Factores individuales e institucionales asociados a la vacunación contra el virus de la hepatitis B en recién nacidos de hospitales de Lima y Callao

Introducción. La vacunación contra el virus de la hepatitis B (VHB) en recién nacidos es crucial para la prevención de la transmisión perinatal. Objetivo. Determinar factores individuales e institucionales asociados a la vacunación contra el VHB en las 12 y 24 primeras horas de vida. Métodos. Se diseñó un estudio transversal y multicéntrico. Los datos sobre la vacunación fueron recogidos de los padres y de la revisión de reportes. Los datos de los variables individuales de los recién nacidos y madres fueron recogidos de las historias clínicas. Los datos institucionales fueron recogidos de registros de atención inmediata y directamente del personal de inmunizaciones. Resultados. Se incluyó 777 recién nacidos en 10 establecimientos. En el análisis multinivel resultó favorable a la vacunación en las primeras 12 horas, el mayor tiempo de atención en los servicios de inmunizaciones (RP: 1,0; IC95%: 0,99 - 1,01). Para la vacunación dentro de las 24 horas de vida fue favorable la mayor cantidad de personal de enfermería en los servicios de vacunación (RP: 1,02; IC95%: 1,01 - 1,03) y desfavorable la mayor cantidad de partos al día de los establecimientos (RP: 0,99; IC95%: 0,99 - 0,997). No se identificó factores individuales. Conclusión. Factores institucionales, como el tiempo de atención, la cantidad de personal de enfermería y la cantidad de partos, estuvieron asociados con la vacunación contra el VHB en recién nacidos. Se requiere estrategias de mejora como la introducción de la vacunación en la atención inmediata del neonato para la prevención de la transmisión perinatal del VHB.

Introduction. Vaccination against hepatitis B Virus (HBV) in newborns is crucial for the prevention of perinatal transmission. Objective. To determine the individual and institutional factors associated with vaccine for HBV in newborns in the first 12 hours and 24 hours of life. Methods. A cross-sectional, multicenter-design study was conducted in high level public and private hospitals in Lima Metropolitana and Callao. Information on vaccination was obtained through consultations with parents and review of health service reports. Individual variables of the newborns and their mothers were obtained from the medical records of the newborns. Institutional data were collected from immediate care records and from health personnel responsible for the immunization program. Results. The study was conducted in 10 health facilities, including 777 newborns. In the multilevel analysis, the longest care time in the vaccination service was favorable for vaccination within 12 hours of life (PR: 1,0; 95% CI: 0,9995-1,01); while for vaccination within 24 hours of life was favorable the greater number of nursing personnel (RP: 1,02; IC95%: 1,01-1,03) and unfavorable the greater number of deliveries per day in the institution (RP:0,99; IC95%: 0,99-0,997). No individual factors related to vaccination were identified. Conclusions. Institutional factors, such as length of care, number of nursing staff, and number of deliveries, were associated with newborn HBV vaccination. Improvement strategies are required, such as the introduction of vaccination in the immediate care of the newborn for the prevention of perinatal transmission of HBV.

Selected Domains within a Comprehensive Geriatric Assessment in Older Patients with Non-Hodgkin Lymphoma are Highly Associated with Frailty.

Background: The incidence of Non-Hodgkin Lymphoma (NHL) is increasing, particularly among older patients who tend to have worse outcomes and can be predisposed to increased toxicities and less treatment tolerance. Therefore, a thorough pre-treatment assessment is essential. A comprehensive geriatric assessment (CGA) can be used to evaluate the older patient considering chemotherapy and is the preferred evaluation tool. However, a formal CGA is laborious, complex and time-consuming. Objectives: To characterize older adults with NHL and determine the CGA variables with the greatest association to frailty in order to propose a more simplified assessment. Methods: We performed a cross-sectional study using data collected from CGAs in NHL patients > 65 years admitted to our oncology service, from September 2015 to August 2017. Our evaluation parameters included: polypharmacy, a screening tool of older people's prescriptions (STOPP), the Lawton scale, Barthel index, Katz index, gait speed, a Timed Up and Go (TUG) test, a Mini-Mental state examination (MMSE), the Yesavage and Gijon scales, a Mini-nutritional assessment (MNA), a Geriatric Syndromes assessment, and a Cumulative Illness Rating Scale-Geriatric (CIRS-G). The formal CGA was comprised of nine domains; frailty was defined as an impairment in > 2 domains. Each parameter was individually compared with frailty, and the results were used to build different multivariate models using logistic regression analyses to obtain the variables with the highest frailty association. Results: A total of 253 patients were included. Their median age was 75.4 years (range 65-92), and 62.1% had > 1 impaired domain, with 39.9% considered frail. Bivariate analysis showed strong associations with age > 85 and all the geriatric parameters except for STOPP. Our final multivariate analysis resulted in 5 domains (the use of > 5 medications, a Lawton < 7, TUG > 20, Yesavage > 5, and the presence of at least one geriatric syndrome) being significantly associated with frailty and performing similarly to a CGA. Conclusion: In our population of older NHL patients, an abbreviated evaluation based of only five domains, polypharmacy, TUG, Lawton scale, Yesavage scale and the presence of at least one geriatric syndrome, had similar performance to a formal CGA in determining frailty.

