Quantifying Overlapping Forms of Malnutrition Across Latin America: A Systematic Literature Review and Meta-Analysis of Prevalence Estimates.

Estimating the prevalence of double burden of malnutrition (DBM) is challenging in the Latin American and Caribbean (LAC) region where various DBM typologies (e.g., obesity and stunting) are heterogeneous and estimates are scattered across literature This study aimed to assess the prevalence of DBM typologies in the LAC region. We searched PubMed, Embase, Scopus, and Web of Science to identify studies on the prevalence of DBM published between 1 January, 2000, and 23 January, 2023. Outcomes were the prevalence of the identified DBM typologies at the household, individual, or across life course levels. Random-effect meta-analyses of proportions were used to estimate pooled period prevalence for all outcomes. Heterogeneity was explored using meta-regressions. From 754 records identified, 60 (8%) studies were eligible, with a median of 4379 individuals. Studies reported data from 27 LAC countries collected between 1988 and 2017. Most studies used nationally representative surveys (68%) and scored as low risk of bias (70%). We identified 17 DBM typologies for which 360 estimates were analyzed. The prevalence of the identified DBM typologies ranged between 0% and 24%, with the DBM typology of "adult with overweight and child with anemia" having the highest prevalence (24.3%; 95% CI: 18.8%, 30.2%). The most frequently reported DBM typology was "adult with overweight and child with stunting," with a prevalence of 8.5% (95% CI: 7.7, 9.3). All prevalences carried large heterogeneity (I2>90%), modestly explained by subregions and countries. DBM across the life course could not be estimated owing to insufficient estimates. In conclusion, using available data, our study suggests that the burden of DBM in the LAC region ranges between 0% and 24%. In the most frequent DBM typologies, overweight was a common contributor. Substantial progress can be made in curbing the burden of DBM in the LAC region through strategies addressing excess weight within these population groups. This study was registered at PROSPERO as CRD42023406755.

Prevalence and factors associated with self-medication for COVID-19 prevention using disproven drugs in Peru: a cross-sectional nationwide study

Objective: The objective of this study was to identify the prevalence and factors associated with the use of drugs without evidence for the prevention of COVID-19 in Peruvians without symptoms or diagnosis, using the National Household Survey (ENAHO) 2021. Methods: A secondary analysis was made of the ENAHO 2021. We evaluated participants older than 18 years who did not undergo any test to diagnose COVID-19 and used any drug to prevent COVID-19. Adjusted prevalence ratios (aPRs) were estimated to determine the associated factors. Results: Among the 69,815 participants analyzed, the prevalence of taking a drug 4 weeks prior to the survey was 5.64%. Factors associated with drug consumption were: age 30-59 years (aPR 1.47; 95% confidence interval [CI]: 1.32-1.65); having a higher education (aPR 1.73; 95% CI:1.28-2.33); having a chronic disease (aPR 1.40; 95% CI: 1.26-1.56); not having poverty status (aPR 1.40; 95% CI: 1.26-1.56); living in an urban area (aPR 1.61; 95% CI: 1.31-1.99). Meanwhile, living in the highlands (aPR 0.77; 95% CI: 0.60-0.97) and not having a landline, cell phone, television or internet at home (aPR 0.65; 95% CI: 0.43-0.98) were protective factors from unnecessary drug consumption. Conclusion: It is concerning that even after one year of living with the pandemic and having refuted the utility of medications such as ivermectin and azithromycin, these drugs are still widely consumed by a sector of the population without symptoms or a diagnosis of COVID-19. Therefore, it is necessary to formulate and implement public health measures that address this problem, taking into account the associated factors to reduce this consumption (AU)

Understanding the contribution of lifestyle in breast cancer risk prediction: a systematic review of models applicable to Europe.

BACKGROUND: Breast cancer (BC) is a significant health concern among European women, with the highest prevalence rates among all cancers. Existing BC prediction models account for major risks such as hereditary, hormonal and reproductive factors, but research suggests that adherence to a healthy lifestyle can reduce the risk of developing BC to some extent. Understanding the influence and predictive role of lifestyle variables in current risk prediction models could help identify actionable, modifiable, targets among high-risk population groups. PURPOSE: To systematically review population-based BC risk prediction models applicable to European populations and identify lifestyle predictors and their corresponding parameter values for a better understanding of their relative contribution to the prediction of incident BC. METHODS: A systematic review was conducted in PubMed, Embase and Web of Science from January 2000 to August 2021. Risk prediction models were included if (i) developed and/or validated in adult cancer-free women in Europe, (ii) based on easily ascertained information, and (iii) reported models' final predictors. To investigate further the comparability of lifestyle predictors across models, estimates were standardised into risk ratios and visualised using forest plots. RESULTS: From a total of 49 studies, 33 models were developed and 22 different existing models, mostly from Gail (22 studies) and Tyrer-Cuzick and co-workers (12 studies) were validated or modified for European populations. Family history of BC was the most frequently included predictor (31 models), while body mass index (BMI) and alcohol consumption (26 and 21 models, respectively) were the lifestyle predictors most often included, followed by smoking and physical activity (7 and 6 models respectively). Overall, for lifestyle predictors, their modest predictive contribution was greater for riskier lifestyle levels, though highly variable model estimates across different models. CONCLUSIONS: Given the increasing BC incidence rates in Europe, risk models utilising readily available risk factors could greatly aid in widening the population coverage of screening efforts, while the addition of lifestyle factors could help improving model performance and serve as intervention targets of prevention programmes.

