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The aim of the present study was to determine the association between different types of intimate partner violence against women and nonattendance at the Growth and Development Control Program (CRED or well-child visits) of their children under 5 years of age. This was an analytical cross-sectional study that comprised a secondary analysis of data from the Demographic and Family Health Survey (ENDES in Spanish) of Peru, 2019. Data from 19,647 mothers (aged 15-49 years) and their children under 5 years were analyzed. The independent variables were the types of intimate partner violence = emotional, physical, and sexual. The outcome variable was nonattendance at CRED in the last 6 months. The mean maternal age was 30.47 ±â€…6.66 years; 66.1% of children were between 25 and 60 months of age; the prevalence of nonattendance at CRED was 29.9%. A relationship was found between partner violence against the mother and nonattendance at CRED. Specifically, there was a higher probability of nonattendance in the children of women who experienced partner violence (sexual = aPR = 1.25 [95% CI = 1.07-1.44]; physical = aPR = 1.17 [95% CI = 1.08-1.26]; emotional = aPR = 1.12 [95% CI = 1.03-1.21]). This study showed an association indicating that children born to mothers experiencing intimate partner violence exhibit an elevated likelihood of nonattendance at CRED when compared to children of mothers not subjected to such violence. Therefore, emphasizing the promotion and monitoring of child development, especially for those with a history of maternal violence, should be a primary priority, particularly in primary care.

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Introducción: A pesar de la importancia de la medicina basada en la evidencia, es necesario una mejor comprensión de la situación para el desarrollo de esfuerzos educativos y prácticos en función de implementar la medicina basada en la evidencia en el sistema de salud. Objetivo: Determinar la actitud, el uso, las barreras y los conocimientos de la medicina basada en la evidencia en los médicos peruanos según el nivel de atención. Métodos: Se realizó un estudio analítico transversal a través de una encuesta que se aplicó a los médicos peruanos que trabajan en diferentes niveles de atención en salud. Resultados: Se encuestó un total de 1396 médicos. El 64,35 % señaló una actitud positiva hacia la aplicación de la medicina basada en la evidencia. En el caso de las barreras, el 51,01 % no tenía suficiente evidencia relevante; el 49,35 % no contaba con tiempo; el 47,20 % no poseía suficientes habilidades para encontrarla; mientras que el 44,40 % no podía hacer lectura crítica de estas. En cuanto a los accesos de información, casi el 80 % de los participantes reportó que no tiene acceso a ninguna base de datos de las mencionadas. Teniendo en cuenta la comprensión de los términos estadísticos, más de dos tercios de los participantes tenían un alto nivel de comprensión. Conclusiones: Aunque la mayoría de los médicos encuestados tienen un buen conocimiento y una actitud positiva hacia la medicina basada en la evidencia, aún existen barreras y uso de la información que se deben mejorar.

Introduction: Despite the importance of evidence-based medicine, a better understanding of the situation is necessary for developing educational and practical efforts to implement evidence-based medicine in the health system. Objective: To determine the attitude, use, barriers and knowledge of evidence-based medicine in Peruvian doctors according to the level of care. Methods: A cross-sectional analytical study was carried out through a survey that was applied to Peruvian doctors who work at different levels of health care. Results: A total of 1396 physicians were surveyed. 64.35% indicated positive attitude towards the application of evidence-based medicine. In the case of barriers, 51.01% did not have enough relevant evidence; 49.35% did not have time; 47.20% did not have sufficient skills to find it; while 44.40% could not critically read them. Regarding information access, almost 80% of the participants reported that they do not have access to any of the aforementioned databases. Taking into account the understanding of statistical terms, more than two-thirds of the participants had high level of understanding. Conclusions: Although the majority of physicians surveyed have good knowledge and positive attitude towards evidence-based medicine, there are still barriers and use of information that need to be improved.

