Fruits and vegetables consumption and depressive symptoms: A population-based study in Peru.

OBJECTIVES: Among different factors, diet patterns seem to be related to depression. The aim of this study was to evaluate the association between the consumption of fruits and/or vegetables and depressive symptoms. METHODOLOGY/PRINCIPAL FINDINGS: A secondary data analysis was conducted using information from a population-based survey from 25 regions from Peru. The outcome was the presence of depressive symptoms according to the Patient Health Questionnaire (cutoff ≥15 to define major depressive syndrome); whereas the exposure was the self-reported consumption of fruits and/or vegetables (in tertiles and using WHO recommendation ≥5 servings/day). The association of interest was evaluated using Poisson regression models controlling for the complex-sample survey design and potential confounders. Data from 25,901 participants were analyzed, mean age 44.2 (SD: 17.7) and 13,944 (54.0%) women. Only 910 (3.8%; 95%CI: 3.5%-4.2%) individuals reported consuming ≥5 servings of fruits and/or vegetables/day; whereas 819 (2.8%; 95%CI: 2.5%-3.1%) had depressive symptoms. Those in the lowest tertile of fruits and/or vegetables consumption had greater prevalence of depressive symptoms (PR = 1.88; 95%CI: 1.39-2.55) than those in the highest tertile. This association was stronger with fruits (PR = 1.92; 95%CI: 1.46-2.53) than vegetables (PR = 1.42; 95%CI: 1.05-1.93) alone. CONCLUSIONS: An inverse relationship between consumption of fruits and/or vegetables and depressive symptoms is reported. Less than 5% of subjects reported consuming the amount of fruits and vegetables recommended by the WHO. There is a need to implement strategies to promote better diet patterns with potential impact on mental health

Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools.

INTRODUCTION: The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT). METHODS: A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools. RESULTS: We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%. CONCLUSIONS: Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools

Perceived stress and high fat intake: A study in a sample of undergraduate students.

OBJECTIVES: Different studies have reported the association between perceived stress and unhealthy diet choices. We aimed to determine whether there is a relationship between perceived stress and fat intake among undergraduate medical students. METHODS/PRINCIPAL FINDINGS: A cross-sectional study was performed including first-year medical students. The outcome of interest was the self-report of fat intake assessed using the Block Screening Questionnaire for Fat Intake (high vs. low intake), whereas the exposure was perceived stress (low/normal vs. high levels). The prevalence of high fat intake was estimated and the association of interest was determined using prevalence ratios (PR) and 95% confidence intervals (95%CI). Models were created utilizing Poisson regression with robust standard errors. Data from 523 students were analyzed, 52.0% female, mean age 19.0 (SD 1.7) years. The prevalence of high fat intake was 42.4% (CI: 38.2%-46.7%). In multivariate model and compared with those with lowest levels of stress, those in the middle (PR = 1.59; 95%CI: 1.20-2.12) and highest (PR = 1.92; 95%CI: 1.46-2.53) categories of perceived stress had greater prevalence of fat intake. Gender was an effect modifier of this association (p = 0.008). CONCLUSIONS: Greater levels of perceived stress were associated with higher fat intake, and this association was stronger among males. More than 40% of students reported having high fat consumption. Our results suggest the need to implement strategies that promote decreased fat intake

Sodium and Potassium Consumption in a Semi-Urban Area in Peru: Evaluation of a Population-Based 24-Hour Urine Collection.

Despite the negative effects of high sodium and low potassium consumption on cardiovascular health, their consumption has not been quantified in sites undergoing urbanization. We aimed to determine the sodium and potassium consumption in a semi-urban area in Peru with a cross-sectional study. 24-h urine samples were collected. The outcomes were mean consumption of sodium and potassium, as well as adherence to their consumption recommendation: <2 g/day and ≥3.51 g/day, respectively. Bivariate analyses were conducted to identify socio-economic and clinical variables associated with the consumption recommendations of 602 participants, complete urine samples were found in 409: mean age of participants was 45.7 (standard deviation (SD): 16.2) years and 56% were women. The mean sodium and potassium consumption was 4.4 (SD: 2.1) and 2.0 (SD: 1.2) g/day. The sodium and potassium recommendation was met by 7.1% and 13.7% of the study sample; none of the participants met both recommendations. People not adherent to the sodium recommendation had higher diastolic (73.1 mmHg vs. 68.2 mmHg, p = 0.015) and systolic (113.1 mmHg vs. 106.3 mmHg, p = 0.047) blood pressure than those who comply with the recommendation. Public health actions ought to be implemented in areas undergoing urbanization to improve sodium and potassium consumption at the population level

Implementation of foot thermometry plus mHealth to prevent diabetic foot ulcers: study protocol for a randomized controlled trial.

