Sofia Fuentes - Academia.edu (original) (raw)
Papers by Sofia Fuentes
Environmental Science and Pollution Research
COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventi... more COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26
Journal of Venomous Animals and Toxins including Tropical Diseases
Background: The intrinsic sensitivity limitations of basic parasitological methods, along with th... more Background: The intrinsic sensitivity limitations of basic parasitological methods, along with the particular biological characteristics of parasites, make these methods ineffective to differentiate morphologically indistinguishable species. Molecular detection and characterization techniques could be used to overcome these problems. The purpose of this work was to standardize molecular polymerase chain reaction (PCR) techniques, described in the literature, for the detection and molecular characterization of intestinal protozoa and other pathogens in humans. Methods: DNA was extracted from human or animal feces, previously washed or cultured in Boeck Drbohlav's Modified Medium. DNA extraction was performed with Machery-Nagel extraction kits. The standardization of the PCR, nested-PCR or RFLP techniques was carried out according to the literature. For each molecular technique performed, the sensitivity of the test was determined based on the minimun quantity required of DNA (sensitivity A) and the minimum quantity of life forms that the test detected (sensitivity B). Results: Sensitivity A was 10 fg for G. duodenalis, 12.5 pg for Entamoeba histolytica or Entamoeba dispar, 50 fg for Cryptosporidium spp., 225 pg for Cyclospora spp. and 800 fg or 8 fg for Blastocystis spp. after performing a 1780 bp PCR or 310 bp nested PCR, respectively. The sensitivity B was 100 cysts for G. duodenalis, 500 cysts for E. histolytica or E. dispar, 1000 oocysts for Cyclospora spp. and 3600 or four vegetatives forms for PCR or nested PCR of Blastocystis spp., respectively. Conclusions: The molecular detection of protozoa and chromist was achieved and the molecular characterization allowed the genotyping of some of the parasites such as Giardia duodenalis, Cryptosporidium spp., and Blastocystis spp. This study summarizes the molecular techniques for epidemiological studies in humans and animals, and helps in the investigation of their transmission sources in countries where intestinal parasites are a public health problem.
BackgroundCOVID-19 vaccination may reduce anxiety and depression. However, the pandemic significa... more BackgroundCOVID-19 vaccination may reduce anxiety and depression. However, the pandemic significantly impacted the elderly from low-middle-income countries. Therefore, we aimed to estimate the effect of vaccination against COVID-19 on the emotional health of older adults.MethodsWe selected a nationally stratified sample of non-hospitalized adults aged 60 to 79 years who intended to receive the COVID-19 vaccine or had already received it during recruitment. We assess the fear, anxiety, and worry about COVID-19, general anxiety, and depression at baseline and after a month. We estimated the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for each altered emotional health outcomes in those who had one and two doses, compared with those who were not vaccinated using multilevel logistic regression with mixed effects.ResultsWe recruited 861 older adults. Loss to follow-up was 20.8%. At baseline, 43.9% had only one dose of the vaccine, and 49.1% had two doses. In the analy...
MedEdPublish, 2021
Introduction Medical training should include a strong emphasis on primary health care. There is a... more Introduction Medical training should include a strong emphasis on primary health care. There is a need for primary care teaching centres and teachers who can provide excellent instruction in primary health care (PHC). Objectives This investigation explores the characteristics of the doctors who teach in PHC in Peru, their educational needs and their perceptions of their teaching. Method Using a mixed method approach we ran an online questionnaire on the educational needs and focus groups which explored the challenges, problems and skills required for teaching in PHC. Results 66 teachers from 10 regions answered the questionnaire: 59 (89.4%) were family doctors; 76,7% had a formal university contract; they dedicated an average of 12.9 hours/week to teaching and 9 (13,6%) had had some training in teaching during the last 5 years. In the focus groups they showed interest in developing their teaching skills and 4 dimensions were defined: willingness to teach; teaching family medicine; teacher-student relationships; the organization of the teaching. Conclusion The PHC teachers in Peru have great interest in teaching and a need for training in teaching skills.
