Population Of Peru Research Articles

The mid-eighteenth-century Bourbon reform of repartos de mercancías to the Indian population in Peru and New Spain. Monopoly or government policy?

ABSTRACT Although the matter of repartos (the sale on credit to Indians of goods they might need) has been extensively studied, the purpose that led the Crown to establish a system around them in 1751 is often neglected. Scholars usually understood the repartos as abuses carried out by the corregidores and alcaldes mayores (judges and local Spanish authorities) in the provinces of Peru and New Spain and tolerated by the government until their abolition from 1780 onwards. It is almost completely ignored that the 1751 decree was not a simple legalisation of the repartos to favour local elites, but quite the opposite, a true Bourbon reform with the intention of increasing the industriousness of the Indians and transforming them into buyers of colonial goods (mules, clothes, food) and European goods (textiles, iron, manufactures). It was a reform aimed at encouraging production, trade and the royal exchequer through taxation. The participation of different social sectors in the system contrasts with the idea of monopoly so often associated with the reparto. It is precisely this idea that results from prioritising the testimonies of the detractors of the repartos in the context of abolition rather than paying attention to the purpose of the system.

English

Introduction: The prison population in Peru exceeds 90,000 individuals, many of whom face conditions that increase their vulnerability to human immunodeficiency virus (HIV), such as exposure to illicit substances, risky sexual behaviors, and discrimination. Materials and Methods: A secondary analysis was carried out, using data from the 2016 national prison population census to identify factors associated with HIV risk in the incarcerated population of Peru. A total of 75,613 male inmates from prisons across the country participated, answering a comprehensive questionnaire consisting of 405 items. Multivariable regression Poisson models were used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results: Our findings revealed significant associations between HIV risk and sexual orientation, with homosexual (aPR: 5.50; CI: 2.62-11.56) and bisexual (aPR: 4.92; 95% CI: 2.26-10.72) individuals being at higher risk. Additionally, a history of tuberculosis (aPR: 2.82; 95% CI: 1.75-4.56) and sexually transmitted diseases (aPR 48.14; 95% CI: 31.07-74.56) were strongly correlated with increased HIV risk. Marital status, specifically being widowed, divorced, separated, or single, also showed a statistically significant association with HIV infection in both raw and adjusted regression models. Discussion: Our study highlights important risk factors for HIV infection among the male prison population in Peru. The identified associations will inform the development of effective health policies aimed at identifying and addressing HIV transmission within the country’s prisons. Furthermore, our findings provide a basis for future research in similar settings with a comparable male prison population profile.

Differences in cardiovascular risk in the general population of low and high altitude residents in Peru. HIGH Altitude CArdiovascular REsearch Latin America Population Study (HIGHCARE-LAPS)

Abstract Introduction Living at high altitude (HA) is associated with profound changes in cardiovascular physiology, mostly caused by chronic hypoxia. Available data from high income countries (Switzerland, Austria) suggest beneficial effects of moderate altitude residence in terms of cardiovascular risk. Little is known, however, about cardiovascular risk profile in long-term residents of higher altitudes from low-income countries. Aim To compare cardiovascular risk estimated with validated score in population-based samples of permanent residents of low and high-altitude communities in Peru. Methods Study participants (adults permanently residing at either low or high altitude) were recruited by sex- and age-stratified random multistage cluster sampling from the general population of urban areas at different altitudes in Peru (lowlanders: <500 m above sea level, highlanders: cities at 3287 m, 3824 m and 4330 m). For all participants questionnaire-based information, conventional blood pressure (BP; 3 seated measurements with a validated oscillometric device) and laboratory variables were obtained. Based on the collected data atherosclerotic cardiovascular disease (ASCVD) risk was estimated according to Pooled Cohort Equations (PCE, previously calibrated in South American population). Participants below 40 years of age, with ASVCD history, with LDL-C≥190 mg/dL or on LDL-C lowering therapy were excluded from this analysis. Results The analysis included 146 lowlanders and 373 highlanders, most of whom had low 10-year ASVCD risk, with the median estimated risk being significantly higher among lowlanders. Comparisons between the groups in terms of principal variables of interest are reported in the Table. The highlanders were slightly younger, had lower BMI, conventional BP, HDL cholesterol, lower prevalence of antihypertensive medication and of diabetes, and higher heart rate. In a multivariable model the difference in ASCVD risk between lowlanders and highlanders was significant (p=0.0009) after adjusting for BMI and socio-economic variables but not after systolic BP was included in the model (p=0.800). Conclusions Residence at HA is associated with a lower estimated ASCVD risk in the general population of Peru, mainly because of lower BP levels. Considering that the prognostic value of cardiovascular risk estimates in highland populations is unknown, longitudinal cohort studies would be required to assess whether this finding is associated with a lower rate of cardiovascular events.

