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RESUMEN Objetivo: Comparar el cumplimiento por parte de los médicos de las recomendaciones que establecen las guías de manejo y prevención de pie diabético entre un hospital público y uno privado. Materiales y métodos: Realizamos un análisis secundario de la base de datos del estudio transversal "Calidad del control metabólico en pacientes ambulatorios con diabetes mellitus tipo 2 atendidos en dos hospitales generales de Lima". Se utilizaron dos cuestionarios, el primero para recolectar datos demográficos y un segundo de 5 preguntas aplicados al terminar su cita en el consultorio externo de endocrinología: 1) Pedido del médico de retirarse los zapatos, 2) Evaluación de sensibilidad en extremidades inferiores, 3) Recomendación de zapatos especiales, 4) Derivación al servicio de pie diabético y 5) Uso de zapatos especiales por el paciente. Para el análisis de datos se calculó la proporción y los intervalos de confianza al 95% del cumplimiento de las recomendaciones y se usó chi cuadrado o la prueba exacta de Fisher par a evaluar asociación entre tipo de hospital y cumplimiento de las recomendaciones. Resultados: Se encontró una diferencia significativa entre el hospital público y el hospital privado (p <0,05) en el cumplimiento de cuatro de las cinco recomendaciones. En los cuatro casos el cumplimiento fue mayor en el hospital privado que en el hospital público. Las recomendaciones con diferencia significativa fueron: 1. Participante afirmó haberse retirado los zapatos por pedido del médico (37% hospital público vs 77% hospital privado p <0,001); 2. Paciente recibió recomendación de usar calzado especial (16% hospital público vs 61% hospital privado p <0,001) 3. Paciente fue derivado a un servicio de pie diabético (3% hospital público vs 18% hospital privado p =0,001); 4. Paciente afirmaba usar calzado especial (64% hospital público vs 82% hospital privado p =0,012). La única recomendación que no tuvo una diferencia significativa fue el examen de búsqueda de neuropatía (45% hospital público vs 54% hospital privado). Conclusiones: El cumplimiento de las recomendaciones por parte de los médicos de cuidado de pies en pacientes con Diabetes mellitus tipo 2, fue significativamente mayor en la institución privada vs. La pública. Sin embargo, incluso en la institución privada el resultado distó de ser idóneo. La mejor performance en el hospital privado, sugiere que existirían diferencias de la calidad de la atención, lo que tendría repercusiones en la salud de las personas
ABSTRACT Objective: To compare physicians' compliance with the recommendations established by the guides for diabetic foot management and prevention in a public hospital and a private hospital. Materials and methods:: This is a secondary analysis study of the data base from the 'Quality of Metabolic Control in Type 2 Diabetes Outpatients Managed in Lima General Hospitals'. Two questionnaires were used, the first one for collecting demographic data, and the second with 5 questions, and both were administered at the end of their appointment in the endocrinology clinic. The second questionnaire requested the following information: i. Request from the physician to take out their shoes. ii. Sensitivity assessment in the legs. iii. Recommending the use of special shoes. iv. Referring patients to the diabetic foot service, and v. Use of special shoes by the patients. The rates and the 95% confidence intervals for compliance with the aforementioned recommendations were calculated, and chisquare test and Fisher's exact method were used for determining an association between the hospital type and compliance with the recommendations. Results: A significant difference was found between the public hospital and the private hospital (p<0.05) in complying with four of five recommendations (in these four cases compliance was higher in the private hospital). These were as follows: 1. The participants declared having taken out their shoes at the physicians' request (37% public vs. 77% private, p<0.001); 2. The patients received a recommendation about using special shoes (16% public vs. 61% private, p<0.001); 3. Patients were referred to a diabetic foot service (3% public vs. 18% private, p= 0.001); 4. Patients reported using special shoes (64% public vs. 82% private, p= 0.012). Conclusions: Compliance with physicians' recommendations regarding feet care in patients with type 2 diabetes mellitus was significantly higher in a private hospital compared to a public hospital. However, even in the private institution the result was far from being optimal. The best performance in the private hospital suggests there are differences in quality of care, which may have consequences in people's health
