Satisfacción y percepciones sobre aspectos de la ciudad que afectan la salud, por nivel socioeconómico, 2010-2019, en Lima Metropolitana / Satisfaction and perceptions about aspects of the city that affect health, by socioeconomic status, 2010-2019, in Lima

RESUMEN Se buscó caracterizar la satisfacción y percepciones de los residentes de Lima Metropolitana sobre distintos aspectos de la ciudad que pueden afectar su calidad de vida y salud, identificando diferencias por nivel socioeconómico (NSE) y cambios en el tiempo. Se realizó un análisis secundario de la Encuesta «Lima Cómo Vamos¼ entre 2010 y 2019, reportando los resultados mediante porcentajes, con diferencias entre NSE para cada año y entre años. En 2019 la satisfacción y percepciones eran mayoritariamente desfavorables, y han disminuido hasta en 30 puntos porcentuales con el tiempo. Las personas de NSE más bajos tenían valoraciones más desfavorables y con mayores reducciones en el tiempo. Esta insatisfacción y percepciones desfavorables revelan deficiencias en servicios públicos y condiciones urbanas que podrían afectar negativamente la calidad de vida y salud, haciendo necesarias políticas que reduzcan las brechas socioeconómicas y mejoren la salud de los ciudadanos de Lima Metropolitana.

ABSTRACT We aimed to characterize the satisfaction and perceptions of the residents of Lima about different aspects of urban life that can affect their quality of life and health, identifying differences by socioeconomic status (SES) and changes over time. A secondary data analysis of the "Lima Cómo Vamos" survey was conducted between 2010 and 2019. Results are reported through percentages, with differences between SES for each year and between years. In 2019, satisfaction and perceptions were mostly unfavorable, and have decreased by up to 30% over time. People with lower SES had more unfavorable evaluations and with greater reductions over time. This dissatisfaction and unfavorable perceptions reveal deficiencies in public services and urban conditions that could negatively affect the quality of life and health, making it necessary to design and implement policies that reduce socioeconomic gaps and improve the health of Lima citizens.

Intercambio desde los cigarrillos convencionales a los sistemas electrónicos de administración de nicotina: revisión sistemática rápida con metaanálisis y aspectos económicos / Switching from cigarettes to electronic nicotine delivery system: rapid systematic review and meta-analysis and economic aspects

RESUMEN Objetivos. Evaluar cómo y en qué medida se produce un intercambio desde los cigarrillos convencionales (CC) a los sistemas electrónicos de administración de nicotina (SEAN). Materiales y métodos. Se realizó una revisión sistemática hasta agosto de 2019. El desenlace primario fue la proporción de un intercambio completo o parcial de CC a los SEAN y sus aspectos económicos. Los desenlaces secundarios como medidas de resultado fueron la probabilidad de intercambio y la tendencia en el intercambio por países. Resultados. Se encontraron 3628 referencias y se incluyeron 49 estudios con datos epidemiológicos y económicos. Los estudios económicos sobre la elasticidad cruzada de precios mostraron que los CC son parcialmente intercambiables por SEAN. La mayoría de los estudios reportaron que la prevalencia del consumo de cigarrillos electrónicos se incrementó con el tiempo. Tres estudios reportaron una reducción significativa de los CC consumidos por día entre fumadores duales (convencionales más SEAN) en comparación con los consumidores de CC. El odds ratio ajustado y combinado de dejar los CC entre consumidores de SEAN en comparación con quienes nunca consumieron o lo hicieron en el pasado fue de 1,19 (IC95%: 1,09-1,30; heterogeneidad 0%). Los estudios longitudinales mostraron una creciente prevalencia del uso de cigarrillos electrónicos, principalmente en adolescentes. Se encontró una relación negativa entre el consumo y aumento de precio de CC y electrónicos. Conclusión. La probabilidad de dejar de fumar CC entre consumidores habituales de SEAN se incrementó respecto a los consumidores que nunca o que solían consumir SEAN. Estudios económicos reportaron que los cigarrillos electrónicos son parcialmente intercambiables por los CC.

ABSTRACT Objectives. To assess how and in what extent the electronic nicotine delivery systems (ENDS) use substituted the consumption of traditional combustible cigarettes (c-cigarettes, c-cig). Materials and Methods. We performed a systematic review of the literature up to August 2019 in scientific databases. Primary outcomes were proportion of complete or partial substitution of conventional to electronic cigarettes and related economic aspects. Secondary outcomes were odds ratio of substitution and country-wise time trends. Results. We retrieved 3,628 references and included 49 studies, providing economic and epidemiological data. Economic studies of cross-price elasticity showed that combustible cigarettes are partially substitutable for electronic cigarettes. Most studies reported that electronic cigarettes consumption prevalence increased over time. Three studies reported a significant reduction of combustible cigarettes consumed per day among dual users (combustible- plus electronic- cigarettes users) versus combustible-cigarettes users. The pooled adjusted odds ratio of quitting combustible cigarettes among electronic cigarettes users versus never or past electronic cigarettes (e-cigarettes, e-cig) users was 1.19 (95% confidence interval 1.09 to 1.30; heterogeneity score 0%). Longitudinal studies showed globally a growing prevalence of electronic cigarettes use, mainly in adolescents. A negative relationship between consumption and price increase of electronic and combustible cigarettes was found. Conclusion. The chance of quitting smoking combustible cigarettes among current electronic nicotine delivery systems users was increased with respect to never- or past- electronic nicotine delivery systems users. Economic studies reported that electronic cigarette is partially substitutable for combustible cigarettes.

