Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru.

BACKGROUND: The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru. METHODS: A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect). RESULTS: In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively). CONCLUSION: The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.

Prison as a driver of recent transmissions of multidrug-resistant tuberculosis in Callao, Peru: a cross-sectional study.

Background: We sought to identify resistance patterns and key drivers of recent multidrug-resistant tuberculosis (MDR-TB) transmission in a TB-prevalent area in Peru. Methods: Cross-sectional study including MDR Mycobacterium tuberculosis complex (Mtbc) strains identified in Callao-Peru between April 2017 and February 2019. Mtbc DNA was extracted for whole genome sequencing which was used for phylogenetic inference, clustering, and resistance mutation analyses. Clusters indicative of recent transmission were defined based on a strain-to-strain distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). Epidemiologic factors linked to MDR-TB clustering were analyzed using Poisson regression. Findings: 171 unique MDR-Mtbc strains were included; 22 (13%) had additional fluoroquinolone resistance and were classified as pre-XDR. Six strains (3.5%) harboured bedaquiline (BDQ) resistance mutations and were classified as MDR + BDQ. 158 (92%) Mtbc strains belonged to lineage 4 and 13 (8%) to lineage 2. Using a cluster threshold of ≤5 SNPs, 98 (57%) strains were grouped in one of the 17 D5 clusters indicative of recent transmission, ranging in size from 2 to the largest cluster formed by 53 4.3.3 strains (group_1). Lineage 4.3.3 strains showed the overall highest cluster rate (43%). In multivariate analyses, current or previous imprisonment was independently associated with being part of any MDR-TB transmission clusters (adjusted prevalence ratio [aPR], 1.45; 95% CI, 1.09-1.92). Interpretation: Pre-XDR-TB emerged in more than 10% of the MDR-TB strains investigated. Transmission of 4.3.3 Mtbc strains especially of the dominant group_1 clone is a major driver of the MDR-TB epidemic in Callao. Current or previous imprisonment was linked to recent MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic. Funding: This work was supported in part by the ERANet-LAC Network of the European Union, Latin America and the Caribbean Countries on Joint Innovation and Research Activities, and FONDECYT. Additional support was received from Leibniz Science Campus Evolutionary Medicine of the Lung, the Deutsche Forschungsgemeinschaft (German Research Foundation, under Germany's Excellence Strategy-EXC 2167 Precision Medicine in Inflammation), and the Research Training Group 2501 TransEvo.

Propiedades psicométricas de la Escala Breve de Sentido de Comunidad (BSCS) en los barrios de Barranquilla, Colombia / Psychometric Properties of the Brief Sense of Community Scale (BSCS) in the Neighborhoods of Barranquilla (Colombia

Se analizan las propiedades psicométricas de la Escala Breve de Sentido de Comunidad (BSCS) en colombianos que residían en Barranquilla, norte de Colombia, teniendo en cuenta la categorización en estratos socioeconómicos de los barrios en la ciudad. Se examina si el modelo teórico de cuatro factores se mantiene o no en este contexto y si la variable estrato socioeconómico de los barrios afecta a su puntuación. Se encuestó a 858 personas: 491 mujeres, 367 hombres, con edades de 18 a 82 años (M =31.2 años, DE = 14.6). Se utilizó un análisis factorial exploratorio y confirmatorio para examinar la estructura de los factores y la igualdad de los parámetros del BSCS entre los grupos de barrios con alta y baja categorización socioeconómica. Se encontró que, de tres modelos en comparación, el modelo de un factor de segundo orden que explica las cuatro dimensiones del Sentido de Comunidad (SC), brindó el mejor ajuste a los datos y responde mejor al modelo de McMillan y Chavis (1986). Las medidas de confiabilidad interna fueron ω de 0.92 y α de 0.91. Se propone una norma de corrección calculada para la matriz de correlación policórica, donde las puntuaciones más altas indican un mayor SC. Se termina identificando que el SC es mucho mayor en los barrios de estratos socioeconómicos altos y medios con respecto a los barrios de estratos bajos (AU)

