"Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

BACKGROUND: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system and community of a low-resource setting prior to implementation of an HPV screen-and-treat program. METHODS: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. RESULTS: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. CONCLUSIONS: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system and community in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

"Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.

Background: Cervical cancer is preventable with vaccination and early detection and treatment programs. However, in order for these programs to work as intended, stigma related to HPV and cervical cancer must be understood and addressed. We explored pre-existing stigma associated with HPV and cervical cancer in the public healthcare system of a low-resource setting prior to implementation of an HPV screen-and-treat program. Methods: This study conducted thematic analysis of data collected during implementation of a novel HPV screen-and-treat system for cervical cancer early detection and treatment in Iquitos, Peru. We included 35 semi-structured interviews (19 health professionals, 16 women with cervical precancer or cancer), eight focus groups (70 community women), one workshop (14 health professionals), 210 counseling observations (with 20 nurse-midwives), and a document review. We used the Socio-Ecological Model to organize the analysis. Results: We identified three main themes: 1. the implication that women are to blame for their HPV infection through characterizations of being easy or promiscuous, 2. the implication that men are to blame for women's HPV infections through being considered careless or unfaithful, 3. HPV is shameful, embarrassing, and something that should be hidden from others. Consequently, in some cases, women refrained from getting screened for HPV. These themes were seen at the individual level among women, relationship level among women, men, and family members, community level among healthcare staff, and societal level within components of cervical cancer guidelines and male chauvinism. Conclusions: Cervical cancer early detection and treatment programs in limited resource settings must address stigma entrenched throughout the entire healthcare system in order to sustainably and successfully implement and scale-up new programs. Interventions to tackle this stigma can incorporate messages about HPV infections and latency to lessen the focus on the influence of sexual behavior on HPV acquisition, and instead, promote screening and treatment as paramount preventative measures.

Avances y desafíos de la reforma de salud mental en el Perú en el último decenio

En la última década, en el Perú se han realizado esfuerzos para la puesta en marcha de la reforma de la atención de salud mental garantizando, con la implementación del modelo comunitario, la disponibilidad de programas y servicios a nivel nacional; así como el acceso a prestaciones de salud adecuadas y de calidad, incluyendo intervenciones de promoción, prevención, recuperación y rehabilitación psicosocial. Esto se ha logrado con el liderazgo del Ministerio de Salud y en trabajo colaborativo con los gobiernos regionales, locales, instituciones de salud, organizaciones comunitarias y organizaciones internacionales, como la OPS/OMS. Este trabajo se enmarca en la problemática identificada en estudios realizados durante los últimos 20 años que muestran que las enfermedades neuropsiquiátricas, y los trastornos mentales y del comportamiento ocupan el primer lugar sobre todas las causas de morbilidad. De igual manera, estudios epidemiológicos de salud mental realizados por e INSM del 2004 al 2017, muestran las prevalencias anuales de algún trastorno psiquiátrico en los departamentos del país, encontrándose que las ciudades de mayor prevalencia son Puerto Maldonado (25.4%), Iquitos (24.4%), Tumbes (23.8%), Puno (22.1%) y Pucallpa (21.9%). Este documento revisa los avances y desafíos de la reforma de salud mental en el Perú durante los últimos 10 años. Resalta que con la implementación del modelo de salud mental comunitario, la oferta de servicios de salud mental pasó de estar centralizada en Lima Metropolitana a expandirse a todas las regiones. Actualmente, existen 1438 establecimientos del primer nivel de atención con profesionales de psicología, 248 centros de salud mental comunitaria, 43 hospitales generales con unidades de hospitalización en salud mental y adicciones y 87 hogares protegidos. Así mismo, se incrementó el número de recursos humanos, así como la cobertura de los servicios de salud de 1.9% el 2017 a 27.6% el año 2022. Por otro lado, se amplió de 1 a 20 psicofármacos considerados medicamentos estratégicos para entrega gratuita a los pacientes que lo requieran, como un derecho de salud pública, independientemente de su condición socioeconómica o de asegurado. Además, la inversión en salud mental creció 223.7% entre el 2015 y 2022 con un incremento anual promedio del 16%, excepto el 2021 cuando disminuyó (0.8%) debido a la priorización de las intervenciones en el marco de la emergencia por la COVID-19.

Intersectional stigma and the arc of intranational migration: experiences of transgender adolescents and women who migrate within Peru.

