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Abstract Background Peru is facing a double burden of malnutrition (DBM), characterized by the co-existence of undernutrition and overnutrition. Double-duty actions that concurrently target common drivers of undernutrition and overnutrition, while ensuring no unintended side effects, are recommended to effectively address the DBM. To understand these complex common mechanisms and design context-specific double-duty actions, there is a need for participatory systems approaches. This paper provides a case study of applying a community-based system dynamics approach to capture stakeholder perspectives of food system drivers of the DBM in two regions in Peru. Methods We implemented a multi-stage community-based system dynamics approach, which included processes for research capacity building for systems approaches, and the designing, piloting, and implementation of stakeholder workshops. A total of 36 stakeholders, representing diverse perspectives, participated in five group model building workshops. Stakeholder views are presented in a causal loop diagram that showcases the feedback mechanisms between key food system drivers of overweight and stunting in Peru. Results The causal loop diagram highlights that prioritization of undernutrition over overnutrition in the policymaking process, due to Peru’s historically high levels of undernutrition, may undermine action against the DBM. It also describes potential mechanisms of unintended impacts of undernutrition policies on the DBM in Peru, including impacts related to within-family distribution and quality of food provided through food assistance programs, and unintended impacts due to regional dynamics. Conclusions This paper highlights the importance of a participatory approach to understand local needs and priorities when recommending double-duty actions in Peru and shares practical methodological guidance on applying participatory systems approaches in public health.

Background The co-occurrence of chronic diseases and acute infectious events exacerbates disability and diminishes quality of life, yet research in Low- and Middle-Income countries is scarce. We aimed to investigate the relationship between infectious events and multimorbidity in resource-constrained settings. Methods We conducted a sequential mixed-method study in Lima and Tumbes, Peru, with participants having multimorbidity from the CRONICAS Cohort Study. They completed a questionnaire on the occurrence, treatment, and health-seeking behaviour related to acute infectious events. Qualitative interviews explored the perceptions and links between multimorbidity and acute infectious events for a subgroup of participants. Findings Among individuals with multimorbidity, low awareness of chronic conditions and poor medication adherence. The cumulative incidence for respiratory and gastrointestinal infections, the most reported acute conditions, was 2.0 [95%CI: 1.8–2.2] and 1.6 [1.2–1.9] events per person per year, respectively. Individuals with cancer (6.4 [1.6–11.2] events per person per year) or gastrointestinal reflux (7.2 [4.4–10.1] events per person per year) reported higher cumulative incidence of infectious events than others, such as those with cardiovascular and metabolic conditions (5.2 [4.6–5.8] events per person per year). Those with three or more chronic conditions had a slightly higher cumulative incidence compared with individuals with two conditions (5.7 [4.4–7.0] vs 5.0 [4.4–5.6] events per person per year). Around 40% of individuals with multimorbidity sought healthcare assistance, while others chose drugstores or didn't seek help. Our qualitative analysis showed diverse perceptions among participants regarding the connections between chronic and acute conditions. Those who recognized a connection emphasized the challenges in managing these interactions. Interpretation Our study advances understanding of multimorbidity challenges in resource-limited settings, highlighting the impact of acute infections on patients' existing multimorbidity burden.

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Abstract Background Point-of-care testing (POCT) devices may facilitate the delivery of rapid and timely results, providing a clinically important advantage in patient management. The challenges and constraints in the implementation process, considering different levels of actors have not been much explored. This scoping review aimed to assess literature pertaining to implementation facilitators and barriers of POCT devices for the diagnosis or monitoring of cardiometabolic diseases. Methods A scoping review of the literature was conducted. The inclusion criteria were studies on the inception, planning, or implementation of interventions with POCT devices for the diagnosis or monitoring of cardiometabolic diseases defined as dyslipidemia, cardiovascular diseases, type 2 diabetes, and chronic kidney disease. We searched MEDLINE, Embase, and Global Health databases using the OVID searching engine until May 2022. The Consolidated Framework of Implementation Research (CFIR) was used to classify implementation barriers and facilitators in five constructs. Also, patient, healthcare professional (HCP), and organization level was used. Results Twenty studies met the eligibility criteria for data extraction. All studies except two were conducted in high-income countries. Some findings are: 1) Intervention: the most widely recognized facilitator was the quick turnaround time with which results are obtained. 2) Outer setting: at the organizational level, the lack of clear regulatory and accreditation mechanisms has hindered the adoption and sustainability of the use of POCT. 3) Inner setting: for HCP, performing POCT during the consultation was both a facilitator and a barrier in terms of time, personnel, and service delivery. 4) Individuals: the implementation of POCT may generate stress and discomfort in some HCP in terms of training and new responsibilities. 5) Process: for patients, it is highly appreciated that obtaining the sample was simple and more comfortable if venipuncture was not used. Conclusion This scoping review has described the facilitators and barriers of implementing a POCT device for cardiometabolic conditions using the CFIR. The information can be used to design better strategies to implement these devices and benefit more populations that have low access to cardiometabolic tests.