Mapping of the network connection between sleep quality symptoms, depression, generalized anxiety, and burnout in the general population of Peru and El Salvador

BackgroundA meta-analysis of randomized controlled trials has suggested a bidirectional relationship between sleep problems and mental health issues. Despite these findings, there is limited conclusive evidence on the relationship between sleep quality, depression, anxiety, and burnout.ObjectiveThe current study aimed to evaluate the relationships between sleep quality symptoms, anxiety, depression, and burnout in samples of adult individuals from two Latin American countries, Peru and El Salvador, through network analysis and to identify key symptoms that reinforce the correlation and intensify the syndromes.MethodsA total of 1012 individuals from El Salvador and Peru participated, with an average age of 26.5 years (SD = 9.1). Symptom networks were constructed for both countries based on data from the Jenkins Sleep Scale, Patient Health Questionnaire-2, General Anxiety Disorder-2, and a single burnout item.ResultsThe results indicated that Depressed Mood, Difficulty Falling Asleep, and Nervousness were the most central symptoms in a network in the participating countries. The strongest conditional associations were found between symptoms belonging to the same construct, which were similar in both countries. Thus, there is a relationship between Nervousness and Uncontrollable Worry, Anhedonia and Depressed Mood, and Nighttime Awakenings and Difficulty in Staying Asleep. It was observed that burnout is a bridge symptom between both countries and presents stronger conditional associations with Tiredness on Awakening, Depressed Mood, and Uncontrollable Worry. Other bridge symptoms include a Depressed Mood and Nervousness. The network structure did not differ between the participants from Peru and El Salvador.ConclusionThe networks formed by sleep quality, anxiety, depression, and burnout symptoms play a prominent role in the comorbidity of mental health problems among the general populations of Peru and El Salvador. The symptom-based analytical approach highlights the different diagnostic weights of these symptoms. Treatments or interventions should focus on identifying central and bridge symptoms.

HIV Risk Behaviors and the Use of Geosocial Networking Dating Apps among Men Who have Sex with Men and Transgender Women in Lima, Peru: a Cross-Sectional Study.

Geosocial networking dating apps (GSN apps) are an increasingly widespread technology used by populations throughout the world to facilitate sexual encounters. Studies from a variety of settings suggest a possible association between GSN app use and HIV risk behaviors, including among sexual and gender minority populations such as men who have sex with men (MSM) and transgender women (TW). However, it remains unclear to what extent GSN apps play a causal role. We explored the relationship between GSN app use and sexual risk behaviors among MSM and TW in Lima, Peru by analyzing data from a multi-site cross-sectional survey assessing both general and partner-specific sexual behaviors. We performed bivariate analysis to estimate the association of GSN app use with different individual and partner-specific factors, then fit multivariable regression models adjusting for age and education. Among 741 total participants (698 MSM, 43 TW), 64% met at least one sex partner in the prior three months using a GSN app. GSN app users were significantly more likely to report engaging in HIV risk behaviors in general, including condomless receptive anal sex, group sex, transactional sex, and sex under the influence of alcohol or drugs. Having condomless anal sex with a given partner was not associated with meeting that partner via GSN app. These findings highlight GSN app users as a particularly vulnerable subpopulation among MSM and TW in Lima. GSN apps could provide a useful vehicle for targeted HIV prevention efforts for priority populations in Peru.

