Alvaro Taype-Rondan

Sci-Hub and medical practice: an ethical dilemma in Peru

Sci-Hub is a pirate repository of scientifi c papers launched in 2011, and currently hosts more than 46 million articles. Thousands of people use this repository every day to access information, reaching more than 200 000 daily downloads of scientifi c articles that they would otherwise have to buy. We present a dilemma in the form of Dr J, a Peruvian physician who is evaluating a patient with several infectious and chronic comorbidities— an experience not uncommon to clinicians in countries, like Peru, that experience the double burden of disease. Dr J believes he needs to review recent medical literature to decide the best management of this complex patient. However, his sources are scarce: his medical books are old and outdated; the medical conferences that he has attended in his country have not delved into this subject (and have serious confl icts of interest for being largely funded by players in the pharmaceutical industry); he does not have institutional access to the scientifi c papers he needs; and he does not have funding to cover the cost of the subscriptions. Additionally, initiatives off ering access to biomedical and health literature to low-income and middle-income countries such as HINARI currently do not consider Peru as a candidate for benefit. The National Council of Science and Technology (CONCYTEC) has been providing access to Scopus since 2014 (with approximately 18 000 titles) and the ScienceDirect Freedom Collection (consisting of 2653 journals), yet few physicians can access these databases because it is only available for selected academic institutions and researchers who have accomplished specific milestones. Given this scenario, physicians face the following dilemma: is it ethical for them to use Sci-Hub (an illegal medium) to access the information required to provide the best and most timely care for their patients? In recent years there has been an increase in open access journals, which do not have subscription plans or payments to access their content. Additionally, Harvard University’s Global Health Delivery Online (GHDonline.org) recently started a 1-year complementary international grant subscription programme to UpToDate, an evidence-based, physician-authored clinical decision support tool. Nevertheless, there is still a long way to go before clinicians worldwide have access to the papers and information they need to care for a growing and diverse set of patients. Meanwhile, many of the world’s physicians, like Dr J, will continue to face this ethical dilemma to access information every day.

Abortion services offered via the Internet in Lima, Peru: methods and prices

In Peru, like many developing countries, abortion is legally restricted.1 In 2005, a survey carried out in a randomised sample of women aged 18–29 years in 20 Peruvian cities demonstrated that the prevalence of induced abortions in women who had ever been sexually active was 13.6%,2 and that 17.5% of Peruvian maternal mortality is caused by abortion.3 Clandestine abortion services in Peru are advertised via different media including the Internet, newspapers, and posters in public places. Of these, the Internet is probably one of the most accessible sources of information for young people. In order to assess the costs of clandestine abortion services advertised online in Lima, …

Poverty and abortion complications in Peru

Each year, approximately 20 million unsafe abortions – those performed by people lacking necessary skills or in environments lacking minimal medical standards, or both – take place worldwide, producing a variety of complications such as incomplete abortion, haemorrhage, sepsis, peritonitis, cervical, vaginal or uterine trauma, psychological problems, chronic infection, infertility, and death.1 Moreover, in countries where abortion is penalised, the incidence of unsafe abortions is 23 per 1000 women of childbearing age (WCA), considerably higher than the 2 per 1000 WCA observed in countries where abortion is not penalised.1 In Peru, abortion is illegal, except when it is the only option to prevent death or permanent health damage to the woman. In such cases, abortion is regulated by a technical guideline approved in 2014, which aims to improve access to this procedure, although it is not being broadly used by Peruvian doctors …

Smoking and heavy drinking patterns in rural, urban and rural-to-urban migrants: the PERU MIGRANT Study

BackgroundPrevious studies have found mixed results about cigarette and alcohol consumption patterns among rural-to-urban migrants. Moreover, there are limited longitudinal data about consumption patterns in this population. As such, this study aimed to compare the smoking and heavy drinking prevalence among rural, urban, and rural-to-urban migrants in Peru, as well as the smoking and heavy drinking incidence in a 5-year follow-up.MethodsWe analyzed the PERU MIGRANT Study data from rural, urban, and rural-to-urban migrant populations in Peru. The baseline study was carried out in 2006–2007 and follow-up was performed five years later. For the baseline data analysis, the prevalence of lifetime smoking, current smokers, and heavy drinking was compared by population group using prevalence ratios (PR) and 95% confidence intervals (95% CI). For the longitudinal analysis, the incidence of smoking and heavy drinking was compared by population group with risk ratios (RR) and 95% CI. Poisson regression with robust variance was used to calculate both PRs and RRs.ResultsWe analyzed data from 988 participants: 200 rural dwellers, 589 migrants, and 199 urban dwellers. Compared with migrants, lifetime smoking prevalence was higher in the urban group (PR = 2.29, 95% CI = 1.64–3.20), but lower in the rural group (PR = 0.55, 95% CI = 0.31–0.99). Compared with migrants, the urban group had a higher current smoking prevalence (PR = 2.29, 95% CI = 1.26–4.16), and a higher smoking incidence (RR = 2.75, 95% CI = 1.03–7.34). Current smoking prevalence and smoking incidence showed no significant difference between rural and migrant groups. The prevalence and incidence of heavy drinking was similar across the three population groups.ConclusionsOur results show a trend in lifetime smoking prevalence (urban > migrant > rural), while smoking incidence was similar between migrant and rural groups, but higher in the urban group. In addition, our results suggest that different definitions of smoking status could lead to different smoking rates and potentially different measures of association. The prevalence and incidence of heavy drinking were similar between the three population groups.