BACKGROUND: Migration is recognized as a key determinant of health. Yet, limited research addresses the arc of intranational migration and, even less, the experiences of transgender (trans) adolescents and women migrants and the associated health vulnerabilities. Using intersectional stigma as a theoretical frame, this study seeks to better understand the sexual health vulnerabilities and needs of trans women migrants in Peru. METHODS: Between October and November 2016, in-depth interviews (n = 14) and two focus groups (n = 20) were conducted in Spanish with trans women in three Peruvian cities. To explore pre- and during migration experiences, focus groups were conducted in Pucallpa and Iquitos, key cities in the Amazon where trajectories often originate. To assess during migration and post-migration experiences, we conducted interviews in Pucallpa, Iquitos, and Lima to better understand processes of relocation. Audio files were transcribed verbatim and analysed via an immersion crystallization approach, an inductive and iterative process, using Dedoose (v.6.1.18). RESULTS: Participants described migration as an arc and, thus, results are presented in three phases: pre-migration; during migration; and post-migration. Intersectional stigma was identified as a transversal theme throughout the three stages of migration. The pre-migration stage was characterized by poverty, transphobia, and violence frequently motivating the decision to migrate to a larger city. Exploitation was also described as pervasive during migration and in relocation. Many participants spoke of their introduction to sex work during migration, as key to economic earning and associated violence (police, clients). CONCLUSION: Findings advance understandings of intranational migration and forced displacement as key determinants of trans women's health. Dimensions of violence at the intersection of classism and cisgenderism render trans women highly vulnerable at every step of their migratory journeys. Experiences of intranational mobility and relocation were described as uniquely tied to age, intersectional transphobic stigma, engagement in sex work, and multiple forms of violence, which impact and can magnify sexual health vulnerabilities for transgender women in Peru who migrated intranationally.

"Day or night, no matter what, I will go": Women's perspectives on challenges with follow-up care after cervical cancer screening in Iquitos, Peru: a qualitative study.

BACKGROUND: The study's objective was to explore the factors associated with loss to follow-up among women with abnormal cervical cancer screening results in Iquitos, Peru from women's perspectives. METHODS: In-depth interviews were conducted with 20 screen-positive women who were referred for follow-up care but for whom evidence of follow-up was not found. Interview transcripts were thematically analyzed inductively, and the codes were then categorized using the Health Care Access Barriers Model for presentation of results. RESULTS: All interviewed women were highly motivated to complete the continuum of care but faced numerous barriers along the way, including cognitive barriers such as a lack of knowledge about cervical cancer and poor communication from health professionals regarding the process, structural barriers such as challenges with scheduling appointments and unavailability of providers, and financial barriers including out-of-pocket payments and costs related to travel or missing days of work. With no information system tracking the continuum of care, we found fragmentation between primary and hospital-level care, and often, registration of women's follow-up care was missing altogether, preventing women from being able to receive proper care and providers from ensuring that women receive care and treatment as needed. CONCLUSIONS: The challenges elucidated demonstrate the complexity of implementing a successful cervical cancer prevention program and indicate a need for any such program to consider the perspectives of women to improve follow-up after a positive screening test.

Etiology of acute febrile illness in the peruvian amazon as determined by modular formatted quantitative PCR: a protocol for RIVERA, a health facility-based case-control study.

BACKGROUND: The study of the etiology of acute febrile illness (AFI) has historically been designed as a prevalence of pathogens detected from a case series. This strategy has an inherent unrealistic assumption that all pathogen detection allows for causal attribution, despite known asymptomatic carriage of the principal causes of acute febrile illness in most low- and middle-income countries (LMICs). We designed a semi-quantitative PCR in a modular format to detect bloodborne agents of acute febrile illness that encompassed common etiologies of AFI in the region, etiologies of recent epidemics, etiologies that require an immediate public health response and additional pathogens of unknown endemicity. We then designed a study that would delineate background levels of transmission in the community in the absence of symptoms to provide corrected estimates of attribution for the principal determinants of AFI. METHODS: A case-control study of acute febrile illness in patients ten years or older seeking health care in Iquitos, Loreto, Peru, was planned. Upon enrollment, we will obtain blood, saliva, and mid-turbinate nasal swabs at enrollment with a follow-up visit on day 21-28 following enrollment to attain vital status and convalescent saliva and blood samples, as well as a questionnaire including clinical, socio-demographic, occupational, travel, and animal contact information for each participant. Whole blood samples are to be simultaneously tested for 32 pathogens using TaqMan array cards. Mid-turbinate samples will be tested for SARS-CoV-2, Influenza A and Influenza B. Conditional logistic regression models will be fitted treating case/control status as the outcome and with pathogen-specific sample positivity as predictors to attain estimates of attributable pathogen fractions for AFI. DISCUSSION: The modular PCR platforms will allow for reporting of all primary results of respiratory samples within 72 h and blood samples within one week, allowing for results to influence local medical practice and enable timely public health responses. The inclusion of controls will allow for a more accurate estimate of the importance of specific prevalent pathogens as a cause of acute illness. STUDY REGISTRATION: Project 1791, Registro de Proyectos de Investigación en Salud Pública (PRISA), Instituto Nacional de Salud, Perú.

Dengue and COVID-19 Co-Circulation in the Peruvian Amazon: A Population-Based Study.

