Clinical manifestations and complications of preeclampsia and eclampsia in populations residing at high altitudes and very high altitudes: A scoping review.

INTRODUCTION: Preeclampsia and eclampsia are conditions that affect gestation, characterized by high blood pressure and direct organ damage, while geographical altitude directly affects cardiovascular physiology. The aim of this review is to identify the clinical manifestations and complications of preeclampsia in pregnant women at high and very high altitudes. METHODS: A scoping review was conducted to assess the objective. A systematic search was performed on Pubmed, Web of Science, Embase, Scopus, Scielo, and Lilacs. Studies including pregnant women with preeclampsia or eclampsia at high altitudes and very high altitudes were included, excluding non-citable documents. Results were summarized in tables based on bibliographic data, methodological aspects, and key findings. RESULTS: Eight documents meeting the inclusion and exclusion criteria were obtained. Seven studies focused on populations in Latin America, with the highest geographical altitude being 4380 m above sea level in the city of Cerro de Pasco, Peru. One report suggests a higher admission rate to the Intensive Care Unit and a higher frequency of HELLP syndrome. Functional cardiovascular changes were also observed. CONCLUSIONS: There are few studies directly evaluating pregnant populations at high altitudes and very high altitudes experiencing preeclampsia and eclampsia. Complications may be more frequent at high altitudes and very high altitudes with clinically unobservable cardiovascular changes.

substance use and recidivism of intimate partner violence in Peru: A cross-sectional study.

Background: Intimate Partner Violence (IPV) carries significant global burden, with approximately 27% of women who have ever had a partner experiencing IPV. Additionally, substance use (alcohol and drugs) is often associated with aggressive attitudes and serves as a risk factor for IPV. Objective: Determine the association between substance use and the recurrence of IPV in the Peruvian population in 2022. Methods: A cross-sectional study was conducted using public data from the Ministry of Women, employing regression based on generalized linear models to calculate crude and adjusted Odds Ratios. Results: A total of 65,290 cases of IPV were analyzed, the results revealed that 93.70% of the reports were cases of recidivism. A relationship was identified between substance use and IPV, with an Odds Ratio of 2.24 for the perpetrator's alcohol consumption and an Odds Ratio of 2.33 for drug use. Conclusion: Based on these findings, it can be concluded that a relationship exists between substance use and IPV, and national strategies should incorporate proper monitoring after the initial report of violence, as well as effective control of substance use among perpetrators.

Evolution and differences of suicide rates in Peru by gender and department, 2017-2019.

INTRODUCTION: Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019. METHODS: The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization. RESULTS: A total of 1666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20-29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; P<.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna. CONCLUSIONS: In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

Evolución y diferencias en las tasas de suicidio en Perú por sexo y por departamentos, 2017-2019

Introducción: Cada ano, los casos de suicidio vienen en notable aumento en todo el mundo por diversos factores de riesgo. El objetivo de este estudio es conocer las tasas de mortalidad por suicidios y su distribución entre los años 2017 y 2019. Métodos: Se analizaron los registros nacionales del Sistema Nacional de defunciones del Ministerio de Salud del Perú. Se calcularon las tasas regionales de mortalidad por suicidios ajustadas por edad y sexo mediante la estandarización recomendada por la Organización Mundial de la Salud. Resultados: Se identificaron 1.666 casos de suicidio (el 69,3% varones); el grupo etario con mayor frecuencia fue el de 20 a 29 años (27,8%); la media de edad al suicidio fue mayor en los varones (37,49 ± 18,96 frente a 27,86 ± 15,42; p< 0,001). El ahorcamiento fue el método de suicidio más prevalente entre los varones (58,87%) y las mujeres (48,14%). En el caso de los varones, los demás métodos fueron envenenamiento (22,6%) y armas de fuego (4,59%); en el de las mujeres, envenenamiento (38,75%) y uso de armas de fuego (0,59%). La tasa de suicidio aumento de 2017 (1,44 muertes/100.000 hab.) a 2019 (1,95). Las mayores tasas se identificaron en los departamentos de Arequipa, Moquegua y Tacna. Conclusiones: En los últimos años ha habido un aumento en el número de casos de suicidio y en las tasas por departamento; el mayor número de casos reportados se da en los varones, que tienden a utilizar métodos de suicidio más violentos. Se requiere conocer los factores de riesgo en las poblaciones vulnerables identificadas en este estudio.

