- Email: [email protected]
Latin American Clinical Epidemiology Network Series – Paper 1: The Latin American Clinical Epidemiology Network “LatinCLEN”
Accepted Manuscript The Latin American Clinical Epidemiology Network “LatinCLEN” Carlos Gómez Restrepo, Director and Professor titular, President LatinCLEN, Sergio Muñoz N, Professor titular, Alvaro J. Ruiz, Professor titular, Fernando Lanas, Professor titular PII:
S0895-4356(16)30548-0
DOI:
10.1016/j.jclinepi.2016.10.002
Reference:
JCE 9255
To appear in:
Journal of Clinical Epidemiology
Received Date: 2 October 2016 Accepted Date: 10 October 2016
Please cite this article as: Gómez Restrepo C, Muñoz N S, Ruiz AJ, Lanas F, The Latin American Clinical Epidemiology Network “LatinCLEN”, Journal of Clinical Epidemiology (2016), doi: 10.1016/ j.jclinepi.2016.10.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Latin American Clinical Epidemiology Network “LatinCLEN”
RI PT
Carlos Gómez Restrepo1 Sergio Muñoz N2 Alvaro J Ruiz3 Fernando Lanas 4
TE D
M AN U
SC
Abstract The Latin American Clinical Epidemiology Network (LatinCLEN) was born in the nineties as a branch of the International Clinical Epidemiology Network (INCLEN). Clinical Epidemiology Units that made up this network in the region were initially composed of health professionals trained in Australia and North America. From these units, second and third generation training centers started to develop in the region, with the main purpose of introducing clinical research methodology and critical appraisal, as well as health economics and biostatistics. The field of Clinical Epidemiology has been introduced into health schools, and has had great influence on health policies and practices in Latin America. The articles in this series provide a bird’s eye view of research development in the region which include, among others, the capacity to conduct clinical trials on innovative therapies, systematic reviews, economic analyses, as well as studies on risk factors and burden of illness.
Resumen
EP
Keywords: Network, research network, Latin America, clinical epidemiology, INCLEN, LatinCLEN
1
AC C
LatinCLEN, la Red Latinoamericana de Epidemiología Clínica (INCLEN) nació en los años noventa como una rama de INCLEN (la Red Mundial de Epidemiología Clínica). Las primeras personas entrenadas lo hicieron en Australia y Norteamérica. Se crearon unidades de Epidemiología Clínica por egresados del INCLEN y empezaron a desarrollarse centros de segunda y tercera generación con el propósito Director and Professor titular. Department of Clinical Epidemiology and Biostatistics. Department Psychiatry and Mental Health.Pontificia Universidad Javeriana. President LatinCLEN. Hospital Universitario San Ignacio. Colombia. 2 Professor titular. Department of Public Health & CIGES, Universidad de la Frontera.Chile. 3 Professor titular. Department of Clinical Epidemiology and Biostatistics. Pontificia Universidad Javeriana.Colombia. 4 Professor titular. Department of Internal Medicine & CIGES,Universidad de la Frontera.Chile.
ACCEPTED MANUSCRIPT
SC
RI PT
de introducir en la región los conceptos de metodología de investigación clínica, apreciación crítica de la literatura, economía clínica y bioestadística. El área de Epidemiología Clínica ha sido introducido en las escuelas de áreas de la salud y ha tenido gran influencia, a través de infestigación y de la aplicación de medicina basada en evidencia, en políticas de salud y en prácticas en América Latina. Una red de investigadores y la colaboración entre centros ha permitido mayor desarrollo en la región. Los artículos de esta serie proveen una breve impresión del desarrollo de investigación en la región que incluye, entre otros temas, la capacidad de conducir ensayos clínicos en terapias innovativas, revisiones sistemáticas, análisis económicos, como estudios sobre factores de riesgo y carga de enfermedad.
