Measuring people's views on health system performance: Design and development of the People's Voice Survey.

Todd Lewis and co-authors discuss development and use of the People's Voice Survey for health system assessment.

Bypassing sources of care by level and coverage: Access to essential services in Peru and Uruguay in the post-pandemic era.

BACKGROUND AND AIMS: Healthcare provision to distinct social groups in Latin America contributes to inequities. Individuals make active choices by bypassing their coverage and intended healthcare source. After the pandemic, we sought to characterize bypassing behaviors and quantify their effects on access to essential services. METHODS: Cross-sectional data from a population-based telephone survey in Peru and Uruguay were analyzed. Participants were selected by random digit dialing. Outcomes were defined as access to preventive screenings and satisfaction of emerging health needs. Bypassing by level was defined as when participants went around primary care for the usual source of care or last preventive visit; bypassing by coverage when care was sought outside of public coverage or social security. Sociodemographic characteristics were included, and the adjusted average treatment effect was calculated. RESULTS: Data from 1,255 participants in Peru and 1,237 participants in Uruguay were analyzed. Bypassing behaviors by level (32% Peru; 60% Uruguay) and coverage (29% Peru; 21% Uruguay) were more prevalent in more privileged groups, especially in Peru. System competence was low overall and varied by bypassing mode, especially in Peru. In the adjusted analysis, statistically significant differences were found in bypassing by coverage in Peru (-8% difference in unmet health needs) and by level in Uruguay (5% more unmet needs). CONCLUSION: Provision of essential preventive services was insufficient in both countries. In Peru, bypassing could serve as a proxy measure of inequities. Reminders of preventive services could be offered to bypassers of primary care. Profound health system reforms are needed to ensure equitable access to essential services.

User-reported quality of care: findings from the first round of the People's Voice Survey in 14 countries.

High-quality care is essential for improving health outcomes, although many health systems struggle to maintain good quality. We use data from the People's Voice Survey-a nationally representative survey conducted in 14 high-income, middle-income, and low-income countries-to describe user-reported quality of most recent health care in the past 12 months. We described ratings for 14 measures of care competence, system competence, and user experience and assessed the relationship between visit quality factors and user recommendation of the facility. We disaggregated the data by high-need and underserved groups. The proportion of respondents rating their most recent visit as high quality ranged from 25% in Laos to 74% in the USA. The mean facility recommendation score was 7·7 out of 10. Individuals with high needs or who are underserved reported lower-quality services on average across countries. Countries with high health expenditure per capita tended to have better care ratings than countries with low health expenditure. Visit quality factors explained a high proportion of variation in facility recommendations relative to facility or demographic factors. These results show that user-reported quality is low but increases with high national health expenditure. Elevating care quality will require monitoring and improvements on multiple dimensions of care quality, especially in public systems.

Health system quality and COVID-19 vaccination: a cross-sectional analysis in 14 countries.

The social and behavioural determinants of COVID-19 vaccination have been described previously. However, little is known about how vaccinated people use and rate their health system. We used surveys conducted in 14 countries to study the health system correlates of COVID-19 vaccination. Country-specific logistic regression models were adjusted for respondent age, education, income, chronic illness, history of COVID-19, urban residence, and minority ethnic, racial, or linguistic group. Estimates were summarised across countries using random effects meta-analysis. Vaccination coverage with at least two or three doses ranged from 29% in India to 85% in Peru. Greater health-care use, having a regular and high-quality provider, and receiving other preventive health services were positively associated with vaccination. Confidence in the health system and government also increased the odds of vaccination. By contrast, having unmet health-care needs or experiencing discrimination or a medical mistake decreased the odds of vaccination. Associations between health system predictors and vaccination tended to be stronger in high-income countries and in countries with the most COVID-19-related deaths. Access to quality health systems might affect vaccine decisions. Building strong primary care systems and ensuring a baseline level of quality that is affordable for all should be central to pandemic preparedness strategies.

A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys.

High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.

HaNDL syndrome and seizures: An unusual presentation.

The Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis syndrome (HaNDL) is a rare, benign and self-limited entity of unknown cause, diagnosed by exclusion. It usually presents with neurological deficits such as hemiparesthesia, dysphasia and hemiparesis. However, seizures are not usually associated with the clinical spectrum of this syndrome. Here we report a case of a 35 year-old male patient with multiple episodes of moderate-severe headaches with transient hemiparesthesia, dysarthria, confusion, visual hallucinations, disinhibited behavior, and a bilateral tonic-clonic seizure. HaNDL diagnosis was made after clinical improvement and CSF evolution. Clinicians should consider HaNDL syndrome in patients presenting with headache, seizures, and confusion, when all other etiologies are ruled out.

