Fear of COVID-19, risk perception and preventive behavior in health workers: a cross-sectional analysis in middle-income Latin American countries.

The aim of this study was to examine the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from four Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and unstandardized beta coefficient and value of ps were calculated. Four hundred and thirty-five health professionals were included, the majority were aged 42 years or older (45.29, 95%CI: 40.65-50.01) and female (67.82, 95%CI: 63.27-72.05). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B = 2.21, p = 0.002 for total behavior; B = 1.12, p = 0.037 for additional protection at work; B = 1.11, p < 0.010 for hand washing). The risk perception of COVID-19 infection had a slight direct relationship with preventive behaviours (B = 0.28, p = 0.021 for total behavior; B = 0.13, p = 0.015 for hand washing), with the exception of the preventive behavior of using additional protection at work (p = 0.339). We found that fear and risk perception are associated with increased practice of hand washing and use of additional protection at work. Further studies are required on the influence of working conditions, job performance and the occurrence of mental health problems in frontline personnel with regard to COVID-19.

Access to health services and its influence on adherence to treatment of arterial hypertension during the COVID-19 pandemic in a Hospital in Callao, Peru: A cross-sectional study.

Background: Access to health services compromises therapeutic adherence in patients with arterial hypertension (HTN), which is a risk factor for cardiovascular disease and premature death. The aim of the research is to determine the influence of access to health services on adherence to antihypertensive treatment during the COVID-19 pandemic. Methods: We included a cross-sectional analytical study. A survey was applied to 241 hypertensive patients at the Daniel Alcides Carrión Hospital, Callao-Peru. Data were analyzed using SPSS software. Absolute and relative frequencies were reported and the chi-square test was applied with a statistical significance level of p<0.05. In addition, multiple logistic regression analysis was performed using the Stepwise method. Results: Our results show that non-adherence to treatment is associated with health expenses (ORa: 1.9 CI 95% 1.7-2.2), considers the environment clean (ORa: 1.4 IC 95% 1.2-1.8), not receiving care due to lack of a doctor (ORa: 2.8 CI 95% 1.5-3.2), difficult with procedures (ORa: 2.8 IC 95% 1.2-2.8), having difficulty with schedules (ORa: 3.7 CI 95% 2. 3-5.5), fear of receiving care at the hospital (ORa: 4.5 CI 95 % 2.7-6.8), trust in health staff (ORa: 7.5 CI 95% 2.3-10.5) and considering that the physician does not have enough knowledge (ORa: 3.1 CI 95% 2.4-7.8). Conclusion: Therapeutic adherence was associated with expenses in the consultation considers the environment clean, not receiving care due to lack of a doctor, difficult with procedures, having difficulty with schedules, fear of receiving care at the hospital, trust in health staff and considering that the physician does not have enough knowledge.

Factors Associated with Mortality with Tuberculosis Diagnosis in Indigenous Populations in Peru 2015-2019.

OBJECTIVE: To identify factors associated with mortality in indigenous populations diagnosed with tuberculosis in Peru, 2015-2019. METHODS: We conducted a nested case-control study in a retrospective cohort using the registry of indigenous peoples of the National Health Strategy for TB Prevention and Control of the Ministry of Health of Peru. A descriptive analysis was performed, and then bivariate and multivariate logistic regression was used to evaluate associations between the variables and the outcome (alive-deceased). The results are shown as OR with their respective 95% confidence intervals. RESULTS: The mortality rate of the total indigenous population of Peru was 1.75 deaths per 100,000 indigenous people diagnosed with TB. The community of Kukama Kukamiria-Yagua reported 505 (28.48%) individuals, followed by the Shipibo-Konibo community with 385. The final logistic model showed that indigenous males (OR = 1.93; 95% CI: 1.001-3.7) with a history of HIV prior to TB (OR = 16.7; 95% CI: 4.7-58.7), and indigenous people in old age (OR = 2.95; 95% CI: 1.5-5.7) were factors associated with a greater chance of dying from TB. CONCLUSIONS: It is important to reorient health services among indigenous populations, especially those related to improving a timely diagnosis and early treatment of TB/HIV co-infection, to ensure comprehensive care for this population considering that they are vulnerable groups.

