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Introduction: People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia. Methods: A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation. Results: DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively. Conclusion: Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic, with over 83 million confirmed cases and 1.8 million deaths, has raised concerns about long-term cognitive issues, especially in populations facing disparities. Despite a few years since Peru's first COVID-19 wave, the cognitive effects on adults remain unclear. This study is the first in Peru to explore COVID-19's impact on general cognition and executive function. Methods: A retrospective cross-sectional study compared individuals with COVID-19 history to controls, assessing general cognition, verbal fluency, attention, and executive function. Among 240 assessed, 154 met the study inclusion criteria, with about 60% female and an average age of 38.89 ± 16.001 years. Groups included controls (n = 42), acute phase (AP, n = 74) (1-14 days of symptoms), and hyperinflammatory phase (HP, n = 38) (>14 days of symptoms). Results: Significant cognitive differences were observed. The HP group exhibited lower general cognitive performance (p = 0.02), working memory (p = 0.01), and executive function (planning; p < 0.001; flexibility; p = 0.03) than controls. Those with <14 days of illness (AP vs. HP) had deficits in general cognitive performance (p = 0.02), working memory (p = 0.02), and planning (p < 0.001), mainly during the hyperinflammatory phase, showing differences in working memory (p = 0.003) and planning (p = 0.01). Gender differences emerged, with males in the HP phase having poorer working memory (p = 0.003) and planning (p = 0.01). Discussion: This study underscores COVID-19's negative impact on cognitive function, even in mild cases, with potential heightened effects in men during acute or hyperinflammatory phases. The findings provide Peru's first evidence, highlighting the vulnerability of populations facing socioeconomic disparities. [ABSTRACT FROM AUTHOR]

The study evaluated microbial and Potentially Toxic Elements—PTEs risks in high Andean river water in Peru using Monte Carlo simulation. A total of 144 water samples were collected from four rivers and evaluated for physicochemical parameters, PTEs and bacterial pathogens. The microbial risk analysis for exposure to pathogens present in the water was based on the probability of occurrence of diseases associated with Escherichia coli, Pseudomonas aeruginosa and enterococci. PTEs risk analysis was performed using a Monte Carlo simulation approach. The results showed that the highest microbial risk due to exposure to water contaminated by E. coli, P. aeruginosa and enterococci was recorded in the Miraflores and Chia rivers. Meanwhile, the analysis of carcinogenic and non-carcinogenic risk by PTEs in adults and children revealed that the Chia river presents a high risk of contamination by PTEs, especially the carcinogenic risk for children. The Monte Carlo simulation indicated a 56.16% and 94.85% probability of exceeding the limit value of 0.0001 for carcinogenic risk in adults and children, respectively. It can be concluded that children consuming the waters of the Chia river are potentially at risk of As toxicity. [ABSTRACT FROM AUTHOR]

Introduction: As disease-modifying therapies become available for Alzheimer's disease (AD), detection of AD in early stages of illness (mild cognitive impairment [MCI], early dementia) becomes increasingly important. Biomarkers for AD in low- and middle-income countries (LMICs) are costly and not widely available; hence, it is important to identify cognitive tests that correlate well with AD biomarker status. In this study, we evaluated the memory alteration test (M@T) to detect biomarker-proven AD and quantify its correlation with neurodegeneration and cerebrospinal fluid (CSF) AD biomarkers in a cohort of participants from Lima, Peru. Methods: This is a secondary analysis of a cohort of 185 participants: 63 controls, 53 with amnestic MCI (aMCI), and 69 with dementia due to AD. Participants underwent testing with M@T and a gold standard neuropsychological battery. We measured total tau (t-tau), phosphorylated tau (p-tau), and beta-amyloid (β-amyloid) in CSF, and evaluated neurodegeneration via medial temporal atrophy score in MRI. We used receiver-operator curves to determine the discriminative capacity of the total M@T score and its subdomains. We used the Pearson coefficient to correlate M@T score and CSF biomarkers. Results: The M@T had an area under the curve (AUC) of 0.994 to discriminate between controls and cognitively impaired (aMCI or AD) patients, and an AUC of 0.98 to differentiate between aMCI and AD patients. Free-recall and cued recall had the highest AUCs of all subdomains. Total score was strongly correlated with t-tau (−0.77) and p-tau (−0.72), and moderately correlated with β-amyloid (0.66). The AUC for discrimination of neurodegeneration was 0.87. Conclusion: The M@T had excellent discrimination of aMCI and dementia due to AD. It was strongly correlated with CSF biomarkers and had good discrimination of neurodegeneration. In LMICs, the M@T may be a cost-effective screening tool for aMCI and dementia caused by AD. [ABSTRACT FROM AUTHOR]

