1 00:00:05,280 --> 00:00:10,760 >>GOOD MORNING, EVERYONE. 2 00:00:10,760 --> 00:00:12,720 THIS IS LARISSA AVILES-SANTA, 3 00:00:12,720 --> 00:00:14,640 THE DIRECTOR OF THE DIVISION OF 4 00:00:14,640 --> 00:00:15,200 CLINICAL AND HEALTH SERVICES 5 00:00:15,200 --> 00:00:17,600 RESEARCH AT NIMHD AND I'M VERY 6 00:00:17,600 --> 00:00:20,400 GRAD THAT YOU ARE JOINING US FOR 7 00:00:20,400 --> 00:00:23,280 THE SECOND DAY OF THIS UNIQUE 8 00:00:23,280 --> 00:00:23,560 WORKSHOP. 9 00:00:23,560 --> 00:00:26,920 I WILL PASS THE MICROPHONE TO MY 10 00:00:26,920 --> 00:00:29,600 COLLEAGUE, DR. MICHELLE DOOSE. 11 00:00:29,600 --> 00:00:30,840 >>MICHELLE DOOSE: GOOD MORNING. 12 00:00:30,840 --> 00:00:33,280 WELCOME TO DAY 2. 13 00:00:33,280 --> 00:00:34,080 I'M MICHELLE DOOSE, A PROGRAM 14 00:00:34,080 --> 00:00:35,680 OFFICIAL HERE AT THE NATIONAL 15 00:00:35,680 --> 00:00:37,680 INSTITUTE ON MINORITY HEALTH AND 16 00:00:37,680 --> 00:00:39,000 HEALTH DISPARITIES. 17 00:00:39,000 --> 00:00:40,680 IT IS AN HONOR TO BE HERE WITH 18 00:00:40,680 --> 00:00:42,320 YOU TODAY AND I'M EXCITED TO GET 19 00:00:42,320 --> 00:00:42,560 STARTED. 20 00:00:42,560 --> 00:00:45,000 I WANTED TO COVER A COUPLE OF 21 00:00:45,000 --> 00:00:47,640 HOUSEKEEPING ITEMS BEFORE WE GET 22 00:00:47,640 --> 00:00:48,000 STARTED. 23 00:00:48,000 --> 00:00:49,960 ALL TOPIC PRESENTATIONS HAVE 24 00:00:49,960 --> 00:00:51,600 BEEN PRE RECORDED AND WILL BE 25 00:00:51,600 --> 00:00:54,640 FOLLOWED BY A LIVE Q&A SESSION. 26 00:00:54,640 --> 00:00:56,240 PLEASE SUBMIT YOUR QUESTIONS 27 00:00:56,240 --> 00:00:59,000 THROUGHOUT THE DAY BY CLICKING 28 00:00:59,000 --> 00:01:01,640 ON, SEND YOUR FEEDBACK, ON THE 29 00:01:01,640 --> 00:01:03,360 NIH VIDEOCAST WEB PAGE. 30 00:01:03,360 --> 00:01:07,280 THE WORKSHOP IS BEING RECORDED 31 00:01:07,280 --> 00:01:08,400 AND WILL BE AVAILABLE SHORTLY 32 00:01:08,400 --> 00:01:10,240 AFTER THE WORKSHOP. 33 00:01:10,240 --> 00:01:11,880 SO, WITHOUT FURTHER DELAY, IT IS 34 00:01:11,880 --> 00:01:15,360 MY PRIVILEGE TO START OUR NEXT 35 00:01:15,360 --> 00:01:18,360 SESSION TO BE MODERATED BY 36 00:01:18,360 --> 00:01:22,600 LARISSA AVILES-SANTA. 37 00:01:22,600 --> 00:01:26,200 >>LARISSA AVILES-SANTA: GOOD 38 00:01:26,200 --> 00:01:26,440 MORNING. 39 00:01:26,440 --> 00:01:28,920 MY NAME IS LARISSA AVILES-SANTA. 40 00:01:28,920 --> 00:01:31,680 I'M THE MODERATOR OF TOPIC 9 OF 41 00:01:31,680 --> 00:01:32,160 OUR WORKSHOP. 42 00:01:32,160 --> 00:01:34,400 BEST PRACTICES AND LESSONS 43 00:01:34,400 --> 00:01:35,280 LEARNED. 44 00:01:35,280 --> 00:01:37,680 EMBEDDING CLINICAL RESEARCH INTO 45 00:01:37,680 --> 00:01:39,280 HEALTH CARE SETTINGS AND HEALTH 46 00:01:39,280 --> 00:01:39,680 SERVICES RESEARCH. 47 00:01:39,680 --> 00:01:45,000 OUR PANELISTS ARE, DR. TRAYVON 48 00:01:45,000 --> 00:01:48,320 MARTIN, DR. WILMA PETERMAN, 49 00:01:48,320 --> 00:01:49,120 DR. GUSTAVO GOSSLING AND 50 00:01:49,120 --> 00:01:50,320 DR. PIECE PIECE. 51 00:01:50,320 --> 00:01:51,880 AFTER THE PRESENTATIONS, WE WILL 52 00:01:51,880 --> 00:01:53,400 HAVE A LIVE Q&A. 53 00:01:53,400 --> 00:01:57,760 LET'S BEGIN. 54 00:01:57,760 --> 00:02:01,080 >>HI, GOOD MORNING FROM MEXICO 55 00:02:01,080 --> 00:02:01,280 CITY. 56 00:02:01,280 --> 00:02:05,440 I WOULD LIKE TO START BY THANK 57 00:02:05,440 --> 00:02:07,040 YOU FOR THE KIND INVITATION TO 58 00:02:07,040 --> 00:02:10,000 PRESENT THE WORK OF THE 59 00:02:10,000 --> 00:02:12,960 FOUNDATION IN THE ENGINEERING OF 60 00:02:12,960 --> 00:02:15,040 DETECTION AND DISEASE MANAGEMENT 61 00:02:15,040 --> 00:02:18,680 OF DIFFERENT NCDs IN CLINICS, 62 00:02:18,680 --> 00:02:20,360 PARTICULARLY DIABETES, OBESITY 63 00:02:20,360 --> 00:02:21,520 AND HYPERTENSION. 64 00:02:21,520 --> 00:02:25,040 ALLOW ME TO START BY SHARING MY 65 00:02:25,040 --> 00:02:26,640 SCREEN THAT I HAVE PREPARED FOR 66 00:02:26,640 --> 00:02:29,720 THIS PRESENTATION. 67 00:02:29,720 --> 00:02:32,360 SO THE WORK OF THE FOUNDATION IS 68 00:02:32,360 --> 00:02:32,920 FOCUSED ON THE DESIGN AND 69 00:02:32,920 --> 00:02:34,640 DEVELOPMENT OF SOLUTIONS TO 70 00:02:34,640 --> 00:02:37,000 TACKLE THE MOST PRESSING PUBLIC 71 00:02:37,000 --> 00:02:38,960 HEALTH PROBLEMS. 72 00:02:38,960 --> 00:02:40,040 AND THESE PROBLEMS ARE 73 00:02:40,040 --> 00:02:42,360 PARTICULARLY FOCUSED ON THREE 74 00:02:42,360 --> 00:02:44,760 HEALTH AREAS, ON THE ONE HAND 75 00:02:44,760 --> 00:02:45,680 NON-COMMUNICABLE DISEASES. 76 00:02:45,680 --> 00:02:47,680 ON THE OTHER HAND IS MATERNAL 77 00:02:47,680 --> 00:02:50,600 AND CHILD HEALTH AND ON THE 78 00:02:50,600 --> 00:02:52,040 THIRD AREA IS IMMUNIZATION OF 79 00:02:52,040 --> 00:02:52,320 VACCINATION. 80 00:02:52,320 --> 00:02:53,720 THE WORK THAT I'M GOING TO 81 00:02:53,720 --> 00:02:58,360 PRESENT TO YOU IS FOCUSED ON 82 00:02:58,360 --> 00:02:58,960 NCDs IN PARTICULAR DIABETES, 83 00:02:58,960 --> 00:03:01,480 OBESITY AND HYPERTENSION. 84 00:03:01,480 --> 00:03:02,160 AT THE FOUNDATION, WE HAVE 85 00:03:02,160 --> 00:03:06,200 DEVELOPED A STRATEGIC APPROACH 86 00:03:06,200 --> 00:03:06,760 THAT IS COMPOSED OF THREE 87 00:03:06,760 --> 00:03:07,680 DIFFERENT ELEMENTS. 88 00:03:07,680 --> 00:03:11,240 ON THE ONE HAND THE PROCESS OF 89 00:03:11,240 --> 00:03:11,520 ENGINEERING. 90 00:03:11,520 --> 00:03:12,760 WE GO TO THE FIELD, WE 91 00:03:12,760 --> 00:03:15,640 UNDERSTAND WHAT ARE THE 92 00:03:15,640 --> 00:03:17,240 DIFFERENT BARRIERS, WHAT ARE THE 93 00:03:17,240 --> 00:03:18,920 DIFFERENT PROBLEMS THAT HEALTH 94 00:03:18,920 --> 00:03:20,800 PROFESSIONALS ARE FACING. 95 00:03:20,800 --> 00:03:22,040 BASED ON THAT, WE DESIGN AND 96 00:03:22,040 --> 00:03:24,760 DEVELOP NEW SOLUTIONS THAT CAN 97 00:03:24,760 --> 00:03:25,960 HELP TACKLE THESE PROBLEMS. 98 00:03:25,960 --> 00:03:27,520 ON THE OTHER HAND, WE WORK ON 99 00:03:27,520 --> 00:03:29,280 THE STRENGTHENING OF 100 00:03:29,280 --> 00:03:31,800 DECISION-MAKING USING AI AND 101 00:03:31,800 --> 00:03:32,320 ANALYTICS. 102 00:03:32,320 --> 00:03:34,360 OUR MODEL IS THAT THE DATA IS 103 00:03:34,360 --> 00:03:37,120 NOT ONLY TO BE GENERATED BUT 104 00:03:37,120 --> 00:03:40,360 ACTUALLY TO BE USED SO THAT 105 00:03:40,360 --> 00:03:42,200 PEOPLE CAN MAKE BETTER DECISIONS 106 00:03:42,200 --> 00:03:43,200 WITH THIS DATA. 107 00:03:43,200 --> 00:03:45,400 OF COURSE THIS IMPLIES TEACHING 108 00:03:45,400 --> 00:03:47,360 PEOPLE HOW TO USE AND INTERPRET 109 00:03:47,360 --> 00:03:50,200 THIS DATA. 110 00:03:50,200 --> 00:03:54,280 FINALLY, WE IMPLEMENT A 111 00:03:54,280 --> 00:03:55,280 STRUCTURED ACCOMPANYING PROCESS 112 00:03:55,280 --> 00:03:56,520 SO THROUGHOUT THE IMPLEMENTATION 113 00:03:56,520 --> 00:03:57,160 AND THE OPERATION OF THE 114 00:03:57,160 --> 00:03:59,200 DIFFERENT SOLUTIONS THAT I WILL 115 00:03:59,200 --> 00:04:01,280 DESCRIBE, WE CAN WORK WITH THEM 116 00:04:01,280 --> 00:04:06,280 IN IMPROVING THEM OR IN ADJU 117 00:04:06,280 --> 00:04:07,720 ADJUSTING WHAT THEY ARE NEEDING. 118 00:04:07,720 --> 00:04:10,720 ALLOW ME TO BEGIN WITH THE 119 00:04:10,720 --> 00:04:11,520 PROCESS OF REENGINEERING. 120 00:04:11,520 --> 00:04:13,440 WHEN WE STARTED ABOUT 12 YEARS 121 00:04:13,440 --> 00:04:17,000 AGO, WE FIRST DID A MAP OF THE 122 00:04:17,000 --> 00:04:20,840 PERSON'S JOURNEY THROUGH NCDC 123 00:04:20,840 --> 00:04:22,200 DETECTION AND MANAGEMENT. 124 00:04:22,200 --> 00:04:23,720 THIS IS WHAT WE CAME WITH. 125 00:04:23,720 --> 00:04:24,880 THERE ARE FIVE DIFFERENT STEPS 126 00:04:24,880 --> 00:04:28,960 IN THE PROCESS AND WE LOOKED AT 127 00:04:28,960 --> 00:04:32,120 THE DIFFERENT POINTS THAT WERE 128 00:04:32,120 --> 00:04:35,400 IMPEDING VERY OPTIMAL DISEASE 129 00:04:35,400 --> 00:04:38,120 MANAGEMENT OR EVEN DETECTION 130 00:04:38,120 --> 00:04:38,640 PROCESS. 131 00:04:38,640 --> 00:04:42,480 SO AT FIRST THERE WAS A 132 00:04:42,480 --> 00:04:44,160 PAPER-BASED PROCESS AND THE 133 00:04:44,160 --> 00:04:46,160 FORMATS THAT WEREN'T BEING USED 134 00:04:46,160 --> 00:04:46,720 WERE BEING OUTDATED AND THEY 135 00:04:46,720 --> 00:04:48,800 WERE USING PHOTO COPIES WHICH 136 00:04:48,800 --> 00:04:50,000 MOSTLY WERE BLURRED AND COULD 137 00:04:50,000 --> 00:04:54,320 NOT BE READ IN A VERY EASY WAY. 138 00:04:54,320 --> 00:04:56,800 ALSO, THE MEASUREMENTS THAT WERE 139 00:04:56,800 --> 00:04:59,240 BEING DONE WERE RARELY IN ONE 140 00:04:59,240 --> 00:05:02,080 SINGLE PHYSICAL SPACE. 141 00:05:02,080 --> 00:05:04,160 UNFORTUNATELY, SOME OF THESE 142 00:05:04,160 --> 00:05:05,520 DEVICES WERE SPREAD THROUGHOUT 143 00:05:05,520 --> 00:05:07,520 THE CLINIC AND PEOPLE DID NOT 144 00:05:07,520 --> 00:05:12,840 HAVE ACCESS, FOR EXAMPLE, TO 145 00:05:12,840 --> 00:05:16,560 BLOOD STRIPS OR TO A LOU COM 146 00:05:16,560 --> 00:05:16,760 TER. 147 00:05:16,760 --> 00:05:18,600 THE OTHER THING IS THAT PEOPLE 148 00:05:18,600 --> 00:05:19,720 WERE CLASSIFIED EITHER AS 149 00:05:19,720 --> 00:05:21,720 HEALTHY OR WITH A DISEASE BUT 150 00:05:21,720 --> 00:05:24,240 THEY WERE NOT LOOKING AT PEOPLE 151 00:05:24,240 --> 00:05:27,680 WITH PRE-DISEASE STAGE, NAMELY 152 00:05:27,680 --> 00:05:31,600 PRE-DIABETES, PRE-OBESITY OR 153 00:05:31,600 --> 00:05:32,480 PRE-HYPERTENSION. 154 00:05:32,480 --> 00:05:34,480 THE COUNSELING WAS POOR. 155 00:05:34,480 --> 00:05:36,400 RESULTS OF THE ASSESSMENT WERE 156 00:05:36,400 --> 00:05:37,720 NOT PROPERLY EXPLAINED AND 157 00:05:37,720 --> 00:05:39,000 RECOMMENDATIONS WERE RARELY 158 00:05:39,000 --> 00:05:40,800 PROVIDED BECAUSE PEOPLE WERE 159 00:05:40,800 --> 00:05:41,760 ONLY FOCUSED ON TELLING THEM YOU 160 00:05:41,760 --> 00:05:43,280 HAVE A DISEASE AND WE HAVE TO 161 00:05:43,280 --> 00:05:44,120 BEGIN TREATMENT. 162 00:05:44,120 --> 00:05:47,280 OR, YOU ARE OKAY AND YOU CAN GO 163 00:05:47,280 --> 00:05:47,920 BACK HOME. 164 00:05:47,920 --> 00:05:48,880 AND OF COURSE BECAUSE 165 00:05:48,880 --> 00:05:51,280 RECOMMENDATIONS WERE RARELY 166 00:05:51,280 --> 00:05:52,960 PROVIDED, FOLLOW-UP WAS ALSO 167 00:05:52,960 --> 00:05:58,840 POOR AND DISEASE MANAGEMENT WAS 168 00:05:58,840 --> 00:06:01,000 NOT PROVIDED NOT BECAUSE 169 00:06:01,000 --> 00:06:02,640 SERVICES WERE NOT AVAILABLE BUT 170 00:06:02,640 --> 00:06:03,400 BECAUSE PEOPLE SOMETIMES DIDN'T 171 00:06:03,400 --> 00:06:04,400 UNDERSTAND WHAT NEEDED TO HAPPEN 172 00:06:04,400 --> 00:06:06,880 AND THE PROCESS OF INCORPORATING 173 00:06:06,880 --> 00:06:09,120 INTO SOMEONE INTO DISEASE 174 00:06:09,120 --> 00:06:10,560 MANAGEMENT WAS SOMEHOW 175 00:06:10,560 --> 00:06:10,880 BUREAUCRATIC. 176 00:06:10,880 --> 00:06:14,400 SO THIS IS THE PERSON'S JOURNEY. 177 00:06:14,400 --> 00:06:16,000 WHAT WE CAME UP WITH IN TRYING 178 00:06:16,000 --> 00:06:19,120 TO SOLVE ONE OF THE -- EACH OF 179 00:06:19,120 --> 00:06:20,480 THE COMPONENTS, WAS WE CAME UP 180 00:06:20,480 --> 00:06:22,760 APPROXIMATE A DIGITAL PLATFORM 181 00:06:22,760 --> 00:06:24,960 THAT OPERATES BOTH ON LINE AND 182 00:06:24,960 --> 00:06:27,680 OFF LINE AND THIS PLATFORM HAS 183 00:06:27,680 --> 00:06:30,760 EMBEDDED ALGORITHMS THAT SUPPORT 184 00:06:30,760 --> 00:06:31,920 DECISION-MAKING IN THE FIELD SO 185 00:06:31,920 --> 00:06:34,400 THAT HEALTH PROFESSIONALS CAN 186 00:06:34,400 --> 00:06:36,560 UNDERSTAND BY PERFORMING THE 187 00:06:36,560 --> 00:06:37,560 PROCESS, THEY CAN UNDERSTAND 188 00:06:37,560 --> 00:06:42,960 WHAT IS NEEDED TO RECOMMEND OR 189 00:06:42,960 --> 00:06:51,480 TO PRESCRIBE A BETTER TREATMENT. 190 00:06:51,480 --> 00:06:53,360 WE MADE SURE THESE MEASUREMENTS 191 00:06:53,360 --> 00:06:54,880 WERE IMPLEMENTED IN A SINGLE 192 00:06:54,880 --> 00:06:55,080 PLACE. 193 00:06:55,080 --> 00:06:57,560 AND WE CAME UP WITH AN ALL IN 194 00:06:57,560 --> 00:07:01,680 ONE SOLUTION WITH TWO CASE 195 00:07:01,680 --> 00:07:01,960 SCENARIOS. 196 00:07:01,960 --> 00:07:03,720 A MOBILE CARTER BACKPACK -- AND 197 00:07:03,720 --> 00:07:06,680 BOTH CAN BE USED AT A PUBLIC 198 00:07:06,680 --> 00:07:09,240 SPACE, A SUBWAY STATION, OR A 199 00:07:09,240 --> 00:07:10,480 MARKET OR THE PUBLIC PLAZA. 200 00:07:10,480 --> 00:07:12,680 AND ON THE OTHER HAND, A PRIMARY 201 00:07:12,680 --> 00:07:18,520 HEALTH CARE CLINIC. 202 00:07:18,520 --> 00:07:19,520 THIS WAS SYSTEMATIC. 203 00:07:19,520 --> 00:07:22,120 SO WE CAME UP WITH A PROCESS IN 204 00:07:22,120 --> 00:07:25,120 WHICH YOU ID'D A PERSON, 205 00:07:25,120 --> 00:07:25,760 PERFORMED ITS MEASUREMENTS, FILL 206 00:07:25,760 --> 00:07:27,520 OUT THE QUESTIONNAIRE AND THEN 207 00:07:27,520 --> 00:07:29,280 YOU PROVIDE THE COUNSELING BASED 208 00:07:29,280 --> 00:07:33,600 ON THE RISK AND THEN FOLLOW-UP 209 00:07:33,600 --> 00:07:34,000 SYSTEMATICALLY. 210 00:07:34,000 --> 00:07:39,040 AND THIS PROFILING WAS ALSO VERY 211 00:07:39,040 --> 00:07:41,160 IMPORTANT BECAUSE WE 212 00:07:41,160 --> 00:07:44,200 INCORPORATED A PRE-DISEASE STAGE 213 00:07:44,200 --> 00:07:50,240 SO WE FIRST STARTED IMPLEMENTING 214 00:07:50,240 --> 00:07:52,520 PRE-DIABETES, PRE-HYPERTENSION 215 00:07:52,520 --> 00:07:54,320 AND PRE-OBESITY. 216 00:07:54,320 --> 00:07:56,120 WE DID NOT PROVIDE A DIFFERENT 217 00:07:56,120 --> 00:07:59,360 RECOMMENDATION FOR OBESITY OR 218 00:07:59,360 --> 00:08:03,160 DIABETES OR HYPERTENS. 219 00:08:03,160 --> 00:08:05,600 WE MADE THESE THREE DETECTIONS 220 00:08:05,600 --> 00:08:09,520 INTO ONE SINGLE RISK ASSESSMENT. 221 00:08:09,520 --> 00:08:10,880 RISK PROFILES WERE THEN 222 00:08:10,880 --> 00:08:15,120 CLASSIFIED INTO ONE OF 21 OF 223 00:08:15,120 --> 00:08:16,840 THESE CATEGORIES AND 224 00:08:16,840 --> 00:08:17,920 RECOMMENDATIONS WERE BASED ON 225 00:08:17,920 --> 00:08:18,120 THESE. 226 00:08:18,120 --> 00:08:20,600 AND THESE RECOMMENDATIONS WERE 227 00:08:20,600 --> 00:08:21,520 DONE THROUGH COUNSELING. 228 00:08:21,520 --> 00:08:24,120 AND I WOULD LIKE TO TAKE A MEANT 229 00:08:24,120 --> 00:08:26,600 TO REALLY -- A MINUTE TO REALLY 230 00:08:26,600 --> 00:08:27,480 EXPLAIN THE PURPOSE OF 231 00:08:27,480 --> 00:08:29,000 COUNSELING BECAUSE TO ME, THIS 232 00:08:29,000 --> 00:08:31,320 IS THE MOST IMPORTANT STEP OF 233 00:08:31,320 --> 00:08:31,680 ALL. 234 00:08:31,680 --> 00:08:33,280 BECAUSE COUNSELING IS REALLY 235 00:08:33,280 --> 00:08:35,480 ABOUT EXPLAINING THE RESULTS TO 236 00:08:35,480 --> 00:08:39,360 THE PERSON IN A VERY SIMPLIFIED 237 00:08:39,360 --> 00:08:39,800 MANNER. 238 00:08:39,800 --> 00:08:41,760 ONE OF THE MAJOR BARRIERS TO 239 00:08:41,760 --> 00:08:43,400 HEALTH CARE THAT WE HAVE FOUND 240 00:08:43,400 --> 00:08:46,040 IS THAT PEOPLE SOMETIMES DO NOT 241 00:08:46,040 --> 00:08:47,280 UNDERSTAND THEIR DISEASE AND DO 242 00:08:47,280 --> 00:08:48,400 NOT UNDERSTAND WHAT ARE THE 243 00:08:48,400 --> 00:08:50,160 STEPS THAT THEY NEED TO TAKE IN 244 00:08:50,160 --> 00:08:53,040 ORDER FOR THEM TO ACTUALLY BEGIN 245 00:08:53,040 --> 00:08:55,000 TAKING CARE OF THEMSELVES. 246 00:08:55,000 --> 00:08:56,280 SO WE PROVIDE THE COUNSELING IN 247 00:08:56,280 --> 00:08:58,240 A VERY SIMPLIFIED WAY. 248 00:08:58,240 --> 00:09:01,160 THEY CAN EITHER BE ACCOMPANIED 249 00:09:01,160 --> 00:09:03,640 BY THE COUPLE OR BY THE MOM OR 250 00:09:03,640 --> 00:09:06,280 BY HER SON, FOR EXAMPLE, BY HIS 251 00:09:06,280 --> 00:09:09,160 SON, SO THEY CAN HAVE A BETTER 252 00:09:09,160 --> 00:09:09,960 UNDERSTANDING OF THE DISEASE. 253 00:09:09,960 --> 00:09:13,120 AND FINALLY, WE MAKE SURE THAT 254 00:09:13,120 --> 00:09:15,280 FOLLOW-UP WAS SYSTEMATIC SO THAT 255 00:09:15,280 --> 00:09:17,200 PEOPLE WHO WERE REFERRED FOR 256 00:09:17,200 --> 00:09:20,080 DISEASE MANAGEMENT, WE MAKE SURE 257 00:09:20,080 --> 00:09:22,240 THAT PEOPLE WERE STARTING TO 258 00:09:22,240 --> 00:09:23,680 ACTUALLY BEGIN TREATMENT AND THE 259 00:09:23,680 --> 00:09:25,680 OTHER THING IS THAT THE DATA WAS 260 00:09:25,680 --> 00:09:27,840 THEN TRANSFERRED TO A SECOND 261 00:09:27,840 --> 00:09:30,840 PLATFORM IN WHICH THEY CAN START 262 00:09:30,840 --> 00:09:32,280 FOLLOWING UP PEOPLE LIVING WITH 263 00:09:32,280 --> 00:09:34,280 DIABETES OR LIVING WITH 264 00:09:34,280 --> 00:09:36,720 HYPERTENSION OR LIVING WITH 265 00:09:36,720 --> 00:09:37,320 OBESITY, FOR EXAMPLE. 266 00:09:37,320 --> 00:09:39,080 AND OF COURSE, ALSO FOLLOW-UP 267 00:09:39,080 --> 00:09:42,720 WAS PROVIDED FOR PEOPLE WITH 268 00:09:42,720 --> 00:09:44,600 PRE-DIABETES, PRE-HYPERTENSION 269 00:09:44,600 --> 00:09:47,280 OR PRE-OBESITY. 270 00:09:47,280 --> 00:09:51,600 SO IN SUM, THE REENGINEERING 271 00:09:51,600 --> 00:09:57,000 PROCESS IS NAMED MIDO, THE TITLE 272 00:09:57,000 --> 00:09:57,880 OF THE SESSION. 273 00:09:57,880 --> 00:09:58,480 AND THESE FIVE COMPONENTS ARE 274 00:09:58,480 --> 00:10:02,360 WHAT REALLY COMPOSE THE 275 00:10:02,360 --> 00:10:03,160 STRATEGY, MIDO. 276 00:10:03,160 --> 00:10:06,120 SO WE EVOLVED THE TRADITIONAL 277 00:10:06,120 --> 00:10:08,560 PROCESS OF NCD DETECTION AND 278 00:10:08,560 --> 00:10:12,360 MANAGEMENT TO WHAT I JUST 279 00:10:12,360 --> 00:10:12,640 PRESENTED. 280 00:10:12,640 --> 00:10:14,000 THE OTHER THING, AS I SAID, IS 281 00:10:14,000 --> 00:10:15,680 THE STRENGTHENING OF 282 00:10:15,680 --> 00:10:18,480 DECISION-MAKING, USE OF AI AND 283 00:10:18,480 --> 00:10:18,920 ANALYTICS. 284 00:10:18,920 --> 00:10:22,040 WHAT WE HAVE DONE IS, WE STARTED 285 00:10:22,040 --> 00:10:25,680 WORKING WITH IN MAKING SURE THAT 286 00:10:25,680 --> 00:10:28,600 WE COULD ACTUALLY TACKLE THE 287 00:10:28,600 --> 00:10:31,120 MOST PRESSING PAIN POINTS IN THE 288 00:10:31,120 --> 00:10:31,360 PROCESS. 289 00:10:31,360 --> 00:10:32,760 FIRST, WE MADE SURE THAT THE 290 00:10:32,760 --> 00:10:36,120 DIGITAL PLATFORM WAS 291 00:10:36,120 --> 00:10:36,640 EVIDENCE-BASED. 292 00:10:36,640 --> 00:10:38,200 SO FOR EXAMPLE, SOME OF THE 293 00:10:38,200 --> 00:10:42,000 ALERTS IN THE DIFFERENT 294 00:10:42,000 --> 00:10:43,600 VARIABLES ARE -- LET'SSADE YOU 295 00:10:43,600 --> 00:10:46,200 HAVE YOUR GLUCOSE LEVELS ARE 296 00:10:46,200 --> 00:10:46,400 HIGH. 297 00:10:46,400 --> 00:10:50,840 SO THERE IS AN ALERT. 298 00:10:50,840 --> 00:10:52,080 IT CAN BE RED OR ORANGE OR 299 00:10:52,080 --> 00:10:54,320 YELLOW, DEPENDING OF COURSE ON 300 00:10:54,320 --> 00:10:55,600 THE NUMBER. 301 00:10:55,600 --> 00:10:57,480 BUT ALSO YOU CAN HAVE RISK 302 00:10:57,480 --> 00:10:58,320 ASSESSMENT ALGORITHMS. 303 00:10:58,320 --> 00:11:02,840 SO FOR EXAMPLE, WE STARTED USING 304 00:11:02,840 --> 00:11:06,200 SOME OF THE MOST IMPORTANT RISK 305 00:11:06,200 --> 00:11:09,760 SCALE FOR CARDIOVASCULAR 306 00:11:09,760 --> 00:11:10,040 DISEASES. 307 00:11:10,040 --> 00:11:13,200 AND OVER TIME, WE CAME UP WITH 308 00:11:13,200 --> 00:11:16,560 OUR OWN SCALES, MOST OF THEM 309 00:11:16,560 --> 00:11:18,840 AI-BASED, BECAUSE WE REALIZED 310 00:11:18,840 --> 00:11:21,680 THAT WE NEEDED A PERSONALIZED 311 00:11:21,680 --> 00:11:25,000 SCALE FOR MEXICAN POPULATION AND 312 00:11:25,000 --> 00:11:28,600 ALSO FOR THE DIFFERENT RISK 313 00:11:28,600 --> 00:11:32,400 PROFILES THAT I SHARED WITH YOU 314 00:11:32,400 --> 00:11:32,640 BEFORE. 315 00:11:32,640 --> 00:11:34,360 THE 21 PROFILES. 316 00:11:34,360 --> 00:11:36,240 AND THE THIRD THING THAT WAS 317 00:11:36,240 --> 00:11:38,560 VERY IMPORTANT WAS PERSONALIZED 318 00:11:38,560 --> 00:11:39,240 RECOMMENDATIONS. 319 00:11:39,240 --> 00:11:41,680 SO HEALTH PROFESSIONALS HAD 320 00:11:41,680 --> 00:11:43,480 ACCESS TO THE DIFFERENT 321 00:11:43,480 --> 00:11:45,320 RECOMMENDATIONS THAT THEY COULD 322 00:11:45,320 --> 00:11:48,200 PRESCRIBE TO PATIENTS BASED ON 323 00:11:48,200 --> 00:11:49,080 RESULTS. 324 00:11:49,080 --> 00:11:51,200 THE OTHER THING IS THAT WE 325 00:11:51,200 --> 00:11:53,840 CREATED SOME ACTION-ORIENTED 326 00:11:53,840 --> 00:11:54,080 REPORTS. 327 00:11:54,080 --> 00:11:57,040 I'M PRETTY SURE THIS HELPSINOUS 328 00:11:57,040 --> 00:11:59,800 ALL OF OUR COUNTRIES IN LATIN 329 00:11:59,800 --> 00:12:00,880 AMERICA, BUT PEOPLE IS VERY USED 330 00:12:00,880 --> 00:12:04,000 TO REPORTING BUT THEY ARE NOT 331 00:12:04,000 --> 00:12:06,920 ACTUALLY USED TO USING THE DATA. 332 00:12:06,920 --> 00:12:08,280 AND WHAT WE FELT WAS IMPORTANT 333 00:12:08,280 --> 00:12:11,480 WAS THAT WE NEEDED TO REALLY 334 00:12:11,480 --> 00:12:15,200 SHIFT THAT CULTURE OF NOT ONLY 335 00:12:15,200 --> 00:12:16,440 REPORTING BUT ACTUALLY USING THE 336 00:12:16,440 --> 00:12:16,800 DATA. 337 00:12:16,800 --> 00:12:20,400 SO FOR EXAMPLE, WE HAD A REPORT 338 00:12:20,400 --> 00:12:22,560 ON ACCESS IN WHICH WE 339 00:12:22,560 --> 00:12:23,320 ESTABLISHED THE PERCENTAGE OF 340 00:12:23,320 --> 00:12:26,040 POPULATION THAT ACTUALLY HAS A 341 00:12:26,040 --> 00:12:26,920 METER ASSESSMENT. 342 00:12:26,920 --> 00:12:28,560 AND THEN WE HAD A REPORT ON 343 00:12:28,560 --> 00:12:29,880 EFFICIENCY SO WE WANT TO MAKE 344 00:12:29,880 --> 00:12:32,040 SURE THAT PEOPLE HAD A COMPLETE 345 00:12:32,040 --> 00:12:32,640 ASSESSMENT. 346 00:12:32,640 --> 00:12:35,240 LET'S SAY FOR EXAMPLE THAT YOU 347 00:12:35,240 --> 00:12:37,360 DON'T HAVE A LOU COM TERAT THE 348 00:12:37,360 --> 00:12:38,640 TIME, THEN WE DO NOT CONSIDER 349 00:12:38,640 --> 00:12:40,600 THAT A METER ASSESSMENT BECAUSE 350 00:12:40,600 --> 00:12:41,960 IT'S NOT COMPLETE. 351 00:12:41,960 --> 00:12:43,680 AND OF COURSE THE THIRD ONE, AS 352 00:12:43,680 --> 00:12:48,280 I HAVE BEEN SAYING, BEFORE WE 353 00:12:48,280 --> 00:12:50,800 WANT TO MAKE SURE THAT PEOPLE 354 00:12:50,800 --> 00:12:51,400 WHO WERE SCREENED AND WHO WERE 355 00:12:51,400 --> 00:12:52,040 CONFIRMED WITH A DISEASE, THEY 356 00:12:52,040 --> 00:12:55,280 CAN HAVE A FOLLOW-UP AND THEY 357 00:12:55,280 --> 00:12:58,360 CAN BE INCORPORATED INTO 358 00:12:58,360 --> 00:12:58,600 TREATMENT. 359 00:12:58,600 --> 00:13:00,680 THE OTHER THING IS THAT WE HAVE 360 00:13:00,680 --> 00:13:02,920 A ROBUST -- AND WE WORK WITH 361 00:13:02,920 --> 00:13:05,840 DIFFERENT ORGANIZATIONS TO BUILD 362 00:13:05,840 --> 00:13:07,280 A ROBUST BI PLATFORM. 363 00:13:07,280 --> 00:13:10,800 WE HAVE A DISPLAY OF KPIs AT 364 00:13:10,800 --> 00:13:11,840 DIFFERENT LEVELS. 365 00:13:11,840 --> 00:13:13,680 PEOPLE CAN LOOK AT THEM FROM 366 00:13:13,680 --> 00:13:15,440 PRIMARY HEALTH CARE CLINICS OR 367 00:13:15,440 --> 00:13:16,840 REGIONS HERE IN MEXICO FROM 368 00:13:16,840 --> 00:13:18,680 STATES OR PROVINCES AND AT THE 369 00:13:18,680 --> 00:13:19,400 NATIONAL LEVEL. 370 00:13:19,400 --> 00:13:22,520 AND DATA IS CONTINUOUSLY 371 00:13:22,520 --> 00:13:23,160 UPDATED. 372 00:13:23,160 --> 00:13:27,320 YOU CAN ACCESS IT ON THE MAP OR 373 00:13:27,320 --> 00:13:31,280 THE DATA CAN BE ACCESSED DAILY. 374 00:13:31,280 --> 00:13:37,920 AND PEOPLE WITH ACCESS, BECAUSE 375 00:13:37,920 --> 00:13:39,400 THERE ARE SOME SPECIFIC LOCKS IN 376 00:13:39,400 --> 00:13:43,560 THERE, THEY HAVE ACCESS TO 377 00:13:43,560 --> 00:13:46,040 DATABASES AND THEY CAN ACCESS 378 00:13:46,040 --> 00:13:47,280 THE NAMES SO THEY CAN FOLLOW-UP 379 00:13:47,280 --> 00:13:49,040 WITH THE PEOPLE. 380 00:13:49,040 --> 00:13:51,080 THE FOURTH ONE IS AI MODELING. 381 00:13:51,080 --> 00:13:52,800 WE HAVE BEEN WORKING WITH THE 382 00:13:52,800 --> 00:13:54,880 DATA AND WITH THE DIFFERENT 383 00:13:54,880 --> 00:13:55,560 ORGANIZATIONS HERE AT THE PUBLIC 384 00:13:55,560 --> 00:14:01,120 HEALTH SERVICES IN MEXICO TO 385 00:14:01,120 --> 00:14:03,320 DESIGN DIFFERENT MODELS. 386 00:14:03,320 --> 00:14:05,680 AIMED ON ONE HAND AT IMPROVING 387 00:14:05,680 --> 00:14:07,680 FILTER SERVICES. 388 00:14:07,680 --> 00:14:10,640 SO WE DESIGNED A PREDICTIVE 389 00:14:10,640 --> 00:14:12,280 MODEL TO UNDERSTAND DIABETES 390 00:14:12,280 --> 00:14:14,640 ONSET AND WE ARE ALSO NOW 391 00:14:14,640 --> 00:14:17,600 WORKING ON THE DESIGN OF 392 00:14:17,600 --> 00:14:19,280 PRESCRIPTIVE MODEL BASED ON THE 393 00:14:19,280 --> 00:14:21,160 DIFFERENT TYPES OF TYPE II 394 00:14:21,160 --> 00:14:22,520 DIABETES BECAUSE NOW WE KNOW 395 00:14:22,520 --> 00:14:23,800 THAT THERE ARE FOUR DIFFERENT 396 00:14:23,800 --> 00:14:27,200 TYPES OF TYPE II DIABETES BASED 397 00:14:27,200 --> 00:14:29,920 ON INSULIN RESISTANCE, INSULIN 398 00:14:29,920 --> 00:14:33,240 DEFICIENCY, AGE, OBESITY, 399 00:14:33,240 --> 00:14:33,520 ET CETERA. 400 00:14:33,520 --> 00:14:35,280 THE SECOND ONES ARE AIMED AT 401 00:14:35,280 --> 00:14:38,000 IMPROVING QUALITY OF CARE. 402 00:14:38,000 --> 00:14:38,680 SO WE DESIGNED A DIABETES 403 00:14:38,680 --> 00:14:42,800 QUALITY OF CARE INDEX, WHICH IS 404 00:14:42,800 --> 00:14:45,640 MAINLY FOCUSED ON DOING SOME 405 00:14:45,640 --> 00:14:46,440 COMPARATIVE PERFORMANCE 406 00:14:46,440 --> 00:14:48,200 ASSESSMENT SO YOU CAN HAVE A 407 00:14:48,200 --> 00:14:50,760 SCORE FOR EACH OF THE CLINICS 408 00:14:50,760 --> 00:14:53,360 AND THEY CAN COMPARE THEMSELVES 409 00:14:53,360 --> 00:14:55,320 AND YOU CAN HAVE A SCORE FOR A 410 00:14:55,320 --> 00:14:57,080 REGION AND STATE AND AT THE 411 00:14:57,080 --> 00:14:57,680 NATIONAL LEVELS. 412 00:14:57,680 --> 00:14:58,480 AND YOU CAN UNDERSTAND WHAT IS 413 00:14:58,480 --> 00:15:01,920 THE QUALITY OF CARE OF THESE 414 00:15:01,920 --> 00:15:02,440 DIFFERENT PUBLIC HEALTH 415 00:15:02,440 --> 00:15:02,680 SERVICES. 416 00:15:02,680 --> 00:15:05,760 AND FINALLY, THE DECISION-MAKING 417 00:15:05,760 --> 00:15:07,920 ALSO, AS I SAID BEFORE, MEANT 418 00:15:07,920 --> 00:15:10,680 SHIFTING THE CULTURE OF NOT ONLY 419 00:15:10,680 --> 00:15:12,280 REPORTING BUT USING THE DATA. 420 00:15:12,280 --> 00:15:16,160 SO WE HAVE ALSO CREATED VERY 421 00:15:16,160 --> 00:15:18,240 PRACTICAL COURSES FOR PRIMARY 422 00:15:18,240 --> 00:15:19,600 HEALTH CARE CLINIC WORKERS AND 423 00:15:19,600 --> 00:15:22,600 ALSO FOR DECISION MAKERS SO THAT 424 00:15:22,600 --> 00:15:24,160 THEY CAN STRENGTHEN THEIR 425 00:15:24,160 --> 00:15:25,240 ANALYTICAL CAPACITY. 426 00:15:25,240 --> 00:15:26,200 THIS IS VERY IMPORTANT BECAUSE 427 00:15:26,200 --> 00:15:29,440 WE ARE LOOKING AT PEOPLE, AT 428 00:15:29,440 --> 00:15:30,640 FIELD PROFESSIONALS WHO PERHAPS 429 00:15:30,640 --> 00:15:34,560 HAVE BEEN WORKING FOR OVER 15-20 430 00:15:34,560 --> 00:15:34,760 YEARS. 431 00:15:34,760 --> 00:15:37,400 THEY ARE NOT USED TO USING THE 432 00:15:37,400 --> 00:15:37,880 DATA. 433 00:15:37,880 --> 00:15:39,920 MOST OF THEIR PROFESSIONAL LIVES 434 00:15:39,920 --> 00:15:42,760 HAVE BEEN DEVOTED TO ONLY 435 00:15:42,760 --> 00:15:43,040 REPORTING. 436 00:15:43,040 --> 00:15:44,000 SO THIS IS VERY IMPORTANT FOR US 437 00:15:44,000 --> 00:15:46,680 THAT THEY CAN UNDERSTAND WHAT WE 438 00:15:46,680 --> 00:15:46,960 DO. 439 00:15:46,960 --> 00:15:50,840 AND FINALLY, THE STRUCTURE 440 00:15:50,840 --> 00:15:51,320 ACCOMPANYING PROCESS. 441 00:15:51,320 --> 00:15:55,160 WE HAVE -- OUR GOAL IS TO 442 00:15:55,160 --> 00:15:55,720 IMPLEMENT A DIGITAL LEARNING 443 00:15:55,720 --> 00:15:57,840 MANAGEMENT SYSTEM. 444 00:15:57,840 --> 00:15:59,880 SO WE DEPLOYED TWO TEAMS, BOTH 445 00:15:59,880 --> 00:16:02,680 IN OPERATIONS AND ANALYTICS. 446 00:16:02,680 --> 00:16:04,600 AND WHAT IS OUR FOCUS? 447 00:16:04,600 --> 00:16:07,080 WE WANT TO IMPLEMENT THE 448 00:16:07,080 --> 00:16:07,920 SYSTEMATIC IMPROVEMENT PROCESS. 449 00:16:07,920 --> 00:16:10,920 SO WE WANT TO MAKE SURE THAT 450 00:16:10,920 --> 00:16:12,760 THERE AREN'T ANY BARRIERS 451 00:16:12,760 --> 00:16:14,360 THROUGHOUT THE IMPLEMENTATION OR 452 00:16:14,360 --> 00:16:16,080 THROUGHOUT THE USE OF THE DATA. 453 00:16:16,080 --> 00:16:18,560 AND WE ACCOMPANY THESE WITH 454 00:16:18,560 --> 00:16:19,400 CONTINUOUS MEDICAL EDUCATION. 455 00:16:19,400 --> 00:16:22,360 WE ARE CONSTANTLY UPDATING THE 456 00:16:22,360 --> 00:16:23,560 ALGORITHMS BASED ON EITHER THE 457 00:16:23,560 --> 00:16:25,600 GUIDELINES FOR BEST PRACTICES, 458 00:16:25,600 --> 00:16:27,320 AND WE ARE ALSO INCORPORATING 459 00:16:27,320 --> 00:16:30,440 THIS AS NEW SOLUTIONS OR 460 00:16:30,440 --> 00:16:31,240 INNOVATIONS. 461 00:16:31,240 --> 00:16:33,080 AND FINALLY, YOU ALWAYS WANT TO 462 00:16:33,080 --> 00:16:37,400 DOCUMENT THE BENEFITS OF MIDO 463 00:16:37,400 --> 00:16:38,080 THROUGH DIFFERENT PUBLIC, 464 00:16:38,080 --> 00:16:40,040 SCIENTIFIC PUBLICATIONS AND 465 00:16:40,040 --> 00:16:41,200 PRESENTATIONS AND CONFERENCES 466 00:16:41,200 --> 00:16:42,680 AND SEMINARS. 467 00:16:42,680 --> 00:16:45,600 TO FINALIZE, LET ME SHOW YOU 468 00:16:45,600 --> 00:16:45,880 SOME DATA. 469 00:16:45,880 --> 00:16:50,360 TO DATE, WE HAVE PERFORMED -- 470 00:16:50,360 --> 00:16:53,640 PUBLIC SERVICES HAS PERFORMED 471 00:16:53,640 --> 00:16:55,320 2.7 MILLION MIDO ASSESSMENTS. 472 00:16:55,320 --> 00:16:59,120 WE HAVE BEEN WORKING WITH PUBLIC 473 00:16:59,120 --> 00:17:01,000 HEALTH ENTITIES WITH NATIONAL 474 00:17:01,000 --> 00:17:02,320 INSTITUTES OF HEALTH WITH 475 00:17:02,320 --> 00:17:03,800 ACADEMIC INSTITUTIONS. 476 00:17:03,800 --> 00:17:05,360 AND YOU CAN LOOK AT THE DATA AND 477 00:17:05,360 --> 00:17:07,280 YOU'LL SEE THAT THERE IS A 478 00:17:07,280 --> 00:17:09,760 FAMILY HISTORY, PEOPLE ARE 479 00:17:09,760 --> 00:17:10,280 SMOKING. 480 00:17:10,280 --> 00:17:12,560 PEOPLE DO NOT HAVE HEALTHY SLEEP 481 00:17:12,560 --> 00:17:15,680 HABITS OR THEY HAVE A SEDENTARY 482 00:17:15,680 --> 00:17:15,960 LIFESTYLE. 483 00:17:15,960 --> 00:17:17,560 AND OF COURSE THERE IS A REALLY 484 00:17:17,560 --> 00:17:20,000 WINDOW OF OPPORTUNITY FOR PEOPLE 485 00:17:20,000 --> 00:17:22,760 WITH PRE DISEASES AS YOU CAN SEE 486 00:17:22,760 --> 00:17:28,120 WITH PRE-OBESITY, 487 00:17:28,120 --> 00:17:31,280 PRE-HYPERTENSIONS AND 488 00:17:31,280 --> 00:17:31,720 PRE-DEBITIES. 489 00:17:31,720 --> 00:17:33,280 AND CURRENTLY THIS IS THE 490 00:17:33,280 --> 00:17:34,760 OFFICIAL HEALTH INFORMATION 491 00:17:34,760 --> 00:17:36,240 SYSTEM FOR PUBLIC HEALTH 492 00:17:36,240 --> 00:17:36,640 CLINICS. 493 00:17:36,640 --> 00:17:39,360 TO DATE, WE KNOW THAT ONE.7 494 00:17:39,360 --> 00:17:42,440 MILLION PEOPLE IS BEING TAKEN 495 00:17:42,440 --> 00:17:43,120 CARE OF AT THESE CLINICS. 496 00:17:43,120 --> 00:17:45,080 AND YOU CAN LOOK AT THE DATA AND 497 00:17:45,080 --> 00:17:46,520 YOU HAVE PEOPLE LIVING WITH 498 00:17:46,520 --> 00:17:51,080 DIABETES, HYPERTENSION, OBESITY 499 00:17:51,080 --> 00:17:53,200 AND OF COURSE THIS GIVES ROOM TO 500 00:17:53,200 --> 00:17:56,280 LOOKING AT METABOLIC SYNDROME OR 501 00:17:56,280 --> 00:17:57,160 CARDIOMETABOLIC SYNDROME. 502 00:17:57,160 --> 00:18:00,760 IN SUM, THE WORD OF THE 503 00:18:00,760 --> 00:18:03,280 FOUNDATION IS HOW TO STRENGTHEN 504 00:18:03,280 --> 00:18:04,920 PRIMARY CARE FOR BOTH DETECTION 505 00:18:04,920 --> 00:18:07,120 AND DISEASE MANAGEMENT PROCESS. 506 00:18:07,120 --> 00:18:08,400 I THANK YOU THE OPPORTUNITY AND 507 00:18:08,400 --> 00:18:09,840 I WELCOME YOUR QUESTIONS. 508 00:18:09,840 --> 00:18:13,360 THANK YOU VERY MUCH. 509 00:18:13,360 --> 00:18:14,160 >>HELLO. 510 00:18:14,160 --> 00:18:15,840 IT GIVES ME GREAT PLEASURE TO BE 511 00:18:15,840 --> 00:18:17,560 ABLE TO SPEAK WITH ALL OF YOU 512 00:18:17,560 --> 00:18:19,080 TODAY ABOUT THIS PARTICULAR 513 00:18:19,080 --> 00:18:19,280 TOPIC. 514 00:18:19,280 --> 00:18:22,720 BECAUSE IT REALLY TOUCHES SOME 515 00:18:22,720 --> 00:18:23,640 OF THE THEMES THAT HAVE BEEN 516 00:18:23,640 --> 00:18:27,520 VERY CENTRAL TO MY OWN WORK WITH 517 00:18:27,520 --> 00:18:29,440 HISPANIC AND LATINO POPULATIONS, 518 00:18:29,440 --> 00:18:33,120 NOW FOR OVER 15 YEARS. 519 00:18:33,120 --> 00:18:35,760 HOW DO WE HELP CASH-STRAPPED OR 520 00:18:35,760 --> 00:18:37,840 UNDERFUNDED SAFETY NET HEALTH 521 00:18:37,840 --> 00:18:41,160 CARE SYSTEMS IMPROVE SERVICES 522 00:18:41,160 --> 00:18:43,280 FOR POPULATIONS THAT HAVE 523 00:18:43,280 --> 00:18:44,400 DIFFICULTY ACCESSING CARE? 524 00:18:44,400 --> 00:18:45,840 AND IT'S ALSO A REAL PLEASURE TO 525 00:18:45,840 --> 00:18:48,960 BE SPEAKING WITH YOU TODAY ABOUT 526 00:18:48,960 --> 00:18:49,560 THIS TOPIC BECAUSE WE LIKE TO 527 00:18:49,560 --> 00:18:51,040 THINK THAT WE HAVE COME ACROSS A 528 00:18:51,040 --> 00:18:53,800 COUPLE OF DIRECTIONS TO TAKE 529 00:18:53,800 --> 00:18:55,840 THIS RESEARCH THAT ARE REALLY 530 00:18:55,840 --> 00:18:57,440 QUITE PROMISING, THAT ARE REALLY 531 00:18:57,440 --> 00:18:58,920 STARTING TO BEAR FRUIT AND WE 532 00:18:58,920 --> 00:18:59,920 ARE EXCITED TO SHARE WITH YOU 533 00:18:59,920 --> 00:19:02,400 SOME OF THOSE SUCCESSES AND SOME 534 00:19:02,400 --> 00:19:03,720 OF THE DIRECTIONS WE'D LIKE TO 535 00:19:03,720 --> 00:19:08,680 TAKE THAT WORK IN THE COMING 536 00:19:08,680 --> 00:19:08,880 YEARS. 537 00:19:08,880 --> 00:19:10,800 THE WORK I'M GOING TO BE TALKING 538 00:19:10,800 --> 00:19:12,640 WITH YOU ABOUT MAYBE BEGINS IN A 539 00:19:12,640 --> 00:19:15,640 SOMEWHAT UNLIKELY PLACE. 540 00:19:15,640 --> 00:19:16,920 I ALSO HAPPEN TO BE AN 541 00:19:16,920 --> 00:19:19,040 INVESTIGATOR WITH THE U.S. 542 00:19:19,040 --> 00:19:19,840 DEPARTMENT OF VETERAN'S AFFAIRS 543 00:19:19,840 --> 00:19:20,560 HEALTH CARE SYSTEM. 544 00:19:20,560 --> 00:19:23,120 MANY OF YOU ARE PROBABLY 545 00:19:23,120 --> 00:19:24,360 FAMILIAR, THE V.A. IS A LARGE 546 00:19:24,360 --> 00:19:27,840 NATIONAL SAFETY NET HEALTH CARE 547 00:19:27,840 --> 00:19:28,080 SYSTEM. 548 00:19:28,080 --> 00:19:30,760 IT TREATS 7-8 MILLION PATIENTS 549 00:19:30,760 --> 00:19:32,720 THAT ARE LOW-INCOME, HIGH 550 00:19:32,720 --> 00:19:34,800 PREVALENCE OF SUBSTANCE ABUSE 551 00:19:34,800 --> 00:19:35,720 DISORDERS, MENTAL HEALTH 552 00:19:35,720 --> 00:19:37,720 CO-MORBIDITY AND DIFFICULT TO 553 00:19:37,720 --> 00:19:38,600 ACCESS IN CARE. 554 00:19:38,600 --> 00:19:42,280 LIKE MANY HEALTH CARE SYSTEMS, 555 00:19:42,280 --> 00:19:44,400 THE V.A. EMPHASIZES 556 00:19:44,400 --> 00:19:44,920 EVIDENCE-BASED TREATMENT 557 00:19:44,920 --> 00:19:45,200 PRACTICES. 558 00:19:45,200 --> 00:19:47,080 ONE OF THOSE TREATMENT PRACTICES 559 00:19:47,080 --> 00:19:51,040 IS COGNITIVE BEHAVIORAL THERAPY. 560 00:19:51,040 --> 00:19:53,520 CBT IS A PRACTICE THROUGH WHICH 561 00:19:53,520 --> 00:19:55,440 WE WORK WITH PATIENTS TO MODIFY 562 00:19:55,440 --> 00:19:57,880 THEIR SYMPTOMS, TO IMPROVE THEIR 563 00:19:57,880 --> 00:19:58,760 FUNCTIONING AND IMPROVE THEIR 564 00:19:58,760 --> 00:19:59,080 MENTAL HEALTH. 565 00:19:59,080 --> 00:20:02,680 WE DO THAT BY HELPING THEM 566 00:20:02,680 --> 00:20:04,000 UNDERSTAND THEIR THINKING 567 00:20:04,000 --> 00:20:05,360 PROCESS, SOME OF THEIR THOUGHT 568 00:20:05,360 --> 00:20:07,920 PROCESSES THAT MIGHT NOT BE VERY 569 00:20:07,920 --> 00:20:09,720 PRODUCTIVE, THAT ARE HOLDING 570 00:20:09,720 --> 00:20:11,280 THEM BACK. 571 00:20:11,280 --> 00:20:13,720 HELPING THEM ADJUST THEIR 572 00:20:13,720 --> 00:20:15,240 BEHAVIORS AND REACH BEHAVIORAL 573 00:20:15,240 --> 00:20:16,560 GOALS AROUND SUBSTANCE ABUSE OR 574 00:20:16,560 --> 00:20:17,520 SLEEP OR RELAXATION. 575 00:20:17,520 --> 00:20:18,800 AND REALLY TO SEE THE 576 00:20:18,800 --> 00:20:22,000 CONNECTIONS BETWEEN THEIR 577 00:20:22,000 --> 00:20:22,880 THINKING, THEIR BEHAVIOR, THEIR 578 00:20:22,880 --> 00:20:26,640 EMOTIONS AND THEIR PHYSICAL 579 00:20:26,640 --> 00:20:26,920 REACTIONS. 580 00:20:26,920 --> 00:20:28,640 CBT IS THE GO-TO TREATMENT FOR 581 00:20:28,640 --> 00:20:29,520 MANY, MANY CONDITIONS. 582 00:20:29,520 --> 00:20:32,160 IT'S THE GO-TO TREATMENT FOR 583 00:20:32,160 --> 00:20:34,680 DEPRESSION, FOR ANXIETY, FOR 584 00:20:34,680 --> 00:20:35,760 POST-TRAUMATIC STRESS DISORDER, 585 00:20:35,760 --> 00:20:40,440 FOR SYMPTOMS OF FIBROMYALGIA OR 586 00:20:40,440 --> 00:20:41,920 MENOPAUSE, FOR MIGRAINE 587 00:20:41,920 --> 00:20:44,360 HEADACHES, FOR SUBSTANCE ABUSE. 588 00:20:44,360 --> 00:20:48,320 FOR MANY, MANY CONDITIONS. 589 00:20:48,320 --> 00:20:51,280 AND HERE YOU SEE A TYPICAL CBT 590 00:20:51,280 --> 00:20:52,680 PROGRAM FOR PATIENTS WITH 591 00:20:52,680 --> 00:20:54,440 CHRONIC PAIN. 592 00:20:54,440 --> 00:20:55,320 FOR CHRONIC PAIN PATIENTS YOU 593 00:20:55,320 --> 00:20:57,400 CAN SEE WE WORK WITH PATIENTS 594 00:20:57,400 --> 00:20:59,080 OVER IN THIS CASE, A SERIES OF 595 00:20:59,080 --> 00:21:00,480 10 WEEKLY SESSIONS. 596 00:21:00,480 --> 00:21:03,080 SESSIONS USUALLY LAST ABOUT 45 597 00:21:03,080 --> 00:21:03,440 MINUTES. 598 00:21:03,440 --> 00:21:06,520 AND PATIENTS LEARN TO MODIFY 599 00:21:06,520 --> 00:21:07,640 THEIR PHYSICAL ACTIVITY, 600 00:21:07,640 --> 00:21:09,480 HOPEFULLY BE MORE ACTIVE, START 601 00:21:09,480 --> 00:21:12,480 A WALKING PROGRAM, MAYBE LEARN 602 00:21:12,480 --> 00:21:15,120 TO RELAX WHEN THEY ARE 603 00:21:15,120 --> 00:21:15,520 EXPERIENCING PAIN. 604 00:21:15,520 --> 00:21:20,400 LEARN TO MODIFY THEIR SLEEP, 605 00:21:20,400 --> 00:21:21,040 MAYBE MODULATE THEIR CONSUMPTION 606 00:21:21,040 --> 00:21:22,160 OF ALCOHOL. 607 00:21:22,160 --> 00:21:23,760 AND I CAN'T EMPHASIZE ENOUGH, 608 00:21:23,760 --> 00:21:25,360 CBT PROGRAMS FOR CHRONIC PAIN 609 00:21:25,360 --> 00:21:26,920 AND OTHER PROGRAMS WORK. 610 00:21:26,920 --> 00:21:29,000 THEY ARE VERY, VERY EFFECTIVE 611 00:21:29,000 --> 00:21:30,320 IMPROVING PATIENT SYMPTOMS 612 00:21:30,320 --> 00:21:32,120 PROFILE AND ALSO IMPROVING THEIR 613 00:21:32,120 --> 00:21:32,520 FUNCTIONING. 614 00:21:32,520 --> 00:21:34,240 SO WHAT IS THE PROBLEM? 615 00:21:34,240 --> 00:21:36,440 WELL, MANY PATIENTS DON'T GET 616 00:21:36,440 --> 00:21:39,840 EVIDENCE-BASED CBT PRACTICES AND 617 00:21:39,840 --> 00:21:41,960 SESSIONS ARE REALLY QUITE 618 00:21:41,960 --> 00:21:42,880 BURDENSOME FOR PATIENTS. 619 00:21:42,880 --> 00:21:43,880 PATIENTS MIGHT HAVE 620 00:21:43,880 --> 00:21:45,760 TRANSPORTATION PROBLEMS. 621 00:21:45,760 --> 00:21:47,280 THEY HAVE CONFLICTS WITH WORK 622 00:21:47,280 --> 00:21:50,400 SCHEDULES, WITH CHILD CARE 623 00:21:50,400 --> 00:21:50,800 RESPONSIBILITIES. 624 00:21:50,800 --> 00:21:52,320 AND PATIENTS AREN'T WELL. 625 00:21:52,320 --> 00:21:54,120 I MEAN, THEY FEEL PHYSICALLY 626 00:21:54,120 --> 00:21:54,280 ILL. 627 00:21:54,280 --> 00:21:55,520 THEY MIGHT HAVE MOBILITY ISSUES. 628 00:21:55,520 --> 00:21:58,640 EVEN WHEN PATIENTS ARE ABLE AND 629 00:21:58,640 --> 00:22:01,040 WILLING TO COME TO CBT, SADLY, 630 00:22:01,040 --> 00:22:02,200 MANY HEALTH CARE SYSTEMS 631 00:22:02,200 --> 00:22:04,400 INCLUDING SAFETY NET HEALTH CARE 632 00:22:04,400 --> 00:22:06,960 SYSTEMS FOR HISPANIC/LATINO 633 00:22:06,960 --> 00:22:08,800 PEOPLE DON'T HAVE THE RESOURCES 634 00:22:08,800 --> 00:22:11,440 TO PROVIDE THIS INTENSITY OF 635 00:22:11,440 --> 00:22:11,680 SERVICES. 636 00:22:11,680 --> 00:22:12,800 THE THERAPISTS ARE SCARCE. 637 00:22:12,800 --> 00:22:15,280 THEY NEED SPECIALIZED TRAINING. 638 00:22:15,280 --> 00:22:17,280 THEY NEED REGULAR SUPERVISION 639 00:22:17,280 --> 00:22:20,680 AND REIMBURSEMENT IS OFTEN 640 00:22:20,680 --> 00:22:21,080 INADEQUATE. 641 00:22:21,080 --> 00:22:23,000 PATIENTS MIGHT HAVE TO PAY 642 00:22:23,000 --> 00:22:24,080 OUT-OF-POCKET AND MIGHT NOT BE 643 00:22:24,080 --> 00:22:25,760 ABLE TO MAKE THOSE PAYMENTS. 644 00:22:25,760 --> 00:22:30,760 THIS IS IMPORTANT IN ITS OWN 645 00:22:30,760 --> 00:22:34,200 RIGHT; BUT IT'S ALSO VERY MUCH 646 00:22:34,200 --> 00:22:36,080 AN EXEMPLAR OF A MUCH MORE 647 00:22:36,080 --> 00:22:37,080 GENERAL COMMON PROBLEM THAT 648 00:22:37,080 --> 00:22:38,760 EFFECTS THE CARE OF HISPANIC AND 649 00:22:38,760 --> 00:22:39,440 LATINO PEOPLE. 650 00:22:39,440 --> 00:22:42,160 AND THAT IS THAT AFTER 20 YEARS 651 00:22:42,160 --> 00:22:45,640 OF GREAT ADVANCES IN BEHAVIORAL 652 00:22:45,640 --> 00:22:49,680 SCIENCE, WE KNOW WHAT WORKS TO 653 00:22:49,680 --> 00:22:50,320 HELP PATIENTS TO BE BETTER BUT 654 00:22:50,320 --> 00:22:52,480 THE SERVICES THAT WE IDENTIFIED 655 00:22:52,480 --> 00:22:54,200 AREN'T SIMPLY NOT AVAILABLE 656 00:22:54,200 --> 00:22:56,520 BECAUSE THEY ARE TOO 657 00:22:56,520 --> 00:22:57,640 LABOR-INTENSIVE AND TOO COSTLY 658 00:22:57,640 --> 00:22:58,800 AND TOO COMPLEX. 659 00:22:58,800 --> 00:23:00,440 HOW DO WE GET THESE 660 00:23:00,440 --> 00:23:04,120 EVIDENCE-BASED PRACTICES INTO 661 00:23:04,120 --> 00:23:05,560 REAL-WORLD CLINICS AND HEALTH 662 00:23:05,560 --> 00:23:05,800 SYSTEMS? 663 00:23:05,800 --> 00:23:06,520 THAT IS REALLY THE FIRST 664 00:23:06,520 --> 00:23:07,800 CHALLENGE THAT WE HAVE BEEN 665 00:23:07,800 --> 00:23:09,760 FOCUSING ON FOR A NUMBER OF 666 00:23:09,760 --> 00:23:10,040 YEARS. 667 00:23:10,040 --> 00:23:13,760 WITH RESPECT TO CBT PROGRAMS, WE 668 00:23:13,760 --> 00:23:16,240 THINK THAT WE HAVE IDENTIFIED 669 00:23:16,240 --> 00:23:18,760 ONE WAY TO DO JUST THAT. 670 00:23:18,760 --> 00:23:20,960 AS I EXPLAINED, ONE MODEL OF CBT 671 00:23:20,960 --> 00:23:23,200 WOULD BE 10 WEEKLY CBT SESSIONS. 672 00:23:23,200 --> 00:23:25,280 IN THIS CASE, FOR CHRONIC PAIN. 673 00:23:25,280 --> 00:23:28,640 BUT IF YOU LOOK CLOSELY AT 674 00:23:28,640 --> 00:23:30,720 PATIENTS IN A CBT PROGRAM FOR 675 00:23:30,720 --> 00:23:31,600 CHRONIC PAIN OR SOME OTHER 676 00:23:31,600 --> 00:23:33,240 HIGH-SYMPTOM CONDITION, WHAT YOU 677 00:23:33,240 --> 00:23:34,680 SEE IS THAT AFTER THREE WEEKS OR 678 00:23:34,680 --> 00:23:37,920 FOUR WEEKS OR SIX WEEKS, A 679 00:23:37,920 --> 00:23:38,560 SIGNIFICANT NUMBER OF THOSE 680 00:23:38,560 --> 00:23:41,080 PATIENTS HAVE ACHIEVED THEIR 681 00:23:41,080 --> 00:23:41,280 GOALS. 682 00:23:41,280 --> 00:23:44,080 THEIR SYMPTOMS ARE BETTER. 683 00:23:44,080 --> 00:23:44,680 THEY MADE BEHAVIORAL CHANGES. 684 00:23:44,680 --> 00:23:46,400 SO IF WE CAN IDENTIFY WHICH OF 685 00:23:46,400 --> 00:23:49,720 THE PATIENTS THAT REALLY NEED 686 00:23:49,720 --> 00:23:52,440 MORE INTENSIVE FOLLOW-UP, AND 687 00:23:52,440 --> 00:23:54,080 WHICH PATIENTS MIGHT BE OKAY 688 00:23:54,080 --> 00:23:57,880 WITH SOME LESSER -- LESS 689 00:23:57,880 --> 00:23:59,920 INTENSIVE FORM OF TREATMENT, WE 690 00:23:59,920 --> 00:24:03,640 POTENTIALLY COULD GET ALL 691 00:24:03,640 --> 00:24:06,920 PATIENTS TO DRAMATICALLY THE 692 00:24:06,920 --> 00:24:07,280 COST. 693 00:24:07,280 --> 00:24:08,800 WE DID THAT IN THIS TRIAL. 694 00:24:08,800 --> 00:24:10,720 WE REALLY RECENTLY PUBLISHED 695 00:24:10,720 --> 00:24:11,320 THIS STUDY. 696 00:24:11,320 --> 00:24:13,040 IT'S GOTTEN A LOT OF ATTENTION. 697 00:24:13,040 --> 00:24:16,400 IT WAS PUBLISHED IN JEMAAH 698 00:24:16,400 --> 00:24:16,800 INTERNAL MEDICINE. 699 00:24:16,800 --> 00:24:19,280 THIS WAS A RANDOMIZED 700 00:24:19,280 --> 00:24:20,400 COMPARATIVE EFFECTIVENESS TRIAL 701 00:24:20,400 --> 00:24:22,880 FOR CBT CHRONIC PAIN IN THE V.A. 702 00:24:22,880 --> 00:24:23,640 HEALTH CARE SYSTEM. 703 00:24:23,640 --> 00:24:25,080 THE CONTROL GROUP PATIENTS 704 00:24:25,080 --> 00:24:26,560 RECEIVED THE STANDARD 10-SESSION 705 00:24:26,560 --> 00:24:29,400 COURSE OF TELEPHONE CBT. 706 00:24:29,400 --> 00:24:32,800 FOR PATIENTS IN THE INTERVENTION 707 00:24:32,800 --> 00:24:33,440 GROUP, AN ARTIFICIAL 708 00:24:33,440 --> 00:24:36,160 INTELLIGENCE ENGINE, WE CALL IT, 709 00:24:36,160 --> 00:24:38,320 SPECIFICALLY SOMETHING CALLED 710 00:24:38,320 --> 00:24:39,280 REINFORCEMENT LEARNING -- WAS 711 00:24:39,280 --> 00:24:43,080 MAKING CHOICES EACH WEEK ABOUT 712 00:24:43,080 --> 00:24:45,400 HOW INTENSIVE PATIENTS NEEDED TO 713 00:24:45,400 --> 00:24:49,480 BE ATTENDED TO TO GET TO THEIR 714 00:24:49,480 --> 00:24:51,280 GOAL. 715 00:24:51,280 --> 00:24:53,200 SO, IN VERY BRIEF T WORKS 716 00:24:53,200 --> 00:24:53,840 SOMETHING LIKE THIS: WE HOPE IT 717 00:24:53,840 --> 00:24:55,960 WORKED LIKE A GOOD CLINICIAN 718 00:24:55,960 --> 00:24:57,960 LEARNING FROM EXPERIENCE WITH 719 00:24:57,960 --> 00:25:01,760 HIS OR HER PATIENTS HOW TO 720 00:25:01,760 --> 00:25:03,480 PERSONALIZE TREATMENT IN A WAY 721 00:25:03,480 --> 00:25:05,400 THAT GETS PATIENTS QUICKLY TO 722 00:25:05,400 --> 00:25:06,520 GOAL AND MEETS WITH THEIR 723 00:25:06,520 --> 00:25:09,640 PARTICULAR LIMITATIONS AND 724 00:25:09,640 --> 00:25:09,920 PREFERENCES. 725 00:25:09,920 --> 00:25:11,680 SPECIFICALLY IN THIS PROGRAM, 726 00:25:11,680 --> 00:25:13,720 WHAT HAPPENED WAS, THAT THE AI 727 00:25:13,720 --> 00:25:17,520 PROGRAM WOULD MAKE A CHOICE EACH 728 00:25:17,520 --> 00:25:19,200 WEEK FOR EACH PATIENT DURING 729 00:25:19,200 --> 00:25:20,280 THEIR 10 WEEKS WHETHER THEY 730 00:25:20,280 --> 00:25:22,080 NEEDED A 45-MINUTE SESSION WITH 731 00:25:22,080 --> 00:25:24,480 A THERAPIST, WHETHER A 15-MINUTE 732 00:25:24,480 --> 00:25:25,880 BOOSTER SESSION MIGHT BE ENOUGH, 733 00:25:25,880 --> 00:25:27,640 OR WHETHER THE PATIENT COULD 734 00:25:27,640 --> 00:25:30,040 SIMPLY GET SUPPORT BY SOME 735 00:25:30,040 --> 00:25:30,840 DIGITAL TOOL. 736 00:25:30,840 --> 00:25:33,360 SO SOMETHING FAR LESS INTENSIVE 737 00:25:33,360 --> 00:25:35,040 WITH RESPECT TO THERAPIST TIME. 738 00:25:35,040 --> 00:25:36,840 HOW WAS THE PROGRAM LEARNING TO 739 00:25:36,840 --> 00:25:38,160 MAKE THESE DECISIONS? 740 00:25:38,160 --> 00:25:40,240 WELL, LIKE A GOOD CLINICIAN, IT 741 00:25:40,240 --> 00:25:42,280 WAS LEARNING FROM EXPERIENCE. 742 00:25:42,280 --> 00:25:43,520 IT WAS LEARNING FROM MAKING 743 00:25:43,520 --> 00:25:45,840 THESE DECISIONS AND WATCHING 744 00:25:45,840 --> 00:25:47,200 PATIENTS CAREFULLY. 745 00:25:47,200 --> 00:25:48,680 IN THIS PARTICULAR TRIAL, 746 00:25:48,680 --> 00:25:51,160 PATIENTS WERE PROVIDING REGULAR 747 00:25:51,160 --> 00:25:52,440 FEEDBACK ABOUT THE INTENSITY OF 748 00:25:52,440 --> 00:25:55,640 THEIR PAIN, THEIR SLEEP, THEIR 749 00:25:55,640 --> 00:25:57,880 FUNCTIONAL MOBILITY, THEIR 750 00:25:57,880 --> 00:26:01,120 PRACTICE OF CBT SKILLS AND OTHER 751 00:26:01,120 --> 00:26:02,480 INFORMATION, AND THE AI PROGRAM 752 00:26:02,480 --> 00:26:03,760 ALSO HAD OTHER INFORMATION ABOUT 753 00:26:03,760 --> 00:26:05,400 THAT PERSON. 754 00:26:05,400 --> 00:26:07,600 SO IT COULD PERSONALIZE THESE 755 00:26:07,600 --> 00:26:08,800 DECISIONS IN CASE THAT TREATMENT 756 00:26:08,800 --> 00:26:11,640 WAS MORE NEEDED FOR SOME SORTS 757 00:26:11,640 --> 00:26:13,080 OF PATIENTS, MAYBE OLDER 758 00:26:13,080 --> 00:26:15,320 PATIENTS OR PATIENTS THAT HAD 759 00:26:15,320 --> 00:26:16,320 CO-MORBID MENTAL HEALTH 760 00:26:16,320 --> 00:26:16,600 PROBLEMS. 761 00:26:16,600 --> 00:26:19,440 AND VERY BRIEF, THAT'S HOW THIS 762 00:26:19,440 --> 00:26:23,000 AI-SUPPORTED PROGRAM OF CBT WAS 763 00:26:23,000 --> 00:26:25,720 WORKING. 764 00:26:25,720 --> 00:26:29,000 WHAT WE FOUND IN THIS 765 00:26:29,000 --> 00:26:29,600 COMPARATIVE EFFECTIVENESS TRIAL, 766 00:26:29,600 --> 00:26:31,280 WHEN PATIENTS RECEIVED THIS MODE 767 00:26:31,280 --> 00:26:32,640 OF CBT, THEY ACHIEVED OUTCOMES 768 00:26:32,640 --> 00:26:35,440 AT LEAST AS GOOD AS STANDARD 769 00:26:35,440 --> 00:26:36,520 CARE, AS STANDARD 10 SESSIONS 770 00:26:36,520 --> 00:26:37,720 WITH A THERAPIST. 771 00:26:37,720 --> 00:26:39,400 BUT THE EXCITING PART WAS THAT 772 00:26:39,400 --> 00:26:42,480 THE AI-SUPPORTED PROGRAM 773 00:26:42,480 --> 00:26:43,280 INCREASED THE NUMBER OF WEEKS IN 774 00:26:43,280 --> 00:26:45,400 WHICH THEY HAD CONTACT WHILE 775 00:26:45,400 --> 00:26:47,880 USING LESS THAN HALF OF THE 776 00:26:47,880 --> 00:26:48,280 THERAPIST'S TIME. 777 00:26:48,280 --> 00:26:51,720 SO IN THEORY, THIS WOULD MEAN 778 00:26:51,720 --> 00:26:52,320 THAT YOU COULD TREAT TWICE AS 779 00:26:52,320 --> 00:26:55,080 MANY PATIENTS WITH THE SAME 780 00:26:55,080 --> 00:26:55,720 LIMITED NUMBER OF THERAPISTS. 781 00:26:55,720 --> 00:27:00,200 WE BELIEVE THIS HAS GREAT 782 00:27:00,200 --> 00:27:02,240 IMPLICATIONS FOR HOW WE CAN 783 00:27:02,240 --> 00:27:03,920 EXTEND ACCESS TO EVIDENCE-BASED 784 00:27:03,920 --> 00:27:07,200 PROGRAMS LIKE CBT, FOR PEOPLE 785 00:27:07,200 --> 00:27:10,200 THAT ARE HISPANIC OR LATINO. 786 00:27:10,200 --> 00:27:12,000 AND WE ARE PURSUING A FOLLOW-UP 787 00:27:12,000 --> 00:27:16,240 OF THIS PARTICULAR MODEL OF CARE 788 00:27:16,240 --> 00:27:17,720 WITH HEALTH SYSTEMS AND 789 00:27:17,720 --> 00:27:19,080 COMMUNITY PARTNERS IN THE 790 00:27:19,080 --> 00:27:20,960 COUNTRY OF HONDURAS. 791 00:27:20,960 --> 00:27:23,600 IN THAT COUNTRY, LIKE IN MANY OF 792 00:27:23,600 --> 00:27:27,280 OUR CONVERSATIONS WITH THE 793 00:27:27,280 --> 00:27:28,320 COMMUNITY PARTNERS IN COUNTRIES 794 00:27:28,320 --> 00:27:31,320 OF LATIN AMERICA, WHAT WE HAVE 795 00:27:31,320 --> 00:27:33,400 HEARD IS THAT A PRIORITY IS 796 00:27:33,400 --> 00:27:34,520 VIOLENCE AND SPECIFICALLY THE 797 00:27:34,520 --> 00:27:37,720 WAY IN WHICH VIOLENCE IS CAUSING 798 00:27:37,720 --> 00:27:39,240 DEPRESSION, ANXIETY AND 799 00:27:39,240 --> 00:27:40,240 POST-TRAUMATIC STRESS FOR WOMEN. 800 00:27:40,240 --> 00:27:43,000 SO THIS IS A PROJECT THAT IS 801 00:27:43,000 --> 00:27:44,600 FOCUSED ON CBT FOR WOMEN THAT 802 00:27:44,600 --> 00:27:47,720 HAVE EXPERIENCED VIOLENCE AND 803 00:27:47,720 --> 00:27:49,120 HAVE THESE PARTICULAR PROBLEMS 804 00:27:49,120 --> 00:27:50,760 WITH THEIR MOOD. 805 00:27:50,760 --> 00:27:53,920 GOOD NEWS IS THAT CBT WORKS FOR 806 00:27:53,920 --> 00:27:55,200 THOSE DISORDERS AND BECAUSE WE 807 00:27:55,200 --> 00:27:56,960 ARE ADDRESSING HEALTH SYSTEM 808 00:27:56,960 --> 00:28:00,800 PRIORITIES, THIS PROJECT HAS 809 00:28:00,800 --> 00:28:01,920 GREAT ENTHUSIASM FROM THE 810 00:28:01,920 --> 00:28:03,000 LARGEST PSYCHIATRIC HOSPITAL IN 811 00:28:03,000 --> 00:28:07,280 THE CAPITAL OF HONDURAS AS WELL 812 00:28:07,280 --> 00:28:08,680 AS FROM THE NATIONAL SECRETARY 813 00:28:08,680 --> 00:28:10,680 OF HEALTH IN THAT COUNTRY. 814 00:28:10,680 --> 00:28:13,320 AND WE ARE WORKING WITH REALLY 815 00:28:13,320 --> 00:28:18,240 STRONG COMMUNITY PARTNERS 816 00:28:18,240 --> 00:28:19,960 REPRESENTING WOMEN WHO ARE AT 817 00:28:19,960 --> 00:28:22,080 RISK OR HAVE EXPERIENCED OR HAVE 818 00:28:22,080 --> 00:28:24,280 BEEN THE VICTIMS OF VIOLENCE AND 819 00:28:24,280 --> 00:28:26,960 EXPERIENCED MENTAL HEALTH 820 00:28:26,960 --> 00:28:27,440 PROBLEMS. 821 00:28:27,440 --> 00:28:29,120 AND THE FOUNDATION IS A 822 00:28:29,120 --> 00:28:30,600 COMMUNITY-BASED ORGANIZATION IN 823 00:28:30,600 --> 00:28:32,160 HON DUR US WORKING WITH US THAT 824 00:28:32,160 --> 00:28:35,400 REPRESENTS CONSUMERS. 825 00:28:35,400 --> 00:28:36,400 PEOPLE THAT EXPERIENCE MENTAL 826 00:28:36,400 --> 00:28:37,240 HEALTH PROBLEMS. 827 00:28:37,240 --> 00:28:38,920 SO THAT'S ONE DIRECTION WE ARE 828 00:28:38,920 --> 00:28:40,360 TAKING THIS WORK THAT I THINK 829 00:28:40,360 --> 00:28:43,240 HAS GREAT RELEVANCE FOR 830 00:28:43,240 --> 00:28:46,760 HISPANIC/LATINO POPULATIONS. 831 00:28:46,760 --> 00:28:50,120 ANOTHER ISSUE THAT WE ARE REALLY 832 00:28:50,120 --> 00:28:52,920 TACKLING WITH HEALTH SYSTEMS IS 833 00:28:52,920 --> 00:28:54,360 THIS: IN FORTUNATELY, WE KNOW 834 00:28:54,360 --> 00:28:56,640 THAT WHEN HISPANIC AND LATINO 835 00:28:56,640 --> 00:28:58,160 PATIENTS COME IN CONTACT WITH 836 00:28:58,160 --> 00:29:00,280 HEALTH CARE PROVIDERS, THEY ARE 837 00:29:00,280 --> 00:29:03,840 NOT ALWAYS HAVING THE QUALITY OF 838 00:29:03,840 --> 00:29:04,360 INTERACTION THAT WOULD BE 839 00:29:04,360 --> 00:29:07,840 IMPORTANT TO BUILD A TRUSTING 840 00:29:07,840 --> 00:29:08,800 CLINICAL RELATIONSHIP THAT WOULD 841 00:29:08,800 --> 00:29:11,560 ALLOW THE PATIENT TO REPORT HOW 842 00:29:11,560 --> 00:29:13,800 THEY ARE DOING AND THAT WOULD 843 00:29:13,800 --> 00:29:15,400 MAKE THEM INTERESTED IN 844 00:29:15,400 --> 00:29:17,000 FOLLOWING UP WITH TREATMENT AND 845 00:29:17,000 --> 00:29:22,040 REACHING THEIR BEHAVIORAL GOALS. 846 00:29:22,040 --> 00:29:23,480 WE SEE THIS RECENTLY IN THIS 847 00:29:23,480 --> 00:29:26,960 STUDY, WHICH I RECENTLY CAME 848 00:29:26,960 --> 00:29:27,600 ACROSS CONFIRMING SOMETHING WE 849 00:29:27,600 --> 00:29:29,480 KNOW, THAT WE HEAR FROM HEALTH 850 00:29:29,480 --> 00:29:32,600 SYSTEMS IN THE U.S. AND LATIN 851 00:29:32,600 --> 00:29:32,840 AMERICA. 852 00:29:32,840 --> 00:29:34,440 MANY PATIENTS FEEL INHIBITED IN 853 00:29:34,440 --> 00:29:36,240 TALKING WITH PROVIDERS. 854 00:29:36,240 --> 00:29:37,320 THEY MIGHT SIMPLY NOT HAVE THE 855 00:29:37,320 --> 00:29:40,600 TIME IN THESE VERY, VERY BRIEF 856 00:29:40,600 --> 00:29:41,440 ENCOUNTERS WITH PROVIDERS TO 857 00:29:41,440 --> 00:29:44,160 SHARE THEIR STORY, TO SHARE 858 00:29:44,160 --> 00:29:44,600 THEIR CONCERNS, TO ASK 859 00:29:44,600 --> 00:29:46,200 QUESTIONS, ET CETERA. 860 00:29:46,200 --> 00:29:47,560 THE GOOD NEWS IS, THAT JUST LIKE 861 00:29:47,560 --> 00:29:50,200 WITH EVIDENCE-BASED CBT 862 00:29:50,200 --> 00:29:51,200 PROGRAMS, WE KNOW HOW TO MAKE 863 00:29:51,200 --> 00:29:53,080 COMMUNICATION AND HEALTH CARE 864 00:29:53,080 --> 00:29:54,640 SYSTEMS BETTER. 865 00:29:54,640 --> 00:29:55,640 THAT'S THROUGH SOMETHING CALLED 866 00:29:55,640 --> 00:29:57,200 MOTIVATIONAL INTERVIEWING WHERE 867 00:29:57,200 --> 00:30:00,400 WE CAN TEACH PROVIDERS TO BE 868 00:30:00,400 --> 00:30:01,480 MORE EMPATHETIC, TO GIVE 869 00:30:01,480 --> 00:30:04,480 PATIENTS THE SPACE TO TALK, TO 870 00:30:04,480 --> 00:30:05,960 REALLY AFFIRM PATIENT'S 871 00:30:05,960 --> 00:30:08,880 STRUGGLES AND THEIR SUCCESSES AS 872 00:30:08,880 --> 00:30:10,880 LIMITED AS THEY MAY BE. 873 00:30:10,880 --> 00:30:12,440 MOTIVATIONAL INTERVIEWING WORKS 874 00:30:12,440 --> 00:30:17,680 BUT JUST LIKE WITH CBT, WE SEE 875 00:30:17,680 --> 00:30:21,640 THE SAME CHALLENGES THAT WE KNOW 876 00:30:21,640 --> 00:30:22,160 WHAT WORKS BUT THE 877 00:30:22,160 --> 00:30:23,560 IMPLEMENTATION OF A PROGRAM OF 878 00:30:23,560 --> 00:30:25,040 TRAINING PROVIDERS WITH 879 00:30:25,040 --> 00:30:26,240 MOTIVATIONAL INTERVIEWING 880 00:30:26,240 --> 00:30:28,600 TECHNIQUES IS QUITE 881 00:30:28,600 --> 00:30:28,960 LABOR-INTENSIVE. 882 00:30:28,960 --> 00:30:31,960 YOU NEED SPECIALISTS IN THAT 883 00:30:31,960 --> 00:30:32,680 AREA. 884 00:30:32,680 --> 00:30:33,720 PROVIDERS OFTEN NEED BOOSTERS. 885 00:30:33,720 --> 00:30:36,880 THEY NEED FOLLOW-UP. 886 00:30:36,880 --> 00:30:37,320 THEY NEED SUPERVISION. 887 00:30:37,320 --> 00:30:39,800 SO OUR CHALLENGE IS, HOW CAN WE 888 00:30:39,800 --> 00:30:41,760 MAKE SURE THAT HEALTH CARE 889 00:30:41,760 --> 00:30:42,400 PROFESSIONALS COMMUNICATE WITH 890 00:30:42,400 --> 00:30:44,200 HISPANIC AND LATINO PEOPLE IN 891 00:30:44,200 --> 00:30:45,520 WAYS THAT ARE RESPECTFUL AND 892 00:30:45,520 --> 00:30:47,560 SUPPORT POSITIVE OUTCOMES? 893 00:30:47,560 --> 00:30:49,720 IT TURNS OUT THAT WE ARE DOING 894 00:30:49,720 --> 00:30:51,960 THAT WITH ANOTHER FORM OF 895 00:30:51,960 --> 00:30:54,120 ARTIFICIAL INTELLIGENCE AND THIS 896 00:30:54,120 --> 00:30:58,800 IS A FIELD OF ARTIFICIAL 897 00:30:58,800 --> 00:30:59,880 INTELLIGENCE THAT YOU MAY HAVE 898 00:30:59,880 --> 00:31:02,600 HEARD OF IT'S CALLED NATURAL 899 00:31:02,600 --> 00:31:03,040 LANGUAGE PROCESSING. 900 00:31:03,040 --> 00:31:04,360 IF YOU HAVE INTERACTED WITH 901 00:31:04,360 --> 00:31:09,080 SIRI, OR YOU HAVE USED SOME 902 00:31:09,080 --> 00:31:10,920 SPEECH-TO-TEXT PROGRAM OR A CHAT 903 00:31:10,920 --> 00:31:13,480 BOT, THAT IS NLP, NATURAL 904 00:31:13,480 --> 00:31:14,440 LANGUAGE PROCESSING. 905 00:31:14,440 --> 00:31:17,160 AND THAT IS A WAY THAT WE CAN 906 00:31:17,160 --> 00:31:19,280 TEACH COMPUTERS TO LISTEN TO 907 00:31:19,280 --> 00:31:21,560 HUMAN CONVERSATIONS AND GIVE 908 00:31:21,560 --> 00:31:23,160 SCORES AMONG OTHER THINGS. 909 00:31:23,160 --> 00:31:24,440 I MEAN IT CAN RATE THE 910 00:31:24,440 --> 00:31:25,600 CONVERSATION, UNDERSTAND AT SOME 911 00:31:25,600 --> 00:31:28,000 LEVEL WHAT IS HAPPENING. 912 00:31:28,000 --> 00:31:30,520 ONE SIMPLE THING THAT WE CAN 913 00:31:30,520 --> 00:31:33,720 TEACH AN NLP PROGRAM TO DO IS TO 914 00:31:33,720 --> 00:31:36,040 GIVE FEEDBACK ON WHAT PROPORTION 915 00:31:36,040 --> 00:31:38,520 OF THE TIME IN THE 916 00:31:38,520 --> 00:31:39,160 CLINICIAN/PATIENT RELATIONSHIP, 917 00:31:39,160 --> 00:31:40,640 THE PROVIDER IS TALKING VERSUS 918 00:31:40,640 --> 00:31:41,400 THE PATIENT. 919 00:31:41,400 --> 00:31:42,840 SO SOMETHING THAT WOULD BE 920 00:31:42,840 --> 00:31:43,960 FRANKLY NOT VERY HELPFUL IS WE 921 00:31:43,960 --> 00:31:47,320 HAVE A CLINICIAN-DOMINATED 922 00:31:47,320 --> 00:31:48,480 INTERACTION WITH PROVIDERS DOING 923 00:31:48,480 --> 00:31:49,320 ALL THE TALKING AND THE PATIENT 924 00:31:49,320 --> 00:31:50,680 IS NOT TALKING AT ALL. 925 00:31:50,680 --> 00:31:52,280 THAT IS AN INTERACTION THAT IS 926 00:31:52,280 --> 00:31:55,280 LESS LIKELY TO RESULT IN 927 00:31:55,280 --> 00:31:56,160 POSITIVE PATIENT OUTCOMES. 928 00:31:56,160 --> 00:32:00,800 REALLY HOPING THAT WE HAVE A 929 00:32:00,800 --> 00:32:02,080 MORE EGAL TARYN INTERACTION SO 930 00:32:02,080 --> 00:32:04,040 WE COULD TEACH AN NLP PROGRAM TO 931 00:32:04,040 --> 00:32:06,440 LISTEN TO RECORDINGS OF 932 00:32:06,440 --> 00:32:07,520 CONVERSATIONS AND GIVE PROVIDERS 933 00:32:07,520 --> 00:32:09,480 AND HEALTH SYSTEMS FEEDBACK 934 00:32:09,480 --> 00:32:12,680 ABOUT WHAT IS ACTUALLY HAPPENING 935 00:32:12,680 --> 00:32:15,280 INTERACTIONS SO IT IS CORRECTIVE 936 00:32:15,280 --> 00:32:15,560 FEEDBACK. 937 00:32:15,560 --> 00:32:17,880 THEY CAN USE THIS INFORMATION IN 938 00:32:17,880 --> 00:32:18,960 TRAINING ON MORE EFFECTIVE 939 00:32:18,960 --> 00:32:20,560 COMMUNICATION STRATEGIES TO DO A 940 00:32:20,560 --> 00:32:22,720 BETTER JOB AND IMPROVE THEIR 941 00:32:22,720 --> 00:32:25,720 RELATIONSHIPS WITH PATIENTS AND 942 00:32:25,720 --> 00:32:28,960 PATIENT OUTCOMES. 943 00:32:28,960 --> 00:32:31,280 WE THINK THIS HAS A LOT OF 944 00:32:31,280 --> 00:32:31,760 IMPORTANT IMPLICATIONS. 945 00:32:31,760 --> 00:32:33,000 WE ARE WORKING WITH HEALTH 946 00:32:33,000 --> 00:32:35,800 SYSTEMS IN MEXICO AND HONDURAS 947 00:32:35,800 --> 00:32:38,000 TO TRAIN NLP PROGRAMS TO DO JUST 948 00:32:38,000 --> 00:32:39,720 THAT, SPECIFICALLY FOR 949 00:32:39,720 --> 00:32:40,400 SPANISH-SPEAKING PATIENTS. 950 00:32:40,400 --> 00:32:43,640 AND WE HOPE TO DEVELOP SYSTEMS 951 00:32:43,640 --> 00:32:46,440 THAT WILL ALLOW US TO UNDERSTAND 952 00:32:46,440 --> 00:32:47,400 BETTER WHETHER CLINICIANS ARE 953 00:32:47,400 --> 00:32:50,400 MORE LIKELY TO USE NEGATIVE 954 00:32:50,400 --> 00:32:51,480 COMMUNICATION STYLES WITH SOME 955 00:32:51,480 --> 00:32:55,040 OF THEIR PATIENTS THAN WITH 956 00:32:55,040 --> 00:32:55,280 OTHERS. 957 00:32:55,280 --> 00:32:57,240 WHICH OF THE CLINICIANS ARE 958 00:32:57,240 --> 00:32:59,360 STRUGGLING MOST WITH 959 00:32:59,360 --> 00:33:00,600 COMMUNICATION WITH THEIR 960 00:33:00,600 --> 00:33:00,880 PATIENTS? 961 00:33:00,880 --> 00:33:04,320 IS IT CLINICIANS THAT HAVE LESS 962 00:33:04,320 --> 00:33:05,360 FAMILIARITY WITH HISPANIC 963 00:33:05,360 --> 00:33:06,720 POPULATIONS OR AREN'T AS 964 00:33:06,720 --> 00:33:08,280 COMFORTABLE SPEAKING SPANISH? 965 00:33:08,280 --> 00:33:09,640 WHO ARE THE CLINICIANS WE NEED 966 00:33:09,640 --> 00:33:11,240 TO TARGET WITH CORRECTIVE 967 00:33:11,240 --> 00:33:12,640 TRAINING AND FOLLOW-UP? 968 00:33:12,640 --> 00:33:15,280 WHAT ARE THE OUTCOMES THAT ARE 969 00:33:15,280 --> 00:33:16,080 AFFECTED BY THIS COMMUNICATION? 970 00:33:16,080 --> 00:33:18,320 I MEAN MY HYPOTHESES IS THAT 971 00:33:18,320 --> 00:33:22,200 FOLLOW UM RATES, NO SHOW RATES, 972 00:33:22,200 --> 00:33:23,240 HEALTH OUTCOMES MIGHT BE 973 00:33:23,240 --> 00:33:26,840 IMPACTED BY THESE NEGATIVE 974 00:33:26,840 --> 00:33:27,520 COMMUNICATION STYLES WE NOW WILL 975 00:33:27,520 --> 00:33:28,600 BE ABLE TO MEASURE. 976 00:33:28,600 --> 00:33:30,200 AND MOST IMPORTANTLY, HOW CAN WE 977 00:33:30,200 --> 00:33:30,600 HELP? 978 00:33:30,600 --> 00:33:33,080 HOW CAN WE HELP CLINICIANS AND 979 00:33:33,080 --> 00:33:34,200 HEALTH SYSTEMS UNDERSTAND WHAT 980 00:33:34,200 --> 00:33:35,360 IS HAPPENING WITH THEIR 981 00:33:35,360 --> 00:33:37,240 PROVIDERS AND WITH THEIR 982 00:33:37,240 --> 00:33:38,280 PROVIDER PATIENT COMMUNICATION 983 00:33:38,280 --> 00:33:46,640 AND DO A BETTER JOB? 984 00:33:46,640 --> 00:33:48,840 >>MY NAME IS --OON COLGIST FROM 985 00:33:48,840 --> 00:33:49,440 BRAZIL. 986 00:33:49,440 --> 00:33:51,640 HAPPY TO BE HERE PRESENTING TO 987 00:33:51,640 --> 00:33:54,080 YOU THIS PRESENTATION THAT IS 988 00:33:54,080 --> 00:33:55,760 ENTITLED FOSTERING CLINICAL 989 00:33:55,760 --> 00:33:57,280 CANCER RESEARCH IN LATIN 990 00:33:57,280 --> 00:33:57,600 AMERICA. 991 00:33:57,600 --> 00:33:58,400 WHY AND HOW? 992 00:33:58,400 --> 00:34:01,080 THESE ARE MY DISCLOSURES. 993 00:34:01,080 --> 00:34:03,320 FIRST OF ALL, THE WHY. 994 00:34:03,320 --> 00:34:05,320 THIS IS WHY YOU CAN SEE THE 995 00:34:05,320 --> 00:34:07,320 GLOBAL DISTRIBUTION OF CLINICAL 996 00:34:07,320 --> 00:34:09,960 TRIALS AND YOU CAN SEE A VERY 997 00:34:09,960 --> 00:34:10,960 THIN LINE OF BLUE. 998 00:34:10,960 --> 00:34:16,560 THERE IS LATIN AMERICA. 999 00:34:16,560 --> 00:34:18,640 SO THIS VERY THIN LAYER IS THE 1000 00:34:18,640 --> 00:34:21,160 PROPORTION OF REGISTERED 1001 00:34:21,160 --> 00:34:22,040 CLINICAL TRIALS THAT ARE 1002 00:34:22,040 --> 00:34:24,720 CONDUCTED IN LATIN AMERICA IN 1003 00:34:24,720 --> 00:34:26,880 PROPORTION TO WHAT IS CONDUCTED 1004 00:34:26,880 --> 00:34:28,640 IN NORTH AMERICA OR EUROPE OR 1005 00:34:28,640 --> 00:34:30,960 MORE RECENTLY, ASIA, AS YOU CAN 1006 00:34:30,960 --> 00:34:31,400 SEE. 1007 00:34:31,400 --> 00:34:33,520 WE HAVE A VERY SMALL MARKET 1008 00:34:33,520 --> 00:34:36,320 SHARE OF CLINICAL TRIALS IN THE 1009 00:34:36,320 --> 00:34:36,520 WORLD. 1010 00:34:36,520 --> 00:34:42,160 YOU CAN SEE THIS MARKED CLEARLY 1011 00:34:42,160 --> 00:34:42,960 HERE IN THIS MAP WHERE YOU CAN 1012 00:34:42,960 --> 00:34:52,320 SEE THAT WE HAVE APPROXIMATELY 1013 00:34:52,320 --> 00:34:54,720 5.2% OF CLINICAL TRIALS AND THAT 1014 00:34:54,720 --> 00:34:56,280 WAS TAKEN AT THE END OF AUGUST, 1015 00:34:56,280 --> 00:34:59,240 SO THIS IS VERY RECENT. 1016 00:34:59,240 --> 00:35:00,280 ADDITIONALLY LATIN AMERICA IS 1017 00:35:00,280 --> 00:35:01,760 QUITE A LARGE PHARMACEUTICAL 1018 00:35:01,760 --> 00:35:02,480 MARKET SIZE. 1019 00:35:02,480 --> 00:35:05,320 YOU CAN SEE THAT BRAZIL IS 1020 00:35:05,320 --> 00:35:08,080 ESTIMATED TO BE THE FIFTH 1021 00:35:08,080 --> 00:35:11,320 LARGEST MARKET SIZE IN 2023. 1022 00:35:11,320 --> 00:35:14,480 IN THAT LIST THAT ALSO HAS THE 1023 00:35:14,480 --> 00:35:16,560 20 LARGEST MARKET SIZE EXPECTED 1024 00:35:16,560 --> 00:35:23,200 TO BE IN 2023, WE WILL ALSO SEE 1025 00:35:23,200 --> 00:35:24,800 MEXICO. 1026 00:35:24,800 --> 00:35:25,280 REGARDING RESEARCH AND 1027 00:35:25,280 --> 00:35:27,320 DEVELOPMENT INVESTMENT, WE CAN 1028 00:35:27,320 --> 00:35:30,640 SEE THAT THE GLOBAL 1029 00:35:30,640 --> 00:35:31,760 DISTRIBUTION -- USUALLY THERE IS 1030 00:35:31,760 --> 00:35:34,280 A PREDOMINANCE OF PRIVATE 1031 00:35:34,280 --> 00:35:37,240 INVESTMENTS FOR RESEARCH AND 1032 00:35:37,240 --> 00:35:38,080 DEVELOPMENT. 1033 00:35:38,080 --> 00:35:41,120 BUT, IN THE SOUTH AMERICA, YOU 1034 00:35:41,120 --> 00:35:43,320 CAN SEE THAT PRIVATE INVESTMENT 1035 00:35:43,320 --> 00:35:45,120 IS NOT AS LARGE AS IT IS IN 1036 00:35:45,120 --> 00:35:49,360 EUROPE OR AS IT IS IN NORTH 1037 00:35:49,360 --> 00:35:49,600 AMERICA. 1038 00:35:49,600 --> 00:35:52,760 SO, THIS SUGGESTS THAT PRIVATE 1039 00:35:52,760 --> 00:35:54,760 INVESTMENT IS DISPROPORTIONATELY 1040 00:35:54,760 --> 00:35:57,360 LOW IN SOUTH AMERICA AND OTHER 1041 00:35:57,360 --> 00:36:00,600 PARTS OF THE WORLDCOM PAIRED TO 1042 00:36:00,600 --> 00:36:04,200 EUROPE AND NORTH AMERICA. 1043 00:36:04,200 --> 00:36:04,960 HOWEVER, WE CAN SEE THAT PUBLIC 1044 00:36:04,960 --> 00:36:07,080 INVESTMENT IN RESEARCH AND 1045 00:36:07,080 --> 00:36:08,400 DEVELOPMENT IS NOT AS LARGE IN 1046 00:36:08,400 --> 00:36:10,760 LATIN AMERICA AND THE SCRIBBIAN 1047 00:36:10,760 --> 00:36:13,320 AS IT IS IN EUROPE AND NORTH 1048 00:36:13,320 --> 00:36:15,960 AMERICA -- AND THE CARIBBEAN -- 1049 00:36:15,960 --> 00:36:17,880 WHERE IT USUALLY RANGES BETWEEN 1050 00:36:17,880 --> 00:36:19,880 2-4% OF THE GDP. 1051 00:36:19,880 --> 00:36:21,560 AND IN LATIN AMERICA THE HIGHEST 1052 00:36:21,560 --> 00:36:26,160 IS BRAZIL, 1.1% OF GDP AND THE 1053 00:36:26,160 --> 00:36:28,320 OTHER COUNTRIES IN LATIN 1054 00:36:28,320 --> 00:36:30,360 AMERICA, THE CARIBBEAN ARE 1055 00:36:30,360 --> 00:36:34,960 REASONABLY LESS THAN THAT. 1056 00:36:34,960 --> 00:36:37,440 CONSIDERING THAT, I THINK WE DO 1057 00:36:37,440 --> 00:36:38,600 HAVE SOME SHARP CONCLUSIONS 1058 00:36:38,600 --> 00:36:39,240 HERE. 1059 00:36:39,240 --> 00:36:41,680 THE FIRST ONE IS THAT LATIN 1060 00:36:41,680 --> 00:36:42,520 AMERICA IS SERIOUSLY 1061 00:36:42,520 --> 00:36:45,280 UNDERREPRESENTED IN CLINICAL 1062 00:36:45,280 --> 00:36:48,360 TRIALS AND THIS LEADS TO OTHER 1063 00:36:48,360 --> 00:36:50,160 CONCLUSIONS. 1064 00:36:50,160 --> 00:36:51,440 ARE THE RESULTS FROM OTHER 1065 00:36:51,440 --> 00:36:54,400 POPULATIONS VALID FOR LATIN 1066 00:36:54,400 --> 00:36:56,400 AMERICA? 1067 00:36:56,400 --> 00:36:58,960 OR CAN WE EXPECT A DIFFERENT 1068 00:36:58,960 --> 00:37:01,000 BEHAVIOR FROM DISEASES FOR 1069 00:37:01,000 --> 00:37:02,680 LATIN-AMERICAN POPULATION? 1070 00:37:02,680 --> 00:37:05,200 I THINK THIS COULD BE DISCUSSED 1071 00:37:05,200 --> 00:37:08,200 IN ONE BY ONE BASIS ON TRIALS. 1072 00:37:08,200 --> 00:37:11,000 AND THERE IS ALSO SOMETHING VERY 1073 00:37:11,000 --> 00:37:12,880 IMPORTANT THAT AS LATIN AMERICA 1074 00:37:12,880 --> 00:37:14,440 HAS A GREAT REPUTATION FOR 1075 00:37:14,440 --> 00:37:18,360 DEVELOPMENT OF CLINICAL TRIALS. 1076 00:37:18,360 --> 00:37:19,760 AS RESEARCH AND DEVELOPMENT IS 1077 00:37:19,760 --> 00:37:21,920 SERIOUSLY UNDERFUNDED IN LATIN 1078 00:37:21,920 --> 00:37:26,680 AMERICA BY BOTH PRIVATE AND 1079 00:37:26,680 --> 00:37:28,600 PUBLIC SECTORS. 1080 00:37:28,600 --> 00:37:32,320 AND THIS IS INFORMATION THAT IS 1081 00:37:32,320 --> 00:37:32,880 VERY IMPORTANT. 1082 00:37:32,880 --> 00:37:37,040 IT'S VERY FREQUENT THAT STANDARD 1083 00:37:37,040 --> 00:37:38,280 OF CARE TREATMENTS CONSIDERED AT 1084 00:37:38,280 --> 00:37:40,320 EUROPE OR AT UNITED STATES ARE 1085 00:37:40,320 --> 00:37:42,280 NOT AVAILABLE FOR PATIENTS IN 1086 00:37:42,280 --> 00:37:46,800 THE PUBLIC HEALTH SYSTEMS IN 1087 00:37:46,800 --> 00:37:48,480 LATIN AMERICA. 1088 00:37:48,480 --> 00:37:49,320 SO THIS POSES BOTH A CHALLENGE 1089 00:37:49,320 --> 00:37:53,120 AND AN OPPORTUNITY FOR CLINICAL 1090 00:37:53,120 --> 00:37:55,000 TRIALS BECAUSE WE CAN ENROLL 1091 00:37:55,000 --> 00:37:58,920 PATIENTS AND PROPOSE THEM THE 1092 00:37:58,920 --> 00:37:59,440 STANDARD OF CARE. 1093 00:37:59,440 --> 00:38:01,680 HOWEVER FOR TRIALS THAT NEED 1094 00:38:01,680 --> 00:38:07,160 STANDARD OF CARE TO ALSO HAVE 1095 00:38:07,160 --> 00:38:08,000 BEEN PERFORMED, THIS POSES A 1096 00:38:08,000 --> 00:38:11,760 SIGNIFICANT CHALLENGE AT LEAST 1097 00:38:11,760 --> 00:38:15,440 IN THE -- NOT THAT WELL-FUNDED 1098 00:38:15,440 --> 00:38:17,600 PARTS OF THE COUNTRIES. 1099 00:38:17,600 --> 00:38:18,880 CONSIDERING WHAT I TOLD YOU 1100 00:38:18,880 --> 00:38:23,960 BEFORE, I LIKE TO PRESENT YOU TO 1101 00:38:23,960 --> 00:38:27,680 THE LATIN-AMERICAN ONCOLOGY 1102 00:38:27,680 --> 00:38:28,920 GROUP. 1103 00:38:28,920 --> 00:38:30,080 A NONPROFIT RESEARCH INSTITUTION 1104 00:38:30,080 --> 00:38:32,880 THAT IS DEDICATED TO PROMOTE 1105 00:38:32,880 --> 00:38:35,040 CANCER RESEARCH IN LATIN 1106 00:38:35,040 --> 00:38:35,880 AMERICA. 1107 00:38:35,880 --> 00:38:39,080 WE DID HAVE PARTNERS AND SOME 1108 00:38:39,080 --> 00:38:44,720 VERY LARGE PARTNERS. 1109 00:38:44,720 --> 00:38:47,440 AND WE DO PROMOTE, CONDUCT, 1110 00:38:47,440 --> 00:38:50,280 DEVELOP, RESEARCH IN LATIN 1111 00:38:50,280 --> 00:38:51,480 AMERICA. 1112 00:38:51,480 --> 00:38:55,280 LACOG HAS MORE THAN 400 MEMBERS 1113 00:38:55,280 --> 00:38:58,080 IN 16 COUNTRIES THAT PRESENT 1114 00:38:58,080 --> 00:39:02,200 MORE THAN 200 HOSPITALS IN LATIN 1115 00:39:02,200 --> 00:39:02,680 AMERICA. 1116 00:39:02,680 --> 00:39:05,480 SO HOW CAN LACOG PROMOTE 1117 00:39:05,480 --> 00:39:07,160 CLINICAL CANCER RESEARCH IN 1118 00:39:07,160 --> 00:39:10,480 LATIN AMERICA? 1119 00:39:10,480 --> 00:39:14,560 THE FIRST STEP IS SPONSORING 1120 00:39:14,560 --> 00:39:15,920 INVESTIGATOR IN THE TRIALS. 1121 00:39:15,920 --> 00:39:20,560 ONE OF OUR MEMBERS THAT WANTS TO 1122 00:39:20,560 --> 00:39:21,880 DEVELOP A CLINICAL TRIAL, HE 1123 00:39:21,880 --> 00:39:24,280 COMES UP WITH AN IDEA AND THEN 1124 00:39:24,280 --> 00:39:27,840 THIS IDEA IS PRESENTED TO US AND 1125 00:39:27,840 --> 00:39:30,280 WE CREATE THE CONCEPT. 1126 00:39:30,280 --> 00:39:35,280 WE PLAN THE TRIAL, INCLUDING 1127 00:39:35,280 --> 00:39:36,560 STATISTICS, STATISTICAL ANALYSIS 1128 00:39:36,560 --> 00:39:36,760 PLAN. 1129 00:39:36,760 --> 00:39:37,920 WE DEVELOP THE PROTOCOL. 1130 00:39:37,920 --> 00:39:39,560 WE GET THE FUNDING. 1131 00:39:39,560 --> 00:39:43,680 WE LOOK FOR THE FUNDING, AND WE 1132 00:39:43,680 --> 00:39:47,920 DO THE ETHICAL PROCESSES IN ALL 1133 00:39:47,920 --> 00:39:48,200 COUNTRIES. 1134 00:39:48,200 --> 00:39:51,800 AND THEN THE TRIAL FINALLY GOES, 1135 00:39:51,800 --> 00:39:54,000 WORKS AND WE GET THE RESULTS AND 1136 00:39:54,000 --> 00:39:57,240 WE PUBLISH THEM AND WE HELP THE 1137 00:39:57,240 --> 00:39:59,440 INVESTIGATORS TO PUBLISH THEM. 1138 00:39:59,440 --> 00:40:04,840 SO THIS IS THE FIRST AND MOST 1139 00:40:04,840 --> 00:40:06,960 IMPORTANT IDEA OF LACOG, THAT IS 1140 00:40:06,960 --> 00:40:11,680 MAKING A STRUCTURE THAT MAKES 1141 00:40:11,680 --> 00:40:15,160 CLINICAL CANCER RESEARCH IN 1142 00:40:15,160 --> 00:40:16,000 MULTICENTER TRIALS FOR LATIN 1143 00:40:16,000 --> 00:40:20,440 AMERICA AND IN LATIN AMERICA, 1144 00:40:20,440 --> 00:40:21,120 WORK. 1145 00:40:21,120 --> 00:40:24,560 SO THIS IS JUST AN EXAMPLE OF 1146 00:40:24,560 --> 00:40:27,840 THE PROCESS I JUST MENTIONED TO 1147 00:40:27,840 --> 00:40:28,040 YOU. 1148 00:40:28,040 --> 00:40:31,640 THIS TRIAL WAS DEVELOPED BY 1149 00:40:31,640 --> 00:40:32,320 PRINCIPAL INVESTIGATOR WHO CAME 1150 00:40:32,320 --> 00:40:34,800 UP WITH THE IDEA AND HE BROUGHT 1151 00:40:34,800 --> 00:40:37,280 US THE CONCEPT. 1152 00:40:37,280 --> 00:40:38,040 WE DEVELOPED A TRIAL. 1153 00:40:38,040 --> 00:40:42,360 WE HELPED HIM TO MAKE THE 1154 00:40:42,360 --> 00:40:43,920 PROTOCOL AND THIS TRIAL 1155 00:40:43,920 --> 00:40:46,600 SPECIFICALLY WAS HAPPILY 1156 00:40:46,600 --> 00:40:50,960 PRESENTED AT 2020ASCO MEETING. 1157 00:40:50,960 --> 00:40:53,960 THIS IS WHY LACOG DOES WHAT IT 1158 00:40:53,960 --> 00:40:56,720 DOES IT'S FOR PROMOTING CANCER 1159 00:40:56,720 --> 00:40:57,880 RESEARCH IN LATIN AMERICA AND 1160 00:40:57,880 --> 00:41:03,400 ESPECIALLY FOR LATIN-AMERICAN 1161 00:41:03,400 --> 00:41:03,640 PATIENTS. 1162 00:41:03,640 --> 00:41:07,320 THE SECOND THING THAT LACOG CAN 1163 00:41:07,320 --> 00:41:10,440 DO IS CREATING NEW RESEARCH 1164 00:41:10,440 --> 00:41:11,040 SITES. 1165 00:41:11,040 --> 00:41:13,680 WE ALL KNOW THAT IT'S VERY HARD, 1166 00:41:13,680 --> 00:41:16,960 VERY DEMANDING THE PROCESS OF 1167 00:41:16,960 --> 00:41:20,360 CREATING CLINICAL RESEARCH 1168 00:41:20,360 --> 00:41:20,680 CENTER SITE. 1169 00:41:20,680 --> 00:41:23,480 IT'S QUITE HARD FOR THE 1170 00:41:23,480 --> 00:41:23,800 INVESTIGATORS. 1171 00:41:23,800 --> 00:41:25,800 MANY INVESTIGATORS HERE IN LATIN 1172 00:41:25,800 --> 00:41:26,800 AMERICA DO NOT KNOW HOW TO DO 1173 00:41:26,800 --> 00:41:27,120 IT. 1174 00:41:27,120 --> 00:41:31,120 THEY DO NOT HAVE THE EXPERTISE 1175 00:41:31,120 --> 00:41:33,560 TO DO IT. 1176 00:41:33,560 --> 00:41:38,080 SO, WE CREATE TOGETHER WITH 1177 00:41:38,080 --> 00:41:41,840 INSTITUTE -- ALSO A NONPROFIT 1178 00:41:41,840 --> 00:41:45,000 ORGANIZATION AND RECEIVE SUPPORT 1179 00:41:45,000 --> 00:41:55,560 FROM SOME PHARMAS TO PAIR UP TO 1180 00:41:56,600 --> 00:41:59,040 FOSTER NEW RESEARCH CENTER SITES 1181 00:41:59,040 --> 00:41:59,680 ACROSS BRAZIL. 1182 00:41:59,680 --> 00:42:02,680 AND WE DID THAT ACTUALLY. 1183 00:42:02,680 --> 00:42:07,720 WE CAME UP WITH PROPOSALS FROM 1184 00:42:07,720 --> 00:42:15,680 SITES AND I'M JUST PRESENTING 1185 00:42:15,680 --> 00:42:17,320 YOU SOME OF THE SITES. 1186 00:42:17,320 --> 00:42:19,800 THE FIRST SITE IS IN THE 1187 00:42:19,800 --> 00:42:21,840 NORTHEAST OF BRAZIL. 1188 00:42:21,840 --> 00:42:28,720 THIS IS A SPECIFIC SITE IS THE 1189 00:42:28,720 --> 00:42:31,160 REFERENCE HOSPITAL FOR A MILLION 1190 00:42:31,160 --> 00:42:33,720 INHABITANTS OF THE CITIES 1191 00:42:33,720 --> 00:42:33,960 AROUND. 1192 00:42:33,960 --> 00:42:36,800 SO THIS IS EXPECTED TO BE A VERY 1193 00:42:36,800 --> 00:42:37,400 LARGE CLINICAL CANCER RESEARCH 1194 00:42:37,400 --> 00:42:39,840 SITE AND WE ARE VERY HAPPY TO 1195 00:42:39,840 --> 00:42:42,240 PARTNER WITH THEM TO HELP THEM 1196 00:42:42,240 --> 00:42:44,800 GET THE STRUCTURE. 1197 00:42:44,800 --> 00:42:51,360 ALSO THE SECOND ONE IS SIMILARLY 1198 00:42:51,360 --> 00:42:52,920 AS THE FIRST ONE. 1199 00:42:52,920 --> 00:42:56,000 THEY DO -- THEY ARE THE 1200 00:42:56,000 --> 00:42:57,120 REFERENCE FOR THE CITIES AROUND 1201 00:42:57,120 --> 00:42:58,600 WITH A POPULATION OF MORE THAN 1202 00:42:58,600 --> 00:43:01,800 TWO MILLION INHABITANTS. 1203 00:43:01,800 --> 00:43:04,640 AND THE THIRD ONE IS THE FIRST 1204 00:43:04,640 --> 00:43:07,200 CANCER RESEARCH CENTER IN THE 1205 00:43:07,200 --> 00:43:15,440 NORTH OF BRAZIL AT THE 1206 00:43:15,440 --> 00:43:15,800 UNIVERSITY. 1207 00:43:15,800 --> 00:43:19,280 AND THERE IS A THIRD VERY 1208 00:43:19,280 --> 00:43:25,080 SPECIFIC AND HARD ISSUE THAT IN 1209 00:43:25,080 --> 00:43:27,880 BRAZIL WE DEVELOP THAT WE HAVE 1210 00:43:27,880 --> 00:43:29,920 HIGH WILLINGNESS TO PARTICIPATE 1211 00:43:29,920 --> 00:43:33,440 IN CLINICAL TRIALS BUT DATA SAYS 1212 00:43:33,440 --> 00:43:37,880 WE DO NOT REACH NORTH AMERICAN. 1213 00:43:37,880 --> 00:43:41,160 WE ARE 93% OF PATIENTS ARE 1214 00:43:41,160 --> 00:43:43,320 WILLING TO PARTICIPATE IN 1215 00:43:43,320 --> 00:43:44,000 CLINICAL TRIALS. 1216 00:43:44,000 --> 00:43:47,640 IN EUROPE AS YOU CAN SEE, IT IS 1217 00:43:47,640 --> 00:43:50,440 EXPECTED TO BE 58% AND IN SOUTH 1218 00:43:50,440 --> 00:43:53,640 AMERICA 64%. 1219 00:43:53,640 --> 00:43:55,880 AND WE BELIEVE THAT THIS COULD 1220 00:43:55,880 --> 00:43:59,480 BE SOMEHOW CORRECTED OR WE COULD 1221 00:43:59,480 --> 00:44:01,360 ACT ON THAT SOMEHOW. 1222 00:44:01,360 --> 00:44:07,080 SO THIS IS WHAT WE DID. 1223 00:44:07,080 --> 00:44:10,000 WE DEVELOPED A PROJECT. 1224 00:44:10,000 --> 00:44:14,000 THIS PROJECT IS KIND OF A BRANCH 1225 00:44:14,000 --> 00:44:16,560 THAT IS DIRECTED TO PATIENTS. 1226 00:44:16,560 --> 00:44:19,000 THIS IS MADE FOR PATIENTS. 1227 00:44:19,000 --> 00:44:23,800 AND IT IS MADE BY PATIENTS TOO. 1228 00:44:23,800 --> 00:44:27,360 SO, WHAT IS PROJECT CURA? 1229 00:44:27,360 --> 00:44:30,920 IT IS ALSO NONPROFIT. 1230 00:44:30,920 --> 00:44:33,120 IT WORKS IN TWO SPECIFIC 1231 00:44:33,120 --> 00:44:33,440 ACTIVITIES. 1232 00:44:33,440 --> 00:44:37,080 THE FIRST ONE IS TO GET FUNDING 1233 00:44:37,080 --> 00:44:40,360 FOR CLINICAL RESEARCH TRIALS. 1234 00:44:40,360 --> 00:44:43,880 WE DO FIGHT FOR FUNDING WITH 1235 00:44:43,880 --> 00:44:46,760 THEM IN MANY, MANY WAYS. 1236 00:44:46,760 --> 00:44:49,120 THIS INCLUDES GOVERNMENT AND 1237 00:44:49,120 --> 00:44:51,280 THIS INCLUDES PHARMA 1238 00:44:51,280 --> 00:44:51,960 OCCASIONALLY, AND THIS ALSO 1239 00:44:51,960 --> 00:44:54,680 INCLUDES DONATIONS. 1240 00:44:54,680 --> 00:44:59,800 AND ALSO CURA IS THE BRANCH THAT 1241 00:44:59,800 --> 00:45:02,600 IS PARTLY LINKED TO PATIENTS. 1242 00:45:02,600 --> 00:45:07,960 AND WE DO PROMOTE FORUMS AND 1243 00:45:07,960 --> 00:45:09,920 PROMOTE MEETINGS TO GET THEM TO 1244 00:45:09,920 --> 00:45:12,600 KNOW WHAT CLINICAL RESEARCH IS 1245 00:45:12,600 --> 00:45:15,840 AND HOW CLINICAL RESEARCH CAN 1246 00:45:15,840 --> 00:45:18,560 HELP BOTH THE PATIENT, THE 1247 00:45:18,560 --> 00:45:22,000 RESEARCH CENTER AND ALSO SCIENCE 1248 00:45:22,000 --> 00:45:22,320 AS A WHOLE. 1249 00:45:22,320 --> 00:45:27,280 HOW CAN WE PROMOTE -- HOW CAN WE 1250 00:45:27,280 --> 00:45:29,240 PROMOTE SCIENCE IN A VERY 1251 00:45:29,240 --> 00:45:30,680 DIFFERENT WAY FOR BEING A 1252 00:45:30,680 --> 00:45:30,920 PATIENT. 1253 00:45:30,920 --> 00:45:34,080 AND THIS IS WHAT PROJECT CURA 1254 00:45:34,080 --> 00:45:34,560 DOES. 1255 00:45:34,560 --> 00:45:37,880 IT HAS BEEN WONDERFUL FOR THE 1256 00:45:37,880 --> 00:45:42,520 LAST YEARS. 1257 00:45:42,520 --> 00:45:43,160 THANK YOU FOR YOUR OPPORTUNITY. 1258 00:45:43,160 --> 00:45:43,760 I'D BE HAPPY TO ANSWER ANY 1259 00:45:43,760 --> 00:45:52,080 QUESTIONS YOU MAY HAVE. 1260 00:45:52,080 --> 00:45:53,560 THESE ARE THE ASSOCIATE 1261 00:45:53,560 --> 00:45:53,800 NETWORKS. 1262 00:45:53,800 --> 00:45:55,320 THANK YOU. 1263 00:45:55,320 --> 00:45:56,200 >>HELLO. 1264 00:45:56,200 --> 00:45:58,680 MY NAME IS MADELINE PESEC 1265 00:45:58,680 --> 00:46:01,800 INTERNAL MEDICINE AT BRIGHAM AND 1266 00:46:01,800 --> 00:46:02,760 WOMEN'S HOSPITAL IN BOSTON AND 1267 00:46:02,760 --> 00:46:05,120 I'M ALSO A RESEARCH ASSISTANT IN 1268 00:46:05,120 --> 00:46:05,880 A LAB. 1269 00:46:05,880 --> 00:46:07,040 THANK YOU VERY MUCH FOR HAVING 1270 00:46:07,040 --> 00:46:07,280 ME TODAY. 1271 00:46:07,280 --> 00:46:08,960 I'D LIKE TO SPEND THE NEXT 15 1272 00:46:08,960 --> 00:46:11,760 MINUTES TALKING WITH YOU ABOUT 1273 00:46:11,760 --> 00:46:12,680 COSTA RICA'S PRIMARY HEALTH CARE 1274 00:46:12,680 --> 00:46:15,320 SYSTEM AND LESSONS I'VE LEARNED 1275 00:46:15,320 --> 00:46:16,320 AFTER STUDYING THEIR SYSTEM FOR 1276 00:46:16,320 --> 00:46:17,800 THE PAST SEVEN YEARS. 1277 00:46:17,800 --> 00:46:19,880 COSTA RICA IS A CENTRAL AMERICAN 1278 00:46:19,880 --> 00:46:22,880 COUNTRY WITH A POPULATION OF 1279 00:46:22,880 --> 00:46:23,960 APPROXIMATELY 5 MILLION PEOPLE. 1280 00:46:23,960 --> 00:46:26,440 THEY HAVE A VERY UNIQUE 1281 00:46:26,440 --> 00:46:28,400 SOCIO-POLITICAL HISTORY IN THAT 1282 00:46:28,400 --> 00:46:30,600 THEY HAVE NOT HAD AN ARMY SINCE 1283 00:46:30,600 --> 00:46:31,600 THE MID 20TH CENTURY. 1284 00:46:31,600 --> 00:46:33,200 AND HAVE BEEN ABLE TO INVEST 1285 00:46:33,200 --> 00:46:35,040 THAT MONEY INTO EDUCATION AND 1286 00:46:35,040 --> 00:46:35,360 HEALTH CARE. 1287 00:46:35,360 --> 00:46:37,000 THEY ARE A MIDDLE-INCOME COUNTRY 1288 00:46:37,000 --> 00:46:40,120 WITH A GDP PER CAPITA OF ABOUT 1289 00:46:40,120 --> 00:46:42,000 12,000 DOLLARS PER PERSON PER 1290 00:46:42,000 --> 00:46:43,280 YEAR AND THE MAJORITY OF HEALTH 1291 00:46:43,280 --> 00:46:45,000 CARE HAS BEEN DELIVERED THROUGH 1292 00:46:45,000 --> 00:46:47,280 PUBLIC HOSPITALS AND PUBLIC 1293 00:46:47,280 --> 00:46:47,520 CLINICS. 1294 00:46:47,520 --> 00:46:49,280 ABOUT 1973. 1295 00:46:49,280 --> 00:46:51,320 THEY DO ALSO HAVE A PRIVATE 1296 00:46:51,320 --> 00:46:52,040 HEALTH CARE SECTOR BUT THE 1297 00:46:52,040 --> 00:46:53,720 MAJORITY OF HEALTH CARE IS 1298 00:46:53,720 --> 00:46:54,280 DELIVERED THROUGH THE PUBLIC 1299 00:46:54,280 --> 00:46:58,240 HOSPITALS AND THE PUBLIC CLIN 1300 00:46:58,240 --> 00:46:58,480 CLINICS. 1301 00:46:58,480 --> 00:47:00,640 SO IF WE LOOK AT WHERE COSTA 1302 00:47:00,640 --> 00:47:03,280 RICA SITS OVERALL IN TERMS OF 1303 00:47:03,280 --> 00:47:04,600 LIFE EXPECTANCY, IT IS DOING 1304 00:47:04,600 --> 00:47:05,200 EXTREMELY WELL. 1305 00:47:05,200 --> 00:47:07,720 SO WITHIN THE WESTERN 1306 00:47:07,720 --> 00:47:08,440 HEMISPHERE, IT RANKS THIRD FOR 1307 00:47:08,440 --> 00:47:10,320 LIFE EXPECTANCY OVER ALL. 1308 00:47:10,320 --> 00:47:12,880 YOU CAN COMPARE THAT TO THE 1309 00:47:12,880 --> 00:47:15,480 AVERAGE TO LATIN AMERICA. 1310 00:47:15,480 --> 00:47:16,440 IT BEATS OUT THE UNITED STATES 1311 00:47:16,440 --> 00:47:18,960 IN TERMS OF LIFE EXPECTANCY. 1312 00:47:18,960 --> 00:47:21,800 SIGNIFICANTLY ABOVE THE AVERAGE 1313 00:47:21,800 --> 00:47:23,360 WORLDWIDE. 1314 00:47:23,360 --> 00:47:25,920 LOOKING AT THE AMOUNT OF MONEY 1315 00:47:25,920 --> 00:47:27,280 THAT COSTA RICA INVESTS IN THE 1316 00:47:27,280 --> 00:47:28,320 HEALTH CARE SYSTEM, IT IS HAVING 1317 00:47:28,320 --> 00:47:29,720 A HIGH RETURN ON INVESTMENT. 1318 00:47:29,720 --> 00:47:32,400 SO YOU CAN SEE THAT IT HAS A 1319 00:47:32,400 --> 00:47:33,840 RELATIVELY LOW HEALTH 1320 00:47:33,840 --> 00:47:35,600 EXPENDITURE AS A PERCENTAGE OF 1321 00:47:35,600 --> 00:47:37,080 GDP AND THEN WE TALKED ABOUT IT 1322 00:47:37,080 --> 00:47:38,000 AS A MIDDLE-INCOME COUNTRY. 1323 00:47:38,000 --> 00:47:41,240 SO IT'S NOT THAT IT HAS AN 1324 00:47:41,240 --> 00:47:43,360 EXTRAORDINARILY HIGH GDP EITHER. 1325 00:47:43,360 --> 00:47:45,240 AND IT'S ABLE TO OBTAIN A REALLY 1326 00:47:45,240 --> 00:47:46,440 HIGH LIFE EXPECTY FOR THAT 1327 00:47:46,440 --> 00:47:49,560 INVESTMENT THAT IT HAS. 1328 00:47:49,560 --> 00:47:50,560 WHEN WE LOOK AT SOME OF THE 1329 00:47:50,560 --> 00:47:51,880 COVERAGE INDICATORS FOR 1330 00:47:51,880 --> 00:47:53,520 COSTA RICA, WE SEE THAT THEY ARE 1331 00:47:53,520 --> 00:47:54,720 ABLE TO DELIVER HEALTH CARE TO 1332 00:47:54,720 --> 00:47:57,000 THE VAST MAJORITY OF THEIR 1333 00:47:57,000 --> 00:47:57,320 POPULATION. 1334 00:47:57,320 --> 00:47:59,480 SO THESE DATA COME FROM THE 1335 00:47:59,480 --> 00:48:01,120 PRIMARY HEALTH CARE PERFORMANCE 1336 00:48:01,120 --> 00:48:02,240 INITIATIVE WHICH WAS A COALITION 1337 00:48:02,240 --> 00:48:05,560 OF NONPROFIT ORGANIZATIONS 1338 00:48:05,560 --> 00:48:07,240 DEDICATED TO TRANSPARENCY IN 1339 00:48:07,240 --> 00:48:10,560 DATA, SPECIFICALLY TO THE 1340 00:48:10,560 --> 00:48:11,120 COUNTRIES COULD VALLEY THEIR 1341 00:48:11,120 --> 00:48:11,800 HEALTH CARE SYSTEMS AND HOW THEY 1342 00:48:11,800 --> 00:48:12,520 WERE PERFORMING. 1343 00:48:12,520 --> 00:48:15,320 AND YOU WILL SEE ESPECIALLY ON 1344 00:48:15,320 --> 00:48:16,440 THE BOTTOM HERE THAT COSTA RICA 1345 00:48:16,440 --> 00:48:18,240 DOES INCREDIBLY WELL ACROSS MOST 1346 00:48:18,240 --> 00:48:19,680 OF THESE COVERAGE METRICS. 1347 00:48:19,680 --> 00:48:21,920 SO CHILDREN WITH DIARRHEA 1348 00:48:21,920 --> 00:48:23,200 RECEIVING APPROPRIATE TREATMENT. 1349 00:48:23,200 --> 00:48:26,440 PERCENTAGE OF WOMEN GETTING 1350 00:48:26,440 --> 00:48:27,280 APPROPRIATE ANTI-NATAL CARE. 1351 00:48:27,280 --> 00:48:29,240 THE VERY LOW PERCENTAGE OF DROP 1352 00:48:29,240 --> 00:48:30,840 OUT RATE FOR VACCINATIONS. 1353 00:48:30,840 --> 00:48:33,720 MEANING HIGH VACCINATION RATE 1354 00:48:33,720 --> 00:48:36,160 AND RELATIVELY LOW DROP OUT RATE 1355 00:48:36,160 --> 00:48:38,080 FOR ANTI-NATAL CARE AS WELL. 1356 00:48:38,080 --> 00:48:40,120 AND NOT ONLY ARE THEY COVERING A 1357 00:48:40,120 --> 00:48:41,600 WIDE SWATH OF THEIR POPULATION, 1358 00:48:41,600 --> 00:48:43,240 THEY ARE ALSO ACHIEVING 1359 00:48:43,240 --> 00:48:43,680 EXCELLENT OUTCOMES. 1360 00:48:43,680 --> 00:48:45,720 SO THIS IS JUST A HANDFUL OF 1361 00:48:45,720 --> 00:48:47,800 THEIR HEALTH OUTCOMES AND THEIR 1362 00:48:47,800 --> 00:48:48,560 PUBLICLY AVAILABLE. 1363 00:48:48,560 --> 00:48:51,600 BUT THEY HAVE EXCELLENT 1364 00:48:51,600 --> 00:48:52,840 MORTALITY. 1365 00:48:52,840 --> 00:48:54,720 EXCELLENT ADULT MORTALITY FOR 1366 00:48:54,720 --> 00:48:55,480 NON-COMMUNICABLE DISEASES AND 1367 00:48:55,480 --> 00:48:59,080 EXCELLENT MATERNAL MORTALITY 1368 00:48:59,080 --> 00:49:00,760 RATE AS WELL. 1369 00:49:00,760 --> 00:49:01,640 SO OF COURSE THE QUESTION 1370 00:49:01,640 --> 00:49:03,360 BECOMES HOW DO THEY DO IT? 1371 00:49:03,360 --> 00:49:05,080 HOW ARE THEY HAVING EXCELLENT 1372 00:49:05,080 --> 00:49:07,920 LIFE EXPECTANCY WITH RELATIVELY 1373 00:49:07,920 --> 00:49:09,280 LOW HEALTH EXPENDITURE AND 1374 00:49:09,280 --> 00:49:10,960 REALLY HAVING GREAT HEALTH CARE 1375 00:49:10,960 --> 00:49:13,160 DELIVERY QUALITY METRICS AS 1376 00:49:13,160 --> 00:49:13,360 WELL? 1377 00:49:13,360 --> 00:49:15,560 AND OVER THE NEXT 15 MINUTES OR 1378 00:49:15,560 --> 00:49:17,400 SO, I'M GOING TO ELABORATE AND 1379 00:49:17,400 --> 00:49:18,760 HOPEFULLY CONVINCE YOU WHY I 1380 00:49:18,760 --> 00:49:20,280 THINK THAT THE KEY TO THEIR 1381 00:49:20,280 --> 00:49:22,200 SUCCESS LIES IN THEIR PRIMARY 1382 00:49:22,200 --> 00:49:22,920 HEALTH CARE SYSTEM. 