Criminalistic and criminological analysis of the Thomas Restobar case in Peru in the context of sanitary measures by COVID-19: A case study.

Background: The aim of this study was to collect and analyze the experiences in regard to the application of criminalistic and criminological protocols and procedures, which were used to carry out the intervention in the premises of Thomas Restobar in Peru, in the context of the declaration of sanitary measures to control COVID 19. This police intervention resulted in the death of 13 people. Methods: For the collection of information, we used the focus group technique, for which a script was designed and validated by five experts, considering six major subcategories: C1SC1: Joint investigation and prosecution work, C1SC2: Protocols and guidelines, C1SC3: Chain of custody (police, experts, and prosecutor), C1SC4: Quality of results; C2SC1: Participation of agents of Thomas Restobar and the municipality, C2SC2: Compliance with DIGESA-DIRIS health regulations. The study was approved by the Institutional Research Ethics Committee of the Universidad Norbert Wiener, with approval file N°864-2021. Results: From the criminological analysis it became evident that the deficiencies identified in the six structured subcategories have led to the tragic death of thirteen people from asphyxiation. The people who attended this bar did not comply with the sanitary norms, exposing the health and life of their relatives and other people. The security agents of the premises and of the Municipality of Los Olivos did not comply with the norms of supervision and control, which finally led to the unfortunate death of 13 people from asphyxiation, closely related to the case of Utopia, in 2002. Conclusions: When evaluated by the experts of the focus group, it has generated two emerging categories: creation of a School of Experts and the categorization of the experience, which would prevent cases like Utopia and Thomas Restobar from happening again.

Factors associated with scientific production of professors working at a private university in Peru: An analytical cross-sectional study.

Objective: To estimate the association between the academic, personal, and work characteristics and scientific production of professors at a private university of Lima, Peru, in 2021. Methods: We undertook an observational, analytical, and cross-sectional study. The sample included 322 professors through simple random sampling. Two questionnaires were administered. The first gathered personal, academic, and work characteristics; while the second evaluated scientific production. The chi-squared test was used, with a significance level of p<0,05, to evaluate the association between the different characteristics and scientific production. A multiple logistic regression was analyzed through the Stepwise method to evaluate the relationship between the variables of exposure and scientific production. We calculated prevalence ratios (PRs) with their respective 95% confidence intervals (95% CI). Results: We analyzed 322 professors, 59,6% were male. Scientific production was associated with being registered in Renacyt (PR = 5,52; 95% CI: 2,14 to 4,23; p = <0.001), having a doctoral degree (PR = 2,45; 95% CI: 1,60 to 3,85; p = <0.001), having been a thesis advisor (PR = 3,83; 95% CI: 1,45 to 5,66; p = <0.001), having facilities to conduct research at the workplace (PR = 1,58; 95% CI: 1,12 to 2,47; p = 0.006), and having received training by the university (PR = 1,99; 95% CI: 1,55 to 2,56; p =0.001). Conclusions: Scientific production was associated with being registered in Renacyt, having a doctoral degree, having been a thesis advisor, having facilities to conduct research at the workplace, and having being trained in research by the university. Hence, evaluation systems and the monitoring of university quality standards should be strengthened. In addition, it is necessary to undertake wider scope studies in order to enhance the strategies that promote professors' research.

Factors associated with knowledge, attitudes and preventive practices towards COVID-19 in health care professionals in Lima, Peru.