Abandoned mining–metallurgical sites can significantly impact the environment and human health by accumulating heavy metals in aquatic ecosystems. The water in the sub-basin near an abandoned smelting facility in the city of La Oroya, Peru, is primarily used for pisciculture. The objective of this study was to assess the risk to human health from exposure to heavy metals via dietary intake of rainbow trout (Oncorhynchus mykiss) in the influence area of a smelting facility located in the central Andean region of Peru. The bioconcentration factor, biosediment accumulation factor, and consumption risks were evaluated using the Monte Carlo method. The results showed that the concentrations of elements (Zn > Pb > Cu > As) in rainbow trout muscle did not exceed the maximum limit (ML). However, the water significantly exceeded the ML for Pb in all sectors and As in the lower and middle parts of the river. The concentration of Pb in sediments also significantly exceeded the ML in the upper and lower parts of the river. Consequently, rainbow trout consumption in the study area presents risks to human health due to the bioaccumulation of heavy metals, with a 1.27% carcinogenic risk in samples from the lower part of the river. [ABSTRACT FROM AUTHOR]

There is a need to define mine tailings in a clear, precise, multidisciplinary, transdisciplinary, and holistic manner, considering not only geotechnical and hydraulic concepts but also integrating environmental and geochemical aspects with implications for the sustainability of mining. This article corresponds to an independent study that answers questions concerning the definition of mine tailings and the socio-environmental risks linked with mine tailings chemical composition by examining the practical experience of industrial-scale copper and gold mining projects in Chile and Peru. Definitions of concepts and analysis of key aspects in the responsible management of mine tailings, such as characterization of metallic–metalloid components, non-metallic components, metallurgical reagents, and risk identification, among others, are presented. Implications of potential environmental impacts from the generation of acid rock drainage (ARD) in mine tailings are discussed. Finally, the article concludes that mine tailings are potentially toxic to both communities and the environment, and cannot be considered as inert and innocuous materials; thus, mine tailings require safe, controlled, and responsible management with the application of the most high management standards, use of the best available technologies (BATs), use of best applicable practices (BAPs), and implementation of the best environmental practices (BEPs) to avoid risk and potential socio-environmental impact due to accidents or failure of tailings storage facilities (TSFs). [ABSTRACT FROM AUTHOR]