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Introducción: La resistencia a la insulina (RI) es una de las principales causas del desarrollo de patologías crónicas. Es indispensable su detección temprana, por ello es importante estudiar métodos más asequibles y menos costosos como los biomarcadores. Objetivo: Determinar la precisión diagnóstica de once biomarcadores para RI en una muestra de pobladores peruanos. Metodología: Estudio de pruebas diagnósticas. Análisis de base de datos secundario del estudio PERU MIGRANT. Para medir RI se utilizó como referencia la evaluación del modelo homeostático (HOMA-IR) ≥ 2,8. Los biomarcadores se basaron en la ratio de lípidos, los indicadores de lípido visceral, los indicadores con triglicéridos y glucosa (TyG), y los indicadores con cintura abdominal. Para la precisión se utilizó el análisis de la curva de características operativas del receptor y el área bajo la curva (AUC) con sus respectivos intervalos de confianza al 95% (IC95%). Resultados: Se estudió a 938 participantes. La prevalencia de RI fue del 9,91%. En relación con el análisis ROC, el índice TyG - índice de masa corporal (TyG - IMC) tuvo el mayor AUC, tanto en hombres: AUC=0,85 (0,81 - 0,90), corte=241,55; sens=92,5 (79,6 - 98,4) y esp=78,3 (73,9 - 82,2); como en mujeres: AUC=0,81 (0,76 - 0,85), corte=258,77; sens=79,2 (70,3 - 86,5) y esp= 82,1 (78,0 - 85,8). Discusión: Según los datos analizados, el índice TyG-IMC es el mejor indicador para medir RI. Es un índice simple que se puede tomar de manera rutinaria en la práctica clínica diaria. Es conveniente añadir futuros estudios prospectivos que confirmen su capacidad predictiva.

Introduction: Insulin resistance (IR) is one of the main causes of chronic disease. Early detection is essential, which is why it is important to study more affordable and less expensive methods, such as biomarkers. Objective: To determine the diagnostic accuracy of 11 biomarkers of IR in a sample of Peruvian residents. Method: diagnostic tests. Secondary Database Analysis of the PERU-MIGRANT Study. To measure RI, a homeostatic model evaluation (HOMA-IR) ≥ 2.8 was used as a reference. Biomarkers were based on the lipid ratio, visceral lipid indicators, indicators of triglycerides and glucose (TyG), and indicators of abdominal waist. For precision, the receiver operating characteristic curve and area under the curve (AUC) with their respective 95% confidence intervals (95%CI) were used. Results: A total of 938 participants were studied. The prevalence of IR was 9.91%. In relation to the ROC analysis, the TyG index - body mass index (TyG - BMI) had the highest AUC, both in men: AUC=0.85 (0.81 - 0.90), cut-off=241.55; sens=92.5 (79.6 - 98.4) and sp=78.3 (73.9 - 82.2); as in women: AUC=0.81 (0.76 - 0.85), cut-off=258.77; sens=79.2 (70.3 - 86.5) and esp= 82.1 (78.0 - 85.8). Discussion: According to the data analyzed, the TyG-IMC index is the best indicator for measuring IR. It is a simple index that can be routinely used in clinical practice. Future prospective studies are needed to confirm its predictive capacity.

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During the pandemic, there has been evidence of work limitations during telework, which are believed to cause mental health problems. Our objective was to assess the association between perceived work limitations during telework and posttraumatic stress during the COVID-19 pandemic in Latin America. A cross-sectional study was conducted in Latin America in 2020. Exposure was measured by self-reporting using a self-perception questionnaire; the SPRINT-E questionnaire was used for outcome measurements. Generalized linear models were applied. Of 1329 participants, 15.2% (n = 202) had posttraumatic stress. In a multivariate analysis, the highest frequency of posttraumatic stress was found among those with moderate depression or more (PR = 1.29; 95% CI: 1.03-1.61), moderate or more anxiety (PR = 2.34; 95% CI: 1.61-3.41), and moderate or more stress (PR = 2.45; 95% CI: 1.46-4.12). In conclusion, there is an association between perceived work limitations during telework and posttraumatic stress in Latin American workers. For this reason, it is recommended that occupational physicians, companies, and institutions assess the frequency of posttraumatic stress and monitor the mental health of workers.

