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Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.

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Presentación de Jaime Miranda en el marco del III Congreso Chileno de Salud Pública y el V Congreso Chileno de Epidemiología. Santiago de Chile, Julio 2014.

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Desafíos para el Epidemiólogo en América Latina! Jaime Miranda, MD, MSc, PhD! ! Santiago de Chile, 24 julio 2014!
! @jjaimemiranda! ! !!![Disclaimer]!
! En esta charla! no van a recibir nada! de métodos! ! !!![Disclaimer]!
! En esta charla! solamente, y humildemente,! sabrán de mi historia! ! !!![Disclaimer]!
! Hacer una charla de epidemiología sin mostrar ningún IC 95% ni tampoco un p-value! ! !![Mi reto]!
Conflictos de interés! §  Acerca de mi! §  MD, PhD Epidemiología! §  CRONICAS Centro de Excelencia en Enfermedades Crónicas! §  IEA! §  Apoyo financiero! §  Wellcome Trust, NIH, IDRC, WHO, GCC, WB! §  No financiamiento industria farmacéutica!
Conflictos de interés! §  Creo en las personas! §  Apostar por y trabajar con personas “cansa”! §  Equivocarse y arriesgar, mucho! §  No pretendo tener la razón! §  Ego de académico! §  Lo tengo, por allí anda… ojalá bien lejos! §  Edad 38 años! §  Quiero pensar que puedo invertir tiempo en dar. Estoy cerca de llegar a mi etapa de gruñón.!
Un sinvergüenza sin vergüenza 
 en el estudio de las enfermedades crónicas! Jaime Miranda, MD, MSc, PhD! ! Santiago de Chile, 24 julio 2014!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
¿Por qué estamos en esto?!
! ! !Yo vivo de preguntar,! saber no puede ser un lujo! ! !!!Silvio Rodríguez!
Stupidity vs. altruism?! “For many social entrepreneurs, happiness comes from the feeling they are making a difference.”!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
Nuestro grupo desde 2009! §  Un equipo, decisiones compartidas! §  ~100 publicaciones (4 personas)! §  ~15 proyectos financiados. Muchos más, los más bonitos, sin dinero! §  ~$15 million en grants, >50% fondos à Peru! §  Nuestro CRONICAS Centro de Excelencia en Enfermedades Crónicas… “to gravitate, locally and internationally”!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
Lo bueno! §  Dar! §  Comparte! §  Cultiva! §  Creer! §  Perfectionista! §  Focus… me cuesta mucho! §  Competitividad internacional! §  NUNCA sacrificar la calidad! §  Colabora! §  Respeta! §  “What goes around comes around”!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
Lo malo, lo que nos limita! §  Tiempo! §  Tiempo! §  Tiempo! §  ¡no es el dinero!! §  Saturados! §  Cansados! §  Overcommitted?! §  Unfocused?!
Pero… Miremos pa’lante!
21  
Repeat after me… #1! ! ! !Perseverancia! ! “El que persevera alcanza”!
Repeat after me… #2! ! ! !Perseverancia! ! “El que persevera alcanza”!
Repeat after me… #3! ! ! !Perseverancia! ! “El que persevera alcanza”!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
¿Cuál es nuestro ‼’lԳٱ”?!
Addressing geographical variation in the progression of non-communicable diseases in Peru! §  Objective: To assess the progression rate and risk factors associated with non-communicable diseases in settings with different level of urbanization in Peru: Lima, Tumbes and Puno. ! §  Design: Cohort study.! §  Source: National Heart, Lung and Blood Institute (NHLBI)! §  Funding:   USD 4,162,526. ! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
Lección aprendida! §  5 años es mucho tiempo para renegar! §  Aprende a escuchar, a ceder y a cerrar la boca! §  Escoge bien a tus colaboradores! §  Tienes tiempo y margen para arriesgar con otras cosas!
