Challenges in the management of depressive disorders comorbid with tuberculosis and type 2 diabetes.

PURPOSE OF REVIEW: The aim of this study was to address the most relevant diagnostic and therapeutic challenges in the management of depressive disorders among patients with diabetes mellitus and tuberculosis (TB). RECENT FINDINGS: Depressive disorder, diabetes mellitus and TB are considered important contributors to the global burden of diseases with an emphasis on developing countries. Depressive disorder increases the chance of negative outcomes during the treatment of both diabetes mellitus and TB, while biological and adaptive changes due to diabetes mellitus and TB increase in turn the chance of depressive disorder. SUMMARY: In this review, we present major challenges in the management of depressive disorder among patients with TB and diabetes mellitus, from detection and clinical diagnosis using appropriate diagnostic tools, to selecting the best psychotherapeutic and/or pharmacological intervention, considering the potential, adverse events and interactions due to potential polypharmacy.

Are trajectories of depressive symptoms during the first half of drug-sensitive pulmonary tuberculosis treatment associated with loss to follow-up? A secondary analysis of longitudinal data.

OBJECTIVE: The objective of this study was to identify trajectories of depressive symptoms (DSs) during the first half of drug-sensitive pulmonary tuberculosis (PTB) treatment and examine their association with loss to follow-up (LTFU) in the second half. DESIGN: This study involved a secondary analysis of longitudinal data to identify potential trajectories of DS and their relationship with LTFU. SETTING: The study was conducted in first and second-level health centres located in San Juan de Lurigancho, Lima, Peru. PARTICIPANTS: Anonymised data from 265 individuals, including monthly measures of DSs from diagnosis to the completion of treatment, initiation of treatment for multidrug resistant TB, LTFU or death, were collected. RESULTS: Three trajectories were identified: 'declining', 'growth' and 'high'. These trajectories were observed in 182 (68.7%), 53 (20%) and 30 (11.3%) of the 265 individuals, respectively, during the first half of PTB treatment. Compared with those with a 'declining' trajectory, individuals with a 'growth' trajectory had a higher likelihood of experiencing LTFU during the second half of PTB treatment, after controlling for sociodemographic factors and at least weekly alcohol use (OR 3.9; 95% CI 1.09 to 13.97, p=0.036). CONCLUSIONS: The findings suggest that a trajectory of increasing DSs during the first half of PTB treatment is associated with a higher risk of LTFU during the second half.

Gait speed according to cognitive status in older adults: a cross-sectional study in a resource-limited country.

OBJECTIVE: We aimed to investigate the association between gait speed and cognitive status in outpatient older adults from a resource-limited setting in Peru. METHODS: We performed a cross-sectional study including older adults aged ≥60 years attending a geriatrics outpatient clinic between July 2017 and February 2020. Gait speed was measured over a 10-meters distance without considering the first and last meter traveled. Cognitive status was assessed through the Short Portable Mental Status Questionnaire (SPMSQ) and the Mini-Mental State Examination (MMSE). We used a multivariate binomial logistic regression to conduct both an epidemiological and fully adjusted models. RESULTS: We included 519 older adults (mean age: 75 years; IQR = 10), of whom 95 (18.3%) and 151 (31.5%) were cognitively impaired according to the SPMSQ and MMSE, respectively. Gait speed was slower among patients with poorer cognitive status as assessed by both tools (p < 0.001). Malnutrition (PR: 1.74; CI: 1.45-2.08) and functional dependency (PR: 4.35; CI: 2.68-7.08) were associated with a greater prevalence of cognitive impairment according to the SPMSQ, whereas a faster gait speed (PR: 0.27, CI: 0.14-0.52) and longer years of education (PR: 0.83, CI: 0.77-0.88) were associated with a less prevalence. CONCLUSIONS: Slower gait speed was associated with poorer cognitive status in outpatient older adults. Gait speed may be a complementary tool in the cognitive assessment of older adults from resource-limited settings.

Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis.