M AN U
Introduction
In 1978, a conference on “Health in the Third World” (Bellagio) concluded that a major hindrance to health improvement in developing countries was the scarcity of health professionals with the interest and capacity to conduct research and analyze major health problems [ 1-4]. In response to this problem, the Rockefeller Foundation established an international training program known as the International Clinical Epidemiology Network
TE D
(INCLEN). INCLEN was created in the mid 80's with participants from 27 schools of Medicine from all over the world, sent to train in North America and Australia. As part of that initiative, Clinical Epidemiology Units (CEUs) were created in Latin American countries including Mexico, Colombia, Brazil and Chile. These units were composed of
EP
INCLEN scholars who were trained in Clinical Epidemiology, Biostatistics, Health Social
AC C
Sciences and Health Economics.
After a few years, some of the CEUs became training centers themselves. Three centers in Latin America became the starting point of the regional network: Pontificia Universidad Javeriana in Bogotá, Colombia, Universidade Federal do São Paulo in São Paulo, Brazil and Universidad de la Frontera in Temuco, Chile. These centers gave priority to training of university professors from the region, who were to return to their home institutions, create new CEUs and spread this new area of knowledge. Strong support was given by first generation Clinical Epidemiology Research and Training Centers (CERTCs) which
ACCEPTED MANUSCRIPT
included McMaster University in Canada, The University of Pennsylvania and University of North Carolina in the USA, and the University of Newcastle in Australia. The beginning
RI PT
LatinClen was born in Africa during the 1991 INCLEN Annual Meeting, in Mombassa, Kenya. The idea of creating a group for collaboration in research in the Latin American region was presented and approved by the authorities of the Health Division of the Rockefeller Foundation, with the following objectives:
to develop and conduct regional research projects, focused on national essential
SC
-
health problems;
to increase the potential for national, regional and international funding;
-
to exchange knowledge, solutions to common problems and teaching strategies; and
-
to improve the possibilities of influencing national health policies.
M AN U
-
Alvaro J. Ruiz was the first President. Since then, new CEUs have developed in Argentina, Bolivia, Peru, Colombia, Brazil and Mexico (Figure 1). A regional congress is held every 2
TE D
to 3 years in the region. Currently, more than 400 clinical epidemiologists have been trained and Master's Degree programs have begun in most countries, as well as Degrees in Health Economics, Biostatistics and a PhD in Clinical Epidemiology.
EP
Present and future
The Rockefeller Foundation founded LatinCLEN and supported it from its inception, but policy changes within the organization led to the end of sponsorship. This presented a
AC C
significant challenge to the entire Network, and funding sources had to diversify. INCLEN (now INCLEN Trust) also faced, changes but it still is a leading force, now from India. A Regional Advisory Committee (RAB) was created (coordinated by Carlos Gómez-Restrepo) to help in harmonization of the regional CLENs. LatinCLEN has current presence in 10 countries (Table 1).
ACCEPTED MANUSCRIPT
Table 1. Latin American Clinical Epidemiology Network participant institutions and number of researchers
Bolivia • Universidad Mayor de San Andrés
RI PT
Argentina • Instituto de Efectividad Clínica y Sanitaria. Universidad de Buenos Aires (Centro Argentino de la Red Cochrane Iberoamericana) • Universidad Nacional de Tucumán
M AN U
SC
Brasil • CERTC and Centro Paulista de Economía en Salud. Universidad Federal de Sao Paulo • Universidade Federal Do Rio de Janeiro • Universidade Federal Do Ceará - Fortaleza • Faculdade de Medicina de Marília Chile • CIGES, Universidad de La Frontera (Centro Chileno de la Red Cochrane Iberoamericana)
EP
TE D
Colombia • Pontificia Universidad Javeriana - Bogota- (Centro Colombiano de la Red Cochrane Iberoamericana) • Universidad Nacional de Colombia (Centro Colombiano de la Red Cochrane Iberoamericana) • Universidad de Antioquia - Medellin • Universidad del Cauca – Popayán • Universidad Industrial de Santander- Bucaramanga
AC C
España • Centro Cochrane Iberoamericano México • Instituto Mexicano de Seguridad Social • Instituto Nacional de Nutrición Salvador Zubiran Perú • Universidad Peruana Cayetano Heredia
Education
ACCEPTED MANUSCRIPT
Most of the institutions have training programs in clinical epidemiology, evidence based medicine (EBM), health economics and biostatistics. Currently there are 9 Master’s Degree programs in Clinical Epidemiology (Brazil, Chile, Colombia and Peru), one in Clinical Effectiveness in Argentina, 2 in Biostatistics (Universidad de Chile and Javeriana), 2 in
RI PT
Health Economics (Escola Paulista and Javeriana) and one PhD program in Clinical Epidemiology (Javeriana).
