[Undiagnosed arterial hypertension in a Latin American country, 2019 to 2021]. / Hipertensión arterial no diagnosticada en un país de Latinoamérica, 2019 a 2021.

Objective: To determine the factors associated with undiagnosed hypertension. Method: A quantitative, observational, retrospective, cross-sectional and analytical study was carried out in people aged 15 years and over included in the Demographic and Family Health Survey from 2019 to 2021 in Peru. A statistical analysis was carried out using the corrected F test, and crude and adjusted prevalence ratio (aPR), with a 95% confidence interval (95%CI) for inferential analysis, through Poisson regression with robust variance. Likewise, the CSPLAN analysis was carried out for complex samples according to the sample design and taking into account the weighting factor. Results: In the multivariate analysis, a significant association was found between the factors male sex (aPR: 1.22; 95%CI: 1.19-1.26), age from 30 to 49 years (aPR: 0.94; 95%CI: 0.92-0.96), native ethnicity (aPR: 1.07; 95%CI: 1.04-1.10), having health insurance (aPR: 0.91; 95%CI: 0.89-0.93), suffering from some permanent limitation (aPR: 0.83; 95%CI: 0.76-0.91) and diabetes mellitus (aPR: 0.59; 95%CI: 0.55-0.64). No significant association was found with educational level, language, Afro-Peruvian ethnicity, or alcohol or tobacco consumption (p > 0.05). Conclusions: The prevalence of undiagnosed arterial hypertension is high, 69.5%. The associated factors are male sex, native ethnicity, age between 30 and 49 years, having health insurance, suffering from some permanent limitation and having diabetes mellitus.

Objetivo: Determinar los factores asociados a hipertensión arterial no diagnosticada. Método: Estudio de tipo cuantitativo, observacional, retrospectivo, transversal y analítico, en personas de 15 y más años de edad contenidas en la Encuesta Demográfica y Salud Familiar de 2019 a 2021 en Perú. Se realizó un análisis estadístico haciendo uso de la prueba F corregida y la razón de prevalencia cruda y ajustada (RPa), con un intervalo de confianza del 95% (IC95%) para el análisis inferencial, a través de regresión de Poisson con varianza robusta. Asimismo, se realizó el análisis CSPLAN para muestras complejas de acuerdo con el diseño de la muestra y teniendo en cuenta el factor de ponderación. Resultados: En el análisis multivariado se halló una asociación significativa de los factores sexo masculino (RPa: 1.22; IC95%: 1.19-1.26), edad de 30 a 49 años (RPa: 0.94; IC95%: 0.92-0.96), etnia nativa (RPa: 1.07; IC95%: 1.04-1.10), tenencia de un seguro de salud (RPa: 0.91; IC95%: 0.89-0.93), sufrir alguna limitación permanente (RPa: 0.83; IC95%: 0.76-0.91) y diabetes mellitus (RPa: 0.59; IC95%: 0.55-0.64). No se encontró asociación significativa con el nivel de instrucción, el idioma, la etnia afroperuana ni el consumo de alcohol o tabaco (p > 0.05). Conclusiones: La prevalencia de hipertensión arterial no diagnosticada es alta, del 69.5%. Los factores asociados son el sexo masculino, la etnia nativa, la edad entre 30 y 49 años, la tenencia de un seguro de salud, sufrir alguna limitación permanente y tener diabetes mellitus.

Diagnostic Performance of the Measurement of Skinfold Thickness for Abdominal and Overall Obesity in the Peruvian Population: A 5-Year Cohort Analysis.

The escalating prevalence of overall and abdominal obesity, particularly affecting Latin America, underscores the urgent need for accessible and cost-effective predictive methods to address the growing disease burden. This study assessed skinfold thicknesses' predictive capacity for overall and abdominal obesity in Peruvian adults aged 30 or older over 5 years. Data from the PERU MIGRANT 5-year cohort study were analyzed, defining obesity using BMI and waist circumference. Receiver operating characteristic curves and area under the curve (AUC) with 95% confidence intervals (CI) were calculated. Adults aged ≥ 30 (n = 988) completed the study at baseline, with 47% male. A total of 682 participants were included for overall and abdominal obesity analysis. The 5-year prevalence values for overall and abdominal obesity were 26.7% and 26.6%, respectively. Subscapular skinfold (SS) best predicted overall obesity in men (AUC = 0.81, 95% CI: 0.75-0.88) and women (AUC = 0.77, 95% CI: 0.67-0.88). Regarding abdominal obesity, SS exhibited the highest AUC in men (AUC = 0.83, 95% CI: 0.77-0.89), while SS and the sum of trunk skinfolds showed the highest AUC in women. In secondary analysis excluding participants with type-2 diabetes mellitus (DM2) at baseline, SS significantly predicted DM2 development in men (AUC = 0.70, 95% CI: 0.58-0.83) and bicipital skinfold (BS) did in women (AUC = 0.73, 95% CI: 0.62-0.84). The findings highlight SS significance as an indicator of overall and abdominal obesity in both sexes among Peruvian adults. Additionally, SS, and BS offer robust predictive indicators for DM2.

