Publications by authors named "Marilina Santero"

28 Publications

  • Page 1 of 1

Effectiveness and Safety of Dabigatran Compared to Vitamin K Antagonists in Non-Asian Patients with Atrial Fibrillation: A Systematic Review and Meta-Analysis.

Clin Drug Investig 2021 Oct 13. Epub 2021 Oct 13.

Grup de Recerca d'Epidemiologia Clínica i Serveis Sanitaris, Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.

Background And Objective: Real-life data about the use of dabigatran in patients with non-valvular atrial fibrillation are warranted. The objective of this systematic review and meta-analysis was to assess the effectiveness and safety of dabigatran, globally and stratified by dose (110/150 mg twice daily), vs vitamin K antagonists in non-Asian patients with non-valvular atrial fibrillation from "real-world" studies.

Methods: A systematic review was performed according to Cochrane methodological standards. The results were reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement) statement. The ROBINS-I tool was used to assess bias risk. MEDLINE and EMBASE, from inception up to May 2021, using appropriate controlled vocabulary and free search terms, were searched.  RESULTS: A total of 34 studies, corresponding to 37 articles involving 1,600,722 participants (1,154,283 exposed to vitamin K antagonists and 446,439 to dabigatran) were eligible for this review. Dabigatran 150 mg reduced the risk of ischemic stroke compared with vitamin K antagonists, with a 14% risk reduction (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.74-0.98). Globally, dabigatran reduced the risk of all-cause mortality compared with vitamin K antagonists (HR 0.76, 95% CI 0.69-0.84), with a greater effect observed with dabigatran 150 mg (HR 0.65, 95% CI 0.58-0.73). There was a trend towards a lower risk of myocardial infarction with dabigatran 150 mg (HR 0.86, 95% CI 0.71-1.04). Regarding the primary safety outcomes, dabigatran (either at a dose of 150 mg or 110 mg) reduced the risk of major bleeding compared with vitamin K antagonists (HR 0.77, 95% CI 0.70-0.83), as well as the risk of intracranial bleeding (HR 0.44, 95% CI 0.39-0.50) and fatal bleeding (HR 0.76, 95% CI 0.60-0.95), but with a slight increase in gastrointestinal bleeding risk (HR 1.16, 95% CI 1.08-1.26).

Conclusions: Dabigatran has a favorable impact on effectiveness and safety outcomes compared with vitamin K antagonists in real-world populations.
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http://dx.doi.org/10.1007/s40261-021-01091-wDOI Listing
October 2021

Effectiveness of financial incentives and message framing to improve clinic visits of people with moderate-high cardiovascular risk in a vulnerable population in Argentina: A cluster randomized trial.

Prev Med 2021 Jul 20;153:106738. Epub 2021 Jul 20.

Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.

In Argentina, cardiovascular disease (CVD) represents the first cause of mortality, but effective coverage for CVD prevention is low. Strategies based on behavioral economics are emerging worldwide as key pieces to increase the effectiveness of CVD prevention approaches. The aim of this study was to evaluate whether the implementation of two strategies based on financial incentives and framing increased attendance to clinical visits as proposed by the national program for CVD risk factors management among the uninsured and poor population with moderate or high CVD risk in Argentina. We conducted a cluster randomized trial in nine primary care clinics (PCCs) in Argentina. Three PCCs were assigned to financial incentives, 3 to framing-text messages (SMS) and 3 to usual care. The incentive scheme included a direct incentive for attending the first clinical visit and the opportunity to participate in a lottery when attending a second clinical visit. The framing-text messages group received messages with a gain-frame format. The main outcome was the proportion of participants who attended the clinical visits. A total of 918 individuals with a risk ≥10% of suffering a CVD event within the next 10 years were recruited to participate in the study. The financial incentive group had a significantly higher percentage of participants who attended the first (59.0% vs 33.9%, p˂ 0.001) and the follow up visit (34.4% and 16.6%, p˂ 0.001) compared to control group. However, the framing-SMS group did not show significant differences compared to the control group. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT03300154.
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http://dx.doi.org/10.1016/j.ypmed.2021.106738DOI Listing
July 2021

Socioeconomic inequalities in abdominal obesity among Peruvian adults.

PLoS One 2021 21;16(7):e0254365. Epub 2021 Jul 21.

Universidad Peruana Cayetano Heredia, Facultad de Ciencias y Filosofía, Lima, Peru.

Objectives: Abdominal obesity (AO) has become a public health issue due to its impact on health, society and the economy. The relationship between socioeconomic disparities and the prevalence of AO has yet to be studied in Peru. Thus, our aim was to analyze the socioeconomic inequalities in AO distribution defined using the International Diabetes Federation (IDF) cut-off points in Peruvian adults in 2018-2019.

Methods: This was a cross-sectional study using data from the 2018-2019 Demographic and Family Health Survey (ENDES) of Peru. We analyzed a representative sample of 62,138 adults over 18 years of age of both sexes from urban and rural areas. Subjects were grouped into quintiles of the wealth to calculate a concentration curve and the Erreygers Concentration Index (ECI) in order to measure the inequality of AO distribution. Finally, we performed a decomposition analysis to evaluate the major determinants of inequalities.

