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1.
Lung ; 197(6): 793-801, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31583454

RESUMO

CONTEXT: Observational studies investigating household air pollution (HAP) exposure to biomass fuel smoke as a risk factor for pulmonary tuberculosis have reported inconsistent results. OBJECTIVE: To evaluate the association between HAP exposure and the prevalence of self-reported previous pulmonary tuberculosis. DESIGN: We analyzed pooled data including 12,592 individuals from five population-based studies conducted in Latin America, East Africa, and Southeast Asia from 2010 to 2015. We used multivariable logistic regression to model the association between HAP exposure and self-reported previous pulmonary tuberculosis adjusted for age, sex, tobacco smoking, body mass index, secondary education, site and country of residence. RESULTS: Mean age was 54.6 years (range of mean age across settings 43.8-59.6 years) and 48.6% were women (range of % women 38.3-54.5%). The proportion of participants reporting HAP exposure was 38.8% (range in % HAP exposure 0.48-99.4%). Prevalence of previous pulmonary tuberculosis was 2.7% (range of prevalence 0.6-6.9%). While participants with previous pulmonary tuberculosis had a lower pre-bronchodilator FEV1 (mean - 0.7 SDs, 95% CI - 0.92 to - 0.57), FVC (- 0.52 SDs, 95% CI - 0.69 to - 0.33) and FEV1/FVC (- 0.59 SDs, 95% CI - 0.76 to - 0.43) as compared to those who did not, we did not find an association between HAP exposure and previous pulmonary tuberculosis (adjusted odds ratio = 0.86; 95% CI 0.56-1.32). CONCLUSIONS: There was no association between HAP exposure and self-reported previous pulmonary tuberculosis in five population-based studies conducted worldwide.

2.
PLoS One ; 14(9): e0221717, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31498796

RESUMO

OBJECTIVE: Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population. METHOD: Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued. RESULTS: Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87). CONCLUSIONS: The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.

3.
Public Health Nutr ; : 1-11, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31456536

RESUMO

OBJECTIVE: To determine if specific dietary patterns are associated with risk of hypertension, type 2 diabetes mellitus (T2DM) and high BMI in four sites in Peru. DESIGN: We analysed dietary patterns from a cohort of Peruvian adults in four geographical settings using latent class analysis. Associations with prevalence and incidence of hypertension, T2DM and high BMI were assessed using Poisson regression and generalised linear models, adjusted for potential confounders. SETTING: Four sites in Peru varying in degree of urbanisation. PARTICIPANTS: Adults aged ≥35 years (n 3280). RESULTS: We identified four distinct dietary patterns corresponding to different stages of the Peruvian nutrition transition, reflected by the foods frequently consumed in each pattern. Participants consuming the 'stage 3' diet, characterised by high proportional consumption of processed foods, animal products and low consumption of vegetables, mostly consumed in the semi-urban setting, showed the highest prevalence of all health outcomes (hypertension 32·1 %; T2DM 10·7 %; high BMI 75·1 %). Those with a more traditional 'stage 1' diet characterised by potato and vegetables, mostly consumed in the rural setting, had lower prevalence of hypertension (prevalence ratio; 95 CI: 0·57; 0·43, 0·75), T2DM (0·36; 0·16, 0·86) and high BMI (0·55; 0·48, 0·63) compared with the 'stage 3' diet. Incidence of hypertension was highest among individuals consuming the 'stage 3' diet (63·75 per 1000 person-years; 95 % CI 52·40, 77·55). CONCLUSIONS: The study found more traditional diets were associated with a lower prevalence of three common chronic diseases, while prevalence of these diseases was higher with a diet high in processed foods and low in vegetables.

