Monitoring Indicators of Universal Access to Accessible and Safe Anesthetic and Surgical Care in a Peruvian Region: An Ambispective Study.

INTRODUCTION: The Lancet Commission on Global Surgery indicators for monitoring anesthetic and surgical care allow the identification of access barriers, evaluate the safety of surgeries, facilitate planning, and assess changes over time. The primary objective was to measure these indicators in all health facilities of a Peruvian region in 2020. METHODS: This was an ambispective observational study to measure the anesthetic and surgical care indicators in Piura, a region in Peru, between January 2020 and June 2021. Public and private health facilities in the Piura region that performed surgical care or had specialists from any surgical specialty participated in the study. Data were collected from all regional health facilities that provided surgical care to estimate the density of surgical workforce. Likewise, the percentage of the population with access to an operating room within 2 h was estimated using georeferenced tools. Finally, a public database was accessed to determine the surgical volume, the percentage of the regional population protected with health insurance. RESULTS: In 2020, 88.4% of the inhabitants of this Peruvian region had access to timely essential surgery. There were 18.4 surgical specialists and 1174 surgeries per 100,000 populations, and 91% of the population had health insurance. In addition, there was a rate of 2.1 working operating rooms per 100,000 inhabitants in 2021. CONCLUSIONS: This Peruvian region presented an increasing trend with respect to the population's access to essential and timely surgical care, and health insurance coverage. However, the workforce distribution was inequitable among the provinces of the region, the surgical volume was reduced, and timely access was hindered because of the SARS-CoV-2 pandemic.

High prevalence and advanced silicosis in active granite workers: a dose-response analysis including FEV1.

OBJECTIVE: To evaluate silica exposure and respiratory disease in granite workers. METHODS: A cross-sectional study of 440 active granite workers. RESULTS: Seventy-seven (17.5%) have silicosis, complicated in 15 of them; 18 have an obstructive ventilatory defect and 73 had exceeded 3.5 mg/m-year of cumulative silica exposure. Percent predicted FEV1 have a significant negative relation with mg/m(3)-year (P < 0.001) with a trend toward dose-response excluding silicotics and controlling for tobacco. The odds ratio (95% confidence interval) of having a percent predicted FEV1 below 50th percentile is 1.18 (0.66 to 2.11) for nonexposed smokers, 1.47 (0.76 to 2.84) for exposed nonsmokers, and 2.07 (1.12 to 3.85) for exposed smokers, in comparison with the control group. CONCLUSIONS: This study suggests that silica induces functional alteration regardless of silicosis and, in all likelihood, synergistically with tobacco. Exposure levels must be controlled better in these workers and those with silicosis must be relocated to risk-free jobs or retired.