A large number of short courses and diploma certifications have been conducted in the
SC
region, on EBM and critical analysis of literature, literature search, research design, fundamentals of clinical epidemiology, controlled clinical trials, clinical study
M AN U
development, basic biostatistics, advanced biostatistics, health economics, decision analysis, GRADE, sample size calculation, design and analysis of sample surveys, among others. Most universities in the region have implemented undergraduate contents in research methods, basic biostatistics, EBM and literature search, with a clearly visible impact on the amount and quality of clinical research being produced and published.
TE D
Researchers, Networking and Research Lines
More than 1200 papers have been published in indexed journals as well as in books and documents used for decision-making in different countries. The book “Clinical
EP
Epidemiology – Applied Clinical Research” produced by Javeriana has been a very popular textbook and is currently in its sixth reprint [5].
AC C
The articles included in this issue of the Journal of Clinical Epidemiology are a good example of the spectrum of research accomplished in the LatinCLEN sites: 3 economic evaluations - the use of apixaban for atrial fibrillation [ 6 JCE 15-227], ticagrelor for acute coronary syndrome [7 JCE 14-775], and Kangaroo Mother Care (KMC) for pre-term and low birthweight infants [8 JCE 14-785]; clinical trials on KMC [9 JCE 15-71]; studies on the burden of illness from traffic accidents [10 JCE 14-819]; and studies on risk factors for coronary artery disease [11 JCE 14-769] and accidents [12 JCE 14-768]. The role of LatinCLEN in the conduct of systematic reviews is also described in the paper about the Cochrane collaboration [13 JCE 15-39].
ACCEPTED MANUSCRIPT
Currently, there are around 234 researchers working at the regional CERTC´S and CEUs (Table 1) and it is estimated that there are over 250 graduates of the programs. Networking within a country, between LatinCLEN countries, and with other international
RI PT
networks has promoted further development. A functional network was created in
Colombia between Universidad Javeriana, Universidad Nacional and Universidad de
Antioquia 4 years ago. These institutions (all of them CERTC’s) founded CINETS (the
National Center for Evidence Research and Health Technologies Evaluation), a very active
SC
center in the development of Evidence-based Clinical Practice Guides. So far, there are more than 35 guidelines, embedded in the Health and Social Security Ministry main
M AN U
webpage (http://gpc.minsalud.gov.co/Pages/Default.aspx). Chilean Universidad de la Frontera and Argentinian IECS have worked together in topics regarding Infant Health and CESCAS I study, and are part of major international research networks that have produced landmark studies like INTERHEART [14 ] ,CARMELA[ 15 -17 ] and PURE [16-17]. It should be noted that several of the network researchers have held positions of great importance in Latin America's governments and others have worked at international
TE D
institutions such as the PAHO, WHO, World Bank and Interamerican Bank among others. LatinCLEN and its centers and units have had a decisive and positive influence in the health of the countries in the region. There are plans for resource sharing, exchanging of professor and partnerships in macro projects that will provide global solutions to the
EP
essential health problems of the region. The network will continue its efforts in the harmonization of the existing resources in the region, as well as in the spreading of
AC C
knowledge and abilities that will improve the health of the participating countries.