The psychometric properties of the Brief Sense of Community Scale (BSCS) are analyzed in Colombians residing in Barranquilla, northern Colombia, taking into account the socioeconomic strata categorization of neighborhoods in the city. We examine whether or not the four-factor theoretical model holds in this context and whether the socioeconomic strata variable of the neighborhoods affects their score. We surveyed 858 people: 491 women, 367 men, aged 18-82 years (M =31.2 years, SD= 14.6). Exploratory and confirmatory factor analysis was used to examine the factor structure and equality of BSCS parameters between groups of neighborhoods with high and low socioeconomic categorization. It was found that, of three models in comparison, the second-order one-factor model explaining the four dimensions of Sense of Community (SC) provided the best fit to the data and is most responsive to the McMillan and Chavis (1986) model.The internal reliability measures were ω of 0.92 and α of 0.91. A correction rule calculated for the polychoric correlationmatrix is proposed, where higher scores indicate higher SC. It ends up identifying that the SC is much higher in high and middle socioeconomic strata neighborhoods with respect to low strata neighborhoods (AU)

Prevalencia, manifestaciones clínicas y factores asociados al COVID-19 de larga duración / Prevalence, clinical manifestations, and associated factors of long COVID-19

El objetivo fue describir la prevalencia, las manifestaciones clínicas y los factores asociados de COVID-19 de larga duración. Se realizó una búsqueda bibliográfica de revisiones sistemáticas y metaanálisis sobre COVID-19 de larga duración en MEDLINE (vía PubMed) hasta el 7 de abril de 2022. Se encontraron 37 artículos y se incluyeron 3. La calidad de la evidencia fue evaluada a través de los criterios de AMSTAR 2. La prevalencia reportada de COVID-19 de larga duración fue 43% (IC95%: 39% ­ 46%). Las principales manifestaciones clínicas fueron debilidad (41% [IC95%: 25% ­ 59%]), malestar general (33% [IC95%: 15% ­ 57%]), fatiga (31% [IC95%: 24% ­ 39%]), alteración en la concentración (26% [IC95%: 21% ­ 32%]) y sensación de falta de aire (25% [IC95%: 18% ­ 34%]). Los factores asociados a COVID de larga duración incluyeron sexo femenino, severidad de cuadro inicial, edad y presencia de comorbilidades.

The aim was to describe the prevalence, clinical manifestations, and associated factors of long-COVID. Bibliographic research of systematic reviews and meta-analyses was carried out in MEDLINE (through PubMed) until April 7th, 2022. 37 articles were found and 3 were included. Evidence quality was assessed via AMSTAR 2 criteria. Long-COVID prevalence is 43% (IC95%: 39% ­ 46%). Main clinical manifestations were weakness (41% [IC95%: 25% ­ 59%]), malaise (33% [IC95%: 15% ­ 57%]), fatigue (31% [IC95%: 24% ­ 39%]), concentration impairment (26% [IC95%: 21% ­ 32%]), and breathlessness (25% [IC95%: 18% ­ 34%]). Factors associated with long COVID were female sex, initial disease severity, age, and presence of comorbidities.

Estrategia educativa para elevar el conocimiento sobre hipertensión arterial en la población, de 20 años en adelante / Educational strategy to raise knowledge about arterial hypertension in the population aged 20 and over

En el mundo las enfermedades cardiovasculares son responsables de casi un tercio del total de las muertes por año. Cada vez son más las personas que padecen hipertensión arterial (HTA), desconociendo muchos su condición. Objetivo: Diseñar una estrategia educativa para elevar el conocimiento sobre hipertensión arterial en la población de 20 años y más en el consultorio 2 de Medicina Familiar y Comunitaria; Centro de Salud Luchadores del Norte, año 2021.Materiales métodos: Se realizó una investigación descriptiva, observacional, prospectiva y transversal con la población de adultos del Centro de Salud Luchadores Norte, para elaborar el diseño de una estrategia educativa que eleve el conocimiento sobre esta enfermedad; se midieron variables sociodemográficas, de estilos de vida y de conocimiento. Resultados: El grupo de edad más frecuente de 50 a 59 años 26,2%; sexo masculino 66,4%; escolaridad nivel básico 41,1%; estado civil unión libre 52,3%; etnia mestizo 58,9% y ocupación empleado privado 29,0%; no realizan actividad física 65,4%; consumo excesivo de sal 67,3%; grasa 58,9%; gaseosas y energizantes 52,8%; no conocen de la enfermedad 62,6%; técnica charla 39,3%; frecuencia una vez cada 15 días 43,9%; horario de mañana 57,0%; duración 30 minutos 52,3%; lugar centro de salud 50,5% y tamaño del grupo de 6 a 10 (42,1%). Conclusión: La bibliografía concuerda mayoritariamente con los resultados de la investigación, en consumo de sal elevado, grasas, gaseosas y bebidas energizantes; el conocimiento sobre la enfermedad es escaso en los hipertensos, concordando con las citas de referencia; concluyendo, que coexisten estilos de vida no saludables con desconocimiento; favoreciendo las complicaciones de la enfermedad, una intervención educativa elevaría conocimiento y cambia actitudes evitando consecuencias y daños irreversibles(AU)

