Longitudinal Relationships Between Depressive Symptoms and Generalized Anxiety Symptoms in Adolescents: A Cross-Lagged Network Analysis.

The comorbidity of depression and generalized anxiety have raised questions about the existing classification system. Based on the perspective of network analysis, the developmental relationship between psychological symptoms can be explored more clearly. The current study aimed to explore the longitudinal network association of depressive symptoms and generalized anxiety symptoms in non-clinical adolescents. The sample contained 1,947 Chinese adolescents (Mage = 13.93, SD = 1.71; 48.5% girls). Their depression (PHQ-9) and generalized anxiety (GAD-7) symptoms were assessed at baseline (T1) and 6-month follow-up (T2). Data was analyzed using a cross-lagged network analysis. Depressive symptoms and generalized anxiety symptoms were closely related and did not appear to be distinct categories in adolescence. More generalized anxiety symptoms predicted depressive symptoms rather than vice versa. After controlling for gender, and age, "Difficulty relaxing" presented the highest out-expected influence (out-EI) in the network, while "trouble concentrating", and "suicidal ideation" showed the lowest in expected influence (in-EI). Findings suggested that interventions for generalized anxiety symptoms may help reduce depressive symptoms among Chinese adolescents. Specifically, alleviating "difficulty relaxing" may improve overall mental health.

[Electroacupuncture intervention improves lipid metabolism and promotes browning of white adipose tissue by activating AMPK/Sirt1 pathway and up-regulating Nrg4 content in middle-aged and aged obese rats].

OBJECTIVE: To investigate the mechanism of electroacupuncture （EA） in promoting the browning of white adipose tissue in middle-aged and aged obese rats induced by high fat by regulating AMP-activated protein kinase （AMPK） /silence-information regulatory factor 1 （Sirt1） pathway and neuregulin 4 （Nrg4）. METHODS: Twenty-four male SD rats were randomized into blank control, model and EA groups （n=8 per group）. The obesity model was established by feeding the rats with high-fat diet for 6 weeks. For the EA group, EA （2 Hz/15 Hz, 1.5 mA） was applied to "Guanyuan" （CV4） and bilateral "Shenshu" （BL23）, "Fenglong" （ST40） and "Tianshu" （ST25） for 20 min, once a day, 5 days a week for 6 weeks. Rats of the blank control and model groups were also restrained for 20 min. The body mass and food intake were measured every week, and the Lee's index, epididymal fat, perirenal fat and brown adipose tissue were weighed. The contents of serum total cholesterol （TC）, triglyceride （TG）, high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C） and norepinephrine （NE） were determined by ELISA. H.E. staining was used to observe the morphological changes of white and brown adipose tissue. The mRNA expression levels of mitochondrial uncoupling protein 1 （UCP1）, peroxisome proliferator activated receptor γ co-activator 1α （PGC-1α）, PR-domain protein 16 （PRDM16）, peroxisome proliferator activated receptor γ （PPARγ） and Nrg4 in the adipose tissue were detected by quantitative real time PCR, and the protein expression levels of Nrg4, AMPKα, Sirt1 and interleukin-6 （IL-6） in the white and brown adipose tissue were detected by Western blot. RESULTS: Compared with the blank control group, the body mass, food intake, the Lee's index, epididymal fat and perirenal fat mass, and serum TG, TC and LDL-C contents and the expression level of IL-6 protein were significantly increased （P<0.01, P<0.05, P<0.001）, and the brown adipose mass, serum HDL-C and NE contents, the expression levels of UCP1, PGC-1α, PRDM16, PPARγ and Nrg4 mRNAs, and the protein expression levels of AMPKα, Sirt1 and Nrg4 proteins in both white and brown adipose tissues were significantly decreased in the model group （P<0.01, P<0.05）. After EA intervention, the increased levels of body mass, food intake, Lee's index, epididymal fat and perirenal fat mass, serum TG, TC and LDL-C contents, and the expression of IL-6 protein, and the decreased levels of brown adipose mass, serum HDL-C and NE contents, expression levels of UCP1, PGC-1α, PRDM16, PPARγ and Nrg4 mRNAs, and those of AMPKα, Sirt1 and Nrg4 proteins in both white and brown adipose tissues were apparently reversed（P<0.05, P<0.01, P<0.001）. H.E. staining showed an increase of the volume and content of intracellular vacuoles of both white and brown adipose tissues, disordered arrangement of cells with vague boundary in the model group, which was relatively milder including a decrease of volume and content of vacuoles of both white and brown adipose, neat arrangement of cells with clear boundary. CONCLUSION: EA intervention can improve lipid metabolism and promote white adipose tissue browning in middle-aged and aged obese rats, which is possibly associated with its functions in activating AMPK/Sirt1 signaling pathway and up-regulating the level of Nrg4.

