Frecuencia de depresión y calidad de vida en pacientes con diabetes mellitus en establecimientos de salud pública de Lima Metropolitana / Frequency of depression and quality of life in patients with diabetes mellitus in public health facilities in metropolitan Lima

RESUMEN Introducción: La diabetes es una de las principales pandemias en los últimos anos. Su asociación con depresión incrementa el riesgo de mortalidad y morbilidad. La coexistencia de ambas patologías produce un mal manejo de la diabetes, lo que conlleva a una peor calidad de vida. Objetivo: Determinar la frecuencia de depresión en pacientes con diabetes mellitus y el efecto que tienen ambas patologías sobre la calidad de vida en pacientes que acuden de forma ambulatoria a establecimientos de salud públicos de Lima y Callao. Métodos: Análisis secundario de la base de datos del Estudio Epidemiológico de Salud Mental de depresión en adultos diabéticos. El instrumento empleado para determinar el episodio depresivo fue el MINI (Entrevista Neuropsiquiátrica Internacional) mientras que la calidad de vida fue medida empleando el Índice de Calidad de Vida de Mezzich. Se obtuvo información de diagnóstico de diabetes tipo1ó2del registro médico diario (HIS) de atención. Resultados: La frecuencia de depresión en los 471 pacientes con diabetes fue 5,8% en las últimas dos semanas. Mientras que la frecuencia anual fue 8,6% y en algún momento de la vida 31,8%. Ser mujer se asoció con mayor frecuencia de depresión. La calidad de vida fue menor en los pacientes con diabetes y depresión (p<0,005). Conclusiones: La frecuencia de depresión en pacientes con diabetes que son atendidos en forma ambulatoria en centros de salud públicos es mayor a la población general y su calidad de vida se ve reducida significativamente, lo que plantea la necesidad de considerar la depresión como un factor aditivo a la carga de morbilidad de esta condición.

ABSTRACT Introduction: Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life. Objective: To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao. Methodology: Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care. Results: The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p < 0.005). Conclusions: The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Frequency of depression and quality of life in patients with diabetes mellitus in public health facilities in Metropolitan Lima.

INTRODUCTION: Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life. OBJECTIVE: To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao. METHODOLOGY: Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care. RESULTS: The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p < 0.005). CONCLUSIONS: The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Acute Altitude Acclimatization in Young Healthy Volunteers: Nocturnal Oxygenation Increases Over Time, Whereas Periodic Breathing Persists.

Ju, Jia-Der, Cristian Zhang, Francis P. Sgambati, Lidia M. Lopez, Luu V. Pham, Alan R. Schwartz, and Roberto A. Accinelli. Acute altitude acclimatization in young healthy volunteers: nocturnal oxygenation increases over time whereas periodic breathing persists. High Alt Med Biol. 22:14-23, 2021. Study Objectives: This study aimed to examine the acute effects of high altitude (HA) on sleep disordered breathing (sleep apnea and nocturnal hypoxemia) and acute mountain sickness and to characterize acclimatization over time. Methods: Ten native lowlanders residing at sea level (SL) completed the Lake Louise Score (LLS) and underwent nocturnal polygraphy (ApneaLink Plus) for nine consecutive nights (N1-N9) at HA (2,761 m) and two nights before and after HA. Nocturnal oxygen profiles were assessed by measuring the mean nocturnal oxyhemoglobin saturation (SpO2) during sleep, and sleep apnea severity as assessed by measuring the Apnea-Hypopnea Index (AHI). Mixed-effects linear regression was used to model responses in outcomes (mean nocturnal SpO2, logAHI, and LLS) between HA and SL. Changes in SpO2 and AHI were examined in subgroups with mild versus marked nocturnal SpO2 and low versus high AHI during exposure to HA and compared between subgroups. Results: Compared with SL, the mean nocturnal SpO2 was lower (p < 0.0001) and AHI was higher (p < 0.0001) at HA. The mean nocturnal SpO2 increased progressively (p < 0.001), whereas AHI remained high (p < 0.978) and relatively unchanged over nine successive nights at HA. Those with markedly reduced SpO2 upon arrival at HA exhibited progressive increases in the mean nocturnal SpO2 over time at HA compared with those with mild nocturnal desaturation. LLS rose at HA, but no differences were observed between subgroups. Conclusions: In healthy HA sojourners, the mean nocturnal SpO2 increased progressively over time, whereas AHI remained elevated, suggesting distinctive phenotypes and acclimatization responses to HA.

