Sociodemographic Inequalities in COVID-19 Booster Dose Vaccination Coverage: a Retrospective Study of 196 Provinces in Peru.

BACKGROUND: The COVID-19 vaccination coverage shows variability in booster doses between residency areas or ethnicity. The aim of this study was to evaluate how sociodemographic conditions influence unequal vaccination coverage with booster doses against COVID-19 in Peru. METHODS: A retrospective, ecological study with an evaluation of 196 provinces in Peru. The sociodemographic conditions were evaluated as sources of inequality (sex, age group, educational level, residence area, and ethnic group). The inequality measure used was the GINI, an index that show the inequal vaccination coverage with third and fourth booster doses against COVID-19 in Peruvians provinces. The index allow determinate a higher inequality when the value is near to 1, and a lower inequality when the value is near to 0. Also, the impact of each sociodemographic condition in the general inequality was evaluate with a decomposition analysis of GINI coefficient into Sk (composition effect), Gk (redistribution effect), Rk (differential effect). RESULTS: In provinces evaluated the mean vaccine coverage for the third and fourth booster doses was 57.00% and 22.19%, respectively at twelve months since the beginning of vaccination campaign. The GINI coefficient was 0.33 and 0.31, for the third and fourth booster doses coverage, respectively. In the decomposition analysis, twelve months after the start of the third and fourth dose vaccination campaign, revealed higher Sk values for people living in rural areas (Sk = 0.94 vs. Sk = 2.39, respectively for third and fourth dose), while higher Gk values for Aymara (Gk = 0.92 vs. Gk = 0.92, respectively), Quechua (Gk = 0.53 vs. Gk = 0.53, respectively), and Afro-Peruvians (Gk = 0.61 vs. Gk = 0.61, respectively). Also, higher negative correlation in Rk values for people with elementary education (Rk=-0.43 vs. Rk=-0.33, respectively), aged between 15 and 19 years (Rk=-0.49 vs. Rk=-0.37, respectively), and Aymara (Rk=-0.51 vs. Rk=-0.66, respectively). CONCLUSION: The rural residency area, lower education and Quechua, Aymara or Afro-Peruvians ethnicity determinated inequalities in vaccination coverage with booster doses against COVID-19 in Peruvian provinces.

Prison as a driver of recent transmissions of multidrug-resistant tuberculosis in Callao, Peru: a cross-sectional study.

Background: We sought to identify resistance patterns and key drivers of recent multidrug-resistant tuberculosis (MDR-TB) transmission in a TB-prevalent area in Peru. Methods: Cross-sectional study including MDR Mycobacterium tuberculosis complex (Mtbc) strains identified in Callao-Peru between April 2017 and February 2019. Mtbc DNA was extracted for whole genome sequencing which was used for phylogenetic inference, clustering, and resistance mutation analyses. Clusters indicative of recent transmission were defined based on a strain-to-strain distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). Epidemiologic factors linked to MDR-TB clustering were analyzed using Poisson regression. Findings: 171 unique MDR-Mtbc strains were included; 22 (13%) had additional fluoroquinolone resistance and were classified as pre-XDR. Six strains (3.5%) harboured bedaquiline (BDQ) resistance mutations and were classified as MDR + BDQ. 158 (92%) Mtbc strains belonged to lineage 4 and 13 (8%) to lineage 2. Using a cluster threshold of ≤5 SNPs, 98 (57%) strains were grouped in one of the 17 D5 clusters indicative of recent transmission, ranging in size from 2 to the largest cluster formed by 53 4.3.3 strains (group_1). Lineage 4.3.3 strains showed the overall highest cluster rate (43%). In multivariate analyses, current or previous imprisonment was independently associated with being part of any MDR-TB transmission clusters (adjusted prevalence ratio [aPR], 1.45; 95% CI, 1.09-1.92). Interpretation: Pre-XDR-TB emerged in more than 10% of the MDR-TB strains investigated. Transmission of 4.3.3 Mtbc strains especially of the dominant group_1 clone is a major driver of the MDR-TB epidemic in Callao. Current or previous imprisonment was linked to recent MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic. Funding: This work was supported in part by the ERANet-LAC Network of the European Union, Latin America and the Caribbean Countries on Joint Innovation and Research Activities, and FONDECYT. Additional support was received from Leibniz Science Campus Evolutionary Medicine of the Lung, the Deutsche Forschungsgemeinschaft (German Research Foundation, under Germany's Excellence Strategy-EXC 2167 Precision Medicine in Inflammation), and the Research Training Group 2501 TransEvo.

