National and local vulnerability to climate-related disasters in Latin America: the role of social asset-based adaptation

The Latin American region is particularly prone to climate-related natural hazards. However, this article argues that natural hazards are only partly to blame for the region's vulnerability to natural disasters with quantitative evidence suggesting instead that income per capita and inequality are main determinants of natural disaster mortality in Latin America. Locally, the region's poor are particularly susceptible to climate-related natural hazards. As a result of their limited access to capital, adaptation based on social assets constitutes an effective coping strategy. Evidence from Bolivia and Belize illustrates the importance of social assets in protecting the most vulnerable against natural disasters.

The future of urban water services in Latin America

In recent decades, problems with the provision of drinking water and sanitation services around the world have increasingly been addressed by attempts at privatisation, recasting clean water as an essentially economic, rather than public, good. This approach gained particular acceptance in Latin America, but with limited success. In order to address the full range of social, economic and environmental values necessary to sustain water resources over time, public and governmental involvement in establishing integrated water management, pursuing ‘soft path’ approaches, assuring stakeholder input and setting policy will be essential to the process.

Being born in Sweden increases the risk for type 1 diabetes - a study of migration of children to Sweden as a natural experiment

AIM

To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.

METHODS

Register study in a Swedish study population in the age 6-25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24,252 international adoptees; 47,986 immigrants and 40,971 Swedish-born with two foreign-born parents and a comparison group of 1,770,092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression.

RESULTS

The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03-2.73).

CONCLUSIONS

Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM.

The Latin American cohabitation boom, 1970–2007

The article describes the rise of unmarried cohabitation in Latin American countries during the last 30 years of the twentieth century, both at the national and regional levels. It documents that this major increase occurred in regions with and without traditional forms of cohabitation alike. In addition, the striking degree of catching up of cohabitation among the better-educated population segments is illustrated. The connections between these trends and economic (periods of high inflation) and cultural (reduction of stigmas in ethical domains) factors are discussed. The conclusion is that the periods of inflation and hyperinflation may have been general catalysts, but no clear indications of correlation were found between such economic factors and the rise in cohabitation. The shift toward more tolerance for hitherto stigmatized forms of conduct (e.g., homosexuality, euthanasia, abortion, singleparent household) is in line with the rise of cohabitation in regions of Argentina, Chile, and Brazil where cohabitation used to be uncommon. Further rises in cohabitation during the first decade of the twenty-first century are expected in a number of countries (e.g., mexico) despite conditions of much lower inflation.

Declining suburbs in Europe and Latin America

Suburban shrinkage, understood as a degenerative urban process stemming from the demise of the Fordist mode of urbanism, is generally manifested in a decline in population, industry and employment. It is also intimately linked to the global restructuring of industrial organization associated with the rise of the post-Fordist mode of urbanism and, more recently, the thrust of Asian industrialization. Framed in the discourse of industrial urbanism, this article examines the first ring of industrial suburbs that developed around large cities in their most rapid Fordist urbanization phase. These industrial suburbs, although they were formed at different times, are today experiencing specific mutations and undergoing profound restructuring on account of their particular spatial position between the central area and the expanding peripheries of the post-Fordist metropolis. This article describes and compares suburban decline in two European cities (Glasgow and Paris) and two Latin American Cities (São Paulo, Brazil and Guadalajara, Mexico), as different instances of places asymmetrically and fragmentarily integrated into the geography of globalization.

Chagas disease in Italy: breaking an epidemiological silence

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.

Chagas disease in Switzerland: history and challenges

Chagas disease, endemic in Latin America, is an emerging health problem in Europe affecting an estimated 80,000 persons. Around 60,000 Latin American migrants live in Switzerland, and cases of Chagas disease have been reported since 1979. As of June 2011, 258 cases have been diagnosed, mostly adults in the indeterminate phase of the chronic stage of the disease. Vertical transmission has been identified and there is a high potential for blood- and organ-borne transmission in the absence of systematic screening. Major challenges include (i) raising awareness among migrants and healthcare professionals, (ii) developing national protocols for screening and treatment targeting high-risk groups such as pregnant woman, newborns, migrants from highly endemic areas (e.g. Bolivia), and immunocompromised migrants, (iii) preventing blood- and organ-borne transmission by appropriate screening strategies, (iv) taking into account the social vulnerability of individuals at risk in the design and implementation of public health programmes, and (v) facilitating contacts with the communities at risk through outreach programmes, for example in churches and cultural groups.

Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

Since the year 2000, Chagas disease, traditionally known as a rural Latin American affliction, has been rising in the ranking of international health priorities due to the growing migration flows from endemic areas to non-endemic ones. Using the example of Italy and reporting preliminary results of a study carried out in the district of Bologna, the paper will argue that a disease-centred public health approach might be inadequate when dealing with complex and uncertain situations, in which complete statistical data are not available or not reliable, and in which the involved actors, health professionals on the one side, migrants on the other, appear to be unaware of the issue, or might even be denying it. In such a context, an effective public health approach should be capable of crossing disciplinary boundaries and bridging the gap between health services and communities, as well as between health and social issues.

Chagas disease in European countries: the challenge of a surveillance system

A study of aggregate data collected from the literature and official sources was undertaken to estimate expected and observed prevalence of Trypanosoma cruzi infection, annual incidence of congenital transmission and rate of underdiagnosis of Chagas disease among Latin American migrants in the nine European countries with the highest prevalence of Chagas disease. Formal and informal data sources were used to estimate the population from endemic countries resident in Europe in 2009, diagnosed cases of Chagas disease and births from mothers originating from endemic countries. By 2009, 4,290 cases had been diagnosed in Europe, compared with an estimated 68,000 to 122,000 expected cases. The expected prevalence was very high in undocumented migrants (on average 45% of total expected cases) while the observed prevalence rate was 1.3 cases per 1,000 resident migrants from endemic countries. An estimated 20 to 183 babies with congenital Chagas disease are born annually in the study countries. The annual incidence rate of congenital transmission per 1,000 pregnancies in women from endemic countries was between none and three cases. The index of under diagnosis of T. cruzi infection was between 94% and 96%. Chagas disease is a public health challenge in the studied European countries. Urgent measures need to be taken to detect new cases of congenital transmission and take care of the existing cases with a focus on migrants without legal residency permit and potential difficulty accessing care.

'Before you teach me, I cannot know': immigrant women's barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada

OBJECTIVE

To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socio-economic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups.

METHOD

Within a health behaviour framework, we used a qualitative explanatory multiple-case study approach consisting of focus group interviews (n = 11) in Hamilton, Canada. Participants were newly immigrated (1-5 years) women and a group of Canadian-born women of low socio-economic status; all participants were in the age range 35-69 years and married. Language groups were Arabic, Cantonese, Somali, Dari (Afghanistan) and Spanish (Latin America). Two separate focus groups for each ethnolinguistic group were conducted; one in English and one in the native language. A template approach to analysis was used.

RESULTS

All groups indicated a strong need for information on necessity of screening and on how the procedure is done. Use of a video and a group discussion format were desired strategies. Women had positive feelings about being proactive for their health even if prevention had not been the norm in their home countries. There were differences between groups with respect to preferring a female clinician, which was a higher priority than language congruence with the provider. Only Chinese and Arabic groups discussed embarrassment and modesty as barriers.

CONCLUSION

Addressing key knowledge gaps around cervical cancer screening through personal approaches, educational videos and invitations may be useful core strategies to remove stigma and fear around screening and improve uptake across multiple ethnic groups and in women of lower socioeconomic status.

Latin America: native populations affected by early onset periodontal disease

Millions of individuals are affected by early onset periodontal disease in Latin America, a continent that includes more than 20 countries. The decision-makers claim that the disease is not commonly encountered. In 2009, 280,919 authorized immigrants were registered in the United States versus 5,460,000 unauthorized (2,600,000 in California). The objective of the present article is to raise awareness about the high prevalence of the disease among Latin Americans and the good prognosis of preventive measures associated with minimal financial cost.

