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BackgroundPrevious studies have found mixed results about cigarette and alcohol consumption patterns among rural-to-urban migrants. Moreover, there are limited longitudinal data about consumption patterns in this population. As such, this study aimed to compare the smoking and heavy drinking prevalence among rural, urban, and rural-to-urban migrants in Peru, as well as the smoking and heavy drinking incidence in a 5-year follow-up.MethodsWe analyzed the PERU MIGRANT Study data from rural, urban, and rural-to-urban migrant populations in Peru. The baseline study was carried out in 2006–2007 and follow-up was performed five years later. For the baseline data analysis, the prevalence of lifetime smoking, current smokers, and heavy drinking was compared by population group using prevalence ratios (PR) and 95% confidence intervals (95% CI). For the longitudinal analysis, the incidence of smoking and heavy drinking was compared by population group with risk ratios (RR) and 95% CI. Poisson regression with robust variance was used to calculate both PRs and RRs.ResultsWe analyzed data from 988 participants: 200 rural dwellers, 589 migrants, and 199 urban dwellers. Compared with migrants, lifetime smoking prevalence was higher in the urban group (PR = 2.29, 95% CI = 1.64–3.20), but lower in the rural group (PR = 0.55, 95% CI = 0.31–0.99). Compared with migrants, the urban group had a higher current smoking prevalence (PR = 2.29, 95% CI = 1.26–4.16), and a higher smoking incidence (RR = 2.75, 95% CI = 1.03–7.34). Current smoking prevalence and smoking incidence showed no significant difference between rural and migrant groups. The prevalence and incidence of heavy drinking was similar across the three population groups.ConclusionsOur results show a trend in lifetime smoking prevalence (urban > migrant > rural), while smoking incidence was similar between migrant and rural groups, but higher in the urban group. In addition, our results suggest that different definitions of smoking status could lead to different smoking rates and potentially different measures of association. The prevalence and incidence of heavy drinking were similar between the three population groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4080-7) contains supplementary material, which is available to authorized users.

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Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.

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Sr. Editor. El aborto inseguro es definido como el procedimiento para terminar la gestación realizado por personas que no poseen las competencias necesarias o en un ambiente sin los mínimos estándares médicos (1) . El aborto inseguro es considerado una pandemia prevenible que afecta en mayor medida a países que presentan restricciones legales al respecto (2) . En Perú, un país en el que se penaliza el aborto, muchas mujeres se someten de manera clandestina a una serie de procedimientos que acarrean un gran número de complicaciones y muertes maternas, cuyas cifras analizaremos a continuación.¿Cuántos abortos inducidos se realizan en Perú? Se ha estimado una incidencia anual de 371 420 abortos inducidos para el 2004 (3) . Estas cifras, probablemente, estén en aumento, debido al crecimiento demográfico y la restricción de métodos anticonceptivos a adolescentes. ¿Cuántos de estos abortos terminan en hospitalización? El número de hospitalizaciones anuales por abortos inducidos en el Perú se ha estimado en 54 200 para 1989 (4) y 28 652 para el 2013 (5) . Esta aparente disminución puede deberse al incremento del uso clandestino de misoprostol, que resulta más fácil de utilizar y tiene un menor riesgo de complicaciones en comparación con otros procedimientos (2) .¿Cuántas mujeres mueren a causa del aborto inducido? Para el año 2015, la Dirección General En este contexto, la despenalización del aborto puede transformar el aborto clandestino inseguro en aborto seguro, disminuyendo exponencialmente las hospitalizaciones y la mortalidad asociadas. ¿Cuántas hospitalizaciones se evitarían? Recordemos que se han estimado 28 652 hospitalizaciones anuales por aborto inducido. El aborto seguro presenta menos de 0,4% de hospitalizaciones, por lo que los 371 420 abortos anuales presentarían apenas 1 486 hospitalizaciones. De esta manera, al despenalizar el aborto se evitarían 28 652 -1 486 = 27 166 hospitalizaciones anualmente. ¿Cuántas muertes se evitarían? Como hemos mencionado, se estima que cada año mueren 58 mujeres por aborto inducido en Perú. El aborto realizado en condiciones seguras tiene una mortalidad menor a 1/100 000 abortos, por lo cual los 371 420 abortos anuales en Perú presentarían como máximo 4 muertes. De esta manera, al despenalizar el aborto se evitarían 54 muertes al año.En conclusión, a pesar de que en Perú no se cuentan con cifras sobre el impacto del aborto inseguro, se estima que cada año causa 28 652 hospitalizaciones y 58 muertes. Además, la no despenalización del aborto traería como consecuencia 27 166 hospitalizaciones y 54 muertes al año en el Perú, cifras que merecen ser tomadas en consideración al debatir este tema.Contribuciones de autoría: ATR y NMG han participado en la concepción y redacción del artículo Conflictos de interés: los autores declaran no tener conflictos de interés con respecto a la publicación del presente artículo.Financiamiento: autofinanciado.

A considerable lack of knowledge about tuberculosis symptoms and a low perception of risk for tuberculosis exists among public transport workers in Lima. Education strategies directed to this population need to be implemented.

Background Different prophylactic and episodic clotting factor treatments are used in the management of hemophilia. A summarize of the evidence is needed inform decision-making. Objective To compare the effects of factor replacement therapies in patients with hemophilia. Methods We performed a systematic search in PubMed, Central Cochrane Library, and Scopus. We included randomized controlled trials (RCTs) published up to December 2020, which compared different factor replacement therapies in patients with hemophilia. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42021225857). Results Nine RCTs were included in this review, of which six compared episodic with prophylactic treatment, all of them performed in patients with hemophilia A. Pooled results showed that, compared to the episodic treatment group, the annualized bleeding rate was lower in the low-dose prophylactic group (ratio of means [RM]: 0.27, 95% CI: 0.17 to 0.43), intermediate-dose prophylactic group (RM: 0.15, 95% CI: 0.07 to 0.36), and high-dose prophylactic group (RM: 0.07, 95% CI: 0.04 to 0.13). With significant difference between these subgroups (p = 0.003, I2 = 82.9%). In addition, compared to the episodic treatment group, the annualized joint bleeding rate was lower in the low-dose prophylactic group (RM: 0.17, 95% CI: 0.06 to 0.43), intermediate-dose prophylactic group (RM of 0.14, 95% CI: 0.07 to 0.27), and high-dose prophylactic group (RM of 0.08, 95% CI: 0.04 to 0.16). Without significant subgroup differences. The certainty of the evidence was very low for all outcomes according to GRADE methodology. The other studies compared different types of clotting factor concentrates (CFCs), assessed pharmacokinetic prophylaxis, or compared different frequencies of medication administration. Conclusions Our results suggest that prophylactic treatment (at either low, intermediate, or high doses) is superior to episodic treatment for bleeding prevention. In patients with hemophilia A, the bleeding rate seems to have a dose-response effect. However, no study compared different doses of prophylactic treatment, and all results had a very low certainty of the evidence. Thus, future studies are needed to confirm these results and inform decision making.