In the world, cardiovascular diseases are responsible for almost a third of all deaths per year. More and more people suffer from high blood pressure (HBP), many unaware of their condition. Objective: To design an educational strategy to raise awareness about arterial hypertension in the population aged 20 and over in Family and Community Medicine office 2; Luchadores del Norte Health Center, year 2021. Materials and methods: A descriptive, observational, prospective and cross-sectional investigation was carried out with the adult population of the Luchadores Norte Health Center, to develop the design of an educational strategy that raises knowledge about this illness; sociodemographic, lifestyle and knowledge variables were measured. Results: The most frequent age group was 50 to 59 years old, 26.2%; male sex 66.4%; basic level schooling 41.1%; marital status free union 52.3%; mestizo ethnic group 58.9% and occupation private employee 29.0%; do not perform physical activity 65.4%; excessive consumption of salt 67.3%; fat 58.9%; soft drinks and energy drinks 52.8%; 62.6% do not know about the disease; talk technique 39.3%; frequency once every 15 days 43.9%; morning hours 57.0%; duration 30 minutes 52.3%; health center location 50.5% and group size from 6 to 10 (42.1%). Conclusion: The bibliography mostly agrees with the results of the investigation, in consumption of high salt, fat, soft drinks and energy drinks; knowledge about the disease is scarce in hypertensive patients, in agreement with the reference citations; concluding that unhealthy lifestyles coexist with ignorance; favoring the complications of the disease, an educational intervention would increase knowledge and change attitudes, avoiding consequences and irreversible damage(AU)

COVID-19 case fatality rate and tuberculosis in a metropolitan setting.

In this study, we aimed to assess the relationship between tuberculosis case rate and COVID-19 case fatality rate (CFR) among districts within a tuberculosis-endemic metropolitan area. We analyzed data from 43 districts in Lima, Peru. We used districts as the units of observation. Linear regressions were used to investigate the relationship between COVID-19 CFRs and tuberculosis case rates. The mean COVID-19 CFR in each district for reporting Weeks 5-32 was used as the dependent variable. Independent variable was the mean rate of confirmed pulmonary tuberculosis cases for 2017-2019 period. Analyses were adjusted by population density, socioeconomic status, crowded housing, health facility density, and case rates of hypertension, diabetes mellitus, and HIV infection. The mean COVID-19 CFR in Lima was 4.0% ± 1.1%. The mean tuberculosis rate was 16.0 cases per 10,000 inhabitants. In multivariate analysis, tuberculosis case rate was associated with COVID-19 CFR (ß = 1.26; 95% confidence interval: 0.24-2.28; p = .02), after adjusting for potential confounders. We found that Lima districts with a higher burden of tuberculosis exhibited higher COVID-19 CFRs, independent of socioeconomic, and morbidity variables.

Percepción del ambiente educacional de los estudiantes de medicina de una universidad pública peruana en el año 2014 / Perception of the medical student educational environment from a Peruvian public university in 2014

OBJETIVO: Evaluar la percepción de los estudiantes de medicina humana sobre el ambiente educacional en la Facultad de Medicina «San Fernando» de la Universidad Nacional Mayor de San Marcos de Lima, Perú. MATERIAL Y MÉTODOS: Estudio de tipo cuantitativo y corte transversal mediante la aplicación del instrumento Dundee Ready Education Environment Measure. El instrumento fue aplicado a 177 estudiantes de medicina del segundo al sexto año de estudio. RESULTADOS: El 53,7% de los estudiantes tuvieron una percepción positiva del aprendizaje, de los docentes (73,5%), de la atmósfera (66,1%) y de su situación académica (66,1%), pero la percepción social de la facultad fue desfavorable (57,1%) y la calificación total de la percepción del ambiente educacional fue favorable (75,7%). DISCUSIÓN: La percepción de los estudiantes de medicina sobre el ambiente educacional en la escuela de medicina fue favorable. Se recomienda afianzar los aspectos relacionados con el ambiente social del estudiante de medicina

