How appropriate is treating patients diagnosed with advanced esophageal cancer with anticancer drugs? A multicenter retrospective cohort Spanish study.

AIM: To assess the appropriateness of systemic oncological treatments (SOT) provided to patients diagnosed with advanced esophageal cancer (EC) across a group of participating hospitals. METHODS: Multicenter, retrospective cohort study in five Spanish hospitals including newly confirmed advanced EC cases between July 1, 2014, and June 30, 2016, with a 5-year follow-up. RESULTS: We identified 157 patients fulfilling the inclusion criteria (median age: 65 years, 85.9% males). Most patients, 125 (79.6%) were treated at least with one active treatment, and 33% received two or more lines of SOT. The 1-, 2- and 5-year overall survival rates were 30.3% [95%CI: 23.8, 38.7], 14.0% [95%CI: 9.3, 21.0], and 7.1% [95% CI: 3.8, 13.1] respectively, and the median survival time 8 months (95% CI: 6, 19) for stages IIIb IIIc and 7 months (95% CI: 5, 9) for stage IV. Clinical stage, receiving more than one line of SOT, and treatment with radiotherapy accelerated the time to death (0.4, 0.9-, and 0.8-times shorter survival respectively, p < 0.05). Better performance status (ECOG < 2) extended survival time by 2.2 times (p = 0.04). Age < 65 years (OR 9.4, 95% CI 3.2, 31.4, p < 0.001), and being treated in one particular hospital (OR 0.2, 95% CI 0.0, 0.8, p < 0.01) were associated with the administration of two or more lines of SOT. Altogether, 18.9% and 9.0% of patients received chemotherapy in the last four and two weeks of life, respectively. Moreover, 2.5% of patients were prescribed a new line of chemotherapy during the last month of life. The proportion of all patients who did not have access to palliative care reached 29.3%, and among those who had access to it, 34.2% initiated it in the last month of life. CONCLUSION: A high proportion of advanced EC patients receive many treatments not based on sound evidence and they do not benefit enough from palliative care services. The most accepted appropriateness indicators point out that some of the analyzed patients could have been overtreated. This study provides important insights into the quality of care provided to advanced EC, and furthermore, for giving valuable insight and opportunities for improvement.

Assessing the methodological strengths and limitations of the Spanish Society of Medical Oncology (SEOM) guidelines: a critical appraisal using AGREE II and AGREE-REX tool.

BACKGROUND: The Spanish Society of Medical Oncology (SEOM) has provided open-access guidelines for cancer since 2014. However, no independent assessment of their quality has been conducted to date. This study aimed to critically evaluate the quality of SEOM guidelines on cancer treatment. METHODS: Appraisal of Guidelines for Research and Evaluation II (AGREE II) and AGREE-REX tool was used to evaluate the qualities of the guidelines. RESULTS: We assessed 33 guidelines, with 84.8% rated as "high quality". The highest median standardized scores (96.3) were observed in the domain "clarity of presentation", whereas "applicability" was distinctively low (31.4), with only one guideline scoring above 60%. SEOM guidelines did not include the views and preferences of the target population, nor did specify updating methods. CONCLUSIONS: Although developed with acceptable methodological rigor, SEOM guidelines could be improved in the future, particularly in terms of clinical applicability and patient perspectives.

Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis.

While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.

Anticancer Drugs Compared to No Anticancer Drugs in Patients with Advanced Hepatobiliary Cancer: A Mapping Review and Evidence Gap Map.

Introduction: Despite being commonly recommended, the impact of anticancer drugs (ACDs) on patient-important outcomes beyond survival for advanced hepatobiliary cancers (HBCs) may not have been sufficiently assessed. We aim to identify and map the evidence regarding ACDs versus best supportive care (BSC) for advanced HBCs, considering patient-centered outcomes. Methods: In this mapping review, we included systematic reviews, randomized controlled trials, quasi-experimental, and observational studies comparing ACDs (chemotherapy, immunotherapy, biological/targeted therapy) versus BSC for advanced HBCs. We searched MEDLINE (PubMed), EMBASE (Ovid), Cochrane Library, Epistemonikos, PROSPERO and clinicaltrials.gov for eligible studies. Two reviewers performed the screening and data extraction processes. We developed evidence maps for each type of cancer. Results: We included 87 studies (60 for advanced liver cancer and 27 for gallbladder or bile duct cancers). Most of the evidence favored ACDs for survival outcomes, and BSC for toxicity. We identified several evidence gaps for non-survival outcomes, including quality of life or quality of end-of-life care. Discussion: Patient-important outcomes beyond survival in advanced HBCs are insufficiently assessed by the available evidence. Future studies need to address these gaps to better inform decision-making processes.

