EPIDEMIOLOGY AND COMMUNITY STUDIES - LATIN-AMERICA

Over the past two decades in Latin America, there has been a slow but definite upsurge in studies on the epidemiology of RD but, thus far, the data on the distribution and determinants of RD in the population are limited, and knowledge of time trends and geographical differences in disease risk are lacking. It is still not clear what proportion of disabilities are due to RD. The impact of RD on communities in developing countries is believed to be substantial, due to the cost of treatment and rehabilitation, and loss of earnings. There are important gaps in our knowledge, leaving unanswered such questions as the cost to society of RD and the potential impact of RD prevention on the overall burden of disability. It is also important to point out, however, that from the relatively simple descriptive studies which dominated the RD literature a few years ago, we are now witnessing a shift towards increasing sophistication in study design and incorporation of multicentre collaboration. The rheumatologists and epidemiologists in LA who have managed to continue their work merit admiration. Even with unavoidable omissions, this summary demonstrates that the epidemiology of RD is alive and well in LA, where it has managed to continue to function under extremely difficult conditions. Yet, few methodologists appear to have directed their attention to the unique challenges of conducting studies in a resource-poor environment. Severe constraints related to professional development (insufficient training), the work environment (poor facilities) and the macroenvironment (poor public support, political instability and bureaucratic rigidity) definitely play a critical role. Finally, few LA rheumatologists have been adequately trained to design and conduct original research or to critically analyse existing evidence. The expansion of training opportunities for LA rheumatologists and scientists as well as assistance in obtaining funding for research remain a high priority for the long-term future of epidemiologic research activities in the field of rheumatology. © 1995 Baillière Tindall.