• Identfication of viral and bacterial etiologic agents of the pertussis-like syndrome in children under 5 years old hospitalized

      Saiki-Macedo, Stephanie; Valverde-Ezeta, Jorge; Cornejo-Tapia, Angela; Castillo, Maria Esther; Petrozzi-Helasvuo, Verónica; Aguilar-Luis, Miguel Angel; Del Valle, Luis J.; Cieza-Mora, Erico; Bada, Carlos; Del Aguila, Olguita; Silva-Caso, Wilmer; Martins-Luna, Johanna; Vasquez-Achaya, Fernando; Del Valle-Mendoza, Juana (BioMed Central Ltd., 2019-01-21)
      Background: Acute respiratory infections (ARIs) represent an important cause of morbidity and mortality in children, remaining a major public health concern, especially affecting children under 5 years old from low-income countries. Unfortunately, information regarding their epidemiology is still limited in Peru. Methods: A secondary data analysis was performed from a previous cross-sectional study conducted in children with a probable diagnosis of Pertussis from January 2010 to July 2012. All samples were analyzed via Polymerase Chain Reaction (PCR) for the following etiologies: Influenza-A, Influenza-B, RSV-A, RSV-B, Adenovirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Mycoplasma pneumoniae and Chlamydia pneumoniae. Results: A total of 288 patients were included. The most common pathogen isolated was Adenovirus (49%), followed by Bordetella pertussis (41%) from our previous investigation, the most prevelant microorganisms were Mycoplasma pneumonia (26%) and Influenza-B (19.8%). Coinfections were reported in 58% of samples and the most common association was found between B. pertussis and Adenovirus (12.2%). Conclusions: There was a high prevalence of Adenovirus, Mycoplasma pneumoniae and other etiologies in patients with a probable diagnosis of pertussis. Despite the presence of persistent cough lasting at least two weeks and other clinical characteristics highly suspicious of pertussis, secondary etiologies should be considered in children under 5 years-old in order to give a proper treatment.
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    • Identification of a norovirus outbreak on a hematopoietic stem cell transplant unit and development and implementation of a novel infection prevention algorithm for controlling transmission

      Branch-Elliman, Westyn; Araujo-Castillo, Roger V.; Snyder, Graham M.; Sullivan, Bernadette F.; Alonso, Carolyn D.; Wright, Sharon B. (Cambridge University Press, 2020-04-01)
      Controlling norovirus transmission in units with immunocompromised patients is challenging. We present a cluster of norovirus cases that occurred on a stem-cell transplant unit and the prevention efforts that were implemented to limit the outbreak. Protocols developed to control this cluster may provide a model for other facilities.
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    • Identification of coinfections by viral and bacterial pathogens in covid-19 hospitalized patients in peru: Molecular diagnosis and clinical characteristics

      Pérez-Lazo, Giancarlo; Silva-Caso, Wilmer; Del Valle-Mendoza, Juana; Morales-Moreno, Adriana; Ballena-López, José; Soto-Febres, Fernando; Martins-Luna, Johanna; Carrillo-Ng, Hugo; Del Valle, Luís J.; Kym, Sungmin; Aguilar-Luis, Miguel Angel; Peña-Tuesta, Issac; Tinco-Valdez, Carmen; Illescas, Luis Ricardo (MDPI, 2021-11-01)
      The impact of respiratory coinfections in COVID-19 is still not well understood despite the growing evidence that consider coinfections greater than expected. A total of 295 patients older than 18 years of age, hospitalized with a confirmed diagnosis of moderate/severe pneumonia due to SARS-CoV-2 infection (according to definitions established by the Ministry of Health of Peru) were enrolled during the study period. A coinfection with one or more respiratory pathogens was detected in 154 (52.2%) patients at hospital admission. The most common coinfections were Mycoplasma pneumoniae (28.1%), Chlamydia pneumoniae (8.8%) and with both bacteria (11.5%); followed by Adenovirus (1.7%), Mycoplasma pneumoniae/Adenovirus (0.7%), Chlamydia pneumoniae/Adenovirus (0.7%), RSV-B/Chlamydia pneumoniae (0.3%) and Mycoplasma pneumoniae/Chlamydia pneumoniae/Adenovirus (0.3%). Expectoration was less frequent in coinfected individuals compared to non-coinfected (5.8% vs. 12.8%). Sepsis was more frequent among coinfected patients than non-coinfected individuals (33.1% vs. 20.6%) and 41% of the patients who received macrolides empirically were PCR-positive for Mycoplasma pneumoniae and Chlamydia pneumoniae.
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    • Identification of human papillomavirus as a preventive strategy for cervical cancer in asymptomatic women in the Peruvian Andes