Background: Nowadays, we are facing a disease caused by SARS-CoV-2, known globally as COVID-19, which is considered a threat to global health due to its high contagiousness and rapid spread. Methods: Analytical cross-sectional study in 302 health professionals. An online questionnaire consisting of questions about knowledge, attitudes and practices (KAP) towards COVID-19 was applied. Socio-demographic, occupational and comorbidities factors were explored. Simple and multiple logistic regression models were used to identify factors associated with KAP. Results: Of the total, 25.2%, 31.5% and 37.4% had high levels of knowledge, preventive practices and risk perception attitudes respectively. Being married (aOR=6.75), having a master's degree (aOR= 0.41), having a working day with less than ten hours (ORa=0.49) and obesity (aOR=0.38) were associated with a low level of knowledge of COVID-19. The variables associated with preventive practices were being over the age of 50 (aOR=0.52), working in the hospitalization area (aOR=1.86) and having comorbidities such as arterial hypertension (aOR=0.28) and obesity (aOR=0.35). In relation to negative attitudes towards COVID 19, it was found that physical contact with patients with a confirmed diagnosis (aOR=1.84) and having asthma (aOR=2.13) were associated with these attitudes. Conclusion: Being married, having a master's degree, working less than ten hours were associated with having a low level of knowledge of COVID-19. Being older than 50, working in the hospitalization area were associated with preventive practices. Physical contact with COVID-19 patients was associated with negative attitudes.

Factores asociados al estigma en personas afectadas por tuberculosis en una región peruana de alto riesgo / Factors associated to stigma in people with tuberculosis from a high-risk region in Peru

Introducción: El estigma hacia los afectados por tuberculosis es un desafío importante para el control de la enfermedad. De ahí la necesidad de conocer los factores que lo desencadenan, ya que puede comprometer la adherencia al tratamiento y, por tanto, incremento de complicaciones y mortalidad. Objetivos: Determinar los factores asociados al estigma en personas afectadas por tuberculosis en una región de alto riesgo en el Perú. Métodos: Estudio correlacional en 110 pacientes tratados por tuberculosis. Los factores fueron la funcionalidad familiar medida con la escala de Apgar familiar; las características sociodemográficas y clínicas, los conocimientos sobre la enfermedad y la comunicación médico-paciente, a través de una encuesta. Para el estigma se utilizó la escala de Yang. En el análisis bivariado se utilizó la prueba de chi cuadrado. La relación entre variables se evaluó mediante la correlación de Pearson y la regresión lineal multivariada. Resultados: El nivel de estigma mostró un punto de corte (cutt off) ≥ 9 en 21,3 por ciento en tuberculosis sensible y 69,4 por ciento en tuberculosis multirresistente, con diferencias significativas (p = 0,000). El análisis de regresión lineal multivariado evidenció que el nivel bajo de conocimientos sobre la tuberculosis (ß = -0,32; p = 0,000), bajas puntuaciones en escala Apgar familiar (ß = -0,41; p = <0,000) y la baja comunicación médico-paciente (ß = -0,47; p = 0,000) se asociaron negativamente con estigma. Conclusiones: Se encontró un nivel alto de estigma relacionado con tuberculosis y una asociación negativa entre el estigma con el nivel de conocimientos sobre la enfermedad, la funcionalidad familiar y la comunicación con el médico.(AU)

Introduction: The stigma attached to people with tuberculosis is an important challenge posed to the control of this disease. Hence the need to know what factors trigger it, for they may affect adherence to treatment, increasing complications and mortality. Objectives: Determine the factors associated to stigma in people with tuberculosis from a high-risk region in Peru. Methods: A correlational study was conducted of 110 patients treated for tuberculosis. The factors analyzed were family function as gauged by the Family Apgar scale, sociodemographic and clinical characteristics, knowledge about the disease and doctor-patient communication as measured through a survey. Stigma was determined by Yang's scale. Bivariate analysis was based on the chi-square test, whereas the relationship between variables was evaluated by Pearson's correlation and multivariate linear regression. Results: The level of stigma showed a cut off value ≥ 9 in 21.3 percent in sensitive tuberculosis and 69.4 percent in multiresistant tuberculosis, with significant differences (p = 0.000). Multivariate linear regression analysis found that a low level of knowledge about tuberculosis (ß = -0.32; p = 0.000), low scores on the Family Apgar scale (ß = -0.41; p = <0.000) and poor doctor-patient communication (ß = -0.47; p = 0.000) were negatively associated to stigma. Conclusions: The study found a high level of stigma associated to tuberculosis, as well as a negative association between stigma and knowledge about the disease, family function and communication with the doctor(AU)