Prevalencia, manifestaciones clínicas y factores asociados al COVID-19 de larga duración / Prevalence, clinical manifestations, and associated factors of long COVID-19

El objetivo fue describir la prevalencia, las manifestaciones clínicas y los factores asociados de COVID-19 de larga duración. Se realizó una búsqueda bibliográfica de revisiones sistemáticas y metaanálisis sobre COVID-19 de larga duración en MEDLINE (vía PubMed) hasta el 7 de abril de 2022. Se encontraron 37 artículos y se incluyeron 3. La calidad de la evidencia fue evaluada a través de los criterios de AMSTAR 2. La prevalencia reportada de COVID-19 de larga duración fue 43% (IC95%: 39% ­ 46%). Las principales manifestaciones clínicas fueron debilidad (41% [IC95%: 25% ­ 59%]), malestar general (33% [IC95%: 15% ­ 57%]), fatiga (31% [IC95%: 24% ­ 39%]), alteración en la concentración (26% [IC95%: 21% ­ 32%]) y sensación de falta de aire (25% [IC95%: 18% ­ 34%]). Los factores asociados a COVID de larga duración incluyeron sexo femenino, severidad de cuadro inicial, edad y presencia de comorbilidades.

The aim was to describe the prevalence, clinical manifestations, and associated factors of long-COVID. Bibliographic research of systematic reviews and meta-analyses was carried out in MEDLINE (through PubMed) until April 7th, 2022. 37 articles were found and 3 were included. Evidence quality was assessed via AMSTAR 2 criteria. Long-COVID prevalence is 43% (IC95%: 39% ­ 46%). Main clinical manifestations were weakness (41% [IC95%: 25% ­ 59%]), malaise (33% [IC95%: 15% ­ 57%]), fatigue (31% [IC95%: 24% ­ 39%]), concentration impairment (26% [IC95%: 21% ­ 32%]), and breathlessness (25% [IC95%: 18% ­ 34%]). Factors associated with long COVID were female sex, initial disease severity, age, and presence of comorbidities.

COVID-19 case fatality rate and tuberculosis in a metropolitan setting.

In this study, we aimed to assess the relationship between tuberculosis case rate and COVID-19 case fatality rate (CFR) among districts within a tuberculosis-endemic metropolitan area. We analyzed data from 43 districts in Lima, Peru. We used districts as the units of observation. Linear regressions were used to investigate the relationship between COVID-19 CFRs and tuberculosis case rates. The mean COVID-19 CFR in each district for reporting Weeks 5-32 was used as the dependent variable. Independent variable was the mean rate of confirmed pulmonary tuberculosis cases for 2017-2019 period. Analyses were adjusted by population density, socioeconomic status, crowded housing, health facility density, and case rates of hypertension, diabetes mellitus, and HIV infection. The mean COVID-19 CFR in Lima was 4.0% ± 1.1%. The mean tuberculosis rate was 16.0 cases per 10,000 inhabitants. In multivariate analysis, tuberculosis case rate was associated with COVID-19 CFR (ß = 1.26; 95% confidence interval: 0.24-2.28; p = .02), after adjusting for potential confounders. We found that Lima districts with a higher burden of tuberculosis exhibited higher COVID-19 CFRs, independent of socioeconomic, and morbidity variables.

