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Background: Tenofovir-based daily oral HIV pre-exposure prophylaxis (HIV PrEP) is a highly efficacious HIV prevention modality, but sustained use over time is needed for continued protection among individuals at high risk for HIV exposure. Suboptimal adherence and retention in care threaten to diminish the impact of HIV PrEP on reducing HIV burden. PrEP PERU is an ongoing, multi-site, prospective cohort study evaluating HIV PrEP implementation among adult men who have sex with men (MSM) and transgender women (TGW) accessing care at non-government health centers in Peru. We sought to evaluate HIV PrEP adherence and retention in care among PrEP PERU participants prior to the onset of COVID-19 service disruptions. Method(s): We analyzed baseline and follow-up data from the PrEP PERU study through 3/15/2020, the first day of Peru's COVID-19 lockdown. MSM and TGW >=18 years of age with at least one HIV risk factor were eligible for enrollment. After the first follow-up visit at 4 weeks, TDF/FTC refills and clinic visits occur quarterly, at the discretion of the prescribing clinician. The medication is provided free of charge, but participants pay for laboratory testing plus a small service fee for clinic visits. Data is collected at baseline and quarterly follow-up visits on sexual risk behaviors and HIV PrEP use. We used bivariate analysis to evaluate the association between baseline factors and 6-month HIV PrEP retention in care. As a proxy for adherence, pharmacy dispensation records were used to calculate the proportion of days covered (PDC) by TDF/FTC. Result(s): Overall, 351 participants started TDF/FTC at four study sites in Lima from 1/23/2017 to 3/15/2020. Of this analysis population, 94% were cisgender men, 10% identified as bisexual, and median age was 31 (interquartile range [IQR], 27 - 38). Among those with at least 6 months of observation time (n=302), 91% attended >=1 follow-up visit and 77% attended >=2 follow-up visits during the 6 months after enrollment. The proportion with favorable adherence (PDC >=0.8) was 85%. There were 6 confirmed HIV seroconversions in the analysis period (1.2 per 100 person-years). Conclusion(s): In this analysis of HIV PrEP outcomes among MSM and TGW prior to COVID-19 pandemic disruptions in Peru, over 3/4 of the population remained in care and had favorable measures of adherence during the first 6 months after.
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The following reflection is derived from a research study titled The Current Colombian Family and its Relationship with Internalized and Externalized Problems in Adolescents. Its purpose is to analyse the conclusions of the referred study regarding the impersonal education of children in the modern family, based on a clinical approach of the COVID-19 Pandemic. Upon unraveling the social dynamics that have configured family arrangements-which are understood from the evolution of employment and school as social institutions -the apparent inexorability of paternal absence in the family is questioned, and at the same time a paradox is highlighted -a new family dynamic in which confinement does not necessarily lead to the favoring of better parenting processes or parental-filial interactions.
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Introduction: The Post COVID Functional Status Scale (PCFS) was designed to measure functional changes in patients after SARS-COV2 infection. Objective(s): To compare the status of fatigue, dyspnea, and mental health of patients with COVID-19 according to the PCFS score. Method(s): Cross-sectional study that included patients hospitalized for at least 10 days. Were grouped according to the PCFS score. In addition, the Fatigue Assessment Scale (FAS), Hospital Anxiety and Depression Scale (HADS), and the modified Medical Research Council (mMRC) were applied. The study was approved by the ethics committee of Clinica de Occidente in Cali-Colombia. Result(s): Between February and August 2021, 72 participants (age 57.4 +/- 15.3 years, 47,2% women) were included;patients with a score of 3 and 4 in PCFS presented worse levels in the result of FAS, HADS, and mMRC (p < 0.001) compared to the other groups;participants with a score of 0 had better results in the clinical variables (Table 1). Conclusion(s): Patients with COVID19 with greater functional limitations also have more impact on fatigue, dyspnea, anxiety, and depression;this result stimulates the referral of patients to rehabilitation programs. .
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Introduction: Currently, major depressive disorder generates a high burden of disease in the general population, which is usually higher in medical students. The Patient Health Questionnaire-9 (PHQ-9) is a widely used instrument in the general population to assess the severity of depression in primary care. Objective: To validate the factorial structure of the PHQ-9 questionnaire in human medicine interns at a reference university in Peru. Methods: An observational, cross-sectional and instrumental design was used. We worked with a sample of 343 human medicine interns. From the responses to the questionnaire, the Cronbach's alpha coefficient was calculated, as well as the factorial analysis to determine the construct validity of this instrument in the target population. Results: Cronbach's alpha coefficient was 88.2%, the item/test conversion coefficients presented values greater than 0.5. A value greater than 0.05 was obtained for the chi2 goodness-of-fit test for the model, as well as results greater than 0.9 for the model's goodness-of-fit coefficients. Conclusion: The factorial structure of the PHQ-9 has adequate validity and reliability in the population of human medicine interns.