Results: The prevalence of AO among Peruvian adults was 73.8%, being higher among women than men (85.1% and 61.1% respectively, p < 0.001). Socioeconomic inequality in AO was more prominent among men (ECI = 0.342, standard error (SE) = 0.0065 vs. ECI = 0.082, SE = 0.0043). The factors that contributed most to inequality in the prevalence of AO for both sexes were having the highest wealth index (men 37.2%, women 45.6%, p < 0.001), a higher education (men 34.4%, women 41.4%, p < 0.001) and living in an urban setting (men 22.0%, women 57.5%, p < 0.001).

Conclusions: In Peru the wealthy concentrate a greater percentage of AO. The inequality gap is greater among men, although AO is more prevalent among women. The variables that most contributed to inequality were the wealth index, educational level and area of residence. There is a need for effective individual and community interventions to reduce these inequalities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254365PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294571PMC
July 2021

Efficacy of systemic oncological treatments in patients with advanced pancreatic cancer at high risk of dying in the short or medium-term: overview of systematic reviews.

Eur J Cancer 2021 Sep 9;154:82-91. Epub 2021 Jul 9.

Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain. Electronic address:

Background: Patients with advanced pancreatic cancer (PC) have a high risk of dying in the short or medium-term. This overview aimed to assess the evidence regarding systemic oncological treatments (SOT) versus supportive care for advanced PC.

Methods: We searched for systematic reviews (SRs) in MEDLINE, Embase, The Cochrane Library, Epistemonikos, and PROSPERO. Two authors assessed eligibility independently. Data extraction and methodological quality assessment were conducted by one author and cross-checked by another one. We evaluated the overlap of primary studies, performed a de novo meta-analysis, and assessed the certainty of evidence. Primary outcomes were overall survival (OS), quality of life (QoL), functional status (FS), and toxicity.

Results: We identified three SRs that assessed SOT versus supportive care in patients with advanced PC. All SRs had critically low methodological quality. At 12 months, OS improved with chemotherapy, radiotherapy followed by chemotherapy, and immunotherapy, but the certainty of the evidence supporting these findings is very low. The evidence on chemotherapy is very uncertain about its effects on QoL; it suggests a slight increase in toxicity and little to no difference in FS. The evidence on immunotherapy is very uncertain about its effects in toxicity.

Conclusions: The identified evidence is very uncertain about the benefits of oncological treatments on OS and QoL in patients with advanced PC with a high risk of dying in the short or medium-term, so its use should be proposed only to selected patients. Further studies that include a thorough assessment of patient-centred outcomes are needed.
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http://dx.doi.org/10.1016/j.ejca.2021.05.034DOI Listing
September 2021

Inequalities in access to safe drinking water in Peruvian households according to city size: an analysis from 2008 to 2018.

Int J Equity Health 2021 06 5;20(1):133. Epub 2021 Jun 5.

CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, 12 Lima, Peru.

Background: Peru is one of the countries with the lowest percentage of population with access to safe drinking water in the Latin American region. This study aimed to describe and estimate, according to city size, socioeconomic inequalities in access to safe drinking water in Peruvian households from 2008 to 2018.

Methods: Secondary analysis of cross-sectional data using data from the 2008-2018 ENAHO survey. Access to safe drinking water, determined based on the presence of chlorinated water supplied by the public network, as well as socioeconomic variables were analyzed. A trend analysis from 2008 to 2018, and comparisons between 2008 versus 2018 were performed to understand and describe changes in access to safe drinking water, according to city size. Concentration curves and Erreygers concentration index (ECI) were estimated to measure inequalities in access to safe drinking water.

Results: In 2008, 47% of Peruvian households had access to safe drinking water, increasing to 52% by 2018 (p for trend < 0.001). For small cities, access to safe drinking water did not show changes between 2018 and 2008 (difference in proportions - 0.2 percentage points, p = 0.741); however, there was an increase in access to safe drinking water in medium (difference in proportions 3.3 percentage points, p < 0.001) and large cities (difference in proportions 12.8 percentage points, p < 0.001). The poorest households showed a decreasing trend in access to safe drinking water, while the wealthiest households showed an increasing trend. In small cities, socioeconomic inequalities showed an increase between 2008 and 2018 (ECI 0.045 and 0.140, p < 0.001), while in larger cities, socioeconomic inequality reduced in the same period (ECI: 0.087 and 0.018, p = 0.036).

Conclusions: We report a widening gap in the access to safe drinking water between the wealthiest and the poorest households over the study period. Progress in access to safe drinking water has not been equally distributed throughout the Peruvian population. Promoting and supporting effective implementation of policies and strategies to safe drinking water, including equity-oriented infrastructure development and resource allocation for most vulnerable settings, including emerging small cities, is a priority.
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http://dx.doi.org/10.1186/s12939-021-01466-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8178848PMC
June 2021

Metrics of Ideal Cardiovascular Health are Unequally Distributed between Peruvian Men and Women: Analysis of a National Population-Based Survey in 2017.

Int J Prev Med 2020 11;11:190. Epub 2020 Dec 11.

Universidad de Buenos Aires, Buenos Aires, Argentina.

Background: To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex.

Methods: An observational, cross-sectional study was conducted in 26,175 individuals aged 18-65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables.

Results: Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women ( < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: -0.0817; men: -0.2699).

Conclusions: Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_326_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000168PMC
December 2020

Efficacy and safety of treatment with biologicals for severe chronic rhinosinusitis with nasal polyps: A systematic review for the EAACI guidelines.

