ABSTRACT Introduction: Low back pain is an unavoidable condition in all health personnel, ranging from physical discomfort to functional disability of the individual. Objective: To determine the factors associated with low back pain among health workers at a reference hospital in Peru. Methods: This study is observational, analytical, cross-sectional, temporally prospective, with non-probabilistic sampling. The population was made up of health workers from the Hospital Santa Rosa de Pueblo Libre during the period from June to December of the year 2022. Results: The multivariate analysis determined that being a man (OR: 2.818, p value: 0.017), being overweight (OR:1.782, p value: 0.013), high labor demand (OR: 4.750, p value: 0.026), performing physical (OR: 3.610, p value: 0.031) and having a history of low back trauma (OR: 2.423, p value: 0.034) were statistically significant factors associated with low back pain. Discussion: It was possible to observe that the factors associated with low back pain were the male sex, being overweight, high work demand, physical activity and a history of low back trauma. Knowing these variables will make it possible to carry out preventive schemes and talks to deal with this recurring pathology.

RESUMEN Introducción: El dolor lumbar es una condición inevitable en todo el personal del rubro de la salud, con llevando desde malestar físico hasta una incapacidad funcional del individuo. Objetivo: Determinar los factores asociados a dolor lumbar entre los trabajadores sanitarios en un hospital de referencia del Perú. Metodología: El presente estudio es observacional, analítico, de corte transversal, temporalmente prospectivo, con muestreo no probabilístico. La población estuvo conformada por trabajadores sanitarios del Hospital Santa Rosa de Pueblo Libre durante el periodo de junio a diciembre del año 2022. Resultados: El análisis multivariado determinó que el ser hombre (OR: 2.818, p valor: 0.017), tener sobrepeso (OR:1.782, p valor: 0.013), demanda laboral alta (OR: 4.750, p valor: 0.026), realizar actividad física (OR: 3.610, p valor: 0.031) y tener antecedentes de trauma lumbar (OR: 2.423, p valor: 0.034), fueron factores estadísticamente significativos que se asociaron al dolor lumbar. Discusión: Se pudo observar que, los factores asociados a dolor lumbar fueron el sexo masculino, el sobrepeso, la demanda laboral alta, el realizar actividad física y el antecedente de trauma lumbar. Conocer estas variables permitirá realizar esquemas y charlas preventivas para afrontar esta recurrente patología.

Abstract: Background: The ageing between the Chilean population and the epidemiological transition that the country is going through has increased the need to train, among other specialists, geriatric doctors. Objective: To estimate the gap between geriatricians in Chile according to the epidemiological needs of the population aged 65 years and over. Method: An estimate of the gap in geriatrician hours was made for the health network based on a consultation of 57 active geriatricians out of 156 registered as of January 2021. In this consultation, the duration and frequency of ideal consultations were inquired according to the functional capacity of the elderly at the national level and by region obtained from the Casen 2017 survey. Results: as of February 2022, there are 162 geriatricians in Chile, equivalent to one geriatrician for every 15,806 people aged 65 years and over. According to the estimate, a total of 1,244,689 hours of annual geriatrician would be required in Chile, equivalent to 589 geriatricians nationwide. Conclusion: According to the study's results, at the national level, a total of 589 geriatricians would be needed to cover the care needs of older people with some level of dependence. According to these figures, in the first quarter of 2022, the country would present a gap of 427 geriatricians. Given the highness of this gap, it is believed necessary to advance general training strategies in geriatrics and gerontology in health and socio-health teams.