Características de la población peruana que no busca atención médica por deficiencias de la calidad de atención en salud en el periodo 2005-2015 / Characteristics of the Peruvian population that does not seek medical attention for the deficiencies the health care quality in the period 2005-2015

Introducción: Las deficiencias de la calidad de atención en salud son un problema de salud pública. Están considerados como una barrera para las mejoras de los indicadores nacionales en salud. En la actualidad existen numerosas investigaciones sobre calidad de atención pero fueron realizadas dentro de servicios hospitalarios. No se encontraron estudios en el país que evalúen las características de las personas que no buscaron atención por deficiencia de calidad de atención. Objetivo: Determinar las características de la población peruana que no buscó atención médica por deficiencias de calidad de atención en salud según el análisis de la base de datos de la ENAHO en el periodo 2005-2015. Metodología: Estudio cuantitativo, descriptivo, retrospectivo. Se utilizó como fuente de datos las bases de datos de la Encuesta Nacional de Hogares (ENAHO) en el periodo 2005-2015. Se consideró como deficiencia de calidad de atención a los casos de maltrato del personal de salud, demora de atención y lejanía del centro de salud. Resultados: Se encontró un aumento de la proporción de personas que no buscaron atención médica por deficiencia de calidad de atención en 90,0 por ciento, el aumento de la proporción por maltrato fue 368,4 por ciento, el aumento por demora en la atención aumentó en 320,2 por ciento y el aumento por lejanía fue 11 por ciento. La mayoría fueron mujeres, de edad comprendida entre 30 y 59 años, de educación primaria, residentes de zonas rurales, no pobres y afiliadas al Seguro Integral de Salud. Conclusiones: Se encontró un incremento de la proporción de la población peruana con un problema de salud que no buscó atención médica por deficiencia de calidad de atención. Es necesario mejorar los servicios de salud para una mejor atención a los pacientes.

Background: Deficiencies in the health care quality is a public problem. They are considered as a barrier to the improvement of national health indicators. Nowadays, there are a lot of research about care quality but were not made in hospital services. No studies were found in the country about characteristics of people who did not seek health attention because of care quality deficiency. Objective: Determine the characteristics of the Peruvian population who did not seek medical attention because of care quality deficiency according to the analysis of the database ENAHO in the period 2005-2015. Methodology: Quantitative, descriptive, retrospective. National Household Survey (ENAHO) in the period 2005-2015 was used as a data source. Cases of health worker abuse, delay care and remoteness was considered deficient quality of care clinic. Results: There is an increase in the proportion of people who did not seek medical attention because of care quality deficiency in 90.0 per cent. The increase of the proportion for mistreatment was 368.4 per cent, by delay in care increased by 320.2 per cent and by distance was increased by 11 per cent. The majority were women, aged between 30 and 59 years, primary education, rural residents, not poor and affiliated to the Seguro Integral de Salud (Health Insurance). Conclusions: Exist an increase in the proportion of the Peruvian population with health problems who did not seek health care because of care quality deficiency. It is necessary to improve health services for better patient care.

Ayahuasca: el encuentro de dos paradigmas / Ayahuasca: the meeting of two paradigms

