Background Cervical cancer continues to show a high burden among young women worldwide, particularly in low- and middle-income countries. Limited data is available describing cervical cancer mortality among young women in Latin America and the Caribbean (LAC). The purpose of this study was to examine the mortality trends of cervical cancer among young women in LAC and predict mortality rates to 2030. Methods Deaths from cervical cancer were obtained from the World Health Organization mortality database. Age-standardized mortality rates per 100,000 women-years were estimated in women aged 20–44 years using the world standard population for 16 countries (and territories) in LAC from 1997 to 2017. We estimated the average mortality rates for the last 4 years (2014–2017). Joinpoint regression models were used to identify significant changes in mortality trends. Nordpred method was used for the prediction of the mortality rates to 2030. Results Between 2014 and 2017, Paraguay and Venezuela had the highest mortality rates of cervical cancer, whereas Puerto Rico had the lowest rates. Overall, most of the LAC countries showed downward trends of cervical cancer mortality over the entire period. Significant decreases were observed in Chile (Average annual percent change [AAPC]: − 2.4%), Colombia (AAPC: − 2.0%), Cuba (AAPC: − 3.6%), El Salvador (AAPC: − 3.1%), Mexico (AAPC: − 3.9%), Nicaragua (AAPC: − 1.7%), Panama (AAPC: − 1.7%), and Peru (AAPC: − 2.2%). In contrast, Brazil (AAPC: + 0.8%) and Paraguay (AAPC: + 3.7%) showed significant upward trends. By 2030, mortality rates are not predicted to further decrease in some LAC countries, including Argentina, Paraguay, and Venezuela. Conclusions Mortality trends of cervical cancer among young women have large variability in LAC countries. Cervical cancer screening programs have a high priority for the region. Primary and secondary prevention in the community are necessary to accelerate a reduction of cervical cancer mortality by 2030.

Objectives. The analysis of transmission dynamics is crucial to determine whether mitigation or suppression measures reduce the spread of coronavirus disease 2019 (COVID-19). This study sought to estimate the basic (R0) and time-varying (Rt) reproduction number of COVID-19 and contrast the public health measures for ten South American countries. Methods. Data was obtained from the European Centre for Disease Prevention and Control. Country-specific R0 values during the first two weeks of the outbreak and Rt values after 90 days were estimated. Results. Countries used a combination of isolation, physical distancing, quarantine, and community-wide containment measures to staunch the spread of COVID-19 at different points in time. R0 ranged from 1.52 (95% confidence interval: 1.13-1.99) in Venezuela to 3.83 (3.04-4.75) in Chile, whereas Rt after 90 days ranged from 0.71 (95% credible interval: 0.39-1.05) in Uruguay to 1.20 (1.19-1.20) in Brazil. Different R0 and Rt values may be related to the testing capacity of each country. Conclusion. R0 in the early phase of the outbreak varied across the South American countries. The public health measures adopted in the initial period of the pandemic appear to have reduced Rt over time in each country, albeit to different levels.

BackgroundSchool violence and bullying are prevalent problems that affect health in general, especially through the development of emotional and behavioral problems, and can result in the deterioration of the academic performance of the student victim. The objective of this study was to determine the prevalence rates of aggressive behaviors according to types of school violence and bullying, sociodemographic characteristics, and variation by department, region, and time in the period between 2014 and 2018 in Peru.MethodsThe design was observational and cross-sectional based on data from the Specialized System for Reporting Cases of School Violence (Sistema Especializado en Reporte de Casos sobre Violencia Escolar—SíseVe) in Peru, which covers a population of 23,641 students at the initial, primary, and secondary levels of Basic Regular Education [Educación Básica Regular (EBR)], for the 2014–2018 period. The prevalence rates of the different types of school violence and bullying, the sociodemographic characteristics, and the variation by department, region, and time in the period between 2014 and 2018 were estimated.ResultsPsychological violence/bullying occurred at higher prevalence rates (185.8 and 62.6 per 100,000 residents). Women from public institutions reported greater sexual violence, mostly by teachers (67.8%) than by other students (32.2%). The Selva region had the highest prevalence rate of sexual violence (10.1 per 100,000 residents). The departments of Tacna and Piura had the highest and lowest rates of psychological/verbal violence and bullying in 2018 (95.79 and 25.31 per 100,000 residents).ConclusionPsychological/verbal violence and bullying is highly prevalent among students; women report being victims of sexual violence by administrative personnel of public institutions. The Selva region had the highest rate of sexual violence, and Piura and Tacna had the highest and lowest rates of violence and psychological/verbal bullying. Based on these results, it is suggested to conduct evidence-based prevention programs in Peruvian schools to reduce these social problems.

