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Latin America and the Caribbean still have high maternal mortality rates and access to health care is very uneven in some countries. Indigenous women, in particular, have poorer maternal health outcomes than the majority of the population and are less likely to benefit from health-care services. Therefore, inequities in maternal health between different ethnic groups should be monitored to identify critical factors that could limit health-care coverage. In adopting the United Nations'sustainable development goals, governments have committed to providing equitable and universal health coverage. It is, therefore, the right time to assess ethnic disparities in maternal health care. However, finding a standard method of identifying ethnicity has been difficult, because ethnicity involves several features, such as language, religion, tribe, territory and race. In this study, spoken indigenous language was used successfully as a proxy for ethnicity to detect inequities in maternal health-care coverage between indigenous and non-indigenous populations in four Latin American countries: Guatemala, Mexico, Peru and the Plurinational State of Bolivia. Although, quantifying ethnic inequities in health care is just a starting point, this quantification can help policy-makers and other stakeholders justify the need for monitoring these inequities. This monitoring is essential for designing more culturally appropriate programmes and policies that will reduce the risks associated with maternity among indigenous woman. As long as inequities persist, identifying them is an important step towards their elimination. [phrase omitted] [phrase omitted] L'Amerique latine et les Caraibes continuent d'afficher des taux de mortalite maternelle eleves et dans certains pays, l'acces aux soins de sante est tres inegal. Les femmes autochtones, en particulier, sont dans un plus mauvais etat de sante maternelle que la majorite de la population et sont moins susceptibles de beneficier des services de sante. Il convient donc de suivre les inegalites relatives a la sante maternelle entre les differents groupes ethniques pour identifier les facteurs determinants qui peuvent limiter la couverture sanitaire. En adoptant les objectifs de developpement durable des Nations Unies, les gouvernements se sont engages a fournir une couverture sanitaire equitable et universelle. Il est donc temps d'evaluer les disparites ethniques en matiere de soins de sante maternelle. Il s'est neanmoins avere difficile de trouver une methode standard permettant de definir l'appartenance ethnique, car cette derniere implique plusieurs caracteristiques, telles que la langue, la religion, la tribu, le territoire et la race. Dans cette etude, la langue autochtone parlee a ete utilisee avec succes en tant qu'indicateur d'appartenance ethnique pour detecter les inegalites concernant la couverture des soins de sante maternelle entre les populations autochtones et non autochtones de quatre pays latino-americains: l'Etat plurinational de Bolivie, le Guatemala, le Mexique et le Perou. Bien que la quantification des inegalites ethniques en matiere de soins de sante ne soit qu'un point de depart, elle peut aider les responsables politiques et d'autres parties prenantes a justifier la necessite d'un suivi de ces inegalites. Ce suivi est essentiel pour concevoir des programmes et des politiques mieux adaptes a la culture des populations et reduire ainsi les risques associes a la maternite chez les femmes autochtones. Tant que des inegalites persistent, les identifier est une etape importante vers leur elimination. [phrase omitted] America Latina y el Caribe siguen teniendo altas tasas de mortalidad materna y el acceso a la atencion sanitaria es muy desigual en algunos paises. Las mujeres indigenas, en particular, tienen peores resultados en salud materna que la mayoria de la poblacion y menos probabilidades de beneficiarse de los servicios de atencion sanitaria. Por tanto, deben vigilarse las desigualdades en temas de salud materna entre los diferentes grupos etnicos para determinar los factores criticos que podrian limitar la cobertura de la atencion sanitaria. Al adoptar los objetivos de desarrollo sostenible de las Naciones Unidas, los gobiernos se han comprometido a proporcionar una cobertura sanitaria equitativa y universal. Por tanto, es el momento adecuado para evaluar las disparidades etnicas en la atencion sanitaria materna. Sin embargo, ha sido dificil encontrar un metodo estandar para identificar la etnia, pues esta tiene varias caracteristicas, como el idioma, la religion, la tribu, el territorio y la raza. En este estudio, el idioma indigena hablado se utilizo con exito como indicador de la etnicidad para detectar las desigualdades en la cobertura de la atencion sanitaria materna entre las poblaciones indigenas y no indigenas en cuatro paises de America Latina: el Estado Plurinacional de Bolivia, Guatemala, Mexico y Peru. Aunque la cuantificacion de las inequidades etnicas en la atencion sanitaria es solo un punto de partida, esta cuantificacion puede ayudar a los responsables de la formulacion de politicas y a otros interesados a justificar la necesidad de monitorizar estas inequidades. Esta monitorizacion es esencial para disenar programas y politicas culturalmente mas adecuadas que reduzcan los riesgos asociados con la maternidad entre las mujeres indigenas. Mientras persistan las desigualdades, identificarlas es un paso importante hacia su eliminacion., Abstracts in [phrase omitted], Francais, [phrase omitted] and Espanol at the end of each article. Introduction Countries in Latin America and the Caribbean have some of the highest adolescent pregnancy [...]