Latin American and the Caribbean Code Against Cancer 1st edition: Weight, physical activity, diet, breastfeeding, and cancer.

In Latin America and the Caribbean a considerable proportion of the population have excess body weight, do not meet the recommendations of physical activity and healthy diet, and have suboptimal rates of breastfeeding. Excess body weight is associated with at least 15 cancer sites, physical activity protects against three cancers, with some evidence suggesting a protective effect for eight more cancer sites, and sedentary behavior probably increases the risk of five cancer sites. Fiber and wholegrains protect against colorectal cancer, high intake of fruits and vegetables could reduce the risk of aerodigestive cancers; processed and red meat increase the risk of colorectal cancer; and very hot beverages are associated with esophageal cancer. Moreover, sugar-sweetened beverages and ultra-processed foods are a convincing cause for excess body weight, increasing cancer risk through this pathway, with some emerging evidence suggesting also direct pathways. Breastfeeding protects against breast cancer, and could protect against ovarian cancer. Taking this evidence into account, the Latin America and the Caribbean Code Against Cancer recommends the general public to maintain a healthy body weight, be physically active and limit sedentary behavior, eat a healthy diet (eat plenty of vegetables, fruits, wholegrains and legumes; avoid sugar-sweetened beverages and processed meat; and limit ultra-processed foods, red meat and very hot beverages), and breastfeed. Moreover, the Latin America and the Caribbean Code Against Cancer also includes a set of public policy recommendations for cancer prevention to inform policy makers and civil society about the need of policies to shape healthy environments and create opportunities to facilitate the adoption of the recommendations directed to the public.

Quality improvement intervention to increase colorectal cancer screening at the primary care setting: a cluster-randomised controlled trial.

BACKGROUND: Approximately 81% of deaths in Argentina are from chronic non-communicable diseases and 21% caused by cancer. Colorectal cancer (CRC) is the second most frequent cancer in Argentina. Even though CRC screening has been recommended for adults from 50 to 75 years old by using a faecal immunochemical test (FIT) annually, screening rates remain below 20% in the country. METHODS: We conducted an 18-month, two-arm, pragmatic cluster-randomised controlled trial evaluating the effect of a quality improvement intervention, based on the Plan-Do-Study-Act cycles, considering barriers and catalysts to articulate theory and practice, to increase CRC screening rates using FITs at primary care level. The study involved ten public primary health centres in Mendoza province, Argentina. The primary outcome measure was the rate of effective CRC screening. Secondary outcomes were the rate of participants with a positive FIT, tests with invalid results and the rate of participants referred for colonoscopy. RESULTS: Screening was effective in 75% of the participants in the intervention arm vs 54.2% in the control arm, OR 2.5 (95% CI 1.4 to 4.4, p=0.001). These results remained unchanged after adjusting for individual demographic and socioeconomic characteristics. Regarding secondary outcomes, the overall prevalence of positive tests was 17.7% (21.1% in the control arm and 14.7% in the intervention arm, p=0.3648). The overall proportion of participants with inadequate test results was 5.2% (4.9% in the control arm vs 5.5% in the intervention arm, p=0.8516). All the participants with positive tests were referred for colonoscopy in both groups. CONCLUSIONS: An intervention based on quality improvement strategies proved to be highly successful in increasing effective CRC screening in Argentina's primary care setting within the public healthcare system. TRIAL REGISTRATION NUMBER: NCT04293315.

Systemic Oncological Treatments versus Supportive Care for Patients with Advanced Hepatobiliary Cancers: An Overview of Systematic Reviews.