Prevalence and Determinants of Adequate Compliance with Antenatal Care in Peru / Prevalência e determinantes da conformidade adequada à atenção pré-natal no Peru

Abstract Objective To determine the adequacy of compliance with antenatal care (ANC) by pregnant women in Peru and to identify the associated factors. Methods An analytical cross-sectional study of data from the 2019 Peruvian Demographic and Family Health Survey (Encuesta Demográfica y de Salud Familiar, ENDES, in Spanish) was conducted. The dependent variable was adequate compliance with ANC (provided by skilled health care professionals; first ANC visit during the first trimester of pregnancy; six or more ANC visits during pregnancy; ANC visits with appropriate content) by women aged 15 to 49 years in their last delivery within the five years prior to the survey. Crude and adjusted prevalence ratios and their 95% confidence intervals were calculated using a log-binomial regression model. Results A total of 18,386 women were analyzed, 35.0% of whom adequately complied with ANC. The lowest proportion of compliance was found with the content of ANC (42.6%). Sociodemographic factors and those related to pregnancy, such as being in the age groups of 20 to 34 years and 35 to 49 years, havingsecondaryor higher education, belonging to a wealth quintile of the population other than the poorest, being from the Amazon region, not being of native ethnicity, having a second or third pregnancy, and having a desired pregnancy, increased the probability of presenting adequate compliance with ANC. Conclusion Only 3 out of 10women in Peru showed adequate compliancewith ANC. Compliance with the content of ANC must be improved, and strategies must be developed to increase the proportion of adequate compliance with ANC.

Resumo Objetivo Determinar a adequação do cumprimento dos cuidados pré-natais (CPN) por mulheres grávidas no Peru e identificar os fatores associados. Métodos Foi realizado um estudo analítico transversal dos dados da Pesquisa Demográfica e de Saúde da Família Peruana de 2019 (Encuesta Demográfica y de Salud Familiar, ENDES, em espanhol). A variável dependente foi conformidade adequada coma CPN (fornecida por profissionais de saúde qualificados; primeira visita CPN durante o primeiro trimestre de gravidez; seis ou mais visitas CPN durante a gravidez; visitas CPN com conteúdo apropriado) por mulheres de 15 a 49 anos em seu último parto nos cinco anos anteriores à pesquisa. Os índices de prevalência bruta e ajustada e seus intervalos de confiança de 95% foram calculados usando um modelo de regressão log-binomial. Resultados Foi analisado um total de 18.386 mulheres, das quais 35,0% cumpriram adequadamente o CPN. A menor proporção de conformidade foi encontrada com o conteúdo de ANC (42,6%). Fatores sociodemográficos e aqueles relacionados à gravidez, como estar na faixa etária de 20 a 34 anos e 35 a 49 anos, ter educação secundária ou superior, pertencer a um quintil de riqueza da população que não a mais pobre, ser da região da selva, não ser de etnia nativa, ter um segundo ou terceiro gravidez, e tendo uma gravidez desejada, aumentou a probabilidade de apresentar conformidade adequada com CPN. Conclusão Apenas 3 em cada 10 mulheres no Peru mostraram conformidade adequada com o CPN. O cumprimento do conteúdo do CPN deve ser melhorado, e estratégias devem ser desenvolvidas para aumentar a proporção de cumprimento adequado com o CPN.

Predictors and geographic analysis of road traffic accidents in Leon, Nicaragua / Preditores e análise geográfica de acidentes de trânsito em León, Nicarágua

ABSTRACT: Objective: To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua. Methods: The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated. Results: Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence. Conclusion: We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.

RESUMO: Objetivo: Identificar os fatores ambientais presentes em áreas com alta densidade de acidentes de trânsito rodoviário (ATR) em León, Nicarágua. Métodos: Foram incluídos na análise todos os acidentes registrados pelo Departamento de Polícia da cidade de León de janeiro a junho de 2017. Georreferenciamos todos os acidentes e coletamos dados dos elementos ambientais em um perímetro de 20 metros do local até os acidentes ocorridos por meio de um instrumento de coleta de dados pré-testado. Foi especificado um modelo de regressão de Poisson para estimar as razões das taxas de incidência (TI) e intervalos de confiança de 95% (IC95%) para determinar os fatores ambientais associados à incidência do evento. Para identificar áreas com alta, média e baixa ocorrência de acidentes, estimamos a densidade do núcleo em torno dos pontos onde o ATR ocorreu. Resultados: Dos 667 acidentes registrados, 90% envolveram homens com idades entre 15 e 40 anos, e os acidentes de motocicleta representaram 60% dos ferimentos ou mortes. Os fatores ambientais que foram associados positivamente aos ATR incluíram boas condições da estrada (TI ajustada = 1,36; IC95% 1,13 - 1,63) e a existência de ciclovias (TI ajustada = 1,64; IC95% 1,29 - 2,10). Características ambientais associadas a velocidades mais altas e acidentes mais pesados podem aumentar a incidência deles. Conclusão: Constatamos que os centros comerciais ou turísticos com tráfego intenso são três áreas com alta densidade de acidentes. As autoridades locais podem usar essas descobertas para promover medidas de segurança no trânsito em áreas de alta incidência na cidade de León.