[The electronic cigarette: an emerging public health problem]. / El cigarrillo electrónico: un problema de salud pública emergente.

Since 2004, the electronic cigarette (EC) is available, a device that heats nicotine and administers it as part of a vapor. We present a narrative review of the EC and its effect on health. Its use is to stop smoking, in which the evidence is low, and ends up being used at the same time as the cigarette they could not quit. In addition, those who never smoked, mainly teenagers and young people, begin consumption. Its use rais es the levels of nicotine, particles, volatile organic compounds, polycyclic aromatic hydrocarbons, carbo nyls and metals such as aluminum. In vitro, the EC causes inflammation, oxidative stress and is toxic to multiple cell types, including lung, endothelial and stem cells. Produces increased susceptibility to viral and bacterial infections. Compared to cigarettes, the EC produces a larger and more intense number of deleted genes. At bronchoscopy the airways are friable and erythematous, and the bronchial epithelium with a differentiated protein expression. It has been associated with cough, bronchitis symptoms and the respiratory failure by pneumonitis epidemic that has led several dozen people to death. Because of its harmful effects, the EC should only be used by medical prescription, as a measure to help quit tobacco, and its use in indoor and public environments be prohibited. As the EC components responsible for the associated deaths have not been determined, their use should be banned until these factors are known.

Desde el 2004 se dispone del cigarrillo electrónico (CE), dispositivo que calienta nicotina y la administra formando parte de un vapor. Presentamos una revisión narrativa del CE y su efecto en la salud. Su uso es para dejar de fumar, en lo que la evidencia es baja, terminando usándolo a la vez que el cigarrillo que no pudieron dejar. Además, los que nunca fumaron, principalmente adolescentes y jóvenes, se inician en su consumo. Su uso eleva en el aire los niveles de nicotina, partículas, compuestos orgánicos volátiles, hidrocarburos aromáticos policíclicos, carbonilos y metales como aluminio. In vitro el CE causa infla mación, estrés oxidativo y es tóxico para múltiples tipos de células, incluyendo células pulmonares, en doteliales y células madre. Produce incremento de la susceptibilidad a infecciones virales y bacterianas. Comparado con cigarrillos, el CE produce un número mayor y más intenso de genes suprimidos. A la broncoscopia las vías aéreas están friables y eritematosas, y el epitelio bronquial con expresión diferen ciada de proteínas. Se le ha asociado con tos, síntomas de bronquitis y con la epidemia de insuficiencia respiratoria por neumonitis que ha llevado a varias decenas de personas a la muerte. Por sus efectos dañinos el CE debería solo usarse por prescripción médica, como una medida para ayudar a dejar el tabaco, y estar prohibido su uso en interiores y ambientes públicos. Como no se han determinado los componentes del CE responsables de las muertes asociadas, su uso debería ser proscrito hasta que se conozcan cuáles son estos factores.

El cigarrillo electrónico: un problema de salud pública emergente / The electronic cigarette: an emerging public health problem

