>>Chair Aviles-Santa: WELCOME.
I AM LA REESE A AVILES-SANTA.
GREETINGS FROM NIMHD.
THE NATIONAL INSTITUTE OF
MINORITY HEALTH AND HEALTH
DISPARITIES.
IT'S AN HONOR TO BE HERE
SURROUNDED BY COLLEAGUES AND BY
EXPERTS TO DISCUSS CRUCIAL
TOPICS AND DIFFICULT TOPICS IN
THIS UNIQUE WORKSHOP, LATINO
AMERICA, SYNERGIESING RESEARCH
ACROSS THE HEMISPHERE.
TODAY AND TOMORROW, WE WILL HAVE
36 EXPERTS FROM LATINO AMERICA,
THE UNITED STATES AND AMERICA
EUROPE DISCUSSING THE -- IN U.S.
LATINO/HU.S./.
>>THAT WILL BE OF MUTUAL
INTEREST AND BENEFIT TO BOTH
LATIN AMERICA AND THE U.S.
LATINO COMMUNITIES.
I WANT TO THANK ALL EXPERTS WHO
HAVE ACCEPTED THE INVITATION TO
PARTICIPATE IN OUR WORKSHOP.
AND WHO HAVE SET ASIDE TIME TO
REALLY SHARE THEIR KNOWLEDGE AND
ENGAGE IN CRUCIAL AND RECENT
CONVERSATIONS.
I ALSO WANT TO THANK Dr.
PEREZ-STABLE FOR SUPPORTING THIS
WORKSHOP.
I WANT TO THANK ALL OF YOU, IN
LATIN AMERICA, AND IN THE U.S.
WHO ARE TAKING TIME FROM THIS
VERY SPECIAL DAY.
TO BE HERE WITH US.
WE KNOW THIS IS A MAJOR
CELEBRATION ACROSS LATIN AMERICA
AND WE ARE GRATEFUL FOR YOUR
PRESENCE.
AND NOW, I WANT TO PASS THE
MICROPHONE TO OUR COLLEAGUE.
>>THANK YOU.
GOOD MORNING AND WELCOME,
EVERYONE.
I AM CONSTANZA, AN INVESTIGATOR
IN THE DIVISION OF CANCER
EPIDEMIOLOGY AND GENETICS AT THE
NATIONAL CANCER INSTITUTE.
IT'S AN HONOR TO BE PART OF THE
ORGANIZING COMMITTEE OF THIS
UNPRECEDENTED MEETING.
WE HAVE A MOMENTUM AND A AGAIN
DA AND A PROMISE FOR ADVANCING
HEALTH IN HISPANIC LATINO
POPULATIONS IN YEARS AHEAD OF
THE I LOOK FORWARD TO LEARNING
ABOUT THE BEST PRACTICES AND
EMERGING RESEARCH OPPORTUNITIES
TO BE DISCUSSED TODAY AND
TOMORROW.
NOW, I'M GOING TO TURN THE
MICROPHONE OVER TO Dr.
MICHELLE DOOSE.
THANK YOU.
>>THANK YOU.
GREETINGS, I'M Dr. MICHELLE
DOOSE A PROGRAM OFFICIAL AT THE
NATIONAL INSTITUTE ON MINORITY
HEALTH AND HEALTH DISPARITY.
IT'S AN HONOR COULD BE A
CO-CHAIR AND FOR THIS WORKSHOP
TO ADVANCE THE SCIENCE TO
IMPROVE THE HEALTH OF HISPANICS
AND LATINOS AND REDUCE HEALTH
DISPARITIES ACROSS THE
HEMISPHERE.
WHERE ARE YOU WATCHING FROM?
SO PLEASE TAKE A MOMENT TO GO TO
SLIDO.COM.
VIA YOUR PHONE, COMPUTER OR
TABLET AND TYPE IN LATAM.
IT'S AN OPPORTUNITY TO SHARE
WHERE YOU ARE WATCHING FROM
TODAY AND SELECT WHAT COUNTRY
YOU ARE ENJOYING US FROM.
WE HOPE AT THE END, WE'LL BE
ABLE TO SHARE A MAP WHERE
EVERYBODY IS WATCHING US FROM
TODAY.
WE'LL SHOW THE SLIDE LATER, WE
CAN DO IT DURING THE BREAK BUT
PLEASE SHARE WHERE YOU ARE
JOINING US FROM.
NOW I WANT TO COVER A COUPLE
HOUSEKEEPING ITEMS.
ALL TOPIC PRESENTATIONS, EXCEPT
FOR THE OPEN DISCUSSION, AT THE
END OF DAY ONE, HAVE BEEN
PRE-RECORDED.
THEY WILL BE FOLLOWED BY A LIVE
Q&A SESSION.
PLEASE SUBMIT QUESTIONS VIA
E-MAIL TO OUR WORKSHOP E-MAIL.
LATAMWKSP@MAIL.COM.
THE BEE OWES ARE AVAILABLE WHERE
CAN YOU FIND MORE INFORMATION ON
EACH SPEAKER'S AFFILIATION AND
RESEARCH EXPERTISE.
THE WORKSHOP IS BEING RECORDED
AND IT WILL BE PUBLICLY
AVAILABLE SHORTLY AFTER THE
WORKSHOP.
IT'S MY PRIVILEGE TO Dr.
INTRODUCINTRODUCEDr. PEREZ-STABY
START THE WORKSHOP WITH
INOPENING REMARKS.
>>WELCOME, MY NAME ISN'TLY SAY
OWE PEREZ-STABLE AND I'M THE
DIRECTOR OF THE NATIONAL
INSTITUTE MINORITY HEALTH AND
HEALTH DISPARITIES AND IT IS A
REAL PLEASURE TO BE HOSTING THIS
SCIENTIFIC WORKSHOP ON HEALTH
RESEARCH IN LATIN AMERICA AND
IT'S RELATIONSHIP TO U.S. HEALTH
DISPARITIES.
SO WHY LATIN AMERICA AT NIMHD.
FIRST OF ALL, 19% OF THE U.S.
POPULATION IN 2020 HAVE THEIR
ORIGINS IN LATIN AMERICA.
THIS WORKSHOP FOCUSES ON NON
COMMUNICABLE CHRONIC DISEASES
BECAUSE THE TRANSLATION OF
POPULATION HEALTH IN LATIN
AMERICA HAPPEN DECADES AGO FROM
INFECTIOUS DISEASES TO
MALNUTRITION, DIABETES AND OTHER
CHRONIC DISEASES AS THE LEADING
CAUSES OF DEATH.
NIMHD HAS SUBSTANTIAL GRANTS IN
PUERTO RICO LIEU THE RESEARCH
CENTERS FOR MINORITY
INSTITUTIONS, POSTMA REA, RO1s
AS WELL AS SOME TRAINING GRANTS.
AND WE ARE INTERESTED IN
IMMIGRANTS IN THE U.S. SO THAT
COMING FROM LATIN AMERICA.
AND FINALLY, THE NIH HAS LARGELY
IGNORED LATIN AMERICA AND THAT
IS ANOTHER REASON TO HIGHLIGHT
THIS WORKSHOP.
SO OPPORTUNITIES FOR RESEARCH
AND LATIN AMERICA FROM OUR
PERSPECTIVE ARE NUMEROUS.
COMPARISONS TO U.S. POPULATIONS.
SO WHAT HAPPENS OVER TIME WITH
IMMIGRANTS?
WHAT ABOUT THOSE WHO DIDN'T
MIGRATE?
HOW DO THEY COMPARE TO THE
POPULATIONS HERE?
THERE ARE PRECIOUS FEW STUDIES
IN THAT AREA.
WHAT'S THE ROLE OF CULTURE AND
ENVIRONMENT IN DEVELOPMENT AND
EVOLUTION OF CHRONIC DISEASES
INCLUDING ISSUES AROUND
BEHAVIORAL HEALTH AND MENTAL
HEALTH.
WHAT'S THE ROLE OF RACISM,
ETHNICITY AND SOCIAL CLASS IN
THE LATIN AMERICAN CONTEXT?
LATIN AMERICA AFTER ALL IS MIXED
POPULATION.
AND SO THIS IS VERY RELEVANT.
WHAT ABOUT MODELS OF HEALTHCARE
FOR CHRONIC DISEASES?
DO SYSTEMS IN LANE AMERI LATIN A
BETTER JOB IN SOME CASES THAN
THE UNITED STATES.
THE ROLE OF POPULATION MIXTURE,
CANCER, METABOLIC DISORDERS,
USING ANCESTORIAL MARKERS OR
OTHER BIOLOGICAL MARKERS THAT
WOULD BE OF INTEREST TO US AS
WELL.
A QUICK TOUR OF SOME OF THE
PROFILE OF MORTALITY IN LATIN
AMERICA SHOWS YOU SEE FROM THIS
DATA FROM THE PAN AMERICAN
HEALTH ORGANIZATION WERE THE
UNITED STATES SITS AT 5.6 IN
INFANT MORTALITY IN 2015 TO
MEXICO AT 11.3.
HIGHER BUT NOT DRAMATICALLY
DIFFERENT AND IT WAS BETTER AT
4.0 AND INTER PERSONAL VIOLENCE
BEING A GREATER PROBLEM IN SOME
LATIN AMERICA COUNTRIES AS WELL
AS SELF-HARM BEING LESS OF A
PROBLEM IN MOST LATIN AMERICAN
COUNTRIES COMPARED TO THE U.S.
LUNG CANCER MORTALITY IS TOBACCO
USE AND WE'VE SEEN IT RISE AND
FALL WITH THAT EPIDEMIC BEING
MANAGED AND YOU SEE THERE'S A
HIGHER MORTALITY FOR MEN WITH
LUNG CANCER THAN YOU UNITED
STATES OR CANADA WHICH IS A NEW
DEVELOPMENT IN THE LAST DECADE
MANY OF.
YOU SEE MUCH LOWER RATES IN
MEXICO.
LOOKING AT THIS FROM DIFFERENT
PERSPECTIVES WOULD BE OF
INTEREST TO HEALTH IN THE UNITED
STATES.
AS MORTALITY RATES THAT WAS DONE
BY AN INTRAMURAL GROUP HERE AT
NIH, PUBLISHED A COUPLE OF YEARS
AGO, AND THIS COMPARES AND THE
RED BARS U.S., AFRICAN
AMERICANS, U.S. WHITES, AND U.S.
LATINOS.
YOU SEE U.S. LATINOS DO WELL IN
OVER ALL MORTALITY AMONG MEN
COMPARED TO NOT ONLY LATIN
AMERICA BUT ALSO WHITE AND
AFRICAN AMERICAN COUNTERPARTS.
YOU SEE THAT MOST LATIN AMERICAN
COUNTRY WITH GOOD DATA ARE IN
BETWEEN WHITES AND AFRICAN
AMERICANS WITH A COUPLE DOING
BETTER THAN EVEN U.S. WHITES.
THIS INCLUDES NICARAGUA AND PERU
AND PANAMA.
THIS MIDDLE-INCOME PART OF THE
CONTINENT IS DOING GOOD IN TERMS
OF MORTALITY RATES AND THESE ARE
RATES FOR WOMEN, SIMILAR
RELATIONSHIPS, CARDIOVASCULAR
AND ACCIDENTS AND RESPIRATORY
DISEASE JUST TO GIVE YOU A
FLAVOR OF WHAT THESE RESULTS
WERE.
I WANT TO THANK YOU FOR JOINING
US TODAY AND THIS SCIENTIFIC
WORKSHOP.
I LOOK FORWARD TO THE EXCITING
PRESENTATIONS PLANNED OVER THE
NEXT TWO DAYS AND THANK YOU FOR
ATTENDING AND I LOOK FORWARD FOR
WHAT THIS WILL BE IN THE FUTURE.
>>THANK YOU FOR SETTING THE
STAGE FOR TODAY'S WORKSHOP AND
YOUR REMARKS TO ADVANCE SCIENCE
TO REDUCE HEALTH AND HEATH CARE
DISPARITIES FOR U.S. LATINOS.
IT'S MY HONOR TO OPEN THE
OPENING SESSION, HEALTH PROFILE
OF U.S. HISPANICS AND LATINOS IN
LATIN AMERICA.
>>Chair Aviles-Santa: GOOD
MORNING.
MY NAME IS LARISSA AVILES-SANTA
AND I AM THE DIRECTOR OF THE
DIVISION OF CLINICAL AND HEALTH
SERVICES RESEARCH AT THE NIMHD.
I'M HONORED TO SHARE SOME KEY
THOUGHTS ABOUT U.S. HISPANIC
LATINO HEALTH THAT WILL SERVE AS
BACKGROUND TO THE DISCUSSIONS
THAT WILL TAKE PLACE TODAY AND
TOMORROW.
IN 2020, 62.1 MILLION PERSONS
LIVING IN 50 STATES THAT IS NOT
INCLUDING PUERTO RICO AND THE
OTHER TERRITORIES,
SELF-IDENTIFIED AS HISPANIC OR
LATINO.
MAKING ALMOST 19% OF THE U.S.
POPULATION.
10 STATES HAVE THE HIGHEST
CONCENTRATION OF HISPANIC OR
ADEENE OWES AND ONE GROUP ARE
THE SECOND LARGEST RACIAL OR
ETHNIC GROUP IN THE U.S. AFTER
NON HISPANIC WHITES.
WITH THIS SIZE AND PRESENCE, IN
ACROSS THE U.S., UNDERSTANDING
THE HEALTH AND ADDRESSING THE
HEALTH DISPARITIES BY THIS
HEALTH POPULATION WOULD HAVE A
CRUCIAL INFLUENCE ON MANY LIVES
IN THE NATION.
FOR INSTANCE, AS ONE GROUP,
HISPANICS OR LATINOS LIVING IN
THE U.S. EXPERIENCE THE LONGEST
LIFE EXPECTANCY AFTER ASIANS.
FURTHERMORE, ON AVERAGE,
HISPANICS OR LATINOS LIVE TWO
YEARS LONGER THAN NON-HISPANIC
WHITES AND SEVEN YEARS LONGER AN
AFRICAN AMERICANS.
AND THE SAME TIME, THE
PREVALENCE OF CHRONIC DISEASESES
IN THIS POPULATION HAS BEEN
CONSPICUOUSLY INCREASES WHERE AS
THE AWARENESS, TREATMENT, AND
CONTROL OF THIS CONDITIONS HAS
REMAINED UNACCEPTABLY SUB
OPTIMAL.
VERY IMPORTANTLY, DIFFERENCES IN
THE PREVALENCE OF CHRONIC
DISEASES AMONG DIFFERENT
HERITAGE GROUPS HAVE BEEN
OPTIMAL.
THE STUDY OF LATINOS, BOTH MEN
AND WOMEN ARE SOUTH AMERICAN
DISSENT HAD THE HIGHEST PERCENT
OF PARTICIPANTS WITH NO
CARDIOVASCULAR RISK FACTORS,
HOWEVER, MEN AND WOMEN OF PUERTO
RICAN DISSENT HAVE THE HIGHEST
PERCENT OF PARTICIPANTS WITH
THREE OR MORE CARDIOVASCULAR
RISK FACTORS.
IN THE SAME STUDY, AT SIX YEARS,
AFTER BASELINE, THE INCIDENTS OF
DIABETES WAS THE HIGHEST AMONG
HISPANICS OR LATINOS OF MEXICAN,
PUERTO RICAN AND DOMINICAN
DISSENT AND THE PREVALENCE OF
DIABETES WAS THE HIGHEST IN
THESE POPULATIONS.
OF NOTE, DIFFERENCES IN THE
PREVALENCE OF DIABETES AMONG
MEXICANS, PUERTO RICANS AND
CUBANS HAVE BEEN DESCRIBED IN
THE HISPANIC HEALTH EXAMINATION
SURVEY IN THE 1980s.
IN OTHER WORDS, DIFFERENCES IN
THE PREVALENCE OF DIABETES AMONG
HISPANIC GROUPS HAVE BEEN
DOCUMENTED ALMOST 40 YEARS AGO.
ALSO, IN THE STUDY, THE
INCIDENTS OF CHRONIC KIDNEY
DISEASE WAS SIGNIFICANTLY HIGHER
AMONG PARTICIPANTS OF PUERTO
RICAN DISSENT AT SIX YEARS OF
FOLLOW-UP.
THIS AND OTHER DIFFERENCES IN
HEALTH OUTCOMES, LEAD US TO ASK,
WHY?
WHAT ARE THE MEDIATING FACTORS?
WITH THESE QUESTIONS IN MIND, WE
NEED TO REMEMBER THE DIVERSITY
OF THE ORIGINS OF THE HISPANIC
OR LATINO POPULATION.
HISPANIC OR LATINOS OF MEXICAN
DISSENT HAVE LIVED IN THIS LAND
LONG BEFORE THIS COUNTRY BECAME
TO BE KNOWN AS THE UNITED STATES
OF AMERICA.
THE EXPANSION TO THE WEST AND
THE MEXICAN-AMERICAN WAR, A
LARGE PORTION OF THE TERRITORY
OF MEXICO BECAME PART OF THE
UNITED STATES.
IN 1998, THE SPANISH-AMERICAN
WAR BROUGHT PUERTO RICO AS A
U.S. TERRITORY.
OTHER WORKFORCE RECRUITMENT
PROGRAMS WROTE MEXICANS AND
PUERTO RICANS TO WORK IN
AGRICULTURE AND INDUSTRY.
AND VARIOUS SOCIAL YO POLITICAL
EVENTS IN LATIN AMERICAN HAVE
TRIGGERED WAVES OF MIGRATION
FROM THE CARIBBEAN CENTRAL AND
SOUTH AMERICA.
IT'S CLEAR THAT U.S.
HISPANIC/LATINOS SHARE SOME
COMMONALITIES IN LANGUAGE,
CULTURE AND HISTORY.
AND AT THE SAME TIME, THEY ARE
ALSO LINGUISTICALLY HISTORICALLY
AND CULTURALLY DIVERSE.
IN FACT, A LARGE SIGNIFICANT
PREPORTION OF HISPANICS OR
LATINOS ARE BORN IN THE U.S. OR
THEIR FAMILIES HAVE LIVED IN THE
U.S. FOR GENERATIONS.
THE DIVERSITY OF THE PLACES
WHERE WE WORK, WHERE WE LIVE,
ALSO HAVE SOME EXPERIENCES
RELATED TO ENVIRONMENT,
OCCUPATION, PUBLIC AND
HEALTHCARE POLICIES, THAT
CLEARLY WILL INFLUENCE OUR
HEALTH.
FOR INSTANCE, AS I MENTIONED
BEFORE, 10 STATES HAVE THE
HIGHEST CONCENTRATION OF U.S.
HISPANIC LATINOS.
WITHIN THE LAST DECADE, THE
GROWTH OF THE TOTAL HISPANIC
LATINOS POPULATION HAS BEEN 23%
ON AVERAGE.
BUT IT'S NOT ONLY IN THOSE 10
STATES, IT'S ALSO IN OTHER NEW
LOCATIONS.
AND AT THE SAME TIME, ALTHOUGH
MANY ADVANCES AND PROGRESS HAS
BEEN MADE, IN THE PERCENT OF
PEOPLE WITH HEALTH INSURANCE,
THE NUMBER OF HISPANICS OR
LATINOS WITHOUT HEALTH INSURANCE
IS STILL HIGH.
IN ADDITION, DISPARITIES HAVE
BEEN DESCRIBED AMONG THOSE WITH
INSURANCE AND ESPECIALLY
MEDICARE AND ESPECIALLY
DISPARITIES IN THE ATTAINMENT OF
CARE AMONG BETWEEN MEDICARE
ENROLL'S IN PUERTO RICO COMPARED
TO LATINO/HISPANIC DISSENT IN
THE MAINLAND.
IN ADDITION, THE DIAGNOSIS OF
CONCERN CONDITIONS, ESPECIALLY
COGNITIVE DECLINE AND DEMENTIA,
TENDS TO BE UNTIMELY.
AND THE UTILIZATION OF
SCREENING, TESTS, LESS THAN
IDEAL.
IT'S VERY IMPORTANT TO NOTE THAT
MANY HISPANICS/LATINOS MAINTAIN
CLOSE CONTACT WITH THE COUNTRY
OF ORIGIN OR THE COUNTRY OF
ORIGIN OF THEIR ANCESTORS AND
FOR SOME, THIS CONTACT HAPPENS
ON A DAILY BASIS.
CONVERSELY, THE STUDY OF
HISPANIC/LATINOS HEALTH TENDS TO
HAPPEN WITHIN THE CONTEXT OF THE
U.S.
IT FOCUSES ON THE IMMEDIATE
ENVIRONMENT.
HOWEVER, IN THE SAME WAY, THAT
DIFFERENCES IN THE PREVALENCE OF
CHRONIC DISEASES AMONG THE
DIFFERENT U.S. HISPANIC/LATINOS
GROUPS HAVE BEEN DOCUMENTED,
ALSO THOSE DIFFERENCES HAVE BEEN
DOCUMENTED AMONG COUNTRIES IN
LATIN AMERICA.
LIKE OUR COLLEAGUES JAIME WILL
DISCUSS.
HEALTH RESEARCH PERFORMED IN
LATIN AMERICA, PROVIDES A
CRUCIAL OPPORTUNITY TO FURTHER
OUR UNDERSTANDING OF U.S.
HISPANIC-LATINO HEALTH THAT CAN
BE SOLELY ACCOMPLISHED IN THE
U.S.
LESSON LEARNED AND BEST
PRACTICES RELATED TO RESEARCH
AND EMERGING HEALTH RESEARCH
OPPORTUNITIES IN LATINO AMERICA
WOULD RESYNERGIES OUR COMMON
INTEREST IN IMPROVING HEALTH
OUTCOMES ACROSS THE HEMISPHERE.
>>THANK YOU FOR EVERYONE
JOINING US TODAY AND TOMORROW
AND WARPING IN VERY ENRICHING
CONVERSATIONS.
NOW, IRE COLLEAGUE JAIME MIRANDA
WILL SHARE INSIGHTS ABOUT
CHRONIC CONDITIONS IN LATIN
AMERICA.
THANK YOU.
>>IT'S VERY NICE TO BE JOINING
US ON THIS VIRTUAL HYBRID FORM
TO THIS EVENT THAT IS VERY
PROMISING AND I'M VERY PLEASED
TO HAVE BOTH COMMUNITIES GETTING
TOGETHER.
AND THIS IS MY SLIDES OF
DECLARATION OF CONFLICT OF
INTEREST.
AND AN ORIGINAL HAT I'M WEARING
IS THE MEMBER OF THIS GROUP OF
SCIENTISTS AND WE WERE
DESCRIBING 2018 AS INTER
DISCIPLINARY RESEARCH AND
THERE'S A MANY PART OF THE WORLD
AND I I SUPPOSE WE'RE DOING
SOMETHING GOOD IS THAT WORTH
SHARING WITH THE ENTIRE LATIN
COMMUNITY IN THE REGION.
I CANNOT DECIDE WITHOUT GIVING
MY THANKS TO ALL OF YOU, WHERE
YOU ARE WHERE YOU HAVE BEEN AND
WHERE YOU CONTINUE TO BE, FOR
YOUR EFFORTS AND WORK IN THE
LAST YEARS.
AND WHAT DO I THINK WHEN I HEAR
THE WORD LATINO/AMERICAN.
I AM FROM THE GENERATION OF THE
MID 1970s, 1970s THIS GRAPH
FROM 2000 ONWARDS AND WHAT I MAN
BY LONG-TERM POPULATION HANDY
CAPS THE RATES OF STANDING IN
THE POPULATION, PARTICULARLY MY
GENERATION, WE'RE VERY HIGH.
I'VE SEEN BREAKERS AND I NEED TO
DIG OUT MORE DETAILS BUT IT USED
TO BE AS HIGH A 50%.
1/2 HAVE SUFFERED THE EARLY
IMPACTS OF CHILDHOOD SO THAT'S
ONE BIOLOGICAL HANDICAP.
THE SECOND THING IS, REGION OF
MASSIVE RAPID CHANGES AND THIS
IS A PICTURE OF URBANIZATION.
WHERE YOU SEE IN THE AXIS 100
YEARS BEING PLOTTED AND THE
CURVE OF LATIN AMERICA IN THE
LIGHT BLUE, SEE HOW RAPIDLY IT
HAS OVER THE SCOPE OF A VERY FEW
DECADES AND THOSE CHANGES ARE
OBVIOUSLY GOING TO HAVE
IMPLICATIONS.
IMPLICATIONS THAT ARE
CONTEXTUALIZED WITH SOCIAL
STRUCTURES THAT ARE NOT
CONDUCIVE TO HIGH LEVELS OF
HEALTH.
WITH THAT COMBINATIONS AND
UNDERSTANDING BIOLOGY AND THE
CONTEXT AND WERE IN THAT
PUBLICATION WE PROPOSE THIS
CAPACITY MODEL WHEREBY, THE
BIOLOGICAL PICTURES AND
CHARACTERISTICS OF PARTICULAR
POPULATIONS BEING EXPOSED TO
HARDSHIPS IN INFANCY ARE
COMPOUNDED WITH ENVIRONMENT OF
TODAY, RIGHT.
LATIN AMERICA HAVE PARTICULAR
UNIQUE COMBINATIONS OF THE
STRESSES.
AND THIS MATTERS BECAUSE
ACHIEVING IN CHILDHOOD YOUR
DEVELOPMENTAL POTENTIAL HAS AN
IMPACT FOR LIFE.
THIS IS THE PRICE OF CHILD
SURVIVAL.
HERE IS A PICTURE OF NEURONS,
VERY DELICATE, FINE, VERY
CROSS-COMMUNICATED BEAUTIFUL
NEURONS AND THEN YOU HAVE NEXT
TO IT THIS LIGHT A KID WHO
SUFFERED SOMETHING AND YOU SEE
THE DEVELOPMENT OF THEIR BRAIN
IS LESS AWESOME, LESS GROTESQUE
AND THIS IS THE ENDING THAT YOU
CARRY ON INTO OTHER.
IF WE HAVE STUNTED CHILDREN AND
WE HAVE LARGE NUMBER OF COHORTS
WHO SUFFER STUNTING.
THEN WE CAN BE WITH THE STUNTED
BRAINS THE QUESTION IS, WHAT
ABOUT THE ORGANS?
ARE WE COMING WITH THE ORGANS AS
WELL?
THIS REPLICATIONS THEN AND
SOCIAL REPERCUSSIONS THAT HAVE
BEEN UNRAVELED AND PUT TO THE
FRONT DURING THE PANDEMIC.
I ALWAYS WANTED TO SEE PERU ON
THE FRONT PAGE OF THE "NEW YORK
TIMES" BUT NOT WITH IMAGES LIKE
THESE.
THEY'RE FAMILIAR FOR MANY OF US
AND MANY OF YOU, I SUPPOSE, AND
WHEN PEOPLE TALK ABOUT THE
HEALTH SITS TOM SYSTEM.
THIS IS THE VIDEO I HAVE TODAY
TRAVELING AROUND THE WORLD I
HAVE SEEN HOW THINGS ARE
OPERATING AND WORK BUT THIS IS A
PICTURE THAT I HAVE ON MY MIND
WHEN I HEAR ABOUT HEALTH
SYSTEMS.
WHERE DO WE GO FROM HERE?
ONE REFLECTION IS UNDERSTANDING
THIS TRANSITIONS AS A ENTIRE
REGISTER ON SO THEY'RE
TRANSITION THAT'S HAVE VERY
STRONG SOCIOECONOMIC PATTERNING.
WE DEMONSTRATED HOW THE OBESITY
TRANSITION IS DEPICTED OR
PICTURED OR ACCOMPANIED BY USING
DIFFERENT INDICATORS SO THE
MESSAGE IS THAT YOU DON'T HAVE
TO WAIT FOR A VISIT TO SEE MOST
DEPRIVED GROUPS TO TRY TO REACT
TO IT SO THERE'S AN OPPORTUNITY
THERE AND THEN ALSO THE
TRANSITION TO DIFFERENT MULTIPLE
COMMON RISK FACTORS FOR MANY OF
THE NCBs AND HERE WE SAW OVER
A STUDY PERIOD HOW THESE WERE
GROUPING TOGETHER AND CHANGING
RAPIDLY AND THEY'RE INSIGHTFUL
OBSERVATIONS PARTICULARLY FOR
THESE FEMALES.
AND FROM HERE, I WANT TO JUMP
INTO WHAT CAN WE LEARN?
WHAT CAN WE LEARN MOVING FORWARD
IN THESE TWO DAYS OF THIS EVENT.
TAKING ADVANTAGE OF THIS STUDY,
WE KNEW WHAT IS KNOWN FROM THE
DIFFERENCES THE MIGRANTS SERVE
AS A UNIQUE NATURAL EXPERIMENT,
HOW DO THEY MOVE AROUND.
WHEN WE DO THESE INTO A COHORT,
WE SAW THAT THE MIGRANTS HAVE
HIGHER INCIDENTS FOR OBESITY,
THE RURAL GROUP HIGHER INCIDENTS
FOR HYPERTENSION AND THE URBAN
GROUP HIGHER INCIDENTS FOR
DIABETES AND ANOTHER MESSAGE
THAT NOT EVERYBODY IS THE SAME,
IT'S CHALLENGES AND THE
DIFFERENT DIRECTIONS BETWEEN
HUMANS AND ENVIRONMENTS I'M
GOING TO GIVE US ON SIZE AND
VERY INFORMED RESPONSES.
AND IN THIS TYPE OF MORE INTO
INSIGHTS LATIN AMERICA IS A VERY
PECULIAR AND PARTICULAR WITH ALL
THESE GEOGRAPHIC DIVERSE TEASE
AND HERE WE DID THIS STUDY AND
PEOPLE IN URBAN AND RURAL POONA
WHICH IS 4,000 METERS ABOVE SEA
LEVEL AND ON THE BORDER WITH
EQUADOR.
THE PREVALENCE AND WEIGHT OF THE
ARROWS AND THE COMMON CONDITIONS
AND YOU SEE WHEN THE MESSAGE
HERE IS THAT ONE SIZE DOES NOT
FIT ALL.
AND THIS IS PARTICULARLY FOR THE
FIELD OF CARDIOVASCULAR.
WHICH MANY OTHER PUBLISHED AND
WHEN WE PLOTTED THOSE TOOLS, YOU
KNOW, DIFFERENT ENVIRONMENT AND
POPULATIONS WE SEE THEY PERFORM
DIFFERENTLY SO NOW I SAY LOOK,
WE NEED TO UNDERSTAND BETTER THE
POPULATION BEHIND IT AND THE
BASELINE LEVELS OF RISK FACTORS
ARE COEXISTENCE OF RISK FACTORS
IN THIS DIFFERENT POPULATIONS
ACKNOWLEDGING THAT INCOMPETENTES
ARE MULTIPLE AND DIVERSE.
WHAT DOES IT MEAN IN TERMS OF
INTERVENTION THIS IS WHAT CAN WE
DO FROM HERE?
NOW WITH THE PANDEMIC, WE HAVE
ALL SUPPORTING A MOVEMENT
TOWARDS TELEMEDICINE OR
TELEHEALTH OPTIONS AND HERE WHAT
WE'RE STUDYING WITH RIGHT BEFORE
THE PANDEMIC AND HAD TO SO WE
NEED A DOCTOR IT TELL YOU START
WITH OBSERVATION WHEN YOU BECOME
HYPHYPER TENSE I HAVE.
WE CAN DEMONSTRATE IMPORTANT
EFFECTS ON WEIGHT LOSS.
ONE OF THE STUDIES THE USE OF
FOOT THEY ARE MOM TREE AND WE
DESIGNED THIS TO IMPROVE IT FROM
A 30% ADHERENCE IN THE U.S. ON A
U.S. SETTING, TO 50%.
THE ACTUAL APPETITE WAS WELL 80%
SO IT WAS A NEGATIVE STUDY FOR
THE PROPOSED INTERVENTION BUT
ALSO IT TAUGHT US A LOT THAT
THERE WAS THESE WILLINGNESS OF
PEOPLE TO RECEIVE SOMETHING OUT
OF ASSISTANCE TO ANOTHER
APPROACH.
ALSO, YOU HERE TESTING WITH WHAT
OUTCOME.
THE OUTCOME FOR THESE RELEASING
SODIUM AND WAS SALE SO AN
INVITATION FOR US TO BE
VERSATILE TO BE OPEN AND TO BE
ADAPTIVE TO THE DIFFERENT NEEDS
OF THE DIFFERENT GROUPS AND I'M
GOING TO FINISH HERE WITH TWO
STUDIES.
THEY WILL TELL US ALSO HOW ON
THE FOREFRONT OF HIGH-QUALITY
RESEARCH THAT CAN BENEFIT THE
LATINO COMMUNITY IN THE U.S.
THIS IS USING SALT SUBSTITUTES
WHERE PART OF THE SODIUM IS
REPLACED BY POTASSIUM AND THEY
ARE WORKING TOWARDS REDUCING
BLOOD PRESSURE AND THE QUESTION
IS HERE HOW TO SHAPE PRESSURE
AND WORKING WITH THE GROUPS AT
HIGH-RISK AND HOW CAN WE COVER
THE ENTIRE GROUPS AND ENTIRE
POPULATION AND WE
DEMONSTRATESSED BENEFITS IN
THERE.
HERE IS ANOTHER ONE AND ANOTHER
STUDY THAT WAS CONDUCTED IN
BRAZIL AND PERU AND AGAIN, THE
ONE IN PERU IS DIFFERENT AND
THEY HAVE A ROLE IN REDUCING THE
DEPRESSIVE SYMPTOMS IN PERU SO
ANOTHER TO SHARE.
PERSEVERANCE AND PERSEVERANCE
AND I WANT THIS CONVERSATION WE
START TODAY TO BE CONTINUED AND
THANK YOU TO MY GROUP LIVING
WITH AGAIN OWE RECEIPT TEE AND U
VERY MUCH AND I WILL STOP HERE.
BYE FOR NOW.
>>Chair Aviles-Santa: THANK YOU
FOR YOUR VERY INSIGHTFUL NOTE
ABOUT LATIN AMERICA.
THIS IS LARISSA AVILES-SANTA.
AND NOW, WE WILL TRANSITION TO
THE VERY FIRST TOPIC OF THE
WORKSHOP.
DIABETES.
OUR PANELISTS ARE BA PABLO
ASCHNER AND DID JUAN JOSE
GAGLIARDINO.
WE WILL HAVE A LIVE Q&A AFTER
THE PRESENTATIONS.
>>HELLO.
THANK YOU FOR IN INVITING ME TO
THIS VERY INTERESTING WORKSHOP.
I'M GOING TO PRESENT HERE SOME
EVIDENCE, REAL-WORLD EVIDENCE,
IN PREVENTION OF TYPE-2 DIABETES
WHICH WAS IN LATIN AMERICA
SPECIFICALLY IN COLOMBIA.
I WANT TO START BY SHOWING THE
PREVALENCE OF THE TOLERANCE
AROUND THE WORLD BECAUSE PEOPLE
WITH IMPAIRED GLUCOSE TOLERANCE
ARE THOSE AT HIGHER RISK OF
DEVELOPING DIABETES.
AND AS YOU CAN SEE, SOUTH
AMERICA AND CENTRAL AND NORTH
AMERICA ARE IN THE MEDIUM TO
HIGH RANGE OF IGT PREVALENCE.
WHEN WE LOOK AT THE THOSE WITH
THE -- COUNTRIES WITH LOW INCOME
ARE THOSE WITH THE HIGHEST
PREVALENCE OF IGT ALTHOUGH THE
NUMBER IS NOT AS HIGH AS IN THE
OTHER COUNTRIES.
AND WHEN WE COMPARE THE
PREVALENCE OF IGT WITH THE
PREVALENCE OF DIABETES, WE CAN
SEE THAT IN ALL THE COUNTRIES OR
IN MOST COUNTRIES, IGT
PREVALENCE IS EQUAL OR HIGHER
THAN THAT OF DIABETES, WHICH
MEANS THAT THIS IS A BIG PROBLEM
BECAUSE THESE PEOPLE ARE SO TO
SPEAK, IN LINE TO DEVELOP
DIABETES IN THE NEAR FUTURE AND
ACTUALLY THE CONVERSION OF TWO
DIABETES AND THE COMMUNITY OF
INCIDENTS AT ONE YEAR IS 13% AND
CAN BE AS HIGH AS 23% BUT 20
YEARS, IT'S ALMOST 70% AND THERE
HAVE BEEN STRATEGIES, SUCCESSFUL
STRATEGIES TO PREVENT
PROGRESSION TO DIABETES IN
PEOPLE WITH IGT AND OTHER FORMS
OF PRE DIABETES AND THIS IS A
META ANALYSIS WHERE WE CAN SEE
THAT THE BEST STRATEGY FOR THAT
HAS BEEN THE BARIATRIC SURGERY
AND WE KNOW THAT IS THE BEST
STRATEGY ALSO TO LOSE WEIGHT
WITHOUT RISK REDUCTION OF AROUND
84% BUT I WANT TO EMPHASIS THIS
STUDIES THAT HAVE BEEN DONE WITH
CHANGES IN LIFESTYLE WHICH CAN
OBTAIN A REDUCTION OF AROUND 50%
OR MORE IN THE PROGRESSION TO
DIABETES.
AND WE WANTED TO SEE WHETHER
THIS IS FEASIBLE IN REAL LIFE IN
OUR COUNTRY IN COLOMBIA, SO THIS
WAS DONE IN THE CARIBBEAN COAST
WHERE MORE THAN 14,000 PEOPLE
WERE SCREENED WITH A FIN RISK
WHICH WAS DEVELOPED IN FINLAND
AROUND THE THIRD HAD A FINDRISC
OF 12 WHICH IS OUR CUT OFF OF
PREDICTING THE PRESENCE OF
DIABETES OR IN HYPER GLYCEMIA
AND THEY WERE INVITE TODAY A
OGTT AND 13% HAD ACTUALLY
UNKNOWN TYPE-2 DIABETES AND
AROUND 28% HAD ONE FORM OF PRE
DIABETES EITHER IFG, IGT OR
BOTH.
AND THESE WERE THE PEOPLE THAT
WERE INVITED TO THE STUDY AND
THEY WERE RANDOMIZED TO
LIFESTYLE INTERVENTION OR TO A
CONTROL GROUP.
THE LIFESTYLE INTERVENTION THERE
WERE TWO GROUPS, ONE WHICH
STARTED WITH NUTRITIONISTS
INTERVENTION THE OTHER WITH
EXERCISE AND THE SIX TO 12
MONTHS BOTH GROUPS WERE DOING
BOTH STRATEGIES.
AND THE GOALS WERE SIMILAR TO
THE DIABETES PREVENTION STUDY
DONE IN FINLAND AND THE STUDY
LED BY Dr. TOMMY LETO WHO WAS
WAS A P.I. FOR THESE STUDY.
AND AFTER TWO YEARS FOLLOW-UP
THESE ARE THE PEOPLE REMAINING
IN THE PROGRAM AND THERE WAS NO
DIFFERENCE IN THE REVERSAL TO
NORMAL GLUCOSE TOLERANCE BETWEEN
THE GROUPS AND THERE WAS NO
DIFFERENCE ALSO IN THE
PROGRESSION TO DIABETES IN THE
DIFFERENT GROUPS.
BUT, THERE WAS A REDUCTION, A
SIGNIFICANT REDUCTION IN THE
BLOOD GLUCOSE POST GLUCOSE LOAD
SUGGESTING SOME CONTAMINATION
FROM THE CONTROL GROUPS POSITIVE
CONTAMINATION PROBABLY BECAUSE
THEY LIVE IN THE SAME AREA AND
THEY MAY HAVE ADOPTED THE SAME
CHANGES IN LIFESTYLE, ACTUALLY,
THE CONVERSION TO DIABETES WAS
AROUND 5% AND SO TO FURTHER
EXPLORE THIS, WE DID THIS, WE
ARE DOING THIS PROJECT WHICH IS
JUST FINISHING IN OUR CAPITOL
CITY AND IS IN ANDEAN REGION WE
SCREENED 3,000 ALMOST 4,000
PEOPLE APPROPRIATE FOR OUR
POPULATIONS AND WE DID THE SAME
AND OGTT ON THOSE WHICH HAD A
HIGH FINDRISC AND WE HAD A LOWER
PREVALENCE OF TYPE-2 DIABETES
AND AROUND 5.5% AND AROUND 13
ALMOST 14% HAD IGT WHICH IS THE
GROUP WE CONSIDERED HIGH-RISK.
THE REST WERE MODERATE RISK AND
TYPE-2 DIABETES WAS REFERRED TO
HEALTH SERVICE AND PEOPLE WITH
IGT WERE INVITED TO JOIN A
STRUCTURE PROGRAM THAT I WILL
EXPLAIN LATER AND WE NEEDED A
NUMBER OF 1 OTHER AND WE GOT
THAT AND FOR THE MODERATE RISK,
WE GAVE THEM GENERAL INFORMATION
ON DIABETES PREVENTION AND
CHANGES IN LIFESTYLE AND THOSE
WHO HAVE THE LOW FINDRISC LESS
EQUAL TO 12 THEY WERE LOW RISK
AND THEY WERE INVOLVED IN A
COMMUNITY PROGRAM BASED ON
INTERVENTION MAPPING AND AT THE
BEGINNING, THERE WAS A RANDOM
SAMPLE AMONG THEM AND FOR SOME
TESTS AND AFTER A YEAR, THE
PEOPLE IN THE HIGH-RISK GROUP
ARE AGAIN TESTED WITH AN OGTT
AND THE MAIN OBJECTS, THE MAIN
OUTCOMES WERE CHANGES IN WEIGHT
AND GLYCEMIC STATUS AND THE REST
WERE SELECTED AT RANDOM FOR A
NEW TEST AND TO COMPARE CHANGES
IN THE PARAMETER AND SO THE
INTERVENTION OF THE HIGH-RISK
GROUP WAS DONE BASED ON THE
NATIONAL DIABETES PREVENTION
PROGRAM IN THE U.S. WHICH IS
COORDINATED BY THE CDC AND
ADOPTED FOR HISPANICS.
IT'S A 26-SESSION PROGRAM
LASTING ONE YEAR AND WE THOUGHT
THAT WAS TOO MUCH FOR OUR
POPULATION SO WITH PERMISSION OF
BETSY RODRIGUEZ, THE COORDINATOR
OF THIS ADD APPLICATION, WE
ADAPTED IT AGAIN TO THE ONLY 10
GROUP SESSIONS COMPRISING
NUTRITION AND PHYSICAL ACTIVITY
WORKSHOPS OF 1.5 HOURS EACH AND
SMALL GROUPS WORKSHOPS AND THIS
SESSIONS WERE LED BY CULTURES
FROM THE COMMUNITY WHICH THEY
WERE PREVIOUS TRAINED BY
RESEARCH GROUP AND SUPER ARE
VICED BY A FIELD COORDINATOR AND
WE USE TO CONDUCT THE PEOPLE
WITH MOBILE PHONES.
SO 87 SUBJECT AROUND 57% OF
THOSE IN THE HIGH-RISK GROUP
COMPLETED THIS STRUCTURED
PREVENTION PROGRAM.
THOSE ARE THE MAIN
CHARACTERISTICS INCLUDING A BMI
OF 31 KILOGRAMS SUPERVISOR
SQUARE METER AND THERE WAS A
MEDIUM CHANGE TO OUR BLOOD
GLUCOSE AND IT WAS SIGNIFICANT
AND THE WEIGHT CHANGE OF ONE
YEAR WAS -2° .4 BUT 78% OF THE
PEOPLE LOST WEIGHT AND WAS
ALMOST FOUR KILOGRAMS AND THE
GLYCEMIC STATUS 60% REVERSE TO
NORMAL GLUCOSE TOLERANCE AND 1%
PROGRESSES ONE OF THE MAIN
DRIVING FACTORS IN THIS NETWORK
OF STUDIES IN REAL LIFE, WE CAN
SEE IN A MATTER THE WEIGHT LOSS
WAS ASSOCIATED WITH A LOWER RISK
OF DEVELOPING DIABETES, ONE
KILOGRAM LOST ASSOCIATED WITH A
43% LOWER RISK OF DEVELOPING
DIABETES.
SO, TO CONCLUDE, I BELIEVE THAT
IT CAN BE DONE AND THE
PREVENTION OF TYPE-2 DIABETES,
WITH LIFESTYLE CHANGES AND EVEN
IN COMMUNITIES SUCH AS OURS.
THANK YOU, VERY MUCH.
>>GOOD MORNING, AUDIENCE.
I WOULD LIKE TO THANK THERESA
AND HER TEAM TO PARTICIPATE IN
THIS IMPORTANT OFTEN AND -- I WF
ALL TO START WITH THE WE HAVE IN
THE WORLD 537 MILLION HAVING
DIABETES.
32 MILLION OF THEM ARE LOCATED
IN OUR SOUTH AMERICAN AND
CENTRAL AMERICAN REGION.
541 MILLION ADULTS HAVE
PRE-DIABETES THAT MEANS THAT
THEY HAVE HIGH-RISK OF
DEVELOPING THE DISEASE.
DIABETES ON THE OTHER SIDE HAVE
PRODUCED 6.7 MILLION DEATHS IN
THE LAST YEAR AND IS RESPONSIBLE
OF PAY ATTENTION TO THIS DATA
BECAUSE AROUND 966 BILLION
AMERICAN DOLLARS EXPENDITURES
RELATED TO THE TREATMENT AND AN
INCREMENT THAT REPRESENTS 316%
COMPARED TO THE LAST 15 YEARS.
IN ADDITION, THE WHO HAVE MADE
PROGNOSIS THE NEXT PANDEMIC IN
THE 21st CENTURY IS GOING TO
BE DIABETES AND OBESITY.
THAT WAS A PROGNOSIS BUT NOW WE
HAVE SOME COMPARISON AND
SIGNIFICANT DATA TO COMPARE
WITH.
CORONAVIRUS HAS PRODUCED ONLY
INFECTED PEOPLE 346 MILLION OF
THEM AND PRODUCED 5.9 MILLION OF
THIS AND THIS IS SIGNIFICANT AND
THE PROGNOSIS IS THE WHO IS NOT
THE PROGNOSIS IS A FACT AND AND
NOW WE ARE GOING TO PRESENT AND
AMERICAN AND IT'S LISTED HERE
AND IF WE COMPARE WHAT HAPPENED
WITH ONE OF THEM, DIABETES, FROM
2005, AND 2018 YOU CAN SEE HERE
THAT IT WENT TO 8.5 TO 12.7
MEANING 51% INCREASE AND OBESITY
AT THE SAME TIME COULD HAVE 74%
AND IF WE DON'T TAKE CARE OF
HIGH CONSIDERATION ABOUT THESE
FIGURES, THESE THINGS, OBESITY
IS GOING TO BE SLOWLY COMING
DOWN TO DIABETES AND INCREASING
AGAIN.
WE ARE TALKING ABOUT ALL OF
DIABETES BUT WE DON'T HAVE PRE
DIABETES.
AND PRE DIABETES ARE COMING HERE
FROM ONE OF OUR STUDIES AND MAKE
IT PREVENTION STUDY ABOUT TYPE-2
DIABETES IS HEALTHY HABITS AND
WE HAVE A STUDY IN THE PROVINCE
AND TO INCLUDE THE POPULATION WE
APPLIED THE AND THE IT WAS ONE
OF OUR ADVISERS WHEN WE GO TO
FIELD RISK AND 13 POINTS WE HAVE
TO KNOW EXACTLY WHAT HAPPENED
WITH A NUMBER OF PRE DIABETES
AND FROM THIS CENTER, WE HAVE
41% PEOPLE WITH PRE DIABETES AND
ALSO, WE HAVE 5% AND DIAGNOSED
TYPE-2 DIABETES AND UNFORT THESE
ARE NOT TREATED.
WHAT ABOUT THE PEOPLE WITH PRE
DIABETES?
WE HAVE FASTING GLUCOSE AND THE
FIRST STAGE OF THE DISEASE AND
14% WITH IMPAIRED SECOND STATION
OVER THE DISEASES AND 17% OF
ALMOST -- 17% HAVE COMPARED
DISEASES AND WHY IS IT IMPORTANT
THIS KNOWLEDGE?
BECAUSE, THE ANNUAL TRANSITION
RATE OF DIABETES ACCORDING TO
THE METABOLIC DYSFUNCTION AND
THE, IF YOU COMPARE FASTING
GLUCOSE, THIS RATE IS 4.66 AND
IF YOU HAVE BOTH, YOU HAVE 12%.
IT MEANS THAT IF YOU ARE A
PERSON WITH PRE DIABETES AND THE
PHYSICIAN PAYS ATTENTION TO
THESE THINGS, WE'LL MAKE IT
HEALTHY HABITS TO PREVENT THE
TRANSITION RATE THAT IS SHOWN
HERE.
NOW, EVEN EXAMPLE OF DIRECT COST
THAT WE HAVE AN IMPACT ON THE
HEALTH SYSTEM, FROM THIS STUDY
THAT WE HAVE MENTIONED BEFORE.
AND WE HAVE INCLUDED IN THIS
TABLE, ALL THE THINGS THAT WE
HAVE CONSIDERED FROM THE POINT
OF VIEW OF COURSE AND WE HAVE
EXPRESSED A TOTAL COST BY AND
INDEPENDENT OF THE ARGENTINE AN
PESO THAT IS HERE YOU PAY
ATTENTION TO THE RATE OF
INCREASE AND IF YOU COMPARE THE
GROUP OF CONTROL, PEOPLE WITHOUT
DIABETES, AND PEOPLE WITH
DIABETES BUT WITHOUT
COMPLICATIONS, THIS INCREASE FOR
5.8 AND TO 9.04 MEANS 78%
INCREASE AND IF YOU HAVE ALREADY
DEVELOPED DIABETES
COMPLICATIONS, YOU GO FROM 5.8
IN A CONTROLLED TO 260 TIMES THE
INCREASING COST.
THAT MEANS THAT WE HAVE TO
PREVENT AT ANY PRICE, THE
DEVELOPMENT OF COMPLICATIONS TO
CUT DOWN THE COSTS.
NOW, THIS IS ONE SIDE OF THE
COIN, BECAUSE EVERYBODY KNOWS,
THAT YOU HAVE POVERTY ASSOCIATED
WITH LOW LEVEL OF EDUCATION, AND
YOU PROMOTE DIABETES.
NOW, WHAT IS THE IMPACT OF
DIABETES UPON THIS SOCIOCULTURAL
DEVELOPMENT AND THIS IS FROM A
STUDY THAT WE REPORTED FROM
2014, AND YOU HAVE SEEN FOR
EXAMPLE THE EDUCATION IN
ARGENTINA THE FORMAL EDUCATION
AND PRIMARY SCHOOL IS OBLIGATORY
AND YOU COME DOWN FROM ALMOST
14% IN THE CONTROL AND TO 12.2
IN THE TYPE-2 DIABETES WITH
COMPLICATIONS.
WHAT ABOUT UNIVERSITY ARE
COMPLETED.
THIS IS MORE IMPACTED AND YOU
HAVE COMING DOWN FROM 55% TO 43%
AND FROM THE POINT OF VIEW IF
YOU COMPARE FULL-TIME OR
PART-TIME JOBS YOU COME FROM 43%
IN THE CONTROL TO 27% IN THE
TYPE-2 DIABETESES WITH
COMPLICATIONS.
WHAT ABOUT THE MONTHLY INCOME?
THE MINIMAL SALARY COMING DOWN
FROM 53% IN CONTROL TO 25% IN
DIABETES WITH COMPLICATIONS BUT
IN ANY CONTROL, IN ANY CASE, IF
WE COMPARE MEN WITH WOMEN, YOU
SEE THE FIGURES ARE RESPONDING
TO THE WOMAN ARE MORE EFFECTIVE
THAN THE MALE.
THIS IS NOT AN ARGENTINIAN
PHENOMENON, IT'S WORLDWIDE,
UNFORTUNATELY IT'S ASSOCIATED
WITH THE GENDER.
NOW, BASED ON THAT DATA, WE
BELIEVE WE PROPOSE THAT THIS IS
GOING TO PROMOTE FROM POVERTY
AND EDUCATION DEFICIT AND TO
TYPE-2 DIABETES COMPLICATION AND
FROM THESE COMPLICATIONS YOU
HAVE A LOW SOCIOECONOMIC
DEVELOPMENT AND IT'S GOING AND
GOING AND EVEN IF YOU DON'T STOP
ANY TIME, IN ANY POINT, THIS IS
GOING TO BE WORSE AND WORSE AND
WORSE.
NOW, WHAT ABOUT QUALITY OF CARE
PROVIDED TO THE POPULATION THAT
IS IN OUR COUNTRY AND WE HAVE A
STUDY AND WITH 2,550 PATIENTS
WITH DIABETES 2 DIABETES AND 8%
OF THEM TREATED BY
DIABETOLOGISTS AND WE HAVE SEEN
THAT WHAT HAPPENED WITH THE
PATIENTS ACCORDING TO THE
DURATION OF THE EXPRESS IN YEARS
AND BELOW 7 AND WE HAVE 78% AS
SOON AS WE GET TREAT TREATED.
WE GET 61% ACTIVE 6% OR THE SIX
YEARS IN 10 YEARS AND YOU HAVE
MORE THAN 10 YEARS, YOU HAVE 54%
THAT MEANS THAT THESE ARE THE
PATIENCE THAT THEY WERE
CARDIOMETABOLIC AND GLUCOSE MA
LAB LIS HAVE REMAINED.
BUT AS SOON AS YOU REGRESS THE
CELLS REMAIN IN THE BODY AND BY
THE COMBINATION THEY DO IT OF
PATIENCE AND PHYSICIANS YOU CAN
DOWN THIS RULE OF 7% REALLY
DRAMATICALLY THAT MEANS THAT
EVEN A PERCENT YEARS AFTER THE
DISCOVERY, AND FACILITY THAT WE
HAVE WITH YOU STILL HAVE TO
LEARN HOW TO HANDLE THE THIS AND
TREATMENT.
THIS IS THE ONLY PROBLEM THAT WE
HAVE RIGHT NOW.
WE HAVE SOMETHING ELSE.
GLUCOSE LEVELS IS THE DIAGNOSIS
FOR DIABETES AND THE CONTROL
THAT WE HAVE.
BUT TYPE-2 DIABETES, THE MOST
FREQUENT VERSION OF THE DISEASE,
IS NOT ONLY GRO GLUCOSE IT'S
HYPERTENSION, OBESITY, AND THIS
EP DEEMIA AND TO DEMONSTRATE
THAT YOU HAVE TO TAKE CARE OF
THE WHOLE PICTURE TO HAVE A
PRIMARY PREVENTION OF THESE
THINGS AND WHAT HAPPENS IN OUR
CASE?
WE ATTAIN COMBINED GOALS.
IF YOU CONSIDER ORAL ANTIBIOTIC
BUT IF YOU GO TO SIN INSULIN YE
DOWN TO 2.7 AND PAY ATTENTION TO
THESE.
OAD THAT WE SUGGEST WE'VE TAKEN
ACTION NOW AND PAY ATTENTION TO
CUT DOWN THIS SITUATION.
>>GOOD MORNING, EVERYONE.
WE ARE BACK.
THANK YOU TO Dr. ASCHNER AND
Dr. GAGLIARDINO ABOUT DIABETES
AND PREVENTING DIABETES.
NOW WE START THE LIVE Q&A WITH
BOTH OF THEM.
SO I WOULD LIKE TO START WITH
THE FIRST QUESTION.
AND BY THE WAY, THIS Q&A WILL BE
ABOUT 19 MINUTES LONG AND WE
HAVE A BREAK AT 9:45A.M.
THE FIRST QUESTION IS FOR Dr.
ASCHNER, AND THE EXPLANATION OF
THE PREVENTION STUDY THAT WAS
PERFORMED, AND IS THE PREVENTION
STUDY GOING ON STILL AND ANY
FOLLOW-UP BEYOND 12 MONTHS?
IF YOU HAVE CONTINUED THE STUDY,
WE WOULD LIKE TO HEAR MORE ABOUT
WHAT HAS MADE IT SUCCESSFUL?
EITHER IN THE FIRST 12 MONTHS
AND LATER.
AND ALSO, ANY POTENTIAL OR PLANS
FOR SCALING IT UP?
>>WELL, THANK YOU LARISSA AND
THE ANSWER IS NO, WE HAVEN'T
FOLLOWED THE STUDY NOW.
IT WAS KIND OF A PROOF OF
CONCEPT.
