Hypertension prevalence by degrees of urbanization and altitude in Peru: pooled analysis of 186 906 participants.

OBJECTIVE: Few studies, using countrywide data, examined how hypertension prevalence varies at diverse degrees of urbanization and altitude. This study examined the association between urbanization and altitude, including the potential interaction between those variables, with hypertension prevalence in Peru. METHODS: Cross-sectional analysis of the Peruvian Demographic and Health Survey (2014-2019). Hypertension (SBP ≥140 mmHg or DBP ≥90 mmHg or self-reported diagnosis) was the outcome. Exposures were altitude levels, and urbanization assessed with four indicators (urban/rural; type of place of residence; population density level; and population size level). RESULTS: Among 186 906 participants (mean age ± standard deviation: 40.6 ± 17.9; 51.1% women), pooled hypertension prevalence was 19% [95% confidence interval (CI) 18.7-19.3], which was higher in urban compared with rural areas (prevalence ratio: 1.09; 95% CI 1.05-1.15). Compared with countryside, hypertension was higher in towns (prevalence ratio: 1.09; 95% CI 1.04-1.15), small cities (prevalence ratio: 1.07; 95% CI 1.02-1.13) and large cities (prevalence ratio: 1.19; 95% CI 1.12-1.27). Compared with least density settings (1-500 inhabitants/km 2 ), hypertension was higher in the highest density (≥10 001 inhabitants/km 2 ) settings (prevalence ratio: 1.12; 95% CI 1.07-1.18). Population size was not associated with hypertension. Compared with low altitude, hypertension was lower above 2500 m (prevalence ratio 0.91; 95% CI 0.87-0.94) and above 3500 m (prevalence ratio 0.89; 95% CI 0.84-0.95). Interaction between exposures had varying patterning. CONCLUSION: Hypertension in Peru is more prevalent at urban than rural areas, especially in large cities and in more densely populated areas above 10 001 inhabitants/km 2 , and less prevalent at altitudes above 2500 m.

Effectiveness of the BBIBP-CorV vaccine in preventing infection and death in health care workers in Peru 2021.

BACKGROUND: During 2021, Peru started the vaccination against SARS-CoV-2 using the BBIBP-CorV inactivated virus vaccine for health care workers (HCW). We aim to evaluate the effectiveness of the BBIBP-CorV vaccine to prevent SARS-CoV-2 infection and deaths among HCWs. METHODS: Retrospective cohort study, from February 9 to June 30, 2021, using national registries of health care workers, laboratory tests for SARS-CoV-2 and deaths. We calculated the vaccine effectiveness for preventing laboratory-confirmed SARS-CoV-2 infection, COVID-19-mortality, and all-cause mortality among partially immunized and fully immunized HCWs. An extension of Cox proportional hazards regression was used to model the mortality results, and Poisson regression was used to model SARS-CoV-2 infection. RESULTS: The study included 606,772 eligible HCWs, the mean age was 40 (IQR: 33.0, 51.0). In fully immunized HCW, the effectiveness for preventing all-cause mortality was 83.6 (95% CI: 80.2 to 86.4), 88.7 (95% CI: 85.1 to 91.4) for preventing COVID-19 mortality, and 40.3 (95% CI 38.9 to 41.6) for preventing SARS-CoV-2 infection. CONCLUSION: The BBIBP-CorV vaccine showed high levels of effectiveness for preventing all-cause and COVID-19 deaths among fully immunized HCW. These results were consistent within different subgroups and sensitivity analyses. However, the effectiveness for preventing infection was suboptimal in this particular setting.

Usability and perceptions of a one-on-one telementoring program for young physicians in rural settings of Peru: a mixed method study.