Factors related to depression in older adults during the COVID-19 pandemic in two coastal regions of Peru: An analytical cross-sectional study.

Background: Mental health problems such as anxiety, depression and their aggravation have been studied extensively in the general population. However, there are few studies on depression in older adults and the few existing results may be contradictory, especially in the context of the COVID-19 pandemic. The aim of this study is to determine the factors associated with depression in older adults in two coastal regions of Peru during the COVID-19 pandemic. Methods: This study uses an analytical cross-sectional design in a population of older adults, who participated in a non-governmental ambulatory social support program in Callao and Ica, two coastal regions of Peru. We administered an on-site structured questionnaire to record sociodemographic data, the Geriatric Depression Scale by Yesavage to measure depression, and the Barthel Index to assess physical function. In order to determine cognitive impairment as an exclusion criterion, the MEC-30 was used. The association between variables was assessed through contingency tables, using the odds ratio (OR) with its corresponding confidence interval (95% CI) and the X2 test. Finally, a binary logistic regression analysis was performed. Results: Out of the 244 older adults surveyed, 39% had depressive symptoms, of which 28.3% (n=69) and 10.7% (n=26) were moderately and severely depressive, respectively. The findings significantly associated with the presence of depressive symptoms were being 76 years old or older [p=0.005, OR: 2.33, 95% CI: 1.29-4.20], not participating in weekly recreational activities [p=0.004, OR: 2.28, 95% CI: 1.31-3.99] and the presence of comorbidities [p=0.026, OR: 1.88, 95% CI: 1.07-3.29]. Conclusion: There are few studies exploring depression in older adults during the COVID-19 pandemic; this research shows the importance of mental health care in this population and, particularly, of those who are 76 or older because they suffer from comorbid conditions and have interrupted recreational activities.

Tracheostomy During the COVID-19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries.

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. DATA SOURCES: Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. REVIEW METHODS: The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. CONCLUSIONS: Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. IMPLICATIONS FOR PRACTICE: Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.

Determinantes del acceso a los servicios de salud y adherencia al tratamiento de la tuberculosis / Determinants of the access to health services and adherence to TB treatment

Introducción: El papel fundamental de un sistema de salud es responder a las necesidades de la población, lo cual implica desarrollar mecanismos que permitan una prestación integral, accesible y equitativa a sus servicios. Objetivos: Valorar las barreras de acceso a la atención de salud y la adherencia en pacientes con tuberculosis en una región de alta carga en el Perú. Métodos: Investigación de enfoque mixto, realizada en el periodo de enero a septiembre del 2018 en 120 pacientes con tuberculosis. Para el enfoque cuantitativo se realizó un estudio transversal analítico, donde se abordaron preguntas de acceso a servicios de salud utilizando el modelo de Tanahashi. La adherencia al tratamiento fue medida a través del test de Morisky-Green. Para el diseño cualitativo se utilizó la metodología de grupos focales con 30 pacientes para profundizar sus experiencias acerca de los determinantes de acceso. Resultados: La mayoría de las barreras se identificaron en las dimensiones: aceptabilidad, contacto y disponibilidad. Se encontró asociación entre la adherencia al tratamiento y los siguientes indicadores: el temor o vergüenza de atenderse en un servicio de salud, desconfianza con los equipos de salud, percepción de mala calidad de la atención, falta de conciencia de la enfermedad, efectos secundarios de los medicamentos el número y tamaño de las píldoras. Conclusiones: Los hallazgos del presente estudio sugieren la existencia de barreras contextuales y del sistema de salud que impiden el acceso a los pacientes con tuberculosis, y si estas no se tienen en consideración podrían dificultar la adherencia del tratamiento para tuberculosis. Sin embargo, conseguir actuar dentro de una lógica que privilegie una asistencia centrada en el paciente, considerando sus singularidades y autonomía frente al proceso terapéutico puede tornarse una tarea difícil para los servicios de salud donde la demanda supera los recursos y su estructura(AU)