4.
Diabetes Res Clin Pract ; : 107829, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31465811

RESUMO

AIMS: This study aimed (1) to estimate the prevalence of prediabetes according to different definitions, (2) to evaluate regression to normal glucose levels and progression towards T2DM, and (3) to determine factors associated with regression and progression across four diverse geographical settings in a Latin American country. METHODS: The CRONICAS Cohort Study was conducted in four different areas in Peru. Enrollment started in September 2010 and follow-up was conducted in 2013. Prediabetes, T2DM and normal glucose levels were defined according to the World Health Organization (WHO), American Diabetes Association (ADA), and National Institute for Health and Care Excellence (NICE) definitions. The main outcomes were regression to normal glucose levels and incidence of T2DM. Prevalence estimates and 95% confidence intervals (95% CI) were calculated. Crude and adjusted regression models using Poisson were performed and relative risk ratios (RRR) and 95% CI were calculated. RESULTS: At baseline, the prevalence of prediabetes varied markedly by definition used: 6.5%(95% CI 5.6% - 7.6%), 53.6%(95% CI 51.6% - 55.6%), and 24.6%(95% CI 22.8% - 26.4%) according to WHO, ADA and NICE criteria, respectively. After 2.2 years of follow-up, in those with prediabetes, the cumulative incidence of regression to euglycemia ranged between 31.4% and 68.9%, whereas the incidence of T2DM varied from 5.5% to 28.8%. Factors associated with regression to normal glucose levels and progression to diabetes were age, body mass index, and insulin resistance. CONCLUSIONS: Regression from pre-diabetes back to euglycemia was much more common than progression to diabetes.

5.
Rev Panam Salud Publica ; 43, August 2019
Artigo em Inglês | PAHO-IRIS | ID: phr-51471

RESUMO

[ABSTRACT]. Objective. To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods. This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered—the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies’ websites were searched for training grants. Results. In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion. There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities.


[RESUMEN]. las capacidades de investigación sobre enfermedades no transmisibles (ENT) en América Latina. Métodos. Se realizó una revisión exploratoria de los programas de posgrado sobre las ENT disponibles en las mejores universidades de América Latina y de las becas para investigadores otorgadas por los organismos internacionales de financiamiento. Se consideraron tres listas de clasificación académica de universidades del mundo: QS Ranking, Shanghai Ranking y Times Ranking. Se seleccionaron las universidades de América Latina que figuraban en al menos dos de ellas. Se utilizaron los sitios web de las universidades para buscar los programas de posgrado actuales en las áreas de bioestadística, epidemiología, salud mundial, economía de la salud y salud pública. La información se extrajo, se resumió y se evaluó para encontrar todos los programas centrados en las ENT. Además, se realizó una búsqueda de las becas de formación ofrecidas en los sitios web de siete organismos internacionales de financiamiento. Resultados. En total, 33 universidades que ofrecían 72 programas de posgrado reunieron los criterios de inclusión. Uno de estos programas estaba exclusivamente dedicado a las ENT, y doce incluían las ENT como tema de investigación en tesis de grado. Solo dos becas de formación fueron otorgadas a una institución latinoamericana para fortalecer las capacidades de investigación sobre las ENT. Existen pocos programas para la formación de investigadores sobre las ENT en América Latina y hay un solo programa exclusivamente centrado en las ENT. Conclusiones. Al parecer, hay pocos programas específicos para la formación de investigadores sobre las ENT en América Latina. Aprovechar mejor los programas existentes y ampliar aquellos que se centran en las ENT podría ayudar a aumentar las capacidades de investigación sobre ENT en la región. Estas iniciativas deben contar con el apoyo de los organismos internacionales de financiamiento mediante el aumento de las oportunidades de financiamiento.


[RESUMO]. Objetivo. Identificar lacunas no ensino de pós-graduação e cursos de formação em pesquisa em doenças não transmissíveis na América Latina. Métodos. Trata-se de uma revisão da literatura do tipo scoping review das oportunidades de pós-graduação em doenças não transmissíveis nas principais universidades da América Latina e das bolsas de estudo oferecidas por organismos internacionais de financiamento. O estudo se baseou em três rankings mundiais de universidades – QS Ranking, Ranking de Xangai e The Times Higher Education World University Ranking – e as universidades latino-americanas que figuravam em pelo menos dois destes rankings foram incluídas na análise. Nos sites das universidades, foi feito um levantamento dos cursos atuais de pós-graduação em bioestatística, epidemiologia, saúde global, economia da saúde e saúde pública. As informações obtidas foram sumarizadas e avaliadas para identificar os cursos em doenças não transmissíveis. Além disso, nos sites de sete organismos internacionais de financiamento, foi feita uma pesquisa das bolsas de estudo oferecidas. Resultados. Ao todo, 33 universidades com 72 cursos de pós-graduação atenderam os critérios de inclusão no estudo. Verificou-se que um curso tinha foco exclusivo no estudo de doenças não transmissíveis e 12 cursos tinham doenças não transmissíveis como tópico de pesquisa de dissertação. Foram concedidas somente duas bolsas de estudo em doenças não transmissíveis a uma instituição latino-americana. Observou-se um pequeno número de programas de formação em pesquisa de doenças não transmissíveis na América Latina, com apenas um programa com foco exclusivo nestas doenças. Conclusões. Existem poucos programas de formação em pesquisa especificamente dedicados ao estudo de doenças não transmissíveis na América Latina. Faz-se necessário tirar proveito dos programas existentes e ampliar os programas com foco em doenças não transmissíveis para melhorar a capacidade de pesquisa em doenças não transmissíveis na Região. Essas iniciativas devem receber o apoio de organismos internacionais com maior oferta de bolsas de estudo.