Introduction: Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019. Methods: The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization. Results: A total of 1,666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20 to 29 years (27.8%); the mean age at suicide was higher in males (37.49 ± 18.96 vs. 27.86 ± 15.42; p < 0.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna. Conclusions: In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

Type 2 diabetes mellitus and hypertension as predictors of community-acquired pneumonia in Peruvian older adults with cancer

Objective: To evaluate DM2 and hypertension as predictors of CAP in older adults with cancer. Material and Methods: We conducted a secondary data analysis of a prospective cohort study in older adults with cancer from the Geriatrics Service of the Centro Médico Naval (CEMENA) of Peru during 2013-2015. T2DM and hypertension diagnosis were obtained from medical records. CAP was defined according to clinical and radiological diagnostic criteria and it was collected from the medical records of the patients up to one year after their inclusion in the study. We used the statistical software STATA v14.0 to develop the analysis. We performed multivariate analysis using crude and adjusted Cox regression models. The reported measure was the hazard ratio (HR) with their respective 95% confidence intervals (95%CI). Results: A total of 231 older adults with cancer were analyzed. The mean age of the participants was 78.6 ± 4.2 (range: 74-92 years) and all of them were men. 33 (14.29%) patients developed CAP during the follow-up, 53 (21.65%) had hypertension, and 56 (22.65%) T2DM. CAP was more frequent in patients with lung cancer and lymphomas. In the adjusted Cox regression models, we found T2DM (aHR=1.49; 95%CI: 1.21-1.79) and hypertension (aHR=1.32; 95%CI: 1.24-1.50) were predictors of CAP incidence. Conclusion: T2DM and hypertension were associated with CAP incidence in oncogeriatric patients. Future intervention studies are needed to improve the functionality and prevent CAP in this vulnerable population.

Objetivo: Evaluar la DM2 y la hipertensión como predictores de NAC en adultos mayores con cáncer. Materiales y métodos: Se realizó un análisis de base secundaria de una cohorte prospectiva en adultos mayores con diagnóstico de cáncer del Servicio de Geriatría del Centro Médico Naval (CEMENA) del Perú durante 2013-2015. Los diagnósticos de DM2 e hipertensión se obtuvieron de las historias clínicas. La NAC se definió según criterios diagnósticos clínicos y radiológicos y se recogió de las historias clínicas de los pacientes hasta un año después de su inclusión en el estudio. Utilizamos el software estadístico STATA v14.0 para desarrollar el análisis. Realizamos un análisis multivariante utilizando modelos de regresión de Cox crudos y ajustados. La medida reportada fue la razón de hazards (HR) con sus respectivos intervalos de confianza del 95% (IC95%). Resultados: Se analizaron un total de 231 adultos mayores con cáncer. La edad media de los participantes fue de 78,6 ± 4,2 (rango: 74-92 años) y todos ellos eran hombres. 33 (14,29%) pacientes desarrollaron NAC durante el seguimiento, 53 (21,65%) tenían hipertensión y 56 (22,65%) DM2. La NAC fue más frecuente en pacientes con cáncer de pulmón y linfomas. En los modelos de regresión de Cox ajustados se encontró que tener DM2 (HRa=1,49; IC95%: 1,21-1,79) o hipertensión arterial (HRa=1,32; IC95%: 1,24-1,50) fueron predictores para la incidencia de NAC. Conclusiones: La DM2 y la hipertensión se asociaron con la incidencia de NAC en pacientes oncogeriátricos. Son necesarios futuros estudios de intervención para mejorar la funcionalidad y prevenir la NAC en esta población vulnerable.

Evolution and Differences of Suicide Rates in Peru by Gender and Department, 2017-2019. / Evolución y diferencias en las tasas de suicidio en Perú por sexo y por departamentos, 2017-2019.