The COVID-19 pandemic affected the main Amazon cities dramatically, with Iquitos City reporting the highest seroprevalence of anti-SARS-CoV-2 antibodies during the first COVID-19 wave worldwide. This phenomenon raised many questions about the possibility of a co-circulation of dengue and COVID-19 and its consequences. We carried out a population-based cohort study in Iquitos, Peru. We obtained a venous blood sample from a subset of 326 adults from the Iquitos COVID-19 cohort (August 13-18, 2020) to estimate the seroprevalence of anti-dengue virus (DENV) and anti-SARS-CoV-2 antibodies. We tested each serum sample for anti-DENV IgG (serotypes 1, 2, 3, and 4) and SARS-CoV-2 antibodies anti-spike IgG and IgM by ELISA. We estimated an anti-SARS-CoV-2 seroprevalence of 78.0% (95% CI, 73.0-82.0) and an anti-DENV seroprevalence of 88.0% (95% CI, 84.0-91.6), signifying a high seroprevalence of both diseases during the first wave of COVID-19 transmission in the city. The San Juan District had a lower anti-DENV antibody seroprevalence than the Belen District (prevalence ratio, 0.90; 95% CI, 0.82-0.98). However, we did not observe these differences in anti-SARS-CoV-2 antibody seroprevalence. Iquitos City presented one of the highest seroprevalence rates of anti-DENV and anti-SARS-CoV-2 antibodies worldwide, but with no correlation between their antibody levels.

Quantifying heterogeneities in arbovirus transmission: Description of the rationale and methodology for a prospective longitudinal study of dengue and Zika virus transmission in Iquitos, Peru (2014-2019).

Current knowledge of dengue virus (DENV) transmission provides only a partial understanding of a complex and dynamic system yielding a public health track record that has more failures than successes. An important part of the problem is that the foundation for contemporary interventions includes a series of longstanding, but untested, assumptions based on a relatively small portion of the human population; i.e., people who are convenient to study because they manifest clinically apparent disease. Approaching dengue from the perspective of people with overt illness has produced an extensive body of useful literature. It has not, however, fully embraced heterogeneities in virus transmission dynamics that are increasingly recognized as key information still missing in the struggle to control the most important insect-transmitted viral infection of humans. Only in the last 20 years have there been significant efforts to carry out comprehensive longitudinal dengue studies. This manuscript provides the rationale and comprehensive, integrated description of the methodology for a five-year longitudinal cohort study based in the tropical city of Iquitos, in the heart of the Peruvian Amazon. Primary data collection for this study was completed in 2019. Although some manuscripts have been published to date, our principal objective here is to support subsequent publications by describing in detail the structure, methodology, and significance of a specific research program. Our project was designed to study people across the entire continuum of disease, with the ultimate goal of quantifying heterogeneities in human variables that affect DENV transmission dynamics and prevention. Because our study design is applicable to other Aedes transmitted viruses, we used it to gain insights into Zika virus (ZIKV) transmission when during the project period ZIKV was introduced and circulated in Iquitos. Our prospective contact cluster investigation design was initiated by detecttion of a person with a symptomatic DENV infection and then followed that person's immediate contacts. This allowed us to monitor individuals at high risk of DENV infection, including people with clinically inapparent and mild infections that are otherwise difficult to detect. We aimed to fill knowledge gaps by defining the contribution to DENV transmission dynamics of (1) the understudied majority of DENV-infected people with inapparent and mild infections and (2) epidemiological, entomological, and socio-behavioral sources of heterogeneity. By accounting for factors underlying variation in each person's contribution to transmission we sought to better determine the type and extent of effort needed to better prevent virus transmission and disease.

Resolving the enigma of Iquitos and Manaus: A modeling analysis of multiple COVID-19 epidemic waves in two Amazonian cities.

The two nearby Amazonian cities of Iquitos and Manaus endured explosive COVID-19 epidemics and may well have suffered the world's highest infection and death rates over 2020, the first year of the pandemic. State-of-the-art epidemiological and modeling studies estimated that the populations of both cities came close to attaining herd immunity (>70% infected) at the termination of the first wave and were thus protected. This makes it difficult to explain the more deadly second wave of COVID-19 that struck again in Manaus just months later, simultaneous with the appearance of a new P.1 variant of concern, creating a catastrophe for the unprepared population. It was suggested that the second wave was driven by reinfections, but the episode has become controversial and an enigma in the history of the pandemic. We present a data-driven model of epidemic dynamics in Iquitos, which we also use to explain and model events in Manaus. By reverse engineering the multiple epidemic waves over 2 y in these two cities, the partially observed Markov process model inferred that the first wave left Manaus with a highly susceptible and vulnerable population (≈40% infected) open to invasion by P.1, in contrast to Iquitos (≈72% infected). The model reconstructed the full epidemic outbreak dynamics from mortality data by fitting a flexible time-varying reproductive number [Formula: see text] while estimating reinfection and impulsive immune evasion. The approach is currently highly relevant given the lack of tools available to assess these factors as new SARS-CoV-2 virus variants appear with different degrees of immune evasion.