1383 00:49:22,920 --> 00:49:24,560 SO WHEN WE TALK ABOUT PRIMARY 1384 00:49:24,560 --> 00:49:27,000 HEALTH CARE, WE ARE TALKING 1385 00:49:27,000 --> 00:49:29,080 ABOUT THE MOST FOUNDATIONAL 1386 00:49:29,080 --> 00:49:30,720 FUNDAMENTAL LEVEL OF A HEALTH 1387 00:49:30,720 --> 00:49:31,040 CARE SYSTEM. 1388 00:49:31,040 --> 00:49:33,680 SO WHEN YOU THINK ABOUT A BIG 1389 00:49:33,680 --> 00:49:34,800 ACADEMIC MEDICAL CENTER, THAT IS 1390 00:49:34,800 --> 00:49:36,800 GOING TO BE YOUR TERTIARY CARE, 1391 00:49:36,800 --> 00:49:40,560 LIVER TRANSPLANTS, ALL OF YOUR 1392 00:49:40,560 --> 00:49:43,080 SPECIALTY CARE WILL BE UP IN 1393 00:49:43,080 --> 00:49:44,400 THAT TERTIARY CARE LEVEL. 1394 00:49:44,400 --> 00:49:47,280 SECONDARY CARE LEVEL IS REALLY 1395 00:49:47,280 --> 00:49:50,200 SOME OF THE MORE BROAD AND 1396 00:49:50,200 --> 00:49:51,880 GENERAL SPECIALTIES, GYNECOLOGY, 1397 00:49:51,880 --> 00:49:53,600 PEDIATRICS, SOME GENERAL SURGERY 1398 00:49:53,600 --> 00:49:53,840 AS WELL. 1399 00:49:53,840 --> 00:49:57,640 AND THEN PRIMARY CARE 1400 00:49:57,640 --> 00:49:58,200 ENCOMPASSES THE REST OF THE 1401 00:49:58,200 --> 00:49:59,480 HEALTH CARE SYSTEM. 1402 00:49:59,480 --> 00:50:01,040 SO WHO IS THAT FIRST CONTACT 1403 00:50:01,040 --> 00:50:02,240 WITH THE HEALTH CARE SYSTEM? 1404 00:50:02,240 --> 00:50:05,880 WHO IS PROVIDING BASIC CURATIVE 1405 00:50:05,880 --> 00:50:06,840 CARE AND PRESENTIVE CARE? 1406 00:50:06,840 --> 00:50:08,480 AND IN COASTED REEKA, I WILL 1407 00:50:08,480 --> 00:50:10,320 ARGUE THAT THEIR PRIMARY CARE IS 1408 00:50:10,320 --> 00:50:13,000 REAL WHAT HE IS DRIVING THEIR 1409 00:50:13,000 --> 00:50:14,200 SUCCESS. 1410 00:50:14,200 --> 00:50:17,160 SO IN 1995, COSTA RICA HAD A 1411 00:50:17,160 --> 00:50:19,440 MAJOR OVERHAUL OF THE PRIMARY 1412 00:50:19,440 --> 00:50:20,520 CARE SYSTEM AND I WILL EXPLAIN 1413 00:50:20,520 --> 00:50:23,200 MUCH MORE DETAIL ABOUT THAT 1414 00:50:23,200 --> 00:50:23,680 REFORM IN JUST A MINUTE. 1415 00:50:23,680 --> 00:50:24,600 BUT WHAT IS IMPORTANT TO KNOW 1416 00:50:24,600 --> 00:50:26,280 THAT THE MOMENT IS THE REFORM 1417 00:50:26,280 --> 00:50:31,280 THAT THEY HAD WAS ROLLED OUT 1418 00:50:31,280 --> 00:50:32,840 STEP-WISE ACROSS THE COUNTRY TO 1419 00:50:32,840 --> 00:50:35,400 VARIOUS COUNTY LEVELS. 1420 00:50:35,400 --> 00:50:40,120 SO ACROSS EIGHT-YEAR MURDER 1421 00:50:40,120 --> 00:50:40,720 DIFFERENT CONTUSION ACROSS THE 1422 00:50:40,720 --> 00:50:48,880 COUNTRY RECEIVED -- - AN 1423 00:50:48,880 --> 00:50:50,160 EIGHT-YEAR PERIOD. 1424 00:50:50,160 --> 00:50:53,880 -- WE CAN COMPARE IT TO COUNTIES 1425 00:50:53,880 --> 00:50:57,400 THAT HAVE OPEN HEALTH CARE 1426 00:50:57,400 --> 00:50:58,800 CLINICS AND COMPARED TO THOSE 1427 00:50:58,800 --> 00:50:59,920 WHO HAVE CLOSED HEALTH CARE 1428 00:50:59,920 --> 00:51:01,160 CLINICS AND COMPARE THE RESULT 1429 00:51:01,160 --> 00:51:04,560 BEFORE AND AFTER THE CLINIC WAS 1430 00:51:04,560 --> 00:51:05,080 OPENED. 1431 00:51:05,080 --> 00:51:08,560 SO THIS IS A STUDY THAT I 1432 00:51:08,560 --> 00:51:12,080 CONDUCTED WITH DR. GARCIA OUT OF 1433 00:51:12,080 --> 00:51:12,880 THE BUSINESS SCHOOL IN 1434 00:51:12,880 --> 00:51:13,920 COSTA RICA. 1435 00:51:13,920 --> 00:51:16,040 WHAT WE SHOWED IS THAT AS EACH 1436 00:51:16,040 --> 00:51:18,400 NEW PRIMARY CARE CLINIC OPENED, 1437 00:51:18,400 --> 00:51:20,880 AS PART OF THAT 1995 HEALTH 1438 00:51:20,880 --> 00:51:23,320 REFORM, THERE WAS A 13% 1439 00:51:23,320 --> 00:51:25,560 REDUCTION IN MORTALITY OVER THE 1440 00:51:25,560 --> 00:51:26,760 ENSUING NINE YEARS. 1441 00:51:26,760 --> 00:51:28,840 AND THIS IS ON A NATIONAL LEVEL 1442 00:51:28,840 --> 00:51:31,920 ACROSS THE POPULATION OF ABOUT 5 1443 00:51:31,920 --> 00:51:34,960 MILLION PEOPLE. 1444 00:51:34,960 --> 00:51:37,480 AND WHEN WE EXAMINE IN THE 1445 00:51:37,480 --> 00:51:40,680 SUBGROUP ANALYSIS WHERE DO WE 1446 00:51:40,680 --> 00:51:42,080 SEE THE BENEFITS OR RESULTS OF 1447 00:51:42,080 --> 00:51:43,280 THIS MOST HIGHLY CONCENTRATED? 1448 00:51:43,280 --> 00:51:46,640 WE SEE IT IN TWO SPECIFIC AREAS. 1449 00:51:46,640 --> 00:51:48,720 SO FIRST ON THE LEFT YOU'LL SEE 1450 00:51:48,720 --> 00:51:50,920 THAT THE ELDERLY POPULATIONS SAW 1451 00:51:50,920 --> 00:51:52,680 THE GREATEST REDUCTION IN 1452 00:51:52,680 --> 00:51:54,200 MORTALITY AND IT'S REALLY AN 1453 00:51:54,200 --> 00:51:56,760 INCREDIBLE 22% REDUCTION IN 1454 00:51:56,760 --> 00:51:58,800 MORTALITY AFTER OPENING A 1455 00:51:58,800 --> 00:52:00,160 PRIMARY CARE CLINIC COMPARED TO 1456 00:52:00,160 --> 00:52:01,800 THE 13% OVERALL. 1457 00:52:01,800 --> 00:52:03,440 AND NOTICING THE SHAPE OF THOSE 1458 00:52:03,440 --> 00:52:04,280 CURVES, YOU'LL NOTE THAT IT 1459 00:52:04,280 --> 00:52:06,160 SEEMS LIKE THE REDUCTION IN 1460 00:52:06,160 --> 00:52:07,440 MORTALITY FOR THE ELDERLY IS 1461 00:52:07,440 --> 00:52:08,840 WHAT IS DRIVING A LOT OF THE 1462 00:52:08,840 --> 00:52:11,680 MORTALITY CHANGE WE SEE OVERALL. 1463 00:52:11,680 --> 00:52:15,520 SO THEN WE ASKED OURSELVES WHAT 1464 00:52:15,520 --> 00:52:16,080 DISEASES ARE WE MOVING THE 1465 00:52:16,080 --> 00:52:18,280 NEEDLE IN TERMS OF MORTALITY? 1466 00:52:18,280 --> 00:52:20,680 AND WHEN WE LOOKED, IT SEEMS 1467 00:52:20,680 --> 00:52:21,760 THAT THE VAST MAJORITY OF 1468 00:52:21,760 --> 00:52:24,040 DISEASES THAT HAD A MAJOR 1469 00:52:24,040 --> 00:52:26,240 BENEFIT WHEN THEY OPENED A 1470 00:52:26,240 --> 00:52:28,680 PRIMARY CARE CENTER WERE 1471 00:52:28,680 --> 00:52:29,200 NON-COMMUNICABLE DISEASES. 1472 00:52:29,200 --> 00:52:31,360 SO DEATH FROM CARDIOVASCULAR 1473 00:52:31,360 --> 00:52:34,200 DISEASE, CANCER, COFD AND 1474 00:52:34,200 --> 00:52:34,600 DIABETES. 1475 00:52:34,600 --> 00:52:36,080 -- COPD. 1476 00:52:36,080 --> 00:52:39,840 AND THIS IS ENCOURAGING BECAUSE 1477 00:52:39,840 --> 00:52:42,000 ESPECIALLY AS LOW TO 1478 00:52:42,000 --> 00:52:42,640 MIDDLE-INCOME COUNTRIES CONTINUE 1479 00:52:42,640 --> 00:52:44,640 TO THEIR BURDEN OF DISEASE WITH 1480 00:52:44,640 --> 00:52:45,840 INFECTIOUS DISEASE AND 1481 00:52:45,840 --> 00:52:47,560 NON-COMMUNICABLE DISEASE, THE 1482 00:52:47,560 --> 00:52:48,920 SOLUTIONS FOR INFECTIOUS DISEASE 1483 00:52:48,920 --> 00:52:52,480 SEEM AT LEAST MUCH MORE CLEARLY 1484 00:52:52,480 --> 00:52:54,000 DELINEATED THAN THE COMPLEX 1485 00:52:54,000 --> 00:52:55,000 SYSTEM-WIDE CHANGE THAT IS 1486 00:52:55,000 --> 00:52:57,440 NEEDED TO MOVE THE NEEDLE ON 1487 00:52:57,440 --> 00:52:58,120 NON-COMMUNICABLE DISEASE. 1488 00:52:58,120 --> 00:53:00,200 BUT HERE WE SEE THAT COSTA RICA 1489 00:53:00,200 --> 00:53:02,360 HAS DONE THAT OVER THE PAST 1490 00:53:02,360 --> 00:53:03,680 DECADE OR SO SINCE IMPLEMENTING 1491 00:53:03,680 --> 00:53:07,400 THEIR NEW PRIMARY HEALTH CARE 1492 00:53:07,400 --> 00:53:09,600 SYSTEM. 1493 00:53:09,600 --> 00:53:11,000 SO LETS GET INTO MORE DETAIL 1494 00:53:11,000 --> 00:53:13,000 ABOUT WHAT THIS PRIMARY HEALTH 1495 00:53:13,000 --> 00:53:15,440 CARE REFORM IN 1995 ENTAILS 1496 00:53:15,440 --> 00:53:17,040 BECAUSE IT SEEMS LIKE COSTA RICA 1497 00:53:17,040 --> 00:53:19,040 IS ACHIEVING GREAT OUTCOMES AT 1498 00:53:19,040 --> 00:53:20,960 LOW COST AND REALLY ABLE TO PIN 1499 00:53:20,960 --> 00:53:25,080 A LOT OF THAT SUCCESS TO THEIR 1500 00:53:25,080 --> 00:53:27,840 STRONG HEAL HEALTH CARE SYSTEM. 1501 00:53:27,840 --> 00:53:29,920 SO WHEN YOU LOOK AT WHAT 1502 00:53:29,920 --> 00:53:31,720 COSTA RICA DID IN 1995 REFORM, 1503 00:53:31,720 --> 00:53:34,520 THIS REFORM WAS WIDESPREAD 1504 00:53:34,520 --> 00:53:37,280 ACROSS THE COUNTRY AND IT 1505 00:53:37,280 --> 00:53:38,760 ENCOMPASSED ALL PUBLIC, PRIMARY 1506 00:53:38,760 --> 00:53:40,440 CARE DELIVERY. 1507 00:53:40,440 --> 00:53:43,600 IT DREW ON THE EXPERIENCES OF 1508 00:53:43,600 --> 00:53:45,160 PHYSICIANS, PUBL PUBLIC HEALTH 1509 00:53:45,160 --> 00:53:46,640 EXPERTS AND IT REALLY WAS ABLE 1510 00:53:46,640 --> 00:53:48,760 TO DRAW FROM COSTA RICA'S STRONG 1511 00:53:48,760 --> 00:53:50,840 HISTORY OF PRIMARY CARE. 1512 00:53:50,840 --> 00:53:52,040 SO THIS DID NOT APPEAR OUT OF 1513 00:53:52,040 --> 00:53:53,200 THIN AIR. 1514 00:53:53,200 --> 00:53:55,280 COSTA RICA HAD ALREADY HAD MANY 1515 00:53:55,280 --> 00:53:57,080 EXCELLENT PRIMARY CACE PROGRAMS, 1516 00:53:57,080 --> 00:53:58,360 PUBLIC HEALTH EXAMPLES IN THE 1517 00:53:58,360 --> 00:53:59,920 COUNTRY THAT THEY WERE ABLE TO 1518 00:53:59,920 --> 00:54:03,360 BUILD ON AND EXPAND THOSE 1519 00:54:03,360 --> 00:54:03,920 MODELS. 1520 00:54:03,920 --> 00:54:04,920 THEY ALSO WORKED INCREDIBLY 1521 00:54:04,920 --> 00:54:07,360 DIFFICULT TO DEVELOP BUY IN FROM 1522 00:54:07,360 --> 00:54:08,160 STAKEHOLDERS PRIOR TO TRYING TO 1523 00:54:08,160 --> 00:54:10,320 GET THE LAW TO PASS THE REFORM 1524 00:54:10,320 --> 00:54:10,720 THROUGH CONGRESS. 1525 00:54:10,720 --> 00:54:12,880 SO BY THE TIME THAT LAW GOT TO 1526 00:54:12,880 --> 00:54:14,400 CONGRESS, THEY HAD WIDESPREAD 1527 00:54:14,400 --> 00:54:17,040 COALITION OF SUPPORT BEHIND 1528 00:54:17,040 --> 00:54:17,600 THEM. 1529 00:54:17,600 --> 00:54:19,600 AND INCREDIBLY INTENTIONAL ABOUT 1530 00:54:19,600 --> 00:54:22,440 HOW THEY IMPLEMENTED RENORM. 1531 00:54:22,440 --> 00:54:24,240 THEY SET UP PRINCIPLES FOR 1532 00:54:24,240 --> 00:54:26,400 IMPLEMENTATION THAT WERE REALLY 1533 00:54:26,400 --> 00:54:28,960 USE EQUITY LENSE IN ALL THE 1534 00:54:28,960 --> 00:54:30,800 DECISIONS IN DECIDING WHICH 1535 00:54:30,800 --> 00:54:32,080 CLINICS TO OPEN FIRST VERSUS 1536 00:54:32,080 --> 00:54:33,440 SECOND AND THIRD. 1537 00:54:33,440 --> 00:54:36,200 THEY HAD VOLUNTARY PARTICIPATION 1538 00:54:36,200 --> 00:54:37,480 AT THE BEGINNING. 1539 00:54:37,480 --> 00:54:40,320 TOWARDS THE END OF THE REFORM IT 1540 00:54:40,320 --> 00:54:41,920 BECAME COMPULSORY BUT THE FIRST 1541 00:54:41,920 --> 00:54:43,960 FOLKS TO PILOT THE MODEL WERE 1542 00:54:43,960 --> 00:54:46,080 ABSOLUTELY YOUY SOLICITED 1543 00:54:46,080 --> 00:54:46,360 VOLUNTARILY. 1544 00:54:46,360 --> 00:54:48,280 AND THEN IT ALSO WAS REALLY 1545 00:54:48,280 --> 00:54:49,200 GROUNDED IN COMMUNITY 1546 00:54:49,200 --> 00:54:49,480 ENGAGEMENT. 1547 00:54:49,480 --> 00:54:51,000 SO THESE ARE THE FOUR ELEMENTS 1548 00:54:51,000 --> 00:54:52,280 OF THE REFORM THAT WE'LL WALK 1549 00:54:52,280 --> 00:54:55,320 THROUGH ONE BY ONE. 1550 00:54:55,320 --> 00:54:57,280 SO THE FIRST THING THAT 1551 00:54:57,280 --> 00:54:59,560 COSTA RICA DID WHICH I THINK IS 1552 00:54:59,560 --> 00:55:01,440 REALLY KEY TO PRIMARY CARE IS 1553 00:55:01,440 --> 00:55:03,920 THAT THEY INTEGRATED THEIR 1554 00:55:03,920 --> 00:55:06,080 PUBLIC HEALTH SYSTEM, PREVENTIVE 1555 00:55:06,080 --> 00:55:07,520 CARE SYSTEM AND THEIR TERTIARY 1556 00:55:07,520 --> 00:55:09,400 CARE SYSTEM ALL AT THE PRIMARY 1557 00:55:09,400 --> 00:55:09,720 CARE LEVEL. 1558 00:55:09,720 --> 00:55:13,080 SO BEFORE THE REFORM, THE 1559 00:55:13,080 --> 00:55:14,120 PRESENTIVE CARE AND THE PUBLIC 1560 00:55:14,120 --> 00:55:16,120 HEALTH CARE FUNCTIONS WERE 1561 00:55:16,120 --> 00:55:19,600 COMPLETELY SEPARATE FROM THE 1562 00:55:19,600 --> 00:55:20,280 CURATIVE CARE THAT WAS PROVIDED 1563 00:55:20,280 --> 00:55:22,960 BY THE SOCIAL SECURITY AGENCY. 1564 00:55:22,960 --> 00:55:25,760 AFTER THE REFORM IN THIS NEW 1565 00:55:25,760 --> 00:55:27,640 PRIMARY CARE LEVEL, THE SOCIAL 1566 00:55:27,640 --> 00:55:29,720 SECURITY AGENCY WAS RESPONSIBLE 1567 00:55:29,720 --> 00:55:32,240 FOR ALL ASPECTS OF PRIMARY CARE 1568 00:55:32,240 --> 00:55:36,120 SO THAT IS THE PREVENTIVE CARE, 1569 00:55:36,120 --> 00:55:36,720 CURATIVE CARE AND THE PUBLIC 1570 00:55:36,720 --> 00:55:37,360 HEALTH FUNCTIONS WERE ALL 1571 00:55:37,360 --> 00:55:41,920 WRAPPED UP INTO THE SAME SYSTEM. 1572 00:55:41,920 --> 00:55:43,800 THE SECOND KEY ELEMENT OF THEIR 1573 00:55:43,800 --> 00:55:47,120 PRIMARY CARE SYSTEM IS SOMETHING 1574 00:55:47,120 --> 00:55:48,360 CALLED GEOGRAPHIC EM PANELMENT, 1575 00:55:48,360 --> 00:55:50,840 THE PROCESS OF ASSIGNING EACH 1576 00:55:50,840 --> 00:55:52,520 COASTA RICAN TO A PRIMARY CARE 1577 00:55:52,520 --> 00:55:52,720 TEAM. 1578 00:55:52,720 --> 00:55:56,480 AND THE WAY COSTA RICA DID THIS 1579 00:55:56,480 --> 00:55:59,400 WAS BY GEOGRAPHIC LOCATION OF 1580 00:55:59,400 --> 00:56:02,040 THE PERSON'S HOME. 1581 00:56:02,040 --> 00:56:03,800 AND THIS IS IMPORTANT SO THAT 1582 00:56:03,800 --> 00:56:05,560 EACH PRIMARY CARE TEAM KNOWS 1583 00:56:05,560 --> 00:56:07,680 EXACTLY WHO IT IS RESPONSIBLE 1584 00:56:07,680 --> 00:56:09,880 FOR AND THIS ENABLES POPULATION 1585 00:56:09,880 --> 00:56:10,400 HEALTH MANAGEMENT. 1586 00:56:10,400 --> 00:56:11,680 UNLESS YOU KNOW THE POPULATION 1587 00:56:11,680 --> 00:56:13,120 THAT YOU NEED TO TAKE CARE OF, 1588 00:56:13,120 --> 00:56:16,360 IT'S REALLY HARD TO BECOME PRO 1589 00:56:16,360 --> 00:56:17,480 ACTIVE ABOUT THEIR CARE AND 1590 00:56:17,480 --> 00:56:19,920 REACH OUT FOR THE PREVENTIVE 1591 00:56:19,920 --> 00:56:20,120 STEPS. 1592 00:56:20,120 --> 00:56:22,160 I WOULD LIKE TO NOTE THIS IS ALL 1593 00:56:22,160 --> 00:56:25,440 DONE IN THE MID 1990S BEFORE 1594 00:56:25,440 --> 00:56:27,400 THERE WERE COMPLEX GIS MAPPING 1595 00:56:27,400 --> 00:56:29,440 MODELS, BEFORE SATELLITE 1596 00:56:29,440 --> 00:56:29,680 IMAGING. 1597 00:56:29,680 --> 00:56:31,640 ALL THIS WAS DONE BY HAND IN 1598 00:56:31,640 --> 00:56:34,720 PARTNERSHIP WITH CARTOGRAPHERS 1599 00:56:34,720 --> 00:56:38,520 FROM THE UNIVERSITY. 1600 00:56:38,520 --> 00:56:39,320 THE NEXT IMPORTANT ELEMENT OF 1601 00:56:39,320 --> 00:56:40,800 THEIR PRIMARY HEALTH CARE MODEL 1602 00:56:40,800 --> 00:56:43,600 IS A MULTIDISCIPLINARY TEAM 1603 00:56:43,600 --> 00:56:45,960 STRUCTURE WHICH ISN'T EXACTLY A 1604 00:56:45,960 --> 00:56:47,320 REVOLUTIONARY STRATEGY BUT I 1605 00:56:47,320 --> 00:56:48,960 WOULD ARGUE IT IS KEY TO THEIR 1606 00:56:48,960 --> 00:56:49,280 SUCCESS. 1607 00:56:49,280 --> 00:56:52,120 SO THE NAME FOR THESE 1608 00:56:52,120 --> 00:56:58,320 MULTIDISCIPLINARY TEAMS ARE -- 1609 00:56:58,320 --> 00:56:58,760 [ SPEAKING SPANISH ] 1610 00:56:58,760 --> 00:57:00,720 AND THESE TEAMS ARE COMPRISED OF 1611 00:57:00,720 --> 00:57:01,600 FIVE PEOPLE AND SERVE A 1612 00:57:01,600 --> 00:57:04,240 POPULATION OF ABOUT 4000 PEOPLE 1613 00:57:04,240 --> 00:57:04,440 EACH. 1614 00:57:04,440 --> 00:57:06,800 THEY ARE COMPRISED OF A DOCTOR 1615 00:57:06,800 --> 00:57:09,240 THAT DOES THE PREVENTIVE CARE 1616 00:57:09,240 --> 00:57:09,880 AND ALSO CURATIVE CARE. 1617 00:57:09,880 --> 00:57:12,240 A NURSE ASSISTANT THAT HELPS 1618 00:57:12,240 --> 00:57:14,600 ROOM PATIENTS, GET THOSE 1619 00:57:14,600 --> 00:57:16,680 ASSIGNED IN THE CLINIC AND ATAP, 1620 00:57:16,680 --> 00:57:18,480 A COMMUNITY HEALTH WORKER. 1621 00:57:18,480 --> 00:57:19,400 YOU WILL SEE IN THIS GRAPHIC 1622 00:57:19,400 --> 00:57:21,720 THAT THE ATAPs ARE VISITING 1623 00:57:21,720 --> 00:57:23,400 THE HOMES OF THEIR PATIENTS, 1624 00:57:23,400 --> 00:57:24,920 DELIVERING IMMUNIZATIONS IN THE 1625 00:57:24,920 --> 00:57:27,520 HOME, THEY ARE CONDUCTING 1626 00:57:27,520 --> 00:57:29,200 EPIDEMIOLOGIC SURVEYS AND 1627 00:57:29,200 --> 00:57:30,000 IDENTIFYING THE SOCIAL 1628 00:57:30,000 --> 00:57:31,920 DETERMINANTS OF HEALTH OF THEIR 1629 00:57:31,920 --> 00:57:33,560 PATIENTS AND THEN ACTING UPON 1630 00:57:33,560 --> 00:57:34,080 THOSE. 1631 00:57:34,080 --> 00:57:37,360 THE COMMUNITY HEALTH WORKERS 1632 00:57:37,360 --> 00:57:39,160 ALSO GO TOUT COMMUNITY LOCATIONS 1633 00:57:39,160 --> 00:57:40,560 SUCH AS SCHOOLS, CHURCHES AND 1634 00:57:40,560 --> 00:57:43,080 OTHER MUNICIPAL GOVERNMENT 1635 00:57:43,080 --> 00:57:44,440 BUILDINGS IN ORDER TO PROMOTE 1636 00:57:44,440 --> 00:57:48,280 HEALTH AND HEALTH EDUCATION 1637 00:57:48,280 --> 00:57:50,280 ACTIVITIES. 1638 00:57:50,280 --> 00:57:51,280 THEN A REALLY UNIQUE MEMBER OF 1639 00:57:51,280 --> 00:57:52,760 THE TEAM IS MEDICAL DATA CLERK. 1640 00:57:52,760 --> 00:57:55,440 AND THEY ARE IN CHARGE OF NOT 1641 00:57:55,440 --> 00:57:56,040 ONLY SOME OF THE SECRETARIAL 1642 00:57:56,040 --> 00:57:57,280 FUNCTIONS OF THE CLINIC, 1643 00:57:57,280 --> 00:57:59,720 CHECKING PATIENTS IN, BUT THEY 1644 00:57:59,720 --> 00:58:01,360 ARE ALSO IN CHARGE OF KEEPING 1645 00:58:01,360 --> 00:58:02,680 INCREDIBLY DETAILED NOTES ABOUT 1646 00:58:02,680 --> 00:58:04,760 THE PATIENTS THAT ENABLE THEIR 1647 00:58:04,760 --> 00:58:05,840 QI SYSTEM THAT WE'LL TALK ABOUT 1648 00:58:05,840 --> 00:58:07,280 IN THE NEXT SLIDE. 1649 00:58:07,280 --> 00:58:09,000 SOME CLINICS IN MORE REMOTE 1650 00:58:09,000 --> 00:58:10,960 AREAS ALSO HAVE A PHARMACIST 1651 00:58:10,960 --> 00:58:13,040 THAT ENABLES THEM TO PROVIDE 1652 00:58:13,040 --> 00:58:17,000 MEDICATION AT THE CLINIC LEVEL. 1653 00:58:17,000 --> 00:58:20,120 SO THE LAST KEY ELEMENT OF THE 1654 00:58:20,120 --> 00:58:20,720 PRIMARY HEALTH CARE SYSTEM IN 1655 00:58:20,720 --> 00:58:23,800 COSTA RICA IS THEIR ROBUST DATA 1656 00:58:23,800 --> 00:58:25,920 MANAGEMENT SYSTEM THAT UNDERLIES 1657 00:58:25,920 --> 00:58:27,760 THEIR QUALITY IMPROVEMENT 1658 00:58:27,760 --> 00:58:28,120 EFFORTS. 1659 00:58:28,120 --> 00:58:32,120 AND SO THERE ARE A MULTIITUDE OF 1660 00:58:32,120 --> 00:58:33,000 DATA STREAMS THAT FLOW IN THE 1661 00:58:33,000 --> 00:58:33,680 LOCAL TO REGIONAL LEVEL AND THEN 1662 00:58:33,680 --> 00:58:34,760 TO THE NATIONAL LEVEL. 1663 00:58:34,760 --> 00:58:36,160 BUT CRITICALLY, THOSE DATA THAT 1664 00:58:36,160 --> 00:58:37,600 ARE COLLECTED THEN ALSO FLOW 1665 00:58:37,600 --> 00:58:42,320 BACK DOWN TO THE LOCAL LEVEL TO 1666 00:58:42,320 --> 00:58:42,880 ENABLE RESOURCE PLANNING AND 1667 00:58:42,880 --> 00:58:43,920 QUALITY IMPROVEMENTS AT THE 1668 00:58:43,920 --> 00:58:46,000 PRIMARY CARE LEVEL. 1669 00:58:46,000 --> 00:58:46,960 OVER THE COURSE OF THE REFORM, 1670 00:58:46,960 --> 00:58:48,520 THEY CREATED A CULTURE OF 1671 00:58:48,520 --> 00:58:50,960 VALUING DATA TO ASSESS 1672 00:58:50,960 --> 00:58:53,080 PERFORMANCE NON PUNITIVELY. 1673 00:58:53,080 --> 00:58:55,400 AND MOST FASCINATING TO ME IS 1674 00:58:55,400 --> 00:58:57,680 SOMETHING CALLED THE QUALITIY 1675 00:58:57,680 --> 00:59:00,360 IMPROVEMENT INDEX WHICH ANNUALLY 1676 00:59:00,360 --> 00:59:01,600 RANKS THE HEALTH CLINICS FROM 1677 00:59:01,600 --> 00:59:02,880 BEST TO WORST. 1678 00:59:02,880 --> 00:59:06,560 AND THIS IS PUBLISHED PUBLICLY. 1679 00:59:06,560 --> 00:59:08,880 AND IT RANKS THE DIFFERENT 1680 00:59:08,880 --> 00:59:09,640 HEALTH AREAS OR DIFFERENT 1681 00:59:09,640 --> 00:59:13,360 CLINICS BASED ON A SERIES OF 1682 00:59:13,360 --> 00:59:14,360 DIFFERENT INDICATORS. 1683 00:59:14,360 --> 00:59:15,400 AND THIS ACTIVITY, THIS QUALITY 1684 00:59:15,400 --> 00:59:17,000 RANKING REALLY STIMULATES 1685 00:59:17,000 --> 00:59:20,400 QUALITY IMPROVEMENT AT THE LOCAL 1686 00:59:20,400 --> 00:59:21,360 LEVEL AT THE CLINIC LEVEL. 1687 00:59:21,360 --> 00:59:22,200 AND THERE ARE NO FINANCIAL 1688 00:59:22,200 --> 00:59:23,840 INCENTIVES ATTACHED TO THIS. 1689 00:59:23,840 --> 00:59:27,120 AND YET IT STILL HOLDS I THINK 1690 00:59:27,120 --> 00:59:27,720 CREDIBLE IMPORTANCE AND DRIVES 1691 00:59:27,720 --> 00:59:31,920 FORWARD QUALITY IMPROVEMENT 1692 00:59:31,920 --> 00:59:32,160 EFFORTS. 1693 00:59:32,160 --> 00:59:32,960 OVERALL, WHAT I LEARNED FROM THE 1694 00:59:32,960 --> 00:59:34,440 COSTA RICAN PRIMARY HEALTH CARE 1695 00:59:34,440 --> 00:59:35,920 SYSTEM IS THAT ROBUST PRIMARY 1696 00:59:35,920 --> 00:59:38,560 CARE MODELS CAN DRIVE IMPRESSIVE 1697 00:59:38,560 --> 00:59:41,640 REDUCTIONS IN MORTALITY. 1698 00:59:41,640 --> 00:59:43,280 BY INTEGRATING PREVENTIVE AND 1699 00:59:43,280 --> 00:59:43,960 CURATIVE CARE, WE CAN IMPROVE 1700 00:59:43,960 --> 00:59:45,480 CARE FOR THE WHOLE POPULATION 1701 00:59:45,480 --> 00:59:48,400 AND SPECIFICALLY HAVE AN IMPACT 1702 00:59:48,400 --> 00:59:49,600 ON NON-COMMUNICABLE DISEASES. 1703 00:59:49,600 --> 00:59:51,160 CLEARLY DEFINED POPULATIONS 1704 00:59:51,160 --> 00:59:54,320 ENABLE ACTIVE POPULATION HEALTH 1705 00:59:54,320 --> 00:59:55,920 MANAGEMENT WHICH FLOOD THE 1706 00:59:55,920 --> 00:59:57,880 TRADITIONAL MODEL OF DOCTORS 1707 00:59:57,880 --> 01:00:00,000 TREATING PATIENTS THAT ARRIVE TO 1708 01:00:00,000 --> 01:00:01,480 HEALTH CARE TEAMS PROMOTING 1709 01:00:01,480 --> 01:00:04,360 HEALTH FOR THEIR POPULATION. 1710 01:00:04,360 --> 01:00:05,560 TEAMS OF MULTIPLE TYPES OF 1711 01:00:05,560 --> 01:00:07,360 PROVIDERS CAN PROVIDE HOLISTIC 1712 01:00:07,360 --> 01:00:09,320 PRIMARY CARE TO PATIENTS AND 1713 01:00:09,320 --> 01:00:09,720 COMMUNITIES. 1714 01:00:09,720 --> 01:00:13,480 AND RELIABLE DATA FEEDBACK LOOPS 1715 01:00:13,480 --> 01:00:14,120 PROMOTE QUALITY IMPROVEMENT AT 1716 01:00:14,120 --> 01:00:16,160 THE PRIMARY CARE LEVEL. 1717 01:00:16,160 --> 01:00:17,880 THANK YOU VERY MUCH FOR HAVING 1718 01:00:17,880 --> 01:00:19,160 ME AND I LOOK FORWARD TO HEARING 1719 01:00:19,160 --> 01:00:20,600 YOUR QUESTIONS IN THE Q&A 1720 01:00:20,600 --> 01:00:22,320 SESSION. 1721 01:00:22,320 --> 01:00:25,240 THANK YOU. 1722 01:00:25,240 --> 01:00:26,640 >>GOOD MORNING, AGAIN. 1723 01:00:26,640 --> 01:00:35,480 THANK YOU TO THE SPEAKERS FOR 1724 01:00:35,480 --> 01:00:37,720 THEIR VERY INSIGHTFUL 1725 01:00:37,720 --> 01:00:38,080 PRESENTATIONS. 1726 01:00:38,080 --> 01:00:42,720 AND NOW WE ARE IN THE LIVE Q&A 1727 01:00:42,720 --> 01:00:44,520 WITH THEM. 1728 01:00:44,520 --> 01:00:46,520 AND THIS Q&A IS GOING TO BE 1729 01:00:46,520 --> 01:00:47,800 ABOUT 40 MINUTES LONG AND AFTER 1730 01:00:47,800 --> 01:00:51,760 THAT, WE WILL HAVE A BREAK. 1731 01:00:51,760 --> 01:00:54,640 SO, THANK YOU AGAIN TO THE 1732 01:00:54,640 --> 01:00:55,800 SPEAKERS FOR YOUR PARTICIPATION 1733 01:00:55,800 --> 01:00:58,400 AND FOR SHARING YOUR EXPERIENCE 1734 01:00:58,400 --> 01:01:02,640 WITH US AND YOUR PERSPECTIVES ON 1735 01:01:02,640 --> 01:01:03,800 THE VARIOUS ASPECTS OF RESEARCH 1736 01:01:03,800 --> 01:01:08,480 EMBEDDED INTO CLINICAL SETTINGS 1737 01:01:08,480 --> 01:01:10,800 OR HEALTH RESEARCH. 1738 01:01:10,800 --> 01:01:15,360 AND I'M GOING TO ASK THE FIRST 1739 01:01:15,360 --> 01:01:17,960 QUESTION TO DR. MARTINEZ. 1740 01:01:17,960 --> 01:01:20,560 COULD YOU ELABORATE FURTHER ON 1741 01:01:20,560 --> 01:01:22,240 IMPROVEMENTS IN HEALTH OUTCOMES 1742 01:01:22,240 --> 01:01:25,280 THAT YOU HAVE OBSERVED WITH 1743 01:01:25,280 --> 01:01:25,960 MIDO? 1744 01:01:25,960 --> 01:01:27,600 YOU MENTIONED SOME IN ONE OF THE 1745 01:01:27,600 --> 01:01:31,000 SLIDES, SOME OUTCOMES, SOME 1746 01:01:31,000 --> 01:01:33,760 GOALS ON HEMOGLOBIN A1C, WEIGHT, 1747 01:01:33,760 --> 01:01:34,240 BLOOD PRESSURE. 1748 01:01:34,240 --> 01:01:37,080 DO YOU HAVE OTHER OUTCOMES AS 1749 01:01:37,080 --> 01:01:43,080 WELL LIKE PREVENTION AND 1750 01:01:43,080 --> 01:01:44,120 HOSPITALIZATIONS OR REDUCTION OF 1751 01:01:44,120 --> 01:01:46,240 PLEA VENTABLE HOSPITALIZATIONS 1752 01:01:46,240 --> 01:01:47,600 OR MEDICATIONS SAFETY? 1753 01:01:47,600 --> 01:01:49,960 OTHER OUTCOMES LIKE THAT? 1754 01:01:49,960 --> 01:01:54,720 AND I WOULD LIKE TO ADD 1755 01:01:54,720 --> 01:01:59,360 SOMETHING VERY INTERESTING THAT 1756 01:01:59,360 --> 01:02:02,880 YOU SHOWED IN YOUR ALGORITHM OR 1757 01:02:02,880 --> 01:02:04,400 YOUR SYSTEM. 1758 01:02:04,400 --> 01:02:07,960 THE APPLICATION OF PERSONALIZED 1759 01:02:07,960 --> 01:02:10,080 RISK SCALES OR THE ALGORITHMS 1760 01:02:10,080 --> 01:02:11,840 THAT ALREADY EXIST. 1761 01:02:11,840 --> 01:02:13,960 SO HOW -- I THINK THERE ARE TWO 1762 01:02:13,960 --> 01:02:15,280 QUESTIONS IN ONE. 1763 01:02:15,280 --> 01:02:17,040 FOR ADDITIONAL HEALTH OUTCOMES 1764 01:02:17,040 --> 01:02:20,080 THAT YOU HAVE DERIVED FROM YOUR 1765 01:02:20,080 --> 01:02:25,720 SYSTEM AND HOW YOU INTEGRATE THE 1766 01:02:25,720 --> 01:02:25,960 SCALES? 1767 01:02:25,960 --> 01:02:27,480 THANK YOU. 1768 01:02:27,480 --> 01:02:28,800 >>DR. MARTINEZ: THANK YOU VERY 1769 01:02:28,800 --> 01:02:29,160 MUCH. 1770 01:02:29,160 --> 01:02:33,080 IT IS A PLEASURE TO BE HERE. 1771 01:02:33,080 --> 01:02:35,840 THE RISK SCALES, THE REASON WE 1772 01:02:35,840 --> 01:02:37,240 BEGAN USING THEM IS BECAUSE AT 1773 01:02:37,240 --> 01:02:41,680 FIRST WE REALIZED THAT THE LEVEL 1774 01:02:41,680 --> 01:02:43,800 OF HEALTH LITERACY IN HEALTH 1775 01:02:43,800 --> 01:02:44,920 PROFESSIONALS WAS ALSO LOW DUE 1776 01:02:44,920 --> 01:02:48,720 TO A LACK OF TRAINING AND 1777 01:02:48,720 --> 01:02:51,280 ESPECIALLY IN THE UP-TO-DATE 1778 01:02:51,280 --> 01:02:52,360 CLINICAL GUIDELINES. 1779 01:02:52,360 --> 01:02:55,280 MOST OF THE PEOPLE WE HAVE BEEN 1780 01:02:55,280 --> 01:02:55,840 WORKING WITH HAS BEEN IN THE 1781 01:02:55,840 --> 01:02:58,720 FIELD PERHAPS FOR 15-20-25 1782 01:02:58,720 --> 01:02:58,920 YEARS. 1783 01:02:58,920 --> 01:03:03,840 AND THEY HAVE NOT RECEIVED 1784 01:03:03,840 --> 01:03:05,800 PROPER PROFESSIONAL -- CONTINUED 1785 01:03:05,800 --> 01:03:06,480 MEDICAL EDUCATION. 1786 01:03:06,480 --> 01:03:09,280 SO THE USE OF RISK SCALES THEN, 1787 01:03:09,280 --> 01:03:11,960 IT BECOMES A VERY EASY TO ADAPT 1788 01:03:11,960 --> 01:03:16,320 SOLUTION BECAUSE PEOPLE CAN HAVE 1789 01:03:16,320 --> 01:03:19,120 ACCESS TO A VERY REALLY QUICK 1790 01:03:19,120 --> 01:03:21,240 INTERPRETATION OF DATA AND THEY 1791 01:03:21,240 --> 01:03:22,880 CAN UNDERSTAND THE RESULTS IN A 1792 01:03:22,880 --> 01:03:24,520 VERY EASY WAY. 1793 01:03:24,520 --> 01:03:27,880 SO FOR EXAMPLE, THE 21 PROFILES 1794 01:03:27,880 --> 01:03:31,280 THAT MIDO HAS REALLY VERY EASY 1795 01:03:31,280 --> 01:03:31,960 TO UNDERSTAND. 1796 01:03:31,960 --> 01:03:33,520 THE THING IS, WHAT ARE THE 1797 01:03:33,520 --> 01:03:34,880 RECOMMENDATIONS THEY ARE GOING 1798 01:03:34,880 --> 01:03:36,960 TO PROVIDE TO PATIENTS? 1799 01:03:36,960 --> 01:03:40,840 AND THAT IS WHY I MADE SO MUCH 1800 01:03:40,840 --> 01:03:41,680 EMPHASIS ON THE COUNCILLING 1801 01:03:41,680 --> 01:03:42,920 BECAUSE YOU REALLY NEED TO MAKE 1802 01:03:42,920 --> 01:03:45,920 SURE THAT PEOPLE UNDERSTAND WHAT 1803 01:03:45,920 --> 01:03:47,240 THE RISK CONDITIONS ARE. 1804 01:03:47,240 --> 01:03:50,560 AND REALLY THAT PROCESS OF 1805 01:03:50,560 --> 01:03:52,720 AWARENESS OR RAISING AWARENESS 1806 01:03:52,720 --> 01:03:54,920 ON YOUR CONDITION, TO ME, IS THE 1807 01:03:54,920 --> 01:03:56,120 MOST IMPORTANT PART OF THE 1808 01:03:56,120 --> 01:03:59,080 PROCESS BECAUSE YOU CAN HAVE 1809 01:03:59,080 --> 01:04:00,040 ACCESS TO THE DEVICES. 1810 01:04:00,040 --> 01:04:01,720 YOU CAN HAVE ACCESS TO THE 1811 01:04:01,720 --> 01:04:02,840 RESULTS, BUT IF YOU DON'T KNOW 1812 01:04:02,840 --> 01:04:04,040 HOW TO UNDERSTAND THEM, THEY ARE 1813 01:04:04,040 --> 01:04:06,360 NOT ACTUALLY MAKING A 1814 01:04:06,360 --> 01:04:06,680 DIFFERENCE. 1815 01:04:06,680 --> 01:04:08,960 SO THE MOST IMPORTANT THING -- 1816 01:04:08,960 --> 01:04:11,840 AND I WOULD SAY THAT THE -- I 1817 01:04:11,840 --> 01:04:13,760 WOULD FIND MOST INTERESTING ARE 1818 01:04:13,760 --> 01:04:15,880 THOSE THAT ALLOW PEOPLE TO 1819 01:04:15,880 --> 01:04:17,920 ACTUALLY UNDERSTAND THEIR 1820 01:04:17,920 --> 01:04:19,200 DISEASE MORE OR THEIR HEALTH 1821 01:04:19,200 --> 01:04:20,120 CARE CONDITION MORE. 1822 01:04:20,120 --> 01:04:22,520 AND THAT MAKING SURE THAT YOU 1823 01:04:22,520 --> 01:04:24,120 PREVENT HOSPITALIZATIONS OR THAT 1824 01:04:24,120 --> 01:04:27,280 YOU PREVENT COMPLICATIONS, WE 1825 01:04:27,280 --> 01:04:28,240 HAVEN'T MADE A COHORT. 1826 01:04:28,240 --> 01:04:31,480 SO REALLY WE HAVEN'T FOLLOWED UP 1827 01:04:31,480 --> 01:04:33,640 PEOPLE IN LONG TERM. 1828 01:04:33,640 --> 01:04:34,560 AND PART OF THE DIFFICULTIES OF 1829 01:04:34,560 --> 01:04:36,320 DOING THAT IS IN THE END WE ARE 1830 01:04:36,320 --> 01:04:39,240 NOT HEALTH SERVICES PROVIDERS. 1831 01:04:39,240 --> 01:04:40,120 WE WORK WITH ORGANIZATIONS AND 1832 01:04:40,120 --> 01:04:42,800 WE DO PROVIDE THOSE HEALTH 1833 01:04:42,800 --> 01:04:43,080 SERVICES. 1834 01:04:43,080 --> 01:04:44,360 AND WE WOULD LOVE TO HAVE AN 1835 01:04:44,360 --> 01:04:46,320 OPPORTUNITY TO HAVE A COHORT IN 1836 01:04:46,320 --> 01:04:48,400 WHICH WE CAN TEST THIS BECAUSE 1837 01:04:48,400 --> 01:04:51,560 IN THE END, I'M CONVINCED THAT 1838 01:04:51,560 --> 01:04:55,280 THE EDUCATIONAL SIDE, ALONGSIDE 1839 01:04:55,280 --> 01:04:56,320 PHARMACOLOGICAL TREATMENT AND 1840 01:04:56,320 --> 01:04:57,240 ALONGSIDE ACCESS TO OTHER 1841 01:04:57,240 --> 01:04:58,480 SERVICES, IS REALLY WHAT MAKES 1842 01:04:58,480 --> 01:04:59,240 THE DIFFERENCE. 1843 01:04:59,240 --> 01:05:02,720 BUT I WOULD SAY THAT RISK SCALES 1844 01:05:02,720 --> 01:05:04,920 ARE REALLY IMPORTANT IN THAT 1845 01:05:04,920 --> 01:05:08,160 THEY HAVE ENABLED US TO REALLY 1846 01:05:08,160 --> 01:05:10,320 PROVIDE PROFESSIONAL HEALTH RISK 1847 01:05:10,320 --> 01:05:12,080 SERVICES AND REALLY STRENGTHEN 1848 01:05:12,080 --> 01:05:15,680 THE QUALITY OF THEM. 1849 01:05:15,680 --> 01:05:16,040 THANK YOU. 1850 01:05:16,040 --> 01:05:18,160 >>THANK YOU DR. MARTINEZ. 1851 01:05:18,160 --> 01:05:20,000 MY NEXT QUESTION OR THE NEXT 1852 01:05:20,000 --> 01:05:23,000 QUESTION IS FOR DR. PIETTE. 1853 01:05:23,000 --> 01:05:25,400 CAN YOU SAY MORE ABOUT THE 1854 01:05:25,400 --> 01:05:28,520 IMPLICATIONS OF YOUR WORK USING 1855 01:05:28,520 --> 01:05:30,920 ARTIFICIAL INTELLIGENCE TO MAKE 1856 01:05:30,920 --> 01:05:31,520 EVIDENCE-BASED HEALTH SERVICES 1857 01:05:31,520 --> 01:05:34,040 MORE ACCESSIBLE IN LATIN 1858 01:05:34,040 --> 01:05:34,440 AMERICA? 1859 01:05:34,440 --> 01:05:36,360 AND I WOULD LIKE TO ADD A COUPLE 1860 01:05:36,360 --> 01:05:42,040 OF THINGS TO THAT QUESTION. 1861 01:05:42,040 --> 01:05:44,320 AS WE CONTINUE OBSERVING AND 1862 01:05:44,320 --> 01:05:49,160 LISTENING TO YOUR PRESENTAT 1863 01:05:49,160 --> 01:05:51,160 PRESENTATION -- AND THIS MAY 1864 01:05:51,160 --> 01:05:54,320 APPLY ALSO TO MIDO -- IS THE 1865 01:05:54,320 --> 01:05:59,800 QUALITY OF THE DATA ALSO WOULD 1866 01:05:59,800 --> 01:06:04,200 HELP BUILD THE ALGORITHM OR THE 1867 01:06:04,200 --> 01:06:04,560 DECISION-MAKING? 1868 01:06:04,560 --> 01:06:06,960 SO HOW IN THE IMPLICATIONS OF 1869 01:06:06,960 --> 01:06:09,640 YOUR WORK, HOW YOU SEE THE 1870 01:06:09,640 --> 01:06:16,720 QUALITY OF DATA OR THE 1871 01:06:16,720 --> 01:06:18,440 COMPLETENESS OF YOUR DATA TO 1872 01:06:18,440 --> 01:06:19,720 BUILD THOSE ALGORITHMS AND HELP 1873 01:06:19,720 --> 01:06:21,760 WITH THE DECISION-MAKING? 1874 01:06:21,760 --> 01:06:27,040 AND IF THERE IS A ROLE FOR 1875 01:06:27,040 --> 01:06:31,000 PATIENT REPORTED OUTCOMES IN 1876 01:06:31,000 --> 01:06:31,600 THIS STRUCTURE THAT YOU HAVE 1877 01:06:31,600 --> 01:06:33,720 BEEN WORKING? 1878 01:06:33,720 --> 01:06:34,840 >>DR. PIETTE: THANK YOU VERY 1879 01:06:34,840 --> 01:06:37,120 MUCH FOR THIS OPPORTUNITY TO BE 1880 01:06:37,120 --> 01:06:37,840 HERE. 1881 01:06:37,840 --> 01:06:42,680 IT'S A WONDERFUL SESSION. 1882 01:06:42,680 --> 01:06:43,280 FIRST LET ME ADDRESS THAT 1883 01:06:43,280 --> 01:06:47,280 QUESTION ABOUT THE QUALITY OF 1884 01:06:47,280 --> 01:06:48,120 THE DATA. 1885 01:06:48,120 --> 01:06:49,680 IN THE TRIAL THAT I PRESENTED 1886 01:06:49,680 --> 01:06:51,440 ABOUT PAIN CBT, COGNITIVE 1887 01:06:51,440 --> 01:06:56,040 BEHAVIORAL THERAPY, THOSE REAL 1888 01:06:56,040 --> 01:06:58,360 ARE ARE PATIENT-REPORTED 1889 01:06:58,360 --> 01:06:58,640 OUTCOMES. 1890 01:06:58,640 --> 01:06:59,280 PATIENTS ARE TELLING US HOW BAD 1891 01:06:59,280 --> 01:07:00,000 THEIR PAIN IS, HOW BAD THEIR 1892 01:07:00,000 --> 01:07:01,480 SLEEP IS, HOW THEIR FUNCTIONING 1893 01:07:01,480 --> 01:07:01,760 IS. 1894 01:07:01,760 --> 01:07:03,880 ALL THAT IS PATIENT-REPORT THE 1895 01:07:03,880 --> 01:07:04,160 OUTCOMES. 1896 01:07:04,160 --> 01:07:06,520 IN THE WORK WE ARE REALLY 1897 01:07:06,520 --> 01:07:07,920 EMBARKING ON IN LATIN AMERICA 1898 01:07:07,920 --> 01:07:10,240 WHEN WE ARE LOOKING AT WOMEN 1899 01:07:10,240 --> 01:07:13,640 THAT HAVE A POST-TRAUMATIC 1900 01:07:13,640 --> 01:07:15,680 STRESS, DEPRESSION, ANXIETY 1901 01:07:15,680 --> 01:07:17,520 DISORDERS, AGAIN THOSE ARE ALL 1902 01:07:17,520 --> 01:07:19,080 PATIENT REPORTED OUTCOMES THERE 1903 01:07:19,080 --> 01:07:20,840 IS NO OTHER WAY TO GET THEM. 1904 01:07:20,840 --> 01:07:24,040 WE KNOW THAT BETWEEN VISIT 1905 01:07:24,040 --> 01:07:24,640 REPORTS WHILE PATIENTS ARE IN 1906 01:07:24,640 --> 01:07:26,040 THEIR NATURAL ENVIRONMENT, WHILE 1907 01:07:26,040 --> 01:07:28,240 PEOPLE ARE IN THEIR HOMES, 1908 01:07:28,240 --> 01:07:30,360 LEADING DAILY LIVES, THOSE SORTS 1909 01:07:30,360 --> 01:07:32,880 OF PATIENT-REPORTED OUTCOMES ARE 1910 01:07:32,880 --> 01:07:34,000 MORE ACCURATE AND REFLECTIVE OF 1911 01:07:34,000 --> 01:07:36,200 WHAT IS HAPPENING WITH THE 1912 01:07:36,200 --> 01:07:37,520 PERSON THAN WHEN THEY COME IN TO 1913 01:07:37,520 --> 01:07:39,280 THE CLINIC, IF THEY COME INTO 1914 01:07:39,280 --> 01:07:40,600 THE CLINIC. 1915 01:07:40,600 --> 01:07:42,320 SO PATIENT-REPORTED OUTCOMES AND 1916 01:07:42,320 --> 01:07:44,200 USING DIGITAL TOOLS TO COLLECT 1917 01:07:44,200 --> 01:07:45,920 THOSE, I THINK ARE -- I TOTALLY 1918 01:07:45,920 --> 01:07:47,080 AGREE ARE FUNDAMENTAL. 1919 01:07:47,080 --> 01:07:50,840 MORE GENERALLY, THE IMPLICATIONS 1920 01:07:50,840 --> 01:07:54,240 OF THIS AREA OF WORK ARE THAT I 1921 01:07:54,240 --> 01:07:57,120 THINK WE HAVE A NEW WAY TO MAKE 1922 01:07:57,120 --> 01:07:58,760 EVIDENCE-BASED PROGRAMS MORE 1923 01:07:58,760 --> 01:07:59,680 SCALABLE. 1924 01:07:59,680 --> 01:08:02,360 SO I TALKED A LOT ABOUT CBT BUT 1925 01:08:02,360 --> 01:08:04,360 ANOTHER GREAT EXAMPLE IS THE 1926 01:08:04,360 --> 01:08:05,720 DIABETES PREVENTION PROGRAM, 1927 01:08:05,720 --> 01:08:07,480 WHICH MANY, IF YOU'RE FAMILIAR 1928 01:08:07,480 --> 01:08:10,800 WITH, THAT WAS COMPARING 1929 01:08:10,800 --> 01:08:11,680 BEHAVIORAL SUPPORT FOR PATIENTS 1930 01:08:11,680 --> 01:08:14,040 WITH PRE-DIABETES TO SAY 1931 01:08:14,040 --> 01:08:16,320 METFORMIN, TO MEDICATION. 1932 01:08:16,320 --> 01:08:17,240 THEY ACTUALLY STOPPED THE TRIAL 1933 01:08:17,240 --> 01:08:18,720 EARLY BECAUSE THE BEHAVIORAL 1934 01:08:18,720 --> 01:08:20,200 INTERVENTION WAS SO MUCH MORE 1935 01:08:20,200 --> 01:08:22,400 EFFECTIVE THAN EVEN MEDICATIONS 1936 01:08:22,400 --> 01:08:23,600 THAT IT WASN'T ETHICAL TO 1937 01:08:23,600 --> 01:08:25,120 CONTINUE WITH THE TRIAL. 1938 01:08:25,120 --> 01:08:25,960 BUT GUESS WHAT? 1939 01:08:25,960 --> 01:08:27,600 THAT TRIAL WAS PUBLISHED OVER 20 1940 01:08:27,600 --> 01:08:28,480 YEARS AGO. 1941 01:08:28,480 --> 01:08:31,280 MOST PATIENTS DON'T HAVE ACCESS. 1942 01:08:31,280 --> 01:08:33,320 SO WHAT WE ARE HEARING FROM 1943 01:08:33,320 --> 01:08:35,160 CLINICIANS AND HEALTH SYSTEMS 1944 01:08:35,160 --> 01:08:37,360 AND PATIENTS IS NOT ONE MINUTE 1945 01:08:37,360 --> 01:08:40,360 MORE, NOT $1 MORE. 1946 01:08:40,360 --> 01:08:42,160 THERE IS FOCUS ON KIND OF 1947 01:08:42,160 --> 01:08:45,800 EFFICIENCY AND FIGURING OUT WHO 1948 01:08:45,800 --> 01:08:47,200 NEEDS HOW MUCH ATTENTION. 1949 01:08:47,200 --> 01:08:49,840 I THINK IT HAS BROAD 1950 01:08:49,840 --> 01:08:51,200 APPLICABILITY FOR ADDRESSING A 1951 01:08:51,200 --> 01:08:54,080 VARIETY OF THINGS THAT HAVE BEEN 1952 01:08:54,080 --> 01:08:55,400 REALLY THE FUNDAMENTAL DRIVERS 1953 01:08:55,400 --> 01:08:57,160 OF THIS GAP BETWEEN WHAT WE KNOW 1954 01:08:57,160 --> 01:08:59,160 WORKS IN ACADEMIA AND WHAT IS 1955 01:08:59,160 --> 01:09:00,760 HAPPENING IN THE REAL WORLD. 1956 01:09:00,760 --> 01:09:03,200 IN ADDITION, THESE SORTS OF AI 1957 01:09:03,200 --> 01:09:05,720 APPROACHES WILL ALLOW US TO 1958 01:09:05,720 --> 01:09:06,120 PERSONALIZE CARE. 1959 01:09:06,120 --> 01:09:09,240 SO INSTEAD OF HAVING A 1960 01:09:09,240 --> 01:09:11,360 ONE-SIZE-FITS-ALL APPROACH, IN 1961 01:09:11,360 --> 01:09:12,720 THEORY, SOME OF THE PROGRAMS 1962 01:09:12,720 --> 01:09:13,960 EITHER THAT PAIN PROGRAM, FOR 1963 01:09:13,960 --> 01:09:16,600 EXAMPLE, THAT WE TESTED IN 1964 01:09:16,600 --> 01:09:18,000 MICHIGAN, COULD BE APPLIED 1965 01:09:18,000 --> 01:09:19,800 DIRECTLY IN MEXICO OR HON DUR 1966 01:09:19,800 --> 01:09:22,440 ASS OR IN COLUMBIA. 1967 01:09:22,440 --> 01:09:24,640 -- HONDURAS -- AND IT WOULD 1968 01:09:24,640 --> 01:09:26,280 LEARN A DIFFERENT PATTERN OF 1969 01:09:26,280 --> 01:09:28,080 INTERACTIONS WITH PATIENTS USING 1970 01:09:28,080 --> 01:09:28,480 THE SAME PROGRAM. 1971 01:09:28,480 --> 01:09:31,320 NOT NECESSARILY RECOMMENDED WE 1972 01:09:31,320 --> 01:09:33,000 DO SOMETHING JUST LIKE THAT, BUT 1973 01:09:33,000 --> 01:09:34,760 THE IDEA IS THAT THESE PROGRAMS 1974 01:09:34,760 --> 01:09:37,080 WILL LISTEN AND ADAPT TO WHAT 1975 01:09:37,080 --> 01:09:38,120 THEY ARE DOING TO INDIVIDUALS 1976 01:09:38,120 --> 01:09:40,200 AND TO HEALTH SYSTEMS AND 1977 01:09:40,200 --> 01:09:40,440 CONTEXT. 1978 01:09:40,440 --> 01:09:42,640 SO THAT IS AN EXCITING ADVANCE 1979 01:09:42,640 --> 01:09:46,160 TO THE WAY WE THOUGHT ABOUT 1980 01:09:46,160 --> 01:09:48,200 GUIDELINE RECOMMENDED PROGRAMS 1981 01:09:48,200 --> 01:09:49,200 IN THE PAST. 1982 01:09:49,200 --> 01:09:54,120 THE LAST IMPLICATION, I GUESS, 1983 01:09:54,120 --> 01:09:55,480 IS THAT ARTIFICIAL INTELLIGENCE 1984 01:09:55,480 --> 01:09:57,800 IN GENERAL IS A GAME OF LARGE 1985 01:09:57,800 --> 01:09:58,200 NUMBERS. 1986 01:09:58,200 --> 01:09:59,880 IT WORKS BEST WHEN IT HAS A LOT 1987 01:09:59,880 --> 01:10:01,360 OF INFORMATION AND A LOT OF 1988 01:10:01,360 --> 01:10:04,200 EXPERIENCE AND A LOT OF 1989 01:10:04,200 --> 01:10:06,080 INTERACTIONS FROM WHICH TO 1990 01:10:06,080 --> 01:10:06,480 LEARN. 1991 01:10:06,480 --> 01:10:07,960 JUST LIKE WE KNOW THAT A 1992 01:10:07,960 --> 01:10:10,840 CLINICIAN THAT HAS BEEN 1993 01:10:10,840 --> 01:10:11,440 PRACTICING FOR 20 YEARS HAS A 1994 01:10:11,440 --> 01:10:12,600 DIFFERENT WAY OF MAKING 1995 01:10:12,600 --> 01:10:14,240 DECISIONS IN A MORE EFFECTIVE, 1996 01:10:14,240 --> 01:10:15,240 MORE EFFICIENT WAY, THAN SOMEONE 1997 01:10:15,240 --> 01:10:17,160 WHO IS JUST OUT OF MEDICAL 1998 01:10:17,160 --> 01:10:17,720 SCHOOL. 1999 01:10:17,720 --> 01:10:19,840 SO, THE IMPLICATIONS ARE 2000 01:10:19,840 --> 01:10:23,160 SPECIFICALLY RELATED TO THE 2001 01:10:23,160 --> 01:10:26,400 OVERALL TOPIC OF THIS CONFERENCE 2002 01:10:26,400 --> 01:10:30,640 IS THAT WE HOPE THAT WE CAN HAVE 2003 01:10:30,640 --> 01:10:33,640 BOTH -- WITHIN COUNTRY AND 2004 01:10:33,640 --> 01:10:34,240 INTERNATIONALLY LARGER TRIALS 2005 01:10:34,240 --> 01:10:36,880 WHERE WE CAN TEST THESE METHODS 2006 01:10:36,880 --> 01:10:37,080 OUT. 2007 01:10:37,080 --> 01:10:39,440 WE FIND THEM AND SEE FOR WHOM 2008 01:10:39,440 --> 01:10:40,480 THEY WORK, WHERE THEY WORK AND 2009 01:10:40,480 --> 01:10:42,960 HOW WE CAN MAKE THEM BETTER. 2010 01:10:42,960 --> 01:10:43,960 >>THANK YOU. 2011 01:10:43,960 --> 01:10:47,280 THANK YOU DR. PIETTE. 2012 01:10:47,280 --> 01:10:49,200 AND DR. GUSTAVO GOSSLING, ARE 2013 01:10:49,200 --> 01:10:50,800 YOU ON YET? 2014 01:10:50,800 --> 01:10:51,640 THANK YOU. 2015 01:10:51,640 --> 01:10:55,200 >>GUSTAVO GOSSLING: YES, I AM. 2016 01:10:55,200 --> 01:10:57,200 >>SO YOUR QUESTION IS WHAT ARE 2017 01:10:57,200 --> 01:11:00,000 THE MOST COMMON CHALLENGES THAT 2018 01:11:00,000 --> 01:11:03,240 IN YOUR CASE, THAT YOU HAVE 2019 01:11:03,240 --> 01:11:07,240 CONFRONTED OR ADDRESSED WHILE 2020 01:11:07,240 --> 01:11:08,800 INTEGRATING CANCER RESEARCH 2021 01:11:08,800 --> 01:11:10,960 EMBEDDED IN A HEALTH CARE 2022 01:11:10,960 --> 01:11:15,280 SETTING OR HEALTH CARE SYSTEM? 2023 01:11:15,280 --> 01:11:18,360 IN LATIN AMERICA, ANY STRATEGIES 2024 01:11:18,360 --> 01:11:19,160 THAT HAVE WORKED? 2025 01:11:19,160 --> 01:11:22,760 ANY STRATEGIES YOU WOULD 2026 01:11:22,760 --> 01:11:23,280 RECOMMEND? 2027 01:11:23,280 --> 01:11:27,280 AND YESTERDAY, YOUR COLLEAGUE 2028 01:11:27,280 --> 01:11:27,920 MENTIONED SOME CHALLENGES AT THE 2029 01:11:27,920 --> 01:11:28,640 HIGH LEVEL. 2030 01:11:28,640 --> 01:11:31,560 IF YOU COULD MENTION SOME 2031 01:11:31,560 --> 01:11:33,040 CHALLENGES, PROBABLY AT THE 2032 01:11:33,040 --> 01:11:35,280 CLINICAL LEVEL AND THE CLINICAL 2033 01:11:35,280 --> 01:11:35,800 SETTING LEVEL. 2034 01:11:35,800 --> 01:11:41,320 >>GUSTAVO GOSSLING: THERE ARE 2035 01:11:41,320 --> 01:11:43,560 SO MANY ISSUES BUT THE FIRST ONE 2036 01:11:43,560 --> 01:11:44,520 AND MOST IMPORTANT ONE IS 2037 01:11:44,520 --> 01:11:46,600 GETTING A MOTIVATED TEAM. 2038 01:11:46,600 --> 01:11:50,880 THIS IS WHY THE FIRST THING WE 2039 01:11:50,880 --> 01:11:52,640 EVER THOUGHT OF DOING WHEN WE 2040 01:11:52,640 --> 01:11:54,120 WERE TRYING TO OPEN NEW CLINICAL 2041 01:11:54,120 --> 01:11:57,080 SITES, NEW RESEARCH SITES IN 2042 01:11:57,080 --> 01:12:00,120 BRAZIL WAS GETTING A KIND OF 2043 01:12:00,120 --> 01:12:00,880 PROPOSAL FROM THE SITES. 2044 01:12:00,880 --> 01:12:05,600 BECAUSE WE NEED THE MOTIVATED 2045 01:12:05,600 --> 01:12:06,440 TEAM. 2046 01:12:06,440 --> 01:12:07,400 BECAUSE CLINICAL RESEARCH HOLDS 2047 01:12:07,400 --> 01:12:09,560 A LOT OF PAPERWORK AND WE ALL 2048 01:12:09,560 --> 01:12:11,680 KNOW THAT WE HAVE TO APPLY FOR 2049 01:12:11,680 --> 01:12:13,600 GRANTS. 2050 01:12:13,600 --> 01:12:15,800 WE HAVE TO WRITE MANUSCRIPTS WE 2051 01:12:15,800 --> 01:12:18,880 HAVE A LOT OF ETHICAL 2052 01:12:18,880 --> 01:12:19,680 REGULATIONS TO DO. 2053 01:12:19,680 --> 01:12:21,960 SO GETTING A TEAM THAT IS 2054 01:12:21,960 --> 01:12:24,680 MOTIVATED IS KIND OF THE MOST 2055 01:12:24,680 --> 01:12:26,600 IMPORTANT THING. 2056 01:12:26,600 --> 01:12:30,800 HOWEVER, WE DO HAVE ALSO TO DEAL 2057 01:12:30,800 --> 01:12:41,240 WITH ETHICAL REGULATIONS. 2058 01:12:42,200 --> 01:12:43,760 BECAUSE WE HAVE TO DO THE 2059 01:12:43,760 --> 01:12:48,040 ETHICAL EVALUATION FOR THEIR OWN 2060 01:12:48,040 --> 01:12:49,520 CLINICAL RESEARCH. 2061 01:12:49,520 --> 01:12:52,880 AND THERE IS ALSO ONE SPECIAL 2062 01:12:52,880 --> 01:12:55,320 IMPORTANT THING THAT IS CLINICAL 2063 01:12:55,320 --> 01:12:58,000 RESEARCH IN SOME COUNTRIES IT 2064 01:12:58,000 --> 01:12:58,920 CANNOT BE -- IT CANNOT HAPPEN 2065 01:12:58,920 --> 01:13:01,520 TOGETHER WITH THE PUBLIC HEALTH 2066 01:13:01,520 --> 01:13:04,480 SETTING LIKE IN THE SAME PLACE. 2067 01:13:04,480 --> 01:13:08,760 BUT THIS IS SOMETHING THAT WE 2068 01:13:08,760 --> 01:13:10,960 CAN DISCUSS IN ANOTHER TIME. 2069 01:13:10,960 --> 01:13:13,000 THESE ARE THE MOST IMPORTANT 2070 01:13:13,000 --> 01:13:14,840 CHALLENGE IS TO GET TEAM THAT IS 2071 01:13:14,840 --> 01:13:18,480 MOTIVATED BECAUSE IT TAKES TIME 2072 01:13:18,480 --> 01:13:20,480 AND IT TAKES A LOT OF PAPERWORK 2073 01:13:20,480 --> 01:13:22,360 TO MAKE IT HAPPEN. 2074 01:13:22,360 --> 01:13:23,280 >>MODERATOR: THANK YOU, 2075 01:13:23,280 --> 01:13:26,760 DR. GUSTAVO GOSSLING. 2076 01:13:26,760 --> 01:13:28,040 THANK YOU. 2077 01:13:28,040 --> 01:13:30,400 DR. MADELINE PESEC, OMENED IN 2078 01:13:30,400 --> 01:13:37,200 ONE OF THE FIRST SLIDES SOME 2079 01:13:37,200 --> 01:13:38,960 MEASURES OR RATES WHEN YOU WERE 2080 01:13:38,960 --> 01:13:40,520 EXPLAINING THE SUCCESS OF 2081 01:13:40,520 --> 01:13:42,360 PRIMARY CARE IN COSTA RICA. 2082 01:13:42,360 --> 01:13:46,240 AND THE MEASURES WERE MORE ABOUT 2083 01:13:46,240 --> 01:13:49,040 MATERNAL CHILDREN'S HEALTH. 2084 01:13:49,040 --> 01:13:50,720 WHAT ARE THE MEASURES THAT HAVE 2085 01:13:50,720 --> 01:13:55,240 BEEN APPLIED OR INCORPORATED FOR 2086 01:13:55,240 --> 01:13:57,200 CHRONIC DISEASES AND HOW DO THEY 2087 01:13:57,200 --> 01:14:00,240 RELATE TO THE REDUCTION IN 2088 01:14:00,240 --> 01:14:04,240 MORTALITY THAT YOU INFORMED US? 2089 01:14:04,240 --> 01:14:05,160 >>MADELINE PESEC: ABSOLUTELY. 2090 01:14:05,160 --> 01:14:06,120 THANK YOU VERY MUCH FOR HAVING 2091 01:14:06,120 --> 01:14:07,280 ME TODAY. 2092 01:14:07,280 --> 01:14:12,960 I'M SO GRATEFUL TO BE ABLE TO BE 2093 01:14:12,960 --> 01:14:13,680 HERE. 2094 01:14:13,680 --> 01:14:15,200 IT'S A CHALLENGING QUESTION. 2095 01:14:15,200 --> 01:14:17,800 SO THOSE METRICS COME FROM 2096 01:14:17,800 --> 01:14:19,720 INTERNATIONALLY-VALIDATED 2097 01:14:19,720 --> 01:14:20,080 METRICS. 2098 01:14:20,080 --> 01:14:21,920 SO WHEN THEY CAME TOGETHER, THEY 2099 01:14:21,920 --> 01:14:23,400 DECIDED THEY WOULD ONLY USE DATA 2100 01:14:23,400 --> 01:14:25,080 FROM THE WORLD BANK OR 2101 01:14:25,080 --> 01:14:25,640 INTERNATIONAL SITES. 2102 01:14:25,640 --> 01:14:27,640 COSTA RICA HAS A LOT OF INTERNAL 2103 01:14:27,640 --> 01:14:30,480 DATA ON THE NON-COMMUNICABLE 2104 01:14:30,480 --> 01:14:30,760 DISEASES. 2105 01:14:30,760 --> 01:14:32,840 BUT IT WASN'T INCORPORATED INTO 2106 01:14:32,840 --> 01:14:35,000 THE PAGE CPI MODEL IN 2107 01:14:35,000 --> 01:14:35,320 PARTICULAR. 2108 01:14:35,320 --> 01:14:39,320 SO LOOKING AT WHAT COSTA RICA 2109 01:14:39,320 --> 01:14:42,120 DOES ON A NATIONAL LEVEL TO 2110 01:14:42,120 --> 01:14:44,120 MONITOR CHRONIC DISEASE, IS 2111 01:14:44,120 --> 01:14:46,960 ACTUALLY AN INCREDIBLY BROAD 2112 01:14:46,960 --> 01:14:49,000 TOPIC BECAUSE EACH PART OF THE 2113 01:14:49,000 --> 01:14:50,800 HEALTH SYSTEM HAS MULTIPLE 2114 01:14:50,800 --> 01:14:52,520 METRICS THEY USE. 2115 01:14:52,520 --> 01:14:54,280 BUT I'LL GIVE YOU THIS AS AN 2116 01:14:54,280 --> 01:14:55,480 EXAMPLE FROM THE QUALITY INDEX 2117 01:14:55,480 --> 01:14:56,840 THAT I TALKED ABOUT AT THE END 2118 01:14:56,840 --> 01:14:58,600 OF THE PRESENTATION. 2119 01:14:58,600 --> 01:15:02,200 SO THE METRICS THAT GO INTO THAT 2120 01:15:02,200 --> 01:15:06,840 QUALITY RANKING SPECIFICALLY 2121 01:15:06,840 --> 01:15:07,400 LOOKING AT NON-COMMUNICABLE 2122 01:15:07,400 --> 01:15:08,040 DISEASES, ARE THE PERCENTAGE OF 2123 01:15:08,040 --> 01:15:09,080 PEOPLE WITHIN THAT HEALTH AREA, 2124 01:15:09,080 --> 01:15:11,440 THAT GEOGRAPHIC AREA, WITH TYPE 2125 01:15:11,440 --> 01:15:14,840 II DIABETES WHO HAVE OPTIMAL 2126 01:15:14,840 --> 01:15:20,080 CONTROL OF THEIR HEMOGLOBIN A1C 2127 01:15:20,080 --> 01:15:21,640 AND BLOOD PRESSURE AND WHO HAVE 2128 01:15:21,640 --> 01:15:22,240 CONTROL OF THEIR CHOLESTEROL. 2129 01:15:22,240 --> 01:15:23,000 AS MEASURED BY THE MOST RECENT 2130 01:15:23,000 --> 01:15:30,120 VISIT TO THE CLINIC. 2131 01:15:30,120 --> 01:15:33,440 PERCENTAGE OF HYPOLIPIDEMIA 2132 01:15:33,440 --> 01:15:35,480 AND/OR CHOLESTEROL AND ALSO 2133 01:15:35,480 --> 01:15:38,920 METRICS OF PERCENTAGE OF WOMEN 2134 01:15:38,920 --> 01:15:41,040 35-65 WHO HAVE HAD A PAP SMEAR 2135 01:15:41,040 --> 01:15:41,480 IN THE LAST TWO YEARS. 2136 01:15:41,480 --> 01:15:42,800 SO ALL OF THESE METRICS ARE 2137 01:15:42,800 --> 01:15:43,720 MEASURED BY AN INDEPENDENT 2138 01:15:43,720 --> 01:15:45,480 INVESTIGATOR THAT COMES TO DO A 2139 01:15:45,480 --> 01:15:47,480 CHART REVIEW OF THE CLINIC AND 2140 01:15:47,480 --> 01:15:50,600 THEY ARE CHOOSING CHARTS, 50-100 2141 01:15:50,600 --> 01:15:52,160 CHARTS AT RANDOM BASED ON THE 2142 01:15:52,160 --> 01:15:53,400 SIZE OF THE CLINIC AND THEN 2143 01:15:53,400 --> 01:15:56,600 CONDUCTING THAT REVIEW AND THEN 2144 01:15:56,600 --> 01:15:58,760 GOING THROUGH ON A PATIENT BY 2145 01:15:58,760 --> 01:15:59,800 PATIENT LEVEL TO MAKE SURE, WAS 2146 01:15:59,800 --> 01:16:02,120 THE QUALITY TARGET MET OR NOT 2147 01:16:02,120 --> 01:16:03,760 MET FOR EACH PARTICULAR PATIENT. 2148 01:16:03,760 --> 01:16:06,560 AND THEN I THINK IT IS REALLY 2149 01:16:06,560 --> 01:16:14,440 IMPORTANT TO MENTION HERE THIS 2150 01:16:14,440 --> 01:16:17,560 POINTED, IT'S NOT SOMETHING THAT 2151 01:16:17,560 --> 01:16:18,120 IS OCCURRING AT THE OFFICIAL 2152 01:16:18,120 --> 01:16:18,320 LEVEL. 2153 01:16:18,320 --> 01:16:18,920 SO THE MULTIDISCIPLINARY TEAM 2154 01:16:18,920 --> 01:16:19,840 MODEL THEY HAVE IS REALLY 2155 01:16:19,840 --> 01:16:21,720 TACKLING EXACTLY WHAT WE WERE 2156 01:16:21,720 --> 01:16:23,080 TALKING ABOUT, THE COMMUNITY 2157 01:16:23,080 --> 01:16:25,360 HEALTH WORKERS ARE ABLE TO 2158 01:16:25,360 --> 01:16:26,960 PROVIDE EDUCATION IN PEOPLE'S 2159 01:16:26,960 --> 01:16:29,440 HOME, IN THEIR CHURCHES, IN 2160 01:16:29,440 --> 01:16:30,040 THEIR COMMUNITY ORGANIZATIONS 2161 01:16:30,040 --> 01:16:31,400 AND THE PLACES WHERE THEY LIVE 2162 01:16:31,400 --> 01:16:32,800 AND WORK. 2163 01:16:32,800 --> 01:16:34,280 THEY ALSO HAVE NURSES THAT ARE 2164 01:16:34,280 --> 01:16:37,080 AT THE HEALTH AREA LEVEL THAT 2165 01:16:37,080 --> 01:16:39,040 CAN DO ADDITIONAL EDUCATION. 2166 01:16:39,040 --> 01:16:40,440 AND THEY HAVE PROTOCOLS ON THE 2167 01:16:40,440 --> 01:16:42,880 PHYSICIAN SIDE OF THINGS THAT 2168 01:16:42,880 --> 01:16:44,560 INCLUDES THINGS LIKE PRE 2169 01:16:44,560 --> 01:16:46,120 DIABETES, PRE HYPERTENSION, THAT 2170 01:16:46,120 --> 01:16:49,440 THEY ARE ABLE TO TRACK FOLKS AT 2171 01:16:49,440 --> 01:16:51,360 RISK FOR PROGRESSION TO 2172 01:16:51,360 --> 01:16:52,880 NON-COMMUNICABLE DISEASES. 2173 01:16:52,880 --> 01:16:56,280 SO THIS IS REALLY A TEAM MODEL 2174 01:16:56,280 --> 01:16:59,960 THAT IS ABLE TO ACHIEVE SUCH 2175 01:16:59,960 --> 01:17:03,000 GREAT REDUCTION IN MORTALITY FOR 2176 01:17:03,000 --> 01:17:06,840 NON-COMMUNICABLE DISEASES. 2177 01:17:06,840 --> 01:17:07,960 >>MODERATOR: THANK YOU, 2178 01:17:07,960 --> 01:17:09,840 DR. MADELINE PESEC. 2179 01:17:09,840 --> 01:17:11,280 THANK YOU VERY MUCH. 2180 01:17:11,280 --> 01:17:15,160 THERE IS ANOTHER QUESTION FOR 2181 01:17:15,160 --> 01:17:17,880 DR. TRAYVON MARTIN. 2182 01:17:17,880 --> 01:17:19,080 DR. A DR. EDUARDO RODRIGO 2183 01:17:19,080 --> 01:17:19,880 SAUCEDO-MARTINEZ. 2184 01:17:19,880 --> 01:17:22,680 COULD YOU ELABORATE FURTHER FOR 2185 01:17:22,680 --> 01:17:24,520 THE INTERNATIONAL STATUS OF CARE 2186 01:17:24,520 --> 01:17:26,360 AND COORDINATION OF CARE FOR 2187 01:17:26,360 --> 01:17:29,560 PATIENTS WITH MORE THAN ONE 2188 01:17:29,560 --> 01:17:33,080 CHRONIC DISEASE IN LOW RESOURCE 2189 01:17:33,080 --> 01:17:38,000 SETTINGS? 2190 01:17:38,000 --> 01:17:38,800 WE WANT TO ALSO UNDERSTAND -- 2191 01:17:38,800 --> 01:17:41,680 YOU MENTIONED INTERPRETATION OF 2192 01:17:41,680 --> 01:17:44,160 THE FINDINGS OF THE RESULTS. 2193 01:17:44,160 --> 01:17:47,120 THAT ASPECT OF PATIENT CLINICIAN 2194 01:17:47,120 --> 01:17:47,880 COMMUNICATION OR RELATIONSHIP 2195 01:17:47,880 --> 01:17:53,480 WITHIN THE CONTEXT OF ARTIFICIAL 2196 01:17:53,480 --> 01:17:57,280 INTELLIGENCE. 2197 01:17:57,280 --> 01:17:57,720 >>EDUARDO RODRIGO 2198 01:17:57,720 --> 01:17:58,720 SAUCEDO-MARTINEZ: I THINK YOU 2199 01:17:58,720 --> 01:17:59,760 ARE TOUCHING ON A SENSITIVE 2200 01:17:59,760 --> 01:18:01,960 POINT THAT WE HAVE TAKEN GREAT 2201 01:18:01,960 --> 01:18:03,400 PRECAUTION AT THE FOUNDATION 2202 01:18:03,400 --> 01:18:04,800 BECAUSE PEOPLE TEND TO THINK 2203 01:18:04,800 --> 01:18:08,120 THAT THE DIFFICULTY ON THE EARS 2204 01:18:08,120 --> 01:18:09,400 OF ARTIFICIAL INTELLIGENCE LIES 2205 01:18:09,400 --> 01:18:11,040 IN ANALYTICAL METHODS. 2206 01:18:11,040 --> 01:18:12,280 WHEREAS THE MOST IMPORTANT AND 2207 01:18:12,280 --> 01:18:14,800 THE MOST SENSITIVE TOPICS ARE 2208 01:18:14,800 --> 01:18:16,160 AROUND INTERPRETATION AND 2209 01:18:16,160 --> 01:18:19,280 COMMUNICATION AND REALLY HOW TO 2210 01:18:19,280 --> 01:18:22,960 MAKE THESE ARTIFICIAL 2211 01:18:22,960 --> 01:18:26,200 INTELLIGENCE ACTUALLY PROMOTING 2212 01:18:26,200 --> 01:18:29,520 MORE EQUITY AND MORE QUALITY OF 2213 01:18:29,520 --> 01:18:29,960 CARE. 2214 01:18:29,960 --> 01:18:31,560 ONE OF THE DIFFICULTIES THAT WE 2215 01:18:31,560 --> 01:18:34,000 HAVE FACED HERE IN MEXICO IS 2216 01:18:34,000 --> 01:18:38,960 THAT ON ONE HAND, THE DATA THAT 2217 01:18:38,960 --> 01:18:41,640 WE USE NEEDS TO BE CURATED AND 2218 01:18:41,640 --> 01:18:42,680 WE WANT TO MAKE SURE THAT WE 2219 01:18:42,680 --> 01:18:45,160 HAVE THE APPROPRIATE DATASETS TO 2220 01:18:45,160 --> 01:18:45,360 USE. 2221 01:18:45,360 --> 01:18:46,920 THE OTHER THING IS THAT WE HAVE 2222 01:18:46,920 --> 01:18:49,360 TO BE VERY REALISTIC ON THE 2223 01:18:49,360 --> 01:18:51,240 MEXICAN HEALTH SYSTEM. 2224 01:18:51,240 --> 01:18:54,240 SO WE CAN USE, WE CAN START 2225 01:18:54,240 --> 01:18:55,600 USING CLINICAL GUIDELINES AND WE 2226 01:18:55,600 --> 01:18:58,360 CAN COME UP WITH THE MOST 2227 01:18:58,360 --> 01:19:02,000 SOPHISTICATED AND MOST, LET'S 2228 01:19:02,000 --> 01:19:03,720 SAY, THE FRONTIER TREATMENTS, 2229 01:19:03,720 --> 01:19:06,240 BUT THE REALITY HITS YOU IN THE 2230 01:19:06,240 --> 01:19:08,160 FACE AND YOU NEED TO MAKE SURE 2231 01:19:08,160 --> 01:19:08,920 YOU PRESCRIBE SOMETHING THAT 2232 01:19:08,920 --> 01:19:10,320 PEOPLE CAN USE. 2233 01:19:10,320 --> 01:19:12,400 AND I'M NOT ONLY TALKING ABOUT 2234 01:19:12,400 --> 01:19:13,040 PHARMACOLOGICAL TREATMENT. 2235 01:19:13,040 --> 01:19:15,440 I'M ALSO TALKING ABOUT HOW TO 2236 01:19:15,440 --> 01:19:17,560 PRESCRIBE HEALTHY DIET, HOW CAN 2237 01:19:17,560 --> 01:19:18,840 YOU PRESCRIBE A DIET THAT 2238 01:19:18,840 --> 01:19:21,000 ACTUALLY PEOPLE CAN BUY AT THE 2239 01:19:21,000 --> 01:19:22,400 MARKET IN THE LOCAL COMMUNITIES 2240 01:19:22,400 --> 01:19:24,640 AND NOT REALLY LOOKING INTO 2241 01:19:24,640 --> 01:19:27,080 FANCY FOODS THAT THEY CANNOT 2242 01:19:27,080 --> 01:19:27,920 AFFORD. 2243 01:19:27,920 --> 01:19:30,360 SO ONE OF THE MOST DIFFICULT 2244 01:19:30,360 --> 01:19:32,520 PARTS OF USING ARTIFICIAL 2245 01:19:32,520 --> 01:19:35,520 INTELLIGENCE IS REALLY MAKING 2246 01:19:35,520 --> 01:19:37,080 SURE THAT YOU'RE TESTING YOUR 2247 01:19:37,080 --> 01:19:38,720 MODELS IN THE FIELD WITH REAL 2248 01:19:38,720 --> 01:19:40,120 PEOPLE. 2249 01:19:40,120 --> 01:19:40,720 AND BE VERY HUMBLE IN THAT YOU 2250 01:19:40,720 --> 01:19:42,960 MAY HAVE COME UP WITH A SOLUTION 2251 01:19:42,960 --> 01:19:44,640 THAT IN THEORY IS BEAUTIFUL BUT 2252 01:19:44,640 --> 01:19:47,280 IN REALITY IT IS NOT PRACTICAL. 2253 01:19:47,280 --> 01:19:51,760 SO IT REALLY IS WHAT WE SAY IN 2254 01:19:51,760 --> 01:19:54,320 SPANISH,. 2255 01:19:54,320 --> 01:19:54,760 [ SPEAKING SPANISH ] 2256 01:19:54,760 --> 01:19:55,360 YOU NEED TO GO BACK-AND-FORTH 2257 01:19:55,360 --> 01:19:57,600 MANY TIMES BEFORE YOU COME TO 2258 01:19:57,600 --> 01:19:58,440 WITH AN ACTIONABLE SOLUTION. 2259 01:19:58,440 --> 01:20:01,400 SO I CAN SAY THAT THE MOST 2260 01:20:01,400 --> 01:20:02,240 DIFFICULT PART -- AND THIS IS 2261 01:20:02,240 --> 01:20:04,120 SOMETHING THAT IS NOT BEING 2262 01:20:04,120 --> 01:20:05,800 DISCUSSED WITH THE INTENSITY AND 2263 01:20:05,800 --> 01:20:07,160 WITH THE DEPTH THAT WE SHOULD. 2264 01:20:07,160 --> 01:20:08,960 ONE OF THE MOST DIFFICULT PARTS 2265 01:20:08,960 --> 01:20:10,720 IS ACTUALLY COMING UP WITH 2266 01:20:10,720 --> 01:20:16,640 PRACTICAL SOLUTIONS. 2267 01:20:16,640 --> 01:20:17,760 >>MODERATOR: THANK YOU, 2268 01:20:17,760 --> 01:20:20,360 DR. EDUARDO RODRIGO 2269 01:20:20,360 --> 01:20:20,760 SAUCEDO-MARTINEZ. 2270 01:20:20,760 --> 01:20:21,600 THANK YOU VERY MUCH. 2271 01:20:21,600 --> 01:20:24,440 ANOTHER QUESTION FOR DR. PIETTE. 2272 01:20:24,440 --> 01:20:25,920 WHAT WOULD BE HIGH PRIORITY 2273 01:20:25,920 --> 01:20:28,480 TOPICS FOR COLLABORATIVE 2274 01:20:28,480 --> 01:20:29,320 RESEARCH TO ADDRESS THE MENTAL 2275 01:20:29,320 --> 01:20:32,920 HEALTH NEEDS OF PEOPLE IN LATIN 2276 01:20:32,920 --> 01:20:37,560 AMERICA AS WELL AS NEW 2277 01:20:37,560 --> 01:20:39,200 IMMIGRANTS IN THE U.S.? 2278 01:20:39,200 --> 01:20:41,760 >>DR. PIETTE: SINCE YOU 2279 01:20:41,760 --> 01:20:42,360 MENTIONED SPECIFICALLY MENTAL 2280 01:20:42,360 --> 01:20:43,000 HEALTH, WHEN I WAS THINKING 2281 01:20:43,000 --> 01:20:46,480 ABOUT PRIORITIES IN MY OWN MIND, 2282 01:20:46,480 --> 01:20:48,760 I CONFESS TO A BIT OF A BIAS, 2283 01:20:48,760 --> 01:20:50,160 BUT MENTAL HEALTH DEFINITELY 2284 01:20:50,160 --> 01:20:52,600 ITSELF IS A PRIORITY. 2285 01:20:52,600 --> 01:20:56,800 WE KNOW THAT IMMIGRANTS ARE 2286 01:20:56,800 --> 01:20:57,400 FLEEING THEIR HOME COUNTRIES 2287 01:20:57,400 --> 01:20:59,680 BECAUSE OF EXTREMELY DISTRESSING 2288 01:20:59,680 --> 01:21:02,760 CIRCUMSTANCES, INCLUDING 2289 01:21:02,760 --> 01:21:03,560 VIOLENCE WHERE OPPRESSIVE 2290 01:21:03,560 --> 01:21:04,880 SITUATIONS WHICH ARE CAUSING 2291 01:21:04,880 --> 01:21:06,120 DEPRESSION AND ANXIETY. 2292 01:21:06,120 --> 01:21:08,560 AND THEN THE PROCESS OF 2293 01:21:08,560 --> 01:21:11,280 IMMIGRATING TO THE UNITED STATES 2294 01:21:11,280 --> 01:21:12,440 IS A VERY TRAUMATIC. 2295 01:21:12,440 --> 01:21:13,160 WE KNOW THAT. 2296 01:21:13,160 --> 01:21:16,000 AND THEN ONCE THEY GET TO THE 2297 01:21:16,000 --> 01:21:16,560 UNITED STATES, THERE ARE THE 2298 01:21:16,560 --> 01:21:19,160 ADDITIONAL TRAUMAS THAT THEY ARE 2299 01:21:19,160 --> 01:21:20,080 EXPERIENCING AS NEW IMMIGRANTS. 2300 01:21:20,080 --> 01:21:22,920 SO I'M QUITE CONVINCED THAT 2301 01:21:22,920 --> 01:21:26,720 MENTAL HEALTH IS GOING TO BE A 2302 01:21:26,720 --> 01:21:29,800 PRIORITY FOR RESEARCH, 2303 01:21:29,800 --> 01:21:32,000 SPECIFICALLY FOR AGAIN, MAKING 2304 01:21:32,000 --> 01:21:34,480 MY BIASES CLEAR FOR HEALTH 2305 01:21:34,480 --> 01:21:36,160 SYSTEMS THAT ARE GOING TO BE AND 2306 01:21:36,160 --> 01:21:38,480 ARE OVERWHELMED WITH NEED BUT 2307 01:21:38,480 --> 01:21:40,320 DON'T HAVE THE RESOURCES. 2308 01:21:40,320 --> 01:21:43,280 SOME OF THE APPROACH THAT IS 2309 01:21:43,280 --> 01:21:44,400 HAVE DESCRIBED, I THINK MIGHT BE 2310 01:21:44,400 --> 01:21:47,920 HELPFUL AND AGAIN, THE GOOD NEWS 2311 01:21:47,920 --> 01:21:49,680 IS THAT THESE COGNITIVE -- 2312 01:21:49,680 --> 01:21:52,080 FORGETTING ABOUT THE AI FOR A 2313 01:21:52,080 --> 01:21:52,320 SECOND. 2314 01:21:52,320 --> 01:21:53,320 COGNITIVE BEHAVIORAL THERAPY 2315 01:21:53,320 --> 01:21:54,800 WORKS. 2316 01:21:54,800 --> 01:21:55,760 BRIEF INTERVENTIONS WORK FOR 2317 01:21:55,760 --> 01:21:56,080 MENTAL HEALTH. 2318 01:21:56,080 --> 01:21:57,360 THEY WORK AROUND THE WORLD. 2319 01:21:57,360 --> 01:21:59,360 THEY HAVE BEEN TESTED IN LATIN 2320 01:21:59,360 --> 01:21:59,560 AMERICA. 2321 01:21:59,560 --> 01:22:01,760 THEY HAVE BEEN TESTED IN AFRICA. 2322 01:22:01,760 --> 01:22:03,200 THEY HAVE BEEN TESTED IN 2323 01:22:03,200 --> 01:22:03,880 WAR-TORN PARTS OF THE MIDDLE 2324 01:22:03,880 --> 01:22:04,080 EAST. 2325 01:22:04,080 --> 01:22:05,080 THEY CAN WORK. 2326 01:22:05,080 --> 01:22:07,600 THEY CAN BE DELIVERED BY 2327 01:22:07,600 --> 01:22:10,280 COMMUNITY HEALTH WORKERS. 2328 01:22:10,280 --> 01:22:13,200 WE SLIGHTLY NEED MORE -- WE 2329 01:22:13,200 --> 01:22:14,680 ABSOLUTELY NEED MORE TESTING OF 2330 01:22:14,680 --> 01:22:14,880 THAT. 2331 01:22:14,880 --> 01:22:17,360 SO PRIORITY TO ME WOULD BE TO DO 2332 01:22:17,360 --> 01:22:18,080 MORE RANDOMIZED TRIALS. 2333 01:22:18,080 --> 01:22:19,960 SO THE PROJECT THAT I MENTIONED 2334 01:22:19,960 --> 01:22:21,920 THAT WE'RE DOING IN HONDURAS 2335 01:22:21,920 --> 01:22:26,920 WILL USE AI TO KIND OF TRY TO 2336 01:22:26,920 --> 01:22:28,680 MINIMIZE THE USE OF SCARCE 2337 01:22:28,680 --> 01:22:29,760 CLINICAL RESOURCES BUT IT WON'T 2338 01:22:29,760 --> 01:22:31,040 BE A CLINICAL TRIAL. 2339 01:22:31,040 --> 01:22:33,440 IT'S NOT SOMETHING OF THAT SIZE. 2340 01:22:33,440 --> 01:22:35,160 THE GOOD NEWS IS THAT AGAIN 2341 01:22:35,160 --> 01:22:36,400 WITHOUT GOING INTO SOME OF THE 2342 01:22:36,400 --> 01:22:39,280 TECHNICAL DETAILS, THESE 2343 01:22:39,280 --> 01:22:41,400 PROCESSES WORK EXACTLY THROUGH A 2344 01:22:41,400 --> 01:22:48,840 PROCESS THAT YOU COULD SAY IS. 2345 01:22:48,840 --> 01:22:49,280 [ SPEAKING SPANISH ] 2346 01:22:49,280 --> 01:22:50,280 THAT IS AS EDUARDO RODRIGO 2347 01:22:50,280 --> 01:22:51,000 SAUCEDO-MARTINEZ SAID. 2348 01:22:51,000 --> 01:22:54,080 THAT IS WHAT IS GOOD ABOUT THEM. 2349 01:22:54,080 --> 01:22:56,000 SO WE AREN'T DECIDING AHEAD OF 2350 01:22:56,000 --> 01:22:58,080 TIME WHAT IS GOING TO WORK FOR A 2351 01:22:58,080 --> 01:23:00,520 SPECIFIC IMMIGRANT TO THE UNITED 2352 01:23:00,520 --> 01:23:03,280 STATES. 2353 01:23:03,280 --> 01:23:04,440 THOSE INTERVENTION TRIALS 2354 01:23:04,440 --> 01:23:05,480 THEMSELVES WILL TEACH US A LOT. 2355 01:23:05,480 --> 01:23:06,600 I HAVE OTHER PRIORITIES. 2356 01:23:06,600 --> 01:23:09,760 THERE ARE SOME REALLY EXCITING 2357 01:23:09,760 --> 01:23:11,280 ADVANCES ON A TECHNICAL SIDE 2358 01:23:11,280 --> 01:23:12,480 WITH ARTIFICIAL INTELLIGENCE. 2359 01:23:12,480 --> 01:23:16,640 SO NOT ONLY TRYING TO OPTIMIZE 2360 01:23:16,640 --> 01:23:18,320 THE CARE FOR INDIVIDUAL PATIENT, 2361 01:23:18,320 --> 01:23:20,880 BUT ENSURING, FOR EXAMPLE, THAT 2362 01:23:20,880 --> 01:23:22,880 IN A POPULATION OF PATIENTS 2363 01:23:22,880 --> 01:23:26,120 SERVED BY A CLINIC, THAT THE 2364 01:23:26,120 --> 01:23:26,680 MOST -- THAT THE INDIVIDUALS 2365 01:23:26,680 --> 01:23:29,480 THAT ARE MOST LIKELY TO BENEFIT 2366 01:23:29,480 --> 01:23:31,120 FROM CARE RECEIVE AUTOMATICALLY 2367 01:23:31,120 --> 01:23:32,640 PRIORITY FOR SERVICES. 2368 01:23:32,640 --> 01:23:33,760 THAT IS SOMETHING THAT I THINK 2369 01:23:33,760 --> 01:23:35,760 MOST OF US CAN GET VERY EXCITED 2370 01:23:35,760 --> 01:23:36,000 ABOUT. 2371 01:23:36,000 --> 01:23:37,960 SOMETHING THAT HEALTH SYSTEMS 2372 01:23:37,960 --> 01:23:39,360 AND INDIVIDUAL CLINICIANS HAVE A 2373 01:23:39,360 --> 01:23:41,080 TOUGH TIME DOING. 2374 01:23:41,080 --> 01:23:43,200 SO WE CAN ADD ADDITIONAL 2375 01:23:43,200 --> 01:23:44,600 FEATURES OF THESE ARTIFICIAL 2376 01:23:44,600 --> 01:23:47,880 INTELLIGENCE ALGORITHMS TO MAKE 2377 01:23:47,880 --> 01:23:50,960 THEM MORE JUST AND FAIR AND 2378 01:23:50,960 --> 01:23:52,960 ENSURE THAT PATIENTS THAT REALLY 2379 01:23:52,960 --> 01:23:55,080 NEED OUR SUPPORT ARE THE ONES 2380 01:23:55,080 --> 01:24:00,760 THAT ARE FIRST IN LINE, SO TO 2381 01:24:00,760 --> 01:24:00,960 SPEAK. 2382 01:24:00,960 --> 01:24:01,920 >>MODERATOR: THANK YOU, 2383 01:24:01,920 --> 01:24:02,640 DR. PIETTE. 2384 01:24:02,640 --> 01:24:05,920 ANOTHER QUESTION FOR DR. GUSTAVO 2385 01:24:05,920 --> 01:24:06,200 GOSSLING. 2386 01:24:06,200 --> 01:24:07,920 IT IS ABOUT INTEGRATING CLINICAL 2387 01:24:07,920 --> 01:24:10,520 RESEARCH OR CLINICAL TRIAL 2388 01:24:10,520 --> 01:24:13,680 WITHIN THE CONTEXT OF THE HEALTH 2389 01:24:13,680 --> 01:24:16,760 CARE SETTING. 2390 01:24:16,760 --> 01:24:21,000 SOMETIMES THERE COULD BE A 2391 01:24:21,000 --> 01:24:23,120 CONFUSION AMONG STAFF, AMONG 2392 01:24:23,120 --> 01:24:26,120 PATIENTS, ABOUT THE DIFFERENCE 2393 01:24:26,120 --> 01:24:29,880 BETWEEN CLINICAL CARE AND 2394 01:24:29,880 --> 01:24:30,280 CLINICAL RESEARCH. 2395 01:24:30,280 --> 01:24:32,120 AND WHEN IT NAPS THIS SETTING T 2396 01:24:32,120 --> 01:24:33,320 IS EVEN MORE. 2397 01:24:33,320 --> 01:24:38,280 SO WHAT ARE THE KEY ELEMENTS 2398 01:24:38,280 --> 01:24:41,720 THAT YOU RECOMMEND OR HAS BEEN 2399 01:24:41,720 --> 01:24:42,680 YOUR EXPERIENCE AT INTEGRATING, 2400 01:24:42,680 --> 01:24:44,640 MAKING SURE THAT THIS 2401 01:24:44,640 --> 01:24:45,360 DISTINCTION HAPPENS? 2402 01:24:45,360 --> 01:24:49,120 OR IS IT POSSIBLE AT ALL? 2403 01:24:49,120 --> 01:24:52,960 OR THEY DO YOU RECOMMEND TAKING 2404 01:24:52,960 --> 01:24:53,800 CARE OF BOTH? 2405 01:24:53,800 --> 01:24:54,600 WHAT IS YOUR EXPERIENCE IN LATIN 2406 01:24:54,600 --> 01:24:57,640 AMERICA AND WHAT ARE THE 2407 01:24:57,640 --> 01:24:58,000 RECOMMENDATIONS? 2408 01:24:58,000 --> 01:25:01,240 >>GUSTAVO GOSSLING: SO, I 2409 01:25:01,240 --> 01:25:03,080 BELIEVE THAT IN LATIN AMERICA, 2410 01:25:03,080 --> 01:25:06,400 THIS IS NOT THAT COMMON, 2411 01:25:06,400 --> 01:25:08,880 ESPECIALLY BECAUSE WE DO HAVE 2412 01:25:08,880 --> 01:25:10,480 SOME GOVERNMENTS WHO PROVIDE 2413 01:25:10,480 --> 01:25:13,920 PUBLIC HEALTH CARE. 2414 01:25:13,920 --> 01:25:16,760 AND THIS IS A VERY SPECIFIC 2415 01:25:16,760 --> 01:25:18,400 LEGAL ISSUE THAT HAPPENS IN SOME 2416 01:25:18,400 --> 01:25:20,520 COUNTRIES IN LATIN AMERICA. 2417 01:25:20,520 --> 01:25:23,960 BECAUSE WHEN YOU ARE DOING 2418 01:25:23,960 --> 01:25:26,400 CLINICAL RESEARCH, EITHER 2419 01:25:26,400 --> 01:25:28,640 SPONSORED BY PHARMA OR ACADEMIC 2420 01:25:28,640 --> 01:25:30,560 GROUP OR NOT SPONSORED AT ALL, 2421 01:25:30,560 --> 01:25:37,720 THIS SHOULD NOT EVER HAVE OR USE 2422 01:25:37,720 --> 01:25:39,080 THE RESOURCES AT THE PUBLIC 2423 01:25:39,080 --> 01:25:40,960 HEALTH SYSTEM. 2424 01:25:40,960 --> 01:25:42,480 THIS IS VERY IMPORTANT LEGAL 2425 01:25:42,480 --> 01:25:43,280 ISSUE. 2426 01:25:43,280 --> 01:25:45,520 SO FOR LATIN AMERICA, I DO NOT 2427 01:25:45,520 --> 01:25:50,000 THINK THIS IS SUCH A LARGE, SUCH 2428 01:25:50,000 --> 01:25:51,560 A COMMON CONDITION AS IT IS IN 2429 01:25:51,560 --> 01:25:54,400 EUROPE OR UNITED STATES WHERE 2430 01:25:54,400 --> 01:25:57,240 THOSE ARE KIND OF MORE MIXED. 2431 01:25:57,240 --> 01:25:59,680 THIS IS SOMETHING WE REALLY MUST 2432 01:25:59,680 --> 01:26:06,240 TAKE A LOOK AT BECAUSE THIS IS 2433 01:26:06,240 --> 01:26:07,640 VERY IMPORTANT FOR THE 2434 01:26:07,640 --> 01:26:08,400 INVESTIGATORS AND THE 2435 01:26:08,400 --> 01:26:09,000 INSTITUTION WHICH WOULD NEVER 2436 01:26:09,000 --> 01:26:11,920 USE THE PUBLIC RESOURCES TO 2437 01:26:11,920 --> 01:26:13,760 CONDUCT CLINICAL RESEARCH IN 2438 01:26:13,760 --> 01:26:14,080 LATIN AMERICA. 2439 01:26:14,080 --> 01:26:17,000 THIS IS ABSOLUTELY NOT 2440 01:26:17,000 --> 01:26:18,560 ADVISABLE. 2441 01:26:18,560 --> 01:26:23,840 THIS IS EVEN LIABLE. 2442 01:26:23,840 --> 01:26:24,480 ONE OF THE MOST IMPORTANT THINGS 2443 01:26:24,480 --> 01:26:27,160 ABOUT HEALTH CARE, HOW TO END 2444 01:26:27,160 --> 01:26:27,960 BAD HEALTH CARE SYSTEMS AND 2445 01:26:27,960 --> 01:26:30,040 CLINICAL RESEARCH IN LATIN 2446 01:26:30,040 --> 01:26:33,560 AMERICA BECAUSE AS WE CANNOT MIX 2447 01:26:33,560 --> 01:26:36,440 THEM TOGETHER IN EXACTLY THE 2448 01:26:36,440 --> 01:26:38,920 SAME PLAGUES, WE HAVE TO GET 2449 01:26:38,920 --> 01:26:43,800 AROUND AND KNOW HOW TO MIX THE 2450 01:26:43,800 --> 01:26:47,880 THEMES FROM CLINICAL RESEARCH 2451 01:26:47,880 --> 01:26:50,880 AND FROM THOSE WHO ACTUALLY TAKE 2452 01:26:50,880 --> 01:26:51,680 CARE OF PATIENTS SO THAT THEY 2453 01:26:51,680 --> 01:26:52,480 ARE MIXED. 2454 01:26:52,480 --> 01:26:55,320 AND THEY CAN, AT THE SAME TIME, 2455 01:26:55,320 --> 01:27:03,960 ACCRUE AND MAKE EVERYTHING AS 2456 01:27:03,960 --> 01:27:07,440 CLEAR AND SEAMLESS AS POSSIBLE 2457 01:27:07,440 --> 01:27:10,880 FOR CLINICAL INVESTIGATORS AND 2458 01:27:10,880 --> 01:27:11,880 FOR PATIENTS. 2459 01:27:11,880 --> 01:27:13,280 >>MODERATOR: THANK YOU 2460 01:27:13,280 --> 01:27:13,760 DR. GUSTAVO GOSSLING. 2461 01:27:13,760 --> 01:27:15,240 THANK YOU VERY MUCH. 2462 01:27:15,240 --> 01:27:16,720 AND DR. MADELINE PESEC, I HAVE A 2463 01:27:16,720 --> 01:27:19,360 QUESTION FOR YOU THAT ACTUALLY 2464 01:27:19,360 --> 01:27:22,760 HAS BEEN HAPPENING IN THE CHAT. 2465 01:27:22,760 --> 01:27:25,240 THERE IS ANOTHER ONE THERE FOR 2466 01:27:25,240 --> 01:27:25,520 YOU. 2467 01:27:25,520 --> 01:27:27,400 BUT THE FIRST QUESTION IS ABOUT 2468 01:27:27,400 --> 01:27:31,000 THE QUALITY MEASURES. 2469 01:27:31,000 --> 01:27:33,160 WHAT ARE THE ELEMENTS OF 2470 01:27:33,160 --> 01:27:35,600 MEASUREMENT AND QUALITYIVE 2471 01:27:35,600 --> 01:27:35,960 PROVEMENTS? 2472 01:27:35,960 --> 01:27:37,800 YOU INDICATED SOMETHING IN THE 2473 01:27:37,800 --> 01:27:39,600 CHAT BOX FOR THOSE WHO ARE 2474 01:27:39,600 --> 01:27:41,600 WATCHING ON VIDEOCAST. 2475 01:27:41,600 --> 01:27:43,600 COULD YOU EXPLAIN THE QUALITY 2476 01:27:43,600 --> 01:27:46,480 INDEX THAT YOU REFERRED TO? 2477 01:27:46,480 --> 01:27:51,480 >>MADELINE PESEC: ABSOLUTELY. 2478 01:27:51,480 --> 01:27:54,240 SO THE DATA LANDSCAPE IN 2479 01:27:54,240 --> 01:27:57,080 COSTA RICA IS EXTREMELY COMPLEX 2480 01:27:57,080 --> 01:27:59,680 AND I WAS ABLE TO PRINT OUT KIND 2481 01:27:59,680 --> 01:28:02,760 OF AN ORIGINAL DRAFT OF SOME OF 2482 01:28:02,760 --> 01:28:05,560 THE COMPLEXITY OF DATA STREAMS 2483 01:28:05,560 --> 01:28:06,920 FOR EVERYONE. 2484 01:28:06,920 --> 01:28:10,000 BUT IT PRINTED OUT A LITTLE 2485 01:28:10,000 --> 01:28:11,360 FUNNY BUT THE DATA LANDSCAPE 2486 01:28:11,360 --> 01:28:12,680 GOES FROM INCREDIBLY COMPLEX 2487 01:28:12,680 --> 01:28:14,680 WITH DATA BEING REALLY 2488 01:28:14,680 --> 01:28:18,040 PRIORITIZED AND DATA BEING 2489 01:28:18,040 --> 01:28:20,000 VALUED AS SOMETHING ON WHICH 2490 01:28:20,000 --> 01:28:22,040 DECISIONS SHOULD BE TAKEN. 2491 01:28:22,040 --> 01:28:23,880 AND SO I THINK THAT UNDERLIES 2492 01:28:23,880 --> 01:28:25,000 ALL THESE CONVERSATIONS THAT YOU 2493 01:28:25,000 --> 01:28:26,680 CAN HAVE AN INDEX THAT IS NOT 2494 01:28:26,680 --> 01:28:30,280 GOING TO IMPACT OR PROMOTE 2495 01:28:30,280 --> 01:28:31,920 QUALITY IMPROVEMENT IF NOBODY 2496 01:28:31,920 --> 01:28:34,080 CARES ABOUT THE INDEX OR NOBODY 2497 01:28:34,080 --> 01:28:34,840 BELIEVES IN IT. 2498 01:28:34,840 --> 01:28:37,440 SO I THINK JUST TO SAY THAT THIS 2499 01:28:37,440 --> 01:28:39,560 CULTURE OF EVALUATING DATA AND 2500 01:28:39,560 --> 01:28:43,320 THE SCIENTIFIC AND PRECISE 2501 01:28:43,320 --> 01:28:43,920 ACQUISITION COLLECTION AND 2502 01:28:43,920 --> 01:28:46,040 ANALYSIS OF THAT DATA HAS TO 2503 01:28:46,040 --> 01:28:48,000 UNDERLIE ANY SYSTEM THAT IS 2504 01:28:48,000 --> 01:28:51,640 GOING TO ATTEMPT TO USE DATA TO 2505 01:28:51,640 --> 01:28:54,200 PROMOTE QUALITY IMPROVEMENT. 2506 01:28:54,200 --> 01:28:55,280 THAT'S THE BAGS OF THE 2507 01:28:55,280 --> 01:28:55,600 DISCUSSION. 2508 01:28:55,600 --> 01:28:58,680 AND THEN I'D SAY THE -- BASE OF 2509 01:28:58,680 --> 01:28:59,520 THE DISCUSSION -- THE QUALITY 2510 01:28:59,520 --> 01:29:00,800 INDEX THAT WAS RELATED IS 2511 01:29:00,800 --> 01:29:01,600 SOMETHING I IDENTIFIED AS 2512 01:29:01,600 --> 01:29:05,360 CREATING A LOT OF THE QUALITYIVE 2513 01:29:05,360 --> 01:29:06,800 PROVEMENT ACTIVITIES BUT SUMMERY 2514 01:29:06,800 --> 01:29:08,000 THERE ARE QUALITY IMPROVEMENT 2515 01:29:08,000 --> 01:29:09,400 INITIATIVES GOING ON THAT ARE 2516 01:29:09,400 --> 01:29:11,240 NOT DRIVEN SOLELY BY THIS INDEX. 2517 01:29:11,240 --> 01:29:14,000 ANY TIME YOU USE AN INDEX, 2518 01:29:14,000 --> 01:29:14,960 INDICATORS THAT ARE NOT INCLUDED 2519 01:29:14,960 --> 01:29:19,280 IN THE INDEX, MAYBE SOME KIND 2520 01:29:19,280 --> 01:29:20,600 FALL BY THE WAYSIDE. 2521 01:29:20,600 --> 01:29:24,040 SO INTENTIONAL CREATION OF THE 2522 01:29:24,040 --> 01:29:27,440 INDICATORS ON IT IS REALLY 2523 01:29:27,440 --> 01:29:28,080 CRITICAL. 2524 01:29:28,080 --> 01:29:30,320 SO LOOKING AT THE INDEX ITSELF, 2525 01:29:30,320 --> 01:29:32,040 IT DOES CHANGE FROM YEAR TO YEAR 2526 01:29:32,040 --> 01:29:35,680 BASED ON INTERNATIONAL STANDARDS 2527 01:29:35,680 --> 01:29:37,080 OF QUALITY MEASUREMENTS. 2528 01:29:37,080 --> 01:29:38,920 SO IN THE EARLY TWO THOUSANDS, 2529 01:29:38,920 --> 01:29:42,680 IT WAS MAINLY BASED ON PROCESS 2530 01:29:42,680 --> 01:29:43,280 MEASURES WHERE YOU SEE PEOPLE 2531 01:29:43,280 --> 01:29:45,760 WITH HYPERTENSION, WHERE YOU ARE 2532 01:29:45,760 --> 01:29:46,920 TAKING THEIR BLOOD PRESSURE, 2533 01:29:46,920 --> 01:29:49,320 WHERE YOU'RE DOING CERTAIN EXAMS 2534 01:29:49,320 --> 01:29:50,520 FOR PATIENTS WITH THOSE WHO HAVE 2535 01:29:50,520 --> 01:29:50,800 DIABETES. 2536 01:29:50,800 --> 01:29:54,560 WHAT PERCENT OF PATIENTS WITH 2537 01:29:54,560 --> 01:29:55,360 HYPERTENSION HAD A VISIT TO THE 2538 01:29:55,360 --> 01:29:55,840 CLINIC IN THE LAST YEAR? 2539 01:29:55,840 --> 01:29:58,840 AND THEN OVER THE LAST DECADE 2540 01:29:58,840 --> 01:30:01,400 THINGS SHIFTED TOWARDS OUTCOME. 2541 01:30:01,400 --> 01:30:02,600 DOES THAT PATIENT HYPERTENSION 2542 01:30:02,600 --> 01:30:03,240 HAVE GOOD BLOOD PRESSURE CONTROL 2543 01:30:03,240 --> 01:30:06,200 WHEN THEY SEE YOU IN THE CLINIC? 2544 01:30:06,200 --> 01:30:07,760 THERE WAS A QUESTION IN THE CHAT 2545 01:30:07,760 --> 01:30:09,080 ABOUT IS THIS EVALUATION 2546 01:30:09,080 --> 01:30:11,480 COMPULSORY OR VOLUNTARY? 2547 01:30:11,480 --> 01:30:13,120 IT'S A MANDATORY EVALUATION THAT 2548 01:30:13,120 --> 01:30:15,720 IS CONDUCTED BY THE NATIONAL 2549 01:30:15,720 --> 01:30:17,080 CENTRAL LEVEL GOVERNMENT 2550 01:30:17,080 --> 01:30:19,280 REACHING OUT TO EACH CLINIC, 2551 01:30:19,280 --> 01:30:20,760 GOING OUT PHYSICALLY THERE TO 2552 01:30:20,760 --> 01:30:23,400 SEE THE CLINIC AND EVALUATE. 2553 01:30:23,400 --> 01:30:26,520 AND THEN TO TALK ABOUT SOME OF 2554 01:30:26,520 --> 01:30:28,200 THE OTHER THINGS, INDICATORS IN 2555 01:30:28,200 --> 01:30:31,640 THE INDEX. 2556 01:30:31,640 --> 01:30:33,480 COST INTEGRATED INTO THE INDEX. 2557 01:30:33,480 --> 01:30:36,840 AND THE ANSWER TO THAT IS, NO. 2558 01:30:36,840 --> 01:30:38,000 BECAUSE MOST CLINICS ARE PAID OR 2559 01:30:38,000 --> 01:30:42,360 NEARLY ALL CLINICS ARE PAID ON A 2560 01:30:42,360 --> 01:30:42,920 CONFRONTATION BASIS WITH A 2561 01:30:42,920 --> 01:30:45,000 LITTLE BIT OF HISTORICAL PAYMENT 2562 01:30:45,000 --> 01:30:45,720 JUDGMENT AS WELL. 2563 01:30:45,720 --> 01:30:49,320 AND SO COST IS NOT REALLY 2564 01:30:49,320 --> 01:30:51,320 FACTORED IN. 2565 01:30:51,320 --> 01:30:54,600 PATIENT REPORTED EXPERIENCES AND 2566 01:30:54,600 --> 01:30:55,480 SATISFACTION ARE FACTORED INTO 2567 01:30:55,480 --> 01:30:56,800 THE MODEL. 2568 01:30:56,800 --> 01:30:58,840 THE EXACT STATISTICAL WAY THAT 2569 01:30:58,840 --> 01:31:01,520 THOSE PATIENT EXPERIENCES ARE 2570 01:31:01,520 --> 01:31:02,200 FACTORED IN DIFFERS FROM YEAR TO 2571 01:31:02,200 --> 01:31:03,920 YEAR BUT THAT IS ALSO A VARIABLE 2572 01:31:03,920 --> 01:31:06,360 ON WHICH THE CLINICS ARE GRADED 2573 01:31:06,360 --> 01:31:07,760 AND THOSE PATIENT EXPERIENCES 2574 01:31:07,760 --> 01:31:10,000 AND PATIENT SURVEYS ARE 2575 01:31:10,000 --> 01:31:11,960 CONDUCTED BY A SEPARATE 2576 01:31:11,960 --> 01:31:14,200 DEPARTMENT AND GROUP THAT DOES 2577 01:31:14,200 --> 01:31:17,280 PATIENT SATISFACTION EXPERIENCE 2578 01:31:17,280 --> 01:31:17,920 THROUGHOUT DIFFERENT SECTORS, 2579 01:31:17,920 --> 01:31:19,720 NOT ONLY IN HEALTH CARE. 2580 01:31:19,720 --> 01:31:22,840 THERE IS ALSO A QUESTION ABOUT 2581 01:31:22,840 --> 01:31:23,920 WHERE ONE COULD GET ACCESS TO 2582 01:31:23,920 --> 01:31:25,640 THEIR QUALITY INDEX AND SEE 2583 01:31:25,640 --> 01:31:28,560 EXACTLY WHAT METRICS THEY ARE 2584 01:31:28,560 --> 01:31:28,960 USING. 2585 01:31:28,960 --> 01:31:32,200 THE REPORTS AREN'T PUBLISHED 2586 01:31:32,200 --> 01:31:35,240 ABOUT TWO YEARS BEHIND THE 2587 01:31:35,240 --> 01:31:35,560 EVALUATION. 2588 01:31:35,560 --> 01:31:37,520 AND SINCE THE PANDEMIC 2589 01:31:37,520 --> 01:31:38,480 UNFORTUNATELY, I HAVE NOT BEEN 2590 01:31:38,480 --> 01:31:40,840 ABLE TO GET AHOLD OF ANY 2591 01:31:40,840 --> 01:31:42,600 ADDITIONAL COPIES. 2592 01:31:42,600 --> 01:31:44,160 SO THE EARLIEST ONE THAT I HAVE 2593 01:31:44,160 --> 01:31:45,720 OR THE LATEST ONE I HAVE IS FROM 2594 01:31:45,720 --> 01:31:48,880 ABOUT 2018 AND I BELIEVE THAT IS 2595 01:31:48,880 --> 01:31:53,240 AVAILABLE PUBLICLY ON GOOGLE IF 2596 01:31:53,240 --> 01:31:53,920 YOU JUST SEARCH -- 2597 01:31:53,920 --> 01:31:54,920 [ SPEAKING SPANISH ] 2598 01:31:54,920 --> 01:31:56,440 YOU SHOULD BE ABLE TO FIND IT 2599 01:31:56,440 --> 01:31:58,480 AND HAVE IT COME UP. 2600 01:31:58,480 --> 01:32:03,400 BUT I WILL SAY THAT IT'S NOT A 2601 01:32:03,400 --> 01:32:04,000 COPY PASTE. 2602 01:32:04,000 --> 01:32:05,720 AND THEIR SPECIFIC QUALITY 2603 01:32:05,720 --> 01:32:07,520 MEASUREMENTS THAT THEY USE ARE 2604 01:32:07,520 --> 01:32:09,520 INCREDIBLY BASED ON WHAT THEY 2605 01:32:09,520 --> 01:32:10,280 HAVE THE CAPACITY TO MEASURE, 2606 01:32:10,280 --> 01:32:14,480 WHAT THEY HAVE THE CAPACITY TO 2607 01:32:14,480 --> 01:32:15,280 TRACK. 2608 01:32:15,280 --> 01:32:16,680 AND THEY HAVE MADE REAL 2609 01:32:16,680 --> 01:32:18,200 INTENTIONAL DECISIONS ABOUT 2610 01:32:18,200 --> 01:32:19,440 THEIR METRICS, WHAT IS RELEVANT 2611 01:32:19,440 --> 01:32:22,560 TO THEM, WHAT IS CULTURALLY 2612 01:32:22,560 --> 01:32:24,120 IMPORTANT, AND YOU DON'T WANT TO 2613 01:32:24,120 --> 01:32:25,640 HAVE SO MANY METRICS THAT PEOPLE 2614 01:32:25,640 --> 01:32:27,280 DON'T KNOW WHERE TO FOCUS THEIR 2615 01:32:27,280 --> 01:32:28,960 ATTENTION BUT YOU DON'T WANT TO 2616 01:32:28,960 --> 01:32:31,080 HAVE SO FEW METRICS THAT YOU'RE 2617 01:32:31,080 --> 01:32:33,440 MOVING OUT KEY AREAS. 2618 01:32:33,440 --> 01:32:35,360 SO IT'S A DELICATE BALANCE AND 2619 01:32:35,360 --> 01:32:37,320 CLEARLY A SUBJECT I'M VERY 2620 01:32:37,320 --> 01:32:39,280 PASSIONATE ABOUT AND I'M HAPPY 2621 01:32:39,280 --> 01:32:40,680 TO TALK WITH ANYONE OFF LINE IF 2622 01:32:40,680 --> 01:32:42,640 THEY HAVE MORE QUESTIONS. 2623 01:32:42,640 --> 01:32:43,200 >>MODERATOR: THANK YOU. 2624 01:32:43,200 --> 01:32:44,240 I DO HAVE A QUESTION ATTACHED TO 2625 01:32:44,240 --> 01:32:45,200 THAT ONE. 2626 01:32:45,200 --> 01:32:47,160 IT IS HOW -- YOU MENTIONED 2627 01:32:47,160 --> 01:32:49,800 PATIENT SATISFACTION. 2628 01:32:49,800 --> 01:32:52,120 HOW ABOUT ADVERSE EVENTS OR 2629 01:32:52,120 --> 01:32:52,600 PATIENT SAFETY? 2630 01:32:52,600 --> 01:32:55,640 ARE THEY PART OF THE METRICS? 2631 01:32:55,640 --> 01:32:57,120 >>MADELINE PESEC: THAT'S A 2632 01:32:57,120 --> 01:32:57,600 GREAT QUESTION. 2633 01:32:57,600 --> 01:33:06,200 I AM NOT AWARE OF ANY ORGANIZED 2634 01:33:06,200 --> 01:33:07,960 PATIENT-SAFETY ACTIVITIES THAT 2635 01:33:07,960 --> 01:33:10,400 ARE SEPARATE FROM KIND OF A 2636 01:33:10,400 --> 01:33:11,080 SPECIFIC REPORTING SYSTEM. 2637 01:33:11,080 --> 01:33:14,800 SO CERTAINLY PATIENTS INDIVIDUAL 2638 01:33:14,800 --> 01:33:17,320 ABILITY TO REPORT ADVERSE EVENTS 2639 01:33:17,320 --> 01:33:20,120 TO THE CLINIC OR TO THE THE 2640 01:33:20,120 --> 01:33:23,560 SOCIAL SECURITY AGENCY OVERALL. 2641 01:33:23,560 --> 01:33:24,880 BUT I DON'T THINK THOSE ARE 2642 01:33:24,880 --> 01:33:26,240 INCORPORATED AT THE CLINIC 2643 01:33:26,240 --> 01:33:26,440 LEVEL. 2644 01:33:26,440 --> 01:33:28,240 I'M NOT AS FAMILIAR WITH THE 2645 01:33:28,240 --> 01:33:28,880 HOSPITAL LEVEL. 2646 01:33:28,880 --> 01:33:30,800 I THINK THERE MAY BE SOME 2647 01:33:30,800 --> 01:33:32,000 ADDITIONAL THINGS THERE AT THE 2648 01:33:32,000 --> 01:33:33,960 HOSPITAL LEVEL IN TERMS OF 2649 01:33:33,960 --> 01:33:34,520 MORTALITY. 2650 01:33:34,520 --> 01:33:37,960 BUT AT THE PRIMARY CARE LEVEL, 2651 01:33:37,960 --> 01:33:39,280 THOSE AREN'T INCORPORATED INTO 2652 01:33:39,280 --> 01:33:43,200 THE INDEX, TO MY KNOWLEDGE. 2653 01:33:43,200 --> 01:33:43,760 >>MODERATOR: THANK YOU. 2654 01:33:43,760 --> 01:33:44,800 THERE IS ONE MORE QUESTION FOR 2655 01:33:44,800 --> 01:33:47,400 YOU AND ONE QUESTION FOR ALL OF 2656 01:33:47,400 --> 01:33:48,400 YOU SPEAKERS. 2657 01:33:48,400 --> 01:33:49,520 SO THE QUESTION SPECIFICALLY FOR 2658 01:33:49,520 --> 01:33:54,840 YOU, DR. MADELINE PESEC, IS 2659 01:33:54,840 --> 01:33:56,600 ABOUT THE TEAM-BASED CARE AND 2660 01:33:56,600 --> 01:33:57,400 THE QUESTION IS. 2661 01:33:57,400 --> 01:34:00,360 WHAT CAN WE LEARN FROM COSTA 2662 01:34:00,360 --> 01:34:02,640 RICA'S HEALTH SYSTEM ON HOW TO 2663 01:34:02,640 --> 01:34:05,320 PROMOTE TEAM-BASED CARE AND 2664 01:34:05,320 --> 01:34:06,280 TEAM-WORK PROCESSES. 2665 01:34:06,280 --> 01:34:09,440 FOR EXAMPLE, COMMUNICATION, 2666 01:34:09,440 --> 01:34:10,000 COORDINATION, COLLABORATION, 2667 01:34:10,000 --> 01:34:12,760 THAT LEAD TO BETTER HEALTH AND 2668 01:34:12,760 --> 01:34:13,560 CARE OUTCOMES? 2669 01:34:13,560 --> 01:34:15,480 >>MADELINE PESEC: THIS IS SUCH 2670 01:34:15,480 --> 01:34:16,680 AN IMPORTANT QUESTION. 2671 01:34:16,680 --> 01:34:18,520 AND I DON'T THINK THAT 2672 01:34:18,520 --> 01:34:19,760 COSTA RICA HAS ALL OF THE 2673 01:34:19,760 --> 01:34:20,360 ANSWERS TO THIS. 2674 01:34:20,360 --> 01:34:22,320 I THINK IT'S ACTUALLY AN AREA 2675 01:34:22,320 --> 01:34:26,200 WHERE COSTA RICA COULD IMPROVE 2676 01:34:26,200 --> 01:34:27,080 EVEN FURTHER. 2677 01:34:27,080 --> 01:34:29,640 I THINK THAT WHAT I HAVE SEEN AS 2678 01:34:29,640 --> 01:34:32,000 I VISITED DIFFERENT CLINICS IS 2679 01:34:32,000 --> 01:34:33,600 THE CLINICS WHERE THERE IS 2680 01:34:33,600 --> 01:34:36,320 REALLY A TEAM-BASED COHESIVE 2681 01:34:36,320 --> 01:34:37,560 STRUCTURE ARE THE CLINICS WHERE 2682 01:34:37,560 --> 01:34:40,200 THE TEAM MEMBERS ARE ALL 2683 01:34:40,200 --> 01:34:42,840 PHYSICALLY CO-LOCATED TOGETHER. 2684 01:34:42,840 --> 01:34:43,760 AND CLINICS WHERE THEY STRUGGLE 2685 01:34:43,760 --> 01:34:45,800 MORE WITH THE TEAM-BASED MODEL 2686 01:34:45,800 --> 01:34:47,280 ARE THOSE CLINICS WHERE ALL THE 2687 01:34:47,280 --> 01:34:50,920 COMMUNITY HEALTH WORKERS SIT IN 2688 01:34:50,920 --> 01:34:53,840 THEIR PART, ALL THE DOCTORS ARE 2689 01:34:53,840 --> 01:34:55,720 IN THEIR PART AND THE SECTS 2690 01:34:55,720 --> 01:34:57,000 SITED OVER HERE AND EVERYONE IS 2691 01:34:57,000 --> 01:34:57,640 GROUPED AT THE LEVEL OR WITHIN 2692 01:34:57,640 --> 01:35:01,120 THEIR DISCIPLINE AND NOT BY 2693 01:35:01,120 --> 01:35:01,320 TEAM. 2694 01:35:01,320 --> 01:35:02,440 AND I'LL ALSO MENTION THAT IF 2695 01:35:02,440 --> 01:35:04,960 YOU WANT TO PROMOTE TEAM 2696 01:35:04,960 --> 01:35:06,120 STRUCTURES, MANAGEMENT AT THE 2697 01:35:06,120 --> 01:35:07,720 TEAM LEVEL IS ALSO REALLY 2698 01:35:07,720 --> 01:35:08,040 IMPORTANT. 2699 01:35:08,040 --> 01:35:11,360 SO IF ALL OF YOUR MANAGEMENT 2700 01:35:11,360 --> 01:35:13,560 END, TEAM BUILDING ACTIVITIES 2701 01:35:13,560 --> 01:35:15,920 AND KIND OF DISCIPLINARY 2702 01:35:15,920 --> 01:35:18,880 STRUCTURES AND EDUCATION HAPPEN 2703 01:35:18,880 --> 01:35:21,000 AT THE DISCIPLINE LEVEL -- SO IF 2704 01:35:21,000 --> 01:35:22,480 ALL YOUR COMMUNITY HEALTH 2705 01:35:22,480 --> 01:35:23,800 WORKERS ARE BEING MANAGED BY 2706 01:35:23,800 --> 01:35:26,000 ANOTHER COMMUNITY HEALTH WORKER, 2707 01:35:26,000 --> 01:35:26,800 THAT IS NOT GOING TO BE AS 2708 01:35:26,800 --> 01:35:28,920 HELPFUL IN FOSTERING THAT 2709 01:35:28,920 --> 01:35:30,240 TEAM-BASED APPROACH TO PATIENT 2710 01:35:30,240 --> 01:35:30,440 CARE. 2711 01:35:30,440 --> 01:35:33,600 SO, I SEE IT WORK BEST WHERE 2712 01:35:33,600 --> 01:35:36,040 EVERYONE IS PHYSICALLY VERY 2713 01:35:36,040 --> 01:35:37,720 CLOSE TOGETHER AND THE DOCTOR 2714 01:35:37,720 --> 01:35:39,960 CAN LEAN OVER AND STAY, HEY, I 2715 01:35:39,960 --> 01:35:42,520 AM WORRIED ABOUT THAT PATIENT I 2716 01:35:42,520 --> 01:35:43,160 JUST SAW. 2717 01:35:43,160 --> 01:35:43,840 CAN YOU PUT HER ON YOUR LIST AND 2718 01:35:43,840 --> 01:35:45,640 MAYBE DO A HOME VISIT IN A WEEK 2719 01:35:45,640 --> 01:35:45,880 OR SO. 2720 01:35:45,880 --> 01:35:49,320 AND GENERALLY WITH TECHNOLOGY, 2721 01:35:49,320 --> 01:35:50,760 CHANGING AND ADAPTING AND DIRECT 2722 01:35:50,760 --> 01:35:52,560 TRONNIC MEDICAL SYSTEMS BEING 2723 01:35:52,560 --> 01:35:53,440 DEVELOPED, THERE ARE DEFINITELY 2724 01:35:53,440 --> 01:35:58,000 A LOT OF OPPORTUNITIES FOR MORE 2725 01:35:58,000 --> 01:35:59,760 VIRTUAL-BASED COMMUNICATION. 2726 01:35:59,760 --> 01:36:02,160 BUT I THINK I HAVE IMPRESSED 2727 01:36:02,160 --> 01:36:04,320 WITH THE POWER THAT PHYSICAL 2728 01:36:04,320 --> 01:36:05,800 CO-LOCATION CAN HAVE IN 2729 01:36:05,800 --> 01:36:08,040 COORDINATING CARE AND PROMOTING 2730 01:36:08,040 --> 01:36:10,360 TEAM-BASED MENTALITY. 2731 01:36:10,360 --> 01:36:11,200 >>MODERATOR: THANK YOU, 2732 01:36:11,200 --> 01:36:11,800 DR. MADELINE PESEC. 