Diabetes care quality according to facility setting: A cross-sectional analysis in six Peruvian regions.

OBJECTIVE: To characterize diabetes care across healthcare facilities in six Peruvian regions. METHODS: Cross-sectional study of patients with type 2 diabetes mellitus (T2DM), ranging from primary care facilities to hospital-based facilities, in six Peruvian regions. Data was collected by health staff trained between 2012 and 2016. We studied six diabetes care outcomes and four adequate diabetes care outcomes considering the healthcare facility as the exposure of interest. We estimated prevalence ratios (PR) and their 95% confidence intervals (95% CI) using Poisson regression with robust variance. RESULTS: Data from 8879 patients with T2DM, mean age 59.1 years (SD ± 12.2), 53.6% males, was analyzed. Of these, 8096 (91.2%) were treated at primary care facilities. The proportions of patients who had HbA1c, LDL-c, and creatinine/microalbumin test performed increased with the setting of the healthcare facility. Overall, 39%-56% of patients had an adequate HbA1c control, being higher in hospital-based facilities with specialists in comparison to primary care facilities. CONCLUSIONS: We observed that the higher the setting of the facility, the higher the rate of the assessed diabetes care outcomes and adequate diabetes care for four of the six targets (fasting glucose, HbA1c, LDL-c and creatinine or microalbumin) and for three of the four targets (glucose≤130 mg/dL, HbA1c ≤7%(53 mmol/mol) and LDL-c <100 mg/dL), respectively. Substantial gaps were observed at the primary care facilities, calling for the strengthening of diabetes care.

Factores asociados con la satisfacción del conocimiento, puntualidad y evaluaciones que realizan los docentes de diecisiete facultades de medicina peruanas / Factors associated with satisfaction knowledge, punctuality and assessments made by teachers seventeen faculties of Peruvian medicine

Introducción: La correcta enseñanza es un aspecto académico sumamente importante, sin embargo, en nuestro medio no ha sido evaluado, a diferencia de otros países que si poseen registros. Objetivo: Determinar los factores asociados con la satisfacción del conocimiento, puntualidad y evaluaciones que realizan los docentes de diecisiete facultades de medicina peruanas. Métodos: Estudio transversal analítico de datos secundarios, se usó los datos de las encuestas realizadas a estudiantes de medicina, se consideró satisfacción a los que respondieron satisfecho o muy satisfecho ante las preguntas del conocimiento, la puntualidad y las evaluaciones que realizan sus docentes, esto fue asociado a variables socio-educativas mediante estadística bivariada y multivariada. Resultados: El 62 por ciento (1789), 46 por ciento (1324) y 49 por ciento (1431) estuvieron satisfechos con el conocimiento, la puntualidad y las evaluaciones, respectivamente. La mayor satisfacción en el conocimiento (p<0,01), la puntualidad (p<0,001) y las evaluaciones (p<0,01) estuvo relacionado con aquellos alumnos que más pagan mensualmente, por el contrario, la menor satisfacción se encontró a medida que aumenta la edad (conocimiento (p<0,05) y las evaluaciones (p<0,01)), los años de estudios (puntualidad, p<0,05), entre los alumnos de las universidades nacionales (conocimiento, p<0,05) y en los alumnos de las universidades que tienen acreditación internacional (evaluaciones, p<0,05). Conclusiones: El estudiante de medicina se encuentra regularmente satisfecho con el desempeño de sus docentes, variando según el año de estudios y las características propias de la universidad. Siendo necesario que cada institución evalúe su realidad, para que pueda implementar actividades para mejorar la calidad educativa de los futuros médicos del país(AU)

Introduction: The correct teaching is an extremely important academic aspect, however in our media it has not been evaluated, unlike other countries that do have records. Objective: To determine the factors associated with dissatisfaction of the research carried out sixteen faculties of Peruvian medicine. Methodology: Analytical cross-sectional study of secondary data analysis, a survey self-applied was applied and was taken as dependent variable which respondents manifest that they were very dissatisfied and / or unhappy with the research done in its power, this was contrasted with other variables; It was obtained statistical association with generalized linear models. Results: 46.4 percent (1369) said they were dissatisfied with their faculty research. They increased the frequency of dissatisfaction the greatest year of study (RPCs: 1.06; 95 percent CI: 1.00 to 1.13: p value: 0.049), dissatisfaction with the university virtual library (RPCs: 1,12: IC95: 1.01 to 1.25, p value: 0.025), with support for search (RPCs: 1.16; 95 percent CI: 1.04 to 1.30; p-value: 0.008), the agreements that have university (RPCs: 2.25; 95 percent CI: 1.47 to 3.46; p value <0.001) and receiving instruction in general (RPC: 1.30; 95 percent CI: 1.08 to 1.57; p value: 0.007), adjusted for sex, age, incentives for research, if your university has a research and dissatisfaction with the knowledge of teachers and computer lab. Conclusion: The medical student is regularly satisfied with the performance of his teachers, varying according to the year of studies and the characteristics of the university. It is necessary for each institution to evaluate its reality, so that it can implement activities to improve the educational quality of future doctors in the country(AU)

Geographic differences in overweight and obesity prevalence in Peruvian children, 2010-2015.