BACKGROUND: Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment. METHODS: We systematically reviewed studies that evaluated depressive symptoms (DS) directly or indirectly through psychological distress (PD) and measured negative treatment outcomes of drug-sensitive pulmonary TB, defined as death, loss to follow-up, or non-adherence. Sources included PubMed, Global Health Library, Embase, Scopus and Web of Science from inception to August 2019. RESULTS: Of the 2,970 studies initially identified, eight articles were eligible for inclusion and two were used for the primary outcome meta-analysis. We found a strong association between DS and negative TB treatment outcomes (OR = 4.26; CI95%:2.33-7.79; I2 = 0%). DS were also associated with loss to follow-up (OR = 8.70; CI95%:6.50-11.64; I2 = 0%) and death (OR = 2.85; CI95%:1.52-5.36; I2 = 0%). Non-adherence was not associated with DS and PD (OR = 1.34; CI95%:0.70-2.72; I2 = 94.36) or PD alone (OR = 0.92; CI95%:0.81-1.05; I2 = 0%). CONCLUSIONS: DS are associated with the negative TB treatment outcomes of death and loss to follow-up. Considerable heterogeneity exists in the definition of depression and outcomes such as non-adherence across the limited number of studies on this topic.

Aripiprazol en dosis bajas para somnolencia diurna excesiva asociada a uso de haloperidol: un reporte de caso / Low dose aripiprazole for excessive daytime sleepiness associated with the use of haloperidol: A case report

La somnolencia diurna es un efecto adverso frecuentemente asociado al uso de antipsicóticos en pacientes con esquizofrenia. Presentamos el caso de una mujer de 43 años con esquizofrenia y tratamiento antipsicótico desde hace 24 años, que inicialmente, presentó mala respuesta a antipsicóticos clásicos de baja potencia, llegando a lograr estabilizar los síntomas psicóticos por más de 10 años con uso de haloperidol. Sin embargo, con este tratamiento presentó somnolencia diurna que llegó a ser un efecto adverso importante limitando su funcionalidad y calidad de vida. Luego de añadirse primero 3,75 mg y luego 7,5 mg de aripiprazol, mejoró hasta un 80% la somnolencia sin exacerbación de los síntomas psicóticos

Daily somnolence is a frequent adverse event associated to the use of antipsychotic medication in patients with schizophrenia. We present the case of a 43 years old women with schizophrenia and pharmacological treatment for 24 years, who, at the start of the treatment, showed inadequate response to low potency classical antipsychotics, achieving clinical stability for more than 10 years with the use of haloperidol. However, she presented severe daily somnolence which significantly limited her functionality and quality of life. After the addition of 3.75 mg and later 7.5 mg of aripiprazole the somnolence improved in nearly 80% without exacerbation of psychotic symptoms

Frecuencia de tendencias suicidas (suicidalidad) y factores asociados en mujeres durante el primer año posparto / Frequency of suicidality and associated factors in women during the first postpartum year

Objetivos: Estimar la frecuencia de tendencias suicidas (suicidalidad) y explorar su relación con diversas variables en mujeres atendidas en un hospital público peruano durante el primer año del periodo posparto. Material y Métodos: Se realizó un análisis secundario de datos de un trabajo de investigación realizado en el Hospital Cayetano Heredia (Lima, Perú) que incluía 321 mujeres durante el primer año posparto, con registros de variables sociodemográficas, ginecológicas, clínico-psiquiátricas y de suicidalidad definida como la presencia del síntoma 9 del criterio A de Episodio Depresivo Mayor evaluado mediante la Entrevista Clínica Estructurada para el DSM-IV (Structured Clinical Interview for DSM-IV Disorders, SCID). Resultados: Se encontró una frecuencia de 15,58 % (IC 95%: 11,79-20,01%) de suicidalidad en mujeres durante el primer año posparto. El análisis bivariado mostró relación significativa entre la presencia de suicidalidad y depresión mayor (OR = 14,52; p <0,001), trastorno obsesivo-compulsivo (OR = 3,96; p= 0,001), trastorno disfórico premenstrual (OR=3,25; p=0,002) y episodio maniaco o hipomaniaco previo (OR=2,12; p=0,025). Asimismo, el análisis multivariado encontró relación significativa con status de separada/divorciada (OR = 6,96; p = 0,027), abortos previos (OR = 2,92; p = 0,006), sueño menor de 6 horas (OR=5,34; p=0,003) y lactancia materna (OR=0,15; p=0,004). Conclusiones: Las tendencias suicidas en mujeres con menos de un año posparto fueron detectadas en 15,58% de la muestra y se relacionaron con una serie de variables de diversa índole, las cuales deben ser tenidas en cuenta para eventuales intervenciones preventivas y/o de atención clínica focalizada.

