Full Text Available Abstract Background National malaria control programmes must deal with the complex process of changing national malaria treatment guidelines, often without guidance on the process of change. Selecting a replacement drug is only one issue in this process. There is a paucity of literature describing successful malaria treatment policy changes to help guide control programs through this process. Objectives To understand the wider context in which national malaria treatment guidelines were formulated in a specific country (Peru. Methods Using qualitative methods (individual and focus group interviews, stakeholder analysis and a review of documents, a retrospective analysis of the process of change in Peru's anti-malarial treatment policy from the early 1990's to 2003 was completed. Results The decision to change Peru's policies resulted from increasing levels of anti-malarial drug resistance, as well as complaints from providers that the drugs were no longer working. The context of the change occurred in a time in which Peru was changing national governments, which created extreme challenges in moving the change process forward. Peru utilized a number of key strategies successfully to ensure that policy change would occur. This included a having the process directed by a group who shared a common interest in malaria and who had long-established social and professional networks among themselves, b engaging in collaborative teamwork among nationals and between nationals and international collaborators, c respect for and inclusion of district-level staff in all phases of the process, d reliance on high levels of technical and scientific knowledge, e use of standardized protocols to collect data, and f transparency. Conclusion Although not perfectly or fully implemented by 2003, the change in malaria treatment policy in Peru occurred very quickly, as compared to other countries. They identified a problem, collected the data necessary to justify the
Sobrevilla, L A
Peru's 1985 Population Policy Law states as its second objective that individuals and couples should be well informed and provided with the education and health services that will assist them in making responsible decisions about the number and spacing of their children. Thus, the law establishes a firm basis for IEC programs. With regard to population education, the purpose of the law is to create awareness through all educational channels of the reciprocal influence of population dynamics and socioeconomic development and to promote positive attitudes toward small family size. The law promotes the use of the communications media to educate and inform about population issues. The National Population Council, which coordinates and supervises the IEC activities of public sector agencies, has issued publications and audiovisual materials, conducted meetings with government officials and opinion leaders, and promoted awareness of population policy as a key part of development planning. In 1984, the Council organized the First National Seminar on Communication and Population to review activities, set the basis for intersectoral coordination, unify criteria, and review population policy concepts and language. The Ministry of Health carries out IEC activities as part of its family planning services program. In addition, the Ministry of Education has organized a national population education program that aims to revise school curricula to include a greater emphasis on population dynamics and family life education. The activities of a number of private institutions complement the IEC work public sector organizations.
Le Bienvenu, Elena; Prewitt-Diaz, Joseph O.
The purpose of this paper is to describe the implementation of bilingual education programs in Peru. The first part of the paper consists of a general discussion of Peruvian history and the problem of native language suppression under Spanish colonialism and, later, a Spanish dominant independent government. Educational policies and the…
Full Text Available The article analyzes the case of reproductive health policy-making in Peru in the context of recent social policy reforms. Health-sector reforms have only partially redressed Peruvian women’s unequal access to family planning, reproductive rights and maternal care. The main sources of inequalities are related to the segmented character of the health-care system, with the highest burden placed on the public sector. The majority of women from popular classes, who are not protected by an insurance plan, are dependent upon what and how public services are provided. Simultaneously, the continuing role of conservative sectors in public debates about reproductive health policy has a strong impact on public family planning services and other reproductive rights.
This publication provides a brief account of Peru's geographic, history, government, and political and economic conditions. With an area of 1.28 million sq. km., Peru is the third largest country in South American and is home to 20.2 million inhabitants (6 million live in the capital city of Lima). The population is 45% Indian, 37% mestizo, 15% white, and 3% black, Asian, and other. The 2 official languages are Spanish and Quechua. Its literacy rate stands at 79%, and its infant mortality rate and life expectancy measure 91/1000 and 60.8 years respectively. Peru's pre-Colombian period notes the impressive achievements of the Inca civilization, which was conquered by Spain in 1531. The country gained its independence from Spanish rule in 1821. The article also mentions Peru's turbulent contemporary history, with territorial disputes, a strong military presence, and a series of coups that have interrupted civilian constitutional governments. As recently as 1985, Peru had its first exchange of power from 1 democratically elected leader to another in 40 years, when 36 year-old Alan Garcia Perez became president. Leader of the American Popular Revolutionary Alliance (APRA), GArcia espouses leftist but not non-communist politics, and is well-known for his message of anti-imperialism and Latin American integration. Peru's has seen terrorist activity from 2 marxist organizations, the Maoist Sendero Luminoso (The Shining Path) and the MRTA-MIR (Tupac Amaru Revolutionary Movement-Movement of the Revolutionary Left. In 1986, Peru's economy had a $17 billion Gross Domestic Product (GDP), a per capital GDP of $839, and an inflation rate of 62.9. The article also provides information concerning US economic assistance to Peru, as well as an assessment of US-Peruvian relations.
Alcohol is the world's third largest risk factor for disease burden. It has had a dramatic impact on morbidity, mortality, and healthcare costs in South America and the Caribbean. This project aims to inform policymakers in two countries with emerging alcohol policies: Peru and St. Kitts and Nevis. It is designed to help guide ...
Leung, Leonard; Jenkins, Glenn P.
Peru's Camisea gas fields hold nearly 90% of the country's natural gas reserves. In the 1990s, the government had a policy to prioritize Camisea gas for domestic consumption. The revocation of this policy in the 2000s allowed private developers to export 40% of Camisea's proven reserves, equivalent to one third of Peru's total. This USD 3.9 billion liquefied natural gas (LNG) export project boasts the largest single foreign direct investment in Peru's history. A major component of the financing was granted by international financial institutions on economic grounds. While the project was expected to yield a substantial return to private investors, the export of one third of Peru's total proven natural gas reserves is not in line with its long-term interests. We undertake cost–benefit analyses for a series of scenarios, starting with the project's formative stage in the mid-2000s, and then in 2012, two years after it began its commercial operation. In all cases, Peru does not have sufficient reserves to warrant export, and the economic costs far exceed the benefits. This policy of LNG exports should not have been approved by the government, nor should the loans have been granted by international financial institutions to make it possible. - Highlights: • Peru's Liquefied Natural Gas project is creating an economic loss to the country. • Results of our analyses are robust for all scenarios considered. • The present value of the cost of replacing exported energy far exceeds tax revenue. • Projects cannot be approved based only on immediate benefits. • The potential opportunity costs of projects must be considered
With its origins in the early 1990s, feminist advocacy directed at influencing public policies is a relatively new phenomenon in Latin America that is commonly studied at the national level. The aim of this thesis was to study feminist advocacy on reproductive rights at the sub-national level in Peru. Specifically, it explored two research questions: how do feminist movements carry out advocacy to intervene with government agencies and what effects does their advocacy have on policies. This a...
Chaparro, M Pia; Estrada, Leobardo
The study objectives were to map the different stages of the nutrition transition for each department within Peru, and to determine the nutrition policy needs for each geographic area based on their current stage in the nutrition transition. Results show that most of the country is suffering from a double-burden of malnutrition, with high rates of stunting among children less than 5 years of age and high rates of overweight and obesity among women of reproductive age. Currently, Peru has only country-wide nutrition policies, administered by the Ministry of Health, that are primarily focused on stunting prevention. This study argues for the need to have decentralized nutrition policies that vary according to what type of malnutrition is being experienced in each geographic area.
Mario D. Tello; José Távara
This paper assesses the institutional setting and productive impact of selected productive development policies (PDPs), institutions, and programs implemented in Peru during the period 1990-2007. The assessment is based on a simple, basic framework of a series of economic or market failures that may have constrained the transformation of the productive structure, the process of innovation, and the growth of total factor productivity. Evidence indicates that the PDPs and structural reforms imp...
Curioso, Walter H
Health information systems play a key role in enabling high quality, complete health information to be available in a timely fashion for operational and strategic decision-making that makes it possible to save lives and improve the health and quality of life of the population. In many countries, health information systems are weak, incomplete, and fragmented. However, there is broad consensus in the literature of the need to strengthen health information systems in countries around the world. The objective of this paper is to present the essential components of the conceptual framework to strengthen health information systems in Peru. It describes the principal actions and strategies of the Ministry of Health of Peru during the process of strengthening health information systems. These systems make it possible to orient policies for appropriate decision-making in public health.
The status of Quechua in Peruvian society is discussed, noting specific social and political factors contributing to the dying out of the Quechua language, functional domains the language serves, and possible measures to improve its status. The relationship of those functional domains to Peruvian language policies is also explored. An introductory…
Mubayi, V.; Palmedo, P.F.; Doernberg, A.B.
The potential of various energy sources and technology options in meeting national economic and social development goals in developing countries is assessed. The resource options that are of interest are the development of indigenous resources. In general, two categories of options can be considered: those which correspond to the accelerated implementation of existing elements of the energy system and those which correspond to the introduction of a new technology, such as solar electricity. The various resource and technology options that must be analyzed with respect to a number of criteria or payoff functions are: total demand and fuel mix; reduction of oil consumption; national social goals; total energy costs; and environmental quality. First, a view is constructed of the energy implications of current national economic development plans. A consistent description of the future energy system of the country, under the assumption of current trends and policies is constructed for certain reference years in the future. The values of the payoff functions selected are then calculated for that reference case. The major resource and technology options are identified and the rates at which they can be implemented are determined. Finally, the impact on the various payoff functions of the implementation of each option is calculated. The basic element of the framework is the Reference Energy System, discussed in Secton 3. The energy policy analysis for Peru is used as a reference case. 11 references, 10 figures, 2 tables.
Stewart, Donna E; Dorado, Linda M; Diaz-Granados, Natalia; Rondon, Marta; Saavedra, Javier; Posada-Villa, Jose; Torres, Yolanda
Gender inequities in health prevail in most countries despite ongoing attempts to eliminate them. Assessment of gender-sensitive health policies can be used to identify country specific progress as well as gaps and issues that need to be addressed to meet health equity goals. This study selected and measured the existence of gender-sensitive health policies in a low- (Peru), middle- (Colombia), and high (Canada)-income country in the Americas. Investigators selected 10 of 20 gender-sensitive health policy indicators and found eight to be feasible to measure in all three countries, although the wording and scope varied. The results from this study inform policy makers and program planners who aim to develop, improve, implement, and monitor national gender-sensitive health policies. Future studies should assess the implementation of policy indicators within countries and assess their performance in increasing gender equity.
Volpicelli, Kathryn; Buttenheim, Alison M
Objectives Diarrheal disease is a significant cause of morbidity among children in Peru. Oral rehydration therapy (ORT) is a cost-effective evidence-based approach to treat diarrhea in young children, yet many Peruvian children in poorer households do not receive this life-saving treatment. This study investigates the social determinants of care-seeking behavior and utilization of appropriate home treatment for diarrheal episodes. Methods We used the nationally-representative 2008 Peru Demographic and Health Survey to: (1) describe the burden of non-bloody diarrheal disease among children <5 years old; and (2) identify socioeconomic correlates of care-seeking behavior and utilization/appropriateness of treatment among mothers of children with recent non-bloody diarrheal episodes (N = 1365). For the former, we reported descriptive statistics; for the latter, we utilized logistic regression to generate odds ratios. Results 2-week period prevalence of diarrheal disease was almost twice as high among poor (17 %) compared with wealthier (10 %) children, higher among children aged 12-23 months old (22 %), and higher among children from households that do not have an improved source of drinking water (16 %) compared with those that have an improved source (12 %). Interestingly, rural residence was a significant predictor of seeking care for diarrhea. Furthermore, although widely available, few mothers (15 %) used appropriate treatment for a recent diarrheal episode. Water source, mother's education, and wealth were significant predictors of appropriate home treatment. Conclusions Mothers in rural areas-typically with less access to care-were more likely to seek care for diarrheal disease in their children, even when adjusting for other variables. However, this increase in care seeking behavior did not extend to appropriate home treatment. Innovative behavior change strategies to reduce barriers to access and appropriate home treatment for diarrheal disease are
Alexy, E R; Podewils, L J; Mitnick, C D; Becerra, M C; Laserson, K F; Bonilla, C
Confirmation of cure for multidrug-resistant tuberculosis (MDR-TB) patients requires laboratory tests for Mycobacterium tuberculosis growth on culture media. Outcome decisions dictate patient management, and inaccuracies place patients at an increased risk of morbidity and mortality, and may contribute to continued transmission of MDR-TB. To examine concordance between programmatic and laboratory-based MDR-TB treatment outcomes. The study population included 1658 MDR-TB patients in Peru treated between 1996 and 2002 with both program and laboratory-based outcomes. Laboratory-based outcomes were assigned according to international standards requiring at least five consecutive negative cultures in the last 12 months of treatment to confirm cure. Compared to the global culture-defined standard classification, only 1.1% of treatment successes, but 54.3% of failures, were misclassified programmatically. Overall, 10.4% of patients identified by a clinician as having a successful treatment outcome still had cultures positive for MDR-TB. Most patients with successful treatment outcomes by strict culture definitions were also classified by clinicians as having successful outcomes. However, many culture-confirmed failures were missed. In light of delays and incomplete access to culture in MDR-TB programs, efforts should be made to improve the accuracy of programmatically determined treatment outcomes.
This comparison of the development of bilingual education policies and practices presents the legal framework of Peruvian and American policies, the processes of their establishment, and bilingual program implementation. The sociocultural and historical circumstances out of which the policies grew and which the bilingual programs reflect are also…
Magee, M J; Bloss, E; Shin, S S; Contreras, C; Huaman, H Arbanil; Ticona, J Calderon; Bayona, J; Bonilla, C; Yagui, M; Jave, O; Cegielski, J P
Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5 kg/m(2) (pdiabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Tovar, Marco A; Huff, Doug; Boccia, Delia; Montoya, Rosario; Ramos, Eric; Datta, Sumona; Saunders, Matthew J; Lewis, James J; Gilman, Robert H; Evans, Carlton A
Abstract Objective To evaluate the impact of socioeconomic support on tuberculosis preventive therapy initiation in household contacts of tuberculosis patients and on treatment success in patients. Methods A non-blinded, household-randomized, controlled study was performed between February 2014 and June 2015 in 32 shanty towns in Peru. It included patients being treated for tuberculosis and their household contacts. Households were randomly assigned to either the standard of care provided by Peru’s national tuberculosis programme (control arm) or the same standard of care plus socioeconomic support (intervention arm). Socioeconomic support comprised conditional cash transfers up to 230 United States dollars per household, community meetings and household visits. Rates of tuberculosis preventive therapy initiation and treatment success (i.e. cure or treatment completion) were compared in intervention and control arms. Findings Overall, 282 of 312 (90%) households agreed to participate: 135 in the intervention arm and 147 in the control arm. There were 410 contacts younger than 20 years: 43% in the intervention arm initiated tuberculosis preventive therapy versus 25% in the control arm (adjusted odds ratio, aOR: 2.2; 95% confidence interval, CI: 1.1–4.1). An intention-to-treat analysis showed that treatment was successful in 64% (87/135) of patients in the intervention arm versus 53% (78/147) in the control arm (unadjusted OR: 1.6; 95% CI: 1.0–2.6). These improvements were equitable, being independent of household poverty. Conclusion A tuberculosis-specific, socioeconomic support intervention increased uptake of tuberculosis preventive therapy and tuberculosis treatment success and is being evaluated in the Community Randomized Evaluation of a Socioeconomic Intervention to Prevent TB (CRESIPT) project. PMID:28479622
Williams, Holly Ann; Durrheim, David; Shretta, Rima
Widespread resistance of Plasmodium falciparum parasites to commonly used antimalarials, such as chloroquine, has resulted in many endemic countries considering changing their malaria treatment policy. Identifying and understanding the key influences that affect decision-making, and factors that facilitate or undermine policy implementation, is critical for improving the policy process and guiding resource allocation during this process. A historical review of archival documents from Malaŵi and data obtained from in-depth policy studies in four countries (Tanzania, South Africa, Kenya and Peru) that have changed malaria treatment policy provides important lessons about decision-making, the policy cycle and complex policy environment, while specifically identifying strategies successfully employed to facilitate policy-making and implementation. Findings from these country-level studies indicate that the process of malaria drug policy review should be institutionalized in endemic countries and based on systematically collected data. Key stakeholders need to be identified early and engaged in the process, while improved communication is needed on all levels. Although malaria drug policy change is often perceived to be a daunting task, using these and other proven strategies should assist endemic countries to tackle this challenge in a systematic fashion that ensures the development and implementation of the rational malaria drug policy.
Ruiz, Lastenia; Ruiz, Liliana; Maco, Martha; Cobos, Marianela; Gutierrez-Choquevilca, Andréa-Luz; Roumy, Vincent
In order to evaluate the antimalarial potential of traditional remedies used in Peru, Indigenous and Mestizo populations from the river Nanay in Loreto were interviewed about traditional medication for the treatment of malaria. The survey took place on six villages and led to the collection of 59 plants. 35 hydro-alcoholic extractions were performed on the 21 most cited plants. The extracts were then tested for antiplasmodial activity in vitro on Plasmodium falciparum chloroquine resistant strain (FCR-3), and ferriprotoporphyrin inhibition test was also performed in order to assume pharmacological properties. Extracts from 9 plants on twenty-one tested (Abuta rufescens, Ayapana lanceolata, Capsiandra angustifolia, Citrus limon, Citrus paradise, Minquartia guianensis, Potalia resinífera, Scoparia dulcis, and Physalis angulata) displayed an interesting antiplasmodial activity (IC(50)<10 μg/ml) and 16 remedies were active on the ferriprotoporphyrin inhibition test. The results give scientific validation to the traditional medical knowledge of the Amerindian and Mestizo populations from Loreto and exhibit a source of potentially active plants. Copyright Â© 2010 Elsevier Ireland Ltd. All rights reserved.
Garcia, Maria Elena
This paper explores recent changes in Peruvian national education policy and the effects these have had on indigenous populations. Situating Peruvian education reforms within a context of international multicultural development, the paper traces the history of reforms as implemented by national and international actors in varying degrees and…
Kuypers, Marshall A.; Lambert, Gregory Joseph; Moore, Thomas W.; Glass, Robert John,; Finley, Patrick D.; Ross, David; Chartier, Maggie
Chronic infection with Hepatitis C virus (HCV) results in cirrhosis, liver cancer and death. As the nations largest provider of care for HCV, US Veterans Health Administration (VHA) invests extensive resources in the diagnosis and treatment of the disease. This report documents modeling and analysis of HCV treatment dynamics performed for the VHA aimed at improving service delivery efficiency. System dynamics modeling of disease treatment demonstrated the benefits of early detection and the role of comorbidities in disease progress and patient mortality. Preliminary modeling showed that adherence to rigorous treatment protocols is a primary determinant of treatment success. In depth meta-analysis revealed correlations of adherence and various psycho-social factors. This initial meta-analysis indicates areas where substantial improvement in patient outcomes can potentially result from VA programs which incorporate these factors into their design.
Guerra, Humberto; Palomino, Juan Carlos; Falconí, Eduardo; Bravo, Francisco; Donaires, Ninoska; Van Marck, Eric; Portaels, Françoise
Eight adult patients (ages 18-58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1-5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.
Cabada, Miguel M.; Lopez, Martha; Cruz, Maria; Delgado, Jennifer R.; Hill, Virginia; White, A. Clinton
Triclabendazole is reported to be highly effective in treatment of human fascioliasis. We present 7 of 19 selected cases of human fascioliasis referred to our center in the Cusco region of Peru that failed to respond to triclabendazole. These were mostly symptomatic adults of both sexes that continued passing Fasciola eggs in the stool despite multiple treatments with 2 doses of triclabendazole at 10 mg/kg per dose. We documented the presence of eggs by rapid sedimentation and Kato Katz tests after each treatment course. We found that repeated triclabendazole courses were not effective against fascioliasis in this group of people. These findings suggest that resistance to triclabendazole may be an emerging problem in the Andes. PMID:26808543
Miguel M Cabada
Full Text Available Triclabendazole is reported to be highly effective in treatment of human fascioliasis. We present 7 of 19 selected cases of human fascioliasis referred to our center in the Cusco region of Peru that failed to respond to triclabendazole. These were mostly symptomatic adults of both sexes that continued passing Fasciola eggs in the stool despite multiple treatments with 2 doses of triclabendazole at 10 mg/kg per dose. We documented the presence of eggs by rapid sedimentation and Kato Katz tests after each treatment course. We found that repeated triclabendazole courses were not effective against fascioliasis in this group of people. These findings suggest that resistance to triclabendazole may be an emerging problem in the Andes.
Cabada, Miguel M; Lopez, Martha; Cruz, Maria; Delgado, Jennifer R; Hill, Virginia; White, A Clinton
Triclabendazole is reported to be highly effective in treatment of human fascioliasis. We present 7 of 19 selected cases of human fascioliasis referred to our center in the Cusco region of Peru that failed to respond to triclabendazole. These were mostly symptomatic adults of both sexes that continued passing Fasciola eggs in the stool despite multiple treatments with 2 doses of triclabendazole at 10 mg/kg per dose. We documented the presence of eggs by rapid sedimentation and Kato Katz tests after each treatment course. We found that repeated triclabendazole courses were not effective against fascioliasis in this group of people. These findings suggest that resistance to triclabendazole may be an emerging problem in the Andes.
Kevany, J; Fierro-Benitez, R; Pretell, E A; Stanbury, J B
Endemic goiter is a health problem in many areas of the world; in some areas the disease is so severe that cretinism and other defects are found. In many areas geographic, economic, and other factors prevent the use of iodized salt as a preventive measure. Field studies were begun in 1966 to determine the feasibility and effectiveness of parenteral administration of iodized oil in goiter prevention. Studies were carried out in Ecuador and Peru. In Ecuador 2 villages were chosen in which the prevalence of goiter was about 60%; in Peru 3 villages were chosen where incidence was about 50%. Prevalence of goiter decreased for 20 months during the study but then began to rise again with the maximum reduction seen up to age 18 and minimal reduction after 40 years of age. The control groups in the study experienced only slight decreases in rate of incidence. Cretinism has not yet appeared among the progeny of the population injected with iodized oil but several instances have appeared in control groups. The use of iodized oil as a public health procedure for the prevention of endemic goiter and its associated defects is an acceptable measure in regions where salt iodization cannot be done.
Tyler, N. A.; Ramirez, C.
Transport has been identified as one of the biggest sectors that contribute to climate change (23%) due to its energy demand and polluting emissions and therefore one of the sectors that needs to take action to mitigate its impact. A few countries in Latin America (Brazil, Chile, Mexico and Colombia) have started their transport NAMA development and are at different stages in the process. Peru has started this process more recently and this report aims at facilitating the NAMA development and...
The future safe development of nuclear energy and progressive increasing use of sealed sources in medicine, research, industry and other fields in Peru, in the past years have determined the necessity to formulate and apply an Institutional policy to assure harmless and ecologically rational management of disused sealed sources in Peru. Some results of the studies, which served as a basis for design and construction of a facility for treatment, conditioning and storage of conditioned sealed sources are presented in this paper. The waste management system in Peru comprises operational and regulatory capabilities. Both of these activities are performed under a legislation. The Nuclear Research Center RACSO has a radioactive waste management department which is in charge of the management of disused sealed sources produced in the country. It is considered as a centralized waste processing and storage facility (WPSF). (author)
Roque, Celine; Guibert, Pierre E-mail: firstname.lastname@example.org; Vartanian, Mmanuel; Vieillevigne, Emmanuelle; Bechtel, Francoise
TL-dating studies were carried out on pre hispanic pottery attributed to he Moche culture of Peru (from BC 200 to AD 800 according to the previously known chronology). A greater than expected scatter in ages was found for samples known, from archaeological considerations, to have been contemporaneous. This was related to applying a fixed, but inappropriate, annealing temperature to the grains prior to their irradiation to regenerate he TL growth curve. The dependence of growth of TL and equivalent dose valuation on this annealing temperature was tested in the range 400-1000 eg. C. A combined cathodoluminescence/TL study was used to select the appropriate thermal treatment for evaluation of the final equivalent dose. his procedure, which we suggest can be generally applied in pottery dating, resulted in a reduction of age dispersion when applied to groups of contemporaneous ceramics.
Roque, Celine; Guibert, Pierre; Vartanian, Mmanuel; Vieillevigne, Emmanuelle; Bechtel, Francoise
TL-dating studies were carried out on pre hispanic pottery attributed to he Moche culture of Peru (from BC 200 to AD 800 according to the previously known chronology). A greater than expected scatter in ages was found for samples known, from archaeological considerations, to have been contemporaneous. This was related to applying a fixed, but inappropriate, annealing temperature to the grains prior to their irradiation to regenerate he TL growth curve. The dependence of growth of TL and equivalent dose valuation on this annealing temperature was tested in the range 400-1000 eg. C. A combined cathodoluminescence/TL study was used to select the appropriate thermal treatment for evaluation of the final equivalent dose. his procedure, which we suggest can be generally applied in pottery dating, resulted in a reduction of age dispersion when applied to groups of contemporaneous ceramics
Bourque, Susan C.
This paper discusses affirmative action in Peru and considers what the government must do to solve the inferior status of the Indian majority. Ethnically and geographically diverse, Peru's population is said to be marked by inequities in wealth, education, and employment. The policies developed by Peruvian governments over the past 20 years to…
Full Text Available Isoniazid and rifampicin are the two most efficacious first-line agents for tuberculosis (TB treatment. We assessed the prevalence of isoniazid and rifampicin mono-resistance, associated risk factors, and the association of mono-resistance on treatment outcomes.A prospective, observational cohort study enrolled adults with a first episode of smear-positive pulmonary TB from 34 health facilities in a northern district of Lima, Peru, from March 2010 through December 2011. Participants were interviewed and a sputum sample was cultured on Löwenstein-Jensen (LJ media. Drug susceptibility testing was performed using the proportion method. Medication regimens were documented for each patient. Our primary outcomes were treatment outcome at the end of treatment. The secondary outcome included recurrent episodes among cured patients within two years after completion of the treatment.Of 1292 patients enrolled, 1039 (80% were culture-positive. From this subpopulation, isoniazid mono-resistance was present in 85 (8% patients and rifampicin mono-resistance was present in 24 (2% patients. In the multivariate logistic regression model, isoniazid mono-resistance was associated with illicit drug use (adjusted odds ratio (aOR = 2.10; 95% confidence interval (CI: 1.1-4.1, and rifampicin mono-resistance was associated with HIV infection (aOR = 9.43; 95%CI: 1.9-47.8. Isoniazid mono-resistant patients had a higher risk of poor treatment outcomes including treatment failure (2/85, 2%, p-value<0.01 and death (4/85, 5%, p<0.02. Rifampicin mono-resistant patients had a higher risk of death (2/24, 8%, p<0.01.A high prevalence of isoniazid and rifampicin mono-resistance was found among TB patients in our low HIV burden setting which were similar to regions with high HIV burden. Patients with isoniazid and rifampicin mono-resistance had an increased risk of poor treatment outcomes.
This paper reports on the preferential treatment and exemption policy of the Federal Energy Regulatory Commission (FERC) for State and State Agencies which creates an anticompetitive and restraint of trade attitude in California against the development of alternative energy resources by the private sector when such development competes directly with state owned power generation under the State Water and Central Valley Water Projects, particularly in the area of water and power supply. The existing state water policy fails to address the effects of global warming and the adverse potential of the greenhouse effect in California, i.e. rising tides can seriously impact sea water intrusion problems of the San Francisco Bay-Delta Area by not only flooding agricultural lands in the Delta and Central Valley, but impacting the supply of water to large population areas in Southern and Northern California, especially when coupled with drought conditions. The California investigative research results herein reported demonstrates the fallacy of a preferential treatment and exemption policy in a free market economy, especially when such policy creates the potential for excessive state budget burdens upon the public in the face of questionable subsidies to special interest, i.e., allowing the resulting windfall profits to be passed onto major utilities and commingled at the expense of public interest so as to undermine the financial means for development of alternative energy resources. The cited Congressional and State Legislative Laws which provide the ways and means to resolve any energy or water resource problems are only as good as the enforcement and the commitment by the executive branch of government and the lawmakers to up-hold existing laws
Terris-Prestholt, Fern; Vickerman, Peter; Torres-Rueda, Sergio; Santesso, Nancy; Sweeney, Sedona; Mallma, Patricia; Shelley, Katharine D; Garcia, Patricia J; Bronzan, Rachel; Gill, Michelle M; Broutet, Nathalie; Wi, Teodora; Watts, Charlotte; Mabey, David; Peeling, Rosanna W; Newman, Lori
Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non-treponemal antibodies (dual RSTs) are now available. This study assessed the cost-effectiveness of algorithms using these tests to screen pregnant women. Observed costs of maternal syphilis screening and treatment using clinic-based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost-effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results. Although this analysis found screening using RPR to be relatively cheap, most (>70%) true cases went untreated. Algorithms using single RSTs were the most cost-effective in all observed settings, followed by dual RSTs, which became the most cost-effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women. This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings. Copyright © 2015 International Federation of Gynecology and Obstetrics. All rights reserved.
Otero, L; De Orbegoso, A; Navarro, A F; Ríos, J; Párraga, T; Gotuzzo, E; Seas, C; Van der Stuyft, P
To determine the time from diagnosis to start of multidrug resistant tuberculosis (MDR TB) treatment in Lima, Peru. We studied new smear-positive TB adults that were started on MDR TB treatment or that were switched to it between June 2008 and December 2011. Time from the first positive smear to MDR-TB treatment was >30 days in 35% (13/37) of patients. Among the 27% (24/88) of patients that switched to MDR-TB treatment, time from the last dose of a drug-susceptible regimen was >30 days. Start of and switching to MDR TB treatment is still delayed. © 2014 John Wiley & Sons Ltd.
Heaton, T B; Forste, R
Using data from the World Fertility and Demographic and Health Surveys of Colombia, Peru, and Bolivia, we model the effects of education on three demographic outcomes: the timing of first sexual union, contraceptive use, and fertility. These effects are examined over time and across geographic areas using a multivariate framework. We find substantial improvements in female educational attainment over the last fifty years and a strong relationship between education and the demographic outcomes. Each successive increment in education is associated with declines in the marriage rate, increased contraceptive use, and lower fertility. Education accounts for some of the changes over time in the demographic outcomes, but the pattern varies by outcome, time period, and geographic area. In support of the social diffusion hypothesis, our results indicate that educational differences in reproductive behavior are reduced as the level of development increases and societies pass through their demographic transition.
