Health survey in a peruvian health system (ENSSA): design, methodology and general results / Encuesta de salud en un sistema sanitario peruano (ENSSA): diseño, metodología y resultados generales

ABSTRACT OBJECTIVE To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.

RESUMEN OBJETIVO Reportar el diseño, metodología y resultados iniciales de la Encuesta Nacional Socioeconómica de Acceso a la Salud de los Asegurados de EsSalud. MÉTODOS La Encuesta se ejecutó en los 24 departamentos del país. Los temas investigados fueron: características de la vivienda y miembros del hogar, educación, salud, empleo e ingreso y gastos del hogar. Se realizó un tipo de muestreo bi-etápico: la unidad primaria de muestreo estuvo conformada por conglomerados compuestos por una manzana dentro del ámbito de cobertura del centro asistencial; la unidad secundaria de muestreo fueron viviendas particulares donde habitaba al menos un asegurado a EsSalud. Se analizaron los datos de 62,659 afiliados y se muestran porcentajes ajustados por el factor de expansión. Para las comparaciones, se utilizó la prueba de chi-cuadrado. RESULTADOS Se entrevistaron 25000 viviendas, encuestándose a 79,874 personas, de las cuales 62,659 eran afiliados a EsSalud. Los afiliados son principalmente varones (50.6%) con un nivel de educación técnico superior (39.7%). La población afiliada cuenta mayoritariamente con vivienda independiente (95.0%) y propia (68.1%). Solo el 34.5% de los asegurados practica algún deporte o ejercicio físico. El 14.0% de la población padece de alguna enfermedad crónica; el 3.5% presenta diabetes; y el 7.1%, hipertensión arterial. En los últimos tres meses, el 35.4% de los afiliados necesitaron atención médica; de estos, solo el 73.1% recibieron atención sanitaria y el 10.9% restante se atendieron en farmacias o servicios no formales de atención en salud. CONCLUSIONES Esta encuesta es la primera realizada en la población de afiliados a EsSalud, aplicada a nivel nacional, y cuenta con datos socioeconómicos y demográficos de los asegurados, su distribución, factores de riesgo de la salud, prevalencia de los problemas de salud y el grado de acceso a los servicios de salud.

Association between mammographic features and response to neoadjuvant chemotherapy in locally advanced breast carcinoma

Mammography is the cornerstone of breast cancer [BC] evaluation. This report investigates whether breast density [BD] and mammographic features of the tumor can provide information on both BC susceptibility to chemotherapy and other clinicopathologic features of locally advanced BC [LA BC]. We evaluated mammography films and clinicopathological information of patients with LA BC who received neoadjuvant chemotherapy [NAC] followed by tumor resection at the Instituto Nacional de Enfermedades Neoplasicas [INEN] from 2000 to 2011. We selected 494 LA BC cases. Most cases were at clinical tumor stage 4 [48.5%], node stage 1 [58.8%] and had high histologic grade [53.3%]. BI-RADS 1, 2, 3, and 4 BD were found in 16.9%, 22%, 35.7% and 25.1% of patients, respectively. High BD has been associated with younger age [p<0.001], obesity [p = 0.017] and no skin infiltration [T3 vs T4] [p = 0.018]. An association between dusty microcalcifications and HER2 group, as well as between casting microcalcifications and TN BC group [p = 0.05] was found. NAC included anthracyclines and taxanes in 422 [85.5%] cases. Miller-Payne pathologic responses 4 and 5 [pCR] in the primary lesion and absence of axillary lymph nodes involvement were found in 15.3% of cases and were associated with younger age [p < 0.001] and HG-3 lesions [p < 0.001], but not with mammographic images. Mammographic features are associated with specific clinicopathological features of pre-NAC BC lesions but do not predict pCR. The implications and biological reasons for these findings require further study

Addition of amifostine to the CHOP regimen in elderly patients with aggressive non-Hodgkin lymphoma: a phase II trial showing reduction in toxicity without altering long-term survival

We report the 8-year follow-up of 34 patients aged >/= 69 years old with NHL included in a phase IIb open-label randomized parallel groups study to evaluate the effectiveness of amifostine in preventing the toxicity of cyclophosphamide, doxorubicin, vincristine and prednisone [CHOP regime]. Patients were randomized to receive classical CHOP [cyclophosphamide 750 mg/ m[2], doxorubicin 50 mg/m[2], vincristine 1.4 mg/m[2] [maximum 2 mg] on day 1 and prednisone 100 mg/day for 5 days] or CHOP plus amifostine [6 cycles of amifostine 910 mg/m[2] on day 1]. Efficacy [time to progression, TTP; disease-free survival, DFS; overall survival, OS] and toxicity endpoints were evaluated. Thirty-four patients were randomized to A-CHOP [n=18] or CHOP [n=16]. Patients with A-CHOP vs CHOP had significantly lower toxicity; neutropenia grade 4 ocurred in 13/92 [13%] vs 23/85 [27%, P=0.007] cycles, febrile neutropenia in 3/92 A-CHOP [3%] vs 8/85 [10%, P=.056] CHOP cycles, hospitalization for toxicity in 4/92 [4%] A-CHOP vs 11/85 [13%, P=.05] CHOP cycles. Median hospitalization stay for toxicity was 5 days with A-CHOP vs 8 days with CHOP [P=.05]. There were no significant differences at 8 years in TTP [A-CHOP, 48.9% vs CHOP, 36.3%; P=.65], DFS [A-CHOP, 72.9% vs CHOP 55.6%; P=.50] and OS [A-CHOP, 44.3% vs CHOP, 54.4%]. There was no long-term toxicity of clinical interest. The only prognostic factor identified to 8 years was the International Prognostic Index [IPI low/low intermediate risk vs high intermediate/high risk; HR=2.98; CI 95%:1.01-8.77; P=.048]. These results show that amifostine can be added to the standard CHOP treatment schedule with less acute toxicity and without influencing the outcome