Disability, caregiver's dependency and patterns of access to rehabilitation care: results from a national representative study in Peru

PURPOSE:  To determine the prevalence of disability in Peru, explore dependency on caregiver's assistance and assess access to rehabilitation care.

 METHOD:  Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported.  RESULTS:  From 798 308 people screened, 37 524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37 117 were included in further analysis, mean age 57.8 (SD ± 24.1) years, 52.1% women. Dependency was self-reported by 14 980 (40.5%; 95%CI: 39.2-41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3-95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7-11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance. CONCLUSIONS:  Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities. Implications for Rehabilitation Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care. Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers. Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.

Authors: Bernabe Ortiz, Antonio; Diez Canseco, Francisco; Vásquez, Alberto; Miranda, J. Jaime

Source:Disability and Rehabilitation

URL: Full text

Quantitative real-time polymerase chain reaction for enteropathogenic Escherichia coli: a tool for investigation of asymptomatic versus symptomatic infections

BACKGROUND: Enteropathogenic Escherichia coli (EPEC) strains are pediatric pathogens commonly isolated from both healthy and sick children with diarrhea in areas of endemicity. The aim of this study was to compare the bacterial load of EPEC isolated from stool samples from children with and without diarrhea to determine whether bacterial load might be a useful tool for further study of this phenomenon. METHODS: EPEC was detected by polymerase chain reaction (PCR) of colonies isolated on MacConkey plates from 53 diarrheal and 90 healthy children aged <2 years. DNA was isolated from stool samples by cetyltrimethylammonium bromide extraction. To standardize quantification by quantitative real-time PCR (qRT-PCR), the correlation between fluorescence threshold cycle and copy number of the intimin gene of EPEC E2348/69 was determined. RESULTS: The detection limit of qRT-PCR was 5 bacteria/mg stool. The geometric mean load in diarrhea was 299 bacteria/mg (95% confidence interval [CI], 77-1164 bacteria/mg), compared with 29 bacteria/mg (95% CI, 10-87 bacteria/mg) in control subjects (P = .016). Bacterial load was significantly higher in children with diarrhea than in control subjects among children <12 months of age (178 vs 5 bacteria/mg; P = .006) and among children with EPEC as the sole pathogen (463 vs 24 bacteria/mg; P = .006). CONCLUSIONS: EPEC load measured by qRT-PCR is higher in diarrheal than in healthy children. qRT-PCR may be useful to study the relationship between disease and colonization in settings of endemicity.
Authors: Barletta, Francesca; Ochoa, Theresa J.; Mercado, Erik H.; Ruiz, Joaquim; Ecker, Lucie; Lopez, Giovanni; Mispireta, Monica;Gil, Ana I.; Lanata, Claudio F.; Cleary, Thomas G.
Source: Clinical Infectious Diseases
URL:  Full text

Age-related susceptibility to infection with diarrheagenic Escherichia coli among infants from Periurban areas in Lima, Peru

BACKGROUND: Diarrheagenic Escherichia coli strains are being recognized as important pediatric enteropathogens worldwide. However, it is unclear whether there are differences in age-related susceptibility to specific strains, especially among infants. METHODS: We conducted a passive surveillance cohort study of diarrhea that involved 1034 children aged 2-12 months in Lima, Peru. Control stool samples were collected from randomly selected children without diarrhea. All samples were analyzed for common enteric pathogens and for diarrheagenic E. coli with use of multiplex real-time polymerase chain reaction. RESULTS: The most frequently isolated pathogens in 1065 diarrheal episodes were diarrheagenic E. coli strains (31%), including enteroaggregative (15.1%) and enteropathogenic E. coli (7.6%). Diarrheagenic E. coli, Campylobacter species, and rotavirus were more frequently isolated from infants aged >or=6 months. Among older infants, diffusely adherent E. coli and enterotoxigenic E. coli were more frequently isolated from diarrheal samples than from control samples (P <.05). Children aged >or=6 months who were infected with enterotoxigenic E. coli had a 4.56-fold increased risk of diarrhea (95% confidence interval, 1.20-17.28), compared with younger children. Persistent diarrhea was more common in infants aged <6 months (13.5% vs 3.6%; P <.001). Among children with diarrheagenic E. coli-positive samples, coinfections with other pathogens were more common in children with diarrhea than in control children (40.1% vs 15.6%; P <.001). CONCLUSIONS: Diarrheagenic E. coli strains were more frequently isolated in samples from older infants. In this setting with high frequency of pathogen exposure and high frequency of breastfeeding, we hypothesize that the major age-related differences result from decreased exposure to milk-related protective factors and from increased exposure to contaminated food and water.
Authors: Ochoa, Theresa J.; Ecker, Lucie; Barletta, Francesca; Mispireta, Mónica L.; Gil, Ana I.; Contreras, Carmen; Molina, Margarita;Amemiya, Isabel; Verastegui, Hector; Hall, Eric R.; Cleary, Thomas G.; Lanata, Claudio F.
Source:Clinical Infectious Diseases 
URL: Full text

Se publicó el último nro. de la Revista Médica Herediana (2015)

La Revista Médica Herediana (RMH) es una publicación patrocinada por la Facultad de Medicina Alberto Hurtado de la Universidad Peruana Cayetano Heredia, que publica resultados de investigaciones originales del área biomédica y de Salud Publica realizados a nivel nacional e internacional.