Abstract Background The effect of tobacco smoking and alcohol drinking on esophageal cancer (EC) has never been explored in Spain where black tobacco and wine consumptions are quite prevalent. We estimated the independent effect of different alcoholic beverages and type of tobacco smoking on the risk of EC and its main histological cell type (squamous cell carcinoma) in a hospital-based case-control study in a Mediterranean area of Spain. Methods We only included incident cases with histologically confirmed EC (n = 202). Controls were frequency-matched to cases by age, sex and province (n = 455). Information on risk factors was elicited by trained interviewers using structured questionnaires. Multiple logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals (CI). Results Alcohol drinking and tobacco smoking were strong and independent risk factors for esophageal cancer. Alcohol was a potent risk factor with a clear dose-response relationship, particularly for esophageal squamous-cell cancer. Compared to never-drinkers, the risk for heaviest drinkers (≥ 75 g/day of pure ethanol) was 7.65 (95%CI, 3.16–18.49); and compared with never-smokers, the risk for heaviest smokers (≥ 30 cigarettes/day) was 5.07 (95%CI, 2.06–12.47). A low consumption of only wine and/or beer (1–24 g/d) did not increase the risk whereas a strong positive trend was observed for all types of alcoholic beverages that included any combination of hard liquors with beer and/or wine (p-trend Conclusion Our study shows that the risk of EC, and particularly the squamous cell type, is strongly associated with alcohol drinking. The consumption of any combination of hard liquors seems to be harmful whereas a low consumption of only wine may not. This may relates to the presence of certain antioxidant compounds found in wine but practically lacking in liquors. Tobacco smoking is also a clear risk factor, black more than blond.

Background: Few studies have investigated international variations in the gestational age (GA) distribution of births. While preterm births (22-36 weeks GA) and early term births (37-38 weeks) are at greater risk of adverse health outcomes compared to full term births (39-40weeks), it is not known if countries with high preterm birth rates also have high early term birth rates. We examined rate associations between preterm and early term births and mean term GA by mode of delivery onset. Methods: We used routine aggregate data on the GA distribution of singleton live births from up to 34 high-income countries/regions in 1996, 2000, 2004, 2008 and 2010 to study preterm and early term births overall and by spontaneous or indicated onset. Pearson correlation coefficients were adjusted for clustering in time trend analyses. Results: Preterm and early term births ranged from 4.1% to 8.2% (median 5.5%) and 15.6% to 30.8% (median 22.2%) of live births in 2010, respectively. Countries with higher preterm birth rates in 2004-2010 had higher early term birth rates (r>0.50, P<0.01) and changes over time were strongly correlated overall (adjusted-r=0.55, P<0.01) and by mode of onset. Conclusion: Positive associations between preterm and early term birth rates suggest that common risk factors could underpin shifts in the GA distribution. Targeting modifiable population risk factors for delivery before 39weeks GA may provide a useful preterm birth prevention paradigm. [ABSTRACT FROM AUTHOR]