Revista Ciencia y Tecnología aplicada a la Salud Pública
The journal “Revista Ciencia y Tecnología aplicada a la Salud Pública”, EsSalud’s scientific journal, is published by the Institute for Health Technology Assessment and Research (IETSI). It publishes original, unpublished, and high-quality scientific manuscripts aimed at advancing the health sciences in all their branches, including biomedical, clinical, surgical, and related disciplines. Approved by Resolution No. 001963-GG-ESSALUD-2025.
Responsible Innovation and Digital Transformation: Implications for Governance, Workforce Development, and Access to Health Technologies
Introduction: Digital transformation and artificial intelligence are reshaping institutional governance, workforce organization, and access to health technologies. However, their implementation should be guided by principles of responsible innovation aimed at promoting equity, sustainability, and human capital development. Objective: To discuss the implications of responsible innovation and digital transformation for institutional governance, workforce development, and equitable access to health technologies, with particular emphasis on healthcare systems. Content: Recent evidence from international organizations on digital health, employment, artificial intelligence, and health technology assessment is reviewed. The article addresses workforce transformation, talent management, population aging, digital infrastructure, institutional governance, and biomedical innovation. It also proposes a governance framework integrating human expertise with artificial intelligence while emphasizing the importance of strengthening institutional capacities, regulatory frameworks, and equitable access to medicines and health technologies. Conclusions: Responsible innovation represents a strategic pillar for sustainable digital transformation. Strengthening digital capabilities, AI governance, technological infrastructure, and collaboration among governments, academia, and the productive sector will be essential to ensure an inclusive digital transition, reinforce health systems, and improve equitable access to healthcare innovations.
Copyright (c) 2026 Víctor Piriz Correa, Cristian Díaz-Vélez (Author) https://creativecommons.org/licenses/by/4.0
The Hidden Cost of Publishing: Why the Transition to Open Access Did Not Make Science Cheaper for Latin American Universities
Introduction: The transition from subscription-based publishing to open access has transformed the scientific communication landscape. However, this shift has not reduced overall publishing costs for Latin American universities but has instead redistributed expenditures toward article processing charges (APCs), transformative agreements, and institutional incentives. Objective: To discuss the economic impact of the open access publishing model on Latin American universities, particularly in Peru, and to propose strategies to improve the financial sustainability of scholarly communication. Content: Recent evidence regarding the concentration of the academic publishing market, the continuous increase in APCs, transformative publishing agreements, and national research funding policies is examined. The article also discusses the influence of institutional incentives on scientific productivity and highlights the need for responsible research assessment frameworks that emphasize research quality rather than publication volume. Conclusions: The true cost of scientific publishing remains largely underestimated within higher education institutions. Developing institutional cost-monitoring systems, promoting collective negotiations with publishers, strengthening diamond open access infrastructures, and adopting responsible research assessment models are essential strategies to ensure sustainable and equitable scholarly communication across Latin America.