Abstract Stroke is a recurrent and well-known cardiovascular event and a leading cause of death worldwide. We identified reliable epidemiological evidence of stroke in Latin America and the Caribbean (LAC) and estimated the prevalence and incidence of stroke, overall and by sex, in that region. A systematic search in OVID (Medline, Embase and Global Health) and in the Latin America and Caribbean Health Sciences Literature (LILACS) until the end of 2020 was made for all cross-sectional or longitudinal studies estimating (or allowing the estimation of) the prevalence or incidence of stroke among individuals of the general population ≥ 18 years from LAC countries. No language restriction was applied. Studies were assessed for methodological quality and risk of bias. Pooled estimates were calculated using random effect meta-analysis as high heterogeneity was expected. A total of 31 papers for prevalence and 11 papers for incidence were included in the review for analysis. The overall pooled stroke prevalence was 32 (95% CI 26–38) per 1000 subjects and were similar among men (21; 95% CI 17–25) and women (20; 95% CI 16–23) per 1000 subjects. The overall pooled stroke incidence was 255 (95% CI 217–293) per 100 000 person-years, being higher in men (261; 95% CI 221–301) compared to women (217; 95% CI 184–250) per 100 000 person-years. Our results highlight the relevance of the prevalence and incidence of stroke in the LAC region. The estimates were similar in stroke prevalence by sex, but with higher incidence rates among males than females. Subgroup analyses highlight the need for standardized methodologies to obtain appropriate prevalence and incidence estimates at the population level in a region with a great burden of cardiovascular events.

Objective To assess if the duration and quality of sleep vary due to the presence of multimorbidity.

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Objetivo. El objetivo del presente estudio fue evaluar las tendencias ocurridas en diferentes indicadores de tabaquismo en adolescentes peruanos. Asimismo, se evaluó las tendencias en dichos indicadores de acuerdo a sexo y en aquellos sin antecedente de tabaquismo previo. Materiales y métodos. El presente estudio usa la Encuesta Mundial sobre Tabaquismo en Jóvenes (Global Youth Tobacco Survey 2007, 2014, 2019). Tabaquismo activo se definió según el consumo de tabaco en los últimos 30 días. Tabaquismo pasivo se definió en función a exposición a tabaco dentro y fuera del hogar, tanto global como en forma diaria. Los análisis consideraron el diseño muestral. Resultados. Un total de 17 047 registros (9869 en el 2007, 3424 en el 2014, y 3754 en el 2019) fueron analizados; edad media 14 años y 49,9% mujeres. El 26,6% reportó antecedente de tabaquismo previo; dicha prevalencia cayó de 45,2% (2007), a 25,3% (2014), y a 19,4% (2019, p de tendencias < 0,001), mientras que el tabaquismo activo cayó de 17,1% (2007) a 8,7% (2014) y a 5,7% (2019). La prevalencia global de tabaquismo pasivo en el hogar cayó de 24,7%, a 12,9% y a 10,4% (p de tendencias

Objetivo. Determinar si existe asociación entre la presencia de diabetes mellitus tipo 2 (DM2) y la duración, dificultad para dormir, y calidad de sueño, en sujetos de 30 a 69 años en Tumbes. Materiales y métodos. Estudio transversal analítico. Las variables dependientes fueron dificultad para dormir (a veces/casi nunca y frecuentemente), duración del sueño (normal, corto y prolongado) y calidad del sueño (buena y mala). La variable independiente fue la presencia de DM2 evaluada usando la prueba de tolerancia oral a la glucosa (no DM2, con DM2 y sin diagnóstico previo, y con DM2 y diagnóstico previo). Se usó modelos de regresión de Poisson para reportar razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados. Se analizaron 1604 individuos, con una edad media de 48,2 años; 50,3% fueron mujeres; 71 (4,4%) tenían DM2 sin diagnóstico previo y 105 (6,5%) tenían DM2 con diagnóstico previo. Según las características del sueño, 12,0% presentó sueño corto y 8,2% presentó sueño prolongado; 3,7% reportó dificultad para dormir, y 19,5% tuvo mala calidad de sueño. En el modelo multivariable, tener DM2 con diagnóstico previo estuvo asociado con dificultad para dormir (RP = 2,20; IC 95%: 1,13–4,27) y mala calidad de sueño (RP = 1,40; IC 95%: 1,05–1,92) comparado con aquellos sin DM2. Conclusiones. Los individuos con DM2 que tenían diagnóstico previo tuvieron mayor probabilidad de presentar dificultad para dormir y mala calidad de sueño. Nuestros resultados sugieren la necesidad de evaluar en forma periódica las características del sueño en pacientes con DM2.