BACKGROUND: The trade-off between systemic oncological treatments (SOTs) and UPSC in patients with primary advanced hepatobiliary cancers (HBCs) is not clear in terms of patient-centred outcomes beyond survival. This overview aims to assess the effectiveness of SOTs (chemotherapy, immunotherapy and targeted/biological therapies) versus UPSC in advanced HBCs. METHODS: We searched for systematic reviews (SRs) in PubMed, EMBASE, the Cochrane Library, Epistemonikos and PROSPERO. Two authors assessed eligibility independently and performed data extraction. We estimated the quality of SRs and the overlap of primary studies, performed de novo meta-analyses and assessed the certainty of evidence for each outcome. RESULTS: We included 18 SRs, most of which were of low quality and highly overlapped. For advanced hepatocellular carcinoma, SOTs showed better overall survival (HR = 0.62, 95% CI 0.55-0.77, high certainty for first-line therapy; HR = 0.85, 95% CI 0.79-0.92, moderate certainty for second-line therapy) with higher toxicity (RR = 1.18, 95% CI 0.87-1.60, very low certainty for first-line therapy; RR = 1.58, 95% CI 1.28-1.96, low certainty for second-line therapy). Survival was also better for SOTs in advanced gallbladder cancer. No outcomes beyond survival and toxicity could be meta-analysed. CONCLUSION: SOTs in advanced HBCs tend to improve survival at the expense of greater toxicity. Future research should inform other patient-important outcomes to guide clinical decision making.

Systemic oncological treatments in patients with advanced pancreatic cancer: a scoping review and evidence map.

PURPOSE: To identify, describe, and organise currently available evidence regarding systemic oncological treatments (SOTs) (chemotherapy, targeted/biological therapies, and immunotherapy) compared to best supportive care (BSC) for patients with advanced pancreatic cancer (PC). METHODS: We conducted a scoping review and evidence mapping, adhering to PRISMA-ScR checklist. We searched MEDLINE, EMBASE, Cochrane Library, Epistemonikos, PROSPERO, and clinicaltrials.gov for eligible studies. We included systematic reviews (SRs), randomised controlled trials (RCTs), quasi-experimental, and observational studies evaluating SOTs compared to BSC or no treatment in patients with advanced PC. Two independent reviewers performed the screening process and data extraction. We developed evidence maps as an interactive visualization display, including the assessed interventions and outcomes. RESULTS: Of the 50,601 records obtained from our search, we included 43 studies: 2 SRs, 16 RCTs, 4 quasi-experimental studies, 20 observational studies, and 1 protocol for a quasi-experimental study. Forty-two studies reported survival-related outcomes and most favoured SOTs, while five reported toxicity and most favoured BSC. Other patient-centred outcomes, such as quality of life, were scarcely reported. CONCLUSIONS: This study highlights the current evidence gaps in studies assessing treatments for patients with advanced PC, mainly the lack of reports of non-survival-related outcomes, pointing out research areas that need further attention to make better recommendations for these patients.

Efficacy and Safety of Topical Application of Olive Oil for Preventing Pressure Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

The purpose was to identify and summarize the existing evidence on the efficacy and safety of the topical application of olive oil for preventing pressure ulcers (PUs). We included only randomized controlled trials (RCTs) involving patients at risk of developing PUs, testing the topical application of olive oil versus other products for PU prevention. We assessed the risk of bias using the RoB 2 tool, and the certainty of the evidence with GRADE. Four RCTs met the eligibility criteria. All studies were judged at a low risk of bias overall. The meta-analysis showed that the clinical efficacy of olive oil for prevention occurs by reducing the incidence of PUs (RR = 0.56, 95% CI = 0.30 to 0.79, I2 = 0%); with no differences in adverse effects, it may be associated with a shorter development time of PUs and shorter hospital stays. The certainty of the evidence assessed by the GRADE approach was moderate and low. The topical application of olive oil is effective and safe in reducing the incidence of PUs compared to other treatments. These findings could provide new insights into olive oil as a preventive and alternative treatment for PUs as it is accessible and inexpensive compared to other products.

European clinical practice guidelines on the use of chemotherapy for advanced oesophageal and gastric cancers: a critical review using the AGREE II and the AGREE-REX instruments.