Allergy 2021 08 24;76(8):2337-2353. Epub 2021 Mar 24.

Department of Clinical Immunology, University of Wroclaw, Wroclaw, Poland.

This systematic review evaluates the efficacy and safety of biologicals for chronic rhinosinusitis with nasal polyps (CRSwNP) compared with the standard of care. PubMed, Embase, and Cochrane Library were searched for RCTs. Critical and important CRSwNP-related outcomes were considered. The risk of bias and the certainty of the evidence were assessed using GRADE. RCTs evaluated (dupilumab-2, omalizumab-4, mepolizumab-2, and reslizumab-1) included 1236 adults, with follow-up of 20-64 weeks. Dupilumab reduces the need for surgery (NFS) or oral corticosteroid (OCS) use (RR 0.28; 95% CI 0.20-0.39, moderate certainty) and improves with high certainty smell evaluated with UPSIT score (mean difference (MD) +10.54; 95% CI +9.24 to +11.84) and quality of life (QoL) evaluated with SNOT-22 (MD -19.14; 95% CI -22.80 to -15.47), with fewer treatment-related adverse events (TAEs) (RR 0.95; 95% CI 0.89-1.02, moderate certainty). Omalizumab reduces NFS (RR 0.85; 95% CI 0.78-0.92, high certainty), decreases OCS use (RR 0.38; 95% CI 0.10-1.38, moderate certainty), and improves high certainty smell (MD +3.84; 95% CI +3.64 to +4.04) and QoL (MD -15.65; 95% CI -16.16 to -15.13), with increased TAE (RR 1.73; 95% CI 0.60-5.03, moderate certainty). There is low certainty for mepolizumab reducing NFS (RR 0.78; 95% CI 0.64-0.94) and improving QoL (MD -13.3; 95% CI -23.93 to -2.67) and smell (MD +0.7; 95% CI -0.48 to +1.88), with increased TAEs (RR 1.64; 95% CI 0.41-6.50). The evidence for reslizumab is very uncertain.
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http://dx.doi.org/10.1111/all.14809DOI Listing
August 2021

Cut-off points of anthropometric markers associated with hypertension and diabetes in Peru: Demographic and Health Survey 2018.

Public Health Nutr 2020 Oct 16:1-11. Epub 2020 Oct 16.

Universitat Autònoma de Barcelona, Barcelona, Spain.

Objective: To determine the optimal anthropometric cut-off points for predicting the likelihood ratios of hypertension and diabetes in the Peruvian population.

Design: A cross-sectional study was performed to establish cut-off values for body mass index (BMI), waist circumference (WC), waist:height ratio (WHtR) and Conicity index (C-index) associated with increased risk of hypertension and diabetes. Youden's index (YIndex), area under the curve (AUC), sensitivity and specificity were calculated.

Setting: Peruvian households.

Participants: Peruvian population over the age of 18 years.

Results: A total of 31 553 subjects were included, 57 % being women. Among the women, 53·06 % belonged to the 25- to 44-year-old age group [mean age: 41·66 in men and 40·02 in women]. The mean BMI, WHtR and C-index values were higher in women 27·49, 0·61, 1·30, respectively, while the mean WC value was higher in men 92·12 cm (sd ± 11·28). The best predictors of hypertension in men were the WHtR (AUC = 0·64) and the C-index (AUC = 0·64) with an optimal cut-off point of 0·57 (YIndex = 0·284) and 1·301 (YIndex = 0·284), respectively. Women showed an AUC of 0·63 and 0·61 in the WHtR and C-index, respectively, with an optimal cut-off of 0·61 (YIndex = 0·236) and 1·323 (YIndex = 0·225). The best predictor for diabetes was the C-index: with an AUC = 0·67 and an optimal cut-off of 1·337 (YIndex = 0·346) for men and an AUC = 0·66 and optimal cut-off of 1·313 (YIndex = 0·319) for women.

Conclusions: Our findings show that in Peruvian adults, the WHtR and the C-index have the strongest association with hypertension in both sexes. Likewise, the C-index had the strongest association with diabetes.
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http://dx.doi.org/10.1017/S1368980020004036DOI Listing
October 2020

Music Therapy in Pain and Anxiety Management during Labor: A Systematic Review and Meta-Analysis.

Medicina (Kaunas) 2020 Oct 10;56(10). Epub 2020 Oct 10.

Instituto de Efectividad Clínica y Sanitaria (IECS), Escuela de Salud Pública de la Universidad de Buenos Aires, Marcelo T. de Alvear, Buenos Aires 2202, Argentina.

The study of music therapy in labor is unknown. The main objective of this research was to evaluate the effectiveness of music therapy to manage pain and anxiety during labor. A search strategy was used with PubMed/MEDLINE, LILACS, Cochrane, TRIPDATABASE, and Google Scholar. The selection criteria were based on randomized clinical trials; quasi-experimental research on pain intensity and anxiety during labor was evaluated. The primary outcomes were measured by the Visual Analogue Scale (VAS). A meta-analysis of the fixed effects was performed using mean differences (MD). Twelve studies were included for the final analysis, six (778 women) of which were meta-analyzed. Decreased VAS scores for pain intensity associated with music therapy were found in the latent (MD: -0.73; 95% CI -0.99; -0.48) and active (MD: -0.68; 95% CI -0.92; -0.44) phases of labor. VAS scores for anxiety decreased both in the latent (MD: -0.74; 95% CI -1.00; -0.48) and active (MD: -0.76; 95% CI -0.88; -0.64) phases. Music therapy seems to have beneficial effects on pain intensity and anxiety during labor, especially for women giving birth for the first time. However, the evidence is qualified as low.
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http://dx.doi.org/10.3390/medicina56100526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599829PMC
October 2020

A public-private collaborative model for a trauma program implementation: findings from a prospective trauma registry at 14 hospitals in Buenos Aires, Argentina.

