Estimating mortality and disability in Peru before the COVID-19 pandemic: a systematic analysis from the Global Burden of the Disease Study 2019.

Background: Estimating and analyzing trends and patterns of health loss are essential to promote efficient resource allocation and improve Peru's healthcare system performance. Methods: Using estimates from the Global Burden of Disease (GBD), Injuries, and Risk Factors Study (2019), we assessed mortality and disability in Peru from 1990 to 2019. We report demographic and epidemiologic trends in terms of population, life expectancy at birth (LE), mortality, incidence, prevalence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) caused by the major diseases and risk factors in Peru. Finally, we compared Peru with 16 countries in the Latin American (LA) region. Results: The Peruvian population reached 33.9 million inhabitants (49.9% women) in 2019. From 1990 to 2019, LE at birth increased from 69.2 (95% uncertainty interval 67.8-70.3) to 80.3 (77.2-83.2) years. This increase was driven by the decline in under-5 mortality (-80.7%) and mortality from infectious diseases in older age groups (+60 years old). The number of DALYs in 1990 was 9.2 million (8.5-10.1) and reached 7.5 million (6.1-9.0) in 2019. The proportion of DALYs due to non-communicable diseases (NCDs) increased from 38.2% in 1990 to 67.9% in 2019. The all-ages and age-standardized DALYs rates and YLLs rates decreased, but YLDs rates remained constant. In 2019, the leading causes of DALYs were neonatal disorders, lower respiratory infections (LRIs), ischemic heart disease, road injuries, and low back pain. The leading risk factors associated with DALYs in 2019 were undernutrition, high body mass index, high fasting plasma glucose, and air pollution. Before the COVID-19 pandemic, Peru experienced one of the highest LRIs-DALYs rates in the LA region. Conclusion: In the last three decades, Peru experienced significant improvements in LE and child survival and an increase in the burden of NCDs and associated disability. The Peruvian healthcare system must be redesigned to respond to this epidemiological transition. The new design should aim to reduce premature deaths and maintain healthy longevity, focusing on effective coverage and treatment of NCDs and reducing and managing the related disability.

Differential sperm expenditure reveals a possible role for post-copulatory sexual selection in a lekking moth.

Male reproductive success in the lesser wax moth Achroia grisella is strongly determined by pre-copulatory mate choice, during which females choose among males aggregated in small leks based on the attractiveness of ultrasonic songs. Nothing is known about the potential of post-copulatory mechanisms to affect male reproductive success. However, there is evidence that females at least occasionally remate with a second male and that males are unable to produce ejaculates quickly after a previous copulation. Here we investigated the effects of mating history on ejaculate size and demonstrate that the number of transferred sperm significantly decreased from first (i.e., virgin) to second (i.e., nonvirgin) copulation within individual males. For males of identical age, the number of sperm transferred was higher in virgin than in nonvirgin copulations, too, demonstrating that mating history, is responsible for the decrease in sperm numbers transferred and not the concomitant age difference. Furthermore, the number of transferred sperm was significantly repeatable within males. The demonstrated variation in ejaculate size both between subsequent copulations as well as among individuals suggests that there is allocation of a possibly limited amount of sperm. Because female fecundity is not limited by sperm availability in this system, post-copulatory mechanisms, in particular sperm competition, may play a previously underappreciated role in the lesser wax moth mating system.

Validation of the Turkish version of the Edinburgh Postnatal Depression Scale among women within their first postpartum year.

BACKGROUND: The aim of the study was to find out the validity and reliability of the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS) and to determine the optimum cut-off value for postnatal depression. METHOD: Validation of the Turkish version of the EPDS was conducted on a sample of 341 women who were within their first postpartum year. Structured Diagnostic Interview for DSM-IV Axis I Disorders was used as the gold standard test, and receiver operating characteristic analysis was used to evaluate test performance of the EPDS. RESULTS: The study of sensitivity, specificity and predictive values versus SCID-I indicated a cut-off score of 12.5 as the best (sensitivity: 75.5, specificity: 71.5). Positive predictive value was 30.3% and negative predictive value was 94.5%. Cronbach's alpha value was calculated as 0.72. CONCLUSIONS: It was concluded that: (1) values for the validity were respectable, but not excellent; (2) the scale needs to be improved for use in the Turkish population; and (3) the high prevalence of postnatal depression found in this study may be a function of the low validity of the test.

Attitudes of hospital staff toward mentally ill patients in a teaching hospital, Turkey.

UNLABELLED: The aim of this study was to examine the attitudes of hospital staff toward major mental diseases: schizophrenia and depression. Negative attitudes were common among all of the hospital staff, and were more common among academicians, resident physicians and nurses. Causes of attitude variations were discussed. BACKGROUND: Attitudes of hospital staff are important for admission, early diagnosis and treatment, and the rehabilitation process of mentally ill patients. AIMS: The main objective of this study was to investigate and compare hospital workers' attitudes toward and knowledge of schizophrenia and depression. METHODS: In 2001, a total of 160 hospital staff (40 academicians, 40 resident physicians, 40 nurses and 40 hospital employees) in a teaching hospital were interviewed with a questionnaire. The questionnaire included items about background information, a one-paragraph vignette, questions on social distance and expected burden, recognition of mental illness, hospitalization, prognostic outcome, and to whom and where the patient should be admitted. RESULTS: Although academicians, resident physicians, and nurses have sufficient knowledge about schizophrenia and depression, the frequency of their negative attitudes towards mentally ill subjects was more than that for uneducated hospital employees. CONCLUSIONS: It was commented that this difference might be as a result of negative effects of the medical education system.

Neuropsychological effects of low mercury exposure in dental staff in Erzurum, Turkey.

OBJECTIVE: To carry out measurements of the Hg levels and personal exposure in Turkish dental clinics, and to evaluate possible adverse effects on the CNS in dental personnel. SETTING: Five dental clinics (1 private, 4 public) in Erzurum, Turkey. SUBJECTS AND METHODS: 43, Hg vapour-exposed dental staff were examined and 43 hospital employees with no known exposure to Hg acted as the control group. Hg concentrations in plasma and urine were analysed by atomic absorption spectrophotometry. Possible effects on the central nervous system (CNS) were estimated by neuropsychological tests (Weschler Memory Scale-Revised (WMS-R) and Verbal Test of Memory Processes (VTMP)) and two self-administered questionnaires (Symptom Checklist-90-Revised (SCL-90-R) and Beck Depression Inventory (BDI)). RESULTS: The dental staff group had higher whole blood (B-Hg) and urine (U-Hg) Hg levels than the control group. The mean B-Hg value was 2.18 nmol/l and U-Hg was 1.17 nmol/mmol creatinine. U-Hg had an inverse relationship with logical memory (in WMS-R test) and total retention score (in VTMP test), and a positive relationship with increased scores of Anxiety and Psychoticism (in SCL-90-R). CONCLUSION: These results may represent long-term consequences of low Hg exposure. In dentistry, to decrease toxic effects, proper Hg hygiene should be practiced by all dental health care workers.