BACKGROUND: Telementoring seems to be a promising strategy to deliver training and counselling to physicians in remote areas. In Peru, early graduated physicians must work for the Rural and Urban-Edge Health Service Program where they face important training needs. The aim of this study was to describe the usage of a one-on-one telementoring program for rural physicians and evaluate the aspects related to the perceptions of acceptability and usability. METHODS: Mixed methods study on recently graduated physicians who work in rural areas and participate in the telementoring program. The program used a mobile application to connect these young doctors with specialized mentors to answer queries about real-life problems raised by working in a rural area. We summarize administrative data to assess participant characteristics and their participation in the program. Additionally, we conducted in-depth interviews to explore the perceived usability, ease of use, and reason for non-use of the telementoring program. RESULTS: Of 74 physicians (mean age 25, 51.4% women) enrolled, 12 (16.2%) actively used the program and performed a total of 27 queries, which received response in an average time of 5.4 ± 6.3 h. In the interviews, the main reasons for non-use were connectivity issues, feelings of shame, and self-efficacy. For those who used the telementoring program they referred it was easy to use and solve their inquiries timely. CONCLUSIONS: The implementation of a telementoring program sought to provide guidance to recently graduated physicians working in rural areas. Low use rates show that administrative and process-related deficiencies in the program implementation need to be improved.

Can working at home be a hazard? Ergonomic factors associated with musculoskeletal disorders among teleworkers during the COVID-19 pandemic: a scoping review.

Objectives. The improvised and massive adoption of remote work in the context of COVID-19 has forced us to adapt homes as workspaces, which could promote development of musculoskeletal disorders (MSDs). This review explores the evidence for ergonomic factors associated with MSDs in teleworkers. Methods. A literature search was conducted in MEDLINE, Embase, Scopus, SciELO and EBSCO. We included observational studies published between March 2020 and October 2021 that included teleworking personnel due to the restrictions of the pandemic. Results. A total of 212 studies were identified, 14 were chosen for complete review. Associated factors were change of work modality (on-site work to telework), use of home environments as workspaces (areas not adapted for work and with low lighting), working furniture (non-ergonomic chairs and desks), use of electronic devices (tablets, cell phones and laptops), organizational factors (working hours, active breaks, sitting time) and individual factors (physical activity practice). Conclusion. Various ergonomic home factors and the characteristics of teleworking - mainly furniture, the environment of work and physical activity - are associated with MSDs. This evidence suggests that the norms and regulation of telework can consider the adaptation of workspace and conditions at home to prevent health problems in the medium and long term.

An Experimental Study Evaluating the Influence of Front-of-Package Warning Labels on Adolescent's Purchase Intention of Processed Food Products.

Front-of-package warning labels (WLs) are among the public health policies adopted by some countries, mainly in Latin-America, to tackle childhood obesity; however, their impact is still under review. The aim of this study was to assess, using an experimental design, whether WLs influence purchase intention of processed foods and identification of the healthiest products among adolescents in Peru, in May 2019, just before WLs mandatory implementation. Four hundred forty-nine adolescents from two public schools were randomly assigned to an experimental group (received three different processed products with either zero, one or two WLs, informing if they were high in sugar, sodium and/or saturated fats) or a control group (received the same products but unlabeled). Participants chose which product they would buy, and which they considered to be the healthiest. No differences between groups were found neither in purchase intention (p = 0.386) nor in the identification of the healthiest product (p = 0.322). In both groups, the most-selected product was always the healthiest of the triad (>40% in purchase intention and >80% in identification of the healthiest). Front-of-package WLs did not influence purchase intention, or identification of healthier products among adolescents from public schools in Peru. Mass media and educational campaigns should accompany the WLs implementation to help achieve the policy objective.

Quality of stroke guidelines in low- and middle-income countries: a systematic review.

OBJECTIVE: To identify gaps in national stroke guidelines that could be bridged to enhance the quality of stroke care services in low- and middle-income countries. METHODS: We systematically searched medical databases and websites of medical societies and contacted international organizations. Country-specific guidelines on care and control of stroke in any language published from 2010 to 2020 were eligible for inclusion. We reviewed each included guideline for coverage of four key components of stroke services (surveillance, prevention, acute care and rehabilitation). We also assessed compliance with the eight Institute of Medicine standards for clinical practice guidelines, the ease of implementation of guidelines and plans for dissemination to target audiences. FINDINGS: We reviewed 108 eligible guidelines from 47 countries, including four low-income, 24 middle-income and 19 high-income countries. Globally, fewer of the guidelines covered primary stroke prevention compared with other components of care, with none recommending surveillance. Guidelines on stroke in low- and middle-income countries fell short of the required standards for guideline development; breadth of target audience; coverage of the four components of stroke services; and adaptation to socioeconomic context. Fewer low- and middle-income country guidelines demonstrated transparency than those from high-income countries. Less than a quarter of guidelines encompassed detailed implementation plans and socioeconomic considerations. CONCLUSION: Guidelines on stroke in low- and middle-income countries need to be developed in conjunction with a wider category of health-care providers and stakeholders, with a full spectrum of translatable, context-appropriate interventions.

