Cristian Morales, an economist by training, has dedicated his career to improving health and health equity in the Americas through his work with PAHO/WHO. This has taken him from hurricanes, earthquakes and epidemics in Haiti to PAHO’s Washington DC offices, where he was instrumental in achieving consensus on a resolution aiming for universal health—coverage plus […]
Dr Héctor Javier Sánchez specializes in public health and research methodology and holds a master’s degree in epidemiology. He is a senior researcher in the Society, Culture and Health Department at El Colegio de la Frontera Sur, Mexico. The Colegio is a public research institution concentrating on environmental, economic and social issues related to a […]
ABSTRACT
The current pandemic has rocked the lives of human beings everywhere in ways never imagined, forcing us to question where our civilization is headed. In this article, we explore and discuss scientific evidence that helps explain recent events in the context of the COVID-19 pandemic.
COVID-19 is caused by infection with a zoonotic-origin novel virus, SARS-CoV-2, that is genetically close to two coronavirus types isolated in bats. The transmission dynamics to humans from the original and intermediary hosts remain poorly understood, but it is highly likely that the SARS-CoV-2 virus infected humans after undergoing an interspecies transfer from bats to an intermediate species, and from there to human beings. Crossing the species barrier is largely fostered by industrial-scale agricultural practices that simplify original ecosystem connections by reducing biodiversity, facilitating the emergence of new infectious diseases.
The scientific community has played an exemplary role in responding to this global emergency, working to find timely, relevant solutions for governments and society as a whole. We need to take this opportunity to promote a global and open science that delves into the interrelationships of the biological, environmental, social and economic dimensions of this and other diseases while questioning current modes of production and their impact on the environment, and thus on human health worldwide.
Keywords: Coronavirus infections; communicable diseases; zoonoses; ecosystems; technology, industry, and agriculture; pandemics; global health; Mexico
ERRATUM
The following erratum has been corrected in all versions of this article.
Page 16, in the Figure 1 should read “SARS, MERS, SARS-CoV-2”
INTRODUCTION The consequences of de novo balanced structural chromosome aberrations diagnosed antenatally are unpredictable, and, as a result, they introduce uncertainty into genetic counseling decisions.
OBJECTIVE Describe de novo balanced structural aberrations present at antenatal diagnosis in samples from pregnant women in five Latin American countries and determine their effect on carrier individuals.
METHODS This was a retrospective observational study based on analysis of 109,011 antenatal tests conducted from January 1981 to December 2016 in Cuba, Uruguay, Costa Rica, Mexico, and Colombia. Thirteen cytogenetic laboratories provided information that included the cases analyzed during the study period; number of de novo balanced structural aberrations diagnosed antenatally; number of diagnoses with de novo balanced structural aberrations that resulted in termination of pregnancy; detailed descriptions of the karyotypes of de novo balanced structural aberration carriers, and descriptions of the form of diagnosis, including types of samples used (amniotic fluid, chorionic villus or fetal blood). Each laboratory also provided pathology reports and genetic counseling at time of diagnosis. Postnatal followup for pregnancies carried to term continued for at least two years.
RESULTS Of the 109,011 antenatal tests studied, 72 (0.07%) showed de novo balanced structural aberrations. These events primarily involved chromosomes 1, 2, 7, 14, 18, and 20. Of the 79 breakpoints identified, the most common were 5p15.3, 7q11.2, 7q22, and 14q24. We identified three breakpoints corresponding to 3.8% (3q13.1, 3q13.2, and 9p12) that were not reported in other studies of de novo balanced structural aberrations diagnosed antenatally in patients from other geographic regions or in studies of chromosomal fragile sites. Two of these breakpoints (3q13.1 and 3q13.2) were associated with high risk of phenotypic abnormalities. Information on antenatal or postnatal followup was available for 62 (86%) of de novo balanced structural aberration carriers; of the 44 carriers with postnatal followup, 10 had phenotypic abnormalities.
CONCLUSIONS Three new de novo breakpoints were identified, presumably related to genetic admixture characteristics in Latin America. Since some diseases associated with de novo balanced structural aberrations detected antenatally have a late onset, followup for at least two years is recommended for carriers of these aberrations. The information in this study is useful in genetic counseling for pregnant women in Latin America.
KEYWORDS Antenatal diagnosis, prenatal diagnosis, antenatal screening, chromosomal aberrations, chromosomal breakpoints, pregnancy, Colombia, Costa Rica, Cuba, Mexico, Uruguay, Latin America
ABSTRACT
INTRODUCTION Despite growing research interest in the epidemic of chronic kidney disease of nontraditional etiology (a distinct form of chronic kidney disease disproportionately affecting agricultural populations across Mesoamerica—Central America and southern Mexico), its etiology remains poorly understood.
OBJECTIVE Elucidate factors that impact researchers’ efforts to understand the epidemic of chronic kidney disease of nontraditional etiology.
METHODS Semistructured interviews were conducted with 39 international researchers, selected based on their publications and participation in conferences about chronic kidney disease of nontraditional etiology. Interviews were conducted from May through September of 2015 in English or Spanish by video conference, telephone or in person. Interviews were audio recorded, transcribed, and analyzed iteratively using content analysis.
