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COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26 languages via web-based platforms. The findings of this study suggest that detergents, alcohol-based substances, and chlorinated compounds emerged as the most prevalent chemical agents compared to other sanitizers and disinfectants examined. Most frequently reported health issues include skin effects and respiratory effects. The Chi-square test showed a significant association between chlorinated compounds (sodium hypochlorite and per-chlorine) with all possible health effects under investigation (p-value

Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams for the benefit of patients. Resumo Desde 2012, o Centro Besrour de Medicina Global de Família, na Faculdade de Medicina de Família do Canadá, reúne seus parceiros das Américas anualmente para refletir sobre a evolução da Medicina de Família no continente desde Alma-Ata e para os desafios futuros. Os médicos de família são apenas um elemento de um forte sistema de saúde. A Medicina de Família fornece ingredientes-chave para responder às necessidades de saúde da população, especialmente à medida em que os países passam pela transição epidemiológica para enfrentar um fardo maior de doenças crônicas e de multimorbidade. Neste artigo, fornecemos uma visão geral de alto nível do estado da Medicina de Família no continente. Em seguida, analisamos as tendências na educação dos médicos de família para enfrentar esse cenário em mudança, incluindo a ênfase no papel de líder dos futuros médicos de família. Os programas de pós-graduação em Medicina de Família nas Américas estão enfatizando cada vez mais o ensino do cuidado colaborativo, a fim de criar equipes de saúde verdadeiramente interdisciplinares para o benefício dos pacientes.

Introduction: COVID-19 not only acutely compromises peoples health but can also generate symptoms that remain weeks after the infection. Moreover, older adults may have different symptomatologic patterns than other age groups. Objective: To describe the acute and persistent symptoms of COVID-19 in older adult users of Social Security senior centers. Methods: A retrospective descriptive study was carried out by telephone call to older adults from five Peruvian senior centers, from July to September 2020, who reported being positive for COVID-19 in the last three months. Older adults were asked about associated symptoms, with a follow-up of up to four months. Results: The most frequent acute symptoms were cough, fever, headache, and myalgia. The mean num- ber of symptoms per person was one to three. We also found that 4.4% of COVID-19 cases had symptoms that persisted over three weeks. Conclusions: Older persons in senior centers have a low frequency of persistent COVID-19 symptoms. Introducción: COVID-19 no sólo compromete agudamente la salud de las personas, sino que puede generar síntomas que permanecen luego de la infección aguda, incluso por más de tres semanas. Más aún, las personas adultas mayores podrían tener patrones sintomatológicos diferentes a otros grupos etarios. Objetivo: Describir los síntomas agudos y persistentes de COVID-19 en personas adultas mayores usuarias de centros del adulto mayor de la Seguridad Social. Método: Se realizó un estudio descriptivo retrospectivo por llamada telefónica a adultos mayores de cinco centros del adulto mayor peruanos, de julio a septiembre de 2020, quienes habían reportado ser positivos a COVID-19 en el monitoreo telefónico de los últimos tres meses. En las llamadas se les pregunto por los síntomas asociados, con un seguimiento de hasta cuatro meses. Resultados: Los síntomas agudos más frecuentes fueron tos, fiebre, cefalea y mialgia. La media de síntomas por persona fue de uno a tres. Un 4,4% de los casos tuvo COVID-19 prolongado. Conclusiones: Las personas mayores de los centros del adulto mayor presentan una baja frecuencia de síntomas post COVID-19 agudo.

Given Peru's epidemiologic transition, this exploratory study sought to understand the role that primary care holds in Lima's medical system. Key stakeholders in Peru were administered semi-structured qualitative interviews to understand the factors that influence the availability and quality of primary care. Five areas were targeted for inquiry: financing, the training of primary care providers, access to services, patients’ first contact with the health-care system, and treatment coordination. Interviewees described primary health-care services as having a lack of treatment continuity, inconsistent record keeping, and often staffed by recent medical graduates with little primary care training, which can manifest to reduce the use of primary care services. Despite identifying numerous barriers to quality primary care services, interviewees remained committed to the principles of universal access espoused by Peruvian legislation and offered recommendations related to metrics, financing, technology, and workforce development to improve both primary care access and quality.