Diagnostics and monitoring tools for noncommunicable diseases: a missing component in the global response.

A key component of any health system is the capacity to accurately diagnose individuals. One of the six building blocks of a health system as defined by the World Health Organization (WHO) includes diagnostic tools. The WHO's Noncommunicable Disease Global Action Plan includes addressing the lack of diagnostics for noncommunicable diseases, through multi-stakeholder collaborations to develop new technologies that are affordable, safe, effective and quality controlled, and improving laboratory and diagnostic capacity and human resources. Many challenges exist beyond price and availability for the current tools included in the Package of Essential Noncommunicable Disease Interventions (PEN) for cardiovascular disease, diabetes and chronic respiratory diseases. These include temperature stability, adaptability to various settings (e.g. at high altitude), need for training in order to perform and interpret the test, the need for maintenance and calibration, and for Blood Glucose Meters non-compatible meters and test strips. To date the issues surrounding access to diagnostic and monitoring tools for noncommunicable diseases have not been addressed in much detail. The aim of this Commentary is to present the current landscape and challenges with regards to guidance from the WHO on diagnostic tools using the WHO REASSURED criteria, which define a set of key characteristics for diagnostic tests and tools. These criteria have been used for communicable diseases, but so far have not been used for noncommunicable diseases. Diagnostic tools have played an important role in addressing many communicable diseases, such as HIV, TB and neglected tropical diseases. Clearly more attention with regards to diagnostics for noncommunicable diseases as a key component of the health system is needed.

Cambios en la densidad de recursos humanos en salud durante la epidemia de COVID-19 en el Perú, abril - agosto 2020

Objetivo. Analizar los cambios en la Densidad de Recursos Humanos en Salud (DRHS) en el Ministerio de Salud a nivel regional y provincial en el Perú; a fin de describir la respuesta del sistema de salud sobre este componente durante la epidemia de COVID-19. Métodos. Estudio descriptivo basado en el análisis de la base de datos nacional de INFORHUS del Ministerio de Salud. Para el cálculo de la DRHS, se consideró como numerador al personal de salud registrado en la base de INFORHUS y como denominador a la población adscrita al Seguro Integral de Salud - SIS. Se excluyó a personal de salud que falleció y aún estaba registrado, y a personal diagnosticado de COVID-19 por prueba rápida o molecular durante los meses considerados en el análisis. Se analizaron los cambios porcentuales de DRHS entre los meses de abril hasta agosto de 2020 a nivel regional y provincial en el Perú. Resultados. En el periodo abril-agosto la DRHS a nivel nacional se incrementó en un 5,1%. A nivel regional este incremento se logró en 15 de las 25 regiones con una variación desde 0,2% hasta 12,3%, y se visualizó una reducción brusca y sostenida del personal nombrado, juntamente con un incremento del personal con contratos temporales. En el resto de las regiones se visualizó una reducción de DRHS la cual varió entre -0,7% hasta -7,7%. Conclusiones. La DRHS en el Perú mostró un leve incremento a nivel nacional durante el primer periodo de cuarentena por la pandemia de COVID-19; sin embargo, este resultado no ha sido equitativo en las diferentes regiones y provincias a nivel nacional. Esto sugiere una limitación en el alcance de las medidas tomadas por el gobierno, y la necesidad de tomar acciones para el fortalecimiento de la situación de salud y despliegue de RHUS en los sectores más desfavorecidos.