Introduction: The fundamental role of a health system is to respond to the needs of the population, which involves developing mechanisms that enable a comprehensive, accessible and equitable delivery of its services. Objectives: Assess access barriers to health care and adherence in TB patients in a high-burden region of Peru. Methods: Mixed-approach research conducted in the period January to September 2018 in 120 TB patients. For the quantitative approach, an analytical cross-sectional study was conducted, where questions on access to health services were addressed using the Tanahashi model. Adherence to treatment was measured through the Morisky-Green test. For qualitative design, the focus group methodology with 30 patients was used to deepen in their experiences of access determinants. Results: Most barriers were identified in the following dimensions: acceptability, contact and availability. An association was found between adherence to treatment and the following indicators: the fear or shame of being attended in a health service, mistrust with health teams, perception of poor quality of care, lack of awareness of the disease, side effects of medications, the number and size of the pills. Conclusions: The findings of this study suggest contextual and health system barriers that prevent access to TB patients, and if these are not taken into account, they could hinder adherence to TB treatment. However, acting within a logic that favors patient-centered care, considering its uniqueness and autonomy from the therapeutic process can become a difficult task for health services where demand exceeds the resources and their structure(AU)

Situación de la tuberculosis en el Perú / Tuberculosis in Peru: current status

Cada año se registran 220 000 nuevos casos de tuberculosis en la Región de las Américas y mueren mas de 50 000 personas a consecuencia de esta enfermedad. Uno de los aspectos más importantes y fascinantes en relación a la tuberculosis, es que es una enfermedad 100 por ciento curable y prevenible, sin embargo se ha convertido en la infección trasmisible más importante en los seres humanos. En el Perú una comprensión cabal de la situación de la epidemia de la tuberculosis en el país, permite aplicar eficazmente las herramientas disponibles para su control, incrementando la eficiencia de las intervenciones habiendosé logrado considerables progresos en prevención y control de la tuberculosis, asi en el año 1992 se notificaron en total mas de 55 mil casos, mientras que el 2007, se ha logrado reducir esta cifra en 32,7 por ciento, la meta al 2011 es disminuir el número de casos en 50 por ciento. Tambien se ha mejorado e incrementado la la capacidad diagnostica de TB MDR Y TB XDR. No obstante, tanto la TB MDR, TB XDR, la comorbilidad TB/VIH-SIDA, el estigma, la discriminación y lo complicado de las intervenciones técnicas, socioeconómicas y culturales, significan un reto para el mejoramiento. El 58 por ciento de casos de TB, 82 por ciento de casos de TB MDR y 93 por ciento de casos de TB XDR son notificados por Lima y Callao. El primer caso de TB XDR1,2 , fue notificado el año de 1999 y hasta agosto del 2008 se han notificado 186 casos acumulados, de los cuales el 85 por ciento se concentran en los distritos de La Victoria, Lima Cercado, San Martin de Porres, San Juan de Lurigancho, Ate, Santa Anita y El Agustino.