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Introduction: Cardiovascular disease is one of the leading causes of morbidity and death globally. As a result of the COVID-19 pandemic, many rehabilitation programs have shifted to remote delivery models. Telerehabilitation is a way to perform cardiac rehabilitation while reducing the risk of COVID-19 transmission. Objective: This study aimed to describe the effects of a physical exercise program in persons with cardiovascular disease who performed telerehabilitation in the period of mandatory preventive isolation due to the COVID-19 emergency. Materials and methods: This was a quasiexperimental 6-month study of persons with cardiovascular disease who entered a virtual technology-assisted physical exercise program in a clinic in Cali, Colombia. Results: Significant differences were found at the beginning and end of the study in the variables of left ventricular ejection fraction, heart rate, blood pressure, respiratory rate, body mass index, abdominal perimeter, percentage of fat, percentage of muscle mass, cholesterol, state of depression, distance traveled, oxygen consumption and metabolic equivalent (METs), showing p-value <0.05. Conclusions: A physical exercise program in persons with cardiovascular disease performing telerrehabilitation proves effective in achieving treatment goals. © 2022 Asociación Española de Fisioterapeutas
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Based on historical institutionalism, the actions developed by the National Police of Colombia in 2020 regarding the police service are delineated, on the occasion of the health emergency scenario generated by the COVID-19 pandemic, which changed the criminogenic framework and the behaviour of criminal actors and crime in the country. Hence, the police used a proactive policing and tactical criminology approach to crime containment in Colombia, which is explained in this chapter. Among the main results, we underscore the use of scientific evidence and tactical criminology as support for police service planning, for the design of actions that were associated with a 4.2% decrease in homicide in Colombia, evidencing the containment of rebound crime as an effect of the reconfiguration of crime at the critical juncture of the confinement. Likewise, this chapter can be a reference for security agencies, providing a reflection on the lessons learned in the application of a proactive policing approach towards the recent changes in crime during the COVID-19 pandemic scenario.
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The criminality behavior during the year 2020 evidenced variations associated with changes in population dynamics throughout the country. This article, using descriptive elements, exposes the characteristics of crime in Colombia during the year 2020 and the criminogenic context associated with the transformations of crime, with emphasis on homicide. In particular, the article includes a section that reflects on the contributions of neurocriminology to the understanding of criminal behavior. Among the conclusions are: 1) a significant reduction in homicide, which represented the lowest rate of the last 46 years in Colombia, equivalent to 23.8 homicides per one hundred thousand inhabitants. 2) a decrease equivalent to 29% of impact crimes occurred in the country when comparing 2019 with 2020. 3) associated with a year of health emergency the National Police captured 173,217 subjects for the commission of different crimes and according to analytical exercises carried out in territories, police units increased their workload with new tasks derived from COVID-19 attention and prevention measures.
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Women’s options and rights to sexual and reproductive health care must be respected regardless of their status secondary to the COVID-19 pandemic, including access to contraception. The general objective of this work is to determine the level of access and basic knowledge of contraceptive methods for the population in times of COVID-19. The universe determined in this research was a group of young Ecuadorians, who have basic knowledge of the subject. To choose a contraceptive method that best meets the needs of the users, some aspects must be taken into account, mainly the user, health, financial capacity and lifestyle. Economic capacity is very important for the use of a contraceptive method when you do not have free access to them, otherwise, you must look for a method that is within your reach. COVID-19 has changed the world in different aspects, including affecting family planning, this according to bibliographic reviews and a survey resulting in a high rate of unwanted pregnancies and the different problems that this entails, under the current circumstances to face the In this situation, we could encourage training and prevention campaigns through the media. © 2021, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.