Eur J Trauma Emerg Surg 2020 Mar 31. Epub 2020 Mar 31.

Fundación Trauma, Tacuarí 352, CABA, C1071 AAH, Buenos Aires, Argentina.

Introduction: Trauma is a leading cause of mortality and comprises an important cause of functional impairment among young people worldwide. The trauma registry (TR) is an integral component of modern comprehensive trauma care systems. Nevertheless, TRs have not been yet established in most developing countries. The objective of this study was to summarize the challenges, results, and lessons learned from a trauma program including initial results from a TR at tertiary-care public hospitals of Buenos Aires, Argentina.

Material And Methods: This is a descriptive study of the implementation of a trauma program in 14 hospitals and analysis of the initial results in the period between January 2010 and December 2018, using data from Fundación Trauma TR. Patients fitting injury definition that remained in hospital for more than 23 h were included. Injured patients were divided by age groups. Data on patients' demographics, mechanism of injury and severity, complications, treatments, and in-hospital mortality were analyzed between groups. A descriptive analysis is presented.

Results: There were 29,970 trauma cases during the study period. Median age was 23 years (RIC 12, 39) with a 2.4:1 male-to-female ratio. Road traffic injuries (RTI) were the leading mechanism (30.8%) of admission and head was the most frequently injured body region (33.2%). Two-thirds of RTIs were motorcycle-related. Overall in-hospital mortality was 6.1%. Intentional self-harm in adult males and burns in adult females had the highest mortality rates (17.6% and 17.9%, respectively).

Conclusions And Discussion: The implementation of a trauma program within a public-private collaborative program in a resource-limited environment is feasible. The hospital-based TR can be used as a tool for injury surveillance, monitoring of the quality of trauma care, development of a trauma system, and to guide public health policies.
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http://dx.doi.org/10.1007/s00068-020-01348-7DOI Listing
March 2020

[Changes in the prevalence of hypertension in Peru using the new guideline of the American College of Cardiology].

Rev Med Chil 2019 May;147(5):545-556

CRONICAS, Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú.

Introduction And Objective: There is little evidence in Latin America about the impact of the ACC/AHA 2017 guideline. Taking as reference the JNC 7 guideline, the objective of our study is to estimate changes in the prevalence of arterial hypertension (HBP) according to socio-demographic characteristics and geographic regions, applying the criteria of the new ACC / AHA guide 2017.

Methods: Cross-sectional study of the Demographic and Family Health Survey conducted in Peru in 2017. Standardized weighted hypertension prevalence's were estimated for the WHO population according to both guidelines, and absolute differences with 95% CI.

Results: We included 30,682 people aged 18 years and over, with an average age of 42.3 years, 51.1% women. The standardized prevalence of HBP for 2017 according to JNC 7 was 14.4% (95% CI: 13.8-15.1) and according to ACC / AHA 2017 it was 32.9% (95% CI: 32.0-33.7), so the prevalence increase is 18.5 percentage points, being higher in males than females (24.2 vs 12.9 respectively). In people with obesity and / or who consume tobacco, the increases were higher (24.3 and 24.1 percentage points respectively). In the regions of Tacna, Ica and Metropolitan Lima, the increase, in comparison with the JNC 7 guidelines, overcome the national average (22.4, 20.7 and 20.4, percentage points, respectively).

Conclusions: Considering the context of a Latin American country and knowing the epidemiology of hypertension in Peru, the potential adoption of the ACC/AHA 2017 guidelines for the prevention, detection, evaluation, and management of hypertension should be accompanied by an evaluation of the impact at the individual, system and social level.
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http://dx.doi.org/10.4067/S0034-98872019000500545DOI Listing
May 2019

Association between religiosity and depression varies with age and sex among adults in South America: Evidence from the CESCAS I study.

PLoS One 2019 16;14(12):e0226622. Epub 2019 Dec 16.

Department of Chronic Diseases, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and 74 years old were recruited between 2011 and 2012 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Religiosity was assessed with a questionnaire from the Hispanic Community Health Study/Study of Latinos. Two dimensions were used: 1) recognition as belonging to a religion; and 2) frequency of participation in religious activities. Depression was measured using the PHQ-9. Prevalence of religiosity was described by sociodemographic characteristics. Association between religiosity and depression was examined through logistic regression models controlling for sex, age and other potential confounders. Weekly religious activities were reported by 32.3% (95% CI: 30.1, 33.6) of participants. Prevalence of major depressive episode (MDE) was 14.6% (95% CI: 13.6, 15.6). After controlling for confounders, older women (≥65 years) who reported religious affiliation had 70% lower likelihood of having MDE (OR: 0.3; 95% CI, 0.1, 0.8). Moreover, in this group, women participating in religious activities more than once per week compared with "never" had 50% lower likelihood of having a MDE (OR: 0.5; 95% CI: 0.3, 0.9). No association between religious activities and depression was found in men. Religiosity is highly prevalent among adults in four cities of South America. Our study found an inverse association between religiosity and depression only in women, stronger in olders. Although longitudinal studies are necessary to determine the true nature of these relationships, religiosity may be a relevant factor that health care providers could take into account when exploring depression in their patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226622PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913958PMC
April 2020

Substance abuse in adolescents before admission to Peruvian juvenile detention centers: results from a national census in Peru, 2016.