RESUMEN Desde el 2004 se dispone del cigarrillo electrónico (CE), dispositivo que calienta nicotina y la administra formando parte de un vapor. Presentamos una revisión narrativa del CE y su efecto en la salud. Su uso es para dejar de fumar, en lo que la evidencia es baja, terminando usándolo a la vez que el cigarrillo que no pudieron dejar. Además, los que nunca fumaron, principalmente adolescentes y jóvenes, se inician en su consumo. Su uso eleva en el aire los niveles de nicotina, partículas, compuestos orgánicos volátiles, hidrocarburos aromáticos policíclicos, carbonilos y metales como aluminio. In vitro el CE causa infla mación, estrés oxidativo y es tóxico para múltiples tipos de células, incluyendo células pulmonares, en doteliales y células madre. Produce incremento de la susceptibilidad a infecciones virales y bacterianas. Comparado con cigarrillos, el CE produce un número mayor y más intenso de genes suprimidos. A la broncoscopia las vías aéreas están friables y eritematosas, y el epitelio bronquial con expresión diferen ciada de proteínas. Se le ha asociado con tos, síntomas de bronquitis y con la epidemia de insuficiencia respiratoria por neumonitis que ha llevado a varias decenas de personas a la muerte. Por sus efectos dañinos el CE debería solo usarse por prescripción médica, como una medida para ayudar a dejar el tabaco, y estar prohibido su uso en interiores y ambientes públicos. Como no se han determinado los componentes del CE responsables de las muertes asociadas, su uso debería ser proscrito hasta que se conozcan cuáles son estos factores.

ABSTRACT Since 2004, the electronic cigarette (EC) is available, a device that heats nicotine and administers it as part of a vapor. We present a narrative review of the EC and its effect on health. Its use is to stop smoking, in which the evidence is low, and ends up being used at the same time as the cigarette they could not quit. In addition, those who never smoked, mainly teenagers and young people, begin consumption. Its use rais es the levels of nicotine, particles, volatile organic compounds, polycyclic aromatic hydrocarbons, carbo nyls and metals such as aluminum. In vitro, the EC causes inflammation, oxidative stress and is toxic to multiple cell types, including lung, endothelial and stem cells. Produces increased susceptibility to viral and bacterial infections. Compared to cigarettes, the EC produces a larger and more intense number of deleted genes. At bronchoscopy the airways are friable and erythematous, and the bronchial epithelium with a differentiated protein expression. It has been associated with cough, bronchitis symptoms and the respiratory failure by pneumonitis epidemic that has led several dozen people to death. Because of its harmful effects, the EC should only be used by medical prescription, as a measure to help quit tobacco, and its use in indoor and public environments be prohibited. As the EC components responsible for the associated deaths have not been determined, their use should be banned until these factors are known.

Frequency of Depression and Quality of Life in Patients with Diabetes Mellitus in Public Health Facilities in Metropolitan Lima. / Frecuencia de depresión y calidad de vida en pacientes con diabetes mellitus en establecimientos de salud pública de Lima Metropolitana.

INTRODUCTION: Diabetes is one of the main pandemics in recent years. Its association with depression increases the risk of mortality and morbidity. The coexistence of both diseases leads to poor management of diabetes, which leads to a worse quality of life. OBJECTIVE: To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao. METHODOLOGY: Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults. The instrument used to determine the depressive episode was the MINI (Mini-International Neuropsychiatric Interview) while quality of life was measured using the Mezzich Quality of Life Index. Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record (HIS) of care. RESULTS: The frequency of depression in the 471 patients with diabetes was 5.8% in the last two weeks. While the annual frequency was 8.6% and 31.8% at some point in life. Being a woman was associated with a greater frequency of depression. Quality of life was lower in patients with diabetes and depression (p <0.005). CONCLUSIONS: The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced, which raises the need for considering depression as an additional factor to the burden of morbidity of this condition.

Solid fuel use is associated with anemia in children.

Over 3 billion people use solid fuels as a means of energy and heating source, and ~ 50% of households burn them in inefficient, poorly ventilated stoves. In 2010, ~ 43% of the 640 million preschool children in 220 countries suffered from a certain degree of anemia, with iron deficiency as the main cause in developed countries whereas its causes remained multifactorial in the undeveloped group. In this study, we explore the relations of country-wide variables that might affect the people's health status (from socioeconomic status to more specific variables such as water access). We found independent relationship between solid fuel use and anemia in children under five years old (p < 0.0001), taking into account the prevalence of anemia in pregnant woman and the access to improved water sources. Countries in which the population uses solid fuel the most have over three times higher anemia rates in children than countries with the lowest prevalence of solid fuels use. There is still a complex relationship between solid fuels use and anemia, as reflected in its worldwide significance (p < 0.05) controlled for measles immunization, tobacco consumption, anemia in pregnant mothers, girl's primary education, life expectancy and improved water access but not (p > 0.05) when weighing for sanitation access or income per capita.