VOL. 26, NÚM. 1 (2015): ENERO - MARZO 2015

Fuente: Universidad Peruana Cayteno Heridia (UPCH)
URL: Texto completo

Se publicó el último número de la Revista Peruana de Biologia (2015)

Es una publicación científica arbitrada producida por el Instituto de Investigaciones de Ciencias Biológicas Antonio Raimondi, Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Lima, Perú; publica artículos completos, originales e inéditos en los temas de biodiversidad, biotecnología, ecología, manejo ambiental y biomedicina.

Vol. 22, Núm. 1 (2015)
Fuente: Portal de Revistas de Investigación UNMSM
URL: Texto completo

The hospitalized patient's perception of the nursing attention in a public hospital

Objetivo Determinar y asociar la percepción del paciente hospitalizado respecto a la atención de enfermería con las variables sociodemográficas y estancia hospitalaria en el servicio de medicina de un hospital público. Método Estudio cuantitativo, descriptivo y transversal con 50 pacientes de ambos sexos mayores de 18 años atendidos en un servicio de medicina. Para la recolección de datos se utilizó el cuestionario de perfil social y el cuestionario de percepción del paciente de la atención de enfermería. Resultados Se observó predominio del sexo femenino, edad entre 40 y 49 años, solteros, con secundaria completa y con menos de 5 días de estancia hospitalaria. La atención de enfermería fue categorizada como medianamente favorable. Los componentes Técnico e Interpersonal fueron categorizados como medianamente favorables y el componente Confort desfavorable. Se observó que la mujer percibe mejor la atención de enfermería. Conclusión Los resultados apuntaron la necesidad de un proceso reflexivo por parte del personal de enfermería para mejorar la atención, la percepción del paciente y brindar un cuidado de calidad.; beto fhon@hotmail.com; Objective To determine and associate the perception of the hospitalized patient regarding the nursing attention, using social and demographical variables and hospital stay in the medical service of a public hospital. Method Quantitative, descriptive and transversal study with 50 patients of both sexes over 18 being treated by a medical service. Data were collected through a social profile questionnaire and a patient questionnaire on their perception of nursing attention. Results There was a prevalence of females, aged between 40 and 49 years old, single, with high-school education and admitted to the hospital for less than 5 days. Nursing attention was categorized as broadly favorable. The Technical and Interpersonal components were categorized as fairly favorable, while Comfort was unfavorable. It was observed that women perceive the nursing attention better than men. Conclusion The results pointed towards the need for a reflexive process for the nursing staff to improve attention and the patient's perception of this, as well as to offer better quality care
Authors: Silva Fhon, J.; Ramón Cordova, S.; Vergaray Villanueva, S.; Palacios Fhon, V.; Partezani Rodrigues, R.
Source: Enfermeria Universitaria
URL: http://hdl.handle.net/10757/555880

Association of poor subjective sleep quality with suicidal ideation among pregnant Peruvian women

Objective: To examine the independent and joint relationships of poor subjective sleep quality and antepartum depression with suicidal ideation among pregnant women. Methods: A cross-sectional study was conducted among 641 pregnant women attending prenatal care clinics in Lima, Peru. Antepartumdepression and suicidal ideationwere assessed using the Patient Health Questionnaire-9 scale. Antepartumsubjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Logistic regression procedures were performed to estimate odds ratios (aOR) and 95% confidence intervals (95% CI) adjusted for confounders. Results: Overall, the prevalence of suicidal ideation in this cohort was 16.8% and poor subjective sleep qualitywas more common among women endorsing suicidal ideation as compared to their counterpartswho did not (47.2% vs. 24.8%, Pb.001). After adjustment for confounders including maternal depression, poor subjective sleep quality (defined using the recommended criteria of PSQI global score of N5 vs. ≤5) was associated with a 1.7-fold increased odds of suicidal ideation (aOR=1.67; 95% CI 1.02–2.71). When assessed as a continuous variable, each 1-unit increase in the global PSQI score resulted in an 18% increase in odds for suicidal ideation, even after adjusting for depression (aOR=1.18; 95% CI 1.08–1.28). Women with both poor subjective sleep quality and depression had a 3.5-fold increased odds of suicidal ideation (aOR=3.48; 95% CI 1.96–6.18) as compared with those who had neither risk factor. Conclusion: Poor subjective sleep quality was associated with increased odds of suicidal ideation. Replication of these findings may promote investments in studies designed to examine the efficacy of sleep-focused interventions to treat pregnant women with sleep disorders and suicidal ideation.
Authors: Gelaye, Bizu; Barrios, Yasmin V.; Zhong, Qiu-Yue; Rondon, Marta B.; Borba, Christina P.C.; Sánchez, Sixto E.; Henderson, David C.; Williams, Michelle A.
Source: General Hospital Psychiatry
URL: http://hdl.handle.net/10757/555873

Why are Authors Citing Older Papers?