Peru's Ministry of Health focuses on achieving the fourfold goal for its health system: seeking to improve the health of the population, a better user experience when using health services, better use of public resources being invested during the last decade, and better job satisfaction for healthcare workers. The enactment of Law 30885 on Integrated Health Networks marks a milestone in the country's effort to meet the care needs of citizens in a network and is the health sector´s proposal to improve the performance of the healthcare system. To this end, key elements for organization and functioning are proposed: identification of the population and families, assignment of liability for care, strengthening of the entry gates to the health system, stratification of individual and family risks, coordination to facilitate access to and use of health services, continuity and complementarity of care, and network governance. This new proposal involves adjustments to the health service network: 12- and 24-hour health facilities (family clinics) for individual care, family care, management of health determinants, and hospitals to supplement care. The model of care will be more complex and difficult to advance if it is not linked to adjustments in the financing, coverage, and management of the cultural change of workers and users of the system, and the health governance system.El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanitario; buscando mejorar la salud de la población, una mejor experiencia del usuario cuando utiliza los servicios sanitarios, mejor uso de los recursos públicos que se vienen inyectando en la última década y una mejor satisfacción laboral de los trabajadores de salud. La promulgación de la Ley 30885 de Redes Integradas de Salud, marca un hito en el esfuerzo del país de lograr resolver las necesidades de atención de los ciudadanos en una red y es la apuesta del sector salud para mejorar el desempeño del sistema sanitario. Para ello se plantean elementos clave para la organización y funcionamiento: Identificación de población y familias, asignación de responsabilidad del cuidado, fortalecimiento de las puertas de entrada al sistema de salud, estratificación de riesgos individuales y familiares, coordinación para facilitar el acceso y utilización de servicios de salud, continuidad y complementariedad del cuidado, y gobernanza en la red. Esta nueva propuesta política implica ajustes en la red de servicios de salud: establecimientos de salud (clínicas de familia) de 12 y 24 horas para el cuidado individual, familiar, manejo de los determinantes de la salud y hospitales para complementar el cuidado. El modelo de cuidado será más complejo y de avance difícil si no está unido a ajustes en el financiamiento, aseguramiento y en la gestión del cambio cultural de los trabajadores, usuarios del sistema y del sistema de gobernanza en salud.

El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanitario; buscando mejorar la salud de la población, una mejor experiencia del usuario cuando utiliza los servicios sanitarios, mejor uso de los recursos públicos que se vienen inyectando en la última década y una mejor satisfacción laboral de los trabajadores de salud. La promulgación de la Ley 30885 de Redes Integradas de Salud, marca un hito en el esfuerzo del país de lograr resolver las necesidades de atención de los ciudadanos en una red y es la apuesta del sector salud para mejorar el desempeño del sistema sanitario. Para ello se plantean elementos clave para la organización y funcionamiento: Identificación de población y familias, asignación de responsabilidad del cuidado, fortalecimiento de las puertas de entrada al sistema de salud, estratificación de riesgos individuales y familiares, coordinación para facilitar el acceso y utilización de servicios de salud, continuidad y complementariedad del cuidado, y gobernanza en la red. Esta nueva propuesta política implica ajustes en la red de servicios de salud: establecimientos de salud (clínicas de familia) de 12 y 24 horas para el cuidado individual, familiar, manejo de los determinantes de la salud y hospitales para complementar el cuidado. El modelo de cuidado será más complejo y de avance difícil si no está unido a ajustes en el financiamiento, aseguramiento y en la gestión del cambio cultural de los trabajadores, usuarios del sistema y del sistema de gobernanza en salud. Peru's Ministry of Health focuses on achieving the fourfold goal for its health system: seeking to improve the health of the population, a better user experience when using health services, better use of public resources being invested during the last decade, and better job satisfaction for healthcare workers. The enactment of Law 30885 on Integrated Health Networks marks a milestone in the country's effort to meet the care needs of citizens in a network and is the health sector´s proposal to improve the performance of the healthcare system. To this end, key elements for organization and functioning are proposed: identification of the population and families, assignment of liability for care, strengthening of the entry gates to the health system, stratification of individual and family risks, coordination to facilitate access to and use of health services, continuity and complementarity of care, and network governance. This new proposal involves adjustments to the health service network: 12- and 24-hour health facilities (family clinics) for individual care, family care, management of health determinants, and hospitals to supplement care. The model of care will be more complex and difficult to advance if it is not linked to adjustments in the financing, coverage, and management of the cultural change of workers and users of the system, and the health governance system.

In their Series paper, Catherine Duggan and colleagues state that a community-based programme for breast health is a successful example of an intervention to increase breast health-care capacity in a country like Peru. The authors indicate that 75% of breast cancers detected are in advanced stages; a situation that can be improved through effective and early community detection...