Resumen: Antecedentes: el envejecimiento de la población chilena y la transición epidemiológica que atraviesa el país, ha incrementado la necesidad de formar, entre otros especialistas, a médicos geriatras. Objetivo: estimar la brecha de geriatras en Chile de acuerdo con necesidades epidemiológicas de la población de 65 años y más. Método: se realizó una estimación de brecha de horas de geriatra para la red de salud, a partir de una consulta a 57 geriatras de laboralmente activos de un total de 156 geriatras registrados a enero del 2021. En dicha consulta se indagó sobre tiempo de duración de consulta y frecuencia de consultas ideales de acuerdo con la capacidad funcional de las personas mayores a nivel nacional y por región obtenida de la encuesta Casen 2017. Resultados: a febrero del 2022 existe un total de 162 geriatras en Chile, cifra que equivale a un geriatra por cada 15.806 personas de 65 años y más. De acuerdo con la estimación realizada, se requeriría en Chile, un total de 1.244.689 horas de geriatra anual, equivalentes a la existencia de 589 geriatras a nivel nacional. Conclusión: según los resultados del estudio, a nivel nacional se necesitarían de un total de 589 geriatras para cubrir las necesidades de atención de las personas mayores con algún nivel de dependencia. De acuerdo con estas cifras, al primer trimestre del 2022 el país presentaría una brecha de 427 geriatras. Ante lo elevada de esta brecha, se cree necesario avanzar en estrategias de formación general en geriatría y gerontología en los equipos de salud y socio-sanitarios.

The article presents the main impact of COVID-19 pandemic on the health status of older people, systematizing the information about the direct impact of the pandemic in terms of number of cases, hospitalizations, deaths, the policies implemented for the prevention and management of COVID-19 in older people and the indirect impact of the two years of pandemic. Adopting a broad definition of health, the need to monitor and recover health care of older people is highlighted. The recovery of their functionality and mental health must be emphasized. The policies towards institutionalized older people must be revised. These areas should be the focus of health care policies for older people in Chile.

Background: Chile is currently updating the Comprehensive Policy on Positive Aging, which establishes a positive association between Subjective Well-being, Self-perceived Health, Functional status, and Social Participation in older people. Aim: To study the relationship between Subjective Well-being, General Health, Functional status, and Social Participation in older people in Chile. Material and Methods: In a cross-sectional observational study, 2.031 people aged 60 years and over were included in the National Health Survey 2016-2017 (ENS). The study included analysis of correlations between the relevant variables, in addition to binomial logistic regression with Subjective Well-being as a response variable, as well as the application of structural equation techniques (SEM). Results: Subjective Well-being had a positive association with Self-perceived Health (Rho = 0.370), functional status (Rho = 0.360), and Social Participation (Rho = 0.290). However, in the logistic regression analysis only Self-perceived Health (OR = 0.293) and Functional status (OR = 0.932) had predictive capacity for Subjective Well-being. Conclusions: The relevance of Self-perceived Health and Functionality in the sensation of Well-being among older people, reinforces the need to improve health care within a framework of a comprehensive policy for this age group.

ABSTRACT Objective. To analyze the changes in the density of human resources in health (DHRH), in the Ministry of Health at the regional and provincial level in Peru, in order to describe the response of the health system on this component during the COVID-19 epidemic. Methods. Descriptive study based on the analysis of the INFORHUS national database of the Ministry of Health. To calculate the DHRH, the health personnel registered in the INFORHUS database were considered as the numerator and the population assigned to the Seguro Integral de Salud - SIS as the denominator. Health personnel who died and were still registered, and personnel diagnosed with COVID-19 by rapid or molecular testing during the months considered in the analysis, were excluded. The percentage changes of DHRH between the months of april to august 2020 were analyzed at the regional and provincial level in Peru. Results. In the april-august 2020 period, in response to the first phase of the COVID-19 pandemic, Peru increased the DHRH by 5,1%. At the regional level, this increase was achieved in 15 of the 25 regions with a variation from 0,2% to 12,3%, and a sharp and sustained reduction in appointed personnel was observed, together with an increase in personnel with temporary contracts. In the rest of the regions, a reduction in DHRH was observed, which ranged from -0,7% to -7,7%. Conclusions. DHRH in Peru showed a slight increase at the national level during the first quarantine period due to the COVID-19 pandemic, however, this result has not been equitable in the different regions and provinces at the national level. This suggests a limitation in the scope of the measures taken by the government, and the need to take actions to strengthen the health situation and deployment of human resources in health in the most disadvantaged sectors.