With so much new literature published each year, why are authors increasingly citing older papers?

Late last year, computer scientists at Google Scholar published a report describing how authors were citing older papers. The researchers posed several explanations for the trend that focused on the digitization of publishing and the marvelous improvements to search and relevance ranking.

However, as I wrote in my critique of their paper, the trend to cite older papers began decades before Google Scholar, Google, or even the Internet was invented. When you are in the search business, everything good in this world must be the result of search.

Source: The Scholarlykitchen
URL: Full text

Maintaining Relationships with Readers as They Cross Affiliations

Commencement is a joyous event at every university, one where almost no one is thinking about scholarly communications. But it also signals a moment where thousands of authorized users of licensed e-resources lose access, as they graduate from their student status. Many universities will already have begun courting these students as alumni representatives and even donors. Libraries and scholarly publishers, too, should be considering how to serve users as they cross affiliations and their institutional affinities become more diffuse.
Source: The Scholarlykitchen
URL: Full text

Public Access: Getting Medical Information to Patients

Helping patients learn more about medical conditions and potential treatments is a driving force behind efforts to broaden access to the research literature. While there remains a lengthy gap between basic research and clinical application of findings, research articles and books can serve as valuable tools to improve communication between physicians and patients. A good example can be found around the 31 minute mark in the video below, from Ken Burns’ documentary series, Cancer: The Emperor of All Maladies.
Source: The Scholarlykitchen
URL: Full text

Research courses’ characteristics in Peruvian medical schools

Aim: To evaluate the research courses’ characteristics and the scientific output of its teachers within Peruvian medical schools. Methods: A cross-sectional descriptive study was performed, using data from the medical schools existing in Peru in 2011. The research courses’ syllabi and its teachers were evaluated. The number of courses, its teachers and the scientific output of them were assessed. Results: Schools had a median of 5.5 [range 2 to 18] credits of research courses, and 1.75% [0.6 to 6.3] was the median of percentages of total credits. In 18/32 (56%) schools existed at least one course requiring the student to present a final inform, and only one school entailed the students to publish the courses’ products in scientific journals. Furthermore, only five (16%) schools employed at least one instructor that had ever published at least one original article as the corresponding author in a Scopus-indexed journal. Conclusion: Peruvian medical schools’ research courses do not include the publication process as a targeted skill and its teachers have a poor scientific output
Source: Archivos de Medicina
URL: http://hdl.handle.net/10757/555579

Explore the impact of your books!

Bookmetrix.com is a new and unique platform that Springer developed in partnership with 
Altmetric. It offers you a comprehensive overview of the reach, usage and readership of your book or chapter by providing various book-level and chapter-level metrics all in one place.
Source: Springer
URL: Full text

Reducing salt in bread: a quasi-experimental feasibility study in a bakery in Lima, Peru

Objectives: To explore salt content in bread and to evaluate the feasibility of reducing salt contained in ‘pan francés’ bread. Design: The study had two phases. Phase 1, an exploratory phase, involved the estimation of salt contained in bread as well as a triangle taste test to establish the amount of salt to be reduced in ‘pan francés’ bread without detection by consumers. In Phase 2, a quasi-experimental, pre–post intervention study assessed the effects of the introduction of low-salt bread on bakery sales. Setting: A municipal bakery in Miraflores, Lima, Peru. Subjects: Sixty-five clients of the bakery in Phase 1 of the study; sales to usual costumers in Phase 2. Results: On average, there was 1·25 g of salt per 100 g of bread. Sixty-five consumers were enrolled in the triangle taste test: fifty-four (83·1 %) females, mean age 58·9 (SD 13·7) years. Based on taste, bread samples prepared with salt reductions of 10 % (P = 0·82) and 20 % (P =0·37) were not discernible from regular bread. The introduction of bread with 20 % of salt reduction, which contained 1 g of salt per 100 g of bread, did not change sales of ‘pan francés’ (P=0·70) or other types of bread (P =0·36). Results were consistent when using different statistical techniques. Conclusions: The introduction of bread with a 20 % reduction in salt is feasible without affecting taste or bakery sales. Results suggest that these interventions are easily implementable, with the potential to contribute to larger sodium reduction strategies impacting the population’s cardiovascular health.
Source: Public Health Nutrition
URL: http://hdl.handle.net/10757/555477

Atypical presentation of Gorham-Stout syndrome. Case report

Gorham-Stout syndrome is an extremely rare pathology, of unknown etiology. It is characterized by proliferation of vascular channels that causes destruction and reabsorption of the bone matrix. We present a nine year-old male patient with an acute episode characterized by fever, chest pain, respiratory distress and dyspnea. The patient was submitted to computed tomography scan and a biopsy. The findings in the biopsy were multiple lytic lesions, osteolysis, and a mediastinal lymphangioma (lymphangiomatosis). The diagnosis was Gorham-Stout syndrome with atypical presentation.
Source: Archivos argentinos de pediatría 
URL: http://hdl.handle.net/10757/555429

Pediatric musculoskeletal disorders: Inclusion of Manual Therapy

Sr. Editor

Nos es grato saludarle. Hemos leído con sumo interés la carta: Prevención de dolor lumbar en niños en etapa escolar,¹ ya que nos parece de vital importancia el trabajo interdisciplinario en la prevención y atención primaria de estas disfunciones, por ende las felicitaciones del caso por la propuesta y las ideas planteadas.

De tal manera creemos importante abordar esta temática ya que las disfunciones musculoesqueléticas son un problema frecuente en la salud pública, siendo uno de los principales motivos por el que se solicita asistencia sanitaria, siendo la prevalencia en niños y adolescentes comparable a la de adultos,² además de añadir que varios autores han informado que el dolor de espalda, consecuencia de estas disfunciones, en la infancia y adolescencia se asocia con dolor de espalda en un futuro.²

Por lo antes mencionado, brindamos una alternativa, que vendría a ser la Terapia Manual Ortopédica, ya que viene brindando mucha eficacia en el abordaje de estas disfunciones, además no solo en estas, sino también en disfunciones de diversos sistemas.² Esta especialidad de la Fisioterapia y/o Kinesiología, establece un parámetro básico y de suma importancia que es el razonamiento clínico, cuya principal premisa es el abordaje biopsicosocial del paciente,³ este se refiere al manejo integral de la disfunción y las causas que llevaron a esta, es decir, que no solo brinda un análisis de la zona disfuncional sino que analiza todos los factores biomecánicos implícitos en esta, analizando concienzudamente las estructuras y diseñando un plan específico para la función que realiza el paciente, siendo principalmente en esta población la relación entre la postura en sedente y el mobiliario escolar (mesa y silla).¹

Esta propuesta de abordaje en pacientes pediátricos y adolescentes, está recibiendo mayor atención en esta última década, tenemos además demonografías y comentarios, muchas ideas presentadas en publicaciones que tratan esta temática⁵ y su consecuente trabajo interdisciplinario, orientado siempre a mejorar los abordajes en pos del paciente.

Por consiguiente, el trabajo de atención primaria del Pediatra con el Fisioterapeuta de la especialidad, sería bastante benéfico para el paciente y sus implicancias a largo plazo tales como las disfunciones posturales y su consecuente dolor músculo esquelético, pudiendo lograr una educación adecuada del paciente, familiares y su entorno, fomentando la prevención de disfunciones mas complejas y degenerativas en los pacientes pediátricos, trayendo así cambios a mediano y largo en la salud pública de su país.

Fuente: Archivos argentinos de pediatría

URL: http://hdl.handle.net/10757/555444

An unidentified cluster of infection in the Peruvian Amazon region

Introduction: Bartonella bacilliformis is the etiological agent of Carrion’s disease, which is a neglected disease linked to people in low-socioeconomic populations in Andean valleys. An outbreak of B. bacilliformis was reported in a rural area of the Peruvian Amazon region. The aim of this study was to characterize this outbreak using molecular techniques. Methodology: Fifty-three blood samples from patients diagnosed with Carrion’s disease were analyzed by molecular tools, using both a Bartonella-specific polymerase chain reaction (PCR) and an universal PCR, both based on 16S rRNA gene amplification. Additional water samples from the area were also analyzed. Results: Unexpectedly, the samples were positive only when the universal PCR was used. Although environmental contamination cannot be ruled out, the results showed that Sphingomonas faeni was the possible causative agent of this outbreak, and that water was the most feasible infection source. Conclusions: Diagnosis by clinical criteria or microscopy may lead to misdiagnosis. There is a need to include molecular tools in the routine diagnosis of febrile syndromes, including Carrion’s disease.
Source: The Journal of Infection in Developing Countries
URL: http://hdl.handle.net/10757/555445

Prevalence of ideal cardiovascular health in Peru: The cronicas cohort study

Background: American Heart Association 2020 Impact Goal focuses on promotion of health and control of cardiovascular risk. We aimed to determine the prevalence of Ideal Cardiovascular Health in Peru. Methods: Ideal Cardiovascular Health is the presence of 3 ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/ <80 mm Hg, and untreated fasting plasma glucose <100 mg/dL) and 4 ideal health behaviors (never smoker, body mass index <25 kg/m2, high physical activity, and fruit and vegetable consumption >3 times/day). Data from the CRONICAS longitudinal study, an age-and-sex stratified random sample of participants aged 35 years or older in four Peruvian settings. Results: 3058 of 3618 (84.5%) of the CRONICAS cohort participants had complete information for analysis. Figure 1 shows the agestandardized prevalence estimates of ideal, intermediate and poor health metrics. No one had all 7 metrics; only 48 (15.7%) had 6 ideal health metrics and 650 (21.3%) had ≤ 1 ideal health metric. Compared to urban Lima, living in rural Puno was associated with more Ideal Cardiovascular Health (OR 2.09, 95% CI 1.49-2.91) and rural Tumbes was less ideal (OR 0.54, 95% CI 0.39-0.76) after adjusting for sex, age, education and wealth index. Conclusion: There is an alarmingly low prevalence of Ideal Cardiovascular Health in Peru and the metrics with the greatest potential for improvement are health behaviors, including diet quality, physical activity and body weight.
Source: The Journal of the American College of Cardiology
URL: http://hdl.handle.net/10757/555446