Copyright (c) 2026 Joshuan J. Barboza Meca (Author) https://creativecommons.org/licenses/by/4.0
Artificial Intelligence in Healthcare Institutions: Opportunities, Risks, and Challenges for Social Security
Introduction: Artificial intelligence (AI) is transforming healthcare systems and social security institutions through applications ranging from administrative automation to clinical decision support and predictive analytics. However, its implementation requires robust governance frameworks to ensure safety, equity, and transparency. Objective: To review current evidence on the use of artificial intelligence in healthcare institutions, with emphasis on social security systems, highlighting opportunities, risks, challenges, and requirements for responsible implementation. Methods: A narrative review was conducted using technical reports, institutional documents, and scientific literature on AI in healthcare and social security. Sources included publications from the International Social Security Association (ISSA), the Pan American Health Organization (PAHO), the Inter-American Development Bank (IDB), the World Health Organization (WHO), the 2025 Latin American Artificial Intelligence Index (ILIA), and representative clinical studies on AI applications. The evidence was organized into six thematic domains: institutional applications, clinical use cases, organizational innovation, governance and regulation, cybersecurity, and implementation requirements. Results: AI has demonstrated potential to improve patient services through intelligent chatbots, optimize administrative management, strengthen auditing and fraud detection, support clinical diagnosis, screening, rehabilitation, and public health surveillance. Nevertheless, successful implementation depends on data quality, local validation, workflow integration, human oversight, data governance, interoperability, and continuous performance evaluation. Frameworks such as AI-GUARD provide structured approaches for risk-based governance before deployment. Conclusions: Artificial intelligence offers a strategic opportunity to strengthen healthcare and social security institutions when implemented under principles of transparency, equity, data protection, human oversight, and continuous evaluation. In Latin America, expanding institutional capacity, digital infrastructure, and governance mechanisms will be essential for responsible and sustainable AI adoption.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0
Sleep Disorders During Pregnancy: Mechanisms, Maternal-Fetal Outcomes, and Clinical Approach
Introduction: Sleep disorders are highly prevalent during pregnancy and include alterations in sleep duration, quality, and continuity, as well as specific conditions such as insomnia, obstructive sleep apnea, and restless legs syndrome. Their prevalence increases throughout pregnancy and may adversely affect both maternal and fetal health through multiple biological mechanisms. Objective: To summarize current scientific evidence regarding the pathophysiological mechanisms, epidemiology, maternal-fetal outcomes, clinical assessment, and management of sleep disorders during pregnancy. Methods: A narrative review was conducted following SANRA quality criteria. Literature published between 2019 and 2026 was retrieved from PubMed, Web of Science, Scopus, and SciELO, including systematic reviews, meta-analyses, prospective cohorts, multicenter studies using polysomnography, intervention protocols, and clinical reviews. Evidence was synthesized according to sleep physiology, epidemiology, specific sleep disorders, obstetric and perinatal outcomes, mental health, and prenatal care recommendations. Results: Current evidence indicates that sleep fragmentation, intermittent hypoxia, sympathetic activation, systemic inflammation, endothelial dysfunction, and insulin resistance are plausible mechanisms linking sleep disorders with gestational diabetes, gestational hypertension, preeclampsia, cesarean delivery, preterm birth, and perinatal depression. Evidence regarding low birth weight and fetal growth restriction remains inconsistent. Screening using validated instruments, combined with non-pharmacological interventions and cognitive behavioral therapy for insomnia, represents the preferred first-line management approach. Conclusions: Sleep disorders are common and clinically important during pregnancy and represent potentially modifiable risk factors. Routine sleep screening during prenatal care, together with timely diagnosis and individualized management, may improve maternal and neonatal outcomes. Additional longitudinal studies, particularly in Latin American populations, are warranted.
Telemonitoring to the Primary Caregiver and Reduction of Their Overload During the COVID-19 Pandemic
Introduction: During the COVID-19 pandemic, primary caregivers of frail and disabled patients experienced increased physical and emotional burden due to prolonged caregiving responsibilities. Telemonitoring emerged as a telehealth strategy aimed at providing continuous follow-up and personalized support. Objective: To determine whether telemonitoring reduces caregiver burden among primary caregivers of frail and disabled patients enrolled in the Home Care Program (PADOMI) of an EsSalud primary healthcare center during the first wave of the COVID-19 pandemic. Materials and Methods: An uncontrolled quasi-experimental study was conducted among 56 primary caregivers. Participants received a two-month intervention consisting of personalized telephone follow-up and group videoconferences led by Family Medicine specialists. Caregiver burden was assessed before and after the intervention using the Zarit Burden Interview, together with sociodemographic variables and descriptive and inferential statistical analyses. Results: Most caregivers were women (82.1%), direct relatives (83.9%), and devoted a median of 13.8 hours per day to caregiving. Overall caregiver burden decreased from 26.8% at baseline to 14.3% after two months, while severe burden declined from 16.1% to 5.4%. Although Zarit scores showed a downward trend after the intervention, the overall reduction was not statistically significant. Women exhibited higher baseline burden than men, but the magnitude of improvement was comparable between sexes. Conclusions: Personalized and continuous telemonitoring may contribute to reducing caregiver burden among caregivers of frail and disabled patients. Despite encouraging trends, larger controlled studies with longer follow-up periods are needed to establish its effectiveness.