Int J Adolesc Med Health 2019 Dec 4. Epub 2019 Dec 4.

Bachelor of Science in Health Sciences and a Minor in Chemistry, Master of Public Health in Community Health, California State University, Long Beach, CA, USA.

Objectives To estimate the prevalence of drug use before admission to juvenile detention centers (JDC) in Peru and determine individual, family and social influences on behavior. Methods A cross-sectional analysis was performed using data from the 2016 National Population Census in Juvenile Detention Centers (NPCJDC). A total of 1960 Peruvian adolescent offenders were included. Generalized linear models of the Poisson family with a log link function were used to determine if characteristics before admission to a JDC were associated with drug use. These characteristics included employment, depression, neighborhood gang activity, having friends with a criminal record, a history of multiple admissions to a JDC, a history of running away from home, physical abuse during childhood and family history of drug use and incarceration. Results More than half of young offenders reported using drugs before entering a JDC (59%) in Peru. The drug most frequently consumed was cannabis (86.6%), followed by cocaine and/or crack (11.6%), and inhalants and/or pills (1.8%). Smoking cigarettes [prevalence ratios (PR): 1.12, p = 0.003], using alcohol (PR: 1.22, p = 0.003), neighborhood gang activity (PR: 1.28, p < 0.001), having friends with a criminal record (PR: 1.62, p < 0.001), running away from home (PR: 1.20, p < 0.001) and a family history of incarceration (PR: 1.09, p = 0.010) were associated with drug use prior to admission to a JDC. Conclusion Drug use before admission to a JDC was high among young offenders in Peru, with marijuana being the drug most frequently used. Having friends with a criminal record and neighborhood gang activity had the greatest association with drug use in young offenders.
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http://dx.doi.org/10.1515/ijamh-2019-0157DOI Listing
December 2019

Cluster Randomized Trial for Hypertension Control: Effect on Lifestyles and Body Weight.

Am J Prev Med 2019 10 29;57(4):438-446. Epub 2019 Aug 29.

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

Introduction: Lifestyle modification, such as healthy diet habits, regular physical activity, and maintaining a normal body weight, must be prescribed to all hypertensive individuals. This study aims to test whether a multicomponent intervention is effective in improving lifestyle and body weight among low-income families.

Study Design: Cluster randomized trial conducted between June 2013 and October 2016.

Setting/participants: A total of 1,954 uninsured adult patients were recruited in the study within 18 public primary healthcare centers of Argentina.

Intervention: Components targeting the healthcare system, providers, and family groups were delivered by community health workers; tailored text messages were sent for 18 months.

Main Outcome Measures: Changes in the proportion of behavioral risk factors and body weight from baseline to end of follow-up. Data were analyzed in 2017.

Results: Low fruit and vegetable consumption (fewer than 5 servings per day) decreased from 96.4% at baseline to 92.6% at 18 months in the intervention group, whereas in the control group it increased from 97.0% to 99.9% (p=0.0110). The proportion of low physical activity (<600 MET-minutes/week) decreased from 54.3% at baseline to 46.2% at 18 months in the intervention group and kept constant around 52% (p=0.0232) in the control group. The intervention had no effect on alcohol intake (p=0.7807), smoking (p=0.7607), addition of salt while cooking or at the table (p=0.7273), or body weight (p=0.4000).

Conclusions: The multicomponent intervention was effective for increasing fruit and vegetable intake and physical activity with no effect on alcohol consumption, smoking, addition of salt, or body weight among low-income families in Argentina.

Trial Registration: This study is registered at www.clinicaltrials.gov NCT01834131.
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http://dx.doi.org/10.1016/j.amepre.2019.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6755040PMC
October 2019

A review of assessment indicators used by Healthy Municipalities and Communities Program in Latin America and the Caribbean region.

Health Promot Int 2020 Aug;35(4):714-729

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

The Healthy Municipalities and Communities Strategy (HMCS) was developed by the Pan American Health Organization in 1990. Evaluation and monitoring are fundamental components of health promotion policies. The aim of this study is to explore the indicators used in Latin America and the Caribbean (LAC) countries to assess the performance of HMCS. We searched MEDLINE, EMBASE, LILACS, BVSDE and Google Advanced Search for documents published between January 2000 and April 2016. We included only documents with assessment indicators of the strategy. All articles were independently assessed for eligibility by pairs of reviewers. We classified the indicators with a supporting framework proposed by O'Neill and Simard (Choosing indicators to evaluate Healthy Cities projects: a political task? Health Promot Int 2006, 21, 145-152.). Local level indicators figured far more prominently among countries and were distributed both in projects and specific activities. Regarding the evolution of the HMCS, indicators were reported in the five levels of analysis (local projects and activities, provincial, national and international networks). Empowerment was represented through the presence of active community organizations and different methods of community participation (forums, open hearing and participation maps). Public policies (such as for tobacco cessation) and bylaws adherence and changes in school's curricula regarding healthy eating were frequently mentioned. However, this review demonstrated that impact indicators related to lifestyle changes or built environment are not clearly defined and there is a lack of indicators to measure progress in achieving change in long-term outcomes in LAC. We highlight the importance of designing validated indicators for measuring the impact of health promotion policies in partnership with each country involved.
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http://dx.doi.org/10.1093/heapro/daz059DOI Listing
August 2020

Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013.