Dióxido de cloro y derivados del cloro para prevenir o tratar la COVID-19: revisión sistemática / Chlorine dioxide and chlorine derivatives for the prevention or treatment of COVID-19: a systematic review

RESUMEN Objetivos: Realizar una revisión sistemática acerca de la efectividad y seguridad del uso de dióxido de cloro y derivados del cloro, en la prevención o el tratamiento de la COVID-19. Materiales y métodos: Se siguieron las pautas internacionales de elaboración de revisiones sistemáticas de PRISMA y el Manual Cochrane para revisiones sistemáticas de intervenciones. La estrategia de búsqueda la desarrolló un bibliotecario y la revisaron dos de los autores. Se complementó la búsqueda electrónica con una búsqueda manual. Se incluyeron ensayos clínicos aleatorizados, estudios cuasiexperimentales, estudios de cohorte, estudios de casos y controles, estudios de corte transversal y reportes de casos; y se excluyeron estudios in vitro o realizados en animales. Dos revisores, de forma independiente, seleccionaron los estudios según los criterios de elegibilidad definidos, usando el aplicativo web Rayyan, en caso de discordancia se hizo partícipe a un tercer revisor. El protocolo de la revisión sistemática se registró en PROSPERO (CRD42020200641). Resultados: No se identificó ningún estudio publicado ni en proceso de publicación que haya evaluado el uso del dióxido de cloro o derivados del cloro, administrado por vía inhalatoria, oral o parenteral en humanos, como agente preventivo o terapéutico de la COVID-19 o en infecciones por otros coronavirus. Solo se identificó el registro de un único estudio catalogado como observacional que hasta ahora no tiene resultados. Conclusiones: A la fecha, no existe evidencia científica que apoye el uso del dióxido de cloro o derivados del cloro para prevenir o tratar la COVID-19.

ABSTRACT Objectives: To systematically review the effectiveness and safety of chlorine dioxide solution and chlorine derivatives used in the prevention or treatment of COVID-19. Methods: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) and follows the guidelines provided in the Cochrane Handbook for Systematic Reviews of Interventions. A librarian developed and executed the search strategy; it was further reviewed by two of the authors and complemented by manual search. Randomized clinical trials, quasi-experimental studies, cohort studies, case-control studies, cross-sectional studies, and case reports were included; in vitro or animal studies were excluded. Abstract and full-text screening according to pre-defined eligibility criteria were performed by two reviewers independently using web application Rayyan QCRI. Disagreements on study selection were resolved by a third reviewer. The systematic review protocol was registered in PROSPERO (CRD42020200641). Results: Neither published nor pre-print studies evaluating the use of chlorine dioxide or derivatives on SARS-CoV-2 infection were identified. The only finding was an unpublished observational study registry which has no results released yet. Conclusions: To date, there are no scientific evidence to uphold the use of chlorine dioxide or derivatives as preventive or therapeutic agents against COVID-19.

Oferta y publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de Lima Metropolitana. Un estudio exploratorio / Food and beverage supply and advertising in schools and their surroundings in Metropolitan Lima. An exploratory study

Resumen El objetivo del estudio fue describir la oferta y la publicidad de alimentos y bebidas en instituciones educativas y entornos escolares de 15 colegios públicos y privados de Lima en 2019. Se realizaron observaciones inopinadas y se registraron los alimentos ofrecidos, la presencia de advertencias publicitarias, octógonos y la publicidad en quioscos y cafeterías. A la hora de salida se observó la venta ambulatoria de alimentos. Todas las escuelas ofrecían productos ultraprocesados, el 73,3% vendía alimentos con octógonos y el 60% tenía publicidad de alimentos procesados y ultraprocesados. En el 86,7% de los colegios había vendedores ambulantes de alimentos, varios de los alimentos eran productos ultraprocesados. Los resultados sugieren un ambiente alimentario no saludable dentro y alrededor de las escuelas, y el incumplimiento de la regulación actual. Resulta necesario mejorar la difusión y supervisión de la política alimentaria, y construir con las escuelas estrategias para promover una alimentación saludable.

Abstract This study aimed to describe the supply and advertising of foods and beverages both inside educational institutions and in their respective local areas in 15 public and private schools in Lima during 2019. Unbiased observations were recorded regarding the types of food available, the presence of octagons, and advertisements used in kiosks and cafeterias. Mobile food vendors were observed at the end of the school day. All schools offered processed products, 73.3% sold food with octagons, and 60% displayed advertising for processed and ultraprocessed foods. Mobile food vendors were observed in 86.7% of schools, several of which were found to sell ultraprocessed products. The results suggest an unhealthy food environment both inside and outside schools, and a noncompliance with current regulations. It is therefore necessary to improve the dissemination and supervision of the food policy, and develop strategies with schools to promote healthy eating.

