Prioridades regionales y nacionales de investigación en salud, Perú 2010-2014: un proceso con enfoque participativo y descentralista

Caballero, Patricia; Yagui, Martín; Espinoza, Manuel Ignacio Martínez; Castilla, Teresa; Granados, Arturo; Velásquez, Aníbal; Cabezas, César

doi:10.1590/s1726-46342010000300013

Cited by 32 publications

(19 citation statements)

References 13 publications

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“…These are research to address the problems of human health resources; research to recognize mental health problems; impact evaluations of the social programs for reduction of child malnutrition; impact evaluations of the social programs for actual interventions in maternal mortality; and operational research and impact evaluations of interventions in communicable diseases 28. Results from our study will be of importance when looking at programs aimed at reducing high rates of cesarean sections, particularly when the procedure is medically unjustified.…”

Section: Discussionmentioning

confidence: 94%

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Gonzales¹,

Tapia²,

Fort³

et al. 2013

IJWH

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A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01). The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01). On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01). More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.

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Section: Discussionmentioning

confidence: 94%

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Gonzales¹,

Tapia²,

Fort³

et al. 2013

IJWH

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“…Ultimately, we expect that our findings provide new information related to some aspects contributing to this problem, in particular job preferences which influence the uptake of a rural post in Peru, and can contribute towards more evidence-based policies. In this regard, the definition of priorities for research needs to match resources [46], which would further inform planning and costing activities for human resources for health [47].…”

Section: Discussionmentioning

confidence: 99%

Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

Miranda

Diez-Canseco

Lema³

et al. 2012

PLoS ONE

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BackgroundDoctors’ scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors’ stated preferences for rural jobs.Methods and FindingsA labelled discrete choice experiment (DCE) was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho’s capital) and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54). Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.ConclusionsDoctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.

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“…In Peru, the burden of mental health in the population is not well known [10], and the relation of the depression and TB is not well studied. The Center for Epidemiologic Studies Depression Scale (CES-D), 5-items, self-report test, performed well when validated in a Peruvian population [11].…”

Section: Introductionmentioning

confidence: 99%

Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment

et al. 2013

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BackgroundPulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient’s compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significance and magnitude of major depressive episode as a hazard factor for negative outcomes (NO), including abandon or death in patients receiving TB treatment.Methodology/Principal FindingsA longitudinal study was conducted to evaluate the association of major depressive episode (MDE), as measured by a 5-item version of the Center for Epidemiological Studies Depression Scale (CES-D) with NO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment. Death and treatment default were assessed monthly. Survivor function (SF) for NO according to MDE status (CES-D≥6) at baseline (MDEb) was estimated. Cox’s Regression was performed for bivariate analyses as well as for the multivariate model. A total of 325 patients accepted to participate in the study, of which 34 where excluded for diagnosis of MDR-TB. NO was observed in 24 patients (8.2%); 109 (37%) presented MDEb. Statistically significant difference was found on the SF of patients with and without MDEb (0.85 vs. 0.96, p-value = 0.002). The hazard ratio for NO, controlled for age, sex, marital status and instruction level was 3.54 (95%CI 1.43–8.75; p-value = 0.006).ConclusionThe presence of MDE at baseline is associated to NO of TB treatment. Targeting detection and treatment of MDE may improve TB treatment outcomes.

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Prioridades regionales y nacionales de investigación en salud, Perú 2010-2014: un proceso con enfoque participativo y descentralista

Cited by 32 publications

References 13 publications

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

Stated Preferences of Doctors for Choosing a Job in Rural Areas of Peru: A Discrete Choice Experiment

Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment

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