Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015.

INTRODUCTION: Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. METHODS: Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. RESULTS: Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition. CONCLUSIONS: There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.

Social determinants of mammography screening among women aged 50 to 59, Peru 2015.

Breast cancer (BC) screening could reduce its mortality; however, its access is influenced by societal forces. Our objective is to identify the social determinants associated with mammography screening (MS) in women aged 50 to 59 in Peru. In this cross-sectional analysis of the Peruvian Demographic Health Survey, 2015, MS within the past two years was evaluated through self-report. Prevalence for MS was 21.9% [95% CI: 18.9 to 25.1]. The average age was 54 years (s.d.: 2.5). The higher the socioeconomic status, the higher the prevalence of screening (3.2% vs 41.4% in extreme quintiles, p < .001). In the adjusted models, higher socioeconomic status (PR: 5.81, 95% CI: 2.28 to 14.79), higher education level (PR: 2.03, 95% CI: 1.30 a 3,15) and having health insurance from the Ministry of Health (PR: 2.21, 95% CI: 1.28 to 3.82) and EsSalud (PR: 4.37, 95% CI: 2.67 to 7.15), were positively associated with MS. Social inequalities in screening access exist and might translate into inequalities in cancer morbidity and mortality. The Peruvian government urgently needs to improve screening rates in these vulnerable populations.

Place of origin associated with depressive symptoms in health professionals performing social health service in Ancash, Peru, 2015.

INTRODUCTION: Health professionals performing their social health service (SHS) in rural communities could be at risk of developing depression. Moreover, those who migrate from farther places to perform their SHS could have an increased risk. The objective of this study was to evaluate the association between place of origin and the presence of depressive symptoms, in health professionals performing rural social health service (SHS) in Ancash, Peru. METHODS: This was a cross-sectional study. During April 2015, a survey was applied to health professionals performing SHS in the Peruvian Ministry of Health (MINSA) facilities in Ancash. The main outcome was the presence of depressive symptoms, defined as a score ≥2 points in the Patient Health Questionnaire-2. The main exposure was the place of origin, defined as the place where the subjects completed their undergraduate professional studies (Ancash, Lima city or others). Poisson regressions with robust variance were performed to calculate crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence interval (95%CI). RESULTS: From 573 health professionals performing their SHS in MINSA in Ancash, 347 were included in the study. The mean age was 27.2±4.5 years, 78.7% were women, and 14.7% scored positive for depressive symptoms. Those who had completed their undergraduate professional studies in Lima city had a higher prevalence of presence of depressive symptoms compared to those who did in Ancash (aPR=2.59, 95%CI=1.23-5.45). CONCLUSIONS: Those who completed their undergraduate professional studies in Lima had a higher prevalence of depressive symptoms than those who did in Ancash. Possible explanations include the difficulty in visiting family and friends, acculturation, and lack of Quechua language proficiency.

[Latin American medical students' appraisal on university scientific research training]. / Apreciación de estudiantes de medicina latinoamericanos sobre la capacitación universitaria en investigación científica.

BACKGROUND: Learning research skills should be a goal during undergraduate training of physicians. AIM: To identify Latin American medical students' appraisal on research skills university training. MATERIAL AND METHODS: A self-administered survey about experience in research, self-assessment of research skills, quality of training in the area received at the university and that importance of publishing as undergraduate students, was answered by 208 medical students aged 23 ± 3 years (54% male), attending a medical students congress. RESULTS: Seventy percent of respondents pertained to medical students' scientific societies and 34% had published in a scientific journal. Fifty two percent considered as good or very good the training level received at their universities on information retrieval and 45% considered good the training in research methodology. Thirty two percent considered as poor or none the training received in scientific writing and 37% in the publishing process. Eighty nine percent considered student publishing as important and 61% perceived limitations in this matter. CONCLUSIONS: The university training level received by Latin American medical students on research and publication process was evaluated as deficient by these students.

Association between breastfeeding duration and educational achievement in England: results from the Millennium Cohort Study.