Lrrk2 p.Q1111H substitution and Parkinson's disease in Latin America

Mutations in the LRRK2 gene are the most common genetic cause of Parkinson's disease, with frequencies displaying a high degree of population-specificity. Although more than 100 coding substitutions have been identified, only seven have been proven to be highly penetrant pathogenic mutations. Studies however are lacking in non-white populations. Recently, Lrrk2 p.Q1111H (rs78365431) was identified in two affected Hispanic brothers and absent in 386 non-Hispanic white healthy controls. We therefore screened this variant in 1460 individuals (1150 PD patients and 310 healthy controls) from 4 Latin American countries (Peru, Chile, Uruguay and Argentina). In our case-control series from Peru and Chile we observed an increased frequency of Lrrk2 p.Q1111H in patients (7.9%) compared to controls (5.4%) although the difference did not reach significance (OR 1.38; p = 0.10). In addition, the frequency of Lrrk2 p.Q1111H varied greatly between populations and further screening in a set of pure Amerindian and pure Spanish controls suggested that this variant likely originated in an Amerindian population. Further studies in other Latin American populations are warranted to assess its role as a risk factor for Parkinson's disease. Screening in Parkinson's disease patients from under-represented populations will increase our understanding of the role of LRRK2 variants in disease risk worldwide.

[Imported and non-imported diseases in the immigrant population. A decade of experience from an infectious diseases unit]

INTRODUCTION

Immigration is an inexorable process. Immigrants may suffer infectious diseases commonly seen in our environment, or those more exotic or more prevalent in their own environment.

MATERIAL AND METHODS

A study was performed including all immigrants see in an Infectious Diseases Unit of a general hospital from June 2001 to May 2010.

RESULTS

We studied 1,071 patients from Latin America (n=405, 37.8%), Northern Africa (n=281, 26.2%), Eastern Europe (n=186, 17.4%), sub-Saharan Africa (n=178, 16.6%), and Asia (21, 2.0%). Transmissible infectious diseases were the leading cause of consultation (53.8%), and they were more common among people coming from Northern Africa (61.6%) and Eastern Europe (69.4%) (P=.001). The second reason for consultation was for common infectious diseases (29%). Tropical infectious diseases were diagnosed in 16.4% of the patients, particularly from sub-Saharan Africa (36%), and Latin America (25.9%) (P<.001). The most common diagnoses were latent tuberculous infection (20.8%) [most common in those from Eastern Europe (27.4%) (P=.004)], respiratory tract infection (12.5%), sexually transmitted infections (10.6%) [most common in patients from Northern Africa (17.1%) (P=.004)], chronic hepatitis (10.4%) [most common in patients from Eastern Europe (26.3%) (P<.001) and sub-Saharan Africa (16.9%) (P=.004)], and active tuberculosis (8.7%) [most common in sub-Saharan Africa patients (15.7%) (P=.001)].

CONCLUSIONS

The spectrum of infectious diseases in the immigrant population in our area is broad, and includes a wide variety of tropical and communicable diseases, but also of common infections. While communicable diseases are the leading cause of consultation, common infections constitute an important part of health care activity.

Getting REDD-y: conservation and climate change in Latin America

Deforestation in Latin America, especially in the Amazon basin, is a major source of greenhouse gases such as carbon dioxide that contribute to global warming. Protected areas play a vital role in minimizing forest loss and in supplying key environmental services, including carbon sequestration and rainfall regulation, which mitigate the adverse impacts of climate change amid a rising tide of economic development in the region. The area of protected forest has expanded rapidly since 1980 to cover one-fifth of Latin America and more than two-fifths of Amazonia, a region whose rain forest captures some 40 percent of Latin America's carbon emissions. The reserve sector has traditionally suffered from severe underfunding, but the possibility of new resources being generated through financial compensation for "reduced emissions from deforestation and forest degradation" (REDD) or "avoided deforestation" under a new Kyoto protocol after 2012 could help strengthen the environmental and social roles of protected areas. However, a number of major implementation and governance challenges will need to be addressed.

Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

OBJECTIVES

To compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.

METHODS

Patients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.

RESULTS

Four hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.

CONCLUSIONS

The demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Latino parents' perceptions of their ability to prevent obesity in their children

The obesity epidemic in Latino children has reached staggering proportions. This study explored Latino parents' perceptions of their ability to prevent obesity in children. Three focus groups were conducted with 26 Latino parents of preschoolers at a New York City Head Start program. Parents perceived high levels of ability to prevent obesity primarily via dietary influence. Four factors negatively impacted parents' ability: family history, intergenerational and interparental issues, adolescence, and societal pressures. Culturally effective, family-based obesity interventions among Latinos should build upon parental perceptions of ability to prevent obesity, while simultaneously helping parents address the factors they perceive challenge this ability.

Abortion law reforms in Colombia and Nicaragua: issue networks and opportunity contexts

This article analyses two instances of abortion law reform in Latin America. In 2006, after a decades-long impasse, the highly controversial issue of abortion came to dominate the political agenda when Colombia liberalized its abortion law and Nicaragua adopted a total ban on abortion. The article analyses the central actors in the reform processes, their strategies and the opportunity contexts. Drawing on Htun's (2003) framework, it examines why these processes concluded with opposing legislative outcomes. The authors argue for the need to understand the state as a non-unitary site of politics and policy, and for judicial processes to be seen as a key variable in facilitating gender policy reforms in Latin America. In addition, they argue that ‘windows of opportunity’ such as the timing of elections can be critically important in legislative change processes.

Who cares in Nicaragua? A care regime in an exclusionary social policy context

In Latin American countries with historically strong social policy regimes (such as those in the Southern Cone), neoliberal policies are usually blamed for the increased burden of female unpaid work. However, studying the Nicaraguan care regime in two clearly defined periods — the Sandinista and the neoliberal eras — suggests that this argument may not hold in the case of countries with highly familialist social policy regimes. Despite major economic, political and policy shifts, the role of female unpaid work, both within the family and in the community, remains persistent and pivotal, and was significant long before the onset of neoliberal policies. Nicaragua's care regime has been highly dependent on the ‘community’ or ‘voluntary’ work of mostly women. This has also been, and continues to be, vital for the viability of many public social programmes.

How much do they know about sexual health?: Knowledge and information-seeking behaviors of Spanish-speaking immigrant adolescents in Curacao, Netherlands Antilles

Scant HIV/AIDS prevalence data from Curacao suggest that 65.9% of the HIV/AIDS cases in the Netherlands Antilles are currently being documented in this country. The present cross-sectional qualitative study evaluated levels of knowledge of sexual health and information-seeking behavior of Spanish-speaking immigrant adolescents in Curacao. Findings point to a greater need for channels of sexual health information targeting adolescents that focus on the interpersonal aspects of sexuality, to encourage greater parental involvement in their adolescents' lives, and to improve communications between adolescents and their parents. Study findings also suggest the need for a more thoughtful and systematic exploration of the indications by participants that force/coercion specifically by older men including stepfathers was a reason for sexual initiation of many young Latina girls in Curacao.

[Chagas disease in a non endemic country: a study in the district of Bologna (Italy). Multidisciplinary analysis of the disease in the Latin American migrant population]

Chagas disease is a parasitic illness endemic in 21 countries of Central and South America, affecting over 10 million people. Due to the increase of migration flows to Europe, Chagas disease is an emerging public health issue in non endemic countries. In Italy, where no specific policy has yet been developed, the Centre for International Health of the University of Bologna is carrying out the project "Chagas disease in a non endemic country: a study in the district of Bologna". A multidisciplinary and multi-method approach was adopted to estimate the problem and its impact in our territory. A retrospective analysis was performed searching several databases in order to collect information concerning the demographic and epidemiological profile of Latin American migrants coming from endemic countries. At the same time, a preliminary ethnographic research was conducted to start unveiling the main socio-anthropological characteristics of this population, thanks to the involvement of key informants and community associations. According to preliminary findings, Chagas disease is a present and possibly increasing reality in our territory. Due to the particular features of the affected population, socio-cultural variables have to be considered for their impact on the visibility of the condition and on health seeking behaviors.

