ALTO RIESGO DE CONSUMO DE ALCOHOL EN TRABAJADORES DE ATENCIÓN PRIMARIA DE SALUD, LORETO, PERÚ, 2011

El consumo de alcohol de alto riesgo o dependencia puede afectar la salud y el desempeño profesional. Los trabajadores de la atención primaria de salud (TAPS) son clave en la referencia, prevención y tratamiento de las consecuencias de este consumo. Sin embargo, existe poca evidencia sobre el nivel de consumo de alcohol en TAPS. La investigación fue de tipo transversal, aleatorizado por conveniencia. 150 TAPS (médicos, enfermeras y obstetras) de 3 centros de salud primarios fueron reclutados y se les aplicó el Cuestionario de Identificación de los Trastornos debidos al Consumo de Alcohol (AUDIT). Los TAPS de los tres centros estudiados, presentaron un alto porcentaje de bebedores en alto riesgo (40%-46%), al menos 50% de bebedores de alto riesgo fueron de sexo masculino y en grupos de edad correspondiente al rango de 31 a 40 años (56.3%). El porcentaje de bebedores con dependencia encontrado en este estudio es mayor a lo encontrado en otros estudios nacionales que incluían Loreto. El alto riesgo de consumo de alcohol podría ser un problema laboral aun no evaluado en salud que necesita futura investigación

Defining Catastrophic Costs and Comparing Their Importance for Adverse Tuberculosis Outcome with Multi-Drug Resistance: A Prospective Cohort Study, Peru

Background Even when tuberculosis (TB) treatment is free, hidden costs incurred by patients and their households (TB-affected households) may worsen poverty and health. Extreme TB-associated costs have been termed “catastrophic” but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to create a clinically relevant definition of catastrophic costs. Methods and Findings From 26 October 2002 to 30 November 2009, TB patients (n = 876, 11% with multi-drug-resistant [MDR] TB) and healthy controls (n = 487) were recruited to a prospective cohort study in shantytowns in Lima, Peru. Patients were interviewed prior to and every 2–4 wk throughout treatment, recording direct (household expenses) and indirect (lost income) TB-related costs. Costs were expressed as a proportion of the household's annual income. In poorer households, costs were lower but constituted a higher proportion of the household's annual income: 27% (95% CI = 20%–43%) in the least-poor houses versus 48% (95% CI = 36%–50%) in the poorest. Adverse TB outcome was defined as death, treatment abandonment or treatment failure during therapy, or recurrence within 2 y. 23% (166/725) of patients with a defined treatment outcome had an adverse outcome. Total costs ≥20% of household annual income was defined as catastrophic because this threshold was most strongly associated with adverse TB outcome. Catastrophic costs were incurred by 345 households (39%). Having MDR TB was associated with a higher likelihood of incurring catastrophic costs (54% [95% CI = 43%–61%] versus 38% [95% CI = 34%–41%], p<0.003). Adverse outcome was independently associated with MDR TB (odds ratio [OR] = 8.4 [95% CI = 4.7–15], p<0.001), previous TB (OR = 2.1 [95% CI = 1.3–3.5], p = 0.005), days too unwell to work pre-treatment (OR = 1.01 [95% CI = 1.00–1.01], p = 0.02), and catastrophic costs (OR = 1.7 [95% CI = 1.1–2.6], p = 0.01). The adjusted population attributable fraction of adverse outcomes explained by catastrophic costs was 18% (95% CI = 6.9%–28%), similar to that of MDR TB (20% [95% CI = 14%–25%]). Sensitivity analyses demonstrated that existing catastrophic costs thresholds (≥10% or ≥15% of household annual income) were not associated with adverse outcome in our setting. Study limitations included not measuring certain “dis-saving” variables (including selling household items) and gathering only 6 mo of costs-specific follow-up data for MDR TB patients. Conclusions Despite free TB care, having TB disease was expensive for impoverished TB patients in Peru. Incurring higher relative costs was associated with adverse TB outcome. The population attributable fraction indicated that catastrophic costs and MDR TB were associated with similar proportions of adverse outcomes. Thus TB is a socioeconomic as well as infectious problem, and TB control interventions should address both the economic and clinical aspects of this disease

Rickettsial Disease in the Peruvian Amazon Basin.

Using a large, passive, clinic-based surveillance program in Iquitos, Peru, we characterized the prevalence of rickettsial infections among undifferentiated febrile cases and obtained evidence of pathogen transmission in potential domestic reservoir contacts and their ectoparasites. Blood specimens from humans and animals were assayed for spotted fever group rickettsiae (SFGR) and typhus group rickettsiae (TGR) by ELISA and/or PCR; ectoparasites were screened by PCR. Logistic regression was used to determine associations between patient history, demographic characteristics of participants and symptoms, clinical findings and outcome of rickettsial infection. Of the 2,054 enrolled participants, almost 2% showed evidence of seroconversion or a 4-fold rise in antibody titers specific for rickettsiae between acute and convalescent blood samples. Of 190 fleas (Ctenocephalides felis) and 60 ticks (Rhipicephalus sanguineus) tested, 185 (97.4%) and 3 (5%), respectively, were positive for Rickettsia spp. Candidatus Rickettsia asemboensis was identified in 100% and 33% of the fleas and ticks tested, respectively. Collectively, our serologic data indicates that human pathogenic SFGR are present in the Peruvian Amazon and pose a significant risk of infection to individuals exposed to wild, domestic and peri-domestic animals and their ectoparasites

Alto riesgo de consumo de alcohol en trabajadores de atención primaria de salud, Loreto, Perú, 2011

El consumo de alcohol de alto riesgo o dependencia puede afectar la salud y el desempeño profesional. Los trabajadores de la atención primaria de salud (TAPS) son clave en la referencia, prevención y tratamiento de las consecuencias de este consumo. Sin embargo, existe poca evidencia sobre el nivel de consumo de alcohol en TAPS. La investigación fue de tipo transversal, aleatorizado por conveniencia. 150 TAPS (médicos, enfermeras y obstetras) de 3 centros de salud primarios fueron reclutados y se les aplicó el Cuestionario de Identificación de los Trastornos debidos al Consumo de Alcohol (AUDIT). Los TAPS de los tres centros estudiados, presentaron un alto porcentaje de bebedores en alto riesgo (40%-46%), al menos 50% de bebedores de alto riesgo fueron de sexo masculino y en grupos de edad correspondiente al rango de 31 a 40 años (56.3%). El porcentaje de bebedores con dependencia encontrado en este estudio es mayor a lo encontrado en otros estudios nacionales que incluían Loreto. El alto riesgo de consumo de alcohol podría ser un problema laboral aun no evaluado en salud que necesita futura investigación

ALTO RIESGO DE CONSUMO DE ALCOHOL EN TRABAJADORES DE ATENCIÓN PRIMARIA DE SALUD, LORETO, PERÚ, 2011

El consumo de alcohol de alto riesgo o dependencia puede afectar la salud y el desempeño profesional. Los trabajadores de la atención primaria de salud (TAPS) son clave en la referencia, prevención y tratamiento de las consecuencias de este consumo. Sin embargo, existe poca evidencia sobre el nivel de consumo de alcohol en TAPS. La investigación fue de tipo transversal, aleatorizado por conveniencia. 150 TAPS (médicos, enfermeras y obstetras) de 3 centros de salud primarios fueron reclutados y se les aplicó el Cuestionario de Identificación de los Trastornos debidos al Consumo de Alcohol (AUDIT). Los TAPS de los tres centros estudiados, presentaron un alto porcentaje de bebedores en alto riesgo (40%-46%), al menos 50% de bebedores de alto riesgo fueron de sexo masculino y en grupos de edad correspondiente al rango de 31 a 40 años (56.3%). El porcentaje de bebedores con dependencia encontrado en este estudio es mayor a lo encontrado en otros estudios nacionales que incluían Loreto. El alto riesgo de consumo de alcohol podría ser un problema laboral aun no evaluado en salud que necesita futura investigación

Defining catastrophic costs and comparing their importance for adverse tuberculosis outcome with multi-drug resistance: a prospective cohort study, Peru.