Factors Associated with Normal-Weight Abdominal Obesity Phenotype in a Representative Sample of the Peruvian Population: A 4-Year Pooled Cross-Sectional Study.

To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018-2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43-11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65-1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81-2.02); and 70 or older(aPR: 1.99; 95% CI 1.87-2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15-1.28); 2020 (aPR: 1.17; 95% CI 1.11-1.24); and 2021 (aPR: 1.12; 95% CI 1.06-1.18); living in Andean region (aPR: 0.91; 95% CI 0.86-0.95); wealth index poor (aPR: 1.26; 95% CI 1.18-1.35); middle (aPR: 1.17; 95% CI 1.08-1.26); rich (aPR: 1.26; 95% CI 1.17-1.36); and richest (aPR: 1.25; 95% CI 1.16-1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92-0.98); history of hypertension (aPR: 1.08; 95% CI 1.03-1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07-1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89-0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.

Dual-Mode Based Sliding Mode Control Approach for Nonlinear Chemical Processes.

This paper synthesizes a new sliding mode controller (SMC) approach to enhance tracking and regulation tasks by following dual-mode concepts. The new control law consists of two distinct types of operation, using the combination of higher gain to large error signals (transient) and lower gain to small error signals (the region around the set point). The design is presented from a dual-mode (PD-PID) sliding surface operating in concert, fulfilling desired control objectives to ensure stability and performance. Therefore, a new controller was established, and we called it a dual-mode based SMC. The proposed controller is tested by computer simulations applied to two nonlinear processes, a continuous stirred-tank reactor (CSTR) and a mixing tank with a variable dead time. The results are compared with two different alternatives of SMC. In addition, the merits and drawbacks of the control schemes are analyzed using radial graphs, comparing the control methods with various performance measures for set points and disturbances changes. The ITSE (integral of time multiplied by the squared error), TVu (total variation of control effort) indices, Mp (maximum overshoot), and ts (settling time) were the indices used for performance analysis and comparisons.

Factors Associated with Symptoms of Depression among People with Obesity: Analysis of a 3-Year-Peruvian National Survey.

INTRODUCTION: Obesity and depression contribute to the global burden of economic cost, morbidity, and mortality. Nevertheless, not all people with obesity develop depression. OBJECTIVE: To determine the factors associated with depressive symptoms among people aged 15 or older with obesity from the National Demographic and Family Health Survey (ENDES in Spanish 2019-2021). METHODS: Cross-sectional analytical study. The outcome of interest was the presence of depressive symptoms, assessed using the Patient Health Questionnaire-9 (PHQ-9). Crude (cPR) and adjusted (aPR) prevalence ratios were estimated using GLM Poisson distribution with robust variance estimates. RESULTS: The prevalence of depression symptoms was 6.97%. In the multivariate analysis, a statistically significant association was found between depressive symptoms and female sex (PRa: 2.59; 95% CI 1.95-3.43); mountain region (PRa: 1.51; 95% CI 1.18-1.92); wealth index poor (PRa: 1.37; 95% CI 1.05-1.79, medium (PRa: 1.49; 95% CI 1.11-2.02), and rich (PRa: 1.65; 95% CI 1.21-2.26); daily tobacco use (PRa: 2.05, 95% CI 1.09-3.87); physical disability (PRa: 1.96, 95% CI 1.07-3.57); and a history of arterial hypertension (PRa: 2.05; 95% CI 1.63-2.55). CONCLUSION: There are several sociodemographic factors (such as being female and living in the Andean region) and individual factors (daily use of tobacco and history of hypertension) associated with depressive symptoms in Peruvian inhabitants aged 15 or older with obesity. In this study, the COVID-19 pandemic was associated with an increase in depressive symptoms.

