Vaccination against the hepatitis B virus in newborns of peruvian women participating in the demographic and family health survey, 2016

Introducción. El esquema nacional de vacunación del Perú incluye la vacuna contra hepatitis B en recién nacidos; la Organización Mundial de Salud ha establecido metas para la cobertura de dicha vacunación. El objetivo del estudio fue estimar la proporción de recién nacidos de mujeres peruanas participantes de la Encuesta Demográfica y de Salud Familiar (ENDES) del 2016, que recibieron la primera dosis de la vacuna contra hepatitis B al nacer. Métodos. Se realizó un estudio de fuente secundaria, la unidad informante fueron las mujeres en edad fértil de 15 a 49 años, que reportaron tener niños menores de cinco años, cuyo peso al nacer haya sido de 2000g o más, y que contaban con datos referentes a vacunación. Los datos sobre el estado de vacunación contra hepatitis B se obtuvieron a partir de la tarjeta de vacunación del niño menor de cinco años. Los resultados son presentados para el nivel nacional, regional, y según algunos subgrupos específicos. Resultados. A nivel nacional, el 67,5% (IC95%: 66,3-68,6) de recién nacidos de mujeres participantes de la ENDES 2016 recibieron la vacunación contra hepatitis B. La región con mayor cobertura fue Huánuco con 84,3% (IC95%: 80,8-87,2). Entre los recién nacidos en establecimientos de salud públicos, la vacunación llegó al 72,6%, mientras que en establecimientos de salud privados fue el 43,2%. Conclusiones. La proporción de recién nacidos que recibieron la vacunación contra hepatitis B es variable según región, siendo esta mayor entre aquellos que nacieron en establecimientos de salud públicos.Introduction. The national vaccination scheme in Peru includes the hepatitis B vaccine at birth, the World Health Organization established goals for the coverage of this vaccination. The objective of the study was to estimate the proportion of newborns of women participating in the Demographic and Family Health Survey (ENDES) of Peru in 2016, who received vaccination against hepatitis B. Methods. A secondary study was conducted, the informants subject were childbearing age women from 15 to 49 years old, who reported having a child under five years of age, whose weight at birth was 2000g or more, and who have data regarding vaccination. The data on vaccination status against hepatitis B was obtained from the vaccination card. The results are presented for the national, regional level, and according to some specific sub groups. Results. At the national level, 67,5% (95% CI: 66,3-68,6) of newborns received vaccination against hepatitis B. The region with the highest coverage was Huanuco with 84,3% (95% CI: 80,8-87,2). Among newborns in public health facilities, vaccination reached 72,6%, while in private health facilities was 43,2%. Conclusions. The proportion of newborns who received vaccination against hepatitis B varies according to region, being higher among those who were born in public health facilities

Knowledge, perceptions and practices of health care workers about detection of respiratory symptomatics in a very high risk region of tuberculosis transmission in Peru

Introducción. Tacna es una región de muy alto riesgo de transmisión de tuberculosis. Sin embargo, se ha encontrado que el rendimiento diagnóstico de la baciloscopia en sus establecimientos de salud es del 1,5%. Objetivo. Describir los conocimientos, percepciones y prácticas sobre detección de sintomáticos respiratorios (SR). Diseño. Estudio transversal. Lugar. Establecimientos de salud de la Dirección Regional de Salud de Tacna. Participantes. Profesionales de salud (médicos y enfermeras). Intervenciones. Cuestionario estructurado auto-administrado y anónimo, elaborado por los autores del estudio en base a la vigente “Norma Técnica de Salud para la Atención Integral de las Personas Afectadas por Tuberculosis”. Principales medidas de resultado. Frecuencia absoluta y relativa de conocimientos adecuados, percepciones y prácticas sobre detección de sintomáticos respiratorios. Resultados. De 178 profesionales de salud (médicos y enfermeras), 89,9% conocían la definición de SR; 93,3% sabía que debe solicitarse dos muestras de esputo a los SR; 22,5% conocía el indicador que evalúa la calidad de detección de SR, y 28,1%, el indicador que evalúa la capacidad del personal para realizar la baciloscopia entre los sintomáticos respiratorios identificados; 49,4% sabía que la meta del indicador de intensidad de búsqueda es 5 por 100 atenciones en mayores de 15 años y 60,8% señaló haber leído la norma técnica vigente. Conclusiones. En el estudio, existió una brecha en el conocimiento de médicos y enfermeras en la detección de sintomáticos respiratorios. Esta brecha fue mayor en el conocimiento sobre los indicadores operacionales de detección.Introduction. Tacna is a region with very high risk of tuberculosis transmission; however, the diagnostic performance of direct smears in their healthcare centers is 1.5%. Objectives. To describe the knowledge, perceptions and practices about detection of respiratory symptomatic subjects. Design. Cross sectional study. Setting. Health care centers of Tacna Regional Health Directorate. Participants. Health professionals including physicians and nurses. Interventions. A structured self-administered, anonymous questionnaire, developed by the authors, based on the current "Technical Standard for Comprehensive Management of People Affected by Tuberculosis", was applied to 178 health professionals (physicians and nurses). Main outcome measures. Absolute and relative frequency of adequate knowledge, perceptions and practices on detection of respiratory symptomatic subjects. Results. In the study, 89.9% knew the definition of respiratory symptomatic, 93.3% was aware that two sputum specimens should be requested to the respiratory symptomatic persons, 22.5% recognized the indicator that assesses the quality of detection of respiratory symptomatic, and 28.1% knew the indicator that assesses the ability of staff to perform the smear in identified respiratory symptomatic. 49.4% distinguished that the goal of the search intensity indicator is 5 per 100 attentions in people older than 15 years, and 60.8% reported having read the current technical standard. Conclusions. A gap in the knowledge of physicians and nurses in the detection of respiratory symptomatic subjects was found. This gap was greater in knowledge about operational indicators of detection