When Your Pronominal Marking Matters during a Pandemic: Shawi Pronominals and COVID-19 Interventions

In this communication, I focus on Shawi forms of address used in Peruvian State posters during the COVID-19 pandemic. The COVID-19 pandemic took a heavy toll on the Peruvian Indigenous population. A recent study showed that Indigenous people had 3.18 times the risk of infection and 0.4 times the mortality risk of the general population in Peru. The Shawi have not been included among the most heavily affected. A preliminary descriptive and critical account of Peruvian State posters whereby languages such as Shawi and other Peruvian Indigenous languages (Awajun, Ashaninka, different varieties of Quechua, Shipibo, etc.) have been used to prevent the spread of COVID-19 is provided. Shawi seems to be the only language of the sample where information has been framed using first-person inclusive forms. This appears to have led to enhanced communal engagement in the suggested health-related practices. Additionally, opinions on the issue from local stakeholders are briefly discussed. While the results are derived solely from preliminary observations, my findings could serve as a basis for enhancing health communication strategies in other Indigenous contexts, utilizing linguistically informed intercultural approaches.

RESIDENCE AT HIGH ALTITUDE IS ASSOCIATED WITH LOWER CONVENTIONAL AND AMBULATORY BLOOD PRESSURE THAN LIVING AT SEA LEVEL IN THE GENERAL POPULATION OF PERU. HIGHCARE-LAPS STUDY

Objective: Acute exposure to hypoxia at high altitude (HA) leads to an increase in blood pressure (BP) in healthy individuals and in hypertensive patients. Little is known, however, about the effect of long-term HA residence on BP. Available data based on conventional BP measurements are inconsistent and no general population studies using 24-h ambulatory BP monitoring (ABPM) have been conducted. Aim of HIGHCARE-LAPS was to compare BP levels and cardiovascular risk profile among population-based samples of subjects residing in Peruvian communities living at different altitudes. BP-related data are reported in this paper. Design and method: Study participants were recruited by sex- and age-stratified random multistage cluster sampling from the general adult population residing permanently in urban areas at different altitudes in Peru (Lima, <500m, Huancayo 3287m, Juliaca 3824m, Cerro de Pasco 4330m). In all participants questionnaire-based information, conventional BP (3 seated measurements with a validated oscillometric device, HEM7121 OMRON, Japan), 24-hour ambulatory BP (A&D TM2430, Japan) and laboratory variables were obtained. Results: The study included 206 lowlanders and 595 highlanders. Highlanders were slightly younger, had lower BMI, oxygen saturation and prevalence of antihypertensive medication use and higher haematocrit. In highlanders all conventional and ambulatory BP values were lower and heart rate values higher than in lowlanders. Comparisons between lowlander and highlander samples and for individual sites at different altitudes are reported in the Table. The difference in 24-hour systolic BP between highlanders and lowlanders remained significant (7.2 mmHg, p<0.001) in a linear multiple regression model adjusting for age, sex, BMI, 24-hour heart rate, respiratory rate, and haematocrit. These covariates were selected by LASSO method from a set also including lifestyle-related variables. Conclusions: Permanent residence at high altitude is independently associated with lower conventional and ambulatory BP levels than low altitude residence in the general population of Peru. This relationship does not seem to be explained by lifestyle differences. Mechanisms behind this difference and its impact on cardiovascular risk should be further investigated. Also, comparative studies with other highland populations with different adaptive characteristics would allow to understand better the effects of HA residence on cardiovascular health.

Chronic Neck Pain Prevalence Before and After COVID-19 Restrictions and Its Relationship With Digital Device Screen Viewing: A Population Study.