Factores asociados al trastorno depresivo en adultos mayores peruanos

Objetivo: Determinar la prevalencia y los factores asociados con el trastorno depresivo en adultos peruanos mayores de 60 años. Materiales y métodos: Se realizó un estudio observacional, analítico y transversal a partir de un análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2019, aplicada con un alcance nacional por el Instituto Nacional de Estadística e Informática del Perú (INEI). La muestra fue de 4174 adultos mayores. Se consideró como variable principal el padecer de trastorno depresivo (con depresión/sin depresión) y como variables independientes, edad, sexo, grado de instrucción, quintil de riqueza (clasificado en cinco niveles de riqueza), área de residencia (clasificada como urbano y rural), dominio geográfico (clasificado como Lima Metropolitana, resto de la Costa, Sierra y Selva), cobertura de salud (clasificada como sin cobertura y con cobertura), consumo de alcohol (sí/no), hábito de fumar (sí/no) y presencia de discapacidad (sí/no). Se realizaron análisis de frecuencias absolutas y relativas, diferencias de proporciones y un análisis multivariado mediante modelos lineales generalizados. Resultados: La prevalencia del trastorno depresivo fue del 13,18 % y de la discapacidad, 7,86 %. Los adultos mayores de sexo masculino tuvieron menos probabilidades de padecer trastorno depresivo (RPa = 0,602; IC 95 %: 0,513-0,706) que las mujeres, así como los integrantes del grupo etario de mayores de 85 años presentaron mayor riesgo que los de 60 a 74 (RPa = 1,664; IC 95 %: 1,304-2,124). Además, el no padecer de alguna discapacidad se comportó como un factor preventivo (RPa = 0,542; IC 95 %: 0,440-0,668), mientras que un mayor grado de instrucción y quintil de riqueza, desde el quintil "medio", indicaron también ser factores de protección al tomarse como referencia las categorías "sin educación" y "los más pobres", respectivamente (p < 0,005). Conclusiones: El pertenecer al grupo de mayores de 85 años, del sexo femenino, de bajos quintiles de riqueza, padecer de alguna discapacidad y tener un menor grado de instrucción constituyen factores de riesgo para el trastorno depresivo en adultos mayores peruanos.

Objective: To determine the prevalence and factors associated with depressive disorder among Peruvian older adults over 60 years of age. Materials and methods: An observational, analytical and cross-sectional study was conducted based on a secondary analysis of the 2019 Encuesta Demográfica y de Salud Familiar (ENDES National Demographic and Family Health Survey), administered at national level by Instituto Nacional de Estadística e Informática del Perú (INEI National Institute of Statistics and Informatics of Peru). The sample consisted of 4,174 older adults. The main variable was suffering from a depressive disorder (depressed/not depressed) and the independent variables were age, sex, educational level, wealth quintile (classified into five levels of wealth), area of residence (classified as urban/rural), geographic domain (classified as Lima Metropolitan Area, the rest of the coast, the highlands and the jungle), health coverage (classified as insured/uninsured), alcohol consumption (yes/no), smoking (yes/no) and presence of a disability (yes/no). Analyses of absolute and relative frequencies, differences in proportions and a multivariate analysis using generalized linear models (GLM) were performed. Results: The prevalence of depressive disorder and disability accounted for 13.18 % and 7.86 %, respectively. Older males were less likely to suffer from a depressive disorder (PRa = 0.602; 95 % CI: 0.513-0.706) than females, and the group over 85 years of age showed a higher risk than those from 60 to 74 years (PRa = 1.664; 95 % CI: 1.304-2.124). Besides, not presenting a disability behaved as a preventive factor (PRa = 0.542; 95 % CI: 0.440-0.668), while a higher educational level and wealth quintile, starting from the "Middle" quintile, were protective factors when taking the categories "No education" and "The poorest" as reference, respectively (p < 0.005). Conclusions: Belonging to the group over 85 years of age, being a female, being in lower wealth quintiles, suffering from a disability and having a lower educational level were risk factors for depressive disorder among Peruvians older adults.

Asociación entre vacunación completa y anemia en niños menores de 5 años, del Perú, en los años 2019 a 2021 / Association between complete vaccination and anemia in children under 5 years of age, in Peru, in the years 2019 to 2021

Objetivo: Determinar la relación entre vacunación completa y anemia en niños menores a 5 años en los años 2019, 2020 y 2021. Materiales y métodos: Estudio transversal, de análisis secundario de la Encuesta Demográfica y de Salud Familiar (ENDES) proporcionada por el Instituto Nacional de Estadística e Informática (INEI) para los años 2019, 2020 y 2021. Se realizaron estimaciones respecto a la tenencia y nivel de anemia en los niños menores de 5 años, tomando como variable principal que los niños se encuentren al día en sus vacunas, según su edad en meses. La vacunación está en función a la Resolución Ministerial Nº 719-2018/MINSA y el periodo de estudio fue entre los años 2019 al 2021. Se describieron las frecuencias y medias de las variables de interés y luego se realizó un análisis bivariado de tipo Logit; finalmente se estimó un análisis ajustado aplicando un modelo de Poisson. Resultados: Se puede observar que, en el año 2019, la magnitud que tiene la inmunización completa, tanto a nivel individual como colectivo, es mayor a los años posteriores. De esta premisa se desprende la conclusión principal, la cual indica que existe asociación entre vacunación completa y probabilidad de anemia en menores a 5 años. Conclusiones: El presente estudio muestra que la vacunación en menores de 5 años reduce significativamente la probabilidad de anemia. Es necesario diseñar nuevas estrategias que permitan garantizar la cobertura de vacunación en la población infantil, dado que previene enfermedades entre ellas la anemia.(AU)