Factors associated with hemoglobin levels in children under 6 months of age hospitalized in a pediatric center in Peru / Factores asociados a los niveles de hemoglobina en niños menores de 6 meses de edad hospitalizados en un centro pediátrico de Perú

Introduction: Anemia is a condition in which there is a low concentration of hemoglobin (Hb) levels. Although many causes of anemia have been identified, there are few studies in which they are related to epidemiological factors in the first months of life.  Objective: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Methods: To determine the factors associated with hemoglobin levels in children under 6 months of age hospitalized in a specialized pediatric center in Peru. Results: 61.4% of the infants were women, and only 6.7% of the proportion of the studied population was less than 1 month old. 6.7% had a low birth weight, and 53.2% had a normal delivery. The level of anemia in hospitalized children under 6 months of age is 66.7%. Conclusions: The factors associated with hemoglobin levels were age, nutritional status, weight for length, and hospital causes. Likewise, an association was found between age and the median Hb in boys and girls aged 0 to 5 months.

Introducción: La anemia es una condición en la cual hay una baja concentración de los niveles de hemoglobina (Hb). Si bien se ha identificado muchas causas de la anemia, existen pocos estudios en los cuales se relacionan con factores epidemiológicos en los primeros meses de vida. Objetivo: Determinar los factores asociados a los niveles de hemoglobina en niños menores de 6 meses de edad hospitalizados en un centro pediátrico especializado de Perú. Métodos: Estudio analítico, transversal en niños menores de 6 meses de edad hospitalizados en los servicios de medicina de un centro pediátrico durante el año 2017, se revisaron 267 historias clínicas dándose énfasis en características clínicas y epidemiológicas. Resultados: El 61,4% de los lactantes eran mujeres, y solo un 6,7% de la proporción de la población estudiada presentaba menos de 1 mes. El 6,7% tuvieron baso peso al nacer, y el 53,2% tuvo un parto eutócico. El nivel de anemia en niños menores de 6 meses de edad hospitalizados es del 66,7%. Conclusion: Los factores asociados a los niveles de hemoglobina fueron  edad, estado nutricional de peso para la longitud y causas hospitalarias. Asimismo, se encontró asociación entre la edad con la mediana de Hb en los niños y niñas de 0 a 5 meses.

Factors associated with post-delivery complications, according to the demographic and family health survey in Perú 2019-2020 / Factores asociados a complicaciones post parto según la encuesta demográfica y de salud familiar en Perú 2019-2020

Introduction: Postpartum complications are important health problems in Peru, therefore it is necessary to determine their associated factors. Objectives: Determine the factors associated with postpartum complications in Peru during the years 2019 and 2020. Methods: Cross-sectional, analytical study, carried out from the analysis of the Demographic and Family Health Survey (ENDES) 2019-2020, of Peru. The unit of analysis was women between the ages of 12 and 49 residing in Peru in the years 2019-2020. Multivariate analysis was performed using Poisson regression with robust variance. Results: It is evidenced that the age of 20 to 35 years has a prevalence ratio of 1.12 of ending in complications after childbirth (PRa: 1.12, 95% CI: 1.07 to 1.18) compared to women who have 36 years and over. Having complications during childbirth has a 2.75 times higher prevalence of complications after childbirth (APR: 2.75, 95% CI: 2.64 to 2866). Having a degree of primary (RPa: 0.90, 95% CI: 0.84 to 0.96), secondary (RPa: 0.94, 95% CI: 0.89 to 0.98) education decreases the probability of having complications after childbirth compared to women with a higher level of education. and having a single marital status (APR 0.85, 95% CI: 0.76 to 0.94) decreases the probability of having complications after childbirth, compared to cohabitants. Conclusion. The prevalence of postpartum complications is regular. The factors associated with postpartum complications are: age, educational level, marital status and complications during childbirth.

