Diaz Orihuela, Maria Magdalena

Preferred name
Diaz Orihuela, Maria Magdalena
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Email
magi@upeu.edu.pe
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    Global, regional, and national burden of HIV/AIDS, 1990–2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021
    (2024-11-25)
    ;
    Meixin Zhang
    ;
    Khai Hoan Tram
    ;
    Magdalene K Walters
    ;
    Deepa Jahagirdar
    BACKGROUND: As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally. METHODS: We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period. FINDINGS: Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels. INTERPRETATION: Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat. FUNDING: The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.
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    Neuroepidemiology of transverse myelitis and its etiologies in Latin America: A systematic review and meta-analysis
    (2025-03-01)
    ;
    Chhitij M. Tiwari
    ;
    Marleny Nolasco
    ;
    Bettsie Garcia
    ;
    Carrie Baldwin-SoRelle
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    Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: a multicountry time-series study in 757 global locations
    (2025-09-01)
    ;
    Xiong Ying
    ;
    Francesco Sera
    ;
    Ana Maria Vicedo-Cabrera
    ;
    Rosana Abrutzky
    Background The presence of benzene, toluene, ethylbenzene, and xylene isomers (BTEX) in the environment is of increasing concern due to their toxicity and ubiquity.Although the adverse health effects of BTEX exposure have been documented, robust epidemiological evidence from large-scale, multicountry studies using advanced exposure assessment methodologies remains scarce.We aimed to assess the association of short-term ambient exposure to individual BTEX components and their mixture with daily total, cardiovascular, and respiratory mortality on a global scale. Methods Daily data on mortality, meteorological factors, and air pollution were collected from 757 locations across 46 countries or regions. Data on individual chemicals (ie, benzene, toluene, xylenes [summation of ethylbenzene, m-xylene, p-xylene, and o-xylene]) and the aggregate mixture (ie, BTEX) were estimated using a chemistry-climate model.We examined the short-term associations of each individual chemical as well as the BTEX mixture with daily total, cardiovascular, and respiratory mortality in a multicountry framework.Using a two-stage time-series design, we first applied generalised additive models with a quasi-Poisson distribution to obtain location-specific associations, which were subsequently pooled using random-effects meta-analysis.Two-pollutant models were used to assess the independent effects of BTEX after adjusting for co-pollutants (PM 25 , PM 10 , nitrogen dioxide, sulphur dioxide, ozone, and carbon monoxide).Additionally, we assessed the overall exposure-response curves with spline terms.Findings An IQR increment of BTEX concentration on lag 0-2 days (3-day moving average of the present day and the previous 2 days) was associated with increases of 057% (95% CI 049-065), 042% (030-054), and 068% (050-086) in total, cardiovascular, and respiratory mortality, respectively.The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 038-061%, 044-070%, and 041-065%, respectively.The associations remained significant after adjusting for co-pollutants, with a general decline in magnitude, except for a slight increase after adjustment for ozone.The shape of the exposureresponse curves for all pollutants and causes of death was almost linear, with steeper slopes at low concentrations and no discernible thresholds.Interpretation This global study provides novel evidence linking short-term exposure to ambient BTEX, both individually and as a mixture, with increased daily total, cardiovascular, and respiratory mortality.Our findings underscore the need for comprehensive air pollution mitigation policies, including stringent controls on BTEX emissions, to protect public health.
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    ESTRESSE EM IDOSOS NO CONTEXTO DA PANDEMIA DA COVID-19 E SEUS FATORES ASSOCIADOS
    (2023-01-01)
    ;
    Lili Fernandes-Molocho
    ;
    Maria Rosario Mocarro-Aguilar
    ;
    ;
    Jack Roberto Silva Fhon
    RESUMO: Objetivo: identificar o estresse nos idosos que vivem na cidade de Lima e sua associação com fatores demográficos, infodemias, a presença de sintomas físicos e psicológicos e o uso de substâncias ilícitas no contexto da pandemia de COVID-19. Método: estudo quantitativo, transversal e analítico através da pesquisa baseada na web com 384 idosos da cidade de Lima - Peru, entre abril e agosto de 2021. Os instrumentos de perfil demográfico, Escala de Estresse Percebido e sintomas autorrelatados foram utilizados para o estudo. A regressão logística múltipla foi utilizada, considerando o nível de significância de 5%. Resultados: 62% eram mulheres, e a idade variou entre 60 e 95 anos, com uma média de 70,5 anos. A média de estresse foi de 26,8 pontos. O estresse estava associado ao medo da morte de parentes e à preocupação com os idosos. Conclusões: é importante para profissionais de saúde treinados para identificar mudanças de humor nos idosos e criar planos de cuidados individualizados.