To estimate the prevalence of chronic neck pain (CNP) among the adult population in Peru during the post-coronavirus disease 2019 (COVID-19) restriction period compared with that during the pre-pandemic period and evaluate its association with prolonged digital devices connected to the internet (DDCI) screen viewing. We conducted a cross-sectional study using a representative sample of adults living in Peru in November 2022. A structured survey was employed to identify CNP, and the exposure variable was set as the duration of DDCI screen viewing. The McNemar test was used to compare CNP prevalence pre- and post-COVID-19 restrictions, and ordinal logistic regression was used to evaluate its association with prolonged screen viewing. A total of 1,202 individuals participated, with 52.8% females and 79.9% residing in urban areas. Following the restrictions, the prevalence of CNP occurring daily or almost daily and at least once a week was 14.8% and 27.8%, respectively (95% confidence Interval [95% CI], 12.6-17.3 and 24.9-30.9), representing a significant increase (p<0.001) compared with pre-pandemic estimates. Notably, among those viewing DDCI screens for ≥8 hours, the odds ratio for CNP frequency escalation compared with those who did not or rarely view screens was 1.61 (95% CI, 1.04-2.50; p=0.033). Approximately 4 of 10 adults in Peru experienced CNP following the lifting of COVID-19 social restrictions, more than double the pre-pandemic prevalence. Furthermore, prolonged viewing of DDCI screens increased the risk of having this condition.

The prevalence and demographic associations of headache in the adult population of Peru: a national cross-sectional population-based study

BackgroundThe Global Campaign against Headache is conducting a series of population-based studies to fill the large geographical gaps in knowledge of headache prevalence and attributable burden. One major region not until now included is South America. Here we present a study from Peru, a country of 32.4 million inhabitants located at the west coast of South America, notable for its high Andes mountains.MethodsThe study was conducted in accordance with the standardized methodology used by the Global Campaign. It was a cross-sectional survey using cluster randomised sampling in five regions to derive a nationally representative sample, visiting households unannounced, and interviewing one randomly selected adult member (aged 18–65 years) of each using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire translated into South American Spanish. The neutral screening question (“Have you had headache in the last year?”) was followed by diagnostic questions based on ICHD-3 and demographic enquiry.ResultsThe study included 2,149 participants from 2,385 eligible households (participating proportion 90.1%): 1,065 males and 1,084 females, mean age 42.0 ± 13.7 years. The observed 1-year prevalence of all headache was 64.6% [95% CI: 62.5–66.6], with age-, gender- and habitation-adjusted prevalences of 22.8% [21.0-24.6] for migraine (definite + probable), 38.9% [36.8–41.0] for tension-type headache (TTH: also definite + probable), 1.2% [0.8–1.8] for probable medication-overuse headache (pMOH) and 2.7% [2.1–3.5] for other headache on ≥ 15 days/month (H15+). One-day prevalence of headache (reported headache yesterday) was 12.1%. Migraine was almost twice as prevalent among females (28.2%) as males (16.4%; aOR = 2.1; p < 0.001), and strongly associated with living at very high altitude (aOR = 2.5 for > 3,500 versus < 350 m).ConclusionThe Global Campaign’s first population-based study in South America found headache disorders to be common in Peru, with prevalence estimates for both migraine and TTH substantially exceeding global estimates. H15 + was also common, but with fewer than one third of cases diagnosed as pMOH. The association between migraine and altitude was confirmed, and found to be strengthened at very high altitude. This association demands further study.

Environmental exposure to multiple chemical elements in Peruvian populations: a review of selected studies

