Crisis y pobreza rural en América Latina : el caso de Guatemala

Este documento de trabajo es el número 9 de la serie Crisis y Pobreza Rural en América Latina, y presenta los efectos de la actual crisis en la población rural en el caso de Guatemala: efectos potenciales de las diferentes medidas políticas adoptadas, y sugiere alternativas de cooperación con actores internacionales. La ruralidad en Guatemala concentra al 70% de la población en situación de pobreza. Aunque en los últimos años se observa una leve reducción en los índices de desigualdad, tales avances han sucedido fundamentalmente en el ámbito urbano, revelando inamovilidad en las condiciones estructurales de la población rural. Además, la leve disminución de pobreza rural se explica principalmente por el crecimiento económico del país y no por redistribución de recursos, lo cual revela ausencia del Estado y políticas públicas efectivas para la reducción de la pobreza. El sistema financiero del país no tiene un significativo nivel de integración a mercados internacionales, razón por la cual los efectos de la actual crisis en Guatemala se transmiten esencialmente a través del sector real de la economía. Los datos analizados sugieren un bajo nivel de impacto de la crisis financiera en las poblaciones rurales, las cuales son impactadas principalmente por dos vías: una contracción en el empleo y un menor flujo de remesas provenientes del exterior

Crisis y pobreza rural en Guatemala

"Los fundamentos macroeconómicos estables y el manejo conservador de la política económica que ha demostrado tradicionalmente Guatemala, unidos a la reducida integración a los mercados internacionales de su sistema financiero, deberían implicar una relativamente baja exposición a la actual crisis económica mundial y un mayor espacio para implementar medidas anticíclicas en el país. El impacto de la crisis en Guatemala se hace sentir, fundamentalmente, en la pérdida de dinamismo en la actividad económica, en la que las proyecciones de crecimiento continúan bajando. Esto ha repercutido en una reducción de los ingresos fiscales, principalmente por la vía del impuesto al valor agregado a las importaciones, un rubro que constituye un cuarto de la recaudación total. Otros canales de transmisión de la crisis son los flujos de remesas, el comercio intrarregional (centroamericano) y la posible reducción de las líneas de crédito a la banca comercial, aunque este último es un efecto que todavía no se manifiesta con claridad. Como producto de la desaceleración económica internacional, el gobierno ya ha comenzado a experimentar una merma en sus ingresos fiscales. Ello implica una restricción adicional a la capacidad de respuesta del sector público, sobre todo ante la incertidumbre sobre la duración y profundidad de la crisis."–página 2.Rimisp-Centro Latinoamericano para el Desarrollo Rural; Fondo Internacional de Desarrollo Agrícola (FIDA)

Genetic Counseling and Testing for Alzheimer's Disease and Frontotemporal Lobar Degeneration: An Italian Consensus Protocol

Background: Genetic testing of familial Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD) is attracting interest thanks to innovative primary prevention clinical trials and increased request for information by at-risk individuals. However, ethical, social, and psychological implications are paramount and genetic testing must be supported by structured genetic counseling. In Italy, practice parameters and guidelines for genetic counseling in dementia are not available. Objective: To develop a nationally harmonized protocol for genetic counseling and testing of familial AD and FTLD. Method: Activities were carried out in the context of the Italian Dominantly Inherited Alzheimer's and Frontotemporal Network (IT-DIAfN) project, a national network of centers of excellence with expertise in managing patients with familial AD and FTLD. A survey of the literature on genetic counseling protocols and guidelines was conducted. Local protocols for genetic counseling were surveyed. Differences and commonalities among protocols were identified and discussed among project partners. Consensus was reached following implicit aggregation methods. Results: Consensus was reached on a protocol for patients with clinically diagnosed familial AD or FTLD and a distinct protocol for their at-risk relatives. Genetic counseling should be provided by a multidisciplinary team including a geneticist, a neurologist/geriatrician, and a psychologist/psychiatrist, according to the following schedule: (i) initial consultation with tailored information on the genetics of the dementias; (ii) clinical, psychological, and cognitive assessment; if deemed appropriate (iii) genetic testing following a structured decision tree for gene mutation search; (iv) genetic testing result disclosure; (v) psychological support follow-up. Conclusions: This genetic counseling protocol provides Italian centers with a line of shared practice for dealing with the requests for genetic testing for familialADand FTLD from patients and at-risk relatives, who may also be eligible participants for novel prevention clinical trials

Position paper of the Italian Society for the study of Dementias (SINDEM) on the proposal of a new lexicon on Alzheimer disease

A panel of Italian neurologists of the Italian Society for the study of Dementias (SINDEM) discussed the recently proposed new lexicon for Alzheimer disease (AD) and the related diagnostic criteria for the different phases of the disease (Preclinical AD, prodromal AD and Alzheimer's dementia) (Dubois et al. in Lancet Neurol 6:734-746, 2007; in Lancet Neurol 9:1118-1127, 2010). The aim of this discussion was to reach a consensus, among the Italian neurologists involved in the study and care of persons with dementia, in particular in reference to the potential use of the proposed diagnostic criteria in clinical practice. After having critically revised the scientific evidence related to the new lexicon and to the new proposed diagnostic criteria, the panel concluded that the proposed new diagnostic criteria and the new proposed lexicon for AD are conceptually attractive. However, the evidence about the instrumental and laboratory markers for the diagnosis of the preclinical and asymptomatic states of the disease are, until to now, insufficient to support the routine clinical use of these investigations

Accuracy of the clinical diagnosis of dementia with Lewy bodies (DLB) among the Italian Dementia Centers: a study by the Italian DLB study group (DLB-SINdem)

Introduction: Dementia with Lewy bodies (DLB) may represent a diagnostic challenge, since its clinical picture overlaps with other dementia. Two toolkits have been developed to aid the clinician to diagnose DLB: the Lewy Body Composite Risk Score (LBCRS) and the Assessment Toolkit for DLB (AT-DLB). We aim to evaluate the reliability of these two questionnaires, and their ability to enhance the interpretation of the international consensus diagnostic criteria. Methods: LBCRS and AT-DLB were distributed to 135 Italian Neurological Centers for Cognitive Decline and Dementia (CDCDs), with the indication to administer them to all patients with dementia referred within the subsequent 3 months. We asked to subsequently apply consensus criteria for DLB diagnosis, to validate the diagnostic accuracy of the two toolkits. Results: A total of 23 Centers joined the study; 1854 patients were enrolled. We found a prevalence of possible or probable DLB of 13% each (26% total), according to the consensus criteria. LBCRS toolkit showed good reliability, with a Cronbach alpha of 0.77, stable even after removing variables from the construct. AT-DLB toolkit Cronbach alpha was 0.52 and, after the subtraction of the "cognitive fluctuation" criterion, was only 0.31. Accuracy, sensitivity, and specificity were higher for LBCRS vs. AT-DLB. However, when simultaneously considered in the logistic models, AT-DLB showed a better performance (p\u2009<\u20090.001). Overall, the concordance between LBCRS positive and AT-DLB possible/probable was of 78.02% CONCLUSIONS: In a clinical setting, the LBCRS and AT-DLB questionnaires have good accuracy for DLB diagnosis