Pobreza y su influencia en el riesgo y daño familiar en un distrito de Lima, Perú: resultados por sectorización y atención primaria en salud / Poverty and its influence on risk and family damage in a district of Lima, Peru: results by sector analysis and Primary Health Care

OBJETIVO: La pobreza impacta negativamente en la salud, educación y entorno familiar. La sectorización a través de sus componentes permite identificar los grupos de riesgo y daño en las familias. El objetivo del presente trabajo es determinar el estado de pobreza y su influencia en el riesgo y daño familiar del distrito de Villa María del Triunfo, Lima, Perú. MATERIALES Y MÉTODOS: Estudio ecológico que usó la base de datos de un establecimiento de salud del distrito de Villa María del Triunfo, en el que se evalúa el riesgo familiar y el nivel socioeconómico de 450 familias en 7 sectores entre los años 2015 y junio del 2017. RESULTADOS: Más de la mitad de las familias son pobres (77,9%). Los daños más prevalentes fueron malnutrición y salud mental. Los factores de riesgo familiar más frecuentes fueron violencia familiar, ausencia de lactancia materna y gestante adolescente o añosa. Se encontró que la pobreza está asociada a riesgo familiar (OR: 1,84; IC 95%: 1,07-3,23) y a riesgo de daño (OR: 2,29; IC 95%: 1,32-3,92). CONCLUSIÓN: El nivel de pobreza es alto y se encontró asociada a un mayor riesgo y daño familiar, especialmente para condiciones como malnutrición y problemas de salud mental. Se deben realizar intervenciones en las familias, sobre todo en las pobres, y aplicar medidas que modifiquen sus determinantes sociales de mala salud

OBJECTIVE: Poverty generates negative effects on health, education, and family environment. Sectoral analysis through its components enables to identify the risk groups and damage in the families. The objective of this work is to determine the state of poverty and its influence on the risk and family damage in the district of Villa Maria del Triunfo (VMT), Lima, Peru. MATERIALS AND METHODS: Ecological study that used the database of the health facility of the VMT district, in which the family risk and the socioeconomic level of 450 families in 7 sectors are evaluated between the years 2015 to June 2017. RESULTS: More than three-quarters of the families are poor (77.9%). The most prevalent damages were malnutrition and mental health. The most frequent family risk factors were family violence, with the absence of breastfeeding in infants, adolescent pregnancy, and old age. It was found that poverty was associated with family risk (P = .019, OR: 1.84, 95% CI: 1.07-3.23), and damage risk (P < .001, OR: 2.29; 95% CI: 1.32-3.92). CONCLUSION: The level of poverty is high. This condition was associated with increased risk and family damage, especially for malnutrition and mental health problems. Interventions should be carried out in families, especially among the poor, and decisive measures should be made on the social factors determining ill-health

[Poverty and its influence on risk and family damage in a district of Lima, Peru: results by sector analysis and Primary Health Care]. / Pobreza y su influencia en el riesgo y daño familiar en un distrito de Lima, Perú: resultados por sectorización y atención primaria en salud.

OBJECTIVE: Poverty generates negative effects on health, education, and family environment. Sectoral analysis through its components enables to identify the risk groups and damage in the families. The objective of this work is to determine the state of poverty and its influence on the risk and family damage in the district of Villa Maria del Triunfo (VMT), Lima, Peru. MATERIALS AND METHODS: Ecological study that used the database of the health facility of the VMT district, in which the family risk and the socioeconomic level of 450 families in 7 sectors are evaluated between the years 2015 to June 2017. RESULTS: More than three-quarters of the families are poor (77.9%). The most prevalent damages were malnutrition and mental health. The most frequent family risk factors were family violence, with the absence of breastfeeding in infants, adolescent pregnancy, and old age. It was found that poverty was associated with family risk (P=.019, OR: 1.84, 95% CI: 1.07-3.23), and damage risk (P<.001, OR: 2.29; 95% CI: 1.32-3.92). CONCLUSION: The level of poverty is high. This condition was associated with increased risk and family damage, especially for malnutrition and mental health problems. Interventions should be carried out in families, especially among the poor, and decisive measures should be made on the social factors determining ill-health.