Correspondence :
Carlos Gómez-Restrepo Departamento de Epidemiología y Bioestadística Facultad de Medicina - Pontificia Universidad Javeriana Hospital Universitario San Ignacio Kra. 7 no. 40 -62 Piso 2
ACCEPTED MANUSCRIPT
TE D
M AN U
SC
RI PT
Bogotá-Colombia e-mail: [email protected]
AC C
EP
Figure 1: The Latin American Clinical Epidemiology Network (LatinCLEN)
References
1. Murray CJL , Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997; 349: 1436-1442. DOI: http://dx.doi.org/10.1016/S01406736(96)07495-8
2. Marmot M. Social determinants and health inequalities. Lancet. 2005:365: 1099-1104. doi:10.1016/S0140-6736(05)71146-6
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
3.Alarcón RD. Mental health and mental health care in Latin America. World Psychiatry.2003; 2 (1): 54-6. 4. Almeida Filho N. Inequalities in health based on living conditions: Analysis of scientific output in Latin America and the Caribbean and annotated bibliography. Washington, DC: Pan American Health Organization; 1999. (Research in public health #19). 5. Ruiz A, Gómez-Restrepo C . Investigación clínica: Epidemiología clínica aplicada. 2 edición. Bogotá: Médica Panamericana; 2015. 6. JCE 15-227 7. JCE 14-775 8. JCE 14-785 9. JCE 15-71 10. JCE 14-819 11. JCE 14-769 12. JCE 14-768 13. JCE 15-39 14. Lanas F, Potthoff S, Mercadal E, Santibáñez C, Lanas A, Standen D. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile. Rev Méd Chile 2008; 136: 555-560. 15. Hernández-Hernández R, Silva H, Velasco M, Pellegrini F, Macchia A, Escobedo J, et al; CARMELA Study Investigators. Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study. J Hypertens 2010;28:24-34. 16. Touboul PJ, Vicaut E, Labreuche J, Acevedo M, Torres V, Ramirez- Martinez J, et al; CARMELA Study Investigators. Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results. Cerebrovasc Dis 2011;31:43-50. 17. Vinueza R, Boissonnet CP, Acevedo M, Uriza F, Benitez FJ, Silva H, Schargrodsky H, et al; CARMELA Study Investigators. Dyslipidemia in seven Latin American cities: CARMELA study. Prev Med 2010;50:106-11. 18. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low, middle-, and high-income countries. N Engl J Med 2014;371:818- 27. http://doi.org/xcq 19. Teo K, Chow CK, Vaz M, Ranjarajan S, Yusuf S; PURE Investigators-Writing Group. The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic non-communicable diseases in low-, middle-, and high-income countries. Am Heart J 2009; 158:1-7.
S0895-4356(16)30548-0
DOI:
10.1016/j.jclinepi.2016.10.002
Reference:
JCE 9255
To appear in:
Journal of Clinical Epidemiology
Received Date: 2 October 2016 Accepted Date: 10 October 2016
Please cite this article as: Gómez Restrepo C, Muñoz N S, Ruiz AJ, Lanas F, The Latin American Clinical Epidemiology Network “LatinCLEN”, Journal of Clinical Epidemiology (2016), doi: 10.1016/ j.jclinepi.2016.10.002. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
The Latin American Clinical Epidemiology Network “LatinCLEN”
RI PT
Carlos Gómez Restrepo1 Sergio Muñoz N2 Alvaro J Ruiz3 Fernando Lanas 4
TE D
M AN U
SC
Abstract The Latin American Clinical Epidemiology Network (LatinCLEN) was born in the nineties as a branch of the International Clinical Epidemiology Network (INCLEN). Clinical Epidemiology Units that made up this network in the region were initially composed of health professionals trained in Australia and North America. From these units, second and third generation training centers started to develop in the region, with the main purpose of introducing clinical research methodology and critical appraisal, as well as health economics and biostatistics. The field of Clinical Epidemiology has been introduced into health schools, and has had great influence on health policies and practices in Latin America. The articles in this series provide a bird’s eye view of research development in the region which include, among others, the capacity to conduct clinical trials on innovative therapies, systematic reviews, economic analyses, as well as studies on risk factors and burden of illness.
