Perceived behavioral control as a potential precursor of walking three times a week: Patient's perspectives.

BACKGROUND: Behavior change theories can identify people's main motivations to engage in recommended health practices and thus provide better tools to design interventions, particularly human centered design interventions. OBJECTIVES: This study had two objectives: (a) to identify salient beliefs about walking three times a week for 30 minutes nonstop among patients with hypertension in a low-resource setting and, (b) to measure the relationships among intentions, attitudes, perceived social pressure and perceived behavioral control about this behavior. METHODS: Face-to-face interviews with 34 people living with hypertension were conducted in September-October 2011 in Lima, Peru, and data analysis was performed in 2015. The Reasoned Action Approach was used to study the people's decisions to walk. We elicited people's salient beliefs and measured the theoretical constructs associated with this behavior. RESULTS: Results pointed at salient key behavioral, normative and control beliefs. In particular, perceived behavioral control appeared as an important determinant of walking and a small set of control beliefs were identified as potential targets of health communication campaigns, including (not) having someone to walk with, having work or responsibilities, or having no time. CONCLUSIONS: This theory-based study with a focus on end-users provides elements to inform the design of an intervention that would motivate people living with hypertension to walk on a regular basis in low-resource settings

Perceived behavioral control as a potential precursor of walking three times a week: Patient’s perspectives

Background: Behavior change theories can identify people’s main motivations to engage in recommended health practices and thus provide better tools to design interventions, particularly human centered design interventions. Objectives: This study had two objectives: (a) to identify salient beliefs about walking three times a week for 30 minutes nonstop among patients with hypertension in a low-resource setting and, (b) to measure the relationships among intentions, attitudes, perceived social pressure and perceived behavioral control about this behavior. Methods: Face-to-face interviews with 34 people living with hypertension were conducted in September-October 2011 in Lima, Peru, and data analysis was performed in 2015. The Reasoned: Action Approach was used to study the people’s decisions to walk. We elicited people’s salient beliefs and measured the theoretical constructs associated with this behavior. Results: Results pointed at salient key behavioral, normative and control beliefs. In particular, perceived behavioral control appeared as an important determinant of walking and a small set of control beliefs were identified as potential targets of health communication campaigns, including (not) having someone to walk with, having work or responsibilities, or having no time. Conclusions: This theory-based study with a focus on end-users provides elements to inform the design of an intervention that would motivate people living with hypertension to walk on a regular basis in low-resource settings

Exportando "fracasso": porquê a pesquisa de países desenvolvidos pode não beneficiar os países em desenvolvimento

La brecha 10/90, establecida por el Global Forum for Health Research, enfatiza que el 90% del gasto global en investigación médica está orientada a problemas que afectan solo al 10% de la población mundial. El aplicar los resultados de investigaciones de los países desarrollados a los problemas de los países pobres podría resultar en un una solución conveniente, potencialmente fácil y tentadora para esta brecha. En este artículo, argumentamos que tal aproximación acarrea el riesgo de exportar fracasos. Las intervenciones de salud que demuestran ser efectivas en el contexto de un país desarrollado no implican, necesariamente, que funcionará en los países en desarrollo.O "gap 10/90" foi inicialmente apontada pelo Global Forum for Health Research. Refere-se ao achado de que 90% dos gastos mundiais em pesquisa médica é voltada a problemas que afetam apenas 10% da população mundial. Resultados de pesquisa aplicáveis provenientes dos países ricos aos problemas dos pobres poderiam ser uma solução tentadora, conveniente e potencialmente fácil para solução desse gap. O artigo teve por objetivo apresentar argumentos de que tal abordagem acarretaria o risco de exportar fracassos. Intervenções em saúde que se mostram efetivas no contexto específico de um país ocidental industrializado necessariamente não funcionará em um país em desenvolvimento.The '10/90 gap' was first highlighted by the Global Forum for Health Research. It refers to the finding that 90% of worldwide medical research expenditure is targeted at problems affecting only 10% of the world's population. Applying research results from the rich world to the problems of the poor may be a tempting, potentially easy and convenient solution for this gap. This paper had the objective of presenting arguments that such an approach runs the risk of exporting failure. Health interventions that are shown to be effective in the specific context of a Western industrialized setting will not necessarily work in the developing world

Cost and Cost-Effectiveness of Smear-Positive Tuberculosis Treatment by Health Extension Workers in Southern Ethiopia: A Community Randomized Trial

by HEWs in the health posts and general health workers at health facility were compared along a community-randomized trial. Costs were analysed from societal perspective in 2007 in US $using standard methods. We prospectively enrolled smear positive patients, and calculated cost-effectiveness as the cost per patient successfully treated. The total cost for each successfully treated smear-positive patient was higher in health facility ($158.9) compared with community ($61.7). Community-based treatment reduced the total, patient and caregiver cost by 61.2$8.80 (14.3 % of total cost) on health service per patient treated in the community. Conclusions/Significance: Community-based treatment by HEWs costs only 39 % of what treatment by general health workers costs for similar outcomes. Involving HEWs in TB treatment is a cost effective treatment alternative to the health service, to the patients and the family. There is an economic and public health reason to consider involving HEWs in TB treatment in Ethiopia. However, community-based treatment requires initial investment to start its implementation, training and supervision

A 26-Year-Old Man with Sternoclavicular Arthritis

A 26-year-old man presented to a hospital in Lima, Peru, with a two-week history of fever, myalgias, and arthralgia of the left hip and right sternoclavicular joint. The authors discuss the work up, diagnosis, and management

Corruption in Health Systems: The Conversation Has Started, Now Time to Continue it Comment on "We Need to Talk About Corruption in Health Systems"

Holistic and multi-disciplinary responses should be prioritized given the depth and breadth through which corruption in the healthcare sector can cover. Here, taking the Peruvian context as an example, we will reflect on the issue of corruption in health systems, including corruption with roots within and outside the health sector, and ongoing efforts to combat it. Our reflection of why corruption in health systems in settings with individual and systemic corruption should be an issue that is taken more seriously in Peru and beyond aligns with broader global health goals of improving health worldwide. Addressing corruption also serves as a pragmatic approach to health system strengthening and weakens a barrier to achieving universal health coverage and Sustainable Development Goals related to health and justice. Moreover, we will argue that by pushing towards a practice of normalizing the conversation about corruption in health has additional benefits, including expanding the problematization to a wider audience and therefore engaging with communities. For young researchers and global health professionals with interests in improving health systems in the early career stages, corruption in health systems is an issue that could move to the forefront of the list of global health challenges. This is a challenge that is uniquely multi-disciplinary, spanning the health, economy, and legal sectors, with wider societal implications

Ácido tranexámico: evidencia científica y su traducción en la práctica clínica

Letter - No abstract availabl

Using satellite imagery to estimate heavy vehicle volume for ecological injury analysis in India.

A major limitation of road injury research in low- and-middle income countries is the lack of consistent data across the settings, such as traffic counts, to measure traffic risk. This study presents a novel method in which traffic volume of heavy vehicles - trucks and buses - is estimated by identifying these vehicles from satellite imagery of Google Earth. For Rajasthan state in India, a total of ∼44,000 such vehicles were manually identified and geo-located on national highways (NHs), with no distinction made between trucks and buses. To estimate population living in proximity to NHs, defined as those living within 1 km buffer of NH, we geocoded ∼45,000 villages and ∼300 cities using Google Maps Geocoding Application Programming Interface (API). We fitted a spatio-temporal Bayesian regression model with the number of road deaths at the district level as the outcome variable. We found a strong Pearson correlation of 0.84 (p < 0.001) between Google Earth estimates of heavy vehicles and freight vehicle counts reported by a national-level study for different road sections. The regression results show that the volume of heavy vehicles and rural population in proximity to highways are positively associated with fatality risk in the districts. These effects have been estimated after controlling for other modes of travel.Contributions from RG and JW were undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research (NIHR) and the Wellcome Trust (MR/K023187/1). RG, JJM, NG and JW were supported by TIGTHAT (MR/P024408/1), an MRC Global Challenges Project

[Venezuelan immigration in Peru: challenges and opportunities from a health perspective].

As a result of the political, social, and economic crisis in the Bolivarian Republic of Venezuela, more than 700,000 people have immigrated to Peru since the second semester of 2017. In the year following the 2017 census, Peru's population grew by nearly one million, some 300,000 of them Peruvian, the rest being predominantly young Venezuelan immigrants. This article describes and analyzes the situation and health implications stemming from the fact that Peru became a migratory destination. To this end, a secondary analysis of surveys applied to the Venezuelan population in Peru was carried out. The main challenges arise from limited access to healthcare. Sexual and reproductive healthcare shows the largest deficits, below Peru's urban populations. The vulnerabilities of the Venezuelan migrant population are not detached from those already faced by Peru's poorest urban populations, whose services do not meet their needs and demands, neither in terms of coverage nor quality. However, immigration also generates opportunities, such as that represented by health professionals and technicians, who could contribute to offset the deficit generated by the emigration of thousands of Peruvian health professionals in recent decades. It is also an opportunity not to lose sight of the fact that inequalities in the right to healthcare are still challenges to inclusive development