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1.
J Adolesc Health ; 76(1): 62-71, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39352360

RESUMO

PURPOSE: This study investigated symptoms of anxiety and depression, feelings of loneliness, and life satisfaction among low-to-middle income Peruvian adolescents during 2 years of remote schooling due to the COVID-19 lockdown. METHODS: We used a four-wave longitudinal observational approach. Data were collected in April 2020, October 2020, June 2021, and November 2021 in Perú. A total of 2,392 adolescents (ages 10-15; 57% female) participated in the study. We described longitudinal changes in symptoms of anxiety and depression, feelings of loneliness, and life satisfaction across the four time points and investigated sex and school grade differences. RESULTS: Symptoms of anxiety, depression, and loneliness increased, and life satisfaction decreased over the course of 2 years of remote education. The rate of change was different for each outcome of well-being. We found robust sex differences for all outcomes. In addition, we found school grade differences for anxiety and depression. DISCUSSION: The mental health and well-being of Peruvian adolescents, particularly female adolescents, declined during 2 years of remote education, despite loosening of other pandemic restrictions. Depression appears to have the earliest impacts, with anxiety levels showing even some improvement for male adolescents. School grade differences in levels of anxiety and depression for seventh and eighth graders in 2020 and 2021 provide initial evidence to disentangle pandemic from developmental effects.


Assuntos
Ansiedade , COVID-19 , Depressão , Saúde Mental , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Adolescente , Peru/epidemiologia , Masculino , Feminino , Estudos Longitudinais , Depressão/epidemiologia , Depressão/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Criança , Solidão/psicologia , Satisfação Pessoal , Educação a Distância , SARS-CoV-2 , Fatores Sexuais
2.
J Glob Health ; 14: 05039, 2024 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-39703982

RESUMO

Background: The resilience of Peru´s health system was weakened by a political crisis that started in 2016 and was further challenged by the coronavirus 2019 (COVID-19) pandemic. We assessed the indirect impact of the pandemic on the utilisation of essential maternal and child health (MCH) services in Peru at national and subnational levels. Methods: We assessed the trends in MCH services utilisation and the percentage change from 2018 to 2021, using routine health facility data. We used an interrupted time series analysis to quantify the impact of COVID-19 on the utilisation of health services. Results: The utilisation of most maternal and child health services dropped dramatically in 2020 after the outbreak. However, we observed a quick recovery in 2021, with service utilisation fairly similar or higher to the pre-pandemic period (2018-2019). The decrease was higher in the utilisation of antenatal care visit one or more (incidence rate ratio (IRR) = 0.79; 95% CI = 0.74-0.83) and antenatal care visits four or more (IRR= 0.76; 95% = 0.74-0.79) in 2020. The IRR showed a drop of 5, 6, 9, and 13% in the utilisation of skilled birth attendances, institutional deliveries, caesarean sections and postnatal care visits within two days of childbirth, respectively in 2020 in comparison to pre-pandemic service utilisation. In 2020 the utilisation decreased in all three natural regions, with the Rainforest being the most affected. In 2021 there was a recovery in all natural regions. Conclusions: The pandemic decreased the utilisation of essential maternal and child health services in Peru. This highlights the need to preserve the resilience of a health system both at central and local levels, to face more successfully future pandemics.


Assuntos
COVID-19 , Análise de Séries Temporais Interrompida , Humanos , Peru/epidemiologia , COVID-19/epidemiologia , Feminino , Gravidez , Criança , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Pré-Escolar , Serviços de Saúde Materna/estatística & dados numéricos , Lactente , Pandemias
3.
Rev Bras Enferm ; 77(6): e20240217, 2024.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-39699371

RESUMO

OBJECTIVES: to analyze the relationship between religion and professional experience with spiritual intelligence in nurses. METHODS: cross-sectional and analytical study carried out in 2021, with the participation of 544 nursing professionals working in health facilities in Peru during the COVID-19 pandemic. Multiple regression analysis and Pearson's correlation were used to analyze the data. RESULTS: in nurses, a healthy level of spiritual intelligence predominated (42.8%). Those who did not profess a religion were more likely to have a lower spiritual intelligence score (global scale and dimensions); however, experienced nurses were more likely to have higher spiritual intelligence (global scale and dimensions) than novice nurses (p<0.05). CONCLUSIONS: spiritual intelligence in nurses was predicted by religion and professional experience. This finding suggests that spiritual intelligence in nursing is consolidated through religious practices and during professional practice.


Assuntos
COVID-19 , Espiritualidade , Humanos , Estudos Transversais , Feminino , Adulto , Masculino , COVID-19/psicologia , COVID-19/enfermagem , COVID-19/epidemiologia , Peru , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Inquéritos e Questionários , SARS-CoV-2 , Religião , Pandemias
4.
Soc Sci Med ; 365: 117581, 2024 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-39667171

