Fetal death and its association with indicators of social inequality: 20-year analysis in Tacna, Peru

OBJECTIVE

The aim of this study was to evaluate the rates of fetal mortality in a Peruvian hospital between 2001 and 2020 and to investigate the association of indicators of social inequality (such as access to prenatal care and education) with fetal mortality.

METHODOLOGY

We conducted a retrospective cohort study, including all pregnant women who attended a Peruvian hospital between 2001 and 2020. We collected data from the hospital's perinatal computer system. We used Poisson regression models with robust variance to assess the associations of interest, estimating adjusted relative risks (aRR) and their 95% confidence intervals (95% CI).

RESULTS

We analyzed data from 67,908 pregnant women (median age: 26, range: 21 to 31 years). Of these, 58.3% had one or more comorbidities; the most frequent comorbidities were anemia (33.3%) and urinary tract infection (26.3%). The fetal mortality ratio during the study period was 0.96%, with the highest rate in 2003 (13.7 per 1,000 births) and the lowest in 2016 (6.1 per 1,000 births), without showing a marked trend. Having less than six (aRR: 4.87; 95% CI: 3.99-5.93) or no (aRR: 7.79; 6.31-9.61) prenatal care was associated with higher fetal mortality compared to having six or more check-ups. On the other hand, higher levels of education, such as secondary education (aRR: 0.73; 0.59-0.91), technical college (aRR: 0.63; 0.46-0.85), or university education (aRR: 0.38; 0.25-0.57) were associated with a lower risk of fetal death compared to having primary education or no education. In addition, a more recent year of delivery was associated with lower fetal mortality.

CONCLUSION

Our study presents findings of fetal mortality rates that are comparable to those observed in Peru in 2015, but higher than the estimated rates for other Latin American countries. A more recent year of delivery was associated with lower fetal mortality, probably due to reduced illiteracy and increased access to health care between 2000 and 2015. The findings suggest a significant association between indicators of social inequality (such as access to prenatal care and education) with fetal mortality. These results emphasize the critical need to address the social and structural determinants of health, as well as to mitigate health inequities, to effectively reduce fetal mortality.

Imposter syndrome and its associated factors in medical students in six Peruvian faculties

OBJECTIVE

To determine the factors associated with impostor syndrome in medical students from six regions of Peru.

MATERIAL AND METHODS

A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalised linear models were performed using crude and adjusted estimated prevalence ratios.

RESULTS

Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR=2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR=1.12; 95%CI, 1.01-1.26).

CONCLUSIONS

Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Factors associated with the non-use of health services in LGBTI people from Peru

OBJECTIVE

To determine the factors associated with the non-use of health services in a sample of the lesbian, gay, bisexual, transgender, and intersex population of Peru.

MATERIALS AND METHODS

Analytical cross-sectional study, analysis of secondary data from the First LGBTI Survey of Peru. Those who suffered from a medical condition during the last twelve months and had to receive medical attention were considered a variable of interest. Crude prevalence ratios (PRc) and adjusted (PRa), with 95% confidence intervals (95% CI) were calculated using Poisson regressions with robust variance. Three models were developed, adjusted to variables grouped according to sexual orientation, gender identity, and intersexuality.

RESULTS

55.4% were male at birth, the median age was 25 years (IR: 21-30). 16% stated that they had not sought medical attention. The three models presented a negative association in having suffered a chronic disease, infectious, contagious diseases, and mental illness and those who expressed their orientation openly. Not being respected for the gender they identified with was related to not using the services in model 3. Models 1 and 3 included a positive association with not being respected with the gender identified.

CONCLUSION

Suffering from a mental illness, an infectious contagious disease, a chronic disease, and not being treated with respect according to their gender identity are factors associated with the non-use of health services.

Imposter Syndrome and its Associated Factors in Medical Students in Six Peruvian Faculties

OBJECTIVE

To determine the factors associated with impostor syndrome in medical students from six regions of Peru.

MATERIAL AND METHODS

A multicentre, cross-sectional study was conduced on students from first to the sixth year in six Peruvian regions. Sociodemographic, academic, and psychological characteristics were included through the Depression, Anxiety, and Stress Scale-21, the Rosenberg Self-Esteem Scale and the Clance Imposter Phenomenon Scale. Generalised linear models were performed using crude and adjusted estimated prevalence ratios.

