[Effectiveness of tertiary prevention on quality of life and control of risk factors in patients with ischemic coronary heart disease]. / Efectividad de la prevención terciaria en la calidad de vida y control de los factores de riesgo en pacientes con cardiopatía coronaria isquémica.

Objective: Determine the effectiveness of cardiac rehabilitation (CR) as a tertiary prevention strategy in the quality of life and control of risk factors of patients with ischemic coronary heart disease (ICC) of the National Cardiovascular Institute (INCOR) of EsSalud- Lima during the year 2018. Materials and methods: A retrospective cohort of 280 patients with a diagnosis of CCI was studied who, after medical, interventional, or surgical treatment, were referred to the INCOR CR program for tertiary prevention (PT) in 2018. The program was developed according to the institutional guide for eight weeks with exercise sessions and educational, psychological, nutritional, and recreational workshops. At the beginning and at the end of this, the QLMI-2 quality of life test was applied, and anthropometric, laboratory, and risk factor control measurements were performed. Results: Quality of life levels at the end of CR showed a statistically significant improvement in the emotional, social, physical, and global dimensions (p < 0.001). The same behavior was observed for the nutritional variables of weight, abdominal circumference, and BMI (p < 0.001). Physical capacity showed a statistically significant improvement in the aspects of muscle strength (12.2%), physical activity (38.0%), and functional capability (25.4%) (p < 0.001). The result was not homogeneous for the biochemical metabolic variables, where glycosylated hemoglobin, glycemia, and lipid profile did not show significant improvement, except for HDL, which raised its levels statistically significantly (p < 0.001). Conclusions: CR is effective as a central strategy to perform tertiary prevention in patients with ICC since it notably improves quality of life and coronary risk factors.

Structure of the perception of health professionals regarding the quality of health services in the context of COVID-19.

BACKGROUND: The health emergency caused by COVID-19 revealed the shortcomings of health services (HS), but little is known about how this has impacted the mental health of health professionals (HP) when perceiving these difficulties. METHODS: Data were collected through an online survey administered to HP in Lima (Peru) between May and July 2020. A questionnaire was applied to identify perceived quality of health services (PHQS). A network analysis was performed, and the centrality measures of the variables were calculated and plotted. RESULTS: A total of 507 HP completed the survey. In the network analysis of PHQS, four clusters were identified: (A) "empathy" and "recognition of competencies," (B) "logistical support," "protection," "personal early diagnosis," and "early family diagnosis"; C) "professional competence with regard to their treatment and treatment for their family," "equipment for their treatment and treatment for their family," "professional competence with regard to their treatment and treatment for their family," and "institutional support for them and their family"; and D) "fear of being infected or infecting their family," "fear of dying or death of a family member," "knowledge stability," "job burnout," and "role change." The variables of PHQS with the greatest centrality were "equipment for their treatment," "equipment for the treatment of their family," and "early family diagnosis." CONCLUSIONS: The structure of the PHQS of HP describes direct and indirect influences of different variables in the context of COVID-19.

[Cardiac tele-rehabilitation in times of pandemic. Experience at the National Cardiovascular Institute INCOR in Lima-Peru]. / Tele-rehabilitación cardiaca en tiempos de pandemia. Experiencia en el Instituto Nacional Cardiovascular-INCOR.