OBJECTIVE: To evaluate medical students perception of the educational environment in the "San Fernando" School of Medicine of the National University of San Marcos of Lima, Peru. MATERIALS AND METHODS: A quantitative and cross-sectional study was performed using the Dundee Ready Educational Environment Measure. A total of 177 medical students from second to sixth year were tested. RESULTS: The scores obtained from the DREEM demonstrate that medical student's perceptions were positive in learning (53.7%), teachers (7.5%), environment (66.1%), and academic situation (66.1%). However, there was a negative perception of their medical school (57.1%). The overall rating of the perception of the educational environment was positive (75.7%). DISCUSSION: The medical student's perception of the medical school educational environment was positive. It is recommended to strengthen the medical student's social environment related to medical school

Accidentes con objetos punzocortantes en internos de medicina de dos hospitales de Perú / Accidental puncture injuries among interns practicing at 2 hospitals in Peru

No disponible

Características de la población peruana que no busca atención médica por deficiencias de la calidad de atención en salud en el periodo 2005-2015 / Characteristics of the Peruvian population that does not seek medical attention for the deficiencies the health care quality in the period 2005-2015

Introducción: Las deficiencias de la calidad de atención en salud son un problema de salud pública. Están considerados como una barrera para las mejoras de los indicadores nacionales en salud. En la actualidad existen numerosas investigaciones sobre calidad de atención pero fueron realizadas dentro de servicios hospitalarios. No se encontraron estudios en el país que evalúen las características de las personas que no buscaron atención por deficiencia de calidad de atención. Objetivo: Determinar las características de la población peruana que no buscó atención médica por deficiencias de calidad de atención en salud según el análisis de la base de datos de la ENAHO en el periodo 2005-2015. Metodología: Estudio cuantitativo, descriptivo, retrospectivo. Se utilizó como fuente de datos las bases de datos de la Encuesta Nacional de Hogares (ENAHO) en el periodo 2005-2015. Se consideró como deficiencia de calidad de atención a los casos de maltrato del personal de salud, demora de atención y lejanía del centro de salud. Resultados: Se encontró un aumento de la proporción de personas que no buscaron atención médica por deficiencia de calidad de atención en 90,0 por ciento, el aumento de la proporción por maltrato fue 368,4 por ciento, el aumento por demora en la atención aumentó en 320,2 por ciento y el aumento por lejanía fue 11 por ciento. La mayoría fueron mujeres, de edad comprendida entre 30 y 59 años, de educación primaria, residentes de zonas rurales, no pobres y afiliadas al Seguro Integral de Salud. Conclusiones: Se encontró un incremento de la proporción de la población peruana con un problema de salud que no buscó atención médica por deficiencia de calidad de atención. Es necesario mejorar los servicios de salud para una mejor atención a los pacientes.

Background: Deficiencies in the health care quality is a public problem. They are considered as a barrier to the improvement of national health indicators. Nowadays, there are a lot of research about care quality but were not made in hospital services. No studies were found in the country about characteristics of people who did not seek health attention because of care quality deficiency. Objective: Determine the characteristics of the Peruvian population who did not seek medical attention because of care quality deficiency according to the analysis of the database ENAHO in the period 2005-2015. Methodology: Quantitative, descriptive, retrospective. National Household Survey (ENAHO) in the period 2005-2015 was used as a data source. Cases of health worker abuse, delay care and remoteness was considered deficient quality of care clinic. Results: There is an increase in the proportion of people who did not seek medical attention because of care quality deficiency in 90.0 per cent. The increase of the proportion for mistreatment was 368.4 per cent, by delay in care increased by 320.2 per cent and by distance was increased by 11 per cent. The majority were women, aged between 30 and 59 years, primary education, rural residents, not poor and affiliated to the Seguro Integral de Salud (Health Insurance). Conclusions: Exist an increase in the proportion of the Peruvian population with health problems who did not seek health care because of care quality deficiency. It is necessary to improve health services for better patient care.