Launching a salt substitute to reduce blood pressure at the population level in Peru! §  Objective: To implement a population-level intervention to replace high-sodium salt for a salt substitute (low-sodium, high-potassium salt) to reduce blood pressure levels among adults aged 20 years and over of the semi-urban area of Tumbes. The implementation of this sort of strategy must involve a range of participants, from villagers, their families and local leaders to local institutions as well as local, regional and national authorities.! §  Design: Stepped wedge trial.! §  Source: National Heart, Lung and Blood Institute (NHLBI).! §  Funding: USD 2,029,250. ! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
Lecciones! §  Arriesga! §  Aprende de otros! §  Apunta alto! §  Auto-publicidad: vean video de YouTube!
Latin America Treatment & Innovation Network in Mental Health 
 (LATIN-MH)! §  Objective: To establish a regional hub for mental health research and training addressing the co-morbidity between mental and chronic diseases, aiming to decrease the treatment gap for mental disorders among people with physical disorders in LA & C.! §  Design: Clinical trial.! §  Countries: Brazil, Peru and Guatemala.  ! §  Source: National Institute of Mental Health (NIMH)! §  Funding: USD 2,801,398.! §  Partners: University of Sao Paulo, University of Bristol, Northwestern University.!
Lecciones! §  Comparte! §  Escucha! §  Métele tiempo, y esfuerzo, igual puedes hacer cosas. Do not give up.! §  Financiamiento estancado!
Tackling the elephant in the room: Integration of mental health into quotidian routine practices of primary health care services! §  Objective: To develop and test an intervention using mobile technology (mHealth), training of non-mental primary health care providers, and empowering patients with information to improve the early identification, opportune referral, and access to treatment of people suffering depression among socially disadvantaged people in Lima, Peru.! §  Design: Feasibility study.! §  Source: Grand Challenges Canada (GCC).! §  Funding: CAD $249,921.! §  Partners: University of Bristol.!
Lecciones aprendidas! §  Invierte en el sistema! §  Hoy por tí, mañana por mí!
Cooking for Health: Capitalizing on Comedores Populares to deliver healthy diets to low-income families in Peru for the prevention of NCDs! §  Objective: To explore alternatives to promote the adoption of healthy dietary habits among poor inhabitants of urban communities who are members, as suppliers, consumers or both, of Comedores Populares. This project will use tools common to public health research, health economics and behavioral economics to explore opportunities, barriers and preferences on healthy foods. ! §  Design: Qualitatitve study & Discrete choice experiment.! §  Source: International Development Research Center (IDRC).! §  Funding: CAD $302,700.! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
Lecciones aprendidas! §  Ser realista con tus tiempos y esfuerzos! §  Aprende a corregir temprano!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
Identifying barriers of access to treatment of chronic non communicable diseases in Peru.! §  Objective: To identify the barriers that people have to access medicine and the treatment of non-transmissible diseases in Peru; plus develop proposals to better the health system and a political response that contributes to a healthier lifestyle for people with non- transmissible diseases in Peru. Once the barriers are identified, the priorities must be defined with the help of local agents and policy makers to ensure the acceptance of the results.! §  Design: Health systems assessment.! §  Source: Alliance for Health Policy and Systems Research - WHO! §  Funding: USD 44,000.! §  Partners: University of Geneva.!
Lecciones aprendidas! §  Cuándo cerrar!
Mobile health to prevent progression of pre-hypertension in Latin American urban settings! §  Objective: To decrease the number of cases of high blood pressure and prevent the cases of pre-hypertension from escalating to hypertension in middle-class people that come from urban clinics from Argentina, Guatemala and Peru through an intervention based on the use of mobile technologies of health (mHealth): SMS and personal phone calls.     ! §  Design: Clinical trial.! §  Countries: Peru, Guatemala and Argentina.! §  Sources: National Heart, Lung and Blood Institute (NHLBI)  & Medtronics Foundation  ! §  Funding: USD 590,000.    ! §  Partners: IECS, INCAP, RAND Corporation.!
Do we know how to do it?!
Lecciones aprendidas! §  mHealth no es simple! §  Sigue siendo intevenciones complejas! §  Tecnología + Intervención + Captura datos!
