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BACKGROUND: Violence against women (VAW) severely impacts their physical and mental health. In some cultures, women can normalize certain types of violence if they were linked to home models in childhood and, eventually, do not seek for help in adulthood. We aimed to determine, in Peruvian women, (1) the association between witnessing violence in their family of origin and VAW experienced in adulthood, (2) the extent to which women who have experienced VAW seek some help, and (3) identify VAW prevalence by Peruvian region. METHODS: Cross-sectional study of secondary data obtained from the 2019 National Demographic and Family Health Survey (ENDES). The outcome was VAW (psychological, physical and sexual violence), whereas the exposure was witnessing violence in the home of origin. Help-seeking behavior was a secondary outcome, for which VAW was the exposure. Prevalence ratios (PR) were estimated to assess both associations, unadjusted and adjusted for covariates (aPR). RESULTS: Data from 14,256 women aged 15 to 49 years were analysed. 51.5% reported having experienced VAW and 43.8% witnessed violence in the home of origin during childhood. Witnessing inter-parental violence in childhood was associated with psychological violence aPR = 1.25 (95% CI: 1.17-1.33), physical aPR = 1.52 (95% CI: 1.38-1.67), and sexual aPR = 1.99 (95% CI: 1.57-2.52). Women who have experienced both types of violence (physical and sexual) were more likely to help-seeking (aPR = 1.30, 95% CI: 1.14-1.50) than women suffering only one type of violence. CONCLUSION: Women who reported having witnessed home violence in their childhood are more likely to experience Violence Against Women (VAW) by their current partner. Physical and sexual violence with a current partner was more associated with witnessing inter-parental violence in childhood, and when physical and sexual violence jointly occurred women were more help-seeking. The southern region of Peru is identified as an area of high vulnerability for women. It is crucial to promote educative and community-based programs aimed at the prevention and early recognition of VAW.

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OBJECTIVE: Cultural adaptation of the Patient Health Questionnaire-PHQ-9 to Bolivian Quechua and analysis of the internal structure validity, reliability, and measurement invariance by sociodemographic variables. METHODS: The PHQ-9 was translated and back-translated (English-Quechua-English) to optimise translation. For the cultural adaptation, experts, and people from the target population (e.g., in focus groups) verified the suitability of the translated PHQ-9. For the psychometric analysis, we performed a Confirmatory Factor Analysis (CFA) to evaluate internal validity, calculated α and ω indices to assess reliability, and performed a Multiple Indicator, Multiple Cause (MIMIC) model for evaluating measurement invariance by sex, age, marital status, educational level and residence. We used standard goodness-of-fit indices to interpret both CFA results. RESULTS: The experts and focus groups improved the translated PHQ-9, making it clear and culturally equivalent. For the psychometric analysis, we included data from 397 participants, from which 73.3% were female, 33.0% were 18-30 years old, 56.7% reported primary school studies, 63.2% were single, and 62.0% resided in urban areas. In the CFA, the single-factor model showed adequate fit (Comparative Fit Index = 0.983; Tucker-Lewis Index = 0.977; Standardized Root Mean Squared Residual = 0.046; Root Mean Squared Error of Approximation = 0.069), while the reliability was optimal (α = 0.869-0.877; ω = 0.874-0.885). The invariance was confirmed across all sociodemographic variables (Change in Comparative Fit Index (delta) or Root Mean Square Error of Approximation (delta) < 0.01). CONCLUSIONS: The PHQ-9 adapted to Bolivian Quechua offers a valid, reliable and invariant unidimensional measurement across groups by sex, age, marital status, educational level and residence.

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The COVID-19 pandemic drastically affected higher education and higher education students around the world, but few studies of college students' experiences during the COVID-19 pandemic have been conducted in Latin America. This study describes the COVID-19-related experiences and perspectives of Peruvian college students. We surveyed 3,427 full-time college students (average age: 23 years) attending a multi-campus Peruvian university in fall 2020. Participants were recruited through the digital platform of the learning management system at their university, email, and social media. We asked participants how they were managing risks related to COVID-19; the continuity of social, educational, and work activities; and the psychological and economic impacts of the pandemic on their lives. Since March 2020, 73.0% of participants reported COVID-19-related symptoms, but only 33.9% were tested for COVID-19. During the national quarantine imposed by the Peruvian government (March 15-June 30, 2020), 64.3% of participants remained in their house. Furthermore, while 44.0% of participants were working in February 2020 (95% CI: [41.7%, 46.4%]), only 23.6% (95% CI: [21.7%, 25.7%]) were working immediately after the pandemic began (i.e., at the end of April 2020). Participants were more stressed about the health and educational implications of COVID-19 for Peruvian society and their families than about themselves. The public health, economic, and educational implications of COVID-19 on college students are continuing to unfold. This study informed Peruvian higher education institutions' continued response to the COVID-19 pandemic, the progressive return to postpandemic activities, as well as other future pandemics and other crises.