Nivel de conocimientos de higiene de manos en enfermeras y médicos de tres hospitales nacionales del seguro social de salud, 2018 / Knowledge of hand hygiene among nurses and physicians in three national hospitals of the Peruvian social health insurance, 2018

Introducción: Las manos de los trabajadores de la salud son los más frecuentes medios portadores de los microorganismos responsables de infecciones asociadas a la atención en salud. El objetivo de nuestro estudio fue evaluar el nivel de conocimientos de lavado de manos de tres hospitales nacionales del seguro social de salud en Lima metropolitana, 2018. Material y Métodos: Durante abril-agosto 2018, entrevistamos a enfermeras y médicos de tres hospitales nacionales con un cuestionario administrado en tres secciones y evaluado en escala vigesimal: generalidades, razones de la higiene de manos durante atención en salud y situaciones para realizar la higiene de manos. Resultados: La mediana del nivel de conocimientos de enfermeras y médicos sobre higiene de manos fue de 13,41. El nivel de conocimientos es diferente entre enfermeras y médicos (13,3 vs. 13,6). Asimismo, se encontraron menor frecuencia de acierto en los ítems: desinfección de manos dura 20 a 30 segundos (54,1%, n=276), desinfección de manos tiene 8 pasos (52,9%, n=270), eliminar los microorganismos transitorios de la piel (47,1%, n=240), cuando existe un diagnóstico infeccioso (34,7%, n=177). Conclusión: El nivel de conocimientos de las enfermeras y médicos fue bajo y existe diferencia entre subgrupos profesionales. Se recomienda implementar entrenamientos continuos siguiendo las estrategias multimodulares de la OMS

Introduction: The hands of health care workers are the most common means of carrying the microorganisms responsible for healthcare-associated infections. The objective of our study was to evaluate the level of handwashing knowledge in three national social health insurance hospitals in metropolitan Lima, 2018. Material and Methods: During April-August 2018, we interviewed nurses and physicians from three national hospitals with a three-sections questionnaire to evaluate on a twenty-first scale the following domains: generalities, reasons for hand hygiene during health care, and situations to perform hand hygiene. Results: The median knowledge of nurses and physicians about hand hygiene was 13.41. The knowledge differs between nurses and physicians (13.3 vs. 13.6). Also, there was a lower frequency of success in the following items: hand disinfection lasts 20 to 30 seconds (54.1%, n=276), hand disinfection has 8 steps (52.9%, n=270), elimination of transitory skin microorganisms (47.1%, n=240), when there is an infectious diagnosis (34.7%, n=177). Conclusion:The knowledge of nurses and physicians was low and there is a difference between professional subgroups. It is recommended to implement continuous training following the WHO multimodular strategies

Proceso de definición de prioridades institucionales de investigación en el Seguro Social de Salud del Perú, 2020-2022 / Process of defining institutional priorities for research in the Peruvian Social Health Insurance, 2020-2022

Introducción: La definición de prioridades de investigación en salud dirige los esfuerzos de investigación para promover ciencia, tecnología e innovación en salud. Material y Métodos: La definición de estas en el Seguro Social de Salud peruano para el periodo 2020-2022 se realizó en cuatro etapas y de forma sistemática, estructurada, participativa y secuencial. Resultados: Primero, se evaluó el avance de investigación en las prioridades del periodo 2017-2019. En la segunda etapa, se consultó diversas fuentes y se identificó necesidades de investigación orientadas a enfermedades y se estableció el marco para prioridades orientadas a sistemas de salud e intervenciones sanitarias. La tercera etapa consistió en una consulta ampliada para seleccionar los temas prioritarios orientados a enfermedades. Finalmente, se desarrolló un taller participativo y multidisciplinario para seleccionar temas, subtemas y áreas prioritarias de investigación. Conclusión: El producto final fue la definición de 11 temas prioritarios, siete para enfermedades y cuatro para sistemas de salud e intervenciones sanitarias.

