RESUMO
A pattern of population crash and rapid recovery is a common feature of the pacification and settlement experience of the indigenous peoples of tropical South America. Despite the obvious importance of these events to the demographic and anthropological sciences as a whole, as well as their significant practical implications, little is known about the microdemographic determinants of these paired phenomena. Using methods of asymptotic and stochastic demographic analysis, we reconstructed the microdemographic drivers of this history among one indigenous population: the Northern Aché of eastern Paraguay. This article explores the implications of these relationships for understanding the overall demographic turnaround observed within similar groups, as well as for the future trajectory of the Northern Aché in particular.
Assuntos
Indígenas Sul-Americanos/história , Crescimento Demográfico , História do Século XX , História do Século XXI , Humanos , Paraguai/etnologia , Dinâmica Populacional/históriaRESUMO
PURPOSE: Drug-resistant tuberculosis (DRTB) is steadily increasing in Mexico, but little is known of patient risk factors in the Mexico-United States border region. This preliminary case-control study included 95 patients with active pulmonary TB with drug susceptibility results attending the José E. González University Hospital in the urban hub of Nuevo León-the Monterrey Metropolitan Area. We report potential social and clinical risk factors of DRTB among this hospital-based sample. METHODS: We collected data through face-to-face interviews and medical record reviews from 25 cases with DRTB and 70 drug-sensitive controls. DNA was collected to assess an effect of genetic ancestry on DRTB by using a panel of 291,917 genomic markers. We calculated crude and multivariate logistic regression. RESULTS: After adjusting for potential confounding factors, we found that prior TB treatment (odds ratio, 4.5; 95% confidence interval, 0.9-21.1) and use of crack cocaine (odds ratio, 4.6; 95% confidence interval, 1.1-18.7) were associated with DRTB. No other variables, including genetic ancestry and comorbidities, were predictive. CONCLUSIONS: Health care providers may benefit from recognizing predictors of DRTB in regions where routine drug susceptibility testing is limited. Prior TB treatment and illicit drug use, specifically crack cocaine, may be important risk factors for DRTB in this region.
Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack/efeitos adversos , Marcadores Genéticos , Mycobacterium/genética , Tuberculose Resistente a Múltiplos Medicamentos/genética , Tuberculose Pulmonar/tratamento farmacológico , Adulto , Estudos de Casos e Controles , Comorbidade , DNA/análise , DNA/genética , Feminino , Hospitais Urbanos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Prontuários Médicos/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/genéticaRESUMO
Diverse socioeconomic and clinical factors influence susceptibility to tuberculosis (TB) disease in Mexico. The role of genetic factors, particularly those that differ between the parental groups that admixed in Mexico, is unclear. The objectives of this study are to identify the socioeconomic and clinical predictors of the transition from latent TB infection (LTBI) to pulmonary TB disease in an urban population in northeastern Mexico, and to examine whether genetic ancestry plays an independent role in this transition. We recruited 97 pulmonary TB disease patients and 97 LTBI individuals from a public hospital in Monterrey, Nuevo León. Socioeconomic and clinical variables were collected from interviews and medical records, and genetic ancestry was estimated for a subset of 142 study participants from 291,917 single nucleotide polymorphisms (SNPs). We examined crude associations between the variables and TB disease status. Significant predictors from crude association tests were analyzed using multivariable logistic regression. We also compared genetic ancestry between LTBI individuals and TB disease patients at 1,314 SNPs in 273 genes from the TB biosystem in the NCBI BioSystems database. In crude association tests, 12 socioeconomic and clinical variables were associated with TB disease. Multivariable logistic regression analyses indicated that marital status, diabetes, and smoking were independently associated with TB status. Genetic ancestry was not associated with TB disease in either crude or multivariable analyses. Separate analyses showed that LTBI individuals recruited from hospital staff had significantly higher European genetic ancestry than LTBI individuals recruited from the clinics and waiting rooms. Genetic ancestry differed between individuals with LTBI and TB disease at SNPs located in two genes in the TB biosystem. These results indicate that Monterrey may be structured with respect to genetic ancestry, and that genetic differences in TB susceptibility in parental populations may contribute to variation in disease susceptibility in the region.
Assuntos
Filogenia , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/genética , Genoma Humano/genética , Genótipo , Humanos , Tuberculose Latente , Modelos Logísticos , México/epidemiologia , Análise Multivariada , Polimorfismo de Nucleotídeo Único/genética , Tamanho da Amostra , Fatores SocioeconômicosRESUMO
Demographic estimates of population at risk often underpin epidemiologic research and public health surveillance efforts. In spite of their central importance to epidemiology and public-health practice, little previous attention has been paid to evaluating the magnitude of errors associated with such estimates or the sensitivity of epidemiologic statistics to these effects. In spite of the well-known observation that accuracy in demographic estimates declines as the size of the population to be estimated decreases, demographers continue to face pressure to produce estimates for increasingly fine-grained population characteristics at ever-smaller geographic scales. Unfortunately, little guidance on the magnitude of errors that can be expected in such estimates is currently available in the literature and available for consideration in small-area epidemiology. This paper attempts to fill this current gap by producing a Vintage 2010 set of single-year-of-age estimates for census tracts, then evaluating their accuracy and precision in light of the results of the 2010 Census. These estimates are produced and evaluated for 499 census tracts in New Mexico for single-years of age from 0 to 21 and for each sex individually. The error distributions associated with these estimates are characterized statistically using non-parametric statistics including the median and 2.5th and 97.5th percentiles. The impact of these errors are considered through simulations in which observed and estimated 2010 population counts are used as alternative denominators and simulated event counts are used to compute a realistic range fo prevalence values. The implications of the results of this study for small-area epidemiologic research in cancer and environmental health are considered.
RESUMO
A firm link between small size at birth and later more centralized fat patterning has been established in previous research. Relationships between shortened interbirth intervals and small size at birth suggest that maternal energetic prioritization may be an important, but unexplored determinant of offspring fat patterning. Potential adaptive advantages to centralized fat storage (Baker et al., 2008: In: Trevathan W, McKenna J, Smith EO, editors. Evolutionary Medicine and Health: New Perspectives. New York: Oxford) suggest that relationships with interbirth intervals may reflect adaptive responses to variation in patterns of maternal reproductive effort. Kuzawa (2005: Am J Hum Biol 17:5-21; 2008: In: Trevathan W, McKenna J, Smith EO, editors. Evolutionary Medicine and Health: New Perspectives. New York: Oxford) has argued that maternal mediation of the energetic quality of the environment is a necessary component of developmental plasticity models invoking predictive adaptive responses (Gluckman and Hanson 2004: Trends Endocrinol Metab 15:183-187). This study tested the general hypothesis that shortened interbirth intervals would predict more centralized fat patterning in offspring. If long-term maternally mediated signals are important determinants of offspring responses, then we expected to observe a relationship between the average interbirth interval of mothers and offspring adiposity, with no relationship with the preceding interval. Such a finding would suggest that maternal, endogenous resource allocation decisions are related to offspring physiology in a manner consistent with Kuzawa's description. We observed exactly such a relationship among the Ache of Paraguay, suggesting that maternally mediated in utero signals of postnatal environments may be important determinants of later physiology. The implications of these findings are reviewed in light of life history and developmental plasticity theories and ourability to generalize the results to other populations. Recommendations for further empirical research are briefly summarized.