Association between self-perceived consultation time and understanding of the prescribed treatment: An analysis of a national survey in Peru

OBJECTIVE

To assess the relationship between the self-perceived consultation time and the knowledge of the proposed treatment.

METHODS

Secondary data from a 2015 national survey of health services in Peru were analyzed. The self-perceived consultation time was calculated by asking how long it took from when you entered the consultation until you departed. It was then categorized as low, medium, and high. Five self-reported questions were used to construct a knowledge of the prescribed treatment. Adjusted regression models from the Poisson family models were used to evaluate the relationship. We report adjusted prevalence ratios (aPR) with their 95% confidence intervals (95%CI).

RESULTS

A total of 9939 outpatients were analyzed, with 58% women; the average age was 44 years; and 45.4% had higher education. Using low self-perceived consultation time as references, medium and high consultation times were associated with understanding the prescribed treatment (aPR=1.17; 95%CI, 1.04-1.33 and aPR=1.30; 95%CI, 1.20-1.40, respectively).

CONCLUSION

Patients who reported a medium and high self-perceived consultation time better understood the prescribed treatment.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should strive to maximize consultation time to ensure effective communication and improve patient knowledge of treatments, improving overall patient satisfaction and health outcomes.

Diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD) has become the most frequent liver disease, closely related with metabolic risk factors such as obesity, insulin resistance, dyslipidemia, diabetes mellitus, and metabolic syndrome. In this context, γ-Glutamyl transpeptidase (GGT) and high-density lipoprotein cholesterol (HDL-C) have shown correlations with steatosis severity and metabolic syndrome, respectively. This positions the GGT/HDL-C ratio as a potential diagnostic indicator for NAFLD.

OBJECTIVE

To assess the diagnostic performance of the GGT/HDL-C ratio for NAFLD in adults with obesity undergoing bariatric surgery.

METHODS

We conducted an analytical cross-sectional study, designed as a diagnostic test evaluation. A secondary database of 249 adults with obesity was analyzed. The optimal cut-off point was ascertained using three methodologies, and five adjustment models were constructed for the total population, further stratified by sex.

RESULTS

The optimal cut-off point was 20.5 U/mmol and the AUC of the ratio was 0.81 (95% CI: 0.64-0.98), with sensitivity and specificity being 82.5% and 77.8%, respectively. In the overall group with an elevated GGT/HDL-C ratio, the prevalence of NAFLD increased by 14% (PR: 1.14; 95% CI: 1.04-1.33). Specifically, women displaying this altered ratio showed a 19% increased prevalence (PR: 1.19; 95% CI: 1.07-1.42) compared to those with normal values.

CONCLUSIONS

The GGT/HDL-C ratio is a promising biomarker for the diagnosis of NAFLD in an adult population living with obesity.

Ethnic Minority Participation in Clinical Trials from Latin America and the Caribbean: A Scoping Review

We summarize the clinical trials (CTs) main characteristics, including members of ethnic minorities from Latin America. We carried out a systematic search in six databases. We made a descriptive synthesis of CTs, summarizing the characteristics, interventions, main findings, results, and conclusions reported. 4411 studies were acquired in search strategy, leaving 24 CTs in the final selection. Of these, ten were randomized, four were non-randomized, and the remainder had other designs. Most of the studies were carried out in the population of infants and children (08), ten of the studies included only women, and two studies included men. Nine studies were conducted in Mexico, with the Mayan ethnic minority being mostly evaluated (05). In only 15 it was mentioned that their research was approved by a research ethics committee. Finally, half of the CTs reported funding from international agencies and third reported funding from government agencies. Our results show that that CTs in ethnic minorities are limited and reduced to a few native peoples of the continent.