Iquitos, la primera ciudad en caer: Relatos en pandemia / Iquitos, the first city to fall: Stories in a pandemic

La presente publicación centra sus esfuerzos en conocer el impacto de la pandemia en la vida de las personas a través de sus historias y narrativas convertidas en relatos es parte del entendimiento que hoy proponen para construir una ruta que lleve al encuentro social. Trayectoria que llevará a comparar la situación actual con la previa (prepandemia) y las expectativas y aspiraciones cuando se termine esta situación (pospandemia)

Occurrence and characterization of insect galls in two reserves of the Peruvian Amazon / Ocorrência e caracterização de galhas de insetos em duas reservas da Amazônia peruana

Abstract An insect gall inventory was carried out in two reserves of the Peruvian Amazon, Allpahuayo-Mishana National Reserve and Quistococha Regional Reserve, both situated in Iquitos, northeastern Peru. Four vegetation types were surveyed between December, 2021 and December, 2022: terra firme forest, white-sand wet forest, and white-sand dry forest in Allpahuayo-Mishana National Reserve, and palm swamp forest in Quistococha Regional Reserve. Overall, we found 262 gall morphotypes, distributed across 75 host species representing 66 plant genera and 30 families. Fabaceae was the plant family with the greatest number of gall morphotypes (n = 48), followed by Calophyllaceae (n = 21) and Euphorbiaceae (n = 20). The plant genera that supported the highest diversity of galls were Caraipa (n = 17), Eschweilera (n = 16), Tapirira (n = 16), Micrandra (n = 14), and Iryanthera (n = 10). The plant species Tapirira guianensis (n = 16), Caraipa utilis (n = 14), Micrandra elata (n = 14), Eschweilera coriacea (n = 11), and Sloanea parvifructa (n = 10) exhibited the highest richness of galls. Among the host plants, C. utilis stands alone as the only species noted as both endemic to the Amazonian region and bearing a Vulnerable (VU) conservation status. The leaves were the most attacked organs (90% of all galls). Most morphotypes are glabrous (89%), green (67%), globoid (53%), and one-chambered (91%). We found galling insects belonging to the orders Diptera, Thysanoptera, Lepidoptera, and Hemiptera. The galling insects of Cecidomyiidae (Diptera) were the most common, inducing 22% of the gall morphotypes. In addition to the gallers, we also observed the presence of successors, cecidophages, and parasitoids. Among the sampled vegetation types, the terra firme forest presented the highest richness of gall morphotypes and host plant species. This is the first systematic inventory of insect galls in this part of the Peruvian Amazon.

Resumo Um inventário de galhas de insetos foi realizado em duas reservas da Amazônia peruana, Reserva Nacional Allpahuayo-Mishana e Reserva Regional Quistococha, ambas situadas em Iquitos, nordeste do Peru. Quatro tipos de vegetação foram pesquisados entre dezembro de 2021 e dezembro de 2022: floresta de terra firme, floresta úmida de areia branca e floresta seca de areia branca na Reserva Nacional Allpahuayo-Mishana, e floresta de pântano de palmeiras na Reserva Regional Quistococha. No total, encontramos 262 morfotipos de galhas, distribuídos em 75 espécies hospedeiras representando 66 gêneros de plantas e 30 famílias. Fabaceae foi a família de plantas com o maior número de morfotipos de galhas (n = 48), seguida por Calophyllaceae (n = 21) e Euphorbiaceae (n = 20). Os gêneros de plantas que apresentaram a maior diversidade de galhas foram Caraipa (n = 17), Eschweilera (n = 16), Tapirira (n = 16), Micrandra (n = 14) e Iryanthera (n = 10). As espécies de plantas Tapirira guianensis (n = 16), Caraipa utilis (n = 14), Micrandra elata (n = 14), Eschweilera coriacea (n = 11) e Sloanea parvifructa (n = 10) apresentaram a maior riqueza de galhas. Dentre as plantas hospedeiras, C. utilis destaca-se como a única espécie listada como endêmica da região amazônica e com um status de conservação Vulnerável (VU). As folhas foram os órgãos mais atacados (90% de todas as galhas). A maioria dos morfotipos é glabra (89%), verde (67%), globoide (53%) e possui apenas uma câmara interna (91%). Encontramos insetos galhadores pertencentes às ordens Diptera, Thysanoptera, Lepidoptera e Hemiptera. Os insetos galhadores da família Cecidomyiidae (Diptera) foram os mais comuns, induzindo 22% dos morfotipos de galhas. Além dos galhadores, também observamos a presença de sucessores, cecidófagos e parasitoides. Entre os tipos de vegetação amostrados, a floresta de terra firme apresentou a maior riqueza de morfotipos de galhas e espécies de plantas hospedeiras. Este é o primeiro inventário sistemático de galhas de insetos nesta região da Amazônia peruana.

New Genetic Variants of Leptospira spp Characterized by MLST from Peruvian Isolates.

Leptospirosis is a zoonotic disease caused by the genus Leptospira, presenting complex and dynamic epidemiology. To determine the genetic variability and its phylogenetic relationship of Leptospira spp isolates from three sources in Iquitos (Peruvian Amazon) from 2002 to 2013, seven MLST genes were analyzed to obtain the Sequence Type (ST) and these sequences were concatenated for phylogenetic analysis. The genetic relationship between STs was determined with the goeBURST algorithm and genetic diversity was determined using DnaSP. Of 51 isolates, 48 were pathogenic belonging to five different species: Leptospira interrogans Nascimento 2004, Leptospira santarosai Feil 2004, Leptospira noguchii Haake 2021, Leptospira borgpetersenii Levett 2021, and Leptospira kirschneri Levett 2021. Of 20 STs identified, 60% corresponded to new genotypes circulating only in Peru. The genotypes ST17, ST37, and ST301 were recorded in rodents and humans. A high intraspecific genetic diversity was demonstrated in L. noguchi. The goeBURST analysis revealed three clonal complexes (CCs) and 16 singletons. The STs were found to show high genetic variability and phylogenetic and goeBURST analysis determined that the genotypes found did not form specific groups according to the source of infection or origin, which confirms the zoonotic potential of these STs in an area highly endemic for leptospirosis.

