Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima. / Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana.

We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana / Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima

RESUMEN Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

ABSTRACT We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru.

BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164.

Optimal 4DFlow MR sequence parameters for the assessment of internal carotid artery stenosis: a simulation study.

PURPOSE: In patients with ICA stenosis, increased peak systolic velocity is a marker of stenosis at risk of ischemic stroke. 4DFlow MRI is a reproducible technique to evaluate velocities in ICA stenosis, although it seems to underestimate velocities as compared with Doppler ultrasonography. The purpose of our study was to confirm that velocities were underestimated on a new set of data acquired with a clinical 4DFlow sequence, and to devise optimal acquisition parameters for ICA stenosis exploration based on a numerical simulation. METHODS: After review board approval, 15 healthy controls and 12 patients presenting ICA stenosis were explored with Doppler ultrasonography and 4DFlow MRI. We created a 2-dimensional simulation of ICA stenosis and its corresponding 4DFlow acquisition, and compared its mean peak systolic velocity underestimation to real MRI and Doppler. We then simulated the acquisition for voxel size ranging from 0.5 to 1.25 mm and number of phases per cardiac cycle ranging from 10 to 25. RESULTS: On acquired data, 4DFlow MR underestimated peak systolic velocities (mean difference between Doppler and 4DFlow: - 35 cm/s), especially high velocities. With spatial and temporal resolutions equivalent to MR acquisition, our simulation yielded similar underestimation (mean difference: - 31 cm/s, P = 0.30). Simulations showed that 0.7-mm resolution and 20 phases per cardiac cycle would be necessary to record peak systolic velocities up to 250 cm/s. CONCLUSION: Higher spatial resolution can provide accurate peak systolic velocities measurement with 4DFlow MRI, thus allowing better ICA stenosis assessment. Further studies are needed to validate the proposed parameters.

Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services.

BACKGROUND: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. METHODS: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. RESULTS: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. CONCLUSION: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a number of legal, policy and fiscal milestones, thereby presenting a unique and fertile environment for the expansion of mental health services.