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The COVID-19 pandemic has had a major impact on family relationships, as several families have lost family members due to COVID-19 pandemic and become physically and emotionally estranged due to lockdown measures and critically economic periods. Our study contrasted two hypotheses: (1) family functioning changed notably before and after the COVID-19 pandemic initiation in terms of cohesion, flexibility, communication and satisfaction; (2) balanced families have a greater capacity to strictly comply with quarantine (i.e., social confinement), compared to unbalanced families. We performed an observational study comparing family functioning between two independent groups, evaluated before and during the first wave of the COVID-19 pandemic in Peru. A total of 7,980 participants were included in the study. For the first hypothesis, we found that, during the pandemic, families became more balanced in terms of cohesion (adjusted before-during mean difference or ß1 = 1.4; 95% CI [1.0-1.7]) and flexibility (ß2 = 2.0; 95% CI [1.6-2.4]), and families were less disengaged (ß3 = -1.9; 95% CI [-2.3 to -1.5]) and chaotic (ß4 = -2.9; 95% CI [-3.3 to -2.4]). Regarding the second hypothesis, we confirmed that families with balanced cohesion (adjusted prevalence ratio or aPR = 1.16; 95% CI [1.12-1.19) and flexibility (aPR = 1.23; 95% CI [1.18-1.27]) allowed greater compliance with quarantine restrictions; while disengaged (aPR = 0.91; 95% CI [0.88-0.93]) and chaotic families (aPR = 0.89; 95% CI [0.87-0.92]) were more likely to partially comply or not comply with the quarantine. Finally, family communication (aPR = 1.17; 95% CI [1.11-1.24]) and satisfaction (aPR = 1.18; 95% CI [1.11-1.25]) also played a role in favouring quarantine compliance. This new evidence enlightens the family systems theory while informing future interventions for improving compliance with quarantine measures in the context of social confinement.

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OBJECTIVE: . To translate and culturally adapt the Patient Health Questionnaire (PHQ-9) to three varieties of Quechua and analyse their validity, reliability, and measurement invariance. MATERIALS AND METHODS: . 1) Cultural adaptation phase: the PHQ-9 was translated from English into three variants of Quechua (Central, Chanca, Cuzco-Collao) and translated again into English. Then, experts and focus groups allowed the translations to be culturally adapted. 2) Psychometric phase: the unidimensionality of the adapted PHQ-9 was evaluated by using Confirmatory Factor Analysis (CFA), reliability was evaluated by internal consistency (Alpha and Omega), and measurement invariance according to Quechua varieties and sociodemographic variables was evaluated by using CFA, multigroups and MIMIC models (Multiple Indicator Multiple Cause). RESULTS: . Each of the adaptations of the PHQ-9 to the three Quechua varieties reported clear and culturally equivalent items. Subsequently, data from 970 Quechua-speaking adult men and women were analyzed. The general one-dimensional model reported an adequate fit (Comparative fit index = 0.990, Tucker-Lewis index = 0.987, Standardized root mean squared residual= 0.048, Root mean squared error of approximation=0.071); each of the Quechua varieties also showed an adequate fit. Reliability was high for all varieties (α = 0.865 - 0.915; ω = 0.833 - 0.881). The results of the multigroup CFA and MIMIC models confirmed measurement invariance according to Quechua variant, sex, residence, age, marital status and educational level. CONCLUSIONS: . The PHQ-9 adaptations to Central Quechua, Chanca and Cuzco-Collao offer a valid, reliable and invariant measurement, confirming that comparisons can be made between the evaluated groups. Its use will benefit mental health research and care for Quechua-speaking populations.

OBJETIVO: . Traducir y adaptar culturalmente el Patient Health Questionnaire (PHQ-9) a tres variedades del quechua y analizar su validez, confiabilidad e invarianza. MATERIALES Y MÉTODOS: . 1) Fase de adaptación cultural: el PHQ-9 fue traducido del inglés a tres variantes del quechua (Central, Chanca, Cuzco-Collao) y traducido nuevamente al inglés, posteriormente expertos y grupos focales permitieron adaptar culturalmente las traducciones. 2) Fase psicométrica: se evaluó la uni-dimensionalidad del PHQ-9 adaptado mediante un Análisis Factorial Confirmatorio (CFA), la confiabilidad se evaluó mediante consistencia interna (Alpha y Omega), y la invarianza de medida según variedades del quechua y variables sociodemográficas se evaluó empleando CFA multigrupos y modelos MIMIC (Múltiples Indicadores y Múltiples Causas). RESULTADOS: . Cada una de las adaptaciones del PHQ-9 a las tres variedades de quechua reportaron ítems claros y culturalmente equivalentes. Posteriormente, con 970 datos de quechuahablantes adultos varones y mujeres, el modelo general unidimensional reportó un ajuste adecuado (índice de ajuste comparativo: 0,990, índice de Tucker-Lewis: 0,987, residuo estandarizado cuadrático medio: 0,048, raíz del error cuadrático medio de aproximación: 0,071), lo mismo ocurrió para cada variedad del quechua. La confiabilidad fue alta para todas las variedades (α = 0,865 - 0,915; ω = 0,833 - 0,881). Los resultados del CFA multigrupos y modelos MIMIC confirmaron invarianza de medida según variante del quechua, sexo, residencia, edad, estado civil y nivel educativo. CONCLUSIONES: . Las adaptaciones del PHQ-9 a Quechua Central, Chanca y Cuzco-Collao ofrecen una medición válida, confiable e invariante, confirmando que se pueden hacer comparaciones en los grupos evaluados. Su uso beneficiará a la investigación y a la atención en salud mental de poblaciones quechuahablantes.

