Prostate cancer mortality rates in Peru and its geographical regions.

OBJECTIVE: To evaluate the mortality rates for prostate cancer according to geographical areas in Peru between 2005 and 2014. MATERIALS AND METHODS: Information was extracted from the Deceased Registry of the Peruvian Ministry of Health. We analysed age-standardised mortality rates (world population) per 100 000 men. Spatial autocorrelation was determined according to the Moran Index. In addition, we used Cluster Map to explore relations between regions. RESULTS: Mortality rates increased from 20.9 (2005-2009) to 24.1 (2010-2014) per 100 000 men, an increase of 15.2%. According to regions, during the period 2010-2014, the coast had the highest mortality rate (28.9 per 100 000), whilst the rainforest had the lowest (7.43 per 100 000). In addition, there was an increase in mortality in the coast and a decline in the rainforest over the period 2005-2014. The provinces with the highest mortality were Piura, Lambayeque, La Libertad, Callao, Lima, Ica, and Arequipa. Moreover, these provinces (except Arequipa) showed increasing trends during the years under study. The provinces with the lowest observed prostate cancer mortality rates were Loreto, Ucayali, and Madre de Dios. This study showed positive spatial autocorrelation (Moran's I: 0.30, P = 0.01). CONCLUSION: Mortality rates from prostate cancer in Peru continue to increase. These rates are higher in the coastal region compared to those in the highlands or rainforest.

Temporal Variation of Treatment Patterns and Survival Outcomes of Triple-Negative Breast Cancer Patients: A Real-World Experience From 2000 to 2014.

BACKGROUND: Previous studies have reported a higher prevalence of triple-negative breast cancer (TNBC) in US Hispanic/Latina populations. However, survival outcomes and treatment approaches over time in Latin American females are scarcely reported. We aimed to evaluate the temporal variation in treatment patterns and overall survival (OS) outcomes of females with TNBC according to cancer stage. MATERIALS AND METHODS: We performed a single-center retrospective cohort study on 1840 females from 2000 to 2014. Patients were classified in 3 calendar periods (2000-2004, 2005-2009, and 2010-2014). The Kaplan-Meier method and multivariable regression analyses were employed. RESULTS: Stage III cancer was identified in half of the population. Five-year OS estimates for cancer stages I, II, and IV remained unchanged across all calendar periods. However, we found worsening 5-year OS estimates in stage III females (49% in 2000-2004 and 31% in 2010-2014; P < .001). Despite increased uptake of overall use of neoadjuvant therapy in stage III females, the time from diagnosis to treatment initiation (P = .013) and time to complete the planned cycles (P < .001) increased over time. Fifty-sex percent of stage IV patients were untreated. Females aged ≥70 years were less likely to receive treatment. CONCLUSIONS: Survival estimates were lower than those reported in high-income countries. Most females were diagnosed with advanced disease, and the OS for stage III females worsened over time. Our outcomes show difficulties in delivering timely neoadjuvant therapy in an overwhelmed healthcare system. Public health authorities should improve screening practices, develop regional clinical guidelines, and expand trial enrollment.

[Low-intensity extracorporeal shock wave treatment improves erectile function in non-responder PDEi5 patients: A systematic review]. / Ondas de choque de baja intensidad para la mejora en el tratamiento de la disfunción eréctil en pacientes no respondedores a PDE5-i: revisión sistemática.

OBJECTIVE: To determine the effectiveness and safety in the short, medium, and long term of LISWT in patients with Erectile Dysfunction who do not respond to PDE5 inhibitors. METHODOLOGY: Clinical study, quasi-experimental cohort and systematic review following the guidelines of the Cochrane collaboration and the PRISMA writing guides. The measurement of the variables was determined as a primary outcome to the evaluation of erectile function, by means of a validated questionnaire. The baseline scale was evaluated, as well as the difference at 1, 3 and 6 months, evidenced by the possibility of maintaining an erection or responding to therapy with PDEi5. An information search was carried out from its beginning to the current date, in the databases: Medline, Embase, Central, Science Direct and Lilacs. RESULTS: The studies found used different outcome variables to show efficacy in the follow-up: All the studies used the IIEF-EF as outcome variable in its different variations. CONCLUSION: LISWT could be an effective and safe treatment in patients not responding to PDEi5. It is important to point out that the evidence is currently limited, randomized studies with greater methodological rigidity and follow-up longer than 12 months are needed in order to verify the medium and long-term effect of the application of shock waves in this group of patients.

