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  • Bioimpedance markers and tuberculosis outcome among HIV-infected patients

    Montalvo, R; Bernabe Ortiz, A; Kirwan, D; Gilman, R; otivo3@hotmail.com (Obafemi Awolowo University, 2018)
    ackground: The changes in body composition markers (weight, fat mass, lean mass, and BMI) over time can be associated with TB treatment outcome among HIV-infected patients. The aim of this study was to investigate whether changes in fat mass and lean mass were associated with the treatment response among patients with HIV infection and pulmonary tuberculosis. Materials and Methods: This was a prospective cohort study. Data from HIV-infected patients commencing TB therapy were analyzed. This included body weight measurement using bioimpedance equipment at baseline, one month, and two months after starting TB treatment. Results: The study was conducted in 125 patients, 17 patients (13.6%) died during treatment, of which 5 died during the first month of treatment, 4 during the second month and 8 after the second month. The group of patients with good response, increased their weight by 1.3 kg (p <0.001) at the end of the first month of TB treatment and 2.6 kg in the second month (p <0.001), and body fat increase was 1.2 Kg (p <0.001) and 2.3 kg (p <0.001), the first and second month respectively. The group of patients who died had lost 2.1 kg fat mass after the first month (p <0.001) and 3.7 kg in the second month (p <0.001). Conclusions: Our results show that the weight change during TB treatment (increased fat mass) helps us predict therapeutic response. Weight loss during the first month of starting therapy should be evaluated thoroughly to identify the probable cause of treatment failure.
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  • Síndrome metabólico en pacientes con infección por VIH: ¿oportunidad para la suplementación nutricional?

    Valdivia-Caramantín, Wendy; Mezones-Holguín, Edward; michellvc@gmail.com (Sociedad Chilena de Infectologia, 2018)
    “Cartas al editor”
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  • Estrategia de uno en uno para mejorar la técnica correcta de higiene de manos

    Carpio Rodríguez, A; Mercado Gonzáles, S; sofimg2311@gmail.com (Instituto Nacional de Pediatria, 2018-01)
    Acceso abierto
  • Re: Maud Rijnders, Ronald de Wit, Joost L. Boormans, Martijn P.J. Lolkema, Astrid A.M. van der Veldt. Systematic Review of Immune Checkpoint Inhibition in Urological Cancers. Eur Urol. 2017;72:411–23

    Martinez Merizalde Balarezo, Nelson; Monroe Rivera, Mark; Tejada, Romina A.; nelson.mmb1402@gmail.com (Elsevier B.V., 2018-03)
    “Cartas al editor”
    Acceso restringido temporalmente
  • Biliary peritonitis due to a ruptured amebic liver abscess mimicking a periampullary tumor and liver metastases with the elevation of CA 19-9 and CA 125: a case report

    Marin-Leiva, Javiera; Jeri-Yabar, Antoine; Hernandez Fernandez, Wendy; Damian Bello, Edwin (S. Karger AG, 2018-06)
    Introduction: An amebic liver abscess is the most common presentation of extraintestinal amebiasis. This condition is the result of a parasite infection caused by Entamoeba histolytica. Materials and Methods: We report a case of a 53-year-old male who presented with abdominal pain in the right upper quadrant, jaundice, and a 10-kg weight loss within a 1-month span. Results and Conclusion: A wide range of symptoms and findings in the imaging tests suggestive of neoplasia, elevated levels of CA 19-9 and CA 125, and the presentation of biliary peritonitis as a complication makes this case a challenge for its approach and management.
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  • “All citizens of the world can save a life” — The World Restart a Heart (WRAH) initiative starts in 2018

    Böttiger, B.W.; Lockey, A.; Aickin, R.; Castren, M.; de Caen, A.; Escalante, R.; Kern, K.B.; Lim, S.H.; Nadkarni, V.; Neumar, R.W.; Nolan, J.P.; Stanton, D.; Wang, T.-L.; Perkins, G.D.; bernd.boettiger@uk-koeln.de (Elsevier Ireland Ltd, 2018-07)
    “All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.
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  • Response