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty-three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2-fold and 3.5-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage 1 and stage 2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Objective. To determine the prevalence and incidence of arterial hypertension, as well as the prevalence of previous diagnosis of arterial hypertension (self-reported) among the adult population of Peru. Materials and methods. Systematic review and meta-analysis of epidemiological studies available in LILACS, EMBASE, MEDLINE and Global Health. Studies were included if they followed a random sampling approach in adult population. Screening and assessment of manuscripts was carried out independently by two researchers. A random-effects meta-analysis was conducted to quantify the overall prevalence and incidence of hypertension. The Newcastle-Ottawa scale was used to assess the risk of bias in the manuscripts. Results. A total of 903 papers were screened, and only 15 were included in the estimation of hypertension prevalence, 8 in the assessment of previous hypertension diagnosis, and 4 for incidence estimations. The pooled prevalence of hypertension was 22.0% (95% CI: 20.0% - 25.0%; I2=99.2%). This estimate was lower in national studies [20.0% (95% CI: 17.0% - 22.0%; I2=99.4%] than in sub-national studies [24.0% (95% CI: 17.0% - 30.0%; I2=99.2%]. The pooled prevalence of previous hypertension diagnosis was 51.0% (95% CI: 43.0% - 59.0%; I2=99.9%). The pooled incidence of hypertension was 4.2 (95% CI: 2.0 - 6.4; I2=98.6%) per 100 person-years. The included studies did not present high risk of bias. Conclusions. Our findings show that one in five Peruvians has hypertension, and that four new cases appear per 100 persons per year; in addition, only half of the subjects with hypertension are previously diagnosed.

Objective: To determine the incidence of stroke, overall and by sub-types, in Peru between 2017 and 2018. Materials and Methods: Analysis of hospital morbidity data obtained from SUSALUD (open data). Using the ICD-10 codes, the following were studied: subarachnoid hemorrhage (I60), atraumatic intracerebral hemorrhage (I61), cerebral infarction (I63), and unspecified stroke (I64). The crude and age-standardized incidence was calculated according to the population of the World Health Organization and using the national projected population number of people according to year, age and sex as the denominator. Results: In 2017, a total of 10,570 stroke cases were recorded, whereas, in 2018, there were 12,835 cases. Ischemic events were more frequent in both years. Regardless of stroke subtype and year, men were more affected than women. In the 35+ year-old population, an increase in the crude incidence of total stroke was observed between 2017 and 2018, from 80.9 to 96.7 per 100,000 person-years. The age-standardized incidence showed the same trend, but in a greater magnitude: from 93.9 to 109.8 per 100,000 person-years. Ischemic stroke was the one that increased the most, with an age-standardized rate in people aged 35+ years of 35.2 in 2017 and 46.3 per 100,000 person-years in 2018. Conclusions: The incidence of stroke is high in Peru. Ischemic cases are the most frequent and they disproportionately affect men. Our results suggest the need for a surveillance system to robustly quantify the incidence of these cases and understand their determinants.

ABSTRACT OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006–2007, 2009–2010, 2013–2014, and 2016–2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35–1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10–1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02–1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68–3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75–3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39–3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.

Background Peru faces challenges to provide adequate care to stroke patients. Length of hospitalization and in-hospital mortality are two well-known indicators of stroke care. We aimed to describe the length of stay (LOS) of stroke in Peru, and to assess in-hospital mortality risk due to stroke, and subtypes. Methods This retrospective cohort study used hospitalization registries coding with ICD-10 from 2002 to 2017 (N = 98,605) provided by the Ministry of Health; in-hospital mortality was available for 2016–2017 (N = 6,566). Stroke cases aged ≥35 years were divided into subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhage or infarction (I64). Data included stroke LOS and in-hospital mortality; socio-demographic and clinical variables. We fitted a region- and hospital level-stratified Weibull proportional hazard model to assess the in-hospital mortality. Results The median LOS was 7 days (IQR: 4–13). Hemorrhagic strokes had median LOS longer than ischemic strokes and stroke not specified as hemorrhage or infarction (P =

ABSTRACT OBJECTIVE To determine the association between socioeconomic level and the presence of obesity, hypertension and type 2 diabetes mellitus in the Peruvian population. METHODS Secondary analysis of data from the National Demographic and Family Health Survey ( Encuesta Nacional Demográfica y de Salud Familiar , Endes) from 2018 to 2020. The outcomes were obesity, hypertension, and type 2 diabetes mellitus. The exposure variables were two indicators of socioeconomic status: educational level (< 7 years, 7–11 years, and 12+ years) and wealth index (in tertiles). Models were created using Poisson regression, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Data from 98,846 subjects were analyzed. Mean age: 45.3 (SD: 16.0) years, and 55.5% were women. The prevalence of obesity was 26.0% (95%CI: 25.4–26.6); of hypertension, 24.9% (95%CI: 24.3–25.5); and of type 2 diabetes mellitus, 4.8% (95%CI: 4.5–5.1). In multivariate model, and compared with those with a low wealth index, those with a high wealth index had a higher prevalence of obesity (PR = 1.49; 95%CI: 1.38–1.62), hypertension (PR = 1.09; 95%CI: 1.02–1.17) and type 2 diabetes mellitus (PR = 1.72; 95%CI: 1.29–2.29). On the other hand, higher educational level was only associated with a reduction in the prevalence of obesity (PR = 0.89; 95%CI: 0.84–0.95). CONCLUSIONS There is a differential association between the wealth index, educational level and markers of noncommunicable diseases. There is evidence of a positive association between wealth index and obesity, hypertension and type 2 diabetes mellitus, whereas educational level was only negatively associated with obesity.