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Objetivo: Evaluar la calidad de control metabólico en pacientes ambulatorios con diabetes mellitus tipo 2 (DM2) de una clínica privada en Lima, Perú. Materiales y métodos: Estudio de corte transversal en la consulta externa del Servicio de endocrinología de una clínica privada de Lima, Perú. Se recolectó información socio demográfica, historia de enfermedad, autorreporte de complicaciones y comorbilidades, medidas antropométricas y presión arterial. Además, se tomó muestras de sangre para análisis de prueba rápida de glucosa, hemoglobina glicosilada (HbA1c) y perfil lipídico. Se consideró pobre control metabólico si el participante tenía HbA1c >7%, colesterol LDL (LDL-c) =100 mg/dl, y presión arterial =130/80 mmHg. Se aplicaron cuestionarios adicionales, para medir la adherencia al tratamiento, actividad física, calidad de vida, autoeficacia y depresión. Resultados: Se incluyó a 60 participantes, 53,3% (32/60) fueron de sexo femenino y la media de edad fue 63,1 ±13,2 años. Se encontró pobre control metabólico en 85% (51/60) de los participantes; presión arterial controlada en 71,2% (42/60), LDL-c controlado en 10% (6/60) y HbA1c controlado en 48,3% (29/60) de los participantes respectivamente. Complicaciones crónicas como retinopatía se autorreportó en el 3,3% (2/60) participantes, neuropatía en 10% (6/60), nefropatía en 1,7% (1/60), presión arterial alta en 30% (18/60) y enfermedad cerebro vascular en 5% (3/60) de los participantes. Conclusión: La prevalencia de control metabólico no controlado es elevada, a pesar del contexto de atención en una clínica privada. Regulación y medidas para mejorar el control en centros privados es necesario
Objective: To assess the quality of metabolic control among outpatients with type 2 diabetes mellitus (DM2) in a private clinic in Lima, Peru. Materials and methods: This is a cross-sectional study in the outpatient endocrinology service of a private clinic in Lima, Peru. Socio-demographic information, history of diabetes, self-report of complications and comorbidities, anthropometric measures and blood pressure data were collected. Blood samples were taken for assessing fasting blood glucose, glycated hemoglobin (HbA1c) and lipid profile. A poor metabolic control was considered if the participant had HbA1c >7%, LDL cholesterol (LDL-c) =100 mg/dl, and blood pressure =130/80 mmHg. Additional questionnaires were administered for measuring adherence to therapy, physical activity, quality of life, self-efficacy and depression. Results: Sixty participants were included; 53.3% (32/60) were female and their mean age was 63.1 ±13.2 years. Poor metabolic control was found in 85% (51/60) of all participants; controlled blood pressure in 71.2% (42/60), controlled LDL-C levels in 10% (6/60), and controlled HbA1c values in 48.3% (29/60) participants, respectively. Chronic complications such as retinopathy were found in 3.33% (2/60) participants, neuropathy in 10% (6/60), nephropathy in 1.7% (1/60), high blood pressure in 30% (18/60) and cerebrovascular disease in 5% (3/60) of all participants. Conclusion: There is a high prevalence of poor metabolic control in patients with type 2 diabetes, despite being taken care of in a private clinic. It is necessary to take actions in order to improve the metabolic control in patients with type 2 diabetes attending the private health care sector
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Objective: Explore the perspectives, decision-making process, and final mode of delivery among pregnant women with a previous C-section (Cesarean section) in a general public sector hospital in Lima, Peru. Methods: A qualitative prospective study using semistructured interviews at two time points in the outpatient obstetrics and gynecology clinic of a public sector, university-affiliated reference hospital in Lima, Peru. Seventeen adult pregnant women with a prior C-section who were deemed by their attending obstetrician to be candidates for a trial of labor were interviewed. The first interview was between 37 and 38 weeks of pregnancy, and the second interview was 24 to 48 hours after delivery. MAIN OUTCOME MEASURES: Predelivery decision-making process and final mode of delivery. Results: Among the 17 participants, about half (9) of the participants stated that the physician explained that they had two approaches for delivery, a trial of labor after C-section (TOLAC) or elective repeated C-section (ERCD). Two women stated that their respective providers explained only one option, either an ERCD or TOLAC. However, 6 women did not receive any information from their providers about their delivery options. Of the 10 participants that decided TOLAC, 8 ended up having a C-section, and of the 7 patients that had planned an ERCD, 1 ended up having a vaginal delivery. Conclusion: Many participants affirmed that they made the decision about their approach of delivery. However, most of the participants that decided a TOLAC ended up having a C-section because of complications during the final weeks of pregnancy or during labor.
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INTRODUCTION: Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings. OBJECTIVE: Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality. METHODS: Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline. RESULTS: Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74). CONCLUSIONS: Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes.