Sociodemographic determinants associated with breastfeeding in term infants with low birth weight in Latin American countries

BACKGROUND A progressive decrease in exclusive breastfeeding(BF)is observed in Latin America and the Caribbean compared with global results.The possibility of being breastfed and continuing BF for>6 months is lower in low birth weight than in healthy-weight infants.AIM To identify factors associated with BF maintenance and promotion,with particular attention to low-and middle-income countries,by studying geographic,socioeconomic,and individual or neonatal health factors.METHODS A scoping review was conducted in 2018 using the conceptual model of social determinants of health published by the Commission on Equity and Health Inequalities in the United States.The extracted data with common characteristics were synthesized and categorized into two main themes:(1)Sociodemographic factors and proximal determinants involved in the initiation and maintenance of BF in low-birth-weight term infants in Latin America;and(2)individual characteristics related to the self-efficacy capacity for BF maintenance and adherence in low-birth-weight term infants.RESULTS This study identified maternal age,educational level,maternal economic capacity,social stratum,exposure to BF substitutes,access to BF information,and quality of health services as mediators for maintaining BF.CONCLUSION Individual self-efficacy factors that enable BF adherence in at-risk populations should be analyzed for better health outcomes.

Dissemination of Traditional Chinese Medicine in Latin America and the Caribbean: the Cases of Peru, Chile, and Cuba

Traditional Chinese medicine(TCM) arrived from China to Latin America and the Caribbean in the 1840s due to the massive migration of Chinese people to the region. In a few years, the press noticed the presence of Chinese herbalists practicing in different cities and countries regardless of the demographic weight of the Chinese community. The fascination with Chinese doctors implicated not only the press but also the literature, a phenomenon particularly observed in Cuba. In the first decades of the 20th century, the reactivation of Chinese immigration to the region fostered an anti-Chinese climate that materialized in more significant migratory restrictions and control of their businesses, such as what happened with Chinese herbalists. These herbalists who practiced inside and outside the Chinese community started to object to criticism and persecution by the conservative press and professional doctors. Despite this, Chinese doctors will continue to maintain their support of a significant number of ill persons. This work seeks to illuminate the historical relevance of TCM in Latin America and the Caribbean, focusing on the cases of Peru, Chile, and Cuba. This last country was far from China culturally and geographically, but as in many other small towns in the region, Chinese medicine presented an alternative to the treatment of illnesses.

Role of gene polymorphisms in gastric cancer and its precursor lesions:Current knowledge and perspectives in Latin American countries

Latin America shows one of the highest incidence rates of gastric cancer in the world,with variations in mortality rates among nations or even within countries belonging to this region.Gastric cancer is the result of a multifactorial complex process,for which a multistep model of carcinogenesis is currently accepted.Additionally to the infection with Helicobacter pylori,that plays a major role,environmental factors as well as genetic susceptibility factors are significant players at different stages in the gastric cancer process.The differences in population origin,demographic structure,socio-economic development,and the impact of globalization lifestyles experienced in Latin America in the last decades,all together offer opportunities for studying in this context the influence of genetic polymorphisms in the susceptibility to gastric cancer.The aim of this article is to discuss current trends on gastric cancer in Latin American countries and to review the available published information about studies of association of gene polymorphisms involved in gastric cancer susceptibility from this region of the world.A total of 40 genes or genomic regions and69 genetic variants,58%representing markers involved in inflammatory response,have been used in a number of studies in which predominates a low number of individuals(cases and controls)included.Polymorphisms of IL-1B(-511 C/T,14 studies;-31 T/C,10 studies)and IL-1RN(variable number of tandem repeats,17 studies)are the most represented ones in the reviewed studies.Other genetic variants recently evaluated in large metaanalyses and associated with gastric cancer risk were also analyzed in a few studies[e.g.,prostate stem cell antigen(PSCA),CDH1,Survivin].Further and better analysis centered in gene polymorphisms linked to other covariates,epidemiological studies and the information provided by meta-analyses and genome-wide association studies should help to improve our understanding of gastric cancer etiology in order to develop appropriate health programs in Latin America.

Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma(HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients.

Hepatitis B virus infection in Latin America:A genomic medicine approach

Hepatitis B virus(HBV)infection is the leading cause of severe chronic liver disease.This article provides a critical view of the importance of genomic medicine for the study of HBV infection and its clinical outcomes in Latin America.Three levels of evolutionary adaptation may correlate with the clinical outcomes of HBV infection.Infections in Latin America are predominantly of genotype H in Mexico and genotype F in Central and South America;these strains have historically circulated among the indigenous population.Both genotypes appear to be linked to a benign course of disease among the native and mestizo Mexicans and native South Americans.In contrast,genotypes F,A and D are common in acute and chronic infections among mestizos with Caucasian ancestry.Hepatocellular carcinoma is rare in Mexicans,but it has been associated with genotype F1b among Argentineans.This observation illustrates the significance of ascertaining the genetic and environmental factors involved in the development of HBV-related liver disease in Latin America,which contrast with those reported in other regions of the world.

Helicobacter pylori recurrence after eradication in Latin America:Implications for gastric cancer prevention

To estimate Helicobacter pylori (H. pylori) recurrence rate in Latin America, a region with a significant H. pylori prevalence and gastric cancer burden. METHODSPubMed, LILACS, SciELO, Cochrane databases and abstracts from relevant meetings were reviewed. Information collected included: Participants’ characteristics, recruitment strategy, diagnostic modality, treatment arms, follow-up and recurrence rates. Recurrence was calculated using 100-patients-year rates, and data were pooled using a random effects model. The I2 statistic assessed between study heterogeneity. Meta-regression analyses evaluated for effect modifying variables. RESULTSLiterature search yielded 163 articles. Twelve studies involving 4848 patients from 9 countries met inclusion criteria. Four hundred and thirty-two reinfections were recorded in 5487 person-years of follow-up. Pooled analysis showed a recurrence rate of 7.9 cases per 100 person-years (95%CI: 5.3-10.5). Meta-regression revealed that neither the antibiotic schema, a second antibiotic course, nor the diagnostic modality had an impact on the observed risk of recurrence. The recurrence rate in the first year after treatment, predominantly recrudescence, was 11.2 (6.1-16.4) per 100 patient years. Recurrence in subsequent years, was only 6.2 (3.8-8.7). CONCLUSIONH. pylori recurrence rates in Latin America are significant, and with geographic variability, yet are acceptable based upon the current literature for consideration of large scale intervention trials. Further research in Latin America is warranted to evaluate the efficacy, cost-effectiveness, and potential adverse outcomes of proposed eradication programs.

Management of Helicobacter pylori infection in Latin America: A Delphi technique-based consensus

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature.

Research Priorities and the Future of Alfalfa in Latin America

Agro-food and agro-industrial systems in Latin America must anticipate future trends and ensure permanent adjustment ofresearch priorities to the evolving global needs. Innovations should follow the logic of productive chains, which are highly dependentupon knowledge and technology. Agribusiness sector needs to reinvent itself for efficiently providing new products based on stricterquality controls, traceability, and greater diversification. In the region, alfalfa has an enormous potential to be cultivated for multiplepurposes other than just animal products, going from pharmaceutical and cosmetic industry to human consumption. No singleorganization or isolated group of scientists hold alone the capacity to deal with increasingly complex and dynamic productionsystems in order to efficiently compete in a globalized market. These challenges require an interdisciplinary approach, not only to adomestic level but also to an international one. The present paper proposed the constitution of a virtual alfalfa network platform forarticulating and guiding alfalfa research efforts in Latin America. The network will focus on identifying the most important needs forLatin America, promoting an active interaction among educational and scientific institutions through collaborative research projects.The platform comprises four main research axes: (1) efficient production (agronomy);(2) animal production (diversified feeds);(3)quality and innocuousness applied (human feeding);(4) novel products (pharmaceutical and cosmetics). During the initial phase, theBrazilian Agricultural Research Corporation (EMBRAPA, Brazil) and National Institute of Agricultural Technology (INTA,Argentina) will jointly coordinate the network.

Cardiovascular disease research in Latin America:A comparative bibliometric analysis

AIM:To investigate the number of publications in cardiovascular disease(CVD)in Latin America and the Caribbean over the last decade.METHODS:We performed a bibliometric analysis in PubMed from 2001 to 2010 for Latin America and the Caribbean,the United States,Canada,Europe,China,and India.RESULTS:Latin America published 4%of articles compared with 26%from the United States/Canada and 42%from Europe.In CVD,Latin America published 4% of articles vs 23%from the United States/Canada and 40%from Europe.The number of publications in CVD in Latin America increased from 41 in 2001 to 726 in 2010.CONCLUSION:Latin America,while publishing more articles than previously,lags behind developed countries.Further advances in research infrastructure are necessary to develop prevention strategies for this region.

Health Systems in Latin America: Principal Components of Attention

This article discusses the evolution of healthcare systems in Latin American countries, their origins and main characteristics and sources of financing, coverage and the availability of services and human resources from the Donabedian perspective, which also considers indicators of behaviors and preferences and social values underlying healthcare in different societies. The method adopted is the estimation of correlations and principal components to explore how health expenditures, poverty and inequalities are associated with healthcare indicators such as life expectancy, immunizations, treatments offered by health systems in transmissible and chronic diseases, considering indirect indicators of patient’s behaviors and preferences, as well as social values and cultural diversity in Latin American societies. The results show that the expansion and actual availability of immunization, treatments against transmissible diseases and hospital beds are the main criteria responsible for the results in healthcare and increase in life expectancy;the availability of health services is an important component for secondary level of care and allows the population to be committed to positive behaviors in a context of poverty and inequalities, with disadvantages for indigenous people.

Progress and Prospects of RMB Internationalization in Latin America

Promoting the internationalization of the RMB in Latin America is not only a requirement of the China-Latin American relationship and of China’s reform and opening-up policy in the financial sectors, but is also a strategic choice. With the support of internal, external and bilateral factors,China and Latin American countries have seen a lot progress in RMB trade settlement, investment, financing, and so on, yet Latin American countries’ willingness to use the RMB is still low, there is an obvious shortage of exchange mechanisms, and currency cooperation between them may face more obstacles as China-US competition intensifies. Under these circumstances, in order to further promote the internationalization of the RMB in Latin America, China should seize the opportunity of Latin America’s participation in the Belt and Road Initiative and their demand for currency diversification, as well as the friction between the US-Latin American relationship, start reducing the shortage of institutional exchange mechanisms, and plan for the RMB internationalization process in Latin America at a strategic level.

Situational Analysis and Expert Evaluation of the 1000 Days: Nutritional and Health Status in 4 Countries in Latin America

Background: The first 1000 days of life, including pregnancy and the first 2 years of age have been considered essential for an adequate development and growth. Several studies have stated that malnutrition during pregnancy and not having a normal birth weight have negative impact on childhood and adulthood, and contribute to burden of disease. Adequate information on this matter provides the possibility for making recommendations on health and nutrition policies. Objective: The aim is to describe the nutritional status during the first 1000 days in four countries of Latin America: Colombia, Argentina, Chile and Brazil. Methods: The analysis consists of two complementary approaches: 1) An extensive search on published and gray literature and a critical analysis of secondary data bases was conducted in Colombia, Argentina, Chile and Brazil following a standardized methodology in 2013. Maternal and child nutritional status, breast feeding, nutri-tional deficiencies, and dietary habits during the first 1000 days were the variables of interest;2) Information gaps were identified, interviews to local experts from academia, government and hospitals were conducted to fill each of the countries information gap. Data was organized in an online data base called NutriPl@net. Results: Despite the inherent country differences, the nutritional challenges during the first 1000 days are similar. Obesity prevalence is increasing in pregnant women. Under weight remains a problem in all 4 countries, with the highest prevalence in Argentina. Over weight prevalence is highest in Chile and obesity prevalence in Brazil. Micronutrient deficiencies in pregnant women have been described, especially high for folic acid, iron, zinc, vitamins A, B6, B12, C, E and riboflavin. Moreover, in the region, anemia is the most common micronutrient deficiency during pregnancy. Gestational diabetes, hypertension, obesity and pre-eclampsia are major causes of maternal, perinatal and infant morbidity and mortality. Conclusions: In order to understand regional and country-specific needs, it is fundamental to collect standardized information related to the nutrition status during the first 1000 days. The low prevalence of exclusive breastfeeding and micronutrient deficiencies such as iron, zinc and vitamin A as risk factors for morbidity and mortality in children 0 - 2 years old is common and priority issues in the region. Persistence of anemia despite the use of fortified foods and supplementation remains a problem, and no complete data regarding sugar, sodium and fatty acids consumption and changes in the diet and habits before, during and after pregnancy are available. The gaps that are found to justify the need for further studies including population based surveys with standardized methodology that can warrant comparability.