Worldwide original research production on maternal near-miss: A 10-year bibliometric study

Abstract Objective To evaluate the global productivity regarding original articles on maternal near-miss (MNM). Methods We conducted a bibliometric analysis of original articles published from 2008 to November 2019 in the journals indexed in the Scopus database. The averages of the number of articles by author, of the number of authors by article, of the number of citations by article, and the total number of documents with one or more authors were obtained. An analysis of the co-citation of authors and a co-occurrence analysis of the terms included in the titles and abstracts were performed and were presented as network visualization maps. Results A total of 326 original articles were analyzed. There was an increase in the number of articles (p < 0.001; average annual growth rate = 12.54%;). A total of 1,399 authors, an average number of articles per author of 4.29, with an index of authors per document of 0.23, and an index of co-authors per document of 8.16 were identified. A total of 85 countries contributed with original articles on MNM. Among the top ten countries regarding the contribution of articles, five were low and middle-income countries (LMICs). Brazil had the highest volume of production (31.1%;), followed by the US (11.5%;). Terms related to countries and the measurement of the rates and cases of MNM and the associated factors were found in recent years in the analysis of the co-occurrence of terms. Conclusion There was an increase in the production of original articles on MNM, with a significant participation of authors and institutions from LMICs, which reveals a growing interest in the use of MNM indicators to improve the quality of maternal health care.

Peruvian scientific production on Helicobacter pylori: a bibliometric analysis / Producción científica peruana sobre Helicobacter pylori: un análisis bibliométrico

ABSTRACT Objective : To evaluate the Peruvian scientific production on Helicobacter pylori. Materials and methods : Bibliometric analysis of original articles published until September 8, 2020, in journals indexed in PubMed, Scopus, Web of Science, LILACS, and SciELO. Bibliometric indicators were obtained. Likewise, analysis of the co-citation of authors and co-occurrence of terms with the terms included in the title and the abstract of publications was performed. Results : Data from 180 original articles were analyzed. An increase in the number of articles on H. pylori was found (R2 = 0.64, an average annual growth rate of 8.01%). A total of 777 authors were identified, with an average number of articles per author of 0.18, and a collaboration index of 5.64. The average number of citations per original article was 1.91. The Universidad Peruana Cayetano Heredia was the institution with the highest number of original articles (63.2%). The analysis of co-occurrence of terms found terms related to gastric cancer during the whole study period and, for recent years, terms related to the treatment of H. pylori infection and water sources. Conclusion : There is an increase in Peruvian production in original articles on H. pylori. In recent years, the study of the eradication of H. pylori and the transmission of the agent from water sources have been topics of interest.

RESUMEN Objetivo : Evaluar la producción científica peruana sobre Helicobacter pylori. Materiales y métodos : Análisis bibliométrico de artículos originales publicados hasta el 8 de setiembre de 2020 en revistas indexadas en PubMed, Scopus, Web of Science, LILACS y SciELO. Se obtuvieron indicadores bibliométricos. Asimismo, se realizó un análisis de la co-citación de autores y co- ocurrencia de términos con los términos incluidos en el título y el resumen de las publicaciones. Resultados : Se analizaron datos de 180 artículos originales. Se encontró un aumento en el número de artículos sobre H. pylori (R2 = 0,64, una tasa de crecimiento anual promedio de 8,01%). Se identificaron un total de 777 autores, con una media de artículos por autor de 0,18 y un índice de colaboración de 5,64. El número medio de citas por artículo original fue de 1,91. La Universidad Peruana Cayetano Heredia fue la institución con mayor número de artículos originales (63,2%). El análisis de co-ocurrencia de términos encontró términos relacionados con el cáncer gástrico durante todo el período de estudio y, en los últimos años, términos relacionados con el tratamiento de la infección por H. pylori y fuentes de agua. Conclusión : Existe un aumento en la producción peruana de artículos originales sobre H. pylori. En los últimos años, el estudio de la erradicación de H. pylori y la transmisión del agente desde fuentes de agua han sido temas de interés.

Exceso de mortalidad en Lima Metropolitana durante la pandemia de COVID-19: comparación a nivel distrital / Excess mortality in Metropolitan Lima during the COVID-19 pandemic: a district level comparison

OBJECTIVE: To compare excess mortality by district quintiles according to the Human Development Index (HDI) in Metropolitan Lima, the capital of Peru, and analyze the socioeconomic factors associated with excess mortality within the context of COVID-19. METHODS: Retrospective cross-sectional analysis of the mortality records from non-violent causes registered in the National Death Information System in the 50 districts of Metropolitan Lima of the first 24 weeks of the years 2019 and 2020. Descriptive analysis was performed using contingency tables and time series graphs by sex, age group, and quintile of the district of residence according to the HDI. Negative binomial regression analysis was performed to identify possible explanatory factors for excess mortality. RESULTS: An excess of 20 093 non-violent deaths and 2,979 confirmed deaths from COVID-19 were registered in Metropolitan Lima during the study period. The increase was observed primarily in men and adults aged 60 and over. Residents in the districts belonging to the fifth quintile, according to HDI, presented, in most cases, the lowest rates. Multivariate analysis revealed that a higher HDI level (p = 0.009) and a higher proportion of inhabitants living in extreme poverty (p = 0.014) decreased the excess mortality. CONCLUSION: Excess of non-violent deaths in Metropolitan Lima is higher in the quintiles with the lowest HDI, in men, and the age group from 60 to more years of age. The study of social and economic health determinants in Peru is crucial for the design of measures to be taken by the government against the COVID-19 pandemic.