RESUMEN Objetivo. Analizar los cambios en la Densidad de Recursos Humanos en Salud (DRHS) en el Ministerio de Salud a nivel regional y provincial en el Perú; a fin de describir la respuesta del sistema de salud sobre este componente durante la epidemia de COVID-19. Métodos. Estudio descriptivo basado en el análisis de la base de datos nacional de INFORHUS del Ministerio de Salud. Para el cálculo de la DRHS, se consideró como numerador al personal de salud registrado en la base de INFORHUS y como denominador a la población adscrita al Seguro Integral de Salud - SIS. Se excluyó a personal de salud que falleció y aún estaba registrado, y a personal diagnosticado de COVID-19 por prueba rápida o molecular durante los meses considerados en el análisis. Se analizaron los cambios porcentuales de DRHS entre los meses de abril hasta agosto de 2020 a nivel regional y provincial en el Perú. Resultados. En el periodo abril-agosto la DRHS a nivel nacional se incrementó en un 5,1%. A nivel regional este incremento se logró en 15 de las 25 regiones con una variación desde 0,2% hasta 12,3%, y se visualizó una reducción brusca y sostenida del personal nombrado, juntamente con un incremento del personal con contratos temporales. En el resto de las regiones se visualizó una reducción de DRHS la cual varió entre -0,7% hasta -7,7%. Conclusiones. La DRHS en el Perú mostró un leve incremento a nivel nacional durante el primer periodo de cuarentena por la pandemia de COVID-19; sin embargo, este resultado no ha sido equitativo en las diferentes regiones y provincias a nivel nacional. Esto sugiere una limitación en el alcance de las medidas tomadas por el gobierno, y la necesidad de tomar acciones para el fortalecimiento de la situación de salud y despliegue de RHUS en los sectores más desfavorecidos.

Abstract Background: Infectious diarrhea is still a major problem in public health, especially in children under 5 years of age. The identification of the etiologic agent is important for the clinical management of the diarrhea episode and, from the epidemiological point of view, to implement control measures. Aim: To determine the presence of gastrointestinal pathogens in children under five years of age with diarrhea in a Chilean rotavirus surveillance center. Methods: Observational study in children under five years of age who were hospitalized for diarrhea at the Dr. Luis Calvo Mackenna Hospital from December 2015 to December 2019. Molecular detection was performed using the FilmArray gastrointestinal (FilmArray GI®) panel. Results: We analyzed 493 diarrheal stool samples of children, 427 samples (87%) were positive and 66 samples (13%) were negative. Of positive samples, 174 samples (41%) and 253 samples (59%) were positive for one or more pathogen, respectively. In children under one year and the group between one and four years there was a predominance of infections caused by enteric virus. Rotavirus and norovirus were the most common virus in both age groups. The most frequent bacteria were EPEC (27%), C. difficile (17%), EAEC (14%) and Campylobacter (9%). In parasites, Giardia lamblia and Cryptosporidium were identified, in 3% and 1% of the total samples, respectively. Conclusions: The molecular detection system used allowed an increase in the detection of enteropathogens in children under five years of age. The information generated by this type of surveillance could help to characterize the episodes of diarrhea in the population and might be a tool to technically advise the authorities in the decision-making process for the implementation of control measures.

Resumen Introducción: Las diarreas de causa infecciosa son un problema de salud pública, especialmente en niños bajo los cinco años. La identificación de los agentes etiológicos puede ser relevante para el manejo del cuadro clínico y, desde el punto de vista epidemiológico, para la implementación de medidas de control. Objetivo: Determinar la presencia de patógenos entéricos en niños bajo los cinco años que se hospitalizaron por diarrea aguda en uno de los centros centinelas de la red de vigilancia de rotavirus en Chile. Pacientes y Métodos: Estudio observacional en niños menores de cinco años que se internaron por cuadros de diarrea en el Hospital Dr. Luis Calvo Mackenna, durante diciembre del 2015 a diciembre del 2019, el que forma parte de la red de vigilancia de rotavirus del Ministerio de Salud de Chile. Las muestras fecales se analizaron mediante un test molecular, FilmArray GI® panel, que permite la detección de 22 patógenos entéricos virales, bacterianos y parasitarios. Resultados: Se analizaron 493 muestras fecales de niños con episodios de diarrea infecciosa, detectando al menos un patógeno en 427 muestras (87%). De estas muestras positivas, se detectó solo un patógeno en 174 muestras (41%) y dos o más patógenos en 253 muestras (59%). En el grupo de niños bajo un año y el grupo entre uno y cuatro años hubo un predominio de infecciones causadas por virus gastroentéricos, siendo rotavirus y norovirus los virus más detectados en ambos grupos de edad. Las bacterias más frecuentes fueron EPEC (27%), C. difficile (17%), EAEC (14%) y Campylobacter (9%). Respecto a los parásitos, se identificó Giardia lamblia y Cryptosporidium, en el 3 y 1% del total de las muestras, respectivamente. Conclusión: La detección molecular utilizada permitió detectar un alto número de enteropatógenos en niños bajo los cinco años. La información generada por este tipo de vigilancia, podría ayudar a caracterizar en la población los episodios de diarrea causados por los principales patógenos entéricos y podría ser una herramienta para asesorar técnicamente a las autoridades en la toma de decisión para la implementación de medidas de control contra estos patógenos.