      Silva-Caso, Wilmer; Olivera Irazábal, Miluska; León Álvarez, Pedro; Del Valle, Luis J.; Díaz Estacio, Sonia; Vargas, Martha; Ruiz, Joaquim; Bermúdez García, Alejandro; Del Valle Mendoza, Juana (Elsevier B.V., 2014-11-20)
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    • Identification of infection by Chikungunya, Zika, and Dengue in an area of the Peruvian coast. Molecular diagnosis and clinical characteristics

      Sánchez-Carbonel, José; Tantaléan-Yépez, Derek; Aguilar-Luis, Miguel Angel; Silva-Caso, Wilmer; Weilg, Pablo; Vásquez-Achaya, Fernando; Costa, Luis; Martins-Luna, Johanna; Sandoval, Isabel; del Valle-Mendoza, Juana (BioMed Central Ltd., 2018-03-14)
      Objective: To assess the presence of Dengue, Chikungunya, and Zika in serum samples of patients with acute febrile illness in Piura, Peru and describe the most common clinical features. Results: Dengue was the most common arbovirus detected in 170/496 (34.3%), followed by Zika in 39/496 (7.9%) and Chikungunya in 23/496 (4.6%). Among the 170 samples positive for Dengue, serotype 2 was the most predominant type present in 97/170 (57.1%) of samples, followed by the serotype 3 in 9/170 (5.3%). Headaches, muscle pain, and joint pain were the most common symptoms associated with fever in patients with Dengue and Zika. No symptoms predominance was observed in patients with Chikungunya.Dengue is considered the most frequent arbovirus in Peru and the number of cases has increased dramatically in the last 5 years. However, it is not the only arbovirus that circulates along the northern coast of Peru. It has also been determined the presence of Zika and Chikungunya in our population, which may suggest the circulation of other arboviruses that have not been detected.
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    • Immunosuppressive and angiogenic cytokine profile associated with Bartonella bacilliformis infection in post-outbreak and endemic areas of Carrion's disease in Peru

      Pons, Maria J.; Gomes, Cláudia; Aguilar, Ruth; Barrios, Diana; Aguilar-Luis, Miguel Angel; Ruiz, Joaquim; Dobaño, Carlota; del Valle-Mendoza, Juana; Moncunill, Gemma; [email protected] (Public Library of Science, 2017-06-19)
      Analysis of immune responses in Bartonella bacilliformis carriers are needed to understand acquisition of immunity to Carrion’s disease and may allow identifying biomarkers associated with bacterial infection and disease phases. Serum samples from 144 healthy subjects from 5 villages in the North of Peru collected in 2014 were analyzed. Four villages had a Carrion’s disease outbreak in 2013, and the other is a traditionally endemic area. Thirty cytokines, chemokines and growth factors were determined in sera by fluorescent bead-based quantitative suspension array technology, and analyzed in relation to available data on bacteremia quantified by RT-PCR, and IgM and IgG levels measured by ELISA against B. bacilliformis lysates. The presence of bacteremia was associated with low concentrations of HGF (p = 0.005), IL-15 (p = 0.002), IL-6 (p = 0.05), IP-10 (p = 0.008), MIG (p = 0.03) and MIP-1α (p = 0.03). In multi-marker analysis, the same and further TH1-related and pro-inflammatory biomarkers were inversely associated with infection, whereas angiogenic chemokines and IL-10 were positively associated. Only EGF and eotaxin showed a moderate positive correlation with bacteremia. IgM seropositivity, which reflects a recent acute infection, was associated with lower levels of eotaxin (p = 0.05), IL-6 (p = 0.001), and VEGF (p = 0.03). Only GM-CSF and IL-10 concentrations were positively associated with higher levels of IgM (p = 0.01 and p = 0.007). Additionally, IgG seropositivity and levels were associated with high levels of angiogenic markers VEGF (p = 0.047) and eotaxin (p = 0.006), respectively. Our findings suggest that B. bacilliformis infection causes immunosuppression, led in part by overproduction of IL-10. This immunosuppression probably contributes to the chronicity of asymptomatic infections favoring B. bacilliformis persistence in the host, allowing the subsequent transmission to the vector. In addition, angiogenic markers associated with bacteremia and IgG levels may be related to the induction of endothelial cell proliferation in cutaneous lesions during chronic infections, being possible candidate biomarkers of asymptomatic infections.
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    • Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru.

