:00:15,760 SECURITY SECTOR INVESTS IT'S A 8312 07:00:15,760 --> 07:00:16,800 DIFFERENCE AND THAT MAKES AN 8313 07:00:16,800 --> 07:00:18,320 INEQUALITY AND YOU HAVE 8314 07:00:18,320 --> 07:00:19,400 DIFFERENCES AND HOW ARE YOU 8315 07:00:19,400 --> 07:00:20,640 GOING TO TRY TO PUT THEM 8316 07:00:20,640 --> 07:00:21,800 TOGETHER AT THE SAME TIME. 8317 07:00:21,800 --> 07:00:24,840 ONE OF THE ISSUES TO GET THERE 8318 07:00:24,840 --> 07:00:27,440 IS WHAT SHE WAS SAYING, TRYING 8319 07:00:27,440 --> 07:00:31,280 TO ACHIEVE AT LEAST 4% TO 6% OF 8320 07:00:31,280 --> 07:00:33,800 PUBLIC GDP EXPENDITURE IN 8321 07:00:33,800 --> 07:00:34,160 HEALTH. 8322 07:00:34,160 --> 07:00:35,880 PUBLIC NOT JOINT PUBLIC AND OUT 8323 07:00:35,880 --> 07:00:36,640 OF POCKET. 8324 07:00:36,640 --> 07:00:39,760 BECAUSE WHEN WE GO OUT OF POCKET 8325 07:00:39,760 --> 07:00:42,120 WE GO SOMETIMES HIGHER THAN 6% 8326 07:00:42,120 --> 07:00:46,280 BUT WITH THE GOAL OF PUBLIC 8327 07:00:46,280 --> 07:00:46,600 EXPENDITURES. 8328 07:00:46,600 --> 07:00:48,760 HOW TO GET TO A BETTER HEALTH 8329 07:00:48,760 --> 07:00:53,800 SYSTEM OR FINAL SYSTEM IS JUST A 8330 07:00:53,800 --> 07:00:54,720 POLITICAL WILL AND HAVING 8331 07:00:54,720 --> 07:00:56,800 CONGRESS AND GOVERNMENT WORKING 8332 07:00:56,800 --> 07:00:58,800 TOGETHER TOWARDS ACHIEVING THIS. 8333 07:00:58,800 --> 07:01:00,040 THIS IS SOMETHING WE HAVE TO 8334 07:01:00,040 --> 07:01:05,720 HAVE A CLEAR MIND ON THE 8335 07:01:05,720 --> 07:01:06,360 WILLINGNESS OF THE GOVERNMENT 8336 07:01:06,360 --> 07:01:07,800 AND CONGRESS TO WORK TOGETHER 8337 07:01:07,800 --> 07:01:10,880 AND HAVE A CLEAR MODEL OF CARE 8338 07:01:10,880 --> 07:01:16,120 AND IT'S UNIQUE BECAUSE OF THEIR 8339 07:01:16,120 --> 07:01:23,560 OWN WORKING FORCE OR DEVELOPMENT 8340 07:01:23,560 --> 07:01:27,440 THEY'VE HAD AND I THINK WHAT 8341 07:01:27,440 --> 07:01:29,880 THEY WERE TRYING TO DO IN MEXICO 8342 07:01:29,880 --> 07:01:32,200 WHICH WAS ALREADY ABOLISHED BY 8343 07:01:32,200 --> 07:01:33,920 THE GOVERNMENT IS TO HAVE 8344 07:01:33,920 --> 07:01:35,560 FUNDING TO MAKE SURE THE 8345 07:01:35,560 --> 07:01:39,880 UNINSURED PEOPLE IN THE COUNTRY 8346 07:01:39,880 --> 07:01:43,280 WOULD RECEIVE FREE MEDICAL CARE 8347 07:01:43,280 --> 07:01:44,080 WHENEVER AND WHENEVER THEY GO 8348 07:01:44,080 --> 07:01:45,440 NOT ONLY TO THE STATE THEY WERE 8349 07:01:45,440 --> 07:01:46,640 LIVING IN BUT IF THEY WERE 8350 07:01:46,640 --> 07:01:48,880 TRAVELLING AND THEY NEEDED TO GO 8351 07:01:48,880 --> 07:01:52,880 TO A HEALTH CENTER THEY CAN GO 8352 07:01:52,880 --> 07:01:54,200 THERE GET SERVICE. 8353 07:01:54,200 --> 07:01:57,000 OF THE COURSE THERE'S A PART FOR 8354 07:01:57,000 --> 07:01:58,720 CATASTROPHIC DISEASES. 8355 07:01:58,720 --> 07:02:06,000 SO IT WAS FROM CATARACT SURGERY 8356 07:02:06,000 --> 07:02:08,480 TO CANCERS SO THOSE WERE IN 8357 07:02:08,480 --> 07:02:16,320 WELL-SET SET OF DISEASES AND 8358 07:02:16,320 --> 07:02:19,520 THEY'LL GATE FREE HEALTH CARE. 8359 07:02:19,520 --> 07:02:22,680 THAT WAS WORKING AND WITH THAT 8360 07:02:22,680 --> 07:02:27,120 THE HEALTH CARE ACCESS IMPROVED 8361 07:02:27,120 --> 07:02:27,440 DRAMATICALLY. 8362 07:02:27,440 --> 07:02:29,160 AND THE OPPORTUNITY AND THE NEW 8363 07:02:29,160 --> 07:02:30,960 GOVERNMENT DIDN'T SEE THAT AS 8364 07:02:30,960 --> 07:02:36,520 THE WAY TO GO AHEAD SO THEY 8365 07:02:36,520 --> 07:02:47,080 BANISHED THE PLAN AND MOVED INTO 8366 07:02:51,520 --> 07:03:00,360 THE GOVERNMENT AND EXPLAINED AND 8367 07:03:00,360 --> 07:03:01,880 IT'S TAKING OVER THE STATES 8368 07:03:01,880 --> 07:03:03,320 SIGNING WITH THE NEW MODEL OF 8369 07:03:03,320 --> 07:03:08,360 CARE AND WERE GOING TAKE OVER 8370 07:03:08,360 --> 07:03:13,040 THE OPERATIONS AND IT BRINGS 8371 07:03:13,040 --> 07:03:13,640 CONFUSION AND TRYING TO 8372 07:03:13,640 --> 07:03:14,680 UNDERSTAND THE MODEL OF CARE 8373 07:03:14,680 --> 07:03:16,520 THAT CAME OUT YESTERDAY TO SEE 8374 07:03:16,520 --> 07:03:19,320 WHAT'S GOING ON WITH THIS. 8375 07:03:19,320 --> 07:03:21,760 SO THIS IS ALSO SOMETHING THE 8376 07:03:21,760 --> 07:03:23,280 GOVERNMENT BRINGS TO HEALTH WHEN 8377 07:03:23,280 --> 07:03:28,480 THEY START MAKING THESE CHANGES. 8378 07:03:28,480 --> 07:03:30,880 WHEN THEY START NOT BUILDING BUT 8379 07:03:30,880 --> 07:03:32,960 CHANGE WHAT YOU HAVE IN HEALTH 8380 07:03:32,960 --> 07:03:35,200 CARE YOU CAN CREATE HAVOC AND 8381 07:03:35,200 --> 07:03:39,600 THAT'S HAPPENING IN MEXICO. 8382 07:03:39,600 --> 07:03:41,840 IT'S BEEN CONSISTENT WITH THE 8383 07:03:41,840 --> 07:03:45,360 WAY THEY FINANCE THE SYSTEM AND 8384 07:03:45,360 --> 07:03:47,280 WITH PEOPLE PARTICIPATING 7% OF 8385 07:03:47,280 --> 07:03:49,440 THE INCOME FOR HEALTH CARE AND 8386 07:03:49,440 --> 07:03:51,920 FOR THOSE THAT ARE NO INCOME 8387 07:03:51,920 --> 07:03:56,320 THEY CAN GO TO ZERO GOING TO THE 8388 07:03:56,320 --> 07:03:59,720 SYSTEM. 8389 07:03:59,720 --> 07:04:01,240 THEY ALSO OPT EITHER ONE OF 8390 07:04:01,240 --> 07:04:04,000 THOSE THEY CAN TAKE OVER. 8391 07:04:04,000 --> 07:04:05,960 OF COURSE, THE MINISTER OF 8392 07:04:05,960 --> 07:04:09,240 HEALTH HAS STEWARDSHIP AND THE 8393 07:04:09,240 --> 07:04:14,720 DIRECTORSHIP SAME AS MEXICO AND 8394 07:04:14,720 --> 07:04:16,240 WHEN YOU SEE COVID, YOU CAN SEE 8395 07:04:16,240 --> 07:04:21,280 THE DIFFERENCES ONLY HOW STRONG 8396 07:04:21,280 --> 07:04:24,320 THE GOVERNANCE IS IN PLACE. 8397 07:04:24,320 --> 07:04:29,520 SOME COUNTRIES WERE DOING VERY 8398 07:04:29,520 --> 07:04:37,120 WELL THEY WERE ABLE TO SUSTAIN 8399 07:04:37,120 --> 07:04:41,480 THE IMMUNIZATION AND SOME 8400 07:04:41,480 --> 07:04:44,160 COUNTRIES LIKE MINE LOST TRACK 8401 07:04:44,160 --> 07:04:46,440 OF HEALTH CARE AND IMMUNIZATION 8402 07:04:46,440 --> 07:04:50,240 AND CHILE AND COSTA RICA HAD 8403 07:04:50,240 --> 07:04:55,440 COVERAGES AND OTHER COUNTRIES 8404 07:04:55,440 --> 07:05:00,560 WENT BAD AND WE'RE SEEING 8405 07:05:00,560 --> 07:05:02,680 DIVISION AND LOOKS HOW FRAGILE 8406 07:05:02,680 --> 07:05:03,720 THE HEALTH SYSTEMS WERE IN COVID 8407 07:05:03,720 --> 07:05:08,360 AND IT WAS DEMONSTRATED. 8408 07:05:08,360 --> 07:05:10,920 >>THANK YOU FOR SHARING THE 8409 07:05:10,920 --> 07:05:11,200 EXAMPLES. 8410 07:05:11,200 --> 07:05:13,840 I WANT TO CIRCLE BACK TO COVID. 8411 07:05:13,840 --> 07:05:14,680 I DID RECEIVE QUESTIONS FROM THE 8412 07:05:14,680 --> 07:05:21,880 AUDIENCE ABOUT THAT. 8413 07:05:21,880 --> 07:05:24,320 THERE'S A LOT REPORTED ABOUT 8414 07:05:24,320 --> 07:05:26,440 PUERTO RICO ABOUT THEIR HEALTH 8415 07:05:26,440 --> 07:05:29,200 SYSTEM RESILIENCY AND I WANT TO 8416 07:05:29,200 --> 07:05:33,320 ASK A QUESTION, DR. ORTEGA, WHAT 8417 07:05:33,320 --> 07:05:34,400 EFFORTS ARE NEEDED TO PROMOTE 8418 07:05:34,400 --> 07:05:35,880 AND LEARN FROM THE HEALTH SYSTEM 8419 07:05:35,880 --> 07:05:38,560 IN PUERTO RICO AND CAPTURE THE 8420 07:05:38,560 --> 07:05:40,080 RELEVANT POPULATION-LEVEL DATA 8421 07:05:40,080 --> 07:05:42,320 IN PUERTO RICO TO MAKE SURE 8422 07:05:42,320 --> 07:05:42,880 HEALTH CARE RESEARCH IS 8423 07:05:42,880 --> 07:05:52,400 SUSTAINABLE IN THE COUNTRY? 8424 07:05:52,400 --> 07:05:55,800 >>THANK YOU MICHELLE AND I'M 8425 07:05:55,800 --> 07:05:58,280 IMPRESSED WITH YOUR ABILITY TO 8426 07:05:58,280 --> 07:06:03,840 DO THIS AT THE AIRPORT, CARINA. 8427 07:06:03,840 --> 07:06:07,840 THE CONCEPT OF HEALTH SYSTEM 8428 07:06:07,840 --> 07:06:10,400 RESILIENCY IS RELATIVELY NEW IN 8429 07:06:10,400 --> 07:06:11,600 PUBLIC HEALTH. 8430 07:06:11,600 --> 07:06:16,040 THOUGH THE IDEA OF HEALTH SYSTEM 8431 07:06:16,040 --> 07:06:18,240 RESILIENCY GOES BACK TO THE 8432 07:06:18,240 --> 07:06:19,600 EBOLA OUTBREAK IN SOUTH AFRICA 8433 07:06:19,600 --> 07:06:23,160 AND THE STRAIN AON THE SYSTEM 8434 07:06:23,160 --> 07:06:27,920 AFTER THE EPIDEMIC AND CAUGHT ON 8435 07:06:27,920 --> 07:06:34,440 RECENTLY IN THE UNITED STATES. 8436 07:06:34,440 --> 07:06:35,840 THERE'S DIFFERENT DEFINITIONS 8437 07:06:35,840 --> 07:06:38,800 BUT THE MOST COMMON IS THE 8438 07:06:38,800 --> 07:06:40,480 CAPACITY OF HEALTH SYSTEMS TO 8439 07:06:40,480 --> 07:06:42,920 EFFECTIVELY RESPOND AND RECOVER 8440 07:06:42,920 --> 07:06:45,040 FROM CRISES SUCH AS NATURAL 8441 07:06:45,040 --> 07:06:46,560 DISASTERS WHICH THERE HAVE BEEN 8442 07:06:46,560 --> 07:06:47,720 A NUMBER OF IN PUERTO RICO 8443 07:06:47,720 --> 07:06:52,960 ESPECIALLY OVER THE LAST COUPLE 8444 07:06:52,960 --> 07:06:57,560 OF YEARS AND INFECTIOUS DISEASE 8445 07:06:57,560 --> 07:06:58,720 OUTBREAKS INCLUDING COVID-19 8446 07:06:58,720 --> 07:07:01,600 INCLUDING A NUMBER OF TROPICAL 8447 07:07:01,600 --> 07:07:05,960 DISEASE OUTBREAKS IN PUERTO 8448 07:07:05,960 --> 07:07:06,160 RICO. 8449 07:07:06,160 --> 07:07:08,120 IN ORDER FOR A HEALTH CARE 8450 07:07:08,120 --> 07:07:09,640 SYSTEM TO BE RESILIENT IT MUST 8451 07:07:09,640 --> 07:07:14,560 BE AWARE OF ITS STRENGTHS AND 8452 07:07:14,560 --> 07:07:19,520 RESILIENCIES ACROSS HEALTH NEEDS 8453 07:07:19,520 --> 07:07:22,200 AND MUST CONTAIN HEALTH THREATS 8454 07:07:22,200 --> 07:07:22,840 WHILE CONTINUING TO DELIVER 8455 07:07:22,840 --> 07:07:27,680 HEALTH CARE TO THE POPULATION 8456 07:07:27,680 --> 07:07:29,760 AND MUST INTEGRATE DIVERSE 8457 07:07:29,760 --> 07:07:31,880 PLAYERS TO SOLVE CRISES AND THE 8458 07:07:31,880 --> 07:07:32,840 HEALTH CARE SYSTEM MUST BE 8459 07:07:32,840 --> 07:07:36,200 ADAPTABLE AND BE ABLE TO IMPROVE 8460 07:07:36,200 --> 07:07:37,760 PERFORMANCE BOTH AT TIMES OF 8461 07:07:37,760 --> 07:07:43,160 CRISIS AND NON-CRISES. 8462 07:07:43,160 --> 07:07:45,680 AND RESEARCH AND POLICY EFFORTS 8463 07:07:45,680 --> 07:07:51,600 ARE NEEDED TO UNDERSTAND AND 8464 07:07:51,600 --> 07:07:54,520 PROMOTE TEAM CLINICAL CARE AND 8465 07:07:54,520 --> 07:07:58,760 NEED DIFFERENT STRATEGIES SUCH 8466 07:07:58,760 --> 07:08:03,320 AS TELEHEALTH AND TRAINING 8467 07:08:03,320 --> 07:08:05,040 PROVIDERS TO USE TELEHEALTH AND 8468 07:08:05,040 --> 07:08:07,000 UNDERSTAND THE FACTORS THAT 8469 07:08:07,000 --> 07:08:09,320 INHIBITED CARE DURING A CRISIS 8470 07:08:09,320 --> 07:08:12,320 AND HAVE STRATEGIES IN PLACE TO 8471 07:08:12,320 --> 07:08:13,400 IMPROVE AND RESPOND MOVING 8472 07:08:13,400 --> 07:08:13,800 FORWARD. 