Abstract An initial survey of total mercury (THg) in vicuñas (Vicugna vicugna) was made atlocalities with gold mining activity in the north-west of the department of La Paz, Bolivia, during chakus in the wild, between October and November 2018. We obtained 14 blood samples in five locations in Apolobamba, La Paz, Bolivia. Sampling locations, sex and age of vicuña were compared, using one-way ANOVA. Blood samples showed between 0.10 - 0.15 .g/l THg. No significant differences were found (. > 0.05) in the variables studied. We recommend evaluating mercury in environments, and methyl-mercury in vicuña, cattle and carnivorous fish for better mining management.

Resumen Se realizó una evaluación inicial de los niveles de mercurio total (THg) en vicuñas (Vicugna vicugna) durante chakus en silvestría, entre octubre y noviembre 2018 y se obtuvieron 14 muestras sanguíneas en cinco localidades de Apolobamba, La Paz, Bolivia. Se compararon localidades de muestreo, sexo y edad de vicuñas, mediante ANOVA de una vía. Las muestras sanguíneas presentaron entre 0.10 - 0.15 .g/l de THg. No se encontraron diferencias significativas (.> 0.05) en las variables estudiadas. Se recomienda evaluar mercurio en ambientes, y metil-mercurio en vicuñas, ganado y peces carnívoros para una mejor gestión de la minería.

La investigación se realizó en el ciclo agropecuario 2017-2018, en cuatro comunidades características del Municipio de Toledo del departamento de Oruro del Estado Plurinacional de Bolivia. El objetivo fue identificar saberes locales sobre tecnologías y estrategias de producción agropecuaria que puedan generan sostenibilidad en los sistemas de producción agropecuaria para fortalecer la resiliencia al CC. El enfoque utilizado fue la investigación histórico cultural lógico, investigación participativa revalorizadora. De acuerdo a los resultados se lograron identificar 10 tecnologías de producción agropecuaria utilizadas con mayor frecuencia, de estas la utilizada por los productores con mayor incidencia (100%) es la wijiña (reservorio cónico excavado en el suelo para acumular agua de lluvia), seguido por el pozo que tiene una preferencia del 79.3% de productores, las kurmi khotas (trampas para cosecha de agua de lluvia) que solo el 16.6% de los productores la utilizan. De estas tecnologías agrupadas en 4 estrategias de producción agropecuaria resilientes al CC, se evidenció que el plan de manejo de agua de lluvia y el aprovechamiento y manejo de pastos nativos y especies forrajeras introducidas son los que el productor aprovecha en sus sistemas de producción.

The research was carried out in the 2017-2018 agricultural cycle, in four characteristic communities of the Municipality of Toledo of the Oruro department of the Plurinational State of Bolivia. The objective was to identify local knowledge about agricultural production technologies and strategies that can generate sustainability in agricultural production systems to strengthen the resilience of Climate Change. The approach used was logical cultural historical research, participatory revaluative research. According to the results, it was possible to identify 10 agricultural production technologies used with the highest frequency, of which are used by the producers with the highest incidence (100%) is the wijiña (conical deposit dug in the ground to accumulate rainwater), followed by because it has a preference for 79.3% of producers, the kurmi khotas (traps to harvest rainwater) that only 16.6% of producers use. From these technologies grouped into 4 CC-resistant agricultural production strategies, it is evident that the Rainwater management plan and the management and management of native pastures and forage species introduced by those that the producer approves in their production systems.