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BACKGROUND: Mental health data from Latin America and the Caribbean countries (LACC) national and international surveys are essential for public health surveillance. This review aimed to identify and describe available mental health survey data in LACC, providing access details for researchers. METHODS: Our study was a scoping review. The search for available mental health survey data was conducted in PubMed and through grey literature searches, and the search dates were between 26 August 2021 and 15 October 2021. Included survey data were/had (1) nationally representative, (2) the latest version available from 2012 onward, (3) collected in at least one LACC and (4) at least one mental health variable or related factor. We accepted all written languages, including Spanish and English. RESULTS: A total of 56 national and 13 international surveys were included, with data available on 95 mental health variables classified into 10 categories. Most national surveys were performed in upper-middle-income countries. Variables categorised as 'Substance use' and 'Violence' were the most frequent. Mexico and Colombia had the highest production in both the national and international surveys. The main target population was the adult population. However, there are several mental health topics and LACC yet unsurveyed. CONCLUSION: We identified a total of 69 representative surveys from LACCs since 2012. We categorised the available data on mental health variables into 10 categories, and provided technical details to facilitate the future selection and use of these surveys.

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BACKGROUND: Cyberchondria is defined as the increase in health-related anxiety or anguish associated with excessive or repeated online searches for health-related information. Our objective was to cross-culturally adapt and validate the CSS-12 scale for Peruvian Spanish speakers, to determine whether the Bifactor model works as well in our population as in previous studies' and to explore whether the Bifactor-ESEM is a more suitable model. METHODS: We performed a cultural adaptation using the Delphi method and a validation study on medical students between 2018 and 2019. Reliability was evaluated by using Cronbach's alpha (α) and McDonald's omega (Ω) for internal consistency, and Pearson's r and intraclass correlation coefficient (ICC), for test-retest reliability. We evaluated construct validity by contrasting four measurement models for the CSS-12 and the convergent validity against health anxiety. RESULTS: The Spanish CSS-12 showed excellent reliability (α = .93; Ω = .93; ICC = .93; r = .96). The Bifactor ESEM model showed the best fit, supporting a unidimensional measure of the general cyberchondria. This measure was positively associated with health anxiety (r = .51). CONCLUSIONS: The Spanish CSS-12 provides a valid and reliable unidimensional measure of cyberchondria, which is distinguishable from the more general health anxiety. This can be applied to similar populations and future research. The Bifactor-ESEM model appears to offer a more accurate and realistic representation of the multifaceted nature of cyberchondria. We provide a free-to-use form of the Spanish CSS-12 as supplemental material.

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OBJECTIVES: The Patient Health Questionnaire (PHQ) and Generalised Anxiety Disorder Scale (GAD) are widely used screening tools, but their sensitivity and specificity in low-income and middle-income countries are lower than in high-income countries. We conducted a study to determine the sensitivity and specificity of different versions of these scales in a Peruvian hospital population. DESIGN: Our study has a cross-sectional design. SETTING: Our participants are hospitalised patients in a Peruvian hospital. The gold standard was a clinical psychiatric interview following ICD-10 criteria for depression (F32.0, F32.1, F32.2 and F32.3) and anxiety (F41.0 and F41.1). PARTICIPANTS: The sample included 1347 participants. A total of 334 participants (24.8%) were diagnosed with depression, and 28 participants (2.1%) were diagnosed with anxiety. RESULTS: The PHQ-9's≥7 cut-off point showed the highest simultaneous sensitivity and specificity when contrasted against a psychiatric diagnosis of depression. For a similar contrast against the gold standard, the other optimal cut-off points were: ≥7 for the PHQ-8 and ≥2 for the PHQ-2. In particular, the cut-off point ≥8 had good performance for GAD-7 with sensitivity and specificity, and cut-off point ≥10 had lower levels of sensitivity, but higher levels of specificity, compared with the cut-off point of ≥8. Also, we present the sensitivity and specificity values of each cut-off point in PHQ-9, PHQ-8, PHQ-2, GAD-7 and GAD-2. We confirmed the adequacy of a one-dimensional model for the PHQ-9, PHQ-8 and GAD-7, while all PHQ and GAD scales showed good reliability. CONCLUSIONS: The PHQ and GAD have adequate measurement properties in their different versions. We present specific cut-offs for each version.