Background Population-based exposure assessments for heavy metals and metalloids (by governmental and private institutions) are common in Peru, but most studies generally focus on the analysis of a single chemical element, like lead or mercury, and lack an appropriate reference regarding the health impact on the exposed population. The complex/mixed chemical interactions within the human body have not yet been studied for all long-term health effects. Methods We reviewed laboratory results from five studies, between 2005-2013, that analysed multiple elements (between 13 and 17 chemical elements in each study) in spot urine samples from Peruvian communities considered exposed and not exposed. All laboratory analysis were performed using inductively coupled plasma mass spectrometry (ICP-MS) at the Environmental Health Laboratory Division of the Centers for Disease Control and Prevention (CDC) of the United States. Results Six chemical elements (total arsenic, caesium, cobalt, lead, molybdenum, and thallium) were present in almost all spot urine samples (&gt;98% of participants), evidencing exposure (qualitative assessment). Exposure to other chemical elements like barium, cadmium, tungsten, antimony and uranium, varied among localities, while chemical elements like beryllium and platinum were rarely detected (&lt;3% and &lt;10% of participants, respectively) in spot urine samples. Most geometric means of urine concentration for total arsenic, lead, cadmium and mercury are higher for the Peruvian locations than for national estimates in Canada and the United States, but not in all locations. Conclusion Comparing averages across different populations can be misleading but comparing periodic values from the same population in the future could evidence an exposure trend. Future studies are needed to develop reference levels for exposed Peruvian populations. This study highlights potential health risks from exposure to environmental chemical elements and can be the first step towards understanding and mitigating human exposure to heavy metals and metalloids for known exposed populations in Peru.

Whole genome sequencing of nine Vibrio parahaemolyticus strains encoding (Pir) toxin-like genes from shrimp cultures in northern Peru using Oxford Nanopore technology.

Nine Peruvian isolates of Vibrio parahaemolyticus were characterized through sequencing, revealing the presence of simple sequence repeat, Pir toxin-like genes, and genes associated with antibiotic resistance, toxic components, and transposable elements. These findings expand our understanding of the genetic diversity, disease resistance, and virulence in cultivated shrimp populations in Peru.

A qualitative study on the social representations of populism and democracy in Peru

The purpose of this paper is to describe and analyze the social representations of democracy, populism and the relationship between both concepts in a sample of citizens from different regions of Peru (n = 76). To this end, a qualitative research design was proposed, using in-depth interviews, which were analyzed from a discursive approach. The results show that democracy and populism are two closely related concepts in tension. On the one hand, the social representation of democracy is semantically poor, closely related to electoral behavior and is seen as a political system that, ideally, is positively valued. Populism, on the other hand, is seen as a political strategy based on the manipulation of citizens' needs in order to reach power using the democratic process of elections. The representation of populism in general is negative, and it is mentioned that it appears and acquires strength in the face of citizen dissatisfaction with democracy, when it cannot solve problems of poverty, corruption or exclusion. The representations of populism take up the constitutive components proposed by different authors on the topic (people, elites and democracy as a product of popular will), but the participants do not necessarily structure the relationships between these components as proposed in the academic literature. Finally, the results shows that respondents' experiences with democracy and populism in Peru act as important socializing forces that will frame how citizens relate to politics and the public.

Sex Work and Health Problems in the Sexual and Gender Minority Population: Analysis of a Population Survey in Peru

Background. Sexual and gender minorities (SGM) who perform sex work are susceptible to sexually transmitted infections and substance abuse that can lead to chronic diseases, as well as discrimination and violence that deteriorate their mental health. Aim. To evaluate the association between a history of sex work and health problems in the sexual and gender minority population from Peru. Methods. A cross-sectional study was conducted based on the data of the first virtual survey for LGBTI people in Peru in 2017. The prevalence of self-reported chronic diseases, infectious diseases, and mental health problems in the last 12 months and their association with the history of sex work were evaluated. Adjusted prevalence ratios (APR) with 95% confidence intervals were calculated using Poisson regression with robust variance. Results. We analyzed data from 10629 people, of which 7.0% performed sex work. The prevalence of chronic diseases, infectious diseases, and mental health problems was 13.0%, 10.4%, and 23.7%, respectively. A significant association was found between a history of sex work with chronic diseases (APR: 1.25, 95% CI: 1.04–1.50), infectious diseases (APR: 2.11, 95% CI: 1.86–2.41), and mental health problems (APR: 1.27, 95% CI, 1.12–1.45). Conclusion. We found evidence that chronic diseases, infectious diseases, and mental health problems are associated with sex work history among the SGM population in Peru. There is a need to provide health interventions focused on disease prevention and control for this population.