Estacionalidad de la cefalea en el hemisferio norte y el hemisferio sur: una aproximación utilizando Google Trends

Sr. Editor: La cefalea es un problema importante de salud publica. Entre la mitad y las tres cuartas partes de los adultos de 18 a 65 anos han sufrido de cefalea alguna vez durante el ultimo ano(1).Las cefaleas primarias mas frecuentes son la cefalea tensional y la migrana(2). La cefalea tensional es la mas comun, esta relacionada con estres y problemas osteomusculares del cuello, puede ser episodica o cronica, y se manifiesta como una opresion alrededor de la cabeza. Por su parte, la migrana es originada por la liberacion de sustancias inflamatorias causantes de dolor alrededor de los nervios y los vasos sanguineos en la cabeza, dura toda la vida y su presentacion es episodica (1). Estos tipos de cefalea tienen entre sus desencadenantes principalmente factores clinicos, psicologicos y climatologicos. Leer mas...

Hair follicle characteristics as early marker of Type 2 Diabetes

Type 2 Diabetes mellitus (DM2) includes a continuum of metabolic disorders characterized by hyperglycemia that causes several chronic long-term complications such as coronary artery disease, peripheral arterial disease, nephropathy, and neuropathy. The hair follicle could reveal signs of early vascular impairment, yet its relationship to early metabolic injuries has been largely ignored. We propose that in earlier stages of the continuum of DM2-related metabolic disorders, a group of susceptible patients who do not yet meet the diagnostic criteria to be considered as persons with DM2 may present chronic vascular impairment and end organ damage, including hair follicle damage, which can be evaluated to identify an early risk marker. This hypothesis is based in the association found between insulin resistance and alopecia in non-diabetic persons, and the hair loss on the lower limbs as a manifestation of long-term peripheral arterial disease among subjects with DM2. In order to test this hypothesis, studies are required to evaluate if hair follicle characteristics are related to and can predict hyperglycemic complications, and if they do so, which feature of the hair follicle, such as hair growth, best characterizes such DM2-related conditions. If this hypothesis were proven to be true, significant advances towards a personalized approach for early prevention strategies and management of DM2 would be made. By focusing on the hair follicles, early stages of metabolic-related organ damage could be identified using non-invasive low-cost techniques. In so doing, this approach could provide early identification of DM2-susceptible individuals and lead to the early initiation of adequate primary prevention strategies to reduce or avoid the onset of large internal organ damage.

Disrespect and abuse during childbirth in fourteen hospitals in nine cities of Peru

To assess the prevalence of disrespect and abuse during childbirth and its associated factors in Peru.

Ingresos económicos en médicos peruanos según especialidad: Un análisis transversal de la ENSUSALUD 2015

OBJECTIVES To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with higher and lower density of medical doctors in Peru. MATERIALS AND METHODS : We analyzed data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey, with a national level of inference, was performed on physicians working at health facilities in Peru. Monthly income was measured considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their 95% confidence intervals (95% CI) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. RESULTS Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The probability of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% for clinical specialists; 70.5% for surgeons, and 55.7% for other specialties. Compared to general practitioners, physicians with clinical, surgical, and other specialties were more likely to earn > S/5 000 per month (aPR = 1.44, 1.49, and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. CONCLUSIONS Monthly incomes were higher for specialist physicians than for non-specialists. Economic incomes were higher in departments with lower density of physicians, which may encourage physicians to work in these departments.

Hospitalizaciones y muertes por aborto clandestino en Perú: ¿qué dicen los números?

Sr. Editor. El aborto inseguro es definido como el procedimiento para terminar la gestación realizado por personas que no poseen las competencias necesarias o en un ambiente sin los mínimos estándares médicos (1). El aborto inseguro es considerado una pandemia prevenible que afecta en mayor medida a países que presentan restricciones legales al respecto (2). En Perú, un país en el que se penaliza el aborto, muchas mujeres se someten de manera clandestina a una serie de procedimientos que acarrean un gran número de complicaciones y muertes maternas, cuyas cifras analizaremos a continuación.

Inadequate glycaemic control in LMIC: health system failures in Peru.

Photo: Socios en Salud, Sucursal Peru ©SES 2014. Worldwide, 80% of patients with diabetes reside in low- and middle-income countries (LMICs). These patients are at higher risk of having inadequate glycaemic control and developing serious complications from their diabetes when compared with patients from high-income countries.1 There are multiple causes explaining poor outcomes, one being the failure of healthcare systems to adapt to the necessary challenges of managing patients with chronic diseases. In Peru’s highly fragmented health system, most patients use free or low-cost public health services. In comparison with private healthcare services, those using the public healthcare system report lower satisfaction rates and longer waiting times. Nevertheless, it seems that neither public nor private health systems provide adequate diabetes prevention and management services.2 …