Análisis bibliométrico de la producción científica sobre las agendas nacionales de investigación en el Perú 2011-2014

Objectives. To analyze the scientific production framed in the National Research Agenda 2011-2014. Design. Bibliometric research using SCOPUS, LILACS and LIPECS databases. Setting National Health Institute, Lima, Peru. Unit of analysis. Original article with at least one researcher with a Peruvian institution affiliation or whose study population or part of it, came from Peru and framed on any issue of national research agendas. Main outcome measures. Bibliometric indicators of production. Results. Out of the 882 publications retrieved, 215 (24.4%) were admitted to the analysis. The national research agendas with more scientific production were tuberculosis and STD-HIV/AIDS that included 78 and 59 articles respectively. The most common language of publication was English (69.8%). The articles were published in 90 scientific journals. Peruvian institutions with the highest number of signatures were the Universidad Peruana Cayetano Heredia (49.3%), followed by the Ministry of Health (19.5%) and the National Institute of Health (14.4%). The National Institutes of Health (USA) participated in the financing of 50.7% of the articles analyzed. Peruvian institutions that funded more research were the National Institute of Health (4.2%) and the Ministry of Health (2.8%). Conclusions. Peruvian scientific production framed in the six national research agendas in the period 2011-2014 is limited and focused on tuberculosis and STI-HIV / AIDS research; funding was primarily by international institutions.Objetivo. Analizar la producción científica enmarcada en las Agendas Nacionales de Investigación de Perú, periodo 2011-2014. Diseño. Estudio bibliométrico en las bases de datos SCOPUS, LILACS y LIPECS. Lugar. Instituto Nacional de Salud, Lima, Perú. Unidad de análisis. Artículo original que cuenta con al menos un investigador con filiación a una institución peruana o cuya población de estudio o parte de ella procede de Perú y enmarcados en algún tema de las Agendas Nacionales de Investigación. Principales medidas de resultados. Indicadores bibliométricos de producción. Resultados. De las 882 publicaciones recuperadas, 215 (24,4%) ingresaron al análisis. Las Agendas Nacionales de Investigación con mayor producción científica fueron sobre tuberculosis e ITS-VIH/sida con 78 y 59 artículos. El idioma más frecuente de publicación fue el inglés (69,8%). Los artículos fueron publicados en 90 revistas científicas. Las instituciones peruanas con mayor cantidad de firmas en artículos originales fueron la Universidad Peruana Cayetano Heredia (49,3%), seguido por el Ministerio de Salud (19,5%) e Instituto Nacional de Salud (14,4%). Los Institutos Nacionales de Salud de los Estados Unidos participaron en el financiamiento del 50,7% de los artículos analizados. Las instituciones peruanas que más investigaciones han financiado son el Instituto Nacional de Salud (4,2%) y el MINSA (2,8%). Conclusiones. La producción científica peruana enmarcada en las seis Agendas Nacionales de Investigación del periodo 2011-2014 es limitada, a predominio de la investigación en tuberculosis y ITS-VIH/sida, y se encuentra financiada principalmente por instituciones internacionales

Frecuencia del fenotipo de cintura hipertrigliceridémica y su asociación con anormalidades metabólicas en adolescentes de una región andina del Perú

