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.

Factores asociados a mortalidad en pacientes con infarto cerebral del Instituto Nacional de Ciencias Neurológicas. Enero 2008 - Diciembre 2010 / Factors associated with mortality in patients with ischemic stroke at the National Institute of Neurological Sciences. January 2008-December 2010

Objetivos: Determinar los factores asociados a mortalidad de pacientes con infarto cerebral que fueron hospitalizados en el Instituto Nacional de Ciencias Neurológicas. Método: Se estudiaron a los pacientes con diagnóstico de infarto cerebral hospitalizados en el Instituto Nacional de Ciencias Neurológicas, durante Enero del 2008 hasta Diciembre del 2010. Se describen las variables demográficas y clínicas de los pacientes, además se utilizó el modelo de regresión logística para determinar los factores asociados a mortalidad en los pacientes. Resultados: Se analizaron 461 pacientes, que presentaron una media de edad de 67 años, el 56 por ciento fueron hombres. Se calculó una proporción de muertos del 7.6 por ciento, IC 95 por ciento (5.3-10.4); las factores asociados significativamente son: el déficit sensitivo OR=2.7, cefalea OR=2.75, trastorno de conciencia OR=12, Escala NIHSS al ingreso OR=1.25 y el territorio vascular anterior OR=2.65. Conclusiones: Los factores asociados a mortalidad por infarto cerebral fueron la presencia de déficit sensitivo, cefalea, pérdida de conciencia, déficit neurológico severo y territorio vascular de la circulación anterior. No se demostró la asociación con mortalidad de los factores de riesgo vascular clásicos ni los subtipos etiológicos con el infarto cerebral.

Objective: Determine factors associated with mortality of patients with Ischemic stroke. Methods: We studied patients with diagnosis of Ischemic stroke hospitalized at the Instituto Nacional de Ciencias Neurologicas, January 2008 to December 2010. We describe the demographic and clinical variables. In addition, the logistic regression model was used to determine the factors associated with mortality in these patients. Results: We report 461 patients, median age was 67 years, 56 per cent were men. We calculated a ratio of 7.6 per cent dead, 95 per cent IC (5.3-10.4); the factors significantly associated are the sensitive deficit OR=2.7, headache OR=2.75, consciousness disorder OR=12, NIHSS scale OR=1.25 and anterior vascular territory OR=2.65. Conclusions: Factors associated with mortality by Ischemic stroke were the presence of sensitive deficit, headache, loss of consciousness, severe neurological deficit and vascular territory of the anterior circulation. No association was found between classical vascular risk factors or etiologic subtypes to Ischemic stroke mortality.