Relación entre adicción a Internet y madurez psicológica en adolescentes del Perú / Relationship between Internet Addiction and Psychological Maturity in Adolescents from Peru

Introducción: Internet es un recurso indispensable para las personas, permite acceder a contenidos académicos, comunicacionales, sociales y otros; sin embargo, su uso indiscriminado genera conductas antisociales, bajo rendimiento académico, inadecuadas relaciones interpersonales y costo social. Los adolescentes se encuentran en riesgo por estar en el proceso de madurez y desarrollo psicoemocional. Objetivo: Describir la relación entre la adicción a Internet y la madurez psicológica en adolescentes del Perú. Métodos: Estudio cuantitativo, diseño descriptivo correlacional, transversal en colegios de Lima, Cusco, Iquitos, Pucallpa, San Martin, Tacna y Tumbes, Lima-Perú, en el año 2019. Muestra de 1707 estudiantes de tercer, cuarto y quinto de secundaria. Se usó como técnica la encuesta y como instrumentos válidos y confiables el Test de Adicción a Internet y el Cuestionario de Madurez Psicológica. Los datos fueron procesados mediante programa Excel y SPSS versión 25. Para el análisis de datos se usó la estadística descriptiva e inferencial: Coeficiente de correlación de Pearson y U de Mann Whitney. Resultados: El nivel de adicción a Internet según dimensiones alcanzó nivel promedio en Costa, Sierra y Selva: tolerancia (57,67 por ciento, 56,08 por ciento, 38,78 por ciento), uso excesivo (58,20 por ciento, 42,91 por ciento, 44,27 por ciento), retirada (58,86 por ciento, 52,03 por ciento, 40,92 por ciento) y consecuencias negativas (59,13 por ciento, 52,71 por ciento, 49,31 por ciento); igualmente para madurez psicológica: orientación al trabajo (53,44 por ciento, 37,04 por ciento, 51,59 por ciento), autonomía (43,58, 34,46 por ciento, 45,95 por ciento) e identidad (65,50 por ciento, 53,74 por ciento, 57,25 por ciento). Conclusiones: Existe relación significativa e inversa entre la adicción a Internet y la madurez psicológica de los adolescentes, al igual que en todas sus dimensiones(AU)

Introduction: The Internet is an indispensable resource for people, since it allows access to academic, communicational, social and other contents. However, its indiscriminate use leads to antisocial behavior, poor academic performance and inadequate interpersonal relationships, as well as it has social costs. Adolescents are at risk because they are in the process of maturity and psychoemotional development. Objective: To describe the relationship between Internet addiction and psychological maturity in adolescents in Peru. Methods: Quantitative study, with a descriptive, correlational and cross-sectional design, carried out in 2019 in schools from Lima, Cusco, Iquitos, Pucallpa, San Martin, Tacna and Tumbes, Lima-Peru. The sample was made up of 1707 students in their third, fourth or fifth high school years. The survey was used as a technique, while the Internet Addiction Test and the Psychological Maturity Questionnaire were used as valid and reliable tools. The data were processed using Excel and the SPSS (version 25). Descriptive and inferential statistics were used for data analysis: Pearson's correlation coefficient and Mann-Whitney U. Results: Internet addiction, according to the analyzed dimensions, reached the average level in Costa, Sierra and Selva: tolerance (57.67 percent, 56.08 percent, 38.78 percent), excessive use (58.20 percent, 42.91 percent, 44.27 percent), withdrawal (58.86 percent, 52.03 percent, 40.92 percent) and negative consequences (59.13 percent, 52.71 percent, 49.31 percent). The same phenomenon manifested for psychological maturity: work orientation (53.44 percent, 37.04 percent, 51.59 percent), autonomy (43.58, 34.46 percent, 45.95 percent) and identity (65.50 percent, 53.74 percent, 57.25 percent). Conclusions: There is a significant and inverse relationship between Internet addiction and psychological maturity in adolescents, as well as in all its dimensions(AU)

Resistance to single dose albendazole and reinfection with intestinal helminths among children ages 2 to 11 years from the Peruvian Amazon region: a study protocol.