2733 01:36:11,800 --> 01:36:14,480 I HAVE ONE QUESTION FOR ALL OF 2734 01:36:14,480 --> 01:36:14,880 YOU. 2735 01:36:14,880 --> 01:36:17,320 AND IT'S, WHAT ARE THE MAIN 2736 01:36:17,320 --> 01:36:18,760 LESSONS LEARNED AND BEST 2737 01:36:18,760 --> 01:36:21,160 PRACTICES RELATED TO HEALTH CARE 2738 01:36:21,160 --> 01:36:23,280 RESEARCH OR EMBEDDING RESEARCH 2739 01:36:23,280 --> 01:36:27,280 INTO HEALTH CARE SETTINGS FROM 2740 01:36:27,280 --> 01:36:30,800 YOUR WORK IN LATIN AMERICA THAT 2741 01:36:30,800 --> 01:36:33,720 COULD BE APPLICABLE TO RESEARCH 2742 01:36:33,720 --> 01:36:36,000 INVOLVING U.S. HISPANIC LATINOS 2743 01:36:36,000 --> 01:36:40,840 OR RESEARCH IN U.S. 2744 01:36:40,840 --> 01:36:51,320 HISPANIC/LATINO COMMUNITIES? 2745 01:36:56,760 --> 01:36:58,920 >>DR. PIETTEE: I'LL JUMP IN. 2746 01:36:58,920 --> 01:37:00,480 SPECIFICALLY TO GIVE CREDIT TO 2747 01:37:00,480 --> 01:37:03,400 YOUR INSTITUTE, NIMHD. 2748 01:37:03,400 --> 01:37:06,640 THIS SORT OF OPPORTUNITY TO 2749 01:37:06,640 --> 01:37:09,400 DIALOGUE INTERNATIONALLY IS 2750 01:37:09,400 --> 01:37:11,120 EXTREMELY VALUABLE IT'S OFTEN 2751 01:37:11,120 --> 01:37:13,320 NOT DONE ENOUGH. 2752 01:37:13,320 --> 01:37:14,760 IT'S OFTEN SET IN BEST 2753 01:37:14,760 --> 01:37:18,480 PRACTICES, OFTEN WE ARE NOT 2754 01:37:18,480 --> 01:37:20,080 DOING SOME OF THE MOST IMPORTANT 2755 01:37:20,080 --> 01:37:20,760 CUTTING-EDGE RESEARCH BECAUSE WE 2756 01:37:20,760 --> 01:37:22,080 DON'T HAVE THIS SORT OF 2757 01:37:22,080 --> 01:37:24,880 COLLABORATION TO LEARN FROM ONE 2758 01:37:24,880 --> 01:37:25,160 ANOTHER. 2759 01:37:25,160 --> 01:37:27,040 AT THE OTHER TIMES, MAYBE WE ARE 2760 01:37:27,040 --> 01:37:30,640 ALL RE-CREATING THE SAME WHEEL 2761 01:37:30,640 --> 01:37:31,080 IN DIFFERENT PLACES. 2762 01:37:31,080 --> 01:37:34,160 SO SHARING AND CONTINUING TO 2763 01:37:34,160 --> 01:37:36,480 TALK, I'LL ADMIT I'M PERSONALLY 2764 01:37:36,480 --> 01:37:37,200 SOMEONE THAT I'M NOT GOOD AT 2765 01:37:37,200 --> 01:37:38,840 THIS. 2766 01:37:38,840 --> 01:37:39,520 I TEND TO JUST HAVE MY HEAD DOWN 2767 01:37:39,520 --> 01:37:41,800 AND FOCUSED ON MY IMMEDIATE 2768 01:37:41,800 --> 01:37:42,800 GOALS. 2769 01:37:42,800 --> 01:37:44,720 THIS SORT OF COLLABORATION IS 2770 01:37:44,720 --> 01:37:46,080 INCREDIBLY USEFUL. 2771 01:37:46,080 --> 01:37:47,880 SO DURING THIS -- DOING THIS 2772 01:37:47,880 --> 01:37:50,160 VIRTUALLY AND IF I MAY SAY, 2773 01:37:50,160 --> 01:37:51,080 PROVIDING OTHER OPPORTUNITIES IN 2774 01:37:51,080 --> 01:37:52,880 THE FUTURE FOR THE COLLABORATION 2775 01:37:52,880 --> 01:37:54,920 WOULD BE A WONDERFUL GOAL TO 2776 01:37:54,920 --> 01:37:56,080 PROMOTE THIS AS AN AGENDA BOTH 2777 01:37:56,080 --> 01:37:58,680 FOR IMMIGRANTS IN THE U.S. AND 2778 01:37:58,680 --> 01:38:01,680 AS A WIN-WIN FOR, INCLUDING THE 2779 01:38:01,680 --> 01:38:03,040 COUNTRIES WHERE MANY OF OUR 2780 01:38:03,040 --> 01:38:06,040 IMMIGRANTS ARE COMING FROM IN 2781 01:38:06,040 --> 01:38:06,360 LATIN AMERICA. 2782 01:38:06,360 --> 01:38:08,800 IN ADDITION TO THAT, I WOULD SAY 2783 01:38:08,800 --> 01:38:11,040 THERE IS NO SUBSTITUTE FOR 2784 01:38:11,040 --> 01:38:14,720 ACTUAL TRAVEL AND GOING TO MEET 2785 01:38:14,720 --> 01:38:15,240 ONE ANOTHER. 2786 01:38:15,240 --> 01:38:17,440 NOW I JUST GOT BACK FROM 2787 01:38:17,440 --> 01:38:17,720 HONDURAS. 2788 01:38:17,720 --> 01:38:19,400 IT WAS INCREDIBLY PRODUCTIVE 2789 01:38:19,400 --> 01:38:20,240 VISIT. 2790 01:38:20,240 --> 01:38:22,640 BUT THERE IS SO MUCH THAT YOU 2791 01:38:22,640 --> 01:38:23,840 CAN NEVER REALLY ACCOMPLISH 2792 01:38:23,840 --> 01:38:25,880 UNLESS YOU TRAVEL TO THE 2793 01:38:25,880 --> 01:38:26,680 COUNTRIES. 2794 01:38:26,680 --> 01:38:27,920 SO IF WE'RE TALKING ABOUT BEST 2795 01:38:27,920 --> 01:38:30,680 PRACTICES THAT WOULD BE WHAT 2796 01:38:30,680 --> 01:38:32,520 I'LL SAY IN A PARTLY HUMOROUS 2797 01:38:32,520 --> 01:38:32,720 WAY. 2798 01:38:32,720 --> 01:38:34,640 IS THAT IN MY EXPERIENCE, MANY 2799 01:38:34,640 --> 01:38:37,120 LATINO COLLEAGUES ARE NOT SO 2800 01:38:37,120 --> 01:38:39,160 GOOD AT E-MAIL CULTURE. 2801 01:38:39,160 --> 01:38:41,560 SO I WON'T GET AN E-MAIL BACK 2802 01:38:41,560 --> 01:38:42,360 AND THEN I'LL TRAVEL THERE AND 2803 01:38:42,360 --> 01:38:43,920 SAY, BOY, I HAVE BEEN E-MAILING 2804 01:38:43,920 --> 01:38:47,280 YOU AND THEY MIGHT SAY, YES, 2805 01:38:47,280 --> 01:38:48,400 I'VE SEEN THOSE E-MAILS. 2806 01:38:48,400 --> 01:38:51,280 BUT THERE IS NO RESPONSE. 2807 01:38:51,280 --> 01:38:51,560 [ LAUGHS ] 2808 01:38:51,560 --> 01:38:55,240 SO REALLY THE TRAVEL AND 2809 01:38:55,240 --> 01:38:56,120 ACTUALLY GETTING TRUST AND 2810 01:38:56,120 --> 01:38:57,040 RECOGNITION IN OTHER COUNTRIES, 2811 01:38:57,040 --> 01:38:58,880 OF COURSE THERE IS THAT SENSE 2812 01:38:58,880 --> 01:39:00,160 THAT THESE INTERNATIONAL 2813 01:39:00,160 --> 01:39:02,000 PROJECTS COME AND GO BUT NOTHING 2814 01:39:02,000 --> 01:39:03,720 REALLY CHANGES. 2815 01:39:03,720 --> 01:39:05,280 SO SHOWING THAT YOU HAVE A 2816 01:39:05,280 --> 01:39:08,280 COMMITMENT AND BRINGING BEST 2817 01:39:08,280 --> 01:39:08,920 PRACTICES AND REALLY MEAN TO 2818 01:39:08,920 --> 01:39:09,960 MAKE A DIFFERENCE, I THINK THAT 2819 01:39:09,960 --> 01:39:12,880 WOULD BE SOMETHING ELSE I WOULD 2820 01:39:12,880 --> 01:39:16,280 PRIORITIZE. 2821 01:39:16,280 --> 01:39:20,320 >>MODERATOR: THANK YOU, 2822 01:39:20,320 --> 01:39:21,000 DR. PIETTE. 2823 01:39:21,000 --> 01:39:21,400 >>EDUARDO RODRIGO 2824 01:39:21,400 --> 01:39:22,720 SAUCEDO-MARTINEZ: I CAN SAY ONE 2825 01:39:22,720 --> 01:39:24,440 OF THE LESSONS THE FOUNDATION 2826 01:39:24,440 --> 01:39:26,160 HAS COME UP AND APPLICABLE TO US 2827 01:39:26,160 --> 01:39:29,080 IN THE U.S., IS WE NEED TO FIND 2828 01:39:29,080 --> 01:39:31,240 DIFFERENT WAYS IN WHICH WE CAN 2829 01:39:31,240 --> 01:39:31,840 COMMUNICATE WITH PATIENTS. 2830 01:39:31,840 --> 01:39:35,840 ONE OF THE MOST CHALLENGING 2831 01:39:35,840 --> 01:39:36,840 REALLY -- I WOULD SAY THE 2832 01:39:36,840 --> 01:39:38,040 GREATEST CHALLENGE IS REALLY TO 2833 01:39:38,040 --> 01:39:42,000 FIND WAYS IN WHICH WE CAN 2834 01:39:42,000 --> 01:39:42,920 COMMUNICATE DIFFERENTLY, MEN TO 2835 01:39:42,920 --> 01:39:46,120 WOMEN, YOUNG POPULATION TO OLD 2836 01:39:46,120 --> 01:39:47,160 POPULATION, USING DETAILED 2837 01:39:47,160 --> 01:39:51,120 TOOLS, USING ALSO VIDEOS, USING 2838 01:39:51,120 --> 01:39:54,600 FACE-TO-FACE INTERACTIONS AND 2839 01:39:54,600 --> 01:39:55,160 UNDERSTANDING THAT AND 2840 01:39:55,160 --> 01:39:55,800 UNDERSTANDING THAT PEOPLE REALLY 2841 01:39:55,800 --> 01:39:58,480 HAVE THE LITTLE TO NO TIME TO 2842 01:39:58,480 --> 01:39:59,440 HAVE AN INTERACTION AND THAT YOU 2843 01:39:59,440 --> 01:40:00,880 NEED TO FIND CREATIVE WAYS IN 2844 01:40:00,880 --> 01:40:02,120 WHICH YOU CAN COMMUNICATE. 2845 01:40:02,120 --> 01:40:05,080 I WOULD SAY THAT IS THE MOST 2846 01:40:05,080 --> 01:40:06,400 VALUABLE LESSON. 2847 01:40:06,400 --> 01:40:10,560 AND I BELIEVE THAT IN THE END, 2848 01:40:10,560 --> 01:40:11,680 IMMIGRANTS ARE HARDWORKING 2849 01:40:11,680 --> 01:40:13,560 PEOPLE WHO REALLY WANT TO MAKE A 2850 01:40:13,560 --> 01:40:15,320 DIFFERENCE AND WANT TO TAKE CARE 2851 01:40:15,320 --> 01:40:15,800 OF THEMSELVES. 2852 01:40:15,800 --> 01:40:18,000 BECAUSE THEY MOST OF THE TIMES 2853 01:40:18,000 --> 01:40:19,760 ARE RELATED TO PEOPLE IN THEIR 2854 01:40:19,760 --> 01:40:21,440 OWN COMMUNITIES AND WANT TO 2855 01:40:21,440 --> 01:40:23,040 REALLY SPEND TIME WITH THEM. 2856 01:40:23,040 --> 01:40:24,600 SO THERE ARE WAYS IN WHICH YOU 2857 01:40:24,600 --> 01:40:26,560 CAN INTERACT AND ENGAGE THEM. 2858 01:40:26,560 --> 01:40:28,680 YOU JUST HAVE TO FIND A NEW 2859 01:40:28,680 --> 01:40:31,640 CREATIVE WAY OF DOING SO. 2860 01:40:31,640 --> 01:40:34,480 >>MODERATOR: THANK YOU, EDUARDO 2861 01:40:34,480 --> 01:40:36,480 RODRIGO SAUCEDO-MARTINEZ. 2862 01:40:36,480 --> 01:40:36,960 OTHERS? 2863 01:40:36,960 --> 01:40:38,040 YES? 2864 01:40:38,040 --> 01:40:39,360 DR. GUSTAVO GOSSLING? 2865 01:40:39,360 --> 01:40:41,080 >>GUSTAVO GOSSLING: SO I THINK 2866 01:40:41,080 --> 01:40:45,000 WE ARE DEALING HERE WITH AN 2867 01:40:45,000 --> 01:40:45,560 ISSUE OF ACCESS. 2868 01:40:45,560 --> 01:40:48,160 AND IN LATIN AMERICA, WE HAVE A 2869 01:40:48,160 --> 01:40:50,800 PROBLEM TO ACCESS CLINICAL 2870 01:40:50,800 --> 01:40:54,520 TRIALS AND INVESTIGATION FOR 2871 01:40:54,520 --> 01:40:55,280 PATIENTS. 2872 01:40:55,280 --> 01:40:58,040 HOWEVER, WE DO SEE AND WE DO 2873 01:40:58,040 --> 01:41:02,000 KNOW THAT SOME PATIENTS, 2874 01:41:02,000 --> 01:41:02,800 ESPECIALLY LATINO, AND 2875 01:41:02,800 --> 01:41:04,000 MINORITIES, THEY DO HAVE TROUBLE 2876 01:41:04,000 --> 01:41:06,520 TO ACCESS HEALTH CARE AS A WHOLE 2877 01:41:06,520 --> 01:41:07,280 EVERYWHERE. 2878 01:41:07,280 --> 01:41:09,280 BUT ALSO IN THE U.S. 2879 01:41:09,280 --> 01:41:12,480 I THINK WE NEED TO FOCUS OUR 2880 01:41:12,480 --> 01:41:16,600 EFFORTS IN ACCESS TO THOSE 2881 01:41:16,600 --> 01:41:17,640 POPULATIONS. 2882 01:41:17,640 --> 01:41:19,000 AND LATIN AMERICA HAS SOME GREAT 2883 01:41:19,000 --> 01:41:22,440 EXAMPLES OF PUBLIC HEALTH CARE 2884 01:41:22,440 --> 01:41:24,120 SYSTEMS THAT DO WORK AT 2885 01:41:24,120 --> 01:41:24,560 ESPECIALLY LOW COST. 2886 01:41:24,560 --> 01:41:26,960 BECAUSE THEY FOCUS ON THE 2887 01:41:26,960 --> 01:41:30,920 INDIVIDUALS AND ON THE MOST 2888 01:41:30,920 --> 01:41:33,640 COMMON DISEASE. 2889 01:41:33,640 --> 01:41:35,200 AND I THINK THESE ARE VERY 2890 01:41:35,200 --> 01:41:37,680 IMPORTANT LESSONS FROM LATIN 2891 01:41:37,680 --> 01:41:38,400 AMERICA TO THE REST OF THE 2892 01:41:38,400 --> 01:41:42,440 WORLD, HOW TO ORGANIZE, HOW THEY 2893 01:41:42,440 --> 01:41:44,440 ORGANIZE THEIR HEALTH CARE 2894 01:41:44,440 --> 01:41:48,080 SYSTEMS SO THAT THEY COULD BE 2895 01:41:48,080 --> 01:41:48,440 COST-EFFICIENT. 2896 01:41:48,440 --> 01:41:51,280 AND I BELIEVE WE IS HAVE SOME 2897 01:41:51,280 --> 01:41:53,520 EXAMPLES HERE. 2898 01:41:53,520 --> 01:41:54,200 >>MODERATOR: THANK YOU. 2899 01:41:54,200 --> 01:41:55,800 DR. MADELINE PESEC? 2900 01:41:55,800 --> 01:42:00,360 >>MADELINE PESEC: EXCELLENT. 2901 01:42:00,360 --> 01:42:01,960 I WOULD AGREE WITH MOST OF WHAT 2902 01:42:01,960 --> 01:42:04,760 HAS BEEN SAID AND CERTAINLY WHAT 2903 01:42:04,760 --> 01:42:05,520 DR. EDUARDO RODRIGO 2904 01:42:05,520 --> 01:42:06,520 SAUCEDO-MARTINEZ HAS BEEN SAYING 2905 01:42:06,520 --> 01:42:07,440 ABOUT THE POWER OF COMMUNITY. 2906 01:42:07,440 --> 01:42:11,080 AND I WOULD JUST ADD THAT WHILE 2907 01:42:11,080 --> 01:42:12,440 THERE IS A LOT OF CHALLENGE THAT 2908 01:42:12,440 --> 01:42:15,280 IS LATINO POPULATIONS IN THE 2909 01:42:15,280 --> 01:42:16,920 UNITED STATES BASE, THERE ARE 2910 01:42:16,920 --> 01:42:17,760 ALSO INCREDIBLE STRENGTHS THAT 2911 01:42:17,760 --> 01:42:19,720 THIS COMMUNITY HAS THAT WE CAN 2912 01:42:19,720 --> 01:42:22,520 REALLY CAPITALIZE ON. 2913 01:42:22,520 --> 01:42:26,640 SO, A STRONG SENSE OF COMMUNITY, 2914 01:42:26,640 --> 01:42:28,120 INTENSE ENGAGEMENT WITH 2915 01:42:28,120 --> 01:42:31,040 COMMUNITY ORGANIZATIONS WITH 2916 01:42:31,040 --> 01:42:32,000 CHURCHES, AND THEN I WOULD ALSO 2917 01:42:32,000 --> 01:42:34,160 ARGUE THAT MANY LATINO CULTURES 2918 01:42:34,160 --> 01:42:36,240 ALREADY HAVE A STRONG 2919 01:42:36,240 --> 01:42:38,600 APPRECIATION OF FOOD AS 2920 01:42:38,600 --> 01:42:38,840 MEDICINE. 2921 01:42:38,840 --> 01:42:41,080 ED AND A STRONG APPRECIATION OF 2922 01:42:41,080 --> 01:42:44,360 HOLISTIC WELL-BEING THAT PERHAPS 2923 01:42:44,360 --> 01:42:45,640 OTHER GROUPS OF AMERICANS DON'T 2924 01:42:45,640 --> 01:42:45,960 APPRECIATE. 2925 01:42:45,960 --> 01:42:50,040 AND SO WHEN I SAY TO MY LATINO 2926 01:42:50,040 --> 01:42:52,880 PATIENTS, WHAT YOU EAT MATTERS. 2927 01:42:52,880 --> 01:42:53,480 FOOD IS MEDICINE. 2928 01:42:53,480 --> 01:42:54,560 THEY ARE LIKE, MY MOM TOLD ME I 2929 01:42:54,560 --> 01:42:56,160 ALWAYS HAVE TO HAVE THIS KIND OF 2930 01:42:56,160 --> 01:42:58,120 FOOD WHEN I'M FEELING THIS WAY. 2931 01:42:58,120 --> 01:43:00,160 SO THERE IS HUGE OPPORTUNITIES 2932 01:43:00,160 --> 01:43:03,000 TO CAPITALIZE ON THAT. 2933 01:43:03,000 --> 01:43:06,080 SO I THINK SWITCHING THAT 2934 01:43:06,080 --> 01:43:07,040 NARRATIVE FROM THERE ARE 2935 01:43:07,040 --> 01:43:08,120 DISADVANTAGED GROUP THAT HAVE 2936 01:43:08,120 --> 01:43:09,360 DIFFERENT UNDERSTANDINGS OF 2937 01:43:09,360 --> 01:43:09,720 HEALTH. 2938 01:43:09,720 --> 01:43:11,480 INSTEAD SAYING, THIS IS A GROUP 2939 01:43:11,480 --> 01:43:13,160 THAT IS INCREDIBLY ENGAGED WITH 2940 01:43:13,160 --> 01:43:16,400 THE HEALTH CARE SYSTEM WHEN IT'S 2941 01:43:16,400 --> 01:43:19,760 ACCESSIBLE AND RESPECTFUL AND 2942 01:43:19,760 --> 01:43:20,880 THEY HAVE A STRONG COMMUNITY 2943 01:43:20,880 --> 01:43:22,600 TIES THAT WE CAN BUILD ON. 2944 01:43:22,600 --> 01:43:23,600 THEY ARE OPEN TO COMMUNITY 2945 01:43:23,600 --> 01:43:26,240 HEALTH WORKERS. 2946 01:43:26,240 --> 01:43:27,880 THEY ALREADY HAVE UNDERSTANDINGS 2947 01:43:27,880 --> 01:43:29,760 OF HOLISTIC MEDICINE AND THE 2948 01:43:29,760 --> 01:43:30,720 FACT THAT IT MAY BE NOT JUST A 2949 01:43:30,720 --> 01:43:35,120 PILL BUT IT MAY BE CBT THAT 2950 01:43:35,120 --> 01:43:38,120 HELPS YOU OVERCOME THE CHRONIC 2951 01:43:38,120 --> 01:43:38,680 KNEE PAIN, THAT YOU NEED TO 2952 01:43:38,680 --> 01:43:39,800 EXERCISE TO GET YOUR BLOOD 2953 01:43:39,800 --> 01:43:42,520 PRESSURE AND DIABETES UNDER 2954 01:43:42,520 --> 01:43:42,760 CONTROL. 2955 01:43:42,760 --> 01:43:43,280 SO I THINK THERE IS HUGE 2956 01:43:43,280 --> 01:43:46,040 OPPORTUNITIES FOR COMMUNITY 2957 01:43:46,040 --> 01:43:46,640 HEALTH WORKERS, WITH REACHING 2958 01:43:46,640 --> 01:43:47,920 OUT MORE AND BEING MORE 2959 01:43:47,920 --> 01:43:49,360 PROACTIVE INSTEAD OF JUST KIND 2960 01:43:49,360 --> 01:43:51,760 OF RECEIVING PEOPLE AS THEY COME 2961 01:43:51,760 --> 01:43:53,680 TO THE HEALTH CLINIC. 2962 01:43:53,680 --> 01:43:55,760 AND SO I THINK THAT THE THINGS 2963 01:43:55,760 --> 01:43:57,880 THAT COSTA RICA HAS SHOWN US IS 2964 01:43:57,880 --> 01:44:00,640 THE POWER OF TEAM-BASED CARE AND 2965 01:44:00,640 --> 01:44:02,000 THE POWER IN HEALTH EDUCATION 2966 01:44:02,000 --> 01:44:05,320 AND HEALTH PROMOTION AS 2967 01:44:05,320 --> 01:44:07,960 FOUNDATIONAL TO ANY IMPROVEMENT 2968 01:44:07,960 --> 01:44:10,200 ON NON-COMMUNICABLE DISEASES. 2969 01:44:10,200 --> 01:44:10,840 >>MODERATOR: THANK YOU, 2970 01:44:10,840 --> 01:44:12,360 DR. MADELINE PESEC. 2971 01:44:12,360 --> 01:44:15,680 ANY OTHER QUESTIONS FROM OTHER 2972 01:44:15,680 --> 01:44:16,000 SPEAKERS? 2973 01:44:16,000 --> 01:44:18,280 WE HAVE ONE MORE MINUTE BEFORE 2974 01:44:18,280 --> 01:44:22,800 THE BREAK. 2975 01:44:22,800 --> 01:44:26,040 OR ANYTHING ELSE THAT THE 2976 01:44:26,040 --> 01:44:26,640 SPEAKERS WOULD LIKE TO ADD THAT 2977 01:44:26,640 --> 01:44:28,040 THEY DIDN'T HAVE THE OPPORTUNITY 2978 01:44:28,040 --> 01:44:31,880 TO SAY? 2979 01:44:31,880 --> 01:44:39,520 >>I BELIEVE THERE IS A QUESTION 2980 01:44:39,520 --> 01:44:41,520 HERE? 2981 01:44:41,520 --> 01:44:42,920 >>I WAS JUST CLAPPING BECAUSE I 2982 01:44:42,920 --> 01:44:46,000 THINK THIS QUESTION WAS VERY, 2983 01:44:46,000 --> 01:44:46,280 VERY NICE. 2984 01:44:46,280 --> 01:44:52,000 I WOULD LIKE TO KNOW, MAYBE FOR 2985 01:44:52,000 --> 01:44:55,880 YOU GUSTAV OH, WHAT YOU THINK IS 2986 01:44:55,880 --> 01:44:57,800 THE ROLE OF THE GOVERNMENT IN 2987 01:44:57,800 --> 01:44:59,640 TERMS OF FACILITATING ALL OF 2988 01:44:59,640 --> 01:45:01,280 THIS INTERACTIONS BETWEEN THE 2989 01:45:01,280 --> 01:45:10,640 U.S. AND LATIN AMERICA? 2990 01:45:10,640 --> 01:45:11,440 >>THAT IS THE MILLION DOLLAR 2991 01:45:11,440 --> 01:45:14,320 QUESTION, I BELIEVE. 2992 01:45:14,320 --> 01:45:16,360 WE NEED MORE THAN A FEW MINUTES 2993 01:45:16,360 --> 01:45:18,360 TO GET INTO THAT. 2994 01:45:18,360 --> 01:45:19,360 IT'S A VERY DIFFICULT QUESTION. 2995 01:45:19,360 --> 01:45:24,160 I COULD SAY THAT REALLY GETTING 2996 01:45:24,160 --> 01:45:25,160 TO KNOW THESE EXPERIENCES AND 2997 01:45:25,160 --> 01:45:27,680 KNOWING THAT THERE IS AN AREA OF 2998 01:45:27,680 --> 01:45:29,400 OPPORTUNITY, I THINK THAT IS A 2999 01:45:29,400 --> 01:45:32,040 VERY VALUABLE FIRST STEP AND THE 3000 01:45:32,040 --> 01:45:34,040 WORK THAT WE ARE DOING IN THIS 3001 01:45:34,040 --> 01:45:35,720 WORKSHOP IS ONE FANTASTIC FIRST 3002 01:45:35,720 --> 01:45:37,800 STEP IN UNDERSTANDING WHAT IS 3003 01:45:37,800 --> 01:45:38,680 OUT THERE. 3004 01:45:38,680 --> 01:45:41,840 I COULD SAY THAT WOULD BE ONE, 3005 01:45:41,840 --> 01:45:43,280 PERHAPS NOT THE GOVERNMENT ROLE 3006 01:45:43,280 --> 01:45:46,280 AS THE EXECUTIVE BRANCH, BUT 3007 01:45:46,280 --> 01:45:48,520 CERTAINLY THE ROLE OF NIH IS 3008 01:45:48,520 --> 01:45:52,800 VALUABLE IN THAT REGARD. 3009 01:45:52,800 --> 01:45:54,040 >>MODERATOR: THANK YOU, EDUARDO 3010 01:45:54,040 --> 01:45:54,640 RODRIGO SAUCEDO-MARTINEZ AND 3011 01:45:54,640 --> 01:45:56,760 THANK YOU TO ALL THE PANELISTS 3012 01:45:56,760 --> 01:45:58,600 OF THIS TOPIC. 3013 01:45:58,600 --> 01:46:02,600 IT'S 10:15 EASTERN TIME. 3014 01:46:02,600 --> 01:46:05,280 WE ARE NOW TAKING A BREAK. 3015 01:46:05,280 --> 01:46:07,880 SEE YOU LATER. 3016 01:46:07,880 --> 01:46:25,960 AND THANK YOU. 3017 01:46:25,960 --> 01:46:27,840 >>MODERATOR: NEXT WATCH THE 3018 01:46:27,840 --> 01:46:32,400 VIDEOS. 3019 01:46:32,400 --> 01:46:33,840 GREETINGS, I'M A PROGRAM 3020 01:46:33,840 --> 01:46:34,800 OFFICIAL AT THE NATIONAL 3021 01:46:34,800 --> 01:46:36,640 INSTITUTE ON MINORITY HEALTH AND 3022 01:46:36,640 --> 01:46:37,360 HEALTH DISPARITIES. 3023 01:46:37,360 --> 01:46:38,000 A MODERATOR FOR TODAY'S SESSION 3024 01:46:38,000 --> 01:46:41,320 ON BEST PRACTICES AND LESSONS 3025 01:46:41,320 --> 01:46:42,080 LEARNED, EFFECTIVE 3026 01:46:42,080 --> 01:46:43,880 COMMUNITY-ENGAGED RESEARCH. 3027 01:46:43,880 --> 01:46:45,520 DURING THIS SESSION, YOU WILL BE 3028 01:46:45,520 --> 01:46:48,560 VIEWING FOUR PRESENTATIONS BY 3029 01:46:48,560 --> 01:46:52,520 DOCTORS TATIANA VIDAURRE, JOHN 3030 01:46:52,520 --> 01:47:02,280 PIETTE, CARMEN VELEZ VEGA AND 3031 01:47:02,280 --> 01:47:03,120 DR. MAESTHO. 3032 01:47:03,120 --> 01:47:05,120 ENJOY THE PRESENTATIONS. 3033 01:47:05,120 --> 01:47:06,600 >>THANK YOU VERY MUCH FOR THIS 3034 01:47:06,600 --> 01:47:10,640 OPPORTUNITY TO TALK ABOUT CANCER 3035 01:47:10,640 --> 01:47:10,880 RESEARCH. 3036 01:47:10,880 --> 01:47:13,760 LATIN AMERICA POPULATION IS MIX 3037 01:47:13,760 --> 01:47:18,000 OF NATIVE-AMERICANS, EUROPEANS 3038 01:47:18,000 --> 01:47:19,200 AND AFRICAN ANCESTRY AND 3039 01:47:19,200 --> 01:47:21,680 TECHNOLOGY ADVANCES IN GENETICS 3040 01:47:21,680 --> 01:47:23,360 AND GENOMICS FOR CANCER SHOULD 3041 01:47:23,360 --> 01:47:24,040 BE IMPORTANT. 3042 01:47:24,040 --> 01:47:27,680 THE CANCER INCIDENTS IN LATIN 3043 01:47:27,680 --> 01:47:29,520 AMERICA IN GENERAL -- THE 3044 01:47:29,520 --> 01:47:31,840 MORTALITY IS SIGNIFICANTLY 3045 01:47:31,840 --> 01:47:32,080 HIGHER. 3046 01:47:32,080 --> 01:47:33,440 50% OF THE LATIN-AMERICAN 3047 01:47:33,440 --> 01:47:34,920 POPULATION DOES NOT HAVE ACCESS 3048 01:47:34,920 --> 01:47:37,920 TO HIGH-COST DRUGS, HEALTH CARE 3049 01:47:37,920 --> 01:47:39,280 COVERAGE IS NOT THE RULE IN 3050 01:47:39,280 --> 01:47:46,440 LATIN AMERICA AND EVEN THE -- 3051 01:47:46,440 --> 01:47:48,560 RESEARCH IS A CHALLENGE IN LATIN 3052 01:47:48,560 --> 01:47:51,280 AMERICA COUNTRIES. 3053 01:47:51,280 --> 01:47:53,400 CANCER INCREASE IN THE 3054 01:47:53,400 --> 01:47:53,840 DEVELOPING COUNTRY. 3055 01:47:53,840 --> 01:47:57,800 THERE IS A SPECIAL CONCERN ABOUT 3056 01:47:57,800 --> 01:48:01,520 CANCER AMONG THE PEOPLE IN UNDER 3057 01:48:01,520 --> 01:48:04,840 RECOMMENDED RESEARCH ANALYSIS. 3058 01:48:04,840 --> 01:48:07,280 CANCER NEW CASES MORE THAN 3059 01:48:07,280 --> 01:48:13,000 70,000 PER YEAR, MORE THAN 4000 3060 01:48:13,000 --> 01:48:13,800 CANCER DEATHS PER YEAR. 3061 01:48:13,800 --> 01:48:15,120 MORE THAN 1/3 PERSONS LIVING 3062 01:48:15,120 --> 01:48:21,400 WITH CANCER AND MASSIVE DISEASE 3063 01:48:21,400 --> 01:48:25,480 75%-Y%. 3064 01:48:25,480 --> 01:48:29,080 NATIVE COMMUNITIES VULNERABILITY 3065 01:48:29,080 --> 01:48:30,720 DISADVANTAGED POPULATION, LACK 3066 01:48:30,720 --> 01:48:36,120 OF DATA, INNOVATION AND 3067 01:48:36,120 --> 01:48:37,040 TECHNOLOGY. 3068 01:48:37,040 --> 01:48:37,800 CANCER TREATMENT IN LATIN 3069 01:48:37,800 --> 01:48:39,440 AMERICA IS A CHALLENGE BECAUSE 3070 01:48:39,440 --> 01:48:41,920 OF THE BIOLOGICAL COMPLEXITIES 3071 01:48:41,920 --> 01:48:43,800 OF CANCER AND THE NEW TECHNOLOGY 3072 01:48:43,800 --> 01:48:46,480 FOR MOLECULAR APPROACH IN 3073 01:48:46,480 --> 01:48:48,720 CANCER. 3074 01:48:48,720 --> 01:48:51,760 MOLECULAR BIOLOGY ADVANCE IS 3075 01:48:51,760 --> 01:48:52,880 IMPORTANT FOR RESEARCH. 3076 01:48:52,880 --> 01:48:57,280 THE NATIONAL CANCERINS NEWT PERU 3077 01:48:57,280 --> 01:48:58,960 IS A INSTITUTIONAL CANCER CARE 3078 01:48:58,960 --> 01:49:01,520 AND A HUB OF THE PATIENTS ARE 3079 01:49:01,520 --> 01:49:06,760 FROM THE PROVINCE OF THE 3080 01:49:06,760 --> 01:49:08,800 COUNTRYSIDE. 3081 01:49:08,800 --> 01:49:15,280 THIS IS THE POPULATION SITE -- 3082 01:49:15,280 --> 01:49:21,960 THIS IS INDIGENOUS COMMUNITY IN 3083 01:49:21,960 --> 01:49:24,720 THESE PEOPLE WITH CONDITIONS, 3084 01:49:24,720 --> 01:49:27,240 REACH A HIGHER PERCENTAGE IN 3085 01:49:27,240 --> 01:49:34,480 LIMA, 23%. 3086 01:49:34,480 --> 01:49:35,480 THEY -- 3087 01:49:35,480 --> 01:49:35,920 [ SPEAKING SPANISH ] 3088 01:49:35,920 --> 01:49:40,480 THE LATIN POPULATION THAT SELF 3089 01:49:40,480 --> 01:49:42,040 IDENTIFIES AS INDIGENOUS OR 3090 01:49:42,040 --> 01:49:48,520 ORIGINALLY FROM AMAZON ARE 3091 01:49:48,520 --> 01:49:52,200 AMAZONIANS AND -- IN OUR 3092 01:49:52,200 --> 01:49:53,400 INSTITUTE MAIN CENTER OF 3093 01:49:53,400 --> 01:49:55,000 EXCELLENCE FOR ONCOLOGY 3094 01:49:55,000 --> 01:49:58,280 RESEARCH. 3095 01:49:58,280 --> 01:49:58,880 THESE NATIVE COMMUNITIES COME 3096 01:49:58,880 --> 01:50:03,680 INTO OUR INSTITUTE BECAUSE THESE 3097 01:50:03,680 --> 01:50:11,480 INSTITUTES WE HAVE IN -- 3098 01:50:11,480 --> 01:50:13,120 [ SPEAKING SPANISH ] 3099 01:50:13,120 --> 01:50:21,000 AND WE STUDY CANCERS. 3100 01:50:21,000 --> 01:50:24,840 -- PROMOTING GLOBAL COOPERATION 3101 01:50:24,840 --> 01:50:27,800 IS MAKING ROOM FOR GENETIC AND 3102 01:50:27,800 --> 01:50:29,280 GENOMIC RESEARCH IS IMPORTANT. 3103 01:50:29,280 --> 01:50:35,600 IT WILL HAVE THESE BIOMARKER 3104 01:50:35,600 --> 01:50:41,600 NETWORKS -- SOUTH AMERICAN HAVE 3105 01:50:41,600 --> 01:50:46,000 THESE OPPORTUNITY TO CONNECT OUR 3106 01:50:46,000 --> 01:50:50,160 DIFFERENT COUNTRIES AND THE 3107 01:50:50,160 --> 01:50:52,160 CANCER RESEARCH -- CALLING FOR 3108 01:50:52,160 --> 01:50:52,440 INNOVATION. 3109 01:50:52,440 --> 01:50:57,480 IN THIS MODEL WE HAVE 3110 01:50:57,480 --> 01:51:02,640 COOPERATION FOR EXAMPLE U.S. AND 3111 01:51:02,640 --> 01:51:05,320 WE CAN SEE THE RESULTS IN BREAST 3112 01:51:05,320 --> 01:51:09,400 CANCER ETHNICITY. 3113 01:51:09,400 --> 01:51:10,280 HIGHER PROPORTION WAS ASSOCIATED 3114 01:51:10,280 --> 01:51:14,360 WITH HIGHER INCIDENT OF HER2 3115 01:51:14,360 --> 01:51:18,040 POSITIVE CANCER AND WE HAVE SOME 3116 01:51:18,040 --> 01:51:23,280 HIGHER FREQUENCY OF HER2 AMONG 3117 01:51:23,280 --> 01:51:26,640 LATINS IN PERU TO THE SAME 3118 01:51:26,640 --> 01:51:26,960 INFORMATION. 3119 01:51:26,960 --> 01:51:28,680 IT IS ESSENTIAL FOR THIS MAPPING 3120 01:51:28,680 --> 01:51:37,280 OUR COUNTRY WE HAVE -- THREE 3121 01:51:37,280 --> 01:51:40,200 MORE INSTITUTES IN OUR COUNTRY. 3122 01:51:40,200 --> 01:51:47,680 ONE OF THE MAIN INSTITUTES IN 3123 01:51:47,680 --> 01:51:54,480 LIMA BUT WE HAVE -- AND THE 3124 01:51:54,480 --> 01:51:55,400 THIRD -- 3125 01:51:55,400 --> 01:51:57,120 [ SPEAKING SPANISH ] 3126 01:51:57,120 --> 01:52:00,440 AND WE CAN UNDERSTAND THESE 3127 01:52:00,440 --> 01:52:01,960 POPULATION OF THE NATIVE 3128 01:52:01,960 --> 01:52:05,720 COMMUNITY BECAUSE OF THE 3129 01:52:05,720 --> 01:52:08,920 DISTRIBUTION OF BREAST CANCER -- 3130 01:52:08,920 --> 01:52:19,480 HIGHLY INDIGENOUS -- MORE LIKELY 3131 01:52:21,600 --> 01:52:24,040 TO BE DIAGNOSTIC WITH CANCER AND 3132 01:52:24,040 --> 01:52:26,800 LES LIKELY COM FIRED WOMAN FROM 3133 01:52:26,800 --> 01:52:32,480 SIERRA REGION. 3134 01:52:32,480 --> 01:52:34,840 THIS INFORMATION DIFFERENCE IN 3135 01:52:34,840 --> 01:52:39,440 ACCESS TO BREAST CANCER 3136 01:52:39,440 --> 01:52:49,960 AWARENESS -- IN THIS STUDY WE 3137 01:53:03,160 --> 01:53:06,320 ANALYZE COLLABORATIVE APPROACH, 3138 01:53:06,320 --> 01:53:08,080 DIFFERENTS OF PROTECTIVE GENES 3139 01:53:08,080 --> 01:53:12,000 AND IN THIS POPULATION OF 3140 01:53:12,000 --> 01:53:18,040 PATIENT WE HAVE INDIGENOUS WELL 3141 01:53:18,040 --> 01:53:27,280 RESPECTED POPULATION FOR BREAST 3142 01:53:27,280 --> 01:53:28,080 CANCER. 3143 01:53:28,080 --> 01:53:34,800 -- IN INDIGENOUS AMERICAN 3144 01:53:34,800 --> 01:53:37,880 ANCESTRY TOO BREAST CANCER 3145 01:53:37,880 --> 01:53:45,840 DISPARITY -- ANALYZING RISK FOR 3146 01:53:45,840 --> 01:53:47,160 CANCER PREVENTION. 3147 01:53:47,160 --> 01:53:49,240 DIFFERENT PROPORTION OF 3148 01:53:49,240 --> 01:53:50,360 MOLECULAR SUBTYPE ACCORDING TO 3149 01:53:50,360 --> 01:53:53,720 ANCESTRY COMPONENT. 3150 01:53:53,720 --> 01:53:59,480 WE CONTINUE ANALYZING THESE 3151 01:53:59,480 --> 01:54:09,960 LARGE SAMPLE SIZE POPULATION. 3152 01:54:26,400 --> 01:54:30,200 OUR INSTITUTE PERUVIAN RESEARCH 3153 01:54:30,200 --> 01:54:34,720 IN PERU IS ANALYZING TO THIS 3154 01:54:34,720 --> 01:54:38,520 HIGH-QUALIFIED GROUP TO 3155 01:54:38,520 --> 01:54:39,560 UNDERSTAND CARCINOMA IS A 3156 01:54:39,560 --> 01:54:46,440 DIFFERENT DISEASE IN PERU. 3157 01:54:46,440 --> 01:54:50,440 THIS COMBINATION IS INTEGRATED 3158 01:54:50,440 --> 01:54:51,800 IN RESEARCH AND WE MAINTAIN 3159 01:54:51,800 --> 01:54:57,160 STUDIES IN THIS FIELD OF CANCER 3160 01:54:57,160 --> 01:54:59,640 INCLUSIVE YOUNG RESEARCHERS AND 3161 01:54:59,640 --> 01:54:59,880 STUDENTS. 3162 01:54:59,880 --> 01:55:07,440 WE ARE ANALYZING SAMPLES FROM 3163 01:55:07,440 --> 01:55:07,960 PATIENT FROM COMMUNITIES. 3164 01:55:07,960 --> 01:55:13,080 IN THIS PLATFORM WE HAVE MAIN 3165 01:55:13,080 --> 01:55:17,240 BANK, BIOBANK THAT NOW IS IN 3166 01:55:17,240 --> 01:55:20,880 PERU AND THIS IS WELL 3167 01:55:20,880 --> 01:55:23,520 IMPLEMENTED. 3168 01:55:23,520 --> 01:55:27,280 BUT WE EDUCATIONAL PLATFORM WE 3169 01:55:27,280 --> 01:55:29,320 LEARN THAT IT IS IMPORTANT TO 3170 01:55:29,320 --> 01:55:31,440 ACQUIRE TOOLS OF PRECISION 3171 01:55:31,440 --> 01:55:31,920 MEDICINE IN ONCOLOGY. 3172 01:55:31,920 --> 01:55:36,760 THAT'S WHY WE NEED TO TRANSFER 3173 01:55:36,760 --> 01:55:42,200 THIS KNOWLEDGE AND MARKERS OF 3174 01:55:42,200 --> 01:55:43,680 ANCOLOGY WITH UNIVERSITY. 3175 01:55:43,680 --> 01:55:48,280 IT IS IMPORTANT TO PROMOTE THESE 3176 01:55:48,280 --> 01:55:50,120 EDUCATIONAL PLATFORM. 3177 01:55:50,120 --> 01:55:54,080 PEPATO CELLULAR CARCINOMA IN 3178 01:55:54,080 --> 01:55:57,440 PERU, WE HAVE MINORITY OF OUR 3179 01:55:57,440 --> 01:56:02,880 PATIENTS -- THIS IS MORALITY AND 3180 01:56:02,880 --> 01:56:06,080 CLINICAL PATHOLOGY ANALYSIS -- 3181 01:56:06,080 --> 01:56:08,600 HUGE TUMOR WE HAVE SURGERY 3182 01:56:08,600 --> 01:56:11,520 APPROACH FOR THIS KIND OF HUGE 3183 01:56:11,520 --> 01:56:11,880 TUMORS. 3184 01:56:11,880 --> 01:56:15,280 MOLECULAR CLASSIFICATION IS 3185 01:56:15,280 --> 01:56:15,560 DIFFERENT. 3186 01:56:15,560 --> 01:56:21,240 PERU IS SPECIAL CLASSIFICATION. 3187 01:56:21,240 --> 01:56:24,280 MOLECULAR SIGNATURE IS TOO 3188 01:56:24,280 --> 01:56:29,800 DIFFERENT INCLUDING 97% AMERICAN 3189 01:56:29,800 --> 01:56:34,480 INDIAN LINEAGE. 3190 01:56:34,480 --> 01:56:35,600 PERU HAS AMONG HIGHER RATE OF 3191 01:56:35,600 --> 01:56:37,520 NATIVE PEOPLE IN ITS POPULATION. 3192 01:56:37,520 --> 01:56:39,640 THIS HAS IMPACT ON GENOMIC 3193 01:56:39,640 --> 01:56:44,440 ARCHITECTURE OF PERUVIAN PEOPLE. 3194 01:56:44,440 --> 01:56:47,240 IN COLLABORATIVE RESEARCH CAN BE 3195 01:56:47,240 --> 01:56:52,280 IMPORTANT TO DO NEW PROJECTS FOR 3196 01:56:52,280 --> 01:56:55,600 CANCER DISPARITIES BECAUSE WE 3197 01:56:55,600 --> 01:56:57,960 HAVE ACCESS TO NATIVE COMMUNITY. 3198 01:56:57,960 --> 01:57:03,040 THIS IS WHY WE HAVE IMPORTANT 3199 01:57:03,040 --> 01:57:07,280 INSTITUTIONS LIKE CANCER CENTER 3200 01:57:07,280 --> 01:57:13,480 AND UNIVERSITY AND WE HAVE 3201 01:57:13,480 --> 01:57:20,080 REPORTS FROM FRENCH RESEARCHER 3202 01:57:20,080 --> 01:57:24,000 AND LOCAL RESEARCH INFORMATION. 3203 01:57:24,000 --> 01:57:25,600 OPPORTUNITIES FOR COLLABORATION 3204 01:57:25,600 --> 01:57:27,320 DUE TO HIGH BURDEN OF THIS 3205 01:57:27,320 --> 01:57:28,960 DISEASE IN THE COUNTRY AND THE 3206 01:57:28,960 --> 01:57:31,080 HIGH VOLUME OF PATIENTS 3207 01:57:31,080 --> 01:57:31,880 ADMITTED, INE! 3208 01:57:31,880 --> 01:57:34,280 A STRATEGIC CENTER TO PERFORM 3209 01:57:34,280 --> 01:57:44,440 HIGH-QUALITY RESEARCH IN CANCER. 3210 01:57:44,440 --> 01:57:47,000 BIOBANK AND CANCER RESEARCH HAVE 3211 01:57:47,000 --> 01:57:49,080 INCLUDE IN THE NATIONAL CANCER 3212 01:57:49,080 --> 01:57:50,280 CONTROL PLAN FOR BUILDING 3213 01:57:50,280 --> 01:57:54,000 CAPACITY IN MOLECULAR ONCOLOGY. 3214 01:57:54,000 --> 01:57:55,320 NATIONAL AND INTERNATIONAL 3215 01:57:55,320 --> 01:57:58,440 COOPERATION NETWORK FOR RESEARCH 3216 01:57:58,440 --> 01:57:59,080 IN PREVENTION AND CANCER CONTROL 3217 01:57:59,080 --> 01:58:01,760 ARE IMPORTANT TO IMPROVE 3218 01:58:01,760 --> 01:58:02,120 DISPARITIES. 3219 01:58:02,120 --> 01:58:04,920 I IN CONCLUSIONS, INEN AS WELL 3220 01:58:04,920 --> 01:58:07,280 AS TWO REGIONAL CANCER CENTERS 3221 01:58:07,280 --> 01:58:09,840 IN PERU ARE NOTATED ON THE 3222 01:58:09,840 --> 01:58:11,720 PERUVIAN COASTAL REGION AND ONE 3223 01:58:11,720 --> 01:58:13,880 REGIONAL CANCER CENTER ON THE 3224 01:58:13,880 --> 01:58:17,240 SIERRA REGION AND WE HAVE 3225 01:58:17,240 --> 01:58:23,440 CONCENTRATED PATIENTS IN THESE 3226 01:58:23,440 --> 01:58:24,080 DIFFERENT INSTITUTES THAT WE CAN 3227 01:58:24,080 --> 01:58:27,160 ESTABLISH THESE INDIGENOUS 3228 01:58:27,160 --> 01:58:27,920 AMERICAN TOWNS. 3229 01:58:27,920 --> 01:58:30,120 THE SIERRA REGION IS CLOSER TO 3230 01:58:30,120 --> 01:58:34,800 THE PROXIMITY TO THE COAST THAN 3231 01:58:34,800 --> 01:58:36,640 THE SELVA REGION AND WILL HAVE 3232 01:58:36,640 --> 01:58:37,520 TO TRAVEL FROM FATHER DISTANCE 3233 01:58:37,520 --> 01:58:39,000 AND POTENTIALLY EXPERIENCE 3234 01:58:39,000 --> 01:58:41,360 GREATER BARRIERS FOR ACCESS TO 3235 01:58:41,360 --> 01:58:42,680 RESEARCH THAN THE PATIENT WHO 3236 01:58:42,680 --> 01:58:46,200 TRAVEL FROM THE SIERRA REGION. 3237 01:58:46,200 --> 01:58:46,640 GIVEN THAT THE AVERAGE 3238 01:58:46,640 --> 01:58:49,520 PROPORTION OF INDIGENOUS 3239 01:58:49,520 --> 01:58:52,000 AMERICAN ANCESTRY IN PERU IS 3240 01:58:52,000 --> 01:58:53,720 70-80% IT IS REASONABLE TO 3241 01:58:53,720 --> 01:58:55,400 ASSUME THAT THE PATIENT WHO 3242 01:58:55,400 --> 01:58:57,920 RESIDE IN WELL-KNOWN INDIGENOUS 3243 01:58:57,920 --> 01:58:58,920 POPULATION ARE LIKELY TO HAVE A 3244 01:58:58,920 --> 01:59:02,680 HIGH AVERAGE PROPORTION OF 3245 01:59:02,680 --> 01:59:03,280 INDIGENOUS AMERICAN ANCESTRY. 3246 01:59:03,280 --> 01:59:06,760 THANK YOU VERY MUCH FOR YOUR 3247 01:59:06,760 --> 01:59:09,160 ATTENTION. 3248 01:59:09,160 --> 01:59:11,280 >>JOHN PIETTE: HELLO, WHAT I'D 3249 01:59:11,280 --> 01:59:13,000 LIKED TO DO IN THE BRIEF AMOUNT 3250 01:59:13,000 --> 01:59:14,600 OF TIME I HAVE STUDY TO SHARE 3251 01:59:14,600 --> 01:59:16,600 WITH YOU SOME OF THE INSIGHTS 3252 01:59:16,600 --> 01:59:20,000 THAT WE HAVE GAINED FROM WORKING 3253 01:59:20,000 --> 01:59:21,200 WITH THE COMMUNITIES ACROSS 3254 01:59:21,200 --> 01:59:22,960 LATIN AMERICA IN TERMS OF SOME 3255 01:59:22,960 --> 01:59:26,000 OF THE FEATURES OF 3256 01:59:26,000 --> 01:59:27,840 COMMUNITY-BASED INTERVENTIONS 3257 01:59:27,840 --> 01:59:30,760 THAT THEY WANT AND THAT ADDRESS 3258 01:59:30,760 --> 01:59:31,920 SOME OF THE MOST IMPORTANT 3259 01:59:31,920 --> 01:59:34,560 PRIORITIES THAT THEY HAVE FOR 3260 01:59:34,560 --> 01:59:37,720 IMPROVING THE HEALTH AND PUBLIC 3261 01:59:37,720 --> 01:59:39,040 HEALTH OF THEIR COMMUNITIES, BE 3262 01:59:39,040 --> 01:59:40,440 THEY IN COUNTRIES LIKE HONDURAS 3263 01:59:40,440 --> 01:59:46,760 OR MEXICO OR BOLIVIA OR AFTER 3264 01:59:46,760 --> 01:59:49,600 IMMIGRATING TO THE UNITED 3265 01:59:49,600 --> 01:59:50,160 STATES. 3266 01:59:50,160 --> 01:59:51,680 TELEHEALTH INTERVENTIONS ARE 3267 01:59:51,680 --> 01:59:54,960 MORE AND MORE FEASIBLE IN LATIN 3268 01:59:54,960 --> 01:59:56,600 AMERICA AND OTHER LOW AND 3269 01:59:56,600 --> 01:59:59,640 MIDDLE-INCOME COUNTRIES AROUND 3270 01:59:59,640 --> 02:00:01,040 THE WORLD. 3271 02:00:01,040 --> 02:00:01,640 I RECENTLY RETURNED FROM 3272 02:00:01,640 --> 02:00:03,080 HONDURAS AND IT WAS CONFIRMED TO 3273 02:00:03,080 --> 02:00:07,080 ME AGAIN THAT AT LEAST IN ALDBUT 3274 02:00:07,080 --> 02:00:09,120 THE MOST RURAL AREAS, 3275 02:00:09,120 --> 02:00:09,760 INDIVIDUALS NOT ONLY HAVE A CELL 3276 02:00:09,760 --> 02:00:12,520 PHONE BUT INCREASINGLY THEY HAVE 3277 02:00:12,520 --> 02:00:15,280 ACCESS TO A SMARTPHONE THAT THEY 3278 02:00:15,280 --> 02:00:16,160 ARE USING WHATSAPP. 3279 02:00:16,160 --> 02:00:18,160 THAT'S REALLY GOOD NEWS BECAUSE 3280 02:00:18,160 --> 02:00:20,920 WITHOUT GOING INTO DETAILS, 3281 02:00:20,920 --> 02:00:24,400 WHATSAPP AND TWILLS ANOTHER 3282 02:00:24,400 --> 02:00:25,520 LARGE TELECOMMUNICATION COMPANY 3283 02:00:25,520 --> 02:00:27,680 SERVING BUSINESSES WITH 3284 02:00:27,680 --> 02:00:29,440 TEXT-MANAGED SUPPORT SERVICES. 3285 02:00:29,440 --> 02:00:31,320 THEY PARTNERED AND PARTNERING 3286 02:00:31,320 --> 02:00:34,560 WITH US IN WAYS TO DEVELOP 3287 02:00:34,560 --> 02:00:36,760 INTERVENTIONS SO THAT WE CAN, 3288 02:00:36,760 --> 02:00:42,800 FOR EXAMPLE, DO TO-WAY TEXT 3289 02:00:42,800 --> 02:00:43,320 MESSAGING AND SEND TENTHS 3290 02:00:43,320 --> 02:00:45,880 EVERTEXT AND REMINDERS AND 3291 02:00:45,880 --> 02:00:47,320 MANAGE PATIENT SYMPTOMS AND GET 3292 02:00:47,320 --> 02:00:48,160 FEEDBACK AND DIRECT HEALTH 3293 02:00:48,160 --> 02:00:49,840 SYSTEMS AND COMMUNITY-BASED 3294 02:00:49,840 --> 02:00:51,280 ORGANIZATIONS TO TREAT PATIENTS 3295 02:00:51,280 --> 02:00:53,000 MORE EFFECTIVELY. 3296 02:00:53,000 --> 02:00:54,120 SO, TEXT MESSAGING IS SOMETHING 3297 02:00:54,120 --> 02:00:55,720 THAT WORKS. 3298 02:00:55,720 --> 02:00:57,040 TELEPHONE CALL WORKS FOR 3299 02:00:57,040 --> 02:00:58,800 LATIN-AMERICAN POPULATIONS. 3300 02:00:58,800 --> 02:01:00,800 BUT ALSO IT IS SOMETHING THAT IS 3301 02:01:00,800 --> 02:01:02,040 MORE AND MORE FEASIBLE. 3302 02:01:02,040 --> 02:01:03,640 AND IF PEOPLE HAVE QUESTIONS, WE 3303 02:01:03,640 --> 02:01:06,360 CAN TALK ABOUT THAT DURING THE 3304 02:01:06,360 --> 02:01:10,680 QUESTION-AND-ANSWER PERIOD. 3305 02:01:10,680 --> 02:01:12,080 TELEMEDICINE AND INTERVENTION IS 3306 02:01:12,080 --> 02:01:13,480 SOMETHING THAT HAS INTERESTED US 3307 02:01:13,480 --> 02:01:15,280 FOR A VERY LONG TIME. 3308 02:01:15,280 --> 02:01:17,120 WHAT YOU SEE HERE IS AN 3309 02:01:17,120 --> 02:01:17,800 ILLUSTRATION OF ONE OF OUR 3310 02:01:17,800 --> 02:01:22,120 EARLIER STUDIES WHERE WE SET UP 3311 02:01:22,120 --> 02:01:22,760 A PLATFORM AT THE UNIVERSITY OF 3312 02:01:22,760 --> 02:01:23,040 MICHIGAN. 3313 02:01:23,040 --> 02:01:24,640 IN THIS CASE, TO TARGET AND 3314 02:01:24,640 --> 02:01:27,280 REACH COMMUNITY MEMBERS WITH 3315 02:01:27,280 --> 02:01:29,400 DIABETES AND COMMUNITIES AROUND 3316 02:01:29,400 --> 02:01:32,000 HONDURAS AND SERVED BY COMMUNITY 3317 02:01:32,000 --> 02:01:32,240 CLINICS. 3318 02:01:32,240 --> 02:01:33,560 THIS PARTICULAR INTERVENTION 3319 02:01:33,560 --> 02:01:35,600 USED AUTOMATED CALLS AND 3320 02:01:35,600 --> 02:01:36,600 PATIENTS WOULD GET REGULAR 3321 02:01:36,600 --> 02:01:38,640 AUTOMATED CALLS ON THEIR PHONE 3322 02:01:38,640 --> 02:01:41,080 AND RESPOND TO RECORDED MESSAGES 3323 02:01:41,080 --> 02:01:42,560 USING THEIR TOUCH TONE PHONE AND 3324 02:01:42,560 --> 02:01:43,800 BASED ON THAT INFORMATION, THEY 3325 02:01:43,800 --> 02:01:47,160 WOULD GET TARGETED AND TAILORED 3326 02:01:47,160 --> 02:01:49,600 SELF-MANAGEMENT SUPPORT 3327 02:01:49,600 --> 02:01:50,480 INFORMATION AND IMPORTANTLY IF 3328 02:01:50,480 --> 02:01:52,840 THEY REPORTED SOMETHING 3329 02:01:52,840 --> 02:01:53,400 PARTICULARLY CONCERNING, AN 3330 02:01:53,400 --> 02:01:56,080 ALERT WOULD GO BACK TO THE 3331 02:01:56,080 --> 02:01:57,000 CLINIC IS. 3332 02:01:57,000 --> 02:01:58,560 AND THE RIGHT HAND OF THE SCREEN 3333 02:01:58,560 --> 02:02:00,960 HERE IS THAT FIRST ALERT. 3334 02:02:00,960 --> 02:02:02,600 AT THAT TIME THOSE ALERTS WERE 3335 02:02:02,600 --> 02:02:06,080 PROVIDED TO CLINICIANS VIA FAX. 3336 02:02:06,080 --> 02:02:06,680 THIS WAS THE FIRST FAX TO COME 3337 02:02:06,680 --> 02:02:09,640 OUT OF THAT CLINIC'S FAX 3338 02:02:09,640 --> 02:02:10,040 MACHINE. 3339 02:02:10,040 --> 02:02:11,640 YOU CAN SEE THAT THERE WAS SO 3340 02:02:11,640 --> 02:02:13,240 MUCH EXCITEMENT ABOUT THIS 3341 02:02:13,240 --> 02:02:15,800 ADVANCE IN THEIR ABILITY TO 3342 02:02:15,800 --> 02:02:17,720 SUPPORT PATIENTS WHILE IN 3343 02:02:17,720 --> 02:02:19,520 COMMUNITIES RATHER THAN HAVING 3344 02:02:19,520 --> 02:02:21,640 THEM COME IN FOR A FACE-TO-FACE 3345 02:02:21,640 --> 02:02:21,840 VISIT. 3346 02:02:21,840 --> 02:02:22,360 THE FAX WAS SIGNED BY THE 3347 02:02:22,360 --> 02:02:25,560 DOCTORS, BY THE NURSES, BY THE 3348 02:02:25,560 --> 02:02:27,440 CHILDREN OF ALL THOSE 3349 02:02:27,440 --> 02:02:28,720 CLINICIANS. 3350 02:02:28,720 --> 02:02:29,320 THIS FAX HANGS IN MY OFFICE AT 3351 02:02:29,320 --> 02:02:32,400 THE UNIVERSITY OF MICHIGAN AS A 3352 02:02:32,400 --> 02:02:37,360 GREAT SOURCE OF INSPIRATION. 3353 02:02:37,360 --> 02:02:38,840 OF COURSE IN THAT PARTICULAR 3354 02:02:38,840 --> 02:02:41,760 STUDY WE DID MORE THAN RELY ON 3355 02:02:41,760 --> 02:02:44,240 THE INFORMAL FEEDBACK OF THOSE 3356 02:02:44,240 --> 02:02:46,080 CLINICIANS AND COMMUNITY MEMBERS 3357 02:02:46,080 --> 02:02:47,840 ABOUT WHETHER THE INTERVENTION 3358 02:02:47,840 --> 02:02:48,160 WAS VALUABLE. 3359 02:02:48,160 --> 02:02:51,440 WE THINK IT'S IMPORTANT TO 3360 02:02:51,440 --> 02:02:53,080 CONTINUALLY IN COMMUNITIES WORK 3361 02:02:53,080 --> 02:02:55,320 TO DO SYSTEMATIC EVALUATIONS 3362 02:02:55,320 --> 02:02:55,720 INCLUDING PILOTS. 3363 02:02:55,720 --> 02:02:58,280 LIKE THIS WAS A PILOT STUDY. 3364 02:02:58,280 --> 02:03:00,440 IN THIS PARTICULAR STUDY, WE 3365 02:03:00,440 --> 02:03:02,120 SURVEYED PARTICIPANTS WHO WERE 3366 02:03:02,120 --> 02:03:03,720 RECEIVING THESE AUTOMATED 3367 02:03:03,720 --> 02:03:05,000 SELF-MEDICINE SUPPORT CALLS AND 3368 02:03:05,000 --> 02:03:07,280 DESPITE VERY LIMITED FORMAL 3369 02:03:07,280 --> 02:03:08,480 EDUCATION, PARTICIPANTS TOLD US 3370 02:03:08,480 --> 02:03:10,760 THAT THE CALLS WERE EASY TO 3371 02:03:10,760 --> 02:03:14,200 RESPOND TO, THAT THEY HELPED 3372 02:03:14,200 --> 02:03:14,680 THEM A LOT. 3373 02:03:14,680 --> 02:03:16,920 AND WHAT WAS REALLY ENCOURAGING 3374 02:03:16,920 --> 02:03:19,760 IS THAT MANY PATIENTS HAD 3375 02:03:19,760 --> 02:03:21,240 SIGNIFICANT DECREASES OR 3376 02:03:21,240 --> 02:03:23,080 IMPROVEMENTS IN THE HEMOGLOBIN 3377 02:03:23,080 --> 02:03:24,760 A1C, MEASURE OF GLYCEMIC 3378 02:03:24,760 --> 02:03:26,800 CONTROL, DURING THE 3379 02:03:26,800 --> 02:03:27,120 INTERVENTION. 3380 02:03:27,120 --> 02:03:29,000 THAT WAS VERY ENCOURAGING TO US. 3381 02:03:29,000 --> 02:03:29,720 WE FOLLOWED UP ON THIS 3382 02:03:29,720 --> 02:03:33,040 PARTICULAR STUDY WITH A 3383 02:03:33,040 --> 02:03:34,200 RANDOMIZED INTERVENTION WITH A 3384 02:03:34,200 --> 02:03:34,680 CONTROL GROUP. 3385 02:03:34,680 --> 02:03:37,040 BECAUSE SINGLE GROUP STUDIES ARE 3386 02:03:37,040 --> 02:03:41,360 NOT A PARTICULARLY RIGOROUS OR 3387 02:03:41,360 --> 02:03:41,920 HIGH-QUALITY OF EVIDENCE. 3388 02:03:41,920 --> 02:03:44,520 SO WE CONDUCTED A RANDOMIZED 3389 02:03:44,520 --> 02:03:47,280 TRIAL, IN THIS CASE WITH 3390 02:03:47,280 --> 02:03:48,960 COMMUNITIES NOT ONLY IN HONDURAS 3391 02:03:48,960 --> 02:03:53,280 BUT BOTH IN HONDURAS AND IN 3392 02:03:53,280 --> 02:03:53,520 MEXICO. 3393 02:03:53,520 --> 02:03:54,680 THIS WAS A STUDY THAT INCLUDED 3394 02:03:54,680 --> 02:03:57,880 PATIENTS WITH POORLY-CONTROLLED 3395 02:03:57,880 --> 02:03:58,240 HYPERTENSION. 3396 02:03:58,240 --> 02:03:59,280 ONCE AGAIN, LIKE WITH OUR 3397 02:03:59,280 --> 02:04:00,480 DIABETES INTERVENTION, PATIENTS 3398 02:04:00,480 --> 02:04:05,200 WERE RECEIVING REGULAR AUTOMATED 3399 02:04:05,200 --> 02:04:07,760 CALLS COMING FROM MICHIGAN TO 3400 02:04:07,760 --> 02:04:09,120 THEIR STANDARD CELL PHONES. 3401 02:04:09,120 --> 02:04:11,360 AND BASED ON THAT INFORMATION, 3402 02:04:11,360 --> 02:04:12,960 CLINICIANS COULD GET ALERTED. 3403 02:04:12,960 --> 02:04:14,680 PATIENTS COULD GET MORE ACCESS 3404 02:04:14,680 --> 02:04:20,240 TO SELF-MANAGEMENT AND HEALTH 3405 02:04:20,240 --> 02:04:21,720 EDUCATION ADVICE. 3406 02:04:21,720 --> 02:04:23,240 THE RESULTS OF THE TRIAL WERE 3407 02:04:23,240 --> 02:04:25,120 REALLY QUITE ENCOURAGING TO US. 3408 02:04:25,120 --> 02:04:27,640 COMPARED TO RANDOMIZED CONTROL 3409 02:04:27,640 --> 02:04:28,880 PATIENTS, PATIENTS IN THAT 3410 02:04:28,880 --> 02:04:31,960 INTERVENTION GROUP WHO HAD THIS 3411 02:04:31,960 --> 02:04:33,120 TELEPHONIC SUPPORT HAD ON 3412 02:04:33,120 --> 02:04:35,320 AVERAGE ABOUT A 4 POINT DROP IN 3413 02:04:35,320 --> 02:04:36,360 THEIR SYSTOLIC BLOOD PRESSURE, 3414 02:04:36,360 --> 02:04:38,360 WHICH IS QUITE RESPECTABLE 3415 02:04:38,360 --> 02:04:41,120 IMPROVEMENT IN SYSTOLIC BLOOD 3416 02:04:41,120 --> 02:04:41,960 PRESSURE CONTROL. 3417 02:04:41,960 --> 02:04:43,280 WE LEARNED SOMETHING ELSE THAT 3418 02:04:43,280 --> 02:04:44,640 WAS REALLY PARTICULARLY 3419 02:04:44,640 --> 02:04:46,320 IMPORTANT IN OUR SUBSEQUENT 3420 02:04:46,320 --> 02:04:46,520 WORK. 3421 02:04:46,520 --> 02:04:48,240 THAT IS THAT WHEN WE FOCUS ON 3422 02:04:48,240 --> 02:04:50,080 THE SUBSET OF PATIENTS THAT IT 3423 02:04:50,080 --> 02:04:52,360 IS WE MIGHT CONSIDER THE MOST 3424 02:04:52,360 --> 02:04:54,400 VULNERABLE, PATIENTS WITH LOW 3425 02:04:54,400 --> 02:04:56,360 LITERACY ENTERING THE STUDY, 3426 02:04:56,360 --> 02:04:58,640 LOWER LEVELS OF EDUCATION, 3427 02:04:58,640 --> 02:04:59,200 PATIENTS THAT TOLD US THEY 3428 02:04:59,200 --> 02:05:00,280 DIDN'T UNDERSTAND THEIR 3429 02:05:00,280 --> 02:05:01,560 MEDICATIONS, THAT THEY WERE 3430 02:05:01,560 --> 02:05:04,680 HAVING TROUBLE FOLLOWING THEIR 3431 02:05:04,680 --> 02:05:05,080 SELF-MANAGEMENT. 3432 02:05:05,080 --> 02:05:07,080 THAT WAS TWO-THIRDS OF THE 3433 02:05:07,080 --> 02:05:08,040 OVERALL SAMPLE. 3434 02:05:08,040 --> 02:05:09,720 IN THAT PARTICULAR SUBGROUP OF 3435 02:05:09,720 --> 02:05:10,920 PATIENTS, THERE WAS A VERY 3436 02:05:10,920 --> 02:05:13,440 SIGNIFICANT IMPROVEMENT IN THEIR 3437 02:05:13,440 --> 02:05:14,520 SYSTOLIC BLOOD PRESSURE WHEN 3438 02:05:14,520 --> 02:05:17,280 THEY HAD ACCESS TO THE 3439 02:05:17,280 --> 02:05:18,920 ADDITIONAL INFORMATION VIA 3440 02:05:18,920 --> 02:05:20,160 TELEHEALTH OR AUTOMATED 3441 02:05:20,160 --> 02:05:21,840 TELEHEALTH SUPPORT SYSTEM. 3442 02:05:21,840 --> 02:05:23,120 SO THAT WAS REALLY ENCOURAGING 3443 02:05:23,120 --> 02:05:24,120 TO US. 3444 02:05:24,120 --> 02:05:26,040 IN ADDITION, THOSE INTERVENTION 3445 02:05:26,040 --> 02:05:27,280 PATIENTS WERE MORE LIKELY TO 3446 02:05:27,280 --> 02:05:30,080 TELL US THAT THEIR OVERALL 3447 02:05:30,080 --> 02:05:33,040 HEALTH WAS BETTER AFTER 3448 02:05:33,040 --> 02:05:33,960 RECEIVING THE INTERVENTION, 3449 02:05:33,960 --> 02:05:35,040 FEWER PROBLEMS TAKING MEDICATION 3450 02:05:35,040 --> 02:05:37,200 AND SOMETHING WE SEEN REPEATEDLY 3451 02:05:37,200 --> 02:05:38,240 IS THAT THEY ALSO TOLD US THAT 3452 02:05:38,240 --> 02:05:40,280 THEY HAD FEWER DEPRESSIVE 3453 02:05:40,280 --> 02:05:40,680 SYMPTOMS. 3454 02:05:40,680 --> 02:05:46,320 SO WE REALLY CENTERED OUR WORK 3455 02:05:46,320 --> 02:05:47,000 ON MENTAL HEALTH IN COMMUNITIES 3456 02:05:47,000 --> 02:05:48,920 OVER RECENT YEARS, SPECIFICALLY 3457 02:05:48,920 --> 02:05:51,080 AROUND WOMEN THAT ARE 3458 02:05:51,080 --> 02:05:51,560 EXPERIENCING VIOLENCE. 3459 02:05:51,560 --> 02:05:53,320 SO WE REALLY TRIED TO 3460 02:05:53,320 --> 02:05:58,200 CONTINUALLY DO THIS SORT OF 3461 02:05:58,200 --> 02:05:59,120 COMMUNITY ENGAGED PILOTING AND 3462 02:05:59,120 --> 02:06:01,840 FEASIBILITY AND KIND OF 3463 02:06:01,840 --> 02:06:02,880 ENGAGEMENT WORK WITH 3464 02:06:02,880 --> 02:06:03,400 COMMUNITIES. 3465 02:06:03,400 --> 02:06:05,200 ANOTHER PLACE THAT WE HAVE 3466 02:06:05,200 --> 02:06:08,200 WORKED FOR A NUMBER OF YEARS IS 3467 02:06:08,200 --> 02:06:09,480 IN BOLIVIA. 3468 02:06:09,480 --> 02:06:10,560 THIS IS A WOMAN THAT WAS 3469 02:06:10,560 --> 02:06:12,280 PARTICIPATING IN ONE OF OUR 3470 02:06:12,280 --> 02:06:14,120 STUDIES MANY YEARS AGO. 3471 02:06:14,120 --> 02:06:21,520 SHE IS FROM A COMMUNITY IN -- 3472 02:06:21,520 --> 02:06:23,400 INDIGENOUS COMMUNITY AROUND THE 3473 02:06:23,400 --> 02:06:23,960 CAPITOL OF BOLIVIA. 3474 02:06:23,960 --> 02:06:25,800 BECAUSE PATIENTS ARE GETTING 3475 02:06:25,800 --> 02:06:26,960 REGULAR AUTOMATED CALLS. 3476 02:06:26,960 --> 02:06:31,560 ONE THING WE CAN DO TO KIND OF 3477 02:06:31,560 --> 02:06:32,760 EVALUATE ENGAGEMENT AND 3478 02:06:32,760 --> 02:06:34,600 FEASIBILITY OF COMMUNICATING 3479 02:06:34,600 --> 02:06:37,600 WITH PARTICIPANTS IN THIS WAY, 3480 02:06:37,600 --> 02:06:38,720 IS WE CAN MONITOR THE EXTENT TO 3481 02:06:38,720 --> 02:06:40,560 WHICH PATIENTS ARE SUCCESSFULLY 3482 02:06:40,560 --> 02:06:41,560 COMPLETING THOSE CALLS. 3483 02:06:41,560 --> 02:06:42,800 I MEAN, THEY GET THEM ABOUT 3484 02:06:42,800 --> 02:06:45,640 EVERY DAY OR MAYBE ONCE A WEEK. 3485 02:06:45,640 --> 02:06:46,960 WE CAN LOOK AT THE PROBABILITY 3486 02:06:46,960 --> 02:06:49,160 THAT THEY ARE COMPLETING CALLS 3487 02:06:49,160 --> 02:06:51,400 AND WHETHER THAT LIKELIHOOD OR 3488 02:06:51,400 --> 02:06:53,520 THE NUMBER OF CALLS PATIENTS ARE 3489 02:06:53,520 --> 02:06:55,520 COMPLETING VARIES ACCORDING TO 3490 02:06:55,520 --> 02:06:57,600 SUBGROUPS OF THAT POPULATION. 3491 02:06:57,600 --> 02:07:00,640 SO WHAT YOU SEE HERE FOR EXAMPLE 3492 02:07:00,640 --> 02:07:03,160 IS THAT CALL COMPLETION RATES 3493 02:07:03,160 --> 02:07:05,800 WAS ROUGHLY CONSISTENT IN 3494 02:07:05,800 --> 02:07:07,280 BOLIVIA IN THIS PARTICULAR PILOT 3495 02:07:07,280 --> 02:07:09,760 STUDY UNTIL PATIENTS WERE ABOUT 3496 02:07:09,760 --> 02:07:10,120 65 YEARS OLD. 3497 02:07:10,120 --> 02:07:11,880 AND FOR THE OLDER PARTICIPANTS 3498 02:07:11,880 --> 02:07:14,960 IN THIS STUDY, COMPLETION RATES 3499 02:07:14,960 --> 02:07:17,280 WENT DOWN SIGNIFICANTLY. 3500 02:07:17,280 --> 02:07:18,560 IT WAS SIGNIFICANTLY WORSE. 3501 02:07:18,560 --> 02:07:21,480 IN OTHER WORDS, PATIENTS THAT OR 3502 02:07:21,480 --> 02:07:22,960 PARTICIPANTS 70 OR 75 WERE MUCH 3503 02:07:22,960 --> 02:07:24,640 LESS LIKELY THAN YOUNGER 3504 02:07:24,640 --> 02:07:28,320 PATIENTS TO ENGAGE WITH THE 3505 02:07:28,320 --> 02:07:29,960 INTERVENTION. 3506 02:07:29,960 --> 02:07:32,120 SO WORKING WITH THOSE 3507 02:07:32,120 --> 02:07:34,920 COMMUNITIES, WE TRIED TO FIGURE 3508 02:07:34,920 --> 02:07:35,680 OUT WHAT WE COULD DO AND WE 3509 02:07:35,680 --> 02:07:36,880 LEARNED SOMETHING ELSE THAT WAS 3510 02:07:36,880 --> 02:07:38,040 VERY IMPORTANT. 3511 02:07:38,040 --> 02:07:41,040 THAT WAS THE POSSIBILITY OR THE 3512 02:07:41,040 --> 02:07:42,080 POSSIBLE BENEFITS OF INCLUDING 3513 02:07:42,080 --> 02:07:44,240 THE COMMUNICATION LOOP NOT JUST 3514 02:07:44,240 --> 02:07:46,440 THE PATIENT AND THE CLINICIAN, 3515 02:07:46,440 --> 02:07:48,240 BUT MAYBE AN ADULT CHILD OR 3516 02:07:48,240 --> 02:07:50,080 OTHER TRUSTED FAMILY MEMBER. 3517 02:07:50,080 --> 02:07:51,840 SO WE DEVELOPED A SYSTEM WHERE 3518 02:07:51,840 --> 02:07:54,080 PATIENTS WOULD GET THESE REGULAR 3519 02:07:54,080 --> 02:07:56,480 SELF-MANAGEMENT ASSISTANCE CALLS 3520 02:07:56,480 --> 02:07:57,480 BUT BESIDES WHAT THEY WERE 3521 02:07:57,480 --> 02:07:59,680 REPORTING, FAMILY MEMBERS COULD 3522 02:07:59,680 --> 02:08:01,360 GET FEEDBACK AT THAT TIME. 3523 02:08:01,360 --> 02:08:03,360 IT WAS OFTEN BY AN E-MAIL OR A 3524 02:08:03,360 --> 02:08:05,560 TEXT MESSAGE TO THOSE FAMILY 3525 02:08:05,560 --> 02:08:05,800 MEMBERS. 3526 02:08:05,800 --> 02:08:08,560 SO THOSE FAMILY MEMBERS FELT IN 3527 02:08:08,560 --> 02:08:10,280 THE LOOP AND THEY WOULD SUPPORT 3528 02:08:10,280 --> 02:08:12,280 THE PATIENTS ENGAGEMENT AND 3529 02:08:12,280 --> 02:08:13,600 IDENTIFY WHEN PATIENTS WEREN'T 3530 02:08:13,600 --> 02:08:16,640 BEING ENGAGED AND HELP THEM 3531 02:08:16,640 --> 02:08:19,280 TROUBLESHOOT PROBLEMS, ET CET 3532 02:08:19,280 --> 02:08:19,560 ET CETERA. 3533 02:08:19,560 --> 02:08:23,720 WE CONDUCTED A PILOT OF THAT 3534 02:08:23,720 --> 02:08:24,360 INTERVENTION AMONG PATIENTS 3535 02:08:24,360 --> 02:08:26,360 DIABETES AND HYPERTENSION IN LA 3536 02:08:26,360 --> 02:08:26,560 PAS. 3537 02:08:26,560 --> 02:08:29,320 ALL THE PARTICIPANTS IN THAT 3538 02:08:29,320 --> 02:08:31,280 PILOT STUDY WERE GETTING THESE 3539 02:08:31,280 --> 02:08:33,040 REGULAR SELF-MANAGEMENT 3540 02:08:33,040 --> 02:08:34,360 ASSISTANCE CALLS. 3541 02:08:34,360 --> 02:08:36,840 BUT, IN ONLY ONE OF THE TWO 3542 02:08:36,840 --> 02:08:38,280 INTERVENTION GROUPS WAS THIS 3543 02:08:38,280 --> 02:08:40,360 TRUSTED FAMILY MEMBER GETTING 3544 02:08:40,360 --> 02:08:42,160 FEEDBACK ABOUT HOW THE PATIENT 3545 02:08:42,160 --> 02:08:43,800 WAS DOING. 3546 02:08:43,800 --> 02:08:46,800 OUR HYPOTHESIS WAS THAT FAMILY 3547 02:08:46,800 --> 02:08:49,240 ENGAGEMENT WOULD SUPPORT THE 3548 02:08:49,240 --> 02:08:51,480 PATIENT'S ABILITY TO ADHERE TO 3549 02:08:51,480 --> 02:08:54,120 CONTINUE TO BE ENGAGED 3550 02:08:54,120 --> 02:08:57,080 SUCCESSFULLY IN THE 3551 02:08:57,080 --> 02:08:57,680 INTERVENTION. 3552 02:08:57,680 --> 02:08:58,960 THAT'S EXACTLY WHAT WE FOUND. 3553 02:08:58,960 --> 02:09:01,040 SO WHAT YOU SEE HERE IS THAT IN 3554 02:09:01,040 --> 02:09:02,960 THE OVERALL SAMPLE, AFTER A 3555 02:09:02,960 --> 02:09:06,080 NUMBER OF WEEKS OF THIS SORT OF 3556 02:09:06,080 --> 02:09:07,360 INTERVENTION, THE GROUP IN BLUE 3557 02:09:07,360 --> 02:09:09,320 IS THE GROUP THAT HAD FAMILY 3558 02:09:09,320 --> 02:09:11,280 MEMBERS GETTING FEEDBACK ABOUT 3559 02:09:11,280 --> 02:09:13,680 HOW THEY WERE DOING AND COMPARED 3560 02:09:13,680 --> 02:09:15,720 TO THE ORANGE BAR YOU SEE HERE 3561 02:09:15,720 --> 02:09:18,400 ON THE RIGHT, WHEN FAMILY MEMBER 3562 02:09:18,400 --> 02:09:21,400 WAS GETTING FEEDBACK, PATIENTS 3563 02:09:21,400 --> 02:09:23,080 WERE SUBSTANTIALLY MORE LIKELY 3564 02:09:23,080 --> 02:09:26,560 TO COMPLY WITH THE INTERVENTION. 3565 02:09:26,560 --> 02:09:27,960 BUT JUST LIKE IN OUR STUDY IN 3566 02:09:27,960 --> 02:09:30,960 HONDURAS OR HONDURAS AND MEXICO 3567 02:09:30,960 --> 02:09:33,560 FOR PATIENTS WITH HYPERTENSION, 3568 02:09:33,560 --> 02:09:38,480 WE FOUND THAT THE MOST 3569 02:09:38,480 --> 02:09:38,960 VULNERABLE PATIENTS, THE 3570 02:09:38,960 --> 02:09:40,120 PATIENTS MOST CONCERNED ABOUT, 3571 02:09:40,120 --> 02:09:42,720 THE MOST INTERESTED IN SERVING. 3572 02:09:42,720 --> 02:09:43,760 THOSE PATIENTS BENEFITED THE 3573 02:09:43,760 --> 02:09:46,480 MOST FROM THIS SORT OF FAMILY 3574 02:09:46,480 --> 02:09:46,760 ENGAGEMENT. 3575 02:09:46,760 --> 02:09:49,160 LET ME SHOW YOU WHAT THAT LOOKS 3576 02:09:49,160 --> 02:09:49,360 LIKE. 3577 02:09:49,360 --> 02:09:50,960 IN THE SUBSET OF PARTICIPANTS 3578 02:09:50,960 --> 02:09:52,400 THAT IDENTIFIED AS INDIGENOUS, 3579 02:09:52,400 --> 02:09:55,160 IN THIS CASE, LIKE THE WOMAN IN 3580 02:09:55,160 --> 02:09:59,960 THE PICTURE YOU SAW EARLIER, 3581 02:09:59,960 --> 02:10:00,640 WHEN THOSE PATIENTS DID NOT HAVE 3582 02:10:00,640 --> 02:10:01,840 A FAMILY MEMBER IN THE 3583 02:10:01,840 --> 02:10:03,160 COMMUNICATION GROUP, THEY REALLY 3584 02:10:03,160 --> 02:10:04,680 DID QUITE POORLY. 3585 02:10:04,680 --> 02:10:07,280 THEY ONLY COMPLETED ABOUT 19% OF 3586 02:10:07,280 --> 02:10:07,800 THEIR CALLS. 3587 02:10:07,800 --> 02:10:10,000 IN CONTRAST, WHEN FAMILY MEMBERS 3588 02:10:10,000 --> 02:10:13,920 WERE INCLUDED, THOSE INDIGENOUS 3589 02:10:13,920 --> 02:10:15,960 PARTICIPANTS COMPLETED 58% OF 3590 02:10:15,960 --> 02:10:17,400 THEIR CALLS. 3591 02:10:17,400 --> 02:10:17,960 SENATORIALLY, AMONG PATIENTS 3592 02:10:17,960 --> 02:10:20,000 THAT TOLD US THAT THEIR 3593 02:10:20,000 --> 02:10:20,560 MEDICATION ADHERENCE WAS NOT 3594 02:10:20,560 --> 02:10:23,280 THAT GOOD, WHEN THEY ENROLLED IN 3595 02:10:23,280 --> 02:10:25,880 THIS STUDY, IF FAMILY MEMBERS 3596 02:10:25,880 --> 02:10:29,840 WERE NOT INCLUDED IN THE 3597 02:10:29,840 --> 02:10:31,000 COMMUNICATION LOOP, THEY 3598 02:10:31,000 --> 02:10:33,760 COMPLETED 28 OR 29% OF THEIR 3599 02:10:33,760 --> 02:10:34,040 CALLS. 3600 02:10:34,040 --> 02:10:34,640 IN CONTRAST THEY COMPLETED 62% 3601 02:10:34,640 --> 02:10:37,440 WHEN FAMILY MEMBERS WERE -- WHEN 3602 02:10:37,440 --> 02:10:38,480 INFORMATION WAS SHARED WITH 3603 02:10:38,480 --> 02:10:39,080 FAMILY MEMBERS. 3604 02:10:39,080 --> 02:10:42,480 AND FINALLY, THOSE LOW LITERACY 3605 02:10:42,480 --> 02:10:43,960 PATIENTS OFTEN THE MOST 3606 02:10:43,960 --> 02:10:48,120 CONCERNED ABOUT, THEY REALLY 3607 02:10:48,120 --> 02:10:49,280 INCLUSION OF FAMILY MEMBERS TO 3608 02:10:49,280 --> 02:10:50,600 HELP THEM ENGAGE WITH THE 3609 02:10:50,600 --> 02:10:54,120 INTERVENTION, TRUST THE 3610 02:10:54,120 --> 02:10:54,680 INTERVENTION, TROUBLESHOOT 3611 02:10:54,680 --> 02:10:55,360 PROBLEMS, UNDERSTAND WHAT THE 3612 02:10:55,360 --> 02:10:57,360 MEANING OF THOSE CALLS FOR THEM 3613 02:10:57,360 --> 02:11:01,040 AND FOR THE FAMILY AND FOR 3614 02:11:01,040 --> 02:11:01,400 SELF-MANAGEMENT. 3615 02:11:01,400 --> 02:11:04,480 THAT FAMILY ENGAGEMENT TRIPLED 3616 02:11:04,480 --> 02:11:06,120 THE NUMBER OF TIMES IN WHICH 3617 02:11:06,120 --> 02:11:07,160 PATIENTS COMPLETED THE 3618 02:11:07,160 --> 02:11:07,480 INTERVENTION. 3619 02:11:07,480 --> 02:11:08,680 WE LEARNED SOMETHING REALLY 3620 02:11:08,680 --> 02:11:10,960 IMPORTANT FROM THIS ABOUT THE 3621 02:11:10,960 --> 02:11:16,120 POTENTIAL ROLE OF FAMILY IN 3622 02:11:16,120 --> 02:11:18,120 INTERVENTIONS FOR PEOPLE IN 3623 02:11:18,120 --> 02:11:19,920 COMMUNITIES, ESPECIALLY SOME OF 3624 02:11:19,920 --> 02:11:21,880 THE MOST VULNERABLE SUBSETS OF 3625 02:11:21,880 --> 02:11:23,440 HISPANIC AND LATINO PEOPLE IN 3626 02:11:23,440 --> 02:11:28,200 LATIN AMERICA AND IN THE U.S. 3627 02:11:28,200 --> 02:11:31,320 AS I MENTIONED, WE REALLY 3628 02:11:31,320 --> 02:11:32,360 CENTERED MENTAL HEALTH AS REALLY 3629 02:11:32,360 --> 02:11:33,880 A FOCUS OF OUR WORK. 3630 02:11:33,880 --> 02:11:35,200 AND I'LL SHARE WITH YOU SOME 3631 02:11:35,200 --> 02:11:39,440 DATA CONCERNING DATA FROM THE 3632 02:11:39,440 --> 02:11:41,160 CDC, MORBIDITY AND MORTALITY 3633 02:11:41,160 --> 02:11:42,120 WEEKLY REPORT. 3634 02:11:42,120 --> 02:11:43,200 THIS WAS A 3635 02:11:43,200 --> 02:11:46,080 NATIONALLY-REPRESENTATIVE SURVEY 3636 02:11:46,080 --> 02:11:47,280 IN THE UNITED STATES DURING THE 3637 02:11:47,280 --> 02:11:48,760 COVID PANDEMIC. 3638 02:11:48,760 --> 02:11:50,880 IN WHAT THIS REPORT SHOWED IS 3639 02:11:50,880 --> 02:11:52,200 THAT HISPANIC/LATINO PEOPLE WERE 3640 02:11:52,200 --> 02:11:54,640 MORE LIKELY TO BE REPORTED 3641 02:11:54,640 --> 02:11:56,840 SIGNIFICANT SYMPTOMS OF ANXIETY 3642 02:11:56,840 --> 02:11:59,920 THAN WHITE NON-HISPANIC, LATIN 3643 02:11:59,920 --> 02:12:01,760 HISPANIC OR ASIAN PATIENTS. 3644 02:12:01,760 --> 02:12:03,240 HISPANICS WERE MORE LIKELY TO 3645 02:12:03,240 --> 02:12:05,520 REPORT SYMPTOMS OF DEPRESSION. 3646 02:12:05,520 --> 02:12:08,160 MORE LIKELY TO REPORT SUICIDAL 3647 02:12:08,160 --> 02:12:10,240 THOUGHTS, MORE LIKELY TO REPORT 3648 02:12:10,240 --> 02:12:12,400 INCREASING THEIR ALCOHOL INTAKE. 3649 02:12:12,400 --> 02:12:14,480 THEY WERE MORE LIKELY TO REPORT 3650 02:12:14,480 --> 02:12:16,920 CONCERNS ABOUT COVID. 3651 02:12:16,920 --> 02:12:18,960 SO MENTAL HEALTH IS CLEARLY 3652 02:12:18,960 --> 02:12:21,840 SIGNIFICANT AND WE SEE THAT WITH 3653 02:12:21,840 --> 02:12:23,280 IMGRANT POPULATIONS COMING FROM 3654 02:12:23,280 --> 02:12:25,400 REALLY QUITE DISTRESSING 3655 02:12:25,400 --> 02:12:27,280 ENVIRONMENTS WHERE THEY MIGHT BE 3656 02:12:27,280 --> 02:12:28,920 COMING TO THE U.S. WITH TRAUMA 3657 02:12:28,920 --> 02:12:29,880 FROM THEIR HOME COUNTRY OR 3658 02:12:29,880 --> 02:12:31,040 TRAUMA FROM THE PROCESS OF 3659 02:12:31,040 --> 02:12:32,760 ENTERING THE UNITED STATES. 3660 02:12:32,760 --> 02:12:35,760 AND SO WE ARE FOCUSING ON THESE 3661 02:12:35,760 --> 02:12:37,240 INTERVENTIONS LISTENING TO THOSE 3662 02:12:37,240 --> 02:12:39,600 COMMUNITIES AND FOCUSING ON 3663 02:12:39,600 --> 02:12:41,920 THESE PROBLEMS OF MENTAL HEALTH 3664 02:12:41,920 --> 02:12:43,280 SPECIFICALLY DEPRESSION, ANXIETY 3665 02:12:43,280 --> 02:12:52,760 AND PTSD AMONG WOMEN WE HAVE AN 3666 02:12:52,760 --> 02:12:54,680 ONGOING PROJECT FOR WOMEN IN 3667 02:12:54,680 --> 02:12:55,000 HONDURAS. 3668 02:12:55,000 --> 02:12:56,800 IT'S REALLY QUITE RELEVANT AND 3669 02:12:56,800 --> 02:12:59,280 WE ARE VERY ANXIOUS TO EXPAND 3670 02:12:59,280 --> 02:13:00,960 SOME OF THESE PROGRAMS TO SOME 3671 02:13:00,960 --> 02:13:02,120 OF THOSE IMMIGRANTS THAT MIGHT 3672 02:13:02,120 --> 02:13:05,360 BE EXPERIENCING TRAUMA IN THE 3673 02:13:05,360 --> 02:13:07,280 UNITED STATES. 3674 02:13:07,280 --> 02:13:08,560 THE LAST THING I WANTED TO 3675 02:13:08,560 --> 02:13:10,880 MENTION VERY BRIEFLY IS THAT IN 3676 02:13:10,880 --> 02:13:12,680 ADDITION TO CONTINUING A 3677 02:13:12,680 --> 02:13:14,200 DIALOGUE WITH COMMUNITY 3678 02:13:14,200 --> 02:13:17,400 PARTNERS, IT'S GOOD TO USE THESE 3679 02:13:17,400 --> 02:13:18,920 COMMUNITY-BASED INTERVENTION 3680 02:13:18,920 --> 02:13:23,680 PRACTICES SORT OF THE BEST 3681 02:13:23,680 --> 02:13:25,800 PRACTICES FOR ADOPTING AND 3682 02:13:25,800 --> 02:13:27,320 ADAPTING AN INTERVENTION FOR A 3683 02:13:27,320 --> 02:13:27,680 NEW CONTEXT. 3684 02:13:27,680 --> 02:13:29,960 THAT IS WHAT WE ARE DOING WITH 3685 02:13:29,960 --> 02:13:32,880 THIS ONGOING WORK WITH COMMUNITY 3686 02:13:32,880 --> 02:13:34,920 PARTNERS AROUND MENTAL HEALTH, 3687 02:13:34,920 --> 02:13:35,440 TELEHEALTH INTERVENTIONS. 3688 02:13:35,440 --> 02:13:38,080 SPECIFICALLY WE ARE TAKING THESE 3689 02:13:38,080 --> 02:13:38,720 EVIDENCE-BASED PROGRAMS LOOKING 3690 02:13:38,720 --> 02:13:41,640 AT EVERYTHING, TRAINING, 3691 02:13:41,640 --> 02:13:42,440 SUPERVISION, MATERIALS AND 3692 02:13:42,440 --> 02:13:46,520 DELIVERY AND WE ARE ASKING TWO 3693 02:13:46,520 --> 02:13:46,800 QUESTIONS. 3694 02:13:46,800 --> 02:13:47,400 FIRST WHAT NEEDS TO BE MODIFIED 3695 02:13:47,400 --> 02:13:48,800 TO MAKE THE PROGRAM WORK IN THIS 3696 02:13:48,800 --> 02:13:50,440 NEW CONTEXT IN ENGAGING 3697 02:13:50,440 --> 02:13:52,920 COMMUNITY PARTNERS TO HELP 3698 02:13:52,920 --> 02:13:53,440 PROFESSIONALS ET CETERA? 3699 02:13:53,440 --> 02:13:54,680 WE ARE ALSO ASKING THE EXPERTS 3700 02:13:54,680 --> 02:13:56,880 WHAT ARE THE KEY ELEMENTS THAT 3701 02:13:56,880 --> 02:14:00,480 WE NEED TO MAINTAIN TO ENSURE 3702 02:14:00,480 --> 02:14:03,760 THAT THESE PROGRAMS HAVE KEY 3703 02:14:03,760 --> 02:14:05,440 FEATURES THAT MAKE THEM 3704 02:14:05,440 --> 02:14:06,440 EFFECTIVE AND WILL CONTINUE TO 3705 02:14:06,440 --> 02:14:08,720 MAKE THEM EFFECTIVE FOR HISPANIC 3706 02:14:08,720 --> 02:14:11,280 AND LATINO PEOPLE. 3707 02:14:11,280 --> 02:14:16,560 THANK YOU. 3708 02:14:16,560 --> 02:14:18,600 >>MY NAME IS CARMEN VELEZ VEGA, 3709 02:14:18,600 --> 02:14:20,600 THE DIRECTOR OF COMMUNITY 3710 02:14:20,600 --> 02:14:23,120 ENGAGEMENT CORE FOR THE CENTER 3711 02:14:23,120 --> 02:14:23,720 OF COLLABORATIVE RESEARCH AND 3712 02:14:23,720 --> 02:14:24,240 HEALTH DISPARITIES AT THE 3713 02:14:24,240 --> 02:14:25,840 UNIVERSITY OF PUERTO RICO ON 3714 02:14:25,840 --> 02:14:27,400 MEDICAL SCIENCES CAMPUS. 3715 02:14:27,400 --> 02:14:30,520 I'M HERE TO TALK ABOUT 3716 02:14:30,520 --> 02:14:35,800 COMMUNITY-ENGAGED RESEARCH. 3717 02:14:35,800 --> 02:14:37,160 THE DAY OF THE DEAD. 3718 02:14:37,160 --> 02:14:42,080 THIS IS A CELEBRATION THAT IS 3719 02:14:42,080 --> 02:14:42,680 COMMEMORATED THROUGHOUT LATIN 3720 02:14:42,680 --> 02:14:42,920 AMERICA. 3721 02:14:42,920 --> 02:14:45,160 I DEDICATE THIS PRESENTATION TO 3722 02:14:45,160 --> 02:14:47,480 OUR ANCESTORS THAT CAME BEFORE 3723 02:14:47,480 --> 02:14:49,600 ME AND MADE IT POSSIBLE FOR OUR 3724 02:14:49,600 --> 02:14:51,600 JOURNEY TO BE EASIER AND OUR 3725 02:14:51,600 --> 02:14:52,080 ACHIEVEMENTS POSSIBLE. 3726 02:14:52,080 --> 02:14:59,240 MAY THEIR JOURNEY ARE FILLED 3727 02:14:59,240 --> 02:15:02,120 WITH LIGHT. 3728 02:15:02,120 --> 02:15:03,240 I LEARNED THIS FROM OUR 3729 02:15:03,240 --> 02:15:10,600 COMMUNITY LEADER IN PUERTO RICO. 3730 02:15:10,600 --> 02:15:11,640 SHE IS A FEARLESS IN OUR 3731 02:15:11,640 --> 02:15:12,320 COMMUNITY AND TAUGHT ME A LONG 3732 02:15:12,320 --> 02:15:14,680 TIME AGO THAT PUERTO RICO IS IT 3733 02:15:14,680 --> 02:15:15,400 AN ARK PEL GA. 3734 02:15:15,400 --> 02:15:17,280 WE ARE NOT AN ISLAND. 3735 02:15:17,280 --> 02:15:20,320 WE ARE SEVERAL ISLANDS AND ON 3736 02:15:20,320 --> 02:15:21,200 EACH ISLAND PEOPLE LIVE AND NEED 3737 02:15:21,200 --> 02:15:22,480 AND SUFFER AND CELEBRATE. 3738 02:15:22,480 --> 02:15:25,760 SO FROM HERE ON, PUERTO RICO IS 3739 02:15:25,760 --> 02:15:26,600 AN ARK PEL GO. 3740 02:15:26,600 --> 02:15:29,480 THIS PRESENTATION, I WILL BE 3741 02:15:29,480 --> 02:15:30,120 TALKING ABOUT COMMUNITY-ENGAGED 3742 02:15:30,120 --> 02:15:32,120 RESEARCH. 3743 02:15:32,120 --> 02:15:32,480 THE VALUE OF THE 3744 02:15:32,480 --> 02:15:34,440 COMMUNITY-ENGAGED RESEARCH, THE 3745 02:15:34,440 --> 02:15:36,360 IMPORTANT ELEMENTS OF THIS 3746 02:15:36,360 --> 02:15:38,000 RESEARCH AND SOME EXPERIENCES 3747 02:15:38,000 --> 02:15:48,520 FROM THE ARK PEL GO PUERTO RICO. 3748 02:16:00,240 --> 02:16:01,800 THIS IS IMPORTANT SO YOU KNOW 3749 02:16:01,800 --> 02:16:02,920 WHY MY RELATIONSHIP IS TO THE 3750 02:16:02,920 --> 02:16:07,400 COMMUNITIES AND HOW I USE 3751 02:16:07,400 --> 02:16:08,240 COMMUNITY ENGAGEMENT RESEARCH. 3752 02:16:08,240 --> 02:16:11,240 COMMUNITY IS A GROUP OF PEOPLE 3753 02:16:11,240 --> 02:16:13,040 WHO HAVE COMMON INTERESTS. 3754 02:16:13,040 --> 02:16:13,800 COMMUNITIES ARE DEFINED BY 3755 02:16:13,800 --> 02:16:15,480 GEOGRAPHIC LOCATION, ETHICAL OR 3756 02:16:15,480 --> 02:16:17,720 RACIAL GROUP, AGE, OCCUPATION, 3757 02:16:17,720 --> 02:16:20,200 SHARED INTERESTS OR AFFINITIES 3758 02:16:20,200 --> 02:16:21,880 LIKE RELIGION OR FAITH OR OTHER 3759 02:16:21,880 --> 02:16:23,280 COMMON BONDS. 3760 02:16:23,280 --> 02:16:23,960 SOMETIMES THE COMMUNITY COMES 3761 02:16:23,960 --> 02:16:26,640 TOGETHER BECAUSE OF OPPRESSION. 3762 02:16:26,640 --> 02:16:27,360 MANY OF OUR COMMUNITIES COME 3763 02:16:27,360 --> 02:16:29,680 TOGETHER BAYS OF OPPRESSION. 3764 02:16:29,680 --> 02:16:31,800 WHAT IS COMMUNITY ENGAGEMENT? 3765 02:16:31,800 --> 02:16:33,480 IT'S THE PROCESS EVER 3766 02:16:33,480 --> 02:16:36,680 MEANINGFULLY INVOLVING 3767 02:16:36,680 --> 02:16:37,800 COMMUNITIES AFFECTED BY RESEARCH 3768 02:16:37,800 --> 02:16:39,240 AND FINDING IN THE RESEARCH 3769 02:16:39,240 --> 02:16:39,480 PROCESS. 3770 02:16:39,480 --> 02:16:42,800 THE PROCESS OF WORKING 3771 02:16:42,800 --> 02:16:44,200 COLLABORATIVE WITH AND THROUGH 3772 02:16:44,200 --> 02:16:47,280 GROUPS OF PEOPLE AFFILIATED BY 3773 02:16:47,280 --> 02:16:49,520 GEOGRAPHIC PROXIMITIES, SPECIAL 3774 02:16:49,520 --> 02:16:50,160 INTERESTS OR SIMILARIVATIONS TO 3775 02:16:50,160 --> 02:16:51,920 ADDRESS ISSUES AFFECTING THE 3776 02:16:51,920 --> 02:16:53,520 WELL-BEING OF THOSE PEOPLE. 3777 02:16:53,520 --> 02:16:54,920 THIS IS FROM THE CENTER OF 3778 02:16:54,920 --> 02:16:57,560 DISEASE CONTROL AND PREVENTION. 3779 02:16:57,560 --> 02:16:59,480 ALSO THE GOALS OF COMMUNITY 3780 02:16:59,480 --> 02:17:00,080 ENGAGEMENT ARE TO BUILD TRUST 3781 02:17:00,080 --> 02:17:01,760 AND LIST NEW RESOURCES AND 3782 02:17:01,760 --> 02:17:02,240 ALLIES, CREATE BETTER 3783 02:17:02,240 --> 02:17:03,960 COMMUNICATION AND IMPROVE 3784 02:17:03,960 --> 02:17:07,280 OVERALL HEALTH OUTCOMES AS 3785 02:17:07,280 --> 02:17:10,040 SUCCESSFUL PROJECTS LAST INTO 3786 02:17:10,040 --> 02:17:12,120 COLLABORATIONS. 3787 02:17:12,120 --> 02:17:14,720 THERE ARE LEVELS TO COMMUNITY 3788 02:17:14,720 --> 02:17:15,280 ENGAGEMENT. 3789 02:17:15,280 --> 02:17:15,840 THIS IS A PROCESS. 3790 02:17:15,840 --> 02:17:18,120 WE CAN BE IN ANY OF THE STEPS. 3791 02:17:18,120 --> 02:17:20,680 IT CAN BE AN APPROACH -- 3792 02:17:20,680 --> 02:17:21,640 CONSULTATION PROCESS. 3793 02:17:21,640 --> 02:17:22,760 IT COULD BE WHERE WE ARE 3794 02:17:22,760 --> 02:17:23,840 INVOLVING PEOPLE IN THE 3795 02:17:23,840 --> 02:17:26,120 COMMUNITY IT'S WHERE WE ARE 3796 02:17:26,120 --> 02:17:27,160 COLLABORATING. 3797 02:17:27,160 --> 02:17:29,440 AND FINALLY IT COULD BE SHARING 3798 02:17:29,440 --> 02:17:31,280 LEADERSHIP OR HAVING COMMUNITY 3799 02:17:31,280 --> 02:17:33,760 MEMBERS AS PART OF THE GROUP OF 3800 02:17:33,760 --> 02:17:35,280 THE RESEARCH GROUP, AND 3801 02:17:35,280 --> 02:17:39,280 LEADERSHIP OF THAT GROUP. 3802 02:17:39,280 --> 02:17:40,640 THIS IS A PROCESS. 3803 02:17:40,640 --> 02:17:46,480 IT'S ANIT RAT PROCESS SO IT'S 3804 02:17:46,480 --> 02:17:47,040 CONSTANTLY BEING REVIEWED. 3805 02:17:47,040 --> 02:17:50,080 IT MUST HAVE THE BIDIRECTIONAL 3806 02:17:50,080 --> 02:17:50,400 COMMUNICATION. 3807 02:17:50,400 --> 02:17:52,360 AND THAT MUST BE OPEN AND 3808 02:17:52,360 --> 02:17:53,080 TRANSPARENT. 3809 02:17:53,080 --> 02:17:54,840 IT'S IMPORTANT FOR PEOPLE TO 3810 02:17:54,840 --> 02:17:55,920 KNOW WHAT TO EXPECT FROM US AND 3811 02:17:55,920 --> 02:17:56,760 WE SHOULD KNOW. 3812 02:17:56,760 --> 02:18:00,360 WE SHOULD BE CLEAR IN OUR 3813 02:18:00,360 --> 02:18:00,720 EXPECTATIONS. 3814 02:18:00,720 --> 02:18:02,200 IT MUST BE RELEVANT TO ALL 3815 02:18:02,200 --> 02:18:02,440 PARTIES. 3816 02:18:02,440 --> 02:18:03,760 FOR COMMUNITIES IF THERE IS NO 3817 02:18:03,760 --> 02:18:06,080 RELEVANCY, THERE IS NO TIME FOR 3818 02:18:06,080 --> 02:18:06,320 THIS. 3819 02:18:06,320 --> 02:18:09,080 IF THERE IS -- THERE MUST BE 3820 02:18:09,080 --> 02:18:10,120 CLEAR ROLES, WHATEVER YOU'RE 3821 02:18:10,120 --> 02:18:12,000 EXPECTING FOR OUR COMMUNITY 3822 02:18:12,000 --> 02:18:12,240 PARTNERS. 3823 02:18:12,240 --> 02:18:12,880 WHAT SHOULD THEY BE EXPECTING 3824 02:18:12,880 --> 02:18:14,160 FROM US? 3825 02:18:14,160 --> 02:18:15,600 IT IT MUST BE COMMUNICATIVE. 3826 02:18:15,600 --> 02:18:17,080 WE HAVE TO BE COMMUNICATING ALL 3827 02:18:17,080 --> 02:18:22,640 THROUGH THE PROCESS. 3828 02:18:22,640 --> 02:18:23,280 BAYS THAT BRINGS THE TRUST THAT 3829 02:18:23,280 --> 02:18:23,880 IS SO NEEDED FOR ANY KIND OF 3830 02:18:23,880 --> 02:18:25,920 RELATIONSHIP OF THIS SORT. 3831 02:18:25,920 --> 02:18:27,280 THE GOAL SHOULD BE TO BRING 3832 02:18:27,280 --> 02:18:29,000 JUSTICE INTO THE PROCESS. 3833 02:18:29,000 --> 02:18:29,680 THAT IS THE IDEA. 3834 02:18:29,680 --> 02:18:31,160 IT SHOULDN'T BE SOMETHING THAT 3835 02:18:31,160 --> 02:18:33,240 IS FOR RESEARCHERS AND FOR 3836 02:18:33,240 --> 02:18:34,640 LIBRARIES AND FOR PROFESSIONALS 3837 02:18:34,640 --> 02:18:35,920 T SHOULD BE SOMETHING THAT IS 3838 02:18:35,920 --> 02:18:39,120 FOR ALL TO HELP AND TO DIMINISH 3839 02:18:39,120 --> 02:18:42,440 AND ELIMINATE HEALTH 3840 02:18:42,440 --> 02:18:42,760 DISPARITIES. 3841 02:18:42,760 --> 02:18:44,760 COMMUNITY-ENGAGED RESEARCH 3842 02:18:44,760 --> 02:18:46,800 SHOULD BE PRIORITIZED AND VERY 3843 02:18:46,800 --> 02:18:47,440 IMPORTANT IN OUR INSTITUTIONS T 3844 02:18:47,440 --> 02:18:48,800 SHOULDN'T BE AN AFTERTHOUGHT. 3845 02:18:48,800 --> 02:18:51,240 IT SHOULD BE PARTICIPATORY WHERE 3846 02:18:51,240 --> 02:18:52,400 THEY HAVE THEIR SAY. 3847 02:18:52,400 --> 02:18:55,920 NOT ONLY IN TERMS OF HOW WE 3848 02:18:55,920 --> 02:18:57,480 RERIGHT AND HOW WE DO THE 3849 02:18:57,480 --> 02:18:58,480 RESEARCH ACTIVITIES BUT ALSO IN 3850 02:18:58,480 --> 02:19:01,360 THE QUESTIONS T SHOULD BE 3851 02:19:01,360 --> 02:19:01,680 TRANSLATED. 3852 02:19:01,680 --> 02:19:02,800 THE MEANING SHOULD BE CLEAR. 3853 02:19:02,800 --> 02:19:04,120 THE FINDING SHOULD BE CLEAR. 3854 02:19:04,120 --> 02:19:06,800 AND WE SHOULD BE USING REAL-LIFE 3855 02:19:06,800 --> 02:19:07,120 SETTINGS. 3856 02:19:07,120 --> 02:19:11,160 SO IT MUST BE RELEVANT, 3857 02:19:11,160 --> 02:19:12,160 RELATABLE AND VALUABLE. 3858 02:19:12,160 --> 02:19:15,560 THESE ARE SOME OF THE STORIES 3859 02:19:15,560 --> 02:19:17,000 FROM PORES RICO. 3860 02:19:17,000 --> 02:19:18,080 WHAT HAS GONE WELL AND WHAT HAS 3861 02:19:18,080 --> 02:19:19,640 BEEN CHALLENGING AND WHAT HAS 3862 02:19:19,640 --> 02:19:20,120 BEEN BOTH. 3863 02:19:20,120 --> 02:19:25,200 HURRICANE IRMA AND MARIA CAME IN 3864 02:19:25,200 --> 02:19:26,720 2017. 3865 02:19:26,720 --> 02:19:27,360 THESE ARE IMPORTANT THINGS THAT 3866 02:19:27,360 --> 02:19:28,920 HAPPENED TO US. 3867 02:19:28,920 --> 02:19:33,760 EARTHQUAKES IN 2019, 2020 AND 3868 02:19:33,760 --> 02:19:34,080 2020. 3869 02:19:34,080 --> 02:19:38,120 AND COVID PANDEMIC THAT WE ARE 3870 02:19:38,120 --> 02:19:39,080 STILL GOING THROUGH. 3871 02:19:39,080 --> 02:19:40,320 MOST IMPORTANT THINGS OF ALL IS 3872 02:19:40,320 --> 02:19:41,920 THAT COMMUNITY PARTICIPANTS KNOW 3873 02:19:41,920 --> 02:19:43,280 WE ARE HERE FOR THE LONG RUN 3874 02:19:43,280 --> 02:19:45,760 JUST NOT FOR OUR RESEARCH 3875 02:19:45,760 --> 02:19:48,400 PROJECT, NOT JUST TO GET THE 3876 02:19:48,400 --> 02:19:51,680 INFORMATION WE NEED AND TO 3877 02:19:51,680 --> 02:19:54,120 PUBLISH OUR PAPERS, PRESENT IN 3878 02:19:54,120 --> 02:19:54,480 OUR CONFERENCES. 3879 02:19:54,480 --> 02:20:00,880 BUT WE ARE THERE FOR THE LONG 3880 02:20:00,880 --> 02:20:02,320 RUN. 3881 02:20:02,320 --> 02:20:02,840 OOZE THESE AEMERGENCIES 3882 02:20:02,840 --> 02:20:04,800 APPROACHED US IN PUERTO RICO, WE 3883 02:20:04,800 --> 02:20:05,720 IMMEDIATELY STOPPED RESEARCH 3884 02:20:05,720 --> 02:20:07,280 50s STEPPED IN RESPONSE AND 3885 02:20:07,280 --> 02:20:07,520 RECOVERY. 3886 02:20:07,520 --> 02:20:09,680 WE LEARNED TO BE A RESEARCH 3887 02:20:09,680 --> 02:20:11,520 ENTITY THAT WAS MORE THAN THAT. 3888 02:20:11,520 --> 02:20:13,280 IT WAS COMMUNITY PARTNER AS WELL 3889 02:20:13,280 --> 02:20:15,920 TO OUR COMMUNITY PARTNERS AND TO 3890 02:20:15,920 --> 02:20:17,200 OUR PARTICIPANTS AS WELL. 3891 02:20:17,200 --> 02:20:19,360 SO WE DID RAPID NEEDS ASSESSMENT 3892 02:20:19,360 --> 02:20:21,200 OF COMMUNITY PARTNERSES AND 3893 02:20:21,200 --> 02:20:23,960 PARTICIPANTS, WHAT THEY NEEDED. 3894 02:20:23,960 --> 02:20:25,200 NOT WHAT EVERYBODY THINKS PEOPLE 3895 02:20:25,200 --> 02:20:29,320 NEED IN AN EMERGENCY, WHAT THEY 3896 02:20:29,320 --> 02:20:29,760 SPECIFICALLY NEEDED. 3897 02:20:29,760 --> 02:20:30,640 WE CATERED TO WOMEN WHO ARE 3898 02:20:30,640 --> 02:20:33,320 PREGNANT AND MOTHERS OF YOUNG 3899 02:20:33,320 --> 02:20:33,600 CHILDREN. 3900 02:20:33,600 --> 02:20:35,240 SO SPECIFIC NEEDS FOR THIS 3901 02:20:35,240 --> 02:20:35,960 COMMUNITY. 3902 02:20:35,960 --> 02:20:38,280 THE NETWORK TO SUPPORT OF 3903 02:20:38,280 --> 02:20:39,720 COLLABORATORS TO PROVIDE 3904 02:20:39,720 --> 02:20:41,280 RESOURCES FOR THE RESPONSE. 3905 02:20:41,280 --> 02:20:44,560 BECAUSE WE NEEDED THINGS TO BE 3906 02:20:44,560 --> 02:20:45,720 ABLE TO SEND TO COMMUNITIES. 3907 02:20:45,720 --> 02:20:49,680 WE NEEDED SOME MATERIAL HELP. 3908 02:20:49,680 --> 02:20:54,160 WE ADJUSTED INCENTIVESES TO 3909 02:20:54,160 --> 02:20:56,120 CONTEXTUAL SITUATION, 3910 02:20:56,120 --> 02:20:57,360 TRANSPORTATION WAS OUT AND IT 3911 02:20:57,360 --> 02:20:58,120 WAS DIFFICULT. 3912 02:20:58,120 --> 02:20:59,000 RECRUITMENT WAS NOT AFFECTED IN 3913 02:20:59,000 --> 02:20:59,680 THE LONG RUN. 3914 02:20:59,680 --> 02:21:02,800 AND IT REALLY CONTRIBUTED TO THE 3915 02:21:02,800 --> 02:21:03,360 TRUST IN THE RELATIONSHIP. 3916 02:21:03,360 --> 02:21:06,160 NOW WE HAVE A PROTOCOL. 3917 02:21:06,160 --> 02:21:06,920 A WAY TO RESPOND EVERY TIME 3918 02:21:06,920 --> 02:21:08,440 THERE IS AN EMERGENCY BECAUSE WE 3919 02:21:08,440 --> 02:21:11,040 KNOW THAT THERE WILL BE ANOTHER 3920 02:21:11,040 --> 02:21:11,440 ONE. 3921 02:21:11,440 --> 02:21:12,440 AND THIS IS AN EXAMPLE OF SOME 3922 02:21:12,440 --> 02:21:13,800 OF THE PROTECTIVE MATERIALS THAT 3923 02:21:13,800 --> 02:21:16,080 WE WERE ABLE TO OFFER OUR 3924 02:21:16,080 --> 02:21:17,720 COMMUNITIES THROUGHOUT THESE 3925 02:21:17,720 --> 02:21:19,160 EXPERIENCES, ESPECIALLY DURING 3926 02:21:19,160 --> 02:21:21,760 THE COVID AND THE EARTHQUAKES. 3927 02:21:21,760 --> 02:21:24,560 AND YOU CAN SEE THERE ARE THINGS 3928 02:21:24,560 --> 02:21:26,960 THAT PEOPLE NEED DURING THIS 3929 02:21:26,960 --> 02:21:30,440 TIME AND THERE IS COLORING BOOKS 3930 02:21:30,440 --> 02:21:31,600 BECAUSE WEICATOR ALSO TO ELDERLY 3931 02:21:31,600 --> 02:21:32,320 POPULATIONS AND THEY WERE 3932 02:21:32,320 --> 02:21:35,040 SITTING IN THEIR HOMES IN THE 3933 02:21:35,040 --> 02:21:36,160 LOCKDOWN, BORED. 3934 02:21:36,160 --> 02:21:36,760 AND THIS IS ONE OF THE THINGS 3935 02:21:36,760 --> 02:21:37,840 THAT THEY ASKED US TO PROVIDE. 3936 02:21:37,840 --> 02:21:40,480 SO WE DID. 3937 02:21:40,480 --> 02:21:44,600 AND DELIVERED THEM SAFELY. 3938 02:21:44,600 --> 02:21:46,320 SOME OF THE STRATEGIES THAT ARE 3939 02:21:46,320 --> 02:21:48,120 REALLY HELPFUL FOR ENGAGE THINK 3940 02:21:48,120 --> 02:21:49,880 COMMUNITIES IN OUR EXPERIENCE 3941 02:21:49,880 --> 02:21:52,520 ARE COMMUNITY ADVISORY COUNCILS, 3942 02:21:52,520 --> 02:21:55,720 RETURN OF RESULTS, NEEDS 3943 02:21:55,720 --> 02:21:59,360 ASSESSMENT SURVEYS, ANALYSIS AND 3944 02:21:59,360 --> 02:22:02,360 COMMUNITY ENGAGEMENT STUDIOS. 3945 02:22:02,360 --> 02:22:03,160 IN OUR PROJECT IN PUERTO RICO 3946 02:22:03,160 --> 02:22:04,960 TEAM FOR EXPLORING CONTAMINATION 3947 02:22:04,960 --> 02:22:07,040 THREATS, WE STUDIED THE EFFECTS 3948 02:22:07,040 --> 02:22:09,720 OF PRETERM BIRTH OF 3949 02:22:09,720 --> 02:22:12,720 CONTAMINATION ON PRETERM BIRTH. 3950 02:22:12,720 --> 02:22:16,120 WE PROVIDE THE REPORT BACK. 3951 02:22:16,120 --> 02:22:18,880 WE DELIVER THE INFORMATION FROM 3952 02:22:18,880 --> 02:22:20,280 THE SAMPLES THAT THE 3953 02:22:20,280 --> 02:22:22,600 PARTICIPANTS HAVE GIVEN TO US. 3954 02:22:22,600 --> 02:22:24,360 SO WE GIVE THEM BACK WHAT THEY 3955 02:22:24,360 --> 02:22:25,000 GAVE TO US. 3956 02:22:25,000 --> 02:22:25,800 EXPLAINED IN A WAY. 3957 02:22:25,800 --> 02:22:29,480 AND WE DID IT THROUGH A 3958 02:22:29,480 --> 02:22:30,160 SMARTPHONE APP THAT WAS 3959 02:22:30,160 --> 02:22:32,480 DEVELOPED IN A PARTICIPATORY 3960 02:22:32,480 --> 02:22:35,160 MANNER WITH OUR PARTICIPANTS. 3961 02:22:35,160 --> 02:22:36,040 WE HAD PEOPLE FROM OUR 3962 02:22:36,040 --> 02:22:39,280 COLLABORATING CLINICS AND 3963 02:22:39,280 --> 02:22:40,840 PARTICIPANTS LOOK INTO THE 3964 02:22:40,840 --> 02:22:45,120 PROTOTYPE THAT WAS CREATED BY 3965 02:22:45,120 --> 02:22:46,440 THE INSTITUTE, AN ORGANIZATION 3966 02:22:46,440 --> 02:22:50,720 IN MASSACHUSETTS THAT HELPS 3967 02:22:50,720 --> 02:22:53,080 RESULTS AND DOING SOMETHING 3968 02:22:53,080 --> 02:22:53,400 ABOUT THEM. 3969 02:22:53,400 --> 02:22:55,800 WE WERE ALSO ABLE TO CATER TO 3970 02:22:55,800 --> 02:22:57,640 PARTICIPANTS IN TERMS OF THE 3971 02:22:57,640 --> 02:22:58,680 MOST SIMPLE THING AS THE AVATAR. 3972 02:22:58,680 --> 02:23:01,040 THEY WANTED TO THE WOMEN TO LOOK 3973 02:23:01,040 --> 02:23:01,600 LIKE THEM. 3974 02:23:01,600 --> 02:23:04,440 THEY WANTED THEIR PHOTOS IN THAT 3975 02:23:04,440 --> 02:23:06,120 REPORT THAT WERE SUGGESTING 3976 02:23:06,120 --> 02:23:08,840 THINGS THAT PEOPLE COULD DO TO 3977 02:23:08,840 --> 02:23:12,160 PREVENT OR DIMINISH EXPOSURE TO 3978 02:23:12,160 --> 02:23:13,360 THINGS THAT WERE COMMON TO THEM. 3979 02:23:13,360 --> 02:23:14,800 PHOTOS THAT MEANT SOMETHING THAT 3980 02:23:14,800 --> 02:23:16,040 WAS IN THEIR CONTEXT. 3981 02:23:16,040 --> 02:23:23,600 SO THIS WAS REALLY SUCCESSFUL. 3982 02:23:23,600 --> 02:23:24,480 IT TAKES US TOOLS LEARNING ABOUT 3983 02:23:24,480 --> 02:23:24,960 OTHER NEEDS. 3984 02:23:24,960 --> 02:23:28,000 THROUGH THE PANDEMIC, POST 3985 02:23:28,000 --> 02:23:30,120 PANDEMIC AND POST EARTHQUAKES WE 3986 02:23:30,120 --> 02:23:35,280 HAD A LOT OF REQUESTS ON MENTAL 3987 02:23:35,280 --> 02:23:36,160 HEALTH SERVICES. 3988 02:23:36,160 --> 02:23:38,480 AND WE STILL ARE RECEIVING THEM. 3989 02:23:38,480 --> 02:23:39,640 SO WE HAVE DEVELOPED MATERIALS 3990 02:23:39,640 --> 02:23:41,960 THAT NOT ONLY TELL YOU WHAT YOU 3991 02:23:41,960 --> 02:23:43,760 CAN DO, BUT ALSO WHERE AND WHEN 3992 02:23:43,760 --> 02:23:48,120 YOU CAN GET HELP. 3993 02:23:48,120 --> 02:23:48,760 THE COMMUNITY ADVISORY COUNCIL. 3994 02:23:48,760 --> 02:23:50,600 THIS IS A STRATEGY THAT WE USED 3995 02:23:50,600 --> 02:23:52,240 AT THE CENTER FOR COLLABORATIVE 3996 02:23:52,240 --> 02:23:54,040 RESEARCH AND HEALTH DISPARITIES 3997 02:23:54,040 --> 02:23:55,120 FOR THE PAST FIVE YEARS AND IT 3998 02:23:55,120 --> 02:23:57,480 HAS BEEN VERY SUCCESSFUL. 3999 02:23:57,480 --> 02:24:00,400 WE HAVE A COLLECTIVE OF 4000 02:24:00,400 --> 02:24:00,880 COMMUNITY MEMBERS AND 4001 02:24:00,880 --> 02:24:01,280 ORGANIZATIONS AND 4002 02:24:01,280 --> 02:24:01,840 REPRESENTATIVES THAT PROVIDE 4003 02:24:01,840 --> 02:24:02,880 COMMUNITY INFORMATION, GUIDANCE 4004 02:24:02,880 --> 02:24:05,080 AND ASSISTANCE TO THE RESEARCH 4005 02:24:05,080 --> 02:24:06,920 PROJECT OR INITIATIVE TEAM. 4006 02:24:06,920 --> 02:24:10,840 THEY HELP US WITH OUR 4007 02:24:10,840 --> 02:24:11,760 RESEARCHERS DEVELOP WAYS AND 4008 02:24:11,760 --> 02:24:14,840 STRATEGIES TO BE ABLE TO PRESENT 4009 02:24:14,840 --> 02:24:16,320 TO LAY POPULATIONS, TO BE ABLE 4010 02:24:16,320 --> 02:24:17,760 TO BE UNDERSTOOD BY COMMUNITIES 4011 02:24:17,760 --> 02:24:20,000 AND ALSO RECEIVE QUESTIONS ON 4012 02:24:20,000 --> 02:24:20,600 OUR COMMUNITY ADVISORY COUNCIL 4013 02:24:20,600 --> 02:24:22,840 IN TERMS OF HOW THEY CAN DO A 4014 02:24:22,840 --> 02:24:25,040 BETTER JOB NOT ONLY PRESENTING 4015 02:24:25,040 --> 02:24:26,120 THEIR RESULTS AND WHAT THEY ARE 4016 02:24:26,120 --> 02:24:30,120 DOING BUT ALSO DOING RESEARCH 4017 02:24:30,120 --> 02:24:32,760 THAT IS MORE AKIN TO THE NEEDS 4018 02:24:32,760 --> 02:24:34,080 AND TO THE INTERESTS OF THE 4019 02:24:34,080 --> 02:24:34,400 COMMUNITY. 4020 02:24:34,400 --> 02:24:37,520 IT ALSO IS A WAY TO PROVIDE. 4021 02:24:37,520 --> 02:24:39,400 THEY ALSO HELP US PROVIDE 4022 02:24:39,400 --> 02:24:40,640 RELATIONSHIPS WITH OTHER 4023 02:24:40,640 --> 02:24:42,120 COMMUNITY MEMBERS AND OTHER 4024 02:24:42,120 --> 02:24:42,920 REPRESENTATIVES IN THE 4025 02:24:42,920 --> 02:24:43,160 COMMUNITY. 4026 02:24:43,160 --> 02:24:44,560 SO IT HAS BEEN A GREAT HELP FOR 4027 02:24:44,560 --> 02:24:47,560 US AND OUR RESEARCHERS. 4028 02:24:47,560 --> 02:24:49,600 WE NEED TO KEEP IN MIND THAT 4029 02:24:49,600 --> 02:24:51,200 THERE MUST BE ACTIVE LISTENING. 4030 02:24:51,200 --> 02:24:53,360 WE HAVE TO LISTEN MORE THAN WE 4031 02:24:53,360 --> 02:24:53,560 TALK. 4032 02:24:53,560 --> 02:24:56,560 THAT WE HAVE TO VALIDATE 4033 02:24:56,560 --> 02:24:58,640 EXPERIENCES BECAUSE THEY ARE THE 4034 02:24:58,640 --> 02:25:01,200 EXPERTS IN THEIR COMMUNITIES AND 4035 02:25:01,200 --> 02:25:01,600 IN THEIR CONTEXT. 4036 02:25:01,600 --> 02:25:03,360 THAT OUR PHYSICAL PRESENCE IS 4037 02:25:03,360 --> 02:25:04,880 IMPORTANT TO BE THERE. 4038 02:25:04,880 --> 02:25:08,920 THAT WE NEED TO IDENTIFY 4039 02:25:08,920 --> 02:25:10,600 RESOURCES AS WELL AS NEEDS. 4040 02:25:10,600 --> 02:25:11,680 RECOGNIZE THOSE RESOURCES. 4041 02:25:11,680 --> 02:25:13,080 ALL COMMUNITIES HAVE RESOURCES. 4042 02:25:13,080 --> 02:25:14,320 AND ALSO TO FOLLOW-UP. 4043 02:25:14,320 --> 02:25:19,840 WE HAVE TO WALK THE WALK. 4044 02:25:19,840 --> 02:25:21,600 WE NEED NEEDS ASSESSMENT SURVEYS 4045 02:25:21,600 --> 02:25:24,080 IS ANOTHER WAY OF ASKING 4046 02:25:24,080 --> 02:25:24,720 COMMUNICATED I GROUPS WHAT THEY 4047 02:25:24,720 --> 02:25:26,920 SEE IS THE MOST IMPORTANT NEEDS 4048 02:25:26,920 --> 02:25:27,520 OF THE GROUP OF THE COMMUNITY. 4049 02:25:27,520 --> 02:25:29,440 RESULTS OF THE SURVEY GUIDE 4050 02:25:29,440 --> 02:25:30,720 FUTURE ACTION. 4051 02:25:30,720 --> 02:25:31,360 SO THESE ARE SOME OF THE REASONS 4052 02:25:31,360 --> 02:25:34,240 THAT WE DO THIS. 4053 02:25:34,240 --> 02:25:34,960 ESPECIALLY TO GET MORE PEOPLE 4054 02:25:34,960 --> 02:25:37,200 INVOLVED AND TO LEARN ABOUT THE 4055 02:25:37,200 --> 02:25:39,280 NEEDS, TO BE MORE HONEST AND 4056 02:25:39,280 --> 02:25:40,480 OBJECTIVE DESCRIPTION OF THE 4057 02:25:40,480 --> 02:25:43,920 NEEDS THAT PEOPLE MIGHT TELL YOU 4058 02:25:43,920 --> 02:25:44,360 PUBLICLY. 4059 02:25:44,360 --> 02:25:46,800 TO DOCUMENT THE NEEDS WHICH CAN 4060 02:25:46,800 --> 02:25:50,120 HELP FUNDING AND ADVANCING OR 4061 02:25:50,120 --> 02:25:51,360 LOBBYING YOUR CASE. 4062 02:25:51,360 --> 02:25:59,800 THE ANALYSIS A STRATEGIC 4063 02:25:59,800 --> 02:26:00,080 FRAMEWORK. 4064 02:26:00,080 --> 02:26:01,240 IT'S A SIGNIFICANT TOOL FOR 4065 02:26:01,240 --> 02:26:03,200 SITUATION ANALYSIS THAT HELPS 4066 02:26:03,200 --> 02:26:04,320 IDENTIFY ORGANIZATIONAL 4067 02:26:04,320 --> 02:26:05,360 ENVIRONMENTAL FACTORS. 4068 02:26:05,360 --> 02:26:09,040 SO IT HELPS ORGANIZATIONS TO 4069 02:26:09,040 --> 02:26:10,000 DEFINE STRATEGIES FOR GOALS. 4070 02:26:10,000 --> 02:26:13,360 WE USED IT WITH OUR RESEARCHERS 4071 02:26:13,360 --> 02:26:15,160 TO GAUGE WHAT IS THEIR INTEREST, 4072 02:26:15,160 --> 02:26:16,960 WHERE THEY ARE IN TERMS OF 4073 02:26:16,960 --> 02:26:17,720 COMMUNITY ENGAGEMENT AND WHERE 4074 02:26:17,720 --> 02:26:19,280 WE NEED TO GO. 4075 02:26:19,280 --> 02:26:19,880 AND IT HELPED US IN THE PAST 4076 02:26:19,880 --> 02:26:21,600 FIVE YEARS TO DEVELOP A SERIES 4077 02:26:21,600 --> 02:26:24,080 OF ACTIVITIES AND OBJECTIVES 4078 02:26:24,080 --> 02:26:26,760 TOWARDS THE GOAL OF CREATING 4079 02:26:26,760 --> 02:26:27,760 MORE PARTNERSHIPS WITH 4080 02:26:27,760 --> 02:26:28,880 COMMUNITIES. 4081 02:26:28,880 --> 02:26:30,720 THE INFORMATION THAT THE 4082 02:26:30,720 --> 02:26:32,680 ANALYSIS PROVIDED HAS BEEN OF 4083 02:26:32,680 --> 02:26:35,000 GREAT HELP IN THIS PROCESS. 4084 02:26:35,000 --> 02:26:39,080 THE COMMUNITY STUDIO IS A 4085 02:26:39,080 --> 02:26:40,960 METHODOLOGY DEVELOPED BY 4086 02:26:40,960 --> 02:26:41,920 VANDERBILT UNIVERSITY. 4087 02:26:41,920 --> 02:26:44,400 AND IT PROVIDES A STRUCTURE TO 4088 02:26:44,400 --> 02:26:45,640 GAIN VALUABLE COMMUNITY INSIGHT 4089 02:26:45,640 --> 02:26:47,680 AT ANY PHASE OF RESEARCH. 4090 02:26:47,680 --> 02:26:50,840 MEMBERS OF THE RESEARCH 4091 02:26:50,840 --> 02:26:52,360 POPULATION OF INTEREST WHICH IS 4092 02:26:52,360 --> 02:26:55,280 IMPORTANT TO HAVE AS A 4093 02:26:55,280 --> 02:26:57,600 CONSULTATIVE GROW. 4094 02:26:57,600 --> 02:26:58,760 THE COMMUNITIES INCREASES 4095 02:26:58,760 --> 02:26:59,680 UNDERSTANDING OF RESEARCH AND 4096 02:26:59,680 --> 02:27:01,480 INCLUDING THE MOTIVATION AND THE 4097 02:27:01,480 --> 02:27:02,240 RESEARCHERS AND HOW THE RESEARCH 4098 02:27:02,240 --> 02:27:03,400 IS CONDUCTED. 