RESUMO

BACKGROUND: The outbreak of COVID-19 was followed by an unprecedented package of measures to protect public health. Over 150 countries mandated school closures to reduce the risk of transmission. Decisions on whether to close schools involve trade-offs between important effects on public health, learning outcomes, well-being of children, productivity of parents. OBJECTIVES: Investigate Peruvian citizens' preferences for schools opening during a public-health crisis such as the COVID-19 pandemic in two scenarios: (i) when the threat from COVID-19 is low and schools are open; and, (ii) when the threat from COVID-19 is high and schools are closed. METHODS: We conducted a Participatory Value Evaluation (PVE) from 22 September to 17 October 2022, on which 2007 respondents assessed which policy measures to implement in the two scenarios. (i) In Scenario 1 "Schools are open", children go to school, teachers and parents go to their jobs, but children still experience learning deficits from previous school closures. (ii) In Scenario 2 "Schools are closed", children cannot go to school and do not receive any formal teaching, leading to learning losses; many teachers must change careers; and, many parents have to stay at home to take care of their children and lose income. Respondents were shown a range of policy measures in each of the scenarios and received information about the effects of each measure on public health, children's well-being and learning loss. RESULTS: We found that most respondents in Scenario 1 preferred mandatory vaccination for teachers and quarantine measures. In Scenario 2 we found that most respondents were positive towards reopening school policies. In both Scenarios respondents prioritized mandatory vaccination and quarantine measures over other mitigation measures. In Scenario 2, most respondents from the Highland region selected opening schools with 100% on-location teaching while hybrid teaching was mostly selected in the Coast region. Most respondents (82%) evaluated PVE as a good method to involve citizens in policy decision-making. CONCLUSIONS: Policies that focus on prevention (e.g. mandatory vaccination for teachers and quarantine measures) can count on substantial support in a scenario when schools are open. The strong preference for opening schools with a noticeable difference in the way classes are provided (e.g. teaching on location most preferred by respondents from the Highlands and hybrid teaching by respondents from the Coast) show the importance of introducing differentiated strategies among regions.

5.
Diagnostics (Basel) ; 14(22)2024 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-39594168

RESUMO

Cardiac troponin serum concentration is a marker of myocardial injury, but NT-pro BNP is a marker of myocardial insufficiency. The purpose of this study was to determine binary logistic regression models to verify the possible association of cardiovascular risk indicators, pre-pandemic history, the number of times participants were infected with SARS-CoV-2, and vaccination against these biomarkers. A total of 281 residents of Trujillo city (Peru) participated between September and December 2023. We found a high prevalence of abdominal obesity of 55.2%; glycemia > 100 m/dL in 53%; hypercholesterolemia in 49.8%; low HDL in 71.9%; and LDL > 100 mg/dL in 78.6%. A total of 97.5% were vaccinated against COVID-19, and 92.2% had three or more doses. Also, 2.5% had cTnI > 0.05 ng/mL, and 3.3% had NT-proBNP > 125 pg/mL. The number of COVID-19 infections versus cTnI > 0.05 ng/mL presented an OR = 3.513 (p = 0.003), while for NT-proBNP > 125 pg/mL, the number of comorbidities presented an OR = 2.185 (p = 0.025) and LDL an OR = 0.209 (p = 0.025). A regression model was obtained in which there is an association between a higher number of COVID-19 infections and elevated cTnI values and a model implying an association of the number of comorbidities and LDL with the NT-proBNP level in a direct and inverse manner, respectively. Both models contribute to the prevention of cardiac damage.

6.
Am J Trop Med Hyg ; 2024 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-39591639

RESUMO

In the early coronavirus disease 2019 pandemic, limited understanding of severe acute respiratory syndrome coronavirus 2 transmission and fears of infection hindered mass dog vaccination efforts in dog rabies-affected areas. Interruption of dog rabies vaccination campaigns could lead to a rapid increase in the risk of human rabies. To address these challenges, we applied human-centered design (HCD) principles to develop a vaccination strategy that prioritizes safety while ensuring dog rabies vaccination continuity in Arequipa, Peru, a rabies-affected area. We describe the process of rapid prototyping and testing undertaken by our research team to adapt the vaccination process in response to a health crisis. A multidisciplinary team met twice a week to prototype a fixed-point vaccination campaign that ensured distancing and reduction of fomite transmission while allowing for the continuation of dog vaccination. Field notes and videos informed successive meetings. The final prototype was used in rabies hotspots. In 4 weeks, six prototypes of safe booths and supporting safety protocols were designed, and two copies of each prototype were field tested. During testing, additional innovations were identified and implemented, including virtual vaccine certificates and online data collection forms. The final prototype was implemented across 251 sites, and 17,876 dogs were vaccinated. Using HCD principles, we swiftly developed a mass vaccination strategy that provided safety and enabled the maintenance of rabies vaccination programs. This work highlights the importance of innovative and adaptive approaches to address public health challenges in times of crisis.

7.
Diabetes Metab Syndr Obes ; 17: 4307-4317, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39588132

RESUMO

Purpose: To compare the levels of cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in apparently non-COVID-19 (COVID-19-) and post-COVID-19 (COVID-19+) persons with metabolic syndrome (MetS+) and without metabolic syndrome (MetS-). Methods: The descriptive correlational study was carried out in 275 inhabitants of the city of Trujillo in 2023. Cardiac markers were determined by time-resolved immunofluorescence. Results: It was determined that 58.2% of the participants presented COVID-19 and 46.5% presented a diagnosis of MetS according to the harmonized ATP III criteria. Levels of cTnI greater than 0.05 ng/mL were found in low percentages in the COVID-19-/MetS-, COVID-19-/MetS+, and COVID-19+/MetS- groups at 0.7% each, and in the COVID-19+/SM+ group, it was 0.4%. NT-proBNP concentrations higher than 125 pg/mL were found in 2.9% of participants, of which 1.1% were in the COVID-19+/MetS+ group, a slightly higher proportion compared to the other groups. Conclusion: The proportion of individuals with normal or elevated cTnI and NT-ProBNP levels does not differ significantly in both healthy individuals, with MetS only, and those with mild Post COVID-19 with or without MetS; however, longitudinal studies are required to detect possible myocardial events in either group for adequate treatment, especially in those with COVID-19+/MetS+.