Assuntos
Doenças não Transmissíveis , Pesquisa , Educação , Pesquisadores , América Latina , Doenças não Transmissíveis , Pesquisa , Educação , Pesquisadores , América Latina , Doenças não Transmissíveis , Educação , Pesquisa , Pesquisadores
6.
Rev. chil. nutr ; 46(4): 392-399, ago. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1013803

RESUMO

RESUMEN Existe limitada evidencia de la asociación entre actividad física ocupacional y síndrome metabólico. Esto es importante ya que una gran parte del día cotidiano se gasta en el trabajo, el cual es mayormente sedentario. El objetivo del presente estudio fue evaluar la asociación entre niveles de actividad física ocupacional y la presencia de síndrome metabólico. Método: Análisis de datos secundarios usando información de un estudio poblacional en cinco estratos geográficos del Perú. La variable dependiente fue síndrome metabólico definido según consenso internacional; la exposición fue el auto-reporte de actividad física ocupacional (alto, moderado, bajo). Se usaron modelos de regresión de Poisson reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC95%). Resultados principales: Datos de 4029 individuos fueron analizados, edad promedio 42,1 años (DE: 15,3) y 2013 (50,0%) fueron mujeres. Un total de 1011 (25,1%; IC95%: 23,8%-26,5%) sujetos presentaban síndrome metabólico. El modelo multivariable mostró asociación entre actividad física ocupacional y síndrome metabólico: comparado con los que reportaron altos niveles de actividad física, aquellos con actividad física moderada y baja tenían RP= 1,51 (IC95%: 1,25-1,81) y RP= 1,71 (IC95%: 1,42-2,06) veces más prevalencia de síndrome metabólico. La asociación fue más fuerte en los varones que en las mujeres (p= 0,001). Conclusiones: Nuestros hallazgos confirman la asociación entre niveles de actividad física ocupacional y la presencia de síndrome metabólico. Además 25% de la población de estudio cumplió con los criterios diagnósticos de síndrome metabólico.


ABSTRACT There is limited evidence about the association between work-related physical activity and metabolic syndrome. This is important as a great part of a usual day is related to work, and most of this is sedentary. The aim on this study was to assess the association between work-related physical activity and metabolic syndrome. Methods: A secondary analysis of data from a population-based study in five geographical strata in Peru. The outcome of interest was metabolic syndrome based on international consensus; exposure was the self-report of work-related physical activity (high, moderate, and low). Crude and adjusted Poisson regression models, with robust variance were used, from which prevalence ratios (PR) and 95% confidence intervals (95%CI) were reported. Results: Data from 4029 individuals were analyzed, mean age 42.1 (SD: 15.3) years, and 2013 (50.0%) were females. A total of 1011 (25.1%; 95%CI: 23.8%-26.5%) subjects had metabolic syndrome. The multivariable model evidenced an association between work-related physical activity and metabolic syndrome: compared to those reporting high levels of physical activity, those with moderate and low physical activity had 1.51 (95%CI: 1.25-1.81) and 1.71 (95%CI: 1.42-2.06) greater prevalence of metabolic syndrome. The association was stronger among males than females (p= 0.001). Conclusions: Our results confirm the association between work-related physical activity and the presence of metabolic syndrome. In addition, 25% of the study population had metabolic syndrome.


