Zinc for prevention and treatment of the common cold.

BACKGROUND: The common cold is an acute, self-limiting viral respiratory illness. Symptoms include nasal congestion and mucus discharge, sneezing, sore throat, cough, and general malaise. Given the frequency of colds, they are a public health burden and a significant cause of lost work productivity and school absenteeism. There are no established interventions to prevent colds or shorten their duration. However, zinc supplements are commonly recommended and taken for this purpose. OBJECTIVES: To assess the effectiveness and safety of zinc for the prevention and treatment of the common cold. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and LILACS to 22 May 2023, and searched Web of Science Core Collection and two trials registries to 14 June 2023. We also used reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) in children or adults that tested any form of zinc against placebo to prevent or treat the common cold or upper respiratory infection (URTI). We excluded zinc interventions in which zinc was combined with other minerals, vitamins, or herbs (e.g. a multivitamin, or mineral supplement containing zinc). DATA COLLECTION AND ANALYSIS: We used the Cochrane risk of bias tool to assess risks of bias, and GRADE to assess the certainty of the evidence. We independently extracted data. When necessary, we contacted study authors for additional information. We assessed zinc (type and route) with placebo in the prevention and treatment of the common cold. Primary outcomes included the proportion of participants developing colds (for analyses of prevention trials only), duration of cold (measured in days from start to resolution of the cold), adverse events potentially due to zinc supplements (e.g. unpleasant taste, loss of smell, vomiting, stomach cramps, and diarrhoea), and adverse events considered to be potential complications of the common cold (e.g. respiratory bacterial infections). MAIN RESULTS: We included 34 studies (15 prevention, 19 treatment) involving 8526 participants. Twenty-two studies were conducted on adults and 12 studies were conducted on children. Most trials were conducted in the USA (n = 18), followed by India, Indonesia, Iran, and Turkey (two studies each), and Australia, Burkina Faso, Colombia, Denmark, Finland, Tanzania, Thailand, and the UK (one study each). The 15 prevention studies identified the condition as either common cold (n = 8) or URTI (n = 7). However, almost all therapeutic studies (17/19) focused on the common cold. Most studies (17/34) evaluated the effectiveness of zinc administered as lozenges (3 prevention; 14 treatment) in acetate, gluconate, and orotate forms; gluconate lozenges were the most common (9/17). Zinc gluconate was given at doses between 45 and 276 mg/day for between 4.5 and 21 days. Five (5/17) lozenge studies gave acetate lozenges and two (2/17) gave both acetate and gluconate lozenges. One (1/17) lozenge study administered intranasal (gluconate) and lozenge (orotate) zinc in tandem for cold treatment. Of the 17/34 studies that did not use lozenges, 1/17 gave capsules, 3/17 administered dissolved powders, 5/17 gave tablets, 4/17 used syrups, and 4/17 used intranasal administration. Most studies were at unclear or high risk of bias in at least one domain. There may be little or no reduction in the risk of developing a cold with zinc compared to placebo (risk ratio (RR) 0.93, 95% CI 0.85 to 1.01; I2 = 20%; 9 studies, 1449 participants; low-certainty evidence). There may be little or no reduction in the mean number of colds that occur over five to 18 months of follow-up (mean difference (MD) -0.90, 95% CI -1.93 to 0.12; I2 = 96%; 2 studies, 1284 participants; low-certainty evidence). When colds occur, there is probably little or no difference in the duration of colds in days (MD -0.63, 95% CI -1.29 to 0.04; I² = 77%; 3 studies, 740 participants; moderate-certainty evidence), and there may be little or no difference in global symptom severity (standardised mean difference (SMD) 0.04, 95% CI -0.35 to 0.43; I² = 0%; 2 studies, 101 participants; low-certainty evidence). When zinc is used for cold treatment, there may be a reduction in the mean duration of the cold in days (MD -2.37, 95% CI -4.21 to -0.53; I² = 97%; 8 studies, 972 participants; low-certainty evidence), although it is uncertain whether there is a reduction in the risk of having an ongoing cold at the end of follow-up (RR 0.52, 95% CI 0.21 to 1.27; I² = 65%; 5 studies, 357 participants; very low-certainty evidence), or global symptom severity (SMD -0.03, 95% CI -0.56 to 0.50; I² = 78%; 2 studies, 261 participants; very low-certainty evidence), and there may be little or no difference in the risk of a change in global symptom severity (RR 1.02, 95% CI 0.85 to 1.23; 1 study, 114 participants; low-certainty evidence). Thirty-one studies reported non-serious adverse events (2422 participants). It is uncertain whether there is a difference in the risk of adverse events with zinc used for cold prevention (RR 1.11, 95% CI 0.84 to 1.47; I2 = 0%; 7 studies, 1517 participants; very low-certainty evidence) or an increase in the risk of serious adverse events (RR 1.67, 95% CI 0.78 to 3.57; I2 = 0%; 3 studies, 1563 participants; low-certainty evidence). There is probably an increase in the risk of non-serious adverse events when zinc is used for cold treatment (RR 1.34, 95% CI 1.15 to 1.55; I2 = 44%; 2084 participants, 16 studies; moderate-certainty evidence); no treatment study provided information on serious adverse events. No study provided clear information about adverse events considered to be potential complications of the common cold. AUTHORS' CONCLUSIONS: The findings suggest that zinc supplementation may have little or no effect on the prevention of colds but may reduce the duration of ongoing colds, with an increase in non-serious adverse events. Overall, there was wide variation in interventions (including concomitant therapy) and outcomes across the studies, as well as incomplete reporting of several domains, which should be considered when making conclusions about the efficacy of zinc for the common cold.

