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El SARS-CoV-2 es un virus ARN monocatenario de la familia de los coronavirus, causante de la COVID-19 (Coronavirus Disease 2019). Este virus es responsable de la pandemia actual que, desde su aparición a finales de 2019, ha provocado la muerte de millones de personas y ha tenido un impacto global no solo a nivel sanitario sino también económico y social. Por ello, el presente artículo tiene como objetivo revisar la información más actualizada sobre el SARS-CoV-2, empezando por describir los mecanismos de transmisión del virus, su fisiopatología y filogenética. Asimismo, presentará a las variantes emergentes del SARS-CoV-2, su relevancia para la salud pública local y global, su epidemiología en Perú, y finalmente, el rol y la importancia de las vacunas en este contexto. / SARS-CoV-2 is a single-stranded RNA virus of the coronavirus family, which causes COVID-19 (Coronavirus Disease 2019). This virus is responsible for the current pandemic, which, since its emergence in late 2019, has caused millions of deaths and has had a global impact not only on public health but also on social and economic areas. Therefore, this article aims to review the most up-to-date information on SARS-CoV-2, beginning with the description of the pathophysiology and phylogenetics of the virus. Also, we will present the emerging SARS-CoV-2 variants, their relevance for local and global public health, their epidemiology in Peru, and finally, the role and importance of vaccines in this context.

Objetivos. Diseñar y validar un instrumento para evaluar la percepción de riesgo de contagio de COVID-19 en población colombiana. Materiales y métodos. Estudio observacional transversal de tipo psicométrico con una muestra de 2350 personas entre los 16 a 65 años, se propusieron las dimensiones e ítems a partir de la revisión de estudios previos sobre la evaluación de la percepción de riesgo en enfermedad y desastres, integrando los lineamientos expuestos por la Organización Mundial de la Salud respecto a las medidas de autoprotección y protocolos de bioseguridad para evitar el contagio de la COVID-19. El proceso de validación ocurrió en dos momentos, primero con una revisión por jueces expertos que evaluaron claridad, suficiencia y pertinencia de cada ítem con respecto a la variable y su dimensión; en segundo momento un análisis factorial confirmatorio y se estimó la consistencia interna con los índices de alpha de Cronbach (α) y omega de McDonald (ω). Resultados. El instrumento elaborado tuvo adecuadas propiedades psicométricas para evaluar la percepción de riesgo de contagio de COVID-19 (α=0,924), con cuatro dimensiones: vulnerabilidad cognitiva (α=0,873); vulnerabilidad emocional (α=0,882); gravedad (α=0,893) y las conductas de riesgo-protección (α=0,941). Conclusiones. Los hallazgos muestran que el instrumento de percepción de riesgo de contagio de COVID-19 (PCRCV19) es una herramienta válida y confiable para evaluar la percepción de riesgo contagio, el cual puede ser adaptado en diferentes grupos poblacionales y contextos.

<p>This dissertation examines lead exposure and effects across the lifespan among vulnerable populations. The vulnerable population that this dissertation focuses on are the elderly, newcomers to the US, which represents immigrants, as well as adolescents and women of childbearing age. The first chapter gives an introduction and highlights the history of lead as it relates to environmental and occupational exposure having deleterious effects on the human system. The second chapter highlights the association between blood lead level and subsequent Alzheimer’s disease (AD) mortality in those 65 years and older. Chapter 3 looks at whether length of time in the United States is a predictor of adolescent and adult blood lead levels. The fourth chapter assesses whether early life lead exposure is associated with AD mortality later in life. Adaptations of Chapter 2 and Chapter 3 of this dissertation have been submitted for publication.