Background: Cognitive impairment and dementia may result from a combination of modifiable and nonmodifiable risk and protective factors, such as the environment, educational attainment, time devoted to cognitively stimulating activities, and physical activity.Objective: This study aimed to investigate the mediating role of sociodemographic characteristics and lifestyle factors in the years of education and cognitive performance in Peruvian adults.Methods: This cross-sectional study included 1,478 subjects assessed by Addenbrooke's Cognitive Examination Revised (ACE-R). Using mediation models, we evaluated the mediation role of parents' educational level, reading time (RT), and physical activity time (PAT) in the years of education (IYE) and cognitive performance.Results: People who reported having lived in an urban area during their childhood are estimated to have, on average, 2.085 years more formal education than those who lived in rural areas. In addition, 49% of cognitive performance scores are explained by the mediation effect of reading and physical activity time in the IYE. This implies that higher levels of education, mediated by RT and PAT per week, are 1.596 units associated with higher scores on the ACE-R.Conclusion: Despite the fact that nonmodifiable factors (i.e., childhood residence area, parents' educational level) seem to exert an effect on older adults' cognition, their influence is mediated by other factors that are indeed modifiable (i.e., reading time, physical activity engagement). In this sense, lifestyle changes could help prevent or decrease the risk of cognitive impairment and reduce the disease's impact on vulnerable environments in Latin American and Caribbean countries. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE‐Pe), of INECO Frontal Screening (IFS‐Pe) and of the Mini‐Mental State Examination (MMSE‐Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non‐dementia stages (VCI‐ND) and vascular dementia (VD) in patients with cerebral stroke in Lima—Peru. Materials and methods: A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI. Results: Two hundred and four patients were evaluated: 61% Non‐VCI, 30% VCI‐ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE‐Pe, IFS‐Pe and MMs‐Pe were 0.99 (95% confidence interval [CI] 0.98–0.99), 0.99 (95%CI 0.98–0.99) and 0.87 (95%CI 0.82–0.92), respectively. Of the three BCS, the IFS‐Pe presented a larger AUC to discriminate VCI‐ND from VD (AUC = 0.98 [95%CI 0.95–1]) compared to ACE‐Pe (AUC = 0.84 [95%CI 0.74–0.95]) and MMSE‐Pe (0.92 [95%CI 0.86–0.99]). The IFS‐Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (−LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and −LR = 0.03) than ACE‐Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and −LR = 0.05) and MMSE‐Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and −LR = 0.12). In the multiple regression analysis, the IFS‐Pe was not affected by age, sex or years of schooling. Conclusion: The IFS‐Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre‐dementia (VCI‐ND) and dementia (VD) stages. Key points: Brief cognitive screening (BCS) tools for the detection of vascular cognitive impairment (VCI) must be adapted and validated for each region and include evaluation of individuals with a low level of education and illiterate subjects from urban and rural settingsA diagnostic test design was used to determine the diagnostic accuracy indicators of the three BSC: Peruvian version of Addenbrooke's Cognitive Examination (ACE‐Pe), INECO Frontal Screening (IFS‐Pe) and the Mini‐Mental State Examination (MMSE‐Pe)IFS‐Pe presented a higher sensitivity, specificity, and positive and negative likelihood ratios than ACE‐Pe and MMSE‐PeIFS‐Pe was more accurate in differentiating pre‐dementia (VCI non‐dementia stage) from dementia stages (vascular dementia) compared to ACE‐Pe and the MMSE‐Pe [ABSTRACT FROM AUTHOR]

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Introduction: Frontotemporal dementia (FTD) is a complex syndrome characterized by changes in behavior, language, executive control, and motor symptoms. Its annual economic burden per patient in developed countries has been classified as considerable, amounting to US$119,654 per patient, almost double the patient costs reported for Alzheimer's disease. However, there is little information regarding cost-of-illness (COI) for FTD in Latin-America (LA). Aim: To describe the costs related to FTD in LA. Methods: We included COI studies on FTD conducted in LA published in English, Spanish, or Portuguese from inception to September 2020. We carried out a systematic search in Pubmed/Medline, Scopus, Web of Science, Scielo, Cochrane, and gray literature. For quality assessment, we used a COI assessment tool available in the literature. All costs were reported in USD for 1 year and adjusted for inflation. Results: We included three studies from Argentina, Brazil, and Peru. Direct costs (DCs) included medication (from US$959.20 to US$ 4,279.20), health care costs (from US$ 2,275.80 to US$7,856.16), and caregiver costs (from US$9,634.00 to US$28,730.28). Indirect costs (ICs) amounted to US$43,076.88. Conclusions: In LA countries, the reporting of costs related to FTD continues to be oriented toward DCs. They remain lower than in developed countries, possibly due to the limited health budget allocated. Only one Brazilian report analyzed ICs, representing the highest percentage of the total costs. Therefore, studies on the COI of this disease in LA are essential, focusing on both out-of-pocket spending and the potential economic loss to patients' homes and families. [ABSTRACT FROM AUTHOR]