WE WANTED TO SEE WHETHER IN REAL
LIFE WE COULD IMPLEMENT SUCH A
PROBLPROGRAM HAS THE ONE DONE IE
U.S.
AND BASICALLY, WE WANTED TO SEE
IF WE COULD SHORTEN IT WHICH WE
DID, AND WHETHER THAT WOULD WORK
BUT OUR MAIN OUTCOMES WAS NOT
THE REDUCTION IN THE INCIDENTS
OF DIABETES BUT ACTUALLY
REDUCTION IN WEIGHT BECAUSE IT
WAS A SHORT TIME TO DEMONSTRATE
ANY CHANGES IN DIABETES
INCIDENTS.
AND WE DID SHOW THAT LOSING
WEIGHT IS POSSIBLE BUT TO SEE A
LONG -- I MEAN, TO SEE RESULTS
AT THE LONGER TIME, WE HAVEN'T
FOLLOWED THEM BUT WE WOULD, I
WOULD SUGGEST AND THINK THAT THE
MAIN FACTOR TO SEE PROLONGED
EFFECT OF THE INTERVENTIONS, IS
TO THE WEIGHT LOST WITH NOT BE
INCREASING LATER ON.
SO I WOULD SAY THAT STRATEGIES
TO KEEP THE WEIGHT LOSS TO AVOID
WEIGHT GAIN AND TO CONTINUE
LOSING WEIGHT AND CHANGE A
LIFESTYLE HABITS, THE LIFESTYLE,
ARE ESSENTIAL.
WE WANTED TO HAVE THE LOW RISK
GROUP AS I MENTIONED AND THAT
WAS UNFORTUNATE BECAUSE WE HAD
THE PANDEMIC.
JUST WHEN WE STARTED THAT, THE
PANDEMIC CAME AND PEOPLE WERE
KEPT IN THEIR HOUSES AND AS WE
LEARNED FROM A QUESTIONNAIRE, WE
GAVE TO THEM AND THEY WORKED
MUCH LESS, THEY INCREASED THEIR
FOOD INTAKE OF STARCH MAINLY
ALTHOUGH THE GENERAL FOOD INTAKE
WAS DECREASED BECAUSE OF THE
UNAVAILABILITY AND THESE WERE
PEOPLE WITH LOW INCOME SO WE
HAVEN'T BEEN REALLY ABLE TO
CONCLUDE WHAT WE WANTED FROM THE
LOW RISK GROUP AND THAT IS WHAT
WE'RE DOING NOW.
TRYING TO UNDERSTAND WHAT
HAPPENED WITH THEM.
ABOUT SCALING, WELL,NESS, I
THINK THAT BEING ABLE TO LOWER
IT TO AROUND 10 SESSIONS, THAT'S
FEASIBLE AND THAT CAN BE SCALED
AND WE HOPE TO DO THAT IN THE
NEAR FUTURE.
>>Chair Aviles-Santa: THANK
YOU.
THANK YOU VERY MUCH.
WHAT ARE THE CHALLENGES RELATED
TO TIMELY SCREENING ASK
DIAGNOSIS OF DIABETES,
ESPECIALLY CONSIDERING THE
CONTEXT OF POVERTY OR EVEN LOW
RESOURCE SETTINGS?
AND NOT ADEQUATE ACCESS TO
MEDICAL CARE, WE HEARD OF YOUR
MODEL AND YOUR INTERVENTION AND
WE WOULD LIKE TO HEAR MORE ABOUT
THE SOCIAL CHALLENGES AND WHAT
ARE THE POTENTIAL SOLUTIONS TO
OVERCOME AND MAKE THIS
INTERVENTIONS MORE EFFECTIVE AT
COULD BE REACHED BY THE
POPULATION.
>>THANK YOU, LARISSA.
YES, THE QUESTION IS QUITE
CLEAR.
ON THE DIAGNOSIS FROM THE POINT
OF VIEW FROM THE COST, FOR US,
THE BEST IDEA IS TO COMBINE THE
FIELD RISK THAT IS ONLY PENCIL
AND PAPER NOT MORE ON THAT AND
JUST IN CASE THAT YOU HAVE A
SCORE OF 8 OR 13, WE PERFORM A
GLUCOSE TEST BECAUSE IT SEEMS
IT'S ONLY HAVE TO MEASURE BLOOD
GLUCOSE AND IT'S VERY SIMPLE,
IT'S QUITE WELL STANDARDIZED
ANYWHERE.
AND WITH THIS CONDITION, WE CAN
APPLY A PREVENTION STRATEGY
BASED ON EDUCATION AND EDUCATION
IS A GOOD WAY TO PROMOTE EARLY
REACTION AND EARLY TREATMENT FOR
THE PATIENT AND IN OUR CASE IT'S
THE BEST WAY AND THE MOST
EFFECTIVE WAY TO TREAT THE
PATIENTS AND TO AFTER THE
DIAGNOSIS HA I MENTIONED HOW TO
DO IT AND THANK YOU.
>>Chair Aviles-Santa: THANK
YOU, DOCTOR.
NOW, FOR Dr. ASCHNER, HAVE
DIABETES PREVENTION PROGRAMS
ALSO DEMONSTRATED THE PREVENTION
OF CARDIOVASCULAR DISEASE IN
LATIN AMERICA?
OR DO YOU THINK THAT WITHIN THE
CONTEXT OF DIABETES PREVENTION
PROGRAMS, OTHER PREVENTIONS
COULD BE INTEGRATED FOR OTHER
CHRONIC CONDITIONS COULD BE
INTEGRATED AND HOW?
>>THAT'S A VERY CHALLENGING
QUESTION BECAUSE, IT IS NOT EASY
TO DEMONSTRATE WHETHER THERE'S A
LOWER INCIDENTS OF
CARDIOVASCULAR DISEASE BY
PREVENTING DIABETES.
IT SEEMS TO BE FROM THE
THEORETICAL POINT OF VIEW IT
SEEMS TO BE THE CASE BUT WE
DON'T KNOW BECAUSE WE ARE ONLY
IF WE DO REALLY CHANGE THE
NATURAL HISTORY OF DIABETES, WE
WOULD EXPECT LESS CARDIOVASCULAR
DISEASE BUT CERTAINLY ANY
STRATEGY THAT UNCOVERS THE RISK
THAT CALLS FOR ACTION AND IF WE
ACTUALLY DO ACT IN TERMS OF
CHANGING LIFESTYLE WILL
CERTAINLY BE LESS CARDIOVASCULAR
IN THE INCIDENTS OF CARD YE
VASCULAR ACCIDENTS AND THAT
HASN'T BEEN PROVEN AND CERTAINLY
NOT IN LATIN AMERICA.
AND ON THE OTHER HAND, YOU ARE
RIGHT, THE STRATEGY SHOULD BE
COMPREHENSIVE AND NOT JUST
FOCUSING ON BLOOD GLUCOSE BUT
ALSO FOCUSING ON LIPIDS,
FOCUSING ON HYPERTENSION, AND
DEFINITELY FOCUSING ON OBESITY
AND THAT IS FUNDAMENTAL AND ALSO
OTHER BAD HABITS SO TO SPEAK AND
WE'RE ACTUALLY DOING THAT
BECAUSE STUDYING WHAT HAPPENED
WITH HIM BECAUSE WE ENDED UP
BEING EXPLORE THE RISK FACTORS
AND SEEING WHAT KIND OF CHANGES
WE WERE WELCOME BACK TO OBTAIN.
>>THANK YOU Dr. ASCHNER.
THANK YOU, VERY MUCH.
I HAVE A QUESTION FOR THE TWO OF
YOU.
ACTUALLY TWO QUESTIONS.
SO, ONE OF THEM IS, HOW WOULD
YOU DESCRIBE THE IDEAL IMAGE TO
PROMOTE DIABETES PREVENTION AND
ACROSS LATIN AMERICA AND U.S.
HISPANICS LATINOS.
WHAT COMPONENTS, WHO WOULD BE
THE MAIN PLAYERS, ACADEMIC
CENTERS AND COMMUNITIES AND
ORGANIZATIONS AND WHAT KIND OF
RESEARCH WOULD BE INVOLVED OR
EVEN RESEARCH CAPACITY?
>>GO AHEAD.
>>OK.
FROM MAYBE PROBLEM IS PROBLEM OF
FATE AND YOU BELIEVE IN THAT IF
YOU ADOPT HEALTHY HABITS, WE ARE
GOING TO PREVENT CARDIOVASCULAR
DIABETES AND IN OUR CASE, WE
STILL BELIEVE THAT THIS IS
REALLY TRUE AND AGAIN, FROM OUR
POINT OF VIEW, EDUCATION AT
EVERY LEVEL IS THE BEST WAY TO
OBTAIN PREVENTION AND PREVENTION
FIRST COST AND THE SECOND ONE IS
TREATMENT OF THE THREE THINGS
SUGGESTED BY THEM BY THE AIM
MEANS HYPERTENSION OBESITY AND
HYPER GLYCEMIA AND IF YOU GET
ALL THINGS TOGETHER YOU ARE
GOING TO BE PREVENT
COMPLICATIONS, FIRST OF ALL THE
DIABETES DISEASE AND SECOND THE
COMPLICATIONS THAT IS THE SIMPLE
RECIPE DIFFICULT TO GET IT AND
VERY, VERY COMPLICATE AND YOU
HAVE TO HAVE A VERY GOOD TEAM
READY TO ACT IMMEDIATELY AND AS
SOON AS POSSIBLE AND TO
TREATMENT ALL THE COMPLICATIONS
THAT YOU HAVE TO PREVENT.
THANK YOU.
>>I AGREE AND I WOULD SAY THIS
WOULD BE A PARALLEL STRATEGY AS
IN TERMS OF USING RESOURCES, FOR
EXAMPLE, WE CONDITION USE THE
RESOURCE THAT'S ARE NOW DESTINED
TO TREAT DIABETES AND WE SAW
FROM THE TALK AND HOW POORLY WE
ARE TREATED PEOPLE WITH DIABETES
WOULD KIND OF TAKE RESOURCES
HUMAN RESOURCES AND MONEY FROM
THE DIABETES TO PREVENT DIABETES
AND WE HAVE TO DO IT WITH
DIFFERENT RESOURCES AND ONE OF
THE MAIN RESULTS OF OUR STUDY
WAS THAT THIS CAN BE DONE WITH
PEOPLE FROM THE COMMUNITY.
WE DON'T NEED HEALTH
PROFESSIONALS WHO ARE ALREADY
HAVING A LOT OF WORK BY TREATING
PEOPLE WITH DIABETES AND WE CAN
DO IT WITH CULTURES, WELL
TRAINED, AND IN THAT WAY AND WE
ARE NOT CONSUMING THE RESOURCES
FOR DIABETES AND ALSO, IN TERMS
OF USING RESOURCES, WE HAVE TO
HAVE IN MIND THAT AS WE SCREEN
FOR PEOPLE WITH PRE DIABETES WE
WILL HAVE A HIGHER BURDEN ON
MONDAY THE HEALTH SERVICES IN
TREATING PEOPLE WITH DIABETES
AND WE MIGHT INCREASE THE NUMBER
OF DIABETES TWICE OR MORE, TWO
FOLDS OR MORE, SO WE HAVE TO BE
PREPARED FOR THAT I WOULD
SUGGEST WE SHOULD START BY DOING
IT IN THE OPPORTUNISTIC WAY THAT
MEANS INSIDE THE SYSTEM.
ARE THERE A LOT OF PEOPLE INSIDE
THE SYSTEM HAVING BEEN DIAGNOSED
PRE DIABETES AND NOT WITH
EMPHASIS BUT THEY HAVE GONE
THROUGH A OGPT OR WHATEVER AND
THEY'RE FLOATING AROUND AND THEY
HAVE NO TREATMENT AND THEY HAVE
NOT BEEN PROPERLY ADDRESS AND
THEY HAVEN'T BEEN INCORPORATED
INTO PREVENTION PROGRAMS AND SO
INSIDE THE SYSTEM WE SHOULD
START THERE BY SPOTTING THESE
PEOPLE WITH PRE DIABETES AND
SUGGESTING, AND INVISITING THEM
TO SPECIAL PROGRAMS WHERE WE
HAVE DIABETES SHOULD WE SHOULD
HAVE A PROGRAM FOR PREVENTING
DIABETES AND FOR PEOPLE WITH PRE
DIABETES SO THAT WE CAN ADDRESS
THAT.
>>THANK YOU Dr. ASCHNER.
SO I HAVE ONE MORE QUESTION AND
MOVING FROM PREVENTING DIABETES,
MOVING TO DIABETES, WHAT ARE THE
EMERGING OR OBVIOUS
OPPORTUNITIES FOR RESEARCH AND
RESEARCH QUESTIONS AND DIABETES
AND THAT YOU SEE THAT COULD BE
PROPOSED IN COLLABORATION ACROSS
COUNTRIES IN LATIN AMERICA AND
IT'S RELEVANT AND COULD BE A
COLLABORATION WITH INVESTIGATORS
THAT ARE INTERESTED AND THAT ARE
INTERESTED AND HISPANIC
POPULATION AND THIS IS ABOUT
DIABETES.
>>SORRY, PABLO.
I WILL TAKE ADVANTAGE OF YOUR
WORK.
YOU MENTIONED OPPORTUNISTIC
APPROACH AND THIS MEANS THAT YOU
HAVE TO GO TO PRIMARY CARE LEVEL
AND THIS IS THE FIRST CONTACT
THAT THE PEOPLE HAVE WITH THE
HEALTH SYSTEM AND THEN IF YOU
HAVE THIS OPPORTUNITIES APPROACH
YOU ARE TAKING CARE OF THE FOR
EXAMPLE THE FIELD RISK AND THE
ORAL GLUCOSE COLORRANCE AND NO
MATTER THE PATIENTS COMES TO SEE
THE APPOINTMENT FOR ANYTHING AND
ANYTHING ELSE YOU MADE THESE
THINGS AND THIS IS THE
OPPORTUNITY APPROACH AND YOU
HAVE A LARGE POPULATION AND YOU
CAN MAKE AN EARLY DIAGNOSTIC OF
DIABETES AND EARLY TREATMENT
THAT MEANS THAT YOU ARE GOING IN
THE BEST WAY TO PREVENT THE
DEVELOPMENT OF THE DISEASE AND
THE DEVELOPMENT OF THE
COMPLICATIONS.
THIS IS A WAY WE ARE USING THIS
AND THIS IS THE BEST RESULT
THAT'S WE HAVE OBTAINED IN OUR
POPULATION.
PERHAPS PABLO HAS SIMILAR
EXPERIENCES AND I WOULD LIKE TO
SEE WHAT IS THERE IN THE
POSITION THAT HE HAS.
>>Dr. ASCHNER.
>>WELL, THIS IS ALWAYS A
DISCUSSION AMONG EPIDEMIOLOGISTS
WHETHER TO ADDRESS OUR EFFORTS
TO THE POPULATION AND HAVE A
LITTLE IMPACT IN A LOT OF PEOPLE
OR ADDRESS TO PEOPLE WITH HIGH
PICK AND HAVE A BIG IMPACT ON A
SMALL AMOUNT OF PEOPLE AND I
THINK WE HAVE TO DO BOTH BUT IT
DEPENDS ON THE RESOURCE AND WE
HAVE TO BE PREPARED TO HANDLE
WHATEVER WE DO, WHATEVER WE TRY
AND ABOUT YOUR QUESTION, LARI
LARISSA, I THERE ARE MANY, MANY
ISSUES THAT HAVEN'T BEEN
PROPERLY ADDRESSED.
I WOULD SAY ONE MAIN ISSUE IS
THE FACT THAT ALTHOUGH THAT WAS
SHOWN, WE HAVE A LOT OF TOOLS TO
TREAT DIABETES.
WE STILL HAVE A VERY POOR
PERFORMANCE IN TERMS OF HAVING
PEOPLE THAT GO AND IT SEEMS THAT
EVEN WHEN YOU ADD INSULIN, IT'S
EVEN WORSE.
IF INSULIN WAS A TREATMENT FOR
FAILURE AND IT ALL HAS TO DO
WITH INERTIA AND SO WE HAVE TO
STUDY WHAT IS GOING ON WITH
INERTIA.
WHAT ARE THE MAIN OBSTACLES THAT
PRODUCE INERTIA IN THE TREATMENT
OF DIABETES AND I WOULD START BY
THE BIGGEST INERTIA OF ALL WHICH
IS LOSING WEIGHT.
WE HAVEN'T BEEN SUCCESSFUL IN
GETTING OUR PATIENCE WITH TYPE
TWO DIABETES AT THE BEGINNING TO
LOSE WEIGHT.
WE KNOW FROM STUDIES LIKE THE
DIRECT STUDY IF YOU START EARLY,
AND YOU HAVE A REAL GOOD RESULT,
YOU CAN EVEN GET REMISSION OF
DIABETES.
AND I APPLAUD THE NEW STATEMENT
OF THE ASD WHERE THEY PUT THE
TREATMENT OF OBESITY IN THE
HIGHEST PLACE EQUAL TO THE
TREATMENT OF OF BLOOD GLUCOSE
AND OTHER RISK FACTORS SO
INERTIA I WOULD SAY MEANS MORE
ATTENTION EXPLORING WHAT IS
HAPPENING AND PROBABLY THAT HAS
TO DO WITH A LOT OF VARIABLES
THAT ARE DIFFERENT IN DIFFERENT
REGIONS AND PROBABLY DIFFERENT
EVEN IN DIFFERENT COUNTRIES IN
LATIN AMERICA.
AND IN THE U.S. WITH THE
HISPANIC POPULATION BUT WE COULD
LEARN FROM THAT COMPARING THAT
THE DIFFERENT ASPECTS OF THAT
PROBLEM.
>>THANK YOU Dr. ASCHNER.
ANY QUESTIONS FROM THE SPEAKERS.
I DON'T SEE ANY QUESTIONS POSTED
IN THE CHAT.
WE ARE FOUR MINUTES AWAY FROM
THE BREAK.
I WANT TO GIVE AN OPPORTUNITY
FOR ANY OF THE SPEAKERS TO ASK
ANY QUESTIONS OR, OR Dr.
ASCHNER AND Dr. GAGLIARDINO --
ONE SECOND.
I SEE ONE.
THERE'S A QUESTION.
CAN THE CURRENT SPEAKER ADDRESS
THE RELATIONSHIP WITH
INCORPORATE INFLUENCE THAT IS
PUT IN THE INCREASE IN DIABETES.
>>WELL, THE FOOD INDUSTRY IS
ALWAYS THE CULPRIT, ISN'T IT.
AND I'M NOT SURE THAT IT'S ONLY
THEIR FAULT BECAUSE WE ARE THE
ONES WHO CHOSE FOODS AND I
REMEMBER, I WENT TO CONGRESS IN
CHILE OBESITY CONGRESS AND ONE
OF THE STANDS WAS MCDONALD'S AND
I WAS SURPRISED AND ASKED THEM,
WELL, IT'S INTERESTING TO SEE
YOU IN THIS CONFERENCE AND WE
SAID WE WANT TO SHOW WE HAVE
HEALTHY FOOD TO OFFER.
WE DO HAVE HEALTHY FOOD BUT
PEOPLE JUST DON'T BUY IT.
THEY DON'T GO TO MCDONALD'S TO
HAVE HEALTHY FOOD AND IT'S A
QUESTION OF NOT JUST WHAT THEY
PRODUCE, BUT HOW WE CONSUME IT.
I AGREE THAT AND IN OUR
COUNTRIES, ACTUALLY IN COLOMBIA,
WE HAVE JUST RECENTLY APPROVED
THE LABELS ON THE FOOD SHOWING
WHICH ARE MORE HARMFUL THAN
OTHERS AND CERTAINLY, THAT HELPS
AND PEOPLE CHOOSING, BETTER
HAVING BETTER CHOICES NOT
NECESSARILY CHOICES THAT WILL
REDUCE WEIGHT WHICH IS ONE OF
THE MAIN DRIVERS OF DIABETES AND
STILL IT IS HAPPENING AND IT'S
CHANGING AND I WOULD SAY IT
STARTS WITH SCHOOLS.
CHILDREN DO HAVE TO LEARN WHAT
WE EAT AND EVEN INFLUENCE THEIR
PARENTS AND THEIR FAMILIES AND
HAVE A BETTER CONSUMPTION OF
FOOD.
>>YES, I MEAN AND THE PROBLEM
REASON THAT OBESITY IS NOT JUST
PROBLEM HEALTH SYSTEM AND WE
NEED A ROUND CABLE IS POVERTY
AND POVERTY IS NOT A PROBLEM AND
SYSTEM IT'S A PROBLEM OF
ECONOMY.
AND LOW EDUCATION IS NOT THE
PROBLEM OF DIABETES ON THE
HEALTH SYHEALTH SYSTEM.
MASS MEDIA IS PROMOTING ALWAYS
THE HEALTHY HABITS AND THEN WE
NEED THESE THINGS AND YOU NEED
THE POPULATION AND EDUCATION AND
THROUGH THIS SYSTEM AND ALL
TOGETHER, IS GOING LIKE A AND
WE'RE GOING TO NOTICE.
YOU ARE ONLY MISSENNING AND THEY
MADE THEIR AGREEMENT BETWEEN
DIFFERENT INSTRUMENTS AND AS
SOON AS YOU GET THE SECOND
DIRECTOR YOU HAVE THE AGREEMENT
AND YOU GET THE MEL BEE AND WE
HAVE TO GET THE MELODY WORKING
ALL TOGETHER IN COORDINATING WAY
AND THAT IS THE ONLY WAY THAT
MAKES THE SOLUTION FOR THE
PROBLEM.
OTHERWISE, WE ARE GOING TO GET
LOST.
>>THANK YOU Dr. ASCHNER AND
THANK YOU Dr. GAGLAIARINO.
WE'RE GOING TO A BREAK NOW,
AFTER THE BREAK, WE WILL BE BACK
WITH ANOTHER SESSION.
>>THANK YOU.
>>THANK YOU TO EVERYBODY AND
PABLO AND LARISSA AS WELL.
BYE-BYE.
>>YES.
>>BYE-BYE.
>>WELCOME BACK FROM THE BREAK.
I WANT TO REITERATE, SEND IN
YOUR QUESTIONS FOR ANY OF THE
SPEAKERS AND SO WE CAN ADDRESS
THEM DURING THE LIVE Q&A
SESSION.
YOU CAN E-MAIL IT.
AND AGAIN, PLEASE COMPLETE THE
SLIDE POLL AT SLIDEO.COM AND
TYPE IN LATAM SO THAT WE KNOW
WHERE YOU ARE JOINING FROM
TODAY.
SO NOW WE'RE GOING TO GET
STARTED AND RESUME THE
PROCEEDINGS RIGHT AWAY.
I WILL NOW TURN THINGS OVER TO
THE MODERATOR FOR THE NEXT
SESSION, Dr. LARISSA
AVILES-SANTA.
THANK YOU.
>>Chair Aviles-Santa: GOOD
MORNING, AGAIN.
MY NAME IS LARISSA AVILES-SANTA.
I AM THE MODERATOR OF THE SECOND
TOPIC OF THE OUR WORKSHOP, CAR
YO VASCULAR DISEASES AND RISK
FACTORS.
OUR ANNALISTS ARE Dr. FERNANDO
LANAS ZANETTI AND Dr. PATRICIO
LOPEZ JARAMILLO.
WE WILL HAVE A LIVE Q&A AFTER
THE PRESENTATIONS, LET'S BEGIN.
>>GOOD MORNING, I WOULD LIKE
FIRST TO THANK THE OPPORTUNITIES
TO BE PART OF THIS IMPORTANT
WORKSHOP.
AND SECOND TO APOLOGIZE FOR MY
VOICE BUT I AM IN THE MIDDLE OF
A SEVERE CORD.
IF WE LOOK AT THE CARDIOVASCULAR
DISEASE IN LATIN AMERICA AND
IT'S AROUND A MILLION DEATHS A
YEAR, HEART DISEASE IS THE MOST
IMPORTANT WITH THE FULLY 2% OF
THE TOTAL, WE STUDIED A CAUSES
OF MIO CARDIA IN FUNCTION IN
CASE CONTROL STUDY NAMED INTER
HEART, AND YOU CAN SEE FROM OUR
REGION, OBESITY IS THE RISK
FACTORS WITH THE GREATER
POPULATION ACHIEVABLE RISK FOR
LOW DIABETES EP DEEMIA AND
HYPERTENSION.
THE SECOND CAUSE OF
CARDIOVASCULAR DISEASE IS
STROKE, THAT IS RESPONSIBLE FOR
29% OF THE MORTALITY AND WE
STUDY THE CAUSES FOR STROKE IN
ANOTHER CASE CONTROL STUDY NAMED
INTER TR STROKE AND HYPERTENSION
WAS THE MAIN RISK OF 50% FOR
THAT IS DIET AND ABDOMINAL OBESE
TEASE SO YOU CAN SEE THAT FOR
BOTH, DISEASES, THE RISK FACTORS
REALLY ARE THE SAME IF YOU HAVE
HYPERTENSION, YOU HAVE MORE THAN
80% OF THE CAUSES OF DEATH IN
THE REGION.
THERE ARE SOME DIFFERENCES
BETWEEN LATIN AMERICA AND THE
REST OF THE WORLD IN THE
POPULATION OF RISK.
FOR OUR REGION, WAYS TO HIT
RATIO AS MEASUREMENT OF OBESITY
IT'S THE MOST IMPORTANT, WE
DON'T HAVE MUCH DIFFERENCE IN
TERM OF THE TOBACCO ASSOCIATED
WITH RISK AND ALSO IN
HYPERTENSION AND STRESS SEEMS TO
BE MORE IMPORTANT IN OUR REGION.
IN THE FEW THAT IT IS BIG COVER
THE STUDY THAT INCLUDES FROM
LATIN AMERICA AND ARGENTINA,
BRAZIL AND COLOMBIA AND CHILE,
WE WERE ABLE TO CONFIRM OUR
RESULTS AND THE POPULATION
ACHIEVED A FRACTION FOR CARD YE
VASCULAR DISEASE FOR
HYPERTENSION IS 22% FOR TOBACCO
15% AND ABDOMINAL OBESITY 14%.
THAT IS THE FACT AOR WENT TO
IMPROVE THE PROGNOSIS OF
CARDIOVASCULAR DISEASE IN THE
REGION AND ALSO DIABETES IS
IMPORTANT AND YOU CAN SEE THE
DIFFERENCE BETWEEN REGIONS ARE
QUITE MARKED.
IF WE GO TO HYPERTENSION THE
MAIN RISK FACTORS IN TWO COHORTS
IN LATIN AMERICA AND INCLUDES
SUBJECTS FROM ARGENTINA ALL THE
WAY AND CHILE AND WE CAN
SUMMARIZE THE RESULTS SAYING
THAT FOR EACH HYPERTENSION I
HAVES IN THE REGION, FOUR FOUR
ARE NOT AWARE OF IT AND SO THOSE
ARE THE PERSON WHO ARRIVED WITH
THE STROKE OR HEART FAILURE AND
THEY NEVER KNOW THEY ARE
HYPERTENSIVE.
FROM THOSE TREATED THAT HALF OF
THE HYPERTENSIVES IN OUR SAMPLE,
THREE OF THEM DOES NOT HAVE
BLOOD PRESSURE CONTROL AND SO I
THINK THAT THE RESEARCH ON
SURVEYS TO BLOOD PRESSURE
CONTROL ARE IMPORTANT RESEARCH
AREAS.
SO SECOND, I WOULD LIKE TO SPEAK
ABOUT SECONDARY PREVENTION IT'S
CONSIDERED A LOW-HANGING FRUIT
BECAUSE IT'S WITH A NEED TO
SCREEN AND WE ALREADY KNOW THAT
WE HAVE THE DISEASE AND SIMPLE
TREATMENT CAN REDUCE THE RATE BY
TWO-THIRDS.
AND THOSE ARE THE RESULTS FROM
THOSE LOOK AT HEALTHY LIFESTYLE
BEHAVIOR AND THAT MEANS THOSE
WHO FOLLOW DIET, RECOMMENDATIONS
WHO DO EXERCISE AND DO NOT
SMOKE.
DO WE HAVE THE RESULTS FROM
SOUTH AMERICA?
THIS IS MORE CLEAR BUT REPRESENT
THOSE THAT HAVE A MAJOR EVENT IN
MY STROKE AND CONTINUOUS SMOKING
AND DO NOT FOLLOW DIET, AND DO
NOT DO EXERCISES AND THEY ARE AT
20% AND THERE'S MORE AND IT'S
THE PREPORTION OF THOSE WHO HAVE
A HEALTHY LIFESTYLE IN OUR
REGION AFTER A MAJOR EVENT.
WE CAN SEE A CERTAIN OF THEM
RECEIVED ANTI-PLATELETS AN AND
LEAVING THEM ONE OF THE FIVE
STUDIES AND THIS IS RESULTS ARE
VALID AND HOWEVER, UNFORTUNA
UNFORTUNATELY, THREE TIMES THE
MORTALITY IN HIGH INCOME
COUNTRIES AND THAT IS HAPPENING
FOR TOTAL MORTALITY.
AND THIS ILLUSTRATED THE
WEAKNESS OF OUR HEALTH SYSTEM
AND AGAIN, MORE AREAS FOR
RESEARCH.
RECENTLY WE PUBLISHED THE
TRANSFER H -- AND IT HAS DECREAD
IN THE 1% CHANGE OF 2.5% AND
IT'S QUITE DIFFERENT IN
DIFFERENT REGIONS SEW IN NORTH
AMERICA WE HAVE A ADEQUATE
REDUCTION OF MORTALITY AND IN
THE CENTRAL AMERICA, MEXICO AND
WE ARE LEADING THE MORTALITY
HASN'T BEEN REDUCED IN THE LAST
20 YEARS.
FINALLY, I WOULD LIKE TO SHOW
THAT HEALTH POLICY CHANGE IS
IMPACTING CARDIOVASCULAR DISEASE
AND IT'S THE CASE OF CHILE AND
SINCE 2004, THEY PROVIDE A GUN
TEE TO ACCESS OPPORTUNITIES AND
PROTECTION AND QUALITY AND TO 85
HEALTH CONDITIONS WHERE IMPLEME.
BY LOW WE MUST PROVIDE ANGIE
OWEPLASTY TO INDIVIDUALS WHO ARE
ATTENDING ANY HOSPITAL OR CLINIC
IN THE COUNTRY.
AND ALSO, SECONDARY PREVENTION
IS INCLUDED.
AND WE HAD STROKE HYPERTENSION
AND DIABETES AND YOU CAN SEE HOW
MUCH THE DROP IN ADJUSTED
MORTALITY FOR HEART DISEASE IS
FOR MALE AND FEMALE AND SO IN
MUM REAND IN LATIN AMERICA
THEY'RE FREQUENT AND EASY TO
IDENTIFY AND WE ALL KNOW THE
RICH FACTOR FOR CARDIO AND
ASSOCIATED AND WITH POVERTY, LOW
EDUCATION AND LEVEL OF
MINORITIES AND WE MAY NOT BE
MORE ON THIS RISK FACTOR
PREVALENCE AND DISTRIBUTION BUT,
WHAT WE ALL NEED IS INFORMATION
ABOUT THE IMPLEMENTATION OF
EFFECTIVE INTERVENTION AND
ESPECIALLY IN LOW RESOURCE
SETTINGS.
THANK YOU.
>>GOOD MORNING, I AM Dr.
JARAMILLO FROM COLOMBIA.
FIRST OF ALL, I WOULD LIKE TO
SAY THANK YOU FOR THE KIND
INVITATION TO PARTICIPATE OF
THIS IMPORTANT ACTIVITY.
IN SOUTH AMERICA, THE PRINCIPLE
CAUSE OF MORTALITY IS
CARDIOVASCULAR DISEASE AND THAT
THE PRINCIPLE RISK FACT OR ARE
HYPERTENSION, OBESITY, SMOKING,
DIABETES, AND LOW -- THIS IS
PARTICULARLY IMPORTANT TO
EXPLAIN THE PARTIC PARTICULAR AN
DISEASES.
AND AS WAS PRESENTED ALREADY,
THESE ARE THE RISK FACTORS
ASSOCIATED TO DIABETES GLOBALLY
AND AND DIABETES AND WAIT TO AND
ARE THE PRINCIPLE BUT ONE SCENE
THAT IS IMPORTANT, IS TO SHOW
THAT OF DIABETESS DEPENDING OF
THE INCOME OF THE COUNTRIES.
FROM LOW INCOME COUNTRIES
PRESENT AND INCREASE OF ALMOST
SIX TIMES HIGHER PREVALENCE OF
DIABETES.
IT'S THE SAME WHEN YOU EVALUATE
WAYS TO SIN CREASE ALMOST FOUR
TIMES HIGHER PREVALENCE OF
DIABETES IN PEOPLE WITH THE
LOWER LEVELS OF ABDOMINAL
OBESITY.
WHY IS THE REASON?
AS WE HAVE PROPOSED SOME TIME
AGO, IS THAT ALL POPULATIONS
PRESENT AN INCREASE OF
SENSITIVITY TO DEVELOP LOW
DEGREE INFLAMMATION AND INSULIN
RESISTANT TO LOW LEVELS OF THIS
IS CERTAINLY ASSOCIATED WITH NO
SO THE METABOLIC SYNDROME
PROBABLY HAVE AS ONE OF THE
PRINCIPLE MECHANISMS THE
RELATION BETWEEN OBESITY AND
MUSS LIEU CAR STRENGTH AND THIS
IS PRODUCING INSULIN REDUCE TEE,
LOW AGREE INFLAMMATION AND OF
COURSE AN INCREASE RISK OF
DIABETES TYPE 2 AND CARD YE
VASCULAR DISEASE AND LET'S GO TO
SHOW SOME EVIDENCE THAT SUPPORTS
THESE PROPOSALS.
FIRST, WE EVER USE.
AND INDICATER OF MUSS LIEU CAR
STRENGTH AND AS THIS SHOWS, THIS
GRAPHS SHOW THE MUSCULAR
STRENGTH IS DEPENDING OF THE
COUNTRIES YOU SEE FOR INSTANCE,
PAKISTAN, A LOW INCOME COUNTRY,
FEMALE AND MALES HAVE A
SIGNIFICANTLY LOWER STRENGTH OF
POPULATION OF RISK CON TREES AS
CANADA AND SWEDEN AND THIS IS
RELATED NOT ONLY WITH THE
PARTICULAR ETHNIA AND THE
PROGRAMMING THAT IS THE
DETERMINATED THAT YOU HAVE LOW
MUSCULAR STRENGTH.
MUSCULAR STRENGTH IS IMPORTANT
PREDICT OR OF MORTALITY.
WE ARE SHOWING IN THIS TABLE AS
BY 5-KILOGRAM OR REDUCING TO
HAVE AN INCREASE MORTALITY MORE
CARDIOVASCULAR MORTALITY AND
IT'S DIABETES.
SO, IT IS IMPORTANT TO
UNDERSTAND THAT THERE IS NOT
ONLY ALSO THE MUSCULAR MASS AND
THE MUSCULAR STRENGTH THAT ARE
IN THE WAYS TO PRESENT
CARDIOMETABOLIC DISEASES AND NOT
ONLY THAT, BUT ALSO THE RATE OF
CASE MORTALITY IS INCREASING IN
PEOPLE THAT HAVE THE LOWER TECH
TILE.
YOU DID SEE IT STROKE PEOPLE
THAT HAVE THESE PRESENT A HIGHER
RISK OF DEATH IF THEY HAVE A LOW
HAND GRIP SO MUSCULAR STRENGTH
IS AN IMPORTANT FACTOR THAT WE
NEED TO CONSIDER IT WHEN WE ARE
TALKING ABOUT THE MANAGEMENT THE
RISK OF CARDIOVASCULAR DISEASE
IN COUNTRIES AT THE LATIN
AMERICA AND ONE OF THE PEOPLE AS
THE LATINA AMERICAN LIVING IN
THE UNITED STATES THAT PRESENT
AN INCREASE RATES TO THEIR RATE
OF DIABETES AND CARDIOVASCULAR
DISEASE.
WE HAVE SHOWN EARLY, SOME YEARS
AGO, THAT ANY INCREASE OF ONE
KILOGRAM OF MUSCULAR STRENGTH OF
GRIP IS ASSOCIATED WITH A LOWER
RISK OF CARDIOVASCULAR AND MIO
CARTAL AND A MORTALITY OF ALL
CAUSE IF YOU HAVE ONLY AN
INCREASE OF ONE KILOGRAM SO,
THIS IS SUPPORTING THAT NEEDED
THAT WE HAVE TO IMPROVE OR
ACKNOWLEDGE ABOUT MUSCULAR
ASSOCIATED WITH CHRONIC DISEASES
THAT IS INTERESTING THAT THE IN
YOUR REGION, MEDICAL DOCTORS AND
THE TEAM OF OCCURRED HEALTH TEAL
HAVE VERY LOW KNOWLEDGE ABOUT
THE IMPORTANCE OF MUSCULAR
STRENGTH IN THE AREAS OF
DISEASES AND THE PROPOSAL IS
THIS ONE YOU HAVE IN MORE
COUNTRIES A HIGH PERCENT OF
WOMEN THAT HAVE NOT PREGNANCY
AND NEW BIRTH WEIGHT AND THIS
LOW BIRTH WEIGHT THAT IS EXPOSED
CHANGING THEIR LIFESTYLE OF
PHYSICAL INACTIVE TEE AND STRESS
AND LESS TO AN IMBALANCE BETWEEN
INFLAMMATION AND
ANTI-INFLAMMATION AND LOW MUSCLE
AND HIGH PRODUCED AN INCREASE OF
INFLAMMATION IF YOU CHANGE IT BY
GOOD MUTATION AND STRAINING YOU
WILL HAVE A BETTER MESS KULAR
MASS AND THIS DIS BALANCE
BETWEEN INFLAMMATION AND
ANTI-INFLAMMATION.
I WOULD LIKE TO FINISH HERE AND
I OPEN TO ANY QUESTIONS TO
DISCUSSION ABOUT THE ETH NIA NEW
POSSIBILITY THAT'S WE HAVE TO
CHANGE THE LIFESTYLE, CHANGING
TOE GOOD TO IMPROVE CONDITIONS
THE SITUATION OF CARD YE
VASCULAR DISEASES IN LATIN
AMERICA.
THANK YOU FOR YOUR ATTENTION.
>>FOR THOSE JOIN USs NOW WE
ARE IN THE LIVE Q&A AND THE
PRESENTATION OF THE SECOND TOPIC
OF THE WORKSHOP CARDIOVASCULAR
DISEASES AND RISK FACTORS IN
LATIN AMERICA SO WELCOME TO
EVERYONE.
WE HAVE SEVERAL QUESTIONS AND
THIS Q&A WILL LAST 20 MINUTES
AND TO 10:35 WE ARE SHIFTING TO
ANOTHER PRESENTATION.
AND SO THE FIRST VERY IS FOR
Dr. LANAS.
YOU OBSERVED THE AWARENESS,
TREATMENT AND CONTROL OF
HYPERTENSION AND OTHER
CARDIOVASCULAR RISK FACTORS AND
MEDICATION INTAKE, FOR SECONDARY
PREVENTION OF CARDIOVASCULAR
DISEASE HAS BEEN SELF-OPTIMAL IN
LATIN AMERICA.
WHAT ARE THE POTENTIAL
STRATEGIES TO ADDRESS THESE AND
WHAT HAS WORKED OR WHAT IS BEING
DONE RIGHT NOW.
>>LET ME START FIRST BY
SPEAKING ABOUT THE AWARENESS OF
HYPERTENSION AND ONE INITIATIVE
THAT MANY COUNTRIES IN LATIN
AMERICA HAS JOINED IS THE MMM
INITIATIVE FROM THE NOT NATIONAF
HYPERTENSION -- IS TO HAVE ONE
DAY TO RAISE THE CONCERNS ABOUT
HYPERTENSION IN THE WORLD IS TO
HAVE A FULL MONTH DEDICATED TO
THE ACTIVITIES SO THIS HAS TWO
BRANCHES REALLY.
ONE, IT'S TO RELATE WITH THE
COMMUNICATIONS ABOUT THE
IMPORTANCE OF HYPERTENSION TO
THE COMMUNITY AND IT'S STARTING
IN THE MEDIA AND TV AND RADIO,
NEWSPAPERS, AND ON THE OTHER
HAND, SCREENING ACTIVITIES THAT
TAKE PLACE IN MANY LOCATIONS IN
THE COUNTRIES LIKE THE HEALTH
SYSTEM FACILITIES, THE
UNIVERSITIES, THE MORGUE AND IN
CHILE THIS RAISES THE INTEREST
OF MINISTER OF HEALTH SO THE MAY
MONTH MEASUREMENT IS PART OF THE
OFFICIAL ACTIVITIES OF THE
MINISTRY OF HEALTH AND TO
IMPROVE THE KNOWLEDGE OF
HYPERTENSION AND THE SECOND
THING WE HAVE REGARDING
IDENTIFYING WITH A POTENTIAL IS
THAT IF HEALTH FACILITY MUST DO
GENERAL SURVEY TO THE POPULATION
UNDER THEIR CARE, TO ASSESS RISK
FACTORS WITH TOBACCO,
HYPERTENSION AND CHOLESTEROL AND
THE PREPORTION IT'S AT, EVERY
YEAR.
WITH THIS MEASUREMENTS, THE
KNOWLEDGE OF HYPERTENSION IN THE
COMMUNITY HAS RAISED FROM 23% TO
73% IN THE POPULATION THAT IS
NOT VERY HIGH BUT IT'S SOME
IMPROVEMENT.
AND IN THE AREA OF TREATMENT,
AGAIN, CHILE AND OTHER
COUNTRIES, IN THE REGISTER ON
HAVE JOINED THE HEART INITIATIVE
AND THAT IT IS FOR THOSE WHO MAY
NOT KNOW, IT'S A SET OF
ACTIVITIES THAT INCLUDES SIMPLE
PROTOCOLS STANDARDIZED TO MAKE
MEDICATION AVAILABLE FOR THE
HYPERTENSIVE TRIED TO USE
LONG-TERM MEDICATIONS AND IT
ALSO HAS BEEN SUCCESSFUL SO
PEOPLE WHO IN THE CARDIOVASCULAR
PROGRAM IN CHILE THE
HYPERTENSION IS ABOUT 66% SO,
TWO-THIRDS OF THE INDIVIDUALS
WHO HAVE BEEN SUITED FOR HYPE
ARE TENSION IN THE COUNTRY STILL
HAS NORMAL BLOOD PRESSURE BUT
WITH THE TWO MILLION THAT ARE
NOT AWARE OF BEING HYPERTENSION
I HAVE AND SO, WE HAVE A LOW WAY
TO IMPROVING OUR CARE.
>>Chair Aviles-Santa: THANK
YOU, Dr. LANAS.
THE NEXT QUESTION IS FOR Dr.
LOPEZ-JARAMILL-O ARE YOU WORKING
ON MUSCLE STRENGTHENING
INTERVENTIONS AND IF SO, COULD
YOU SHARE SOME OBSERVATIONS OR
FINDINGS?
>>THANK YOU.
WE HAVE SOME RESULTS AND
CLINICAL TRIALS AND USING
ESPECIALLY IN RESISTANT EXERCISE
ON THESE RESISTANT EXERCISES
ESPECIALLY ONCE PRODUCE A
REDUCTION IN HYPERTENSION
PATIENTS OF ABOUT (INAUDIBLE).
THE RESULTS OF THE STUDY FOR
INSTANCE WHERE WE USED TWO
HYPERTENSIVE MEDICATION AND
PRODUCE OUR REDUCE OF 6 MILLION
SO IT IS INCREASING AND IT IS
ONLY THREE TIMES A WEEK AND
APPROXIMATELY EIGHT MINUTES OF
EXERCISE TWO MINUTES OF EXERCISE
WE DO THE REST THREE TIMES A
WEEK WITH THESE IMPORTANT
REDUCTIONS AND THE OTHER HAND,
JUST NOW, WE ARE ORGANIZING AND
WE WOULD LIKE TO INVITE TO THE
SITES TO PARTICIPATE OF A
CLINICAL TRIAL WITH A TO SHOW IF
ONE STRENGTH AND PRODUCED THE
SAME RESULTS BECAUSE FOR YOU
NEED TO HAVE THE MOMENTS AND OR
TO SEE THE AND I DON'T SAY
EXACTLY AS YOU SAY IN THE EAST,
NOT NEED OF ANY INSTRUMENTS.
>>THANK YOU, DOCTOR.
IN FACT, THERE'S A QUESTION IN
THE CHAT PRECISELY ABOUT MUSCLE
STRENGTH AND IT'S RELATED TO IF
A PERSON ALREADY HAS A LOWER
HAND GRIP STRENGTH OR IT IS AN
INDICATE ERROR IT COULD BE AN
INDICATE OR OF VERY CHRONIC
DAMAGE OR THE DEFICIENCIES AND
HOW EFFECTIVE COULD THIS WORK IN
A PERSON LIKE THAT?
IS THERE A RECOVERY?
>>YES, THANK YOU FOR THAT
QUESTION.
REALLY, WE ARE TALKING ABOUT
PRECISION MEDICINE AND WHEN THE
FIRST THING IS TO HAVE
PREDICTION OF RISK AND IF YOU
HAVE A NEW CHILD AND WITH A LOW
BIRTH WEIGHT, IT'S REASON TO
DEVELOP CARDIOMETABOLIC DISEASE
SO YOU CAN START WITH THIS
PREDICTION OF RISK AND INCLUDE
PRE TENSION AND PREVENTION IS TO
IMPROVE THE QUALITY OF BODY
COMPOSITION THAT MEANS
INCREASING MUSCULAR MASS AND IT
STOPS THE INCREASE OF FATTY
TISSUE AND THIS MEANS GOOD
PHYSICAL ACTIVITY AND THIS MEANS
GOOD NUTRITION.
SO, EARLY IN LIFE YOU START THE
PREVENTION AND ALSO, IN LIFE,
YOU INTRODUCE SOME INTERVENTION
AS FOR INSTANCE ICE OWE METRIC
EXERCISE IN THE PLACE OF THE
WORLD THAT THIS IS THE MOST
INTERESTING THING, YOU DO NEED
TO GO TO THE GYM, DUE NEED TO
LIVE AT YOUR PLACE OF WORK TO DO
ICE OWE METRIC EXERCISES.
IT'S IMPROVING INSULIN
SENSITIVITY AND IMPROVING LOW
DEGREE INFLAMMATION THAT ARE THE
TWO MECHANISMS THAT ARE RELATED
WITH A CLARITY SO IT'S POSSIBLY
IN ADULTS, SO WE HAVE A VERY
SMALL REASON WE NEED IT INCLUDES
MORE PEOPLE AT THE MOMENT, IN
SOME LATINO AMERICAN COUNTRIES
IN COORDINATION WITH PEOPLE OF
SPAIN WE HAVE ORGANIZING A
NETWORK TO START A STUDY
INCLUDING MORE PEOPLE SO I WOULD
LIKE TO TAKE CARE ADVANTAGE OF
THESE MEETINGS TO INVITE THE
PEOPLE TO HAVE INTERESTED TO
PARTICIPATE TO JOIN US.
>>Chair Aviles-Santa: THANK
YOU.
I HAVE ANOTHER QUESTION FOR
Dr. LANAS.
YOU ILLUSTRATED THE RELATIONSHIP
BETWEEN SOCIOECONOMIC STATUS AND
CARDIOVASCULAR MORTALITY AND
WE'VE SEEN IN THIS RELATIONSHIP
FOR OTHER CHRONIC DISEASES ABOUT
WHAT COULD BE THE MOST IMPACTFUL
AND REALISTIC INTERVENTIONS TO
ADDRESS THIS DISPARITY AND WHAT
WOULD BE THE IMPLICATIONS OF
SUCH INTERVENTIONS FOR U.S.
HISPANICS AND LATINOS.
>>THANK YOU FOR THE QUESTION.
THIS IS A ISSUE THAT WORRIES ME
AND A LOT OF PEOPLE REALLY.
IN PER EYE, PERU, WE HAVE DOCUMF
YOU ARE FROM A LOW INCOME
COUNTRY AND YOU HAVE A INCOME
COUNTRIES AND YOU ARE POOR OR
LESS EDUCATED OR YOU LIVE IN A
RURAL AREA, YOU HAVE MORE RISK
FACTORS THAN SOMEONE FROM HIGH
INCOME COUNTRIES AND YOU HAVE A
MORE CARDIOVASCULAR EVENTS AND
MORE GENERAL MORTALITY.
THIS IS A FACT TO SHOW THAT HOW
WE CAN IMPROVE THAT ANDER
FINDING A SOLUTION TO THIS MAJOR
INEQUITY AND I DON'T REALLY
THINK THAT AN ISOLATED AND IT
WILL BE SUCCESSFUL AND OF
COURSE, OF COURSE THERE'S AN
NEED THE COUNTRIES FOCUS THE
INVESTMENT IN HEALTH AND IN TOES
WHO ARE AT INDICTS ADVANTAGE AND
THE THEY GO FAR HEALTH AND IT'S
AN ISSUE OF EDUCATION AND
SECURITY HOUSING AND ENVIRONMENT
AND THE PRIV OF THE HEALTHY FOOD
AND MANY OTHERS AND SO WE ARE,
WE NEED TO TROY TO MOVE THE
GOVERNMENT AND THE HEALTH SYSTEM
TO PROVIDE MORE CARE FOR THOSE
WHO ARE LESS RESOURCES AND IN
SOME WAY AND THE REGIONAL
CARDIOLOGY OF SCIENTISTS AND
PUTTING THIS SOCIAL DISADVANTAGE
AND ONE MAJOR RISK FACTOR SO
DEAL WITH THE MORE TURN AND WE
ALL KNOW THAT IT'S IN A
HIGH-RISK OF CARDIOVASCULAR
PROBLEMS AND WE DEVELOP WHAT WE
CALL ROAD MAPS AND IT'S STUDY
TIME PROVE THE BARRIERS AND FOR
GOOD CARE AND WE HAVE THE
SCIENTIFIC SOCIETIES AND THE
HEALTH PROVIDERS THAT MINISTRY
OF HEALTH AND IN ORDER TO AGAIN
RAIL A NATIONAL STRATEGY AND AND
IT'S A VERY DIFFICULT AFFECT I'M
SURE.
>>THANK YOU.
I HAVE TO TWO MORE QUESTIONS AND
THESE TWO QUESTIONS ARE FOR THE
TWO OF YOU.
WHAT WOULD THE STUDY OF PRIMARY
OR SECONDARY PREVENTION OF
CARDIOVASCULAR DISEASES
CONTRIBUTE?
TO THE REDUCTION OF SCARED YO
WORTH WHILE AND U.S. HISPANIC
AND LATINOS?
>>OK, I WILL START.
WE HAVE TWO HOPE THREE AND FOUR
THAT SHOWS AT REDUCTIONS OF 40%
OF CARDIO AND STROKE AND THAT
WAS COMPOSED OF OUTCOME WITH THE
USE OF TWO HYPERTENSIVE AND ONE
SETTING IN PEOPLE WITH
HYPERTENSION.
HYPERTENSION THAT MEANS HIGHER
THAN 140 MILLIONS AND AFTER
THESE WE SHOW A IT'S CHANGE IN
THE STRATEGY OF CONTROL OF
CARDIOVASCULAR RISK FACTOR AND
IT'S USE AND IT'S NOT MEDICAL
HEALTH WORKERS DOING THE
TREATMENT AT HOME AND IDENTIFY
THE PEOPLE AND PROVIDING FREE
ACCESS MEDICATIONS TO
ANTIHYPERTENSIVE AND STUDY A
REDUCTION WITH THE WE DISCOVER
OF 11 POINTS SO, IT'S VERY CLEAR
WE NEED SOME STYLES AND IN THIS
WAY THE USE OF SOME INTER
TENSION TO IMPROVE MUSCULAR
STRENGTH IS SO IMPORTANT AND
ALSO WE HAVE SO THAT
INTERVENTION WITH MEDICATION IS
PARTICULARLY AND IT'S A GOOD
APPROACH TO THE AND WE HAVE
STUDY AND WE MUST COMPARE WITH
TWO GROUPS WITH TRADITIONAL
HYPERTENSION AND AND IT WAS A
HUGE INCREASE AND COMPLY IN THE
NEW ONES SO, MORE BROAD IN THE
REGION WITH MORE SIDES AND IN
HYPERTENSION OR IN SECONDARY
PREVENTION AND IT COULD BE QUITE
IMPORTANT.
>>THANK YOU Dr. LANAS.
I HAVE ONE MORE QUESTION FOR THE
TWO OF YOU AND WE HAVE THREE
MINUTES TO SHARE THE ANSWER FOR
THIS QUESTION.
WHAT ARE SOME POTENTIAL RESEARCH
OPPORTUNITIES AND YOU COULD
ELABORATE ON KEY RESEARCH
STUDIES IN LATIN AMERICA AND
THAT COULD ALSO HAVE AN IMPACT
IN THE STUDY AND IN THE CARE OF
DISEASE INCLUDING STROKES AND
RISK FACTORS AND U.S. HISS PAN
PICK AND LATINO POPULATIONS.
>>LET ME GO FIRST.
THE AND DISEASE AND MIO CARDIAL
AND SO WE HAVE MAJOR PROBLEMS IN
OUR CONTROL OF HEART FAILURE AND
WE HAVE DOCUMENTED THAT AND IN
RELATIONS AND SO I THINK WE NEED
SOME SIMPLE STUDIES WITH THE
SOMEWAY TO SCREEN POPULATION AND
SIMPLE TREATMENT AND TO DO IT
WITH THE COST EFFECTIVENESS AND
PART OF THE STUDY SO WE CAN
CONVINCE THE AUTHORITIES TO SO
THEY DECIDE TO INVEST IN THAT
AND SO.
>>Dr. LOPEZ-JARAMILLO.
>>I'M REALLY INTERESTED IN
AGING HEALTHY.
WITH THIS COMING THE BIG PROBLEM
OF THE KNOWLEDGE MATURATION SO I
THINK THAT IT'S IMPORTANT THAT
WE STARTED TO IDENTIFY WHY SOME
PEOPLE AND MYSELF THAT WE ARE
OLDER THAN 70 YEARS AND STILL WE
ARE VERY ACTIVE AND PHYSICAL
ACTIVE AND ANOTHER PEOPLE WITH
THE SAME AGE, ARE REALLY DOING
NOTHING AND WE NEED TO IDENTIFY
ONE OF THE RISKS FOR THIS
DIFFERENCE AND WE HAVE CLEARLY
OF COURSE, TAKEN PROGRAMMING AND
MUSCULAR STRENGTH AND LOW DEGREE
INFLAMMATION ARE SO IN THE
PROBLEM OF DEMENTIA AND A
PROBLEMS RELATED WITH THESE SO,
I THINK THAT IT IS AN AREA THAT
WE NEED TO START TO THINK ABOUT
DEVELOP INTERNATIONAL STOPS AND
ALSO, I THINK THAT IT'S SO
IMPORTANT NOW TO DEFINE IF
REALLY THE POLICY AND THE AND
YOU HAVE USING SOME CLINICAL
TRIALS AND IS THAT IT WORK IN
OUR COUNTRIES.
>>Chair Aviles-Santa: THANK YOU
DOCTORS FOR YOUR PRESENTATIONS
AND FOR THIS VERY INTERESTING IN
Q&A AND NOW WE MOVE INTO THE
PRESENTATIONS FOR THE THIRD
TOPIC.
WORKSHOP WHICH IS CAN SEPTE CAN.
>>SEE YOU.
>>BYE-BYE.
>>I'M INVESTIGATOR AT THE
NATIONAL CANCER INSTITUTE AND
MODERATOR FOR TODAY'S SESSION OF
CANCER.
YOU WILL HEAR TWO PRESENTATIONS.
FIRST ON CANCER BURDEN AND
CONTROL BY Dr. SUYAPA BERARANO
AND SECOND BY Dr. GUSTAVO
WERUTSKY.
THEM TAKE QUESTIONS LIVE AFTER
THE PRESENTATIONS.
>>GOOD MORNING, EVERYONE, I AM
A ONCOLOGIST AND WORK AS A PEDRO
SULA, HONDURAS.
THANK YOU FOR PUTTING TOGETHER
THESE SELECTED GROUP OF
PROFESSIONALS AND INVITING ME TO
JOIN THIS I WANT TO ADDRESS TO
YOU THIS MORNING AND COMMENT A
LITTLE BIT OF REGARDING THE
CANCER BURDEN LATIN AMERICA AND
THE CARIBBEAN AND SOME RISK
FACTORS AND WHAT WE HAVE TO FACE
WHAT DO WE KNOW IS IT'S A VAST
REGION AND THAT ACCOUNT FOR 20
COUNTRIES AND 14 DEPENDENCIES
AND WE HAVE A POPULATION AMONG
THE COUNTRIES FROM GENETIC
BACKGROUNDS FROM ETHNIC GROUPS
AND FROM DIFFERENT LANGUAGES
WHERE SPANISH AND PORTUGUESE ARE
BEING THE MAIN LANGUAGES AND 80%
OF OUR POPULATION LIVE IN URBAN
AREAS AND THERE'S 2019 G.D.P.
REPORTED OF $5.6 TRILLION BUT IF
WE SEE MORE DEEP INTO THESE
NUMBERS AND WE SEE IT PROJECTED
WE CAN SEE A HIGH VARIETY FROM
$1,000 TO $30,000 IN DIFFERENT
COUNTRIES.
WHY IS THIS IMPORTANT?
BECAUSE THE POPULATION, THE
DOUGH MET TICK BACKGROUND AND
THE SOCIOECONOMIC CONDITION THAT
POSES EXPOSURES TO THOSE
SPECIFIC POPULATION COULD
EXPLAIN THE CANCER BURDEN THAT
WE'RE FACING TODAY IN LATIN
AMERICA AND THE CARIBBEAN.
AS WE SEE IN THIS GRAPH, WE HAVE
COUNTRIES WITH HIGH INCIDENTS OF
CANCER LIKE URUGUAY WITH 257,000
INHABITS AND COUNTRIES AS
CENTRAL AMERICA IN CENTRAL
AMERICA, THAT ARE LESS THAN 111
WORLDWIDE.
AND AS I MENTIONED BEFORE, THE
HUMAN LEVEL OF THE INDEX HAS
BEEN PREDICTED OF CANCER BY
DISEASE AND WITH SPECIFIC BURDEN
OF CANCER WITH COLORECTAL,
BREAST AND CERVIC AND LIVER
CANCER WHILE THE VERY HIGH HDI
COUNTRIES HAVE MORE LONG BREAST,
COCOCOLORECTAL AND PROSTATE.
WE CAN SEE WHAT I'M TALKING
ABOUT THIS.
WE STILL HAVE BREAST AND
COLORECTAL AS THE MAIN INCIDENTS
THROUGH THE COUNTRIES BUT WE
ALSO SEE COUNTRIES LIKE BOLIVIA
WHERE CERVICAL CANCER IS THE
FIRST CANCER OF INCIDENTS AND
THEN WE HAVE OTHER WHERE STOMACH
CANCER AND CERVICAL CANCER AND
BLADDER RELATED TO SEDENTARY
CONDITIONS AND INFECTIONS AND
THEY ARE IN THE MAIN TYPES OF
CANCER.
SO, THERE'S A DIFFERENCE BETWEEN
THE COUNTRIES AND THE DIFFERENCE
OF THE RISK FACTORS PRESENTED IN
THESE POPULATIONS WHICH MAKES IT
DIFFICULT TO ADDRESS FROM A
UNIFORM WAY THE CANCER CONTROL
IN THE REGION.
AND THE IMPORTANT ISSUE THAT WE
HAVE A VERY YOUNG POPULATION AND
WITH THE AGE OF 31 YEARS AND
THERE IS A EXPECTED RISE IN THE
HDI IN THE FOLLOWING DECADES AND
ALSO, A RISE IN THE INCIDENTS OF
CANCER AND IT'S CURIOUS TO SEE
THAT THE EXTRAPOLATED DATA THE
REGIONS OF THE HIGHEST INCREASE
IN CANCER RATES IN THE NEXT
DECADES.
SO, IN THIS VERY DIFFICULT FOR
US TO ADDRESS THE PROBLEM OF
CANCER, KNOWING THAT WE HAVE A
VARIETY OF SITUATIONS LIKE
THESE, MOST OF OUR INFORMATIONS
ARE RELYING ON MORTALITY BECAUSE
THERE'S NOT ENOUGH POPULATION
BASED CANCER REGISTRY WORKING
PROPERLY IN THE REGION.
THESE FACTORS THAT WE HAVE
IDENTIFIED.
WE CAN SEE THAT THE DISTRIBUTION
OF THIS RISK FACTORS IN THE
INFECTIONS AND ALCOHOL DRINKING
AND IT'S RELATED TO THEM AND
WHICH WE ALSO SEE THAT ARE
RELATED WITH HDI, HIGHER HDI AND
COLOR ALCOHOL CONSUMPTION AND
HAS A HIGHER BODY MASS INDEX BUT
ALSO WE CAN SEE THAT INFECTIONS
IN THE LOWER HDI ONE OF THE MAIN
CONTINUED STUDY AND IT'S
STANDARDIZED RATES OF CANCER.
AND SO VERY IMPORTANT POINT
REGARDING THE LIFESTYLES IS
THERE'S INSUFFICIENT PHYSICAL
ACTIVITY IN THROUGH LATIN
AMERICA OF IMPORTANT DIFFERENCE
WITHIN MEN AND WOMEN BOTH OVER
ALL WE HAVE INSUFFICIENT
PHYSICAL ACTIVITIES REPORTED TO
THE COUNTRIES.
REGARDING THE ALCOHOL EXPOSURE,
WE WOULD EXPECT THAT WITH ALL
THE CAMPAIGNS THAT WE HAVE BEEN
DOING THROUGH THE YEARS AGAIN,
LEARNING ABOUT THE CANCER RISK
AND LEARNING OF OTHER DISEASES
RELATED TO TOBACCO SMOKING AND
OTHER FORMS OF THE TOBACCO, WE
HAVE SEEN THE REDUCTION LESS
THAN 10% IN THE LAST DECADE AND
ALSO THE COUNTRIES WITH THE
HIGHER HDI HAS THE HIGHER
CONSUMPTION OF ALCOHOL CONSUMING
TOBACCO.
AND FROM 2018 AND ANOTHER
IMPORTANT FACTOR THAT WE HAVE
IDENTIFIED, REGARDING THE
INCIDENTS OF CANCER LIKE GASTRIC
CANCER IS THE SODIUM INTAKE.
AS WE SEE IN THIS GRAPH THROUGH
ALL THAT IN AMERICA, THERE'S A
HIGHER INTAKE OF SODIUM RELATED
TO THE RECOMMENDATION OF THE
AMERICAN HEART ASSOCIATION WHICH
IS ASSOCIATED WITH A SIGNIFICANT
RISK OF GASTRIC CANCER.
THERE IS INTERESTING PHENOMENON
HAVE JUST EMERGED IS THAT IT HAS
BEEN THAT IN CERTAIN COUNTRY,
THE LIGHT INCREASE IN MORTALITY
OF CANCER FOR GASTRIC CANCER IN
YOUNGER AGES, RELATED TO OR
OTHER COUNTRIES AND OTHER AGES
AND THIS IS A PHENOMENON THAT
NEEDS TO BE RESEARCH AND NEEDS
TO BE CHANGED TO KNOW WHAT IS
THE CAUSE OF THIS BEHAVIOR.
AND THEN WE HAVE THE INDIGENOUS
PEOPLE, WE HAVE A RICH VARIETY
OF ETHNIC GROUPS IN LATIN
AMERICA WHICH ARE HE IS POSED TO
CARCINOMCARCINOGENS AND SANITARY
CONDITIONS AND POOR
SOCIOECONOMIC OUTCOME THAT POSES
A CANCER RISK DIFFERENT THAN
FROM OTHER POPULATIONS AND THESE
POPULATIONS ARE ALWAYS OR
USUALLY FAR FROM ANTI-WAIT POINT
OF CARE AND THERE ARE INEQUITIES
AMONG THE EDUCATION AND AMONG
THE HETERO SERVICES THEY
RECEIVED AND WE HAVE TO ADDRESS
THIS POPULATIONS IN CULTURALLY
CORRECT WAY SO THERE IS ALSO
ANOTHER WAY AND ANOTHER FORM OF
INTEREST THAT WE CAN DEVELOP IN
RESEARCH AND IN THIS SPECIFIC
POPULATIONS.
AND OVER ALL, THERE IS POOR
AVAILABILITY FOR HIGH-QUALITY
HEALTHCARE IN LATIN AMERICA FOR
MANY REASONS.
THE UNIVERSAL HEALTH COVERAGE IS
OVER 70% IN MOST COUNTRIES BUT
STILL, MORE THAN 58% OF THE
CANCER CARE COME OUT OF THE
POCKET EXPENDITURE AND AS I
MENTIONED BEFORE, WE DON'T HAVE
ENOUGH CANCER IN POPULATION
BASED CANCER REGISTRY THAT HELP
US AND NO ABOUT WHAT IS THE REAL
INCIDENTS OF MORTALITY OF CANCER
IN THE REGION AND ONLY NINE OF
THE 20 COUNTRIES HAVE CANCER
CONTROL PLANS.
THERE'S INSUFFICIENT SPECIALISTS
FOR CANCER CARE AND IN LATIN
AMERICA THERE ARE DIFFERENCES IN
AMONG THE COUNTRIES BUT OVER
ALL, THE AMOUNT OF ONCOLOGISTS
ARE LOWER THAN THE POPULATIONS,
AS WE SEE, LATIN AMERICA IS AN
INTERESTING AREA IN THE REGION
AND WE HAVE OPPORTUNITIES AND
THREATS THAT CAN BE OVERCOME IF
WE INCREASE CANCER RESEARCH, IF
WE INCREASE THE TECH TRANSFER
AND WE INCREASE FUNDING SO WE
CAN UNDERSTAND OUR SITUATIONS OF
THE IMPORTANCE OF CANCER AND
HAVE OUT OWN RESEARCH AND
UNDERSTAND WHAT IS THE
CONDITIONS THAT CAN HELP US
REDUCE THE INCIDENTS AND
MORTALITY OF CANCER IN LATIN
AMERICA AND THE CARIBBEAN.
THANK YOU FOR YOUR ATTENTION AND
I WILL BE LOOKING FORWARD TO
YOUR QUESTIONS AND COMMENTS.
>>HELLO I'M GUSTAVO WERUTSKY
AND CHAIR FROM THE LATINO ON COL
GOUGH GROUP IN BRAZIL AND I WILL
PRESENT TO YOU TODAY THE
CLINICAL RESEARCH FOR CONTROL IN
AMERICAN AND THE CARIBBEAN.
I WORK FOR CLINICAL RESEARCH
ESPECIALLY IN BREAST CANCER IN
MY INSTITUTION.
SO IN THE THE LAST 20 OR 30
YEARS, WE SAW A GLOBAL MIGRATION
OF CLINICAL TRIALS COMING AND
THE MAJORITY COMING TO ASIA AND
AS WELL TO LATIN AMERICA AND
OTHER DEVELOPING COUNTRIES AND
AS YOU CAN SEE IN THE GRAPH, THE
PREPORTION OF UPPER MIDDLE AND
LOWER MIDDLE INCOME COUNTRIES
THAT ARE PARTICIPATING IN
REGISTRATION TRIALS IN CLINICAL
TRIALS THAT ARE increasing over
the years, if you look to phase
1 to clinical trials on going
open foray cruel in the clinical
trials, we see that Latina
America participate in around 5%
of the studies and Latin America
sites participate in clinical
trials we see that we don't have
a huge number of sites but that
a few number of sites we've high
amount of patients to we include
several patients in the single
enters Tuesday.
THIS IS WINSTITUTION.
WHEN WE PARTICIPATE IN THE
CLINICAL TRIALS.
IF WE LOOK AT PROFILE OF
CLINICAL TRIALS THAT HAVE BEEN
DOING IN LATIN AMERICA, WE SEE
THAT THE 95% OF THE STUDIES ARE
CONDUCTED BY PHARMA SPONSORS SO
BASICALLY WE PARTICIPATE IN
CLINICAL TRIAL ININCLUDED
PATIENTS.
WE DON'T HAVE IN LATIN AMERICA
THAT RECOGNIZE THE ACADEMIC
CLINICAL RESEARCH.
SO IT MEANS THAT WE NEED TO RELY
ON THE SAME CLINICAL PHARMA
INDUSTRIES TO DEVELOP OUR
INVESTIGATIVE TRIALS AND IT
MEANS THAT WE NEED TO COVER ALL
THE CARE OF PATIENTS SO THIS IS
VERY EXPENSIVE TO DEVELOP THE
TRIALS IF WE NEED TO RESPONSE
AND COVER ALL THE CARE AND THIS
IS WHY WE DON'T HAVE A HUGE
NUMBER OF INITIATIVES
INVESTIGATIVE TRIALS IN THE
REGION AS WE SEE HERE IN THIS
PICTURE, WE SEE THAT LATIN
AMERICA GOVERNMENTS, THEY DON'T
INVEST A LOT IN RESEARCH AND
DEVELOPMENT AND EVEN THE
NATIONAL COMPANIES THAT O WE SEE
BRAZIL HAS GDP DEVELOPMENT AND
IF YOU COMPARE AND TWO TIMES
MORE SO BASICALLY, LATIN AMERICA
RELIES A LOT IN THE PUBLIC
FUNDING AND IN THE RIGHTS YOU
CAN SEE THAT WHEN WE HAVE
ECONOMIC CRISIS AS THIS IS AN
EXAMPLE FROM BRAZIL, FOR
EXAMPLE, AND THE GOVERNMENT THE
FIRST THING THE GOVERNMENT DOES
IT INVESTMENT IN RESEARCH SO
THIS IS WHY WHOA NEED TO SHIFT D
MAKE AN ENVIRONMENT THAT IS
FRIENDLY AND EASY TO DEVELOP AND
INVEST IN CLINICAL TRIALS IN OUR
REGION SO WHEN WE LOOK AT THE
TIME TO APPROVAL OF CLINICAL
TRIALS THIS IS AN EXAMPLE FROM
AFFINITY TRIAL IN BREAST CANCER
AND WE SEE THAT FOR EXAMPLE,
NORTH AMERICA THE TIME IN DAYS
TO REGULATORY APPROVAL IS AROUND
30 DAYS COMPARED TO LATIN
AMERICA IT'S AROUND 53 OR 55
DAYS SO IT'S BASICALLY DOUBLE
TIME FOR REGULATORY APPROVAL.
WHEN WE SEE ALSO THE COUNTRIES
BY INCOME WE SEE THE UPPER
MIDDLE I OBJECT COME TAKES MORE
TIME THAN THE HIGH INCOME TO
APPROVE A PROTOCOL SO WHEN WE
ASK THE PATIENTS AROUND THE
WORLD IF THEY PARTICIPATE, 93%
OF THE PATIENTS IN NORTH AMERICA
THEY ARE WANTING TO PARTICIPATE
BUT EVEN IN SOUTH AMERICA ABOUT
THE MAJORITY OF PATIENTS ARE
WANTING TO PARTICIPATE IN
CLINICAL TRIALS AND THE PROBLEM
HERE IS THAT WE DON'T HAVE A
EDUCATION AND WE DON'T HAVE
EDUCATION FOR OUR PATIENTS TO
UNDERSTAND THE CLINICAL TRIALS
SO THERE'S NO INFORMATION FROM
THE MINISTER OF HEALTH AND
NATIONAL INSTITUTES AND OTHER
PATIENTS AND ADVOCACY GROUPS
INVOLVED CLINICAL TRIALS AND WHY
IT'S IMPORTANT TO PARTICIPATE IN
THIS STUDY SO I REALLY FEEL WE
NEED TO HAVE MORE EDUCATIONAL
INFORMATION FOR THE PATIENTS IN
THE REGION.
THIS IS A INITIATIVE FROM
FUNDRAISING INITIATIVE TO INVEST
IN AK A TEMPERATURE I CAN ACADEN
LATIN AMERICA.
THIS WAS MEETING WITH PATIENTS
AND PATIENT ADVOCACY GROUPS TO
EXPLAIN WHAT THIS CONCEPT AND
WHY IT'S IMPORTANT THIS CLINICAL
TRIALS AND CONCEPTS SO THIS IS A
VERY GOOD INITIATIVE THAT MAY
ATTRACT A PATIENT ADVOCACY
GROUPS AND CLINICAL TRIALS AND
TO GIVE MORE INFORMATION TO
PEOPLE IN THIS MEETING WAS
BROADCASTS SO, THEN WE CAN REACH
MANY, MANY WE ARE LEARNING ABOUT
THE CLINICAL TRIALS AS THEY
CENTRALIZE THE CLINICAL TRIALS
THAT WOULD BE I THINK FROM LATIN
AMERICA AND WITH THE HUGE HEAD
GEOGRAPHY OF THE COUNTRIES AND
BECAUSE YOU HAVE THE COST OF IS
THIS SET THAT YOU REQUEST THE
RECRUITMENT IN DIVERSITY OF THE
POPULATION THAT THE PATIENT
DON'T NEED TO CENTER FOR
SOMETIMES IT'S 200 KILOMETRES
FROM THE AND FOR EXAMPLE WE CAN
GENERATE A LOT OF DATA SO THAT
AND ESPECIALLY I AM NOT FEED THE
DEVASTATION PROCESS OF THIS
STUDIES IN THE IT WAS GOING TO
SPEAK ABOUT THE THE LA TEENY
AMERICAN CO-OPERATIVE GROUP AND
THIS IS A RESEARCH GROUP AND
THIS IS NOT A NON-PROFIT
ORGANIZATION THAT WAS VIEWED TO
THE WE HAVE ABOUT 427 MEMBERS IN
16 COUNTRIES IN LATIN AMERICA
AND THEY COVER AROUND 200
HOSPITALS AND WE DID AROUND THE
59 EPIDEMIOLOGICAL WITH MORE
THAN 10,000 PATIENTS IN THIS
SERVICE AND WE PRODUCE MORE THAN
AND SEVERAL IN DIFFERENT TUMOR
TYPES AND SO, IN 202020, THERE
WAS A BIG ACHIEVEMENT TO OUR
GROUP THAT WAS THE FIRST
CLINICAL TRIAL INVESTIGATED THAT
CAUSE CONDUCTED AND PRESENTED AS
A PRESENTATION AND IN 2020 AND
THIS WAS A STUDY IN PROSTATE
CONCERN AND TODAY, THEY HAVE
SEVERAL PARTNERS AND WE
PARTNERSHIP WITH SEVERAL
NATIONAL GROUPS AND BRAZIL AND
ALSO FROM LATIN AMERICA AND
GROUPS FROM YOU'RE UP AND HOW DO
WE FOSTER CLUB CLIN CLINICAL TR.
WE NEED TO DECENTRALIZE THE
COMMUNITY IN A ROLE FOR EXAMPLE
NA BRAZIL WE NEED TO OPEN 10
SITES AND SO THIS PROCESS IS
VERY AT LENGTH SO IT'S A LONG
PROCESS AND IT'S DELAYED THE
STARTING OF THE CRISIS SO WE CAN
TREATMENT LINE THE INTERNAL
PROCESS FOR REGULATORY AND ALSO
THE CONTACT APPROVAL THAT IS
IMPORTANT AND SOMETIMES IT'S TWO
OR THROW MONTHS OR FOUR MONTHS
IN CONTRACTS AND APPROVALS SO
THIS WOULD BE CERTAINLY
SOMETHING TO IMPROVE INSIDE THE
CENTERS AND ALSO THE INDUCE
TREMENDOUS AROUND THE SPONSOR
AND THEY NEED TO INCORPORATE
DIGITAL TECHNOLOGIES AND IN
CLINICAL TRIALS FOR EXAMPLE
CONSENT AND MONITORING AND ALSO
ALL THE POSSIBILITIES THAT IS
STREAMLINE THE PROCESS INSIDE
THE CENTER AND FACILITATE THE
WORK AND FOR PATIENTS AND
RECRUITMENT I THINK THAT WE NEED
TO STIMULATE MORE THE USE
PROMOTING CLINICAL TRIALS AND WE
NEED TO ENGAGE AS WELL THE
PATIENTS AND ADVOCACY GROUPS TO
KNOW ABOUT THESE STUDIES BECAUSE
TODAY, THE PATIENTS AND THE
POPULATION JUST DON'T KNOW WHERE
THEY STUDIES ARE OPEN FOR RULE.
THERE'S NO INFORMATION ON THE
INTERNET AND EVEN IN SOCIAL
MEDIA AND LASTLY THE TRANSLATION
OF RESEARCH WE NEED TO STIMULATE
THE FUNDING FOR TRANSLATIONAL SO
WE RELY BASICALLY IN LATIN
AMERICA PUBLIC FUNDING FOR
RESEARCH AND PH.D, BUT WE NEVER
IN LATIN AMERICA MAKE A DEVICE
OR A NEW DRUG APPROVAL FROM THIS
INVESTMENT AND THEY WILL WILL
DOR FOR SEVERAL DECADES SO THAT
IS VERY IMPORTANT TO FACILITATE
THE REBATE FUNDING FOR THOSE
NATIONS AND RESEARCH ESPECIALLY
FOR ACADEMIC INITIATED CLINICAL
TRIALS.
THANK YOU, VERY MUCH.
>>GOOD MORNING, EVERYONE,
WELCOME.
THANK YOU FOR YOUR EXCELLENT AND
INFORMATIVE PRESENTATION AND I'M
DELIGHTED TO MODERATE YOUR
CONVERSATION.
MY FIRST QUESTION FROM THE
AUDIENCE FOR Dr. BEJARANO.
WOULD YOU PLEASE DESCRIBE THE
CURRENT EVENTS TO FACILITATE AND
PROMOTE RESEARCH IN CENTRAL
AMERICA?
>>GOOD MORNING, WE HAVE SOME
MANY OPPORTUNITIES AS Dr.
WERUTSKY JUST MENTIONED, ONE IS
IN AMERICA.
ONE YOU CAN SEE THERE'S A
NETWORK OF COMMITTEES AND THIS
IS FROM VERY RECENT CREATION AND
IT'S HELPING OUT TO IDENTIFY
MORE THAN 1500 ETHICS COMMITTEE
AND THIS MEANS THAT THERE'S A
LOT OF PEOPLE INTERESTED IN
RESEARCH AND TRYING TO ACQUIRE
BETTER QUALITY CLINICAL TRIALS.
TO EMPOWER THIS NEW RESEARCHERS,
PROMOTE THE ACQUISITION OF THIS
TOOLS THAT WE ENABLE THEM TO
PERFORM ADEQUATELY RESEARCH IN
THE REGION.
>>THANK YOU.
THE NEXT QUESTION IS FOR Dr.
WERUTSKY.
WHAT MAKES IT SUCCESSFUL?
WHAT LESSONS LEARNED CAN YOU
SHARE WITH US THAT WILL NEED TO
BE CONSIDERED FOR AN IDEAL
U.S.-LATIN AMERICA
COLLABORATION?
>>SO, I THINK PART BASICALLY IT
WAS IN THE BEGINNING NETWORK OF
INVESTIGATORS AND SO THERE WAS A
WAY TO START TO PERFORM,
INVESTIGATE AND STUDIES IN THE
REGION.
AT THAT TIME, WE HAD PEOPLE
WORKING AND GETTING ALL THE
IDEAS FROM THE INVESTIGATORS AND
MEETING THESE IDEAS TO
ESPECIALLY IN THE CLINICAL
TRIALS TO PHARMA, TO SEE IF THEY
HAVE INTEREST TO DEVELOP THIS
PROPOSALS IN THE REGION BUT AS
WELL, WE SENT PROPOSALS FOR THE
GOVERNMENT AND ESPECIALLY TO
GENERATE THE REEVOLVING DATA
THAT WE GENERATE IN SEVERAL
HUMOR TYPES AND THIS STEPS US A
LOT TO UNDERSTAND THE REALITY OF
OUR WE SAW INVESTIGATORS BECAUSE
WE STARTED TO PUBLISH OUR RESULT
AND THIS GENERATES A LOT OF
CREDIBILITY INTERNATIONALLY AND
NOW WE'RE IN THE NEXT STEP.
NOW WE HAVE PARTICIPATING MORE
MORE IN INTRA GROUP STUDIES AND
GROUPS FROM U.S. AND EUROPE IN
PHASE 3 REGISTRATION PRICE SO
DOING ACTIVITIES HERE IN BRAZIL
AND LATIN AMERICA WITH
MONITORING PAYMENTS, CONTRACTS
AND EVERYTHING SO, THIS IS A
HISTORY NA THIS SHOWS THAT IT IS
POSSIBLE TO DO OK, WHAT I THINK
IS IMPORTANT IS THAT I BELIEVE
WE CAN, WE HAVE A VERY PROMISING
POSSIBILITY TO INTERACT MORE
WITH THE U.S. AND U.S. GROUPS
AND THE MODEL OF GROUP STUDIES
WE NEED TO EVALUATE BECAUSE
THERE IS ALSO MANY BAD YEARS IN
TERMS OF NCI HOW THE NCI WORKS
WITH GROUPS OUTSIDE THE, S. THAT
WE NEED MAYBE TO BE MORE
FLEXIBILITY BECAUSE LATIN
AMERICA HAS SEVERAL REGULATORY
TYPES OF SUBMISSIONS AND ALSO
INSURANCE FOR THE INVESTIGATORS
AND PAYMENTS OF THE SYSTEM OF
CARE SO WE NEED A BIT MORE
COMMUNICATION TO TRY TO
STREAMLINE OUR PARTNERSHIP WITH
THE U.S.
>>THANK YOU, CONGRATULATIONS ON
THE GREAT INITIATIVE.
WE'RE GOING BACK TO Dr.
BEJARANO.
HOW DO YOU INCREASE HUMAN
RESOURCES IN CANCER HEALTHCARE?
ARE THERE ANY INTERVENTIONS OR
POLICIES IN PLACE IN THE REGION?
>>IT'S A VERY IMPORTANT
QUESTION.
NOT MANY COUNTRIES HAVE CANCER
POLICIES SO THE RESULT IS THAT
THERE'S NO PLANS FOR SCHOOLS FOR
ONCOLOGY TRAINING AND ONE OF MY
PROPOSALS FROM A GROUP THAT
WE'VE BEEN TALKING ABOUT WITH
OUR COLLEAGUES IS TO PROMOTE THE
OPENING OF THESE CANCER
TRAININGS SCHOOLS NOT ONLY FOR
PHYSICIANS BUT ALSO FOR NURSES
AND TECHNICIANS AND SO MANY WAYS
PSYCHOLOGY AND SPECIALIZING IN
CANCER CARE BECAUSE IT'S ANOTHER
PART OF THE MANAGEMENT OF CANCER
PATIENTS THAT IS VERY IMPORTANT
TO ADDRESS SO ONE OF THE
RECOMMENDATIONS WOULD BE TO
EMPOWER OR PROMOTE LOCAL
TRAINING CENTERS IN COUNTRIES
WHO DOESN'T HAVE AND FOR IN
CENTRAL AMERICA, COSTA RICA HAS
A VERY SOLID ONCOLOGY TRAINING
PROGRAM BUT IT'S NOT OPEN TO
FOREIGNERS SO ONLY FOR COAST A
REEKANCE SO MAYBE WE CAN HAVE A
NETWORK THAT WE CAN CHAIR AND WE
HAVE ACCESS FOR ALL THE PERSONS
WHO ARE INTERESTED.
BUT THE OTHER HAND, THERE'S
STILL THE PROBLEM OF THE
GOVERNMENTS BECAUSE WE NEED A
LOT OF PROFESSIONAL AND
SOMETIMES MOST OF THE TIMES
THERE'S NOT A BUDGET TO HIRE
THEM SO IT'S AN ISSUE.
THIS IS A LOCAL ISSUE BUT WE CAN
ADDRESS IT AS A GROUP AND
PROMOTE.
>>THANK YOU.
I THINK THE ORGANIZED REGION ARE
KEY.
YOU MENTIONED LIMITATIONS ABOUT
FUNDING, WHAT IS THE BEST WAY TO
SUPPORT CANCER RESEARCH IN
LATINO AMERICAN AND
INVESTIGATORS INITIATED STYLES?
>>SO, I THINK IT'S IMPORTANT TO
RECOGNIZE, FOR EXAMPLE, IN
BRAZIL WHEN LATIN AMERICA IS THE
SAME THAT PHARMA SPONSORED
TRIALS IN OUR HOSPITALS HAVE
BEEN DONE IN THE LAST 20 TO 25
YEARS AND THIS BRINGS TO OUR
CONSCIOUS A LOT OF INVESTMENTS.
OK.
THESE ALSO HAVE INDIRECTLY WHY
DO WE SAY THAT?
BECAUSE IN OUR HOSPITALS, THAT
PARTICIPATE IN CLINICAL TRIALS
THEY NEED TO CHANGE THE PRACTICE
AND IN TERMS OF QUALITY FOR
EXAMPLE, IN THE SURGERY, IN
PATHOLOGY, THE HYDROLOGIST NEEDS
TO UNDERSTAND AND LEARN ABOUT
THE RISKS AND THIS IS WILL
IMPACT ALL THE PATIENTS WE SEE,
OK.
SO THE INVESTMENT THAT INDUSTRY
DID IN THE LAST 20 YEARS WAS
VERY IMPORTANT TO BECAUSE THERE
WAS AT INTERESTS INSIDE THE
HOSPITALS, OK.
BUT WE NEED GO TO THE NEXT STEP.
THE NEXT STEP IS INNOVATION.
FOR IN OVATION, FOR EXAMPLE, THE
ORGANIZATION BASICALLY RELY ON
PROJECTS THAT WE DO WITH PHARMA
AS THEY DO AROUND THE WORLD AS
WE INVESTIGATE THE STUDIES WE
DON'T HAVE ANY SUPPORT FROM THE
GOVERNMENT AND I THINK THAT
THERE'S A VERY NICE INTERESTING
PROGRAM FROM THE GOVERNMENT IN
BRAZIL THE LAST YEARS THAT THE
PEOPLE AND THE COMPANIES CAN
INVEST OR CAN DONATE MONEY FOR
RESEARCH PROJECTS AND SO IT'S A
PROJECT THAT PEOPLE AND
COMPANIES CAN DONATE FOR ITS
RESEARCH PROJECTS AND THEN THEY
CAN DO IT AS A DONATION IN THE.
SO THIS MAKES A LOT OF NEW
POSSIBILITIES FOR PEOPLE AND
COMPANIES TO INVEST IN CLINICAL
RESEARCH AND THIS IS A WAY TO
PREVENT COMPANIES FROM BRINGING
PEOPLE ALSO TO SUPPORT
INVESTIGATIVE AND PRICE AND.
>>YOU SHOW US HOW SOMETIMES
MORE RATES ALIGN WITH INCIDENTS
AND AND THEY ARE DIAGNOSED AT
LATE STAGES AND HOW TO IMPROVE
CANCER PREVENTION AND IN LATIN
AMERICA AND THE CANADIAN.
>>WE HAVE THE PROBLEM THAT IT'S
A DIVERSITY OF PRIMARY CANCERS
IN LATIN AMERICA AND THE POINT
THAT IS COME TO ALL OF THEM, IS
THAT WE CAN DETECT EARLY CANCERS
AND WE UNDERSTAND HOW CAN WE
DETECT EARLY CANCERS VIA
SCREENING OR VIA EARLY DETECTION
AND WE CAN MAKE AN IMPACT ON
MORTALITY NOT ONLY IN LATIN
AMERICA BUT FOR PATIENTS THAT
MIGRATE TO OTHER COUNTRIES
BECAUSE THEY ARE ALREADY HAVE
DISEASES THAT ARE CARRYING FROM
THEIR ORIGINAL REGIONS SO
UNDERSTANDING THE EMERGING
CANCER LIKE LIVER CANCER FOR
EXAMPLE, LIKE GASTRIC CANCER AND
MORTALITY AND IT WILL ONLYING
EXPLAINED IF WE DO RESEARCH IN
THESE EARLY STAGES AND WE
ENFORCE EARLY DETECTION IN EARLY
CANCERS.
>>THANK YOU.
>>Dr. VERUTSKY CAN YOU TALK
ABOUT AMERICA AND THE KA RAIN
YAN, WE SEE THE LACK OF LATIN
AMERICA, THE LACK OF
PRECIPITATION IN SOME KEY PAP
PRECIPITATPARTICIPATION.WHAT ISO
BANKS?
THANK YOU.
>>YES, SO, BIOBANKING IN LATIN
AMERICA IS PERFORMING BASICALLY
BY A FEW INSTITUTIONS.
OK.
AND WE DON'T HAVE, FOR EXAMPLE,
OUR NATIONAL BIOBANK AND THAT IS
ALL DECIDE ON THAT AND SO, WE
DON'T HAVE IN THIS WAY A SUPPORT
TO THE INSTITUTIONS FROM THE
GOVERNMENT FOR EXAMPLE, TWO
PERFORM AND VIEW BIO BLANK SET
SO IT'S DIFFICULT FOR
UNIVERSITIES AND HOSPITALS TO
VIEW THE BEE O BIO BANKING SO WD
TO ORGANIZE AND INCENTIVIZE AND
IT WOULD BE VERY IMPORTANT THAT
THE GOVERNMENT BE INVOLVED IN
THAT TO THE BIOBANK AND THE
SECOND THING THAT IS VERY
IMPORTANT, OK, FOR EXAMPLE, IN
BRAZIL, THE REGULATION OF
BIOBANKING DOESN'T ALLOW THE
PATIENT TO DONATE THE SAMPLES
AND SO THEY WILL CONTRIBUTE TO
THE NATIONAL AND INTERNATIONAL
BIOBANKING BECAUSE THEY DID NOT
DONATE THIS OK AND THE THIRD
THING IS IMPOSSIBLE IN BRAZIL
AND REGULATION FOR EXAMPLE, TO
MAKE AND IT'S NOT POSSIBLE TO
PATENT NEW TESTS OR DEVICES
USING SAMPLE COMMUTATIONS SO
SOMETIMES, IT'S VERY IMPORTANT
FOR THE PROBLEM IS OUR
REGULATIONS THAT MAKE IT HERE
FOR THE ALLOT THE AND NOT THE
PROBLEM OF THE PEOPLE THAT DON'T
WANT TO CONTRIBUTE, OK, SO IN
THIS WAY I RECOMMEND THAT FOR
EXAMPLE, INSTITUTIONS FROM U.S.
AND THE U.S. GOVERNMENT WHO
MAYBE HAVE A JOINT EFFORT WITH
LATIN AMERICA TO HELP TO BAYS WE
FIELD THE INSTITUTION 0 BRAZIL
AND THE REGULATORY THEY NEED TO
HELP IN UNDERSTAND WHAT IS
POSSIBLE TO DO AND SO I THINK IT
NEEDS TO MAKE AN CHANGE OUR
REGULATION TO FACILITATE THE
COLLABORATIONS CONNECTION.
WE WILL BE ABLE TO TRANSFER IN
SAMPLES TOO OTHER, TO THE
COLLABORATIVE EFFORTS AND THE
INTERNATIONAL ONES AND THIS
QUESTION APPLIED TO BOTH YOU.
WOULD YOU PLEASE SUGGEST A
POTENTIAL RESEARCH OPPORTUNITY
IT COULD BE A RESEARCH QUESTION
AND A SPECIFIC STUDY AND
INTERVENTION AND THAT COULD BE
IN LATIN AMERICAN POPULATIONS TO
REDUCE THE DISPARITIES AMONG
HISPANIC LATINO POPULATIONS IN
THE U.S.?
THIS QUESTION COULD BE ALSO SEEN
AS WHAT SHOULD BE THE KEY TOPICS
OF COLLABORATION BETWEEN THE
U.S. AND LATIN AMERICAN AND THE
CARIBBEAN.
AS I MENTIONED BEFORE, EMERGING
COUNCILS IN POPULATION AND
CANCER LIKE GASTRIC AND LIVER
CANCER WOULD BE TOPIC OF
INTEREST AND THIS MORNING AND
MOST OF THE PEOPLE THAT MIGRATE
TO THE UNITED STATES ONCE THAT
LIVE IN THE UNITED STATES, HAVE
THE SAME BEHAVIOR WHEN THEY GIVE
IN THEIR OWN COUNTRIES AND THEIR
LATE DIAGNOSIS, HIGH MORTALITY
AND ADDRESSING THESE KEY POINTS
WOULD BE IMPORTANT FOR CANCER
WHICH ARE PREVALENT IN THE
POPULATION OF LATIN AMERICA AND
THE UNITED STATES.
SO, THIS WOULD BE MY POINT OF
VIEW REGARDING OF IMMEDIATE
RESEARCH QUESTION IS ABOUT THIS
CANCER WHICH ARE EMERGING AND
ARE VERY PREVALENT IN THE
POPULATION.
>>THANK YOU.
Dr. WERUTSKY.
>>I THINK THAT WE NEED TO
UNDERSTAND MUCH MORE THE
GENETICS RISK OF OUR HISS PAN
PICK AND LATINO POPULATION IN
TERMS OF SOME TYPES AND ALSO THE
MOLECULAR OF ALSO IN SOME TUMOR
TYPES SO WE KNOW IN BRAZIL AND
THE RISK AND SOME PARTICULAR
IT'S OFF VARIANTS AND NO YOU GO
GENE VARIANTS AND THIS IMPACT
THE DIAGNOSIS OF RECOMMENDATION
AND THIS IS A CASE FOR EXAMPLE
WE BUT ALSO A LOT OF HIGH
INCIDENTS FOR THE CARCINOMA AND
IT'S SO MUCH CARCINOMA AND
CARCINOMA IN BRAZIL THAT SOME OF
THE TOP IN THE WORLD SO WHY
THESE PATIENTS, WHY THIS DISEASE
IS SO PREVALENT.
SO WE HAVE A GOOD OPPORTUNITIES
HERE TO UNDERSTAND MORE OF THE
GENETIC RISK BUT ALSO VERY
IMPORTANT FOR SOME TUMOR TYPES,
FOR EXAMPLE, ARE USED AND LUNG
CANCER AND EACH OF THE MUTATION
IS VERY HIGH IN THE PACIFIC
COAST.
>>AND FIND THE STUDY LIKE IN
AMERICAN TO HELP PATIENTS TO
HAVE A MORE HAPPILY DIAGNOSIS OF
CONCEPT.
>>THANK YOU TO BOTH.
I APPRECIATE YOUR COMMENTS AND
INSIGHTS AND THANK YOU TO THE
AUDIENCE FOR THE QUESTIONS AND
BECAUSE OF THE INTEREST OF TIME,
I WILL NOW TURN THINGS OVER TO
THE MODERATOR OF THE NEXT
SESSION, Dr. DOOSE.
>>THANK YOU.
>>GREETINGS.
I'M THE MODERATOR OF PULMONARY
DISEASE AND ENVIRONMENT HEALTH.
BEFORE THE LIVE Q&A SESSION, YOU
WILL HEAR PRESENTATIONS FROM
Dr. ROGELIO PEREZ-PADILLA AND
FOLLOWED BY Dr. ANADIEXROUX.
>>FROM THE NATIONAL INSTITUTE
INSTITUTE OF RESPIRATORY
DISEASES IN MEXICO.
NO CONFLICTS AND I'M GOING TO
TALK MAINLY ABOUT COPD AND THE
RISK FACTORS FOR COPD,
ESPECIALLY THE EXPOSURE TO
SMOKING IN RURAL YEARS AND JUST
A FEW WORDS ABOUT HAVING NOT
INTRA GRAY TIVE PROGRAM FOR COPD
AND I WORD ON PREVENTION.
COPD HAS BEEN INCREASING IN
MEXICO AND ALSO THE DEATH RATE
FOR COPD IN DISEASES FROM GLOBAL
IMPORTANCE OF DISEASES AND IN
2019 AND YOU CAN IS HE MEXICO
HAS GONE UP AND OTHER COUNTRY IN
LATIN AMERICA AS WELL.
LATIN AMERICA IS A VAST COUNTRY
OR AREA WITH A MANY HEALTH
ISSUES AND YOU CAN SEE HERE,
THAT AS RATE OF COPD AND WE HAVE
OTHER RATES OF HEINE INCOME
COUNTRIES AND OTHER COUNTRIES
WITH VERY LOW ESTIMATED DEATH
RATE AND YOU CAN SEE THE RISK
FACTORS AND WHY IT'S MAINLY DUE
TO SMOKING TOBACCO AND WE ALSO
HAVE SOME COUNTRIES WITH RED AND
EXPOSURE TO HOUSEHOLD AREAS.
RISK FACTORS AND THE PREVALENCE
OF COPD ALSO CHANGES A LOT HERE
AND THERE ARE SURVEYS POPULATION
BASED?
CITIES AND YOU CAN SEE THAT WE
HAVE SOME CITIES WITHOUT
PREVALENCE.
CLOSE TO 15% OF THOSE OLDER THAN
40 YEARS OF AGE BUT YOU HAVE
MEXICO CITY WITH A MUCH LOWER
PREVALENCE OF COPD AND THIS HAS
TO DO MAINLY WITH TOBACCO
SMOKING.
AS YOU CAN SEE HERE, CHILE HAS A
VERY HIGH PREVALENCE OF SMOKERS
AND PANAMA HAS LESS THAN 10% IN
SOME GROUPS.
THERE ARE OTHER FACTORS AND
EXPOSURE AND PROBABLY
SUSCEPTIBLE.
THIS FROM MEXICO AND I SHOW THE
DECREASE IN SMOKING, MEXICO HAS
A PLATEAU THAT WE HAVE TO
OVERCOME AND SMOKING HAS BEEN
IMPROVING.
OF COURSE, BIO MASS IS SMALL HAS
A COMPANION DEMAND FOR THOUSANDS
OF YEARS AND MANY GENERATIONS
AND STILL IS IT'S HIGH IN WOMEN
AND THIS THE STATE OF AND MEXICO
AND MORE THAN HALF OF HOUSE
CLOUDS AND UTILIZING FUEL AND
OTHER CITIES WITH ALMOST NON AND
IN CENTERS AND YOU ANALYZE THE
DATA OF COPD, MOST ARE SMOKERS
AND BUT ABOUT A FOURTH AT LEAST
THIS HAPPENS HERE BUT AND ONLY
EXPOSURE AND THEY WERE NEVER
SMOKERS AND THEY LOOK THE SAME
WITH A LOT OF CARBON AND IN
PATHOLOGY, SMOKERS HAVE MORE
EMPHYSEMA AND THOSE EXPOSED TO
BIO MASS MORE SMALLER WITH
FIBROSIS AND THICKNESS OF THE
ARTERIES AND THIS IS THE SAME
CITIES SCANING AND MOREEN NAZEM
A AND MORE TRAPPING IN BIOMASS
GROUP AND THAT ALSO HAS MORE
HYPER RESPONSENESS AND OF COURSE
EXPOSURE IS DIFFERENT AND
BIOMASS OF SMOKE IS MAINLY AND
IN THE SMOKERS IS ORAL AND
DEEPER INHALLTATIONS AND THE
POSITION IS ALSO MORE PRE FOUND
AND MORE IMPORTANT THAN THOSE
EXPOSED TO BIO MASS ABOUT BUT IT
OVERLAPS IN BOTH GROUPS AND WHEN
YOU ADJUST FOR A ONE AND SO IT'S
A BAD DISEASE AS WELL AND THAT
PRODUCING WOMEN EXPOSED TO BIO
MASS OR EVEN THOUGH THE
DECLINING LUNG FUNCTION IS
NORMAL IN THE BUY EMAS GROUP AND
YOU CAN SEE HERE HOW WITH A
HIGHER SLOPE IN THE SMOKERS AND
SO THIS GROUP OF MARKERS WITH
COPD AND SOME HAVE A FROM A
STUDY AND SOME HAVE PREVIOUSLY
TB WHICH IS AN IMPORTANT ISSUE
AND IT HAS TO BE TREATED
CORRECTLY SINCE INFANCY TO AVOID
PERMANENT DAMAGE AND THIS IS
FROM FROM PLATINO STUDY WITH
HAVING A PREVIOUSLY STATEMENT OR
PREVIOUS CLOSE THIS IS MORE A
FLOW OF STRUCTURE AND THAT IS
BECAUSE OF THIS SCARRING AND
THAT IS MOR IMPORTANT IN DRUG
RESISTANT TUBERCULOSIS AND
ANOTHER IMPORTANT ISSUE IS THE
DISEASE THAT DEVELOPS IN SMOKERS
PEOPLE EXPOSED TO BIO MASS BUT
NOT WITH AIR FLOW INSTRUCTION
THEY DON'T HAVE COPD BUT THE
PRESENCE OF SYMPTOMS INCREASES
THE MORTALITY AND THIS IS FROM
LATINO STUDY AND ALSO,
INCREASING THE LONG FUNCTION
DECLINE AND IS AN IMPORTANT
ISSUE AND OF COURSE, WE SHOULD
NOT HAVE A ONE THIS INCLUDING
COPD AND WE NEED TO REDUCE
SMOKING, IMPROVE AIR QUALITY AND
OF COURSE HAVING PROGRAMS FROM
PRIMARY CARE AND FROM REFERRALS
CENTERS WITH TEACHING AND
PREVENTION IS KIND OF DIFFICULT
BECAUSE EXPOSURE TO BIO MASS IS
ASSOCIATED WITH POVERTY AND IN
THIS PROGRAM IN CHINA, THEY WERE
VERY EFFECTIVE PREVENTING COPD
JUST WITH A ACHIEVEMENT BUT IN
MEXICO AND ON ANOTHER COUNTRIES,
THIS IS CALLED EXPOSURE TO CALL
NOT TO CHARCOAL AND SO, THIS IS
A LITTLE DIFFERENT AND ADHERENCE
TO THE IMPROVE IT HAS BEEN VERY
POOR AND OF COURSE, THERE ARE
QUESTIONS TO BE ANSWERED AND FOR
EXAMPLE, THERE ARE ANCESTRY IS
CENTER IN THE USER AND TRYING TO
AVOID OPEN FIRES BECAUSE
SOMETIMES THEY COMBINE DIFFERENT
STOVES AND BEFORE IMPLEMENTING
WIDELY IMPROVE
LONG-TERM ADHERENCE.
ANOTHER KIND OF QUESTION WE HAVE
TO ANSWER IS, FOR EXAMPLE, IF
STEROIDS WORK BETTER IN COPD
THAN BIOMASS BECAUSE THE REPORTS
ON BRONCHIAL HYPER
RESPONSIVENESS AND THE MAIN
ISSUE WE EXTRAPOLATE TREATMENTS
TO THIS FROM SMOKER STUDY AND WE
NEED STUDIES DONE IN THIS TYPE
OF PATIENTS AND IT'S PHENOTYPE A
DIFFERENT PHENOTYPE AND OF
COURSE WE NEED TREATMENT FOR
PATIENTS WITH SYMPTOMS AND
CHRONIC BRONCHITIS TO KNOW THE
IMPORTANCE OF THIS CHRONIC
BRONCHITIS AND SYMPTOMS IN
PATIENTS EXPOSED TO BIO MASS.
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
>>GOOD MORNING, THANK YOU FOR
THE OPPORTUNITY TO SHARE WITH
YOU SOME DATA AND SOME
REFLECTIONS ON CERTAINLY AND
ENVIROSOCIAL ANDDETERMINANTS OFS
LATIN AMERICAN CITIES.
I'M DOING WORK AND THIS IS A
PROJECT LED BY THE DREXEL AND 14
PARTNERS BASED IN LATIN AMERICA
AND THE PROJECT WAS LAUNCH
INSIDE 2017 SO YOU CAN SEE THAT
OUR PARTNERS ALL OVER THE
REGION.
THE PROJECT HAS FOUR AIMS, AIM
ONE IS TO IDENTIFY CITY AND
NEIGHBORHOOD DRIVERS OF HEALTH
AND HEALTH INEQUALITIES AMONG
AND WITHIN CITIES.
TIME AIM TO AND AIM THREE IS TO
EMPLOY SYSTEMS THINKING AND
SIMULATION MODEL TO EVALUATE
URBAN HEALTH ENVIRONMENTAL LINKS
AND PLAUSIBLE POLICY IMPACTS AND
ENGAGE THE SCIENTIFIC COMMUNITY
THE PUBLIC AND POLICYMAKERS TO
TRANSLATE FINDINGS SO TODAY I'M
GOING TO FOCUS PRIMARILY ON
RESULT DEASE ARRIVED FROM AIM
ONE BUT THE STUDY IS VERY RICH
SO I WANTED TO SHARE THE OTHER
AIMS WITH YOU AS WELL.
AS YOU KNOW, SOCIAL BUILT AND
PHYSICAL ENVIRONMENTS ARE KEY
DETERMINANTS OF HEALTH AND ONE
CAN ARGUE NON COMMUNICABLE
DISEASES.
SO SHOW ONE ILLUSTRATION OF
THIS, ECONOMIC AND I EQUALITY
AND RACISM, CONTRIBUTE TO
RESIDENTIAL SEGREGATION WHICH IN
TURN CREATES AND REINFORCES
INEQUALITY THIS IS POWER AND
RESOURCE DISTRIBUTION AND THIS
DYNAMIC CREATES DIFFERENCES,
ACROSS NEIGHBORHOODS AND
NEIGHBORHOOD PHYSICAL
ENVIRONMENTS AND IN NEIGHBORHOOD
SOCIAL ENVIRONMENTS AND --
SPECIFICALLY, URBAN
ENVIRONMENTS, IN PARTICULAR, CAN
HAVE A NEGATIVE IMPACT ON NON
COMMUNICABLE DISEASES THROUGH
THE PROMOTION OF SEDENTARY
LIFESTYLE BECAUSE OF MOBILITY ON
ABLE TRANSPORTATION AND
SEDENTARY WORK.
THEY CAN ALSO INCREASE ACCESS TO
AND PROMOTION OF PROCESSED
FOODS, INCREASED FOOD
CONSUMPTION OUTSIDE THE HOME,
AND ALSO INCREASE EXPOSURE TO
AIR POLLUTION BECAUSE URBAN
AREAS HAVE HIGHER LEVELS OF AIR
POLLUTION.
BUT THERE ARE ALSO WAYS IN WHICH
URBAN ENVIRONMENTS CAN HAVE
POSITIVE EFFECTS AND REDUCE NON
COMMUNICABLE DISEASE RISK AND
THEY PROMOTE MIXED LAND USE,
PEDESTRIAN FRIENDLY ENVIRONMENTS
AND HIGH POPULATION DENSITY AND
THEY CAN CREATE OPPORTUNITIES
FOR PROMOTION OF HEALTHY EATING
AND FOOD AND ADVERTISING
RESTRICTIONS ON PROCESSED FOODS
AND TOBACCO PRODUCTS AND THEY
CAN ALSO REDUCE AIR POLLUTION
EXPOSURE AND SO THERE'S NO
SINGLE WAY IN WHICH URBAN
ENVIRONMENTS AFFECT NON COM
UNIKE ABLE DISEASE DEPENDS ON
THE FORM IN WHICH URBANIZATION
TAKES AND HOW IT'S MANAGE AND
HOW CITIES ARE GOVERNED AND THIS
IS TRUE IN LATIN AMERICA AND
ALSO OF COURSE IN THE U.S.
AND NOW NON COMMUNICABLE
DISEASES, AS YOU KNOW, ARE A
MAJOR CAUSE OF MOR BILL TEE AND
MORTALITY BUT THEY HAVE HIT YO
AGAIN A THETEROGENEITY.THESE AR0
PEOPLE MOR MORE IN ALL THE
COUNTRIES INCLUDED IN OUR STUDY.
THE CITIES ARE ORDER BY DEATH
DUE TO VIOLENT INJURIES BUT I
WANT TO HIGHLIGHT THE ORIGINAL
AND THE RED WHICH AS YOU CAN SEE
IT'S A SIGNIFICANT PREPORTION
BUT IT'S ALSO VARIABLE ACROSS
THE CITIES AND IN FACT, IF WE
SORT THE CITIES ACCORDING TO THE
PREPORTION OF THE DEATH THAT ARE
BY NON COMMUNICABLE DISEASES WE
SEE HETERO AGAIN EIG HETEROGENE.
WHAT CITY LEVEL OR OTHER FACTORS
ARE RELATED TO THESE DIFFERENCES
AND THIS IS NOT ATTRIBUTABLE TO
COUNTRIES IT'S CITIES WITHIN A
COUNTRY PRIMARILY.
WE HAVE LOOKED AT SOME FACTORS
INCLUDING SOCIAL ENVIRONMENT
FACTORS TO EXPLAIN THIS AND AS
I'LL SHOW IN THE NEXT FEW
SLIDES, THEY ARE LINKED TO
SOCIAL CONDITIONS AT THE LEVELS
OF CITIES, NEIGHBORHOODS AND
INDIVIDUALS.
THIS FIRST EXAMPLE SHOWS
PATTERNS ACROSS CITIES.
IF WE LOOK AT THE RELATIONSHIP
BETWEEN THE PREPORTION OF
MORTALITY FOR VARIOUS CAUSES OF
DEATH AND THE INDEX WHICH IS A
COMPOSITE OF CITY LEVEL
EDUCATION OVER CROWD WATER AND
SANITATION AND BETTER SOCIAL
CONDITIONS WE SEE THE PREPORTION
OF DEATHS DUE TO NON SCHOOL
UNIKECOMMUNICABLE AND THIS BEGIO
DECREASE AND WHEREAS FOR A
CANCER THERE'S A CLEAR INCREASE
IN PREPORTION AS THE CITY SOCIAL
ENVIRONMENTAL INDEX INCREASES.
AND IF WE LOOK WITHIN CITIES, WE
ALSO SEE SIGNIFICANT PATTERNING
IN NEIGHBORHOODS.
THIS IS DATA HAVE A STUDY WE
PUBLISHED A YEAR OF YEARS AGO
SHOWING AGE ADJUSTED
CARDIOVASCULAR MORTALITY ACCUSED
THE CITY OF AND THERE'S A STRONG
ASSOCIATION WITH RESIDENTS
WITHIN COMPLETE SECONDARY
EDUCATION AND THE RISK OF TOTAL
DEATHS BUT ALSO CARDIOVASCULAR
DEATHS.
IN ADDITION TO THIS PATTERNING
BY NEIGHBORHOODS, WE ALSO SEE
SOCIAL PATTERNING ACROSS
INDIVIDUALS AND THIS IS DATA
COMPILED AND HARMONIZED OVER
100,000 SURVEY RESPONSES AND
ACROSS OUR 232 CITIES AND WE
ESTIMATED ADJUSTED PREVALENCE OF
DIABETES AND FOUND THAT IN
GENERAL IN WOMEN, THERE WAS THE
EXPECTED INVERSE ASSOCIATION,
HIGHER EDUCATION, LESS DIABETES
BUT IN MEN THERE WAS QUITE A BIT
OF HIT PRO AGAIN A TEE AND SOME
THERE WAS AN INVERSE AND HIGHER
EDUCATION AND MORE DIABETES AND
SOME OF THIS HETERO INGAY TEE HS
ACROSS DIFFERENT GROWTHS AND WE
CAN TALK ABOUT THAT LATER.
WE HAD ALSO SEEN IN A PREVIOUS
STUDY THAT THE INVERSE GRADIENT
OF ASSOCIATED WITH INDIVIDUALS
LEVEL EDUCATION, EMERGED AS
URBANNATION INCREASED.
SO HE IS ARE IN BMI AND
HYPERTENSION ASSOCIATED WITH
HIGHER EDUCATION AND THE INVERSE
SO SOCIAL GRADIENTS AS WELL.
NOW THERE ARE IMPORTANT
ENVIRONMENTAL EXPOSURES LINKED
TO NON COMMUNICABLE DISEASE AND
I'M GOING TO FOCUS ON AIR
POLLUTION.