La ayahuasca es una liana que crece en la Amazonía y con la cual se prepara una sustancia con potentes propiedades psicoactivas, también denominada ayahuasca. Esta sustancia está ligada con la cosmovisión de los pueblos amazónicos que la consideran una planta espiritual y medicinal por las visiones y percepción de los efectos que produce. Las investigaciones en laboratorio muestran que la ayahuasca contiene derivados betacarbolínicos como la harmina y derivados triptamínicos como la N,N-dimetiltriptamina (DMT), moléculas que intervienen en determinados fenómenos psicodislépticos de tipo alucinatorio -visiones de seres sobrenaturales- junto a alteraciones de la conciencia del yo descritas como una sensación de muerte y renacimiento que pueden llevan al usuario de la ayahuasca a un estado de éxtasis espiritual y bienestar. Estos efectos han sido descritos en la literatura y se ha considerado el potencial terapéutico de la ayahuasca frente a trastornos del estado de ánimo y problemas adictivos en los cuales se han reportado algunos resultados favorables. Sin embargo, los efectos psicoactivos que genera la ayahuasca son complejos debido a sus aspectos subjetivos, sociales y culturales y por consiguiente son difíciles de abordar objetivamente en el marco del paradigma científico actual. Por tales motivos resulta necesario el replanteamiento de formas alternativas de investigación que puedan interpretar la subjetividad presente en la experiencia psicoactiva por uso de ayahuasca.

Ayahuasca is a vine that grows in the Amazon, used to prepare a substance with high psychoactive properties also called ayahuasca. This substance is linked with the worldview of the Amazonian people who consider it a spiritual and medicinal plant due to the views and perceptions of the effects it produces. Laboratory research shows that ayahuasca contains ß-carbolinicderivates, such as harmineand tryptaminederivatives such as N,N-dimethyltryptamine (DMT), which are molecules involved in psychoactive processes related to visions of supernatural beings and the sense of death and rebirth that leads to a state of higher spirituality and wellness. These effects were studied to evaluate the therapeutic potential of ayahuasca in mood disorders and addictions, and favorable results were found. However, the psychoactive effects of ayahuasca are accompanied by subjective, social and cultural features which generate difficulties for an objective approach to the experience under the positivist paradigm. For these reasons it is necessary to rethink alternative forms of research that can interpret the subjectivity present in the psychoactive experience and, with it, a change in training and in the practice of medicine.

Procrastinación en el estudio: exploración del fenómeno en adolescentes escolarizados: Lima Metropolitana, Perú / Procrastination in learning: exploring the phenomenon among adolescent students: Metropolitan Lima, Peru

Objetivo: Explorar el fenómeno de la Procrastinación en el Estudio (PrE) y evaluar la asociación con apoyo familiar y uso de internet en adolescentes escolares. Estudio observacional, analítico de corte transversal. Se realizó un muestreo aleatorio, por conglomerados, con selección bietápica. Se incluyó a 292 estudiantes. Se evaluó el nivel de procrastinación en el estudio (PrE), mediante la ôEscala de la Procrastinación en el Estudioõ, el apoyo familiar mediante la ôEscala Multidimensional del Apoyo Social Percibidoõ y el uso de internet. La edad media de los entrevistados fue de 13.9 ± 1.7 años, siendo 66.1% varones. El puntaje promedio para PrE fue de 5.4 ± 3.1 puntos con un rango de 0 a 15. Al análisis bivariado, se encontró que la PrE se asocia significativamente con jornada de estudio, plan de vida, apoyo familiar y motivos de uso de internet. La PrE no es un fenómeno aislado a la vida del adolescente. Existe asociación significativa entre PrE y variables que en conjunto evidencian una mala administración del tiempo por parte de los adolescentes.

Aim: To explore the procrastination phenomenon in learning (PrL) and evaluate its association with family support and use of the Internet in teenagers. Methods: Analytic, observational and cross-sectional study. We conducted a randomized sampling by clusters, with two-stage selection. We assessed the level of procrastination in learning through "The Procrastination Scale in Learning ", family support through "Multidimensional Scale of Perceived Social Support" and Internet use by direct question. Results: The study included 292 students. The average age of respondents was 13.9±1.7 years, with 66.1% being males. The average score for PrL was 5.4±3.1 points with a range of 0 to 15. In the bivariate analysis, we found that PrL was significantly associated with study day, life plan, family support and reasons for Internet use. Conclusions: PrL is not an isolated phenomenon in the life of a teenager. Significant association between PrL and other variables has been found which shows that teenagers have a poor management of their time.