Guido Bendezú-Quispe

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 However, his sources are scarce: his medical books are old and outdated; the medical conferences that he has attended in his country have not delved into this subject (and have serious confl icts of interest for being largely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.

Acceso a servicios de salud dental en menores de doce años en Perú, 2014

The aim of the study was to explore the patterns of dental health services access in children under twelve years of age in Peru. Data from 25,285 children under 12 years who participated in the Demographic and Family Health Survey of 2014 were reviewed. An exploratory spatial analysis was performed to project the proportions of children with access to dental health services, according to national regions, type of health service and urban or rural place of residence. The results show that of the total sample, 26.7% had access to dental health services in the last six months, 39.6% belonged to the age group 0-4 years, 40.6% lived in the Andean region and 58.3% lived in urban areas. The regions of Huancavelica, Apurimac, Ayacucho, Lima and Pasco had the highest percentages of access nationwide. In conclusion, there is low access to dental health services in the population under 12 years of age in Peru. The spatial distribution of access to dental health services allows regions to be identified and grouped according to similar access patterns, in order to better focus public health actions.

Análisis espacial del sobrepeso y la obesidad infantil en el Perú, 2014

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.

Producción científica en diabetes en Perú: Un estudio bibliométrico

Alvaro Taype-Rondan1, Oscar Huapaya-Huertas2, Guido Bendezu-Quispe2, Josmel Pacheco-Mendoza3, Mayte Bryce-Alberti1. ABSTRACT Objective: to describe the scientific production related to diabetes in Peru between 1996 and 2015. Methods: Bibliometric study. Scientific papers on diabetes published between 1996 and 2015 were identified by authors with Peruvian affiliation in the Web of Science Core Collection (WoS) and Scopus databases. The variables of interest were extracted manually. We present descriptive results and collaborative networks. Results: We found 81 publications, 75.3% were original articles, of which none evaluated public health interventions and 60.7% received foreign funding; 55.6% had an author affiliated with the Universidad Peruana Cayetano Heredia (UPCH), and 65.4% had a foreign author. Five clusters of international collaboration networks could be distinguished, all with the participation of the UPCH. Conclusion: Peruvian scientific production related to diabetes is low, with an absence of studies evaluating public health interventions, and with collaboration networks focused on UPCH.

Utility of massive open online courses (MOOCs) concerning outbreaks of emerging and reemerging diseases

The emergence and re-emergence of infectious diseases such as Ebola, chikungunya, and Zika increase the necessity of knowledgeable and skilled health professionals. Massive open online courses (MOOCs) arise as opportunities that allow people around the world to participate in higher education courses. A search was conducted on specialized MOOC platforms to find courses related to outbreaks, using terms included in the list of the WHO disease outbreaks from January 1st to December 31 st, 2016. We found seven courses about Ebola, two about Zika, three about the dynamics of epidemics and pandemics, and only one course about dengue, chikungunya, and malaria. Most of the courses were conducted in English. The courses on Ebola, Zika and chikungunya were released after their last outbreak. MOOCs could be used to learn about health issues of global relevance, and with the necessity of fast divulgation of knowledge and skills. Translating the courses into more languages could give these courses more traction, and allow participation of professionals in regions affected by these outbreaks.

Sistemas de información geográfica: aplicación práctica para el estudio de atropellos en el Cercado de Lima, Perú

The aim of this study was to geospatially explore the occurrence rates of car accidents involving pedestrians in Cercado de Lima (Lima District), Peru. Car accidents involving pedestrians recorded in the 2015 National Police Station Census of the National Statistics and Information Institute were described and georeferenced. Subsequently, a Kernel Density analysis was carried out to locate areas with high, medium, and low density events. Records of 171 car accidents involving pedestrians were studied: the types of vehicles involved were automobiles (56.7%) and smaller vehicles (22.8%). The highest percentage of car accidents involving pedestrians (38.6%) took place between 12:00 p.m. and 5:00 p.m. There were two densely populated areas and two areas with intermediate density for car accidents involving pedestrians, locations that were previously reported as critical due to their deficiencies and high probability of traffic accidents. The use of geographic information systems offers a quick overview of the occurrence rates of car accidents involving pedestrians to make comparisons and enable the local implementation of strategies.

Por qué hacen huelga los internos de Medicina en Perú

Sr. Editor: El internado medico es una etapa en la que el estudiante de medicina consolida e integra los conocimientos adquiridos en anos previos de su carrera(1).A pesar de la importancia del internado en la formacion medica, existen problemas que impiden su adecuado desarrollo, como carencias de areas de descanso, de equipos de bioseguridad, de las remuneraciones acordadas, entre otros.(2) Ante estos problemas, los internos de medicina han elevado su voz de protesta, llegando incluso a realizar interrupciones colectivas desu actividad laboral, conocidas como huelgas. De esta manera se tiene informacion sobre huelgas de internos en varios paises de Latinoamerica:Honduras (3), Chile (4) yCosta Rica(5). Estas huelgas traen como consecuencia una carencia de personal que perjudica la atencion de los pacientes. Ademas, se interrumpe la actividad academica del interno, afectando su preparacion en este periodo clave(6). Por ello, es importante conocer las caracteristicas de estas huelgas, lo cual permitira prevenirlas en el futuro. Leer mas...