Ecological study on solid fuel use and pneumonia in young children: A worldwide association.

BACKGROUND AND OBJECTIVE: Pneumonia constitutes one of the major causes of worldwide mortality in young children. Poverty has been traditionally assigned as the underlying factor accounting for these trends. However, the independent role of solid fuel use yielding biomass pollution on pneumonia rates among young children has not been extensively examined. METHODS: Independent socio-economic variables, and the percentage of solid fuel use, tobacco consumption, improved water access source and sanitation facilities were extracted for each country from the available public databases. Multivariate regression analyses were performed to assess potential associations between these recognized risk factors and country pneumonia incidence in young children <5 years of age. RESULTS: Multivariate linear regression analyses yielded two models that accounted for approximately 87% of the variance, and included solid fuel use, tobacco consumption, sanitation access, measles immunization, life expectancy, access to electricity and the Human Development Index (HDI) as being independently associated with the number of annual pneumonia cases per child <5 years of age. CONCLUSION: In this ecological study, current country rates of pneumonia among young children are independently associated with the use of solid fuels. We postulate that interventions aimed at reducing indoor solid fuel biomass pollution through implementation of efficient stoves will translate into meaningful decreases in child mortality and morbidity.

Caregiver perception of sleep-disordered breathing-associated symptoms in children of rural Andean communities above 4000 masl with chronic exposure to biomass fuel.

BACKGROUND: Previous studies have uncovered a very high prevalence of sleep disorders in general, and of sleep-disordered breathing in particular among children exposed to indoor biomass fuel pollution. However, despite the significant symptomatology, parents are unlikely to report these issues during health-care visits. OBJECTIVE: The objective of this study was to determine whether reduced caregiver perception of sleep disorders may account for the infrequent diagnosis and treatment of such problems in children residing at high altitudes and exposed to high biomass pollution. METHODS: Parents of children aged 9-15 years of three communities residing in the Pasco region in Peru located between 3800 and 4200 meters above sea level were surveyed using a validated questionnaire instrument focused on symptoms associated with sleep-disordered breathing as well as whether caregivers perceived that their child suffered from a sleep disorder. RESULTS: Among the 77 children included, 48.1% had nocturnal awakenings and 46.8% had repetitive movements and restless sleep. Habitual snoring was present in 33.8% of all children. However, only 10.4% of mothers considered that their children had sleep problems, and all of their children had positive answers for ≥4 sleep symptoms. CONCLUSIONS: Children residing at high altitudes and exposed to traditional biomass-fueled stoves exhibit an extremely high frequency of sleep symptoms that are misperceived by their mothers as being "normal." Interventions aimed at increasing parental recognition and awareness of sleep problems will be essential to foster improved diagnosis and treatment.

Adherence to reduced-polluting biomass fuel stoves improves respiratory and sleep symptoms in children.

BACKGROUND: Symptoms of sleep apnea are markedly increased in children exposed to smoke from biomass fuels and are reduced by kitchen stoves that improve indoor biomass pollution. However, the impact of adherence to the use of improved stoves has not been critically examined. METHODS: Sleep-related symptom questionnaires were obtained from children <15 years of age in 56 families residing in the communities of Lliupapuquio, Andahuaylas province in Peru before and 2 years after installation of less-polluting Inkawasi cooking stoves. RESULTS: 82 children with lifetime exposures to indoor fuel pollution were included. When compared to those alternating between both types of stoves or those using traditional stoves only, those children who exclusively used Inkawasi cooking stoves showed significant improvements in sleep and respiratory related symptoms, but some minor albeit significant improvements occurred when both stoves were concomitantly used. CONCLUSIONS: Improvements in respiratory and sleep-related symptoms associated with elevated indoor biomass pollution occur only following implementation and exclusive utilization of improved kitchen stoves.