THIS IS DATA FROM THE STUDY
DESCRIBING LEVELS OF PM2.5, IT'S
BEEN RELATED TO CARDIOVASCULAR
DISEASE ACROSS THE CITIES IN OUR
SAMPLE AND THE DOTTED LINE IS
THE WHO STANDARD, IT'S EVEN
LOWER THAN THAT NOW THIS IS
BEFORE THE REDUCED THE STANDARD
RECENTLY AND A HIGH PREPORTION
OF THE CITIES HAVE LEVELS ABOVE
THE W.H.O. STANDARD AND IN FACT,
SIGNIFICANT PREPORTIONS OF THE
POPULATION IN MANY OF OUR
COUNTRIES LIVE IN AREAS WHERE
THE MEAN PM2.5 IS ABOVE THE WHO
STANDARD AND SO THIS OBVIOUSLY
HAS IMPLICATIONS FOR NON COM UNI
CAN ABLE DISEASE RATES AND THESE
LEVELS ARE RELATED TO CITY
CHARACTERISTICS AND I DON'T HAVE
TIME TO GO INTO THE DETAILS ON
THIS FIGURE IN THIS TABLE BUT
THINGS LIKE, MASS TRANSIT,
RELATED TO LOWER LEVELS OF AIR
POLLUTION, HAVING MORE
CONGESTION, HIGHER LEVELS, MORE
MOTORIZATION, HIGHER LEVELS AS
WELL SO SOME OF THE THINGS YOU
EXPECT BUT WHAT THIS ILLUSTRATES
IS THAT THEIR POLICIES THAT
CITIES KIM NOTMENT TO REDUCE
THESE AIR POLLUTION LEVELS WHICH
WILL ALSO HAVE BENEFICIAL
EFFECTS FOR NON COMMUNICABLE
DISEASES.
THE LAST THING I WANT TO FOCUS
ON IS THE IMPACT OF CLIMATE
CHANGE AS AN EMERGING THREAT TO
NON COMMUNICABLE DISEASES IN THE
REGION AND THIS IS DATA FROM A
PAPER WE JUST PUBLISHED IN
NATURE MEDICINE LOOKING AT THE
RELATIONSHIP BETWEEN
TEMPERATURES AND MORTALITY AND
326 LATIN AMERICAN CITIES AND
THESE FIGURES SHOW THE SHAPE OF
THE MORTALITY TEMPERATURE
RELATIONSHIP AS WELL AS THE
DISTRIBUTION OF TEMPERATURES IN
DIFFERENT CITIES ACROSS THE
REGION.
AND WHAT WE FOUND, THIS IS VERY
SIMILAR TO WHAT STUDIES IN OTHER
REGIONS HAVE FOUND, IS THAT
ABOUT 0.7%, 0.7, 0.8% OF DEATHS
ARE ATTRIBUTABLE TO HIGH
TEMPERATURES AND FIVE TO SIX
PERCENT OF DEATHS TO LOW
TEMPERATURES AND YOU MAY THINK
WELL THAT MEANS THAT HEAT IS NOT
IMPORTANT, THIS IS A LITTLE BIT
MISLEADING BECAUSE AS I SHOWED
YOU IN THE PREVIOUS FIGURE, THE
NUMBER OF DAYS AT LOW
TEMPERATURES IS GENERALLY LARGER
THAN THE NUMBER OF DAYS AT HIGH
TEMPERATURES AND SO WHEN WE
LOOKED AT THE SLOPE, THE
STEEPNESS IS PRONOUNCED FOR HEAT
THAN IT IS FOR COLD AND IT
SUGGESTS THAT AS WE SLIDE THE
CURVE TOWARDS HIGHER
TEMPERATURES, WE WILL SEE
IMPORTANT INCREASE THIS IS THE
NUMBER OF DEATHS.
THIS IS OBSERVED FOR ALL DEATHS
BUT IT'S PRESENT FOR
CARDIOVASCULAR AND RESPIRATORY
DISEASE BECAUSE THESE CAUSES OF
DEATH ARE ALSO EFFECTED BY
TEMPERATURE.
I ALSO WANTED VERY BRIEFLY NOTE
THE FACT THAT SIGNIFICANT
PREPORTION OF GREENHOUSE GAS
EMISSIONS ARE LINKED TO OUR
DIETS AND MANY COUNTRIES IN THE
REGION OF LATIN AMERICA ARE
UNDERGOING A NUTRITION
TRANSITION WITH IMPORTANT
IMPLICATIONS FOR FOOD SYSTEMS
AND ENVIRONMENTAL IMPACT AND THE
SAME DIETS BAD FOR GREENHOUSE
GHAZI MISSIONS SO WE HAVE A
PERFECT EXAMPLE OF THE CROW
BENEFITS OF A POLICY THAT COULD
SIMULTANEOUSLY IMPROVE HEALTH
AND SUSTAINABILITY.
SO IN SUMMARY, THEY ARE MAJOR
CAUSE OF MORTALITY ACROSS LATIN
AMERICA CITIES AND THERE'S
HETEROGENEITY ACROSS CITIES ASK
NEIGHBORHOODS WITHIN CITIES AND
SOCIAL ENVIRONMENTAL FACTORS ARE
KEY BUT REMAIN UNDER EXPLORED IN
THE REGION IN PARTICULAR AND
THERE'S SIGNIFICANT POLICY
IMPLICATIONS BEYOND HEALTHCARE
AT THE NEED FOR COORDINATED
EFFORTS ACROSS THE REGION AND
ALSO, REGIONAL CAPACITY
STRENGTHEN TO COLLECT AND
ANALYZE DATA AS WE WERE DOING IS
FUNDAMENTAL TO GENERATING
LOCALLY RELEVANT EVIDENCE BOTH
ACROSS ALL OF THE AMERICAS.
LAST BUT NOT LEAST, HERE IS OUR
CONTACT INFORMATION IF YOU WANT
TO LEARN MORE.
THANK YOU FOR HAVING ME.
>>WELCOME TO THE LIVE Q&A
SESSION.
YOU BOTH HIGHLIGHTED IN YOUR
PRESENTATIONS THE HETERO AGAIN
EIGHT TEE OF ENVIRONMENTAL RISK
FACTORS AT THE COUNTRY AND CITY
LEVEL WITHIN LATIN AMERICA.
THIS IS TRUE FOR AMONG LATINOS
AND HISPANICS IN THE U.S. WHICH
MAY BE ONE GROUP.
FOR EXAMPLE, Dr. PEREZ HE
HIGHLIGHTED COPD IS 50% AND
ESTIMATED TO BE 7.6% AMONG
U.S.-LED FEMALES.
LIKEWISE SMOKING RATES AMONG
HISPANIC LATINOS IN THE U.S. IS
8% AND 40% IN CHILE SO GIVEN
THIS BETWEEN CITIES AND
COUNTRIES AND ACROSS THE
HEMISPHERE, I WANTED TO START BY
ASKING YOU, Dr. PEREZ, WHAT
WOULD A NATIONAL OR REGIONAL
PROGRAM TO PREVENT AND TREAT
RESPIRATORY DISEASES LIKE LIKE
AND WHAT ARE THE MOST URGENT
QUESTIONS THAT SUCH A PROGRAM
WOULD ANSWER?
>>I THINK WHAT Dr. ANA DIEZ
ROUX IS PUBLIC-HEALTH, REDUCING
AIR POLLUTION AT ALL LEVELS.
I MENTIONED MAINLY SMOKING AND
BIOMASS POLLUTION BUT CITIES ARE
POLLUTED, WORKS ARE POLLUTED SO
WE HAVE TO CLEAN THE AIR IN ALL
THE AREAS FROM THE PREVENTATIVE
POINT OF VIEW.
FROM A CLINICAL POINT OF VIEW,
WE WANT TO DO SOMETHING QUICKLY
OR QUICKER AND WE HAVE TO FOCUS
ON TOBACCO AND HOUSEHOLD AIR
POLLUTION.
SO THERE ARE COMPLIMENT EACH
OTHER.
AND TAKING CARE OF PATIENTS ALSO
IS VERY IMPORTANT AND I
MENTIONED SOMETHING ABOUT THAT.
>>THERE'S SOME URGENT QUESTIONS
THAT YOU THINK THAT WE NEED TO
BE ANSWERED NOW AS IT RELATES TO
CREATING OUR RESPIRATORY
PROGRAM?
>>FEW COUNTRIES HAVE A
RESPIRATORY PROGRAM.
USUALLY, WE HAVE A PROGRAM FOR
TUBERCULOSIS AND SOME COUNTRIES
FOR ACUTE RESPIRATORY INFECTIONS
AND FOR CHRONIC DISEASES, AND
ESPECIALLY NOT E ENTA GRAY TIVE
PROGRAMS TO GIVE ACCESS TO
DIAGNOSIS AND MEDICATIONS THAT
ARE REQUIRED FOR ASTHMA, FOR
COPD AND SO, THAT IS AMAZING IN
MOST COUNTRIES AND MISSING IN
MEXICO NOW AND SO BASICALLY IT'S
INEXIST ANT AND ONE OF THE
PROPOSALS THAT I THINK IS VERY
IMPORTANT IS TO GROW FROM THE
TUBERCULOSIS PROGRAM THAT IS ALL
OVER THE COUNTRIES AND EVEN ALL
PRIMARY CARE CAN DO TREATMENT
ASK DIAGNOSIS OF TUBERCULOSIS SO
GROWING FROM THE SERVICES OF
TUBERCULOSIS IS ONE OF THE
PROPOSALS THAT I THINK CAN WORK.
>>GREAT.
THANK YOU.
SO Dr. DIEZ ROUX I'M EXCITED
FROM THE RESEARCH EMERGING BUT
AS YOU STATED SOCIAL AND
ENVIRONMENTAL FACTORS REMAIN
UNDER EXPLORE.
COULD YOU ELABORATE MORE ON THIS
AND SUCH AS WHAT ARE THE
RESEARCH GAP AND OPPORTUNITIES?
>>SURE.
SO, I THINK SOCIAL AND
ENVIROMENTAL FACTORS ARE
PROBABLY PORT UNDERSTAND
UNDERSTAND THE HETEROGENEITY AND
THERE WILL BE CLINICAL FACTORS
THAT AN INDIVIDUAL FACTOR THAT
CONTRIBUTE TO THE HETEROGENEITY
BUT MANY ARE AFFECTED BY SOCIAL
AND ENVIRONMENTAL DETERMINANTS
SO CHARACTERIZING THAT BETTER TO
UNDERSTAND WHAT IS HAPPENING IN
THE REGION WHAT ARE THE KEY
ENVIRONMENTAL FACTORS THAT ARE
IMPORTANT AND THAT'S NOT, I
FOCUSED ON AIR POLUTION BUT IT
INCLUDES BUILT ENVIRONMENTS THAT
ARE RELATED TO PHYSICAL ACTIVITY
AND DIET.
AND ALSO, BETTER CHARACTERIZING
THE SOCIAL PATTERNING AND HOW
IT'S CHANGING AND EVOLVING OVER
TIME BECAUSE IT'S NOT BY ANY
MEANS INGVAR' APARTMENT.
IT'S REALLY IMPORTANT JUST FROM
THE DESCRIPTIVE POINT OF VIEW.
I THINK THAT IN ADDITION AN
IMPORTANT AREA FOR RESEARCH IS
TO UNDERSTAND WHAT BUILT AND
SOCIAL ENVIRONMENT FACTORS ARE
PARTICULARLY RELEVANT IN THE
LATIN AMERICAN REGION BECAUSE WE
TEND TO EXTRAPOLATE RESEARCH
FROM THE U.S. AND EUROPE AND
IT'S SOMETIMES VALID BUT
SOMETIMES PARTICULARLY FOR MORE
SOCIAL AND ENVIRONMENTAL THINGS,
THERE MAY BE NUANCES FOR ASPECTS
OF IT THAT NEED LOCAL RESEARCH
AND THEN THE LAST THING I'LL SAY
IN TERMS OF RESEARCH
OPPORTUNITIES, I THINK MANY
COUNTRIES AND CITIES HAVE
IMPLEMENTED POLICIES AT THE
POPULATION LEVEL AND I MEAN
THERE ARE MANY EXAMPLES ACROSS
THE REGION.
MENU LABELING, TOBACCO
REDESCRIPTIONS, MANY, EVEN NEW
TRANSPORTATION INITIATIVES
REDUCTIONS IN CAR USE, POLICIES
TO REDUCE CAR BUSE AND
CONGESTION AND THERE'S A
OPPORTUNITY FOR EVALUATE THE
BENEFITS OF THOSE POLICIES AND I
THINK THAT WOULD BE VERY
POWERFUL EVIDENCE AND WOULD
TEACH US ABOUT THE CAUSES OF NON
CON UNICH ABLE DISEASE AND WHAT
POLICIES MIGHT BE MOST EFFECTIVE
AND ARE ACTUALLY FEASIBLE ACROSS
THREGION.
>>THANK YOU FOR HIGHLIGHT TAG
AND I KNOW WE HAVE A SESSION TO
TALK ABOUT PUBLIC POLICY IN MORE
DEPTH LATER ON.
ANOTHER QUESTION I WANTED TO ASK
YOU, WHAT RESEARCH EFFORTS ARE
NEEDED TO BETTER CAPTURE
ENVIRONMENVIRONMENVIRONMENTAL EE
LIFE FEAR AND IN LATIN AMERICA
AND U.S. AND THOSE WHO HAVE
EMIGRATED, AS YOU SAID, Dr.
DIAZ ROUX WE NEED THE LATIN
AMERICA CONTEXT AND WHAT DOES IT
MEAN OVER THE LIFE COURSE AND
GENERATION AND BOTH ACROSS THE
HEMISPHERE?
COULD YOU COMMENT ON THAT?
IT'S OPEN FOR BOTH OF YOU TO
ANSWER.
>>WELL, ONE ISSUE THAT I
CONSIDER VERY IMPORTANT IS THE
CONTRIBUTION OF MEASURE I HAD AD
THERE ARE SOME INFORMATION ABOUT
THESE BUT THERE IS ALSO, I
THINK, IT'S GOING TO BE
IMPORTANT TO EXPLAIN SOME OF
THESE VARIATIONS AND MEXICO MAY
BE ONE EXAMPLE BECAUSE SMOKING
IS NOT AS HEAVY HERE AS IN OTHER
COUNTRIES AND THE PREVALENCE OF
COPD IS MUCH LOWER THAN YOU
COULD EXPECT AND SO I THINK THAT
IT COULD BE WIDESPREAD COLLATION
SITUATION AND SEVERAL
PERSPECTIVES AND AND I THINK
THAT THE ALTITUDE OF OC LEVEL
AND IT'S A REALITY AND,
INCREASES A LOT IN CITIES LIKE
MEXICO CITY AND ET CETERA MAY BE
IMPACTS TO AIR POLLUTION AT THE
SAME CONCENTRATION AND YOU
BREATH AND MORE IN MEXICO CITY
THAN AT SEA LEVEL SO THE
EXPOSURE IS HIGHER.
I WOULD JUST ADD BUILDING ON ONE
THING IS THE LIMITED AMOUNT OF
DATA THAT WE COLLECT IN LATIN
AMERICA ON RACE AND ETHNIC
ORIGIN IN MANY OF OUR, VITAL
STATISTICS AND THE SURVEYS, THE
SURVEILLANCE SURVEYS THAT ARE
DONE AND IT'S AN AREA THAT IS
REALLY IMPORTANT TO EXPLORE
FURTHER TO UNDERSTAND INEQUITIES
SO LOOKING AT SOCIOECONOMIC AND
RACE AND ETHNIC AND DIFFERENCES
ACROSS THESE GROUPS AND EMERGE
AND MANY NOT RELATED TO GENETICS
AND SOCIAL CIRCUMSTANCES AND
HISTORY BUT IT'S IMPORTANT TO
UNDERSTAND THOSE AS WELL AND
WITH RESPECT TO YOUR QUESTIONS,
MICHELLE, I THINK THAT LATINOS
CARRY WITH THEM THE RISK THEY
EXPERIENCE EARLY IN LIFE AND
ALSO, THEIR EXPERIENCE PARENTED
BECAUSE WE KNOW SOME OF THESE
THINGS TRAVEL ACROSS GENERATION
AND SO I THINK THAT AN
UNDERSTANDING THE HEALTH OF
LATINOS AND THE U.S.,
UNDERSTANDING THEIR HISTORY AND
IMMIGRATION HISTORY AND THE
ENVIRONMENTS IN WHICH THEY GREW
UP IS VERY IMPORTANT AND I THINK
THERE ARE A LOT OF COMMONALITIES
BETWEEN IN LATIN AMERICA AND
CITIES IN THE U.S.
THERE'S WAYS WE CAN LEVERAGE
ACROSS THE REGION OF THE AMERICA
TO BETTER UNDERSTAND THE DRIVERS
OF NON COM UNIKE ABLE DISEASE
AND ITS AND HOW THEY EVOLVE AND
CHANGE OVER TIME AND WHAT THAT
MEANS FOR POLICY BUT ALSO FOR
CLINICAL.
>>
>>CAN I COMMENT.
IT'S FROM BEFORE BIRTH AND IT'S
TRUE FOR SMOKING OR AIR
POLLUTION IN THE CITIES SO, BY
ADOLESCENCE, MOST OF THE DAMAGE
IS PROBABLY DONE SO THE GROWTH
OF THE RESPIRATORY SYSTEM AND
IT'S EFFECTIVE SO, BY THE TIME
THEY IMMIGRANT, MOST OF THE
PEOPLE DO UNITED STATES AND THEY
ALREADY HAVE THESE ADVANTAGES
>>HIGHLIGHTING CAPTURING THAT
DATA AND I WANT TO TO SAY WE
HAVE A SESSION LATER ON THIS
AFTERNOON, RACE AND ETHNICITY IN
LATIN AMERICA, IT'S ACTUALLY
TOMORROW.
>>THAT'S GREAT.
YEAH.
>>STAY TUNED FOR THAT.
ANOTHER QUESTION I WANT TO ASK
FROM THE AUDIENCE AND THIS IS
FOR YOU, HOW CAN COUNTRY SWITCH
RURAL POPULATIONS FROM USING
WOOD, COAL, CHARCOAL INDOORS.
ARE THERE INTERVENTION THAT'S
WORKED IN THIS REGARD?
>>IT IMPROVES STOPPING AND WORK
WELL IN THE LABORATORIES BUT
THEY ARE NOT USED FOR A LONG
TIME SO THERE'S NO ADHERENCE TO
THESE PROGRAMS AND SO PEOPLE
KEEP USING OPEN FIRES WITH A BIG
COMMAND TO DO MANY THINGS AT THE
SAME TIME.
SO THERE ARE NO, FROM MY POINT
OF VIEW, A GOOD PROGRAM THAT CAN
USE SO UNFORTUNATELY THERE ARE
MANY THOUSANDS OF STOPS THAT ARE
WORRYING AND THE IMPACT HAS BEEN
VERY POOR AND ALMOST FROM THE
HEALTH POINT OF VIEW.
>>THANK YOU SO MUCH FOR COMING
ON THAT IT'S AN IMPORTANT AREA
OF RESEARCH AS IT IMPACTS RURAL
POPULATION AND WOMEN AND
CHILDREN AND I ALSO WANT TO ASK
YOU TO GIVE ME YOUR EXPERIENCE
WITH THE TRANS NATIONAL RESEARCH
AND COLLABORATION.
YOU KNOW, WHAT ARE EXAMPLES
OF -- ABOUT WHAT ARE SOME OF THE
CHALLENGES IN THESE RESEARCH
COLLABORATION AND HOW HAVE YOU
OVERCOME THEM IN YOUR RESEARCH?
>>I MEAN, I CAN TAKE A STAB OF
THAT.
I THINK, YOU KNOW, THE
EXPERIENCE OF HAS BEEN REALLY
INCREDIBLE AND I MEAN, BECAUSE
WE HAVE BEEN ABLE TO CREATE A
REALLY MULTI-NATIONAL TEAM
ACROSS THE AMERICAS REALLY AND
IT'S BEEN JUST AMAZING TO SEE
WHAT'S POSSIBLE.
THIS REQUIRES, YOU KNOW, A
SIGNIFICANT FUNDING AND WE WERE
FORTUNATE TO GET FUNDING FROM A
FOUNDATION TO WELCOME TRUST TO
REALLY CREATE THE RESEARCH
PLATFORM WHICH MEANS, ESTABLISH
MECHANISMS FOR COLLABORATIONS SO
WE HAVE A WHOLE STRUCTURE THAT
INVOLVES A GOVERNANCE STRUCTURE
FOR THE PROJECT AND WORKING
GROUPS AND COORS OF PROCESS FOR
REVIEW OF PUBLICATION COMMITTEE
TO ENGAGE JUNIOR INVESTIGATORS
AND TRAINEES SO A SYSTEM, A DATA
PLATFORM THAT WE'VE DEVELOPED SO
IT'S A REAL SYSTEM TO CREATE A
CULTURE OF COLLABORATION THAT IS
REALLY ABOUT SUPPORTING
INVESTIGATORS IN THE REGION AND
NOT AND EXTRACTING DATA AND AN
EYES SOMEWHERE ELSE AND THAT
REALLY TIRES INVESTMENTS AND
SUPPORT FOR THIS KIND OF WORK
AND THERE'S AN INCREDIBLE
RICHNESS CAPACITY IN THE REGION
TO BE LEVERAGED TO REALLY LEARN
MORE AND USE IT.
SO, YOU KNOW, I'M VERY POSITIVE
ABOUT THE POSSIBILITIES BUT IT
REQUIRES INVESTMENTS.
>>WHAT ARE THE KEY PLAYERS AND
TO DO THIS TYPE OF
TRANS-NATIONAL RESEARCH
COLLABORATIONS?
>>WELL, WE HAVE A TEAM, WE HAVE
MULTIPLE INSTITUTIONS AND
RESEARCH CENTERS AND
UNIVERSITIES ACROSS THE REGION
AND THEY HAVE EACH SENIOR AND
JUNIOR PEOPLE AND IT'S VERY
INTER DISCIPLINARY WITH
PHYSICIANS, EPIDEMIOLOGISTS AND
SOCIOLOGISTS AND URBAN PLANNERS,
AIR POLLUTION EXPERTS AND WE
HAVE A BIG POLICY MAKER
ENGAGEMENT COMPONENT TO THE
PROJECT SO WE DO DISSEMINATION
EFFORTS TO REALLY GET THE WORD
OUT AND GET INPUT ON WHAT WE
SHOULD LOOK AT SO MANY DIFFERENT
KINDS OF STAKEHOLDERS AND WE
ALSO WORK WITH NON PROFITS TO
DISSEMINATE THE FINDINGS FOCUSED
ON URBAN ISSUES AND PAN AMERICAN
HAS BEEN A PARTNER AS WELL SO
IT'S A MULTI-DISCIPLINARY TEAM
WITH MANY DIFFERENT PLAYERS IN
IT.
>>WOULD YOU LIKE TO COMMENT
ALSO?
YOUR WORK IN LATIN AMERICA, HOW
ARE YOU BEEN ABLE TO ADVANCE THE
RESEARCH AND DO THIS
COLLABORATION IF.
>>I AGREE COMPLETELY WITH ANNA.
FUNDING HAS BEEN BOTTLENECK.
THERE ARE GROUPS INTERESTED IN
BUT AT THIS MOMENT, WE WERE ABLE
TO DO SOME THINGS IN
COLLABORATION WITH OIR CITIES IN
LATIN AMERICA BUT WE HAVE BEEN
HAVING A LOT OF TROUBLE GETTING
FUNDING AND ESPECIALLY FUNDING
FOR LATIN AMERICA AND IT'S VERY
DIFFICULT AND IT NEEDS TO BE
IMPROVED AND YOU KNOW, IF THESE
GROUPS DEVELOP AND VERY
IMPORTANT QUESTIONS CAN BE
ANSWERED AS ANNA HAS MENTIONED.
>>THANK YOU TWO SO MUCH.
WE ARE AT TIME.
THIS IS BEEN A WONDERFUL
DISCUSSION AND JUST REALLY
THOUGHT PROVOKING AND DISCUSSION
AND IDEAS AND AN OPPORTUNITY FOR
ADVANCING THE RESEARCH IN THIS
AREA AND I NOW WANT TO LET YOU
ALL KNOW WE'RE TAKING A BREAK
FOR LUNCH AND PLEASE COME BACK
AT 12:55.
WE STILL HAVE SOME WONDERFUL
PRESENTATIONS THIS AFTERNOON AND
LIVE Q&A SESSIONS SO AGAIN,
THANK YOU Dr. DIEZ ROUX AND
Dr. PER HE'S PEREZ FOR A GREAT
DISCUSSION AND PRESENTATION.
THANK YOU.
>>WELCOME BACK FROM BREAK.
IN THE INTEREST OF TIME WE'RE
GOING RESUME THE PROCEEDINGS
RIGHT AWAY.
I'M NOW TURN THINGS OVER TO THE
MODERATOR FOR THE NEXT SESSION,
DR. DOOS.
>>WE HAVE THREE PRESENTATIONS
FROM DOCTOR.
LET'S START.
>>GOOD AFTERNOON AND THANK YOU
FOR JOINING THE SESSION I'LL
TALK MAINLY BE THE LATINO
COMMUNITY AND ON DEMENTIA IN
LATIN AMERICA AND THE PROBLEMS
THERE AND IN THE U.S.
FIRST I'D LIKE TO TALK ABOUT WHY
WE'RE TALKING ABOUT DEMENTIA IN
THE LATINO COMMUNITY OR
POPULATION.
FOR LATIN AMERICA, IN THE NEXT
TWO DECADES DEMENTIA WILL DOUBLE
IN LATIN AMERICA COUNTRIES.
THIS IS RELEVANT BECAUSE THIS
PROCESS TOOK ALMOST FOUR DECADES
IN WESTERN EUROPE AND NORTH
AMERICA.
THE PROCESS THAT TOOK FOUR
DECADES WILL TAKE ONLY TWO
DECADES IN LATIN AMERICA.
THIS IS RELEVANT BECAUSE IN OUR
POPULATION THERE IS LITTLE
AWARENESS ABOUT ALZHEIMER'S
DISEASE AND RELATED DEMENTIA.
WE DON'T HAVE ENOUGH RESEARCH IN
THE LATINO COMMUNITY.
LESS THAN 5% OF ALL GENETIC
STUDIES DONE OR ALZHEIMER'S
DISEASE IS DONE IN HISPANIC
POPULATION AND THERE'S POOR
UNDERSTANDING ABOUT THE DISEASE
TRAJECTORY IN OUR POPULATION.
THERE'S RESEARCH IN THE MAIN
INTERACTION BETWEEN GENETIC AND
THE DIFFERENT ENVIRONMENT IN OUR
POPULATION.
LET ME BRING THAT TO CONTEXT TO
ONE OF OUR COMMUNITIES.
I WILL START WITH THE CASE OF A
76-YEAR-OLD WOMAN LIVING IN THIS
PERIOD AND FOR HER COMMUNITY AND
GREGORIA THERE'S NEUROLOGY OR
HEALTH OR CARDIOVASCULAR FACTORS
ARE NOT KNOWN TO THE COMMUNITY
AND HAVE NO ACCESS TO HEALTH
CARE.
THIS IS WHAT WE SEE IN SEVERAL
COMMUNITIES IN LATIN AMERICA.
APPROXIMATELY THERE'S MORE THAN
30 MILLION CASES LIKE HERS IN
LATIN AMERICA AND LOW-INCOME
COUNTRIES.
SOME OF HE STORIES HAVE HELPED
TO HAVE UNDERSTANDING OF THE
MAIN RISK FACTORS FOR DEMENTIA
IN COMMUNITIES LIKE THE ONES
WHERE GREGORIA LIVES.
I'M GOING BRIEFLY SUMMARIZE THE
STUDY HERE AND IT STARTED IN
2000 WITH THE FIRST WAVE IN
DEMENTIA FOLLOWING BY THE
INCIDENT WAVE AND NOW WE JUST
CONCLUDED THE PREVALENCE WAVE
AND SECOND INCIDENCE WAVE.
THE MAIN GOAL HAS BEEN TRYING TO
ESTABLISH WHAT ARE THE MAIN RISK
FACTORS FOR DEMENTIA AND IT'S A
POPULATION-BASED STUDY WITH MORE
THAN 4,000 PATIENTS IN MORE THAN
SEVEN COUNTRIES AND OTHER
COUNTRIES SO THEY HAVE ALWAYS
USED THE SAME ACROSS-CULTURAL
VALIDATED ASSESSMENT FOR
DEMENTIA DIAGNOSIS.
WHAT WE KNOW SO FAR.
NUMBER ONE, WE BELIEVE THERE'S 7
MILLION PEOPLE LIVING WITH
DEMENTIA 70% OF THOSE CARING FOR
THOSE PEOPLES ARE UNPAID CARE
AND WHERE SHOULD RESEARCH BE
GOING ESPECIALLY IN LATIN
AMERICA WE HAVE UNDERSTANDING OF
THE DEMENTIA PREVALENCE, HOW DO
WE PREPARE THE HEALTH CARE
SYSTEM OR CONTINUE TO VALIDATE
KNOWN BIOMARKERS AND GENETIC
RISK FACTORS AND HOW DO WE
VALIDATE THOSE OR FIND NEW
BIOMARKERS OR GENETIC RISK
FACTORS IN OUR POPULATION?
ALSO, LET ME CHANGE A LITTLE BIT
AND TALK ABOUT WHAT ARE THE NEW
TRENDS THAT WE ARE SEEING IN THE
STUDY?
FIRST I'M GOING TO TO PUT IT IN
CONTEXT AND SHOW WHAT IS GOING
IN MOST THE HIGH-INCOME
COUNTRIES WE'RE SEEING EITHER
STABLE OR DECREASING DEMENTIA
PREVALENCE IN HIGH-INCOME
COUNTRIES.
THE DEMENTIA PREVALENCE IS GOING
DOWN COMPARED TO PREVIOUS YEARS.
HOWEVER, THIS IS NOT THE CASE IN
LATIN AMERICA.
FOR MOST OF COUNTRIES INCLUDING
PERU AND MEXICO WE'RE MISSING
DATA FROM PUERTO RICO AND
VENEZUELA SO FAR WE ARE SEEING
THE PREVALENCE WAVE FROM 2006
WE'RE SEEING INCREASES IN
DEMENTIA INCIDENTS IN LATIN
AMERICA IN THE NEW WAVE AND IN
COUNTRIES LIKE PERU AND MEXICO
IT'S ALMOST DOUBLED RELATIVE TO
THE WAVE FROM 2006.
THERE'S A FEW FACTORS WE BELIEVE
MAY EXPLAIN THE INCREASE IN
DEMENTIA PREVALENCE AND THOSE
ARE MAINLY CARDIOVASCULAR RISK
FACTORS.
THIS TABLE KIND OF SUMMARIZES A
FEW OF THE MAIN RISK FACTORS IN
THE FIRST WAVE HIGHLIGHTING IN
BLUE THE ONE THAT WERE
SIGNIFICANT BUT ALSO IN MANY
WAYS HELP TO DECREASE DEMENTIA
PREVALENCE AND THOSE ARE AN
INCREASE IN EDUCATION IN MOST OF
OUR COUNTRIES AND WE'RE SEEING
COUNTRIES LIKE CUBA WE'RE SEEING
BETTER CONTROLS OF HYPERTENSION
AND LOWER RATES OF SMOKING.
HOWEVER, IN SOME EUROPEAN
COUNTRIES WE'RE SEEING AN
INCREASE IN DEMENTIA PREVALENCE
AND SEEING INCREASED
CARDIOVASCULAR RISK FACTORS AND
HYPERTENSION INCREASING IN PERU
AND MEXICO AND THE PREVALENCE OF
DIABETES AND INCREASE IN THE
DOMINICAN REPUBLIC AND PERU AND
WE SEE THIS DRIVING THE INCREASE
IN DEMENTIA PREVALENCE.
TO PUT IT IN CONTEXT
APPROXIMATELY ONLY 10% OF OUR
POPULATION IN LATIN AMERICA HAS
HAS INHERITED CARDIOVASCULAR
HEALTH AND WE'RE SEEING THOSE
WITH HIGHER VASCULAR BURDEN HAVE
HIGHER RATES OF DEMENTIA.
ALSO NOW GOING BACK TO DEMENTIA
IN LATIN AMERICA I WANT TO
HIGHLIGHT THAT HISPANIC
COMMUNITIES ARE NOT A MINORITY
GROUP EVEN WHEN OUR RESEARCH
ESPECIALLY IN THE U.S. WE PUT
THE HISPANIC GROUP AS A UNIQUE
GROUP.
IT'S NOT A MONOLITHIC GROUP AND
HERE IT'S SHOWN ACROSS THE
COUNTRIES WHERE WE'RE SEEING
DEMENTIA PREVALENCE IS HIGHER IN
THE CARIBBEAN POPULATIONS AND
THERE ARE MANY FACTORS THAT MAY
DRIVE LIKE LIKE DIFFERENCE
INDICT AND LIFESTYLE AND GENETIC
RISK FACTOR.
AND THERE'S GENETIC ORIGINS AND
HISPANIC POPULATIONS FROM THE
CARIBBEAN INCLUDE EUROPEAN
ANCESTRY AND FROM SOUTH AMERICA
AND PERU IT'S NATIVE AMERICAN
AND EUROPEAN CONTRIBUTION AND
THIS PRETTY MUCH DRIVES
DIFFERENCE IN WHAT COULD BE
GENETIC RISK FACTORS IN OUR
POPULATION.
AS YOU'LL NOTE ONE OF THE MAIN
DRIVERS OR ONE OF THE MAIN
GENETIC RISK FACTORS FOR
ALZHEIMER'S DISEASE IF YOU HAVE
THESE YOU'RE TWO TIMES MORE
LIKELY TO HAVE ALZHEIMER'S
DISEASE AROUND THERE'S A RISK IN
HISPANIC AND CARIBBEAN HAVING
THE LOWEST RISK TO DEVELOP
ALZHEIMER'S DISEASE IF YOU HAVE
APOE4 AND IT'S HIGHER IN
POPULATION THAT RANGES FROM FIVE
TO SEVEN TIMES MORE LIKELY TO
DEVELOP DEMENTIA AND IN HISPANIC
POPULATION IT SEEMS IT'S LOWER
THAN WHEN YOU COMPARE WITH
CAUCASIAN POPULATION AND THIS IS
WHAT UNDERSTAND ABOUT DEMENTIA
IN LATIN AMERICA AND UNDERSTAND
THE HISPANIC COMMUNITY IN THE
U.S.
IF THE RISK FACTORS ARE THE SAME
OR NOT AND IF THOSE ARE
DIFFERENT WHAT ARE THE
DIFFERENTIAL AFFECTS OF
DIFFERENT RISK FACTORS IN OUR
COMMUNITY LIVING IN LATIN
AMERICA AND IN THE U.S. AND THIS
ONE OF STUDIES THAT I BELIEVE
WILL HELP ANSWER SOME QUESTIONS
IS A STUDY WHERE THE MAIN GOAL
IS TO STUDY THE MAIN RISK
FACTORS OF POPULATIONS IN LATIN
AMERICA AND COMPARE THOSE WITH
SIMILAR POPULATIONS LIVING IN
U.S. USING HRS DATA AND LET'S
SEE DATA WE WANT TO FOCUS.
.
THIS DATA COMES FROM THE H ARE
RS AND HIGHLIGHTING THE
PREVALENCE OF DEMENTIA.
PEOPLE WITH MEXICAN ORIGIN OR
NON-HISPANICS WITH NON-MEXICAN
ORIENT HAVE THE PREVALENCE OF
DEMENTIA THAT IS HIGHER THAN THE
ONE WE DESCRIBED IN STUDIES IN
SIMILAR COMMUNITIES.
SO IT'S SIGNIFICANTLY HIGHER IN
MEXICANS LIVING IN THE
U.S. COMPARED TO MEXICANS LIVING
IN MEXICO AND WITH CARIBBEAN
AMERICANS LIVING IN THE
CARIBBEAN AND CARIBBEAN
AMERICANS LIVING IN THE U.S. AND
SIGNIFICANTLY HIGHER THAN THOSE
LIVING IN OTHER AREAS AND WHAT
ARE THE CAUSES OF PREVALENCE?
THOSE ARE THINGS WE NEED TO GET
BETTER AND GET GLOBAL RESEARCH.
WITH THAT I'D LIKE TO FINISH AND
LEAVE YOU WITH A FEW TAKE-HOME
MESSAGES.
FIRST, WHAT I THINK IS MORE
IMPORTANT CARDIOVASCULAR RISK
FACTORS I BELIEVE ARE ONE OF THE
MAJOR TRIGGERS OF DEMENTIA IN
LATIN AMERICA AND IN A WAY GIVES
ROOM FOR PREVENTION OF SOME OF
THE FACTORS.
WITH THAT, OF COURSE THANKS TO
ALL MY ALBERTAERS AND I'LL I'LL
TAKE QUESTIONS AND TALK WITH YOU
MORE ABOUT OUR RESEARCH.
THANK YOU VERY MUCH FOR THAT.
>>GOOD DAY TO YOU ALL.
I'M GOING TO START WITH MY
PRESENTATION.
THIS IS THE OUTLINE I WILL
FOLLOW.
HEALTH DISPARITY INS OLD AGE
RESULT FROM A LIFE TIME OF
UNEQUAL EXPOSURES AND
EXPERIENCES.
I HOPE TO PRESENT EVIDENCE USING
LONGITUDINAL COHORTS OF MEXICAN
OLDER ADULTS WE HAVE FOLLOWED IN
MEXICO.
.
I'LL FOCUS ON FUNCTIONALITY AND
FISCAL FUNCTION AND LIMITATIONS
AND IN THE MAIN LIFE COURSE
EXPERIENCES CHILDHOOD
EXPERIENCES, MAIN OCCUPATION AND
THE DAILY LIFE ENVIRONMENT.
AND FINALLY, I WILL CLOSE WITH
OPPORTUNITIES FOR RESEARCH AND
HEALTH DISPARITIES BASED ON THE
RESULTS IN THE UNITED STATES.
JUST TO SET THE STAGE I'LL FOCUS
ON PHYSICAL FUNCTION AND MIDDLE
AND OLD AGE FOR THE BRINGS
PRESENTATION.
THESE ARE ACTIVITIES SUCH AS
BATHING, EATING, DRESSING, USING
THE TOILET AND THESE ARE
IMPORTANT.
THE DATA USED BY RESEARCHERS
CAME FROM THE MEXICAN HEALTHY
AGING STUDY A LONGITUDINAL STUDY
THAT STARTED FOLLOWING ADULTS
AGE 50 AND OVER IN 2001 IN
REPRESENTATIVE SAMPLES OF URBAN
AND RURAL AREAS OF MEXICO.
MEXICO UNDERWENT FAST AGING
SURVIVAL IN PARTICULAR STARTING
IN 1950 AND THE RESEARCH AGENDA
HERE TRIES TO RESPOND TO THE
QUESTION, HOW DO SURVIVORS FARE
WITH RESPECT TO PHYSICAL
FUNCTION IN OLD AGE UNDER
CONDITIONS OF FAST SURVIVAL.
ADULTS AGE 50 IN MEX CROW --
MEXICO ARE EXPECTED TO LIVE
ALMOST 30 YEARS THEN
TRAJECTORIES OF ADL DISABILITY
IS WORSE FOR WOMEN THAN FOR MEN.
THE PREVALENCE OF ADL DISABILITY
IS APPROXIMATELY TWICE FOR WOMEN
THAN FOR MEN, 17% COMPARED TO 8%
AMONG ADULTS 55 TO 74 YEARS OLD.
THE QUESTION IS OF THAT LIFE
EXPECTANCY HOW MANY YEARS ARE
EXPECTED TO BE IN WITH
DISABILITY.
AND ANOTHER QUESTION IS WHETHER
THE COHORTS ARE CHANGING.
THAT IS, IS IT IMPROVING OR
WORSENING AS SUCCESSIVE
GENERATIONS ARE COMING INTO OLD
AGE.
THIS RESEARCH COMPARES GROUPS OF
OLDER ADULTS WHO ARE 10 YEARS A
PART.
YOU CAN SEE NO DIFFERENCE IN
LIFE EXPECTANCY BUT FIND THE
MORE RECENT COHORTS ARE SPANNING
A LARGER FRACTION OF THEIR LIFE
WITH PHYSICAL IMPAIRMENTS BUT
IT'S EVIDENCE OF EXPANSION OF
DISABILITY.
A LARGER FRACTION AT EACH AGE,
50, 59, 60, 69 AND 70 AND 79.
THIS EXPANSION OF DISABILITY IS
MORE PRONOUNCED AMONG WOMEN THAN
MEN.
THOUGH THE MORE RECENT COHORTS
ARE MORE EDUCATED, THEY TEND TO
HAVE HIGHER DIABETES IN THIS
COULD BE THE REASON NOR
EXPANSION OF DISABILITY.
INSTEAD OF COMPRESSION OF
DISABILITY.
OTHER RESEARCHERS HAVE SHOWN
THAT THE LIFE COURSE INFLUENCES
OLD AGE FUNCTION AND THE
QUESTION FOR THEM IS HOW LONG IS
THIS ARM OF CHILDHOOD
CONDITIONS, WHAT IS THE REACH OF
THOSE CONDITIONS IN CHILDHOOD?
FOR THIS, THEY COMPARED PHYSICAL
IMPAIRMENT IN ALL AGE AND HOW
IT'S ASSOCIATED WITH SOCIO
ECONOMIC LEVELS IN CHILDHOOD,
ADULTHOOD AND OLD AGE
CONTRASTING ACROSS LIFE AND FIND
LOW SES IN CHILDHOOD EVEN AFTER
CONSIDERING THIS SOCIO ECONOMIC
STATUS IN THE OTHER STAGES OF
THE LIFE COURSE.
THAT IS, THE PERSISTENT EFFECT
OF CHILDHOOD CONDITIONS AND THE
AFFECTS VARY FOR MEN AND WOMEN
AND RURAL AND URBAN RESIDENTS
BUT CONSISTENTLY FAIR.
UNLIKE IN THE UNITED STATES,
THESE RESEARCH FINDS NO AFFECT
OF CHILDHOOD SES CHANGING WITH
OLDER AGE.
THERE'S NO SIGN OF DIMINISHING
THE EFFECT AND THE RESEARCHERS
SPECULATE THIS COULD BE BECAUSE
OF THE COUNTER-INFLUENCE OF
SOCIAL PROTECTION SUCH AS
MEDICARE AND MEDICAID IN OLD
AGE.
THAT IS ABLE TO COUNTER ACT THE
AFFECTS OF CHILDHOOD AS MORE
OLDER ADULTS LIVE LONGER.
THIS IS NOT THE CASE IN MEXICO.
ANOTHER GROUP IS LOOKING AT
OCCUPATION AL AND FIND IT'S
DICTATED BY THE FISCAL INTENSITY
OF THE PRIMARY OCCUPATION THEY
HELD OVER THEIR LIFE COURSE.
THE MOST IN CARE HAD THE MOST
WORK INJURIES OR WITH MORE
PHYSICAL WEAR AND TEAR OR
REPETITIVE MOTION FOR WORKERS IN
THE PRODUCTION OF FOOD AND
TOBACCO FOR MEN AND THAT MEANS
THE PATTERNS HOLD FOR MEN AND
WOMEN WHEREAS THEY FIND THE
EDUCATIONAL EXPERIENCE IS INDEED
A NOTICEABLE MARKER OF PHYSICAL
LIMITATIONS IN OLD AGE.
ANOTHER BODY OF RESEARCH LOOKS
AT THE ENVIRONMENT EXPOSURES IN
THE CONTEXT OF THE DAILY LIFE.
THEY LOOK AT THE USE OF UNCLEAN
FUEL FOR COOKING OR HEATING.
IN THIS CASE, WOOD OR CHARCOAL
IN MEXICO.
THIS IS PREVALENT IN AROUND 70%
IN ADULTS 70 AND UP TO 30% IN
RURAL AREAS.
THEY LOOK AT THE AFFECT OF USING
THIS KIND OF COOKING OR HEATING
FUEL ON COGNITIVE FUNCTION IN
OLD AGE AND THEY FIND THAT
INDEED THE AFFECT IS NEGATIVE
AND ROBUST AFTER ADJUSTMENT FOR
SOCIO ECONOMIC INDICATORS.
THE AFFECT OF USING THIS KIND OF
FUEL ON COGNITION IS EQUIVALENT
TO BEING THREE YEARS OLDER AND
SO IT'S A MEANINGFUL AFFECT THAT
IS THE USE OF THE FUELS.
THE LONG-TERM EXPOSURES RESULT
IN THE IMMEASURABLE IMPAIRMENTS
AND IN THE DAILY LIFE IN MEXICO.
AS A CONCLUSION THEY ASKED ME TO
LINK THE WORK WE'VE DONE IN
MEXICO TO RESEARCH IN THE UNITED
STATES REGARDING GROUPS WITH
HIGH BURDEN OF LIFE COURSE
EXPOSURES.
HOPEFULLY I'VE MOTIVATED THAT
INDEED THIS EXPOSURES OVER THE
LIFE COURSE HAVE AN IMPACT ON
OLD AGE FUNCTION.
THE SOURCES OF HEALTH
DISPARITIES AND OLD AGE IN THE
UNITED STATES ARE OF COURSE ALSO
RURAL RESIDENTS, LACK OF HEALTH
INSURANCE, HAVING LOW INCOME OR
MEDICAL DEBT OR OTHER DEBTS.
THIS IS NOT THE CASE FOR MEXICO
ONLY BECAUSE PROBABLY BECAUSE
THERE ARE NOT HIGH FUNCTIONALING
OF THESE TIMES OF MARKETS AND
THE LACK OF EDUCATION IN MEXICO
AND THE UNITED STATES AND THE
LIFE OF PRIMARY EDUCATION MARKS
THE DIFFERENCE IN CONTRAST IN
UNEQUAL OUTCOMES.
THE EVIDENCE WE NEED TO HAVE TO
CONDUCT THIS RESEARCH HAS TO BE
REPRESENTATIVE OF THE GROUPS FOR
WHOM WE WANT TO PROMOTE EQUITY.
THIS IS PERHAPS THE MAJOR
BARRIER IN RESEARCH ACROSS THE
UNITED STATES TO TRY TO STUDY
THE LIFE COURSE EXPOSURES OF
DIFFERENT GROUPS.
WE DON'T HAVE THE STATISTICAL
POWER TO CONTRAST AND COMPARE
ACROSS GROUPS AND PRODUCE THE
EVIDENCE.
THE TYPE OF RESEARCH WE PROBABLY
NEED TO INFORM THE PATH TO
EQUITY ACCORDING TO WHAT I SEE
IN THE RESULTS FROM MEXICO IS
THAT WE WOULD LIKE TO KNOW WHAT
ARE THE MIDDLE AGE OR OLD AGE
POLICIES AND PROGRAMS THAT CAN
HELP OVERCOME THE AFFECTS OF
EARLIER LIFE COURSE EXPOSURES.
WHICH POLICIES AND PROGRAMS WORK
FOR WHICH GROUPS AND HAVE TO BE
PROGRAM SPECIFIC AND GROUP
SPECIFIC.
ANOTHER TYPE OF RESEARCH COULD
BE WHAT ARE THE MARKERS OF
RESILIENCE AMONG OLDER ADULTS,
THAT IS WHO ARE THOSE STRONGER
AND BETTER CAPABLE OF OVERCOMING
SETBACKS THAN THEIR LIFE COURSE
DISADVANTAGE WOULD INDICATE.
WE CAN LEARN A LOT FROM THESE
RESILIENT OLDER ADULTS.
ANOTHER POSSIBILITY WE NEED TO
STUDY MORE IS FINDING CONSISTENT
DESPAIRS AMONG MEN AND WOMEN AND
OUTCOMES AND THE AFFECT AND HOW
PROGRAMS AND EXPOSURES WORK.
WHAT OCCUPATIONAL AND WHAT
DOMESTIC LIFE EXPOSURES SHOULD
BE TARGETED.
THINK THAT'S A PRIORITY RESEARCH
QUESTION.
THANK YOU VERY MUCH FOR THE
OPPORTUNITY TO ADDRESS YOU IN A
SHORT PRESENTATION.
>>HI.
I'M MARICRUZ RIVERA HERNANDEZ
AND MY PRESENTATION IS OUTCOMES
AND QUALITY OF CARE AMONG
MEDICARE ENROLLEES IN PUERTO
RICO.
I'M FUNDED BY THE NIA AND NIMHD.
I DON'T HAVE ANY OTHER CONFLICTS
OF INTEREST WITH THE REPRESENTED
MATERIAL.
I'M GOING TO TALK ABOUT
POPULATION AGING AND HEALTH
DISPARITIES AND MEDICARE
ADVANTAGE AND THE IMPACT OF
HURRICANE MARIA ON VULNERABLE
PATIENTS AND THE OVERLAPPING
THEMES IN THE STUDIES.
ASSESSING QUALITY OF CARE AND
OUTCOMES FOR MEDICARE
BENEFICIARIES IN PUERTO RICO IS
IMPORTANT FOR A NUMBER OF
REASONS.
FIRST I'LL PROVIDE CONTEXT IN
PUERTO RICO.
THE ISLAND'S POPULATION HAS
GROWN OLDER AND THE POPULATION
HAS CHANGED AND THE PERCENTAGE
OF ALL THE ADULTS 65 AND OLDER
IN THE U.S. WAS 17% IN 2021.
I'M GOING TO USE U.S. TO REFER
TO THE U.S. MAIN LAND.
PUERTO RICO CHANGES DUE TO LIFE
EXPECTANCY AND WORKING AGE
ADULTS.
IT'S BEEN DESCRIBED AS AN ISLAND
IN CRISIS WITH HIGH POVERTY RATE
AND STRAINED HEALTH CARE SYSTEM.
THE U.S. NATIONAL POVERTY RATE
IS ABOUT 13% IN 2021 AND THE
MEDIAN INCOME IN PUERTO RICO IS
30% OF THAT OF THE UNITED
STATES.
ABOUT $22,000 COMPARED TO
$70,000 AND THE RATE OF
EMPLOYMENT IS LOWER THAN THE
RATE OF EMPLOYMENT IN THE U.S.
FINALLY, PEOPLE IN PUERTO RICO
ARE LESS LIKELY TO HAVE
BACHELOR'S DEGREE COMPARED TO
THE U.S.
IN ADDITION, PUERTO RICO HAS
BEEN FACING A CRISIS.
AND DUE TO THESE ECONOMIC
CONSTRAINTS IT FACE AS A NUMBER
OF CHALLENGES REGARDING THE
HEALTH CARE SYSTEM AND
ADDRESSING HEALTH CARE NEEDS.
THERE'S A HIGH PREVALENCE OF
CHRONIC CONDITIONS WITH HIGH
RATES OF DISABILITY IN PUERTO
RICO THAN IN THE U.S.
THE TABLE DESCRIBES THE CHRONIC
CONDITIONS IN PUERTO RICO AND IN
THE U.S.
MEDICARE BENEFICIARIES IN PUERTO
RICO ARE MORE LIKELY TO HAVE
ALZHEIMER'S DISEASE AND RELATED
DEMENTIAS, CHRONIC KIDNEY
DISEASE, DIABETES, HEART FAILURE
AND HYPERTENSION COMPARED TO
MEDICARE BENEFICIARIES IN THE
U.S.
IN ADDITION, OLDER ADULTS IN
PUERTO RICO ARE MORE LIKELY TO
HAVE DIFFICULTIES WITH
ACTIVITIES OF DAILY LIVING AND
POOR HEALTH COMPARED TO OLDER
ADULTS IN THE U.S.
NOW I'M GOING TO TALK ABOUT
MEDICARE ADVANTAGE BENEFICIARIES
FROM THE ARTICLE MY COLLEAGUES
AND I PUBLISHED.
THE MEDICARE ADVANTAGE PROGRAM
PLAYS A CRITICAL ROLE IN
DELIVERING HEALTH CARE IN PUERTO
RICO.
OF THE 6,000 BENEFICIARIES IN ,
93% ARE ENROLLED THE HIGHEST OF
ANY STATE OR TERRITORY.
MEDICARE ADVANTAGE PLANS IN
PUERTO RICO SIMILAR TO MA PLANS
OFTEN HAVE LOWER COST SHARING
THAN THAT OF TRADITIONAL
MEDICARE OR MEDICARE FEE FOR
SERVICE.
PUERTO RICANS HAVE TRADITIONALLY
RECEIVED LOWER PAYMENT THAN
U.S. MA PLANS.
RATES ARE BASED ON EXPENDITURES
MEDICARE FEE FOR SERVICE OR THE
MEDICARE POPULATION.
IN 2022 MA PLANS IN PUERTO RICO
RECEIVED 40% LOWER PER CAPITA
PAYMENTS COMPARED TO PLANS IN
THE SIXU.S.
FUNDING FOR MEDICAID IS MORE
CONSTRAINED THAN ANY STATE THIS
IS IMPORTANT BECAUSE THERE'S
MEDICAID AND MEDICARE DUAL
BENEFICIARIES AND THEY PROVIDE
ASSISTANCE FOR MEDICARE
COPAYMENTS AND DEDUCTIBLES FOR
BENEFICIARIES WITH LOW INCOMES.
THE LACK OF FUNDING FOR MEDICARE
AND MEDICAID HAS RESULTED IN
PHYSICIAN SHORTAGES, POORLY
COORDINATED CARE AND LONG WAIT
TIMES.
ACCORDING TO DATA FROM PUERTO
RICO THERE'S ABOUT 11,000 TO
SERVE THE POPULATION OF 3.2
MILLION AND SPECIALTY CARE IS
MINIMIZED.
MOST THE STUDIES THAT LOOKED AT
THE QUALITY OF CARE AND OUTCOMES
OFTEN EXCLUDE BENEFICIARIES FROM
PUERTO RICO.
IN THIS STUDY WE'RE STUDYING THE
QUALITY OF CARE AND OUTCOMES
AMONG BENEFICIARIES IN PUERTO
RICO AND USED DATA FROM MEDICARE
FROM 2011.
THIS TABLE SHOWS THE ADJUSTED
ABSOLUTE DIFFERENCES IN
PERFORMANCE RATES BETWEEN
U.S. HISPANIC AND PUERTO RICAN
HISPANIC MA ENROLLEES.
THIS LEFT SIDE SHOWS ADJUSTED
DIFFERENCES BY AGE AND SEX AND
THIS RIGHT SIDE SHOWS ADJUSTED
DIFFERENCES BY AGE, SEX AND
POVERTY.
WE FOUND THAT COMPARED TO
MEDICARE BENEFICIARIES IN THE
U.S. HISPANIC MEDICARE
BENEFICIARIES IN PUERTO RICO
RECEIVED LOWER QUALITY OF CARE
FROM CHRONIC CONDITIONS
INCLUDING WORSE CONTROL OF
DIABETES, HYPERLIPIDEMIA AND
LOWER USE OF EFFECTIVE
MEDICATION IN RHEUMATOID
ARTHRITIS AND COPD.
SOME DIFFERENCES WERE HIGHER
THAN 20 PERCENTAGE POINTS.
NOW I'LL TALK ABOUT THE IMPACT
OF HURRICANE MARIA AMONG
VULNERABLE PATIENTS IN PUERTO
RICO.
MY COLLEAGUES AND I RECENTLY
PUBLISHED THIS PAPER IN JAMA AND
EXPLORED THE CHANGES IN
MIGRATION AND MORTALITY AMONG
PATIENT WITH KIDNEY FAILURE IN
PUERTO RICO AFTER HURRICANE
MARIA.
HURRICANE MARIA IS CONSIDERED
ONE OF THE HISTORIC HURRICANES
IN U.S. HISTORY.
ON SEPTEMBER 20 OF 2017,
HURRICANE MARIA MADE LANDFALL IN
PUERTO RICO.
IT CAUSED DAMAGE TOTALLING MORE
THAN $100 MILLION THE THIRD
COSTLY HURRICANE IN THE U.S.
IT DESTROYED PUERTO RICO'S
ELECTRIC GRID CAUSING ONE OF THE
MOST EXTENSIVE POWER OUTAGES IN
U.S. HISTORY AND IT INTERRUPTED
SANITATION SERVICES IN DIFFERENT
AREAS ACROSS PUERTO RICO.
LIMITED WATER AFFECTED HOSPITALS
AND HEALTH CARE FACILITIES AND
THEY STRUGGLED AND IT AFFECTED
POPULATIONS RELIANT ON HEALTH
CARE.
FOR INSTANCE, A REPORT SUGGESTS
MANY PERSONS WITH KIDNEY FAILURE
LEFT PUERTO RICO TO RECEIVE
DIALYSIS CARE SOMEWHERE ELSE.
GIVEN THE IMPACT OF MARIA IN
PUERTO RICO, WE ASSESSED
PATIENTS WITH KIDNEY FAILURE AND
USED DATA AND THE RENAL
MANAGEMENT INFORMATION SYSTEM
FROM 2012 TO 2020.
WE USED INTERRUPTED TIME SERIES
DESIGN.
WE FOUND THEY WERE SUBSTANTIAL
DIFFERENCES IN THE NUMBER OF
PERSONS UNDERGOING DIALYSIS IN
PUERTO RICO BEFORE AND AFTER
MARIA.