The present study consists of observing the relationship between immunizations and anemia in children under 5 years ofage. Anemia is a public health problem worldwide and LatinAmerica is no exception. Particularly, for the Peruvian case,approximately one third of children under 5 years of age present this disease. The consequences vary depending on thedegree of anemia that occurs; Mild anemia being the mostcommon case among minors. In order to combat anemia, thePeruvian Ministry of Health proposes various actions, including vaccination against rotavirus and pneumococcus as someof them. From this perspective, the question arises if there isa relationship between immunization and anemia. For this,taking information from the Demographic Survey of FamilyHealth (ENDES), estimates are made regarding the possession and level of anemia in children under 5 years of age, taking as the main variable that children are up to date with theirvaccinations, according to their age in months. Vaccination isbased on Ministerial Resolution No. 719-2018/MINSA and the study period is from 2019 to 2021, considering the year inwhich the pandemic began.It can be seen that in 2019, the magnitude of complete immunization, both individually and collectively, is greater thanin subsequent years. From this premise the main conclusioncan be drawn, which indicates that there is an inverse association between complete immunization and the tenure ofanemia in children under 5 years of age.(AU)

Vigilancia de la situación del sobrepeso, obesidad y sus determinantes en el marco del Observatorio de Nutrición y estudio del sobrepeso y obesidad. Informe técnico 2023 / Monitoring of the situation of overweight, obesity and its determinants within the framework of the Nutrition Observatory and study of overweight and obesity. Technical report 2023

La presente publicación describe el análisis de la situación nutricional de la población peruana, con énfasis en los indicadores de sobrepeso y obesidad en niñas, niños y adolescentes. El presente informe tiene como fuentes de Información la Encuesta Demográfica y de Salud Familiar-ENDES del INEI (2007-2022), el Sistema de Información de Estado Nutricional SIEN-HIS (2009-2022) y los resultados de las Encuestas de Vigilancia Alimentaria y Nutricional por Etapas de Vida (2015-2021) realizado por el Instituto Nacional de Salud, a través del Centro Nacional de Alimentación, Nutrición y Vida Saludable-CENAN

Caracterización de las mujeres mediante variables obstétricas, según Robson / Characterization of women through obstetric variables, according to Robson / Caracterização da mulher por meio de variáveis obstétricas, segundo Robson

En los últimos tiempos, la praxis de la cesárea en los centros hospitalarios se ha incrementado notablemente, el cual es ha sido corroborado según fuentes del INEI, por su parte, la OMS estandarizó que la variabilidad máxima es el 15%, superado aquello genera un grave problema al estado en cuestiones económicos, para constatar la problemática se tuvo en cuenta el objetivo de caracterizar a las mujeres de parto por cesárea a través de variables obstétricas desde la perspectiva de Robson, por lo que la investigación correspondió al enfoque cuantitativo, tipo no experimental y diseño descriptivo, la muestra representada por 1365 mujeres registradas en el base de datos correspondientes al 2019. El análisis de los resultados obedeció al método inductivo-deductivo, la misma que permitió diferenciar la tasa global de cesárea, el modelo de Robson mostró como resultado el 53%, cifra que supera en 38% a lo que establece la OMS, mientras que los grupos con mayor contribución a la tasa global de cesáreas fueron los grupos: 5, 1, 3 y 10. Finalmente, se concluye que la mayor cantidad de las mujeres han sido sometida al parto por cesárea, siendo mayor la tasa global durante el año indicado, en consecuencia generó mayor gasto al estado, exigiendo incrementar presupuesto al sector salud, cabe precisar que existe la posibilidad de controlar a través de la inducción a las mujeres embarazadas para el parto vaginal aplicación de los métodos y técnicas eficaces que permitan generar confianza a la mayor población de mujeres gestantes.

In recent times, the practice of cesarean section in hospital centers has increased notably, which has been corroborated according to INEI sources, on the other hand, the WHO standardized that the maximum variability is 15%, exceeding this generates a serious problem for the state in economic matters, In order to verify the problem, the objective of characterizing women who give birth by cesarean section through obstetric variables from Robson's perspective was taken into account, so the research corresponded to the quantitative approach, non-experimental type and descriptive design, the sample represented by 1365 women registered in the database corresponding to 2019. The analysis of the results obeyed the inductive-deductive method, the same that allowed differentiating the global rate of cesarean section, Robson's model showed as a result 53%, a figure that exceeds by 38% what the WHO establishes, while the groups with the highest contribution to the global rate of cesarean section were the groups: 5, 1, 3 and 10. Finally, it is concluded that most women have been subjected to cesarean delivery, being higher the overall rate during the year indicated, consequently generated greater expenditure to the state, requiring increased budget to the health sector, it should be noted that there is the possibility of controlling through the induction of pregnant women for vaginal delivery application of effective methods and techniques to generate confidence to the largest population of pregnant women.

Nos últimos tempos, a prática da cesárea nos centros hospitalares tem aumentado notavelmente, o que tem sido corroborado de acordo com fontes do INEI, enquanto a OMS padronizou que a variabilidade máxima é de 15%, o que gera um grave problema para o Estado em questões econômicas, A fim de verificar o problema, foi levado em conta o objetivo de caracterizar as mulheres que dão à luz por cesárea através de variáveis obstétricas da perspectiva de Robson, de modo que a pesquisa correspondeu à abordagem quantitativa, tipo não experimental e desenho descritivo, a amostra representada por 1365 mulheres registradas no banco de dados correspondente a 2019. A análise dos resultados obedeceu ao método indutivo-dedutivo, que nos permitiu diferenciar a taxa geral de cesárea, o modelo de Robson mostrou um resultado de 53%, que é 38% maior do que o estabelecido pela OMS, enquanto os grupos com maior contribuição para a taxa geral de cesárea foram os grupos 5, 1, 3 e 10. Finalmente, conclui-se que a maioria das mulheres passou por cesarianas, sendo a taxa geral mais alta durante o ano em questão, e como resultado, o Estado gastou mais dinheiro, exigindo um aumento no orçamento do setor de saúde. Deve-se notar que é possível controlar as mulheres grávidas através da indução ao parto vaginal, aplicando métodos e técnicas eficazes que gerarão confiança na população maior de mulheres grávidas.