Full Text Available The efficacy and safety of a fixed-dose combination of atovaquone and proguanil hydrochloride (MalaroneTM were compared with chloroquine or pyrimethamine/sulfadoxine in patients with acute falciparum malaria in northern Peru. Patients were initially randomized to receive 1,000 mg atovaquone and 400 mg proguanil hydrochloride daily for 3 days (n=15 or 1,500 mg chloroquine (base over a 3 day period (n=14 (phase 1. The cure rate with chloroquine was lower than expected and patients were subsequently randomized to receive a single dose of 75 mg pyrimethamine and 1,500 mg sulfadoxine (n=9 or atovaquone/proguanil as before (n=5 (phase 2. In phase 1, atovaquone/proguanil was significantly more effective than chloroquine (cure rate 100% [14/14] versus 8% [1/13], P<0.0001. In phase 2, atovaquone/proguanil and pyrimethamine/sulfadoxine were both highly effective (cure rates 100% [5/5] and 100% [7/7]. There were no significant differences between treatment groups in parasite or fever clearance times. Adverse events were typical of malarial symptoms and did not differ significantly between groups. Overall efficacy of atovaquone/proguanil was 100% for treatment of acute falciparum malaria in a region with a high prevalence of chloroquine resistance.
Full Text Available The efficacy and safety of a fixed-dose combination of atovaquone and proguanil hydrochloride (MalaroneTM were compared with chloroquine or pyrimethamine/sulfadoxine in patients with acute falciparum malaria in northern Peru. Patients were initially randomized to receive 1,000 mg atovaquone and 400 mg proguanil hydrochloride daily for 3 days (n=15 or 1,500 mg chloroquine (base over a 3 day period (n=14 (phase 1. The cure rate with chloroquine was lower than expected and patients were subsequently randomized to receive a single dose of 75 mg pyrimethamine and 1,500 mg sulfadoxine (n=9 or atovaquone/proguanil as before (n=5 (phase 2. In phase 1, atovaquone/proguanil was significantly more effective than chloroquine (cure rate 100% [14/14] versus 8% [1/13], P<0.0001. In phase 2, atovaquone/proguanil and pyrimethamine/sulfadoxine were both highly effective (cure rates 100% [5/5] and 100% [7/7]. There were no significant differences between treatment groups in parasite or fever clearance times. Adverse events were typical of malarial symptoms and did not differ significantly between groups. Overall efficacy of atovaquone/proguanil was 100% for treatment of acute falciparum malaria in a region with a high prevalence of chloroquine resistance.
Llanos-Cuentas, A; Campos, P; Clendenes, M; Canfield, C J; Hutchinson, D B
The efficacy and safety of a fixed-dose combination of atovaquone and proguanil hydrochloride (Malarone) were compared with chloroquine or pyrimethamine/sulfadoxine in patients with acute falciparum malaria in northern Peru. Patients were initially randomized to receive 1,000 mg atovaquone and 400 mg proguanil hydrochloride daily for 3 days (n=15) or 1,500 mg chloroquine (base) over a 3 day period (n=14) (phase 1). The cure rate with chloroquine was lower than expected and patients were subsequently randomized to receive a single dose of 75 mg pyrimethamine and 1,500 mg sulfadoxine (n=9) or atovaquone/proguanil as before (n=5) (phase 2). In phase 1, atovaquone/proguanil was significantly more effective than chloroquine (cure rate 100% [14/14] vs. 8% [1/13], Pproguanil and pyrimethamine/sulfadoxine were both highly effective (cure rates 100% [5/5] and 100% [7/7]). There were no significant differences between treatment groups in parasite or fever clearance times. Adverse events were typical of malarial symptoms and did not differ significantly between groups. Overall efficacy of atovaquone/proguanil was 100% for treatment of acute falciparum malaria in a region with a high prevalence of chloroquine resistance.
Full Text Available Tuberculosis (TB is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru.We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data.Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants.The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence
Albino, Sandra; Tabb, Karen M; Requena, David; Egoavil, Miguel; Pineros-Leano, Maria F; Zunt, Joseph R; García, Patricia J
Tuberculosis (TB) is global health concern and a leading infectious cause of mortality. Reversing TB incidence and disease-related mortality is a major global health priority. Infectious disease mortality is directly linked to failure to adhere to treatments. Using technology to send reminders by short message services have been shown to improve treatment adherence. However, few studies have examined tuberculosis patient perceptions and attitudes towards using SMS technology to increase treatment adherence. In this study, we sought to investigate perceptions related to feasibility and acceptability of using text messaging to improve treatment adherence among adults who were receiving treatment for TB in Callao, Peru. We conducted focus group qualitative interviews with current TB positive and non-contagious participants to understand the attitudes, perceptions, and feasibility of using short message service (SMS) reminders to improve TB treatment adherence. Subjects receiving care through the National TB Program were recruited through public health centers in Ventanilla, Callao, Peru. In four focus groups, we interviewed 16 patients. All interviews were recorded and transcribed verbatim. Thematic network analysis and codebook techniques were used to analyze data. Three major themes emerged from the data: limits on health literacy and information posed challenges to successful TB treatment adherence, treatment motivation at times facilitated adherence to TB treatment, and acceptability of SMS including positive perceptions of SMS to improve TB treatment adherence. The majority of patients shared considerations about how to effectively and confidentially administer an SMS intervention with TB positive participants. The overall perceptions of the use of SMS were positive and indicated that SMS technology may be an efficient way to transmit motivational texts on treatment, health education information, and simple reminders to increase treatment adherence for low
Villena, Jaime E
Peru is an upper medium-income developing country with an increasing prevalence of chronic diseases, including diabetes. To review and describe the epidemiology, drivers, and diabetes care plan in Peru. The medical literature was reviewed based on systematic searching of PubMed, Scielo, and various gray literature from the International Diabetes Federation, World Health Organization, and local Peruvian agencies. In Peru, diabetes affects 7% of the population. Type 2 diabetes accounts for 96.8% of outpatients visits with this condition. Type 1 diabetes has an incidence of 0.4/100,000 per year, and gestational diabetes affects 16% of pregnancies. The prevalence of glucose intolerance is 8.11% and that of impaired fasting glucose 22.4%. The prevalence of overweight, obesity, and metabolic syndrome in adults is 34.7%, 17.5%, and 25%, respectively. Metabolic syndrome prevalence is greater in women and the elderly and at urban and low-altitude locations. Diabetes is the eighth cause of death, the sixth cause of blindness, and the leading cause of end-stage kidney disease and nontraumatic lower limb amputation. In Peru, diabetes accounts for 31.5% of acute myocardial infarctions and 25% of strokes. Infections, diabetic emergencies, and cardiovascular disorders are the main causes for admissions, with a mortality rate Diabetes is a major health care issue in Peru that exposes difficult challenges and shortcomings. The national strategy for tackling diabetes includes promotion of healthy lifestyles; training primary care physicians and providing them with evidence-based clinical practice guidelines, safe and effective medications, and tools for monitoring treatment; and, finally, construction of a comprehensive health care network for early referral in order to prevent, detect, and treat diabetic complications. Copyright © 2015 The Author. Published by Elsevier Inc. All rights reserved.
This article highlights population statistics from Peru, the 3rd largest country in Latin America. The population in 1985 has been estimated at 19.7 million. In 1982, the birth rate was 35/1000 and the mortality rate was 10/1000. Infant mortality stood at 99/1000 live births and life expectancy at birth was 59 years. 41% of Peru's population is under 15 years of age, and only 4% is 65 years of age or older. The country's total fertility rate is 5.2 births/woman. Only 0.4% of the population is foreign born. Peru is highly urbanized, and 65% of the country's total population growth in 1981 occurred in its cities. 1 in 3 Peruvians resides in the capital city of Lima. The 2 largest racial groups are mestizos and whites (53%) and Indians (46%). 21% of the population is illiterate. 40.7% of the labor force is employed in agriculture; however, only 15% of the national income is derived from agriculture. The GNP per capita was US$1040 in 1983. The country's economy is in serious trouble at present, with an annual inflation rate of 250% and a foreign debt of US$13.5 billion.
Carmen Rosa Silupú García
Full Text Available Comercial activated carbon samples (A, B, C, and D used in filters for the treatment of water were characterized and evaluated in the decontamination of heavy metals present in river water and in the elimination of coliform microorganisms. The carbon samples had microporous and mesoporous structures. Surface areas of between 705 and 906 m2/g were found. The carbons samples were amorphous and the presence of antibacterial agents such as Ag, Cl, Cu, and Si was detected. It was determined that for As and Pb, whose initial concentrations in contaminated water (water of the Tumbes river-Peru were 56.7 and 224.0 μg/L, respectively, the percentage of adsorption was close to 100%. The relationship between point of zero charge pH of the activated carbons and pH of the river water during the experiments plays a determinant role in the adsorption of the analyzed elements. The antibacterial capacity was evaluated satisfactorily against the following strains of fecal gram negative bacteria: Escherichia coli (ATCC® 25922™, Salmonella typhimurium (ATCC® 14028™, and Shigella flexneri (ATCC® 12022™. This ability is based on the surface presence in the carbons of the mentioned antibacterial agents.
Full Text Available El artículo analiza el caso del proceso de elaboración de políticas de salud reproductiva en el Perú, en el contexto de las reformas de las políticas sociales implementadas durante los últimos 15 años. Las reformas en el sector de la salud sólo han reparado en forma parcial el acceso desigual de las mujeres a la planificación familiar, a los derechos reproductivos y a la atención materna. Las fuentes principales de desigualdad están relacionadas con la naturaleza segmentada del sistema de la atención de la salud que ocasiona, entre otros temas, que la mayoría de las mujeres sin seguro provenientes de las clases populares dependan de qué y cómo sean provistos los servicios públicos de la atención médica. Por otra parte, el continuo papel de sectores conservadores en los debates sobre políticas de salud reproductiva sigue teniendo un impacto sobre los servicios públicamente disponibles de planificación familiar.The article analyzes the case of reproductive health policy-making in Peru in the context of recent social policy reforms. Health-sector reforms have only partially redressed Peruvian women's unequal access to family planning, reproductive rights and maternal care. The main sources of inequalities are related to the segmented character of the health-care system, with the highest burden placed on the public sector. The majority of women from popular classes, who are not protected by an insurance plan, are dependent upon what and how public services are provided. Simultaneously, the continuing role of conservative sectors in public debates about reproductive health policy has a strong impact on public family planning services and other reproductive rights.
Klee, Carol A.
Presents an overview of language policy in Peru from colonial times to the present and analyzes the impact of this policy, together with the underlying social conditions, on Spanish-Quechua language contact and Spanish language change in present-day Peru. (Author/VWL)
Huicho, Luis; Trelles, Miguel; Gonzales, Fernando
Information on profiles for under-five causes of death is important to guide choice of child-survival interventions. Global level data have been published, but information at country level is scarce. We aimed at defining national and departmental trends and profiles of under-five mortality in Peru from 1996 through 2000. We used the Ministry of Health registered under-five mortality data. For correction of under-registration, a model life-table that fitted the age distribution of the population and of registered deaths was identified for each year. The mortality rates corresponding to these model life-tables were then assigned to each department in each particular year. Cumulative reduction in under-five mortality rate in the 1996-2000 period was estimated calculating the annual reduction slope for each department. Departmental level mortality profiles were constructed. Differences in mortality profiles and in mortality reduction between coastal, andean and jungle regions were also assessed. At country level, only 4 causes (pneumonia, diarrhoea, neonatal diseases and injuries) accounted for 68% of all deaths in 1996, and for 62% in 2000. There was 32.7% of under-five death reduction from 1996 to 2000. Diarrhoea and pneumonia deaths decreased by 84.5% and 41.8%, respectively, mainly in the andean region, whereas deaths due to neonatal causes and injuries decreased by 37.2% and 21.7%. For 1996-2000 period, the andean, coast and jungle regions accounted for 52.4%, 33.1% and 14.4% of deaths, respectively. These regions represent 41.0%, 46.4% and 12.6% of under-five population. Both diarrhoea and pneumonia constitute 30.6% of under-five deaths in the andean region. As a proportion, neonatal deaths remained stable in the country from 1996 to 2000, accounting for about 30% of under-five deaths, whereas injuries and "other" causes, including congenital anomalies, increased by about 5%. Under-five mortality declined substantially in all departments from 1996 to 2000, which
Full Text Available Abstract Background Information on profiles for under-five causes of death is important to guide choice of child-survival interventions. Global level data have been published, but information at country level is scarce. We aimed at defining national and departmental trends and profiles of under-five mortality in Peru from 1996 through 2000. Methods We used the Ministry of Health registered under-five mortality data. For correction of under-registration, a model life-table that fitted the age distribution of the population and of registered deaths was identified for each year. The mortality rates corresponding to these model life-tables were then assigned to each department in each particular year. Cumulative reduction in under-five mortality rate in the 1996–2000 period was estimated calculating the annual reduction slope for each department. Departmental level mortality profiles were constructed. Differences in mortality profiles and in mortality reduction between coastal, andean and jungle regions were also assessed. Results At country level, only 4 causes (pneumonia, diarrhoea, neonatal diseases and injuries accounted for 68% of all deaths in 1996, and for 62% in 2000. There was 32.7% of under-five death reduction from 1996 to 2000. Diarrhoea and pneumonia deaths decreased by 84.5% and 41.8%, respectively, mainly in the andean region, whereas deaths due to neonatal causes and injuries decreased by 37.2% and 21.7%. For 1996–2000 period, the andean, coast and jungle regions accounted for 52.4%, 33.1% and 14.4% of deaths, respectively. These regions represent 41.0%, 46.4% and 12.6% of under-five population. Both diarrhoea and pneumonia constitute 30.6% of under-five deaths in the andean region. As a proportion, neonatal deaths remained stable in the country from 1996 to 2000, accounting for about 30% of under-five deaths, whereas injuries and "other" causes, including congenital anomalies, increased by about 5%. Conclusion Under
Huicho, Luis; Trelles, Miguel; Gonzales, Fernando
Background Information on profiles for under-five causes of death is important to guide choice of child-survival interventions. Global level data have been published, but information at country level is scarce. We aimed at defining national and departmental trends and profiles of under-five mortality in Peru from 1996 through 2000. Methods We used the Ministry of Health registered under-five mortality data. For correction of under-registration, a model life-table that fitted the age distribution of the population and of registered deaths was identified for each year. The mortality rates corresponding to these model life-tables were then assigned to each department in each particular year. Cumulative reduction in under-five mortality rate in the 1996–2000 period was estimated calculating the annual reduction slope for each department. Departmental level mortality profiles were constructed. Differences in mortality profiles and in mortality reduction between coastal, andean and jungle regions were also assessed. Results At country level, only 4 causes (pneumonia, diarrhoea, neonatal diseases and injuries) accounted for 68% of all deaths in 1996, and for 62% in 2000. There was 32.7% of under-five death reduction from 1996 to 2000. Diarrhoea and pneumonia deaths decreased by 84.5% and 41.8%, respectively, mainly in the andean region, whereas deaths due to neonatal causes and injuries decreased by 37.2% and 21.7%. For 1996–2000 period, the andean, coast and jungle regions accounted for 52.4%, 33.1% and 14.4% of deaths, respectively. These regions represent 41.0%, 46.4% and 12.6% of under-five population. Both diarrhoea and pneumonia constitute 30.6% of under-five deaths in the andean region. As a proportion, neonatal deaths remained stable in the country from 1996 to 2000, accounting for about 30% of under-five deaths, whereas injuries and "other" causes, including congenital anomalies, increased by about 5%. Conclusion Under-five mortality declined substantially in
Curioso, Walter H; Espinoza-Portilla, Elizabeth
In this article we present the essential components and policies that are most relevant regarding the conceptual framework to strengthen the health information systems in Peru. The article also presents the main policies, actions and strategies made in the field of electronic health in Peru that are most significant. The health information systems in Peru play a key role and are expected to achieve an integrated and interoperable information system. This will allow health information to be complete, efficient, of good quality and available in a timely manner to achieve better quality of life for people and allow meaningful modernization of public health in the context of health reform in Peru.
Calvo, C.S.; Maghella, G.; Mamani, E.; Berne, P.; Brisset, P.; Leclerc, J.-P.
The objectives of this paper are to present an overview of possible applications of the radiotracers for better understanding of water and waste water treatment plants. Numerous experiments have been carried out in different plants located in Lima. Four processes have been investigated: desanders, floculators, clarifiers and digesters. Depending on the studied process, the experimental results have been interpreted at different levels of complexity: from simple troubleshooting to the modelling of the flow behaviour inside the process. (author)
Pineda-Reyes, Roberto; Llanos-Cuentas, Alejandro; Dancuart, Mauricio
In order to know the first-choice treatment by villagers of an endemic area of Cutaneous Leishmaniasis (CL) prior to medical attention in a health care center, a cross sectional study was realized in Pichupampa town. A census was made in order to collect demographic data and previous history of CL. 254 participants were surveyed. 41.7% (106/254) of the village had CL at least once in their lives and only half of them went to a health center to seek for primary care. 76/106 (71.7%) used some traditional treatment as their first choice and only 23.6% (25/106) subjects went to a health-care center without manipulation of their lesions. It's evident that a high percentage (71.7%) of people potentially infected by CL manipulate and treat their lesions with traditional treatments prior to professional health-care, actions that could interfere with the diagnosis and effectiveness of the program implemented by the Health Ministry.
Huggel, Christian; Carey, Mark; Frey, Holger; Jurt, Christine; Mechler, Reinhard; Motschmann, Alina; Vicuña, Luis
Climatic changes involve emergence and changes of both sudden-onset and slow-onset risks. In the field of disaster risk reduction a solid range of strategies and measures has been developed to address sudden-onset risks such as floods, mass movements or storms. Comparably less experience is available for management of slow-onset risks. While, for instance, drought prone regions do have important knowledge how to cope with such conditions in other regions where climatic changes have induced new challenges and risks there is limited experience about how to adapt to slow-onset processes and risks. Examples are impacts of sea level rise in coastal regions or glacier shrinkage in mountain regions. The lack of understanding of how to address impacts from slow-onset processes has recently also been highlighted by the Executive Committee of the Warsaw International Mechanism on Loss and Damage (WIM) acting under the United Nations Framework Convention on Climate Change (UNFCCC). In climate change science, practice and policy it is often assumed that risk management and climate change adaptation would see a seamless continuum when addressing both sudden-onset and slow-onset risks. Here we draw on recent experiences from the Andes of Peru showing that management of, and adaptation to combined sudden-onset and slow-onset impacts of climate change may involve serious social disruption. Carhuaz, a city in the Cordillera Blanca of Peru with a number of local communities pertaining to it, is affected by multiple effects of climate change and glacier shrinkage. After a flood event from glacier lake 513 a flood early warning system has been developed and installed. Multiple use and demand of glacier melt water makes water resource management a challenge and conflicts arise especially during the dry season when water is scarce. The drought at the end of 2016 over much of the tropical Andes has resulted in a situation where local communities started to vigorously and violently turn
Hoffman, Kim A; Beltrán, Jessica; Ponce, Javier; García-Fernandez, Lisset; Calderón, María; Muench, John; Benites, Carlos; Soto, Leslie; McCarty, Dennis; Fiestas, Fabián
Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA. After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru. focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients. Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.
This paper shows that there is a long-run relationship between the expected rate of depreciation in the black-market-exchange rate and the ratio of domestic to foreign money in Peru; that is, the hypothesis of currency substitution can explain the behavior of real holdings of money in Peru. The paper also shows that, while the importance of currency substitution as a transmission mechanism through which domestic policies affected the dynamics of inflation was relatively small during a period ...
Carmen Phang Romero
Full Text Available Este artículo analiza el Programa de Administración Compartida de Farmacias (PACFARM y su articulación con la Política Farmacéutica en Perú, en el contexto de la reforma del sector salud. La ejecución de los diversos Programas de Medicamentos Esenciales precedentes muestra el permanente esfuerzo por mejorar la cobertura con medicamentos esenciales a la población, no obstante, el marco jurídico en esta área presenta normas dispersas y desarticuladas, que dificultan la construcción de una Política Nacional de Medicamentos. El PACFARM es un sistema descentralizado de abastecimiento de medicamentos esenciales para el primer nivel de atención, auto-sustentado a través de fondos rotatorios. Mientras la ampliación de cobertura y la disminución de las barreras económicas de acceso a medicamentos esenciales fundamentaban lineamientos de una política farmacéutica, en tanto trazos de eficiencia gerencial en el suministro acompasaban la modernización de la gestión como parte de la reforma, otros aspectos dificultaron su implantación y limitaron sus efectos, tales como: la desregulación y los propios procesos de cambio en el sector. El abordaje metodológico incluyó técnicas cuali y cuantitativas, privilegiando el análisis de implantación del Programa.This article analyzes the Shared Pharmaceutical Management Program (PACFARM and its relationship to pharmaceutical policy in Peru within the scope of health sector reform. Implementation of various programs for essential medicines has involved an on-going effort towards improving the supply of essential drugs to the community. However, the corresponding legal framework includes random and disconnected regulations which hinder the feasibility of a consistent national drug policy. PACFARM is a decentralized system for the provision of essential medicines on a care-level basis, self-supported by revolving funds. While expanded coverage and decreased economic barriers to access to
Scheg, K E
Public policy initiatives offer greater promise than other strategies for reducing the major public health problem of death and disease due to smoking. Three of the most critical public policy areas today are smoke-free environments, youth access, and advertising. While earlier laws separated smokers and nonsmokers into separate sections, the focus now is on smoke-free environments. Various places, however, most notably restaurants, often remain polluted with tobacco smoke and put women at heightened risk of disease and death. Restricting youth access to tobacco products has also gained momentum in the 1990s. The recently proposed Food and Drug Administration regulations designed to reduce smoking by minors by 50% over seven years are the most significant national public policy initiatives ever to address the problem of children smoking. Measures to counter the tobacco industry's massive advertising and promotion campaigns have also increased. The federal government has begun enforcing the prohibition on cigarette advertising on television, and local jurisdictions have restricted tobacco billboards and point-of-sale advertising.
Japanese Investment in Latin America was considerable in the 1960s and 1970s, but the investment never took off in the developmental style as in East Asia. The author examines why Japanese Foreign Direct Investment in Peru did not follow the pattern of developmental investment, analyzing the elements involved regarding policies in Peru and particular circumstances in Japan in the 1990 decade.
Krishnan, Archana; Ferro, Enrico G; Weikum, Damian; Vagenas, Panagiotis; Lama, Javier R; Sanchez, Jorge; Altice, Frederick L
The HIV epidemic in Peru is concentrated among men who have sex with men (MSM). Given that MSM have been documented as early adopters of emerging technology, we examined communication technology access and utilization, and mobile health (mHealth) acceptance among Peruvian MSM and transgender women (TGW) in order to gauge opportunities for mHealth-enabled HIV interventions. A convenience sample of 359 HIV-infected MSM and TGW recruited from three sites in Lima, Peru completed standardized assessments of alcohol use disorders (AUDs), risky sexual behavior, and antiretroviral therapy (ART) adherence along with self-constructed measures of communication technology access and utilization, and mHealth acceptance. Most participants (86%) had daily access to any cell phone, including smartphones (30%). The most frequent communication activities were receiving and making calls, and receiving and sending text messages using cell phones. On a 5-point Likert scale, participants expressed interest in using mHealth for medication reminders (M = 3.21, SD = 1.32) and engaging in anonymous online interactions with health professionals to discuss HIV-related issues (M = 3.56, SD = 1.33). Importantly, no significant differences were found in communication technology use and mHealth acceptance among participants with AUDs, depression, and suboptimal ART adherence, all of which are associated with poor HIV treatment outcomes. Findings show support for implementing mHealth-based intervention strategies using cell phones to assess and reduce HIV-risk behaviors among HIV-infected MSM and TGW.
Dave, Hreem B; Gordillo, Luz; Yang, Zhou; Zhang, Monica S; Hubbard, G Baker; Olsen, Timothy W
To determine the cost-effectiveness of laser treatment for retinopathy of prematurity (ROP) in Lima, Peru. A cost-of-illness study (in US dollars) to determine the direct cost of treatment, the indirect lifetime cost of blindness, and the quality-adjusted life years. The direct cost of ROP-related treatment was determined by reviewing data retrospectively from a social security sector hospital. The indirect cost was determined using national economic data of Peru published by the Central Information Agency (CIA), including the per capita gross domestic product, the sex-adjusted income distribution, and years spent in the work force. Indirect costs per child that were avoided by treatment were calculated using the known natural history of ROP vs evidence-based treatment. For ROP-related neonatal blindness in Peru, we estimate the total indirect cost saving at $197,753 per child and the direct cost of laser treatment at $2496 per child. The societal lifetime cost saving per child is estimated at $195,257. The mean annual income per educated adult in Peru is $8000 and treating 1 child is equivalent to employing 24 educated Peruvians per year. The generational cost savings for society is approximately $516 million, or the equivalent of 64,500 educated Peruvian work years. The societal burden of blindness far exceeds the costs of treatment per child. Proper screening and treatment of ROP prevents blindness and leads to substantial cost savings for society. Public health policy in Peru and other middle-income countries should consider financial impact when allocating healthcare resources. Copyright © 2012 Elsevier Inc. All rights reserved.
Llanos-Cuentas, A.; Campos, P.; Clendenes, M.; Canfield, C. J.; Hutchinson, D. B. A.
The efficacy and safety of a fixed-dose combination of atovaquone and proguanil hydrochloride (MalaroneTM) were compared with chloroquine or pyrimethamine/sulfadoxine in patients with acute falciparum malaria in northern Peru. Patients were initially randomized to receive 1,000 mg atovaquone and 400 mg proguanil hydrochloride daily for 3 days (n=15) or 1,500 mg chloroquine (base) over a 3 day period (n=14) (phase 1). The cure rate with chloroquine was lower than expected and patients were sub...
This paper shows that there is a long-run relationship between the expected rate of depreciation in the black-market-exchange rate and the ratio of domestic to foreign money in Peru: that is, the hypothesis of currency substitution can explain the behavior of real holdings of money in Peru. The paper also shows that, while, the importance of currency substitution as a transmission mechanism through which domestic policies affected the dynamics of inflation was relatively small during a period...
Lerner, Alana G; Bernabe-Ortiz, Antonio; Gilman, Robert H; Smeeth, Liam; Miranda, J Jaime
To determine the awareness, treatment, and control of hypertension and diabetes by migration status. Cross-sectional study, secondary analyses of the PERU MIGRANT study. Rural, rural-to-urban migrants, and urban participants. Awareness, treatment, and control of hypertension and diabetes mellitus were calculated using weights to account for participant's group size. Of 205 of the 987 (weighted prevalence 24.1%, 95% confidence interval: 21.1%-27.1%) participants identified as hypertensive, 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33 of the 987 (weighted prevalence 4.6%, 95% confidence interval: 3.1%-6%), and diabetes awareness, treatment, and control were 71.1%, 40.6%, and 7.7%, respectively. Suboptimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment, and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared with rural participants. However, treatment rates were much lower among migrants compared with the urban group. These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas.
A focus on the changes in the relationship between international cooperation and local actors in the skills development field in Peru as the country strengthened its financial position in the last two decades allows us to examine the role of the economic factor in these changes. The paper argues that indeed there is an association between the two.…
Murakami, Yuki; Blom, Andreas
This paper examines the financing of tertiary education in Brazil, Colombia, Mexico and Peru, comparing the affordability and accessibility of tertiary education with that in high-income countries. To measure affordability, the authors estimate education costs, living costs, grants, and loans. Further, they compute the participation rate,…
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Full Text Available This study aims to present the students' perception on the accounting profiles and professional accountants regarding the forms of manifestations of creative accounting. The article is structured in the following part: introduction, literature review, methodology and research results, as well conclusions and limits on the research. Based on hypotheses, the target group was questioned about a number of issues related the tendency to resort to creative accounting practices. The respondents reject the idea of calling own initiatives to manipulate practices of accounting numbers and distortion the image regarding the financial statements and their performance. They believe that resorting to ethics in accounting is essential when on the basis of professional judgment are developed and substantiates the enterprise accounting policies. We specify that the introduction into the university curricula of creative accounting rate contributes to the acquisition of knowledge in the field, without follow the manipulation of accounting numbers and distortion of the entity's financial image
Adaui, Vanessa; Lye, Lon-Fye; Akopyants, Natalia S; Zimic, Mirko; Llanos-Cuentas, Alejandro; Garcia, Lineth; Maes, Ilse; De Doncker, Simonne; Dobson, Deborah E; Arevalo, Jorge; Dujardin, Jean-Claude; Beverley, Stephen M
Cutaneous and mucosal leishmaniasis, caused in South America by Leishmania braziliensis, is difficult to cure by chemotherapy (primarily pentavalent antimonials [Sb(V)]). Treatment failure does not correlate well with resistance in vitro, and the factors responsible for treatment failure in patients are not well understood. Many isolates of L. braziliensis (>25%) contain a double-stranded RNA virus named Leishmaniavirus 1 (LRV1), which has also been reported in Leishmania guyanensis, for which an association with increased pathology, metastasis, and parasite replication was found in murine models. Here we probed the relationship of LRV1 to drug treatment success and disease in 97 L. braziliensis-infected patients from Peru and Bolivia. In vitro cultures were established, parasites were typed as L. braziliensis, and the presence of LRV1 was determined by reverse transcription-polymerase chain reaction, followed by sequence analysis. LRV1 was associated significantly with an increased risk of treatment failure (odds ratio, 3.99; P = .04). There was no significant association with intrinsic Sb(V) resistance among parasites, suggesting that treatment failure arises from LRV1-mediated effects on host metabolism and/or parasite survival. The association of LRV1 with clinical drug treatment failure could serve to guide more-effective treatment of tegumentary disease caused by L. braziliensis. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail email@example.com.
Adaui, Vanessa; Lye, Lon-Fye; Akopyants, Natalia S.; Zimic, Mirko; Llanos-Cuentas, Alejandro; Garcia, Lineth; Maes, Ilse; De Doncker, Simonne; Dobson, Deborah E.; Arevalo, Jorge; Dujardin, Jean-Claude; Beverley, Stephen M.