Abstract A key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO’s Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

Abstract Background This study estimated the prevalence and risk factors for decreased estimated glomerular filtration rate (eGFR) in those without known hypertension, type 2 diabetes mellitus, or heavy proteinuria as a surrogate marker for chronic kidney disease of unknown cause (CKDu) among adults in the North of Peru. Methods A cross-sectional study was conducted following the Disadvantaged Populations eGFR Epidemiology (DEGREE) Study protocol. Low eGFR was defined based on a single eGFR ≤60 mL/min/1.7m2 estimated using the CKD-EPI equation. Environmental conditions related to CKDu (i.e., work in agriculture or sugarcane, water source, heat intolerance, and pesticide exposure) were evaluated, in addition to traditional risk factors for CKD (i.e., smoking, heavy drinking, physical activity, hypertension, type 2 diabetes mellitus, urolithiasis, among others). Results A total of 1514 subjects were included in the study, mean age 45.1 (SD: 16.4), and 55.2% were females. Overall, only 26 cases (1.7%; 95%CI: 1.1–2.5%) had an eGFR

Patients diagnosed with type 2 diabetes mellitus, who then become infected with SARS-CoV-2, are at greater risk of developing complications from COVID-19, which may even lead to death. Diabetes is a chronic condition that requires continuous contact with healthcare facilities; therefore, this type of patients should have regular access to medicines, tests and appointments with healthcare personnel. In Peru, care and treatment continuity have been affected since the national state of emergency due to COVID-19 began; because many healthcare facilities suspended outpatient consultations. The strategies presented in this study were developed by different Peruvian health providers in the pandemic context to ensure care continuity for people with diabetes. This article provides recommendations to strengthen primary healthcare, because it is the first level of healthcare contact for patients with diabetes.

Introducción: Existen diversos métodos para evaluar el exceso de grasa corporal, pero si alguno de ellos es mejor para detectar diabetes mellitus tipo 2 (DMT2) no ha sido completamente evaluado en Perú. El objetivo de este estudio fue explorar el rendimiento diagnóstico de ciertos marcadores antropométricos de obesidad para detectar casos recientes de DMT2 a nivel poblacional y según el sexo. Metodología: Se realizó un análisis secundario de un estudio transversal realizado en Tumbes; Perú, reclutando pacientes de 30 a 69 años. La variable desenlace fue el diagnóstico reciente de DMT2, determinado por la prueba de tolerancia oral a la glucosa. Las variables de exposición fueron los marcadores antropométricos: índice de masa corporal (IMC), circunferencia de cintura (CC), razón cintura-talla (RCT). Para la valoración diagnóstica de estos marcadores, se utilizaron curvas ROC (área bajo la curva: AUC), y se estimó la sensibilidad y especificidad en base al índice de Youden. Resultados: Se analizaron los datos de 1500 participantes, encontrándose una prevalencia de DMT2 recién diagnosticada del 4,7%. La edad promedio fue de 47,6 años (desviación estándar: 10,6) y el 50,1% fueron varones. El rendimiento diagnóstico de los marcadores para el tamizaje de DMT2 en la población general fueron: RCT (AUC: 0,67; IC 95%: 0,60-0,73), IMC (AUC: 0,65; IC 95%: 0,58-0,72) y CC (AUC: 0,65; IC 95%: 0,58-0,72). Cuando se estratificó por sexo los resultados fueron similares, excepto por el valor de CC en varones cuyo rendimiento diagnóstico fue aceptable (AUC: 0,70; IC 95%: 0,60–0,81). Conclusiones: El rendimiento diagnóstico de los marcadores de obesidad incluidos en el presente trabajo (IMC, RCT y CC) para el tamizaje de DMT2 en la población general fue pobre.

Background The long-term impact of elevated blood pressure on mortality outcomes has been recently revisited due to proposed changes in cut-offs for hypertension. This study aimed at assessing the association between high blood pressure levels and 10-year mortality using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology and the American Heart Association (ACC/AHA) 2017 blood pressure guidelines. Methods Data analysis of the PERU MIGRANT Study, a prospective ongoing cohort, was used. The outcome of interest was 10-year all-cause mortality, and exposures were blood pressure categories according to the JNC-7 and ACC/AHA 2017 guidelines. Log-rank test, Kaplan-Meier and Cox regression models were used to assess the associations of interest controlling for confounders. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated. Results A total of 976 records, mean age of 60.4 (SD: 11.4), 513 (52.6%) women, were analyzed. Hypertension prevalence at baseline almost doubled from 16.0% (95% CI 13.7%–18.4%) to 31.3% (95% CI 28.4%–34.3%), using the JNC-7 and ACC/AHA 2017 definitions, respectively. Sixty three (6.4%) participants died during the 10-year follow-up, equating to a mortality rate of 3.6 (95% CI 2.4–4.7) per 1000 person-years. Using JNC-7, and compared to those with normal blood pressure, those with pre-hypertension and hypertension had 2.1-fold and 5.1-fold increased risk of death, respectively. Similar mortality effect sizes were estimated using ACC/AHA 2017 for stage-1 and stage-2 hypertension. Conclusions Blood pressure levels under two different definitions increased the risk of 10-year all-cause mortality. Hypertension prevalence doubled using ACC/AHA 2017 compared to JNC-7. The choice of blood pressure cut-offs to classify hypertension categories need to be balanced against the patients benefit and the capacities of the health system to adequately handle a large proportion of new patients.