Effect of reductions in biomass fuel exposure on symptoms of sleep apnea in children living in the peruvian andes: a preliminary field study.

BACKGROUND: Multiple studies have evaluated the prevalence of sleep apnea in pediatric populations. Although environmental exposures to cigarette smoke (ECS) increase the risk of habitual snoring, no studies have thus far examined the potential contribution of indoor pollution in children. OBJECTIVE: To determine the frequency of symptoms associated with sleep apnea in children exposed to traditional wood-burning stoves to open fire, and assess whether symptoms subside following implementation of improved less environmentally contaminating stoves. METHODS AND MATERIALS: Residents of the communities of Chucllapampa, Sayhuapata, and Alparcuna in Cangallo province, department of Ayacucho, Peru were surveyed on two occasions within 12 months before and after the installation of an improved Inkawasi wood stove. The frequency of symptoms associated with sleep apnea was assessed in all children <15 years of age using a previously validated questionnaire. RESULTS: Parents of 59 children (62.7% males; mean age 7.76 ± 4.2 years) were interviewed representing >97% of the children in those small villages. The most common symptoms included nighttime awakenings, habitual snoring, repetitive movements during sleep, nasal congestion, and sore throat. After implementation of improved stoves in the homes, snoring (52.5% vs. 18.2%, P < 0.0001) nasal congestion (33.9% vs. 1.8%, P < 0.0001), behavioral hyperactivity (28.8% vs. 3.8%, P < 0.002), nighttime awakenings (42.4% vs. 1.7%, P < 0.0001), sore throat (38.2% vs. 5.5% P < 0.0001), breathing through the mouth during the day (33.9% vs. 1.8%, P < 0.001), daytime sleepiness (21.1% vs. 1.8%, P < 0.003), and falling asleep at school (14.6% vs. 0%, P < 0.03) were all significantly improved. CONCLUSIONS: Children exposed to traditional biomass fuel stoves had a higher frequency of symptoms related to sleep apnea, which decrease with improvements in biomass pollution.

OBSTRUCTIVE LUNG DISEASE AND EXPOSURE TO BURNING BIOMASS FUEL IN THE INDOOR ENVIRONMENT.

It is estimated that up to half of the world's population burns biomass fuel (wood, crop residues, animal dung and coal) for indoor uses such as cooking, lighting and heating. As a result, a large proportion of women and children are exposed to high levels of household air pollution (HAP). The short and long term effects of these exposures on the respiratory health of this population are not clearly understood. On May 9-11, 2011 NIH held an international workshop on the "Health Burden of Indoor Air Pollution on Women and Children," in Arlington, VA. To gather information on the knowledge base on this topic and identify research gaps, ahead of the meeting we conducted a literature search using PubMed to identify publications that related to HAP, asthma, and chronic obstructive pulmonary disease (COPD). Abstracts were all analyzed and we report on those considered by the respiratory sub study group at the meeting to be most relevant to the field. Many of the studies published are symptom-based studies (as opposed to objective measures of lung function or clinical examination etc.) and measurement of HAP was not done. Many found some association between indoor exposures to biomass smoke as assessed by stove type (e.g., open fire vs. liquid propane gas) and respiratory symptoms such as wheeze and cough. Among the studies that examined objective measures (e.g. spirometry) as a health outcome, the data supporting an association between biomass smoke exposure and COPD in adult women are fairly robust, but the findings for asthma are mixed. If an association was observed between the exposures and lung function, most data seemed to demonstrate mild to moderate reductions in lung function, the pathophysiological mechanisms of which need to be investigated. In the end, the group identified a series of scientific gaps and opportunities for research that need to be addressed to better understand the respiratory effects of exposure to indoor burning of the different forms of biomass fuels.