PLoS One 2019 7;14(6):e0217845. Epub 2019 Jun 7.

Departmento de Enfermedades Crónicas, Instituto de Efectividad Clínica y Sanitaria (IECS), Buenos Aires, Argentina.

Background: Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013.

Methods: Data were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis.

Results: Prevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES.

Conclusions: While overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217845PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555547PMC
February 2020

An Educational Intervention to Improve Statin Use: Cluster RCT at the Primary Care Level in Argentina.

Am J Prev Med 2019 07 23;57(1):95-105. Epub 2019 May 23.

Institute for Clinical Effectiveness and Health Policy, Research in Chronic Diseases Department, Buenos Aires, Argentina.

Introduction: Statins are essential drugs for high cardiovascular disease (CVD) risk management; however, there is still low adherence to good clinical practice guidelines for statin use at the primary care level in low- and middle-income countries. This study aimed to test whether a complex intervention targeting physicians improves treatment and control of hypercholesterolemia among patients with moderate to high CVD risk in Argentina.

Study Design: Cluster RCT.

Setting/participants: Ten primary care centers from the public healthcare system of Argentina.

Intervention: Primary care physicians in the intervention group received an educational program with three main components: (1) an intensive 2-day training workshop; (2) educational outreach visits; and (3) a mobile health application installed on the physician's smartphones.

Main Outcome Measures: Reduction in mean low-density lipoprotein cholesterol level, reduction in mean Framingham risk score, proportion of patients receiving an appropriate statin dose, and mean annual number of primary care center visits.

Results: Data were analyzed in 2017-2018. Between April 2015 and April 2016, a total of 357 participants were enrolled (179 patients in the intervention group and 178 in the control group). The global follow-up rate was 97.2%. At the end of the follow-up period, there was no difference in low-density lipoprotein cholesterol levels in any of the follow-up points among the groups. Mean CVD risk had a significant net difference in the first 6 months in the intervention group versus the control group (-4.0, 95% CI = -6.5, -1.5). At the end of follow-up, there was an absolute 41.5% higher rate of participants receiving an appropriate statin dose in the intervention group versus the control group.

Conclusions: Although the intervention did not reach a reduction in cholesterol levels, it had a significant positive impact on the promotion of adequate use of clinical practice guidelines.

Trial Registration: This study is registered at www.clinicaltrials.gov NCT02380911.
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http://dx.doi.org/10.1016/j.amepre.2019.02.018DOI Listing
July 2019

Perceptions and Acceptability of Text Messaging for Diabetes Care in Primary Care in Argentina: Exploratory Study.

JMIR Diabetes 2019 Mar 18;4(1):e10350. Epub 2019 Mar 18.

Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.

Background: Engagement in self-care behaviors that are essential to optimize diabetes care is challenging for many patients with diabetes. mHealth interventions have been shown to be effective in improving health care outcomes in diabetes. However, more research is needed on patient perceptions to support these interventions, especially in resource settings in low- and middle-income countries.

Objective: The goal of the research was to explore perceptions and acceptability of a short message service (SMS) text messaging intervention for diabetes care in underserved people with diabetes in Argentina.

Methods: A qualitative exploratory methodology was adopted as part of the evaluation of a program to strengthen diabetes services in primary care clinics located in low-resource settings. The diabetes program included a text messaging intervention for people with diabetes. A total of 24 semistructured telephone interviews were conducted with people with diabetes.

Results: Twenty-four middle-aged persons with diabetes were interviewed. Acceptability was considered adequate in terms of its actual use, frequency, and the role of texts as a reminder. We found that text messages could be a mediating device in the patient's learning processes. Also, being exposed to the texts seemed to help bring about changes in risk perception and care practices and to function as psychosocial support. Another relevant finding was the role of text messaging as a potential facilitator in diabetes care. In this sense, we observed a strong association between receiving text messages and having a better patient-physician relationship. Additionally, social barriers that affect diabetes care such as socioeconomic and psychosocial vulnerability were identified.

Conclusions: Our findings show positive contributions of a text messaging intervention for the care of people with diabetes. We consider that an SMS strategy has potential to be replicated in other contexts. However, further studies are needed to explore its sustainability and long-term impact from the perspective of patients.
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http://dx.doi.org/10.2196/10350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441856PMC
March 2019

Use of oral health care services in Peru: trends of socio-economic inequalities before and after the implementation of Universal Health Assurance.

BMC Oral Health 2019 03 7;19(1):39. Epub 2019 Mar 7.

Universidad de Buenos Aires, Buenos Aires, Argentina.

Background: Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).

Methods: Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).

Results: We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.

Conclusions: The use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.
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http://dx.doi.org/10.1186/s12903-019-0731-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407179PMC
March 2019

Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina.

Int J Environ Res Public Health 2019 01 14;16(2). Epub 2019 Jan 14.

Instituto de Efectividad Clinica y Sanitaria (IECS), Dr. Emilio Ravignani 2024, C1414CPV Buenos Aires, Argentina.

: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. : A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. : The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. : This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.
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http://dx.doi.org/10.3390/ijerph16020213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352269PMC
January 2019

[Health-related out-of-pocket expenses in older peruvian adults: analysis of the national household survey on living conditions and poverty 2017].

Rev Peru Med Exp Salud Publica 2018 Jul-Sep;35(3):390-399

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana. Bogotá, Colombia.

Objectives: . To estimate out-of-pocket spending on health (GBS) and identify its associated factors in Peruvian older adults.

Materials And Methods.: Analytical cross-sectional study of the National Household Survey on Living Conditions and Poverty (ENAHO) 2017. Older adults were considered to be all individuals aged 60 and over and the GBS was considered the main study variable. Prevalence ratios (PR) and adjusted prevalence ratios (PRa) were estimated for each of the factors associated with GBS. GBS means were estimated using a generalized linear model with gamma distribution and log binding function. All confidence intervals (95%) of the estimators were calculated by bootstrapping with the normal-based method.

Results: . Eighteen 386 older adults were included, of which 56.5% reported GBS. The mean and median GBS is S/. 140.8 (USD 43.2) and S/. 34.5 (USD 10.6), respectively. Factors such as urban origin, a higher level of education, chronic diseases and higher per capita expenses increase the probability of GBS by up to 1.6 times. In those affiliated to the Integral Health Insurance (SIS), the GBS is reduced by 63.0 soles (USD 19.3) compared to those without any health insurance.

Conclusions: . Six out of ten older Peruvian adults reported GBS to attend to their health needs. This generates an access inequity in terms of health services, mainly for socially-vulnerable groups. We suggest researching into the economic impact of health insurance and the preventive-promotional approach to chronic diseases, in order to reduce GBS and improve the efficiency of the Peruvian health system.
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http://dx.doi.org/10.17843/rpmesp.2018.353.3815DOI Listing
June 2019

New 2017 ACC/AHA hypertension guideline: Implications for a Latin American country like Peru.

Eur J Prev Cardiol 2019 04 5;26(6):668-670. Epub 2018 Sep 5.

2 Clinical Effectiveness and Health Policy Institute (IECS), University of Buenos Aires, Argentina.

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http://dx.doi.org/10.1177/2047487318799489DOI Listing
April 2019

Using mHealth strategies in a Diabetes Management Program to improve the quality of care in Argentina: Study design and baseline data.

Prim Care Diabetes 2018 12 27;12(6):510-516. Epub 2018 Aug 27.

Institute for Clinical Effectiveness and Health Policy (IECS), Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina. Electronic address:

Aim: To evaluate the one-year post effect of the implementation of a diabetes program that includes mHealth interventions on the quality of diabetic care in public primary care centers.

Method: It is a quasi-experimental study with outcome measurements at baseline, 6 and 12months. The program includes primary care team training, a diabetes registry with a decision support tool in an app. and text messages for patients.

Results: At baseline, 947 patients were included in the registry, 62.3% women with a mean age of 53.6±11.5years and 92% with type 2 diabetes. Common comorbidities were hypertension (61.3%) and obesity (59%). Only 16.9% had one HbA1c and 48.9% a cholesterol lab in the last year, 61.9% were screened for diabetic peripheral neuropathy, and 29.0% had one eye exam in the previous year. With respect to blood sugar, lipid and blood pressure control: 44.4% of those with HbA1c measurements had levels ≥8%, total cholesterol was over 200mg/dL in 40.6% and 48.2% had uncontrolled blood pressure values.

Conclusion: Patients with diabetes received a low quality of care at public primary care clinics. A diabetes registry allowed us to draw an epidemiological profile of diabetic patients and determine the quality of care provided.
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http://dx.doi.org/10.1016/j.pcd.2018.07.014DOI Listing
December 2018

Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial.

JAMA 2017 09;318(11):1016-1025

Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.

Importance: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries.

Objective: To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension.

Design, Setting, And Participants: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016.

Interventions: Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care.

Main Outcomes And Measures: The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses.

Results: Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported.

Conclusions And Relevance: Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome.

Trial Registration: clinicaltrials.gov Identifier: NCT01834131.
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http://dx.doi.org/10.1001/jama.2017.11358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5761321PMC
September 2017

Educational intervention to improve effectiveness in treatment and control of patients with high cardiovascular risk in low-resource settings in Argentina: study protocol of a cluster randomised controlled trial.

BMJ Open 2017 01 31;7(1):e014420. Epub 2017 Jan 31.

Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.

Introduction: Hypercholesterolaemia is estimated to cause 2.6 million deaths annually and one-third of the cases of ischaemic heart disease. In Argentina, the prevalence of hypercholesterolaemia increased between 2005 and 2013 from 27.9% to 29.8%. Only one out of four subjects with a self-reported diagnosis of coronary heart disease is taking statins. Since 2014, statins (simvastatin 20 mg) are part of the package of drugs provided free-of-charge for patients according to cardiovascular disease (CVD) risk stratification. The goal of this study is to test whether a complex intervention targeting physicians and pharmacist assistants improves treatment and control of hypercholesterolaemia among patients with moderate-to-high cardiovascular risk in Argentina.