PURPOSE: To assess the methodological quality of all relevant and recent European clinical practice guidelines (CPGs) for advanced oesophageal and gastric cancers, and to synthesise their recommendations on the use of chemotherapy. METHODS: We searched PubMed, EMBASE, guidelines repositories, and other sources from 2010 onwards. We appraised quality using AGREE-II and AGREE-REX. RESULTS: 11 CPGs were included (five high, five low, and one moderate quality). Most guidelines showed deficiencies in the domain "applicability", with only three scoring above 60%. Nine did not report having sought the views and preferences of the target population. The lowest scores for AGREE-REX were item Values and Preferences of Target Users (1.6; SD 1.3), and item Values and Preferences of Policy/Decision-Makers (1.8; SD 1.7). The domain Clinical Applicability got the highest score and the domain Implementability got the lowest. CONCLUSIONS: An urgent area of research is how to develop credible and implementable recommendations on the clinical use of CT for advanced oesophageal and gastric cancer. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42021236753).

Health Related Values and Preferences Regarding Meat Intake: A Cross-Sectional Mixed-Methods Study.

BACKGROUND: In addition to social and environmental determinants, people's values and preferences determine daily food choices. This study evaluated adults' values and preferences regarding unprocessed red meat (URM) and processed meat (PM) and their willingness to change their consumption in the face of possible undesirable health consequences. METHODS: A cross-sectional mixed-methods study including a quantitative assessment through an online survey, a qualitative inquiry through semi-structured interviews, and a follow-up assessment through a telephone survey. We performed descriptive statistics, logistic regressions, and thematic analysis. RESULTS: Of 304 participants, over 75% were unwilling to stop their consumption of either URM or PM, and of those unwilling to stop, over 80% were also unwilling to reduce. Men were less likely to stop meat intake than women (odds ratios < 0.4). From the semi-structured interviews, we identified three main themes: the social and/or family context of meat consumption, health- and non-health-related concerns about meat, and uncertainty of the evidence. At three months, 63% of participants reported no changes in meat intake. CONCLUSIONS: When informed about the cancer incidence and mortality risks of meat consumption, most respondents would not reduce their intake. Public health and clinical nutrition guidelines should ensure that their recommendations are consistent with population values and preferences.

Efficacy of systemic oncological treatments in patients with advanced pancreatic cancer at high risk of dying in the short or medium-term: overview of systematic reviews.

BACKGROUND: Patients with advanced pancreatic cancer (PC) have a high risk of dying in the short or medium-term. This overview aimed to assess the evidence regarding systemic oncological treatments (SOT) versus supportive care for advanced PC. METHODS: We searched for systematic reviews (SRs) in MEDLINE, Embase, The Cochrane Library, Epistemonikos, and PROSPERO. Two authors assessed eligibility independently. Data extraction and methodological quality assessment were conducted by one author and cross-checked by another one. We evaluated the overlap of primary studies, performed a de novo meta-analysis, and assessed the certainty of evidence. Primary outcomes were overall survival (OS), quality of life (QoL), functional status (FS), and toxicity. RESULTS: We identified three SRs that assessed SOT versus supportive care in patients with advanced PC. All SRs had critically low methodological quality. At 12 months, OS improved with chemotherapy, radiotherapy followed by chemotherapy, and immunotherapy, but the certainty of the evidence supporting these findings is very low. The evidence on chemotherapy is very uncertain about its effects on QoL; it suggests a slight increase in toxicity and little to no difference in FS. The evidence on immunotherapy is very uncertain about its effects in toxicity. CONCLUSIONS: The identified evidence is very uncertain about the benefits of oncological treatments on OS and QoL in patients with advanced PC with a high risk of dying in the short or medium-term, so its use should be proposed only to selected patients. Further studies that include a thorough assessment of patient-centred outcomes are needed.

Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines.