Peruvian Risk of Stroke and Mortality (PRISM): a study of  lifestyle, biomarker and genetic determinants of stroke in Latin America! §  Objective: To assess locally relevant exposures, established vascular risk factors, and biochemical and genetic factors in relation to new-onset stroke risk and post-event mortality among stroke survivors.            ! §  Source: University of Pennsylvania.! §  Funding: USD 20,000.! §  Partners: University of Pennsylvania.!
Lecciones! §  No subsidies financieramente un proyecto! §  Invierte en conocer a tus partners! §  Proyecto NUNCA empezó!
Vínculo con otros campos!
Nuevas colaboraciones! §  Inter-American Institute for Global Change Research, Collaborative Research Network (CRN3) program! §  Title: LUCIA – Land Use, Climate and Infections in Western Amazonia.! §  Total Budget: USD $906,500! §  Partners: Universidade Federal of Minas Gerais, Duke University, Universidad San Francisco de Quito. ! §  Instituto Nacional de Salud del Niño! §  Title: Early determinants of physical growth, cognitive development and health status in infancy. A family cohort study.! §  Total Budget: PER S/. 3,696,000 (USD $ 1,451,695)! §  Partners: INSN!
Additional take home messages! §  Invest time! §  Do not sacrifice quality! §  Share, do share! §  Plant ideas! §  Build and cultivate relationships! §  Trust, do trust!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.
www.facebook.com/cronicasperu! §  Solidaridad! §  Integridad! §  Generosidad! §  Transparencia! §  Calidad!
¿Vamos a clasificar al mundial?! §  No hay fórmula perfecta! §  Estilos, paradigmas, objetivos distintos! §  Sinvergüenza vs sin vergüenza! §  Negociación, respeto y firmeza! §  CRONICAS: Generosidad, Integridad, Colaboración! §  Dedicación, sacrificios!
¡Muchas gracias!! §  IEA! §  Universidad Antioquía! §  NHLBI-NIH! §  Wellcome Trust! §  Various colleagues at UPCH, LSHTM, JHU PRISMA! §  Jaime.Miranda@upch.pe!
www.cronicas.pe!
Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.

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Desafíos para el Epidemiólogo en América Latina. Por Jaime Miranda.

  • 1. Desafíos para el Epidemiólogo en América Latina! Jaime Miranda, MD, MSc, PhD! ! Santiago de Chile, 24 julio 2014!
  • 3. ! En esta charla! no van a recibir nada! de métodos! ! !!![Disclaimer]!
  • 4. ! En esta charla! solamente, y humildemente,! sabrán de mi historia! ! !!![Disclaimer]!
  • 5. ! Hacer una charla de epidemiología sin mostrar ningún IC 95% ni tampoco un p-value! ! !![Mi reto]!
  • 6. Conflictos de interés! §  Acerca de mi! §  MD, PhD Epidemiología! §  CRONICAS Centro de Excelencia en Enfermedades Crónicas! §  IEA! §  Apoyo financiero! §  Wellcome Trust, NIH, IDRC, WHO, GCC, WB! §  No financiamiento industria farmacéutica!
  • 7. Conflictos de interés! §  Creo en las personas! §  Apostar por y trabajar con personas “cansa”! §  Equivocarse y arriesgar, mucho! §  No pretendo tener la razón! §  Ego de académico! §  Lo tengo, por allí anda… ojalá bien lejos! §  Edad 38 años! §  Quiero pensar que puedo invertir tiempo en dar. Estoy cerca de llegar a mi etapa de gruñón.!
  • 8. Un sinvergüenza sin vergüenza 
 en el estudio de las enfermedades crónicas! Jaime Miranda, MD, MSc, PhD! ! Santiago de Chile, 24 julio 2014!
  • 10. ¿Por qué estamos en esto?!
  • 11. ! ! !Yo vivo de preguntar,! saber no puede ser un lujo! ! !!!Silvio Rodríguez!
  • 12. Stupidity vs. altruism?! “For many social entrepreneurs, happiness comes from the feeling they are making a difference.”!
  • 15. Nuestro grupo desde 2009! §  Un equipo, decisiones compartidas! §  ~100 publicaciones (4 personas)! §  ~15 proyectos financiados. Muchos más, los más bonitos, sin dinero! §  ~$15 million en grants, >50% fondos à Peru! §  Nuestro CRONICAS Centro de Excelencia en Enfermedades Crónicas… “to gravitate, locally and internationally”!