BACKGROUND: Childhood obesity is emerging as a major public health problem worldwide. To date, most studies of obesity and overweight in Peru are focused on adults, with few of them involving children, a population at a critical stage of development. The trend in overweight and obesity prevalence in Peruvian children under the age of five has not yet been determined. Thus, the objective of the present study is to evaluate the prevalence rates of overweight and obesity between 2010 and 2015 in children under the age of five, stratified by geographical areas in Peru. METHODS: Data were obtained from the Nutritional Status Information System of Peru. The total number of children evaluated was 14,155,914. For the Geographic Information Systems (GIS), the program Geo Da 1.8® was used to ascertain the spatial distribution of prevalence rates and was mapped for children under five. To assess the degree of spatial dependence, exploratory spatial data analysis was performed using the Moran's I statistic and was assessed with the Local Indicators of Spatial Association (LISA) analysis to identify geographic concentrations of high and low of obesity and overweight levels. RESULTS: Between 2010 and 2015, the national prevalence of childhood overweight and obesity ranged from 6.2%- 6.8% and 1.5%-2.7%, respectively. The highest prevalence of childhood overweight and obesity was found in 2014 and 2013, respectively. During these years, we observed that obesity decreased, but overweight remained stable. The highest prevalence of overweight and obesity was found in the departments located on the coast. Significant positive spatial autocorrelation was found for both overweight and obesity. The departments with the highest prevalence of overweight and obesity were concentrated in Lima, Callao, Ica, Moquegua and Tacna. The lowest were found in Loreto, Cusco and San Martin. CONCLUSION: The decrease in obesity and the stabilisation of overweight are positive results for the Peruvian childhood. However, in comparison with other Latin American countries, Peru still lags in obesity prevention.

Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru.

OBJECTIVE: To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru. METHODS: In an observational cross-sectional study, women were surveyed within 48 hours of live delivery at 14 hospitals located in nine Peruvian cities between April and July 2016. The survey was based on seven categories of disrespect and abuse proposed by Bowser and Hill. To evaluate factors associated with each category, prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated using adjusted Poisson models with robust variances. RESULTS: Among 1528 participants, 1488 (97.4%) had experienced at least one category of disrespect and abuse. Frequency of abandonment of care was increased with cesarean delivery (PR 1.27, 95% CI 1.03-1.57) but decreased in the jungle region (PR 0.27, 0.14-0.53). Discrimination was associated with the jungle region (PR 5.67, 2.32-13.88). Physical abuse was less frequent with cesarean than vaginal delivery (PR 0.23, 0.11-0.49). The prevalences of abandonment of care (PR 0.42, 0.29-0.60), non-consented care (PR 0.70, 0.57-0.85), discrimination (PR 0.40, 0.19-0.85), and non-confidential care (PR 0.71, 0.55-0.93) were decreased among women who had been referred. CONCLUSION: Nearly all participants reported having experienced at least one category of disrespect and abuse during childbirth care, which was associated with type of delivery, being referred, and geographic region.

Massive open online courses in health sciences from Latin American institutions: A need for improvement?

Background: Massive open online courses (MOOCs) have undergone exponential growth over the past few years, offering free and worldwide access to high-quality education. We identified the characteristics of MOOCs in the health sciences offered by Latin American institutions (LAIs). Methods: We screened the eight leading MOOCs platforms to gather their list of offerings. The MOOCs were classified by region and subject. Then, we obtained the following information: Scopus H-index for each institution and course instructor, QS World University Ranking® 2015/16 of LAI, and official language of the course. Results: Our search identified 4170 MOOCs worldwide. From them, 205 MOOCs were offered by LAIs, and six MOOCs were health sciences related. Most of these courses (n = 115) were offered through Coursera. One health science MOOC was taught by three instructors, of which only one was registered in Scopus (H-index = 0). The remaining five health science MOOCs had solely one instructor (H-index = 4 [0-17]). The Latin American country with the highest participation was Brazil (n = 11). Conclusion: The contribution of LAI to MOOCs in the health sciences is low.