BEFORE MARIA, THE MAIN NUMBER OF
UNIQUE PERSONS IN PUERTO RICO
WAS A LITTLE OVER 2800 PEOPLE.
AFTER MARIA, IT DROPPED BY 261
PEOPLE.
WE ALSO FOUND THE PERCENTAGE OF
PEOPLE WHO RECEIVED DIALYSIS AT
DIFFERENT FACILITIES OUTSIDE OF
PUERTO RICO INCREASED
IMMEDIATELY AFTER MARIA
INDICATING MIGRATION OF PEOPLE
WITH KIDNEY FAILURE TO THE
MAINLAND.
PRE-MARIA IT WAS 7.1%.
THERE WAS AN INCREASE AFTER
MARIA OF 5.8%.
FINALLY, I'M GOING BRIEFLY
DISCUSS THE OVERLAPPING THEMES
ACROSS THE DIFFERENT STUDIES.
THERE'S SIGNIFICANT ECONOMIC
CHALLENGE IN PUERTO RICO.
THE ISLAND'S ECONOMY HAS LED
MEASURES AND POLICIES THAT
NEGATIVELY IMPACT SOCIAL HEALTH
CARE SERVICES AND IN ADDITION TO
LOWER FUNDING FOR MEDICARE AND
MEDICAID, IN APRIL OF THIS YEAR
THE SUPREME COURT OF THE UNITED
STATES RULED CONGRESS CAN
CONTINUE TO EXCLUDE THEM FROM
THE SUPPLEMENTAL SECURITY AND
PHYSICIANS HAVE DESCRIBED IT AS
A PROBLEM FOR THE HEALTH CARE
SYSTEM AND A HUMANITARIAN CRISIS
THAT MAY IMPACT QUALITY OF CARE
AMONG MEDICARE BENEFICIARIES AND
OLDER ADULTS.
IN FACT WE SHOWED THEY RECEIVE
LOWER QUALITY OF CARE AND WE SAW
VULNERABLE PATIENTS INCLUDING
OLDER ADULTS MIGRATING TO THE
U.S. TO SEEK SPECIALIZED CARE
ESPECIALLY AFTER DISRUPTIONS OF
CARE DUE TO NATURAL DISASTERS.
AND CONSIDERED IMPLEMENTING
CHANGES TO ENSURE OLDER ADULT IN
PUERTO RICO RECEIVE APPROPRIATE
CARE AND DO NOT HAVE TO LEAVE
THEIR HOMES.
THANK YOU AND I'M HAPPY TO
ANSWER ANY QUESTIONS.
>>WELCOME TO THE LIVE Q&A
SESSION FOR SUCH AN IMPORTANT
DISCUSSION ON THE HEALTH OF
OLDER ADULTS.
HISPANIC AND LATINO ADULTS WILL
REPRESENT THE LARGEST SEGMENT OF
OLDER ADULTS BY 1960 WITH AN
INCREASE OF 9% TO 21%.
THE PREVALENCE INCIDENTS OF
DEMENTIA AS WELL AS OTHER
NON-COMMUNICABLE DISEASES WHICH
ARE RISK FACTORS FOR DEMENTIA
ARE INCREASING AMONG LATIN
AMERICA AND IN THE U.S. AND
HEALTH DISPARITIES AND OLDER AGE
AND HOW DISABILITIES INCREASE
MORE RECENT COHORTS OF OLDER
ADULTS.
AND DR. RIVERA HERNANDEZ
HIGHLIGHTED THE ACCESS TO HEALTH
CARE AND HEALTH CARE FUNDING FOR
OLDER ADULTS IN PUERTO RICO.
DR. WONG EFFORTS ARE NEEDED TO
ADVANCE RESEARCH TO IMPROVE THE
HEALTH AND HEALTH CARE OF OLDER
ADULTS BOTH LATIN AMERICANS AND
FOR LATINOS AND HISPANICS IN THE
U.S.?
>>THANK YOU, MICHELLE.
I APPRECIATE AGAIN THE
INVITATION AND BEING ON THIS
DISTINCT PANEL.
I WAS THINKING ABOUT THE WAY
THAT WE DO THIS RESEARCH IS IN
POPULATION-BASED TEND TO BE
LONGITUDINAL SAMPLES AND STUDIES
TO EXAMINING THE TRAJECTORY OF
AGING OF POPULATIONS.
SO IN THE U.S. I THINK THAT WE
NEED TO BUY IN TO EXISTING
COHORTS BECAUSE IT WOULD BE VERY
COSTLY TO LAUNCH REPRESENTATIVE
COHORTS FOR ALL THE GROUPS WE
NEED TO REPRESENT.
THESE COHORTS TEND TO BE
FOLLOWED OVER TIME
PROSPECTIVELY.
THERE'S STUDIES LIKE THAT BUT
DON'T HAVE THE REPRESENTATION OF
THE GROUPS THAT WE WANT TO
REPRESENT.
IT WOULD GOOD-BYE TO ADD AND
SUPPLEMENT THESE STUDIES AND I
KNOW THAT'S A WAY MANY ARE
THINKING ABOUT IT.
AND THEN IN ADDITION, WE NEED TO
PARTNER THE STUDIES AS A DATA
PRODUCER NOW.
WE NEED TO THINK ABOUT
PARTNERING WITH SOMEONE OR
GROUPS THAT CAN HELP US RECRUIT
THESE PARTICIPANTS OR GROUPS WE
WANT TO REPRESENT IN THE UNITED
STATES, SOCIAL MEDIA, ETCETERA.
FINALLY I WANTED TO ADD A PITCH
FOR HUMAN CAPITAL IN LATIN
AMERICA.
I THINK THE U.S. PARTNER WITH
INSTITUTIONS IN LATIN AMERICA
AND RESEARCH INSTITUTIONS, GRAD
SCHOOLS AND PUBLIC HEALTH TO
GATHER IN AND USE THE DATA AND
BE ABLE TO PARTNER WITH THE
INSTITUTIONS TO HIGHER BACK
GRADUATES GRADUATING FROM THE
UNITED STATES AND GO BACK TO
THEIR COUNTRIES TO HAVE A
CONTINUED COLLABORATION WITH
U.S. PARTNERS.
THANK YOU.
>>THANK YOU FOR GETTING US
STARTED.
I WANT TO BUILD ON WHAT YOU
SAID, DR. WONG.
DR. RIVERA HERNANDEZ, CAN YOU
TALK MORE ABOUT THE DATA SOURCES
NEEDED TO STUDY QUALITY OF CARE
AND OUTCOMES AMONG OLDER ADULTS
IN PUERTO RICO AND PUERTO RICANS
AND THE U.S. MAINLAND.
>>YES, FIRST I WANT TO MENTION
IT'S PUBLICLY AVAILABLE THROUGH
CMS TO TRACK LIKE THE COMPARE
SITE THAT TRACKS QUALITY OF CARE
OF HOSPITALIZATIONS AND
FACILITIES.
AND WE HAVE USED SOME OF THE
DATA FOR DIFFERENT PROJECTS
HOWEVER, IN TERMS OF THE DATA,
MEDICARE BENEFICIARIES ARE UNDER
REPRESENTED AND AS MENTIONED A
LOT OF MEDICARE ENROLLEES IN
PUERTO RICO ARE MEDICARE
BENEFICIARIES.
WE NEED TO TRACK THE HEALTH CARE
OUTCOMES AMONG PEOPLE FROM
PUERTO RICO.
I HAVE GRANTS UNDER REVIEW TO
CONTINUE WORKING ON A DESIGN
WITH BENEFICIARIES IN PUERTO
RICO AND TRACK OUTCOMES FOR
THESE POPULATIONS.
THIS WILL HELP ME TO CONTINUE TO
IDENTIFY COLLABORATORS AND BUILD
DATA SETS AND TRACK OUTCOMES FOR
MEDICARE ENROLLEES IN PUERTO
RICO.
>>THANK YOU.
AND ADDING TO OUR DISCUSSION ON
DATA, DR. LLIBRE-GUERRA, WHAT
EFFORTS ARE NEEDED TO ADVANCE
PHENOTYPES OF DEMENTIA TO
CONTRIBUTE TO THE PROMPT
PREVENTION OR DELAY ITS NATURE
COURSE?
-- NATURAL COURSE.
>>THANK YOU FOR THE INVITATION.
THERE'S THINGS WE NEED TO TAKE
INTO CONSIDERATION.
ONE, INTERVENTIONS AT THE
POPULATION LEVEL AND
INTERVENTIONS THAT WE SHOULD DO
IN OUR HEALTH CARE SYSTEM AND AT
POPULATION LEVEL I THINK WE
STILL NEED TO WORK TO BRING
AWARENESS TO ALZHEIMER'S DISEASE
IN THE HISPANIC POPULATION AND
FOR MANY YEARS THE HISPANIC
POPULATION HAVE CONSIDERED
MEMORY IMPAIRMENT AND DEMENTIA
AS PART OF NORMAL AGING.
THAT'S CHANGING AND THE OTHER
THING IN TERMS OF PHENOTYPING
AND EARLY DIAGNOSIS, I THINK WE
HAVE TO ASSESS PEOPLE WITH THIS
AND THAT REQUIRES CAPACITY
BUILDING AND TRAINING AND LASTLY
I THINK IN TERMS OF PHENOTYPING,
WE HAVE VALIDATE THE GENETICS
AND THE BIOMARKERS THAT WE ARE
NOW FINDING IN THE POPULATION.
WE CANNOT ASSUME THE POPULATION
THAT WAS THE SAME IN LATIN
AMERICA.
WE KNOW LESS THAN 5% OF GENETIC
STUDIES IN ALZHEIMER'S DISEASE
ARE DONE AND THAT'S A GAP WE
NEED AND BIOMARKERS.
WE HAVE THE RARE UNDERSTANDING
OF BLOOD-BASED BIOMARKERS THOSE
ARE NOT BEING SYSTEMATICALLY
VALIDATED IN THE HISPANIC
POPULATION WHICH IS THE NEXT
STEP FOR OUR REGION AND
POPULATIONS IN THE U.S.
>>THANK YOU.
ARE THERE FINDINGS ABOUT THE
EFFECTIVENESS OF CURRENT
TREATMENT FOR DEMENTIA AMONG
HISPANIC LATINOS OR IN LATIN
AMERICANS?
>>AS WE SAW IN SOME
REPRESENTATIONS IN THE MORNING
AND ALSO IN THE AFTERNOON,
CARDIOVASCULAR RISK FACTORS ARE
THE MAIN CONTRIBUTOR TO THIS AND
IN HISPANICS LIVING IN THE U.S.
EARLY INTERVENTION AND
PREVENTION OF CARDIOVASCULAR
RISK FACTOR WILL HELP DECREASE
THIS PREVALENCE IN THE HISPANIC
COMMUNITY AND BY INTERVENING WE
CAN REDUCE 30% OF DEMENTIA
CASES.
THREES NOT ENOUGH OF OUR
COMMUNITY REPRESENTED AND WE'RE
NOW SEEING THE FIRST DATA COMING
TO THE FIELD SHOWING
EFFECTIVENESS IN TERMS OF THE
DECLINE WITH THE EFFECT ON
BIOMARKERS.
NOW WE NEED TO MOVE MORE OF THIS
POPULATION TO THESE TRIALS.
>>WHAT ARE POTENTIAL
STRATEGIES, INTERVENTION AND
POLICIES NEEDED TO PREPARE OUR
HEALTH CARE SYSTEM AND WORKFORCE
AND FAMILY MEMBERS AND
CAREGIVERS WHO CARE FOR OLDER
ADULTS WITH CHRONIC DISEASE AND
DISABILITY IN LATIN AMERICA AND
IN THE U.S.?
>>THINKING THAT WE CAN DO IT
FROM THE HEALTH CARE SYSTEM NOT
REALISTIC.
WE NEED TO THINK OF FORMAL
STRATEGIES OR FAMILIES.
WE CAN THINK ABOUT HOW TO TRAIN
AND HOW TO HAVE A FAST WAY OF
TRAINING THE CAREGIVERS AND
TAKING CARE OF THEMSELVES.
SELF CARE CAREGIVERS IS AN
EMPOWERING WAY OF SAYING WE'RE
THINKING OF YOU.
WE WANT TO HELP YOU AND WANT TO
HELP YOU TO PROVIDE CARE AND
TAKE CARE OF YOURSELF AND THE
CARE GIVING RESPONSIBILITIES AND
THE WOMEN WHO ARE MOTHERS TAKING
CARE OF OTHERS.
AND THE STRATEGY OF HAVING TO
JUGGLE AS WELL AS HAVING TO TAKE
CARE OF THEMSELVES.
THANK YOU.
>>PUERTO RICO IS A
U.S. TERRITORY.
THEIR FUNDING MECHANISMS THAT
ALIGN TO THE U.S. IN MEDICARE OR
MEDICAID HOWEVER THERE'S LOWER
FUNDING TO PUERTO RICO.
WE'VE SEEN THOSE WITH COMPLEX
CONDITIONS MAY LEAVE THE ISLAND
AND COME TO THE U.S. TO SEEK
CARE THAT IS HARD TO GET IN
PUERTO RICO.
FROM THAT POINT OF VIEW I DO
BELIEVE WE SHOULD IMPLEMENT SOME
INTERVENTION TO HELP CAREGIVERS
WHO DON'T WANT TO LEAVE THE
ISLAND AND CONTINUE TO ABLE AT
HOME AND NOT HAVE TO MIGRATE.
AND THERE'S MANY BENEFITS AND
FUNDING IN PUERTO RICO AND THINK
OF PROVIDING INCENTIVES TO HAVE
SPECIALIZED CARE IN PUERTO RICO
AS WE'VE SEEN THEY'RE NOT
PROVIDING SPECIALTY CARE IN
PUERTO RICO.
>>I WANT TO TALK ABOUT THE
HEALTH CARE SYSTEM THAT IS NOT
READY YET TO DEAL WITH THIS AND
WE STILL NEED TO THINK HOW DO WE
ADDRESS THIS IN PRIMARY CARE AND
IT'S A NOT UNIQUE AND HAVE
PROVIDERS TO ASSESS PEOPLE IN
THEIR FIRST LANGUAGE.
>>AND LOOKING AT OUR WORKFORCE
AND MAKING SURE CLINICIANS AND
THE HEALTH CARE SYSTEM IS
DELIVERING CARE IN A RESPONSIVE
WAY TO THE CULTURE OF THE
HISPANIC LATINOS AND THE
LANGUAGE THEY WANT ARE IMPORTANT
POINTS YOU ALL HAVE BROUGHT UP.
I HAVE A COUPLE MORE QUESTIONS
THAT CAME OUT AND I ENJOYED YOUR
PRESENTATIONS.
DR. WONG, ONE QUESTION I
RECEIVED, IS OLDER ADULTS ABUSE
IDENTIFIED IN YOUR RESEARCH AND
HOW'S IT MANIFEST AND ARE THERE
EFFECTIVES TO ADDRESS THAT?
>>IN OUR STUDY WE SELECTED
AREAS IN MEXICO AND QUESTIONS OF
VIOLENCE AND DOMESTIC VIOLENCE
ARE VERY DELICATE BECAUSE WE
HAVE TO REPORT SOMEBODY IN THE
HOUSEHOLD IS ABUSING THEM.
SO WE HAVE NOT ASKED THOSE
QUESTIONS FROM OLDER ADULTS
THOUGH WE PILOT ED HOW TO DO IT,
IT WASN'T POSSIBLE TO IMPLEMENT
SO WE DON'T HAVE THAT IN OUR
STUDIES BUT IN SMALLER SAMPLES
THERE'S EVIDENCE OF ABUSE THAT
IS THEN HANDLED USUALLY BY
RELATIVES THAT REPORT OR PROTECT
THE OLDER ADULT OR THE
CAREGIVER, THE HEALTH CARE
PROVIDER.
>>DO YOU THINK IT'S STILL MAYBE
TABOO TO DISCUSS IN LATIN
AMERICA AND AMONG LATINOS IN THE
U.S.
>>IT WAS VERY HARD TO ASK THE
QUESTION.
YOU ALMOST HAVE TO ASK WITHOUT
ASKING CAN YOU REPORT IT AND SAY
YES, NO.
IT'S DIFFICULT IF YOU CAN'T READ
AND SO THERE'S BEEN DIFFERENT
ATTEMPTS BUT IT'S A TABOO TOPIC
AND WHY WE CAN'T MEASURE IT
AMONG ALL THE THINGS WE MEASURE
IN THE LAST 20 YEARS WE EVENT
GOTTEN TO THAT VERY IMPORTANT
AREA .
>>THANK YOU FOR SHARING.
FOR DR. RIVERA HERNANDEZ, I WANT
TO ASK ABOUT YOUR WORK IN PUERTO
RICO.
HAVE YOU EXPLORED MIGRATION
PATTERNS AMONG BENEFICIARIES
WITH OTHER COMPLEX CONDITIONS IN
PUERTO RICO AND HOW DO YOU DEAL
WITH CARE CONTINUITY MAKING SURE
THAT IF THEY GO BACK TO THE MAIN
LAND AND THE INFORMATION IS
BEING COMMUNICATED TO THEIR NEW
CLINICIANS?
CAN YOU TALK MORE ABOUT THAT?
>>GREAT QUESTION.
IN ONE OF THE GRANTS I JUST
RECEIVED FUNDING WE'RE GOING TO
TRACK MIGRATION AMONG PEOPLE
WITH KIDNEY FAILURE WHICH
INCLUDES PEOPLE WITH COMPLEX
CONDITIONS IS TRACKING WHERE
THEY RECEIVE CARE AND IF THEY'RE
OKAY IN PUERTO RICO THEY'RE
RECEIVING CARE AND IF THE
FACILITIES ARE IN THE U.S. MAIN
LAND IT MEANS THEY HAVE MOVED TO
COMMON AREAS LIKE FLORIDA, NEW
YORK AND ETCETERA.
WE'RE ABLE TO TRACK WHERE THEY
RECEIVE CARE AND SEE THE
PATTERNS ACROSS PUERTO RICO AND
THE U.S.
TO THE DATA SETS, THEY OFTEN
HAVE TO SUBMIT CLINICAL
INFORMATION WHICH MAKES IT
EASIER TO TRACK NOT ONLY WHERE
THEY'RE RECEIVING CARE BUT
OUTCOMES AMONG CLINICIANS AND
PROVIDERS.
>>UNDERSTANDING I GUESS THE
COMPLEXITY OF THE HEALTH CARE
SYSTEM AND FUNDING IN PUERTO
RICO, CONSIDER WHERE IS MA OR
MEDICARE PARTICIPATION RATES SO
HIGH IN PUERTO RICO?
I THINK 93% WERE REPRESENTED AND
IN THE OTHER STATES AS HIGH AS
24% AND WHY IS FEE FOR SERVICE A
BIG PARTICIPATION IN PUERTO
RICO?
>>IF WE LOOK AT THE OVER ALL
TRENDS IN THE U.S. AS WELL AS,
HISPANIC AND LATIN AMERICANS
HAVE HIGHER PARTICIPATION
BECAUSE THEY'RE LOWER
OUT-OF-POCKET COSTS AND MAKE THE
PLANS ATTRACTIVE TO PEOPLE WITH
LOWER INCOMES.
IN PUERTO RICO THERE IS A
PREFERENCE TO ENROLLING AN IN
HMO PLAN THAN FEE OR SERVICE
ALTERNATIVE.
ONE OF THE ISSUES AS PEOPLE MAY
SEE IS MOVING TO THE U.S. MAIN
LAND AND THE HEALTH CARE MAY NOT
BE TRANSFERABLE AND WHAT THE
CONSEQUENCES OF SWITCHING THAT
COULD CORRELATE WITH MIGRATION.
>>VERY IMPORTANT WORK.
DR. LLIBRE-GUERRA YOU PRESENTED
WORK AMONG LATINOS IN U.S. AND
WHAT FURTHER COLLABORATION NEEDS
TO BE DONE IN THE U.S. AND LATIN
AMERICA AND WHAT ARE THE
CHALLENGES TO FORMING THE
RESEARCH COLLABORATION TRANS
NATIONALLY?
>>I THINK NUMBER ONE IN
MATERIALS OF PARTNERSHIP IT
SHOULD WAY AND NEEDS TO BE
ADDRESSED MOTORCYCLELY AND
AND IT'S BEING TRANSLATED TO THE
U.S.
AND ALZHEIMER'S RESEARCH IS THE
BEST WAY TO MOVE FORWARD IN
TERMS OF THE COLLABORATIONS.
>>CAN YOU SHARE WHY YOU'RE
SUCCESSFUL AT PARTICIPATION
RATION OR STRATEGIES WE CAN
LEARN TO IMPLEMENT IN THE U.S.?
AND WE HAD CLOSE TO 75% IN SOME
COUNTRIES AND 90% IN OTHER
COUNTRIES WHICH HIGH WITH
U.S. RESPONSE RATE IN OUR
COMMUNITY.
AND GOING TO THE COMMUNITY AND
TALKING ABOUT RESEARCH STUDIES
AND TALKING ABOUT THE DISEASE.
AND IT'S BEEN SUCCESSFUL IN OUR
RESEARCH.
>>THE TECHNICAL CAPACITY IS IN
LATIN AMERICA AND SOMEONE
MENTIONED THE CAPACITY IS THERE.
AND WE JUST NEED TO TAKE
ADVANTAGE AND SAYING IF WE CAN
COLLABORATE WITH THEM IT
PROVIDES AN INCENTIVE FOR THEM
TO BE MOTIVATED AND CHALLENGED
AND CONTINUE TO WORK AND STAY IN
THE RESEARCH INSTITUTIONS TO
WORK WITH AMONG THEMSELVES AND
WITH US.
AND IN TRYING TO ESTABLISH A
PROGRAM IS LANGUAGE.
THEY CAN SPEAK THE SCIENTIFIC
LANGUAGE IN ENGLISH BUT NOT THE
EVERYDAY LANGUAGE AS WELL.
SO TRYING TO REACH OUT AND WORK
FOR US TO WORK IN SPANISH
DOESN'T HAVE TO BE JUST ONE WAY.
LIKE SAYING THEY HAVE TO KNOW
ENGLISH AND HAVING MANY WHO CAN
SPEAK SPANISH.
THE OTHER THING IS THE POLITICAL
WILL.
IF WE'RE OUTSIDE THE UNITED
STATES WE'RE FIGHTING A
POLITICAL WILL AND HAVING A
PARTNER WITH A LARGE ROLE HAS
BEEN IMPORTANT FROM THE
BEGINNING TO SUSTAIN A STUDY FOR
20 YEARS WAS IMPORTANT TO STUDY
POLITICAL WILL AND NOW IT'S VERY
TRUST -- TRUST HAS CONTINUALLY
BEEN ACCUMULATED BECAUSE PEOPLE
CHANGE SO WE HAVE TO
RE-ESTABLISH THE TRUST.
THE OTHER THING I THINK WE
SHOULD THINK ABOUT IS THAT QUE
NEED TO BE MORE AWARE OF HOW WE
CAN MAKE THE NIH TYPE OF
COLLABORATIONS LESS DIFFICULT.
A
AND IF WE WANT TO HAVE MORE OF A
GLOBAL PRESENTATION IN THE SENSE
OF COLLABORATION, WE NEED TO
TAKE A HARD LOOK AT HOW THE NIH
CAN BECOME LESS COMPLEX AS A
FUNDER.
>>I APPRECIATE THE COMMENTS.
AND DR. RIVERA HERNANDEZ DID YOU
WANT TO ADD ANYTHING ABOUT THE
RESEARCH COLLABORATION IN PUERTO
RICO AND HAVE YOU OVERCOME ANY
BARRIERS OR EVEN OPPORTUNITIES
AS WELL.
>>I HAVE NOT FACED THE BARRIERS
MY COLLEAGUES HAVE MENTIONED.
I'M THANKFUL WE'RE RECEIVING
FUNDING AS WELL AS PUBLISHING
WORK THAT MAY BE RELATED TO WHAT
I'M DOING.
I'VE BEEN THANKFUL AND
SUCCESSFUL BY DOING A LOT OF
REACHING OUT AND NETWORKING TO
DIFFERENT WORKSHOPS.
IT'S A GREAT OPPORTUNITY TO SEE
WHAT THEY'RE DOING IN PUERTO
RICO AND OTHER AREAS AND TO
START THE COLLABORATIONS AND
REACHING OUT TO RESEARCHERS AND
SHARE OF THE IDEAS I HAVE.
AND MOST OF THE TIME THEY HAVE
BEEN VERY INTERESTING AND I HAVE
FOUND RESEARCHERS THAT WANT TO
BE CO-INVESTIGATORS AND I'M
THANKFUL AND I HAVE FOUND IT'S
BEEN SUCCESSFUL.
>>THANK YOU, THANK YOU.
SO ONE QUESTION THAT I RECEIVED
FROM THE AUDIENCE IS FOR
DR. WONG, HOW DO WE NOT
[INDISCERNIBLE] DUE TO THE
INCREASE IN VISIBILITY AND WHERE
WE SEEING THIS AMONG THE MEXICAN
HEALTH AND AGING STUDY?
>>I THINK THAT THE AUTHORS THAT
LOOKED AT THE TWO COHORTS
SEPARATED BY 10 YEARS AND
LOOKING AT HOW THE MORE RECENT
COHORTS BORN IN THE '50s OPPOSED
TO THE '40s SEEM MORE DISABLED.
IT'S MOSTLY BECAUSE OF THE
ABILITY TO SURVIVE LONGER WHICH
AN INCREASED SURVIVAL AND THE
IDEA IS YOU MAY SURVIVE TRAVEL
CONDITIONS PREVIOUS COHORTS
COULDN'T SURVIVE AND NOW THIS
COHORT CAN SURVIVE AND MAY
ARRIVE IN OLD AGE WEAKER BUT
MORE RECENT COHORTS ARE ARRIVING
WITH HIGHER OBESITY AND DIABETES
AND WE'RE SEEING IT ON THE
POPULATION ENTERING OLD AGE MORE
DISABLED.
>>THANK YOU FOR SHARING THAT.
WE HAVE ANOTHER QUESTION FOR THE
AUDIENCE FOR DR. LLIBRE-GUERRA,
WHAT NEEDS TO BE DOWN TO
IDENTIFY DEMENTIA EARLY OR RISK
OF DEVELOPING DEMENTIAING
AMONGST LATINOS AND HISPANIC
AMERICANS.
>>RAISE AWARENESS IN OUR
COMMUNITY.
WE KNOW HISPANIC COMMUNITY
USUALLY GO LATER ESPECIALLY WHEN
THEY START SEEING SYMPTOMS
THAT'S WHEN THEY GO TO THEIR
PHYSICIAN AND WHEN THEY SEE
EARLY MEMORY IMPAIRMENT.
THAT'S ONE STEP AND THE OTHER
THING I THINK IS GET A BETTER
UNDERSTANDING OF THE RISK
FACTORS FOR DEMENTIA IN THE
HISPANIC COMMUNITY.
IF YOU HAVE BETTER UNDERSTANDING
OF DEMENTIA ONCE YOU GO TO THE
PRIMARY CARE EVENT AND IT COULD
INCLUDE AS PART OF THE REGULAR
SHAPE AND ACCORDING TO THE
SCREENING I THINK THAT WOULD BE
SOME ELEMENTS I THINK WOULD BE
KEY FOR THE EARLY DIAGNOSIS.
>>WE HAVE ANOTHER QUESTION ALSO
FOR YOU, DO WE HAVE EXAMPLES IN
LATIN AMERICA ABOUT EFFECTIVE
OUTREACH AND EARLY DIAGNOSIS FOR
EXAMPLE, DEMENTIA TO BE ABLE TO
INTERVENE EARLIER?
>>SO I THINK THERE ARE A FEW
EXAMPLES WE COULD TRY TO SEE
MORE BUT IN TERMS OF EARLY
INTERVENTION, THERE'S NOW GOING
IN LATIN AMERICA A STUDY OF
PHYSICAL ACTIVITY DIAD
INTERVENTION AND IN TERMS OF
RECRUITMENT WE'RE STILL SEEING
THE RESULT ONGOING AND WE'RE
SEEING CLINICAL TRIALS AND
STARTING TO DO PRIMARY VERY
VENTION AND SECONDARY PREVENTION
STUDIES AND THOSE ARE A FEW IN
CHILE AND ARGENTINA AND I THINK
WE'LL START SEEING A FEW OF
THOSE ALREADY.
>>GREAT.
WE HAVE A COUPLE SECONDS.
ANYTHING ELSE ANYBODY WANTS IT
ADD BEFORE WE CLOSE?
WELL, THANK YOU SO MUCH.
IT'S BEEN A WONDERFUL
DISCUSSION, PRESENTATION.
I APPRECIATE SHARING YOUR
COMMENTS AND EXPERTISE AND FOR A
THOUGHT-PROVOKING DISCUSSION ON
THE HEALTH OF OLDER ADULTS AND
NOW WE'LL MOVE TO OUR NEXT
SESSION MODERATED BY DR. LARISSA
AVILES-SANTA.
THANK YOU.
>>GOOD AFTERNOON.
MY NAME IS LARISSA AVILES-SANTA.
I'M THE MODERATOR OF TOPIC 6,
BEST PRACTICES AND LESSONS
LEARNED IN RESEARCH.
OUR PANELISTS ARE DR. JUAN JOSÉ
GAGLIARDINO AND DR. HOORAY LIB
GUBE GUR GUR AND AFTER WE'LL
HAVE A LIVE Q&A.
>>HELLO.
WE'RE GOING AGAIN TOGETHER AND
THIS TIME I'M GOING TO BE MORE
OPTIMIST BECAUSE WE'RE TALKING
QUALITY AT THE PRIMARY CARE
LEVEL THIS REPRESENTS WHAT
HAPPENED USUALLY WHEN YOU MAKE A
MISTAKE AND IMMEDIATELY YOU HAVE
THIS.
THIS IS WHAT THE ANIMAL IS
DOING.
IT'S NOT THE TIME TO CHANGE
MEDICAL CARE AND WHAT IS THE
CARE PARITY IS LIKE A PYRAMID.
IN THE TOP YOU HAVE THE
PATHOLOGIST AND OTHER PEOPLE AND
UNFORTUNATELY, MOST OF THE
PATIENTS ARE NOT ATTENDED BY TO
THE SPECIALIST.
MOST THE PATIENTS HAVE THE
PRIMARY CARE LEVEL AND THEY'RE
NOT THE BEST PREPARED FOR THE
JOB BUT AT THE LONGER PATIENTS
BECAUSE IT'S THE FIRST BETWEEN
THE HEALTH CARE SYSTEM AND THE
POPULATION.
AND IF ARE LUCKY YOUR PRIMARY
CARE UNIT HAVE YOU THE PHYSICIAN
AND NUTRITIONIST AND NURSE.
AND ALSO YOU HAVE TO HAVE THE
CONTROL AT LEAST OF THE
CARDIOVASCULAR AND THE EASIEST
WAY TO DEVELOPING OF
COMPLICATIONS AND TO PUT
TOGETHER THE SYSTEM HAVE YOU
EDUCATION.
AND NOW I'LL EXPLAIN WHY I SAY
THAT.
WE MAKE AN EXPERIMENT AND REPORT
THE RESULT AND WE HAVE SELECTED
ARGENTINA AND WITHIN BUNOS AIRES
AND THE LOWEST LEVEL OF
EDUCATION AND THE HIGHER
MORTALITY.
WE'RE GOING FACE SEVERAL
DIFFICULTIES AND THE SUPPORT AND
THE ECONOMIC SUPPORT TO MAKE
THIS DEVELOPMENT WAS BASED ON
THAT.
WE HAVE AT THE GOVERNMENTAL AREA
THE PRIMARY CARE UNIT AND WE
HAVE RANDOMLY SELECTED OUT OF
THIS 40 WE HAVE 30 OF THEM.
IN EACH ONE WE HAVE THE
PHYSICIAN AND NURSES AND WE
RANDOMLY SELECTED ALF OF THEM
PRIMARY CARE UNIT WITH THE CARE
AND THE NURSES AND THEY'RE GOING
NOT TO DO ANY CHANGE.
WE'LL KEEP DOING WHAT THEY DO AS
WELL AS TO HAVE A CONTROL.
AND INVENTION WE HAVEN'T
INTRODUCED EDUCATION WE FOLLOWED
THE PATIENTS ONE YEAR AND ONE
CONTROL AND ONE OF THE SIGNALS
AND IN EACH APPOINTMENT THEY
HAVE TO FILL A FORM AND RECORD
JUST TO HAVE THE CLINICAL
BACKGROUND AND METABOLIC DATA
AND THERAPY AND THEN WE HAVE
INCORPORATED IN THE DATABASE AND
WE HAVE A GOOD RECORD OF THE
STAGE.
WE HAVE INTRODUCED AN EDUCATION
PROGRAM AT THE LEVEL OF DOCTORS
AND MANY HAVE BEEN EVALUATED BY
THE END OF THE COURSE.
WE HAVE THE SAME CONCEPT BUT
WITH DIFFERENT COMPLEXITY WHEN
DEVOTED TO PHYSICIAN AND NURSES.
IN ADDITION, WE ALSO HAVE A
MANUAL FOR THE PATIENTS.
WE MAKE A FOCUS ON THE PHYSICAL
ACTIVITY REGULARLY PRACTICED AND
MEAL PLAN IN OPTIMAL CONDITION
MEANS HEALTHY HABITS WITH MOST
THEM.
NOW, WE HAVE A RECORD THE
QUALITY OF RECORD AND CLINICAL
DATA AND METABOLIC DATA AND SOME
ON EDUCATION THE PATIENT HAS
RECEIVED AND IF THEY'VE HAD A
HOSPITALIZATION IT'S RECORDED
THERE AND YOU HAVE THE TREATMENT
AND THE TREATMENT AND MEDICAL
TREATMENT AND THE FIRST TIME YOU
COME TO THE APPOINTMENT AND IT'S
LOADED IN THE DATABASE AND THE
SECOND TIME YOU CAN COMPARE WHAT
HAPPENED THE LAST TIME AND THIS
TIME.
AND THERE'S PATIENTS AND GROUPS
AND DISAGREEMENT MEANS THE
PATIENT DID NOT IMPROVE AND FOR
EXAMPLE THE LAST APPOINTMENT WAS
10% AND THIS TIME COMES WITH THE
SAME SCORE AND THAT MEANS THAT
HE'S GOING RECEIVE THIS AND THIS
IS NOT DOING THAT.
YOU CAN COMPARE THE PATIENTS
TOGETHER AND THEY CONTROL WHAT
HAPPENED AND IN THIS WAY THEY
HAVE A HELP FOR THE PHYSICIAN TO
RECOGNIZE AND IN ADDITION WE GOT
THE APPOINTMENT BETWEEN THREE
DIFFERENT COMPONENTS.
LIKE I MENTIONED THE
RECEPTIONIST AND WE DON'T HAVE A
NUTRITIONIST AND HAVE TO REPLACE
IT AND TAKE THE DIFFERENT
GENERAL THINGS ABOUT THE PATIENT
AND NOT MEDICAL THINGS BUT HE'S
WRITING AND GIVES THE WRITING TO
THE NURSE AND THE NURSE TAKES
CARE OF THE BLOOD PRESSURE AND
FOOD CARE AND HE'S WRITING THERE
AND GIVES TO THE DOCTOR AND
PHYSICIAN AND TAKE A LOOK AT THE
THINGS THEY HAVE WRITTEN BEFORE
AND IF THEY SEE SOMETHING THAT
IS UNCLEAR FOR HIM, HE REPEAT IT
AND HAVE A DESCRIPTION.
IN THIS WAY WE HAVE OPTIMIZED
THE TIME BECAUSE EACH HAVE 10
MINUTES BUT TOGETHER THEY HAVE
30 MINUTES DEVOTED TO A PATIENT.
THAT'S LONGER THAN THE ONE TIME
THEY REGULARLY PAY ATTENTION TO
EACH PATIENT.
NOW, WHILE THE PATIENT IS IN THE
WAITING ROOM WAITING FOR THIS,
THERE IS NO MATTER FOR WHAT KIND
OF THING IN THE PRIMARY CARE
UNIT.
THEY HAVE A SYSTEMATIC SURVEY OF
PEOPLE AT RISK FOR DEVELOPING
TYPE II DIABETES.
AND IN CASE YOU HAVE THE TIME
POINTS IN THE TO PERFORM SURVEYS
AND THEN HAVE YOU A CLEAR DOVE
MISSION ABOUT THE STAGE.
AND IN ADDITION IN CASES.
PEOPLE WITH DIABETES AND
PRE-DIABETES THEY GET MEDICAL
FOLLOW-UP CONTROL APPOINTMENT
ONE WEEK AHEAD VIA A CALL CENTER
AND MAKE THE PHONE CALL AND
REMIND HIM OF THESE THINGS.
AND WHAT IS THE RESULT WE HAVE
OBTAINED USING THIS?
FROM THE POINT OF VIEW OF THE
SURGEON, WE GOT A 48% USUALLY
ABOUT 50% IN THE PRIMARY CARE
UNIT.
IN THE INTERVENTION, THIS CUTS
DOWN TO 28% AND IT'S A CLEAR
IMPROVEMENT.
AND WITHIN THE CONSULTATION, AT
LEAST ONCE A YEAR AT LEAST 70%
IN THE CONTROL GROUP AND THIS
WENT OUT TO 100% IN THE CASE OF
THE INTERVENTION GROUP.
OTHERWISE WHAT ABOUT THE
RESULTS?
HERE WE HAVE LISTED WHAT THE
DIFFERENT PARAMETERS WE HAVE
CONTROL.
AND OF COURSE WE DIDN'T EXPECT
TO HAVE ANY CHANGE IN THE
CONTROL GROUP BECAUSE THEY KEPT
DOING THE SAME AS THE BEFORE AND
WHY ARE THEY GOING CHANGE?
AND FOR EXAMPLE THIS VALUE COMES
DOWN AFTER SIX MONTHS BUT COMES
DOWN AGAIN ALMOST THE SAME AS
THE BEGINNING OF 12 MONTHS AND
SAME WITH THE INTERVENTION GROUP
AND YOU CAN SEE ALL THE ONES WE
HAVE AND THE BLOOD PRESSURE
GROUP AND YOU CAN SEE LIPIDS AND
SO ON AND IN ALMOST EVERY CASE
WE DEFINED THE GOAL AND SO ON.
AND NOW IF WE COMPARE THE RESULT
WE HAVE OBTAINED WITH THE
INTERNATIONAL REPORTS, PRODUCED
IF WE COMPARE THE META-ANALYSIS
AND YOU SEE IT GOES 3
MILLIMETERS WE HAVE RESULTS OF
THE META-ANALYSIS AND THEN WHAT
ABOUT THE COST?
AND THIS COST WE COMPARED THE
PEOPLE THAT HAVE LESS THAN 7%
AND PEOPLE WHO HAVE MORE THAN 7%
AND FROM THE POINT OF VIEW IT
GOES TO 715 IN THIS ONE IT MEANS
A SIGNIFICANT DECREASE AND THIS
IS ABOUT 175%.
IF YOU COMPARE THE THERAPY YOU
HAVE THIS SIGNIFICANT DECREASE
AND THE SAME THING.
IN ANY CASE YOU HAVE A
SIGNIFICANT DIFFERENCE MEANS
IMPROVING THE CARE PROVISION YOU
DECREASE THE COST.
NOW, WITH WHAT WE RECOMMEND IS
PRIMARY PREVENTION AND WE CAN
ADOPT HEALTHY LIFE AND NOW
SECONDARY WE START TO TREAT
DIABETES PATIENT, EARLY
TREATMENT AND FINALLY SYSTEMATIC
RECORDS OF DATA ARE REMINDERS WE
HAVE SEEN THE RESULTS IN A GOOD
IMPROVEMENT AND WHEN WE HAVE A
GOOD RECORD DATA TO FOLLOW-UP
THE INTERVENTION THAT WE POINT
FORWARD.
KNOW, WHAT ARE THE LEVELS WE ARE
PUTTING TOGETHER?
PRIMARY CARE LEVEL AND
ESPECIALLY CARE AT ANY TIME IF
WE THAT THE PATIENT HAS NOT
ENOUGH CARE CONTROL WE HAVE
SWITCHED TO SPECIALIST CARE AND
WE HAVE DIFFERENT ACTSORS.
THEY HAVE TO BELIEVE IN THESE
THING.
SECOND, THE PUBLIC HEALTH SYSTEM
AND THE SOCIAL SECURITY SYSTEM
AND WE HAVE THE MEDICAL SCHOOLS.
WHAT KIND OF LEARNING, WHAT KIND
OF TEACHING THINGS ARE PROVIDED
TO THE FUTURE DOCTORS TO SUPPORT
THE POPULATION CONSULTATION AND
FINALLY THE TOOLS.
WE HAVE WE HAVE TO IMPLEMENT
EDUCATION AT EVERY LEVEL AND
THINK ABOUT THIS IS AN EASY
TASK, NO.
WE DON'T BELIEVE IT'S EASY BUT
WE CAN DO WHAT PEOPLE SAY.
FOR EXAMPLE, DON'T GIVE UP ON
YOUR DREAMS.
AND SOMETIMES YOU HAVE TO PICK
UP YOURSELF AND CARRY ON AND
THANK YOU FOR YOUR ATTENTION.
>>THANK YOU, FOR JOINING YOU
ARE SESSION TODAY.
THIS TIME I'M GOING TO FOCUS ON
CLINICAL TRIALS AND
IMPLEMENTATION IN LATIN AMERICA
AND ESPECIALLY HIGHLIGHT A FEW
EXPERIENCE ABOUT OVERCOMING
BARRIERS FOR CLINICAL TRIAL
IMPLEMENTATION IN LATIN AMERICA.
THESE ARE MY DISCLOSURES.
FIRST I'D LIKE TO SHARE A FEW
IDEAS TO GIVE A PERSPECTIVE OF
THE NEED OF IMPLEMENTATION OF
CLINICAL TRIALS IN HISPANIC
POPULATION AND IN LATIN AMERICA.
FIRST, I BELIEVE THAT IN 1906
WAS A KEY MOMENT OF ALZHEIMER'S
DISEASE AND AFTER THAT WE HAVE
BEEN SEEING KEY ELEMENTS OF
SUCCESS IN ORDER TO BETTER
UNDERSTAND ALZHEIMER'S DISEASE
AND RELATED DEMENTIA.
ESPECIALLY IN 2022 WE SAW THE
FIRST TIME AMYLOID REMOVAL FOR
CLINICAL IMPROVED OUTCOME.
WE'VE SEEN THIS THROUGH
IMPLEMENTATION OF DIFFERENT
CLINICAL TRIALS BUT HOWEVER,
THEY'VE TAKEN PLACE IN
HIGH-INCOME COUNTRIES AND MORE
THAN 90% OF CLINICAL TRIALS ARE
IN HIGH-INCOME COUNTRIES AN ONLY
10% ARE CONDUCTED IN EMERGING
ECONOMIES.
THAT'S BEEN THE TREND OVER THE
LAST TWO DECADES.
WE'RE SEEING THAT SHOWN HERE IN
THIS WHERE THE CLINICAL TRIALS
ARE IMPLEMENTED IN HIGH-INCOME
COUNTRIES.
THIS IS ALSO THE TREND WE SEE
WHERE 80% OF ALL CLINICAL TRIALS
ARE IMPLEMENTED EITHER IN U.S.,
CANADA OR EUROPE.
AND THEY'RE FOCUSSED ON THE TWO
REGIONS AND IT'S ON LATIN
AMERICA AND AFRICA ARE THE ONES
WITH THE LOWER DENSITY OF
CLINICAL TRIALS.
IT'S CAUGHT THE ATTENTION ABOUT
THE NEED FOR GLOBALIZATION OF
CLINICAL TRIALS IN ALZHEIMER'S
DISEASE AND RELATED DEMENTIA.
WHY WE NEED TO EXPAND CLINICAL
TRIALS TO LOOK AT CLINICAL
TRIALS MORE DIVERSE AND INCLUDE
OTHER COUNTRIES?
NUMBER ONE, WE KNOW THE
DEMOGRAPHICS AND RISK FACTORS
THAT CANNOT BE EXTRAPOLATED FROM
ONE POPULATION TO THE OTHER AND
THAT'S PART OF THE EDUCATION AND
CARDIOVASCULAR RISK FACTORS AND
AND WE NEED TO HAVE BETTER
UNDERSTANDING AND MORE SEEKING
TREATMENT ON DIAGNOSIS.
THAT MAY BE THE POPULATION-BASED
DIFFERENCE BASED ON THE GENETICS
IF WE DON'T EXPAND OUR CLINICAL
TRIALS AND HAVE A MORE DIVERSE
GROUP AND THE OTHER ELEMENTS THE
POPULATION FACTORS THAT MAY
AFFECT BIOLOGY AND THESE ARE
FACTORS AMONG OTHERS THAT MAY
HAPPEN IN THE DISEASE.
AND IN TERMS OF THE DOSE WE
SHOULD BE USING FREQUENCY AND
THIS IS DATA WHY WE NEED
CLINICAL TRIALS.
STOPPING THERE I'D LIKE TO
CHANGE AND TALK ABOUT OUR
EXPERIENCE IN IMPLEMENTING
CLINICAL TRIALS IN LATIN AMERICA
AND DIFFERENT SITES.
FOR THAT, I THINK THE USE OF THE
NETWORK ARE KEY FOR SUCCESS IN
THIS IMPLEMENTATION.
I'M GOING USE THE EXAMPLE OF
SOMETHING WE'VE BEEN DOING IN
THE ALZHEIMER'S TRIAL UNITS.
THIS IS A TRIAL UNIT WITH THE
MAIN GOAL TO IMPLEMENT SAFE
EFFECTIVE CLINICAL TRIALS IN
POPULATION WITH ALZHEIMER'S
DISEASE.
AND I WILL SAY IN THE FIRST
TRIALS OF THE NETWORK ESPECIALLY
THOSE INCLUDING THIS MOST OF OUR
SITES WERE INCLUDED WERE IN
EUROPE AND U.S.
ONE OF OUR GOALS WAS TO
IMPLEMENT NEW TRIALS AND HAVE
THE NEW SITE READY FOR UPCOMING
TRIALS TO THE PLATFORM.
WITH THAT, WE STARTED THE
INITIATIVE WHERE THE MAIN GOAL
WAS TO EXPAND CLINICAL TRIALS
AND CREATE THIS IN LATIN AMERICA
AND THE INITIAL GOAL WAS TO HAVE
SITES IN MEXICO, ALSO COLUMBIA,
SAU PABLO AND ARGENTINA AND SOME
SITES IN THE REGION.
HOW DO WE PREPARE FOR THE
CLINICAL TRIALS?
WE WANTED TO GET AN
UNDERSTANDING ON THE FREQUENCY
AND PREVALENCE OF THE
ALZHEIMER'S DISEASE IN LATIN
AMERICA TO HAVE A REGISTER OF
THIS AND ONE GOAL WAS TO COMPARE
THE BIOMARKERS OF THE
ALZHEIMER'S DISEASE IN HISPANICS
IN THE HISPANIC POPULATION AND
AT THE SAME TIME TRY TO IDENTIFY
NOVEL VARIANTS AND AGE OF ONSET
IN THE FAMILIES.
AT THE SAME TIME, HOW TO BETTER
UNDERSTAND WHAT IS THE AFFECT OF
A
FACTORS AND THOUGHT THIS NEEDED
TO START BEING EXPLORED AND
COLLABORATION WITH OUR PARTNERS
AND TO IDENTIFY THE COHORT READY
POPULATION TO BE ENROLLED IN THE
PLATFORM.
AND ONE OF THE STEPS WAS HAVING
A BETTER UNDERSTANDING OF WHAT
IS IN LATIN AMERICA AND WHERE
THE FAMILY IS LIVING AND WHAT'S
THE DISTRIBUTION AND THE MAIN
GENETIC VARIANTS.
IN COLLABORATION WITH OUR P.I.s
WE STARTED SCREENING FAMILIES
FOR ALZHEIMER'S DISEASE AND THIS
IS ONE OF THE EXAMPLES OF A
RURAL POPULATION DESCRIBED BY
OUR COLLABORATORS IN ARGENTINA
AND A POPULATION IN THIS AREA
AND THIS IS HOW WE IMPLEMENTED
THEM THROUGH THE NETWORK AND
THERE'S ABLE EXAMPLE HERE AND
THERE'S A SIMILAR EXPERIENCE
WITH MEXICO, BRAZIL, CHILE AND
OTHER COUNTRIES.
TO SUMMARIZE THE DISTRIBUTION OF
DIFFERENT VARIANTS CAUSING
ALZHEIMER'S DISEASE IN LATIN
AMERICA AND YOU CAN SEE THE
DISPARITIES IN BRAZIL AND
COLOMBIA AND SOME DESCRIBED BY
THE GROUP OF AND WE ALSO
DESCRIBED NEW VARIANTS IN
BRAZIL, MEXICO AND ARGENTINA.
AT THE SAME TIME WE GET A BETTER
UNDERSTANDING OF THE DIFFERENT
REPORTS IN LATIN AMERICA AND YOU
MAY SEE THERE'S A FEW WHERE WE
DON'T HAVE REPORTS BUT THIS ALSO
HIGHLIGHTS A LACK OF ACCESS TO
GENETIC TESTING AND COUNSELLING
WE'RE ALSO TRYING TO WORK ON.
THE OTHER ELEMENT THAT WAS
INTERESTING IN THE DISCOVERY WAS
THE DISTRIBUTION OF GENETIC
ANCESTRY FOR SOME OF THE
ALZHEIMER'S DISEASE AND WE ALSO
HAD VARIANTS WITH AFRICAN
ABSCAB --
ANCESTRY AND OTHERS FROM BRAZIL
AND IT HIGHLIGHTS THE
DISTRIBUTION OF THE UNITS OF
SOME OF THESE VARIANTS.
AS WE START THINKING OF
IMPLEMENTING TRIALS IN
ALZHEIMER'S DISEASE ONE KEY
ELEMENT WE NEED TO HAVE READY IS
PROGRAMS ON GENETIC TESTING AND
CONSULT.
THOUGH MANY HAVE BEEN TESTED IN
HIGH-INCOME COUNTRIES INCLUDING
THE U.S. AND EUROPE THERE'S
DIFFERENT LEVELS AND STIGMA
AROUND DISEASE AND OTHER ELEMENT
S HIGHLIGHTING THE NEED FOR
TESTING IN OUR STUDY.
WE DEVELOPED THIS WHERE PEOPLE
WITH ALZHEIMER'S DISEASE WILL GO
THROUGH GENETIC TESTING AND
COUNSELLING AND WILL HAVE
CONTROL AND WE'LL HAVE
ADDITIONAL ASSESSMENT AND THREE
MONTHS FOLLOW-UP ASSESSMENT
AFTER LEARNING THEIR GENETICS.
WHERE WE'VE COME SORE FAR IS THE
ACTIVITY IN EUROPE AND GENETIC
COUNSELLING IS SAFE AND THOSE
RECEIVING A POSITIVE
CONFIRMATION OF THE VARIANTS DID
NOT DEFER FROM THE ONE THAT
SHOWED THE IDENTITY STATUS WHICH
IS HARD TO LOCK AT THE RELEVANCE
OF GENETIC TESTING AND IN TERMS
OF EXPLAINING THE ELEMENTS.
WITH THAT I THINK THAT'S HOW WE
ARE TODAY.
RIGHT NOW WE HAVE THREE SIDES
THAT ARE ACTIVE IN LATIN AMERICA
AND READY FOR CLINICAL TRIALS
AND OBSERVATIONAL STUDIES AND
THESE ARE LOCATED IN MEXICO,
COLOMBIA AND IN ARGENTINA.
WE HAVE TWO IN ACTIVATION.
ONE ROY -- GUARALAJARA AND
OTHER SITES IN LATIN AMERICA.
THE OTHER ELEMENTS WE WANT TO
HIGHLIGHT AFTER TESTING AND MANY
SITES HAVE ONGOING TESTING AND
GIVE FAMILIES ACCESS TO THE
PROGRAM AND SOMETHING WE NEEDED
TO HELP BUILD WAS LOCAL
RESOURCES.
AND THIS WAS MAINLY FOCUSSING ON
IMPLEMENTATION FOR SOME OF THE
CLINICAL TRIALS WE NEED TO USE
DIFFERENT TRACERS AND SOME OF
THE IMPORTANCE OF OUR CLINICAL
TRIALS.
IMPLEMENTING THE CENTER AND
HELPING DEVELOP THE RESOURCE WAS
KEY TO THE IMPLEMENTATION.
OUR FRESH APPROACH WAS TO CREATE
THIS ACROSS THE NETWORK TO
SUPPORT SITES THAT DON'T HAVE
THAT RESOURCE RIGHT NOW.
WE HELP MEXICO TO HELP BUILD
WITH TRAINING AN CAPACITY
BILLING TO PRODUCE SOME CENTERS
AND PEOPLE FROM COLOMBIA WILL
GET THEIR IMAGING AND IN
ARGENTINA WE HELPED WITH THE
PRODUCTION OF SOME OF THE
TRACERS AND WE'LL TRAVEL FROM
ARGENTINA AND OTHER PARTS AND TO
BUENOS AIRES.
AND THE GROUP FOR COLOMBIA ALSO
TRAVELED TO ARGENTINA.
WITH THAT IS HOW WE HELPED TO
GET THE NETWORK READY OR SITES
READY FOR LATIN AMERICA.
AND THEY ARE NOW STARTING TO
ENROLL AND FAMILY MEMBERS FROM
LATIN AMERICA WILL BE ENROLLING
OUR TWO MAIN ARMS FOR THE
CLINICAL INTERVENTION TRIAL AND
A COMBINATION TRIAL BETWEEN
THESE TWO AND THE MAP AND WILL
ENROLL UP TO 160 PARTICIPANTS
AND IT'S A PRIMARY PREVENTION
TRIAL IN THE FIELD AND WE'LL
ENROLL PARTICIPANTS IN LATIN
AMERICA.
NOW, I ALSO WANT TO HIGHLIGHT
THERE'S STILL EXISTING BARRIERS
BUT THOSE BARRIERS COULD BE
OVERCOME HERE AND I WANT TO
SHARE SOME OF THE BARRIERS WE
ENCOUN
ENCOUNTERED.
SOME WERE ORIGINAL BARRIERS
INCLUDING HAVING A SYSTEM THAT
WAS NOT SUPPORT I ENOUGH FOR OUR
P.I.s TO MOVE FORWARD WITH OTHER
REGULATORY VIEWS NEEDED TO BRING
WHAT IS READY AND HAVE DELAYS
AND TRYING TO OVERCOME AND MOST
OF OUR LACK OF FUNDING IS
SOMETHING WE ENCOUNTERED IN
MULTIPLE SITES IN LATIN AMERICA.
HOWEVER, A SUCCESSFUL
PARTNERSHIP MAY HELP OVERCOME
THE LACK OF FUNDING WE SEE IN
OUR SITES.
AND WITH POPULATION-RELATED
INDIVIDUAL RELATED
IMPLEMENTATION AND WE LOOK AT
LACK OF AWARENESS AND LACK OF
TRUST IN SCIENCE AND THESE WERE
ELEMENTS WE WERE ABLE TO
OVERCOME BY HAVING MEET IN THE
REGION AND TALKING WITH FAMILIES
ABOUT THEIR NEEDS AND SOME OF
OUR CONCERNS OF OUR TRIALS.
WITH THAT I'D LIKE TO STOP HERE
AND LEAVE A FEW TAKE-HOME
MESSAGES AND HIGH-INCOME
COUNTRIES HAVE PARTICIPATED IN
OVER 90% OF THE TRIALS AND WE
NEED TO IMPLEMENT MORE TRIALS IN
POPULATIONS WITHIN LOW-INCOME
COUNTRIES AND WE NEED
COLLABORATION BETWEEN HIGH AND
LOW-INCOME COUNTRIES IS
ESSENTIAL TO IMPLEMENTATION.
I JUST SHARED A FEW EXPERIENCES
WE HAD WE WERE ABLE TO IMPLEMENT
PLANS IN LATIN AMERICA AND THESE
IS FEASIBLE AND THERE'S OTHERS
LIKE THE ONGOING TRIAL THAT JUST
FINISHED AND THE OTHER TRIAL
STILL ONGOING.
AND WITH THAT I'LL STOP HERE AND
I'LL BE LOOKING FORWARD TO THE
QUESTIONS AT THE END OF THIS
SESSION.