Assuntos
Humanos , Local de Trabalho , Síndrome Metabólica , Dislipidemias , Pressão Arterial , Hiperglicemia , Atividade Motora , Peru , Prevalência
7.
J. Hypertens ; 37(9): 1813-1821, Jul., 31, 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1015823

RESUMO

OBJECTIVES: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. METHODS: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay)were included. HTN was defined as self-reported HTN on blood pressure (BP)medication or average BP over 140/90 mmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90 mmHg. RESULTS: Mean age was 52 years,60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%)58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90 mmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN. CONCLUSION: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is na urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.(AU)


Assuntos
Humanos , Hipertensão/epidemiologia , América Latina/epidemiologia
8.
Public Health Nutr ; : 1-9, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31159908

RESUMO

OBJECTIVE: To determine the association between excess body fat, assessed by skinfold thickness, and the incidence of type 2 diabetes mellitus (T2DM) and hypertension (HT). DESIGN: Data from the ongoing PERU MIGRANT Study were analysed. The outcomes were T2DM and HT, and the exposure was skinfold thickness measured in bicipital, tricipital, subscapular and suprailiac areas. The Durnin-Womersley formula and SIRI equation were used for body fat percentage estimation. Risk ratios and population attributable fractions (PAF) were calculated using Poisson regression. SETTING: Rural (Ayacucho) and urban shantytown district (San Juan de Miraflores, Lima) in Peru. PARTICIPANTS: Adults (n 988) aged ≥30 years (rural, rural-to-urban migrants, urban) completed the baseline study. A total of 785 and 690 were included in T2DM and HT incidence analysis, respectively. RESULTS: At baseline, age mean was 48·0 (sd 12·0) years and 47 % were males. For T2DM, in 7·6 (sd 1·3) years, sixty-one new cases were identified, overall incidence of 1·0 (95 % CI 0·8, 1·3) per 100 person-years. Bicipital and subscapular skinfolds were associated with 2·8-fold and 6·4-fold risk of developing T2DM. On the other hand, in 6·5 (sd 2·5) years, overall incidence of HT was 2·6 (95 % CI 2·2, 3·1) per 100 person-years. Subscapular and overall fat obesity were associated with 2·4- and 2·9-fold risk for developing HT. The PAF for subscapular skinfold was 73·6 and 39·2 % for T2DM and HT, respectively. CONCLUSIONS: We found a strong association between subscapular skinfold thickness and developing T2DM and HT. Skinfold assessment can be a laboratory-free strategy to identify high-risk HT and T2DM cases.

9.
High Alt Med Biol ; 20(2): 133-140, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31063411

RESUMO

Background: Kidney health needs to be studied in low- and middle-income countries with populations living at high altitude and undergoing urbanization. We studied whether greater level of urbanization was associated with worse kidney function and higher hemoglobin was associated with worse kidney function at high altitude. Methods: Cross-sectional analysis of population-based studies in Peru including five sites at different altitude above the sea level and urbanization level (in decreasing order of urbanization): Lima (sea level), Arequipa (2335 m), urban Puno (3825 m), Tumbes (sea level), and rural Puno (3825 m). The exposures were urbanization and altitude as per study site, and hemoglobin (g/dL). The outcome was the estimated glomerular filtration rate (eGFR). Results: Four thousand two hundred eight people were studied: mean age was 57.4 years (standard deviation: 12.4) and 51.9% were women. In comparison to rural Puno, eGFR was similar in Lima; in comparison to rural Puno, Arequipa, urban Puno, and Tumbes had worse eGFR, for example, in Arequipa, ß = -8.07 (95% confidence interval [CI]: -10.90 to -5.24). Intermediate (ß = -8.60; 95% CI: -10.55 to -6.66) and high (ß = -11.21; 95% CI: -14.19 to -8.24) altitude were negatively correlated with eGFR when only urban places were analyzed. At high altitude, there was a trend for a negative association between hemoglobin and eGFR: ß = -1.09 (95% CI: -2.22 to 0.04). Conclusions: Apparently, higher altitude and level of urbanization, except for one highly urbanized site, were associated with worse kidney function. Our findings suggest that some of the adverse impact of high altitude on kidney function has been balanced by the lower risk conferred by rural environments.