Introducción: Las complicaciones post parto son problemas de salud importante en el Perú, por lo tanto, es necesario determinar sus factores asociados. Objetivos. Determinar los factores asociados a las complicaciones después del parto en mujeres de 12 a 49 años en Perú, según la encuesta demográfica y salud familiar, 2019-2020. Métodos. Estudio de fuente secundaria basado en la ENDES 2019-2020. La unidad de análisis fueron todas las mujeres de 12 a 49 años de edad residentes en el Perú en los años 2019-2020, que hayan presentado complicaciones post parto, y que respondieron a las preguntas de las variables del estudio. Resultados. Se evidencia que la edad de 20 a 35 años tiene una razón de prevalencia de 1,12 de terminar en complicaciones después del parto (RPa: 1,12, IC95%: 1,07 a 1,18). Tener complicaciones durante el parto tiene 2,75 más veces la prevalencia de complicaciones después del parto (RPa: 2,75, IC95%: 2,64 a 2866).  Tener grado de instrucción primaria (RPa: 0,90, IC95%: 0,84 a 0,96), secundaria (RPa: 0,94, IC95%: 0,89 a 0,98) y tener estado civil soltera (RPa 0,85, IC95%: 0,76 a 0,94) disminuyen la probabilidad de tener complicaciones después del parto. Conclusión. La prevalencia de las complicaciones después del parto es de 37,7%. Los factores asociados a las complicaciones después del parto son: la edad, grado de instrucción, estado civil y complicaciones durante el parto.

Lactancia materna exclusiva según la ENDES 2019: caso de Perú en América Latina

Objetivo Analizar los factores asociados a la lactancia materna exclusiva (LME) en mujeres del Perú según la ENDES-2019. Métodos Se hizo un estudio observacional, retrospectivo, analítico y de corte transversal. La muestra la conformaron 4 212 mujeres, de 15 a 49 años, con un hijo menor de 6 meses. En el análisis inferencial, la asociación de los factores se evaluó por la razón de prevalencia cruda (RPc). Por medio del modelo de regresión de Poisson con varianza robusta se calculó la razón de prevalencia ajustada (RPa), con sus respectivos IC de 95%, con una significancia p<0,05 y se elaboró el análisis CSPLAN en SPSS para muestras complejas. Resultados La prevalencia de LME fue 67,3%. En el análisis bivariado los factores asociados fueron residencia rural (RPc: 1,22; IC 95%: 1,17-1,27, p:0,000), multiparidad (RPc: 1,10; IC 95%: 1,05-1,16, p:0,000), parto vaginal (RPc: 1,1; IC 95%: 1,03-1,16, p:0,003), enseñanza de preparar pezones para lactancia materna (LM) (RPc: 1,12; IC 95%: 1,051,19, p:0,000), enseñanza de cómo dar el pecho a su bebe (RPc: 1,12; IC 95%: 1,051,19, p:0,000) y la capacitación sobre LM (RPc: 1,11; IC 95%: 1,05-1,17, p:0,000). Los factores asociados significativamente a la LME en el análisis multivariado fueron lugar de residencia rural (RPa: 1,21; IC 95%: 1,15-1,27, p:0,000) y ser multíparas (RPa: 1,12; IC 95%: 1,05-1,19, p:0,000). Conclusiones La prevalencia de LME encontrada en el Perú se consideró cercana al objetivo del milenio. El perfil materno asociado significativamente a la LME fue tener residencia rural y ser multípara.

Objective To analyze the factors associated with exclusive breastfeeding (EBF) in Peruvian women according to the ENDES-2019. Methodology This was an observational, retrospective, analytical, cross-sectional study that included a sample of 4 212 women aged 15 to 49 years who had a child under 6 months. In the inferential analysis, the association of factors was evaluated using the crude prevalence ratio (RPc). Additionally, the Poisson regression model with robust variance was used to calculate the adjusted prevalence ratio (RPa) along with their respective 95% confidence intervals, with a significance level set at p<0.05. The CSPLAN analysis was performed using SPSS for complex samples. Results The prevalence of SCI was 67.3%. In the bivariate analysis the associated factors were rural residence (RPc: 1.22; 95% CI: 1.17-1.27, p: 0.000), multiparity (RPc: 1.10; 95% CI: 1.05-1.16, p:0.000), vaginal delivery (RPc: 1.1; 95% CI: 1.03-1.16, p:0.003), teaching to prepare nipples for breastfeeding (BF) (PRc: 1.12; 95% CI: 1.051.19, p:0.000), teaching how to breastfeed your baby (PRc: 1.12; 95% CI:1.05-1.19, p:0.000) and BF training (PRc: 1.11; 95% CI:1.05-1.17, p:0.000). The factors significantly associated with EBF in mul-tivariate analysis were rural place of residence (PRa: 1.21; 95% CI: 1.15-1.27, p:0.000) and being multiparous (PRa: 1.12; 95% CI: 1.05-1.19, p:0.000). Conclusions The prevalence of EBF found in Peru was considered to be close to the millennium goal. The maternal profile significantly associated with EBF was rural residence and being multiparous.