8473 07:08:13,800 --> 07:08:16,960 THEY HAVE TO LEARN FROM PREVIOUS 8474 07:08:16,960 --> 07:08:19,320 EXPERIENCES OF CRISES BOTH 8475 07:08:19,320 --> 07:08:24,320 WITHIN ITS OWN SYSTEM AND AS 8476 07:08:24,320 --> 07:08:27,280 WELL AS OTHER SYSTEMS NATIONALLY 8477 07:08:27,280 --> 07:08:33,560 AND WHILE THE HEALTH CARE 8478 07:08:33,560 --> 07:08:37,520 CONTEXT IN PUERTO RICO THAN IT 8479 07:08:37,520 --> 07:08:39,160 IS IN OTHER LATIN AMERICA 8480 07:08:39,160 --> 07:08:39,400 COUNTRIES. 8481 07:08:39,400 --> 07:08:41,240 THERE'S LESSONS TO BE LEARNED 8482 07:08:41,240 --> 07:08:43,440 HOW THE HEALTH CARE SYSTEM 8483 07:08:43,440 --> 07:08:45,920 BECOMES RESILIENT IN THE FACE OF 8484 07:08:45,920 --> 07:08:46,800 THESE NATURAL DISASTERS AND 8485 07:08:46,800 --> 07:08:52,560 GROWING CLIMATE CHANGE. 8486 07:08:52,560 --> 07:08:56,320 THERE MUST BE EVALUATION OF 8487 07:08:56,320 --> 07:08:59,320 PREVIOUS EXPERIENCE AND LEARNING 8488 07:08:59,320 --> 07:08:59,560 PROCESS. 8489 07:08:59,560 --> 07:09:01,480 A HEALTH CARE SYSTEM MUST ABLE 8490 07:09:01,480 --> 07:09:05,080 TO TRANSFORM THE STATUS AND 8491 07:09:05,080 --> 07:09:06,840 STRATEGIES AND BEHAVIORS NO 8492 07:09:06,840 --> 07:09:10,120 LONGSER FEASIBLE AND THERE'S A 8493 07:09:10,120 --> 07:09:20,040 OF METHODOLOGICAL APPROACHES AND 8494 07:09:20,040 --> 07:09:23,120 METHODS INCLUDING SURVEYS OF 8495 07:09:23,120 --> 07:09:24,320 PATIENTS AND PROVIDERS AND 8496 07:09:24,320 --> 07:09:26,480 INTERVIEWS OF LEADERS AND 8497 07:09:26,480 --> 07:09:31,600 PARTNERS AND ANALYSIS OF 8498 07:09:31,600 --> 07:09:34,240 ADMINISTRATIVE DATA AND IT'S 8499 07:09:34,240 --> 07:09:35,120 IMPORTANT TO INCLUDE PUERTO RICO 8500 07:09:35,120 --> 07:09:37,520 WHICH IS A PART OF THE UNITED 8501 07:09:37,520 --> 07:09:38,840 STATES. 8502 07:09:38,840 --> 07:09:40,600 IT'S A TERRITORY AND ITS 8503 07:09:40,600 --> 07:09:45,920 RESIDENTS ARE CITIZENS OF THE 8504 07:09:45,920 --> 07:09:49,480 UNITED STATES IN NATIONAL HEALTH 8505 07:09:49,480 --> 07:09:51,520 CARE SURVEYS AND OTHERS. 8506 07:09:51,520 --> 07:09:54,120 IN ORDER TO LEARN ABOUT WHAT'S 8507 07:09:54,120 --> 07:09:56,840 HAPPENING IN PUERTO RICO AND TO 8508 07:09:56,840 --> 07:09:58,520 BE ABLE TO DO COMPARISONS WITH 8509 07:09:58,520 --> 07:09:59,480 THE MAINLAND STATES. 8510 07:09:59,480 --> 07:10:04,880 >>THAT'S GREAT. 8511 07:10:04,880 --> 07:10:06,320 I HAVE MORE QUESTIONS ABOUT 8512 07:10:06,320 --> 07:10:07,520 PUERTO RICO BUT CIRCLING BACK TO 8513 07:10:07,520 --> 07:10:08,880 THE COVID COMMENT I'D LIKE YOU 8514 07:10:08,880 --> 07:10:13,240 TO ALL ANSWER THIS CAME IN IN 8515 07:10:13,240 --> 07:10:16,480 THE U.S. WE HAVE EXPERIENCED A 8516 07:10:16,480 --> 07:10:19,720 WORKFORCE SHORTAGE DUE TO THE 8517 07:10:19,720 --> 07:10:20,200 COVID PANDEMIC. 8518 07:10:20,200 --> 07:10:24,360 WHAT'S BEEN THE IMPACT ON THE 8519 07:10:24,360 --> 07:10:25,000 WORKFORCE IN LATIN AMERICA AND 8520 07:10:25,000 --> 07:10:30,840 PUERTO RICO? 8521 07:10:30,840 --> 07:10:35,720 THAT'S ALL FOR TO ANSWER. 8522 07:10:35,720 --> 07:10:46,240 AND SOLUTIONS TO ADDRESS THAT. 8523 07:11:14,440 --> 07:11:17,480 >>IF YOU DON'T HAVE ENOUGH 8524 07:11:17,480 --> 07:11:23,040 FINANCING TO SUSTAIN A WORKFORCE 8525 07:11:23,040 --> 07:11:27,920 THAT CAN SUPPORT THE SYSTEM HAVE 8526 07:11:27,920 --> 07:11:28,800 YOU A LOT OF PROBLEMS. 8527 07:11:28,800 --> 07:11:30,400 YOU ARE UNDER STAFFED AND PEOPLE 8528 07:11:30,400 --> 07:11:34,440 HAVE TO RUN TWO OR THREE SHIFTS 8529 07:11:34,440 --> 07:11:35,600 AT THE SAME TIME AND EVERYBODY 8530 07:11:35,600 --> 07:11:41,480 IS STRESSED OUT AND THE 8531 07:11:41,480 --> 07:11:43,280 FRAGILITY OF THE HEALTH SYSTEMS 8532 07:11:43,280 --> 07:11:53,840 WE HAVE TO HIRE MORE PEOPLE AND 8533 07:12:15,400 --> 07:12:18,880 IT'S CALCULATED BETWEEN 70% TO 8534 07:12:18,880 --> 07:12:19,800 80% OF THE HEALTH BUDGET GOES TO 8535 07:12:19,800 --> 07:12:21,920 SALARIES. 8536 07:12:21,920 --> 07:12:22,960 THAT LEAVES WITH A MINIMUM FOR 8537 07:12:22,960 --> 07:12:26,040 OPERATIONS. 8538 07:12:26,040 --> 07:12:28,240 THAT CAUSES HAVOC EVERYWHERE. 8539 07:12:28,240 --> 07:12:31,600 IF YOU DON'T HAVE THE FUNDING TO 8540 07:12:31,600 --> 07:12:36,160 INCREASE THE HEALTH RESOURCES 8541 07:12:36,160 --> 07:12:37,280 AND WORKFORCE TO PROVIDE A 8542 07:12:37,280 --> 07:12:38,600 HEALTH SYSTEM YOU ARE GOING TO 8543 07:12:38,600 --> 07:12:39,360 BE SUFFERING. 8544 07:12:39,360 --> 07:12:42,800 PEOPLE ARE GOING TO BE OVER 8545 07:12:42,800 --> 07:12:48,000 STRESSED, OVER WORKED AND THOSE 8546 07:12:48,000 --> 07:12:49,960 WHO YOU HIRED YOU'LL NOT BE ABLE 8547 07:12:49,960 --> 07:12:53,440 TO HIRE FULL TIME AFTERWARDS AND 8548 07:12:53,440 --> 07:12:54,840 CAUSING THIS IS HAPPENING IN 8549 07:12:54,840 --> 07:12:56,320 MEXICO. 8550 07:12:56,320 --> 07:13:06,560 OVER TO YOU. 8551 07:13:07,400 --> 07:13:11,120 >>FRANCISCO DID A GREAT JOB BUT 8552 07:13:11,120 --> 07:13:12,440 IN TERMS OF THE PUERTO RICO 8553 07:13:12,440 --> 07:13:16,440 CONTEXT THE HEALTH CARE SYSTEM 8554 07:13:16,440 --> 07:13:20,320 IN PUERTO RICO HAD ALREADY BEEN 8555 07:13:20,320 --> 07:13:27,240 STRAINED TO THE MAX BECAUSE OF 8556 07:13:27,240 --> 07:13:28,640 HURRICANE MARIA AND THE 8557 07:13:28,640 --> 07:13:30,560 EARTHQUAKES AND HAD BEEN 8558 07:13:30,560 --> 07:13:35,000 PROMISED BEFORE THE NATURAL 8559 07:13:35,000 --> 07:13:39,280 DISASTERS BECAUSE OF THE WAY THE 8560 07:13:39,280 --> 07:13:44,280 SYSTEM IS FINANCED AND THERE'S 8561 07:13:44,280 --> 07:13:47,240 STILL EVEN AFTER HURRICANE FIONA 8562 07:13:47,240 --> 07:13:49,240 WHICH HIT RECENTLY HOSPITALS 8563 07:13:49,240 --> 07:13:50,240 WITHOUT POWER. 8564 07:13:50,240 --> 07:13:51,800 SURGEONS HAVING TO DO SURGERY 8565 07:13:51,800 --> 07:14:00,320 WITH FLASHLIGHTS. 8566 07:14:00,320 --> 07:14:02,000 COVID-19 MADE IT WORSE AND 8567 07:14:02,000 --> 07:14:02,600 EXACERBATED THE PROBLEMS WITH 8568 07:14:02,600 --> 07:14:12,440 THE HEALTH CARE SYSTEM. 8569 07:14:12,440 --> 07:14:17,720 THERE'S POLICIES THAT NEED TO BE 8570 07:14:17,720 --> 07:14:18,560 CHANGED IN THE UNITED STATES AND 8571 07:14:18,560 --> 07:14:20,240 CONGRESS IN ORDER TO IMPROVE THE 8572 07:14:20,240 --> 07:14:22,400 MEDICAID FUNDING AND IMPROVE THE 8573 07:14:22,400 --> 07:14:23,040 OVER ALL HEALTH CARE SYSTEM IN 8574 07:14:23,040 --> 07:14:33,240 PUERTO RICO. 8575 07:14:33,720 --> 07:14:37,840 >>THE RATE WAS AT 76% WHAT 8576 07:14:37,840 --> 07:14:40,360 AFFECT WILL IT HAVE TO ACCESS TO 8577 07:14:40,360 --> 07:14:41,960 HEALTH CARE AND INCREASING THE 8578 07:14:41,960 --> 07:14:43,120 WORKFORCE IN PUERTO RICO? 8579 07:14:43,120 --> 07:14:45,840 >>SO TO BE CLEAR, THAT INCREASE 8580 07:14:45,840 --> 07:14:52,240 IS ONLY TEMPORARY AND IT ENDS IN 8581 07:14:52,240 --> 07:14:52,840 DECEMBER. 8582 07:14:52,840 --> 07:14:57,040 HISTORICALLY THE U.S. CONGRESS 8583 07:14:57,040 --> 07:15:03,560 HAS RAISED THE CAP TEMPORARILY 8584 07:15:03,560 --> 07:15:06,240 BUT THAT CREATES AN UNSTABLE 8585 07:15:06,240 --> 07:15:07,440 FINANCIAL SYSTEM WHERE THE 8586 07:15:07,440 --> 07:15:09,080 TERRITORY DIDN'T KNOW WHEN THE 8587 07:15:09,080 --> 07:15:09,760 MEDICATE CAP IS GOING INCREASE 8588 07:15:09,760 --> 07:15:20,080 OR WHEN IT WON'T. 8589 07:15:20,360 --> 07:15:22,080 THIS BECOMES MORE STRESSFUL AS 8590 07:15:22,080 --> 07:15:24,800 IT TRIES TO RECOVER AFTER THE 8591 07:15:24,800 --> 07:15:35,120 NATURAL DISASTERS. 8592 07:15:44,520 --> 07:15:46,560 AND AS PART OF THE AFFORDABLE 8593 07:15:46,560 --> 07:15:48,360 CARE ACT IT'S STILL NOT 8594 07:15:48,360 --> 07:15:50,160 SUFFICIENT AND RUNS OUT MIDDLE 8595 07:15:50,160 --> 07:15:53,040 OF THE YEAR AND SO THE 8596 07:15:53,040 --> 07:15:54,080 TERRITORY'S ON THE HOOK FOR 8597 07:15:54,080 --> 07:15:59,240 PAYING THE REST OF THE BILL AND 8598 07:15:59,240 --> 07:16:00,520 THAT CREATES PROBLEMS WITH 8599 07:16:00,520 --> 07:16:03,080 ELIGIBILITY AND ACCESS TO CARE 8600 07:16:03,080 --> 07:16:05,960 AND PROVIDER REIMBURSEMENT. 8601 07:16:05,960 --> 07:16:08,280 IT MAKES THE SITUATION WORSE AND 8602 07:16:08,280 --> 07:16:09,800 LEADS THE TERRITORY WITH 8603 07:16:09,800 --> 07:16:11,080 UNSTABLE HEALTH COVERAGE. 8604 07:16:11,080 --> 07:16:12,400 >>THANK YOU FOR PROVIDING MORE 8605 07:16:12,400 --> 07:16:21,480 CONTEXT. 8606 07:16:21,480 --> 07:16:25,600 >>CARINA WHAT'S BEEN THE IMPACT 8607 07:16:25,600 --> 07:16:26,880 OF THE PANDEMIC AND THE 8608 07:16:26,880 --> 07:16:27,520 WORKFORCE? 8609 07:16:27,520 --> 07:16:36,720 I'LL GIVE YOU THE FINAL WORD. 8610 07:16:36,720 --> 07:16:39,920 >>FROM THE PERSPECTIVE OF THE 8611 07:16:39,920 --> 07:16:48,280 WORK WE'RE DOING IN TERMS OF THE 8612 07:16:48,280 --> 07:16:50,720 FUNCTIONS CONCENTRATED IN HUMAN 8613 07:16:50,720 --> 07:16:54,440 RESOURCES INCLUDING THE ISSUES 8614 07:16:54,440 --> 07:16:57,920 OF EDUCATION AND CLOSING THE GAP 8615 07:16:57,920 --> 07:16:59,280 AND MAKING SURE WHAT IS IN PLACE 8616 07:16:59,280 --> 07:17:02,440 IS RELATED TO THE AGAIN THE 8617 07:17:02,440 --> 07:17:05,160 COUNTRY HAS MAKING SURE THE 8618 07:17:05,160 --> 07:17:12,200 NATIONAL HEALTH AUTHORITY HAS A 8619 07:17:12,200 --> 07:17:14,600 ROLE AND SEEING WHERE THE FOCUS 8620 07:17:14,600 --> 07:17:16,200 NEEDS TO BE. 8621 07:17:16,200 --> 07:17:22,000 I'D SAY WHAT WE SAW DURING THE 8622 07:17:22,000 --> 07:17:26,520 PANDEMIC IS REDIRECTING HUMAN 8623 07:17:26,520 --> 07:17:29,720 RESOURCES FROM PRIMARY HEALTH 8624 07:17:29,720 --> 07:17:32,360 CARE AND DIFFERENT AREAS OF 8625 07:17:32,360 --> 07:17:33,200 SPECIALTY TO RESPONSE TO THE 8626 07:17:33,200 --> 07:17:34,280 COVID PANDEMIC. 8627 07:17:34,280 --> 07:17:40,240 IN THE CASE OF ECUADOR PERU WE 8628 07:17:40,240 --> 07:17:45,640 HAVE THE EXCESS DEATH RATES THE 8629 07:17:45,640 --> 07:17:49,920 HIGHEST IN THE WORLD BUT NOT 8630 07:17:49,920 --> 07:17:52,920 ONLY RELATED TO COVID AND 8631 07:17:52,920 --> 07:17:54,640 UNDERSTANDING WHAT HAPPENED BUT 8632 07:17:54,640 --> 07:17:56,960 SEEING DUPLICATION OF RATES IN 8633 07:17:56,960 --> 07:18:01,920 TERMS OF DIABETES, HYPERTENSION, 8634 07:18:01,920 --> 07:18:03,240 MATERNAL MORTALITY AND IN 8635 07:18:03,240 --> 07:18:09,280 ECUADOR WE SAW PROBABLY A 8636 07:18:09,280 --> 07:18:09,880 DUPLICATION OF THE MATERNAL 8637 07:18:09,880 --> 07:18:20,400 MORTALITY RATE IN THE COUNTRY. 