Background There are several ecological studies, but few studies of the prevalence of SARS-COV-2 at high altitude. We aimed to estimate the population-based seroprevalence of SARS-COV-2 in three settings of Cusco at the end of the first wave among adults. Methods A population-based survey was conducted in September 2020, in three settings in the region of Cusco: (1) Cusco city at 3,300 meters above the sea level (m.a.s.l.), (2) the periphery of Cusco (Santiago, San Jerónimo, San Sebastián, and Wanchaq) at 3,300 m.a.s.l., and (3) Quillabamba city, located at 1,050 m.a.s.l. People aged ≥ 18 years within a family unit were included. The diagnosis of SARS-CoV-2 infection was based on identifying anti- SARS-CoV-2 total antibodies (IgM and IgG) in serum using the Elecsys Anti-SARS-CoV-2 chemiluminescence test. Results We enrolled 1924 participants from 712 families. Of the total, 637 participants were anti-SARS-CoV-2 seropositive. Seroprevalence was 38.8% (95% CI [33.4%–44.9%]) in Cusco city, 34.9% (95% CI [30.4%–40.1%]) in the periphery of Cusco, and 20.3% (95% CI [16.2%–25.6%]) in Quillabamba. In 141 families (19.8%; 95% CI [17.0%–22.8%]) the whole members were positive to the test. Living with more than three persons in the same house, a positive COVID-19 case at home, and a member who died in the last five months were factors associated with SARS-COV-2 seropositivity. Dysgeusia/dysosmia was the symptom most associated with seropositivity (aPR = 2.74, 95% CI [2.41–3.12]); whereas always wearing a face shield (aPR = 0. 73; 95% CI [0.60–0.89]) or a facial mask (aPR = 0.76, 95% CI [0.63–0. 92) reduced that probability. Conclusions A great proportion of Cusco’s city inhabitants presented anti-SARS-CoV-2 antibodies at the end of the first wave, with significant differences between settings. Wearing masks and face shields were associated with lower rate of seropositivity; however, efforts must be made to sustain them over time since there is still a high proportion of susceptible people.

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

Las enfermedades no transmisibles (ENT) son causa importante de carga de enfermedad en el Perú así como en otros países en desarrollo. Las respuestas para el control de las ENT requieren de investigación multidisciplinaria, tanto a nivel local como internacional. Desde hace más de 10 años, CRONICAS: Centro de Excelencia en Enfermedades Crónicas, de la Universidad Peruana Cayetano Heredia, realiza investigación en el campo de las ENT en el Perú. En el presente artículo se describen algunos estudios realizados, incluyendo los estudios epidemiológicos PERU MIGRANT, y la cohorte CRONICAS. También se presentan resultados de revisiones sistemáticas y resultados de intervenciones frente a las ENT. A través de estos estudios llevados a cabo por el centro CRONICAS se señalan potenciales áreas para afrontar las ENT en países en desarrollo.

Objetivos. Describir la tendencia de mortalidad por enfermedad renal crónica (ERC) en el Perú en el periodo 2003-2015. Materiales y Métodos. Análisis de datos secundarios y de diseño ecológico. Se analizaron registros nacionales de mortalidad basados en certificados de defunción. ERC fue definida como código CIE 10: N18 en la causa básica. Se describen frecuencias absolutas y relativas de muerte por ERC. Para estimar la proporción de muertes por ERC en cada región del Perú, se utilizó un modelo lineal mixto generalizado. La variable desenlace fue la proporción de muertes, las variables independientes fueron cada región del país y el año. Resultados. El análisis incluyó 1 086 778 defunciones, de los cuales 25 091 (2,0 % ajustado por edad y sexo) fueron por ERC. Durante el periodo de estudio la edad promedio, al momento del fallecimiento, aumentó en 2,6 años (p0,001); además, la proporción de muertes por ERC ajustada por edad y sexo fue siempre mayor en mujeres. En el periodo de observación la región con mayor mortalidad por ERC fue Puno (4,1 %), y con menor mortalidad fue Amazonas (1,1 %). Aquellas regiones que mostraron un aumento significativamente mayor que las demás fueron Tacna, La Libertad, Tumbes, Apurímac, Cusco, Ica, Moquegua, Ayacucho, Huancavelica y Puno. Conclusiones. En el periodo 2003-2015, la mortalidad por ERC en el Perú ha aumentado; esta tendencia se observa en varias regiones del país. Es necesario implementar medidas de prevención, temprana identificación, y acceso al tratamiento, para mejorar esta tendencia.