[SARS-CoV-2 variants: epidemiology, pathophysiology and the importance of vaccines]. / Variantes del SARS-CoV-2: epidemiología, fisiopatología y la importancia de las vacunas.

SARS-CoV-2 is a single-stranded RNA virus of the coronavirus family, which causes COVID-19 (Coronavirus Disease 2019). This virus is responsible for the current pandemic, which, since its emergence in late 2019, has caused millions of deaths and has had a global impact not only on public health but also on social and economic areas. Therefore, this article aims to review the most up-to-date information on SARS-CoV-2, beginning with the description of the pathophysiology and phylogenetics of the virus. Also, we will present the emerging SARS-CoV-2 variants, their relevance for local and global public health, their epidemiology in Peru, and finally, the role and importance of vaccines in this context.

El SARS-CoV-2 es un virus ARN monocatenario de la familia de los coronavirus, causante de la COVID-19 (Coronavirus Disease 2019). Este virus es responsable de la pandemia actual que, desde su aparición a finales de 2019, ha provocado la muerte de millones de personas y ha tenido un impacto global no solo a nivel sanitario sino también económico y social. Por ello, el presente artículo tiene como objetivo revisar la información más actualizada sobre el SARS-CoV-2, empezando por describir los mecanismos de transmisión del virus, su fisiopatología y filogenética. Asimismo, presentará a las variantes emergentes del SARS-CoV-2, su relevancia para la salud pública local y global, su epidemiología en Perú, y finalmente, el rol y la importancia de las vacunas en este contexto.

Convulsive Status Epilepticus in a Cohort of Patients from a Peruvian Academic Hospital.

BACKGROUND AND PURPOSE: Status epilepticus is a neurologic emergency whose epidemiology, etiology and management are scarcely known in developing countries. Our objective was to describe the demographic and clinical features as well as the management of generalized convulsive status epilepticus (GCSE) in adult patients admitted to the emergency department of an academic hospital in Peru, between March 2019 and March 2020. METHODS: Observational study of a prospective cohort in which patients were assessed by the emergency and neurology department on the first day of hospitalization, at discharge and at 30 days post-discharge in a follow-up visit. Relevant demographics and clinical data were collected. After being encoded and sorted, univariate statistical analysis was carried out. RESULTS: Of the sample of 59 patients, 62.7% were males, 57.6% were unemployed, 89.8% did not finish high school, and 55.9% had intermittent GCSE with no seizure at arrival. The total calculated median times were: 60 minutes from GCSE onset to hospital arrival, 110 minutes from GCSE onset to 1st line therapy, and 7 minutes from hospital arrival to 1st line therapy. The most frequently used antiepileptic drugs were one dose of benzodiazepine (41.7%), phenytoin (76.9%), and additional doses of benzodiazepines (60%) for 1st, 2nd, and 3rd line therapies, respectively. The most frequent etiologies were antiepileptic drug suspension (27.1%), undetermined (25.4%) and acute stroke (11.8%). 62.71% had 0-2 modified Rankin score at discharge. CONCLUSIONS: In this cohort of patients, GCSE was mainly intermittent. Management times differed from the guidelines' recommendations.

Variantes del SARS-CoV-2: epidemiología, fisiopatología y la importancia de las vacunas / SARS-CoV-2 variants: epidemiology, pathophysiology and the importance of vaccines

RESUMEN El SARS-CoV-2 es un virus ARN monocatenario de la familia de los coronavirus, causante de la COVID-19 (Coronavirus Disease 2019). Este virus es responsable de la pandemia actual que, desde su aparición a finales de 2019, ha provocado la muerte de millones de personas y ha tenido un impacto global no solo a nivel sanitario sino también económico y social. Por ello, el presente artículo tiene como objetivo revisar la información más actualizada sobre el SARS-CoV-2, empezando por describir los mecanismos de transmisión del virus, su fisiopatología y filogenética. Asimismo, presentará a las variantes emergentes del SARS-CoV-2, su relevancia para la salud pública local y global, su epidemiología en Perú, y finalmente, el rol y la importancia de las vacunas en este contexto.

ABSTRACT SARS-CoV-2 is a single-stranded RNA virus of the coronavirus family, which causes COVID-19 (Coronavirus Disease 2019). This virus is responsible for the current pandemic, which, since its emergence in late 2019, has caused millions of deaths and has had a global impact not only on public health but also on social and economic areas. Therefore, this article aims to review the most up-to-date information on SARS-CoV-2, beginning with the description of the pathophysiology and phylogenetics of the virus. Also, we will present the emerging SARS-CoV-2 variants, their relevance for local and global public health, their epidemiology in Peru, and finally, the role and importance of vaccines in this context.