8638 07:18:21,560 --> 07:18:23,080 THE FUNCTION IS BUILDING ON THE 8639 07:18:23,080 --> 07:18:27,000 HEALTH SYSTEM AND BUILDING 8640 07:18:27,000 --> 07:18:28,240 RESILIENT HEALTH SYSTEMS INCLUDE 8641 07:18:28,240 --> 07:18:33,960 FROM THE POINT OF VIEW OF 8642 07:18:33,960 --> 07:18:37,240 MONITORING AND SURVEILLANCE AND 8643 07:18:37,240 --> 07:18:38,480 POLICIES FINANCING AND 8644 07:18:38,480 --> 07:18:40,880 MEDICATIONS AND ACCESS TO HEALTH 8645 07:18:40,880 --> 07:18:45,920 TECHNOLOGIES AND I'LL PAUSE 8646 07:18:45,920 --> 07:18:47,920 BECAUSE I THINK WE SAW LACK OF 8647 07:18:47,920 --> 07:18:53,200 ACCESS TO VACCINES. 8648 07:18:53,200 --> 07:19:01,760 OUTSIDE THE AND IN TERMS OF 8649 07:19:01,760 --> 07:19:08,560 ACHIEVING AND BUILDING CAPACITY 8650 07:19:08,560 --> 07:19:11,400 AND LOOKING AT THAT SENSE. 8651 07:19:11,400 --> 07:19:21,800 CAN YOU STILL HEAR ME? 8652 07:19:25,480 --> 07:19:27,480 >>THERE'S SO MUCH THAT WE CAN 8653 07:19:27,480 --> 07:19:31,840 LEARN HERE IN THE U.S. AND HOW 8654 07:19:31,840 --> 07:19:35,200 DO WE IMPLEMENT IT TO BETTER THE 8655 07:19:35,200 --> 07:19:36,240 HEALTH CARE FOR LATINOS IN THE 8656 07:19:36,240 --> 07:19:36,400 U.S. 8657 07:19:36,400 --> 07:19:37,680 THANK YOU FOR YOUR PRESENTATION 8658 07:19:37,680 --> 07:19:39,280 AND FOR THE DISCUSSION. 8659 07:19:39,280 --> 07:19:42,560 I HOPE TO CONTINUE THIS 8660 07:19:42,560 --> 07:19:43,160 DISCUSSION AND THANK YOU SO 8661 07:19:43,160 --> 07:19:43,360 MUCH. 8662 07:19:43,360 --> 07:19:48,800 WE ARE NOW GOING TO MOVE ON TO 8663 07:19:48,800 --> 07:19:53,000 OUR FINAL SESSION BEING LED BY 8664 07:19:53,000 --> 07:20:03,360 DR. CONSTANZA CAMARGO. 8665 07:20:07,720 --> 07:20:10,520 >>WELCOME TO SESSION 8. 8666 07:20:10,520 --> 07:20:14,280 I'M AN STRINVESTIGATOR AT THE 8667 07:20:14,280 --> 07:20:20,400 NATIONAL CANCER INSTITUTE AND 8668 07:20:20,400 --> 07:20:21,600 MODERATING THE SESSION FOR 8669 07:20:21,600 --> 07:20:23,720 IMPROVING ACCESS TO AND CON NEWT 8670 07:20:23,720 --> 07:20:27,000 OF CARE FOR PERSONS FROM UNDER 8671 07:20:27,000 --> 07:20:37,520 SERVED OR ISOLATED COMMUNITIES. 8672 07:20:56,880 --> 07:21:00,560 WE HAVE DR. ARACHU CASTRO AND 8673 07:21:00,560 --> 07:21:02,800 ANNA LOWER INNA RUANO. 8674 07:21:02,800 --> 07:21:04,160 THEY'LL DESCRIBE THE RESEARCHERS 8675 07:21:04,160 --> 07:21:08,120 ON THE TOPIC OF INTEREST 8676 07:21:08,120 --> 07:21:08,920 INCLUDING SPECIFIC RESEARCH 8677 07:21:08,920 --> 07:21:10,480 QUESTIONS OF STUDY POPULATIONS 8678 07:21:10,480 --> 07:21:13,520 AND ANALYTICAL APPROACHES. 8679 07:21:13,520 --> 07:21:15,120 WE'LL START WITH DR. CASTRO 8680 07:21:15,120 --> 07:21:18,240 FOLLOWED BY DR. RUANO AND CLOSE 8681 07:21:18,240 --> 07:21:21,960 WITH DR. PESANTES. 8682 07:21:21,960 --> 07:21:24,320 DR. CASTRO, PLEASE GO AHEAD. 8683 07:21:24,320 --> 07:21:31,520 >>THANK YOU VERY MUCH. 8684 07:21:31,520 --> 07:21:35,080 >>THANK YOU FOR HAVING INVITED 8685 07:21:35,080 --> 07:21:35,240 ME. 8686 07:21:35,240 --> 07:21:37,240 WE HAVE LOOKED AT IMPROVING 8687 07:21:37,240 --> 07:21:40,360 CONTINUITY OF CARE FOR PEOPLE OF 8688 07:21:40,360 --> 07:21:41,880 UNDER SERVED COMMUNITIES IN 8689 07:21:41,880 --> 07:21:43,000 LATIN AMERICA FOR OVER 20 YEARS. 8690 07:21:43,000 --> 07:21:45,920 I HAVE FOCUSSED ON WOMEN, 8691 07:21:45,920 --> 07:21:49,120 CHILDREN AND ADOLESCENCE WHO 8692 07:21:49,120 --> 07:21:51,160 LIVE IN POVERTY AND WHEN THEY 8693 07:21:51,160 --> 07:21:54,640 SEEK CARE GO TO PUBLIC HEALTH 8694 07:21:54,640 --> 07:21:55,520 FACILITY WHICH IS ARE OFTEN 8695 07:21:55,520 --> 07:21:58,160 UNDER FUNDED AND NOT DESIGN TO 8696 07:21:58,160 --> 07:21:59,200 MEET THEIR NEEDS PARTICULARLY 8697 07:21:59,200 --> 07:22:01,680 WHEN THEY LIVE IN POVERTY. 8698 07:22:01,680 --> 07:22:04,200 GIVEN MY BACKGROUND IN MEDICAL 8699 07:22:04,200 --> 07:22:05,560 AANTHRO 8700 07:22:05,560 --> 07:22:10,000 AANTHROPOLOGY AND IN PUBLIC 8701 07:22:10,000 --> 07:22:11,040 HEALTH I YOU'VE RESEARCH 8702 07:22:11,040 --> 07:22:13,320 INSTRUMENTS THAT RELY ON 8703 07:22:13,320 --> 07:22:20,320 QUALITATIVE AND QUANTITATIVE 8704 07:22:20,320 --> 07:22:20,960 APPROACHES. 8705 07:22:20,960 --> 07:22:23,960 THIS ALLOWS ME TO ADDRESS MY 8706 07:22:23,960 --> 07:22:27,320 RESEARCH QUESTION FROM AN IN 8707 07:22:27,320 --> 07:22:33,920 DEPTH PERSPECTIVE AND THIS 8708 07:22:33,920 --> 07:22:34,760 ALLOWS PLEA TO ESTABLISH 8709 07:22:34,760 --> 07:22:35,360 STRONGER ASSOCIATIONS BETWEEN 8710 07:22:35,360 --> 07:22:41,840 OBSERVATIONS. 8711 07:22:41,840 --> 07:22:44,240 I LED A MULTI-COUNTRY INITIATIVE 8712 07:22:44,240 --> 07:22:48,760 IN MY RESEARCH TO INFORM HOW TO 8713 07:22:48,760 --> 07:22:50,640 INTEGRATE PRENATAL CARE WITH THE 8714 07:22:50,640 --> 07:22:54,640 CARE OF HIV AND SYPHILIS SO 8715 07:22:54,640 --> 07:22:56,920 WOMEN WITH HIV AND/OR SYPHILIS 8716 07:22:56,920 --> 07:22:59,160 CAN BE THE FOCUS OF HEALTH 8717 07:22:59,160 --> 07:23:02,440 POLICIES AND MEDICAL CARE FOR 8718 07:23:02,440 --> 07:23:04,160 THEIR OWN HEALTH AND NOT JUST TO 8719 07:23:04,160 --> 07:23:04,760 PREVENT TRANSMISSION TO THE 8720 07:23:04,760 --> 07:23:08,760 CHILD. 8721 07:23:08,760 --> 07:23:11,800 I HAVE CONDUCTED RESEARCH TO 8722 07:23:11,800 --> 07:23:18,040 IDENTIFY THE CAUSES OF MATERNAL 8723 07:23:18,040 --> 07:23:23,280 MORTALITY SUCH AS IN THE 8724 07:23:23,280 --> 07:23:27,760 DOMINICAN REPUBLIC AND PERU AND 8725 07:23:27,760 --> 07:23:29,680 I FOCUSSED IN AREAS INFORMING 8726 07:23:29,680 --> 07:23:30,960 POLICY MAKERS AND IMPROVING THE 8727 07:23:30,960 --> 07:23:41,520 QUALITY AND TIMELINESS OF CARE. 8728 07:23:42,040 --> 07:23:48,400 I HAVE WORKED ON THE 8729 07:23:48,400 --> 07:23:53,640 MISTREATMENT AND BIAS TO 8730 07:23:53,640 --> 07:23:57,200 UNDERSTAND THE ASSOCIATION WITH 8731 07:23:57,200 --> 07:24:02,320 MATERNAL AND NEWBORN HEALTH 8732 07:24:02,320 --> 07:24:07,360 OUTCOMES AND I HAVE CONDUCTED 8733 07:24:07,360 --> 07:24:09,280 RESEARCH ON THE INTERDIRECT 8734 07:24:09,280 --> 07:24:10,960 AFFECTS OF THE PANDEMIC ON 8735 07:24:10,960 --> 07:24:12,720 HEALTH CARE ACCESS FOR WOMEN, 8736 07:24:12,720 --> 07:24:15,480 CHILDREN AND ADOLESCENTS AND THE 8737 07:24:15,480 --> 07:24:19,640 IMPACT ON HEALTH OUTCOMES. 8738 07:24:19,640 --> 07:24:21,120 FOR EXAMPLE, WE HAVE FOUND 8739 07:24:21,120 --> 07:24:23,240 INCREASE IN MATERNAL MORTALITY 8740 07:24:23,240 --> 07:24:24,320 IN THE COUNTRIES FOR WHICH WE 8741 07:24:24,320 --> 07:24:32,320 HAVE DATA. 8742 07:24:32,320 --> 07:24:33,720 AND LOOKED AT THE ASSOCIATION 8743 07:24:33,720 --> 07:24:35,520 BETWEEN CULTURAL PRACTICES SUCH 8744 07:24:35,520 --> 07:24:40,360 AS CHILD REARING AND EXPOSURE TO 8745 07:24:40,360 --> 07:24:43,880 ADVERSE OUTCOMES AND EXPERIENCE 8746 07:24:43,880 --> 07:24:45,560 ADVERSE EXPERIENCES AND EARLY 8747 07:24:45,560 --> 07:24:47,600 CHILDHOOD DEVELOPMENT. 8748 07:24:47,600 --> 07:24:50,360 AREA IS OF PARTICULAR RELEVANCE 8749 07:24:50,360 --> 07:24:56,840 FOR THE PREVENTION OF NCDs GIVEN 8750 07:24:56,840 --> 07:25:01,280 THE ASSOCIATION BETWEEN EARLY 8751 07:25:01,280 --> 07:25:04,640 CHILDHOOD DELAY AND THE CHRONIC 8752 07:25:04,640 --> 07:25:06,320 HEALTH CONDITIONS IN ADULTHOOD 8753 07:25:06,320 --> 07:25:08,120 AND SHORTER LIFE SPANS. 8754 07:25:08,120 --> 07:25:10,160 IN ALL CASES WE'RE WORKING ON 8755 07:25:10,160 --> 07:25:11,480 ANOTHER PROJECT AS WELL AND 8756 07:25:11,480 --> 07:25:14,280 WANTED TO HIGHLIGHT THESE THREE. 8757 07:25:14,280 --> 07:25:16,000 IN ALL THE CASES AN APPROACH MY 8758 07:25:16,000 --> 07:25:20,520 RESEARCH QUESTIONS WITH THE 8759 07:25:20,520 --> 07:25:21,800 HEALTH EQUITY PERSPECTIVE 8760 07:25:21,800 --> 07:25:24,320 FOCUSSING ON HOW SOCIO ECONOMIC 8761 07:25:24,320 --> 07:25:26,240 CONDITION AFFECTS EXPOSURE TO 8762 07:25:26,240 --> 07:25:28,200 ADVERSE HEALTH OUTCOMES AND 8763 07:25:28,200 --> 07:25:30,480 ACCESS TO TIMELY DIAGNOSIS AND 8764 07:25:30,480 --> 07:25:32,320 TREATMENT. 8765 07:25:32,320 --> 07:25:36,040 THANK YOU VERY MUCH. 8766 07:25:36,040 --> 07:25:37,240 >>THANK YOU. 8767 07:25:37,240 --> 07:25:44,320 VERY COMPREHENSIVE AGENDA. 8768 07:25:44,320 --> 07:25:47,200 DR. RUAN, THANK YOU. 8769 07:25:47,200 --> 07:25:47,800 >>THANK YOU. 8770 07:25:47,800 --> 07:25:49,480 I'M A SOCIOLOGIST. 8771 07:25:49,480 --> 07:25:51,680 I FOCUS AND MY Ph.D. IS IN 8772 07:25:51,680 --> 07:25:52,640 PUBLIC HEALTH. 8773 07:25:52,640 --> 07:25:53,800 I FOCUS ON COMMUNITY 8774 07:25:53,800 --> 07:25:55,200 PARTICIPATION AND PARTICULARLY 8775 07:25:55,200 --> 07:25:59,840 HOW TO STUDY AND WORK WITH 8776 07:25:59,840 --> 07:26:02,560 INDIGENOUS PEOPLE AND I STUDY 8777 07:26:02,560 --> 07:26:03,640 RACISM, DISCRIMINATION AND ABUSE 8778 07:26:03,640 --> 07:26:06,560 AND HOW THAT IMPACTED THEIR 8779 07:26:06,560 --> 07:26:07,080 ACCESS TO HEALTH CARE. 8780 07:26:07,080 --> 07:26:10,200 ONE OF MY FOCUS IS ON HEALTH 8781 07:26:10,200 --> 07:26:11,680 SYSTEM GOVERNANCE AND COMMUNITY 8782 07:26:11,680 --> 07:26:14,560 AND SOCIAL PARTICIPATION AND HOW 8783 07:26:14,560 --> 07:26:17,600 HEALTH SYSTEMS CAN BECOME MORE 8784 07:26:17,600 --> 07:26:18,760 RESPONSIVE AND RESILIENT THROUGH 8785 07:26:18,760 --> 07:26:19,920 COMMUNITY PARTICIPATION AND HOW 8786 07:26:19,920 --> 07:26:24,200 DECISION PROCESSES CAN IMPROVE 8787 07:26:24,200 --> 07:26:30,120 AND HOW CAN IT IMPROVE THE 8788 07:26:30,120 --> 07:26:31,880 QUALITY OF CARE INDIGENOUS 8789 07:26:31,880 --> 07:26:33,240 PATIENTS RECEIVE. 8790 07:26:33,240 --> 07:26:34,560 THE STUDY POPULATION IS 8791 07:26:34,560 --> 07:26:36,120 INDIGENOUS PEOPLE PARTICULARLY 8792 07:26:36,120 --> 07:26:37,960 THE MAYA AND WORK WITH 8793 07:26:37,960 --> 07:26:40,280 CULTURALLY SENSITIVE 8794 07:26:40,280 --> 07:26:41,760 INTERVENTIONS TO WORK TOGETHER 8795 07:26:41,760 --> 07:26:42,680 AND HAVING INDIGENOUS PEOPLE 8796 07:26:42,680 --> 07:26:44,760 LEAD THE PROCESS. 8797 07:26:44,760 --> 07:26:46,600 FINALLY, MY ANALYTICAL APPROACH 8798 07:26:46,600 --> 07:26:49,600 IS A POWER THEORY ONE. 8799 07:26:49,600 --> 07:26:51,920 I UNDERSTAND POWER AS BOTH 8800 07:26:51,920 --> 07:26:54,600 CONFLICT AND AGENCY. 8801 07:26:54,600 --> 07:26:56,360 AS CONFLICT I UNDERSTAND IT AS A 8802 07:26:56,360 --> 07:26:57,800 WAY TO GO INTO THE DECISION 8803 07:26:57,800 --> 07:27:00,120 MAKING PROCESSES AND IMPACT 8804 07:27:00,120 --> 07:27:01,240 HEALTH POLICY AND AS AGENCY WHEN 8805 07:27:01,240 --> 07:27:03,120 WE WORK WITH COMMUNITIES TO MAKE 8806 07:27:03,120 --> 07:27:04,800 THEM REALIZE THEY THEMSELVES ARE 8807 07:27:04,800 --> 07:27:06,440 POWER HOLDERS. 