Depressive symptoms among Peruvian adult residents amidst a National Lockdown during the COVID-19 pandemic.

BACKGROUND: Population health and well-being in Latin America, the current epicenter of the COVID-19 pandemic, has been severely affected during the past semester. Despite the growing evidence about the link between the pandemic, its control measures, and mental health worldwide, there is still no regional evidence of the potential mental health impact. We describe the prevalence and distribution of depressive symptoms across demographic and socioeconomic risk factors in the Peruvian population amidst a national lockdown during the COVID-19 pandemic. METHODS: Cross-sectional study conducted during the community transmission phase and national lockdown in Peru (May 4th-16th, 2020). We recorded 64,493 responses from adult Peruvian residents through an opt-in online questionnaire. All analyses were weighted using raking based on proportions of sociodemographic variables from the last Peruvian census in 2017. The prevalence of depressive symptoms was calculated using the Patient Health Questionnaire (PHQ-9) score of 10 or more. We identified associated demographic and socioeconomic factors by prior mental health diagnosis. Sensitivity analysis considered an alternative cut-off point for depressive symptoms of PHQ-9 ≥ 14. RESULTS: A total of 57,446 participants were included in the analytical sample. A third of the participants (n = 23,526, unweighted) showed depressive symptoms in the 2 weeks prior to the study. Participants who reported a previous mental health diagnosis doubled the sample prevalence of depressive symptoms (59, 95%CI 56.7, 61.4%) of those without a prior diagnosis. Psychosocial and functioning reactions were largely more prevalent among females and young adults. A dose-response relationship was found between household income and depressive symptoms across previous mental health diagnosis strata, being as low as 32% less in the wealthiest than the most impoverished group (PR: 0.68, 95%CI 0.58,0.79). Other critical factors associated with a higher burden of depressive symptoms were lower education level, single, unemployed, and chronic comorbidity. CONCLUSIONS: An increased burden of depressive symptoms and psychosocial reactions has emerged during the COVID-19 pandemic in Peru compared to previous years. The mental health burden disproportionately affects women, the younger population, and those with low income and education. As the country eases the social distancing measures, it is crucial to use local evidence to adjust public health policies and mental health services to the renewed population needs.

Social predictors of food insecurity during the stay-at-home order due to the COVID-19 pandemic in Peru. Results from a cross-sectional web-based survey.