Background: The accurate diagnosis of neurocognitive disorders in illiterate Peruvian populations is challenging, largely owing to scarcity of brief cognitive screening tools (BCST) validated in these diverse populations. The Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) is a BCST that relies minimally on educational attainment and has shown good diagnostic accuracy in an urban illiterate population in Peru, yet its psychometric properties in illiterate populations in rural settings of the country have not been previously investigated. Objectives: To establish the diagnostic accuracy of the RUDAS-PE compared to expert clinical diagnosis using the Clinical Dementia Rating (CDR) Scale in healthy and cognitively impaired illiterate persons living in two culturally and geographically distinct rural communities of Peru. Methods: A cross-sectional, population-based study of residents ≥ 50 years of age living in the Peruvian rural communities of Santa Clotilde and Chuquibambilla. A total of 129 subjects (76 from Santa Clotilde and 53 from Chuquibambilla) were included in this study. Gold standard diagnostic neurocognitive evaluation was based on expert neurological history and examination and administration of the CDR. Receiver operating characteristics, areas under the curve (AUC), and logistic regression analyses were conducted to determine the performance of RUDAS-PE compared to expert gold standard diagnosis. Results: Compared to gold standard diagnosis, the RUDAS-PE was better at correctly discriminating between MCI and dementia than discriminating between MCI and controls in both sites (97.0% vs. 76.2% correct classification in Chuquibambilla; 90.0% vs. 64.7% in Santa Clotilde). In Chuquibambilla, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.4% (optimal cutoff at <18), whereas between MCI and controls it was 82.8% (optimal cutoff at <22). In Santa Clotilde, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.1% (optimal cutoff at <17), whereas between MCI and controls it was 75.5% (optimal cutoff at <21). Conclusions: The RUDAS-PE has acceptable psychometric properties and performed well in its ability to discriminate MCI and dementia in two cohorts of illiterate older adults from two distinct rural Peruvian communities. [ABSTRACT FROM AUTHOR]

Surface sediment quality of potential rivers in Peru was evaluated using indicators of contamination, accumulation and ecological risk of heavy metals and As. Surface sediment samples were collected at 54 sampling sites in the Tishgo and Chia rivers during 2018. The determination of Cu, Pb, Zn and As was performed by flame atomic absorption spectrophotometry. The results revealed the decreasing order of the mean concentrations of heavy metals and As in the Chia River of Zn > Cu > As > Pb and Tishgo of Zn > Pb > As > Cu. The PLI for the Tishgo River were greater than one (PLI > 1) denoting the deterioration it has been experiencing. In the Chia River, 60% of the sampling sites indicated no appreciable contamination by these elements (PLI < 1). The Igeo values of As in both rivers showed a state of contamination, from moderately to severely contaminated. In the Tishgo River the potential ecological risk varied from low to moderate and in the Chia River from low to considerable. Finally, this study reveals the applicability of the evaluation indexes of contamination, accumulation and potential ecological risk of toxic metals so that special control measures can be adopted. [ABSTRACT FROM AUTHOR]

The change and intensification of land use has been generating impoverishment of soils with negative effects on biological communities. It was analyzed the bacterial composition of maca (Lepidium meyenii Walp) cultivation soils by Illumina sequencing in the Bombón plateau, during 2019. Three sampling sectors were defined, a control sector (natural soil) and two sectors with use pressure ("first use" and "second use" soils). Soil physicochemical indicators were determined through analytical methods and the composition of bacterial communities through Illumina sequencing of 16S rRNA gene amplicons. The results of pH and EC, in control soils and with use pressure, varied from 7.51 to 4.53 and from 0.06 to 0.47 dS/m, respectively. The highest OM, N, P, K and Ca contents were recorded in control soils, decreasing significantly in soils with use pressure. Principal components analysis (PCA) presented a percentage of total variation of 97.1%. Illumina sequencing revealed 3776 bacterial families. SIMPER analysis showed that the highest contribution percentages were made by the Acidobacteriaceae (2.95%), Verrucomicrobiaceae (2.68%), Thermoactinomycetaceae (2.11%) and Akkermansiaceae (2.10%) families. Redundancy analysis (RDA) showed a good association between physicochemical variables and bacterial families. The metagenomic analysis has allowed the identification of bacterial families that can be used as indicators of good and bad soil physicochemical quality according to the pressure of use by maca crops. As well as the best physicochemical indicators predictive of changes in the composition of bacterial communities. [ABSTRACT FROM AUTHOR]