Factors interfering screening for gynecological cancers in peruvian women / Factores que interfieren los cribados para cánceres ginecológicos en mujeres peruanas

Objective: To identify the factors associated with the interference of gynecological cancer screening in women aged 25-69 years, according to the Demographic and Family Health Survey (ENDES) for the years 2019 and 2020. Materials and methods: Quantitative, observational, analytical cross- sectional study. It was a secondary database analysis obtained by ENDE for the years 2019 and 2020. Generalized linear Poisson family crude and adjusted models were used to estimate the association. The measure of association. The measure of association used was the adjusted prevalence ratio (Rpa) with 95% confidence interval (95% CI). Results: We worked with a total of 18,113 women aged 25-69 who were interviewed at the ENDES 2019-2020. In the descriptive analysis, it is observed that 19.3% did not take a PAP smear (PAP) and 53.6% did not perform "screening for breast cancer". Women with a primary education level have 19% and 58% more opportunities to present interference for taking PAP and screening for breast cancer respectively (RPa: 1,19, 95% CI 1.08-1,31 and RPa:1.58, 95% CI 1:51 ­ 1:64). Living in the jungle increases 56%and 20%more chance of presenting interference for taking PAP and screening for breast cancer respectively (RPa: 1.46, 95% CI 1.42-1.71 and RPa: 1.20, 95% CI: 1.15- 1.25). The level of knowledge increases the interference for taking PAP and screening for breast cancer by 43% and 3% respectively (RPa: 1.43, 95% CI: 1.34- 1.54 and RPa: 1.03, 95% CI:1.00 -1.06) Conclusions: Sociodemographic, sociocultural and economic factors have a marked influence on the performance of gynecological cancers such as cervical cancer and breast cancer, so it is necessary to implement strategies to promote the prevention of these pathologies.

Objetivo: Identificar los factores asociados con la interferencia de los cribados para cánceres ginecológicos en mujeres peruanas de 25 ­ 69 años de edad, según la Encuesta Demográfica y de Salud Familiar (ENDES) de los años 2019 y 2020. Materiales y métodos: Estudio cuantitativo, observacional, analítico de corte transversal. Fue un análisis de base de datos secundaria obtenido por ENDES de los años 2019 y 2020. Se usó modelos lineales generalizados de familia Poisson crudas y ajustadas para poder estimar la asociación. La medida de asociación utilizada fue la razón de prevalencia ajustada (RPa) con un intervalo de confianza al 95% (IC95%). Resultados: Se trabajó con un total de 18113 mujeres peruanas de 25-69 años entrevistadas en la ENDES 2019-2020. En el análisis descriptivo se observa que un 19,3% no se realizó la toma de Papanicolaou (PAP) y 53,6 no se realizó "cribado para cáncer de mama". Las mujeres con nivel educativo primario tienen 20% y 58% más oportunidades de presentar interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.20, IC95%: 1.09-1.32 y RPa: 1.58, IC95%: 1.52-1.65). Vivir en la selva aumenta en 57% y 20% más oportunidades de presentar interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.57, IC95%: 1.43-1.71 y RPa: 1.20, IC95%: 1.15-1.25). El nivel de conocimiento aumenta en un 44% y 4% la interferencia para la toma de PAP y cribado para cáncer de mama respectivamente (RPa: 1.44, IC95%: 1.34-1.54 y RPa: 1.04, IC95%: 1.01-1.07). Conclusión: Los factores sociodemográficos, socioculturales y económicos influyen de manera marcada en la realización de los cribados de cánceres ginecológicos como el cáncer de cuellouterino y el cáncer de mama, por lo que es necesario implementar estrategias para promover la prevención de estas patologías.

Diversidad alimentaria en habitantes de tres provincias de Perú durante la COVID-19 y factores asociados