Objective: Cardiac Rehabilitation (CR) programs based on telehealth are an alternative in the context of a pandemic and represent an opportunity to continue in the intervention of cardiovascular diseases (CVD). The present study aims to evaluate the effect of a Cardiac Tele-Rehabilitation (CTR) program on quality of life, anxiety/depression index, exercise safety and Level Of disease awareness in patients discharged from a national referral institute in times of pandemic. Methods: A pre-experimental study in cardiac patients who entered the cardiac rehabilitation program at INCOR from August to December 2020. The study included low-risk patients who were administered a questionnaire (on cardiovascular disease, exercise safety, anxiety/depression, and quality of life) at the beginning and end of the program, which was applied through a virtual platform. Descriptive and comparative before-after analysis was used through hypothesis testing. Results: Sixty-four patients were included (71.9% male). The mean age was 63.6 ±11.1 years. Regarding exercise safety, an increase in the mean score was found after the application of the program (3.06 ± 0.8 to 3.18 ± 0.7, p=0.324). Concerning anxiety, the mean score was reduced from 8.61 to 4.75, while for depression, the reduction was from 7.27 to 2.92. Regarding the quality-of-life score, the global component improved from 111.48 to 127.92. Conclusions: The CTR program implemented through a virtual platform during the COVID-19 pandemic enhanced quality of life and decreased stress and depression in cardiac patients discharged from a national cardiovascular referral center.

Relationship between depression, anxiety, and perceived stress in health professionals and their perceptions about the quality of the health services in the context of COVID-19 pandemic.

BACKGROUND: The health emergency caused by COVID-19 revealed the shortcomings of health services (HS), but little is known about how this has impacted the mental health of health professionals (HP). METHODS: Data were collected through an online survey administered to HP in Lima (Peru) between May and July 2020. Instruments were applied to evaluate anxiety, depression, perceived stress (PS), and perceived quality of health services (PQHS). RESULTS: A total of 507 HP completed the survey. In the multivariate analysis, younger age and female gender were related to anxiety, depression, and PS (all with p < .001). The most relevant unfavorable PQHS associated with anxiety were competence of other HP to care for HP if infected (p = .002) and support for HP or their families in the event of becoming infected (p = .001); the most relevant unfavorable PHQS associated with depression were equipment to care for HP and their families if infected (p = .003); support for HP or their families if infected (p < .001); fear of HP and/or family members being infected or dying (p = .006); and HP' recognition of their competencies (p < .001); and the most relevant unfavorable PHQS associated with PS were support for HP or their families if infected (p < .001) and instability of knowledge (p = .027). CONCLUSIONS: There was an association between impaired mental health and PQHS scores among HP. This study shows the need for HP to express their concerns about how HS are supporting their safety and that of their family during health emergencies.

Patrones de costos de atención a pacientes con enfermedades isquémicas del corazón en el Instituto Nacional Cardiovascular, 2019 / Cost patterns of care for patients with ischemic heart disease at the Instituto Nacional Cardiovascular, 2019

RESUMEN Introducción. La enfermedad isquémica del corazón (EIC) es actualmente un problema de salud pública en el Perú, y su tratamiento tiende a ser muy costoso para el sistema de salud. Objetivo. Establecer los patrones de costos de atención de las EIC en el Instituto Nacional Cardiovascular (INCOR) de la Seguridad Social en Salud del Perú (EsSalud). Métodos. Se utilizaron las bases de datos de atenciones, cirugías, egresos y valor bruto de la producción del INCOR de la población diagnosticada y atendida con EIC en el año 2019 (879 pacientes). Se estimaron los costos de las atenciones mediante costeo basado en actividad; se utilizó un modelo econométrico para establecer los determinantes de los costos, y con el método de distancia euclidiana se formaron "clústeres" con características similares para establecer patrones de costos. Resultados. El costo de atención de EIC más alto fue de 148 567 soles (US$ 44 830) para un paciente con 40 días de estancia. Fueron principales determinantes del costo de la atención la estancia hospitalaria y el número de ingresos al establecimiento. Se identificó que los "clúster" que tuvieron un costo mayor, fueron pacientes con edad de 70 y 72 años como mediana, con altos número de días de estancia y con alguna cirugía de alta complejidad. Conclusión. Los patrones de costos de la atención de la EIC estuvieron asociados a la estancia y los reingresos al establecimiento de salud. Los "clústers" con mayor costo estuvieron relacionados a la edad y complejidad de la cirugía.