BACKGROUND: Stay-at-home orders and social distancing have been implemented as the primary tools to reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, this approach has indirectly lead to the unemployment of 2·3 million Peruvians, in Lima, Perú alone. As a result, the risk of food insecurity may have increased, especially in low-income families who rely on a daily wage. This study estimates the prevalence of moderate or severe food insecurity (MSFI) and identifies the associated factors that explain this outcome during the stay-at-home order. METHODS: A cross-sectional web-based survey, with non-probabilistic sampling, was conducted between May 18 and June 30, 2020, during the stay-at-home order in Peru. We used social media advertisements on Facebook to reach 18-59-year-olds living in Peru. MSFI was assessed using the Food Insecurity Experience Scale (FIES). Rasch model methodology requirements were considered, and factors associated with MSFI were selected using stepwise forward selection. A Poisson generalized linear model (Poisson GLM), with log link function, was employed to estimate adjusted prevalence ratios (aPR). FINDINGS: This analysis is based on 1846 replies. The prevalence of MSFI was 23·2%, and FIES proved to be an acceptable instrument with reliability 0·72 and infit 0·8-1·3. People more likely to experience MSFI were those with low income (less than 255 US$/month) in the pre-pandemic period (aPR 3·77; 95%CI, 1·98-7·16), those whose income was significantly reduced during the pandemic period (aPR 2·27; 95%CI, 1·55-3·31), and those whose savings ran out in less than 21 days (aPR 1·86; 95%CI, 1·43-2·42). Likewise, heads of households (aPR 1·20; 95%CI, 1·00-1·44) and those with probable SARS-CoV2 cases as relatives (aPR 1·29; 95%CI, 1·05-1·58) were at an increased risk of MSFI. Additionally, those who perceived losing weight during the pandemic (aPR 1·21; 95%CI, 1·01-1·45), and increases in processed foods prices (aPR 1·31; 95%CI, 1·08-1·59), and eating less minimally processed food (aPR 1·82; 95%CI, 1·48-2·24) were more likely to experience MSFI. INTERPRETATION: People most at risk of MSFI were those in a critical economic situation before and during the pandemic. Social protection policies should be reinforced to prevent or mitigate these adverse effects.

Emerging mental health challenges, strategies, and opportunities in the context of the COVID-19 pandemic: Perspectives from South American decision-makers.

OBJECTIVE: To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. METHODS: An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. RESULTS: Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity-building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners. CONCLUSIONS: Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

Emerging mental health challenges, strategies, and opportunities in the context of the COVID-19 pandemic: Perspectives from South American decision-makers

[ABSTRACT]. Objective. To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. Methods. An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. Results. Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity- building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners. Conclusions. Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

[RESUMEN]. Objetivo. Determinar los problemas de salud mental emergentes, las estrategias para abordarlos y las oportunidades para reformar los sistemas de salud durante la pandemia de COVID-19 en América del Sur. Métodos. A mediados de abril del 2020, se envió un cuestionario en línea a los encargados de tomar decisiones en materia de salud mental en los Ministerios de Salud de diez países de América del Sur. El cuestionario semiestructurado consistía en doce preguntas agrupadas en tres secciones principales: desafíos emergentes en materia de salud mental, estrategias actuales y posibles para enfrentar la pandemia, y elementos clave para la reforma de la salud mental. Establecimos palabras clave y temas para cada sección mediante el análisis del contenido sumativo. Resultados. Se informó un aumento de la carga y las necesidades en materia de salud mental como consecuencia directa e indirecta de la pandemia de COVID-19. Los confinamientos a nivel nacional representan un desafío en la prestación y el acceso al tratamiento y la atención de la salud mental. Las estrategias para satisfacer las necesidades de salud mental dependen en gran medida de las respuestas oportunas y adecuadas, que requieren el fortalecimiento de la gobernanza y de los sistemas en el ámbito de la salud mental, la disponibilidad de servicios y plataformas virtuales, y la formación de capacidad apropiada para los prestadores de servicios. Las estrategias a corto y mediano plazo se centran en reforzar las redes comunitarias de salud mental y la telemedicina para los grupos poblacionales de alto riesgo. Las oportunidades para la reforma de la salud mental a largo plazo entrañan fortalecer los marcos jurídicos, la redistribución de los recursos financieros y la colaboración con los asociados a nivel nacional e internacional. Conclusiones. En los países de América del Sur, se ha determinado que la salud mental y el apoyo psicosocial son un área prioritaria en la respuesta a la COVID-19. La pandemia ha generado necesidades específicas que requieren medidas apropiadas, como las intervenciones virtuales, la orientación de la formación de capacidad hacia la protección de los usuarios y prestadores de servicios de salud, el fortalecimiento de la toma de decisiones basadas en la evidencia, y la integración de la salud mental y el apoyo psicosocial en los mecanismos de alto nivel que guían la respuesta a la COVID-19.