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The present work addresses the importance of institutional advertising to counter hoaxes during the first ten months since the outbreak of COVID-19. Institutional advertising campaigns run by Spanish central and regional governments have been studied from a quantitative point of view to establish their length, periodicity, views and interactions, and from a qualitative point of view in terms of strategy, intentionality, discourse and narrative and filming techniques. The main results suggest that institutional advertising campaigns are clearly focused on social networks and have not been the main tool to fight COVID-19 hoaxes, but rather to inform citizens. Their main characters are anonymous people, followed by affected individuals and health care workers, and these campaigns showed greater intensity during the first months of the pandemic and picked up again in December, due to fear of the consequences of a third wave. It can also be said that the different public administrations have fulfilled their duty to inform public opinion. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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TOPIC: Obstructive Lung Diseases TYPE: Original Investigations PURPOSE: Chronic obstructive pulmonary disease (COPD) course with air trapping that causes respiratory symptoms that limit the activities of daily living. In patients with SARS-COV2 infection, symptoms increase and the clinical condition worsen, increasing the complications and mortality. Aim: To describe the clinical condition and symptoms of patients with COPD and COVID-19. METHODS: Cross-sectional descriptive study in patients with a medical diagnosis of COPD and who presented coronavirus infection confirmed by PCR during February 2021 in a clinic in Cali, Colombia. Institutional ethics endorsement and informed consent were obtained from the participants. Sociodemographic, clinical and symptoms variables were taken 21 days after the onset of the patients' symptoms by personal interview and telephone call. RESULTS: 18 patients with chronic obstructive pulmonary disease and coronavirus infection were linked to the study. The mean age of the patients was 67.4±17.1, the sex distribution was higher for men 66.7%. The place where they made the recovery corresponded in 61.1% at home, 33.3% Hospitalization and 5.6% in the intensive care unit. The most frequent GOLD classification was A (33.3%), C (27.8%), B (22.2%), D (16.7%). Only 16.3% used home oxygen and 27.8% corticosteroids. The most frequent comorbidity was arterial hypertension (33.3%), 5.6% of the patients had a smoking habit. Respiratory failure occurred in 3 patients (16.7%). The most frequent respiratory symptoms were cough 61.1%, fever 50%, adynamia 44.4% and respiratory distress 38.9%. CONCLUSIONS: Patients with chronic obstructive pulmonary disease who presented coronavirus infection present a greater distribution in men, they recover at home mainly although one third have respiratory failure treated in the clinic, most of them have A GOLD classification, the most prevalent comorbidity is hypertension and the most frequent symptoms are cough and fever represented in more than half of the patients. CLINICAL IMPLICATIONS: The identification of complications in COPD patients with coronavirus infection implies knowledge of the high probability of presenting respiratory failure associated with comorbidities such as arterial hypertension. In turn, the symptoms in COPD patients could better guide respiratory care to avoid future complications. DISCLOSURES: No relevant relationships by Juan Carlos Avila-Valencia, source=Web Response No relevant relationships by Vicente Benavides, source=Web Response No relevant relationships by Jhonatan Betancourt-Peña, source=Web Response No relevant relationships by Jenifer Rodríguez-Castro, source=Web Response
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Objective. To analyze the changes in the density of human resources in health (DHRH), in the Ministry of Health at the regional and provincial level in Peru, in order to describe the response of the health system on this component during the COVID-19 epidemic. Methods. Descriptive study based on the analysis of the INFORHUS national database of the Ministry of Health. To calculate the DHRH, the health personnel registered in the INFORHUS database were considered as the numerator and the population assigned to the Seguro Integral de Salud - SIS as the denominator. Health personnel who died and were still registered, and personnel diagnosed with COVID-19 by rapid or molecular testing during the months considered in the analysis, were excluded. The percentage changes of DHRHbetween the months of april to august 2020 were analyzed at the regional and provincial level in Peru. Results. In the april-august 2020 period, in response to the first phase of the COVID-19pandemic, PeruincreasedtheDHRHby5,1%. At theregional level, thisincreasewasachievedin15of the25regionswithavariation from 0,2% to 12,3%, and a sharp and sustained reduction in appointed personnel was observed, together with an increase in personnel with temporary contracts. In the rest of the regions, a reduction in DHRH was observed, which ranged from -0,7%to -7,7%. Conclusions. DHRH in Peru showed a slight increase at the national level during the first quarantine period due to the COVID-19 pandemic, however, this result has not been equitable in the different regions and provinces at the national level. This suggests a limitation in the scope of the measures taken by the government, and the need to take actions to strengthen the health situation and deployment of human resources in health in the most disadvantaged sectors.
