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The Eight Americas Study divides the U.S. population into eight distinct groups with different epidemiologic patterns and mortality experience. The Eight Americas are Asians (America 1), below-median-income whites living in the Northland (America 2), middle America (America 3), poor whites living in Appalachia and the Mississippi Valley (America 4), Native Americans living on reservations in the West (America 5), black middle-America (America 6), poor blacks living in the rural South (America 7), and blacks living in high-risk urban environments (America 8). Life expectancy for males in America 8 is 21 years lower than life expectancy for females in America 1. For males, the gap between America 1 and America 8, 16.1 years, is as large as the gap between Iceland with the highest male life expectancy in the world and Bangladesh. Even in Americas 5, 6, 7, and 8, U.S. child mortality is in the middle of the range defined by the Organization of Economic Cooperation and Development (OECD) countries. For young and middle-aged males and females, however, mortality experience in the disadvantaged Americas is up to two times worse than the worst OECD country. The enormous excess of young and middle-aged mortality is largely due to chronic disease death. Based on the World Health Organization Comparative Risk Assessment project, we expect the major risks in the United States to be tobacco, alcohol, obesity, blood pressure, and cholesterol. Risk factor analysis using Behavioral Risk Factor Surveillance System data for the Eight Americas suggests that the pattern for tobacco, alcohol, and obesity is distinct for each America. Currently available data in the public domain do not provide an adequate basis to assess levels of blood pressure and cholesterol in the Eight Americas. To tackle disparities in the United States, public health will need to increase its focus on chronic diseases in young and middle-aged Americans. In particular, if blood pressure and cholesterol are confirmed as major contributors to current mortality patterns, innovative strategies such as the Polypill and unique individual and population approaches need to be explored.
The SENTRY Antimicrobial Surveillance Program was established in January, 1997 to monitor the predominant pathogens and antimicrobial resistance patterns of nosocomial and community-acquired infections via a network of sentinel hospitals in the United States (30 sites), Canada (eight sites), Latin America (10 sites), and Europe (24 sites). During the first 12-month study period (January to December, 1997), a total of 9519 blood stream infections (BSI) were reported by SENTRY participants in the U.S. (6150), Canada (1727), and Latin America (1642). The Gram-positive cocci, Staphylococcus aureus, coagulase-negative staphylococci (CoNS), enterococci, and streptococci accounted for 53.9% (5131 infections) of all BSI (56.5% U.S., 55.7% Canada, and 42.9% Latin America). The staphylococci, Enterococcus spp., S. pneumoniae, beta-hemolytic streptococci, and viridans group streptococci accounted for 6 of the top 11 BSI pathogens in the U.S. and Canada, whereas only S. aureus (1st), CoNS (3rd), and Enterococcus spp. (9th) were among the top 11 pathogens in Latin American hospitals. The results of this survey affirm the importance of Gram-positive cocci as causes of BSI in both North America and Latin America and demonstrate that important antimicrobial resistance exists among isolates of staphylococci, streptococci, and enterococci from all three geographic regions. This includes oxacillin-resistance among S. aureus (26.9% U.S., 29.2% Latin America, and 4.0% Canada) and CoNS (71.5% U.S., 68.4% Latin America, and 65.6% Canada), penicillin resistance among viridans group streptococci (48.5% U.S., 45.1% Canada, and 33.3% Latin America) and pneumococci (36.1% U.S., 27.5% Canada, and 65.6% Latin America), high-level resistance (HLR) to aminoglycosides among enterococci (27.2 to 70.1% U.S., 33.3 to 75.7% Canada and 16.7 to 51.5% Latin America), and macrolide resistance among beta-hemolytic streptococci (12.4 to 14.2% U.S., 10.5 to 12.3% Canada, and 0.0 to 4.0% Latin America), viridans group streptococci (32.4 to 39.7% U.S., 22.5-35.2% Canada, and 20.0% Latin America), and pneumococci (10.0 to 10.6% U.S., 9.8-10.8% Canada, and 9.4-18.7% Latin America). BSI isolates of Gram-positive cocci from the U.S. and Latin America were considerably more resistant than those from Canada. New agents with Gram-positive activity will be essential for optimal treatment of BSI attributable to Gram-positive cocci in both North and Latin America.