ABSTRACT Introduction. Ischemic heart disease (IHD) is currently a public health problem in Peru, and its treatment tends to be very expensive for the health system. Goal. Establish the patterns of care costs of the EIC in the National Cardiovascular Institute (INCOR) of the Social Security in Health of Peru (EsSalud). Methods. The databases of care, surgeries, discharges and gross value of INCOR production of the population diagnosed and treated with IHD in 2019 (879 patients) were used. Costs of care were estimated using activity-based costing; an econometric model was used to establish the determinants of costs, and with the Euclidean distance method, "clusters" with similar characteristics were formed to establish cost patterns. Results. The highest cost of EIC care was 148 567 soles (US$ 44 830) for a patient with a 40-day stay. The main determinants of the cost of care were the hospital stay and the number of admissions to the establishment. It was identified that the "clusters" that had a higher cost were patients with a median age of 70 and 72 years, with a high number of days of stay and with some highly complex surgery. Conclusion. Cost patterns for IHD care were associated with length of stay and readmissions to the health facility. The "clusters" with the highest cost were related to age and complexity of the surgery.

[Perceptions of resident physicians on the development of the cardiology resident program during the COVID-19 pandemic in Lima, Peru]. / Percepciones de los médicos residentes sobre el desarrollo del programa de residentado de cardiología durante la pandemia por COVID-19 en Lima, Perú.

Objective: To describe the perceptions of resident doctors about the development of their training program during the pandemic in the city of Lima - Peru. Materials and methods: Through a cross-sectional study, a questionnaire was applied to seventy-eight cardiology residents in the last two years of training in the specialty. The perceptions about the accompaniment and support of the universities in the educational venues, for the development of the training program in cardiology during the pandemic, were evaluated. Results: Regarding the support provided for their training, the items evaluated showed shortcomings above 60%, where permanent supervision was lacking in 90.0% of the residents. Regarding compliance with the rotations, the residents only received supervision in 24.4%, observing that they did not manage to carry out adequate rotations in 80.8% of the cases. The courses of the curricular plan were adequately developed in 92.5% of the cases, and the actions for the health of the resident were very low, highlighting that only in 9.0% of the cases did the university inquire about the state of health of the resident. Conclusions: The development of the cardiology residency training program during the pandemic presented important shortcomings, showing that the deficiencies were accentuated compared to previous studies.

[Compliance with the cardiology residency training program during the COVID-19 pandemic, Lima-Peru]. / Cumplimiento del programa de formación del residentado en cardiología durante la pandemia COVID-19, Lima-Perú.

Objective: To characterize compliance with the annual curricular program of second and third-year cardiology residents in hospital of Lima-Peru during the COVID-19 pandemic. Materials and methods: A cross-sectional study was conducted, through a questionnaire applied to seventy-eight cardiology residents from the second and third year of specialty. We evaluated the compliance with rotations in clinical fields, individual compliance with the annual program, and the achievement of minimum training standards. Results: Compliance with rotations in clinical fields was highly variable (from 7.9% in Cardiac Rehabilitation for the second year to 90.9% for imaging in cardiology). Regarding individual compliance, 98.7% did not manage to comply with the annual program. Finally, only the standard of evaluation by radionuclides of myocardial function and perfusion was achieved by all residents, concerning the scope of the other achievements, variations are reported from 4.4% for performing stress tests to 75.8% in the to participate in interventional cardiology procedures. Associations were found between compliance with rotations with the type of health organization and type of university. Conclusions: The COVID-19 pandemic has considerably affected the training of cardiology residents, mainly due to non-compliance with the annual curriculum.

Depression and anxiety symptoms and perceived stress in health professionals in the context of COVID-19: Do adverse childhood experiences have a modulating effect?