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TOPIC: Cardiovascular Disease TYPE: Global Case Reports INTRODUCTION: COVID-19 infection has generated cardiovascular affectations such as dilated heart disease, responsible for a high rate of morbidity and mortality due to its combination of dilatation and systolic dysfunction of the left ventricle or both ventricles. In addition to pharmacological intervention, cardiac rehabilitation (CR) could be useful. The aim was To establish the effect of cardiac rehabilitation in dilated heart disease due to residual damage from covid-19 infection. CASE PRESENTATION: Observational case study-type study in a 25-year-old woman with a diagnosis of dilated heart disease due to residual damage from COVID-19 infection confirmed by a cardiologist. Ethical approval was obtained from the institution and the informed consent was previously signed by the patient, the cardiac rehabilitation program consisted of 3 sessions a week for 12 weeks with a duration of 60 minutes, warming up, strength training was performed for 20 minutes with weights between 2 to 6 pounds increasing 2 pounds every 4 weeks performing 3 to 4 sets of 12 to 15 repetitions, the aerobic capacity was worked at an intensity of 60% -80% of the VO2 obtained in the 6 minute walk test (6MWT);Clinical variables, functional capacity, health-related quality of life and POST-COVID19 functional status (PCFS) were taken at the beginning and end of the CR. DISCUSSION: : 25-year-old female patient with dilated heart disease due to residual damage due to covid-19 infection, beginning and ending CR with the following values in the variables: Weight-pre 76.5kg, - post 74.7 kg, BMI-pre 28.1 kg / m2 -post 27.4 kg / m2, HR- pre 62 bpm- post 60 bpm, BP -pre 110/66 mmHg- post 110/60 mmHg, Distance 6MWT -pre 500 mts- post 549 mts, VO2 estimated: 11.8 ml / kg / min- post 12.7 ml / kg / min, PHQ-9 -pre 4 -post 4, DASI -pre 23.0 ml / kg / min -post 27.9 ml / kg / min, MLHFQ -pre D. Physical 3 D. Emotional 3 D.Total 6 -post Physical D. 1 Emotional D. 1 Total D. 2, PCFS -pre Grade 2 -post Grade 0. (Table 1) CONCLUSIONS: Cardiac rehabilitation in dilated heart disease caused by residual damage due to COVID-19 infection shows improvement in clinical variables, increased functional capacity, health-related quality of life and PCFS functional status. REFERENCE #1: Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart Fail Rev. 2021 Jan;26(1):1-10. doi: 10.1007/s10741-020-10008-2. DISCLOSURES: No relevant relationships by Juan Carlos Avila-Valencia, source=Web Response No relevant relationships by Vicente Benavides, source=Web Response No relevant relationships by Jhonatan Betancourt-Peña, source=Web Response No relevant relationships by Kirby Gutierrez, source=Web Response No relevant relationships by Jenifer Rodríguez-Castro, source=Web Response
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Background: Stigma and poor linkage to care, amplified in the setting of the COVID-19 pandemic, are significant barriers for treating hepatitis C (HCV) in vulnerable patients, reducing our ability to implement a rapid test and treat (TnT) strategy with minimal monitoring within a simple patient cascade, as currently available HCV therapies would allow us to do This real-world analysis evaluates our ability to implement this approach in both general (GP) and vulnerable (VP) populations Methods: HCV-infected patients from 32 clinical cohorts in 8 countries treated with sofosbuvir/ velpatasvir without a history of decompensation or prior NS5A-inhibitor exposure were included in this analysis The VP included prisoners, homeless patients and patients with mental disorders Time to treatment (TT) between the most recent HCV RNA measurement and treatment initiation was estimated based on available data Results: A total of 2449 patients were included, 937 in GP (58% males), 1512 (72% males) in VP (59% with mental disorders, 31% homeless, 10% imprisoned) Mean age [standard deviation] was 55 [14] and 50 [14] years in GP and VP respectively Genotype 3 was observed in 35% and 33% respectively, compensated cirrhosis confirmed in 20% and 18% of GP versus VP. The median TT [MTT, interquartile range] was 55 days [23- 107] in GP and 60 days [27-132] in VP The longest MTT of 66 days [32-134] was observed in patients with mental disorders MTT was 63 days [29-149] in prisoners and 27 days [13-71] among the homeless Only 13% of GP and 8% of VP were treated the same day of diagnosis, and 70% of GP and 63% of VP were treated within 3 months In patients with mental disorders only 4% were treated the same day of diagnosis Cure rates were high and consistent with previously reported cure rates Conclusion: MTT varies across HCV patient groups, from over 6 months to 1 day This analysis shows that a quick treatment start is possible, both in general population and in vulnerable populations, supporting the feasibility of a TnT approach in all populations New strategies should be considered to engage patients with mental disorders in this model of care more effectively.
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Objectives. To evaluate the survival of health personnel infected by SARS-CoV-2 in the context of the vaccination process against COVID-19 in Peru.