RESUMO
BACKGROUND: The Global Campaign against Headache is conducting a series of population-based studies to fill the large geographical gaps in knowledge of headache prevalence and attributable burden. One major region not until now included is South America. Here we present a study from Peru, a country of 32.4 million inhabitants located at the west coast of South America, notable for its high Andes mountains. METHODS: The study was conducted in accordance with the standardized methodology used by the Global Campaign. It was a cross-sectional survey using cluster randomised sampling in five regions to derive a nationally representative sample, visiting households unannounced, and interviewing one randomly selected adult member (aged 18-65 years) of each using the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire translated into South American Spanish. The neutral screening question ("Have you had headache in the last year?") was followed by diagnostic questions based on ICHD-3 and demographic enquiry. RESULTS: The study included 2,149 participants from 2,385 eligible households (participating proportion 90.1%): 1,065 males and 1,084 females, mean age 42.0 ± 13.7 years. The observed 1-year prevalence of all headache was 64.6% [95% CI: 62.5-66.6], with age-, gender- and habitation-adjusted prevalences of 22.8% [21.0-24.6] for migraine (definite + probable), 38.9% [36.8-41.0] for tension-type headache (TTH: also definite + probable), 1.2% [0.8-1.8] for probable medication-overuse headache (pMOH) and 2.7% [2.1-3.5] for other headache on ≥ 15 days/month (H15+). One-day prevalence of headache (reported headache yesterday) was 12.1%. Migraine was almost twice as prevalent among females (28.2%) as males (16.4%; aOR = 2.1; p < 0.001), and strongly associated with living at very high altitude (aOR = 2.5 for > 3,500 versus < 350 m). CONCLUSION: The Global Campaign's first population-based study in South America found headache disorders to be common in Peru, with prevalence estimates for both migraine and TTH substantially exceeding global estimates. H15 + was also common, but with fewer than one third of cases diagnosed as pMOH. The association between migraine and altitude was confirmed, and found to be strengthened at very high altitude. This association demands further study.
Assuntos
Transtornos da Cefaleia Primários , Transtornos da Cefaleia Secundários , Transtornos de Enxaqueca , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estudos Transversais , Cefaleia/epidemiologia , Transtornos da Cefaleia Primários/diagnóstico , Transtornos da Cefaleia Secundários/epidemiologia , Transtornos de Enxaqueca/epidemiologia , Peru/epidemiologia , Prevalência , Distribuição Aleatória , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN: Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS: In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS: Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.
RESUMO
BACKGROUND: There are few instruments to evaluate teachers' performance during medical residency in Spanish. AIM: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). MATERIAL AND METHODS: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. RESULTS: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. CONCLUSIONS: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.
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Internato e Residência , Humanos , Capacitação em Serviço , Competência Profissional , Reprodutibilidade dos Testes , Inquéritos e Questionários , EnsinoRESUMO
Background: There are few instruments to evaluate teachers' performance during medical residency in Spanish. Aim: To determine the validity and reliability of the MEDUC-PG14 instrument to evaluate teaching performance in the medical residency programs of the Faculty of Medicine, Universidad Peruana Cayetano Heredia (UPCH). Material and Methods: An open question about positive aspects that characterize a good teacher was added to the MEDUC-PG14 questionnaire. A pilot test was carried out with 15 residents to assess the correct comprehension of each question and carry out necessary changes. Subsequently, the instrument was sent by email to 366 residents of the UPCH Department of Medical Clinics. The reliability of the instrument was evaluated using Cronbach's Alpha. Construct validity was assessed by factor analysis, and the validity of content by a qualitative analysis of the answers to the open question added. Results: Seventy residents answered the questionnaire evaluating 46 teachers. Each resident evaluated one teacher. The factor analysis showed two dimensions explaining 83% of the variance: the dimension "Teaching and Evaluation" (11 items) and the dimension "Respectful Behavior" (three items). The global Cronbach's Alpha was 0.97 (0.97 for the Teaching Dimension 0.96 and for the Behavioral Dimension). The concept of "professional competence as a medical specialist" was rescued from the responses to the open question. Conclusions: The MEDUC-PG14 is an instrument with valid and highly reliable results. It is useful and easy to apply to evaluate teaching performance in postgraduate studies. Its use is recommended in residency programs of Spanish-speaking countries. However, the inclusion of an item referring to the professional competence of the teacher is suggested.