Health Technology Assessment of Medical Devices Through the Ad Hoc Methodology: Experience of the Social Health Insurance in Peru
Introduction: Health technology assessment (HTA) plays a key role in supporting decisions regarding the adoption and use of healthcare technologies. Medical devices pose unique challenges because of their technological heterogeneity, rapid innovation, and dependence on implementation settings, requiring adapted assessment methodologies. Objective: To describe the experience of implementing an ad hoc methodology for health technology assessment of medical devices within the Peruvian Social Health Insurance system (EsSalud). Materials and Methods: A retrospective descriptive observational study was conducted using HTA reports of medical devices published by the Institute for Health Technology Assessment and Research (IETSI) between 2020 and 2025. The methodology included PICO question development and validation, evidence search and selection, critical appraisal, evidence synthesis, methodological review, and preparation of the final recommendation. Institutional, clinical, and technological variables were analyzed using descriptive statistics. Results: A total of 76 HTA reports were included; 37 (48.7%) received favorable recommendations and 39 (51.3%) unfavorable recommendations. The highest number of assessments occurred in 2023 and 2025. Most requests originated from the Rebagliati, Almenara, and Sabogal healthcare networks and the National Cardiovascular Institute (INCOR). Surgical specialties and adult populations predominated. Favorable recommendations were mainly related to cardiology/cardiovascular surgery, traumatology, interventional oncology, and therapeutic gastroenterology technologies. Conclusions: The ad hoc methodology enabled timely and structured assessments of medical devices through an evidence-based institutional process supported by methodological review and evaluation of institutional applicability, strengthening transparent and context-specific decision-making within EsSalud.
Clinical Characteristics and Outcomes of Cases During the COVID-19 Pandemic: A Retrospective Study in a Private Clinic in Lima
Introduction: COVID-19 caused substantial morbidity and mortality in Peru, particularly during the first pandemic waves. Characterizing hospitalized patients is essential to better understand the clinical course and outcomes of the disease. Objective: To describe the clinical, epidemiological, and hospital outcomes of patients with COVID-19 admitted to a private clinic in Lima during the pandemic. Materials and Methods: A descriptive observational case series was conducted including 100 adults with laboratory-confirmed COVID-19 by RT-PCR, antigen, or serological tests, hospitalized between March 2020 and December 2022. Clinical records were reviewed to collect demographic, clinical, radiological, comorbidity, and outcome data, which were analyzed using descriptive statistics. Results: Most patients were men (68%), with the highest proportion aged 40–60 years (41%). The mean interval from symptom onset to clinical evaluation was 6.3 days. Fever occurred in 74% and respiratory distress in 77% of patients. Among those with oxygen saturation measurements, 28% had severe respiratory failure (SpO₂ ≤92%). Chest CT showed predominantly moderate pulmonary involvement (44.8%), followed by mild (25.6%) and severe (19.2%) disease. Comorbidities were identified in 51% of patients, mainly hypertension and obesity. Fifteen percent required intensive care unit admission and in-hospital mortality reached 12%. Conclusions: Hospitalized patients were predominantly middle-aged men presenting with fever and significant respiratory involvement. More than half exhibited moderate-to-severe pulmonary disease and a substantial proportion required critical care. These findings contribute to understanding the clinical profile and outcomes of COVID-19 in the private healthcare setting in Peru during the first pandemic waves.