Objectives: To estimate the frequency of suicidality and to explore its relation with different variables in women seen in a Peruvian public hospital during their first year of their postpartum period. Material and Methods: A secondary data analysis of a research study carried out in the Hospital Cayetano Heredia (Lima, Peru) was conducted on 321 women seen during their first postpartum year, with focus on sociodemographic, psychiatric, gynecological and suicidality variables. Suicidality was defined as the presence of symptom 9 of criterion A of a Major Depressive Episode assessed through the Structured Clinical Interview for DSM-IV Disorders (SCID). Results: Suicidality was found in 15.58% (95% CI: 11.79-20.01%) of the sample. Bivariate analyses showed a significant relationship between suicidality and major depression (OR = 14.52, p <0.001), obsessive-compulsive disorder (OR = 3.96, p = 0.001), premenstrual dysphoric disorder (OR=3.25, p = 0.002) and previous manic or hypomanic episode (OR = 2.12, p = 0.025). In addition, multivariate analysis found a significant relationship with being separated / divorced (OR = 6.96, p = 0.027), previous abortions (OR = 2.92, p = 0.006), sleep of less than 6 hours (5.34, p = 0.003) and breastfeeding (OR = 0.15, p = 0.004). Conclusions: The suicidality in women with less than one year postpartum had a frequency of 15.58% and was related to a series of variables to be taken into account for eventual preventive and/or focused clinical interventions.

Spatial distribution of individuals with symptoms of depression in a periurban area in Lima: an example from Peru.

PURPOSE: To map the geographical distribution and spatial clustering of depressive symptoms cases in an area of Lima, Peru. METHODS: Presence of depressive symptoms suggesting a major depressive episode was assessed using a short version of the Center for Epidemiologic Studies Depression Scale. Data were obtained from a census conducted in 2010. One participant per selected household (aged 18 years and above, living more than 6 months in the area) was included. Residence latitude, longitude, and elevation were captured using a GPS device. The prevalence of depressive symptoms was estimated, and relative risks (RRs) were calculated to identify areas of significantly higher and lower geographical concentrations of depressive symptoms. RESULTS: Data from 7946 participants, 28.3% male, mean age 39.4 (SD, 13.9) years, were analyzed. The prevalence of depressive symptoms was 17.0% (95% confidence interval = 16.2%-17.8%). Three clusters with high prevalence of depressive symptoms (primary cluster: RR = 1.82; P = .003 and secondary: RR = 2.83; P = .004 and RR = 5.92; P = .01), and two clusters with significantly low prevalence (primary: RR = 0.23; P = .016 and secondary: RR = 0; P = .035), were identified. Further adjustment by potential confounders confirmed the high prevalence clusters but also identified newer ones. CONCLUSIONS: Screening strategies for depression, in combination with mapping techniques, may be useful tools to target interventions in resource-limited areas.

Ansiedad, síndrome de piernas inquietas y onicofagia en estudiantes de medicina / Anxiety, restless legs syndrome and onychophagia in medical students

Describir la frecuencia de ansiedad, onicofagia y síndrome de piernas inquietas (SPI) en estudiantes de medicina y explorar la relación entre los mismos. Materiales y métodos: Participaron 315 estudiantes del primer al quinto año de medicina de una universidad privada de Lima. Se administraron la Escala de Ansiedad de Beck (BAI), una escala Likert para onicofagia, el Inventario de Estudios Epidemiológicos de SPI (García - Borreguero) y el Inventario de SPI (Grupo Internacional de SPI). Resultados: Se halló la frecuencia de ansiedad (61,3%), onicofagia (52,63%) y SPI (9,29%). Ser hombre es un factor protector para ansiedad (razón de prevalencia (RP) = 0,74; p = 0,001; IC 95% = 0,63 û 0,89). Existe asociación entre sintomatología ansiosa y SPI (RP =2,52; p = 0,036; IC 95% = 1,06 û 6); y entre sintomatología ansiosa y onicofagia (RP = 1,47; p = 0,002; IC 95% = 1,15 û 1,87). La presencia de onicofagia y SPI tenía asociación con sintomatología ansiosa (RP = 5,37; p = 0,023; IC 95% = 1,26 û 22,82). No se encontró asociación significativa entre SPI y onicofagia. Conclusiones: Existe una asociación entre ansiedad y SPI; y entre ansiedad y onicofagia; pero no entre SPI y onicofagia...