Ayahuasca: el encuentro de dos paradigmas / Ayahuasca: the meeting of two paradigms

La ayahuasca es una liana que crece en la Amazonía y con la cual se prepara una sustancia con potentes propiedades psicoactivas, también denominada ayahuasca. Esta sustancia está ligada con la cosmovisión de los pueblos amazónicos que la consideran una planta espiritual y medicinal por las visiones y percepción de los efectos que produce. Las investigaciones en laboratorio muestran que la ayahuasca contiene derivados betacarbolínicos como la harmina y derivados triptamínicos como la N,N-dimetiltriptamina (DMT), moléculas que intervienen en determinados fenómenos psicodislépticos de tipo alucinatorio -visiones de seres sobrenaturales- junto a alteraciones de la conciencia del yo descritas como una sensación de muerte y renacimiento que pueden llevan al usuario de la ayahuasca a un estado de éxtasis espiritual y bienestar. Estos efectos han sido descritos en la literatura y se ha considerado el potencial terapéutico de la ayahuasca frente a trastornos del estado de ánimo y problemas adictivos en los cuales se han reportado algunos resultados favorables. Sin embargo, los efectos psicoactivos que genera la ayahuasca son complejos debido a sus aspectos subjetivos, sociales y culturales y por consiguiente son difíciles de abordar objetivamente en el marco del paradigma científico actual. Por tales motivos resulta necesario el replanteamiento de formas alternativas de investigación que puedan interpretar la subjetividad presente en la experiencia psicoactiva por uso de ayahuasca.

Ayahuasca is a vine that grows in the Amazon, used to prepare a substance with high psychoactive properties also called ayahuasca. This substance is linked with the worldview of the Amazonian people who consider it a spiritual and medicinal plant due to the views and perceptions of the effects it produces. Laboratory research shows that ayahuasca contains ß-carbolinicderivates, such as harmineand tryptaminederivatives such as N,N-dimethyltryptamine (DMT), which are molecules involved in psychoactive processes related to visions of supernatural beings and the sense of death and rebirth that leads to a state of higher spirituality and wellness. These effects were studied to evaluate the therapeutic potential of ayahuasca in mood disorders and addictions, and favorable results were found. However, the psychoactive effects of ayahuasca are accompanied by subjective, social and cultural features which generate difficulties for an objective approach to the experience under the positivist paradigm. For these reasons it is necessary to rethink alternative forms of research that can interpret the subjectivity present in the psychoactive experience and, with it, a change in training and in the practice of medicine.

Procrastinación en el estudio: exploración del fenómeno en adolescentes escolarizados: Lima Metropolitana, Perú / Procrastination in learning: exploring the phenomenon among adolescent students: Metropolitan Lima, Peru

Objetivo: Explorar el fenómeno de la Procrastinación en el Estudio (PrE) y evaluar la asociación con apoyo familiar y uso de internet en adolescentes escolares. Estudio observacional, analítico de corte transversal. Se realizó un muestreo aleatorio, por conglomerados, con selección bietápica. Se incluyó a 292 estudiantes. Se evaluó el nivel de procrastinación en el estudio (PrE), mediante la ôEscala de la Procrastinación en el Estudioõ, el apoyo familiar mediante la ôEscala Multidimensional del Apoyo Social Percibidoõ y el uso de internet. La edad media de los entrevistados fue de 13.9 ± 1.7 años, siendo 66.1% varones. El puntaje promedio para PrE fue de 5.4 ± 3.1 puntos con un rango de 0 a 15. Al análisis bivariado, se encontró que la PrE se asocia significativamente con jornada de estudio, plan de vida, apoyo familiar y motivos de uso de internet. La PrE no es un fenómeno aislado a la vida del adolescente. Existe asociación significativa entre PrE y variables que en conjunto evidencian una mala administración del tiempo por parte de los adolescentes.

Aim: To explore the procrastination phenomenon in learning (PrL) and evaluate its association with family support and use of the Internet in teenagers. Methods: Analytic, observational and cross-sectional study. We conducted a randomized sampling by clusters, with two-stage selection. We assessed the level of procrastination in learning through "The Procrastination Scale in Learning ", family support through "Multidimensional Scale of Perceived Social Support" and Internet use by direct question. Results: The study included 292 students. The average age of respondents was 13.9±1.7 years, with 66.1% being males. The average score for PrL was 5.4±3.1 points with a range of 0 to 15. In the bivariate analysis, we found that PrL was significantly associated with study day, life plan, family support and reasons for Internet use. Conclusions: PrL is not an isolated phenomenon in the life of a teenager. Significant association between PrL and other variables has been found which shows that teenagers have a poor management of their time.