What Drives Abdominal Obesity in Peru? A Multilevel Analysis Approach Using a Nationally Representative Survey.

Abdominal obesity (AO) is a serious public health threat due to its increasing prevalence and effect on the development of various non-communicable diseases. A multilevel analysis of the 2019 Demographic and Family Health Survey (ENDES in Spanish) using the Latin American Diabetes Association (ALAD in Spanish) cut-off points was carried out to evaluate the individual and contextual factors associated with AO in Peru. A total of 30,585 individuals 18 years and older were included in the analysis. The prevalence of AO among Peruvians in 2019 was 56.5%. Individuals of older age (aOR 4.64; 95% CI: 3.95-5.45), women (aOR 2.74; 95% CI: 2.33-3.23), individuals with a higher wealth index (aOR 2.81; 95% CI: 2.40-3.30) and having only secondary education (aOR 1.45; 95% CI: 1.21-1.75) showed increased odds of presenting AO compared to their peers. At a contextual level, only the Human Development Index (aOR 1.59; 95% CI: 1.17-2.16) was associated with the development of AO. A high Human Development Index is the contextual factor most associated with AO. It is necessary to formulate and implement new public health policies focused on these associated factors in order to reduce the prevalence of OA and prevent the excessive burden of associated noncommunicable diseases.

Multimorbidity analysis and hospitalizations for diabetes before and after lockdown due to the COVID-19 pandemic in Peru.

COVID-19 has disrupted the treatment of non-communicable diseases (NCDs). This study conducted a multimorbidity analysis and evaluated hospital admissions and death rates among diabetic patients before and after the implementation of lockdown due to the COVID-19 pandemic in Peru. Data from the Ministry of Health (MINSA) of Peru from January 2017 to December 2020 was used. Hospital death, discharge and the percentage of death/hospital admissions were defined as outcomes of interest. We performed an interrupted time series analysis to assess the aggregate change in the outcomes of interest before and after mandatory lockdown in response to the COVID-19 pandemic in Peru (n = 65,935). Additionally, a network analysis was performed to evaluate the frequency of occurrence of hospital admissions before and after the mandatory lockdown according to demographic characteristics. The average monthly hospital admissions among diabetic patients in Peru decreased by 29% after the implementation of the lockdown. The largest reduction was observed in women (-41%) and for patients 60 years or older (-35%). Furthermore, there was a 92% increase in the average number of monthly deaths. The largest percentage change occurred in men (+113%) and in the group of 40-59 years (+144%). After the implementation of lockdown in Peru, hospital admissions among diabetic patients significantly decreased while in-hospital mortality slightly increased. Our findings shed light on the limitations of the Peruvian health system and the importance of ensuring continued care of NCDs as part of the response strategy during times of crisis.

Interventions to Improve the Oral Hygiene of Individuals with Alzheimer's Disease: A Systematic Review.

This systematic review evaluates published evidence on oral hygiene interventions conducted in Alzheimer's disease (AD) patients. PubMed, Embase, Cochrane Library, CINAHL, Dentistry & Oral Sciences Source, and Web of Science were searched for articles published up to 19 April 2021. The main outcomes of interest were the Plaque index score (PI), oral health knowledge of participants or their caregivers, and behaviors and attitudes towards oral hygiene. Study quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the National Institutes of Health. The study was conducted under PROSPERO registration code CRD42021247733. Two studies met the inclusion criteria. One was a pre-post study conducted in Brazil, and the other was a prospective cohort study carried out in China. The sample sizes of these studies were 29 and 168, respectively. Both studies were carried out in institutionalized patients and presented a significant loss to follow-up. The PI and gingival index scores both improved after the application of the respective interventions, yet the differing methodologies used precluded further comparisons. The studies were deemed to be of good and regular quality, respectively. Despite the need for more comprehensive interventions to ensure a better oral health status and a higher quality of life for AD patients, an alarming lack of studies have been conducted in this population.

Mouthrinses and SARS-CoV-2 viral load in saliva: a living systematic review.

