Socio-demographic inequalities in the uptake of Papanicolaou tests in Peru: analysis of the 2015-2017 Demographic and Family Health Survey.

OBJECTIVES: This study was conducted to analyze the inequalities in Papanicolaou test (also referred to as the Pap smear) uptake according to the socio-demographic characteristics of Peruvian women 30 years to 59 years of age using information from the 2015-2017 Demographic and Family Health Survey (ENDES, acronym in Spanish). METHODS: This is an analytical, cross-sectional study based on information acquired from the 2015-2017 ENDES surveys. Socio-demographic characteristics were reported using absolute frequencies and weighted proportions with 95% confidence intervals, considering results with a p-value <0.05 as statistically significant. Concentration curves (CCs) and concentration indices (IndCs) were created based on the interaction of the wealth index and uptake of Pap smears, taking into account the different characteristics of the population studied for the measure of inequalities. RESULTS: All the CCs were distributed below the line of equality. Similarly, all the IndCs were higher than zero, indicating inequality in the uptake of Pap smears, favoring those with a higher wealth index. The highest IndC values were obtained from women aged 50-59 (IndC, 0.293), those who lived in the jungle (IndC, 0.230), and those without health insurance (IndC, 0.173). CONCLUSIONS: We found socio-demographic inequalities in the uptake of Pap smears in Peru, favoring women with a higher wealth index. More funding is needed to promote cervical cancer screening programs and to create systems that ensure equal access to healthcare in Peru.

Las personas con enfermedad terminal y la necesidad de cuidados paliativos: una deuda pendiente de los servicios de salud / Patients with terminal illness and needs for palliative care: a pending issue for healthcare services

Los cuidados paliativos, además de ser parte de las competencias que debería haber adquirido un profesional de la salud durante su formación, son una necesidad en crecimiento para pacientes de diferentes grupos etarios, ya sea para enfermedades oncológicas, cardiovasculares, degenerativas, entre otras. Se consideran un reto para los servicios de salud por ser cuidados complejos, que requieren de trabajo en equipo, recursos humanos y sistemas que funcionen adecuadamente. Los aspectos de gestión, salud pública, integración de servicios, dilemas éticos y aspectos legales en transición son las principales barreras a las que se enfrentan los profesionales que atienden personas con enfermedad terminal. Una de las principales armas que tenemos es consolidar programas educativos para empoderar con conocimiento a los profesionales y, de esta forma, que hagan notar la necesidad del manejo humano de la salud de personas con enfermedades terminales.

On top of all competences that a healthcare professional should have achieved during his/her training, palliative care is a growing need for patients from different age groups affected with cancer, cardiovascular diseases, degenerative conditions, and the like. Palliative care is a huge challenge for healthcare services, because this requires adequate teamwork, human resources and adequately functioning systems. Management, public health, service integration, ethical dilemmas, and ethical issues are the main barriers that physicians taking care of terminally ill patients must deal with. One of our main strategies for tackling this situation is to consolidate educational programs, so healthcare professionals may become empowered with knowledge; so, they may disclose the need for humanizing healthcare of terminally ill subjects.

Calidad de servicio a pacientes en consultorio externo de geriatría de un hospital de la seguridad social: un estudio cualitativo / Quality of service at the geriatric outpatient department of a social security hospital: a qualitative study

Objetivo: Determinar la calidad de servicio a pacientes adultos mayores en niveles asistenciales ambulatorios de geriatría. Materiales y métodos: Estudio cualitativo con un grupo de 45 participantes mayores de 60 años que acudieron para atención médica al servicio de Geriatría del Hospital Guillermo Almenara Irigoyen entre enero y junio de 2005. Resultados: Se determinó que el 77 % de los participantes se mostraron satisfechos con la calidad de atención, además las categorías que presentaron mayores quejas fueron la falta de interacción médico paciente, falta de empatía y seguridad durante su atención del servicio. Los aspectos que destacaron fueron la confiabilidad y la entrega de información. Conclusiones: La falta de interacción médico paciente y la falta de empatía son los problemas más destacables.

Objective: To determine the quality of service to elderly patients in geriatric outpatient levels of care. Materials and methods: A qualitative study with a group of 45 participants over 60 years of age who attended the geriatric department of the Hospital Guillermo Almenara Irigoyen between January and June 2005. Results: It was determined that 77 % of the participants were satisfied with the quality of care. The categories with the greatest complaints were lack of patient-physician interaction, lack of empathy, and lack of safety during their health care. Aspects that stood out were reliability and information submission. Conclusions: The lack of patient-physician interaction and lack of empathy are the most outstanding problems in the geriatric department.

Functional assessment as a predictor of cognitive impairment: a retrospective cohort study. / La valoración funcional como predictor de deterioro cognitivo: cohorte retrospectiva.

