Burden of disease due to hip, knee, and unspecified osteoarthritis in the Peruvian social health insurance system (EsSalud), 2016.

Introduction: Since its introduction by the World Health Organization (WHO), the concept of burden of disease has been evolving. The current method uses life expectancy projected to 2050 and does not consider age-weighting and time-discounting. Our aim is to estimate the burden of disease due to hip, knee, and unspecified osteoarthritis using this new method in the Peruvian Social Health Insurance System (EsSalud) during 2016. Methods: We followed the original 1994 WHO study and the current 2015 Global Burden of Disease (GBD) methods to estimate disability adjusted life years (DALY) due to osteoarthritis, categorized by sex, age, osteoarthritis type, and geographical area. We used disability weights employed by the Peruvian Ministry of Health, and the last update issued by WHO. Results: Overall, EsSalud reported 17.9 new cases of osteoarthritis per 1000 patients per year. Annual incidence was 23.7/1000 among women, and 72.6/1000 in people above 60 years old. Incidence was 5.6/1000 for knee osteoarthritis and 1.1/1000 for hip. According to the 1994 WHO method, there were 399,884 DALYs or 36.6 DALYs/1000 patients per year due to osteoarthritis. 12.4 and 2.2 DALYs/1000 patients per-year were estimated for knee and hip osteoarthritis, respectively. Using the 2015 GBD method, there were 1,037,865 DALYs or 94.9 DALYs/1000 patients per year. 31.4 and 5.3 DALYs/1000 patients per year were calculated for knee and hip osteoarthritis, respectively. Conclusions: In the Peruvian social health insurance subsystem, hip, knee, and unspecified osteoarthritis produced a high burden of disease, especially among women and patients over 60. The 2015 GBD methodology yields values almost three times higher than the original recommendations.

[Institutional differences in the ineffective access to prescription medication in health care centers in Peru: analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014)]. / Diferencias institucionales en el insuficiente acceso efectivo a medicamentos prescritos en instituciones prestadoras de servicios de salud en Perú: análisis de la Encuesta Nacional de Satisfacción de Usuarios de los Servicios de Salud (ENSUSALUD 2014).

Objectives To estimate the prevalence of ineffective access to drugs (IAD) and associated factors in patients receiving a prescription in an outpatient clinic in Peru. Materials and Methods We performed a secondary data-analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014), a two-stage population-based study carried out in health care centers of the Ministry of Health and Regional Governments (MOHRG), Social Security (EsSalud), Armed Forces and Police (AFP) and the private sector across all 25 regions of Peru. IAD was defined as incomplete or no dispensing of any prescribed medication in the health care center pharmacy. Generalized linear models with Poisson distribution for complex survey sampling were fit to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Results Out of 13,360 participants, 80.9 % (95% CI: 79.9-81.8) had an active prescription, and of those, 90.8 % (95% CI: 90.1-91.6) sought their medications in a health care center pharmacy, where 30.6 % (95% CI 28.8-32.4) had IAD. In the multiple regression model, receiving medical attention in the MOHRG (PR 4.8; 95%CI: 3.5-6.54) or AFP (PR: 3.2; 95%CI: 2.3-4.5), being over 60 years old (PR: 1.17; 95%CI: 1.04-1.34) and being in the poorest income quintile (PR: 1.05; 95%CI: 1.05-1.41) increased IAD. Furthermore, in contrast to seeking care for pregnancy or other routine control, IAD was also more common for medical consultation for diseases diagnosed in the last 15 days (PR: 1.37; 95% CI: 1.05-1.79) or more than 15 days prior (PR: 1.51; 95% CI: 1.16-1.97). Conclusions In Peru, IAD is associated with the provider institution, older age, poverty and the reason for medical consultation. We suggest strategies to promote access to medicines, especially in the most disadvantaged segments of the Peruvian population.

Agotamiento profesional: prevalencia y factores asociados en médicos y enfermeras en siete regiones del Perú / Burnout: prevalence and associated factors in doctors and nurses in seven regions of Peru