OBJECTIVE: To evaluate the association between breastfeeding duration and educational outcomes at the end of secondary education among children from the Millennium Cohort Study. DESIGN: Cohort study comparing school results at age 16 according to breastfeeding duration. SETTING: England. PARTICIPANTS: Children born in 2000-2002 (nationally representative sample). EXPOSURE: Self-reported breastfeeding duration (categorised). MAIN OUTCOME MEASURES: Standardised school assessments taken at the end of secondary education (General Certificate of Secondary Education (GCSEs), marked 9-1) in English and Mathematics, categorised as: 'fail, marks <4', 'low pass, marks 4-6' and 'high pass, marks ≥7 (equivalent to A-A*)'. Additionally, overall achievement was measured using the 'attainment 8' score (adding the marks of eight GCSEs, English and Mathematics double weighted; 0-90). RESULTS: Approximately 5000 children were included. Longer breastfeeding was associated with better educational outcomes. For example, after full adjustment for socioeconomic markers and maternal cognitive ability, in comparison with children who were never breastfed, those who were breastfed for longer were more likely to have a high pass in their English and Mathematics GCSEs, and less likely to fail the English GCSE (but not the Mathematics GCSE). Additionally, compared with those never breastfed, those breastfed for at least 4 months had, on average, a 2-3 point higher attainment 8 score (coefficients: 2.10, 95% CI 0.06 to 4.14 at 4-6 months; 2.56, 95% CI 0.65 to 4.47 at 6-12 months and 3.09, 95% CI 0.84 to 5.35 at ≥12 months). CONCLUSIONS: A longer breastfeeding duration was associated with modest improvements in educational outcomes at age 16, after controlling for important confounders.

To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study.

BACKGROUND: Breastfeeding duration is associated with improved cognitive development in children, but it is unclear whether this is a causal relationship or due to confounding. This study evaluates whether the observed association is explained by socioeconomic position (SEP) and maternal cognitive ability. METHODS: Data from 7,855 singletons born in 2000-2002 and followed up to age 14 years within the UK Millennium Cohort Study were analysed. Mothers reported breastfeeding duration, and children's cognitive abilities were assessed at 5, 7, 11, and 14 years using validated measures. Standardised verbal (age 5 to 14) and spatial (age 5 to 11) cognitive scores were compared across breastfeeding duration groups using multivariable linear mixed-effects models (repeated outcome measures). RESULTS: At all ages, longer breastfeeding durations were associated with higher cognitive scores after accounting for the child's own characteristics. Adjustment for SEP approximately halved the effect sizes. Further adjustment for maternal cognitive scores removed the remaining associations at age 5, but not at ages 7, 11 and 14 (e.g.: verbal scores, age 14; breastfed ≥12 months vs never breastfed: 0.26 SD; 95%CI: 0.18, 0.34). CONCLUSION: The associations between breastfeeding duration and cognitive scores persist after adjusting for SEP and maternal cognitive ability, however the effect was modest.

Disparities in scientific research activity between doctors and nurses working in the Peruvian health care system: Analysis of a nationally representative sample.

AIM: To evaluate disparities in the frequency of scientific activity between medical doctors and nurses in Peru. METHODS: We carried out a secondary data analysis of the National Health Services Users' Satisfaction Survey (ENSUSALUD), 2016. This nationally representative survey evaluates doctors and nurses working in clinical settings. We defined scientific activity as i) having published an original article (journal indexed in Web of Science, Scopus or Medline); and ii) having authored an abstract in a national or international conference. We estimated crude and adjusted disparities prevalence ratios (aDPR) and 95% confidence intervals (95%CI). RESULTS: We included 2025 doctors and 2877 nurses in the analysis; 71% of doctors doctor were male, and 93% of nurses were female (p<0.001). Among doctors, 13.9% had published an article, and 8.4% presented an abstract at a conference in the last two years, while these proportions were 0.6% and 2.5% for nurses, respectively. The adjusted models showed that doctors, when compared to nurses, were approximately 27 times likely to have published a paper (aDPR = 27.86; 95% CI 10.46 to 74.19) and twice as likely to have authored a conference abstract (aDPR = 2.51; 95% CI 1.39 to 4.53). CONCLUSIONS: There are important disparities in scientific activity between doctors and nurses working in clinical settings in Peru. Disparities are more significant for article publication than for authoring in conference abstracts. We suggest public policies that promote research dissemination between health professionals, with emphasis on nurses.

[Low publication of the papers presented at the Congresses of Gastroenterology Society of Peru 1998-2008]. / Baja publicación de los trabajos presentados a los Congresos de la Sociedad de Gastroenterología del Perú 1998-2008.

OBJECTIVES: To determine the proportion of abstracts presented at the Congreso Peruano de Gastroenterología (the major Peruvian gastroenterological scientific meeting), that had been published in scientific journals, the date of publication and its associated factors. MATERIALS & METHODS: Longitudinal retrospective and analytic study; the publicationrate of all the abstracts presented in the biennial Congreso Peruano de Gastroenterología between 1998 and 2008 was assessed. Google Scholar engine was used. The searching strategy performed included: ("Study location" AND "population studied" AND "main outcome") AND (autor:First OR autor:Second OR autor:Last). Logistic regression was used, considering p<0.05 statistically significant. RESULTS: Publication rate was 8.2% (34/217), statistically significant differences were found among meeting years (p<0.001). There were also differences between study design, objectives (more in analytic studies) and measurement (more in longitudinal studies (p<0.001). 82.4% were published in the Revista de Gastroenterología del Perú. The median time for publication was 10.8±10.4 months; this variable and the meeting year, study type, journal of publication or accordance between the abstract and publication characteristic showed no statistical differences. The mean authors' number was 5.02±2.4; analytic studies have less authors than the descriptive ones (3.6 vs 6.1; p=0.012). CONCLUSION: The Congreso Peruano de Gastroenterología presents a low publication rate of the abstracts presented, which can be used as a quality indicator of the abstracts and the reviewing process.

Migration to study in medical schools of Peru. / Migración para estudiar en escuelas de medicina humana en Perú.

The aim of this study was to describe the frequency of migration to study medicine in Peru. We con ducted a secondary data analysis of the Red-LIRHUS study (2011-2012). We included 3 680 Peruvian students. Approximately, 23.2% migrated for medical school. Less than 1% were international migrants. We found a higher proportion of migrant students in Universities outside of Lima than in Universities in Lima (27.1% vs. 15.8%). There was also a higher proportion of migrants in private universities (28.3% vs. 16.0%) Migrant students were more likely to live alone (27.4% vs. 6.4%) and to report having failed a module/course (51.0% vs. 38.6%) compared to non-migrant students. It is necessary to evaluate potential interventions for the preservation of the well-being of people who migrate for their medical training.

Con el objetivo de caracterizar el perfil del estudiante de medicina migrante de primer y quinto año de 32 escuelas de medicina del Perú, se realizó un análisis secundario del estudio Red-LIRHUS (2011-2012). De los 3680 estudiantes peruanos incluidos, uno de cada cuatro (23,2%) fueron migrantes. Menos de 1% fueron migrantes internacionales. Hubo mayor proporción de estudiantes migrantes en universidades de provincias que en universidades de Lima (27,1% vs. 15,8%). Asimismo, hubo mayor proporción de migrantes en universidades privadas (28,3% vs. 16,0%). Los estudiantes migrantes tenían mayor proba bilidad de vivir solos (37,4% vs. 6,4%) y de haber desaprobado cursos (51,0% vs. 38,6%) en comparación con los estudiantes no migrantes. Es necesario evaluar potenciales intervenciones para la preservación del bienestar de las personas que migran para su formación médica.

Clinical and Serological Findings of Madariaga and Venezuelan Equine Encephalitis Viral Infections: A Follow-up Study 5 Years After an Outbreak in Panama.

BACKGROUND: Human cases of Madariaga virus (MADV) infection were first detected during an outbreak in 2010 in eastern Panama, where Venezuelan equine encephalitis virus (VEEV) also circulates. Little is known about the long-term consequences of either alphavirus infection. METHODS: A follow-up study of the 2010 outbreak was undertaken in 2015. An additional survey was carried out 2 weeks after a separate 2017 alphavirus outbreak in a neighboring population in eastern Panama. Serological studies and statistical analyses were undertaken in both populations. RESULTS: Among the originally alphavirus-seronegative participants (n = 35 of 65), seroconversion was observed at a rate of 14.3% (95% CI, 4.8%-30.3%) for MADV and 8.6% (95% CI, 1.8%-23.1%) for VEEV over 5 years. Among the originally MADV-seropositive participants (n = 14 of 65), VEEV seroconversion occurred in 35.7% (95% CI, 12.8%-64.9%). In the VEEV-seropositive participants (n = 16 of 65), MADV seroconversion occurred in 6.3% (95% CI, 0.2%-30.2%). MADV seroreversion was observed in 14.3% (95% CI, 1.8%-42.8%) of those who were originally seropositive in 2010. VEEV seroconversion in the baseline MADV-seropositive participants was significantly higher than in alphavirus-negative participants. In the population sampled in 2017, MADV and VEEV seroprevalence was 13.2% and 16.8%, respectively. Memory loss, insomnia, irritability, and seizures were reported significantly more frequently in alphavirus-seropositive participants than in seronegative participants. CONCLUSIONS: High rates of seroconversion to MADV and VEEV over 5 years suggest frequent circulation of both viruses in Panama. Enhanced susceptibility to VEEV infection may be conferred by MADV infection. We provide evidence of persistent neurologic symptoms up to 5 years following MADV and VEEV exposure.

