Family Support and Diabetes: Patient's Experiences From a Public Hospital in Peru.

Family support is crucial for managing chronic conditions but it is often overlooked when designing behavioral interventions in type 2 diabetes mellitus (T2DM). As part of the formative phase of a feasibility randomized control trial (RCT), we conducted 20 semistructured interviews with people with T2DM from Lima, Peru. Based on such results, we describe the support people with T2DM receive from their families and the role that such support has in their efforts to implement diabetes management practices. We learned that participants receive support from family members, but mostly from their spouses and children. Their relatives encourage them and motivate them to fight for their health, they also provide instrumental support by preparing healthy meals, reminding them to take medications, and sharing physical activity. Participants also reported controlling actions which were not always "well received." Thus, any intervention supporting self-management practices need to work with key family members. We support the literature that suggests that interventions should target family members to ensure improved T2DM self-management practices

Percepciones de aceptabilidad y reticencia a las vacunas contra la COVID-19 en el Perú

Objetivos. Explorar los factores que predisponen la aceptabilidad o reticencia a la vacunación contra la COVID-19 utilizando métodos cualitativos. Materiales y métodos. Estudio cualitativo descriptivo realizado entre abril y junio del 2021. Se utilizó una guía de entrevista semiestructurada que exploró las percepciones de los participantes de diferentes regiones del Perú con relación a la aplicación de la vacuna para la COVID-19, tomando como marco teórico el modelo de creencias en salud, cuyas dimensiones son: susceptibilidad, severidad, beneficios, barreras y estímulos asociados para ejecutar la acción. Resultados. Se entrevistó a treinta personas, en su mayoría mujeres. Para los participantes la eficacia de las vacunas se relaciona con el país de procedencia, además, consideran que es importante conocer los efectos a largo plazo en la salud luego de la aplicación de la vacuna. La información recibida por las autoridades gubernamentales y sanitarias puede ser un factor decisivo para la aplicación de la vacuna. Las personas con la intención de no vacunarse sienten que las estrategias de promoción de la vacunación vulneran sus derechos humanos. Conclusiones. Existe un grupo de personas indecisas o inseguras de recibir las vacunas contra la COVID-19 en quienes es necesario fomentar estímulos de acuerdo con sus preocupaciones y necesidades. Las autoridades gubernamentales y sanitarias deben trabajar conjuntamente para mejorar la confianza de la población y brindar mensajes que despejen las principales dudas sobre la eficacia y las reacciones adversas de las vacunas

Responding to the sexual and reproductive health needs of Venezuelan migrant women in Lima=Resposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima

Objetivo. Presentar y analizar la respuesta que el sistema de salud peruano viene dando a las necesidades en salud sexual y reproductiva de las mujeres venezolanas que radican en la ciudad de Lima, Perú e identificar algunas de las razones que nos permite entender esta respuesta. Métodos. La información se recogió mediante entrevistas a profundidad semiestructuradas por vía telefónica a 30 mujeres venezolanas, 10 trabajadores de salud y 2 funcionarios del Ministerio de Salud. Resultados. A partir de las experiencias de mujeres venezolanas que acudieron a estos servicios durante el 2019-2020 y de las perspectivas del personal y autoridades de salud presentamos un análisis de la capacidad y limitaciones que los servicios de salud públicos tienen para atender las necesidades de salud sexual y reproductiva de esta población. Los testimonios de las mujeres migrantes reportan una experiencia positiva con un sistema de salud que, a pesar de las deficiencias, responde a las necesidades de salud sexual y reproductiva más comunes. Estas coinciden con los testimonios del personal de salud y con las de las autoridades quienes enfatizan la existencia de políticas prioritarias para la atención de la Salud Sexual y Reproductiva. Conclusión. Este estudio muestra cómo un marco de prioridad nacional (disminuir la mortalidad materna), acompañado de mecanismos operativos de protección social (como el Seguro Integral de Salud), se convierten en instrumentos complementarios, que repercute de manera positiva y extiende beneficios para las y los migrantes, a pesar de no haber considerado a esta población durante el diseño de estas políticas

[Responding to the sexual and reproductive health needs of Venezuelan migrant women in LimaResposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima].