10.
Rev Peru Med Exp Salud Publica ; 36(1): 26-36, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31116335

RESUMO

Objetives. To identify prevalence and incidence studies of type 2 diabetes mellitus in the general adult population in Peru. MATERIALS AND METHODS: Observational studies involving randomly selected individuals from the general population were evaluated. The definition of diabetes had to include at least one laboratory parameter (e.g. baseline glucose). LILACS, SciELO, Scopus, Medline, Embasem and Global Health were reviewed without restriction. Risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: The search identified 909 results; additionally, an article from another source was added. After evaluating the results, 20 articles representing nine studies were selected (n=16 585). One of the studies was national in scope and another semi-national (ENINBSC, 2004-05 and PERUDIAB, 2010-12). The first study reported a prevalence of 5.1% in subjects ≥35 years, while the second reported 7.0% in subjects ≥25 years. Other studies focused on populations in one or more cities in the country, or on selected population groups, such as the PERU MIGRANT study (2007-08) which reported the prevalence of diabetes in subjects in rural areas (0.8%), in rural-urban migrants (2.8%), and in urban areas (6.3%). Three studies followed up prospectively, one of them being PERUDIAB: a cumulative incidence of 19.5 new cases per 1,000 people per year. The risk of bias was low in all studies. CONCLUSIONS: Population studies indicate that the prevalence of diabetes has increased and that there are approximately two new cases per 100 people per year. Evidence is still scarce in the jungle and in rural populations.

11.
COPD ; 16(1): 58-65, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31032662

RESUMO

The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35-95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8 kg/m2. Participants with BMI < 19.8 kg/m2 had a 2.28 greater odds (95% CI 1.83-2.86) of having COPD and had a 0.21 (0.13-0.30) lower FEV1 and 0.34 (0.27-0.41) lower FEV1/FVC z-score compared to those with BMI ≥ 19.8 kg/m2. The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.

12.
J Hypertens ; 37(9): 1813-1821, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30964825

RESUMO

OBJECTIVES: The objective is to describe hypertension (HTN) prevalence, awareness, treatment and control in urban and rural communities in Latin America to inform public and policy-makers. METHODS: Cross-sectional analysis from urban (n = 111) and rural (n = 93) communities including 33 276 participants from six Latin American countries (Argentina, Brazil, Chile, Colombia, Peru and Uruguay) were included. HTN was defined as self-reported HTN on blood pressure (BP) medication or average BP over 140/90 mmHg, awareness as self-reported HTN, and controlled as those with BP under 140/90 mmHg. RESULTS: Mean age was 52 years, 60% were Female and 32% belonged to rural communities. HTN prevalence was 44.0%, with the lowest rates in Peru (17.7%) and the highest rates in Brazil (52.5%). 58.9% were aware of HTN diagnosis and 53.3% were receiving treatment. Prevalence of HTN were higher in urban (44.8%) than rural (42.1%) communities in all countries. Most participants who were aware of HTN were receiving medical treatment (90.5%), but only 37.6% of patients receiving medical treatment had their BP controlled (<140/<90 mmHg), with the rates being higher in urban (39.6%) than in rural (32.4%) communities. The rate of use of two or more drugs was low [36.4%, lowest in Argentina (29.6%) and highest in Brazil (44.6%)]. Statin use was low (12.3%), especially in rural areas (7.0%). Most modifiable risk factors were higher in people with HTN than people without HTN. CONCLUSION: HTN prevalence is high but BP control is low in Latin America, with marked differences between countries and between urban and rural settings. There is an urgent need for systematic approaches for better detection, treatment optimization and risk factor modification among those with HTN in Latin America.

13.
Nutr Diet ; 2019 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-30997733

RESUMO

AIM: To assess if there is an association between sitting time and obesity among adult Peruvian population, using three different anthropometric measurements. METHODS: A secondary analysis using data from a population-based study, the National Household Survey (ENAHO, in Spanish), was conducted enrolling adults aged ≥18 years from the 25 regions of Peru using a multistage random sampling technique. The outcome of interest was obesity, determined by body mass index (BMI > 30 kg/m2 ), waist circumference (WC > 80 and >90 cm in women and men, respectively) and waist to height ratio (WHR > 0.5); while the exposure was sitting time, measured using the last domain of the International Physical Activity Questionnaire and then categorised in <4 hours/day, 4 to <8 hours/day and 8+ hours/day. Associations were estimated using Poisson regression models, reporting prevalence ratios (PRs) and their respective 95% CI. RESULTS: Data from 8587 subjects were analysed; mean age was 38.4 (SD: 13.5) and 53.6% were females. The prevalence of obesity was 16.3% (95% CI: 15.2-17.5%) by BMI, 58.5% (95% CI: 56.9-60.0%) by WC, and 78.0% (95% CI: 76.5-79.3%) by WHR. In the multivariable model, subjects reporting a sitting time of 8+ hours/day were more likely to be obese than those reporting <4 hours/day according to BMI (PR: 1.38; 95% CI: 1.15-1.65), WC (PR: 1.20; 95% CI: 1.12-1.28) and WHR (PR: 1.05; 95% CI: 1.01-1.10). CONCLUSIONS: Subjects with greater sitting time were more likely to be obese, and this association was evident with three different anthropometric indicators. Findings suggest the need of generating public health actions to reduce sedentary behaviour.