Objective. To analyze the changes in the density of human resources in health (DHRH), in the Ministry of Health at the regional and provincial level in Peru, in order to describe the response of the health system on this component during the COVID-19 epidemic. Methods. Descriptive study based on the analysis of the INFORHUS national database of the Ministry of Health. To calculate the DHRH, the health personnel registered in the INFORHUS database were considered as the numerator and the population assigned to the Seguro Integral de Salud - SIS as the denominator. Health personnel who died and were still registered, and personnel diagnosed with COVID-19 by rapid or molecular testing during the months considered in the analysis, were excluded. The percentage changes of DHRH between the months of april to august 2020 were analyzed at the regional and provincial level in Peru. Results. In the april-august 2020 period, in response to the first phase of the COVID-19 pandemic, Peru increased the DHRH by 5,1%. At the regional level, this increase was achieved in 15 of the 25 regions with a variation from 0,2% to 12,3%, and a sharp and sustained reduction in appointed personnel was observed, together with an increase in personnel with temporary contracts. In the rest of the regions, a reduction in DHRH was observed, which ranged from -0,7% to -7,7%. Conclusions. DHRH in Peru showed a slight increase at the national level during the first quarantine period due to the COVID-19 pandemic, however, this result has not been equitable in the different regions and provinces at the national level. This suggests a limitation in the scope of the measures taken by the government, and the need to take actions to strengthen the health situation and deployment of human resources in health in the most disadvantaged sectors.

Attitudes, health lifestyle behaviors and cardiometabolic risk factors among relatives of individuals with type 2 diabetes mellitus.

OBJECTIVE: To describe and compare attitudes, lifestyle behaviors, and cardiometabolic risk factors between individuals with and without a relative with type 2 diabetes mellitus (T2DM) living in the same household. METHODS: A secondary analysis of baseline data from an implementation study in Peru was conducted. The outcomes were attitudes towards changing lifestyle behaviors (e.g. intentions towards losing weight, increasing physical activity, reducing salt consumption, etc), profiles of health lifestyle behaviors (e.g. daily smoking, heavy drinking, and physical activity), and cardiometabolic risk factors (e.g., overweight [body mass index ≥25 kg/m2] and hypertension); whereas the exposure was the presence of at least one relative with known diagnosis of T2DM living in the same household. Multilevel logistic mixed effect regression models were used to estimate odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: A total of 2298 records, 1134 (49.4%) males, mean age 43.3 (SD: 17.2) years, were analyzed. There was no evidence of a difference in lifestyle-changing attitudes, smoking, alcohol drinking, physical activity levels, and hypertension between individuals with and without relatives with T2DM. Overweight was 63% more common among individuals having a relative with a T2DM in multivariable model (OR = 1.63; 95% CI: 1.03-2.61). CONCLUSIONS: Individuals with relatives with T2DM have higher probabilities of being overweight compared to those who did not have relatives with T2DM in the same household. The absence of differences on lifestyle-related attitudes and behaviors highlight the need of involving relatives of patients with T2DM on intervention strategies to further enhance diabetes prevention and management efforts.

Access barriers to medical facilities for people with physical disabilities: the case of Peru.

People with disabilities (PWD) face several challenges accessing medical services. However, the extent to which architectural and transportation barriers impede access to healthcare is unknown. In Peru, despite laws requiring that buildings be accessible for PWD, no report confirms that medical facilities comply with such regulations. Thus, we aim to provide an association between these barriers and access to medical facilities. Data from a Peruvian disability survey were analyzed. Participants were 18 years of age and older people who reported having a physical disability. Accessibility was defined by reported struggles accessing medical facilities (health or rehabilitation centers). Absence of ramps, handrails, elevators, adapted bathrooms, and information counters in medical facilities were reported as architectural barriers. The transportation barriers analyzed included struggles using buses or trains. Poisson regression models with robust variance were used to estimate prevalence ratios (PR) and to control for confounding variables. 20,663 participants were included, their mean age was 66.5 years and 57.5% were females. Architectural and transportation barriers reported were 40% and 61%, respectively. All barriers reported were more prevalent in rural compared to urban areas (p < 0.001). Inadequacy of ramps, handrails, and adapted elevators and bathrooms were associated with limited use of rehabilitation centers (p < 0.001) but not of health centers (p > 0.05). Architectural and transportation barriers represent a hindrance to seeking treatment at rehabilitation centers. Actions to improve this situation are needed.