Variations in the Prevalence of Childhood Anemia by Ethnicity Before and During the COVID-19 Pandemic in Peru

We aimed to determine the variations in the prevalence of childhood anemia according to the ethnic group before and during the COVID-19 pandemic in Peru. Secondary analysis of the Demographic and Family Health Survey during 2016-2021. The outcome variable was anemia, and the exposure variable was maternal ethnicity. Also, we included sociodemographic and clinical confounding variables. We constructed generalized linear models of the Poisson family with a logarithmic link function. We evaluated 85,905 records; 30.34% had anemia, 50.83% were mestizo, 25.98% were Quechua, and 2% were Aymara. Compared with mestizos, Quechua children (PR: 1.11; 95% CI: 1.07-1.15; p < 0.001), Aymara (PR: 1.35; 95% CI: 1.27-1 .44; p < 0.001), natives of the Amazon (PR: 1.20; 95% CI: 1.12-1.28; p < 0.001) and those who belonged to other indigenous peoples (PR: 1.29; 95% CI: 1.05-1.57; p = 0.013) had a higher prevalence of childhood anemia. On the contrary, compared to mestizos, white children had a lower prevalence of anemia (PR: 0.93; 95% CI: 0.89-0.99; p = 0.019). During the COVID-19 pandemic, compared to mestizos, only Quechua (PR: 1.15; 95% CI: 1.08-1.23; p < 0.001) and Aymara (PR: 1.38; 95% CI: 1.23-1.55; p < 0.001) had a higher prevalence of childhood anemia. Except for Afro-descendants, children from 6 to 59 months of age who belong to an ethnic minority had a higher probability of having childhood anemia than mestizos. However, only Quechua and Aymara children had higher odds of anemia during the COVID-19 pandemic than mestizos.

Retraction of health science articles by researchers in Latin America and the Caribbean: A scoping review

We aimed to conduct a scoping review to assess the profile of retracted health sciences articles authored by individuals affiliated with academic institutions in Latin America and the Caribbean (LAC). We systematically searched seven databases (PubMed, Scopus, Web of Science, Embase, Medline/Ovid, Scielo, and LILACS). We included articles published in peer-reviewed journals between 2003 and 2022 that had at least one author with an institutional affiliation in LAC. Data were collected on the year of publication, study design, authors' countries of origin, number of authors, subject matter of the manuscript, scientific journals of publication, retraction characteristics, and reasons for retraction. We included 147 articles, the majority being observational studies (41.5%). The LAC countries with the highest number of retractions were Brazil (n = 69), Colombia (n = 16), and Mexico (n = 15). The areas of study with the highest number of retractions were infectology (n = 21) and basic sciences (n = 15). A retraction label was applied to 89.1% of the articles, 70.7% were retracted by journal editors, and 89.1% followed international retraction guidelines. The primary reasons for retraction included errors in procedures or data collection (n = 39), inconsistency in results or conclusions (n = 37), plagiarism (n = 21), and suspected scientific fraud (n = 19). In conclusion, most retractions of scientific publications in health sciences in LAC adhered to international guidelines and were linked to methodological issues in execution and scientific misconduct. Efforts should be directed toward ensuring the integrity of scientific research in the field of health.

Ethnic disparities in out-of-pocket expense on medicines in Peru: Evidence from a nationwide survey

Background

Despite improvements in health insurance coverage, out-of-pocket (OOP) health spending remains a public health issue in Peru, and OOP payment has implications for disease treatment in ethnic minorities. We aimed to analyze the ethnic disparities in the OOP payment and estimate the gaps related to observable risk factors in the OOP payment on medicines by ethnic conditions during 2014-2016 in Peru.

Study design

cross-sectional study.

Methods

We conducted a secondary data analysis using the National Health User Satisfaction Survey. The outcome was the participants' OOP payment in self-reported medications. Ethnic minorities were considered participants who habitually spoke a language other than Spanish at home. Crude and adjusted linear regression models were performed, and the Oaxaca-Blinder decomposition method was used to assess the OPP payment differential by ethnic minority condition, explained by their individual and sociodemographic characteristics.