4099 02:27:03,400 --> 02:27:05,400 AND IT'S ONE THING VERY 4100 02:27:05,400 --> 02:27:06,800 IMPORTANT, WE MUST PROVIDE 4101 02:27:06,800 --> 02:27:07,680 INCENTIVES FOR THIS. 4102 02:27:07,680 --> 02:27:10,280 MANY TIMES MONETARY INCENTIVES. 4103 02:27:10,280 --> 02:27:14,800 SO WE CAN SHOW AND DEMONSTRATE 4104 02:27:14,800 --> 02:27:18,160 THAT THEIR WORK IS VALUED AND IS 4105 02:27:18,160 --> 02:27:18,440 IMPORTANT. 4106 02:27:18,440 --> 02:27:21,760 WE ALSO DEVELOP A LIST. 4107 02:27:21,760 --> 02:27:25,080 A DEPOSITORY OF COMMUNITY 4108 02:27:25,080 --> 02:27:28,360 ENGAGED EXPERTS THAT CAN HELP US 4109 02:27:28,360 --> 02:27:30,120 IN FUTURE RESEARCH. 4110 02:27:30,120 --> 02:27:33,200 THIS IS A SMALL VIDEO THAT I'D 4111 02:27:33,200 --> 02:27:37,840 LIKE TO PRESENT. 4112 02:27:37,840 --> 02:27:39,040 >>PROTECT. 4113 02:27:39,040 --> 02:27:41,240 PUERTO RICO -- ONE 4114 02:27:41,240 --> 02:27:42,000 CONTAMINATION. 4115 02:27:42,000 --> 02:27:52,440 GET TO KNOW THE RESULTS. 4116 02:27:53,800 --> 02:27:54,880 AS PART OF THE PROJECT WE 4117 02:27:54,880 --> 02:27:56,600 PROVIDE YOU WITH A FINAL REPORT 4118 02:27:56,600 --> 02:27:59,280 USING DIGITAL PLATFORM. 4119 02:27:59,280 --> 02:28:00,720 YOUR REPORT HAS ALL THE 4120 02:28:00,720 --> 02:28:02,680 INFORMATION FROM THE ANALYSIS OF 4121 02:28:02,680 --> 02:28:04,160 THE TEST AND SAMPLES THAT YOU 4122 02:28:04,160 --> 02:28:05,680 PROVIDED DURING YOUR PREGNANCY 4123 02:28:05,680 --> 02:28:08,520 AND THE TIME YOU PARTICIPATED IN 4124 02:28:08,520 --> 02:28:10,480 OUR PROGRAM. 4125 02:28:10,480 --> 02:28:12,160 THE RESULTS COME TOGETHER WITH 4126 02:28:12,160 --> 02:28:15,640 THE CHEMICAL CONTAMINANTS IN 4127 02:28:15,640 --> 02:28:17,320 YOUR BODY DURING PREGNANCY, THE 4128 02:28:17,320 --> 02:28:17,880 DEFINITION AND WHERE YOU CAN 4129 02:28:17,880 --> 02:28:20,480 FIND THEM IN YOUR HOME AND IN 4130 02:28:20,480 --> 02:28:21,760 YOUR DAILY USE PRODUCTS. 4131 02:28:21,760 --> 02:28:22,760 ALSO, YOU WILL FIND 4132 02:28:22,760 --> 02:28:24,480 RECOMMENDATIONS TO REDUCE 4133 02:28:24,480 --> 02:28:27,280 EXPOSURE TO THE CONTAMINANTS. 4134 02:28:27,280 --> 02:28:29,880 IN ADDITION TO THE SHARED 4135 02:28:29,880 --> 02:28:31,320 PLATFORM, PROTECT MEMBERS ARE 4136 02:28:31,320 --> 02:28:32,840 AVAILABLE TO ANSWER QUESTIONS 4137 02:28:32,840 --> 02:28:33,640 AND INFORMATION TO HELP YOU 4138 02:28:33,640 --> 02:28:35,240 UNDERSTAND YOUR RESULTS, 4139 02:28:35,240 --> 02:28:37,560 INCLUDING EDUCATIONAL MATERIALS 4140 02:28:37,560 --> 02:28:38,880 ON USE OF ENVIRONMENTAL 4141 02:28:38,880 --> 02:28:40,560 POLLUTION, PREGNANCY AND HEALTH 4142 02:28:40,560 --> 02:28:43,160 INFORMATION CONCERNING YOU AND 4143 02:28:43,160 --> 02:28:43,800 YOUR BABY. 4144 02:28:43,800 --> 02:28:45,680 FOR MORE INFORMATION, WE INVITE 4145 02:28:45,680 --> 02:28:53,600 YOU TO GIVE US A CALL AT: THANK 4146 02:28:53,600 --> 02:28:59,920 YOU. 4147 02:28:59,920 --> 02:29:00,400 THANK YOU VERY MUCH. 4148 02:29:00,400 --> 02:29:02,520 THIS IS OUR CONTACT INFORMATION 4149 02:29:02,520 --> 02:29:03,200 AND THANK YOU VERY MUCH FOR YOUR 4150 02:29:03,200 --> 02:29:06,640 ATTENTION TO. 4151 02:29:06,640 --> 02:29:08,000 >>I WANT TO THANK THE 4152 02:29:08,000 --> 02:29:10,480 ORGANIZERS OF THIS EVENT TO 4153 02:29:10,480 --> 02:29:14,760 ALLOW ME TO SHARE WITH YOU OUR 4154 02:29:14,760 --> 02:29:16,760 EXPERIENCES IN VENEZUELA. 4155 02:29:16,760 --> 02:29:19,240 I'M A PROFESSOR OF NEUROSCIENCE 4156 02:29:19,240 --> 02:29:20,200 AND HUMAN GENETICS AT THE 4157 02:29:20,200 --> 02:29:23,240 UNIVERSITY OF TEXAS. 4158 02:29:23,240 --> 02:29:26,680 I ALSO WANT TO THANK MY 4159 02:29:26,680 --> 02:29:27,680 COLLABORATORS AT COLUMBIA 4160 02:29:27,680 --> 02:29:31,040 UNIVERSITY AT THE UNIVERSITY OF 4161 02:29:31,040 --> 02:29:35,760 JULIA IN VENEZUELA AND NYU AND 4162 02:29:35,760 --> 02:29:38,520 IN PARTICULAR, THE ROLE OF JESUS 4163 02:29:38,520 --> 02:29:44,160 WHO IS NOW AT UNIVERSITY. 4164 02:29:44,160 --> 02:29:44,680 I ALSO NEED TO ACKNOWLEDGE 4165 02:29:44,680 --> 02:29:46,040 FUNDING FROM THE NATIONAL 4166 02:29:46,040 --> 02:29:49,160 INSTITUTES OF AGING IN THE U.S. 4167 02:29:49,160 --> 02:29:51,280 INCLUDING THE AGING INSTITUTE 4168 02:29:51,280 --> 02:29:54,600 AND THE NATIONAL EYE INSTITUTE 4169 02:29:54,600 --> 02:29:58,520 AND THE FOGARTY INTERNATIONAL 4170 02:29:58,520 --> 02:29:59,640 CENTER AND THE FIRST 10 YEARS OF 4171 02:29:59,640 --> 02:30:03,840 THIS STUDY WAS FUNDED BY THE 4172 02:30:03,840 --> 02:30:05,120 VENEZUELAN AGENCY. 4173 02:30:05,120 --> 02:30:06,080 I NEED TO REPORT A POTENTIAL 4174 02:30:06,080 --> 02:30:09,120 CONFLICT WITH A SMALL NONPROFIT 4175 02:30:09,120 --> 02:30:10,160 THAT I FOUND. 4176 02:30:10,160 --> 02:30:15,120 TODAY, I WILL BE TALKING MORE 4177 02:30:15,120 --> 02:30:16,360 COMMUNITY ENGAGEMENT RATHER THAN 4178 02:30:16,360 --> 02:30:19,680 TO SPECIFIC SCIENTIFIC ADVANCES 4179 02:30:19,680 --> 02:30:21,960 THAT WE HAVE MANAGED TO OBTAIN 4180 02:30:21,960 --> 02:30:22,280 IN VENEZUELA. 4181 02:30:22,280 --> 02:30:26,440 I WILL BE GIVING YOU A GENERAL 4182 02:30:26,440 --> 02:30:28,000 BACKGROUND OF WHAT THE STUDY IS 4183 02:30:28,000 --> 02:30:30,120 AND HOW THE HUMANITARIAN CRISIS 4184 02:30:30,120 --> 02:30:33,360 IN VENEZUELA AFFECTED OUR WORK, 4185 02:30:33,360 --> 02:30:37,240 HOW WE ADAPTED OUR EYE STUDIES. 4186 02:30:37,240 --> 02:30:39,120 I WOULD SUMMARIZE COMMUNITY 4187 02:30:39,120 --> 02:30:41,000 ENGAGEMENT ACTIVITIES AND SHARE 4188 02:30:41,000 --> 02:30:44,200 WITH YOU OUR MOST VALUABLE 4189 02:30:44,200 --> 02:30:45,680 LESSONS. 4190 02:30:45,680 --> 02:30:48,200 AS A GENERAL BACKGROUND, I WAS 4191 02:30:48,200 --> 02:30:51,960 BORN AND FINISHED MY MEDICAL 4192 02:30:51,960 --> 02:30:54,080 EDUCATION AT THE UNIVERSITY OF 4193 02:30:54,080 --> 02:30:54,320 SOULIA. 4194 02:30:54,320 --> 02:30:56,800 LATER I CONTINUED MY STUDIES AT 4195 02:30:56,800 --> 02:30:57,920 THE MASS GENERAL HOSPITAL, 4196 02:30:57,920 --> 02:31:00,320 DEPARTMENT OF PSYCHIATRY, 4197 02:31:00,320 --> 02:31:01,600 REALIZING THAT I REALLY WANTED 4198 02:31:01,600 --> 02:31:04,520 TO STUDY NEUROBIOLOGY AND 4199 02:31:04,520 --> 02:31:06,080 BEHAVIOR, WHICH I DID THROUGH 4200 02:31:06,080 --> 02:31:09,280 PH.D. AND MASTERS AT COLUMBIA 4201 02:31:09,280 --> 02:31:09,600 UNIVERSITY. 4202 02:31:09,600 --> 02:31:12,680 WHEN I FINISHED, I WENT BACK TO 4203 02:31:12,680 --> 02:31:14,800 ESTABLISH THE AGING STUDY. 4204 02:31:14,800 --> 02:31:16,560 I HAVE CONTINUED MY 4205 02:31:16,560 --> 02:31:19,280 COLLABORATION WITH MY COLLEAGUES 4206 02:31:19,280 --> 02:31:20,920 FROM COLUMBIA UNIVERSITY AND I 4207 02:31:20,920 --> 02:31:24,640 MOVED TO TEXAS IN 2016 AND I 4208 02:31:24,640 --> 02:31:25,960 STILL KEEP THE COLLABORATION AND 4209 02:31:25,960 --> 02:31:29,360 THE STUDY GOING. 4210 02:31:29,360 --> 02:31:33,600 HERE I WANT TO SHOW YOU THAT 4211 02:31:33,600 --> 02:31:34,600 THERE ARE MANY SIMILARITIES 4212 02:31:34,600 --> 02:31:37,400 BETWEEN TEXAS AND VENEZUELA. 4213 02:31:37,400 --> 02:31:39,680 AND THIS HAS ALLOWED ME TO 4214 02:31:39,680 --> 02:31:41,520 IMPLEMENT SOME OF THE LESSONS 4215 02:31:41,520 --> 02:31:44,720 FROM THE VENEZUELA IN TEXAS. 4216 02:31:44,720 --> 02:31:48,320 WE WANTED TO ESTABLISH THE FIRST 4217 02:31:48,320 --> 02:31:50,000 LONGITUDINAL STUDY OF AGING IN 4218 02:31:50,000 --> 02:31:53,520 LATIN AMERICA AND WE SELECTED 4219 02:31:53,520 --> 02:31:57,240 THIS AREA, IN THE CITY OF 4220 02:31:57,240 --> 02:31:57,520 MARQUISO. 4221 02:31:57,520 --> 02:31:59,560 AS MANY OF LATIN-AMERICAN 4222 02:31:59,560 --> 02:32:02,840 CITIES, YOU WOULD SEE THE 4223 02:32:02,840 --> 02:32:04,160 DOWNTOWN AREA, HISTORICAL AREA 4224 02:32:04,160 --> 02:32:09,320 IN THE BACKDROP OF MODERN 4225 02:32:09,320 --> 02:32:09,760 BUILDINGS. 4226 02:32:09,760 --> 02:32:12,840 WE BUILD DOOR-BY-DOOR REGISTRY 4227 02:32:12,840 --> 02:32:14,960 OF INDIVIDUALS OLDER THAN 55 4228 02:32:14,960 --> 02:32:17,120 YEARS AND OLDER. 4229 02:32:17,120 --> 02:32:18,280 INITIALLY, THE FIRST 10 YEARS OF 4230 02:32:18,280 --> 02:32:22,320 THE STUDY WERE FOUNDED BY 4231 02:32:22,320 --> 02:32:24,080 VENEZUELAN GOVERNMENT. 4232 02:32:24,080 --> 02:32:26,920 THROUGH OUR SURVEY GOING 4233 02:32:26,920 --> 02:32:31,160 DOOR-BY-DOOR, WE IDENTIFIED 3,65 4234 02:32:31,160 --> 02:32:34,000 INDIVIDUALS, 55 YEARS OF AGE -- 4235 02:32:34,000 --> 02:32:34,920 3,065 INDIVIDUALS. 4236 02:32:34,920 --> 02:32:38,800 WE WERE ABLE TO CONTACT 97% OF 4237 02:32:38,800 --> 02:32:39,000 THEM. 4238 02:32:39,000 --> 02:32:41,800 AND THEN WE DECIDED TO DO A 4239 02:32:41,800 --> 02:32:44,040 FAMILY INTERVIEW. 4240 02:32:44,040 --> 02:32:47,240 WE INTERVIEWED 94% OF THE 4241 02:32:47,240 --> 02:32:51,440 INDIVIDUALS AND THEIR FAMILIES 4242 02:32:51,440 --> 02:32:54,760 AND REALLY NOBODY REFUSED TO 4243 02:32:54,760 --> 02:32:56,480 GIVE US THE CONSENT TO 4244 02:32:56,480 --> 02:32:58,320 PARTICIPATE IN THIS STUDY. 4245 02:32:58,320 --> 02:33:00,960 BUT WHEN WE WENT TO PHASE III, 4246 02:33:00,960 --> 02:33:02,760 WHICH WE HAD TO DO ALL THE 4247 02:33:02,760 --> 02:33:04,080 CLINICAL ASSESSMENTS, 70% OF 4248 02:33:04,080 --> 02:33:07,760 THEM AGREED TO PARTICIPATE. 4249 02:33:07,760 --> 02:33:10,600 AND WE DID ONE PHASE STUDY 4250 02:33:10,600 --> 02:33:12,080 MEANING THAT ALL OF THEM 4251 02:33:12,080 --> 02:33:15,280 RECEIVED THE SAME TYPE OF DEEP 4252 02:33:15,280 --> 02:33:20,120 PHENOTYPING IN TERMS OF 4253 02:33:20,120 --> 02:33:22,280 NEUROPSYCHOLOGY, 4254 02:33:22,280 --> 02:33:23,040 NEUROPSYCHIATRIC, CARDIOVASCULAR 4255 02:33:23,040 --> 02:33:26,600 AND SOME ALSO ENDOGRAPHIC 4256 02:33:26,600 --> 02:33:28,560 STUDIES. 4257 02:33:28,560 --> 02:33:30,360 ONE OF THE FAMILIES REPORTED TO 4258 02:33:30,360 --> 02:33:33,360 BE FROM SANTA ROSA, A VILLAGE 4259 02:33:33,360 --> 02:33:36,640 NEARBY AND IS ONE OF THE TOWN'S 4260 02:33:36,640 --> 02:33:39,800 OF WATER AROUND THE LAKE. 4261 02:33:39,800 --> 02:33:43,360 AND THEY ARE HOUSES BUILT ON 4262 02:33:43,360 --> 02:33:45,160 STILTS. 4263 02:33:45,160 --> 02:33:47,400 THESE WERE THE ONES THAT GAVE 4264 02:33:47,400 --> 02:33:50,320 VENEZUELA THE ORIGIN AS AMERICA 4265 02:33:50,320 --> 02:33:53,520 CAME AND SAW THEM AND REMINDED 4266 02:33:53,520 --> 02:33:54,840 HIM OF LITTLE VENICE. 4267 02:33:54,840 --> 02:33:58,680 SO VENEZUELA MEANS LITTLE 4268 02:33:58,680 --> 02:33:58,880 VENICE. 4269 02:33:58,880 --> 02:34:00,640 WE ENGAGED IN DIFFERENT 4270 02:34:00,640 --> 02:34:01,680 ACTIVITIES AT THE TIME I 4271 02:34:01,680 --> 02:34:05,520 REALIZED I REALLY NEEDED THE 4272 02:34:05,520 --> 02:34:07,360 SUPPORT OF OTHER SCIENTISTS AND 4273 02:34:07,360 --> 02:34:10,280 REACHED TOUT MY COLLEAGUES, MY 4274 02:34:10,280 --> 02:34:12,000 CLASSMATES, MY PROFESSORS AND 4275 02:34:12,000 --> 02:34:14,000 THEY CAME. 4276 02:34:14,000 --> 02:34:16,280 WE HAD DIFFERENT COMMUNITY 4277 02:34:16,280 --> 02:34:20,200 ASSEMBLIES, CLASSES AND OPTED 4278 02:34:20,200 --> 02:34:23,200 FOR APPLY TO NIH TO FORWARD 4279 02:34:23,200 --> 02:34:27,080 INTERNATIONAL CENTER FOR D43 4280 02:34:27,080 --> 02:34:34,400 GRANT THAT WAS IMPLEMENTED AS A 4281 02:34:34,400 --> 02:34:34,920 CAPACITY-BUILDING ACTIVITY 4282 02:34:34,920 --> 02:34:36,360 THROUGH DIFFERENT SERIES OF 4283 02:34:36,360 --> 02:34:38,720 SESSIONS TO IDENTIFY AND TO PUT 4284 02:34:38,720 --> 02:34:43,160 TOGETHER A TEAM OF VENEZUELANS 4285 02:34:43,160 --> 02:34:44,080 THAT WILL ACTUALLY LEAD THIS 4286 02:34:44,080 --> 02:34:49,160 STUDY AND COLLABORATE WITH OUR 4287 02:34:49,160 --> 02:34:51,200 COLLEAGUES IN THE UNITED STATES. 4288 02:34:51,200 --> 02:34:54,000 THE FIRST PUBLICATION FOR THIS 4289 02:34:54,000 --> 02:34:59,240 STUDY HAD TO DO WITH REPORTING 4290 02:34:59,240 --> 02:35:01,400 THE CHARACTERISTICS ON NORMATIVE 4291 02:35:01,400 --> 02:35:04,160 POPULATIONS THAT HAD TO DO WITH 4292 02:35:04,160 --> 02:35:09,080 METRICS, NUTRITION, ELEMENTS, 4293 02:35:09,080 --> 02:35:11,360 PREVALENCE AND INCIDENCE. 4294 02:35:11,360 --> 02:35:13,000 AND WE BEGAN STUDYING 4295 02:35:13,000 --> 02:35:14,520 CARDIOVASCULAR ASPECTS AND ONE 4296 02:35:14,520 --> 02:35:18,840 THAT WAS QUICKLY IDENTIFIED WAS 4297 02:35:18,840 --> 02:35:20,520 THE NEW MEASURE FOR BLOOD 4298 02:35:20,520 --> 02:35:21,240 PRESSURE BY ABILITY. 4299 02:35:21,240 --> 02:35:23,560 WHICH HE TIME IT WAS NOT A 4300 02:35:23,560 --> 02:35:26,000 SIGNIFICANT FACTOR AND THANKS TO 4301 02:35:26,000 --> 02:35:30,000 THIS INDEX AND OTHERS THAT HAVE 4302 02:35:30,000 --> 02:35:31,680 COME AFTERWARDS, IT'S NOW A 4303 02:35:31,680 --> 02:35:35,200 TARGET OF A LOT OF IMPORTANT 4304 02:35:35,200 --> 02:35:36,160 RESEARCH. 4305 02:35:36,160 --> 02:35:38,720 THESE STUDIES EMERGE ALSO. 4306 02:35:38,720 --> 02:35:42,080 IT WAS VERY CLEAR THAT THERE 4307 02:35:42,080 --> 02:35:45,920 WAS -- THIS SET OF DATA, 4308 02:35:45,920 --> 02:35:47,600 PARTICULARLY AROUND 24-HOUR 4309 02:35:47,600 --> 02:35:48,920 BLOOD PRESSURE MONITORING WAS 4310 02:35:48,920 --> 02:35:49,600 VERY VALUABLE. 4311 02:35:49,600 --> 02:35:53,360 WE WERE ABLE TO PARTICIPATE IN 4312 02:35:53,360 --> 02:35:57,680 SEVERAL CONSORTIA, IN PARTICULAR 4313 02:35:57,680 --> 02:35:59,040 THE ONE THAT CONGLOMERATED ALL 4314 02:35:59,040 --> 02:36:01,600 THE STUDIES AROUND THE GLOBE TO 4315 02:36:01,600 --> 02:36:04,720 STUDY THIS TYPE OF BLOOD 4316 02:36:04,720 --> 02:36:06,440 PRESSURE. 4317 02:36:06,440 --> 02:36:09,800 24-HOUR BLOOD PRESSURE. 4318 02:36:09,800 --> 02:36:12,160 AND THEN WE HAD HUMANITARIAN 4319 02:36:12,160 --> 02:36:20,120 CRISIS THAT BEGAN SLOWLY AND AS 4320 02:36:20,120 --> 02:36:21,120 ANY CRISIS IN RELATIONSHIP TO 4321 02:36:21,120 --> 02:36:25,480 POVERTY, TO VIOLENCE AND TO 4322 02:36:25,480 --> 02:36:26,640 POLITICAL ISSUES THAT IMPAIR THE 4323 02:36:26,640 --> 02:36:29,240 ABILITY OF A SOCIETY TO COPE 4324 02:36:29,240 --> 02:36:38,040 USING ITS OWN RESOURCES. 4325 02:36:38,040 --> 02:36:38,880 AN IMPORTANT CONSEQUENCE HAS 4326 02:36:38,880 --> 02:36:40,840 BEEN MIGRATION. 4327 02:36:40,840 --> 02:36:42,440 A HIGH NUMBER OF VENEZUELANS 4328 02:36:42,440 --> 02:36:43,480 HAVE LEFT THE COUNTRY. 4329 02:36:43,480 --> 02:36:46,040 AND VENEZUELA IS ONLY SECOND TO 4330 02:36:46,040 --> 02:36:51,000 SYRIA IN TERMS OF NUMBERS OF 4331 02:36:51,000 --> 02:36:53,640 VENEZUELAN'S DISPLACEMENT. 4332 02:36:53,640 --> 02:36:58,200 IF YOU LOOK AT THE FIRST FIVE 4333 02:36:58,200 --> 02:36:58,960 COUNTRIES IN THE WORLD FOR -- AS 4334 02:36:58,960 --> 02:37:01,120 A MAJOR SOURCE OF MIGRANTS OR 4335 02:37:01,120 --> 02:37:03,160 DISPLACED INDIVIDUALS, VENEZUELA 4336 02:37:03,160 --> 02:37:11,080 IS THE SECOND IN THE WORLD. 4337 02:37:11,080 --> 02:37:13,240 THIS LED US TO, IN EARLY 2015, 4338 02:37:13,240 --> 02:37:16,840 SOME OF THE PARTICIPANTS OF OUR 4339 02:37:16,840 --> 02:37:17,920 STUDY SUFFERED. 4340 02:37:17,920 --> 02:37:19,600 THIS WAS NOT ALONE. 4341 02:37:19,600 --> 02:37:21,280 THIS HAPPENED IN THE CITY WHERE 4342 02:37:21,280 --> 02:37:27,280 IN ONE WEEK WE WILL HAVE 70 4343 02:37:27,280 --> 02:37:27,480 CASES. 4344 02:37:27,480 --> 02:37:30,960 THE WORLD WAS EXPERIENCING ZIKA 4345 02:37:30,960 --> 02:37:31,560 BUT WE DIDN'T KNOW THIS WAS 4346 02:37:31,560 --> 02:37:33,760 ALREADY IN VENEZUELA AND EITHER 4347 02:37:33,760 --> 02:37:37,920 THIS SICKNESS OR UV-ITIS WAS 4348 02:37:37,920 --> 02:37:40,720 SOMETHING THAT WAS PART OF THE 4349 02:37:40,720 --> 02:37:44,600 SYNDROME THAT IS CAUSED BY ZIKA. 4350 02:37:44,600 --> 02:37:46,960 THIS SEVERE CONSEQUENCES OF ZIKA 4351 02:37:46,960 --> 02:37:49,080 IN ADULTS AND THE EYES OF KIDS, 4352 02:37:49,080 --> 02:37:51,280 WE WERE SEEING UNTIL BOTH OF OUR 4353 02:37:51,280 --> 02:37:53,320 POPULATIONS AND THAT IS WHY WE 4354 02:37:53,320 --> 02:37:58,800 DECIDED TO PARTNER WITH 4355 02:37:58,800 --> 02:37:59,760 COLLEAGUES IN OPHTHALMOLOGY IN 4356 02:37:59,760 --> 02:38:03,320 COLUMBIA IN NEW YORK HERE TO 4357 02:38:03,320 --> 02:38:03,800 STUDY THIS. 4358 02:38:03,800 --> 02:38:05,440 AND WE WERE AMONG THE FIRST TO 4359 02:38:05,440 --> 02:38:09,440 REPORT THIS TYPE OF CONSEQUENCES 4360 02:38:09,440 --> 02:38:11,320 IN RELATIONSHIP TO THE EPIDEMIC 4361 02:38:11,320 --> 02:38:17,800 OF ZIKA. 4362 02:38:17,800 --> 02:38:21,040 FROM OUR RELATIONSHIP WITH THE 4363 02:38:21,040 --> 02:38:23,200 MONTHMOLOGIST DURING THIS 4364 02:38:23,200 --> 02:38:23,840 CRISIS, EMERGE ONE OF THE 4365 02:38:23,840 --> 02:38:28,080 MEMBERS OF YOUNGER MEMBERS OF 4366 02:38:28,080 --> 02:38:30,480 OUR TEAM WHO ENTERED IN THAT 4367 02:38:30,480 --> 02:38:31,800 RELATIONSHIP AND DECIDED TO 4368 02:38:31,800 --> 02:38:33,840 CONTINUE THE EYE STUDIES JUST 4369 02:38:33,840 --> 02:38:39,760 NOT RELATED TO ZIKA BUT ALSO TO 4370 02:38:39,760 --> 02:38:40,240 THE NEURODEGENERATION. 4371 02:38:40,240 --> 02:38:42,040 AND SEVERAL PAPERS HAVE COME OUT 4372 02:38:42,040 --> 02:38:47,360 AND IN FACT, HE FINISHED HIS 4373 02:38:47,360 --> 02:38:48,720 THESIS -- DOCTORAL THESIS AT 4374 02:38:48,720 --> 02:38:50,200 UNIVERSITY OF LUBE IN IN 4375 02:38:50,200 --> 02:38:50,440 BELGIUM. 4376 02:38:50,440 --> 02:38:54,920 ONE OF THE MAIN FINDINGS THAT 4377 02:38:54,920 --> 02:38:58,440 JESUS ARRIVE WAS THAT 4378 02:38:58,440 --> 02:39:01,200 HYPOTENSION DURING THE NIGHT, 4379 02:39:01,200 --> 02:39:02,920 NOCTURNAL HYPOTENSION, HAS BEEN 4380 02:39:02,920 --> 02:39:05,920 RELATED AS A VERY STRONG RISK 4381 02:39:05,920 --> 02:39:07,160 FACTOR FOR GLAUCOMA. 4382 02:39:07,160 --> 02:39:09,240 WHAT HE IDENTIFIED WAS NOT ONLY 4383 02:39:09,240 --> 02:39:12,640 THAT THE LEVEL WAS IMPORTANT BUT 4384 02:39:12,640 --> 02:39:15,280 THE BLOOD PRESSURE VIABILITY 4385 02:39:15,280 --> 02:39:16,280 DURING THE NIGHT. 4386 02:39:16,280 --> 02:39:20,040 AND JUST THIS YEAR, WE WERE ABLE 4387 02:39:20,040 --> 02:39:20,840 TO BRING THIS SUBJECT AGAIN 4388 02:39:20,840 --> 02:39:23,600 DURING THE PANDEMIC TO HAVE 4389 02:39:23,600 --> 02:39:26,000 THEIR EYES AND BLOOD PRESSURE 4390 02:39:26,000 --> 02:39:26,240 EXAMINED. 4391 02:39:26,240 --> 02:39:29,880 AND HERE YOU SEE ONE OF OUR 4392 02:39:29,880 --> 02:39:32,240 PARTICIPANTS WHERE WE ARE 4393 02:39:32,240 --> 02:39:41,320 LOOKING AT THE OPTICAL RESULTS. 4394 02:39:41,320 --> 02:39:43,320 WE ENVISION RESEARCH AND SUPPORT 4395 02:39:43,320 --> 02:39:48,440 TO GO HAND BY HAND. 4396 02:39:48,440 --> 02:39:49,080 ESTABLISH DIFFERENT MECHANISMS 4397 02:39:49,080 --> 02:39:50,440 GIVE FEEDBACK TO THE COMMUNITY. 4398 02:39:50,440 --> 02:39:55,640 HERE WE SEE EXPERIENCE 4399 02:39:55,640 --> 02:39:56,720 NEUROLOGISTS PROVIDING RESULTS 4400 02:39:56,720 --> 02:40:00,360 OF THE STUDIES TO A PARTICIPANT 4401 02:40:00,360 --> 02:40:02,320 ON HER FAMILY. 4402 02:40:02,320 --> 02:40:04,760 WE ALSO ESTABLISHED A MEDICAL 4403 02:40:04,760 --> 02:40:07,000 SCHOOL, WHICH IS AN ACTIVITY 4404 02:40:07,000 --> 02:40:08,480 PEER-LED IN WHICH OLDER ADULTS 4405 02:40:08,480 --> 02:40:10,960 BRING THEIR MEDICATIONS THEY ARE 4406 02:40:10,960 --> 02:40:13,240 TAKING AND WE EXPLORE THE 4407 02:40:13,240 --> 02:40:15,440 PROBLEMS OF INTERACTIONS AMONG 4408 02:40:15,440 --> 02:40:17,480 DRUGS AND SECONDARY EFFECTS AND 4409 02:40:17,480 --> 02:40:20,400 ADVERSE EVENTS. 4410 02:40:20,400 --> 02:40:22,560 ESTABLISHED A SCHOOL FOR 4411 02:40:22,560 --> 02:40:25,840 CAREGIVERS, ALSO PEER-LED. 4412 02:40:25,840 --> 02:40:27,600 WE ALWAYS CONSIDERED THE 4413 02:40:27,600 --> 02:40:29,280 IMPORTANCE OF COLLECTIVE 4414 02:40:29,280 --> 02:40:29,960 ABILITY. 4415 02:40:29,960 --> 02:40:33,680 SO WE PLAN DIFFERENT EVENTS FOR 4416 02:40:33,680 --> 02:40:36,240 COMMUNITY MOBILIZATION AND 4417 02:40:36,240 --> 02:40:37,600 EMERGENCY RESPONSES. 4418 02:40:37,600 --> 02:40:42,880 WE GATHER TOGETHER ABOUT 1500 4419 02:40:42,880 --> 02:40:46,280 INDIVIDUALS BEFORE OR PRIOR TO 4420 02:40:46,280 --> 02:40:46,600 THE PANDEMIC. 4421 02:40:46,600 --> 02:40:49,320 WE PARTNERED WITH DIFFERENT 4422 02:40:49,320 --> 02:40:50,320 ORGANIZATIONS THAT ALREADY HAVE 4423 02:40:50,320 --> 02:40:53,480 THE MISSION OF PROMOTING 4424 02:40:53,480 --> 02:40:56,000 HEALTHIER LIFESTYLES. 4425 02:40:56,000 --> 02:40:59,400 AND MAKE THEM AWARE OF HOW TO BE 4426 02:40:59,400 --> 02:41:02,600 MORE INCLUSIVE, INCLUDING 4427 02:41:02,600 --> 02:41:03,800 INDIVIDUALS THAT WERE 4428 02:41:03,800 --> 02:41:05,520 COGNITIVELY IMPAIRED BUT ALSO 4429 02:41:05,520 --> 02:41:12,080 THAT WERE HARD TO SEE OR BLIND. 4430 02:41:12,080 --> 02:41:14,640 SO WHAT ARE THE MAIN LESSONS 4431 02:41:14,640 --> 02:41:17,440 THAT I WOULD LIKE TO SHARE? 4432 02:41:17,440 --> 02:41:19,600 ONE OF THE THINGS I WOULD LIKE 4433 02:41:19,600 --> 02:41:21,840 TO SHARE IS THAT IT'S USUALLY 4434 02:41:21,840 --> 02:41:23,840 VERY IMPORTANT TO LOOK AT 4435 02:41:23,840 --> 02:41:25,160 CHALLENGES BUT ALSO LOOK AT THE 4436 02:41:25,160 --> 02:41:29,760 ROOT CAUSES OF THOSE CHALLENGES. 4437 02:41:29,760 --> 02:41:32,200 FOR EXAMPLE, WHAT ARE THE 4438 02:41:32,200 --> 02:41:36,240 LOGISTICS BEING EFFECTED FOR THE 4439 02:41:36,240 --> 02:41:38,080 STAFF MOBILIZATION AND 4440 02:41:38,080 --> 02:41:41,920 EVERYTHING THAT GOES AROUND THE 4441 02:41:41,920 --> 02:41:42,240 LOGISTICS? 4442 02:41:42,240 --> 02:41:43,480 AND WHAT IS THE ORANGE IN? 4443 02:41:43,480 --> 02:41:46,240 WHAT IS THE MECHANISM THAT IS 4444 02:41:46,240 --> 02:41:50,440 GIVING THAT IT IS PROVIDING THIS 4445 02:41:50,440 --> 02:41:50,680 CHALLENGE. 4446 02:41:50,680 --> 02:41:51,680 OF COURSE IT'S NOT ONE THING BUT 4447 02:41:51,680 --> 02:41:53,200 IDENTIFYING THE MECHANISMS, FOR 4448 02:41:53,200 --> 02:41:55,600 EXAMPLE WHAT IS HAPPENING IN THE 4449 02:41:55,600 --> 02:41:57,320 COMMUNITY IN GENERAL, THE 4450 02:41:57,320 --> 02:41:58,840 DYNAMICS OF THE COMMUNITY. 4451 02:41:58,840 --> 02:42:02,080 AND THIS LED US TO ACTIVITIES TO 4452 02:42:02,080 --> 02:42:05,000 COUNTER ACT THOSE CHALLENGES. 4453 02:42:05,000 --> 02:42:09,280 SO BY HAVING REFLECTION AMONG 4454 02:42:09,280 --> 02:42:12,240 OURSELVES AND THE TEAM, IT WAS 4455 02:42:12,240 --> 02:42:15,200 VERY IMPORTANT TO IDENTIFY THIS 4456 02:42:15,200 --> 02:42:17,720 MECHANISMS OF -- HERE ARE SOME 4457 02:42:17,720 --> 02:42:19,520 OF THE MECHANISMS WE HAVE 4458 02:42:19,520 --> 02:42:24,240 IDENTIFIED AND WE PUBLISHED THIS 4459 02:42:24,240 --> 02:42:25,320 IN 2021. 4460 02:42:25,320 --> 02:42:30,040 AND THE BMC COLLECTION IS 4461 02:42:30,040 --> 02:42:32,240 SPONSORED. 4462 02:42:32,240 --> 02:42:33,400 THE KEY LESSONS FROM OUR 4463 02:42:33,400 --> 02:42:34,880 EXPERIENCE HAS TO DO WITH THE 4464 02:42:34,880 --> 02:42:36,880 FACT THAT CULTURAL AGILITY IS 4465 02:42:36,880 --> 02:42:39,960 NOT INTUITIVE FOR OUR 4466 02:42:39,960 --> 02:42:41,560 INTERNATIONAL COLLABORATORS. 4467 02:42:41,560 --> 02:42:45,640 AND IT WAS HARDER TO GET ON BOTH 4468 02:42:45,640 --> 02:42:48,000 SIDES THE -- OUR U.S. PARTNERS 4469 02:42:48,000 --> 02:42:50,880 HAVING ACQUIRING THE AGILITY AND 4470 02:42:50,880 --> 02:42:53,280 ALSO OUR TEAM IN VENEZUELA TO 4471 02:42:53,280 --> 02:42:55,920 ACQUIRE THE CULTURAL AGILITY TO 4472 02:42:55,920 --> 02:42:58,960 INTERACT WITH OUR PARTNERS IN 4473 02:42:58,960 --> 02:43:00,200 THE U.S. 4474 02:43:00,200 --> 02:43:02,120 THE CAPACITY BUILDING APPROACH, 4475 02:43:02,120 --> 02:43:04,320 I THINK IS THE NECESSARY 4476 02:43:04,320 --> 02:43:04,800 APPROACH. 4477 02:43:04,800 --> 02:43:07,920 IT'S NOT IMPOSING. 4478 02:43:07,920 --> 02:43:10,600 IT'S THE IDEAL CAPACITY AND NOT 4479 02:43:10,600 --> 02:43:12,000 THINKING THAT THE RETURN WILL BE 4480 02:43:12,000 --> 02:43:12,280 IMMEDIATE. 4481 02:43:12,280 --> 02:43:14,400 WE HAVE BEEN DOING THIS FOR MORE 4482 02:43:14,400 --> 02:43:16,520 THAN 25 YEARS NOW. 4483 02:43:16,520 --> 02:43:18,360 PARTICIPANTS NEED TRANSPARENCY. 4484 02:43:18,360 --> 02:43:20,040 THEY WANT TO SEE WHAT IS THE 4485 02:43:20,040 --> 02:43:22,240 RESULT OF THEIR PARTICIPATION. 4486 02:43:22,240 --> 02:43:25,880 WE ALSO NEED TO THINK ABOUT OUR 4487 02:43:25,880 --> 02:43:28,280 OPERATIONS AND TARGETED 4488 02:43:28,280 --> 02:43:30,520 OPERATIONS IN THE SENSE OF 4489 02:43:30,520 --> 02:43:31,320 FLEXIBILITY AND THE PURPOSE TO 4490 02:43:31,320 --> 02:43:32,400 COUNTER ACT. 4491 02:43:32,400 --> 02:43:34,120 AND THE INDIVIDUALIZED APPROACH 4492 02:43:34,120 --> 02:43:36,240 BECAUSE WE NEED TO BE FLEXIBLE 4493 02:43:36,240 --> 02:43:39,160 BUT WE CANNOT FORGET THAT WE 4494 02:43:39,160 --> 02:43:41,880 NEED TO BE PERSONAL FOR AND EACH 4495 02:43:41,880 --> 02:43:44,640 PARTICIPANT IS SUSPECTING TO BE 4496 02:43:44,640 --> 02:43:46,720 CONSIDERED UNIQUE PERSON. 4497 02:43:46,720 --> 02:43:49,280 SO, ENGAGEMENT IS A RELATIONAL 4498 02:43:49,280 --> 02:43:49,640 PROCESS. 4499 02:43:49,640 --> 02:43:51,640 THIS MEANS THAT ENGAGEMENT IS 4500 02:43:51,640 --> 02:43:55,400 THE RESULT OF ONGOING 4501 02:43:55,400 --> 02:43:56,120 INTERACTIONS. 4502 02:43:56,120 --> 02:43:58,800 AND IT'S LIKE A BEACH WHERE YOU 4503 02:43:58,800 --> 02:44:01,080 HAVE THE WATER AND YOU HAVE THE 4504 02:44:01,080 --> 02:44:01,640 LAND. 4505 02:44:01,640 --> 02:44:03,360 AND ENGAGEMENT, IT'S THE RESULT 4506 02:44:03,360 --> 02:44:07,280 OF THE INTERACTION OF THE TWO. 4507 02:44:07,280 --> 02:44:09,280 THIS IS A PICTURE OF THE TEAM. 4508 02:44:09,280 --> 02:44:11,760 MANY OF THEM ARE NOW IN OTHER 4509 02:44:11,760 --> 02:44:13,520 COUNTRIES BUT WE KEEP TOGETHER 4510 02:44:13,520 --> 02:44:16,960 ONE WAY OR ANOTHER, NOT ONLY TO 4511 02:44:16,960 --> 02:44:19,880 ADVANCE KNOWLEDGE IN VENEZUELA 4512 02:44:19,880 --> 02:44:22,000 BUT TO SUPPORT THE COMMUNITIES 4513 02:44:22,000 --> 02:44:32,280 THAT WE SERVE. 4514 02:44:34,080 --> 02:44:36,520 >>GREETINGS EVERYONE AND THANK 4515 02:44:36,520 --> 02:44:41,320 YOU TO ALL THE SPEAKERS FOR 4516 02:44:41,320 --> 02:44:42,760 THEIR GREAT PRESENTATIONS DURING 4517 02:44:42,760 --> 02:44:46,760 THIS SESSION ON BEST PRACTICES, 4518 02:44:46,760 --> 02:44:47,360 LESSONS LEARNED, EFFECTIVE 4519 02:44:47,360 --> 02:44:51,400 COMMUNITY-ENGAGED RESEARCH. 4520 02:44:51,400 --> 02:44:56,400 I'M DR. JOHN JONC A JARRETT JOH. 4521 02:44:56,400 --> 02:45:00,240 WE ARE LIVE FOR Q&A. 4522 02:45:00,240 --> 02:45:01,560 YOU PRESENTED SEVERAL 4523 02:45:01,560 --> 02:45:02,920 COLLABORATIONS THAT DEMONSTRATE 4524 02:45:02,920 --> 02:45:04,640 CANCER RESEARCH IN PERU. 4525 02:45:04,640 --> 02:45:05,560 WHAT ARE SOME OF THE LESSONS 4526 02:45:05,560 --> 02:45:09,240 LEARNED FROM CONDUCTING SUCH 4527 02:45:09,240 --> 02:45:15,000 COLLABORATIONS? 4528 02:45:15,000 --> 02:45:17,920 >>THANK YOU FOR THE INVITATION 4529 02:45:17,920 --> 02:45:19,280 FOR THIS PANEL. 4530 02:45:19,280 --> 02:45:21,240 IT'S A GREAT OPPORTUNITY. 4531 02:45:21,240 --> 02:45:22,440 I THINK THAT IT IS IMPORTANT 4532 02:45:22,440 --> 02:45:24,160 QUESTION BECAUSE PERU HAS A VERY 4533 02:45:24,160 --> 02:45:28,800 HIGH RATE OF NATIVE PEOPLE IN 4534 02:45:28,800 --> 02:45:32,440 ITS POPULATION AND THE 4535 02:45:32,440 --> 02:45:33,840 INDIGENOUS AMERICAN ANCESTRY IS 4536 02:45:33,840 --> 02:45:35,240 70-80%. 4537 02:45:35,240 --> 02:45:38,920 THE LESSONS WE LEARNED IS THAT 4538 02:45:38,920 --> 02:45:42,160 WE HAVE RESEARCH IN CANCER 4539 02:45:42,160 --> 02:45:44,480 CENTERS AND EXPERIENCE IN THE 4540 02:45:44,480 --> 02:45:46,120 ORIGIN. 4541 02:45:46,120 --> 02:45:48,640 THIS HAVE A LOT NUMBER OF 4542 02:45:48,640 --> 02:45:49,120 PATIENT. 4543 02:45:49,120 --> 02:45:51,640 THIS IS ALSO NATIONAL RESEARCH 4544 02:45:51,640 --> 02:45:53,680 PROJECT AND SAMPLES AND THIS 4545 02:45:53,680 --> 02:45:56,040 PERMIT TO BE CONNECTED WITH THE 4546 02:45:56,040 --> 02:45:57,800 GLOBAL RESEARCH OPPORTUNITIES IN 4547 02:45:57,800 --> 02:45:58,880 CANCER AND THE RESEARCH TO BE 4548 02:45:58,880 --> 02:46:01,040 INVOLVED IN MOLECULAR RESEARCH 4549 02:46:01,040 --> 02:46:03,400 PROJECTS. 4550 02:46:03,400 --> 02:46:06,760 FOR THIS PURPOSE, WE LEARNING 4551 02:46:06,760 --> 02:46:08,240 HOW TO CONNECT THESE TO ONCOLOGY 4552 02:46:08,240 --> 02:46:10,640 TRAINING AND BUILDING CAPACITY 4553 02:46:10,640 --> 02:46:14,920 FOR MOLECULAR APPROACH LINKING 4554 02:46:14,920 --> 02:46:18,960 THE BIOBANK TO THE NETWORK 4555 02:46:18,960 --> 02:46:23,280 UNIVERSITY NETWORK FOR EDUCATION 4556 02:46:23,280 --> 02:46:24,480 PLATFORM FOR SAMPLE RESEARCH 4557 02:46:24,480 --> 02:46:27,240 MASTER COURSE AND THIS EXPAND 4558 02:46:27,240 --> 02:46:28,560 COLLABORATION TO OTHER 4559 02:46:28,560 --> 02:46:31,520 INSTITUTIONS INCLUDING THE 4560 02:46:31,520 --> 02:46:33,400 PARTICIPATION OF NATIONAL AND 4561 02:46:33,400 --> 02:46:34,320 INTERNATIONAL RESEARCHERS AND 4562 02:46:34,320 --> 02:46:34,680 STUDENTS. 4563 02:46:34,680 --> 02:46:37,000 THIS GIVE US A CHANCE TO HAVE 4564 02:46:37,000 --> 02:46:42,240 WORLDWIDE PRESENCE IN ONCOLOGY 4565 02:46:42,240 --> 02:46:47,280 RESEARCH 4566 02:46:47,280 --> 02:46:47,600 [ INAUDIBLE ] 4567 02:46:47,600 --> 02:46:51,280 AND COLLABORATION POSSIBLE FOR 4568 02:46:51,280 --> 02:46:54,280 TEACHING BREAST CANCER STUDENTS 4569 02:46:54,280 --> 02:46:56,640 AND ACKNOWLEDGMENT -- 4570 02:46:56,640 --> 02:46:58,040 >>MODERATOR: THANK YOU FOR THAT 4571 02:46:58,040 --> 02:46:58,640 RESPONSE. 4572 02:46:58,640 --> 02:46:59,400 SO YOUR SECOND QUESTION. 4573 02:46:59,400 --> 02:47:01,240 FOR THE PROJECT THAT FOCUSES ON 4574 02:47:01,240 --> 02:47:03,160 THE INDIGENOUS POPULATION, COULD 4575 02:47:03,160 --> 02:47:04,160 YOU PROVIDE SOME ADDITIONAL 4576 02:47:04,160 --> 02:47:06,200 DETAILS ABOUT THE PROCESS FOR 4577 02:47:06,200 --> 02:47:07,600 THIS COLLABORATION? 4578 02:47:07,600 --> 02:47:10,400 FOR EXAMPLE, HOW DID YOU GAIN 4579 02:47:10,400 --> 02:47:11,480 ENTRY OR BUY IN FROM THIS 4580 02:47:11,480 --> 02:47:14,280 POPULATION AND HOW WAS TRUST 4581 02:47:14,280 --> 02:47:19,200 ESTABLISHED TO CONDUCT SAID 4582 02:47:19,200 --> 02:47:20,600 RESEARCH? 4583 02:47:20,600 --> 02:47:28,760 >>AS I SAY BEFORE, THE MAIN 4584 02:47:28,760 --> 02:47:32,880 INSTITUTE -- WE HAVE 55,000 4585 02:47:32,880 --> 02:47:33,600 PATIENT BY YEAR. 4586 02:47:33,600 --> 02:47:37,960 HIGH PARTICIPATION COMING FROM 4587 02:47:37,960 --> 02:47:39,840 THE -- WE CAN SELECT PATIENT 4588 02:47:39,840 --> 02:47:41,920 THAT COME IN FROM THE NATIVE 4589 02:47:41,920 --> 02:47:46,320 COMMUNITY AND THIS IS OUR 4590 02:47:46,320 --> 02:47:48,440 STRATEGY FOR COMMUNITY 4591 02:47:48,440 --> 02:47:48,920 ENGAGEMENT. 4592 02:47:48,920 --> 02:47:50,760 WE DISCUSS TO SEE IF IT IS 4593 02:47:50,760 --> 02:47:54,960 BENEFICIAL AND FEASIBLE IN THE 4594 02:47:54,960 --> 02:47:58,080 ONCOLOGY DEPARTMENT. 4595 02:47:58,080 --> 02:48:04,520 IN CASE OF -- WE SET UP THE 4596 02:48:04,520 --> 02:48:07,160 PROCESS AND THE DOCTORS -- WE 4597 02:48:07,160 --> 02:48:09,640 HAVE TO HAVE CLOSE RELATIONSHIP 4598 02:48:09,640 --> 02:48:12,200 WITH THE PATIENT AND THE FAMILY. 4599 02:48:12,200 --> 02:48:15,000 IT'S LIKE TA GAIN TRUST WE HAVE 4600 02:48:15,000 --> 02:48:16,120 TO CREATE THIS ENVIRONMENT 4601 02:48:16,120 --> 02:48:19,000 TOGETHER WITH THE FAMILY AND THE 4602 02:48:19,000 --> 02:48:21,040 PATIENT CAREFULLY FOR CONSENT 4603 02:48:21,040 --> 02:48:25,400 PROCESS BECAUSE WE HAVE SOME 4604 02:48:25,400 --> 02:48:27,320 HEALTH PROFESSIONALS -- SOME 4605 02:48:27,320 --> 02:48:28,880 INDIGENOUS POPULATION AND IT IS 4606 02:48:28,880 --> 02:48:31,760 POSSIBLE TO ESTABLISH NETWORK 4607 02:48:31,760 --> 02:48:33,400 WITH CIVIL SOCIETY AS PATIENT 4608 02:48:33,400 --> 02:48:36,840 GROUPS WE TRAIN ABOUT RESEARCH 4609 02:48:36,840 --> 02:48:39,280 AND HAVE TO TRANSFER THE 4610 02:48:39,280 --> 02:48:41,840 INFORMATION FROM THE PATIENTS. 4611 02:48:41,840 --> 02:48:42,400 >>MODERATOR: THANK YOU. 4612 02:48:42,400 --> 02:48:45,120 SO MY NEXT QUESTION IS FOR 4613 02:48:45,120 --> 02:48:46,600 DR. JOHN PIETTE. 4614 02:48:46,600 --> 02:48:47,720 BASED ON YOUR EXPERIENCE, WHAT 4615 02:48:47,720 --> 02:48:49,000 ARE THE STRATEGIES THAT SHOULD 4616 02:48:49,000 --> 02:48:50,160 BE PROMOTED THROUGH 4617 02:48:50,160 --> 02:48:52,320 INTERNATIONAL COLLABORATIONS IN 4618 02:48:52,320 --> 02:48:53,920 ORDER TO ADDRESS SOME OF THE 4619 02:48:53,920 --> 02:48:54,840 COMMUNITIES MOST PRESSING NEEDS 4620 02:48:54,840 --> 02:48:57,960 AND PRIORITIES? 4621 02:48:57,960 --> 02:48:59,960 >>JOHN PIETTE: THANK YOU, 4622 02:48:59,960 --> 02:49:01,720 DR. JOHNSON FOR THAT QUESTION 4623 02:49:01,720 --> 02:49:04,320 AND THANK YOU TO THE INSTITUTE 4624 02:49:04,320 --> 02:49:06,040 FOR THIS OPPORTUNITY TO TALK 4625 02:49:06,040 --> 02:49:09,520 WITH YOU AND LEARN FROM YOU ALL. 4626 02:49:09,520 --> 02:49:11,920 WE ALREADY TALKED THIS MORNING 4627 02:49:11,920 --> 02:49:13,840 ABOUT SOME OF THE STRATEGIES 4628 02:49:13,840 --> 02:49:15,720 THAT I THINK WILL BE VERY 4629 02:49:15,720 --> 02:49:17,960 IMPORTANT IN IMPROVING CARE IN 4630 02:49:17,960 --> 02:49:18,880 LATIN-AMERICAN COMING YEARS. 4631 02:49:18,880 --> 02:49:22,400 THOSE INCLUDE USING DIGITAL 4632 02:49:22,400 --> 02:49:24,440 TOOLS THAT ARE MORE AND MORE 4633 02:49:24,440 --> 02:49:25,600 POSSIBLE GIVEN SOME OF THE 4634 02:49:25,600 --> 02:49:26,680 INTERNATIONAL PLATFORMS. 4635 02:49:26,680 --> 02:49:28,680 WE TALKED ABOUT ARTIFICIAL 4636 02:49:28,680 --> 02:49:29,040 INTELLIGENCE. 4637 02:49:29,040 --> 02:49:30,200 WE COULD TALK MORE ABOUT THAT. 4638 02:49:30,200 --> 02:49:32,240 AND THE PRIORITY OF MENTAL 4639 02:49:32,240 --> 02:49:35,320 HEALTH AS A GROWING NEED AMONG 4640 02:49:35,320 --> 02:49:37,280 IMMIGRANTS IN THE UNITED STATES 4641 02:49:37,280 --> 02:49:39,120 AND AMONG PEOPLE IN THEIR HOME 4642 02:49:39,120 --> 02:49:40,200 COUNTRIES IN LATIN AMERICA. 4643 02:49:40,200 --> 02:49:42,320 SO, I WON'T GO BACK TO THOSE 4644 02:49:42,320 --> 02:49:42,840 POINTS AS MUCH. 4645 02:49:42,840 --> 02:49:46,000 I WILL SAY ABOUT MENTAL HEALTH, 4646 02:49:46,000 --> 02:49:46,240 THOUGH. 4647 02:49:46,240 --> 02:49:48,240 THERE IS KIND OF A NEW ADVANCE 4648 02:49:48,240 --> 02:49:49,360 IN COGNITIVE BEHAVIORAL THERAPY 4649 02:49:49,360 --> 02:49:50,800 AND THE TREATMENT OF MENTAL 4650 02:49:50,800 --> 02:49:52,760 HEALTH WITH COMMUNITY HEALTH 4651 02:49:52,760 --> 02:49:55,440 WORKERS AND BRIEF PSYCHOLOGICAL 4652 02:49:55,440 --> 02:49:55,840 INTERVENTION. 4653 02:49:55,840 --> 02:49:59,440 THAT ADVANCE IS REALLY WHAT IS 4654 02:49:59,440 --> 02:50:03,200 CALLED TRANSDIAGNOSTIC CBT 4655 02:50:03,200 --> 02:50:03,440 PROGRAMS. 4656 02:50:03,440 --> 02:50:04,600 AND THAT IS, INSTEAD OF HAVING A 4657 02:50:04,600 --> 02:50:06,320 PROGRAM THAT IS SPECIFICALLY 4658 02:50:06,320 --> 02:50:08,480 FOCUSED ON DEPRESSION OR ANXIETY 4659 02:50:08,480 --> 02:50:10,720 OR POST-TRAUMATIC STRESS, AS THE 4660 02:50:10,720 --> 02:50:13,480 NAME WOULD IMPLY, 4661 02:50:13,480 --> 02:50:16,120 TRANSDIAGNOSTIC CBT FOCUSES ON 4662 02:50:16,120 --> 02:50:17,520 THE DRIVERS OF THE VARIETY OF 4663 02:50:17,520 --> 02:50:19,560 MENTAL HEALTH SYMPTOMS AND HELPS 4664 02:50:19,560 --> 02:50:20,560 PEOPLE FUNCTION BETTER AND FEEL 4665 02:50:20,560 --> 02:50:20,760 BETTER. 4666 02:50:20,760 --> 02:50:21,960 AND WITHOUT GOING INTO DETAIL 4667 02:50:21,960 --> 02:50:24,240 ABOUT IT, IT'S REALLY THE 4668 02:50:24,240 --> 02:50:26,880 ADVANCE AND IT IS A PROGRAM THAT 4669 02:50:26,880 --> 02:50:29,160 HAS SHOWN GREAT PROMISE IN LATIN 4670 02:50:29,160 --> 02:50:31,560 AMERICA AND OTHER LOW AND 4671 02:50:31,560 --> 02:50:32,160 MIDDLE-INCOME COUNTRIES AROUND 4672 02:50:32,160 --> 02:50:32,440 THE WORLD. 4673 02:50:32,440 --> 02:50:33,440 THAT IS ONE THING I WOULD 4674 02:50:33,440 --> 02:50:33,800 HIGHLIGHT. 4675 02:50:33,800 --> 02:50:36,280 THE NEXT I WOULD HIGHLIGHT AS I 4676 02:50:36,280 --> 02:50:38,600 MENTIONED AT THE END OF MY TALK 4677 02:50:38,600 --> 02:50:39,720 THIS MORNING, IS THAT I HOPE WE 4678 02:50:39,720 --> 02:50:43,160 CAN WORK TOGETHER TO IMPROVE THE 4679 02:50:43,160 --> 02:50:44,560 QUALITY OF COMMUNICATION BETWEEN 4680 02:50:44,560 --> 02:50:46,160 PATIENTS AND HEALTH SYSTEMS OR 4681 02:50:46,160 --> 02:50:48,880 MORE GENERALLY THE RELATIONSHIP 4682 02:50:48,880 --> 02:50:51,280 THAT PATIENTS HAVE IN HEALTH 4683 02:50:51,280 --> 02:50:53,880 SYSTEMS. 4684 02:50:53,880 --> 02:50:54,480 IN MANY COMMUNITIES, I'M SURE 4685 02:50:54,480 --> 02:50:55,120 SOME OF YOU ARE QUITE AWARE OF 4686 02:50:55,120 --> 02:50:55,320 THIS. 4687 02:50:55,320 --> 02:50:56,760 HOSPITALS ARE WHERE YOU GO TO 4688 02:50:56,760 --> 02:50:57,560 DIE. 4689 02:50:57,560 --> 02:50:59,120 OR HEALTH SYSTEMS ARE WHERE YOU 4690 02:50:59,120 --> 02:51:00,480 GO WHEN YOU'RE REALLY AT THE END 4691 02:51:00,480 --> 02:51:03,000 OF LIFE OR AT THE END OF YOUR 4692 02:51:03,000 --> 02:51:03,800 ROPE. 4693 02:51:03,800 --> 02:51:06,240 INCLUDING IN OUR OWN SAMPLES, IN 4694 02:51:06,240 --> 02:51:08,040 PARTICULAR WHEN WE IDENTIFY 4695 02:51:08,040 --> 02:51:09,760 SAMPLES IN CLINICS, THE SAMPLE 4696 02:51:09,760 --> 02:51:12,080 MIGHT BE 80% WOMEN, 20% MEN. 4697 02:51:12,080 --> 02:51:14,200 MEN AREN'T GOING TO CLINIC IN 4698 02:51:14,200 --> 02:51:15,760 PARTICULAR, BUT IN GENERAL GOING 4699 02:51:15,760 --> 02:51:18,280 TO HEALTH SYSTEMS IS NOT SEEN AS 4700 02:51:18,280 --> 02:51:20,880 SOMETHING THAT IS USEFUL. 4701 02:51:20,880 --> 02:51:22,160 PARTLY WE HAVE TO ADMIT IT'S 4702 02:51:22,160 --> 02:51:23,760 BECAUSE THE QUALITY OF 4703 02:51:23,760 --> 02:51:27,200 COMMUNICATION BETWEEN PROVIDERS 4704 02:51:27,200 --> 02:51:27,720 AND PATIENTS ISN'T GOOD. 4705 02:51:27,720 --> 02:51:30,160 I'M VERY SYMPATHETIC TO HEALTH 4706 02:51:30,160 --> 02:51:32,160 CARE PROVIDERS, PHYSICIANS AND 4707 02:51:32,160 --> 02:51:33,760 OTHERS IN THE UNITED STATES AND 4708 02:51:33,760 --> 02:51:34,200 LATIN AMERICA. 4709 02:51:34,200 --> 02:51:36,760 SPECIFICALLY IN LATIN AMERICA, 4710 02:51:36,760 --> 02:51:38,800 THEY ARE HORRIBLY UNDERPAID. 4711 02:51:38,800 --> 02:51:40,120 IN MANY CIRCUMSTANCES THEY ARE 4712 02:51:40,120 --> 02:51:41,400 RUNNING OFF TO A PRIVATE 4713 02:51:41,400 --> 02:51:42,400 PRACTICE IN THE AFTERNOON JUST 4714 02:51:42,400 --> 02:51:46,360 TO MAKE ENOUGH MONEY TO SUPPORT 4715 02:51:46,360 --> 02:51:46,680 THEIR FAMILY. 4716 02:51:46,680 --> 02:51:50,160 BUT, WE HAVE TO ADMIT THAT MANY 4717 02:51:50,160 --> 02:51:53,240 PROVIDERS STILL HAVE SORT OF A 4718 02:51:53,240 --> 02:51:55,760 TRADITIONAL VIEW, HIERARCHAL 4719 02:51:55,760 --> 02:51:56,480 VIEW OF THEIR RELATIONSHIP WITH 4720 02:51:56,480 --> 02:51:57,520 PATIENTS. 4721 02:51:57,520 --> 02:52:01,560 I LEARNED JUST IN THE LAST YEAR 4722 02:52:01,560 --> 02:52:02,120 ABOUT THE TERM, OBSTETRIC 4723 02:52:02,120 --> 02:52:03,360 VIOLENCE SUCH A HORRIBLE TERM. 4724 02:52:03,360 --> 02:52:06,080 BUT SOME OF YOU IT LOOKS LIKE 4725 02:52:06,080 --> 02:52:08,280 DR. VEGA KNOWS ABOUT THAT. 4726 02:52:08,280 --> 02:52:12,240 BASICALLY THIS IDEA THAT 4727 02:52:12,240 --> 02:52:12,720 PROVIDERS IN GENERAL, IN 4728 02:52:12,720 --> 02:52:18,080 OBSTETRIC CASES AND IN OTHERS, 4729 02:52:18,080 --> 02:52:18,640 THREATEN PATIENTS, CHASTISE 4730 02:52:18,640 --> 02:52:19,240 THEM, CRITICIZE THEM OR ARE 4731 02:52:19,240 --> 02:52:21,400 SHORT WITH THEM, DON'T LISTEN TO 4732 02:52:21,400 --> 02:52:21,600 THEM. 4733 02:52:21,600 --> 02:52:23,520 AND IT IS SOMETHING THAT WE ARE 4734 02:52:23,520 --> 02:52:26,880 REALLY WORKING ON IN THE UNITED 4735 02:52:26,880 --> 02:52:27,440 STATES. 4736 02:52:27,440 --> 02:52:29,120 NEWER PHYSICIANS AND MEDICAL 4737 02:52:29,120 --> 02:52:30,440 PROGRAMS REALLY EMPHASIZE BEING 4738 02:52:30,440 --> 02:52:33,080 MORE HOLISTIC AND MORE 4739 02:52:33,080 --> 02:52:33,480 PATIENT-CENTERED. 4740 02:52:33,480 --> 02:52:36,000 OUR OLDER DOCTORS DIDN'T GROW UP 4741 02:52:36,000 --> 02:52:36,440 THAT WAY. 4742 02:52:36,440 --> 02:52:36,680 CLEARLY. 4743 02:52:36,680 --> 02:52:39,520 NOT ALL OF OUR DOCTORS DO IT 4744 02:52:39,520 --> 02:52:39,720 WELL. 4745 02:52:39,720 --> 02:52:41,440 BUT DEFINITELY I HAVE TO SAY, IN 4746 02:52:41,440 --> 02:52:43,560 OUR EXPERIENCE IN LATIN AMERICA, 4747 02:52:43,560 --> 02:52:46,200 IT'S SOMETHING WE COULD WORK ON 4748 02:52:46,200 --> 02:52:48,040 EVEN MORE. 4749 02:52:48,040 --> 02:52:49,440 AND AS THOSE PATIENTS, LET'S 4750 02:52:49,440 --> 02:52:51,120 CALL THEM, COME INTO U.S. HEALTH 4751 02:52:51,120 --> 02:52:54,520 CARE SYSTEMS, YOU MIGHT ADD ON 4752 02:52:54,520 --> 02:52:56,640 TOP OF ALL OF THAT, A LANGUAGE 4753 02:52:56,640 --> 02:53:00,040 GAP AND A VERY 4754 02:53:00,040 --> 02:53:00,680 RESOURCE-CONSTRAINED HEALTH CARE 4755 02:53:00,680 --> 02:53:01,920 SYSTEM, WOW, WORKING ON THE 4756 02:53:01,920 --> 02:53:04,320 QUALITY OF COMMUNICATION THAT WE 4757 02:53:04,320 --> 02:53:05,680 KNOW IS IMPORTANT TO BUILD A 4758 02:53:05,680 --> 02:53:07,360 TRUSTING ALLIANCE AND TO GET 4759 02:53:07,360 --> 02:53:09,680 PATIENTS TO COME BACK FOR CARE 4760 02:53:09,680 --> 02:53:11,640 IS SOMETHING THAT I HOPE WE CAN 4761 02:53:11,640 --> 02:53:11,960 PRIORITIZE. 4762 02:53:11,960 --> 02:53:13,480 THE LAST THING I GUESS I WOULD 4763 02:53:13,480 --> 02:53:15,440 MENTION THAT SEEMED VERY 4764 02:53:15,440 --> 02:53:17,960 PATIENT-CENTERED TO ME AND IT 4765 02:53:17,960 --> 02:53:19,280 HASN'T HAPPENED TO BE MENTIONED. 4766 02:53:19,280 --> 02:53:26,400 IT WAS MENTIONED BRIEFLY. 4767 02:53:26,400 --> 02:53:27,720 IT WAS MENTIONED THAT MANY 4768 02:53:27,720 --> 02:53:28,440 IMMIGRANTS TO THE UNITED STATES 4769 02:53:28,440 --> 02:53:31,560 REALLY WANT TO WORK. 4770 02:53:31,560 --> 02:53:32,160 THAT CERTAINLY IS SOMETHING WE 4771 02:53:32,160 --> 02:53:32,360 HEARD. 4772 02:53:32,360 --> 02:53:34,440 I SAW A SERIES OF INTERVIEWS 4773 02:53:34,440 --> 02:53:36,320 WITH NEW IMMIGRANTS WHO HAD JUST 4774 02:53:36,320 --> 02:53:38,080 COME TO THE UNITED STATES AND 4775 02:53:38,080 --> 02:53:39,640 THE INTERVIEWER WAS ASKING THEM, 4776 02:53:39,640 --> 02:53:40,720 WHAT DO YOU EXPECT YOUR LIFE TO 4777 02:53:40,720 --> 02:53:41,560 BE LIKE HERE? 4778 02:53:41,560 --> 02:53:43,800 WHAT ARE YOU HOPING TO DO? 4779 02:53:43,800 --> 02:53:46,240 AND EVERY SINGLE ONE, YOU KNOW 4780 02:53:46,240 --> 02:53:46,600 WHAT THEY SAID? 4781 02:53:46,600 --> 02:53:47,640 I JUST WANT TO WORK. 4782 02:53:47,640 --> 02:53:47,840 RIGHT? 4783 02:53:47,840 --> 02:53:50,720 SO WORK IS VERY IMPORTANT AND A 4784 02:53:50,720 --> 02:53:52,320 VALUE FOR OBVIOUS ECONOMIC 4785 02:53:52,320 --> 02:53:53,320 REASONS AND FOR CULTURAL REASONS 4786 02:53:53,320 --> 02:53:53,840 TOO. 4787 02:53:53,840 --> 02:53:55,000 WORK IS A VALUE. 4788 02:53:55,000 --> 02:53:58,640 WORK IS A SIGN OF DIGNITY AND A 4789 02:53:58,640 --> 02:54:00,200 SIGN OF CENTERS A GOOD LIFE 4790 02:54:00,200 --> 02:54:02,600 AROUND BEING A GOOD WORKER. 4791 02:54:02,600 --> 02:54:03,680 WHAT DOES THAT MEAN? 4792 02:54:03,680 --> 02:54:08,960 THAT MEANS THAT WHEN WE THINK OF 4793 02:54:08,960 --> 02:54:09,480 ENGAGING COMMUNITIES AND 4794 02:54:09,480 --> 02:54:10,320 PRIORITIES AND HEALTH PROBLEMS, 4795 02:54:10,320 --> 02:54:13,760 WE HAVE TO THINK ABOUT THAT AS 4796 02:54:13,760 --> 02:54:15,480 THEIR PRIORITY. 4797 02:54:15,480 --> 02:54:16,480 IN OTHER WORDS, PATIENTS MIGHT 4798 02:54:16,480 --> 02:54:17,720 NOT NECESSARILY BE ALL THAT 4799 02:54:17,720 --> 02:54:21,400 EXCITED ABOUT IMPROVING THEIR 4800 02:54:21,400 --> 02:54:23,520 HEMOGLOBIN A1C AS A BLOOD LEVEL, 4801 02:54:23,520 --> 02:54:25,000 BLOOD VALUE OR IMPROVING A 4802 02:54:25,000 --> 02:54:27,480 NUMBER LIKE A HIS STOLLIC BLOOD 4803 02:54:27,480 --> 02:54:29,000 PRESSURE NUMBER, GETTING IT FROM 4804 02:54:29,000 --> 02:54:30,720 150 DOWN TO 130. 4805 02:54:30,720 --> 02:54:31,000 FINE. 4806 02:54:31,000 --> 02:54:33,120 THAT IS SOMETHING A DOCTOR MIGHT 4807 02:54:33,120 --> 02:54:33,440 WANT TO DO. 4808 02:54:33,440 --> 02:54:34,280 BUT I JUST WANT TO WORK. 4809 02:54:34,280 --> 02:54:37,320 SO IF WE ARE ABLE TO DEFINE 4810 02:54:37,320 --> 02:54:40,080 HEALTH PROBLEMS AND FRAME OUR 4811 02:54:40,080 --> 02:54:42,880 WORK IN COMMUNITIES AND HEALTH 4812 02:54:42,880 --> 02:54:44,640 SYSTEMS IN RELATION TO THAT AS A 4813 02:54:44,640 --> 02:54:48,120 VERY STRONG COMMUNITY VALUE, I 4814 02:54:48,120 --> 02:54:49,160 THINK IT WILL BE VALUABLE. 4815 02:54:49,160 --> 02:54:52,160 I'LL TELL YOU ONE LAST ANECDOTE. 4816 02:54:52,160 --> 02:54:53,240 SOMEONE IN BOLIVIA ONCE TOLD ME 4817 02:54:53,240 --> 02:54:54,960 WHERE WE WERE REALLY STARTING TO 4818 02:54:54,960 --> 02:54:56,680 FOCUS ON MENTAL HEALTH, I HAD A 4819 02:54:56,680 --> 02:54:58,520 GOOD RELATIONSHIP WITH THIS 4820 02:54:58,520 --> 02:54:59,800 PERSON AND THEY SAID, YOU KNOW, 4821 02:54:59,800 --> 02:55:02,080 JOHN, I HAVE TO CONFESS TO YOU, 4822 02:55:02,080 --> 02:55:04,240 THIS THING ABOUT DEPRESSION, 4823 02:55:04,240 --> 02:55:05,360 THAT'S A GRINGO PROBLEM. 4824 02:55:05,360 --> 02:55:05,560 RIGHT? 4825 02:55:05,560 --> 02:55:07,000 IN OTHER WORDS, THAT'S SOMETHING 4826 02:55:07,000 --> 02:55:09,800 YOU HAVE THE LUXURY TO FOCUS ON. 4827 02:55:09,800 --> 02:55:10,680 WE HAVE TO WORK. 4828 02:55:10,680 --> 02:55:12,920 WE DON'T HAVE THE LUXURY OF 4829 02:55:12,920 --> 02:55:14,560 BEING DEPRESSED. 4830 02:55:14,560 --> 02:55:15,800 WE JUST KEEP BARRELING ON 4831 02:55:15,800 --> 02:55:16,040 THROUGH. 4832 02:55:16,040 --> 02:55:19,560 SO SHOWING PEOPLE THAT FOCUSING 4833 02:55:19,560 --> 02:55:20,080 ON THEIR MENTAL HEALTH OR 4834 02:55:20,080 --> 02:55:21,120 PHYSICAL HEALTH REALLY WILL 4835 02:55:21,120 --> 02:55:23,560 ALLOW THEM TO FUNCTION BETTER IN 4836 02:55:23,560 --> 02:55:24,920 THE WORK WORLD, WHATEVER THAT 4837 02:55:24,920 --> 02:55:28,520 MAY BE, AND THEIR FAMILY ROLES 4838 02:55:28,520 --> 02:55:29,280 WHICH ARE VERY IMPORTANT TO 4839 02:55:29,280 --> 02:55:29,480 THEM. 4840 02:55:29,480 --> 02:55:32,920 SO AS IN TERMS OF PRIORITIZING 4841 02:55:32,920 --> 02:55:34,400 AND HOW WE THINK ABOUT PROBLEMS, 4842 02:55:34,400 --> 02:55:35,920 IT'S A REALLY DIFFERENT WAY OF 4843 02:55:35,920 --> 02:55:37,360 THINKING ABOUT HEALTH CARE GOALS 4844 02:55:37,360 --> 02:55:40,240 WHERE AGAIN WE MIGHT THINK OF 4845 02:55:40,240 --> 02:55:42,240 IMPROVING HEMOGLOBIN A1C OR 4846 02:55:42,240 --> 02:55:43,880 DECREASING SMOKING RATES. 4847 02:55:43,880 --> 02:55:45,720 BUT THERE ARE WAYS OF THINKING 4848 02:55:45,720 --> 02:55:47,000 ABOUT IMPROVING QUALITY OF LIFE 4849 02:55:47,000 --> 02:55:48,320 AND WHAT LIFE MEANS MIGHT BE 4850 02:55:48,320 --> 02:55:49,400 VERY DIFFERENT. 4851 02:55:49,400 --> 02:55:51,920 SO I WOULD SAY CENTER WORK. 4852 02:55:51,920 --> 02:55:53,000 >>MODERATOR: THANK YOU, 4853 02:55:53,000 --> 02:55:54,920 DR. JOHN PIETTE FOR THAT 4854 02:55:54,920 --> 02:55:55,600 ELABORATE ANSWER. 4855 02:55:55,600 --> 02:55:58,320 WE REALLY APPRECIATE THAT AND 4856 02:55:58,320 --> 02:56:00,120 APPRECIATE YOUR ATTENTION TO 4857 02:56:00,120 --> 02:56:02,960 MENTAL HEALTH WHICH HAS BECOME 4858 02:56:02,960 --> 02:56:05,080 MORE PROMINENT AND BROUGHT TO 4859 02:56:05,080 --> 02:56:07,240 THE FOREFRONT DURING THIS 4860 02:56:07,240 --> 02:56:07,760 PANDEMIC. 4861 02:56:07,760 --> 02:56:09,720 MY NEXT QUESTION IS FOR 4862 02:56:09,720 --> 02:56:10,680 DR. CARMEN VELEZ VEGA. 4863 02:56:10,680 --> 02:56:12,960 DURING YOUR PRESENTATION, YOU 4864 02:56:12,960 --> 02:56:17,280 MENTIONED THAT COMMUNITY MEMBERS 4865 02:56:17,280 --> 02:56:17,680 AREN'T EXPERTS. 4866 02:56:17,680 --> 02:56:18,280 THANK YOU FOR MENTIONING THAT. 4867 02:56:18,280 --> 02:56:21,120 SO NOW FOR MY QUESTION. 4868 02:56:21,120 --> 02:56:24,360 YOU MENTIONED PERFORMING A SWOT 4869 02:56:24,360 --> 02:56:25,320 ANALYSIS IN YOUR SETTING. 4870 02:56:25,320 --> 02:56:29,560 WHAT ARE SOME KEY AREAS IN WHICH 4871 02:56:29,560 --> 02:56:30,600 NEWER MEASUREMENT TOOLS ARE 4872 02:56:30,600 --> 02:56:33,400 NEEDED TO ADDRESS GAPS IN 4873 02:56:33,400 --> 02:56:34,400 COMMUNITY-ENGAGED RESEARCH? 4874 02:56:34,400 --> 02:56:42,640 >>CARMEN VELEZ VEGA: THANK YOU 4875 02:56:42,640 --> 02:56:43,360 FOR THIS INTERESTING QUESTION 4876 02:56:43,360 --> 02:56:45,880 AND I WANT TO SAY I'M SO HONORED 4877 02:56:45,880 --> 02:56:46,480 TO BE WITH THIS GROUP HERE AND 4878 02:56:46,480 --> 02:56:48,080 WITH ALL OF THESE PEOPLE THAT 4879 02:56:48,080 --> 02:56:49,720 HAVE PRESENTED IN THIS WONDERFUL 4880 02:56:49,720 --> 02:56:50,640 CONFERENCE. 4881 02:56:50,640 --> 02:56:51,960 WE NEED MORE QUALITATIVE 4882 02:56:51,960 --> 02:56:52,920 MEASUREMENT TOOLS TO BETTER 4883 02:56:52,920 --> 02:56:54,320 UNDERSTAND WHAT IS NEEDED AND 4884 02:56:54,320 --> 02:56:55,520 WHAT CAN BE DONE TO ADDRESS 4885 02:56:55,520 --> 02:56:57,720 THESE GAPS IN THE FIELD. 4886 02:56:57,720 --> 02:56:58,840 WE NEED TO HAVE INSTRUMENTS THAT 4887 02:56:58,840 --> 02:57:00,280 HELP US LISTEN TO VOICE THAT IS 4888 02:57:00,280 --> 02:57:03,160 HAVE BEEN SILENCED FOR VERY 4889 02:57:03,160 --> 02:57:03,360 LONG. 4890 02:57:03,360 --> 02:57:04,480 COMMUNITY ENGAGEMENT AND 4891 02:57:04,480 --> 02:57:05,800 RESEARCH SUPPORTS ARE ASKING THE 4892 02:57:05,800 --> 02:57:07,520 RIGHT QUESTIONS IN ORDER TO FIND 4893 02:57:07,520 --> 02:57:09,400 COLLECTIVE SOLUTIONS AND WAYS TO 4894 02:57:09,400 --> 02:57:11,840 REDUCE HEALTH DISPARITIES THAT 4895 02:57:11,840 --> 02:57:13,200 INFLUENCE IN A POSITIVE WAY, 4896 02:57:13,200 --> 02:57:15,640 SOCIAL DETERMINANTS OF HEALTH. 4897 02:57:15,640 --> 02:57:17,040 QUALITATIVE MEASURES CAN OPEN UP 4898 02:57:17,040 --> 02:57:19,640 THE COMMUNICATION BETWEEN 4899 02:57:19,640 --> 02:57:21,440 COMMUNITIES AND INVESTIGATORS. 4900 02:57:21,440 --> 02:57:22,840 AND THESE MEASURES CAN ALSO 4901 02:57:22,840 --> 02:57:26,080 SERVE AS A WAY TO EVALUATE THE 4902 02:57:26,080 --> 02:57:27,400 PROCESS, REVIEW EXPECTATIONS AND 4903 02:57:27,400 --> 02:57:28,960 BRING FORWARD CONCERNS IN ORDER 4904 02:57:28,960 --> 02:57:29,960 TO ESTABLISH TRUST. 4905 02:57:29,960 --> 02:57:33,080 THIS IS A CONTINUOUS PROCESS. 4906 02:57:33,080 --> 02:57:33,920 FOR EXAMPLE WE CAN USE PHOTO 4907 02:57:33,920 --> 02:57:37,880 VOICE AS A QUALITATIVE 4908 02:57:37,880 --> 02:57:38,440 METHODOLOGIY AND GET PEOPLE 4909 02:57:38,440 --> 02:57:40,720 TALKING ABOUT THEIR CONCERNS, 4910 02:57:40,720 --> 02:57:42,640 MEANINGS, RESOURCES THAT ARE IN 4911 02:57:42,640 --> 02:57:43,440 THE COMMUNITY, NOT ONLY THE 4912 02:57:43,440 --> 02:57:45,680 NEGATIVE BUT THE POSITIVE. 4913 02:57:45,680 --> 02:57:46,280 AND UNDERSTAND BETTER THEIR 4914 02:57:46,280 --> 02:57:49,040 SOCIAL DETERMINANTS OF HEALTH 4915 02:57:49,040 --> 02:57:51,240 AND AT THE SAME TIME ENGAGE THEM 4916 02:57:51,240 --> 02:57:53,600 IN THE PROCESS. 4917 02:57:53,600 --> 02:57:54,280 >>MODERATOR: THANK YOU VERY 4918 02:57:54,280 --> 02:57:54,960 MUCH. 4919 02:57:54,960 --> 02:57:57,720 I APPRECIATE THAT RESPONSE. 4920 02:57:57,720 --> 02:58:02,320 MY NEXT QUESTION IS FOR 4921 02:58:02,320 --> 02:58:02,600 DR. MAESTRE. 4922 02:58:02,600 --> 02:58:04,920 I LOVED YOUR METAPHOR OF THE 4923 02:58:04,920 --> 02:58:06,560 BEACH FOR COMMUNITY ENGAGEMENT. 4924 02:58:06,560 --> 02:58:08,440 I THINK THAT CAPTURES THE TRUE 4925 02:58:08,440 --> 02:58:10,400 ESSENCE OF THIS COMMUNITY 4926 02:58:10,400 --> 02:58:10,920 ENGAGEMENT. 4927 02:58:10,920 --> 02:58:11,760 SO THANK YOU FOR THAT. 4928 02:58:11,760 --> 02:58:15,200 I MAY USE IT IN THE FUTURE. 4929 02:58:15,200 --> 02:58:17,360 SO NOW FOR MY QUESTION. 4930 02:58:17,360 --> 02:58:19,000 DURING YOUR PRESENTATION YOU 4931 02:58:19,000 --> 02:58:21,640 MENTIONED GETTING TO THE ROOT 4932 02:58:21,640 --> 02:58:22,240 CAUSES OF THE CHALLENGES FACED 4933 02:58:22,240 --> 02:58:24,880 BY PARTICIPANTS AND THE STUDY. 4934 02:58:24,880 --> 02:58:27,120 WERE YOU ABLE TO EXAMINE THE 4935 02:58:27,120 --> 02:58:28,240 REASONS FOR THE SIGNIFICANT DROP 4936 02:58:28,240 --> 02:58:30,280 OF NUMBERS OF PARTICIPANTS FOR 4937 02:58:30,280 --> 02:58:33,600 PHASE III? 4938 02:58:33,600 --> 02:58:34,280 AND WHO DECIDED NOT TO GO ON FOR 4939 02:58:34,280 --> 02:58:39,280 THE CLINICAL EXAMINATION? 4940 02:58:39,280 --> 02:58:42,240 >>I THINK THIS WAS IN ABOUT -- 4941 02:58:42,240 --> 02:58:44,960 WE DID THIS STUDIES IN 1997. 4942 02:58:44,960 --> 02:58:47,800 THAT WAS THE VERY FIRST STUDIES. 4943 02:58:47,800 --> 02:58:49,800 AND THE SOCIAL REPRESENTATION OF 4944 02:58:49,800 --> 02:58:51,960 DISEASE WAS THE TARGET FOR US TO 4945 02:58:51,960 --> 02:58:52,320 UNDERSTAND. 4946 02:58:52,320 --> 02:58:56,760 SO THEY CONSENTED TO BE PART OF 4947 02:58:56,760 --> 02:58:59,080 THE STUDY. 4948 02:58:59,080 --> 02:59:01,040 EVEN THOUGH WE EXPLAINED THE 4949 02:59:01,040 --> 02:59:03,720 BEST WAY POSSIBLE THAT WE 4950 02:59:03,720 --> 02:59:06,280 THOUGHT IT WAS -- WE WERE DOING 4951 02:59:06,280 --> 02:59:16,480 A GOOD JOB. 4952 02:59:17,600 --> 02:59:18,560 THEN IT WAS TIME TO GO TO THE 4953 02:59:18,560 --> 02:59:19,960 PLACE AND HAVE YOUR BLOOD DRAWN 4954 02:59:19,960 --> 02:59:23,720 OR YOU'RE GOING TO HAVE THIS 4955 02:59:23,720 --> 02:59:25,200 TEST, THEY DIDN'T. 4956 02:59:25,200 --> 02:59:27,960 70% OF THEM AGREED. 4957 02:59:27,960 --> 02:59:31,520 WHICH STILL IT IS QUITE 4958 02:59:31,520 --> 02:59:34,600 SIGNIFICANT WITH THE LEVEL OF 4959 02:59:34,600 --> 02:59:35,880 TECH -- NUMBER OF TESTS AND 4960 02:59:35,880 --> 02:59:38,320 TIMES TO BE DEVOTED. 4961 02:59:38,320 --> 02:59:39,480 SO MOST OF THE TIME I'M INVITED 4962 02:59:39,480 --> 02:59:41,320 TO TALK ABOUT HOW DID YOU GET 4963 02:59:41,320 --> 02:59:46,320 THE 70% TO PARTICIPATE? 4964 02:59:46,320 --> 02:59:47,560 AND THE MAIN ANSWER FOR THOSE 4965 02:59:47,560 --> 02:59:50,720 30% BECAUSE WE WERE ABLE TO 4966 02:59:50,720 --> 02:59:54,240 OBTAIN SOME BIOMETRICS AND ALL 4967 02:59:54,240 --> 02:59:57,880 OF THEM GAVE US INSIGHTS AND WE 4968 02:59:57,880 --> 03:00:00,280 DID COGNITIVE ASSESSMENTS. 4969 03:00:00,280 --> 03:00:02,480 SO WE HAD A BASELINE WITH ALL OF 4970 03:00:02,480 --> 03:00:04,920 THEM AND THEN 30% DIDN'T 4971 03:00:04,920 --> 03:00:06,160 PROCEED. 4972 03:00:06,160 --> 03:00:07,080 THIS WAS SOCIAL REPRESENTATION 4973 03:00:07,080 --> 03:00:08,200 OF A GUINEA PIG? 4974 03:00:08,200 --> 03:00:11,440 AND STILL WE ARE SEEING THESE IN 4975 03:00:11,440 --> 03:00:14,400 MANY OF THE ALZHEIMER'S STUDIES 4976 03:00:14,400 --> 03:00:15,200 AND THE EYE STUDIES. 4977 03:00:15,200 --> 03:00:17,520 WITH THE EYE IT'S EASIER BECAUSE 4978 03:00:17,520 --> 03:00:21,360 EVERYBODY WANTS TO HAVE THEIR 4979 03:00:21,360 --> 03:00:22,440 EYE TESTED SOME WAY OR ANOTHER. 4980 03:00:22,440 --> 03:00:28,400 BUT WITH AGING AND BRAIN AND 4981 03:00:28,400 --> 03:00:30,880 GOING INTO A MACHINE SUCH AS 4982 03:00:30,880 --> 03:00:31,040 MRI. 4983 03:00:31,040 --> 03:00:33,840 SO THEY EXPRESSED TO US THIS 4984 03:00:33,840 --> 03:00:37,040 GUINEA PIG. 4985 03:00:37,040 --> 03:00:37,840 I DON'T WANT TO BE. 4986 03:00:37,840 --> 03:00:38,240 [ SPEAKING SPANISH ] 4987 03:00:38,240 --> 03:00:38,920 I DON'T WANT TO BE THAT. 4988 03:00:38,920 --> 03:00:42,960 AND THAT'S SOCIAL REPRESENTATION 4989 03:00:42,960 --> 03:00:48,400 GAVE US THE IDEA OF ELABORATING 4990 03:00:48,400 --> 03:00:49,960 ELEMENTS AND MESSAGES, TRYING TO 4991 03:00:49,960 --> 03:00:51,880 MEET THEM WHERE THEY ARE BUT AT 4992 03:00:51,880 --> 03:00:53,200 THE POINT THAT WE CLOSE THIS 4993 03:00:53,200 --> 03:00:54,960 STUDY, WE DIDN'T HAVE THAT. 4994 03:00:54,960 --> 03:00:59,280 WE HAD TO APPLY THAT REACHING 4995 03:00:59,280 --> 03:01:00,720 THEM WHERE THEY ARE IN OTHER 4996 03:01:00,720 --> 03:01:02,440 STUDIES THAT WE HAVE DONE 4997 03:01:02,440 --> 03:01:02,760 AFTERWARDS. 4998 03:01:02,760 --> 03:01:07,000 BUT THIS STUDY THAT BEGAN IN 4999 03:01:07,000 --> 03:01:09,320 1997 WITH ENDOGRAPHIC 5000 03:01:09,320 --> 03:01:11,240 INFORMATION, AT THE TIME WE WERE 5001 03:01:11,240 --> 03:01:15,080 NOT AWARE THAT THIS WAS GOING TO 5002 03:01:15,080 --> 03:01:16,760 HAPPEN. 5003 03:01:16,760 --> 03:01:18,360 SO, ALSO THE IMPORTANT TO 5004 03:01:18,360 --> 03:01:21,440 SUPPORT WHAT DR. VEGA MENTIONED, 5005 03:01:21,440 --> 03:01:22,880 THE IMPORTANCE OF QUALITATIVE 5006 03:01:22,880 --> 03:01:26,080 WORK BEFORE WE ACTUALLY ENTER 5007 03:01:26,080 --> 03:01:30,000 THE COMMUNITY, NOT ONLY 5008 03:01:30,000 --> 03:01:32,240 AFTERWARDS. 5009 03:01:32,240 --> 03:01:32,880 >>MODERATOR: THANK YOU VERY 5010 03:01:32,880 --> 03:01:35,160 MUCH. 5011 03:01:35,160 --> 03:01:38,120 THAT IS ALSO A THOROUGH 5012 03:01:38,120 --> 03:01:38,400 RESPONSE. 5013 03:01:38,400 --> 03:01:39,840 MY NEXT QUESTION AND THIS 5014 03:01:39,840 --> 03:01:41,800 APPLIES TO EVERYONE. 5015 03:01:41,800 --> 03:01:46,960 SO FEEL FREE TO CHIME IN. 5016 03:01:46,960 --> 03:01:48,800 HOW CAN RESEARCHERS IDENTIFY 5017 03:01:48,800 --> 03:01:51,280 STRONG COMMUNITY PARTNERS FOR 5018 03:01:51,280 --> 03:01:52,480 RESEARCH IN THE UNITED STATES 5019 03:01:52,480 --> 03:01:59,320 AND IN LATIN AMERICA? 5020 03:01:59,320 --> 03:02:00,360 >>I'M GOING JUMP IN. 5021 03:02:00,360 --> 03:02:02,800 I THINK WE ALL HAVE TO RECOGNIZE 5022 03:02:02,800 --> 03:02:03,360 THAT WE ARE ALL PART OF 5023 03:02:03,360 --> 03:02:05,040 COMMUNITIES. 5024 03:02:05,040 --> 03:02:06,960 THIS IS NOT SOMETHING ALIEN TO 5025 03:02:06,960 --> 03:02:07,200 US. 5026 03:02:07,200 --> 03:02:08,680 WE ARE COMMUNITIES. 5027 03:02:08,680 --> 03:02:10,000 WE BELONG TO SEVERAL 5028 03:02:10,000 --> 03:02:11,600 COMMUNITIES, EACH AND EVERY ONE 5029 03:02:11,600 --> 03:02:11,840 OF US. 5030 03:02:11,840 --> 03:02:14,160 INK WE NEED TO SORT OF STEP OUT 5031 03:02:14,160 --> 03:02:16,480 OF THE ACADEMIA, STEP OUT OF THE 5032 03:02:16,480 --> 03:02:17,880 IVORY TOWER AND GO INTO THE 5033 03:02:17,880 --> 03:02:18,200 COMMUNITIES. 5034 03:02:18,200 --> 03:02:23,280 DO ACTIVITIES WITH OUR STUDENTS. 5035 03:02:23,280 --> 03:02:25,400 JOIN CONCERNS THAT COMMUNITIES 5036 03:02:25,400 --> 03:02:25,600 HAVE. 5037 03:02:25,600 --> 03:02:27,560 AND THERE ARE MANY THINGS GOING 5038 03:02:27,560 --> 03:02:31,320 ON, ESPECIALLY IN PUERTO RICO 5039 03:02:31,320 --> 03:02:31,920 AFTER THE HURRICANES. 5040 03:02:31,920 --> 03:02:32,600 THERE WAS SUCH DEVASTATION HERE. 5041 03:02:32,600 --> 03:02:36,200 COMMUNITIES REALLY HAD TO DO FOR 5042 03:02:36,200 --> 03:02:36,680 THEMSELVES BECAUSE THE 5043 03:02:36,680 --> 03:02:37,880 GOVERNMENT RESPONSE WASN'T WHAT 5044 03:02:37,880 --> 03:02:39,280 WAS EXPECTED. 5045 03:02:39,280 --> 03:02:42,400 AND BEING PART OF THAT, OF THESE 5046 03:02:42,400 --> 03:02:45,440 INITIATIVES, HELPS US LEARN MORE 5047 03:02:45,440 --> 03:02:46,800 OF WHAT ARE THE CONCERNS OF THE 5048 03:02:46,800 --> 03:02:47,080 COMMUNITIES. 5049 03:02:47,080 --> 03:02:49,080 WHAT ARE THE RESOURCES AND 5050 03:02:49,080 --> 03:02:49,360 QUESTIONS? 5051 03:02:49,360 --> 03:02:52,360 AND THAT HELPS US DEVELOP BETTER 5052 03:02:52,360 --> 03:02:53,240 RESEARCH QUESTIONS. 5053 03:02:53,240 --> 03:02:56,080 IT HELPS US IDENTIFY PEOPLE THAT 5054 03:02:56,080 --> 03:02:57,040 CAN HELP US UNDERSTAND BETTER 5055 03:02:57,040 --> 03:02:59,240 WHERE THEY ARE COMING FROM, WHAT 5056 03:02:59,240 --> 03:03:01,440 IS EFFECTING THEM. 5057 03:03:01,440 --> 03:03:02,600 AND TO FIND SOLUTIONS. 5058 03:03:02,600 --> 03:03:04,920 I THINK THAT GETTING OUT OF THE 5059 03:03:04,920 --> 03:03:05,920 ACADEMICS, WALKING INTO THE 5060 03:03:05,920 --> 03:03:09,400 COMMUNITY, DOING WORK THERE, IS 5061 03:03:09,400 --> 03:03:11,960 VERY IMPORTANT. 5062 03:03:11,960 --> 03:03:14,960 >>MODERATOR: THANK YOU. 5063 03:03:14,960 --> 03:03:15,240 DR. MAESTRE. 5064 03:03:15,240 --> 03:03:17,360 >>I WOULD LIKE TO ADD TO THAT 5065 03:03:17,360 --> 03:03:21,200 REALLY DEPENDS ON WHAT YOU THINK 5066 03:03:21,200 --> 03:03:25,040 ABOUT A PARTNERSHIP. 5067 03:03:25,040 --> 03:03:28,280 FOR EXAMPLE, WHILE IN VENEZUELA 5068 03:03:28,280 --> 03:03:30,880 DURING ALL THIS TIME, WE HAVE 5069 03:03:30,880 --> 03:03:33,040 SEVERAL CHANGES, TREMENDOUS 5070 03:03:33,040 --> 03:03:34,200 CHANGE, POLITICAL CHANGE, AND I 5071 03:03:34,200 --> 03:03:36,400 HAVE PARTNERS THAT COME TO ME 5072 03:03:36,400 --> 03:03:40,400 SAYING, I WANT TO PARTNER THE 5073 03:03:40,400 --> 03:03:40,840 MINISTER OF HEALTH. 5074 03:03:40,840 --> 03:03:42,560 AND I SAY THAT IS GOOD BUT THEN 5075 03:03:42,560 --> 03:03:46,800 YOU HAVE TO GO TO THEM BECAUSE 5076 03:03:46,800 --> 03:03:48,600 THE COMMUNITY IS NOT ACCEPTING 5077 03:03:48,600 --> 03:03:51,520 US BECAUSE WE COME FROM THE 5078 03:03:51,520 --> 03:03:54,240 CURRENT ADMINISTRATION. 5079 03:03:54,240 --> 03:03:57,920 SO SETTING YOURSELF WITH THE 5080 03:03:57,920 --> 03:03:59,240 MINISTER OF HEALTH WILL GIVE YOU 5081 03:03:59,240 --> 03:04:02,040 A LOT OF ACCESS BUT NOT TO THIS 5082 03:04:02,040 --> 03:04:02,560 COMMUNITY. 5083 03:04:02,560 --> 03:04:06,240 SOMETIMES THEY COME AND SAY, I 5084 03:04:06,240 --> 03:04:08,640 NEED TO GET SOME DNA FROM 5085 03:04:08,640 --> 03:04:10,400 INDIGENOUS PEOPLE, HOW CAN YOU 5086 03:04:10,400 --> 03:04:10,640 GET IT? 5087 03:04:10,640 --> 03:04:14,080 I SAY I'M SORRY, THAT'S NOT MY 5088 03:04:14,080 --> 03:04:14,560 BUSINESS. 5089 03:04:14,560 --> 03:04:18,960 SO HOW DO YOU REALLY CONCEIVE A 5090 03:04:18,960 --> 03:04:19,280 PARTNERSHIP? 5091 03:04:19,280 --> 03:04:21,800 AND THAT'S SOMETHING THAT I HAD 5092 03:04:21,800 --> 03:04:24,240 A QUESTION IN THE CHAT. 5093 03:04:24,240 --> 03:04:25,720 HOW DO YOU CONCEIVE? 5094 03:04:25,720 --> 03:04:27,880 AND THAT'S THE CULTURAL AGILITY. 5095 03:04:27,880 --> 03:04:31,120 NOT ONLY TO BE AWARE, NOT ONLY 5096 03:04:31,120 --> 03:04:33,680 TOW RECOGNIZE CULTURE, BUT HOW 5097 03:04:33,680 --> 03:04:36,280 TO SOLVE PROBLEMS WITHIN THE 5098 03:04:36,280 --> 03:04:37,040 CULTURE. 5099 03:04:37,040 --> 03:04:38,560 AND IN THIS TYPE OF 5100 03:04:38,560 --> 03:04:41,720 PARTNERSHIPS, YOU REALLY NEED TO 5101 03:04:41,720 --> 03:04:44,240 PULT OUT UPFRONT WHAT IS A 5102 03:04:44,240 --> 03:04:44,520 PARTNERSHIP? 5103 03:04:44,520 --> 03:04:46,600 SO IN VENEZUELA, HOW I PRESENT 5104 03:04:46,600 --> 03:04:49,680 TO THE COMMUNITY IS I'M FAMILY. 5105 03:04:49,680 --> 03:04:51,880 YOU CAN COUNT ON ME. 5106 03:04:51,880 --> 03:04:54,520 DURING THE WORST TIMES, YOU CAN 5107 03:04:54,520 --> 03:04:54,800 COUNT. 5108 03:04:54,800 --> 03:04:58,400 AND MY TEAM, IF SOMEBODY IN THE 5109 03:04:58,400 --> 03:05:01,720 TEAM IS NOT AVAILABLE 24 HOURS, 5110 03:05:01,720 --> 03:05:03,240 THAT PERSON IS NOT RIGHT TO WORK 5111 03:05:03,240 --> 03:05:05,200 WITH THE COMMUNITY. 5112 03:05:05,200 --> 03:05:07,320 BECAUSE IT'S NOT 8-5. 5113 03:05:07,320 --> 03:05:10,880 IN THE UNITED STATES IN TEXAS 5114 03:05:10,880 --> 03:05:11,480 AND IN NEW YORK WHERE I HAVE 5115 03:05:11,480 --> 03:05:13,960 WORKED, THIS CONCEPT COULD BE 5116 03:05:13,960 --> 03:05:15,320 VERY STRANGE. 5117 03:05:15,320 --> 03:05:17,920 PEOPLE WANT TO HAVE BUSINESS 5118 03:05:17,920 --> 03:05:19,320 WITH THE COMMUNITY. 5119 03:05:19,320 --> 03:05:21,400 AND PARTNERSHIPS IS NOT A 5120 03:05:21,400 --> 03:05:21,960 BUSINESS. 5121 03:05:21,960 --> 03:05:25,680 PARTNERSHIP IS REALLY PUTTING 5122 03:05:25,680 --> 03:05:26,440 OUT A STRONG LINKS. 5123 03:05:26,440 --> 03:05:28,400 IN VENEZUELA THIS MEANS FEELING 5124 03:05:28,400 --> 03:05:32,720 LIKE A FAMILY. 5125 03:05:32,720 --> 03:05:33,280 >>MODERATOR: ABSOLUTELY. 5126 03:05:33,280 --> 03:05:33,560 THANK YOU. 5127 03:05:33,560 --> 03:05:34,360 DR. JOHN PIETTE AND THEN WE'LL 5128 03:05:34,360 --> 03:05:39,880 GO TO -- THEN I'LL TRANSITION TO 5129 03:05:39,880 --> 03:05:44,320 DR. VICTURE. 5130 03:05:44,320 --> 03:05:46,920 >>JOHN PIETTE: I'M GOING TO SAY 5131 03:05:46,920 --> 03:05:47,480 SOMETHING REALLY PRACTICAL, 5132 03:05:47,480 --> 03:05:49,000 MAYBE SLIGHTLY BOLD, NOT TOO 5133 03:05:49,000 --> 03:05:49,200 BOLD. 5134 03:05:49,200 --> 03:05:50,720 BUT THE PRACTICAL THING IS, IF 5135 03:05:50,720 --> 03:05:54,240 WE WANT TO ENGAGE COMMUNITY I 5136 03:05:54,240 --> 03:05:55,760 PARTNERS, IN MANY AREAS OF LATIN 5137 03:05:55,760 --> 03:05:57,960 AMERICA OR EVEN IN THE U.S., 5138 03:05:57,960 --> 03:06:01,480 AGAIN IT'S LIKE WHAT I SAID 5139 03:06:01,480 --> 03:06:01,880 SOMETIME EARLIER. 5140 03:06:01,880 --> 03:06:02,440 YOU JUST HAVE TO BE ON THE 5141 03:06:02,440 --> 03:06:02,680 GROUND. 5142 03:06:02,680 --> 03:06:04,120 YOU HAVE TO GO. 5143 03:06:04,120 --> 03:06:08,320 SO FOR EXAMPLE, WE ARE WORKING 5144 03:06:08,320 --> 03:06:10,720 VERY CLOSE IN THE CAPITAL OF 5145 03:06:10,720 --> 03:06:12,920 HONDURAS WITH A COMMUNITY 5146 03:06:12,920 --> 03:06:16,840 PARTNER THAT REPRESENTS PEOPLE 5147 03:06:16,840 --> 03:06:17,640 WITH MENTAL HEALTH DISORDERS. 5148 03:06:17,640 --> 03:06:20,720 THEY DON'T HAVE A WEBSITE. 5149 03:06:20,720 --> 03:06:22,000 THEY ARE STILL TALKING ABOUT 5150 03:06:22,000 --> 03:06:23,360 GETTING A FACEBOOK PRESENCE. 5151 03:06:23,360 --> 03:06:25,520 HOW WOULD YOU EVEN KNOW THEY 5152 03:06:25,520 --> 03:06:26,520 EXIST IF YOU WEREN'T THERE? 5153 03:06:26,520 --> 03:06:28,760 I MEAN YOU LITERALLY HAVE TO GO 5154 03:06:28,760 --> 03:06:28,960 THERE. 5155 03:06:28,960 --> 03:06:30,480 SO THAT'S THE GENERAL THING. 5156 03:06:30,480 --> 03:06:32,120 AGAIN, IT'S NOT A BIG SURPRISE. 5157 03:06:32,120 --> 03:06:34,120 THE SLIGHTLY BOLD BUT JUST 5158 03:06:34,120 --> 03:06:35,880 TRYING TO BE REALLY PRACTICAL, 5159 03:06:35,880 --> 03:06:39,480 THE SLIGHTLY BOLD THING IF I MAY 5160 03:06:39,480 --> 03:06:42,800 SAY, INSTITUTES LIKE NIMHD MIGHT 5161 03:06:42,800 --> 03:06:44,320 HELP BUILDING COMMUNITY 5162 03:06:44,320 --> 03:06:48,200 PARTNERSHIP BY MAKING RELATIVELY 5163 03:06:48,200 --> 03:06:49,760 SMALL GRANTS THAT WOULD BE FOR 5164 03:06:49,760 --> 03:06:51,920 TRAVEL, THAT WOULD BE FOR 5165 03:06:51,920 --> 03:06:53,320 AMERICAN TEAMS TO GO THERE AND 5166 03:06:53,320 --> 03:07:00,760 FOR THOSE TEAMS TO COME TO THE 5167 03:07:00,760 --> 03:07:00,920 U.S. 5168 03:07:00,920 --> 03:07:01,560 WE HAVE THOSE AT THE UNIVERSITY 5169 03:07:01,560 --> 03:07:01,840 OF MICHIGAN. 5170 03:07:01,840 --> 03:07:02,240 WE ARE VERY LUCKY. 5171 03:07:02,240 --> 03:07:02,760 WE HAVE TRAVEL FUNDS THAT 5172 03:07:02,760 --> 03:07:03,680 SOMEONE LIKE MYSELF CAN ACCESS. 5173 03:07:03,680 --> 03:07:06,800 NOT EVERYONE DOES. 5174 03:07:06,800 --> 03:07:09,320 AND BUT SOME WAY TO MAKE THAT 5175 03:07:09,320 --> 03:07:10,480 PRACTICALLY POSSIBLE WOULD BE 5176 03:07:10,480 --> 03:07:10,960 REALLY USEFUL. 5177 03:07:10,960 --> 03:07:12,280 AND LIKE I SAID, IT MIGHT BE 5178 03:07:12,280 --> 03:07:15,280 JUST 5000 DOLLAR GRANTS OR 5179 03:07:15,280 --> 03:07:16,800 $10,000 GRANTS AT MOST THAT 5180 03:07:16,800 --> 03:07:19,440 WOULD PROMOTE THE DEVELOPMENT 5181 03:07:19,440 --> 03:07:22,200 AND AGAIN, WE HAVE THOSE WITHIN 5182 03:07:22,200 --> 03:07:23,280 OUR UNIVERSITY, FOR MAYBE TWO 5183 03:07:23,280 --> 03:07:25,920 YEARS, TO DEVELOP A NEW 5184 03:07:25,920 --> 03:07:26,280 COLLABORATION. 5185 03:07:26,280 --> 03:07:26,640 THAT'S THE GOAL. 5186 03:07:26,640 --> 03:07:28,320 WE DON'T KNOW WHERE IT IS GOING 5187 03:07:28,320 --> 03:07:28,880 TO GO. 5188 03:07:28,880 --> 03:07:30,160 WE DON'T KNOW IF WE ARE GOING TO 5189 03:07:30,160 --> 03:07:31,520 HAVE A SUCCESSFUL COLLABORATION 5190 03:07:31,520 --> 03:07:34,080 BUT THERE IS NO WAY TO FIND OUT 5191 03:07:34,080 --> 03:07:35,520 UNLESS WE START MEETING AND 5192 03:07:35,520 --> 03:07:36,600 START TALKING. 5193 03:07:36,600 --> 03:07:38,320 SO THAT WOULD BE SOMETHING, 5194 03:07:38,320 --> 03:07:39,840 AGAIN, JUST TO BE LIKE AGAIN 5195 03:07:39,840 --> 03:07:41,800 SLIGHTLY BOLD BUT TRYING TO BE 5196 03:07:41,800 --> 03:07:43,120 VERY PRACTICAL. 5197 03:07:43,120 --> 03:07:46,000 SOME GROUPS MIGHT NEED START UP 5198 03:07:46,000 --> 03:07:48,360 FUNDING TO MAKE THOSE 5199 03:07:48,360 --> 03:07:49,640 COLLABORATIONS HAPPEN BECAUSE 5200 03:07:49,640 --> 03:07:52,040 COMMUNITY ORGANIZATIONS IN LATIN 5201 03:07:52,040 --> 03:07:52,920 AMERICA, THEY AIN'T NECESSARILY 5202 03:07:52,920 --> 03:07:53,480 ON LINE. 5203 03:07:53,480 --> 03:07:57,480 THEY ARE NOT NECESSARILY SHOWING 5204 03:07:57,480 --> 03:07:58,080 UP AT EVENTS LIKE THIS BECAUSE 5205 03:07:58,080 --> 03:07:59,680 THEY ARE NOT NECESSARILY HAVE 5206 03:07:59,680 --> 03:08:01,400 ANY WAY THAT THEY WOULD GET ON 5207 03:08:01,400 --> 03:08:03,560 THE E-MAIL LIST OR FIND OUT 5208 03:08:03,560 --> 03:08:07,120 ABOUT IT IF EVEN IF THEY HAD THE 5209 03:08:07,120 --> 03:08:09,080 TECHNOLOG IN INFRASTRUCTURE THAT 5210 03:08:09,080 --> 03:08:10,080 LETS THEM GET ON LINE FOR A 5211 03:08:10,080 --> 03:08:11,360 MEETING LIKE THIS. 5212 03:08:11,360 --> 03:08:14,840 THAT'S MY THOUGHT. 5213 03:08:14,840 --> 03:08:16,200 >>MODERATOR: THANK YOU. 5214 03:08:16,200 --> 03:08:18,360 A QUESTION IS ABOUT INDIGENOUS 5215 03:08:18,360 --> 03:08:19,640 GROUPS. 5216 03:08:19,640 --> 03:08:20,240 SO THAT'S WHY I DIRECTED THE 5217 03:08:20,240 --> 03:08:22,040 QUESTION TO YOU FIRST. 5218 03:08:22,040 --> 03:08:24,040 SO, THE QUESTION IS, HOW ARE THE 5219 03:08:24,040 --> 03:08:25,800 SPECIFIC HEALTH ISSUES OF 5220 03:08:25,800 --> 03:08:29,200 INDIGENOUS GROUPS ADDRESSED IN 5221 03:08:29,200 --> 03:08:32,040 LATIN-AMERICAN SYSTEM CONTEXT 5222 03:08:32,040 --> 03:08:35,240 BEST PRACTICES? 5223 03:08:35,240 --> 03:08:39,680 >>TATIANA VIDAURRE: YES, I 5224 03:08:39,680 --> 03:08:44,040 THINK THAT THIS IMPORTANT TO 5225 03:08:44,040 --> 03:08:46,200 PROMOTE RESEARCH FAMILIES, TO 5226 03:08:46,200 --> 03:08:48,400 TRANSLATE THIS INFORMATION TO 5227 03:08:48,400 --> 03:08:50,840 THE BEST PRACTICE. 5228 03:08:50,840 --> 03:08:56,000 PERU IS A COUNTRY THAT IS MIXED 5229 03:08:56,000 --> 03:08:56,280 POPULATION. 5230 03:08:56,280 --> 03:08:58,320 WE CALL -- 5231 03:08:58,320 --> 03:08:58,760 [ SPEAKING SPANISH ] 5232 03:08:58,760 --> 03:09:02,680 WE CAN FIND HIGH LEVEL OF 5233 03:09:02,680 --> 03:09:05,560 ANCESTRY IN THESE POPULATION. 5234 03:09:05,560 --> 03:09:11,640 A GOOD WAY TO ESTABLISH THE 5235 03:09:11,640 --> 03:09:17,600 CONVERSATION -- FOR THAT WE NEED 5236 03:09:17,600 --> 03:09:17,880 RESOURCES. 5237 03:09:17,880 --> 03:09:22,080 WE NEED FAMILY. 5238 03:09:22,080 --> 03:09:25,480 YOU NEED TECHNOLOGICAL -- I 5239 03:09:25,480 --> 03:09:26,760 THINK THAT IN COUNTRIES -- 5240 03:09:26,760 --> 03:09:28,480 [ INAUDIBLE ] 5241 03:09:28,480 --> 03:09:34,680 PERU HAS TO BE INCLUDED IN THE 5242 03:09:34,680 --> 03:09:35,280 BUDGET FOR THIS INITIATIVE TO 5243 03:09:35,280 --> 03:09:37,040 GET CONNECTED WITH THE GLOBAL 5244 03:09:37,040 --> 03:09:38,280 PLATFORM. 5245 03:09:38,280 --> 03:09:39,600 THESE FACILITIES TO PROMOTE 5246 03:09:39,600 --> 03:09:42,000 ONCOLOGY RESEARCH, INNOVATION, 5247 03:09:42,000 --> 03:09:44,520 AND WE CAN STANDARDIZE THE BEST 5248 03:09:44,520 --> 03:09:47,280 PRACTICE, NOT ONLY IN THE 5249 03:09:47,280 --> 03:09:50,040 GENERAL POPULATION, WE CAN 5250 03:09:50,040 --> 03:09:53,080 STANDARDIZE IN THE GENERAL AND 5251 03:09:53,080 --> 03:09:55,320 GENETIC APPROACH AND WE CAN 5252 03:09:55,320 --> 03:10:01,440 IMPROVE THE DISPARITY,ETH 5253 03:10:01,440 --> 03:10:02,000 NECESSITY IN CANCERS THAT 5254 03:10:02,000 --> 03:10:05,440 PRESENT DIFFERENT IN OUR 5255 03:10:05,440 --> 03:10:06,280 COUNTRIES. 5256 03:10:06,280 --> 03:10:06,840 >>MODERATOR: THANK YOU. 5257 03:10:06,840 --> 03:10:12,360 I APPRECIATE THAT RESPONSE. 5258 03:10:12,360 --> 03:10:14,280 I THINK I'LL MOVE TO THE NEXT 5259 03:10:14,280 --> 03:10:14,520 QUESTION. 5260 03:10:14,520 --> 03:10:15,080 BEFORE RERUN OUT OF TIME. 5261 03:10:15,080 --> 03:10:17,840 IN REGARDS TO GENOMIC DATA, WHAT 5262 03:10:17,840 --> 03:10:21,160 CHALLENGES DO YOU SEE IN YOUR 5263 03:10:21,160 --> 03:10:21,760 RESPECTIVE COMMUNITIES? 5264 03:10:21,760 --> 03:10:23,880 WHO OWNS THE DATA AND ARE THE 5265 03:10:23,880 --> 03:10:25,920 PROTECTIONS SUCH AS GENETIC 5266 03:10:25,920 --> 03:10:27,880 INFORMATION AND DISCRIMINATION 5267 03:10:27,880 --> 03:10:31,600 ACT IN THE U.S.? 5268 03:10:31,600 --> 03:10:35,000 ANYONE WANT TO TAKE A STAB AT 5269 03:10:35,000 --> 03:10:38,000 THAT? 5270 03:10:38,000 --> 03:10:41,240 >>WE HAD THIS EXPERIENCE 5271 03:10:41,240 --> 03:10:42,720 OBTAINING -- ASKING THE 5272 03:10:42,720 --> 03:10:44,360 PARTICIPANTS, ASKING THE 5273 03:10:44,360 --> 03:10:44,640 COMMUNITY. 5274 03:10:44,640 --> 03:10:49,120 AND WE HAVE TO DO A LOT OF 5275 03:10:49,120 --> 03:10:49,720 COMMUNITY EDUCATION. 5276 03:10:49,720 --> 03:10:54,560 SO I HAD TO BRING THE EXPERTS, 5277 03:10:54,560 --> 03:10:59,040 REAL GENOMIC PEOPLE, 5278 03:10:59,040 --> 03:11:01,760 GENETICISTS, TO EXPLAIN WHY THEY 5279 03:11:01,760 --> 03:11:03,320 ARE NOST GOING TO CLONE 5280 03:11:03,320 --> 03:11:03,600 SOMEBODY. 5281 03:11:03,600 --> 03:11:06,000 WHY IT'S NOT JURASSIC PARK THEY 5282 03:11:06,000 --> 03:11:06,800 ARE TRYING TO DO. 5283 03:11:06,800 --> 03:11:10,840 WHY THIS IS NOT GOING TO HELP A 5284 03:11:10,840 --> 03:11:12,320 PREGNANT PERSON THAT WAS TOLD 5285 03:11:12,320 --> 03:11:15,600 YESTERDAY THAT SHE HAD A 5286 03:11:15,600 --> 03:11:17,320 MALFORMATION OR CONGENITAL. 5287 03:11:17,320 --> 03:11:21,320 SO WE HAVE TO DO LIKE TWO YEARS 5288 03:11:21,320 --> 03:11:23,920 OF COMMUNITY READINESS 5289 03:11:23,920 --> 03:11:27,960 ACTIVITIES TO INCREASE THEIR 5290 03:11:27,960 --> 03:11:28,560 READINESS OF THE COMMUNITY AND 5291 03:11:28,560 --> 03:11:28,960 THE PARTICIPANTS. 5292 03:11:28,960 --> 03:11:30,400 AND GIVEN THE WAY OUT IF THEY 5293 03:11:30,400 --> 03:11:32,960 DON'T WANT IT -- IF THEY DIDN'T 5294 03:11:32,960 --> 03:11:36,960 WANT -- IN TERMS OF THE 5295 03:11:36,960 --> 03:11:40,760 PROTECTIONS, IN VENEZUELA, IT IS 5296 03:11:40,760 --> 03:11:47,720 PROTECTED IN DIFFERENT WAYS BUT 5297 03:11:47,720 --> 03:11:50,760 WE ALWAYS HAVE TOLD THE 5298 03:11:50,760 --> 03:11:52,280 COMMUNITY AND COMPLIED WITH THE 5299 03:11:52,280 --> 03:11:54,440 COUNTRIES BY PROTECTING A 5300 03:11:54,440 --> 03:11:57,400 PERSONAL HEALTH INFORMATION, 5301 03:11:57,400 --> 03:11:59,680 KEEPING THE STANDARDS THAT ALL 5302 03:11:59,680 --> 03:12:02,120 DATA WILL BE DENON MYSELFED. 5303 03:12:02,120 --> 03:12:07,040 WE HAVE TO EXPLAIN TO THEM -- 5304 03:12:07,040 --> 03:12:07,360 DEANONMIZED. 5305 03:12:07,360 --> 03:12:11,480 WE HAVE TO EXPLAIN TO CHEM 5306 03:12:11,480 --> 03:12:12,040 WHAT -- HOW RESEARCHERS ARE 5307 03:12:12,040 --> 03:12:15,840 GOING TO HAVE ACCESS TO THEIR 5308 03:12:15,840 --> 03:12:16,040 DATA. 5309 03:12:16,040 --> 03:12:17,640 AND I SHOW THEM, THIS IS THEIR 5310 03:12:17,640 --> 03:12:18,960 DATA. 5311 03:12:18,960 --> 03:12:22,480 THE DATA IS IN A CD OR DVD OR 5312 03:12:22,480 --> 03:12:22,680 USB. 5313 03:12:22,680 --> 03:12:23,680 THERE IS NOTHING REALLY. 5314 03:12:23,680 --> 03:12:27,240 IT'S A BUNCH OF LETTERS THAT IT 5315 03:12:27,240 --> 03:12:30,120 DOESN'T -- THEY DON'T HAVE THE 5316 03:12:30,120 --> 03:12:31,440 ABILITY TO PREDICT IF YOU'RE 5317 03:12:31,440 --> 03:12:34,360 GOING TO GET CANCER. 5318 03:12:34,360 --> 03:12:37,360 SO IT'S THE READINESS. 5319 03:12:37,360 --> 03:12:38,560 I KNOW THAT THERE ARE OTHER 5320 03:12:38,560 --> 03:12:40,640 COUNTRIES EVEN COSTA RICA AND 5321 03:12:40,640 --> 03:12:46,520 BRAZIL THAT ARE VERY STRICT IN 5322 03:12:46,520 --> 03:12:48,840 RELATIONSHIP TO DNA OUT OF THEIR 5323 03:12:48,840 --> 03:12:49,120 COUNTRIES. 5324 03:12:49,120 --> 03:12:50,640 BUT IN VENEZUELA, WE TRY TO 5325 03:12:50,640 --> 03:12:53,480 PARTNER AND WE ALSO HAVE TO DO 5326 03:12:53,480 --> 03:12:56,000 READINESS TRAINING WITH LOCAL 5327 03:12:56,000 --> 03:12:56,280 OFFICIALS. 5328 03:12:56,280 --> 03:12:59,280 WE HAVE TO EXPLAIN WHY BECAUSE 5329 03:12:59,280 --> 03:13:03,440 THE POPULATION IN VENEZUELA, 5330 03:13:03,440 --> 03:13:05,240 IT'S ONE OF THE FEW POPULATIONS 5331 03:13:05,240 --> 03:13:07,400 IN THE WORLD THAT ACTUALLY 5332 03:13:07,400 --> 03:13:10,560 RECEIVE AN APOLOGIES FROM THE 5333 03:13:10,560 --> 03:13:13,320 U.S. BECAUSE OF THE -- SO, WE 5334 03:13:13,320 --> 03:13:14,800 HAVE TO EXPLAIN WHAT THE 5335 03:13:14,800 --> 03:13:15,800 DIFFERENCE WAS. 5336 03:13:15,800 --> 03:13:17,240 WHAT HAPPENED IN THE 60s IS 5337 03:13:17,240 --> 03:13:18,480 VERY DIFFERENT THAN WHAT IS 5338 03:13:18,480 --> 03:13:22,360 HAPPENING NOWADAYS AND HOW THE 5339 03:13:22,360 --> 03:13:24,240 LEGAL STANDARDS AND POLITICAL 5340 03:13:24,240 --> 03:13:26,360 STANDARDS HAVE CHANGED INVOLVING 5341 03:13:26,360 --> 03:13:28,280 SCIENCE. 5342 03:13:28,280 --> 03:13:28,840 >>MODERATOR: ABSOLUTELY. 5343 03:13:28,840 --> 03:13:29,800 DID YOU WANT TO ADD ANYTHING TO 5344 03:13:29,800 --> 03:13:39,880 IT? 5345 03:13:41,320 --> 03:13:47,720 >>IT IS IMPORTANT -- TO 5346 03:13:47,720 --> 03:13:52,600 BUILDING A STRONG COMMUNITY, 5347 03:13:52,600 --> 03:13:54,120 INTERNATIONAL COMMUNITY FOR 5348 03:13:54,120 --> 03:13:55,280 RESEARCH, I THINK THAT WE HAVE 5349 03:13:55,280 --> 03:14:01,040 TO PROMOTE THE INTERNATIONAL 5350 03:14:01,040 --> 03:14:03,840 PROFESSORS, STUDENTS, TO 5351 03:14:03,840 --> 03:14:07,320 COLLABORATE TO STANDARDIZE TO 5352 03:14:07,320 --> 03:14:13,120 POLICY TOO FOR THE -- HOW TO 5353 03:14:13,120 --> 03:14:15,080 MOVE THE SAMPLES. 5354 03:14:15,080 --> 03:14:17,720 AND TRAINING AND RESEARCH IS 5355 03:14:17,720 --> 03:14:21,240 IMPORTANT COMPONENT OF THESE 5356 03:14:21,240 --> 03:14:23,800 PROCESS. 5357 03:14:23,800 --> 03:14:24,680 IF YOU HAVE BETTER HEALTH 5358 03:14:24,680 --> 03:14:29,080 PROFESSIONAL THAT IS QUALIFIED 5359 03:14:29,080 --> 03:14:31,240 AS SCIENTIST, WE WILL UNDERSTAND 5360 03:14:31,240 --> 03:14:32,440 BETTER THE PROCESS. 5361 03:14:32,440 --> 03:14:34,760 AND WE HAVE A BETTER 5362 03:14:34,760 --> 03:14:36,960 RELATIONSHIP TO GET THAT 5363 03:14:36,960 --> 03:14:39,080 INFORMATION. 5364 03:14:39,080 --> 03:14:41,160 AND I THINK THAT IN PERU, WE 5365 03:14:41,160 --> 03:14:47,360 HAVE A NEW LAW, A LAW THAT 5366 03:14:47,360 --> 03:14:48,400 CREATING NETWORK IN THE 5367 03:14:48,400 --> 03:14:50,560 INSTITUTE OF TUMOR BANK TO 5368 03:14:50,560 --> 03:14:53,560 PROMOTE THIS KIND OF RESEARCH. 5369 03:14:53,560 --> 03:14:58,920 AND THIS IS OUR OPPORTUNITY TO 5370 03:14:58,920 --> 03:14:59,480 COLLATE SAMPLE OF DIFFERENT 5371 03:14:59,480 --> 03:15:04,880 TUMORS AND ESPECIALLY THE NATIVE 5372 03:15:04,880 --> 03:15:06,240 COMMUNITIES THAT EXIST AND I 5373 03:15:06,240 --> 03:15:09,960 THINK THERE IS A WAY TO BUILD 5374 03:15:09,960 --> 03:15:14,520 THIS INFORMATION AND 5375 03:15:14,520 --> 03:15:14,920 INTERNATIONALLY. 5376 03:15:14,920 --> 03:15:15,600 >>MODERATOR: THANK YOU VERY 5377 03:15:15,600 --> 03:15:16,960 MUCH. 5378 03:15:16,960 --> 03:15:18,680 DR. CARMEN VELEZ VEGA? 5379 03:15:18,680 --> 03:15:20,400 >>CARMEN VELEZ VEGA: YES, WE 5380 03:15:20,400 --> 03:15:21,120 ACTUALLY IN THE BEGINNING OF OUR 5381 03:15:21,120 --> 03:15:23,240 PROTECT PROJECT 10 YEARS AGO, WE 5382 03:15:23,240 --> 03:15:29,280 STARTED TO ASK FOR SAMPLES FOR 5383 03:15:29,280 --> 03:15:30,880 GENOMEIFICATION. 5384 03:15:30,880 --> 03:15:33,200 OUR PARTICIPANTS HAVE TO SAY YES 5385 03:15:33,200 --> 03:15:33,800 TO MANY THINGS AND THEY WOULD 5386 03:15:33,800 --> 03:15:34,560 SAY YES TO ALL OF IT EXCEPT FOR 5387 03:15:34,560 --> 03:15:35,360 THAT. 5388 03:15:35,360 --> 03:15:37,960 20% OF OUR PARTICIPANTS WOULD 5389 03:15:37,960 --> 03:15:40,480 NOT WANT TO DO THE GENOTYPIC OR 5390 03:15:40,480 --> 03:15:42,080 GIVE SAMPLES FOR THAT. 5391 03:15:42,080 --> 03:15:46,600 AND AGAIN, I AGREE WITH YOU 5392 03:15:46,600 --> 03:15:48,520 SAYING IT WAS A MATTER OF 5393 03:15:48,520 --> 03:15:48,800 EDUCATION. 5394 03:15:48,800 --> 03:15:49,440 WE WENT BACK TO THE PARTICIPANTS 5395 03:15:49,440 --> 03:15:53,680 AND DID A QUALITATIVE STUDY AND 5396 03:15:53,680 --> 03:15:54,640 FOCUS GROUPS AND INTERVIEWS AND 5397 03:15:54,640 --> 03:15:58,200 STARTED TO FIND OUT WHY. 5398 03:15:58,200 --> 03:15:59,760 WHAT WERE THE CONCERNS. 5399 03:15:59,760 --> 03:16:01,440 AND AS SHE SAID, PEOPLE ARE 5400 03:16:01,440 --> 03:16:02,840 AFRAID OF BEING CLONED. 5401 03:16:02,840 --> 03:16:04,160 PEOPLE ARE AFRAID OF SO MANY 5402 03:16:04,160 --> 03:16:07,200 THINGS THAT ARE REALLY 5403 03:16:07,200 --> 03:16:07,840 DISINFORMATION, MISINFORMATION. 5404 03:16:07,840 --> 03:16:10,480 SO IT TOOK US A WHILE TO GET 5405 03:16:10,480 --> 03:16:11,760 BACK AND WE WENT BACK TO THE 5406 03:16:11,760 --> 03:16:14,960 CONSENT FORM AND WE CREATED A 5407 03:16:14,960 --> 03:16:15,800 CONSENT FORM THAT WAS 5408 03:16:15,800 --> 03:16:17,240 UNDERSTANDABLE AND WE REALLY 5409 03:16:17,240 --> 03:16:19,280 VERIFIED THAT PEOPLE KNEW WHAT 5410 03:16:19,280 --> 03:16:20,040 WE WERE PLANNING TO DO WITH 5411 03:16:20,040 --> 03:16:20,240 THIS. 5412 03:16:20,240 --> 03:16:22,880 AND THAT IT WOULD NOT BE USED IN 5413 03:16:22,880 --> 03:16:24,880 FURTHER STUDIES IF WE DID NOT 5414 03:16:24,880 --> 03:16:26,560 CONTACT THEM BEFORE THAT AND GET 5415 03:16:26,560 --> 03:16:26,960 THEIR PERMISSION. 5416 03:16:26,960 --> 03:16:28,600 SO THINGS LIKE THAT HELPED US. 5417 03:16:28,600 --> 03:16:34,400 AND ACTUALLY IT IMPROVED A 5418 03:16:34,400 --> 03:16:35,280 GREATLY. 5419 03:16:35,280 --> 03:16:35,800 >>MODERATOR: THANK YOU. 5420 03:16:35,800 --> 03:16:37,240 DR. JOHN PIETTE LAST WORD ON 5421 03:16:37,240 --> 03:16:38,000 THIS QUESTION. 5422 03:16:38,000 --> 03:16:39,400 >>JOHN PIETTE: I THINK IT'S 5423 03:16:39,400 --> 03:16:42,560 WORTH NOTING THAT INDIVIDUALS IN 5424 03:16:42,560 --> 03:16:44,440 WHATEVER COMMUNITY MIGHT HAVE 5425 03:16:44,440 --> 03:16:46,600 CONCERNS ABOUT BEING CLONED OR 5426 03:16:46,600 --> 03:16:47,040 ABOUT JURASSIC PARK. 5427 03:16:47,040 --> 03:16:48,720 THAT IS DEFINITELY SOMETHING 5428 03:16:48,720 --> 03:16:49,480 THAT SOUNDS FAMILIAR. 5429 03:16:49,480 --> 03:16:50,680 BUT THEY ALSO MIGHT, ANOTHER 5430 03:16:50,680 --> 03:16:53,520 LAYER OF THAT IS WHO IS ASKING 5431 03:16:53,520 --> 03:16:54,360 FOR THE DATA? 5432 03:16:54,360 --> 03:16:57,720 AND I'LL GIVE YOU ANOTHER BRIEF 5433 03:16:57,720 --> 03:16:57,920 STORY. 5434 03:16:57,920 --> 03:17:00,360 THE PROJECT I MENTIONED IN 5435 03:17:00,360 --> 03:17:01,320 BOLIVIA WHERE WE WERE DOING OR 5436 03:17:01,320 --> 03:17:03,120 DEVELOPING A SELF-MANAGEMENT 5437 03:17:03,120 --> 03:17:05,000 SUPPORT PROGRAM FOR OBLIVION 5438 03:17:05,000 --> 03:17:05,960 PEOPLE THAT HAD LIMITED ACCESS 5439 03:17:05,960 --> 03:17:07,320 TO CARE. 5440 03:17:07,320 --> 03:17:12,600 WE WENT TO THE IRB OF A MAJOR 5441 03:17:12,600 --> 03:17:14,360 UNIVERSITY AND THE IRB CAME BACK 5442 03:17:14,360 --> 03:17:16,000 WITH A QUESTION, WHY AREN'T YOU 5443 03:17:16,000 --> 03:17:20,600 TESTING THIS OUT ON YOUR OWN 5444 03:17:20,600 --> 03:17:21,000 POPULATION? 5445 03:17:21,000 --> 03:17:22,480 IN OTHER WORDS THERE WAS THE 5446 03:17:22,480 --> 03:17:25,680 INSINUATION THAT WE WERE USING 5447 03:17:25,680 --> 03:17:27,720 THEM AS GUINEA PIGS TO TEST 5448 03:17:27,720 --> 03:17:29,720 SOMETHING FOR OUR BENEFIT 5449 03:17:29,720 --> 03:17:33,880 BECAUSE OF THE LONG HISTORY OF 5450 03:17:33,880 --> 03:17:35,480 EXPLOITATION THAT THAT 5451 03:17:35,480 --> 03:17:36,080 PARTICULAR COUNTRY FEELS ABOUT 5452 03:17:36,080 --> 03:17:37,400 THEIR RELATIONSHIP WITH THE 5453 03:17:37,400 --> 03:17:38,600 UNITED STATES. 5454 03:17:38,600 --> 03:17:40,720 SO ONE THING THAT I GOT TO SAY, 5455 03:17:40,720 --> 03:17:43,600 I WAS MORE NAIVE ABOUT 10-15 5456 03:17:43,600 --> 03:17:45,600 YEARS AGO, IS THAT I CAN, 5457 03:17:45,600 --> 03:17:47,240 SPEAKING FOR MYSELF, I CAN COME 5458 03:17:47,240 --> 03:17:49,040 WITH THE BEST OF INTENTIONS AND 5459 03:17:49,040 --> 03:17:51,120 THE BEST DESIGNED PROJECT BUT AT 5460 03:17:51,120 --> 03:17:51,720 THE END OF THE DAY, THEY ARE 5461 03:17:51,720 --> 03:17:52,840 SEEING ME AS AN AMERICAN AND IF 5462 03:17:52,840 --> 03:17:55,480 I HAVE MONEY FROM THE UNITED 5463 03:17:55,480 --> 03:17:56,640 STATES GOVERNMENT, BASED ON 5464 03:17:56,640 --> 03:17:58,160 THINGS THAT ARE HISTORICALLY 5465 03:17:58,160 --> 03:18:00,720 TRUE OR HISTORICALLY SOMEWHAT 5466 03:18:00,720 --> 03:18:02,800 DISTORTED, THEY ARE SEEING ME 5467 03:18:02,800 --> 03:18:03,240 THROUGH THAT LENSE. 5468 03:18:03,240 --> 03:18:05,400 AND WE HAVE TO RECOGNIZE THAT 5469 03:18:05,400 --> 03:18:07,360 THESE INTERNATIONAL 5470 03:18:07,360 --> 03:18:09,760 COLLABORATIONS ARE GOING TO 5471 03:18:09,760 --> 03:18:11,200 NECESSARILY DECONTEXTURALIZE 5472 03:18:11,200 --> 03:18:11,560 THAT WAY. 5473 03:18:11,560 --> 03:18:13,400 THAT MIGHT MEAN THAT SOME 5474 03:18:13,400 --> 03:18:15,520 RELATIONSHIPS ARE HARDER. 