BACKGROUND: Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. METHODS/DESIGN: This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. INTERVENTIONS: participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat™). TempStat™ is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm will receive an mHealth component in the form of SMS and voice messages as reminders to use the thermometry device, and instructions to promote foot care. OUTCOMES: the primary outcome is foot ulceration, evaluated by a trained nurse, occurring at any point during the study. DISCUSSION: This study has two principal contributions towards the prevention of DFU. First, the introduction of messages to promote self-management of diabetes foot care as well as using reminders as a strategy to improve adherence to daily home-based measurements. Secondly, the implementation of a thermometry-based strategy complemented by SMS and voice messages in an LMIC setting, with wider implications for scalability. TRIAL REGISTRATION: This study is registered in ClinicalTrials.gov: Identifier NCT02373592

Weight Variation over Time and Its Association with Tuberculosis Treatment Outcome: A Longitudinal Analysis

OBJECTIVE: Weight variation during therapy has been described as a useful marker to predict TB treatment outcome. No previous study has used longitudinal analysis to corroborate this finding. The goal of this study was to evaluate change and trends of patients' bodyweight over time depending on TB treatment outcome. METHODS AND FINDINGS: A retrospective cohort study with all TB cases diagnosed from 2000 to 2006 was carried out. Information from 5 public tuberculosis treatment facilities at Pampas de San Juan de Miraflores, Lima, Peru was analyzed. Poor outcome was defined as failure or death during TB therapy, and compared to good outcome defined as cured. Longitudinal analysis with a pre-specified marginal model was fitted using Generalized Estimating Equations to compare weight trends for patients with good and poor outcome adjusting for potential confounders. A total of 460 patients (55.4% males, mean age: 31.6 years) were included in the analysis: 42 (9.1%) had a poor outcome (17 failed and 25 died). Weight at baseline was not different comparing outcome groups (p = 0.17). After adjusting for age, gender, type of TB, scheme of treatment, HIV status and sputum variation during follow-up, after the first month of treatment, patients with good outcome gained, on average, almost 1 kg compared to their baseline weight (p<0.001), whereas those with poor outcome lost 1 kg (p = 0.003). Similarly, after 4 months, a patient with good outcome increased 3 kg on average (p<0.001), while those with poor outcome only gained 0.2 kg (p = 0.02). CONCLUSIONS: Weight variation during tuberculosis therapy follow-up can predict treatment outcome. Patients losing weight during TB treatment, especially in the first month, should be more closely followed as they are at risk of failure or death

Previous tuberculosis disease as a risk factor for chronic obstructive pulmonary disease:a cross-sectional analysis of multicountry, population-based studies

Background Risk factors for COPD in high-income settings are well understood; however, less attention has been paid to contributors of COPD in low-income and middle-income countries (LMICs) such as pulmonary tuberculosis. We sought to study the association between previous tuberculosis disease and COPD by using pooled population-based cross-sectional data in 13 geographically diverse, low-resource settings. Methods We pooled six cohorts in 13 different LMIC settings, 6 countries and 3 continents to study the relationship between self-reported previous tuberculosis disease and lung function outcomes including COPD (defined as a postbronchodilator forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) below the lower limit of normal). Multivariable regressions with random effects were used to examine the association between previous tuberculosis disease and lung function outcomes. Results We analysed data for 12 396 participants (median age 54.0 years, 51.5% male); 332 (2.7%) of the participants had previous tuberculosis disease. Overall prevalence of COPD was 8.8% (range 1.7%-15.5% across sites). COPD was four times more common among those with previous tuberculosis disease (25.7% vs 8.3% without previous tuberculosis disease,

HBV Infection in Relation to Consistent Condom Use: A Population-Based Study in Peru

Data on hepatitis B virus (HBV) prevalence are limited in developing countries. There is also limited information of consistent condom use efficacy for reducing HBV transmission at the population level. The study goal was to evaluate the prevalence and factors associated with HBV infection in Peru, and the relationship between anti-HBc positivity and consistent condom use.Data from two different surveys performed in 28 mid-sized Peruvian cities were analyzed. Participants aged 18-29 years were selected using a multistage cluster sampling. Information was collected through a validated two-part questionnaire. The first part (face-to-face) concerned demographic data, while the second part (self-administered using handheld computers) concerned sexual behavior. Hepatitis B core antibody (anti-HBc) was tested in 7,000 blood samples. Prevalences and associations were adjusted for sample strata, primary sampling units and population weights. Anti-HBc prevalence was 5.0% (95%CI 4.1%-5.9%), with the highest prevalence among jungle cities: 16.3% (95%CI 13.8%-19.1%). In the multivariable analysis, Anti-HBc positivity was directly associated with geographic region (highlands OR = 2.05; 95%CI 1.28-3.27, and jungle OR = 4.86; 95%CI 3.05-7.74; compared to coastal region); and inversely associated with age at sexual debut (OR = 0.90; 95%CI 0.85-0.97). Consistent condom use, evaluated in about 40% of participants, was associated with reduced prevalence (OR = 0.34; 95%CI 0.15-0.79) after adjusting for gender, geographic region, education level, lifetime number of sex partners, age at sexual debut and year of survey.Residence in highlands or jungle cities is associated with higher anti-HBc prevalences, whereas increasing age at sexual debut were associated with lower prevalences. Consistent condom use was associated with decreased risk of anti-HBc. Findings from this study emphasize the need of primary prevention programs (vaccination) especially in the jungle population, and imply that condom use promotion might be a potential strategy to prevent HBV infection

Developing consensus measures for global programs: lessons from the Global Alliance for Chronic Diseases Hypertension research program.