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Objetivo . Traducir y adaptar culturalmente el Patient Health Questionnaire (PHQ-9) a tres variedades del quechua y analizar su validez, confiabilidad e invarianza. Materiales y métodos . 1) Fase de adaptación cultural: el PHQ-9 fue traducido del inglés a tres variantes del quechua (Central, Chanca, Cuzco-Collao) y traducido nuevamente al inglés, posteriormente expertos y grupos focales permitieron adaptar culturalmente las traducciones. 2) Fase psicométrica: se evaluó la uni-dimensionalidad del PHQ-9 adaptado mediante un Análisis Factorial Confirmatorio (CFA), la confiabilidad se evaluó mediante consistencia interna (Alpha y Omega), y la invarianza de medida según variedades del quechua y variables sociodemográficas se evaluó empleando CFA multigrupos y modelos MIMIC (Múltiples Indicadores y Múltiples Causas). Resultados . Cada una de las adaptaciones del PHQ-9 a las tres variedades de quechua reportaron ítems claros y culturalmente equivalentes. Posteriormente, con 970 datos de quechuahablantes adultos varones y mujeres, el modelo general unidimensional reportó un ajuste adecuado (índice de ajuste comparativo: 0,990, índice de Tucker-Lewis: 0,987, residuo estandarizado cuadrático medio: 0,048, raíz del error cuadrático medio de aproximación: 0,071), lo mismo ocurrió para cada variedad del quechua. La confiabilidad fue alta para todas las variedades (α = 0,865 - 0,915; ω = 0,833 - 0,881). Los resultados del CFA multigrupos y modelos MIMIC confirmaron invarianza de medida según variante del quechua, sexo, residencia, edad, estado civil y nivel educativo. Conclusiones . Las adaptaciones del PHQ-9 a Quechua Central, Chanca y Cuzco-Collao ofrecen una medición válida, confiable e invariante, confirmando que se pueden hacer comparaciones en los grupos evaluados. Su uso beneficiará a la investigación y a la atención en salud mental de poblaciones quechuahablantes.

Objective . To translate and culturally adapt the Patient Health Questionnaire (PHQ-9) to three varieties of Quechua and analyse their validity, reliability, and measurement invariance. Materials and methods . 1) Cultural adaptation phase: the PHQ-9 was translated from English into three variants of Quechua (Central, Chanca, Cuzco-Collao) and translated again into English. Then, experts and focus groups allowed the translations to be culturally adapted. 2) Psychometric phase: the unidimensionality of the adapted PHQ-9 was evaluated by using Confirmatory Factor Analysis (CFA), reliability was evaluated by internal consistency (Alpha and Omega), and measurement invariance according to Quechua varieties and sociodemographic variables was evaluated by using CFA, multigroups and MIMIC models (Multiple Indicator Multiple Cause). Results . Each of the adaptations of the PHQ-9 to the three Quechua varieties reported clear and culturally equivalent items. Subsequently, data from 970 Quechua-speaking adult men and women were analyzed. The general one-dimensional model reported an adequate fit (Comparative fit index = 0.990, Tucker-Lewis index = 0.987, Standardized root mean squared residual= 0.048, Root mean squared error of approximation=0.071); each of the Quechua varieties also showed an adequate fit. Reliability was high for all varieties (α = 0.865 - 0.915; ω = 0.833 - 0.881). The results of the multigroup CFA and MIMIC models confirmed measurement invariance according to Quechua variant, sex, residence, age, marital status and educational level. Conclusions . The PHQ-9 adaptations to Central Quechua, Chanca and Cuzco-Collao offer a valid, reliable and invariant measurement, confirming that comparisons can be made between the evaluated groups. Its use will benefit mental health research and care for Quechua-speaking populations.

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OBJECTIVE: We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. METHODS: First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. RESULTS: A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. CONCLUSION: This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

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Wastewater reuse for agricultural irrigation is a widespread beneficial practice, in line with the sustainable development goals. However, contaminants of emerging concern (CECs) present in wastewater, such as pharmaceuticals, pose an environmental risk. The Tula Valley in Mexico is one of the world's largest agricultural areas reusing wastewater for agriculture. However, no untargeted CEC monitoring has been undertaken there, limiting the information available to prioritise local environmental risk assessment. Furthermore, CEC environmental presence in the Global South remains understudied, compared to the Global North. There is a risk that current research efforts focus on CECs predominantly found in the Global North, leading to strategies that may not be appropriate for the Global South where the pollution profile may be different. To address these knowledge gaps, a sampling campaign at five key sites in the Tula Valley was undertaken and samples analysed using multi-residue targeted and untargeted liquid chromatography mass spectrometry methods. Using the targeted data, ten CECs were found to be of environmental risk for at least one sampling site: 4­tert-octylphenol, acetaminophen, bezafibrate, diclofenac, erythromycin, levonorgestrel, simvastatin, sulfamethoxazole, trimethoprim and tramadol as well as total estrogenicity (combination of three steroid hormones). Six of these have not been previously quantified in the Tula Valley. Over one hundred pollutants never previously measured in the area were identified through untargeted analysis supported by library spectrum match. Examples include diclofenac and carbamazepine metabolites and area-specific pollutants such as the herbicide fomesafen. This research contributes to characterising the presence of CECs in the Global South, as well as providing site-specific data for the Tula Valley.