Ciência & Saúde Coletiva, 2020
Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of C... more Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams...
Revista Medica Herediana, 2019
Objetivo: Evaluar la eficacia de un entrenamiento corto en habilidades de comunicación con el mét... more Objetivo: Evaluar la eficacia de un entrenamiento corto en habilidades de comunicación con el método CICAA (conectar, identificar, comprender, acordar y ayudar) en una universidad de Lima-Perú. Material y métodos: Estudio de intervención antes y después, donde cada médico residente fue su propio control. Participantes: 25 médicos residentes del primer año académico de los programas de especialización en medicina familiar, medicina interna y pediatría de la Universidad Peruana Cayetano Heredia (UPCH). Intervención: Entrenamiento en entrevista clínica basado en el método CICAA. El método CICAA incluye cuatro tareas agrupadas en tres dominios: Conectar (dominio 1), Identificar y comprender (dominio 2), Acordar y Ayudar (dominio 3). Se realizó un entrenamiento de 26 horas de duración, el cual consistió en clases teóricas, talleres, role-play de escenarios diseñados por los docentes y alumnos. Se diseñó una evaluación clínica objetiva estructurada (ECOE) con la participación de dos pacie...
Revista Peruana de Medicina Experimental y Salud Pública, 2019
El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanita... more El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanitario; buscando mejorar la salud de la población, una mejor experiencia del usuario cuando utiliza los servicios sanitarios, mejor uso de los recursos públicos que se vienen inyectando en la última década y una mejor satisfacción laboral de los trabajadores de salud. La promulgación de la Ley 30885 de Redes Integradas de Salud, marca un hito en el esfuerzo del país de lograr resolver las necesidades de atención de los ciudadanos en una red y es la apuesta del sector salud para mejorar el desempeño del sistema sanitario. Para ello se plantean elementos clave para la organización y funcionamiento: Identificación de población y familias, asignación de responsabilidad del cuidado, fortalecimiento de las puertas de entrada al sistema de salud, estratificación de riesgos individuales y familiares, coordinación para facilitar el acceso y utilización de servicios de salud, continuidad y complementariedad del cuidado, y gobernanza en la red. Esta nueva propuesta política implica ajustes en la red de servicios de salud: establecimientos de salud (clínicas de familia) de 12 y 24 horas para el cuidado individual, familiar, manejo de los determinantes de la salud y hospitales para complementar el cuidado. El modelo de cuidado será más complejo y de avance difícil si no está unido a ajustes en el financiamiento, aseguramiento y en la gestión del cambio cultural de los trabajadores, usuarios del sistema y del sistema de gobernanza en salud.
Anales de la Facultad de Medicina, 2018
El Perú es un país de ingreso mediano, con un sistema de salud fragmentado. Para fortalecer el si... more El Perú es un país de ingreso mediano, con un sistema de salud fragmentado. Para fortalecer el sistema de salud basado en atención primaria de salud, existen dimensiones claves que deben ser analizadas: gobernanza, financiamiento, recursos humanos, accesibilidad, longitudinalidad, integralidad, coordinación, equidad, eficiencia y calidad. El logro del desarrollo de estas dimensiones puede llevar a garantizar una atención primaria de salud fuerte, con mejoras en la salud de las personas
Obesity surgery, Jan 24, 2018
With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients ... more With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain. A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change. Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6 months, 20.1% at 12 months, 18.8% at 24 months, and 21.8% at 36 months after the procedure. The final model suggests that preoperative BMI is the most significant indicator ...
The Lancet. Oncology, 2018
World Medical & Health Policy, 2017
Given Peru's epidemiologic transition, this exploratory study sought to understand the role that ... more Given Peru's epidemiologic transition, this exploratory study sought to understand the role that primary care holds in Lima's medical system. Key stakeholders in Peru were administered semistructured qualitative interviews to understand the factors that influence the availability and quality of primary care. Five areas were targeted for inquiry: financing, the training of primary care providers, access to services, patients' first contact with the health-care system, and treatment coordination. Interviewees described primary health-care services as having a lack of treatment continuity, inconsistent record keeping, and often staffed by recent medical graduates with little primary care training, which can manifest to reduce the use of primary care services. Despite identifying numerous barriers to quality primary care services, interviewees remained committed to the principles of universal access espoused by Peruvian legislation and offered recommendations related to metrics, financing, technology, and workforce development to improve both primary care access and quality.