ONCE AGAIN, THANK YOU FOR
JOINING US TODAY.
>>HI, THIS IS CLAUDIA BAMBS
FROM THE DEPARTMENT OF
DEPARTMENT HEALTH AND ADVANCED
CENTER FOR CHRONIC DISEASES.
I'M HERE TO TALK ABOUT PROMOTING
CESSATION OF SMOKING OF WOMEN IN
LATIN AMERICA AND I'LL SHARE
SOME RESULTS OF THE STUDY IN
PARALLEL.
MAYBE YOU HAVE HEARD THE
REPRODUCTIVE AGE OF THESE WOMEN
SMOKING IS HIGH AND SUPPORT FOR
SMOKING CESSATION SADLY IS A
TOBACCO CONTROLLED MEASURE WITH
THE LEAST PROGRESS IN OUR
COUNTRY.
ON THE OTHER HAND, MOBILE
PHONE-BASED INTERVENTIONS HAVE
PROVEN EFFECTIVE IN COUNTRIES
AND IN OUR POPULATION THERE'S A
MASSIVE USE OF MOBILE
TELEPHONES.
ALSO, THE EVIDENCE MOSTLY FROM
DEVELOPED COUNTRIES SHOWS
MOBILE-PHONE BASED INTERVENTIONS
ARE VERY EFFECTIVE FOR SMOKING
CESSATION.
HOWEVER, MOST STUDIES INCLUDED
IN REVIEWS AND SYSTEMATIC
REVIEWS AND META-ANALYSIS ARE
BASED ON TEXT-MESSAGE
INTERVENTIONS IN HIGH-INCOME
COUNTRIES.
.
THAT IS NOT THE CASE IN CHILE.
IN TERMS OF OUR CONTEXT, FOR
EXAMPLE, IN CHILE, FEWER AND
FEWER PEOPLE USE TEXT MESSAGES
AS A WAY OF DAILY COMMUNICATION.
THEREFORE THE GOAL OF THE STUDY
WAS TO EVALUATE THE
EFFECTIVENESS OF AN INTERVENTION
BASED ON THE DESIGN OF MOBILE
PHONE APPLICATION TO SUPPORT
SMOKING CESSATION IN CHILEAN
WOMEN.
APPS ARE VERY POPULAR AND WIDELY
USED AMONG OUR POPULATION.
WE DESIGN THE MOBILE APPLICATION
FOR ANDROID SYSTEM WORKING WITH
BOTH EXPERTS IN DESIGN OF THIS
KIND OF MOBILE APPLICATIONS ALSO
WE HAD A QUALITATIVE STAGE WITH
WOMEN SMOKERS FROM THE COMMUNITY
THAT WAS VERY INFORMATIVE FOR
THE DESIGN OF THE APPLICATION.
THEN, WE CONDUCTED A RANDOMIZED
CLINICAL TRIAL TO ASSESS THE
EFFECTIVENESS AND SAFETY OF THIS
APPLICATION.
THIS WAS A SINGLE BLIND STUDY
AND OUR GOAL WAS TO RECRUIT
WOMEN WHO WANT QUIT SMOKING.
THEY WERE FROM MIDDLE TO
LOW-INCOME DISTRICTS.
THIS STUDY WAS FUNDED BY THE
AGENCY FOR RESEARCH AND
DEVELOPMENT IN CHILE.
WE DESIGN FOLLOW-UP STRATEGY AT
FOUR WEEKS, THREE MONTHS AND SIX
MONTHS TO ELECTRONIC
QUESTIONNAIRES PARTICIPATING
WOMEN SELF-REPORTED SEVERAL
OUTCOMES ABOUT ABSTINENCE,
NUMBER OF QUICK ATTEMPTS, ALSO
THE NUMBER OF DAILY OR WEEKLY
CIGARETTES AMONG THOSE WOMEN WHO
DO NOT ACHIEVE COMPLETE
ABSTINENCE.
WE ALSO ASKED THE PARTICIPANTS
TO REPORT THE USE OF OTHER
TREATMENT OR CESSATION SERVICES
AS CO-INTERVENTIONS.
THEY ALSO REPORTED ANY ADVERSE
AFFECT SPECIFICALLY WE WERE
INTERESTED IN KNOWING IF OUR
PARTICIPANTS HAD BEEN INVOLVED
ANY TRAFFIC ACCIDENTS OR IF THEY
HAD ANY INJURIES OF THE HANDS
POTENTIALLY LINKED TO THE USE OR
FREQUENT USE OF THE TELEPHONE.
WHAT I WILL SHOW YOU NOW ARE THE
RESULTS OF THE FIRST STAGE OF
OUR STUDY WHICH WAS BASED IN
FOCUS GROUPS WITH WOMEN FROM 18
TO 44 YEARS OLD FROM THE COUNTY
OF PUENTE ALTO IN THE
METROPOLITAN REGION OF SANTIAGO.
THE FOCUS GROUP WOMEN SHARED
WITH US THEIR EXPECTATIONS AND
PREFERENCES REGARDING THE
CONTENT AND THE DESIGN OF A
POTENTIAL APPLICATION, MOBILE
APPLICATION TO SUPPORT QUITTING
SMOKING.
YOU MAY SEE IN THE LIST OF
CONTENTS WHAT THE WOMEN SAID.
THEY WANTED THE APP TO BE
PERSONALIZED.
SOMETHING CLOSE LIKE THE VOICE
OF THE CONSCIENCE THEY SAID.
THEY SAID WOMEN NEED SOMETHING
FAST AND THEY WANTED -- THE APP
MAY REPLACE SOME BORING TIMES
BECAUSE SAID WHEN IT'S NOT BUSY
OR SMOKING AND SAID KEEP IT
SIMPLE BUT ATTRACTIVE.
AND THE SAME AND CONTENT SHOULD
BE IN A STUDY AND THEY ALSO
REQUEST THAT WE HAD A PANIC
BUTTON.
SOMETHING THAT WOMEN COULD PRESS
AND WHEN THEY HAVE CRAVINGS OR
IF THEY HAD ALREADY HAD RELAXED
THE SMOKING.
THEY WANTED THE APP HAS A
PERSONAL GOAL AND THEY LOOK LIKE
A GAME.
YOU MAY FIND THE FULL TEXT
DESCRIPTION OF THIS QUALITATIVE
STAGE OF THE STUDY WHICH IS
ALREADY PUBLISHED.
I WANT TO SHOW YOU NOW SOME
IMAGES THAT REFLECT THE DESIGN,
THE NAME AND LOGO OF THE STUDY
AND THE DISSEMINATION STRATEGY
WE USED FOR THEIR RECRUITMENT.
PLEASE PAY ATTENTION TO THE
IMAGES LOOK AT THE AGE OF THE
WOMEN IN THE IMAGES AND THE
ACTIVITIES.
WE ADVERTISED THIS STUDY THROUGH
FOSTERS IN HEALTH CARE CENTERS
AND PUBLIC SPACES AND SUPER
MARKETS IN MALLS AND IN SOCIAL
NETWORKS.
WHEN WE HAD THE DESIGN OF THE
APP WE MADE IT AVAILABLE ON THE
GOOGLE PLAY STORE AND THE
PARTICIPANTS OF THE STUDY HAD AN
EXCLUSIVE ACCESS DURING THE
EXPERIMENTAL PHASE OF THE STUDY.
YOU MAY STATE HERE HOW THE APP
LOOKED BY THE WOMEN IN THE STAGE
OF THE STUDY INCLUDING THE PANIC
BUTTONS THEY WANTED US TO
INCLUDE.
ONE WAS LIKE A CRAVING BUTTON I
WANT TO SMOKE AND THE OTHER IS
WHEN THE WOMAN SAID I WENT BACK
TO SMOKING AND WHEN THEY AND THE
APP DISPLAYED A LIST OF
DIFFERENT MESSAGES TO INCREASE
MOTIVATION AND TO REMIND WOMEN
OF THE ORIGINAL GOALS THEY HAD
AND HOW TO DEAL WITH STRESS AND
SOME OTHER TECHNIQUES THAT
AREN'T WIDELY KNOWN IN SMOKING
CESSATION.
IN THIS PRESENTATION I HAVE
SHARED WITH YOU MOSTLY SOME
INFORMATION ABOUT THE
QUALITATIVE PART OF THE STUDY
WHICH IS ALREADY PUBLISHED.
THE RESULT OF THE CLINICAL TRIAL
ARE CURRENTLY BEING REVIEWED FOR
PUBLICATION BUT WE STILL MAY
HAVE SOME CONCLUSIONS.
WE MAY SAY THE DESIGN CONSIDERED
THE INITIAL QUALITATIVE STABLE
AND THERE'S AN APP WHO'S CONTENT
AND LANGUAGE ARE CULTURALLY
APPROPRIATE FOR THE TARGET
POPULATION.
WE BELIEVE AND WE HAVE POTENTIAL
USERS AND THE COMMUNITY AIMS TO
INCORPORATE THEIR VISION IN THE
DESIGN OF THE INTERVENTION.
AND THIS MAY CONTRIBUTE TO ITS
ACCEPTANCE AND THE APP IS AN
EFFECTIVE AND SAFE TOOL TO
SUPPORT THE SMOKING CESSATION IN
YOUNG WOMEN AND I CAN SHARE WITH
YOU THE CLINICAL TRIAL SHOWED
THAT PARTICIPANTS IN THE
INTERVENTION ARM ALMOST TRIPLED
THE CHANCE OF SMOKING ABSTINENCE
BOTH AT SIX WEEKS AND SIX MONTHS
FOLLOW-UP COMPARED TO THE
CONTROL PART OF THE STUDY.
WHILE THIS APP HAS ADVANTAGED
THAT ARE COMMON TO HEALTH
INTERVENTIONS BUT THIS IS
PARTICULARLY IMPORTANT FOR LATIN
AMERICA COUNTRIES AND LATINO
WOMEN AND THESE HEALTH
INTERVENTION USUALLY LOW COST
WITH A GREAT POTENTIAL FOR
SCALABILITY.
WOMEN WHO WANT TO QUIT SMOKING
HAVE A STRATEGY THAT WORKS
THROUGH THEIR MOBILE PHONES AND
TAKING THIS ASPECT INTO ACCOUNT
CAN BE VERY IMPORTANT FOR WOMEN
IN OUR TIMES.
AND THERE'S SMOKING CESSATION
AND WE HOPE THIS APPLICATION
CONTINUE TO IMPROVE HEALTH AMONG
LATINA WOMEN.
THANK YOU FOR YOUR ATTENTION AND
I'LL BE VERY HAPPY TO HAVE YOUR
QUESTIONS AND COMMENTS IN THE
PANEL.
>>HI, I'M CARMEN ZORRILLA AT
THE PUERTO RICO MEDICAL SCIENCES
CAMPUS AND THANK YOU FOR INV
INVITING US RELATING TO OUR
EXPERIENCES IN ENROLLING AND
RECRUITING AND RETAINING
SPECIFIC GROUPS FOR CLINICAL
TRIALS OR STUDIES.
I'LL SHARE SOME OF OUR
EXPERIENCES WITH DIVERSE STUDIES
THROUGHOUT THE TIME.
I WANT TO READ FIRST A QUOTE
FROM ONE OF MY FAVORITE AUTHORS
AND HE WROTE THE REWARD OF OUR
WORK IS NOT WHAT WE GET BUT WHAT
WE BECOME.
I'LL USE A TERM SUCH AS TARGET
POPULATION TO REFER TO GROUPS
WHERE WE OFFER PARTICIPATION AND
STUDIES BASED ON EXCLUSION
CRITERIA AND MAY BE PEOPLE OF A
CERTAIN AGE OR GEOGRAPHIC
LOCATIONS AND SOME RECEIVE
SERVICES LIKE FAMILY PLANNING,
PRENATAL CARE AND HIV CARE AND
DIABETES OR CANCER TREATMENT.
THIS IS NOT INTENDED TO BE
STIGMATIZING BUT IT'S ONE WAY TO
DEFINE THE POPULATIONS THAT WILL
BE ENROLLED OR ARE TARGET TO
PARTICIPATING IN THE STUDY.
AND TO STUDY SPECIFIC DISEASES
OR CONDITIONS SUCH AS THE ONES
MENTIONED WE'LL NEED DIVERSE
STRATEGIES DEPENDING ON THE AIMS
OF THE STUDY AND TYPES OF
POPULATION AN LOCATIONS AND
DURATION OF THE STUDY.
THERE'S LOCATIONS AND STORAGE
AREA AND INFRASTRUCTURE TO BE
ABLE TO ENROLL PATIENTS
RECEIVING SERVICES, DATA ACCESS
AND REGULATORY COMMUNITIES,
LABORATORY AND SAMPLE SHIPPING
AGREEMENTS AND SO ON.
SCREENING, DIAGNOSIS AND
MONITORING CAPABILITIES FOR THE
SPECIFIC CONDITIONS YOU WANT TO
STUDY IS IMPORTANT.
FOR DIABETES YOU NEED TO BE ABLE
TO HAVE SCREENING AND CAPACITY
IN PLACE AT THE CLINIC TO SCREEN
PARTICIPANTS AND FOLLOW NEM AND
THERE'S CONDITIONS THAT AND
SCREENING WAS COMPLICATED
SOMETIMES AND THAT WAS AN ISSUE
SOMETIMES WHEN WE WERE ENROLLING
PARTICIPANTS.
COMMUNITY INVOLVEMENT IS
ESSENTIAL INVESTIGATORS IS
IMPORTANT AND STRATEGIES ARE
NEEDED.
PLANNING AND LEARNING WITH THE
TARGET POPULATION DEPENDS ON THE
TYPE OF STUDY DISEASE, DURATION
OF INTERVENTION AND PERCEIVED
NEEDS OF THE COMMUNITY AMONG
OTHER ISSUES.
AND WE SEARCHED PASSION AND
ALLOW THE VOLUNTEERS TO ACCESS
SPECIFIC TESTS OR DIAGNOSIS AND
INTERACT WITH HEALTH CARE
PROFESSIONALS AND LEARN ABOUT
SPECIFIC CONDITIONS AND THEIR
PREVENTION, OBTAIN SERVICES,
RETAIN STRATEGIES AND DEVELOP A
SENSE OF COMMUNITY WITH OTHER
AFFECTS OR PARTICIPATING
INDIVIDUALS.
IN GENERAL, WE RECRUITERS NEED
TO BE SELECTED FROM THE SAME
TARGET POPULATION WHO HAVE
DIRECT KNOWLEDGE AND CAN CONNECT
WITH THEM.
I'M GOING TO MENTION SOME OF THE
SPECIFIC TARGET GROUPS WE HAVE
ENROLLED FOR STUDIES.
FOR EXAMPLE, AT HIGH RISK OR
DIFFICULT TO ACCESS POPULATIONS
WE'VE DONE HIV PREVENTION,
VACCINE PREPAREDNESS STUDIES AND
PARTNERED WITH COMMUNITY
ORGANIZATION THAT PROVIDE
SERVICES TO THE WORKER AND
CONTRACTED THEIR STAFF AS
RECRUITERS TO PROVIDE
TRANSPORTATION OR TO CARRY OUT
HOME VISITS.
WE THEN LOCATED WHERE A
PARTICIPANT AND WHAT TO DO IF
THEY WERE UNDER THE INFLUENCE
WHEN THEY CAME TO THE
APPOINTMENT OR WERE SUPPOSED TO
HAVE THE VISIT AND SAFETY
PRECAUTIONS AND WHAT TO DO WITH
MONETARY INCENTIVES AND ONE
EXAMPLE IS WE TELL EVERYBODY WE
DON'T HAVE CASH IN OUR CLINIC
AND WHENEVER WE NEED TO PAY
PEOPLE FOR VISITS, OUR STAFF
NEED TO GO TO THE CAMPUS
BUILDING TO GET THE MONEY.
PEOPLE DON'T UNDERSTAND THERE'S
NO MONEY AT THE CLINIC THEREFORE
TO REDUCE THE RISK OF INCIDENTS.
FOR PREVENTION STUDY OF TO TEST
AND TREAT FOR HIV WE ACQUIRED
TWO MOBILE UNITS TO COVER
DIVERSE GEOGRAPHIC AREAS AND
IMPLEMENT THE STUDY.
THE MOBILE UNITS WERE MANAGED BY
A CVO STAFF AND MOST THE STUDY
PROCEDURES INCLUDING SAMPLING
QUESTIONNAIRES AND STUDY VISITS
WERE CARRIED OUT USING THE
MOBILE UNITS.
THESE ARE EXAMPLES OF THE
PUBLICATIONS ADDRESSING THE
POPULATIONS AND I'M GOING
MENTION AN EXAMPLE ON THE
PARTICULAR STUDY ON RECRUITMENT
OF WORKERS IN THE CARIBBEAN.
IN THIS STUDY IT WAS HAITI,
JAMAICA AND PUERTO RICO
PARTICIPATED FOR THE VACCINE
TRIALS NETWORK.
SOME OF THE COUNTRIES TARGETED
WOMEN WHO WERE COMMERCIAL SEX
WORKERS BECAUSE OF THEIR
HIGH-RISK OF STREET SEX WORKERS
WE TARGETED WOMEN WHO WERE
STREET SEX WORKERS AND WE
PARTNERED WITH COMMUNITY-BASED
ORGANIZATION WHO WERE THE ONES
WHO WERE IN CONTACT WITH THEM
AND ACTUALLY GAVE THEM
TRANSPORTATION FOR THE STUDY
VISITS AT THE CLINIC.
ONE INTERESTING ISSUE THAT
EMERGED WAS THE PARTICIPANTS THE
CVO STAFF PROPOSED TOOLS WE
NEEDED TO HAVE LIKE A PHOTO I.D.
OF PARTICIPATION IN THE STUDY
AND FELT IT WAS A GREAT IDEA
BECAUSE WE WANTED A PHOTO THEIR
PARTICIPANT SO IT WOULD CHANGE
APPEARANCE AS THEY OFTEN DO
ESPECIALLY PEOPLE ON THE STREETS
WE WOULD BE ABLE TO IDENTIFY
THEM FOR STUDY VISITS.
AND IT SO HAPPENED THE
PARTICIPANTS ENROLLED IN THE
STUDY LOVED THE PHOTO I.D.
BECAUSE IT GAVE THEM SORT OF
LIKE INE IDEA SAYING I'M
PARTICIPATING IN THE HIV
PREVENTION STUDY THAT REQUIRES
ME TO BE HIV NEGATIVE SO THEY
WOULD SHOW THE I.D. TO THEIR
FRIENDS AND CLIENTS.
AND THIS WAS NOT A GOVERNMENT
ISSUE I.D. BUT THEY WERE HAPPY
TO HAVE THAT AND REUSED IT AS A
STRATEGY IN THAT STUDY.
PREGNANT POPULATIONS WE
CERTAINLY ENROLLED THEM IN THE
PRENATAL CARE CLINIC.
FOR EXAMPLE, WE HAD A
PROSPECTIVE STUDY IN PREGNANCY
AND WE ENROLLED WOMEN FROM THE
PRENATAL CLINIC IN OUR HOSPITAL
FOR ANOTHER STUDY SPONSORED BY
THE CDC ON ZIKA EXPOSED INFANTS
WE RECEIVED WOMEN DIAGNOSED BY
PROVIDERS AND THE SECOND STUDY
DIDN'T REQUIRE SPECIFIC
GESTATIONAL AGE FOR PARTICIPANTS
BUT THE FIRST STUDY NEEDED WOMEN
WHO WERE WITHIN THE FIRST OR
SECOND TRIMESTER.
WE NEEDED TO HAVE STAFF AT THE
CLINIC TO BE ABLE TO IDENTIFY
PARTICIPANTS ACCORDING TO THE
GESTATIONAL AGE AND OTHER
CRITERIA AND OFFER PARTICIPATION
AND COORDINATE THE APPOINTMENTS.
ANOTHER STUDY WE DID ON CARE
SAME THING WE NEEDED TO HAVE
STAFF AT THE CLINIC TO BE ABLE
TO OFFER THE PARTICIPATION TO
THE PATIENTS.
CLINIC STAFF IS USUALLY BUSY AND
UNINTERESTED IN RECRUITING
PARTICIPANTS THEREFORE THIS IS
WHY WE NEED TO HAVE STUDY STAFF
LOCATED AT THE CLINICS WHEN THEY
ARE WORKING SO WE ARE ABLE TO
ENROLL AND THIS IS A STRATEGY
HIGHLY SUCCESSFUL.
AND THESE ARE SOME PUBLICATIONS
OF THE STUDY.
ONE OF THE COGNITIVE ASSESSMENTS
ON THE INFANTS OF ZIKA-EXPOSED
INFANTS.
AND FROM THOSE POPULATIONS SOME
TIME AFTER THE STUDY AND WE HAD
HALF THE COHORT HAD DELIVERED BY
HURRICANE MARIA AND HALF WERE
STILL PREGNANT.
WE WESTBOUND ABLE TO DEVELOP
ANOTHER STUDY ON EXPERIENCES AND
WE USE THE SAME STRATEGIES TO
ENROLL AND TO MAINTAIN AND THEY
HAD THE OPPORTUNITY OF
PARTICIPATING INTO OTHER STUDIES
BECAUSE WE INCLUDED IN THE
CONSENT FORM SENTENCES THAT WE
COULD CONTACT THEM FOR
PARTICIPATION IN ADDITIONAL
STUDIES FOR THEM OR THE INFANLT
-- INFANTS AND THE ELIMINATION
OF PRE NATAL TRANSMISSION.
THIS IS WHERE WE STARTED
PRENATAL SCREENING YEARS BEFORE
THE CDC RECOMMEND ED HIV
SCREENING AND AFTER WE HAD A
LONGITUDINAL FOLLOW-UP OF THE
PREGNANT PERSONS AND WE HAD
ACCESS TO A POPULATION OF WOMEN
OF REPRODUCTIVE AGE OF WOMEN
LIVING WITH HIV.
WOMEN OF REPRODUCTIVE AGE NOT
PREGNANT ARE ALSO TARGETED FOR
SPECIFIC STUDIES SUCH AS DRUG
CLINICAL TRIALS.
ONE STUDY ON PREVALENCE OF HPV
AMONG WOMEN LIVING WITH HIV OR
OTHER PREVENTION TRIAL.
FOR THIS TRIAL WE OFFERED THE
PARTICIPATION AT A
FAMILY-PLANNING CLINIC.
WE HAD STAFF AT THE CLINIC WHO
CONNECTED WITH THE PATIENTS AND
ALL THE STUDY PROCEDURES WERE
CARRIED OUT AT THE CLINIC.
SOME OF THE PUBLICATIONS OF THE
STUDIES OF NON-PREGNANT WOMEN
CLINICAL TRIALS, HPV PREVALENCE
AND DRUG INTERACTIONS.
FINALLY I WANT TO MENTION OUR
EXPERIENCE WITH ENROLLING
GENERAL POPULATION OF WOMEN FROM
21 TO PLUS FOR A VACCINE STUDY A
COVID VACCINE STUDY.
AT THIS TIME THIS WAS AN NOVAVAC
STUDY.
AT THE TIME VACCINES WERE NOT
AVAILABLE FOR THE GENERAL PUBLIC
AND PEOPLE WERE REALLY WILLING
TO PARTICIPATE IN A TRIAL IN
ORDER TO GET THE VACCINE OR
POTENTIAL USEFUL VACCINE.
THE STUDY HAD A 2:1 RATIO
VACCINE TO PLACEBO AND WITHIN
SIX MONTHS ALL PARTICIPANTS
WOULD HAVE RECEIVED THE VACCINE
AND THIS WAS ATTRACTIVE IN THIS
STUDY.
WE ENROLLED PEOPLE FROM ALL
WALKS OF LIFE FROM PEOPLE WHO
HAD BEEN HOMELESS TO
MILLIONAIRES AND DURING THE
SCREENING PHASE AND EVALUATIONS
FOR PREEXISTING CONDITIONS WE
DIAGNOSED A LOT OF PEOPLE WITH
HYPERTENSION AND DIABETES AND WE
HAD TO REFER THEM FOR MANAGEMENT
SO THIS WAS SOMETHING THAT THEY
GAINED FROM THE SCREENING WAS TO
BE ABLE TO HAVE A CONDITION THAT
WAS UNSUSPECTED, DIAGNOSED AND
MANAGED.
IT WAS A GREAT EXPERIENCE FOR
STAFF AND FOR ME BECAUSE THIS IS
AN UNUSUAL GROUP OF PEOPLE FROM
ALL WALKS OF LIFE.
WE HAD AND LAWYERS AND WE HAD
PEOPLE WHO WERE REQUIRED AND
THEY WERE ALL REALLY VERY
WILLING TO PARTICIPATE IN THE
TRIAL AND WE STILL GET CALLED
WHEN THEY GET SYMPTOMS OF COVID
AND WE FELT WE NEEDED TO MANAGE
THEM WITH PRESCRIPTIONS AND
WHATEVER THEY NEEDED AND THOUGH
THE STUDY ENDED WE'RE STILL
EVALUATING LONG-TERM OUTCOMES
AND POTENTIAL COVID-19
INVECTIONS FOR THE GROUP OF
PARTICIPANTS.
WE'RE NOW IMPLEMENT STUDY OF
INJECTABLE PREVENTION DRUG FOR
LGBTQI PLUS POPULATIONS AND WE
CREATED AN ADVISORY BOARD OF
PEOPLE WHO HAVE A SIGNIFICANT
SOCIAL MEDIA AND REPRESENT THE
COMMUNITY INCLUDING TRANS
PERSONS AND OTHER SELF-REPORTED
PEOPLE AND THEY'RE WILLING TO
DISSEMINATE THEIR ADS IN THEIR
OWN SOCIAL MEDIA.
THIS IS GOING TO BE OUR STRATEGY
FOR ENROLLMENT.
FOR ANOTHER MICROBIALCYTE
STUDIES WE HAD A YOUNG MAN FROM
THE COMMUNITY AND HE WAS
INVOLVED IN SOCIAL MEDIA AND
COMMUNITY INTERVENTIONS
INCLUDING VISITING BARS AND
OTHER MEETING PLACES AND EVENTS.
FINAL THOUGHTS, INVESTIGATORS
NEED TO BE HIGHLY MOTIVATED.
RESOURCES NEED TO BE AVAILABLE
AND RETENTION STRATEGIES CAN
INCLUDE LABORATORIES, MONETARY
INCENTIVES, GASOLINE OR FOOD
CARDS.
STAFF NEEDS TO BE FRIENDLY AND
SENSITIVE ABOUT THE NEEDS OF THE
POPULATION AND CONSTANT
COMMUNICATION IS ESSENTIAL TO
MAKE THEM FEEL THE STUDY BELONGS
TO THEM AND IS AN IMPORTANT
CONTRIBUTION FROM THE COMMUNITY
TO SCIENCE AND TO THE REST OF
THE COMMUNITY.
I'D LIKE TO CHOOSE STUDIES AND
PROJECTS I THINK WILL IMPACT
PEOPLE EVEN IF ONLY ONE AT A
TIME.
AND FINALLY I'LL READ A QUOTE
FROM MY FAVORITE AUTHOR AN HE
WROTE BEFORE MAKING AN IMPORTANT
DECISION LIKE DECLARING A WAR OR
MOVING TO OTHER PLANES OAR WHERE
TO PLANT A WARRIOR ASKS HOW WILL
THIS AFFECT MY DESCENDENTS.
THE WARRIOR KNOWS THAT EVERY
ACTION HAS A LONG-TERM
CONSEQUENCES AND NEEDS TO
UNDERSTAND WHAT KIND OF WORLD HE
IS LEAVING FOR THAT FIFTH
GENERATION.
THANK YOU VERY MUCH.
>>GOOD AFTERNOON.
THANK YOU FOR THE IN THE
INVITATION TO PARTICIPATE.
SO IMPORTANT FOR OUR REGION.
TODAY WE'LL TALK ABOUT THE ROLE
OF IMPLEMENTATION SCIENCE TO
ADVANCE THE IMPACT OF RESEARCH
IN PUBLIC HEALTH.
LET ME START BY REFLECTING ON
THE KNOWLEDGE THAT WE ALREADY
HAVE IN HEALTH SCIENCE.
THERE ARE MANY INTERVENTIONS,
TREATMENTS, STRATEGIES THAT HAVE
BEEN PROVEN EFFECTIVE IN
CONTROLLED RESEARCH SETTINGS.
THE PROBLEM IS THAT THOSE PROVEN
EFFECTIVE, EVIDENCE-BASED
INTERVENTIONS ARE NOT
IMPLEMENTED IN HEALTH CARE
SERVICES AND IT TAKES A LONG
TIME TO REACH EFFECTIVE
IMPLEMENTATION.
SO THERE IS A GAP BETWEEN WHAT
WE KNOW AND WHAT WE DO IN
PRACTICE.
THE AIM OF THE IMPLEMENTATION
RESEARCH IS TO BRIDGE THIS GAP.
TO CONTRIBUTE TO REDUCE THIS
GAP.
WE CAN DEFINE IMPLEMENTATION
SCIENCE AS THE STUDY OF METHODS
TO PROMOTE THE UPTAKE AND
INTEGRATION OF EVIDENCE-BASED
PRACTICES, INTERVENTIONS AND
POLICIES IN ROUTINE HEALTH CARE
AND PUBLIC HEALTH SETTINGS TO
IMPROVE THE IMPACT OF POPULATION
HEALTH.
AND AN IMPORTANT CONCEPT HERE IS
THAT IN IMPLEMENTATION SCIENCE
WE WORK IN COMPLEXITY.
THE PROJECTS TAKE PLACE ALWAYS
IN COMPLEX REALITIES.
FIRST, WE DEAL WITH COMPLEX
PROBLEMS WITH MULTIPLE CAUSES,
FEEDBACK LOOPS, MEDIATORS,
MODERATORS, FACTORS WE CANNOT
MEASURE OR WE DID NOT KNOW ABOUT
AND WE DESIGN COMPLEX
INTERVENTIONS AND ADDRESSING
DIFFERENT BARRIERS AND ASPECTS
OF THE PROBLEM.
WORKING AT DIFFERENT LEVELS, THE
SYSTEM LEVEL, THE PROVIDE LEVEL
AND PATIENT LEVEL AND COMMUNITY
AND WE USUALLY APPROACH
DIFFERENT BEHAVIORS.
THE CONTEXT IS ALSO COMPLEX
DYNAMIC AND MULTI-DIMENSIONAL.
THERE'S BARRIERS AND
FACILITATORS WE NEED TO
IDENTIFY.
THE PROCESS OF IMPLEMENTATION IS
COMPLEX AND INCLUDES MULTIPLE
STRATEGIES AND MANY ACT ORS,
IMPLEMENTERS, DECISION MAKERS,
CIVIL SOCIETY, STAKEHOLDERS WITH
DIFFERENT LEVELS OF POWER,
INFLUENCE AND INTEREST.
FINALLY, POPULATIONS ARE
COMPLEX.
DIFFERENT GROUPS AND SUB GROUPS
WITH DIFFERENT CHARACTERISTICS,
RESOURCES AND NEEDS.
LET ME BRIEFLY TELL YOU ABOUT AN
IMPLEMENTATION SCIENCE STUDY TO
TEST A COMPREHENSIVE
INTERVENTION TO IMPROVE
HYPERTENSION CONTROL IN
VULNERABLE POPULATION IN THE
PRIMARY CARE SETTING IN FIVE
PROVINCES IN ARGENTINA.
WE CONDUCTED A NEEDS ASSESSMENT
TO UNDERSTAND THE LOCAL NEEDS
AND PRIORITIES AND BARRIERS,
FACILITATORS FOR HYPERTENSION
MANAGEMENT AT THE PRIMARY CARE
LEVEL IN THE PROVINCES FROM
DIFFERENT PERSPECTIVES, FOR
EXAMPLE, HEALTH CARE PROVIDERS,
PATIENTS AND THEIR FAMILIES.
WITH ALSO CONDUCTED STAKE
HEADLHOLDER
MAPPING AND LOOKED AT THE
DESIGN, CO-CREATION AND
IMPLEMENTATION OF THE
INTERVENTION.
WE USED PARTICIPATORY RESEARCH
METHODS WITH THE COMMUNITY AS
WELL AND THIS IN A SHELL ARE THE
FINAL COMPONENTS OF THE
INTERVENTION.
WE HAVE THREE COMPONENTS.
THE FIRST WAS LED BY COMMUNITY
HEALTH WORKERS WHO VISITED MO
MONTHLY OR BIMONTHLY THE HOMES
AND PROVIDED PATIENTS WITH
TRAINING TO SELF-MONITOR THEIR
BLOOD PRESSURE AND GAVE
COUNSELLING ON HEALTHY HABITS
AND ADHERENCE TO MEDICATION.
THE SECOND COMPONENT WAS A
DIGITAL COMPONENT, PATIENTS
RECEIVED WEEKLY TEXT MESSAGES
FOCUSSED ON HEALTHY HABITS AND
HYPERTENSION TREATMENT
ADHERENCE.
THE THIRD COMPONENT WAS CAPACITY
BUILDING CONSISTENT WITH
TRAINING THE PRIMARY CARE TEAM
AND DOCTORS AND NURSES AND
COMMUNITY HEALTH WORKERS IN THE
USE OF HYPERTENSION GUIDELINES
AND MEETING AT THE PRIMARY CARE
CENTER TO DISCUSS CASES AND
RECEIVE FEEDBACK.
THE PRIMARY OUTCOMES WERE
CHANGES IN SYSTOLIC AND
DIASTOLIC BLOOD PRESSURE AND
HYPERTENSION CONTROL.
THESE ARE THE MAIN RESULTS.
A SUMMARY OF THE MAIN RESULTS OF
THE STUDY.
THIS IS THE EFFECT OF THE
INTERVENTION ON SYSTOLIC BLOOD
PRESSURE.
WE CAN SEE SYSTOLIC BLOOD
PRESSURE WAS REDUCED IN THE
INTERVENTION GROUP COMPARED TO
THE CONTROL GROUP AT 6, 12 AND
18 MONTHS.
THE SAME HAPPENED WITH 6, 12 AND
18 MONTHS IN DIASTOLIC AND WE
FOUND AN IMPROVEMENT IN THE
PROPORTION OF PATIENTS WITH
BLOODS PRESSURE CONTROL AND
IMPROVED AT 6, 12 AND 18 MONTHS
OF FOLLOW-UP.
WHAT HAPPENED TO ADHERENCE TO
MEDICATION IT IMPROVED IN THE
INTERVENTION GROUP COMPARED TO
THE CONTROL GROUP AND THE SAME
HAPPENED WITH TREATMENT AND
ATTACHMENT BY THE PRIMARY CARE
TEAM.
WELL, NOW THE QUESTION IS WHAT
HAPPENED NEXT?
FIRST, THIS IS ONE OF THE
PROVINCES WHERE THE STUDY WAS
CONDUCTED.
AS PART OF THE STUDY, WE
IMPLEMENTED THE INTERVENTION IN
THREE DISTRICTS IN THIS
PROVINCE.
BASED ON THE RESULT OF THE
STUDY, THE PROVINCIAL SECRETARY
OF HEALTH DECIDED TO EXPAND
PROGRESSIVELY THE INTERVENTION
TO OTHER DISTRICTS IN THE
PROVINCE.
AT THE SAME TIME, WE WERE
WORKING WITH THE NATIONAL
MINISTRY OF HEALTH TO
INCORPORATE OUR FINDINGS TO THE
NATIONAL HYPERTENSION PROGRAM
WHICH WAS BEING DEVELOPED AT
THAT VERY MOMENT.
AND SOMETHING HAPPENED.
ARGENTINA WAS INVITED TO
PARTICIPATE IN THE INITIATIVE
FOR THE AMERICAS.
FOR THOSE WHO MAY NOT BE
FAMILIAR WITH THIS INITIATIVE
HERTS HAS A FOCUS ON ME CONTROL
OF HYPERTENSION.
AND IT'S BASED ON SIX PILLARS
WHICH ARE STANDARDIZED TREATMENT
AND SIMPLIFIED PROTOCOLS, BLOOD
PRESSURE MEASUREMENTS WITH
VALIDATED DEVICES, CAPACITY
BUILDING AND TRAINING FOR THE
PRIMARY CARE TEAM, DATA
STANDARDIZATION AND USE OF
OUTCOME AND PROCESS INDICATORS,
IMPLEMENTATION RESEARCH AND
PROGRAM EVALUATION AND
TEAM-BASED AVERAGE.
WE STRONGLY SUPPORT AND ADVOCATE
FOR THESE RELEVANT INITIATIVES
IN THE REGION AND ALL THE
EXPERIENCE AND LESSONS LEARNED
AND MATERIALS DEVELOPED IN OUR
STUDY WERE SHARED AND USED TO
HELP THE PROCESS OF ADAPTATION
AND IMPLEMENTATION OF THE HEARTS
INITIATIVE IN OUR COUNTRY.
FINALLY, LET ME SHARE
REFLECTIONS AND LESSONS LEARNED.
FIRST, I'D LIKE TO SAY THAT
IMPLEMENTATION SCIENCE IS KEY TO
ADVANCE RESEARCH AND MORE
IMPORTANT TRANSLATION OF
RESEARCH FINDINGS INTO HEALTH
CARE SERVICES AND POLICIES IN
OUR REGION.
INTERVENTION STRATEGIES AND
PRACTICES HAVE TO BE ADOPTED TO
THE LOCAL CONTEXT TO PROMOTE
ADOPTION AND ACCEPTABILITY.
STAKEHOLDER ENGAGEMENT AND
INVOLVEMENT FROM THE VERY
BEGINNING AND THROUGHOUT THE
DESIGN AND IMPLEMENTATION
PROCESS IS KEY FOR
SUSTAINABILITY AND MONITORING
HELP US DECIDE USEFUL ADAPT
ADAPTATIONS.
STRONG LEADERSHIP AND GOVERNANCE
AND OWNERSHIP ARE INSTRUMENTAL
FOR SCALING UP AND THE IMPORTANT
WE NEED TO BE OPEN TO EMERGING
OPPORTUNITIES, SYNERGIES AND
PROACTIVE COLLABORATIONS TO BE
ABLE TO CONTRIBUTE TO BRIDGE TO
REDUCE THE GAP.
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
>>GOOD AFTERNOON, EVERYONE.
AND THANK YOU TO ALL THE
SPEAKERS FOR ALL THOSE VERY
COMPREHENSIVE PRESENTATIONS AND
THE INFORMATION THEY HAVE
PROVIDED TO US.
AND WE HAVE DR. BAMBS,
DR. ZORRILLA AND DR. IRAZOLA AND
THE Q&A WILL END AT 3:50.
WE HAVE A BREAK.
SO IT'S 3:10 AND THANK YOU.
THE FIRST QUESTION IS FOR DR
DR. GAGLIARDINO.
WHAT ARE THE RESULTS BEYOND A
YEAR AND CAN THEY BE SUSTAINED
AND DO YOU INTEGRATE CARE FOR
OTH
OTHERS IN THIS MODEL.
THANK YOU.
>>WE'RE COLLECTING THE DATA AND
PERSEVERING WITH THIS STUDY WE
PERFORM WE'RE SEEING RESULTS AT
THE MOMENT WE'RE PRODUCED THESE
THINGS IN THE COUNTRY AND WE
CONTROL WHAT'S GOING ON IN
ADDITION IN 14 PROVINCES THAT IS
MORE OR LESS CONTROL AND WE
DON'T HAVE AND WE HAVE RESEARCH
AND HOPEFULLY WE'RE GOING
PRODUCE AND TO CHANGE THE
QUALITY OF CARE PROVIDED TO
PEOPLE WITH DIABETES IS THE MAIN
ISSUE WE ARE DEALING WITH.
OF COURSE DIABETES HAVE THE MOST
COMMON AND SO FAR WE GET PEOPLE
AT THE PRIMARY CARE LEVEL
BECAUSE AS USUAL WE BELIEVE MOST
OF PATIENTS ARE AT THE LEVEL AND
A MINIMAL AMOUNT GOES TO THE
SPECIALIST.
AGAIN, WE'RE WORKING WITH BOTH
SYSTEMS THE PRIMARY CARE LEVEL
AND THE SPECIALIST BECAUSE SOME
CANNOT WORK ON THE PRIMARY CARE
THEY HAVE TO GO TO THE
SPECIALIST AND IT'S A MOMENT TO
BE SURE EVERYBODY RECEIVE THE
QUALITY OF CARE THEY NEEDED.
>>THANK YOU.
WHAT ARE KEY FACTORS THAT
EXPLAIN THE SUCCESS OF THE
NETWORK WITH LATIN AMERICA.
YOU HAVE THE NETWORKS OF TRIAL
UNITS AND THEN EXPAND IT INTO
LATIN AMERICA.
WHAT ARE THE KEY FACTORS THAT
ASSURE THE SUCCESS AND WHAT ARE
THE IMPLICATIONS OF THE STUDY
FINDINGS.
ARE THE INTERVENTIONS PLANNED
AND ARE THEY INTEGRATED INTO
CLINICAL CARE.
>>LOTS OF QUESTIONS.
NUMBER ONE, I THINK IN TERMS OF
SUCCESS I WOULD SAY HAVING A
STUDY TEAM IN LATIN AMERICA AND
I THINK WE HAVE THE HUMAN
CAPITAL TO BRING THIS TO LATIN
AMERICA IN MANY SENSE.
I THINK THAT'S ONE.
THE SECOND IS TO A CONVERSATION
WITH THE P.I.s AND STUDY TEAMS
ON WHAT WAS NEEDED BEYOND THE
TRIAL.
WHAT DO WE NEED TO GET READY FOR
THE TRIAL AND THERE WERE THINGS
IN THE POPULATIONS AND ALSO WITH
RESOURCES NEEDED AND TRYING TO
BUILD THE RESOURCE LOCALLY WAS
ALSO KEY AND HAVING FUNDERS THAT
UNDERSTAND THE RELEVANCE OF
GLOBAL HEALTH AND HAVING THOSE
PARTNERSHIPS.
I THINK THOSE WILL BE THE THREE
MAIN KEY ELEMENTS AND WILL BE A
DIFFERENCE I THINK NOW IN TERMS
OF HOW TO INTEGRATE THE
LEARNINGS, NUMBER ONE I THINK WE
HAVE NOW REALLY COMPREHENSIVE
GENETIC TESTING AND COUNSELLING
FOR FAMILIAL ALZHEIMER'S DISEASE
AND THAT CAN GO TO DISEASES WITH
A GENETIC COMPONENT AND THIS IS
EXTREMELY RELEVANT BECAUSE WE
CAN ASSUME HOW WE DO IT WILL BE
THE SAME AND THEY'RE DIFFERENT
IN TERMS OF EDUCATIONAL LEVEL
AND THERE'S A STIGMA AROUND
GENETIC DISEASES AND WE WE HOPE
THAT NOW THE PROGRAM WILL BE
APPLIED TO OR INTEGRATED IN
CLINICAL CARE.
THAT'S OUR HOPE AND THING NOW
WE'RE GOING AND STARTING IN
CLINICAL TRIALS TWO OF OUR SITES
ARE READY TO IMPLEMENT.
I THINK WE'RE DOING GOOD IN
TERMS OF INTERVENTION WE PLAN.
>>THANK YOU.
WHAT MADE YOUR INTERVENTION
SUCCESSFUL AND I HAVE A SECOND
QUESTION, DO YOU THINK THE APP
COULD BE APPLIED TO OTHER
CHRONIC CONDITIONS?
DO YOU SEE IT BEING USED FOR
OTHER CONDITIONS OR WE WANT TO
HEAR YOUR THOUGHTS ON THAT.
>>I THINK ONE KEY FACTORS THAT
MADE THIS APP SUCCESSFUL WAS THE
EARLY INVOLVEMENT OF POTENTIAL
PARTICIPANTS IN THE DESIGN OF
THE APPLICATION ITSELF.
THE FINAL APP WAS SOMETHING THAT
CHILEAN WOMEN REALLY LIKED AND
EVEN TRYING TO KEEM IT SIMPLE WE
TRIED TO INCORPORATE MOST THE
SUGGESTIONS AND ALL THE
MATERIALS AND PROCESS OF THE
DESIGN WE CONDUCTED IS AVAILABLE
AND COULD BE USED AS A TEMPLATE
TO PERHAPS DESIGN INTERVENTIONS
FOR OTHER POPULATIONS.
FOR INSTANCE, THERE'S A GAP IN
TERMS OF INTERVENTIONS FOR
PREGNANT WOMEN STUDY DID NOT
COVER PREGNANT WOMEN AND
ADOLESCENTS AND WE HAD AN
INTEREST IN YOUNG WOMEN AND
LIMITED RESEARCH WE LAD TO
CHOOSE AND OUR GOAL IS TO HAVE
THESE MATERIALS AND THE LESSONS
LEARNED AVAILABLE FOR OTHER
RESEARCHERS.
>>THANK YOU.
FOR DR. ZORRILLA.
YOU REACH OUT TO PARTICIPANTS
WERE AND THE STRATEGIES WERE
BUILT UP AROUND WHERE WE CAN
FIND THEM AND CONNECT WITH THEM.
AT THE SAME TIME, WHAT IS THE
ROLE OF THE RECRUITERS IN BRAIN
STORMING ABOUT THIS AND
IMPLEMENTING THE RECRUITMENT AND
THE IMPRESSION OR THE ATTITUDES
OR EVEN CONCERNS OF PARTICIPANTS
AND MOTIVATION TO PARTICIPATE.
YOU MENTIONED A FEW THINGS.
WE WANT TO KNOW A LITTLE BIT
DEEPER ABOUT SPECIFICALLY THE
VACCINE TRIALS AND WHAT
MOTIVATED THE PARTICIPANTS TO
PARTICIPATE AND HOW THEY BECAME
ENGAGED AND THE ROLE OF THE
RECRUITERS.
>>SHUSH.
-- SURE.
FOR SPECIFIC TRIALS WE
APPROACHED COMMUNITY
ORGANIZATIONS THAT WORK WITH
SPECIFIC GROUPS, FOR EXAMPLE,
STREET SEX WORKERS WHICH ARE
REALLY DIFFICULT TO ENROLL.
ALSO WE HAVE TO WORK WITHIN THE
LEGAL CONSIDERATIONS AND WE CAN
NO LONGER HAVE FOOD VOUCHERS
BECAUSE THERE'S LAWS IN PUERTO
RICO THAT DON'T ALLOW YOU TO DO
THAT.
WITHIN THE CONSTRAINTS OF THE WE
HAD FOR THE VACCINE TRIAL THERE
WERE LOTS -- I'VE NEVER SEEN A
STUDY WHERE PEOPLE WERE SO MUCH
INTERESTED BECAUSE I THINK IT
WAS BECAUSE THERE WAS A NEED AND
THEY WANT THE VACCINE AS SOON AS
POSSIBLE AND WE LAD -- HAD TO
DEAL WITH VOLUMES OF PEOPLE
PARTICIPATING.
ONE PERSON HAD ACCESS TO PRIVATE
PLANES WE TOLD THEM WE CANNOT
ENROLL YOU BECAUSE IF YOU'RE
SICK AND SOME PLACE ELSE, WE
NEED TO EXAMINE YOU AND MAKE
SURE YOU HAVE BLOOD DRAW TO MAKE
SURE IT'S COVID OR NOT.
THEY SAID, DON'T WORRY, I HAVE A
PRIVATE PLANE AND I CAN GET
WHEREVER OR HAVE YOUR STAFF COME
TO WHERE I AM.
THAT WAS SURPRISING TO ME WE DID
NOT ENROLL THIS PARTICIPANT IN
PARTICULAR BUT IT TOLD ME A LOT
ABOUT THE PEOPLE INTERESTED IN
PARTICIPATING IN THE VACCINE
TRIAL AND OTHER THAN HAVING THE
PRODUCT EARLY ON, THERE WAS
THERE IS THE ALTRUISM.
A RETIRED POLICEMAN IN HIS 7
70s -- DECIDED HE WANTED TO BE
PART OF THE STUDY AND BY TO THE
TIME THERE WERE VACCINES FOR
PEOPLE 65 HE WANTED TO FINISH
WHAT HE STARTED.
THAT TO ME WAS INCREDIBLE IN
TERMS OF THE CONNECTION OF
VOLUNTEERS WITH STUDY STAFF.
>>VERY INSIGHTFUL.
DR
>>DR. IRAZOLA WHAT HAPPENED TO
THE STUDY?
IF YOUR STUDY WAS GOING TO BE
SCALED UP, WHAT HAVE YOU HAVE
DONE?
>>THE FIRST REFLECTION ON THAT
IS THAT AS YOU SAID ARE THE
LESSONS LEARNED TRAINING
MATERIALS FOR PARTICIPANTS AND
WHAT USED TO FIT IN OUR COUNTRY
AND AS RESEARCHERS, WE ARE SO
HAPPY ABOUT THAT BECAUSE WE FELT
OUR PROJECT HAD THE OPPORTUNITY
TO MERGE WITH SOMETHING BIGGER
WHICH IS THE HEART INITIATIVE.
IN TERMS AND NOW WHAT IS
HAPPENING WITH THE HEART
INITIATIVE IN OUR COUNTRY, WE
ARE JUST RECOVERING RECOVERING
AFTER THE PANDEMIC SO THAT'S A
CHALLENGE THAT WE ARE DEALING
WITH AT THE MOMENT AND ALSO
WE'RE WORK ON AN EVALUATION PLAN
WITH KEY IMPLEMENTATION OUTCOMES
WITH QUALITY OF CARE OUTCOMES I
THINK THE HEART INITIATIVE IS
THE BEST WE COULD IMAGINE,
REALLY.
>>THANK YOU.
DR. GAGLIARDINO HOW WILL THE
COORDINATION OF CARE AND THE
FOLLOW-UP YOU HAVE PRESENTED AND
IS PERFORMED, WHAT WOULD BE
REALISTIC STRATEGY TO IMPLEMENT
A PROGRAM LIKE THAT WITH FEWER
RESOURCES?
>>
>>THIS WAS SUPPORTED BY THE
FOUNDATION AND THEY SAID, DO IT
IN A PLACE THAT YOU HAVE HIGH
DEFICIENCIES BECAUSE IF YOU CAN
DO IT LATER, LATER ON YOU WON'T
HAVE ANY PROBLEM IN DIFFICULT
AREAS AND WE DID IT.
WHERE WE IMPLEMENTED THE STUDY
WAS THE HIGHEST POPULATION PER
SQUARE KILOMETER AND POVERTY OF
THE LARGEST PERCENTAGE AND IN
ADDITION THE HIGHEST MORTALITY
MEANING WE THINK IT'S A
POPULATION STUDY THAT CAN BE
DONE WITHOUT MANY DIFFICULTIES.
THE MAIN THING IS THE EDUCATION.
THAT'S THE TOOL.
NOT JUST ANY TOOL BUT WE HAVE IT
THROUGH THE UNIVERSITY STUDIES
AND EVALUATION OF THE OUTREACH
AND SCALE AND WE HAVE AN
EVALUATION FROM THE CLINICAL AND
METABOLIC POINT OF VIEW AND IT'S
AN INTEGRATED PROGRAM AND IT'S
HARD TO I MPLEMENT AND YOU NEED
TO MOTIVATE THE PEOPLE YOU HAVE
TO DECIDE TO BE EVALUATED AND
THEN HAVE RECORD OF THE DATA
OTHERWISE YOU NEVER COME THROUGH
WHAT HAPPENED.
THIS IS ONE OF THE
RECOMMENDATION.
EDUCATION, EVALUATION AND IMPACT
OF THE PROVISION OF THE
INFORMATION.
THAT'S MY SUGGESTION.
>>THANK YOU.
THERE'S SOME ECHO.
YOU MENTIONED THE RECRUITMENT OF
COUNTRIES WITH COHORTS AND WHAT
ARE THE MAIN SOLUTIONS FOR
IMPLEMENTING TRIALS THOSE
REQUIRING GENETIC TESTING?
CAN YOU MENTION IF ANY ARE
RELATED TO CAPACITY BUILDING,
TRAINING OR THE INFRASTRUCTURE
AND AGAIN WHAT ARE THE POTENTIAL
SOLUTIONS FOR HOW WOULD YOU --
WORK THROUGH THOSE IMPLEMENT
STUDY LIKE THIS.
>>IT'S NOT ONE BUT A
COMBINATION OF GETTING LOCAL
RESOURCES AND TRAINING TO USE
THOSE RESOURCES.
ONE EXPERIENCE WE'RE GETTING IN
THE REGION WE COULD CONCENTRATE
RESOURCES TO SUPPORT THE REST OF
THE NETWORK AND IDEALLY IT'S A
DYNAMIC PROCESS AND IT WILL
SUPPORT THE NETWORK AND ONCE
HAVE YOU THE SIDE FUNCTIONING
YOU GET TO WHERE THE RESOURCES
ARE NEEDED AND WE START
EXPLORING SITES TO GET NEW SITES
READY AND THE OTHER THING THAT
IS POSITIVE IS THOUGH OUR TRIALS
ARE MAINLY FOCUSSED ON
ALZHEIMER'S DISEASE A GENETIC
FORM OF ALZHEIMER'S DISEASE YOU
CAN BRING THE TRIALS TO YOUR
SIDE.
I THINK THAT'S HOW WE DEFINE
MOST OF OUR SITES AND NOW MOVE
TO NEW SITES IN THE REGION.
AND NOT SEEING WE HAVE TO HAVE
THE SAME SAFETY STANDARD AND
HAVE DIFFERENT COMMITTEES AND
ALL THE COMMITTEES ARE THE SAME
AND HAVE TO GET THROUGH THE
COMMITTEE SO WHY NOT JUST ONE
THAT'S THE TYPE OF SYSTEM
SOMETIMES NOT EFFICIENT ENOUGH
AND NEED TO WORK IN PARTNERSHIP
AND THE OTHER IS FUNDING.
THERE'S A LIMITATION.
>>I HAVE A QUESTION ABOUT THE
APP AND THE USE OF DIGITAL
TECHNOLOGY HELPING INFORMATION
TECHNOLOGY.
HOW DO YOU SEE APPS LIKE THE ONE
BUILT FOR THE INTERVENTION IN
YOUR STUDY OR ANY OTHER APP
ADVANCING OR BEING MORE COMMON
AND INTEGRATED INTO CLINICAL
CARE.
WHAT WOULD IT TAKE AND IS IT
POSITIVE WOULD THERE BE USEFUL?
PLEASE COMMENT.
>>THANK YOU FOR THE QUESTION.
I THINK THERE ARE MANY APPS OUT
THERE BUT THE PROBLEM WITH THE
APP IS WE NEED AN EVALUATION AND
IN THIS CASE WE ARE ABLE TO
DEMONSTRATE IT IS SAFE AND
EFFECTIVE.
LIKE STEP ONE, NOW WE NEED TO
MOVE TO INTERVENTION AND MAKE IT
AVAILABLE TO THE
COMMUNICATION COMMUNITY AND WITH
MOBILE APPS IN GENERAL I WOULD
SAY THAT'S THE PROBLEM.
NOT ALL THE APPS ARE EFFECTIVE
AND WE NEED TO BE CAREFUL AT
WHAT MATERIALS AND INFORMATION
WE DISCUSS WITH OUR PATIENTS BUT
WHEN WE HAVE TOOLS THAT ARE
EFFECTIVE I THINK WE CAN DISCUSS
THEM AND ICE THEM AAS -- AS A
TOOL IN CLINICAL SETTING BUT
DOING THAT TAKES WORK AND
RESOURCES AND THE IMPLEMENTATION
IS NOT EASY AT ALL.
WE'RE HAPPY TO SHARE THAT WITH
THE COLLEAGUES HERE AND OTHER
COUNTRIES.
>>THANK YOU.
I'M GOING MOVE INTO TWO QUESTION
FOR EVERY ONE OF YOU TO ANSWER.
ONE, WHAT ARE THE KEY LESSONS
LEARNED YOU WOULD LIKE TO SHARE
WITH INVESTIGATORS PERFORMING
CLINICAL RESEARCH RELATING TO
HISPANIC LATINO HEALTH IN THE
U.S.?
WHAT ARE THE KEY LESSONS LEARNED
YOU'D LIKE TO SHARE WITH
INVESTIGATORS PERFORMING
CLINICAL RESEARCH INVOLVING OR
RELATED TO HISPANIC LATINO
HEALTH IN THE U.S.?
>>YES, DR. ZORRILLA.
>>SORRY FOR THE NOISE.