BACKGROUND: Deworming programs aimed at reducing morbidity and mortality from geohelminth infections are common in many countries where these infections are endemic, but data demonstrating increasing levels of resistance to albendazole and mebendazole are causes for concern. Studies to evaluate the clinical efficacy of deworming programs are critical to maintain high infection control goals. METHODS: We propose to assess the clinical efficacy of Peruvian national guidelines for deworming programs in a prospective observational study conducted in the Amazon River basin area near Iquitos, Peru. Major outcomes to be evaluated include (1) albendazole resistance of intestinal helminths (trichuriasis, ascariasis, hookworm), and (2) frequency of reinfection with intestinal helminths 4 months after treatment with albendazole. Children ages 2-11 years from the Belén District of Iquitos will be identified based on a community census. Following parental informed consent, demographic data, weight, and height will be recorded and a stool specimen for parasitological exam by direct observation and Kato-Katz concentration method, and helminthic egg counts will be collected prior to administration of albendazole, following Peruvian national guidelines. Follow-up stool specimens examined in the same manner will be collected at 20 days, 90 days, and 100 days following initial administration of albendazole, and based on parasites found repeat treatment will be administered in accordance with national guidelines. Real-time multiplex qPCR will be performed on helminth positive samples collected prior to initial deworming and on helminth-positive specimens detected on day 15-20. A total sample size of 380 participants was calculated based on total population in the target group and prevalence estimates of helminth infections and clinical resistance based on recent data. DISCUSSION: Data from observational clinical efficacy studies are important to guide geohelminth infection control programs. Trial registration https://www.researchregistry.com/ . Identification number: researchregistry7736; Registered retrospectively March 13, 2022; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/622e024cf06132001e3327bf/.

Wild meat trade over the last 45 years in the Peruvian Amazon.

The trade in wild meat is an important economic component of rural people's livelihoods, but it has been perceived to be among the main causes of the decline of wildlife species. Recently, the COVID-19 pandemic has brought to light an additional concern of wildlife markets as a major human-health challenge. We analyzed data from the largest longitudinal monitoring (1973-2018) of the most important urban wild-meat markets in Iquitos, Peru, to examine the trends in and impacts of these markets on people's livelihoods. Over the last 45 years, wild meat sales increased at a rate of 6.4 t/year (SD 2.17), paralleling urban population growth. Wild meat sales were highest in 2018 (442 t), contributing US$2.6 million (0.76%) to the regional gross domestic product. Five species of ungulates and rodents accounted for 88.5% of the amount of biomass traded. Vulnerable and Endangered species represented 7.0% and 0.4% of individuals sold, respectively. Despite growth in sales, the contribution of wild meat to overall urban diet was constant: 1-2%/year of total meat consumed. This result was due to greater availability and higher consumption of cheaper meats (e.g., in 2018, poultry was 45.8% cheaper and was the most consumed meat) coupled with the lack of economic incentives to harvest wild meat species in rural areas. Most wild meat was sold salted or smoked, reducing the likelihood of foodborne diseases. Community-based wildlife management plans and the continued trade bans on primates and threatened taxa may avoid biodiversity loss. Considering the recent COVID-19 pandemic, future management plans should include potential viral hosts and regulation and enforcement of hygiene practices in wild-meat markets.

Comercio de Carne de Monte en los Últimos 45 Años en la Amazonia Peruana Resumen El comercio de carne de monte es un componente económico importante del sustento de habitantes de zonas rurales, pero se ha percibido como una de las principales causas de la declinación de especies de vida silvestre. Recientemente, la pandemia de COVID-19 ha traído a la luz una preocupación adicional de los mercados de vida silvestre como un reto importante para la salud humana. Analizamos datos del monitoreo longitudinal más extenso (1973-2018) de los mercados urbanos de carne de monte más importantes en Iquitos, Perú, para examinar las tendencias y los impactos de estos mercados sobre el sustento de los habitantes. Las ventas de carne de monte incrementaron en los últimos 45 años a una tasa de 6.4 t/año (DS 2.17), en paralelo con el crecimiento de la población. Las ventas de carne de monte fueron más altas en 2018 (442 t), aportando U.S. $2.6 millones (0.76%) al producto interno bruto de la región. Cinco especies de ungulados y roedores comprendieron el 88.5% de la biomasa comercializada. Especies vulnerables y en peligro representaron 7.0% y 0.4% de los individuos vendidos, respectivamente. A pesar del incremento de las ventas, la contribución de la carne de monte al total de la dieta urbana fue constante: 1-2%/año del total de carne consumida. Este resultado se debió a una mayor disponibilidad y consumo de carnes más baratas (e. g., en 2018 la carne de pollo fue 45.8% más barata y fue la más consumida) aparejado con la falta de incentivos económicos para cosechar carne de especies silvestres en áreas rurales. La mayor parte de la carne de monte se vendía salada o ahumada, reduciendo con ello la probabilidad de enfermedades transmitidas por alimentos. Los planes de manejo de vida silvestre basados en comunidades y la prohibición continua del comercio de primates y taxa amenazados pueden evitar la pérdida de biodiversidad. Considerando la reciente pandemia de COVID-19, los planes de manejo futuros deben incluir potenciales huéspedes virales y la regulación y aplicación de prácticas de higiene en los mercados de carne de especies silvestres.