14.
Rev. peru. med. exp. salud publica ; 36(1): 26-36, ene.-mar. 2019. ilus
Artigo em Espanhol | LILACS-Express | ID: biblio-1014518

RESUMO

Objetivos. Identificar estudios de prevalencia e incidencia de diabetes mellitus tipo 2 en población general adulta de Perú. Materiales y métodos. Se evaluaron estudios observacionales que incluyeron individuos de población general seleccionados aleatoriamente. La definición de diabetes debió incluir al menos un parámetro de laboratorio (p. ej. glucosa basal). Se revisó LILACS, SciELO, Scopus, Medline, Embase y Global Health, sin restricciones. El riesgo de sesgo se evaluó con la escala Newcastle-Ottawa. Resultados. La búsqueda identificó 909 resultados, adicionalmente se agregó un artículo de otra fuente. Luego de evaluar los resultados, se seleccionaron 20 artículos que representaron nueve estudios (n=16 585). Uno de los estudios fue de alcance nacional y otro seminacional (ENINBSC, 2004-05 y PERUDIAB, 2010-12); el primero reportó una prevalencia de 5,1% en sujetos ≥35 años, mientras que el segundo reportó 7,0% en sujetos ≥25 años. Otros estudios se enfocaron en poblaciones de una o varias ciudades del país, o en grupos poblacionales selectos, como el estudio PERU MIGRANT (2007-08) que reportó la prevalencia de diabetes en sujetos de zonas rurales (0,8%), en migrantes de zonas rurales a urbanas (2,8%), y en zonas urbanas (6,3%). Tres estudios realizaron seguimiento prospectivo, siendo uno de ellos el PERUDIAB: incidencia acumulada de 19,5 nuevos casos por 1000 personas al año. El riesgo de sesgo fue bajo en todos los estudios. Conclusiones. Estudios poblacionales señalan que la prevalencia de diabetes ha aumentado y se registran aproximadamente dos casos nuevos por cada cien personas al año. La evidencia aún es escasa en la selva y en poblaciones rurales.


Objetives. To identify prevalence and incidence studies of type 2 diabetes mellitus in the general adult population in Peru. Materials and Methods. Observational studies involving randomly selected individuals from the general population were evaluated. The definition of diabetes had to include at least one laboratory parameter (e.g. baseline glucose). LILACS, SciELO, Scopus, Medline, Embasem and Global Health were reviewed without restriction. Risk of bias was assessed using the Newcastle-Ottawa scale. Results. The search identified 909 results; additionally, an article from another source was added. After evaluating the results, 20 articles representing nine studies were selected (n=16 585). One of the studies was national in scope and another semi-national (ENINBSC, 2004-05 and PERUDIAB, 2010-12). The first study reported a prevalence of 5.1% in subjects ≥35 years, while the second reported 7.0% in subjects ≥25 years. Other studies focused on populations in one or more cities in the country, or on selected population groups, such as the PERU MIGRANT study (2007-08) which reported the prevalence of diabetes in subjects in rural areas (0.8%), in rural-urban migrants (2.8%), and in urban areas (6.3%). Three studies followed up prospectively, one of them being PERUDIAB: a cumulative incidence of 19.5 new cases per 1,000 people per year. The risk of bias was low in all studies. Conclusions. Population studies indicate that the prevalence of diabetes has increased and that there are approximately two new cases per 100 people per year. Evidence is still scarce in the jungle and in rural populations.

15.
Diabetes Metab Res Rev ; 35(4): e3139, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30761721

RESUMO

Type 2 diabetes mellitus (T2DM) is associated with a high mortality risk, although the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis: inclusion criteria were (1) men and women 18 years old and above with T2DM; (2) study outcomes all-cause and/or cause-specific mortality; and (3) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health, and LILACS) were searched. Risk of bias was evaluated with the ROBINS-I criteria. Initially, there were 979 identified studies, of which 17 were selected for qualitative synthesis; 14 were included in the meta-analysis (N = 416 821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I2 ] = 85.7%, p < 0.001; 95% confidence interval [CI], 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I2  = 93.9%, p < 0.001; 95% CI, 1.36-3.74). The pooled risk estimates were similar between men and women, although higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I2  = 59.2%; p < 0.061; 95% CI, 1.99-3.82) and for renal mortality 15.85 (I2  = 0.00%; p < 0.645; 95% CI, 9.82-25.57). Using available population-based cohort studies, this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.