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, Jan 20, 2017
Peru has achieved sustained development in the last two decades. However, despite this achievemen... more Peru has achieved sustained development in the last two decades. However, despite this achievement, it has not been matched with improvements in the quality of education and health; investment in both sectors is among the lowest in the region. This situation perpetuates huge gaps in infrastructure and also conditions a poor literacy level of the population specifically in health. Currently, there is a fragmented model of patient care, in which the systems are exclusive of each other. They do not cooperate or communicate with each other; and if there is no vertical communication within the system, preventing referral of patients directly from the basic level to the complex level of care when needed. In addition, there has been no progress in the development of an empathetic, respectful or person-centered clinical practice; instead, economic, social and educational differences perpetuate a paternalistic clinical practice. The task of orienting medical training towards the development ...
Revista Peruana de Medicina Experimental y Salud Pública, 2016
Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de... more Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de muchos factores como el físico, cognoscitivo y sociofamiliar; por otro lado, tienen características como la heterogeneidad, la gran carga de enfermedad, la pluripatología, entre otras, que repercuten no solo en el ámbito familiar sino social. Es importante ofrecer a la población adulta mayor los medios para ejercer un mejor control sobre su salud y mejorarla. Todo ello con el fin de lograr un envejecimiento exitoso, es decir, sin discapacidad, con la menor cantidad de enfermedades posibles o adecuadamente controladas y, sobre todo, intentando mantener en todo momento su autonomía y calidad de vida, respetando siempre sus valores y preferencias. Por otro lado, las actividades preventivas en los adultos mayores deben tener en cuenta no solo el riesgo de enfermedad, sino también la alteración de la función que produce la enfermedad, así como aquellas condiciones frecuentes en el adulto mayor que pueden deteriorar su estado de salud como la fragilidad, las caídas, y las complicaciones iatrogénicas; las actividades preventivas en el adulto mayor deben estar dirigidas a todos estos factores. Presentamos algunas pautas que podrían ser importantes para promover un envejecimiento activo y actividades preventivas que podrán ser aplicadas según el contexto particular de cada persona.
Acta Medica Peruana, 2013
En el presente artículo invitamos al lector a conocer mejor la Atención Primaria, sus diferencias... more En el presente artículo invitamos al lector a conocer mejor la Atención Primaria, sus diferencias con la atención especializada y su importancia en los sistemas de salud actuales. Además, hablaremos sobre los cuatro atributos que debe cumplir la Atención Primaria, descritos por Bárbara Starfield: Accesibilidad y primer contacto, donde debe existir un fácil acceso al sistema sanitario; Longitudinalidad, donde se debe establecer una relación personal y continua entre el médico y paciente; Integralidad, que da solución a las necesidades de salud más frecuentes de la comunidad; y Coordinación, que significa un trabajo en conjunto entre los médicos de Atención Primaria y otros especialistas.
Banca Y Finanzas Revista Profesional De Gestion Financiera, 2008
Acta Medica Peruana, 2013
Atencion primaria de salud, Accesibilidad a los SUMMARY In this article we invite our readers to ... more Atencion primaria de salud, Accesibilidad a los SUMMARY In this article we invite our readers to know about primary care,their differences with the secondary care and its importance in the current health systems. We talk about the four attributes of primary care described by Barbara Starfield : Accessibility and first contact where there should be easy access to the health system; Longitudinality, which must establish a personal relationship between the physician and continuous patient .Integrity,which gives solution to the most common health needsof the community and Coordination, where there isa joint effort between primary care physicians and other specialists.