OBJETIVO: Comparar el exceso de muertes según quintiles distritales del Índice de Desarrollo Humano (IDH) en Lima Metropolitana, capital de Perú, y analizar los factores socioeconómicos asociados con el exceso de muertes en el contexto de la COVID-19. MÉTODOS: Estudio transversal retrospectivo de los registros de mortalidad por causas no violentas registrados en el Sistema Informático Nacional de Defunciones de los 50 distritos de Lima Metropolitana durante las primeras 24 semanas de los años 2019 y 2020. Se realizó un análisis descriptivo mediante tablas de contingencia y gráficos de series de tiempo por sexo, grupo de edad y quintil del distrito de residencia según el IDH. Se realizó un análisis de regresión binomial negativa para identificar posibles factores asociados con el exceso de muertes. RESULTADOS: Un exceso de 20 093 muertes no violentas y 2.979 muertes confirmadas por COVID-19 se registraron en Lima Metropolitana durante el período de estudio. El exceso de mortalidad se observó especialmente en hombres y adultos de 60 años o más. Los distritos pertenecientes al quintil 5 según el IDH presentan, en la mayoría de los casos, las tasas más bajas de exceso de muertes. El análisis multivariado halló que el IDH (p = 0.009) y el porcentaje de habitantes en pobreza extrema (p = 0.014) disminuyen la tasa de exceso de muertes en Lima Metropolitana. CONCLUSIONES: El exceso de muertes no violentas en Lima Metropolitana es mayor en los quintiles con el IDH más bajo, en los hombres y en el grupo de edad de 60 a más años. El estudio de los determinantes sociales y económicos de la salud en Perú es fundamental para el diseño de las medidas que debe tomar el gobierno contra la pandemia de COVID-19.

Massive Open Online Courses for continuing education for nursing professionals in Peru / Massive Open Online Courses para educação continuada em profissionais de enfermagem no Peru / Massive Open Online Courses para la educación continua en profesionales de enfermería en Perú

Objective: to determine the global offer of Massive Open Online Courses (MOOCs) in health and nursing, and to know the characteristics of its content, for continuing education in nursing professionals in Peru. Method: exploratory study was carried out on the websites: Coursera, edX, FutureLearn, XuetangX and Udacity, Class Central and MOOC List. The courses were classified according to the five nursing areas recognized by the Peruvian College of Nurses (Colegio de Enfermeros del Perú, CEP). From each course, data was collected on institution and country of origin, hours per week and total duration in weeks, audio and subtitle language. Results: a total of 654 courses in this modality are offered in health were found, covering the five areas contemplated by the Peruvian College of Nurses. Fourteen courses were specifically developed for nursing with an average duration of five weeks (3.2 hours per week of activities). Eleven came from Anglo-Saxon institutions, with content in English. Only two courses were offered in Spanish and one in Turkish. Conclusion: Massive Open Online Courses would be a useful tool for the continuing education of the Peruvian nurse given the wide offer, including some specifically for nurses, in the different areas of nursing. The content of the course is mostly in English. Expanding the range of languages or subtitles would facilitate the participation of a larger audience.

Objetivo: determinar a oferta global de Massive Open Online Courses (MOOCs) em saúde e enfermagem e conhecer as características de seu conteúdo para a educação continuada em profissionais de enfermagem. Método: estudo exploratório realizado nos sites Coursera, edX, FutureLearn, XuetangX e Udacity, Class Central e MOOC List. Os cursos foram classificados de acordo com as cinco áreas de enfermagem reconhecidas pelo Colégio Peruano de Enfermeiros (Colegio de Enfermeros del Perú, CEP). Para cada curso foram coletadas as variáveis instituição e país de origem, horas semanais e duração total em semanas, idioma do áudio e das legendas. Resultados: foram encontrados 654 cursos nessa modalidade em saúde, cobrindo as cinco áreas contempladas pelo Colégio Peruano de Enfermeiros. Quatorze cursos foram desenvolvidos especificamente para enfermagem, com duração média de cinco semanas (3,2 horas por semana de atividades). Onze procediam de instituições anglo-saxônicas, com conteúdo em inglês. Apenas dois cursos foram oferecidos em espanhol e um em turco. Conclusão: Massive Open Online Courses é uma ferramenta útil para a educação continuada do enfermeiro peruano, dada a ampla oferta, incluindo alguns especificamente para enfermeiros, nas diferentes áreas da enfermagem. O seu conteúdo é oferecido principalmente em inglês. Expandir a variedade de idiomas ou incluir legendas facilitaria a participação de um público maior.