    Khunger, Monica; Hernandez, Adrian V.; Velcheti, Vamsidhar; velchev@ccf.org (Elsevier Inc, 2018-10)
    Carta al editor
    Acceso abierto
  • Polypoid angiodysplasia mimicking diverticular disease

    Cálamo-Guzmán, Bernardo; De Vinatea-Serrano, Luis; Piscoya, Alejandro; bernardocalamoguzman@gmail.com (Ediciones Doyma, S.L., 2018-11)
  • Understanding drivers of domestic public expenditure on reproductive, maternal, neonatal and child health in Peru at district level: an ecological study

    Huicho, Luis; Hernandez, Patricia; Huayanay-Espinoza, Carlos A.; Segura, Eddy R.; Niño de Guzman, Jessica; Flores-Cordova, Gianfranco; Rivera-Ch, Maria; Friedman, Howard S.; Berman, Peter; lhuicho@gmail.com; patricia.hernandez.consultancy@gmail.com; carlos.huayanay@upch.pe; eddysegura@gmail.com; jninodeguzman@mef.gob.pe; g.flores.cordova@gmail.com; maria.rivera.c@upch.pe; friedman@unfpa.org; pberman@hsph.harvard.edu (BioMed Central Ltd., 2018-11)
    Background: Peru has increased substantially its domestic public expenditure in maternal and child health. Peruvian departments are heterogeneous in contextual and geographic factors, underlining the importance of disaggregated expenditure analysis up to the district level. We aimed to assess possible district level factors influencing public expenditure on reproductive, maternal, neonatal and child health (RMNCH) in Peru. Methods: We performed an ecological study in 24 departments, with specific RMNCH expenditure indicators as outcomes, and covariates of different hierarchical dimensions as predictors. To account for the influence of variables included in the different dimensions over time and across departments, we chose a stepwise multilevel mixed-effects regression model, with department-year as the unit of analysis. Results: Public expenditure increased in all departments, particularly for maternal-neonatal and child health activities, with a different pace across departments. The multilevel analysis did not reveal consistently influential factors, except for previous year expenditure on reproductive and maternal-neonatal health. Our findings may be explained by a combination of inertial expenditure, a results-based budgeting approach to increase expenditure efficiency and effectiveness, and by a mixed-effects decentralization process. Sample size, interactions and collinearity cannot be ruled out completely. Conclusions: Public district-level RMNCH expenditure has increased remarkably in Peru. Evidence on underlying factors influencing such trends warrants further research, most likely through a combination of quantitative and qualitative approaches.
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  • Premature clinical trial discontinuation in the era of immune checkpoint inhibitors

    Khunger, Monica; Rakshit, Sagar; Hernandez, Adrian V.; Pasupuleti, Vinay; Glass, Kate; Galsky, Matthew D.; Grivas, Petros; pgrivas@uw.edu (Wiley-Blackwell, 2018)
    Background: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. We assessed factors of early terminated/withdrawn oncology trials focusing on trials with immune checkpoint inhibitors (ICI), hypothesizing that the latter may be associated with lower rates of premature discontinuation. Materials and Methods: We reviewed all adult, intervention, oncology trials registered in ClinicalTrials.gov (November 16, 2011, to April 16, 2015) to identify all terminated/withdrawn trials and reasons for termination. Logistics regression model was used to identify factors associated with early termination/withdrawal. Discontinuation rate was compared in trials with and without ICI. Results: We identified 12,875 trials (35% industry funded, 12% federal funded), of which 8.5% were prematurely terminated (5%) or withdrawn (3.5%); the main reasons were poor accrual (33%) and logistical (24%). ICI trials (n = 350) had a nonsignificant lower rate of termination or withdrawal compared with all other oncology trials (5.4% vs. 8.5%; p =.9) and were less likely to discontinue due to poor accrual (nonsignificant difference: 21% vs. 33%; p =.4). ICI trials were also less likely to discontinue compared with all other oncology drug trials (e.g., chemotherapy, targeted inhibitors, antiangiogenesis, biologics; 5.4% vs. 7.9%, respectively, nonsignificant difference). The 4-year cumulative incidence of failing to complete for reasons unrelated to toxicity or efficacy was 18% (95% confidence interval 16%–20%). There was no association between annual incidence across different tumor types or accrual goal and rate of trial termination. Conclusion: Poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in ICI compared with other trials. Clinical trial completion remains a high priority and can be influenced by provider and patient factors. Implications for Practice: Clinical trial completion is critical for new cancer therapies. Premature trial termination or withdrawal is common and impairs progress. This study assessed factors of early terminated/withdrawn oncology trials, focusing on trials with immune checkpoint inhibitors (ICI), and found that poor accrual represents the main cause of early cancer trial termination. Premature termination/withdrawal rate was not significantly lower in immune checkpoint inhibitor trials compared to other trials. The discussion herein is focused on measures taken by the National Cancer Institute and other institutions to improve clinical trial accrual and prevent premature clinical trial discontinuation.
  • Association of antepartum suicidal ideation during the third trimester with infant birth weight and gestational age at delivery