16.
Child Obes ; 15(4): 237-243, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30810346

RESUMO

Background: We aimed to evaluate if there is association between hours of sleep and the risk of obesity among children and whether this association differs by sex. Methods: A secondary data analysis, using information of the Young Lives study, was conducted. The outcome was obesity, based on the BMI for age z-score; the exposure was child's sleep duration (reported by parents) categorized using the National Sleep Foundation guidelines, and as a numerical variable. Baseline and three follow-ups information were used to evaluate association, reporting relative risks (RRs), and 95% confidence intervals (CIs), as well as coefficients and 95% CI. Results: Data from 1949 children, baseline mean age 4.3 (standard deviation: 0.3) and 962 (49.5%) females, were analyzed. Short sleep duration was present in 26.0% (95% CI: 24.0-28.0) at baseline. After 9.6 years of follow-up, the incidence of obesity was 0.83 (95% CI: 0.70-0.98) per 100 person-years at risk. In multivariable model (n = 1579), there was no association between short sleep duration and obesity in the whole sample (p = 0.13); but the risk of obesity was lower among girls (n = 816; RR = 0.45; 95% CI: 0.21-0.96; p = 0.03) compared with boys (n = 763; RR = 1.43; 95% CI: 0.95-2.14; p = 0.09). On the contrary, each additional hour of sleep was associated with an increase of boy's BMI mean (0.05; 95% CI: 0.02-0.08; p < 0.001), but not among girls (-0.02; 95% CI: -0.05 to 0.01; p = 0.11). Conclusions: Our results evidenced a lower risk of obesity due to short sleep duration in girls, but not in boys. Each additional hour of sleep was associated with an increase of BMI in boys, but not in girls. Strategies are needed to guarantee adequate sleep duration in Peruvian children.

17.
Heart ; 105(12): 953-960, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30661034

RESUMO

OBJECTIVE: A systematic review and meta-analysis was conducted to assess the efficacy of low-sodium salt substitutes (LSSS) as a potential intervention to reduce cardiovascular (CV) diseases. METHODS: Five engines and ClinicalTrials.gov were searched from inception to May 2018. Randomised controlled trials (RCTs) enrolling adult hypertensive or general populations that compared detected hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), overall mortality, stroke and other CV risk factors in those receiving LSSS versus regular salt were included. Effects were expressed as risk ratios or mean differences (MD) and their 95% CIs. Quality of evidence assessment followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS: 21 RCTs (15 in hypertensive (n=2016), 2 in normotensive (n=163) and 4 in mixed populations (n=5224)) were evaluated. LSSS formulations were heterogeneous. Effects were similar across hypertensive, normotensive and mixed populations. LSSS decreased SBP (MD -7.81 mm Hg, 95% CI -9.47 to -6.15, p<0.00001) and DBP (MD -3.96 mm Hg, 95% CI -5.17 to -2.74, p<0.00001) compared with control. Significant increases in urinary potassium (MD 11.46 mmol/day, 95% CI 8.36 to 14.55, p<0.00001) and calcium excretion (MD 2.39 mmol/day, 95% CI 0.52 to 4.26, p=0.01) and decreases in urinary sodium excretion (MD -35.82 mmol/day, 95% CI -57.35 to -14.29, p=0.001) were observed. Differences in detected hypertension, overall mortality, total cholesterol, triglycerides, glucose or BMI were not significant. Quality of evidence was low to very low for most of outcomes. CONCLUSIONS: LSSS significantly decreased SBP and DBP. There was no effect for detected hypertension, overall mortality and intermediate outcomes. Large, long-term RCTs are necessary to clarify salt substitute effects on clinical outcomes.