Objectives: The present work describes the frequency of anxiety, onychophagy and restless legs syndrome (RLS) in medical students and explore the relation among these conditions. Materials and methods: 315 medical students from the first to the fifth year from a private university where selected to participate. The instruments used for the study where: The Beck Anxiety Inventory, a Likert scale for onychophagy (nail biting), the Inventory of Epidemiological Studies for RLS (García - Borreguero) and the RLS Inventory (International RLS Group). Results: A frequency of anxiety (61.3%), onychophagy (52.63%) and RLS (9.29%) were found. Being male was a protective factor for anxiety (prevalence ratio (PR) = 0.74; p = 0.001, 95% CI = 0.63 to 0.89). There was an association between anxiety symptoms and RLS (PR = 2.52; p = 0.036, 95% CI = 1.06 - 6.00); and between anxious and onychophagy symptoms (PR = 1.47; p = 0.002, 95% CI = 1.15 - 1.87). Coexistence of onychophagy and RLS were associated with anxiety symptoms (PR = 5.37; p = 0.023, 95% CI = 1.26 - 22.82). There was no significant association between RLS and onychophagy. Conclusions: There is an association between anxiety and RLS, and between anxiety and onychophagy; but not between RLS and onychophagy...

[Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Peru]. / Uso y percepciones de las tecnologías de información y comunicación en pacientes con hipertensión arterial, dislipidemia o diabetes de un hospital nacional de Lima, Perú.

This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them.

Uso y percepciones de las tecnologías de información y comunicación en pacientes con hipertensión arterial, dislipidemia o diabetes de un hospital nacional de Lima, Perú / Use and perceptions of information and communication technologies in patients with hypertension, dyslipidemia or diabetes in a national hospital in Lima, Perú

El presente estudio tuvo como objetivo determinar el uso y percepciones hacia las tecnologías de información y comunicación (TIC), en 206 pacientes portadores de hipertensión arterial, dislipidemia y diabetes, reclutados de la consulta externa en un hospital nacional de Lima, Perú. El 54,4% fueron adultos mayores y 70,4% mujeres. El uso diario de llamadas por celular fue 44,7%; la mayoría nunca había usado una computadora (78,2%), correo electrónico (84%) o Internet (84%). Muchos nunca han enviado (80,6%) o recibido (69,9%) un mensaje de texto. El 70% ha olvidado alguna vez tomar su medicina. Al 72,8% le gustaría que le recuerden tomar sus medicinas y 67,9% tiene algún familiar que podría ayudarlos a acceder a las TIC. Pese al bajo uso de las TIC en esta población, existe predisposición y expectativa por los pacientes a participar en programas que las implementen.

This study aimed to determine the use and perceptions towards information and communication technologies (ICT) in 206 patients with arterial hypertension, dyslipidemia and diabetes, recruited from the outpatient clinic in a national hospital in Lima, Peru. 54.4% were older adults and 70.4% were women. The use of daily phone calls was 44.7%. Most had never used a computer (78.2%), email (84%) or the Internet (84%). Many have never sent (80.6%) or received (69.9%) a text message. 70% had at some time forgotten to take their medicine. 72.8% would like to be reminded to take their medication and 67.9% had a family member who could help them with access to ICT. Despite the low use of ICT in this population, there is willingness and expectation from the patients to participate in programs that implement them.

Depressive Mood Among Within-Country Migrants in Periurban Shantytowns of Lima, Peru.

In low- and middle-income countries, migration to urban settings has reshaped the sprawl and socio demographic profiles of major cities. Depressive episodes make up a large portion of the burden of disease worldwide and are related to socio-demographic disruptions. As a result of terrorism, political upheaval, followed by economic development, Peru has undergone major demographic transitions over the previous three decades including large migrations within the country. We aimed to determine the prevalence of current depressive mood and its relationship with parameters of internal migration, i.e. region of origin, age at migration, and years since migration. A community-wide census was carried out between January and June 2010 within a shantytown immigrant receiving community in Lima, Peru. One male or female adult per household completed a survey. Depressive mood was assessed with a 2-item Center for Epidemiologic Studies Depression (CESD) scale. Migration-related variables included place of birth, duration of residence in Lima, and age at migration. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated. A total of 8,551 out of 9,561 participants, response rate 89%, participated in the census. Of these, 8,091 records were analyzed: 71.8% were women [average age 39.4 (SD 13.9 years)] and 59.3% were immigrants. The overall prevalence of individuals with current depressive mood was 17.1% (95% CI 16.2-17.9%) and varied significantly by all socio-demographic and migration variables assessed. On unadjusted analyses, immigrants to Lima had higher prevalence of depressive mood if they originated in other costal or Andean areas, had lived in Lima for more than 20 years, or were <30 years of age when they out-migrated. When controlling for age, gender and socio-demographic variables the association was no longer significant, the only exception being a 20% lower prevalence of current depressive mood among those who out-migrated aged ≥30 years old (PR = 0.79; 95% CI 0.63-0.98). In conclusion, these results suggest that current depressive mood is very prevalent in this immigrant receiving community. Among all proxies for internal migration explored, in fully adjusted models, there was evidence of an association between age at migration (≥30 years old) and a lower probability of current depressive mood compared to non-migrants.