Cutaneous and mucosal leishmaniasis, caused in South America by Leishmania braziliensis, is difficult to cure by chemotherapy (primarily pentavalent antimonials [SbV]). Treatment failure does not correlate well with resistance in vitro, and the factors responsible for treatment failure in patients are not well understood. Many isolates of L. braziliensis (>25%) contain a double-stranded RNA virus named Leishmaniavirus 1 (LRV1), which has also been reported in Leishmania guyanensis, for which an association with increased pathology, metastasis, and parasite replication was found in murine models. Here we probed the relationship of LRV1 to drug treatment success and disease in 97 L. braziliensis–infected patients from Peru and Bolivia. In vitro cultures were established, parasites were typed as L. braziliensis, and the presence of LRV1 was determined by reverse transcription–polymerase chain reaction, followed by sequence analysis. LRV1 was associated significantly with an increased risk of treatment failure (odds ratio, 3.99; P = .04). There was no significant association with intrinsic SbV resistance among parasites, suggesting that treatment failure arises from LRV1-mediated effects on host metabolism and/or parasite survival. The association of LRV1 with clinical drug treatment failure could serve to guide more-effective treatment of tegumentary disease caused by L. braziliensis. PMID:26123565
Project. IDRC's Think Tank Initiative is a multi-donor program dedicated to ... Technologies for Social Inclusion and Public Policies in Latin America ... Region: Argentina, South America, Brazil, Chile, Peru, Uruguay, North and Central America.
Program: Agriculture and Food Security. Total Funding: ... Technologies for Social Inclusion and Public Policies in Latin America. Project ... Region: Argentina, South America, Brazil, Chile, Peru, Uruguay, North and Central America. Program: ...
Apr 27, 2016 ... ... job (most of them are self-employed or work in small enterprises). ... Image. Peru Photo. There is an urgent need for solid research and policy ... on Labour Ministry's website (in Spanish); Media articles (in Spanish).
Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies Cartografía de la transición nutricional en el Perú: datos que avalan la necesidad de políticas nutricionales descentralizadas
M. Pia Chaparro
Full Text Available The study objectives were to map the different stages of the nutrition transition for each department within Peru, and to determine the nutrition policy needs for each geographic area based on their current stage in the nutrition transition. Results show that most of the country is suffering from a double-burden of malnutrition, with high rates of stunting among children less than 5 years of age and high rates of overweight and obesity among women of reproductive age. Currently, Peru has only country-wide nutrition policies, administered by the Ministry of Health, that are primarily focused on stunting prevention. This study argues for the need to have decentralized nutrition policies that vary according to what type of malnutrition is being experienced in each geographic area.Los objetivos de este estudio consistían en trazar un mapa por departamentos y etapas de la transición nutricional en el Perú y determinar las políticas nutricionales necesarias en las distintas zonas geográficas en función de sus etapas en la transición. Los resultados demuestran que la mayor parte del país está sufriendo la llamada "doble carga de la malnutrición", en la que coexisten tasas elevadas de desnutrición crónica entre los menores de 5 años y tasas elevadas de sobrepeso y obesidad en las mujeres en edad fecunda. En el Perú actual, las políticas nutricionales, gestionadas por el Ministerio de Salud, están centralizadas y su prioridad es prevenir la detención del crecimiento. Este estudio aboga por la necesidad de contar con políticas nutricionales descentralizadas que varíen en función del tipo de malnutrición que se esté padeciendo en cada zona geográfica.
Nanyunja, Miriam; Nabyonga Orem, Juliet; Kato, Frederick; Kaggwa, Mugagga; Katureebe, Charles; Saweka, Joaquim
Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ) was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.
Full Text Available Malaria due to P. falciparum is the number one cause of morbidity and mortality in Uganda where it is highly endemic in 95% of the country. The use of efficacious and effective antimalarial medicines is one of the key strategies for malaria control. Until 2000, Chloroquine (CQ was the first-line drug for treatment of uncomplicated malaria in Uganda. Due to progressive resistance to CQ and to a combination of CQ with Sulfadoxine-Pyrimethamine, Uganda in 2004 adopted the use of ACTs as first-line drug for treating uncomplicated malaria. A review of the drug policy change process and postimplementation reports highlight the importance of managing the policy change process, generating evidence for policy decisions and availability of adequate and predictable funding for effective policy roll-out. These and other lessons learnt can be used to guide countries that are considering anti-malarial drug change in future.
Lerner, Alana G.; Bernabe-Ortiz, Antonio; Gilman, Robert H.; Smeeth, Liam; Miranda, J. Jaime
Objective To determine the awareness, treatment, and control of hypertension and diabetes by migration status. Design Cross-sectional study, secondary analyses of the PERU MIGRANT study. Patients Rural, rural-to-urban migrants, and urban participants. Main outcome measures Awareness, treatment and control of hypertension and diabetes mellitus were calculated using weights to account for participant’s group size. Results Of the 205/987 (weighted prevalence 24.1%, 95%CI: 21.1%–27.1%) participants identified as hypertensive 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33/987 (weighted prevalence 4.6%, 95%CI: 3.1%–6%) and diabetes awareness, treatment and control were 71.1%, 40.6%, and 7.7%, respectively. Sub-optimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared to rural participants. However, treatment rates were much lower among migrants compared to the urban group. Conclusions These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas. PMID:23680809
Designed for horticulture, horticulture therapy, and botany students at Edmonds Community College (Washington), this 6-hour module explores the pre-Columbian use of plant materials in Peru and its relationships to cultural practices in modern Peru. The first sections provide basic information about the module, such as its objectives, the concepts…
Lerner, R; Ferrando, D
In Peru, the prevalence and consequences of inhalant abuse appear to be low in the general population and high among marginalized children. Inhalant use ranks third in lifetime prevalence after alcohol and tobacco. Most of the use appears to be infrequent. Among marginalized children, that is, children working in the streets but living at home or children living in the street, the problem of inhalant abuse is a serious problem. Among children working in the streets but living at home, the lifetime prevalence rate for inhalant abuse is high, ranging from 15 to 45 percent depending on the study being cited. For children living in the streets, the use of inhalant is even more severe. As mentioned earlier in this chapter, most of these street children use inhalants on a daily basis. The lack of research on the problem of inhalant abuse is a serious impediment to development of intervention programs and strategies to address this problem in Peru. Epidemiologic and ethnographic research on the nature and extent of inhalant abuse are obvious prerequisites to targeted treatment and preventive intervention programs. The urgent need for current and valid data is underscored by the unique vulnerability of the youthful population at risk and the undisputed harm that results from chronic abuse of inhalants. Nonetheless, it is important to mention several programs that work with street children. Some, such as the Information and Education Center for the Prevention of Drug Abuse, Generation, and Centro Integracion de Menores en Abandono have shelters where street children are offered transition to a less marginal lifestyle. Teams of street educators provide the children with practical solutions and gain their confidence, as well as offer them alternative socialization experiences to help them survive the streets and avoid the often repressive and counterproductive environments typical of many institutions. Most of the children who go through these programs tend to abandon
Mukherjee, J S; Joseph, J K; Rich, M L; Shin, S S; Furin, J J; Seung, K J; Sloutsky, A; Socci, A R; Vanderwarker, C; Vasquez, L; Palacios, E; Guerra, D; Viru, F A; Farmer, P; Del Castillo, H E
Since 2000, the directly observed treatment, short-course (DOTS) strategy has been expanded in several countries to include treatment of multidrug-resistant tuberculosis (MDR-TB). This strategy is known as DOTS-Plus. Tuberculosis is a common cause of morbidity and mortality for children throughout the developing world. Children may also be infected with MDR-TB, yet most developing countries do not specifically address pediatric MDR-TB. To present the intermediate outcomes of the first 16 children enrolled in the Peruvian DOTS-Plus program and to demonstrate the tolerability of second-line anti-tuberculosis drugs. Three children completed therapy and are cured, one child had bacteriologic and clinical failure after 12 months of therapy and died of respiratory insufficiency, and 12 have intermediate outcomes demonstrating favorable clinical, bacteriologic, and radiographic evidence of improvement after 9-19 months of therapy. Of the 16 pediatric DOTS-Plus patients, 15 have tolerated therapy well and have had favorable clinical evolution. However, the diagnosis of pediatric MDR-TB is often extremely delayed due to reliance on the adult case definition and should be changed to prevent progressive, chronic illness in such children. Programmatic changes could facilitate earlier diagnosis and treatment of pediatric MDR-TB in Peru and in other DOTS-Plus programs.
... Trade Promotion Agreement AGENCIES: U.S. Customs and Border Protection, Department of Homeland Security... tariff treatment and other customs-related provisions of the United States-Peru Trade Promotion Agreement... other customs-related provisions of the United States-Peru Trade Promotion Agreement (PTPA). Please...
, California, is the U.S. Science team leader; Bjorn Eng of JPL is the project manager. The Terra mission is part of NASA's Earth Science Enterprise, a long- term research effort to understand and protect our home planet. Through the study of Earth, NASA will help to provide sound science to policy and economic decision-makers so as to better life here, while developing the technologies needed to explore the universe and search for life beyond our home planet. Size: 31.8 x 31.8 km (19.7 x 19.7 miles) Location: 9.5 deg. South lat., 77.5 deg. West long. Orientation: North at top Image Data: ASTER bands 1,2, and 3. Original Data Resolution: 15 m Date Acquired: November 5, 2001
Cornejo-Olivas, Mario; Espinoza-Huertas, Keren; Velit-Salazar, Mario R; Veliz-Otani, Diego; Tirado-Hurtado, Indira; Inca-Martinez, Miguel; Silva-Paredes, Gustavo; Milla-Neyra, Karina; Marca, Victoria; Ortega, Olimpio; Mazzetti, Pilar
Neurogenetics, the science that studies the genetic basis of the development and function of the nervous system, is a discipline of recent development in Peru, an emerging Latin American country. Herein, we review the clinical, scientific and ethical aspects regarding the development of this discipline, starting with the first molecular diagnosis of neurogenetic diseases, to family and population-based genetic association studies. Neurogenetics in Peru aims to better explain the epidemiology of monogenic and complex neurodegenerative disorders that will help in implementing public health policies for these disorders. The characterization of Peru and its health system, legal issues regarding rare diseases and the historical milestones in neurogenetics are also discussed.
Komabayashi, Takashi; Sato, Manuel; Rodiguez, Lyly; Sato, Doris; Bird, William F
This paper provides information about Peru's dental history and dental school system, including the curriculum and dental licensure. With the increase in the number of dental schools in Peru, the number of dentists is also increasing. Until 1965, Peru had only three dental schools; currently, there are 14. Four of these dental schools are public, and ten are private. A five- or six-year dental program leads to the B.D.S. degree. After successful completion of a thesis defense or competency examination, the D.D.S. degree is awarded. The D.D.S. is mandatory for practicing dentistry in Peru. Currently, there are approximately 14,000 active dentists, with a dentist-patient ratio of approximately 1:2,000.
Barrientos Hernandez, Dora H; Church, Adam L
Two major domestic terrorist groups have plagued Peru over the past 20 years, the Sendero Luminoso or "Shining Path" (SL) and the Revolutionary Movement Túpac Amaru (MRTA). On 28 August 2003, the Peruvian Truth and Reconciliation Commission reported that an estimated 69,280 persons were killed in the internal conflict in Peru from 1980 to 2000. Most of the victims were farmers (56%), most attacks occurred in rural settings (79%), and the SL was responsible for most of the deaths (54%). Aggressive anti-terrorism efforts by police and military during this period, often at the expense of basic human rights, also contributed to this large burden of terrorism on Peru. During the 1990s, terrorist attacks in Peru had spread to its urban areas. On 17 December 1996, 22 members of MRTA took over the Japanese ambassador's residence in Lima, holding 72 hostages until the grounds were stormed by Peruvian special forces on 23 April 1997. Until recently, emergency planning and preparedness for terrorism-related events in Peru were largely underdeveloped. In the last five years, Peru has taken two key steps towards developing a mature emergency response system, with the establishment of the country's first emergency medicine residency training program and the construction of the first dedicated trauma center in Lima.
Rosas-Aguirre, Angel; Gamboa, Dionicia; Manrique, Paulo; Conn, Jan E; Moreno, Marta; Lescano, Andres G; Sanchez, Juan F; Rodriguez, Hugo; Silva, Hermann; Llanos-Cuentas, Alejandro; Vinetz, Joseph M
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s-2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005-2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine-primaquine for P. vivax Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination. © The American Society of Tropical Medicine and Hygiene.
Rosas-Aguirre, Angel; Gamboa, Dionicia; Manrique, Paulo; Conn, Jan E.; Moreno, Marta; Lescano, Andres G.; Sanchez, Juan F.; Rodriguez, Hugo; Silva, Hermann; Llanos-Cuentas, Alejandro; Vinetz, Joseph M.
Malaria in Peru, dominated by Plasmodium vivax, remains a public health problem. The 1990s saw newly epidemic malaria emerge, primarily in the Loreto Department in the Amazon region, including areas near to Iquitos, the capital city, but sporadic malaria transmission also occurred in the 1990s–2000s in both north-coastal Peru and the gold mining regions of southeastern Peru. Although a Global Fund-supported intervention (PAMAFRO, 2005–2010) was temporally associated with a decrease of malaria transmission, from 2012 to the present, both P. vivax and Plasmodium falciparum malaria cases have rapidly increased. The Peruvian Ministry of Health continues to provide artemesinin-based combination therapy for microscopy-confirmed cases of P. falciparum and chloroquine–primaquine for P. vivax. Malaria transmission continues in remote areas nonetheless, where the mobility of humans and parasites facilitates continued reintroduction outside of ongoing surveillance activities, which is critical to address for future malaria control and elimination efforts. Ongoing P. vivax research gaps in Peru include the following: identification of asymptomatic parasitemics, quantification of the contribution of patent and subpatent parasitemics to mosquito transmission, diagnosis of nonparasitemic hypnozoite carriers, and implementation of surveillance for potential emergence of chloroquine- and 8-aminoquinoline-resistant P. vivax. Clinical trials of tafenoquine in Peru have been promising, and glucose-6-phosphate dehydrogenase deficiency in the region has not been observed to be a limitation to its use. Larger-scale challenges for P. vivax (and malaria in general) in Peru include logistical difficulties in accessing remote riverine populations, consequences of government policy and poverty trends, and obtaining international funding for malaria control and elimination. PMID:27799639
do Lago, Regina Ferro; Costa, Nilson do Rosário
This paper addresses institutional constraints that have affected Brazilian politics regarding provision of anti-retroviral treatment (ART) to HIV/Aids patients. We analyzed the normative conflict resulting from international agreements on intellectual property rights, especially patent protection, and the constitutional rights of Brazilian patients to universal and free access to ART. These constraints have not substantially changed the Brazilian public policy yet, but they may impact the future sustainability of this policy. As the main barrier to the production of patented drugs is not technological but institutional, Brazilian government faces a dilemma. It may either abide by existing monopolistic restrictions or it may incite competitiveness of domestic industries and developing countries in the pharmaceutical market.
Rosa, Ghislaine; Huaylinos, Maria L.; Gil, Ana; Lanata, Claudio; Clasen, Thomas
Background Household water treatment (HWT) can improve drinking water quality and prevent disease if used correctly and consistently by vulnerable populations. Over 1.1 billion people report treating their water prior to drinking it. These estimates, however, are based on responses to household surveys that may exaggerate the consistency and microbiological performance of the practice—key factors for reducing pathogen exposure and achieving health benefits. The objective of this study was to examine how HWT practices are actually performed by households identified as HWT users, according to international monitoring standards. Methods and Findings We conducted a 6-month case study in urban (n = 117 households) and rural (n = 115 households) Peru, a country in which 82.8% of households report treating their water at home. We used direct observation, in-depth interviews, surveys, spot-checks, and water sampling to assess water treatment practices among households that claimed to treat their drinking water at home. While consistency of reported practices was high in both urban (94.8%) and rural (85.3%) settings, availability of treated water (based on self-report) at time of collection was low, with 67.1% and 23.0% of urban and rural households having treated water at all three sampling visits. Self-reported consumption of untreated water in the home among adults and children water of self-reported users was significantly better than source water in the urban setting and negligible but significantly better in the rural setting. However, only 46.3% and 31.6% of households had drinking water water quality. The lack of consistency and sub-optimal microbiological effectiveness also raises questions about the potential of HWT to prevent waterborne diseases. PMID:25522371
Garcia Schreck, M.
This report focuses on the current petroleum investment conditions in Peru, and Peru's hydrocarbon potential. Investment conditions are examined, and political risk, internal security, the economic environment, and the legal framework for investment are considered. (UK)
Reisner, Sari L; Perez-Brumer, Amaya G; McLean, Sarah A; Lama, Javier R; Silva-Santisteban, Alfonso; Huerta, Leyla; Sanchez, Jorge; Clark, Jesse L; Mimiaga, Matthew J; Mayer, Kenneth H
Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care (i.e., hormone therapy) in Lima, Peru. Perceived acceptability of the integrated care model was high among TW and healthcare professionals alike. Barriers included stigma, lack of provider training or Peruvian guidelines regarding optimal TW care, and service delivery obstacles (e.g., legal documents, spatial placement of clinics, hours of operation). The hiring of TW staff was identified as a key facilitator for engagement in health care. Working in partnership with local TW and healthcare provider organizations is critical to overcoming existing barriers to successful implementation of an integrated HIV services and gender-affirmative medical care model for this key population in Peru.
Paxson, Christina; Schady, Norbert
The effect of macroeconomic crises on child health is a topic of great policy importance. This article analyzes the impact of a profound crisis in Peru on infant mortality. It finds an increase of about 2.5 percentage points in the infant mortality rate for children born during the crisis of the late 1980s, which implies that about 17,000 more children died than would have in the absence o...
Zavala-Loayza, J Alfredo; Benziger, Catherine Pastorius; Cárdenas, María Kathia; Carrillo-Larco, Rodrigo M; Bernabé-Ortiz, Antonio; Gilman, Robert H; Checkley, William; Miranda, J Jaime
Over one-quarter of the world's adult population has hypertension, yet achieving adequate treatment or control targets remains a challenge. This study sought to identify, longitudinally, characteristics associated with antihypertensive treatment and blood pressure (BP) control among individuals with hypertension. Data from individuals enrolled in the population-based CRONICAS Cohort Study (adults ≥35 years, living in 4 different rural/urban and coastal/high-altitude Peruvian settings) with hypertension at baseline were used. Antihypertensive treatment and BP control were assessed at baseline and at 15 months. Multinomial logistic regressions were used to estimate relative risk ratios (RRR) and 95% confidence intervals (95% CI) of factors associated with antihypertensive treatment and BP control at follow-up. At baseline, among 717 individuals with hypertension (53% women, mean age 61.5 ± 12.4 years), 28% were unaware of their hypertension status, 30% were aware but untreated, 16% were treated but uncontrolled, and 26% were treated and controlled. At follow-up, 89% of unaware and 82% of untreated individuals persisted untreated, and only 58% of controlled individuals remained controlled. Positive predictors of receiving treatment and being controlled at follow-up included age (RRR: 0.81; 95% CI: 0.73 to 0.91 for every 5 years) and family history of a chronic disease (RRR: 0.53; 95% CI: 0.31 to 0.92 vs. no history); whereas Puno rural site (RRR: 16.51; 95% CI: 1.90 to 143.56 vs. Lima) and male sex (RRR: 2.59; 95% CI: 1.54 to 4.36) were risk factors. Systolic BP at baseline (RRR: 1.27; 95% CI: 1.16 to 1.39 for every 5 mm Hg) and male sex (RRR: 1.75, 95% CI: 1.02 to 2.98) were risk factors for being treated but uncontrolled at follow-up. Large gaps in treatment of hypertension were observed. Targeting specific populations such as men, younger individuals, or those without family history of disease may increase coverage of antihypertensive treatment. Also, targeting
This book deals with the Nuclear Energy in Peru. It consists of ten chapters. In the first chapter is presented a rapid overview on nuclear science history. The second chapter describes the nuclear proliferation and the nuclear competition in South America. The nuclear organization in Peru, the Peruvian Institute of Nuclear Energy, and the main centers are described in the third chapter. The following chapters deals with peruvian advances in nuclear medicine, agriculture and food, nuclear application to industry, hydrology, earth sciences and environmental considerations. In the last chapter, the perspectives for nuclear science and technology in Peru are described from the inter institutional cooperation point of view. This book also includes appendix and bibliography. (author)
Why is the urban-rural gap in child malnutrition increasing in Peru despite government efforts to improve the provision of public services? To answer this question, the impact of regional public expenditure in Peru on young children's nutritional outcomes is examined. To account for policy endogeneity, public expenditures are instrumented using unanticipated regional mining revenues. Even ...
Coronel-Molina, Serafin M.
Examines the status of Quechua in Peru and how it has affected language maintenance efforts; discusses the functional domains served by Quechua, relating them to Peruvian language policies; notes the lack of grassroots efforts by indigenous people in Peru; and suggests possible measures to improve its status, noting predictions of the future of…
out, is it acceptable to require patients who have been successfully treated with heroin in Canada, to be forced to move back to less effective treatments (treatments that failed to be efficacious in the past? This essay discusses this dilemma and places it in the broader context of ethics, science, and health policy. It makes the case for continuation of the current successful patients in heroin treatment and the institution of heroin treatment to all Canadian patients living with active addictions who qualify.
Campbell, Leon G.
Presents a bibliographic review essay on the topic of colonial Peru organized according to the following topics: Pre-Columbian Peru, 5500 B.C.- 1532; the conquest of Peru, 1532-1572; Peru under the Hapsburgs, 1516-1700; Bourbon Peru, 1700-1808; and the coming of independence, 1808-1821. The essay is based on a bibliography composed largely of…
financial services for the poor. For more information visit the. Regional Office for Latin America and the Caribbean (LAC) website: www.idrc.ca/lacro. Subscribe to the IDRC Bulletin and our regional bulletin: www.idrc.ca/idrcbulletin. PERU. ○. BRAZIL. COLOMBIA. ECUADOR. BOLIVIA. Pacific Ocean. 150 km. Lima. Callao.
British Council, London (England). English Language and Literature Div.
The role and status of English in Peru are examined, with attention directed to: (1) English within the education system; (2) teachers of English; (3) educational administration of English teaching, (4) materials support, development, and planning, (5) English outside the education system; (6) British and American support for the teaching of…
This inquiry deals with religion and politics in Peru from the beginning of agrarisation, c. 8000 B.C. up until AD 1991. Of central importance for the analysis are state formation and development, the relations between church and state, the internal and external relations within and among the
Funding: $3,412,926. Donor: Canadian International Food Secu- rity Research Fund (IDRC and the Canadian. International Development Agency). Duration: 2011–2014. Grantees: Universidad Nacional Agraria La. Molina and Sociedad Peruana de Derecho. Ambiental, Peru and University of British. Columbia, Canada.
Angela Huanca Barrantes, a highly respected teacher of English as a foreign language (EFL) in the city of Ilo, has a strong impact on the lives of students at the Admirante Miguel Grau secondary school and at Centro Cultural Peruano Norteamericano, which is one of four binational centers in southern Peru. Due to Ms. Huanca's lack of understanding…
The report provides an assessment of accounting, financial reporting, and auditing practices within the corporate sector in Peru, using International Financial Reporting Standards (IFRS), and International Standards on Auditing (ISA) as benchmarks, drawing on international experience and best practices in that field. This Report on the Observance of Standards and Codes (ROSC) Accounting & ...
Lima's population grew from 1 million to 7 million during 1969-89, almost entirely due to rural-urban immigration. Other urban areas such as Iquitos experienced similar growth over the period. National, regional, and municipal governments have been working to restore civil order in the country and to bring basic health, sanitation, and education programs to the population. However, language, attitudinal, and cultural differences impede progress in this diverse and changing country. Peru's young population of median age 21 years presents a challenge to the development and implementation of effective reproductive health care programs for the country. Pathfinder's work in Peru is helped by current President Alberto Fujimori's strong and active support for family planning. In the face of strong opposition from the Roman Catholic Church, President Fujimori has held onto his conviction and commitment to reduce levels of maternal morbidity and mortality in Peru by increasing the accessibility of family planning programs. Pathfinder's work in Peru with the US Agency for International Development (USAID) includes the 5-year program Project 2000 designed to improve maternal and child health in 12 priority regions of the country. Pathfinder is also working with USAID to link family planning to postpartum services in 30 public hospitals throughout the country. New programs will be launched with contributions from individuals and foundations.
In 1975, a group of professionals in Peru who were experts on national health systems began a process that led the country to be the first in South America to initiate a modern organization of the health system. This pioneering development meant that the creation of the National Health Services System [in Peru] in 1978 occurred before the health system reforms in Chile (1980), Brazil (1990), Colombia (1993), and Ecuador (2008). This encouraging start has had permanent reformist fluctuations since then, with negative development because of the lack of a State policy. Current features of the Peruvian system are inefficient performance, discontinuity, and lack of assessment, which creates a major setback in comparison with other health systems in America. In the 21st century, significant technical efforts have been missed to modernize the system and its functions. The future is worrying and the role of new generations will be decisive.
Olivia Hernández Pozas, Ph.D
Full Text Available Organizations need well trained employees in order to maintain a competitive advantage. The purpose of this paper is to describe current training practices in Peru and to provide recommendations for improving organizational performance. This paper also aims to set priorities for future research work. Human capital theory and contributions on need assessment, and training planning, implementation and evaluation served as theoretical framework. This is a cross-sectional, exploratory study that used information from surveys conducted in 24 Peru-vian companies. The findings reveal a strong interest in training, particularly with regard to the improvement of competencies, preference for face-to-face training, and the use of reaction evaluation methods. The recommendations include, among others, improving the provisions for internal support, policies, technology, behavioral evaluation, and resources.
Caballero N Patricia
Full Text Available Abstract Background Peru has a concentrated HIV epidemic with an estimated 76,000 people living with HIV (PLHIV. Access to highly active antiretroviral therapy (HAART expanded between 2004-2006 and the Peruvian National Institute of Health was named by the Ministry of Health as the institution responsible for carrying out testing to monitor the effectiveness of HAART. However, a national public health laboratory information system did not exist. We describe the design and implementation of an e-health driven, web-based laboratory information system - NETLAB - to communicate laboratory results for monitoring HAART to laboratory personnel, health providers and PLHIV. Methods We carried out a needs assessment of the existing public health laboratory system, which included the generation and subsequent review of flowcharts of laboratory testing processes to generate better, more efficient streamlined processes, improving them and eliminating duplications. Next, we designed NETLAB as a modular system, integrating key security functions. The system was implemented and evaluated. Results The three main components of the NETLAB system, registration, reporting and education, began operating in early 2007. The number of PLHIV with recorded CD4 counts and viral loads increased by 1.5 times, to reach 18,907. Publication of test results with NETLAB took an average of 1 day, compared to a pre-NETLAB average of 60 days. NETLAB reached 2,037 users, including 944 PLHIV and 1,093 health providers, during its first year and a half. The percentage of overall PLHIV and health providers who were aware of NETLAB and had a NETLAB password has also increased substantially. Conclusion NETLAB is an effective laboratory management tool since it is directly integrated into the national laboratory system and streamlined existing processes at the local, regional and national levels. The system also represents the best possible source of timely laboratory information for
Schenk C.; Staib E.
We are in the second year of fieldwork surveying for Giant Otters in the southeastern rainforest of Peru, in three areas with differing levels of legal protection. While there is some illegal hunting still happening outside the protected areas, the main threat to the otters is badly-conducted tourism. Well-organised tourism can be a promising argument for establishing protected areas like national parks.
Malnutrition stunts physical growth and/or limits mental development in one child out of three in developing countries and is a factor in one-third of the 13 million child deaths which occur annually in developing countries. The Department of Technical Co-operation is sponsoring a programme, with technical support from the Human Health Division, to evaluate the effectiveness of a Government food supplement intervention to combat malnutrition in Peru. (IAEA)
In Lima, Peru, solid waste management is an informal activity involving poor communities working under difficult conditions. ... Special journal issue highlights IDRC-supported findings on women's paid work. Policy in Focus publishes a special issue profiling evidence to empower women in the labour market.
Region: Argentina, South America, Mexico, North and Central America, Peru ... to be a significant obstacle to equitable, human development in Latin America. ... SMALL ENTERPRISES, MEDIUM ENTERPRISES, EMPLOYMENT POLICY, ... and institutions that allow them to adapt and evolve in their natural environment.
27 avr. 2016 ... There is an urgent need for solid research and policy guidance to tackle youth employment challenges in Latin America. In the region almost 9 million youth are unemployed. Regionally, for every three young workers, two are employed in precarious jobs. Peru surpasses the regional average: almost 4 out ...
Nemeth, Edward J.
An overview of the basic system of education in Peru is presented. Despite various achievements in education, Peruvian authorities in recent years generally have not considered educational progress sufficient to meet the social and economic needs of their society. As a result, two educational structures are presently operating in Peru. The…
Heyman, Cory; Brush, Lorie; Provasnik, Stephen; Fanning, Marina; Lent, Drew; De Wilde, Johan
Access to quality education is a problem for all rural children in Peru, but especially for rural girls, who complete primary school at far lower rates than other Peruvian children. In 1998, USAID launched the Girls' Education Activity (GEA) in Peru, also known as New Horizons for Girls' Education, which aims to increase girls' completion of…
Norrbom, Allen L; Rodriguez, Erick J; Steck, Gary J; Sutton, Bruce A; Nolazco, Norma
Twenty-eight new species of Anastrepha are described and illustrated: A. acca (Bolivia, Peru), A. adami (Peru), A. amplidentata (Bolivia, Peru), A. annonae (Peru), A. breviapex (Peru), A. caballeroi (Peru), A. camba (Bolivia, Peru), A. cicra (Bolivia, Peru), A. disjuncta (Peru), A. durantae (Peru), A. echaratiensis (Peru), A. eminens (Peru), A. ericki (Peru), A. gonzalezi (Bolivia, Peru), A. guevarai (Peru), A. gusi (Peru), A. kimi (Colombia, Peru), A. korytkowskii (Bolivia, Peru), A. latilanceola (Bolivia, Peru), A. melanoptera (Peru), A. mollyae (Bolivia, Peru), A. perezi (Peru), A. psidivora (Peru), A. robynae (Peru), A. rondoniensis (Brazil, Peru), A. tunariensis (Bolivia, Peru), A. villosa (Bolivia), and A. zacharyi (Peru). The following host plant records are reported: A. amplidentata from Spondias mombin L. (Anacardiaceae); A. caballeroi from Quararibea malacocalyx A. Robyns & S. Nilsson (Malvaceae); A. annonae from Annona mucosa Jacq. and Annona sp. (Annonaceae); A. durantae from Duranta peruviana Moldenke (Verbenaceae); and A. psidivora from Psidium guajava L. (Myrtaceae).