8.
Inquiry ; 61: 469580241301307, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39584549

RESUMO

The COVID-19 pandemic has led many people to turn to self-medication as an accessible and convenient method of managing their health. Thus, this study sought to describe the self-medication practices (SMP) and their risk factors among the Peruvian population during the COVID-19 outbreak. A cross-sectional study was conducted from January to March, 2021, in 3 cities of Peru (Lima, Ica, and Chincha). An e-survey was distributed virtually to these populations. The association among the SMP and other variables was explored using the Chi-square test and then analyzed by the Poisson regression model (step-wise). The degree of association was represented by a prevalence ratio (PR) with its respective 95% confidence interval (95% CI). A total of 2207 participants (38.86 ± 15.1 yo) were included. 70.1% (n = 1547) were women and 70.0% (n = 1544) were from Lima. The frequency of SMP among all participants was 35.93%. In the self-medicated population, the most used drugs without a prescription were ivermectin (drops, 72.01%, n = 571), paracetamol (41.24%, n = 327), and azithromycin (25.81%, n = 284). The main factors associated with SMP were living in Chincha (P < .001; PR:1.44; 95% CI: 1.26-1.65), being divorced or widowed (P = .002; PR: 1.37; 95% CI: 1.27-1.93), being an informal employee (P < .001; PR:1.45; 95% CI: 1.23-1.71), and having symptoms of SARS-CoV-2 infection with no confirmed diagnosis (P < .001; PR: 2.17; 95% CI: 1.88-2.50). Our results showed that more than a third of all our participants self-medicated themselves. The SMP was associated mainly with residing in Chincha, not having any marital status, being informally employed, and having the presence of symptoms related to COVID-19 without diagnosis.


Assuntos
COVID-19 , Automedicação , Humanos , Estudos Transversais , Feminino , Masculino , Automedicação/estatística & dados numéricos , Peru/epidemiologia , Adulto , COVID-19/epidemiologia , Pessoa de Meia-Idade , SARS-CoV-2 , Inquéritos e Questionários , Fatores de Risco , Pandemias , Adulto Jovem
9.
Acta Trop ; 260: 107453, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39491661

RESUMO

Coronaviruses are common around the world and infect a wide variety of animals, including domestic and wild ones. They are characterized by causing respiratory, enteric, hepatic, and neurological diseases of varying severity, from asymptomatic to severe. Wild animals play a crucial role in this group of viruses since they can act as hosts or reservoirs for pathogenic species of humans and domestic animals. The purpose of this study was to molecularly identify coronaviruses present in wild mammals seized and rescued by the National Forestry and Wildlife Service (SERFOR) of Peru. We molecularly analyzed tracheal and rectal swabs from 90 wild mammals seized and/or rescued by SERFOR, partially amplifying the coronavirus RdRp gene. Ten of the 90 animals studied (11.1%) were positive only for Alphacoronavirus. These were non-human primates (Aotus sp., Sapajus apella, and Saimiri sciureus), the crab-eating raccoon (Procyon cancrivorus), and the South American sea lion (Otaria flavescens). The partial sequence analysis of the RdRp gene revealed that nine sequences belonged to the Pedacovirus subgenus and shared 99.1% nucleotide identity with the porcine epidemic diarrhea virus (PEDV), and only one sequence belonged to the Tegacovirus subgenus and shared 95.6% identity with the Feline coronavirus (FCoV). The results show that various wild mammal species from Peru can act as hosts for coronaviruses capable of infecting domestic species. Due to this, it is necessary to implement measures that help us identify the genera and species of coronaviruses in these species to prevent and contain future epidemics or pandemics resulting from the high rate of recombination and mutation of this virus.


Assuntos
Animais Selvagens , Mamíferos , Animais , Peru/epidemiologia , Animais Selvagens/virologia , Mamíferos/virologia , Infecções por Coronavirus/veterinária , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Filogenia , Coronavirus/genética , Coronavirus/classificação , Coronavirus/isolamento & purificação
10.
BMC Palliat Care ; 23(1): 265, 2024 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-39548480

RESUMO

BACKGROUND: When there is limited access to primary care or end-of-life services for patients with chronic diseases, caregivers often need to bring their loved ones to emergency departments (EDs) to solve or control distressing physical and psychosocial-spiritual problems. There is limited literature about the experiences of primary caregivers of patients with nononcologic chronic diseases who are at the end of life and are evaluated in EDs in Latin America. METHODS: We conducted in-depth interviews with primary caregivers of adult patients with advanced and terminal chronic nononcologic diseases who were evaluated in the ED of a hospital in Lima, Peru. This qualitative study employed a phenomenological approach. Themes, categories, codes, and quotes were analyzed using ATLAS.ti 9.1.4. RESULTS: Twelve primary caregivers, aged 38 to 76 years old, mostly female immediate family members (daughter or wife), participated. They described their experiences in the ED, including feelings of despair and anguish due to prolonged waiting times, insufficient resources, incomplete information regarding the patient's problems, and "insensitive" treatment by the staff. Some also expressed gratitude for "saving patient's lives." They also experienced deficiencies in home care follow-up and patient transfers, which worsened during the COVID-19 pandemic; many times they felt that "they were ignored." When caring for patients at home, caregivers felt sad, helpless, and frustrated as they observed patients' progressive deterioration. As patients approached death, caregivers expressed that they tried to "give them all the love" and to have them present for as long as possible, although at the same time caregivers did not want patients to continue to suffer and hoped for "a better place" after this life. Caregivers found their faith to be a source of strength as they continued to care for and be with their loved one until the end. CONCLUSION: Caregivers reported "traumatic" and "shocking" experiences during ED care, as well as conflict between wanting the patient's suffering to end and wanting to prolong their lives. They also expressed feelings of gratitude, resignation, love, faith, and hope.