Walter José del Carmen Portugal Benavides
Epidemiological characterization, spatial and temporal trends of loxoscelism cases reported in Peru, 2006–2023
Introduction: Loxoscelism is an important public health problem in Peru due to the morbidity associated with bites from spiders of the genus Loxosceles. Although national reports are available, epidemiological evidence remains limited and fragmented. Objective: To describe the epidemiological patterns of loxoscelism in Peru from 2006 to 2023 according to time, place, and person. Materials and Methods: An observational descriptive study was conducted using secondary data obtained from the National Epidemiology Network (RENACE). Descriptive analyses were performed to estimate frequencies, incidence rates, and the spatial, temporal, and demographic distribution of reported cases. Results: Between 2006 and 2023, a total of 17,689 confirmed and 108 probable cases of loxoscelism were reported. Lima (27.5%) and Arequipa (17.9%) accounted for the highest proportion of cases. Overall, 68% of cases occurred in the coastal region and 51.96% in central Peru. Adults aged 30–59 years represented the largest affected group (41%), followed by children (22%). Females accounted for a slight majority of cases (51.96%). A clear seasonal pattern was observed, with the highest number of cases occurring during the first epidemiological weeks of each year. Conclusions: Loxoscelism in Peru shows a well-defined seasonal pattern and a marked geographic concentration in coastal departments, particularly Lima, Arequipa, and La Libertad. Differences in age distribution and geographic occurrence provide valuable epidemiological evidence for surveillance and support the development of future analytical studies aimed at identifying associated risk factors.
Cardiovascular risk factors in workers at a public hospital in piura, 2025
Objective: To identify the most frequent modifiable cardiovascular risk factors among workers at a public hospital in Piura, Peru. Methods: Quantitative, descriptive, cross-sectional study based on secondary data from 411 healthcare workers enrolled in the “Prevenir EsSalud” program. Results: The most prevalent risk factors were increased abdominal circumference (83.9%), elevated BMI (78.8%), insufficient physical activity (87.3%), unhealthy diet (68.6%), low HDL cholesterol (50.1%), and hypertriglyceridemia (39.4%). More than 75% presented four or more concurrent cardiovascular risk factors. Conclusions: Modifiable cardiovascular risk factors were highly prevalent, highlighting the need for workplace prevention strategies and periodic cardiovascular risk assessment.
Copyright (c) 2026 Samanta Ovalle Meramendi, Hector Pereyra Zaldivar, Natalia Beatriz Allccaco Vacas (Author) https://creativecommons.org/licenses/by/4.0
Demographic, Clinical, and Healthcare Characteristics of Patients with Schizophrenia Treated with Clozapine in the Almenara Healthcare Network of EsSalud, 2019–2024
Objective: To describe the sociodemographic, clinical, and healthcare-related characteristics of patients with schizophrenia treated with clozapine within the Almenara Healthcare Network of EsSalud between 2019 and 2024. Methods: An observational, retrospective, and descriptive study based on administrative, clinical, and prescription records from 2019 to 2024. Patients with ICD-10 diagnoses F20.x and F2X who had received at least one prescription for clozapine were included. Descriptive analyses were performed, followed by comparisons using Student's t test or the Mann–Whitney U test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. Annual prevalence rates were calculated per 100,000 insured individuals with 95% confidence intervals. Results: A total of 2,074 patients with psychotic disorders were included, of whom 199 received clozapine. Patients treated with clozapine were younger, more frequently male, and predominantly managed at tertiary-level hospitals (all p < 0.05). Schizophrenia was significantly more common among patients receiving clozapine (p < 0.001), whereas psychiatric comorbidities were less frequent (p < 0.001). The annual prevalence of clozapine use remained below 3 per 100,000 insured individuals throughout the study period, with no sustained increase over time. Conclusions: Clozapine use within the Almenara Healthcare Network remains limited and is concentrated in high-complexity hospitals, primarily among young men diagnosed with schizophrenia. These findings highlight the need for longitudinal real-world studies to better understand the factors influencing timely access to and continuity of clozapine treatment and to support strategies aimed at improving equitable implementation of this evidence-based therapy.