Dec 27, 2008 ... advantages and disadvantages associated with screening and referral. Policy Option 3: ... Skill-building approaches such as training with healthcare workers or .... Science and Technology, Grand Challenges Canada and.
Ferrando, D; Aramburu, C E
Data from national censuses and sample surveys are the basis for this examintion of differential fertility and the fertility transition in Peru. Changes in the level and structure of fertility in the 3 major geographic regions are compared, and the role of contraceptive usage and nuptiality changes in the fertility decline are analyzed. Peru's total fertility rate was estimated at 6.85 in 1965 and has since declined to 6.56 in 1965-70, 6.00 in 1970-75, 5.30 in 1975-80, 4.65 in 1980-85, and 4.00 in 1985-90. The fertility decline varied in intensity and timing in the geographic regions. A clear fertility decline began among upper and middle income groups in the principal cities in the 1960s, spreading gradually to the urban low income sectors. Not until the late 1970s did the fertility decline spread to the rest of the population, coinciding with the years of severe economic crisis. The urban total fertility rate declined from 6 to 3.77 during 1961-86, but rural fertility increased through 1972 to 8.12, before declining slightly to 7.62 in 1981 and more markedly to 6.65 in 1986. Sociocultural and economic differences between Peru's natural regions are appreciable, and account for the contrasts in fertility trends. The greatest changes occurred in metropolitan Lima, which already had relatively low fertility in 1961. Its total fertility rate declined 44% from 5.6 in 1961 to 3.13 in 1986. Fertility declined by slightly under 40% in the rest of the coast, by almost 25% in the jungle, and by scarcely 14% in the sierra. The total fertility rates in 1961 and 1986, respectively, were 6.38 and 4.13 on the coast, 6.64 and 6.45 in the highlands, and 7.92 and 5.97 in the lowlands. The fertility decline, especially in the lower classes, was a response initially to the process of cultural modernization which in slightly over 2 decades saw a profound transformation of Peru from a rural, Andean, illiterate, and agrarian society to an urban, coastal, literate, and commercial society
The past, present, and future of Peru is discussed in terms of solar energy development and the social, economic, climatic, and technical factors involved. It is pointed out that there are 3 geographical divisions in Peru including: (1) the foggy coastal strip where rain is infrequent, insolation is low and population is high; (2) the mountainous Andes region with high insolation and many populated high mountain valleys; and (3) the rainy, Amazon basin covered with jungle, and sparcely populated with high but inconsistent insolation. Since there is little competition with other forms of energy, solar energy shows promise. Passive solar heating of buildings, particularly in the Andes region, is described, as well as the use of solar water heaters. Prototypes are described and illustrated. Industrial use of solar heated water in the wool industry as well as solar food drying and solar desalination are discussed. High temperature applications (electrical generators and refrigeration) as well as photovoltaic systems are discussed briefly. It is concluded that social and political factors are holding back the development of solar energy but a start (in the form of prototypes and demonstration programs) is being made. (MJJ)
Twenty-eight new species of Anastrepha are described and illustrated: A. acca (Bolivia, Peru), A. adami (Peru), A. amplidentata (Bolivia, Peru), A. annonae (Peru), A. breviapex (Peru), A. caballeroi (Peru), A. camba (Bolivia, Peru), A. cicra (Bolivia, Peru), A. disjuncta (Peru), A. durantae (Peru), ...
Andersen, Mikael Skou; Smith, Carey; Kristensen, Peter
, and two have only recently acceded to the EU and are therefore allowed more time to accomplish the environmental acquis. The report seeks to clarify the role of local authorities, policy instruments and financial mechanisms in securing effective implementation, and it also addresses the issue of cost...
Petroleos del Peru predicts a 10% increase in Peru's oil production this year and a further increase in 1994. Petroperu also forecasts a sharp increase in drilling in Peru this year. After several years of declining oil production, a gradual turnaround in the cash strapped country's petroleum industry is largely tied to its progress in privatization. The government last year began a campaign to privatize all state owned companies by the end of July 1995. The paper discusses forecasts by Petroperu; the contract of Occidental del Amazonas Inc.; the Petromar privatization; Great Western's contract; development of the Aguaytia gas field; and refinery contracts
Keywords: policy, treatment, insulting lexical items, sensitive lexical items, dictionary, woordeboek van die afrikaanse taal, simplexes, compounds, expressions, general usage criterion, labelling, synonyms, metalanguage, collocations, editorial usage examples, citations, advisors, racist lexical items, neutral lemmas, ...
National Oceanic and Atmospheric Administration, Department of Commerce — In 1970, an earthquake-induced rock and snow avalanche on Mt. Huascaran, Peru, buried the towns of Yungay and Ranrahirca. The magnitude 7.8 earthquake killed 66,794...
Aquino-Vivanco, Óscar; Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud. Lima, Perú. Nutricionista.; Aramburu, Adolfo; Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud. Lima, Perú. Nutricionista.; Munares-García, Óscar; Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud. Lima, Perú. obstetra, magíster en Salud Pública.; Gómez-Guizado, Guillermo; Centro Nacional de Alimentación y Nutrición, Instituto Nacional de Salud. Lima, Perú. médico cirujano. especialista en epidemiología de campo.; García-Torres, Elizabeth; Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de Salud. Lima, Perú. médico cirujano. especialista en Gestión de Salud.; Donaires-Toscano, Fernando; Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de Salud. Lima, Perú. médico infectólogo.; Fiestas, Fabián; Unidad de Análisis y Generación de Evidencias en Salud Pública, Instituto Nacional de Salud. Lima, Perú. médico epidemiólogo.
Overweight and obesity in children and adolescents represent a serious public health problem in Peru, with high costs for society that require the implementation of a set of public policies directed toward its control. Thus, interventions have been proposed as the regulation of advertising of unhealthy foods, self-regulation, the implementation of kiosks healthy and nutritional labeling. From the analysis of the problem of overweight and obesity in children and adolescents in Peru, this a...
Aquino-Vivanco, Óscar; Aramburu, Adolfo; Munares-García, Óscar; Gómez-Guizado, Guillermo; García-Torres, Elizabeth; Donaires-Toscano, Fernando; Fiestas, Fabián
Overweight and obesity in children and adolescents represent a serious public health problem in Peru, with high costs for society that require the implementation of a set of public policies directed toward its control. Thus, interventions have been proposed as the regulation of advertising of unhealthy foods, self-regulation, the implementation of kiosks healthy and nutritional labeling. From the analysis of the problem of overweight and obesity in children and adolescents in Peru, this article is a narrative review of such interventions.
Valerie A Paz-Soldan
Full Text Available Abstract: Tuberculosis (TB remains a significant public health challenge worldwide, and particularly in Peru with one of the highest incidence rates in Latin America. TB patient behavior has a direct influence on whether a patient will receive timely diagnosis and successful treatment of their illness. Objectives: The objective was to understand the complex factors that can impact TB patient health seeking behavior. Methods: In-depth interviews were conducted with adult and parents of pediatric patients receiving TB treatment (n=43, within that group a sub-group was also co-infected with HIV (n=11. Results: Almost all of the study participants recognized delays in seeking either their child’s or their own diagnosis of their TB symptoms. The principal reasons for treatment-seeking delays were lack of knowledge and confusion of tuberculosis symptoms, fear and embarrassment of receiving a TB diagnosis, and a patient tendency to self-medicate prior to seeking formal medical attention.Conclusions: Health promotion activities that target patient delays have the potential to improve individual patient outcomes and mitigate the spread of TB at a community level.
Salazar, Ximena; Núnez-Curto, Arón; Villayzán, Jana; Castillo, Regina; Benites, Carlos; Caballero, Patricia; Cáceres, Carlos F
As a group, transwomen in Peru have the highest prevalence of HIV (>20%) in the country, but they have little access to HIV prevention, testing and care services. Until recently, Peru's national HIV programme did not recognize transwomen and had remained essentially static for decades. This changed in December 2014, when the Ministry of Health expressed its commitment to improve programming for transwomen and to involve transwomen organizations by prioritizing the development of a "Targeted Strategy Plan of STIs/HIV/AIDS Prevention and Comprehensive Care for Transwomen." A policy dialogue between key stakeholders - Peru's Ministry of Health, academic scientists, civil society, transgender leaders and international agencies - created the conditions for a change in Peru's national HIV policy for transwomen. Supported by the effective engagement of all sectors, the Ministry of Health launched a plan to provide comprehensive HIV prevention and care for transwomen. The five-year plan includes new national guidelines for HIV prevention, care and support, and country-level investments in infrastructure and equipment. In addition to new biomedical strategies, the plan also incorporates several strategies to address structural factors that contribute to the vulnerability of transwomen. We identified three key factors that created the right conditions for this change in Peru's HIV policy. These factors include (1) the availability of solid evidence, based on scientific research; (2) ongoing efforts within the transwomen community to become better advocates of their own rights; and (3) a dialogue involving honest discussions between stakeholders about possibilities of changing the nation's HIV policy. The creation of Peru's national plan for HIV prevention and care for transwomen shows that long-term processes, focused on human rights for transwomen in Peru, can lead to organizational and public-policy change.
Valdiviezo, Laura Alicia
Intercultural education policy and programs in Peru emerged as a response to the right of education for marginalised indigenous populations. Under the influence of international dialogue regarding education for all, Peruvian policy has recently proposed interculturality as a guiding principle of education for all Peruvians. In this context,…
Gomero Gonzáles, Nicko Alberto
It is important that a country develop strong competitive to gaing solid macroeconomic result and keep constant growing. In Peru has been achieving these past years, and that have been showing in the principals indicator of economic management. The public policies implemented have created favorable scenarios to bring in investments in all productive sectors, At the same time the national companies have been develop capabilities to achieve with successes of the market globalization. The divers...
One of three handbooks dealing with pottery traditions from around the world, this packet draws together information about historical, ethnographic, and pottery traditions of Peru. The first of 13 brief subsections focuses on Peru's land and people. A presentation of a potter's history of Peru is followed by a discussion of the Chavin Cult (800…
The Nasca Lines are located in the Pampa region of Peru, the desolate plain of the Peruvian coast 400 km south of Lima. The Lines were first spotted when commercial airlines began flying across the Peruvian desert in the 1920's. Passengers reported seeing 'primitive landing strips' on the ground below. The Lines were made by removing the iron-oxide coated pebbles which cover the surface of the desert. When the gravel is removed, they contrast with the light color underneath. In this way the lines were drawn as furrows of a lighter color. On the pampa, south of the Nasca Lines, archaeologists have now uncovered the lost city of the line-builders, Cahuachi. It was built nearly two thousand years ago and was mysteriously abandoned 500 years later. This ASTER sub-image covers an area of 14 x 18 km, was acquired on December 22, 2000, and is located at 14.7 degrees south latitude and 75.1 degrees west longitude. The U.S. science team is located at NASA's Jet Propulsion Laboratory, Pasadena, Calif. The Terra mission is part of NASA's Science Mission Directorate.
Zuloaga, R L
Bioethics has still not acquired an identity of its own in Peru. The Ethics Committee of the Peruvian Medical School and the National AIDS Commission are review committees that deal with ethical problems arising in practice. Doubts regarding quality control of the drugs being tested have been raised in research on human subjects. Questions related to reproduction are very important. There is a high incidence of adolescent pregnancies, and illegal abortions result in many deaths and hospitalizations of women in serious condition. Birth control methods, such as vasectomy, conflict with attitudes about manhood in Peruvian society. Euthanasia is prohibited by the Ethical Code of the Peruvian Medical School, and legislation penalizes assisted suicide. Organ transplantation is hindered by concerns over early declaration of death. Handicapped children are often rejected by society owing to an absurd belief in the possibility that disorders such as Down's syndrome are contagious. The Ministry of Health requires state hospitals to accept AIDS patients, but instances of rejection are still reported.
Should grammar be taught at all?Is it a hindrance or anaid?Communicative language teaching approach seems to havecast doubts on the value of grammar teaching.The present paperargues that the positive effect of grammar in College Englishteaching and learning should not be overlooked.Grammar servesas a means to the final achievement of language proficiency.Itis time for language teachers to reconsider the role of grammarand to come up with a more appropriate and thus,moreeffective treatment of grammar in College English teaching.
Káren Mendes Jorge de Souza
Full Text Available Objective Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. Method This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. Results On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients’ lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. Conclusion It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.
Souza, Káren Mendes Jorge de; Sá, Lenilde Duarte de; Silva, Laís Mara Caetano da; Palha, Pedro Fredemir
Analyzing the policy transfer of directly observed treatment of tuberculosis from the perspective of nursing. This is a descriptive study with qualitative approach, which had 10 nurses of the Family Health Strategy in São Paulo as subjects. The interviews were carried out between May and June 2013, and were adopted the technique of thematic content analysis and the referential of policy transfer. On the signification of this treatment, are related the senses of disciplinary monitoring, the bond and approximation to the context of patients' lives. Operationally, nurses, community health agents and nursing technicians stand out as agents of implementation of this policy, developing multiple actions of user embracement. The nurse is evidenced as an educator in health, leader in the family health team, and capable of creating emotional bond with users. It was found that the innovations proposed in the treatment are incipient in the daily work of nurses.
Dra. Lyudmyla Yezers´ka
Full Text Available This article analyzes some of the tendencies of the development of the digital media in Peru. The results that are presented were obtained by means of a survey carried out to responsible people of the digital redactions of the national generalist newspapers that, when concluding the first decade of the existence of the online journalism in the country (1995-2005, had digital editions. From historical perspective, different stages of evolution and consolidation of the Peruvian daily editions in the Global Network have not had temporary clear definition. The media progressed at their own pace, depending among other factors –at the time of entry into the network, the staff assigned to the publication, and especially on the strength of the journalistic company and its policy regarding digital editing. With regard to the presence on the Internet, digital newspapers have shown a steady and numerous growth, over the first decade (1995-2005.
R. N. Akalayev
Full Text Available Objective: to evaluate the efficiency of combination use of hyperbaric oxygenation, succinate-containing solutions, and anti-edematous agents in patients with acute carbon monoxide poisoning. Subjects and methods. The results of treatment were analyzed in 32 patients admitted in 2009—2011 for severe acute carbon monoxide poisoning and a Glasgow coma score of 6—8. The patients were divided into 2 groups: 1 patients whose combination therapy involved hyperbaric oxygenation, Succinasol infusions, and L-lysine-aescinate injections; 2 those who received traditional therapy. All the patients underwent complex clinical, laboratory, and neurophysiologic examinations. Results. Just 24 hours after the combination use of Succinasol and L-lysine-aescinate, Group I patients were observed to have substantially reduced lactate, the content of the latter approached the normal value following 48 hours, which was much below the values in the control group. The similar pattern was observed when endogenous intoxication parameters were examined. During the performed therapy, the level of consciousness and that of intellect according to the MMSE and FAB scales were restored more rapidly in the study group patients than in Group 2. Conclusion. The combination use of hyperbaric oxygenation, the succinate-containing solution Succinasol, and the anti-edematous agent L-lysine-aescinate considerably enhances the efficiency of intensive therapy for acute carbon monoxide poisoning. Key words: carbon monoxide, toxic hypoxic encephalopathy, combination therapy, hyperbaric oxygenation, succinic acid, L-lysine-aescinate.
Toro, Leonor; Doran, Sandra
Intended for elementary teachers to use with migrant students, this bilingual English/Spanish social studies resource booklet provides an encyclopedia-style overview of Peru's history, geography, economy, and culture. Topics included are the people, geographic regions, festivals and celebrations, the economy, natural resources, Lake Titicaca,…
Cardenas Acosta, Liliana
San Martin and Cashiriari fields, located to 500 kilometers to the southeast of Lima, conform the Camisea field that possesses the reserves more important of gas in Latin America. Camisea has gas and proven liquids of 13 quintillion cubic feet of natural gas and 600 million liquid barrels respectively. The paper includes projections, markets and benefits for the Peru
Martin, R.; Sitter-Koomans, de C.
In a previous note on “Americanites” (Martin, 1934) from Colombia and Peru, the writer came to the conclusion, on the basis solely of published data, that it was very likely that these so-called tectites are in reality obsidian of terrestrial origin. He stated, however, that “before it is possible
Barry, Colleen L; McGinty, Emma E; Pescosolido, Bernice A; Goldman, Howard H
Public attitudes about drug addiction and mental illness were compared. A Web-based national survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support in regard to drug addiction and mental illness. Respondents held significantly more negative views toward persons with drug addiction. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them. Respondents were more willing to accept discriminatory practices against persons with drug addiction, more skeptical about the effectiveness of treatments, and more likely to oppose policies aimed at helping them. Drug addiction is often treated as a subcategory of mental illness, and insurance plans group them together under the rubric of "behavioral health." Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches to reducing stigma and advancing public policy.
Rasooly, I; Lavery, J V; Urowitz, S; Choudhry, S; Seeman, N; Meslin, E M; Lowy, F H; Singer, P A
OBJECTIVE: To determine the prevalence and content of hospital policies on life-sustaining treatments (cardiopulmonary resuscitation [CPR], mechanical ventilation, dialysis, artificial nutrition and hydration, and antibiotic therapy for life-threatening infections) and advance directives in Canada. DESIGN: Cross-sectional mailed survey. SETTING: Canada. PARTICIPANTS: Chief executive officers or their designates at public general hospitals. MAIN OUTCOME MEASURES: Information regarding the exis...
Werb, Dan; Strathdee, Steffanie A; Meza, Emilo; Rangel Gomez, Maria Gudelia; Palinkas, Lawrence; Medina-Mora, Maria Elena; Beletsky, Leo
Mexico has experienced disproportionate drug-related harms given its role as a production and transit zone for illegal drugs destined primarily for the USA. In response, in 2009, the Mexican federal government passed legislation mandating pre-arrest diversion of drug-dependent individuals towards addiction treatment. However, this federal law was not specific about how the scale-up of the addiction treatment sector was to be operationalised. We therefore conducted in-depth qualitative interviews with key 'interactors' in fields affected by the federal legislation, including participants from the law enforcement, public health, addiction treatment, and governmental administration sectors. Among 19 participants from the municipal, state and federal levels were interviewed and multiple barriers to policy reform were identified. First, there is a lack of institutional expertise to implement the reform. Second, the operationalisation of the reform was not accompanied by a coordinated action plan. Third, the law is an unfunded mandate. Institutional barriers are likely hampering the implementation of Mexico's policy reform. Addressing the concerns expressed by interactors through the scale-up of services, the provision of increased training and education programmes for stakeholders and a coordinated action plan to operationalise the policy reform are likely needed to improve the policy reform process.
This paper reports that foreign oil companies are weathering Peru's political crisis, and the outlook for increased foreign participation in Peru's petroleum sector remains promising. There has been improvement in the political turmoil and soured international relations that followed President Alberto Fujimori's Apr. 5 suspension of Peru's Congress, charging political corruption and attempts to block his fiscal reforms. But there are fresh concerns over an increase in terrorism aimed at oil industry facilities by antigovernment guerrilla groups in Peru. Meanwhile, state-owned oil company Petroleos del Peru (Petroperu) continues efforts to sell assets as part of Fujimori's mandated privatization program. And foreign companies continue to grapple with uncertainty and bureaucratic red tape in chasing investment opportunities in Peru's beleaguered but opening petroleum sector
A comprehensive assessment of the biofuel potential of Peru is presented. Topics discussed cover current biofuel utilization practices; evaluation of Peruvian biomass productivity; identification of Peruvian agricultural and forestry resources; assessment of resource development and management concerns; identification of market considerations; description of biofuel technological options; and regional identification of biofuel technology applications. The discussion of current biofuel utilization centers on a qualitative description of the main conversion approaches now being practiced in Peru. Biomass productivity is evaluated in the context of the terrain, soil, and climatic conditions found in Peru. A quantitative description of the energy potential that could be realized from agricultural and forestry resources of Peru follows. A regional picture is given for the production of agricultural residues and forest resources that could potentially supply energy. The assessment of resource development and management concerns focuses on harvesting, reforestation, training, and the environmental consequences of utilization of forest resources. Market factors assessed include: importation, internal market development, external market development, energy policy and pricing, and transportation. Ten biofuel technology options for Peru were identified: small- to medium-scale gasification, a wood waste inventory, stationary and mobile charcoal production systems, wood distillation, forest resource development and management, electrical cogeneration, anaerobic digestion technology, development of ethanol production capabilities, and agricultural strategies for fuel production.Based upon these biofuel options, nine applications were identified for the Costa Region, eight for the Sierra Region, and ten for the Selva Region.
Belo, Elsia Nascimento; Orellana, Jesem Douglas Yamall; Levino, Antônio; Basta, Paulo Cesar
To describe the epidemiological situation and the incidence of tuberculosis and to investigate the factors associated with treatment default in the Amazonian municipalities located in the northern Brazilian international border. This retrospective study employed sociodemographic, clinical, and epidemiological tuberculosis data recorded in the Brazilian Notifiable Diseases Information System (SINAN) between 2001 and 2010. Logistic regression was used to identify factors associated with treatment default. Tuberculosis affected mostly indigenous peoples (51.9%), males (57.9%), and people aged 25-44 years (31.4%). The predominant clinical presentation was pulmonary (89.7%), yet in 24.5% of the cases the patients did not undergo sputum smear microscopy, and only half received supervised treatment. In 70.0% of the cases notified, patients were discharged as cured. Treatment default was recorded in 10.0% of the patients. Of all deaths, 4.1% were by tuberculosis and other causes, and 1.7% by multidrug-resistant tuberculosis. The average incidence by race/color was greater among indigenous peoples, ranging from 202.3/100 000 in 2001 to 65.6/100 000 in 2010. Treatment default was associated with failure to perform the follow-up smear at the second, fourth, and sixth months (OR = 11.9, 95%CI: 7.4-19.0); with resuming treatment after default (OR = 3.0, 95%CI: 1.5-5.9); and with living in specific subregions, particularly the Alto Solimões region (OR = 6.7, 95%CI: 4.6-9.8). The present results show a high incidence of tuberculosis in the Amazon portion of the northern Brazilian international border, especially among indigenous peoples. Considering the socio-cultural specificities of these populations and the poor tuberculosis control in this area, the authors of the study conclude that the integration of different national health systems is both necessary and urgent.
During the last decade Peru has experienced a euphoric rediscovery –pseudo revaluation as a country– due to its booming gastronomy, tourism and economic growth.In this context, the presentresearch uses semio-psychoanalytic and postcolonial theories to explain Peru’s social outlook regarding the concept of nation, its reunion with a non-existent identity and the construction of the idea of nation based on the marketing campaign titled the Peru Brand. Thus, Peru Brand, far from uniting all Peru...
del Mar, Juan Quintanilla; Sicardy, Bruno; Giraldo, Víctor Ayma; Callo, Víctor Raúl Aguilar
Peru and France are to conclude an agreement to provide Peru with an astronomical observatory equipped with a 60-cm diameter telescope. The principal aims of this project are to establish and develop research and teaching in astronomy. Since 2004, a team of researchers from Paris Observatory has been working with the University of Cusco (UNSAAC) on the educational, technical and financial aspects of implementing this venture. During an international astronomy conference in Cusco in July 2009, the foundation stone of the future Peruvian Observatory was laid at the top of Pachatusan Mountain. UNSAAC, represented by its Rector, together with the town of Oropesa and the Cusco regional authority, undertook to make the sum of 300,000€ available to the project. An agreement between Paris Observatory and UNSAAC now enables Peruvian students to study astronomy through online teaching.
Full Text Available This paper intends to show that the problem is not in the model itself but in the mismanagement of the prescribed policies. Despite their different social and economical structures, Argentina and Peru faced similar problems during the same period (1990-2000: a hyperinflation in the beginning and an institutional crisis at the end. After several years of economic recovery, Argentina faced a big political and economic crisis and after blaming to the so-called «neoliberal policy», reverses her policy. Actually Peru has better perspectives and Argentina has a collapse in perspective.
Guillén-Mendoza, Daniel; Quiroga de Michelena, María
Alkaptonuria is an inborn error of metabolism caused by deficiency of homogentisate 1,2-dioxygenase (HGD) which produces an excess of homogentisic acid (HGA). A case is presented of a 57 year old woman whose urine has turned black since birth. For 9 years she presented a greenish pigmentation in her nail beds that did not improve with antifungal treatments, and in the last 9 months she showed worsening large joint osteoarthritis. This situation forced her to use a wheelchair due to the intense pain caused by osteoarthritis in her hips and lumbar spine. From the description of symptoms, her urinary HGA was measured which confirmed the diagnosis of alkaptonuria. Analgesics and a diet without tyrosine-containing products were suggested. The patient was also referred for hip replacement surgery. This is the first reported case of alkaptonuria in Peru.
mi) border), on the south by Chile (160 km (99 mi) border), and in the west by the Pacific Ocean (2,414 km (1,497 mi) coast). Peru consists of three...1993), Brazil (1993), Paraguay (1996) and Chile (1997). Two isolates of hantavirus were reported in late 1996 from the rice rat, Oligoryzomys...Simuliidae. Fauna de Agua Dulce de la Republica Argentina. 38. (Insecta, Diptera, Simuliidae), Fascicle 2, 304 pp. +78 pp. of unnumbered figures
Hall, M. Francoise
It was carried out a case study of pregnancies and contraceptive methods used by a random sample of 500 women in Lima, Peru . During the five years preceding the interview, the proportion of pregnancies ending in abortions was 19 , 20 and 15 % in the socio- economic middle and lower respectively upper levels . Although the percentage of induced abortions was admitted as low , the rate of abortions was considered relatively high , and it was thought that probably included many whose provocatio...
Mostert, S; Njuguna, F; van de Ven, P M; Olbara, G; Kemps, L J P A; Musimbi, J; Strother, R M; Aluoch, L M; Skiles, J; Buziba, N G; Sitaresmi, M N; Vreeman, R C; Kaspers, G J L
Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop. © 2013 Wiley Periodicals, Inc.
Only two percent of the territory of Peru consists of arable land. Sixteen million people depend on the production of about three million hectares of land, which means that on the average only 1800 square metres is available per person. It is clear that Peru is one of the poorest countries of the world as far as available arable land is concerned and consequently it will have to drastically increase its agricultural production per unit area or import large quantities of agricultural products to feed its rapidly growing population. Agricultural research on the efficient use of fertilizers is being carried out by the regional experiment station (CRIA), by the National University of Agriculture, La Molina, Lima, dealing with programmes on maize, potatoes, cereals and forage crops, by national universities in the country and by specialized research institutes for tropical agriculture on sugar-cane, cotton, coffee and tea. Isotope and radiation techniques are a particularly effective means of determining the best cultural practices for the efficient use of fertilizers and water, and the Joint FAO/IAEA Division of Atomic Energy in Food and Agriculture has been involved in the organization of field and greenhouse programmes at experiment stations and universities in Peru since 1963
Jenssen, Brian P; Wilson, Karen M
Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate nicotine addiction without clear health benefits. In addition to reviewing traditional and new tobacco products, we discuss the unique role that pediatricians should play in tobacco treatment and control efforts. New policies and technologies can empower pediatric clinicians and pediatric health care systems to help parent smokers quit, and new policies outside of the health care setting might help prevent smoking initiation as well as improve cessation treatments. Future research is needed to continue to study the consequences of tobacco use exposure as well as the best ways to help patients and parents stop tobacco use. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Rajkotia, Yogesh; Lescano, Andres G; Gilman, Robert H; Cornejo, Christian; Garcia, Hector H
Neurocysticercosis (NCC) is a major cause of neurological morbidity in the developing world. This study aimed to assess the treatment costs and productivity losses associated with NCC in Peru. NCC patients were identified through retrospective chart analysis. Patients meeting inclusion criteria were interviewed in order to obtain data on symptom history, treatment costs, productivity losses and health service utilisation patterns. These data were modelled to determine average treatment costs and productivity losses over 2 years. Our findings show that treatment costs and productivity losses consume 54% of an annual minimum wage salary during the first year of treatment and 16% during the second year. Diagnosis (36%) and drug therapy (27%) represent the most expensive healthcare-related costs. These costs are prohibitive for some-8% of our study sample had no diagnostic tests during their first 6 months of disease, and two-thirds of those who delayed treatment reportedly did so due to their inability to pay. Two-thirds of wage-earners lost their jobs owing to NCC and only 61% were able to re-engage in wage-earning activities. This study highlights the need to expand financial coverage to ensure the poor have access to health services and do not become further impoverished.
Independent Evaluation Group
Since 2003, Peru has emerged as an open, rapidly growing economy. Over the review period of 2003-09, successive governments adopted policy platforms aimed at maintaining macroeconomic stability, furthering the private sector supply response, broadening participation in growth, improving social service delivery, and strengthening public institutions. The World Bank Group (WBG) supported each of ...
Dec 16, 2010 ... At that time, Peru was instituting a tough new structural adjustment program ... As the study points out, the real “challenge was not to supervise the market, ... education and travel policies added to the agency's reputation as an ...
Full Text Available ABSTRACT Objective To assess how raising cigarette excise taxes in Peru might impact cigarette consumption, and to determine if higher taxes would be regressive. Methods Total demand price elasticity was estimated by income groups using two datasets: quarterly time-series data from 1993 – 2012 and data from a cross-sectional survey of income and expenses conducted in 2008 – 2009 . A functional form of the cigarette demand in Peru was specified using the quarterly data set, and the demand price elasticity was estimated for the short and long run. Using the second data set and Deaton methodology, the implementation of elasticity estimation and by groups’ elasticity was done in a two-step procedure. Results Demand price elasticity was −0.7, implying that a 10% price increase via a new tax would reduce consumption by 7%. Demand price elasticity estimations by income group suggested that poorer families are not more price sensitive than richer ones, which implies that increasing cigarette taxes could be regressive. Conclusions Increasing cigarette taxes is the most efficient policy for inducing a reduction in smoking. However, in the case of Peru, an increase in cigarette taxes could be regressive.