Assuntos
Cuidadores , Serviço Hospitalar de Emergência , Pesquisa Qualitativa , Assistência Terminal , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Cuidadores/psicologia , Adulto , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Idoso , Assistência Terminal/psicologia , Assistência Terminal/métodos , Peru , Doença Crônica/psicologia , COVID-19/psicologia , Entrevistas como Assunto/métodos
11.
Nat Commun ; 15(1): 10393, 2024 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-39613754

RESUMO

Infectious disease is the result of interactions between host and pathogen and can depend on genetic variations in both. We conduct a genome-to-genome study of paired human and Mycobacterium tuberculosis genomes from a cohort of 1556 tuberculosis patients in Lima, Peru. We identify an association between a human intronic variant (rs3130660, OR = 10.06, 95%CI: 4.87 - 20.77, P = 7.92 × 10-8) in the FLOT1 gene and a subclavaluee of Mtb Lineage 2. In a human macrophage infection model, we observe hosts with the rs3130660-A allele exhibited stronger interferon gene signatures. The interacting strains have altered redox states due to a thioredoxin reductase mutation. We investigate this association in a 2020 cohort of 699 patients recruited during the COVID-19 pandemic. While the prevalence of the interacting strain almost doubled between 2010 and 2020, its infection is not associated with rs3130660 in this recent cohort. These findings suggest a complex interplay among host, pathogen, and environmental factors in tuberculosis dynamics.


Assuntos
Interações Hospedeiro-Patógeno , Mycobacterium tuberculosis , Tuberculose , Humanos , Mycobacterium tuberculosis/genética , Mycobacterium tuberculosis/patogenicidade , Tuberculose/microbiologia , Tuberculose/genética , Peru/epidemiologia , Interações Hospedeiro-Patógeno/genética , Genoma Bacteriano , COVID-19/genética , COVID-19/virologia , Macrófagos/microbiologia , Feminino , Polimorfismo de Nucleotídeo Único , Masculino , Estudos de Coortes , Mutação , Adulto , Tiorredoxina Dissulfeto Redutase/genética , Tiorredoxina Dissulfeto Redutase/metabolismo , SARS-CoV-2/genética
12.
Occup Environ Med ; 81(10): 532-534, 2024 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-39375034

RESUMO

OBJECTIVE: This descriptive study aimed to measure the excess all-cause mortality potential years of working life lost (PYWLL) in the working-age population of six Ibero-American countries in 2020 and 2021. METHODS: This study was based on all-cause deaths for the age group 15-69 years for men and women in six countries: Colombia, Costa Rica, México, Peru, Portugal and Spain. The expected PYWLL was the average value determined from the previous 5 years (2015-2019). To estimate the excess of PYWLL, the expected PYWLL was subtracted from the observed PYWLL values for 2020 and 2021, separately. RESULTS: In the four Latin American countries, the excess PYWLL per death was approximately double (between 12 and 16 years) that of the two European countries (between 3 and 9 years). CONCLUSIONS: The loss of working-age individuals will probably have a profound social and economic recovery impact, affecting families and communities. The informal employment and labour market structures may be contributing to the adverse effects of the pandemic in the region. Investing in universal, comprehensive and sustainable health and social protection systems in the Latin American countries is crucial to build resilience against current and future crises.


Assuntos
Emprego , Humanos , Pessoa de Meia-Idade , Masculino , Adulto , Feminino , Adolescente , Idoso , Adulto Jovem , América Latina/epidemiologia , Europa (Continente)/epidemiologia , Emprego/estatística & dados numéricos , Expectativa de Vida/tendências , COVID-19/epidemiologia , COVID-19/mortalidade , Portugal/epidemiologia , Mortalidade/tendências , Espanha/epidemiologia , Causas de Morte/tendências , Peru/epidemiologia
13.
Am J Trop Med Hyg ; 111(6): 1290-1294, 2024 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-39353444

