Overall assessment of responsiveness to change is just the very first step: a technical commentary on Abanto et al.'s study

Carta al EditorRevisión por pare

Profile and professional expectations of medical students from 11 Latin American countries: the Red-LIRHUS project

Background Latin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students. Results We conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011–2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed. Conclusions This study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions

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 [email protected]: Describir las características de los cursos de investigación y la producción científica de sus docentes en las escuelas de medicina del Perú. Métodos: Se realizó un estudio descriptivo, con los datos de las 32 escuelas de medicina del Perú existentes al 2011, las currículas de los cursos de investigación de estas escuelas, y los docentes de dichos cursos. Se evaluó el número de cursos, docentes y sus publicaciones. Resultados: La mediana de créditos de investigación fue 5,5 [rango 2 a 18] por escuela, y la mediana del porcentaje del total de créditos fue de 1,75% [rango 0,6 a 6,3]. En 18/32 (56%) escuelas existió algún curso en el que se solicitó al estudiante la presentación de un informe final, pero solo una escuela tuvo algún curso que incluyó prácticas de envío a publicación. Además, solo 5 (15,6%) escuelas contaron con algún docente que haya publicado al menos un artículo original como autor corresponsal en Scopus alguna vez en su vida. Conclusión: Los cursos de investigación de las escuelas de medicina del Perú no enseñan el proceso de publicación en revistas indizadas y los docentes de estos cursos tienen una baja producción científica.Revisión por pare

To what extent does confounding explain the association between breastfeeding duration and cognitive development up to age 14? Findings from the UK Millennium Cohort Study

Background Breastfeeding duration is associated with improved cognitive development in children, but it is unclear whether this is a causal relationship or due to confounding. This study evaluates whether the observed association is explained by socioeconomic position (SEP) and maternal cognitive ability. Methods Data from 7,855 singletons born in 2000–2002 and followed up to age 14 years within the UK Millennium Cohort Study were analysed. Mothers reported breastfeeding duration, and children’s cognitive abilities were assessed at 5, 7, 11, and 14 years using validated measures. Standardised verbal (age 5 to 14) and spatial (age 5 to 11) cognitive scores were compared across breastfeeding duration groups using multivariable linear mixed-effects models (repeated outcome measures). Results At all ages, longer breastfeeding durations were associated with higher cognitive scores after accounting for the child’s own characteristics. Adjustment for SEP approximately halved the effect sizes. Further adjustment for maternal cognitive scores removed the remaining associations at age 5, but not at ages 7, 11 and 14 (e.g.: verbal scores, age 14; breastfed ≥12 months vs never breastfed: 0.26 SD; 95%CI: 0.18, 0.34). Conclusion The associations between breastfeeding duration and cognitive scores persist after adjusting for SEP and maternal cognitive ability, however the effect was modest

Endemic and epidemic human alphavirus infections in Eastern Panama; an analysis of population-based cross-sectional surveys

Madariaga virus (MADV), has recently been associated with severe humanb disease in Panama, where the closely related Venezuelan equine encephalitis virus (VEEV) also circulates. In June, 2017, a fatal MADV infection was confirmed in a community of Darien province. We conducted a cross-sectional outbreak investigation with human and mosquito collections in July 2017, where sera were tested for alphavirus antibodies and viral RNA. Additionally, by applying a catalytic, force-of-infection statistical model to two serosurveys from Darien province in 2012 and 2017, we investigated whether endemic or epidemic alphavirus transmission occurred historically. In 2017, MADV and VEEV IgM seroprevalence was 1.6% and 4.4%, respectively; IgG antibody prevalences were MADV: 13.2%; VEEV: 16.8%; Una virus (UNAV): 16.0%; and Mayaro virus (MAYV): 1.1%. Active viral circulation was not detected. Evidence of MADV and UNAV infection was found near households — raising questions about its vectors and enzootic transmission cycles. Insomnia was associated with MADV and VEEV infection, depression symptoms were associated with MADV, and dizziness with VEEV and UNAV. Force-of-infection analyses suggest endemic alphavirus transmission historically, with recent increased human exposure to MADV and VEEV in some regions. The lack of additional neurological cases suggest that severe MADV and VEEV infections occur only rarely. Our results indicate that, over the past five decades, alphavirus infections have occurred at low levels in eastern Panama, but that MADV and VEEV infections have recently increased — potentially during the past decade. Endemic infections and outbreaks of MADV and VEEV appear to differ spatially