A randomized split-face comparative study of long-pulsed alexandrite plus low-fluence Nd:YAG laser versus pulsed-dye laser in the treatment of rosacea.

OBJECTIVES: To compare the effectiveness of long-pulsed alexandrite laser (LPAL) with that of pulsed-dye laser (PDL) for rosacea. METHODS: This was a single-blind randomized controlled trial on 27 patients who were clinically diagnosed with rosacea. Randomly assigned split face in each patient received four times monthly treatment of LPAL plus low-fluence Nd:YAG with the contralateral side serving as the control treated with PDL. At every visit, the erythema index (EI) was measured with skin analysis systems, and two independent dermatologists evaluated digital photographs for five-point global aesthetic improvement scale (GAIS). RESULTS: The EI significantly decreased on both treated sides (LPAL 366.5 ± 101.0 vs. 295.8 ± 90.2, p < 0.001, PDL 369.0 ± 124.3 vs. 302.7 ± 92.1, p < 0.001) 1 month after fourth treatment (visit 5). Also 3 months after the fourth treatment (visit 6), the reduction in the EI was well maintained on both sides (LPAL 360.3 ± 96.8 vs. 282.0 ± 89.2, p < 0.001, PDL 364.3 ± 121.6 vs. 281.6 ± 97.8, p < 0.001). When comparing the improvement in the EI between the two groups, the percentage reduction in the EI on the LPAL-treated side was not inferior to the PDL-treated side (visit 5: LPAL 18.7 ± 15.7% vs. PDL 16.4 ± 12.9%, p = 0.501 and visit 6: LPAL 21.7 ± 13.9% vs. PDL 21.9 ± 15.2%, p = 0.943). The GAIS and patient satisfaction were comparable between the LPAL and PDL sides and did not show any significant difference. No serious adverse events occurred on either of the treated sides. CONCLUSION: This study showed that the decrease in EI in the treatment of rosacea was comparable between PDL and LPAL. Therefore, LPAL could be a promising alternative treatment option with good merits for rosacea, considering no consumables are required for device maintenance.

Boletín Epidemiológico Nacional N°622 Semana 40 / National Epidemiological Bulletin No. 622 Week 40

Este boletín contiene información de Viruela símica, vigilancia de dengue y otros arbovirus, Infecciones respiratorias agudas, caracterización de virus influenza en el laboratorio nacional de referencia, INEI ANLIS-Carlos Malbrán y resurgimiento de Cólera en Haití: recomendaciones para la vigilancia en Argentina

Motivo de consulta y tiempo de espera en establecimientos de salud públicos durante la pandemia por COVID-19, Perú 2020

Objetivo: Identificar si el motivo de atención se asocia al tiempo de espera en estabecimientos de salud públicos durante la pandemia por COVID-19, según análisis de la ENAHO 2020. Materiales y Métodos: Estudio no experimental de tipo transversal con análisis secundario de datos de la ENAHO del Instituto de Estadística e Informática (INEI) del año 2020. Para el análisis, respecto al motivo de acudir al establecimiento de salud, se consideraron síntomas compatibles con COVID-19 y otros síntomas agudos. Resultados: Se realizó el análisis de 1363 personas encuestadas. En el modelo de regresión multivariado ajustado, las variables asociadas significativamente a mayor tiempo de espera fueron sexo femenino (RP: 2,97; IC: 1,09 - 1,54), acudir a establecimiento de MINSA (RP:2,18; CI: 1,02 - 1,59) y ser atendido por personal médico (RP: 6,52; IC: 1,53 - 2,21). No se encontró asociación entre motivo de consulta y tiempo de espera. Conclusiones: Entre las variables que presentan asociación con mayor tiempo de espera, se encuentra sexo femenino, establecimiento MINSA y ser atendido por médico.

Objective: Identify whether the reason for care influences the waiting time in the health facility in the PeruvianpopulationduringtheCOVID-19 pandemic,according to analysis by ENAHO2020. Material and Methods: Crosssectional study with secondary analysis of data from the ENAHO of the Institute of Statistics and Informatics (INEI) done in year 2020. For the analysis, regarding the reason for going to the health facility, symptoms were considered compatible with COVID- 19 and other acute symptoms. Results: Data of 1363 participants were analyzed No association was found between reason for consultation and waiting time. In the multivariate analysis found an association with female sex (PR: 2,97; IC: 1,09 - 1,54), being attended in centers of Ministerio de Salud (MINSA) establishment (PR:2,18; CI: 1,02 - 1,59)) and be attended by a doctor (PR: 6,52; IC: 1,53 - 2,21). Conclusión: Variables that have association with longer waiting time were female sex, MINSA as establishment of attendance and profesional of attendane is the doctor.

First Report of Thread Blight Caused by Marasmius tenuissimus on Cacao (Theobroma cacao) in Peru.