    Gelaye, Bizu; Domingue, Amber; Rebelo, Fernanda; Friedman, Lauren E; Qiu, Chunfang; Sanchez, Sixto E; Larrabure-Torrealva, Gloria; Williams, Michelle A; bgelaye@hsph.harvard.edu (Routledge, 2019-02)
    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.
  • The role of B-type natriuretic peptide in diagnosing acute decompensated heart failure in chronic kidney disease patients

    Kadri, Amer N.; Kaw, Roop; Al-Khadra, Yasser; Abumasha, Hasan; Ravakhah, Keyvan; Hernandez, Adrian V.; Tang, Wai Hong Wilson; kadria@ccf.org (Termedia Publishing House Ltd., 2018)
    Introduction: Chronic kidney disease (CKD) and congestive heart failure (CHF) patients have higher serum B-type natriuretic peptide (BNP), which alters the test interpretation. We aim to define BNP cutoff levels to diagnose acute decompensated heart failure (ADHF) in CKD according to CHF subtype: heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Material and methods: We reviewed 1,437 charts of consecutive patients who were admitted for dyspnea. We excluded patients with normal kidney function, without measured BNP, echocardiography, or history of CHF. BNP cutoff values to diagnose ADHF for CKD stages according to CHF subtype were obtained for the highest pair of sensitivity (Sn) and specificity (Sp). We calculated positive and negative likelihood ratios (LR+ and LR–, respectively), and diagnostic odds ratios (DOR), as well as the area under the receiver operating characteristic curves (AUC) for BNP. Results: We evaluated a cohort of 348 consecutive patients: 152 had ADHF, and 196 had stable CHF. In those with HFpEF with CKD stages 3–4, BNP < 155 pg/ml rules out ADHF (Sn90%, LR– = 0.26 and DOR = 5.75), and BNP > 670 pg/ml rules in ADHF (Sp90%, LR+ = 4 and DOR = 6), with an AUC = 0.79 (95% CI: 0.71–0.87). In contrast, in those with HFrEF with CKD stages 3–4, BNP < 412.5 pg/ml rules out ADHF (Sn90%, LR– = 0.19 and DOR = 9.37), and BNP > 1166.5 pg/ml rules in ADHF (Sp87%, LR+ = 3.9 and DOR = 6.97) with an AUC = 0.78 (95% CI: 0.69–0.86). All LRs and DOR were statistically significant. Conclusions: BNP cutoff values for the diagnosis of ADHF in HFrEF were higher than those in HFpEF across CKD stages 3–4, with moderate discriminatory diagnostic ability.
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  • Effect of a salt-reduction strategy on blood pressure and acceptability among customers of a food concessionaire in Lima, Peru