</p><p>Chapter 2 presents a longitudinal study of 8080 elders (≥60 years) with BLL data from the 1999-2008 National Health and Nutrition Examination Survey, where mortality was determined from linked 1999-2014 National Death Index data. In this study, a causal diagram presented causal assumptions and identified a sufficient set of confounders: age, sex, poverty, race/ethnicity, and smoking. Cox proportional hazard models were used to determine the association between BLL and subsequent AD mortality. Impacts of competing risks and design effect were also assessed. Adjusted hazard rate ratio (HRR) and 95% confidence interval (CI) were reported. Results showed that those with BLL of 1.5 μg/dL and 5 μg/dL had 1.2 (95% CI: 0.70, 2.1) and 1.4 (95% CI: 0.54, 3.8) times the rate of AD mortality compared to those with BLL of 0.3 μg/dL, respectively, after accounting for competing risks. Adjusted HRRs were 1.5 (95% CI 0.81, 2.9) and 2.1 (95% CI 0.70, 6.3), respectively, after considering design effect. This longitudinal study demonstrated a positive, albeit statistically non-significant association between BLL and AD mortality, after adjustment for competing risks or design effect.</p><p>Chapter 3 included cross-sectional 1580 women of childbearing age (15-45 years) and 5933 men and women (≥15 years) from the 2013-2016 United States National Health and Nutrition Examination Survey. Linear regression models adjusted for race/ethnicity, education, blood cotinine, age, sex (as appropriate) and accounted for complex survey design. Results showed that women of childbearing age who have lived 0-4 years in the US have, on average, a 43% (95% confidence interval (CI): 31%, 56%) higher BPb compared to women born in the US. Corresponding results for all adults and adolescents was 40% (95% CI: 28%, 51%). Similar, statistically significant, results were observed for other time periods (5-9 years, 10-19 years, and ≥20 years); the magnitude of the association decreased with increasing time in the US. Higher BPb was also significantly associated with Asian (vs. white), lower education, higher age, and male (vs. female).</p><p>Chapter 4 is an ecologic study utilizing data from the United States Census Bureau and American Fact Finder. This ecologic study uses publicly available data from the 1930s US census and the Centers for Disease Control and Prevention to compare estimated historic lead exposure with AD mortality rates among US states and Indiana counties. Occupations were assigned a numeric weight based on the likelihood of lead exposure. The proportion of workers in each occupation multiplied by this weight was used to create a historic lead exposure index; quintiles of this index were used in analyses. AD mortality rates among persons ≥ 65 years old from 1999-2016 were obtained from the Centers for Disease Control and Prevention. The relationship between the historic exposure index and mortality was evaluated using correlation coefficients and linear regression models adjusting for age, sex, education, socioeconomic status (SES). Maps to characterize spatial pattern of historic lead exposure and AD mortality were completed using Geographic Information System (GIS) spatial analysis tools for the U.S. at state level and at county level for Indiana. Results showed that among states, the average AD mortality rate was 202.2 per 100,000 (SD=44.4). Within Indiana, the average AD mortality rate was 209.6 per 100,000 (SD= 64.9). Among Indiana counties, the unadjusted model shows an association of higher HEI with higher AD mortality, with the fifth quintile reaching statistical significance. Results for the adjusted model were not statistically significant. Results for US states for both unadjusted and adjusted regression models show that the third, fourth, and fifth quintiles of the historic exposure index were associated with a significantly lower AD mortality rate when compared to the lowest quintile.</p><p>Conclusion: The first study, using a longitudinal design, shows a positive but non-significant association between BLL and subsequent AD mortality after adjustments for competing risks or design effects. The second study, using a cross-sectional design, showed that newcomers to the US may be a population at higher risk for elevated BPb. The third, ecological study, did not find any significant association between historic lead exposure and AD mortality rates for Indiana counties, however there was a significant association of higher historic lead exposure index with lower AD mortality rates for states in the US.</p>

Content removed due to copyright restrictions: Appendix 6: Paper presented at the 15th New Zealand Ergonomics Society Conference: Ergonomics for the Ageing Population, Martinborough. Scuffham, A., Stevenson, M., Legg, S. & Firth, E. Prevalence of musculoskeletal discomfort in New Zealand small animal veterinarians. In: 15th New Zealand Ergonomics Society Conference: Ergonomics for the Ageing Population. Eds R. G. Adank & L. Gardner Wood. Martinborough, New Zealand Ergonomics Society. 27-28 May, 2009, [CD-ROM]. Appendix 7: Paper presented at the Society of Diary Cattle Veterinarians of the New Zealand Veterinary Association 26th annual conference, Rotorua. Scuffham, A., Firth, E., Stevenson, M., & Legg, S. Musculoskeletal discomfort in New Zealand large animal veterinarians. In: Proceedings of the Society of Dairy Cattle Veterinarians of the New Zealand Veterinary Association 26th annual conference. Ed. T. Parkinson. VetLearn, Palmerston North. 24-27 June 2009, pg 201-204. Appendix 8: Paper presented at the New Zealand Equine Veterinary Association Annual Conference, Taupo. Scuffham, A., Firth, E., Stevenson, M. & Legg, S. Musculoskeletal discomfort in New Zealand equine veterinarians. In: Proceedings of the New Zealand Equine Veterinary Association of the NZVA Annual Conference. Ed. M Leyland. VetLearn, Palmerston North. 24-27 June 2009, pg 163. Appendix 9: Paper presented at the 17th International Ergonomics Association World Congress on Ergonomics, Beijing. Musculoskeletal discomfort in New Zealand (non-clinical) veterinarians. Scuffham, A., Legg, S., Stevenson, M. & Firth, E. (9-14 August, 2009). [CD-ROM] / This thesis comprises three chapters about musculoskeletal discomfort (MSD) in veterinarians. Two of these chapters have been submitted to peer reviewed journals and one is in preparation for submission. The first chapter describes the prevalence and risk factors associated with MSD in New Zealand veterinarians. The second chapter is a paper on the tasks considered by veterinarians to cause MSD. The third chapter is a review of published literature on musculoskeletal problems (MSP) in veterinarians. The first chapter in this thesis describes a cross-sectional study of 867 New Zealand veterinarians. We used a modified Nordic musculoskeletal questionnaire to enquire about the presence or absence of MSD, whether this affected normal activities and if MSD necessitated absenteeism from work. Additional questions enquired about work activities, psychosocial factors and workload. The overall period prevalence of MSD was 96%. Normal activities were affected in 67% and 18% of participants reported that they had been absent from work due to MSD. Factors associated with the presence of MSD requiring time off work for clinical veterinarians included 10 year increases in age (odds ratio (OR) 1.26, 95% CI 1.05 - 1.52), work involving awkward grip and hand movements 100% of time (OR 12.91, 95% CI 3.46 – 84.21) and those who were dissatisfied with the level and difficulty of their work (OR 2.72, 95% CI 1.11 - 6.56). In the second chapter in this thesis, veterinarians were asked to indicate tasks that they considered ‘most likely to lead to musculoskeletal aches and pains’ and ‘why these tasks were likely to be the most risky’. They were also asked to suggest ‘any solutions that they applied or knew of’ to reduce musculoskeletal aches and pains. They identified the following tasks: lifting, surgery, rectal palpations and animal handling. Their reasons were primarily related to physical risk factors. Few identified psychosocial risk factors. The most common suggested solutions involved training and selection strategies rather than redesign of tasks, activities or facilities. These findings are consistent with a participatory ergonomics approach for reducing the risk of MSD, which aims to enhance personal well-being and improved system performance. The third chapter in this thesis - a review of the literature - focuses on the prevalence and nature (discomfort, pain, injury and disorders) of MSP amongst veterinarians. Veterinarians are exposed to a range of physical and psychosocial occupational hazards that have been well documented and associated with MSP. The range of reported prevalence estimates in this review was 50% to 96%. This range may reflect real differences among the veterinary populations studied, or more likely be due to differences in MSP definitions, study methodologies, and response rates. The magnitude of the reported prevalence justifies further research to triangulate data and determine other factors associated with MSD. Most of the studies in the review focused on physical risk factors. The lack of studies into psychosocial risk factors for MSP needs to be addressed.

