Introducción: Las motivaciones para estudiar la carrera de medicina podrían jugar un rol importante en el futuro desempeño de los profesionales. Objetivo: Validar una escala para evaluar las motivaciones para estudiar medicina en estudiantes de medicina latinoamericanos. Métodos: Estudio de corte transversal multicéntrico que incluyó a una muestra de estudiantes de 18 escuelas de medicina de ocho países hispanohablantes. A partir de un instrumento español y estudios cualitativos se generó una matriz inicial de 24 ítems con escala tipo-Likert, cuya compresión fue evaluada en un estudio piloto. Se efectuó un análisis factorial exploratorio (AFE), mediante el análisis de componentes principales con rotación oblicua oblimin y normalización de Kaiser, previa evaluación de la correlación ítem-test. La determinación estadística del número de dominios fue basada en el criterio de Kaiser, la pendiente de Catell y una varianza explicada mínima de 5%. La asignación de los ítems se basó en valores de carga superiores a 0,35. Se midió la consistencia interna con el alpha de Cronbach (α). Resultados: Se incluyó 435 participantes; 55% fueron varones y la media de la edad fue 21,7±2,7 años. Se excluyeron dos ítems debido a una baja correlación ítemtest. En el AFE, se identificaron cinco dominios iniciales; sin embargo, tres de ellos no contaban con una adecuada consistencia interna y su exclusión no afectaba a la consistencia interna global del cuestionario. Finalmente, fueron incluidos dos dominios de seis ítems cada uno: i) social/altruista (α=0,80) y ii) económico/ prestigio (α=0,71), presentaron los cuales explicaban en conjunto el 45,5% de la varianza y presentaron una adecuada consistencia interna global (α=0,74). Conclusiones: La escala generada (MEM-12) es válida y confiable, y está conformada por dos dominios, los cuales denotan aspectossociales y económicos. Se sugiere su uso en la valoración de las motivaciones en la elección de la carrera de medicina en Latinoamérica.

Objectives: To develop a Latin American Consensus about Pediatric Cardiopulmonary Resuscitation. To clarify, reinforce, and adapt some specific recommendations for pediatric patients and to stimulate the implementation of these recommendations in clinical practice. Design: Expert consensus recommendations with Delphi methodology. Setting: Latin American countries. Subjects: Experts in pediatric cardiopulmonary resuscitation from 19 Latin American countries. Interventions: Delphi methodology for expert consensus. Measurements and Main Results: The goal was to reach consensus with all the participating experts for every recommendation. An agreement of at least 80% of the participating experts had to exist in order to deliver a recommendation. Two Delphi voting rounds were sent out electronically. The experts were asked to score between 1 and 9 their level of agreement for each recommendation. The score was then classified into three groups: strong agreement (score 7–9), moderate agreement (score 4–6), and disagreement (score 1–3). Nineteen experts from 19 countries participated in both voting rounds and in the whole process of drafting the recommendations. Sixteen recommendations about organization of cardiopulmonary resuscitation, prevention, basic resuscitation, advanced resuscitation, and postresuscitation measures were approved. Ten of them had a consensus of 100%. Four of them were agreed by all the participants except one (94.7% consensus). One recommendation was agreed by all except two experts (89.4%), and finally, one was agreed by all except three experts (84.2%). All the recommendations reached a level of agreement. Conclusions: This consensus adapts 16 international recommendations to Latin America in order to improve the practice of cardiopulmonary resuscitation in children. Studies should be conducted to analyze the effectiveness of the implementation of these recommendations.

Background: The purpose of this study was to determine the association between social media dependence and depressive symptoms and also, to characterize the level of dependence. It was a transversal, analytical research. Subjects and Methods: The stratified sample was 212 students from a private university that used Facebook, Instagram and/or Twitter. To measure depressive symptoms, Beck Depression Inventory was used, and to measure the dependence to social media, the Social Media Addiction Test was used, adapted from the Internet Addiction Test of Echeburúa. The collected data were subjected for analysis by descriptive statistics where STATA12 was used. Results: The results show that there is an association between social media dependence and depressive symptoms (PR [Prevalence Ratio] = 2.87, CI [Confidence Interval] 2.03–4.07). It was also shown that preferring the use of Twitter (PR = 1.84, CI 1.21–2.82) over Instagram (PR = 1.61, CI 1.13–2.28) is associated with depressive symptoms when compared to the use of Facebook. Conclusion: Excessive social media use is associated with depressive symptoms in university students, being more prominent in those who prefer the use of Twitter over Facebook and Instagram.

Objective. To estimate cause of death and to identify factors associated with risk of inhospital mortality among patients with T2D. Methods. Prospective cohort study performed in a referral public hospital in Lima, Peru. The outcome was time until event, elapsed from hospital admission to discharge or death, and the exposure was the cause of hospital admission. Cox regression was used to evaluate associations of interest reporting Hazard Ratios (HR) and 95% confidence intervals. Results. 499 patients were enrolled. Main causes of death were exacerbation of chronic renal failure (38.1%), respiratory infections (35.7%), and stroke (16.7%). During hospital stay, 42 (8.4%) patients died. In multivariable models, respiratory infections (HR = 6.55, ), stroke (HR = 7.05, ), and acute renal failure (HR = 16.9, ) increased the risk of death. In addition, having 2+ (HR = 7.75, ) and 3+ (HR = 21.1, ) conditions increased the risk of dying. Conclusion. Respiratory infections, stroke, and acute renal disease increased the risk of inhospital mortality among hospitalized patients with T2D. Infections are not the only cause of inhospital mortality. Certain causes of hospitalization require standardized and aggressive management to decrease mortality.