Methods And Analysis: This is a cluster trial of 350 patients from 10 public primary care centres in Argentina to be randomised to either the intervention or usual care. The study is designed to have 90% statistical power to detect a 0.7 mmol/L reduction in low-density lipoproteins cholesterol from baseline to 12 months. The physician education programme consists of a 2-day initial intensive training and certification workshop followed by educational outreach visits (EOVs) conducted at 3, 6 and 9 months from the outset of the study. An on-site training to pharmacist assistants during the first EOV is performed at each intervention clinic. In addition, two intervention support tools are used: an app installed in physician's smartphones to serve as a decision aid to improve prescription of statins according to patient's CVD risk and a web-based platform tailored to send individualised SMS messages to patients.

Ethics And Dissemination: Ethical approval was obtained from an independent ethics committee. Results of this study will be presented to the Ministry of Health of Argentina for potential dissemination and scale-up of the intervention programme to the entire national public primary care network in Argentina.

Trial Registration Number: NCT02380911.
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http://dx.doi.org/10.1136/bmjopen-2016-014420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293870PMC
January 2017

[Spatial analysis of childhood obesity and overweight in Peru, 2014].

Rev Peru Med Exp Salud Publica 2016 Jul-Sep;33(3):489-497

Johns Hopkins Bloomberg School of Public Health. Baltimore, USA.

Objectives.: To estimate regional prevalence and identify the spatial patterns of the degree of overweight and obesity by districts in under five years children in Peru during 2014.

Materials And Methods.: Analysis of the information reported by the Information System Nutritional Status (SIEN) of the number of cases of overweight and obesity in children under five years recorded during 2014. Regional prevalence for overweight and obesity, and their respective confidence intervals to 95% were calculated. Moran index was used to determine patterns of grouping districts with high prevalence of overweight and/or obesity.

Results.: Data from 1834 districts and 2,318,980 children under five years were analyzed. 158,738 cases (6.84%; CI 95%: 6.81 to 6.87) were overweight, while 56,125 (2.42%; CI 95%: 2.40 to 2.44) obesity. The highest prevalence of overweight were identified in the regions of Tacna (13.9%), Moquegua (11.8%), Callao (10.4%), Lima (10.2%) and Ica (9.3%), and in the same regions for obesity with 5.3%; 4.3%; 4.0%; 4.0% and 3.8% respectively. The spatial analysis found grouping districts of high prevalence in 10% of all districts for both overweight and obesity, identifying 199 districts for overweight (126 urban and 73 rural), and 184 for obesity (136 urban and 48 rural).

Conclusions.: The highest prevalence of overweight and obesity were identified in the Peruvian coast regions. Moreover, these regions are predominantly exhibited a spatial clustering of districts with high prevalence of overweight and obesity.
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http://dx.doi.org/10.17843/rpmesp.2016.333.2298DOI Listing
March 2018

Prevalence of Childhood Obesity by Sex and Regions in Peru, 2015.

Rev Esp Salud Publica 2016 Sep 13;90:e1-e10. Epub 2016 Sep 13.

Instituto de Investigación - Universidad Católica los Ángeles de Chimbote. Chimbote. Perú.

Objective: Childhood obesity is a global problem, sociodemographic and cultural factors influence its presence. An analysis of disparities in the prevalence of childhood obesity in Peru was made by sex and region in 2015.

Methods: Analysis of the information reported by the Sistema de Información del Estado Nutricional of the number of obesity cases in 2,336,791 children under five years, evaluated in public health facilities during 2015. The distribution of obesity cases was analyzed by sex and region of residence, also a spatial projection of the regional prevalence of obesity and the prevalence differences between men and women was performed.

Results: Data from 2,336,791 children under five was analyzed. An obesity prevalence of 1.52% (girls: 1.3% and boys: 1.7%) was found; the highest prevalence were observed in urban areas (girls: 1.5% and boys: 1.9%) and on the Costa (girls: 1.9% and boys: 2.5%). Highest prevalence of obesity were in Tacna (girls: 3.2% y boys: 3.9%), Moquegua (girls: 2.4% y boys: 3.1%) and Callao (girls: 2.3% y boys: 2.8%).

Conclusions: Childhood obesity predominates on the coast and in urban areas of Peru particularly among boys. The regions of higher prevalence of obesity were Tacna Moquegua and Callao.
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September 2016

[Spatial distribution of accidents, incidents and diseases related to work in Peru, 2012-2014].

Rev Peru Med Exp Salud Publica 2016 Mar;33(1):106-12

We analyzed geospatially accidents, incidents and diseases related to work of regional reports in Peru (2012-2014). The 52887 events were classified as work related accidents (93%), dangerous incidents (5.1%), occupational diseases (1%) and fatal accidents (0.9%). The highest rates of fatal accidents were reported in Pasco, Callao, Lima, Moquegua and Arequipa. Callao and Lima are the regions with the highest rates of occupational accidents. The highest rates of dangerous incidents were reported in Arequipa, Callao, Lima, Ica and Piura. Occupational diseases are distributed with high rates in Huancavelica, Ancash, Pasco, Callao and Cusco. The economic activities that reported most of the occupational diseases were mining and quarrying (49.2%); followed by manufacturing industry (23.4%); and construction (8%). It is concluded that there are high rates and common spatial patterns of laboral accidents in Peru that could be used by decision makers to focus interventions.
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March 2016
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