18.
Rev Peru Med Exp Salud Publica ; 35(3): 409-415, 2018 Jul-Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-30517500

RESUMO

OBJECTIVES.: To describe the mortality trend due to chronic kidney disease (CKD) in Peru in the period 2003-2015. MATERIALS AND METHODS.: Analysis of secondary data and ecological design. National mortality registries based on death certificates were analyzed. ERC was defined as CIE code 10: N18 in the basic cause. Absolute and relative frequencies of death by ERC are described. To estimate the proportion of deaths by CKD in each region of Peru, a generalized mixed linear model was used. The outcome variable was the proportion of deaths, the independent variables were each region of the country and the year. RESULTS.: The analysis included 1,086,778 deaths, of which 25,091 (2.0 % age- and sex-adjusted) were by CKD. During the study period, the average age at death increased by 2.6 years (p<0.001); in addition, the proportion of age- and sex-adjusted CKD deaths was always higher in women. In the observation period, the region with the highest mortality from CKD was Puno (4.1%), and with the lowest mortality was Amazonas (1.1%). Those regions that showed a significantly greater increase than the others were Tacna, La Libertad, Tumbes, Apurímac, Cusco, Ica, Moquegua, Ayacucho, Huancavelica and Puno. CONCLUSIONS.: In the 2003-2015 period, mortality from CKD in Peru has increased; this trend is observed in several regions of the country. Preventive measures, early identification, and access to treatment must be implemented to control this trend.

19.
PLoS One ; 13(12): e0208441, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30586426

RESUMO

BACKGROUND: Disability rates increase with age. In 2012, Peruvian older adults (≥ 65 years) represented 9% of the population. Additionally, older population reported disabilities at about 5 times the rate of Peruvians between 36 and 64 years old, and 30% of older population lived in poverty. Peruvian seniors living in extreme poverty experience disabilities and the extent of their access to healthcare is unknown. OBJECTIVE: This study assesses associations between disability and access to healthcare among Peruvians older individuals living in extreme poverty. METHODS: Secondary analysis of a national representative population based survey that utilizes information from Peru's 2012 survey Health and Wellbeing in Older Adults (ESBAM), which includes older adults living in extreme poverty. We define disability in terms of the Activities of Daily Living (ADL disability) framework. Healthcare access was assessed as having any of Peru's available health insurance schemes combined with preventive health services (vision assessment, influenza vaccination, blood pressure assessment, diabetes screening, and cholesterol assessment). Poisson robust regression models were used to evaluate the associations among relevant variables. Prevalence Ratios and 95% confidence intervals (95%CI) were reported. RESULTS: Data from 3869 individuals (65 to 80 years old), of whom 1760 (45.5%) were females, were analyzed. The prevalence of ADL disability was 17.3% (95%CI: 16.0%-18.4%). In addition, more than 60% had never received any of the preventive measures evaluated, except for the blood pressure assessment. In the adjusted model, people with ADL disability had 63% less probability of having extensive insurance, compared to those without disability (p<0.05). CONCLUSIONS: This study shows that this Peruvian older population living in extreme poverty has limited access to healthcare services. Although there was no consistent association between ADL disability and the healthcare access, there is an urgent need to reduce the inequitable access to healthcare of this poor Peruvian older population.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Acesso aos Serviços de Saúde , Pobreza , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Peru/epidemiologia , Pobreza/estatística & dados numéricos , Prevalência
20.
PeerJ ; 6: e5948, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30473936

RESUMO

Background: The underlying cause of death is used to study country and global mortality trends and profiles. The final cause of death could also inform the ultimately cause of death in individuals with underlying conditions. Whether there is a pattern between the underlying and final cause of death has not been explored using national death registries. We studied what final causes of death were most common among selected underlying causes using national death registries in Peru, 2015. Methods: Underlying and final causes of death were classified according to their ICD-10 codes. Underlying causes included chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), diabetes, and selected cancers (cervix, breast, stomach, prostate, and lung). Final causes were categorized as: communicable, cardiovascular, and cancers. Descriptive statistics were used. Results: A total of 77,065 death registries were analyzed; cases had a mean age of 69.4 (SD: 19.3) years at death and were mostly men (53.9%). When the underlying cause was HTN, the most frequent final cause was cardiovascular diseases (82.3%). For all the other underlying causes, the most frequent final cause was communicable diseases: COPD (86.4%), CKD (79.3%), cancer (76.5%), and diabetes (68.3%). Conclusions: In four selected underlying causes of death there was a divergence with respect to the final cause, suggesting there was a shift from non-communicable to communicable causes. Although efforts should be deployed to prevent underlying non-communicable diseases, potential communicable complications should not be neglected.

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