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1.

Improving household air, drinking water and hygiene in rural Peru: a community-randomized-controlled trial of an integrated environmental home-based intervention package to improve child health.

Hartinger, S M; Lanata, C F; Hattendorf, J; Verastegui, H; Gil, A I; Wolf, J; Mäusezahl, D
| Idioma(s): Inglés
BACKGROUND: Diarrhoea and acute lower respiratory infections are leading causes of childhood morbidity and mortality, which can be prevented by simple low-cost interventions. Integrated strategies can provide additional benefits by addressing multiple health burdens simultaneously. METHODS: We conducted a community-randomized-controlled trial in 51 rural communities in Peru to evaluate whether an environmental home-based intervention package, consisting of improved solid-fuel stoves, kitchen sinks, solar disinfection of drinking water and hygiene promotion, reduces lower respiratory infections, diarrhoeal disease and improves growth in children younger than 36 months. The attention control group received an early child stimulation programme. RESULTS: We recorded 24 647 child-days of observation from 250 households in the intervention and 253 in the attention control group during 12-month follow-up. Mean diarrhoea incidence was 2.8 episodes per child-year in the intervention compared with 3.1 episodes in the control arm. This corresponds to a relative rate of 0.78 [95% confidence interval (CI): 0.58-1.05] for diarrhoea incidence and an odds ratio of 0.71 (95% CI: 0.47-1.06) for diarrhoea prevalence. No effects on acute lower respiratory infections or children's growth rates were observed. CONCLUSIONS: Combined home-based environmental interventions slightly reduced childhood diarrhoea, but the confidence interval included unity. Effects on growth and respiratory outcomes were not observed, despite high user compliance of the interventions. The absent effect on respiratory health might be due to insufficient household air quality improvements of the improved stoves and additional time needed to achieve attitudinal and behaviour change when providing composite interventions.
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2.

Biomonitoring Human Exposure to Household Air Pollution and Association with Self-reported Health Symptoms - A Stove Intervention Study in Peru.

Li, Zheng; Commodore, Adwoa; Hartinger, Stella; Lewin, Michael; Sjödin, Andreas; Pittman, Erin; Trinidad, Debra; Hubbard, Kendra; Lanata, Claudio F; Gil, Ana I; Mäusezahl, Daniel; Naeher, Luke P
| Idioma(s): Inglés
BACKGROUND: Household air pollution (HAP) from indoor biomass stoves contains harmful pollutants, such as polycyclic aromatic hydrocarbons (PAHs), and is a leading risk factor for global disease burden. We used biomonitoring to assess HAP exposure and association with self-reported symptoms in 334 non-smoking Peruvian women to evaluate the efficacy of a stove intervention program. METHODS: We conducted a cross-sectional study within the framework of a community randomized control trial. Using urinary PAH metabolites (OH-PAHs) as the exposure biomarkers, we investigated whether the intervention group (n=155, with new chimney-equipped stoves) were less exposed to HAP compared to the control group (n=179, with mostly open-fire stoves). We also estimated associations between the exposure biomarkers, risk factors, and self-reported health symptoms, such as recent eye conditions, respiratory conditions, and headache. RESULTS: We observed reduced headache and ocular symptoms in the intervention group than the control group. Urinary 2-naphthol, a suggested biomarker for inhalation PAH exposure, was significantly lower in the intervention group (GM with 95% CI: 13.4 [12.3, 14.6] µg/g creatinine) compared to control group (16.5 [15.0, 18.0] µg/g creatinine). Stove type and/or 2-naphthol was associated with a number of self-reported symptoms, such as red eye (adjusted OR with 95% CI: 3.80 [1.32, 10.9]) in the past 48h. CONCLUSIONS: Even with the improved stoves, the biomarker concentrations in this study far exceeded those of the general populations and were higher than a no-observed-genotoxic-effect-level, indicating high exposure and a potential for increased cancer risk in the population.
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3.