Outreach strategies for expanding health insurance coverage in children

BACKGROUND

Health insurance has the potential to improve access to health care and protect people from healthcare costs when they are ill. However, coverage is often low, particularly in people most in need of protection.

OBJECTIVES

To assess the effectiveness of outreach strategies for expanding insurance coverage of children who are eligible for health insurance schemes.

SEARCH STRATEGY

We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) Specialised Register (The Cochrane Library 2009, Issue 2), PubMed (January 1951 to January 2010), EMBASE (January 1966 to April 2009), PsycINFO (January 1967 to April 2009) and other relevant databases and websites. In addition, we searched the reference lists of included studies and relevant reviews, and carried out a citation search for included studies to find more potentially relevant studies.

SELECTION CRITERIA

Randomised controlled trials, controlled clinical trials, controlled before-after studies and interrupted time series which evaluated the effects of outreach strategies on increasing health insurance coverage for children. We defined outreach strategies as measures to improve the implementation of existing health insurance to enrol more eligible populations. This included increasing awareness of schemes, modifying enrolment, improving management and organis ation of insurance schemes, and mixed strategies.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias . We narratively summari sed the data.

MAIN RESULTS

We included two studies, both from the United States. One randomised controlled trial study with a low risk of bias showed that community- based case managers who provided health insurance information, application support, and negotiated with the insurer were effective in enrolling and maintaining enrolment of Latino American children into health insurance schemes (n = 257). The second quasi-randomised controlled trial, with an unclear risk of bias (n = 223), indicated that handing out insurance application materials in hospital emergenc y departments can increase enrolment of children into health insurance.

AUTHORS' CONCLUSIONS

The two studies included in this review provide evidence that in the US providing health insurance information and application assistance, and handing out application materials in hospital emergency departments can probably both improve insurance coverage of children. Further studies evaluating the effectiveness of different outreach strategies for expanding health insurance coverage of children in different countries are needed, with careful attention given to study design.

Discrimination, psychosocial stress, and health among Latin American immigrants in Oregon

Chronic psychosocial stress related to discrimination has been shown to be associated with biological measures such as elevated systolic blood pressure (SBP), increased body fat, and higher fasting glucose levels. Few studies have examined these relationships in immigrant populations. The present study recruited a sample of 132 Oregon Latino immigrant adults to investigate the relationships between perceived discrimination and several health measures (blood pressure, body mass index [BMI], and fasting glucose). Results indicate that perceived discrimination stress predicted elevated SBP among men but not among women. Perceived discrimination was significantly higher among obese women than among women of normal BMI. The same pattern was not observed for men. Further, a strong trend relationship was detected: the higher women's reported discrimination stress, the higher their fasting glucose levels. Again, this pattern was not observed for men. These results suggest that chronic psychosocial stress plays an important role in disease risk among Latin American immigrants, and that male and female immigrants may have distinctive physiological responses. If confirmed, these findings may have important clinical and public health implications for chronic disease prevention among Latinos.

[Chagas disease. American trypanosomiasis. Recommendation for non-endemic zones]

The following recommendations were made at the end of the consensus workshop organized by the Société de Pathologie Exotique (Exotic Pathology Society) (Paris, 26 June 2009). They apply to people of Latin American origin (immigrants, children born in France to a Latin-American mother, French people originating in Guyana) and expatriates and travellers who have stayed in areas where Chagas disease is endemic. These recommendations concern screening for people who are infected but asymptomatic, diagnosis of acute forms, diagnosis of chronic forms with clinical manifestations and therapeutic procedure.