Access barriers to medical facilities for people with physical disabilities: the case of Peru / Barreras de acceso a centros de salud para personas con discapacidad física: el caso de Perú / Barreiras de acesso aos serviços de saúde para pessoas portadoras de deficiência física: o caso peruano

Abstract: People with disabilities (PWD) face several challenges accessing medical services. However, the extent to which architectural and transportation barriers impede access to healthcare is unknown. In Peru, despite laws requiring that buildings be accessible for PWD, no report confirms that medical facilities comply with such regulations. Thus, we aim to provide an association between these barriers and access to medical facilities. Data from a Peruvian disability survey were analyzed. Participants were 18 years of age and older people who reported having a physical disability. Accessibility was defined by reported struggles accessing medical facilities (health or rehabilitation centers). Absence of ramps, handrails, elevators, adapted bathrooms, and information counters in medical facilities were reported as architectural barriers. The transportation barriers analyzed included struggles using buses or trains. Poisson regression models with robust variance were used to estimate prevalence ratios (PR) and to control for confounding variables. 20,663 participants were included, their mean age was 66.5 years and 57.5% were females. Architectural and transportation barriers reported were 40% and 61%, respectively. All barriers reported were more prevalent in rural compared to urban areas (p < 0.001). Inadequacy of ramps, handrails, and adapted elevators and bathrooms were associated with limited use of rehabilitation centers (p < 0.001) but not of health centers (p > 0.05). Architectural and transportation barriers represent a hindrance to seeking treatment at rehabilitation centers. Actions to improve this situation are needed.

Resumen: Las personas con discapacidades (PWD por sus siglas en inglés) se enfrentan a diversos desafíos, en lo que se refiere a servicios de salud. Pese a ello, se desconoce hasta qué punto se extienden las barreras arquitectónicas y de transporte que impiden el acceso al sistema de salud. En Perú, a pesar de que las leyes requieren que los edificios sean accesibles para PWD, no existe ningún informe que muestre que los establecimientos médicos cumplan con esta normativa. Por lo tanto, nos proponemos determinar la asociación entre tales barreras y el acceso a centros médicos. Se analizaron datos procedentes de una encuesta nacional sobre discapacidad. Los participantes eran personas de 18 años y más que informaron de una discapacidad física. La accesibilidad se definió mediante las dificultades de acceder a centros de salud (centros de salud o rehabilitación). Las barreras arquitectónicas consideradas, y que fueron informadas, son: ausencia de rampas, barandillas, ascensores, baños adaptados para discapacitados, así como mostradores de información en centros médicos. Las barreras de transporte examinadas incluyeron las dificultades usando autobuses o trenes. Los modelos de regresión Poisson con variancia robusta se usaron para estimar la ratio de prevalencia (PR) y para controlar las variables de confusión. Se incluyeron a 20.663 participantes. La edad media fue 66,5 años y un 57,5% eran mujeres. Las barreras arquitectónicas de las que se informó representaron un 40% y las de transporte un 61%. Los informes de todas las barreras fueron mayores en áreas rurales, en comparación con las áreas urbanas (p < 0,001). Las deficiencias en rampas, barandillas, ascensores y baños adaptados estuvieron asociadas con una baja utilización de los centros de rehabilitación (p < 0,001), pero no en el caso de los centros de salud (p > 0,05). Las barreras arquitectónicas y de transporte representan un impedimento para la búsqueda de centros de salud y rehabilitación. Se necesitan más iniciativas para mejorar esta situación.

Resumo: As pessoas portadoras de deficiência (PPD) enfrentam diversos desafios no acesso aos serviços de saúde. Entretanto, não se sabe até que ponto as barreiras arquitetônicas e de transporte impedem o acesso à assistência. No Peru, apesar de leis que exigem a acessibilidade dos prédios para PPD, não há relato de que os serviços de saúde cumpram com tais regras. O estudo teve como objetivo determinar a associação entre esse tipo de barreira e o acesso aos serviços de saúde. Foram analisados os dados de um inquérito nacional sobre deficiência. Os participantes eram pessoas com 18 anos ou mais que relatavam ser portadoras de deficiência física. A acessibilidade era definida pelo relato de dificuldades em acesso aos serviços de saúde (centros de saúde ou de reabilitação). As barreiras arquitetônicas consistiam na ausência de rampas, corrimões, elevadores e banheiros adaptados e balcões de informação nos serviços de saúde. As barreiras de transporte incluíam dificuldades no uso de ônibus ou trens. Foram utilizados modelos de regressão Poisson com variância robusta para estimar razões de prevalência (RP) e controlar por fatores de confusão. Foram incluídos 20.663 participantes, com média de idade de 66,5 anos, sendo 57,5% do sexo feminino. Houve relato de barreiras arquitetônicas e de transporte por 40% e 61% dos participantes, respectivamente. O relato de barreiras era mais frequente em áreas rurais comparado com áreas urbanas (p < 0,001). A ausência de rampas, corrimões e elevadores e banheiros adaptados estava associada com menor utilização de centros de reabilitação (p < 0,001), mas não de centros de saúde (p > 0,05). As barreiras arquitetônicas e de transporte representam um impedimento à busca de assistência em centros de reabilitação. São necessárias medidas para melhorar essa situação.