Copyright (c) 2026 Jeff David Huarcaya Victoria, Alexis Germán Murillo Carrasco, Mitshell Bikrham Ramos Quispe, Javier Flores Cohaila, Bryan Christopher Bastidas Reyes (Author) https://creativecommons.org/licenses/by/4.0
Prevention, Science, and Public Health Responsibility: Living Longer and Better
Copyright (c) 2026 Revista Ciencia y Tecnología aplicada a la Salud Pública https://creativecommons.org/licenses/by/4.0
Reticulocyte hemoglobin is useful for the diagnosis and monitoring of iron deficiency
Los reticulocitos son hematíes inmaduros que se producen en la médula ósea y se liberan a la sangre, donde maduran en 1 a 2 días. Su recuento brinda información sobre la actividad eritropoyética y ayuda a diagnosticar anemias y disfunciones medulares. El reticulocito se enuclea durante su maduración y elimina organelos como mitocondrias y ribosomas, conservando ARN ribosómico residual, que puede teñirse con colorantes para su identificación. La eritropoyetina (EPO) estimula la producción de reticulocitos, con un desfase de varios días entre el aumento hormonal y la elevación del número de células (1).
Copyright (c) 2026 Revista Ciencia y Tecnología aplicada a la Salud Pública
Challenges of the Edgardo Rebagliati Martins National Hospital Toward 2050
El Hospital Nacional Edgardo Rebagliati Martíns (HNERM), desde su creación en 1958, ha sido una institución emblemática de la seguridad social peruana. En la actualidad más que un hospital de alta complejidad, su situación está reflejando, y en muchos casos anticipando, las tensiones estructurales del sistema sanitario nacional. La sobre congestión y sobre saturación que hoy ocurre en sus salas y unidades críticas no solo es la expresión de la demanda actual, sino un indicio temprano de los retos y desafíos que el país enfrentará en las próximas décadas, en consonancia con la planificación sanitaria nacional al 2030 y la visión prospectiva al 2050 (1).
Modified Mediastinoscopy Using Thoracoscopic Optics for Invasive Staging of Non-Small Cell Lung Cancer in a Hospital in Lima, Peru
Introduction: In centers where video-mediastinoscopy (VAM) and endobronchial ultrasound (EBUS) are unavailable, surgery is essential for the diagnosis and staging of non-small cell lung cancer (NSCLC).Case report: We describe our initial experience with modified mediastinoscopy using thoracoscopic optics (MMTO) and its results in the invasive staging of NSCLC. We report a series of six cases with clinical stage IIb–IIIb NSCLC who underwent MMTO at the Hospital Nacional Guillermo Almenara Irigoyen (HNGAI) between March and June 2025. The surgical technique, clinical characteristics, intraoperative findings, and immediate outcomes are described. The technique allowed adequate access and visualization of lymph node stations 2R, 4R, 4L, and 7 in all cases, with no postoperative complications reported. Conclusion: MMTO is a safe and feasible alternative for invasive mediastinal staging in NSCLC in centers without access to VAM or EBUS.
Corruption and its impact on the mental health of public managers in Peru
To analyze the impact of corruption on the mental health of public managers in Peru, identifying the main psychological manifestations, risk factors, and mitigation strategies described in the scientific literature. A structured narrative review of the literature published between 2015 and 2025 was conducted in databases such as PubMed, Scopus, SciELO, and Google Scholar, using MeSH and DeCS descriptors in Spanish and English. A total of 38 publications were included, selected through explicit inclusion and exclusion criteria. Public managers operating in high-corruption environments show higher rates of emotional exhaustion, deterioration of professional identity, and persistent ethical conflicts. Regulatory ambiguity, institutional pressure to participate in irregular acts, and systemic impunity are identified as risk factors. A bidirectional relationship exists between corruption and deterioration of mental health in Peruvian public managers, with implications for human talent management policies in the public sector. Organizational integrity systems, public ethics training, and strengthened whistleblowing mechanisms constitute protective strategies.