8808 07:27:06,440 --> 07:27:13,640 THANK YOU. 8809 07:27:13,640 --> 07:27:14,880 >>THANK YOU. 8810 07:27:14,880 --> 07:27:16,880 DR. PESANTES. 8811 07:27:16,880 --> 07:27:17,400 >>GOOD AFTERNOON. 8812 07:27:17,400 --> 07:27:18,880 I'M ALSO VERY PLEASED TO BE HERE 8813 07:27:18,880 --> 07:27:21,320 AND BE ABLE TO SHOW SOME OF THE 8814 07:27:21,320 --> 07:27:21,920 RESEARCH EXPERIENCE I HAVE 8815 07:27:21,920 --> 07:27:23,560 ACCOUPLE LATED MOSTLY WORKING 8816 07:27:23,560 --> 07:27:30,240 IN -- ACCUMULATED WORKING IN 8817 07:27:30,240 --> 07:27:30,440 PERU. 8818 07:27:30,440 --> 07:27:33,040 ACTUALLY, I CONDUCT RESEARCH 8819 07:27:33,040 --> 07:27:38,520 WITH TWO TYPES OF VULNERABLE 8820 07:27:38,520 --> 07:27:38,800 POPULATIONS. 8821 07:27:38,800 --> 07:27:40,320 I HAVE MY RESEARCH IN WORKING 8822 07:27:40,320 --> 07:27:46,520 WITH INDIGENOUS PEOPLE FROM THE 8823 07:27:46,520 --> 07:27:49,800 PERUVIAN AMAZON AND DEAL WITH 8824 07:27:49,800 --> 07:27:51,440 PEOPLE LIVING WITH CHRONIC 8825 07:27:51,440 --> 07:27:52,720 CONDITIONS SUCH AS DIABETES AND 8826 07:27:52,720 --> 07:27:54,040 HYPERTENSION AND SOME THAT ARE 8827 07:27:54,040 --> 07:28:00,360 THE RESULT OF INFECTIOUS 8828 07:28:00,360 --> 07:28:04,440 DISEASES AND WITHIN THE GROUP OF 8829 07:28:04,440 --> 07:28:07,800 PEOPLE LIVING WITH CHRONIC 8830 07:28:07,800 --> 07:28:09,480 CONDITIONS I AM INTERESTED IN 8831 07:28:09,480 --> 07:28:11,960 THE INTERSECTION OF MASCULINITY 8832 07:28:11,960 --> 07:28:15,960 AND HEALTH AND THERE'S NOT A LOT 8833 07:28:15,960 --> 07:28:16,400 OF IN LATIN AMERICA. 8834 07:28:16,400 --> 07:28:21,440 WITH INDIGENOUS PEOPLE MOST THE 8835 07:28:21,440 --> 07:28:31,920 RESEARCH AND LOOKING AT THE 8836 07:28:35,880 --> 07:28:36,800 INITIATIVES THAT INDIGENOUS 8837 07:28:36,800 --> 07:28:38,360 PEOPLE ARE THE DEVELOPING TO BE 8838 07:28:38,360 --> 07:28:39,920 ABLE TO ADDRESS THE CHALLENGES 8839 07:28:39,920 --> 07:28:44,920 TO MAKE THEIR MEDICAL SYSTEMS 8840 07:28:44,920 --> 07:28:47,040 RECOGNIZE AND ACCEPTED AND 8841 07:28:47,040 --> 07:28:52,480 INCORPORATED IN THE PUBLIC 8842 07:28:52,480 --> 07:28:54,840 HEALTH SERVICES AND INTERESTED 8843 07:28:54,840 --> 07:28:57,280 IN UNDERSTANDING THE POLICIES 8844 07:28:57,280 --> 07:29:03,280 AND HOW THEY ARE RELEVANT FOR 8845 07:29:03,280 --> 07:29:04,120 ENGAGING WITH THE WAY THE 8846 07:29:04,120 --> 07:29:05,600 INDIGENOUS PEOPLE FRAME THEIR 8847 07:29:05,600 --> 07:29:06,280 DEMANDS. 8848 07:29:06,280 --> 07:29:11,720 IN TERMS OF THE RESEARCH WITH 8849 07:29:11,720 --> 07:29:15,440 PEOPLE WITH DIABETES I ALSO AM 8850 07:29:15,440 --> 07:29:19,720 AN ANTHROPOLOGIST AND FIRST I 8851 07:29:19,720 --> 07:29:22,520 LOOK AT THE EXPERIENCES OF 8852 07:29:22,520 --> 07:29:25,000 MANAGING DIABETES AND MORE FROM 8853 07:29:25,000 --> 07:29:26,080 THE PERSPECTIVE OF HOW THEIR 8854 07:29:26,080 --> 07:29:30,680 LIVES ARE DISRUPTED AND HOW THEY 8855 07:29:30,680 --> 07:29:32,000 HAVE TO CHANGE THE WAY THEY 8856 07:29:32,000 --> 07:29:33,480 THINK ABOUT THEMSELVES AND THE 8857 07:29:33,480 --> 07:29:36,000 RELATIONSHIP WITH THEIR FAMILIES 8858 07:29:36,000 --> 07:29:36,960 AND IT'S IMPORTANT TO 8859 07:29:36,960 --> 07:29:39,680 INFORMATION THE EXPERIENCES ARE 8860 07:29:39,680 --> 07:29:42,200 FRAMED BY THE FACT THE HEALTH 8861 07:29:42,200 --> 07:29:43,960 SYSTEM IS NOT REALLY PREPARED TO 8862 07:29:43,960 --> 07:29:47,480 ADDRESS THE NEEDS OF PEOPLE WITH 8863 07:29:47,480 --> 07:29:48,560 CHRONIC CONDITIONS BECAUSE MOST 8864 07:29:48,560 --> 07:29:50,440 THE PUBLIC HEALTH BUDGET AND 8865 07:29:50,440 --> 07:29:55,600 PRIORITIES ARE MATERNAL HEALTH 8866 07:29:55,600 --> 07:29:56,840 OR INFECTIOUS CONDITIONS. 8867 07:29:56,840 --> 07:30:00,280 THAT FRAMES THE EXPERIENCE. 8868 07:30:00,280 --> 07:30:01,880 MY RESEARCH WAS GEARED TOWARDS 8869 07:30:01,880 --> 07:30:04,480 THE HEALTH SYSTEMS APPROACH. 8870 07:30:04,480 --> 07:30:07,520 THAT'S SOMETHING THAT IS HAS 8871 07:30:07,520 --> 07:30:08,600 OPENED A LOT OF MY VIEWS ABOUT 8872 07:30:08,600 --> 07:30:11,600 THE IMPORTANCE OF HAVING A 8873 07:30:11,600 --> 07:30:15,080 BETTER SENSE OF THE CONTEXTUAL 8874 07:30:15,080 --> 07:30:17,760 FACTORS THAT ALSO CONSTRAIN NOT 8875 07:30:17,760 --> 07:30:19,680 ONLY PATIENTS BUT AFFECT THE 8876 07:30:19,680 --> 07:30:21,040 HEALTH CARE PROVIDER AND HOW 8877 07:30:21,040 --> 07:30:25,880 THEY CAN PROVIDER CARE AND THEY 8878 07:30:25,880 --> 07:30:30,520 WANT TO PROVIDE NOT ALWAYS 8879 07:30:30,520 --> 07:30:31,160 UNDERSTANDING THE POLICIES IN 8880 07:30:31,160 --> 07:30:34,880 PLACE AND WHETHER DIABETES IS A 8881 07:30:34,880 --> 07:30:36,320 PRIORITY ARE NOT FOR THE 8882 07:30:36,320 --> 07:30:43,880 MINISTRY OF HEALTH OR NOT AND 8883 07:30:43,880 --> 07:30:45,320 WHAT KIND OF TRAINING THEY 8884 07:30:45,320 --> 07:30:46,680 RECEIVE IN SCHOOL AND WHAT IS 8885 07:30:46,680 --> 07:30:47,720 AVAILABLE FOR PATIENTS AND 8886 07:30:47,720 --> 07:30:51,520 MEDICATIONS AVAILABLE FOR THE 8887 07:30:51,520 --> 07:30:53,120 PATIENTS. 8888 07:30:53,120 --> 07:30:55,800 THAT'S THE APPROACH I'M USING 8889 07:30:55,800 --> 07:30:58,640 AND HAVING THE COMPREHENSIVE 8890 07:30:58,640 --> 07:31:00,320 VIEW OF THE HEALTH SYSTEM TO 8891 07:31:00,320 --> 07:31:02,560 BETTER UNDERSTAND WHERE HEALTH 8892 07:31:02,560 --> 07:31:07,680 CARE WORKERS COME FROM AND THE 8893 07:31:07,680 --> 07:31:09,280 EXPERIENCE OF PATIENTS THAT IS 8894 07:31:09,280 --> 07:31:12,000 NOT ALWAYS WELCOME IN HEALTH 8895 07:31:12,000 --> 07:31:13,880 CARE SERVICES. 8896 07:31:13,880 --> 07:31:14,200 THANK YOU. 8897 07:31:14,200 --> 07:31:15,800 >>THANK YOU FOR DESCRIBING YOUR 8898 07:31:15,800 --> 07:31:16,360 RESEARCH PROGRAM. 8899 07:31:16,360 --> 07:31:19,760 IT'S NICE HOW YOU THREE ARE 8900 07:31:19,760 --> 07:31:22,360 COMPLIMENTARY AND HOW 8901 07:31:22,360 --> 07:31:23,520 COMPREHENSIVE AND THE DIFFERENT 8902 07:31:23,520 --> 07:31:25,160 DOMAINS YOU ADDRESS. 8903 07:31:25,160 --> 07:31:25,560 CONGRATULATIONS. 8904 07:31:25,560 --> 07:31:29,360 WE'LL MOVE TO THE FIRST ROUND OF 8905 07:31:29,360 --> 07:31:30,560 QUESTIONS AND WE HAVE INTEREST 8906 07:31:30,560 --> 07:31:31,520 IN TWO TOPICS. 8907 07:31:31,520 --> 07:31:34,000 I'M GOING TO MERGE THEM. 8908 07:31:34,000 --> 07:31:39,960 THE QUESTION IS WHETHER THE 8909 07:31:39,960 --> 07:31:49,640 MEND -- METHODOLOGICAL STRUCTURE 8910 07:31:49,640 --> 07:31:54,000 CHANGES WITH DIFFERENT 8911 07:31:54,000 --> 07:31:56,360 POPULATIONS. 8912 07:31:56,360 --> 07:31:58,600 DR. PESANTES. 8913 07:31:58,600 --> 07:32:09,160 >>COMING FROM MY VIEW POINT YOU 8914 07:32:13,000 --> 07:32:14,280 NEED A SENSE OF THE POPULATION 8915 07:32:14,280 --> 07:32:17,520 YOU'RE WORKING WITH AND THAT 8916 07:32:17,520 --> 07:32:22,760 MEANS TIME OR HAVING 8917 07:32:22,760 --> 07:32:28,360 INTERACTIONS WITH THE POPULATION 8918 07:32:28,360 --> 07:32:32,880 AND I THINK WORKING WITH 8919 07:32:32,880 --> 07:32:34,200 INDIGENOUS PEOPLE ONE OF THE 8920 07:32:34,200 --> 07:32:36,800 THINGS THAT IS ESSENTIAL FOR 8921 07:32:36,800 --> 07:32:40,320 DOING RESEARCH WITH THEM IS TO 8922 07:32:40,320 --> 07:32:45,080 BE AWARE OF THE ORGANIZATION 8923 07:32:45,080 --> 07:32:46,760 THAT THEY OPERATE UNDER. 8924 07:32:46,760 --> 07:32:52,080 FOR EXAMPLE, IN THE PERUVIAN 8925 07:32:52,080 --> 07:32:52,920 AMAZON THERE'S DIFFERENT 8926 07:32:52,920 --> 07:32:56,680 ORGANIZATIONS. 8927 07:32:56,680 --> 07:32:58,000 IF YOUR GOING TO GO AND 8928 07:32:58,000 --> 07:32:58,960 INTERESTED IN DOING RESEARCH 8929 07:32:58,960 --> 07:33:01,600 WITH THEM YOU NEED TO OBTAIN THE 8930 07:33:01,600 --> 07:33:08,320 NECESSARY PERMISSIONS TO MAKE 8931 07:33:08,320 --> 07:33:10,600 SURE THEY'RE AWARE OF YOUR AND 8932 07:33:10,600 --> 07:33:12,840 CREATE A SPACE WHERE YOU CAN 8933 07:33:12,840 --> 07:33:18,240 RECEIVE THE OPINIONS EVEN IF 8934 07:33:18,240 --> 07:33:22,560 IT'S CRITICAL AND HAVING A SPACE 8935 07:33:22,560 --> 07:33:28,640 IN WHICH YOU UNDERSTAND IN WHAT 8936 07:33:28,640 --> 07:33:30,600 WAYS CAN YOU SHARE RESULTS OR 8937 07:33:30,600 --> 07:33:32,720 THINGS YOU CAN DO. 8938 07:33:32,720 --> 07:33:33,560 SOMETIMES THERE'S CONSTRAINTS 8939 07:33:33,560 --> 07:33:35,200 BUT I THINK IT'S IMPORTANT FOR 8940 07:33:35,200 --> 07:33:37,160 RESEARCHERS WORKING WITH THIS 8941 07:33:37,160 --> 07:33:39,160 KIND OF POPULATIONS TO FIND 8942 07:33:39,160 --> 07:33:44,120 SPACES FOR FLEXIBILITY AND 8943 07:33:44,120 --> 07:33:46,720 ADVOCATE FOR THAT WITH FUNDING 8944 07:33:46,720 --> 07:33:48,160 AGENCIES BECAUSE IT'S IMPORTANT 8945 07:33:48,160 --> 07:33:54,760 TO MEET PEOPLE HALFWAY. 8946 07:33:54,760 --> 07:34:03,760 SOMETIMES WE'VE ALLOCATED INTO 8947 07:34:03,760 --> 07:34:05,920 TRANSLATING OR POLICY BRIEFS 8948 07:34:05,920 --> 07:34:06,560 GEARED TOWARDS ANOTHER 8949 07:34:06,560 --> 07:34:08,320 STAKEHOLDER AND IF THERE'S ONE 8950 07:34:08,320 --> 07:34:15,000 FOR INDIGENOUS PEOPLE TO SUPPORT 8951 07:34:15,000 --> 07:34:16,320 THEIR ABILITIES LET'S DO IT THE 8952 07:34:16,320 --> 07:34:17,040 BEST WAY POSSIBLE. 8953 07:34:17,040 --> 07:34:21,240 THAT'S SOME OF THE MOST 8954 07:34:21,240 --> 07:34:24,200 IMPORTANT CONSIDERATION AND TO 8955 07:34:24,200 --> 07:34:25,320 BE CAREFUL IN LATIN AMERICA AND 8956 07:34:25,320 --> 07:34:27,000 THIS APPLIES TO OTHER SITUATIONS 8957 07:34:27,000 --> 07:34:32,600 NOT TO GROUP TOGETHER VULNERABLE 8958 07:34:32,600 --> 07:34:33,920 PEOPLE. 8959 07:34:33,920 --> 07:34:36,200 YOU NEED TO BE AWARE THERE'S 8960 07:34:36,200 --> 07:34:39,040 DIFFERENT HISTORIES OF 8961 07:34:39,040 --> 07:34:41,160 MARGINALIZATION AND THEY HAVE 8962 07:34:41,160 --> 07:34:44,480 DIFFERENT WAYS OF FRAMING HEALTH 8963 07:34:44,480 --> 07:34:46,080 NEEDS AND AND YOU NEED TO BE 8964 07:34:46,080 --> 07:34:47,560 SENSITIVE TO THOSE DIFFERENCES 8965 07:34:47,560 --> 07:34:49,080 BECAUSE OFTEN TIMES PEOPLE SAY 8966 07:34:49,080 --> 07:34:53,600 I'M GOING TO DO AN INTERVENTION 8967 07:34:53,600 --> 07:34:55,200 WITH VULNERABLE PEOPLE AND YOU 8968 07:34:55,200 --> 07:34:57,040 HAVE A BLANKET IDEA AND IT'S 8969 07:34:57,040 --> 07:34:58,440 IMPORTANT TO PAY ATTENTION TO 8970 07:34:58,440 --> 07:35:02,480 THE DIFFERENCES IN THE LATIN 8971 07:35:02,480 --> 07:35:03,720 AMERICA CONTEXT OF DIFFERENT 8972 07:35:03,720 --> 07:35:09,320 VULNERABLE GROUPS AND ETHNIC 8973 07:35:09,320 --> 07:35:19,520 MINORITIES. 8974 07:35:32,440 --> 07:35:36,920 AND I SHARE THE LANGUAGE IN MANY 8975 07:35:36,920 --> 07:35:39,080 CASES AND MY FIRST LANGUAGE IS 8976 07:35:39,080 --> 07:35:42,520 SPANISH BUT I'M FROM SPAIN AND I 8977 07:35:42,520 --> 07:35:45,240 LOOK VERY DIFFERENT FROM MANY 8978 07:35:45,240 --> 07:35:47,120 PEOPLE WITH WHOM I WORK IN THE 8979 07:35:47,120 --> 07:35:49,240 CARIBBEAN FOR EXAMPLE IN 8980 07:35:49,240 --> 07:35:52,360 SPANISH-SPEAKING CARIBBEAN AND I 8981 07:35:52,360 --> 07:35:54,560 UNDERSTAND THAT I ALSO ARE COME 8982 07:35:54,560 --> 07:35:58,480 FROM MY U.S.-BASED INSTITUTION 8983 07:35:58,480 --> 07:36:00,360 I'M OFTEN PERCEIVED AS A PERSON 8984 07:36:00,360 --> 07:36:01,240 OF PRIVILEGE AND PAY ATTENTION 8985 07:36:01,240 --> 07:36:10,720 TO THAT INTERACTION. 8986 07:36:10,720 --> 07:36:13,520 I ALSO PAY ATTENTION TO THE ROLE 8987 07:36:13,520 --> 07:36:18,320 WOMEN HAVE IN SOCIETY AND FOR 8988 07:36:18,320 --> 07:36:19,720 EXAMPLE IN LATIN AMERICA I HAVE 8989 07:36:19,720 --> 07:36:22,000 OBSERVED ONCE A WOMAN GIVES 8990 07:36:22,000 --> 07:36:28,800 BIRTH SHE'S PLACED TO A 8991 07:36:28,800 --> 07:36:31,160 SECONDARY ROLE IN THE CONTINUUM 8992 07:36:31,160 --> 07:36:33,240 OF CARE THOUGH POSTPARTUM IS 8993 07:36:33,240 --> 07:36:36,120 IMPORTANT FOR SURVIVAL AND 8994 07:36:36,120 --> 07:36:39,880 INCLUDING IN UNITED STATES THE 8995 07:36:39,880 --> 07:36:41,000 REPRODUCTIVE RIGHTS OF WOMEN ARE 8996 07:36:41,000 --> 07:36:46,400 SHAPED BY OTHERS AND IT'S VERY 8997 07:36:46,400 --> 07:36:56,880 IMPORTANT I AM AWARE OF THE 8998 07:36:57,800 --> 07:37:02,720 RIGHTS OF PEOPLE AND NEED TO 8999 07:37:02,720 --> 07:37:04,480 NAVIGATE THAT AND I CAN PROVIDE 9000 07:37:04,480 --> 07:37:08,280 EXAMPLES HOW I HAVE DEALT WITH 9001 07:37:08,280 --> 07:37:10,840 ISSUES OF TRAUMA OR VIOLENCE BY 9002 07:37:10,840 --> 07:37:12,440 STUDY PARTICIPANTS. 9003 07:37:12,440 --> 07:37:20,720 FOR EXAMPLE, I HAVE CONDUCT ED 9004 07:37:20,720 --> 07:37:23,480 INTERVIEWS WITH WOMEN AND MEN 9005 07:37:23,480 --> 07:37:28,360 SUCH AS HIV FOR EXAMPLE IN 9006 07:37:28,360 --> 07:37:30,040 SETTINGS OF LIMA AND THOUGH I 9007 07:37:30,040 --> 07:37:35,200 WASN'T DIRECTLY ASKING THEM 9008 07:37:35,200 --> 07:37:37,200 ABOUT THEIR ENCOUNTERS WITH 9009 07:37:37,200 --> 07:37:38,400 VIOLENCE I HAVE SHOWN INTEREST 9010 07:37:38,400 --> 07:37:41,040 IN INTERVIEWING PEOPLE AND I 9011 07:37:41,040 --> 07:37:43,640 THINK THE FACT I HAVE SHOWN 9012 07:37:43,640 --> 07:37:45,240 GENUINE INTEREST IN 9013 07:37:45,240 --> 07:37:47,120 UNDERSTANDING THE LIFE 9014 07:37:47,120 --> 07:37:48,760 TRAJECTORY HAS ALLOWED THEM TO 9015 07:37:48,760 --> 07:37:54,240 SHARE WITH ME LOTS OF INSTANCES 9016 07:37:54,240 --> 07:37:55,120 OF HAVING SUFFERED VIOLENCE FROM 9017 07:37:55,120 --> 07:37:55,680 CLOSE FAMILY MEMBERS, FOR 9018 07:37:55,680 --> 07:38:02,160 EXAMPLE. 9019 07:38:02,160 --> 07:38:07,240 THAT WAS A TIME WHEN I WAS 9020 07:38:07,240 --> 07:38:09,360 HELPING PEOPLE WITH INFECTIOUS 9021 07:38:09,360 --> 07:38:12,400 DISEASE AND THERE WERE TIMES IT 9022 07:38:12,400 --> 07:38:16,680 WAS PREVALENT EVEN WHEN IT 9023 07:38:16,680 --> 07:38:17,880 WASN'T IN MY STRUCTURED 9024 07:38:17,880 --> 07:38:23,360 QUESTIONS BUT CAME OUT OFTEN AND 9025 07:38:23,360 --> 07:38:29,360 WHEN IT HAPPENS AND MORE 9026 07:38:29,360 --> 07:38:39,680 DIFFICULT FOR THEM AND IT'S 9027 07:38:39,680 --> 07:38:41,120 IMPORTANT WE SHOW EMPATHY AND 9028 07:38:41,120 --> 07:38:43,480 I'M NOT A ROBOT AND IT'S 9029 07:38:43,480 --> 07:38:45,160 IMPORTANT THAT WE SHOW 9030 07:38:45,160 --> 07:38:46,320 PARTICIPANTS WE CARE ABOUT THEM 9031 07:38:46,320 --> 07:38:51,520 AND WHY WE DO RESEARCH. 9032 07:38:51,520 --> 07:38:54,120 IT DIDN'T HURT THE RESEARCH 9033 07:38:54,120 --> 07:38:55,960 OUTCOMES TO SHOW EMPATHY FOR THE 9034 07:38:55,960 --> 07:38:58,160 PEOPLE WE STUDY. 9035 07:38:58,160 --> 07:39:01,400 IN THE DOMINICAN REPUBLIC I PLAN 9036 07:39:01,400 --> 07:39:04,080 TO USE FOR THE FIRST TIME 9037 07:39:04,080 --> 07:39:09,440 COMPUTER-ASSISTED INTERVIEWS. 9038 07:39:09,440 --> 07:39:18,360 WE AND WE HAVE WE ARE STUDYING 9039 07:39:18,360 --> 07:39:21,440 DIFFERENT FACTORS ASSOCIATED 9040 07:39:21,440 --> 07:39:22,440 WITH EARLY CHILDHOOD DELAY IN 9041 07:39:22,440 --> 07:39:24,880 THE CONTEXT OF POVERTY AND WE'RE 9042 07:39:24,880 --> 07:39:29,920 PLANNING TO VISIT PEOPLE IN 9043 07:39:29,920 --> 07:39:40,440 THEIR HOMES WE WANT TO TEST A 9044 07:39:46,080 --> 07:39:50,800 TABLET WHICH HAS CONNECTED WITH 9045 07:39:50,800 --> 07:39:56,080 HEADSETS SO NOBODY ELSE IS 9046 07:39:56,080 --> 07:40:00,560 LISTENING TO THE QUESTIONS AND 9047 07:40:00,560 --> 07:40:04,200 TAKING INTO ACCOUNT THE SETTINGS 9048 07:40:04,200 --> 07:40:06,480 OF POVERTY SO THE WOMEN CAN 9049 07:40:06,480 --> 07:40:11,680 LISTEN TO THE QUESTIONS IN WAYS 9050 07:40:11,680 --> 07:40:17,880 THAT ARE EASY TO PROVIDE HER 9051 07:40:17,880 --> 07:40:19,240 RESPONSES. 9052 07:40:19,240 --> 07:40:24,400 WE ARE PRESERVING THE 9053 07:40:24,400 --> 07:40:28,040 CONFIDENTIALITY OF HER RESPONSES 9054 07:40:28,040 --> 07:40:29,440 EVEN IF SHE'S SURROUNDED BY 9055 07:40:29,440 --> 07:40:33,000 OTHERS AND I THINK IT'S A GOOD 9056 07:40:33,000 --> 07:40:34,840 APPROACH TO PREVENT THEM FROM 9057 07:40:34,840 --> 07:40:36,680 BEING FRIGHTENED BY FAMILY 9058 07:40:36,680 --> 07:40:40,000 MEMBERS WHO MAY FIND OUT THEY 9059 07:40:40,000 --> 07:40:44,640 SHARED INSTANCES OF VIOLENCE AND 9060 07:40:44,640 --> 07:40:47,160 WE'RE GOING TO TEST IT BUT IT'S 9061 07:40:47,160 --> 07:40:52,320 INTENDED TO OBTAIN THE 9062 07:40:52,320 --> 07:40:55,200 INFORMATION IN AN ENVIRONMENT 9063 07:40:55,200 --> 07:40:56,560 THAT PROVIDES THEM THE TRUST 9064 07:40:56,560 --> 07:41:01,080 THEY NEED TO SHARE SENSITIVE 9065 07:41:01,080 --> 07:41:01,440 INFORMATION. 9066 07:41:01,440 --> 07:41:06,520 IT'S IMPORTANT TO TAKE INTO 9067 07:41:06,520 --> 07:41:07,600 ACCOUNT CULTURE AND THE FACT 9068 07:41:07,600 --> 07:41:11,480 THAT PEOPLE WHO LIVE IN POVERTY 9069 07:41:11,480 --> 07:41:16,720 HAVE DIFFERENT NEEDS WE HAVE AS 9070 07:41:16,720 --> 07:41:18,640 RESEARCHERS AND WE NEED TO 9071 07:41:18,640 --> 07:41:19,720 UNDERSTAND WHERE THEY ARE TO 9072 07:41:19,720 --> 07:41:22,640 BETTER DO OUR RESEARCH. 9073 07:41:22,640 --> 07:41:29,200 >>THANK YOU. 9074 07:41:29,200 --> 07:41:31,080 >>UNLIKE MY COLLEAGUES IN THIS 9075 07:41:31,080 --> 07:41:32,840 SESSION I'M NOT AN 9076 07:41:32,840 --> 07:41:38,640 ANTHROPOLOGIST BUT I'M A 9077 07:41:38,640 --> 07:41:39,560 SOCIOLOGIST AND WORK WITH 9078 07:41:39,560 --> 07:41:40,480 POPULATIONS IN DIFFERENT WAYS. 9079 07:41:40,480 --> 07:41:42,920 I START MY APPROACH FROM A 9080 07:41:42,920 --> 07:41:43,440 DIFFERENT STANDPOINT. 9081 07:41:43,440 --> 07:41:50,280 TODAY I WOULD LIKE TO TALK ABOUT 9082 07:41:50,280 --> 07:41:57,760 FOUR METHODOLOGICAL CONDITIONS. 9083 07:41:57,760 --> 07:42:04,440 WHO AM I CONDUCTS THE RESEARCH 9084 07:42:04,440 --> 07:42:05,120 FOR? 9085 07:42:05,120 --> 07:42:08,320 THIS UNDERSTANDING REQUIRES A 9086 07:42:08,320 --> 07:42:11,360 GROUNDED COMPREHENSIVE CONTEXT 9087 07:42:11,360 --> 07:42:13,480 AND HOW THAT LED TO THE 9088 07:42:13,480 --> 07:42:14,200 VULNERABILITY AND THE EXCLUSION 9089 07:42:14,200 --> 07:42:14,840 OF THE POPULATIONS THAT I WORK 9090 07:42:14,840 --> 07:42:18,640 WITH. 9091 07:42:18,640 --> 07:42:20,760 ALSO WHEN I ASK MYSELF WHO IS 9092 07:42:20,760 --> 07:42:23,920 THE RESEARCH FOR IT HELPS ME 9093 07:42:23,920 --> 07:42:25,200 UNDERSTAND THE PYRAMID OF 9094 07:42:25,200 --> 07:42:26,360 EVIDENCE AND SOMETHING 9095 07:42:26,360 --> 07:42:28,040 SOCIOLOGISTS AND PUBLIC HEALTH 9096 07:42:28,040 --> 07:42:29,360 PEOPLE HEADLINE ON TO TIGHTLY 9097 07:42:29,360 --> 07:42:32,960 MAY NOT BE THE BEST THING TO 9098 07:42:32,960 --> 07:42:34,400 GUARD MY RESEARCH. 9099 07:42:34,400 --> 07:42:35,800 FOR MY SECOND CONSIDERATION, IF 9100 07:42:35,800 --> 07:42:37,520 MY RESEARCH IS FOR COMMUNITY, 9101 07:42:37,520 --> 07:42:40,040 THEN HOW DO I RESEARCH WHAT THEY 9102 07:42:40,040 --> 07:42:42,560 NEED TO KNOW? 9103 07:42:42,560 --> 07:42:44,160 HOW DO I COME TO AN 9104 07:42:44,160 --> 07:42:46,240 UNDERSTANDING OF WHAT MATTERS TO 9105 07:42:46,240 --> 07:42:50,080 THEM AND THIS REQUIRES BUILDING 9106 07:42:50,080 --> 07:42:51,600 LONG-STANDING RELATIONSHIPS 9107 07:42:51,600 --> 07:42:53,720 BASED ON TRUST WHERE I'M NOT 9108 07:42:53,720 --> 07:42:54,680 APPROACHING THE WORK AS AN 9109 07:42:54,680 --> 07:42:59,200 EXPERT BUT MORE AS THE PERSON 9110 07:42:59,200 --> 07:43:00,760 COMING TO AN UNDERSTANDING TO 9111 07:43:00,760 --> 07:43:02,320 GET THE EXCLUSION AND 9112 07:43:02,320 --> 07:43:02,960 VULNERABILITIES THAT AFFECT THEM 9113 07:43:02,960 --> 07:43:08,520 AND HOW THEY CAN WORK WITH THEM 9114 07:43:08,520 --> 07:43:16,120 OR UNDERSTAND THEM TO GAIN 9115 07:43:16,120 --> 07:43:17,880 HIGHER LEVELS OF POLITICAL 9116 07:43:17,880 --> 07:43:21,280 CONSCI 9117 07:43:21,280 --> 07:43:21,680 CONSCIOUSNESS. 9118 07:43:21,680 --> 07:43:22,680 MY THIRD CONSIDERATION IS HOW 9119 07:43:22,680 --> 07:43:25,080 CAN COMMUNITIES DECIDE WHAT WE 9120 07:43:25,080 --> 07:43:28,520 NEED TO KNOW? 9121 07:43:28,520 --> 07:43:30,400 BECAUSE VULNERABLE COMMUNITIES 9122 07:43:30,400 --> 07:43:32,320 AGAIN THE EXAMPLE OF THE MAYA 9123 07:43:32,320 --> 07:43:37,560 DON'T HAVE ACCESS TO A LOT OF 9124 07:43:37,560 --> 07:43:39,040 EDUCATION THEY MAY NOT 9125 07:43:39,040 --> 07:43:39,840 UNDERSTAND WHAT I'M TRYING TO 9126 07:43:39,840 --> 07:43:41,400 FIND OUT AND SO HOW DO AN 9127 07:43:41,400 --> 07:43:43,400 APPROACH THIS IN A NON-CON DA 9128 07:43:43,400 --> 07:43:45,000 SENDING WAY? 9129 07:43:45,000 --> 07:43:47,720 HOW DO I BUILD THE SKILLS TO 9130 07:43:47,720 --> 07:43:49,240 COMMUNICATE WHAT MATTERS TO THEM 9131 07:43:49,240 --> 07:43:51,040 AND BUILD THE SKILLS INSIDE 9132 07:43:51,040 --> 07:43:53,880 MYSELF TO UNDERSTAND WHAT THEIR 9133 07:43:53,880 --> 07:43:57,240 WORK MEANS BECAUSE MAYBE THEY 9134 07:43:57,240 --> 07:44:00,600 DON'T KNOW HOW THIS AND IN OUR 9135 07:44:00,600 --> 07:44:03,920 WORK IN GUATEMALA WE FOUND 9136 07:44:03,920 --> 07:44:06,360 INDIGENOUS LANGUAGES DIDN'T HAVE 9137 07:44:06,360 --> 07:44:09,600 A WORD FOR RACISM OR ABUSE OR 9138 07:44:09,600 --> 07:44:11,160 DISCRIMINATION AND WE HAD TO 9139 07:44:11,160 --> 07:44:12,560 WORK WITH ANTHROPOLOGISTS TO 9140 07:44:12,560 --> 07:44:13,640 UNDERSTAND WHAT WORDS THEY USE 9141 07:44:13,640 --> 07:44:17,000 AND WHAT MATTERS TO THEM AND 9142 07:44:17,000 --> 07:44:19,000 BUILD CONSCIOUS NESS OF 9143 07:44:19,000 --> 07:44:23,960 UNDERSTANDING THEY'RE RIGHTS 9144 07:44:23,960 --> 07:44:26,200 HOLDERS AND IN THAT WAY WE COME 9145 07:44:26,200 --> 07:44:28,280 TO UNDERSTAND WHAT MATTERS MOST 9146 07:44:28,280 --> 07:44:31,440 TO THE COMMUNITY. 