INTRODUCTION: Annual suicide rates are increasingly notably worldwide due to various accompanying risk factors. The objective of this study is to know the suicide mortality rates and their distribution between the years 2017 and 2019. METHODS: The national death registries of the Ministry of Health of Peru were analysed, calculating the regional death rates from suicides adjusted for age and gender using the standardisation recommended by the World Health Organization. RESULTS: A total of 1,666 cases of suicide were identified (69.3% males); the age group with the highest frequency was that of 20 to 29 years (27.8%); the mean age at suicide was higher in males (37.49±18.96 vs. 27.86±15.42; p<0.001). Hanging was the most common suicide method among both males (58.87%) and females (48.14%). For males, hanging was followed by poisoning (22.6%) and firearms (4.59%); for females, by poisoning (38.75%) and firearms (0.59%). The suicide rate increased from 2017 (1.44/100,000 inhabitants) to 2019 (1.95). The highest rates were identified in the departments of Arequipa, Moquegua and Tacna. CONCLUSIONS: In recent years, there has been an increase in the number of suicide cases and the rates by department, with the highest number of cases reported in males. Males tend to use more violent suicide methods. The risk factors in the vulnerable populations that were identified in this study need to be known.

Clinical characteristics of older patients with COVID-19: a systematic review of case reports.

In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. OBJECTIVE: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. METHODS: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. RESULTS: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. CONCLUSIONS: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. OBJETIVO: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. MÉTODO: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. RESULTADOS: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. CONCLUSÕES: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Clinical characteristics of older patients with COVID-19: a systematic review of case reports / Características clínicas de pacientes idosos com covid-19: uma revisão sistemática de relatos de casos

ABSTRACT. In the context of the current COVID-19 pandemic, higher morbidity and mortality have been reported in older adults. This age group presents physiological changes and its own clinical conditions such as frailty, dementia, among others. Objective: To describe the characteristics of COVID-19 patients, both over and under 80 years old, by conducting a systematic review of the literature describing case reports, and to summarize and critically assess these characteristics. Methods: Systematic review. The study was registered on the Registry of Health Research Projects (PRISA) of the Peruvian National Institute of Health (code EI00000631). Five electronic databases (Scopus, PubMed, PubMed Central, LILACS, and SCIELO) were systematically searched during the period between December 31, 2019 and April 16, 2020. The search focused on case reports, case studies, and case series of older people with COVID-19 infection aged over or under 80 years. When selecting the cases, priority was given to clinical and epidemiological profile, laboratory and imaging patterns, and comprehensive geriatric evaluation. Results: 1,149 articles were identified; after applying the filters, a total of 15 publications of case reports and complete records of 27 older adults were obtained. The most frequent age group was between 60 to 69 years old. There is little literature regarding case reports of older adults aged over 80 years. The most frequent parameters were hypertension, fever, cough, respiratory distress, ground-glass opacification in chest radiography and tomography. Furthermore, decrease in PaO2/FiO2 ratio and lymphocytes, and increase in C-reactive protein and Interleukin 6 were observed. Conclusions: This systematic review found little available information of patients under 80 years old, and far less for those over 80 years old, and an absence of comprehensive geriatric assessment.

RESUMO. No contexto da atual pandemia de covid-19, maior morbidade e mortalidade têm sido relatadas em idosos. Sabe-se que essa faixa etária apresenta alterações fisiológicas e condições clínicas próprias, como fragilidade, demência, entre outras. Objetivo: Descrever as características de pacientes com covid-19, maiores e menores de 80 anos, por meio de uma revisão sistemática da literatura que descreve relatos de casos, e resumir e avaliar criticamente essas características. Método: Revisão sistemática. O estudo foi registrado no Registro de Projetos de Pesquisa em Saúde (PRISA) do Instituto Nacional de Saúde do Peru (código EI00000631). Local: cinco bases de dados eletrônicas (Scopus, PubMed, PubMed Central, LILACS e SCIELO) foram sistematicamente pesquisadas entre 31 de dezembro de 2019 e 16 de abril de 2020. A busca se concentrou em relatos de caso, estudos de caso e séries de casos mais antigos pessoas com infecção por SARS-CoV-2 com mais e menos de 80 anos. Na seleção dos casos, a prioridade foi dada ao perfil clínico e epidemiológico, padrões laboratoriais e de imagem, e avaliação geriátrica abrangente. Resultados: Foram identificados 1.149 artigos. Após a aplicação dos filtros, obteve-se um total de 15 publicações de relatos de caso e registros completos de 27 idosos. A faixa etária mais frequente foi de 60 a 69 anos. Há pouca literatura sobre relatos de casos de adultos com mais de 80 anos. Os parâmetros mais frequentes foram hipertensão, febre, tosse, dificuldade respiratória, vidro fosco na radiografia e tomografia de tórax. Também foram observados diminuição da PaO2 / FiO2 e linfócitos, e aumento da proteína C reativa e Interleucina 6. Conclusões: Esta revisão sistemática encontrou poucas informações disponíveis sobre pacientes com menos de 80 anos, em quantidade ainda menor para aqueles com mais de 80 anos, além de uma ausência de avaliação geriátrica abrangente.