This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared with the standard of care. PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CRSwNP-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab-2, omalizumab-4, mepolizumab-2, and reslizumab-1) included 1236 adults, with follow-up of 20-64 weeks. Dupilumab reduces the need for surgery (NFS) or oral corticosteroid (OCS) use (RR 0.28; 95% CI 0.20-0.39, moderate certainty) and improves with high certainty smell evaluated with UPSIT score (mean difference (MD) +10.54; 95% CI +9.24 to +11.84) and quality of life (QoL) evaluated with SNOT-22 (MD -19.14; 95% CI -22.80 to -15.47), with fewer treatment-related adverse events (TAEs) (RR 0.95; 95% CI 0.89-1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95% CI 0.78-0.92, high certainty), decreases OCS use (RR 0.38; 95% CI 0.10-1.38, moderate certainty), and improves high certainty smell (MD +3.84; 95% CI +3.64 to +4.04) and QoL (MD -15.65; 95% CI -16.16 to -15.13), with increased TAE (RR 1.73; 95% CI 0.60-5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95% CI 0.64-0.94) and improving QoL (MD -13.3; 95% CI -23.93 to -2.67) and smell (MD +0.7; 95% CI -0.48 to +1.88), with increased TAEs (RR 1.64; 95% CI 0.41-6.50). The evidence for reslizumab is very uncertain.

A public-private collaborative model for a trauma program implementation: findings from a prospective trauma registry at 14 hospitals in Buenos Aires, Argentina.

INTRODUCTION: Trauma is a leading cause of mortality and comprises an important cause of functional impairment among young people worldwide. The trauma registry (TR) is an integral component of modern comprehensive trauma care systems. Nevertheless, TRs have not been yet established in most developing countries. The objective of this study was to summarize the challenges, results, and lessons learned from a trauma program including initial results from a TR at tertiary-care public hospitals of Buenos Aires, Argentina. MATERIAL AND METHODS: This is a descriptive study of the implementation of a trauma program in 14 hospitals and analysis of the initial results in the period between January 2010 and December 2018, using data from Fundación Trauma TR. Patients fitting injury definition that remained in hospital for more than 23 h were included. Injured patients were divided by age groups. Data on patients' demographics, mechanism of injury and severity, complications, treatments, and in-hospital mortality were analyzed between groups. A descriptive analysis is presented. RESULTS: There were 29,970 trauma cases during the study period. Median age was 23 years (RIC 12, 39) with a 2.4:1 male-to-female ratio. Road traffic injuries (RTI) were the leading mechanism (30.8%) of admission and head was the most frequently injured body region (33.2%). Two-thirds of RTIs were motorcycle-related. Overall in-hospital mortality was 6.1%. Intentional self-harm in adult males and burns in adult females had the highest mortality rates (17.6% and 17.9%, respectively). CONCLUSIONS AND DISCUSSION: The implementation of a trauma program within a public-private collaborative program in a resource-limited environment is feasible. The hospital-based TR can be used as a tool for injury surveillance, monitoring of the quality of trauma care, development of a trauma system, and to guide public health policies.

Metrics of Ideal Cardiovascular Health are Unequally Distributed between Peruvian Men and Women: Analysis of a National Population-Based Survey in 2017.

BACKGROUND: To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex. METHODS: An observational, cross-sectional study was conducted in 26,175 individuals aged 18-65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables. RESULTS: Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women (P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: -0.0817; men: -0.2699). CONCLUSIONS: Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.

A review of assessment indicators used by Healthy Municipalities and Communities Program in Latin America and the Caribbean region.

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O'Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145-152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school's curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.

Substance abuse in adolescents before admission to Peruvian juvenile detention centers: results from a national census in Peru, 2016.