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Abstract Objective We describe the development and structure of a novel mobile application in a mixed model of prenatal care, in the context of the COVID-19 pandemic. Furthermore, we assess the acceptability of this mobile app in a cohort of patients. Methods First, we introduced a mixed model of prenatal care; second, we developed a comprehensive, computer-based clinical record to support our system. Lastly, we built a novel mobile app as a tool for prenatal care. We used Flutter Software version 2.2 to build the app for Android and iOS smartphones. A cross-sectional study was carried out to assess the acceptability of the app. Results A mobile app was also built with the main attribute of being connected in real-time with the computer-based clinical records. The app screens detail information about activities programmed and developed in the prenatal care according to gestational age. A downloadable maternity book is available and some screens show warning signs and symptoms of pregnancy. The acceptability assessment was mostly rated positively regarding the characteristics of the mobile app, by 50 patients. Conclusion This novel mobile app was developed as a tool among pregnant patients to increase the information available about their pregnancies in the provision of a mixed model of prenatal care in the context of the COVID-19 pandemic. It was fully customized to the needs of our users following the local protocols. The introduction of this novel mobile app was highly accepted by the patients.

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OBJECTIVE: Describe the occupational characteristics of farmer and non-farmer workers and investigate critical occupational risk factors for mental disorders in sugarcane farmers in Peru. METHOD: We conducted a cross-sectional study with occupational health and safety focus among farmers and non-farmers. Mental disorder symptoms were evaluated through the local validated version of the 12-Item General Health Questionnaire (GHQ-12). We explored the association between mental disorder symptoms, work conditions and known occupational risk factors (weekly working hours, pesticide exposures, heat stress and heavy workload). Negative binomial regression models were fitted, and 95% CIs were calculated. RESULTS: We assessed 281 workers between December 2019 and February 2020. One hundred and six (37.7%) respondents identified themselves as farmworkers. The mean GHQ-12 scores for farmers and non-farmers were 3.1 and 1.3, respectively. In the fully adjusted multivariable model, mental disorder symptom counts among farmers were more than twice as high as those of non-farmers (ß: 2.11; 95% CI: 1.48 to 3.01). The heavy workload increased the mean number of mental disorder symptoms by 68% (95% CI: 21% to 133%), and each additional working hour per day increased the mean number of mental disorder symptoms by 13% (95% CI: 1% to 25%). CONCLUSION: Farmers have higher mental disorder symptoms than non-farmers. A heavy workload and more working hours per day are independently associated with more mental disorder symptoms. Our findings highlight the importance of including mental health within occupational programmes and early interventions tailored to sugarcane industrial mill workers in the Latin American context.

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Background: Genetic testing for hereditary cancers is inconsistently applied within the healthcare systems in Latin America. In Peru, the prevalence and spectrum of cancer-predisposing germline variants is thus poorly characterized. Purpose: To determine the spectrum and prevalence of cancer-predisposing germline variants and variants of uncertain significance (VUS) in high-risk individuals located in a Peruvian low-resource setting city. Methods: Individuals presenting clinical criteria for hereditary cancer syndromes or being unaffected with familial history of cancer were included in the study. Samples from a total of 84 individuals were subjected to a high-throughput DNA sequencing assay that targeted a panel of 94 cancer predisposition genes. The pathogenicity of detected germline variants was classified according to the established American College of Medical Genetics and Genomics (ACMG) criteria. All pathogenic variants were validated by cycling temperature capillary electrophoresis. Results: We identified a total of eight pathogenic variants, found in 19 out of 84 individuals (23%). Pathogenic variants were identified in 24% (10/42) of unaffected individuals with family history of cancer and in 21% (9/42) of individuals with a cancer diagnosis. Pathogenic variants were identified in eight genes: RET (3), BRCA1 (3), SBDS (2), SBDS/MLH1 (4), MLH1 (4), TP53 (1), FANCD2 (1), DDB2/FANCG (1). In cancer cases, all colon cancer cases were affected by pathogenic variants in MLH1 and SBDS genes, while 20% (2/10) of the thyroid cancer cases by RET c.1900T>C variants were affected. One patient with endometrial cancer (1/3) had a double heterozygous pathogenic variant in DDB2 and FANCG genes, while one breast cancer patient (1/14) had a pathogenic variant in TP53 gene. Overall, each individual presented at least 17 VUS, totaling 1926 VUS for the full study population. Conclusion: We describe the first genetic characterization in a low-resource setting population where genetic testing is not yet implemented. We identified multiple pathogenic germline variants in clinically actionable predisposition genes, that have an impact on providing an appropriate genetic counselling and clinical management for individuals and their relatives who carry these variants. We also reported a high number of VUS, which may indicate variants specific for this population and may require a determination of their clinical significance.