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Background: Endemic pemphigus foliaceus and endemic pemphigus vulgaris are autoimmune dermatologic disorders endemic to the Peruvian Amazon. Objective: To determine the ultrastructural skin alterations of three healthy subjects with anti DSG-1 antibodies in areas endemic to pemphigus foliaceus and pemphigus vulgaris in the Peruvian Amazon. Patients and methods: Case series carried out from data of three clinically healthy subjects positive to anti DSG-1 antibodies, from Peru. This study consists of a sub-analysis of data gathered in a previous study. Results: Ultrastructural results are presented from the skin biopsies of three clinically healthy patients positive to anti-desmoglein 1 (DSG-1) antibodies. High Resolution Optical Microscopy (HROM) showed the absence of acantholysis. Transmission Electron Microscopy (TEM) showed the widening of intercellular space between keratinocytes, the presence of vacuoles in intercellular space with granular material and cytoplasmic vacuolization, loss of desmosome structure, loss of normal distribution among tonofilaments and lateral separation among cells in the stratum basale. Conclusion: According to our results, healthy subjects that present anti-desmoglein 1 antibodies can develop ultrastructural alterations that are visible through transmission electron microscopy but not through conventional optical microscopy.

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Introducción: La presencia del síndrome metabólico está asociada con enfermedades crónicas a largo plazo, por lo que se buscan diferentes formas de obtener un diagnóstico temprano. Objetivo: Determinar el rendimiento diagnóstico de 3 índices antropométricos de peso y talla para síndrome metabólico en una muestra de trabajadores peruanos. Métodos: La población son trabajadores de 18 a 65 años, de ambos sexos, ocupación operarios y administrativos. Las variables estudiadas son: edad, sexo, ocupación, peso, talla, perímetro de cintura, antecedentes de diabetes mellitus tipo 2, presión arterial sistólica, diastólica, glucosa en ayunas, triglicéridos y lipoproteína de alta densidad. Se incluyeron 370 trabajadores, se crearon curvas características operativa del receptor con su respectiva área bajo la curva (AUC), se obtuvo la sensibilidad y especificidad de cada índice. Resultados: Del total, el 20 % presentó síndrome metabólico; el 46,76 % fueron mujeres, el 60 % tomaron alcohol alguna vez, el 5,14 % señaló haber fumado. El índice de masa corporal tuvo la mayor AUC= 0,73; corte= 26,04; sensibilidad= 78,4 y especifidad= 67,9) seguido del nuevo índice de masa corporal (AUC= 0,70; corte= 27,85; sensibilidad= 68,9 y especificidad= 70,6); el último lugar lo ocupa el índice triponderal (AUC= 0,66; corte= 16,67; sensibilidad= 67,6 y especificidad= 64,5); los parámetros para síndrome metabólico mostraron asociación estadísticamente significativa. Conclusión: El índice de masa corporal es el de mejor rendimiento diagnóstico para síndrome metabólico; podría ser un predictor útil para detectar este síndrome.

Introduction: Metabolic syndrome is associated with long-term chronic diseases, which is why different ways of obtaining an early diagnosis are sought. Objective: To determine the diagnostic yield of 3 anthropometric indices of weight and height for metabolic syndrome in a sample of Peruvian workers. Methods: The population are workers from 18 to 65 years old, both sexes, occupation operators and administrators; the studied variables were: age, sex, occupation, weight, height, waist circumference, history of type 2 diabetes mellitus, pressure systolic and diastolic blood pressure, fasting glucose, triglycerides, and high-density lipoprotein; 370 workers were included, receiver operating characteristic curves (ROC) were created with their respective area under the curve, obtaining the sensitivity and specificity of each of the indices. Results: Of the total number of workers, 20% presented Metabolic Syndrome; 46.76% were women, 60% drank alcohol at some time, and 5.14% reported having smoked. The Body Mass Index the greatest ROC= 0.73; cutoff= 26.04; sensitivity= 78.4 and specificity= 67.9) followed by the New Body Mass Index (ROC= 0.70; cutoff= 27.85; sensitivity= 68.9 and specificity= 70.6), the last place was occupied by the Triponderal Index (ROC= 0.66; cutoff= 16.67; sensitivity= 67.6 and specificity= 64.5); the parameters for metabolic syndrome showed a statistically significant association. Conclusion: Body Mass Index is the best diagnostic yield for Metabolic Syndrome and could be a useful predictor to detect this syndrome.