Progresión de casos de Coronavirus en Latinoamérica: Análisis comparativo a una semana de iniciada la pandemia en cada país / Progression of Coronavirus cases in Latin America: Comparative analysis one week after the start of the pandemic in each country

La pandemia generada por la COVID-19 progresa diferente cuando llega a cada territorio, se comparó la progresión de casos de Coronavirus en la primera semana de la pandemia en cada país en Latinoamérica. Se realizó un estudio descriptivo, con la información de los casos confirmados en cada país, esto desde que se anunciara el primer caso en cada territorio. Se muestran las progresiones en formas de gráficas, con los casos totales y ajustados por la densidad poblacional. Uruguay y Panamá fueron los países que destacaron de todos los evaluados, tuvieron una mayor cantidad de casos confirmados ponderados en la primera semana de la pandemia. Así mismo, estos dos países también fueron los que tuvieron mayor cantidad de casos absolutos (no ponderados por la cantidad de población), así como, el país de Venezuela; que incluso se piensa que tiene más casos, por sus problemas políticos. Hubo algunas diferencias en la cantidad de casos que se presentaron en cada país Latinoamericano al final de su primera semana de epidemia COVID-19; esto podría deberse a las políticas gubernamentales que se tomaron antes y durante esos primeros días, las cuales deben servir como ejemplo para el actuar en futuros casos similares

The pandemic generated by COVID-19 progresses differently when it reaches each territory, the progression of Coronavirus cases in the first week of the pandemic was compared in each country in Latin America. A descriptive study was carried out, with the information of the confirmed cases in each country, this since the first case was announced in each territory. Progressions are shown in graphical forms, with total cases and adjusted for population density. Uruguay and Panama were the countries that stood out from all those evaluated, they had a greater number of confirmed cases weighted in the first week of the pandemic. Likewise, these two countries were also those with the highest number of absolute cases (not weighted by the number of population), as well as the country of Venezuela; that he is even thought to have more cases, due to his political problems. There were some differences in the number of cases that occurred in each Latin American country at the end of its first week of the COVID-19 epidemic; this could be due to the government policies that were taken before and during those first days, which should serve as an example for acting in future similar cases

Estrategias de la Organización Mundial de la Salud en Medicina Tradicional y Reconocimiento de Sistemas de Medicina Tradicional / Strategies of the World Health Organization in Traditional Medicine and Recognition of Traditional Medicine Systems

La Constitución de la Organización Mundial de la Salud (OMS) entró en vigor el 7 de abril de 1948, fecha que conmemoramos cada año mediante el Día Mundial de la Salud , teniendo como definición de la salud a "un estado de completo bienestar físico, mental y social

Traditional medicine and COVID-19, opportunity for the revaluation of Peruvian Medicinal Plants / Medicina tradicional y COVID-19, oportunidad para la revaloración de las Plantas Medicinales Peruanas

En Diciembre del 2019 en Wuhan-China empezó el brote por COVID-19, con 27 pacientes con neumonía viral (fiebre, tos seca, y disnea), el 11 de Marzo del 2020, La Organización Mundial de la Salud (OMS) declara a la infección como una pandemia

Depression among Peruvian adults with hypertension and diabetes: Analysis of a national survey.