Peru ist ein südamerikanisches Land, das in den letzten zwei Jahrzehnten von nachhaltigem Wachstum geprägt war. Allerdings konnte das Niveau im Bildungs- und Gesundheitswesen mit dieser Entwicklung nicht Schritt halten, denn die Investionen in diese beiden Bereiche gehören zu den geringsten in der Region. Dieser Umstand führt zum einen zu einer Verstetigung der enormen infrastrukturellen Defizite, zum anderen ist er auch für die geringe Gesundheitskompetenz der Bevölkerung verantwortlich. Das peruanische Gesundheitssystem ist derzeit fragmentiert und ineffizient; darüber hinaus schließen sich die Teilsysteme gegenseitig aus bzw. sind voneinander unabhängig. Es mangelt an Kooperation und Kommunikation; findet innerhalb des Systems aber keine vertikale Kommunikation statt, dann kommt es dazu, dass Patienten aus der Grundversorgung im Bedarfsfall nicht auf die komplexeren Versorgungsebenen überwiesen werden. Darüber hinaus ist der Umgang von Ärzten mit ihren Patienten nicht empathischer, respektvoller und patientenorientierter geworden. Stattdessen hat aufgrund der ökonomischen, bildungsbedingten und sozialen Unterschiede zwischen Ärzten und Patienten der Paternalismus im Praxisalltag nach wie vor Bestand. Die Entwicklung einer an humanitären Grundsätzen orientierten medizinischen Ausbildung ist eine dringliche Aufgabe. Hierbei steht der Patient im Mittelpunkt der medizinischen Behandlung und der ärztlichen Aufmerksamkeit. Ein humanistischer Versorgungsansatz würde nicht nur den Patienten dazu befähigen, sich an ihn betreffenden medizinischen Entscheidungen zu beteiligen, sondern würde auch Schritte in Richtung einer von Empathie, Fürsorge, Respekt und Zuwendung getragenen klinischen Praxis ermöglichen. Peru has achieved sustained development in the last two decades. However, despite this achievement, it has not been matched with improvements in the quality of education and health; investment in both sectors is among the lowest in the region. This situation perpetuates huge gaps in infrastructure and also conditions a poor literacy level of the population specifically in health. Currently, there is a fragmented model of patient care, in which the systems are exclusive of each other. They do not cooperate or communicate with each other; and if there is no vertical communication within the system, preventing referral of patients directly from the basic level to the complex level of care when needed. In addition, there has been no progress in the development of an empathetic, respectful or person-centered clinical practice; instead, economic, social and educational differences perpetuate a paternalistic clinical practice. The task of orienting medical training towards the development of humanism is pending. The patient is the center of the medical act and the main objective of doctors' actions. A humanistic care approach will not only empower the person in the clinical encounter - to participate and make decisions related to his/her health care - but it will allow us to move towards an empathetic, caring, respectful and kind model of clinical practice.

Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de muchos factores como el físico, cognoscitivo y sociofamiliar; por otro lado, tienen características como la heterogeneidad, la gran carga de enfermedad, la pluripatología, entre otras, que repercuten no solo en el ámbito familiar sino social. Es importante ofrecer a la población adulta mayor los medios para ejercer un mejor control sobre su salud y mejorarla. Todo ello con el fin de lograr un envejecimiento exitoso, es decir, sin discapacidad, con la menor cantidad de enfermedades posibles o adecuadamente controladas y, sobre todo, intentando mantener en todo momento su autonomía y calidad de vida, respetando siempre sus valores y preferencias. Por otro lado, las actividades preventivas en los adultos mayores deben tener en cuenta no solo el riesgo de enfermedad, sino también la alteración de la función que produce la enfermedad, así como aquellas condiciones frecuentes en el adulto mayor que pueden deteriorar su estado de salud como la fragilidad, las caídas, y las complicaciones iatrogénicas; las actividades preventivas en el adulto mayor deben estar dirigidas a todos estos factores. Presentamos algunas pautas que podrían ser importantes para promover un envejecimiento activo y actividades preventivas que podrán ser aplicadas según el contexto particular de cada persona. Older adults represent a growing population whose health status depends on many factors, including physical, cognitive, and social factors, as well as family. They also have features including heterogeneity, a high disease burden, and comorbidities that affect the family and social spheres. It is important to offer the older adult population methods to exercise better control over their health and, thus, improve it. The goal is to achieve successful aging, that is, aging without disabilities, with the fewest possible or adequately controlled ailments while helping them maintain their autonomy and quality of life and always respecting their values and preferences. On the other hand, preventive activities in older adults consider the risk of disease; functional alteration causing the disease; and conditions common to the elderly that can damage their health, including frailty, falls, and iatrogenic complications. Preventive activities for the elderly should consider all of these factors. Here we present some guidelines that may be important for promoting active aging as well as preventive activities that can be used according to each person’s individual situation.