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Introduction: The COVID-19 pandemic led to the transition to remote work, triggering variations in stress and physical activity (PA), associated with context-specific instability. Objective: To identify the association between perceived stress (PS) and the level of physical activity (PA) and explore its relationship with the sociodemographic, family, work and individual characteristics of professors working remotely during the COVID-19 pandemic. Material and methods: Cross-sectional analytical study based on a virtual survey of professors. PS was assessed using the Perceived Stress Scale (PSS-14), and PA using an International Physical Activity Questionnaire. The prevalence of high PS and the association with PA were estimated using a Poisson regression analysis with robust variance that estimated crude prevalence ratios (cPR) and adjusted prevalence ratios (aPR) with a 95% confidence interval (CI). Five models were developed to assess associations of PS and PA with sociodemographic, family, work, and individual variables. Results: The information of 191 professors was analyzed; 39.27% were women, aged 52 (41-60). The prevalence of high stress was 47.12%. The age and being head of household did not show significant individual associations with PS. However, the regression analysis assessing the association of PS and other factors showed that compared to the moderate PA group, a statistically significant association was found between stress and high PA (aPR = 0.19; 0.06-0.59), low PA (aPR = 1.43; 1.02-2.01), mainly influenced by age, being head of household and sleep quality. Conclusion: Stress was associated with PA level, family and individual factors. These findings allow identifying characteristics, such as being head of household, age and quality of sleep among teachers, as being associated with a higher probability of having high stress. Subsequent studies should consider the role of individuals and working conditions as part of occupational health surveillance, given the presence of hybrid education in the education sector.

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To examine factors associated with abdominal obesity among normal-weight individuals from the Demographic and Health Survey of Peru (2018-2021). Cross-sectional analytical study. The outcome variable was abdominal obesity defined according to JIS criteria. Crude (cPR) and adjusted prevalence ratios (aPR) were estimated for the association between sociodemographic and health-related variables and abdominal obesity using the GLM Poisson distribution with robust variance estimates. A total of 32,109 subjects were included. The prevalence of abdominal obesity was 26.7%. The multivariate analysis showed a statistically significant association between abdominal obesity and female sex (aPR: 11.16; 95% CI 10.43-11.94); categorized age 35 to 59 (aPR: 1.71; 95% CI 1.65-1.78); 60 to 69 (aPR: 1.91; 95% CI 1.81-2.02); and 70 or older(aPR: 1.99; 95% CI 1.87-2.10); survey year 2019 (aPR: 1.22; 95% CI 1.15-1.28); 2020 (aPR: 1.17; 95% CI 1.11-1.24); and 2021 (aPR: 1.12; 95% CI 1.06-1.18); living in Andean region (aPR: 0.91; 95% CI 0.86-0.95); wealth index poor (aPR: 1.26; 95% CI 1.18-1.35); middle (aPR: 1.17; 95% CI 1.08-1.26); rich (aPR: 1.26; 95% CI 1.17-1.36); and richest (aPR: 1.25; 95% CI 1.16-1.36); depressive symptoms (aPR: 0.95; 95% CI 0.92-0.98); history of hypertension (aPR: 1.08; 95% CI 1.03-1.13), type 2 diabetes (aPR: 1.13; 95% CI 1.07-1.20); and fruit intake 3 or more servings/day (aPR: 0.92; 95% CI 0.89-0.96). Female sex, older ages, and low and high income levels increased the prevalence ratio for abdominal obesity, while depressive symptoms, living in the Andean region, and fruit intake of 3 or more servings/day decreased it.