9147 07:44:31,440 --> 07:44:36,680 MY THIRD METHODOLOGICAL 9148 07:44:36,680 --> 07:44:37,640 CONSIDERATION IS HOW CAN WE 9149 07:44:37,640 --> 07:44:38,960 BUILD THE KNOWLEDGE AND MY 9150 07:44:38,960 --> 07:44:42,160 FOURTH, HOW CAN WE AFFORD 9151 07:44:42,160 --> 07:44:44,360 AWKWARD ACCOUNTABILITY TRAPS AND 9152 07:44:44,360 --> 07:44:45,160 GENERATING THE KIND OF KNOWLEDGE 9153 07:44:45,160 --> 07:44:49,480 ONLY USEFUL TO MY FUNDER OR TO 9154 07:44:49,480 --> 07:44:52,880 THE EDITORS FOR THE JOURNAL I'M 9155 07:44:52,880 --> 07:44:54,240 WRITING FOR OR PEERS AND THAT'S 9156 07:44:54,240 --> 07:44:56,560 NOT USEFUL FOR THE COMMUNITIES 9157 07:44:56,560 --> 07:44:58,320 I'M RESEARCH. 9158 07:44:58,320 --> 07:45:01,840 HOW CAN I PRODUCE ACTIONABLE 9159 07:45:01,840 --> 07:45:02,080 KNOWLEDGE. 9160 07:45:02,080 --> 07:45:07,720 NOT FOR ME TO PUBLISH BUT 9161 07:45:07,720 --> 07:45:08,600 PRODUCE INFORMATION USEFUL FOR 9162 07:45:08,600 --> 07:45:10,320 THEM IN THE BATTLES THEY HAVE TO 9163 07:45:10,320 --> 07:45:11,720 CONFRONT WHEN THEY'RE TRYING TO 9164 07:45:11,720 --> 07:45:13,640 GOOD QUALITY CARE AND TRYING TO 9165 07:45:13,640 --> 07:45:16,040 APPROVE A CULTURALLY INSENSITIVE 9166 07:45:16,040 --> 07:45:16,680 HEALTH SYSTEM? 9167 07:45:16,680 --> 07:45:17,960 WHEN THEY'RE OUTSIDE THEIR 9168 07:45:17,960 --> 07:45:19,960 CULTURAL SYSTEM EVEN OUTSIDE OF 9169 07:45:19,960 --> 07:45:21,120 GUATEMALA, WHAT IS THE KNOWLEDGE 9170 07:45:21,120 --> 07:45:25,960 WE NEED TO GENERATE FOR THEM TO 9171 07:45:25,960 --> 07:45:27,320 TRANSLATE THE KNOWLEDGE INTO 9172 07:45:27,320 --> 07:45:28,320 ACTION AND IMPACT HEALTH POLICY 9173 07:45:28,320 --> 07:45:30,640 BECAUSE AT THE END OF THE DAY 9174 07:45:30,640 --> 07:45:32,040 EVERYONE AS THE IN PUBLIC HEALTH 9175 07:45:32,040 --> 07:45:34,680 OR GLOBAL HEALTH IS TRYING TO 9176 07:45:34,680 --> 07:45:38,360 GET SOME SORT OF INFLUENCE OR 9177 07:45:38,360 --> 07:45:39,400 IMPACT INTO POLICY. 9178 07:45:39,400 --> 07:45:41,200 DO I WANT TO IMPACT BECAUSE I 9179 07:45:41,200 --> 07:45:42,560 HAVE MY OWN AGENDA OR UNDERSTAND 9180 07:45:42,560 --> 07:45:44,120 WHAT THE AGENDA OF THE 9181 07:45:44,120 --> 07:45:45,120 COMMUNITIES I RESEARCH IN ARE 9182 07:45:45,120 --> 07:45:47,640 AND HOW CAN I HIGHLIGHT THAT AND 9183 07:45:47,640 --> 07:45:50,400 HOW CAIN GIVE INFORMATION THEY 9184 07:45:50,400 --> 07:45:52,320 CAN ACT UPON? 9185 07:45:52,320 --> 07:45:57,600 THANK YOU. 9186 07:45:57,600 --> 07:45:59,920 >>THANK YOU FOR SHARING YOUR 9187 07:45:59,920 --> 07:46:01,400 SYSTEMATIC APPROACH. 9188 07:46:01,400 --> 07:46:06,840 WE'LL SWITCH FLNOW TO INDEPENDE 9189 07:46:06,840 --> 07:46:07,120 QUESTIONS. 9190 07:46:07,120 --> 07:46:17,440 DR. RUE -- RUANO. 9191 07:46:24,360 --> 07:46:30,200 >>THE POPULATIONS IN THE UNITED 9192 07:46:30,200 --> 07:46:34,640 STATES, MIGRANTS ARE BEING 9193 07:46:34,640 --> 07:46:37,280 PUSHED INTO SECOND TIER AND 9194 07:46:37,280 --> 07:46:37,920 THIRD-TIER CITIES THAT DON'T 9195 07:46:37,920 --> 07:46:39,560 HAVE THE RESOURCES OR CAPACITY 9196 07:46:39,560 --> 07:46:40,880 TO PROVIDE CARE TO THE 9197 07:46:40,880 --> 07:46:42,480 VULNERABLE PEOPLE COMING FROM 9198 07:46:42,480 --> 07:46:44,840 RURAL AREAS THAT HAVE NEVER BEEN 9199 07:46:44,840 --> 07:46:48,680 IN AN URBAN AREA AND THIS 9200 07:46:48,680 --> 07:46:49,960 DISASSOCIATES THEM FROM THEIR 9201 07:46:49,960 --> 07:46:51,320 CULTURE AND CULTURAL BELIEFS 9202 07:46:51,320 --> 07:46:53,400 WHILE THERE'S FORCES HAPPENING 9203 07:46:53,400 --> 07:46:56,320 THAT ARE PUSHING THE PEOPLE IN 9204 07:46:56,320 --> 07:46:58,800 THOSE SECOND AND THIRD-TIER 9205 07:46:58,800 --> 07:47:00,240 CITIES INTO FIRST-TIER CITIES. 9206 07:47:00,240 --> 07:47:01,640 THEY'RE NOT PREPARED AND DON'T 9207 07:47:01,640 --> 07:47:06,440 HAVE SOCIAL CAPITAL OR CULTURAL 9208 07:47:06,440 --> 07:47:07,880 CAPITAL AND SO WHAT DO WE HAVE 9209 07:47:07,880 --> 07:47:09,440 TO DO TO UNDERSTAND THE 9210 07:47:09,440 --> 07:47:10,760 RESOURCES WE NEED AND 9211 07:47:10,760 --> 07:47:14,320 EXPERIENCES OF THEIR OWN 9212 07:47:14,320 --> 07:47:14,640 POPULATIONS. 9213 07:47:14,640 --> 07:47:17,360 THE MOST VULNERABLE GO TO PLACES 9214 07:47:17,360 --> 07:47:18,720 THAT HAVE NOTHING FOR THEM 9215 07:47:18,720 --> 07:47:19,760 BECAUSE THE PEOPLE IN THOSE 9216 07:47:19,760 --> 07:47:25,120 CITIES ALREADY LEFT. 9217 07:47:25,120 --> 07:47:33,000 HOW CAN WE BUILD LANGUAGE AND 9218 07:47:33,000 --> 07:47:36,320 CULTURAL SKILLS AND THAT'S NOT 9219 07:47:36,320 --> 07:47:41,680 HOUSING OR SCHOOLS OR JOBS FOR 9220 07:47:41,680 --> 07:47:44,880 THE SKILLS THEY HAVE AND THERE'S 9221 07:47:44,880 --> 07:47:48,320 ILLEGAL CHARGES IN GUATEMALA AND 9222 07:47:48,320 --> 07:47:50,680 SERVICES AREN'T FREE AT THE 9223 07:47:50,680 --> 07:47:52,000 POINT OF SERVICE IN THE UNITED 9224 07:47:52,000 --> 07:47:54,120 STATES EITHER. 9225 07:47:54,120 --> 07:47:56,480 THESE TURN INTO BIG CHALLENGES 9226 07:47:56,480 --> 07:47:59,360 FOR THE PROVIDERS AND HOW DO WE 9227 07:47:59,360 --> 07:48:00,720 MAKE HEALTH SYSTEMS MORE 9228 07:48:00,720 --> 07:48:01,880 RESPONSIVE AND WE NEED TO 9229 07:48:01,880 --> 07:48:03,720 UNDERSTAND HOW THE BARRIERS FEEL 9230 07:48:03,720 --> 07:48:06,440 TO THE MIGRANTS LEAVING THESE 9231 07:48:06,440 --> 07:48:11,760 TRADITIONAL CONTEXT AND ALL OF A 9232 07:48:11,760 --> 07:48:12,600 SUDDEN ARE STUCK IN THE WHERE 9233 07:48:12,600 --> 07:48:16,240 WE'RE ALL COHORTED AND NO LONGER 9234 07:48:16,240 --> 07:48:18,440 IN MULTI-GENERATIONAL 9235 07:48:18,440 --> 07:48:19,000 HOUSEHOLDS. 9236 07:48:19,000 --> 07:48:20,040 LEARNING DOESN'T HAPPEN IN THE 9237 07:48:20,040 --> 07:48:25,160 HOUSEHOLD BUT OUTSIDE THE 9238 07:48:25,160 --> 07:48:25,520 SCHOOL? 9239 07:48:25,520 --> 07:48:30,720 HOW DOES THAT STRUCTURE CHANGE 9240 07:48:30,720 --> 07:48:36,160 AND IMPACT THE VALUES OF THE 9241 07:48:36,160 --> 07:48:39,720 CULTURES. 9242 07:48:39,720 --> 07:48:41,920 >>WE'LL SWITCH TO DR. PESANTES. 9243 07:48:41,920 --> 07:48:43,840 THE QUESTION IS WHAT ARE CHANGES 9244 07:48:43,840 --> 07:48:46,560 THAT COULD BE INTRODUCED TO 9245 07:48:46,560 --> 07:48:47,360 REDUCE GAPS IN HEALTH CARE 9246 07:48:47,360 --> 07:48:47,640 ACCESS? 9247 07:48:47,640 --> 07:48:49,440 >>I'M GOING TO MAKE A 9248 07:48:49,440 --> 07:48:52,120 CONNECTION BETWEEN WHAT I WAS 9249 07:48:52,120 --> 07:48:56,320 TALKING ABOUT EARLIER ABOUT THE 9250 07:48:56,320 --> 07:48:59,680 DIFFERENT WAYS I WAS DOING DOING 9251 07:48:59,680 --> 07:49:00,560 RESEARCH WITH PEOPLE WITH 9252 07:49:00,560 --> 07:49:05,240 CHRONIC CONDITIONS. 9253 07:49:05,240 --> 07:49:07,360 I MOVED FROM FOCUSSING ON 9254 07:49:07,360 --> 07:49:08,960 EXPERIENCES AND MANAGING HEALTH 9255 07:49:08,960 --> 07:49:10,840 CONDITION AND THE INTERACTION 9256 07:49:10,840 --> 07:49:13,240 WITH THE HEALTH SYSTEM AND THEN 9257 07:49:13,240 --> 07:49:14,800 IT TOOK ME TO HAVING THE 9258 07:49:14,800 --> 07:49:16,000 APPROACH OF UNDERSTANDING THE 9259 07:49:16,000 --> 07:49:17,720 HEALTH SYSTEM AS A WHOLE. 9260 07:49:17,720 --> 07:49:20,320 AND I THINK ONE OF THE THINGS I 9261 07:49:20,320 --> 07:49:22,160 HAVE LEARNED IN THE PROCESS IS 9262 07:49:22,160 --> 07:49:24,560 THAT WE NEED TO UNDERSTAND THE 9263 07:49:24,560 --> 07:49:26,520 CONTEXT IN WHICH HEALTH SERVICES 9264 07:49:26,520 --> 07:49:28,280 THE HEALTH SYSTEM CONTEXT IN 9265 07:49:28,280 --> 07:49:30,760 WHICH SERVICES ARE PROVIDED. 9266 07:49:30,760 --> 07:49:38,120 AND I WAS CONDUCTING RESEARCH TO 9267 07:49:38,120 --> 07:49:41,200 TREATMENT AND DIAGNOSIS AND 9268 07:49:41,200 --> 07:49:44,840 FOLLOW-UP TREATMENT WITH PEOPLE 9269 07:49:44,840 --> 07:49:48,040 IN THE PERUVIAN AMAZON AND 9270 07:49:48,040 --> 07:49:51,280 TRYING TO UNDERSTAND THE MOST 9271 07:49:51,280 --> 07:49:52,120 IMPORTANT GAPS FOR ACCESSING 9272 07:49:52,120 --> 07:49:56,840 THIS CARE. 9273 07:49:56,840 --> 07:50:07,400 AND WE FOUND OUT THEY HAD TO USE 9274 07:50:11,880 --> 07:50:13,320 CANDLES TO FIX THINGS AND ALSO 9275 07:50:13,320 --> 07:50:14,560 ADDITIONAL CHALLENGE WAS THEY 9276 07:50:14,560 --> 07:50:17,240 HAVE TO SEND THE SAMPLES TO THE 9277 07:50:17,240 --> 07:50:20,320 NEAREST TOWN WHERE THEY HAD A 9278 07:50:20,320 --> 07:50:20,680 LAPSE. 9279 07:50:20,680 --> 07:50:23,000 THE SAMPLES WAS IN THIS BOX BUT 9280 07:50:23,000 --> 07:50:25,240 THEY HAVE TO ACT AS A FAVOR TO 9281 07:50:25,240 --> 07:50:27,040 THE BOAT DRIVER TO TAKE IT SO 9282 07:50:27,040 --> 07:50:28,680 THERE WAS NOT A SYSTEM IN PLACE 9283 07:50:28,680 --> 07:50:30,640 FOR THE SAMPLES TO BE REACHED IN 9284 07:50:30,640 --> 07:50:31,640 TIME. 9285 07:50:31,640 --> 07:50:37,440 AND ONCE THEY REACHED THE SAMPLE 9286 07:50:37,440 --> 07:50:40,480 THEY WERE GOOD ENOUGH AND THE 9287 07:50:40,480 --> 07:50:45,720 LAB TECHNICIAN WAS THERE AND 9288 07:50:45,720 --> 07:50:50,000 THEY CAN SEE THE DELAYS AND IT 9289 07:50:50,000 --> 07:50:52,320 AFFECTS THE WAY IN WHICH HEALTH 9290 07:50:52,320 --> 07:50:57,480 CARE AND THE TRUST PEOPLE HAVE 9291 07:50:57,480 --> 07:51:01,880 AND THE RELATIONSHIP PEOPLE CAN 9292 07:51:01,880 --> 07:51:05,720 BUILD WITH THEM AND ALSO AND 9293 07:51:05,720 --> 07:51:08,720 HEALTH CARE WORKERS WHAT HAVE 9294 07:51:08,720 --> 07:51:13,600 BEEN TRAINED IN MY COUNTRY WHERE 9295 07:51:13,600 --> 07:51:15,320 THE EMPHASIS WAS ON CHRONIC 9296 07:51:15,320 --> 07:51:17,240 CONDITIONS SOMETIMES THEY DON'T 9297 07:51:17,240 --> 07:51:17,920 TREAT CERTAIN THINGS BECAUSE 9298 07:51:17,920 --> 07:51:19,360 THAT WAS NOT THE TRAINING YOU 9299 07:51:19,360 --> 07:51:19,640 RECEIVED. 