Sistemas de Prescripción y Medicación de Control Sanitario para Ciudadanos Vulnerables en el Perú

This article discusses the challenges and solutions to providing healthcare to vulnerable citizens in remote areas, focusing on Peru as a case study. It highlights the need to improve health monitoring, prescribing, and medication systems to improve healthcare delivery. The paper identifies existing barriers and explores innovative and accessible strategies to overcome them. The proposed solution through a Medication and Prescription Health Monitoring System leverages digital, web, IoT, and mobile technology for remote medication administration and health monitoring. This system allows physicians to conduct virtual consultations and diagnose and prescribe medications delivered to remote communities through a logistics network. The proposed approach concludes that it effectively improves access to health care and quality of life for remote populations in Peru and alleviates the burden on overburdened health professionals.

Intention to receive the monkeypox vaccine and its psychological and sociodemographic predictors: a cross-sectional survey in the general population of Peru

ObjectiveThe objective of this study was to identify predictors of intention to be vaccinated against Monkeypox (Mpox) in a sample of Peruvian citizens. MethodsA set of sociodemographic and psychological predictors were used, such as sex, sexual orientation, educational level, previous diagnosis of COVID-19, marital status, complete vaccination against COVID-19, employment status, living with vulnerable people, presence of chronic disease, area of residence, perceived usefulness of COVID-19 vaccines, fear of Mpox, conspiracy beliefs about Mpox, among others.A total of 472 Peruvian adults participated, selected by non-probabilistic snowball convenience sampling. A sociodemographic survey, the Mpox Fear Scale, was used. Conspiracy Beliefs about Mpox was assessed using three questions created specifically for this study. For inferential purposes, simple ordinal regressions ("crude models") were performed between each factor and the outcome. ResultsRegarding their intention to be vaccinated against Mpox, more than 60% expressed clear approval. Being non-heterosexual, having greater emotional fear of Mpox, and perceiving some potential for this disease to become the next pandemic were related to greater intention to vaccinate. On the other hand, being older, having low perceived usefulness of COVID-19 vaccines, and having higher conspiracy beliefs about Mpox were associated with lower intention to vaccinate. ConclusionThe study provides initial information for future research seeking to better analyze Mpox vaccination intention. In addition, cross-sectional data are provided that can be used to develop public health policies that target subgroups with low prevalence of intention to vaccinate against Mpox.

Hospitalization and mortality during the pandemic in chronic hemodialysis patients and the general population in Peru

Resumo Histórico: Pacientes com DRC apresentam maior risco de doença grave e mortalidade por COVID-19 do que a população geral. Objetivo: Comparar taxas de hospitalização e mortalidade durante a pandemia entre pacientes em hemodiálise crônica (HD) e a população geral em Lima (Peru). Métodos: Esta coorte retrospectiva incluiu avaliação do banco de dados de pacientes em HD crônica dos prestadores de serviços de saúde das redes de benefícios do seguro social de saúde de Lima e Callao, entre 2019–2021. Obteve-se taxas de hospitalização e mortalidade para cada 1.000 indivíduos, e foram calculadas variações nas porcentagens de casos de COVID-19 e óbitos. Estas taxas foram comparadas com os dados da população geral e padronizadas por idade e sexo. Resultados: Uma média de 3.937 pacientes em HD crônica foram avaliados mensalmente. Destes, 4,8% tinham COVID-19, 64,97% eram casos leves. As taxas de hospitalização por 1.000 pacientes foram 19,5; 29,28; e 36,7 em 2019, 2020, e 2021, respectivamente. As taxas de mortalidade por 1.000 pacientes foram 5,9; 9,74 e 11,49 em 2019, 2020, e 2021, respectivamente. Quando comparados à população geral padronizada, os picos das taxas coincidiram com os platôs das ondas da pandemia. A taxa de hospitalização para COVID-19 foi 12 vezes maior em pacientes em HD do que na população geral e a taxa de mortalidade por COVID-19 foi duas vezes maior. Conclusão: Pacientes em HD apresentaram taxas de hospitalização e mortalidade padronizada mais elevadas do que a população geral. Os picos das hospitalizações e mortalidade coincidiram com os platôs da primeira e segunda ondas da pandemia.

Genetic diversity in creole pigs in south central Peru.

The creole pigs represent 67% of the national population in Peru. They are a source of economic income in rural communities, and due to their rusticity, they are not much labor demanding. However, knowledge about its genetic diversity remains scarce. The objective of this study was to determine the population structure and genetic diversity of creole pigs from rural communities in south central Peru. Thirteen microsatellites were used to characterize 120 creole pigs from the departments of Ayacucho (57) and Apurimac (63). The samples were taken from hair follicles and ear tissue. Nine microsatellites were highly polymorphic and informative (PIC > 0.5) for both departments. The Ayacucho population had a mean number of alleles (MNA) and expected heterozygosity (HE) of 8.8 and 0.68, respectively, while in the Apurimac population, these were 8.9 and 0.71, respectively. Both populations showed in less than 50% of their loci a deviation from Hardy-Weinberg equilibrium. There was a moderate genetic structure according to the analysis of molecular variance and the FST statistics (0.06), which was corroborated by Bayesian methods. In conclusion, the genetic diversity was mostly due to the intrapopulation variance (91%). Some individuals from Ayacucho shared similar alleles with those from Apurimac. This latter result may be due to their geographic proximity and the introduction of the same new exotic breeds. This is the first research on the genetic diversity of creole pigs in south central Peru. In fact, this study could serve as a basis for conservation strategies and actions in this region.

Obesity after Induction Is Associated with Poor Overall Survival in Adults with Acute Lymphoblastic Leukemia: Results from a Peruvian Adaptation of the CALGB10403 Protocol

Background:Acute lymphoblastic leukemia (ALL) is a lymphoid malignancy with wide racial disparities. Indeed, ALL is more frequently diagnosed among the Latino population who classically achieve lower remission rates and experience worse survival than other racial and ethnic groups. Several high-risk features including genetic polymorphisms and metabolic issues have been implicated in Latino ethnicity, including obesity. A high body mass index (BMI) at different stages of treatment represents a well-known risk factor in several prospective studies mainly based on white populations. It is unclear whether these findings are consistent in other racial and ethnic unrepresentative groups. We aimed to evaluate the effect of BMI at the end of induction on the overall survival (OS) of Latino adults with ALL. Methods:We conducted a retrospective cohort study among adult patients diagnosed with ALL in an academic cancer center (Instituto Nacional de Enfermedades Neoplasicas - INEN) from 2017 to 2019, with follow-up through July 2023. The INEN is a national tertiary referral center in Lima-Peru that provides leukemia treatment for approximately 85% of the insured population in Peru. Patients aged 20-65 who successfully achieved complete remission after 4 weeks of intensive induction treatment were included. Patient data were manually abstracted from the medical records. BMI was classified as underweight, healthy weight, overweight and obese according to the CDC and WHO recommendations. Vital status was ascertained with the National Vital Registry. The Kaplan-Meier method and the Log-rank test were used to estimate OS probabilities. Multivariable Cox regression was used to evaluate the effect of BMI on OS, adjusting for sex, age, risk, and immunophenotype. Results: Of 784 patients identified in the electronic records of the INEN, we excluded 578 because they didn't achieve complete remission, yielding 206 patients for analysis. The median age at diagnosis was 33 years, most were aged 20-40 years old (68%), and female (54%). 160 (78%) were ALL-B Ph- and 126 (61%) corresponded to the high-risk stratification. At the end of the induction, 119 patients presented a healthy weight (58%), 49 (24%) overweight, 26 (13%) obese, and 12 (6%) underweight (Table 1). With a median follow-up of 55 months, the median OS was 18 months (95% CI: 16-23), and the 5-year OS was 23% for all patients. The 5-year OS was lower in patients with obesity (12%), followed by patients with overweight (20%), healthy weight (26%), and underweight (33%), as evidenced by the Kaplan-Meier curve (Figure 1, p=0.036). In the multivariable analysis, obesity (p-value=0.006) was associated with an increased risk of all-cause mortality (adjusted Hazard Ratio [aHR]: 1.93; 95% CI: 1.21-3.08). A very high-risk disease was also associated with poor OS (aHR:2.69; 95% CI: 1.15-6.26) (Table 1). Conclusion: This study identified that obesity at the end of induction is associated with inferior OS among Peruvian patients who achieved complete remission. Our real-world findings should be validated in prospective studies including other Latino populations to recommend the feasibility of weight reduction strategies.