Características clínico y sociodemográficas de los pacientes de un centro de rehabilitación para las adicciones./ Características clínico y sociodemográficas de los pacientes de un centro de rehabilitación para las adicciones./ Clinical and socio-demographic characteristics of patients at a rehabilitation center for chemical dependency.

Díaz, José Eduardo Cruz; Gaino, Loraine Vivian; Souza, Jacqueline de
| Idioma(s): Inglés; Español
OBJECTIVE: Identify the socio-demographic and clinical characteristics of a sample of chemically dependent people undergoing treatment at a daytime ambulatory care center specialized in treating chemical dependency in Lima, Peru, and describe their dropout rates. METHOD: Quantitative, descriptive, and exploratory study based on secondary data. The instrument used was the individual notification record from the information system for the treatment demand. RESULTS: The demand was composed mostly of young, single men who were unemployed or underemployed. The most common diagnosis was dependency on cocaine-based drugs and the age of the onset of use was between 15 and 19 years. The dropout rate was 85%, and 48% remained in treatment for only one day. CONCLUSION: The results highlight important factors to be considered in the evaluation of public policies on prevention, treatment, and supply control. We recommend more inclusive and participatory public policies.
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5.

Evolución del concepto de cambio climático y su impacto en la salud pública del Perú./ [Evolution of the climate change concept and its impact in the public health of Peru].

Sánchez Zavaleta, Carlos A
| Idioma(s): Español
The term "climate change" is not a new concept but its impact on public health is under constant review. We know that climate has already changed and will continue to change for centuries with the rise in average global temperature, and the associated rise in sea level. This fact makes mitigation efforts relevant only in the very long term and for generations of humans whose parents have not yet been born. When we talk about public health in the context of climate change, we are talking about adaptation. In the present, countries that are currently the most affected by climate change are precisely countries like Peru, without a significant carbon footprint at the global level but that are highly sensitive to the effects of climate. Without reliable climate projections, the health impact of climate change can be uncertain and complicated. Nevertheless, at the local level, every district can identify its vulnerabilities and define priorities to protect the health of its population. There are, and it can also be developed, environmental health indicators that can help monitor how well we are adapting and how prepared we are for changes in the climate. Adaptation to climate change implies improving living conditions, enhancing epidemiological surveillance systems and extending access to healthcare. The fight against the effects of climate change in public health is a fight against poverty and inequality, and that is nothing new in Peru.
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6.

Tobacco consumption and positive mental health: an epidemiological study from a positive psychology perspective.

Bazo-Alvarez, Juan Carlos; Peralta-Alvarez, Frank; Bernabé-Ortiz, Antonio; Alvarado, Germán F; Miranda, J Jaime
| Idioma(s): Inglés
BACKGROUND: Positive mental health (PMH) is much more than the absence of mental illnesses. For example, PMH explains that to be happy or resilient can drive us to live a full life, giving us a perception of well-being and robustness against everyday problems. Moreover, PMH can help people to avoid risky behaviours like tobacco consumption (TC). Our hypothesis was that PMH is negatively associated with TC, and this association differs across rural, urban and migrant populations. METHODS: A cross-sectional study was conducted using the PERU MIGRANT Study's dataset, including rural population from the Peruvian highlands (n = 201), urban population from the capital city Lima (n = 199) and migrants who were born in highlands but had to migrated because of terrorism (n = 589). We used an adapted version of the 12-item Global Health Questionnaire to measure PMH. The outcome was TC, measured as lifetime and recent TC. Log-Poisson robust regression, performed with a Maximum Likelihood method, was used to estimate crude prevalence ratios (PR) and 95 % confidence intervals (95%CI), adjusted by sex, age, family income and education which were the confounders. The modelling procedure included the use of LR Test, Akaike information criteria (AIC) and Bayesian information criteria (BIC). RESULTS: Cumulative occurrence of tobacco use (lifetime TC) was 61.7 % in the rural group, 78 % in the urban group and 76.2 % in rural-to-urban migrants. Recent TC was 35.3 % in the rural group, 30.7 % in the urban group and 20.5 % in rural-to-urban migrants. After adjusting for confounders, there was evidence of a negative association between PMH and lifetime TC in the rural group (PR = 0.93; 95%CI: 0.87-0.99), and a positive association between PMH and recent TC in migrants (PR = 1.1; 95%CI: 1.0-1.3). CONCLUSIONS: PMH was negatively associated with TC in rural participants only. Urbans exhibited just a similar trend, while migrants exhibited the opposite one. This evidence represents the first step in the route of knowing the potential of PMH for fighting against TC. For rural populations, this study supplies new information that could support decisions about prevention programmes and psychotherapy for smoking cessation. However, more research in the topic is needed.
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7.