Cartas al editor.

Purchase management of medical supplies is a critical and important process that affects the services provision quality. Nonetheless, it is facing a growing pressure to provide visibility and traceability of the purchase, to reduce fraud, to improve flexibility and to ensure communication between everyone involved. Currently, private health institutions in Peru choose to implant different software products within the same company with restricted visibility access to other concerned parties and based on information from a single source. A new alternative is Blockchain technology, since it provides a single source of shared truth to all participants and ensures that the information cannot be altered, thus offering high levels of transparency that, together with IoT technology, creates not only visibility about where things are, but also traceability, showing the current state of things.

Este documento examina el impacto de la membresía cooperativa agropecuaria sobre los rendimientos financiero y productivo en los años 2015 y 2016. Empleamos los modelos Propensity Score Matching y Pooled OLS sobre los datos del Censo de Cooperativas y de la Encuesta Nacional Agropecuaria. Nuestro análisis revela que la membresía cooperativa afecta positivamente los rendimientos en los sectores agrario y agropecuario, pero no en el sector pecuario. Dicho impacto supera los impactos estimados para otras formas de asociatividad. Asimismo, se encuentra un efecto spillover positivo de una localidad con alta presencia cooperativa sobre localidades aledañas. Finalmente, se descubre que la participación femenina en directorios cooperativos agropecuarios también influye positivamente sobre los rendimientos de los productores agropecuarios.

Antepartum suicidal behaviors are a leading cause of maternal injury and death. Previous research has not investigated associations between antepartum suicidal ideation and perinatal complications. Our study objective was to evaluate the relationship of antepartum suicidal ideation with low infant birthweight, small for gestational age, and preterm birth. A cohort study was conducted among 1,108 women receiving prenatal care in Peru. Suicidal ideation was measured using the Patient Health Questionnaire-9 during pregnancy. Birth outcomes were extracted from medical records. Linear regressions and multivariable logistic regressions were used to estimate were used to investigate associations between suicidal ideation and pregnancy outcomes. The prevalence of suicidal ideation was 8.7%, preterm delivery was 5.7%, low birthweight was 4.4%, and small for gestational age was 3.4%. In an adjusted model, infant birthweight was 94.2 grams lower for mothers with antepartum suicidal ideation (95% CI: −183.0, −5.5, p = 0.037) compared with those without suicidal ideation. After adjusting for confounders including depression, participants with suicidal ideation had a nearly four-fold increased odds of delivering a small for gestational age infant (OR: 3.73; 95% CI: 1.59–8.74). These findings suggest suicidal ideation during pregnancy is associated with adverse perinatal outcomes, especially low infant birthweight.

Cervical cancer is one of the main causes of death by disease worldwide. In Peru, it holds the first place in frequency and represents 8% of deaths caused by sickness. To detect the disease in the early stages, one of the most used screening tests is the cervix Papanicolaou test. Currently, digital images are increasingly being used to improve Pap test efficiency. This work develops an algorithm based on adaptive thresholds, which will be used in Pap smear assisted quality control software. The first stage of the method is a pre-processing step, in which noise and background removal is done. Next, a block is segmented for each one of the points selected as not background, and a local threshold per block is calculated to search for cell nuclei. If a nucleus is detected, an artifact rejection follows, where only cell nuclei and inflammatory cells are left for the doctors to interpret. The method was validated with a set of 55 images containing 2317 cells. The algorithm successfully recognized 92.3% of the total nuclei in all images collected.

El término de “cambio climático” no es un concepto nuevo, pero su impacto en la salud pública está en continua revisión. Sabemos que el clima ya cambió y va seguir cambiando por los próximos siglos con el aumento de la temperatura global promedio, y el consecuente aumento del nivel del mar. Este hecho hace que los esfuerzos para la mitigación de la emisión de gases sean relevantes únicamente a muy largo plazo y para generaciones de humanos cuyos padres aun no nacen. Si hablamos de salud pública en el contexto de cambio climático, hablamos de adaptación. En el presente, los países más afectados por los efectos del cambio climático son justamente los países como el Perú, sin una huella ecológica significativa a nivel mundial, pero que son altamente sensibles a los efectos del clima. Sin proyecciones confiables del cambio en el clima, el impacto en la salud puede ser incierto y complicado. Sin embargo, a nivel local, cada distrito puede identificar sus propias vulnerabilidades y definir sus prioridades para asegurar la salud de su población. Existen y se pueden crear indicadores de salud ambiental para monitorizar qué tan bien nos estamos adaptando y qué tan preparados estamos para los cambios en el clima. La adaptación a los cambios del clima implica elevar las condiciones de vida, mejorar los sistemas de vigilancia epidemiológica y ampliar el acceso a servicios de salud. La lucha contra los efectos del cambio climático en salud pública es la lucha contra la pobreza y la desigualdad, y eso no es nada nuevo en el Perú.