      Carrillo Larco, Rodrigo M; Miranda, J Jaime; Bernabe-Ortiz, Antonio; [email protected] (American Journal of Public Health, 2016-05-19)
      Objectives. To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs). Methods. We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006–2007). The outcome was overweight and obesity in mothers and children at follow-up (2009–2010). Results. Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15). Conclusions. Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers.
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    • The impact of the method of consent on response rates in the ISAAC time trends study.

      Ellwood, P; Asher, M I; Stewart, A W; Chiarella, Pacual; ISAAC Phase III Study Group; [email protected] (nternational Union against Tubercul. and Lung Dis., 2010-08-01)
      BACKGROUND: Centres in Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) programme used the method of consent (passive or active) required by local ethics committees. METHODS: Retrospectively, relationships between achieved response rates and method of consent for 13-14 and 6-7-year-olds (adolescents and children, respectively), were examined between phases and between English and non-English language centres. RESULTS: Information was obtained for 113 of 115 centres for adolescents and 72/72 centres for children. Both age groups: most centres using passive consent achieved high response rates (>80% adolescents and >70% children). English language centres using active consent showed a larger decrease in response rate. Adolescents: seven centres changed from passive consent in Phase I to active consent in Phase III (median decrease of 13%), with five centres showing lower response rates (as low as 34%). Children: no centre changed consent method between phases. Centres using active consent had lower median response rates (lowest response rate 45%). CONCLUSION: The requirement for active consent for population school-based questionnaire studies can impact negatively on response rates, particularly English language centres, thus adversely affecting the validity of the data. Ethics committees need to consider this issue carefully.
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    • Impacto de la intervención farmacéutica en la adherencia al tratamiento antirretroviral en pacientes de un hospital de Lima (Perú).

      Tafur Valderrama, E.J.; Ortiz Alfaro, C.; García-Jiménez, E.; Faus Dader, M.J.; Martínez Martínez, F. (Fundación Pharmaceutical Care España, 2014-03-20)
      Introduction: Pharmaceutical care improves medication adherence that is why is important that the pharmacist uses instruments to evaluate and improves it through pharmaceutical intervention at pharmaceutical care. Objective: To evaluate the impact of the pharmaceutical intervention in the improvement of the medication adherence of the patients with HIV and AIDS, and to identify the factors that infl uence on medication adherence and which one could be modifi ed by the pharmaceutical intervention during pharmaceutical care. Methods: Pharmacotherapeutic follow-up was realized for 23 months to 52 patients, older than 18 years, with antiretroviral treatment for up to three months, consent informed was obtained from patients. Medication adherence was evaluated with CEAT-HIV (questionnaire to evaluate the adhesion to the antiretroviral treatment) at the beginning and at the end of the study (6 months). Results: The fi nal score from CEAT-HIV (p <0.05; 95% IC), treatment compliance (p <0.001) and patient’s beliefs to the disease and antiretroviral treatment (p <0.001) improved signifi cantly with the pharmaceutical intervention. The more frequent pharmaceutical intervention was education to the patient to increment the adherence to the treatment (46%). Conclusion: These results demonstrate that the pharmacists’ intervention through pharmacotherapeutic follow-up improves the adherence to the antiretroviral treatment. The pharmacist was able to improve aspects of compliance and patient’s beliefs about the treatment and disease. The pharmacist could utilize CEAT-VIH as an instrument to evaluate the adherence in HIV/AIDS patients.
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    • Impacto de las revistas de salud colombianas: comparación de Publindex versus Google Scholar Metrics, SciELO y SCOPUS