5475 03:18:15,520 --> 03:18:17,400 IN MY EXPERIENCE THERE ARE 5476 03:18:17,400 --> 03:18:18,000 CERTAIN COUNTRIES THAT ARE 5477 03:18:18,000 --> 03:18:20,120 HARDER TO WORK IN, SAY 5478 03:18:20,120 --> 03:18:22,640 NICARAGUA, CUBA AND BOLIVIA IS 5479 03:18:22,640 --> 03:18:23,320 VERY DIFFICULT. 5480 03:18:23,320 --> 03:18:24,960 SOME COUNTRIES MIGHT BE EASIER. 5481 03:18:24,960 --> 03:18:26,800 IT DOESN'T MEAN WE SHOULDN'T DO 5482 03:18:26,800 --> 03:18:26,960 IT. 5483 03:18:26,960 --> 03:18:29,680 BUT RECOGNIZING THAT KIND OF -- 5484 03:18:29,680 --> 03:18:33,360 THAT GREATER POLITICAL CONTEXT 5485 03:18:33,360 --> 03:18:35,560 AND THE HISTORY BETWEEN OUR 5486 03:18:35,560 --> 03:18:37,240 COUNTRIES MAY EFFECT HOW WE ARE 5487 03:18:37,240 --> 03:18:39,200 ABLE TO DEVELOP THESE 5488 03:18:39,200 --> 03:18:42,240 RELATIONSHIPS WITH COMMUNITIES. 5489 03:18:42,240 --> 03:18:42,760 >>MODERATOR: THANK YOU. 5490 03:18:42,760 --> 03:18:43,640 DID YOU HAVE SOMETHING ELSE TO 5491 03:18:43,640 --> 03:18:45,560 ADD? 5492 03:18:45,560 --> 03:18:51,280 I'M JUST -- 5493 03:18:51,280 --> 03:18:54,320 >>I THINK IT'S VERY IMPORTANT. 5494 03:18:54,320 --> 03:18:58,280 I THINK THAT ALSO WE NEED TO 5495 03:18:58,280 --> 03:18:59,480 UNDERSTAND THAT EVERY COUNTRY IN 5496 03:18:59,480 --> 03:19:01,880 LATIN AMERICA IS VERY DIFFERENT 5497 03:19:01,880 --> 03:19:02,680 AND THERE ARE DIFFERENT 5498 03:19:02,680 --> 03:19:04,240 RELATIONS ALSO DEPENDING ON THE 5499 03:19:04,240 --> 03:19:07,680 DISEASE THAT YOU ARE ADDRESSING 5500 03:19:07,680 --> 03:19:09,720 OR THE CONDITION. 5501 03:19:09,720 --> 03:19:12,360 THAT THERE ARE -- AS ANYWHERE 5502 03:19:12,360 --> 03:19:14,280 ELSE, MORE VULNERABLE 5503 03:19:14,280 --> 03:19:14,560 POPULATIONS. 5504 03:19:14,560 --> 03:19:17,360 AND WE NEED TO UNDERSTAND THE 5505 03:19:17,360 --> 03:19:19,680 DIVERSITY WITHIN THE COUNTRY 5506 03:19:19,680 --> 03:19:22,720 THAT WE ARE STUDYING. 5507 03:19:22,720 --> 03:19:24,040 PERHAPS PEOPLE THAT ARE KNOWN TO 5508 03:19:24,040 --> 03:19:28,240 BE GENETICALLY AT RISK, FOR 5509 03:19:28,240 --> 03:19:30,560 EXAMPLE, THERE IS A POPULATION 5510 03:19:30,560 --> 03:19:33,080 AT THE HIGH RISK FOR HUNTINGTON 5511 03:19:33,080 --> 03:19:36,360 DISEASE BECAUSE IT'S THE LARGEST 5512 03:19:36,360 --> 03:19:38,400 CONGLOMERATE IN THE WORLD FOR 5513 03:19:38,400 --> 03:19:39,960 HUNTINGTON DISEASE WHICH IS 5514 03:19:39,960 --> 03:19:42,440 TRANSMUTED DOMINANTLY. 5515 03:19:42,440 --> 03:19:44,640 SO WE HAVE EXPERIENCED, FOR 5516 03:19:44,640 --> 03:19:46,760 EXAMPLE, THE VERY WELL 5517 03:19:46,760 --> 03:19:48,560 INTENTIONED SCIENTISTS WILL COME 5518 03:19:48,560 --> 03:19:50,760 AND THEY WILL BE HOUSES, REAL 5519 03:19:50,760 --> 03:19:51,280 HOUSES. 5520 03:19:51,280 --> 03:19:54,080 I MEAN NOT ON STILTS, IN THE 5521 03:19:54,080 --> 03:19:55,680 GROUND AND HAVE BATHROOMS, WHERE 5522 03:19:55,680 --> 03:19:57,360 WE DO ALL OF THAT. 5523 03:19:57,360 --> 03:20:03,040 AND THEN WHEN VENEZUELANS GO TO 5524 03:20:03,040 --> 03:20:04,440 DO SOMETHING, PEOPLE ARE 5525 03:20:04,440 --> 03:20:07,880 EXPECTING TO HAVE A HOUSE FOR IN 5526 03:20:07,880 --> 03:20:09,560 EXCHANGE FOR THE BLOT. 5527 03:20:09,560 --> 03:20:12,680 WE REALLY NEED TO -- AND THAT'S 5528 03:20:12,680 --> 03:20:16,080 WHY I MENTIONED CULTURAL 5529 03:20:16,080 --> 03:20:16,320 AGILITY. 5530 03:20:16,320 --> 03:20:17,400 ON BOTH SIDES THERE NEEDS TO BE 5531 03:20:17,400 --> 03:20:21,440 AN AWARENESS THAT WE ARE 5532 03:20:21,440 --> 03:20:22,760 ENTERING IN A RELATIONSHIP IN 5533 03:20:22,760 --> 03:20:25,880 WHICH WE NEED TO KNOW MORE ABOUT 5534 03:20:25,880 --> 03:20:26,720 THE SUBJECT. 5535 03:20:26,720 --> 03:20:31,280 AND THE SUBJECTS HERE ARE BOTH 5536 03:20:31,280 --> 03:20:33,840 SIDES OF THE COLLABORATION. 5537 03:20:33,840 --> 03:20:34,400 >>MODERATOR: ABSOLUTELY. 5538 03:20:34,400 --> 03:20:37,440 THANK YOU ALL FOR YOUR INPUT ON 5539 03:20:37,440 --> 03:20:38,040 THAT QUESTION. 5540 03:20:38,040 --> 03:20:40,640 WE ARE JUST UP ON TIME BUT THIS 5541 03:20:40,640 --> 03:20:46,040 WILL GIVE US A CLOSING QUESTION. 5542 03:20:46,040 --> 03:20:46,600 YOU HAVE ALL HINTED ESTIMATE 5543 03:20:46,600 --> 03:20:50,720 POINT IN YOUR ANSWERS ABOUT 5544 03:20:50,720 --> 03:20:51,280 MISINFORMATION. 5545 03:20:51,280 --> 03:20:53,120 AND DURING THIS PANDEMIC WE SEEN 5546 03:20:53,120 --> 03:20:55,360 THIS HAS COME TO THE FOREFRONT. 5547 03:20:55,360 --> 03:20:59,560 SO, HOW HAS MISINFORMATION AND 5548 03:20:59,560 --> 03:21:00,560 MISTRUST IN SCIENCE THAT HAVE 5549 03:21:00,560 --> 03:21:03,400 SURFACED DURING COVID-19 5550 03:21:03,400 --> 03:21:08,760 PANDEMIC AFFECTED COMMUNITY 5551 03:21:08,760 --> 03:21:09,160 ENGAGED RESEARCH? 5552 03:21:09,160 --> 03:21:14,040 >>FOR US, REALLY HAD BEEN -- I 5553 03:21:14,040 --> 03:21:16,280 HAVE TO SAY THAT THE FEAR OF 5554 03:21:16,280 --> 03:21:20,080 PEOPLE IN VENEZUELA HAD LED THEM 5555 03:21:20,080 --> 03:21:23,840 TO BE REALLY SELF CONTAINED, 5556 03:21:23,840 --> 03:21:26,680 EVEN MUCH MORE THAN THE U.S., I 5557 03:21:26,680 --> 03:21:28,240 HAVE TO SAY. 5558 03:21:28,240 --> 03:21:31,960 BUT THIS MEANS, THIS HAS MEANT 5559 03:21:31,960 --> 03:21:33,880 THAT THEY HAVE LESS ACCESS TO 5560 03:21:33,880 --> 03:21:34,160 SERVICES. 5561 03:21:34,160 --> 03:21:36,960 SO WHEN WE WENT THIS YEAR TO SAY 5562 03:21:36,960 --> 03:21:40,000 HEY, WE NEED TO DO THE FOLLOW-UP 5563 03:21:40,000 --> 03:21:42,400 ON THE EYES. 5564 03:21:42,400 --> 03:21:45,320 THEY WANTED TO BE PART. 5565 03:21:45,320 --> 03:21:45,960 THEY WANTED TO COME AND THEY 5566 03:21:45,960 --> 03:21:47,240 SAID, CAN YOU DO MORE TESTS? 5567 03:21:47,240 --> 03:21:49,880 CAN YOU DO A BLOOD TEST? 5568 03:21:49,880 --> 03:21:51,200 CAN YOU DO OTHERS? 5569 03:21:51,200 --> 03:21:52,920 CHECK FOR BREAST CANCER OR 5570 03:21:52,920 --> 03:21:53,680 PROSTATE OR WHATEVER? 5571 03:21:53,680 --> 03:21:59,280 SO THEY WANTED TO USE THEIR 5572 03:21:59,280 --> 03:21:59,960 ABILITIES AND CAPACITIES OF OUR 5573 03:21:59,960 --> 03:22:02,000 TEAM BECAUSE THEY HAD LESS 5574 03:22:02,000 --> 03:22:08,000 ACCESS TO HEALTH CARE. 5575 03:22:08,000 --> 03:22:08,640 >>MODERATOR: DR. CARMEN VELEZ 5576 03:22:08,640 --> 03:22:11,680 VEGA AND THEN DR. JOHN PIETTE. 5577 03:22:11,680 --> 03:22:14,240 >>YES, WE, IN OUR EXPERIENCE, 5578 03:22:14,240 --> 03:22:15,440 SOMETHING THAT HELPED A LOT WAS 5579 03:22:15,440 --> 03:22:18,400 THE TRUST THAT WE ALREADY WERE 5580 03:22:18,400 --> 03:22:19,440 ABLE TO HAVE WITH OUR 5581 03:22:19,440 --> 03:22:23,840 PARTICIPANTS IN OUR COMMUNITY 5582 03:22:23,840 --> 03:22:24,080 PARTNERS. 5583 03:22:24,080 --> 03:22:26,600 AFTER THE HURRICANES, AFTER THE 5584 03:22:26,600 --> 03:22:27,920 EARTHQUAKES, AS WELL AS COVID. 5585 03:22:27,920 --> 03:22:30,360 WE IMMEDIATELY CONTACTED THEM 5586 03:22:30,360 --> 03:22:32,040 AND STARTED TO GAUGE WHAT ARE 5587 03:22:32,040 --> 03:22:34,520 THE NEEDS THAT THEY HAD IN TERMS 5588 03:22:34,520 --> 03:22:36,120 OF INFORMATION, WHAT WERE THEIR 5589 03:22:36,120 --> 03:22:36,360 QUESTIONS? 5590 03:22:36,360 --> 03:22:39,160 AND QUESTIONS THAT, CAN I 5591 03:22:39,160 --> 03:22:41,000 BREASTFEED MY KID? 5592 03:22:41,000 --> 03:22:42,400 WILL I BE TRANSMITTED -- DO I 5593 03:22:42,400 --> 03:22:46,240 HAVE TO WEAR A MASK? 5594 03:22:46,240 --> 03:22:47,440 SO WE START -- WE HAD OUR TEAM 5595 03:22:47,440 --> 03:22:49,320 DEVELOP MATERIALS, FOLLOW-UP 5596 03:22:49,320 --> 03:22:50,840 WITH THESE QUESTIONS AND ANSWER 5597 03:22:50,840 --> 03:22:53,960 THEM AND ALSO WITH OUR 5598 03:22:53,960 --> 03:22:55,280 COLLABORATION AND COMMUNITY 5599 03:22:55,280 --> 03:22:56,920 HEALTH CENTERS FROM WHERE WE 5600 03:22:56,920 --> 03:23:00,280 RECRUIT THESE PARTICIPANTS, 5601 03:23:00,280 --> 03:23:01,360 THESE FQHCs THAT DID A 5602 03:23:01,360 --> 03:23:03,360 WONDERFUL WORK IN TERMS OF BEING 5603 03:23:03,360 --> 03:23:06,360 ABLE TO PROVIDE THE TESTING, THE 5604 03:23:06,360 --> 03:23:08,160 VACCINES AND COMMUNITY OUTREACH 5605 03:23:08,160 --> 03:23:10,040 TO GO HOME BY HOME AND EXPLAIN 5606 03:23:10,040 --> 03:23:11,440 TO PEOPLE WHY THIS IS IMPORTANT 5607 03:23:11,440 --> 03:23:14,360 AND HOW THEY CAN REACH -- ABLE 5608 03:23:14,360 --> 03:23:16,760 TO GET THESE RESOURCES. 5609 03:23:16,760 --> 03:23:19,960 ALSO BE ABLE TO PROVIDE ACCESS 5610 03:23:19,960 --> 03:23:20,840 TO MENTAL HEALTH SUPPORT, WHICH 5611 03:23:20,840 --> 03:23:23,160 WAS A BIG THING DURING -- AND 5612 03:23:23,160 --> 03:23:24,960 STILL IS DURING THE PANDEMIC, 5613 03:23:24,960 --> 03:23:29,160 THAT ISOLATION, LACK OF FEELING 5614 03:23:29,160 --> 03:23:30,280 PART OF THE COMMUNITY. 5615 03:23:30,280 --> 03:23:32,360 SO THAT IS FOR US IMPORTANT. 5616 03:23:32,360 --> 03:23:33,880 HAVING THAT TRUST AND BEING ABLE 5617 03:23:33,880 --> 03:23:35,960 TO BE THERE AT THESE TIMES IS 5618 03:23:35,960 --> 03:23:36,720 SOMETHING THAT HAS HELPED US 5619 03:23:36,720 --> 03:23:42,360 BUILD ON IT. 5620 03:23:42,360 --> 03:23:42,880 >>JOHN PIETTE. 5621 03:23:42,880 --> 03:23:47,040 I WOULD SAY IT IS JUST LIKE IN 5622 03:23:47,040 --> 03:23:48,640 THE UNITED STATES PEOPLE'S 5623 03:23:48,640 --> 03:23:50,040 PERCEPTION OF COVID AND COVID 5624 03:23:50,040 --> 03:23:52,200 RISK IS A MIX OF SOME REAL HARD 5625 03:23:52,200 --> 03:23:53,960 FACTS THAT THEY ARE DEALING WITH 5626 03:23:53,960 --> 03:23:55,640 AND ALSO SOME MISPERCEPTIONS 5627 03:23:55,640 --> 03:23:58,080 ABOUT WHAT MIGHT INCREASE RISK. 5628 03:23:58,080 --> 03:23:58,760 WHAT IS DIFFERENT IN LATIN 5629 03:23:58,760 --> 03:24:01,280 AMERICA OR MANY PLACES, UNDER 5630 03:24:01,280 --> 03:24:03,120 SERVED POPULATIONS IN GENERAL, 5631 03:24:03,120 --> 03:24:05,560 IS THAT OFTEN IN THE U.S. AT 5632 03:24:05,560 --> 03:24:06,840 LEAST FOR LET'S SAY PEOPLE THAT 5633 03:24:06,840 --> 03:24:09,280 HAVE ACCESS TO HEALTH CARE, 5634 03:24:09,280 --> 03:24:10,880 WE'RE KIND OF CALCULATING OUR 5635 03:24:10,880 --> 03:24:13,000 RISK BASED ON OUR 5636 03:24:13,000 --> 03:24:15,040 CHARACTERISTICS, NOT REALLY 5637 03:24:15,040 --> 03:24:15,440 THINKING ABOUT THE 5638 03:24:15,440 --> 03:24:16,200 CHARACTERISTICS OF OUR HEALTH 5639 03:24:16,200 --> 03:24:16,960 SYSTEM. 5640 03:24:16,960 --> 03:24:19,080 SO IF YOU HAVE -- IF YOU REAL 5641 03:24:19,080 --> 03:24:19,680 DON'T TRUST YOUR HEALTH CARE 5642 03:24:19,680 --> 03:24:22,200 SYSTEM, YOU'RE GOING TO BE THAT 5643 03:24:22,200 --> 03:24:22,840 MUCH MORE CAREFUL BECAUSE YOU 5644 03:24:22,840 --> 03:24:25,480 THINK IF I GET SICK, I'M TOAST. 5645 03:24:25,480 --> 03:24:26,640 I'M NOT GOING TO GET MEDICATION. 5646 03:24:26,640 --> 03:24:27,280 I'M NOT GOING TO BE ABLE TO GO 5647 03:24:27,280 --> 03:24:30,400 TO THE DOCTOR. 5648 03:24:30,400 --> 03:24:31,040 THAT HIGHTENS PEOPLE'S RISK. 5649 03:24:31,040 --> 03:24:34,080 I HAVE A COLLEAGUE WHEN I WAS IN 5650 03:24:34,080 --> 03:24:36,360 HONDURAS ABOUT A YEAR AGO THAT 5651 03:24:36,360 --> 03:24:37,520 WENT AROUND WITH ME. 5652 03:24:37,520 --> 03:24:39,280 NOT ONLY DID HE WANT ME TO WEAR 5653 03:24:39,280 --> 03:24:40,760 A MASK WHICH WAS FINE BUT WHEN I 5654 03:24:40,760 --> 03:24:42,960 GOT INTO HIS CAR, HE WOULD WANT 5655 03:24:42,960 --> 03:24:44,480 ME TO -- BEFORE I GOT IN, THROW 5656 03:24:44,480 --> 03:24:47,720 AWAY THE MASK I WAS WEARING AND 5657 03:24:47,720 --> 03:24:48,280 HE WOULD HAND ME A NEW MASK. 5658 03:24:48,280 --> 03:24:49,800 SO I WOULD KIND OF HAVE A NEW 5659 03:24:49,800 --> 03:24:50,240 FRESH MASK. 5660 03:24:50,240 --> 03:24:52,000 SO IT GIVES YOU A SONS THAT SOME 5661 03:24:52,000 --> 03:24:54,960 PEOPLE ARE EXTREMELY STILL 5662 03:24:54,960 --> 03:24:57,080 CONCERNED ABOUT THAT. 5663 03:24:57,080 --> 03:24:58,560 SO YOU CAN ALWAYS THINK OF A 5664 03:24:58,560 --> 03:25:00,840 NUMBER OF WAYS THAT MIGHT EFFECT 5665 03:25:00,840 --> 03:25:01,480 PEOPLE'S ENGAGEMENT WITH HEALTH 5666 03:25:01,480 --> 03:25:05,600 CARE SYSTEMS AND NEW PROJECTS. 5667 03:25:05,600 --> 03:25:06,440 >>MODERATOR: DR. TATIANA 5668 03:25:06,440 --> 03:25:07,240 VIDAURRE LAST WORD ON THIS 5669 03:25:07,240 --> 03:25:08,520 QUESTION AND WE'LL WRAP UP. 5670 03:25:08,520 --> 03:25:12,360 >>TATIANA VIDAURRE: I THINK THE 5671 03:25:12,360 --> 03:25:13,920 PANDEMIC MISINFORMATION ABOUT 5672 03:25:13,920 --> 03:25:17,520 THIS INTERVENTION, COVID-19 5673 03:25:17,520 --> 03:25:22,240 PANDEMIC, I THINK NOT ONLY 5674 03:25:22,240 --> 03:25:24,360 SERVED AS -- ONCOLOGY SERVICES 5675 03:25:24,360 --> 03:25:27,160 IN PERU IN OUR COUNTRY WE THIS 5676 03:25:27,160 --> 03:25:29,200 THAT EXCESSIVE MORTALITY IN THE 5677 03:25:29,200 --> 03:25:32,240 FIRST OF PANDEMIC. 5678 03:25:32,240 --> 03:25:37,160 IN PERU THE HIGH MORTALITY IT 5679 03:25:37,160 --> 03:25:42,680 WAS BY CLOSING THE ONCOLOGY 5680 03:25:42,680 --> 03:25:43,280 CLOSED AND SECOND LEVEL. 5681 03:25:43,280 --> 03:25:46,520 WE HAD ONLY OPENED EMERGENCY 5682 03:25:46,520 --> 03:25:49,960 ROOM. 5683 03:25:49,960 --> 03:25:55,280 THAT IS WHY IN THE INSTITUTE, WE 5684 03:25:55,280 --> 03:25:56,600 SAY -- ONCOLOGY PATIENTS. 5685 03:25:56,600 --> 03:25:59,280 AT THE INSTITUTE WE KEEP THE 5686 03:25:59,280 --> 03:26:01,200 RESEARCH CONTINUING BUT IN THE 5687 03:26:01,200 --> 03:26:04,600 REST OF THE COUNTRY WAS SO HARD. 5688 03:26:04,600 --> 03:26:08,040 I THINK THAT IS IMPORTANT TO 5689 03:26:08,040 --> 03:26:13,520 ADDRESS FOR ANOTHER TIME THAT WE 5690 03:26:13,520 --> 03:26:17,200 KEEP IN DIFFICULT SITUATION 5691 03:26:17,200 --> 03:26:17,960 BECAUSE CANCER RESEARCH KEEP 5692 03:26:17,960 --> 03:26:23,080 GOING BECAUSE WE HAVE TO PROCESS 5693 03:26:23,080 --> 03:26:25,680 THE COMPLIANCE AND THAT IS 5694 03:26:25,680 --> 03:26:28,320 IMPORTANT TO FOLLOW-UP WITH THE 5695 03:26:28,320 --> 03:26:30,360 TRAINING PEOPLE BECAUSE WE CAN'T 5696 03:26:30,360 --> 03:26:33,240 GIVE ANOTHER OPPORTUNITIES 5697 03:26:33,240 --> 03:26:35,400 INCLUSIVE IN THESE DIFFICULT 5698 03:26:35,400 --> 03:26:35,640 MOMENTS. 5699 03:26:35,640 --> 03:26:36,240 >>MODERATOR: THANK YOU VERY 5700 03:26:36,240 --> 03:26:36,440 MUCH. 5701 03:26:36,440 --> 03:26:38,600 AND WE ARE AT TIME. 5702 03:26:38,600 --> 03:26:44,320 THANK YOU AGAIN TO YOU ALL. 5703 03:26:44,320 --> 03:26:46,880 FOR THIS INTRIGUING 5704 03:26:46,880 --> 03:26:47,560 THOUGHT-PROVOKING DISCUSSION AND 5705 03:26:47,560 --> 03:26:49,480 THE AUDIENCE FOR YOUR QUESTIONS. 5706 03:26:49,480 --> 03:26:52,320 NEXT IS OUR LUNCH BREAK. 5707 03:26:52,320 --> 03:26:55,560 PLEASE RETURN AT OR BEFORE 5708 03:26:55,560 --> 03:26:56,240 1:05 P.M. EASTERN STANDARD TIME 5709 03:26:56,240 --> 03:26:57,520 FOR THE NEXT PORTION OF THIS 5710 03:26:57,520 --> 03:26:58,920 UNIQUE WORKSHOP. 5711 03:26:58,920 --> 03:27:06,400 OUR NEXT SESSION IS ON PUBLIC 5712 03:27:06,400 --> 03:27:07,360 POLICIES AND WILL BE MODERATED 5713 03:27:07,360 --> 03:27:12,000 BY DR.-- SEE YOU THEN. 5714 03:27:12,000 --> 03:27:13,760 >>WELCOME BACK, OUR NEXT 5715 03:27:13,760 --> 03:27:21,400 SECTION IS PUBLIC POLICIES 5716 03:27:21,400 --> 03:27:25,680 MODERATEDDED BY DR. CAROLINA 5717 03:27:25,680 --> 03:27:26,080 SANABRIA. 5718 03:27:26,080 --> 03:27:27,760 >>HELLO, I'M A PROGRAM OFFICIAL 5719 03:27:27,760 --> 03:27:29,280 HERE AT NIMHD AND TODAY I HAVE 5720 03:27:29,280 --> 03:27:32,120 THE PLEASURE OF BEING YOUR 5721 03:27:32,120 --> 03:27:36,960 MODERATOR FOR THE SESSION ON 5722 03:27:36,960 --> 03:27:39,240 PUBLIC POLICIES. 5723 03:27:39,240 --> 03:27:41,480 WE HAVE THREE PRESENTATIONS, DR. 5724 03:27:41,480 --> 03:27:42,960 CHRISTINA PETTIAN-BREWER FROM 5725 03:27:42,960 --> 03:27:47,880 UNIVERSITY OF WASHINGTON, DR. 5726 03:27:47,880 --> 03:27:54,440 CLAUDIA BAMBS FROM CHILE, AND 5727 03:27:54,440 --> 03:27:56,560 DR. MERIKE BLOFIELD FROM GERMAN 5728 03:27:56,560 --> 03:27:58,360 INSTITUTE FOR GLOBAL AND AREA 5729 03:27:58,360 --> 03:28:01,000 STUDIES, FOLLOWED BY A TIME FOR 5730 03:28:01,000 --> 03:28:03,360 Q&A, AND WITHOUT FURTHER ADO LET 5731 03:28:03,360 --> 03:28:05,800 US GET STARTED. 5732 03:28:05,800 --> 03:28:07,600 5733 03:28:07,600 --> 03:28:08,240 >>HELLO, EVERYBODY. 5734 03:28:08,240 --> 03:28:10,440 IT'S A GREAT PLEASURE TO BE HERE 5735 03:28:10,440 --> 03:28:13,480 WITH ALL OF YOU TODAY TO SHARE 5736 03:28:13,480 --> 03:28:17,600 OUR EXPERIENCES FOR A HEALTHIER 5737 03:28:17,600 --> 03:28:21,840 PLANET AND WORLD FOR ALL. 5738 03:28:21,840 --> 03:28:23,120 I'M FREIGHTFUL TO BE HERE WITH 5739 03:28:23,120 --> 03:28:30,560 YOU FOR THIS WORKSHOP AS WELL AS 5740 03:28:30,560 --> 03:28:35,840 THANK YOU TO THE ORGANIZERS FOR 5741 03:28:35,840 --> 03:28:37,800 THE WORKSHOP. 5742 03:28:37,800 --> 03:28:39,720 I'M A VETERINARIAN, WHAT IS 5743 03:28:39,720 --> 03:28:41,800 VETERINARIAN DOING HERE TODAY? 5744 03:28:41,800 --> 03:28:45,920 AGAIN, IT IS JUST TO SHARE OR 5745 03:28:45,920 --> 03:28:47,360 EXPERIENCE AS VETERINARIANS AND 5746 03:28:47,360 --> 03:28:49,320 OTHER HEALTH PROFESSIONALS HOW 5747 03:28:49,320 --> 03:28:51,960 WE CAN WORK TOGETHER FOR A 5748 03:28:51,960 --> 03:28:53,920 HEALTHIER PLANET, AND HUMAN 5749 03:28:53,920 --> 03:28:56,960 HEALTH AS WELL. 5750 03:28:56,960 --> 03:28:58,840 PARTICULARLY, FOR CONTROL AND 5751 03:28:58,840 --> 03:29:00,920 PREVENTION OF THE NEXT 5752 03:29:00,920 --> 03:29:01,480 PANDEMICS. 5753 03:29:01,480 --> 03:29:03,760 I'M GRADUATED FROM BRAZIL, AND I 5754 03:29:03,760 --> 03:29:05,600 HAVE BEEN HERE FOR 32 YEARS IN 5755 03:29:05,600 --> 03:29:09,000 THE UNITED STATES WORKING WITH 5756 03:29:09,000 --> 03:29:13,480 INTERNATIONAL WORK IN LATIN 5757 03:29:13,480 --> 03:29:15,480 AMERICA. 5758 03:29:15,480 --> 03:29:19,520 MY EXPERIENCE ALSO I HAVE BEEN 5759 03:29:19,520 --> 03:29:24,880 TRAINED AT U.C. DAVIS AND CDC, 5760 03:29:24,880 --> 03:29:29,040 AND MADISON, NOW TODAY AN 5761 03:29:29,040 --> 03:29:31,000 ASSOCIATE PROFESSOR, SENIOR 5762 03:29:31,000 --> 03:29:31,520 RESEARCHER, WORKING AT THE 5763 03:29:31,520 --> 03:29:34,520 SCHOOL OF MEDICINE HERE AT THE 5764 03:29:34,520 --> 03:29:42,280 UNIVERSITY OF WASHINGTON IN 5765 03:29:42,280 --> 03:29:42,960 SEATTLE. 5766 03:29:42,960 --> 03:29:43,720 MY EXPERIENCE WITH HUMAN 5767 03:29:43,720 --> 03:29:45,680 MEDICINE SINCE I WAS A 5768 03:29:45,680 --> 03:29:47,880 VETERINARY STUDENT FOR OUTREACH 5769 03:29:47,880 --> 03:29:50,480 PROGRAMS IN RURAL COMMUNITIES, 5770 03:29:50,480 --> 03:29:51,400 IN BRAZIL. 5771 03:29:51,400 --> 03:29:54,320 I WILL SHARE TODAY THE HISTORY 5772 03:29:54,320 --> 03:29:57,600 AND NEW PARADIGM FOR ONE HEALTH, 5773 03:29:57,600 --> 03:29:59,680 AND IT IS THE ONE HEALTH 5774 03:29:59,680 --> 03:29:59,920 CONCEPT. 5775 03:29:59,920 --> 03:30:02,480 THE ONE HEALTH CONCEPT IS NOT 5776 03:30:02,480 --> 03:30:02,640 NEW. 5777 03:30:02,640 --> 03:30:05,720 AND AS A MATTER OF FACT IT CAME 5778 03:30:05,720 --> 03:30:08,640 FROM AIRS, WATER AND PLACES, A 5779 03:30:08,640 --> 03:30:10,200 BOOK BY HIPPOCRATES. 5780 03:30:10,200 --> 03:30:11,760 ALSO THE IMPORTANCE OF THE 5781 03:30:11,760 --> 03:30:16,240 CONNECTION OF ONE HEALTH WITH 5782 03:30:16,240 --> 03:30:17,240 INDIGENOUS COMMUNITIES AND 5783 03:30:17,240 --> 03:30:21,600 TRADITIONS IN CULTURE, SINCE THE 5784 03:30:21,600 --> 03:30:22,400 ANCIENT CIVILIZATIONS TO 5785 03:30:22,400 --> 03:30:27,080 NOWADAYS, WE DO HAVE TO LEARN A 5786 03:30:27,080 --> 03:30:29,520 LOT, ESPECIALLY THE ONE HEALTH 5787 03:30:29,520 --> 03:30:31,680 CONCEPT THROUGH INDIGENOUS 5788 03:30:31,680 --> 03:30:32,080 POPULATIONS. 5789 03:30:32,080 --> 03:30:33,680 I MENTIONED THE BOOK, I ALREADY 5790 03:30:33,680 --> 03:30:35,960 MENTIONED THE IMPORTANCE OF THE 5791 03:30:35,960 --> 03:30:44,160 ENVIRONMENT TO THE HUMAN HEALTH. 5792 03:30:44,160 --> 03:30:44,880 ARISTOTLE AND THE ITALIAN 5793 03:30:44,880 --> 03:30:45,720 BROUGHT IMPORTANCE OF THE 5794 03:30:45,720 --> 03:30:47,160 ENVIRONMENT, HOW IT WAS 5795 03:30:47,160 --> 03:30:49,160 IMPORTANT OVER THE DEVELOPMENT 5796 03:30:49,160 --> 03:30:50,520 OF DISEASES. 5797 03:30:50,520 --> 03:30:57,880 IN THE 19th CENTURY, TWO 5798 03:30:57,880 --> 03:31:00,400 PHYSICIANS INCLUDING THE 5799 03:31:00,400 --> 03:31:06,800 CANADIAN WILLIAM OSLER SHARED 5800 03:31:06,800 --> 03:31:11,440 ASPECTS OF ONE HEALTH. 5801 03:31:11,440 --> 03:31:13,400 IN 20th CENTURY, AN 'EM 5802 03:31:13,400 --> 03:31:14,160 DEEMOLOGYIST FROM UC-DAVIS 5803 03:31:14,160 --> 03:31:16,480 BROUGHT BACK THIS ONE HEALTH, 5804 03:31:16,480 --> 03:31:23,040 ONE MEDICINE, THE TERM ONE 5805 03:31:23,040 --> 03:31:25,880 HEALTH WAS COINED BETWEEN 5806 03:31:25,880 --> 03:31:28,400 2004-2007, A GLOBAL EFFORT FROM 5807 03:31:28,400 --> 03:31:32,440 OTHER COUNTRIES WORKING TOGETHER 5808 03:31:32,440 --> 03:31:35,080 FOR THIS CONCEPT AND 5809 03:31:35,080 --> 03:31:35,640 IMPLEMENTATION. 5810 03:31:35,640 --> 03:31:38,360 IN LATIN AMERICA, IT'S IMPORTANT 5811 03:31:38,360 --> 03:31:42,960 THAT ALSO AGRICULTURE, ANCIENT 5812 03:31:42,960 --> 03:31:44,200 CIVILIZATIONS AND INDIGENOUS HAS 5813 03:31:44,200 --> 03:31:45,720 BEEN PART OF THE HISTORY OF ONE 5814 03:31:45,720 --> 03:31:48,200 HEALTH IN THE WORLD AS WELL. 5815 03:31:48,200 --> 03:31:49,840 THE DEFINITION IS THE 5816 03:31:49,840 --> 03:31:53,160 COLLABORATIVE EFFORT OF MULTIPLE 5817 03:31:53,160 --> 03:31:55,640 DISCIPLINES WORKING LOCALLY, 5818 03:31:55,640 --> 03:31:58,720 NATIONAL, GLOBALLY, TO ATTAIN 5819 03:31:58,720 --> 03:32:02,560 OPTIMAL HEALTH FOR HUMANS, 5820 03:32:02,560 --> 03:32:03,840 ANIMALS, AND OUR ENVIRONMENT, 5821 03:32:03,840 --> 03:32:06,600 2008, JUST NOW THIS YEAR PLANTS 5822 03:32:06,600 --> 03:32:10,440 HAVE BEEN ADDED AS THE FOURTH 5823 03:32:10,440 --> 03:32:16,000 PILLAR OF THE ONE HEALTH 5824 03:32:16,000 --> 03:32:16,240 CONCEPT. 5825 03:32:16,240 --> 03:32:18,400 THERE ARE A LOT OF ORGANIZATIONS 5826 03:32:18,400 --> 03:32:21,320 AND COMMISSIONS OPEN FOR US TO 5827 03:32:21,320 --> 03:32:24,520 JOIN TOGETHER, INCLUDING 5828 03:32:24,520 --> 03:32:25,760 EMBASSIES AND GOVERNMENT 5829 03:32:25,760 --> 03:32:26,080 ASSOCIATIONS. 5830 03:32:26,080 --> 03:32:28,160 THIS WEEK WE'RE CELEBRATING THE 5831 03:32:28,160 --> 03:32:32,400 ONE HEALTH DAY ON NOVEMBER 3. 5832 03:32:32,400 --> 03:32:33,720 THIS WAS VERY IMPORTANT TO 5833 03:32:33,720 --> 03:32:34,960 DESCRIBE THE ONE HEALTH CONCEPT, 5834 03:32:34,960 --> 03:32:39,880 YOU CAN SEE HOW THE DISCIPLINE 5835 03:32:39,880 --> 03:32:40,680 IS INTRINSICALLY INTERCONNECTED, 5836 03:32:40,680 --> 03:32:51,200 BUT MOST IMPORTANT COMING FROM 5837 03:32:52,920 --> 03:32:56,120 THE EGO TO ECO PERSPECTIVE TO 5838 03:32:56,120 --> 03:32:57,960 WORK DIRECTLY WITH COMMUNITIES 5839 03:32:57,960 --> 03:32:59,560 BY ONE HEALTH APPROACHES. 5840 03:32:59,560 --> 03:33:02,680 YOU WILL HEAR DIFFERENT TERMS AS 5841 03:33:02,680 --> 03:33:04,560 ONE HEALTH, ECO-HEALTH, 5842 03:33:04,560 --> 03:33:06,320 PLANETARY HEALTH, ONE WELFARE, 5843 03:33:06,320 --> 03:33:07,520 DEPENDS WHICH VISION, WHICH 5844 03:33:07,520 --> 03:33:10,040 APPROACH YOU'RE COMING FROM, BUT 5845 03:33:10,040 --> 03:33:12,040 BASICALLY THE INTENTION IS THE 5846 03:33:12,040 --> 03:33:12,360 SAME. 5847 03:33:12,360 --> 03:33:14,880 SOMETIMES I EVEN JOKE SO WE 5848 03:33:14,880 --> 03:33:16,680 DON'T SEPARATE OURSELVES AGAIN, 5849 03:33:16,680 --> 03:33:20,360 WHY NOT CREATE AN INTERGALACTIC 5850 03:33:20,360 --> 03:33:22,240 ONE HEALTH SINCE NOW WE'RE IN 5851 03:33:22,240 --> 03:33:22,560 SPACE. 5852 03:33:22,560 --> 03:33:23,720 THERE ARE DIFFERENT APPROACHES 5853 03:33:23,720 --> 03:33:25,920 AS EXAMPLES, WE DO HAVE TO KNOW 5854 03:33:25,920 --> 03:33:29,360 WHAT IS AND WHAT IS NOT ONE 5855 03:33:29,360 --> 03:33:29,760 HEALTH. 5856 03:33:29,760 --> 03:33:31,120 KNOW AND UNDERSTAND THE CONCEPT. 5857 03:33:31,120 --> 03:33:33,840 IN ONE OF THEM IT IS PUBLIC 5858 03:33:33,840 --> 03:33:35,040 HEALTH POLICY AND REGULATION AS 5859 03:33:35,040 --> 03:33:37,680 WE'RE GOING TO DISCUSS TODAY. 5860 03:33:37,680 --> 03:33:41,400 THIS ARTICLE IS VERY GOOD TO 5861 03:33:41,400 --> 03:33:43,920 EXPLAIN IN LATIN AMERICA ONE 5862 03:33:43,920 --> 03:33:46,240 HEALTH CAME MORE FROM GRASS 5863 03:33:46,240 --> 03:33:48,280 ROOTS MOVEMENTS FROM THE ACTIONS 5864 03:33:48,280 --> 03:33:49,600 TO THE CONCEPT. 5865 03:33:49,600 --> 03:33:51,240 WE'RE STILL DEVELOPING AND 5866 03:33:51,240 --> 03:33:55,080 TRYING TO UNDERSTAND THE 5867 03:33:55,080 --> 03:33:55,280 CONCEPT. 5868 03:33:55,280 --> 03:33:57,280 SINCE 2007 AND 2019 ONE HEALTH 5869 03:33:57,280 --> 03:33:59,880 HAS BEEN IMPLEMENTED IN BRAZIL 5870 03:33:59,880 --> 03:34:03,160 AND LATIN AMERICA, IN 2012 I 5871 03:34:03,160 --> 03:34:06,240 RECEIVED A FULBRIGHT AWARD, 5872 03:34:06,240 --> 03:34:07,960 STARTED BUILDING TOGETHER WITH 5873 03:34:07,960 --> 03:34:09,600 PERSONS IN LATIN AMERICAN 5874 03:34:09,600 --> 03:34:16,320 COMMUNITIES THAT CENTERS FOR ONE 5875 03:34:16,320 --> 03:34:18,680 HEALTH RESEARCH AND STUDIES. 5876 03:34:18,680 --> 03:34:19,680 EXAMPLE OF ACCOMPLISHMENTS OF 5877 03:34:19,680 --> 03:34:21,280 ONE HEALTH CENTERS OF EXCELLENCE 5878 03:34:21,280 --> 03:34:25,240 IN BRAZIL AND LATIN AMERICA 5879 03:34:25,240 --> 03:34:33,800 SINCE 2012 AND THEREFORE ONE 5880 03:34:33,800 --> 03:34:36,760 HEALTH ACTIONS IN MATO GROSSO, I 5881 03:34:36,760 --> 03:34:44,560 HAVES CAL -- VISCERAL, THROUGH 5882 03:34:44,560 --> 03:34:46,520 THE SCHOOL OF VETERINARY 5883 03:34:46,520 --> 03:34:47,480 MEDICINE, PROFESSOR AND 5884 03:34:47,480 --> 03:34:50,760 RESEARCHER GOING TO COMMUNITIES 5885 03:34:50,760 --> 03:34:52,400 WITH THIS INTERDISCIPLINARY TEAM 5886 03:34:52,400 --> 03:34:55,440 OF STUDENTS OF DIFFERENT 5887 03:34:55,440 --> 03:34:56,120 BACKGROUNDS, DIFFERENT 5888 03:34:56,120 --> 03:34:57,000 DISCIPLINES. 5889 03:34:57,000 --> 03:35:00,920 AS WE CAN SEE, THIS HAPPENED IN 5890 03:35:00,920 --> 03:35:03,040 2015, AND ONLY NOW, NEXT WEEK IN 5891 03:35:03,040 --> 03:35:05,120 BRAZIL, WE'LL HAVE ONE HEALTH 5892 03:35:05,120 --> 03:35:07,640 WORKSHOP WITH MINISTRY OF 5893 03:35:07,640 --> 03:35:08,200 HEALTH. 5894 03:35:08,200 --> 03:35:10,000 SO, THE IMPLEMENTATION IS 5895 03:35:10,000 --> 03:35:11,440 ALREADY HAPPENING THROUGH 5896 03:35:11,440 --> 03:35:14,960 ACTIONS, BUT THE POLICIES ARE 5897 03:35:14,960 --> 03:35:23,480 STILL NOT READY YET. 5898 03:35:23,480 --> 03:35:26,240 ANOTHER EXAMPLE OF ANOTHER 5899 03:35:26,240 --> 03:35:34,120 ACCOMPLISHMENT IN COLOMBIA AND 5900 03:35:34,120 --> 03:35:36,080 BOLIVIA WITH RIVER COMMUNITIES, 5901 03:35:36,080 --> 03:35:37,920 BRING ENVIRONMENTAL EDUCATION 5902 03:35:37,920 --> 03:35:42,000 AND BIODIVERSITY THROUGH THE 5903 03:35:42,000 --> 03:35:42,520 COMMUNITIES. 5904 03:35:42,520 --> 03:35:45,600 NOT ONLY IN COLOMBIA BUT CHILE 5905 03:35:45,600 --> 03:35:46,720 AND PERU. 5906 03:35:46,720 --> 03:35:47,800 GOING THROUGH THE HIGHER 5907 03:35:47,800 --> 03:35:49,560 EDUCATION AT THE UNIVERSITY AND 5908 03:35:49,560 --> 03:35:50,640 RESEARCH LEVELS, THERE ARE 5909 03:35:50,640 --> 03:35:52,960 CENTERS OF EXCELLENCE OF ONE 5910 03:35:52,960 --> 03:35:56,560 HEALTH THAT UNITED AND MADE 5911 03:35:56,560 --> 03:36:00,240 MULTI-CENTRIC RESEARCH, IN THIS 5912 03:36:00,240 --> 03:36:01,960 CASE FOR COVID IMPACTS, AND IT 5913 03:36:01,960 --> 03:36:05,240 HAS BEEN PUBLISHED AS WELL FOR 5914 03:36:05,240 --> 03:36:07,960 THE IMPORTANCE OF ANIMALS IN THE 5915 03:36:07,960 --> 03:36:10,880 COVID PANDEMIC. 5916 03:36:10,880 --> 03:36:14,760 OTHER EXAMPLES, IN THE CENTER OF 5917 03:36:14,760 --> 03:36:16,600 EXCELLENCE WHICH THERE'S HUMAN 5918 03:36:16,600 --> 03:36:17,600 MEDICINE AND HUMAN HEALTH AND 5919 03:36:17,600 --> 03:36:19,760 HUMAN METRICS, AT THE SAME TIME 5920 03:36:19,760 --> 03:36:22,320 THEY ARE STUDYING THE 5921 03:36:22,320 --> 03:36:24,520 ENVIRONMENT AND PATH, ALSO 5922 03:36:24,520 --> 03:36:26,040 ANOTHER EXAMPLE, ANOTHER 5923 03:36:26,040 --> 03:36:30,840 SUCCESSFUL CENTER OF EXCELLENCE 5924 03:36:30,840 --> 03:36:32,640 WITH INDIGENOUS POPULATIONS 5925 03:36:32,640 --> 03:36:34,600 COLLECTING SAMPLES, WORKING IN 5926 03:36:34,600 --> 03:36:36,680 EDUCATION, AND WORKING TOGETHER 5927 03:36:36,680 --> 03:36:38,760 WITH THE COMMUNITY TO PREVENT 5928 03:36:38,760 --> 03:36:41,800 AND BRING SHALL HEALTH TO HUMAN 5929 03:36:41,800 --> 03:36:43,040 MEDICINE, ANIMAL MEDICINE, AND 5930 03:36:43,040 --> 03:36:43,920 THE ENVIRONMENT. 5931 03:36:43,920 --> 03:36:45,640 VERY IMPORTANT FOR US TO DISCUSS 5932 03:36:45,640 --> 03:36:48,320 THE CENTERS OF EXCELLENCE OF ONE 5933 03:36:48,320 --> 03:36:49,560 HEALTH IN THE AMAZON. 5934 03:36:49,560 --> 03:36:53,840 AS WE KNOW, THE MINING AND OTHER 5935 03:36:53,840 --> 03:36:57,440 CAUSES ARE DESTROYING THE AMAZON 5936 03:36:57,440 --> 03:36:59,440 FOREST, AND ALSO ALL THIS 5937 03:36:59,440 --> 03:37:01,080 DISTURBANCE OF THE ENVIRONMENT, 5938 03:37:01,080 --> 03:37:04,440 HOW IT'S AFFECTING OUR OWN 5939 03:37:04,440 --> 03:37:05,240 INDIGENOUS COMMUNITIES. 5940 03:37:05,240 --> 03:37:07,000 WE WORK DIRECTLY WITH THE 5941 03:37:07,000 --> 03:37:10,080 INDIGENOUS CENTERS, IN THIS CASE 5942 03:37:10,080 --> 03:37:11,280 WE'RE LEARNING FROM THE 5943 03:37:11,280 --> 03:37:14,000 INDIGENOUS MEDICINE HOW THAT CAN 5944 03:37:14,000 --> 03:37:15,400 BE BROUGHT TO POPULATION HEALTH. 5945 03:37:15,400 --> 03:37:18,120 LET'S DISCUSS A LITTLE BIT OF 5946 03:37:18,120 --> 03:37:19,120 SOCIAL AND ENVIRONMENTAL 5947 03:37:19,120 --> 03:37:20,720 DETERMINANTS OF HEALTH AND 5948 03:37:20,720 --> 03:37:24,600 IMPORTANCE OF PUBLIC POLICIES. 5949 03:37:24,600 --> 03:37:29,560 THE IMPACT OF CLIMATE CHANGE IN 5950 03:37:29,560 --> 03:37:31,400 HUMAN HEALTH IS VERY IMPORTANT. 5951 03:37:31,400 --> 03:37:33,600 ONE EXAMPLE OF CLIMATE CHANGE ON 5952 03:37:33,600 --> 03:37:35,120 HUMAN HEALTH AND ANIMAL HEALTH 5953 03:37:35,120 --> 03:37:38,240 FOR INSTANCE CHRONIC DISEASES 5954 03:37:38,240 --> 03:37:41,680 SUCH AS CARDIOVASCULAR DISEASES 5955 03:37:41,680 --> 03:37:44,440 AND OBESITY IS A DISEASE OF THE 5956 03:37:44,440 --> 03:37:45,160 ENVIRONMENT. 5957 03:37:45,160 --> 03:37:49,880 AND ALSO IN THIS ASPECT, HOW 5958 03:37:49,880 --> 03:37:53,320 IMPORTANT THE SOCIAL EQUITY TO 5959 03:37:53,320 --> 03:37:56,080 PREVENT THESE DISEASES THAT WILL 5960 03:37:56,080 --> 03:37:59,120 BE AFFECTED, SO VULNERABLE 5961 03:37:59,120 --> 03:38:03,080 POPULATIONS HAVE MORE FOR 5962 03:38:03,080 --> 03:38:03,760 INSTANCE CARDIOVASCULAR DISEASES 5963 03:38:03,760 --> 03:38:06,800 AS CHRONIC -- EXAMPLE OF CHRONIC 5964 03:38:06,800 --> 03:38:07,040 DISEASES. 5965 03:38:07,040 --> 03:38:11,640 LET'S GO TO THE POLICIES. 5966 03:38:11,640 --> 03:38:14,440 THE UNIFIED HEALTH SYSTEM OF 5967 03:38:14,440 --> 03:38:17,200 BRAZIL HAS BEEN CREATED SINCE 5968 03:38:17,200 --> 03:38:22,160 1988, AND, AGAIN, IT'S A FREE 5969 03:38:22,160 --> 03:38:24,120 ACCESS TO ALL, CONSULTATIONS, 5970 03:38:24,120 --> 03:38:26,920 SURGERIES, EMERGENCY AS WELL, 5971 03:38:26,920 --> 03:38:28,920 VACCINATIONS, CAMPAIGNS, AND 5972 03:38:28,920 --> 03:38:30,360 ORGAN DONATIONS AND TRANSPLANTS, 5973 03:38:30,360 --> 03:38:33,120 ALL FREE. 5974 03:38:33,120 --> 03:38:34,840 OF COURSE, THIS HAPPENED EVEN IN 5975 03:38:34,840 --> 03:38:39,000 THE CONCEPT OF ONE HEALTH WAS 5976 03:38:39,000 --> 03:38:42,400 ESTABLISHED AS WE CAN SHARE 5977 03:38:42,400 --> 03:38:47,240 ACTIONS COMING BEFORE 5978 03:38:47,240 --> 03:38:48,040 IMPLEMENTATION OF POLICIES, BUT 5979 03:38:48,040 --> 03:38:50,400 THIS IS A VERY IMPORTANT POLICY 5980 03:38:50,400 --> 03:38:54,480 IN BRAZIL, AND YOU CAN READ IN 5981 03:38:54,480 --> 03:38:55,880 DETAIL THE UNIFIED HEALTH SYSTEM 5982 03:38:55,880 --> 03:39:00,040 EXAMPLE OF ONE HEALTH APPROACH 5983 03:39:00,040 --> 03:39:01,240 IN BRAZIL. 5984 03:39:01,240 --> 03:39:04,200 TWENTY YEARS LATER, OR JUST NOW 5985 03:39:04,200 --> 03:39:07,880 LAST WEEK IN BERLIN, THROUGH THE 5986 03:39:07,880 --> 03:39:10,360 WORLD HEALTH SUMMIT, THE FIRST 5987 03:39:10,360 --> 03:39:18,440 POLICY WAS MADE THROUGH THE 5988 03:39:18,440 --> 03:39:20,200 WORLD -- QUADRIPARTITE 5989 03:39:20,200 --> 03:39:21,640 ORGANIZATION, WORKING FOR 5990 03:39:21,640 --> 03:39:22,640 HUMANS, PLANTS, THE ENVIRONMENT. 5991 03:39:22,640 --> 03:39:25,680 THERE ARE A LOT OF CHALLENGES IN 5992 03:39:25,680 --> 03:39:27,720 IMPLEMENTATION OF ONE HEALTH AS 5993 03:39:27,720 --> 03:39:33,120 WELL AS RESEARCH FINDINGS INTO 5994 03:39:33,120 --> 03:39:34,640 POLICY, EXCESSIVE BUREAUCRACY, 5995 03:39:34,640 --> 03:39:36,960 COULD BE POLITICS, POWER AT THE 5996 03:39:36,960 --> 03:39:39,040 TOP, COULD BE POLITICS IN THEIR 5997 03:39:39,040 --> 03:39:40,360 EXTREMES, WE CAN GO FURTHER IN 5998 03:39:40,360 --> 03:39:40,960 THE DISCUSSION. 5999 03:39:40,960 --> 03:39:42,840 IT IS VERY IMPORTANT AND I 6000 03:39:42,840 --> 03:39:44,800 INVITE ALL OF YOU, OUR 6001 03:39:44,800 --> 03:39:46,800 COLLEAGUES FROM MEDICINE AND 6002 03:39:46,800 --> 03:39:48,800 PHYSICIANS, TO PLEASE JOIN US ON 6003 03:39:48,800 --> 03:39:50,840 THE GROUPS THAT ARE FORMED FOR 6004 03:39:50,840 --> 03:39:52,760 INSTANCE THIS ONE ALLIANCE 6005 03:39:52,760 --> 03:39:57,280 AGAINST HEALTH RISKS IN THE 6006 03:39:57,280 --> 03:39:57,880 WILDLIFE TRADE. 6007 03:39:57,880 --> 03:40:01,880 ALSO PUBLICATION IS VERY 6008 03:40:01,880 --> 03:40:04,760 IMPORTANT, SO MANUSCRIPT, WORK, 6009 03:40:04,760 --> 03:40:05,720 COLLABORATE, COOPERATE, LET'S 6010 03:40:05,720 --> 03:40:10,720 MAKE PARTNERSHIPS SO WE CAN 6011 03:40:10,720 --> 03:40:12,400 SHARE AND BRING OUR KNOWLEDGE 6012 03:40:12,400 --> 03:40:17,720 AND OUR EXPERIENCE FOR A 6013 03:40:17,720 --> 03:40:20,240 SUSTAINABLE PLANET. 6014 03:40:20,240 --> 03:40:21,760 WITH SUSTAINABLE GOALS, THE 6015 03:40:21,760 --> 03:40:25,240 PEACE AND THE WAR ALWAYS BRING 6016 03:40:25,240 --> 03:40:27,320 MORE DISEASES AND INEQUALITY TO 6017 03:40:27,320 --> 03:40:28,960 HUMAN HEALTH, AND TO THE 6018 03:40:28,960 --> 03:40:29,640 ENVIRONMENT. 6019 03:40:29,640 --> 03:40:36,720 IT'S VERY IMPORTANT THAT WE WORK 6020 03:40:36,720 --> 03:40:38,360 TOGETHER AS PARTNERS TO BRING 6021 03:40:38,360 --> 03:40:39,480 SUSTAINABLE GOALS. 6022 03:40:39,480 --> 03:40:41,880 ONE HEALTH BRAZIL WORKS WITH 6023 03:40:41,880 --> 03:40:45,800 OVER 800 MEMBERS, AS YOU CAN SEE 6024 03:40:45,800 --> 03:40:48,440 THERE ARE ALL THESE PROJECTS OF 6025 03:40:48,440 --> 03:40:54,920 ONE HEALTH ACTION GOING ON IN 6026 03:40:54,920 --> 03:40:55,160 BRAZIL. 6027 03:40:55,160 --> 03:41:05,680 IMPLEMENTATION OF POLICIES IS 6028 03:41:06,880 --> 03:41:07,880 STILL UNDER PROCESS. 6029 03:41:07,880 --> 03:41:09,840 IT'S IMPORTANT POLICIES MUST BE 6030 03:41:09,840 --> 03:41:10,600 MADE AND IMPLEMENTED 6031 03:41:10,600 --> 03:41:10,920 IMMEDIATELY. 6032 03:41:10,920 --> 03:41:12,000 THANK YOU VERY MUCH. 6033 03:41:12,000 --> 03:41:14,520 I'M VERY GRATEFUL TO BE HERE AND 6034 03:41:14,520 --> 03:41:15,640 LOOKING FORWARD TO DISCUSS 6035 03:41:15,640 --> 03:41:18,800 FURTHER WITH ALL OF YOU. 6036 03:41:18,800 --> 03:41:24,880 6037 03:41:24,880 --> 03:41:27,360 6038 03:41:27,360 --> 03:41:29,880 6039 03:41:29,880 --> 03:41:32,080 6040 03:41:32,080 --> 03:41:34,480 >>THIS IS CLAUDIA BAMBS, FROM 6041 03:41:34,480 --> 03:41:35,360 CHILE. 6042 03:41:35,360 --> 03:41:37,680 PLEASED TO BE HERE. 6043 03:41:37,680 --> 03:41:40,720 TODAY I'M GOING TO TALK ABOUT 6044 03:41:40,720 --> 03:41:42,920 SCIENCE, SOCIETY, AND HEALTH 6045 03:41:42,920 --> 03:41:45,320 POLICIES TO TACKLE CHRONIC 6046 03:41:45,320 --> 03:41:46,760 DISEASES AND I WANT TO SHARE 6047 03:41:46,760 --> 03:41:49,360 WITH YOU SOME OF THE LESSONS 6048 03:41:49,360 --> 03:41:53,360 THAT WE HAVE LEARNED ABOUT THESE 6049 03:41:53,360 --> 03:41:57,800 POLICIES IN OUR COUNTRY. 6050 03:41:57,800 --> 03:42:03,640 AS OTHER COUNTRIES IN LATIN 6051 03:42:03,640 --> 03:42:06,800 AMERICA, CHILE EXPERIENCED RAPID 6052 03:42:06,800 --> 03:42:08,120 EPIDEMIOLOGIC TRANSITIONS, 6053 03:42:08,120 --> 03:42:11,480 DECREASING INFANT MORTALITY, 6054 03:42:11,480 --> 03:42:13,480 POPULATION AGING, AND CLEAR 6055 03:42:13,480 --> 03:42:16,720 SHIFT TOWARDS OBESITY AND 6056 03:42:16,720 --> 03:42:18,600 CHRONIC DISEASES. 6057 03:42:18,600 --> 03:42:22,120 WE ALREADY KNOW THE RISK FACTORS 6058 03:42:22,120 --> 03:42:24,960 BEHIND THESE EPIDEMICS. 6059 03:42:24,960 --> 03:42:27,240 TOBACCO, ALCOHOL, AND UNHEALTHY 6060 03:42:27,240 --> 03:42:30,880 DIET ARE THE MAIN RISK FACTORS 6061 03:42:30,880 --> 03:42:33,200 FOR THESE DISEASES. 6062 03:42:33,200 --> 03:42:36,200 THE ECONOMIC GROWTH IN CHILE HAS 6063 03:42:36,200 --> 03:42:38,080 LED TO LOW PHYSICAL ACTIVITY IN 6064 03:42:38,080 --> 03:42:44,320 GENERAL, AND A DIET THAT IS RICH 6065 03:42:44,320 --> 03:42:50,280 IN SATURATED FAT, SUGAR, SALT, 6066 03:42:50,280 --> 03:42:52,920 LOW IN FIBER. 6067 03:42:52,920 --> 03:42:55,960 IN 2019, THE ORGANIZATION FOR 6068 03:42:55,960 --> 03:42:58,800 ECONOMIC COOPERATION AND 6069 03:42:58,800 --> 03:43:01,960 DEVELOPMENT IDENTIFIED THE TOP 6070 03:43:01,960 --> 03:43:06,920 PUBLIC HEALTH CHALLENGES FOR OUR 6071 03:43:06,920 --> 03:43:07,240 COUNTRY. 6072 03:43:07,240 --> 03:43:11,920 AND THERE WERE THREE RISK 6073 03:43:11,920 --> 03:43:14,720 FACTORS THAT WERE IDENTIFIED. 6074 03:43:14,720 --> 03:43:16,440 FIRST OF ALL, SMOKING. 6075 03:43:16,440 --> 03:43:19,200 STILL VERY HIGH. 6076 03:43:19,200 --> 03:43:21,480 SECOND, ALCOHOL CONSUMPTION LOW 6077 03:43:21,480 --> 03:43:24,880 BUT RISING. 6078 03:43:24,880 --> 03:43:26,720 AND THIRD, OVERWEIGHT AND 6079 03:43:26,720 --> 03:43:32,200 OBESITY AMONG ADULTS AND 6080 03:43:32,200 --> 03:43:32,560 CHILDREN. 6081 03:43:32,560 --> 03:43:36,720 HERE YOU CAN SEE THE PREVALENCE 6082 03:43:36,720 --> 03:43:40,560 OF TOBACCO CONSUMPTION AMONG THE 6083 03:43:40,560 --> 03:43:42,080 GENERAL POPULATION IN CHILE, 6084 03:43:42,080 --> 03:43:47,800 ACCORDING TO OUR NATIONAL HEALTH 6085 03:43:47,800 --> 03:43:48,320 SURVEY. 6086 03:43:48,320 --> 03:43:52,480 ALTHOUGH WE CAN SEE DECREASING 6087 03:43:52,480 --> 03:43:56,200 TREND IN THIS PREVALENCE, STILL 6088 03:43:56,200 --> 03:44:00,040 1 IN 3 CHILEANS 15 YEARS OLD AND 6089 03:44:00,040 --> 03:44:03,320 ABOVE STILL SMOKES CIGARETTES. 6090 03:44:03,320 --> 03:44:07,680 WHICH IS VERY HIGH. 6091 03:44:07,680 --> 03:44:12,720 THERE WAS AN EFFECT THAT WAS 6092 03:44:12,720 --> 03:44:16,640 CALLED 2010 EARTHQUAKE EFFECT. 6093 03:44:16,640 --> 03:44:23,120 WE HAD AN IMPACT THAT WAS VERY 6094 03:44:23,120 --> 03:44:25,440 EVIDENT ON TOBACCO TAXATION DUE 6095 03:44:25,440 --> 03:44:34,440 TO THE URGENCY TO COLLECT FUNDS 6096 03:44:34,440 --> 03:44:35,920 TO REBUILD DEVASTATED AREAS. 6097 03:44:35,920 --> 03:44:41,080 THIS WAS ONE OF THE FACTORS WE 6098 03:44:41,080 --> 03:44:42,560 IDENTIFIED AS BEHIND THE 6099 03:44:42,560 --> 03:44:46,480 DECREASING TRENDS THAT WE ARE 6100 03:44:46,480 --> 03:44:50,240 SEEING NOW. 6101 03:44:50,240 --> 03:44:52,560 YOU HAVE HERE SUMMARY OF THE 6102 03:44:52,560 --> 03:44:55,760 PUBLIC POLICIES THAT WE HAVE 6103 03:44:55,760 --> 03:44:58,600 IMPLEMENTED IN OUR COUNTRY. 6104 03:44:58,600 --> 03:44:59,680 BEGINNING WITH RATIFICATION OF 6105 03:44:59,680 --> 03:45:03,600 THE W.H.O. FRAMEWORK MENTIONING 6106 03:45:03,600 --> 03:45:10,720 TOBACCO CONTROL, AND THEN IN 6107 03:45:10,720 --> 03:45:12,160 2010 WITH PRICE INCREASE, VERY 6108 03:45:12,160 --> 03:45:14,880 IMPORTANT, NOT ONLY A TAX 6109 03:45:14,880 --> 03:45:20,440 MODIFICATION BUZZ A TAX MOD -- 6110 03:45:20,440 --> 03:45:21,440 BUT A TAX MODIFICATION 6111 03:45:21,440 --> 03:45:24,640 INCREASING FINAL PRICES TO THE 6112 03:45:24,640 --> 03:45:25,400 CONSUMERS. 6113 03:45:25,400 --> 03:45:28,560 AND FOLLOWED BY OTHER IMPORTANT 6114 03:45:28,560 --> 03:45:32,920 MEASURES SUCH AS SMOKE-FREE 6115 03:45:32,920 --> 03:45:33,840 PUBLIC SPACES LAW. 6116 03:45:33,840 --> 03:45:38,320 THE IMPACT HAS BEEN MEASURED AND 6117 03:45:38,320 --> 03:45:39,720 DEMONSTRATED IT'S VERY 6118 03:45:39,720 --> 03:45:44,000 EFFECTIVE, BUT WE STILL -- STILL 6119 03:45:44,000 --> 03:45:46,320 WE HAVE IMPORTANT WORK TO DO AND 6120 03:45:46,320 --> 03:45:49,360 NOW WE ARE WORKING ON THE 6121 03:45:49,360 --> 03:45:51,880 INTRODUCTION OF PLAIN PACKAGING 6122 03:45:51,880 --> 03:45:55,040 FOR TOBACCO, BANNING SMOKING IN 6123 03:45:55,040 --> 03:45:58,360 OPEN PUBLIC PLACES, BANS ON 6124 03:45:58,360 --> 03:46:00,520 MENTHOL AND OTHER FLAVORING, 6125 03:46:00,520 --> 03:46:01,120 INCREASE TOBACCO CESSATION 6126 03:46:01,120 --> 03:46:04,840 ACCESS, AND THIS IS A VERY 6127 03:46:04,840 --> 03:46:07,880 IMPORTANT POINT, AND REGULATE 6128 03:46:07,880 --> 03:46:11,400 NEWER TOBACCO PRODUCTS, SUCH AS 6129 03:46:11,400 --> 03:46:17,440 ELECTRONIC CIGARETTES AND CIGAR 6130 03:46:17,440 --> 03:46:20,280 PRODUCTS. 6131 03:46:20,280 --> 03:46:26,600 IN TERMS OF ALCOHOL, THE TREND 6132 03:46:26,600 --> 03:46:28,760 IS THAT OUR PREVALENCES OF 6133 03:46:28,760 --> 03:46:30,880 ALCOHOL CONSUMPTION ARE ON THE 6134 03:46:30,880 --> 03:46:33,480 RISE, AND THIS IS CONTRARY TO 6135 03:46:33,480 --> 03:46:34,840 OTHER DEVELOPED COUNTRIES. 6136 03:46:34,840 --> 03:46:37,760 WE KNOW THAT OUR TEENS START 6137 03:46:37,760 --> 03:46:42,600 DRINKING ALCOHOL AT THE AGE OF 6138 03:46:42,600 --> 03:46:46,120 13 YEARS OLD, AND 40% OF SCHOOL 6139 03:46:46,120 --> 03:46:47,920 AGE CHILDREN REPORT THAT FOR 6140 03:46:47,920 --> 03:46:51,360 THEM IT WOULD BE EASY OR VERY 6141 03:46:51,360 --> 03:46:55,120 EASY TO GET ACCESS TO ALCOHOL. 6142 03:46:55,120 --> 03:46:57,080 ALSO, AMONG HIGH SCHOOL 6143 03:46:57,080 --> 03:47:02,440 STUDENTS, BOTH WOMEN AND MEN, 6144 03:47:02,440 --> 03:47:06,280 THE PREVALENCE OF BINGE DRINKING 6145 03:47:06,280 --> 03:47:08,680 IS VERY HIGH. 6146 03:47:08,680 --> 03:47:11,280 THE CONTEXT FOR THIS IN CHILE, 6147 03:47:11,280 --> 03:47:15,360 WE STILL HAVE AN AGGRESSIVE 6148 03:47:15,360 --> 03:47:18,440 MARKETING OF ALCOHOL PRODUCTS, 6149 03:47:18,440 --> 03:47:22,400 TARGETED SPECIFICALLY TO YOUNG 6150 03:47:22,400 --> 03:47:23,480 PEOPLE. 6151 03:47:23,480 --> 03:47:28,520 YOU MAY IDENTIFY SOME OF OUR 6152 03:47:28,520 --> 03:47:34,080 MOST FAMOUS SOCCER PLAYERS AND 6153 03:47:34,080 --> 03:47:35,200 HOW SPORTS, SPECIFICALLY SOCCER, 6154 03:47:35,200 --> 03:47:40,760 HAVE BEEN USED BY THE ALCOHOL 6155 03:47:40,760 --> 03:47:42,760 INDUSTRY. 6156 03:47:42,760 --> 03:47:45,680 SO WE HAVE A PROBLEM WITH 6157 03:47:45,680 --> 03:47:47,760 MARKETING OF ALCOHOL THAT IS 6158 03:47:47,760 --> 03:47:50,280 VERY CLEAR, AND ALSO THERE IS A 6159 03:47:50,280 --> 03:47:52,280 LACK OF REGULATION OF 6160 03:47:52,280 --> 03:47:56,840 ADVERTISING AND SPONSORSHIP OF 6161 03:47:56,840 --> 03:47:58,200 ALCOHOL PRODUCTS. 6162 03:47:58,200 --> 03:48:03,320 BUT ALSO A HUGE PROBLEM IS THAT 6163 03:48:03,320 --> 03:48:04,600 ALCOHOL IS EASILY AVAILABLE, AND 6164 03:48:04,600 --> 03:48:06,840 ITS PRICE IS VERY LOW COMPARED 6165 03:48:06,840 --> 03:48:12,960 TO OTHER COUNTRIES. 6166 03:48:12,960 --> 03:48:16,880 FOR INSTANCE, FOLLOW ME IN 6167 03:48:16,880 --> 03:48:21,480 COMPARING THIS BOTTLE OF SPIRIT 6168 03:48:21,480 --> 03:48:28,720 IN ICELAND, THE SAME VOLUME 6169 03:48:28,720 --> 03:48:30,680 BOTTLE COSTS $84, COMPARED TO $4 6170 03:48:30,680 --> 03:48:32,880 IN OUR COUNTRY. 6171 03:48:32,880 --> 03:48:36,600 THEREFORE, IN TERMS OF ALCOHOL 6172 03:48:36,600 --> 03:48:38,440 CONSUMPTION, WE HAVE HAD SOME 6173 03:48:38,440 --> 03:48:41,760 PROGRESS BUT WE STILL HAVE A 6174 03:48:41,760 --> 03:48:47,880 LONG WAY TO FOLLOW WHAT IT HAS 6175 03:48:47,880 --> 03:48:51,360 BEEN ACCOMPLISHED WITH TOBACCO 6176 03:48:51,360 --> 03:48:53,240 CONTROL MEASURES. 6177 03:48:53,240 --> 03:48:59,360 SPECIFICALLY IN 2014, THERE WAS 6178 03:48:59,360 --> 03:49:02,080 A TAX MODIFICATION FOR ALCOHOL 6179 03:49:02,080 --> 03:49:06,040 BUT THAT TAX MODIFICATION LED TO 6180 03:49:06,040 --> 03:49:09,320 NO INCREASE IN PRICES OF 6181 03:49:09,320 --> 03:49:12,040 ALCOHOL, AND WAS COMPLETELY 6182 03:49:12,040 --> 03:49:13,960 ABSORBED BY THE ALCOHOL 6183 03:49:13,960 --> 03:49:18,040 INDUSTRY. 6184 03:49:18,040 --> 03:49:21,240 THEREFORE, IN TERMS OF FUTURE 6185 03:49:21,240 --> 03:49:24,400 DIRECTIONS, WE NEED TO WORK, 6186 03:49:24,400 --> 03:49:27,800 CHANGING THE TAX STRUCTURE TO 6187 03:49:27,800 --> 03:49:32,520 GET HIGHER PRICE IMPACT AND ALSO 6188 03:49:32,520 --> 03:49:36,000 WORK ON OTHER HEALTH POLICIES 6189 03:49:36,000 --> 03:49:37,560 INCLUDING REGULATION OF 6190 03:49:37,560 --> 03:49:40,360 MARKETING AND LABELING AND 6191 03:49:40,360 --> 03:49:40,960 AVAILABILITY OF ALCOHOLIC 6192 03:49:40,960 --> 03:49:46,960 BEVERAGES. 6193 03:49:46,960 --> 03:49:50,360 THIRD RISK FACTOR THAT I WANT TO 6194 03:49:50,360 --> 03:49:53,080 MENTION TODAY, HIGH PREVALENCE 6195 03:49:53,080 --> 03:49:56,560 OF OBESITY AMONG ADULTS IN 6196 03:49:56,560 --> 03:49:59,800 CHILE, SECOND ONLY BEHIND THE 6197 03:49:59,800 --> 03:50:01,760 UNITED STATES IN THIS 6198 03:50:01,760 --> 03:50:06,520 COMPARISON, AND IN TERMS OF 6199 03:50:06,520 --> 03:50:08,440 CHILDREN, TOP ONE AMONG THE 6200 03:50:08,440 --> 03:50:12,480 ORGANIZATION FOR ECONOMIC 6201 03:50:12,480 --> 03:50:14,920 COOPERATION AND DEVELOPMENT IN 6202 03:50:14,920 --> 03:50:15,120 2019. 6203 03:50:15,120 --> 03:50:19,200 MORE RECENTLY, NATIONAL SURVEY 6204 03:50:19,200 --> 03:50:20,800 WAS CONDUCTED FROM KINDERGARTEN 6205 03:50:20,800 --> 03:50:24,840 TO NINTH GRADE STUDENTS, AND WE 6206 03:50:24,840 --> 03:50:28,480 FOUND 31% OF SCHOOL CHILDREN 6207 03:50:28,480 --> 03:50:32,000 SUFFERING FROM OBESITY, AND 6208 03:50:32,000 --> 03:50:35,760 ALMOST 11% OF OUR CHILDREN 6209 03:50:35,760 --> 03:50:39,720 SUFFERING FROM SEVERE OBESITY. 6210 03:50:39,720 --> 03:50:42,040 6211 03:50:42,040 --> 03:50:48,960 BEHIND THESE STATISTICS WE'VE 6212 03:50:48,960 --> 03:50:50,160 BEEN MONITORING SUGAR-SWEETENED 6213 03:50:50,160 --> 03:50:51,120 BEVERAGES AMONG OUR POPULATION, 6214 03:50:51,120 --> 03:50:58,240 AND WE KNOW THAT SADLY, CHILE IS 6215 03:50:58,240 --> 03:51:00,760 ON THE TOP PLACE IN TERMS OF 6216 03:51:00,760 --> 03:51:03,800 SALES OF CALORIC SOFT DRINKS, 6217 03:51:03,800 --> 03:51:06,920 EVEN HIGHER THAN IN UNITED 6218 03:51:06,920 --> 03:51:09,880 STATES, MEXICO, AND BRAZIL. 6219 03:51:09,880 --> 03:51:11,280 6220 03:51:11,280 --> 03:51:15,880 SO, IN TERMS OF PUBLIC POLICIES, 6221 03:51:15,880 --> 03:51:22,760 WE HAVE A HISTORY OF STRATEGIES 6222 03:51:22,760 --> 03:51:24,080 INCLUDING TRANSFAT LABELING, 6223 03:51:24,080 --> 03:51:25,040 SUGAR-SWEETENED BEVERAGES TAX, 6224 03:51:25,040 --> 03:51:32,400 FOOD LABELING LAW THAT WAS 6225 03:51:32,400 --> 03:51:36,080 PASSED AND IMPLEMENTED SINCE 6226 03:51:36,080 --> 03:51:39,840 2016, WITH NOT ONLY WARNING 6227 03:51:39,840 --> 03:51:41,760 SIGNS ON UNHEALTHY FOODS THAT 6228 03:51:41,760 --> 03:51:44,200 BLOCK FIELDS BUT ALSO 6229 03:51:44,200 --> 03:51:46,840 RESTRICTION OF MARKETING AND 6230 03:51:46,840 --> 03:51:49,000 ADVERTISING OF UNHEALTHY FOOD 6231 03:51:49,000 --> 03:51:51,960 FOR CHILDREN UNDERSTOOD THE 6232 03:51:51,960 --> 03:51:53,520 A GE -- UNDER THE AGE OF 14 6233 03:51:53,520 --> 03:51:55,560 YEARS OLD, RESTRICTION OF 6234 03:51:55,560 --> 03:51:56,760 UNHEALTHY FOOD SALE, 6235 03:51:56,760 --> 03:51:59,800 DISTRIBUTION OR PROMOTION AT 6236 03:51:59,800 --> 03:52:00,080 SCHOOLS. 6237 03:52:00,080 --> 03:52:02,800 THIS IS HAVING AN IMPACT IN 6238 03:52:02,800 --> 03:52:06,640 TERMS OF FOOD INDUSTRY 6239 03:52:06,640 --> 03:52:09,840 REFORMULATION, IN TERMS OF 6240 03:52:09,840 --> 03:52:10,560 DECREASING SUGAR-SWEETENED 6241 03:52:10,560 --> 03:52:12,560 BEVERAGE USE, AND ALSO CHANGING 6242 03:52:12,560 --> 03:52:16,040 THE PREFERENCES AND CHOICES OF 6243 03:52:16,040 --> 03:52:17,040 CONSUMERS AND SEVERAL 6244 03:52:17,040 --> 03:52:19,920 EVALUATIONS ARE STILL IN 6245 03:52:19,920 --> 03:52:23,480 PROGRESS. 6246 03:52:23,480 --> 03:52:27,960 IN TERMS OF FUTURE DIRECTIONS, 6247 03:52:27,960 --> 03:52:32,680 WE NEED TO MOVE FORWARD IN 6248 03:52:32,680 --> 03:52:34,400 EFFECTIVE TAXATION AND 6249 03:52:34,400 --> 03:52:35,000 SUGAR-SWEETENED BEVERAGES 6250 03:52:35,000 --> 03:52:37,160 FOLLOWING EXAMPLES OF OTHER 6251 03:52:37,160 --> 03:52:39,600 COUNTRIES IN THE AMERICAS, AND 6252 03:52:39,600 --> 03:52:41,320 WORK ON STRENGTHENING THE 6253 03:52:41,320 --> 03:52:43,040 IMPLEMENTATION AND ENFORCEMENT 6254 03:52:43,040 --> 03:52:45,880 OF THE FOOD LABELING LAW. 6255 03:52:45,880 --> 03:52:48,320 ALSO INCREASE IN FRUIT AND 6256 03:52:48,320 --> 03:52:49,760 VEGETABLE MARKETING AVAILABILITY 6257 03:52:49,760 --> 03:52:51,840 AND FINANCIAL ACCESS, WHICH IS A 6258 03:52:51,840 --> 03:52:55,200 PROBLEM NOW IN OUR COUNTRY, AND 6259 03:52:55,200 --> 03:52:58,160 ALSO INCLUDE FAST FOOD AND 6260 03:52:58,160 --> 03:52:59,480 ALCOHOLIC BEVERAGES IN 6261 03:52:59,480 --> 03:53:01,560 NUTRITIONAL LABELING 6262 03:53:01,560 --> 03:53:01,840 REGULATIONS. 6263 03:53:01,840 --> 03:53:08,000 THEY HAVE NO REGULATIONS, 6264 03:53:08,000 --> 03:53:08,880 LABELING REGULATIONS, CURRENTLY. 6265 03:53:08,880 --> 03:53:13,200 THIS WAS ONE OF THE CAMPAIGNS IN 6266 03:53:13,200 --> 03:53:18,520 TERMS OF THE NEW LAW, TRYING TO 6267 03:53:18,520 --> 03:53:20,280 ADVERTISE THESE TO OUR 6268 03:53:20,280 --> 03:53:28,320 POPULATION, THEY PREFER FOOD 6269 03:53:28,320 --> 03:53:32,440 ITEMS WITH LESS BLACK SEALS. 6270 03:53:32,440 --> 03:53:38,360 IF THEY DON'T HAVE ANY BLACK 6271 03:53:38,360 --> 03:53:40,000 SEALS, EVEN BETTER. 6272 03:53:40,000 --> 03:53:43,800 I WOULD LIKE TO TALK ABOUT 6273 03:53:43,800 --> 03:53:45,880 SOCIETY TACKLING THIS COMPLEX 6274 03:53:45,880 --> 03:53:46,960 SCENARIO. 6275 03:53:46,960 --> 03:53:48,640 WELL, THE PROBLEM THAT WE 6276 03:53:48,640 --> 03:53:51,560 IDENTIFIED IS THAT MOST CURRENT 6277 03:53:51,560 --> 03:53:53,560 DISEASES ARE RESEARCH ARISES 6278 03:53:53,560 --> 03:53:55,400 FROM EUROPE AND USA, WHOSE 6279 03:53:55,400 --> 03:54:01,120 CHARACTERISTICS ARE DIFFERENT 6280 03:54:01,120 --> 03:54:03,360 FROM LATINO POPULATION. 6281 03:54:03,360 --> 03:54:08,760 IN 2013, SEVERAL SCIENTISTS IN 6282 03:54:08,760 --> 03:54:10,160 OUR COUNTRY CREATED THE 6283 03:54:10,160 --> 03:54:12,000 ADVANTAGED CENTER FOR CHRONIC 6284 03:54:12,000 --> 03:54:14,400 DISEASE AND MAUCO STUDY, THE 6285 03:54:14,400 --> 03:54:15,240 FIRST POPULATION-BASED COHORT 6286 03:54:15,240 --> 03:54:25,720 STUDY FOR CHRONIC DISEASE IN 6287 03:54:26,080 --> 03:54:27,560 MAULE, CENTRAL CHILE. 6288 03:54:27,560 --> 03:54:31,080 THIS IS A JOINT EFFORT FROM 6289 03:54:31,080 --> 03:54:33,040 BASIC SCIENTISTS, CLINICIANS, 6290 03:54:33,040 --> 03:54:35,960 AND EXPERTS IN EPIDEMIOLOGY AND 6291 03:54:35,960 --> 03:54:38,160 PUBLIC HEALTH, AND HAS A 6292 03:54:38,160 --> 03:54:44,320 PARTICULARLY TO BE LOCATED IN A 6293 03:54:44,320 --> 03:54:45,440 COMMUNITY DEDICATED MAINLY TO 6294 03:54:45,440 --> 03:54:46,400 AGRICULTURAL ACTIVITIES. 6295 03:54:46,400 --> 03:54:48,480 WE HOPE THIS INFORMATION AND 6296 03:54:48,480 --> 03:54:51,360 KNOWLEDGE THAT WE'RE GENERATING 6297 03:54:51,360 --> 03:54:53,520 IN THE MAULE COHORT WILL BE USED 6298 03:54:53,520 --> 03:54:55,160 FOR OTHER COUNTRIES IN SOUTH 6299 03:54:55,160 --> 03:55:01,120 AMERICA AND BECAUSE OF THE 6300 03:55:01,120 --> 03:55:05,120 SHARED GENETIC AND SOCIOCULTURAL 6301 03:55:05,120 --> 03:55:06,320 HERITAGE. 6302 03:55:06,320 --> 03:55:07,680 WE FACE DIFFICULT SCENARIO OF 6303 03:55:07,680 --> 03:55:09,640 CONFLICTSES OF INTEREST AND 6304 03:55:09,640 --> 03:55:10,920 AGGRESSIVE LOBBYING BY THE 6305 03:55:10,920 --> 03:55:11,960 TOBACCO, ALCOHOL, AND FOOD 6306 03:55:11,960 --> 03:55:14,680 INDUSTRY IN OUR COUNTRY. 6307 03:55:14,680 --> 03:55:18,800 SO, NOW MORE THAN EVER, WE NEED 6308 03:55:18,800 --> 03:55:20,240 THAT HEALTH PROFESSIONALS, 6309 03:55:20,240 --> 03:55:22,200 SCIENTISTS, THE WHOLE COMMUNITY, 6310 03:55:22,200 --> 03:55:24,640 BECOME EMPOWERED AND TRAINED TO 6311 03:55:24,640 --> 03:55:27,160 SUPPORT AND ADVOCATE FOR BOTH 6312 03:55:27,160 --> 03:55:28,840 INDIVIDUAL AND POPULATION-WIDE 6313 03:55:28,840 --> 03:55:31,760 SYSTEMIC CHANGES. 6314 03:55:31,760 --> 03:55:33,640 THE ROLE OF LOCAL GOVERNMENTS, 6315 03:55:33,640 --> 03:55:36,040 VERY IMPORTANT IN MONITORING AND 6316 03:55:36,040 --> 03:55:38,320 REGULATING THE LOCAL MARKETS, AS 6317 03:55:38,320 --> 03:55:40,960 WELL AS IN GENERATING INCENTIVES 6318 03:55:40,960 --> 03:55:44,800 TO IMPROVE ACCESS TO HEALTHIER 6319 03:55:44,800 --> 03:55:45,240 OPTIONS. 6320 03:55:45,240 --> 03:55:47,400 AT THE CASE OF TOBACCO CONTROL, 6321 03:55:47,400 --> 03:55:52,240 THAT WE HAVE BEEN TALKING ABOUT 6322 03:55:52,240 --> 03:55:53,760 IN THIS PRESENTATION, PROVIDES 6323 03:55:53,760 --> 03:55:57,400 HOPE AND AN IMPORTANT LESSON. 6324 03:55:57,400 --> 03:56:00,840 AND THE LESSON IS THAT WHILE THE 6325 03:56:00,840 --> 03:56:03,040 PUBLIC HEALTH POLICIES ARE 6326 03:56:03,040 --> 03:56:06,320 EFFECTIVE, THEY ARE ASSOCIATED 6327 03:56:06,320 --> 03:56:08,720 WITH POPULATION AND CAN BE 6328 03:56:08,720 --> 03:56:10,600 IMPLEMENTED IN CHILE AND IN 6329 03:56:10,600 --> 03:56:12,120 OTHER COUNTRIES IN LATIN 6330 03:56:12,120 --> 03:56:12,360 AMERICA. 6331 03:56:12,360 --> 03:56:15,440 THANK YOU FOR YOUR ATTENTION. 6332 03:56:15,440 --> 03:56:21,480 6333 03:56:21,480 --> 03:56:24,760 6334 03:56:24,760 --> 03:56:28,480 >>PUBLIC POLICIES THAT PROMOTE 6335 03:56:28,480 --> 03:56:30,080 HEALTH AND WELL-BEING, 6336 03:56:30,080 --> 03:56:31,320 ESPECIALLY ECONOMICALLY 6337 03:56:31,320 --> 03:56:34,040 DISADVANTAGED FAMILIES, 6338 03:56:34,040 --> 03:56:36,360 ESPECIALLY IMPORTANT SINCE ONSET 6339 03:56:36,360 --> 03:56:38,840 OF CORONA PANDEMIC IN 2020, 6340 03:56:38,840 --> 03:56:40,280 CATCH TRANSFER AND DOMESTIC 6341 03:56:40,280 --> 03:56:44,520 VIOLENCE POLICIES, IN LATIN 6342 03:56:44,520 --> 03:56:45,360 AMERICA. 6343 03:56:45,360 --> 03:56:47,280 A VARIETY OF CO-AUTHORS OVER THE 6344 03:56:47,280 --> 03:56:54,160 LAST 2 1/2 YEARS. 6345 03:56:54,160 --> 03:56:55,160 MY PRESENTATION OUTLINES 6346 03:56:55,160 --> 03:56:57,280 TRANSFERS, INVESTMENT IN FAMILY 6347 03:56:57,280 --> 03:56:59,600 HEALTH, SECONDLY I DEFINE BEST 6348 03:56:59,600 --> 03:57:00,880 PRACTICES IN CASH TRANSFERS, 6349 03:57:00,880 --> 03:57:02,960 THAT ENSURE BROAD COVERAGE FOR 6350 03:57:02,960 --> 03:57:05,040 THOSE AT RISK OF POVERTY AND 6351 03:57:05,040 --> 03:57:08,240 ADEQUATE LEVELS TO COVER BASIC 6352 03:57:08,240 --> 03:57:10,200 NEEDS. 6353 03:57:10,200 --> 03:57:13,280 THIRD, I DISCUSS EVOLUTION. 6354 03:57:13,280 --> 03:57:15,120 SECOND, I DISCUSSION POLICIES TO 6355 03:57:15,120 --> 03:57:17,200 ADDRESS INTIMATE PARTNER AND 6356 03:57:17,200 --> 03:57:19,120 DOMESTIC VIOLENCE, SEPARATE, 6357 03:57:19,120 --> 03:57:23,240 SOME LINKS TO CASH TRANSFERS AS 6358 03:57:23,240 --> 03:57:25,080 WELL. 6359 03:57:25,080 --> 03:57:25,960 AND HERE EVEN 6360 03:57:25,960 --> 03:57:26,960 MULTI-DIMENSIONALITY OF PROBLEM 6361 03:57:26,960 --> 03:57:29,240 OF DOMESTIC VIOLENCE WITH MY 6362 03:57:29,240 --> 03:57:32,760 CO-AUTHORS DEFINE BEST 6363 03:57:32,760 --> 03:57:36,800 PRACTICES, THE BUNDLE OF 6364 03:57:36,800 --> 03:57:37,800 SERVICES, COORDINATING SYSTEM 6365 03:57:37,800 --> 03:57:39,520 INCLUDING ACCESSIBLE EMERGENCY 6366 03:57:39,520 --> 03:57:42,240 AND HEALTH SERVICES, EFFECTIVE 6367 03:57:42,240 --> 03:57:44,040 PROTECTION MECHANISMS, SAFELY 6368 03:57:44,040 --> 03:57:47,080 SHELTER, ECONOMIC ASSISTANCE. 6369 03:57:47,080 --> 03:57:50,040 THEN WE -- I SHARE PRELIMINARY 6370 03:57:50,040 --> 03:57:51,560 FINDINGS FROM RESEARCH ON THIS 6371 03:57:51,560 --> 03:57:54,160 BUNDLE OF POLICIES IN LATIN 6372 03:57:54,160 --> 03:57:56,120 AMERICA, AND FINALLY DISCUSS 6373 03:57:56,120 --> 03:57:57,920 POLICY RECOMMENDATIONS. 6374 03:57:57,920 --> 03:58:01,120 SO, FIRST, CASH TRANSFERS TO 6375 03:58:01,120 --> 03:58:05,560 HOUSEHOLDS AT RISK. 6376 03:58:05,560 --> 03:58:08,880 SO, WE FOCUS TO SOCIALLY 6377 03:58:08,880 --> 03:58:11,440 VULNERABLE GROUPS, ALSO COG 6378 03:58:11,440 --> 03:58:13,240 COGNIZANT OF THE FACT HALF THE 6379 03:58:13,240 --> 03:58:15,840 POPULATION IN THE REGION IN 6380 03:58:15,840 --> 03:58:16,600 LATIN AMERICA LABOR INFORMALLY, 6381 03:58:16,600 --> 03:58:21,280 THEY ARE NOT PART OF 6382 03:58:21,280 --> 03:58:22,280 CONTRIBUTORY CASH TRANSFER 6383 03:58:22,280 --> 03:58:22,520 SYSTEMS. 6384 03:58:22,520 --> 03:58:24,480 AND BEFORE THE PANDEMIC THE KEY 6385 03:58:24,480 --> 03:58:28,000 GROUPS THAT WERE INCLUDED IN 6386 03:58:28,000 --> 03:58:31,080 SUCH PROGRAMS IN EXISTING POLICY 6387 03:58:31,080 --> 03:58:31,840 INFRASTRUCTURES WERE ELDERLY, 6388 03:58:31,840 --> 03:58:34,360 DISABLED, THE CHILDREN. 6389 03:58:34,360 --> 03:58:37,000 SO BASICALLY INDIVIDUALS WHO ARE 6390 03:58:37,000 --> 03:58:40,960 NOT ABLE-BODIED ADULTS, WHO WERE 6391 03:58:40,960 --> 03:58:43,080 EXPECTED TO PROVIDE INCOME FOR 6392 03:58:43,080 --> 03:58:44,920 THEMSELVES THROUGH PARTICIPATION 6393 03:58:44,920 --> 03:58:46,760 OF THE LABOR MARKET. 6394 03:58:46,760 --> 03:58:49,680 WE FOCUS ESPECIALLY ON TRANSFERS 6395 03:58:49,680 --> 03:58:50,800 TO CHILDREN. 6396 03:58:50,800 --> 03:58:52,440 AND TODAY TRANSFERS TO CHILDREN 6397 03:58:52,440 --> 03:58:55,080 EXIST IN ALMOST ALL LATIN 6398 03:58:55,080 --> 03:58:56,080 AMERICAN COUNTRIES, HAVE BEEN 6399 03:58:56,080 --> 03:58:57,880 DEVELOPED OVER THE LAST 25 6400 03:58:57,880 --> 03:58:59,760 YEARS, AND TARGET MOTHERS, UNDER 6401 03:58:59,760 --> 03:59:03,160 ASSUMPTION MOTHERS CAN AND WILL 6402 03:59:03,160 --> 03:59:04,800 INVEST IN CHILDREN. 6403 03:59:04,800 --> 03:59:06,880 EVEN IF IT WASN'T INTENDED, A 6404 03:59:06,880 --> 03:59:07,960 BENEFICIAL SIDE EFFECT, WASN'T A 6405 03:59:07,960 --> 03:59:09,720 GOAL OF THE POLICY, A BENEFICIAL 6406 03:59:09,720 --> 03:59:11,400 SIDE EFFECT IS THAT IT PUTS 6407 03:59:11,400 --> 03:59:15,080 INCOME IN THE HANDS OF WOMEN WHO 6408 03:59:15,080 --> 03:59:17,520 HAVE HISTORICALLY NOT HAD 6409 03:59:17,520 --> 03:59:18,880 INCOME, ESPECIALLY POOR WOMEN IN 6410 03:59:18,880 --> 03:59:21,760 THE REGION, AND HAS ALSO 6411 03:59:21,760 --> 03:59:23,840 PROMOTED ECONOMIC AUTONOMY OF 6412 03:59:23,840 --> 03:59:24,920 THESE WOMEN. 6413 03:59:24,920 --> 03:59:26,480 OVERALL, POSITIVE HEALTH EFFECTS 6414 03:59:26,480 --> 03:59:28,240 OF CASH TRANSFERS TO CHILDREN 6415 03:59:28,240 --> 03:59:30,280 VIA MOTHERS HAVE BEEN 6416 03:59:30,280 --> 03:59:33,080 EXTENSIVELY DOCUMENTED IN BOTH 6417 03:59:33,080 --> 03:59:33,720 MEDICAL AND NON-MEDICAL 6418 03:59:33,720 --> 03:59:35,600 LITERATURE AND YOU MIGHT BE 6419 03:59:35,600 --> 03:59:37,960 AWARE OF THIS LITERATURE. 6420 03:59:37,960 --> 03:59:42,240 BUT THEY HAVE HAD A POSITIVE 6421 03:59:42,240 --> 03:59:45,200 EFFECT ON CHILD NUTRITION, 6422 03:59:45,200 --> 03:59:48,680 EDUCATION, WOMEN'S HEALTH, 6423 03:59:48,680 --> 03:59:51,320 HOUSEHOLD WELL-BEING, EVEN OUR 6424 03:59:51,320 --> 03:59:53,400 SECOND TOPIC, REDUCTION OF 6425 03:59:53,400 --> 03:59:54,840 INTIMATE PARTNER VIOLENCE, AND 6426 03:59:54,840 --> 03:59:56,440 ON THIS LAST ISSUE THE 6427 03:59:56,440 --> 04:00:04,680 MECHANISMS THE LILT A -- 6428 04:00:04,680 --> 04:00:07,320 LITERATURE HAS FOUND, TARGETING 6429 04:00:07,320 --> 04:00:09,280 WOMEN, INCREASED WOMEN'S 6430 04:00:09,280 --> 04:00:13,000 ECONOMIC AUTONOMY, HENCE 6431 04:00:13,000 --> 04:00:14,120 BARGAINING POWER, PROVIDES 6432 04:00:14,120 --> 04:00:14,960 PROTECTIVE BUFFER AGAINST 6433 04:00:14,960 --> 04:00:17,280 VIOLENCE FROM PARTNERS AND 6434 04:00:17,280 --> 04:00:21,000 SECONDLY CASH TRANSFERS INCREASE 6435 04:00:21,000 --> 04:00:24,840 HOUSEHOLD ECONOMIC WELL-BEING 6436 04:00:24,840 --> 04:00:25,720 OVERALL, AND ABUSE, STRESSES 6437 04:00:25,720 --> 04:00:28,120 RELATED TO EXTREME FINANCIAL 6438 04:00:28,120 --> 04:00:30,880 INSECURITY AND PROVIDE 6439 04:00:30,880 --> 04:00:32,880 PROTECTIVE BUFFER AGAINST 6440 04:00:32,880 --> 04:00:35,240 INTIMATE PARTNER VIOLENCE. 6441 04:00:35,240 --> 04:00:38,480 SO, CASH TRANSFERS TO SOCIALLY 6442 04:00:38,480 --> 04:00:39,160 VULNERABLE HOUSEHOLDS, SINCE 6443 04:00:39,160 --> 04:00:43,800 2020 IN THE REGION, LET ME START 6444 04:00:43,800 --> 04:00:49,560 OUT BY SAYING THAT DESPITE THE 6445 04:00:49,560 --> 04:00:50,280 POLICY INFRASTRUCTURE CASH 6446 04:00:50,280 --> 04:00:54,280 TRANSFER PROGRAM TO CHILDREN AND 6447 04:00:54,280 --> 04:00:56,040 DOCUMENTED BENEFITS, IN FACT, 6448 04:00:56,040 --> 04:00:57,440 ALMOST HALF THE CHILDREN IN THE 6449 04:00:57,440 --> 04:01:02,200 REGION STILL LIVE IN POVERTY AT 6450 04:01:02,200 --> 04:01:04,920 THE EVE THE PANDEMIC, AGE IS THE 6451 04:01:04,920 --> 04:01:08,360 BEST PREDICTOR OF WHETHER YOU'RE 6452 04:01:08,360 --> 04:01:14,120 IN POVERTY OR NOT. 6453 04:01:14,120 --> 04:01:16,400 0-14 YEAR OLDS, 46% WERE AT 6454 04:01:16,400 --> 04:01:19,080 POVERTY IN THE REGION COMPARED 6455 04:01:19,080 --> 04:01:21,440 TO 15% OF THE ELDERLY, AND 6456 04:01:21,440 --> 04:01:26,200 INDEED WHEN THE PANDEMIC HIT THE 6457 04:01:26,200 --> 04:01:29,800 REGION, THE ELDERLY WERE 6458 04:01:29,800 --> 04:01:31,520 EPIDEMIOLOGICALLY MOST AT RISK, 6459 04:01:31,520 --> 04:01:35,920 THOSE SOCIALLY MOST AT RISK WERE 6460 04:01:35,920 --> 04:01:38,680 HOUSEHOLDS WITH CHILDREN. 6461 04:01:38,680 --> 04:01:41,640 ONCE GOVERNMENTS MADE POLICIES 6462 04:01:41,640 --> 04:01:43,240 OF SOCIAL ISOLATION, DISTANCING, 6463 04:01:43,240 --> 04:01:45,960 EVEN COUNTRIES THAT WEREN'T 6464 04:01:45,960 --> 04:01:50,120 STRONG, ECONOMIC FALLOUT CREATED 6465 04:01:50,120 --> 04:01:51,560 MASSIVE POTENTIAL, HUMANITARIAN 6466 04:01:51,560 --> 04:01:52,320 CRISIS AMONG VULNERABLE 6467 04:01:52,320 --> 04:01:54,320 HOUSEHOLDS THAT FOR MANY OF 6468 04:01:54,320 --> 04:01:57,560 THESE HOUSEHOLDS WAS EQUIVALENT 6469 04:01:57,560 --> 04:02:01,240 OR EXCEEDED THE EFFECT OF THE 6470 04:02:01,240 --> 04:02:02,120 VIRUS ITSELF. 6471 04:02:02,120 --> 04:02:04,560 WE LOOK AT CASH TRANSFERS TO 6472 04:02:04,560 --> 04:02:05,640 CHILDREN IN EXISTING PROGRAMS, 6473 04:02:05,640 --> 04:02:08,160 WHAT HAPPENED TO THEM SINCE 6474 04:02:08,160 --> 04:02:10,640 MARCH 2020, AND WE ALSO LOOK AT 6475 04:02:10,640 --> 04:02:14,320 THE CREATION OF NEW CASH 6476 04:02:14,320 --> 04:02:17,320 TRANSFERS TO INFORMAL 6477 04:02:17,320 --> 04:02:18,240 HOUSEHOLDS. 6478 04:02:18,240 --> 04:02:22,280 IF YOU LOOK, DESPITE EXITING 6479 04:02:22,280 --> 04:02:23,520 CONTRIBUTOR AND NON-CONTRIBUTORY 6480 04:02:23,520 --> 04:02:26,000 PROGRAM, ONE-THIRD OF HOUSEHOLDS 6481 04:02:26,000 --> 04:02:30,280 IN THE REGION WERE IN NEITHER 6482 04:02:30,280 --> 04:02:32,040 PROGRAM, RELIED ENTIRELY ON 6483 04:02:32,040 --> 04:02:37,520 PRIVATE SOURCES OF INCOME, AND 6484 04:02:37,520 --> 04:02:39,920 CORRELATES HIGHLY WITH INCOME, 6485 04:02:39,920 --> 04:02:41,240 SO ADDITIONAL VERY IMPORTANT 6486 04:02:41,240 --> 04:02:42,880 SOCIAL PROTECTION POLICY WAS TO 6487 04:02:42,880 --> 04:02:45,160 CREATE EMERGENCY CASH TRANSFERS 6488 04:02:45,160 --> 04:02:48,000 TO WHAT WE CALL INFORMAL 6489 04:02:48,000 --> 04:02:48,320 HOUSEHOLDS. 6490 04:02:48,320 --> 04:02:50,400 AND HERE WE SHOWED THE RESULTS, 6491 04:02:50,400 --> 04:02:53,120 I'LL TRY AND GET THROUGH THIS 6492 04:02:53,120 --> 04:02:53,360 QUICKLY. 6493 04:02:53,360 --> 04:02:55,360 I CAN CERTAINLY SHARE DETAILS OF 6494 04:02:55,360 --> 04:02:59,160 OUR MEASUREMENTS IN THE Q&A, BUT 6495 04:02:59,160 --> 04:03:03,000 THIS YEAR BASICALLY THIS GRAPH 6496 04:03:03,000 --> 04:03:05,440 SHOWS COVERAGE, IN THE EMERGENCY 6497 04:03:05,440 --> 04:03:06,880 CRASH TRANSFER PROGRAM 6498 04:03:06,880 --> 04:03:08,600 GOVERNMENTS CREATED TO MAKE UP 6499 04:03:08,600 --> 04:03:10,920 FOR LOST INCOME OF INFORMAL 6500 04:03:10,920 --> 04:03:12,440 WORKERS EXPECTED TO SHELTER AT 6501 04:03:12,440 --> 04:03:15,280 HOME. 6502 04:03:15,280 --> 04:03:18,040 SO THE GREEN GRAPH MEASURES 6503 04:03:18,040 --> 04:03:19,000 PERCENTAGE OF THE OCCUPIED 6504 04:03:19,000 --> 04:03:21,560 POPULATION AS RECIPIENTS IN THE 6505 04:03:21,560 --> 04:03:23,640 NEW TRANSFERS PROGRAM AS A SHARE 6506 04:03:23,640 --> 04:03:31,200 OF THE TOTAL INPUT POPULATION IN 6507 04:03:31,200 --> 04:03:33,160 RED, BASICALLY FUNCTIONAL NEED 6508 04:03:33,160 --> 04:03:34,360 FOR THIS CASH TRANSFER, SO YOU 6509 04:03:34,360 --> 04:03:36,560 CAN SEE IT'S QUITE IMPRESSIVE. 6510 04:03:36,560 --> 04:03:38,320 IN FEBRUARY 2020, NONE OF THESE 6511 04:03:38,320 --> 04:03:39,360 PROGRAMS EXISTED. 6512 04:03:39,360 --> 04:03:41,600 THERE WAS A LOT OF CREATION OF 6513 04:03:41,600 --> 04:03:43,480 NEW AND BROAD EMERGENCY CASH 6514 04:03:43,480 --> 04:03:47,440 TRANSFER PROGRAMS. 6515 04:03:47,440 --> 04:03:49,480 YOU CAN SEE SIGNIFICANT 6516 04:03:49,480 --> 04:03:52,560 VARIATION FOR VERY BRAZIL AND 6517 04:03:52,560 --> 04:03:53,760 BOLIVIA, ARGENTINA TO MINIMAL 6518 04:03:53,760 --> 04:03:56,400 AND NO COVERAGE IN MEXICO. 6519 04:03:56,400 --> 04:03:59,120 AND ON THE RIGHT-HAND SIDE, WE 6520 04:03:59,120 --> 04:04:00,880 MEASURED EVOLUTION OF COVERAGE 6521 04:04:00,880 --> 04:04:01,960 IN EXISTING CASH TRANSFER 6522 04:04:01,960 --> 04:04:03,520 PROGRAMS TO CHILDREN, AND HERE 6523 04:04:03,520 --> 04:04:05,560 100% IS THE TOTAL NUMBER OF 6524 04:04:05,560 --> 04:04:08,760 CHILDREN IN THE COUNTRY. 6525 04:04:08,760 --> 04:04:12,040 AND IF WE -- INITIAL GRAPH IS 6526 04:04:12,040 --> 04:04:14,120 PRE-COVID COVERAGE. 6527 04:04:14,120 --> 04:04:15,800 THIS ALSO SHOWS THAT IF WE 6528 04:04:15,800 --> 04:04:16,880 REMEMBER THAT ABOUT HALF THE 6529 04:04:16,880 --> 04:04:20,240 CHILDREN IN THE REGION LIVED IN 6530 04:04:20,240 --> 04:04:21,360 POVERTY PRE-COVID, VERY FEW 6531 04:04:21,360 --> 04:04:25,280 COUNTRIES IN TERMS OF COVERAGE, 6532 04:04:25,280 --> 04:04:27,280 ADEQUATE COVERAGE BEFORE THE 6533 04:04:27,280 --> 04:04:29,480 PANDEMIC HIT. 6534 04:04:29,480 --> 04:04:31,520 WE CAN ALSO SEE THAT GOVERNMENTS 6535 04:04:31,520 --> 04:04:33,000 DIDN'T REALLY MUCH EXTEND 6536 04:04:33,000 --> 04:04:34,520 COVERAGE DURING THE FIRST YEAR 6537 04:04:34,520 --> 04:04:36,120 OF THE PANDEMIC AND THESE GRAPHS 6538 04:04:36,120 --> 04:04:37,680 SHOWED EVOLUTION OF THAT, OR THE 6539 04:04:37,680 --> 04:04:41,160 FIRST YEAR OF THE PANDEMIC, WITH 6540 04:04:41,160 --> 04:04:42,160 EXCEPTION OF ECUADOR. 6541 04:04:42,160 --> 04:04:43,680 THAT DOESN'T MEAN THEY DIDN'T 6542 04:04:43,680 --> 04:04:47,000 USE THESE PROGRAMS AT ALL WHERE 6543 04:04:47,000 --> 04:04:48,720 WE ACTUALLY SEE SIGNIFICANT 6544 04:04:48,720 --> 04:04:51,800 EFFORTS TO HELP POOR HOUSEHOLDS 6545 04:04:51,800 --> 04:04:55,160 IN THE ADEQUACY, WITH EXISTING 6546 04:04:55,160 --> 04:04:58,880 TRANSFERS, SO HERE WE MEASURE 6547 04:04:58,880 --> 04:05:00,960 THE AMOUNT THAT HOUSEHOLDS GOT, 6548 04:05:00,960 --> 04:05:02,160 AND BASICALLY WHAT GOVERNMENTS 6549 04:05:02,160 --> 04:05:05,120 DID WAS INCREASE THE VALUE OF 6550 04:05:05,120 --> 04:05:07,120 THE TRANSFERS TO, AND HERE IN 6551 04:05:07,120 --> 04:05:09,920 THIS GRAPH, WE LOOKED AT CASH 6552 04:05:09,920 --> 04:05:13,080 COVERAGE IN THE EXISTING CASH 6553 04:05:13,080 --> 04:05:15,160 TRANSFER PROGRAMS TO CHILDREN. 6554 04:05:15,160 --> 04:05:17,160 AND WHAT THIS SHOWS IS THE RED 6555 04:05:17,160 --> 04:05:20,800 LINE IS THE EXTREME POVERTY 6556 04:05:20,800 --> 04:05:23,760 LINE, AND WE MEASURE THESE, WE 6557 04:05:23,760 --> 04:05:25,600 USE TYPICAL HOUSEHOLD OF FOUR 6558 04:05:25,600 --> 04:05:27,120 PEOPLE, TWO ADULTS, TWO 6559 04:05:27,120 --> 04:05:33,160 CHILDREN, AND MEASURE AMOUNT OF 6560 04:05:33,160 --> 04:05:35,680 TRANSFERS. 6561 04:05:35,680 --> 04:05:38,080 THE AVERAGE IS MONTHLY, 6562 04:05:38,080 --> 04:05:40,200 TRANSFERS, AND OVER THE FIRST 12 6563 04:05:40,200 --> 04:05:41,520 MONTHS OF THE PANDEMIC. 6564 04:05:41,520 --> 04:05:44,520 AND WHAT THIS SHOWS IS THE GREEN 6565 04:05:44,520 --> 04:05:47,040 GRAPH HERE IS PRE-COVID 6566 04:05:47,040 --> 04:05:50,760 COVERAGE, ADEQUACY, WHICH IS IN 6567 04:05:50,760 --> 04:05:52,600 ALL COUNTRIES MUCH BELOW THE 6568 04:05:52,600 --> 04:05:55,360 EXTREME POVERTY LINE. 6569 04:05:55,360 --> 04:05:58,040 AND THEN WE SHOW HOW IN MANY 6570 04:05:58,040 --> 04:06:01,680 COUNTRIES THE ADEQUACY OF THE 6571 04:06:01,680 --> 04:06:03,720 TRANSFERS INCREASED, QUITE 6572 04:06:03,720 --> 04:06:06,640 DRAMATICALLY, SO 7 OUT OF 10 6573 04:06:06,640 --> 04:06:07,520 INCREASED ADEQUACIES OF 6574 04:06:07,520 --> 04:06:11,680 TRANSFERS, IN BRAZIL AND CHILE 6575 04:06:11,680 --> 04:06:12,920 THEY CAME TO BASICALLY MEETING 6576 04:06:12,920 --> 04:06:15,160 THE EXTREME POVERTY LINE. 6577 04:06:15,160 --> 04:06:17,920 AND HERE THIS IS THE SAME 6578 04:06:17,920 --> 04:06:20,160 MEASUREMENTS, BUT FOR THE NEW 6579 04:06:20,160 --> 04:06:24,240 EMERGENCY CASH TRANSFER PROGRAM. 6580 04:06:24,240 --> 04:06:29,280 HERE WE ALSO SEE GOVERNMENTS, 6581 04:06:29,280 --> 04:06:31,400 THE LEVELS AT WHICH THEY GAVE 6582 04:06:31,400 --> 04:06:33,640 CASH TRANSFERS DIFFERED QUITE A 6583 04:06:33,640 --> 04:06:35,240 BIT OVER COUNTRIES, AND HERE 6584 04:06:35,240 --> 04:06:38,720 AGAIN ALSO BRAZIL AND CHILE COME 6585 04:06:38,720 --> 04:06:42,680 CLOSEST TO MEETING BASICALLY, 6586 04:06:42,680 --> 04:06:46,520 THE BASIC NEEDS LEVEL IN 6587 04:06:46,520 --> 04:06:46,880 ADEQUACY. 6588 04:06:46,880 --> 04:06:49,760 WHAT WE THEN DO IS KIND OF 6589 04:06:49,760 --> 04:06:50,960 POPULATE ALL THIS TOGETHER IN 6590 04:06:50,960 --> 04:06:52,720 TERMS OF ADEQUACY AND COVERAGE 6591 04:06:52,720 --> 04:07:00,400 ANDED -- AND ADEQUACY IS 6592 04:07:00,400 --> 04:07:03,800 MEASURED, HOW BROAD THE COVERAGE 6593 04:07:03,800 --> 04:07:04,320 IS. 6594 04:07:04,320 --> 04:07:07,280 IN BRAZIL AND CHILE WE DO THE 6595 04:07:07,280 --> 04:07:12,240 BEST IN TERMS OF PROVIDING BROAD 6596 04:07:12,240 --> 04:07:18,720 ADEQUACY, MEXICO DOES THE LEAST. 6597 04:07:18,720 --> 04:07:21,640 SECOND, POLICIES TO ADDRESS 6598 04:07:21,640 --> 04:07:22,920 INTIMATE PARTNER DOMESTIC 6599 04:07:22,920 --> 04:07:24,560 VIOLENCE, A RESEARCH PROJECT I'M 6600 04:07:24,560 --> 04:07:27,000 DOING WITH TWO GRADUATE 6601 04:07:27,000 --> 04:07:29,600 STUDENTS, BRIEFLY THE CONTEXT IS 6602 04:07:29,600 --> 04:07:33,880 ABOUT ONE-THIRD OF WOMEN OF 6603 04:07:33,880 --> 04:07:37,160 REPRODUCTIVE AGE REPORT HAVING 6604 04:07:37,160 --> 04:07:39,160 INTIMATE PARTNER VIOLENCE, 6605 04:07:39,160 --> 04:07:39,880 THERE'S SIGNIFICANT LITERATURE 6606 04:07:39,880 --> 04:07:43,640 ON IMPACTI DON'T HAVE TIME TO GO 6607 04:07:43,640 --> 04:07:44,040 INTO THAT. 6608 04:07:44,040 --> 04:07:48,760 WHAT WE FOCUSED HERE IN RELATION 6609 04:07:48,760 --> 04:07:51,720 TO IMPACT OF THE PANDEMIC, WE 6610 04:07:51,720 --> 04:07:54,280 LOOKED AT SERVICES FOR 6611 04:07:54,280 --> 04:07:56,320 SURVIVORS, THOSE AT IMMEDIATE 6612 04:07:56,320 --> 04:07:58,960 RISK OF INTIMATE PARTNER 6613 04:07:58,960 --> 04:07:59,200 VIOLENCE. 6614 04:07:59,200 --> 04:08:01,480 GIVEN THE THREAT OF THE COVID-19 6615 04:08:01,480 --> 04:08:03,640 SHELTER AT HOME POLICIES 6616 04:08:03,640 --> 04:08:04,320 PRESENTED TO THE THREAT OF 6617 04:08:04,320 --> 04:08:07,160 DOMESTIC VIOLENCE IN THE HOME 6618 04:08:07,160 --> 04:08:10,000 AND INDEED STUDIES HAVE SHOWN 6619 04:08:10,000 --> 04:08:12,720 DOMESTIC VIOLENCE DID INCREASE, 6620 04:08:12,720 --> 04:08:13,920 THE POLICIES, ECONOMIC 6621 04:08:13,920 --> 04:08:17,080 INSECURITY, ALL THE STRESSORS, 6622 04:08:17,080 --> 04:08:18,200 SO ON. 6623 04:08:18,200 --> 04:08:20,720 AGAIN, LOOKING AT THIS ISSUE, 6624 04:08:20,720 --> 04:08:23,760 IT'S A VERY CHALLENGING ISSUE 6625 04:08:23,760 --> 04:08:26,720 AND COMPLEX GIVEN THE DEPENDENCY 6626 04:08:26,720 --> 04:08:29,240 BETWEEN AGGRESSOR AND VICTIM OR 6627 04:08:29,240 --> 04:08:29,520 SURVIVOR. 6628 04:08:29,520 --> 04:08:33,720 AND SO IT'S HARD TO KNOW KIND OF 6629 04:08:33,720 --> 04:08:35,720 ANALYZE POLICY INTERVENTIONS ON 6630 04:08:35,720 --> 04:08:37,720 THEIR OWN, THEY TEND TO -- IT'S 6631 04:08:37,720 --> 04:08:39,320 MORE THAN ONE TYPE OF POLICY 6632 04:08:39,320 --> 04:08:42,080 THAT IS NEEDED TO ADDRESS THEM. 6633 04:08:42,080 --> 04:08:43,480 WE ALSO DON'T HAVE A LOT OF 6634 04:08:43,480 --> 04:08:44,680 IMPACT EVALUATION STUDIES. 6635 04:08:44,680 --> 04:08:45,920 WE DO KNOW, HOWEVER, FROM 6636 04:08:45,920 --> 04:08:48,840 STUDIES IN THE REGION THAT 6637 04:08:48,840 --> 04:08:50,040 PROVISION AND SOCIOECONOMIC 6638 04:08:50,040 --> 04:08:52,680 SECURITY IS IMPORTANT NOT JUST 6639 04:08:52,680 --> 04:08:54,080 PREVENTIVE BUT ALSO IN ALLOWING 6640 04:08:54,080 --> 04:08:56,320 VICTIM OR SURVIVOR TO LEAVE THE 6641 04:08:56,320 --> 04:08:57,840 SITUATION OF VIOLENCE AND START 6642 04:08:57,840 --> 04:09:00,560 A NEW LIFE SOMEWHERE ELSE, FOR 6643 04:09:00,560 --> 04:09:05,720 HERSELF AND HER CHILDREN AS 6644 04:09:05,720 --> 04:09:06,080 WELL. 6645 04:09:06,080 --> 04:09:09,000 WOMEN CENTERS, WOMEN'S EMERGENCY 6646 04:09:09,000 --> 04:09:10,400 CENTERS, ONE-STOP SHOP, LEGAL, 6647 04:09:10,400 --> 04:09:11,840 MEDICAL, SOCIAL SERVICES IN ONE 6648 04:09:11,840 --> 04:09:17,520 SPOT HAVE BEEN FOUND TO BE 6649 04:09:17,520 --> 04:09:17,840 EFFECTIVE. 6650 04:09:17,840 --> 04:09:25,880 AND FINALLY ANKLE BRACELETS THAT 6651 04:09:25,880 --> 04:09:27,400 CAN MONITOR. 6652 04:09:27,400 --> 04:09:30,880 SO, WHAT WE DO IS WE LOOKED AT 6653 04:09:30,880 --> 04:09:35,280 THE POLICIES AND THIS BUNDLE OF 6654 04:09:35,280 --> 04:09:37,000 SERVICES, RELATED TO BEST 6655 04:09:37,000 --> 04:09:41,520 PRACTICES, AND SO WE'RE 6656 04:09:41,520 --> 04:09:43,040 CURRENTLY COLLECTING -- IT'S 6657 04:09:43,040 --> 04:09:45,880 COMPLICATED BECAUSE THERE'S NO 6658 04:09:45,880 --> 04:09:46,560 SYSTEMATIC INFORMATION 6659 04:09:46,560 --> 04:09:50,280 AVAILABLE, WE'RE LOOKING AT NINE 6660 04:09:50,280 --> 04:09:52,560 COUNTRIES AND WE'RE MEASURING 6661 04:09:52,560 --> 04:09:54,200 HOTLINES, ACCESS TO THEM, 6662 04:09:54,200 --> 04:09:55,960 EMERGENCY CENTERS, LEGAL 6663 04:09:55,960 --> 04:09:59,680 SERVICES, HEALTH SERVICES, AND 6664 04:09:59,680 --> 04:10:00,480 SOCIOECONOMIC PROGRAMS, LOOKING 6665 04:10:00,480 --> 04:10:03,080 AT WHETHER AND HOW THERE'S 6666 04:10:03,080 --> 04:10:05,480 COORDINATION AMONG THESE 6667 04:10:05,480 --> 04:10:05,720 SERVICES. 6668 04:10:05,720 --> 04:10:06,280 BRIEFLY, SOME PRELIMINARY 6669 04:10:06,280 --> 04:10:08,440 FINDINGS WE HOPE TO PUBLISH A 6670 04:10:08,440 --> 04:10:12,160 REPORT BY THE END OF THE YEAR ON 6671 04:10:12,160 --> 04:10:16,760 IT, BUT 7 OUT OF 9 HAVE 6672 04:10:16,760 --> 04:10:19,720 DEDICATED HOT LINES, 7 OUT OF 9 6673 04:10:19,720 --> 04:10:23,320 HAVE EASILY ACCESSIBLE ONLINE 6674 04:10:23,320 --> 04:10:24,600 SERVICE INFORMATION, INCLUDES 6675 04:10:24,600 --> 04:10:27,520 SOME FORM OF WOMEN'S EMERGENCY 6676 04:10:27,520 --> 04:10:30,240 CENTERS, BUT THERE IS LARGE 6677 04:10:30,240 --> 04:10:35,200 VARIATION IN THE NUMBER OF 6678 04:10:35,200 --> 04:10:36,400 CENTERS, SERVICES OFFERED, 6679 04:10:36,400 --> 04:10:39,120 COORDINATION, OFTEN INCLUDES 6680 04:10:39,120 --> 04:10:44,600 NETWORK OF SHELTERS, AGAIN 6681 04:10:44,600 --> 04:10:46,160 VARIATION, HEALTH AND POLICE, 6682 04:10:46,160 --> 04:10:48,000 HOW TO HANDLE VIOLENCE, HOWEVER 6683 04:10:48,000 --> 04:10:49,840 THERE'S VERY LITTLE SYSTEMATIC 6684 04:10:49,840 --> 04:10:54,440 INFORMATION ABOUT HOW THEY ARE 6685 04:10:54,440 --> 04:10:55,560 ACTUALLY IMPLEMENTED. 6686 04:10:55,560 --> 04:10:59,080 ONE WAS NATIONAL LEVEL BROADLY 6687 04:10:59,080 --> 04:11:01,160 IMPLEMENTED EFFECTIVE PROGRAM, 6688 04:11:01,160 --> 04:11:02,440 IN TERMS OF SOCIOECONOMIC 6689 04:11:02,440 --> 04:11:03,440 ASSISTANCE REQUIRES NATIONAL 6690 04:11:03,440 --> 04:11:05,880 LEVEL HOUSING PROGRAM FOR 6691 04:11:05,880 --> 04:11:09,480 SURVIVORS AND ONE ARGENTINA HAS 6692 04:11:09,480 --> 04:11:13,080 NEW NATIONAL LEVEL CASH TRANSFER 6693 04:11:13,080 --> 04:11:13,320 PROGRAM. 6694 04:11:13,320 --> 04:11:15,400 THE MAIN CHALLENGES, ON THE 6695 04:11:15,400 --> 04:11:19,840 BASIS OF PRELIMINARY FINDINGS, 6696 04:11:19,840 --> 04:11:23,160 THAT WE FIND FOR ACHIEVING BEST 6697 04:11:23,160 --> 04:11:24,920 PRACTICES, LACK OF SUFFICIENT 6698 04:11:24,920 --> 04:11:26,800 AND STABLE BUDGET COMMITMENTS TO 6699 04:11:26,800 --> 04:11:30,400 ALL THESE KEY SERVICES, AND ALSO 6700 04:11:30,400 --> 04:11:31,240 LACK OF COORDINATION. 6701 04:11:31,240 --> 04:11:36,000 NOT JUST MONEY BUT ALSO 6702 04:11:36,000 --> 04:11:39,480 COORDINATION, ACROSS GOVERNMENTS 6703 04:11:39,480 --> 04:11:40,600 AND CIVIL SOCIETY SERVICES. 6704 04:11:40,600 --> 04:11:43,440 I'M ALMOST OUT OF TIME. 6705 04:11:43,440 --> 04:11:44,400 BEST PRACTICES POLICY 6706 04:11:44,400 --> 04:11:45,520 RECOMMENDATIONS FOR CASH 6707 04:11:45,520 --> 04:11:48,880 TRANSFERS AS WELL AS DOMESTIC 6708 04:11:48,880 --> 04:11:51,840 VIOLENCE SERVICES, DESPERATE 6709 04:11:51,840 --> 04:11:56,320 NEED FOR STABLE RESEARCH 6710 04:11:56,320 --> 04:11:58,840 ALLOCATION, AND FOR BUNDLE OF 6711 04:11:58,840 --> 04:12:01,920 DOMESTIC VIOLENCE SERVICES. 6712 04:12:01,920 --> 04:12:03,120 INVESTMENT IN COORDINATION, 6713 04:12:03,120 --> 04:12:03,680 BETWEEN CASH TRANSFER AND 6714 04:12:03,680 --> 04:12:05,840 DOMESTIC VIOLENCE AS MUCH AS, 6715 04:12:05,840 --> 04:12:08,240 AND BETWEEN DIFFERENT TYPES AND 6716 04:12:08,240 --> 04:12:09,880 DIMENSION OF DOMESTIC VIOLENCE 6717 04:12:09,880 --> 04:12:10,760 SERVICES. 6718 04:12:10,760 --> 04:12:13,280 AND HERE WHAT'S NEEDED IS 6719 04:12:13,280 --> 04:12:15,840 INTERSECTING AGENCIES WITH HIGH 6720 04:12:15,840 --> 04:12:17,880 PROFILE THAT PRIORITIZE THESE 6721 04:12:17,880 --> 04:12:18,600 ISSUES. 6722 04:12:18,600 --> 04:12:20,640 INVESTMENT IN PUBLICLY AVAILABLE 6723 04:12:20,640 --> 04:12:22,680 ONLINE RESOURCES, INTERNET 6724 04:12:22,680 --> 04:12:24,280 CONNECTIVITY, AND FINALLY LAST 6725 04:12:24,280 --> 04:12:27,000 BUT NOT LEAST INVESTMENT IN DATA 6726 04:12:27,000 --> 04:12:28,360 COLLECTION, SYSTEMATIC DATA 6727 04:12:28,360 --> 04:12:29,960 COLLECTION, TAKEUP RATES, 6728 04:12:29,960 --> 04:12:32,840 IMPACTS EVALUATION, AND HERE 6729 04:12:32,840 --> 04:12:36,640 ALSO AN IMPORTANT ROLE, NOT JUST 6730 04:12:36,640 --> 04:12:37,760 FOR MINISTRIES BUT AGENCIES TO 6731 04:12:37,760 --> 04:12:40,200 DO ANALYSES OF HOW GOVERNMENT 6732 04:12:40,200 --> 04:12:42,040 AGENCIES ARE PERFORMING. 6733 04:12:42,040 --> 04:12:42,400 I'LL STOP HERE. 6734 04:12:42,400 --> 04:12:44,200 I HAVE A LIST OF SITES FOR 6735 04:12:44,200 --> 04:12:45,360 ANYBODY INTERESTED BUT I'M OUT 6736 04:12:45,360 --> 04:12:45,880 OF TIME. 6737 04:12:45,880 --> 04:12:48,360 THANK YOU. 6738 04:12:48,360 --> 04:12:54,400 6739 04:12:54,400 --> 04:12:57,480 6740 04:12:57,480 --> 04:13:02,960 6741 04:13:02,960 --> 04:13:06,920 >>HELLO, EVERYONE I'M DR. 6742 04:13:06,920 --> 04:13:07,840 CAROLINA SANABRIA, MODERATOR FOR 6743 04:13:07,840 --> 04:13:09,320 THIS SESSION. 6744 04:13:09,320 --> 04:13:15,440 THANK YOU SO MUCH TO DR. 6745 04:13:15,440 --> 04:13:17,000 PATON-BREWER FOR TALKING ABOUT 6746 04:13:17,000 --> 04:13:19,400 ONE HEALTH, FOR DR. BAMBS FOR 6747 04:13:19,400 --> 04:13:21,480 TALKING ABOUT POLICIES INVOLVING 6748 04:13:21,480 --> 04:13:24,200 OBESITY, TOBACCO, AND ALCOHOL IN 6749 04:13:24,200 --> 04:13:29,800 CHILE AND TO DR. BLOFIELD FOR 6750 04:13:29,800 --> 04:13:34,040 TALKING TO US ABOUT DOMESTIC 6751 04:13:34,040 --> 04:13:36,200 VIOLENCE AND CASH TRANSFER 6752 04:13:36,200 --> 04:13:37,880 POLICIES. 6753 04:13:37,880 --> 04:13:39,400 FIRST STARTING WITH INDIVIDUAL 6754 04:13:39,400 --> 04:13:40,600 EASY FOR RESPECTIVE SPEAKERS AND 6755 04:13:40,600 --> 04:13:44,120 THEN WE'RE GOING TO BE ASKING 6756 04:13:44,120 --> 04:13:45,400 MORE GENERAL QUESTIONS AND WE 6757 04:13:45,400 --> 04:13:53,760 WANT THIS SESSION TO BE 6758 04:13:53,760 --> 04:13:56,920 INTERACTIVE, SO PLEASE FEEL FREE 6759 04:13:56,920 --> 04:13:58,560 TO JUMP IN IF YOU HEAR SOMEBODY 6760 04:13:58,560 --> 04:14:00,320 ELSE TALKING ABOUT A TOPIC AND 6761 04:14:00,320 --> 04:14:03,280 YOU WANT TO ADD SOMETHING. 6762 04:14:03,280 --> 04:14:05,040 WE REALLY HOPE THIS IS A TIME 6763 04:14:05,040 --> 04:14:05,920 FOR RICH DISCUSSION. 6764 04:14:05,920 --> 04:14:12,800 I'M GOING TO START OFF WITH 6765 04:14:12,800 --> 04:14:14,240 ASKING DR. PETTIAN-BREWER A 6766 04:14:14,240 --> 04:14:14,640 QUESTION. 6767 04:14:14,640 --> 04:14:20,040 THANK YOU FOR YOUR PRESENTATION 6768 04:14:20,040 --> 04:14:21,640 ON ONE HEALTH. 6769 04:14:21,640 --> 04:14:27,240 A QUESTION FROM THE AUDIENCE, 6770 04:14:27,240 --> 04:14:29,520 WITH REGARDS TO POLICIES AND 6771 04:14:29,520 --> 04:14:32,280 THEIR IMPACT ON CHRONIC DISEASES 6772 04:14:32,280 --> 04:14:38,320 AND WE'D LIKE TO KNOW IF YOU 6773 04:14:38,320 --> 04:14:44,920 COULD LIST PERHAPS EXAMPLES OF 6774 04:14:44,920 --> 04:14:46,920 SOME OF THOSE POLICIES. 6775 04:14:46,920 --> 04:14:47,680 >>AS I MENTIONED BEFORE, THE 6776 04:14:47,680 --> 04:14:51,640 IDEA IS TO BRING THE ONE HEALTH 6777 04:14:51,640 --> 04:14:54,040 CONCEPT TO OUR AUDIENCE SO WE 6778 04:14:54,040 --> 04:14:55,680 CAN, AS I'LL GIVE EXAMPLES 6779 04:14:55,680 --> 04:15:01,840 LATER, WE CAN WORK TOGETHER. 6780 04:15:01,840 --> 04:15:04,520 SO IT IS -- POLICIES, IT DEPENDS 6781 04:15:04,520 --> 04:15:07,400 ON WHICH FIELD WE'RE WORKING ON, 6782 04:15:07,400 --> 04:15:10,240 AND THAT'S HOW SOME HAVE ALREADY 6783 04:15:10,240 --> 04:15:11,760 IMPLEMENTED, OTHERS ARE NOT 6784 04:15:11,760 --> 04:15:12,080 IMPLEMENTED. 6785 04:15:12,080 --> 04:15:14,600 SO SPECIFICALLY FOR ONE HEALTH, 6786 04:15:14,600 --> 04:15:16,240 THERE ARE NO POLICIES 6787 04:15:16,240 --> 04:15:18,200 IMPLEMENTED YET, AND AS WE CAN 6788 04:15:18,200 --> 04:15:27,520 SEE THAT ONE HEALTH IS A 6789 04:15:27,520 --> 04:15:29,640 HOLISTIC APPROACH TO THE HEALTH, 6790 04:15:29,640 --> 04:15:33,120 HOW WE'RE GOING TO DEAL WITH 6791 04:15:33,120 --> 04:15:34,600 DISEASES, TOGETHER, DIFFERENT 6792 04:15:34,600 --> 04:15:35,080 STAKEHOLDERS, DIFFERENT 6793 04:15:35,080 --> 04:15:37,080 PROFESSIONALS, HOW WE CAN WORK. 6794 04:15:37,080 --> 04:15:40,560 SO COMING FROM THE POLICIES, 6795 04:15:40,560 --> 04:15:41,880 WE'RE TALKING ABOUT RESEARCHERS, 6796 04:15:41,880 --> 04:15:43,400 WE'RE TALKING ABOUT COMMUNITY 6797 04:15:43,400 --> 04:15:45,840 LEADERS, AND THEN WE'RE TALKING 6798 04:15:45,840 --> 04:15:47,240 WITH GOVERNMENT AND GOVERNANCE. 6799 04:15:47,240 --> 04:15:50,160 WE'RE NOT TALKING TO EACH OTHER 6800 04:15:50,160 --> 04:15:50,360 YET. 6801 04:15:50,360 --> 04:15:52,600 SO SOMETIMES THEY ARE DEVELOPING 6802 04:15:52,600 --> 04:15:54,440 THE POLICIES, BUT IT'S NOT IN A 6803 04:15:54,440 --> 04:15:56,520 PAPER YET AND IT'S NOT 6804 04:15:56,520 --> 04:15:56,800 IMPLEMENTED. 6805 04:15:56,800 --> 04:15:59,240 AND HERE WE ARE WITH THE 6806 04:15:59,240 --> 04:16:01,800 RESEARCH RESULTS, WITH THE 6807 04:16:01,800 --> 04:16:03,120 COMMUNITY, BUT WE'RE NOT TALKING 6808 04:16:03,120 --> 04:16:07,280 YET WITH EACH OTHER. 6809 04:16:07,280 --> 04:16:11,440 SO IF THERE ARE NUMBERS, YES, 6810 04:16:11,440 --> 04:16:16,440 EVEN PRESIDENTS PRESIDENTS 6811 04:16:16,440 --> 04:16:18,120 SIGNED -- OBAMA SIGNED A ONE 6812 04:16:18,120 --> 04:16:20,520 HEALTH AGREEMENT BUT IT'S NOT 6813 04:16:20,520 --> 04:16:22,680 YET KNOWN EVERYWHERE, OR 6814 04:16:22,680 --> 04:16:26,400 SENATORS IN EACH STATE HAS 6815 04:16:26,400 --> 04:16:28,600 ALREADY APPROVED THE ONE HEALTH 6816 04:16:28,600 --> 04:16:30,800 CONCEPT, BUT NOT EVERYBODY KNOWS 6817 04:16:30,800 --> 04:16:30,960 YET. 6818 04:16:30,960 --> 04:16:32,640 I'M HERE IN BRAZIL TODAY, AND 6819 04:16:32,640 --> 04:16:35,920 THE SENATE ARE MEETING TODAY TO 6820 04:16:35,920 --> 04:16:37,840 IMPLEMENT, TO HAVE SIGNED A 6821 04:16:37,840 --> 04:16:41,520 DOCUMENT THAT THERE'S A MEETING 6822 04:16:41,520 --> 04:16:43,400 HAPPENING IN ONE STATE, ANOTHER 6823 04:16:43,400 --> 04:16:44,920 MEETING OF RESEARCHERS OF THE 6824 04:16:44,920 --> 04:16:46,680 SAME TALK IN ANOTHER STATE. 6825 04:16:46,680 --> 04:16:49,720 SO I THINK IT'S HARD, IT IS VERY 6826 04:16:49,720 --> 04:16:50,720 GOOD. 6827 04:16:50,720 --> 04:16:55,400 WE NEED TO HAVE POLICY, IT WILL 6828 04:16:55,400 --> 04:16:57,160 BE EVEN IMPORTANT FOR DR. MERIKE 6829 04:16:57,160 --> 04:16:59,600 WHEN WE NEEDS THE FUNDING, THE 6830 04:16:59,600 --> 04:17:02,160 CASH TO GO, THERE'S NOT YET 6831 04:17:02,160 --> 04:17:03,200 WHERE IS IT GOING. 