BACKGROUND: Even when tuberculosis (TB) treatment is free, hidden costs incurred by patients and their households (TB-affected households) may worsen poverty and health. Extreme TB-associated costs have been termed "catastrophic" but are poorly defined. We studied TB-affected households' hidden costs and their association with adverse TB outcome to create a clinically relevant definition of catastrophic costs. METHODS AND FINDINGS: From 26 October 2002 to 30 November 2009, TB patients (n = 876, 11% with multi-drug-resistant [MDR] TB) and healthy controls (n = 487) were recruited to a prospective cohort study in shantytowns in Lima, Peru. Patients were interviewed prior to and every 2-4 wk throughout treatment, recording direct (household expenses) and indirect (lost income) TB-related costs. Costs were expressed as a proportion of the household's annual income. In poorer households, costs were lower but constituted a higher proportion of the household's annual income: 27% (95% CI = 20%-43%) in the least-poor houses versus 48% (95% CI = 36%-50%) in the poorest. Adverse TB outcome was defined as death, treatment abandonment or treatment failure during therapy, or recurrence within 2 y. 23% (166/725) of patients with a defined treatment outcome had an adverse outcome. Total costs ≥20% of household annual income was defined as catastrophic because this threshold was most strongly associated with adverse TB outcome. Catastrophic costs were incurred by 345 households (39%). Having MDR TB was associated with a higher likelihood of incurring catastrophic costs (54% [95% CI = 43%-61%] versus 38% [95% CI = 34%-41%], p<0.003). Adverse outcome was independently associated with MDR TB (odds ratio [OR] = 8.4 [95% CI = 4.7-15], p<0.001), previous TB (OR = 2.1 [95% CI = 1.3-3.5], p = 0.005), days too unwell to work pre-treatment (OR = 1.01 [95% CI = 1.00-1.01], p = 0.02), and catastrophic costs (OR = 1.7 [95% CI = 1.1-2.6], p = 0.01). The adjusted population attributable fraction of adverse outcomes explained by catastrophic costs was 18% (95% CI = 6.9%-28%), similar to that of MDR TB (20% [95% CI = 14%-25%]). Sensitivity analyses demonstrated that existing catastrophic costs thresholds (≥10% or ≥15% of household annual income) were not associated with adverse outcome in our setting. Study limitations included not measuring certain "dis-saving" variables (including selling household items) and gathering only 6 mo of costs-specific follow-up data for MDR TB patients. CONCLUSIONS: Despite free TB care, having TB disease was expensive for impoverished TB patients in Peru. Incurring higher relative costs was associated with adverse TB outcome. The population attributable fraction indicated that catastrophic costs and MDR TB were associated with similar proportions of adverse outcomes. Thus TB is a socioeconomic as well as infectious problem, and TB control interventions should address both the economic and clinical aspects of this disease. Please see later in the article for the Editors' Summary

Study population baseline data.

<p>All data are at individual level and pre-treatment except where indicated.</p><p>*Univariable regression adjusted for sex. The first <i>p</i>-value column corresponds to comparison of controls (<i>n</i> = 487) with all TB patients regardless of MDR status (<i>n</i> = 876). The second <i>p</i>-value column corresponds to comparison of patients with non-MDR TB (<i>n</i> = 783) versus MDR TB (<i>n</i> = 93).</p><p>**Household earnings per month during different treatment stages represented as mean Peruvian Soles and, in parentheses, as a proportion of TB patients' mean monthly household earnings throughout entire illness. Confidence intervals are those of mean monthly earnings in Peruvian Soles.</p><p>***Debt at recruitment represented as mean Peruvian Soles and, in parentheses, as a proportion of TB patients' mean monthly household earnings. Debt at recruitment was used in the final multivariable regression model rather than total debt (sum of debt at recruitment plus debt at 24 wk of treatment) because only 461 patients had 24-wk debt data available.</p><p>CI, confidence interval; IQR, interquartile range; SD, standard deviation.</p