Association between perceived discrimination and healthcare-seeking behavior in people with a disability.

BACKGROUND: Experiences of discrimination lead people from vulnerable groups to avoid medical healthcare. It is yet to be known if such experiences affect people with disabilities (PWD) in the same manner. OBJECTIVES: To determine the association between perceived discrimination and healthcare-seeking behavior in people with disabilities and to explore differences of this association across disability types. METHODS: We performed a cross-sectional study with data from a national survey of people with disabilities. Perceived discrimination and care-seeking behavior were measured as self-reports from the survey. Dependence for daily life activities, possession of health insurance, and other disability-related variables were included and considered as confounders. We used Poisson regression models and techniques for multistage sampling in the analyses. A stratified analysis was used to explore effects of discrimination across types of disability. RESULTS: Most of PWD were 65 years or older (67.1%). Prevalence of healthcare seeking was 78.8% in those who perceived discrimination, and 86.1% in those who did not. After adjusting for potential confounders, the probability of not seeking care was higher in people who reported perceived discrimination (adjusted PR = 1.15; 95%CI: 1.04-1.28). In a stratified analysis, significant effects of discrimination were found in people with communication disability (adjusted PR = 1.34, 95%CI: 1.07-1.67) and with physical disability (adjusted PR = 1.17, 95%CI: 1.03-1.34). CONCLUSIONS: People with disabilities who perceive discrimination are less likely to seek healthcare. This association was higher for people with communication and physical disabilities. These results provide evidence to institutions who attempt to tackle discrimination.

Assessment of Rehabilitation Infrastructure in Peru.

OBJECTIVE: To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks. DESIGN: Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input. SETTING: Large public hospitals and referral centers and an online survey platform. PARTICIPANTS: Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems. RESULTS: Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent. CONCLUSIONS: Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.

Experiencias y percepciones de los donantes de sangre sobre la donación en un hospital público de Perú / Blood donors' experiences and perceptions of donation at a Peruvian public hospital

Objetivo: Conocer las experiencias y percepciones de donantes de sangre en un hospital público. Materiales y métodos: Se realizó un estudio cualitativo con orientación fenomenológica en un hospital público de Lima. Se realizaron entrevistas semiestructuradas a profundidad y notas de campo basadas en observaciones a los participantes. Resultados: Se entrevistó a doce donantes, los cuales manifestaron no haber tenido mucha información sobre la donación y el banco de sangre. Sin embargo, luego de su experiencia de donar se identificó aspectos positivos como la atención de calidad, rápida y minuciosa. Los participantes valoran el trato cordial del personal a la hora de brindar información, el reducido tiempo de espera y la compañía durante el proceso de extracción de la sangre. Los aspectos negativos fueron la falta de publicidad y difusión de la donación voluntaria de sangre. A pesar de ello la mayoría de entrevistados manifestaron su intención de retornar debido a la calidad del servicio. En resumen, la percepción de los participantes fue favorable a la donación, al recibir una atención de calidad, con información oportuna en el tiempo adecuado. Conclusiones: Los entrevistados no tenían mayor información sobre la posibilidad de hacer donaciones voluntarias de sangre en el hospital. Posterior a su experiencia, la percepción sobre la donación fue favorable, indicando su intención de participar en futuras donaciones.

Objective: To know the experiences and perceptions of blood donors at a public hospital. Materials and methods: A qualitative study with phenomenological orientation was performed at a public hospital in Lima. Semi-structured in-depth interviews and field notes based on participants' observations were conducted. Results: A total of 12 donors who reported not having much information about donation and blood banks were interviewed. However, after their donation experience, they identified positive aspects such as a high-quality, fast and thorough care. Participants appreciated the personnel's cordial treatment when providing information, the short waiting time, and the personnel's company during the process of blood extraction. The negative aspects were the lack of dissemination and publicity of voluntary blood donation. In spite of this, most interviewees expressed their intention to return due to the high-quality service they received. In summary, participants' perception of blood donation was favorable because they received high-quality care, with timely information in the appropriate time. Conclusions: Interviewees had limited information about the possibility of making voluntary blood donations at the hospital. After their experience, participants perceived that donating blood was favorable and indicated their intention to participate in future donations.