Objetivo: determinar la oferta global de Massive Open Online Courses (MOOCs) en salud y enfermería, y conocer las características de su contenido, para la educación continua de profesionales de enfermería en Perú. Método: estudio exploratorio se llevó a cabo en sitios web Coursera, edX, FutureLearn, XuetangX y Udacity, Class Central y MOOC List. Los cursos se clasificaron según las cinco áreas de enfermería reconocidas por el Colegio de Enfermeros del Perú (CEP). De cada curso se recopilaron datos sobre institución y país de origen, horas por semana y duración total en semanas, idioma de audio y de subtítulos. Resultados: se encontró un total de 654 cursos en esta modalidad en salud, que abarcaron las cinco áreas contempladas por el Colegio de Enfermeros del Perú. Catorce cursos fueron elaborados específicamente para enfermería con una duración promedio de cinco semanas (3,2 horas semanales de actividades). Once procedían de instituciones anglosajonas, con contenido en inglés. Solo dos se ofrecieron en español y uno en turco. Conclusión: Massive Open Online Courses es una herramienta útil para la educación continua del enfermero peruano dada la amplia oferta, incluyendo algunos específicamente para enfermeros, en las distintas áreas de la enfermería. El contenido de los cursos se ofrecen mayoritariamente en inglés. Ampliar la oferta de idiomas o subtítulos facilitaría la participación de un mayor público.

Cepillado dental y niveles de flúor en pastas dentales usadas por niños peruanos menores de 12 años / Tooth brushing and fluoride levels in toothpaste used by peruvian children under 12 years old

RESUMEN Análisis secundario de los datos de 41 330 niños de uno a 11 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se reportó la frecuencia de cepillado y el uso de pasta dental según el nivel de flúor (no cepillado, adecuado, inadecuado, no mostró/no usa pasta, e ilegible), según variables socioeconómicas y geográficas. Un 7,8% de los niños evaluados no se cepillaba los dientes, se evidenció diferencias porcentuales significativas (p <0,001) en el uso de pasta dental con concentración inadecuada de flúor entre las categorías extremas de las variables edad (12,3%), uso de servicios odontológicos (7,7%), nivel educativo del responsable (20,4%), índice de riqueza (17,8%), dominio geográfico (11,3%) y área de residencia (9,1%). Un porcentaje considerable de niños peruanos no se cepilla los dientes; además, un gran número de niños que se cepillan emplean pastas dentales con contenidos de flúor sin efecto preventivo.

ABSTRACT Secondary analysis of data on 41,330 children aged one to 11 from the Demographic and Family Health Survey (ENDES) carried out in 2018. The frequency of brushing and the use of toothpaste were reported according to the level of fluoride (no brushing, adequate, inadequate, did not show/did not use toothpaste, and illegible), according to socioeconomic and geographical variables. The evaluation showed that 7.8% of children did not brush their teeth; there were significant percentage differences (p <0.001) in the use of toothpaste with inadequate fluoride concentration between the extreme categories of the variables: age (12.3%), use of dental services (7.7%), educational level of the person responsible (20.4%), wealth index (17.8%), geographical domain (11.3%), and area of residence (9.1%). A considerable percentage of Peruvian children do not brush their teeth; in addition, a large number of children who brush use toothpastes with a fluoride content that has no preventive effect.

Factores asociados a la no utilización de servicios de salud en inmigrantes venezolanos en Perú / Factors associated with the non-utilization of healthcare services among venezuelan migrants in Peru

RESUMEN Objetivo. Estimar la prevalencia y determinar los factores asociados a la no utilización de instituciones prestadoras de servicios de salud (NUIPSS) en inmigrantes adultos venezolanos en Perú. Materiales y métodos. Estudio transversal analítico de la «Encuesta Dirigida a la Población Venezolana que Reside en el País¼ 2018. Se calculó la proporción de inmigrantes con NUIPSS (inmigrantes con algún síntoma o malestar, enfermedad, recaída de enfermedad crónica, accidente y molestia o problema como depresión, miedo, enojo, ansiedad, estrés y que consideraron que no era tan grave o necesario acudir a una institución prestadora de servicios de salud). Se estimaron razones de prevalencia (RP) crudas y ajustadas (RPa) de presentar NUIPSS usando modelos lineales generalizados. Resultados . Se incluyeron 2144 venezolanos inmigrantes. El 57,2% presentó NUIPSS, reportando motivos como: no contar con dinero (64,5%), carecer de seguro de salud (24,3%), automedicación (12,8%) y no disponer de tiempo (8,4%). Residir en Arequipa (Rpa:0,69; IC95%: 0,57-0,83) o Trujillo (Rpa: 0,87; IC95%: 0,76-0,99), padecer una enfermedad crónica (Rpa: 0,83; IC95%: 0,71-0,97) y estar afiliado al Seguro Integral de Salud (SIS) (Rpa: 0,28; IC95%: 0,13-0,61) se asoció con una menor probabilidad de NUIPSS. Ser de un grupo etario más joven al de 60 a más años se asoció con una mayor probabilidad de NUIPSS. Conclusiones. Uno de cada dos venezolanos inmigrantes en Perú presenta NUIPSS. Contar con SIS incrementa la probabilidad de acudir a atención médica en inmigrantes venezolanos en territorio peruano. Incrementar el aseguramiento público en salud de esta población, que actualmente es bajo, podría incrementar el uso de servicios de salud.