Nabyonga-Orem, Juliet; Ssengooba, Freddie; Macq, Jean; Criel, Bart
Although increasing attention is being paid to knowledge translation (KT), research findings are not being utilized to the desired extent. The present study explores the role of evidence, barriers, and factors facilitating the uptake of evidence in the change in malaria treatment policy in Uganda, building on previous work in Uganda that led to the development of a middle range theory (MRT) outlining the main facilitatory factors for KT. Application of the MRT to a health policy case will contribute to refining it. Using a case study approach and mixed methods, perceptions of respondents on whether evidence was available, had been considered and barriers and facilitatory factors to the uptake of evidence were explored. In addition, the respondents' rating of the degree of consistency between the policy decision and available evidence was assessed. Data collection methods included key informant interviews and document review. Qualitative data were analysed using content thematic analysis, whereas quantitative data were analysed using Excel spreadsheets. The two data sets were eventually triangulated. Evidence was used to change the malaria treatment policy, though the consistency between evidence and policy decisions varied along the policy development cycle. The availability of high-quality and contextualized evidence, including effective dissemination, Ministry of Health institutional capacity to lead the KT process, intervention of the WHO and a regional professional network, the existence of partnerships for KT with mutual trust and availability of funding, tools, and inputs to implement evidence, were the most important facilitatory factors that enhanced the uptake of evidence. Among the barriers that had to be overcome were resistance from implementers, the health system capacity to implement evidence, and financial sustainability. The results agree with facilitatory factors identified in the earlier developed MRT, though additional factors emerged. These
Asakura, Kohji; Kataura, Akikatsu; Hareyama, Masato
To realize the treatment policy for early stage oral cancer, a survey of 102 institutes in Japan was performed by questionnaire. A majority of the otolaryngologists preferred surgery for the treatment of T1N0 and T2N0 cases of oral cancer. The preferred method of treatment for the T1N0 cases was simple tumor resection and that for the T2N0 cases was extended tumor resection with plastic surgery, elective neck dissection and combined radio-and/or chemotherapy. A majority of the radiologists preferred brachytherapy for T1N0 and non-invasive T2N0 cases. For invasive cases of T2N0 oral cancer, radiologists preferred either surgical treatment or the combination of brachytherapy and external irradiation. (author)
Dante Roger Culqui
Full Text Available OBJETIVO: Identificar factores de pronóstico del abandono del tratamiento antituberculoso en la provincia de Ica, Perú. MÉTODOS: Entre 1998 y 2000 se llevó a cabo un estudio de casos y testigos (razón numérica de 1:1 en la provincia de Ica. Se identificaron 55 casos de abandono del tratamiento antituberculoso. Los factores evaluados se seleccionaron a partir del modelo del campo de la salud de Lalonde. Las respectivas razones de posibilidades se calcularon por medio de análisis unifactorial y multifactorial. RESULTADOS: Se identificaron como factores pronósticos del abandono del tratamiento anti-tuberculoso los siguientes: considerar insuficiente la información proporcionada por el personal de salud sobre el tratamiento (razón de posibilidades [odds ratio, OR]: 4,20; intervalo de confianza de 95% [IC95%]: 1,77 a 10,02, considerar inadecuados los horarios para recibir el tratamiento (OR: 9,95; IC95%: 1,97 a 50,21 y consumir drogas ilícitas (OR: 7,15; IC95%: 1,69 a 30,23. CONCLUSIONES: Para mejorar el cumplimiento del régimen antituberculoso es necesario brindar a los pacientes información personalizada sobre la enfermedad y su tratamiento, además de ofrecerles horarios flexibles y apropiados para recibirlo. El consumo de drogas es el factor de riesgo más alto de abandono, por lo que resultan cruciales su identificación y seguimiento.OBJECTIVE: To identify factors that predict noncompliance with tuberculosis treatment in the province of Ica, Peru. METHODS: Between 1998 and 2000 a case-control study (1:1 ratio was conducted in the province of Ica, with 55 cases (persons who dropped out of treatment being identified. The factors evaluated were chosen from Lalonde's model of the field of health. The respective odds ratios were calculated by means of univariate analysis and multivariate analysis. RESULTS: The following factors were identified as being predictive of noncompliance with tuberculosis treatment: thinking that the
Sobero, R A; Peabody, J W
In 2003, Peru and Bolivia reported the highest annual tuberculosis (TB) incidence rates in the Americas. Neighboring Colombia and Chile had lower annual incidence rates despite their proximity. To determine what factors contribute to differences in TB incidence rates among Chile, Colombia, Bolivia and Peru. Multiple sources of literature dating between 1990 and 2005 were used and World Health Organization TB control guidelines were consulted for policy level comparisons. Comprehensive implementation of the DOTS strategy is the main factor explaining the differences in TB incidence rates, even after considering socio-economic factors. Cross-national comparisons suggest ways to improve regional DOTS implementation.
example of successful government consolidation following an internal conflict. 1. “Si no hacemos algo tendremos unas FARC,” El Comercio (19 April 2009...and Shining Path in Peru,” Shining Path of Peru, 3-4. 18. “Suman 15 los Soldados Asesinados,” El Comercio , 22 April 2009. 19. “Por lo menos 50...terroristas atacaron sede policial del poblado de San Jose de Secce,” El Comercio , 2 August 2009. 20. “Helicóptero Caído Cumplía Misión de Rescate de Heridos
A comprehensive portrait of the current status of gifted and talented concepts, identification of the gifted, and associated provisions within Peru is presented. The major purposes of this article are (a) to analyze the primary conception of giftedness in Peru; (b) to describe the beliefs that people have about gifted individuals; (c) to present…
The history of intellectual assessment with children and youth in Peru is presented from the foundation of scientific psychology in Peru until now. Current practices are affected by the multicultural ethnolinguistic diversity of the country, the quality of the different training programs, as well as by Peruvian regulations for becoming an academic…
Julian Cristia; Alejo Czerwonko; Pablo Garofalo
In policy circles a lively debate exists regarding the effects on educational outcomes of introducing computers in schools. A number of empirical studies have measured its effect on test scores. There is a lack of empirical evidence, however, on the effects of this type of intervention on drop-out and repetition rates, variables that have a direct impact on years of education. This paper aims to fill this gap in the literature. To this end, we analyze rich longitudinal censal data from Peru a...
Griffing, Sean M; Gamboa, Dionicia; Udhayakumar, Venkatachalam
Malaria has been part of Peruvian life since at least the 1500s. While Peru gave the world quinine, one of the first treatments for malaria, its history is pockmarked with endemic malaria and occasional epidemics. In this review, major increases in Peruvian malaria incidence over the past hundred years are described, as well as the human factors that have facilitated these events, and concerted private and governmental efforts to control malaria. Political support for malaria control has varied and unexpected events like vector and parasite resistance have adversely impacted morbidity and mortality. Though the ready availability of novel insecticides like DDT and efficacious medications reduced malaria to very low levels for a decade after the post eradication era, malaria reemerged as an important modern day challenge to Peruvian public health. Its reemergence sparked collaboration between domestic and international partners towards the elimination of malaria in Peru.
Barry, Colleen L; McGinty, Emma Elizabeth; Pescosolido, Bernice; Goldman, Howard H.
Objective This study compares current public attitudes about drug addiction with attitudes about mental illness. Methods A web-based national public opinion survey (N=709) was conducted to compare attitudes about stigma, discrimination, treatment effectiveness, and policy support. Results Respondents hold significantly more negative views toward persons with drug addiction compared to those with mental illness. More respondents were unwilling to have a person with drug addiction marry into their family or work closely with them on a job. Respondents were more willing to accept discriminatory practices, more skeptical about the effectiveness of available treatments, and more likely to oppose public policies aimed at helping persons with drug addiction. Conclusions Drug addiction is often treated as a sub-category of mental illness, and health insurance benefits group these conditions together under the rubric of behavioral health. Given starkly different public views about drug addiction and mental illness, advocates may need to adopt differing approaches for advancing stigma reduction and public policy. PMID:25270497
... Inspection Service 7 CFR Part 319 [Docket No. APHIS-2012-0014] RIN 0579-AD68 Importation of Papayas From Peru... from Peru into the continental United States. The conditions for the importation of papayas from Peru... action would allow for the importation of papayas from Peru while continuing to provide protection...
A peruvian man, victim of an important accidental irradiation arrived on the Saturday twenty ninth of may 1999 to the centre of treatment of serious burns at the Percy military hospital (Clamart -France). The accident spent on the twentieth of February 1999, on the site of a hydroelectric power plant, in construction at 300 km at the East of Lima. The victim has picked up an industrial source of iridium devoted to gamma-graphy operations and put it in his back pocket; of trousers. The workman has serious radiation burns. (N.C.)
Ing. Lyudmyla Yezers´ka
Full Text Available The results of an investigation whose primary target is to analyze the panorama of media on the Internet in Peru in the last quarter of the 2004 are presented. The birth and the consolidation of the Peruvian media on the Internet have been influenced by the economic, political and social problems that this country has lived through throughout its history. In spite of the few users which the media still have on the Internet, however, Peruvian journalism is making an effort to experiment with new formats and is conscious that in the future these means of communication will become essential elements for publication on the Web.
Lynch, T F; Gillespie, R; Gowlett, J A; Hedges, R E
Dating by accelerator mass spectrometry of wooden artifacts, cord, and charcoal samples from Guitarrero Cave, Peru, supports the antiquity of South America's earliest textiles and other perishable remains. The new dates are consistent with those obtained from disintegration counters and leave little doubt about the integrity of the lower Preceramic layers and their early cultivars. Re-evaluation of the mode of deposition suggests that most of the remains resulted from short-term use of the cave in the eighth millennium B.C., with a possible brief human visit as early as 12,560 years ago.
This paper reports on strong measures that are being taken to resuscitate Peru's hydrocarbon sector. The first step last August was the cutting of fuel subsidies in half. Then the administration issued tax vouchers to state utilities for the money they still owed national oil company Petroperu. A precursor to what are expected to be widespread changes to the existing petroleum legislation occurred last fall. As part of a package of fiscal reforms, the official base rate that the government paid Occidental Petroleum to produce crude for Petroperu was dropped. A new, free market rate was adopted, which was six times the old base rate
Without an equal sharing of costs and benefits of natural and human resources worldwide, imbalances and lack of human development lead to migration within and between countries. Economic integration blocks in Latin America provide a context for shared development: in Central America, in the Andean Region, and in the Southern Cone. Over the past 60 years migration policy was based on national protectionism, labor supply, and/or occupation of territory. When economic conditions changed to market economies and world markets, migration policy was redefined. Each of the economic integration blocks has developed its own strategies. The Andean Agreement on Labor Migrations was established to determine the rules for bilateral and multilateral treatment of problems. In the Southern Cone bilateral agreements have been longstanding. Multilateral efforts were recently underway within the Southern Common Market and throughout the region. The Central American Organization for Migrations has spearheaded the adoption of a multilateral strategy. All three regions have made considerable progress in the last three years in constructing multilateral policies for economic integration. Government awareness has been the primary force in these policy changes. Government has come to an understanding that clear domestic and regional migration policies were lacking and that obsolete migration practices of the 1930s did not meet the needs of the 1990s. Migration policy was considered an instrument of development. Movement of economic factors or goods was considered equally with movement of labor. Migration policies must integrate the human rights of migrants into their definitions. Methods of facilitating the movements of populations need to be constructed within the computerization and modernization of the migration administration. Legalization of illegal immigrants has occurred among a number of countries. PROCAM and PRIMCOS were action programs which aimed to integrate migration and
Carlos R. Maia
Full Text Available Objective: To estimate the economic consequences of the current Brazilian government policy for attention-deficit/hyperactivity disorder (ADHD treatment and how much the country would save if treatment with immediate-release methylphenidate (MPH-IR, as suggested by the World Health Organization (WHO, was offered to patients with ADHD. Method: Based on conservative previous analyses, we assumed that 257,662 patients aged 5 to 19 years are not receiving ADHD treatment in Brazil. We estimated the direct costs and savings of treating and not treating ADHD on the basis of the following data: a spending on ADHD patients directly attributable to grade retention and emergency department visits; and b savings due to impact of ADHD treatment on these outcomes. Results: Considering outcomes for which data on the impact of MPH-IR treatment are available, Brazil is probably wasting approximately R$ 1.841 billion/year on the direct consequences of not treating ADHD in this age range alone. On the other hand, treating ADHD in accordance with WHO recommendations would save approximately R$ 1.163 billion/year. Conclusions: By increasing investments on MPH-IR treatment for ADHD to around R$ 377 million/year, the country would save approximately 3.1 times more than is currently spent on the consequences of not treating ADHD in patients aged 5 to 19 years.
Duke, Karen; Herring, Rachel; Thickett, Anthony; Thom, Betsy
Based on documentary analyses and interviews with twenty key informants in 2012, this paper analyses the shift in British drugs policy towards "recovery" from the perspectives of major stakeholders. The processes involved in reopening the debate surrounding the role of substitution treatment and its re-emergence on to the policy agenda are examined. Drawing on Kingdon's work on agenda-setting, the ways in which methadone maintenance was challenged and defended by key stakeholders in the initial phase of policy development and the negotiation of a "recovery" focus as the organizing concept for British drugs policy are explored. Study limitations are noted.
Veien, N K; Hattel, T; Laurberg, G
Previous studies have shown that some patients sensitive to balsams and/or fragrances obtain long-term benefits by following a low-balsam diet, whereas others do not. This study was performed to determine whether a low-balsam diet was a helpful long-term treatment for selected patients sensitive to balsam of Peru and/or a perfume mixture and to determine whether oral challenge with balsam of Peru could predict which balsam-sensitive patients might benefit from a reduction in balsam intake. Questionnaires were sent to 46 patients with positive patch test results to balsam of Peru and/or a perfume mixture and chronic dermatitis of a morphology consistent with endogenous dermatitis who had experienced improvement after 1 to 2 months on a diet intended to reduce the intake of balsams. The questionnaires were mailed 1 to 3 years after the initiation of the diet treatment to inquire about a possible long-term benefit of the diet. Twenty-eight of the 46 patients stated in the questionnaire that they had long-term benefits from the diet treatment. These included 16 of 22 patients who had reacted to a placebo-controlled oral challenge with 1 g balsam of Peru, 3 of 10 who had no reaction or a placebo reaction to the oral challenge, and 9 of 14 who had not been challenged orally. The efficacy of the diet treatment was not correlated to whether the patient had patch test reactivity to either balsam of Peru, the perfume mixture, or both substances. Food items most commonly mentioned by patients as causing aggravation of their symptoms on at least three different occasions were wine, candy, chocolate, cinnamon, curry, citrus fruit, and flavorings. In its present form, the oral challenge procedure with balsam of Peru offers only limited assistance in selecting patients who are likely to benefit from diet treatment.
Potenza, Marc N
Despite significant advances in our understanding of the biological bases of addictions, these disorders continue to represent a huge public health burden that is associated with substantial personal suffering. Efforts to target addictions require consideration of how the improved biological understanding of addictions may lead to improved prevention, treatment, and policy initiatives. In this article, we provide a narrative review of current biological models for addictions with a goal of placing existing data and theories within a translational and developmental framework targeting the advancement of prevention, treatment, and policy strategies. Data regarding individual differences, intermediary phenotypes, and main and interactive influences of genetic and environmental contributions in the setting of developmental trajectories that may be influenced by addictive drugs or behavior indicate complex underpinnings of addictions. Consideration and further elucidation of the biological etiologies of addictions hold significant potential for making important gains and reducing the public health impact of addictions. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Cadaxa, Aedê Gomes; Sousa, Maria Fátima de; Mendonça, Ana Valéria Machado
To identify health promoting contents (information that can be transformed into decision-making resources to improve quality of life and the health of individuals or groups) in Facebook postings by the ministries of health in Brazil and Peru. This case study compared the messages published in Facebook by the ministries of health from Brazil and Peru during World AIDS Day. Content analysis was employed to identify health promoting contents in the messages posted between November 2013 and February 2014. A total of 105 messages were published on the topic of interest (37 from Peru and 68 from Brazil). In both cases, most messages focused on individuals, addressing the change or adoption of personal behaviors relating to the prevention and detection of HIV - 34 messages (50.0%) for Brazil and 17 (45.9%) for Peru. Twenty-one (30.9%) messages with a structural emphasis were published by Brazil and 14 (37.8%) by Peru, addressing the context of health care system organization, including HIV/ AIDS health policies, available services, access to HIV testing and initiatives to promote testing. Hybrid messages, including both emphases, were less frequent: 13 (19.1%) for Brazil and six (16.2%) for Peru. Health promoting contents were identified in hybrid messages, which provided resources to expand the understanding of individuals about the susceptibility to AIDS.
The recent charges in Peru's energy sector are reported as the privatisation campaign draws to a close. Sectors covered include the splitting of the petroleum company into its components of production, refining, transport and marketing. (UK)
Full Text Available During the last decade Peru has experienced a euphoric rediscovery –pseudo revaluation as a country– due to its booming gastronomy, tourism and economic growth.In this context, the presentresearch uses semio-psychoanalytic and postcolonial theories to explain Peru’s social outlook regarding the concept of nation, its reunion with a non-existent identity and the construction of the idea of nation based on the marketing campaign titled the Peru Brand. Thus, Peru Brand, far from uniting all Peruvians and bring them together into the wellknown “melting pot”, becomes the resemantization of the old colonial discourse longing for a republic without natives. Therefore, in the Peru Brand advertising discourse, the “primitive natives” are white people brought from Nebraska and speak English.
Moock, Peter; Bellew, Rosemary
The relative costs of and returns to VTE (Vocational and Technical Education) and general education in Peru are investigated here. The paper is composed as follows. Following a brief introduction, section 2 describes the system of education in Peru and changes that have occurred in this system over time. Section 3 surveys the (relatively sparse) literature on comparative rates of return to VTE and general education. Sections 4 and 5 describe, respectively, the data used for this study and the...
single or of multiple organ systems. Interestingly, the histological features of BA lesions and verruga peruana are virtually identical (Cockerell et al... Biblioteca Nacional del Peru. lima, Peru, 115 pp. Hertig, M., 1937-38. Studies on Phlebotomus as the Possible Vector. Proc Soc Exp Bioi Med. 37: 598-.600...Vectors of Bartonellosis and Leishmaniasis as Early as 1764. Science. 190: 154-155. Herrer. A.. 1990. Epidemiologia de la Verruga Peruana. Biblioteca
Abraham, Amanda J; Bagwell-Adams, Grace; Jayawardhana, Jayani
Given the high prevalence of smoking among substance use disorder (SUD) patients, the specialty SUD treatment system is an important target for adoption and implementation of tobacco cessation (TC) services. While research has addressed the impact of tobacco control on individual tobacco consumption, largely overlooked in the literature is the potential impact of state tobacco control policies on availability of services for tobacco cessation. This paper examines the association between state tobacco control policy and availability of TC services in SUD treatment programs in the United States. State tobacco control and state demographic data (n=51) were merged with treatment program data from the 2012 National Survey of Substance Abuse Treatment Services (n=10.413) to examine availability of TC screening, counseling and pharmacotherapy services in SUD treatment programs using multivariate logistic regression models clustered at the state-level. Approximately 60% of SUD treatment programs offered TC screening services, 41% offered TC counseling services and 26% offered TC pharmacotherapy services. Results of multivariate logistic regression showed the odds of offering TC services were greater for SUD treatment programs located in states with higher cigarette excise taxes and greater spending on tobacco prevention and control. Findings indicate cigarette excise taxes and recommended funding levels may be effective policy tools for increasing access to TC services in SUD treatment programs. Coupled with changes to insurance coverage for TC under the Affordable Care Act, state tobacco control policy tools may further reduce tobacco use in the United States. Published by Elsevier Ltd.
Influencing parliamentary debate on labour policy in Uruguay ... The study has been presented in international conferences and was recently published in the ... Mini soap operas foster financial education and inclusion of women in Peru.
Krisher, Lyndsay K; Krisher, Jesse; Ambuludi, Mariano; Arichabala, Ana; Beltrán-Ayala, Efrain; Navarrete, Patricia; Ordoñez, Tania; Polhemus, Mark E; Quintana, Fernando; Rochford, Rosemary; Silva, Mercy; Bazo, Juan; Stewart-Ibarra, Anna M
In recent years, malaria (Plasmodium vivax and Plasmodium falciparum) has been successfully controlled in the Ecuador-Peru coastal border region. The aim of this study was to document this control effort and to identify the best practices and lessons learned that are applicable to malaria control and to other vector-borne diseases. A proximal outcome evaluation was conducted of the robust elimination programme in El Oro Province, Ecuador, and the Tumbes Region, Peru. Data collection efforts included a series of workshops with local public health experts who played central roles in the elimination effort, review of epidemiological records from Ministries of Health, and a review of national policy documents. Key programmatic and external factors are identified that determined the success of this eradication effort. From the mid 1980s until the early 2000s, the region experienced a surge in malaria transmission, which experts attributed to a combination of ineffective anti-malarial treatment, social-ecological factors (e.g., El Niño, increasing rice farming, construction of a reservoir), and political factors (e.g., reduction in resources and changes in management). In response to the malaria crisis, local public health practitioners from El Oro and Tumbes joined together in the mid-1990s to forge an unofficial binational collaboration for malaria control. Over the next 20 years, they effectively eradicated malaria in the region, by strengthening surveillance and treatment strategies, sharing of resources, operational research to inform policy, and novel interventions. The binational collaboration at the operational level was the fundamental component of the successful malaria elimination programme. This unique relationship created a trusting, open environment that allowed for flexibility, rapid response, innovation and resilience in times of crisis, and ultimately a sustainable control programme. Strong community involvement, an extensive microscopy network and
In Peru, the incidence of gastric cancer is reported to be around 15.8 per 100,000 inhabitants and it is the second most common oncological disease in men and the third one in women. Additionally, a high mortality index was reported, especially among poor people. To address this issue, in 2008, Peru initiated several insurance treatment plans of oncological diseases with promising results. In Mexico, there is a high predominance of gastric cancer in male gender compared to female gender, even reaching a 2/1 ratio, and the detection rate of early gastric cancer is low (10% to 20%) which results in a mainly palliative treatment with an overall survival rate in 5 years about 10% to 15% only. In Peru, the average age at diagnosis is around 62.96±14.75 years old and the most frequent symptoms includes abdominal pain, indigestion, loss of appetite, weight loss and gastrointestinal bleeding, while in Mexico, some studies reported an average age at diagnosis around 60.3±4.1 years old (range, 23-78 years old) and the most frequent symptoms were postprandial fullness (74.4%), abdominal pain (37.2%), weight loss (18.6%), and melena (4.6%). The anemia rate was 65.1% with a mean Hb level of 6.14 g/dL. In Peru, the most common gastric cancer type is the intestinal-type adenocarcinoma (around 34%), followed by the diffuse-type adenocarcinoma (18.7%), whilst among Mexicans, the diffuse-type was reported in 55.2% of cases, the intestinal-type was reported in 28.2% and the undifferentiated-type corresponded to 6%. In both, Peru and Mexico, 90% of the associated factors includes tabaquismo, diets rich in salt, smoked foods, and a sedentary lifestyle. Family inheritance and advanced age and pharmacological-resistant Helicobacter pylori infection are also important. Poverty has been heavily associated with a higher incidence of gastric cancer. The management of gastric cancer patients in Peru is carried out by general surgeons or general surgical oncologists. In recent years, efforts
Millet, L.; Serres, F. [Electricite de France, Group des Laboratoires (France); Vermeeren, D. [Electricite de France, Groupe Ingenierie Process (France); Moreaux, D. [Electricite de France, Groupe Environnement (France)
In French nuclear power plants, the secondary water conditioning is essentially based on the use of a volatile amine and a reducing reagent. The additional use of a corrosion inhibitor is limited to units with secondary side corrosion of Alloy 600 MA SG tubes. The main aim of secondary water treatment optimisation is to achieve the best compromise as follows: to minimize the different types of corrosion of the different PWRs materials (copper corrosion, flow assisted corrosion, SG fouling and secondary side corrosion), to reduce operation and maintenance costs (short term and long term), to minimise the impacts on the environment, to protect workers health. In a first part, this paper describes the studies recently carried out to try to optimise the secondary water treatment in French PWRs. They concern the possibility to use ethanolamine (ETA) in replacement of morpholine and ammonia and the possibility to use carbohydrazide (CBH) in replacement of hydrazine. In a second part, this paper presents the French secondary water treatment policy established in 2000, which is depending on the presence or not of copper alloys. (authors)
Millet, L.; Serres, F.; Vermeeren, D.; Moreaux, D.
In French nuclear power plants, the secondary water conditioning is essentially based on the use of a volatile amine and a reducing reagent. The additional use of a corrosion inhibitor is limited to units with secondary side corrosion of Alloy 600 MA SG tubes. The main aim of secondary water treatment optimisation is to achieve the best compromise as follows: to minimize the different types of corrosion of the different PWRs materials (copper corrosion, flow assisted corrosion, SG fouling and secondary side corrosion), to reduce operation and maintenance costs (short term and long term), to minimise the impacts on the environment, to protect workers health. In a first part, this paper describes the studies recently carried out to try to optimise the secondary water treatment in French PWRs. They concern the possibility to use ethanolamine (ETA) in replacement of morpholine and ammonia and the possibility to use carbohydrazide (CBH) in replacement of hydrazine. In a second part, this paper presents the French secondary water treatment policy established in 2000, which is depending on the presence or not of copper alloys. (authors)
An examination of the energy sources of Peru was undertaken by the USA in collaboration with Peru. First, an introduction establishes the purpose and summarizes results, after which the status of energy supply is presented. The ensuing sections contain the contributions of the participating technical specialists, namely: Peru's hydrocarbon potential, estimated reserves, and projected production rates; coal deposits in Peru; geothermal energy; uranium; miscellaneous energy sources; energy-related minerals; water resources in Peru; and geologic hazards in Peru. A separate abstract was prepared for each of the sections. (MCW)
Kozlowski, Dawid; Worthington, Dave
chain and discrete event simulation models, to provide an insightful analysis of the public hospital performance under the policy rules. The aim of this paper is to support the enhancement of the quality of elective patient care, to be brought about by better understanding of the policy implications...... on the utilization of public hospital resources. This paper illustrates the use of a queue modelling approach in the analysis of elective patient treatment governed by the maximum waiting time policy. Drawing upon the combined strengths of analytic and simulation approaches we develop both continuous-time Markov...
Lavado-Casimiro, Waldo; Mauchle, Fabian; Diaz, Amelia; Seiz, Gabriela; Rubli, Alex; Rossa, Andrea; Rosas, Gabriela; Ita, Niceforo; Calle, Victoria; Villegas, Esequiel; Ambrosetti, Paolo; Brönnimann, Stefan; Hunziker, Stefan; Jacques, Martin; Croci-Maspoli, Mischa; Konzelmann, Thomas; Gubler, Stefanie; Rohrer, Mario
The climate variability and change will have increasing influence on the economic and social development of all countries and regions, such as the Andes in Latin America. The CLIMANDES project (Climate services to support decision-making in the Andean Region) will address these issues in Peru. CLIMANDES supports the WMO Regional Training Centre (RTC) in Lima, which is responsible for the training of specialized human resources in meteorology and climatology in the South American Andes (Module 1). Furthermore, CLIMANDES will provide high-quality climate services to inform policy makers in the Andean region (Module 2). It is coordinated by the World Meteorological Organization (WMO) and constitutes a pilot project under the umbrella of the WMO-led Global Framework for Climate Services (GFCS). The project is funded by the Swiss Agency for Development and Cooperation (SDC) and runs from August 2012 - July 2015. Module 1 focuses on restructuring the curricula of Meteorology at the La Molina Agraria University (UNALM) and applied training of meteorologists of the Peruvian National Service of Meteorology and Hydrology (SENAMHI). In Module 2, the skills will be shared and developed in the production and delivery of high-quality climate products and services tailored to the needs of the decision makers in the pilot regions Cusco and Junín. Such services will benefit numerous sectors including agriculture, education, health, tourism, energy, transport and others. The goals of the modules 1 and 2 will be achieved through the collaboration of the UNALM, SENAMHI and the Federal Office of Meteorology and Climatology MeteoSwiss, with the support of the University of Bern (UNIBE), Meteodat and WMO.
Tovar, Marco A.; Huff, Doug; Boccia, Delia; Montoya, Rosario; Ramos, Eric; Lewis, James J.; Gilman, Robert H.; Evans, Carlton A.
The End TB Strategy mandates that no tuberculosis (TB)-affected households face catastrophic costs due to TB. However, evidence is limited to evaluate socioeconomic support to achieve this change in policy and practice. The objective of the present study was to investigate the economic effects of a TB-specific socioeconomic intervention. The setting was 32 shantytown communities in Peru. The participants were from households of consecutive TB patients throughout TB treatment administered by the national TB programme. The intervention consisted of social support through household visits and community meetings, and economic support through cash transfers conditional upon TB screening in household contacts, adhering to TB treatment/chemoprophylaxis and engaging with social support. Data were collected to assess TB-affected household costs. Patient interviews were conducted at treatment initiation and then monthly for 6 months. From February 2014 to June 2015, 312 households were recruited, of which 135 were randomised to receive the intervention. Cash transfer total value averaged US$173 (3.5% of TB-affected households' average annual income) and mitigated 20% of households' TB-related costs. Households randomised to receive the intervention were less likely to incur catastrophic costs (30% (95% CI 22–38%) versus 42% (95% CI 34–51%)). The mitigation impact was higher among poorer households. The TB-specific socioeconomic intervention reduced catastrophic costs and was accessible to poorer households. Socioeconomic support and mitigating catastrophic costs are integral to the End TB strategy, and our findings inform implementation of these new policies. PMID:27660507
Knudsen, Hannah K; Abraham, Amanda J
Despite growing interest in the use of evidence-based treatment practices for treating substance use disorders, adoption of medications by treatment programs remains modest. Drawing on resource dependence and institutional theory, this study examined the relationships between adoption of medications by treatment programs and their perceptions about the state policy environment. Data were collected through mailed surveys and telephone interviews with 250 administrators of publicly funded substance abuse treatment programs in the United States between 2009 and 2010. Multiple imputation and multivariate logistic regression were used to estimate the associations between perceptions of the state policy environment and the odds of adopting at least one medication for the treatment of substance use disorders. A total of 91 (37%) programs reported having prescribed any medication for treatment of a substance use disorder. Programs were significantly more likely to have adopted at least one medication if they perceived greater support for medications by the Single State Agency. The odds of adoption were significantly greater if the program was aware that at least one medication was included on their state's Medicaid formulary and that state-contract funding permitted the purchase of medications. States may play significant roles in promoting the adoption of medications, but adequate dissemination of information about state policies and priorities may be vital to further adoption. Future research should continue to study the relationships between the adoption of medications for treating substance use disorders and the evolving policy environment.