Introduction. The hypertriglyceridemic waist has been proposed as a phenotype with a strong association with the metabolic syndrome. The frequency of this phenotype in adolescents from Peru, including Andes population is unknown. Objective. To estimate the frequency of the hypertriglyceridemic waist and its association with metabolic abnormalities and other factors in Peruvian adolescents from an Andean region. Methods. We performed a data secondary analysis through cross-sectional design. We analyzed 397 randomly selected adolescents from two public schools in the Cajamarca city. We defined hypertriglyceridemic waist as the simultaneous presence of increased waist circumference (≥ 90th percentile for age and sex) and serum hypertriglyceridemia (≥110 mg/dL). We estimated the point prevalence of hypertriglyceridemic waist and their 95% confidence interval, we also performed a binary logistic regression analysis to identify associated risks. Results. The phenotype of hypertriglyceridemic waist was 2.01% (95%CI: 0.51 to 3.52). The most frequent component was hypertriglyceridemia with 39.55% (95%CI: 34.61 to 44.48), while increased waist circumference affected 3.02% (95%CI: 1.21 to 4.83). Excess weight was the only variable association with hypertriglyceridemic waist phenotype (adjusted OR: 62.7; 95%CI: 6.7 - 587.9; p<0.001). Conclusions. Two of one hundred adolescents aged 11 to 17 years living in a high Andean region of Peru had the hypertriglyceridemic waist phenotype. This phenotype was associated with excess weight.Introducción. La cintura hipertrigliceridémica ha sido propuesta como un fenotipo con una fuerte asociación al síndrome metabólico, no se conoce la frecuencia de este fenotipo en adolescentes del Perú, incluyendo sus zonas andinas. Objetivo. Estimar la frecuencia de la cintura hipertrigliceridémica y su asociación con anormalidades metabólicas y otros factores en adolescentes peruanos de una región andina. Métodos. Estudio de fuente secundaria de diseño transversal analítico. Analizamos los datos de 397 adolescentes seleccionados aleatoriamente en dos escuelas públicas de la ciudad de Cajamarca. Se definió cintura hipertrigliceridémica como la presencia simultánea de una circunferencia de cintura incrementada (≥ percentil 90 para edad y sexo) e hipertrigliceridemia sérica (≥110 mg/dL). Se realizó la estimación de la prevalencia de manera puntual y con su intervalo de confianza al 95%, también realizamos un análisis de regresión logística binaria para identificar factores asociados. Resultados. El fenotipo de cintura hipertrigliceridémica fue 2,01% (IC95%: 0,51 a 3,52). El componente más frecuente fue hipertrigliceridemia con 39,55% (IC95%: 34,61 a 44,48), mientras que la circunferencia de cintura incrementada afectó al 3,02% (IC95%: 1,21 a 4,83). El exceso de peso fue la única variable asociada con el fenotipo de cintura hipertrigliceridémica (OR ajustado: 62,7; IC95%: 6,7 a 587,9; p<0,001). Conclusiones. Dos de cien adolescentes de 11 a 17 años residentes de una región altoandina del Perú tuvieron el fenotipo de cintura hipertrigliceridémica. Dicho fenotipo estuvo asociado con el exceso de peso

Use of Telemedicine for Post-discharge Assessment of the Surgical Wound: International Cohort Study, and Systematic Review with Meta-analysis

Objective: This study aimed to determine whether remote wound reviews using telemedicine can be safely upscaled, and if standardised assessment tools are needed. Summary background data: Surgical site infection is the most common complication of surgery worldwide, and frequently occurs after hospital discharge. Evidence to support implementation of telemedicine during postoperative recovery will be an essential component of pandemic recovery. Methods: The primary outcome of this study was surgical site infection reported up to 30-days after surgery (SSI), comparing rates reported using telemedicine (telephone and/or video assessment) to those with in-person review. The first part of this study analysed primary data from an international cohort study of adult patients undergoing abdominal surgery who were discharged from hospital before 30-days after surgery. The second part combined this data with the results of a systematic review to perform a meta-analysis of all available data conducted in accordance with PRIMSA guidelines (PROSPERO:192596). Results: The cohort study included 15,358 patients from 66 countries (8069 high, 4448 middle, 1744 low income). Of these, 6907 (45.0%) were followed up using telemedicine. The SSI rate reported using telemedicine was slightly lower than with in-person follow-up (13.4% vs. 11.1%, P<0.001), which persisted after risk adjustment in a mixed-effects model (adjusted odds ratio: 0.73, 95% confidence interval 0.63-0.84, P<0.001). This association was consistent across sensitivity and subgroup analyses, including a propensity-score matched model. In nine eligible non-randomised studies identified, a pooled mean of 64% of patients underwent telemedicine follow-up. Upon meta-analysis, the SSI rate reported was lower with telemedicine (odds ratio: 0.67, 0.47-0.94) than in-person (reference) follow-up (I2=0.45, P=0.12), although there a high risk of bias in included studies. Conclusions: Use of telemedicine to assess the surgical wound post-discharge is feasible, but risks underreporting of SSI. Standardised tools for remote assessment of SSI must be evaluated and adopted as telemedicine is upscaled globally

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially