Educar por competencias a los profesionales de la salud para transformar la salud

Este número de la Revista Peruana de Medicina Experimental y Salud Pública tiene como tema central la educación en salud, tema de gran importancia por la estrecha relación que existe entre la calidad de la atención de salud y la calidad de la formación de los profesionales que la brindan. Al respecto, la OMS señala que el factor humano es indispensable para reforzar los sistemas de salud y que hay numerosas experiencias que demuestran que el número, la densidad y la calidad de los trabajadores sanitarios están efectivamente relacionados con la calidad de salud de la población (1). La relación entre educación y salud toma especial relevancia cuando los sistemas de salud en países ricos y pobres están en un proceso de reforma que demandará profesionales con un nuevo perfil. La principal razón para la reforma es que, actualmente, existen millones de personas que no tienen acceso a la salud. El gran reto del siglo XXI para la humanidad es lograr que todas las personas, sin distinción, tengan acceso a la salud (2). Con este propósito está en marcha la reforma de los sistemas de salud, a nivel global, basada en la estrategia de atención primaria de la salud (APS), la cual integra la reparación, prevención y promoción de la salud y acerca los servicios a la población. Una de las mayores dificultades para llevar a cabo dicha reforma en todos los países, es el número insuficiente de profesionales de la salud, mal distribuidos y con competencias no alineadas con las necesidades de salud de la población (3). En nuestro país el gobierno impulsa la reforma del sector salud orientada a lograr el aseguramiento universal, con base en un nuevo modelo de atención integral de salud basado en familia y comunidad que se sustenta en la estrategia de APS (4-5).
Authors: Risco de Domínguez, Graciela
Source:  Instituto Nacional de Salud
URL:  http://hdl.handle.net/10757/345759

Early Prevention and Screening of Cervical Cancer in a Developing Country

We have read with much interest an article recently published by Ekwueme et al.1 about the impact of the National Breast and Cervical Cancer Early Detection Program on cervical cancer mortality among uninsured low-income women in the U.S. Cervical cancer is a relevant issue in Peru, owing to its high incidence and mortality rate when compared with other countries.2 Despite being a fully preventable cancer with a clearly known pathogen, its early prevention and detection remains a problem in Peru, which is worsened by poverty conditions and inadequate access to health care, as well as unequal distribution of health workers among the country’s different regions.3
Authors: Carvallo Michelena, Alvaro; Rojas Dominguez, Jorge Luis; Piscoya, Alejandro
Source: American Journal of Preventive Medicine (Am J Prev Med)
URL: http://hdl.handle.net/10757/345729

Diarrheagenic Escherichia coli Phylogroups Are Associated with Antibiotic Resistance and Duration of Diarrheal Episode

Conventionally, in Escherichia coli, phylogenetic groups A and B1 are associated with commensal strains while B2 and D are associated with extraintestinal strains. The aim of this study was to evaluate diarrheagenic (DEC) and commensal E. coli phylogeny and its association with antibiotic resistance and clinical characteristics of the diarrheal episode. Phylogenetic groups and antibiotic resistance of 369 E. coli strains (commensal strains and DEC from children with or without diarrhea) isolated from Peruvian children <1 year of age were determined by a Clermont triplex PCR and Kirby-Bauer method, respectively. The distribution of the 369 E. coli strains among the 4 phylogenetic groups was A (40%), D (31%), B1 (21%), and B2 (8%). DEC-control strains were more associated with group A while DEC-diarrhea strains were more associated with group D (𝑃 < 0.05). There was a tendency (𝑃 = 0.06) for higher proportion of persistent diarrhea (≥14 days) among severe groups (B2 and D) in comparison with nonsevere groups (A and B1). Strains belonging to group D presented significantly higher percentages of multidrug resistance than the rest of the groups (𝑃 > 0.01). In summary, DEC-diarrhea strains were more associated with group D than strains from healthy controls.
Authors: Mosquito, Susan; Pons, Maria J.; Riveros, Maribel; Ruiz, Joaquim; Ochoa, Theresa J.
Source: The Scientific World Journal

URL: http://hdl.handle.net/10757/345715

Teenage pregnancy as a risk factor for obstetric and perinatal complications at a hospital in Lima, Peru

Objective: to evaluate the risk of obstetric and perinatal outcomes in teenage pregnancy in comparison with adult pregnancy. Methods: retrospective cohort study of 67.693 pregnant women attended in a public hospital in Lima between 2000 and 2010. Obstetric and perinatal outcomes were evaluated. The adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years) and was compared among the adult group (20-35 years). Adjusted odds ratios were calculated by education, civil status, prenatal care, previous pregnancies, parity, and pre-gesta-tional BMI. Results: higher risk of cesarean (OR=1,28; CI95%=1,07-1,53) and puerperal infection (OR=1,72; CI95%=1,17-2,53) was found in teenager under 15 years old; as well as higher risk of episiotomy (OR=1,34; CI95%=1,29-1,40) in late teenagers. In addition, this study identified a lower risk of teenage pregnancy for preeclampsia (OR=0,90; CI95%=0,85-0,97), 2nd half-pregnancy bleeding (OR=0,80; CI95%=0,71-0,92), premature rupture of membranes(OR=0,83; CI95%=0,79-0,87), preterm labor (OR=0,87; CI95%=0,80-0,94) and vaginal tearing (OR=0,86; CI95%=0,79-0,93). Conclusion: pregnancy behaves as a risk factor for some obstetric outcomes in the adolescent group, especially in the youngest ones. In addition to maternal age, there are other factors that constitute the need to form multidisciplinary teams to reduce obstetric outcomes in this population
Authors: Okumura, Javier A.; Maticorena, Diego A.; Tejeda, José E.; Mayta Tristán, Percy
Source: Revista Brasileira de Saúde Materno Infantil (Rev. Bras. Saude Mater. Infant)

URL: http://hdl.handle.net/10757/344534

Tuberculosis sensible y drogorresistente: Mortalidad y sus factores asociados

Background: An increase in multidrug-resistant tuberculosis (MDR-TB) cases is evident worldwide. Its management implies a complex treatment, high costs, more toxic anti-tuberculosis drug use, longer treatment time and increased treatment failure and mortality. The aims of this study were to compare mortality between MDR and drug-susceptible cases of tuberculosis, and to determine risk factors associated with mortality among MDR-TB cases. Methods and Results: A retrospective cohort study was performed using data from clinical records of the National Strategy for Prevention and Control of Tuberculosis in Lima, Peru. In the first objective, MDR-TB, compared to drug-susceptible cases, was the main exposure variable and time to death, censored at 180 days, the outcome of interest. For the second objective, different variables obtained from clinical records were assessed as potential risk factors for death among MDR-TB cases. Cox regression analysis was used to determine hazard ratios (HR) and 95% confidence intervals (95%CI). A total of 1,232 patients were analyzed: mean age 30.9 ±14.0 years, 60.0% were males. 61 patients (5.0%) died during treatment, whereas the MDR-TB prevalence was 19.2%. MDR-TB increased the risk of death during treatment (HR=7.5; IC95%: 4.1–13.4) when compared to presumed drug-susceptible cases after controlling for potential confounders. Education level (p=0.01), previous TB episodes (p<0.001), diabetes history (p<0.001) and HIV infection (p=0.04) were factors associated with mortality among MDR-TB cases. Conclusions: MDR-TB is associated with an increased risk of death during treatment. Lower education, greater number of previous TB episodes, diabetes history, and HIV infection were independently associated with mortality among MDR-TB cases. New strategies for appropriate MDR-TB detection and management should be implemented, including drug sensitivity tests, diabetes and HIV screening, as well as guarantee for a complete adherence to therapy.
Authors: Chung Delgado, Kocfa; Guillen Bravo, Sonia; Revilla Montag, Alejandro; Bernabe Ortiz, Antonio
Source: PLoS ONE

URL: http://hdl.handle.net/10757/344468