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    Nivel de conocimiento sobre el Proceso de Atención de Enfermería (PAE) en el cuidado de la salud espiritual de los profesionales de Enfermería que laboran en las unidades críticas del Hospital Nacional Hipólito Unanue, Lima 2010
    (2019-08-01)
    ;
    Nira Cutipa Gonzáles
    ;
    Rosa Matos Salgado
    Objetivo: Determinar el nivel de conocimiento sobre el Proceso de Atención de Enfermería (PAE) en el cuidado de la salud espiritual que posee el profesional de enfermería que labora en las unidades críticas: Cirugía, Emergencia y UCI del Hospital Hipólito Unanue”, Lima, 2010. Material y métodos: El estudio fue de diseño no experimental, de enfoque cuantitativo, de tipo descriptivo transversal. La muestra estuvo conformada por 40 enfermeras que laboran en las unidades críticas del Hospital Hipólito Unanue, determinada mediante un muestreo probabilístico aleatorio. Para la recolección de datos se utilizó como instrumento el cuestionario para medir el nivel de conocimiento de los enfermeros sobre el PAE del cuidado de la salud espiritual, el cual fue elaborado por las investigadoras. El instrumento fue sometido a juicio de expertos y a la prueba de confiabilidad de Alpha de Cronbach (0.73). El análisis e interpretación de los mismos se realizó utilizando el paquete estadístico SPSS v. 15. Resultados: Los resultados obtenidos, en cuanto al nivel de conocimiento sobre el PAE del cuidado de la salud espiritual fueron: un 57.5% muestra un nivel de conocimiento deficiente, un 27.5% un nivel regular, un 12.5% un nivel bueno y solo un 2.5% un nivel excelente, esto indica que la mayoría de enfermeras encuestadas tiene un nivel conocimiento deficiente sobre el PAE en el cuidado espiritual. Conclusión: La mayoría de los enfermeros desconoce el fundamento científico del PAE sobre el cuidado de la salud espiritual, siendo esto una limitante para brindar los cuidados de Enfermería de forma integral.
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    Short-term association between hot nights and mortality: a multicountry analysis in 178 locations considering hourly ambient temperature
    (2025-08-22)
    ;
    Francesco Sera
    ;
    Aurelio Tobı́as
    ;
    Masahiro Hashizume
    ;
    Yasushi Honda
    BACKGROUND: The rise in hot nights over recent decades and projections of further increases due to climate change underscores the critical need to understand their impact. This knowledge is essential for shaping public health strategies and guiding adaptation efforts. Despite their significance, research on the implications of hot nights remains limited. OBJECTIVE: This study estimated the association between hot-night excess (the sum of excess heat during the nighttime above a threshold) and duration (the percent of nighttime with a positive excess) based on hourly ambient temperatures and daily mortality in the warm season over multiple locations worldwide. METHODS: We fitted time series regression models to mortality in 178 locations across 44 countries using a distributed lag non-linear model over lags of 0-3 days, controlling for daily maximum temperature and daily mean absolute humidity. Next, we used a multivariate meta-regression model to pool results and estimated attributable burdens. RESULTS: We found a positive, increasing mortality risk with hot-night excess and duration. Assuming 0 as a reference, the pooled relative risks of death associated with extreme excess and duration, defined as the 90th percentile in each index, were both similar at 1.026 (95 % CI, 1.017; 1.036) and 1.026 (95 % CI, 1.013; 1.040). The overall estimated attributable fractions were also observed to be closely similar at 0.60 % (95 % CI, 0.09; 1.10 %) and 0.62 % (95 % CI, 0.00; 1.23 %), respectively. DISCUSSION: This study provides new evidence that hot nights have a specific contribution to heat-related mortality risk. Modeling thermal characteristics' sub-hourly impact on mortality during the night could improve decision-making for long-term adaptions and preventive public health strategies.
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    Neurocognitive disorders, depression, and associated factors in younger and older adults from an urban‐marginalized area of Peru
    (2025-10-01)
    ;
    Eder Herrera‐Pérez
    ;
    Rosa Montesinos
    ;
    Chhitij Tiwari
    ;
    Nilton Custodio
    INTRODUCTION: In urban-marginalized areas of low-to-middle-income countries (LMICs), neurocognitive disorders (NCDs) and depression present significant public health issues, exacerbated by socioeconomic disparities. METHODS: This study explores the prevalence and risk factors of NCDs and depression among 1064 community-dwelling adults in an urban-marginalized district of Lima, Peru. Structured questionnaires collected demographic, health, and socioeconomic data; neurocognitive assessments and depression screening were conducted. RESULTS: Mean age was 50.5 years, with 71% female, and a mean of 9.1 years of education. Among older adults, 32% had mild NCD and 4.2% had major NCD; 21.1% of younger adults had any NCD. Nearly 40% of the cohort was depressed. Risk factors for MCI and NCD included lower education, hypertension, and non-Spanish native language, while depression was associated with female sex, lower education, overcrowding, and chronic diseases. DISCUSSION: The study emphasizes the need for targeted interventions to address NCDs and mental health in urban-marginalized areas of LMICs. HIGHLIGHTS: Among older adults, 32% had mild neurocognitive disorder (NCD) and 4.2% had major NCD; 21.1% of younger adults had any NCD. Nearly 40% of the cohort was depressed. Risk factors for mild cognitive impairment (MCI) and NCD included lower education, hypertension, and non-Spanish native language, while depression was associated with female sex, lower education, overcrowding, and chronic diseases.
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