Juan José Montenegro-Idrogo

Profile and professional expectations of medical students from 11 Latin American countries: the Red-LIRHUS project

BackgroundLatin America is undergoing a human resource crisis in health care in terms of labor shortage, misdistribution and poor orientation to primary care. Workforce data are needed to inform the planning of long-term strategies to address this problem. This study aimed to evaluate the academic and motivational profile, as well as the professional expectations, of Latin American medical students.ResultsWe conducted an observational, cross-sectional, multi-country study evaluating medical students from 11 Spanish-speaking countries in 2011–2012. Motivations to study medicine, migration intentions, intent to enter postgraduate programs, and perceptions regarding primary care were evaluated via a self-administered questionnaire. Outcomes were measured with pilot-tested questions and previously validated scales. A total of 11,072 valid surveys from 63 medical schools were gathered and analyzed.ConclusionsThis study describes the profile and expectations of the future workforce being trained in Latin America. The obtained information will be useful for governments and universities in planning strategies to improve their current state of affairs regarding human resources for health care professions.

PRODUCCIÓN CIENTÍFICA Y REDES DE COLABORACIÓN EN CÁNCER EN EL PERÚ 2000-2011: UN ESTUDIO BIBLIOMÉTRICO EN SCOPUS Y SCIENCE CITATION INDEX

A bibliometric study was carried out to describe the scientific production on cancer written by Peruvians and published in international health journals, as well as to assess the scientific collaboration networks. It included articles on cancer written in Peru between the years 2000 and 2011 and published in health journals indexed in SCOPUS or Science Citation Index Expanded. In the 358 articles identified, an increase in the production was seen, from 4 articles in 2000 to 57 in 2011.The most studied types were cervical cancer (77 publications); breast cancer (53), and gastric cancer (37). The National Institute of Neoplastic Diseases (INEN) was the most productive institution (121 articles) and had the highest number of collaborations (180 different institutions). 52 clinical trials were identified, 29 of which had at least one author from INEN. We can conclude that, cancer research is increasing in Peru, the INEN being the most productive institution, with an important participation in clinical trials.

Cultura de publicación: realidades diferentes

El aumento en los estandares de investigacion de las instituciones medicas en eventos cientificos ha generado una conducta de publicacion mas competitiva entre profesionales medicos, en especial en los medicos jovenes, en algunos paises desarrollados como es el caso de China. Este comportamiento presenta puntos de vista diferentes en su apreciacion. Se menciona que en China se da una prioridad un tanto irrazonable e innecesaria a los estandares de publicacion de los medicos e incluso ha hecho que medicos jo-venes se sientan presionados para la publicacion, lo cual consideran que afecta el interes hacia la adquisicion de experiencia medica y desarrollo de habilidades interpersonales con el paciente en esta etapa de su formacion. No obstante el perfil de produccion cientifica es alto y con metas establecidas.Sr. Editor: El aumento en los estándares de investigación de las instituciones médicas en eventos científicos ha generado una conducta de publicación más competitiva entre profesionales médicos, en especial en los médicos jóvenes, en algunos países desarrollados como es el caso de China. Este comportamiento presenta puntos de vista diferentes en su apreciación. Se menciona que en China se da una prioridad un tanto irrazonable e innecesaria a los estándares de publicación de los médicos e incluso ha hecho que médicos jóvenes se sientan presionados para la publicación, lo cual consideran que afecta el interés hacia la adquisición de experiencia médica y desarrollo de habilidades interpersonales con el paciente en esta etapa de su formación. No obstante el perfil de producción científica es alto y con metas establecidas. Por otro lado, en países en vías de desarrollo, como en Perú, el perfil de publicación de profesionales médicos es bajo. Pereyra-Elias et al encontraron que en 11 años sólo el 8% de los trabajos presentados en los congresos de gastroenterología de Perú fueron publicados, a diferencia del congreso chileno de Gastroenterología con 25,1% de publicaciones y muy distante a los congresos europeos con 60-70% de publicaciones. Se proponen diversos factores asociados a la pobre cultura de publicación médica en el Perú, como la falta de capacitación en redacción científica, factores económicos que limitan la generación de investigaciones de mayor nivel . Sin embargo, en Perú no existen estrategias que incentiven la realización y publicación de investigaciones por parte de los profesionales médicos en los eventos científicos, o si las hay son escasas. Es poco probable el uso de Science Citation Index (SCI) cuando sólo se cuentan con dos revistas biomédicas peruanas indexadas en Medline y ninguna en la Web of Knowledge. Llama la atención que mientras en China se percibe presión para publicar, en Perú hay desinterés y una escasa presión para ello. Por tanto consideramos que en regiones como la nuestra, es necesaria la introducción de estándares de calidad en investigación y publicación en eventos científicos biomédicos y así fortalecer el desarrollo científico en cada área de la medicina, sin que ello desequilibre el interés e impacto de la formación médico profesional y académica.

Gender Associated with the Intention to Choose a Medical Specialty in Medical Students: A Cross-Sectional Study in 11 Countries in Latin America.