      Rodríguez Morales, Alfonso J.; Ochoa Orozco, Sergio Andrés; Mayta-Tristan, Percy (Centro Nacional de Información de Ciencias Médicas. CUBA., 2014-04-30)
      The citation based indicators are recognized by the scientific community to assess the quality of scientific journals. Colombia has a rating system called the National Journal magazines Index (IBN) / Publindex. The objective of this study is to evaluate the impact of the Colombian health journals according to Google ScholarMetrics (GSM), SciELO, and SCOPUS, compared with the IBN classification for 2007-2011. In analyzing journals by GSM H index, we find that among the worst journals classified "C" by Publindex, there are publications with higher H5 index and H5 median than those top-ranked journals by IBN as "B" and "A2". There are journals such as The Colombian Anesthesiology that without being in IBN, has SciELO higher impact factor than several IBN "A1" journals. There are indexed journals in Scopus which despite being quartile 3 (Q3) are rated "A2" by IBN but they are Q4 journals classified as "A1" by IBN. This shows that Publindex classification is not consistent with journal impact indicators in three systems: GSM, Scopus, and SciELO, as it has been previously suggested by other authors. It is required to improve the Publindex classification and such classification should take into account citation and impact parameters so that the quality reflected in international indicators would be consistent with the national classification.
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    • Impacto del fenómeno "El Niño" de 1997-1998 en la salud de la población peruana, riesgo potencial para el 2015

      Suárez Ognio, Luis; Estela Ayamamani, David Gerardo; Cáceres Mejía, Brenda; Gambirazio Carbajal, Carlos; Cabrera, Rufino (Instituto Nacional de Salud (INS), 2015-07-06)
      Sr. Editor. El National Oceanic and Atmospheric Administration de los Estados Unidos y el Servicio Nacional de Meteorología e Hidrología del Perú han comunicado que en el 2015 se presentará un nuevo fenómeno “El Niño” (El Niño Oscilación Sur-ENSO). Este fenómeno produce elevación de la temperatura ambiental y un incremento de las precipitaciones pluviales (1); ocasionando inundaciones y aluviones (“huaycos”) como consecuencias inmediatas y posteriormente alteración del ecosistema favoreciendo el incremento de la vegetación y la aparición de plagas de insectos y roedores.
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    • Importance of analysis of complex sample survey in a probabilistic study stratified by stages

      Zumaeta, Nixon; Mendoza, Aylen; Hernandez, Adrian V.; [email protected] (Elsevier B.V., 2016-10)
      Carta al Editor
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    • Importancia de la enseñanza de la medicina basada en evidencias.

      Rodríguez Morales, Alfonso J.; Mezones-Holguín, Edward; Tolentino Silva, Marcus; Puebla, Sergio; Orellana, Juan J.; Cárcamo, Daniel; Nunes da Silva, Everton; Risquez Parra, Alejandro; Echezuria Marval, Luis; Mayta-Tristan, Percy (Organo de la Academia Nacional de Medicina y del Congreso Venezolano de Ciencias Médicas., 2014-03-24)
      Cartas al editor.
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    • La importancia del índice de masa corporal en la fuerza muscular

      Aliaga-Vega, Raúl; Altuna-Venegas, Sofia; Maguiña, Jorge Luis; [email protected] (Ediciones Doyma, S.L, 2017-03)
      Carta al Editor
    • In response to fluid resuscitation with lactated Ringer’s solution vs. normal saline in acute pancreatitis: A triple-blind, randomized, controlled trial

      Calamo-Guzman, Bernardo; De Vinatea-Serrano, Luis; Piscoya, Alejandro; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru; Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru (SAGE Publications, 2018-01-11)
      Cartas al editor
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    • In Vitro Sealing Properties of Calcium-Enriched Mixture and Mineral Trioxide Aggregate Orifice Barriers during Intra-Coronal Bleaching