Assuntos
Humanos , Internato e Residência , Competência Profissional , Ensino , Inquéritos e Questionários , Reprodutibilidade dos Testes , Capacitação em ServiçoRESUMO
Objetivo: Determinar la relación entre el grado de ôtrabeculaciónõ vesical, el residuo pos miccional y el grado de obstrucción al flujo de salida urinario en pacientes con hiperplasia benigna de próstata (HBP) sintomática. Material y métodos: Serie de casos analítico y retrospectivo que incluyó 37 pacientes con HBP sintomática atendidos ambulatoriamente en el servicio de Urología del Hospital Nacional Cayetano Heredia en el 2009. El grado de ôtrabeculaciónõ vesical se determinó por cistoscopia, el residuo vesical post-miccional por ecografía y el grado de obstrucción mediante uroflujometría. Resultados: La edad de los pacientes fue: 68,2 ± 7,9 (50-83) años. Los valores del volumen prostático, porcentaje de residuo post-miccional y el flujo máximo fueron: 46,4 ± 20,6 cc (20-113); 33,4% ± 20,7 (5- 80) y 6,7 ± 2,12 7 ml/seg (3-10), respectivamente. No se encontró correlación entre: el porcentaje de residuo post-miccional y el flujo urinario máximo (rs = -0,07; p=0,67) y entre el volumen prostático y el flujo máximo con (rs= 0,05; p= 0,7). Tampoco se encontró concordancia entre el grado de ôtrabeculaciónõ vesical y el flujo máximo (Kappa= 0,0034; p=0,5) y entre el porcentaje de residuo post-miccional y el grado de ôtrabeculaciónõ (Kappa= 0,18; p=0,06). Conclusión: No se encontró relación entre el flujo máximo urinario, el porcentaje de residuo post-miccional y el grado de ôtrabeculaciónõ, en pacientes con HBP sintomática.
Objective: To determine the relationship between the degree of bladder trabeculation, post mictional residue and degree of urinary outflow obstruction in patients with benign prostatic hyperplasia (BPH). Methods: Retrospective case series of 37 ambulatory patients with symptomatic BPH attended at the Urology Service of Hospital Nacional Cayetano Heredia in 2009. The degree of bladder trabeculation was determined by cystoscopy, post-mictional residue was measured by ultrasound, and the degree of outflow obstruction was measured by uroflowmetry. Results: Mean (SD) age of patients was 68.2 ± 7.9 years. Mean (SD) values for prostatic volume, percentage of postmictional residue and maximum flow were 46.4 ± 20.6 ml; 33.4 ± 20.7% y 6.7 ± 2.1 ml/seg, respectively. No correlation between the percentage of post-mictional residue and maximum urinary flow (rs = -0.07; p = 0.67), and between prostatic volume and maximum urinary flow was found (rs = 0.05; p = 0.7). There were also no correlations between the degree of bladder trabeculation and maximum urinary flow (Kappa = 0.0034; p = 0.5), and between the percentage of post-mictional residue and the degree of bladder trabeculation Kappa = 0.18; p = 0.06). Conclusions: No relationship was found between the maximum urinary flow, percentage of post-mictional residue and degree of trabeculation in patients with symptomatic BPH.
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Humanos , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Cistoscopia , Hiperplasia Prostática , Próstata , Bexiga Urinária , Estudos Retrospectivos , Relatos de CasosRESUMO
Objetivo: determinar la sobrevida global (SG), los factores pronósticos de sobrevida libre de enfermedad y SG, el porcentaje de complicaciones en pacientes con cáncer de endometrio tratados con radioterapia preoperatoria en el INEN. Material y Métodos: se realizó un estudio retrospectivo analítico de 381 historias clínicas de pacientes con cáncer de endometrio entre 1995 a diciembre del 2004, 53 pacientes cumplieron con los criterios de inclusión: estadiaje clínico I, II, III según FIGO 1971, radioterapia externa (RTE) a la pelvis a dosis de 50Gy a 50,4Gy en 25-28 sesiones más Braquiterapia (BT) seguido de cirugía. Resultados: la dosis promedio de BT fue 45Gy (rango 25Gy a 70Gy) administradas en una sola aplicación de baja tasa de dosis. La sobrevida Global (SG) a los 5 años fue 86,39%. La sobrevida diferenciada por estadios clínicos fue 85,71%, 83,52% y 84,03% para los estadíos I, II y III respectivamente sin diferencia significativa (p=0,55). El 20,75% (11/53) fallecieron por enfermedad, de las cuales 36,36% (4/11) recurrieron a nivel loco regional y 63,64% (7/11) metástasis a distancia. El análisis Bivariado no demostró factores de riesgo asociados con la mortalidad. Sin embargo el análisis multivariado de Regresión de Cox solo la enfermedad extra-pélvica es un factor de mal pronóstico y se relacionó con mayor mortalidad [HR: 5,27 IC 95% (1,10-25,28)] (p=0,038). Las pacientes con viabilidad en la pieza quirúrgica recibieron mayor dosis de radiación al punto A (mayores a 90Gy) que las piezas quirúrgicas no viables (p=0,041). El porcentaje de complicaciones fue del 20,75% (11/53) siendo el 9,44% (5/53) complicaciones severas (grado 4). Conclusiones: La presencia de enfermedad extra-pélvica fue un factor de mal pronóstico para la sobrevida. Palabras Claves: cáncer endometrial, radioterapia preoperatoria, sobrevida global.
