Determinants of non-institutional childbirth: Evidence from the Peruvian demographic and health survey.

Objective: We aimed to evaluate the determinants of non-institutional delivery among women of childbearing age in Peru. Methods: We conducted a secondary analysis of data from the Peru 2019 Demographic and Family Health Survey (ENDES). This multi-stage survey sampling is representative at the urban-rural, regional, and national levels. The outcome variable was place of delivery, collected by self-reporting. Binary logistic regression models were used to assess the factors associated with non-institutionalized delivery. Thus, we estimated crude and adjusted odd ratios (aOR). For the multivariable model, the manual forward selection method and the Wald test were used to obtain a final parsimonious model. Results: The final sample included 14,061 women of reproductive age between the ages of 15 and 49. The prevalence of non-institutional delivery was 7.8 %. Multivariate regression analysis found that having a secondary education (aOR:0.48; 95 % confidence interval [CI]:0.39-0.58) or higher (aOR:0.57; 95 %CI:0.42-0.78); belonging to the second (aOR:0.26; 95 %CI:0.20-0.33), third (aOR:0.28; 95 %CI:0.21-0.38), fourth (aOR:0.21; 95 %CI:0.13-0.33), or fifth wealth quintile (aOR:0.15; 95 %CI:0.09-0.27); and suffering intimate partner violence (aOR:0.76; 95 %CI:0.64-0.91) were associated with lower odds of non-institutional delivery, while not having some type of health insurance (aOR:3.12; 95 %CI:2.47-3.95), living in a rural area (aOR:1.93; 95 %CI:1.54-2.42), and having had three or more deliveries (aOR:1.36; 95 %CI:1.07-1.72), were associated with higher odds of non-institutional delivery. Conclusions: We found that not having health insurance, residing in a rural area, and having had three or more deliveries were factors associated with non-institutional delivery in women of childbearing age. We propose that should focus public health strategies towards providing education to women about maternal health, and likewise, facilitating access to specialized health centers for rural populations.

Hypertension and Histopathology Severity of Non-Alcoholic Fatty Liver Disease Among Adults with Obesity: A Cross-Sectional Study.

Background: Cardiovascular diseases are responsible for the majority of deaths resulting from non-alcoholic fatty liver disease (NAFLD). NAFLD is associated with hypertension and this is a key predictor of severe liver outcomes and an indicator of nonspecific portal fibrosis. Aim: To assess the association between hypertension and NAFLD severity. Methods: We conducted a secondary analysis of data from Peruvian adults with obesity and NAFLD who attended a Peruvian bariatric center. The severity of NAFLD was assessed using the Fatty Liver Inhibition of Progression algorithm / Steatosis, Activity and Fibrosis score. Hypertension was determined by either being recorded in the medical records or if the patient had a systolic pressure ≥ 140 mmHg or diastolic pressure ≥ 90 mmHg. To evaluate the association of interest, we calculated crude and adjusted prevalence ratios (aPR) using Poisson generalized linear models with logarithmic link function and robust variances. For the multivariable models, we adjusted for age, sex, physical activity and smoking. Results: Our study included 234 participants. The prevalence of hypertension was 19.2%, while the prevalence of severe NAFLD was 46.2%. After adjusting for confounders, the prevalence of hypertension was found to be significantly higher in the severe NAFLD group compared to the non-severe group (aPR = 1.33; 95% CI: 1.03-1.74). When stratified by the presence of metabolic syndrome (MetS), the association remained significant only in the group without MetS (aPR = 1.80; 95% CI: 1.05-3.11). Conclusion: We found an association between hypertension and severe NAFLD in adults with obesity, particularly in those without MetS.

Impact of the COVID-19 pandemic on general surgery residency program in Peru: A cross-sectional study.

BACKGROUND: General surgey is a specialty of high demand and relevance. We aimed to collect the opinions of the residents and their tutors and heads of department, regarding the impact that this COVID-19 pandemic is having - and will probably have - on the training of future general surgeons in Peru. METHODS: We conducted a cross-sectional study in Lima, Peru. We surveyed residents of general surgery, as well as their tutors and heads of surgery departments from 14 Peruvian hospitals. RESULTS: The impact of COVID-19 was considered severe in approximately 60% of first-year residents, 100% of second-year residents, 40% of third-year residents and about 80% of attending physicians. The 68.8% of the residents considered that the loss of surgical training opportunities during the pandemic would negatively affect their job performance. In addition, as of 03/16/2020, no residents had performed more than 25 elective surgeries, trauma surgeries or laparoscopic procedures. All the participants (including tutors and heads of departments) highlighted the need to extend the residency period. CONCLUSION: The COVID-19 pandemic has affected the training of the general surgery residents. Deficiencies need to be identified in order to evaluate extending the period of the medical residency program in Peru.

Depression among Peruvian adults with hypertension and diabetes: Analysis of a national survey.

BACKGROUND AND AIMS: Hypertension and diabetes are global health problems with an incidence that is rapidly increasing worldwide. Depression is the most frequent mental health co-morbidity and is considered an important risk factor for the development of both diseases. This study aimed to determine the prevalence and factors associated with depression among Peruvian adults with hypertension and diabetes. METHODS: We performed a secondary analysis of the 2017 Peru Demographic and Family Health Survey, using data from 10,566 adults aged 40 and older. The main outcome was depression assessed with the Patient Health Questionnaire-9 (PHQ-9). Other important variables were the diagnosis of hypertension or diabetes, sex, age, level of education, geographical region, wealth index, daily smoking, harmful alcohol consumption and physical disability. RESULTS: The overall prevalence of depression was 23.15% (CI 95%: 21.42%-24.88%) and among adults with hypertension and diabetes it was 34.96% (CI 95%: 29.33%-40.59%) and 35.56% (CI 95%: 24.49%-46.63%), respectively. Whereas the prevalence of depression among adults with type 2 diabetes mellitus (T2DM) was higher in the physical disability group (PRa: 1.28; CI 95%: 1.12-1.45), the prevalence of depression among adults with hypertension was higher in the female group (PRa: 1.36; CI 95%: 1.20-1.54) and among those with harmful alcohol consumption (PRa: 1.50; CI 95%: 1.01-2.24). CONCLUSION: Peru has a considerable burden of depression in the hypertensive and diabetic populations. While the variables positively associated with depression in hypertensive adults were female gender and harmful alcohol consumption, in adults with diabetes it was the presence of physical disability.