The concentration of Cu, Pb, Zn and As in water, sediment and muscle of Oncorhynchus mykiss from the Tishgo river in the central Andes of Peru were analyzed. The water, sediment and fish samples were collected from 36 sites in three sampling sectors. The analytical determination was performed by flame atomic absorption spectrophotometry. The mean Pb concentrations in the water from the three sampling sectors showed significant differences (p < 0.05) which exceeded the values of the Peruvian standard and the WHO. The mean concentrations of Cu, Pb and As in sediment did not present significant differences (p > 0.05) in the three sectors evaluated. The redundancy analysis (RDA) revealed that the concentrations of As and Pb in water, and Cu, As and Zn in sediment significantly influence the concentration of these elements in the O. mykiss muscle. The mean concentrations of Cu, Pb, Zn and As in the O. mykiss muscle were lower than those established by international regulations. Therefore, the concentrations of heavy metals and As recorded in this study do not represent a threat to the consumption of O. mykiss from the Tishgo river. [ABSTRACT FROM AUTHOR]

Copyright of Colombia Medica is the property of Universidad del Valle and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of this study was to analyze the content of heavy metals and arsenic in soil and cereal grains as well as to evaluate the possible human risk in the central region of Peru. The soil samples of corn and barley grains were collected from seven agricultural zones and the concentrations of Cu, Fe, Pb, Zn and As were determined with the method of atomic absorption flame spectrophotometry. PERMANOVA showed that the effect of the type of crop and the sampling zone significantly influence the concentrations of heavy metals and As in soil and corn and barley grains (p < 0.05). PCA for heavy metals and As in soil and grain samples of the cereals studied showed that the first two main components represented 81.03% and 94.77% of the total variance, respectively. Hazard Quotient (HQ) for ingestion was the most significant. The HQ values of Pb and As in crop soils indicated that detrimental health effects are unlikely (HQ < 1). The soil hazard index (HI) values of both crops did not exceed the threshold value of 1 (HI < 1). The carcinogenic risk level (CR) of As from ingestion of corn and barley crop soils contaminated by As was higher in children than in farmers and adults. The bioconcentration factor (BCF) of As was higher in barley grains than in corn grains. The THQ of As exceeded the target value of 1 in 100% of the barley and corn sampling sites. The RC of As in grains exceeded the acceptable risk level of 10–6 in all sampling zones. [ABSTRACT FROM AUTHOR]

Soil is exposed to heavy metals that are associated with the anthropogenic activities, and is currently an environmental and food safety problem. The concentration and source of heavy metals in soils, the level of contamination and the potential for ecological risk in high Andean ecosystems were evaluated. The soil samples were collected from the surface part in which Andean crops were sown and the concentration of As, Cd, Pb, Fe and Zn was quantified. The concentrations of heavy metals in soils did not exceed the threshold of the national and international standard, while As, Pb and Zn exceeded the values of the background. The contamination factor (CF) values showed a high level of contamination for As and moderate for Pb and Zn. The geoaccumulation index (Igeo) values showed that As had the highest load of accumulated pollutants in soils by anthropogenic contribution. A moderate degree of contamination (CD) was found in 61.5% of the sampling sites. The potential ecological risk index (RI) showed that the soils of the study area presented a moderate to low potential ecological risk, and As was the main pollutant in high Andean soils. As, Pb and Zn occurring in high Andean soils mainly originated from human activities such as agricultural practices, whereas Fe mainly originated from the parent material of the soil. The effects of the use of organic and inorganic fertilizers on the accumulation of heavy metals in and Andean agricultural products must be analyzed and verified to protect the health of the inhabitants and the environment. [ABSTRACT FROM AUTHOR]