Publicación de trabajo de conclusión de curso de estudiantes de medicina de una universidad peruana / Publicação de trabalho de conclusão de curso de estudantes de medicina de uma universidade peruana / Dissertation publication by medical students at a peruvian university

OBJETIVO: Describir las características y tiempo de publicación de los trabajos de investigación desarrollados para fines de obtención de grado por estudiantes de medicina humana de una universidad peruana. MÉTODOS: Se recolectó información de los trabajos de investigación para obtener el grado académico de bachiller en medicina de una universidad peruana sustentados durante los años 2006, 2007 y 2008. Dos autores realizaron una búsqueda sistemática de dichos trabajos en Pubmed, BVS y Google académico de acuerdo al año de sustentación. Así mismo, dos autores de forma independiente evaluaron si los resultados de las búsquedas correspondían a los trabajos de investigación originales. RESULTADOS: 192 trabajos de investigación fueron recolectados, de los cuales 38 (19.79%) se publicaron en revistas indizadas, 32 en revistas nacionales (84.21%) y 6 en revistas extranjeras (15.79%). El tiempo medio desde la sustentación del trabajo de investigación hasta su publicación fue de 10.55 trimestres (31.65 meses, DE: 4.14 trimestres ±12.42 meses). No se evidenciaron asociaciones estadísticas entre las variables estudiadas. CONCLUSIONES: La frecuencia y tiempo de publicación es comparable a la producción de estudiantes de postgrado descritos en la literatura. Si bien no se consideró la calidad de la información u otros factores, la producción científica aparentaría no estar relacionada con un mayor nivel académico de los autores. Es importante mejorar los procesos asociados a la investigación, así como estimularlay promoverla desde etapas tempranas de la formación profesional.

OBJETIVO: Descrever as características e tempo de publicação de trabalhos de conclusão de curso realizado com a finalidade de obtenção do título de bacharel em Medicina em umauniversidade peruana. MÉTODOS: Os dados foramobtidoscom base emtrabalhos de pesquisa de conclusão de curso para o título de bacharel em Medicina durante os anos de 2006, 2007 e 2008. Dois autores conduziramuma busca sistemática dos referidos trabalhosno sitePubMed, Google Scholar e BVS e de acordocom o ano de referência. Da mesmaforma, doisoutros autores avaliaramindependentemente se os resultados da pesquisa correspondiam à pesquisa original. RESULTADOS: Foramobtidos192 trabalhos de pesquisa, dos quais 38 (19,79%) foram publicados em revistas indexadas, 32 em revistas nacionais (84,21%) e 6 em revistas estrangeiras (15,79%). O tempo médiodecorridoentre a execução da pesquisa esuapublicaçãofoi de 10,55 trimestres (31,65 meses, desvio padrão: 4,14 meses ±12,42 meses). Não houve significância estatística entre essas variáveis. CONCLUSÕES: A publicação de trabalhos científicos por alunos de graduação em Medicina é comparável em número às publicações de diferentes programas de pós-graduação. Apesar de não serconsiderada aqualidade da informaçãoououtros fatores, aprodução científicaparecenãoestarrelacionadacom o grau acadêmico mais elevadodos autores. É importantemelhoraros processos associadosà pesquisae promovê-laa partir dosestágios iniciais deformação.