Peru is the second largest producer of organic cocoa and one of the most important suppliers of fine aroma cocoa beans in the world (Sánchez et al. 2019). The fine aroma cocoa produced by smallholder farmers in the Bagua and Utcubamba Provinces, Amazonas Department, under the name of "Cacao Amazonas Peru", is protected by the Peruvian appellation rules (Díaz-Valderrama et al. 2020). Despite this importance, native diseases of the crop (Theobroma cacao) are poorly documented due to difficulty of access in this region. In November 2020 we conducted expeditions into Imaza District (4°47'09.4"S 78°16'51.6"W), a significant producer of fine aroma cocoa in terms of number of cultivated plots (4,651 out of 6,505 total in the Bagua Province) (INEI 2012). We visited 20 farms of < 2-ha in size; in 19 of these small farms, T. cacao trees were found infected with a white fungal thread blight and rhizomorphs covering branches and leaves. Disease incidence ranged from 90 to nearly 100%, and severity exceeded 80% on the eight farms with the most deficient phytosanitary management. Heavily infected leaves were hanging on branches by mycelial threads, harboring tiny (0.5 to 5.3 mm broad) white mushrooms. These symptoms and signs correspond to the thread blight disease constellation (TBD) of cacao caused by various species of Marasmius and Marasmiellus (Amoako-Attah et al. 2020). Mushrooms lacked a collarium, and their stipes were absent or rudimentary (< 2-mm long) and eccentric, consistent with Marasmius tenuissimus (Tan et al. 2009). Axenic cultures were obtained by surface sterilization of mycelium threads with 2% NaClO, rinsed three times in sterile water, plated on potato dextrose agar medium (PDA), and incubated for 7 days at 25°C. Hyphae was non-pigmented with clamp connections, consistent with the genus Marasmius. We extracted the DNA of isolate INDES-AFHP31 using the Wizard® Purification Kit (Promega Corp., Madison, Wisconsin) and sequenced the rDNA internal transcribed spacer 1 and 2 intervening the 5.8S subunit (ITS), and the 28S subunit (LSU) (Accession numbers: OM720123 and OM720135) according to Aime and Phillips-Mora (2005). The ITS and LSU sequences were 97.92 to 98.79% and 99.07 to 99.30% identical, respectively, with published sequences from M. tenuissimus from Ghana (Amoako-Attah et al. 2020). The pathogenicity test was conducted by inoculation of ten healthy cacao leaves with 7-day-old mycelium PDA discs of isolate INDES-AFHP31. An equal number of healthy cacao leaves were inoculated with PDA discs without mycelium as control. The observation of TBD symptoms and signs in the non-control set of cacao leaves starting at 3 days post inoculation, and the re-isolation of the same fungus from infected tissue confirmed its pathogenicity on cacao. Isolate INDES-AFHP31 was deposited as a dried culture into the herbarium Kuélap of the Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (voucher KUELAP-2251). Marasmius tenuissimus was originally reported from dead and living twigs and leaves of unidentified dicotyledonous trees from Indonesia, Brazil, and Bolivia (Singer 1976). However, it was first associated with TBD of cacao in Ghana in 2020, being the most frequently TBD-causing fungus isolated in the country (Amoako-Attah et al. 2020). Its discovery in 19 of the 20 surveyed cacao farms in Imaza District, Amazonas, Peru, reveals its importance as a cacao pathogen in the Western hemisphere.

Network Analysis of Depressive Symptomatology in Underweight and Obese Adults.

BACKGROUND: Depressive symptoms can affect people's quality of life and social environment. In addition, in severe situations, they can lead to suicidal behaviors. OBJECTIVE: This study aimed to analyze the differences in depressive symptoms in underweight and obese Peruvian adults. METHODS: A cross-sectional study was carried out based on secondary data obtained from the Instituto Nacional de Estadística e Informática (INEI), Lima, Peru. A sample of 10 053 participants was considered, of which 55.96% were women. Two Gaussian plot models were estimated and the levels of depressive symptomatology were compared between the 2 groups (adults with underweight and obese). RESULTS: A total of 1510 (15.02%) were underweight adults and 8543 (84.98%) were obese adults. There were differences in the reporting of depressive symptoms in the underweight group; the most central items were "Depressed mood" (PH2), "Tiredness/low energy" (PH4), and "Psychomotor difficulties" (PH8). CONCLUSION: This study provides new evidence on the dynamic relationship between depressive symptoms according to the body mass index categories (underweight and obese) assessed.

Predisposing and enabling factors associated with Venezuelan migrant and refugee women's access to sexual and reproductive health care services and contraceptive usage in Peru.

Objective: Over 6 million migrants and refugees from Venezuela have left their country in the past decade; 1 million of them reside in Peru. Venezuelan migrant and refugee women are known to have limited access to sexual and reproductive health care services (SRHS) and contraceptive usage. To date, research to understand factors influencing access to those services is limited. This study aims to determine which enabling and predisposing factors influence Venezuelan migrant and refugee women's access to SRHS and contraceptive usage. Methods: This is a retrospective cross-sectional study of the first survey administered to the Venezuelan population residing in the Peru in 2018. The survey covered six cities in the country (Metropolitan Lima, Callao, Tumbes, Cusco, Trujillo, Arequipa). The sample for the study included Venezuelan migrant women of reproductive age (15-49 years old). Anderson's Behavior Model of Health Services is the conceptual framework of the investigation. Logistic regression models were fit to examine the relationship between different predisposing and enabling factors and women's access to SRHS and contraceptive usage. Results: The sample size includes a total of 3378 Venezuelan women of reproductive age. 50.7% of the women were between the ages of 21-30 and over 90.6% of the sample were residing in Metropolitan Lima. Only 20.2% of the women reported they had access to modern contraceptives. Results from the study suggest having insurance, residing in Trujillo, and having a higher socio-economic status were associated with more access to certain sexual reproductive health care services and contraceptive usage. Conclusion: This study identified different predisposing and enabling factors relevant to the access to SRHS and contraceptive usage. Difference in access and usage are particularly pronounced based on insurance status, geographical location, and socio-economic status. Displaced Venezuelans will remain abroad for an extended period of time, if not permanently. Focus should shift from providing humanitarian aid to integrating the migrants and refugees, particularly the most vulnerable groups, into the local economic and healthcare system.

