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Recent demographic trends in the Latin American and Caribbean (LAC)
region will shape the growth and age composition of its populations
for decades to come. The rapid mortality decline that began during
the 1950s, and the more recent and even sharper reduction in
fertility, will produce unusually high rates of growth of the older
population, a large change in overall population age composition,
and significant increases in the ratio of older to younger
population. According to the 2013 United Nations projections, the
number of people aged 60 and over in LAC is expected to increase
from 59 million in 2010 to 196 million in 2050, and the number of
people aged 80 and over will increase from 8.6 million to more than
44 million during the same period. To explore the process of rapid
aging in the LAC, a workshop took place at the National Academy of
Medicine in May 2015. Participants of the workshop presented
scientific research emphasizing what is unique about aging in LAC
and what is similar to other processes around the world,
highlighted the main areas where knowledge of the aging process in
LAC is insufficient and new research is required, and proposed data
collection that will produce information for policymaking while
being responsive to the needs of the research community for
harmonized, highly comparable information. The workshop afforded
participants an opportunity to consider strategies for articulating
data collection and research in the region so that country-based
teams can reap the benefits from being part of a larger enterprise
while simultaneously maintaining their own individuality and
responding to the particular needs of each country. Strengthening
the Scientific Foundation for Policymaking to Meet the Challenges
of Aging in Latin America and the Caribbean summarizes the
presentations and discussions of the workshop. Table of Contents
Front Matter 1 Introduction 2 Aging in Latin America and the
Caribbean in Global Perspective 3 Health Status, Disability, and
Mortality 4 Health Care Systems, Access, and Quality 5 Labor Market
Participation/Retirement 6 Family and Social Transfers 7 Resilience
and Aspects of Well-Being in Older Age 8 Opportunities to Generate
Evidence on Older Adults and Move the Research Agenda Forward
References Appendix A WORKSHOP AGENDA
Population surveys traditionally collect information from
respondents about their circumstances, behaviors, attitudes, and
other characteristics. In recent years, many surveys have been
collecting not only questionnaire answers, but also biologic
specimens such as blood samples, saliva, and buccal swabs, from
which a respondent's DNA can be ascertained along with other
biomarkers (e.g., the level of a certain protein in the blood). The
National Health and Nutrition Examination Survey (NHANES),
sponsored by the National Center for Health Statistics (NCHS), has
been collecting and storing genetic specimens since 1991, and other
surveys, such as the Health and Retirement Study (HRS) funded by
the National Institute on Aging, have followed suit. In order to
give their informed consent to participate in a survey, respondents
need to know the disposition and use of their data. Will their data
be used for one research project and then destroyed, or will they
be archived for secondary use? Sponsors of repeated cross-sectional
surveys, such as NHANES, and of longitudinal surveys that follow
panels of individuals over time, such as HRS, generally want to
retain data for a wide range of secondary uses, many of which are
not explicitly foreseen at the time of data collection. They
typically inform respondents that their data will be stored in a
secure manner and may be provided to researchers with suitable
protections against individual identification. The addition of
biologic specimens to a survey adds complications for storing,
protecting, and providing access to such data and measurements made
from them. There are also questions of whether, when, and for which
biologic measurements the results should be reported back to
individual respondents. Recently, the cost of full genomic
sequencing has plummeted, and research findings are beginning to
accumulate that bear up under replication and that potentially have
clinical implications for a respondent. For example, knowing that
one possesses a certain gene or gene sequence might suggest that
one should seek a certain kind of treatment or genetic counseling
or inform one's blood relatives. Biomedical research studies, in
which participants are asked to donate tissues for genetic studies
and are usually told that they will not be contacted with any
results, are increasingly confronting the issue of when and which
DNA results to return to participants. Issues in Returning
Individual Results from Genome Research Using Population-Based
Banked Specimens, with a Focus on the National Health and Nutrition
Examination Survey is the summary of a workshop convened in
February 2013 by the Committee on National Statistics in the
Division of Behavioral and Social Sciences and Education of the
National Research Council. This report considers how population
surveys, in particular NHANES, should implement the reporting of
results from genomic research using stored specimens and address
informed consent for future data collection as well as for the use
of banked specimens covered by prior informed consent agreements.
The report will be of interest to survey organizations that include
or contemplate including the collection of biologic specimens in
population surveys for storing for genetic research. The issues
involved are important for advancing social, behavioral, and
biomedical knowledge while appropriately respecting and protecting
individual survey respondents.
Among the poorest and least developed regions in the world,
sub-Saharan Africa has long faced a heavy burden of disease, with
malaria, tuberculosis, and, more recently, HIV being among the most
prominent contributors to that burden. Yet in most parts of
Africa-and especially in those areas with the greatest health care
needs-the data available to health planners to better understand
and address these problems are extremely limited. The vast majority
of Africans are born and will die without being recorded in any
document or spearing in official statistics. With few exceptions,
African countries have no civil registration systems in place and
hence are unable to continuously generate vital statistics or to
provide systematic information on patterns of cause of death,
relying instead on periodic household-level surveys or intense and
continuous monitoring of small demographic surveillance sites to
provide a partial epidemiological and demographic profile of the
population. In 1991 the Committee on Population of the National
Academy of Sciences organized a workshop on the epidemiological
transition in developing countries. The workshop brought together
medical experts, epidemiologists, demographers, and other social
scientists involved in research on the epidemiological transition
in developing countries to discuss the nature of the ongoing
transition, identify the most important contributors to the overall
burden of disease, and discuss how such information could be used
to assist policy makers in those countries to establish priorities
with respect to the prevention and management of the main causes of
ill health. This report summarizes the presentations and
discussions from a workshop convened in October 2011 that featured
invited speakers on the topic of epidemiological transition in
sub-Saharan Africa. The workshop was organized by a National
Research Council panel of experts in various aspects of the study
of epidemiological transition and of sub-Saharan data sources. The
Continuing Epidemiological Transition in Sub-Saharan Africa serves
as a factual summary of what occurred at the workshop in October
2011. Table of Contents Front Matter 1 Introduction 2 The Changing
Context of the Transition in sub-Saharan Africa 3 Mortality and
Causes of Death 4 Risk Factor Transitions: Exposures and
Comparative Risk Assessment 5 The Role of Migration 6 Health
Financing in sub-Saharan Africa 7 Data Collection and Validation in
Resource-Poor Settings 8 The Epidemiological Transition in Africa:
Are There Lessons from Asia? 9 Future Research Directions
References Appendix A Workshop Agenda Appendix B Participant List
Appendix C Biographical Sketches of Steering Committee Members and
Presenters
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