Migration and health right: Probabilistic estimate of the factors that impact on health right of the migrant population, Peru 2019-2021.

The study aims to identify factors associated with the violation of the right to health of the regular migrant population with respect to the nonmigrant population in Peru during the period 2019-2021, based on the complaints of health services users. It is a three-year cross-sectional and retrospective study on a total population of 122,505 complainants to the National Superintendency of Health (SUSALUD). The types of health rights used were those established in Peruvian Law No. 29414. An unordered multinomial probability model was used to estimate the probability of belonging to five types of violated rights based on the regular migrant and nonmigrant population, and the exogenous variables that affect this probability. The individual significance tests of the model, the tests for combining categories and the test of independence of irrelevant alternatives by means of the Wald and Hausman-McFadden tests were previously taken. The results indicated an increase in complaints from regular migrants of 5.6% in the 2019-2021 period unlike nonmigrants who had a decrease of 12.2%. The greatest probability that health rights of regular migrants are violated refers to access to information and the right to care and recovery, where their probability of violation is 27.7% and 25.4%, respectively (p-v < 0.05, CI = 95%). Likewise, health rights are more likely to be violated if they are women; if they are adults (41 years old on average); if they do not possess any type of health insurance; if they use Peruvian Ministry of Health (MINSA) services; and if they are located in metropolitan cities, such as Lima and Callao.

Guía de práctica clínica para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales en el Seguro Social de Salud del Perú (EsSalud) / Clinical practice guidelines for diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases of the Peruvian Health Social Security (EsSalud)

RESUMEN Introducción : El presente artículo resume las recomendaciones basadas en evidencia de la guía de práctica clínica (GPC) para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales. Métodos : Se conformó un grupo elaborador de la guía (GEG) que incluyó médicos especialistas y metodólogos que formuló siete preguntas clínicas a ser respondidas por la presente GPC. Se realizaron búsquedas sistemáticas de revisiones sistemáticas y -cuando se consideró pertinenteestudios primarios en PubMed y CCENTRAL durante diciembre 2019 y marzo 2020. Se seleccionó la evidencia para responder cada una de las preguntas clínicas planteadas y la certeza de la evidencia fue evaluada usando la metodología Grading of Recommendations Assessment, Development, and Evaluation (GRADE). En reuniones de trabajo periódicas, el GEG usó la metodología GRADE para revisar la evidencia y formular las recomendaciones, los puntos de buena práctica clínica y los flujogramas. Finalmente, la GPC fue aprobada con Resolución Resolución N° 104-IETSI-ESSALUD-2020. Resultados: La presente GPC abordó siete preguntas clínicas, divididas en cuatro temas. En base a dichas preguntas se formularon 12 recomendaciones (3 fuertes y 9 condicionales), 17 BPC, y dos flujogramas (uno de diagnóstico y otro de manejo). Conclusión : El presente artículo resume la metodología y las conclusiones basadas en evidencias de la GPC para el diagnóstico y manejo inicial de la infección por Helicobacter pylori en enfermedades gastroduodenales.

ABSTRACT Introduction : This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases. Methods : For the provision of these recommendations, a guideline development group (local GDG) was established, including medical specialists and methodologists that formulated seven clinical questions. Systematic searches of systematic reviews and -when it was considered pertinentprimary studies were conducted in PubMed and CENTRAL during December 2017 and July 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 104-IETSI-ESSALUD-2020. Results: This CPG addressed seven clinical questions, divided into four topics. Based on these questions, 12 recommendations (3 strong and 9 weak), 17 points of good clinical practice, and two flowcharts (one for diagnosis and another for management) were formulated. Conclusion : This article summarizes the methodology and evidence-based conclusions from the CPG for for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases.

Association between daily working hours and depressive symptoms in resident physicians in Peru. / Asociación entre horas laboradas diariamente y presencia de síntomas depresivos en médicos residentes de Perú.

INTRODUCTION: Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. METHODS: Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. RESULTS: The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR=1.11; 95% CI, 1.04-1.17). CONCLUSIONS: One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.