RESULTS Of 39 researchers interviewed, 30.8% were women, 84.6% had a medical and/or doctoral degree and 74.3% had ≥6 years’ experience carrying out research on chronic kidney disease of nontraditional etiology. Three major themes were identified related to factors affecting research progress. The first, influence of state and private interests, concerned perceptions that sugar industry and some governments in Mesoamerica dismissed, hindered, intimidated and inaccurately represented research on chronic kidney disease of nontraditional etiology. The second, limited material and human resources, had to do with scarcity of stable, impartial funding and adequate in-country research infrastructure. Researchers were largely funded by nontraditional sources (charitable organizations, private donations, sugar industry in Mesoamerica, personal funds) or not funded at all. The third, logistical challenges across study lifetimes, referred to barriers such as unwieldy approval mechanisms, gang interference and publication hurdles.
CONCLUSIONS Producing high quality and clinically relevant studies to address chronic kidney disease of nontraditional etiology in the resource-scarce Mesoamerican research climate has been fraught with challenges. These findings contextualize the progress that has been made in understanding chronic kidney disease of nontraditional etiology to date and highlight the need for public health and biomedical organizations to support researchers’ ongoing efforts to engage all stakeholders in addressing the epidemic, disseminate their research findings and identify feasible strategies for addressing the community-wide suffering caused by chronic kidney disease of nontraditional etiology.
KEYWORDS Chronic kidney disease, chronic renal insufficiency, chronic renal failure, chronic kidney failure, interstitial nephritis, qualitative research, epidemiology, occupational health, Costa Rica, El Salvador, Guatemala, Mexico, Mesoamerica, Nicaragua
INTRODUCCIÓN El consumo de cigarrillos y de alcohol por estudiantes de ciencias de la salud (más allá de lo permitido por las normas sociales) constituye un comportamiento que contradice la función social que ellos desempeñarán como promotores de la salud en sus profesiones.
OBJETIVO Identificar la prevalencia del consumo de alcohol y tabaco en estudiantes de ciencias de la salud en México y Cuba para apoyar intervenciones educativas que promuevan estilos de vida saludables y el desarrollo de competencias profesionales que ayuden a reducir el impacto perjudicial de estas drogas legales en ambos países.
MÉTODOS Se realizó un estudio descriptivo transversal utilizando técnicas cuantitativas y cualitativas. Se recogieron datos proporcionados voluntariamente por estudiantes de ciencias de la salud en ambos países mediante una encuesta anónima autoaplicada, seguida de una entrevista en profundidad.
RESULTADOS La prevalencia de consumo de tabaco fue del 56.4% entre los estudiantes mexicanos y de 37% entre los cubanos. Fue mayor entre los hombres en ambos casos, pero también se observaron niveles sustanciales en las mujeres. En ambos grupos la mayoría estuvo expuesta regularmente al humo de tabaco ambiental.
La prevalencia de consumo de alcohol fue de 76.9% entre los estudiantes mexicanos y de 74.1% entre los estudiantes cubanos. En condiciones de riesgo clasificaron 44.4% entre los estudiantes mexicanos y 3.7% entre los cubanos.
CONCLUSIONES La elevada prevalencia de consumo de tabaco y alcohol en estos estudiantes de ciencias de la salud es motivo de preocupación y tiene consecuencias no solo en su salud individual, sino también sobre su eficacia profesional para disminuir el impacto de estas drogas en ambos países.
PALABRAS CLAVE Hábito de fumar, tabaco, dependencia de la nicotina, dependencia del alcohol, trastornos relacionados con el consumo de sustancias, desórdenes relacionados con el alcohol, adicción, comportamiento de riesgo, estudiantes de las ocupaciones de la salud, México, Cuba
INTRODUCTION Smoking and alcohol use (beyond social norms) by health sciences students are behaviors contradictory to the social function they will perform as health promoters in their eventual professions.
OBJECTIVES Identify prevalence of tobacco and alcohol use in health sciences students in Mexico and Cuba, in order to support educational interventions to promote healthy lifestyles and development of professional competencies to help reduce the harmful impact of these legal drugs in both countries.
METHODS A descriptive cross-sectional study was conducted using quantitative and qualitative techniques. Data were collected from health sciences students on a voluntary basis in both countries using the same anonymous self-administered questionnaire, followed by an in-depth interview.
RESULTS Prevalence of tobacco use was 56.4% among Mexican students and 37% among Cuban. It was higher among men in both cases, but substantial levels were observed in women as well. The majority of both groups were regularly exposed to environmental tobacco smoke. Prevalence of alcohol use was 76.9% in Mexican students, among whom 44.4% were classified as at-risk users. Prevalence of alcohol use in Cuban students was 74.1%, with 3.7% classified as at risk.
CONCLUSIONS The high prevalence of tobacco and alcohol use in these health sciences students is cause for concern, with consequences not only for their individual health, but also for their professional effectiveness in helping reduce these drugs’ impact in both countries.
KEYWORDS Smoking, tobacco, nicotine dependence, alcohol dependence, substance-related disorders, alcohol-related disorders, addiction, risk behavior, health occupations students, Mexico, Cuba