Manual MGIT™ system for the detection of Mycobacterium tuberculosis: insights from a high TB burden setting.

Quispe, R; Valle, G A; Huapaya, J A; Novoa, I; Giraldo, J; Caceres, T; Gotuzzo, E; Zamudio, C; Seas, C
| Idioma(s): Inglés
OBJECTIVE: To evaluate the diagnostic performance of manual MGIT™ (MMGIT) compared to the gold standard, Löwenstein-Jensen (LJ), in the diagnosis of pulmonary tuberculosis (TB) in a high-burden setting. METHODS: Individuals with suspected TB enrolled in parallel diagnostic trials during 2007-2011 were included. Two samples were obtained from each patient and inoculated into MMGIT and LJ medium. Diagnostic tests were performed, and the incremental yield of a second test and time to detection (TTD) were calculated. Analyses were performed per patient and per sample. Gold standard was based on LJ culture. RESULTS: In the per patient and per sample analysis, we evaluated 1436 patients and 4142 samples. The sensitivity and specificity for smear and MMGIT per sample were respectively 89.9%/92.2% and 97.1%/98.9%. Contamination was observed in 1.4% of samples on MMGIT. The mean TTD (days) was 11.8 for MMGIT and 22.9 for LJ. The sensitivity and specificity for smear and MMGIT per patient were respectively 89.9% and 92.2% and 97.1% and 98.3%. A second MMGIT culture had an incremental yield of 1.6%. CONCLUSIONS: MMGIT has high sensitivity and specificity, regardless of smear result, with a 50% reduction in TTD compared to LJ. These features make MMGIT an acceptable TB diagnostic method for use in resource-limited settings.
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9.

Evolución del concepto de cambio climático y su impacto en la salud pública del Perú/ Evolution of the climate change concept and its impact in the public health of Peru

Sánchez Zavaleta, Carlos A.
| Idioma(s): Español
RESUMEN El término de "cambio climático" no es un concepto nuevo, pero su impacto en la salud pública está en continua revisión. Sabemos que el clima ya cambió y va seguir cambiando por los próximos siglos con el aumento de la temperatura global promedio, y el consecuente aumento del nivel del mar. Este hecho hace que los esfuerzos para la mitigación de la emisión de gases sean relevantes únicamente a muy largo plazo y para generaciones de humanos cuyos padres aun no nacen. Si hablamos de salud pública en el contexto de cambio climático, hablamos de adaptación. En el presente, los países más afectados por los efectos del cambio climático son justamente los países como el Perú, sin una huella ecológica significativa a nivel mundial, pero que son altamente sensibles a los efectos del clima. Sin proyecciones confiables del cambio en el clima, el impacto en la salud puede ser incierto y complicado. Sin embargo, a nivel local, cada distrito puede identificar sus propias vulnerabilidades y definir sus prioridades para asegurar la salud de su población. Existen y se pueden crear indicadores de salud ambiental para monitorizar qué tan bien nos estamos adaptando y qué tan preparados estamos para los cambios en el clima. La adaptación a los cambios del clima implica elevar las condiciones de vida, mejorar los sistemas de vigilancia epidemiológica y ampliar el acceso a servicios de salud. La lucha contra los efectos del cambio climático en salud pública es la lucha contra la pobreza y la desigualdad, y eso no es nada nuevo en el Perú. ABSTRACT The term "climate change" is not a new concept but its impact on public health is under constant review. We know that climate has already changed and will continue to change for centuries with the rise in average global temperature, and the associated rise in sea level. This fact makes mitigation efforts relevant only in the very long term and for generations of humans whose parents have not yet been born. When we talk about public health in the context of climate change, we are talking about adaptation. In the present, countries that are currently the most affected by climate change are precisely countries like Peru, without a significant carbon footprint at the global level but that are highly sensitive to the effects of climate. Without reliable climate projections, the health impact of climate change can be uncertain and complicated. Nevertheless, at the local level, every district can identify its vulnerabilities and define priorities to protect the health of its population. There are, and it can also be developed, environmental health indicators that can help monitor how well we are adapting and how prepared we are for changes in the climate. Adaptation to climate change implies improving living conditions, enhancing epidemiological surveillance systems and extending access to healthcare. The fight against the effects of climate change in public health is a fight against poverty and inequality, and that is nothing new in Peru.
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10.