How geography influences complex cognitive ability

Evolutionary explanations for geography's influence on complex cognitive ability (CCA) imply
virtually immutable components of between-nation IQ differences. Their weight vis-à-vis the
weight of situational components was evaluated through an analysis of a 194-country data set.
Additive effects of absolute latitude (AL) and longitudinal distance from Homo sapiens' cradle
(LDC) explain Northeastern Asian higher, Sub-Saharan African lower CCAs. AL exerts cognitive
influence directly and through socioeconomic development and evolutionary genetics whereas
LDC does through evolutionary genetics; however, this occurs differently in Africa-Near East-
Europe and elsewhere. The findings are understood assuming supremacy of contemporary UVB
radiation → hormonal and climatic → socioeconomic mediators of the AL–CCA linkage whose
effects are moderated by heterogeneous genetic and cultural adaptations to radiation and climate.
Geography's cognitive effects are dynamic and public-policy actions may modify them.
Source: Intelligence
URL: http://hdl.handle.net/10757/554348

Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy.
Source: PLoS ONE
URL: http://hdl.handle.net/10757/552402

Association between food assistance program participation and overweight

OBJECTIVE The objective of this study was to investigate the association between food assistance program participation and overweight/obesity according to poverty level. METHODS A cross-sectional analysis of data from 46,217 non-pregnant and non-lactating women in Lima, Peru was conducted; these data were obtained from nationally representative surveys from the years 2003, 2004, 2006, and 2008-2010. The dependent variable was overweight/obesity, and the independent variable was food assistance program participation. Poisson regression was used to stratify the data by family socioeconomic level, area of residence (Lima versus the rest of the country; urban versus rural), and survey year (2003-2006 versus 2008-2010). The models were adjusted for age, education level, urbanization, and survey year. RESULTS Food assistance program participation was associated with an increased risk of overweight/obesity in women living in homes without poverty indicators [prevalence ratio (PR) = 1.29; 95% confidence interval (CI) 1.06;1.57]. When stratified by area of residence, similar associations were observed for women living in Lima and urban areas; no associations were found between food assistance program participation and overweight/obesity among women living outside of Lima or in rural areas, regardless of the poverty status. CONCLUSIONS Food assistance program participation was associated with overweight/obesity in non-poor women. Additional studies are required in countries facing both aspects of malnutrition.
Source: Revista de Saude Pública
URL: http://hdl.handle.net/10757/344303

Association of Childhood Physical and Sexual Abuse with Intimate Partner Violence, Poor General Health and Depressive Symptoms among Pregnant Women

Objective We examined associations of childhood physical and sexual abuse with risk of intimate partner violence (IPV). We also evaluated the extent to which childhood abuse was associated with self-reported general health status and symptoms of antepartum depression in a cohort of pregnant Peruvian women. Methods In-person interviews were conducted to collect information regarding history of childhood abuse and IPV from 1,521 women during early pregnancy. Antepartum depressive symptomatology was evaluated using the Patient Health Questionnaire-9. Multivariable logistic regression procedures were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Results Any childhood abuse was associated with 2.2-fold increased odds of lifetime IPV (95%CI: 1.72–2.83). Compared with women who reported no childhood abuse, those who reported both, childhood physical and sexual abuse had a 7.14-fold lifetime risk of physical and sexual IPV (95%CI: 4.15–12.26). The odds of experiencing physical and sexual abuse by an intimate partner in the past year was 3.33-fold higher among women with a history of childhood physical and sexual abuse as compared to women who were not abused as children (95%CI 1.60–6.89). Childhood abuse was associated with higher odds of self-reported poor health status during early pregnancy (aOR = 1.32, 95%CI: 1.04–1.68) and with symptoms of antepartum depression (aOR = 2.07, 95%CI: 1.58–2.71). Conclusion These data indicate that childhood sexual and physical abuse is associated with IPV, poor general health and depressive symptoms in early pregnancy. The high prevalence of childhood trauma and its enduring effects of on women’s health warrant concerted global health efforts in preventing violence.
Source: PLoS ONE
URL: http://hdl.handle.net/10757/344059

Epidemiological surveillance of Pertussis: the experience of Argentina and its relevance for the other countries in the region

Sr. Editor: Hemos leído con interés el artículo de Romanin y col. titulado: “Situación epidemiológica de coqueluche y estrategias para su control: Argentina, 2002-2011”, 1 donde los autores presentan las estrategias implementadas en los últimos años en Argentina para la vigilancia epidemiológica y control de Bordetella pertussis. De éstas, la más relevante es la cooperación estrecha entre las entidades sanitarias, especialmente el Ministerio de Salud de la Nación (MSN), el Sistema Nacional de Vigilancia de la Salud de Argentina (SNVS) y La Dirección Estadística e Información en Salud (DEIS) del MSN, interacción que no ocurre en todos los países latinoamericanos.
Fuente: Archivos Argentinos de Pediatria
URL: http://hdl.handle.net/10757/338891