    Reynoso-Marreros, Isabel A.; Piñarreta-Cornejo, Perlita K.; Mayta-Tristán, Percy; Bernabé-Ortiz, Antonio; antonio.bernabe@upch.pe (Blackwell Publishing Ltd, 2018)
    Aim: Limited information exists regarding the implementation of salt reduction strategies on collective food services, such as restaurants and food concessionaires. The present study aimed to assess the effect of a salt reduction strategy on blood pressure levels and food acceptability among customers of a food concessionaire. Methods: A quasi-experimental study with two phases was conducted. In the pre-intervention phase, the amount of salt used in food preparation was determined. In the intervention phase, a reduction of 20% in salt added to food preparations was implemented. Four hedonic tests and two blood pressure measurements were performed before and after the intervention implementation using standardised techniques. In addition, an evaluation of uneaten food was conducted daily on all customers' plates. Mixed linear regression models were generated to assess the effect of the intervention on blood pressure and acceptability. Results: A total of 71 workers were evaluated, mean age of 37.5 years, 57.8% females, who consumed the food of the concessionaire, on average, 4.4 (SD: 0.7) days per week. Systolic and diastolic blood pressure were reduced by 3.1 (P<0.001) and 2.9 (P<0.001) mmHg at the end of the study, respectively. The results of the hedonic tests and the uneaten food before and after the intervention did not vary significantly. Conclusions: The reduction of 20% of salt added to food from a concessionaire had a positive impact on the reduction of customers' blood pressure without reducing food acceptability. This strategy could be implemented in other contexts.
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  • Development of a clinical prediction rule for tuberculous meningitis in adults in Lima, Peru

    Solari, L; Soto, A; Van der Stuyft, P; pcmeasot@upc.edu.pe (Blackwell Publishing Ltd, 2018-04)
    Objectives: Diagnosis of tuberculous meningitis (TM) is a challenge in countries with a high burden of the disease and constrained resources and clinical prediction rules (CPRs) could be of assistance. We aimed at developing a CPR for diagnosis of TM in a Latin American setting with high tuberculosis incidence and a concentrated HIV epidemic. Methods: We enrolled adult patients with clinical suspicion of TM attending two hospitals in Lima, Peru. We obtained information on potential anamnestic, clinical and laboratory predictive findings that are easy to collect and promptly available. We independently diagnosed TM according to a composite reference standard that included a series of microbiological tests. We performed bivariate analysis and constructed a logistic regression model to select the predictive findings associated with TM. With the selected predictors included in the model, we developed a score-based CPR. We assessed its internal validity and diagnostic performance. Results: Of 155 analysed patients, 59 (38%) had TM. The CPR we derived includes three predictors: cough for 14 days or more, 10–500 cells in CSF and adenosine deaminase ≥ 6 U/l in CSF. It classifies patients into high-, moderate- or low-score groups and has an overall area under the ROC curve of 0.87. 59% of patients were assigned to either the high- or the low-score group, permitting prompt decision-making. In patients in the high-score group, it attains a positive likelihood ratio for TM of 10.6 and in patients with low scores, a negative likelihood ratio of 0.10. Bootstrap analysis indicated high internal validity. Conclusion: This CPR could support decision-making in patients with clinical suspicion of TM. External validation and further assessment of its clinical impact are necessary before application in other settings.
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  • Diagnosis of erectile dysfunction can be used to improve screening for Type 2 diabetes mellitus