[RESUMO]. Objetivo. Identificar problemas emergentes de saúde mental, as estratégias para enfrentá-los e oportunidades para reformar os sistemas de saúde mental durante a pandemia de COVID-19 na América do Sul. Métodos. Em meados de abril de 2020, enviamos um questionário online aos responsáveis pela tomada de decisões em saúde mental dos ministérios da saúde de 10 países da América do Sul. O questionário semiestruturado continha 12 perguntas agrupadas em três seções principais: desafios emergentes em saúde mental, estratégias atuais e potenciais para enfrentar a pandemia e elementos-chave para a reforma da saúde mental. Identificamos palavras-chave e temas para cada seção através da análise de conteúdo sumativa. Resultados. O aumento das necessidades e da carga sobre os serviços de saúde mental foram descritos como consequências diretas e indiretas da pandemia de COVID-19. As medidas de confinamento implementadas pelos governos nacionais dificultam o acesso e a prestação de cuidados e tratamentos de saúde mental. As estratégias para atender às necessidades de saúde mental dependem de respostas rápidas e adequadas através do fortalecimento da governança e dos sistemas de saúde mental, da disponibilidade de serviços, de plataformas virtuais e da capacitação apropriada dos prestadores de serviços. As estratégias de curto e médio prazo se concentraram no reforço das redes comunitárias de saúde mental e da telemedicina para as populações de alto risco. As oportunidades de reforma da saúde mental a longo prazo implicam o fortalecimento dos quadros jurídicos, a redistribuição de recursos financeiros e a colaboração com parceiros locais e internacionais. Conclusões. A saúde mental e o apoio psicossocial foram identificados como uma área prioritária pelos países da América do Sul na resposta à COVID-19. A pandemia criou necessidades específicas que exigem ações apropriadas, incluindo a implementação de intervenções virtuais, a capacitação orientada à proteção dos usuários e prestadores da atenção à saúde, o fortalecimento da tomada de decisões baseada em evidências e a integração da saúde mental e do apoio psicossocial em mecanismos de alto nível que orientem a resposta à COVID-19.

Inequalities in access to water and soap matter for the COVID-19 response in sub-Saharan Africa.

The COVID-19 pandemic has spread rapidly since the first case notification of the WHO in December 2019. Lacking an effective treatment, countries have implemented non-pharmaceutical interventions including social distancing measures and have encouraged maintaining adequate and frequent hand hygiene to slow down the disease transmission. Although access to clean water and soap is universal in high-income settings, it remains a basic need many do not have in low- and middle-income settings.We analyzed data from Demographic and Health Surveys (DHS) of 16 countries in sub-Saharan Africa, using the most recent survey since 2015. Differences in the percentage of households with an observed handwashing place with water and soap were estimated by place of residence and wealth quintiles. Equiplots showed wide within-country disparities, disproportionately affecting the poorest households and rural residents, who represent the majority of the population in most of the countries.Social inequalities in access to water and soap matter for the COVID-19 response in sub-Saharan Africa. Interventions such as mass distribution of soap and ensuring access to clean water, along with other preventive strategies should be scaled up to reach the most vulnerable populations.

Nonparametric Assessment of Differences Between Competing Risk Hazard Ratios: Application to Racial Differences in Pediatric Chronic Kidney Disease Progression.

Associations between an exposure and multiple competing events are typically described by cause-specific hazard ratios (csHR) or subdistribution hazard ratios (sHR). However, diagnostic tools to assess differences between them have not been described. Under the proportionality assumption for both, it can be shown mathematically that the sHR and csHR must be equal, so reporting different time-constant sHR and csHR implies non-proportionality for at least one. We propose a simple, intuitive approach using the ratio of sHR/csHR to nonparametrically compare these metrics. In general, for the non-null case, there must be at least one event type for which the sHR and csHR differ, and the proposed diagnostic will be useful to identify these cases. Furthermore, once standard methods are used to estimate the csHR, multiplying it with our nonparametric estimate for the sHR/csHR ratio will yield estimates of sHR which fulfill intrinsic linkages of the subhazards that separate analysis may violate. In addition, for non-null cases, at least one must be time dependent (i.e., non-proportional), and thus our tool serves as an indirect test of the proportionality assumption. We applied this proposed diagnostic tool to data from a cohort of children with congenital kidney disease to describe racial differences in the time to first dialysis or first transplant and extend methods to include adjustment for socioeconomic factors.

[Spatial analysis of gestational anemia in Peru, 2015]. / Análisis espacial de la anemia gestacional en el Perú, 2015.