The Latin America and the Caribbean search strategy proposal.

Latin America and the Caribbean's public health literature is not widely recognized. Science in this region has even been compared to a night sky with just a few specks of light. To make those lights as reachable as possible, we developed the Latin America and the Caribbean Search Strategy (LACSS). This is a new method to utilize our region's health promotion results within MEDLINE/PubMed. In contrast to a typical MeSH query, LACSS retrieves up to six times more publication results regarding non-communicable diseases, neglected tropical diseases, injuries and other important public health relevant topics in the region. We believe that global health promotion will be improved in this region by improving its visibility, and this search strategy will contribute to this.

Utility of massive open online courses (MOOCs) concerning outbreaks of emerging and reemerging diseases.

The emergence and re-emergence of infectious diseases such as Ebola, chikungunya, and Zika increase the necessity of knowledgeable and skilled health professionals. Massive open online courses (MOOCs) arise as opportunities that allow people around the world to participate in higher education courses. A search was conducted on specialized MOOC platforms to find courses related to outbreaks, using terms included in the list of the WHO disease outbreaks from January 1st to December 31 st, 2016. We found seven courses about Ebola, two about Zika, three about the dynamics of epidemics and pandemics, and only one course about dengue, chikungunya, and malaria. Most of the courses were conducted in English. The courses on Ebola, Zika and chikungunya were released after their last outbreak. MOOCs could be used to learn about health issues of global relevance, and with the necessity of fast divulgation of knowledge and skills. Translating the courses into more languages could give these courses more traction, and allow participation of professionals in regions affected by these outbreaks.

Hospital management in patients with Dengue: what challenges do we face in Latin America?

Not available.

Características y riesgos de gestantes adolescentes / Characteristics and risks of pregnant adolescents

Objetivos: Establecer la incidencia, riesgos y complicaciones del embarazo y parto en las adolescentes Diseño: Estudio retrospectivo de casos y controles. Institución: Hospital IV “Augusto Hernández Mendoza”, EsSalud, Ica, Perú. Participantes: Gestantes adolescentes. Métodos: Entre el 1 de julio de 2013 y el 30 de junio de 2014 se estudió 177 adolescentes que tuvieron su parto en el hospital y se comparó sus características con un grupo control de 177 gestantes de 20 a 34 años. La información se obtuvo de las historias clínicas de las pacientes y registros de partos. Principales medidas de resultados: Características obstétricas y perinatales. Resultados: El embarazo en las adolescentes representó el 6,63% de la población atendida. Las complicaciones del embarazo anemia (18,2%) e infecciones urinarias (14,1%) ocurrieron más en las adolescentes, en tanto, las enfermedades hipertensivas (17,5%) lo fueron en las gestantes mayores. La incompatibilidad cefalopélvica y el sufrimiento fetal agudo fueron las principales indicaciones de cesárea en las adolescentes. La frecuencia de complicaciones del puerperio en los casos observados fue mayor que en los controles, siendo estadísticamente significativo (p<0,05). Conclusiones: El embarazo en la adolescencia tiene riesgo elevado de complicaciones, haciendo necesario el desarrollo de políticas de salud, de educación sexual y sanitaria encaminadas a reducir las tasas de embarazo en este grupo etario.