Cross-cultural validation of the COVID-19 peritraumatic distress index (CPDI) among Spanish and Peruvian populations

The COVID-19 pandemic has had a significant psychological impact worldwide. The COVID-19 Peritraumatic Distress Index (CPDI) is widely used to assess psychological stress during the COVID-19 pandemic. Although CPDI has been validated in Peru and Spain, no cross-cultural validation studies have been conducted. As an exploratory aim, differences in CPDI factorial scores between the most prevalent medical conditions in the two samples (arterial hypertension, respiratory diseases and anxious-depressive disorders) from a general population of Peru and Spain were investigated. We conducted secondary data analysis with data from Peru and Spain to validate the CPDI in a cross-cultural context. Exploratory factor analysis (EFA) and multigroup confirmatory factor analysis (MGCFA) were performed to evaluate the factor structure and measurement invariance of the CPDI across cultural contexts. Concerning the exploratory analysis, we performed a U-Mann–Whitney test to evaluate differences in the factorial scores in the two samples. This study revealed a two-factor solution (stress and rumination/information) for the CPDI that included 21 of the 24 original items, and consistent with previous studies. The MGCFA demonstrated measurement invariance across cultural contexts (scalar invariance), indicating that the CPDI construct has the same meaning across both groups, regardless of cultural context and language variations of Spanish. Patients with anxious-depressive disorders showed higher CPDI factorial scores for both factors, whereas patients with respiratory diseases were only associated with the stress factor. This study provides evidence for the cross-cultural validity of the CPDI, highlighting its utility as a reliable instrument for assessing psychological stress in the context of COVID-19 across different cultures. These findings have important implications for developing and validating measures to assess psychological distress in different cultural contexts.

Translation and validation of the satisfaction with life scale in the native Quechua (Collao variant) language of southern Perú

Research on life satisfaction in indigenous populations is limited due to language barriers. Therefore, this paper aimed to translate and validate the Life Satisfaction Scale into the original Quechua language (collao variant) of southern Peru. The research was classified as instrumental and transversal and was conducted with the voluntary participation of 242 Quechua adults speaking the collao variant. The instrument that was translated was the 5-item SWLS, previously adapted to Peruvian Spanish. The internal structure was analyzed under an analytical-factorial approach, and the discrimination and difficulty of the items were evaluated from the item response theory (IRT). Expert judgment was favorable for all items (V > 0.70), confirming the 1-dimensional structure of the scale (χ2 = 8.972, df = 5, p = .000; CFI = 0.985; TLI = 0.970 and RMSEA = 0.057), with acceptable reliability (ω = 0.65). All the items of the scale presented adequate discrimination indices; in addition, the results of the evaluation of factorial invariance as a function of gender demonstrated configurational equivalence but an absence of metric invariance. In conclusion, the SWLS translated into Collao Quechua (collao variant) has a stable factorial structure and adequate internal consistency, although it was not possible to completely demonstrate the invariance by gender, it can be used for initial investigations to measure satisfaction with life of the Quechua-speaking indigenous population of southern Peru.