The concentration of Cu, Fe, Pb, Zn and As in the surface water intended for human consumption and other uses in the Mantaro River basin were analysed using multivariate methods. The water samples were collected from seven water bodies in the Junín region in June 2019, in the low discharge period. In each body of water, a sector with six sampling sites was established. The Cu, Fe, Pb, Zn and As contents were determined by the flame atomic absorption spectrophotometry method. The correlation analysis revealed positive and significant correlations (P < 0.05) for the Zn/Pb, Pb/Fe and Zn/Fe pairs with a good association, higher than 0.80 and for the Pb/Cu, Fe/Cu, As/Pb and As/Zn pairs a weak degree of association (P < 0.05). The analysis of the main components showed three components with their own values > 1. The hierarchical grouping analysis classified the evaluated water bodies into three groups according to the concentration of the Cu, Fe, Pb, Zn and As. The high concentrations of heavy metals and arsenic recorded in the CIMIRM and MERIS irrigation channels reveal that the Mantaro River continues to be a sink for mine wastewater discharges and runoff from mining liabilities at the headwaters of the Mantaro basin. It is, therefore, necessary to implement urgent management policies to control and reduce the levels of contamination by potentially toxic metals and metalloids in the Mantaro River. [ABSTRACT FROM AUTHOR]

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The behavior of physical-chemical parameters and potentially toxic metals in the surface water of Lake Chinchaycocha was evaluated using multimetric indices between March and December 2018. Water samples were collected from 10 sampling sites during the rainy and low-water periods, and water quality was determined using the WQI CCME and the Shannon-Wiener index, followed by multivariate analysis. The WQI CCME rated good quality water, except for the LCh1 site. The Shannon-Wiener index rated moderate and extremely contaminated water. The cluster analysis grouped the sampling sites into two clusters with similar characteristics. The ACP presented a total percentage variation of 76.07%. Therefore, this study provides an updated state of the water quality of Lake Chinchaycocha using different indices and multivariate techniques. [ABSTRACT FROM AUTHOR]

The objective of the work was to evaluate the radial and longitudinal variation of the basic density and fiber dimensions of the Guazuma crinita Mart. Ten trees of five and eight years were used. They came from forest plantations of Maquizapallo located in the city of Puerto Inca, Huánuco - Peru. The variables analyzed were basic density based on the standard NTP 251.011: 2014, and the fibers characteristics. The trees were felled and sectioned into 4-meter logs, divided into three parts basal, middle and apical for density determination and fiber evaluations. In general, the basic density and the anatomical characteristics evaluated decrease from the base to the apex, meanwhile, they increase from the marrow to the cortex where age had a significant influence on the basic density but not on the anatomical characteristics, however, since the basic density is greater for 8 years, it could be used where no great effort is needed and also commercially. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Ambiente e Água is the property of Revista Ambiente e Agua and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To analyse the cost‐effectiveness (C‐E) of interferon therapy for MS and the impact of adherence associated with a patient support programme (PSP). Methods: Markov model was structured based on systematic review of the evidence and the opinion of local experts. The model has three health states: (1) Baseline treatment (BT), (2) Interferon‐β (IFN) with patient support programme (PSP) and (3) IFN without PSP. Annual cycles were considered, with a time horizon of 30 years. The analysis perspective was based on the Ministry of Health (MoH). Key findings: Interferon‐β + PSP dominates the treatment of IFN without PSP. The incremental C‐E rate (ICER) for IFN + PSP was estimated at S/. 26 408 per Quality Adjusted Life Year (QALY) in relation to BT. IFN without PSP was dominated by the IFN + PSP treatment. The cost per QALY of IFN + PSP was below the payment threshold in almost 100% of the model simulations. The acceptability curves show that the treatment with PSP + IFN is probabilistically more cost effective from a payment threshold of 1.25 annual Gross Domestic Product per capita (GDP‐pc). The Tornado analysis for the ICER between IFN + PSP and BT shows that the most sensitive variables of the model are the relative risk (RR) for treatment adherence and the cost of IFN + PSP treatment. Conclusion: The addition of a PSP had a significant effect on adherence and C‐E of the intervention. The ICER for IFN + PSP was below 1.5 annual GDP‐pc of payment threshold with an incremental cost near to 3 GDP‐pc. IFN without PSP was dominated by the IFN + PSP. [ABSTRACT FROM AUTHOR]

This study describes a model to intervene in communities affected by the political violence impacting the Ayacucho region of Peru since 1980s. Many community members still experience psychosocial consequences to this day due primarily to grief. Thirty-eight professionals from different sectors in the area received specialized training and implemented five community projects that were accompanied and monitored in the field by a team of community psychologists. This article is grounded on the principles of participation, building community capacity, and community strengthening. We present the analysis of five community action plans implemented over a period of 14 months. The results show a process of internal strengthening of community services and the identification of new social and community resources among the people involved in the action plans. The implications of capacity building for improving community mental health are discussed. [ABSTRACT FROM AUTHOR]

The article presents a study conducted by the authors related to participation of women in communities after an internal armed conflict in Peru. Topics discussed include report of The Truth and Reconciliation Commission (TRC) in August 2003, role of participatory techniques and community work in increasing women's participation in decision making, and house-to-house family visit by women of the Tambobamba community to explain healthy habits and violence free living.