Asociación entre horas laboradas diariamente y presencia de síntomas depresivos en médicos residentes de Perú / Association between daily working hours and depressive symptoms in resident physicians in Peru

RESUMEN Introducción: Los médicos residentes que laboran más horas diarias son propensos a sufrir problemas de salud mental como la depresión, tema que se ha estudiado poco. Por ello, el presente estudio tiene por objetivos determinar la prevalencia de los síntomas depresivos y evaluar la asociación entre el número de horas diarias laboradas y la presencia de síntomas depresivos en residentes del Perú. Métodos: Estudio transversal analítico que usó la base de datos de la Encuesta Nacional para Médicos Residentes-2016, una encuesta voluntaria realizada virtualmente por el Consejo Nacional de Residentado Médico de Perú a médicos que realizaban su residencia en este país. Se consideró presencia de síntomas depresivos una puntuación ≥ 3 con la escala Patient Health Questionnaire-2. Las horas laboradas diariamente se tomaron mediante una pregunta directa. Para evaluar la asociación de interés, se calcularon razones de prevalencia (RP) y sus intervalos de confianza del 95% (IC95%) usando regresiones de Poisson brutas y ajustadas con varianza robusta. Resultados: Se evaluaron las respuestas de 953 residentes (el 41,3% mujeres; media de edad, 32,5 arios), de los que el 14,6% tenía síntomas depresivos. En el análisis ajustado, se encontró que la prevalencia de síntomas depresivos aumentaba por cada hora laborada adicional (RP = 1,11; IC95%, 1,04-1,17). Conclusiones: Uno de cada 7 residentes presentó síntomas depresivos. Por cada hora laborada diariamente extra, la frecuencia de síntomas depresivos aumentó un 11%.

ABSTRACT Introduction: Resident physicians who work more hours a day are prone to suffer mental health problems such as depression, a subject that has been little studied. In this regard, the aim of this study was to determine the prevalence of depressive symptoms and to evaluate the association between the number of daily working hours and depressive symptoms in Peruvian residents. Methods: Analytical cross-sectional study that used the database of the National Survey for Resident Physicians-2016, a voluntary survey issued virtually by the National Council of Medical Residency of Peru to physicians who were undertaking their residency in Peru. The presence of depressive symptoms was considered as having obtained a score ≥3 with the Patient Health Questionnaire-2 scale. The number of hours worked each day was collected through a direct question. To assess the association of interest, prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using crude and adjusted Poisson regressions with robust variance. Results : The responses of 953 residents (41.3% women, mean age: 32.5 years) were evaluated, 14.6% of which presented depressive symptoms. In the adjusted analysis, it was found that the prevalence of depressive symptoms increased for each additional hour worked (PR = 1.11; 95% CI, 1.04-1.17). Conclusions: One in seven residents had depressive symptoms. For every extra daily working hour, the frequency of depressive symptoms increased by 11%.

[Clinical practice guidelines for diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases of the Peruvian Health Social Security (EsSalud)]. / Guía de práctica clínica para el diagnóstico y manejo de la infección por Helicobacter pylori en enfermedades gastroduodenales en el Seguro Social de Salud del Perú (EsSalud).

INTRODUCTION: This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases. METHODS: For the provision of these recommendations, a guideline development group (local GDG) was established, including medical specialists andmethodologists that formulated seven clinical questions. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in PubMed and CENTRAL during December 2017 and July 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading ofRecommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 104-IETSI-ESSALUD-2020. RESULTS: This CPG addressed seven clinical questions, divided into four topics. Based on these questions, 12 recommendations (3 strong and 9 weak), 17 points of good clinical practice, and two flowcharts (one for diagnosis and another for management) were formulated. CONCLUSION: This article summarizes the methodology and evidence-based conclusions from the CPG for for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases.

Aseguramiento universal en salud en el Perú: una aproximación a 10 años de su implementación / Universal insurance in health in Peru: an approximation to 10 years of its implementation

La política del Aseguramiento Universal en Salud estableció que el acceso a los servicios de salud se realizara por medio de la intermediación financiera de seguros de salud, estableciendo para ello cuatro ejes de "reforma": plan de beneficios, financiamiento y pagos, focalización de subsidios, prestación de servicios y regulación. La política del Aseguramiento Universal en Salud se basó en la teoría de los cuasimercados donde la intención del Estado es evitar ser el proveedor de recursos y el proveedor de servicios al mismo tiempo; en lugar de ello, busca convertirse en el proveedor primario de fondos para una variedad de proveedores del sector privado, público y no lucrativos, todos operando en competencia unos contra otro.A 10 años de su implementación en nuestro país se analizan los avances de implementación en los ejes de reforma que planteó la política del Aseguramiento Universal en Salud.