RESUMO

During early 2021, Peru had the highest COVID-19-associated per-capita mortality rate. Socioeconomic inequality, insufficiently prepared healthcare, and surveillance systems are factors explaining the mortality rate, which can be severely worsened by early undetected SARS-CoV-2 circulation. We tested 1,441 individuals with fever sampled during August 2019-May 2021, several months before the first SARS-CoV-2 seroprevalence study available so far in Lima, Peru, for SARS-CoV-2-specific antibodies. The testing algorithm included a chemiluminescence immunoassay and surrogate virus neutralization test. Early positive samples (N = 24) from January-March 2020 were further tested using a plaque-reduction neutralization test (PRNT) and avidity test against the SARS-CoV-2 spike and nucleoprotein. None of the early samples were PRNT-confirmed, in contrast to 81.8% (18/22) of a subsample from April 2020 onward (Fisher exact test; P <0.0001). Therefore, we excluded non-PRNT-confirmed samples from subsequent analyses. The SARS-CoV-2 antibody detection rate was 0.9% in mid-April 2020 (1/104; 95% CI: 0.1-5.8%), suggesting viral circulation in early-middle March 2020, consistent with the first molecular detection of SARS-CoV-2 in Peru on March 2020. Mean avidity increase of 62-77% to 81-94% from all PRNT-confirmed SARS-CoV-2-positive samples during early 2020 were consistent with onset of SARS-CoV-2 circulation during late February/March 2020. Early circulation was also confirmed in a susceptible, exposed, infected, and recovered mathematical model that calculated an effective reproduction number >1 during February-March 2020. Early introduction of SARS-CoV-2 thus contributed to the high COVID-19 mortality rate in Peru. Emphasizing the role of diagnostic confirmation in understanding the pandemic's trajectory, this study highlights the importance of early detection and accurate testing in managing infectious disease outbreaks.


Assuntos
Anticorpos Antivirais , COVID-19 , SARS-CoV-2 , Humanos , Peru/epidemiologia , COVID-19/epidemiologia , COVID-19/diagnóstico , SARS-CoV-2/imunologia , Anticorpos Antivirais/sangue , Feminino , Adulto , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Adulto Jovem , Adolescente , Idoso , Testes de Neutralização , Criança , Pré-Escolar
14.
BMC Health Serv Res ; 24(1): 1216, 2024 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-39390544

RESUMO

BACKGROUND: Infant vaccination coverage rates in Peru have declined in recent years, exacerbated by the COVID-19 pandemic. Introduction of the fully-liquid diphtheria, tetanus, and acellular pertussis (DTaP)-inactivated polio vaccine (IPV)-hepatitis B (HB)-Haemophilus influenzae type B (Hib) hexavalent vaccine (DTaP-IPV-HB-Hib) in Peru's infant National Immunization Program may help improve coverage. We evaluated costs and healthcare outcomes, including coverage, of switching from a pentavalent vaccine containing whole-cell pertussis component (DTwP-HB-Hib) plus IPV/oral polio vaccine (IPV/OPV) to the hexavalent vaccine for the primary vaccination scheme (2, 4 and 6 months). METHODS: The analysis was performed over a 5-year period on a cohort of children born in Peru in 2020 (N = 494,595). Four scenarios were considered: the pentavalent plus IPV/OPV scheme (S1); replacing the pentavalent plus IPV/OPV scheme with the hexavalent scheme (S2); expanded delivery of the pentavalent plus IPV/OPV scheme (S3); expanded delivery of the hexavalent scheme (S4). Vaccine coverage and incidence of adverse reactions (ARs) were estimated using Monte Carlo simulations and previous estimates from the literature. Cases of vaccine-preventable diseases were estimated using a Markov model. Logistical and healthcare costs associated with these outcomes were estimated. Impact of key variables (including coverage rates, incidence of ARs and vaccine prices) on costs was evaluated in sensitivity analyses. RESULTS: The overall cost from a public health payer perspective associated with the pentavalent plus IPV/OPV vaccine scheme (S1) was estimated at $56,719,350, increasing to $61,324,263 (+ 8.1%), $59,121,545 (+ 4.2%) and $64,872,734 (+ 14.4%) in scenarios S2, S3 and S4, respectively. Compared with the status quo (S1), coverage rates were estimated to increase by 3.1% points with expanded delivery alone, and by 9.4 and 14.3% points, if the hexavalent vaccine is deployed (S2 and S4, respectively). In both scenarios with the hexavalent vaccine (S2 and S4), pertussis cases would also be 5.7% and 8.7% lower, and AR rates would decrease by 32%. The cost per protected child would be reduced when the hexavalent vaccine scheme. Incidence of ARs was an important driver of cost variability in the sensitivity analysis. CONCLUSIONS: Implementation of the hexavalent vaccine in Peru's National Immunization Program has a positive public health cost consequence.


Assuntos
Vacinas Anti-Haemophilus , Programas de Imunização , Vacina Antipólio de Vírus Inativado , Cobertura Vacinal , Vacinas Combinadas , Humanos , Peru/epidemiologia , Lactente , Vacinas Anti-Haemophilus/economia , Vacinas Anti-Haemophilus/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Cobertura Vacinal/economia , Vacina Antipólio de Vírus Inativado/economia , Vacina Antipólio de Vírus Inativado/administração & dosagem , Programas de Imunização/economia , Vacinas Combinadas/economia , Vacinas contra Hepatite B/economia , Vacinas contra Hepatite B/administração & dosagem , Feminino , Vacina contra Difteria, Tétano e Coqueluche/economia , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Masculino , Vacinas contra Difteria, Tétano e Coqueluche Acelular/economia , Vacinas contra Difteria, Tétano e Coqueluche Acelular/administração & dosagem , COVID-19/prevenção & controle , COVID-19/economia , COVID-19/epidemiologia , Análise Custo-Benefício , SARS-CoV-2 , Coqueluche/prevenção & controle , Coqueluche/economia , Coqueluche/epidemiologia
15.
Environ Monit Assess ; 196(11): 1142, 2024 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-39480539