Community Kitchens (CKs) are one of the main food providers to low-income families in Peru and may encourage healthier diets. We aimed to determine the prevalence of fruit and vegetable consumption and associated sociodemographic and behavioral factors among CKs customers. A cross-sectional study enrolling customers of 48 CKs in two areas of Lima, Peru, was performed. The self-reported amount of fruits and vegetables consumed (

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

ABSTRACT OBJECTIVE Analyze the prevalence of intrafamilial and extrafamilial sexual assault in adolescents of Peru and its association with alcohol consumption. METHODS We used a two-step and stratified probabilistic sampling to select male and female students in secondary education from all over Peru. The study included data from 54,756 students with information on demographics, alcohol and drug use, and sexual assault. The statistical analysis considered the complex sampling and we conducted two independent analyses by type of sexual assault (intrafamilial and extrafamilial), stratified by the sex of the victim. RESULTS The prevalence of life of intrafamilial sexual assaults (5.4%, 95%CI 5.0–5.8) was similar to that of extrafamilial sexual assaults (6.1%, 95%CI 5.6–6.6). Alcohol consumption in the past year was associated with intrafamilial and extrafamilial sexual assaults that occurred in the same period after adjusting for confounders. Alcohol consumption in the past year was associated with non-physical and physical forms of intrafamilial and extrafamilial sexual assaults in the disaggregated analysis by type of assault. Alcohol consumption in the past year was associated with extrafamilial rape only among females (ORa = 2.8; 95%CI 1.3–5.9). CONCLUSIONS Sexual assault against adolescent males and females by family members is a frequent form of victimization that is associated with alcohol consumption in Peru. It is important to examine this form of victimization among adolescents, especially those who consume alcohol.

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

Introducción: El objetivo de este trabajo fue determinar la proporción de pacientes que cumplen criterios internacionales de gastrectomía en manga, así como estimar la asociación entre porcentaje de pérdida de peso con tasa de abandono del tratamiento nutricional. Materiales y métodos: Cohorte retrospectiva realizada con historias clínicas de pacientes con gastrectomía en manga entre 2008-2014 en una clínica privada. Hubo dos variables resultado de interés: los criterios de inclusión para cirugía bariátrica según criterios internacionales (IMC ≥40 kg/m2 o ≥ 35 kg/m2 con comorbilidades) y el abandono antes o durante (inasistencia ≥ 60 días desde la consulta previa sin recibir alta [IMC < 25]) del tratamiento nutricional. La exposición fue el porcentaje de peso perdido en las primeras cinco semanas después de la cirugía (< 10% vs. ≥ 10%). Se utilizaron modelos de regresión de Poisson. Se calcularon riesgos relativos e intervalos de confianza al 95% (IC95%). Resultados: La muestra incluyó 423 historias clínicas, 294 (69,5%) mujeres, edad media 39,2 (±12,3) años. 117 (27,7%) cumplieron requisitos para cirugía y 48 de esos 117 (41%) abandonaron el tratamiento nutricional antes de iniciarlo. Los pacientes que perdieron ≥10% de peso en el primer mes tuvieron un 90% menos de riesgo de abandonar la terapia nutricional que los que perdieron

OBJETIVO: Evaluar la asociación entre frecuencia de ver televisión, sobrepeso y obesidad en una muestra representativa de mujeres peruanas a nivel nacional. MÉTODOS: Análisis secundario de la Encuesta Nacional Demográfica y de Salud Familiar incluyendo mujeres de 15 a 49 años. Las variables resultados fueron obesidad (índice de masa corporal >30 kg/m²) y sobrepeso (>25 peso OBJETIVO: Analisar a associação entre frequência de assistir televisão com sobrepeso e obesidade em uma amostra representativa de mulheres peruanas em nível nacional. MÉTODOS: Análise secundária da Pesquisa Nacional Demográfica e de Saúde Familiar incluindo 27.712 mulheres de 15 a 49 anos em 2008. As variáveis-desfecho foram obesidade (índice de massa corporal > 30 kg/m2) e sobrepeso (entre 25 e 30 kg/m2); a variável de exposição foi a frequência de assistir televisão (nunca, ocasionalmente, quase todos os dias). Foi utilizada regressão logística para amostras complexas, ajustada por potenciais confundidores. Os resultados foram apresentados como odds ratios ajustados (ORa) com seus respectivos intervalos de 95% de confiança. RESULTADOS: A prevalência de sobrepeso foi de 34,7% (IC95% 33,8;35,7) e de obesidade, 14,3% (IC95% 13,6;5,1). Mulheres que assistiam televisão ocasionalmente e quase todos os dias tiveram maior probabilidade de ter obesidade em comparação às que não assistiam: ORa = 1,7 (IC95% 1,3;2,3) e ORa 2,6 (IC95% 2,0;3,5), respectivamente. A magnitude da associação foi menor para o sobrepeso: ORa 1,2 (IC95% 1,3;2,3) e ORa 1,6 (IC95% 1,1;1,4), respectivamente. A associação foi mais forte na área urbana. CONCLUSÕES: A frequência de assistir televisão esteve associada à apresentar obesidade e sobrepeso entre mulheres peruanas, e a força da associação variou de acordo com a área de residência. Estes achados podem auxiliar estratégias de prevenção da obesidade no contexto peruano.OBJECTIVE: To assess the association between frequency of television viewing, overweight and obesity in a nationally representative sample of Peruvian women. METHODS: Secondary analysis of the Demographic and Health Survey 2008 including women aged from 15 to 49 years old. The outcome variables were obesity (body mass index >30 kg/m²) and overweight (body mass index >25 but