RESULTS

Of 2,231 medical students, 54.3% were female and 30.6% had the impostor phenomenon. An association was found between the PI and those who suffered from depression (aPR=1.51; 95%CI, 1.27-1.79), anxiety (aPR=2.25; 95%CI, 1.75-2.90), stress (aPR=1.37; 95%CI, 1.19-1.57), and being female (aPR=1.12; 95%CI, 1.01-1.26).

CONCLUSIONS

Three out of 10 medical students suffer from PI; having some level of depression, anxiety, stress, being a woman, and/or attending the fourth academic year were predisposing factors for their development.

Depression and Abuse During Medical Internships in Peruvian Hospitals

OBJECTIVE

To estimate the prevalence of depression and abuse and identify the associated factors in medical interns in Peruvian hospitals.

METHODS

We conducted a multicentre, cross-sectional and analytical study during the months of March to May 2016. We included medical interns from 18 Peruvian hospitals, in Lima and provinces. We used a survey that included sociodemographic data and a scale to measure the perception of abuse (psychological, physical and sexual). In addition, we used the Spanish version of the PHQ-9 to evaluate depression. We used Poisson regression with robust variances to calculate prevalence ratios (PRs).

RESULTS

A total of 402 medical interns participated in the study, the median age was 25 [IQR: 21-33], and 52.7% were male. Moreover, 25.4% of them suffered from depression. In the adjusted model, the variables associated with depression were age (PRa=1.15), the number of hours they sleep per day (PRa=1.23), being a woman (PRa=3.33), performing the internship in a province (PRa=0.25), studying at a public university (PRa=0.64), living with parents (PRa=0.65) or alone (PRa=0.33), and having perceived some type of abuse (PRa=1.07).

CONCLUSIONS

A quarter of surveyed medical interns had depression. Early screening is necessary to identify perceived abuse and other triggering depression factors that may adversely affect work performance and overall mental health during medical internships.

Alcohol consumption and suicide risk in medical internship: A Peruvian multicentric study

INTRODUCTION AND AIM

Suicide and harmful alcohol consumption are major health problems, especially in medical students. This study aimed to evaluate the association between risk for alcohol abuse and suicide risk in medical interns of Peruvian hospitals.

DESIGN AND METHODS

We conducted a multicentre cross-sectional study in medical interns from 18 Peruvian hospitals. We measured suicide risk, risk for alcohol abuse, depression and self-esteem using the Plutchik Suicide Risk Scale, CAGE, Zung Self-Rating Depression Scale and Rosenberg Self-Esteem Scale, respectively. We used χ² and Student t-tests for descriptive analysis. To evaluate the association between risk for alcohol abuse and suicide risk we generated crude and adjusted Poisson regression models with robust variance and estimated prevalence ratios with 95% confidence intervals.

RESULTS

We surveyed 433 medical interns. The prevalence of suicide risk and risk for alcohol abuse was 19.6% and 27.5%, respectively. We found significant differences in suicide risk according to age (P < 0.001), region of origin (P = 0.002), with whom the participant lived (P < 0.001), university of origin (P = 0.040), type of hospital (P = 0.042), family history of attempted suicide (P = 0.043), self-esteem level (P < 0.001) and alcohol consumption (P < 0.001). In the adjusted model, age (PRa: 1.11, 95% confidence interval 1.05-1.17) and risk for alcohol abuse (PRa: 7.60, 95% confidence interval 4.46-12, 96) were associated with suicide risk.

DISCUSSION AND CONCLUSIONS

Two out of 10 medical interns had a positive screening for suicide risk. Age and especially risk for alcohol abuse were the associated variables.

[Cavernoma complicated with biliopatia secondary to type 1 Gaucher disease: report of a Peruvian case]

Gaucher disease is an autosomal recessive lysosomal storage disorder characterized by deficiency of beta-glucosidase that would lead to the accumulation of glucosylceramide mainly in cells of the mononuclear phagocytic system causing systemic effectations. We present a patient of twenty years who is suffering from chronic pain in the left hypochondrium with episodes of bleeding for 3 years and sensation of thermal rise, physical examination revealed jaundice and massive splenomegaly, without neurological involvement. Severe osteoporosis, pancytopenia, and the presence of portal vein thrombosis with cavernomatous transformation complicated by portal biliopathy simulating a klatskin tumor, marrow and enzymatic studies were compatible with Gaucher disease, were shown as unexpected findings. he received treatment with imiglucerase, following up. It is a rare case, of great interest, heterogeneity in its clinical manifestations and unpublished by its complication, constituting a challenge to reach its diagnosis of this orphan disease.