Características y calidad de las guías de práctica clínica en el Seguro Social de Salud del Perú / Characteristics and quality of the of clinical practice guidelines in the Social Security of Health of Peru

Objetivo: Elaborar una línea de base al describir las características y calidad de las guías de práctica clínica (GPC) del Seguro Social de Salud del Perú (EsSalud) producidas hasta diciembre de 2015. Material y métodos: Estudio de corte transversal. Se solicitaron las GPC de las 33 redes asistenciales de EsSalud hasta diciembre de 2015. Se evaluó la calidad metodológica con el instrumento AGREE II. Resultados: Se recibieron 710 GPC; el 79% de estas fueron desarrolladas en Lima y Callao, siendo la mayoría del área clínica (62%) y con una antigüedad mayor de 5 años (52%). Se realizó la evaluación de calidad de 31 GPC; se obtuvieron puntuaciones bajas en los 6 dominios, siendo los referidos al rigor metodológico (6%) y aplicabilidad (8%) los que menor promedio obtuvieron. Las GPC elaboradas en regiones diferentes a Lima y Callao obtuvieron puntajes promedios aún menores. Conclusiones: Existe una creciente producción de GPC, pero de baja calidad y poco recomendables para ser usadas

Objective: To describe the characteristics and quality of the clinical practice guidelines (CPG) of the Social Security of Health (EsSalud) of Peru. Material and methods: A cross-sectional study was conducted on the CPGs of the 33 EsSalud networks. The methodological quality of 31 CPGs was evaluated using the AGREE II tool. Results: A total of 710 CPGs were assessed, of which 79% were developed in Lima and Callao, with the majority being from the clinical area (62%), and more than 5 years in use (52%). In the quality evaluation of 31 CPGs, low scores were obtained in the 6 domains, with those referring to the methodological rigour (6%) and applicability (8%) obtaining the lowest mean scores. The CPGs developed in regions other than those of Lima and Callao obtained even lower mean scores. Conclusions: There is an increasing production of CPGs, but of low quality and not really recommended for use

¿Es posible reducir la prevalencia de demencia? Necesitamos nuevos enfoques para enfrentar la demencia / Is it possible to reduce the prevalence of dementia? New approaches are needed to deal with dementia

La demencia es reconocida como un problema de salud pública con incidencia y prevalencia elevadas, incremento en su carga de enfermedad y asociada a mortalidad. Los diferentes tratamientos no han probado tener resultados clínicos que modifiquen el curso de la enfermedad o reduzcan su impacto en términos de mortalidad o discapacidad. Esta revisión señala que es factible evitar el desarrollo de demencia a pesar de que la edad sigue siendo un importante factor de riesgo no modificable. El control de factores modificables ampliamente reconocidos y ligados etiopatogénicamente pueden disminuir el número de casos de demencia. Las intervenciones multimodales enfocadas en el control de estos factores de riesgo aún tienen resultados inconsistentes; por lo tanto, nuevos ensayos deberían ser realizados además de aplicar el enfoque de medicina de precisión clínica que permitan contar con evidencias que mejoren la toma de decisiones en salud pública para afrontar este problema

Dementia is recognised as a public health problem with high incidence and prevalence, as well as an increase in its burden of disease and associated with mortality. The different treatments have not provided clinical results that modify the course of the disease or reduce its impact in terms of mortality or disability. This review indicates that it is feasible to avoid the development of dementia despite the fact that age continues to be an important non-modifiable risk factor. The control of widely recognised modifiable and aetiopathogenically-related factors can decrease the number of cases of dementia. Multimodal interventions focused on the control of these risk factors continue to show inconsistent results; therefore, new trials should be carried out in addition to applying the clinical precision medicine approach that provides evidence to improve public health decision-making in order to address this problem

[Characteristics and quality of the of clinical practice guidelines in the Social Security of Health of Peru]. / Características y calidad de las guías de práctica clínica en el Seguro Social de Salud del Perú.

OBJECTIVE: To describe the characteristics and quality of the clinical practice guidelines (CPG) of the Social Security of Health (EsSalud) of Peru. MATERIAL AND METHODS: A cross-sectional study was conducted on the CPGs of the 33 EsSalud networks. The methodological quality of 31 CPGs was evaluated using the AGREE II tool. RESULTS: A total of 710 CPGs were assessed, of which 79% were developed in Lima and Callao, with the majority being from the clinical area (62%), and more than 5 years in use (52%). In the quality evaluation of 31 CPGs, low scores were obtained in the 6 domains, with those referring to the methodological rigour (6%) and applicability (8%) obtaining the lowest mean scores. The CPGs developed in regions other than those of Lima and Callao obtained even lower mean scores. CONCLUSIONS: There is an increasing production of CPGs, but of low quality and not really recommended for use.

[Is it possible to reduce the prevalence of dementia? New approaches are needed to deal with dementia]. / ¿Es posible reducir la prevalencia de demencia? Necesitamos nuevos enfoques para enfrentar la demencia.

Dementia is recognised as a public health problem with high incidence and prevalence, as well as an increase in its burden of disease and associated with mortality. The different treatments have not provided clinical results that modify the course of the disease or reduce its impact in terms of mortality or disability. This review indicates that it is feasible to avoid the development of dementia despite the fact that age continues to be an important non-modifiable risk factor. The control of widely recognised modifiable and aetiopathogenically-related factors can decrease the number of cases of dementia. Multimodal interventions focused on the control of these risk factors continue to show inconsistent results; therefore, new trials should be carried out in addition to applying the clinical precision medicine approach that provides evidence to improve public health decision-making in order to address this problem.