Endemic and Epidemic Human Alphavirus Infections in Eastern Panama: An Analysis of Population-Based Cross-Sectional Surveys.

Madariaga virus (MADV) has recently been associated with severe human disease in Panama, where the closely related Venezuelan equine encephalitis virus (VEEV) also circulates. In June 2017, a fatal MADV infection was confirmed in a community of Darien Province. We conducted a cross-sectional outbreak investigation with human and mosquito collections in July 2017, where sera were tested for alphavirus antibodies and viral RNA. In addition, by applying a catalytic, force-of-infection (FOI) statistical model to two serosurveys from Darien Province in 2012 and 2017, we investigated whether endemic or epidemic alphavirus transmission occurred historically. In 2017, MADV and VEEV IgM seroprevalences were 1.6% and 4.4%, respectively; IgG antibody prevalences were MADV: 13.2%, VEEV: 16.8%, Una virus (UNAV): 16.0%, and Mayaro virus: 1.1%. Active viral circulation was not detected. Evidence of MADV and UNAV infection was found near households, raising questions about its vectors and enzootic transmission cycles. Insomnia was associated with MADV and VEEV infections, depression symptoms were associated with MADV, and dizziness with VEEV and UNAV. Force-of-infection analyses suggest endemic alphavirus transmission historically, with recent increased human exposure to MADV and VEEV in Aruza and Mercadeo, respectively. The lack of additional neurological cases suggests that severe MADV and VEEV infections occur only rarely. Our results indicate that over the past five decades, alphavirus infections have occurred at low levels in eastern Panama, but that MADV and VEEV infections have recently increased-potentially during the past decade. Endemic infections and outbreaks of MADV and VEEV appear to differ spatially in some locations of eastern Panama.

[Female authorship in the Revista Peruana de Medicina Experimental y Salud Publica: analysis for the period 1997-2017]. / Autoría femenina en la Revista Peruana de Medicina Experimental y Salud Pública: análisis del periodo 1997-2017.

OBJECTIVES.: To explore female authorship trends among the articles published in the Revista Peruana de Medicina Experimental y Salud Pública between 1997 and 2017, as well as its association with characteristics of the research teams. MATERIALS AND METHODS.: We conducted a bibliometric analysis. We evaluated time trends of several forms of female participation in authorship, including "privileged authorship roles" (first author, corresponding author and senior author) and the proportion of female authors (out of the total number of authors). We compared female authorship according to the participation of medical doctors and authors from non-Peruvian institutions. RESULTS.: We analysed 1606/1621 articles; 46.3% were original articles. 63.5% had at least one female author, whilst 92.8% had at least one male author. A woman was the first, corresponding or senior author in 29.6%, 27.8% and 26.9% of the articles, respectively. 33% of authors per article were female (median). These figures did not considerably vary between the start and end of the study period. For original articles, female authorship was less likely if medical doctors were listed in the privileged authorship roles and more likely, if authors from non-Peruvian institutions were. Editorial processing times were longer when a woman served a privileged authorship role. CONCLUSIONS.: Women served privileged authorship roles in less than a third of all articles. Apparently, these gaps have not improved over time. The composition of the research team predicts female authorship.