Gastroenterology training in Latin America

Latin America is characterized by ethnic, geographical, cultural, and economic diversity; therefore, training in gastroenterology in the region must be considered in this context. The continent’s medical education is characterized by a lack of standards and the volume of research continues to be relatively small. There is a multiplicity of events in general gastroenterology and in sub-disciplines, both at regional and local levels, which ensure that many colleagues have access to information. Medical education programs must be based on a clinical vision and be considered in close contact with the patients. The programs should be properly supervised, appropriately defined, and evaluated on a regular basis. The disparity between the patients’ needs, the scarce resources available, and the pressures exerted by the health systems on doctors are frequent cited by those complaining of poor professionalism. Teaching development can play a critical role in ensuring the quality of teaching and learning in universities. Continuing professional development programs activities must be planned on the basis of the doctors’ needs, with clearly defined objectives and using proper learning methodologies designed for adults. They must be evaluated and accredited by a competent body, so that they may become the basis of a professional regulatory system. The specialty has made progress in the last decades, offering doctors various possibilities for professional development. The world gastroenterology organization has contributed to the speciality through three distinctive, but closely inter-related, programs: Training Centers, Train-the-Trainers, and Global Guidelines, in which Latin America is deeply involved.

LATIN AMERICA

In 1997, many Latin American countries will continue with their constitution-al and legal reforms in the political, administrative and electoral fields, which willbe the main tasks before them in the year. At present, Mexico is in the process ofa transition from a de facto one-party rule to a more democratic and open politicalsystem. The main challenge it faces now is how to complete the transition smooth-ly. And what the public is most concerned about is how the various Mexican politi-

Latin America Expecting Chinese Investment

In November,Chinese President Xi Jinping had state-visits to some Latin-American countries including Ecuador,Peru and Chile.In 2015,according to the President Xi,China has pledged to work with Latin America to increase bilateral trade to 500 billion U.S.dollars and elevate investment in the region to 250 billion US dollars by 2025.

Impact of the COVID-19 Pandemic on Latin America and Its Related Thinking

The pandemic’s huge impact on all countries and regions is the biggest black swan event in 2020 and the biggest gray rhino event in 2021.Though Latin America was the last continent attacked by COVID-19,it became in 2020 the designated epicenter of infection,surpassing Europe and catching up with the United States.The rapidity of spread in Latin America,the wide range and high incidence of infections,and the death toll were larger than in other places.The pandemic has resulted in the largest economic recession in Latin American history.It also has a significant impact on China-Latin America relations.When the pandemic in Latin American will end depends on large-scale,wide application of vaccines,strict prevention and control,and international cooperation.丁he pandemic reveals the fierce contradiction between society and nature.

On Latin American Protests in 2019

A large-scale wave of mass protests broke out in fifteen Latin American countries during 2019.Some protests led to the resignation of the president and the collapse of the government.Others caused social unrest and bloody conflicts.Some protests led to a national"curfew",and the government was forced to cancel major international conferences.For a time,over ten countries were engaged in turbulent and chaotic activities.Accordingly,the 2019 Latin American protests were also dubbed"Latin America’s Turmoil"by the international media.The scale,scope and impact of the protests have been rarely seen over the last forty years.They constituted part of the global chaos of 2019.The cause was not only the anxious response of the Latin American countries facing global changes not seen for a century,but also a concentrated outbreak of political,economic and social contradictions that has been accumulating in certain Latin American countries over a long period of time.Facing unprecedented global change over a century,the Latin American countries will be able to usher in the"Latin American Spring"only if they carry out profound reform with great courage,and achieve significant progress in their political systems,economic structures,and social security systems.

Chinese companies＇ outward internationalization to emerging countries： The case of Latin America

This paper aims to review and analyze the literature on the expansion of Chinese firms to Latin America. In order to achieve this objective, it first reviews the literature on the internationalization of Chinese MNCs, the theoretical frameworks discussed in the literature and the principal features of companies from China. Second, it describes the economic and political relations between the countries, specifically the threats and opportunities for Latin America and the trade and investment trends. The review shows that the majority of the current literature on Chinese MNCs has a focus on their expansion to developed countries, on the conceptual framework needed to understand this expansion, and on the competition for foreign investments from developed countries. As a result, the analysis makes evident that research gaps seem to exist in the following areas： （1） the relative value of Chinese companies＇ existing advantages, （2） the sustainability of these advantages once the lead, probably given by OEMs or JVs, had been exhausted, （3） research works based on quantitative and comparative data, （4） the motives for FDI, （5） the entry mode, configuration, control and strategy of Chinese companies investing in Latin America, and （6） the potential opportunities presented to European companies operating in Latin America.