9300 07:51:19,640 --> 07:51:23,560 IN ADDITION TO THE CULTURAL 9301 07:51:23,560 --> 07:51:24,720 DIFFERENCES WITH THE LOCAL 9302 07:51:24,720 --> 07:51:26,080 POPULATIONS AND I FEEL THE WAYS 9303 07:51:26,080 --> 07:51:29,200 WE CAN TRY TO REDUCE THE GAPS IS 9304 07:51:29,200 --> 07:51:31,160 TRYING TO UNDERSTAND BETTER AND 9305 07:51:31,160 --> 07:51:33,200 DO BE THE HEALTH EDUCATION THE 9306 07:51:33,200 --> 07:51:35,240 HEALTH WORKERS RECEIVED BOTH 9307 07:51:35,240 --> 07:51:36,640 DURING THEIR YEARS IN MEDICAL 9308 07:51:36,640 --> 07:51:39,960 SCHOOL OR NURSING SCHOOL OR WHEN 9309 07:51:39,960 --> 07:51:41,120 THEY BECOME MIDWIVES AND ONCE 9310 07:51:41,120 --> 07:51:43,040 THEY ARE PART OF THE PUBLIC 9311 07:51:43,040 --> 07:51:45,000 WORKFORCE WHERE THE MINISTRY OF 9312 07:51:45,000 --> 07:51:47,040 HEALTH SHOULD HAVE RESOURCES TO 9313 07:51:47,040 --> 07:51:49,760 MAKE SURE THEY ARE PREPARED IN 9314 07:51:49,760 --> 07:51:53,320 THE WHOLE SENSE OF THE WORD TO 9315 07:51:53,320 --> 07:51:57,040 BE ABLE TO REALLY WORK UNDER THE 9316 07:51:57,040 --> 07:51:59,920 DIFFICULT SITUATION AND WITH 9317 07:51:59,920 --> 07:52:02,440 POPULATIONS THAT DON'T HAVE A 9318 07:52:02,440 --> 07:52:03,040 GREAT RELATIONSHIP WITH THE 9319 07:52:03,040 --> 07:52:04,200 PUBLIC HEALTH SYSTEM. 9320 07:52:04,200 --> 07:52:07,000 THAT WOULD BE AN INTERVENTION 9321 07:52:07,000 --> 07:52:13,760 THAT COULD REDUCE GAPS IN HEALTH 9322 07:52:13,760 --> 07:52:14,160 CARE. 9323 07:52:14,160 --> 07:52:16,680 >>HOW CAN RESEARCH HELP TO 9324 07:52:16,680 --> 07:52:18,880 IMPROVE GAPS IN ACCESS TO 9325 07:52:18,880 --> 07:52:19,360 CERTAIN POPULATIONS? 9326 07:52:19,360 --> 07:52:25,000 WHEN WE CONDUCT WE HAVE THE 9327 07:52:25,000 --> 07:52:31,000 OPTION TO ADDRESS ISSUES AND 9328 07:52:31,000 --> 07:52:33,440 PRODUCE ACTIONABLE KNOWLEDGE AND 9329 07:52:33,440 --> 07:52:37,600 WITH THE DATA WE GENERATE WE CAN 9330 07:52:37,600 --> 07:52:39,000 FOR EXAMPLE RENDER ISSUES THAT 9331 07:52:39,000 --> 07:52:41,880 MAY NOT SEEM RELEVANT WHEN WE 9332 07:52:41,880 --> 07:52:47,400 WORK AT NATIONAL AVERAGES BUT 9333 07:52:47,400 --> 07:52:50,280 BECOME AND SEGREGATE THE DATA BY 9334 07:52:50,280 --> 07:52:53,680 SOCIAL ECONOMIC POSITION OR 9335 07:52:53,680 --> 07:53:04,160 STATUS OR OTHER FORMS OF D 9336 07:53:05,320 --> 07:53:06,520 DISAGGREGATION AND WITH RESEARCH 9337 07:53:06,520 --> 07:53:09,960 WE CAN IDENTIFY ISSUES THAT MAY 9338 07:53:09,960 --> 07:53:13,400 BE UNDER LOOKED OR CONSIDERED 9339 07:53:13,400 --> 07:53:15,600 ANECDOTAL SUCH AS THE HIGHER 9340 07:53:15,600 --> 07:53:16,440 PREVALENCE OF CERTAIN HEALTH 9341 07:53:16,440 --> 07:53:18,400 CONDITIONS AMONG CERTAIN 9342 07:53:18,400 --> 07:53:19,880 POPULATIONS OR THE HIGH 9343 07:53:19,880 --> 07:53:21,720 PREVALENCE OF MISTREATMENT IN 9344 07:53:21,720 --> 07:53:24,520 HEALTH CARE FACILITIES. 9345 07:53:24,520 --> 07:53:26,320 PARTICULARLY FOR PEOPLE WHO 9346 07:53:26,320 --> 07:53:29,480 BELONG TO ETHNIC MINORITY GROUPS 9347 07:53:29,480 --> 07:53:35,880 IN THE MINORITY IN THE SENSE OF 9348 07:53:35,880 --> 07:53:38,960 NOT NECESSARILY BEING A SMALLER 9349 07:53:38,960 --> 07:53:39,200 NUMBER. 9350 07:53:39,200 --> 07:53:42,560 AS DR. RUAN MENTIONED EARLIER I 9351 07:53:42,560 --> 07:53:47,200 INTERUSE WO UUSE -- INTERVIEWE 9352 07:53:47,200 --> 07:53:48,240 WHO EXPERIENCED VIOLENCE AND 9353 07:53:48,240 --> 07:53:50,240 DON'T USE THE TERMS AND EXPLAIN 9354 07:53:50,240 --> 07:53:55,200 IT IN DIFFERENT TERMS AND I HAVE 9355 07:53:55,200 --> 07:53:57,480 TO UNDERSTAND THEIR EVERYDAY 9356 07:53:57,480 --> 07:54:00,680 EXPERIENCE SOMETIMES LEADS THEM 9357 07:54:00,680 --> 07:54:03,600 TO NORMALIZE THEIR EXPERIENCE 9358 07:54:03,600 --> 07:54:05,320 AND WHAT HAPPENS TO THEM IN A 9359 07:54:05,320 --> 07:54:06,480 HEALTH CARE SETTING. 9360 07:54:06,480 --> 07:54:09,680 EVEN IF THEY'RE USING DIFFERENT 9361 07:54:09,680 --> 07:54:13,560 TERMS OR IF THEY ARE HAPPY THEY 9362 07:54:13,560 --> 07:54:15,080 SURVIVED THE BIRTH EXPERIENCE 9363 07:54:15,080 --> 07:54:20,240 AND HAD A CHILD WHO IS ALIVE 9364 07:54:20,240 --> 07:54:24,120 THERE IS STILL ISSUES THAT THEY 9365 07:54:24,120 --> 07:54:25,880 ENCOUNTER IN HEALTH CARE 9366 07:54:25,880 --> 07:54:27,480 FACILITIES THAT MADE THEM 9367 07:54:27,480 --> 07:54:31,240 UNCOMFORTABLE OR FEEL THEY'RE 9368 07:54:31,240 --> 07:54:32,920 BEING DISRESPECTED. 9369 07:54:32,920 --> 07:54:34,280 THOUGH IN THE SETTINGS WHERE I 9370 07:54:34,280 --> 07:54:36,120 HAVE STUDY THE PHENOMENON, 9371 07:54:36,120 --> 07:54:40,120 EVERYBODY KNOWS THOSE THINGS 9372 07:54:40,120 --> 07:54:43,680 HAPPEN AND IT'S AT THE ANECDOTAL 9373 07:54:43,680 --> 07:54:45,960 LEVEL IT'S IMPORTANT AS 9374 07:54:45,960 --> 07:54:51,000 RESEARCHERS TO TALK ABOUT HOW 9375 07:54:51,000 --> 07:54:56,840 OFTEN THAT HAPPENS AND NOT ALL 9376 07:54:56,840 --> 07:55:07,280 DO THIS AND THERE'S CERTAIN 9377 07:55:09,520 --> 07:55:11,760 TREATMENT AND THOSE ACTIONS CAN 9378 07:55:11,760 --> 07:55:13,280 BE ASSOCIATED NOT ONLY ON ONE 9379 07:55:13,280 --> 07:55:18,520 HAND TO PROVIDING CARE THAT IS 9380 07:55:18,520 --> 07:55:21,440 NOT TAKING THE PEOPLE WITH NOT 9381 07:55:21,440 --> 07:55:23,200 TREATING THE PEOPLE WITH DIGNITY 9382 07:55:23,200 --> 07:55:27,000 BUT ALSO IT COULD BE ASSOCIATED 9383 07:55:27,000 --> 07:55:28,440 WITH ADVERSE HEALTH OUTCOMES AND 9384 07:55:28,440 --> 07:55:32,240 WE SHOULD UNDERSTAND THEY HAVE 9385 07:55:32,240 --> 07:55:33,480 THE POWER TO REVERSE THOSE 9386 07:55:33,480 --> 07:55:39,960 ISSUES SO RESEARCH CAN HELP 9387 07:55:39,960 --> 07:55:40,880 HIGHLIGHT ISSUE WHAT IS 9388 07:55:40,880 --> 07:55:48,880 CONSIDERED ANECDOTAL. 9389 07:55:48,880 --> 07:55:53,880 ONCE WE PROVIDE THE DATA THEY 9390 07:55:53,880 --> 07:55:55,200 BECOME PUBLIC HEALTH ISSUES AND 9391 07:55:55,200 --> 07:55:56,160 THEY CAN BE ADDRESSED AND THAT'S 9392 07:55:56,160 --> 07:55:58,200 THE WE CAN DO AND I LIKE TO DO 9393 07:55:58,200 --> 07:55:59,480 THAT TYPE OF RESEARCH. 9394 07:55:59,480 --> 07:56:01,960 THANK YOU. 9395 07:56:01,960 --> 07:56:05,360 >>I SEE WE HAVE TIME FOR ONE 9396 07:56:05,360 --> 07:56:06,680 ADDITIONAL QUESTION SO I'LL 9397 07:56:06,680 --> 07:56:08,080 SELECT A COMMON ONE. 9398 07:56:08,080 --> 07:56:10,880 WOULD YOU SUGGEST A POTENTIAL 9399 07:56:10,880 --> 07:56:11,960 RESEARCH OPPORTUNITY IT COULD BE 9400 07:56:11,960 --> 07:56:14,080 A RESEARCH QUESTION AND 9401 07:56:14,080 --> 07:56:15,800 SPECIFICALLY A STUDY OF AN 9402 07:56:15,800 --> 07:56:18,560 INTERVENTION THAT CAN BE 9403 07:56:18,560 --> 07:56:20,600 CONDUCTED IN LATIN AMERICA 9404 07:56:20,600 --> 07:56:24,320 POPULATIONS TO REDUCE HEALTH 9405 07:56:24,320 --> 07:56:27,440 CARE DISPARITIES AMONG HISPANIC 9406 07:56:27,440 --> 07:56:29,160 LATINOS IN THE U.S. 9407 07:56:29,160 --> 07:56:39,440 DR. PESANTES AND DR. RUAN AND 9408 07:56:39,440 --> 07:56:39,760 DR. CASTRO. 9409 07:56:39,760 --> 07:56:43,640 >>IT'S RELEVANT TO HAVE THE 9410 07:56:43,640 --> 07:56:44,280 OPPORTUNITY TO DOING RESEARCH 9411 07:56:44,280 --> 07:56:48,440 THAT IS CLOSE TO EACH OTHER AND 9412 07:56:48,440 --> 07:56:50,600 TRYING TO UNDERSTAND WHERE THE 9413 07:56:50,600 --> 07:56:52,480 STANDARDIZED MEASURED OFTEN USED 9414 07:56:52,480 --> 07:56:55,120 IN PUBLIC HEALTH ARE REALLY 9415 07:56:55,120 --> 07:57:06,000 CAPTURIING WHAT THEY CLAIM TO. 9416 07:57:07,400 --> 07:57:17,880 AND LOOKING AT THE TREATMENT AND 9417 07:57:20,800 --> 07:57:21,960 LOOKING AT WHAT'S BEEN VALIDATED 9418 07:57:21,960 --> 07:57:25,720 IN POPULATIONS AND WHEN WE DO 9419 07:57:25,720 --> 07:57:27,760 RESEARCH IN LATIN AMERICA WE 9420 07:57:27,760 --> 07:57:31,280 FIND OURSELVES USING THE 9421 07:57:31,280 --> 07:57:32,160 MEASURES BECAUSE WE KNOW WE WANT 9422 07:57:32,160 --> 07:57:37,800 TO PUBLISHING, WE WANT TO ALSO 9423 07:57:37,800 --> 07:57:39,200 POSITION OURSELVES AS 9424 07:57:39,200 --> 07:57:42,840 RESEARCHERS BUT WE'RE AWARE THE 9425 07:57:42,840 --> 07:57:46,040 MEASURES OFTEN TIMES ARE NOT 9426 07:57:46,040 --> 07:57:47,360 MEASURING WHAT THEY'RE SUPPOSED 9427 07:57:47,360 --> 07:57:49,960 TO AND WE COULD INVEST TIME IN 9428 07:57:49,960 --> 07:57:59,280 ORDER TO PRODUCE BETTER OUTCOMES 9429 07:57:59,280 --> 07:58:00,280 FOR IMPROVING THE HEALTH CARE 9430 07:58:00,280 --> 07:58:01,960 SERVICES AND MAKING SURE THE 9431 07:58:01,960 --> 07:58:04,560 MEASURES ARE VALID FOR OUR 9432 07:58:04,560 --> 07:58:05,560 POPULATIONS AND ARE MEASURING 9433 07:58:05,560 --> 07:58:09,000 WHAT WE WANT TO MEASURE AND 9434 07:58:09,000 --> 07:58:10,400 THAT'S ONE KIND OF RESEARCH I 9435 07:58:10,400 --> 07:58:12,880 THINK WOULD BE USEFUL. 9436 07:58:12,880 --> 07:58:18,840 AND THE OTHER ONE IS FROM A 9437 07:58:18,840 --> 07:58:22,040 QUALITATIVE PERSPECTIVE RESEARCH 9438 07:58:22,040 --> 07:58:24,840 ON THE EXPERIENCE OF THE MIGRANT 9439 07:58:24,840 --> 07:58:29,280 WITH SEXUAL REPRODUCTIVE HEALTH 9440 07:58:29,280 --> 07:58:31,480 CARE SERVICES AND THOSE WHO GO 9441 07:58:31,480 --> 07:58:35,840 FOR PRENATAL CARE OR 9442 07:58:35,840 --> 07:58:41,600 CONTRACEPTION AND ONE OF THE 9443 07:58:41,600 --> 07:58:43,600 THINGS IN THE INTERVIEWS WE 9444 07:58:43,600 --> 07:58:45,400 REALIZED IT WAS IMPORTANT TO GET 9445 07:58:45,400 --> 07:58:47,360 A SENSE OF WHAT WAS THEIR PAST 9446 07:58:47,360 --> 07:58:50,600 EXPERIENCE IN VENEZUELA WITH THE 9447 07:58:50,600 --> 07:58:51,920 HEALTH CARE FACILITIES AND HOW 9448 07:58:51,920 --> 07:58:53,240 THAT EXPERIENCE SHAPED THE WAY 9449 07:58:53,240 --> 07:58:54,160 THEY LOOK AT HEALTH CARE 9450 07:58:54,160 --> 07:58:56,480 FACILITIES IN PERU AND WHAT THEY 9451 07:58:56,480 --> 07:58:58,400 WERE EXPECTING FROM ME. 9452 07:58:58,400 --> 07:59:04,600 I THINK IF WE CAN EXTRAPOLATE 9453 07:59:04,600 --> 07:59:06,400 THAT RESEARCH FINDING WITH 9454 07:59:06,400 --> 07:59:09,320 RESEARCH IN THE UNITED STATES WE 9455 07:59:09,320 --> 07:59:13,560 NEED TO UNDERSTAND WHAT DO USERS 9456 07:59:13,560 --> 07:59:16,400 OF HEALTH CARE FACILITIES HOW DO 9457 07:59:16,400 --> 07:59:20,960 THEY VIEW THIS AND WHAT THEY 9458 07:59:20,960 --> 07:59:23,480 EXPECT AND HOW DO HEALTH CARE 9459 07:59:23,480 --> 07:59:24,760 PROVIDERS SERVE THE POSITION AND 9460 07:59:24,760 --> 07:59:28,320 UNDERSTAND THE TWO VIEWS IN 9461 07:59:28,320 --> 07:59:31,240 ORDER TO GET A SENSE OF HOW DO 9462 07:59:31,240 --> 07:59:34,080 WE DESIGN AN INTERVENTION THAT 9463 07:59:34,080 --> 07:59:36,080 TAKES INTO CONSIDERATION THE 9464 07:59:36,080 --> 07:59:41,200 EXPECTATIONS AND VALIDATE THEIR 9465 07:59:41,200 --> 07:59:43,800 OWN NEEDS AND VALIDATE THEIR 9466 07:59:43,800 --> 07:59:46,080 PERSPECTIVES OF WHAT THEY'RE 9467 07:59:46,080 --> 07:59:49,920 ENTITLED TO WHEN THEY SEEK CARE. 9468 07:59:49,920 --> 07:59:51,240 >>GREAT SUGGESTIONS. 