Scientific production of life members of the peruvian National Academy of Medical Researchers.

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Factores asociados al abandono de la lactancia materna exclusiva en una muestra de madres de Lima, Perú, 2013

Background: Exclusive breastfeeding (EBF) has proven to be highly beneficial for children’s health. Identifying the associated factors with its cessation is useful in order to target specific groups for preventive interventions. Objective: To evaluate the associated factors with EBF cessation before six months of age in women with infants, living in a district in Lima. Methods: A cross-sectional analytic study was performed. It evaluated mothers with infants aged 6-24 months, in a periurban district in Lima, Peru, 2013. The study outcome was cessation in EBF before six months of age. Sociodemographic variables, factors related to gestation and delivery, and factors properly related to breastfeeding were assessed. Crude and adjusted prevalence ratios and their respective 95% confidence intervals (95%CI) were calculated through simple and multiple Poisson regression. Results: From the 109 mothers included in the analysis, 85.3% were 18 years old or more and all of them had a monthly family income under 250 US dollars. Seventy percent of women interrupted EBF before six months of age. Statistically significant association was found between EBF cessation and being primiparous (PR: 1.54; 95%CI: 1.20-1.98), having problems with the nipples (PR: 1.58; 95%CI: 1.07-2.33) and the perception of infant’s persistent hunger with EBF (PR: 1.35; 95%CI: 1.01-1.79). Conclusion: EBF cessation frequency was high in the study sample. Primiparity, having problems with the nipples and the perception of infant’s persistent hunger with EBF were found as associated factors. Preventive strategies might specially focus in mothers with this characteristics.Introducción: La lactancia materna exclusiva (LME) ha probado ser altamente beneficiosa para la salud infantil. Conocer los factores asociados a su abandono es útil para identificar los grupos a los cuales enfocar las intervenciones. Objetivo: Evaluar los factores asociados al abandono de la LME antes de los seis meses en madres de lactantes, residentes en un distrito de Lima. Métodos: Estudio transversal analítico que evaluó, a través de una encuesta, a madres de lactantes entre 6-24 meses de un distrito periférico de Lima, Perú, 2013. Se preguntó por la edad en la que se suspendió la LME y se definió como abandono si esta fue previa a cumplir los seis meses de edad. Se evaluaron variables sociodemográficas, factores relacionados a la gestación y parto, así como factores propiamente relacionados a la lactancia. Se calcularon las razones de prevalencia crudas y ajustadas con sus respectivos intervalos de confianza al 95% (IC95%), a través de regresión de Poisson simple y múltiple, respectivamente. Resultados: De 109 madres incluidas en el análisis, 85,3% eran mayores de 18 años y todas presentaban un ingreso económico familiar menor a 250 dólares americanos. Aproximadamente, 70% abandonó la LME. Se encontró asociación con ser primípara (RP: 1,54; IC95%: 1,20-1,98), presentar problemas con el pezón (RP: 1,58; IC95%: 1,07-2,33) y que perciban que su hijo se encuentra insatisfecho con la LME (RP: 1,35; IC95%: 1,01-1,79). Conclusiones: La frecuencia de abandono de LME en la muestra evaluada fue alta. La primiparidad, los problemas con el pezón y el percibir que su hijo se encuentra insatisfecho con la LME fueron factores asociados. Las estrategias preventivas podrían dirigirse especialmente a mujeres con estas características