    Carrillo Larco, R.M; Luza Dueñas, A.C; Urdániga Hung, M.c; Bernabé Ortiz, A; antonio.bernabe@upch.pe (Blackwell Publishing Ltd, 2018-11)
    Aims: To assess the diagnostic accuracy of four undiagnosed Type 2 diabetes mellitus risk scores accounting for erectile dysfunction status. Methods: This was a population-based cross-sectional study. Type 2 diabetes was defined according to a oral glucose tolerance test and self-reported physician diagnosis. Erectile dysfunction was defined according to the answer to the question, ‘Have you had difficulties obtaining an erection in the last 6 months?’ (yes/no). The risk scores used were the FINDRISC, LA-FINDRISC, American Diabetes Association score and the Peruvian Risk Score. A Poisson regression model was fitted to assess the association between Type 2 diabetes and erectile dysfunction. The area under the receiver-operating characteristic curve was estimated overall and by erectile dysfunction status. Results: A total of 799 men with a mean (sd) age of 48.6 (10.7) years were included in the study. The overall prevalence of Type 2 diabetes was 9.3%. Compared with healthy men, men with Type 2 diabetes had 2.71 (95% CI 1.57–4.66) higher chances of having erectile dysfunction. Having excluded men aware of Type 2 diabetes status (N=38), the area under the receiver-operating characteristic curve of three of the risk scores (not the American Diabetes Association score) improved among those who had erectile dysfunction in comparison with those who did not; for example, the area under the receiver-operating characteristic curve of the LA-FINDRISC score was 89.6 (95% CI 78.7–99.9) in men with erectile dysfunction and 76.5 (95% CI 68.5–84.4) overall. Conclusions: In a population-based study, erectile dysfunction was more common in men with Type 2 diabetes than in the otherwise healthy men. Screening for erectile dysfunction before screening for Type 2 diabetes seems to improve the accuracy of well-known risk scores for undiagnosed Type 2 diabetes.
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  • Place of origin associated with depressive symptoms in health professionals performing social health service in Ancash, Peru, 2015

    Montesinos-Segura, Renee; Maticorena-Quevedo, Jesus; Chung-Delgado, Kocfa; Pereyra-Elías, Reneé; Taype-Rondan, Alvaro; Mayta-Tristán, Percy; p.mayta@gmail.com (ARHEN - Australian Rural Health Education Network Ltd, 2018)
    Introduction: Health professionals performing their social health service (SHS) in rural communities could be at risk of developing depression. Moreover, those who migrate from farther places to perform their SHS could have an increased risk. The objective of this study was to evaluate the association between place of origin and the presence of depressive symptoms, in health professionals performing rural social health service (SHS) in Ancash, Peru. Methods: This was a cross-sectional study. During April 2015, a survey was applied to health professionals performing SHS in the Peruvian Ministry of Health (MINSA) facilities in Ancash. The main outcome was the presence of depressive symptoms, defined as a score =2 points in the Patient Health Questionnaire-2. The main exposure was the place of origin, defined as the place where the subjects completed their undergraduate professional studies (Ancash, Lima city or others). Poisson regressions with robust variance were performed to calculate crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence interval (95%CI). Results: From 573 health professionals performing their SHS in MINSA in Ancash, 347 were included in the study. The mean age was 27.2±4.5 years, 78.7% were women, and 14.7% scored positive for depressive symptoms. Those who had completed their undergraduate professional studies in Lima city had a higher prevalence of presence of depressive symptoms compared to those who did in Ancash (aPR=2.59, 95%CI=1.23-5.45). Conclusions: Those who completed their undergraduate professional studies in Lima had a higher prevalence of depressive symptoms than those who did in Ancash. Possible explanations include the difficulty in visiting family and friends, acculturation, and lack of Quechua language proficiency.
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  • Effect of vegetarian diets on the presentation of metabolic syndrome or its components: a systematic review and meta-analysis