Ciencia e Interculturalidad, 2013
Naturales (ARENA), a partir de su perfil profesional y la práctica de sus diferentes estrategias ... more Naturales (ARENA), a partir de su perfil profesional y la práctica de sus diferentes estrategias pedagógicas en el aula. Esta área tiene 43 docentes, entre ellos: de tiempo completo, horarios y la coordinación del área. La composición étnica corresponde con 70 % al grupo mestizo, seguido del creol con un 23 %; ulwas, garífunas y miskitus con el 2 %, respectivamente. Del total de docentes, el 58 % están en proceso de formación pedagógica y el 42 % de ellos no han iniciado estudios de especialización. La investigación fue cualitativa con enfoque etno-metodológico, tanto en lo que corresponde a la participación de docentes, estudiantes y autoridades del área académica. Se desarrollaron entrevistas, grupos focales y observación directa en las aulas de clase. Relativo a la práctica pedagógicas es importante mencionar que predomina la Pedagogía "depositaria". Entre los factores que han incidido en las prácticas pedagógicas está el abuso del término "libertad de cátedra" y el limitado "acompañamiento participativo", que garantice el cumplimiento del Modelo Pedagógico de URACCAN. Los resultados anteriores, así como el análisis de los reglamentos y normativas internas de la Universidad, conllevan a proponer algunas iniciativas para el diseño de un plan de formación y profesionalización docente.
Medical Physics, 2015
ABSTRACT
Environmental Science and Pollution Research
COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventi... more COVID-19 has affected all aspects of human life so far. From the outset of the pandemic, preventing the spread of COVID-19 through the observance of health protocols, especially the use of sanitizers and disinfectants was given more attention. Despite the effectiveness of disinfection chemicals in controlling and preventing COVID-19, there are critical concerns about their adverse effects on human health. This study aims to assess the health effects of sanitizers and disinfectants on a global scale. A total of 91,056 participants from 154 countries participated in this cross-sectional study. Information on the use of sanitizers and disinfectants and health was collected using an electronic questionnaire, which was translated into 26
Journal of Venomous Animals and Toxins including Tropical Diseases
Background: The intrinsic sensitivity limitations of basic parasitological methods, along with th... more Background: The intrinsic sensitivity limitations of basic parasitological methods, along with the particular biological characteristics of parasites, make these methods ineffective to differentiate morphologically indistinguishable species. Molecular detection and characterization techniques could be used to overcome these problems. The purpose of this work was to standardize molecular polymerase chain reaction (PCR) techniques, described in the literature, for the detection and molecular characterization of intestinal protozoa and other pathogens in humans. Methods: DNA was extracted from human or animal feces, previously washed or cultured in Boeck Drbohlav's Modified Medium. DNA extraction was performed with Machery-Nagel extraction kits. The standardization of the PCR, nested-PCR or RFLP techniques was carried out according to the literature. For each molecular technique performed, the sensitivity of the test was determined based on the minimun quantity required of DNA (sensitivity A) and the minimum quantity of life forms that the test detected (sensitivity B). Results: Sensitivity A was 10 fg for G. duodenalis, 12.5 pg for Entamoeba histolytica or Entamoeba dispar, 50 fg for Cryptosporidium spp., 225 pg for Cyclospora spp. and 800 fg or 8 fg for Blastocystis spp. after performing a 1780 bp PCR or 310 bp nested PCR, respectively. The sensitivity B was 100 cysts for G. duodenalis, 500 cysts for E. histolytica or E. dispar, 1000 oocysts for Cyclospora spp. and 3600 or four vegetatives forms for PCR or nested PCR of Blastocystis spp., respectively. Conclusions: The molecular detection of protozoa and chromist was achieved and the molecular characterization allowed the genotyping of some of the parasites such as Giardia duodenalis, Cryptosporidium spp., and Blastocystis spp. This study summarizes the molecular techniques for epidemiological studies in humans and animals, and helps in the investigation of their transmission sources in countries where intestinal parasites are a public health problem.