RESUMEN Objetivo: Evaluar la diversidad alimentaria entre los habitantes de las provincias de Lima, Arequipa y Sullana de Perú durante el tiempo de aislamiento debido a la COVID-19 y explorar los factores asociados. Métodos: Estudio transversal en el que se aplicó cuestionarios electrónicos a los encuestados entre la última semana de junio y primera semana de julio de 2020. Todas las ciudades se encontraban en cuarentena al momento de realizar el estudio. Evaluamos la diversidad dietética utilizando el Puntaje de Diversidad Dietética del Hogar (HDDS, siglas en inglés). Se recolecto información en un total de 672 hogares, después del control de calidad en gabinete y previo al análisis estadístico se analizaron los datos de 600 hogares: 281 en Lima, 212 en Arequipa y 107 en Sullana; el total de participantes fueron 2.570 residentes de las tres ciudades de Perú. Resultados: El grupo de cereales tuvo el 96,5% de consumo, las misceláneas el 77,7%, los aceites y grasas el 74,7%, y los pescados y mariscos el 52,3%. Tener mayores ingresos económicos se asoció con un HDDS significativamente más alto en comparación con aquellos que tienen menores ingresos (p<0,01). Los habitantes de Sullana tienen el puntaje de diversidad alimentaria más bajo (HDDS= 7,82), seguido por Arequipa (HDDS= 10,19) y Lima (HDDS= 10,93). Conclusiones: Las personas con menor nivel educativo, con menores ingresos económicos y residentes en Sullana tenían un Puntaje de Diversidad Dietética del Hogar más bajo.

ABSTRACT Objective: To evaluate dietary diversity among the inhabitants of the Peruvian provinces of Lima, Arequipa and Sullana during the time of isolation due to COVID-19 and to explore the associated factors. Methods: Cross-sectional study in which electronic questionnaires were applied to respondents between the last week of June and the first week of July 2020. All cities were in quarantine at the time of the study. We assessed dietary diversity using the Household Dietary Diversity Score (HDDS). Information was collected from a total of 672 households, after quality control and prior to statistical analysis, data from 600 households were analyzed: 281 from Lima, 212 from Arequipa and 107 from Sullana, representing 2,570 residents of the three Peruvian cities. Results: The group of cereals had 96.5% of consumption, miscellaneous 77.7%, oils and fats 74.7%, and fish and shellfish 52.3%. Having higher economic income was associated with a significantly higher HDDS compared to those with lower income (p<0.01). The inhabitants of Sullana have the lowest dietary diversity score (HDDS= 7.82), followed by Arequipa (HDDS= 10.19) and Lima (HDDS= 10.93). Conclusions: People with a lower educational level, with lower economic income and residents of Sullana had a lower Household Dietary Diversity Score.

In Situ Ethanolamine ZnO Nanoparticle Passivation for Perovskite Interface Stability and Highly Efficient Solar Cells.

Zinc oxide (ZnO) has interesting optoelectronic properties, but suffers from chemical instability when in contact with perovskite interfaces; hence, the perovskite deposited on the top degrades promptly. Surface passivation strategies alleviate this instability issue; however, synthesis to passivate ZnO nanoparticles (NPs) in situ has received less attention. Here, a new synthesis at low temperatures with an ethanolamine post treatment has been developed. By using ZnO NPs prepared with ethanolamine and butanol (BuOH), (E-ZnO), the stability of the FA0.9Cs0.1PbI3 (FACsPI)−ZnO interface was achieved, with a photoconversion efficiency of >18%. Impedance spectroscopy demonstrates that the recombination at the interface was reduced in the system with E-ZnO/perovskite compared to common SnO2/perovskite and that the quality of the perovskite on the top is clearly due to the ZnO in situ passivation with ethanolamine. This work extends the use of E-ZnO as an n-type charge extraction layer and demonstrates its feasibility with methylammonium perovskite. Moreover, this study paves the way for other in situ passivation methods with different target molecules, along with new insights regarding the perovskite interface rearrangement when in contact with the modified electron transport layer (ETL).

Projection of the health and economic impacts of Chronic kidney disease in the Chilean population.

BACKGROUND: Chronic Kidney Disease (CKD) is a leading public health problem, with substantial burden and economic implications for healthcare systems, mainly due to renal replacement treatment (RRT) for end-stage kidney disease (ESKD). The aim of this study is to develop a multistate predictive model to estimate the future burden of CKD in Chile, given the high and rising RRT rates, population ageing, and prevalence of comorbidities contributing to CKD. METHODS: A dynamic stock and flow model was developed to simulate CKD progression in the Chilean population aged 40 years and older, up to the year 2041, adopting the perspective of the Chilean public healthcare system. The model included six states replicating progression of CKD, which was assumed in 1-year cycles and was categorised as slow, medium or fast progression, based on the underlying conditions. We simulated two different treatment scenarios. Only direct costs of treatment were included, and a 3% per year discount rate was applied after the first year. We calibrated the model based on international evidence; the exploration of uncertainty (95% credibility intervals) was undertaken with probabilistic sensitivity analysis. RESULTS: By the year 2041, there is an expected increase in cases of CKD stages 3a to ESKD, ceteris paribus, from 442,265 (95% UI 441,808-442,722) in 2021 to 735,513 (734,455-736,570) individuals. Direct costs of CKD stages 3a to ESKD would rise from 322.4M GBP (321.7-323.1) in 2021 to 1,038.6M GBP (1,035.5-1,041.8) in 2041. A reduction in the progression rates of the disease by the inclusion of SGLT2 inhibitors and pre-dialysis treatment would decrease the number of individuals worsening to stages 5 and ESKD, thus reducing the total costs of CKD by 214.6M GBP in 2041 to 824.0M GBP (822.7-825.3). CONCLUSIONS: This model can be a useful tool for healthcare planning, with development of preventive or treatment plans to reduce and delay the progression of the disease and thus the anticipated increase in the healthcare costs of CKD.