Aetiology, epidemiology and clinical characteristics of acute moderate-to-severe diarrhoea in children under 5 years of age hospitalized in a referral paediatric hospital in Rabat, Morocco

The objective of the study was to describe the aetiology, epidemiology and clinical characteristics of the principal causes of acute infectious diarrhoea requiring hospitalization among children under 5 years of age in Rabat, Morocco. A prospective study was conducted from March 2011 to March 2012, designed to describe the main pathogens causing diarrhoea in hospitalized children >2 months and less than 5 years of age. Among the 122 children included in the study, enteroaggregative Escherichia coli (EAEC) and rotavirus were the main aetiological causes of diarrhoea detected. Twelve (9.8 %) children were referred to an intensive care unit, while two, presenting infection by EAEC, and EAEC plus Shigella sonnei, developed a haemolytic uraemic syndrome. Additionally, six (4.9 %) deaths occurred, with EAEC being isolated in four of these cases. Diarrhoeagenic E. coli and rotavirus play a significant role as the two main causes of severe diarrhoea, while other pathogens, such as norovirus and parasites, seem to have a minimal contribution. Surveillance and prevention programmes to facilitate early recognition and improved management of potentially life-threatening diarrhoea episodes are needed.
Source: Journal of Medical Microbiology
URL: http://hdl.handle.net/10757/338011

Factors associated with non-use of condoms in an online community of frequent travellers

Background Millions of travellers around the world have gathered together into online communities. The objective is to analyse the factors associated with risky sexual behaviour among travellers. Methods Cross-sectional study was conducted within an online community of travellers using an online survey; we included travellers who had engaged in sexual activity while on their last trip. Risky sexual behaviour was defined as inconsistent condom use (<100%), and the factors associated were evaluated using the prevalence ratio (PR). Results Of the 468 participants, 245 had sex during their last trip. 59.7% did not consistently use condoms, and one out of every four participants reported never using condoms. Having a travel destination of Latin America or the Caribbean was significantly associated with inconsistent condom use. This association was maintained (PR 1.37, CI 95% 1.06–1.77) after adjusting for gender, age, migration, the presence of travel partners, and the use of drugs and alcohol prior to sexual activity. Conclusion An association was observed between travel destination (specifically Latin America or the Caribbean) and risky sexual behaviour. For this reason, tourists should be educated in STI transmission and regional STI and HIV incidences both before and during their travels; public health systems ought to work together with travel agencies, international airports, etc., in order to distribute this information and ensure a responsible travel experience.
Source: Travel Medicine and Infectious Disease
URL: http://hdl.handle.net/10757/338010

Usefulness of Neutrophil-to-Lymphocyte Ratio in Risk Stratification of Patients With Advanced Heart Failure

Elevated neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in patients with acute heart failure (HF) and neoplastic diseases. We investigated the association between NLR and mortality or cardiac transplantation in a retrospective cohort of 527 patients presented to the Cleveland Clinic for evaluation of advanced HF therapy options from 2007 to 2010. Patients were divided according to low, intermediate, and high tertiles of NLR and were followed longitudinally for time to all-cause mortality or heart transplantation (primary outcome). The median NLR was 3.9 (interquartile range 2.5 to 6.5). In univariate analysis, intermediate and highest tertiles of NLR had a higher risk than the lowest tertile for the primary outcome and all-causes mortality. Compared with the lowest tertile, there was no difference in the risk of heart transplantation for intermediate and high tertiles. In multivariate analysis, compared with the lowest tertile, the intermediate and high NLR tertiles remained significantly associated with the primary outcome (hazard ratio [HR] [ 1.61, 95% confidence interval [CI] 1.10 to 2.37 and HR [ 1.55, 95% CI 1.02 to 2.36, respectively) and all-cause mortality (HR [ 1.83, 95% CI 1.07 to 3.14 and HR [ 2.16, 95% CI 1.21 to 3.83, respectively). In conclusion, elevated NLR is associated with increased mortality or heart transplantation risk in patients with advanced HF.
Source: The American Journal of Cardiology 
URL: http://hdl.handle.net/10757/338009

Differences in survival between patients with systemic lupus erythematosus from a public and a private center