Soon after the launching of the Camisea Gas Project, in 2000, Peru became a medium-range Latin American gas exporting country. Our central argument is that energy governance in this country has been shifting from a 'hierarchical' to a 'co-governance' mode. Accordingly, interactions among the State, the society and economic actors are now regulated in a horizontal and decentralized way, rather than a vertical and centralized one. This shift contributed to the success of the Camisea gas project and had a positive effect on foreign direct investments inflow in the energy sector (1). In addition, it has helped Peru reach energetic self-sufficiency, while improving its energy balance (2). Meanwhile, energy policy has welcomed a major participation of social actors, contributing to institutionalized arrangements between the State, the companies and indigenous communities and their NGO partners (3). Two theoretical conclusions can be drawn from this study. First, the State's role remains central in energy governance, thus invalidating the 'hollowing of the State' thesis. Second, the co-governance mode helps to overcome the 'resource curse' thesis.
Roberto F. Kometter
Full Text Available Although bigleaf mahogany [Swietenia macrophylla King (Meliaceae] is the premier timber species of Latin America, its exploitation is unsustainable because of a pattern of local depletion and shifting supply. We surveyed experts on the status of mahogany in Bolivia and Peru, the world's past and present largest exporters. Bolivia no longer has commercially viable mahogany (trees > 60 cm diameter at breast height across 79% of its range. In Peru, mahogany's range has shrunk by 50%, and, within a decade, a further 28% will be logged out. Approximately 15% of the mahogany range in these two countries is protected, but low densities and illegal logging mean that this overestimates the extent of mahogany under protection. The international community can support mahogany conservation by funding park management and by encouraging independent verification of the legality of mahogany in trade. Our findings demonstrate that a systematic expert survey can generate reliable and cost-effective information on the status of widespread species of concern and help to inform appropriate management policy.
The AEC's new policy line for the treatment and disposal of radioactive wastes is explained with three tables added. The first table was prepared by MITI's Nuclear Fuel Advisory Committee regarding the projections on the amounts of radioactive wastes to be discharged from nuclear power plants, fuel fabrication plants and reprocessing plants, and the other two tables were made by the AEC committee on technical development of radioactive waste management, the one proposed the developmental steps necessary for establishing waste management technologies, and the other showed the related research and development items with target time schedule. The proper treatment and disposal of radioactive waste S are the problems that have to be resolved prior to the full development and utilization of nuclear energy. The Atomic Energy Commission set up a committee on July 29, 1975, to discuss the technologies on the management of radioactive wastes. The principle essential to the radioactive waste management was set, and it is desirable that this principle is put into practice with the cooperation and understanding of the people and all parties concerned. The countermeasures proposed will be subject to review yet as the technology makes further progress and they are as follows: on the high level radioactive waste management and the low-and intermediate-level radioactive waste management, the basic idea, targets and measures are given, and the methods for promoting experimental ocean dumping of low level radioactive wastes are proposed. (Iwakiri, K.)
addition, partial citrate synthase (gltA) and outer membrane protein A (ompA) gene sequences were amplified and analyzed, using previously described...views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the...rickettsial and leptospira infections in Andean northern Peru. Am J Trop Med Hyg 70: 357-363. 21. Schoeler GB, Moron C, Richards A, Blair PJ, Olson JG, 2005
Paxson, Christina; Schady, Norbert
The effect of economic crises on child health is a topic of great policy importance. The authors use data from the Demographic and Health Surveys (DHS) to analyze the impact of the profound 1988-92 economic crisis in Peru on infant mortality and anthropometrics. They show that there was an increase in the infant mortality rate of about 2.5 percentage points for children born in late 1989 ...
Perez, Freddy; Gomez, Bertha; Ravasi, Giovanni; Ghidinelli, Massimo
The Pan American Health Organization provides technical cooperation to countries in Latin America and the Caribbean for the scale-up of HIV care and treatment based on the Treatment 2.0 initiative. Fourteen Joint Review Missions (JRMs) were conducted between March 2012 and October 2014. Evaluating the degree of implementation of the recommendations of the JRMs and their impact on health policies, would help countries identify their gaps and areas for priority interventions. A descriptive analysis of the JRM recommendations was conducted for eight countries. An in-depth cross-sectional retrospective analysis of the degree of implementation of these recommendations in Ecuador, Venezuela, Bolivia, and El Salvador was performed through a standardized self-administered questionnaire applied to key informants. A comparative quantitative analysis on the optimization of antiretroviral regimens 'before/after' JRMs was conducted in three of the latter four countries, using data reported in 2013 and 2014. The priority areas with most recommendations were the optimization of antiretroviral treatment (ART) regimens (n = 57), the rational and efficient use of resources (n = 27) and the provision of point-of-care diagnostics and monitoring tools (n = 26), followed by community mobilization (n = 23), strategic information (n = 17) and the adaptation of delivery services (n = 15). The in-depth analysis in four countries showed that the two priority areas where most progress was observed were the rational and efficient use of resources (62%) and the optimization of ART regimens (60%). Adaptation of delivery services, community mobilization and strategic information were rated at 52% and the provision of point-of-care diagnostics and monitoring tools 38%. The quantitative analysis on optimization evidenced a 36% reduction in the number of first-line and second-line ART regimens, a 5.4% increase in the proportion of patients on WHO-recommended first-line regimens, a 19.4% increase in
.... APHIS-2008-0126] RIN 0579-AC93 Importation of Hass Avocados From Peru AGENCY: Animal and Plant Health... to allow the importation of Hass avocados from Peru into the continental United States. As a condition of entry, Hass avocados from Peru will have to be produced in accordance with a systems approach...
... 7 Agriculture 5 2010-01-01 2010-01-01 false Citrus from Peru. 319.56-41 Section 319.56-41... from Peru. Grapefruit (Citrus paradisi), limes (C. aurantiifolia), mandarins or tangerines (C... States from Peru under the following conditions: (a) The fruit must be accompanied by a permit issued in...
Guerrero, P.; Má, C.; Venegas, D.; Bustamante, R.
Peru is the fastest growing economy in Latin America (sustained increase in GDP, low inflation and poverty reduction). The health system is fragmented and until 2012, almost half of the population had no health insurance. The current government poses: Improved access to health and education, employment and social security, reducing extreme poverty, within a context of social inclusion. The Plan for Prevention and Control of Cancer (“Plan Esperanza”) was established in 2012 in order to reduce cancer mortality and morbidity, with greater access to oncology services (promotion, prevention, early diagnosis, treatment and palliative care). With an area of 1 285 216 square kilometers and almost 30 million inhabitants, cancer treatment resources are scarce. Regarding Radiation Therapy, until 2007, it existed only in Lima, the capital city (over 9 million inhabitants). Later, another services were established in two more regions. At present, there is 23 radiotherapy machines in whole country. In this regard, Plan Esperanza is working on strengthening Radiation Therapy Services nationwide. Considering the population demand and availability of other cancer services (chemotherapy, oncologic surgery), the regions where need create new radiotherapy services were identified: 3 Hospitals in Lima (in peripheral areas: Cayetano Heredia at the North, Hipólito Unanue at East and Maria Auxiliadora at South). Also, other Regions of the country: Piura, Lambayeque, La Libertad at North; Junín in the Central Highland, Cusco in the Southern Highland, and Loreto in the Northern Forest. Each with 2 linear accelerators, except Loreto, where they will consider two 60 Cobalt bomb instead, due to the geographical conditions. Moreover, one linear accelerator in Arequipa Region will be acquired. In Lima, the Hospitals are projected to become operational in 2016, while in the Regions, the Ministry of Health is providing them technical assistance in needs identification, planning and
Sacristán, José A; Lizan, Luís; Comellas, Marta; Garrido, Pilar; Avendaño, Cristina; Cruz-Hernández, Juan J; Espinosa, Javier; Dilla, Tatiana
The purpose of this study was to explore the main factors explaining the relative weight of the different attributes that determine the value of oncologic treatments from the different perspectives of healthcare policy makers (HCPM), oncologists, patients and the general population in Spain. Structured interviews were conducted to assess: (1) the importance of the attributes on treatment choice when comparing a new cancer drug with a standard cancer treatment; (2) the importance of survival, quality of life (QoL), costs and innovation in cancer; and (3) the most worrying side effects related to cancer drugs. A total of 188 individuals participated in the study. For all participants, when choosing treatments, the best rated characteristics were greater efficacy, greater safety, treatment adaptation to patients' individual requirements and the rapid reincorporation of patients to their daily activities. There were important differences among participants in their opinion about survival, QoL and cost. In general, oncologists, patients, and the general population gave greater value to gains in QoL than healthcare policy makers. Compared to other participants healthcare policy makers gave greater importance to the economic impact related to oncology treatments. Gains in QoL, survival, safety, cost and innovation are perceived differently by different groups of stakeholders. It is recommended to consider the perspective of different stakeholders in the assessment of a new cancer drugs to obtain more informed decisions when deciding on the most appropriate treatment to use. Eli Lilly & Co, Madrid (Spain).
Madden, Jeanne M; Meza, Edson; Ewen, Margaret; Laing, Richard O; Stephens, Peter; Ross-Degnan, Dennis
To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001. A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI's target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health. No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups). The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts.
Neelsen, Sven; O'Donnell, Owen
Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.
After months of delays, the sale of Petroleos del Peru SA (Petroperu) was postponed earlier this year until after the elections, which saw Peru`s incumbent President Alberto Fujimori reelected. In June, Fujimori appointed Amado Yataco Minister of Energy and Mines. Yataco, also serving as president of the privatization commission Copri, said a decision on the sale of Petroperu would be made quickly, perhaps by July 28, ahead of this report`s presstime. The uncertain status of Petroperu has not, however, slowed activity in Peru`s petroleum sector. The paper first discusses privatization plans and Petroperu`s budget, then describes exploration and development activities in the supergiant Camisea gas/condensate fields in the central southern jungle. Activities in several smaller fields are briefly described.
Northern Peru has an exceptionally rich archaeological heritage that includes metalwork, ceramics and textiles. The success of at least a half-dozen pre-Columbian societies dating back 3,000 years and subsequent Spanish colonization in the 1400s has rested on the effective use of northern Peru's abundant resources. In the summer of 2000, my son Matt and I learned about that connection firsthand by volunteering at the Santa Rita B archaeological site in the Chao Valley near Trujillo in northern Peru. Riding donkey-back through the Andes and talking with local people, we got our hands dirty in the rich archaeology and geology of the area. We were able to correlate mineral occurrences to their various roles in society - opening a window into the region's fascinating past. From construction to metallurgy, pre-Columbian societies flourished and advanced because of their understanding and use of the available mineral resources.
After months of delays, the sale of Petroleos del Peru SA (Petroperu) was postponed earlier this year until after the elections, which saw Peru's incumbent President Alberto Fujimori reelected. In June, Fujimori appointed Amado Yataco Minister of Energy and Mines. Yataco, also serving as president of the privatization commission Copri, said a decision on the sale of Petroperu would be made quickly, perhaps by July 28, ahead of this report's presstime. The uncertain status of Petroperu has not, however, slowed activity in Peru's petroleum sector. The paper first discusses privatization plans and Petroperu's budget, then describes exploration and development activities in the supergiant Camisea gas/condensate fields in the central southern jungle. Activities in several smaller fields are briefly described
Cruz, Ismael; Huerta-Mercado, Raul
Peru is a country located on the Pacific coast of South America with a population of more than 30 million inhabitants. In the past 10 years, Peru has had a steady economic growth. Peru is predominantly an extractive industry country, but the manufacturing and construction sectors are booming. It is in this context that regulations have been implemented to protect the safety and health of workers. One of the most important regulations is the Law on Safety and Health at Work, which has been recently promulgated. Regulations are complemented by training and education in occupational safety and health. The measures are yet to be fully implemented thus a positive effect in reducing accidents and occupational diseases at work has not yet been seen. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.
This paper reports that Petroleos del Peru (Petroperu) is seeking a buyer for its Petromar offshore exploration and production unit. Peru's national oil company wants to sell Petromar acreage, production, and production installations on Block Z-2b for $200 million, payable at $10 million/year for 20 years, plus a share of future production. Petroperu is offering a full interest petroleum exploration and exploitation contract for 30 years for oil and as long as 40 years in the case of gas exploitation. The company seeking the smallest share of current and incremental future production to operate Block Z-2b will be awarded the acreage. Petromar's sale is the latest announced under Peru's privatization program ordered by President Alberto Jujimori
This paper reports that Peru has again extended the deadline for bids on a 30 year operating contract for state owned Petromar SA's offshore Block Z-2b. The tender is key to efforts to privatize Petromar, a subsidiary of state oil company Petroleos del Peru. The committee charged with implementing Petromar privatization extended the deadline for bids another 70 days Oct. 30, following a 60 day extension made in September. The latest deadline for bids is Feb. 10, with the contract expected to be awarded Feb. 26. A bid package on Block Z-2b is available from Petroperu's Lima headquarters for $20,000. Petromar operates the former Belco Petroleum Corp. offshore assets Peru's government expropriated in 1985. It currently produces 17,600 b/d, compared with 27,000 b/d at the time of expropriation
Bartolini, Rosario M; Drake, Jennifer Kidwell; Creed-Kanashiro, Hilary M; Díaz-Otoya, Margarita M; Mosqueira-Lovón, Nelly Rocío; Penny, Mary E; Winkler, Jennifer L; LaMontagne, D Scott; Bingham, Allison
To understand the sociocultural environment, health systems' capacities, and policy processes related to cervical cancer and HPV vaccines in order to inform HPV vaccine introduction. Mixed-method formative research using qualitative and quantitative data collection techniques. Participants included girls, parents, community leaders, health and education officials, and policymakers. Respondents, including policymakers, generally supported HPV vaccine introduction, due partly to appreciation for the benefits of vaccination and the desire to prevent cancer. Community-level concerns regarding safety and quality of services will need to be addressed. The immunization system in Peru is strong and has capacity for including the HPV vaccine. Formative research provides key insights to help shape an effective program for HPV vaccine introduction.
UK policy and strategy for the management of LLW has changed significantly in recent years, not least through development and implementation of the 'UK Strategy for the Management of Solid Low Level Radioactive Waste from the Nuclear Industry' as part of the UK Nuclear Decommissioning Authority's mission. This has influenced all aspects of LLW management in the UK, including metals recycling and VLLW disposal. The paper will outline the legal context for these changes in the UK and highlight how international conventions and legal frameworks have influenced these developments. In particular, the paper will look at the following important influences on choices for recycling and disposal of LLW and VLLW. - The Paris and Brussels Conventions on third party liabilities for nuclear damage; - on-going work to implement the 2004 Protocols to those conventions, including the impact on disposal sites and proposals to exclude VLLW disposal sites from liabilities regimes; - The Revised Waste Framework Directive and Waste Hierarchy; - Relevant European pollution prevention and control legislation and Best Available Techniques. (author)
Mostert, S; Njuguna, F; Langat, S C; Slot, A J M; Skiles, J; Sitaresmi, M N; van de Ven, P M; Musimbi, J; Vreeman, R C; Kaspers, G J L
The principal reason for childhood cancer treatment failure in low-income countries is treatment abandonment, the most severe form of nonadherence. Two often neglected factors that may contribute to treatment abandonment are as follows: (a) lack of information and guidance by doctors, along with the negative beliefs of family and friends advising parents, which contributes to misconceptions regarding cancer and its treatment, and (b) a widespread policy in public hospitals by which children are retained after doctor's discharge until medical bills are settled. This study explored parents' experiences with hospital retention policies in a Kenyan academic hospital and the impact of attitudes of family and friends on parents' decisions about continuing cancer treatment for their child. Home visits were conducted to interview parents of childhood cancer patients who had been diagnosed between 2007 and 2009 and who had abandoned cancer treatment. Retrospective chart review revealed 98 children diagnosed between 2007 and 2009 whose parents had made the decisions to abandon treatment. During 2011-2012, 53 families (54%) could be reached, and 46 (87%) of these agreed to be interviewed. Parents reported the attitudes of community members (grandparents, relatives, friends, villagers, and church members); 61% believed that the child had been bewitched by some individual, and 74% advised parents to seek alternative treatment or advised them to stop medical treatment (54%). Parents also reported that they were influenced by discussions with other parents who had a child being treated, including that their child's life was in God's hands (87%), the trauma to the child and family of forced hospital stays (84%), the importance of completing treatment (81%), the financial burden of treatment (77%), and the incurability of cancer (74%). These discussions influenced their perceptions of cancer treatment and its usefulness (65%). Thirty-six families (78%) had no health insurance, and
Vasquez, Liliana; Diaz, Rosdali; Chavez, Sharon; Tarrillo, Fanny; Maza, Ivan; Hernandez, Eddy; Oscanoa, Monica; García, Juan; Geronimo, Jenny; Rossell, Nuria
Abandonment of treatment is a major cause of treatment failure and poor survival in children with cancer in low- and middle-income countries. The incidence of treatment abandonment in Peru has not been reported. The aim of this study was to examine the prevalence of and factors associated with treatment abandonment by pediatric patients with solid tumors in Peru. We retrospectively reviewed the sociodemographic and clinical data of children referred between January 2012 and December 2014 to the two main tertiary centers for childhood cancer in Peru. The definition of treatment abandonment followed the International Society of Paediatric Oncology, Paediatric Oncology in Developing Countries, Abandonment of Treatment recommendation. Data from 1135 children diagnosed with malignant solid tumors were analyzed, of which 209 (18.4%) abandoned treatment. Bivariate logistic regression analysis showed significantly higher abandonment rates in children living outside the capital city, Lima (forest; odds ratio [OR] 3.25; P < 0.001), those living in a rural setting (OR 3.44; P < 0.001), and those whose parent(s) lacked formal employment (OR 4.39; P = 0.001). According to cancer diagnosis, children with retinoblastoma were more likely to abandon treatment compared to children with other solid tumors (OR 1.79; P = 0.02). In multivariate regression analyses, rural origin (OR 2.02; P = 0.001) and lack of formal parental employment (OR 2.88; P = 0.001) were independently predictive of abandonment. Treatment abandonment prevalence of solid tumors in Peru is high and closely related to sociodemographical factors. Treatment outcomes could be substantially improved by strategies that help prevent abandonment of therapy based on these results. © 2018 Wiley Periodicals, Inc.
Villarreal, M. A
.... A free trade agreement with Peru is one of several bilateral free trade agreements (FTAs) negotiated or being considered by the United States with Latin American countries in its effort to advance free trade throughout the region...
Kim, David D; Basu, Anirban
Cost-effectiveness analysis (CEA) methods fail to acknowledge that where cost-effectiveness differs across subgroups, there may be differential adoption of technology. Also, current CEA methods are not amenable to incorporating the impact of policy alternatives that potentially influence the adoption behavior. Unless CEA methods are extended to allow for a comparison of policies rather than simply treatments, their usefulness to decision makers may be limited. We conceptualize new metrics, which estimate the realized value of technology from policy alternatives, through introducing subgroup-specific adoption parameters into existing metrics, incremental cost-effectiveness ratios (ICERs) and Incremental Net Monetary Benefits (NMBs). We also provide the Loss with respect to Efficient Diffusion (LED) metrics, which link with existing value of information metrics but take a policy evaluation perspective. We illustrate these metrics using policies on treatment with combination therapy with a statin plus a fibrate v. statin monotherapy for patients with diabetes and mixed dyslipidemia. Under the traditional approach, the population-level ICER of combination v. monotherapy was $46,000/QALY. However, after accounting for differential rates of adoption of the combination therapy (7.2% among males and 4.3% among females), the modified ICER was $41,733/QALY, due to the higher rate of adoption in the more cost-effective subgroup (male). The LED metrics showed that an education program to increase the uptake of combination therapy among males would provide the largest economic returns due to the significant underutilization of the combination therapy among males under the current policy. This framework may have the potential to improve the decision-making process by producing metrics that are better aligned with the specific policy decisions under consideration for a specific technology.
Garcia, Hector H; Gonzalez, Armando E; Tsang, Victor C W; O'Neal, Seth E; Llanos-Zavalaga, Fernando; Gonzalvez, Guillermo; Romero, Jaime; Rodriguez, Silvia; Moyano, Luz M; Ayvar, Viterbo; Diaz, Andre; Hightower, Allen; Craig, Philip S; Lightowlers, Marshall W; Gauci, Charles G; Leontsini, Elli; Gilman, Robert H
Taeniasis and cysticercosis are major causes of seizures and epilepsy. Infection by the causative parasite Taenia solium requires transmission between humans and pigs. The disease is considered to be eradicable, but data on attempts at regional elimination are lacking. We conducted a three-phase control program in Tumbes, Peru, to determine whether regional elimination would be feasible. We systematically tested and compared elimination strategies to show the feasibility of interrupting the transmission of T. solium infection in a region of highly endemic disease in Peru. In phase 1, we assessed the effectiveness and feasibility of six intervention strategies that involved screening of humans and pigs, antiparasitic treatment, prevention education, and pig replacement in 42 villages. In phase 2, we compared mass treatment with mass screening (each either with or without vaccination of pigs) in 17 villages. In phase 3, we implemented the final strategy of mass treatment of humans along with the mass treatment and vaccination of pigs in the entire rural region of Tumbes (107 villages comprising 81,170 people and 55,638 pigs). The effect of the intervention was measured after phases 2 and 3 with the use of detailed necropsy to detect pigs with live, nondegenerated cysts capable of causing new infection. The necropsy sampling was weighted in that we preferentially included more samples from seropositive pigs than from seronegative pigs. Only two of the strategies implemented in phase 1 resulted in limited control over the transmission of T. solium infection, which highlighted the need to intensify the subsequent strategies. After the strategies in phase 2 were implemented, no cyst that was capable of further transmission of T. solium infection was found among 658 sampled pigs. One year later, without further intervention, 7 of 310 sampled pigs had live, nondegenerated cysts, but no infected pig was found in 11 of 17 villages, including all the villages in which mass
The relationship between internal migration and employment problems in Peru is examined. The author argues that regional differences in income distribution are the primary causes of migration, particularly to urban areas. A model of the migration process is developed and tested using data from official sources, surveys, and the published literature.
Moro, Pedro L; Budke, Christine M; Schantz, Peter M; Vasquez, Julio; Santivañez, Saul J; Villavicencio, Jaime
Cystic echinococcosis (CE) constitutes an important public health problem in Peru. However, no studies have attempted to estimate the monetary and non-monetary impact of CE in Peruvian society. We used official and published sources of epidemiological and economic information to estimate direct and indirect costs associated with livestock production losses and human disease in addition to surgical CE-associated disability adjusted life years (DALYs) lost. The total estimated cost of human CE in Peru was U.S.$2,420,348 (95% CI:1,118,384-4,812,722) per year. Total estimated livestock-associated costs due to CE ranged from U.S.$196,681 (95% CI:141,641-251,629) if only direct losses (i.e., cattle and sheep liver destruction) were taken into consideration to U.S.$3,846,754 (95% CI:2,676,181-4,911,383) if additional production losses (liver condemnation, decreased carcass weight, wool losses, decreased milk production) were accounted for. An estimated 1,139 (95% CI: 861-1,489) DALYs were also lost due to surgical cases of CE. This preliminary and conservative assessment of the socio-economic impact of CE on Peru, which is based largely on official sources of information, very likely underestimates the true extent of the problem. Nevertheless, these estimates illustrate the negative economic impact of CE in Peru.
Pedro L Moro
Full Text Available BACKGROUND: Cystic echinococcosis (CE constitutes an important public health problem in Peru. However, no studies have attempted to estimate the monetary and non-monetary impact of CE in Peruvian society. METHODS: We used official and published sources of epidemiological and economic information to estimate direct and indirect costs associated with livestock production losses and human disease in addition to surgical CE-associated disability adjusted life years (DALYs lost. FINDINGS: The total estimated cost of human CE in Peru was U.S.$2,420,348 (95% CI:1,118,384-4,812,722 per year. Total estimated livestock-associated costs due to CE ranged from U.S.$196,681 (95% CI:141,641-251,629 if only direct losses (i.e., cattle and sheep liver destruction were taken into consideration to U.S.$3,846,754 (95% CI:2,676,181-4,911,383 if additional production losses (liver condemnation, decreased carcass weight, wool losses, decreased milk production were accounted for. An estimated 1,139 (95% CI: 861-1,489 DALYs were also lost due to surgical cases of CE. CONCLUSIONS: This preliminary and conservative assessment of the socio-economic impact of CE on Peru, which is based largely on official sources of information, very likely underestimates the true extent of the problem. Nevertheless, these estimates illustrate the negative economic impact of CE in Peru.
Bellew, Rosemary; Moock, Peter
This cost-benefit analysis of Peruvian vocational and technical education (VTE) partly substantiates previous research suggesting that VTE in developing countries fails to offer a return commensurate with its cost. The costs of academic and VTE streams in Peru are similar, and graduates' monetary returns and occupational profiles are almost…
Dols, Mary Ann
A high school friendship inspired a love of other cultures and a desire to pursue missionary nursing in South America. As a parish nurse in a remote village in Peru, the author trained village health workers in the basics of hygiene, first aid, and disease prevention.
Citizenship and Political Violence in Peru recounts the hidden history of how local processes of citizen formation in an Andean town were persistently overruled from the nineteenth century on, thereby perpetuating antagonism toward the Peruvian state and political centralism. The analysis points...
Cryptosporidium is a waterborne bacteria that can cause severe diarrhea and vomiting. In this podcast, Dr. Vita Cama, CDC microbiologist, discusses an article in the October 2008 issue of Emerging Infectious Diseases. The paper examines Cryptosporidium infections among children in Peru, including the number of infections, symptoms experienced, and what species of Crypto were responsible.
Rubin, Jennifer K.; Hesketh, Rachel; Martin, Adam; Herman, William H.; Rubino, Francesco
Despite increasing recognition of the efficacy, safety, and cost-effectiveness of bariatric/metabolic surgery in the treatment of type 2 diabetes, few patients who may be appropriate candidates and may benefit from this type of surgery avail themselves of this treatment option. To identify conceptual and practical barriers to appropriate use of surgical procedures, a Policy Lab was hosted at the 3rd World Congress on Interventional Therapies for Type 2 Diabetes on 29 September 2015. Twenty-six stakeholders participated in the Policy Lab, including academics, clinicians, policy-makers, industry leaders, and patient representatives. Participants were provided with a summary of available evidence about the cost-effectiveness of bariatric/metabolic surgery and the costs of increasing the use of bariatric/metabolic surgery, using U.K. and U.S. scenarios as examples of distinct health care systems. There was widespread agreement among this group of stakeholders that bariatric/metabolic surgery is a legitimate and cost-effective approach to the treatment of type 2 diabetes in obese patients. The following four building blocks were identified to facilitate policy changes: 1) communicating the scale of the costs and harms associated with rising prevalence of type 2 diabetes; 2) properly articulating the role of bariatric/metabolic surgery for certain population groups; 3) identifying new funding sources for bariatric/metabolic surgery; and 4) incorporating bariatric/metabolic surgery into the appropriate clinical pathways. Although more research is needed to identify specific clinical scenarios for the prioritization of bariatric/metabolic surgery, the case appears to be strong enough to engage relevant policy-makers and practitioners in a concerted discussion of how to better use metabolic surgical resources in conjunction with other interventions in good diabetes practice. PMID:27222554
Ramírez-Soto, Max Carlos; Bracho, Maria Alma; González-Candelas, Fernando; Huichi-Atamari, Milagros
Although hepatitis B virus (HBV) infection is still endemic in Abancay, Peru, two decades after vaccination against hepatitis B started in the area, little is known about the diversity and circulation of genotypes and subgenotypes of the virus. To identify the genotypes and subtypes of HBV circulating in Abancay, complete genome sequences of 11 treatment-naive HBV-infected patients were obtained, and phylogenetic analysis was conducted with these and additional sequences from GenBank. Genotyping revealed the presence of genotype F in all the samples from Abancay. Subgenotype F1b was dominant and only one isolate belonged to subgenotype F4, which represents the first description of this subgenotype in Peru. Phylogenetic analysis revealed that most subgenotype F1b isolates from Peru clustered in a subgroup along with two sequences from Argentina, whereas two clusters with two HBV/F1b sequences each were indicative of recent epidemiological linkage, but only one could be verified by independent data. These results suggest that the HBV subgenotype F1b seems to be the predominant subgenotype in Abancay, Peru.
Vestergaard, Lasse S; Ringwald, Pascal
of rational and updated malaria treatment policies, but defining and updating such policies requires a sufficient volume of high-quality drug-resistance data collected at national and regional levels. Three main tools are used for drug resistance monitoring, including therapeutic efficacy tests, in vitro...... additional information about changing patterns of resistance. However, some of the tests are technically demanding, and thus there is a need for more resources for training and capacity building in endemic countries to be able to adequately respond to the challenge of drug resistance.......Reduced sensitivity of Plasmodium falciparum to formerly recommended cheap and well-known antimalarial drugs places an increasing burden on malaria control programs and national health systems in endemic countries. The high costs of the new artemisinin-based combination treatments underline the use...
Full Text Available Abstract Objective: To assess the prevalence of drug abuse before prison admission and to identify associated sociodemographic and family history risk factors, according to gender, in prisons of Peru. Materials and methods: A secondary analysis was carried out with data from the First National Prisoner Census 2016, using a questionnaire of 173 items that was applied to the whole prison population of Peru. The types of drugs used before admission were analyzed according to characteristics of the penitentiary population, and generalized linear models were used to calculate prevalence ratios with 95% confidence intervals to identify possible factors associated with drug use. Results: Out of a population of 76,180 prisoners, 71,184 (93.4% answered the survey (men 67,071, 94.2%. The overall prevalence of drug consumption before admission was 24.4% (25.3 % in men and 9.1% in women, the highest prevalence in the 18-29 age group (36.3% in men and 14.9% in women. The most commonly used drugs were marijuana (58.2%, coca paste/cocaine or crack (40.3% and inhalants (1%. The factors most strongly associated with consumption were having a family member who consumed drugs (59.8%, history of previous imprisonment (59.1%, unemployment (48.4%, relationships at school with classmates who had problems with the law (46.9%, background of a family member who attended a penitentiary (38.4%, and history of running away from home before age 15 (35.9%. Conclusions: In Peru, drug use is higher in the prison population than in the general population, and there are differences according to sex in the prevalence of drug use and associated factors prior to admission to a prison. The study demonstrated that childhood events, such as child abuse, having a family member imprisoned, having a family member who used drugs, or who previously abused alcohol, are factors associated with drug use in the penitentiary population. Some of these risk factors are modifiable, so it is
Rattanavipapong, Waranya; Anothaisintawee, Thunyarat; Teerawattananon, Yot
Thailand is encountering challenges to introduce the high-cost sofosbuvir for chronic hepatitis C treatment as part of the Universal Health Care's benefit package. This study was conducted in respond to policy demand from the Thai government to assess the value for money and budget impact of introducing sofosbuvir-based regimens in the tax-based health insurance scheme. The Markov model was constructed to assess costs and benefits of the four treatment options that include: (i) current practice-peginterferon alfa (PEG) and ribavirin (RBV) for 24 weeks in genotype 3 and 48 weeks for other genotypes; (ii) Sofosbuvir plus peginterferon alfa and ribavirin (SOF+PEG-RBV) for 12 weeks; (iii) Sofosbuvir and daclatasvir (SOF+DCV) for 12 weeks; (iv) Sofosbuvir and ledipasvir (SOF+LDV) for 12 weeks for non-3 genotypes and SOF+PEG-RBV for 12 weeks for genotype 3 infection. Given that policy options (ii) and (iii) are for pan-genotypic infection, the cost of genotype testing was applied only for policy options (i) and (iv). Results reveal that all sofosbuvir-based regimens had greater quality adjusted life years (QALY) gains compared with the current treatment, therefore associated with lower lifetime costs and more favourable health outcomes. Additionally, among the three regimens of sofosbuvir, SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype are the most cost-effective treatment option with the threshold of 160,000 THB per QALY gained. The results of this study had been used in policy discussion which resulted in the recent inclusion of SOF+PEG-RBV for genotype 3 and SOF+LDV for non-3 genotype in the Thailand's benefit package.