BackgroundCOVID-19 vaccination may reduce anxiety and depression. However, the pandemic significa... more BackgroundCOVID-19 vaccination may reduce anxiety and depression. However, the pandemic significantly impacted the elderly from low-middle-income countries. Therefore, we aimed to estimate the effect of vaccination against COVID-19 on the emotional health of older adults.MethodsWe selected a nationally stratified sample of non-hospitalized adults aged 60 to 79 years who intended to receive the COVID-19 vaccine or had already received it during recruitment. We assess the fear, anxiety, and worry about COVID-19, general anxiety, and depression at baseline and after a month. We estimated the adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) for each altered emotional health outcomes in those who had one and two doses, compared with those who were not vaccinated using multilevel logistic regression with mixed effects.ResultsWe recruited 861 older adults. Loss to follow-up was 20.8%. At baseline, 43.9% had only one dose of the vaccine, and 49.1% had two doses. In the analy...
MedEdPublish, 2021
Introduction Medical training should include a strong emphasis on primary health care. There is a... more Introduction Medical training should include a strong emphasis on primary health care. There is a need for primary care teaching centres and teachers who can provide excellent instruction in primary health care (PHC). Objectives This investigation explores the characteristics of the doctors who teach in PHC in Peru, their educational needs and their perceptions of their teaching. Method Using a mixed method approach we ran an online questionnaire on the educational needs and focus groups which explored the challenges, problems and skills required for teaching in PHC. Results 66 teachers from 10 regions answered the questionnaire: 59 (89.4%) were family doctors; 76,7% had a formal university contract; they dedicated an average of 12.9 hours/week to teaching and 9 (13,6%) had had some training in teaching during the last 5 years. In the focus groups they showed interest in developing their teaching skills and 4 dimensions were defined: willingness to teach; teaching family medicine; teacher-student relationships; the organization of the teaching. Conclusion The PHC teachers in Peru have great interest in teaching and a need for training in teaching skills.
Ciência & Saúde Coletiva, 2020
Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of C... more Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams...
Revista Medica Herediana, 2019
Objetivo: Evaluar la eficacia de un entrenamiento corto en habilidades de comunicación con el mét... more Objetivo: Evaluar la eficacia de un entrenamiento corto en habilidades de comunicación con el método CICAA (conectar, identificar, comprender, acordar y ayudar) en una universidad de Lima-Perú. Material y métodos: Estudio de intervención antes y después, donde cada médico residente fue su propio control. Participantes: 25 médicos residentes del primer año académico de los programas de especialización en medicina familiar, medicina interna y pediatría de la Universidad Peruana Cayetano Heredia (UPCH). Intervención: Entrenamiento en entrevista clínica basado en el método CICAA. El método CICAA incluye cuatro tareas agrupadas en tres dominios: Conectar (dominio 1), Identificar y comprender (dominio 2), Acordar y Ayudar (dominio 3). Se realizó un entrenamiento de 26 horas de duración, el cual consistió en clases teóricas, talleres, role-play de escenarios diseñados por los docentes y alumnos. Se diseñó una evaluación clínica objetiva estructurada (ECOE) con la participación de dos pacie...
Revista Peruana de Medicina Experimental y Salud Pública, 2019
El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanita... more El Ministerio de Salud del Perú se enfoca en el logro de la cuádruple meta para su sistema sanitario; buscando mejorar la salud de la población, una mejor experiencia del usuario cuando utiliza los servicios sanitarios, mejor uso de los recursos públicos que se vienen inyectando en la última década y una mejor satisfacción laboral de los trabajadores de salud. La promulgación de la Ley 30885 de Redes Integradas de Salud, marca un hito en el esfuerzo del país de lograr resolver las necesidades de atención de los ciudadanos en una red y es la apuesta del sector salud para mejorar el desempeño del sistema sanitario. Para ello se plantean elementos clave para la organización y funcionamiento: Identificación de población y familias, asignación de responsabilidad del cuidado, fortalecimiento de las puertas de entrada al sistema de salud, estratificación de riesgos individuales y familiares, coordinación para facilitar el acceso y utilización de servicios de salud, continuidad y complementariedad del cuidado, y gobernanza en la red. Esta nueva propuesta política implica ajustes en la red de servicios de salud: establecimientos de salud (clínicas de familia) de 12 y 24 horas para el cuidado individual, familiar, manejo de los determinantes de la salud y hospitales para complementar el cuidado. El modelo de cuidado será más complejo y de avance difícil si no está unido a ajustes en el financiamiento, aseguramiento y en la gestión del cambio cultural de los trabajadores, usuarios del sistema y del sistema de gobernanza en salud.