OBJETIVOS.: Explorar la participación femenina en la autoría de los artículos publicados en la Revista Peruana de Medicina Experimental y Salud Pública entre 1997 y 2017, y su asociación con características del equipo de investigación. MATERIALES Y MÉTODOS.: Estudio bibliométrico y analítico. Se evaluaron las tendencias en el tiempo de varias formas de participación femenina, incluyendo «roles privilegiados¼ de autoría (primer autor, autor corresponsal y autor senior), así como la proporción de mujeres respecto al total de autores. Se comparó la participación femenina de acuerdo a la participación de médicos(as) y autores de filiación extranjera. RESULTADOS.: Se analizaron 1606 artículos, 46,3% fueron originales/originales breves. El 63,5% tuvieron al menos una autora, mientras que 92,8% tuvieron al menos un autor varón. El 29,6%, 27,8% y 26,9% tuvieron a una mujer como primer autor, corresponsal o senior, respectivamente; 33% de autores por artículo fueron mujeres. Estas cifras variaron durante el periodo de estudio, pero no mostraron diferencias entre el inicio y el final del mismo. En artículos originales, la participación femenina fue menor si quien ocupaba los roles privilegiados de autoría era un médico(a) y mayor si era un autor de filiación extranjera. Los tiempos editoriales fueron mayores cuando había una mujer en una posición privilegiada de autoría. CONCLUSIONES.: Menos de un tercio de los artículos tuvo a una mujer en alguno de los roles privilegiados de autoría. Estas brechas, aparentemente, no han mejorado con el tiempo. La composición del equipo de investigación influye en la participación femenina en la autoría.

Publication of Abstracts with Peruvian Affiliation Presented to the Annual Meeting of the American Society of Tropical Medicine and Hygiene 2006-2010.

Peruvian research output is one of the lowest in South America and is limited to the work of a small group of institutions and related to few subjects, such as infectious diseases. We determined the proportion of subsequent publication and its associated factors of the abstracts with Peruvian affiliation presented to the American Society of Tropical Medicine and Hygiene annual meetings between 2006 and 2010. Approximately 27% (79/296) of abstracts were published within 6 years of presentation, with a median time to publication of 16 months (interquartile range: 9-28). In the adjusted analysis, abstracts with a higher proportion of authors from Peruvian institutions were less likely to be published (risk ratio: 0.5; 95% CI: 0.3-0.8). In conclusion, one of four of the analyzed abstracts was published. Even though this proportion is higher than that in other meetings in Peru and South America, publication rates -especially among Peruvian-only collaborations- still need to be improved.

Breaking a Vital Trust: Posting Photos of Patients on Facebook Among a Sample of Peruvian Medical Students.

Background: The doctor-patient relationship may be affected by the indiscriminate use of social media platforms. The aim of this study was to evaluate the content of the photos posted on medical students' Facebook accounts to determine whether they have posted private patient information and compare this to their self-reported behavior of posting such photos. Methods: We performed a cross-sectional study of medical students from a Peruvian private university. With their permission, we reviewed their Facebook accounts for the publication of photos or documents that included private patient information (face, name, diagnosis, medical exams). Those who allowed access to their Facebook accounts were also asked to complete an online survey. We assessed variables related to sociodemographic aspects, self reported Facebook use, and what type of private patient information they posted. Results: A total of 160/220 students joined the study, 59% were women, mean age: 20 years. 25.7% self-reported having posted private patient information in their Facebook profiles but we found such information on 33.1% of the students' pages. Of the pages where private patient information was found, in 94% of cases, the patients' faces were identifiable, and in 7.6%, the patients' real names appeared. However, only half of the students believed that the information in their Facebook post might affect or influence the doctor-patient relationship. Association with narcissism, gender, and account privacy was not found. Having uploaded more than 250 photos (OR:2.90; CI95%:1.14-7.39) and posting photos tagged with the location of a hospital (OR:4.02; CI95%:1.36-11.9) were associated with having posted photos containing private patient information. Conclusion: One out of three of medical students posted patients' private information on their personal Facebook profiles. Development, dissemination, and implementation of guidelines related to ethics in social media platforms are needed.

Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries.

The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.

[Prevalence and factors associated with over-the-counter antimicrobial purchases, Peru 2016]. / Prevalencia y factores asociados a la compra de antimicrobianos sin receta médica, Perú 2016.

OBJECTIVES: To describe the prevalence and factors associated with the purchase of antimicrobials without a prescription (CASRM) in drugstore/pharmacy users according to the National Health User Satisfaction Survey (ENSUSALUD). MATERIALS AND METHODS: A secondary analysis of ENSUSALUD 2016 was carried out; a study with two-stage probabilistic sampling in the Health Service Providers of the public and private subsector. The CASRM was evaluated by self-report. Crude (PR) and adjusted (PRa) prevalence ratios with 95% confidence intervals (95% CI) were estimated. RESULTS: The study included 1.165 users who purchased antimicrobials. The mean age was 38.0 years (standard deviation: 13.4). The prevalence of CASRM was 53.4% (95% CI: 48.0-58.8). The prevalence of CASRM in the highlands was (PRa 1.66, 95% CI 1.37-2.02) and in the jungle (PRa 1.61, 95% CI 1.31-1.99); and in pharmacy users (PRa 1.25, 95% CI 1.13-1.39). People with Comprehensive Health Insurance (SIS) had a lower prevalence of CASRM (RP 0.73, 95% CI 0.60-0.88). The prevalence was lower if the antimicrobial was for the spouse (RP 0.65, 95% CI 0.55-0.77) or child (RP 0.70, 95% CI 0.52-0.93). CONCLUSIONS: A 53.4% of drugstore/pharmacy users, who bought antimicrobials, did so without a doctor's prescription. The prevalence of CASRM was higher in the highlands and jungle and in pharmacy users, as well as lower in those who had SIS and those who bought for their spouse or child. We suggest reinforcing the interventions, mainly regulatory and educational, in the highlands and in the jungle, as well as, in the population not affiliated to a health insurance.