6832 04:17:03,200 --> 04:17:06,240 SO I THINK I WOULD LIKE TO BRING 6833 04:17:06,240 --> 04:17:07,680 FIRST THE DIFFICULTIES WE HAVE 6834 04:17:07,680 --> 04:17:09,200 WHEN WE TALK ABOUT PUBLIC 6835 04:17:09,200 --> 04:17:14,480 POLICIES THAT WE NEED IT, BUT IT 6836 04:17:14,480 --> 04:17:16,880 IS HARD TO HAVE EVERYBODY 6837 04:17:16,880 --> 04:17:18,200 TALKING THE SINGLE LANGUAGE, I 6838 04:17:18,200 --> 04:17:23,320 WILL SAY, AS TO BRING THE 6839 04:17:23,320 --> 04:17:24,120 CONTROVERSY HERE. 6840 04:17:24,120 --> 04:17:26,080 WE STILL NEED WORK TO BE DONE 6841 04:17:26,080 --> 04:17:28,360 BUT I'M GLAD WE'RE ALL THE HERE 6842 04:17:28,360 --> 04:17:29,240 TOGETHER. 6843 04:17:29,240 --> 04:17:30,000 >>THANK YOU. 6844 04:17:30,000 --> 04:17:33,200 >>HOPEFULLY TO HELP, TO BRING 6845 04:17:33,200 --> 04:17:33,560 THE DISCUSSION. 6846 04:17:33,560 --> 04:17:34,880 >>THANK YOU SO MUCH FOR THE 6847 04:17:34,880 --> 04:17:36,160 ANSWER TO YOUR QUESTION. 6848 04:17:36,160 --> 04:17:37,640 SOUNDS LIKE WHAT YOU'RE 6849 04:17:37,640 --> 04:17:39,560 DESCRIBING IS THAT YOU'RE TRYING 6850 04:17:39,560 --> 04:17:43,480 TO LAY DOWN THE FOUNDATION AND 6851 04:17:43,480 --> 04:17:45,080 INFRASTRUCTURE FIRST IN ORDER TO 6852 04:17:45,080 --> 04:17:47,560 HAVE THAT SERVE AS A CATALYST 6853 04:17:47,560 --> 04:17:48,880 FOR DEVELOPING POLICIES. 6854 04:17:48,880 --> 04:17:51,160 DR. BAMBS HAS A COMMENT THAT SHE 6855 04:17:51,160 --> 04:17:53,880 WANTS TO SAY. 6856 04:17:53,880 --> 04:17:54,880 >>YEAH, THANK YOU. 6857 04:17:54,880 --> 04:18:00,000 CAROLINA, YOU GAVE US PERMISSION 6858 04:18:00,000 --> 04:18:00,760 TO JUMP IN. 6859 04:18:00,760 --> 04:18:03,520 I HAVE A QUESTION FOR MY 6860 04:18:03,520 --> 04:18:04,960 COLLEAGUE, CHRISTINA, IN TERMS 6861 04:18:04,960 --> 04:18:07,120 OF THE ONE HEALTH CONCEPT. 6862 04:18:07,120 --> 04:18:10,000 WE HAVE BEEN WORKING WITH NEW 6863 04:18:10,000 --> 04:18:12,720 FRAMEWORK HERE IN MY UNIVERSITY 6864 04:18:12,720 --> 04:18:15,160 IN CHILE, BUT ONE THING THAT I 6865 04:18:15,160 --> 04:18:20,400 WOULD LIKE YOU, IF YOU CAN 6866 04:18:20,400 --> 04:18:24,680 COMMENT ON, IS THAT AS FAR AS I 6867 04:18:24,680 --> 04:18:27,200 HAVE UNDERSTOOD, THIS NEW 6868 04:18:27,200 --> 04:18:32,320 CONCEPT WAS BEGUN, TRYING TO 6869 04:18:32,320 --> 04:18:35,400 UNDERSTAND THE WHOLE PHENOMENON 6870 04:18:35,400 --> 04:18:37,920 FROM THE DISEASE FRAMEWORK, HOW 6871 04:18:37,920 --> 04:18:42,080 TO PREVENT DISEASES THAT CAN BE 6872 04:18:42,080 --> 04:18:45,120 CAUSED OR TRANSMITTED BY VECTORS 6873 04:18:45,120 --> 04:18:49,080 OR WHATEVER, MOSQUITOES OR CATS 6874 04:18:49,080 --> 04:18:52,480 AND DOGS, BUT I'M BRINGING THE 6875 04:18:52,480 --> 04:18:56,200 WHOLE CONCEPT OF THE ENVIRONMENT 6876 04:18:56,200 --> 04:18:56,480 TOGETHER. 6877 04:18:56,480 --> 04:19:03,200 BUT MY POINT IS HOW DO YOU SEE 6878 04:19:03,200 --> 04:19:06,160 PROMOTION OF HEALTH AND 6879 04:19:06,160 --> 04:19:08,120 PREVENTION OF DISEASES FROM THIS 6880 04:19:08,120 --> 04:19:10,640 NEW CONCEPT OF ONE HEALTH. 6881 04:19:10,640 --> 04:19:15,160 CAN WE SHIFT A LITTLE BIT THE 6882 04:19:15,160 --> 04:19:19,000 VIEW FROM THE DISEASE MODEL TO 6883 04:19:19,000 --> 04:19:21,920 WHAT'S A MORE PROMOTIONAL MODEL, 6884 04:19:21,920 --> 04:19:23,640 AND MAYBE YOU ARE ALREADY DOING 6885 04:19:23,640 --> 04:19:24,160 THAT. 6886 04:19:24,160 --> 04:19:25,360 BUT THAT'S MY COMMENT. 6887 04:19:25,360 --> 04:19:30,960 IF YOU CAN SHARE SOME THOUGHTS. 6888 04:19:30,960 --> 04:19:32,320 >>YES, THANK YOU, CLAUDIA. 6889 04:19:32,320 --> 04:19:34,520 I SAW YOUR NAME, YES, A GROUP 6890 04:19:34,520 --> 04:19:35,520 FROM ONE HEALTH. 6891 04:19:35,520 --> 04:19:38,720 WE STILL NEED TO PUT TOGETHER 6892 04:19:38,720 --> 04:19:39,920 THE CONNECTIONS. 6893 04:19:39,920 --> 04:19:44,720 I WAS NOT ABLE, AND IT TAKES A 6894 04:19:44,720 --> 04:19:46,160 SEMESTER TO TEACH ONE HEALTH 6895 04:19:46,160 --> 04:19:48,280 HISTORY AND CONCEPT BECAUSE OF 6896 04:19:48,280 --> 04:19:49,560 MISCONCEPT OF ONE HEALTH, 6897 04:19:49,560 --> 04:19:53,480 USUALLY WHEN WE TALK ONE HEALTH, 6898 04:19:53,480 --> 04:19:54,440 VETERINARIANS AND INFECTIOUS 6899 04:19:54,440 --> 04:19:56,080 DISEASE PEOPLE JUMP IN, WE'RE 6900 04:19:56,080 --> 04:19:59,640 TAKING CARE OF DISEASES, 6901 04:19:59,640 --> 04:20:01,280 PREVENTION, ZOONOSIS. 6902 04:20:01,280 --> 04:20:04,040 ONE HEALTH IS BEYOND ZOONOTIC 6903 04:20:04,040 --> 04:20:06,320 DISEASES, IT IS BEYOND DISEASES, 6904 04:20:06,320 --> 04:20:08,920 IT'S THE OPPOSITE. 6905 04:20:08,920 --> 04:20:12,880 IT IS HOUSING, THE INDIGENOUS 6906 04:20:12,880 --> 04:20:16,720 BRAIN, SO THE ENVIRONMENTAL AND 6907 04:20:16,720 --> 04:20:17,360 EVERYBODY HEALTH INCLUDING 6908 04:20:17,360 --> 04:20:21,240 SPIRITUAL, TODAY I TALK WITH 6909 04:20:21,240 --> 04:20:22,200 INDIGENOUS POPULATION, 6910 04:20:22,200 --> 04:20:25,600 IMPORTANCE OF SPIRITUAL AND 6911 04:20:25,600 --> 04:20:26,680 CULTURAL SHARING, THESE 6912 04:20:26,680 --> 04:20:28,440 POPULATIONS ALREADY HAVE, WHICH 6913 04:20:28,440 --> 04:20:32,040 IS BALANCE OF THE ENVIRONMENT. 6914 04:20:32,040 --> 04:20:38,200 AGAIN, IT DEPENDENTS WHO YOU'RE 6915 04:20:38,200 --> 04:20:39,640 TALKING TO, PREVENTING DISEASES 6916 04:20:39,640 --> 04:20:42,480 TO THE NEXT PANDEMIC, AND 6917 04:20:42,480 --> 04:20:44,120 OTHERS, BRINGING IN AMERICAN 6918 04:20:44,120 --> 04:20:47,400 POINT OF VIEW NOW WITH DOMESTIC 6919 04:20:47,400 --> 04:20:48,280 VIOLENCE. 6920 04:20:48,280 --> 04:20:50,160 AS VETERINARIANS WE'RE THE FIRST 6921 04:20:50,160 --> 04:20:51,720 LINE TO DETECT VIOLENCE IN THE 6922 04:20:51,720 --> 04:20:53,400 HOUSEHOLD BECAUSE OF THE PETS. 6923 04:20:53,400 --> 04:20:55,200 WE DON'T KNOW WHAT TO DO. 6924 04:20:55,200 --> 04:20:57,320 BECAUSE WE KNOW WHAT IS 6925 04:20:57,320 --> 04:20:59,000 HAPPENING, WE HAVE AN ANIMAL 6926 04:20:59,000 --> 04:21:00,240 WHICH WAS VIOLATED OR SOMETHING, 6927 04:21:00,240 --> 04:21:02,640 BUT AS VETERINARIANS WE CANNOT 6928 04:21:02,640 --> 04:21:03,720 ACT AS PSYCHOLOGISTS AND 6929 04:21:03,720 --> 04:21:05,800 PSYCHIATRISTS AND DON'T HAVE A 6930 04:21:05,800 --> 04:21:07,080 SOCIAL SCIENCES GROUP TO GO 6931 04:21:07,080 --> 04:21:12,360 KNOCK THE DOOR, PLEASE COME AND 6932 04:21:12,360 --> 04:21:12,920 HELP. 6933 04:21:12,920 --> 04:21:14,760 ACCUMULATORS, WHOEVER IS 6934 04:21:14,760 --> 04:21:15,880 ACCUMULATING ANIMALS, ALSO THIS 6935 04:21:15,880 --> 04:21:16,920 MENTAL HEALTH. 6936 04:21:16,920 --> 04:21:23,160 SO BRING HERE THE ONE HEALTH 6937 04:21:23,160 --> 04:21:27,120 BRINGS THE OPPOSITE 6938 04:21:27,120 --> 04:21:30,400 BRINGING THE HEALTH INCLUDING 6939 04:21:30,400 --> 04:21:33,920 MENTAL HEALTH, SPIRITUAL 6940 04:21:33,920 --> 04:21:36,320 CONNECTION, AND FINANCIAL 6941 04:21:36,320 --> 04:21:37,760 ECONOMICS HEALTH AND ALSO 6942 04:21:37,760 --> 04:21:40,280 PLANETARY HEALTH. 6943 04:21:40,280 --> 04:21:41,800 IT'S SO COMPLEX BUT I THINK 6944 04:21:41,800 --> 04:21:44,440 CLAUDIA WOULD LIKE TO SAY AS 6945 04:21:44,440 --> 04:21:47,360 WE'RE ALL GROWING TOGETHER, IT 6946 04:21:47,360 --> 04:21:49,920 IS DIFFERENT SHIFT, THE HISTORY 6947 04:21:49,920 --> 04:21:54,600 I BROUGHT TOGETHER IS FROM ONE 6948 04:21:54,600 --> 04:21:56,480 MEDICINE, COMPARED TO MEDICINES, 6949 04:21:56,480 --> 04:21:57,760 THE VETERINARIANS, OH, I KNOW 6950 04:21:57,760 --> 04:22:00,520 ALREADY, I'VE BEEN DOING THIS MY 6951 04:22:00,520 --> 04:22:01,400 ENTIRE LIFE. 6952 04:22:01,400 --> 04:22:03,800 IT'S MORE. 6953 04:22:03,800 --> 04:22:07,200 SOCIAL SCIENCE, ANTHROPOLOGY 6954 04:22:07,200 --> 04:22:10,040 COMES TO BRING THIS. 6955 04:22:10,040 --> 04:22:14,000 IT IS FOCUSING ON THE HEALTH, 6956 04:22:14,000 --> 04:22:15,520 PLANETARY HEALTH, GLOBAL HEALTH, 6957 04:22:15,520 --> 04:22:17,080 POPULATION HEALTH, NOT SO 6958 04:22:17,080 --> 04:22:20,360 FOCUSED ON THE DISEASES. 6959 04:22:20,360 --> 04:22:22,080 DOES THAT MAKE SENSE? 6960 04:22:22,080 --> 04:22:23,280 THIRTY MINUTES, IT'S IMPOSSIBLE 6961 04:22:23,280 --> 04:22:23,880 TO SHARE. 6962 04:22:23,880 --> 04:22:24,480 >>THANK YOU. 6963 04:22:24,480 --> 04:22:29,520 >>THANK YOU SO MUCH FOR THAT 6964 04:22:29,520 --> 04:22:32,520 RICH DISCUSSION. 6965 04:22:32,520 --> 04:22:35,200 NOW A QUESTION FOR DR. BAMBS. 6966 04:22:35,200 --> 04:22:36,760 DR. BAMBS, YOU MENTIONED WITH 6967 04:22:36,760 --> 04:22:37,960 REGARDS TO SMOKING THAT THERE 6968 04:22:37,960 --> 04:22:41,240 WAS A DROP IN THE PREVALENCE 6969 04:22:41,240 --> 04:22:49,120 WITH SOME OF THE POLICIES, 6970 04:22:49,120 --> 04:22:53,920 SPECIFICALLY TOBACCO TAXATION, 6971 04:22:53,920 --> 04:22:56,520 ARE THERE REPORTS THAT RESULTED 6972 04:22:56,520 --> 04:23:00,200 AFTER THAT DROP IN SMOKING 6973 04:23:00,200 --> 04:23:01,960 PREVALENCE? 6974 04:23:01,960 --> 04:23:07,640 >>YES, THANK YOU FOR YOUR 6975 04:23:07,640 --> 04:23:08,200 QUESTION. 6976 04:23:08,200 --> 04:23:11,880 TOBACCO, THE TOBACCO EPIDEMIC IS 6977 04:23:11,880 --> 04:23:13,000 PROBABLY THE MOST STUDIED 6978 04:23:13,000 --> 04:23:19,000 EPIDEMIC IN THE WHOLE WORLD, IN 6979 04:23:19,000 --> 04:23:20,760 CHILE AS WELL, MANY LESSONS 6980 04:23:20,760 --> 04:23:22,480 LEARNED IN TERMS OF 6981 04:23:22,480 --> 04:23:25,800 IMPLEMENTATION, BUT ALSO IN 6982 04:23:25,800 --> 04:23:29,320 TERMS OF THE OUTCOMES, IN TERMS 6983 04:23:29,320 --> 04:23:36,080 OF, FOR INSTANCE, WHEN THE NEW 6984 04:23:36,080 --> 04:23:40,920 LAW REGULATING SMOKE-FREE PUBLIC 6985 04:23:40,920 --> 04:23:44,720 SPACES WAS PASSED, THERE WAS 6986 04:23:44,720 --> 04:23:47,920 DECREASE IN THE HOSPITALIZATIONS 6987 04:23:47,920 --> 04:23:50,160 FOR MYOCARDIAL INFARCTION, AND 6988 04:23:50,160 --> 04:23:52,000 OF COURSE RESPIRATORY DISEASES. 6989 04:23:52,000 --> 04:23:59,760 SO, WE HAVE MEASURED THAT IN 6990 04:23:59,760 --> 04:24:04,320 SEVERAL OUTCOMES, ALSO WE HAVE 6991 04:24:04,320 --> 04:24:10,920 ESTIMATED RISKING THAT CAN BE 6992 04:24:10,920 --> 04:24:12,000 AVOIDED BY FURTHER REGULATIONS 6993 04:24:12,000 --> 04:24:14,320 BUT STILL WITH ALL THIS ACCESS 6994 04:24:14,320 --> 04:24:17,720 WE HAVE A CONSTANT FIGHT AGAINST 6995 04:24:17,720 --> 04:24:27,920 TOBACCO IN CHILE AND A LONG WAY 6996 04:24:27,920 --> 04:24:30,480 TO HAVE MORE CONTROL. 6997 04:24:30,480 --> 04:24:31,480 THANK YOU, APPRECIATE YOUR 6998 04:24:31,480 --> 04:24:37,320 ANSWER, GREAT YOU WERE ABLE TO 6999 04:24:37,320 --> 04:24:38,200 MEASURE DECREASES IN 7000 04:24:38,200 --> 04:24:41,000 HOSPITALIZATIONS AND THEN I 7001 04:24:41,000 --> 04:24:43,760 WANTED TO ASK DR. BLOFIELD A 7002 04:24:43,760 --> 04:24:44,840 QUESTION. 7003 04:24:44,840 --> 04:24:47,800 I KNOW YOU DISCUSSED CASH 7004 04:24:47,800 --> 04:24:50,640 TRANSFERS AND THEIR IMPACT ON 7005 04:24:50,640 --> 04:24:51,320 DOMESTIC VIOLENCE. 7006 04:24:51,320 --> 04:24:55,040 ONE OTHER QUESTION THAT WE HAD 7007 04:24:55,040 --> 04:25:00,520 WAS WITH REGARDS TO POLICIES 7008 04:25:00,520 --> 04:25:01,600 LOOKING AT SOCIOCULTURAL 7009 04:25:01,600 --> 04:25:02,920 ETIOLOGICAL FACTORS OF DOMESTIC 7010 04:25:02,920 --> 04:25:03,200 VIOLENCE. 7011 04:25:03,200 --> 04:25:07,960 ARE THERE ANY -- YOU MENTIONED 7012 04:25:07,960 --> 04:25:09,600 MULTIPLE DIFFERENT POLICIES, BUT 7013 04:25:09,600 --> 04:25:17,920 ARE THERE POLICIES THAT INVOLVE 7014 04:25:17,920 --> 04:25:20,000 ADDRESSING ROOT CAUSE ISSUES, 7015 04:25:20,000 --> 04:25:24,720 LIKE GENDER ROLES, EDUCATION ON 7016 04:25:24,720 --> 04:25:30,200 SOME OF THESE VALUES OR FACTORS? 7017 04:25:30,200 --> 04:25:31,080 >>YES, CERTAINLY. 7018 04:25:31,080 --> 04:25:38,640 WHEN YOU GO INTO THINGS LIKE 7019 04:25:38,640 --> 04:25:40,720 EDUCATION, IT CAN BE VERY BROAD, 7020 04:25:40,720 --> 04:25:41,080 RIGHT? 7021 04:25:41,080 --> 04:25:43,120 NOT EVERYTHING NECESSARILY NEEDS 7022 04:25:43,120 --> 04:25:44,480 TO FOCUS ON VIOLENCE PER SE, BUT 7023 04:25:44,480 --> 04:25:48,040 JUST IN TERMS OF THE EDUCATION 7024 04:25:48,040 --> 04:25:50,360 SYSTEM, PROMOTING, YOU KNOW, 7025 04:25:50,360 --> 04:25:51,880 NON-VIOLENT WAYS OF 7026 04:25:51,880 --> 04:25:52,520 COMMUNICATING, PROMOTING GENDER 7027 04:25:52,520 --> 04:25:53,640 EQUALITY, ET CETERA, ET CETERA. 7028 04:25:53,640 --> 04:25:55,800 I MEAN, ALL THOSE FACTORS COME 7029 04:25:55,800 --> 04:25:57,160 INTO PLAY, RIGHT? 7030 04:25:57,160 --> 04:26:00,080 BUT THERE ARE ALSO MORE 7031 04:26:00,080 --> 04:26:02,520 IMMEDIATE PROGRAMS, SOME 7032 04:26:02,520 --> 04:26:04,480 INTERESTING PROGRAMS ACTUALLY 7033 04:26:04,480 --> 04:26:08,480 THAT -- I MEAN OUR STUDY FOR NOW 7034 04:26:08,480 --> 04:26:12,240 IS LIMITED TO THE IMMEDIATE 7035 04:26:12,240 --> 04:26:15,000 FIRST RESPONSE, SO THERE ARE 7036 04:26:15,000 --> 04:26:16,040 ALSO INSIPIENT PROGRAMS AND 7037 04:26:16,040 --> 04:26:20,520 CHILE IS ONE OF THEM WHERE IT'S 7038 04:26:20,520 --> 04:26:24,680 MORE PREVALENT TO ADDRESSING 7039 04:26:24,680 --> 04:26:26,880 MEN, TO PERPETRATORS, MEN'S 7040 04:26:26,880 --> 04:26:28,280 REHABILITATION CENTERS, AND THEY 7041 04:26:28,280 --> 04:26:30,680 ARE POPPING UP IN MORE AND MORE 7042 04:26:30,680 --> 04:26:36,240 PLACES, THE PROBLEM IS THAT THEY 7043 04:26:36,240 --> 04:26:38,120 ARE VERY NOT LETTING MEN WANT TO 7044 04:26:38,120 --> 04:26:40,760 GO AND THEY TEND TO DROP OUT, 7045 04:26:40,760 --> 04:26:40,960 RIGHT? 7046 04:26:40,960 --> 04:26:43,720 IF IT'S ONLY THOSE WILLING TO 7047 04:26:43,720 --> 04:26:45,280 GO, THERE'S A HUGE SELECTION 7048 04:26:45,280 --> 04:26:47,120 BIAS, ET CETERA, ET CETERA, SO 7049 04:26:47,120 --> 04:26:49,120 PROGRAMS ARE NOT AS EFFECTIVE AS 7050 04:26:49,120 --> 04:26:50,280 THEY COULD BE. 7051 04:26:50,280 --> 04:26:51,480 THERE'S CERTAINLY OTHER PROGRAMS 7052 04:26:51,480 --> 04:26:55,680 AS WELL. 7053 04:26:55,680 --> 04:26:59,800 OVERALL THE, YEAH, I FOCUS LATIN 7054 04:26:59,800 --> 04:27:01,400 AMERICA, NOT AN EXPERT IN THE 7055 04:27:01,400 --> 04:27:05,200 U.S. BUT LOOKING AT THE MOST 7056 04:27:05,200 --> 04:27:09,040 RECENT WORLD HEALTH ORGANIZATION 7057 04:27:09,040 --> 04:27:10,080 REPORT BROUGHT UP STATISTICAL 7058 04:27:10,080 --> 04:27:13,960 25%, THE RATES IN THE U.S. ARE 7059 04:27:13,960 --> 04:27:15,600 HIGHER, IT'S NOT THAT LAST 7060 04:27:15,600 --> 04:27:18,320 INAMERICA IS MORE VIOLENT THAN 7061 04:27:18,320 --> 04:27:20,720 THE UNITED STATES, IN LATIN 7062 04:27:20,720 --> 04:27:28,360 AMERICA THERE'S HUGE VARIABLE 7063 04:27:28,360 --> 04:27:28,880 LEVELS. 7064 04:27:28,880 --> 04:27:31,360 EXTREMELY HIGH LEVELS IN 7065 04:27:31,360 --> 04:27:32,640 BOLIVIA, RIGHT? 7066 04:27:32,640 --> 04:27:35,360 SO, HUGE VARIATION THERE. 7067 04:27:35,360 --> 04:27:40,920 ANOTHER INTERESTING THING TO 7068 04:27:40,920 --> 04:27:46,640 OBSERVE IN HERE, I'LL TAP MY 7069 04:27:46,640 --> 04:27:48,600 COLLEAGUE MARY ALICE ELSEBERG, 7070 04:27:48,600 --> 04:27:51,320 WHO COULDN'T JOIN, DID AN 7071 04:27:51,320 --> 04:27:53,520 EXCELLENT STUDY IN NICARAGUA IN 7072 04:27:53,520 --> 04:27:56,160 1995, AND 20 YEARS LATER, WAS 7073 04:27:56,160 --> 04:27:58,720 ABLE TO MEASURE AN ACTUAL 7074 04:27:58,720 --> 04:28:00,760 DECREASE IN LEVELS OF VIOLENTS 7075 04:28:00,760 --> 04:28:04,840 WHICH WE JUST DON'T HAVE THIS 7076 04:28:04,840 --> 04:28:08,480 KIND OF COMPARATIVE DATA. 7077 04:28:08,480 --> 04:28:11,280 ACROSS NATIONAL DATA AND DATA 7078 04:28:11,280 --> 04:28:12,840 THAT'S RELIABLE AND WE CAN SAY 7079 04:28:12,840 --> 04:28:15,360 THIS IS A TREND, NOT JUST 7080 04:28:15,360 --> 04:28:16,240 DIFFERENCE REPORTING, FOR 7081 04:28:16,240 --> 04:28:18,200 EXAMPLE, THE WAY WE ASK THE 7082 04:28:18,200 --> 04:28:20,280 QUESTION, ET CETERA, AND THERE 7083 04:28:20,280 --> 04:28:22,480 SEEMS TO BE -- THIS IS SOMETHING 7084 04:28:22,480 --> 04:28:25,240 VERY POSITIVE AND OVERALL 7085 04:28:25,240 --> 04:28:28,520 DECREASE IN LEVELS OF VIOLENCE, 7086 04:28:28,520 --> 04:28:31,240 JUSTIFICATION THAT VIOLENCE IS 7087 04:28:31,240 --> 04:28:34,160 OKAY, OVER THE LAST COUPLE 7088 04:28:34,160 --> 04:28:34,400 DECADES. 7089 04:28:34,400 --> 04:28:36,360 WE CAN TALK ABOUT FACTORS THAT 7090 04:28:36,360 --> 04:28:37,440 ARE CAUGHTING THAT. 7091 04:28:37,440 --> 04:28:41,720 THERE'S A LOT OF SOCIAL, 7092 04:28:41,720 --> 04:28:44,600 CULTURAL, POLITICAL FACTORS ON 7093 04:28:44,600 --> 04:28:45,600 THAT ISSUE. 7094 04:28:45,600 --> 04:28:50,040 AND SO ALL OF THE CULTURE STEREO 7095 04:28:50,040 --> 04:28:51,120 THIS IS OF MACHISMO EXIST BUT 7096 04:28:51,120 --> 04:28:55,640 THERE'S A LOT OF CHANGE AND 7097 04:28:55,640 --> 04:28:58,480 VARIATION GOING ON. 7098 04:28:58,480 --> 04:29:01,400 >>THANK YOU SO MUCH. 7099 04:29:01,400 --> 04:29:02,960 APPRECIATE THE ANSWER TO THE 7100 04:29:02,960 --> 04:29:03,480 QUESTION. 7101 04:29:03,480 --> 04:29:09,920 ALSO WANTED TO OPEN THE FLOOR TO 7102 04:29:09,920 --> 04:29:11,320 ALL THREE PANELISTS TO SEE IF 7103 04:29:11,320 --> 04:29:13,400 YOU HAVE QUESTIONS FOR OTHER 7104 04:29:13,400 --> 04:29:14,440 PANELISTS BEFORE MOVING TO A FEW 7105 04:29:14,440 --> 04:29:15,800 QUESTIONS TO OPEN UP THE FLOOR 7106 04:29:15,800 --> 04:29:19,240 TO EVERYONE. 7107 04:29:19,240 --> 04:29:21,600 7108 04:29:21,600 --> 04:29:24,320 >>I HAVE A COMMENT, BRINGING 7109 04:29:24,320 --> 04:29:30,200 BACK THE ONE HEALTH APPROACH TO 7110 04:29:30,200 --> 04:29:32,160 SOLVE -- TO BRING HEALTH TO THE 7111 04:29:32,160 --> 04:29:33,720 LIVES, FOR INSTANCE, WHEN WE 7112 04:29:33,720 --> 04:29:36,000 THINK ABOUT THE ENVIRONMENT, 7113 04:29:36,000 --> 04:29:38,720 HAVING A HEALTHY ENVIRONMENT 7114 04:29:38,720 --> 04:29:41,360 ESPECIALLY FOR EXAMPLE OF 7115 04:29:41,360 --> 04:29:44,640 OBESITY, IT'S ONE EXAMPLE, IN 7116 04:29:44,640 --> 04:29:46,760 ORGANIZATION, TO HAVE PARKS THAT 7117 04:29:46,760 --> 04:29:50,000 PROVIDE THE PLACE FOR HUMANS AND 7118 04:29:50,000 --> 04:29:53,080 PETS TO WALK, AND THAT SHOWS HOW 7119 04:29:53,080 --> 04:29:56,040 JUST A SIMPLE WALK, COMING OUT 7120 04:29:56,040 --> 04:29:58,560 OF THIS SEDENTARY LIFE, BESIDES 7121 04:29:58,560 --> 04:30:00,400 THE DIET, ALSO IMPORTANT DIET 7122 04:30:00,400 --> 04:30:03,800 WHICH COMES WITH THE HEALTHY 7123 04:30:03,800 --> 04:30:05,520 PLANS, BUT FOR THE INCREASING 7124 04:30:05,520 --> 04:30:09,160 THE EXERCISE, WE NEED TO HAVE A 7125 04:30:09,160 --> 04:30:10,800 SAFER NEIGHBORHOOD. 7126 04:30:10,800 --> 04:30:16,960 WE NEED TO HAVE PARKS AND EVEN 7127 04:30:16,960 --> 04:30:18,080 SHOWS DECREASES OVER BLOOD 7128 04:30:18,080 --> 04:30:22,320 PRESSURE, BRINGING THE HEALTH. 7129 04:30:22,320 --> 04:30:26,600 SO HOW WE'RE GOING TO BRING THE 7130 04:30:26,600 --> 04:30:29,000 ENVIRONMENT INTO THIS ASPECT OF 7131 04:30:29,000 --> 04:30:32,680 HEALTH. 7132 04:30:32,680 --> 04:30:35,160 SO IT'S A COMMENT, BRING THE 7133 04:30:35,160 --> 04:30:36,840 HOLISTIC APPROACH TO HEALTH. 7134 04:30:36,840 --> 04:30:41,360 >>DR. BAMBS? 7135 04:30:41,360 --> 04:30:42,240 >>YEAH, THANK YOU. 7136 04:30:42,240 --> 04:30:45,160 I WOULD LIKE TO COMMENT ON THAT. 7137 04:30:45,160 --> 04:30:46,360 CONSIDERING PREVENTION FROM THE 7138 04:30:46,360 --> 04:30:49,760 ENVIRONMENT, I THINK IT'S A 7139 04:30:49,760 --> 04:30:57,360 VERY, VERY WISE WAY TO REFRESH 7140 04:30:57,360 --> 04:30:58,880 THE CONCEPT OF PREVENTION, 7141 04:30:58,880 --> 04:31:01,080 PROMOTION OF HEALTH. 7142 04:31:01,080 --> 04:31:05,920 IT PUTS EMPHASIS NOT ONLY ON THE 7143 04:31:05,920 --> 04:31:08,000 INDIVIDUAL'S KNOWLEDGE AND THEIR 7144 04:31:08,000 --> 04:31:10,400 OWN HEALTH BUT STRUCTURAL 7145 04:31:10,400 --> 04:31:12,800 MEASURES WHERE WE ALL LIVE AND 7146 04:31:12,800 --> 04:31:15,680 WORK AND STUDY. 7147 04:31:15,680 --> 04:31:17,320 SO, ONE THING, THE BUILT 7148 04:31:17,320 --> 04:31:18,760 ENVIRONMENT, AS CHRISTINA 7149 04:31:18,760 --> 04:31:19,720 ALREADY MENTIONED. 7150 04:31:19,720 --> 04:31:25,600 BUT AS I MENTIONED IN MY 7151 04:31:25,600 --> 04:31:28,800 PRESENTATION, WE NEED TO ALWAYS 7152 04:31:28,800 --> 04:31:30,000 REMEMBER THAT THE MARKETING 7153 04:31:30,000 --> 04:31:33,920 ENVIRONMENT IS VERY IMPORTANT. 7154 04:31:33,920 --> 04:31:37,240 AND ALSO THE PRICES OF THINGS WE 7155 04:31:37,240 --> 04:31:38,800 WOULD LIKE TO PROMOTE OR 7156 04:31:38,800 --> 04:31:44,880 DISCOURAGE IN THE POPULATION. 7157 04:31:44,880 --> 04:31:46,680 SO ALL THOSE ASPECTS, CULTURAL, 7158 04:31:46,680 --> 04:31:50,000 SOCIAL NORMS, ARE BUILT FROM THE 7159 04:31:50,000 --> 04:31:53,560 EARLY CHILDHOOD, BECAUSE OUR 7160 04:31:53,560 --> 04:31:55,960 CHILDREN ARE WATCHING WHAT IS 7161 04:31:55,960 --> 04:31:59,560 BEING ADVERTISED TO THEM. 7162 04:31:59,560 --> 04:32:03,480 AND IF SOMETHING IS REALLY CHEAP 7163 04:32:03,480 --> 04:32:07,840 AND EASY TO GET, SUCH AS THE 7164 04:32:07,840 --> 04:32:10,280 ALCOHOL IN CHILE, OF COURSE 7165 04:32:10,280 --> 04:32:13,480 TEENS ARE STARTING DRINKING VERY 7166 04:32:13,480 --> 04:32:16,880 EARLY AND NOT ONLY DRINKING BUT 7167 04:32:16,880 --> 04:32:18,840 BINGE DRINKING, AND I WANT TO 7168 04:32:18,840 --> 04:32:20,280 CONNECT THAT WITH IS 7169 04:32:20,280 --> 04:32:23,800 PRESENTATION OF MY COLLEAGUE 7170 04:32:23,800 --> 04:32:27,360 MERIKE, BECAUSE OF PERHAPS ONE 7171 04:32:27,360 --> 04:32:33,280 OF THE FACTORS THAT IS WRITING, 7172 04:32:33,280 --> 04:32:35,000 PREVALENCE OF VIOLENCE AMONG 7173 04:32:35,000 --> 04:32:38,200 CHILEAN MEN, WE HAVE PREVALENCE 7174 04:32:38,200 --> 04:32:39,760 OF ALCOHOL CONSUMPTION REALLY, 7175 04:32:39,760 --> 04:32:41,720 REALLY HIGH. 7176 04:32:41,720 --> 04:32:47,200 I THINK OVERALL TAKING THE 7177 04:32:47,200 --> 04:32:49,880 ENVIRONMENT AS A FRESH POINT TO 7178 04:32:49,880 --> 04:32:52,880 UNDERSTAND PROMOTION OF HEALTH 7179 04:32:52,880 --> 04:32:54,880 AND PREVENTION AND KEEP 7180 04:32:54,880 --> 04:32:57,720 INDIVIDUALS DOING WHAT THEY KNOW 7181 04:32:57,720 --> 04:33:01,000 HOW TO DO AND BUT I THINK THAT 7182 04:33:01,000 --> 04:33:05,360 WE COULD MAKE A CHANGE IF HAVE 7183 04:33:05,360 --> 04:33:10,120 THIS EMPHASIS ON THE CONTEXT. 7184 04:33:10,120 --> 04:33:11,920 AND DAILY LIFE CONTEXT, IT'S NOT 7185 04:33:11,920 --> 04:33:13,640 THAT YOU NEED TO THINK 7186 04:33:13,640 --> 04:33:15,080 PREVENTION AND PROMOTION OF 7187 04:33:15,080 --> 04:33:18,440 HEALTH IN TERMS OF A DAILY 7188 04:33:18,440 --> 04:33:22,840 LIFESTYLES, AND WHERE WE ARE 7189 04:33:22,840 --> 04:33:27,520 EVERY DAY, THAT IS NOT ONLY OUR 7190 04:33:27,520 --> 04:33:33,880 RECREATIONAL TIMES, BUT ALSO OUR 7191 04:33:33,880 --> 04:33:35,400 EMPLOYMENT, WORKPLACES, AND SO 7192 04:33:35,400 --> 04:33:39,240 BUT THE CONTEXT OF ENVIRONMENT I 7193 04:33:39,240 --> 04:33:42,600 THINK BRINGS A NEW -- IT'S NOT 7194 04:33:42,600 --> 04:33:44,280 NEW BUT WE CAN REFRESH THE 7195 04:33:44,280 --> 04:33:44,520 CONCEPT. 7196 04:33:44,520 --> 04:33:47,000 THAT'S WHAT I WAS TRYING TO SAY. 7197 04:33:47,000 --> 04:33:47,760 THANK YOU. 7198 04:33:47,760 --> 04:33:49,040 >>THANK YOU. 7199 04:33:49,040 --> 04:33:51,600 NO, A GREAT COMMENT. 7200 04:33:51,600 --> 04:33:52,440 DR. BLOFIELDEL. 7201 04:33:52,440 --> 04:33:54,560 >>YEAH, LET'S PICK UP ON WHAT 7202 04:33:54,560 --> 04:33:58,080 THEY WERE SAYING, IT POINTS TO 7203 04:33:58,080 --> 04:33:59,040 INTERCONNECTEDNESS, AND YOU 7204 04:33:59,040 --> 04:34:02,120 BROUGHT UP INDEED, I DIDN'T HAVE 7205 04:34:02,120 --> 04:34:04,080 TIME TO DISCUSS INDIVIDUAL RISK 7206 04:34:04,080 --> 04:34:06,560 FACTORS, ALSO TO THE EARLIER 7207 04:34:06,560 --> 04:34:11,760 QUESTION ABOUT KIND OF CULTURAL 7208 04:34:11,760 --> 04:34:15,880 PROGRAMS, PREVENTING PERHAPS, 7209 04:34:15,880 --> 04:34:18,480 INDIVIDUAL RISK FACTORS, TEND TO 7210 04:34:18,480 --> 04:34:22,760 BE LIKE -- FOR BUILT, IN TERMS 7211 04:34:22,760 --> 04:34:25,200 OF THE VICTIM AND PERPETRATOR, 7212 04:34:25,200 --> 04:34:29,240 EXCESSIVE VOLUME USE, ALSO 7213 04:34:29,240 --> 04:34:31,640 SOMETHING THAT YOU CANNOT CHANGE 7214 04:34:31,640 --> 04:34:33,280 WESTBOUND AN EASY POLICY FIX, IF 7215 04:34:33,280 --> 04:34:34,920 YOU EXPERIENCE VIOLENCE OR 7216 04:34:34,920 --> 04:34:36,120 WATCHED YOUR MOTHER BEING 7217 04:34:36,120 --> 04:34:37,760 SUBJECTED TO VIOLENCE WHEN YOU 7218 04:34:37,760 --> 04:34:40,280 WERE A CHILD, SO IT'S VERY MUCH 7219 04:34:40,280 --> 04:34:42,560 AND INTERGENERATIONAL PROBLEM AS 7220 04:34:42,560 --> 04:34:42,760 WELL. 7221 04:34:42,760 --> 04:34:46,360 LOWER LEVELS OF EDUCATION, 7222 04:34:46,360 --> 04:34:48,600 SPECIFICALLY NOT FINISHING HIGH 7223 04:34:48,600 --> 04:34:50,480 SCHOOL, THRESHOLD ON BOTH 7224 04:34:50,480 --> 04:34:50,840 LEVELS. 7225 04:34:50,840 --> 04:34:53,320 AS I MENTIONED ACCESS TO YOUR 7226 04:34:53,320 --> 04:34:54,640 OWN INCOME. 7227 04:34:54,640 --> 04:34:57,600 BEYOND THAT COME MECHANISMS OF 7228 04:34:57,600 --> 04:34:59,240 FIRST RESPONSIVE, BEING ABLE TO 7229 04:34:59,240 --> 04:35:01,720 LEAVE YOUR LOCATION, BEING ABLE 7230 04:35:01,720 --> 04:35:05,120 TO GUARANTEE YOUR PHYSICAL 7231 04:35:05,120 --> 04:35:05,960 SAFETY. 7232 04:35:05,960 --> 04:35:11,040 BUT ALL THOSE FACTORS, AND 7233 04:35:11,040 --> 04:35:14,000 THAT -- LIKE ALCOHOL USE IS NOT 7234 04:35:14,000 --> 04:35:15,080 NECESSARILY INTENDED TO BE -- 7235 04:35:15,080 --> 04:35:17,480 IT'S NOT INTENDED TO BE AN ACT 7236 04:35:17,480 --> 04:35:22,000 OF VIOLENCE POLICY BUT IT HAS 7237 04:35:22,000 --> 04:35:24,360 ALL THESE, IT ALL VERY MUCH -- 7238 04:35:24,360 --> 04:35:27,480 >>IT'S INTERCONNECTED. 7239 04:35:27,480 --> 04:35:29,040 >>POINTS TO THE INTERCONNECTED 7240 04:35:29,040 --> 04:35:30,640 STRATEGY THAT I MENTIONED. 7241 04:35:30,640 --> 04:35:33,120 >>YEAH, NO, ABSOLUTELY. 7242 04:35:33,120 --> 04:35:34,240 THOSE ARE GREAT POINTS. 7243 04:35:34,240 --> 04:35:38,400 AND WE HAVE A QUESTION HERE FROM 7244 04:35:38,400 --> 04:35:40,800 THE AUDIENCE REGARDING THE ROLE 7245 04:35:40,800 --> 04:35:44,080 OF RESEARCH ON PUBLIC POLICIES, 7246 04:35:44,080 --> 04:35:46,960 AND HOW TO MAKE THAT TRANSLATION 7247 04:35:46,960 --> 04:35:50,440 OF RESEARCH FINDINGS INTO 7248 04:35:50,440 --> 04:35:53,040 POLICIES, SO ONE QUESTION WOULD 7249 04:35:53,040 --> 04:35:56,560 BE WHAT ARE THE CHALLENGES OF 7250 04:35:56,560 --> 04:35:58,400 TRANSLATING RESEARCH FINDINGS 7251 04:35:58,400 --> 04:36:00,600 INTO POLICY IN LATIN AMERICA, 7252 04:36:00,600 --> 04:36:04,680 HOW CAN WE OVERCOME SOME OF 7253 04:36:04,680 --> 04:36:06,680 THOSE CHALLENGES IN TRANSLATING 7254 04:36:06,680 --> 04:36:17,080 RESEARCH INTO POLICY. 7255 04:36:20,200 --> 04:36:25,240 >>MAYBE I CAN START QUICKLY ON 7256 04:36:25,240 --> 04:36:28,120 THAT QUESTION. 7257 04:36:28,120 --> 04:36:31,200 ONE IMPORTANT POINT IS MEASURING 7258 04:36:31,200 --> 04:36:34,240 EFFECTIVENESS, MAKE SURE THAT WE 7259 04:36:34,240 --> 04:36:39,760 ALWAYS MEASURE WHAT WE DO. 7260 04:36:39,760 --> 04:36:41,920 AND THAT MEANS EFFECTIVENESS. 7261 04:36:41,920 --> 04:36:45,080 BUT ALSO POPULATION IMPACT. 7262 04:36:45,080 --> 04:36:48,080 SOMETIMES WE CAN HAVE A 7263 04:36:48,080 --> 04:36:50,680 CONDUCTED RESEARCH STUDY AND 7264 04:36:50,680 --> 04:36:53,160 HAVE THE EFFICACY, SAFETY, AND 7265 04:36:53,160 --> 04:36:54,600 EFFECTIVENESS OF AN 7266 04:36:54,600 --> 04:36:57,800 INTERVENTION, BUT THEN WE NEVER 7267 04:36:57,800 --> 04:37:00,760 CONDUCT THE POPULATION IMPACT 7268 04:37:00,760 --> 04:37:02,600 MEASUREMENT ALSO. 7269 04:37:02,600 --> 04:37:06,800 AND I THINK THAT NUTRITIONAL AND 7270 04:37:06,800 --> 04:37:09,840 LABELING LAW NOW HAS BEEN 7271 04:37:09,840 --> 04:37:11,920 CAREFUL IN CHILE TO HAVE THOSE 7272 04:37:11,920 --> 04:37:16,520 EVALUATIONS, IN ORDER TO HAVE 7273 04:37:16,520 --> 04:37:18,280 EVIDENCE, SOLID EVIDENCE, TO NOT 7274 04:37:18,280 --> 04:37:20,800 ONLY FOR OUR COUNTRY BUT FOR 7275 04:37:20,800 --> 04:37:22,880 OTHER COUNTRIES IN LATIN AMERICA 7276 04:37:22,880 --> 04:37:25,400 AND OTHER COUNTRIES IN GENERAL, 7277 04:37:25,400 --> 04:37:28,680 BUT I THINK ONE PERSON KEY 7278 04:37:28,680 --> 04:37:32,080 ASPECT IS TO BE VERY CONSISTENT 7279 04:37:32,080 --> 04:37:37,800 IN MEASURING WHAT WE DO, OUR 7280 04:37:37,800 --> 04:37:41,840 PROTOCOLS, AND HAVE NETWORKS 7281 04:37:41,840 --> 04:37:46,640 THAT WE'RE DOING, RIGHT, AND TO 7282 04:37:46,640 --> 04:37:48,400 SEE OTHER COLLEAGUES TALKING THE 7283 04:37:48,400 --> 04:37:51,040 SAME LANGUAGE, AND THAT OF 7284 04:37:51,040 --> 04:37:54,320 COURSE CAN FACILITATE THAT WE 7285 04:37:54,320 --> 04:37:59,320 CAN THINK TOGETHER, RESEARCH 7286 04:37:59,320 --> 04:38:01,080 QUESTIONS, AND I THINK THAT IS 7287 04:38:01,080 --> 04:38:02,160 VERY IMPORTANT. 7288 04:38:02,160 --> 04:38:05,440 >>DR. BAMBS, A FOLLOW-UP 7289 04:38:05,440 --> 04:38:05,720 QUESTION. 7290 04:38:05,720 --> 04:38:07,200 SO I UNDERSTAND THE PRESENCE OF 7291 04:38:07,200 --> 04:38:09,800 MEASURING IMPACT BUT HOW DO YOU 7292 04:38:09,800 --> 04:38:12,200 MAKE THAT TRANSITION, YOU KNOW, 7293 04:38:12,200 --> 04:38:16,720 FROM THE RESEARCH FINDINGS, YOU 7294 04:38:16,720 --> 04:38:18,440 HAVE THE RESEARCH STUDY DONE AND 7295 04:38:18,440 --> 04:38:20,120 HAVE THE DATA; HOW DO YOU GET 7296 04:38:20,120 --> 04:38:25,560 THE DATA TO THE POLICYMAKERS? 7297 04:38:25,560 --> 04:38:25,680 7298 04:38:25,680 --> 04:38:27,320 >>YEAH, THAT'S A CHALLENGING 7299 04:38:27,320 --> 04:38:28,760 THING, NOW, IN MY UNIVERSITY, 7300 04:38:28,760 --> 04:38:37,160 FOR EXAMPLE, WE HAVE A NEW GROUP 7301 04:38:37,160 --> 04:38:37,960 WORKING SPECIFICALLY ON 7302 04:38:37,960 --> 04:38:39,920 MONITORING THE PROJECT AND THE 7303 04:38:39,920 --> 04:38:43,200 NEW LAWS THAT ARE BEING 7304 04:38:43,200 --> 04:38:46,160 DISCUSSED IN THE NEXT MONTH, IN 7305 04:38:46,160 --> 04:38:47,600 OUR CONGRESS, FOR INSTANCE, 7306 04:38:47,600 --> 04:38:49,640 RELATED TO HEALTH. 7307 04:38:49,640 --> 04:38:53,000 WE DIDN'T HAVE THAT OFFICE. 7308 04:38:53,000 --> 04:38:56,440 IT'S SOMETHING REALLY NEW. 7309 04:38:56,440 --> 04:38:58,280 NOW WE UNDERSTOOD THAT NEED TO 7310 04:38:58,280 --> 04:39:01,240 MOVE FORWARD FROM THE ACADEMIC 7311 04:39:01,240 --> 04:39:04,240 ENVIRONMENT AND MOVE TO 7312 04:39:04,240 --> 04:39:06,520 CONGRESSMEN AND BE ABLE TO 7313 04:39:06,520 --> 04:39:09,240 COMMUNICATE ON MESSAGES IN A 7314 04:39:09,240 --> 04:39:12,160 SIMPLE WAY AND USE A LOT OF 7315 04:39:12,160 --> 04:39:16,920 IMAGES MORE THAN A LOT OF WORDS 7316 04:39:16,920 --> 04:39:25,680 BECAUSE CONGRESS MON --MEN ARE 7317 04:39:25,680 --> 04:39:27,120 VERY TIRED, MESSAGE AT 5 P.M. IN 7318 04:39:27,120 --> 04:39:29,560 THE AFTERNOON, WE'VE LEARNED HOW 7319 04:39:29,560 --> 04:39:32,480 TO COMMUNICATE WITH THEM, AND 7320 04:39:32,480 --> 04:39:35,320 ADVOCATE FOR THE IMPORTANT 7321 04:39:35,320 --> 04:39:39,360 CHANGES, BUT NOW OUR FOCUS WILL 7322 04:39:39,360 --> 04:39:42,640 BE TO MONITORING THOSE LAWS IN 7323 04:39:42,640 --> 04:39:44,840 ADVANCE, TO HAVE -- TO PROMOTE 7324 04:39:44,840 --> 04:39:48,480 WE MAY HAVE AN ACADEMIC 7325 04:39:48,480 --> 04:39:50,600 DISCUSSION WITH OTHER 7326 04:39:50,600 --> 04:39:52,840 UNIVERSITIES, TRYING TO FIND AND 7327 04:39:52,840 --> 04:39:57,240 GO WITH PROPOSALS THAT TRY TO 7328 04:39:57,240 --> 04:39:59,560 PUSH AND ADVOCATE WITH THE BEST 7329 04:39:59,560 --> 04:40:04,080 MESSAGES WE COULD BUILD 7330 04:40:04,080 --> 04:40:04,400 TOGETHER. 7331 04:40:04,400 --> 04:40:05,680 >>GREAT POINT, ONE THING WE'VE 7332 04:40:05,680 --> 04:40:08,760 SEEN HERE IN THE U.S. WITH THE 7333 04:40:08,760 --> 04:40:13,480 WHOLE COVID PANDEMIC, THE 7334 04:40:13,480 --> 04:40:15,560 IMPORTANCE AS PUBLIC HEALTH 7335 04:40:15,560 --> 04:40:16,320 OFFICIALS, DOCTORS AND 7336 04:40:16,320 --> 04:40:18,840 SCIENTISTS, THE ROLE OF HEALTH 7337 04:40:18,840 --> 04:40:20,240 COMMUNICATION AND BRINGING IT 7338 04:40:20,240 --> 04:40:24,080 DOWN TO A LEVEL THAT THE 7339 04:40:24,080 --> 04:40:25,520 POPULATION UNDERSTANDS. 7340 04:40:25,520 --> 04:40:26,560 WE'VE REALIZED HOW IMPORTANT 7341 04:40:26,560 --> 04:40:28,360 THAT IS AND I THINK IT'S 7342 04:40:28,360 --> 04:40:32,000 IMPORTANT TO CONTINUE TO LEARN 7343 04:40:32,000 --> 04:40:34,000 THAT, YOU KNOW, AS PEOPLE WHO 7344 04:40:34,000 --> 04:40:37,520 SPECIALIZE IN PUBLIC HEALTH AND 7345 04:40:37,520 --> 04:40:37,800 MEDICINE. 7346 04:40:37,800 --> 04:40:40,520 ONE OTHER QUESTION THAT WE HAVE 7347 04:40:40,520 --> 04:40:47,760 FROM THE AUDIENCE, WITH REGARDS 7348 04:40:47,760 --> 04:40:48,720 TO POTENTIAL COLLABORATION 7349 04:40:48,720 --> 04:40:50,360 BETWEEN RESEARCHERS IN LATIN 7350 04:40:50,360 --> 04:40:52,200 AMERICA AND THOSE STUDYING 7351 04:40:52,200 --> 04:40:52,880 HISPANIC AND LATINO POPULATIONS 7352 04:40:52,880 --> 04:40:55,720 IN THE U.S., DO YOU HAVE ANY 7353 04:40:55,720 --> 04:40:58,480 IDEAS FOR WHAT MIGHT BE GOOD 7354 04:40:58,480 --> 04:40:59,480 AREAS OF COLLABORATION BETWEEN 7355 04:40:59,480 --> 04:41:02,440 LATIN AMERICA AND THE U.S.? 7356 04:41:02,440 --> 04:41:04,840 OR WAYS WHERE WE CAN HARNESS THE 7357 04:41:04,840 --> 04:41:08,960 FACT THAT WE'RE BOTH STUDYING 7358 04:41:08,960 --> 04:41:09,960 HISPANIC/LATINO POPULATIONS AND 7359 04:41:09,960 --> 04:41:12,680 THINGS WE COULD LEARN FROM ONE 7360 04:41:12,680 --> 04:41:13,040 ANOTHER. 7361 04:41:13,040 --> 04:41:16,440 >>I CAN SHARE SOME EXPERIENCES 7362 04:41:16,440 --> 04:41:20,360 THAT YOU ARE HAVING IN THIS 7363 04:41:20,360 --> 04:41:21,360 IMPLEMENTATION OF PARTNERSHIPS. 7364 04:41:21,360 --> 04:41:23,440 FIRST OF ALL, JUST TO CLARIFY 7365 04:41:23,440 --> 04:41:26,280 AND CONTINUE ALSO THE IMPORTANCE 7366 04:41:26,280 --> 04:41:28,240 OF METRICS, THAT IT'S IMPORTANT 7367 04:41:28,240 --> 04:41:32,400 AS WE HAVE DISCUSSED, IT'S ALSO 7368 04:41:32,400 --> 04:41:34,040 UNDERSTANDING THE TIME. 7369 04:41:34,040 --> 04:41:36,120 A TIME FOR RESEARCHER IS 7370 04:41:36,120 --> 04:41:37,560 DIFFERENT THAN A TIME FOR A 7371 04:41:37,560 --> 04:41:42,840 CLINICIAN AND A TIME FOR THE 7372 04:41:42,840 --> 04:41:43,480 MUSE. 7373 04:41:43,480 --> 04:41:44,800 THE RESEARCHER IS NOT GOING TO 7374 04:41:44,800 --> 04:41:45,680 TELL YOU SOMETHING THEY DON'T 7375 04:41:45,680 --> 04:41:47,120 KNOW FOR SURE AND HOW TO PUT 7376 04:41:47,120 --> 04:41:48,080 THAT IN THE POLICIES. 7377 04:41:48,080 --> 04:41:52,480 SO THIS IS A VERY COMPLEX, TAKES 7378 04:41:52,480 --> 04:41:55,320 US TEN YEARS TO PROVE SOMETHING, 7379 04:41:55,320 --> 04:41:57,080 IMMEDIATELY WE NEED AN ANSWER 7380 04:41:57,080 --> 04:41:59,480 FOR THE CLINICIAN ASPECT, I NEED 7381 04:41:59,480 --> 04:42:01,200 TO HEAR RIGHT NOW, MY PATIENT. 7382 04:42:01,200 --> 04:42:04,000 ALSO WHAT ARE YOU GOING TO TELL 7383 04:42:04,000 --> 04:42:06,720 THE NEWS TO BRING ANOTHER 7384 04:42:06,720 --> 04:42:08,680 CHALLENGING FOR THE SCIENCE TO 7385 04:42:08,680 --> 04:42:13,720 THE PUBLIC POLICIES. 7386 04:42:13,720 --> 04:42:16,080 IN TERMS OF YOUR POTENTIAL AREAS 7387 04:42:16,080 --> 04:42:19,080 OF COLLABORATION, TODAY WE'RE 7388 04:42:19,080 --> 04:42:20,080 ALL HERE, BRINGING DIFFERENT -- 7389 04:42:20,080 --> 04:42:26,000 ONLY THE THREE OF US HERE, OR 7390 04:42:26,000 --> 04:42:26,720 FOUR, DIFFERENT PROFESSIONS, 7391 04:42:26,720 --> 04:42:27,160 LISTENING. 7392 04:42:27,160 --> 04:42:30,680 I DON'T KNOW WHAT SHE'S TALK 7393 04:42:30,680 --> 04:42:32,840 ABOUT THE ECONOMICS AREA, BUT I 7394 04:42:32,840 --> 04:42:36,920 NEED TO LEARN AND LISTEN TO AND 7395 04:42:36,920 --> 04:42:39,120 BRING YOUR DIFFERENCES SO I 7396 04:42:39,120 --> 04:42:43,440 THINK WHAT IS THE POTENTIAL 7397 04:42:43,440 --> 04:42:49,080 AREAS OF COLLABORATION, IT IS 7398 04:42:49,080 --> 04:42:51,920 HAVING FUNDINGS OR SUSTAINABLE 7399 04:42:51,920 --> 04:42:54,320 WAY TO CONTINUE ALL DISCOVERIES 7400 04:42:54,320 --> 04:43:00,680 OR RESEARCH OR STUDIES SO IT'S 7401 04:43:00,680 --> 04:43:04,600 VERY IMPORTANT, THE FINANCIAL 7402 04:43:04,600 --> 04:43:07,320 SUPPORT, AND ALSO PERHAPS TO 7403 04:43:07,320 --> 04:43:09,640 BRING MORE THIS HOLISTIC 7404 04:43:09,640 --> 04:43:11,600 APPROACH, THE MORE DIVERSE 7405 04:43:11,600 --> 04:43:15,760 VIEWS, DIFFERENT VIEWS, TO GET 7406 04:43:15,760 --> 04:43:17,200 TO A SOLUTION. 7407 04:43:17,200 --> 04:43:19,680 I THINK WE'RE DOING THIS. 7408 04:43:19,680 --> 04:43:22,480 WHAT I WANTED TO SHARE OUR 7409 04:43:22,480 --> 04:43:26,680 EXPERIENCE RIGHT NOW, IT IS 7410 04:43:26,680 --> 04:43:28,000 UNDERSTANDING CULTURE 7411 04:43:28,000 --> 04:43:29,000 DIFFERENCES, UNDERSTANDING 7412 04:43:29,000 --> 04:43:31,920 POLITICAL DIFFERENCES AS WELL, 7413 04:43:31,920 --> 04:43:36,640 AND UNDERSTANDING PERHAPS EVEN 7414 04:43:36,640 --> 04:43:38,160 DIFFERENT APPROACHES. 7415 04:43:38,160 --> 04:43:43,440 IN BRINGING LIKE WHATEVER WE 7416 04:43:43,440 --> 04:43:45,720 LEARNED IN LATIN AMERICAN, THAT 7417 04:43:45,720 --> 04:43:48,280 INCLUSION, LET'S PUT IT THIS 7418 04:43:48,280 --> 04:43:54,160 WAY, IMCOLLUSION THAT -- 7419 04:43:54,160 --> 04:43:55,680 INCLUSION THAT SOMETHING'S BEEN 7420 04:43:55,680 --> 04:43:57,440 DISCUSSION SO WE DON'T NEED TO 7421 04:43:57,440 --> 04:44:02,360 REPEAT BUT SAY WE ARE GOING TO 7422 04:44:02,360 --> 04:44:05,520 IMPLEMENT IN BRAZIL AN CHILE. 7423 04:44:05,520 --> 04:44:07,760 ASK FIRST HAVE YOU GUYS DONE 7424 04:44:07,760 --> 04:44:08,440 THIS BEFORE? 7425 04:44:08,440 --> 04:44:09,800 AND THEY DID. 7426 04:44:09,800 --> 04:44:11,920 NO, THE OPPOSITE, WE ALREADY DO 7427 04:44:11,920 --> 04:44:18,120 THAT, WHAT ARE YOU DOING UP IN 7428 04:44:18,120 --> 04:44:18,440 THERE. 7429 04:44:18,440 --> 04:44:23,840 YOU'RE STILL WRITING LAWS AND 7430 04:44:23,840 --> 04:44:25,800 REGULATIONS. 7431 04:44:25,800 --> 04:44:28,280 BRING EACH OTHER DIFFERENCES, 7432 04:44:28,280 --> 04:44:30,280 AND I HOPE WE'RE DOING THIS 7433 04:44:30,280 --> 04:44:32,320 ALREADY BUT IT'S TO SHARE A 7434 04:44:32,320 --> 04:44:35,120 LITTLE BIT MORE, TO LEARN, TO 7435 04:44:35,120 --> 04:44:38,320 LISTEN, AND I'LL BRING NOW 7436 04:44:38,320 --> 04:44:39,040 INDIGENOUS POPULATIONS. 7437 04:44:39,040 --> 04:44:40,800 WE CAN'T JUST GO THERE. 7438 04:44:40,800 --> 04:44:43,960 YES, I WANT TO SAVE THE AMAZON 7439 04:44:43,960 --> 04:44:49,440 FOREST, BUT I CAN'T JUST GO AND 7440 04:44:49,440 --> 04:44:52,160 SAY WE'RE IMPLEMENTING THIS 7441 04:44:52,160 --> 04:44:54,040 PUBLIC POLICY, I'M FROM THE 7442 04:44:54,040 --> 04:45:01,280 GOVERNMENT, WE CAN'T THAT. 7443 04:45:01,280 --> 04:45:03,880 GOES FOR CIVILIZATIONS, WE HAVE 7444 04:45:03,880 --> 04:45:05,080 TO LISTEN, TO COME TOGETHER AND 7445 04:45:05,080 --> 04:45:08,280 SEE WHAT THEY CAN BRING TO US 7446 04:45:08,280 --> 04:45:12,320 PROFESSIONALS IN ACADEMIA, 7447 04:45:12,320 --> 04:45:15,240 RESEARCHERS AND PHYSICIANS, AND 7448 04:45:15,240 --> 04:45:17,880 FIRST LISTEN TO THEIR 7449 04:45:17,880 --> 04:45:18,200 EXPERIENCES. 7450 04:45:18,200 --> 04:45:22,520 I THINK THAT'S WHAT I WOULD 7451 04:45:22,520 --> 04:45:25,680 LIKE, AREAS OF COLLABORATION. 7452 04:45:25,680 --> 04:45:26,400 INCLUSION OF DIFFERENT 7453 04:45:26,400 --> 04:45:26,720 EXPERIENCES. 7454 04:45:26,720 --> 04:45:30,640 >>THANK YOU SO MUCH. 7455 04:45:30,640 --> 04:45:32,120 I APPRECIATE YOUR ANSWER. 7456 04:45:32,120 --> 04:45:33,000 UNFORTUNATELY WE'RE AT TIME 7457 04:45:33,000 --> 04:45:35,840 RIGHT NOW BUT OHIO VALLEY WE CAN 7458 04:45:35,840 --> 04:45:37,920 CONTINUE THE CONVERSATION IN THE 7459 04:45:37,920 --> 04:45:38,200 FUTURE. 7460 04:45:38,200 --> 04:45:42,200 RIGHT NOW WE'RE GOING TO BE 7461 04:45:42,200 --> 04:45:44,960 MOVING TO DR. JARRETT JOHNSON, 7462 04:45:44,960 --> 04:45:47,640 MODERATING OUR NEXT SESSION. 7463 04:45:47,640 --> 04:45:50,160 THANK YOU SUCH. 7464 04:45:50,160 --> 04:45:52,360 7465 04:45:52,360 --> 04:45:54,360 >>GREETINGS. 7466 04:45:54,360 --> 04:45:56,440 I'M DR. JARRETT JOHNSON, PROGRAM 7467 04:45:56,440 --> 04:45:57,680 OFFICIAL AT THE NATIONAL 7468 04:45:57,680 --> 04:46:00,360 INSTITUTE ON MINORITY HEALTH AND 7469 04:46:00,360 --> 04:46:01,360 HEALTH DISPARITIES. 7470 04:46:01,360 --> 04:46:06,240 MODERATOR FOR TODAY'S SESSION ON 7471 04:46:06,240 --> 04:46:08,240 THE CONCEPTUALIZATION OF RACE 7472 04:46:08,240 --> 04:46:11,280 AND AT THE TIME, THE FIRST 7473 04:46:11,280 --> 04:46:13,400 PRESENTATION IS FROM DR. EDWARD 7474 04:46:13,400 --> 04:46:17,000 TELLES, FORD BY DR. ARACHU 7475 04:46:17,000 --> 04:46:24,960 CASTRO, WE'LL GO LIVE FOR Q&A. 7476 04:46:24,960 --> 04:46:26,680 ENJOY THE PRESENTATIONS. 7477 04:46:26,680 --> 04:46:30,680 >>I'M EDWARD TELLES, UC-IRVINE. 7478 04:46:30,680 --> 04:46:32,200 MY TALK TODAY IS ETHNORACIAL 7479 04:46:32,200 --> 04:46:40,880 CLASS IF I TAIGS -- 7480 04:46:40,880 --> 04:46:41,880 CLASSIFICATION AND 7481 04:46:41,880 --> 04:46:42,480 IMPLEMENTATION, BACKGROUND 7482 04:46:42,480 --> 04:46:47,320 PARTICULARLY REGARDING RACE AND 7483 04:46:47,320 --> 04:46:48,640 ETHNICITY. 7484 04:46:48,640 --> 04:46:52,040 COLONIZATION BY SPANISH AND 7485 04:46:52,040 --> 04:46:53,880 PORTUGUESE, INDEPENDENCE OF TO 7486 04:46:53,880 --> 04:46:56,080 COUNTRIES IN THE 19th CENTURY, 7487 04:46:56,080 --> 04:46:58,800 THROUGHOUT THIS TIME UNTIL 7488 04:46:58,800 --> 04:47:00,240 INDEPENDENCE AND SOMETIMES 7489 04:47:00,240 --> 04:47:04,200 AFTER, THEY HAD SLAVERY BASED ON 7490 04:47:04,200 --> 04:47:13,600 AFRICAN LABOR, DECIMATION. 7491 04:47:13,600 --> 04:47:19,880 BY THE EARLY 20th CENTURY, 7492 04:47:19,880 --> 04:47:26,320 ELITES INTENT ON UNIFYING NEW 7493 04:47:26,320 --> 04:47:30,360 NATIONS, OFTEN DOWNPLAYED OR 7494 04:47:30,360 --> 04:47:34,760 IGNORED THE AFRICAN PART AND 7495 04:47:34,760 --> 04:47:42,560 EMPHASIZED THE SIDE BETWEEN 7496 04:47:42,560 --> 04:47:47,120 EUROPEANS AND INDIGENOUS. 7497 04:47:47,120 --> 04:47:51,600 MESTIZAJE WAS FACILITATED BY 7498 04:47:51,600 --> 04:47:52,080 IMBALANCE. 7499 04:47:52,080 --> 04:47:55,960 YOU HEAR THE SAME WITH SPANISH 7500 04:47:55,960 --> 04:47:57,320 AND PORTUGUESE, A CULTURAL 7501 04:47:57,320 --> 04:48:02,120 ADVANTAGE, THAT THEY WERE ABLE 7502 04:48:02,120 --> 04:48:08,720 TO BLEND WITH NON-WHITE PEOPLE, 7503 04:48:08,720 --> 04:48:11,400 BUT THE IMBALANCE OF THE SEX 7504 04:48:11,400 --> 04:48:13,960 RATIO, THE FACT THEY WERE MOSTLY 7505 04:48:13,960 --> 04:48:18,440 MEN AMONG THE SPANISH AND 7506 04:48:18,440 --> 04:48:21,640 PORTUGUESE COLONIZERS EXPLAINS A 7507 04:48:21,640 --> 04:48:24,040 LOT. 7508 04:48:24,040 --> 04:48:25,320 THEY STARTED NON-WHITE WOMEN, 7509 04:48:25,320 --> 04:48:30,720 THEY HAD CHILDREN FROM THOSE, 7510 04:48:30,720 --> 04:48:32,480 OFTEN ENCOUNTERS WERE 7511 04:48:32,480 --> 04:48:34,240 UNCONSENSUAL AND OFTEN VIOLENT. 7512 04:48:34,240 --> 04:48:38,160 SOMETHING WE FORGET ABOUT. 7513 04:48:38,160 --> 04:48:40,120 POINT 4, THE MESTIZAJE 7514 04:48:40,120 --> 04:48:42,960 NARRATIVES WERE USED TO DENY 7515 04:48:42,960 --> 04:48:43,520 RACISM, PROMOTE MORAL 7516 04:48:43,520 --> 04:48:46,560 SUPERIORITY OVER THE U.S., 7517 04:48:46,560 --> 04:48:47,360 BECAME WIDELY ACCEPTED, 7518 04:48:47,360 --> 04:48:51,640 ESPECIALLY STRONG IN BRAZIL AND 7519 04:48:51,640 --> 04:48:51,840 MEXICO. 7520 04:48:51,840 --> 04:49:02,400 BRAZIL AND MEXICO HAD THEIR OWN 7521 04:49:04,280 --> 04:49:08,000 VERSIONS OF MESTIZAJE, THESE 7522 04:49:08,000 --> 04:49:09,760 BECAME NARRATIVES THEY TAUGHT 7523 04:49:09,760 --> 04:49:12,960 AND THAT WERE LEARNED AND BECAME 7524 04:49:12,960 --> 04:49:23,440 RACIAL COMMON COMMON -- THERE 7525 04:49:34,520 --> 04:49:36,280 WERE NO ANTI-MISSCEGENATION 7526 04:49:36,280 --> 04:49:36,480 LAWS. 7527 04:49:36,480 --> 04:49:40,960 RATHER THAN BECOMING LEGAL 7528 04:49:40,960 --> 04:49:42,160 BECAME A PURIST-BASED, FLUID, 7529 04:49:42,160 --> 04:49:43,160 PEOPLE DIDN'T NECESSARILY 7530 04:49:43,160 --> 04:49:45,440 IDENTIFY WITH ONE CATEGORY OR 7531 04:49:45,440 --> 04:49:50,800 THE OTHER, CUSTOMARY, NOT LEGAL, 7532 04:49:50,800 --> 04:49:51,720 WITH MIXED RACE CATEGORIES. 7533 04:49:51,720 --> 04:49:53,600 THIS IS WHY COLOR MAY BE A 7534 04:49:53,600 --> 04:49:55,840 BETTER INDICATOR BUT I'LL GET TO 7535 04:49:55,840 --> 04:49:56,760 THAT LATER. 7536 04:49:56,760 --> 04:50:00,440 HOWEVER, LIKE THE U.S., RACIAL 7537 04:50:00,440 --> 04:50:04,080 DISCRIMINATION AN INEQUALITY IN 7538 04:50:04,080 --> 04:50:06,200 LATIN AMERICA WERE AND ARE 7539 04:50:06,200 --> 04:50:07,480 PRONOUNCED THROUGHOUT THE 7540 04:50:07,480 --> 04:50:07,880 REGION. 7541 04:50:07,880 --> 04:50:12,600 THE LAST POINT MOST LATIN 7542 04:50:12,600 --> 04:50:14,720 AMERICAN COUNTRIES RECENTLY 7543 04:50:14,720 --> 04:50:16,960 BEGAN COLLECTING ETHNORACIAL 7544 04:50:16,960 --> 04:50:18,640 DATA AMONG MUCH GROWING 7545 04:50:18,640 --> 04:50:19,160 PRESSURE. 7546 04:50:19,160 --> 04:50:20,800 EXAMPLE FOR THE FIRST TIME IN 7547 04:50:20,800 --> 04:50:23,960 THE MEXICAN CENSUS COLLECTS DATA 7548 04:50:23,960 --> 04:50:26,960 FOR ITS BLACK POPULATION. 7549 04:50:26,960 --> 04:50:28,480 OKAY. 7550 04:50:28,480 --> 04:50:31,040 HERE IS A TABLE SHOWING 7551 04:50:31,040 --> 04:50:32,920 INDIGENOUS POPULATION BASED ON 7552 04:50:32,920 --> 04:50:34,880 SEVERAL CENSUSES, MOST BASED ON 7553 04:50:34,880 --> 04:50:37,040 CENSUS, SO HAVE YOU OFFICIAL 7554 04:50:37,040 --> 04:50:40,080 COUNTS, SOME BASED ON SURVEYS. 7555 04:50:40,080 --> 04:50:41,680 YOU CAN PICK YOUR FAVORITE 7556 04:50:41,680 --> 04:50:49,880 COUNTRY AND SEE THE NUMBERS. 7557 04:50:49,880 --> 04:50:54,320 THE DISTRIBUTION OF BLACK AND 7558 04:50:54,320 --> 04:50:55,440 INDIGENOUS POPULATION IS VERY 7559 04:50:55,440 --> 04:50:56,400 DIFFERENT ACROSS THE REGION. 7560 04:50:56,400 --> 04:50:59,360 THIS IS THE MAIN POINT, RACIAL 7561 04:50:59,360 --> 04:51:01,080 CLASSIFICATION AND CENSUS AND 7562 04:51:01,080 --> 04:51:02,960 SURVEYS IS MEASURED IN MULTIPLE 7563 04:51:02,960 --> 04:51:05,800 WAYS, DEPENDS ON CATEGORIES USED 7564 04:51:05,800 --> 04:51:07,880 AND WHETHER RESPONDENTS OR 7565 04:51:07,880 --> 04:51:10,600 INTERVIEWERS DO CLASSIFYING. 7566 04:51:10,600 --> 04:51:12,120 NOW, THERE WERE AS MANY WAYS TO 7567 04:51:12,120 --> 04:51:14,080 ASK THE QUESTION ABOUT RACE AND 7568 04:51:14,080 --> 04:51:15,440 ETHNICITY AND CATEGORIES TO USE 7569 04:51:15,440 --> 04:51:18,520 AS THERE ARE COUNTRIES IN THE 7570 04:51:18,520 --> 04:51:20,600 REGION. 7571 04:51:20,600 --> 04:51:21,920 SO, THIS HAS IMPLICATIONED FOR A 7572 04:51:21,920 --> 04:51:25,760 COUNT OF THE POPULATION, HOW 7573 04:51:25,760 --> 04:51:28,560 MANY PEOPLE THERE ARE AND 7574 04:51:28,560 --> 04:51:31,040 INEQUALITY, OF COURSE THIS IS 7575 04:51:31,040 --> 04:51:33,080 DONE POLITICALLY AND, YOU KNOW, 7576 04:51:33,080 --> 04:51:35,840 DEPENDS HOW CENSUS OR 7577 04:51:35,840 --> 04:51:37,680 STATISTICAL AGENCY WORKS IN EACH 7578 04:51:37,680 --> 04:51:38,840 OF THESE COUNTRIES. 7579 04:51:38,840 --> 04:51:40,560 I'M GOING TO FOCUS ON TWO 7580 04:51:40,560 --> 04:51:42,440 MEASURES OR SYSTEMS OF RACE. 7581 04:51:42,440 --> 04:51:46,800 THE FIRST ONE IS TRADITIONAL WAY 7582 04:51:46,800 --> 04:51:48,800 IT'S USED IN CENSUS TO COLLECT 7583 04:51:48,800 --> 04:51:52,520 RACE AND ETHNICITY BASED ON 7584 04:51:52,520 --> 04:51:53,920 SELF-IDENTIFICATION. 7585 04:51:53,920 --> 04:51:59,760 IN CATEGORIES, OKAY, ARE YOU 7586 04:51:59,760 --> 04:52:03,680 WHITE, MESTIZO, MULATTO, ET 7587 04:52:03,680 --> 04:52:04,200 CETERA. 7588 04:52:04,200 --> 04:52:07,920 THERE'S NOT A STRONG SENSE OF 7589 04:52:07,920 --> 04:52:15,680 HOW PEOPLE IDENTIFY IN THESE 7590 04:52:15,680 --> 04:52:16,280 RACE OR ETHNICITY CATEGORIES 7591 04:52:16,280 --> 04:52:17,760 RACE AND ETHNICITY IS NOT 7592 04:52:17,760 --> 04:52:20,480 CENTRAL TO NOTION OF SELF AMONG 7593 04:52:20,480 --> 04:52:21,400 MOST LATIN AMERICANS. 7594 04:52:21,400 --> 04:52:28,200 ANOTHER MEASURE OR SYSTEM OF 7595 04:52:28,200 --> 04:52:32,360 RACE BASED ON SKIN COLOR, 7596 04:52:32,360 --> 04:52:37,640 CONTINUUM FROM LIGHT TO DARK, 7597 04:52:37,640 --> 04:52:41,200 11-POINT SCALE, 1 IS LIGHTEST, 7598 04:52:41,200 --> 04:52:43,120 AND 11 THE DARKEST. 7599 04:52:43,120 --> 04:52:45,960 IN 2010 IT WAS BASED ON 7600 04:52:45,960 --> 04:52:49,120 INTERVIEWER IDENTIFIED THE RACE 7601 04:52:49,120 --> 04:52:54,040 OF THE RESPONDENTS. 7602 04:52:54,040 --> 04:52:56,280 PEOPLE OFTEN ARE AWARE BUT DON'T 7603 04:52:56,280 --> 04:52:57,680 TALK ABOUT COLOR DIFFERENCES 7604 04:52:57,680 --> 04:52:58,120 MUCH. 7605 04:52:58,120 --> 04:53:05,560 LAST POINT IS IT CUTS THROUGH 7606 04:53:05,560 --> 04:53:07,160 MESTIZO UNIFORMITY. 7607 04:53:07,160 --> 04:53:09,120 THAT CAN INCLUDE PEOPLE WITH 7608 04:53:09,120 --> 04:53:11,880 VERY LIGHT SKIN COLOR AS WELL AS 7609 04:53:11,880 --> 04:53:13,960 PEOPLE WITH VERY DARK SKIN COLOR 7610 04:53:13,960 --> 04:53:18,520 AND THIS CUTS THROUGH THAT WHOLE 7611 04:53:18,520 --> 04:53:28,080 IDEA OF WE ARE ALL MESTIZO, THIS 7612 04:53:28,080 --> 04:53:28,520 NARRATIVE. 7613 04:53:28,520 --> 04:53:30,320 LET ME SHOW HOW THAT HAPPENS. 7614 04:53:30,320 --> 04:53:33,760 WHAT I'M GOING TO DO IS SHOW 7615 04:53:33,760 --> 04:53:34,560 YEARS OF SCHOOLING, AVERAGE 7616 04:53:34,560 --> 04:53:37,960 YEARS OF SCHOOLING FOR PEOPLE IN 7617 04:53:37,960 --> 04:53:39,000 DIFFERENT RACIAL CATEGORIES AND 7618 04:53:39,000 --> 04:53:40,680 BY COLOR. 7619 04:53:40,680 --> 04:53:45,120 IF WE LOOK AT BOLIVIA, 7620 04:53:45,120 --> 04:53:47,440 GUATEMALA, MEXICO, THEY CONDUCT 7621 04:53:47,440 --> 04:53:50,240 DATA ON INDIGENOUS POPULATION, 7622 04:53:50,240 --> 04:53:54,440 THE REST IS NON-INDIGENOUS. 7623 04:53:54,440 --> 04:53:57,200 IN BOLIVIA, GUATEMALA, MEXICO, 7624 04:53:57,200 --> 04:53:58,280 INDIGENOUS POPULATION HAS FEWER 7625 04:53:58,280 --> 04:54:02,000 YEARS OR LOWER YEARS OF 7626 04:54:02,000 --> 04:54:04,000 SCHOOLING THAN NON-INDIGENOUS 7627 04:54:04,000 --> 04:54:10,640 POPULATION, MOSTLY WHITE AND 7628 04:54:10,640 --> 04:54:13,160 MESTIZO, IN COLOMBIA THERE'S NOT 7629 04:54:13,160 --> 04:54:14,720 A CLEAR HIERARCHY. 7630 04:54:14,720 --> 04:54:17,000 FOR REMAINING COUNTRIES IT 7631 04:54:17,000 --> 04:54:19,200 REALLY GETS MURKY WITH EXCEPTION 7632 04:54:19,200 --> 04:54:20,280 OF BRAZIL, THERE'S RACIAL 7633 04:54:20,280 --> 04:54:22,080 HIERARCHY IN THE DIRECTION YOU 7634 04:54:22,080 --> 04:54:25,240 WOULD EXPECT BUT IN THE 7635 04:54:25,240 --> 04:54:26,640 DOMINICAN REPUBLIC, ECUADOR, 7636 04:54:26,640 --> 04:54:28,520 PERU, IT'S NOT -- THERE'S NOT A 7637 04:54:28,520 --> 04:54:31,040 RACIAL HIERARCHY. 7638 04:54:31,040 --> 04:54:34,200 FOR EXAMPLE, IN THE DOMINICAN 7639 04:54:34,200 --> 04:54:36,160 REPUBLIC MULATO IN 2010, WHEN 7640 04:54:36,160 --> 04:54:38,240 THE DATA WAS SELECTED, THEY HAD 7641 04:54:38,240 --> 04:54:39,760 THE HIGHEST LEVEL OF EDUCATION 7642 04:54:39,760 --> 04:54:41,600 BUT THAT'S A QUESTION OF 7643 04:54:41,600 --> 04:54:42,840 SELECTIVITY WE MIGHT DISCUSS IN 7644 04:54:42,840 --> 04:54:47,560 THE QUESTION AND ANSWER PERIOD. 7645 04:54:47,560 --> 04:54:50,600 YEARS OF SCHOOLING BY COLOR, 7646 04:54:50,600 --> 04:54:52,360 THEN THE RACIAL HIERARCHY 7647 04:54:52,360 --> 04:54:56,840 BECOMES CLEAR. 7648 04:54:56,840 --> 04:55:00,440 THIS REFLECTS THE WAY MANY LATIN 7649 04:55:00,440 --> 04:55:03,080 AMERICANS UNDERSTAND THE RACIAL 7650 04:55:03,080 --> 04:55:06,560 HIERARCHY, DESPITE HOW THEY 7651 04:55:06,560 --> 04:55:07,720 SELF-IDENTIFY, WHEN PEOPLE ARE 7652 04:55:07,720 --> 04:55:12,160 CATEGORIZING SKIN LORE - COLOR 7653 04:55:12,160 --> 04:55:15,560 COLOR ARE HIGHEST YEARS OF 7654 04:55:15,560 --> 04:55:17,080 SCHOOL, DARKEST BOLIVIANS HAVE 8 7655 04:55:17,080 --> 04:55:18,520 1/2 YEARS OF SCHOOLING, MIDDLE 7656 04:55:18,520 --> 04:55:20,480 COLORS HAVE MIDDLE LEVELS OF 7657 04:55:20,480 --> 04:55:25,240 SCHOOLING, SAME THING HAPPENS 7658 04:55:25,240 --> 04:55:27,280 FOR EVERY SINGLE COUNTRY. 7659 04:55:27,280 --> 04:55:29,800 IMPLICATIONS OF COURSE ARE SKIN 7660 04:55:29,800 --> 04:55:32,200 COLOR IS PROBABLY A BETTER OR AT 7661 04:55:32,200 --> 04:55:35,480 LEAST A DIFFERENT WAY OF 7662 04:55:35,480 --> 04:55:37,040 COLLECTING ETHNORACIAL DATA. 7663 04:55:37,040 --> 04:55:39,640 WHAT ARE IMPLICATIONS FOR U.S. 7664 04:55:39,640 --> 04:55:41,720 LATINOS OR HISPANICS? 7665 04:55:41,720 --> 04:55:46,640 THE U.S. CENSUS HAS A SEPARATE 7666 04:55:46,640 --> 04:55:49,160 CATEGORY FOR LATINOS, AND THE 7667 04:55:49,160 --> 04:55:49,680 CATEGORY -- THERE'S TWO 7668 04:55:49,680 --> 04:55:53,240 QUESTIONS IN THE U.S. CENSUS, 7669 04:55:53,240 --> 04:56:02,200 LAST FIVE CENSUSES OF THE UNITED 7670 04:56:02,200 --> 04:56:03,280 STATES, LATINOS INCLUDED AS 7671 04:56:03,280 --> 04:56:05,680 SEPARATE RACE, BUT EITHER OF 7672 04:56:05,680 --> 04:56:08,320 THOSE SYSTEMS OF CLASSIFICATION 7673 04:56:08,320 --> 04:56:09,080 HAVE PROBLEMS. 7674 04:56:09,080 --> 04:56:10,520 THERE'S A QUESTION THAT REMAINS 7675 04:56:10,520 --> 04:56:15,240 HOW DO YOU CAPTURE RACE OR COLOR 7676 04:56:15,240 --> 04:56:16,120 VARIATION AMONG LATINOS, THE 7677 04:56:16,120 --> 04:56:18,520 OPTION TO ANSWER MORE THAN ONE 7678 04:56:18,520 --> 04:56:20,480 QUESTION OR RACE RESPONSE 7679 04:56:20,480 --> 04:56:23,120 SEPARATE FROM HISPANIC RESPONSE 7680 04:56:23,120 --> 04:56:23,760 DOESN'T ADEQUATELY CAPTURE THIS 7681 04:56:23,760 --> 04:56:26,840 BECAUSE OF THE NATURE OF LATINO 7682 04:56:26,840 --> 04:56:27,440 RACIAL CLASSIFICATION. 7683 04:56:27,440 --> 04:56:32,040 SO A LOT OF PEOPLE DON'T ANSWER 7684 04:56:32,040 --> 04:56:33,440 MORE THAN -- EVEN THOUGH THEY 7685 04:56:33,440 --> 04:56:36,200 ARE ALLOWED TO ANSWER MORE THAN 7686 04:56:36,200 --> 04:56:37,400 ONE CATEGORY THEY DON'T, AND 7687 04:56:37,400 --> 04:56:39,360 WHEN YOU SEPARATE THESE OF THE 7688 04:56:39,360 --> 04:56:42,960 HISPANIC FROM THE RACE QUESTION, 7689 04:56:42,960 --> 04:56:47,040 IT'S STILL A PROBLEM BECAUSE ONE 7690 04:56:47,040 --> 04:56:48,560 HALF IDENTIFIES WHITE, MOST OF 7691 04:56:48,560 --> 04:56:50,080 THE OTHER HALF CLASSIFIES AS 7692 04:56:50,080 --> 04:56:51,520 SOME OTHER RACE WHICH DOESN'T 7693 04:56:51,520 --> 04:56:53,040 TELL YOU ANYTHING. 7694 04:56:53,040 --> 04:56:53,360 OKAY. 7695 04:56:53,360 --> 04:56:54,440 NOW, WHY IS THAT? 7696 04:56:54,440 --> 04:56:56,640 FOR IMMIGRANTS THERE'S AN ISSUE 7697 04:56:56,640 --> 04:56:59,960 OF FLUIDITY AND LOW SALIENCE OF 7698 04:56:59,960 --> 04:57:01,240 RACIAL SELF-IDENTIFICATION, IT'S 7699 04:57:01,240 --> 04:57:02,600 NOT CLEAR WHAT CATEGORY YOU'RE 7700 04:57:02,600 --> 04:57:04,200 SUPPOSED TO RESPOND TO, U.S. 7701 04:57:04,200 --> 04:57:05,840 CATEGORIES, U.S. WAYS OF 7702 04:57:05,840 --> 04:57:08,160 RESPONDING ARE DIFFERENT THAN 7703 04:57:08,160 --> 04:57:09,040 LATIN AMERICAN ONES. 7704 04:57:09,040 --> 04:57:11,640 IN THE UNITED STATES, ESPECIALLY 7705 04:57:11,640 --> 04:57:14,840 FOR U.S.-BORN LATINOS THERE'S 7706 04:57:14,840 --> 04:57:17,240 THE IDEA LATINOS HAVE ONE RACE, 7707 04:57:17,240 --> 04:57:20,960 AND HISPANIC IS A SUFFICIENT 7708 04:57:20,960 --> 04:57:23,520 DESCRIPTOR, AND NO MORE THAN 7709 04:57:23,520 --> 04:57:23,720 THAT. 7710 04:57:23,720 --> 04:57:27,200 SO I'LL STOP THERE AND I LOOK 7711 04:57:27,200 --> 04:57:30,840 FORWARD TO QUESTIONS AND 7712 04:57:30,840 --> 04:57:33,480 DISCUSSION IN THE PANEL. 7713 04:57:33,480 --> 04:57:35,920 7714 04:57:35,920 --> 04:57:40,200 >>IN MANY PARTS OF LATIN 7715 04:57:40,200 --> 04:57:42,040 AMERICA INDIGENOUS POPULATIONS 7716 04:57:42,040 --> 04:57:49,880 ARE SUBJECT TO WIDESPREAD SOCIAL 7717 04:57:49,880 --> 04:57:53,320 EXCLUSION AND DISCRIMINATION, 7718 04:57:53,320 --> 04:57:54,920 DENIED RIGHTS, RESOURCES, 7719 04:57:54,920 --> 04:57:57,000 SERVICES AVAILABLE TO DOMINANT 7720 04:57:57,000 --> 04:58:02,480 GROUPS BASED ON RACIST 7721 04:58:02,480 --> 04:58:03,800 PREJUDICIAL TREATMENT, WITH A 7722 04:58:03,800 --> 04:58:05,240 SIGNIFICANT NEGATIVE IMPACT ON 7723 04:58:05,240 --> 04:58:09,880 MENTAL AND PHYSICAL HEALTH, THAT 7724 04:58:09,880 --> 04:58:12,800 RESULTS FROM STRESS RESPONSES. 7725 04:58:12,800 --> 04:58:18,840 IN SEGMENTED HEALTH SYSTEMS 7726 04:58:18,840 --> 04:58:27,560 OVERWHELMING FROM THE LOWEST 7727 04:58:27,560 --> 04:58:28,200 QUINTILES, CLINICAL ENCOUNTERS 7728 04:58:28,200 --> 04:58:30,960 BECOMES SITE OF REPRODUCTION OF 7729 04:58:30,960 --> 04:58:33,520 UNBALANCED SOCIAL AND GENDER 7730 04:58:33,520 --> 04:58:38,160 POWER DYNAMICS BETWEEN PATIENTS 7731 04:58:38,160 --> 04:58:39,480 AND CLINICIANS. 7732 04:58:39,480 --> 04:58:41,680 UNBALANCED DYNAMICS CAN RESULT 7733 04:58:41,680 --> 04:58:45,400 FROM RACIST TREATMENT, IN THIS 7734 04:58:45,400 --> 04:58:46,280 CONTEXT THE RESULTING TREATMENT 7735 04:58:46,280 --> 04:58:49,240 WHICH TAKES A FORM OF TRIPLE 7736 04:58:49,240 --> 04:58:51,120 EXCLUSION AND DISCRIMINATION ON 7737 04:58:51,120 --> 04:58:54,720 ACCOUNT OF BEING POOR, DARK 7738 04:58:54,720 --> 04:58:56,280 SKINNED, FEMALE, IS 7739 04:58:56,280 --> 04:58:57,880 SYSTEMATICALLY EMBEDDED WITHIN 7740 04:58:57,880 --> 04:58:59,000 CLINICAL ENCOUNTERS CONTRIBUTING 7741 04:58:59,000 --> 04:59:00,160 TO DIFFERENTIAL HEALTH OUTCOMES, 7742 04:59:00,160 --> 04:59:04,040 NOT ONLY AS A STRESSOR BUT AS A 7743 04:59:04,040 --> 04:59:07,720 RESULT OF LACK OF MECHANISMS TO 7744 04:59:07,720 --> 04:59:09,040 THE POPULATION, WITHHOLDING OF 7745 04:59:09,040 --> 04:59:11,080 TIMELY AND QUALITY CARE OR 7746 04:59:11,080 --> 04:59:14,160 OUTRIGHT NEGLECTS. 7747 04:59:14,160 --> 04:59:16,760 ALL OF WHICH PEOPLE-CENTERED 7748 04:59:16,760 --> 04:59:18,360 HUMAN RIGHTS BASED APPROACHES. 7749 04:59:18,360 --> 04:59:20,840 ALONG WITH MY TEAM AT THE 7750 04:59:20,840 --> 04:59:23,040 COLLABORATIVE GROUP FOR HEALTH 7751 04:59:23,040 --> 04:59:25,360 EQUITY IN LATIN AMERICA, AT 7752 04:59:25,360 --> 04:59:26,320 TULANE UNIVERSITY, WE HAVE 7753 04:59:26,320 --> 04:59:31,480 CONDUCTED A NUMBER OF STUDIES ON 7754 04:59:31,480 --> 04:59:33,000 TREATMENT, DISCRIMINATION, 7755 04:59:33,000 --> 04:59:34,080 VIOLENCE IN LATIN AMERICAN 7756 04:59:34,080 --> 04:59:36,200 HEALTH CARE SETTINGS. 7757 04:59:36,200 --> 04:59:41,440 FIRST, WE CONDUCTED A REVIEW OF 7758 04:59:41,440 --> 04:59:44,760 THE DISCRIMINATION AGAINST 7759 04:59:44,760 --> 04:59:46,360 INDIGENOUS WOMEN. 7760 04:59:46,360 --> 04:59:48,880 WE FOUND THAT DISCRIMINATION AND 7761 04:59:48,880 --> 04:59:50,960 MISTREATMENT OF TREATMENT ARE 7762 04:59:50,960 --> 04:59:52,960 WIDESPREAD, THEY ARE CHIEF 7763 04:59:52,960 --> 04:59:57,840 BARRIERS THAT PREVENT WOMEN OF 7764 04:59:57,840 --> 04:59:59,920 ETHNIC MINORITIES ACCESSING 7765 04:59:59,920 --> 05:00:07,400 HEALTH SERVICE AND CAN MANIFEST 7766 05:00:07,400 --> 05:00:08,600 NUMEROUS CLINICAL PRACTICES. 7767 05:00:08,600 --> 05:00:11,120 ONE, VERBAL ABUSE. 7768 05:00:11,120 --> 05:00:14,520 TWO, POOR RAPPORT WITH HIM. 7769 05:00:14,520 --> 05:00:16,880 THREE SOCIAL CULT CALLETS 7770 05:00:16,880 --> 05:00:17,880 DISCRIMINATION, FOUR PHYSICAL 7771 05:00:17,880 --> 05:00:19,600 ABEES, FIVE FAILURE TO MEET 7772 05:00:19,600 --> 05:00:21,160 PROFESSIONAL STANDARDS OF CARE, 7773 05:00:21,160 --> 05:00:25,000 AND SIX HEALTH SYSTEMS 7774 05:00:25,000 --> 05:00:25,840 CONDITIONS. 7775 05:00:25,840 --> 05:00:27,600 THERE WERE MANY EXAMPLES IN 7776 05:00:27,600 --> 05:00:33,080 WHICH WOMEN WHO HAVE BEEN 7777 05:00:33,080 --> 05:00:34,400 DEHUMANIZED IN CHILD BIRTH 7778 05:00:34,400 --> 05:00:37,240 REFRAIN FROM SEEKING CARE IN THE 7779 05:00:37,240 --> 05:00:38,880 FUTURE, FOUND REPORTS OF WOMEN 7780 05:00:38,880 --> 05:00:42,600 FEELING SHAME AND BEING TREATED 7781 05:00:42,600 --> 05:00:44,480 AS MORALLY AND INTELLECTUALLY 7782 05:00:44,480 --> 05:00:46,120 INFERIOR BY LOCAL HEALTH 7783 05:00:46,120 --> 05:00:46,440 PERSONNEL. 7784 05:00:46,440 --> 05:00:51,560 SIMILAR EXPERIENCES OF SHAME 7785 05:00:51,560 --> 05:00:53,120 REPORTED IN COSTA RICA, AND 7786 05:00:53,120 --> 05:00:55,960 PERUVIAN WOMEN SEEKING CARE IN 7787 05:00:55,960 --> 05:00:56,200 CHILE. 7788 05:00:56,200 --> 05:00:58,160 IN CHILE CLINICIANS WERE NOT 7789 05:00:58,160 --> 05:00:59,600 LIKELY TO SUPPORT THE 7790 05:00:59,600 --> 05:01:02,640 DEVELOPMENT AND ADVOCACY OF 7791 05:01:02,640 --> 05:01:04,040 POLICIES TO MANDATE 7792 05:01:04,040 --> 05:01:06,160 INTERCULTURAL CARE PRACTICES IF 7793 05:01:06,160 --> 05:01:08,480 THEY ARE VIEWED AS UNNECESSARY 7794 05:01:08,480 --> 05:01:10,080 OR IF THEY DEEMED INDIGENOUS 7795 05:01:10,080 --> 05:01:15,040 HEALTH AS UNWORTHY OF SPECIAL 7796 05:01:15,040 --> 05:01:15,600 INITIATIVES. 7797 05:01:15,600 --> 05:01:16,760 AMONG THE YACAPANI AREA, A THIRD 7798 05:01:16,760 --> 05:01:20,200 OF WOMEN IN A STUDY CITED FEAR 7799 05:01:20,200 --> 05:01:21,720 OF MISTREATMENT BY STAFF AS A 7800 05:01:21,720 --> 05:01:24,320 KEY DETERRENT TO SEEKING MEDICAL 7801 05:01:24,320 --> 05:01:25,000 CARE. 7802 05:01:25,000 --> 05:01:31,000 IN PERU THE PERCEIVED LOW 7803 05:01:31,000 --> 05:01:32,280 QUALITY OF SERVICES DISCOURAGED 7804 05:01:32,280 --> 05:01:34,160 INDIGENOUS WOMEN FROM SEEKING 7805 05:01:34,160 --> 05:01:34,400 CARE. 7806 05:01:34,400 --> 05:01:40,040 IN GUATEMALA SOCIAL EXCLUSION OF 7807 05:01:40,040 --> 05:01:47,480 IN INDIGENOUS, STUDIES SHOWED 7808 05:01:47,480 --> 05:01:51,880 MAYAN WOMEN CHOOSE TO GIVE BIRTH 7809 05:01:51,880 --> 05:01:57,360 AT HOME, EXPERIENCING CULTURALLY 7810 05:01:57,360 --> 05:01:58,600 INAPPROPRIATE TREATMENT. 7811 05:01:58,600 --> 05:02:00,520 IN COLOMBIA INEQUITIES HAVE BEEN 7812 05:02:00,520 --> 05:02:03,400 DESCRIBED AS PRODUCT OF BROADER 7813 05:02:03,400 --> 05:02:05,800 SOCIAL AND STRUCTURAL PATTERNS 7814 05:02:05,800 --> 05:02:11,560 OF EXCLUSION FOR DESCENDANTS AND 7815 05:02:11,560 --> 05:02:13,000 OTHER MINORITIES. 7816 05:02:13,000 --> 05:02:15,200 WITH MEMBERS, WE HAVE CONDUCTED 7817 05:02:15,200 --> 05:02:16,680 FIELD WORK IN THE DOMINICAN 7818 05:02:16,680 --> 05:02:21,720 REPUBLIC AS PART OF THE WOMEN TO 7819 05:02:21,720 --> 05:02:23,400 THE CENTER PROJECT. 7820 05:02:23,400 --> 05:02:26,560 LIKE MOST OF THE DOMINICAN 7821 05:02:26,560 --> 05:02:31,720 POPULATION, WOMEN WHO DELIVER IN 7822 05:02:31,720 --> 05:02:42,040 PUBLIC HOSPITALS ARE 7823 05:02:44,560 --> 05:02:47,120 OVERWHELMINGLY OF DESCENDANT. 7824 05:02:47,120 --> 05:02:49,760 COLONIAL PATH EMPHASIZES WHITE 7825 05:02:49,760 --> 05:02:52,600 SPANISH ORIGIN AND DENIAL OF THE 7826 05:02:52,600 --> 05:02:54,000 BLACK AFRICAN HERITAGE IN 7827 05:02:54,000 --> 05:02:56,440 COMPLEX ATTEMPT TO DIFFERENTIATE 7828 05:02:56,440 --> 05:02:58,920 THEMSELVES FROM THE HAITIAN 7829 05:02:58,920 --> 05:03:00,920 POPULATION WITH WHOM THEY SHARE 7830 05:03:00,920 --> 05:03:04,640 THE ISLAND OF HISPANOLIA AND 7831 05:03:04,640 --> 05:03:06,160 CENTURIES OF HISTORY. 7832 05:03:06,160 --> 05:03:08,480 MISTREATMENT IS BASED NOT ONLY 7833 05:03:08,480 --> 05:03:11,120 ON THE LARGE SOCIOECONOMIC 7834 05:03:11,120 --> 05:03:13,600 EDUCATIONAL AND GENDER DISTANCES 7835 05:03:13,600 --> 05:03:15,680 THAT EXIST BETWEEN CARE 7836 05:03:15,680 --> 05:03:17,440 PROVIDERS AND FEMALE PATIENTS 7837 05:03:17,440 --> 05:03:21,200 WHO LIVE WITH MANY SOCIOECONOMIC 7838 05:03:21,200 --> 05:03:24,560 DEPRIVATIONS BUT ABOUT RACE IS 7839 05:03:24,560 --> 05:03:25,560 PREJUDICIAL TREATMENT ACCORDING 7840 05:03:25,560 --> 05:03:28,280 TO THIS THOSE OF HIGHER POSITION 7841 05:03:28,280 --> 05:03:35,280 IDENTIFY WITH THE WHITE 7842 05:03:35,280 --> 05:03:37,000 COLONIALIST IDENTITY, ABOVE THE 7843 05:03:37,000 --> 05:03:38,120 BLACKNESS WHOSE RIGHTS CONTINUE 7844 05:03:38,120 --> 05:03:40,840 TO BE INFRINGED. 7845 05:03:40,840 --> 05:03:42,720 IN 2015 WE INTERVIEWED WOMEN 7846 05:03:42,720 --> 05:03:46,200 AFTER THEY WERE DISCHARGED AFTER 7847 05:03:46,200 --> 05:03:47,520 GIVING BIRTH INTO PUBLIC 7848 05:03:47,520 --> 05:03:48,840 MATERNITY HOSPITALS IN THE 7849 05:03:48,840 --> 05:03:50,200 DOMINICAN REPUBLIC, WE FOUND 7850 05:03:50,200 --> 05:03:54,640 THAT MOST WOMEN WHO EXPERIENCED 7851 05:03:54,640 --> 05:03:56,960 OBSTETRIC VIOLENCE TALKED ABOUT 7852 05:03:56,960 --> 05:04:03,200 IT UNEVENTFULLY, THEY ACCEPTED 7853 05:04:03,200 --> 05:04:04,520 THE CARE EXPERIENCE. 7854 05:04:04,520 --> 05:04:07,360 THEY MAY HAVE ALSO NORMALIZED 7855 05:04:07,360 --> 05:04:09,000 MISTREATMENT AS YET ANOTHER 7856 05:04:09,000 --> 05:04:11,520 MANIFESTATION OF THE PERSISTENT 7857 05:04:11,520 --> 05:04:13,440 RACISM, SEXISM, CLASSISM THAT 7858 05:04:13,440 --> 05:04:15,680 THEY EXPERIENCE IN EVERYDAY 7859 05:04:15,680 --> 05:04:16,000 LIFE. 7860 05:04:16,000 --> 05:04:18,760 WE HAVE IDENTIFIED THIS AS 7861 05:04:18,760 --> 05:04:20,160 ADAPTIVE PREFERENCE OF WOMEN, 7862 05:04:20,160 --> 05:04:22,360 WHO MAY DOWNPLAY NEGATIVE 7863 05:04:22,360 --> 05:04:24,440 EXPERIENCES AT THE HOSPITAL, AND 7864 05:04:24,440 --> 05:04:25,760 ACCEPT OBSTETRIC VIOLENCE AS 7865 05:04:25,760 --> 05:04:27,040 PARTS OF ROUTINE CARE BECAUSE 7866 05:04:27,040 --> 05:04:31,120 THEY DO NOT HAVE THE OPTION TO 7867 05:04:31,120 --> 05:04:33,960 SEEK CARE ELSEWHERE. 7868 05:04:33,960 --> 05:04:35,600 THIS NEGATIVE INTERACTION 7869 05:04:35,600 --> 05:04:37,240 PROMOTES UNEQUAL POWER DYNAMIC 7870 05:04:37,240 --> 05:04:39,440 BETWEEN WOMEN AND HOSPITAL 7871 05:04:39,440 --> 05:04:42,040 PERSONNEL, AND THEY COMPEL WOMEN 7872 05:04:42,040 --> 05:04:45,120 TO ACCEPT PASSIVE ROLE IN BIRTH 7873 05:04:45,120 --> 05:04:47,760 EXPERIENCES WITHOUT ABILITY OF 7874 05:04:47,760 --> 05:04:49,920 GAINING ANY CONTROL. 7875 05:04:49,920 --> 05:04:52,200 IN 2019 WE CONDUCTED 7876 05:04:52,200 --> 05:04:54,600 OBSERVATIONAL STUDY WITH 7877 05:04:54,600 --> 05:04:55,480 STATISTICAL REPRESENTATIVE 7878 05:04:55,480 --> 05:04:59,640 SAMPLE OF 275 BIRTHS IN TWO 7879 05:04:59,640 --> 05:05:02,720 PUBLIC DOMINICAN HOSPITALS, 117 7880 05:05:02,720 --> 05:05:04,840 INCIDENTS OF VERBAL VIOLENCE, 24 7881 05:05:04,840 --> 05:05:06,800 OF PHYSICAL VIOLENCE, 25% OF 7882 05:05:06,800 --> 05:05:09,200 THOSE GIVING BIRTH WERE MINORS, 7883 05:05:09,200 --> 05:05:12,120 THE MOST FREQUENT FORMS OF 7884 05:05:12,120 --> 05:05:14,760 VERBAL VIOLENCE INCLUDED THE 7885 05:05:14,760 --> 05:05:17,080 PREGNANT WOMEN OR GIRL RECEIVED 7886 05:05:17,080 --> 05:05:19,440 NEGATIVE COMMENTS ABOUT HER 7887 05:05:19,440 --> 05:05:22,560 ETHNICITY, SKIN COLOR, OR OTHER 7888 05:05:22,560 --> 05:05:23,760 PHYSICAL CHARACTERISTICS, 23% OF 7889 05:05:23,760 --> 05:05:25,800 WOMEN AND GIRLS IN ONE HOSPITAL 7890 05:05:25,800 --> 05:05:29,200 AND 7% IN THE OTHER. 7891 05:05:29,200 --> 05:05:32,240 WAS SCOLDED OR BLAMED FOR HER OR 7892 05:05:32,240 --> 05:05:33,680 HER NEWBORN'S HEALTH. 7893 05:05:33,680 --> 05:05:36,880 WAS YELLED AT, MADE FUN OF, OR 7894 05:05:36,880 --> 05:05:38,600 WAS CALLED NAMES. 7895 05:05:38,600 --> 05:05:41,560 AND WAS THREATENED WITH PHYSICAL 7896 05:05:41,560 --> 05:05:44,320 VIOLENCE, USE OF PROCEDURE OR 7897 05:05:44,320 --> 05:05:48,320 FAILURE TO CARE FOR THE NEWBORN. 7898 05:05:48,320 --> 05:05:51,520 THE MOST FREQUENT FORMS OF 7899 05:05:51,520 --> 05:05:54,800 PHYSICAL VIOLENCE INCLUDED THAT 7900 05:05:54,800 --> 05:05:57,760 THE PREGNANT WOMEN OR GIRL WERE 7901 05:05:57,760 --> 05:05:59,600 PINCHED, GAGGED, PRESSED AGAINST 7902 05:05:59,600 --> 05:06:02,240 THE BED WITH FORCE, OR SLAPPED, 7903 05:06:02,240 --> 05:06:06,720 BEATEN, PRESSED HARD ON HER 7904 05:06:06,720 --> 05:06:07,280 ABDOMEN. 7905 05:06:07,280 --> 05:06:08,800 ALSO IN 2019, TO UNDERSTAND 7906 05:06:08,800 --> 05:06:18,520 DOCTORS AND NURSES PER 7907 05:06:18,520 --> 05:06:19,960 PERSPECTIVES FOR JUSTIFICATION 7908 05:06:19,960 --> 05:06:24,560 CONDUCTED INTERVIEWS ACROSS 7909 05:06:24,560 --> 05:06:26,960 HOSPITALS, STAFFER EXPLAINED 7910 05:06:26,960 --> 05:06:28,120 NEGATIVE PATIENT PROVIDER 7911 05:06:28,120 --> 05:06:32,560 RELATIONSHIPS, MISTREATMENT AND 7912 05:06:32,560 --> 05:06:34,320 VIOLENCE WERE A RESULT OF WOMEN 7913 05:06:34,320 --> 05:06:37,160 NOT COLLABORATING WITH CARE TEAM 7914 05:06:37,160 --> 05:06:39,080 OR COMPLYING WITH INSTRUCTIONS 7915 05:06:39,080 --> 05:06:40,200 AND ORDERS. 7916 05:06:40,200 --> 05:06:42,200 SOME BLAMED WOMEN FOR BEING 7917 05:06:42,200 --> 05:06:45,560 VIOLENT AND AGGRESSIVE DURING 7918 05:06:45,560 --> 05:06:47,880 LABOR OR BLAME WOMEN FOR 7919 05:06:47,880 --> 05:06:50,080 INABILITY TO COMPLY. 7920 05:06:50,080 --> 05:06:52,920 MANY HEALTH CARE PROVIDERS ALSO 7921 05:06:52,920 --> 05:07:00,360 DESCRIBED WOMEN'S NON-COME 7922 05:07:00,360 --> 05:07:09,600 COMPLIANCE AS A SOURCE OF 7923 05:07:09,600 --> 05:07:10,280 FRUSTRATION. 7924 05:07:10,280 --> 05:07:18,760 SOMETIMES BECAUSE OF LANGUAGE 7925 05:07:18,760 --> 05:07:19,000 BARRIER. 7926 05:07:19,000 --> 05:07:20,280 NON-COMPLIANCE AND AGGRESSION 7927 05:07:20,280 --> 05:07:25,120 ATTRIBUTED TO WOMEN WITH CERTAIN 7928 05:07:25,120 --> 05:07:25,760 SOCIODEMOGRAPHIC 7929 05:07:25,760 --> 05:07:27,840 CHARACTERISTICS, SUCH AS 7930 05:07:27,840 --> 05:07:30,720 EDUCATION, AGE, PARITY OR BEING 7931 05:07:30,720 --> 05:07:30,960 HAITIAN. 7932 05:07:30,960 --> 05:07:33,560 AS ONE FEMALE OB/GYN DESCRIBED, 7933 05:07:33,560 --> 05:07:35,600 A GOOD RELATIONSHIP COULD BE 7934 05:07:35,600 --> 05:07:38,240 WHEN THE PATIENT SPEAKS THE SAME 7935 05:07:38,240 --> 05:07:40,640 LANGUAGE, THAT THE PATIENT IS 7936 05:07:40,640 --> 05:07:42,040 INTERESTED IN HELPING IN 7937 05:07:42,040 --> 05:07:45,480 EVERYTHING THAT THE DOCTOR SAYS. 7938 05:07:45,480 --> 05:07:49,200 THE SAME LANGUAGE, AS YOU WILL 7939 05:07:49,200 --> 05:07:50,280 LEARN ALMOST ALL HAITIAN 7940 05:07:50,280 --> 05:07:51,720 PATIENTS DO NOT SPEAK SPANISH, 7941 05:07:51,720 --> 05:07:54,440 THEY HAVE A DIFFERENT MENTALITY, 7942 05:07:54,440 --> 05:07:58,720 MANY TIMES WE INDICATE AN 7943 05:07:58,720 --> 05:08:00,640 ANALYSIS SONOGRAPHY FOR FREE AND 7944 05:08:00,640 --> 05:08:02,240 MANY TIMES THEY DO NOT DO IT. 7945 05:08:02,240 --> 05:08:04,160 A PATIENT WHO CARES MORE ABOUT 7946 05:08:04,160 --> 05:08:07,160 HER CHECKUPS WOULD BE GOOD, ONE 7947 05:08:07,160 --> 05:08:08,320 WHERE YOU INDICATE VITAMINS, 7948 05:08:08,320 --> 05:08:10,680 SOME TEST, SHE MEETS ALL THE 7949 05:08:10,680 --> 05:08:11,000 REQUIREMENTS. 7950 05:08:11,000 --> 05:08:13,280 HERE THAT IS NOT THE CASE. 7951 05:08:13,280 --> 05:08:15,280 HERE IT IS VERY DIFFICULT. 7952 05:08:15,280 --> 05:08:19,440 FIRST DIFFERENCE IN LANGUAGE, 7953 05:08:19,440 --> 05:08:20,840 SECOND THAT THEY DO THEIR PART. 7954 05:08:20,840 --> 05:08:24,560 OF COURSE THEY WERE NOT 7955 05:08:24,560 --> 05:08:26,680 INCLUDING AT ALL THE 7956 05:08:26,680 --> 05:08:27,720 SOCIOECONOMIC CONTEXT IN WHICH A 7957 05:08:27,720 --> 05:08:31,000 LOT OF THESE PEOPLE LIVE, WHICH 7958 05:08:31,000 --> 05:08:35,840 IS OFTENTIMES POVERTY, AND EVEN 7959 05:08:35,840 --> 05:08:36,480 EXTREME POVERTY. 7960 05:08:36,480 --> 05:08:39,000 OTHER HEALTH CARE PROVIDERS AND 7961 05:08:39,000 --> 05:08:42,400 STAFF SAID ALTHOUGH LACK OF 7962 05:08:42,400 --> 05:08:43,600 COLLABORATION OR COMPLIANCE WAS 7963 05:08:43,600 --> 05:08:47,640 AN IMPORTANT CAUSE OF 7964 05:08:47,640 --> 05:08:49,440 MISTREATMENTS CLINICIANS WERE 7965 05:08:49,440 --> 05:08:51,160 RESPONSIBLE FOR FOSTERING A 7966 05:08:51,160 --> 05:08:52,920 POSITIVE RELATIONSHIP WITH THEIR 7967 05:08:52,920 --> 05:08:55,560 PATIENTS AND CREATING AN 7968 05:08:55,560 --> 05:08:57,440 ENVIRONMENT IN WHICH WOMEN TRUST 7969 05:08:57,440 --> 05:09:01,240 PROVIDERS AND FEEL SAFE DURING 7970 05:09:01,240 --> 05:09:02,240 LABOR. 7971 05:09:02,240 --> 05:09:04,640 WHEN CONNECTING WITH THE PATIENT 7972 05:09:04,640 --> 05:09:06,720 FAILS, SOME CLINICIANS TURN TO 7973 05:09:06,720 --> 05:09:08,560 PHYSICAL AND VERBAL ABUSE TO 7974 05:09:08,560 --> 05:09:10,440 FORCE PATIENTS TO COMPLY DURING 7975 05:09:10,440 --> 05:09:11,760 CHILD BIRTH. 7976 05:09:11,760 --> 05:09:13,960 SOME CLINICIAN ALSO DESCRIBE THE 7977 05:09:13,960 --> 05:09:16,600 WOMEN'S LACK OF COMPLIANCE AS 7978 05:09:16,600 --> 05:09:18,000 SOURCE OF FRUSTRATION AND OTHERS 7979 05:09:18,000 --> 05:09:20,920 EXPLAIN THE USE OF FORCE OR 7980 05:09:20,920 --> 05:09:22,680 OTHER FORMS OF MISTREATMENT WHEN 7981 05:09:22,680 --> 05:09:25,200 WOMEN DO NOT COOPERATE WAS NOT 7982 05:09:25,200 --> 05:09:27,640 MERELY AN ACT OF FRUSTRATION BUT 7983 05:09:27,640 --> 05:09:31,160 A NECESSARY ACTION TO SAVE THE 7984 05:09:31,160 --> 05:09:33,080 WOMAN AND HER CHILD. 7985 05:09:33,080 --> 05:09:34,480 THE EFFECTS OF MISTREATMENT 7986 05:09:34,480 --> 05:09:36,920 DISCRIMINATION AND OTHER FORMS 7987 05:09:36,920 --> 05:09:39,440 OF OBSTETRIC VIOLENCE WITH 7988 05:09:39,440 --> 05:09:40,720 FINANCIAL BARRIERS AFFECT HEALTH 7989 05:09:40,720 --> 05:09:43,520 CARE UTILIZATION AMONG WOMEN OF 7990 05:09:43,520 --> 05:09:45,680 ETHNICITY MINORITIES WHICH CAN 7991 05:09:45,680 --> 05:09:49,960 RESULT IN DIFFERENTIAL HEALTH 7992 05:09:49,960 --> 05:09:52,480 OUTCOMES. 7993 05:09:52,480 --> 05:09:53,200 DISCRIMINATION CAN DETER 7994 05:09:53,200 --> 05:09:54,400 INDIGENOUS FROM PSYCHING MEDICAL 7995 05:09:54,400 --> 05:09:57,040 CARE IN THE FIRST PLACE. 7996 05:09:57,040 --> 05:09:59,880 WHEN THEY DO SEEK CARE WOMEN OF 7997 05:09:59,880 --> 05:10:02,200 ETHNIC MINORITIES MAY BE MORE 7998 05:10:02,200 --> 05:10:05,800 VULNERABLE THAN OTHER WOMEN TO 7999 05:10:05,800 --> 05:10:07,520 RECEIVING SUBSTANDARD QUALITY OF 8000 05:10:07,520 --> 05:10:18,080 CARE OR BEING THE SUBJECTED TO 8001 05:10:21,840 --> 05:10:23,320 LONGER DELAYS. 8002 05:10:23,320 --> 05:10:25,400 EVEN THOUGH UNDERSTAFFING 8003 05:10:25,400 --> 05:10:27,920 MEDICATION SHORTAGES OUTDATED OR 8004 05:10:27,920 --> 05:10:29,200 UNREPAIRED MEDICAL EQUIPMENT, 8005 05:10:29,200 --> 05:10:34,160 LACK OF ADHERENCE TO PROTOCOLS 8006 05:10:34,160 --> 05:10:35,760 AND WEAK SYSTEMS COMPROMISE 8007 05:10:35,760 --> 05:10:38,720 QUALITY OF CARE REGARDLESS OF 8008 05:10:38,720 --> 05:10:39,680 ETHNICITY, DISCRIMINATION IN THE 8009 05:10:39,680 --> 05:10:45,120 HEALTH CARE SETTING IS A DRIVER 8010 05:10:45,120 --> 05:10:46,600 OF INEQUITABLE HEALTH OUTCOMES. 8011 05:10:46,600 --> 05:10:48,120 EXPLAINING THE SUFFERING OF 8012 05:10:48,120 --> 05:10:51,320 WOMEN WILL NOT ON ITS OWN 8013 05:10:51,320 --> 05:10:54,800 PREVENT RACISM OR OBSTETRIC 8014 05:10:54,800 --> 05:10:55,240 VIOLENCE. 8015 05:10:55,240 --> 05:10:57,200 HOWEVER, THE REALIZATION OF 8016 05:10:57,200 --> 05:10:59,280 THESE ISSUES OFFERS TWO KEY 8017 05:10:59,280 --> 05:11:00,760 BENEFITS, FIRST CONTRIBUTES TO 8018 05:11:00,760 --> 05:11:03,920 ADVOCACY FOR THE ADOPTION OF 8019 05:11:03,920 --> 05:11:04,800 HUMAN RIGHTS BASED APPROACHES 8020 05:11:04,800 --> 05:11:06,560 THAT PROTECT WOMEN IN PREGNANCY 8021 05:11:06,560 --> 05:11:10,080 AND CHILD BIRTH WHEN NONE EXIST. 8022 05:11:10,080 --> 05:11:13,080 SECOND, IT CONTRIBUTES TO THE 8023 05:11:13,080 --> 05:11:18,320 MONITORING AND DOCUMENTATION OF 8024 05:11:18,320 --> 05:11:20,680 HUMAN RIGHTS STANDARDS IN HEALTH 8025 05:11:20,680 --> 05:11:21,960 SYSTEMS TO PREVENT OBSTETRIC 8026 05:11:21,960 --> 05:11:25,040 VIOLENCE AND THE CONSEQUENCES OF 8027 05:11:25,040 --> 05:11:25,560 RACISM. 8028 05:11:25,560 --> 05:11:30,080 BY STUDYING THE ASSOCIATIONS 8029 05:11:30,080 --> 05:11:31,480 AMONG OBSTETRIC VIOLENCE, AND 8030 05:11:31,480 --> 05:11:34,160 INEQUITY IN THE RIGHT TO HEALTH, 8031 05:11:34,160 --> 05:11:36,000 WE AIM TO DISPEL THE MYTH 8032 05:11:36,000 --> 05:11:40,560 VIOLENCE IN HEALTH CARE SETTING 8033 05:11:40,560 --> 05:11:42,880 IS UNEVENTFUL. 8034 05:11:42,880 --> 05:11:48,880 8035 05:11:48,880 --> 05:11:52,640 8036 05:11:52,640 --> 05:11:53,520 >>GREETINGS, EVERYONE. 8037 05:11:53,520 --> 05:11:56,680 WE'RE NOW LIVE FOR OUR Q&A. 8038 05:11:56,680 --> 05:11:59,560 I'M DR. JARRETT JOHNSON, YOUR 8039 05:11:59,560 --> 05:12:02,920 SESSION MODERATOR. 8040 05:12:02,920 --> 05:12:11,160 FIRST, LET ME THANK YOU FOR YOUR 8041 05:12:11,160 --> 05:12:11,720 BRIEF PRESENTATIONS COVERING 8042 05:12:11,720 --> 05:12:13,520 HISTORICAL CONTEXT IN THE 8043 05:12:13,520 --> 05:12:16,080 DOMINICAN REPUBLIC. 8044 05:12:16,080 --> 05:12:19,360 THIS IS A SENSITIVE BUT TIMELY 8045 05:12:19,360 --> 05:12:21,760 TOPIC AND WANTED PRESENTATION TO 8046 05:12:21,760 --> 05:12:24,920 BE SHORT, TO ALLOW FOR AMPLE 8047 05:12:24,920 --> 05:12:25,280 DISCUSSION. 8048 05:12:25,280 --> 05:12:28,320 WE'RE A LITTLE BIT OVER TIME BUT 8049 05:12:28,320 --> 05:12:33,280 WE'LL TRY TO DO OUR BEST. 8050 05:12:33,280 --> 05:12:35,800 AGAIN, THANK YOU TO OUR 8051 05:12:35,800 --> 05:12:36,200 PANELISTS. 8052 05:12:36,200 --> 05:12:40,920 NOW FOR MY FIRST QUESTION, RACE 8053 05:12:40,920 --> 05:12:43,760 IS A SOCIOPOLITICAL CONSTRUCT, 8054 05:12:43,760 --> 05:12:46,240 WITH REAL WORLD EFFECTS FOR 8055 05:12:46,240 --> 05:12:47,400 THOSE THAT FACE DISCRIMINATION, 8056 05:12:47,400 --> 05:12:50,800 THOSE OF DARKER SKIN COLOR AS 8057 05:12:50,800 --> 05:12:52,680 SEEN IN BOTH PRESENTATIONS IN 8058 05:12:52,680 --> 05:12:54,600 THE LATIN AMERICAN CONTEXT. 8059 05:12:54,600 --> 05:12:57,800 SO, ARE THERE ANY CURRENT 8060 05:12:57,800 --> 05:13:00,400 INTERVENTIONS OR TOOLS YOU CAN 8061 05:13:00,400 --> 05:13:05,880 DISCUSS THAT ADDRESS THIS 8062 05:13:05,880 --> 05:13:07,960 PERVASIVE PROBLEM? 8063 05:13:07,960 --> 05:13:10,600 WHO WANTS TO GO FIRST? 8064 05:13:10,600 --> 05:13:12,000 >>I'M NOT A HEALTH RESEARCHER, 8065 05:13:12,000 --> 05:13:15,760 I I WANT TO MAKE THAT CLEAR. 8066 05:13:15,760 --> 05:13:17,840 BUT I TRIED TO MAKE THE POINT IN 8067 05:13:17,840 --> 05:13:24,840 THE TEN MINUTES I HAD WAS ABOUT 8068 05:13:24,840 --> 05:13:25,160 DATA. 8069 05:13:25,160 --> 05:13:26,880 THAT'S WHERE MY INTERVENTION IS, 8070 05:13:26,880 --> 05:13:28,560 ABOUT DATA, WE NEED REALLY GOOD 8071 05:13:28,560 --> 05:13:30,840 DATA TO UNDERSTAND THIS. 8072 05:13:30,840 --> 05:13:33,760 AND THE ONE QUESTION OR 8073 05:13:33,760 --> 05:13:34,440 GETTING -- CAPTURING DATA 8074 05:13:34,440 --> 05:13:39,040 WHETHER SOMEBODY IS LATINO OR 8075 05:13:39,040 --> 05:13:40,560 NOT IS IMPORTANT BUT NOT ENOUGH. 8076 05:13:40,560 --> 05:13:42,200 IN HEALTH YOU HAVE ISSUES OF 8077 05:13:42,200 --> 05:13:44,280 HEALTH CARE BUT HEALTH ITSELF, 8078 05:13:44,280 --> 05:13:46,800 AND I CAN IMAGINE THAT STRESS 8079 05:13:46,800 --> 05:13:49,320 LEVELS MAY BE VERY DIFFERENT, 8080 05:13:49,320 --> 05:13:51,200 FOR EXAMPLE, AMONG PEOPLE OF 8081 05:13:51,200 --> 05:13:53,240 DIFFERENT SKIN COLORS OR THEY 8082 05:13:53,240 --> 05:13:54,840 APPEAR MORE AFRICAN OR 8083 05:13:54,840 --> 05:13:56,960 INDIGENOUS, AND SO I THINK IN 8084 05:13:56,960 --> 05:13:58,680 THESE HEALTH SURVEYS IN THE 8085 05:13:58,680 --> 05:14:01,800 LATIN AMERICAN CASE HAVE BEEN 8086 05:14:01,800 --> 05:14:03,480 VERY -- IT'S VERY NEW THEY 8087 05:14:03,480 --> 05:14:05,320 COLLECT RACE DATA, AND NOT IN 8088 05:14:05,320 --> 05:14:08,520 ALL THE COUNTRIES, AND IN THE 8089 05:14:08,520 --> 05:14:11,560 U.S. I DON'T KNOW THAT THEY 8090 05:14:11,560 --> 05:14:12,840 COLLECT RACE, DETAILED RACE 8091 05:14:12,840 --> 05:14:13,040 DATA. 8092 05:14:13,040 --> 05:14:15,160 I IMAGINE YOU COULD DO THIS WITH 8093 05:14:15,160 --> 05:14:17,800 A BATTERY OF QUESTIONS, FOR 8094 05:14:17,800 --> 05:14:20,280 EXAMPLE, TO REALLY UNDERSTAND 8095 05:14:20,280 --> 05:14:21,720 THE DETAILS ABOUT APPEARANCE AND 8096 05:14:21,720 --> 05:14:25,640 HOW PEOPLE THINK ABOUT 8097 05:14:25,640 --> 05:14:27,880 THEMSELVES RACIALLY. 8098 05:14:27,880 --> 05:14:29,920 >>DR. CASTRO? 8099 05:14:29,920 --> 05:14:32,560 >>THERE HAVE BEEN SOME EFFORTS 8100 05:14:32,560 --> 05:14:34,520 UNDERSTOOD THE UMBRELLA OF 8101 05:14:34,520 --> 05:14:37,480 INTERCULTURAL CARE AND SOME HAVE 8102 05:14:37,480 --> 05:14:40,040 BEEN LED BY THE PAN AMERICAN 8103 05:14:40,040 --> 05:14:41,960 HEALTH ORGANIZATION, UNICEF, 8104 05:14:41,960 --> 05:14:42,760 THEY HAVE DIFFERENT 8105 05:14:42,760 --> 05:14:46,240 METHODOLOGIES, AND THOSE HAVE 8106 05:14:46,240 --> 05:14:48,560 BEEN MOSTLY REENTERED TOWARDS 8107 05:14:48,560 --> 05:14:49,920 INDIGENOUS COMMUNITIES, THERE 8108 05:14:49,920 --> 05:14:51,960 ARE SOME SUCCESS STORIES. 8109 05:14:51,960 --> 05:14:58,640 THERE'S A RECENT ONE COMING FROM 8110 05:14:58,640 --> 05:15:02,920 PERU, BECAUSE RACISM IS SO 8111 05:15:02,920 --> 05:15:04,680 PERVASIVE, AND THAT THE WORK 8112 05:15:04,680 --> 05:15:05,640 AGAINST ANTI-RACIST WORK NEEDS 8113 05:15:05,640 --> 05:15:09,480 TO BE DONE MUCH EARLIER AND 8114 05:15:09,480 --> 05:15:12,200 SHOULD BE INCLUDED IN MEDICAL 8115 05:15:12,200 --> 05:15:14,320 EDUCATION, SHOULD BE CLINICIANS 8116 05:15:14,320 --> 05:15:16,800 AND NURSES, AND HOSPITAL STAFF 8117 05:15:16,800 --> 05:15:19,200 SHOULD BE MADE MORE AWARE OF 8118 05:15:19,200 --> 05:15:21,320 THEIR OWN ACTIONS AND THEIR 8119 05:15:21,320 --> 05:15:24,280 IMPACT THAT THOSE HAVE, AND I'M 8120 05:15:24,280 --> 05:15:26,600 NOT VERY FAMILIAR YET WITH 8121 05:15:26,600 --> 05:15:28,440 ACTIONS THAT HAVE BEEN 8122 05:15:28,440 --> 05:15:30,320 SUCCESSFUL AT THE REGIONAL LEVEL 8123 05:15:30,320 --> 05:15:34,400 OR NATIONAL LEVEL. 8124 05:15:34,400 --> 05:15:37,000 >>THANK YOU SO MUCH. 8125 05:15:37,000 --> 05:15:39,200 SO, MY NEXT QUESTION CAN YOU 8126 05:15:39,200 --> 05:15:43,240 SPEAK TO RACISM AND 8127 05:15:43,240 --> 05:15:45,960 DISCRIMINATION FROM PERSONS FROM 8128 05:15:45,960 --> 05:15:48,120 ONE LATIN AMERICAN COUNTRY TO 8129 05:15:48,120 --> 05:15:50,040 ANOTHER BEFORE ARRIVING IN THE 8130 05:15:50,040 --> 05:15:51,200 U.S. ESPECIALLY PERSONS OF 8131 05:15:51,200 --> 05:15:53,320 INDIGENOUS COMMUNITIES, HOW DOES 8132 05:15:53,320 --> 05:15:55,400 THAT EXPERIENCE SHOW UP IN 8133 05:15:55,400 --> 05:15:56,600 INTERACTION WITH OTHER LATINOS 8134 05:15:56,600 --> 05:15:57,960 ON THEIR HEALTH AND STRESS, ET 8135 05:15:57,960 --> 05:16:00,400 CETERA? 8136 05:16:00,400 --> 05:16:04,800 8137 05:16:04,800 --> 05:16:06,000 8138 05:16:06,000 --> 05:16:08,400 >>WELL, MY RESEARCH IN LATIN 8139 05:16:08,400 --> 05:16:11,600 AMERICA, NOT IN THE U.S., SO I 8140 05:16:11,600 --> 05:16:16,840 CANNOT TELL YOU WITH MY OWN DATA 8141 05:16:16,840 --> 05:16:19,440 OR MY OWN FINDINGS ABOUT THOSE 8142 05:16:19,440 --> 05:16:21,640 INTERACTIONS IN THE U.S. 8143 05:16:21,640 --> 05:16:25,360 WHAT I HAVE FOUND INTERESTING IS 8144 05:16:25,360 --> 05:16:27,560 THAT IN THE MOST RECENT CENSUS 8145 05:16:27,560 --> 05:16:30,600 THERE HAS BEEN IN THE U.S. AN 8146 05:16:30,600 --> 05:16:33,360 INCREASE IN THE NUMBER OF PEOPLE 8147 05:16:33,360 --> 05:16:35,760 WHO HAVE SELF-IDENTIFIED AS 8148 05:16:35,760 --> 05:16:36,760 INDIGENOUS, AND THAT THAT 8149 05:16:36,760 --> 05:16:38,400 INCREASE COMES FROM PEOPLE WHO 8150 05:16:38,400 --> 05:16:43,080 HAVE COME FROM LATIN AMERICA. 8151 05:16:43,080 --> 05:16:47,480 THAT I FIND INTERESTING 8152 05:16:47,480 --> 05:16:47,800 OBSERVATION. 8153 05:16:47,800 --> 05:16:49,040 >>I THINK IT'S A GREAT 8154 05:16:49,040 --> 05:16:50,000 QUESTION, ONE PROBLEM IS WE 8155 05:16:50,000 --> 05:16:51,880 DON'T HAVE DATA AND DON'T HAVE 8156 05:16:51,880 --> 05:16:54,600 RESEARCHERS THAT ARE INTERESTED 8157 05:16:54,600 --> 05:16:55,320 IN THIS. 8158 05:16:55,320 --> 05:16:57,640 AND I IMAGINE THE PERSON THAT 8159 05:16:57,640 --> 05:16:59,320 ASKED WAS THINKING ABOUT THE 8160 05:16:59,320 --> 05:17:00,200 CASE OF HAITIANS. 8161 05:17:00,200 --> 05:17:02,040 IT'S A BIG QUESTION. 8162 05:17:02,040 --> 05:17:03,800 HAITIANS ARE IN PLACES LIKE 8163 05:17:03,800 --> 05:17:05,240 CHILE, WHERE THEY DON'T COLLECT 8164 05:17:05,240 --> 05:17:06,320 THIS DATA, THEY HAVE COME 8165 05:17:06,320 --> 05:17:08,280 THROUGH CENTRAL AMERICA AND 8166 05:17:08,280 --> 05:17:10,920 MEXICO AND A LOT IN TIJUANA, I 8167 05:17:10,920 --> 05:17:13,240 DON'T KNOW WHAT THE QUALITY OF 8168 05:17:13,240 --> 05:17:15,520 DATA COLLECTION IS IN MEXICO SO 8169 05:17:15,520 --> 05:17:18,080 DATA SYSTEMS NOT ONLY HAVE TO BE 8170 05:17:18,080 --> 05:17:20,440 FOR IMMIGRANTS HAVE TO BE GOOD 8171 05:17:20,440 --> 05:17:27,000 THERE AS WELL AS HERE. 8172 05:17:27,000 --> 05:17:28,760 NOW, IDENTIFYING AS INDIGENOUS, 8173 05:17:28,760 --> 05:17:30,840 YEAH, THERE'S BEEN INCREASE OF 8174 05:17:30,840 --> 05:17:32,840 PEOPLE IDENTIFYING AS INDIGENOUS 8175 05:17:32,840 --> 05:17:33,480 AMONG LATIN AMERICANS. 8176 05:17:33,480 --> 05:17:37,960 MART IS THE -- PART IS U.S. 8177 05:17:37,960 --> 05:17:40,160 CENSUS BUREAU ATTEMPT TO GIVE 8178 05:17:40,160 --> 05:17:44,840 EXAMPLES, INSTEAD OF JUST U.S. 8179 05:17:44,840 --> 05:17:46,280 GROUPS, LIKE NAVAJO, APACHE, ET 8180 05:17:46,280 --> 05:17:51,680 CETERA, THEY ALSO GIVE EXAMPLES 8181 05:17:51,680 --> 05:17:53,960 OF LATIN AMERICAN GROUPS. 