Resumen
EP
Keywords: Network, research network, Latin America, clinical epidemiology, INCLEN, LatinCLEN
1
AC C
LatinCLEN, la Red Latinoamericana de Epidemiología Clínica (INCLEN) nació en los años noventa como una rama de INCLEN (la Red Mundial de Epidemiología Clínica). Las primeras personas entrenadas lo hicieron en Australia y Norteamérica. Se crearon unidades de Epidemiología Clínica por egresados del INCLEN y empezaron a desarrollarse centros de segunda y tercera generación con el propósito Director and Professor titular. Department of Clinical Epidemiology and Biostatistics. Department Psychiatry and Mental Health.Pontificia Universidad Javeriana. President LatinCLEN. Hospital Universitario San Ignacio. Colombia. 2 Professor titular. Department of Public Health & CIGES, Universidad de la Frontera.Chile. 3 Professor titular. Department of Clinical Epidemiology and Biostatistics. Pontificia Universidad Javeriana.Colombia. 4 Professor titular. Department of Internal Medicine & CIGES,Universidad de la Frontera.Chile.
ACCEPTED MANUSCRIPT
SC
RI PT
de introducir en la región los conceptos de metodología de investigación clínica, apreciación crítica de la literatura, economía clínica y bioestadística. El área de Epidemiología Clínica ha sido introducido en las escuelas de áreas de la salud y ha tenido gran influencia, a través de infestigación y de la aplicación de medicina basada en evidencia, en políticas de salud y en prácticas en América Latina. Una red de investigadores y la colaboración entre centros ha permitido mayor desarrollo en la región. Los artículos de esta serie proveen una breve impresión del desarrollo de investigación en la región que incluye, entre otros temas, la capacidad de conducir ensayos clínicos en terapias innovativas, revisiones sistemáticas, análisis económicos, como estudios sobre factores de riesgo y carga de enfermedad.
M AN U
Introduction
In 1978, a conference on “Health in the Third World” (Bellagio) concluded that a major hindrance to health improvement in developing countries was the scarcity of health professionals with the interest and capacity to conduct research and analyze major health problems [ 1-4]. In response to this problem, the Rockefeller Foundation established an international training program known as the International Clinical Epidemiology Network
TE D
(INCLEN). INCLEN was created in the mid 80's with participants from 27 schools of Medicine from all over the world, sent to train in North America and Australia. As part of that initiative, Clinical Epidemiology Units (CEUs) were created in Latin American countries including Mexico, Colombia, Brazil and Chile. These units were composed of
EP
INCLEN scholars who were trained in Clinical Epidemiology, Biostatistics, Health Social
AC C
Sciences and Health Economics.
After a few years, some of the CEUs became training centers themselves. Three centers in Latin America became the starting point of the regional network: Pontificia Universidad Javeriana in Bogotá, Colombia, Universidade Federal do São Paulo in São Paulo, Brazil and Universidad de la Frontera in Temuco, Chile. These centers gave priority to training of university professors from the region, who were to return to their home institutions, create new CEUs and spread this new area of knowledge. Strong support was given by first generation Clinical Epidemiology Research and Training Centers (CERTCs) which
ACCEPTED MANUSCRIPT
included McMaster University in Canada, The University of Pennsylvania and University of North Carolina in the USA, and the University of Newcastle in Australia. The beginning
RI PT
LatinClen was born in Africa during the 1991 INCLEN Annual Meeting, in Mombassa, Kenya. The idea of creating a group for collaboration in research in the Latin American region was presented and approved by the authorities of the Health Division of the Rockefeller Foundation, with the following objectives:
to develop and conduct regional research projects, focused on national essential
SC
-
health problems;
to increase the potential for national, regional and international funding;
-
to exchange knowledge, solutions to common problems and teaching strategies; and
-
to improve the possibilities of influencing national health policies.
M AN U
-
Alvaro J. Ruiz was the first President. Since then, new CEUs have developed in Argentina, Bolivia, Peru, Colombia, Brazil and Mexico (Figure 1). A regional congress is held every 2
TE D
to 3 years in the region. Currently, more than 400 clinical epidemiologists have been trained and Master's Degree programs have begun in most countries, as well as Degrees in Health Economics, Biostatistics and a PhD in Clinical Epidemiology.
EP
Present and future
The Rockefeller Foundation founded LatinCLEN and supported it from its inception, but policy changes within the organization led to the end of sponsorship. This presented a
AC C
significant challenge to the entire Network, and funding sources had to diversify. INCLEN (now INCLEN Trust) also faced, changes but it still is a leading force, now from India. A Regional Advisory Committee (RAB) was created (coordinated by Carlos Gómez-Restrepo) to help in harmonization of the regional CLENs. LatinCLEN has current presence in 10 countries (Table 1).