9469 07:59:51,240 --> 07:59:53,440 >>I WOULD LIKE TO BUILD ON WHAT 9470 07:59:53,440 --> 07:59:54,080 WAS SAID. 9471 07:59:54,080 --> 07:59:56,240 I THINK WHAT'S IMPORTANT IS WE 9472 07:59:56,240 --> 07:59:57,080 LOOK AT HEALTH SYSTEM GOVERNANCE 9473 07:59:57,080 --> 08:00:01,120 AND PARTICIPATION. 9474 08:00:01,120 --> 08:00:02,800 HOW ARE PEOPLE SHAPING THE 9475 08:00:02,800 --> 08:00:04,960 HEALTH SYSTEM TAKING CARE OF 9476 08:00:04,960 --> 08:00:09,520 THEM AND WHO ARE THE ACTORS 9477 08:00:09,520 --> 08:00:09,760 SHAPING. 9478 08:00:09,760 --> 08:00:12,000 WE NEED TO UNDERSTAND WHO HAS 9479 08:00:12,000 --> 08:00:13,480 POWER AND POWER IN DECISION 9480 08:00:13,480 --> 08:00:15,000 MAKING AND POLICY AND WHO HAS 9481 08:00:15,000 --> 08:00:16,080 POLICY IN IMPLEMENTING THE 9482 08:00:16,080 --> 08:00:17,920 POLICIES AND HOW THAT RELATES TO 9483 08:00:17,920 --> 08:00:19,840 THE VULNERABLE POPULATIONS WE'RE 9484 08:00:19,840 --> 08:00:21,800 LOOKING AT BEING INDIGENOUS 9485 08:00:21,800 --> 08:00:24,320 PEOPLE OR THE VENEZUELANS ONE OF 9486 08:00:24,320 --> 08:00:26,400 THE WORLD'S LARGEST HUMANITARIAN 9487 08:00:26,400 --> 08:00:31,440 CRISIS NOW AND I KNOW PERU IS 9488 08:00:31,440 --> 08:00:33,120 THE SECOND COUNTRY AND YOU HAVE 9489 08:00:33,120 --> 08:00:35,880 MORE THAN A MILLION VENEZUELANS 9490 08:00:35,880 --> 08:00:38,280 IN YOUR COUNTRY AND WE DID A 9491 08:00:38,280 --> 08:00:44,320 STUDY WITH ONE OF MY STUDENTS 9492 08:00:44,320 --> 08:00:45,520 HOW YOU INTEGRATE VENEZUELANS IN 9493 08:00:45,520 --> 08:00:47,040 THE SYSTEM AND YOU HAVE TO LOOK 9494 08:00:47,040 --> 08:00:49,960 AT ACTORS THAT HAVE POWER IN 9495 08:00:49,960 --> 08:00:50,960 MAKING POLICY. 9496 08:00:50,960 --> 08:00:53,880 WE WEREN'T INCLUDING AN OF THE 9497 08:00:53,880 --> 08:00:55,960 VENEZUELANS OR COLLECTIVE ACTORS 9498 08:00:55,960 --> 08:00:58,280 BECAUSE THEY DIDN'T HAVE POWER 9499 08:00:58,280 --> 08:01:00,520 IN IMPACTING HOW THEY WOULD GET 9500 08:01:00,520 --> 08:01:02,760 ACCESS TO HEALTH INSURANCE OR TO 9501 08:01:02,760 --> 08:01:08,360 THE BASIC ACCESS TO THE HEALTH 9502 08:01:08,360 --> 08:01:16,320 SYSTEM. 9503 08:01:16,320 --> 08:01:18,800 WHAT MATTERS TO THE POPULATION 9504 08:01:18,800 --> 08:01:23,040 IS IMPORTANT AND ANTHROPOLOGIC 9505 08:01:23,040 --> 08:01:24,360 PERSPECTIVES ARE IMPORTANT AND 9506 08:01:24,360 --> 08:01:26,320 WHEN WE COME FROM SOCIAL 9507 08:01:26,320 --> 08:01:27,520 SCIENCES WE MAY BE COMING FROM A 9508 08:01:27,520 --> 08:01:29,120 PLACE OF POWER AND PRIVILEGE AND 9509 08:01:29,120 --> 08:01:31,360 NOT UNDERSTAND HOW OTHER PEOPLE 9510 08:01:31,360 --> 08:01:31,800 CANNOT SPEAK. 9511 08:01:31,800 --> 08:01:35,040 SO WE ALSO NEED TO UNDERSTAND 9512 08:01:35,040 --> 08:01:36,640 EMPLOYMENT AND HOUSING. 9513 08:01:36,640 --> 08:01:37,840 WHERE DO DIFFERENT GROUPS LIVE 9514 08:01:37,840 --> 08:01:41,160 AND WORK AND HOW IS THAT 9515 08:01:41,160 --> 08:01:41,680 RELATED. 9516 08:01:41,680 --> 08:01:43,480 HOW DO PEOPLE GET TO GOOD 9517 08:01:43,480 --> 08:01:45,240 QUALITY HEALTH CARE. 9518 08:01:45,240 --> 08:01:48,160 HOW DO THEY RECEIVE GOOD QUALITY 9519 08:01:48,160 --> 08:01:51,920 SEXUAL AND REPRODUCTIVE HEALTH 9520 08:01:51,920 --> 08:01:54,240 SERVICES AND SRH IS SO 9521 08:01:54,240 --> 08:01:54,520 IMPORTANT. 9522 08:01:54,520 --> 08:01:56,120 IT'S SO IMPORTANT BECAUSE MANY 9523 08:01:56,120 --> 08:01:58,360 OF OUR COUNTRIES IN LATIN 9524 08:01:58,360 --> 08:01:59,480 AMERICA BASICALLY PROVIDE ONLY 9525 08:01:59,480 --> 08:02:01,600 MATERNAL CARE SERVICES. 9526 08:02:01,600 --> 08:02:03,600 SO THERE'S ONLY A HEALTH CARE IS 9527 08:02:03,600 --> 08:02:06,160 THAT HELPS YOU NOT GET PREGNANT 9528 08:02:06,160 --> 08:02:08,200 OR LOOKS AT YOU WHILE YOU'RE 9529 08:02:08,200 --> 08:02:08,880 PREGNANT AND THERE'S NOTHING FOR 9530 08:02:08,880 --> 08:02:12,240 ANYONE ELSE AND HOW ARE WE 9531 08:02:12,240 --> 08:02:14,440 ENSURING THE SERVICES THAT WE 9532 08:02:14,440 --> 08:02:18,680 ARE PROVIDING ARE RESPECTFUL, 9533 08:02:18,680 --> 08:02:20,080 ARE SAFEGUARDING THEIR HUMAN 9534 08:02:20,080 --> 08:02:20,480 DIGNITY? 9535 08:02:20,480 --> 08:02:22,200 HOW MANY OF US HAVE HEARD 9536 08:02:22,200 --> 08:02:23,920 TERRIBLE STORIES ABOUT AND 9537 08:02:23,920 --> 08:02:25,520 THEY'RE NOT ANECDOTAL. 9538 08:02:25,520 --> 08:02:27,840 THEY SOUND IT WHEN WE HEAR THEM 9539 08:02:27,840 --> 08:02:29,560 BUT WE KNOW ALL VULNERABLE 9540 08:02:29,560 --> 08:02:32,040 POPULATIONS, ALL OVER THE WORLD 9541 08:02:32,040 --> 08:02:34,960 GET EXTREMELY MISTREATED WHEN 9542 08:02:34,960 --> 08:02:36,600 THEY GO TO DELIVER. 9543 08:02:36,600 --> 08:02:37,800 WHETHER IT'S BECAUSE THEY COME 9544 08:02:37,800 --> 08:02:39,520 FROM POPULATIONS THAT 9545 08:02:39,520 --> 08:02:40,120 TRADITIONALLY HAVE A LOT OF 9546 08:02:40,120 --> 08:02:42,880 CHILDREN OR THEY COME FROM 9547 08:02:42,880 --> 08:02:44,840 POPULATIONS THAT HAVE NOT 9548 08:02:44,840 --> 08:02:46,120 DOMINANT ETHNIC GROUP. 9549 08:02:46,120 --> 08:02:47,120 THEY GET A LOT OF PAIN AND WHAT 9550 08:02:47,120 --> 08:02:48,160 HAPPENS TO MEN? 9551 08:02:48,160 --> 08:02:49,800 ONE THING WE HAVEN'T BROUGHT UP 9552 08:02:49,800 --> 08:02:53,880 IS THAT THERE IS VERY LITTLE 9553 08:02:53,880 --> 08:02:56,480 RESEARCH ON HOW LATIN AMERICA 9554 08:02:56,480 --> 08:02:57,800 MASCULINITY AND UNDERSTANDING 9555 08:02:57,800 --> 08:03:00,760 WHAT A MAN IS IMPACTS BEHAVIOR 9556 08:03:00,760 --> 08:03:03,040 AND HOW IT CHANGES WHEN THEY'RE 9557 08:03:03,040 --> 08:03:03,960 MIGRANTS IN THE UNITED STATES OR 9558 08:03:03,960 --> 08:03:12,560 WENT FROM A RURAL AREA GUATEMALA 9559 08:03:12,560 --> 08:03:15,120 OR INTO PERU, RIGHT. 9560 08:03:15,120 --> 08:03:16,400 I THINK THE HEALTH SYSTEM 9561 08:03:16,400 --> 08:03:21,400 GOVERNANCE IS THE KEY TO MAKING 9562 08:03:21,400 --> 08:03:22,240 PEOPLE-CENTERED HEALTH SYSTEM 9563 08:03:22,240 --> 08:03:24,280 ONE WHERE MORE PEOPLE GET TO BE 9564 08:03:24,280 --> 08:03:27,560 AT THE CENTER OF IT. 9565 08:03:27,560 --> 08:03:27,840 THANK YOU. 9566 08:03:27,840 --> 08:03:30,240 >>DR. CASTRO, YOU'LL HAVE THE 9567 08:03:30,240 --> 08:03:31,160 FINAL WORD. 9568 08:03:31,160 --> 08:03:33,120 >>IT'S IMPORTANT TO INCREASE 9569 08:03:33,120 --> 08:03:36,680 RESEARCH CONDUCTED IN LATIN 9570 08:03:36,680 --> 08:03:39,000 AMERICA FOR MANY REASONS 9571 08:03:39,000 --> 08:03:40,120 INCLUDING TO IMPROVE THE HEALTH 9572 08:03:40,120 --> 08:03:44,320 OF POPULATIONS THAT ARE OF LATIN 9573 08:03:44,320 --> 08:03:44,920 AMERICA ORIGIN IN THE UNITED 9574 08:03:44,920 --> 08:03:55,080 STATES. 9575 08:03:59,000 --> 08:04:01,680 IT'S INTERESTING TO SEE HOW THE 9576 08:04:01,680 --> 08:04:05,120 HEALTH CARE SYSTEM RESPONDS TO 9577 08:04:05,120 --> 08:04:08,320 THE NEEDS DIFFERENTLY IN THE 9578 08:04:08,320 --> 08:04:11,560 DIFFERENT COUNTRIES OF ORIGIN 9579 08:04:11,560 --> 08:04:14,080 EVEN IF IN THE U.S. IT'S CLEAR 9580 08:04:14,080 --> 08:04:18,000 THE MATERNAL MORTALITY THAT IS 9581 08:04:18,000 --> 08:04:20,680 OVERWHELMINGLY EXPERIENCED BY 9582 08:04:20,680 --> 08:04:21,960 CERTAIN POPULATION GROUPS IS 9583 08:04:21,960 --> 08:04:25,800 ASSOCIATED WITH THE EXISTENCE OF 9584 08:04:25,800 --> 08:04:27,840 RACISM IN THE HEALTH CARE 9585 08:04:27,840 --> 08:04:30,760 SETTING IT WOULD BE HARD TO 9586 08:04:30,760 --> 08:04:37,240 THINK THAT THERE ARE NOT ENOUGH 9587 08:04:37,240 --> 08:04:39,520 MECHANISMS IN THE UNITED STATES 9588 08:04:39,520 --> 08:04:43,440 THAT ARE STILL PREVALENT IN THE 9589 08:04:43,440 --> 08:04:44,400 COUNTRIES IN LATIN AMERICA. 9590 08:04:44,400 --> 08:04:48,200 AND THEREFORE IT WOULD BE 9591 08:04:48,200 --> 08:04:50,480 IMPORTANT TO COMPARE HOW THE 9592 08:04:50,480 --> 08:04:51,880 HEALTH CARE SYSTEMS ARE 9593 08:04:51,880 --> 08:04:53,400 STRUCTURED AND ORGANIZED IN 9594 08:04:53,400 --> 08:04:55,000 DIFFERENT SETTINGS. 9595 08:04:55,000 --> 08:04:56,040 THERE'S ALSO SOME HEALTH CARE 9596 08:04:56,040 --> 08:04:58,120 CONDITIONS THAT ARE MORE 9597 08:04:58,120 --> 08:04:59,920 PREVALENT AMONG STUDENT 9598 08:04:59,920 --> 08:05:01,720 POPULATION GROUPS IN LATIN 9599 08:05:01,720 --> 08:05:04,240 AMERICA THAN IN THE UNITED 9600 08:05:04,240 --> 08:05:04,640 STATES. 9601 08:05:04,640 --> 08:05:08,960 THERE'S A LOT TO GAIN IN TERMS 9602 08:05:08,960 --> 08:05:11,240 OF CONDUCTING RESEARCH IN LATIN 9603 08:05:11,240 --> 08:05:14,960 AMERICA AND IN TERMS OF 9604 08:05:14,960 --> 08:05:16,600 COLLABORATION IT'S ALWAYS MORE 9605 08:05:16,600 --> 08:05:18,480 FRUITFUL TO COLLABORATE WITH 9606 08:05:18,480 --> 08:05:24,320 COLLEAGUES WHO HAVE DIFFERENT 9607 08:05:24,320 --> 08:05:26,680 TRAJECTORIES AND WHO ARE WELL 9608 08:05:26,680 --> 08:05:29,600 TRAINED IN LATIN AMERICA AND WHO 9609 08:05:29,600 --> 08:05:31,040 COULD BE FANTASTIC COLLEAGUES TO 9610 08:05:31,040 --> 08:05:35,360 WORK IN COLLABORATION WHO ARE 9611 08:05:35,360 --> 08:05:38,560 COLLABORATION WITH RESEARCHERS. 9612 08:05:38,560 --> 08:05:40,960 THERE'S POSITIVE RESULTS FROM 9613 08:05:40,960 --> 08:05:41,520 INCREASING RESEARCH IN THE 9614 08:05:41,520 --> 08:05:42,120 REGION, THANK YOU. 9615 08:05:42,120 --> 08:05:44,920 >>THANK YOU. 9616 08:05:44,920 --> 08:05:47,640 AND I HOPE WE CAN CONTINUE THE 9617 08:05:47,640 --> 08:05:48,840 CONVERSATION ABOUT THIS 9618 08:05:48,840 --> 08:05:50,960 IMPORTANT TOPIC. 9619 08:05:50,960 --> 08:05:53,720 IT WAS A VERY INTERESTING 9620 08:05:53,720 --> 08:05:54,040 DISCUSSION. 9621 08:05:54,040 --> 08:05:54,680 THANK YOU. 9622 08:05:54,680 --> 08:05:56,800 I APPRECIATE YOUR COMMENTS AND 9623 08:05:56,800 --> 08:05:59,240 RECOMMENDATIONS AND INSIGHTS. 9624 08:05:59,240 --> 08:06:02,960 THANK YOU ALSO TO THE ADD -- 9625 08:06:02,960 --> 08:06:05,240 AUDIENCE FOR THE THOUGHTFUL 9626 08:06:05,240 --> 08:06:06,760 QUESTIONS AND WITH THIS WE 9627 08:06:06,760 --> 08:06:07,960 CONCLUDE OUR ACTIVITIES FOR 9628 08:06:07,960 --> 08:06:08,200 TODAY. 9629 08:06:08,200 --> 08:06:10,080 WE HAD A PRODUCTIVE AND 9630 08:06:10,080 --> 08:06:10,880 EDUCATIONAL DAY. 9631 08:06:10,880 --> 08:06:11,760 I LEARNED A LOT. 9632 08:06:11,760 --> 08:06:12,840 THANK YOU ALL FOR PARTICIPATING. 9633 08:06:12,840 --> 08:06:18,960 WE HOPE YOU CAN JOIN US TOMORROW 9634 08:06:18,960 --> 08:06:22,720 AT 8:30 A.M. FOR ANOTHER FULL 9635 08:06:22,720 --> 08:06:24,160 DAY OF INFORMATIVE DISCUSSIONS. 9636 08:06:24,160 --> 08:06:25,240 HAVE A GOOD EVENING. 9637 08:06:25,240 --> 00:00:00,000 THANK YOU, EVERYONE.