Introduction The selection of a medical specialty has been associated with multiple factors, such as personal preferences, academic exposure, motivational factors and sociodemographic factors, such as gender. The number of women in the medical field has increased in recent years. In Latin America, we have not found any studies that explore this relationship. Objective To determine whether there is an association between gender and the intention to choose a medical specialty in medical students from 11 countries in Latin America. Methods Secondary analysis of the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) data; a multi-country project of students in their first year and fifth year of study, from 63 medical schools in 11 Latin American countries. All students who referred intention to choose a certain medical specialty were considered as participants. Results Of the 11073 surveyed students, 9235 indicated the name of a specific specialty. The specialties chosen most often in the fifth year were General Surgery (13.0%), Pediatrics (11.0%), Internal Medicine (10.3%) and Obstetrics/Gynecology (9.0%). For women, the top choices were Pediatrics (15.8%), Obstetrics/Gynecology (11.0%), Cardiology (8.7%), General Surgery (8.6%), and Oncology (6.4%). In the adjusted analysis, the female gender was associated with the choice of Obstetrics/Gynecology (RP: 2.75; IC95%: 2.24–3.39); Pediatric Surgery (RP: 2.19; IC95%: 1.19–4.00), Dermatology (RP: 1.91; IC95%:1.24–2.93), Pediatrics (RP: 1.83; IC95%: 1.56–2.17), and Oncology (RP: 1.37; IC95%: 1.10–1.71). Conclusions There is an association between the female gender and the intention to choose Obstetrics/Gynecology, Pediatrics, Pediatric Surgery, Dermatology, and Oncology. We recommend conducting studies that consider other factors that can influence the choice of a medical specialty.

Differences on Primary Care Labor Perceptions in Medical Students from 11 Latin American Countries

Background The shortage in Latin-American Primary Care (PC) workforce may be due to negative perceptions about it. These perceptions might be probably influenced by particular features of health systems and academic environments, thus varying between countries. Methods Observational, analytic and cross-sectional multicountry study that evaluated 9,561 first and fifth-year medical students from 63 medical schools of 11 Latin American countries through a survey. Perceptions on PC work was evaluated through a previously validated scale. Tertiles of the scores were created in order to compare the different countries. Crude and adjusted prevalence ratios were calculated using simple and multiple Poisson regression with robust variance. Results Approximately 53% of subjects were female; mean age was 20.4±2.9 years; 35.5% were fifth-year students. Statistically significant differences were found between the study subjects’ country, using Peru as reference. Students from Chile, Colombia, Mexico and Paraguay perceived PC work more positively, while those from Ecuador showed a less favorable position. No differences were found among perceptions of Bolivian, Salvadoran, Honduran and Venezuelan students when compared to their Peruvian peers. Conclusions Perceptions of PC among medical students from Latin America vary according to country. Considering such differences can be of major importance for potential local specific interventions.

Escuela para editores de revistas médicas en Latinoamérica: El rol de las revistas de estudiantes

Sr. Editor: A pesar del aumento de revistas medicas latinoamericanas indizadas en la base de datos de Thomson ISI, que ha estado liderado por Brasil y su politica de publicacion en ingles, estas siguen siendo menos y de menor factor de impacto en relacion a las de origen norteamericano o europeo. 1 Esto puede explicarse en parte por la baja contribucion internacional que reciben, el idioma nativo no angloparlante y deficiencias editoriales. Desde el punto de vista editorial, no hemos encontrado descritos programas sobre como las revistas de nuestra region capacitan y entrenan a nuevos editores. Por otro lado se ha descrito la necesidad de nuevos editores formados y entrenados en temas editoriales y no solo referentes a investigacion, lo que permitiria fortalecer y mejorar el trabajo editorial. 2 A nivel mundial, algunas revistas como New England Journal of Medicine y British Medical Journal han generado estrategias de formacion de editores. Esta ultima cuenta con la beca Clegg Scholarship, que ofrece pasantias editoriales a jovenes estudiantes de medicina europeos. Sin embargo la generacion de escuelas de editores cientificos para revistas biomedicas es una necesidad en paises como Sudafrica y un tema pendiente en Latinoamerica.2 Leer mas

Religious affiliation and the intention to choose psychiatry as a specialty among physicians in training from 11 Latin American countries

The worldwide scarcity of psychiatrists makes the identification of the factors associated with the intention to choose this specialty an important issue. This study aims to evaluate the association between religious affiliation and the intention to choose psychiatry as a specialty among medical students from 11 Latin American countries. We conducted a cross-sectional, multi-country study that included first- and fifth-year students of 63 medical schools in 11 Latin-American countries between 2011 and 2012. The main outcome and measures were the intention to pursue psychiatry as a specialty over other specialties (yes/no) and religious affiliation (without: atheist/agnostic; with: any religion). A total of 8308 participants were included; 53.6% were women, and the average age was 20.4 (SD = 2.9) years. About 36% were fifth-year students, and 11.8% were not affiliated with any religion. Only 2.6% had the intention to choose psychiatry; the highest proportion of students with the intention to choose psychiatry was among students in Chile (8.1%) and the lowest among students in Mexico (1.1%). After adjusting for demographic, family, academic as well as personal and professional projection variable, we found that those who had no religious affiliation were more likely to report the intention to become a psychiatrist [OR: 2.92 (95%CI: 2.14-4.00)]. There is a strong positive association between not having a religious affiliation and the intention to become a psychiatrist. The possible factors that influence this phenomenon must be evaluated in greater depth, ideally through longitudinal research.