I'M AT A PLACE WITH BACKGROUND
NOISE.
REGARDING RESEARCH WITH SPECIFIC
POPULATIONS MAY THEM BE
HISPANICS OR ANY PARTICULAR
GROUP, YOU NEED TO BE COMMITTED
TO THE GROUP AND THEY NEED TO
UNDERSTAND YOU'RE INTERESTED IN
WORKING WITH THEM AND IF YOU
DON'T KNOW THEM AND THEY DON'T
KNOW YOU NEED PEOPLE WHO ARE THE
BRIDGES BETWEEN YOU AND THAT
GROUP SO YOU CAN START THE
COMMUNICATION.
YOU DON'T NEED TO HAVE YEARS OF
INTERACTION TO BE ABLE TO
IMPLEMENT THE STUDY.
AS LONG AS YOU HAVE AND
DEMONSTRATE THE INTEREST IN
MAKING SURE THAT THE STUDY
REPRESENTS THAT COMMUNITY THE
STUDY WILL TREAT THEM
ACCORDINGLY AND RESPECT THEM AND
YOU'LL HAVE RESULTS AFTERWARDS
AND YOU'LL CONSIDER
MODIFICATIONS, SOMETIMES YOU
MIGHT CONSIDER MODIFICATIONS
BASED ON THE COMMUNITY RESPONSES
AND THIS IS MY STRATEGY WHEN I
WANT TO MODIFY A PROTOCOL THAT
CONSTRUCTS SOMEBODY ELSE I HAVE
A COMMUNITY ADVISORY BOARD AND
IF IT TELLS ME THE INCLUSION
CRITERIA NEEDS TO BE MODIFIED OR
YOU NEED TO DO WHATEVER, IT
COMES FROM THE COMMUNITY
ADVISORY BOARD AND HAS TO BE AT
LEAST CONSIDERED.
HEAVILY CONSIDERED.
THAT'S MY STRATEGY OF MAKING
SURE THE VOICES OF MY COMMUNITY
ARE HEARD INCLUDING THE DESIGN
EVEN IF IT'S ALREADY IN PLACE.
>>VERY BRIEFLY, I AGREE WITH
CARMEN.
I WOULD SAY KEEPING MY IDENT
IDENTIFYING OF LOCAL LEADERS AND
THAT'S MY VERY BRIEF REFLECTION.
>>AND ALSO IN TERMS OF DOING
RESEARCH WITH HISPANIC
POPULATION IN THE U.S. WE HAVE
TO BE MORE PRESENT WHEN WE REACH
OUT TO THE COMMUNITY OR DO
ACTIVITIES IT'S USUALLY THE P.I.
THAT EXPLAINS THE TRIAL AND WHAT
WE WANT TO ACHIEVE.
I THINK THAT'S SOMETHING WE
START THINKING IN THE U.S
U.S. LOOKING AT THAT WITH THE
COMMUNITY AND NOT ONLY THAT BUT
HAVING OUR P.I.s AND TALKING TO
WITH THE COMMUNITY AND WHY WE
NEED THE INFORMATION.
I HAVE THE EXPERIENCE ONCE YOU
GO WITH THE COMMUNITY AND TELL
THE POPULATION WHY WE NEED THEM
INVOLVED IN RESEARCH, HOW WE
COULD LEARN FROM OUR EXPERIENCE
AND IT CHANGE THE RESPONSE RATE
AND IN TERMS OF HOW THEY
PERCEIVE AND HOW THEY WANT TO
WORK WITH YOU IN THE RESEARCH
AND ONCE YOU REACH OUT YOU START
RECEIVING REQUESTS FOR DOING
MORE RESEARCH ACTIVITIES WITHIN
THE COMMUNITY.
I THINK THAT'S THE TAKE HOME
MESSAGE FOR RESEARCHERS DOING
RESEARCH HERE IN THE U.S.
>>I WOULD LIKE TO SAY I BELIEVE
CARMEN ZORRILLA HAS CLEARLY
DEMONSTRATED THE MANY POINTS YOU
HAVE TO CONSIDER.
ONE THING THAT YOU CANNOT AVOID
IS YOU HAVE TO DEMONSTRATE.
YOU CAN'T COMPROMISE BECAUSE
YOU'RE THE MODEL AND IF YOU
DON'T TRANSMIT THIS IMPORTANT
THINGS YOU ARE NOT GOING TO GET
IT AND YOU HAVE TO BE CONVINCED
THIS IS IMPORTANT AND THE PEOPLE
HAVE TO FEEL THEY'RE GOING TO
RECEIVE THE BENEFIT BECAUSE IT'S
NOT ONLY FOR HER OR HIM IT'S
FO
FOR EVERYBODY AND WHAT I'D LIKE
TO GET FROM THE PRESENTATIONS
HERE.
>>THANK YOU.
>>IN TERMS OF LESSONS LEARNED,
I HAVE TWO LESSONS.
ONE IS RECRUITMENT AND FOLLOW-UP
ARE GETTING REALLY HARD EVEN IN
THE GENERAL POPULATION I WOULD
SAY AT LEAST IN MY COUNTRY NOT
TO EASY TO GET PEOPLE INVOLVED
FOR LONG-TERM STUDIES.
THE LESSON FOR RESEARCHERS HERE
IS THAT WE NEED TO APPLY SCIENCE
TO THE PROCESS AS WELL AND TO
TRY TO UNDERSTAND FACTORS
ASSOCIATED TO STUDY ADHERENCE,
RETENTION, ATTRITION AND WHAT
KIND OF FACTORS ARE ASSOCIATED
WITH THIS DIFFERENT SCENARIO.
I THINK THERE ARE A FEW STUDIES
TRYING TO UNDERSTAND THAT AT
LEAST IN CHILE AND APPLY SCIENCE
TO THE RETENTION, ATTRITION AND
ADHERENCE AND TRYING TO
UNDERSTAND THE METHOD WE ALL
KNOW AND THE OTHER LESSON HAS TO
BE WITH IMPLEMENTATION.
NOW THAT WE HAVE THIS APP IN
CHILE AND WE HAVE PROVEN IT'S
EFFECTIVE BUT NOW WE ARE FACING
PROBLEMS WITH THE FOLLOW-UP AND
MAINTENANCE OF THE APP AND
GETTING SUPPORT AND UPDATE TO
THE APP OVER TIME.
AND SO WHAT MY COLLEAGUES SAID,
WE ARE NOW HAVING THIS GAP.
WE HAVE THE INTERVENTION.
WE KNOW IT'S EFFECTIVE
CULTURALLY APPROPRIATE BUT WE
HAVE PROBLEMS WITH IT.
WHO IS GOING TO TAKE CARE OF
THIS APP THAT WE DESIGN AND
MAKING THE UPDATES OVER TIME AND
MAKING AVAILABLE FOR COMMUNITY,
ETCETERA.
THOSE ARE SOME THOUGHTS I'D LIKE
TO SHARE WITH MY COLLEAGUES
HERE.
THANK YOU.
>>THANK YOU, DR. BAMBS.
WE HAVE ONE MORE QUESTION IN THE
CHAT.
HOW HAS MISTRUST AND
MISINFORMATION IMPACTED CLINICAL
RESEARCH IN LATIN AMERICA.
HOW HAS MISTRUST AND
MISINFORMATION IMPACTED CLINICAL
RESEARCH IN LATIN AMERICA?
>>THAT'S A GREAT QUESTION.
IT'S DIFFICULT TO APPROACH
BECAUSE MISINFORMATION IS A NEW
DETERMINATE OF HEALTH.
YOU HAVE SOCIAL DETERMINATES OF
HEALTH AND NOW WE HAVE
MISINFORMATION AND WE HAVE
DIFFERENT SOURCES WHERE NICK CAN
SAY ANYTHING AND IT'S DIFFICULT
FOR ALL OF US TO UNDERSTAND THE
AUTHORITY ANY OF US HAVE.
I WOULD SAY GLOBALLY WITH
MISINFORMATION AN REALIZE
THERE'S GROUPS TRYING TO PROPOSE
THE APPROACH TO THIS NEW SOCIAL
DETERMINATE OF HEALTH.
I THINK WE STILL DON'T HAVE THE
RIGHT ANSWERS.
>>THANK YOU.
ANYONE ELSE WHO WOULD LIKE TO
OFFER A COMMENT AROUND THE
QUESTION AROUND MISTRUST AND
MISINFORMATION AND HOW IT
IMPACTS CLINICAL RESEARCH?
>>WE NEED TO LOOK AT HOW TO
OVERCOME THOSE AND WHEN WE SEE
MISINFORMATION THERE'S KEY
ELEMENTS THAT HELPS INFORMATION
THROUGH THE POPULATION.
WE SEE COMPLEX TERMS AND THINGS
NOT SUPPORTED WITH SCIENCE COME
WITH CRAZY CONSPIRACY THEORIES.
WE NEED TO SEND OUR TERM THAT A
POPULATION WOULD UNDERSTAND.
>>I WOULD LIKE TO SAY THIS
MEETING HAS AN IMPORTANT THEME.
YOU HAVE TO PUT TOGETHER
RESEARCH AND CLINICAL PRACTICE
AND QUALITY OF PEOPLE NO MATTER
THE DISEASE.
PEOPLE CAN SEE HOW MUCH IS
IMPORTANT DEDICATED RESEARCH TO
THE QUALITY OF LIFE OF PEOPLE
AND THIS IS GOING TO BE A GREAT
IMPROVEMENT AND GREAT MESSAGE
AND NOT ONLY FOR LATIN AMERICA I
THINK FOR EVERY PART OF THE
WORLD AND THAT'S THANK YOU TO
YOU AND THE NIH FOR THE
OPPORTUNITY AND THANK YOU
EVERYBODY FOR THE CLEAR
PRESENTATIONS.
THANK YOU.
>>THANK YOU, DR. GAGLIARDINO.
OTHER COMMENTS?
WE HAVE ONE MORE QUESTION.
HOW WOULD YOU DESCRIBE A
SUCCESSFUL COLLABORATION WITH
LATINOS AND HISPANIC HOW WOULD
YOU DESCRIBE A SUCCESSFUL
COLLABORATION INVOLVING LATINOS
AND HISPANIC AND WHAT WOULD IT
LOOK LIKE.
I UNDER DIFFERENT DISCIPLINES
LIKE DR. GAGLIARDINO MENTIONED.
EACH HAS APPROACHED A SPECIFIC
CONDITION OR SPECIFIC POPULATION
BUT IF THERE IS A COMMON
MESSAGE?
WHO WOULD LIKE TO START?
>>ADDRESSING HISPANICS IN THE
MAIN LAND U.S. RIGHT NOW BECAUSE
OF THE POLITICAL ENVIRONMENT AND
THE DIVISION IN THE COUNTRY IS A
VERY DIFFICULT PROCESS AND WORK.
POPULATIONS ARE AFRAID OF BEING
MISTREATED NOT JUST DEPORTED,
MISTREATED AND MISUNDERSTOOD I
THINK PEOPLE WORKING RIGHT NOW
WITH HISPANIC POPULATIONS IN THE
MAINLAND HAVE A TOUGH JOB MAKING
SURE THE INFORMATION IS
AVAILABLE THAT THE STUDIES WILL
MAKE SURE THAT PEOPLE ARE
TREATED ADEQUATELY THAT THEY
WILL NOT -- THEIR INFORMATION
WILL NOT BE DISCLOSED TO OTHER
STUDIES AND NOW HAVE BETTER WAYS
OF TRANSLATIONS.
YOU DON'T NEED EVEN PREVIOUS
YEARS YOU HAD THE CHILDREN OF
THE PARTICIPANTS GETTING
INVOLVED IN ANSWERING THE
QUESTIONS WHICH AFFECTED THE
DEGREE OF CERTAINTY OF THE
ANSWERS BECAUSE YOU HAVE A CHILD
RESPONDING FOR THEIR PARENTS.
SO I THINK WE ARE IN A DIFFERENT
TIME.
THINGS ARE GOOD FOR THE USE OF
TECHNOLOGY, WHICH ALLOW PEOPLE
TO BE IN A PRIVATE SPACE AND
HAVE PROTOCOLS WHERE A LOT OF
THINGS CAN HAPPEN ONLINE AND
THINGS CAN HAPPEN AT A CLINIC OR
LABORATORY AND YOU TAKE TO THE
COMMUNITY EITHER THE SAMPLING
PROCESSES OR THE EXAMS OR
SOMETHING LIKE THAT.
IN LATIN AMERICA I WOULD NOT
DARE TO SAY BUT IN THE
U.S. MAINLAND, THINGS CAN BE
DIFFICULT AND WE NEED TO MAKE
THAT WE STRENGTHEN THE CAPACITY
AND THE RESOURCES OF PEOPLE WHO
ARE GOING TO BE STUDYING THE
POPULATIONS.
>>THANK YOU, DR. ZORRILLA.
DR. BAMBS, YOU HAVE YOUR HAND
RAISED?
>>YEAH.
I THINK SUCCESSFUL COLLABORATION
BETWEEN RESEARCHERS AND THOSE
WHO WORK IN POPULATIONS IN THE
U.S. IS IMPORTANT TO CONSIDER
PRINCIPLES OF COLLABORATION
BETWEEN PEERS AND SEEING EACH
OTHER AND GROUPS AND THAT MEANS
TO TRY TO IDENTIFY SOME RESEARCH
QUESTIONS THAT ARE IN IMPORTANT
AND DO THAT IN COMMON AND DESIGN
THE PROTOCOLS TOGETHER AND THEN
IMPLEMENT WHATEVER WE DECIDED TO
DO TOGETHER.
SOMETIMES WHAT HAS HAPPENED IN
THE PAST IS SOME SOUTH AMERICAN
COUNTRIES WORKED WITH PROTOCOLS
DEVELOPED AND WE FOLLOWED THE
DIRECTION AND I THINK NOW WE'RE
IN A DIFFERENT ERA AND WE COULD
WORK TOGETHER KNOWING THAT WE IN
OUR COUNTRIES WE HAVE KNOWLEDGE
THAT IS IMPORTANT THAT IS SOLID
AND WE CAN COLLABORATE IN A MORE
HORIZONTAL WAY AND THAT CAN
BENEFIT A LOT THE SUCCESS OF OUR
RESEARCH NETWORKS.
>>THANK YOU, DR. BAMBS.
VERY INSIGHTFUL.
ANY OTHER?
WE HAVE ONE MINUTE.
>>I AGREE WITH CLAUDIA'S
COMMENT.
TO FOLLOW-UP ON THAT, I THINK
THAT KEY CONCEPTS ARE EQUITY,
POWER BALANCE, HAVE GREAT
COLLABORATION WITH RESEARCHERS
FROM HIGH-INCOME COUNTRIES AND
IN PARTICULAR THE
U.S. RESEARCHERS.
TO ME THOSE ARE THE MAIN POINTS
IN THIS COLLABORATION WHERE WE
LEARN FROM EACH OTHER.
>>EXCELLENT.
THANK YOU, DR. IRAZOLA.
IT'S NOW ALMOST 3:50 AND WE'RE
GOING TO BREAK.
THANK YOU FOR WATCHING OUR
WORKSHOP AND GOOD-BYE FOR NOW.
SEE YOU AT 4:00 P.M.
>>GOOD AFTERNOON, EVERYONE.
IT'S 4:00 P.M.
IT'S TIME TO COME BACK.
WE'RE ABOUT TO START TOPIC 7 OF
OUR WORKSHOP.
THANK YOU FOR JOINING SINCE
EARLY THIS MORNING.
THE TOPIC IS PART OF THE
OVERVIEW OF HEALTH CARE SYSTEMS
AND HEALTH CARE.
WE HAVE THREE SPEAKERS AND THE
MODERATOR IS DR. MICHELLE DOOSE.
LET'S BEGIN.
>>I'LL BE THE MODERATOR.
BEFORE THE LIVE Q&A SESSION WE
HAVE THREE PRESENTATIONS FROM
DOCTORS ERNESTO BASCOLO AND
FRANCISCO BECERRA POSADA AND
DR. ALEX ORTEGA.
>>I'M ERNESTO BASCOLO.
THE ACT BEING UNIT CHIEF OF THE
HEALTH SYSTEM UNITS AT THE PAN
AMERICAN HEALTH ORGANIZATION.
PUBLIC HEALTH HAS SEEN
IMPROVEMENT IN THE REGION OF ME.
THERE'S SIGNIFICANT CHALLENGES
WE NEED TO ADDRESS TO IMPROVE
THE HEALTH OF OUR POPULATION WE
LIVE IN A REGION WHERE THE
INFLUENCE OF THE SOCIAL
DETERMINATES OF HEALTH, THE
CIRCUMSTANCES IN WHICH PEOPLE
ARE BORN, GROW UP, WORK, LIVE
AND AGE AND WHICH HAVE THE
IMPACT ON THE DAILY LIVING
CONDITIONS AND HEALTH OF
INDIVIDUALS IS BECOMING EVIDENT.
WE LIVE IN AN AGING SOCIETY
WHERE PHENOMENON ARE OCCURRING
IN COUNTRIES AND WE MUST HAVE
ADDRESS CLIMATE CHANGE AND
DEMOGRAPHIC TRANSITIONS AND THE
PRESENCE OF EMERGING AND
RE-EMERGING DISEASES AND THE
COVID-19 PANDEMIC TOGETHER WITH
NON-COMMUNICABLE DISEASES.
THESE CHALLENGES ARE THEN TAKING
PLACE IN THE CONTEXT OF
POLITICAL CRISES, CONFLICT IN
SEVERAL COUNTRIES.
WHICH WE CAN LOOK AT STEWARDSHIP
AND GOVERNANCE AND INCREASE
INEQUITY IN ACCESS TO HEALTH
SERVICES.
AND THERE'S A FUNCTIONAL
RELATIONSHIP AND SUPPLY AND
DEMAND AND CONDITION IN THE
CAPACITY TO FACILITATE OR LIMIT
BARRIERS OR ACCESS WHEN THE
POPULATION NEEDS THEM BASED ON
THE 17 COUNTRIES IN THE REGIONS
ABOUT 34% OF THE POPULATION
EXPERIENCES UNMET NEEDS DUE TO
MULTIPLE ACCESS BARRIERS WITH
FINANCIAL AVAILABILITY AND
ADMINISTRATIVE BARRIERS BEING ON
AVERAGE THE MOST COMMON REASONS
FOR UNMET CARE NEEDS.
ADDITIONALLY, THE PERCENTAGE OF
UNMET NEEDS WAS HIGHER ON
AVERAGE AMONG INDIVIDUALS IN THE
POOREST INCOME QUARTILE AND
THOSE WERE MOST LIKELY TO
EXPERIENCE BARRIERS RELATED TO
ISSUES AND FINANCIAL AND
GEOGRAPHICAL ACCESS OR
AVAILABILITY OF RESOURCES
HIGHLIGHTING THE NEED FOR
INTEGRATIVE MULTI-SECTORIAL
APPROACHES AND PRODUCE BARRIERS
TO ACCESS HEALTH SERVICES.
THERE HAS ALSO BEEN A DEFICIT OF
HUMAN RESOURCES FOR HEALTH THAT
HAS REMAINED HIGH DESPITE
EFFORTS FOR IMPROVEMENT BETWEEN
66 AND 94% OF THE LATIN AMERICAN
COUNTRIES AND MEETING THE
THRESHOLD IN 2019 AND HERE WE
CAN SEE THE NUMBER OF COUNTRIES
WITH THE SUM OF TYPES OF CRUCIAL
HUMAN RESOURCES FOR HEALTH
INCLUDE PHYSICIANS, NURSES,
MID-WIVES, DENTISTRY PERSONNEL
AND PHARMACEUTICAL PERSONNEL.
THIS NUMBER HIGHLIGHTS THE NEED
FOR INCREASED INVESTMENT IN
EDUCATION AND EMPLOYMENT
CONDITIONS OF HUMAN RESOURCES
FOR HEALTH TO ACHIEVE UNIVERSAL
HEALTH AND GLOBAL HEALTH
SECURITY.
THE COVID-19 PANDEMIC HAS
AMPLIFIED THESE EXISTING
CHALLENGES PARTICULARLY AMONG
VULNERABLE COMMUNITIES THIS
GRAPH SHOWS THE PERCENTAGE WITH
ESSENTIAL HEALTH SERVICES BY
SERVICE DELIVERY CHANNELS AND
PRIORITY HEALTH AREAS
PROSPECTIVELY.
AT THE END OF 2021, THEDISRUPTI
WERE REPORTED ACROSS ALL
DELIVERY PLATFORMS AND THE FIRST
LEVEL OF CARE AND
COMMUNITY-BASED CARE SERVICES
AMONG THE MOST AFFECTED AREAS.
ADDITIONALLY, COUNTRIES CONTINUE
TO REPORT THIS ACROSS ALL
PRIORITY HEALTH AREAS WITH MORE
THAN HALF OF COUNTRIES REPORTING
DISRUPTIONS TO IMMUNIZATION AND
CARE FOR OTHER PEOPLE AND CANCER
CARE.
EVEN BEFORE THE PANDEMIC THERE
WERE DIFFERENT TYPES OF REFORMS
IN OUR HEALTH SYSTEMS.
THE REFORMS CAN BE DESCRIBED IN
TERMS OF TYPE OF REFORMS AND
REFORM THAT FOCUS ON EXPANDED
INSURANCE COVERAGE AND REFORM
THAT PRIORITIZES CHALLENGES IN
THE ORGANIZATION OF HEALTH
SERVICES.
HERE ARE SOME KEY ELEMENTS TO
CONSIDER AS COMPONENTS OF THOSE
DIFFERENT TYPES OF HEALTH
SYSTEMS RE FOFORMS THE RELATIONP
BETWEEN THE STATE AND MARK AND
SOCIO PROTECTION AND MARKET
REGULATION CONSIDERED AND
CONCEPTION BEHIND THOSE
INITIATIVES AND INSTITUTIONAL
AND POLITICAL PROCESSES.
WHAT ARE THE DRIVERS OF THE
CHALLENGES.
WHAT ARE THE STRATEGIES OF THOSE
REFORMS.
LET'S LOOK IN MORE DETAIL AT
THESE TWO REFORM PROCESSES.
THE FIRST REFORM PROCESS
PROMOTES REFORM ON INNOVATION IN
INSURANCE MODELS AS STRATEGY FOR
REFORMING THE HEALTH SYSTEM AND
EXPANDING COVERAGE TO ASSURE THE
POPULATION IS FINANCIALLY
PROTECTED.
COUNTRIES THAT FOCUS ON REFORMS
TO INSURANCE IMPROVE FINANCIAL
PROTECTION BUT NOT NECESSARILY
WITH RESULT IN POSSIBLE CHANGES
IN ACCESS.
THE SECOND REFORM PROCESS
FOCUSSED ON ORGANIZING HEALTH
SERVICES TO ADDRESS THE
STRUCTURAL FRAGMENTATION OF
HEALTH SYSTEMS AND THIS REFORM
PROCESS LEADS TO IMPROVED ACCESS
YET A LARGE PROPORTION OF THE
POPULATION CONTINUES TO REPORT
BARRIERS TO ACCESS IN THE
COUNTRYIES STUDIED.
FOR BOTH IMPROVING SOCIAL
CONDITIONS OF THE POPULATION AND
ESTABLISH POLICIES ARE NEEDED TO
ACHIEVE MORE SIGNIFICANT
PROGRESS.
AND IN 2020 THE RENEWED
ESSENTIAL PUBLIC HEALTH WHICH
WERE SUPPORTED BY MEMBER STATES
IN THE SEPTEMBER 2021 RESOLUTION
AND THE STRATEGY FOR BUILDING
RESILIENT HEALTH SYSTEM IN
COVID-19 RECOVERY TO SUSTAIN AND
PROTECT PUBLIC HEALTH GAINS AND
STRENGTHENING OF STEWARDSHIP AND
GOVERNANCE THAT GOES FROM THE
LIMIT OF HEALTH SERVICE TO
IMPROVING THE CAPACITY OF THE
HEALTH SYSTEM TO RESPOND WITH AN
INTERSECTIONAL APPROACH TO THE
FACTORS AND SOCIAL DETERMINATES
WAS DEFINED AS A KEY STRATEGY
LINE OF ACTION.
>>GOOD AFTERNOON.
I'M HAPPY TO BE HERE AND THE
ORGANIZERS FOR THE INTER --
INVITATION ON THE SEMINAR ON KEY
ISSUES LATIN AMERICA AND SOME OF
THE INFORMATION I'LL BE
PRESENTING WAS ALIGNED WITH
HEALTH POLICIES AND SYSTEMS
RESEARCH.
THE CHALLENGES IS PRETTY MUCH
THE SAME ALL OVER LATIN AMERICA
AND THERE'S A LOT OF EMERGING
DEMANDS THAT CLISHZ WITH SYSTEMS
LIMITA
-- CLASHES WITH SYSTEMS AND WE
DEAL WITH IMPROVEMENTS AND
SOCIETY AND DISEASE AND
AWARENESS IS NOT ENOUGH AND IT'S
A NOT ALWAYS AS TRANSPARENT AS
WE WISH AND WE NEED A WORKFORCE
AND ACTION AND ALL THIS IS A
PERFECT WAVE AGAINST WHAT WE
REALLY WANT TO ACHIEVE IN
UNIVERSAL HEALTH COVERAGE AND
MOVE FORWARD.
YOU HAVE SEEN INFORMATION OF THE
REGION AND FOR THOSE JOINING THE
SESSION FOR THE FIRST TIME OF
THE SEMINAR, THIS IS A VERY
QUICK LANDSCAPE OF WHAT'S GOING
ON IN TERMS OF DISEASES AND THIS
IS PROBABLY THE LARGEST AMOUNT
OF DISEASES AND BURDEN OF
DISEASE IN THE REGION.
WITH INFECTIOUS DISEASES AND OF
COURSE VIOLENCE IN THE REGION IS
VERY HIGH.
YOU CAN SEE HOW DIFFERENT
COUNTRIES HAVE HIGHER RATES OF
CANCERS IN TERMS OF THE KEY ONES
AND IT'S ESTIMATED ABOUT 1.3
MILLION CASES AND YOU CAN SEE
THE NUMBER OF CANCERS THERE'S
STRONG SPECIFICALLY IN SOME
COUNTRIES LIKE YOU CAN SEE ON
THE RIGHT.
WHEN WE SEE THIS WE HAVE ALSO
PROBLEMS WITH CHILDREN, YOUTH
AND WOMEN AND HOW IT'S AFFECTING
THE PANDEMIC WITH HIGH NUMBER OF
ORPHANS, SCHOOL DROPOUTS.
WE HAVE A PANDEMIC FOR THE
COUNTRIES AND THAT'S GOING TO
TAKE A TOLL AS WELL IN THE
ECONOMIC AND CULTURAL GAINS.
AND THERE'LL BE A LACK OF
EMERGENCY CARE.
THIS IS A CONTRAST TO WHAT WE'RE
SEEING IN OTHER PLACES AND WE
HAVE AN AGING REGION AND IT'S
GOING TO TAKE A TOLL ON HEALTH
CARE AND SOCIAL SERVICES BECAUSE
WE'RE MOVING FORWARD TO A
PERFECT STORM.
WE MAY HAVE STEWARDSHIP AND
GOVERNANCE AND LEGAL FRAMEWORKS
THAT MORE OR LESS WORK IN SOME
COUNTRIES AND THE KEY ONE FOR
ALL OF THEM IS THE CENTER
BECAUSE IF WE DON'T HAVE ENOUGH
WE'LL DEAL WITH INSUFFICIENT
INFRASTRUCTURE AND PERSONNEL AND
THE ADMINISTRATION WILL BE
SUFFERING THERE WILL NOT BE
ENOUGH SUPPLIES AND SURVEILLANCE
WILL BE AFFECTED AND THE MODEL
OF CARE.
ALL THIS HAS TO BE WELL BALANCED
AND WE'RE SEEING IT'S NOT
WORKING TO MANY PLACE AND I'LL
PRESENT BRIEFLY THE EXAMPLE OF
MEXICO BEING MY COUNTRY.
I CAN SPEAK FREELY.
YOU CAN SEE HOW FRAGMENTS IT IS
IN TERMS OF FUNDING AND YOU HAVE
FEDERAL GOVERNMENT, EMPLOYEES
AND FEDERAL FUNDING AND THIS IS
THE PRIVATE SECTOR INSURANCE.
YOU HAVE ALL THE SOCIAL SECURITY
INSTITUTIONS AND THE OPEN
POPULATION WHICH IS THOSE WHO
ARE UNINSURED AND THE PRIVATE
SECTOR.
THERE'S INSTITUTES THAT WORK
WITHIN THEIR OWN HOSPITALS.
EACH HAS THEIR OWN NETWORK AND
YOU HAVE THESE USERS.
THIS IS COMPLEX AND VERY
DUPLIC
DUPLICATED PROCESS IN MEXICO.
AND WE HAVE FRAGMENTATION AND
HEALTH SYSTEMS IS THE NORM.
AND PUBLIC INVESTMENT IS NOT
CONSIDERED OUT OF POCKET AND THE
PANDEMIC HIGHLIGHTED FRAGILE
SYSTEMS AND SOMETHING WE'VE SEEN
NOT ONLY IN LATIN AMERICA BUT
ALL OVER THE WORLD AND IT'S
TAKEN A TOLL INTO HOW TO MAKE
HEALTH SYSTEMS RESILIENT TO
ACHIEVE UNIVERSAL HEALTH
COVERAGE.
SOCIAL SECURITY ARE HIGHER ALL
THE TIME IN OTHER COUNTRIES AND
IT'S A REAL THING IN TERMS OF
INSTITUTIONS HAVING HIGHER PER
CAPITA THAN OTHER COUNTRIES.
AGING IS GOING TO BE AN ISSUE IT
WILL BE TAKEN A BURDEN ON THE
SYSTEMS AND IF WE DON'T HAVE
ENOUGH FUNDING OR PREPAREDNESS
WE'LL SEE A LOT OF PROBLEMS IN
THE FUTURE.
THE ECONOMIC SCENARIO IS NOT
HELPING BECAUSE INFLATION RATES
ARE HIGH.
IN TERMS OF FUNDING AND THE
OTHER PARTIED -- PART, I'D LIKE
TO TOUCH AND SOME COUNTRIES
DEPEND ON LOCATION ON THE BUDGET
S AND RESEARCH FALLS AND SOME
COUNTRIES HAVE DROPPED AND
DISAPPEARED SCHEMES AND WHICH
WERE WORKING AND LIKE IN MEXICO
OTHERS LIKE COLOMBIA AND
ARGENTINA ARE NOW ADOPTING THIS
AND HOPEFULLY ALL COUNTRIES WILL
SHARE MORE FUNDING FOR RESEARCH.
TO THE FINANCIAL SITUATION PLAYS
A ROLE AND ACADEMIA AND WE'RE
LOOKING FOR MONIES OUTSIDE THE
COUNTRY BECAUSE IT'S THE ONLY
REAL FUNDING THEY CAN HAVE AND
NIH IS ONE OF THE MAIN FUNDERS.
AND WE HAVE LOOKED AT REDUCED
FUNDING FOR TECHNOLOGY AND
SOMETHING IS SOMETHING WE HAVE
TO LOOK BECAUSE THIS IS AN ISSUE
HOW RESEARCH IS BEING FUNDED IN
THE REGION SO LET'S SEE AND HOPE
IT CAN BE RESERVED AT SOME
POINT.
SOME COUNTRIES HAVE A UNIFIED
HEALTH SYSTEM AND SOME ARE
FRAGMENTED.
AND THERE'S ALWAYS
FRAGMENTATIONS AND THERE'S AN
ISSUE WE'LL BE SEEING AND
COMORBIDITY CAUSED HIGH
MORTALITY AND THE SCIENCE AND
TECHNOLOGY SECTOR IS NOT WELL
FUNDED.
EACH COUNTRY HAS A DIFFERENT WAY
OF SUPPORTING RESEARCH AND IN
THE CARIBBEAN FUNDING WAS FOR
THE UNIVERSITIES THEMSELVES.
BRAZIL, MEXICO, ARGENTINA AND
PERU CONTRIBUTE AND CARIBBEAN
COUNTRIES ARE IN THE TOP 25.
THIS IS IMPORTANT OF COURSE
BRAZIL IS THE HIGHEST NUMBER OF
PUBLICATIONS AND THAT PUSHES ALL
THE LATIN AMERICA MEDIA
PUBLICATIONS.
IF WE TAKE BRAZIL OUT IT DROPS
DRAMATICALLY BUT GOOD QUALITY OF
THE COUNTRIES AND MOST WITH
COLLABORATION.
THANK YOU SO MUCH AND YOU CAN
HAVE ACCESS TO THE PAPER ON THE
LEFT AND TO THE SERIES ON THE
RIGHT.
THANK YOU.
>>I'M ALEX ORTEGA A DIRECTOR OF
THE CENTER FOR POPULATION HEALTH
AND COMMUNITY IMPACT IN THE
DORNSIFE SCHOOL OF.
LICK HEALTH.
AT DREXEL UNIVERSITY.
I'M THE INVESTIGATOR OF TWO RO1
STUDIES BASED IN PUERTO RICO
BOTH FUNDED BY THE NATIONAL
INSTITUTE ON MINORITY HEALTH AND
HEALTH DISPARITY.
ONE IS OF ISLAND PUERTO RICANS
AND THEIR MENTAL HEALTH BEFORE
HURRICANES IVAN AND MARIA AND
THE SECOND STUDY FOCUSES ON THE
PUERTO RICAN HEALTH CARE SYSTEM
BEFORE AND AFTER RECENT PUBLIC
HEALTH EMERGENCIES AFTER DISEASE
OUTBREAKS AND TROPICAL DISEASE
OUTBRA
OUTBREAKS RELATED TO CLIMATE
CHANGE.
I'M FORCE ON PUBLIC HEALTH
DISASTERS.
OUR STUDY WAS FUNDED IN MAY SO
WE'RE JUST GETTING IN THE FIELD
SO I DO NOT HAVE RESULTS OF OUR
WORK TO SHARE BUT WOULD LIKE TO
HIGHLIGHT THE IMPETUS.
THE IMPACT MUST BE UNDERSTOOD IN
A LONGITUDINAL CONTEXT.
INCREASING NATURAL DISASTERS AND
TROPICAL CYCLONES, HURRICANES,
FLOODS AND EARTHQUAKES HAVE
BECOME MORE COMMON AND MORE
CLOSELY SPACED COMPARED TO ANY
OTHER TIME PERIOD GOING BACK TO
1960.
SUPER IMPOSING INFECTIOUS
DISEASE DEMONSTRATES INCREASING
STRESS ON PUERTO RICO'S SYSTEMS
PRIOR TO THE PANDEMIC.
PUERTO RICO HAS FACED
SIGNIFICANT CHALLENGES OVER THE
PAST FEW YEARS AS IT RECOVERS
FROM FOUR SEPARATE, BACK TO BACK
PUBLIC HEALTH EMERGENCIES AND
NATURAL DISASTERS AND THE
HURRICANES AND EARTHQUAKE AND
THE COVID-19 PANDEMIC ALL OF
WHICH DISASTERS HAVE IMPACTED
PUERTO RICO'S STRUGGLING ECONOMY
AND HIGH UNEMPLOYMENT.
PUERTO RICO HAS 50 GENERAL
HOSPITALS MOSTLY LOCATED IN SAN
JUAN AND OTHER REGIONS AND
HEALTH CENTERS PROVIDING PRIMARY
AND PREVENTIVE CARE.
THE MAJOR METEOROLOGIST AREAS
THERE ARE 35 PRIVATE HOSPITALS
AND 11 PUBLIC HOSPITALS.
ONLY A FEW HOSPITALS SERVE AN
EXTENSIVE RURAL POPULATION ALL
THE HEALTH CARE FACILITIES
EXPERIENCED MAJOR DEVASTATION
AFTER THE DISASTERS AND ONE LOST
ITS ONLY OPERATING HOSPITAL
AFTER HURRICANES IRMA AND MARIA.
FROM 1930 TO 1970, AMERICA'S
HEALTH CARE SYSTEM RESEMBLED THE
LATIN AMERICA SOCIALIZED SYSTEM
WHERE EACH MUNICIPALITY HAD A
HOSPITAL AND HEALTH CARE
PROVIDERS WERE EMPLOYED BY THE
GOVERNMENT.
GROWTH IN PRIVATE HEALTH CARE
CHANGED THE SYSTEM AND IN 1993
PUERTO RICO PUT CONSTRAINTS ON
THE PRIVATIZATION AND PHYSICIANS
WERE INCENTIVIZED TO CONTRACT
WITH MEDICARE AND MEDICAID AND
THE MUNICIPALITIES HAVE REMAIN
LARGELY UNCHANGE.
PUERTO RICO IS LARGELY DEPENDENT
ON MEDICAID AND MEDICARE FOR THE
PUBLIC HEALTH SYSTEM FORMALLY
KNOWN AS LA REFORMA.
49% OF RESIDENTS RECEIVE CHIP.
11% RECEIVE MEDICARE AND 35%
EMPLOYER-BASED COVERAGE AND 6%
ARE UNINSURED AND PEOPLE IN
PUERTO RICO ARE MORE LIKELY TO
REPORT POORER HEALTH THAN THE
MAINLAND.
POVERTY IS HIGHER IN AMERICA AT
41% VERSUS 12% RESPECTIVELY AND
57% OF YOUNG PEOPLE LIVE UNDER
THE FEDERAL POVERTY LEVEL.
THIS IS ALL DIRECTLY RELATED TO
THE HIGH PROPORTION ON MEDICAID
OR CHIP IN PUERTO RICO.
IN ORDER TO QUALIFY A FAMILY OF
FOUR CAN EARN NO MORE THAN $850
A MONTH.
MEDICAID FUNDING HAS A MATCH GAP
OF 50% YIELD MEDICAID
REIMBURSEMENT LOWER THAN THE
STATES AND U.S. MAINLAND.
THE SIGNIFICANT MEDICAL NEED AND
POVERTY ON THE ISLAND HAS PUT A
MAJOR TOLL ON CARE DELIVERY AND
CONTINUES TO EXACERBATE HEALTH
CARE DISPARITIES.
THE U.S. GOVERNMENT TYPICALLY
COVERS 55% OF THE MEDICATE
EXPENDITURES AND AS A RESULT THE
PROGRAM HAS HISTORICALLY USED A
LOWER ELIGIBLE THRESHOLD AND
COVERED FEWER BENEFITS COMPARED
TO MEDICAID IN THE STATES.
MEDICAID IN PUERTO RICO ALSO
REIMBURSES AT A LOWER LEVEL THAN
THE MAINLAND AND THE EXECUTIVE
SESSION AND DISASTERS AFFECTED
THE NEEDS TO COVER THE NEEDS OF
1.6 POLITICAL -- 1.6 POLITICAL
ONPUERTO RICANS.
LESS THAN 30 YEARS AGO, PUERTO
RICO HEALTH CARE WAS EXCLUSIVELY
RUN BY THE LOCAL GOVERNMENT.
WHILE THIS PROVIDED MORE
EQUITABLE ACCESS TO CARE AND
BROADER EDUCATIONAL FACILITIES
IT RESULTED IN SUBSTANTIAL COST
TO THE GOVERNMENT AND UNDER PAID
PROVIDERS.
WITH THE PRIVATIZATION OF THE
HEALTH SYSTEM CAME CAPITATION
PAYMENTS, SELLING OF PUBLIC
HOSPITALS AND HEALTH CENTERS AND
THE INTRODUCTION OF MEDICAID
FUNDS FROM THE FEDERAL
GOVERNMENT.
MEDICARE AND MEDICAID ARE
PRIMARILY RUN BY A FEW MANAGED
CARE ORGANIZATIONS THROUGH THE
PUERTO RICO HEALTH INSURANCE
ADMINISTRATION.
THE HEALTH OF DEATH HAS A
COOPERATIVE AGREEMENT WHICH
IMPLEMENTS AND ADMINISTERED THE
HEALTH INSURANCE SYSTEM.
THE PRIVATIZATION OF HEALTH CARE
IN PUERTO RICO HAS BROUGHT OTHER
QUALITY CONCERNS FOR HEALTH
SERVICES SUCH AS OVERCROWDED
MEDICAL CENTERS, OVER WORKED
PERSONNEL AND PROLONGED WAIT
TIMES AND A LOSS OF ACADEMIC
CENTERS FOR HEALTH CARE
PROVIDERS.
72 OF THE MUNICIPALITIES HAS
BEEN IDENTIFIED AS MEDICALLY
UNDER SERVED AREAS.
PRIOR TO THE ONSET OF THE PUBLIC
HEALTH EMERGENCIES NEARLY HALF
THE POPULATION WAS LIVING IN A
PROVIDER SHORTAGE AND THEY EARN
LESS THAN HALF THE MEDIAN WAGE
OF THE PROVIDERS ON THE MAINLAND
AND REIMBURSED LOWER THAN THOSE
COMPARED TO THE 50 U.S. STATES.
THE MASS EXODUS OF PROVIDERS TO
THE U.S. MAINLAND IN SEARCH OF
BETTER WORKING CONDITIONS AND
HIGHER PAY HAS ONLY INCREASED
THE ECONOMIC CRISIS.
MOREOVER, PUERTO RICO HAS ONE OF
THE LOWEST RETENTION RATES IN
THE U.S. FOR LOCALLY TRAINED
PRACTITIONERS AN THIS OVER
BURDENED PROVIDERS IN PUERTO
RICO AND LEAVES THEM WITH A
DEARTH OF RESOURCES AND
DIFFICULT RESOURCES.
THIS ALSO AGGREGATES EXTENSIVE
WAIT TIMES, LIMITED APPOINTMENT
AVAILABILITY AND LONGER
DISTANCES TO RECEIVE CARE.
HERE ARE SHORT-TERM
RECOMMENDATIONS TO IMPROVE
KNOWLEDGE AND TO IMPROVE
POPULATION HEALTH ON THE ISLAND.
IN ORDER TO IDENTIFY AND
IMPLEMENT STRATEGIES TO IMPROVE
HEALTH CARE OUTCOMES OF
RESIDENTS OF PUERTO RICO, VALID
REPRESENTATIVE DATA ARE NEEDED.
AS IT STANDS, ISLAND PUERTO
RICANS ARE LARGELY EMITTED FROM
HEALTH MONITORING AND SFLS
SYSTEMS SUCH AS THE SURVEY AND
THE AND A HALF HEALTH AND
NUTRITION SURVEY DISPIED BEING
CITIZENS.
THE SURVEILLANCE SYSTEM KNOWN BY
THE CDC IS ONE OF THE FEW
PROBABILITY-BASED SERVURVEYS LOD
AT CITIZEN AND CARE BEYOND COST
AND QUALITY OF HEALTH CARE.
EXPANDING DATA COLLECTION
EFFORTS TO INCLUDE PUERTO RICO
WILL IMPROVE KNOWLEDGE AND
IMPROVE OUTCOMES.
THIS IS TO UNDERSTAND THE
BASELINE UNDERSTANDING OF
POPULATION HEALTH OUTCOMES AND
DEVELOP HOW SERVICES AND POLICY
INTERVENTIONS TO IMPROVE HEALTH
AND WELL BEING OF PUERTO RICO.
PRIOR TO STUDYING THE
IMPLICATIONS OF THE BLOCK GRANT
FOR U.S. TERRITORIES HAS
RECOMMENDED ELIMINATING OR
MODIFYING THE FEDERAL FUNDING
STRUCTURE TO IMPROVE PROGRAM
QUALITY, EXPAND ELIGIBILITY AND
EXTEND COVERED BENEFITS.
TAKING INTO CONSIDERATION THE
FREQUENCY AND INTENSITY OF
DISASTERS IN PUERTO RICO, THE
BLOCK GRANT STRUCTURE AND
COLLAPSING PUBLIC HEALTH SYSTEM
FAILED TO ACCOUNT FOR THE HEALTH
CARE IMPACT OF THESE
UNPREDICTABLE EVENTS.
WITH THAT I THANK YOU VERY MUCH.
>>WELCOME TO THE LAST SESSION
FOR AN IMPORTANT DISCUSSION ON
HEALTH CARE SYSTEM AND HEALTH
CARE AND I WANT TO WELCOME OUR
SPEAKERS.
WOULD YOU LIKE TO INTRODUCE
YOURSELF?
WE CAN'T HEAR YOU.
>>SORRY, I'M CONNECTED FROM AN
AIRPORT BUT I'M TRYING TO HAVE
THE BEST CONDITIONS TO BE ABLE
TO PARTICIPATE.
I'M AN INTERNATIONAL CONSULTANT
WORKING WITH ERNESTO BASCOLO THE
FORMER MINISTER OF HEALTH OF
ECUADOR.
>>I NOTICED A COMMON THREAD IN
THE PRESENTATION IS THE LACK OF
INTEGRATION OF SYSTEMS.
PUBLIC HEALTH AND SOCIAL
SERVICES IN LATIN AMERICA
INCLUDING PUERTO RICO.
AND HEALTH SYSTEM INTEGRATION IS
A PROBLEM IN THE U.S. WITH HALF
THE U.S. POPULATION NOT HAVING
ACCESS AND ALMOST A QUARTER OF
HISPANIC AND LATINOS NOT HAVING
ACCESS TO HEALTH CARE.
STARTING WITH YOU, KARINA, I
WANTED TO ASK WHAT ARE
STRATEGIES, BEST PRACTICES OR
MODELS EMERGING FROM LATIN
AMERICA STRENGTHENING THE
INTEGRATION OF PUBLIC HEALTH AND
HEALTH CARE SYSTEMS.
>>I'LL TALK ABOUT THE
IMPLEMENTATION OF THE PUBLIC
HEALTH FUNCTION AND WHAT WE HAVE
IN TERMS OF ACCESS AND ALSO
POPULATION-LEVEL SERVICES AND
THINK
THINKING HOW THE AUTHORITIES CAN
IMPLEMENT POLICIES AS A STRATEGY
TO ACHIEVE THAT.
THE FUNCTIONS LAUNCHED IN 2020
HAVE BEEN SUPPORTED IN THE
COUNTRIES OF THE AMERICAS AND
THE LAST OCCASION WAS LAST YEAR
IN SEPTEMBER OF 2021 WHEN A
UNANIMOUS RESOLUTION WAS PASSED
BY MEMBER STATES.
ASKING THEY EXERCISE THE FUNDING
AND THIS IS PART OF THE POLICY
CYCLE A STRATEGY WE'RE USING HOW
WE VIEW THE PUBLIC HEALTH
FUNCTIONS.
PART OF THE POLICY CYCLE IS
EVALUATION AND WE FOCUSSED ON
FORMAL CAPACITY THAT IS WHAT ARE
THE CHARACTERISTICS OF THE LEGAL
FRAMEWORK AND FROM THE
PERSPECTIVE OF ACCESS AND
ACHIEVING UNIVERSAL ACCESS AND
HEALTH COVERAGE AS WELL AS THE
IMPLEMENTATION OF MODELS BASED
IN PRIMARY HEALTH CARE.
FORMAL CAPACITY IS ONE WE FOCUS
ON.
THE OTHER IS STRUCTURAL CAPACITY
AND NOT ONLY THINKING ECO
FRIENDLY BUT WHAT ARE THE
INSTITUTIONAL ARRANGEMENTS THAT
CAN BE HELPFUL IN ACHIEVING
UNIVERSAL HEALTH AND THE
INSTITUTIONAL ARRANGEMENT,
COORDINATION BETWEEN DIFFERENT
PUBLIC SECTORS AND PRIVATE
SECTOR AND UNIVERSITIES CIVIL
SOCIETY.
THE OTHER CAPACITY IS THE
SUPERVISORY CAPACITY.
WITH THE STEWARDSHIP OF THE
NATIONAL HEALTH AUTHORITY, WHAT
IS BEING DONE IN TERMS OF
CONTROLLING AND SUPERVISING
THINGS ARE WORKING AND FINALLY
WE FOCUS ON CAPACITY AND THE
ABILITIES OR CAPACITY TO
IMPLEMENT POLICIES TO HAVE THE
RESOURCES NEEDED TO IMPLEMENT
POLICY.
THERE'S FOCUSES ON HUMAN AND
FINANCIAL RESOURCES AND YOU MAY
KNOW REGIONALLY AND
INTERNATIONALLY NOW IT'S GAINING
GROUND THE IDEA OF PUBLIC HEALTH
EXPENDITURE BEING AT LEAST 6% OF
GDP.
THAT'S SOMETHING THAT'S BEEN A
FEW YEARS WE SET THE GOAL AND
IT'S IMPORTANT WE ACCOMPLISH IT
BUT WE'RE FAR AND STILL TRYING
TO ACCOMPLISH THE STANDARD WE
HAD PREVIOUSLY BUT SOMETHING
THAT HAS CHANGE.
ONE INNOVATION OF TERMS OF THE
PUBLIC HEALTH FUNCTION BASED ON
THE HISTORY OF LATIN AMERICA AND
HOW THE HEALTH SYSTEMS IN LATIN
AMERICA HAVE BEEN DEVELOPED IS
SOCIAL PARTICIPATION AND I'D
LIKE TO HIGHLIGHT THAT'S ONE OF
THE IMPORTANT CHANGES IN
FUNCTIONS.
NOT ONLY IN TERMS OF HEALTH
PROMOTION BUT IN MATERIALS OF
POLICY DESIGN AND IMPLEMENTATION
AS WELL.
GOING FROM A MORE DECORATIVE
PARTICIPATION TO A SOCIAL
PARTICIPATION THAT IS TRULY
WORKING WITH THE GOVERNMENT,
WORKING WITH THE NATIONAL HEALTH
AUTHORITY AND THE DIFFERENT ACTS
IN THE HEALTH SYSTEM TO BE ABLE
TO ACCOMPLISH THAT COMMON GOAL
THANK YOU.
>>CAN YOU TALK MORE ABOUT WHERE
THE POTENTIAL HEALTH CARE SYSTEM
SOLUTIONS IN MEXICO.
>>THANK YOU.
I'D LIKE TO SAY HELLO TO CARINA
AND TO MY CO-PANELIST, ALEX.
I THINK THIS IS SOMETHING WE
HAVE TO UNDERSTAND EACH COUNTRY
HAS THEIR OWN MODEL OF CARE.
HOWEVER, THERE'S A LOT OF
FRAGMENTATION AND INSTITUTIONS
WORKING TOGETHER AND YOU HAVE
DIFFERENTIAL HEALTH CARE BECAUSE
WHEN YOU SEE WHAT SHE SOCIAL
SECURITY SECTOR INVESTS IT'S A
DIFFERENCE AND THAT MAKES AN
INEQUALITY AND YOU HAVE
DIFFERENCES AND HOW ARE YOU
GOING TO TRY TO PUT THEM
TOGETHER AT THE SAME TIME.
ONE OF THE ISSUES TO GET THERE
IS WHAT SHE WAS SAYING, TRYING
TO ACHIEVE AT LEAST 4% TO 6% OF
PUBLIC GDP EXPENDITURE IN
HEALTH.
PUBLIC NOT JOINT PUBLIC AND OUT
OF POCKET.
BECAUSE WHEN WE GO OUT OF POCKET
WE GO SOMETIMES HIGHER THAN 6%
BUT WITH THE GOAL OF PUBLIC
EXPENDITURES.
HOW TO GET TO A BETTER HEALTH
SYSTEM OR FINAL SYSTEM IS JUST A
POLITICAL WILL AND HAVING
CONGRESS AND GOVERNMENT WORKING
TOGETHER TOWARDS ACHIEVING THIS.
THIS IS SOMETHING WE HAVE TO
HAVE A CLEAR MIND ON THE
WILLINGNESS OF THE GOVERNMENT
AND CONGRESS TO WORK TOGETHER
AND HAVE A CLEAR MODEL OF CARE
AND IT'S UNIQUE BECAUSE OF THEIR
OWN WORKING FORCE OR DEVELOPMENT
THEY'VE HAD AND I THINK WHAT
THEY WERE TRYING TO DO IN MEXICO
WHICH WAS ALREADY ABOLISHED BY
THE GOVERNMENT IS TO HAVE
FUNDING TO MAKE SURE THE
UNINSURED PEOPLE IN THE COUNTRY
WOULD RECEIVE FREE MEDICAL CARE
WHENEVER AND WHENEVER THEY GO
NOT ONLY TO THE STATE THEY WERE
LIVING IN BUT IF THEY WERE
TRAVELLING AND THEY NEEDED TO GO
TO A HEALTH CENTER THEY CAN GO
THERE GET SERVICE.
OF THE COURSE THERE'S A PART FOR
CATASTROPHIC DISEASES.
SO IT WAS FROM CATARACT SURGERY
TO CANCERS SO THOSE WERE IN
WELL-SET SET OF DISEASES AND
THEY'LL GATE FREE HEALTH CARE.
THAT WAS WORKING AND WITH THAT
THE HEALTH CARE ACCESS IMPROVED
DRAMATICALLY.
AND THE OPPORTUNITY AND THE NEW
GOVERNMENT DIDN'T SEE THAT AS
THE WAY TO GO AHEAD SO THEY
BANISHED THE PLAN AND MOVED INTO
THE GOVERNMENT AND EXPLAINED AND
IT'S TAKING OVER THE STATES
SIGNING WITH THE NEW MODEL OF
CARE AND WERE GOING TAKE OVER
THE OPERATIONS AND IT BRINGS
CONFUSION AND TRYING TO
UNDERSTAND THE MODEL OF CARE
THAT CAME OUT YESTERDAY TO SEE
WHAT'S GOING ON WITH THIS.
SO THIS IS ALSO SOMETHING THE
GOVERNMENT BRINGS TO HEALTH WHEN
THEY START MAKING THESE CHANGES.
WHEN THEY START NOT BUILDING BUT
CHANGE WHAT YOU HAVE IN HEALTH
CARE YOU CAN CREATE HAVOC AND
THAT'S HAPPENING IN MEXICO.
IT'S BEEN CONSISTENT WITH THE
WAY THEY FINANCE THE SYSTEM AND
WITH PEOPLE PARTICIPATING 7% OF
THE INCOME FOR HEALTH CARE AND
FOR THOSE THAT ARE NO INCOME
THEY CAN GO TO ZERO GOING TO THE
SYSTEM.
THEY ALSO OPT EITHER ONE OF
THOSE THEY CAN TAKE OVER.
OF COURSE, THE MINISTER OF
HEALTH HAS STEWARDSHIP AND THE
DIRECTORSHIP SAME AS MEXICO AND
WHEN YOU SEE COVID, YOU CAN SEE
THE DIFFERENCES ONLY HOW STRONG
THE GOVERNANCE IS IN PLACE.
SOME COUNTRIES WERE DOING VERY
WELL THEY WERE ABLE TO SUSTAIN
THE IMMUNIZATION AND SOME
COUNTRIES LIKE MINE LOST TRACK
OF HEALTH CARE AND IMMUNIZATION
AND CHILE AND COSTA RICA HAD
COVERAGES AND OTHER COUNTRIES
WENT BAD AND WE'RE SEEING
DIVISION AND LOOKS HOW FRAGILE
THE HEALTH SYSTEMS WERE IN COVID
AND IT WAS DEMONSTRATED.
>>THANK YOU FOR SHARING THE
EXAMPLES.
I WANT TO CIRCLE BACK TO COVID.
I DID RECEIVE QUESTIONS FROM THE
AUDIENCE ABOUT THAT.
THERE'S A LOT REPORTED ABOUT
PUERTO RICO ABOUT THEIR HEALTH
SYSTEM RESILIENCY AND I WANT TO
ASK A QUESTION, DR. ORTEGA, WHAT
EFFORTS ARE NEEDED TO PROMOTE
AND LEARN FROM THE HEALTH SYSTEM
IN PUERTO RICO AND CAPTURE THE
RELEVANT POPULATION-LEVEL DATA
IN PUERTO RICO TO MAKE SURE
HEALTH CARE RESEARCH IS
SUSTAINABLE IN THE COUNTRY?
>>THANK YOU MICHELLE AND I'M
IMPRESSED WITH YOUR ABILITY TO
DO THIS AT THE AIRPORT, CARINA.
THE CONCEPT OF HEALTH SYSTEM
RESILIENCY IS RELATIVELY NEW IN
PUBLIC HEALTH.
THOUGH THE IDEA OF HEALTH SYSTEM
RESILIENCY GOES BACK TO THE
EBOLA OUTBREAK IN SOUTH AFRICA
AND THE STRAIN AON THE SYSTEM
AFTER THE EPIDEMIC AND CAUGHT ON
RECENTLY IN THE UNITED STATES.