Full Text Available Abstract Background Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs. We examined two cases: the use of magnesium sulphate (MgSO4 in the treatment of eclampsia in pregnancy (a clinical case; and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case. Methods We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. Findings Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three
Woelk, Godfrey; Daniels, Karen; Cliff, Julie; Lewin, Simon; Sevene, Esperança; Fernandes, Benedita; Mariano, Alda; Matinhure, Sheillah; Oxman, Andrew D; Lavis, John N; Lundborg, Cecilia Stålsby
Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO(4)) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case). We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO(4 )and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO(4 )than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO(4), and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries. Translating research knowledge into
... tax authority controls, and primary and secondary data on the market for tobacco ... surveys, data from earlier studies, marketing analyses, and previous reports. ... International Water Resources Association, in close collaboration with IDRC, ...
Full Text Available There are between 8 and 11 million cases of America Human Trypanosomiasis, commonly known as Chagas disease, in Latin America. Chagas is endemic in southern Peru, especially the Arequipa region, where it has expanded from poor, rural areas to periurban communities. This paper summarizes the findings of four studies in periurban Arequipa: on determinants of disease-vector infestation; on prevalence, spatial patterns, and risk factors of Chagas; on links between migration, settlement patterns, and disease-vector infestation; and on the relationship between discordant test results and spatially clustered transmission hotspots. These studies identified two risk factors associated with the disease: population dynamics and the urbanization of poverty. Understanding the disease within this new urban context will allow for improved public health prevention efforts and policy initiatives. Discovered in 1909 by Brazilian physician Carlos Chagas, American Human Trypanosomiasis is a chronic and potentially life-threatening illness found throughout Latin America (Moncayo, 2003. Indeed, it is estimated that there are between 8 and 11 million cases in Mexico and Central and South America (Centers for Disease Control [CDC], 2009. Chagas disease, as it is most commonly known, is endemic in southern Peru, especially in the region of Arequipa. Once thought to be limited to poor, rural areas, the disease is now appearing in the periurban communities that surround Arequipa City, the capital of the region (Cornejo del Carpio, 2003. Understanding the urbanization of Chagas disease will allow public health and medical professionals to better combat the further transmission of the disease. After providing an overview of Chagas and introducing the scope of the disease in Latin America, this paper will summarize the findings of four recent studies conducted in periurban districts in Arequipa. Ultimately, this paper seeks to identify the risk factors associated with Chagas
Salinas, Jorge L; Alave, Jorge L; Westfall, Andrew O; Paz, Jorge; Moran, Fiorella; Carbajal-Gonzalez, Danny; Callacondo, David; Avalos, Odalie; Rodriguez, Martin; Gotuzzo, Eduardo; Echevarria, Juan; Willig, James H
In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
Jesse L Clark
Full Text Available Syndromic management is an inexpensive and effective method for the treatment of symptomatic sexually transmitted infections (STIs, but its effectiveness as a method of STI control in at-risk populations is questionable. We sought to determine the potential utility of syndromic management as a public health strategy to control STI transmission in high-risk populations in urban Peru.We surveyed 3,285 at-risk men and women from three Peruvian cities from 2003-05. Participants were asked about the presence of genital ulcers, discharge, or dysuria in the preceding six months. Participants reporting symptoms were asked about subsequent health-seeking and partner notification behavior. Urine and vaginal swab samples were tested for Neisseria gonorrhoeae and Chlamydia trachomatis by nucleic acid testing. Serum was tested for syphilis and Herpes Simplex Virus-Type 2 antibodies.Recent urogenital discharge or dysuria was reported by 42.1% of participants with gonorrhea or chlamydia versus 28.3% of participants without infection. Genital ulceration was reported by 6.2% of participants with, and 7.4% of participants without, recent syphilis. Many participants reporting symptoms continued sexual activity while symptomatic, and approximately half of all symptomatic participants sought treatment. The positive and negative predictive values of urogenital discharge or genital ulcer disease in detecting STIs that are common in the study population were 14.4% and 81.5% for chlamydia in women and 8.3% and 89.5% for syphilis among gay-identified men.In our study, STIs among high-risk men and women in urban Peru were frequently asymptomatic and symptomatic participants often remained sexually active without seeking treatment. Additional research is needed to assess the costs and benefits of targeted, laboratory-based STI screening as part of a comprehensive STI control program in developing countries.
Clark, Jesse L.; Lescano, Andres G.; Konda, Kelika A.; Leon, Segundo R.; Jones, Franca R.; Klausner, Jeffrey D.; Coates, Thomas J.; Caceres, Carlos F.
Background Syndromic management is an inexpensive and effective method for the treatment of symptomatic sexually transmitted infections (STIs), but its effectiveness as a method of STI control in at-risk populations is questionable. We sought to determine the potential utility of syndromic management as a public health strategy to control STI transmission in high-risk populations in urban Peru. Methodology We surveyed 3,285 at-risk men and women from three Peruvian cities from 2003–05. Participants were asked about the presence of genital ulcers, discharge, or dysuria in the preceding six months. Participants reporting symptoms were asked about subsequent health-seeking and partner notification behavior. Urine and vaginal swab samples were tested for Neisseria gonorrhoeae and Chlamydia trachomatis by nucleic acid testing. Serum was tested for syphilis and Herpes Simplex Virus-Type 2 antibodies. Findings Recent urogenital discharge or dysuria was reported by 42.1% of participants with gonorrhea or chlamydia versus 28.3% of participants without infection. Genital ulceration was reported by 6.2% of participants with, and 7.4% of participants without, recent syphilis. Many participants reporting symptoms continued sexual activity while symptomatic, and approximately half of all symptomatic participants sought treatment. The positive and negative predictive values of urogenital discharge or genital ulcer disease in detecting STIs that are common in the study population were 14.4% and 81.5% for chlamydia in women and 8.3% and 89.5% for syphilis among gay-identified men. Conclusions In our study, STIs among high-risk men and women in urban Peru were frequently asymptomatic and symptomatic participants often remained sexually active without seeking treatment. Additional research is needed to assess the costs and benefits of targeted, laboratory-based STI screening as part of a comprehensive STI control program in developing countries. PMID:19779620
Guy, R.; Stubailo, I.; Skinner, S.; Phillips, K.; Foote, E.; Lukac, M.; Aguilar, V.; Tavera, H.; Audin, L.; Husker, A.; Clayton, R.; Davis, P. M.
This work describes preliminary results from a 50 station broadband seismic network recently installed from the coast to the high Andes in Peru. UCLA's Center for Embedded Network Sensing (CENS) and Caltech's Tectonic Observatory are collaborating with the IRD (French L'Institut de Recherche pour le Developpement) and the Institute of Geophysics, in Lima Peru in a broadband seismic experiment that will study the transition from steep to shallow slab subduction. The currently installed line has stations located above the steep subduction zone at a spacing of about 6 km. In 2009 we plan to install a line of 50 stations north from this line along the crest of the Andes, crossing the transition from steep to shallow subduction. A further line from the end of that line back to the coast, completing a U shaped array, is in the planning phase. The network is wirelessly linked using multi-hop network software designed by computer scientists in CENS in which data is transmitted from station to station, and collected at Internet drops, from where it is transmitted over the Internet to CENS each night. The instrument installation in Peru is almost finished and we have been receiving data daily from 10 stations (out of total 50) since June 2008. The rest are recording on-site while the RF network is being completed. The software system provides dynamic link quality based routing, reliable data delivery, and a disruption tolerant shell interface for managing the system from UCLA without the need to travel to Peru. The near real-time data delivery also allows immediate detection of any problems at the sites. We are building a seismic data and GPS quality control toolset that would greatly minimize the station's downtime by alerting the users of any possible problems.
Full Text Available In many countries around the world, including Iran, obesity is reaching epidemic proportions. Doctors have recently taken, or expressed support for, an extreme ‘personal responsibility for health’ policy against obesity: refusing services to obese patients. This policy may initially seem to improve patients’ incentives to fight obesity. But turning access to medical services into a benefit dependent on health improvement is a bad policy. It conditions the very aid that patients need in order to become healthier or success in becoming healthier. Whatever else we may think of personal responsibility for health policies, this particular one is absurd. Unfortunately, quite a few personal responsibility for health policies use similar absurd conditioning. They mistakenly use ‘carrots’ or ‘sticks’ for adherence the basic means to the same health outcomes that they seek to promote. This perspective proposes the following rule of thumb: any conditional incentive for healthy choice should be in a currency other than the basic means to that healthy choice.
Chambers, G M; Hoang, V P; Illingworth, P J
What was the impact on access to assisted reproductive technology (ART) treatment by different socioeconomic status (SES) groups after the introduction of a policy that increased patient out-of-pocket costs? After the introduction of a policy that increased out-of-pocket costs in Australia, all SES groups experienced a similar percentage reduction in fresh ART cycles per 1000 women of reproductive age. Higher SES groups experienced a progressively greater reduction in absolute numbers of fresh ART cycles due to existing higher levels of utilization. Australia has supportive public funding arrangements for ARTs. Policies that substantially increase out-of-pocket costs for ART treatment create financial barriers to access and an overall reduction in utilization. Data from the USA suggests that disparities exist in access to ART treatment based on ethnicity, education level and income. Time series analysis of utilization of ART, intrauterine insemination (IUI) and clomiphene citrate by women from varying SES groups before and after the introduction of a change in the level of public funding for ART. Women undertaking fertility treatment in Australia between 2007 and 2010. Women from higher SES quintiles use more ART treatment than those in lower SES quintiles, which likely reflects a greater ability to pay for treatment and a greater need for ART treatment as indicated by the trend to later childbearing. In 2009, 10.13 and 5.17 fresh ART cycles per 1000 women of reproductive age were performed in women in the highest and lowest SES quintiles respectively. In the 12 months after the introduction of a policy that increased out-of-pocket costs from ∼$1500 Australian dollars (€1000) to ∼$2500 (€1670) for a fresh IVF cycle, there was a 21-25% reduction in fresh ART cycles across all SES quintiles. The absolute reduction in fresh ART cycles in the highest SES quintile was double that in the lowest SES quintile. In this study, SES was based on the average relative
Czechowicz, Josephine; Huaman, Jose Luis; Forshey, Brett M; Morrison, Amy C; Castillo, Roger; Huaman, Alfredo; Caceda, Roxana; Eza, Dominique; Rocha, Claudio; Blair, Patrick J; Olson, James G; Kochel, Tadeusz J
Although encephalomyocarditis virus (EMCV) infection has been commonly documented among domestic animals, less is known about EMCV transmission among humans. Recently, we described the isolation of EMCV from two febrile patients in Peru. To further investigate EMCV transmission in Peru, we screened febrile patients reporting to health clinics in Peru for serological evidence of recent EMCV infection. We also conducted a serological survey for EMCV-neutralizing antibodies in the city of Iquitos, located in the Amazon basin department of Loreto, Peru. Additionally, we screened serum from rodents collected from 10 departments in Peru for evidence of EMCV exposure. EMCV infection was found to be only rarely associated with acute febrile disease in Peru, accounting for 17% in cities in the tropical rainforest of northeastern Peru (Iquitos and Yurimaguas). On the basis of the serological survey conducted in Iquitos, risk factors for past infection include increased age, socioeconomic indicators such as residence construction materials and neighborhood, and swine ownership. Evidence from the rodent survey indicates that EMCV exposure is common among Murinae subfamily rodents in Peru (9.4% EMCV IgG positive), but less common among Sigmodontinae rodents (1.0% positive). Further studies are necessary to more precisely delineate the mode of EMCV transmission to humans, other potential disease manifestations, and the economic impact of EMCV transmission among swine in Peru.
Eugenics was defined by Galton as 'the science which deals with all influences that improve the inborn qualities of a race'. In Peru, eugenics was related to social medicine and mental hygiene, in accordance with the neo-Lamarckian orientation, that predominated in Latin America. Peruvian eugenists assumed the mission of fighting hereditary and infectious diseases, malnutrition, alcoholism, drug addiction, prostitution, criminality and everything that threatened the future of the 'Peruvian race'. There were some enthusiastic advocates of 'hard' eugenic measures, such as forced sterilization and eugenic abortion, but these were never officially implemented in Peru (except for the compulsory sterilization campaign during the 1995-2000 period). Eugenics dominated scientific discourse during the first half of the twentieth century, but eugenic discourse did not disappear completely until the 1970s.
Zoila Olga de los Milagros Romero Albino
Full Text Available Family medicine in Peru had its origins in 1989, when the first family medicine residency was created; thereafter has had stages of improving and decline, there are currently more than 250 family physician graduated, between 70 and 90 seats of residency in annually, not having even insert family medicine in undergraduate medical schools. The inclusion of family physicians in the health system has been torpid, Peru has a mixed health system with multiple insurers and providers and 30% of the population without coverage, no real compliance characteristics of systems based on attention primary and first contact and access, longitudinality, comprehensiveness and coordination. It is expected to strengthen the specialty improve future training scenarios and developing a united health system.
Moro, Pedro L.; Budke, Christine M.; Schantz, Peter M.; Vasquez, Julio; Santivañez, Saul J.; Villavicencio, Jaime
BACKGROUND: Cystic echinococcosis (CE) constitutes an important public health problem in Peru. However, no studies have attempted to estimate the monetary and non-monetary impact of CE in Peruvian society. METHODS: We used official and published sources of epidemiological and economic information to estimate direct and indirect costs associated with livestock production losses and human disease in addition to surgical CE-associated disability adjusted life years (DALYs) lost. FINDINGS: The to...
The anchovy harvest off the coast of Peru has decreased from a maximum of about 12 million tons in 1970 to about 1 million tons/year between 1977 and 1979. This rise and collapse of the Peruvian anchovy fishery between the 1950s and the 1970s was accompanied by marked changes in the fluxes of a carbon budget for the upwelling ecosystem. These carbon budget changes are discussed in relation to anchovy production. (JMT)
In 2003, a national multi-sectorial Handwashing Initiative (HWI) was created in Peru to increase handwashing with soap among mothers and children. The early years of the HWI focused on laying groundwork, including a formative research study in 2004; the creation of a consultative committee by the Ministry of Health (MoH); and a national decree formalizing the HWI. The Water and Sanitation ...
Wang Mingcai; Xu Yunming
@@ Sino-American Oil Development Corporation (hereinafter referred to as"SODC") has taken part in the international operation activities in petroleum exploration and development in Latin-American area since 1992 and some progress has been made. At present, SODC is carrying out the operations within the Sixth and Seventh Blocks of Tarara oil field of the Republic of Peru and gains a good prestige.
Ramirez Quijada, R.
The paper describes the inventory of radioactive sources in Peru and assesses the control. Three groups of source conditions are established: controlled sources, known sources, and lost and orphan sources. The potential risk, described as not significant, for producing accidents is established and the needed measures are discussed. The paper concludes that, while the control on sealed sources is good, there is still room for improvement. (author)
Cryptosporidium is a waterborne bacteria that can cause severe diarrhea and vomiting. In this podcast, Dr. Vita Cama, CDC microbiologist, discusses an article in the October 2008 issue of Emerging Infectious Diseases. The paper examines Cryptosporidium infections among children in Peru, including the number of infections, symptoms experienced, and what species of Crypto were responsible. Created: 9/25/2008 by Emerging Infectious Diseases. Date Released: 9/25/2008.
OLIVIA HERNÁNDEZ POZAS; KETY LOURDES JAUREGUI
Organizations need well trained employees in order to maintain a competitive advantage. The purpose of this paper is to describe current training practices in Peru and to provide recommendations for improving organizational performance. This paper also aims to set priorities for future research work. Human capital theory and contributions on need assessment, and training planning, implementation and evaluation served as theoretical framework. This is a cross-sectional, exploratory study that ...
Citizenship and Political Violence in Peru recounts the hidden history of how local processes of citizen formation in an Andean town were persistently overruled from the nineteenth century on, thereby perpetuating antagonism toward the Peruvian state and political centralism. The analysis points...... violence in the 1980s. The book builds on the detailed study of a unique municipal archive in Tarma and ethnographic research from both before and after the violence....
... securities issued to the Treasury through the Small Business Lending Fund established under the Small... subject to the Policy Statement as in effect on May 19, 2010. The CPP Subordinated Securities may be... Subordinated Securities from debt. SBLF Subordinated Securities Under the Small Business Jobs Act of 2010 (SBJA...
Mazzetti, Pilar; Inca-Martínez, Miguel; Tirado-Hurtado, Indira; Milla-Neyra, Karina; Silva-Paredes, Gustavo; Vishnevetsky, Anastasia; Cornejo-Olivas, Mario
Neurogenetics is an emerging discipline in Peru that links basic research with clinical practice. The Neurogenetics Research Center located in Lima, Peru is the only unit dedicated to the specialized care of neurogenetic diseases in the country. From the beginning, neurogenetics research has been closely linked to the study of Huntingtons Disease (HD), from the PCR genotyping of the HTT gene, to the current haplogroup studies in HD. Research in other monogenic diseases led to the implementation of alternative methodologies for the genotyping of Fragile X and Myotonic Dystrophy Type 1. Both, national and international collaborative efforts have facilitated the discovery of new genetic variants in complex multigenic diseases such as Parkinsons disease and Alzheimers disease. Additionally, multidisciplinary education and mentoring have allowed for the training of new neurogenetics specialists, supporting the sustained growth of the discipline in the country. The promotion of research in Peru has spurred the growth of neurogenetics research, although limitations in infrastructure, technology, and education remain a challenge for the further growth of research in this field.
Fritz, H. M.; Kalligeris, N.; Borrero, J. C.
On 15 August 2007 an earthquake with moment magnitude (Mw) of 8.0 centered off the coast of central Peru, generated a tsunami with locally focused runup heights of up to 10 m. A reconnaissance team was deployed in the immediate aftermath and investigated the tsunami effects at 51 sites. The largest runup heights were measured in a sparsely populated desert area south of the Paracas Peninsula resulting in only 3 tsunami fatalities. Numerical modeling of the earthquake source and tsunami suggest that a region of high slip near the coastline was primarily responsible for the extreme runup heights. The town of Pisco was spared by the presence of the Paracas Peninsula, which blocked tsunami waves from propagating northward from the high slip region. The coast of Peru has experienced numerous deadly and destructive tsunamis throughout history, which highlights the importance of ongoing tsunami awareness and education efforts in the region. The Peru tsunami is compared against recent mega-disasters such as the 2004 Indian Ocean tsunami and Hurricane Katrina.
Ministerio de Educacion, Lima (Peru).
These two documents describe developments and methods of information dissemination which have contributed to strengthening educational reform in Peru since 1972. Educational developments discussed include: (1) decentralization of school administration with increased community participation; (2) a policy calling for the implementation of…
Hynes, Marya; Demarco, Maria; Araneda, Juan Carlos; Cumsille, Francisco
Young adults 18 to 25 years old show the highest prevalence of marijuana use in Latin America. This study analyzes the changes in prevalence of marijuana use among university students in the Andean Community (Bolivia, Colombia, Ecuador, and Peru) from two studies carried out in 2009 and in 2012. Data were collected through representative two-stage samples of universities and students in the Andean Community. An online survey was administered using a standardized questionnaire. Prevalence was calculated for lifetime, past year, and past month. Marijuana was the most widely used illicit substance consumed among university students, in 2009 and in 2012. Past month prevalence among university students in 2009 in Colombia was 5.27%, in Peru 1.00%, in Ecuador 1.68%, and in Bolivia 0.76%. Past month prevalence in 2012 in Colombia was 7.14%, in Ecuador 3.67%, in Peru 1.62%, and in Bolivia 1.45% in 2012. Among university students in the Andean Community, past month prevalence increased among both males and females between 2009 and 2012 in most countries. Marijuana continues to be the most commonly used illicit drug in Latin American countries. Increases in prevalence among young adults could have important implications for national drug policy.
Diez-Canseco, Francisco; Saavedra-Garcia, Lorena
In recent decades, overweight or obesity have increased dramatically in middle- and low-income countries; a situation which consolidates chronic non-communicable diseases (NCD) as one of the leading causes of mortality and disability worldwide. Currently, half the people in Peru over the age of 15 years are overweight, and one fifth suffer from obesity. The situation is worsening and increasingly affects people in poverty, who frequently benefit from food supplement programs designed to combat food insecurity and malnutrition. There is an urgent worldwide need to find policies and programs that help fight the problem of obesity at the population level, a task that is still pending. In this article, we review the current epidemic of overweight and obesity in Peru and the world and its most significant consequences and causes, with an emphasis on access to and availability of foods. We describe the largest food supplement programs and synthesize the research on interventions in order to reflect on how their findings might help social programs work as a platform to reduce obesity and prevent NCD in Peru.
Full Text Available Young adults 18 to 25 years old show the highest prevalence of marijuana use in Latin America. This study analyzes the changes in prevalence of marijuana use among university students in the Andean Community (Bolivia, Colombia, Ecuador, and Peru from two studies carried out in 2009 and in 2012. Data were collected through representative two-stage samples of universities and students in the Andean Community. An online survey was administered using a standardized questionnaire. Prevalence was calculated for lifetime, past year, and past month. Marijuana was the most widely used illicit substance consumed among university students, in 2009 and in 2012. Past month prevalence among university students in 2009 in Colombia was 5.27%, in Peru 1.00%, in Ecuador 1.68%, and in Bolivia 0.76%. Past month prevalence in 2012 in Colombia was 7.14%, in Ecuador 3.67%, in Peru 1.62%, and in Bolivia 1.45% in 2012. Among university students in the Andean Community, past month prevalence increased among both males and females between 2009 and 2012 in most countries. Marijuana continues to be the most commonly used illicit drug in Latin American countries. Increases in prevalence among young adults could have important implications for national drug policy.
Maina, William K; Kim, Andrea A; Rutherford, George W; Harper, Malayah; K'Oyugi, Boniface O; Sharif, Shahnaaz; Kichamu, George; Muraguri, Nicholas M; Akhwale, Willis; De Cock, Kevin M
AIDS Indicator Surveys are standardized surveillance tools used by countries with generalized HIV epidemics to provide, in a timely fashion, indicators for effective monitoring of HIV. Such data should guide responses to the HIV epidemic, meet program reporting requirements, and ensure comparability of findings across countries and over time. Kenya has conducted 2 AIDS Indicator Surveys, in 2007 (KAIS 2007) and 2012-2013 (KAIS 2012). These nationally representative surveys have provided essential epidemiologic, sociodemographic, behavioral, and biologic data on HIV and related indicators to evaluate the national HIV response and inform policies for prevention and treatment of the disease. We present a summary of findings from KAIS 2007 and KAIS 2012 and the impact that these data have had on changing HIV policies and practice.
Ellen R Rafferty
Full Text Available Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01, followed by Peru ($23.32, and Bangladesh ($7.62. The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M, followed by Kenya ($37.4M; range $1.6-$804.5M and Bangladesh ($9.6M, range $0.28-$91.5M. For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
Rafferty, Ellen R; Schurer, Janna M; Arndt, Michael B; Choy, Robert K M; de Hostos, Eugenio L; Shoultz, David; Farag, Marwa
Cryptosporidium is a leading cause of pediatric diarrhea in resource-limited settings; yet, few studies report the health care costs or societal impacts of this protozoan parasite. Our study examined direct and indirect costs associated with symptomatic cryptosporidiosis in infants younger than 12 months in Kenya, Peru and Bangladesh. Inputs to the economic burden model, such as disease incidence, population size, health care seeking behaviour, hospital costs, travel costs, were extracted from peer-reviewed literature, government documents, and internationally validated statistical tools for each country. Indirect losses (i.e. caregiver income loss, mortality, and growth faltering) were also estimated. Our findings suggest that direct treatment costs per symptomatic cryptosporidiosis episode were highest in Kenya ($59.01), followed by Peru ($23.32), and Bangladesh ($7.62). The total annual economic impacts for the 0-11 month cohorts were highest in Peru ($41.5M; range $0.88-$599.3M), followed by Kenya ($37.4M; range $1.6-$804.5M) and Bangladesh ($9.6M, range $0.28-$91.5M). For all scenarios, indirect societal costs far outweighed direct treatment costs. These results highlight the critical need for innovative improvements to current prevention, diagnostic and treatment strategies available in resource poor settings, as well as the need for solutions that span multiple disciplines including food and water safety, sanitation and livestock production.
Mirelman, Andrew J; Ballard, Sarah Blythe; Saito, Mayuko; Kosek, Margaret N; Gilman, Robert H
With candidate norovirus (NV) vaccines in a rapid phase of development, assessment of the potential economic value of vaccine implementation will be necessary to aid health officials in vaccine implementation decisions. To date, no evaluations have been performed to evaluate the benefit of adopting NV vaccines for use in the childhood immunization programs of low- and middle-income countries. We used a Markov decision model to evaluate the cost-effectiveness of adding a two-dose NV vaccine to Peru's routine childhood immunization schedule using two recent estimates of NV incidence, one for a peri-urban region and one for a jungle region of the country. Using the peri-urban NV incidence estimate, the annual cost of vaccination would be $13.0 million, offset by $2.6 million in treatment savings. Overall, this would result in 473 total DALYs averted; 526,245 diarrhea cases averted;153,735 outpatient visits averted; and 414 hospitalizations averted between birth and the fifth year of life. The incremental cost-effectiveness ratio would be $21,415 per DALY averted; $19.86 per diarrhea case; $68.23 per outpatient visit; and $26,298 per hospitalization. Using the higher jungle NV incidence rates provided a lower cost per DALY of $10,135. The incremental cost per DALY with per-urban NV incidence is greater than three times the 2012 GDP per capita of Peru but the estimate drops below this threshold using the incidence from the jungle setting. In addition to the impact of incidence, sensitivity analysis showed that vaccine price and efficacy play a strong role in determining the level of cost-effectiveness. The introduction of a NV vaccine would prevent many healthcare outcomes in the Peru and potentially be cost-effective in scenarios with high NV incidence. The vaccine cost-effectiveness model could also be applied to the evaluation of NV vaccine cost-effectiveness in other countries. In resource-poor settings, where NV incidence rates are expected to be higher. Published
McDonald, Cody L; Fuhs, Amy K; Kartin, Deborah
This study aimed to better understand current clinical practice of rehabilitation professionals in Lima, Peru, and to explore the existence of and potential for interprofessional collaboration. A secondary purpose was to assess rehabilitation professionals' agreement with evidence-based stroke rehabilitation statements and confidence performing stroke rehabilitation tasks prior to and following an interprofessional stroke rehabilitation training. Current clinical practice for rehabilitation professionals in Peru differs from high-income counties like the United States, as physical therapists work with dysphagia and feeding, prosthetist orthotists serve a strictly technical role, and nurses have a limited role in rehabilitation. Additionally, while opportunity for future interprofessional collaboration within stroke rehabilitation exists, it appears to be discouraged by current health system policies. Pre- and post-training surveys were conducted with a convenience sample of 107 rehabilitation professionals in Peru. Survey response options included endorsement of professionals for rehabilitation tasks and a Likert scale of agreement and confidence. Training participants largely agreed with evidence-based stroke rehabilitation statements. Differences in opinion remained regarding the prevalence of dysphagia and optimal frequency of therapy post-stroke. Substantially increased agreement post-training was seen in favour of early initiation of stroke rehabilitation and ankle foot orthosis use. Participants were generally confident performing traditional profession-specific interventions and educating patients and families. Substantial increases were seen in respondents' confidence to safely and independently conduct bed to chair transfers and determine physiological stability. Identification of key differences in rehabilitation professionals' clinical practice in Peru is a first step toward strengthening the development of sustainable rehabilitation systems and
This paper examines the redistributive impact of fiscal policy for Brazil, Chile, Colombia, Indonesia, Mexico, Peru and South Africa using comparable fiscal incidence analysis with data from around 2010. The largest redistributive effect is in South Africa and the smallest in Indonesia. Success in fiscal redistribution is driven primarily by redistributive effort (share of social spending to GDP in each country) and the extent to which transfers/subsidies are targeted to the poor and direct t...