ACCEPTED MANUSCRIPT
Table 1. Latin American Clinical Epidemiology Network participant institutions and number of researchers
Bolivia • Universidad Mayor de San Andrés
RI PT
Argentina • Instituto de Efectividad Clínica y Sanitaria. Universidad de Buenos Aires (Centro Argentino de la Red Cochrane Iberoamericana) • Universidad Nacional de Tucumán
M AN U
SC
Brasil • CERTC and Centro Paulista de Economía en Salud. Universidad Federal de Sao Paulo • Universidade Federal Do Rio de Janeiro • Universidade Federal Do Ceará - Fortaleza • Faculdade de Medicina de Marília Chile • CIGES, Universidad de La Frontera (Centro Chileno de la Red Cochrane Iberoamericana)
EP
TE D
Colombia • Pontificia Universidad Javeriana - Bogota- (Centro Colombiano de la Red Cochrane Iberoamericana) • Universidad Nacional de Colombia (Centro Colombiano de la Red Cochrane Iberoamericana) • Universidad de Antioquia - Medellin • Universidad del Cauca – Popayán • Universidad Industrial de Santander- Bucaramanga
AC C
España • Centro Cochrane Iberoamericano México • Instituto Mexicano de Seguridad Social • Instituto Nacional de Nutrición Salvador Zubiran Perú • Universidad Peruana Cayetano Heredia
Education
ACCEPTED MANUSCRIPT
Most of the institutions have training programs in clinical epidemiology, evidence based medicine (EBM), health economics and biostatistics. Currently there are 9 Master’s Degree programs in Clinical Epidemiology (Brazil, Chile, Colombia and Peru), one in Clinical Effectiveness in Argentina, 2 in Biostatistics (Universidad de Chile and Javeriana), 2 in
RI PT
Health Economics (Escola Paulista and Javeriana) and one PhD program in Clinical Epidemiology (Javeriana).
A large number of short courses and diploma certifications have been conducted in the
SC
region, on EBM and critical analysis of literature, literature search, research design, fundamentals of clinical epidemiology, controlled clinical trials, clinical study
M AN U
development, basic biostatistics, advanced biostatistics, health economics, decision analysis, GRADE, sample size calculation, design and analysis of sample surveys, among others. Most universities in the region have implemented undergraduate contents in research methods, basic biostatistics, EBM and literature search, with a clearly visible impact on the amount and quality of clinical research being produced and published.
TE D
Researchers, Networking and Research Lines
More than 1200 papers have been published in indexed journals as well as in books and documents used for decision-making in different countries. The book “Clinical
EP
Epidemiology – Applied Clinical Research” produced by Javeriana has been a very popular textbook and is currently in its sixth reprint [5].
AC C
The articles included in this issue of the Journal of Clinical Epidemiology are a good example of the spectrum of research accomplished in the LatinCLEN sites: 3 economic evaluations - the use of apixaban for atrial fibrillation [ 6 JCE 15-227], ticagrelor for acute coronary syndrome [7 JCE 14-775], and Kangaroo Mother Care (KMC) for pre-term and low birthweight infants [8 JCE 14-785]; clinical trials on KMC [9 JCE 15-71]; studies on the burden of illness from traffic accidents [10 JCE 14-819]; and studies on risk factors for coronary artery disease [11 JCE 14-769] and accidents [12 JCE 14-768]. The role of LatinCLEN in the conduct of systematic reviews is also described in the paper about the Cochrane collaboration [13 JCE 15-39].