Posibles impactos de la carretera Iquitos-Saramiriza sobre la biodiversidad de Loreto, Perú / Possible impacts of the Iquitos-Saramiriza highway on the biodiversity of Loreto, Peru

Resumen La construcción de la carretera Iquitos-Saramiriza proyectada en el departamento de Loreto plantea amenazas sobre la fauna y flora de una zona altamente biodiversa y poco alterada. Aquí, resumimos dichas amenazas en tres puntos: 1) impactos probables, identificados a través de revisión de literatura, 2) estimación de la deforestación, realizada por comparación con otras carreteras amazónicas peruanas y 3) especies más probablemente impactadas. La lista de impactos probables incluyó fragmentación de hábitat, deterioro ambiental, atropellos, dispersión de patógenos, especies invasoras, deforestación, caminos no oficiales y cacería. Estos impactos podrían afectar a unas 3961 especies de plantas y 1595 de vertebrados. La deforestación, en el transcurso de las tres próximas décadas, podría llegar a ser entre 1128 y 3200 km², lo que equivale a más del 80% de la deforestación que ha sufrido Loreto en los últimos 20 años. La fragmentación podría afectar principalmente a unas 83 especies arborícolas y ampliarse hasta la totalidad de fauna y flora en áreas con mayor deforestación. Los atropellos impactarían principalmente a unas 287 especies de animales terrestres, mientras la cacería podría dirigirse hacia unas 31 especies principales. Para 14 especies de vertebrados, la carretera corta completamente su distribución conocida, pudiendo generar poblaciones con poco o nulo intercambio genético. En base a los posibles impactos proyectados, proponemos acciones de mitigación, incluyendo el remplazo de un tramo por transporte fluvial, creación de áreas de protección estricta, instalación de pasos de fauna y la consideración de impactos indirectos en el EIA correspondiente y en otros instrumentos ambientales.

Abstract La construcción de la carretera Iquitos-Saramiriza proyectada en el departamento de Loreto plantea amenazas sobre la fauna y flora de una zona altamente biodiversa y poco alterada. Aquí, resumimos dichas amenazas en tres puntos: 1) impactos probables, identificados a través de revisión de literatura, 2) estimación de la deforestación, realizada por comparación con otras carreteras amazónicas peruanas y 3) especies más probablemente impactadas. La lista de impactos probables incluyó fragmentación de hábitat, deterioro ambiental, atropellos, dispersión de patógenos, especies invasoras, deforestación, caminos no oficiales y cacería. Estos impactos podrían afectar a unas 3961 especies de plantas y 1595 de vertebrados. La deforestación, en el transcurso de las tres próximas décadas, podría llegar a ser entre 1128 y 3200 km², lo que equivale a más del 80% de la deforestación que ha sufrido Loreto en los últimos 20 años. La fragmentación podría afectar principalmente a unas 83 especies arborícolas y ampliarse hasta la totalidad de fauna y flora en áreas con mayor deforestación. Los atropellos impactarían principalmente a unas 287 especies de animales terrestres, mientras la cacería podría dirigirse hacia unas 31 especies principales. Para 14 especies de vertebrados, la carretera corta completamente su distribución conocida, pudiendo generar poblaciones con poco o nulo intercambio genético. En base a los posibles impactos proyectados, proponemos acciones de mitigación, incluyendo el remplazo de un tramo por transporte fluvial, creación de áreas de protección estricta, instalación de pasos de fauna y la consideración de impactos indirectos en el EIA correspondiente y en otros instrumentos ambientales.

High seroprevalence for SARS-CoV-2 infection in South America, but still not enough for herd immunity!

Herd immunity is considered to be a relevant aspect of COVID-19 epidemiology. In this regard, seroprevalence studies are essential for understanding how far countries and regions are from that potential point. This study analyzed seroprevalence data in nine studies from South America, which is a region that has been badly affected by COVID-19. Seroprevalence values ​​were high, with percentages up to 70.0% (95% CI 67.0-73.4%) in Iquitos, Peru. A meta-analysis of such data enabled a pooled seroprevalence to be obtained, estimated at 33.6% (95% CI 28.6-38.5%). Despite this, the COVID-19 pandemic in South America continues to significantly affect countries such as Brazil, Colombia, and Peru.

Seroprevalence of anti-SARS-CoV-2 antibodies in Iquitos, Peru in July and August, 2020: a population-based study.