RESUMO Objetivo: Descrevemos o efeito redutor de pressão da trabeculoplastia com laser de micropulso (MLT) em pacientes com glaucoma de ângulo aberto (OAG) descontrolado. Design: Série de casos retrospectiva. Métodos: Foram revisados retrospectivamente 30 olhos com glaucoma de ângulo aberto (OAG) na Clínica Vista em Lima, Peru. Uma única sessão de tratamento com MLT foi administrada usando uma Nd de frequência duplicada de 532 nm. Laser YAG a 360 º da malha trabecular com uma potência de 1000 mW, 25% do ciclo de trabalho e 300 ms. de exposição. A pressão intra-ocular (PIO) foi medida no início e em 1 dia, 1 semana, 3, 6 meses após o tratamento e foram seguidos por um último controle. Resultados: A média da PIO basal foi de 15,6 mmHg e no último controle foi de 12,8 mmHg, com tempo médio de seguimento de 19 meses (+/- 10 DP). A redução média da PIO no primeiro dia foi de 1,6 mmHg (± 2,6 DP) e 1,2 mmHg (± 3,3 DP) no último seguimento. A porcentagem média de redução da PIO foi de 17,9% e 7 olhos (40%) tiveram redução da PIO superior a 20%. Nenhuma diferença estatística em relação às características demográficas dos pacientes. A maior redução foi obtida no primeiro dia com mediana de 2,00 (P 0,001). A tendência de atingir uma redução maior da PIO em pacientes com PIO basal mais alta foi encontrada, mas não foi estatisticamente significativa. Nenhuma reação adversa ocorreu. Conclusões: A trabeculoplastia a laser Micropulse pode ser temporariamente eficaz na redução da PIO em alguns pacientes com glaucoma de ângulo aberto descontrolado e parece ser segura.

ABSTRACT Objective: We describe the pressure lowering effect of micropulse laser trabeculoplasty (MLT) in patients with uncontrolled open angle glaucoma (OAG). Design: Retrospective case series. Methods: We retrospective reviewed 30 eyes with Open angle Glaucoma (OAG) at the Vista Clinic in Lima, Peru. A single session of MLT treatment was delivered using a 532 nm Frequency doubled Nd. YAG laser to 360º of the trabecular meshwork with a power of 1000 mW, 25 % of duty cycle, and 300 ms. of exposure. The intraocular pressure (IOP) was measured at baseline and at 1 day, 1 week, 3, 6 months post-treatment and were followed up for one last control. Results: The mean baseline IOP was 15.6 mmHg and in the last control was12.8 mmHg, mean follow up time of 19 months (+/- 10 SD). The mean reduction of IOP in the first day was 1.6 mmHg (± 2.6 SD) and 1.2 mmHg (± 3.3 SD) in the last follow up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction greater than 20%. No statistical difference in relation to demographics characteristics of the patients. The greatest reduction was achieved in the first day with a median of 2.00 (P 0.001). A tendency to achieve higher reduction of IOP in patients with higher baseline IOP was found, but was not statistical significant. No adverse reactions occurred. Conclusions: Micropulse laser trabeculoplasty can temporarily be effective in reducing the IOP in some patients with uncontrolled Open angle glaucoma and appears to be safe.

Objective: To describe blood pressure (BP) values monitored at home (MAH) and to evaluate cardiovascular risk factors (CRF) in young medical students of a private university in Lima, Peru. Methods: Descriptive study of medical students between 18 and 23 years of age who filled-in a questionnaire on epidemiologic and life style data. An anthropometric evaluation was performed as well. Results: 46 students of the second year at the Medical School were recruited. One participant had high BP previously. Prevalence of high BO was 4.3%; 26.1% had overweight, mostly in males. Abdominal obesity was seen in 45.7% and abdominal obesity adjusted by age was seen in 65.2% of females and in 52.2% of males. Males had higher BP values; 66.7% of overweight and 100% of obese participants were sedentary. Over weighted participants had higher mean BP levels (p<0.05) compared to those with normal body weight. A linear regression was observed between mean BP values and cervical perimeter and abdominal circumference. Conclusions: Frequency of high BP found was not predictable. CRF such as overweight, abdominal obesity and sedentarism were prevalent in this population. BP-MAH should be introduced in future studies of high BP.