  • 17. Lo bueno! §  Dar! §  Comparte! §  Cultiva! §  Creer! §  Perfectionista! §  Focus… me cuesta mucho! §  Competitividad internacional! §  NUNCA sacrificar la calidad! §  Colabora! §  Respeta! §  “What goes around comes around”!
  • 19. Lo malo, lo que nos limita! §  Tiempo! §  Tiempo! §  Tiempo! §  ¡no es el dinero!! §  Saturados! §  Cansados! §  Overcommitted?! §  Unfocused?!
  • 21. 21  
  • 22. Repeat after me… #1! ! ! !Perseverancia! ! “El que persevera alcanza”!
  • 23. Repeat after me… #2! ! ! !Perseverancia! ! “El que persevera alcanza”!
  • 24. Repeat after me… #3! ! ! !Perseverancia! ! “El que persevera alcanza”!
  • 26. ¿Cuál es nuestro ‼’lԳٱ”?!
  • 27. Addressing geographical variation in the progression of non-communicable diseases in Peru! §  Objective: To assess the progression rate and risk factors associated with non-communicable diseases in settings with different level of urbanization in Peru: Lima, Tumbes and Puno. ! §  Design: Cohort study.! §  Source: National Heart, Lung and Blood Institute (NHLBI)! §  Funding:   USD 4,162,526. ! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
  • 28. Lección aprendida! §  5 años es mucho tiempo para renegar! §  Aprende a escuchar, a ceder y a cerrar la boca! §  Escoge bien a tus colaboradores! §  Tienes tiempo y margen para arriesgar con otras cosas!
  • 29. Launching a salt substitute to reduce blood pressure at the population level in Peru! §  Objective: To implement a population-level intervention to replace high-sodium salt for a salt substitute (low-sodium, high-potassium salt) to reduce blood pressure levels among adults aged 20 years and over of the semi-urban area of Tumbes. The implementation of this sort of strategy must involve a range of participants, from villagers, their families and local leaders to local institutions as well as local, regional and national authorities.! §  Design: Stepped wedge trial.! §  Source: National Heart, Lung and Blood Institute (NHLBI).! §  Funding: USD 2,029,250. ! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
  • 30. Lecciones! §  Arriesga! §  Aprende de otros! §  Apunta alto! §  Auto-publicidad: vean video de YouTube!
  • 31. Latin America Treatment & Innovation Network in Mental Health 
 (LATIN-MH)! §  Objective: To establish a regional hub for mental health research and training addressing the co-morbidity between mental and chronic diseases, aiming to decrease the treatment gap for mental disorders among people with physical disorders in LA & C.! §  Design: Clinical trial.! §  Countries: Brazil, Peru and Guatemala.  ! §  Source: National Institute of Mental Health (NIMH)! §  Funding: USD 2,801,398.! §  Partners: University of Sao Paulo, University of Bristol, Northwestern University.!
  • 32. Lecciones! §  Comparte! §  Escucha! §  Métele tiempo, y esfuerzo, igual puedes hacer cosas. Do not give up.! §  Financiamiento estancado!
  • 33. Tackling the elephant in the room: Integration of mental health into quotidian routine practices of primary health care services! §  Objective: To develop and test an intervention using mobile technology (mHealth), training of non-mental primary health care providers, and empowering patients with information to improve the early identification, opportune referral, and access to treatment of people suffering depression among socially disadvantaged people in Lima, Peru.! §  Design: Feasibility study.! §  Source: Grand Challenges Canada (GCC).! §  Funding: CAD $249,921.! §  Partners: University of Bristol.!
  • 34. Lecciones aprendidas! §  Invierte en el sistema! §  Hoy por tí, mañana por mí!