Background Cervical cancer is the third leading cause of cancer-related death among Latin American women. Peru has the sixth highest mortality rate for cervical cancer in the region with regional variations. We aimed to determine overall and regional cervical cancer mortality rates and trends in Peru between 2008 and 2017. Methods We performed an ecological study on the number of deaths by cervical cancer in Peru. Deaths were extracted from the Peruvian Ministry of Health mortality database. Age-standardized mortality rates (ASMR) were estimated per 100,000 women-years using the world standard Segi population. We computed mortality trends using the Joinpoint regression program, estimating the annual percent change (APC). For spatial analysis, GeoDA software was used. Results Peru showed downward trends in the last decade (from 11.62 in 2008 to 9.69 in 2017 (APC = − 2.2, 95% CI: − 4.3, − 0.1, p < 0.05). According to regional-specific analysis, the highest ASMR was in the rainforest region, although this declined from 34.16 in 2008 to 17.98 in 2017 (APC = − 4.3, 95% CI: − 7.2, − 1.3, p < 0.01). Concerning spatial analysis and clustering, the mortality rates from 2008 to 2017 showed a positive spatial autocorrelation and significant clustering (Moran’s I: 0.35, p < 0.001) predominantly in the neighboring North-East departments (Loreto, Ucayali, and San Martin). Conclusions Although mortality trends in the entire population are decreasing, mortality rates remain very high, mainly in the rainforest region. Our results encourage a need for further development and improvement of the current health care delivery system in Peru.

Background Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary. Purpose Evaluate the effect of a one-off priest-led intervention on the choice and preference of soda beverages. Methods We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees, in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one’s health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests. Results Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%–14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15). Conclusions This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice. Clinical Trial information ISRCTN, ISRCTN24676734. Registered 25 April 2017, https://www.isrctn.com/ISRCTN24676734

Objectives: Lung cancer continues to be the leading cause of cancer-related deathworldwide. Have been reported high mortality rates from lung cancer in Latin America, but the disparities within the regions of Peru and under-reporting death certification reported prevent the inclusion of Peru in analysis of the mortality trends for lung cancer. We evaluated lung cancer mortality trends and smoking prevalence in Peru and its geographical areas. Materials and Methods: We obtained the data from the registry of the Peruvian Ministry of Health between 2008 and 2017. Mortality rates per 100,000 person-years were computed using the world's SEGI population and trends were analyzed using the Joinpoint regression Program Version 4.7.0. Smoking prevalence was estimated from the Demographic and Family Health Survey. Results: In Peru, mortality rates were roughly 1.3 times higher in males than in females. The coast region had significant downward trends among males, whereas the highlands region had significant upward trends among females. According to provinces, Apurimac showed an annually significant rise in both sexes (+10.6% in males, and +11.6% in females). In general, smoking prevalence was higher in males compared to females, principally among young adults. Conclusions: Peru showed downward mortality trends in the last decade with variability across regions. Males had a higher smoking prevalence, principally among young adults. Public health interventions for smoking reduction should be implemented to reduce lung cancer mortality.

El mundo atraviesa una crisis de enfermedades no transmisibles (ENT) junto con un panorama de volatilidad climática. El 99% de la carga en salud del cambio climático será asumida por los países en vías de desarrollo. La mejor oportunidad que tiene el Perú frente a la inminencia del cambio climático recae en desarrollar políticas enfocadas en crear cobeneficios mediante las estrategias de mitigación y adaptación al cambio climático que, a la vez, representen mejoras sobre el panorama de las ENT y la salud en general. En este artículo presentamos los compromisos asumidos por el Perú en estrategias de mitigación de emisiones de gases de efecto invernadero (GEI); identificamos oportunidades en salud pública para el Perú en el Acuerdo de París de la 21.ª Conferencia de las Partes (COP21); y culminamos con las recomendaciones sobre la generación de evidencia y políticas para para la Academia y el Gobierno. ABSTRACTThe world is facing a crisis of noncommunicable diseases alongside a state of climate volatility. Of the total health burden attributable to climate change, 99% will be assumed by developing countries. In light of climate change, Peru's best opportunity is to create mitigation and adaptation policies focused on developing health co-benefits, which will improve the state of noncommunicable diseases and the climate system. This article presents Peru's compromises in terms of mitigation of greenhouse gas emissions; identifies public health opportunities for Peru under the Paris Agreement signed in the 21st Conference of the Parties (COP21); and makes recommendations for evidence and policy generation for the National Academy of Medicine and the Peruvian government. a Estudiante de Medicina; b licenciada en Enfermería; c cirujano dentista, d médico, magíster y doctor en Epidemiología Recibido: 20-01-16 Aprobado: 09-03-16 Citar como: Avilez JL, Bazalar J, Azañedo D, Miranda JJ. Perú, cambio climático y enfermedades no trasmisibles: ¿Dónde estamos y a dónde vamos?. Rev Peru Med

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