BACKGROUND AND AIMS: Hypertension and diabetes are global health problems with an incidence that is rapidly increasing worldwide. Depression is the most frequent mental health co-morbidity and is considered an important risk factor for the development of both diseases. This study aimed to determine the prevalence and factors associated with depression among Peruvian adults with hypertension and diabetes. METHODS: We performed a secondary analysis of the 2017 Peru Demographic and Family Health Survey, using data from 10,566 adults aged 40 and older. The main outcome was depression assessed with the Patient Health Questionnaire-9 (PHQ-9). Other important variables were the diagnosis of hypertension or diabetes, sex, age, level of education, geographical region, wealth index, daily smoking, harmful alcohol consumption and physical disability. RESULTS: The overall prevalence of depression was 23.15% (CI 95%: 21.42%-24.88%) and among adults with hypertension and diabetes it was 34.96% (CI 95%: 29.33%-40.59%) and 35.56% (CI 95%: 24.49%-46.63%), respectively. Whereas the prevalence of depression among adults with type 2 diabetes mellitus (T2DM) was higher in the physical disability group (PRa: 1.28; CI 95%: 1.12-1.45), the prevalence of depression among adults with hypertension was higher in the female group (PRa: 1.36; CI 95%: 1.20-1.54) and among those with harmful alcohol consumption (PRa: 1.50; CI 95%: 1.01-2.24). CONCLUSION: Peru has a considerable burden of depression in the hypertensive and diabetic populations. While the variables positively associated with depression in hypertensive adults were female gender and harmful alcohol consumption, in adults with diabetes it was the presence of physical disability.

Factors associated with poor balance ability in older adults of nine high-altitude communities.

INTRODUCTION: Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. MATERIAL AND METHODS: Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013-2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. RESULTS: A total of 365 older adults were studied. The average age was 73.0 ±â€¯6.9 years (range: 60-91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05-1.73), exhaustion (PR = 2.22; 95%CI: 1.49-3.31), gait speed (PR = 0.67; 95%CI: 0.50-0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19-3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10-2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07-2.42) compared to none. CONCLUSIONS: Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.

Asociación entre submarinismo y trastornos neurocognitivos en personal militar retirado / Association between scuba diving and neurocognitive disorders in retired military personnel

Objetivo: Determinar la asociación entre el haber practicado submarinismo durante el servicio militar y el desarrollo de trastornos neurocognitivos en adultos mayores. Materiales y métodos: Estudio analítico retrospectivo, proviene del análisis de la base de datos del estudio: Fragilidad y dependencia funcional en adultos mayores, realizado entre 2010-2015 realizado por el personal del servicio de geriatría del Centro Médico Naval del Perú, en niveles asistenciales ambulatorios. En cuanto a la asociación se usó Chi2, p<0,05 e IC 95 %, para el modelo de regresión, se utilizó un modelo de Poisson. Resultados: Se analizaron en total 1020 participantes. 322 (42,42 %) de los participantes estuvieron en el rango de 71 - 80 años de edad. 240 (31,62 %) presentaban trastornos neurocognitivos. Los factores asociados a los trastornos neurocognitivos fueron los siguientes: el rango de edad entre 71 - 80 años de edad (RP=1,69; IC95 %: 1,12 - 2,54), enfermedad cerebro vascular (RP=1,48; IC95 %: 1,01 - 2,23) y especialidad de submarinismo (RP=2,36; IC95 %: 1,64 - 3,39). Tener grado militar superior se asoció con menor riesgo (RP=0,62; IC95 %: 0,43 - 0,89). Conclusiones: Los pacientes que han practicado el submarinismo tienen un mayor riesgo de padecer trastorno neurocognitivo, sin embargo, se requieren estudios prospectivos adicionales para corroborar dicha asociación.

Objective: To determine the association between the exposure to scuba diving during military service and the development of neurocognitive disorders in elderly people. Materials and methods: A retrospective analytical study, derived from the database analysis of the study "Fragility and functional dependence in older adults" conducted between 2010 and 2015 on an outpatient basis by the staff of the geriatrics service of the Centro Médico Naval del Perú (Peruvian Naval Medical Center). The chi-square test, p<0.05 and 95 % CI were used to establish said association, and the Poisson model was used as regression model. Results: A total of 1,020 participants were analyzed. Three hundred twenty-two (322 [42.42 %]) participants were between 71 and 80 years of age. Two hundred forty (240 [31.62 %]) had neurocognitive disorders. Factors associated with neurocognitive disorders were: age range between 71 and 80 years of age (PR = 1.69, 95 % CI: 1.12 - 2.54), cerebrovascular disease (PR = 1.48, 95 % CI: 1.01-2.23) and major in scuba diving (PR = 2.36, 95 % CI: 1.64-3.39). A higher military rank was associated with a lower risk of developing neurocognitive disorders (PR = 0.62, 95 % CI: 0.43-0.89). Conclusions: Patients who have practiced scuba diving have a higher risk of developing neurocognitive disorders; however, additional prospective studies are required to confirm this association.