Digital health in social security systems in the Americas and Europe: good practices and challenges for more inclusive and sustainable care
Social security systems face concurrent pressures: rising demand driven by demographic and epidemiological transitions, growing expectations for timely care, resource constraints, and the need to reduce inequities and the health sector’s environmental footprint. Digital health offers opportunities to expand access, strengthen continuity of care, streamline processes, and improve the insured person’s experience; however, it may widen gaps if implemented without an explicit focus on inclusion, governance, and human support. This special article synthesizes lessons for social security institutions based on a thematic documentary analysis of International Social Security Association (ISSA) reports, including its Information and Communication Technology (ICT) guidelines, and the World Health Organization’s Global Strategy on Digital Health 2020–2027 as the guiding framework. Illustrative cases from the Americas (EsSalud’s VIVA digital one-stop shop in Peru; EDUS in Costa Rica; Uruguay’s National Electronic Health Record) and Europe (digital empowerment/mandates in Belgium; digital mediation and accessible materials in France; a hybrid assisted model in Latvia; biometric authentication in Spain) are presented. Findings are organized into five domains: (i) service integration and simplification (transformational one-stop shop), (ii) deliberate digital inclusion and multichannel delivery, (iii) interoperability and clinical continuity, (iv) trust, security and a “human-in-the-loop” approach, and (v) measurable environmental sustainability. Operational recommendations oriented to public value are proposed: interoperable architecture, end-to-end integrated services, user segmentation, mediation and accessibility, digital service management (including SLAs), and integrated metrics for equity, quality/safety, efficiency and sustainability.
Thoracolaparoscopic esophagectomy for esophageal cancer: case series and perioperative outcomes in a National Hospital of Peru (2022–2026)
Introduction: Thoracoscopic–laparoscopic esophagectomy is a minimally invasive approach for esophageal cancer, associated with reduced morbidity and adequate oncologic radicality, and represents a cornerstone of multimodal curative treatment. Objective: To evaluate the initial outcomes of patients undergoing thoracoscopic–laparoscopic esophagectomy in a national referral hospital in Peru. The Study: Case series with 30–60-day follow-up. Patients with resectable esophageal cancer underwent thoracoscopic, laparoscopic, and cervical approaches with two-field lymphadenectomy (2022–2026). Results: Eleven patients were included (54.5% female), with a mean age of 61.9 years. Mean operative time was 371.5 minutes and mean blood loss was 108.8 mL. No intraoperative complications were reported. Major postoperative complications included pneumonia (45.5%) and anastomotic leak (36.4%). Mean hospital stay was 61.4 days. No mortality was observed during follow-up. Findings: Thoracoscopic–laparoscopic esophagectomy is feasible and safe in a real-world referral setting, with acceptable perioperative outcomes and no short-term mortality.
Characteristics of Patients Treated by FISSAL for Kidney Transplantation in 2022 in Lima, Peru: A Descriptive Observational Study
Objective: To describe the institutional, demographic, and economic characteristics of patients who underwent kidney transplantation in Lima in 2022 financed by SIS/FISSAL. The study: Descriptive observational study based on secondary data from the FISSAL 2022 database on rare diseases and transplants. The unit of analysis consisted of patients treated in referral hospitals. Variables analyzed included age, sex, healthcare facility, type of insurance, and amount of financing. Findings: A total of 203 patients received kidney transplants; 91% were enrolled in the SIS Free Insurance scheme. Forty-two percent were treated at the Cayetano Heredia National Hospital and 33% at the National Institute of Child Health–San Borja. Adolescents (12–17 years) accounted for the highest expenditure (61.7%; S/ 750,388), followed by young adults (20.6%) and adults (17.7%). Conclusion: Public insurance was the main source of financing. The findings highlight higher expenditures among younger populations and underscore the need to evaluate equity, access, and sustainability of programs funded by FISSAL/SIS.