OBJECTIVES: To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. METHODS: Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. RESULTS: Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. CONCLUSION: This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies

Design of financial incentive interventions to improve lifestyle behaviors and health outcomes: A systematic review

Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery.  We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to foster its use as potential effective interventions

Managing Post-Stroke Care During the COVID-19 Pandemic at a Tertiary Care Level Hospital in Peru.

OBJECTIVES: To understand the hospital-to-outpatient care transition and how the discharge process of stroke patients is managed; and to identify potential opportunities to improve these processes, while contrasting pre- and during COVID-19 experiences in Peru. METHODS: A qualitative study was conducted between February and March 2021 consisting of in-depth interviews of patients with stroke, their caregivers and healthcare personnel regarding stroke care at a national tertiary referral center for stroke care in Lima, Peru. We explored the following phases of the patients' journeys: pre-hospitalization, emergency room, hospitalization, discharge process and post-discharge. For each phase, we explored experiences, feelings and expectations using thematic analysis. RESULTS: We conducted a total of 11 interviews with patients or caregivers and 7 with health care personnel and found disruption in the continuity of care for patients with stroke. Mainly, caregivers and patients referred to problems related to communication with healthcare personnel and an absence of training to provide post-discharge care at home. Potential solutions included increasing human resources and caregiver participation in care, implementation of electronic healthcare records, improving the referral system and reinforcing telemedicine services. CONCLUSION: The continuity of care of patients with stroke was negatively affected during the COVID-19 pandemic. In LMICs, the impact was likely greater due to the already weak and fragmented healthcare systems. The COVID-19 pandemic presents an opportunity to improve post-stroke care services, and address patients' experiences and feelings by developing solutions in a participatory manner