The policy of the Universal Health Insurance established that access to health services will be carried out through the financial intermediation of health insurance, establishing for this four axes of "reform": plan of benefits, financing and payments, targeting of subsidies, service provision and regulation.The policy of the Universal Health Insurance was based on the theory of quasi-markets where the intention of the State is to avoid being the provider of resources and the service provider at the same time; instead, it seeks to become the primary provider of funds to a variety of private, public and nonprofit providers, all operating in competition against each other.Ten years after its implementation in our country, the progress made in the implementation of the reform axis proposed by the Universal Health Insurance policy is analyzed.

Workplace violence by specialty among Peruvian medical residents.

OBJECTIVE: To determine the prevalence of workplace violence among Peruvian medical residents and to evaluate the association between medical specialty and workplace violence per type of aggressor. METHODS: This was a cross-sectional secondary analysis that used data from the Peruvian Medical Residents National Survey 2016 (ENMERE-2016). The outcome of interest was workplace violence, including physical and verbal violence, which were categorized according to the perpetrator of violence (patients/relatives and worker-to-worker). Primary exposure was the medical specialty, categorized as clinical, surgical, and other specialties. To evaluate the associations of interest, we estimated adjusted prevalence ratios (PR) with their respective 95% confidence intervals (95% CI) using Poisson regression models with robust variances. RESULTS: A total of 1054 Peruvian medical residents were evaluated. The mean age was 32.6 years and 42.3% were female. Overall 73.4% reported having suffered of workplace violence sometime during the residency, 34.4% reported violence from patients/relatives, and 61.1% reported worker-to-worker violence. Compared with clinical residents, surgical residents had a lower prevalence of violence from patients/relatives (PR: 0.71; 95% CI: 0.59-0.87), but a higher prevalence of worker-to-worker violence (PR: 1.11, 95% CI: 1.01-1.23). CONCLUSION: Nearly three quarters of medical residents reported having suffered workplace violence sometime during their residency. Compared with clinical residents, surgical residents had lower rates of violence from patients/relatives, but higher rates of worker-to-worker violence; while residents from non-clinical and non-surgical specialties had a lower prevalence of both types of violence.

Prevalencia y factores asociados a publicar artículos científicos durante la residencia médica en Perú / Prevalence and associated factors to publish scientific articles during the medical residency in Peru

Objetivo. Determinar la prevalencia y los factores asociados a publicar artículos científicos en médicos residentes de Perú. Sujetos y métodos. Estudio transversal analítico usando los datos obtenidos por la Encuesta Nacional para Médicos Residentes 2016 (ENMERE-2016), realizada virtualmente durante junio de 2016. Población: los médicos que realizan su residencia en alguna universidad de Perú. Muestra: los residentes que voluntariamente participaron en la ENMERE-2016. Desenlace de interés: autorreporte de haber publicado al menos un artículo científico. Se recogieron variables sociodemográficas, de la universidad, de la sede, de la residencia, de la percepción del residente y de síntomas depresivos. Para evaluar los factores asociados a haber publicado algún artículo científico se calcularon razones de prevalencia crudas y ajustadas con sus intervalos de confianza al 95%. Resultados. Se analizaron datos de 1.062 residentes (42,2% de sexo femenino), de los cuales 118 (11,1%) publicaron algún artículo científico durante la residencia. En el análisis ajustado, cursar los años superiores de la residencia, haber realizado alguna rotación externa fuera del país y tener una puntuación más alta en la opinión global del proceso de formación fueron variables directamente asociadas con haber publicado algún artículo científico, en tanto que el sexo femenino, tener más de 35 años y presentar síntomas depresivos fueron variables inversamente asociadas a dicho desenlace. Conclusión. Aproximadamente uno de cada 10 residentes publicó algún artículo científico durante la residencia. Esto fue menos prevalente en las mujeres, en los residentes de mayor edad, en quienes cursaban años inferiores de la residencia, en quienes no realizaron ninguna rotación fuera del país, en quienes tuvieron una peor opinión del proceso de formación y en quienes presentaban síntomas depresivos