Objetivos. Describir la prevalencia y los factores asociados a la compra de antimicrobianos sin receta médica (CASRM) en usuarios de boticas/farmacias según la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD). Materiales y métodos. Se realizó un análisis secundario de la ENSUSALUD 2016; estudio con muestreo probabilístico bietápico en las Instituciones Prestadoras de Servicios de Salud del subsector público y privado. La CASRM se evaluó mediante autorreporte. Se estimaron las razones de prevalencia crudas (RP) y ajustadas (RPa) con intervalos de confianza al 95% (IC 95%). Resultados. Se incluyeron 1165 usuarios que compraron antimicrobianos. El promedio de edad fue 38,0 años (desviación estándar: 13,4). La prevalencia de CASRM fue 53,4% (IC 95%: 48,0-58,8). La prevalencia de CASRM en la sierra fue (RPa: 1,66; IC 95%: 1,37-2,02) y en la Selva (RPa: 1,61; IC 95%: 1,31-1,99); y en los usuarios de farmacias (RPa: 1,25; IC 95%: 1,13-1,39). Las personas con Seguro Integral de Salud (SIS) tuvieron menor prevalencia de CASRM (RPa: 0,73; IC 95%: 0,60-0,88). La prevalencia fue menor si el antimicrobiano era para el cónyuge (RPa: 0,65; IC 95%: 0,55-0,77) o el hijo(a) (RPa: 0,70; IC 95%: 0,52-0,93). Conclusiones. El 53,4% de usuarios de boticas/farmacias, que compraron antimicrobianos, lo hicieron sin receta médica. La prevalencia de CASRM fue mayor en la sierra y selva y en los usuarios de farmacias, así como menor en quienes contaban con SIS y quienes compraban para su cónyuge o hijo(a). Sugerimos reforzar las intervenciones, principalmente regulatorias y educativas, en la sierra y en la selva, así como, en la población no afiliada a un seguro de salud.

Association between a vegetarian diet and emotional symptoms: a cross-sectional study among adolescents in four developing countries.

BACKGROUND: Studies assessing the association between vegetarianism and mental health have found divergent results. Evidence from adolescents in developing countries is scarce. OBJECTIVE: To evaluate the association between a vegetarian diet and emotional symptoms in 15-year-old adolescents from Ethiopia, India, Peru and Vietnam. METHODS: A cross-sectional, secondary analysis of the Young Lives cohort study was used. The exposure variable was the self-report of being a vegetarian (yes or no). The outcome was the level of emotional symptoms, numerically evaluated using the score obtained in the subscale "Emotional Symptoms" of the Strengths and Difficulties Questionnaire (SDQ). We calculated crude and adjusted coefficients (ß) with 95% confidence intervals (95% CIs), using generalized linear models of the Gaussian family, considering each sentinel site as a cluster. The analysis was stratified by country. Additionally, we made a global analysis including the four countries. RESULTS: A total of 3484 adolescents were analyzed. The overall prevalence of vegetarianism was 4.4%, but it varied between countries (from 0.4% in Vietnam to 11.5% in India). The average emotional symptoms score was 3.5 [standard deviation (SD) 2.3] points. The scores were not statistically different between vegetarians and non-vegetarians (p > 0.05). In the adjusted analysis, in Vietnam, vegetarians had lower emotional symptoms scores on average than non-vegetarians [ß: -1.79; 95% CI: -3.05 to -0.55]. No differences were found neither in the other countries nor in the overall sample. CONCLUSION: There was no association between a vegetarian diet and emotional symptoms in the analyzed adolescents of four developing countries.