Objetivos. Explorar si existe una diferencia en la percepción y autorreporte de calidad de vida en población migrante rural-urbana en comparación con un grupo urbano no migrante. Materiales y métodos. Estudio transversal, análisis secundario del estudio PERU-MIGRANT (PEru’s Rural to Urban MIGRANTs study). Utilizando la prueba de Kruskall- Wallis y evaluando magnitud de efectos se midieron y compararon los puntajes global y por dominios obtenidos en la encuesta WHOQOL-Brief. Resultados. Se encuestó a 307 individuos. La edad promedio de fue de 47 años, 57% correspondieron al sexo femenino y 62,2% a población migrante. Comparado con el grupo urbano, el grupo migrante reportó puntajes menores de calidad de vida a nivel global y en los dominios de salud psicológica y del ambiente en elque viven y a la vez, reportaron una mejor percepción en el dominio de salud física. Conclusiones. El impacto de la migración rural-urbana en la calidad de vida indica un efecto diferencial según sus distintos dominios.Objectives. To explore if there is a difference in the perception and self reported quality of life between rural-to-urban migrants and urban groups. Materials and methods. Cross-sectional study, secondary analysis of the PERU-MIGRANT study (PEru’s Rural to Urban MIGRANTs Study). WHOQOL-Brief survey’s global scores and per specific domains obtained in the survey were compared using Kruskall-Wallis’ test and assessing size effect. Results. A total of 307 subjects (62.2% migrants, 57% female, means age 47 years-old) were surveyed. Compared with the urban group, migrants reported lower quality of life both on the global scores as well as in psychological health and the living environment domains. Migrants reported a higher score on the physical health’s domain. Conclusions. The impact of rural-to-urban migration on quality of life suggests a differential effect within its specific domains.

La Esclerosis Múltiple (EM) es la principal enfermedad desmielinizante a nivel mundial. La epidemiología señala una mayor prevalencia de esta entidad en áreas alejadas de la línea ecuatorial. Existen algunos estudios de prevalencia en Latinoamérica, ninguno publicado en el Perú. Objetivo: Determinar la prevalencia de Esclerosis Múltiple en Lima, Perú. Material y métodos: Se utilizó el método captura recaptura para estimar la prevalencia de EM en Lima en 4 centros de pacientes con Esclerosis Múltiple de la ciudad: Hypnos Instituto del Sueño en la Clínica San Felipe, el Hospital Nacional Cayetano Heredia, la Clínica El Golf y la Asociación "Esclerosis Múltiple Perú" (ESMUP). Resultados: Se calculó la prevalencia de EM en 7,69 x 100 000 habitantes (intervalo de confianza al 95 % 7,09 a 8,30). Conclusiones: La prevalencia estimada de EM, para la ciudad de Lima, se encuentra en rango medio bajo. (Rev Med Hered 2009;20:146-150).

Objetivo: Identificar factores asociados a fracaso de terapia en pacientes con tuberculosis pulmonar durante los 2 primeros meses de tratamiento específico, basados en el peso, el índice de masa corporal (IMC) y el esputo. Materiales y Métodos: Estudio retrospectivo de tipo caso-control apareado por sexo y edad (± 2 años), llevado a cabo en Pampas de San Juan de Miraflores. Todas los fracasos a tratamiento entre el año 2000 y junio del 2005 con frotis positivo fueron incluidos como casos; y los pacientes que ingresaron al programa con prueba de esputo positiva al inicio, y que cumplieron el criterio de cura del programa fueron los controles, 2 por cada caso. Resultados: Veintiocho casos fueron apareados con 56 controles. Los factores asociados a fracaso fueron: al inicio del tratamiento, el antecedente de tratamiento previo (OR = 3,54, IC 95%: 1,22-10,26). Al mes de tratamiento, la pérdida de IMC (OR = 10,65, IC 95%: 2,02-56,01) estuvo asociado a fracaso a tratamiento, mientras que al segundo mes de seguimiento, la presencia de esputo positivo (OR = 25,58, IC 95%: 2,10-311,27) y la pérdida de IMC (OR = 7,08, IC 95%: 1,06-47,55) estuvieron asociados. Ningún control tuvo frotis positivo en o después del tercer mes de tratamiento. Conclusiones: Este estudio muestra que una parte de los pacientes que desarrollaran fracaso a tratamiento podrían detectarse durante el mismo, especialmente mediante el antecedente de tratamiento previo, la variación del IMC y el resultado positivo de esputo al segundo mes. Estos hallazgos podrían mejorar el diagnóstico de formas resistentes y la iniciación de un tratamiento apropiado. (Rev Med Hered 2007;18:123-128).

Objectives. We aimed to assess if Caesarean section is a risk factor for overnutrition in early- and late-childhood, and to assess the magnitude of the effect of child- versus family-related variables in these risk estimates.Methods. Longitudinal data from Peruvian children from the Young Lives Study was used. Outcomes assessed were overweight, obesity, overnutrition (overweight plus obesity), and central obesity (waist circumference) at the age 5 (first follow-up) and 7 (second follow-up) years. The exposure of interests was delivery by Caesarean section. Relative risks (RR) and 95% confidence intervals (95% CI) were calculated using multivariable models adjusted for child-related (e.g., birth weight) and family-related (e.g., maternal nutritional status) variables.Results. At baseline, mean age was 11.7 (± 3.5) months and 50.1% were boys. Children born by Caesarean section were 15.6%. The 10.5% of the children were overweight and 2.4% were obese. For the obesity outcome, data from 6,038 and 9,625 children-years was included from baseline to the first and second follow-up, respectively. Compared to those who did not experience Caesarean delivery, the risk of having obesity was higher in the group born by Caesarean: RRs were higher at early-childhood (first follow-up: 2.25; 95% CI [1.36–3.74]) than later in life (second follow-up: 1.57; 95% CI [1.02–2.41]). Family-related variables had a greater effect in attenuating the risk estimates for obesity at the first, than at the second follow-up.Conclusion. Our results suggest a higher probability of developing obesity, but not overweight, among children born by Caesarean section delivery. The magnitude of risk estimates decreased over time, and family-related variables had a stronger effect on the risk estimates at early-childhood.

OBJECTIVE:We aimed to characterize metabolic status by body mass index (BMI) status. METHODS:The CRONICAS longitudinal study was performed in an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings: Lima (Peru's capital, costal urban, highly urbanized), urban and rural Puno (both high-altitude), and Tumbes (costal semirural). Data from the baseline study, conducted in 2010, was used. Individuals were classified by BMI as normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2), and as metabolically healthy (0-1 metabolic abnormality) or metabolically unhealthy (≥2 abnormalities). Abnormalities included individual components of the metabolic syndrome, high-sensitivity C-reactive protein, and insulin resistance. RESULTS:A total of 3088 (age 55.6±12.6 years, 51.3% females) had all measurements. Of these, 890 (28.8%), 1361 (44.1%) and 837 (27.1%) were normal weight, overweight and obese, respectively. Overall, 19.0% of normal weight in contrast to 54.9% of overweight and 77.7% of obese individuals had ≥3 risk factors (p

Background. Sleep duration, either short or long, has been associated with diseases such as obesity, type-2 diabetes and cardiovascular diseases. Characterizing the prevalence and patterns of sleep duration at the population-level, especially in resource-constrained settings, will provide informative evidence on a potentially modifiable risk factor. The aim of this study was to explore the patterns of sleep duration in the Peruvian adult and adolescent population, together with its socio-demographic profile.Material and Methods. A total of 12,424 subjects, mean age 35.8 years (SD ±17.7), 50.6% males, were included in the analysis. This is a cross-sectional study, secondary analysis of the Use of Time National Survey conducted in 2010. We used weighted means and proportions to describe sleep duration according to socio-demographic variables (area and region; sex; age; education attainment; asset index; martial and job status). We used Poisson regressions, taking into account the multistage sampling design of the survey, to calculate crude and adjusted prevalence ratios (PR) and 95% confidence intervals (95% CI). Main outcomes were short- (

BackgroundWe aimed to describe the patterns of nutritional status and sleep duration in children from Ethiopia, India, Peru and Vietnam; to assess the association between short sleep duration and overweight and obesity, and if this was similar among boys and girls in Peru.Methods and findingsAnalysis of the Young Lives Study, younger cohort, third round. In Ethiopia there were 1,999 observations, 2,011, 2,052 and 2,000 in India, Peru and Vietnam, respectively. Analyses included participants with complete data for sleep duration, BMI, sex and age; missing data: 5.9% (Ethiopia), 4.1% (India), 6.0% (Peru) and 4.5% (Vietnam). Exposure was sleep duration per day: short (ConclusionsChildhood overweight and obesity have different profiles across developing settings. In a sample of children living in resource-limited settings in Peru there is no association between short sleep duration and obesity; the crude association was slightly attenuated by children-related variables but strongly diminished by family-related variables.

We aimed to estimate the morbidity rate and associated factors for diabetic peripheral neuropathy (DPN) in a low-middle income country setting.Cross-sectional study, data was gathered at Peru's Ministry of Health national specialized hospital for endocrinological conditions through standardized interviews, anthropometric measurements and blood tests for glycated haemoglobin (HbA1c). DPN was evaluated using two techniques: the Semmes-Weinstein monofilament test and the diabetic neuropathy symptom score. Overall prevalence and 95% confidence intervals (95% CI) were calculated. Potential factors related to DPN explored included body mass index, years with disease (

BackgroundLittle is known about the extent to which Peruvian physicians seek to involve patients in shared decision making, or about the variation in these efforts across different settings.ObjectiveTo measure the extent to which Peruvian clinicians involve their patients in decision making and to explore the differences between clinicians' behavior in private vs. public practice.DesignVideographic analysis.Participants and settingSeven academic physicians who provided care to patients in a public and a private setting participate in this study. All the encounters in both settings were filmed on one random day of February 2012.ApproachTwo raters, working independently and in duplicate used the 12-item OPTION scale to quantify the extent of physician effort to involve patients in shared decision making (with 0 indicating no effort and 100 maximum possible effort) in 58 video recordings of usual clinical encounters in private and public practice.ResultsThe mean OPTION score was 14.3 (SD 7.0). Although the OPTION score in the private setting (mean 16.5, SD 7.3) was higher than in the public setting (mean 12.3 SD 6.1) this difference was not statistically significant (p = .09).ConclusionPeruvian academic physicians in this convenience sample barely sought to involve their patients in shared decision making. Additional studies are required to confirm these results which suggest that patient-centered care remains an unfulfilled promise and a source of inequity within and across the private and the public sectors in Peru.