Objective: To determine overall survival (OS), prognostic factors for disease-free survival and OS, the percentage of complications in patients with endometrial cancer treated with preoperative radiotherapy at the Instituto Nacional de Enfermedades Neoplásicas (INEN). Material and Methods: An analytical retrospective study of 381 patient records with endometrial cancer between 1995 and December 2004 was done; Only 53 patients full filed the inclusion criteria: clinical stage I, II, III according to FIGO 1971, external beam radiation to the pelvis to a dose of 50Gy - 50.4Gy in 25-28 sessions followed Brachytherapy (BT) and then surgery. Results: The mean dose of BT was 45Gy (range 25Gy to 70Gy) administered in a single application with low dose radiation. The OS at 5 years was 86.39%. OS for clinical stages I, II and III were 85.71%, 83.52% and 84.03% respectively, with no significant difference (p=0.55). 20.75% (11/53) died of disease, of which 36.36% (4/11) had recurrence in the pelvis and 63.64% (7/11) was distant metastases. Bivariate analysis showed no risk factors associated with mortality. However in the multivariate Cox regression only the extra-pelvic disease is a poor prognostic factor and was associated with increased mortality [HR: 5.27 IC 95% (1.10-25.28)] (p=0.038). The patients with viability in the surgical specimen had higher radiation doses to point A than non-viable surgical specimens (greater than 90Gy) difference that was significant (p = 0.041). The complication rate was 20.75% (11/53) and 9.44% (5/53) of complications were grade 4. Conclusions: The presence of extra-pelvic disease proved to be a poor prognostic factor for overall survival. Keywords: endometrial cancer, preoperative radiotherapy, overall survival.
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Humanos , Feminino , Neoplasias do Endométrio , Neoplasias do Endométrio/radioterapia , Neoplasias do Endométrio/terapia , Sobrevida , Estudos RetrospectivosRESUMO
OBJECTIVES: To perform the psychometric validation of the International Index of Erectile Function (IIEF) in patients with erectile dysfunction. MATERIALS AND METHODS: Prospective case series to evaluate the validity and the reliability of the scale. RESULTS: More than 90 % of experts considered that the IIEF questions evaluated the domains and the construct (content validity). There was a perfect concordance between the expert evaluation and the IIEF results (criteria validity, Kappa = 1). Significant differences were found in the score media by domains between patients with and without ED but when severity was evaluated, only differences in the erectile function domain were found (discriminatory validity). The Chronic Prostatitis Symptom Index (ISPC) and the IIEF showed divergent results (Kappa < 0.01, p = 0.44) in relation with the severity and the total scores showed no correlation (divergent validity) (r(s) = -0.22, p = 0.16). The correlation coefficients by domains were mild to moderate and the correlation between the total scores was high (rs = 0.8, p < 0.001) (test retest repeatability). A high degree of internal consistency with Cronbach's alpha values > 0.8 in the five domains was found. CONCLUSIONS: The cross-culturally validated IIEF in Peru is a valid and reliable instrument for its local use in the fields of clinics and research.
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Disfunção Erétil/diagnóstico , Inquéritos e Questionários , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Estudos Prospectivos , Psicometria , Adulto JovemRESUMO
Health Economics is an essential instrument for health management, and economic evaluations can be considered as tools assisting the decision-making process for the allocation of resources in health. Currently, economic evaluations are increasingly being used worldwide, thus encouraging evidence-based decision-making and seeking efficient and rational alternatives within the framework of health services activities. In this review, we present an overview and define the basic types of economic evaluations, with emphasis on complete Economic Evaluations (EE). In addition, we review key concepts regarding the perspectives from which EE can be conducted, the types of costs that can be considered, the time horizon, discounting, assessment of uncertainty and decision rules. Finally, we describe concepts about the extrapolation and spread of economic evaluations in health.