Aim. To determine the prevalence and the factors associated with the publication of scientific articles in medical residents of Peru. Subjects and methods. Cross-sectional analytical study using the data obtained by the National Survey for Resident Physicians 2016 (ENMERE-2016), carried out virtually during June 2016. Population: physicians who live in a university in Peru. Sample: residents who voluntarily participated in ENMERE-2016. Outcome of interest: have published at least one scientific article. Sociodemographic variables were collected, from the university, from the headquarters, from the residence, from the residen's perception, and from depressive symptoms. To evaluate the factors associated with having published a scientific article, crude and adjusted prevalence ratios were calculated with their 95% confidence intervals. Results. Data from 1062 residents (42.2% female) were analyzed, of which 118 (11.1%) published some scientific paper during the resident. In the adjusted analysis, to study the superior years of residency, to have performed some external rotation outside the country and to have a higher score in the overall opinion of the training process were variables directly associated with having published some scientific article. While the female sex, being over 35 years old and presenting with depressive symptoms were variables inversely associated with this outcome. Conclusion. Approximately one in ten residents published a scientific article during the residency. This was less prevalent in women, in older residents, in those who were in lower years of residence, in those who did not perform any rotation outside the country, in those who had a worse opinion of the training process, and in those with depressive symptoms

Características del residentado médico en el Perú: resultados de la primera Encuesta Nacional de Médicos Residentes (ENMERE-2016) / Characteristics of the medical residency in Peru: results of the first National Survey of Medical Residents (ENMERE-2016)

Objetivo: Describir las características laborales, académicas y de investigación de los médicos participantes en el programa de residentado peruano durante el año 2016. Materiales y métodos: Estudio observacional, descriptivo y transversal; mediante el análisis secundario de la Encuesta Nacional para Médicos Residentes (ENMERE-2016) del año 2016 realizada por el Comité Nacional de Residentado Médico del Perú, mediante encuestas virtuales y voluntarias dirigidas a todos los médicos residentes de Perú. Resultados: De los 7 393 médicos que encontraban realizando el residentado médico en el año 2016, 1 196 (16,2%) respondieron al menos una pregunta de la ENMERE-2016. En esta muestra, la edad promedio fue 32,7 ± 5,6 años, el 57,1% fue de sexo masculino, y el 64,1% realizaba su residentado por una universidad de Lima. El 46,1% de los médicos residentes estaban satisfechos con la función de su tutor, el 14,7% presentaron síntomas depresivos, el 80,9% no había tenido descanso posguardia en el último mes (después de una guardia nocturna), el 48,3% podia retirarse de su sede después de las 14:00 horas el día después de una guardia nocturna, el 38,6% afirmó recibir material de bioseguridad (en su hospital de residencia) siempre que lo necesitara, y el 16,1% había realizado al menos un trabajo de investigación durante su residencia. Conclusión: Los resultados de la ENMERE-2016 reportaron diversas falencias en las características laborales, académicas, y de investigación durante el residentado médico en Perú. Palabras clave: Internado y residencia; Médicos; Recursos humanos en salud; Satisfacción en el trabajo; Educación médica (fuente: DeCS BIREME)

Objective: To describe the working, academic, and research conditions for physicians in training in the Peruvian medical residency program during 2016. Materials and methods: This is an observational, descriptive and cross-sectional study that performed a secondary analysis of the National Survey for Medicine Residents (ENMERE-2016, according to its Spanish initials) developed by the Peruvian Committee for Medical Residency. Surveys were virtual and voluntary, and they were sent to all medical residents in Peru. Results: Of the 7393 physicians that were in a residency program during 2016, 1196 (16.2%) responded at least one question of the ENMERE-2016. In this sample, the average age was 32.7 ± 5.6 years, 57.1% residents were male, and 64.1% were having their training in a medical school in Lima. Nearly half (46.1%) of residents were satisfied with their tutors, 14.7% had depressive symptoms, and 80.9% did not have a resting period after a night shift during the last month. Nearly half of the residents were able to get out of their hospitals after 14.00 hours the day after a night shift; 38.6% reported having received biosafety material for their protection in their hospitals when needed, and 16.1% reported having performed at least one research project during their training period. Conclusion: The ENMERE-2016 results reported many failures in labor, academic, and research aspects during the medical residency programs in Peru