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El texto surge a través de las reflexiones conceptuales en el Doctorado en Educación de la Universidad Pontificia Bolivariana, en Medellín, Colombia, y la Pasantía Doctoral en la Universidad de Murcia con el grupo de investigación "Compartimos Educación" con el objetivo de caracterizar el lugar de las escuelas familiares en la promoción de la educación afectivo-sexual de los niños, niñas y adolescentes en la escuela. La metodología es de corte cualitativo. Como resultado se muestra la necesidad de vincular actores que transversalizan el quehacer de los sujetos, la familia y escuela en un lugar común, las escuelas familiares para la promoción de la educación afectivo-sexual para gestar acciones de cambio individual y social. Es evidente la necesidad intrínseca de generar la discusión en cuanto al género para la deconstrucción de prácticas socioculturalmente atribuidas, promover espacios formativos respecto a la sexualidad y la afectividad e incentivar a la reflexión como ejercicio pedagógico

This text emerges through the conceptual reflections of the Doctorate in Education at Universidad Pontificia Bolivariana, in Medellín, Colombia, and the Doctoral Internship at University of Murcia with the research group "Compartimos Educación" with the aim of characterizing the place of family schools in the promotion of affective-sexual education of boys, girls and adolescents at school. The used methodology is qualitative. As a result, the need to link actors that mainstream the work of the subjects, family and school in a common place, the family schools for the promotion of affective-sexual education to create actions of individual and social change is shown. The intrinsic need to generate discussion regarding gender for the deconstruction of sociocultural attributed practices, promote training spaces regarding sexuality and affectivity and encourage reflection as a pedagogical exercise is evident

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Resumen Este artículo se deriva de una investigación sobre experiencias de mediación y gestión transformativa de conflictos en zonas afectadas por el conflicto armado en Colombia, presentando dos hallazgos: uno, que en medio de ciclos repetidos de violencia, las personas han logrado un "empoderamiento pacifista", sobreponerse y apelar a sus capacidades para transformar los conflictos y para restituir el tejido social; y dos, el trabajo sobre el ser, el abordaje simbólico para tramitar los conflictos y para educar en formas de convivencia pacífica. Los recursos culturales identificados sirvieron de base para la construcción de contenidos formativos digitales que aportaran a la Cátedra de la Paz en el país. Por tanto, los contenidos no parten de prescripciones ni de teorías, sino que convirtieron las experiencias concretas en contenidos formativos para la construcción de la paz.

Resumo Este artigo se deriva de uma pesquisa sobre experiências de mediação e gestão transformadora de conflitos em áreas afetadas pelo conflito armado colombiano, apresentando dois achados: em primeiro lugar, que, no meio de ciclos repetidos de violências, as pessoas conseguem obter um "empoderamento pacifista", se superar e apelar para as suas capacidades, a fim de transformar os conflitos e restituir o tecido social; e em segundo, o trabalho sobre o ser, a abordagem simbólica para administrar os conflitos e educar sobre formas de convivência pacífica. Os recursos culturais identificados serviram como base para a construção de conteúdos formativos digitais que contribuíram para a Cátedra da Paz, na Colômbia. Portanto os conteúdos não partem de prescrições nem de teorias, mas transformaram as experiências concretas em conteúdos formativos para a construção da paz.

Résumé Cet article découle d'une recherche sur les expériences de médiation et de gestion et transformation des conflits dans des zones de Colombie touchées par le conflit armé. Il rend compte de deux découvertes : la première est que, malgré les cycles de violence récurrents, la population est parvenue non seulement à s'autonomiser de manière pacifique, mais aussi à se surmonter en mobilisant ses capacités à transformer les conflits et à restaurer le tissu social ; la deuxième étant que grace au travail sur l'être humain lui-même et à une approche symbolique il est possible de gérer les conflits et de mettre en place une éducation bâtie sur des formes de coexistence pacifique. Les ressources culturelles identifiées ont servi de base à la construction des contenus de formation numériques ayant contribué à la Chaire de la Paix en Colombie. Les contenus ne sont donc pas partis de prescriptions ou de théories, mais des expériences concrètes qui ont été converties en contenus de formation pour la construction de la paix.