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Introduction. The clock drawing test (PDR-M) - Manos' version - is a brief cognitive assessment tool for dementia detection. Objectives. To assess the validity and reliability of the PDR-M to discriminate between patients with dementia and healthy control subjects. Materials and methods. We evaluated subjects over 65 years of age, excluding those with severe concomitant diseases and those with hearing or visual impairment. We obtained demographic data and performed the PDR-M and Mini Mental State Examination (MMSE). Subjects of the dementia group were also submitted to clinical, laboratory and neuropsychological evaluations as well as computed tomography scanning. Sensitivity and specificity of the PDR-M were calculated as well as the area under the ROC curve. Results. We evaluated 210 individuals, 103 with confirmed diagnosis of dementia and 107 healthy controls with similar age and sex in both groups, but a higher educational level in the control group. Setting a cutoff point of 7, a sensitivity of 99.0% and a specificity of 83.5% were found. When comparing the areas under the ROC curves of the PDR-M and MMSE we found no statistically significant difference. Conclusions. The PDR-M is a brief and reliable instrument for the detection of dementia in the urban population of Lima, Peru. [ABSTRACT FROM AUTHOR]

In this study, the quality of sediment and surface water in two natural wetlands, Paca and Tragadero, in the central region of Peru was evaluated using pollution indices, including the geoaccumulation index, pollutant load index, modified pollution degree, potential ecological risk index, and site rank index, for four heavy metals. Principal component analysis was used to identify potential metal contaminant sources. The determination of Fe, Zn, Pb, and As was performed by flame atomic absorption spectrophotometry. The average concentrations of metals in the sediments of both lagoons decreased in the order Fe > Zn > Pb > As. The analysis of the contamination indices determined that As and Pb are the elements that contribute the most to environmental degradation in both wetlands. There is a strong correlation between the values of potential ecological risk and the modified degree of contamination, revealing that the Paca wetland has a moderate degree of contamination and potential ecological risk, while Tragadero presents a high degree of contamination and considerable potential ecological risk. The application of the site rank index showed that more than 50% of the sampling sites have between high and severe contamination. The principal component analysis presented 79.2% of the total variance. Finally, the results of this study are essential in order to carry out preventive actions for environmental protection in these lake ecosystems of great importance for many activities, such as bird watching. [ABSTRACT FROM AUTHOR]

Water pollution by heavy metals is one of the leading environmental concerns as a result of intense anthropogenic pressure on the aquatic environment. This constitutes a significant limitation to the human right of access to drinking water. In this context, the risk to humans from exposure to heavy metals and arsenic in water from rivers subject to mining influence in the Central Andes of Peru was assessed. Water samples were collected from seven rivers at 63 sampling sites, and concentrations of Cu, Fe, Pb, Zn, and As were determined using flame atomic absorption spectrophotometry. Cluster analysis was used to group 21 sampling sites into four groups with similar chemical characteristics, and principal component analysis was used to simplify the complex relationship between the toxic elements by generating two main components with a total percentage of variation of 86%. Fe, Zn, and As had higher percentages of contribution in the Mantaro, Cunas, and Chia rivers. The hazard quotient was highest for children and adults. The hazard index for ingestion of all the studied heavy metals and As was higher than the threshold value (HIing > 1). HIing in 43% of the rivers indicated that the adult population is at risk of non-carcinogenic effects, and HIing in 14% of the rivers revealed a very high health risk. The risk of cancer by ingestion for children varied from medium to high risk and for adults from low to high risk. [ABSTRACT FROM AUTHOR]