BACKGROUND: Adverse childhood experiences (ACE) have a great impact on mental health outcomes of adults. However, little is known whether ACE may act as modulators of the mental health of health professionals caring for patients with COVID-19. METHODS: Data were collected through an online cross-sectional survey administered to health professionals in Lima (Peru) between May and July 2020. The survey included standardized self-assessment instruments for anxiety, depression, acute stress (AS) and history of ACE. RESULTS: A total of 542 health professionals completed the survey. Caring for patients with COVID-19 was significantly associated with depression and anxiety and when caring for patients with COVID-19 was combined with a history of early sexual abuse, its effect on the risk of anxiety increased (OR = 7.71, p = .010). Mental health problems were associated with female gender in almost all the analyses and with the majority of ACEs. CONCLUSIONS: Health workers in the context of the COVID-19 pandemic presented a high risk of mental health disorders. Antecedents of sexual abuse acted as a potentiating factor of anxiety in professionals providing COVID-19 care. These findings suggest that the burden of ACE modulates mental health problems in health professionals during the pandemic.

Reducción del riesgo cardiovascular en trabajadores de un instituto de salud especializado mediante un programa de prevención cardiovascular / Reduction of cardiovascular risk in professionals from a specialized health institute by a cardiovascular preventive program

RESUMEN Introducción. Los programas de rehabilitación cardiovascular (PRC) representan una estrategia médico-sanitaria multidisciplinaria eficaz en la prevención y control de los problemas cardiovasculares. Objetivos. Evaluar el impacto de un PRC realizado en el espacio de trabajo, en la reducción del riesgo cardiovascular absoluto en los trabajadores de INCOR. Métodos. Estudio experimental. Se incluyó a 41 trabajadores con diferentes niveles de riesgo cardiovascular, evaluados previa y posteriormente a su participación en el PRC sobre su capacidad funcional, sus factores de riesgo cardiovascular y niveles de estrés. El programa de intervención en el trabajo consistió en 36 sesiones de actividad física controlada, consejería nutricional, consejería psicológica y evaluación de laboratorio. Resultados. Se redujo el riesgo cardiovascular global al nivel bajo en el 100% medido mediante el índice de Framingham y en la medición con el score ASCVD 2013, se eliminó el nivel de riesgo alto y el nivel intermedio se redujo de 17,5% a 10%. La capacidad funcional mejoró, incrementándose la clase funcional I de 19,5% a 90%. Los niveles de VLDL, LDL, colesterol total y triglicéridos se redujeron significativamente en la post-intervención, mientras que para el HDL, la proporción de trabajadores con valores no recomendables se incrementó al final de la intervención. Se encontró disminución significativa del nivel de estrés. Conclusiones. Un PRC puede ser implementado en el mismo ámbito laboral y mostrar su comprobada eficacia para reducir el riesgo cardiovascular y el estrés.

ABSTRACT Introduction. The cardiovascular rehabilitation programs (CRP) represent an effective multidisciplinary medical-health strategy in prevention and control of cardiovascular problems. Objective. To assess the impact of a CRP carried out in the workplace, in reducing absolute cardiovascular risk in INCOR workers. Methods. An experimental study. 41 workers with different levels of cardiovascular risk were included and were evaluated before and after their participation in the CRP on their functional capacity, cardiovascular risk factors and stress levels. The work intervention program consisted of 36 sessions of controlled physical activity, nutritional counseling, psychological counseling and laboratory evaluation. Results. The intervention get a reduction of the overall cardiovascular risk to the low level in all workers (100%), measured by the Framingham index and when it was measured with the ASCVD 2013 score, the high-risk level was eliminated and the intermediate level was reduced from 17,5% to 10%. The functional capacity shows an improvement, with an increase of cardiovascular risk level I from 19,5% to 90%. Blood lipids levels as VLDL, LDL, total cholesterol and triglycerides were significantly reduced in the post-intervention. Contrarily, in the HDL levels, the proportion of workers with non-recommended values increased to the end of the intervention. Finally, the CRP showed effectiveness in reducing workers' stress. Conclusion. A CRP could to be implemented on workplace and it shows effectiveness in reducing cardiovascular risk and stress.

Cancer cases detected in the prevention and control service of a private cancer clinic in Peru.