Results

We analyzed 11,346 surveyed, the mean age was 40.78 years, and 57.67 % were women. There was lower OOP payment in medications among ethnic minorities in the adjusted analysis (Beta coefficient [β]: -0.11; 95 % confidence interval [95%CI]: -0.21 to -0.01; p = 0.043). In the Oaxaca-Blinder decomposition analysis, a gap of 0.19 USD in the OOP payment in medicines among ethnic minorities was found (p < 0.001), and the explained component by the variables measured in this research only represents 40.5 % of the gap (p = 0.001).

Conclusion

There was less OOP expenditure on medicines in ethnic minorities. However, the measured variables explain only 40.5 % of these gaps. Therefore, we recommend future research that measures other variables that explain aspects of OOP spending on medicines not identified in this research. Likewise, our findings can be used to establish policies with an intercultural approach that adapt health documents to native languages or are disseminated by trained people from their communities.

Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults

Background

Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru.

Methods

A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey.

Results

In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51).

Conclusions

This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.

Prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19: A comparative analysis in Colombia and Peru

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About 9 out of 10 parents in Colombia and Peru intend to vaccinate their children and adolescents against COVID-19.

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Colombia: being vaccinated, 35 to 54 years old, maintaining physical distance, using masks, having economic insecurity, anxiety, and comorbidities increased the intention of vaccinating children and adolescents.

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Peru: being vaccinated, female, maintaining physical distancing, using a mask, having economic insecurity, comorbidities, and have had COVID-19 increased the intention to vaccinate children and adolescents.

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Peru: living in a town, village or rural area was associated with reducing the intention to vaccinate children and adolescents.

We aimed to estimate the prevalence and factors associated with parents’ non-intention to vaccinate their children and adolescents against COVID-19 in Colombia and Peru. We performed a secondary analysis using a database generated by the University of Maryland and Facebook (Facebook, Inc). We Included adult (18 and over) Facebook users residing in LAC who responded to the survey between May 20, and November 5, 2021. We Included sociodemographic characteristics, comorbidities, mental health, economic and food insecurity, compliance with mitigation strategies against COVID-19, and practices related to vaccination against this disease. We estimated crude (cPR) and adjusted (aPR) prevalence ratios with their respective 95 %CI. We analyzed a sample of 44,678 adults from Colombia and 24,302 from Peru. The prevalence of parents' non-intention to vaccinate their children and adolescents against COVID-19 was 7.41 % (n = 3,274) for Colombia and 6.64 % (n = 1,464) for Peru. In Colombia, age above 35 years old, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, and being vaccinated were associated with a higher probability of vaccinating children and adolescents against COVID-19. In Peru, female gender, compliance with physical distancing, use of masks, having economic insecurity, anxiety symptoms, having a chronic condition or more comorbidities, having had COVID-19, and being vaccinated were associated with a higher probability of vaccinating children against COVID-19. Living in a town, a village, or a rural area was associated with a higher prevalence of non-intention to vaccinate children and adolescents against COVID-19. About 9 out of 10 parents in Colombia and Peru intend to vaccinate their children and adolescents against COVID-19. This intention is associated with some factors which are similar between the two countries, as well as other factors and variations among the different regions of each country.

Mass Media Use to Learn About COVID-19 and the Non-intention to Be Vaccinated Against COVID-19 in Latin America and Caribbean Countries

Background

The Latin American and Caribbean (LAC) region has been one of the regions most affected by the COVID-19 pandemic, with countries presenting some of the highest numbers of cases and deaths from this disease in the world. Despite this, vaccination intention is not homogeneous in the region, and no study has evaluated the influence of the mass media on vaccination intention. The objective of this study was to evaluate the association between the use of mass media to learn about COVID-19 and the non-intention of vaccination against COVID-19 in LAC countries.

Methods

An analysis of secondary data from a Massachusetts Institute of Technology (MIT) survey was conducted in collaboration with Facebook on people's beliefs, behaviors, and norms regarding COVID-19. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95%CI) were calculated to evaluate the association between the use of mass media and non-vaccination intention using generalized linear models of the Poisson family with logarithmic link.