A Model-Based Economic Evaluation of Cladribine Versus Alemtuzumab, Ocrelizumab and Natalizumab for the Treatment of Relapsing-Remitting Multiple Sclerosis with High Disease Activity in Chile.

PURPOSE: The aim of this study was to evaluate the cost effectiveness of cladribine compared with alemtuzumab, natalizumab, and ocrelizumab for the treatment of highly active multiple sclerosis (HAD-MS) from the perspective of the Chilean health care public sector. MATERIALS AND METHODS: A Markov model was used to compare costs and quality-adjusted life-years (QALYs) over a 45-year time horizon using a 3% discount rate for costs and outcomes. Natural history of the disease was modeled in terms of progression of disability according to the Expanded Disability Status Scale (EDSS). A network meta-analysis was used as a source of comparative effectiveness for disability progression and annual relapse rates. Differences in costs and outcomes were modeled for only 10 years due to high temporal uncertainty. Ocrelizumab was assumed to have the same efficacy as cladribine due to lack of data. Direct costs were taken from national tariffs and expressed in 2019 US dollars. Utilities for EDSS health states were obtained from the literature. Second-order uncertainty was characterized through deterministic and probabilistic sensitivity analysis. FINDINGS: Compared with natalizumab (the current strategy covered in Chile), cladribine is associated with incremental costs and QALYs of US$70,989 and 1.875, respectively (incremental cost-effectiveness ratio [ICER] $37,861). Ocrelizumab was extendedly dominated by cladribine and natalizumab, and alemtuzumab was dominated by cladribine. A scenario analysis of a 10% discount did not modify the results substantially, but showed a decrease in the ICER of cladribine versus natalizumab (ICER $29,833/QALY). IMPLICATIONS: Cladribine is a new oral alternative to treat patients with HAD-MS that is expected to produce higher QALYs than all evaluated alternatives. In the context of a conservative analysis, cladribine cannot be considered cost effective for the Chilean health care public sector using a 1 GDP per capita threshold. However, under reasonable discount scenarios, cladribine becomes an attractive alternative for the health system.

Factores asociados al nivel de conocimiento sobre cuidados paliativos en estudiantes de medicina de una Universidad en Lima, Perú / Factors associated with the level of knowledge about palliative care in medical students at a university in Lima, Peru

Introducción: En el Perú, las facultades de medicina no cuentan con algún curso formal sobre Cuidados Paliativos. Objetivo: Determinar los factores asociados al nivel de conocimiento sobre Cuidados Paliativos en los estudiantes de medicina del sexto y séptimo año de la Universidad Ricardo Palma, durante el segundo semestre del año 2020. Metodología: Estudio observacional, transversal y analítico. La muestra fue de 139 estudiantes del sexto y séptimo año, quienes fueron encuestados con el Palliative Care Knowledge Test (PCKT) modificado por Ordoñez para estudiantes de medicina en Perú. El muestreo fue probabilístico, estratificado. Resultados: El 48.9% fueron alumnos de sexto año y el 51.1% de séptimo año. El 87.8% refirió no haber llevado algún curso electivo/rotación en Cuidados Paliativos. El nivel de conocimiento que predominó, fue el "intermedio" (61.9%) seguido de "bajo" (23.7%). Las variables sexo a predominio femenino (p=0.020), edad a predominio joven (p=0.017) y año de estudio a predominio sexto año (p=0.031) tuvieron asociaciones estadísticamente significativas con el nivel de conocimiento, la variable curso electivo/rotación previa sobre Cuidados Paliativos no mostró asociación significativa. Según la opinión/percepción de los estudiantes de medicina sobre la necesidad de formación y entrenamiento en Cuidados Paliativos, en pregrado: más de la mitad de la población considera esta inclusión como "muy necesaria", seguido de "necesaria". Conclusión: El Nivel de Conocimiento sobre Cuidados Paliativos que predomina en los estudiantes de medicina del sexto y séptimo año, es el nivel "intermedio" seguido de "bajo". Las variables sexo grupo femenino, edad grupo joven y año de estudio grupo sexto año, mostraron asociación significativa.