OBJECTIVES: To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates. MATERIALS AND METHODS: An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index. RESULTS: Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates. CONCLUSIONS: Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.

Análisis espacial de la anemia gestacional en el Perú, 2015 / Spatial analysis of gestational anemia in Peru, 2015

RESUMEN Objetivos Establecer las prevalencias regionales e identificar conglomerados distritales con altas prevalencias deanemia en gestantes atendidas en los establecimientos de salud públicos del Perú en el 2015. Materiales y métodos Se realizó un estudio ecológico de datos de gestantes con anemia, registrados en el Sistema de Información del Estado Nutricional (SIEN), que fueron atendidas en 7703 establecimientos públicos de salud durante el 2015. Se calcularon prevalencias de anemia gestacional regionales y distritales. Mediante el índice de Moran se identificaron conglomerados distritales con alta prevalencia de anemia gestacional. Resultados Se recolectó información de 311 521 gestantes, distribuidas en 1638 distritos del Perú. La prevalencia nacional de anemia fue de 24,2% (IC 95%: 24,0-24,3) y 30,5% en el área rural vs. 22,0% en el área urbana. Las regiones de Huancavelica (45,5%; IC 95%: 44,2-46,7), Puno (42,8%; IC 95%: 41,9-43,7), Pasco (38,5%; IC 95%: 36,9-40,0), Cusco (36,0%; IC 95%: 35,3-36,8) y Apurímac (32,0%; IC 95%: 30,8-33,1) tuvieron las mayores prevalencias de anemia. El índice local de Moran identificó 202 distritos (12,3%) (44 urbanos y 158 rurales) de alta prioridad (alto-alto o hot spots) situados en Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco y Puno, que muestran conglomerados distritales con altas prevalencias. Conclusiones La anemia gestacional en Perú concentra sus mayores prevalencias en las áreas rural y sur de la sierra. Los conglomerados distritales con altas prevalencias de anemia gestacional coinciden con las zonas de alta prevalencia regional.

ABSTRACT Objectives To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates. Materials and Methods An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index. Results Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates. Conclusions Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.

Patient acceptability of and readiness-to-pay for pharmacy-based health membership plans to improve hypertension outcomes in Lima, Peru.

INTRODUCTION: Pharmacies have been used to improve population health in Peru and other countries globally, operating as a non-traditional health access point. A pharmacy-based model holds potential to improve patient management of hypertension, a leading risk factor for non-communicable diseases in low- and middle-income countries. The aim of this study was to evaluate patient acceptability of hypertension services and health membership plans, if offered through private pharmacies in the future. METHODS: A cross-sectional study was conducted with 347 hypertensive individuals who purchased anti-hypertensive medications in a private pharmacy during the study period (July-October 2012). The study included a brief survey assessing patients' acceptability of and readiness-to-pay for pharmacy-based hypertension management services. Chi-square tests for differences in proportions were used to evaluate whether any demographic characteristics (e.g., binary variables for age, time since diagnosis, and type of medication usually purchased) could identify groups of hypertensive individuals that might be more or less likely to use pharmacy-based services. Multiple logistic regression was used to estimate associations between readiness-to-pay for pharmacy-based health membership plans and patient-level characteristics. RESULTS: Over 80% of individuals indicated they would be interested in pharmacy-based hypertension services, particularly discounts on anti-hypertensive medications and free blood pressure screenings. Compared to individuals 65 years of age or older, individuals under 65 years were more interested in receiving at least one pharmacy-based service. Another 80% indicated they would be interested in purchasing a monthly health plan through a pharmacy that provided access to hypertension services each month. The vast majority of individuals interested in pharmacy-based services indicated they would pay ≤$3.69 US/month to participate in a monthly health membership plan. CONCLUSIONS: Hypertensive patients would be interested in using and ready to pay for pharmacy-based hypertension services.

[Spatial analysis of childhood obesity and overweight in Peru, 2014]. / Análisis espacial del sobrepeso y la obesidad infantil en el Perú, 2014.

OBJECTIVES.: To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity by districts in under five years children in Peru during 2014. MATERIALS AND METHODS.: Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity. RESULTS.: Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural). CONCLUSIONS.: The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity.