  • 35. Cooking for Health: Capitalizing on Comedores Populares to deliver healthy diets to low-income families in Peru for the prevention of NCDs! §  Objective: To explore alternatives to promote the adoption of healthy dietary habits among poor inhabitants of urban communities who are members, as suppliers, consumers or both, of Comedores Populares. This project will use tools common to public health research, health economics and behavioral economics to explore opportunities, barriers and preferences on healthy foods. ! §  Design: Qualitatitve study & Discrete choice experiment.! §  Source: International Development Research Center (IDRC).! §  Funding: CAD $302,700.! §  Partners: Johns Hopkins Bloomberg School of Public Health.!
  • 36. Lecciones aprendidas! §  Ser realista con tus tiempos y esfuerzos! §  Aprende a corregir temprano!
  • 38. Identifying barriers of access to treatment of chronic non communicable diseases in Peru.! §  Objective: To identify the barriers that people have to access medicine and the treatment of non-transmissible diseases in Peru; plus develop proposals to better the health system and a political response that contributes to a healthier lifestyle for people with non- transmissible diseases in Peru. Once the barriers are identified, the priorities must be defined with the help of local agents and policy makers to ensure the acceptance of the results.! §  Design: Health systems assessment.! §  Source: Alliance for Health Policy and Systems Research - WHO! §  Funding: USD 44,000.! §  Partners: University of Geneva.!
  • 40. Mobile health to prevent progression of pre-hypertension in Latin American urban settings! §  Objective: To decrease the number of cases of high blood pressure and prevent the cases of pre-hypertension from escalating to hypertension in middle-class people that come from urban clinics from Argentina, Guatemala and Peru through an intervention based on the use of mobile technologies of health (mHealth): SMS and personal phone calls.     ! §  Design: Clinical trial.! §  Countries: Peru, Guatemala and Argentina.! §  Sources: National Heart, Lung and Blood Institute (NHLBI)  & Medtronics Foundation  ! §  Funding: USD 590,000.    ! §  Partners: IECS, INCAP, RAND Corporation.!
  • 41. Do we know how to do it?!
  • 42. Lecciones aprendidas! §  mHealth no es simple! §  Sigue siendo intevenciones complejas! §  Tecnología + Intervención + Captura datos!
  • 43. Peruvian Risk of Stroke and Mortality (PRISM): a study of  lifestyle, biomarker and genetic determinants of stroke in Latin America! §  Objective: To assess locally relevant exposures, established vascular risk factors, and biochemical and genetic factors in relation to new-onset stroke risk and post-event mortality among stroke survivors.            ! §  Source: University of Pennsylvania.! §  Funding: USD 20,000.! §  Partners: University of Pennsylvania.!
  • 44. Lecciones! §  No subsidies financieramente un proyecto! §  Invierte en conocer a tus partners! §  Proyecto NUNCA empezó!
  • 46. Nuevas colaboraciones! §  Inter-American Institute for Global Change Research, Collaborative Research Network (CRN3) program! §  Title: LUCIA – Land Use, Climate and Infections in Western Amazonia.! §  Total Budget: USD $906,500! §  Partners: Universidade Federal of Minas Gerais, Duke University, Universidad San Francisco de Quito. ! §  Instituto Nacional de Salud del Niño! §  Title: Early determinants of physical growth, cognitive development and health status in infancy. A family cohort study.! §  Total Budget: PER S/. 3,696,000 (USD $ 1,451,695)! §  Partners: INSN!
  • 47. Additional take home messages! §  Invest time! §  Do not sacrifice quality! §  Share, do share! §  Plant ideas! §  Build and cultivate relationships! §  Trust, do trust!
  • 49. www.facebook.com/cronicasperu! §  Solidaridad! §  Integridad! §  Generosidad! §  Transparencia! §  Calidad!
  • 50. ¿Vamos a clasificar al mundial?! §  No hay fórmula perfecta! §  Estilos, paradigmas, objetivos distintos! §  Sinvergüenza vs sin vergüenza! §  Negociación, respeto y firmeza! §  CRONICAS: Generosidad, Integridad, Colaboración! §  Dedicación, sacrificios!
  • 51. ¡Muchas gracias!! §  IEA! §  Universidad Antioquía! §  NHLBI-NIH! §  Wellcome Trust! §  Various colleagues at UPCH, LSHTM, JHU PRISMA! §  Jaime.Miranda@upch.pe!