Analysis of Excess All-Cause Mortality and COVID-19 Mortality in Peru: Observational Study.

During the COVID-19 pandemic, an excess of all-cause mortality has been recorded in several countries, including Peru. Most excess deaths were likely attributable to COVID-19. In this study, we compared the excess all-cause mortality and COVID-19 mortality in 25 Peruvian regions to determine whether most of the excess deaths in 2020 were attributable to COVID-19. Excess deaths were calculated as the difference between the number of observed deaths from all causes during the COVID-19 pandemic (in 2020) and the number of expected deaths in 2020 based on a historical from recent years (2017-2019). Death data were retrieved from the Sistema Informatico Nacional de Defunciones (SINADEF) at the Ministry of Health of Peru from January 2017 to December 2020. Population counts were obtained from projections from Peru's Instituto Nacional de Estadística e Informática (INEI). All-cause excess mortality and COVID-19 mortality were calculated by region per 100,000 population. Spearman's test and linear and multiple regression models were used to estimate the correlation between excess all-cause mortality and COVID-19 mortality per 100,000 population. Excess all-cause death rates varied widely among regions (range: 115.1 to 519.8 per 100,000 population), and COVID-19 mortality ranged between 83.8 and 464.6 per 100,000 population. There was a correlation between the all-cause excess mortality and COVID-19 mortality (r = 0.90; p = 0.00001; y = 0.8729x + 90.808; R2 = 0.84). Adjusted for confounding factors (mean age in the region, gender balance, and number of intensive care unit (ICU) beds), the all-cause excess mortality rate was correlated with COVID-19 mortality rate (ß = 0.921; p = 0.0001). These findings suggest that most of the excess deaths in Peru are related to COVID-19. Therefore, these findings can help decision-makers to understand the high COVID-19 mortality rates in Peru.

Más allá de la violencia física y sexual contra la mujer / Going further than physical and sexual violence against women

Hemos leído el artículo titulado Violencia extrema contra la mujer y feminicidio en el Perú publicado en la Revista Cubana de Salud Pública 2018;44(2), donde se menciona que la violencia extrema contra la mujer ha aumentado y el feminicidio es mayor en zonas rurales,1 por lo que queremos dar un enfoque más allá de la violencia física y sexual. La violencia contra la mujer constituye un problema social y una violación de los derechos humanos que repercute de manera importante en la salud y el bienestar de la mujer.2 Los datos actuales nos indican que las medidas adoptadas por el gobierno son insuficientes para lograr controlar este problema de salud pública.3,4 A nivel mundial se estima que alrededor de una de cada tres mujeres han sufrido violencia física y sexual; y que el agresor generalmente es su propia pareja.5 Los casos más severos llegan a feminicidio, que es definido como la muerte de mujeres a causa de la discriminación de género, lo cual constituye la manifestación más cruel que adopta la violencia contra la mujer. Según el Instituto Nacional de Estadísticas e Informática (INEI) entre los años 2011 y 2015, en el Perú se había registrado la muerte de 556 mujeres como tipificación de feminicidio.6 La violencia hacia la mujer no solo implica el ámbito físico y sexual, sino que incluyen también el psicológico, emocional y social que repercuten en el desenvolvimiento adecuado de la mujer en su entorno. Esto ha sido tomado en cuenta en la Declaración de las Naciones Unidas, donde define la violencia contra la mujer como todo acto de violencia de género que...(AU)

Estimation of all-cause excess mortality by age-specific mortality patterns for countries with incomplete vital statistics: a population-based study of the case of Peru during the first wave of the COVID-19 pandemic.

BACKGROUND: All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time. METHODS: Our analytical framework and empirical strategy account for registered mortality and under-registration. This provides a better estimate of the actual mortality impact of the first wave of the COVID-19 pandemic in Peru. We use population and crude mortality rate projections from Peru's National Institute of Statistics and Information (INEI, in Spanish), individual-level registered COVID-19 deaths from the Ministry of Health (MoH), and individual-level registered deaths by region and age since 2017 from the National Electronic Deaths Register (SINADEF, in Spanish).We develop a novel framework combining different estimates and using quasi-Poisson models to estimate total excess mortality across regions and age groups. Also, we use logistic mixed-effects models to estimate the coverage of the new SINADEF system. FINDINGS: We estimate that registered mortality underestimates national mortality by 37•1% (95% CI 23% - 48•5%) across 26 regions and nine age groups. We estimate total all-cause excess mortality during the period of analysis at 173,099 (95% CI 153,669 - 187,488) of which 108,943 (95% CI 96,507 - 118,261) were captured by the vital registration system. Deaths at age 60 and over accounted for 74•1% (95% CI 73•9% - 74•7%) of total excess deaths, and there were fewer deaths than expected in younger age groups. Lima region, on the Pacific coast and including the national capital, accounts for the highest share of excess deaths, 87,781 (95% CI 82,294 - 92,504), while in the opposite side regions of Apurimac and Huancavelica account for less than 300 excess deaths. INTERPRETATION: Estimating excess mortality in low- and middle-income countries (LMICs) such as Peru must take under-registration of mortality into account. Combining demographic trends with data from administrative registries reduces uncertainty and measurement errors. In countries like Peru, this is likely to produce significantly higher estimates of excess mortality than studies that do not take these effects into account. FUNDING: None.