Results

A total of 350,322 Facebook users over the age of 18 from LAC countries were included. 50.0% were men, 28.4% were between 18 and 30 years old, 41.4% had a high school education level, 86.1% lived in the city and 34.4% reported good health condition. The prevalence of using the mass media to learn about COVID-19 was mostly through mixed media (65.8%). The non-intention of vaccination was 10.8%. A higher prevalence of not intending to be vaccinated against COVID-19 was found in those who used traditional media (aPR = 1.36; 95%CI: 1.29–1.44; p &lt; 0.001) and digital media (aPR = 1.70; 95%CI: 1.24–2.33; p = 0.003) compared to those using mixed media.

Conclusion

We found an association between the type of mass media used to learn about COVID-19 and the non-intention of vaccination. The use of only traditional or digital information sources were associated with a higher probability of non-intention to vaccinate compared to the use of both sources.

Consumption of Herbal Supplements or Homeopathic Remedies to Prevent COVID-19 and Intention of Vaccination for COVID-19 in Latin America and the Caribbean

Users of complementary and alternative medicine (CAM) have a lower intention to receive vaccines. Furthermore, Latin America and the Caribbean (LAC) region are among the most affected areas by the COVID-19 pandemics and present a high proportion of CAM users. Therefore, this study evaluates the association between the consumption of herbal supplements or homeopathic remedies to prevent COVID-19 and the intention to vaccinate against COVID-19 in the LAC region. We conducted a secondary data analysis of a Massachusetts Institute of Technology (MIT) survey with Facebook to assess COVID-19 beliefs, behaviours, and norms. Crude and adjusted prevalence ratios (aPR) with their respective 95% confidence intervals (95% CI) were calculated using generalized linear models of the Poisson family with the log link function. The prevalence of the use of products to prevent COVID-19 was the following: consumption of herbal supplements (7.2%), use of homeopathic remedies (4.8%), and consumption of garlic, ginger, and lemon (11.8%). An association was found between using herbal supplements (19.0% vs. 12.8%; aPR = 1.44; 95% CI: 1.30–1.58), the use of homeopathic remedies (20.3% vs. 12.3%; aPR = 1.58; 95% CI: 1.25–1.98), and the consumption of garlic, ginger, and lemon (18.9% vs. 11.9%; aPR = 1.55; 95% CI: 1.50–1.61) and non-intention to vaccinate against COVID-19. In the LAC population, there is an association between using herbal supplements, using homeopathic remedies and consuming garlic, ginger, and lemon to prevent infection by COVID-19 and non-intention to vaccinate against this disease. Therefore, it is necessary to design targeted strategies for groups that consume these products as preventive measures against COVID-19 to increase vaccination coverage and expand the information regarding transmission and prevention strategies for SARS-CoV-2.

Efficacy of Colchicine in the Treatment of COVID-19 Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

We assessed the efficacy of colchicine in COVID-19 patients through a systematic review.

METHODS

Six databases were searched until March 2022 for studies assessing colchicine versus control in hospitalized patients with COVID-19. The primary outcome was mortality, and secondary outcome was length of hospitalization. Inverse variance and random effect meta-analyses were performed. The strength of evidence was assessed using GRADE.

RESULTS

Nine studies (five randomized clinical trials (RCTs) and four non-randomized studies of intervention (NRSI); n = 13,478). Colchicine did not reduce mortality in comparison with the standard of care in RCTs (RR 0.99; 95%CI 0.90 to 1.10; p = 0.90); however, it did reduce mortality in NRSI studies (RR 0.45; 95%CI 0.26 to 0.77; p = 0.02). In the analysis of RCTs, colchicine did not reduce the length of hospitalization in comparison with the standard of care (MD: -2.25 days; 95%CI: -9.34 to 4.84; p = 0.15). Most studies were scored as having a high risk of bias. Quality of evidence was very low for primary and secondary outcomes.