Sr. Editor
Hemos leído con atención el artículo publicado por el servicio de Reumatología del Hospital José María Cullen de Santa Fe, Argentina1. Nos parece relevante la comparación de la evolución del lupus eritematoso sistémico (LES) en un centro privado y uno público, ya que el desenlace de esta enfermedad se podría ver afectado por diversos factores que involucran estar en cualquiera de los centros mencionados, como el tratamiento farmacológico brindado y las características demográficas de la persona que acude a un centro público y uno privado. Estos factores influyen en la calidad de vida y el grado de actividad de la enfermedad en el paciente2. Sin embargo, el estudio presentado tiene algunas limitaciones que ponen en tela de juicio los resultados reportados. En primer lugar, no se define el momento en que los autores inician el seguimiento de enfermedad de los pacientes. Esto podría sesgar el estudio ya que el pronóstico de supervivencia de LES varía de acuerdo con varios factores, como el grado de actividad de la enfermedad en la que se encuentra la persona, la edad y las comorbilidades en el momento de diagnóstico, entre otras3. Segundo, no se determina si los pacientes son usuarios exclusivos de uno de los sistemas de salud (público o privado), si tienen ambos sistemas de salud o si durante los anos ˜ de seguimiento cambiaron de un sistema a otro. Esto generaría que los pacientes reciban más de un tratamiento simultáneamente o tratamientos distintos por cada centro en diversos periodos. Finalmente, el uso de un consentimiento informado es importante en la realización de un estudio, ya que asegura que el paciente tiene conocimiento y acepta su participación en este4. Suena raro que sea necesario un consentimiento informado en un estudio retrospectivo cuando en la sección de métodos se dice que no se ha usado, pero más adelante se menciona que sí se utilizó, lo cual puede generar confusión sobre la ética del estudio.
Por último, consideramos que algunos datos podrían haber estado mejor explicados,tanto en las tablas como en eltexto, ya que puede confundir a los lectores provocando una mala interpretación de los datos. Por ejemplo, en los resultados, los autores explican que, dados 2 grupos de personas, ambos de raza negra, un grupo con seguro de salud y el otro grupo sin seguro de salud, se observa una mayor mortalidad en el grupo sin seguro de salud, lo que da como resultado que la etnia no desempena˜ un papel decisivo en la supervivencia de los pacientes, lo cual puede ser desmentido, ya que en este caso, la etnia es la misma en todos los pacientes estudiados y no una variable5.
Fuente: Reumatología Clínica
URL: http://hdl.handle.net/10757/337884

Characterization of two Achromobacter xylosoxidans isolates from patients with pertussis-like symptoms

Objective: To characterize two Achromobacter xylosoxidans recovered from 2 patients diagnosed with pertussis during a Bordetella pertussis surveillance program. Methods: Nasopharyngeal swabs from 2 children under 1 year of age with clinical suspicion of pertussis were analyzed by culture and PCR. Results: Two Achromobacter xylosoxidans A8, closely related to Bordetella spp. were recovered from 2 patients diagnosed of pertussis, both carrying the ptxA gene and IS418 the pertussis toxin encoding gene. Subsequently, antibiotic susceptibility was evaluated by disk-diffusion method and by PCR. Conclusions: Although more detailed studies are needed, the present data highlight the possibility that Achromobacter xylosoxidans, closely related Bordetella pertussis microorganisms and not covered under the vaccine umbrella, might also result in cases of whooping cough. Thereby further surveillance is necessary to determine the extension and relevance of their pathogenic role in order to discriminate their real public health implication.
Source: Asian Pacific Journal of Tropical Medicine
URL: http://hdl.handle.net/10757/554305

Citation Boost or Bad Data? Academia.edu Research Under Scrutiny

If a free website claimed that you could double citations to your papers simply by uploading them to their file sharing network, would you believe it?

This claim, and the paper supporting it, is displayed prominently on the Academia.edu website, a platform for scholars to share research papers. It was also sent out to all 21 million registered Academia.edu members

Source: The Scholarly Kitchen
UIRL: Full text

Academia Versus Academia.edu: Should Tech Business Needs Trump Scholarly Culture?

Though often used in a pejorative manner, the concept of the “ivory tower” is based on a separation from the concerns of the everyday–the idea of academia serving a higher purpose than the rat race of business. Last week Rick Anderson wrote about the higher standards of behavior required from scholarly publishers, and watchdogs continually call out any deviation from the strict rigor that characterizes academic research itself. As technology startups continue to hold more sway over scholarly communication, should we similarly hold those companies and their business practices to the same high standards? Academia.edu’s recent marketing campaign offers an interesting case study.
Source: The Scholarly Kitchen
URL: Full text

Tutoring as an academic tool and for the development of transversal competences

The work that we are presenting in this document has its origins in IBEROTEC´s model of tutoring. It evolved from an educational proposal about working with transverse competences that made tutoring a tool for the development of these competences. Tutoring is very important, but secondary, in light of the objectives of the formation that intends to reach a particular graduate profile. In this sense, we saw the necessity of generating four principles to orient academic administration and the actions of tutors and teachers. Thus, what this document proposes is a model of academic administration oriented by the following four ideas: the student is autonomous and Iberotec´s principal idea is to contribute to that; the teachers are “learning provocateurs”, they provoke student´s learning; the work is formative; the institution is facilitating. These principles are more than a declaration of intention; they are a series of criteria for daily decision making and for the design of courses and the action plan for tutoring.
Source: Revista Iberoamericana de Educación
URL http://hdl.handle.net/10757/554303

Prevalence of filariasis by Mansonella ozzardi and associated factors among 2 suburban communities of Iquitos, 2009