Evolución del concepto de cambio climático y su impacto en la salud pública del Perú/ Evolution of the climate change concept and its impact in the public health of Peru

Sánchez Zavaleta, Carlos A
| Idioma(s): Español
El término de ôcambio climáticoõ no es un concepto nuevo, pero su impacto en la salud pública está en continua revisión. Sabemos que el clima ya cambió y va seguir cambiando por los próximos siglos con el aumento de la temperatura global promedio, y el consecuente aumento del nivel del mar. Este hecho hace que los esfuerzos para la mitigación de la emisión de gases sean relevantes únicamente a muy largo plazo y para generaciones de humanos cuyos padres aun no nacen. Si hablamos de salud pública en el contexto de cambio climático, hablamos de adaptación. En el presente, los países más afectados por los efectos del cambio climático son justamente los países como el Perú, sin una huella ecológica significativa a nivel mundial, pero que son altamente sensibles a los efectos del clima. Sin proyecciones confiables del cambio en el clima, el impacto en la salud puede ser incierto y complicado. Sin embargo, a nivel local, cada distrito puede identificar sus propias vulnerabilidades y definir sus prioridades para asegurar la salud de su población. Existen y se pueden crear indicadores de salud ambiental para monitorizar qué tan bien nos estamos adaptando y qué tan preparados estamos para los cambios en el clima. La adaptación a los cambios del clima implica elevar las condiciones de vida, mejorar los sistemas de vigilancia epidemiológica y ampliar el acceso a servicios de salud. La lucha contra los efectos del cambio climático en salud pública es la lucha contra la pobreza y la desigualdad, y eso no es nada nuevo en el Perú... The term ôclimate changeõ is not a new concept but its impact on public health is under constant review. We know that climate has already changed and will continue to change for centuries with the rise in average global temperature, and the associated rise in sea level. This fact makes mitigation efforts relevant only in the very long term and for generations of humans whose parents have not yet been born. When we talk about public health in the context of climate change, we are talking about adaptation. In the present, countries that are currently the most affected by climate change are precisely countries like Peru, without a significant carbon footprint at the global level but that are highly sensitive to the effects of climate. Without reliable climate projections, the health impact of climate change can be uncertain and complicated. Nevertheless, at the local level, every district can identify its vulnerabilities and define priorities to protect the health of its population. There are, and it can also be developed, environmental health indicators that can help monitor how well we are adapting and how prepared we are for changes in the climate. Adaptation to climate change implies improving living conditions, enhancing epidemiological surveillance systems and extending access to healthcare. The fight against the effects of climate change in public health is a fight against poverty and inequality, and that is nothing new in Peru...
Resultados  1-10 de 2.102