Objetivos: Estimar la prevalencia y los factores asociados a la intención de vacunación (IDV) contra la COVID-19 en el Perú. Materiales y métodos: Estudio transversal analítico utilizando una encuesta realizada por la Universidad de Maryland, EUA, en Facebook. La variable dependiente fue la IDV. Se calcularon razones de prevalencia (RP) crudas y ajustadas, con sus intervalos de confianza al 95% (IC95%), mediante modelos lineales generalizados de la familia Poisson para evaluar la asociación de variables sociodemográficas, el cumplimiento de estrategias comunitarias de mitigación, los síntomas de la COVID-19, la salud mental y la aceptación de la vacunación ante la recomendación (AVR) por diversos actores y autoridades sanitarias. Resultados: Se analizaron los datos de 17 162 adultos. La prevalencia general de la IDV fue del 74,9%. Se asociaron a una menor prevalencia de la IDV ser de sexo femenino (RP = 0,95; IC95%: 0,94-0,97), vivir en un pueblo (RP = 0,95; IC95%: 0,91-0,99) o en una aldea u otra área rural (RP = 0,90; IC95%: 0,86-0,93) y la AVR de políticos (RP = 0,89; IC95%: 0,87-0,92). Contrariamente, tener síntomas de COVID-19 (RP = 1,06; IC95%: 1,03-1,09), inseguridad económica (RP = 1,04; IC95%: 1,01-1,06), miedo a enfermar o que un familiar enferme de COVID-19 (RP = 1,49; IC95%: 1,36-1,64) y la AVR de familiares y amigos (RP = 1,10; IC95%: 1,08-1,12), trabajadores de la salud (RP = 1,29; IC95%: 1,26- 1,32), la Organización Mundial de la Salud (RP = 1,34; IC95%: 1,29-1,40) y funcionarios del gobierno (RP = 1,18; IC95%: 1,15-1,22) se asociaron con mayor prevalencia de IDV. Conclusiones: Tres cuartas partes de los encuestados manifiestan IDV. Existen factores potencialmente modificables que podrían mejorar la aceptación de la vacuna. / Objectives: To estimate the prevalence and factors associated with COVID-19 vaccination intention (VI) in Peru. Materials and methods: Analytical cross-sectional study using the survey conducted by the University of Maryland, USA, on Facebook. The dependent variable is VI. Crude and adjusted prevalence ratios (PR) were calculated, with their 95% confidence intervals (95%CI) using generalized linear models of the Poisson family, to evaluate the association of sociodemographic variables, com- pliance with community mitigation strategies, symptoms of COVID-19, mental health and acceptance of vaccination before the recommendation (AVR) by various actors and health authorities, with the ITV. Results: Data from 17,162 adults were analyzed. The overall prevalence of VI was 74.9%. A lower prevalence of VI was associated with the female sex (PR=0.95; 95%CI:0.94-0.97), living in a town (PR=0.95; 95%CI:0.91-0.99) or village or other rural area (PR=0.90; 95%CI:0.86-0.93) and the AVR of politicians (PR=0.89; 95%CI:0.87-0.92). Conversely, having COVID-19 symptoms (PR=1.06; 95%CI:1.03-1.09), economic insecurity (PR=1.04; 95%CI:1.01-1.06), fears of becoming seriously ill or that a family member becomes seriously ill from COVID-19 (PR=1.49; 95%CI:1.36-1.64) and the AVR of family and friends (PR=1.10; 95%CI: 1.08-1.12), healthca- re workers (PR=1.29; 95%CI: 1.26-1.32), World Health Organization (PR=1.34; 95%CI: 1.29-1.40) and government officials (PR=1.18; 95%CI: 1.15-1.22) was associated with a higher prevalence of VI. Conclusio of the respondents had VI. There are potentially modifiable factors that could improve vaccine acceptance.

Se reporta el caso de un varón de 62 años quien presentó tos y dolor abdominal por dos semanas, con hallazgos tomográficos pulmonares compatibles con probable infección por SARS-CoV-2, que recibió tempranamente corticoterapia a dosis altas y de manera ambulatoria. El paciente presentó evolución tórpida, fue hospitalizado y falleció en el posoperatorio inmediato por un cuadro de abdomen agudo quirúrgico. El estudio anatomopatológico mostró estructuras parasitarias con características compatibles con amebas, como causa de una colitis aguda fulminante complicada, con perforación múltiple y peritonitis aguda. La colitis aguda fulminante por amebiasis intestinal en el contexto de un paciente con probable COVID-19 no había sido reportada en el Perú. Resulta importante resaltar la presentación fulminante con desenlace fatal de esta infección parasitaria prevalente en nuestro medio, en el contexto del uso de corticoides ante una probable infección pulmonar por COVID-19. / We report the case of a 62-year-old male with cough and abdominal pain for two weeks, associated with pulmonary tomographic findings compatible with probable infection by SARS-CoV-2, and who received high doses of early corticotherapy as an outpatient. The patient showed clinical deterioration, was hospitalized and died in the immediate postoperative period due to acute surgical abdomen. The anatomopathological study showed parasitic structures with characteristics compatible with amebae, which was pointed to as the cause of a complicated acute fulminant colitis, with multiple perforations and acute peritonitis. Acute fulminant colitis due to intestinal amebiasis in the context of a patient with probable COVID-19 had not been previously reported in Peru. It is important to highlight the fulminant presentation with fatal outcome of this prevalent parasitic infection, in the context of corticosteroids use in a probable SARS-CoV-2 pulmonary infection.