High free triiodothyronine and free-triiodothyronine-to-free-thyroxine ratio levels are associated with metabolic syndrome in a euthyroid population.

AIMS: To determine the association between free triiodothyronine (FT3), free thyroxine (FT4) and free-triiodothyronine-to-free-thyroxine ratio (FT3/FT4) levels and Metabolic Syndrome (MetS). MATERIALS AND METHODS: We carried out an analytical cross-sectional study in euthyroid adults of both sexes, who attended the outpatient service of a private clinic in Lima-Peru during the 2014-2016 period. Participants were divided into tertiles (low, intermediate and high) according to their FT3, FT4, and FT3/FT4 ratio values. MetS was defined when three or more metabolic criteria were met by the participants. ROC curves were constructed, and Youden's Index were used to identify the optimal cut-points of each thyroid marker. We elaborated crude/adjusted Poisson regression models to evaluate the association between the thyroid markers and the presence of MetS. The reported association measure was the prevalence ratio (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We analyzed 245 participants, the average age was 38.5 ±â€¯10.3 years, 29.8% were males, and the prevalence of MetS was 31%. In the adjusted Poisson regression models, the prevalence of MetS was higher among the high FT3 tertile compared to the low tertile (aPR = 2.01; 95% CI: 1.22-3.34). The prevalence of MetS was higher among the intermediate FT3/FT4 ratio tertile and the high FT3/FT4 ratio tertile compared to the low tertile, (aPR = 1.78; 95% CI: 1.02-3.10) and (aPR = 2.80; 95% CI: 1.67-4.72); respectively. The highest areas under the curve (AUC) were found for FT3 and FT3/FT4 ratio with areas of 0.654 (95% CI: 0.58-0.73) and 0.649 (95% CI: 0.57-0.72); respectively. CONCLUSION: Elevated levels of FT3 and FT3/FT4 ratio were associated with MetS in a euthyroid population.

[Associated Factors to non-use of Formal Health Services in the Peruvian Population: Analysis of the National Household Survey (ENAHO) 2015]. / Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la encuesta nacional de hogares (ENAHO) 2015.

The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.

El objetivo del estudio fue estimar la prevalencia de la no utilización de los servicios formales de prestación de salud (NUSFPS) y sus factores asociados en Perú. Se realizó un análisis secundario de datos de la Encuesta Nacional de Hogares (ENAHO) del año 2015. Se definió como NUSFPS a aquellos participantes que, pese a haber presentado algún síntoma, malestar, enfermedad, recaída de enfermedad crónica o accidente durante el último mes, no acudieron a los servicios de salud. Se analizaron 35 036 participantes; la prevalencia de NUSFPS fue de 53,9% (IC95%:52,9-54,8). La NUSFPS fue superior en la costa (razón de prevalencia ajustada [RPa] = 1,24;IC95%:1,17-1,31), sierra (RPa =1,38;IC95%:1,31-1,46) y selva (RP = 1,25;IC95%:1,181,33) en comparación a Lima Metropolitana. Hubo mayor prevalencia de NUSFPS en los participantes sinseguro (RPa = 1,59; IC95%: 1,52-1,66) y afiliados al seguro integral de salud (RPa = 1,16; IC95%: 1,11-1,22) comparados con los afiliados a la Seguridad Social. En conclusión, más de la mitad de los participantes padecieron NUSFPS, lo cual se asoció con condiciones geográficas y de aseguramiento. Se sugieren políticas públicas informadas en la evidencia para mejorar esta situación.

Factores asociados a la no utilización de los servicios formales de prestación en salud en la población peruana: análisis de la encuesta nacional de hogares (ENAHO) 2015 / Associated Factors to non-use of Formal Health Services in the Peruvian Population: Analysis of the National Household Survey (ENAHO) 2015

RESUMEN El objetivo del estudio fue estimar la prevalencia de la no utilización de los servicios formales de prestación de salud (NUSFPS) y sus factores asociados en Perú. Se realizó un análisis secundario de datos de la Encuesta Nacional de Hogares (ENAHO) del año 2015. Se definió como NUSFPS a aquellos participantes que, pese a haber presentado algún síntoma, malestar, enfermedad, recaída de enfermedad crónica o accidente durante el último mes, no acudieron a los servicios de salud. Se analizaron 35 036 participantes; la prevalencia de NUSFPS fue de 53,9% (IC95%:52,9-54,8). La NUSFPS fue superior en la costa (razón de prevalencia ajustada [RPa] = 1,24;IC95%:1,17-1,31), sierra (RPa =1,38;IC95%:1,31-1,46) y selva (RP = 1,25;IC95%:1,181,33) en comparación a Lima Metropolitana. Hubo mayor prevalencia de NUSFPS en los participantes sinseguro (RPa = 1,59; IC95%: 1,52-1,66) y afiliados al seguro integral de salud (RPa = 1,16; IC95%: 1,11-1,22) comparados con los afiliados a la Seguridad Social. En conclusión, más de la mitad de los participantes padecieron NUSFPS, lo cual se asoció con condiciones geográficas y de aseguramiento. Se sugieren políticas públicas informadas en la evidencia para mejorar esta situación.

ABSTRACT The aim of the study was to estimate the prevalence of non-use of health services (NUHS) and its associated factors using the National Household Survey (ENAHO 2015). The participants were defined as NUHS if they have presented any symptoms, discomfort, illness, relapse of chronic illness or accident during the last month and did not go to the health services. 35036 participants were analyzed; the prevalence of NUHS was 53,9%. NUHS was higher in the coastal region (adjusted Prevalence Ratio [aPR]=1.24;95%CI:1.17-1.31), highlands (aPR=1.38; 95%CI: 1.31-1.46) and jungle (aPR=1.25,95%CI:1.18-1.33) compared to Lima. Likewise, there were a higher prevalence of NUHS in participants without health insurance (aPR=1.59;95%CI:1.52-1.66) and those affiliated to Ministry of Health insurance (aPR=1.16;95%CI:1.11-1.22) compared to those affiliated to Social Security. More than half of the participants suffered from NUHS, which was associated with geographical and health system conditions. It is required evidenced-informed public policies to improve this situation.

High serum ferritin levels are associated with insulin resistance but not with impaired glucose tolerance in a healthy people population.

AIM: To assess the association between elevated serum ferritin levels and the presence of insulin resistance (IR) or impaired glucose tolerance (IGT) in a population of individuals with no endocrine or metabolic disorders background. METHODS: Analytical cross-sectional study, carried out in adults of both sexes with no medical history of type 2 diabetes mellitus (T2DM) or other metabolic or endocrine disorder, who attended the outpatient service of a private clinic in Lima-Peru during 2012-2014 period. Impaired serum ferritin levels were defined as serum ferritin values >300µg/L in men and >200µg/L in women. IR was defined as a Homeostasis Model Assessment (HOMA-IR) value ≥3.8 and IGT was defined as an oral glucose tolerance test (OGTT) value between 126mg/dL and 199mg/dL. The reported association measure was the prevalence ratio (PR) with their respective 95% confidence intervals (95% CI). RESULTS: We analyzed 213 participants, the average age was 35.8±11.1years and 35.7% were males. The prevalence of impaired serum ferritin levels, IR and IGT in the population was 12.7%, 33.3% and 9.9% respectively. In the adjusted Poisson regression models, the prevalence of IR was higher among the group with impaired serum ferritin levels (PR=1.74; 95%CI:1.18-2.56); however, we found no association between impaired serum ferritin levels and IGT (PR=1.42; 95%CI:0.47-4.30). CONCLUSIONS: Impaired levels of serum ferritin are associated with IR, nevertheless, not with IGT in a metabolically healthy population. Serum ferritin could be considered as an early marker of IR prior to the onset of glycaemia disorders.