Objectives: To determine incidence, risks and complications of pregnancy and delivery in adolescents. Design: Retrospective case-control study. Setting: Augusto Hernández Mendoza Hospital IV, EsSalud, Ica, Peru. Patients: Pregnant adolescents. Methods: Between 1 July 2013 and 30 June 2014, 177 adolescents who delivered at the hospital were studied and their characteristics compared with a control group consisting in 177 pregnant women 20 to 34 years old. Data were obtained from medical records and delivery registries. Main outcome measures: Obstetrical and perinatal outcomes. Results: Teenage pregnancy represented 6.63% of all obstetrical patients attended. Pregnancy complications like anemia (18.2%) and urinary tract infections (14.1%) were predominant in adolescents, and hypertension (17.5%) occurred more in the older group. Cephalo-pelvic disproportion and acute fetal distress were main indications for caesarean section in teenagers. The frequency of postpartum complications in the observed cases was significantly higher than in controls (p <0.05). Conclusions: Pregnancy in adolescence represents a high obstetrical risk. Health and sexual education and sanitary policies are necessary to reduce pregnancy rates in these teenagers.

Salud mental y calidad de sueño en estudiantes de ocho facultades de medicina humana del Perú / Mental health and quality of sleep from eight faculties of medical students in Peru

Introduction: The quality of sleep refers to the fact that we sleep well at night and daytime functioning. Thus, influences health and quality of life. Sleep loss is one of the most striking problem of modern society especially in medical students. This is related to the constant academic demands causing mental health problems and high levels of stress. Methods: A cross-sectional study. We evaluated 1,040 medical students in 8 universities of Peru from the first to the sixth year of study. Of these, 892 surveys were used. Mental health were evaluated according to the scale of Depression, Anxiety and Stress (DASS-21) and "poor sleepers" students were established with a score > 5 according to the Pittsburgh Sleep Quality Index (PSQI). Results: It was found that 693 (77.69%) students were poor sleepers. About mental health was found that 290 (32.51%) suffered from depression, 472 (52.91%) of anxiety and 309 (34.64%) stress. A significant association (p < 0.05) was found between poor sleep quality and female sex (OR = 1.13, CI = 1.05 to 1.21); depression (OR = 1.23, CI = 1,15-1,31); anxiety (OR = 1.32, CI = 1.23 to 1.43); and stress (OR = 1.26, CI = 1.19 to 1.35). Conclusion: We observed a high frequency of poor sleepers in medical students from eight universities of Peru. The poor quality of sleep was associated with anxiety, depression and stress in students of second and third year, respectively.

Introducción: La calidad de sueño nos hace referencia al hecho de dormir bien durante la noche y el rendimiento diurno. De esa forma, influye en salud y la buena calidad de vida. La pérdida de sueño es uno de los problemas de la sociedad moderna más llamativos especialmente en estudiantes de medicina humana. Esto se relaciona a la constante y creciente exigencia académica ocasionando problemas de salud mental y altos niveles de estrés. Métodos: Estudio transversal analítico. Se evaluaron 1.040 estudiantes de medicina humana obtenidos en forma equitativa de 8 universidades del Perú desde el primer al sexto año de estudios. De ellos, se usaron 892 encuestas. Se evaluó la salud mental según la escala de Depresión, Ansiedad y Estrés (DASS-21) y se estableció a los estudiantes "malos dormidores" como aquellos con una puntuación > 5 según el índice de calidad de sueño de Pittsburgh (ICSP). Resultados: Se encontró que 693 (77,69%) alumnos fueron malos dormidores. Con respecto a la salud mental se halló que 290 (32,51%) sufrían de depresión, 472 (52,91%) de ansiedad y 309 (34,64%) de estrés. Se halló asociación significativa (p < 0,05) entre la mala calidad de sueño y el sexo femenino (RP = 1,13; IC = 1,051,21); depresión (RP = 1,23; IC = 1,15-1,31); ansiedad (RP = 1,32; IC = 1,23-1,43); y estrés (RP = 1,26; IC = 1,19-1,35). Conclusión: Se observa una frecuencia elevada de malos dormidores en estudiantes de medicina de ocho universidades del Perú. La mala calidad de sueño se asoció con la ansiedad, depresión y estrés en los estudiantes de segundo y tercer año, respectivamente.