Objetivo: Describir los niveles de presión arterial (PA) mediante el monitoreo domiciliario de la presión arterial (MDPA) y los factores de riesgo cardiovascular (FRC) en un grupo de jóvenes estudiantes de medicina de una universidad privada en Lima, Perú. Material y métodos: Estudio descriptivo de un grupo de estudiantes de medicina entre 18 y 23 años de edad, en quienes se midió la PA aplicando la técnica del MDPA. Los participantes llenaron un cuestionario para recolección de datos demográfico-epidemiológicos y de estilos de vida. Adicionalmente, se realizó la evaluación antropométrica correspondiente. Resultados: Se incluyeron 46 estudiantes de medicina de ambos sexos, voluntarios, que cursaban el segundo año de Medicina. Una participante mujer tenía diagnóstico previo de hipertensión arterial esencial (HTA). La frecuencia de HTA fue 4,3%. El 26,1% presentó sobrepeso, predominante en varones. Obesidad abdominal se presentó en 45,7%, y obesidad abdominal ajustada para la edad (OAAE) en 65,2% de mujeres y 52,2% de varones. Los varones tuvieron mayores niveles de PA. El 66,7% de participantes con sobrepeso y el 100% de obesos eran sedentarios. Los participantes con sobrepeso tuvieron mayor promedio de presión arterial sistólica (PPAS) (p < 0,05), comparado con los de índice de masa corporal (IMC) normal. Se obtuvo regresión lineal significativa entre PPAS y perímetro cervical, y la circunferencia de cintura (CCI). Conclusiones: La frecuencia de HTA encontrada no fue despreciable. FRC como sobrepeso, obesidad abdominal y sedentarismo se presentaron en importante porcentaje. El MDPA se debería introducir en estudios futuros sobre HTA.

We report an outbreak of norovirus(NoV) which occurred at a military training center in Peru. Thirteenstool samples that were taken from initial cases turned out positive for NoV GII by RT-PCR. A case-control study was performedto determine factorsassociated with infection.164 probable cases (45.2%clinical attack rate) were identified. The only factor associatedwith infection was "having shared room with a case" (ORa = 1.7; 95% CI 1.1 to 2.7).Epidemiological findings suggestthat the virus was spread person to person. Future investigations of outbreaks of diarrhea in Peru should consider the NoV as an etiologicagent

Reportamos un brote de norovirus (NoV) ocurrido en un centro de entrenamiento militar peruano. Trece muestras de heces tomadas de casos iniciales resultaron positivas a NoV GII por RT-PCR. Se realizó un estudio caso-control para determinar factoresasociados a la infección. Se identificó 164 casos probables(tasa de ataqueclínica: 45,2%). El único factor asociado a la infecciónfue el "haber compartido habitación con un caso" (ORa=1,7; IC95% 1,1 a 2,7). Los hallazgos epidemiológicos sugieren que el virus fue propagado persona a persona. Futuras investigaciones de brotes de diarrea en el Perú deberían considerar al NoV como un agente etiológico

We report an outbreak of norovirus(NoV) which occurred at a military training center in Peru. Thirteenstool samples that were taken from initial cases turned out positive for NoV GII by RT-PCR. A case-control study was performedto determine factorsassociated with infection.164 probable cases (45.2%clinical attack rate) were identified. The only factor associatedwith infection was "having shared room with a case" (ORa = 1.7; 95% CI 1.1 to 2.7).Epidemiological findings suggestthat the virus was spread person to person. Future investigations of outbreaks of diarrhea in Peru should consider the NoV as an etiologicagent

Reportamos un brote de norovirus (NoV) ocurrido en un centro de entrenamiento militar peruano. Trece muestras de heces tomadas de casos iniciales resultaron positivas a NoV GII por RT-PCR. Se realizó un estudio caso-control para determinar factoresasociados a la infección. Se identificó 164 casos probables(tasa de ataqueclínica: 45,2%). El único factor asociado a la infecciónfue el "haber compartido habitación con un caso" (ORa=1,7; IC95% 1,1 a 2,7). Los hallazgos epidemiológicos sugieren que el virus fue propagado persona a persona. Futuras investigaciones de brotes de diarrea en el Perú deberían considerar al NoV como un agente etiológico