Each year, 220 000 new cases of tuberculosis (TB) are diagnosed in the Americas, and more than 50 000 persons die every year as a consequence of this disease. One of the most important and fascinating aspects with respect to TB is that it is a one hundred per cent curable and preventable disease; however, it has become the most important transmissible disease for human beings. In Peru, a thorough understanding of the tuberculosis epidemics allows us to efficaciously apply the available tools for TB control, and the usefulness of interventions is increased, having achieved considerable progress made in TB prevention and control. In 1992, more than 55,000 cases of TB were notified, and this figure has had a 32.7 per cent reduction for 2007. The goal for year 2011 is to achieve a 50 per cent reduction in the number of cases of TB. The diagnostic capacity for multidrug resistant TB (MDR-TB) and extremely drug resistant TB (XDR-TB) has also been improved and increased. Nevertheless, MDR-TB, XDR-TB, TB/HIV-AIDS, stigma, discrimination, and complicated technical, socioeconomic, and cultural interventions mean a great challenge for us to fulfill. 58 per cent of all cases of TB, 82 per cent of MDR-TB and 93 per cent of XDR-TB cases have been reported by Lima and Callao. The first case of XDR-TB was reported in 1999, and up to August 2008, the cumulative case toll is 186, and 85 per cent of them are concentrated in la Victoria, downtown Lima, San Martin de Porres, San Juan de Lurigancho, Ate, Santa Anita, and El Agustino districts.

Situación de la tuberculosis en el Perú: Informe de gestión / TB situation in Peru: Management Report

El presente documento considera como una prioridad sanitaria nacional, la tuberculosis en el Perú, debido a que la tuberculosis es una enfermedad endémica y afecta a nuestra población pobre y extremadamente pobre que es la de mayor vulnerabilidad, mermando su calidad de vida, contribuyendo a perpetuar el ciclo de pobreza ecxistente

Situación de la tuberculosis en el Perú: Informe de gestión / TB situation in Peru: Management Report

El presente documento considera como una prioridad sanitaria nacional, la tuberculosis en el Perú, debido a que la tuberculosis es una enfermedad endémica y afecta a nuestra población pobre y extremadamente pobre que es la de mayor vulnerabilidad, mermando su calidad de vida, contribuyendo a perpetuar el ciclo de pobreza ecxistente(AU)

Evaluación de la broncofibroscopía flexible en el Hospital Nacional Daniel Alcides Carrión Callao junio-octubre 2000 / Evaluation of the flexible broncofibroscopy in the Hospital Nacional

Se realizó estudio descriptivo prospectivo para evaluar la utilidad de la broncofibroscopia en el diagnóstico de las enfermedades neumológicas prevalentes en nuestro medio. Se realizaron 141 broncofibroscopias. Resultados bacteriológicos: de 84 pacientes (con sospecha de TBC) resultaron 20 pacientes (23.8 por ciento) con baciloscopias positivas; de 48 muestras para cultivo de gérmenes comunes se identificaron: pseudomonas 20 muestras (46.5 por ciento), estreptococos 08 muestras (18.6 por ciento), estafilococos 04 muestras (9.3 por ciento), Neisseria 03 muestras (7 por ciento), y 08 muestras (18.4 por ciento) de otros gérmenes y en examen para hongos, de 71 muestras se obtuvo 04 (5.6 por ciento) cultivos positivos (3:candida albicans, 1:aspergillus fumigatus). Resultados citológicos: En 36 pacientes se realizó papanicolao (PAP) en 5 (13.9 por ciento) se evidenciaron células sospechosas de neoplasia. Resultados histológicos: En 86 pacientes se realizaron biopsias; los resultados fueron bronquitis crónica 43 (46.7 por ciento), Inflamación crónica 15 (16 por ciento), bronquitis aguda 07 (7.6 por ciento), metaplasia epidermoide 07 (7.6 por ciento, granuloma tuberculosos 02 (2.2 por ciento) y otros más. Conclusiones: Se demostró la importancia del uso de la broncofibroscopia flexible en el diagnóstico de enfermedades infecciosas en nuestro medio, siendo el mayor aporte en la detección precoz de la TBC posibilitando su tratamiento con los mas importantes beneficios epidemiológicos, sin dejar de mostrar su aporte importante en el diagnóstico de neoplasias pulmonares.