Factores prenatales asociados al incumplimiento del esquema básico de vacunación en menores de 5 años / Prenatal Factors Associated With Breach Of The Basic Vaccination Scheme In Under 5 Years Of Age

Objetivo: Determinar los factores de riesgo prenatales asociados al incumplimiento del esquema básico de vacunación en menores de 5 años a partir de la encuesta demográfica y de salud familiar (ENDES) del año 2018. Materiales y Métodos: Es un estudio observacional, retrospectivo, analítico y transversal. Se estudia la muestra de la Encuesta Nacional Demográfica y de Salud (ENDES) del año 2018 que comprende a 18 104 niños entre 1 a 5 años con tarjeta de salud vista en la entrevista, encontrándose los resultados en las encuestas del INEI. Se selecciona los archivos que contienen los cuestionarios del esquema de vacunación y se procesan los datos con SPSS versión 25. El procesamiento estadístico es de tipo analítico y descriptivo, bivariado y multivariado con ayuda de STATA v16 y Excel 2016. Resultados: Se contó con una muestra final de 18 104 de menores entre 1 a 5 años el 2018. En el análisis multivariado se encontró la asociación del incumplimiento de esquema de vacunación con la edad de la madre (valor p= <0,01, RP= 1,20, IC= 1,13 ­ 1,28), el número de controles no adecuados (valor p= <0,01, RP= 1,28, IC= 1,23 ­ 1,33) y la gestante no haber recibido la vacuna antitetánica en el embarazo (valor p= <0,01, RP= 1,16, IC= 1,12 ­ 1,20). No se encontró dicha asociación con el lugar de residencia, índice de riqueza y región natural. Conclusiones: Los factores de riesgo prenatales asociados al incumplimiento del esquema básico de vacunación en menores de 5 años fueron la edad materna, el número de controles prenatales inadecuados y la gestante no haber recibido la vacuna antitetánica.

Objective: To determine the prenatal risk factors associated with the failure to comply with the basic vaccination scheme in children under 5 years of age, based on the Demographic and Family Health Survey (ENDES) of 2018. Materials and Methods: It is an observational, retrospective, analytical and transversal study. We study the sample of the National Demographic and Health Survey (ENDES) for 2018 that includes 18 104 children between 1 and 5 years with health card seen in the interview, finding the results in the INEI surveys. The files containing the vaccination scheme questionnaires are selected and the data processed with SPSS version 25. The statistical processing is analytical and descriptive, bivariate and multivariate with the help of STATA v16 and Excel 2016. Results: There was a final sample of 18,104 children between 1 to 5 years old in 2018. The multivariate analysis found the association of non-compliance with the vaccination schedule with the mother's age (p value = <0.01, PR = 1.20, CI = 1.13 - 1.28), the number of controls inadequate (p value = <0.01, PR = 1.28, CI = 1.23 - 1.33) and the pregnant woman did not receive the tetanus vaccine during pregnancy (p= <0.01, RP= 1.16, CI= 1.12 - 1.20). No such association was found with the place of residence, wealth index and natural region. Conclusions: The prenatal risk factors associated with the failure to comply with the basic vaccination scheme in children under 5 years of age were maternal age, the number of inadequate prenatal check-ups and the pregnant woman who had not received the tetanus vaccine.

Estrategias de Comunicación Participativa, Saneamiento Básico y la Salud Pública de los Pobladores de Paucartambo-Cusco / Participatory Communication Strategies, Basic Sanitation And Public Health Of The People Of Paucartambo-Cusco

Objetivos: Analizar la influencia que tiene la aplicación de estrategias de comunicación participativa en el uso adecuado de servicios de saneamiento básico y su incidencia en la salud pública de los pobladores de comunidades de Paucartambo. Explorar las dimensiones políticas y culturales inmersas en los procesos de comunicación entre poblaciones y promotores de salud de las comunidades de estudio Analizar los procesos de intervención en el campo de la comunicación en salud. Métodos: El tipo de investigación es cualitativo y observacional, con un diseño de tipo transversal en base a entrevistas no estructuradas y entrevistas en profundidad, Se utilizó los datos de los Censos Nacionales de Población y Vivienda 2017, 2007- Instituto Nacional de Estadística e Informática (INEI) - PERÚ. Resultados: Las entrevistas a profundidad, así como la observación directa, dan como resultado que si bien se han realizado esfuerzos por mejorar la situación del saneamiento básico a través de la instalación de red pública de desagüe, y otras formas como las letrinas y pozos sépticos, además de ser insuficientes, no fueron utilizados adecuadamente, porque no se aplicaron estrategias de comunicación participativa desde la etapa de diagnóstico, hasta la evaluación final, más aun por la falta permanente de actividades de monitoreo y vigilancia, que tienen un rol muy decisivo en la calidad de vida y por tanto en la salud pública Conclusión: Las estrategias de comunicación más utilizadas por las instituciones que tienen el rol de promover el uso adecuado de los servicios de saneamiento básico como las redes públicas de desagüe han sido de carácter vertical como las charlas, la radio, el uso de láminas, precisamente por esta razón no se generaron conocimientos, actitudes y prácticas adecuadas para el uso y la conservación de los mismos, situación que tuvo impactos negativos sobre la salud pública y también ambiental.