Anales de la Facultad de Medicina, 2018
El Perú es un país de ingreso mediano, con un sistema de salud fragmentado. Para fortalecer el si... more El Perú es un país de ingreso mediano, con un sistema de salud fragmentado. Para fortalecer el sistema de salud basado en atención primaria de salud, existen dimensiones claves que deben ser analizadas: gobernanza, financiamiento, recursos humanos, accesibilidad, longitudinalidad, integralidad, coordinación, equidad, eficiencia y calidad. El logro del desarrollo de estas dimensiones puede llevar a garantizar una atención primaria de salud fuerte, con mejoras en la salud de las personas
Obesity surgery, Jan 24, 2018
With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients ... more With the increase in popularity of laparoscopic sleeve gastrectomy (LSG), the number of patients experiencing weight regain has increased as well. This study aims to demonstrate the outcomes of LSG conversions to Roux-en-Y gastric bypass (RYGB), double anastomosis duodenal switch (DS), and single anastomosis duodeno-ileal sleeve (SADI-S) due to weight regain. A retrospective chart review was performed on 21 patients who underwent a conversion of LSG due to weight regain between March 1, 2013, and April 30, 2017. A longitudinal analysis was performed for the body mass index (BMI) measures, using multilevel model for change. Of 21 patients, 6 underwent a conversion to RYGB, 9 underwent a conversion to SADI-S, and 6 underwent a conversion to double anastomosis DS. Mean percentage of total weight loss was 16.0% at 6 months, 20.1% at 12 months, 18.8% at 24 months, and 21.8% at 36 months after the procedure. The final model suggests that preoperative BMI is the most significant indicator ...
The Lancet. Oncology, 2018
World Medical & Health Policy, 2017
Given Peru's epidemiologic transition, this exploratory study sought to understand the role that ... more Given Peru's epidemiologic transition, this exploratory study sought to understand the role that primary care holds in Lima's medical system. Key stakeholders in Peru were administered semistructured qualitative interviews to understand the factors that influence the availability and quality of primary care. Five areas were targeted for inquiry: financing, the training of primary care providers, access to services, patients' first contact with the health-care system, and treatment coordination. Interviewees described primary health-care services as having a lack of treatment continuity, inconsistent record keeping, and often staffed by recent medical graduates with little primary care training, which can manifest to reduce the use of primary care services. Despite identifying numerous barriers to quality primary care services, interviewees remained committed to the principles of universal access espoused by Peruvian legislation and offered recommendations related to metrics, financing, technology, and workforce development to improve both primary care access and quality.
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen, Jan 20, 2017
Peru has achieved sustained development in the last two decades. However, despite this achievemen... more Peru has achieved sustained development in the last two decades. However, despite this achievement, it has not been matched with improvements in the quality of education and health; investment in both sectors is among the lowest in the region. This situation perpetuates huge gaps in infrastructure and also conditions a poor literacy level of the population specifically in health. Currently, there is a fragmented model of patient care, in which the systems are exclusive of each other. They do not cooperate or communicate with each other; and if there is no vertical communication within the system, preventing referral of patients directly from the basic level to the complex level of care when needed. In addition, there has been no progress in the development of an empathetic, respectful or person-centered clinical practice; instead, economic, social and educational differences perpetuate a paternalistic clinical practice. The task of orienting medical training towards the development ...