Objective To conduct a living systematic review of the clinical evidence about the effect of different mouthrinses on the viral load of SARS-CoV-2 in the saliva of infected patients.Methods This study was reported using the PRISMA guidelines. An electronic search was conducted in seven databases and preprint repositories. We included human clinical trials that evaluated the effect of mouthrinses with antiseptic substances on the viral load of SARS-CoV-2 in the saliva of children or adults, who tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction (RT-PCR). The risk of bias was assessed using the ROBINS-I tool. PROSPERO registration number: CRD42021240561.Results Five studies were included (n = 66 participants). Study participants underwent oral rinses with hydrogen peroxide (H2O2) at 1%, povidone-iodine (PI) at 0.5% or 1%, chlorhexidine gluconate (CHX) at 0.2% or 0.12%, cetylpyridinium chloride (CPC) at 0.075%, and Linolasept. Only one study included a control group with sterile water. Three of the studies identified a reduction in viral load in saliva after the use of mouthrinses with PI (up to three hours), CHX (up to four hours), or Linolasept mouthwash (up to six hours). One study reported a statistically significant reduction after the use of mouthrinses with CPC or PI vs water (up to six hours) and one study reported a non-significant reduction in viral load after the use of H2O2 rinses.Conclusions According to the present systematic review, the effect of mouthrinses on SARS-CoV-2 viral load in the saliva of COVID-19 patients remains uncertain. Evidence from well-designed randomised clinical trials is required for further and more objective evaluation of this effect.

Determinants of Eye Care Service Utilization among Peruvian Adults: Evidence from a Nationwide Household Survey.

PURPOSE: This study analyzes the factors associated with eye care service utilization among Peruvians 50 years of age and older, measured as self-reporting of having undergone examination of visual acuity during the last 12 months. METHODS: A secondary analysis of the 2019 Demographic and Family Health Survey (ENDES, for its acronym in Spanish) database was carried out. We estimated the weighted proportion of adults 50 years of age and older that reported having undergone a visual acuity examination in the previous 12 months and the frequency according to the variables of interest. Crude (PR) and adjusted prevalence ratios (aPR) of eye care service utilization were constructed using generalized linear models. RESULTS: Approximately 28.8% of Peruvians 50 years of age and older underwent a visual acuity examination in the previous 12 months. Having a higher education (aPR = 1.79; 95% CI: 1.33-2.40), health insurance such as EsSalud (aPR = 1.54; 95% CI: 1.28-1.87), a previous diagnosis of cataracts (aPR = 1.86; 95% CI: 1.67-2.09) and being part of the richest wealth quintile (aPR = 2.36; 95% CI: 1.74-3.20) were associated with greater utilization of eye care services, while living in the jungle was associated with a lower likelihood of utilization of these services. CONCLUSION: The unequal distribution of health resources within the territory and socioeconomic gaps among the population could explain our findings. Further efforts are needed to fulfill the eye health needs of the Peruvian population.

Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population.

BACKGROUND: Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post-mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. METHODS: This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. RESULTS: ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P=.916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P=.073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. CONCLUSION: The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

Socioeconomic inequalities in abdominal obesity among Peruvian adults.

OBJECTIVES: Abdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018-2019. METHODS: This was a cross-sectional study using data from the 2018-2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities. RESULTS: The prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001). CONCLUSIONS: In Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities.

Seroprevalence and lethality by SARS-CoV-2 in indigenous populations of Latin America and the Caribbean: a systematic review.

BACKGROUND: Latin America and the Caribbean (LAC) has presented some of the highest numbers of cases and deaths due to COVID-19 in the world. Even though indigenous communities represent 8% of the total population in this region, the impact of COVID-19 on this historically vulnerable population has only been briefly explored. Thus, this study aimed to estimate the seroprevalence and lethality attributable to SARS-CoV-2 in the indigenous population of LAC. METHODS: A systematic review was conducted utilizing multiple databases (registry PROSPERO: CRD42020207862). Studies published in English, Spanish or Portuguese were selected between December 1st, 2019, and April 14th, 2021. The evaluation of the quality of the study was carried out utilizing the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A qualitative synthesis of the data analyzed was conducted following the MOOSE and PRISMA declarations. RESULTS: Fifteen studies met the inclusion criteria. Eleven studies were carried out in a Brazilian population, three in a Mexican population, and one in a Colombian population. Four studies reported data about the seroprevalence of SARS-CoV-2 in indigenous populations of Brazil (range: 4.2-81.65%). Twelve studies reported lethality in indigenous people (eight in Brazil, three in Mexico, and one in Colombia). In Brazil, a lethality of 53.30% was described in a hospital setting and between 1.83% and 4.03% in community studies. In Mexico, the lethality of COVID-19 ranged between 16.5% and 19.9%. Meanwhile, in Colombia, a lethality of 3.41% was reported. Most studies were deemed to be of good quality. CONCLUSIONS: Despite COVID-19 affecting indigenous populations of LAC, there is limited evidence of the seroprevalence and lethality of the infection by SARS-CoV-2 in this population. Future investigations should ensure standardized methods that allow comparability among studies and ensure the precision of the results obtained.

Socio-demographic inequalities in the uptake of Papanicolaou tests in Peru: analysis of the 2015-2017 Demographic and Family Health Survey.

OBJECTIVES: This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish). METHODS: This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities. RESULTS: All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173). CONCLUSIONS: We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.