8182 05:17:53,960 --> 05:17:57,960 SO THAT'S CLEARLY AN EXAMPLE. 8183 05:17:57,960 --> 05:18:00,520 SO IT PROMPTS PEOPLE NOT TO 8184 05:18:00,520 --> 05:18:04,360 ANSWER THEY ARE INDIGENOUS. 8185 05:18:04,360 --> 05:18:06,560 >>THANK YOU. 8186 05:18:06,560 --> 05:18:09,800 SO, I THINK THE QUESTION GOES 8187 05:18:09,800 --> 05:18:13,200 INTO THE LACK OF STUDY YOU 8188 05:18:13,200 --> 05:18:18,440 MENTIONED, AND THIS IS 8189 05:18:18,440 --> 05:18:20,840 PARTICULAR FOR AFRO LATINO OR 8190 05:18:20,840 --> 05:18:21,960 LATINA POPULATION. 8191 05:18:21,960 --> 05:18:23,560 HAVE THERE BEEN LARGE 8192 05:18:23,560 --> 05:18:27,760 LONGITUDINAL STUDIES FOCUSED ON 8193 05:18:27,760 --> 05:18:30,600 THE AFRO LATINO/LATINA 8194 05:18:30,600 --> 05:18:32,120 POPULATION, ESPECIALLY 8195 05:18:32,120 --> 05:18:33,680 COLLECTING DATA SURROUNDING 8196 05:18:33,680 --> 05:18:35,080 LIVED EXPERIENCES? 8197 05:18:35,080 --> 05:18:36,800 >>THERE'S HARDLY ANY DATA 8198 05:18:36,800 --> 05:18:38,000 COLLECTED AT ALL. 8199 05:18:38,000 --> 05:18:39,880 WHEN I WAS REALLY LOOKING INTO 8200 05:18:39,880 --> 05:18:41,320 THIS, FIVE OR TEN YEARS AGO, 8201 05:18:41,320 --> 05:18:47,440 THERE WAS ALMOST NO DATA 8202 05:18:47,440 --> 05:18:48,960 COLLECTED ON AFRO LATINO AND 8203 05:18:48,960 --> 05:18:55,440 RELIANCE ON CENSUS WAS A 8204 05:18:55,440 --> 05:18:55,680 PROBLEM. 8205 05:18:55,680 --> 05:18:57,960 LESS DOMINICANS IDENTIFIED AS 8206 05:18:57,960 --> 05:18:59,840 AFRICAN, FROM WHAT PEOPLE TELL 8207 05:18:59,840 --> 05:19:01,520 ME THAT'S NOT REALISTIC, FOR 8208 05:19:01,520 --> 05:19:03,800 EXAMPLE, AND THAT'S THE EXTENT 8209 05:19:03,800 --> 05:19:04,880 OF THE DATA THERE. 8210 05:19:04,880 --> 05:19:06,520 A GROUP IN NEW YORK WAS 8211 05:19:06,520 --> 05:19:08,560 COLLECTING DATA BUT I'M SURE 8212 05:19:08,560 --> 05:19:10,760 THERE'S NO LONGITUDINAL DATA AND 8213 05:19:10,760 --> 05:19:16,480 THERE'S PROBABLY -- VERY LITTLE 8214 05:19:16,480 --> 05:19:17,440 HEALTH DATA. 8215 05:19:17,440 --> 05:19:18,280 ARACHU WOULD KNOW MORE. 8216 05:19:18,280 --> 05:19:21,400 >>STUD I HAVES HAVE BEEN 8217 05:19:21,400 --> 05:19:21,920 CONDUCTED AMONG LATINA 8218 05:19:21,920 --> 05:19:22,840 POPULATIONS IN THE U.S. BUT THE 8219 05:19:22,840 --> 05:19:24,440 PROBLEM IS THE PROBLEM OF 8220 05:19:24,440 --> 05:19:28,280 CLASSIFICATION IN THE U.S. WHICH 8221 05:19:28,280 --> 05:19:30,480 HAS DR. TELLES WAS EXPLAINING 8222 05:19:30,480 --> 05:19:31,480 THE SAME CONCEPTS THAT ARE 8223 05:19:31,480 --> 05:19:35,880 WIDELY USED IN THE U.S. MAY NOT 8224 05:19:35,880 --> 05:19:37,920 BE COMPATIBLE WITH THE ONES FROM 8225 05:19:37,920 --> 05:19:43,920 THE PEOPLE IN LATIN AMERICA AND 8226 05:19:43,920 --> 05:19:49,080 I SEE STUDIES IN THE U.S. WHERE 8227 05:19:49,080 --> 05:19:51,280 THEY BRING TOGETHER GROUPS YOU 8228 05:19:51,280 --> 05:19:53,360 WOULD NEVER MIX IN LATIN 8229 05:19:53,360 --> 05:19:54,440 AMERICA. 8230 05:19:54,440 --> 05:20:00,240 AND THERE ARE COMPARISONS, FOR 8231 05:20:00,240 --> 05:20:02,440 EXAMPLE, EVEN IF WE DO STUDIES 8232 05:20:02,440 --> 05:20:04,880 FOR EXAMPLE SURVEYS CONDUCTED 8233 05:20:04,880 --> 05:20:06,720 THROUGHOUT THE REGION, AND AS 8234 05:20:06,720 --> 05:20:09,040 DR. TELLES WAS SAYING IN EACH 8235 05:20:09,040 --> 05:20:11,960 COUNTRY THEY USE A DIFFERENT 8236 05:20:11,960 --> 05:20:12,880 CLASSIFICATION FOR ETHNICITY OR 8237 05:20:12,880 --> 05:20:14,720 SKIN COLOR OF PEOPLE AND THERE 8238 05:20:14,720 --> 05:20:19,720 HAVE BEEN ATTEMPTS BY 8239 05:20:19,720 --> 05:20:21,280 RESEARCHERS TO COMPARE, FOR 8240 05:20:21,280 --> 05:20:24,560 EXAMPLE, TO ATTEMPT TO PUT ALL 8241 05:20:24,560 --> 05:20:27,520 THOSE IN THE SURVEY WHO WERE 8242 05:20:27,520 --> 05:20:35,280 CLASSIFIED AS AFRO DESCENDANT 8243 05:20:35,280 --> 05:20:36,600 INTO ONE GROUP AND THAT DOESN'T 8244 05:20:36,600 --> 05:20:38,240 MAKE SENSE, THERE'S A HISTORY 8245 05:20:38,240 --> 05:20:39,560 HOW PEOPLE CLASSIFY THEMSELVES 8246 05:20:39,560 --> 05:20:40,520 IN EACH COUNTRY. 8247 05:20:40,520 --> 05:20:42,280 FOR EXAMPLE, IN BRAZIL THERE WAS 8248 05:20:42,280 --> 05:20:44,960 AN INCREASE IN THE NUMBER OF 8249 05:20:44,960 --> 05:20:48,920 PEOPLE WHO IDENTIFIED AS AFRO 8250 05:20:48,920 --> 05:20:49,760 BRAZILIANS FROM ONE CENSUS TO 8251 05:20:49,760 --> 05:20:52,160 THE OTHER, NOT DUE TO INCREASE 8252 05:20:52,160 --> 05:20:53,120 IN POPULATION, IT WAS INCREASE 8253 05:20:53,120 --> 05:20:57,760 THROUGH A LOT OF EFFORTS TO 8254 05:20:57,760 --> 05:21:02,680 PEOPLE IDENTIFY AS AFRO 8255 05:21:02,680 --> 05:21:03,840 BRAZILIAN ACCORDING TO INCREASE 8256 05:21:03,840 --> 05:21:05,440 PRIDE IN THAT PROCESS. 8257 05:21:05,440 --> 05:21:07,480 SO IN EACH COUNTRY THOSE 8258 05:21:07,480 --> 05:21:10,240 PROCESSES OF IDENTIFICATION ARE 8259 05:21:10,240 --> 05:21:20,920 VERY DIFFERENT, AND YOU CANNOT 8260 05:21:20,920 --> 05:21:24,240 COMPARE AFRO DESCENDANTS IN 8261 05:21:24,240 --> 05:21:25,560 BRAZIL OR DOMINICAN REPUBLIC, 8262 05:21:25,560 --> 05:21:26,400 THOSE HAVE NOT WORKED, EVEN IN 8263 05:21:26,400 --> 05:21:28,760 THE U.S., I SEE STUDIES AND 8264 05:21:28,760 --> 05:21:30,480 THINK, WOW, IT WOULD BE HARD FOR 8265 05:21:30,480 --> 05:21:35,880 ME TO DO MUCH WITH THOSE. 8266 05:21:35,880 --> 05:21:36,240 >>ABSOLUTELY. 8267 05:21:36,240 --> 05:21:38,800 THANK YOU FOR THAT. 8268 05:21:38,800 --> 05:21:40,880 ANOTHER THEME THROUGHOUT THIS 8269 05:21:40,880 --> 05:21:45,360 WORKSHOP HAS BEEN FUNDING. 8270 05:21:45,360 --> 05:21:48,880 SO, IF ONE HAD UNLIMITED 8271 05:21:48,880 --> 05:21:50,400 FUNDING, YOU COULD DESIGN A 8272 05:21:50,400 --> 05:21:52,240 STUDY TO ADDRESS SOME OF THE 8273 05:21:52,240 --> 05:21:55,160 GAPS YOU'VE IDENTIFIED JUST NOW, 8274 05:21:55,160 --> 05:21:57,360 ESPECIALLY SEEING THERE IS A 8275 05:21:57,360 --> 05:22:00,960 DEARTH OF STUDIES SURROUNDING 8276 05:22:00,960 --> 05:22:05,080 THE AFRO LATINO/LATINA 8277 05:22:05,080 --> 05:22:05,400 POPULATION. 8278 05:22:05,400 --> 05:22:08,360 COULD YOU DESCRIBE WHAT THAT 8279 05:22:08,360 --> 05:22:10,360 STUDY WOULD LOOK LIKE AND WHAT 8280 05:22:10,360 --> 05:22:14,000 ARE SOME MEASURES OR ITEMS YOU 8281 05:22:14,000 --> 05:22:19,240 WOULD LIKE TO INCLUDE IN SUCH 8282 05:22:19,240 --> 05:22:19,440 STUDY? 8283 05:22:19,440 --> 05:22:22,480 >>YOU KNOW, I WOULD -- I MEAN, 8284 05:22:22,480 --> 05:22:24,800 YOU MENTIONED THERE'S A 8285 05:22:24,800 --> 05:22:25,680 DIFFERENT POLITICAL SOCIAL 8286 05:22:25,680 --> 05:22:28,640 CONSTRUCTION OF RACE, AND IT IS 8287 05:22:28,640 --> 05:22:30,080 SOMETHING POLITICALLY SOCIAL 8288 05:22:30,080 --> 05:22:31,360 CONSTRUCTED BUT DIFFERENTLY IN 8289 05:22:31,360 --> 05:22:32,200 DIFFERENT COUNTRIES. 8290 05:22:32,200 --> 05:22:38,040 SO WE HAVE TO PAY ATTENTION TO 8291 05:22:38,040 --> 05:22:39,000 NATIONAL PARTICULARITIES OF HOW, 8292 05:22:39,000 --> 05:22:42,280 FOR EXAMPLE, AFRO PEOPLE ARE 8293 05:22:42,280 --> 05:22:42,680 IDENTIFIED. 8294 05:22:42,680 --> 05:22:45,240 AND THAT'S VERY IMPORTANT. 8295 05:22:45,240 --> 05:22:47,880 BUT I THINK, FOR EXAMPLE, THE 8296 05:22:47,880 --> 05:22:52,480 ISSUE OF COLOR, YOU HAD SOME 8297 05:22:52,480 --> 05:22:55,240 KIND OF CONSISTENT COLOR PALETTE 8298 05:22:55,240 --> 05:22:56,840 YOU COULD MEASURE COUNTRY AND 8299 05:22:56,840 --> 05:22:58,920 LOOK AT DIFFERENT HEALTH CARE 8300 05:22:58,920 --> 05:23:02,120 TREATMENTS OR HEALTH OUTCOMES IN 8301 05:23:02,120 --> 05:23:02,680 DIFFERENT PLACES. 8302 05:23:02,680 --> 05:23:09,200 AND ON THE SAME BASIS, WITH THE 8303 05:23:09,200 --> 05:23:09,560 SAME STANDARD. 8304 05:23:09,560 --> 05:23:11,520 >>DR. CASTRO? 8305 05:23:11,520 --> 05:23:16,360 >>I WOULD FUND MORE STUDIES 8306 05:23:16,360 --> 05:23:17,760 THAT COULD COMPARE THE LIVED 8307 05:23:17,760 --> 05:23:19,280 EXPERIENCES OF POPULATIONS IN 8308 05:23:19,280 --> 05:23:22,560 THE U.S. AND COUNTRIES OF ORIGIN 8309 05:23:22,560 --> 05:23:25,480 OR PARENTS' COUNTRIES OF ORIGIN, 8310 05:23:25,480 --> 05:23:30,320 AND DEFINITELY IN TERMS OF 8311 05:23:30,320 --> 05:23:31,440 HEALTH CARE, STUDY ASSOCIATIONS 8312 05:23:31,440 --> 05:23:33,160 ON ONE HAND LIVING CONDITIONS 8313 05:23:33,160 --> 05:23:34,520 AND LIVED EXPERIENCE, AND THE 8314 05:23:34,520 --> 05:23:37,480 OTHER THE EXPERIENCES IN THE 8315 05:23:37,480 --> 05:23:42,320 CLINICAL ENCOUNTER, AND HOW 8316 05:23:42,320 --> 05:23:43,560 RACISM PERMEATES DIFFERENTLY IN 8317 05:23:43,560 --> 05:23:44,240 DIFFERENT HEALTH CARE SETTINGS. 8318 05:23:44,240 --> 05:23:47,440 IN THE U.S. THERE'S AN EFFORT TO 8319 05:23:47,440 --> 05:23:50,200 STUDY RACISM IN CARDIOVASCULAR 8320 05:23:50,200 --> 05:23:53,360 HEALTH, IN DIFFERENT AREAS, TO 8321 05:23:53,360 --> 05:23:55,080 MY KNOWLEDGE IN LATIN AMERICA 8322 05:23:55,080 --> 05:23:57,720 THE LITTLE THAT'S BEEN DONE HAS 8323 05:23:57,720 --> 05:23:59,880 BEEN AROUND MATERNAL AND CHILD 8324 05:23:59,880 --> 05:24:01,040 HEALTH, SEXUAL AND REPRODUCTIVE 8325 05:24:01,040 --> 05:24:04,080 HEALTH BUT WE NEED TO BRING THIS 8326 05:24:04,080 --> 05:24:05,720 MORE PROMINENT. 8327 05:24:05,720 --> 05:24:07,720 WE NEED TO BETTER UNDERSTAND 8328 05:24:07,720 --> 05:24:12,400 WHAT IS HAPPENING IN HEALTH CARE 8329 05:24:12,400 --> 05:24:14,040 SETTINGS, MISDIAGNOSED, 8330 05:24:14,040 --> 05:24:14,760 MISTREATMENT, NOT PROVIDING 8331 05:24:14,760 --> 05:24:18,000 TIMELY CARE FOR PEOPLE WHO NEED 8332 05:24:18,000 --> 05:24:20,280 IT, AND TO ESTABLISH 8333 05:24:20,280 --> 05:24:22,560 ASSOCIATIONS BETWEEN THAT AND 8334 05:24:22,560 --> 05:24:23,800 HEALTH OUTCOMES. 8335 05:24:23,800 --> 05:24:27,040 AND TO USE THAT INFORMATION TO 8336 05:24:27,040 --> 05:24:29,880 MAKE PEOPLE MORE AWARE OF THEIR 8337 05:24:29,880 --> 05:24:31,440 ACTIONS, AND THAT SHOULD BE 8338 05:24:31,440 --> 05:24:33,360 DONE, I THINK IT WOULD BE 8339 05:24:33,360 --> 05:24:34,280 STRONGER IF IT COULD BE DONE IN 8340 05:24:34,280 --> 05:24:40,720 THE U.S. AS IN LATIN AMERICA. 8341 05:24:40,720 --> 05:24:41,800 >>ABSOLUTELY. 8342 05:24:41,800 --> 05:24:45,760 SO, ANOTHER QUESTION HERE, 8343 05:24:45,760 --> 05:24:50,400 REGARDING THE COLLECTION OF RACE 8344 05:24:50,400 --> 05:24:54,000 AND ETHNICITY, ACCORDING TO OBN, 8345 05:24:54,000 --> 05:24:58,920 ANY THOUGHTS ABOUT REDESIGNING 8346 05:24:58,920 --> 05:25:02,720 OR REVISITING SUCH SURVEY? 8347 05:25:02,720 --> 05:25:06,680 OR EVEN REDESIGNING IT, EXCUSE 8348 05:25:06,680 --> 05:25:10,200 ME, FOR NEW VALIDATED MEASURES? 8349 05:25:10,200 --> 05:25:15,800 8350 05:25:15,800 --> 05:25:18,000 OMB CATEGORY, FOR THE RACE AND 8351 05:25:18,000 --> 05:25:21,960 ETHNICITY, IF ONE LOOKED AT THE 8352 05:25:21,960 --> 05:25:23,600 SURVEY, THE SURVEY THAT'S 8353 05:25:23,600 --> 05:25:24,880 CONDUCTED EVERY TEN YEARS, 8354 05:25:24,880 --> 05:25:27,280 THERE'S A DIFFERENT RACIAL 8355 05:25:27,280 --> 05:25:29,360 BREAKDOWN AND OVER THE YEARS IF 8356 05:25:29,360 --> 05:25:32,200 YOU'RE FAMILIAR WITH THAT 8357 05:25:32,200 --> 05:25:36,680 SURVEY, THE CATEGORIES HAVE 8358 05:25:36,680 --> 05:25:39,440 CHANGED, FOR EXAMPLE, THE 8359 05:25:39,440 --> 05:25:40,080 LATIN -- HISPANIC LATINO 8360 05:25:40,080 --> 05:25:42,080 CATEGORY HAS BEEN MORE 8361 05:25:42,080 --> 05:25:44,800 POPULATED, WHERE PEOPLE COULD 8362 05:25:44,800 --> 05:25:49,160 ACTUALLY IDENTIFY THEIR COUNTRY 8363 05:25:49,160 --> 05:25:51,480 OF ORIGIN, OR TIED TO COUNTRY OF 8364 05:25:51,480 --> 05:25:52,440 ORIGIN. 8365 05:25:52,440 --> 05:25:55,200 ARE THERE ANY THOUGHTS ABOUT 8366 05:25:55,200 --> 05:25:56,280 REDESIGNING THAT? 8367 05:25:56,280 --> 05:25:57,720 GO AHEAD. 8368 05:25:57,720 --> 05:26:01,400 >>IT'S BEEN REDESIGNED. 8369 05:26:01,400 --> 05:26:05,360 THE CENSUS BUREAU PUT FORTH A 8370 05:26:05,360 --> 05:26:08,200 ONE-QUESTION FORMAT WITH LATINO 8371 05:26:08,200 --> 05:26:11,400 CATEGORY IN THE RACE -- WOULD BE 8372 05:26:11,400 --> 05:26:17,320 A RACE, AND THEY WOULD ALSO ADD 8373 05:26:17,320 --> 05:26:19,600 MIDDLE EASTERN/NORTH AFRICAN, 8374 05:26:19,600 --> 05:26:22,640 THAT WAS BASICALLY NOT DONE IN 8375 05:26:22,640 --> 05:26:23,960 THE 2020 CENSUS BECAUSE THE 8376 05:26:23,960 --> 05:26:25,080 TRUMP ADMINISTRATION SAT ON IT 8377 05:26:25,080 --> 05:26:26,880 AND THEY DIDN'T LET IT PASS, AND 8378 05:26:26,880 --> 05:26:28,520 THERE WAS A LOT OF OPPOSITION BY 8379 05:26:28,520 --> 05:26:32,520 PEOPLE THAT WERE ON THE PANEL 8380 05:26:32,520 --> 05:26:35,000 THE CENSUS BUREAU -- THE OMB 8381 05:26:35,000 --> 05:26:37,880 PANEL INCLUDING PEOPLE FROM THE 8382 05:26:37,880 --> 05:26:39,960 HERITAGE FOUNDATION, AND THAT 8383 05:26:39,960 --> 05:26:41,480 WOULD HAVE BEEN -- WOULD HAVE 8384 05:26:41,480 --> 05:26:42,920 ALLOWED PEOPLE TO CHECK MORE 8385 05:26:42,920 --> 05:26:46,200 THAN ONE SO THEY COULD CHECK 8386 05:26:46,200 --> 05:26:47,880 HISPANIC AND BLACK, AND BUT IT 8387 05:26:47,880 --> 05:26:50,920 STILL HAS THE SAME PROBLEMS, 8388 05:26:50,920 --> 05:26:54,320 MOST PEOPLE ONLY CHECK ONE. 8389 05:26:54,320 --> 05:26:57,720 BUT IT WOULD OVERCOME THE 8390 05:26:57,720 --> 05:26:59,040 PROBLEM OF 40% OF LATINO 8391 05:26:59,040 --> 05:27:00,440 CLASSIFYING AS SOME OTHER RACE. 8392 05:27:00,440 --> 05:27:03,320 SOME OTHER RACE IS ACTUALLY THE 8393 05:27:03,320 --> 05:27:05,240 SECOND LARGEST OR SECOND LARGEST 8394 05:27:05,240 --> 05:27:06,640 OR THIRD LARGEST RACIAL GROUP IN 8395 05:27:06,640 --> 05:27:08,560 THE UNITED STATES, WHICH DOESN'T 8396 05:27:08,560 --> 05:27:11,160 MAKE ANY SENSE. 8397 05:27:11,160 --> 05:27:14,440 8398 05:27:14,440 --> 05:27:14,960 >>THANK YOU. 8399 05:27:14,960 --> 05:27:19,720 I DO HAVE A QUESTION HERE, 8400 05:27:19,720 --> 05:27:22,000 LEONARDO, WOULD YOU BE ABLE TO 8401 05:27:22,000 --> 05:27:23,320 JUST TYPE IT IN? 8402 05:27:23,320 --> 05:27:31,320 >>YES, I WILL TYPE IT IN. 8403 05:27:31,320 --> 05:27:33,640 >>IN THE MEANTIME I WILL ASK 8404 05:27:33,640 --> 05:27:35,520 THE NEXT QUESTION. 8405 05:27:35,520 --> 05:27:36,800 WHAT ARE IMPORTANT RESEARCH 8406 05:27:36,800 --> 05:27:39,000 QUESTIONS THAT WE NEED TO ANSWER 8407 05:27:39,000 --> 05:27:43,000 NOW TO ADDRESS RACISM IN HEALTH 8408 05:27:43,000 --> 05:27:43,200 CARE? 8409 05:27:43,200 --> 05:27:45,800 8410 05:27:45,800 --> 05:27:47,240 >>LET ME JUST FINISH WHAT I WAS 8411 05:27:47,240 --> 05:27:49,520 GOING TO SAY ON THE LAST ONE, 8412 05:27:49,520 --> 05:27:50,720 OMB QUESTION. 8413 05:27:50,720 --> 05:27:53,480 I MEAN, EITHER THE TWO-QUESTION 8414 05:27:53,480 --> 05:27:54,160 FORMAT OR ONE-QUESTION FORMAT IS 8415 05:27:54,160 --> 05:27:56,400 THE POINT I WAS TRYING TO MAKE 8416 05:27:56,400 --> 05:27:59,920 IN MY TALK, THAT'S NOT ENOUGH. 8417 05:27:59,920 --> 05:28:01,000 THE CENSUS, I GET IT COST 8418 05:28:01,000 --> 05:28:02,760 MILLIONS OF DOLLARS TO ADD A 8419 05:28:02,760 --> 05:28:04,760 QUESTION, BUT MAYBE AT LEAST IN 8420 05:28:04,760 --> 05:28:06,080 SURVEYS WE CAN ASK OTHER 8421 05:28:06,080 --> 05:28:07,800 QUESTIONS LIKE, YOU KNOW, WE CAN 8422 05:28:07,800 --> 05:28:12,600 GET QUESTIONS ON COLOR OR WE CAN 8423 05:28:12,600 --> 05:28:15,000 ASK IN DIFFERENT WAYS IF YOU 8424 05:28:15,000 --> 05:28:16,320 HAVE AFRICAN ANCESTRY, ET 8425 05:28:16,320 --> 05:28:16,840 CETERA. 8426 05:28:16,840 --> 05:28:19,840 >>I THINK BUILDING ON THAT, 8427 05:28:19,840 --> 05:28:24,000 ALSO ADDRESSING THE QUESTION, IS 8428 05:28:24,000 --> 05:28:25,960 THAT WE SHOULD BE MORE DEMANDING 8429 05:28:25,960 --> 05:28:28,480 ABOUT WHAT ARE THE CONCEPTUAL 8430 05:28:28,480 --> 05:28:30,240 MODELS THAT RESEARCHERS IN 8431 05:28:30,240 --> 05:28:32,720 PUBLIC HEALTH USE, WHEN THEY 8432 05:28:32,720 --> 05:28:35,480 WANT TO STUDY THE LATINO/LATINA 8433 05:28:35,480 --> 05:28:36,920 POPULATION IN THE U.S. BECAUSE 8434 05:28:36,920 --> 05:28:41,520 WHAT DOES IT MEAN TO PUT INTO 8435 05:28:41,520 --> 05:28:43,520 ONE SINGLE CATEGORY PEOPLE FROM 8436 05:28:43,520 --> 05:28:47,960 PUERTO RICO, PEOPLE FROM CHILE, 8437 05:28:47,960 --> 05:28:49,400 PEOPLE FROM MEXICO. 8438 05:28:49,400 --> 05:28:51,200 I'M AN ANTHROPOLOGIST, I REALLY 8439 05:28:51,200 --> 05:28:52,920 DON'T UNDERSTAND HOW I CAN 8440 05:28:52,920 --> 05:28:55,800 INTERPRET DATA WHERE PEOPLE WHO 8441 05:28:55,800 --> 05:28:57,400 COME FROM VERY DIFFERENT 8442 05:28:57,400 --> 05:29:00,880 BACKGROUNDS CAN BE JUST PUT 8443 05:29:00,880 --> 05:29:02,560 TOGETHER BECAUSE THEY SHARE A 8444 05:29:02,560 --> 05:29:05,320 COLONIAL LANGUAGE WHICH IS 8445 05:29:05,320 --> 05:29:05,520 SPANISH. 8446 05:29:05,520 --> 05:29:09,320 I'M FROM SPAIN, I'M ALSO IN THE 8447 05:29:09,320 --> 05:29:11,320 CATEGORY OF HISPANIC, AND I 8448 05:29:11,320 --> 05:29:13,520 REALLY DON'T UNDERSTAND WHY LIKE 8449 05:29:13,520 --> 05:29:15,560 PEOPLE FROM SPAIN ARE PUT 8450 05:29:15,560 --> 05:29:17,880 TOGETHER WITH PEOPLE FROM 8451 05:29:17,880 --> 05:29:20,040 GUATEMALA, WHICH, AGAIN, I DON'T 8452 05:29:20,040 --> 05:29:22,680 THINK EVEN FROM, YOU KNOW, 8453 05:29:22,680 --> 05:29:24,600 ANTHROPOLOGICAL OR HEALTH 8454 05:29:24,600 --> 05:29:28,160 PERSPECTIVE MAKES MUCH SENSE, 8455 05:29:28,160 --> 05:29:29,560 MORE WORK NEEDS TO BE DONE IN 8456 05:29:29,560 --> 05:29:32,520 HOW PEOPLE USE THAT DATA TO DO 8457 05:29:32,520 --> 05:29:33,840 RESEARCH. 8458 05:29:33,840 --> 05:29:35,280 >>ABSOLUTELY. 8459 05:29:35,280 --> 05:29:36,560 THANK YOU. 8460 05:29:36,560 --> 05:29:39,640 STILL WAITING FOR THE QUESTION. 8461 05:29:39,640 --> 05:29:41,160 LEONARDO, I WANTED IT TO BE 8462 05:29:41,160 --> 05:29:47,400 TYPED IN THE CHAT AND CAPTURED 8463 05:29:47,400 --> 05:29:49,040 BUT YOU CAN UNMUTE AND ASK. 8464 05:29:49,040 --> 05:29:49,480 >>OKAY. 8465 05:29:49,480 --> 05:29:54,080 IN THE CASE OF LATINOS, MY 8466 05:29:54,080 --> 05:29:56,480 PERSONAL OPINION, I THINK THAT 8467 05:29:56,480 --> 05:29:59,640 SELF-IDENTIFIED RACE IS REALLY 8468 05:29:59,640 --> 05:30:02,280 INSUFFICIENT TO CAPTURE THE 8469 05:30:02,280 --> 05:30:04,360 THREE-WAY RACIAL COMPONENTS THAT 8470 05:30:04,360 --> 05:30:06,320 WE HAVE, THAT LATINOS HAVE. 8471 05:30:06,320 --> 05:30:11,680 SO, WHAT DO YOU GUYS THINK ABOUT 8472 05:30:11,680 --> 05:30:12,840 USING GENERIC CENSUS 3 AS A WAY 8473 05:30:12,840 --> 05:30:14,920 TO MEASURE SOME OF THE 8474 05:30:14,920 --> 05:30:21,320 INEQUITIES THAT YOU'RE TRYING TO 8475 05:30:21,320 --> 05:30:22,200 MEASURE? 8476 05:30:22,200 --> 05:30:29,280 >>WELL, GENETIC ORIGIN IS NOT 8477 05:30:29,280 --> 05:30:30,640 NECESSARILY ASSOCIATED WITH 8478 05:30:30,640 --> 05:30:31,480 CERTAIN HEALTH OUTCOMES. 8479 05:30:31,480 --> 05:30:33,840 THE EXPERIENCE OF RACISM IS NOT 8480 05:30:33,840 --> 05:30:39,480 BASED ON GENETIC COMPOSITION. 8481 05:30:39,480 --> 05:30:42,760 IT'S BASED ON APPEARANCE. 8482 05:30:42,760 --> 05:30:45,520 SO I DON'T KNOW WHY SOME MEME 8483 05:30:45,520 --> 05:30:49,880 MAY NOT EVEN KNOW THEIR GENETIC 8484 05:30:49,880 --> 05:30:55,360 ORIGIN, AND I REALLY AM NOT SURE 8485 05:30:55,360 --> 05:30:58,400 HOW THAT CAN HELP UNDERSTAND 8486 05:30:58,400 --> 05:31:00,200 IDENTITY OR HOW SOMEBODY 8487 05:31:00,200 --> 05:31:03,800 PROJECTS TO OTHERS, THE ONES WHO 8488 05:31:03,800 --> 05:31:07,640 PERPETRATE RACISM AGAINST THEM 8489 05:31:07,640 --> 05:31:09,600 BASED ON GENETIC COMPOSITION. 8490 05:31:09,600 --> 05:31:12,720 >>GO AHEAD. 8491 05:31:12,720 --> 05:31:17,760 >>GO AHEAD, EDWARD. 8492 05:31:17,760 --> 05:31:19,200 >>I MEAN, THERE'S NOT -- 8493 05:31:19,200 --> 05:31:20,520 APPEARANCE IS REALLY IMPORTANT 8494 05:31:20,520 --> 05:31:21,920 IN LATIN AMERICA, THE WAY PEOPLE 8495 05:31:21,920 --> 05:31:23,040 ARE TREATED IS IMPORTANT IN 8496 05:31:23,040 --> 05:31:24,160 LATIN AMERICA AND THE UNITED 8497 05:31:24,160 --> 05:31:27,400 STATES I SHOULD SAY, AND NOT 8498 05:31:27,400 --> 05:31:31,680 NECESSARILY THE WAY PEOPLE 8499 05:31:31,680 --> 05:31:32,120 SELF-IDENTIFY. 8500 05:31:32,120 --> 05:31:36,040 GET WHAT I WOULD TRY TO TO DO 8501 05:31:36,040 --> 05:31:41,840 WITH COLOR PALETTE, GET AT SOME 8502 05:31:41,840 --> 05:31:42,880 APPROXIMATION APPEARANCE. 8503 05:31:42,880 --> 05:31:45,160 I THINK YOU'RE ASKING ABOUT THE 8504 05:31:45,160 --> 05:31:46,360 GENETIC ANCESTRY TEST PEOPLE 8505 05:31:46,360 --> 05:31:54,120 TAKE, I GUESS IN HEALTH YOU 8506 05:31:54,120 --> 05:31:55,800 COULD GET THAT. 8507 05:31:55,800 --> 05:32:00,480 THAT'S LOOSELY CORRELATED WITH 8508 05:32:00,480 --> 05:32:00,840 APPEARANCE. 8509 05:32:00,840 --> 05:32:04,000 IT MIGHT BE A LITTLE BETTER. 8510 05:32:04,000 --> 05:32:08,040 WHEN YOU'RE DOING A HEALTH 8511 05:32:08,040 --> 05:32:09,160 SURVEY, YOU TAKE PEOPLE'S BLOOD 8512 05:32:09,160 --> 05:32:10,800 AND MAYBE THAT WOULD HELP BUT 8513 05:32:10,800 --> 05:32:12,440 THAT'S FAR FROM PERFECT BECAUSE 8514 05:32:12,440 --> 05:32:21,440 OF THE LACK OF ASSOCIATION. 8515 05:32:21,440 --> 05:32:23,120 >>UNFORTUNATELY, WE'RE AT TIME. 8516 05:32:23,120 --> 05:32:26,520 THANK YOU FOR THE 8517 05:32:26,520 --> 05:32:27,640 THOUGHT-PROVOKING AND ENCOURAGE 8518 05:32:27,640 --> 05:32:28,920 DISCUSSION AND AUDIENCE FOR YOUR 8519 05:32:28,920 --> 05:32:29,400 QUESTIONS. 8520 05:32:29,400 --> 05:32:33,840 NEXT IS OUR BREAK. 8521 05:32:33,840 --> 05:32:35,840 PLEASE RETURN AT OR BEFORE 3:20 8522 05:32:35,840 --> 05:32:40,000 FOR THE NEXT SESSION ON 8523 05:32:40,000 --> 05:32:43,240 GENOMICS. 8524 05:32:43,240 --> 05:32:45,800 THANK YOU. 8525 05:32:45,800 --> 05:32:47,200 >>WELCOME BACK. 8526 05:32:47,200 --> 05:32:51,320 THE NEXT SESSION IS GENOMICS 8527 05:32:51,320 --> 05:32:53,600 MODERATED BY RINA DAS. 8528 05:32:53,600 --> 05:32:55,880 ENJOY. 8529 05:32:55,880 --> 05:33:01,720 >>I'M DR. RINA DAS, FROM NIMHD, 8530 05:33:01,720 --> 05:33:03,160 AND I'LL BE THE MODERATOR. 8531 05:33:03,160 --> 05:33:07,080 WE HAVE FIVE GREAT TALKS FOR 8532 05:33:07,080 --> 05:33:17,600 YOU, SPEAKERS ARE DR. LEONARDO 8533 05:33:21,160 --> 05:33:24,600 MARINO, DR. LOPERA 8534 05:33:24,600 --> 05:33:34,040 , FOLLOWED BY A PANEL 8535 05:33:34,040 --> 05:33:34,920 DISCUSSION. 8536 05:33:34,920 --> 05:33:36,440 >>GOOD AFTERNOON, I'M A 8537 05:33:36,440 --> 05:33:37,640 STADTMAN INVESTIGATORS, I'M 8538 05:33:37,640 --> 05:33:40,720 GOING TO PRESENT CONSORTIUM FOR 8539 05:33:40,720 --> 05:33:45,440 GENOMIC DIVERSITY ANCESTRY AND 8540 05:33:45,440 --> 05:33:47,720 HEALTH IN COLOMBIA. 8541 05:33:47,720 --> 05:33:50,360 THIS FIGURE PUBLISHED IN NATURE 8542 05:33:50,360 --> 05:33:58,040 GENETICS PAPER OF 2019 SHOWS HOW 8543 05:33:58,040 --> 05:33:59,760 GENOMIC GWAS STUDIES LAG IN 8544 05:33:59,760 --> 05:34:00,440 DIVERSITY REPRESENTING THE 8545 05:34:00,440 --> 05:34:01,520 GLOBAL POPULATION. 8546 05:34:01,520 --> 05:34:08,840 IN THE UPPER PANEL WE SEE THAT 8547 05:34:08,840 --> 05:34:11,480 THE GWAS FROM DIFFERENT, FOR 8548 05:34:11,480 --> 05:34:16,520 EXAMPLE EUROPEAN IN RED, EAST 8549 05:34:16,520 --> 05:34:19,920 ASIAN IN BLUE, AND SO ON, 79% OF 8550 05:34:19,920 --> 05:34:22,520 ALL GWAS PARTICIPANTS ARE FROM 8551 05:34:22,520 --> 05:34:23,960 EUROPEAN ACCIDENT, DESPITE 8552 05:34:23,960 --> 05:34:26,640 MAKING ONLY ABOUT 15% OF THE 8553 05:34:26,640 --> 05:34:29,200 GLOBAL POPULATION. 8554 05:34:29,200 --> 05:34:30,960 THIS IS PROBLEMATIC, AS AFRICAN 8555 05:34:30,960 --> 05:34:34,280 AMERICAN AND HISPANIC OR LATIN 8556 05:34:34,280 --> 05:34:36,520 AMERICAN ANCESTRY POPULATIONS 8557 05:34:36,520 --> 05:34:37,560 CONTRIBUTE TO DISPROPORTIONATELY 8558 05:34:37,560 --> 05:34:38,960 HIGH NUMBER OF ASSOCIATIONS 8559 05:34:38,960 --> 05:34:47,400 RELATIVE TO STUDIES OF SIMILAR 8560 05:34:47,400 --> 05:34:49,240 SIZES IN EUROPEANS. 8561 05:34:49,240 --> 05:34:52,880 WE AGREE IT'S NECESSARY TO CLOSE 8562 05:34:52,880 --> 05:34:54,080 THE GAP, GENOMIC STUDIES NEED TO 8563 05:34:54,080 --> 05:34:56,400 BE MORE REPRESENTATIVE OF ALL 8564 05:34:56,400 --> 05:34:58,560 POPULATIONS SO PEOPLE FROM 8565 05:34:58,560 --> 05:35:00,760 EVERYWHERE IN EVERY ETHNICITY 8566 05:35:00,760 --> 05:35:03,680 AND RACE CAN BENEFIT FROM 8567 05:35:03,680 --> 05:35:05,720 IMPROVED HEALTH OUTCOMES. 8568 05:35:05,720 --> 05:35:07,640 TO USE GENOMIC DIVERSITY IN 8569 05:35:07,640 --> 05:35:10,160 SUPPORT FOR GLOBAL HEALTH WE 8570 05:35:10,160 --> 05:35:12,360 NEED TO INCREASE DIVERSITY OF 8571 05:35:12,360 --> 05:35:15,760 HUMAN GENOMIC DATASETS IN 8572 05:35:15,760 --> 05:35:17,720 SUPPORT OF GLOBAL PRECISION 8573 05:35:17,720 --> 05:35:21,000 MEDICINE WITH EMPHASIS ON ADMIX 8574 05:35:21,000 --> 05:35:29,880 GENOMES AND NEED TO SUPPORT 8575 05:35:29,880 --> 05:35:30,880 RESEARCH ON GENOMICS, 8576 05:35:30,880 --> 05:35:32,000 BIOINFORMATICS, PRECISION 8577 05:35:32,000 --> 05:35:33,520 MEDICINE, IN LATIN AMERICA AND 8578 05:35:33,520 --> 05:35:37,760 TODAY I'M GOING TO TALK ABOUT 8579 05:35:37,760 --> 05:35:40,400 THE EFFORTS THAT I'VE BEEN 8580 05:35:40,400 --> 05:35:41,920 LEADING AND COLLABORATING WITH 8581 05:35:41,920 --> 05:35:43,960 RESEARCHERS IN COLOMBIA TO BUILD 8582 05:35:43,960 --> 05:35:44,640 BRIDGES BETWEEN COLOMBIA, LATIN 8583 05:35:44,640 --> 05:35:51,040 AMERICA AND THE U.S. 8584 05:35:51,040 --> 05:35:56,840 THIS SETS THE STAGE FOR ANCESTRY 8585 05:35:56,840 --> 05:36:02,400 AND HEALTH IN COLOMBIA, 8586 05:36:02,400 --> 05:36:04,400 COMPREHENSIVE PLATFORM FOR 8587 05:36:04,400 --> 05:36:08,960 ANALYSIS INCLUDING VARIANTS, 8588 05:36:08,960 --> 05:36:09,720 CLINICAL ANNOTATION, ALLELE 8589 05:36:09,720 --> 05:36:13,320 FREQUENCIES, AS WELL AS PATTERNS 8590 05:36:13,320 --> 05:36:15,840 OF GENETIC ANCESTRY AND 8591 05:36:15,840 --> 05:36:17,080 ADMIXTURE. 8592 05:36:17,080 --> 05:36:23,320 AND THIS IS HOW CODIGO WORKS. 8593 05:36:23,320 --> 05:36:26,600 LABORATORIES SHARE WITH A TEAM, 8594 05:36:26,600 --> 05:36:27,120 CONTRIBUTING INVESTIGATORS 8595 05:36:27,120 --> 05:36:30,200 MAINTAIN OWNERSHIP AND CONTROL 8596 05:36:30,200 --> 05:36:32,920 OF THEIR DATA. 8597 05:36:32,920 --> 05:36:34,880 NO INDIVIDUAL DATA OR METADATA 8598 05:36:34,880 --> 05:36:38,720 ARE RELEASED INTO THE PUBLIC. 8599 05:36:38,720 --> 05:36:39,840 ONLY SUMMARY STATISTICS, DERIVED 8600 05:36:39,840 --> 05:36:44,320 FROM THE DATA ARE RELEASED TO 8601 05:36:44,320 --> 05:36:44,600 THE PUBLIC. 8602 05:36:44,600 --> 05:36:45,480 ALL CONTRIBUTING INVESTIGATORS, 8603 05:36:45,480 --> 05:36:46,600 COLLABORATE AND RECEIVE CREDIT 8604 05:36:46,600 --> 05:36:48,480 FOR THE PLATFORM AND ANY 8605 05:36:48,480 --> 05:36:58,120 PUBLICATIONS THAT ARISE FROM IT. 8606 05:36:58,120 --> 05:37:02,000 WE HAVE ALL GENOME SEQUENCES, 8607 05:37:02,000 --> 05:37:03,720 WHOLE EXOME SEQUENCES, WHOLE 8608 05:37:03,720 --> 05:37:05,080 GENOME GENOTYPES. 8609 05:37:05,080 --> 05:37:09,040 AS YOU CAN SEE, THE POPULATIONS 8610 05:37:09,040 --> 05:37:14,840 COME FROM DIVERSE LOCATIONS IN 8611 05:37:14,840 --> 05:37:16,360 COLOMBIA, AND REPRESENT MAJORITY 8612 05:37:16,360 --> 05:37:19,640 OF ADMIX POPULATIONS AS WELL AS 8613 05:37:19,640 --> 05:37:21,960 NATIVE POPULATIONS THAT WERE 8614 05:37:21,960 --> 05:37:23,800 SAMPLED IN COLOMBIA. 8615 05:37:23,800 --> 05:37:26,360 THIS SLIDE SHOWS THE GENETIC 8616 05:37:26,360 --> 05:37:27,760 ANCESTRY COMPOSITION FOR THE 8617 05:37:27,760 --> 05:37:29,760 DIFFERENT POPULATIONS THAT HAVE 8618 05:37:29,760 --> 05:37:32,680 BEEN SAMPLED IN THE CODIGO 8619 05:37:32,680 --> 05:37:33,880 PROJECT. 8620 05:37:33,880 --> 05:37:37,840 YOU CAN SEE, WE HAVE POPULATIONS 8621 05:37:37,840 --> 05:37:40,440 THAT ARE MOSTLY NATIVE AMERICAN, 8622 05:37:40,440 --> 05:37:43,080 REPRESENTING THE RED FRACTION 8623 05:37:43,080 --> 05:37:45,640 HERE, WE ALSO HAVE SOME MORE 8624 05:37:45,640 --> 05:37:50,000 ADMIX POPULATIONS LIKE THE ONES 8625 05:37:50,000 --> 05:37:53,520 IN MEDELLIN, AS WELL AS SOME 8626 05:37:53,520 --> 05:38:01,240 POPULATIONS THAT HAVE MORE 8627 05:38:01,240 --> 05:38:03,240 AFRICAN ANCESTRY SHOWING 8628 05:38:03,240 --> 05:38:06,400 DIVERSITY OF COLOMBIA GENOMES. 8629 05:38:06,400 --> 05:38:08,800 AND THIS IS SUMMARY STATISTICS 8630 05:38:08,800 --> 05:38:14,000 SLIDES THAT SHOW WE HAVE OVER 8631 05:38:14,000 --> 05:38:17,000 100 VARIANTS REPRESENTED HERE 8632 05:38:17,000 --> 05:38:21,880 FROM 1700 PARTICIPANTS, 16 8633 05:38:21,880 --> 05:38:23,920 POPULATIONS, 10 DATA SOURCES. 8634 05:38:23,920 --> 05:38:27,960 IN THIS SLIDE EACH OF THE 8635 05:38:27,960 --> 05:38:30,840 INDIVIDUALS PRESENT IN CODIGO 8636 05:38:30,840 --> 05:38:34,880 HAVE BEEN COLOR CODED BY THEIR 8637 05:38:34,880 --> 05:38:38,400 FRACTION OF AFRICAN, EUROPEAN, 8638 05:38:38,400 --> 05:38:39,800 NATIVE AMERICAN ANCESTRY, 8639 05:38:39,800 --> 05:38:41,000 DEPENDING ON THEIR COMPOSITION 8640 05:38:41,000 --> 05:38:42,080 IN THE GENOME. 8641 05:38:42,080 --> 05:38:46,360 AND AS YOU CAN SEE, WE HAVE 8642 05:38:46,360 --> 05:38:48,960 GREAT DIVERSITY REPRESENTED 8643 05:38:48,960 --> 05:38:51,720 HERE, NOT ONLY FOR THE MOSTLY 8644 05:38:51,720 --> 05:38:55,800 ADMIX GENOMES BUT ALSO SOME 8645 05:38:55,800 --> 05:38:58,920 POPULATIONS THAT ARE MORE NATIVE 8646 05:38:58,920 --> 05:39:01,800 AMERICAN OR MORE AFRICAN IN 8647 05:39:01,800 --> 05:39:02,480 THEIR COMPOSITION. 8648 05:39:02,480 --> 05:39:05,760 AND THIS IS A PREVIEW OF THE 8649 05:39:05,760 --> 05:39:09,800 HOME PAGE FOR THE CODIGO PROJECT 8650 05:39:09,800 --> 05:39:11,320 SOON RELEASED TO THE PUBLIC. 8651 05:39:11,320 --> 05:39:15,200 I WOULD LIKE TO CLOSE BY 8652 05:39:15,200 --> 05:39:17,040 ACKNOWLEDGING ALL THE 8653 05:39:17,040 --> 05:39:18,440 INVESTIGATORS THAT HAVE 8654 05:39:18,440 --> 05:39:28,880 PARTICIPATED IN CODIGO. 8655 05:39:31,320 --> 05:39:34,240 WE HAVE AUGUSTO, MIGUEL, JUAN, 8656 05:39:34,240 --> 05:39:37,840 AND WE HAVE KING JORDAN FROM 8657 05:39:37,840 --> 05:39:39,160 GEORGIA TECH. 8658 05:39:39,160 --> 05:39:40,920 EVERYONE HAVE COLLABORATED AND 8659 05:39:40,920 --> 05:39:42,680 CONTRIBUTED TO MAKE THIS A 8660 05:39:42,680 --> 05:39:49,960 REALITY, AND WITH THIS I WOULD 8661 05:39:49,960 --> 05:39:52,200 LIKE TO TAKE QUESTIONS. 8662 05:39:52,200 --> 05:39:56,240 >>THANK YOU TO THE NIH FOR THE 8663 05:39:56,240 --> 05:39:57,320 OPPORTUNITY TO TALK ABOUT 8664 05:39:57,320 --> 05:39:59,440 ALZHEIMER'S IN COLOMBIA. 8665 05:39:59,440 --> 05:40:02,720 WE'VE STUDIED THE LARGEST 8666 05:40:02,720 --> 05:40:08,520 POPULATION IN THE WORLD WITH 8667 05:40:08,520 --> 05:40:10,840 AUTOSOMAL DOMINANT ALZHEIMER'S 8668 05:40:10,840 --> 05:40:13,680 DISEASE, MOST LIVING IN 8669 05:40:13,680 --> 05:40:21,200 ANTIOCHIA REGION OF COLOMBIA. 8670 05:40:21,200 --> 05:40:22,200 WITH THE UNIVERSITY OF 8671 05:40:22,200 --> 05:40:23,720 WASHINGTON WE DISCOVERED THE 8672 05:40:23,720 --> 05:40:34,400 FAMILIES ARE AFFECTED BY THE 8673 05:40:34,400 --> 05:40:36,480 PATHOGENIC MUTATION E2 80A, 8674 05:40:36,480 --> 05:40:40,000 THERE IS A FOUNDER EFFECT IN 8675 05:40:40,000 --> 05:40:42,680 THIS POPULATION, COMING FROM A 8676 05:40:42,680 --> 05:40:46,840 COMMON ANCESTRY IN 14 OF THE 8677 05:40:46,840 --> 05:40:48,280 FAMILIES FROM 1745 BUT WE THINK 8678 05:40:48,280 --> 05:40:53,880 ALL THE FAMILIES ARE COMING FROM 8679 05:40:53,880 --> 05:40:58,320 THE SAME COMMON ANCESTRY. 8680 05:40:58,320 --> 05:41:00,520 WE HAVE STUDIED ALMOST 5,000 8681 05:41:00,520 --> 05:41:04,880 MEMBERS OF THE FAMILIES, AND 8682 05:41:04,880 --> 05:41:08,400 1,119 OF THEM ARE LIVING 8683 05:41:08,400 --> 05:41:09,400 CARRIERS AFFECTED OF THEY ARE 8684 05:41:09,400 --> 05:41:10,920 GOING TO BE AFFECTED OF 8685 05:41:10,920 --> 05:41:14,200 ALZHEIMER'S DISEASE IN THE NEXT 8686 05:41:14,200 --> 05:41:20,360 YEARS, BECAUSE THIS MUTATION IS 8687 05:41:20,360 --> 05:41:21,360 100% PENETRANT. 8688 05:41:21,360 --> 05:41:26,600 WE PUBLISH IN THIS PAPER THE 8689 05:41:26,600 --> 05:41:30,400 STAGE IN THE POPULATION AND THE 8690 05:41:30,400 --> 05:41:36,000 STARTING AT 49, THEY DIED AT 59 8691 05:41:36,000 --> 05:41:42,560 YEARS OLD, NCI STARTS AT 44, 8692 05:41:42,560 --> 05:41:47,800 SYMPTOMATIC STARTS AT 38, AND 8693 05:41:47,800 --> 05:41:49,120 ASYMPTOMATIC PRE-MCI STARTS AT 8694 05:41:49,120 --> 05:41:52,400 34, WHEN THEY DON'T HAVE MEMORY 8695 05:41:52,400 --> 05:41:55,480 COMPLAINTS BUT THEY HAVE TWO 8696 05:41:55,480 --> 05:41:59,120 STANDARD DEVIATION IN DIFFERENT 8697 05:41:59,120 --> 05:42:01,280 COGNITIVE CONTACTS WITH KNOWN 8698 05:42:01,280 --> 05:42:02,920 CARRIERS. 8699 05:42:02,920 --> 05:42:10,480 WE STUDIED ALSO AMYLOIDOSIS 8700 05:42:10,480 --> 05:42:12,880 USING A MARKER FOR AMYLOID, WE 8701 05:42:12,880 --> 05:42:15,920 TRAVELED WITH 50 MEMBERS OF THE 8702 05:42:15,920 --> 05:42:17,480 FAMILIES FROM MEDELLIN TO 8703 05:42:17,480 --> 05:42:19,960 PHOENIX IN 2011, IN ORDER TO 8704 05:42:19,960 --> 05:42:26,360 LOOK AT BETA AMYLOID, AND WE 8705 05:42:26,360 --> 05:42:31,600 FOUND THAT FOUR CARRIERS WITH 8706 05:42:31,600 --> 05:42:33,760 SLIGHT DEMENTIAA ALSO POSITIVE, 8707 05:42:33,760 --> 05:42:36,600 AND SEVEN CARRIERS WITH MCI, ALL 8708 05:42:36,600 --> 05:42:40,320 OF THEM WERE POSITIVE FOR PET 8709 05:42:40,320 --> 05:42:41,960 AMYLOID, AND 20 NON-CARRIERS, 8710 05:42:41,960 --> 05:42:43,920 ASYMPTOMATIC MEMBERS OF THE 8711 05:42:43,920 --> 05:42:46,600 FAMILY, ALL OF THEM WERE 8712 05:42:46,600 --> 05:42:48,200 NEGATIVE FOR PET AMYLOID. 8713 05:42:48,200 --> 05:42:52,800 INSIDE THE SQUARE YOU HAVE THE 8714 05:42:52,800 --> 05:42:54,600 ASYMPTOMATIC CARRIERS, AND ALL 8715 05:42:54,600 --> 05:42:57,000 OF THEM MORE THAN 28 YEARS OLD 8716 05:42:57,000 --> 05:43:01,160 WERE POSITIVE FOR PET AMYLOID, 8717 05:43:01,160 --> 05:43:03,720 THE CONCLUSION WAS THAT 8718 05:43:03,720 --> 05:43:06,800 AMYLOIDOSIS STARTS AT 28 YEARS 8719 05:43:06,800 --> 05:43:08,400 OLD IN THIS POPULATION. 8720 05:43:08,400 --> 05:43:10,360 AFTER THAT WE TRAVELED WITH 8721 05:43:10,360 --> 05:43:12,320 SEVERAL MEMBERS OF THE FAMILIES 8722 05:43:12,320 --> 05:43:14,920 FROM MEDELLIN TO BOSTON, IN 8723 05:43:14,920 --> 05:43:17,480 ORDER TO LOOK AT PET TAU, WE 8724 05:43:17,480 --> 05:43:20,480 FOUND THAT AT 28 YEARS OLD, EVEN 8725 05:43:20,480 --> 05:43:26,440 IF THEY HAVE AMYLOIDOSIS THEY 8726 05:43:26,440 --> 05:43:27,920 DON'T HAVE TAUOPATHY BUT 8727 05:43:27,920 --> 05:43:31,920 TAUOPATHY STARTS AFTER 38 AND 8728 05:43:31,920 --> 05:43:34,680 PETOPATHY MORE STRONGER AT 44 8729 05:43:34,680 --> 05:43:37,480 WHEN THEY HAVE MCI. 8730 05:43:37,480 --> 05:43:39,640 THE CONCLUSION WAS THAT 8731 05:43:39,640 --> 05:43:42,600 TAUOPATHY STARTS AT 38 YEARS 8732 05:43:42,600 --> 05:43:48,200 OLD, 10 YEARS AFTER AMYLOIDOSIS. 8733 05:43:48,200 --> 05:43:50,920 WE STUDIED LEVEL OF CSF AND 8734 05:43:50,920 --> 05:43:53,680 FOUND IN THE PRE-CLINICAL STATES 8735 05:43:53,680 --> 05:43:58,480 CARRIERS HAVE HIGH LEVEL OF 8736 05:43:58,480 --> 05:44:01,520 A-BETA 4 CSF WITH NON-CARRIERS, 8737 05:44:01,520 --> 05:44:05,040 DECREASED WHEN THEY ARRIVED TO 8738 05:44:05,040 --> 05:44:08,560 MCI STAGE. 8739 05:44:08,560 --> 05:44:11,520 WE STUDIED ALSO BIOMARKERS, AND 8740 05:44:11,520 --> 05:44:14,240 WE FOUND THAT CARRIERS IN RED, 8741 05:44:14,240 --> 05:44:20,680 THEY HAVE HIGH LEVEL OF 8742 05:44:20,680 --> 05:44:23,240 PHOSPHO-TA 217, IN RED HIGH 8743 05:44:23,240 --> 05:44:28,560 LEVEL OF NEUROFILAMENTS IN PLAS 8744 05:44:28,560 --> 05:44:31,280 M A AND BOTH BIOMARKERS ARE 8745 05:44:31,280 --> 05:44:36,160 POSITIVE AT 22 YEARS OLD, 20 8746 05:44:36,160 --> 05:44:40,160 YEARS BEFORE HAVING MCI. 8747 05:44:40,160 --> 05:44:45,120 THEN THESE ARE VERY GOOD 8748 05:44:45,120 --> 05:44:46,840 BIOMARKERS FOR THE PRE-CLINICAL 8749 05:44:46,840 --> 05:44:47,520 STAGE. 8750 05:44:47,520 --> 05:44:50,440 WE STUDIED COGNITIVE DECLINE 8751 05:44:50,440 --> 05:44:53,440 LOOKING FOR ESTIMATE THE CHANGE 8752 05:44:53,440 --> 05:45:03,920 POINT IN SERA TAX, THERE'S 8753 05:45:06,280 --> 05:45:09,080 DECLINE EVER MEMORY AT 32 YEARS 8754 05:45:09,080 --> 05:45:09,240 OLD. 8755 05:45:09,240 --> 05:45:11,560 THEN WITH THIS INFORMATION WE 8756 05:45:11,560 --> 05:45:16,040 WERE ABLE TO RECONSTITUTE 8757 05:45:16,040 --> 05:45:17,400 NATURAL HISTORY EVOLUTION IN 8758 05:45:17,400 --> 05:45:19,240 THIS POPULATION, CLINICAL PHASE 8759 05:45:19,240 --> 05:45:22,760 STARTS AT 44 WITH MCI, FOLLOWED 8760 05:45:22,760 --> 05:45:25,360 BY DEMENTIA AT 49, AND THEY DIED 8761 05:45:25,360 --> 05:45:27,400 AT 59 YEARS OLD. 8762 05:45:27,400 --> 05:45:29,640 THE PRE-CLINICAL PHASE WE CAN 8763 05:45:29,640 --> 05:45:32,640 DITCHED IN SEVERAL PHASES, 8764 05:45:32,640 --> 05:45:35,800 PHASES 0 FROM BIRTH TO 24 YEARS 8765 05:45:35,800 --> 05:45:44,040 OLD WHEN WE CAN SAW HIGH LEVEL 8766 05:45:44,040 --> 05:45:46,080 FOR TAU 217 IN PLASMA. 8767 05:45:46,080 --> 05:45:48,800 PHASE 1 FROM 24 TO 48 WHEN WE 8768 05:45:48,800 --> 05:45:52,040 CAN SEE AMYLOID POSITIVE IN PET 8769 05:45:52,040 --> 05:45:53,840 AMYLOID IMAGE, PHASE 2 FROM 28 8770 05:45:53,840 --> 05:46:00,000 TO 32 WHEN WE CAN SEE DECLINE IN 8771 05:46:00,000 --> 05:46:01,760 MEMORY TAX EVEN IF THEY DON'T 8772 05:46:01,760 --> 05:46:05,680 HAVE MEMORY COMPLAINTS AT THIS 8773 05:46:05,680 --> 05:46:05,920 MOMENT. 8774 05:46:05,920 --> 05:46:09,200 PHASE 3 FROM 32 TO 38 WHEN WE 8775 05:46:09,200 --> 05:46:13,440 CAN SEE PETS AMYLOID POSITIVE IN 8776 05:46:13,440 --> 05:46:19,600 IMAGE, AND PHASE 4, FROM 38 TO 8777 05:46:19,600 --> 05:46:27,800 44, WHEN MCI STARTS. 8778 05:46:27,800 --> 05:46:30,080 WE CAN DO PALLIATIVE TREATMENT 8779 05:46:30,080 --> 05:46:35,040 WHEN THEY HAVE DEMENTIA, WE CAN 8780 05:46:35,040 --> 05:46:38,720 DO PREVENTION WHEN THEY HAVE 8781 05:46:38,720 --> 05:46:40,480 MCI, SECONDARY PREVENTION IN 8782 05:46:40,480 --> 05:46:42,560 PHASE 2, 3, AND 4 IN 8783 05:46:42,560 --> 05:46:45,320 PRE-CLINICAL PHASE, AND PRIMARY 8784 05:46:45,320 --> 05:46:49,000 PREVENTION IN PRE-CLINICAL PHASE 8785 05:46:49,000 --> 05:46:50,440 0 AND 1. 8786 05:46:50,440 --> 05:46:52,640 WE HAVE DISCOVERED A PROTECTIVE 8787 05:46:52,640 --> 05:47:00,240 GENE FOR ALZHEIMER'S DISEASE IN 8788 05:47:00,240 --> 05:47:01,200 THIS POPULATION. 8789 05:47:01,200 --> 05:47:03,600 THE MOST IMPORTANT WOMEN IN THE 8790 05:47:03,600 --> 05:47:04,880 RESEARCH, AUGUSTA HER BRAIN 8791 05:47:04,880 --> 05:47:07,080 SHOWS US HOW THE BRAIN IS 8792 05:47:07,080 --> 05:47:11,360 AFFECTED BY ALZHEIMER'S DISEASE, 8793 05:47:11,360 --> 05:47:13,680 AND ALIRIA'S BRAIN SHOWS HOW A 8794 05:47:13,680 --> 05:47:16,920 BRAIN IS PROTECTED FROM 8795 05:47:16,920 --> 05:47:18,720 ALZHEIMER'S DISEASE. 8796 05:47:18,720 --> 05:47:23,840 ALIRIA WAS A WOMAN WHO HAD THE 8797 05:47:23,840 --> 05:47:28,520 MUTATION, AND ONE OTHER MUTATION 8798 05:47:28,520 --> 05:47:31,960 IN ApoE 3 MUTATION, AND SHE 8799 05:47:31,960 --> 05:47:36,000 HAD RESISTANCE TO AUTOSOMAL 8800 05:47:36,000 --> 05:47:39,520 DOMINANT ALZHEIMER'S DISEASE. 8801 05:47:39,520 --> 05:47:42,200 SHE DID MCI AT 72 YEARS OLD, AND 8802 05:47:42,200 --> 05:47:44,760 AT THIS MOMENT SHE HAD BELOW YOU 8803 05:47:44,760 --> 05:47:49,480 YOU CAN SEE THE P-TAU AT 72 8804 05:47:49,480 --> 05:47:51,880 YEARS, WHEN SHE STARTS MCI AND 8805 05:47:51,880 --> 05:47:58,560 SHE WAS PROTECTED FROM 8806 05:47:58,560 --> 05:48:01,760 TAUOPATHY, IN RELATION TO HER 8807 05:48:01,760 --> 05:48:05,880 COUSIN WHEN SHE HAD 44, SHE HAD 8808 05:48:05,880 --> 05:48:10,160 SO MUCH TAU PATHOLOGY IN THE 8809 05:48:10,160 --> 05:48:15,200 BRAIN, PROTECTED BECAUSE SHE WAS 8810 05:48:15,200 --> 05:48:17,240 CARRIER OF MUTATION. 8811 05:48:17,240 --> 05:48:21,560 WE PUBLISHED HOW THE BRAIN OF 8812 05:48:21,560 --> 05:48:22,440 ALRIRIA WAS PROTECTED FROM 8813 05:48:22,440 --> 05:48:30,000 ALZHEIMER'S DISEASE BECAUSE SHE 8814 05:48:30,000 --> 05:48:34,160 DIED, AND WE STUDIED THE BRAIN, 8815 05:48:34,160 --> 05:48:37,560 MY STUDENTS IN THE LAST YEARS, 8816 05:48:37,560 --> 05:48:40,960 NOW THEY ARE LEADERS IN THE 8817 05:48:40,960 --> 05:48:42,600 RESEARCH IN THE WORLD. 8818 05:48:42,600 --> 05:48:47,640 WHAT HAVE WE LEARNED FROM 40 8819 05:48:47,640 --> 05:48:49,200 YEARS OF AUTOSOMAL DOMINANCE IN 8820 05:48:49,200 --> 05:48:49,440 COLOMBIA? 8821 05:48:49,440 --> 05:48:56,080 WE FOUND A WAY TO PREVENT 8822 05:48:56,080 --> 05:48:59,280 ALZHEIMER'S DISEASE, TO READ, TO 8823 05:48:59,280 --> 05:49:03,840 LEARN, AND TO IMITATE NATURE. 8824 05:49:03,840 --> 05:49:06,800 THIS IS THE LESSON ALIRIA GAVE 8825 05:49:06,800 --> 05:49:09,840 US, AND THE MESSAGE TO TAKE HOME 8826 05:49:09,840 --> 05:49:15,120 IN THIS TALK IS TO PREVENT 8827 05:49:15,120 --> 05:49:16,560 DEMENTIA, READ, LEARN, IMITATE 8828 05:49:16,560 --> 05:49:16,840 NATURE. 8829 05:49:16,840 --> 05:49:18,640 FOR THAT, YOU NEED TO LOOK FOR 8830 05:49:18,640 --> 05:49:20,760 CASINGS OF DEMENTIA BY CAUSALITY 8831 05:49:20,760 --> 05:49:23,240 GENES, YOU NEED TO LOOK FOR 8832 05:49:23,240 --> 05:49:26,080 RESISTANCE CASES OF ALZHEIMER'S 8833 05:49:26,080 --> 05:49:27,080 ZEST OR NEURODEGENERATIVE 8834 05:49:27,080 --> 05:49:28,720 DISEASE, YOU NEED TO LOOK FOR 8835 05:49:28,720 --> 05:49:31,360 PROTECTOR GENES IN THESE CASES. 8836 05:49:31,360 --> 05:49:33,880 LOOK HOW THE PROTECTOR GIRNS 8837 05:49:33,880 --> 05:49:37,360 DELAY OR PREVENTS THE ONSET OF 8838 05:49:37,360 --> 05:49:38,360 SYMPTOMS OF DEMENTIA, AND 8839 05:49:38,360 --> 05:49:43,840 IMITATE WHAT NATURE DOES IN 8840 05:49:43,840 --> 05:49:46,800 THESE CASES. 8841 05:49:46,800 --> 05:49:49,400 THIS IS MY TEAM IN THE 8842 05:49:49,400 --> 05:49:50,160 UNIVERSITY, IN MEDELLIN, 8843 05:49:50,160 --> 05:49:50,920 COLOMBIA. 8844 05:49:50,920 --> 05:49:53,480 THANK YOU VERY MUCH FOR YOUR 8845 05:49:53,480 --> 05:49:56,280 ATTENTION TO THIS TALK. 8846 05:49:56,280 --> 05:50:02,320 8847 05:50:02,320 --> 05:50:04,920 8848 05:50:04,920 --> 05:50:06,800 >>I EXPRESS MY GRATITUDE FOR 8849 05:50:06,800 --> 05:50:09,080 INVITING ME AND TALK ABOUT ROAD 8850 05:50:09,080 --> 05:50:10,320 FOR IMPLEMENTENING PRECISION 8851 05:50:10,320 --> 05:50:13,760 MEDICINE IN TYPE 2 DIABETES. 8852 05:50:13,760 --> 05:50:22,320 THE GOAL IS TO PROVIDE TOOLS FOR 8853 05:50:22,320 --> 05:50:24,760 THE PREDICTION, DIAGNOSIS, 8854 05:50:24,760 --> 05:50:27,440 TREATMENT IN CONDITIONS, 8855 05:50:27,440 --> 05:50:28,240 ACCORDING TO CHARACTERISTIC OF 8856 05:50:28,240 --> 05:50:31,600 THE PATIENTS, THIS IS THE CASE 8857 05:50:31,600 --> 05:50:33,160 FOR TYPE 2 DIABETES. 8858 05:50:33,160 --> 05:50:36,880 THIS CONDITION IS AMONG THE MAIN 8859 05:50:36,880 --> 05:50:40,920 HEALTH ISSUES IN MEXICO, 8860 05:50:40,920 --> 05:50:44,000 CURRENTLY 13.4 MILLION 8861 05:50:44,000 --> 05:50:45,760 INDIVIDUALS LIVE WITH DIABETES, 8862 05:50:45,760 --> 05:50:50,240 34% OF THEM ARE UNDIAGNOSED, 8863 05:50:50,240 --> 05:50:53,280 PRECISION MEDICINE MAY HELP TO 8864 05:50:53,280 --> 05:50:55,600 REDUCE THE UNDIAGNOSED AND 8865 05:50:55,600 --> 05:50:58,800 UNDERTREATMENT OF THAT TYPE 2 8866 05:50:58,800 --> 05:50:59,320 DIABETES. 8867 05:50:59,320 --> 05:51:02,920 FOLLOWING THAT, PRECISION 8868 05:51:02,920 --> 05:51:03,920 MEDICINE SHOULD CONSIDER THE 8869 05:51:03,920 --> 05:51:08,640 CLINICAL EXPRESSION OF THE 8870 05:51:08,640 --> 05:51:12,000 DISEASE, IN MEXICO, 30% OF THE 8871 05:51:12,000 --> 05:51:14,960 PERSON LIVING WITH DIABETES 8872 05:51:14,960 --> 05:51:18,680 BEFORE AGE 40. 8873 05:51:18,680 --> 05:51:24,920 WE HAVE AN INCREASED 8874 05:51:24,920 --> 05:51:31,400 SUSCEPTIBILITY FOR:COMPLICATIONS 8875 05:51:31,400 --> 05:51:34,240 LIKE NEPHROPATHY. 8876 05:51:34,240 --> 05:51:40,040 ALSO, DIABETES ALWAYS COME WITH 8877 05:51:40,040 --> 05:51:41,080 CONDITIONS LIKE NON-ALCOHOLIC 8878 05:51:41,080 --> 05:51:46,920 HEPATITIS OR SEVERAL LIPID 8879 05:51:46,920 --> 05:51:47,320 DISORDERS. 8880 05:51:47,320 --> 05:51:51,840 WE CAN CONFRONT THIS PROBLEM AND 8881 05:51:51,840 --> 05:51:54,240 GENERATE EVIDENCE TO PROVIDE 8882 05:51:54,240 --> 05:51:58,080 PRECISION MEDICINE PROGRAM, IN 8883 05:51:58,080 --> 05:52:02,240 WAYS DOING WAYS DOING THE BEST 8884 05:52:02,240 --> 05:52:04,080 PROVIDED MEDICAL CARE, LINKING 8885 05:52:04,080 --> 05:52:08,440 OUR DAILY ACTION TO RESEARCH. 8886 05:52:08,440 --> 05:52:11,080 SEVEN YEARS AGO WE STARTED DIE 8887 05:52:11,080 --> 05:52:15,280 BETS CENTER IN WHICH WE FOCUSED 8888 05:52:15,280 --> 05:52:19,320 ATTENTION FOR PEOPLE LIVING WITH 8889 05:52:19,320 --> 05:52:25,000 DIABETES, LESS THAN FIVE YEARS, 8890 05:52:25,000 --> 05:52:26,400 FREE OF CHRONIC COMPLICATIONS. 8891 05:52:26,400 --> 05:52:32,640 IN ONE DAY ALL PATIENTS SHEAFED 8892 05:52:32,640 --> 05:52:37,360 TRAINING LIKE SCHOOL TO PREVENT 8893 05:52:37,360 --> 05:52:37,840 CHRONIC COMPLICATIONS, 8894 05:52:37,840 --> 05:52:40,240 EMPOWERING THEM TO TAKE CARE OF 8895 05:52:40,240 --> 05:52:43,240 THEMSELVES, OF THEIR DISEASE. 8896 05:52:43,240 --> 05:52:45,120 IN ADDITION, ELECTRONIC MEDICAL 8897 05:52:45,120 --> 05:52:49,600 RECORD WAS DESIGNED THAT HELPED 8898 05:52:49,600 --> 05:52:51,920 US TO HAVE CLINICIANS TO 8899 05:52:51,920 --> 05:52:56,840 IDENTIFY THE AREAS IN WHICH 8900 05:52:56,840 --> 05:52:58,000 ADDITIONAL EFFORTS ARE REQUIRED 8901 05:52:58,000 --> 05:52:59,920 IN DIABETES. 8902 05:52:59,920 --> 05:53:03,520 AT THE SAME TIME, METABOLIC UNIT 8903 05:53:03,520 --> 05:53:09,000 WAS BUILT, IN THESE WE HAVE 8904 05:53:09,000 --> 05:53:11,040 STATE-OF-THE-ART TECHNIQUES TO 8905 05:53:11,040 --> 05:53:15,560 MEASURE GLUCOSE METABOLISM, BODY 8906 05:53:15,560 --> 05:53:17,760 COMPOSITION, VASCULAR FUNCTION, 8907 05:53:17,760 --> 05:53:20,840 AND RESPONSE TO EXERCISE. 8908 05:53:20,840 --> 05:53:23,040 THE RESULTS WERE OBTAINED IN A 8909 05:53:23,040 --> 05:53:26,920 COUPLE OF YEARS, NOW WE HAVE 8910 05:53:26,920 --> 05:53:29,040 LARGE DATABASE, FOR EXAMPLE WE 8911 05:53:29,040 --> 05:53:33,400 HAVE A COHORT STUDY FOR OVER 8912 05:53:33,400 --> 05:53:40,840 THREE YEARS, LARGE SAMPLE SIZE, 8913 05:53:40,840 --> 05:53:51,080 GWAS STUDIES 8914 05:53:51,760 --> 05:53:53,960 EXOME SEQUENCE, NATIONAL 8915 05:53:53,960 --> 05:53:55,840 SURVEYS, NATIONWIDE SURVEYS, 8916 05:53:55,840 --> 05:53:56,800 ALSO IMPLEMENTING DIABETES 8917 05:53:56,800 --> 05:54:03,720 PREVENTION TRIALS WITH MORE THAN 8918 05:54:03,720 --> 05:54:09,840 1,000, INFORMATION OBTAINED WITH 8919 05:54:09,840 --> 05:54:13,200 BARCODED WEB-BASED 8920 05:54:13,200 --> 05:54:13,960 QUESTIONNAIRES, KEEPING PRIVACY 8921 05:54:13,960 --> 05:54:17,280 OF PATIENTSN A BIOBANK. 8922 05:54:17,280 --> 05:54:19,840 WITH THIS INFORMATION WE 8923 05:54:19,840 --> 05:54:21,800 COLLABORATED WITH OTHER MEXICANS 8924 05:54:21,800 --> 05:54:26,320 AND U.S. INSTITUTIONS TO DO THE 8925 05:54:26,320 --> 05:54:31,560 FIRST GWAS FOR DIABETES, 8926 05:54:31,560 --> 05:54:40,400 COMPARED CONTRIBUTION OF 8927 05:54:40,400 --> 05:54:44,800 SUSCEPTIBILITY GENES, KNOWN IN 8928 05:54:44,800 --> 05:54:51,960 2014, AND THESE VARIANTS HIGHLY 8929 05:54:51,960 --> 05:54:54,560 PREVALENT AMONGST MEXICANS, 8930 05:54:54,560 --> 05:55:03,760 IDENTIFIED NATIVE AMERICAN 8931 05:55:03,760 --> 05:55:05,840 SPECIFIC SUKS ALLELES, I WANT TO 8932 05:55:05,840 --> 05:55:07,960 HIGHLIGHT ONE STRONGLY 8933 05:55:07,960 --> 05:55:15,680 ASSOCIATED WITH TYPE 2 DIABETES, 8934 05:55:15,680 --> 05:55:20,200 SUKS HAPLOTYPE IN 25%, 50% IN 8935 05:55:20,200 --> 05:55:21,280 NATIVE AMERICAN POPULATIONS. 8936 05:55:21,280 --> 05:55:23,720 THIS IS A NEW PLAYER IN THE 8937 05:55:23,720 --> 05:55:27,360 PATHOPHYSIOLOGY OF TYPE 2 8938 05:55:27,360 --> 05:55:29,560 DIABETES AND ALSO IT'S GOOD 8939 05:55:29,560 --> 05:55:39,840 EVIDENCE OF SELECTION PROCESS OF 8940 05:55:39,840 --> 05:55:41,720 POPULATIONS, HIGH SUSCEPTIBILITY 8941 05:55:41,720 --> 05:55:43,920 FOR TYPE 2 DIABETES. 8942 05:55:43,920 --> 05:55:45,920 THESE FINDINGS, EXPLAIN PART OF 8943 05:55:45,920 --> 05:55:48,800 THE CLINICAL CHARACTERISTICS OF 8944 05:55:48,800 --> 05:55:55,240 THE MEXICAN POPULATION, LIVING 8945 05:55:55,240 --> 05:55:58,120 WITH DIABETES, BECAUSE THOSE 8946 05:55:58,120 --> 05:56:01,640 HAVE ALLELE, EXPRESS THE DISEASE 8947 05:56:01,640 --> 05:56:05,000 AT EARLY AGE, THOSE HAVING LOWER 8948 05:56:05,000 --> 05:56:14,080 BODY MASS INDEX. 8949 05:56:14,080 --> 05:56:15,400 THE PRESENCE OF SUSCEPTIBILITY 8950 05:56:15,400 --> 05:56:18,440 ALLELE RESULTS IN ACCUMULATION 8951 05:56:18,440 --> 05:56:26,640 OF SUBSTANCE KNOWN TO CAUSE 8952 05:56:26,640 --> 05:56:28,760 INSULIN RESISTANCE. 8953 05:56:28,760 --> 05:56:31,440 METABOLIC UNIT, STUDY LARGE 8954 05:56:31,440 --> 05:56:33,320 NUMBER OF PATIENTS WITH CASES 8955 05:56:33,320 --> 05:56:43,760 AND CONTROLS AND WE FOUND 8956 05:56:54,200 --> 05:56:55,960 ASSOCIATION WITH ADIPOSEYTES 8957 05:56:55,960 --> 05:56:57,760 DYSFUNCTION, LINKING NATIVE 8958 05:56:57,760 --> 05:57:01,520 AMERICAN BACKGROUND WITH 8959 05:57:01,520 --> 05:57:05,280 METABOLIC DISORDERS, WE ALSO 8960 05:57:05,280 --> 05:57:14,080 HAVE PREVIOUSLY FOUND 8961 05:57:14,080 --> 05:57:18,640 ASSOCIATION WITH ABCC1, ALLELES, 8962 05:57:18,640 --> 05:57:25,120 ALSO CLASSIC ASSOCIATION OF 8963 05:57:25,120 --> 05:57:27,160 PNPLA3 WITH NASH. 8964 05:57:27,160 --> 05:57:32,200 EXTENDING SAMPLE SIZE WE LOOK 8965 05:57:32,200 --> 05:57:34,200 FOR ASSOCIATION WITH GENETIC 8966 05:57:34,200 --> 05:57:37,160 CONSORTIA, MOST RECENT PAPER IS 8967 05:57:37,160 --> 05:57:39,040 ALREADY SUBMITTED FOR 8968 05:57:39,040 --> 05:57:43,160 PUBLICATIONS, AND SAMPLE SIZE 8969 05:57:43,160 --> 05:57:46,880 HAS GROWN SIGNIFICANTLY, TO 8970 05:57:46,880 --> 05:57:50,920 IDENTIFY NEW SPECIFIC 8971 05:57:50,920 --> 05:57:56,320 ASSOCIATIONS AND EFFECT OF RARE 8972 05:57:56,320 --> 05:57:57,320 VARIANTS WITH SMALL FREQUENCY, 8973 05:57:57,320 --> 05:58:01,760 IN THE RIGHT PART YOU CAN SEE 8974 05:58:01,760 --> 05:58:12,280 THE MOST RECENT PLOT IN WHICH 8975 05:58:13,680 --> 05:58:16,160 BOTH SUSCEPTIBILITIES TO 8976 05:58:16,160 --> 05:58:18,040 VARIANTS WERE INCLUDED, ALSO 8977 05:58:18,040 --> 05:58:21,720 SPECIFIC REFERENCE FOR FUTURE 8978 05:58:21,720 --> 05:58:22,320 STUDIES. 8979 05:58:22,320 --> 05:58:25,800 AS YOU KNOW, GENETIC RESULTS ARE 8980 05:58:25,800 --> 05:58:28,680 STILL DIFFICULT TO BE TRANSLATED 8981 05:58:28,680 --> 05:58:32,360 IN CLINICAL PRACTICE. 8982 05:58:32,360 --> 05:58:37,840 BASED ON THAT WE APPLIED 8983 05:58:37,840 --> 05:58:38,960 ARTIFICIAL INTELLIGENCE 8984 05:58:38,960 --> 05:58:40,600 TECHNIQUES TO GENERATE 8985 05:58:40,600 --> 05:58:42,160 PHENOTYPES THAT HAVE 8986 05:58:42,160 --> 05:58:45,960 IMPLICATIONS IN CLINICAL 8987 05:58:45,960 --> 05:58:46,720 PRACTICE. 8988 05:58:46,720 --> 05:58:50,440 WE HAVE FIVE PHENOTYPES THAT HAS 8989 05:58:50,440 --> 05:58:55,680 BEEN DESCRIBED BY AUTHORS, ONE 8990 05:58:55,680 --> 05:58:59,240 RELATED WITH AGE, ANOTHER 8991 05:58:59,240 --> 05:59:05,640 RELATED TO OBESITY, TWO ARE 8992 05:59:05,640 --> 05:59:07,600 SEVERE INSULIN RESISTANCE, WE 8993 05:59:07,600 --> 05:59:09,480 MEASURED PREVALENCE OF 8994 05:59:09,480 --> 05:59:15,200 PHENOTYPES IN COHORTS, INCLUDING 8995 05:59:15,200 --> 05:59:16,800 NATIONWIDE POPULATION SURVEY, 8996 05:59:16,800 --> 05:59:19,120 REGRETTABLY THE MOST FREQUENT 8997 05:59:19,120 --> 05:59:22,920 PHENOTYPE IS SEVERE INSULIN 8998 05:59:22,920 --> 05:59:25,120 DEFICIENCY VARIANT THAT IS DUE 8999 05:59:25,120 --> 05:59:31,600 BY THE LACK TO MEDICAL CARE OR 9000 05:59:31,600 --> 05:59:34,080 DEFICIENT TO MEDICAL CARE, WHEN 9001 05:59:34,080 --> 05:59:35,320 INDIVIDUALS IMPROVED GLUCOSE 9002 05:59:35,320 --> 05:59:40,200 LEVELS THEY USUALLY MOVED TO THE 9003 05:59:40,200 --> 05:59:43,080 AGE-RELATED DIABETES OR 9004 05:59:43,080 --> 05:59:45,480 OBESITY-RELATED DIABETES, FORMS 9005 05:59:45,480 --> 05:59:50,280 HAS A PROGNOSIS, A CLEAR 9006 05:59:50,280 --> 05:59:51,840 EVIDENCE, PRECISION MEDICINE 9007 05:59:51,840 --> 05:59:56,080 COULD BE USEFUL IN CLINICAL 9008 05:59:56,080 --> 06:00:00,480 PRACTICE, IDENTIFYING THAT CAN 9009 06:00:00,480 --> 06:00:02,520 CHANGE PROGNOSIS BY 9010 06:00:02,520 --> 06:00:05,720 CHARACTERIZATION OF THE WHOLE 9011 06:00:05,720 --> 06:00:06,640 DIABETIC POPULATION. 9012 06:00:06,640 --> 06:00:10,520 LESSONS WE LEARNED IN THE 9013 06:00:10,520 --> 06:00:13,400 PROCESS IS THAT EFFECTIVE 9014 06:00:13,400 --> 06:00:14,360 IMPLEMENTATION OF THESE 9015 06:00:14,360 --> 06:00:17,200 PRECISION MEDICINE APPROACH 9016 06:00:17,200 --> 06:00:21,240 STARTS WITH BUILDING THIS 9017 06:00:21,240 --> 06:00:22,360 INFRASTRUCTURE, CREATING 9018 06:00:22,360 --> 06:00:25,080 DATABASES, LINKING OUR CLINICAL 9019 06:00:25,080 --> 06:00:26,920 WORK WITH RESEARCH FROM THE 9020 06:00:26,920 --> 06:00:27,480 BEGINNING. 9021 06:00:27,480 --> 06:00:32,520 THE SECONDS STEP IS CREATING A 9022 06:00:32,520 --> 06:00:34,080 MULTI-DISCIPLINARY TEAM. 9023 06:00:34,080 --> 06:00:36,360 FOLLOWED BY LOOKING FOR 9024 06:00:36,360 --> 06:00:38,320 INCLUSION OF THESE LARGE 9025 06:00:38,320 --> 06:00:43,560 DATABASES IN INTERNATIONAL 9026 06:00:43,560 --> 06:00:46,280 CONSORTIA, HIGHLIGHTING ADDED 9027 06:00:46,280 --> 06:00:49,920 VALUE OF MINORITY GROUPS AND 9028 06:00:49,920 --> 06:00:52,200 FINALLY LOOKING FOR TRANSLATION 9029 06:00:52,200 --> 06:00:56,600 IN CLINICAL WORK OF THIS 9030 06:00:56,600 --> 06:00:59,120 INFORMATION, USING ARTIFICIAL 9031 06:00:59,120 --> 06:01:01,080 INTELLIGENCE DATA IN CONJUNCTION 9032 06:01:01,080 --> 06:01:04,240 WITH GENETIC INFORMATION. 9033 06:01:04,240 --> 06:01:06,000 YOU CAN ACCESS ADDITIONAL DATA 9034 06:01:06,000 --> 06:01:09,200 VISITING OUR WEB PAGE OF THE 9035 06:01:09,200 --> 06:01:10,160 INSTITUTE OF NATIONAL DISEASES. 9036 06:01:10,160 --> 06:01:14,240 THANK YOU VERY MUCH FOR YOUR 9037 06:01:14,240 --> 06:01:16,240 ATTENTION. 9038 06:01:16,240 --> 06:01:17,160 >>HELLO, EVERYBODY. 9039 06:01:17,160 --> 06:01:20,320 I'M EXCITED TO BE HERE, I'M 9040 06:01:20,320 --> 06:01:21,440 LAURA FEJERMAN, PROFESSOR IN THE 9041 06:01:21,440 --> 06:01:23,760 DEPARTMENT OF PUBLIC HEALTH 9042 06:01:23,760 --> 06:01:26,800 SCIENCES, AND I'LL BE TALKING TO 9043 06:01:26,800 --> 06:01:30,200 YOU ABOUT ACHIEVING EQUITY IN 9044 06:01:30,200 --> 06:01:32,160 BREAST CANCER PRECISION 9045 06:01:32,160 --> 06:01:34,840 PREVENTION FOR HISPANIC/LATINA 9046 06:01:34,840 --> 06:01:41,120 WOMEN. 9047 06:01:41,120 --> 06:01:43,240 BREAST CANCER INCIDENCE AROUND 9048 06:01:43,240 --> 06:01:46,600 THE WORLD, ALSO WITHIN THE 9049 06:01:46,600 --> 06:01:50,680 UNITED STATES, VARIES BY RACE, 9050 06:01:50,680 --> 06:01:51,320 ETHNIC. 9051 06:01:51,320 --> 06:01:56,240 YOU CAN SEE HISPANIC/LATINA 9052 06:01:56,240 --> 06:01:58,400 WOMEN COMPARED TO OTHER GROUPS. 9053 06:01:58,400 --> 06:02:01,040 IN LATIN AMERICA YOU CAN SEE 9054 06:02:01,040 --> 06:02:02,240 ANOTHER VARIATION IN TERMS OF 9055 06:02:02,240 --> 06:02:05,760 INCIDENCE, FOR EXAMPLE YOU CAN 9056 06:02:05,760 --> 06:02:10,360 SEE HIGH INCIDENCE IN ARGENTINA 9057 06:02:10,360 --> 06:02:13,240 REGION, BRAZIL, LOWER INCIDENCE 9058 06:02:13,240 --> 06:02:14,400 IN BOLIVIA, PERU, MEXICO. 9059 06:02:14,400 --> 06:02:18,680 I'M VERY INTERESTED IN THIS 9060 06:02:18,680 --> 06:02:19,120 VARIATION. 9061 06:02:19,120 --> 06:02:20,640 IN PARTICULAR, MANY YEARS AGO I 9062 06:02:20,640 --> 06:02:25,520 LOOKED AT THE DISTRIBUTION OF 9063 06:02:25,520 --> 06:02:29,320 GENETIC ANCESTRY, DIFFERENT 9064 06:02:29,320 --> 06:02:31,400 LATIN AMERICAN COUNTRIES, AND 9065 06:02:31,400 --> 06:02:33,360 AMONG U.S. HISPANIC LATINAS IN 9066 06:02:33,360 --> 06:02:35,560 THE U.S. AND FOUND THERE WAS 9067 06:02:35,560 --> 06:02:40,040 ASSOCIATION BETWEEN INDIGENOUS 9068 06:02:40,040 --> 06:02:41,680 AMERICAN COMPONENT IN BLUE, 9069 06:02:41,680 --> 06:02:45,400 LOWER RISK AMONG THOSE WITH HIGH 9070 06:02:45,400 --> 06:02:47,080 INDIGENOUS AMERICAN ANCESTRY, 9071 06:02:47,080 --> 06:02:50,560 HIGHER RISK AMONG HISPANIC 9072 06:02:50,560 --> 06:02:52,200 LATINAS WITH HIGH EUROPEAN 9073 06:02:52,200 --> 06:02:55,280 ANCESTRY, YOU CAN SEE DIFFERENT 9074 06:02:55,280 --> 06:02:58,680 GROUPS FROM KAISER COHORT, FOR 9075 06:02:58,680 --> 06:03:01,880 EXAMPLE, A LOT LESS INDIGENOUS 9076 06:03:01,880 --> 06:03:07,680 AMERICAN ANCESTRY, WOMEN IN 9077 06:03:07,680 --> 06:03:10,400 PERU, PROPORTION OF INDIGENOUS 9078 06:03:10,400 --> 06:03:11,200 AMERICAN ANCESTRY. 9079 06:03:11,200 --> 06:03:15,560 WE FOLLOWED UP TRYING TO 9080 06:03:15,560 --> 06:03:18,160 IDENTIFY SPECIFIC BIAS TO 9081 06:03:18,160 --> 06:03:21,800 EXPLAIN HIGHER RISK AMONG 9082 06:03:21,800 --> 06:03:23,720 INDIGENOUS AMERICAN ANCESTRY 9083 06:03:23,720 --> 06:03:25,520 PARTICIPANTS, AND IN 2014 WE 9084 06:03:25,520 --> 06:03:30,880 PUBLISHED THE FIRST GENOME WIDE 9085 06:03:30,880 --> 06:03:32,760 ASSOCIATION STUDIES, 9086 06:03:32,760 --> 06:03:34,480 HISPANIC/LATINAS, SHOWING 9087 06:03:34,480 --> 06:03:39,360 CHROMOSOME 6, REGION NEAR THE 9088 06:03:39,360 --> 06:03:42,240 ASSOCIATION RECEPTOR 1 GENE. 9089 06:03:42,240 --> 06:03:46,640 WHAT'S INTERESTING ABOUT THE 9090 06:03:46,640 --> 06:03:49,360 POLYMORPHISM, IT HAS RELATIVELY 9091 06:03:49,360 --> 06:03:53,040 HIGH FREQUENCY IN 9092 06:03:53,040 --> 06:03:54,760 HISPANIC/LATINA WOMEN, ALMOST 9093 06:03:54,760 --> 06:03:59,720 ABSENT IN ALL OTHER ANCESTRAL 9094 06:03:59,720 --> 06:04:01,760 BACKGROUNDS, LINKED TO 9095 06:04:01,760 --> 06:04:02,760 INDIGENOUS AMERICAN COMPONENT, 9096 06:04:02,760 --> 06:04:04,520 PRESENTING FREQUENCY IN THOUSAND 9097 06:04:04,520 --> 06:04:09,360 GENOMES, ALSO HERE YOU CAN SEE 9098 06:04:09,360 --> 06:04:10,880 THE HISPANIC-LATINAS IN THOUSAND 9099 06:04:10,880 --> 06:04:13,280 GENOMES, THE GROUP WITH THE 9100 06:04:13,280 --> 06:04:15,240 HIGHEST PROPORTION OF THE 9101 06:04:15,240 --> 06:04:19,200 PROTECTIVE ALLELE THAT WE 9102 06:04:19,200 --> 06:04:21,920 DISCOVERED, IN PERU, ALSO 9103 06:04:21,920 --> 06:04:23,040 COMPARED TO MEXICO, COLOMBIA, 9104 06:04:23,040 --> 06:04:25,520 PUERTO RICO, THE COUNTRY WITH 9105 06:04:25,520 --> 06:04:28,400 THE HIGHEST INDIGENOUS AMERICAN 9106 06:04:28,400 --> 06:04:28,960 ANCESTRY. 9107 06:04:28,960 --> 06:04:32,960 WHY DO WE CARE ABOUT FINDING 9108 06:04:32,960 --> 06:04:34,600 AGAINST ASSOCIATED WITH BREAST 9109 06:04:34,600 --> 06:04:36,560 CANCER RISK? 9110 06:04:36,560 --> 06:04:38,440 THERE'S OF COURSE UNDERSTANDING 9111 06:04:38,440 --> 06:04:40,960 CANCER BIOLOGY FOR DEVELOPMENT, 9112 06:04:40,960 --> 06:04:43,040 PREVENTION, TREATMENT, AND THEN 9113 06:04:43,040 --> 06:04:46,560 THERE'S ALSO BREAST CANCER RISK 9114 06:04:46,560 --> 06:04:48,840 PREDICTION, THIS IS WHERE 9115 06:04:48,840 --> 06:04:49,600 PRECISION PREVENTION COMES IN, 9116 06:04:49,600 --> 06:04:54,000 AND SO WE WANT TO BE ABLE TO 9117 06:04:54,000 --> 06:04:58,360 TELL PARTICIPANTS IN STUDIES , 9118 06:04:58,360 --> 06:04:59,680 WOMEN IN THE COMMUNITIES, THEIR 9119 06:04:59,680 --> 06:05:01,880 RISK TO DEVELOP BREAST CANCER 9120 06:05:01,880 --> 06:05:06,480 FOR PREVENTION AND EARLY 9121 06:05:06,480 --> 06:05:08,040 DETECTION. 9122 06:05:08,040 --> 06:05:11,840 AND MOST HAVE BEEN IN BRCA1 AND 9123 06:05:11,840 --> 06:05:12,920 BRCA2 WHETHER WE CAN TELL A 9124 06:05:12,920 --> 06:05:13,880 PERSON WITH THE MUTATION WHAT 9125 06:05:13,880 --> 06:05:19,600 THEIR RISK OF DEVELOPING THE 9126 06:05:19,600 --> 06:05:21,240 DISEASE IS, THAT THERE'S ALSO 9127 06:05:21,240 --> 06:05:29,240 THIS HAS BEEN GROWING IN THE 9128 06:05:29,240 --> 06:05:31,040 LAST MANY YEARS, HIGHER 9129 06:05:31,040 --> 06:05:32,600 FREQUENCY THAT CAN INFORM MORE 9130 06:05:32,600 --> 06:05:35,480 GENERALLY THE POPULATION IN 9131 06:05:35,480 --> 06:05:39,160 TERMS OF PROVIDING DISTRIBUTION 9132 06:05:39,160 --> 06:05:44,440 OF RISK, AMONG WOMEN, THAT CAN 9133 06:05:44,440 --> 06:05:47,720 THEN BE USED TO PROVIDE ADVICE 9134 06:05:47,720 --> 06:05:51,320 ON HOW TO PERFORM, HOW OFTEN TO 9135 06:05:51,320 --> 06:05:55,400 PERFORM MAMMOGRAMS OR EVEN IF 9136 06:05:55,400 --> 06:05:56,600 YOU'RE THE HIGHER -- YOU'RE IN 9137 06:05:56,600 --> 06:05:58,120 THE TOP PART OF THE DISTRIBUTION 9138 06:05:58,120 --> 06:06:01,320 WITH HIGHEST RISK, WE MIGHT BE 9139 06:06:01,320 --> 06:06:06,080 ABLE TO RECOMMEND ADDITIONAL 9140 06:06:06,080 --> 06:06:07,360 PREVENTION INCLUDING CONSIDERING 9141 06:06:07,360 --> 06:06:08,040 CHEMOPREVENTION AMONG THOSE WHO 9142 06:06:08,040 --> 06:06:14,440 MIGHT BE AT MORE THAN 30% RISK, 9143 06:06:14,440 --> 06:06:17,120 LIFETIME RISK. 9144 06:06:17,120 --> 06:06:22,200 AND SO THIS CAN BE USED TO 9145 06:06:22,200 --> 06:06:25,000 CREATE POLYGENIC RISK SCORES, 9146 06:06:25,000 --> 06:06:27,800 WHICH ADD THEM UP, BASICALLY FOR 9147 06:06:27,800 --> 06:06:33,400 EFFECT SIZE, FOR EACH 9148 06:06:33,400 --> 06:06:36,000 PARTICIPANTS, AND WE'VE DONE 9149 06:06:36,000 --> 06:06:38,200 POLYGENIC RISK PREDICTION IN 9150 06:06:38,200 --> 06:06:40,600 HISPANIC LATINAS IN THE PAST, 9151 06:06:40,600 --> 06:06:41,880 PUBLISHED A PAPER IN 2019 ON 9152 06:06:41,880 --> 06:06:47,920 THIS SHOWING EVEN THOUGH MOST OF 9153 06:06:47,920 --> 06:06:53,160 THE DYADS WE USED WERE EUROPEANS 9154 06:06:53,160 --> 06:06:58,640 OR ASIANS, THERE'S ACTUALLY VERY 9155 06:06:58,640 --> 06:07:00,960 SIMILAR ASSOCIATED PREDICTIVE 9156 06:07:00,960 --> 06:07:06,440 COMPARED TO EUROPEANS, AREA 9157 06:07:06,440 --> 06:07:11,160 UNDER THE CURVE, .64, . 63 FOR 9158 06:07:11,160 --> 06:07:17,280 YOUR APPEARANCE, IN THIS CASE 9159 06:07:17,280 --> 06:07:18,200 ADDED PROTECTIVE POLYMORPHISM, 9160 06:07:18,200 --> 06:07:22,000 ANOTHER IN THE SAME REGION, TO 9161 06:07:22,000 --> 06:07:28,360 THE PRS, AND WE GOT THIS REALLY 9162 06:07:28,360 --> 06:07:35,680 COMPARABLE AREA UNDER THE CURVE. 9163 06:07:35,680 --> 06:07:38,000 HOWEVER, LATER I DEVELOPED 9164 06:07:38,000 --> 06:07:40,760 POLYGENIC RISK SCORE IN A CASE 9165 06:07:40,760 --> 06:07:44,040 CONTROL STUDY THAT IS IN PERU, 9166 06:07:44,040 --> 06:07:53,120 THIS IS PART OF THE STUDY, 9167 06:07:53,120 --> 06:07:54,160 CANCER GENOMIC STUDY. 9168 06:07:54,160 --> 06:07:56,680 CALCULATED AREA UNDER THE CURVE 9169 06:07:56,680 --> 06:08:02,680 WITH A PANEL THAT INCLUDED 178, 9170 06:08:02,680 --> 06:08:05,320 EXCLUDING THE SNPs DISCOVERED 9171 06:08:05,320 --> 06:08:07,600 IN HISPANIC LATINA GWAS, THEN WE 9172 06:08:07,600 --> 06:08:11,200 ADDED THEM AND WHAT WE SAW IN 9173 06:08:11,200 --> 06:08:14,400 BLUE IS THAT REALLY THE ADDING 9174 06:08:14,400 --> 06:08:16,800 THE TWO HISPANIC LATINA SPECIFIC 9175 06:08:16,800 --> 06:08:18,880 SNPs MADE AN IMPORTANT 9176 06:08:18,880 --> 06:08:22,120 DIFFERENCE IN THE POLYGENIC RISK 9177 06:08:22,120 --> 06:08:26,400 SCORE AVERAGE, AND ALSO IF WE 9178 06:08:26,400 --> 06:08:30,080 LOOKED TO INDIGENOUS AMERICAN 9179 06:08:30,080 --> 06:08:30,920 ANCESTRY, WE ALSO SEE INCREASING 9180 06:08:30,920 --> 06:08:33,640 AREA UNDER THE CURVE WITH HIGHER 9181 06:08:33,640 --> 06:08:36,560 INDIGENOUS AMERICAN ANCESTRY 9182 06:08:36,560 --> 06:08:38,560 WHICH WAS UNEXPECTED, AND BEFORE 9183 06:08:38,560 --> 06:08:41,400 WHEN WE LOOKED AT U.S. LATINAS 9184 06:08:41,400 --> 06:08:46,000 AND OTHER COHORTS WE HAD FOR THE 9185 06:08:46,000 --> 06:08:49,040 ORIGINAL PANEL DISEASE, WE ALSO 9186 06:08:49,040 --> 06:08:51,160 GROUPED BY QUARTILE, A BIG 9187 06:08:51,160 --> 06:08:53,040 DIFFERENCE THE HIGHEST QUARTILES 9188 06:08:53,040 --> 06:08:56,080 HERE ARE MORE THAN 80%, EVEN 9189 06:08:56,080 --> 06:08:57,960 MORE THAN 90% INDIGENOUS 9190 06:08:57,960 --> 06:09:00,720 AMERICAN ANCESTRY, IF YOU 9191 06:09:00,720 --> 06:09:02,720 REMEMBER FROM THE PREVIOUS SLIDE 9192 06:09:02,720 --> 06:09:07,920 THIS QUARTILE, THE TOP ONE IS 9193 06:09:07,920 --> 06:09:10,400 MORE THAN 55% INDIGENOUS, A LOT 9194 06:09:10,400 --> 06:09:12,720 MORE HETEROGENEOUS THAN THIS 9195 06:09:12,720 --> 06:09:13,000 GROUP HERE. 9196 06:09:13,000 --> 06:09:19,160 AND HERE THE AREA UNDER THE 9197 06:09:19,160 --> 06:09:22,040 CURVE IS THIS .64, WHICH IS -- 9198 06:09:22,040 --> 06:09:31,320 AND .62, IN THE MORE EUROPEAN 9199 06:09:31,320 --> 06:09:33,040 QUARTILE. 9200 06:09:33,040 --> 06:09:37,320 PRS IN LATINA WOMEN IMPROVES 9201 06:09:37,320 --> 06:09:38,240 INDIGENOUS ANCESTRY SPECIFIC 9202 06:09:38,240 --> 06:09:40,840 ADDED, AND WE THINK THAT 9203 06:09:40,840 --> 06:09:42,480 DIFFERENT ENVIRONMENTAL ANCESTRY 9204 06:09:42,480 --> 06:09:45,000 BACKGROUNDS IN LATINA AMERICAN 9205 06:09:45,000 --> 06:09:47,760 MIGHT AFFECT PREDICTOR OF 9206 06:09:47,760 --> 06:09:50,240 RESPONSE OF PRS, BASED ON THE 9207 06:09:50,240 --> 06:09:52,560 PERUVIAN DATA IT'S NOT OBVIOUS 9208 06:09:52,560 --> 06:09:54,760 IN WHICH DIRECTION, AND COULD 9209 06:09:54,760 --> 06:09:57,600 BIVE THE PANELS MIGHT BE MORE IN 9210 06:09:57,600 --> 06:09:59,440 GROUPS OF HIGH INDIGENOUS 9211 06:09:59,440 --> 06:10:00,880 AMERICAN ANCESTRY. 9212 06:10:00,880 --> 06:10:03,240 WHAT WE ALSO LEARNED THROUGH THE 9213 06:10:03,240 --> 06:10:06,120 PROCESS, WE NEED A LOT MORE DATA 9214 06:10:06,120 --> 06:10:09,520 TO BE ABLE TO IDENTIFY MORE 9215 06:10:09,520 --> 06:10:10,720 POPULATION-SPECIFIC VARIANTS IN 9216 06:10:10,720 --> 06:10:13,480 A TRULY ADD VALUE TO THE PRS, 9217 06:10:13,480 --> 06:10:16,760 AND SO I'VE BEEN WORKING FOR 9218 06:10:16,760 --> 06:10:21,800 MORE THAN TWO YEARS NOW TOGETHER 9219 06:10:21,800 --> 06:10:27,120 WITH COLLABORATING WITH THE 9220 06:10:27,120 --> 06:10:29,520 MONTSERRAT AND CONFLUENCE STUDY 9221 06:10:29,520 --> 06:10:31,960 AT NCI, IT'S AN EFFORT TO FRAM 9222 06:10:31,960 --> 06:10:38,080 BRING TOGETHER ALL THE DIVERSE 9223 06:10:38,080 --> 06:10:41,360 COHORTS FOR ANALYSIS, AND I'M 9224 06:10:41,360 --> 06:10:45,760 TRYING TO FINISH CREATING THE 9225 06:10:45,760 --> 06:10:53,960 LATINA AMERICAN BREAST CANCER 9226 06:10:53,960 --> 06:10:55,160 CONSORTIUM, AND WE'VE BEEN 9227 06:10:55,160 --> 06:10:55,400 GROWING. 9228 06:10:55,400 --> 06:10:58,840 YOU CAN SEE THE MEMBERS OF THE 9229 06:10:58,840 --> 06:10:59,160 CONSORTIUM. 9230 06:10:59,160 --> 06:11:00,680 WE HAVE REPRESENTATION FROM 11 9231 06:11:00,680 --> 06:11:03,120 COUNTRIES, INCLUDING THE U.S., 9232 06:11:03,120 --> 06:11:07,720 AND WE'RE INCLUDING STUDIES IN 9233 06:11:07,720 --> 06:11:08,560 LATIN AMERICA OF HISPANIC 9234 06:11:08,560 --> 06:11:11,680 LATINAS IN THE U.S., TOGETHER WE 9235 06:11:11,680 --> 06:11:14,680 WERE HOPING TO BE ABLE TO HAVE 9236 06:11:14,680 --> 06:11:20,240 DATA FOR 30,000 CASES, 30,000 9237 06:11:20,240 --> 06:11:25,920 CONTROLS, PART OF THE STUDIES 9238 06:11:25,920 --> 06:11:28,000 HAD DATA, ALSO WE'RE ABLE TO 9239 06:11:28,000 --> 06:11:33,120 GENOTYPE STUDIES THAT DIDN'T 9240 06:11:33,120 --> 06:11:34,040 HAVE THESE DATA. 9241 06:11:34,040 --> 06:11:37,280 AND BROAD AIMS FOR THE PROJECT 9242 06:11:37,280 --> 06:11:42,760 ARE TO DISCOVER MORE VARIANTS, 9243 06:11:42,760 --> 06:11:44,080 THROUGH GWAS, MAPPING, TWAS, 9244 06:11:44,080 --> 06:11:46,320 OTHER APPROACHES THAT MIGHT 9245 06:11:46,320 --> 06:11:47,480 LEVERAGE ANCESTRY HETEROGENEITY 9246 06:11:47,480 --> 06:11:50,480 OF THE LATIN AMERICAN 9247 06:11:50,480 --> 06:11:52,760 POPULATIONS, LEARN MORE ABOUT 9248 06:11:52,760 --> 06:11:56,200 BIOLOGY, IMPROVE PRS FOR 9249 06:11:56,200 --> 06:11:58,840 HISPANIC LATINAS, AND KEEP 9250 06:11:58,840 --> 06:12:00,800 BUILDING ANCESTRY AWARE PRS AS 9251 06:12:00,800 --> 06:12:03,800 WELL AS SUBTYPE SPECIFIC FOR THE 9252 06:12:03,800 --> 06:12:05,440 DIFFERENT SUBTYPES OF BREAST 9253 06:12:05,440 --> 06:12:08,480 CANCER, AND MAYBE MORE INTO THE 9254 06:12:08,480 --> 06:12:12,680 FUTURE DISCOVERING NEW INSIGHTS 9255 06:12:12,680 --> 06:12:14,760 INTO BIOLOGICAL MECHANISMS AND 9256 06:12:14,760 --> 06:12:15,720 ASSOCIATIONS WE FIND. 9257 06:12:15,720 --> 06:12:17,840 THAT'S ALL I HAVE TO PRESENT. 9258 06:12:17,840 --> 06:12:20,000 I WANT TO THANK PEOPLE IN MY LAB 9259 06:12:20,000 --> 06:12:22,120 AND ALL THE LABS THAT I WORKED 9260 06:12:22,120 --> 06:12:26,040 WITH ON THE GENOME WIDE 9261 06:12:26,040 --> 06:12:27,280 ASSOCIATION STUDIES IN LATINAS, 9262 06:12:27,280 --> 06:12:30,720 AND GRATEFUL TO THE MEMBERS FOR 9263 06:12:30,720 --> 06:12:32,680 BEING THERE AND STAYING HERE, 9264 06:12:32,680 --> 06:12:35,080 WORKING WITH ME TO HOPEFULLY 9265 06:12:35,080 --> 06:12:35,880 MAKE THIS HAPPEN. 9266 06:12:35,880 --> 06:12:38,000 WE THINK IT'S GOING TO BE A 9267 06:12:38,000 --> 06:12:38,680 GREAT RESOURCE. 9268 06:12:38,680 --> 06:12:41,120 THANK YOU. 9269 06:12:41,120 --> 06:12:45,040 9270 06:12:45,040 --> 06:12:50,880 >>GOOD AFTERNOON, I'M DR. JORGE 9271 06:12:50,880 --> 06:12:56,080 DUCONGE, BRIDGING THE GANT TO 9272 06:12:56,080 --> 06:12:58,440 REDUCE HEALTH CARE DISPARITIES. 9273 06:12:58,440 --> 06:13:00,320 LET ME GIVE SOME CONTEXT HERE, 9274 06:13:00,320 --> 06:13:04,800 EXPLAIN THE REASON WHY WE NEED 9275 06:13:04,800 --> 06:13:08,200 TO CONDUCT THIS STUDY 9276 06:13:08,200 --> 06:13:11,840 PARTICULARLY WHEN GWAS HAS 9277 06:13:11,840 --> 06:13:13,000 ALREADY BEEN (INDISCERNIBLE). 9278 06:13:13,000 --> 06:13:15,960 IT WAS CARRIED OUT IN 9279 06:13:15,960 --> 06:13:16,840 INDIVIDUALS OF MAINLY EUROPEAN 9280 06:13:16,840 --> 06:13:19,080 ANCESTRY, AND NO ONE OF THE 9281 06:13:19,080 --> 06:13:21,480 HISPANIC ORIGIN WAS INCLUDED. 9282 06:13:21,480 --> 06:13:28,200 SO, THE RATIONALE BEHIND THESE, 9283 06:13:28,200 --> 06:13:29,720 ADDRESSING THE LONGSTANDING 9284 06:13:29,720 --> 06:13:32,160 PROBLEM OF EXCLUDING MINORITIES 9285 06:13:32,160 --> 06:13:33,600 FROM CLINICAL RESEARCH, WHICH 9286 06:13:33,600 --> 06:13:37,400 ENTAILS GAP OF KNOWLEDGE ABOUT 9287 06:13:37,400 --> 06:13:38,200 PHARMACOGENOMICS OF THE 9288 06:13:38,200 --> 06:13:39,800 POPULATION IN PUERTO RICO. 9289 06:13:39,800 --> 06:13:43,200 THE VAST MAJORITY OF THESE 9290 06:13:43,200 --> 06:13:47,160 GENOMIC STUDIES HAS BEEN CON 9291 06:13:47,160 --> 06:13:54,480 CONDUCTED IN INDIVIDUALS OF 9292 06:13:54,480 --> 06:13:55,280 MOSTLY EUROPEAN ANCESTRY, 9293 06:13:55,280 --> 06:13:57,520 HISPANICS MAKE UP LESS THAN 1% 9294 06:13:57,520 --> 06:14:01,640 OF PARTICIPANTS IN THE STUDIES, 9295 06:14:01,640 --> 06:14:03,600 A HUGE DISPARITY THAT HASN'T 9296 06:14:03,600 --> 06:14:04,240 BEEN GETTING BETTER. 9297 06:14:04,240 --> 06:14:06,760 IN PRECISION MEDICINE IS GOING 9298 06:14:06,760 --> 06:14:08,960 TO BE EQUITABLE WE NEED TO FIX 9299 06:14:08,960 --> 06:14:11,920 LACK OF REPRESENTATION THAT 9300 06:14:11,920 --> 06:14:14,800 TENDS TO EXACERBATE THE HEALTH 9301 06:14:14,800 --> 06:14:17,400 CARE DISPARITIES ALREADY 9302 06:14:17,400 --> 06:14:17,960 EXISTING. 9303 06:14:17,960 --> 06:14:19,400 WHAT MADE CARIBBEAN HISPANICS 9304 06:14:19,400 --> 06:14:22,000 QUITE APPEALING GROUP FOR GWAS? 9305 06:14:22,000 --> 06:14:25,680 HERE ARE SOME FEATURES THAT CAN 9306 06:14:25,680 --> 06:14:28,760 EXPLAIN THAT. 9307 06:14:28,760 --> 06:14:30,520 FIRST, THEY SHOW HETEROGENEITY 9308 06:14:30,520 --> 06:14:34,240 AND HIGH LEVEL OF GENETIC 9309 06:14:34,240 --> 06:14:35,040 MIXTURE AMONG AFRICAN, 9310 06:14:35,040 --> 06:14:36,320 EUROPEANS, NATURE OF NATIVE 9311 06:14:36,320 --> 06:14:39,960 AMERICANS, AS A RESULT OF THE SO 9312 06:14:39,960 --> 06:14:42,200 CALLED COLONIAL EXCHANGE, 9313 06:14:42,200 --> 06:14:44,160 HISPANIC GENOMES REPRESENT 9314 06:14:44,160 --> 06:14:53,680 RECENT INNOVATION IN HUMAN 9315 06:14:53,680 --> 06:14:54,960 EVOLUTION, CONTAINING VARIANTS 9316 06:14:54,960 --> 06:14:56,360 OF HAPLOTYPES WHICH NEVER 9317 06:14:56,360 --> 06:14:58,880 EXISTED TOGETHER AND LINK DUE TO 9318 06:14:58,880 --> 06:15:01,280 THEIR NATURE. 9319 06:15:01,280 --> 06:15:03,240 IMPORTANT TO MENTION DIFFERENT 9320 06:15:03,240 --> 06:15:09,200 PATTERNS HAS AN IMPACT ON POWER 9321 06:15:09,200 --> 06:15:10,480 TO DETECT SIGNIFICANT SIGNALS. 9322 06:15:10,480 --> 06:15:12,760 THERE'S A HIGH LEVEL OF 9323 06:15:12,760 --> 06:15:14,760 STRATIFICATION IN PUERTO RICO, 9324 06:15:14,760 --> 06:15:17,240 BECAUSE ALLELE FREQUENCIES AND 9325 06:15:17,240 --> 06:15:20,320 EFFECT SIZE CAN DEFER 9326 06:15:20,320 --> 06:15:21,840 SUBSTANTIALLY BETWEEN THESE 9327 06:15:21,840 --> 06:15:25,000 POPULATIONS, SUCH STRATIFICATION 9328 06:15:25,000 --> 06:15:28,440 CAN LEAD TO FALSE OR SPURIOUS 9329 06:15:28,440 --> 06:15:30,720 ASSOCIATIONS OR MASK TRUE 9330 06:15:30,720 --> 06:15:32,480 ASSOCIATION IN PHARMACOGENOMIC 9331 06:15:32,480 --> 06:15:33,240 STUDIES BECOMING AN IMPORTANT 9332 06:15:33,240 --> 06:15:36,280 SOURCE OF BIAS IN GWAS, SO WE 9333 06:15:36,280 --> 06:15:39,480 NEED TO CONTROL FOR POPULATION 9334 06:15:39,480 --> 06:15:40,520 STRATIFICATION, AS POTENTIAL 9335 06:15:40,520 --> 06:15:44,840 CONFOUNDER IN THIS KIND OF STUDY 9336 06:15:44,840 --> 06:15:47,320 WHEN CONDUCTED IN ADMIX 9337 06:15:47,320 --> 06:15:52,400 POPULATIONS LIKE PERUVIAN 9338 06:15:52,400 --> 06:15:52,920 HISPANICS. 9339 06:15:52,920 --> 06:15:56,560 THIS ILLUSTRATES THE SIGNIFICANT 9340 06:15:56,560 --> 06:15:58,400 MIXTURE IN CARIBBEAN HISPANICS, 9341 06:15:58,400 --> 06:16:00,280 INFERRED ANCESTRY IS NOT 9342 06:16:00,280 --> 06:16:01,720 CATEGORICAL IN DIVERSE 9343 06:16:01,720 --> 06:16:03,880 POPULATIONS BUT SHOW VARYING 9344 06:16:03,880 --> 06:16:05,520 DEGREE OF PROPORTIONS AS YOU CAN 9345 06:16:05,520 --> 06:16:09,160 SEE OVER HERE. 9346 06:16:09,160 --> 06:16:11,000 SO, USE OF BIOLOGICAL CONSTRUCT 9347 06:16:11,000 --> 06:16:16,480 SUCH AS SELF-REPORTED RACE TO 9348 06:16:16,480 --> 06:16:18,480 DEFINE ORIGIN BASED ON SKIN 9349 06:16:18,480 --> 06:16:21,840 COLOR AS A PROXY IS INACCURATE, 9350 06:16:21,840 --> 06:16:24,160 TO CAPTURE THE COMPLEX DEGREE OF 9351 06:16:24,160 --> 06:16:30,960 MIXTURE IN POPULATIONS. 9352 06:16:30,960 --> 06:16:38,920 YOU CAN SEE THESE KALEIDOSCOPIC 9353 06:16:38,920 --> 06:16:40,800 COMBINATIONS, NATIVE AMERICAN, 9354 06:16:40,800 --> 06:16:42,320 WEST AFRICAN, YOUR APPEARANCE, 9355 06:16:42,320 --> 06:16:44,960 GIVE RISE TO REPERTOIRE OF 9356 06:16:44,960 --> 06:16:46,920 ALLELIC COME OF COMBINATIONS AND 9357 06:16:46,920 --> 06:16:49,120 HAPLOTYPE BLOODS WITH NOVEL 9358 06:16:49,120 --> 06:16:50,640 PATTERNS THAT ULTIMATELY AFFECT 9359 06:16:50,640 --> 06:16:55,360 ASSOCIATIONS IN PHARMACO GENETIC 9360 06:16:55,360 --> 06:16:55,600 STUDIES. 9361 06:16:55,600 --> 06:16:58,840 WE MAPPED FOUR INDIVIDUALS FROM 9362 06:16:58,840 --> 06:17:01,600 OUR STUDY AGAINST THE FIRST TWO 9363 06:17:01,600 --> 06:17:04,600 PRINCIPAL COMPONENTS FROM THE 9364 06:17:04,600 --> 06:17:05,000 GENOME. 9365 06:17:05,000 --> 06:17:07,440 WHEN THESE TWO SUBJECTS IN THE 9366 06:17:07,440 --> 06:17:10,640 BOTTOM WERE CLOSED TO EACH OTHER 9367 06:17:10,640 --> 06:17:13,880 ON THE PC PLOT, SUGGESTING 9368 06:17:13,880 --> 06:17:23,400 SIMILAR PORTIONS OF PARENTAL 9369 06:17:23,400 --> 06:17:26,080 ANCESTRY, ANCESTRY VARIES 9370 06:17:26,080 --> 06:17:29,160 GREATLY. 9371 06:17:29,160 --> 06:17:32,120 SO BY ACCOUNTING FOR THIS WE MAY 9372 06:17:32,120 --> 06:17:34,520 HAVE UNCOVERED NOVEL 9373 06:17:34,520 --> 06:17:35,160 ASSOCIATIONS. 9374 06:17:35,160 --> 06:17:38,360 THAT'S WHY WE NEEDS TO PLAN 9375 06:17:38,360 --> 06:17:39,880 ADJUSTED GWAS AS I WILL SHOW. 9376 06:17:39,880 --> 06:17:42,720 WITH ALL THAT IN MIND, WE 9377 06:17:42,720 --> 06:17:45,560 INITIALLY PERFORMED THE FIRST 9378 06:17:45,560 --> 06:17:47,440 GWAS OF A PHARMACOGENETIC TRAIT 9379 06:17:47,440 --> 06:17:49,960 IN CARIBBEAN HISPANIC, TO THIS 9380 06:17:49,960 --> 06:17:55,120 END WE USED A CUTOFF OF 230 TO 9381 06:17:55,120 --> 06:17:56,720 DISTINGUISH CONTROLS FROM CASES 9382 06:17:56,720 --> 06:18:01,600 THAT IS THOSE RESIS CAN'T TO 9383 06:18:01,600 --> 06:18:02,960 CLOPIDOGREL, REPRESENTING 33% OF 9384 06:18:02,960 --> 06:18:07,440 THE STUDY COHORT AS CAN BE SEEN 9385 06:18:07,440 --> 06:18:08,640 IN THIS HISTOGRAM. 9386 06:18:08,640 --> 06:18:11,400 THAT'S THREE OUT OF TEN PATIENTS 9387 06:18:11,400 --> 06:18:13,480 WHO DON'T RESPOND TO THIS 9388 06:18:13,480 --> 06:18:13,920 THERAPY. 9389 06:18:13,920 --> 06:18:17,640 WE ALSO CAME UP WITH THE 9390 06:18:17,640 --> 06:18:20,280 MANHATTAN PLOT THAT ILLUSTRATES 9391 06:18:20,280 --> 06:18:23,680 THE ASSOCIATION OF HITS ACROSS 9392 06:18:23,680 --> 06:18:29,240 THE GENOME AND CORRESPONDING 9393 06:18:29,240 --> 06:18:31,000 ASSOCIATIONS WITH AGGREGATION, 9394 06:18:31,000 --> 06:18:33,080 BUT PERFORMING THE GWAS ADJUSTED 9395 06:18:33,080 --> 06:18:34,760 BY COVARIATES WERE ABLE TO 9396 06:18:34,760 --> 06:18:41,400 IDENTIFY FOR THE FIRST TIME EVER 9397 06:18:41,400 --> 06:18:43,360 SOME LOCI SIGNIFICANTLY 9398 06:18:43,360 --> 06:18:45,520 ASSOCIATED WITH ACTIVITY, SOME 9399 06:18:45,520 --> 06:18:48,520 OF THEM ON CHROMOSOME 10 AS 9400 06:18:48,520 --> 06:18:51,120 SUSPECTED INCLUDING TWO HITS AT 9401 06:18:51,120 --> 06:18:54,520 G WAS SIGNIFICANCE, THERE'S A 9402 06:18:54,520 --> 06:18:57,920 CLUSTER OF SIX SNPs WHICH 9403 06:18:57,920 --> 06:18:59,320 SUGGESTED SIGNALS ON CHROMOSOME 9404 06:18:59,320 --> 06:19:04,120 10 SHOWING STRONG EVIDENCE FOR 9405 06:19:04,120 --> 06:19:05,440 NOMMAL ASSOCIATION WITH 9406 06:19:05,440 --> 06:19:06,960 CLOPIDOGREL RESPONSE. 9407 06:19:06,960 --> 06:19:09,520 WE FOUND NOVEL AFRICAN-RELATED 9408 06:19:09,520 --> 06:19:13,000 VARIANT AT CHROMOSOME X THAT 9409 06:19:13,000 --> 06:19:15,400 LEADS FOR THE VALIDATION. 9410 06:19:15,400 --> 06:19:18,240 SO WE PERFORMED A LOCAL ANCESTRY 9411 06:19:18,240 --> 06:19:22,440 ADJUSTED GWAS AND METAL ANALYSIS 9412 06:19:22,440 --> 06:19:26,160 TO BOOST POWER AND ESTIMATE 9413 06:19:26,160 --> 06:19:27,120 ANCESTRY-SPECIFIC EFFECTS. 9414 06:19:27,120 --> 06:19:29,640 INTERESTINGLY, THERE IS A 9415 06:19:29,640 --> 06:19:33,720 SIGNIFICANT SIGNAL IN CHROMOSOME 9416 06:19:33,720 --> 06:19:37,760 9 NOT SEEN BEFORE, WITH TWO 9417 06:19:37,760 --> 06:19:41,040 ENHANCER ELEMENTS, BASED ON THE 9418 06:19:41,040 --> 06:19:44,200 UCSC GENOME BROWSER INFORMATION, 9419 06:19:44,200 --> 06:19:48,600 SUMMARIZING THE SPECIFIC 9420 06:19:48,600 --> 06:19:56,160 ANCESTRY ANALYSIS OF 9421 06:19:56,160 --> 06:19:56,920 META-ANALYSIS, REPLICATED 9422 06:19:56,920 --> 06:20:00,440 SIGNIFICANT HITS FOR 9423 06:20:00,440 --> 06:20:05,360 RESPONSIVENESS IN OUR COHORT AND 9424 06:20:05,360 --> 06:20:13,560 IDENTIFIED NEW ANCESTRY-SPECIFIC 9425 06:20:13,560 --> 06:20:14,960 LOCI. 9426 06:20:14,960 --> 06:20:16,040 FINALLY, ASSOCIATION WITH 9427 06:20:16,040 --> 06:20:18,160 SNPs, ABLE TO DEVELOP 9428 06:20:18,160 --> 06:20:23,320 POLYGENIC RISK SCORE MODEL THAT 9429 06:20:23,320 --> 06:20:25,600 CORRELATED PRETTY WELL AND SHOWS 9430 06:20:25,600 --> 06:20:27,600 HIGH PREDICTIVE VALUE. 9431 06:20:27,600 --> 06:20:29,440 JUST KEEP IN MIND SHIFTING 9432 06:20:29,440 --> 06:20:32,480 ATTENTION TO THIS KIND OF 9433 06:20:32,480 --> 06:20:34,040 POLYGENIC PREDICTION MODELS MORE 9434 06:20:34,040 --> 06:20:36,520 ROBUST AND ACCURATE TO INFORM 9435 06:20:36,520 --> 06:20:39,520 ABOUT GENETIC RISK. 9436 06:20:39,520 --> 06:20:41,760 INTERESTINGLY, RESULTS WERE 9437 06:20:41,760 --> 06:20:43,200 SIGNIFICANT FOR ASSOCIATION 9438 06:20:43,200 --> 06:20:44,960 BETWEEN INCREASED NUMBER OF RISK 9439 06:20:44,960 --> 06:20:47,680 ALLELES IN THE POLYGENIC 9440 06:20:47,680 --> 06:20:51,320 RESISTANCE SCORE AND OCCURRENCE 9441 06:20:51,320 --> 06:20:52,080 OF CARDIOVASCULAR EVENTS 9442 06:20:52,080 --> 06:20:54,720 MACE, SHOWING THE ODDS OF 9443 06:20:54,720 --> 06:20:56,880 REPORTING A MACE IS EIGHT TIMES 9444 06:20:56,880 --> 06:21:02,680 MORE LIKELY TO BE EXPERIENCED IN 9445 06:21:02,680 --> 06:21:07,640 THOSE WITH AT LEAST THREE RACE 9446 06:21:07,640 --> 06:21:08,080 ALLELES. 9447 06:21:08,080 --> 06:21:10,360 POLYGENIC RISK SCORE APPROACH 9448 06:21:10,360 --> 06:21:14,760 IMPROVED PREDICTABILITY OF 9449 06:21:14,760 --> 06:21:16,520 RESPONSIVENESS HELPING WITH 9450 06:21:16,520 --> 06:21:17,160 ANTIPLATELET THERAPY IN THE 9451 06:21:17,160 --> 06:21:18,040 STUDY POPULATION. 9452 06:21:18,040 --> 06:21:21,320 WHAT WE HAVE LEARNED FROM OUR 9453 06:21:21,320 --> 06:21:23,760 STUDIES IN CARIBBEAN HISPANICS, 9454 06:21:23,760 --> 06:21:26,480 FIRST, PREDICTION POWER WILL 9455 06:21:26,480 --> 06:21:31,120 DEPENDS ON DATA FROM ALL ETHNIC 9456 06:21:31,120 --> 06:21:33,600 GROUPS REPRESENTING ETHNIC 9457 06:21:33,600 --> 06:21:33,840 DIVERSITY. 9458 06:21:33,840 --> 06:21:44,400 SECOND, HEALTH DISPARITIES COULD 9459 06:21:52,800 --> 06:21:56,080 BE EXACERBATED, RESIDUAL 9460 06:21:56,080 --> 06:21:58,240 STRATIFICATION TO REDOES BIAS. 9461 06:21:58,240 --> 06:22:01,000 GWAS IN MORE DIVERSE POPULATIONS 9462 06:22:01,000 --> 06:22:04,000 ARE NECESSARY TO REDUCE 9463 06:22:04,000 --> 06:22:05,880 INEQUITY. 9464 06:22:05,880 --> 06:22:11,840 MAXIMIZING DISCOVERY AND 9465 06:22:11,840 --> 06:22:13,480 ENHANCED GENERALIZABILITY. 9466 06:22:13,480 --> 06:22:15,960 META-ANALYSIS CAN HELP IDENTIFY 9467 06:22:15,960 --> 06:22:18,600 NEW ANCESTRY-SPECIFIC LOCI. 9468 06:22:18,600 --> 06:22:20,720 WE NEED TO DERIVE POLYGENIC RISK 9469 06:22:20,720 --> 06:22:24,160 SCORES WEIGHTED BY LOCAL 9470 06:22:24,160 --> 06:22:26,880 ANCESTRY TO OVERCOME THE 9471 06:22:26,880 --> 06:22:27,480 TRANSFERSABILITY ACROSS 9472 06:22:27,480 --> 06:22:28,960 DIFFERENT POPULATIONS. 9473 06:22:28,960 --> 06:22:30,400 CULTURAL AND ENVIRONMENTAL 9474 06:22:30,400 --> 06:22:31,960 DIFFERENCES ARE ALSO IMPORTANT, 9475 06:22:31,960 --> 06:22:37,400 IN ORDER TO MINIMIZE RISK OF 9476 06:22:37,400 --> 06:22:39,040 PHENOCONVERSIONS AND 9477 06:22:39,040 --> 06:22:40,240 GENE/DEVELOP INTERACTIONS. 9478 06:22:40,240 --> 06:22:41,680 PHENOTYPING MATTERED. 9479 06:22:41,680 --> 06:22:50,760 SO WE NEED TO PURSUE INTEGRATED 9480 06:22:50,760 --> 06:22:52,160 MULTIOMIC APPROACH AND 9481 06:22:52,160 --> 06:22:52,800 MULTI-SITE COLLABORATIVE EFFORTS 9482 06:22:52,800 --> 06:22:53,960 ARE THE KEY. 9483 06:22:53,960 --> 06:23:01,200 I WILL STOP HERE. 9484 06:23:01,200 --> 06:23:10,720 THANK YOU VERY MUCH. 9485 06:23:10,720 --> 06:23:15,840 9486 06:23:15,840 --> 06:23:16,520 >>OKAY. 9487 06:23:16,520 --> 06:23:19,800 SO, WE CAN HAVE ALL THE SPEAKERS 9488 06:23:19,800 --> 06:23:23,400 TURN ON THEIR CAMERAS, AND WE 9489 06:23:23,400 --> 06:23:29,520 CAN GET STARTED WITH THE Q&A. 9490 06:23:29,520 --> 06:23:34,120 DO YOU WANT TOP SAY SOMETHING? 9491 06:23:34,120 --> 06:23:35,960 >>NO, THAT'S JUST 9492 06:23:35,960 --> 06:23:37,160 ADMINISTRATIVE SETUP. 9493 06:23:37,160 --> 06:23:40,840 SINCE I INTRODUCED THE SESSION. 9494 06:23:40,840 --> 06:23:44,720 >>GOT IT. 9495 06:23:44,720 --> 06:23:44,920 OKAY. 9496 06:23:44,920 --> 06:23:50,840 SO, THE SPEAKERS, PLEASE TURN ON 9497 06:23:50,840 --> 06:23:53,720 YOUR CAMERAS. 9498 06:23:53,720 --> 06:23:57,080 I WANT TO INTRODUCE, I'M RINA 9499 06:23:57,080 --> 06:23:58,440 DAS, MODERATING. 9500 06:23:58,440 --> 06:24:02,040 THANK YOU FOR A GREAT 9501 06:24:02,040 --> 06:24:02,560 PRESENTATION. 9502 06:24:02,560 --> 06:24:04,440 IT'S REALLY -- I LEARNED ABOUT 9503 06:24:04,440 --> 06:24:06,960 HOW GENOMIC DATA IS IMPORTANT 9504 06:24:06,960 --> 06:24:08,720 AND GENOMIC DIVERSITY IS 9505 06:24:08,720 --> 06:24:09,560 IMPORTANT. 9506 06:24:09,560 --> 06:24:10,560 SO, FOR THIS SESSION I'D LIKE 9507 06:24:10,560 --> 06:24:12,560 THIS TO BE MORE INTERACTIVE 9508 06:24:12,560 --> 06:24:13,880 CONVERSATION, SO FEEL FREE TO 9509 06:24:13,880 --> 06:24:16,400 CHIME IN IF YOU HAVE SOMETHING 9510 06:24:16,400 --> 06:24:20,960 TO SHARE DURING THESE QUESTIONS. 9511 06:24:20,960 --> 06:24:22,600 I'LL START WITH DR. MARINO. 9512 06:24:22,600 --> 06:24:24,680 THANK YOU FOR YOUR PRESENTATION 9513 06:24:24,680 --> 06:24:30,480 ON THE GENOMIC DIVERSITY AND THE 9514 06:24:30,480 --> 06:24:32,680 CONSORTIUM, THAT LOOKS REALLY 9515 06:24:32,680 --> 06:24:33,080 IMPRESSIVE. 9516 06:24:33,080 --> 06:24:35,360 CAN YOU SHARE WHAT HAVE BEEN 9517 06:24:35,360 --> 06:24:39,560 SOME LESSONS LEARNED ABOUT 9518 06:24:39,560 --> 06:24:41,320 ESTABLISHING THIS HUGE 9519 06:24:41,320 --> 06:24:44,160 CONSORTIUM, ESPECIALLY LIKE WHAT 9520 06:24:44,160 --> 06:24:48,400 ARE THE NECESSARY THINGS IN 9521 06:24:48,400 --> 06:24:52,360 TERMS OF INFRASTRUCTURE, 9522 06:24:52,360 --> 06:24:53,360 COLLABORATION, TRAINING, ET 9523 06:24:53,360 --> 06:24:54,120 CETERA? 9524 06:24:54,120 --> 06:25:01,120 >>THANK YOU, RINA. 9525 06:25:01,120 --> 06:25:05,080 I WOULD LIKE TO SAY ONE OF THE 9526 06:25:05,080 --> 06:25:06,400 IMPORTANT THINGS THROUGHOUT THIS 9527 06:25:06,400 --> 06:25:09,920 EXPERIENCE IS TRY TO BUILD 9528 06:25:09,920 --> 06:25:11,520 TRUST. 