Revista Peruana de Medicina Experimental y Salud Pública, 2016
Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de... more Los adultos mayores representan un grupo poblacional en incremento, su estado de salud depende de muchos factores como el físico, cognoscitivo y sociofamiliar; por otro lado, tienen características como la heterogeneidad, la gran carga de enfermedad, la pluripatología, entre otras, que repercuten no solo en el ámbito familiar sino social. Es importante ofrecer a la población adulta mayor los medios para ejercer un mejor control sobre su salud y mejorarla. Todo ello con el fin de lograr un envejecimiento exitoso, es decir, sin discapacidad, con la menor cantidad de enfermedades posibles o adecuadamente controladas y, sobre todo, intentando mantener en todo momento su autonomía y calidad de vida, respetando siempre sus valores y preferencias. Por otro lado, las actividades preventivas en los adultos mayores deben tener en cuenta no solo el riesgo de enfermedad, sino también la alteración de la función que produce la enfermedad, así como aquellas condiciones frecuentes en el adulto mayor que pueden deteriorar su estado de salud como la fragilidad, las caídas, y las complicaciones iatrogénicas; las actividades preventivas en el adulto mayor deben estar dirigidas a todos estos factores. Presentamos algunas pautas que podrían ser importantes para promover un envejecimiento activo y actividades preventivas que podrán ser aplicadas según el contexto particular de cada persona.
Acta Medica Peruana, 2013
En el presente artículo invitamos al lector a conocer mejor la Atención Primaria, sus diferencias... more En el presente artículo invitamos al lector a conocer mejor la Atención Primaria, sus diferencias con la atención especializada y su importancia en los sistemas de salud actuales. Además, hablaremos sobre los cuatro atributos que debe cumplir la Atención Primaria, descritos por Bárbara Starfield: Accesibilidad y primer contacto, donde debe existir un fácil acceso al sistema sanitario; Longitudinalidad, donde se debe establecer una relación personal y continua entre el médico y paciente; Integralidad, que da solución a las necesidades de salud más frecuentes de la comunidad; y Coordinación, que significa un trabajo en conjunto entre los médicos de Atención Primaria y otros especialistas.
Banca Y Finanzas Revista Profesional De Gestion Financiera, 2008
Acta Medica Peruana, 2013
Atencion primaria de salud, Accesibilidad a los SUMMARY In this article we invite our readers to ... more Atencion primaria de salud, Accesibilidad a los SUMMARY In this article we invite our readers to know about primary care,their differences with the secondary care and its importance in the current health systems. We talk about the four attributes of primary care described by Barbara Starfield : Accessibility and first contact where there should be easy access to the health system; Longitudinality, which must establish a personal relationship between the physician and continuous patient .Integrity,which gives solution to the most common health needsof the community and Coordination, where there isa joint effort between primary care physicians and other specialists.
Ciencia e Interculturalidad, 2013
Naturales (ARENA), a partir de su perfil profesional y la práctica de sus diferentes estrategias ... more Naturales (ARENA), a partir de su perfil profesional y la práctica de sus diferentes estrategias pedagógicas en el aula. Esta área tiene 43 docentes, entre ellos: de tiempo completo, horarios y la coordinación del área. La composición étnica corresponde con 70 % al grupo mestizo, seguido del creol con un 23 %; ulwas, garífunas y miskitus con el 2 %, respectivamente. Del total de docentes, el 58 % están en proceso de formación pedagógica y el 42 % de ellos no han iniciado estudios de especialización. La investigación fue cualitativa con enfoque etno-metodológico, tanto en lo que corresponde a la participación de docentes, estudiantes y autoridades del área académica. Se desarrollaron entrevistas, grupos focales y observación directa en las aulas de clase. Relativo a la práctica pedagógicas es importante mencionar que predomina la Pedagogía "depositaria". Entre los factores que han incidido en las prácticas pedagógicas está el abuso del término "libertad de cátedra" y el limitado "acompañamiento participativo", que garantice el cumplimiento del Modelo Pedagógico de URACCAN. Los resultados anteriores, así como el análisis de los reglamentos y normativas internas de la Universidad, conllevan a proponer algunas iniciativas para el diseño de un plan de formación y profesionalización docente.
Medical Physics, 2015
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