BACKGROUND: Chinese in North America have higher rates of many chronic diseases than do Chinese in Asia. However, there is a lack of data among comparisons of the environmental and lifestyle factors for Chinese in China and Chinese residing in North America. METHODS: We examined self-reported dietary nutrient intakes, physical activity patterns and body mass index of 2488 healthy Chinese men and women residing in North America (US and Canada) and in the People's Republic of China. RESULTS: On average, Chinese in China consumed more calories (males 2904 kcal in China, versus 2201 kcal in North America; females 2317 Kcal in China, versus 1795 Kcal in North America and more carbohydrate, but less fat (males 72.2 g in China versus 84.5 g in North America, females 56.6 g in China versus 70.8 g in North America), protein, vitamin A, beta-carotene and vitamin C than did Chinese in North America. Per cent calories from fat was 35% for Chinese in North America and 22% for Chinese in China. In contrast, the per cent of calories from carbohydrates was 62-68% in China and 48% in North America. Chinese in China reported spending more time in vigorous activity, sleeping and walking but less hours in sitting than Chinese in North America. Chinese in China weighted less and were leaner than North American Chinese. CONCLUSIONS: These differences in nutrient intakes, physical activity and body size of Chinese living on two different continents suggest possible explanations for observed differences in chronic disease rates in the two populations.
About two-thirds of the world's population live in areas infested with dengue vectors, mainly Aedes aegypti. All four dengue viruses are circulating, sometimes simultaneously, in most of these areas. It is estimated that up to 80 million persons become infected annually although marked underreporting results in the notification of much smaller figures. Currently dengue is endemic in all continents except Europe and epidemic dengue haemorrhagic fever (DHF) occurs in Asia, the Americas and some Pacific islands. The incidence of DHF is much greater in the Asian countries than in other regions. In Asian countries the disease continues to affect children predominantly although a marked increase in the number of DHF cases in people over 15 years old has been observed in the Philippines and Malaysia during recent years. In the 1990's DHF has continued to show a higher incidence in South-East Asia, particularly in Viet Nam and Thailand which together account for more than two-thirds of the DHF cases reported in Asia. However, an increase in the number of reported cases has been noted in the Philippines, Lao People's Democratic Republic, Cambodia, Myanmar, Malaysia, India, Singapore and Sri Lanka during the period 1991-1995 as compared to the preceding 5-year period. In the Americas, the emergence of epidemic DHF occurred in 1981 almost 30 years after its appearance in Asia, and its incidence is showing a marked upward trend. In 1981 Cuba reported the first major outbreak of DHF in the Americas, during which a total of 344,203 cases of dengue were notified, including 10,312 severe cases and 158 deaths. The DHF Cuban epidemic was associated with a strain of dengue-2 virus and it occurred four years after dengue-1 had been introduced in the island causing epidemics of dengue fever. Prior to this event suspected cases of DHF or fatal dengue cases had been reported by five countries but only a few of them fulfilled the WHO criteria for diagnosis of DHF. The outbreak in Cuba is the most important event in the history of dengue in the Americas. Subsequently to it, in every year except 1983, confirmed or suspected cases of DHF have been reported in the Region. The second major outbreak in the Americas occurred in Venezuela in 1989 and since then this country has suffered epidemics of DHF every year. Between 1981 and 1996 a total of 42,246 cases of DHF and 582 deaths were reported by 25 countries in the Americas, 53% of which originated from Venezuela and 24% from Cuba. Colombia, Nicaragua and Mexico have each reported over 1,000 cases during the period 1992-1996. About 74% of the Colombian cases and 97% of the Mexican cases were reported during 1995-1996. A main cause of the emergence of DHF in the Americas was the failure of the hemispheric campaign to eradicate Aedes aegypti. Following a successful period that resulted in the elimination of the mosquito from 18 countries by 1962, the programme began to decline and as a result there was a progressive dissemination of the vector so that by 1997 with the exception of Canada, Chile and Bermuda, all countries in the Americas are infested. Other factors contributing to the emergence/re-emergence of dengue/DHF include the rapid growth and urbanization of populations in Latin America and the Caribbean, and increased travel of persons which facilitates dissemination of dengue viruses. Presently, all four dengue serotypes are circulating in the Americas, thus increasing the risk for DHF in this region.