RESUMO

The high concentrations of air pollutants in Peru remain a persistent problem, significantly impacting public health. Understanding the extent to which the COVID-19 lockdown affected these contaminants is crucial. To determine variations in NO2, O3, CO, and SO2 concentrations in 10 Peruvian cities before, during, and after lockdown. A comparative ecological study was conducted in urban areas of 10 major Peruvian cities using the Google Earth Engine (GEE) platform. Data on atmospheric pollutant concentrations were extracted from the Sentinel-5P/TROPOMI satellite images for the period between March 16 and June 30, across the years 2019, 2020, 2021, and 2022, for comparative analysis. The Wilcoxon test was used to evaluate changes between the study periods. We included 10 urban cities located across three geographic regions of Peru. Most urban cities experienced a decrease in NO2 concentrations and an increase in O3 and CO levels during the lockdown, while SO2 concentrations remained relatively constant. The lockdown has caused variations in NO2, O3 and CO concentrations. Future studies with accurate data on air pollutant concentrations are needed to ensure targeted and effective interventions.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , COVID-19 , Cidades , Monitoramento Ambiental , Ozônio , Peru/epidemiologia , COVID-19/epidemiologia , Poluição do Ar/estatística & dados numéricos , Poluentes Atmosféricos/análise , Humanos , Monitoramento Ambiental/métodos , Ozônio/análise , Dióxido de Enxofre/análise , Dióxido de Nitrogênio/análise , SARS-CoV-2 , Monóxido de Carbono/análise
16.
Rev Peru Med Exp Salud Publica ; 41(3): 239-246, 2024 Oct 21.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-39442105

RESUMO

BACKGROUND: Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. BACKGROUND: Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. BACKGROUND: Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics. OBJECTIVES.: To analyze the evolution of COVID-19 in rural populations of Loreto and Ucayali in the early stage of the pandemic. MATERIALS AND METHODS.: A community-level longitudinal observational study was conducted and based on two rounds of telephone surveys with local authorities of more than 400 indigenous and non-indigenous rural communities in Loreto and Ucayali, in July and August 2020. We collected information on cases and deaths by COVID-19 in their communities, protective measures adopted and if state assistance was received in the early stage of the pandemic. Descriptive statistics allowed us to evaluate the evolution of the pandemic after the initial outbreak and compare the trends of the two regions, as well as between indigenous and non-indigenous populations. RESULTS.: In July 2020, COVID-19 had reached 91.5% of the communities, although deaths from COVID-19 were reported in 13.0% of the communities, with rural mortality being higher in Ucayali (0.111%) than in Loreto (0.047%) and in non-indigenous communities. By August, prevalence decreased from 44.0% to 32.0% of communities, but became more frequent in indigenous communities, and those in Ucayali. Traveling to the city to receive state bonuses and difficulties maintaining social distancing contributed to the spread. CONCLUSIONS.: Our findings show the evolution of COVID-19 in rural communities and point to important areas of attention in future public policies, for the adoption of protective measures and reconsidering strategies for the distribution of assistance in the face of future pandemics. BACKGROUND: Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. BACKGROUND: Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. BACKGROUND: Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics.


OBJETIVOS.: Analizar la evolución del COVID-19 en poblaciones rurales de Loreto y Ucayali en la etapa temprana de la pandemia. MATERIALES Y MÉTODOS.: Se realizó un estudio observacional longitudinal a nivel de comunidades basado en dos rondas de encuestas telefónicas con autoridades locales de más de 400 comunidades rurales indígenas y no-indígenas en Loreto y Ucayali, en julio y agosto de 2020, para recopilar información sobre casos y muertes por COVID-19 en sus comunidades, medidas de protección adoptadas y la recepción de asistencia estatal en la etapa temprana de la pandemia. Estadísticas descriptivas permiten evaluar la evolución de la pandemia después del brote inicial y comparar las tendencias de las dos regiones, así como entre poblaciones indígenas y no-indígenas. RESULTADOS.: En julio de 2020, el COVID-19 había llegado al 91,5% de las comunidades, aunque se reportaron muertes por COVID-19 en 13,0% de las comunidades, siendo la mortalidad rural mayor en Ucayali (0,111%) que en Loreto (0,047%) y en comunidades no-indígenas. Para agosto, la prevalencia disminuyó de 44,0% a 32,0% de comunidades, pero se volvió más frecuente en las comunidades indígenas, y aquellas en Ucayali. Viajar a la ciudad para recibir bonos estatales y las dificultades para mantener el distanciamiento social contribuyeron al contagio. CONCLUSIONES.: Los hallazgos mostraron la evolución del COVID-19 en comunidades rurales y señalan áreas importantes de atención en futuras políticas públicas, para la adopción de medidas de protección y reconsiderar estrategias para la distribución de asistencia ante pandemias futuras. BACKGROUND: Motivación para realizar el estudio. Documentar la evolución del COVID-19 en poblaciones rurales Amazónicas, las cuales son aún poco conocidas. BACKGROUND: Principales hallazgos. El COVID-19 se propagó rápidamente por las comunidades rurales, extendiéndose inicialmente por los caseríos mestizos y después afectando a comunidades indígenas. La mortalidad rural varió por región y por etnia. El distanciamiento social fue difícil y los viajes para recibir bonos estatales contribuyeron al contagio. BACKGROUND: Implicancias. Conocer los factores que contribuyeron al contagio y las barreras para la adopción de medidas de protección en poblaciones rurales Amazónicas ayudarán a enfrentar pandemias futuras.


Assuntos
COVID-19 , População Rural , COVID-19/prevenção & controle , COVID-19/epidemiologia , Humanos , Estudos Longitudinais , População Rural/estatística & dados numéricos , Peru/epidemiologia , Pandemias/prevenção & controle , Fatores de Tempo , Indígenas Sul-Americanos/estatística & dados numéricos , Feminino
17.
Rev Peru Med Exp Salud Publica ; 41(3): 259-265, 2024 Oct 21.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-39442107

RESUMO

BACKGROUND: Motivation for the study. The COVID-19 pandemic contributed to the development of mental disorders among medical students, including obsessive-compulsive symptoms. However, evidence on this problem in this population is still limited. BACKGROUND: Main findings. One in 10 medical students presented clinically significant obsessive-compulsive symptoms. BACKGROUND: Implications. The health crisis has had a negative impact on the mental health of medical students. Therefore, it is crucial to implement future interventions to promote the preservation of their psychological well-being. OBJECTIVES.: To determine the prevalence of obsessive-compulsive symptoms among medical students in Peru during the COVID-19 pandemic and its associated factors. MATERIALS AND METHODS.: Cross-sectional study in 270 medical students from a Peruvian public university. Participants were recruited through non-probability sampling. Obsessive-compulsive symptoms were assessed with the Yale-Brown Obsessive Compulsive Disorder Scale (Y-BOCS). After the descriptive analysis, Poisson regression with robust variance was used to determine the factors associated with probable obsessive compulsive disorder (probable OCD). The crude (PRc) and adjusted (PRa) prevalence ratios were calculated, along with their respective 95% confidence intervals (95% CI). RESULTS.: The prevalence of obsessive-compulsive symptoms was 13.3% in medical students. During bivariate analysis, students with probable OCD were younger (p=0.044) and had a lower level of knowledge about COVID-19 (p=0.045). The crude model showed a lower prevalence of probable OCD among those with an adequate level of knowledge compared to those with an inadequate level (PR: 0.52, 95% CI: 0.28 to 0.98). However, after adjusting for other variables, none of the described variables were statistically significant. CONCLUSIONS.: One in ten medical students presented clinically significant obsessive-compulsive symptoms. Implementing future interventions is crucial to preserve the mental well-being of this vulnerable population.


Assuntos
COVID-19 , Transtorno Obsessivo-Compulsivo , Estudantes de Medicina , Humanos , Estudos Transversais , Peru/epidemiologia , COVID-19/epidemiologia , Estudantes de Medicina/psicologia , Masculino , Feminino , Transtorno Obsessivo-Compulsivo/epidemiologia , Adulto Jovem , Adulto , Prevalência , Pandemias , Adolescente
18.
Rev Peru Med Exp Salud Publica ; 41(3): 301-308, 2024 Oct 21.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-39442113

RESUMO

BACKGROUND: Motivation for the study. There are few studies describing the variation of COVID-19-associated multisystem inflammatory syndrome (MIS-C) in Peru across pandemic waves. BACKGROUND: Main findings. Cases of MIS-C decreased during the first three years of the pandemic, with higher frequency in the second wave with clinical features similar to Kawasaki disease. BACKGROUND: Implications. MIS-C is a post-infectious complication of SARS-CoV-2. Its diagnostic suspicion is important weeks after peak infections, especially in children who have not yet received COVID-19 vaccines. BACKGROUND: This study aimed to describe the characteristics of multisystemic inflammatory syndrome associated with COVID-19 (MIS-C) in the first three years of the pandemic in children in a pediatric hospital in Peru. We conducted an observational, descriptive study with data from 73 patients and described the clinical and laboratory characteristics, treatment and complications according to the wave of the pandemic and whether they had shock. The median age was 6 years, gastrointestinal and mucocutaneous manifestations were frequent in the three waves. Kawasaki disease-like phenotype was present in 34 (46.6%) patients and 21 (28.8%) patients developed shock. The most commonly used treatment was immunoglobulin (95.9%), followed by acetylsalicylic acid (94.5%) and corticosteroid (86.3%). Five (7%) patients had coronary aneurysm and 17 (23.3%) were admitted to the intensive care unit (ICU). Patients with shock had greater laboratorial alteration and need for mechanical ventilation. In conclusion, MIS-C has decreased in the first three years of the pandemic, possibly due to COVID-19 vaccination in children.


BACKGROUND: El propósito del estudio fue describir las características del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en los primeros tres años de pandemia en niños de un hospital pediátrico del Perú. Se realizó un estudio observacional, descriptivo con datos de 73 pacientes y se describieron las características clínicas, laboratoriales, tratamiento y complicaciones según la ola de la pandemia y si tuvieron shock. La mediana de edad fue 6 años, las manifestaciones gastrointestinales y mucocutáneas fueron frecuentes en las tres olas. El fenotipo similar a enfermedad de Kawasaki se presentó en 34 (46,6%) pacientes y 21 (28,8%) pacientes desarrollaron shock. El tratamiento más usado fue la inmunoglobulina (95,9%), ácido acetil salicílico (94,5%) y corticoide (86,3%). Cinco (7%) pacientes tuvieron aneurisma coronario y 17 (23,3%) ingresaron a la unidad de cuidados intensivos (UCI). Los pacientes con shock tuvieron mayor alteración laboratorial y necesidad de ventilación mecánica. En conclusión, el SIM-C ha disminuido en los primeros tres años de pandemia posiblemente por la vacunación de COVID-19 en niños. BACKGROUND: Motivación para realizar el estudio. Existen limitados estudios que describan la variación del síndrome inflamatorio multisistémico asociado a COVID-19 (SIM-C) en Perú a través de las olas de la pandemia. BACKGROUND: Principales hallazgos. En los primeros tres años de pandemia los casos de SIM-C disminuyeron, con mayor la frecuencia en la segunda ola con características clínicas similares a la enfermedad de Kawasaki. BACKGROUND: Implicancias. El SIM-C es una complicación posinfecciosa del SARS-CoV-2. Es importante su sospecha diagnóstica semanas posteriores a los picos de contagios, especialmente en los niños que aún no han recibido vacunas contra la COVID-19.


Assuntos
COVID-19 , Síndrome de Resposta Inflamatória Sistêmica , Humanos , Peru/epidemiologia , COVID-19/complicações , COVID-19/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Criança , Masculino , Feminino , Pré-Escolar , Adolescente , Lactente , Hospitais Pediátricos , Síndrome de Linfonodos Mucocutâneos/epidemiologia
19.
Soc Sci Med ; 362: 117413, 2024 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-39427570

RESUMO

The goal of this qualitative research study, part of an interdisciplinary project, was to understand the overlapping geographical distribution of COVID-19 and tuberculosis burden in Lima. Using an ethnographic approach, we applied the concept of disease situations to explore how inhabitants' social and spatial situatedness affected their capacity to respond to the pandemic. Our results show that for some populations in Lima, the risk to develop COVID-19 did not emerge suddenly; it could be traced back to situations of living under subsistence models, relying on unstable sources of income, facing food insecurity, depending on certain mechanisms of social protection, residing in precarious living environments and lacking access to quality health care. These populations did not only have less resources to adjust to changes in daily life induced by the pandemic; they were also forced to constantly weigh the risk of COVID-19 against other pressing needs and potentially face increased risks when control measures were actually followed. Pre-existing social networks played fundamental roles as sources of emotional and material support. The lens of disease situations can help to identify and explain spatial and social configurations that enhance vulnerability, as well as resilience mechanisms that are in place to deal with crises. This perspective could inform the design of contextualised prevention and response strategies around health risks in cities as diverse as Lima, whilst building on existing resources at local levels.


Assuntos
COVID-19 , Pesquisa Qualitativa , Análise Espacial , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Peru/epidemiologia , Fatores de Risco , Fatores Socioeconômicos , Feminino , SARS-CoV-2 , Pandemias , Insegurança Alimentar , Masculino , Tuberculose/epidemiologia , Tuberculose/psicologia , Adulto , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Antropologia Cultural
20.
Medicine (Baltimore) ; 103(40): e39931, 2024 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-39465757

RESUMO

P/FP [PaO2/(FiO2*PEEP)] is associated with in-hospital mortality in patients with acute respiratory distress syndrome (ARDS). However, to the best of our knowledge, the association between P/FP after 24 hours of invasive mechanical ventilation (IMV) and in-hospital mortality in patients with ARDS due to Coronavirus Disease 2019 (COVID-19) remained unclear. This study aimed to evaluate the relationship between the P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. We reanalyzed previously published data from Peru. Hueda-Zavaleta et al conducted a retrospective cohort study between April 2020 and April 2021 in southern Peru. A total of 200 hospitalized COVID-19 patients requiring IMV were included in this analysis. We used Cox proportional hazard regression models and Kaplan-Meier survival analysis to investigate the effect of P/FP after 24 hours of IMV on in-hospital mortality. We used a restricted cubic spline regression and a two-piecewise Cox proportional hazards model to explore the relationship between P/FP after 24 hours of IMV and in-hospital mortality in patients with ARDS due to COVID-19. Of the 200 patients, 51 (25.50%) died in hospital. The median P/FP was 20.45 mm Hg/cmH2O [interquartile range 15.79-25.21 mm Hg/cmH2O], with a range of 5.67 mm Hg/cmH2O to 51.21 mm Hg/cmH2O. Based on the P/FP ratio, patients were equally divided into 2 groups (low group [P/FP < 20.50 mm Hg/cmH2O] and high group [P/FP ≥ 20.50 mm Hg/cmH2O]). In-hospital mortality was lower in the high P/FP group than in the low P/FP group (12 [12%] vs 39 [39%]; unadjusted hazard ratio [HR]: 0.33, 95% confidence interval [CI]: 0.17-0.63; adjusted HR: 0.10, 95% CI: 0.02-0.47). We also found a nonlinear relationship between P/FP and in-hospital mortality. After adjusting for potential confounders, the HR was 0.67 (95% CI: 0.56-0.79) for P/FP ≤ 22 mm Hg/cmH2O and 1.10 (95% CI: 0.83-1.47) for P/FP > 22 mm Hg/cmH2O. In addition, lymphocytes ≤ 1 × 109/L and acute kidney failure had a higher risk of death. After adjusting for potential confounders, the P/FP after 24 hours of IMV was nonlinearly associated with in-hospital mortality in patients with ARDS due to COVID-19.


Assuntos
COVID-19 , Mortalidade Hospitalar , Respiração Artificial , Humanos , COVID-19/mortalidade , COVID-19/complicações , Peru/epidemiologia , Feminino , Masculino , Pessoa de Meia-Idade , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Idoso , Síndrome do Desconforto Respiratório/mortalidade , SARS-CoV-2 , Modelos de Riscos Proporcionais , Oxigênio/sangue , Gasometria
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