Voedsel, nieuwe voeding en allergeniciteit

Certain foods lead may to allergic responses in certain individuals. Main allergenic foods are Crustacea (shrimp, lobster, crab), egg, fish, milk, peanuts, soybeans, tree nuts, and wheat, and allergens are always proteins. A wide array of symptoms can result from food allergy (gastrointestinal, skin, respiratory). Severe and life threatening situations can occur. The prevalence is about 2% of the population; 5-8% of children. Based on the possibility to introduce new antigenic determinants when introducting new genes into crops, there is reason for concern that genetically engineered food may provide a health risk. Hazard identification concerning the allergenicity of newly engineered foods comprises evaluation of the source of the newly introduced gene, sequence similarities with known allergens, sensitivity to digestion, solid phase immunoassay with positive sera, skin prick testing and double-blind placebo-controlled food challenge in food allergic individuals. Genetically engineered foods that contain genes from non allergenic sources, but that lead to new proteins that are relatively insensitive to gastric simulated fluid degradation pose the biggest problem for evaluation of potential allergenicity. Therefore, animal models are being developed in which, after oral or parenteral exposure to proteins, analysis of antibody subclasses is performed to discriminate allergenicity from immunogenicity. The developing immune system is especially sensitive to immunomodulatory influences. The time at which food allergens are first encounterd may have an impact on the development of food allergy. Also factors that are in the food but are not allergenic themselves may influence the development of oral tolerance to food allergens, i.e. those moieties that influnece immune responses (immunotoxicants) or may influence entry of proteins into the mucosa.Voedselallergie kan gepaard gaan met een groot aantal symptomen (in het maag-darmkanaal, de huid, en de ademhalingsorganen) en kan leiden tot levensbedreigende situaties. De prevalentie van voedselallergie is ongeveer 2% van de bevolking; in kinderen 5-8%. Schaaldieren (garnalen, kreeft, krab), eieren, vis, melk, pinda, soya, noten, en tarwe zijn belangrijke allergene bronnen in onze voeding; het gaat daarbij altijd om eiwitten. Omdat de vervaardiging van genetisch gemodificeerde gewassen gepaard kan gaan met de introductie van nieuwe allergenen, bestaat bezorgdheid dat dergelijke nieuwe voedingsgewassen een nadelig effect op gezondheid kunnen hebben. Het identificeren van potentiele allergeniciteit van genetisch gemodificeerde voeding houdt in: evaluatie van de bron van het gen in het nieuwe voedsel, homologieen van de geintroduceerde genproducten met bestaande allergenen, stabiliteit in aanwezigheid van maagsappen, solid phase immunoassay met positieve humane sera, huidpriktesten, en dubbelblinde placebo-gecontroleerde voedselprovocatietesten in patienten met bewezen voedselallergie. Gemodificeerde voeding, waarin genen zijn geintroduceerd die afkomstig zijn uit niet allergene bronnen en die coderen voor eiwitten die relatief resistent zijn voor degradatie door maagsappen, vormen een groot probleem voor de beoordeling van het betreffende product. Om die reden worden diermodellen ontwikkeld, waarbij na orale of parenterale blootstelling aan de eiwitten antilichaamresponsen worden gemeten om immunogeniciteit en allergeniciteit te onderscheiden. Het zich ontwikkelende immuunsysteem is met name gevoelig voor effecten van immunologisch actieve factoren. Het tijdstip waarop een eerste contact met voedselallergenen plaats vindt kan een grote impact hebben op het al of niet ontstaan van voedselallergie. Factoren in de voeding die niet zelf allergeen zijn kunnen een invloed hebben op de het ontwikkelen van orale toletantie voor voedselallergenen, bijvoorbeeld omdat die bestanddelen immunologisch actief zijn of de toegang van allergenen tot de mucosa bevorderen

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania

Aims Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC’s attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices.Methods This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers.Results Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring.Conclusions Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings

Online_appendix – Supplemental material for Family Support and Diabetes: Patient’s Experiences From a Public Hospital in Peru

<p>Supplemental material, Online_appendix for Family Support and Diabetes: Patient’s Experiences From a Public Hospital in Peru by M. Amalia Pesantes, Adela Del Valle, Francisco Diez-Canseco, Antonio Bernabé-Ortiz, Jill Portocarrero, Antonio Trujillo, Pilar Cornejo, Katty Manrique and J. Jaime Miranda in Qualitative Health Research</p

Management of type 1 diabetes in low‐ and middle‐income countries: Comparative health system assessments in Kyrgyzstan, Mali, Peru and Tanzania

Aims: To describe and compare the health system responses for type 1 diabetes in Kyrgyzstan, Mali, Peru and Tanzania. Methods: The Rapid Assessment Protocol for Insulin Access, a multi-level assessment of the health system, was implemented in Kyrgyzstan, Mali, Peru and Tanzania using document reviews, site visits and interviews to assess the delivery of care and access to insulin. Results: Despite the existence of noncommunicable or diabetes strategies and Universal Health Coverage policies including diabetes-related supplies, this has not necessarily translated into access to insulin or diabetes care for all. Insulin and related supplies were often unavailable and unaffordable. Across the four countries test strips and insulin, when paid for by the individual, represented respectively 48-82% and 25-36% of total costs. Care was mainly delivered at tertiary-level hospitals by specialists. Only Kyrgyzstan had data collection systems integrated into the Ministry of Health structure. In addition, issues with healthcare worker training and education and empowerment of people with diabetes were present in these health systems. Conclusions: People with type 1 diabetes in these countries face different barriers, including the cost of insulin and care. Given the renewed attention to diabetes on the global health agenda tailored health system responses for type 1 diabetes are needed. Insulin should be prioritized as it is the foundation of type 1 diabetes care, but other elements of care and support need to be fostered by different actors.</p