Freud first saw this in America's attitude toward the use of cocaine. It was freely and legally used and even promoted by American physicians as beneficial in many medical conditions. Freud was first swept along by America's prococaine enthusiasm. He narrowly missed destroying his own medical reputation by his continuing close connection and advocacy of cocaine. Freud made his only visit to America in 1909. Despite the success of his visit and the congeniality of Americans toward him, he was already programmed toward a negative response. He allowed minor everyday inconveniences and cultural differences to spoil the trip for him. The chronic intestinal distress that had bothered him previously now was labelled as his "American dyspepsia." He developed additional reasons for disliking America. They accepted his three key dissenters, Adler, Jung, and Rank. He even believed that these three men achieved greater notoriety and popularity in America than he did. In fact, the Freudian psychoanalytic movement became much larger and more powerful in America than did the followings of any or all of his defectors. Freud did not like the shortcuts and lack of mastery of the basics of psychoanalysis that he believed happened in America. Some of this was true, but it was mainly exaggerated in Freud's mind. The gold of psychoanalysis was never transformed into a practical but deficient psychoanalytic alloy as Freud feared it might. There was a genuine disagreement about whether a psychoanalyst should have to become a medical doctor or not. It was a complicated issue in America because of laws that said that doing psychoanalysis was practicing medicine. Freud viewed the American stand against recognizing lay analysts as more evidence of American's being a rebellious son. Economic factors also played a significant factor in Freud's dislike of America. Freud was initially enthusiastic about President Wilson and his plans for peace. He found after World War I that all of his savings were wiped out and that Vienna suffered from a crippling inflation. As a result of this he had to take increasingly more American analysands as they paid him in valuable American dollars. He resented this financial dependency on Americans. He also had difficulty communicating with these American analysands and largely blamed them for their undisciplined way of speaking. What I have presented is a survey or overview of the reasons for Freud's dislike of America.(ABSTRACT TRUNCATED AT 400 WORDS)
Over the past decade, according to several important indicators, health conditions have improved in the Region of the Americas. However, inequalities persist among the countries of the Region. This article has two primary objectives: 1) to provide some unbiased evidence on health inequalities among countries of the Region of the Americas and 2) to illustrate the application of some of the more frequently used methods for measuring inequalities, including effect measurements, population attributable risk, the slope index of inequality, the relative index of inequality, and the concentration index. Analyses have shown that there are great health disparities in the Region of the Americas. For example, residents of the poorest countries of the Region live nearly 10 years less, on average, than do residents of the richest countries. If the other countries of the Americas had the same incidence of tuberculosis as does the subregion of North America (Bermuda, Canada, and the United States of America), there would be 76% fewer cases of this disease in the Region. In the Americas, nearly 35% of deaths of infants under 1 year old are concentrated in the 20% of live births that occur in the group with the lowest income. As for maternal mortality in the Americas, fewer than 2% of maternal deaths occur in association with the 20% of live births in the group with the highest income. The analyses of health inequalities based on the use of various methods highlight the existence of important disparities among subregions and countries of the Americas that are not readily seen when using only the more-traditional methods for analyzing mortality and morbidity. There is also a need to incorporate the concepts of distribution and socioeconomic dimensions of health when interpreting a given situation. Using this approach will allow decisionmakers to target areas and populations that are in less-favorable conditions. A considerable body of aggregate data at the Regional and country levels from routine information systems is already available--especially on morbidity, mortality, and other health-related factors--that can be used on a regular basis to analyze health inequalities. These kinds of analyses may be regarded as a first step toward the identification of health inequities.
The multicolored Asian lady beetle, Harmonia axyridis (Pallas), native to Asia, has recently been detected in South America after successfully invading North America and Europe. This coccinellid is a voracious predator; therefore, it is popular and effective in biological control. Unfortunately, H. axyridis also has associated adverse impacts (i.e., as a household pest, pest of fruit production, and threat to non-target organisms). To predict the potential geographic extent of impacts of H. axyridis in South America we review the history of its invasion in the Western Hemisphere and address various factors critical to the future invasion (i.e., arrival, establishment, and spread) of new areas of South America. The likelihood of continued introductions (i.e., arrival) of H. axyridis to South America seems high, due to its popularity as a biological control agent and through accidental introductions. Establishment also seems likely in broad regions of South America. Climate matching with the native range suggested that much of southern South America may be suitable for establishment. In contrast, habitat matching with the native range suggested that northern South America may be more suitable. In addition, prey availability should not limit establishment of this predator. Once established, H. axyridis seems likely to spread by flight and human-assisted means. Overall, the invasion of H. axyridis over broad areas in South America seems likely.
With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. Despite differences in absolute number of cases, there has been a remarkable similarity in the temporal rate of increase of AIDS in the countries of the Americas, reflecting delayed introduction of the virus to some areas with an early exponential increase similar to that observed initially in the United States. Although the modes of transmission of HIV are the same throughout the region, evidence of increasing bisexual and heterosexual transmission, particularly in the Caribbean subregion, has resulted in a lower male-to-female ratio of AIDS cases and increased perinatal transmission. Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.