THERE'S DIFFERENT DEFINITIONS
BUT THE MOST COMMON IS THE
CAPACITY OF HEALTH SYSTEMS TO
EFFECTIVELY RESPOND AND RECOVER
FROM CRISES SUCH AS NATURAL
DISASTERS WHICH THERE HAVE BEEN
A NUMBER OF IN PUERTO RICO
ESPECIALLY OVER THE LAST COUPLE
OF YEARS AND INFECTIOUS DISEASE
OUTBREAKS INCLUDING COVID-19
INCLUDING A NUMBER OF TROPICAL
DISEASE OUTBREAKS IN PUERTO
RICO.
IN ORDER FOR A HEALTH CARE
SYSTEM TO BE RESILIENT IT MUST
BE AWARE OF ITS STRENGTHS AND
RESILIENCIES ACROSS HEALTH NEEDS
AND MUST CONTAIN HEALTH THREATS
WHILE CONTINUING TO DELIVER
HEALTH CARE TO THE POPULATION
AND MUST INTEGRATE DIVERSE
PLAYERS TO SOLVE CRISES AND THE
HEALTH CARE SYSTEM MUST BE
ADAPTABLE AND BE ABLE TO IMPROVE
PERFORMANCE BOTH AT TIMES OF
CRISIS AND NON-CRISES.
AND RESEARCH AND POLICY EFFORTS
ARE NEEDED TO UNDERSTAND AND
PROMOTE TEAM CLINICAL CARE AND
NEED DIFFERENT STRATEGIES SUCH
AS TELEHEALTH AND TRAINING
PROVIDERS TO USE TELEHEALTH AND
UNDERSTAND THE FACTORS THAT
INHIBITED CARE DURING A CRISIS
AND HAVE STRATEGIES IN PLACE TO
IMPROVE AND RESPOND MOVING
FORWARD.
THEY HAVE TO LEARN FROM PREVIOUS
EXPERIENCES OF CRISES BOTH
WITHIN ITS OWN SYSTEM AND AS
WELL AS OTHER SYSTEMS NATIONALLY
AND WHILE THE HEALTH CARE
CONTEXT IN PUERTO RICO THAN IT
IS IN OTHER LATIN AMERICA
COUNTRIES.
THERE'S LESSONS TO BE LEARNED
HOW THE HEALTH CARE SYSTEM
BECOMES RESILIENT IN THE FACE OF
THESE NATURAL DISASTERS AND
GROWING CLIMATE CHANGE.
THERE MUST BE EVALUATION OF
PREVIOUS EXPERIENCE AND LEARNING
PROCESS.
A HEALTH CARE SYSTEM MUST ABLE
TO TRANSFORM THE STATUS AND
STRATEGIES AND BEHAVIORS NO
LONGSER FEASIBLE AND THERE'S A
OF METHODOLOGICAL APPROACHES AND
METHODS INCLUDING SURVEYS OF
PATIENTS AND PROVIDERS AND
INTERVIEWS OF LEADERS AND
PARTNERS AND ANALYSIS OF
ADMINISTRATIVE DATA AND IT'S
IMPORTANT TO INCLUDE PUERTO RICO
WHICH IS A PART OF THE UNITED
STATES.
IT'S A TERRITORY AND ITS
RESIDENTS ARE CITIZENS OF THE
UNITED STATES IN NATIONAL HEALTH
CARE SURVEYS AND OTHERS.
IN ORDER TO LEARN ABOUT WHAT'S
HAPPENING IN PUERTO RICO AND TO
BE ABLE TO DO COMPARISONS WITH
THE MAINLAND STATES.
>>THAT'S GREAT.
I HAVE MORE QUESTIONS ABOUT
PUERTO RICO BUT CIRCLING BACK TO
THE COVID COMMENT I'D LIKE YOU
TO ALL ANSWER THIS CAME IN IN
THE U.S. WE HAVE EXPERIENCED A
WORKFORCE SHORTAGE DUE TO THE
COVID PANDEMIC.
WHAT'S BEEN THE IMPACT ON THE
WORKFORCE IN LATIN AMERICA AND
PUERTO RICO?
THAT'S ALL FOR TO ANSWER.
AND SOLUTIONS TO ADDRESS THAT.
>>IF YOU DON'T HAVE ENOUGH
FINANCING TO SUSTAIN A WORKFORCE
THAT CAN SUPPORT THE SYSTEM HAVE
YOU A LOT OF PROBLEMS.
YOU ARE UNDER STAFFED AND PEOPLE
HAVE TO RUN TWO OR THREE SHIFTS
AT THE SAME TIME AND EVERYBODY
IS STRESSED OUT AND THE
FRAGILITY OF THE HEALTH SYSTEMS
WE HAVE TO HIRE MORE PEOPLE AND
IT'S CALCULATED BETWEEN 70% TO
80% OF THE HEALTH BUDGET GOES TO
SALARIES.
THAT LEAVES WITH A MINIMUM FOR
OPERATIONS.
THAT CAUSES HAVOC EVERYWHERE.
IF YOU DON'T HAVE THE FUNDING TO
INCREASE THE HEALTH RESOURCES
AND WORKFORCE TO PROVIDE A
HEALTH SYSTEM YOU ARE GOING TO
BE SUFFERING.
PEOPLE ARE GOING TO BE OVER
STRESSED, OVER WORKED AND THOSE
WHO YOU HIRED YOU'LL NOT BE ABLE
TO HIRE FULL TIME AFTERWARDS AND
CAUSING THIS IS HAPPENING IN
MEXICO.
OVER TO YOU.
>>FRANCISCO DID A GREAT JOB BUT
IN TERMS OF THE PUERTO RICO
CONTEXT THE HEALTH CARE SYSTEM
IN PUERTO RICO HAD ALREADY BEEN
STRAINED TO THE MAX BECAUSE OF
HURRICANE MARIA AND THE
EARTHQUAKES AND HAD BEEN
PROMISED BEFORE THE NATURAL
DISASTERS BECAUSE OF THE WAY THE
SYSTEM IS FINANCED AND THERE'S
STILL EVEN AFTER HURRICANE FIONA
WHICH HIT RECENTLY HOSPITALS
WITHOUT POWER.
SURGEONS HAVING TO DO SURGERY
WITH FLASHLIGHTS.
COVID-19 MADE IT WORSE AND
EXACERBATED THE PROBLEMS WITH
THE HEALTH CARE SYSTEM.
THERE'S POLICIES THAT NEED TO BE
CHANGED IN THE UNITED STATES AND
CONGRESS IN ORDER TO IMPROVE THE
MEDICAID FUNDING AND IMPROVE THE
OVER ALL HEALTH CARE SYSTEM IN
PUERTO RICO.
>>THE RATE WAS AT 76% WHAT
AFFECT WILL IT HAVE TO ACCESS TO
HEALTH CARE AND INCREASING THE
WORKFORCE IN PUERTO RICO?
>>SO TO BE CLEAR, THAT INCREASE
IS ONLY TEMPORARY AND IT ENDS IN
DECEMBER.
HISTORICALLY THE U.S. CONGRESS
HAS RAISED THE CAP TEMPORARILY
BUT THAT CREATES AN UNSTABLE
FINANCIAL SYSTEM WHERE THE
TERRITORY DIDN'T KNOW WHEN THE
MEDICATE CAP IS GOING INCREASE
OR WHEN IT WON'T.
THIS BECOMES MORE STRESSFUL AS
IT TRIES TO RECOVER AFTER THE
NATURAL DISASTERS.
AND AS PART OF THE AFFORDABLE
CARE ACT IT'S STILL NOT
SUFFICIENT AND RUNS OUT MIDDLE
OF THE YEAR AND SO THE
TERRITORY'S ON THE HOOK FOR
PAYING THE REST OF THE BILL AND
THAT CREATES PROBLEMS WITH
ELIGIBILITY AND ACCESS TO CARE
AND PROVIDER REIMBURSEMENT.
IT MAKES THE SITUATION WORSE AND
LEADS THE TERRITORY WITH
UNSTABLE HEALTH COVERAGE.
>>THANK YOU FOR PROVIDING MORE
CONTEXT.
>>CARINA WHAT'S BEEN THE IMPACT
OF THE PANDEMIC AND THE
WORKFORCE?
I'LL GIVE YOU THE FINAL WORD.
>>FROM THE PERSPECTIVE OF THE
WORK WE'RE DOING IN TERMS OF THE
FUNCTIONS CONCENTRATED IN HUMAN
RESOURCES INCLUDING THE ISSUES
OF EDUCATION AND CLOSING THE GAP
AND MAKING SURE WHAT IS IN PLACE
IS RELATED TO THE AGAIN THE
COUNTRY HAS MAKING SURE THE
NATIONAL HEALTH AUTHORITY HAS A
ROLE AND SEEING WHERE THE FOCUS
NEEDS TO BE.
I'D SAY WHAT WE SAW DURING THE
PANDEMIC IS REDIRECTING HUMAN
RESOURCES FROM PRIMARY HEALTH
CARE AND DIFFERENT AREAS OF
SPECIALTY TO RESPONSE TO THE
COVID PANDEMIC.
IN THE CASE OF ECUADOR PERU WE
HAVE THE EXCESS DEATH RATES THE
HIGHEST IN THE WORLD BUT NOT
ONLY RELATED TO COVID AND
UNDERSTANDING WHAT HAPPENED BUT
SEEING DUPLICATION OF RATES IN
TERMS OF DIABETES, HYPERTENSION,
MATERNAL MORTALITY AND IN
ECUADOR WE SAW PROBABLY A
DUPLICATION OF THE MATERNAL
MORTALITY RATE IN THE COUNTRY.
THE FUNCTION IS BUILDING ON THE
HEALTH SYSTEM AND BUILDING
RESILIENT HEALTH SYSTEMS INCLUDE
FROM THE POINT OF VIEW OF
MONITORING AND SURVEILLANCE AND
POLICIES FINANCING AND
MEDICATIONS AND ACCESS TO HEALTH
TECHNOLOGIES AND I'LL PAUSE
BECAUSE I THINK WE SAW LACK OF
ACCESS TO VACCINES.
OUTSIDE THE AND IN TERMS OF
ACHIEVING AND BUILDING CAPACITY
AND LOOKING AT THAT SENSE.
CAN YOU STILL HEAR ME?
>>THERE'S SO MUCH THAT WE CAN
LEARN HERE IN THE U.S. AND HOW
DO WE IMPLEMENT IT TO BETTER THE
HEALTH CARE FOR LATINOS IN THE
U.S.
THANK YOU FOR YOUR PRESENTATION
AND FOR THE DISCUSSION.
I HOPE TO CONTINUE THIS
DISCUSSION AND THANK YOU SO
MUCH.
WE ARE NOW GOING TO MOVE ON TO
OUR FINAL SESSION BEING LED BY
DR. CONSTANZA CAMARGO.
>>WELCOME TO SESSION 8.
I'M AN STRINVESTIGATOR AT THE
NATIONAL CANCER INSTITUTE AND
MODERATING THE SESSION FOR
IMPROVING ACCESS TO AND CON NEWT
OF CARE FOR PERSONS FROM UNDER
SERVED OR ISOLATED COMMUNITIES.
WE HAVE DR. ARACHU CASTRO AND
ANNA LOWER INNA RUANO.
THEY'LL DESCRIBE THE RESEARCHERS
ON THE TOPIC OF INTEREST
INCLUDING SPECIFIC RESEARCH
QUESTIONS OF STUDY POPULATIONS
AND ANALYTICAL APPROACHES.
WE'LL START WITH DR. CASTRO
FOLLOWED BY DR. RUANO AND CLOSE
WITH DR. PESANTES.
DR. CASTRO, PLEASE GO AHEAD.
>>THANK YOU VERY MUCH.
>>THANK YOU FOR HAVING INVITED
ME.
WE HAVE LOOKED AT IMPROVING
CONTINUITY OF CARE FOR PEOPLE OF
UNDER SERVED COMMUNITIES IN
LATIN AMERICA FOR OVER 20 YEARS.
I HAVE FOCUSSED ON WOMEN,
CHILDREN AND ADOLESCENCE WHO
LIVE IN POVERTY AND WHEN THEY
SEEK CARE GO TO PUBLIC HEALTH
FACILITY WHICH IS ARE OFTEN
UNDER FUNDED AND NOT DESIGN TO
MEET THEIR NEEDS PARTICULARLY
WHEN THEY LIVE IN POVERTY.
GIVEN MY BACKGROUND IN MEDICAL
AANTHRO
AANTHROPOLOGY AND IN PUBLIC
HEALTH I YOU'VE RESEARCH
INSTRUMENTS THAT RELY ON
QUALITATIVE AND QUANTITATIVE
APPROACHES.
THIS ALLOWS ME TO ADDRESS MY
RESEARCH QUESTION FROM AN IN
DEPTH PERSPECTIVE AND THIS
ALLOWS PLEA TO ESTABLISH
STRONGER ASSOCIATIONS BETWEEN
OBSERVATIONS.
I LED A MULTI-COUNTRY INITIATIVE
IN MY RESEARCH TO INFORM HOW TO
INTEGRATE PRENATAL CARE WITH THE
CARE OF HIV AND SYPHILIS SO
WOMEN WITH HIV AND/OR SYPHILIS
CAN BE THE FOCUS OF HEALTH
POLICIES AND MEDICAL CARE FOR
THEIR OWN HEALTH AND NOT JUST TO
PREVENT TRANSMISSION TO THE
CHILD.
I HAVE CONDUCTED RESEARCH TO
IDENTIFY THE CAUSES OF MATERNAL
MORTALITY SUCH AS IN THE
DOMINICAN REPUBLIC AND PERU AND
I FOCUSSED IN AREAS INFORMING
POLICY MAKERS AND IMPROVING THE
QUALITY AND TIMELINESS OF CARE.
I HAVE WORKED ON THE
MISTREATMENT AND BIAS TO
UNDERSTAND THE ASSOCIATION WITH
MATERNAL AND NEWBORN HEALTH
OUTCOMES AND I HAVE CONDUCTED
RESEARCH ON THE INTERDIRECT
AFFECTS OF THE PANDEMIC ON
HEALTH CARE ACCESS FOR WOMEN,
CHILDREN AND ADOLESCENTS AND THE
IMPACT ON HEALTH OUTCOMES.
FOR EXAMPLE, WE HAVE FOUND
INCREASE IN MATERNAL MORTALITY
IN THE COUNTRIES FOR WHICH WE
HAVE DATA.
AND LOOKED AT THE ASSOCIATION
BETWEEN CULTURAL PRACTICES SUCH
AS CHILD REARING AND EXPOSURE TO
ADVERSE OUTCOMES AND EXPERIENCE
ADVERSE EXPERIENCES AND EARLY
CHILDHOOD DEVELOPMENT.
AREA IS OF PARTICULAR RELEVANCE
FOR THE PREVENTION OF NCDs GIVEN
THE ASSOCIATION BETWEEN EARLY
CHILDHOOD DELAY AND THE CHRONIC
HEALTH CONDITIONS IN ADULTHOOD
AND SHORTER LIFE SPANS.
IN ALL CASES WE'RE WORKING ON
ANOTHER PROJECT AS WELL AND
WANTED TO HIGHLIGHT THESE THREE.
IN ALL THE CASES AN APPROACH MY
RESEARCH QUESTIONS WITH THE
HEALTH EQUITY PERSPECTIVE
FOCUSSING ON HOW SOCIO ECONOMIC
CONDITION AFFECTS EXPOSURE TO
ADVERSE HEALTH OUTCOMES AND
ACCESS TO TIMELY DIAGNOSIS AND
TREATMENT.
THANK YOU VERY MUCH.
>>THANK YOU.
VERY COMPREHENSIVE AGENDA.
DR. RUAN, THANK YOU.
>>THANK YOU.
I'M A SOCIOLOGIST.
I FOCUS AND MY Ph.D. IS IN
PUBLIC HEALTH.
I FOCUS ON COMMUNITY
PARTICIPATION AND PARTICULARLY
HOW TO STUDY AND WORK WITH
INDIGENOUS PEOPLE AND I STUDY
RACISM, DISCRIMINATION AND ABUSE
AND HOW THAT IMPACTED THEIR
ACCESS TO HEALTH CARE.
ONE OF MY FOCUS IS ON HEALTH
SYSTEM GOVERNANCE AND COMMUNITY
AND SOCIAL PARTICIPATION AND HOW
HEALTH SYSTEMS CAN BECOME MORE
RESPONSIVE AND RESILIENT THROUGH
COMMUNITY PARTICIPATION AND HOW
DECISION PROCESSES CAN IMPROVE
AND HOW CAN IT IMPROVE THE
QUALITY OF CARE INDIGENOUS
PATIENTS RECEIVE.
THE STUDY POPULATION IS
INDIGENOUS PEOPLE PARTICULARLY
THE MAYA AND WORK WITH
CULTURALLY SENSITIVE
INTERVENTIONS TO WORK TOGETHER
AND HAVING INDIGENOUS PEOPLE
LEAD THE PROCESS.
FINALLY, MY ANALYTICAL APPROACH
IS A POWER THEORY ONE.
I UNDERSTAND POWER AS BOTH
CONFLICT AND AGENCY.
AS CONFLICT I UNDERSTAND IT AS A
WAY TO GO INTO THE DECISION
MAKING PROCESSES AND IMPACT
HEALTH POLICY AND AS AGENCY WHEN
WE WORK WITH COMMUNITIES TO MAKE
THEM REALIZE THEY THEMSELVES ARE
POWER HOLDERS.
THANK YOU.
>>THANK YOU.
DR. PESANTES.
>>GOOD AFTERNOON.
I'M ALSO VERY PLEASED TO BE HERE
AND BE ABLE TO SHOW SOME OF THE
RESEARCH EXPERIENCE I HAVE
ACCOUPLE LATED MOSTLY WORKING
IN -- ACCUMULATED WORKING IN
PERU.
ACTUALLY, I CONDUCT RESEARCH
WITH TWO TYPES OF VULNERABLE
POPULATIONS.
I HAVE MY RESEARCH IN WORKING
WITH INDIGENOUS PEOPLE FROM THE
PERUVIAN AMAZON AND DEAL WITH
PEOPLE LIVING WITH CHRONIC
CONDITIONS SUCH AS DIABETES AND
HYPERTENSION AND SOME THAT ARE
THE RESULT OF INFECTIOUS
DISEASES AND WITHIN THE GROUP OF
PEOPLE LIVING WITH CHRONIC
CONDITIONS I AM INTERESTED IN
THE INTERSECTION OF MASCULINITY
AND HEALTH AND THERE'S NOT A LOT
OF IN LATIN AMERICA.
WITH INDIGENOUS PEOPLE MOST THE
RESEARCH AND LOOKING AT THE
INITIATIVES THAT INDIGENOUS
PEOPLE ARE THE DEVELOPING TO BE
ABLE TO ADDRESS THE CHALLENGES
TO MAKE THEIR MEDICAL SYSTEMS
RECOGNIZE AND ACCEPTED AND
INCORPORATED IN THE PUBLIC
HEALTH SERVICES AND INTERESTED
IN UNDERSTANDING THE POLICIES
AND HOW THEY ARE RELEVANT FOR
ENGAGING WITH THE WAY THE
INDIGENOUS PEOPLE FRAME THEIR
DEMANDS.
IN TERMS OF THE RESEARCH WITH
PEOPLE WITH DIABETES I ALSO AM
AN ANTHROPOLOGIST AND FIRST I
LOOK AT THE EXPERIENCES OF
MANAGING DIABETES AND MORE FROM
THE PERSPECTIVE OF HOW THEIR
LIVES ARE DISRUPTED AND HOW THEY
HAVE TO CHANGE THE WAY THEY
THINK ABOUT THEMSELVES AND THE
RELATIONSHIP WITH THEIR FAMILIES
AND IT'S IMPORTANT TO
INFORMATION THE EXPERIENCES ARE
FRAMED BY THE FACT THE HEALTH
SYSTEM IS NOT REALLY PREPARED TO
ADDRESS THE NEEDS OF PEOPLE WITH
CHRONIC CONDITIONS BECAUSE MOST
THE PUBLIC HEALTH BUDGET AND
PRIORITIES ARE MATERNAL HEALTH
OR INFECTIOUS CONDITIONS.
THAT FRAMES THE EXPERIENCE.
MY RESEARCH WAS GEARED TOWARDS
THE HEALTH SYSTEMS APPROACH.
THAT'S SOMETHING THAT IS HAS
OPENED A LOT OF MY VIEWS ABOUT
THE IMPORTANCE OF HAVING A
BETTER SENSE OF THE CONTEXTUAL
FACTORS THAT ALSO CONSTRAIN NOT
ONLY PATIENTS BUT AFFECT THE
HEALTH CARE PROVIDER AND HOW
THEY CAN PROVIDER CARE AND THEY
WANT TO PROVIDE NOT ALWAYS
UNDERSTANDING THE POLICIES IN
PLACE AND WHETHER DIABETES IS A
PRIORITY ARE NOT FOR THE
MINISTRY OF HEALTH OR NOT AND
WHAT KIND OF TRAINING THEY
RECEIVE IN SCHOOL AND WHAT IS
AVAILABLE FOR PATIENTS AND
MEDICATIONS AVAILABLE FOR THE
PATIENTS.
THAT'S THE APPROACH I'M USING
AND HAVING THE COMPREHENSIVE
VIEW OF THE HEALTH SYSTEM TO
BETTER UNDERSTAND WHERE HEALTH
CARE WORKERS COME FROM AND THE
EXPERIENCE OF PATIENTS THAT IS
NOT ALWAYS WELCOME IN HEALTH
CARE SERVICES.
THANK YOU.
>>THANK YOU FOR DESCRIBING YOUR
RESEARCH PROGRAM.
IT'S NICE HOW YOU THREE ARE
COMPLIMENTARY AND HOW
COMPREHENSIVE AND THE DIFFERENT
DOMAINS YOU ADDRESS.
CONGRATULATIONS.
WE'LL MOVE TO THE FIRST ROUND OF
QUESTIONS AND WE HAVE INTEREST
IN TWO TOPICS.
I'M GOING TO MERGE THEM.
THE QUESTION IS WHETHER THE
MEND -- METHODOLOGICAL STRUCTURE
CHANGES WITH DIFFERENT
POPULATIONS.
DR. PESANTES.
>>COMING FROM MY VIEW POINT YOU
NEED A SENSE OF THE POPULATION
YOU'RE WORKING WITH AND THAT
MEANS TIME OR HAVING
INTERACTIONS WITH THE POPULATION
AND I THINK WORKING WITH
INDIGENOUS PEOPLE ONE OF THE
THINGS THAT IS ESSENTIAL FOR
DOING RESEARCH WITH THEM IS TO
BE AWARE OF THE ORGANIZATION
THAT THEY OPERATE UNDER.
FOR EXAMPLE, IN THE PERUVIAN
AMAZON THERE'S DIFFERENT
ORGANIZATIONS.
IF YOUR GOING TO GO AND
INTERESTED IN DOING RESEARCH
WITH THEM YOU NEED TO OBTAIN THE
NECESSARY PERMISSIONS TO MAKE
SURE THEY'RE AWARE OF YOUR AND
CREATE A SPACE WHERE YOU CAN
RECEIVE THE OPINIONS EVEN IF
IT'S CRITICAL AND HAVING A SPACE
IN WHICH YOU UNDERSTAND IN WHAT
WAYS CAN YOU SHARE RESULTS OR
THINGS YOU CAN DO.
SOMETIMES THERE'S CONSTRAINTS
BUT I THINK IT'S IMPORTANT FOR
RESEARCHERS WORKING WITH THIS
KIND OF POPULATIONS TO FIND
SPACES FOR FLEXIBILITY AND
ADVOCATE FOR THAT WITH FUNDING
AGENCIES BECAUSE IT'S IMPORTANT
TO MEET PEOPLE HALFWAY.
SOMETIMES WE'VE ALLOCATED INTO
TRANSLATING OR POLICY BRIEFS
GEARED TOWARDS ANOTHER
STAKEHOLDER AND IF THERE'S ONE
FOR INDIGENOUS PEOPLE TO SUPPORT
THEIR ABILITIES LET'S DO IT THE
BEST WAY POSSIBLE.
THAT'S SOME OF THE MOST
IMPORTANT CONSIDERATION AND TO
BE CAREFUL IN LATIN AMERICA AND
THIS APPLIES TO OTHER SITUATIONS
NOT TO GROUP TOGETHER VULNERABLE
PEOPLE.
YOU NEED TO BE AWARE THERE'S
DIFFERENT HISTORIES OF
MARGINALIZATION AND THEY HAVE
DIFFERENT WAYS OF FRAMING HEALTH
NEEDS AND AND YOU NEED TO BE
SENSITIVE TO THOSE DIFFERENCES
BECAUSE OFTEN TIMES PEOPLE SAY
I'M GOING TO DO AN INTERVENTION
WITH VULNERABLE PEOPLE AND YOU
HAVE A BLANKET IDEA AND IT'S
IMPORTANT TO PAY ATTENTION TO
THE DIFFERENCES IN THE LATIN
AMERICA CONTEXT OF DIFFERENT
VULNERABLE GROUPS AND ETHNIC
MINORITIES.
AND I SHARE THE LANGUAGE IN MANY
CASES AND MY FIRST LANGUAGE IS
SPANISH BUT I'M FROM SPAIN AND I
LOOK VERY DIFFERENT FROM MANY
PEOPLE WITH WHOM I WORK IN THE
CARIBBEAN FOR EXAMPLE IN
SPANISH-SPEAKING CARIBBEAN AND I
UNDERSTAND THAT I ALSO ARE COME
FROM MY U.S.-BASED INSTITUTION
I'M OFTEN PERCEIVED AS A PERSON
OF PRIVILEGE AND PAY ATTENTION
TO THAT INTERACTION.
I ALSO PAY ATTENTION TO THE ROLE
WOMEN HAVE IN SOCIETY AND FOR
EXAMPLE IN LATIN AMERICA I HAVE
OBSERVED ONCE A WOMAN GIVES
BIRTH SHE'S PLACED TO A
SECONDARY ROLE IN THE CONTINUUM
OF CARE THOUGH POSTPARTUM IS
IMPORTANT FOR SURVIVAL AND
INCLUDING IN UNITED STATES THE
REPRODUCTIVE RIGHTS OF WOMEN ARE
SHAPED BY OTHERS AND IT'S VERY
IMPORTANT I AM AWARE OF THE
RIGHTS OF PEOPLE AND NEED TO
NAVIGATE THAT AND I CAN PROVIDE
EXAMPLES HOW I HAVE DEALT WITH
ISSUES OF TRAUMA OR VIOLENCE BY
STUDY PARTICIPANTS.
FOR EXAMPLE, I HAVE CONDUCT ED
INTERVIEWS WITH WOMEN AND MEN
SUCH AS HIV FOR EXAMPLE IN
SETTINGS OF LIMA AND THOUGH I
WASN'T DIRECTLY ASKING THEM
ABOUT THEIR ENCOUNTERS WITH
VIOLENCE I HAVE SHOWN INTEREST
IN INTERVIEWING PEOPLE AND I
THINK THE FACT I HAVE SHOWN
GENUINE INTEREST IN
UNDERSTANDING THE LIFE
TRAJECTORY HAS ALLOWED THEM TO
SHARE WITH ME LOTS OF INSTANCES
OF HAVING SUFFERED VIOLENCE FROM
CLOSE FAMILY MEMBERS, FOR
EXAMPLE.
THAT WAS A TIME WHEN I WAS
HELPING PEOPLE WITH INFECTIOUS
DISEASE AND THERE WERE TIMES IT
WAS PREVALENT EVEN WHEN IT
WASN'T IN MY STRUCTURED
QUESTIONS BUT CAME OUT OFTEN AND
WHEN IT HAPPENS AND MORE
DIFFICULT FOR THEM AND IT'S
IMPORTANT WE SHOW EMPATHY AND
I'M NOT A ROBOT AND IT'S
IMPORTANT THAT WE SHOW
PARTICIPANTS WE CARE ABOUT THEM
AND WHY WE DO RESEARCH.
IT DIDN'T HURT THE RESEARCH
OUTCOMES TO SHOW EMPATHY FOR THE
PEOPLE WE STUDY.
IN THE DOMINICAN REPUBLIC I PLAN
TO USE FOR THE FIRST TIME
COMPUTER-ASSISTED INTERVIEWS.
WE AND WE HAVE WE ARE STUDYING
DIFFERENT FACTORS ASSOCIATED
WITH EARLY CHILDHOOD DELAY IN
THE CONTEXT OF POVERTY AND WE'RE
PLANNING TO VISIT PEOPLE IN
THEIR HOMES WE WANT TO TEST A
TABLET WHICH HAS CONNECTED WITH
HEADSETS SO NOBODY ELSE IS
LISTENING TO THE QUESTIONS AND
TAKING INTO ACCOUNT THE SETTINGS
OF POVERTY SO THE WOMEN CAN
LISTEN TO THE QUESTIONS IN WAYS
THAT ARE EASY TO PROVIDE HER
RESPONSES.
WE ARE PRESERVING THE
CONFIDENTIALITY OF HER RESPONSES
EVEN IF SHE'S SURROUNDED BY
OTHERS AND I THINK IT'S A GOOD
APPROACH TO PREVENT THEM FROM
BEING FRIGHTENED BY FAMILY
MEMBERS WHO MAY FIND OUT THEY
SHARED INSTANCES OF VIOLENCE AND
WE'RE GOING TO TEST IT BUT IT'S
INTENDED TO OBTAIN THE
INFORMATION IN AN ENVIRONMENT
THAT PROVIDES THEM THE TRUST
THEY NEED TO SHARE SENSITIVE
INFORMATION.
IT'S IMPORTANT TO TAKE INTO
ACCOUNT CULTURE AND THE FACT
THAT PEOPLE WHO LIVE IN POVERTY
HAVE DIFFERENT NEEDS WE HAVE AS
RESEARCHERS AND WE NEED TO
UNDERSTAND WHERE THEY ARE TO
BETTER DO OUR RESEARCH.
>>THANK YOU.
>>UNLIKE MY COLLEAGUES IN THIS
SESSION I'M NOT AN
ANTHROPOLOGIST BUT I'M A
SOCIOLOGIST AND WORK WITH
POPULATIONS IN DIFFERENT WAYS.
I START MY APPROACH FROM A
DIFFERENT STANDPOINT.
TODAY I WOULD LIKE TO TALK ABOUT
FOUR METHODOLOGICAL CONDITIONS.
WHO AM I CONDUCTS THE RESEARCH
FOR?
THIS UNDERSTANDING REQUIRES A
GROUNDED COMPREHENSIVE CONTEXT
AND HOW THAT LED TO THE
VULNERABILITY AND THE EXCLUSION
OF THE POPULATIONS THAT I WORK
WITH.
ALSO WHEN I ASK MYSELF WHO IS
THE RESEARCH FOR IT HELPS ME
UNDERSTAND THE PYRAMID OF
EVIDENCE AND SOMETHING
SOCIOLOGISTS AND PUBLIC HEALTH
PEOPLE HEADLINE ON TO TIGHTLY
MAY NOT BE THE BEST THING TO
GUARD MY RESEARCH.
FOR MY SECOND CONSIDERATION, IF
MY RESEARCH IS FOR COMMUNITY,
THEN HOW DO I RESEARCH WHAT THEY
NEED TO KNOW?
HOW DO I COME TO AN
UNDERSTANDING OF WHAT MATTERS TO
THEM AND THIS REQUIRES BUILDING
LONG-STANDING RELATIONSHIPS
BASED ON TRUST WHERE I'M NOT
APPROACHING THE WORK AS AN
EXPERT BUT MORE AS THE PERSON
COMING TO AN UNDERSTANDING TO
GET THE EXCLUSION AND
VULNERABILITIES THAT AFFECT THEM
AND HOW THEY CAN WORK WITH THEM
OR UNDERSTAND THEM TO GAIN
HIGHER LEVELS OF POLITICAL
CONSCI
CONSCIOUSNESS.
MY THIRD CONSIDERATION IS HOW
CAN COMMUNITIES DECIDE WHAT WE
NEED TO KNOW?
BECAUSE VULNERABLE COMMUNITIES
AGAIN THE EXAMPLE OF THE MAYA
DON'T HAVE ACCESS TO A LOT OF
EDUCATION THEY MAY NOT
UNDERSTAND WHAT I'M TRYING TO
FIND OUT AND SO HOW DO AN
APPROACH THIS IN A NON-CON DA
SENDING WAY?
HOW DO I BUILD THE SKILLS TO
COMMUNICATE WHAT MATTERS TO THEM
AND BUILD THE SKILLS INSIDE
MYSELF TO UNDERSTAND WHAT THEIR
WORK MEANS BECAUSE MAYBE THEY
DON'T KNOW HOW THIS AND IN OUR
WORK IN GUATEMALA WE FOUND
INDIGENOUS LANGUAGES DIDN'T HAVE
A WORD FOR RACISM OR ABUSE OR
DISCRIMINATION AND WE HAD TO
WORK WITH ANTHROPOLOGISTS TO
UNDERSTAND WHAT WORDS THEY USE
AND WHAT MATTERS TO THEM AND
BUILD CONSCIOUS NESS OF
UNDERSTANDING THEY'RE RIGHTS
HOLDERS AND IN THAT WAY WE COME
TO UNDERSTAND WHAT MATTERS MOST
TO THE COMMUNITY.
MY THIRD METHODOLOGICAL
CONSIDERATION IS HOW CAN WE
BUILD THE KNOWLEDGE AND MY
FOURTH, HOW CAN WE AFFORD
AWKWARD ACCOUNTABILITY TRAPS AND
GENERATING THE KIND OF KNOWLEDGE
ONLY USEFUL TO MY FUNDER OR TO
THE EDITORS FOR THE JOURNAL I'M
WRITING FOR OR PEERS AND THAT'S
NOT USEFUL FOR THE COMMUNITIES
I'M RESEARCH.
HOW CAN I PRODUCE ACTIONABLE
KNOWLEDGE.
NOT FOR ME TO PUBLISH BUT
PRODUCE INFORMATION USEFUL FOR
THEM IN THE BATTLES THEY HAVE TO
CONFRONT WHEN THEY'RE TRYING TO
GOOD QUALITY CARE AND TRYING TO
APPROVE A CULTURALLY INSENSITIVE
HEALTH SYSTEM?
WHEN THEY'RE OUTSIDE THEIR
CULTURAL SYSTEM EVEN OUTSIDE OF
GUATEMALA, WHAT IS THE KNOWLEDGE
WE NEED TO GENERATE FOR THEM TO
TRANSLATE THE KNOWLEDGE INTO
ACTION AND IMPACT HEALTH POLICY
BECAUSE AT THE END OF THE DAY
EVERYONE AS THE IN PUBLIC HEALTH
OR GLOBAL HEALTH IS TRYING TO
GET SOME SORT OF INFLUENCE OR
IMPACT INTO POLICY.
DO I WANT TO IMPACT BECAUSE I
HAVE MY OWN AGENDA OR UNDERSTAND
WHAT THE AGENDA OF THE
COMMUNITIES I RESEARCH IN ARE
AND HOW CAN I HIGHLIGHT THAT AND
HOW CAIN GIVE INFORMATION THEY
CAN ACT UPON?
THANK YOU.
>>THANK YOU FOR SHARING YOUR
SYSTEMATIC APPROACH.
WE'LL SWITCH FLNOW TO INDEPENDE
QUESTIONS.
DR. RUE -- RUANO.
>>THE POPULATIONS IN THE UNITED
STATES, MIGRANTS ARE BEING
PUSHED INTO SECOND TIER AND
THIRD-TIER CITIES THAT DON'T
HAVE THE RESOURCES OR CAPACITY
TO PROVIDE CARE TO THE
VULNERABLE PEOPLE COMING FROM
RURAL AREAS THAT HAVE NEVER BEEN
IN AN URBAN AREA AND THIS
DISASSOCIATES THEM FROM THEIR
CULTURE AND CULTURAL BELIEFS
WHILE THERE'S FORCES HAPPENING
THAT ARE PUSHING THE PEOPLE IN
THOSE SECOND AND THIRD-TIER
CITIES INTO FIRST-TIER CITIES.
THEY'RE NOT PREPARED AND DON'T
HAVE SOCIAL CAPITAL OR CULTURAL
CAPITAL AND SO WHAT DO WE HAVE
TO DO TO UNDERSTAND THE
RESOURCES WE NEED AND
EXPERIENCES OF THEIR OWN
POPULATIONS.
THE MOST VULNERABLE GO TO PLACES
THAT HAVE NOTHING FOR THEM
BECAUSE THE PEOPLE IN THOSE
CITIES ALREADY LEFT.
HOW CAN WE BUILD LANGUAGE AND
CULTURAL SKILLS AND THAT'S NOT
HOUSING OR SCHOOLS OR JOBS FOR
THE SKILLS THEY HAVE AND THERE'S
ILLEGAL CHARGES IN GUATEMALA AND
SERVICES AREN'T FREE AT THE
POINT OF SERVICE IN THE UNITED
STATES EITHER.
THESE TURN INTO BIG CHALLENGES
FOR THE PROVIDERS AND HOW DO WE
MAKE HEALTH SYSTEMS MORE
RESPONSIVE AND WE NEED TO
UNDERSTAND HOW THE BARRIERS FEEL
TO THE MIGRANTS LEAVING THESE
TRADITIONAL CONTEXT AND ALL OF A
SUDDEN ARE STUCK IN THE WHERE
WE'RE ALL COHORTED AND NO LONGER
IN MULTI-GENERATIONAL
HOUSEHOLDS.
LEARNING DOESN'T HAPPEN IN THE
HOUSEHOLD BUT OUTSIDE THE
SCHOOL?
HOW DOES THAT STRUCTURE CHANGE
AND IMPACT THE VALUES OF THE
CULTURES.
>>WE'LL SWITCH TO DR. PESANTES.
THE QUESTION IS WHAT ARE CHANGES
THAT COULD BE INTRODUCED TO
REDUCE GAPS IN HEALTH CARE
ACCESS?
>>I'M GOING TO MAKE A
CONNECTION BETWEEN WHAT I WAS
TALKING ABOUT EARLIER ABOUT THE
DIFFERENT WAYS I WAS DOING DOING
RESEARCH WITH PEOPLE WITH
CHRONIC CONDITIONS.
I MOVED FROM FOCUSSING ON
EXPERIENCES AND MANAGING HEALTH
CONDITION AND THE INTERACTION
WITH THE HEALTH SYSTEM AND THEN
IT TOOK ME TO HAVING THE
APPROACH OF UNDERSTANDING THE
HEALTH SYSTEM AS A WHOLE.
AND I THINK ONE OF THE THINGS I
HAVE LEARNED IN THE PROCESS IS
THAT WE NEED TO UNDERSTAND THE
CONTEXT IN WHICH HEALTH SERVICES
THE HEALTH SYSTEM CONTEXT IN
WHICH SERVICES ARE PROVIDED.
AND I WAS CONDUCTING RESEARCH TO
TREATMENT AND DIAGNOSIS AND
FOLLOW-UP TREATMENT WITH PEOPLE
IN THE PERUVIAN AMAZON AND
TRYING TO UNDERSTAND THE MOST
IMPORTANT GAPS FOR ACCESSING
THIS CARE.
AND WE FOUND OUT THEY HAD TO USE
CANDLES TO FIX THINGS AND ALSO
ADDITIONAL CHALLENGE WAS THEY
HAVE TO SEND THE SAMPLES TO THE
NEAREST TOWN WHERE THEY HAD A
LAPSE.
THE SAMPLES WAS IN THIS BOX BUT
THEY HAVE TO ACT AS A FAVOR TO
THE BOAT DRIVER TO TAKE IT SO
THERE WAS NOT A SYSTEM IN PLACE
FOR THE SAMPLES TO BE REACHED IN
TIME.
AND ONCE THEY REACHED THE SAMPLE
THEY WERE GOOD ENOUGH AND THE
LAB TECHNICIAN WAS THERE AND
THEY CAN SEE THE DELAYS AND IT
AFFECTS THE WAY IN WHICH HEALTH
CARE AND THE TRUST PEOPLE HAVE
AND THE RELATIONSHIP PEOPLE CAN
BUILD WITH THEM AND ALSO AND
HEALTH CARE WORKERS WHAT HAVE
BEEN TRAINED IN MY COUNTRY WHERE
THE EMPHASIS WAS ON CHRONIC
CONDITIONS SOMETIMES THEY DON'T
TREAT CERTAIN THINGS BECAUSE
THAT WAS NOT THE TRAINING YOU
RECEIVED.
IN ADDITION TO THE CULTURAL
DIFFERENCES WITH THE LOCAL
POPULATIONS AND I FEEL THE WAYS
WE CAN TRY TO REDUCE THE GAPS IS
TRYING TO UNDERSTAND BETTER AND
DO BE THE HEALTH EDUCATION THE
HEALTH WORKERS RECEIVED BOTH
DURING THEIR YEARS IN MEDICAL
SCHOOL OR NURSING SCHOOL OR WHEN
THEY BECOME MIDWIVES AND ONCE
THEY ARE PART OF THE PUBLIC
WORKFORCE WHERE THE MINISTRY OF
HEALTH SHOULD HAVE RESOURCES TO
MAKE SURE THEY ARE PREPARED IN
THE WHOLE SENSE OF THE WORD TO
BE ABLE TO REALLY WORK UNDER THE
DIFFICULT SITUATION AND WITH
POPULATIONS THAT DON'T HAVE A
GREAT RELATIONSHIP WITH THE
PUBLIC HEALTH SYSTEM.
THAT WOULD BE AN INTERVENTION
THAT COULD REDUCE GAPS IN HEALTH
CARE.
>>HOW CAN RESEARCH HELP TO
IMPROVE GAPS IN ACCESS TO
CERTAIN POPULATIONS?
WHEN WE CONDUCT WE HAVE THE
OPTION TO ADDRESS ISSUES AND
PRODUCE ACTIONABLE KNOWLEDGE AND
WITH THE DATA WE GENERATE WE CAN
FOR EXAMPLE RENDER ISSUES THAT
MAY NOT SEEM RELEVANT WHEN WE
WORK AT NATIONAL AVERAGES BUT
BECOME AND SEGREGATE THE DATA BY
SOCIAL ECONOMIC POSITION OR
STATUS OR OTHER FORMS OF D
DISAGGREGATION AND WITH RESEARCH
WE CAN IDENTIFY ISSUES THAT MAY
BE UNDER LOOKED OR CONSIDERED
ANECDOTAL SUCH AS THE HIGHER
PREVALENCE OF CERTAIN HEALTH
CONDITIONS AMONG CERTAIN
POPULATIONS OR THE HIGH
PREVALENCE OF MISTREATMENT IN
HEALTH CARE FACILITIES.
PARTICULARLY FOR PEOPLE WHO
BELONG TO ETHNIC MINORITY GROUPS
IN THE MINORITY IN THE SENSE OF
NOT NECESSARILY BEING A SMALLER
NUMBER.
AS DR. RUAN MENTIONED EARLIER I
INTERUSE WO UUSE -- INTERVIEWE
WHO EXPERIENCED VIOLENCE AND
DON'T USE THE TERMS AND EXPLAIN
IT IN DIFFERENT TERMS AND I HAVE
TO UNDERSTAND THEIR EVERYDAY
EXPERIENCE SOMETIMES LEADS THEM
TO NORMALIZE THEIR EXPERIENCE
AND WHAT HAPPENS TO THEM IN A
HEALTH CARE SETTING.
EVEN IF THEY'RE USING DIFFERENT
TERMS OR IF THEY ARE HAPPY THEY
SURVIVED THE BIRTH EXPERIENCE
AND HAD A CHILD WHO IS ALIVE
THERE IS STILL ISSUES THAT THEY
ENCOUNTER IN HEALTH CARE
FACILITIES THAT MADE THEM
UNCOMFORTABLE OR FEEL THEY'RE
BEING DISRESPECTED.
THOUGH IN THE SETTINGS WHERE I
HAVE STUDY THE PHENOMENON,
EVERYBODY KNOWS THOSE THINGS
HAPPEN AND IT'S AT THE ANECDOTAL
LEVEL IT'S IMPORTANT AS
RESEARCHERS TO TALK ABOUT HOW
OFTEN THAT HAPPENS AND NOT ALL
DO THIS AND THERE'S CERTAIN
TREATMENT AND THOSE ACTIONS CAN
BE ASSOCIATED NOT ONLY ON ONE
HAND TO PROVIDING CARE THAT IS
NOT TAKING THE PEOPLE WITH NOT
TREATING THE PEOPLE WITH DIGNITY
BUT ALSO IT COULD BE ASSOCIATED
WITH ADVERSE HEALTH OUTCOMES AND
WE SHOULD UNDERSTAND THEY HAVE
THE POWER TO REVERSE THOSE
ISSUES SO RESEARCH CAN HELP
HIGHLIGHT ISSUE WHAT IS
CONSIDERED ANECDOTAL.
ONCE WE PROVIDE THE DATA THEY
BECOME PUBLIC HEALTH ISSUES AND
THEY CAN BE ADDRESSED AND THAT'S
THE WE CAN DO AND I LIKE TO DO
THAT TYPE OF RESEARCH.
THANK YOU.
>>I SEE WE HAVE TIME FOR ONE
ADDITIONAL QUESTION SO I'LL
SELECT A COMMON ONE.
WOULD YOU SUGGEST A POTENTIAL
RESEARCH OPPORTUNITY IT COULD BE
A RESEARCH QUESTION AND
SPECIFICALLY A STUDY OF AN
INTERVENTION THAT CAN BE
CONDUCTED IN LATIN AMERICA
POPULATIONS TO REDUCE HEALTH
CARE DISPARITIES AMONG HISPANIC
LATINOS IN THE U.S.
DR. PESANTES AND DR. RUAN AND
DR. CASTRO.
>>IT'S RELEVANT TO HAVE THE
OPPORTUNITY TO DOING RESEARCH
THAT IS CLOSE TO EACH OTHER AND
TRYING TO UNDERSTAND WHERE THE
STANDARDIZED MEASURED OFTEN USED
IN PUBLIC HEALTH ARE REALLY
CAPTURIING WHAT THEY CLAIM TO.
AND LOOKING AT THE TREATMENT AND
LOOKING AT WHAT'S BEEN VALIDATED
IN POPULATIONS AND WHEN WE DO
RESEARCH IN LATIN AMERICA WE
FIND OURSELVES USING THE
MEASURES BECAUSE WE KNOW WE WANT
TO PUBLISHING, WE WANT TO ALSO
POSITION OURSELVES AS
RESEARCHERS BUT WE'RE AWARE THE
MEASURES OFTEN TIMES ARE NOT
MEASURING WHAT THEY'RE SUPPOSED
TO AND WE COULD INVEST TIME IN
ORDER TO PRODUCE BETTER OUTCOMES
FOR IMPROVING THE HEALTH CARE
SERVICES AND MAKING SURE THE
MEASURES ARE VALID FOR OUR
POPULATIONS AND ARE MEASURING
WHAT WE WANT TO MEASURE AND
THAT'S ONE KIND OF RESEARCH I
THINK WOULD BE USEFUL.
AND THE OTHER ONE IS FROM A
QUALITATIVE PERSPECTIVE RESEARCH
ON THE EXPERIENCE OF THE MIGRANT
WITH SEXUAL REPRODUCTIVE HEALTH
CARE SERVICES AND THOSE WHO GO
FOR PRENATAL CARE OR
CONTRACEPTION AND ONE OF THE
THINGS IN THE INTERVIEWS WE
REALIZED IT WAS IMPORTANT TO GET
A SENSE OF WHAT WAS THEIR PAST
EXPERIENCE IN VENEZUELA WITH THE
HEALTH CARE FACILITIES AND HOW
THAT EXPERIENCE SHAPED THE WAY
THEY LOOK AT HEALTH CARE
FACILITIES IN PERU AND WHAT THEY
WERE EXPECTING FROM ME.
I THINK IF WE CAN EXTRAPOLATE
THAT RESEARCH FINDING WITH
RESEARCH IN THE UNITED STATES WE
NEED TO UNDERSTAND WHAT DO USERS
OF HEALTH CARE FACILITIES HOW DO
THEY VIEW THIS AND WHAT THEY
EXPECT AND HOW DO HEALTH CARE
PROVIDERS SERVE THE POSITION AND
UNDERSTAND THE TWO VIEWS IN
ORDER TO GET A SENSE OF HOW DO
WE DESIGN AN INTERVENTION THAT
TAKES INTO CONSIDERATION THE
EXPECTATIONS AND VALIDATE THEIR
OWN NEEDS AND VALIDATE THEIR
PERSPECTIVES OF WHAT THEY'RE
ENTITLED TO WHEN THEY SEEK CARE.
>>GREAT SUGGESTIONS.
>>I WOULD LIKE TO BUILD ON WHAT
WAS SAID.
I THINK WHAT'S IMPORTANT IS WE
LOOK AT HEALTH SYSTEM GOVERNANCE
AND PARTICIPATION.
HOW ARE PEOPLE SHAPING THE
HEALTH SYSTEM TAKING CARE OF
THEM AND WHO ARE THE ACTORS
SHAPING.
WE NEED TO UNDERSTAND WHO HAS
POWER AND POWER IN DECISION
MAKING AND POLICY AND WHO HAS
POLICY IN IMPLEMENTING THE
POLICIES AND HOW THAT RELATES TO
THE VULNERABLE POPULATIONS WE'RE
LOOKING AT BEING INDIGENOUS
PEOPLE OR THE VENEZUELANS ONE OF
THE WORLD'S LARGEST HUMANITARIAN
CRISIS NOW AND I KNOW PERU IS
THE SECOND COUNTRY AND YOU HAVE
MORE THAN A MILLION VENEZUELANS
IN YOUR COUNTRY AND WE DID A
STUDY WITH ONE OF MY STUDENTS
HOW YOU INTEGRATE VENEZUELANS IN
THE SYSTEM AND YOU HAVE TO LOOK
AT ACTORS THAT HAVE POWER IN
MAKING POLICY.
WE WEREN'T INCLUDING AN OF THE
VENEZUELANS OR COLLECTIVE ACTORS
BECAUSE THEY DIDN'T HAVE POWER
IN IMPACTING HOW THEY WOULD GET
ACCESS TO HEALTH INSURANCE OR TO
THE BASIC ACCESS TO THE HEALTH
SYSTEM.
WHAT MATTERS TO THE POPULATION
IS IMPORTANT AND ANTHROPOLOGIC
PERSPECTIVES ARE IMPORTANT AND
WHEN WE COME FROM SOCIAL
SCIENCES WE MAY BE COMING FROM A
PLACE OF POWER AND PRIVILEGE AND
NOT UNDERSTAND HOW OTHER PEOPLE
CANNOT SPEAK.
SO WE ALSO NEED TO UNDERSTAND
EMPLOYMENT AND HOUSING.
WHERE DO DIFFERENT GROUPS LIVE
AND WORK AND HOW IS THAT
RELATED.
HOW DO PEOPLE GET TO GOOD
QUALITY HEALTH CARE.
HOW DO THEY RECEIVE GOOD QUALITY
SEXUAL AND REPRODUCTIVE HEALTH
SERVICES AND SRH IS SO
IMPORTANT.
IT'S SO IMPORTANT BECAUSE MANY
OF OUR COUNTRIES IN LATIN
AMERICA BASICALLY PROVIDE ONLY
MATERNAL CARE SERVICES.
SO THERE'S ONLY A HEALTH CARE IS
THAT HELPS YOU NOT GET PREGNANT
OR LOOKS AT YOU WHILE YOU'RE
PREGNANT AND THERE'S NOTHING FOR
ANYONE ELSE AND HOW ARE WE
ENSURING THE SERVICES THAT WE
ARE PROVIDING ARE RESPECTFUL,
ARE SAFEGUARDING THEIR HUMAN
DIGNITY?
HOW MANY OF US HAVE HEARD
TERRIBLE STORIES ABOUT AND
THEY'RE NOT ANECDOTAL.
THEY SOUND IT WHEN WE HEAR THEM
BUT WE KNOW ALL VULNERABLE
POPULATIONS, ALL OVER THE WORLD
GET EXTREMELY MISTREATED WHEN
THEY GO TO DELIVER.
WHETHER IT'S BECAUSE THEY COME
FROM POPULATIONS THAT
TRADITIONALLY HAVE A LOT OF
CHILDREN OR THEY COME FROM
POPULATIONS THAT HAVE NOT
DOMINANT ETHNIC GROUP.
THEY GET A LOT OF PAIN AND WHAT
HAPPENS TO MEN?
ONE THING WE HAVEN'T BROUGHT UP
IS THAT THERE IS VERY LITTLE
RESEARCH ON HOW LATIN AMERICA
MASCULINITY AND UNDERSTANDING
WHAT A MAN IS IMPACTS BEHAVIOR
AND HOW IT CHANGES WHEN THEY'RE
MIGRANTS IN THE UNITED STATES OR
WENT FROM A RURAL AREA GUATEMALA
OR INTO PERU, RIGHT.
I THINK THE HEALTH SYSTEM
GOVERNANCE IS THE KEY TO MAKING
PEOPLE-CENTERED HEALTH SYSTEM
ONE WHERE MORE PEOPLE GET TO BE
AT THE CENTER OF IT.
THANK YOU.
>>DR. CASTRO, YOU'LL HAVE THE
FINAL WORD.
>>IT'S IMPORTANT TO INCREASE
RESEARCH CONDUCTED IN LATIN
AMERICA FOR MANY REASONS
INCLUDING TO IMPROVE THE HEALTH
OF POPULATIONS THAT ARE OF LATIN
AMERICA ORIGIN IN THE UNITED
STATES.
IT'S INTERESTING TO SEE HOW THE
HEALTH CARE SYSTEM RESPONDS TO
THE NEEDS DIFFERENTLY IN THE
DIFFERENT COUNTRIES OF ORIGIN
EVEN IF IN THE U.S. IT'S CLEAR
THE MATERNAL MORTALITY THAT IS
OVERWHELMINGLY EXPERIENCED BY
CERTAIN POPULATION GROUPS IS
ASSOCIATED WITH THE EXISTENCE OF
RACISM IN THE HEALTH CARE
SETTING IT WOULD BE HARD TO
THINK THAT THERE ARE NOT ENOUGH
MECHANISMS IN THE UNITED STATES
THAT ARE STILL PREVALENT IN THE
COUNTRIES IN LATIN AMERICA.
AND THEREFORE IT WOULD BE
IMPORTANT TO COMPARE HOW THE
HEALTH CARE SYSTEMS ARE
STRUCTURED AND ORGANIZED IN
DIFFERENT SETTINGS.
THERE'S ALSO SOME HEALTH CARE
CONDITIONS THAT ARE MORE
PREVALENT AMONG STUDENT
POPULATION GROUPS IN LATIN
AMERICA THAN IN THE UNITED
STATES.
THERE'S A LOT TO GAIN IN TERMS
OF CONDUCTING RESEARCH IN LATIN
AMERICA AND IN TERMS OF
COLLABORATION IT'S ALWAYS MORE
FRUITFUL TO COLLABORATE WITH
COLLEAGUES WHO HAVE DIFFERENT
TRAJECTORIES AND WHO ARE WELL
TRAINED IN LATIN AMERICA AND WHO
COULD BE FANTASTIC COLLEAGUES TO
WORK IN COLLABORATION WHO ARE
COLLABORATION WITH RESEARCHERS.
THERE'S POSITIVE RESULTS FROM
INCREASING RESEARCH IN THE
REGION, THANK YOU.
>>THANK YOU.
AND I HOPE WE CAN CONTINUE THE
CONVERSATION ABOUT THIS
IMPORTANT TOPIC.
IT WAS A VERY INTERESTING
DISCUSSION.
THANK YOU.
I APPRECIATE YOUR COMMENTS AND
RECOMMENDATIONS AND INSIGHTS.
THANK YOU ALSO TO THE ADD --
AUDIENCE FOR THE THOUGHTFUL
QUESTIONS AND WITH THIS WE
CONCLUDE OUR ACTIVITIES FOR
TODAY.
WE HAD A PRODUCTIVE AND
EDUCATIONAL DAY.
I LEARNED A LOT.
THANK YOU ALL FOR PARTICIPATING.
WE HOPE YOU CAN JOIN US TOMORROW
AT 8:30 A.M. FOR ANOTHER FULL
DAY OF INFORMATIVE DISCUSSIONS.
HAVE A GOOD EVENING.
THANK YOU, EVERYONE.