BACKGROUND: The imperative to improve global health has prompted transnational research partnerships to investigate common health issues on a larger scale. The Global Alliance for Chronic Diseases (GACD) is an alliance of national research funding agencies. To enhance research funded by GACD members, this study aimed to standardise data collection methods across the 15 GACD hypertension research teams and evaluate the uptake of these standardised measurements. Furthermore we describe concerns and difficulties associated with the data harmonisation process highlighted and debated during annual meetings of the GACD funded investigators. With these concerns and issues in mind, a working group comprising representatives from the 15 studies iteratively identified and proposed a set of common measures for inclusion in each of the teams' data collection plans. One year later all teams were asked which consensus measures had been implemented. RESULTS: Important issues were identified during the data harmonisation process relating to data ownership, sharing methodologies and ethical concerns. Measures were assessed across eight domains; demographic; dietary; clinical and anthropometric; medical history; hypertension knowledge; physical activity; behavioural (smoking and alcohol); and biochemical domains. Identifying validated measures relevant across a variety of settings presented some difficulties. The resulting GACD hypertension data dictionary comprises 67 consensus measures. Of the 14 responding teams, only two teams were including more than 50 consensus variables, five teams were including between 25 and 50 consensus variables and four teams were including between 6 and 24 consensus variables, one team did not provide details of the variables collected and two teams did not include any of the consensus variables as the project had already commenced or the measures were not relevant to their study. CONCLUSIONS: Deriving consensus measures across diverse research projects and contexts was challenging. The major barrier to their implementation was related to the time taken to develop and present these measures. Inclusion of consensus measures into future funding announcements would facilitate researchers integrating these measures within application protocols. We suggest that adoption of consensus measures developed here, across the field of hypertension, would help advance the science in this area, allowing for more comparable data sets and generalizable inferences

Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: An individual-level pooled analysis of 31 cohort studies

Background: Estimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown. Methods: We pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor. Results: Our RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana. Interpretation: RRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries. Funding: Wellcome Trust (214185/Z/18/Z)Fil: Carrillo Larco, Rodrigo M.. Imperial College London; Reino UnidoFil: Stern, Dalia. Instituto Nacional de Salud Publica (insp);Fil: Hambleton, Ian R.. The University Of The West Indies; BarbadosFil: Hennis, Anselm. Pan American Health Organization; Estados UnidosFil: Cesare, Mariachiara Di. Middlesex University; Reino UnidoFil: Lotufo, Paulo. Universidade de Sao Paulo; BrasilFil: Ferreccio, Catterina. Pontificia Universidad Católica de Chile; ChileFil: Irazola, Vilma. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Perel, Pablo. London School of Hygiene and Tropical Medicine; Reino UnidoFil: Gregg, Edward W. Imperial College London; Reino UnidoFil: Miranda, J. Jaime. Universidad Peruana Cayetano Heredia; PerúFil: Ezzati, Majid. Imperial College London; Reino UnidoFil: Danaei, Goodarz. Harvard Medical School; Estados UnidosFil: Aguilar Salinas, Carlos A.. Instituto Nacional de Ciencias Médicas y Nutrición; MéxicoFil: Alvarez Váz, Ramón. Universidad de la República; UruguayFil: Amadio, Marselle B.. Centro Universitario Senac Santo Amaro; BrasilFil: Baccino, Cecilia. Universidad de la República; UruguayFil: Bambs, Claudia. Pontificia Universidad Católica de Chile; ChileFil: Bastos, João Luiz. Universidade Federal de Santa Catarina; BrasilFil: Beckles, Gloria. Centers for Disease Control and Prevention; Estados UnidosFil: Bernabe Ortiz, Antonio. Universidad Peruana Cayetano Heredia; PerúFil: Bernardo, Carla DO. University of Adelaide; AustraliaFil: Bloch, Katia V.. Universidade Federal do Rio de Janeiro; BrasilFil: Blümel, Juan E.. Universidad de Chile; ChileFil: Boggia, Jose G.. Universidad de la República; UruguayFil: Borges, Pollyanna K.. Universidade Estadual do Ponta Grossa; BrasilFil: Bravo, Miguel. MELISA Institute; ChileFil: Brenes Camacho, Gilbert. Universidad de Costa Rica; Costa RicaFil: Carbajal, Horacio A.. Universidad Nacional de La Plata; ArgentinaFil: Castillo Rascón, María Susana. Universidad Nacional de Misiones; Argentin