Análisis espacial del sobrepeso y la obesidad infantil en el Perú, 2014 / Spatial analysis of childhood obesity and overweight in Peru, 2014

RESUMEN Objetivos. Estimar las prevalencias regionales e identificar los patrones espaciales del grado de sobrepeso y obesidad por distritos, en menores de cinco años en el Perú durante el año 2014. Materiales y métodos. Análisis de la información reportada por el Sistema de Información del Estado Nutricional (SIEN) del número de casos de sobrepeso y obesidad en menores de cinco años registrados durante el año 2014. Se calcularon prevalencias regionales para sobrepeso y obesidad y sus respectivos intervalos de confianza al 95%. El índice de Moran fue utilizado para determinar los patrones de agrupación de distritos con altas prevalencia de sobrepeso y/o obesidad. Resultados. Se analizaron datos de 1834 distritos y 2 318 980 menores de cinco años, 158 738 casos (6,84%; IC 95%: 6,81-6,87) presentaron sobrepeso, mientras que 56 125 (2,42%; IC 95%: 2,40-2,44) obesidad. Las mayores prevalencias de sobrepeso fueron identificadas en las regiones de Tacna (13,9%), Moquegua (11,8%), Callao (10,4%), Lima (10,2%) e Ica (9,3%), y en las mismas regiones para obesidad con 5,3%; 4,3%; 4,0%; 4,0% y 3,8% respectivamente. El análisis espacial encontró agrupaciones distritales de altas prevalencias en un 10% del total de distritos tanto para sobrepeso y obesidad, identificándose 199 distritos para sobrepeso (126 urbanos y 73 rurales), y 184 para obesidad (136 urbanos y 48 rurales). Conclusiones. Se identificó las mayores prevalencias de sobrepeso y obesidad en regiones de la costa peruana. Asimismo, estas regiones son las que exhibieron predominantemente una agrupación espacial de distritos con altas prevalencias de sobrepeso y obesidad.

ABSTRACT Objectives. To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity by districts in under five years children in Peru during 2014. Materials and methods. Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity. Results. Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural). Conclusions. The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity.

Food Environments around American Indian Reservations: A Mixed Methods Study.

OBJECTIVES: To describe the food environments experienced by American Indians living on tribal lands in California. METHODS: Geocoded statewide food business data were used to define and categorize existing food vendors into healthy, unhealthy, and intermediate composite categories. Distance to and density of each of the composite food vendor categories for tribal lands and nontribal lands were compared using multivariate linear regression. Quantitative results were concurrently triangulated with qualitative data from in-depth interviews with tribal members (n = 24). RESULTS: After adjusting for census tract-level urbanicity and per capita income, results indicate there were significantly fewer healthy food outlets per square mile for tribal areas compared to non-tribal areas. Density of unhealthy outlets was not significantly different for tribal versus non-tribal areas. Tribal members perceived their food environment negatively and reported barriers to the acquisition of healthy food. CONCLUSIONS: Urbanicity and per capita income do not completely account for disparities in food environments among American Indians tribal lands compared to nontribal lands. This disparity in access to healthy food may present a barrier to acting on the intention to consume healthy food.

Length of urban residence and obesity among within-country rural-to-urban Andean migrants.

OBJECTIVE: To evaluate the association between length of residence in an urban area and obesity among Peruvian rural-to-urban migrants. DESIGN: Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study (2007). Exposure was length of urban residence, analysed as both a continuous (10-year units) and a categorical variable. Four skinfold site measurements (biceps, triceps, subscapular and suprailiac) were used to calculate body fat percentage and obesity (body fat percentage >25% males, >33% females). We used Poisson generalized linear models to estimate adjusted prevalence ratios and 95 % confidence intervals. Multicollinearity between age and length of urban residence was assessed using conditional numbers and correlation tests. SETTING: A peri-urban shantytown in the south of Lima, Peru. SUBJECTS: Rural-to-urban migrants (n 526) living in Lima. RESULTS: Multivariable analyses showed that for each 10-year unit increase in residence in an urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher prevalence of obesity. This association was also present when length of urban residence was analysed in categories. Sensitivity analyses, conducted with non-migrant groups, showed no evidence of an association between 10-year age units and obesity in rural (P=0·159) or urban populations (P=0·078). High correlation and a large conditional number between age and length of urban residence were found, suggesting a strong collinearity between both variables. CONCLUSIONS: Longer lengths of urban residence are related to increased obesity in rural-to-urban migrant populations; therefore, interventions to prevent obesity in urban areas may benefit from targeting migrant groups.