      Valverde Huaranga, J.C; Baldeon, G.L; Caballero-García, S.; [email protected] (Iranian Association of Endodontics, 2017-10)
      Carta al Editor
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    • Incidence of Pneumonitis With Use of Programmed Death 1 and Programmed Death-Ligand 1 Inhibitors in Non-Small Cell Lung Cancer

      Khunger, Monica; Rakshit, Sagar; Pasupuleti, Vinay; Hernandez, Adrian V.; Mazzone, Peter; Stevenson, James; Pennell, Nathan A.; Velcheti, Vamsidhar; [email protected] (Elsevier Inc, 2017-08)
      Background Programmed death 1 (PD-1) programmed death-ligand 1 (PD-L1) inhibitors show significant clinical activity in non-small cell lung carcinoma (NSCLC). However, they are often associated with potentially fatal immune-mediated pneumonitis. Preliminary reports of trials suggest a difference in the rate of pneumonitis with PD-1 and PD-L1 inhibitors. We sought to determine the overall incidence of pneumonitis and differences according to type of inhibitors and prior chemotherapy use. Methods MEDLINE, Embase, and Scopus databases were searched up to November 2016. Rates of pneumonitis of any grade and grade ≥ 3 from all clinical trials investigating nivolumab, pembrolizumab, atezolizumab, durvalumab, and avelumab as single agents in NSCLC were collected. The incidence of pneumonitis across trials was calculated using DerSimonian-Laird random effects models. We compared incidences between PD-1 and PD-L1 inhibitors and between treatment naive and previously treated patients. Results Nineteen trials (12 with PD-1 inhibitors [n = 3,232] and 7 with PD-L1 inhibitors [n = 1,806]) were identified. PD-1 inhibitors were found to have statistically significant higher incidence of any grade pneumonitis compared with PD-L1 inhibitors (3.6%; 95% CI, 2.4%-4.9% vs 1.3%; 95% CI, 0.8%-1.9%, respectively; P =.001). PD-1 inhibitors were also associated with higher incidence of grade 3 or 4 pneumonitis (1.1%; 95% CI, 0.6%-1.7% vs 0.4%; 95% CI, 0%-0.8%; P =.02). Treatment naive patients had higher incidence of grade 1 through 4 pneumonitis compared with previously treated patients (4.3%; 95% CI, 2.4%-6.3% vs 2.8%; 95% CI, 1.7%- 4%; P =.03). Conclusions There was a higher incidence of pneumonitis with use of PD-1 inhibitors compared with PD-L1 inhibitors. Higher rate of pneumonitis was more common in treatment naive patients. © 2017 American College of Chest Physicians
    • Incidence of Respiratory Viruses in Peruvian Children With Acute Respiratory Infections

      Del Valle Mendoza, Juana; Cornejo Tapia, Ángela; Weilg, Pablo; Verne, Eduardo; Nazario Fuertes, Ronald; Ugarte, Claudia; del Valle, Luis J.; Pumarola, Toma´ s (John Wiley & Sons, 2015-03-23)
      Acute respiratory infections are responsible for high morbi–mortality in Peruvian children. However, the etiological agents are poorly identified. This study, conducted during the pandemic outbreak of H1N1 influenza in 2009, aims to determine the main etiological agents responsible for acute respiratory infections in children from Lima, Peru. Nasopharyngeal swabs collected from 717 children with acute respiratory infections between January 2009 and December 2010 were analyzed by multiplex RT-PCR for 13 respiratory viruses: influenza A, B, and C virus; parainfluenza virus (PIV) 1, 2, 3, and 4; and human respiratory syncytial virus (RSV) A and B, among others. Samples were also tested with direct fluorescent-antibodies (DFA) for six respiratory viruses. RT-PCR and DFA detected respiratory viruses in 240 (33.5%) and 85 (11.9%) cases, respectively. The most common etiological agents were RSV-A (15.3%), followed by influenza A (4.6%), PIV-1 (3.6%), and PIV-2 (1.8%). The viruses identified by DFA corresponded to RSV (5.9%) and influenza A (1.8%). Therefore, respiratory syncytial viruses (RSV) were found to be the most common etiology of acute respiratory infections. The authors suggest that active surveillance be conducted to identify the causative agents and improve clinical management, especially in the context of possible circulation of pandemic viruses
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    • Incidence, Predictors, and Impact on Survival of Left Ventricular Systolic Dysfunction and Recovery in Advanced Cancer Patients

      Oliveira, Guilherme H.; Mukerji, Siddarth; Hernández, Adrian V.; Qattan, Marwan Y.; Banchs, Jose; Durand, Jean-Bernard; Iliescu, Cezar; Plana, Juan Carlos; Tang, W.H. Wilson (Elsevier B.V., 2014-06-09)
      Although left ventricular (LV) dysfunction occurs not uncommonly in the course of cancer therapy, little is known about its natural history and prognostic impact on patients. To investigate the incidence, predictors, and impact on survival of LV systolic dysfunction and recovery during cancer therapy, we conducted a retrospective cohort observational study over 1 year at the University of Texas MD Anderson Cancer Center. We enrolled patients with a decrease in ejection fraction by echocardiography to <50% while undergoing cancer therapy from January 2009 to December 2009.We collected and analyzed their chart data. Of 7,648 patients with echocardiograms in 2009, 366 (4.8%) had ejection fraction <50% and 104 met study criteria. LV systolic dysfunction was associated with cardiotoxic therapy in 53 patients (51%). Recovery occurred in 57 patients (55%) and was independently predicted by younger age, smaller left atrial volume index, and lower B-type natriuretic peptide. At last follow-up, 69 patients (66%) were dead, and 35 (34%) were alive. There was a 20% advantage in 2-year survival among patients with LV systolic recovery compared with those without (95% confidence interval 4% to 41%, p [ 0.02). In this retrospective study, LV systolic dysfunction recovery occurred in over half of the patients, appeared independent of cardiotoxic etiology, and associated with a 20% survival benefit at 2 years. Multivariable predictors of recovery are younger age, a small left atrial volume index, and lower B-type natriuretic peptide.
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    • Inclusion of persons with disabilities in systems of social protection: a population-based survey and case–control study in Peru

      Bernabe-Ortiz, Antonio; Diez-Canseco, Francisco; Vasquez, Alberto; Kuper, Hannah; Walsham, Matthew; Blanchet, Karl (British Medical Journal, 2016-08-26)
      OBJECTIVE: This study aims to assess the needs of people with disabilities and their level of inclusion in social protection programmes. DESIGN: Population based-survey with a nested case-control study. SETTING: Morropon, a semiurban district located in Piura, northern Peru. PARTICIPANTS: For the population survey, a two-stage sampling method was undertaken using data from the most updated census available and information of each household member aged ≥5 years was collected. In the nested case-control study, only one participant, case or control, per household was included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Disability was screened using the Washington Group short questionnaire. A case, defined as an individual aged ≥5 years with disabilities, was matched with one control without disabilities by sex and age (±5 years). Information was collected on socioeconomic status, education, health and rehabilitation and social protection participation. RESULTS: The survey included 3684 participants, 1848 (50.1%) females, mean age: 36.4 (SD: 21.7). A total of 290 participants (7.9%; 95% CI 7.0% to 8.7%) were classified as having disability. Adults with disabilities were more likely to be single (OR=3.40; 95% CI 1.54 to 7.51) and not to be working (OR=4.36; 95% CI 2.26 to 8.40), while those who did work were less likely to receive the national minimum wage (ie, 750 PEN or about US$265; p=0.007). People with disabilities were more likely to experience health problems. There was no difference between those enrolled in any social protection programme among participants with and without disabilities. CONCLUSIONS: People with disabilities were found to have higher needs for social protection, but were not more likely to be enrolled in social protection programmes. The Peruvian social protection system should consider adding disability status to selection criteria in their cash transfer programmes as well as implementing disability-specific interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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