PURPOSE: Describe the characteristics of patients seen at the Cancer Prevention and Control Service at a Peruvian private cancer clinic in 2014. PATIENTS AND METHODS: This retrospective clinical study analyzed the prevalence of 10 cancers and characteristics of patients seen at a private cancer center located in Lima, Peru. The study sample included 7680 adults, and data were collected from de-identified medical records. RESULTS: The average age of the patients was 44.71 years and 98,82% of them had private insurance. The majority of patients were women (67.69%). Our gross incidence rate of cancer was 35.16 per 100,000 in the Cancer Prevention and Control Service in 2014. Only 0.35% had cancer, and most of those diagnosed with cancer (77.78%) were diagnosed in the early stages, stages I and II. The two most common cancers observed were breast and thyroid cancer. CONCLUSIONS: The high rates of early, rather than late-stage diagnoses at this clinic are dramatically different than national rates. This difference may be because we are analyzing data from a prevention service seeing mainly patients with private insurance as opposed to national data, which consists primarily of patients seen in oncologic services with national insurance.

Correction to: Cancer cases detected in the prevention and control service of a private cancer clinic in Peru.

[This corrects the article DOI: 10.1186/s13027-019-0259-0.].

Eficacia del transplante autologo intracoronario de células madre CD34+ en pacientes con infarto de miocardio antiguo / Efficacy of intracoronary autologous transplantation of CD34+ stem cells in patients with old myocardial infarction

Antecedentes: la recuperación o mejoramiento de la función cardiaca en pacientes con infarto de miocardio antiguo se limita al manejo farmacológico y de rehabilitación. La terapia de células madre podría incrementar la función cardiaca en estos pacientes. Objetivos: determinar el grado de efectividad para recuperar la función cardiaca mediante el transplante de células madre en pacientes con infarto de miocardio antiguo. Método: ensayo clínico sin grupo de control en pacientes con infarto de miocardio antiguo de la menos cinco meses, a quienes se realiza un transplante de células madres por vía transcoronaria. Resultados: todos los pacientes mejoraron su función cardiaca y otros parámetros cardíacos; la Fracción de Eyección (FE) se incremento en un 30 por ciento en promedio en los pacientes entre el valor basal y los 06 meses; también se observó mejora en la Pureba de esfuerxo graduada (PEG) del 10 por ciento y en el consumo de METS en 20 por ciento. Conclusiones: La terapia con células madre CD34+ mejora la función cardiaca y la capacidad funcional.

Background: recovery or improvement of cardiac function in patients with old myocardial infarction is limited to medication management and rehabilitation. The stem cell therapy could improve cardiac function in these patients. Objectives: To determinate the degree of effectiveness to restore heart function by transplanting stem cells in patients with old myocardial infarction. Method: A clinical trial without control group in patients with old myocardial infarction at least five months, who underwent a transplant of stem cells through transcoronaria. Results: All patients improved their cardiac function and other parameters Cardiac Ejection Fraction (EF) was increased by 30 per cent on average in patients between baseline and 06 months, there was also improvement in the stress test graduated (PEG) 10 per cent and METS consumption by 20 per cent. Conclusions: Therapy with CD34+ stem cells improves cardiac function and functional capacity.

Estudio de un brote epidémico de enfermedad febril exantemática en una comunidad campesina del departamento del Cusco / Study of an outbreak of febrile rash illness in a rural community in the department of Cusco

Se describe un brote de enfermedad febril exantemática, compatible con tifus exantemático, ocurrido en una comunidad campesina del Cusco. El brote tuvo 5 semanas de duración y afectó sobre todo al grupo en edad productiva. Además se describe las características clínicas de los afectados, el proceso de intervención, la participación de los líderes y de la comunidad en el control del brote y los procedimientos y resultados de la intervención.

This article describes an epidemic outbreak of exanthematic febrile disease, compatible with typhus exanthematic, the outbreak had five weeks of duration and affected mainly at the productive a age group. Also, it describes the cases’ clinical characteristics, the intervention process, the community participation and the intervention’s procedure and results.