Introduction: Health research priorities definition address research efforts to the promotion of health science, technology, and innovation. Material and Methods: Health research priorities in the Peruvian Social Security for the period 2020-2022 was carried out in four stages using a systematic, structured, participatory and sequential process. Results: First, the progress of the research in the priorities of the period 2017-2019 was evaluated. In the second stage, various sources were consulted to identify disease-oriented research needs and the framework for priorities oriented to health systems and health interventions. The third stage consisted of an expanded consultation to select priority disease-oriented topics. Finally, a participatory and multidisciplinary workshop was developed to select themes, subtopics, and priority areas for research. Conclusion: The final product was the definition of 11 priority themes, seven for diseases and four for health systems and health interventions

Identification of a norovirus outbreak on a hematopoietic stem cell transplant unit and development and implementation of a novel infection prevention algorithm for controlling transmission.

Controlling norovirus transmission in units with immunocompromised patients is challenging. We present a cluster of norovirus cases that occurred on a stem-cell transplant unit and the prevention efforts that were implemented to limit the outbreak. Protocols developed to control this cluster may provide a model for other facilities.

Higher HOMA-IR index is associated with increased excess weight loss in patients with BMI≥35kg/m2 after vertical gastrectomy. / Índice HOMA-IR como predictor de reducción de exceso de peso en pacientes con índice de masa corporal (IMC)≥35kg/m2 sometidos a gastrectomía vertical.

INTRODUCTION: Bariatric surgery is considered the most effective treatment for severe obesity. However, it is not clear if patients with diabetes mellitus or insulin resistance have the same response than patients without those conditions. Our objective was to evaluate association between pre-surgical HOMA-IR index and percentage of excess weight loss (EWL%) one year after bariatric surgery using sleeve gastrectomy. METHODS: Retrospective cohort including patients ≥18 years old with BMI≥35kg/m2, who underwent primary sleeve gastrectomy between 2014-2017 at the Avendaño Medical Center, Peru. Only patients with Type 2 Diabetes, Hypertension, or Dyslipidemia were included. EWL% ≥60% one year after surgery was considered satisfactory. Crude and adjusted Lineal and Poisson regression with robustness was used to assess statistical associations with EWL%. RESULTS: Ninety-one patients were included with a median of 34 years, and 57.1% were women. 85.7% had insulin resistance as per HOMA-IR. One year after surgery, 76.9% had a satisfactory EWL%. The lineal model showed .29% less EWL% per each extra year of life (P=.019), and .93% more EWL% per each extra HOMA-IR point (P=.004). The adjusted Poisson model showed 2% lower risk of having a satisfactory EWL% per each additional year of life (P=.050), and 2% more chance of success per each additional HOMA-IR point (P=.038). CONCLUSIONS: There was association between a higher pre-surgical HOMA-IR index and increased EWL% one year after surgery. It is possible that insulin resistance does not affect negatively sleeve gastrectomy outcomes.

Comments on "Risk of mortality of node-negative, ER/PR/HER2 breast cancer subtypes in T1, T2, and T3 tumors" by Parise CA and Caggiano V, Breast Cancer Res Treat, 2017.

We would like to express our opinion regarding a Parise and Caggiano paper recently published in your journal. We certainly believe this is a great contribution, since it found that node-negative HER2 (+) breast cancer patients have better survival contrary to the common knowledge. This finding could reflect the consequences of targeted therapies that are changing the natural history of the disease. However, we think that such an interesting analysis could also have been done with stage III and IV patients, since this group of people could benefit greatly from these findings. In fact, new guidelines now recommend the use of HER2-specific therapy for stage IV patients with positive markers, even for life if they do not show signs of progression. Additionally, we would like to discuss the value of adding the Ki-67 marker to the classification proposed by the authors, because several papers consider it an important prognostic factor.