Ojective: To describe thecharacteristics and time to publish research forobtaininga degree in medicine at a private Peruvian medical school. Methods: Data was collected from research work formedicine degrees from a Peruvian university published between 2006 and 2008. A systematicreview of the studies was conducted by two of the authors using Pubmed, BVS and Google Scholar. Likewise, two authors independently assessed whether theresults of the publication corresponded to the original work. Results: Data for 192 research works were collected, 38 (19.79%) of which were published in indexed journals, 32 (84.21%) in Peruvian and 6 (15.79%) in international journals. The average time between writing the dissertation and its publication was 10.55 quarters (31.65 months, SD: 4.14 quarters ± 12.42 months). No significant statistical association was found betweenthe variables. Conclusion:The frequency and timing of these publications is comparable to publications by graduate students described in the literature. Althoughthe quality of the information and other factors were not considered, the publication of research would not seem to be related to a higher academic level of the authors. It is important to improve the processes associated with research and to encourage this practice from the early stages of professional training.

Common mental disorders in public transportation drivers in Lima, Peru.

BACKGROUND: Traffic related injuries are leading contributors to burden of disease worldwide. In developing countries a high proportion of them can be attributed to public transportation vehicles. Several mental disorders including alcohol and drug abuse, psychotic disorders, mental stress, productivity pressure, and low monetary income were found predictors of high rates of traffic related injuries in public transportation drivers. The goal of this study was to estimate the prevalence of common mental disorders in the population of public transportation drivers of buses and rickshaws in Lima, Peru. METHODOLOGY/PRINCIPAL FINDINGS: Cross sectional study. A sample of bus and rickshaw drivers was systematically selected from formal public transportation companies using a snowball approach. Participants completed self-administered questionnaires for assessing major depressive episode, anxiety symptoms, alcohol abuse, and burnout syndrome. Socio demographic information was also collected. The analyses consisted of descriptive measurement of outcomes taking into account both between and within cluster standard deviation (BCSD and WCSD). A total of 278 bus and 227 rickshaw drivers out of 25 companies agreed to participate in the study. BCSD for major depressive episode, anxiety symptoms and burnout syndrome was not found significant (p>0.05). The estimated prevalence of each variable was 13.7% (IC95%: 10.7-16.6%), 24.1% (IC95%: 19.4-28.8%) and 14.1% (IC95%: 10.8-17.4%) respectively. The estimated prevalence of alcohol abuse was 75.4% (IC95%: 69-81.7%, BCSD = 12.2%, WCSD = 41.9%, intra class correlation (ICC): 7.8%). CONCLUSION: Common mental disorders such as alcohol abuse, major depressive episode, anxiety symptoms and burnout syndrome presented higher rates in public transportation drivers than general population.

[Association between violence against women inflicted by the partner and chronic malnutrition in their children under five years old in Peru]. / Asociación entre violencia contra la mujer ejercida por la pareja y desnutrición crónica en sus hijos menores de cinco años en Perú

OBJECTIVES: To assess the association between violence against women inflicted by their partner and the prevalence of chronic malnutrition in their children less than five years old. MATERIALS AND METHODS: A secondary cross-sectional analysis of the 2001 Peru Demographic and Health Survey performed in Peru, with national representativeness. The dependent variable was chronic malnutrition in the youngest child under five years old. The independent variables were emotional violence, physical violence (mild or severe) and sexual violence self-report; the violence was inflicted by the mother's last partner or spouse in the last 12 months. Univariate and multivariate analysis was performed, generalized linear models (log-binomial regression) were used, and the nature of the sample was taken into account. Models for socio-demographic and mother-son health variables were adjusted. Prevalence ratios (PR) and confidence intervals were calculated. RESULTS: Data from 5,154 mothers and children were analyzed. The prevalence of chronic malnutrition was 19.8% (CI 95%: 18.1-21.6). In the multivariate analysis, a higher prevalence of chronic malnutrition was found in the children whose mothers had a history of severe physical violence history: PR=1.27% (IC 95%: 1.09-1.48). There was no evidence of association between the prevalence of chronic malnutrition and other kinds of violence inflicted by a partner. CONCLUSIONS: The mothers' report of physical violence in the last year was associated with an increased prevalence of chronic malnutrition in children under five years old.

Asociación entre violencia contra la mujer ejercida por la pareja y desnutrición crónica en sus hijos menores de cinco años en Perú / Association between violence against women inflicted by the partner and chronic malnutrition in their children under five years old in Peru

Objetivos: Evaluar la asociación entre violencia contra la mujer ejercida por su pareja y la prevalencia de desnutrición crónica en sus hijos menores de cinco años. Materiales y métodos. Análisis secundario transversal de la Encuesta Demográfica y de Salud Familiar (ENDES) del año 2011, realizada en el Perú y con representatividad nacional. La variable dependiente fue desnutrición crónica en el último hijo menor de cinco años. Las variables independientes fueron el autorreporte de violencia emocional, violencia física (leve o severa) y violencia sexual, ejercidas por el último compañero o esposo de la madre en los últimos 12 meses. Realizamos análisis univariados y multivariables utilizando modelos generalizados lineales (regresión log-binomial), teniendo en cuenta la naturaleza compleja de la muestra. Se ajustaron los modelos para variables sociodemográficas y de salud madre hijo. Se calcularon razones de prevalencias (RP) e intervalos de confianza al 95%. Resultados. Se analizaron datos de 5154 madres e hijos. La prevalencia de desnutrición crónica fue de 19,8% (IC 95%: 18,1-21,6). En el análisis multivariable se encontró una mayor prevalencia de desnutrición crónica en los hijos de madres con historia de violencia física severa RP 1,27% (IC 95%: 1,09-1,48). No hubo evidencia de asociación entre la prevalencia de desnutrición crónica y los otros tipos de violencia ejercida por la pareja. Conclusiones. El reporte de violencia física severa en el último año, por parte de las madres, estuvo asociado a un aumento en la prevalencia de desnutrición crónica en sus niños menores de cinco años.

Objectives: To assess the association between violence against women inflicted by their partner and the prevalence of chronic malnutrition in their children less than five years old. Materials and methods. A secondary cross-sectional analysis of the 2001 Peru Demographic and Health Survey performed in Peru, with national representativeness. The dependent variable was chronic malnutrition in the youngest child under five years old. The independent variables were emotional violence, physical violence (mild or severe) and sexual violence self-report; the violence was inflicted by the mother’s last partner or spouse in the last 12 months. Univariate and multivariate analysis was performed, generalized linear models (log-binomial regression) were used, and the nature of the sample was taken into account. Models for socio-demographic and mother-son health variables were adjusted. Prevalence ratios (PR) and confidence intervals were calculated. Results. Data from 5,154 mothers and children were analyzed. The prevalence of chronic malnutrition was 19.8% (CI 95%: 18.1-21.6). In the multivariate analysis, a higher prevalence of chronic malnutrition was found in the children whose mothers had a history of severe physical violence history: PR=1.27% (IC 95%: 1.09-1.48). There was no evidence of association between the prevalence of chronic malnutrition and other kinds of violence inflicted by a partner. Conclusions. The mothers’ report of physical violence in the last year was associated with an increased prevalence of chronic malnutrition in children under five years old.

Validation of the Spanish Center for Epidemiological Studies Depression and Zung Self-Rating Depression Scales: a comparative validation study.

BACKGROUND: Depressive disorders are leading contributors to burden of disease in developing countries. Research aiming to improve their diagnosis and treatment is fundamental in these settings, and psychometric tools are widely used instruments to support mental health research. Our aim is to validate and compare the psychometric properties of the Spanish versions of the Center for Epidemiological Studies Depression Scale (CES-D) and the Zung Self-Rating Depression Scale (ZSDS). METHODOLOGY/PRINCIPAL FINDINGS: A Spanish version of the CES-D was revised by 5 native Spanish speaking psychiatrists using as reference the English version. A locally standardized Spanish version of the ZSDS was used. These Spanish versions were administered to 70 patients with a clinical diagnosis of DSM-IV Major Depressive Episode (MDE), 63 without major depression but with clinical diagnosis of other psychiatric disorders (OPD), and 61 with no evidence of psychiatric disorders (NEP). For both scales, Cronbach's alpha (C-α) and Hierarchical McDonald Omega for polychoric variables (MD-Ω) were estimated; and receiver operating characteristics (ROC) analysis performed. For the CES-D and ZSDS scales, C-α was 0.93 and 0.89 respectively, while MD-Ω was 0.90 and 0.75 respectively. The area under the ROC curve in MDE+OPD was 0.83 for CES-D and 0.84 for ZSDS; and in MDE+NEP was 0.98 for CES-D and 0.96 for ZSDS. Cut-off scores (co) for the highest proportions of correctly classified (cc) individuals among MDE+OPD were ≥29 for CES-D (sensitivity (ss) = 77.1/specificity (sp) = 79.4%/(cc) = 78.2%) and ≥47 for ZSDS (ss = 85.7%/sp = 71.4%/cc = 78.9%). In the MDE+NEP, co were ≥24 for the CES-D (ss = 91.4%/sp = 96.7%/cc = 93.9%) and ≥45 for the ZSDS (ss = 91.4%/sp = 91.8%/cc = 91.6%). CONCLUSION: Spanish versions of the CES-D and ZSDS are valid instruments to detect depression in clinical settings and could be useful for both epidemiological research and primary clinical settings in settings similar as those of public hospitals in Lima, Peru.