CONCLUSION

Colchicine did not reduce the mortality and length of hospitalization in comparison with the standard of care in hospitalized patients with COVID-19. The published evidence is insufficient and of very low quality to recommend treatment in patients with COVID-19.

Revisión metodológica sobre el artículo “Factores asociados a la no utilización de servicios de salud en personas LGBTI de Perú"

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Non-medical switching of prescription medications, brand-name drugs and out-of-pocket spending on medicines among Peruvian adults

Objectives

This study evaluated the association between non-medical switching of prescription medications (NMSPM) with brand-name drugs and out-of-pocket spending (OPS) on drugs among Peruvian adults.

Methods

We conducted a secondary analysis of the National Survey of User Satisfaction Health using an analytical cross-sectional design. We included 3155 adults who went to drugstores and pharmacies with prescriptions. The independent variable was the self-reported NMSPM. The outcomes were brand-name drug purchase and OPS on drugs. We calculated crude and adjusted prevalence ratios (PR) with their respective 95% confidence intervals (CIs), and the OPS on drugs was analysed using linear regression with crude and adjusted β and their 95% CIs.

Key findings

The rate of NMSPM was 6.7%, the proportion of brand-name drug purchases was 55.7% and the average spending on drugs was US$1.73. In the adjusted analysis, the proportion of brand-name drug purchases with NMSPM was higher than without (73.3% versus 54.5%; P &lt; 0.001), with a statistically significant association (adjusted PR = 1.38; 95% CI = 1.29 to 1.47; P &lt; 0.001), and the association between NMSPM and OPS on drugs was statistically significant (adjusted β = 0.23; 95% CI = 0.16 to 0.30; P &lt; 0.001).

Conclusions

There is a greater probability of brand-name drug purchases and OPS on drugs when NMSPM exists among adults who go to drugstores and pharmacies in Peru.

Infección metastásica por Staphylococcus aureus en neonatos: a propósito de un caso

Metastatic infection as an infrequent complication of Staphylococcus aureus bacteremia in neonates is challenging due to the limited literature. To report the clinical case of a premature neonate who developed a metastatic infection as a complication of S. aureus bacteremia. We present the case of a premature neonate admitted to the Neonatal Intensive Care Unit, diagnosed with bacterial sepsis, neonatal respiratory distress syndrome, and involvement by premature rupture of the membrane. A patch catheter was inserted, and he was successfully treated for E. coli bacteremia. He was re-admitted for late sepsis due to infection with multi-sensitive S. aureus in a patch catheter. An abscess appears on the front of the chest due to S. aureus, confirming metastatic infection. The abscess was drained with a favorable resolution of the clinical picture. In neonates submitted to invasive procedures, it is essential to monitor the clinical evolution and early identification of metastatic infection after Staphylococcus aureus bacteremia and provide early treatment to avoid sequelae.

Efficacy and Safety of Colchicine in Post-acute Myocardial Infarction Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease. We evaluated the efficacy and safety of colchicine in post–acute myocardial infarction (MI) patients.

Methods: We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post–acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models.

Results: Six RCTs involving 6,005 patients were included. Colchicine did not significantly reduce cardiovascular mortality [risk ratio (RR), 0.91; 95% confidence interval (95% CI), 0.52–1.61; p = 0.64], recurrent MI (RR, 0.87; 95% CI, 0.62–1.22; p = 0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61–1.85; p = 0.78), stroke (RR, 0.28; 95% CI, 0.07–1.09; p = 0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02–8.89; p = 0.19), or decreased levels of follow-up hs-CRP (mean difference, −1.95 mg/L; 95% CI, −12.88 to 8.98; p = 0.61) compared to the control group. There was no increase in any adverse events (RR, 0.97; 95% CI, 0.89–1.07; p = 0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48–12.99; p = 0.20). Subgroup analyses by colchicine dose (0.5 vs. 1 mg/day), time of follow-up (<1 vs. ≥1 year), and treatment duration (≤30 vs. >30 days) showed no changes in the overall findings.

Conclusion: In post–acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events.