ABSTRACT Objective. To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

Satisfacción del usuario externo con la atención en establecimientos del Ministerio de Salud de Perú y sus factores asociados / External user satisfaction with healthcare at facilities of the Ministry of Health of Peru and its associated factors

RESUMEN Objetivos. Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. Materiales y métodos. Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. Resultados. Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno¼. Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. Conclusiones. Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

ABSTRACT Objectives. To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. Materials and Methods. Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. Results. The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. Conclusions. Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

Is anemia a public health problem among children under five years ago in Peru? Findings from a national healthcare administrative database (2012 and 2016) using Geographic Information Systems / ¿Es la anemia un problema de salud pública entre los menores de cinco años en el Perú? Análisis de una base de datos administrativa nacional de salud (2012 y 2016) empleando Sistemas de Información Geográfica

The objective of this study was to assess the change in the prevalence of anemia among under-five children attending public health services in Peru between 2012 and 2016, according to their place of residence, and to identify spatial clusters of districts with a high prevalence of anemia. An analytical cross-sectional study was carried out, based on data from the Nutritional State Information System from 2012 and 2016. We calculated the spatial autocorrelation of anemia prevalence at the district level using a global and local Moran's I index. The prevalence of anemia was 34.4% (2012) and 40.3% (2016). In 2012 and 2016, 41.7% and 46.5% of districts, respectively, had a prevalence of anemia considered a severe public health problem acording WHO criteria. Positive spatial autocorrelation was found between the prevalence of anemia and the districts for both years (2012 Moran's I: 0.22; 2016: 0.31, both p <0.001). Of the total number of districts, 8.3% (2012) and 12.6% (2016) presented a high prevalence of anemia and were also surrounded by districts with high prevalence. Anemia is a public health problem among children under five in Peru attending public health services and we identified areas with a higher concentration of anemia prevalence. Spatial patterns of anemia should be considered in the development and implementation of health interventions.

El objetivo del estudio fue evaluar la prevalencia de anemia en menores de cinco anos atendidos en servidos de salud públicos en Perú entre 2012-2016 e identificar conglomerados espaciales de distritos de alta prevalencia de anemia. Se realizó un estudio analítico de corte transversal, basado en los datos del Sistema de Información dei Estado Nutricional del Perú 2012 y 2016. La autocorrelación espacial de la prevalencia de anemia a nivel distrital se calculó utilizando el índice I de Moran global y local. Se encontro una prevalencia de anemia del 34.4% (2012) y 40.3% (2016), con41.7% (2012) y 46.5% (2016) de distritos con prevalencias de anemia consideradas como grave problema de salud pública según clasificación OMS. Se encontró una autocorrelación espacial positiva entre la prevalencia de anemia y los distritos (Moran's I 2012: 0.22; 2016: 0.31, ambos p <0.001), donde 8.3% (2012) y 12.6% (2016) de distritos con alta prevalencia se encontraban rodeados por distritos con alta prevalencia. La anemia es un problema de salud pública en menores de cinco años en el Perú atendidos en servicios de salud públicos. Existen áreas con mayor concentración de prevalencia de anemia. Los patrones espaciales de anemia deben considerarse en el desarrollo y la implementación de intervenciones de salud.

Factores asociados a la calidad de la atención prenatal en Perú / Factors associated with the quality of prenatal care in Peru

RESUMEN Objetivo. Estimar la proporción de mujeres peruanas que recibieron un control prenatal (CPN) de calidad para el último parto de los últimos cinco años y determinar sus factores asociados. Materiales y métodos. Estudio transversal analítico de la Encuesta Demográfica y de Salud Familiar 2017. Se calculó la proporción de CPN de calidad según número de CPN. Se estimaron razones de prevalencia crudas y ajustadas (RPa) de presentar un CPN de calidad. Resultados. Se analizaron datos de 18 156 mujeres, el 56,1% recibió un CPN de calidad. Recibir más CPN incrementó la probabilidad de recibir un CPN de calidad (49,6% y 59,9% para seis y ocho controles, respectivamente). Ser de la sierra (RPa=0,85; IC 95%: 0,80-0,91), vivir en la zona rural (RPa=0,94; IC 95%: 0,89-0,99) y pertenecer a una etnia nativa (RPa=0,72; IC 95%: 0,66-0,79) se asoció con un menor probabilidad de recibir un CPN de calidad. Tener educación secundaria (RPa=1,16; IC 95%: 1,10-1,22) y superior (RPa=1,15; IC 95%: 1,07-1,23), ser del quintil de riqueza 2 (RPa=1,15; IC 95%: 1,08-1,22), quintil 3 (RPa=1,18; IC 95%: 1,09-1,27), quintil 4 (RPa=1,16; IC 95%: 1,07-1,26) y quintil 5 (RPa=1,16; IC 95%: 1,05-1,28), ser del resto de la Costa (RPa=1,06; IC 95%: 1,00-1,12) y Selva (RPa=1,31; IC 95%: 1,24-1,39), tener una afiliación a un seguro de salud (RPa=1,24; IC 95%: 1,18-1,30), orden de nacimiento 2 a 3 (RPa=1,10; IC 95%:1,06-1,15) o ≥4 (RPa = 1,20; IC 95%:1,14-1,27) y haber recibido un CPN en el primer trimestre (RPa=1,20; IC 95%: 1,14-1,26) se relacionaba a una mayor probabilidad de recibir un CPN de calidad. Conclusiones. Cuatro de cada diez mujeres no recibieron un CPN de calidad. Ser mujer de etnia nativa o de la sierra o zona rural estuvo asociado a una mala calidad del CPN, requiriéndose priorización de estos grupos en las estrategias de salud materna.