Con el objetivo de evaluar las tendencias en el uso de fármacos en pacientes con la COVID-19 en un hospital del Perú durante la primera ola de la pandemia se realizó un estudio retrospectivo entre abril y septiembre del 2020. Se revisaron las historias clínicas de pacientes hospitalizados por neumonía por COVID-19 en el Hospital Nacional Dos de Mayo (Lima, Perú). De un total de 3103 pacientes, se incluyeron aleatoriamente 381 historias clínicas (77,4% de sexo masculino y una mediana de edad de 44 años). Se observó un incremento del uso de cuatro fármacos (azitromicina, ivermectina, corticoides y ceftriaxona) antes de la hospitalización, así como una disminución del uso de seis fármacos (ceftriaxona, azitromicina, hidroxicloroquina, ivermectina, pulso de corticoides y anticoagulación profiláctica) y un aumento en el uso de anticoagulación plena, durante la hospitalización. Estos hallazgos sugieren que el manejo de la COVID-19 varió durante la primera ola de la pandemia, aumentando el uso de fármacos prehospitalarios y disminuyendo el uso de fármacos intrahospitalarios.

Se validó y evaluó un método de RT-PCR en tiempo real usando cebadores y sondas específicas para los genes RdRP de SARS-CoV-2 y GAPDH de humanos; este último fue usado como control endógeno. Se evaluó la especificidad y sensibilidad; además, se evaluó otros parámetros como la robustez, la repetibilidad, reproducibilidad, comparabilidad y el límite de detección. La sensibilidad, especificidad, los valores predictivos positivo y negativo, la robustez, comparabilidad y la repetibilidad-reproducibilidad de la prueba de RT-PCR en tiempo real dúplex fue de 100%, con un límite de detección de 100 copias/μL, de acuerdo con los criterios de aceptación establecidos para validación del protocolo. Esta prueba estandarizada es una buena alternativa para el diagnóstico de COVID-19; además, la prueba fue aplicada de manera exitosa en personas sospechosas de la enfermedad permitiendo controlar el número de falsos negativos.

This study was conducted in a rubber farming community in Southern Thailand with rubber farmers and their first-line public healthcare providers as the study informants. The study aims were to first, explore perceived effects of work exposures in rubber farming on rubber farmers’ health, second, identify decisions made in response to the effects of work exposures on health, and third, determine influencing factors on the construction of the perception and the process of decision making. Data were obtained using ethnographic research methods, underpinned by an interpretative paradigm. Unstructured interviews and participant observation were employed as the principal means of data collection. Together with the primary methods of data collection, note taking (fieldnotes, fieldwork personal journal, and photographs) and reviewing/analysing existing documents were employed. While data were being collected, initial data analysis was carried out to make sense of information gained and direct further steps of the data collection. After terminating the data collection, ethnographic data analysis suggested by Spradley (1979, 1980) was used to determine themes to meet the aims of the study. The study findings reveal that individual rubber farmers and healthcare providers construct perceptions of effects of rubber farming on rubber farmers’ health and decisions on the actions taken to manage the rubber farmers’ work-related health problems based on their own accounts of compounding factors. Among factors identified, discrepancies between health policy and its practice, coupled with the existence of a hierarchy of power-superior-inferior relationships among individual levels of health authority-emerge as the most powerful factors, inducing the emergence of other factors. Recommendations made as a result of this study draw attention mainly to the minimisation of the discrepancies between health policies and their implications, and the establishment of partnership status among authorised health agencies and between health agencies and rubber farmers in order to improve the quality of occupational safety and health services provided to the rubber farmers.