INTRODUCTION: It is estimated that major neurocognitive disorders will affect 115.4 million people by 2050, representing a significant financial burden for society. Likewise, functional dependence for basic or instrumental activities of daily life is usually a consequence of the greater prevalence of disabling pathologies, and of the progressive decrease of the physiological reserve due to aging. OBJECTIVES: To determine the ratio between the functional test and prediction of deterioration of cognitive function in geriatric patients. To determine which factors are associated with decreased cognitive functions in elderly patients. METHODS: This is a retrospective cohort study. We included participants who attended the Geriatrics Outpatient Services of the Naval Medical Center of Peru from 2010 to 2014. Two groups were formed, the first comprised those who presented physiological loss of cognitive functions, defined as the decrease less than 4.1 points in the score of the Mini Mental State Examination during follow-up and a second group who had a pathological loss of cognitive functions, defined as a decrease of 4.2 points in average or more in the Mini Mental State Examination score during follow-up. Patients were followed for four years, performing functional evaluations, as well as collecting data on comorbidities and sociodemographic factors. RESULTS: We included 368 patients, whose mean age was 75.8 years and 50.91% male. Female gender (53.72%), poor education (62.81%), and comorbidities were statistically more frequent in the pathological cognitive decline group. Functional assessment variables had a worse disease progress through follow-up in the group with pathological disease progress of the Mini Mental State Examination score, including Timed Up and Go Test. CONCLUSIONS: Score values of Timed Up and Go Test manage to predict the risk of a pathological decrease in Mini Mental State Examination regardless of sociodemographic factors, comorbidities, and functional assessment.

INTRODUCCIÓN: Se estima que los trastornos neurocognitivos mayores afectarán a 115,4 millones de personas en 2050, lo que representa una carga financiera importante para la sociedad. Asimismo, la dependencia funcional para actividades básicas o instrumentales de la vida diaria suele ser consecuencia de la mayor prevalencia de patologías discapacitantes, y de la progresiva disminución de la reserva fisiológica propia del envejecimiento. OBJETIVOS: Se persiguen dos objetivos: determinar la relación entre los test funcionales y la predicción de deterioro de funciones cognitivas en pacientes geriátricos; y establecer qué factores están asociados a disminución de las funciones cognitivas en pacientes geriátricos. MÉTODOS: Estudio de tipo cohorte retrospectiva. Incluimos participantes que acudieron a los servicios ambulatorios de geriatría del Centro Médico Naval de Perú desde 2010 hasta 2014. Se formaron dos grupos, el primero con los que presentaron pérdida fisiológica de funciones cognitivas, definida como la disminución menor a 4,1 puntos en el puntaje del Mini Mental State Examination durante el seguimiento y otro con una pérdida patológica de funciones cognitivas, definida como la disminución de 4,2 puntos en promedio o más en el puntaje de esta misma encuesta durante el seguimiento. Los pacientes fueron seguidos por cuatro años, período en el que se les efectuaron evaluaciones funcionales y se recogieron datos de comorbilidades y factores sociodemográficos. RESULTADOS: Se incluyeron 368 pacientes, cuya media de edad fue de 75,8 años y 50,91% fueron hombres. El género femenino (53,72%), la presencia de un bajo grado de instrucción (62,81%) y la presencia de comorbilidades fueron más prevalentes en el grupo con disminución de Mini Mental State Examination patológico. Las variables de evaluación funcional, incluyendo al Timed Up and Go Test, presentaron promedios inadecuados durante el seguimiento de cuatro años en el grupo con evolución patológica del puntaje del Mini Mental State Examination, en comparación con el grupo sano. CONCLUSIONES: Los valores del puntaje del Timed Up and Go Test logran predecir el riesgo de una disminución patológica del Mini Mental State Examination, independientemente de factores sociodemográficos, comorbilidades y valoración funcional.

Prevalence and factors associated with frailty among Peruvian older adults.

The objective of this study is to examine the prevalence and factors associated with frailty in Peruvian Navy Veteran's older adults and family members. A total of 311 non-institutionalized men and women aged 60 years and older, from the Geriatrics Service of the Peruvian Navy Medical Center (Centro Médico Naval "Cirujano Mayor Santiago Távara") were assessed between May and October 2010. Frailty was defined as having two or more of the following components: (1) unintentional weight-loss, (2) weakness (lowest 20% in grip-strength), (3) self-reported exhaustion, and (4) slow walking speed (lowest 20% 8-m walk-time in seconds). Additionally, information on socio-demographic factors, medical conditions, depressive symptoms, disability, and cognitive function were obtained. Of the 311 participants, 78 (25.1%) were not frail, 147 (47.3%) were pre-frail, and 86 (27.8%) were frail. Using logistic regression analysis, we found that older age, being married, falls in the last year and disability were factors significantly associated with being frail. We conclude that prevalence of pre-frail and frail status in Peruvian Navy Veterans and family members is high. Our data reports risk factors for frailty that have been reported in the past in other population groups. A larger sample and longitudinal follow-up are needed to design and implement comprehensive geriatric interventions that can benefit Peruvian Navy Veteran's older adults at risk of becoming frail.