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Introducción: La prueba de Papanicolau ayuda a detectar de manera oportuna en la intervención de rutina el cáncer de cuello uterino. Objetivo: Analizar factores asociados al tamizaje para cáncer de cuello uterino en mujeres de 12 a 49 años en Perú durante el año 2019. Metodología: Se realizó un estudio observacional, analítico-transversal de un análisis secundario de datos de la Encuesta Demográfica y de Salud Familiar del 2019. Muestreo bietápico, probabilístico, equilibrado y estratificado. Se utilizó estadística descriptiva y analítica (nivel de inferencia p<0.05). Para el análisis bivariado y multivariado se utilizaron razones de prevalencia con intervalo de confianza de 95% y p<0.05. Resultados: La frecuencia de tamizaje de cáncer de cuello uterino en las regiones políticas con menores valores de prevalencia fueron Pasco (0,52%) y Tumbes (0,55%). Discusión: Los factores asociados al tamizaje de cáncer de cuello uterino son la edad, tener pareja, nivel educación superior, nivel socioeconómico pobre, residir en área rural, tener seguro de salud, edad de inicio de relaciones sexuales y haber escuchado del cáncer de cuello uterino.

Introduction: The Papanicolaou test smear helps detect cervical cancer in a timely manner in routine intervention. Objective: To analyze factors associated with screening for cervical cancer in women aged 12 to 49 years in Peru in 2019. Methods: An observational, analytical-cross-sectional study of a secondary analysis of data from 2019 Demographic and Family Health Survey was carried out. Two-stage, probabilistic, balanced, and stratified sampling. Descriptive and analytical statistics were used (level of inference p<0.05). For the bivariate and multivariate analysis, prevalence ratios were used with a 95% confidence interval and p<0.05. Results: The frequency of cervical cancer screening in the political regions with the lowest prevalence values were Pasco (0.52%) and Tumbes (0.55%). Discussion: The factors associated with cervical cancer screening are age, having a partner, higher education level, poor socioeconomic level, residing in a rural area, having health insurance, age at the start of sexual relations, and having heard of cervical cancer.

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Due to the increase in obesity worldwide, international organizations have promoted the adoption of a healthy lifestyle, as part of which fruit consumption stands out. However, there are controversies regarding the role of fruit consumption in mitigating this disease. The objective of the present study was to analyze the association between fruit intake and body mass index (BMI) and waist circumference (WC) in a representative sample of Peruvians. This is an analytical cross-sectional study. Secondary data analysis was conducted using information from the Demographic and Health Survey of Peru (2019-2021). The outcome variables were BMI and WC. The exploratory variable was fruit intake, which was expressed in three different presentations: portion, salad, and juice. A generalized linear model of the Gaussian family and identity link function were performed to obtain the crude and adjusted beta coefficients. A total of 98,741 subjects were included in the study. Females comprised 54.4% of the sample. In the multivariate analysis, for each serving of fruit intake, the BMI decreased by 0.15 kg/m2 (ß = -0.15; 95% CI -0.24 to -0.07), while the WC was reduced by 0.40 cm (ß = -0.40; 95% CI -0.52 to -0.27). A negative association between fruit salad intake and WC was found (ß = -0.28; 95% CI -0.56 to -0.01). No statistically significant association between fruit salad intake and BMI was found. In the case of fruit juice, for each glass of juice consumed, the BMI increased by 0.27 kg/m2 (ß = 0.27; 95% CI 0.14 to 0.40), while the WC increased by 0.40 cm (ß = 0.40; 95% CI 0.20 to 0.60). Fruit intake per serving is negatively related to general body adiposity and central fat distribution, while fruit salad intake is negatively related to central distribution adiposity. However, the consumption of fruit in the form of juices is positively associated with a significant increase in BMI and WC.

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