Introducción Tres casos de infección por Mansonella ozzardi (M. ozzardi) en muestras de malaria que provenían de 2 comunidades periurbanas de Iquitos (Perú) dieron la sospecha de transmisión local. El objetivo del estudio fue determinar la prevalencia y factores asociados con la filariosis por M. ozzardi en estas comunidades. Materiales y métodos Se realizó un estudio transversal en las comunidades de Laguna Azul y La Unión en Iquitos. A todos los pobladores se les tomó una gota gruesa para la detección de M. ozzardi y se les realizó una encuesta epidemiológica. Se realizó colecta de larvas y mosquitos para identificación de potenciales vectores. Se calcularon los OR ajustados (ORa) usando regresión logística múltiple. Resultados Se evaluaron a 433 personas; 58% fueron mujeres; la mediana de edad fue de 20 años; 58,2% fueron migrantes, 3,7% pescadores y 12,9% habían viajado por las cuencas del Alto Nanay. La prevalencia de M. ozzardi fue de 1,4% (6/433) y el más joven de los casos tuvo 31 años; se encontró asociación con ser pescador (ORa: 8,7; IC 95: 1,1-76,0) y con haber realizado viajes por la cuenca del Alto Nanay (ORa: 11,2; IC 95: 1,2-112,5). No se evidenció densidad significativa de vectores simúlidos o culicoides. Conclusión Las comunidades estudiadas tuvieron una baja prevalencia de M. ozzardi y por la edad de los casos y los factores asociados encontrados se sospecha infección foránea a la zona de estudio, en especial en la cuenca del Alto Nanay.
Source: Asociación Colombiana de Infectología (ACIN) (Infectio)
URL: http://hdl.handle.net/10757/552949

Factors associated with poor sleep quality among patients with chronic kidney diseases in hemodialysis

Introducción y objetivos Los trastornos del sueño son una de las comorbilidades más comunes en pacientes en hemodiálisis. Los objetivos del estudio fueron determinar la prevalencia de mala calidad de sueño y establecer los potenciales factores asociados a ella. Materiales y métodos Estudio transversal analítico que enroló a pacientes con enfermedad renal crónica en hemodiálisis. La variable resultado fue calidad de sueño evaluada mediante la escala de Pittsburgh, mientras que las variables de exposición fueron el tiempo en hemodiálisis, la historia de diabetes mellitus tipo 2 y de hipertensión arterial, la presencia de sintomatología depresiva, la presencia de anemia y el compromiso urémico. Se usó el modelo de regresión de Poisson para verificar las asociaciones de interés, reportándose razones de prevalencia (RP) e intervalos de confianza al 95% (IC 95%). Resultados Fueron enrolados un total de 450 pacientes, de los cuales, 259 (57,5%) fueron varones, y con una edad entre 18 y 97 años. La prevalencia de mala calidad de sueño fue de 79,3% (IC 95%: 75,6-83,1%). Se encontró asociación significativa entre mala calidad de sueño y sintomatología depresiva (RP = 1,28; IC 95%: 1,17-1,39), anemia (RP = 1,18; IC 95%: 1,04-1,34) y compromiso urémico (RP = 1,26; IC 95%: 1,17-1,36) después de controlar por potenciales confusores. Conclusiones La presencia de sintomatología depresiva, anemia y el compromiso urémico estuvieron positivamente asociados a mala calidad de sueño en pacientes con enfermedad renal crónica en hemodiálisis. Un gran porcentaje de esta población sufre de mala calidad de sueño. Se sugiere desarrollar estrategias para mejorar la calidad de sueño en estos pacientes.
Source:  Dialisis y Traspante
URL: http://hdl.handle.net/10757/554084

Nephrology: is a medical specialty unattractive to Peruvian doctors?

Although the National Committee of Medical Residency (CONAREME) has increased the number of nephrology residency positions in Peru, the increase has not been proportional to the number of applicants. This is worrisome in an environment lacking of nephrologists, like our country. The Peruvian Society of Nephrology (SPN) should take the measures to make this specialty more attractive to Peruvian physicians.
Source: Jornal Brasileiro de Nefrologia
URL: http://hdl.handle.net/10757/554221

Factors associated with poor sleep quality among patients with chronic kidney diseases in hemodialysis

Introduction and objectives Sleep disorders are one of the most common comorbidities among patients on hemodialysis. The aims of this study were to determine the prevalence of poor sleep quality as well as to establish potential factors associated with poor sleep quality. Materials and methods A cross-sectional study was performed enrolling patients with chronic kidney disease on hemodialysis. The outcome was sleep quality evaluated using the Pittsburgh Scale, whereas the exposure variables were time on hemodialysis, history of type-2 diabetes and hypertension, depressive symptoms, anemia, and uremia. We used Poisson regression model to determine the association of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). Results A total of 450 patients were enrolled, 259 (57.5%) were male, aged from 18 to 97 years. The prevalence of poor sleep quality was 79.3% (95%CI: 75.6%–83.1%). Poor sleep quality was associated with depressive symptoms (PR = 1.28; 95%CI: 1.17-1.39), anemia (PR = 1.18; 95%CI: 1.04-1.34) and uremia (PR = 1.26; 95%CI: 1.17-1.36) after controlling for potential confounders. Conclusions The presence of depressive symptoms, anemia and uremia were positively associated with poor sleep quality among patients with chronic kidney disease on hemodialysis. A great proportion of this population had poor sleep quality. Strategies are needed to improve sleep quality in these patients.
Source: Elsevier:
URL: http://hdl.handle.net/10757/554084