[Economic income in peruvian physicians according to the specialty: A cross-sectional analysis of the ENSUSALUD 2015]. / Ingresos económicos en médicos peruanos según especialidad: Un análisis transversal de la ENSUSALUD 2015.

OBJECTIVES: To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. MATERIALS AND METHODS: : We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. RESULTS: Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. CONCLUSIONS: Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.

OBJETIVOS: Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. MATERIALES Y MÉTODOS: Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. RESULTADOS: De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. CONCLUSIONES: Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos.

Cognitive impairment and hypertension in older adults living in extreme poverty: a cross-sectional study in Peru.

BACKGROUND: Previous studies have shown that hypertension is a risk factor for cognitive impairment, but whether this association is also present in extremely poor populations in Low Middle Income Countries settings remains to be studied. Understanding other drivers of cognitive impairment in this unique population also merits attention. METHODS: We performed a secondary analysis using data from the "Encuesta de Salud y Bienestar del Adulto Mayor", a regional survey conducted in an extremely poor population of people older than 65 years old from 12 Peruvian cities in 2012. The outcome variable was cognitive impairment, determined by a score of ≤7 in the modified Mini-Mental State Examination. The exposure was self-reported hypertension status. Variables such as age, gender, controlled hypertension, education level, occupation, depression and area of living (rural/urban) were included in the adjusted analysis. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% confidence interval (95% CI) adjusting for confounders. RESULTS: Data from 3842 participants was analyzed, 51.8% were older than 70 years, and 45.6% were females. The prevalence of cognitive impairment was 1.7% (95% CI 1.3%-2.1%). There was no significant difference on the prevalence of cognitive impairment between the group of individuals with hypertension in comparison with those without hypertension (PR = 0.64, 95% CI 0.33-1.23). CONCLUSIONS: The association described between hypertension and cognitive impairment was not found in a sample of extremely poor Peruvian older adults.

Ingresos económicos en médicos peruanos según especialidad: Un análisis transversal de la ENSUSALUD 2015 / Economic income in peruvian physicians according to the specialty: A cross-sectional analysis of the ENSUSALUD 2015

RESUMEN Objetivos Evaluar la asociación entre tener una especialidad médica y el ingreso económico mensual en médicos peruanos, y comparar los ingresos económicos entre áreas con mayor y menor densidad de médicos en Perú. Materiales y métodos Se analizaron los datos de la Encuesta Nacional de Satisfacción de Usuarios de Salud realizada en Perú el año 2015. Esta encuesta con nivel de inferencia nacional fue realizada a médicos que laboran en establecimientos de salud de Perú. Se evaluó el ingreso económico considerando todas las actividades remuneradas del médico. Se calcularon las razones de prevalencia crudas y ajustadas (RP y RPa) y sus intervalos de confianza al 95% (IC95%) mediante regresiones de Poisson con varianza robusta, tomando en cuenta el muestreo complejo de la encuesta. Resultados De 2219 médicos encuestados, se analizaron 2154 (97,0%) observaciones. La frecuencia de ganar >S/ 5000 (1572,3 USD) mensuales fue de 29,1% en médicos generales; 65,6% en especialistas; 63,0% en especialidades clínicas; 70,5% en especialidades quirúrgicas, y 55,7% en otras especialidades. En comparación a los médicos generales, los médicos con especialidades clínicas, quirúrgicas, y otras especialidades, tuvieron más probabilidades de ganar >S/ 5000 mensuales (RPa = 1,44, 1,49, y 1,26, respectivamente). La probabilidad de ganar >S/ 5000 fue mayor en quienes laboraban en departamentos con baja densidad de médicos. Conclusiones Los ingresos económicos fueron mayores en médicos especialistas que en no especialistas. Los ingresos económicos fueron mayores en departamentos con menor densidad de médicos, lo cual puede animar a que los médicos laboren en dichos departamentos.

ABSTRACT Objectives To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. Materials and methods : We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. Results Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. Conclusions Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.