ACCEPTED MANUSCRIPT
Currently, there are around 234 researchers working at the regional CERTC´S and CEUs (Table 1) and it is estimated that there are over 250 graduates of the programs. Networking within a country, between LatinCLEN countries, and with other international
RI PT
networks has promoted further development. A functional network was created in
Colombia between Universidad Javeriana, Universidad Nacional and Universidad de
Antioquia 4 years ago. These institutions (all of them CERTC’s) founded CINETS (the
National Center for Evidence Research and Health Technologies Evaluation), a very active
SC
center in the development of Evidence-based Clinical Practice Guides. So far, there are more than 35 guidelines, embedded in the Health and Social Security Ministry main
M AN U
webpage (http://gpc.minsalud.gov.co/Pages/Default.aspx). Chilean Universidad de la Frontera and Argentinian IECS have worked together in topics regarding Infant Health and CESCAS I study, and are part of major international research networks that have produced landmark studies like INTERHEART [14 ] ,CARMELA[ 15 -17 ] and PURE [16-17]. It should be noted that several of the network researchers have held positions of great importance in Latin America's governments and others have worked at international
TE D
institutions such as the PAHO, WHO, World Bank and Interamerican Bank among others. LatinCLEN and its centers and units have had a decisive and positive influence in the health of the countries in the region. There are plans for resource sharing, exchanging of professor and partnerships in macro projects that will provide global solutions to the
EP
essential health problems of the region. The network will continue its efforts in the harmonization of the existing resources in the region, as well as in the spreading of
AC C
knowledge and abilities that will improve the health of the participating countries.
Correspondence :
Carlos Gómez-Restrepo Departamento de Epidemiología y Bioestadística Facultad de Medicina - Pontificia Universidad Javeriana Hospital Universitario San Ignacio Kra. 7 no. 40 -62 Piso 2
ACCEPTED MANUSCRIPT
TE D
M AN U
SC
RI PT
Bogotá-Colombia e-mail: [email protected]
AC C
EP
Figure 1: The Latin American Clinical Epidemiology Network (LatinCLEN)
References
1. Murray CJL , Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997; 349: 1436-1442. DOI: http://dx.doi.org/10.1016/S01406736(96)07495-8
2. Marmot M. Social determinants and health inequalities. Lancet. 2005:365: 1099-1104. doi:10.1016/S0140-6736(05)71146-6
ACCEPTED MANUSCRIPT
AC C
EP
TE D
M AN U
SC
RI PT
3.Alarcón RD. Mental health and mental health care in Latin America. World Psychiatry.2003; 2 (1): 54-6. 4. Almeida Filho N. Inequalities in health based on living conditions: Analysis of scientific output in Latin America and the Caribbean and annotated bibliography. Washington, DC: Pan American Health Organization; 1999. (Research in public health #19). 5. Ruiz A, Gómez-Restrepo C . Investigación clínica: Epidemiología clínica aplicada. 2 edición. Bogotá: Médica Panamericana; 2015. 6. JCE 15-227 7. JCE 14-775 8. JCE 14-785 9. JCE 15-71 10. JCE 14-819 11. JCE 14-769 12. JCE 14-768 13. JCE 15-39 14. Lanas F, Potthoff S, Mercadal E, Santibáñez C, Lanas A, Standen D. Riesgo individual y poblacional en infarto agudo del miocardio: Estudio INTERHEART Chile. Rev Méd Chile 2008; 136: 555-560. 15. Hernández-Hernández R, Silva H, Velasco M, Pellegrini F, Macchia A, Escobedo J, et al; CARMELA Study Investigators. Hypertension in seven Latin American cities: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study. J Hypertens 2010;28:24-34. 16. Touboul PJ, Vicaut E, Labreuche J, Acevedo M, Torres V, Ramirez- Martinez J, et al; CARMELA Study Investigators. Common carotid artery intima-media thickness: the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study results. Cerebrovasc Dis 2011;31:43-50. 17. Vinueza R, Boissonnet CP, Acevedo M, Uriza F, Benitez FJ, Silva H, Schargrodsky H, et al; CARMELA Study Investigators. Dyslipidemia in seven Latin American cities: CARMELA study. Prev Med 2010;50:106-11. 18. Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, et al. Cardiovascular risk and events in 17 low, middle-, and high-income countries. N Engl J Med 2014;371:818- 27. http://doi.org/xcq 19. Teo K, Chow CK, Vaz M, Ranjarajan S, Yusuf S; PURE Investigators-Writing Group. The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic non-communicable diseases in low-, middle-, and high-income countries. Am Heart J 2009; 158:1-7.