ABSTRACT Objective . To estimate the proportion of Peruvian women who received quality prenatal care (PNC) for their last childbirth in the last five years and to determine its associated factors. Materials and Methods. Analytical cross-sectional study of the 2017 Demographic and Family Health Survey. The proportion of quality PNC was calculated based on the number of PNC control visits. Bivariate and adjusted prevalence ratios (PRa) of quality PNC were estimated. Results. Data from 18,156 women were analyzed; 56.1% received quality PNC. Receiving more PNC visits increased the likelihood of receiving quality PNC (49.6% and 59.9% for six and eight control visits, respectively). Being from the highlands (PRa=0.85; 95% CI: 0.80-0.91), living in rural areas (PRa=0.94; 95% CI: 0.89-0.99), and belonging to a native ethnic group (PRa=0.72; 95% CI: 0.66-0.79) was associated with a lower likelihood of receiving quality PNC. Having completed high-school (PRa=1.16; 95% CI: 1.10-1.22) and higher education (PRa=1.15; 95% CI: 1.07-1.23), being from the 2nd wealth quintile (PRa=1.15; 95% CI: 1.08-1.22), 3rd quintile (PRa=1.18; 95% CI: 1.09-1.27), 4th quintile (PRa=1.16; 95% CI: 1.07-1.26), and 5th quintile (PRa=1.16; 95% CI: 1.05-1.28); being from the rest of the Coast (PRa=1.06; 95% CI: 1.00-1.12) and Jungle (PRa=1.31; 95% CI: 1.24-1.39); being enrolled in health insurance (PRa=1.24; 95% CI: 1.18-1.30); birth order 2-3 (PRa=1.10; 95% CI: 1.06-1.15) or ≥4 (PRa=1.20; 95% CI: 1.14-1.27), and having received PNC in the first trimester (PRa=1.20, 95% CI: 1.14-1.26) was related to an increased likelihood of receiving quality PNC. Conclusions . Four out of ten women did not receive quality PNC, especially in women of native ethnicity or residents of the highlands or rural areas, groups that would require prioritization in maternal health strategies.

¿Qué representa cambiar el umbral diagnóstico de la hipertensión arterial? Guías ACC/AHA 2017 y su aplicación en Perú / Changes in the prevalence of hypertension in Peru using the new guideline of the American College of Cardiology

Introduction and Objective: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017. Methods: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI. Results: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively). Conclusions: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.

Manipulación, análisis y visualización de datos de la encuesta demográfica y de salud familiar con el programa R / Manipulation, analysis, and visualization of data from the demographic and family health survey with the R program

RESUMEN La Encuesta Demográfica de Salud Familiar (ENDES) es una encuesta nacional de base poblacional con representatividad a nivel departamental y área de residencia, constituyéndose en una fuente de información del estado de salud de la población peruana. Con el objetivo de estandarizar su procesamiento y posterior reutilización por parte de la comunidad académica y otros actores interesados; documentamos el código para la manipulación, análisis y visualización de datos del cuestionario de salud de la ENDES 2017, mediante un ejemplo sobre prevalencia de hipertensión arterial y obesidad, utilizando el entorno y lenguaje de programación estadístico R. Se presenta y detalla secuencialmente el código en R, así como, el sustento teórico de la estructura de la encuesta para la manipulación de las bases de datos, considerando que la compleja estructura de la ENDES podría ser una potencial barrera que enfrentan los investigadores. Finalmente, este ejemplo puede servir de base para que se generen mayores estudios basados en la ENDES que sean relevantes para la toma de decisiones en salud pública.

ABSTRACT The Demographic and Family Health Survey (ENDES, in Spanish) is a national population-based survey with representation at the departmental level and area of residence, constituting a source of information on the health status of the Peruvian population. In order to standardize its processing and subsequent reuse by the academic community and other stakeholders, we documented the code for the manipulation, analysis, and visualization of data from the ENDES 2017 health questionnaire, through an example on the prevalence of hypertension and obesity, using the R statistical programming environment and language. The R code is presented and detailed sequentially, as well as the theoretical support of the survey structure for the manipulation of databases, considering that the complex structure of the ENDES could be a potential barrier faced by researchers. Finally, this example can serve as a basis for generating further studies based on the ENDES that are relevant to public health decision-making.

Keywords: Data Science; Epidemiological Surveys; Statistics as a matter; Hypertension; Obesity; Peru