BACKGROUND: Detection of anti-SARS-CoV-2 antibodies among people at risk of infection is crucial for understanding both the past transmission of COVID-19 and vulnerability of the population to continuing transmission and, when done serially, the intensity of ongoing transmission over an interval in a community. We aimed to estimate the seroprevalence of COVID-19 in a representative population-based cohort in Iquitos, one of the regions with the highest mortality rates from COVID-19 in Peru, where a devastating number of cases occurred in March, 2020. METHODS: We did a population-based study of SARS-CoV-2 transmission in Iquitos at two timepoints: July 13-18, 2020 (baseline), and Aug 13-18, 2020 (1-month follow-up). We obtained a geographically stratified representative sample of the city population using the 2017 census data, which was updated on Jan 20, 2020. We included people who were inhabitants of Iquitos since COVID-19 was identified in Peru (March 6, 2020) or earlier. We excluded people living in institutions, people receiving any pharmacological treatment for COVID-19, people with any contraindication for phlebotomy, and health workers or individuals living with an active health worker. We tested each participant for IgG and IgM anti-SARS-CoV-2 antibodies using the COVID-19 IgG/IgM Rapid Test (Zhejiang Orient Gene Biotech, China). We used survey analysis methods to estimate seroprevalence accounting for the sampling design effect and test performance characteristics. FINDINGS: We identified 726 eligible individuals and enrolled a total of 716 participants (99%), distributed across 40 strata (four districts, two sexes, and five age groups). We excluded ten individuals who: did not have consent from a parent or legal representative (n=3), had moved to Iquitos after March 6, 2020 (n=3), were in transit (n=2), or had respiratory symptoms (n=1). After adjusting for the study sampling effects and sensitivity and specificity of the test, we estimated a seroprevalence of 70% (95% CI 67-73) at baseline and 66% (95% CI 62-70) at 1 month of follow-up, with a test-retest positivity of 65% (95% CI 61-68), and an incidence of new exposures of 2% (95% CI 1-3). We observed significant differences in the seroprevalence between age groups, with participants aged 18-29 years having lower seroprevalence than those aged younger than 12 years (prevalence ratio 0·85 [95% CI 0·73-0·98]; p=0·029). INTERPRETATION: After the first epidemic peak, Iquitos had one of the highest rates of seroprevalence of anti-SARS-CoV-2 antibodies worldwide. Nevertheless, the city experienced a second wave starting in January, 2021, probably due to the emergence of the SARS-CoV-2 P1 variant, which has shown higher transmissibility and reinfection rates. FUNDING: Dirección Regional de Salud de Loreto (DIRESA), Loreto, Peru. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.

Prevalence of Overweight and Obesity among Health Sciences Students in the Amazonia Region of Peru.

A cross-sectional study was conducted to evaluate 199 health sciences students in the city of Iquitos. Their socio-demographic characteristics, lifestyle, level of physical activity, type of food, substance abuse, and prevalence of overweight and obesity were ascertained using purpose-validated questionnaires, i.e., the Systematic Alcohol Consumption Interview (Interrogatorio Sistematizado de Consumos Alcohólicos/ISCA), a questionnaire on the frequency of dietary intake (CFCA), the International Physical Activity Questionnaire (IPAQ), and anthropometric measurements. The prevalence of overweight (body mass index (BMI) of 25.0-29.9 kg/m2) was 26.5% (95% CI = 19.9-33.0%) and that of obesity (BMI ≥ 30.0 kg/m2) was 7.9% (95% CI = 3.8-12.1%). A total of 34.4% of students (95% CI = 27.4-41.4%) presented with a BMI > 25 kg/m2. The frequency of overweight was significantly higher in persons aged over 20 years (OR = 2.5) and smokers (OR = 3.2), and the frequency of obesity was significantly higher in older students (OR = 4.1) and males (OR = 5.5). In conclusion, a considerable proportion of health sciences students in the Amazonia region presented with a high BMI. The proportion of students with overweight was higher among students aged over 20 years and smokers, while that of obesity was also higher among males. In the university setting, the development of more overweight- and obesity-preventive activities and educational interventions would therefore be desirable.

Peruvian Valuation of the EQ-5D-5L: A Direct Comparison of Time Trade-Off and Discrete Choice Experiments.

OBJECTIVES: (1) To produce Peruvian general population EQ-5D-5L value sets on a quality-adjusted life-year scale, (2) to investigate the feasibility of a "Lite" protocol less reliant on the composite time trade-off (cTTO), and (3) to compare cTTO and discrete choice experiment (DCE) value sets. METHODS: A random sample of adults (N = 1000) in Lima, Arequipa, and Iquitos did a home interview; 300 were randomly selected to complete 11 cTTOs first. All respondents completed a DCE, including 10 latent-scale pairs (A/B) with 5 EQ-5D-5L attributes, and 12 matched pairs (A/B and B/C) with 5 EQ-5D-5L and one lifespan attributes. We estimated a cTTO heteroscedastic tobit (N = 300) model and 3 DCE Zermelo-Bradley-Terry models (N = 300, 700, and 1000). RESULTS: Each model produced a consistent value set (20 positive incremental parameters). Nevertheless, their lowest quality-adjusted life-year values differed greatly (cTTO: -1.076 [N = 300]; DCE: -0.984 [300], 0.048 [700], -0.213 [1000]). Compared with the cTTO, the DCE (N = 300) produced different parameters (Pearson's correlation = 0.541), fewer insignificant parameters (0 vs 8), and fewer values less than 0 (26% vs 44%). Compared with the DCE (N = 300), the DCE (N = 700) produced higher values but similar parameters (Pearson's correlation = 0.800). CONCLUSIONS: Besides producing EQ-5D-5L value sets for Peru, the results casts doubt about the feasibility of a Lite protocol like the one in this study. Additionally, fundamental differences between cTTO and DCE-without the existence of a gold standard-need further clarification. The choice between the two rational value sets produced in the current study is a matter of judgment and may have substantial policy implications.