    Picasso, Maria C.; Lo-Tayraco, Jessica A.; Ramos-Villanueva, Juselly M.; Pasupuleti, Vinay; Hernandez, Adrian V.; mariaclaudiapicasso@gmail.com; jlotayraco@gmail.com; jurv1114@gmail.com; lepiscean@gmail.com; adrianhernandezdiaz@gmail.com (Churchill Livingstone, 2018)
    Background & aims: Several studies have examined the effect of vegetarian diets (VD) on metabolic syndrome (MetS) or its components, but findings have been inconsistent. The aim of this study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies to assess the association between VD and MetS or its components (systolic blood pressure [SBP], diastolic blood pressure [DBP], fasting glucose triglycerides, waist circumference [WC], HDL-cholesterol (HDL-C)) in adults. Methods: The Cochrane Library, EMBASE, PubMed, Web of Science, and Scopus were searched. RCTs, cohort studies and cross-sectional studies evaluating the effects of VD on MetS or its components in adults, with omnivore diet as control group, were included. Random effects meta-analyses stratified by study design were employed to calculate pooled estimates. Results: A total of 71 studies (n = 103 008) met the inclusion criteria (6 RCTs, 2 cohorts, 63 cross-sectional). VD were not associated with MetS in comparison to omnivorous diet (OR 0.96, 95% CI 0.50–1.85, p = 0.9) according to meta-analysis of five cross-sectional studies. Likewise, meta-analysis of RCTs and cohort studies indicated that consumption of VD were not associated with MetS components. Meta-analysis of cross-sectional studies demonstrated that VD were significantly associated with lower levels of SBP (mean difference [MD] −4.18 mmHg, 95%CI −5.57 to −2.80, p < 0.00001), DBP (MD −3.03 mmHg, 95% CI −4.93 to −1.13, p = 0.002), fasting glucose (MD −0.26 mmol/L, 95% CI −0.35to −0.17, p < 0.00001), WC (MD −1.63 cm, 95% CI −3.13 to −0.13, p = 0.03), and HDL-C (MD −0.05 mmol/L, 95% CI −0.07 to −0.03, p < 0.0001) in comparison to omnivorous diet. Heterogeneity of effects among cross-sectional studies was high. About, one-half of the included studies had high risk of bias. Conclusions: VD in comparison with omnivorous diet is not associated with a lower risk of MetS based on results of meta-analysis of cross-sectional studies. The association between VD and lower levels of SBP, DBP, HDL-C, and fasting glucose is uncertain due to high heterogeneity across the cross-sectional studies. Larger and controlled studies are needed to evaluate the association between VD and MetS and its components.
  • Necesidad de una aproximación integral al estado nutricional del adulto mayor

    Yataco Vicente, Javier Alberto; Araujo Castillo, Roger Vladimir; javieryataco22@gmail.com (Editorial Ciencias Medicas, 2018-07)
    “Cartas al editor”
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  • Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries

    Calizaya-Gallegos, Carlo; Mayta-Tristán, Percy; Pereyra-Elías, Reneé; José Montenegro-Idrogo, Juan; Avila-Figueroa, Johana; Benítez-Ortega, Ingrid; Cabrera-Enriquez, John; Calixto, Omar-Javier; Pablo Cardozo-López, Juan; Grandez-Urbina, José Antonio; Moreno-Loaiza, Oscar; Rodriguez, Manuel A.; Sepúlveda-Morales, Roxana; Sierra-Avendaño, Jairo A.; Carreño, Fabian; Vásquez-García, Gelsing Richard; Vasquez-Sullca, Roy R.; Yescas, Gilberto; pmayta@cientifica.edu.pe (SAGE Publications Ltd, 2018)
    The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.
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  • Sociología médica: origen y campo de acción

    Balarezo López, Gunther; gunther.balarezo@upc.edu.pe (Universidad Nacional de Colombia, 2018-05)
    Se hizo una revisión de la literatura publicada sobre el origen de la sociología médica y su campo de acción. Para ello, se analizaron diversas publicaciones y se resumieron los aspectos más relevantes. A pesar de que la enfermedad siempre ha estado ligada a aspectos socioculturales, recién a mediados del siglo XX, la medicina reconoce la importancia de la sociología en la explicación de temas relacionados a la salud, especialmente para explicar los determinantes sociales de la salud. En la actualidad, los sociólogos trabajan de manera multidisciplinaria con médicos para investigar y analizar cuestiones concernientes a la salud de las personas, para mejorar el bienestar y la calidad de vida de la población. En este sentido, el aporte de la sociología no solo ha enriquecido la comprensión de algunas enfermedades, sino también diferentes aspectos en el quehacer de la medicina.
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