Abstract This article stems from a research project about mediation experiences and transformational conflict management in areas affected by the armed conflict in Colombia. The first finding states that in the midst of repeated violence cycles, people have achieved a "pacifist empowerment". They have overcome and called upon their capacities to transform conflicts and restore social structure. The second one, concerning self-work, is the symbolic approach when dealing with conflict and educating in peaceful coexisting ways. The identified cultural resources served as the basis for creating digital training content that will contribute to the country's Cátedra de Paz in the country. Therefore, specific experiences were transformed into training contents aimed at building peace instead of using contents based on provisions or theories.

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Objetivo: evaluar la estructura interna, invarianza de medida, validez de criterio y confiabilidad del CASM-85 en estudiantes de secundaria peruanos. Materiales y Métodos: se evaluaron 2075 estudiantes de ambos sexos, entre 11 y 18 años, provenientes de colegios nacionales y particulares de Arequipa, Chimbote, Lima y Pucallpa. Se realizó un análisis de la correlación ítem-ítem e ítemresto para cada dimensión del CASM-85, un análisis factorial confirmatorio y modelos MIMIC (Multiple Indicator, Multiple Cause) para evaluar la invarianza de medida a través de grupos según sexo, edad, colegio y ciudad. La confiabilidad fue estimada mediante los coeficientes Alpha y Omega. La validez de criterio entre el CASM-85 y el rendimiento académico se revisó a través de la r de Pearson y modelos de regresión. Resultados: se eliminaron ítems heterogéneos y se obtuvo una forma reducida de 45 ítems a compararse con su original de 53 ítems. Para la forma original el CFI y TLI fue < .9 en todas las ciudades, mientras que para la forma reducida fue < . 9 solo en Chimbote. Los SRMR y RMSEA fueron ≤ .10 y ≤ .09 para las formas original y reducida respectivamente. Los modelos MIMIC confirmaron invarianza para todas las variables excepto para la variable ciudad con la forma original (│ΔCFI│ = .09, │ΔTLI│ = .08). La confiabilidad fue moderada tanto para la forma original (Ω ≥ .68; α ≥ .81) como para la reducida (Ω ≥ .77; α ≥ .84). La r de Pearson mostró una relación positiva y de fuerza débil para la forma original (r = .17) y reducida (r = .18). Conclusión: la forma reducida del CASM-85 (45 ítems) ha mostrado mejores propiedades psicométricas que su forma original.

Objective: To assess the internal structure, measurement invariance, criterion validity and reliability of the CASM-85 in Peruvian high school students. Materials and methods: Two thousand seventy-five (2075) students of both sexes, aged 11 to 18 years, from public and private high schools of Arequipa, Chimbote, Lima and Pucallpa were evaluated. An item-item and item-rest correlation analysis for each dimension of the CASM- 85, a confirmatory factorial analysis and MIMIC (Multiple Indicator, Multiple Cause) models were used to evaluate the measurement invariance across the groups according to their sex, age, school and city. Reliability was estimated using alpha and omega coefficients. The criterion validity between the CASM-85 and academic performance was determined using Pearson’s r and regression models. Results: The heterogeneous items were removed, obtaining a 45-item short form compared to the original 53-item form. In the original form, CFI and TLI were < .9 in all the cities, whereas in the short form, CFI and TLI were < .9 only in Chimbote. SRMR and RMSEA were ≤ .10 and ≤ .09 in the original and short forms, respectively. The MIMIC models confirmed the measurement invariance in all variables, with the exception of the original form between cities (│ΔCFI│ = .09, │ΔTLI│= .08). Reliability was moderate for both the original (Ω ≥ .68; α ≥ .81) and short forms (Ω ≥ .77; α ≥ .84). Pearson’s r showed a positive and weak correlation in the original (r = .17, p < .001) and short (r = .18, p < .001) forms. Conclusion: The CASM-85 short form (45 items) has shown better psychometric properties than its original full form.

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OBJECTIVE: Analyze the measurement invariance and the factor structure of the Patient Health Questionnaire-9 (PHQ-9) in the Peruvian population. METHOD: Secondary data analysis performed using cross-sectional data from the Health Questionnaire of the Demographic and Health Survey in Peru. Variables of interest were the PHQ-9 and demographic characteristics (sex, age group, level of education, socioeconomic status, marital status, and area of residence). Factor structure was evaluated by standard confirmatory factor analysis (CFA), and measurement invariance by multi-group CFA, using standard goodness-of-fit indices criteria for interpreting results from both CFAs. Analysis of the internal consistency (α and ω) was also pursued. RESULTS: Data from 30,449 study participants were analyzed, 56.7% were women, average age was 40.5 years (standard deviation (SD) = 16.3), 65.9% lived in urban areas, 74.6% were married, and had 9 years of education on average (SD = 4.6). From standard CFA, a one-dimensional model presented the best fit (CFI = 0.936; RMSEA = 0.089; SRMR = 0.039). From multi-group CFA, all progressively restricted models had ΔCFI<0.01 across almost all groups by demographic characteristics. PHQ-9 reliability was optimal (α = ω = 0.87). CONCLUSIONS: The evidence presents support for the one-dimensional model and measurement invariance of the PHQ-9 measure, allowing for reliable comparisons between sex, age groups, education level, socioeconomic status, marital status, and residence area, and recommends its use within the Peruvian population.