9529 06:25:11,520 --> 06:25:13,760 TRUST IS VERY IMPORTANT BECAUSE 9530 06:25:13,760 --> 06:25:16,560 WE WANT TO DO CAPACITY BUILDING 9531 06:25:16,560 --> 06:25:22,720 IN LATIN AMERICA. 9532 06:25:22,720 --> 06:25:24,400 I THINK THAT'S IMPORTANT. 9533 06:25:24,400 --> 06:25:25,320 SOMETIMES PROJECTS INVOLVE 9534 06:25:25,320 --> 06:25:29,120 SENDING SAMPLES TO THE U.S. AND 9535 06:25:29,120 --> 06:25:31,440 PEOPLE IN LATIN AMERICA END UP 9536 06:25:31,440 --> 06:25:34,120 JUST SENDING STUFF AS OPPOSED TO 9537 06:25:34,120 --> 06:25:39,240 BUILDING THE CAPACITY THERE. 9538 06:25:39,240 --> 06:25:41,720 NOW, WHAT WE WOULD LIKE TO SEE 9539 06:25:41,720 --> 06:25:44,040 IS REALLY A LOT OF NATIONAL 9540 06:25:44,040 --> 06:25:46,160 EFFORTS, NOT ONLY IN COLOMBIA 9541 06:25:46,160 --> 06:25:48,640 BUT THROUGHOUT LATIN AMERICA, 9542 06:25:48,640 --> 06:25:52,600 WHERE WE CAN BUILD BIOBANKS, SO 9543 06:25:52,600 --> 06:25:55,200 WE'RE NOT ONLY INTERESTED IN 9544 06:25:55,200 --> 06:25:59,040 ANCESTRY BUT ALSO ALL ASPECTS OF 9545 06:25:59,040 --> 06:25:59,600 HEALTH. 9546 06:25:59,600 --> 06:26:02,360 SO, WE HAVE A REALLY NICE EFFORT 9547 06:26:02,360 --> 06:26:05,400 HERE, IN THE U.S., THE "ALL OF 9548 06:26:05,400 --> 06:26:07,920 US" PROGRAM. 9549 06:26:07,920 --> 06:26:11,040 WE ALSO HAVE THE GOLD STANDARD 9550 06:26:11,040 --> 06:26:15,360 FOR BIOBANKS, THE U.K. BIOBANK. 9551 06:26:15,360 --> 06:26:20,600 SO WE WOULD LIKE TO CREATE OR 9552 06:26:20,600 --> 06:26:22,560 TRY TO HELP PEOPLE EITHER LOCAL 9553 06:26:22,560 --> 06:26:27,400 GOVERNMENTS OR THE U.S. TO HELP 9554 06:26:27,400 --> 06:26:29,720 FUND THESE TYPE OF ACTIVITIES. 9555 06:26:29,720 --> 06:26:31,640 SO BUILDING TRUST IS ONE 9556 06:26:31,640 --> 06:26:33,120 IMPORTANT THING, BUT ALSO 9557 06:26:33,120 --> 06:26:35,760 ANOTHER THAT IS IMPORTANT IS TRY 9558 06:26:35,760 --> 06:26:37,920 TO ORGANIZE PEOPLE, RIGHT? 9559 06:26:37,920 --> 06:26:43,680 AND THAT'S HARD IN LATIN 9560 06:26:43,680 --> 06:26:43,880 AMERICA. 9561 06:26:43,880 --> 06:26:45,160 IT'S HARD TO PUT EVERYBODY ON 9562 06:26:45,160 --> 06:26:49,120 THE SAME PAGE. 9563 06:26:49,120 --> 06:26:50,720 SO, BUT THAT'S WHAT WE ARE 9564 06:26:50,720 --> 06:26:58,840 TRYING TO DO WITH THIS PROJECT, 9565 06:26:58,840 --> 06:26:59,160 WITH CODIGO. 9566 06:26:59,160 --> 06:27:00,920 >>THANK YOU SO MUCH. 9567 06:27:00,920 --> 06:27:03,440 THAT WAS REALLY VERY THOUGHTFUL. 9568 06:27:03,440 --> 06:27:07,440 I KNOW ALL THE OTHER SPEAKERS 9569 06:27:07,440 --> 06:27:10,600 HAVE EXPERIENCE IN BUILDING 9570 06:27:10,600 --> 06:27:12,080 THESE CONSORTIUMS, AND FEEL FREE 9571 06:27:12,080 --> 06:27:20,320 TO JUMP IN IF YOU HAVE ANYTHING 9572 06:27:20,320 --> 06:27:30,840 ELSE TO ADD TO THIS DR. DR. 9573 06:27:32,000 --> 06:27:34,880 LOPERA, THANK YOU. 9574 06:27:34,880 --> 06:27:36,800 ARE THERE CLINICAL SIGNS OR 9575 06:27:36,800 --> 06:27:39,960 SYMPTOMS OF MCI, IN EARLY 9576 06:27:39,960 --> 06:27:41,840 DEMENTIA YOU SHOWED PRE-CLINICAL 9577 06:27:41,840 --> 06:27:44,040 AND CLINICAL PHASE, CAN YOU TELL 9578 06:27:44,040 --> 06:27:49,520 WHO IS GOING TO VERY MANY 9579 06:27:49,520 --> 06:27:51,680 DEMENTIA LATER IN LIFE. 9580 06:27:51,680 --> 06:27:56,160 >>THANK YOU, RINA, FOR THE 9581 06:27:56,160 --> 06:28:00,120 OPPORTUNITY TO SHARE THIS TOPIC 9582 06:28:00,120 --> 06:28:01,320 WITH YOU. 9583 06:28:01,320 --> 06:28:09,840 THE SYMPTOMS AND SIGNS OF MCI IN 9584 06:28:09,840 --> 06:28:13,480 EARLY ONSET DEMENTIA COMES BY 9585 06:28:13,480 --> 06:28:16,960 GENES OF CAUSALITY, VERY SIMILAR 9586 06:28:16,960 --> 06:28:22,480 TO THE SYMPTOMS AND SIGNS IN 9587 06:28:22,480 --> 06:28:25,680 IMPAIRMENT IN LATE ONSET IN 9588 06:28:25,680 --> 06:28:29,520 SPORADIC DISEASE, THE DIFFERENCE 9589 06:28:29,520 --> 06:28:39,000 IS ONLY SINCE THE SYMPTOMS ARE 9590 06:28:39,000 --> 06:28:44,560 (INDISCERNIBLE) IN GENERAL THE 9591 06:28:44,560 --> 06:28:46,600 PRINCIPAL SYMPTOMS ARE MEMORY 9592 06:28:46,600 --> 06:28:50,120 LOSS, RECENT MEMORY, THE SAME IN 9593 06:28:50,120 --> 06:28:51,640 LATE AND EARLY ONSET. 9594 06:28:51,640 --> 06:28:56,160 AND THERE ARE MORE OR LESS 10% 9595 06:28:56,160 --> 06:28:58,640 OF THE MEMBERS OF THE FAMILY 9596 06:28:58,640 --> 06:29:01,120 WITH EARLY ONSET ALZHEIMER'S 9597 06:29:01,120 --> 06:29:04,720 DISEASE, WHO START NOT WITH 9598 06:29:04,720 --> 06:29:11,200 MEMORY PROBLEMS BUT WITH OTHER 9599 06:29:11,200 --> 06:29:14,080 TYPICAL SIGNS OR SYMPTOMS, 9600 06:29:14,080 --> 06:29:16,120 PARKINSON, BEHAVIORAL SYMPTOMS, 9601 06:29:16,120 --> 06:29:21,960 BUT IN GENERAL MOST OF THEM HAVE 9602 06:29:21,960 --> 06:29:25,040 MEMORY LOSS, AS OCCURS IN LATE 9603 06:29:25,040 --> 06:29:26,680 ONSET ALZHEIMER'S DISEASE. 9604 06:29:26,680 --> 06:29:29,040 >>THANK YOU. 9605 06:29:29,040 --> 06:29:31,680 THANK YOU. 9606 06:29:31,680 --> 06:29:35,720 I THINK YOUR TALK ON THE 9607 06:29:35,720 --> 06:29:36,720 RESISTANCE TO ALZHEIMER'S WAS 9608 06:29:36,720 --> 06:29:39,560 VERY INTERESTING, THAT DATA THAT 9609 06:29:39,560 --> 06:29:43,920 YOU PRESENTED, SO HOW DOES THIS 9610 06:29:43,920 --> 06:29:44,440 RESISTANCE TO ALZHEIMER'S 9611 06:29:44,440 --> 06:29:49,600 MANIFEST WHEN YOU HAVE THE RISK 9612 06:29:49,600 --> 06:29:53,600 GENOTYPE? 9613 06:29:53,600 --> 06:29:54,520 >>THE RESISTANCE FOR 9614 06:29:54,520 --> 06:29:59,840 ALZHEIMER'S, WE NEED TO LOOK 9615 06:29:59,840 --> 06:30:02,680 THAT IN PEOPLE WHO HAVE FAMILIAL 9616 06:30:02,680 --> 06:30:13,200 FORM OF EARLY ONSET ALZHEIMER'S 9617 06:30:15,920 --> 06:30:17,800 DISEASE WITH AUTOSOMAL EVENTS, 9618 06:30:17,800 --> 06:30:22,040 SYMPTOMS VERY LATE, HAVING GENE 9619 06:30:22,040 --> 06:30:25,160 OF CAUSALITY IN THE FAMILIES. 9620 06:30:25,160 --> 06:30:29,280 THEN THE KEY IS TO LOOK FOR 9621 06:30:29,280 --> 06:30:34,240 PEOPLE WHO START SYMPTOMS VERY 9622 06:30:34,240 --> 06:30:40,680 LATE, OR PEOPLE WHO DEVELOP, WHO 9623 06:30:40,680 --> 06:30:43,960 DON'T DEVELOP THE SYMPTOMS, EVEN 9624 06:30:43,960 --> 06:30:46,920 IN LATE WHEN THEY ARE VERY 9625 06:30:46,920 --> 06:30:52,080 AGING, THE DISEASE MOST 9626 06:30:52,080 --> 06:30:54,480 IMPORTANT KEY TO DISCOVER PEOPLE 9627 06:30:54,480 --> 06:30:56,600 WITH RESISTANCE TO ALZHEIMER'S 9628 06:30:56,600 --> 06:30:57,600 DISEASE. 9629 06:30:57,600 --> 06:30:58,600 >>THANK YOU. 9630 06:30:58,600 --> 06:31:00,200 THANK YOU. 9631 06:31:00,200 --> 06:31:03,800 I'LL COME BACK TO YOU AGAIN, LET 9632 06:31:03,800 --> 06:31:06,200 ME MOVE ON TO DR. AGUILAR 9633 06:31:06,200 --> 06:31:07,160 SALINAS. 9634 06:31:07,160 --> 06:31:09,280 THANK YOU FOR YOUR PRESENTATION 9635 06:31:09,280 --> 06:31:13,520 ON THE GENOMICS OF DIABETES 9636 06:31:13,520 --> 06:31:16,840 AMONGST MEXICANS. 9637 06:31:16,840 --> 06:31:18,480 CLINICAL CHARACTERIZATION OF 9638 06:31:18,480 --> 06:31:21,960 THIS DATA DRIVEN SUBGROUPS THAT 9639 06:31:21,960 --> 06:31:23,840 YOU'VE IDENTIFIED IN MEXICO, WAS 9640 06:31:23,840 --> 06:31:27,360 THAT BASED ON LIKE A 9641 06:31:27,360 --> 06:31:29,400 CROSS-SECTIONAL SURVEY OR DO YOU 9642 06:31:29,400 --> 06:31:31,840 HAVE ANY LONGITUDINAL CLINICAL 9643 06:31:31,840 --> 06:31:32,600 DATA? 9644 06:31:32,600 --> 06:31:35,760 >>THANK YOU FOR THE QUESTION. 9645 06:31:35,760 --> 06:31:42,080 I EXPRESS MY GRATITUDE, TO YOU, 9646 06:31:42,080 --> 06:31:47,120 FOR LETTING ME COUNSEL ON THIS 9647 06:31:47,120 --> 06:31:51,120 TOPIC IN THE SEMINAR. 9648 06:31:51,120 --> 06:31:52,400 PHENOTYPES USING CROSS-SECTIONAL 9649 06:31:52,400 --> 06:31:59,080 DATA, ALSO VALIDATED IN A 9650 06:31:59,080 --> 06:32:01,600 POPULATION-BASED NATIONWIDE 9651 06:32:01,600 --> 06:32:04,880 SURVEY AND LONGITUDINAL 9652 06:32:04,880 --> 06:32:08,600 FOLLOW-UP OF INDIVIDUALS IN 9653 06:32:08,600 --> 06:32:12,000 WHICH 300 OF THEM DEVELOPED 9654 06:32:12,000 --> 06:32:16,360 INCIDENT DIABETES, THESE 9655 06:32:16,360 --> 06:32:19,240 CLUSTERS NOT ONLY FOR THE 9656 06:32:19,240 --> 06:32:21,200 IDENTIFICATION OF RISK FOR THE 9657 06:32:21,200 --> 06:32:26,960 CLINICAL COURSE OF THE DISEASE, 9658 06:32:26,960 --> 06:32:28,840 PREVIOUS PHENOTYPES THAT ARE 9659 06:32:28,840 --> 06:32:33,440 ASSOCIATED WITH METABOLIC 9660 06:32:33,440 --> 06:32:35,880 DISORDERS AND EVOLUTION OF TYPE 9661 06:32:35,880 --> 06:32:45,400 2 DIABETES. 9662 06:32:45,400 --> 06:32:45,920 >>OKAY. 9663 06:32:45,920 --> 06:32:51,600 I HAVE ANOTHER QUESTION IN TERMS 9664 06:32:51,600 --> 06:32:53,800 OF HOW THESE SUBPHENOTYPE DATA 9665 06:32:53,800 --> 06:32:56,880 THAT CAN BE USED FOR PRECISION 9666 06:32:56,880 --> 06:32:58,320 MEDICINE AND IN CLINICAL 9667 06:32:58,320 --> 06:33:00,200 PRACTICE, CAN YOU SHARE YOUR 9668 06:33:00,200 --> 06:33:03,200 THOUGHTS ON THAT? 9669 06:33:03,200 --> 06:33:06,960 >>YES, WE DO THINK IT'S MORE -- 9670 06:33:06,960 --> 06:33:11,200 IN WHICH CLINICAL DATA ARE 9671 06:33:11,200 --> 06:33:14,480 INCLUDED AND THEY PROVIDE WHICH 9672 06:33:14,480 --> 06:33:17,360 PHENOTYPES IS PREVALENT FORM IN 9673 06:33:17,360 --> 06:33:19,240 INDIVIDUAL CASES. 9674 06:33:19,240 --> 06:33:21,440 SINCE GENOMICS ARE STILL 9675 06:33:21,440 --> 06:33:24,600 DIFFICULT TO TRANSLATE IN 9676 06:33:24,600 --> 06:33:28,960 CLINICAL PRACTICE, WE USE MAINLY 9677 06:33:28,960 --> 06:33:31,800 CLINICAL DATA, AND WE'RE NOW 9678 06:33:31,800 --> 06:33:35,320 WORKING TO ADD THE GENOMIC 9679 06:33:35,320 --> 06:33:38,800 INFORMATION TO THIS CLINICAL AND 9680 06:33:38,800 --> 06:33:43,000 BIOCHEMICAL DATA TO HAVE A VERY 9681 06:33:43,000 --> 06:33:46,400 PRECISION, ESPECIALLY FOR THE 9682 06:33:46,400 --> 06:33:50,960 CHRONIC INDICATIONS, NOW THE 9683 06:33:50,960 --> 06:34:00,160 GENOMIC DATA HAS BEEN IDENTIFIED 9684 06:34:00,160 --> 06:34:01,120 (INDISCERNIBLE) THE PHYSIOLOGIC 9685 06:34:01,120 --> 06:34:04,360 TYPE 2 DIABETES, TO TRANSCEND IN 9686 06:34:04,360 --> 06:34:07,560 CLINICAL PRACTICE, NEED TO USE 9687 06:34:07,560 --> 06:34:11,560 ALL THE AVAILABLE INFORMATION, 9688 06:34:11,560 --> 06:34:14,960 GENOMIC, CLINICAL, AND 9689 06:34:14,960 --> 06:34:17,240 ELECTRONIC MEDICAL RECORDS, TO 9690 06:34:17,240 --> 06:34:20,840 IMPROVE THE CARE OF DIABETIC 9691 06:34:20,840 --> 06:34:21,760 PATIENTS IN MEXICO. 9692 06:34:21,760 --> 06:34:24,480 >>THANK YOU. 9693 06:34:24,480 --> 06:34:29,840 THANK YOU FOR SHARING YOUR 9694 06:34:29,840 --> 06:34:30,280 THOUGHTS. 9695 06:34:30,280 --> 06:34:34,120 LET ME MOVE TO DR. FEJERMAN. 9696 06:34:34,120 --> 06:34:37,720 VERY INTERESTING DATA ON THIS 9697 06:34:37,720 --> 06:34:38,440 AMERICAN INDIAN ANCESTRY 9698 06:34:38,440 --> 06:34:39,760 MARKERS, AND HOW THEY ARE 9699 06:34:39,760 --> 06:34:42,960 ASSOCIATED WITH LOWER RISK OF 9700 06:34:42,960 --> 06:34:45,360 BREAST CANCER, SO ARE THESE 9701 06:34:45,360 --> 06:34:48,760 AMERICAN INDIAN ANCESTRY MARKERS 9702 06:34:48,760 --> 06:34:51,280 ASSOCIATED WITH SPECIFIC BREAST 9703 06:34:51,280 --> 06:34:52,720 CANCER PATHOLOGY OR CLINICAL 9704 06:34:52,720 --> 06:34:54,120 MANIFESTATION OF THE DISEASE? 9705 06:34:54,120 --> 06:34:56,000 CAN YOU COMMENT ON THAT? 9706 06:34:56,000 --> 06:34:57,200 >>YES, OF COURSE. 9707 06:34:57,200 --> 06:35:02,560 THANK YOU VERY MUCH FOR HAVING 9708 06:35:02,560 --> 06:35:03,760 ME HERE TODAY. 9709 06:35:03,760 --> 06:35:05,280 WE ONLY HAVE TEN MINUTES SO I 9710 06:35:05,280 --> 06:35:09,880 CUT OFF A LOT OF THE INFORMATION 9711 06:35:09,880 --> 06:35:11,920 BUT YES, LOOKING, PUBLISHED 9712 06:35:11,920 --> 06:35:17,080 RECENTLY A PAPER, LOOKED AT 9713 06:35:17,080 --> 06:35:20,720 ASSOCIATION OF THE POLYMORPHISM 9714 06:35:20,720 --> 06:35:22,960 PARTICULAR TO SUBTYPES AND WE 9715 06:35:22,960 --> 06:35:25,200 CONSISTENTLY SEE YOU'RE LESS 9716 06:35:25,200 --> 06:35:27,000 LIKELY TO DEVELOP BREAST CANCER 9717 06:35:27,000 --> 06:35:28,400 IF HAVE YOU POLYMORPHISM, IF YOU 9718 06:35:28,400 --> 06:35:34,440 HAVE IT, IT'S MORE LIKELY YOU'LL 9719 06:35:34,440 --> 06:35:38,760 HAVE ESTROGEN RECEPTOR TUMORS, 9720 06:35:38,760 --> 06:35:40,720 MEANING MOSTLY YOU'RE PROTECTED, 9721 06:35:40,720 --> 06:35:47,160 LOOKS LIKE YOU'RE PROTECTED FROM 9722 06:35:47,160 --> 06:35:49,640 DEVELOPING HER-2 POSITIVE 9723 06:35:49,640 --> 06:35:57,080 DISEASE. 9724 06:35:57,080 --> 06:35:58,080 9725 06:35:58,080 --> 06:35:58,360 >>WOW. 9726 06:35:58,360 --> 06:35:59,520 SO, SNPs ASSOCIATED WITH 9727 06:35:59,520 --> 06:36:03,640 BREAST CANCER IN LATIN AMERICAN 9728 06:36:03,640 --> 06:36:05,440 WOMAN HAVE THEY BEEN DESCRIBED 9729 06:36:05,440 --> 06:36:06,840 IN EUROPEAN COHORTS? 9730 06:36:06,840 --> 06:36:08,760 >>NO, I'M PREACHING TO THE 9731 06:36:08,760 --> 06:36:10,760 CHOIR HERE BUT THIS IS WHAT 9732 06:36:10,760 --> 06:36:13,280 WE'VE BEEN SAYING FOR MANY, MANY 9733 06:36:13,280 --> 06:36:18,280 YEARS, IS WE COULD HAVE NOT 9734 06:36:18,280 --> 06:36:19,120 DISCOVERED POLYMORPHISMS, 9735 06:36:19,120 --> 06:36:20,560 FINDING THE SAME REGION, YOU 9736 06:36:20,560 --> 06:36:26,360 KNOW, DOING THESE RIGHT NOW, 9737 06:36:26,360 --> 06:36:28,320 FINDING OUR POLYMORPHISMS, 6Q25, 9738 06:36:28,320 --> 06:36:33,680 ONLY SEEN IN LATINAS WITH 9739 06:36:33,680 --> 06:36:35,040 INDIGENOUS ANCESTRY, FREQUENCY 9740 06:36:35,040 --> 06:36:37,320 IN THE SAMPLES WE LOOKED SO FAR 9741 06:36:37,320 --> 06:36:39,960 FROM EUROPEAN AND AFRICAN 9742 06:36:39,960 --> 06:36:41,120 ANCESTRY, THE PROTECTIVE 9743 06:36:41,120 --> 06:36:44,320 POLYMORPHISM IS PRESENT AT A 9744 06:36:44,320 --> 06:36:47,600 VERY LOW FREQUENCY IN CHINESE, 9745 06:36:47,600 --> 06:36:49,400 IN SOME ASIAN SUBGROUPS, AND IT 9746 06:36:49,400 --> 06:36:54,640 MAKES TOTAL SENSE IF YOU THINK 9747 06:36:54,640 --> 06:36:57,680 ABOUT A WAY AMERICAS WERE 9748 06:36:57,680 --> 06:36:58,960 POPULATED, PROBABLY ANCIENT 9749 06:36:58,960 --> 06:37:00,840 SOURCE POPULATION THAT MIGRATES 9750 06:37:00,840 --> 06:37:03,600 THROUGH THE STRAIT INTO THE 9751 06:37:03,600 --> 06:37:05,560 AMERICAS BRINGING THIS VARIANT 9752 06:37:05,560 --> 06:37:09,520 AND THEN MAYBE BY CHANCE OR WE 9753 06:37:09,520 --> 06:37:12,200 DON'T KNOW YET WHY BUT 9754 06:37:12,200 --> 06:37:19,560 INCREASING FREQUENCY ONCE IN THE 9755 06:37:19,560 --> 06:37:20,480 LATINA AMERICAN CONTINENT. 9756 06:37:20,480 --> 06:37:23,760 >>ANY OTHER COMMENTS ON THIS 9757 06:37:23,760 --> 06:37:27,960 TOPIC, HOW IMPORTANT IT IS TO 9758 06:37:27,960 --> 06:37:33,160 HAVE THESE UNIQUE POPULATION 9759 06:37:33,160 --> 06:37:34,200 COHORT STUDIES, ANY OTHER 9760 06:37:34,200 --> 06:37:34,520 THOUGHTS? 9761 06:37:34,520 --> 06:37:38,520 BECAUSE I KNOW MOST OF OUR 9762 06:37:38,520 --> 06:37:43,160 GENETIC DATA IS BASED ON DATA 9763 06:37:43,160 --> 06:37:44,160 FROM EUROPEAN AMERICAN 9764 06:37:44,160 --> 06:37:48,720 POPULATION, AND WE WOULD MISS 9765 06:37:48,720 --> 06:37:51,600 SOME OF THESE RICH INFORMATION. 9766 06:37:51,600 --> 06:37:55,000 ANY THOUGHTS ON HOW IMPORTANT 9767 06:37:55,000 --> 06:38:02,880 THIS KIND OF STUDY IS? 9768 06:38:02,880 --> 06:38:08,200 >>I THINK THAT IT'S VERY 9769 06:38:08,200 --> 06:38:12,960 IMPORTANT TO HIGHLIGHT THE WAY 9770 06:38:12,960 --> 06:38:14,920 LATIN AMERICA WILL ENRICH THE 9771 06:38:14,920 --> 06:38:18,840 EFFORTS TO REPRESENT THE 9772 06:38:18,840 --> 06:38:21,600 VARIABILITY WITH THE DISORDERS, 9773 06:38:21,600 --> 06:38:27,280 THE MOST RECENT GWAS, MORE 9774 06:38:27,280 --> 06:38:27,920 FINDINGS IN UNREPRESENTED GROUPS 9775 06:38:27,920 --> 06:38:33,840 RATHER THAN GROUPS IN THE NORMAL 9776 06:38:33,840 --> 06:38:34,080 SAMPLES. 9777 06:38:34,080 --> 06:38:39,600 SO, TO WORK TOGETHER WITH 9778 06:38:39,600 --> 06:38:41,720 INTERNATIONAL CONSORTIA IS NOT 9779 06:38:41,720 --> 06:38:44,000 JUST CHIPPING, IT'S TO PROVIDE 9780 06:38:44,000 --> 06:38:47,720 IDEAS TO USE THE CLINICAL DATA 9781 06:38:47,720 --> 06:38:50,600 THAT WE HAVE TO INTERPOLATE 9782 06:38:50,600 --> 06:38:55,720 GENETIC AND ADDED VALUE OF OUR 9783 06:38:55,720 --> 06:39:00,640 POPULATIONS FOR THE WHOLE GLOBAL 9784 06:39:00,640 --> 06:39:01,480 CONSORTIA. 9785 06:39:01,480 --> 06:39:04,640 >>THANK YOU. 9786 06:39:04,640 --> 06:39:07,200 DR. MARINO? 9787 06:39:07,200 --> 06:39:10,960 9788 06:39:10,960 --> 06:39:12,200 YOU ARE ON MUTE. 9789 06:39:12,200 --> 06:39:14,560 >>I'M SORRY. 9790 06:39:14,560 --> 06:39:22,320 YEAH, I WAS SAYING, THANK YOU, 9791 06:39:22,320 --> 06:39:23,760 FOR YOUR TALK, SHE PRESENTED 9792 06:39:23,760 --> 06:39:25,040 SOMETHING EVER GREAT IMPORTANCE, 9793 06:39:25,040 --> 06:39:28,880 THAT IS WHY SHOULD WE AS NIH 9794 06:39:28,880 --> 06:39:31,600 SUPPORT RESEARCH IN LATIN 9795 06:39:31,600 --> 06:39:32,080 AMERICA? 9796 06:39:32,080 --> 06:39:34,560 RIGHT? WE HAVE A CLEAR EXAMPLE 9797 06:39:34,560 --> 06:39:37,120 FOR WHY WE SHOULD DO THAT. 9798 06:39:37,120 --> 06:39:39,520 THAT WAS PRESENTED BY LAURA. 9799 06:39:39,520 --> 06:39:43,440 THAT IS WE NEED TO UNDERSTAND 9800 06:39:43,440 --> 06:39:46,040 THE GENETIC VARIATION THAT IS 9801 06:39:46,040 --> 06:39:49,800 PRESENT IN LATINOS, THAT CAN 9802 06:39:49,800 --> 06:39:52,080 BENEFIT LATINOS IN LATIN AMERICA 9803 06:39:52,080 --> 06:39:54,640 BUT ALSO IN THE U.S. AND ALSO 9804 06:39:54,640 --> 06:39:56,040 PEOPLE FROM EUROPEAN ANCESTRY, 9805 06:39:56,040 --> 06:39:57,680 RIGHT? 9806 06:39:57,680 --> 06:40:01,720 WE HAVE SOME PROTECTIVE ALLELES 9807 06:40:01,720 --> 06:40:05,000 THAT MAY EXPLAIN WHY WE HAVE 9808 06:40:05,000 --> 06:40:07,200 LET'S SAY BETTER HEALTH OUTCOMES 9809 06:40:07,200 --> 06:40:09,080 IN THE END. 9810 06:40:09,080 --> 06:40:12,760 ANOTHER POINT THAT IS IMPORTANT 9811 06:40:12,760 --> 06:40:14,280 TO CONSIDER IS PHARMACOGENOMICS 9812 06:40:14,280 --> 06:40:17,720 PART, AND THIS IS RELATED TO 9813 06:40:17,720 --> 06:40:20,880 CLINICAL TRIALS, SO I WAS 9814 06:40:20,880 --> 06:40:22,320 WONDERING IF OTHERS HAVE 9815 06:40:22,320 --> 06:40:32,840 COMMENTS ON THIS. 9816 06:40:32,840 --> 06:40:34,480 >>MAYBE WE CAN COME BACK. 9817 06:40:34,480 --> 06:40:37,240 LAURA, DID YOU WANT TO ADD 9818 06:40:37,240 --> 06:40:38,960 ANYTHING TO THIS COMMENT, 9819 06:40:38,960 --> 06:40:39,360 QUESTION? 9820 06:40:39,360 --> 06:40:43,880 >>YEAH, I JUST WANTED TO 9821 06:40:43,880 --> 06:40:45,400 COMPLIMENT WHAT EVERYONE SAID, 9822 06:40:45,400 --> 06:40:49,360 MAYBE HIGHLIGHT THE FACT THAT 9823 06:40:49,360 --> 06:40:52,320 WORKING WITH DIVERSE, ESPECIALLY 9824 06:40:52,320 --> 06:40:54,200 LATIN AMERICANS IS SO RICH IN 9825 06:40:54,200 --> 06:40:55,800 TERMS OF ANCESTRIES. 9826 06:40:55,800 --> 06:40:58,880 WE DON'T KNOW AT THIS POINT, WE 9827 06:40:58,880 --> 06:41:01,640 DON'T KNOW THE EXTENT OF WHAT 9828 06:41:01,640 --> 06:41:02,960 ARE DIFFERENCE OR SIMILARITIES 9829 06:41:02,960 --> 06:41:04,600 WITH OTHER GROUPS BECAUSE WE 9830 06:41:04,600 --> 06:41:07,080 HAVEN'T HAD THE CHANCE AND THE 9831 06:41:07,080 --> 06:41:09,720 LARGE SAMPLE SIZES TO REALLY SEE 9832 06:41:09,720 --> 06:41:10,720 HOW COMPARABLE AND DIFFERENT 9833 06:41:10,720 --> 06:41:11,600 THINGS ARE. 9834 06:41:11,600 --> 06:41:15,120 FOR BREAST CANCER AND OTHER 9835 06:41:15,120 --> 06:41:16,080 DISEASES. 9836 06:41:16,080 --> 06:41:18,840 AND I THINK SOMETIMES PEOPLE, 9837 06:41:18,840 --> 06:41:21,280 WHENEVER WE SHOW THAT EITHER 9838 06:41:21,280 --> 06:41:22,440 THERE'S A BENEFICIAL EFFECT OR 9839 06:41:22,440 --> 06:41:25,080 SIMILAR TO WHAT YOU SEE IN THE 9840 06:41:25,080 --> 06:41:26,160 EUROPEAN STUDIES, PEOPLE USE 9841 06:41:26,160 --> 06:41:30,560 THAT AS THE REASON FOR NOT 9842 06:41:30,560 --> 06:41:31,200 INVESTING DIVERSITY DATASETS, 9843 06:41:31,200 --> 06:41:33,880 AND I THINK THAT'S A MISTAKE. 9844 06:41:33,880 --> 06:41:36,120 I THINK WE DON'T KNOW YET 9845 06:41:36,120 --> 06:41:37,840 BECAUSE WE DON'T HAVE THE RIGHT 9846 06:41:37,840 --> 06:41:39,720 SAMPLE SIZE AND SECOND AT LEAST 9847 06:41:39,720 --> 06:41:44,120 WE KNOW THERE ARE SOME 9848 06:41:44,120 --> 06:41:45,760 DIFFERENCE, EVEN IF WE COULDN'T 9849 06:41:45,760 --> 06:41:47,760 FIND MANY BECAUSE OF LIMITATIONS 9850 06:41:47,760 --> 06:41:48,640 IN POWER. 9851 06:41:48,640 --> 06:41:51,320 YEAH, THAT I WANTED TO MAKE THAT 9852 06:41:51,320 --> 06:41:51,520 POINT. 9853 06:41:51,520 --> 06:41:56,960 >>THANK YOU. 9854 06:41:56,960 --> 06:42:00,880 DR. DUCONGE, DO YOU WANT TO ADD 9855 06:42:00,880 --> 06:42:01,520 ANYTHING? 9856 06:42:01,520 --> 06:42:06,600 >>QUICKLY, OUT OF CURIOSITY, I 9857 06:42:06,600 --> 06:42:08,800 WANT TO KNOW OUR OPINION ABOUT 9858 06:42:08,800 --> 06:42:13,520 NATIVE AMERICAN ANCESTRY MARKER 9859 06:42:13,520 --> 06:42:16,120 BECAUSE IN MY EXPERIENCE, IT'S 9860 06:42:16,120 --> 06:42:18,200 HARD TO FIND MARKERS, ANCESTRY 9861 06:42:18,200 --> 06:42:22,120 MARKERS, THAT CAN CAPTURE THE 9862 06:42:22,120 --> 06:42:24,520 NATIVE AMERICAN COMPONENT SO I 9863 06:42:24,520 --> 06:42:28,720 JUST WANT TO KNOW IF SHE HAS ANY 9864 06:42:28,720 --> 06:42:31,160 RECOMMENDATION BECAUSE I SAW IN 9865 06:42:31,160 --> 06:42:37,440 HER PRESENTATION THAT NATIVE 9866 06:42:37,440 --> 06:42:40,960 AMERICAN COMPONENTS ANCESTRY 9867 06:42:40,960 --> 06:42:42,200 COMBINES, RELEVANT FOR RISK 9868 06:42:42,200 --> 06:42:43,840 SCORE SHE DEVELOPED. 9869 06:42:43,840 --> 06:42:46,920 >>YEAH, IF YOU TAKE ANY 9870 06:42:46,920 --> 06:42:48,080 POPULATION FROM LATIN AMERICA, 9871 06:42:48,080 --> 06:42:51,640 WE MAKE SURE AND YOU HAVE 9872 06:42:51,640 --> 06:42:57,040 GENOME-WIDE DATA, NOW 9873 06:42:57,040 --> 06:42:59,320 SEQUENCING DATA, CAN YOU FIND A 9874 06:42:59,320 --> 06:43:01,400 LOT OF UNIQUE POLYMORPHISMS ONLY 9875 06:43:01,400 --> 06:43:03,280 SEEN IN THE INDIGENOUS AMERICAN 9876 06:43:03,280 --> 06:43:03,960 COMPONENT. 9877 06:43:03,960 --> 06:43:05,520 YOU KNOW, YOU CAN CHOOSE TO ONLY 9878 06:43:05,520 --> 06:43:07,360 LOOK AT THOSE IN ASSOCIATION 9879 06:43:07,360 --> 06:43:11,200 WITH DISEASE, I DON'T THINK WE 9880 06:43:11,200 --> 06:43:13,200 NEED TO DO THAT. 9881 06:43:13,200 --> 06:43:14,760 I THINK THOSE ASSOCIATIONS WILL 9882 06:43:14,760 --> 06:43:17,600 COME UP EVEN IF YOU DO ANALYSIS 9883 06:43:17,600 --> 06:43:19,280 INCLUDING ALL POLYMORPHISMS, 9884 06:43:19,280 --> 06:43:20,240 SOME ARE DRAMATICALLY DIFFERENT 9885 06:43:20,240 --> 06:43:24,200 LIKE THE ONE WE FOUND FOR BREAST 9886 06:43:24,200 --> 06:43:25,480 CANCER, BUT THERE'S OTHER 9887 06:43:25,480 --> 06:43:27,360 POLYMORPHISMS THAT MIGHT BE JUST 9888 06:43:27,360 --> 06:43:29,240 THE DIFFERENCE IN ALLELE 9889 06:43:29,240 --> 06:43:32,160 FREQUENCY BUT THAT MIGHT MAKE A 9890 06:43:32,160 --> 06:43:34,600 DIFFERENCE IN THE PRS OR OTHER 9891 06:43:34,600 --> 06:43:43,240 CLINICAL USE OF THIS 9892 06:43:43,240 --> 06:43:44,440 INFORMATION. 9893 06:43:44,440 --> 06:43:44,800 >>THANK YOU. 9894 06:43:44,800 --> 06:43:49,840 >>WE HAVE DEVELOPED A PANEL OF 9895 06:43:49,840 --> 06:43:51,440 102 MARKERS THAT SEPARATE THE 9896 06:43:51,440 --> 06:43:53,440 NATIVE AMERICAN COMPONENT IN 9897 06:43:53,440 --> 06:43:57,680 MEXICANS FROM THE OTHER ETHNIC 9898 06:43:57,680 --> 06:44:03,600 GROUPS, AND IT'S CRITICAL TO 9899 06:44:03,600 --> 06:44:07,560 CONTROL VARIABILITY, 9900 06:44:07,560 --> 06:44:09,120 MULTIVARIATE ANALYSIS, AND THE 9901 06:44:09,120 --> 06:44:14,240 SAME WE FOUND IN OUR DIABETES 9902 06:44:14,240 --> 06:44:17,080 HAPLOTYPE, THE FREQUENCY OF THIS 9903 06:44:17,080 --> 06:44:18,720 HAPLOTYPE IS COMPLETELY ABSENT 9904 06:44:18,720 --> 06:44:20,440 IN BLACKS. 9905 06:44:20,440 --> 06:44:28,240 IT'S ONLY ABOUT 1% IN EUROPEANS, 9906 06:44:28,240 --> 06:44:29,520 ONLY 5%. 9907 06:44:29,520 --> 06:44:32,920 AND THE SAME HAPPENS FOR THE 9908 06:44:32,920 --> 06:44:33,160 OTHERS. 9909 06:44:33,160 --> 06:44:38,400 ONE IS A MAJOR CAUSE OF LOWER 9910 06:44:38,400 --> 06:44:40,480 SERUM CHOLESTEROL, THE NUMBERS 9911 06:44:40,480 --> 06:44:43,440 OF METABOLIC DISORDERS IS LARGE 9912 06:44:43,440 --> 06:44:49,200 ENOUGH TO ANSWER THE QUESTIONS, 9913 06:44:49,200 --> 06:44:53,040 FOR EXAMPLE, ADDING NATIVE 9914 06:44:53,040 --> 06:44:57,760 AMERICAN COMPONENT, POLYGENIC 9915 06:44:57,760 --> 06:44:59,840 RISK SCORE, PREDICTIVE VALUE, 9916 06:44:59,840 --> 06:45:06,880 THE BEST WAY IS TO GROUP ALL THE 9917 06:45:06,880 --> 06:45:12,400 ETHNIC VARIABLES, TO THE 9918 06:45:12,400 --> 06:45:13,720 PROGNOSIS OR DIAGNOSIS IN THE 9919 06:45:13,720 --> 06:45:19,320 INFORMATION THAT WE HAVE 9920 06:45:19,320 --> 06:45:20,080 ALREADY. 9921 06:45:20,080 --> 06:45:21,400 >>THANK YOU. 9922 06:45:21,400 --> 06:45:22,720 DR. FEJERMAN, A QUICK COMMENT 9923 06:45:22,720 --> 06:45:26,320 AND WE WANT TO MOVE TO OTHER 9924 06:45:26,320 --> 06:45:27,280 QUESTIONS. 9925 06:45:27,280 --> 06:45:29,560 >>FOR JORGE'S QUESTION, THERE'S 9926 06:45:29,560 --> 06:45:32,560 BEEN 106 PANEL, YOU KNOW, THAT 9927 06:45:32,560 --> 06:45:34,640 WAS DEVELOPED MORE THAN I THINK 9928 06:45:34,640 --> 06:45:39,320 15 YEARS AGO, THAT CAN CLEARLY 9929 06:45:39,320 --> 06:45:43,520 IDENTIFY INDIGENOUS EUROPEAN AND 9930 06:45:43,520 --> 06:45:46,120 AFRICAN ANCESTRY IN ADMIX 9931 06:45:46,120 --> 06:45:46,680 HISPANIC LATINOS BUT WE'RE 9932 06:45:46,680 --> 06:45:49,160 MOVING BEYOND THAT TO USING 9933 06:45:49,160 --> 06:45:51,360 GENOME WIDE DATA WHICH CAN 9934 06:45:51,360 --> 06:45:56,280 EASILY BE PRUNED AND USED TO 9935 06:45:56,280 --> 06:45:57,600 IDENTIFY CONTINENTAL COMPONENTS. 9936 06:45:57,600 --> 06:46:02,440 IN OUR DATA WE CAN IDENTIFY THE 9937 06:46:02,440 --> 06:46:03,760 NORTHERN INDIGENOUS AMERICAN 9938 06:46:03,760 --> 06:46:05,720 COMPONENT AND DISTINGUISH THAT 9939 06:46:05,720 --> 06:46:07,880 FROM THE SOUTHERN, IT COMES UP 9940 06:46:07,880 --> 06:46:09,440 IN THE PCAS AND ANCESTRY 9941 06:46:09,440 --> 06:46:12,880 ESTIMATES, SO IF YOU WANT TO 9942 06:46:12,880 --> 06:46:16,400 TALK MORE I'M HAPPY TO. 9943 06:46:16,400 --> 06:46:17,120 >>THANK YOU. 9944 06:46:17,120 --> 06:46:19,840 THANK YOU FOR THE SUGGESTION. 9945 06:46:19,840 --> 06:46:24,000 I'D LIKE TO MOVE TO DR. DUCONGE. 9946 06:46:24,000 --> 06:46:28,520 THANK YOU FOR YOUR PRESENTATION 9947 06:46:28,520 --> 06:46:32,120 ON THE PHARMACOGENOMICS. 9948 06:46:32,120 --> 06:46:33,720 SO, IT'S REALLY INTRIGUING, HOW 9949 06:46:33,720 --> 06:46:36,720 DO THESE FINDINGS ON THE 9950 06:46:36,720 --> 06:46:39,880 POLYGENIC RISK SCORE FROM YOUR 9951 06:46:39,880 --> 06:46:41,720 RESEARCH TRANSLATE INTO CLINICAL 9952 06:46:41,720 --> 06:46:42,080 CARE? 9953 06:46:42,080 --> 06:46:45,120 I MEAN, IS THERE A WAY TO 9954 06:46:45,120 --> 06:46:48,440 RECOMMEND FOR GENETIC TESTING 9955 06:46:48,440 --> 06:46:50,080 BEFORE YOU PRESCRIBE DRUGS 9956 06:46:50,080 --> 06:46:53,280 BECAUSE ANTICOAGULANTS WITH USED 9957 06:46:53,280 --> 06:46:54,560 PRETTY WIDELY, SO, AND THEN 9958 06:46:54,560 --> 06:46:57,200 WOULD YOU ADJUST FOR THE DOSE OR 9959 06:46:57,200 --> 06:47:01,160 DO YOU HAVE ANY COMMENT ON THAT? 9960 06:47:01,160 --> 06:47:02,800 >>YEAH, ABSOLUTELY. 9961 06:47:02,800 --> 06:47:05,400 THANK YOU SO MUCH, RINA. 9962 06:47:05,400 --> 06:47:09,440 FIRST OF ALL, I'D LIKE TO 9963 06:47:09,440 --> 06:47:13,760 EXPRESS MY GRATITUDE FOR THE 9964 06:47:13,760 --> 06:47:16,280 SYMPOSIUM, VERY, YOU KNOW, 9965 06:47:16,280 --> 06:47:20,920 HONORED AND EXCITED TO BE HERE. 9966 06:47:20,920 --> 06:47:22,960 THANK YOU FOR THAT. 9967 06:47:22,960 --> 06:47:25,320 IN MY PRESENTATION, WE DEVELOPED 9968 06:47:25,320 --> 06:47:28,640 POLYGENIC RISK SCORE MODEL TO 9969 06:47:28,640 --> 06:47:31,400 PREDICT RESPONSE BASED ON OUR 9970 06:47:31,400 --> 06:47:33,360 MAJOR FINDINGS, FROM THE GWAS, 9971 06:47:33,360 --> 06:47:36,400 AND THE OTHER SUBSEQUENT 9972 06:47:36,400 --> 06:47:37,000 ANALYSES. 9973 06:47:37,000 --> 06:47:41,240 THE NEXT LOGICAL STEP WAS TO 9974 06:47:41,240 --> 06:47:44,440 FIND OUT WHETHER THIS SCORE IS 9975 06:47:44,440 --> 06:47:46,280 ABLE TO HELP CARDIOLOGIST, THE 9976 06:47:46,280 --> 06:47:48,080 BURDEN OF CARDIOVASCULAR EVENTS 9977 06:47:48,080 --> 06:47:51,360 IN INDEPENDENT COHORT OF 9978 06:47:51,360 --> 06:47:56,160 CARIBBEAN HISPANIC PATIENTS ON 9979 06:47:56,160 --> 06:47:56,920 CURRENT. 9980 06:47:56,920 --> 06:48:00,000 WE'RE GENOTYPING, WE'RE 9981 06:48:00,000 --> 06:48:01,640 RECOMMENDING GENOTYPING PATIENTS 9982 06:48:01,640 --> 06:48:04,160 TO IDENTIFY GENETIC MARKERS PART 9983 06:48:04,160 --> 06:48:08,200 OF THE POLYGENIC RISK SCORE, AND 9984 06:48:08,200 --> 06:48:09,440 WE'RE CURRENTLY CONDUCTING 9985 06:48:09,440 --> 06:48:13,680 PROSPECTIVE CLINICAL STUDY TO 9986 06:48:13,680 --> 06:48:16,240 IMPLEMENT OUR PHARMACOGENOMIC 9987 06:48:16,240 --> 06:48:18,040 ALGORITHM TO GUIDE ANTIPLATELET 9988 06:48:18,040 --> 06:48:19,600 THERAPY IN CARIBBEAN HISPANICS, 9989 06:48:19,600 --> 06:48:22,880 THIS IS A COHORT STUDY, WITH 9990 06:48:22,880 --> 06:48:28,080 FOLLOW-UP PERIOD OF SIX MONTHS, 9991 06:48:28,080 --> 06:48:33,960 SO FAR WE HAVE 150 PATIENTS, 9992 06:48:33,960 --> 06:48:38,560 ENROLLED IN THE GROUP, ANOTHER 9993 06:48:38,560 --> 06:48:44,400 132 IN THE GROUP BY GENETICS. 9994 06:48:44,400 --> 06:48:46,560 THE IDEA IS TO CALCULATE RISK 9995 06:48:46,560 --> 06:48:51,840 SCORE, IF THE SCORE IS ABOVE 2, 9996 06:48:51,840 --> 06:48:57,280 PATIENTS ARE ESCALATED TO 9997 06:48:57,280 --> 06:48:59,040 ALTERNATIVE, AND HYPOTHESIS IS 9998 06:48:59,040 --> 06:49:01,440 THOSE IN GENETIC WILL SHOW 9999 06:49:01,440 --> 06:49:06,600 REDUCED INCIDENCE RATE OF MACE, 10000 06:49:06,600 --> 06:49:08,600 WHEN COMPARED TO STANDARD OF 10001 06:49:08,600 --> 06:49:10,880 CARE, THIS IS ONGOING STUDY, 10002 06:49:10,880 --> 06:49:15,600 PRELIMINARILY WE CAME UP WITH 10003 06:49:15,600 --> 06:49:16,920 SIGNIFICANT 4% REDUCTION 10004 06:49:16,920 --> 06:49:18,440 REPORTED ADVERSE EVENTS WITH 10005 06:49:18,440 --> 06:49:22,280 RATIO OF 2, IN THE GENETIC GROUP 10006 06:49:22,280 --> 06:49:26,440 VERSUS STANDARD OF CARE, WE'RE 10007 06:49:26,440 --> 06:49:27,680 VERY EXCITED AND ENTHUSIASTIC 10008 06:49:27,680 --> 06:49:29,560 ABOUT THESE RESULTS SO FAR. 10009 06:49:29,560 --> 06:49:32,720 THE GOAL IS TO USE CLINICAL 10010 06:49:32,720 --> 06:49:36,040 DECISION SUPPORT TOOL, THE WAY 10011 06:49:36,040 --> 06:49:38,760 WE ARE TRANSLATING RESULTS OF 10012 06:49:38,760 --> 06:49:42,600 THE FINDINGS TO COMMUNICATE 10013 06:49:42,600 --> 06:49:46,640 RECOMMENDATIONS TO THE 10014 06:49:46,640 --> 06:49:47,840 CLINICIANS, FOR EACH PATIENTS, 10015 06:49:47,840 --> 06:49:50,360 REAL WORLD SCENARIO. 10016 06:49:50,360 --> 06:49:56,280 KIND OF, YOU KNOW, TRANSLATE 10017 06:49:56,280 --> 06:49:57,480 GENOMICS FINDINGS IN MEDICAL 10018 06:49:57,480 --> 06:49:59,040 BENEFIT FOR OUR PATIENTS 10019 06:49:59,040 --> 06:50:01,560 EXPECTING TO REDUCE GAP BETWEEN 10020 06:50:01,560 --> 06:50:03,800 CURRENT PRACTICE AND ADOPTION OF 10021 06:50:03,800 --> 06:50:05,520 PRECISION MEDICINE PARADIGM, IN 10022 06:50:05,520 --> 06:50:07,680 PUERTO RICO AND LATINO 10023 06:50:07,680 --> 06:50:09,080 POPULATION IN GENERAL. 10024 06:50:09,080 --> 06:50:11,160 >>THANK YOU SO MUCH FOR GIVING 10025 06:50:11,160 --> 06:50:13,440 YOU THIS EXAMPLE. 10026 06:50:13,440 --> 06:50:16,440 I'M REALLY EXCITED TO SEE THAT 10027 06:50:16,440 --> 06:50:20,480 THERE IS HOPE THAT ALL GENOMIC 10028 06:50:20,480 --> 06:50:22,920 RESEARCH WILL BE EVENTUALLY 10029 06:50:22,920 --> 06:50:24,280 GETTING INTO CLINICAL CARE. 10030 06:50:24,280 --> 06:50:28,240 I WANT TO EXTEND THAT SAME 10031 06:50:28,240 --> 06:50:31,960 QUESTION TO THE PANELISTS. 10032 06:50:31,960 --> 06:50:36,040 DR. MARINO, DO YOU HAVE ANY 10033 06:50:36,040 --> 06:50:38,680 PLANS OF INTEGRATING THIS 10034 06:50:38,680 --> 06:50:39,520 RESEARCH DATA INTO CLINICAL 10035 06:50:39,520 --> 06:50:39,720 CARE? 10036 06:50:39,720 --> 06:50:47,200 HOW DO YOU SEE THE GENOMIC DATA 10037 06:50:47,200 --> 06:50:49,560 BEING SHARED FOR ADDRESSING 10038 06:50:49,560 --> 06:50:50,280 HEALTH DISPARITIES? 10039 06:50:50,280 --> 06:50:56,880 >>THANK YOU FOR THAT QUESTION, 10040 06:50:56,880 --> 06:50:58,040 RINA. 10041 06:50:58,040 --> 06:51:00,800 I THINK, FIRST, PROBABLY THE 10042 06:51:00,800 --> 06:51:03,320 FASTEST WAY TO GET THERE IS 10043 06:51:03,320 --> 06:51:05,400 PHARMACOGENOMICS AT THE 10044 06:51:05,400 --> 06:51:06,040 POPULATION LEVEL. 10045 06:51:06,040 --> 06:51:10,520 AND THE REASON FOR THAT IS 10046 06:51:10,520 --> 06:51:14,920 BECAUSE IT IS RELATIVELY EASY TO 10047 06:51:14,920 --> 06:51:16,880 IDENTIFY SOME ALLELES THAT ARE 10048 06:51:16,880 --> 06:51:19,520 IN THE POPULATION IN LATIN 10049 06:51:19,520 --> 06:51:23,560 AMERICA, THAT CAN BE IDENTIFIED 10050 06:51:23,560 --> 06:51:27,960 TO HOW PEOPLE METABOLIZE DRUGS, 10051 06:51:27,960 --> 06:51:29,520 RIGHT? 10052 06:51:29,520 --> 06:51:32,200 AND THIS IS IMPORTANT BECAUSE A 10053 06:51:32,200 --> 06:51:36,680 NUMBER OF CLINICAL TRIALS ARE 10054 06:51:36,680 --> 06:51:39,360 USUALLY FOCUSED ON POPULATIONS 10055 06:51:39,360 --> 06:51:40,440 FROM EUROPEAN DESCENT, RIGHT? 10056 06:51:40,440 --> 06:51:44,800 SO WE HAVE A NUMBER OF DRUGS 10057 06:51:44,800 --> 06:51:52,000 THAT MAY HAVE -- THAT ARE NOT AS 10058 06:51:52,000 --> 06:51:54,080 EFFECTIVE WHEN YOU HAVE THEM IN 10059 06:51:54,080 --> 06:52:00,760 MINORITY POPULATIONS SO I GUESS 10060 06:52:00,760 --> 06:52:05,920 THAT'S ONE OF THE THINGS WE CAN 10061 06:52:05,920 --> 06:52:07,320 TACKLE QUICKLY. 10062 06:52:07,320 --> 06:52:10,080 ANOTHER IS CONCEPT OF BIOBANKS, 10063 06:52:10,080 --> 06:52:13,240 AND I WAS MENTIONING THIS AT THE 10064 06:52:13,240 --> 06:52:15,560 BEGINNING, IS SOMETHING THAT NOT 10065 06:52:15,560 --> 06:52:17,760 ONLY CAN BENEFIT A CERTAIN 10066 06:52:17,760 --> 06:52:19,640 REGIONS OF LATIN AMERICA, ALSO 10067 06:52:19,640 --> 06:52:23,520 LATINOS HERE IN THE U.S. AND 10068 06:52:23,520 --> 06:52:28,200 PEOPLE FROM EUROPEAN DESCENT AS 10069 06:52:28,200 --> 06:52:28,600 WELL, RIGHT? 10070 06:52:28,600 --> 06:52:32,880 I THINK IT IS IMPORTANT TO TRY 10071 06:52:32,880 --> 06:52:38,000 TO TALK HERE ABOUT THE NEED TO 10072 06:52:38,000 --> 06:52:42,400 FUND EFFORTS IN LATIN AMERICA 10073 06:52:42,400 --> 06:52:45,040 THAT DEAL WITH GENETIC RESEARCH 10074 06:52:45,040 --> 06:52:46,640 AND CHARACTERIZATION, RIGHT? 10075 06:52:46,640 --> 06:52:48,960 BIOBANK CONSTRUCTION AND SO ON. 10076 06:52:48,960 --> 06:52:52,480 SO, THOSE ARE MY TWO CENTS FOR 10077 06:52:52,480 --> 06:52:53,360 THAT QUESTION. 10078 06:52:53,360 --> 06:52:53,720 >>THANK YOU. 10079 06:52:53,720 --> 06:52:57,920 >>I DON'T KNOW IF OTHERS HAVE 10080 06:52:57,920 --> 06:52:59,240 SOMETHING TO ADD. 10081 06:52:59,240 --> 06:53:01,760 >>YEAH, I REALLY WANT TO OPEN 10082 06:53:01,760 --> 06:53:04,120 THIS FOR ALL THE PANELISTS TO 10083 06:53:04,120 --> 06:53:10,960 GIVE US SOME OF YOUR FEEDBACK. 10084 06:53:10,960 --> 06:53:14,800 DR. LOPERA, HOW ARE ALL THESE 10085 06:53:14,800 --> 06:53:18,720 SCREENINGS FOR THE GENOTYPIC AND 10086 06:53:18,720 --> 06:53:21,280 PHENOTYPIC STUDIES CAN BE STICKY 10087 06:53:21,280 --> 06:53:22,680 INTEGRATED INTO CLINICAL CARE, 10088 06:53:22,680 --> 06:53:25,840 DO YOU HAVE ANY RECOMMENDATION 10089 06:53:25,840 --> 06:53:27,920 AND ESPECIALLY FOR IDENTIFYING 10090 06:53:27,920 --> 06:53:33,600 RESISTANT GENES TO ALZHEIMER'S 10091 06:53:33,600 --> 06:53:34,600 DISEASE. 10092 06:53:34,600 --> 06:53:37,560 >>YES, IN MY LAB HERE IN 10093 06:53:37,560 --> 06:53:40,360 COLOMBIA, WE ARE ABLE TO 10094 06:53:40,360 --> 06:53:44,520 PHENOTYPE, TO LOOK FOR THE 10095 06:53:44,520 --> 06:53:47,400 PHENOTYPE FOR THE MUTATION, THAT 10096 06:53:47,400 --> 06:53:48,920 WE HAVE DISCOVERED HERE. 10097 06:53:48,920 --> 06:53:53,280 FOR INSTANCE, IN THE LAST THREE 10098 06:53:53,280 --> 06:53:56,360 DECADES, WE WERE THINKING THAT 10099 06:53:56,360 --> 06:54:06,880 WE HAVE ONLY ONE MUTATION, BUT 10100 06:54:08,040 --> 06:54:12,200 IN THE LAST YEAR WHEN WE STARTED 10101 06:54:12,200 --> 06:54:15,280 THE CLINICAL TRIAL, WE DID A 10102 06:54:15,280 --> 06:54:19,400 CAMPAIGN IN THE COUNTRY LOOKING 10103 06:54:19,400 --> 06:54:23,040 FOR PEOPLE HAVING EARLY ONSET 10104 06:54:23,040 --> 06:54:26,240 DEMENTIA, AND WE DID 10105 06:54:26,240 --> 06:54:30,280 ADVERTISEMENT IN THE TELEVISION, 10106 06:54:30,280 --> 06:54:34,480 RADIO, NEWSPAPER, LOOKING FOR 10107 06:54:34,480 --> 06:54:39,600 PEOPLE HAVING EARLY ONSET 10108 06:54:39,600 --> 06:54:40,800 DEMENTIA BEFORE 60 YEARS OLD AND 10109 06:54:40,800 --> 06:54:43,920 RECEIVED 1,000 BLOOD SAMPLES 10110 06:54:43,920 --> 06:54:46,040 FROM ALL THE COUNTRY. 10111 06:54:46,040 --> 06:54:51,960 AND WE FOUND THAT ONLY EIGHT OF 10112 06:54:51,960 --> 06:54:53,600 THEM HAVE THE MUTATION, OF 10113 06:54:53,600 --> 06:54:56,840 COURSE WE INVITE THEM TO 10114 06:54:56,840 --> 06:55:01,280 PARTICIPATE IN THE CLINICAL 10115 06:55:01,280 --> 06:55:02,280 TRIAL, THE QUESTION WAS WHAT 10116 06:55:02,280 --> 06:55:06,520 HAPPENED WITH THE OTHERS, WE DID 10117 06:55:06,520 --> 06:55:10,360 A TOTAL GENOME, IN THE LAB AT 10118 06:55:10,360 --> 06:55:11,680 THE CALIFORNIA UNIVERSITY, IN 10119 06:55:11,680 --> 06:55:17,160 SANTA BARBARA, SAND WE FOUND 10120 06:55:17,160 --> 06:55:26,560 THAT WE HAVE 12 MORE DIFFERENT, 10121 06:55:26,560 --> 06:55:36,840 IN COLOMBIA, THAN TODAY WE HAVE 10122 06:55:36,840 --> 06:55:39,880 NINE MUTATIONS, EUROPEAN ORIGIN, 10123 06:55:39,880 --> 06:55:42,720 THREE NATIVE, ONE AFRICAN 10124 06:55:42,720 --> 06:55:43,120 MUTATION. 10125 06:55:43,120 --> 06:55:49,520 NOW WE SEE THAT WE HAVE MANY 10126 06:55:49,520 --> 06:55:52,360 FAMILIES AFFECTED, WITH 10127 06:55:52,360 --> 06:55:59,240 DIFFERENT MUTATION IN GENE, NOW 10128 06:55:59,240 --> 06:56:01,640 WE ARE ABLE TO RUN THIS MUTATION 10129 06:56:01,640 --> 06:56:06,160 IN OUR LAB BUT OF COURSE IF WE 10130 06:56:06,160 --> 06:56:11,640 LIKE TO LOOK FOR MORE GENETIC 10131 06:56:11,640 --> 06:56:15,760 FACTORS THEN WE NEED TO DO 10132 06:56:15,760 --> 06:56:18,320 COLLABORATION WITH FOREIGN LABS, 10133 06:56:18,320 --> 06:56:21,760 AND WE DO THAT WITH OTHER 10134 06:56:21,760 --> 06:56:22,760 COLLABORATORS IN THE ITS. 10135 06:56:22,760 --> 06:56:23,680 >>THANK YOU. 10136 06:56:23,680 --> 06:56:29,800 THANK YOU FOR THOSE COMMENTS. 10137 06:56:29,800 --> 06:56:33,600 DR. AGUILAR SALINAS, DO YOU HAVE 10138 06:56:33,600 --> 06:56:35,600 THOUGHTS ON HOW THESE DATA ON 10139 06:56:35,600 --> 06:56:38,640 THESE SUBPHENOTYPES AND HOW CAN 10140 06:56:38,640 --> 06:56:40,320 THEY BE USED IN PRECISION 10141 06:56:40,320 --> 06:56:44,360 MEDICINE AND HOW CAN WE 10142 06:56:44,360 --> 06:56:47,440 TRANSLATE INTO CLINICAL 10143 06:56:47,440 --> 06:56:49,120 PRACTICE? 10144 06:56:49,120 --> 06:56:51,920 >>IT'S CRITICAL TO LINK 10145 06:56:51,920 --> 06:56:57,080 ELECTRONIC MEDICAL RECORDS 10146 06:56:57,080 --> 06:56:57,840 INFORMATION AND COHORT-BASED 10147 06:56:57,840 --> 06:57:01,440 LONGITUDINAL DATA WITH GENOMIC 10148 06:57:01,440 --> 06:57:05,600 INFORMATION, FOR EXAMPLE FOR 10149 06:57:05,600 --> 06:57:06,920 METABOLIC DISORDERS IN 10150 06:57:06,920 --> 06:57:08,040 HETEROGENEOUS CONDITION, NOT 10151 06:57:08,040 --> 06:57:11,640 EVERYBODY DEVELOPS THE SAME KIND 10152 06:57:11,640 --> 06:57:15,800 OF FINAL COMPLICATIONS. 10153 06:57:15,800 --> 06:57:22,760 AND IT'S INDISPENSABLE THAT TO 10154 06:57:22,760 --> 06:57:24,880 BUILD MULTI-NATIONAL COHORTS, 10155 06:57:24,880 --> 06:57:27,720 THAT INFORMATION OF THOSE 10156 06:57:27,720 --> 06:57:29,760 CLINICAL AND GENOMIC DATA, FOR 10157 06:57:29,760 --> 06:57:32,840 THE PROGNOSTICS OF THE PATIENTS, 10158 06:57:32,840 --> 06:57:37,920 EXAMPLE IN LATIN AMERICA WE HAVE 10159 06:57:37,920 --> 06:57:42,520 AN INCREASED SUSCEPTIBILITY FOR 10160 06:57:42,520 --> 06:57:45,040 DIABETIC RETINOPATHY, AND EARLY 10161 06:57:45,040 --> 06:57:47,080 ONSET TYPE 2 DIABETES, THAT 10162 06:57:47,080 --> 06:57:52,040 NOBODY WILL ANSWER THESE KIND OF 10163 06:57:52,040 --> 06:57:53,240 QUESTIONS IN EUROPE OR U.S. 10164 06:57:53,240 --> 06:57:54,280 BECAUSE THEY DON'T HAVE THESE 10165 06:57:54,280 --> 06:57:58,800 KINDS OF PATIENTS. 10166 06:57:58,800 --> 06:58:01,760 SO MOST OF ALL THESE COHORTS TO 10167 06:58:01,760 --> 06:58:04,760 HAVE GENOMIC AND CLINICAL DATA, 10168 06:58:04,760 --> 06:58:11,280 AS LEONARDO SAID, IS VERY 10169 06:58:11,280 --> 06:58:12,280 IMPORTANT TO IDENTIFY, PERHAPS 10170 06:58:12,280 --> 06:58:22,760 AS A RESULT OF MEETINGS, 10171 06:58:22,760 --> 06:58:28,520 BIOBANKS, COHORTS, ENOUGH 10172 06:58:28,520 --> 06:58:29,920 INFORMATION ABOUT OUTCOMES TO 10173 06:58:29,920 --> 06:58:31,520 MAKE THIS WHOLE IDEA POSSIBLE TO 10174 06:58:31,520 --> 06:58:36,040 IMPROVE HEALTH OF LATIN 10175 06:58:36,040 --> 06:58:36,320 AMERICANS. 10176 06:58:36,320 --> 06:58:38,880 >> THANK YOU FOR YOUR 10177 06:58:38,880 --> 06:58:40,360 THOUGHTFUL COMMENTS. 10178 06:58:40,360 --> 06:58:41,760 DR. FEJERMAN, LET ME POSE A 10179 06:58:41,760 --> 06:58:44,720 QUESTION TO YOU. 10180 06:58:44,720 --> 06:58:51,240 YOU MENTIONED ABOUT PRECISION 10181 06:58:51,240 --> 06:58:54,560 PREVENTION. 10182 06:58:54,560 --> 06:58:55,880 THAT'S A GREAT AREA. 10183 06:58:55,880 --> 06:58:57,840 HOW DO YOU ENVISION RESEARCH 10184 06:58:57,840 --> 06:59:02,120 TRANSLATED INTO CLINICAL CARE 10185 06:59:02,120 --> 06:59:03,320 AND INTO COME CLINICAL DECISION 10186 06:59:03,320 --> 06:59:05,160 MAKING, HOW PATIENTS ARE GOING 10187 06:59:05,160 --> 06:59:08,040 TO MAKE A DECISION BASED ON 10188 06:59:08,040 --> 06:59:09,000 GENOMIC INFORMATION? 10189 06:59:09,000 --> 06:59:11,400 >>THAT'S A GREAT QUESTION, 10190 06:59:11,400 --> 06:59:15,120 THANK YOU. 10191 06:59:15,120 --> 06:59:19,600 IT'S ALREADY HAPPENING. 10192 06:59:19,600 --> 06:59:22,320 MYRIAD INCORPORATED IN THE PRS 10193 06:59:22,320 --> 06:59:30,320 PANEL AND GIVE RESULTS DIRECT TO 10194 06:59:30,320 --> 06:59:31,080 CONSUMER RESULTS. 10195 06:59:31,080 --> 06:59:32,400 THERE'S A QUESTION IN MY MIND 10196 06:59:32,400 --> 06:59:34,280 HOW THIS IS GOING TO COME IN 10197 06:59:34,280 --> 06:59:40,400 PLAY FOR THOSE WITH LESS 10198 06:59:40,400 --> 06:59:43,000 RESOURCES WHO ARE -- THE INSURE 10199 06:59:43,000 --> 06:59:45,520 MIGHT NOT PAY FOR SCREENING 10200 06:59:45,520 --> 06:59:53,040 PANELS, YOU KNOW, BEFORE USUALLY 10201 06:59:53,040 --> 06:59:57,440 MEDICAL, MEDICARE, ESPECIALLY 10202 06:59:57,440 --> 06:59:58,760 FOR PRECISION, THEY COVER WHEN 10203 06:59:58,760 --> 07:00:00,560 YOU HAVE BREAST CANCER, HOW IT 10204 07:00:00,560 --> 07:00:02,120 WORKS, BUT NOT IF YOU DON'T HAVE 10205 07:00:02,120 --> 07:00:03,800 THE DISEASE IS NOT SO EASY TO 10206 07:00:03,800 --> 07:00:09,800 GET THE INSURANCE TO COVER 10207 07:00:09,800 --> 07:00:13,200 TESTING, FOR EXAMPLE; IT'S 10208 07:00:13,200 --> 07:00:13,680 EASIER TO INCORPORATE 10209 07:00:13,680 --> 07:00:17,360 INFORMATION, I DON'T THINK IT'S 10210 07:00:17,360 --> 07:00:20,320 EASY TO MAKE SURE EVERYONE HAS 10211 07:00:20,320 --> 07:00:21,360 ACCESS TO TESTS THAT CAN 10212 07:00:21,360 --> 07:00:27,880 NF-kappaB ABOUT -- THAT CAN 10213 07:00:27,880 --> 07:00:29,000 INFORM ABOUT THE RISK, A PROBLEM 10214 07:00:29,000 --> 07:00:31,840 IN THE U.S., A PROBLEM IN LATIN 10215 07:00:31,840 --> 07:00:33,440 AMERICA WHERE THEY CAN BENEFIT 10216 07:00:33,440 --> 07:00:43,880 FROM THE PRS USEFUL FOR 10217 07:00:44,280 --> 07:00:44,960 PARTICULAR POPULATIONS. 10218 07:00:44,960 --> 07:00:47,480 THE WAY I'M GOING TO WORK ON 10219 07:00:47,480 --> 07:00:48,800 THIS, ADVOCATE, WORK WITH OTHER 10220 07:00:48,800 --> 07:00:51,960 PEOPLE WHO HAVE MORE EXPERIENCE, 10221 07:00:51,960 --> 07:00:54,480 EVEN ADVOCATING, AND TRYING TO 10222 07:00:54,480 --> 07:00:59,880 CHANGE POLICIES, SO EVERYONE CAN 10223 07:00:59,880 --> 07:01:01,720 ACCESS PRECISION PREVENTION 10224 07:01:01,720 --> 07:01:05,360 GENETIC TESTING AND ACCESS TO 10225 07:01:05,360 --> 07:01:08,320 PREVENTIVE TREATMENT LIKE BREAST 10226 07:01:08,320 --> 07:01:12,400 CANCER WOULD BE CHEMOPREVENTION 10227 07:01:12,400 --> 07:01:15,520 OR PREVENT THE MASTECTOMY, 10228 07:01:15,520 --> 07:01:18,160 RECONSTRUCTION, WHATEVER THE 10229 07:01:18,160 --> 07:01:19,320 PARTICIPANT DECIDES TO DO. 10230 07:01:19,320 --> 07:01:21,680 >>THIS IS A REALLY IMPORTANT 10231 07:01:21,680 --> 07:01:25,840 QUESTION, AND FOR THE PANELISTS, 10232 07:01:25,840 --> 07:01:26,880 BECAUSE WE'RE THE NATIONAL 10233 07:01:26,880 --> 07:01:29,480 INSTITUTE ON MINORITY HEALTH AND 10234 07:01:29,480 --> 07:01:32,400 HEALTH DISPARITIES, AND WE KNOW 10235 07:01:32,400 --> 07:01:35,680 TO ADDRESS DISPARITIES, ACCESS 10236 07:01:35,680 --> 07:01:37,880 TO THESE SCIENTIFIC ADVANCES IS 10237 07:01:37,880 --> 07:01:42,280 SO IMPORTANT AND HOW DO YOU SEE 10238 07:01:42,280 --> 07:01:43,560 THIS HAPPENING? 10239 07:01:43,560 --> 07:01:46,520 IS THIS -- ARE THERE ANY 10240 07:01:46,520 --> 07:01:50,680 EXAMPLES WHERE WE COULD LEARN 10241 07:01:50,680 --> 07:01:50,880 FROM? 10242 07:01:50,880 --> 07:01:59,560 ANY THOUGHTS FROM THE PANELISTS? 10243 07:01:59,560 --> 07:02:01,360 >>I CAN SAY I KNOW HERE IN THE 10244 07:02:01,360 --> 07:02:05,640 U.S. THERE'S A LOT OF MOVEMENT 10245 07:02:05,640 --> 07:02:09,040 AROUND ENSURING EVERYONE CAN 10246 07:02:09,040 --> 07:02:10,440 ACCESS PRECISION PREVENTION 10247 07:02:10,440 --> 07:02:10,760 APPROACHES. 10248 07:02:10,760 --> 07:02:13,240 SIMILAR TO TREATMENT. 10249 07:02:13,240 --> 07:02:15,440 I KNOW THERE'S INVESTIGATORS, 10250 07:02:15,440 --> 07:02:19,800 IMPLEMENTING NEW APPROACHES TO 10251 07:02:19,800 --> 07:02:20,880 FACILITATE ACCESS. 10252 07:02:20,880 --> 07:02:22,240 I PERSONALLY FOCUS ON BREAST 10253 07:02:22,240 --> 07:02:26,080 CANCER BUT I'M SURE THIS IS THE 10254 07:02:26,080 --> 07:02:27,880 CASE FOR OTHER PHENOTYPES. 10255 07:02:27,880 --> 07:02:29,760 AND I THINK AT THE END, THERE 10256 07:02:29,760 --> 07:02:33,200 NEEDS TO BE A CHANGE IN THE WAY 10257 07:02:33,200 --> 07:02:37,320 WE PROVIDE ACCESS TO CARE IN THE 10258 07:02:37,320 --> 07:02:41,360 U.S. AND IN LATIN AMERICA TOO. 10259 07:02:41,360 --> 07:02:42,440 >>THANK YOU. 10260 07:02:42,440 --> 07:02:46,280 THERE IS A QUESTION FOR DR. 10261 07:02:46,280 --> 07:02:49,600 DUCONGE, WHAT WAS THE PROCESS 10262 07:02:49,600 --> 07:02:50,760 FOR DEVELOPING THE CLINICAL 10263 07:02:50,760 --> 07:02:54,280 DECISION SUPPORT TOOL? 10264 07:02:54,280 --> 07:02:57,320 CAN YOU COMMENT ON THAT? 10265 07:02:57,320 --> 07:03:01,720 >>YEAH, IT'S ESSENTIALLY 10266 07:03:01,720 --> 07:03:08,600 SIMILAR TO WHAT WAS SHOWN DR. 10267 07:03:08,600 --> 07:03:17,600 FEJERMAN SHOWED IN HER 10268 07:03:17,600 --> 07:03:20,040 PRESENTATION, SOME DIFFERENT 10269 07:03:20,040 --> 07:03:21,760 COEFFICIENTS THAT ARE MODIFIED 10270 07:03:21,760 --> 07:03:23,640 IN THE GENE OR GENETIC MARKER 10271 07:03:23,640 --> 07:03:27,520 THAT IS FOUND TO BE ASSOCIATED 10272 07:03:27,520 --> 07:03:31,520 WITH THE RESISTANCE TO THE DRUG. 10273 07:03:31,520 --> 07:03:35,760 SO IT'S A POLYNOMIAL EQUATION 10274 07:03:35,760 --> 07:03:39,920 THAT INCLUDES ALL THE GENETIC 10275 07:03:39,920 --> 07:03:43,320 MARKERS THAT ARE RELEVANT, 10276 07:03:43,320 --> 07:03:50,080 PREDICTIVE VALUE TO THE RISK FOR 10277 07:03:50,080 --> 07:03:54,280 ADVERSE EVENTS, POOR RESPONSE TO 10278 07:03:54,280 --> 07:03:56,360 THE DRUG, YEAH, WE USED THIS 10279 07:03:56,360 --> 07:03:58,120 APPROACH TO DEVELOP THE 10280 07:03:58,120 --> 07:04:00,960 POLYGENIC RISK SCORE, WHICH IS 10281 07:04:00,960 --> 07:04:03,680 ESSENTIALLY SIMILAR TO WHAT IS 10282 07:04:03,680 --> 07:04:05,920 USED COMMONLY FOR THIS KIND OF 10283 07:04:05,920 --> 07:04:08,840 MODEL, IN THIS CASE THE ONLY 10284 07:04:08,840 --> 07:04:13,560 THING THAT WAS DIFFERENT WAS 10285 07:04:13,560 --> 07:04:18,400 THAT WE ADJUSTED THE MARKERS BY 10286 07:04:18,400 --> 07:04:18,640 ANCESTRY. 10287 07:04:18,640 --> 07:04:25,600 SO WE USED THE LOCAL ANCESTRY TO 10288 07:04:25,600 --> 07:04:31,720 ADJUST THE MARKERS, I WOULD SAY 10289 07:04:31,720 --> 07:04:34,600 TO WAIT, TO PROVIDE WEIGHT 10290 07:04:34,600 --> 07:04:36,160 FACTORS FOR GENETIC MARKERS 10291 07:04:36,160 --> 07:04:38,960 INCLUDED IN THE MODEL. 10292 07:04:38,960 --> 07:04:39,840 10293 07:04:39,840 --> 07:04:41,480 >>THANK YOU. 10294 07:04:41,480 --> 07:04:44,960 THANK YOU FOR THAT COMMENT. 10295 07:04:44,960 --> 07:04:51,600 I DO A QUESTION FOR DR. 10296 07:04:51,600 --> 07:04:52,720 LOPERA. 10297 07:04:52,720 --> 07:04:55,840 YOU MENTIONED HOW TO IMITATE 10298 07:04:55,840 --> 07:04:57,480 NATURE, YOU SUGGESTED, IS ONE 10299 07:04:57,480 --> 07:04:57,760 SOLUTION. 10300 07:04:57,760 --> 07:05:02,720 SO I WANTED TO HEAR A LITTLE BIT 10301 07:05:02,720 --> 07:05:05,040 MORE, DO YOU HAVE IDEAS HOW WE 10302 07:05:05,040 --> 07:05:07,080 CAN PREVENT THIS DISEASE AND HOW 10303 07:05:07,080 --> 07:05:16,440 DO WE IMITATE NATURE? 10304 07:05:16,440 --> 07:05:18,560 >>YES. 10305 07:05:18,560 --> 07:05:22,880 ED DISCOVERY OF PROTECTIVE GENE 10306 07:05:22,880 --> 07:05:27,840 SHOWS US THAT WE CAN IMITATE 10307 07:05:27,840 --> 07:05:31,720 NATURE, THEN WE -- THIS IS THE 10308 07:05:31,720 --> 07:05:38,640 CASE THAT GIVE US A LESSON, VERY 10309 07:05:38,640 --> 07:05:38,880 IMPORTANT. 10310 07:05:38,880 --> 07:05:42,320 THE PREVENTION, THE CURE OF 10311 07:05:42,320 --> 07:05:45,280 ALZHEIMER'S, IS NOW IN THE 10312 07:05:45,280 --> 07:05:48,480 NATURAL BECAUSE ALIRIA WAS AN 10313 07:05:48,480 --> 07:05:52,960 EXCEPTIONAL CASE, IN THE 10314 07:05:52,960 --> 07:05:54,920 FAMILIES WITH AUTOSOMAL DOMINANT 10315 07:05:54,920 --> 07:05:58,000 DISEASE THAT CARRIED GENE OF 10316 07:05:58,000 --> 07:06:06,840 CAUSALITY THAT IS VERY SIMILAR 10317 07:06:06,840 --> 07:06:08,600 IN MANIFESTATION AND SHE DIDN'T 10318 07:06:08,600 --> 07:06:10,720 DEVELOP ALZHEIMER'S DISEASE AT 10319 07:06:10,720 --> 07:06:16,800 THE AGE EXPECTED, 44 YEARS. 10320 07:06:16,800 --> 07:06:18,320 SHE DEVELOPED IMPAIRMENT AT 72 10321 07:06:18,320 --> 07:06:19,880 YEARS OLD. 10322 07:06:19,880 --> 07:06:23,160 THAT SHE WAS PROTECTED FOR 29 10323 07:06:23,160 --> 07:06:27,960 YEARS, THEN IT MEANS THAT NATURE 10324 07:06:27,960 --> 07:06:31,920 HAVE THE OPTION TO RETARD THE 10325 07:06:31,920 --> 07:06:34,880 ONSET OF SYMPTOMS OF ALZHEIMER'S 10326 07:06:34,880 --> 07:06:38,400 DISEASE CAUSED BY GENE OF 10327 07:06:38,400 --> 07:06:42,320 CAUSALITY FOR 29 YEARS, THEN IF 10328 07:06:42,320 --> 07:06:48,360 YOU THINK THAT YOU CAN IMITATE 10329 07:06:48,360 --> 07:06:55,400 NATURE, THEN IT'S POSSIBLE TO 10330 07:06:55,400 --> 07:06:58,760 RETARD ONSET FOR 29 YEARS. 10331 07:06:58,760 --> 07:07:03,120 AND IF MORE SO PEOPLE HAVE 10332 07:07:03,120 --> 07:07:09,920 DISEASE STARTS AT 65 YEARS OLD, 10333 07:07:09,920 --> 07:07:12,080 THEN RETARDING FOR ALMOST THREE 10334 07:07:12,080 --> 07:07:15,400 DECADES, THEY ARE GOING TO 10335 07:07:15,400 --> 07:07:20,480 DEVELOP SYMPTOMS AT 95, THAT 10336 07:07:20,480 --> 07:07:23,360 DISEASE, I THINK THIS IS A CURE, 10337 07:07:23,360 --> 07:07:28,320 THIS IS A METHOD OF PREVENTION, 10338 07:07:28,320 --> 07:07:31,680 AND THE CONCLUSION IS THAT WE 10339 07:07:31,680 --> 07:07:36,960 NEED TO LEARN TO READ THE 10340 07:07:36,960 --> 07:07:41,800 NATURE, TO UNDERSTAND THE NATURE 10341 07:07:41,800 --> 07:07:42,440 AND IMITATE NATURE. 10342 07:07:42,440 --> 07:07:48,600 WE DON'T NEED TO DISCOVER. 10343 07:07:48,600 --> 07:07:48,720 10344 07:07:48,720 --> 07:07:52,720 >>WE NEED TO HAVE THOSE CORRECT 10345 07:07:52,720 --> 07:07:54,400 ENVIRONMENTAL CONDITIONS, 10346 07:07:54,400 --> 07:07:56,040 EXTERNAL CONDITIONS, THAT WILL 10347 07:07:56,040 --> 07:08:01,520 ALLOW THE DISEASE ONSET TO BE 10348 07:08:01,520 --> 07:08:02,520 DELAYED. 10349 07:08:02,520 --> 07:08:05,240 >>AND WE CAN IMITATE NATURE, 10350 07:08:05,240 --> 07:08:06,760 USING TWO WAYS. 10351 07:08:06,760 --> 07:08:13,120 ONE WAY, ONE WAY IS TO DOOR 10352 07:08:13,120 --> 07:08:20,560 GENETIC THERAPY, BECAUSE IF I AM 10353 07:08:20,560 --> 07:08:22,960 ABLE TO INTRODUCE GENETIC 10354 07:08:22,960 --> 07:08:24,160 INFORMATION, PROTECTOR GENETIC 10355 07:08:24,160 --> 07:08:28,080 INFORMATION, IN A PERSON WHO HAS 10356 07:08:28,080 --> 07:08:31,360 A HIGH RISK TO THE DISEASE, WE 10357 07:08:31,360 --> 07:08:34,920 CAN IMITATE NATURE DOING THAT. 10358 07:08:34,920 --> 07:08:44,640 ANOTHER WAY IS TO DEVELOP DRUGS 10359 07:08:44,640 --> 07:08:47,720 THAT HAVE ACTION MECHANISM AS 10360 07:08:47,720 --> 07:08:48,840 PROTECTOR GENE DO IN THE BRAIN 10361 07:08:48,840 --> 07:08:58,880 OF THE PERSON WHO IS PROTECTED. 10362 07:08:58,880 --> 07:09:09,360 WE CAN DO GENETIC THERAPY OR 10363 07:09:11,040 --> 07:09:11,840 DRUG THERAPY. 10364 07:09:11,840 --> 07:09:14,560 >>THANK YOU FOR YOUR INSIGHTFUL 10365 07:09:14,560 --> 07:09:15,040 COMMENTS. 10366 07:09:15,040 --> 07:09:20,480 I WANT TO GO BACK TO ANOTHER 10367 07:09:20,480 --> 07:09:22,040 QUESTION THAT YOU ALL TOUCHED 10368 07:09:22,040 --> 07:09:23,800 UPON IN TERMS OF DEVELOPING 10369 07:09:23,800 --> 07:09:27,160 COLLABORATIONS BETWEEN THE U.S. 10370 07:09:27,160 --> 07:09:28,360 AND LATIN AMERICA BUT I WANTED 10371 07:09:28,360 --> 07:09:31,240 TO HEAR A LITTLE BIT MORE IN 10372 07:09:31,240 --> 07:09:35,280 TERMS OF WHAT ARE SOME OF THE 10373 07:09:35,280 --> 07:09:38,360 LESSONS LEARNED, CHALLENGES, HOW 10374 07:09:38,360 --> 07:09:41,120 DO YOU OVERCOME THOSE AND IS 10375 07:09:41,120 --> 07:09:43,600 THERE ANY INSIGHTS YOU WANT TO 10376 07:09:43,600 --> 07:09:47,000 SHARE ABOUT CREATING BIOBANKS, 10377 07:09:47,000 --> 07:09:48,160 CREATING THESE CROSS-NATIONAL 10378 07:09:48,160 --> 07:09:52,880 CONSORTIA THAT WILL HELP US ALL 10379 07:09:52,880 --> 07:09:54,160 ENRICH THE RESEARCH DATA? 10380 07:09:54,160 --> 07:09:58,440 WHO WANTS TO GO FIRST? 10381 07:09:58,440 --> 07:10:03,120 >>I WOULD LIKE TO SAY THAT I AM 10382 07:10:03,120 --> 07:10:05,280 VERY -- I WANT TO SAY THANKS 10383 07:10:05,280 --> 07:10:08,720 VERY MUCH TO NATIONAL INSTITUTE 10384 07:10:08,720 --> 07:10:09,920 OF HEALTH, UNITED STATES, 10385 07:10:09,920 --> 07:10:15,400 BECAUSE IN MY CASE IN COLOMBIA, 10386 07:10:15,400 --> 07:10:20,920 ALL THE JOBS WE HAVE DONE IN 10387 07:10:20,920 --> 07:10:24,280 AUTOSOMAL DOMINANT ALZHEIMER'S 10388 07:10:24,280 --> 07:10:25,760 ANDS OTHER TOPICS WE HAD SUPPORT 10389 07:10:25,760 --> 07:10:29,240 FROM NATIONAL INSTITUTES OF 10390 07:10:29,240 --> 07:10:29,760 HEALTH. 10391 07:10:29,760 --> 07:10:31,480 WE HAVE SEVERAL GRANTS 10392 07:10:31,480 --> 07:10:35,280 SUPPORTING THAT, AND THAT WAS 10393 07:10:35,280 --> 07:10:37,200 WONDERFUL, WAS VERY INTERESTING. 10394 07:10:37,200 --> 07:10:40,480 AND IT WAS POSSIBLE BECAUSE WE 10395 07:10:40,480 --> 07:10:42,000 HAD GOOD COLLABORATION WITH 10396 07:10:42,000 --> 07:10:47,280 OTHER RESEARCHERS IN THE UNITED 10397 07:10:47,280 --> 07:10:50,640 STATES. 10398 07:10:50,640 --> 07:10:51,760 MASSACHUSETTS GENERAL HOSPITAL, 10399 07:10:51,760 --> 07:10:52,760 CALIFORNIA HOSPITAL, SOME ARE 10400 07:10:52,760 --> 07:10:55,400 MEMBERS OF MY TEAM THAT NOW ARE 10401 07:10:55,400 --> 07:10:57,440 RESEARCHERS, WORKING IN THE 10402 07:10:57,440 --> 07:10:57,880 UNITED STATES. 10403 07:10:57,880 --> 07:11:06,080 BUT BECAUSE THEY ARE FROM HERE, 10404 07:11:06,080 --> 07:11:08,240 THEN WE NEED A NETWORK, COLOMBIA 10405 07:11:08,240 --> 07:11:09,600 RESEARCHERS IN THE UNITED 10406 07:11:09,600 --> 07:11:19,880 STATES, WE LIVING HERE AND WE 10407 07:11:19,880 --> 07:11:21,360 NEED EFFORT IN ORDER TO LOOK FOR 10408 07:11:21,360 --> 07:11:22,160 RESEARCH IN NATIONAL INSTITUTES 10409 07:11:22,160 --> 07:11:24,040 OF HEALTH. 10410 07:11:24,040 --> 07:11:28,560 I THINK THIS IS VERY IMPORTANT 10411 07:11:28,560 --> 07:11:32,320 TO DO BIG NETWORKS IN THE 10412 07:11:32,320 --> 07:11:34,120 COUNTRIES, LATIN AMERICA, ALSO 10413 07:11:34,120 --> 07:11:41,040 WITH OTHER RESEARCHERS IN THE 10414 07:11:41,040 --> 07:11:44,880 UNITED STATES. 10415 07:11:44,880 --> 07:11:49,120 >>PRESENTED EARLIER TODAY, THE 10416 07:11:49,120 --> 07:11:50,680 PERUVIAN STUDIES, STRONG 10417 07:11:50,680 --> 07:11:53,440 COLLABORATION WITH DR. TATIANA, 10418 07:11:53,440 --> 07:11:57,560 AND I THINK, YOU KNOW, 10419 07:11:57,560 --> 07:11:58,400 FACILITATING COLLABORATIONS 10420 07:11:58,400 --> 07:11:59,160 BETWEEN NETWORKS OF SPECIALLY, 10421 07:11:59,160 --> 07:12:04,360 YOU KNOW, AS U.S. LATINAS WITH 10422 07:12:04,360 --> 07:12:06,200 LATINA AMERICAN INVESTIGATORS 10423 07:12:06,200 --> 07:12:07,960 WHERE WE CAN REALLY -- WE GET 10424 07:12:07,960 --> 07:12:12,120 EACH OTHER REALLY WELL AND WE 10425 07:12:12,120 --> 07:12:13,640 HAVE THAT FLEXIBILITY FROM -- I 10426 07:12:13,640 --> 07:12:15,040 LIVED THERE FOR MANY YEARS, I 10427 07:12:15,040 --> 07:12:20,320 KIND OF UNDERSTAND HOW THINGS 10428 07:12:20,320 --> 07:12:20,480 ARE. 10429 07:12:20,480 --> 07:12:22,640 I CAN HAVE A LOT OF DIALOGUE, 10430 07:12:22,640 --> 07:12:25,560 NOT A LOT OF EXPLANATION TO 10431 07:12:25,560 --> 07:12:27,640 NEEDS TO HAPPEN, COLLABORATIONS 10432 07:12:27,640 --> 07:12:29,960 BETWEEN U.S. AND LATINA 10433 07:12:29,960 --> 07:12:30,720 INVESTIGATORS AND LATINA 10434 07:12:30,720 --> 07:12:36,800 AMERICAN P.I.s ARE VERY 10435 07:12:36,800 --> 07:12:38,880 FRUITFUL IN MY OPINION. 10436 07:12:38,880 --> 07:12:43,760 >>THANK YOU. 10437 07:12:43,760 --> 07:12:47,160 DR. DUCONGE? 10438 07:12:47,160 --> 07:12:48,640 YOU'RE MUTED. 10439 07:12:48,640 --> 07:12:50,480 >>YES, I WAS SAYING I FULLY 10440 07:12:50,480 --> 07:12:51,880 AGREE WITH MY COLLEAGUES. 10441 07:12:51,880 --> 07:12:56,040 I JUST WANT TO ADD THAT IN MY 10442 07:12:56,040 --> 07:12:57,440 OPINION THERE'S A GREAT 10443 07:12:57,440 --> 07:13:04,560 POTENTIAL FOR THESE KIND OF 10444 07:13:04,560 --> 07:13:04,920 COLLABORATIONS. 10445 07:13:04,920 --> 07:13:05,880 IT'S BECOMING INCREASINGLY CLEAR 10446 07:13:05,880 --> 07:13:08,960 THE FIELD IS LOOKING FOR 10447 07:13:08,960 --> 07:13:09,600 MULTI-CENTER COLLABORATIVE 10448 07:13:09,600 --> 07:13:11,880 EFFORTS WORLDWIDE SCALE, IN 10449 07:13:11,880 --> 07:13:15,960 ORDER TO ENHANCE DIVERSITY AND 10450 07:13:15,960 --> 07:13:18,360 ACCOUNT FOR POTENTIAL 10451 07:13:18,360 --> 07:13:23,280 CONFOUNDERS, SUCH AS POPULATION 10452 07:13:23,280 --> 07:13:29,880 STRATIFICATION, TO DERIVE ROBUST 10453 07:13:29,880 --> 07:13:30,920 PREDICTIVE ALGORITHMS, INCLUDING 10454 07:13:30,920 --> 07:13:34,560 ACCESS TO DATABASES AND 10455 07:13:34,560 --> 07:13:37,160 REPOSITORIES WITH INFORMATION 10456 07:13:37,160 --> 07:13:39,920 FROM UNDERREPRESENTED GROUPS, 10457 07:13:39,920 --> 07:13:45,480 GIVEN DIFFICULTIES IN 10458 07:13:45,480 --> 07:13:47,320 RECRUITING, LANGUAGE BARRIERS, 10459 07:13:47,320 --> 07:13:49,440 SOME OTHER REASONS, I THINK THAT 10460 07:13:49,440 --> 07:13:51,840 WOULD BE GREAT. 10461 07:13:51,840 --> 07:13:54,160 OTHER AREAS OF POTENTIAL 10462 07:13:54,160 --> 07:13:56,760 COLLABORATIONS ARE TO PERFORM 10463 07:13:56,760 --> 07:13:58,720 META-ANALYSES AND TO CONDUCT 10464 07:13:58,720 --> 07:14:04,000 REPLICATION STUDIES TO CONFIRM 10465 07:14:04,000 --> 07:14:06,080 FINDINGS IN POPULATIONS LIKE 10466 07:14:06,080 --> 07:14:08,120 PUERTO RICO IS A RELATIVELY 10467 07:14:08,120 --> 07:14:11,040 SMALL POPULATION, SO FOR THE 10468 07:14:11,040 --> 07:14:14,160 SAKE OF GENERALIZABILITY AND 10469 07:14:14,160 --> 07:14:15,360 TRANSFERABILITY ACROSS DIFFERENT 10470 07:14:15,360 --> 07:14:17,400 LATINA POPULATIONS I THINK THAT 10471 07:14:17,400 --> 07:14:20,400 WOULD BE A WAY MOVING FORWARD IN 10472 07:14:20,400 --> 07:14:21,640 THIS DIRECTION. 10473 07:14:21,640 --> 07:14:26,040 >>THANK YOU. 10474 07:14:26,040 --> 07:14:30,160 WE'RE OVER TIME. 10475 07:14:30,160 --> 07:14:33,400 DR. SALINAS, A QUICK COMMENT? 10476 07:14:33,400 --> 07:14:38,200 >>YES, TWO QUICK COMMENTS. 10477 07:14:38,200 --> 07:14:40,800 FIRST TO TRY TO STANDARDIZE OUR 10478 07:14:40,800 --> 07:14:46,360 CENTERS IN LATIN AMERICA AND NIH 10479 07:14:46,360 --> 07:14:48,920 CAN HELP PROVIDE EDUCATION AND 10480 07:14:48,920 --> 07:14:51,720 MINIMAL REQUIREMENTS, THAT YOU 10481 07:14:51,720 --> 07:14:54,480 WISH THAT LATIN AMERICAN CENTER 10482 07:14:54,480 --> 07:14:57,120 CAN HAVE TO BE PART OF A 10483 07:14:57,120 --> 07:14:58,240 NETWORK. 10484 07:14:58,240 --> 07:15:05,320 AND THE SECOND ONE IS TO PLAY 10485 07:15:05,320 --> 07:15:08,160 THE ROLE TO CONNECT PEOPLE, ALL 10486 07:15:08,160 --> 07:15:12,000 OF US HAVE COLLABORATION WITH 10487 07:15:12,000 --> 07:15:14,600 THE U.S., BUT PERHAPS THE SAMPLE 10488 07:15:14,600 --> 07:15:18,240 SIZES ARE STILL NOT ENOUGH FOR 10489 07:15:18,240 --> 07:15:20,840 SOME OUTCOMES, JUST BECAUSE WE 10490 07:15:20,840 --> 07:15:23,600 MET ALL THE REQUIRED CENTERS 10491 07:15:23,600 --> 07:15:27,400 THAT CAN HELP US TO ACCOMPLISH 10492 07:15:27,400 --> 07:15:30,960 THE REQUIRED NUMBER. 10493 07:15:30,960 --> 07:15:38,280 SO NIH CAN HELP GIVE THE DIS 10494 07:15:38,280 --> 07:15:39,360 DISSEMINATION OF INFORMATION FOR 10495 07:15:39,360 --> 07:15:40,880 THE RESEARCHERS TO COLLABORATE 10496 07:15:40,880 --> 07:15:41,880 WITH EACH OTHER. 10497 07:15:41,880 --> 07:15:42,520 >>THANK YOU. 10498 07:15:42,520 --> 07:15:42,880 THANK YOU. 10499 07:15:42,880 --> 07:15:46,120 I WANT TO THANK THE PANELISTS 10500 07:15:46,120 --> 07:15:48,520 FOR REALLY VERY ENRICHING 10501 07:15:48,520 --> 07:15:49,320 DISCUSSION AND YOUR 10502 07:15:49,320 --> 07:15:49,760 PARTICIPATION. 10503 07:15:49,760 --> 07:15:50,760 SO WE'RE OVER TIME. 10504 07:15:50,760 --> 07:15:57,920 I'LL NOW TURN IT OVER TO LARISSA 10505 07:15:57,920 --> 07:16:00,400 FOR THE NEXT SESSION. 10506 07:16:00,400 --> 07:16:03,360 TAKE IT AWAY, LARISSA. 10507 07:16:03,360 --> 07:16:09,520 10508 07:16:09,520 --> 07:16:11,440 10509 07:16:11,440 --> 07:16:14,320 >>CAN YOU SEE MY SCREEN? 10510 07:16:14,320 --> 07:16:14,840 SORRY. 10511 07:16:14,840 --> 07:16:15,720 >>YES. 10512 07:16:15,720 --> 07:16:16,440 >>OKAY. 10513 07:16:16,440 --> 07:16:18,440 THANK YOU. 10514 07:16:18,440 --> 07:16:19,960 WELL, THANK YOU, RINA, AND THANK 10515 07:16:19,960 --> 07:16:21,400 YOU TO THE PANELISTS OF THE 10516 07:16:21,400 --> 07:16:23,800 GENOMICS SESSION FOR A VERY, 10517 07:16:23,800 --> 07:16:26,560 VERY ENRICHING AND INTERESTING 10518 07:16:26,560 --> 07:16:26,960 DISCUSSION. 10519 07:16:26,960 --> 07:16:29,960 LIKE WITH ALL THE PANELISTS AND 10520 07:16:29,960 --> 07:16:32,960 OTHER SESSIONS, WE REALLY 10521 07:16:32,960 --> 07:16:36,880 ENJOYED AND BELIEVE THAT THIS 10522 07:16:36,880 --> 07:16:39,960 WAS AN INCREDIBLY EDUCATIONAL 10523 07:16:39,960 --> 07:16:41,640 BRAINSTORMING TWO DAYS, THAT WE 10524 07:16:41,640 --> 07:16:43,600 HOPE ARE GOING TO BE INSPIRING, 10525 07:16:43,600 --> 07:16:47,280 NOT ONLY TO THOSE WHO ARE HERE 10526 07:16:47,280 --> 07:16:51,840 IN THE WORKSHOP, BUT ALSO OTHERS 10527 07:16:51,840 --> 07:16:55,640 WHO ARE WATCHING AFTER IT IS 10528 07:16:55,640 --> 07:16:56,640 POSTED ON VIDEOCAST. 10529 07:16:56,640 --> 07:16:58,720 WE WANT TO TAKE A FEW MINUTES 10530 07:16:58,720 --> 07:16:59,720 FOR CLOSING REMARKS. 10531 07:16:59,720 --> 07:17:01,680 BEFORE WE DO THAT, BEFORE WE 10532 07:17:01,680 --> 07:17:05,760 COME TO THE END I WOULD LIKE TO 10533 07:17:05,760 --> 07:17:09,240 SAY THANK YOU TO CONSTANZA, ONE 10534 07:17:09,240 --> 07:17:11,080 OF THE CO-CHAIRS WHO COULD NOT 10535 07:17:11,080 --> 07:17:13,480 BE HERE. 10536 07:17:13,480 --> 07:17:14,600 SHE WAS EXTREMELY CONTRIBUTORY 10537 07:17:14,600 --> 07:17:18,080 AND WE ENJOYED WORKING WITH HER 10538 07:17:18,080 --> 07:17:21,080 AND SHE ENJOYED CHAIRING TWO OF 10539 07:17:21,080 --> 07:17:24,040 THE -- MODERATING TWO SESSIONS 10540 07:17:24,040 --> 07:17:26,640 YESTERDAY. 10541 07:17:26,640 --> 07:17:28,400 MICHELE DOOSE AND I ARE SHARING 10542 07:17:28,400 --> 07:17:33,600 OUR THOUGHTS FOR THE LAST FEW 10543 07:17:33,600 --> 07:17:33,880 MINUTES. 10544 07:17:33,880 --> 07:17:37,600 FIRST, I WOULD LIKE TO -- SORRY. 10545 07:17:37,600 --> 07:17:39,320 I WOULD LIKE TO SHOW AGAIN THIS 10546 07:17:39,320 --> 07:17:41,760 MAP THAT I SHOWED AT THE VERY 10547 07:17:41,760 --> 07:17:43,520 BEGINNING OF THE WORKSHOP, AND 10548 07:17:43,520 --> 07:17:44,720 IT'S TO HIGHLIGHT AND SAY THANK 10549 07:17:44,720 --> 07:17:48,400 YOU TO ALL THE SPEAKERS THAT 10550 07:17:48,400 --> 07:17:51,920 PARTICIPATED, THAT SHARED TIME, 10551 07:17:51,920 --> 07:17:52,800 KNOWLEDGE, ENTHUSIASM OVER THE 10552 07:17:52,800 --> 07:17:55,000 LAST TWO DAYS. 10553 07:17:55,000 --> 07:17:57,440 WE HAVE 36 SPEAKERS FROM LATIN 10554 07:17:57,440 --> 07:17:59,160 AMERICA, UNITED STATES, EUROPE. 10555 07:17:59,160 --> 07:18:03,400 AND WE HAD AMPLE DISCUSSIONS ON 10556 07:18:03,400 --> 07:18:07,920 WAYS TO COLLABORATE ON ISSUES 10557 07:18:07,920 --> 07:18:09,680 EMERGING RESEARCH TOPICS, 10558 07:18:09,680 --> 07:18:10,560 BRAINSTORMING, FINDING 10559 07:18:10,560 --> 07:18:13,520 SOLUTIONS, FOR COMMON GROUND FOR 10560 07:18:13,520 --> 07:18:15,120 COMMON BENEFIT TO BOTH LATIN 10561 07:18:15,120 --> 07:18:21,280 AMERICA AND U.S. HISPANIC LATINA 10562 07:18:21,280 --> 07:18:21,840 POPULATIONS. 10563 07:18:21,840 --> 07:18:24,680 IN ESSENCE, MULTIPLE CHALLENGES 10564 07:18:24,680 --> 07:18:27,440 AND DISPARITIES EXIST AND 10565 07:18:27,440 --> 07:18:31,800 PERSEVERE RELATED TO NON-COMMUNE 10566 07:18:31,800 --> 07:18:33,520 C OMMUNICABLE DISEASES IN LATIN 10567 07:18:33,520 --> 07:18:34,320 AMERICA, OPPORTUNITIES TO DO 10568 07:18:34,320 --> 07:18:37,160 RESEARCH AND CHANGE FOR GOOD. 10569 07:18:37,160 --> 07:18:39,360 WE LEARNED THAT THERE ARE MANY 10570 07:18:39,360 --> 07:18:41,640 STUDIES AND INTERVENTIONS THAT 10571 07:18:41,640 --> 07:18:45,600 ARE SHEDDING LIGHT ON FINDINGS 10572 07:18:45,600 --> 07:18:48,320 ABOUT HEALTH, ON INTERVENTIONS 10573 07:18:48,320 --> 07:18:50,520 OR APPLICATIONS OF KNOWLEDGE ON 10574 07:18:50,520 --> 07:18:52,920 METHODOLOGY, AND ALSO HOW TO 10575 07:18:52,920 --> 07:18:56,480 COLLABORATE AND HOW TO CONTACT 10576 07:18:56,480 --> 07:18:58,200 THE POPULATION, FOR INSTANCE IT 10577 07:18:58,200 --> 07:19:03,120 WAS A COMMON THEME ACROSS SOME 10578 07:19:03,120 --> 07:19:05,960 OF THE PRESENTATIONS THAT 10579 07:19:05,960 --> 07:19:07,600 THERE'S HUMAN CAPITAL, 10580 07:19:07,600 --> 07:19:08,120 INVESTIGATORS, KNOWLEDGE, 10581 07:19:08,120 --> 07:19:11,320 TRAINING, MORE TRAINING IS 10582 07:19:11,320 --> 07:19:13,520 NEEDED STILL, THERE'S 10583 07:19:13,520 --> 07:19:13,920 INFRASTRUCTURE AND 10584 07:19:13,920 --> 07:19:15,360 INFRASTRUCTURE THAT IS STRONG IN 10585 07:19:15,360 --> 07:19:19,200 SOME PLACES, IN OTHER PLACES 10586 07:19:19,200 --> 07:19:27,840 NEEDS IMPROVEMENT, IT IS THERE. 10587 07:19:27,840 --> 07:19:29,280 IT'S IMPORTANT WHEN WE PERFORMED 10588 07:19:29,280 --> 07:19:30,800 STUDIES THAT THEY ARE RELEVANT 10589 07:19:30,800 --> 07:19:33,000 TO THE POPULATION OF INTEREST, 10590 07:19:33,000 --> 07:19:34,320 AND THAT WE MEET THEIR NEEDS AS 10591 07:19:34,320 --> 07:19:36,400 WELL, THAT WE HAVE THAT 10592 07:19:36,400 --> 07:19:38,360 CONVERSATION WITH THEM, AND BY 10593 07:19:38,360 --> 07:19:40,360 POPULATION WE MEAN BOTH 10594 07:19:40,360 --> 07:19:45,480 PARTICIPANTS IN THE STUDIES AND 10595 07:19:45,480 --> 07:19:47,680 ALSO INVESTIGATORS. 10596 07:19:47,680 --> 07:19:50,800 THAT MANY ADOPTING CREATIVE 10597 07:19:50,800 --> 07:19:51,600 RECRUITMENT APPROACHES GOING 10598 07:19:51,600 --> 07:19:52,720 WHERE THE PATIENTS ARE, WHERE 10599 07:19:52,720 --> 07:19:56,840 THE INDIVIDUALS ARE, WHERE THE 10600 07:19:56,840 --> 07:19:59,960 POPULATION IS, AND THIS MAKES 10601 07:19:59,960 --> 07:20:02,120 ALL SENSE. 10602 07:20:02,120 --> 07:20:04,840 AND IDENTIFYING SOCIAL AND 10603 07:20:04,840 --> 07:20:06,200 ENVIRONMENTAL FACTORS. 10604 07:20:06,200 --> 07:20:06,960 MICHELE? 10605 07:20:06,960 --> 07:20:08,280 >>YEAH, I THINK WE'RE STARTING 10606 07:20:08,280 --> 07:20:09,640 TO IDENTIFY IMPORTANT CITY AND 10607 07:20:09,640 --> 07:20:11,120 NEIGHBORHOOD DRIVERS OF HEALTH 10608 07:20:11,120 --> 07:20:12,400 AND HEALTH INEQUITIES. 10609 07:20:12,400 --> 07:20:13,640 YET THERE'S STILL A LOT OF 10610 07:20:13,640 --> 07:20:18,240 SOCIAL AND ENVIRONMENTAL FACTORS 10611 07:20:18,240 --> 07:20:23,680 THAT REMAIN UNDEREXPLORED. 10612 07:20:23,680 --> 07:20:25,880 >>WE ALSO LEARNED THAT THERE IS 10613 07:20:25,880 --> 07:20:28,720 STILL A HUGE NEED FOR BOTH 10614 07:20:28,720 --> 07:20:30,480 PREVENTION AND MANAGEMENT OF 10615 07:20:30,480 --> 07:20:32,200 CHRONIC DISEASES IN LATIN 10616 07:20:32,200 --> 07:20:35,960 AMERICA, ALSO AMONG U.S. 10617 07:20:35,960 --> 07:20:37,280 HISPANIC LATINAS. 10618 07:20:37,280 --> 07:20:39,880 NOW, COMMENTS WERE MADE TO 10619 07:20:39,880 --> 07:20:44,360 PROTECT RESOURCES FOR BOTH, NOT 10620 07:20:44,360 --> 07:20:45,360 SACRIFICING TREATMENT OR 10621 07:20:45,360 --> 07:20:47,960 MANAGEMENT TO DO PREVENTION OR 10622 07:20:47,960 --> 07:20:51,360 VICE VERSA, THAT BOTH NEED TO BE 10623 07:20:51,360 --> 07:20:51,880 DONE. 10624 07:20:51,880 --> 07:20:53,680 THAT DATA COLLECTION AND QUALITY 10625 07:20:53,680 --> 07:20:55,320 MEASURES ARE EXTREMELY IMPORTANT 10626 07:20:55,320 --> 07:20:58,080 AND THESE WERE HIGHLIGHTED AND 10627 07:20:58,080 --> 07:20:59,600 UNDERLINED IN SEVERAL 10628 07:20:59,600 --> 07:21:01,680 PRESENTATIONS, AND IN FACT SOME 10629 07:21:01,680 --> 07:21:03,680 STUDIES HAVE BEEN DOING IT AND 10630 07:21:03,680 --> 07:21:07,280 HAVE DEMONSTRATED HOW TO DO IT 10631 07:21:07,280 --> 07:21:08,440 EFFICIENTLY. 10632 07:21:08,440 --> 07:21:10,120 THE ROLE OF DIGITAL TECHNOLOGY 10633 07:21:10,120 --> 07:21:13,720 IN ENGAGING PATIENTS OR ENGAGING 10634 07:21:13,720 --> 07:21:16,800 PARTICIPANTS IN REPORTING THEIR 10635 07:21:16,800 --> 07:21:21,720 OWN OUTCOMES BUT ALSO IN 10636 07:21:21,720 --> 07:21:22,320 INTERVENTIONS. 10637 07:21:22,320 --> 07:21:23,280 ARTIFICIAL INTELLIGENCE WAS ALSO 10638 07:21:23,280 --> 07:21:25,960 A THEME THAT ESPECIALLY WAS 10639 07:21:25,960 --> 07:21:27,400 ADDRESSED TODAY. 10640 07:21:27,400 --> 07:21:28,400 ARTIFICIAL INTELLIGENCE IS 10641 07:21:28,400 --> 07:21:31,800 GROWING, IT'S A FIELD THAT IS 10642 07:21:31,800 --> 07:21:35,400 BECOMING MORE AND MORE 10643 07:21:35,400 --> 07:21:35,720 IMPORTANT. 10644 07:21:35,720 --> 07:21:39,640 AND IN A WAY HELPS TO CREATE 10645 07:21:39,640 --> 07:21:42,480 ALGORITHMS TO MAKE DECISIONS. 10646 07:21:42,480 --> 07:21:44,920 NOW, IT IS NOT THE ALGORITHM 10647 07:21:44,920 --> 07:21:47,080 THAT IS GOING TO RESOLVE ALL THE 10648 07:21:47,080 --> 07:21:49,360 PROBLEMS, OR THAT WE SHOULD 10649 07:21:49,360 --> 07:21:55,960 DEPEND ON IT ONLY. 10650 07:21:55,960 --> 07:21:56,720 THE HUMAN COMPONENT, 10651 07:21:56,720 --> 07:21:57,960 RELATIONSHIP BETWEEN CLINICIAN 10652 07:21:57,960 --> 07:21:59,360 AND PATIENT IS ESSENTIAL. 10653 07:21:59,360 --> 07:22:00,320 THROUGH THAT RELATIONSHIP THE 10654 07:22:00,320 --> 07:22:02,320 INTERPRETATIONS OF THE RESULT IS 10655 07:22:02,320 --> 07:22:04,600 GOING TO HAPPEN. 10656 07:22:04,600 --> 07:22:05,000 MICHELE? 10657 07:22:05,000 --> 07:22:08,200 >>YES, I WANT TO ADD UNMET 10658 07:22:08,200 --> 07:22:09,440 HEALTH CARE NEEDS DUE TO 10659 07:22:09,440 --> 07:22:10,960 BARRIERS CONTINUES TO BE A 10660 07:22:10,960 --> 07:22:13,160 PROBLEM, IN LATIN AMERICA AND IN 10661 07:22:13,160 --> 07:22:14,040 THE U.S. 10662 07:22:14,040 --> 07:22:16,960 THERE ARE NEW EFFORTS TO 10663 07:22:16,960 --> 07:22:17,720 INTEGRATE SYSTEMS, PUBLIC 10664 07:22:17,720 --> 07:22:19,280 HEALTH, HEALTH CARE, SOCIAL 10665 07:22:19,280 --> 07:22:20,680 SERVICES, AND LESSONS LEARNED 10666 07:22:20,680 --> 07:22:23,280 HOW TO STRENGTHEN PRIMARY CARE, 10667 07:22:23,280 --> 07:22:24,640 WHAT TEAM-BASED CARE, AND ALSO 10668 07:22:24,640 --> 07:22:29,560 LESSONS TO BE LEARNED FROM 10669 07:22:29,560 --> 07:22:32,760 RESILIENT HEALTH SYSTEMS, 10670 07:22:32,760 --> 07:22:34,160 ESPECIALLY LEARNING FROM PUERTO 10671 07:22:34,160 --> 07:22:34,600 RICO. 10672 07:22:34,600 --> 07:22:37,920 >>WE HEARD ABOUT EFFECTIVE 10673 07:22:37,920 --> 07:22:40,000 COMMUNITY ENGAGED RESEARCH, AND 10674 07:22:40,000 --> 07:22:48,920 WE LEARNED IT WAS SUPER 10675 07:22:48,920 --> 07:22:51,960 EMPHASIZED THAT ENHANCES, 10676 07:22:51,960 --> 07:22:52,480 GUARANTEES, STRENGTHENS 10677 07:22:52,480 --> 07:22:53,880 PARTICIPATION AND MEMBERS OF THE 10678 07:22:53,880 --> 07:22:56,000 COMMUNITY THAT GET THE 10679 07:22:56,000 --> 07:22:58,920 EDUCATION, GET THE LEARNING, THE 10680 07:22:58,920 --> 07:23:01,600 ESSENCE OF WHAT RESEARCH IS AND 10681 07:23:01,600 --> 07:23:05,600 THAT BUILDING TRUST IN SCIENCE. 10682 07:23:05,600 --> 07:23:07,280 ALSO, WE HEARD ABOUT HEALTH AND 10683 07:23:07,280 --> 07:23:08,360 PUBLIC POLICIES. 10684 07:23:08,360 --> 07:23:11,640 AND HOW THEY IMPACT OR INFLUENCE 10685 07:23:11,640 --> 07:23:13,720 HEALTH, HEALTH OUTCOMES, AND 10686 07:23:13,720 --> 07:23:14,400 RESEARCH. 10687 07:23:14,400 --> 07:23:16,120 FOR INSTANCE, WE HEARD ABOUT 10688 07:23:16,120 --> 07:23:18,760 SOME PUBLIC POLICIES THAT HAVE 10689 07:23:18,760 --> 07:23:20,920 DEMONSTRATED POSITIVE IMPACT ON 10690 07:23:20,920 --> 07:23:23,800 HEALTH OUTCOMES LIKE MORTALITY, 10691 07:23:23,800 --> 07:23:25,680 OR SOME INTERMEDIATE OUTCOMES 10692 07:23:25,680 --> 07:23:27,880 LIKE CHANGES IN LIFESTYLE OR 10693 07:23:27,880 --> 07:23:30,160 HABITS OR SOME CLINICAL 10694 07:23:30,160 --> 07:23:30,960 OUTCOMES. 10695 07:23:30,960 --> 07:23:33,600 AT THE SAME TIME, WE HEARD ABOUT 10696 07:23:33,600 --> 07:23:36,400 POLICIES THAT COULD ACTUALLY BE 10697 07:23:36,400 --> 07:23:37,840 HARMING AND HINDERING THE HEALTH 10698 07:23:37,840 --> 07:23:40,440 AND ACCESS TO HEALTH CARE FOR 10699 07:23:40,440 --> 07:23:43,200 SOME POPULATIONS, ALSO HAVING AN 10700 07:23:43,200 --> 07:23:47,400 IMPACT ON THE HEALTH WORKFORCE 10701 07:23:47,400 --> 07:23:48,200 AND FUNDING FOR RESEARCH. 10702 07:23:48,200 --> 07:23:52,600 IN ORDER TO BE EFFECTIVE, IN 10703 07:23:52,600 --> 07:23:53,920 ORDER FOR IMPLEMENTATION OF 10704 07:23:53,920 --> 07:23:57,080 RESEARCH FINDINGS TO BE 10705 07:23:57,080 --> 07:23:59,360 EFFECTIVE AND LONG TERM, 10706 07:23:59,360 --> 07:24:01,560 GOVERNANCE IS NEEDED. 10707 07:24:01,560 --> 07:24:03,200 GOVERNANCE FROM MINISTRIES OF 10708 07:24:03,200 --> 07:24:05,920 HEALTH, FROM ALL THOSE LOCAL 10709 07:24:05,920 --> 07:24:06,640 GOVERNMENTS, AGENCIES OR 10710 07:24:06,640 --> 07:24:10,120 ENTITIES, THAT ARE GOING TO 10711 07:24:10,120 --> 07:24:14,360 FOSTER AND STRENGTHEN AND MAKE 10712 07:24:14,360 --> 07:24:15,960 SURE RESULTS ARE GOING TO BE 10713 07:24:15,960 --> 07:24:19,960 IMPLEMENTED AND GOING TO BE 10714 07:24:19,960 --> 07:24:20,400 LASTING. 10715 07:24:20,400 --> 07:24:23,880 AND THERE'S ALSO -- IT WAS ALSO 10716 07:24:23,880 --> 07:24:27,600 NOTED FOR MANY POLICIES, 10717 07:24:27,600 --> 07:24:28,400 EVALUATION IS NEEDED. 10718 07:24:28,400 --> 07:24:32,440 IN TERMS OF THE HISTORY OF THE 10719 07:24:32,440 --> 07:24:34,480 DISPARITIES, DISCRIMINATION AND 10720 07:24:34,480 --> 07:24:37,680 OPPRESSION, THAT'S EXPERIENCED 10721 07:24:37,680 --> 07:24:40,120 BY INDIGENOUS POPULATIONS, IT 10722 07:24:40,120 --> 07:24:43,360 WAS MENTIONED THAT HEALTH 10723 07:24:43,360 --> 07:24:45,160 EDUCATION IS A GREAT APPROACH TO 10724 07:24:45,160 --> 07:24:47,960 INCREASE EQUITY, AT THE SAME 10725 07:24:47,960 --> 07:24:50,760 TIME RESEARCHERS NEED TO BE 10726 07:24:50,760 --> 07:24:52,160 VERY, VERY EXTREMELY COGNIZANT 10727 07:24:52,160 --> 07:24:55,880 OF THAT HISTORY, OF THAT 10728 07:24:55,880 --> 07:24:57,400 BACKGROUND, AND DEMONSTRATE AND 10729 07:24:57,400 --> 07:25:00,160 APPROACH THIS POPULATION WITH 10730 07:25:00,160 --> 07:25:02,760 EMPATHY, BUT ALSO VERY, VERY 10731 07:25:02,760 --> 07:25:05,200 IMPORTANTLY ADDRESS RESEARCH AND 10732 07:25:05,200 --> 07:25:08,040 CONSIDER RESEARCH DESIGNED AND 10733 07:25:08,040 --> 07:25:09,680 IMPLICATIONS, CONSEQUENCE OF 10734 07:25:09,680 --> 07:25:11,520 THAT RESEARCH FROM ETHICAL 10735 07:25:11,520 --> 07:25:11,880 PERSPECTIVE. 10736 07:25:11,880 --> 07:25:14,080 MICHELE, DO YOU WANT TO SAY 10737 07:25:14,080 --> 07:25:14,720 SOMETHING? 10738 07:25:14,720 --> 07:25:14,920 SORRY. 10739 07:25:14,920 --> 07:25:21,360 >>NO, I WAS AT THE -- I'LL WAIT 10740 07:25:21,360 --> 07:25:24,000 TILL THE NEXT SLIDE. 10741 07:25:24,000 --> 07:25:27,520 >>WE HEARD THAT IT'S DIFFERENT 10742 07:25:27,520 --> 07:25:32,560 FROM THE U.S., STILL 10743 07:25:32,560 --> 07:25:33,760 DISCRIMINATION, RACISM AND 10744 07:25:33,760 --> 07:25:35,280 MISTREATMENT EXISTS ACROSS THE 10745 07:25:35,280 --> 07:25:44,920 REGION. 10746 07:25:44,920 --> 07:25:45,560 LOW REPRESENTATION? 10747 07:25:45,560 --> 07:25:49,640 STUDIES YET THIS IS AN 10748 07:25:49,640 --> 07:25:50,160 OPPORTUNITY. 10749 07:25:50,160 --> 07:25:58,600 THERE IS A STUDY THAT HAS 10750 07:25:58,600 --> 07:25:59,960 DEMONSTRATED UNIQUE VARIANTS 10751 07:25:59,960 --> 07:26:01,200 ASSOCIATED WITH PROTECTION, DUE 10752 07:26:01,200 --> 07:26:03,960 TO INCREASE IN MEN'S DIVERSITY 10753 07:26:03,960 --> 07:26:07,640 OF GENETIC POOL, MIXTURE OF 10754 07:26:07,640 --> 07:26:09,760 LATIN AMERICAN, HISPANIC 10755 07:26:09,760 --> 07:26:10,000 LATINOS. 10756 07:26:10,000 --> 07:26:12,160 AND THESE DISCOVERIES ARE 10757 07:26:12,160 --> 07:26:15,800 SETTING THE PATH, PLANTING THE 10758 07:26:15,800 --> 07:26:17,640 SEEDS, FOR PRECISION MEDICINE. 10759 07:26:17,640 --> 07:26:20,200 DISCOVERIES, DESCRIPTION OF 10760 07:26:20,200 --> 07:26:21,480 CLINICAL PHENOTYPES, 10761 07:26:21,480 --> 07:26:24,560 PHARMACOGENOMICS, FOR EXAMPLE. 10762 07:26:24,560 --> 07:26:25,520 AND THIS REPRESENTS 10763 07:26:25,520 --> 07:26:26,640 OPPORTUNITIES FOR FUTURE 10764 07:26:26,640 --> 07:26:27,480 TRANSLATION INTO CLINICAL CARE. 10765 07:26:27,480 --> 07:26:34,040 >>I WANT TO ADD THAT I 10766 07:26:34,040 --> 07:26:35,800 APPRECIATE HISTORICAL CONTEXT IN 10767 07:26:35,800 --> 07:26:38,000 LATIN AMERICA AND ALSO 10768 07:26:38,000 --> 07:26:41,240 HIGHLIGHTING THAT LATINOS IS NOT 10769 07:26:41,240 --> 07:26:45,760 A MONOLITHTIC GROUP AND WE NEED 10770 07:26:45,760 --> 07:26:47,080 BETTER DATA TO STOP 10771 07:26:47,080 --> 07:26:47,840 DISCRIMINATION IN OUR 10772 07:26:47,840 --> 07:26:48,360 COMMUNITIES. 10773 07:26:48,360 --> 07:26:51,440 I HEARD NEED FOR COORDINATED 10774 07:26:51,440 --> 07:26:52,880 COLLABORATIVE EFFORTS WITH 10775 07:26:52,880 --> 07:26:55,120 REGIONAL CAPACITY STRENGTHENING 10776 07:26:55,120 --> 07:26:57,440 BEING KEY FOR ADVANCING RESEARCH 10777 07:26:57,440 --> 07:26:59,080 AND APPRECIATED SPEAKERS 10778 07:26:59,080 --> 07:27:04,360 HIGHLIGHTING THEIR WORK DOING 10779 07:27:04,360 --> 07:27:05,640 TRANSNATIONAL RESEARCH AND 10780 07:27:05,640 --> 07:27:07,880 LEARNING ABOUT OPPORTUNITIES AND 10781 07:27:07,880 --> 07:27:10,680 CHALLENGES THEY HAVE OVERCOME. 10782 07:27:10,680 --> 07:27:13,840 >>AND WE HEARD ABOUT EFFECTIVE 10783 07:27:13,840 --> 07:27:21,520 COLLABORATIONS WITH U.S. 10784 07:27:21,520 --> 07:27:22,280 INVESTIGATORS. 10785 07:27:22,280 --> 07:27:23,840 RECOMMENDATIONS, JUST MAKING 10786 07:27:23,840 --> 07:27:27,520 SURE, HORIZONTAL ENGAGEMENT OF 10787 07:27:27,520 --> 07:27:29,840 LATIN AMERICAN INVESTIGATORS ALL 10788 07:27:29,840 --> 07:27:33,680 AT THE SAME LEVEL, PARTNERSHIPS, 10789 07:27:33,680 --> 07:27:36,320 RESPECTFUL CONSULTATION AND 10790 07:27:36,320 --> 07:27:36,960 PARTICIPATION, FROM THE OUTSET 10791 07:27:36,960 --> 07:27:41,040 AT THE TIME THE IDEA IS 10792 07:27:41,040 --> 07:27:43,640 CONCEIVED, AND THAT STUDY DESIGN 10793 07:27:43,640 --> 07:27:48,800 AND ALL METHODOLOGY AND ALL THE 10794 07:27:48,800 --> 07:27:51,440 HOW, WHY'S, WHATS, TO INCLUDE 10795 07:27:51,440 --> 07:27:52,200 THEM. 10796 07:27:52,200 --> 07:27:54,280 AND TO CREATE FORUM OR MORE THAN 10797 07:27:54,280 --> 07:28:00,120 ONE FORUM TO FOSTER EXCHANGE OF 10798 07:28:00,120 --> 07:28:00,720 BEST PRACTICES. 10799 07:28:00,720 --> 07:28:01,720 MICHELE? 10800 07:28:01,720 --> 07:28:03,160 >>YOU'VE COVERED ALL THE 10801 07:28:03,160 --> 07:28:06,080 IMPORTANT POINTS. 10802 07:28:06,080 --> 07:28:10,480 >>NOW WE WOULD LIKE TO THANK 10803 07:28:10,480 --> 07:28:12,440 MANY PEOPLE. 10804 07:28:12,440 --> 07:28:14,680 FIRST, DR. ELISEO STABLE-PEREZ 10805 07:28:14,680 --> 07:28:15,600 FOR SUPPORTING THIS WORKSHOP. 10806 07:28:15,600 --> 07:28:19,040 I WOULD LIKE TO THANK OUR 10807 07:28:19,040 --> 07:28:22,640 COLLEAGUES AND FRIENDS FROM 10808 07:28:22,640 --> 07:28:25,560 NIMHD AND OTHERS FOR SUPPORTING 10809 07:28:25,560 --> 07:28:30,640 US, COLLABORATING, PARTICIPATING 10810 07:28:30,640 --> 07:28:32,360 IN THIS WORKSHOP. 10811 07:28:32,360 --> 07:28:36,960 RINA DAS, JARRETT JOHN TOES, 10812 07:28:36,960 --> 07:28:38,520 SIMULATIONRANN AND CAROLINA WITH 10813 07:28:38,520 --> 07:28:48,960 MODERATORS, AND I WANT TO 10814 07:28:50,640 --> 07:28:52,960 MENTION THE OTHERS AND 10815 07:28:52,960 --> 07:28:54,840 ADMINISTRATIVE OFFICIALS. 10816 07:28:54,840 --> 07:28:56,560 MICHELE? 10817 07:28:56,560 --> 07:28:59,240 >>I WANT TO THANK OUR SPEAKERS 10818 07:28:59,240 --> 07:28:59,840 TODAY. 10819 07:28:59,840 --> 07:29:00,880 I HEARD OPTIMISM, OPPORTUNITY, 10820 07:29:00,880 --> 07:29:04,320 SOLUTIONS TO ADDRESS THE BURDENS 10821 07:29:04,320 --> 07:29:05,840 OF NON-COMMUNICABLE DISEASES 10822 07:29:05,840 --> 07:29:07,360 THAT IMPACT OUR COMMUNITY ACROSS 10823 07:29:07,360 --> 07:29:07,840 THE HEMISPHERE. 10824 07:29:07,840 --> 07:29:10,200 I WANT TO THANK OUR TEAM FOR 10825 07:29:10,200 --> 07:29:11,400 MAKING THIS WORKSHOP A SUCCESS 10826 07:29:11,400 --> 07:29:12,840 AND THERE WERE A LOT OF PEOPLE 10827 07:29:12,840 --> 07:29:15,360 BEHIND THE SCENES THAT MADE SURE 10828 07:29:15,360 --> 07:29:18,200 EVERYTHING FLOWED NICELY. 10829 07:29:18,200 --> 07:29:20,920 THANK YOU TO SIDEM, MARK GIFFORD 10830 07:29:20,920 --> 07:29:23,120 FOR THE E-MAILS, MEETINGS, 10831 07:29:23,120 --> 07:29:25,280 EDITS, MAKING SURE THE WORKSHOP 10832 07:29:25,280 --> 07:29:26,640 RAN SMOOTHLY, GREATLY APPRECIATE 10833 07:29:26,640 --> 07:29:31,200 IT. 10834 07:29:31,200 --> 07:29:33,480 I WANT TO THANK MY CO-CHAIR AND 10835 07:29:33,480 --> 07:29:39,520 TAKE A MOMENT TO THANK AND 10836 07:29:39,520 --> 07:29:47,320 RECOGNIZE DR. LARISSA 10837 07:29:47,320 --> 07:29:48,000 AVILES-SANTA. 10838 07:29:48,000 --> 07:29:53,560 HER VISION IS A PARADIGM SHIFT, 10839 07:29:53,560 --> 07:29:55,520 WE AS RESEARCHERS MUST IMPOSE 10840 07:29:55,520 --> 07:29:57,640 OUR KNOWLEDGE ONTO OTHER 10841 07:29:57,640 --> 07:29:59,320 COUNTRIES, TO REALLY REFRAMING 10842 07:29:59,320 --> 07:30:00,360 THIS PERSPECTIVE THERE'S SO MUCH 10843 07:30:00,360 --> 07:30:03,880 WE CAN LEARN FROM RESEARCHERS IN 10844 07:30:03,880 --> 07:30:05,280 LATIN AMERICA AND IDENTIFYING 10845 07:30:05,280 --> 07:30:08,680 OPPORTUNITIES TO COLLABORATE, TO 10846 07:30:08,680 --> 07:30:11,320 ANSWER UNANSWERED QUESTIONS THAT 10847 07:30:11,320 --> 07:30:12,400 REMAIN REGARDING HEALTH AND LIFE 10848 07:30:12,400 --> 07:30:15,520 CARE ACROSS THE LIFE COURSE, 10849 07:30:15,520 --> 07:30:16,040 GENERATIONS, COUNTRIES, 10850 07:30:16,040 --> 07:30:18,200 BOUNDARIES, WITHIN THE DIVERSE 10851 07:30:18,200 --> 07:30:25,920 OF LATINOS AND HISPANICS 10852 07:30:25,920 --> 07:30:26,400 INCLUDING INDIGENOUS 10853 07:30:26,400 --> 07:30:26,680 POPULATIONS. 10854 07:30:26,680 --> 07:30:37,000 [SPEAKING SPANISH] 10855 07:30:55,360 --> 07:30:56,360 >>THANK YOU. 10856 07:30:56,360 --> 07:30:57,200 YOU'RE AN INSPIRATION. 10857 07:30:57,200 --> 07:30:58,400 THANK YOU FOR YOUR HARD WORK TO 10858 07:30:58,400 --> 07:31:01,040 MAKE THIS VISION COME TRUE. 10859 07:31:01,040 --> 07:31:02,440 >>THANK YOU, MICHELE! 10860 07:31:02,440 --> 07:31:03,240 THANK YOU. 10861 07:31:03,240 --> 07:31:05,880 WE WOULD LIKE TO CLOSE WITH A 10862 07:31:05,880 --> 07:31:09,560 NOTE THAT WE ARE VERY, VERY 10863 07:31:09,560 --> 07:31:12,000 COGNIZANT THAT NOVEMBER 1 AND 10864 07:31:12,000 --> 07:31:16,080 NOVEMBER 2 ARE DAYS OF 10865 07:31:16,080 --> 07:31:23,480 CELEBRATION IN LATIN AMERICA, 10866 07:31:23,480 --> 07:31:24,960 DIA DE LOS MUERTOS. 10867 07:31:24,960 --> 07:31:27,360 WE'RE GRATEFUL FOR THAT. 10868 07:31:27,360 --> 07:31:35,400 AND WITH THIS, THANK YOU AGAIN, 10869 07:31:35,400 --> 07:31:36,360 MUCHAS GRACIAS PORE TODO, WE 10870 07:31:36,360 --> 07:31:38,840 HOPE THIS IS THE BEGINNING OF A 10871 07:31:38,840 --> 07:31:41,880 LONG TERM RELATIONSHIP, SO THANK 10872 07:31:41,880 --> 07:31:50,840 YOU AGAIN, GOOD EVENING, GOOD 10873 07:31:50,840 --> 00:00:00,000 NIGHT.