Geographic Isolation and Vulnerability Across Peru's Ecological Regions: The Influence of Regional Contexts of Extraction.

Geographically isolated places are often sites of exported environmental risks, intense resource extraction, exploitation and marginalization, and social policy neglect. These conditions create unique challenges related to vulnerability and adaptation that have direct disaster management implications. Our research investigates the relationship between geographic isolation and flood-related social vulnerability across Peru's ecological regions. Ecoregions have different relationships with colonialism and capitalism that shape vulnerability, and we hypothesize that the relationship between vulnerability and geographic isolation varies across ecoregions. Using mapping techniques and spatial regression analysis, we find that relationships between vulnerability and geographic isolation vary regionally, with differences that suggest alignment with regional contexts of extraction. We find notable differences in vulnerability related to public health infrastructure and access to services and between ecoregions with sharply contrasting histories of natural resource extraction and investment and disinvestment.

Primary care practitioners survey of non-alcoholic fatty liver disease.

BACKGROUND: The rising incidence of non alcoholic fatty liver disease (NAFLD) mirrors the epidemics of obesity and metabolic syndrome. Primary care practitioners (PCPs) are central to management of patients with NAFLD, but data on knowledge and attitudes of PCPs towards NAFLD are lacking. MATERIAL AND METHODS: We conducted a statewide, stratified survey of 250 PCPs to examine knowledge, practices and attitudes regarding NAFLD and the barriers to providing care for this condition. RESULTS: NAFLD was perceived as an important health problem by 83% of PCPs. Eighty five percent of PCPs underestimated the population prevalence of NAFLD. Although the association of NAFLD with metabolic syndrome was identified by 91% of PCPs, only 46% screened diabetic obese patients for NAFLD. Only 27% of PCPs referred NAFLD patients to a hepatologist for evaluation. PCPs who reported seeing more than 5 NAFLD patients annually, referred to hepatology less frequently (P = 0.01). The majority of PCPs (58%) recommended weight loss and a calorie restriction. Only 8% of PCPs would recommend Vitamin E. The major perceived barrier in managing NAFLD was lack of confidence in understanding of the disease (58% of PCPs). DISCUSSION: An overwhelming majority of PCPs perceived NAFLD as an important health issue in their practice. However, screening rates for NAFLD among obese diabetics were low. A major barrier to managing these patients was self-reported lack of knowledge about NAFLD. Development of guidelines should emphasize strategies for screening vulnerable populations (obese, diabetics), evidence based management and barriers to providing care.