Objectives: To analyze the influence that the application of participatory communication strategies has on the adequate use of basic sanitation services and its impact on the public health of the residents of communities in Paucartambo. Explore the political and cultural dimensions immersed in the communication processes between populations and health promoters of the study communities. Analyze the intervention processes in the field of health communication. Methods: The type of research is qualitative and observational, with a cross-sectional design based on unstructured interviews and in-depth interviews. Data from the National Population and Housing Censuses 2017, 2007 - National Institute of Statistics and Informatics were used. (INEI) - PERU. Results: In-depth interviews, as well as direct observation, result in the fact that although efforts have been made to improve the situation of basic sanitation through the installation of a public sewage network, and other forms such as latrines and septic tanks In addition to being insufficient, they were not used properly, because participatory communication strategies were not applied from the diagnostic stage to the final evaluation, even more so due to the permanent lack of monitoring and surveillance activities, which have a very decisive role in the quality of life and therefore in public health Conclusion: The communication strategies most used by institutions that have the role of promoting the adequate use of basic sanitation services such as public sewage networks have been of a vertical nature such as those talks, radio, the use of pictures, precisely for this reason, adequate knowledge, attitudes and practices were not generated s for their use and conservation, a situation that had negative impacts on public and environmental health.

Asociación entre obesidad abdominal y factores demográficos, según niveles de altitud en el Perú / Association between abdominal obesity and demographic factors according to altitude levels in Peru

RESUMEN Objetivo. Determinar en la población adulta del Perú, las características de la obesidad abdominal y su relación con los diferentes niveles de altitud geográfica, de acuerdo a género, grupos de edad, estado nutricional y área de residencia. Métodos. Se realizó un estudio descriptivo en base a las fuentes secundarias: Encuesta Nacional de Hogares (ENAHO 2012-2013) del Instituto Nacional de Estadística e Informática (INEI) y Ministerio de Salud Lima, Perú. La obesidad abdominal se identificó mediante la circunferencia de la cintura y el índice cintura/talla. La altitud se estratificó en 3 niveles: < 1000 m.s.n.m., de 1000 a 2999 m.s.n.m. y ≥ 3000 m.s.n.m. Resultados. Las mayores prevalencias de obesidad abdominal se encontraron en el género femenino (48,2% - 87,4%), en el grupo de edad de 40 a 59 años (38,4 % - 89,5%), en los obesos (85,9% - 99,9%), y en las áreas urbanas (36,8% - 86,3%), respectivamente. Estas prevalencias disminuyeron a partir de los 1000 m.s.n.m., a excepción de las que correspondieron al estado nutricional. La razón de prevalencia ajustada por género, grupo étareo y área de residencia, mostró una disminución en relación a la altitud. Conclusión. La población que vive en ciudades de gran altitud mostró bajas prevalencias de obesidad abdominal en relación a los que viven en ciudades de menor altitud.

ABSTRACT Objective. To determine in the adult population of Peru, the characteristics of abdominal obesity and its relationship with different levels of geographic altitude, according to gender, age groups, nutritional status, and area of residence. Methods. A descriptive study was carried out based on secondary sources: National Household Survey (ENAHO 2012-2013) of the National Institute of Statistics and Informatics (INEI) and Ministry of Health Lima, Peru. Abdominal obesity was identified by waist circumference and waist / height ratio. The altitude was stratified into 3 levels: <1000 meters above sea level, from 1000 to 2999 meters above sea level, and ≥ 3000 m.a.s.l. Results. The highest prevalence of abdominal obesity was found in the female gender (48,2% - 87,4%), in the age group from 40 to 59 years (38,4% - 89,5%), in the obese (85,9% - 99,9%), and in urban areas (36,8% - 86,3%), respectively. These prevalences decreased from 1000 meters above sea level, with the exception of those corresponding to nutritional status. The prevalence ratio adjusted for gender, age group and area of residence, showed a decrease in relation to altitude. Conclusion. The population living in high-altitude cities showed low prevalence of abdominal obesity in relation to those living in lower-altitude cities.

Developing protein arginine methyltransferase 1 (PRMT1) inhibitor TC-E-5003 as an antitumor drug using INEI drug delivery systems.

Injectable implants with the ability to form in situ are one of the most promising carriers for the delivery of chemotherapeutic drugs to tumor sites. We have reported a novel injectable in situ-forming implant system composed of n-butyl-2-cyanoacrylate (NBCA), ethyl oleate, along with the sol-gel phase transition. The chemotherapeutic drug-loaded injectable NBCA ethyl oleate implant (INEI) exhibited excellent therapeutic efficacy for local chemotherapy. Herein, we utilize this INEI to carry N, N'-(Sulfonyldi-4,1-phenylene)bis(2-chloroacetamide) (TE-C-5003), which is a selective protein arginine methyltransferase 1 (PRMT1) inhibitor, to treat the lung cancer mice model. The in vitro experiment shows that TE-C-5003 has a good anti-tumor effect on lung cancer (IC50 = 0.7022 µM for A549; IC50 = 0.6844 µM for NCL-H1299) and breast cancer (IC50 = 0.4128 µM for MCF-7; IC50 = 0.5965 µM for MDA-MB-231). Anti-tumor experiments in animal models showed that the average growth inhibition rate of xenografted human lung cancer cells by the TE-C-5003-loaded INEI (40% NBCA) was 68.23%, which is far more than TC-E-5003 alone (31.76%). Our study further confirms that INEI is an effective technique to improve the anti-tumor effect. The druggability of small molecule compounds can be improved with the help of the mentioned technology. Also, TC-E-5003 may be developed as a broad spectrum anti-tumor drug.