Introducción. El agotamiento profesional es un síndrome clínico multicausal considerado un daño laboral muy importante, por lo que debe ser identificado y analizado en profesionales de la salud dado su rol en la sociedad. Objetivo. Determinar la prevalencia y factores asociados al agotamiento profesional en médicos y enfermeras en siete departamentos del Perú. Diseño. Estudio transversal. Lugar. Departamentos de Apurímac, Ayacucho, Huancavelica, Lima-Callao, Loreto, Piura y San Martín. Participantes. 958 médicos y 840 enfermeras. Intervenciones. Se aplicó encuesta de creación propia que incluía variables sociodemográficas y laborales y la autoaplicación de la prueba de Maslach. El muestreo fue probabilístico, complejo, estratificado y bietápico. El análisis descriptivo usó medidas de tendencia central y porcentajes, mientras que para la asociación se usó las pruebas de chi2, Fisher, Anova y Kruskal-Wallis. El nivel de significancia fue ≤ 0,05. Principales medidas de resultados. Prevalencia de agotamiento profesional. Resultados. La prevalencia de agotamiento profesional fue 5,5%. El 18,7% de participantes tenía un riesgo alto de despersonalización, el 10% cansancio emocional y 32,1% pobre realización personal. Los factores asociados fueron la profesión médico (OR= 2,829), sexo masculino (OR= 2,474), separación familiar (OR= 1,697), insatisfacción con el horario de trabajo (OR= 2,609), enfermedad agravada o causada por el trabajo (OR= 3,120), trabajar en establecimientos nivel II (OR= 2,421) o nivel III (OR= 3,363). Conclusiones. Se encontró asociación entre el agotamiento profesional y la actividad laboral en establecimientos de mayor complejidad, donde la carga emocional por la atención de casos complejos sería mayor; además, la separación familiar o la morbilidad agravada o causada laboralmente son factores estresantes y se encontrarían asociados al mismo.

Introduction: Burnout is a multi-causal clinical syndrome considered to be a very important work-related injury and should be identified and analyzed in health professionals given their role in society. Objective: To determine the prevalence and associated factors of burnout in doctors and nurses in seven regions of Peru. Design: Cross-sectional study. Setting: Regions of Apurímac, Ayacucho, Huancavelica, Lima-Callao, Loreto, Piura and San Martín. Participants: 958 physicians and 840 nurses. Interventions: A self-created survey, which included sociodemographic and labor variables, was conducted and the Maslach test was self-applied. The sample was probabilistic, complex, two-stage and stratified. The descriptive analysis used measures of central tendency and percentages, whereas Chi-square, Fisher, Anova and Kruskal-Wallis tests were used for the associations. The significance level was ≤ 0.05. Main outcome measures: Prevalence of burnout. Results: The burnout prevalence was 5.5%. High risk of depersonalization (18.7%), emotional exhaustion (10%) and poor personal accomplishment (32.1%) were found. Medical profession (OR = 2.829), male sex (OR = 2.474), family separation (OR = 1.697), dissatisfaction with working hours (OR = 2.609), disease worsened or caused by work (OR = 3.120), and working in local level II (OR = 2.421) or III (OR = 3.363) were associated factors. Conclusions: We found an association between burnout and work activity in health facilities of greater complexity where the emotional load caused by attending complex cases would be greater was found. Familiar separation or morbidity aggravated or caused by work were stressing factors probably associated to burnout.

Diferencias institucionales en el insuficiente acceso efectivo a medicamentos prescritos en instituciones prestadoras de servicios de salud en Perú: análisis de la Encuesta Nacional de Satisfacción de Usuarios de los Servicios de Salud (ENSUSALUD 2014) / Institutional differences in the ineffective access to prescription medication in health care centers in Peru: analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014)

RESUMEN Objetivos Estimar la prevalencia de insuficiente acceso efectivo a medicamentos (IAEM) y sus factores asociados en usuariosque reciben prescripción médica en la consulta ambulatoria de instituciones prestadoras de servicios de salud (IPRESS) en Perú. Materiales y métodos Se realizó un análisis secundario de la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD) del año 2014; estudio con muestreo probabilístico bietápico a nivel nacional en IPRESS del Ministerio de Salud y Gobiernos Regionales (MINSA-GR), Seguro Social de Salud (EsSalud), Fuerzas Armadas y Policiales (sanidades), y Clínicas del sector privado. El IAEM se definió como la dispensación incompleta o de ningún medicamento en la farmacia de la IPRESS. Se realizaron modelos lineales generalizados y se estimaron razones de prevalencia (RP) con IC 95% para muestreo complejo. Resultados De los 13 670 entrevistados, el 80,9% (IC 95%: 79,9-81,8%) recibieron indicación de medicamentos, y de éstos el 90,8% (IC 95%: 90,1-91,6%) los solicitaron en la farmacia de la IPRESS, donde el 30,6% (IC 95%:28,8-32,4%) tuvo IAEM. El ser atendido en el MINSA-GR (RP: 4,8; IC95%: 3,5-6,54) y en las sanidades (RP: 3,21; IC 95%: 2,3-4,5), el ser de la tercera edad (RP: 1,17; IC 95%: 1,04-1,34) y el pertenecer al quintil más pobre (RP: 1,21; IC 95%: 1,05-1,41) incrementaron la probabilidad de IAEM. Asimismo, los pacientes atendidos por una enfermedad de menos de 15 días (RP: 1,37; IC 95%: 1,05-1,79) y de 15 días a más (RP: 1,51; IC 95%: 1,16-1,97) tuvieron una mayor prevalencia de IAEM que aquellos atendidos por embarazo u otros controles. Conclusiones El IAEM está asociado al subsistema de salud, edad, pobreza y tipo de consulta realizada. Se sugieren implementar estrategias para fomentar el acceso a medicamentos en la población peruana.