Pérdida de información en historias clínicas: Más allá de la calidad en el registro.

Sr. Editor: El registro escrito de historias clinicas ha sido el soporte tradicional utilizado en la mayoria de las instituciones de atencion en salud. Existen reportes sobre las falencias en la informacion consignada en estas historias clinicas, donde se evidencia subregistro de informacion en algunas areas, lo que generalmdnte se debe a la conducta de reporte por parte del personal que la consigna.(1) Sin embargo en un sistema de registro fisico como este, la informacion no solo suele perderse por no consignarla, sino tambien por la perdida de informacion. Se realizo un estudio en el Hospital Nacional Edgardo Rebagliati Martins, en Lima, Peru, revisando los registros de historias clinicas a partir de reportes de examenes auxiliares registrados en el Laboratorio de Emergencia. Se identificaron 450 registros de examenes auxiliares en el ano 2010. De estos registros se evidencio una tasa de perdida de 63,8% correspondiente a historias clinicas incompletas (147; 32,7%) y a historias clinicas no encontradas (140; 31,1%). De esta forma, la perdida de informacion en los registros clinicos no se debe solo a dificultades en la consignacion de datos en las historias clinicas, sino a la perdida material de esta en los registros materiales de las respectivas historias clinicas. Leer mas...

Mucocutaneous leishmaniasis in a HIV infected patient. Case report

La leishmaniasis es una enfermedad metaxenica andino-tropical, considerada endemica en Peru. Su forma mucocutanea es poco frecuente. Puede presentarse en coinfeccion con los virus HTLV-1 y VIH. Se describe un caso de leishmaniasis mucocutanea en un paciente infectado con VIH, con antecedente de leishmaniasis cutanea con tratamiento incompleto 20 anos atras. Es tratado con estibogluconato sodico por 30 dias, con adecuada respuesta y regresion de la lesion a las cuatro semanas. La coinfeccion de leishmaniasis mucocutanea y VIH no es frecuente. Las manifestaciones de leishmaniasis pueden no presentarse de forma tipica en pacientes con VIH. Se debe considerar la procedencia de la zona endemica y/o el antecedente de haber presentado la forma cutanea previamente.INTRODUCTION Leishmaniasis is an endemic Andean vector-borne- tropical disease in Peru, whose mucocutaneous clinical presentation is rare. Leishmaniasis can occur in co-infections with HTLV-1 virus and HIV. We describe a case of L. mucocutaneous in a patient infected with HIV, with a history of cutaneous leishmaniasis with inadequate treatment 20 years ago. He was treated with stibogluconate with adequate response to treatment and regression of lesion after 4 weeks. Mucocutaneous leishmaniasis and HIV coinfection is rare and its clinical presentation may be atypically. It is important to consider it in patients coming from endemic areas and with a history of a previous cutaneous clinical presentation.

Leishmaniasis mucocutánea en un paciente con infección por VIH: Case report

La leishmaniasis es una enfermedad metaxenica andino-tropical, considerada endemica en Peru. Su forma mucocutanea es poco frecuente. Puede presentarse en coinfeccion con los virus HTLV-1 y VIH. Se describe un caso de leishmaniasis mucocutanea en un paciente infectado con VIH, con antecedente de leishmaniasis cutanea con tratamiento incompleto 20 anos atras. Es tratado con estibogluconato sodico por 30 dias, con adecuada respuesta y regresion de la lesion a las cuatro semanas. La coinfeccion de leishmaniasis mucocutanea y VIH no es frecuente. Las manifestaciones de leishmaniasis pueden no presentarse de forma tipica en pacientes con VIH. Se debe considerar la procedencia de la zona endemica y/o el antecedente de haber presentado la forma cutanea previamente.INTRODUCTION Leishmaniasis is an endemic Andean vector-borne- tropical disease in Peru, whose mucocutaneous clinical presentation is rare. Leishmaniasis can occur in co-infections with HTLV-1 virus and HIV. We describe a case of L. mucocutaneous in a patient infected with HIV, with a history of cutaneous leishmaniasis with inadequate treatment 20 years ago. He was treated with stibogluconate with adequate response to treatment and regression of lesion after 4 weeks. Mucocutaneous leishmaniasis and HIV coinfection is rare and its clinical presentation may be atypically. It is important to consider it in patients coming from endemic areas and with a history of a previous cutaneous clinical presentation.