OBJECTIVES: To estimate the prevalence of drug use before admission to juvenile detention centers (JDC) in Peru and determine individual, family and social influences on behavior. METHODS: A cross-sectional analysis was performed using data from the 2016 National Population Census in Juvenile Detention Centers (NPCJDC). A total of 1960 Peruvian adolescent offenders were included. Generalized linear models of the Poisson family with a log link function were used to determine if characteristics before admission to a JDC were associated with drug use. These characteristics included employment, depression, neighborhood gang activity, having friends with a criminal record, a history of multiple admissions to a JDC, a history of running away from home, physical abuse during childhood and family history of drug use and incarceration. RESULTS: More than half of young offenders reported using drugs before entering a JDC (59%) in Peru. The drug most frequently consumed was cannabis (86.6%), followed by cocaine and/or crack (11.6%), and inhalants and/or pills (1.8%). Smoking cigarettes [prevalence ratios (PR): 1.12, p = 0.003], using alcohol (PR: 1.22, p = 0.003), neighborhood gang activity (PR: 1.28, p < 0.001), having friends with a criminal record (PR: 1.62, p < 0.001), running away from home (PR: 1.20, p < 0.001) and a family history of incarceration (PR: 1.09, p = 0.010) were associated with drug use prior to admission to a JDC. CONCLUSION: Drug use before admission to a JDC was high among young offenders in Peru, with marijuana being the drug most frequently used. Having friends with a criminal record and neighborhood gang activity had the greatest association with drug use in young offenders.

[Changes in the prevalence of hypertension in Peru using the new guideline of the American College of Cardiology]. / ¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú.

INTRODUCTION AND OBJECTIVE: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017. METHODS: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI. RESULTS: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively). CONCLUSIONS: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.

Is anemia a public health problem among children under five years ago in Peru? Findings from a national healthcare administrative database (2012 and 2016) using Geographic Information Systems / ¿Es la anemia un problema de salud pública entre los menores de cinco años en el Perú? Análisis de una base de datos administrativa nacional de salud (2012 y 2016) empleando Sistemas de Información Geográfica

The objective of this study was to assess the change in the prevalence of anemia among under-five children attending public health services in Peru between 2012 and 2016, according to their place of residence, and to identify spatial clusters of districts with a high prevalence of anemia. An analytical cross-sectional study was carried out, based on data from the Nutritional State Information System from 2012 and 2016. We calculated the spatial autocorrelation of anemia prevalence at the district level using a global and local Moran's I index. The prevalence of anemia was 34.4% (2012) and 40.3% (2016). In 2012 and 2016, 41.7% and 46.5% of districts, respectively, had a prevalence of anemia considered a severe public health problem acording WHO criteria. Positive spatial autocorrelation was found between the prevalence of anemia and the districts for both years (2012 Moran's I: 0.22; 2016: 0.31, both p <0.001). Of the total number of districts, 8.3% (2012) and 12.6% (2016) presented a high prevalence of anemia and were also surrounded by districts with high prevalence. Anemia is a public health problem among children under five in Peru attending public health services and we identified areas with a higher concentration of anemia prevalence. Spatial patterns of anemia should be considered in the development and implementation of health interventions.

El objetivo del estudio fue evaluar la prevalencia de anemia en menores de cinco anos atendidos en servidos de salud públicos en Perú entre 2012-2016 e identificar conglomerados espaciales de distritos de alta prevalencia de anemia. Se realizó un estudio analítico de corte transversal, basado en los datos del Sistema de Información dei Estado Nutricional del Perú 2012 y 2016. La autocorrelación espacial de la prevalencia de anemia a nivel distrital se calculó utilizando el índice I de Moran global y local. Se encontro una prevalencia de anemia del 34.4% (2012) y 40.3% (2016), con41.7% (2012) y 46.5% (2016) de distritos con prevalencias de anemia consideradas como grave problema de salud pública según clasificación OMS. Se encontró una autocorrelación espacial positiva entre la prevalencia de anemia y los distritos (Moran's I 2012: 0.22; 2016: 0.31, ambos p <0.001), donde 8.3% (2012) y 12.6% (2016) de distritos con alta prevalencia se encontraban rodeados por distritos con alta prevalencia. La anemia es un problema de salud pública en menores de cinco años en el Perú atendidos en servicios de salud públicos. Existen áreas con mayor concentración de prevalencia de anemia. Los patrones espaciales de anemia deben considerarse en el desarrollo y la implementación de intervenciones de salud.

Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight.

INTRODUCTION: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families. STUDY DESIGN: Cluster randomized trial conducted between June 2013 and October 2016. SETTING/PARTICIPANTS: A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina. INTERVENTION: Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months. MAIN OUTCOME MEASURES: Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017. RESULTS: Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000). CONCLUSIONS: The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01834131.