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Cheese whey, a byproduct of the cheese-making industry, is discarded in many countries in the environment, causing pollution. This byproduct contains high-quality proteins containing encrypted biologically active peptides. The objective of this work was to evaluate the suitability of using this waste to produce bioactive peptides by enzymatic hydrolysis with a digestive enzyme. Cheese whey from white cheese (Panela cheese) was concentrated to increase total protein and hydrolyzed with trypsin. A central composite design was used to find the best conditions of pH and temperature, giving the higher antioxidant capacity and Δ Angiotensin-converting enzyme inhibition (Δ ACEI) activity. Higher biological activities were found when hydrolysis was performed at 52 °C and a pH of 8.2. The maximum value for the 2,2- diphenyl-1-picrylhydrazyl (DPPH)-scavenging activity was 26%, while the higher Δ ACE inhibition was 0.89. Significant correlations were found between these biological activities and the peptides separated by HPLC. The hydrophilic fraction (HI) showed highly significant correlations with the antioxidant capacity (r = 0.770) and with Δ ACE inhibition (r = 0.706). Antioxidant capacity showed a significant positive correlation with 34 peaks and Δ ACE inhibition with 33 peaks. The cheese whey was successfully used as raw material to produce peptides showing antioxidant capacity and ACEI activity.

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OBJECTIVE.: To assess the reliability and validity of the translated and culturally-adapted Institutional Review Board Researcher Assessment Tool (IRB-RAT) for Peruvian research ethics committees (RECs). MATERIALS AND METHODS.: The IRB-RAT is an instrument that determines how RECs are perceived by researchers based on eight factors, using two formats: 1) importance in the work of the researcher and 2) descriptive of the REC being evaluated. Its original English version was translated and culturally adapted into Spanish, with the support of experts and representatives of the target population. Then, according to the responses of 113 users, the heterogeneous items were identified and eliminated until a final version of 29 items was obtained. The reliability of this version was reviewed using Cronbach's α and omega coefficient, its internal structure validity through a confirmatory factor analysis with the unweighted least squares method. RESULTS.: Translation and cultural adaptation complied with internationally recommended steps. Reliability at the level of the eight factors was moderate for format 1 (0.67<α<0.89; 0.71<ω<0.89) and high for format 2 (0.83<α<0.92; 0.85<ω<0.92). Content validity was high at item level and moderate for factors. Internal structure validity was good for format 1 (AGFI=0.97, GFI=0.97, NFI=0.97, RMR=0.04) and moderately good for format 2 (AGFI=0.99, GFI=0.99, NFI=0.99, RMR=0.10). CONCLUSIONS.: Our Spanish adaptation of the IRB-RAT has sufficient reliability and validity to assist in the continuous improvement of the RECs in Peru and other Spanish-speaking countries.

OBJETIVO.: Evaluar la confiabilidad y validez del Institutional Review Board Researcher Assessment Tool (IRB-RAT) traducido y adaptado culturalmente para los comités de ética en investigación (CEI) peruanos. MATERIALES Y MÉTODOS.: El IRB-RAT es un instrumento que determina como son percibidos los CEI por los investigadores en función a ocho factores, mediante dos formatos: 1) importancia en el trabajo del investigador y 2) descriptivo del CEI evaluado. Su versión original en inglés se tradujo y adaptó culturalmente al español, con el apoyo de expertos y representantes de la población objetivo. Luego, según las respuestas de 113 usuarios, se identificaron y eliminaron los ítems heterogéneos hasta obtener una versión final de 29 ítems. La confiabilidad de esta versión se revisó mediante α de Cronbach y coeficiente omega, su validez de estructura interna mediante un análisis factorial confirmatorio con el método de mínimos cuadrados no ponderados. RESULTADOS.: La traducción y adaptación cultural cumplió con los pasos recomendados internacionalmente. La confiabilidad a nivel de los ocho factores fue moderada para el formato 1 (0,67<α<0,89; 0,71<ω<0,89) y alta para el formato 2 (0,83<α<0,92; 0,85<ω<0,92). La validez de contenido fue alta a nivel de ítems y moderada para los factores. La validez de estructura interna fue buena para el formato 1 (AGFI=0,97, GFI=0,97, NFI=0,97, RMR=0,04) y moderadamente buena para el formato 2 (AGFI=0,99, GFI=0,99, NFI=0,99, RMR=0,10). CONCLUSIÓN.: Nuestra adaptación al español del IRB-RAT tiene confiabilidad y validez suficientes para asistir en la mejora continua de los CEI del medio peruano y otros similares de habla hispana.

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