Epidemiology of leukemias in the population covered by the Intangible Solidarity Health Fund (FISSAL), 2022-2023
Objective: To characterize leukemia diagnoses in the population covered by the Intangible Solidarity Health Fund (FISSAL) of the Comprehensive Health Insurance (SIS) during the period 2022–2023. The Study: An observational, descriptive study was conducted using secondary data obtained from FISSAL (SIS) in Peru, which includes records of oncologic care provided during 2022 and 2023. Findings: A total of 7 771 diagnoses corresponding to 5 443 patients were analyzed. Acute leukemias were the most prevalent (65.1%), primarily affecting the pediatric population, whereas chronic leukemias showed a marked predominance among adults (80.6%). Variations were observed according to age group and geographic region, as well as a strong concentration of diagnoses in the capital city. Conclusion: These findings highlight the urgent need to decentralize oncohematologic care and to improve the equitable distribution of resources in order to ensure timely diagnosis and effective treatment across all cities in the country.
Factors associated with erythropoietin resistance in patients with chronic kidney disease onhemodialysis
Introduction. Patients with chronic kidney disease (CKD) present resistance to erythropoietin (αEPO) associated with mortality. Objective. Identify the factors that generate resistance to αEPO in patients with CKD on hemodialysis (HD). Materials and methods. Longitudinal, retrospective, and analytical design. A sample of 56 patients with CKD on HD was analyzed. To determine resistance to αEPO, the erythropoietin resistance index (IRE) was calculated. Serum iron was determined, and patients were classified as absolute resistance when they showed transferrin saturation (ST) < 10%, Hb < 11, and IRE ≥ 9.06, or relative resistance when ST was between 10 - 20%, Hb < 11, and IRE ≥ 9.06. Results. Resistance to αEPO was 28.5%. The prevalence of anemia was 41.1%, of which 69.6% had a high ERI. The ferritin and serum calcium were elevated in the high IRE group, while serum iron presented a lower concentration (8,9 µM/L; 6,6 – 13,2). The risk factors associated with IRE were: Hb <11 (OR=2.31, p<0.020) and ferritin (OR=1.001p<0.001). Conclusions. The study showed high resistance to αEPO and serum iron deficiency in patients with CKD on HD. High IRE was significantly related to Hb, iron, serum calcium, and ferritin. Iron behaves as a protective factor for resistance to αEPO.
Usability of a Chatbot for Health Promotion in Adults Over 40 Years Without a Diagnosis of Chronic Disease
Objective: This study aimed to evaluate the acceptability and usability of the Nutribot tool among Peruvian adults aged 40 years or older without a diagnosis of noncommunicable diseases (NCDs), with the purpose of validating its relevance as a preventive educational resource and laying the groundwork for its large-scale implementation in public health. Material and Methods: The study included 50 participants who interacted with the system for 20–30 minutes and completed a usability questionnaire and one open-ended question. More than 60% of participants agreed or strongly agreed with key items (ease of use, clarity, comprehension, and usefulness). The likelihood of recommendation was high, with a mean score of 8.92/10 (median: 9; range: 6–10), indicating high overall satisfaction. Results: Participants’ ages ranged from 40 to 83 years, with no appreciable differences in ratings across age groups. Qualitative analysis highlighted the speed, clarity, and user-friendly nature of the responses, as well as their practical usefulness in everyday consultations. Key suggestions included the need for greater system proactivity and improved information presentation through more structured formats and additional functionalities. Conclusions: The findings demonstrate the feasibility of implementing an LLM-based nutritional chatbot delivered via WhatsApp as a complementary tool to promote healthy lifestyles and self-management of well-being among adults. Additionally, the study provides operational evidence to optimize the prototype prior to large-scale public health deployment.
Science, innovation and evidence to transform public health in Peru
Con especial satisfacción, saludo la publicación del primer número de la Revista Ciencia y Tecnología aplicada a la Salud Pública, una iniciativa estratégica del Instituto de Evaluación de Tecnologías en Salud e Investigación (IETSI) de EsSalud, lo cual marca un hito y un compromiso institucional en el fortalecimiento del desarrollo científico y del ecosistema nacional de investigación en salud (1).