The association between socioeconomic status and obesity in Peruvian women.

Historically in developing countries, the prevalence of obesity has been greater in more advantaged socioeconomic groups. However, in recent years the association between socioeconomic status (SES) and obesity has changed and varies depending on the country's development stage. This study examines the relationship between SES and obesity using two indicators of SES: education or possession assets. Using the cross-sectional 2008 National Demographic and Family Health Survey of Peru (ENDES 2008), we investigated this relationship in women aged 15-49 years living in rural and urban settings. Descriptive, linear and logistic regressions analyses were conducted accounting for the multistage nature of the sampling design. The overall prevalence of obesity in this study was 14.1% (95% confidence interval (CI): 13.3-14.8); 8.4% (95% CI: 7.5-9.3) in rural areas and 16.2% (95% CI: 15.2-17.2) in urban areas. Wealthier women were more likely to be obese, and this association was stronger in rural areas. Conversely, more educated women were less likely to be obese, especially in urban areas. The distribution of obesity in Peruvian women is strongly related to socioeconomic position, and differs whether measured as possession assets or by level of education. These findings could have important implications for policy development in Peru.

Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009 / Registry of patients with stroke stated in a public hospital of Peru, 2000-2009

Estudio que describe las características de los registros de pacientes con accidente cerebro vascular (ACV), como diagnóstico causante de hospitalización en el Hospital Nacional Cayetano Heredia entre los años 2000 - 2009. Se obtuvieron 2225 registros de pacientes mayores de 18 años, con ACV. De acuerdo con la CIE-10, 1071 tenían el diagnóstico de ACV isquémico, 554 ACV hemorrágico, 183 hemorragia subaracnoidea, 49 isquémico hemorrágico, 10 crisis isquémica transitorias y en 358 no fue posible especificar el tipo. Se registraron 352 muertes (19,6 por ciento), la mayoría en los primeros tres días. La razón hombre/mujer fue 1,09; la edad promedio 64,1 ± 17,2 años y la mediana del tiempo de hospitalización fue de nueve días. Las condiciones asociadas más frecuentes fueron hipertensión arterial, fibrilación auricular y diabetes mellitus tipo 2. La mortalidad descrita es la más alta informada en nuestro medio, es constante en todos los grupos de edad y mayor en mujeres.

We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA) and in 358 we were unable to specify the type of stroke. 352 deaths were recorded (19.6 percent), most of them during the first 3 days. The male / female ratio was 1.09, the mean age 64.1 ± 17.2 years and the median length of hospital stay was 9 days. The most common associated conditions were high blood pressure, atrial fibrillation and type 2 diabetes mellitus. The mortality found is the highest reported in our country, constant in all age groups and higher in women.

[Registry of patients with stroke stated in a public hospital of Peru, 2000-2009]. / Registro de pacientes con accidente cerebro vascular en un hospital público del Perú, 2000-2009.

We performed a descriptive study taking on account the characteristics of the registries of the patients hospitalized at the Hospital Nacional Cayetano Heredia between the years 2000 and 2009 with stroke as hospitalization diagnosis. 2225 records were obtained from patients older than 18, with stroke. According to ICD-10, 1071 had diagnosis of ischemic stroke, 554 were hemorrhagic, 183 were subarachnoid hemorrhage, 49 were ischemic plus hemorrhagic, 10 were transient ischemic attack (TIA) and in 358 we were unable to specify the type of stroke. 352 deaths were recorded (19.6 %), most of them during the first 3 days. The male / female ratio was 1.09, the mean age 64.1 ± 17.2 years and the median length of hospital stay was 9 days. The most common associated conditions were high blood pressure, atrial fibrillation and type 2 diabetes mellitus. The mortality found is the highest reported in our country, constant in all age groups and higher in women.