Introduction: In Peru, medical schools do not have any formal course on palliative care. Objective: To determine the factors associated with the level of knowledge about palliative care in medical students of the sixth and seventh year of Ricardo Palma University, during the second half of 2020. Methodology: Observational, cross-sectional and analytical study. The sample consisted of 139 sixth and seventh year students, who were surveyed with the Palliative Care Knowledge Test (PCKT) modified by Ordoñez for medical students in Peru. Sampling was probabilistic, stratified. Results: 48.9% were sixth year students and 51.1% were seventh year students. 87.8% reported not having taken an elective/rotation course in Palliative Care. The prevailing level of knowledge was "intermediate" (61.9%) followed by "low" (23.7%). In addition, the variables sex predominantly female(p = 0.020), age predominantly young (p = 0.017) and year of study predominantly sixth year(p = 0.031) had statistically significant associations with the level of knowledge, the variable elective course / previous rotation on Palliative Care did not show a significant association. According to the opinion / perception of medical students about the need for education and training in Palliative Care, undergraduate: about half of the population considers this inclusion as "very necessary", followed by "necessary". Conclusion: The Level of Knowledge about Palliative Care that predominates in sixth and seventh year students is the "intermediate" level followed by "low". The variables sex female group, age young group and year of study sixth year group showed a significant association.

Cost-Effectiveness Analysis of Total Neoadjuvant Therapy Followed by Radical Resection Versus Conventional Therapy for Locally Advanced Rectal Cancer.

BACKGROUND: Definitive surgery with total mesorectal excision is the mainstay of treatment for locally advanced rectal cancer. Multimodality therapy improves long-term survival. Current standards advise neoadjuvant chemoradiation followed by radical surgery and adjuvant chemotherapy. Nationally, compliance with adjuvant chemotherapy is only 32%. New research evaluates the effectiveness of total neoadjuvant therapy: complete chemotherapy and chemoradiation before surgery. OBJECTIVE: The aim of this study is to determine the favored treatment for locally advanced rectal cancer by comparing the cost-effectiveness of total neoadjuvant therapy and the current standard of care. DESIGN: Decision analytical modeling using long-term costs and 5-year disease-free survival was performed to determine the cost-effectiveness after total neoadjuvant therapy and the current standard of care. Sensitivity analysis was used to investigate the effect of uncertainty in model parameters. SETTINGS: Centers for Medicare & Medicaid Services billing data perspective was adopted and outcomes modeled according to local and national databases and literature consensus. PATIENTS: Adult patients with stage II or III rectal cancer were selected. MAIN OUTCOME MEASURES: Cost-effectiveness in disease-free life-years, incremental cost-effectiveness ratio, and net monetary benefit were determined over a 5-year posttreatment period. The favored strategy was determined based on cost-effectiveness and sensitivity analyses. RESULTS: Cost-effectiveness for total neoadjuvant therapy was 40,708 $/life-year, and, for conventional therapy, cost-effectiveness was 44,248 $/life-year. Sensitivity analysis showed that, for an estimated total neoadjuvant therapy completion rate of 90%, total neoadjuvant therapy would remain the dominant strategy for any adjuvant chemotherapy completion rate of less than 93%. LIMITATIONS: The samples used to calculate completion rates are small, and survival probabilities are based on existing literature, local database values, and consensus estimates. The model encompasses a 5-year time period from diagnosis. CONCLUSIONS: Cost-effectiveness analysis shows that a strategy of total neoadjuvant therapy followed by radical surgery is favored over the current standard of care for locally advanced rectal cancer. Sensitivity analysis shows that a low rate of adjuvant chemotherapy administration plays a key role in decreasing the cost-effectiveness of the current standard of care. See Video Abstract at http://links.lww.com/DCR/A942.

Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome.

PURPOSE: To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS: A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS: Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION: Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.

The cost-utility of school-based first permanent molar sealants programs: a Markov model.

BACKGROUND: Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention. METHODS: A cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer's perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out. RESULTS: After a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The "seal all" strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the "seal all" strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR. CONCLUSIONS: A school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.