ABSTRACT Objectives To estimate the prevalence of ineffective access to drugs (IAD) and associated factors in patients receiving a prescription in an outpatient clinic in Peru. Materials and Methods We performed a secondary data-analysis of the National Survey on User Satisfaction of Health Services (ENSUSALUD 2014), a two-stage population-based study carried out in health care centers of the Ministry of Health and Regional Governments (MOHRG), Social Security (EsSalud), Armed Forces and Police (AFP) and the private sector across all 25 regions of Peru. IAD was defined as incomplete or no dispensing of any prescribed medication in the health care center pharmacy. Generalized linear models with Poisson distribution for complex survey sampling were fit to estimate prevalence ratios (PR) and 95% confidence intervals (CI). Results Out of 13,360 participants, 80.9 % (95% CI: 79.9-81.8) had an active prescription, and of those, 90.8 % (95% CI: 90.1-91.6) sought their medications in a health care center pharmacy, where 30.6 % (95% CI 28.8-32.4) had IAD. In the multiple regression model, receiving medical attention in the MOHRG (PR 4.8; 95%CI: 3.5-6.54) or AFP (PR: 3.2; 95%CI: 2.3-4.5), being over 60 years old (PR: 1.17; 95%CI: 1.04-1.34) and being in the poorest income quintile (PR: 1.05; 95%CI: 1.05-1.41) increased IAD. Furthermore, in contrast to seeking care for pregnancy or other routine control, IAD was also more common for medical consultation for diseases diagnosed in the last 15 days (PR: 1.37; 95% CI: 1.05-1.79) or more than 15 days prior (PR: 1.51; 95% CI: 1.16-1.97). Conclusions In Peru, IAD is associated with the provider institution, older age, poverty and the reason for medical consultation. We suggest strategies to promote access to medicines, especially in the most disadvantaged segments of the Peruvian population.

Presentación clínica-radiológica de la coinfección tuberculoasis-HIV en adultos mayores en el Hospital Nacional Hipólito Unanue / Clinical-radiological presentation of the coinfection tuberculosis-HIV in major adults in the Hipolito Unanue National Hospital

Objetivo: Conocer el patrón clínico de la presentación de la coinfección entre HIV y Mycobacterium tuberculosis en pacientes adultos mayores e identificar los tipos de alteración radiológica en esta población. Método: Estudio de tipo descriptivo de tipo serie de casos, para lo cual se consideraron pacientes adultos mayores con coinfección de HIV y Mycobacterium tuberculosis. Realizado en los servicios de PCT, Geriatría, Infectología y Emergencia del Hospital Nacional Hipólito Unßnue desde abril de 1998 a abril del 2005. Resultados: De un total de 58 pacientes adultos mayores identificados con infección demostrada por HIV-SIDA se llegaron a identificar 12 pacientes todos varones con diagnostico de tuberculosis cuya edad fluctuaba entre 60 a 72 a±os con una medida de 65.67 (DE=5,37). La presentación clínica de tuberculosis fue: TBC pulmonar en 8 (66,6 por ciento) de estos 2 fueron de tipo militar; en 4 casos (33,3 por ciento) se diagnóstico tuberculosis extrapulmonar, siendo en 3 (25 por ciento) la presentación de tipo meningoencefßlica y 1 (8,3 por ciento) con efusión pleural específica. En relación a los hallazgos radiológicos se encontró alteraciones radiológicas en 11 de los pacientes, siendo el patrón radiológico mßs frecuente el de tipo intersticial y sólo un paciente tenía TBC extrapulmonar con radiografía normal (8,3 por ciento). Las lesiones radiológicas afectaron con mßs frecuencia el lado derecho en el 83,3 por ciento pacientes. Conclusiones: ...

Objetive: To know the clinical pattern of the presentation in coinfection between HIV and Mycobacterium tuberculosis in Major Adults patients and to identify the types of radiological alterations in this population. Method: Descriptive study of types Series of Cases, for which were considered major adults patients with coinfection of HIV and Mycobacterium tuberculosis. Realized in PCT, Geriatrics, Infectology anfd Emergency Services of the Hipólito Unßnue National Hospital from april 1998 to april 2005. Results: Of a total of 58 adult major patients identified with infection demostrated for HIV-AIDS, 12 patients with diagnosis of tuberculosis wich age was fluctuating between 60 to 72 years old with an average of 65.67 (SD=5,37) were men. The clinical presentation of tuberculosis was: Pulmonary TBC in 8 (66.6 per cent) of these 2 they were miliary tuberculosis; in 4 cases (33,3 per cent) the diagnoses was extrapulmonar tuberculosis, being in 3 (25 per cent) the presentation of type meningoencephalic and 1 (8,3 per cent) with specific pleural effusion. In relation to the radiological finds it found radiological alterations in 11 patients, being the interstitial pattern the most frequent and alone one patient had TBC extrapulmonar with normal radiographic (8,3 per cent). The radiological alterations affected with more frequency the right side in 83,3 per cent patient. Conclusions: ...