Shishlov, Igor; Bellassen, Valentin
Among the publications of CDC Climat Research, 'Climate Briefs' presents, in a few pages, hot topics in climate change policy. This issue addresses the following points: As the Clean Development Mechanism (CDM) reached the milestone billionth CER issued and the secondary CER price tipped below 2 euros, the recommendations of the High Level Panel on the CDM Policy Dialogue published on 11 September 2012 could not be timelier. By focusing on the current supply-demand disequilibrium that threatens the very survival of the CDM, the Panel extended its recommendations beyond the traditional scope of CDM reform. The Panel's ambition to pro-actively engage with other climate initiatives such as the Green Fund and regional markets is also innovative. Indeed, the CDM toolbox enriched by 10-years of experience stands to apply to or be partly recycled through new mechanisms. Along the 51 recommendations from the Policy Dialogue, there are calls for further standardization and streamlining, together with both old and new ideas on governance and contribution of the CDM to sustainable development
Ramírez Soto, Max Carlos
Abancay province is a long-standing geographical focus of sporotrichosis in the south central highlands of Peru. Therefore, we examined the features of 36 newly identified cases of sporotrichosis from two hospital centers in Abancay province. We also performed a literature review of studies conducted in this endemic geographical focus over a period of 28 years (1998 to 2012), and analyzed the demographic, clinical and epidemiological features of sporotrichosis in the cases reported in these studies. We examined the features of 36 new cases of sporotrichosis identified from two hospital centers in Abancay. Furthermore, we searched for relevant studies of cases of sporotrichosis in the endemic region using healthcare databases and literature sources. We analyzed a detailed subset of data on cases collected in Abancay, neighboring provinces, and other regions of Peru. A total of nine studies were identified, with 1467 cases included in the final analysis. We also analyzed 36 new cases found in the two hospital centers. Therefore, the combined total of cases analyzed was 1503. Of this total, 58% were male, and approximately 62% were aged ≤14 years. As expected, most cases were from Abancay province (88%), although 12% were from neighboring provinces and other regions of Peru. The lymphocutaneous form (939 cases) was the commonest. The face was the most commonly affected region (647 cases). A total of 1224 patients (81.4%) received treatment: 95.8% received potassium iodide, 2.6% ketoconazole and 1.6% itraconazole. The overall success rates were 60.7% with potassium iodide, 32.2% with ketoconazole and 85% with itraconazole. The epidemic of sporotrichosis has been occurring for three decades in the province of Abancay in Peru. This mycosis affects primarily the pediatric population, with predominantly the lymphocutaneous form in the facial region. Although treatment with potassium iodide is safe and effective, response and adherence to treatment are influenced by its
Describes Peru 2021, an organization of business-related individuals with a vision for Peruvian society. Outlines aspects of their vision in the areas of leadership, education, economy, environment, government, business, technology, and society. Discusses Peru 2021's efforts to develop a strategic plan for implementing the vision, to involve…
Gonzalez-Escalona, Narjol; Gavilan, Ronnie G; Toro, Magaly; Zamudio, Maria L; Martinez-Urtaza, Jaime
In 2009, an outbreak of Vibrio parahaemolyticus occurred in Piura, Cajamarca, Lambayeque, and Lima, Peru. Whole-genome sequencing of clinical and environmental samples from the outbreak revealed a new V. parahaemolyticus clone. All the isolates identified belonged to a single clonal complex described exclusively in Asia before its emergence in Peru.
Jul 20, 2016 ... Mini soap operas foster financial education and inclusion of women in Peru. Having little or no savings can be devastating for poor families, especially in times of crisis. View moreMini soap operas foster financial education and inclusion of women in Peru ...
Smits, Henk L.; Espinosa, Benjamin; Castillo, Rosa; Hall, Eric; Guillen, Alfredo; Zevaleta, Milagros; Gilman, Robert H.; Melendez, Paolo; Guerra, Carlos; Draeger, Angelika; Broglia, Alessandro; Nöckler, Karsten
Recent human Brucella melitensis isolates from Peru were genotyped by multiple locus variable number repeat analysis. All 24 isolates originated from hospitalized patients living in the central part of Peru and consisted of six genomic groups comprising two to four isolates and nine unique
The National Cancer Institute (NCI) Center for Global Health (CGH) had the pleasure of welcoming a delegation of health officials from the Government of Peru for the signing of a memorandum of understanding (MOU) between the U.S. and Peru.
Bayer, Angela M.; Nussbaum, Lauren; Cabrera, Lilia; Paz-Soldan, Valerie A.
Despite cervical cancer being one of the leading causes of cancer-related deaths among women in Peru, cervical Pap smear coverage is low. This article uses findings from 185 direct clinician observations in four cities of Peru (representing the capital and each of the three main geographic regions of the country) to assess missed opportunities for…
Razuri, Hugo; Tokarz, Rafal; Ghersi, Bruno M; Salmon-Mulanovich, Gabriela; Guezala, M Claudia; Albujar, Christian; Mendoza, A Patricia; Tinoco, Yeny O; Cruz, Christopher; Silva, Maria; Vasquez, Alicia; Pacheco, Víctor; Ströher, Ute; Guerrero, Lisa Wiggleton; Cannon, Deborah; Nichol, Stuart T; Hirschberg, David L; Lipkin, W Ian; Bausch, Daniel G; Montgomery, Joel M
We investigated hantaviruses in rodents in the southern Amazon Basin of Peru and identified an Andes virus variant from Neacomys spinosus mice. This finding extends the known range of this virus in South America and the range of recognized hantaviruses in Peru. Further studies of the epizoology of hantaviruses in this region are warranted.
Razuri, Hugo; Tokarz, Rafal; Ghersi, Bruno M.; Salmon-Mulanovich, Gabriela; Guezala, M. Claudia; Albujar, Christian; Mendoza, A. Patricia; Tinoco, Yeny O.; Cruz, Christopher; Silva, Maria; Vasquez, Alicia; Pacheco, Víctor; Ströher, Ute; Guerrero, Lisa Wiggleton; Cannon, Deborah
We investigated hantaviruses in rodents in the southern Amazon Basin of Peru and identified an Andes virus variant from Neacomys spinosus mice. This finding extends the known range of this virus in South America and the range of recognized hantaviruses in Peru. Further studies of the epizoology of hantaviruses in this region are warranted.
Journal of Chemical Education, 2007
The discovery of ancient Inca tax rulers and other metallurgical objects in Peru show that the ancient civilizations of the country smelted metals. The analysis shows that the smelters in Peru switched from the production of copper to silver after a tax was imposed on them by the Inca rulers.
Velásquez, Gustavo E; Cegielski, J Peter; Murray, Megan B; Yagui, Martin J A; Asencios, Luis L; Bayona, Jaime N; Bonilla, César A; Jave, Hector O; Yale, Gloria; Suárez, Carmen Z; Sanchez, Eduardo; Rojas, Christian; Atwood, Sidney S; Contreras, Carmen C; Santa Cruz, Janeth; Shin, Sonya S
Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Of 1701 participants treated for tuberculosis, 136 (8.0%) died during tuberculosis treatment. HIV-positive patients constituted 11.0% of the cohort and contributed to 34.6% of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9%, P Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
Recht, Judith; Siqueira, André M; Monteiro, Wuelton M; Herrera, Sonia M; Herrera, Sócrates; Lacerda, Marcus V G
In spite of significant progress towards malaria control and elimination achieved in South America in the 2000s, this mosquito-transmitted tropical disease remains an important public health concern in the region. Most malaria cases in South America come from Amazon rain forest areas in northern countries, where more than half of malaria is caused by Plasmodium vivax, while Plasmodium falciparum malaria incidence has decreased in recent years. This review discusses current malaria data, policies and challenges in four South American Amazon countries: Brazil, Colombia, Peru and the Bolivarian Republic of Venezuela. Challenges to continuing efforts to further decrease malaria incidence in this region include: a significant increase in malaria cases in recent years in Venezuela, evidence of submicroscopic and asymptomatic infections, peri-urban malaria, gold mining-related malaria, malaria in pregnancy, glucose-6-phosphate dehydrogenase (G6PD) deficiency and primaquine use, and possible under-detection of Plasmodium malariae. Some of these challenges underscore the need to implement appropriate tools and procedures in specific regions, such as a field-compatible molecular malaria test, a P. malariae-specific test, malaria diagnosis and appropriate treatment as part of regular antenatal care visits, G6PD test before primaquine administration for P. vivax cases (with weekly primaquine regimen for G6PD deficient individuals), single low dose of primaquine for P. falciparum malaria in Colombia, and national and regional efforts to contain malaria spread in Venezuela urgently needed especially in mining areas. Joint efforts and commitment towards malaria control and elimination should be strategized based on examples of successful regional malaria fighting initiatives, such as PAMAFRO and RAVREDA/AMI.
Powell, T. Hennessy; And Others
Recent reports have indicated that parents and/or physicians occasionally decide not to provide life-sustaining treatment (referred to as involuntary euthanasia), thus ensuring that the severely handicapped newborn will die. The issues involved relative to treatment or involuntary euthanasia are reviewed from two opposing perspectives…
Van Albada, M.
The experiences of the author during his stay in Peru at UNSA are described. The purpose of the author's stay was to set up a system to evaluate study results and explore the market for openings for graduated physicists. His task is the result of a cooperation project between the Delft University of Technology and UNSA
Maco, Vicente; Maguiña, Ciro; Tirado, Antonio; Maco, Vicente; Vidal, José E
Bartonellosis or Carrion's disease is endemic in some regions of Peru, classically found in the inter-Andean valleys located between 500 and 3200 meters above sea level. We report the case of a 43 year-old male patient, farmer, who was born in the Pichanaki district (Chanchamayo, Junin), located in the High Forest of Peru. He presented with disseminated, raised, erythematous cutaneous lesions, some of which bled. The distribution of these lesions included the nasal mucosa and penile region. Additionally subcutaneous nodules were distributed over the trunk and extremities. Hematologic exams showed a moderate anemia. Serologic studies for HIV and Treponema pallidum were negative. The histopathologic results of two biopsies were compatible with Peruvian wart. Oral treatment with ciprofloxacin (500 mg BID) was begun. Over 10 days, the patient showed clinical improvement. This is the first report of a confirmed case of bartonellosis in the eruptive phase originating from the Peruvian High Forest, showing the geographical expansion of the Carrion's disease.
Mendoza-Mujica, Giovanna; Flores-León, Diana
To evaluate in vitro antimicrobial susceptibility to chloramphenicol (CHL) and ciprofloxacin (CIP) in strains of Bartonella bacilliformis from areas that are endemic to Bartonellosis in Peru, through three laboratory methods. Antimicrobial susceptibility to CHL and CIP from 100 strains of Bartonella bacilliformis isolated in patients from the regions of Ancash, Cusco, Cajamarca, Lima and La Libertad were evaluated. Strains were evaluated by: disk diffusion, E-test and agar dilution. 26% of the strains of Bartonella bacilliformis evaluated were resistant to CIP and 1% to CHL. Similar patterns of antimicrobial sensitivity / resistance were obtained in all three methods. Bartonella bacilliformis strains circulating in Peru have high levels of in vitro resistance to CIP, so it is advisable to expand research on the use of drug treatment regimens of the Bartonellosis. The methods of E-test and disk diffusion were the most suitable for assessment in vitro of antimicrobial susceptibility of the microorganism.
Kushner, David S; Verano, John W; Titelbaum, Anne R
More prehistoric trepanned crania have been found in Peru than any other location worldwide. We examine trepanation practices and outcomes in Peru over nearly 2000 years from 400 BC to provide a perspective on the procedure with comparison with procedures/outcomes of other ancient, medieval, and American Civil War cranial surgery. Data on trepanation demographics, techniques, and survival rates were collected through the scientific analysis of more than 800 trepanned crania discovered in Peru, through field studies and the courtesy of museums and private collections in the United States and Peru, over nearly 3 decades. Data on procedures and outcomes of cranial surgery ancient, medieval, and during 19th-century through the American Civil war were obtained via a literature review. Successful trepanations from prehistoric times through the American Civil War likely involved shallow surgeries that did not pierce the dura mater. Although there are regional and temporal variations in ancient Peru, overall long-term survival rates for the study series were about 40% in the earliest period (400-200 BC), with improvement to a high of 91% in samples from AD 1000-1400, to an average of 75%-83% during the Inca Period (AD 1400s-1500). In comparison, the average cranial surgery mortality rate during the American Civil war was 46%-56%, and short- and long-term survival rates are unknown. The contrast in outcomes highlights the astonishing success of ancient cranial surgery in Peru in the treatment of living patients. Copyright © 2018 Elsevier Inc. All rights reserved.
... in Timber Products from Peru and Assignment of Function under Section 501 of the United States-Peru... Memorandum of May 1, 2009 Establishment of the Interagency Committee on Trade in Timber Products from Peru and Assignment of Function under Section 501 of the United States-Peru Trade Promotion Agreement...
Lavado-Casimiro, W. S.; Felipe, O.; Silvestre, E.; Bourrel, L.
The El Niño and La Niña impacts on the hydrology of Peru were assessed based on discharge data (1968-2006) of 20 river catchments distributed over three drainage regions in Peru: 14 in the Pacific Coast (PC), 3 in the Lake Titicaca (TL) region, and 3 in the Amazonas (AM). To classify the El Niño and La Niña events, we used the Southern Oscillation Index (SOI) based on hydrological years (September to August). Using the SOI values, the events were re-classified as strong El Niño (SEN), moderate El Niño (MEN), normal years (N), moderate La Niña (MLN) and strong La Niña (SLN). On average during the SEN years, sharp increases occurred in the discharges in the north central area of the PC and decreases in the remaining discharge stations that were analyzed, while in the years of MEN events, these changes show different responses than those of the SEN. During the years classified as La Niña, positive changes are mostly observed in the majority of the stations in the rivers located in the center of Peru's Pacific Coast. Another important result of this work is that the Ilave River (south of the Titicaca watershed) shows higher positive (negative) impacts during La Niña (El Niño) years, a fact that is not clearly seen in the rivers of the northern part of the Titicaca watershed (Ramis and Huancane rivers).
Julia S Ampuero
Full Text Available BACKGROUND: Currently, there is a paucity of data regarding human adenovirus (HAdv circulation in Andean regions of South America. To address this shortcoming, we report the clinical, phylogenetic, and epidemiologic characteristics of HAdv respiratory tract infection from a large sentinel surveillance study conducted among adults and children in Peru. METHODS/PRINCIPAL FINDINGS: Oropharyngeal swabs were collected from participants visiting any of 38 participating health centers, and viral pathogens were identified by immunofluorescence assay in cell culture. In addition, molecular characterization was performed on 226 randomly selected HAdv samples. Between 2000 and 2010, a total of 26,375 participants with influenza-like illness (ILI or severe acute respiratory infection (SARI were enrolled in the study. HAdv infection was identified in 2.5% of cases and represented 6.2% of all viral pathogens. Co-infection with a heterologous virus was found in 15.5% of HAdv cases. HAdv infection was largely confined to children under the age of 15, representing 88.6% of HAdv cases identified. No clinical characteristics were found to significantly distinguish HAdv infection from other respiratory viruses. Geographically, HAdv infections were more common in sites from the arid coastal regions than in the jungle or highland regions. Co-circulation of subgroups B and C was observed each year between 2006 and 2010, but no clear seasonal patterns of transmission were detected. CONCLUSIONS/SIGNIFICANCE: HAdv accounted for a significant fraction of those presenting with ILI and SARI in Peru and tended to affect the younger population disproportionately. Longitudinal studies will help better characterize the clinical course of patients with HAdv in Peru, as well as determine the role of co-infections in the evolution of illness.
Ampuero, Julia S; Ocaña, Víctor; Gómez, Jorge; Gamero, María E; Garcia, Josefina; Halsey, Eric S; Laguna-Torres, V Alberto
Currently, there is a paucity of data regarding human adenovirus (HAdv) circulation in Andean regions of South America. To address this shortcoming, we report the clinical, phylogenetic, and epidemiologic characteristics of HAdv respiratory tract infection from a large sentinel surveillance study conducted among adults and children in Peru. Oropharyngeal swabs were collected from participants visiting any of 38 participating health centers, and viral pathogens were identified by immunofluorescence assay in cell culture. In addition, molecular characterization was performed on 226 randomly selected HAdv samples. Between 2000 and 2010, a total of 26,375 participants with influenza-like illness (ILI) or severe acute respiratory infection (SARI) were enrolled in the study. HAdv infection was identified in 2.5% of cases and represented 6.2% of all viral pathogens. Co-infection with a heterologous virus was found in 15.5% of HAdv cases. HAdv infection was largely confined to children under the age of 15, representing 88.6% of HAdv cases identified. No clinical characteristics were found to significantly distinguish HAdv infection from other respiratory viruses. Geographically, HAdv infections were more common in sites from the arid coastal regions than in the jungle or highland regions. Co-circulation of subgroups B and C was observed each year between 2006 and 2010, but no clear seasonal patterns of transmission were detected. HAdv accounted for a significant fraction of those presenting with ILI and SARI in Peru and tended to affect the younger population disproportionately. Longitudinal studies will help better characterize the clinical course of patients with HAdv in Peru, as well as determine the role of co-infections in the evolution of illness.
Ampuero, Julia S.; Ocaña, Víctor; Gómez, Jorge; Gamero, María E.; Garcia, Josefina; Halsey, Eric S.; Laguna-Torres, V. Alberto
Background Currently, there is a paucity of data regarding human adenovirus (HAdv) circulation in Andean regions of South America. To address this shortcoming, we report the clinical, phylogenetic, and epidemiologic characteristics of HAdv respiratory tract infection from a large sentinel surveillance study conducted among adults and children in Peru. Methods/Principal Findings Oropharyngeal swabs were collected from participants visiting any of 38 participating health centers, and viral pathogens were identified by immunofluorescence assay in cell culture. In addition, molecular characterization was performed on 226 randomly selected HAdv samples. Between 2000 and 2010, a total of 26,375 participants with influenza-like illness (ILI) or severe acute respiratory infection (SARI) were enrolled in the study. HAdv infection was identified in 2.5% of cases and represented 6.2% of all viral pathogens. Co-infection with a heterologous virus was found in 15.5% of HAdv cases. HAdv infection was largely confined to children under the age of 15, representing 88.6% of HAdv cases identified. No clinical characteristics were found to significantly distinguish HAdv infection from other respiratory viruses. Geographically, HAdv infections were more common in sites from the arid coastal regions than in the jungle or highland regions. Co-circulation of subgroups B and C was observed each year between 2006 and 2010, but no clear seasonal patterns of transmission were detected. Conclusions/Significance HAdv accounted for a significant fraction of those presenting with ILI and SARI in Peru and tended to affect the younger population disproportionately. Longitudinal studies will help better characterize the clinical course of patients with HAdv in Peru, as well as determine the role of co-infections in the evolution of illness. PMID:23056519
Cynthia E. Milton.
Full Text Available In theaftermath of civil conflict and a truth commission into twenty years of violence (19802000, Peru is presently engaged in the difficult task of establishing overarching narratives that provide frameworks for organizing personal and collective memories in the few public spaces available for the discussion of this recent past. This article looks at two public spaces, a series of performative events in Ayacucho duringthe submission of the truth commission's Final Report, and Lima's memorysite, The Eye that Cries. One contentious memory is over who are appropriate victims and heroes to remember.
Vizcardo L, C.; Espinoza Z, M.
A brief history of twenty four events of real and suspected overexposure to ionizing radiation's reported to IPEN during 1977-1988 period are presented. Thirty-seven persons were involved being twelve really overexposed. Nine of them showed clinically detectable injuries (deterministic effects). The events occurred in different kinds of irradiation facilities or laboratories in Peru, mainly related with the use of radiodiagnostics and gamma radiography equipment. Patients were derived to the radiosanitary medicine service of IPEN were medical examinations and laboratory prescriptions were made. It was possible to perform cytogenetical analysis in eighteen patients. Additional data and comments on six cases of prenatal irradiation reported to this service are presented. (authors)
Manrique, Javier E.; Dirección de Promoción de la Salud, Prevención y Control Nacional del Cáncer, Instituto Nacional de Enfermedades Neoplásicas. Lima, Perú. Cirujano oncólogo.; Sullcahuamán-Allende, Yasser; Unidad de Genética y Biología Molecular, Instituto Nacional de Enfermedades Neoplásicas. Lima, Perú. médico genetista.; Limache-García, Abel; Dirección de Promoción de la Salud, Prevención y Control Nacional del Cáncer, Instituto Nacional de Enfermedades Neoplásicas. Lima, Perú. enfermero.
Cancer is a genetic disease caused by changes in the DNA sequence or expression. Based on the origin of these changes, cancer can be classified as sporadic, and hereditary or familial. Based on the cancer records in Peru, it is expected that 5 to 30% of all patients with cancer, i.e. about 2,000 to 12,000 people, have hereditary cancer, meaning that a similar number of families have a higher risk of developing cancer compared to the general population. Therefore, the purpose of genetic co...
Del Carpio Gallegos, Javier
This article shows how some principles, uses, and practices of risk management are applied in information technology projects in Peru; in the last four years, in representative sectors like manufacturing, banking, information and communications, academics institutions, construction, government, consulting, services, and others. El presente artículo muestra algunos principios, usos y prácticas de cómo la gestión de riesgos de proyectos de tecnología se ha llevado a cabo en los últimos cuatr...
Zelle, Sten G.; Vidaurre, Tatiana; Abugattas, Julio E.; Manrique, Javier E.; Sarria, Gustavo; Jeronimo, José; Seinfeld, Janice N.; Lauer, Jeremy A.; Sepulveda, Cecilia R.; Venegas, Diego; Baltussen, Rob
Objectives In Peru, a country with constrained health resources, breast cancer control is characterized by late stage treatment and poor survival. To support breast cancer control in Peru, this study aims to determine the cost-effectiveness of different breast cancer control interventions relevant for the Peruvian context. Methods We performed a cost-effectiveness analysis (CEA) according to WHO-CHOICE guidelines, from a healthcare perspective. Different screening, early detection, palliative, and treatment interventions were evaluated using mathematical modeling. Effectiveness estimates were based on observational studies, modeling, and on information from Instituto Nacional de Enfermedades Neoplásicas (INEN). Resource utilizations and unit costs were based on estimates from INEN and observational studies. Cost-effectiveness estimates are in 2012 United States dollars (US$) per disability adjusted life year (DALY) averted. Results The current breast cancer program in Peru ($8,426 per DALY averted) could be improved through implementing triennial or biennial screening strategies. These strategies seem the most cost-effective in Peru, particularly when mobile mammography is applied (from $4,125 per DALY averted), or when both CBE screening and mammography screening are combined (from $4,239 per DALY averted). Triennially, these interventions costs between $63 million and $72 million per year. Late stage treatment, trastuzumab therapy and annual screening strategies are the least cost-effective. Conclusions Our analysis suggests that breast cancer control in Peru should be oriented towards early detection through combining fixed and mobile mammography screening (age 45-69) triennially. However, a phased introduction of triennial CBE screening (age 40-69) with upfront FNA in non-urban settings, and both CBE (age 40-49) and fixed mammography screening (age 50-69) in urban settings, seems a more feasible option and is also cost-effective. The implementation of this
Carter, Adrian; Hendrikse, Joshua; Lee, Natalia; Yücel, Murat; Verdejo-Garcia, Antonio; Andrews, Zane B.; Hall, Wayne
There is a growing view that certain foods, particularly those high in refined sugars and fats, are addictive and that some forms of obesity can usefully be treated as a food addiction. This perspective is supported by a growing body of neuroscience research demonstrating that the chronic consumption of energy-dense foods causes changes in the brain's reward pathway that are central to the development and maintenance of drug addiction. Obese and overweight individuals also display patterns of eating behavior that resemble the ways in which addicted individuals consume drugs. We critically review the evidence that some forms of obesity or overeating could be considered a food addiction and argue that the use of food addiction as a diagnostic category is premature. We also examine some of the potential positive and negative clinical, social, and public policy implications of describing obesity as a food addiction that require further investigation.
Hong, Gyeongyeon; White, Jennifer; Zhong, Lihong; Carlson, Linda E
Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America. A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources. Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons. Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research
Matus-López, Mauricio; Toledo, Lorena Prieto; Pedraza, Camilo Cid
Objective To assess the fiscal space for public health in Peru so as to attain the goal of raising health spending to 6% of gross domestic product, as agreed upon by member countries of the Pan American Health Organization in 2014. Methods The main sources of fiscal space were identified by means of a thorough literature review. Technical feasibility was determined from statistics and national and international surveys and by reviewing various documents and official reports. Political feasibility was ascertained by studying policy guidelines. Results The sources showing the greatest technical and political feasibility are economic growth, a broadening of the personal income tax base, and an increase in tobacco-specific taxes. Decreasing informality in the job market and increasing contributory coverage are considered to be less politically feasible, but there is ample technical space for these measures. Conclusions There is enough fiscal space to allow for an increase in public health spending. Nevertheless, the 6% target will be reached only if the timeline is extended, tax revenues are increased, and informality in the job market is reduced.
Khanal, S. P.; Muttiah, R. S.; Janovec, J. P.
The recent landslides in La Conchita, California, Mumbai, India, Ratnapura, Sri Lanka and Sugozu village, Turkey have dramatically illustrated prolonged rainfall on water induced change in soil shear stress. In these examples, the human footprint may have also erased or altered the natural river drainage from small to large scales. By studying patterns of landslides in natural ecosystems, government officials, policy makers, engineers, geologists and others may be better informed about likely success of prevention or amelioration programs in risk prone areas. Our study area in the Los Amigos basin in Amazon rainforests of Southeastern Peru, has recorded several hundred landslides. The area has no large human settlements. The basin is characterized by heavy rainfall, dense vegetation, river meander and uniform soils. Our objectives were: 1). Determine the spatial pattern of landslides using GIS and Remotely sensed data, 2). Model the statistical relationship between environmental variables and, 3). Evaluate influence of drainage on landscape and soil loss. GIS layers consisted of: 50cm aerial imagery, DEMs, digitized streams, soils, geology, rainfall from the TRMM satellite, and vegetation cover from the LANDSAT and MODIS sensors.
Full Text Available Most industrial processes generate liquid waste, which requires treatment prior to disposal. These processes are divided into sectors that generate effluents with time dependent characteristics. Each sector sends the effluent to wastewater treatment plants through pumping-stations. In general, activated sludge is the most suitable treatment and consists of equalization, aeration and settling tanks. During the treatment, there is an increase in the mass of microorganisms, which needs to be removed. Sludge removal represents the major operating costs for wastewater treatment plants. The objective of this work is to propose an optimization model to minimize sludge generation using a superstructure in which the streams from pumping-stations can be sent to the equalization tank. In addition, the aeration tank is divided into cells that can be fed in series and parallel. The model relies on mass balances, kinetic equations, and the resulting Nonlinear Programming problem generates the best operational strategy for the system feed streams with a high substrate removal. Reductions of up to 30 % can be achieved with the proposed strategy maintened BOD efficiency removal upper than 98 %.
Background Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. Objectives To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Methods Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Results Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing
Birgden, Astrid; Grant, Luke
A Compulsory Drug Treatment Correctional Center (CDTCC) was established in Australia in 2006 for repeat drug-related male offenders. Compulsory treatment law is inconsistent with a therapeutic jurisprudence approach. Despite the compulsory law, a normative offender rehabilitation framework has been established based on offender moral rights. Within moral rights, the offender rehabilitation framework addresses the core values of freedom (supporting autonomous decision-making) and well-being (supporting support physical, social, and psychological needs). Moral rights are underpinned by a theory or principle which, in this instance, is a humane approach to offender rehabilitation. While a law that permits offenders to choose drug treatment and rehabilitation is preferable, the article discusses the establishment of a prison based on therapeutic policy, principles, and practices that respond to participants as both rights-violators and rights-holders. The opportunity for accelerated community access and a therapeutic alliance with staff has resulted in offenders actively seeking to be ordered into compulsory drug treatment and rehabilitation. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.
McQuestion, Michael J; Velasquez, Anibal
We evaluate the joint effects of two targeted Peruvian health programs on a mother's choice of whether to deliver in a public emergency obstetric care (EmOC) facility. The national maternal and child health insurance, or SMI Program, provided delivery care coverage to Peru's poorest households beginning in 1998. During 1996-2002, Proyecto 2000 sought to improve the quality of EmOC and increase utilization of public EmOC facilities in the districts reporting the highest maternal and neonatal mortality levels. Our data come from the Proyecto 2000 endline evaluation, which sampled 5335 mothers living in the catchment areas of 29 treatment and 29 matched control EmOC facilities. Using propensity scoring and two quality of care indices, we find significantly higher quality of care in Proyecto 2000 treatment facilities. Using variance components logistic models, we find a mother enrolled in the SMI Program was more likely to have delivered her last child in a public EmOC, controlling for household constraints. Residence in a Proyecto 2000 treatment area did not significantly affect the choice. A cross-level interaction term was insignificant, indicating the two program effects were independent.
Background Evaluation of interventions on road traffic injuries (RTI) going beyond the assessment of impact to include factors underlying success or failure is an important complement to standard impact evaluations. We report here how we used a qualitative approach to assess current interventions implemented to reduce RTIs in Peru. Methods We performed in-depth interviews with policymakers and technical officers involved in the implementation of RTI interventions to get their insight on design, implementation and evaluation aspects. We then conducted a workshop with key stakeholders to analyze the results of in-depth interviews, and to further discuss and identify key programmatic considerations when designing and implementing RTI interventions. We finally performed brainstorming sessions to assess potential system-wide effects of a selected intervention (Zero Tolerance), and to identify adaptation and redesign needs for this intervention. Results Key programmatic components were consistently identified that should be considered when designing and implementing RTI interventions. They include effective and sustained political commitment and planning; sufficient and sustained budget allocation; training, supervision, monitoring and evaluation of implemented policies; multisectoral participation; and strong governance and accountability. Brainstorming sessions revealed major negative effects of the selected intervention on various system building blocks. Conclusions Our approach revealed substantial caveats in current RTI interventions in Peru, and fundamental negative effects on several components of the sectors and systems involved. It also highlighted programmatic issues that should be applied to guarantee an effective implementation and evaluation of these policies. The findings from this study were discussed with key stakeholders for consideration in further designing and planning RTI control interventions in Peru. PMID:22269578
Welsh, Wayne N.; Zajac, Gary
Despite a growing realization that unmeasured programmatic differences influence prison-based drug treatment effectiveness, few attempts to systematically measure such differences have been made. To improve program planning and evaluation in this area, we developed a census instrument to collect descriptive information about 118 prison-based drug…
Van Boven, J.F.; Vemer, P.
Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was
Casiano Flores, Cesar Augusto
A lack of wastewater treatment is one of the main water problems worldwide. In high-income countries, 70% of wastewater is typically treated, but the rate falls to an average 28% in lower-middle-income countries. This low level has negative consequences for human health and for nature, with high
Conclusion: By evaluating the infectious agents during the period of the study, it was found that due to the focus on treatment of Gram negative bacteria, Gram positive bacteria especially Staphylococcus aureus and Coagulase Negative Staphylococcus have at least doubled. This increase in two important nosocomial infections is a next threat of infection and septicemia for burn victims.
Hyams, K C; Phillips, I A; Moran, A Y; Tejada, A; Wignall, F S; Escamilla, J
The prevalence in Peru of antibody to hepatitis C virus (anti-HCV) was determined in a survey of populations living in the northern jungle region and in groups at high risk of parenterally and sexually transmitted diseases. All sera were initially screened for anti-HCV using commercial first and second generation ELISAs; repeatedly reactive sera were further verified with a second generation immunoblot assay. Serum samples were also tested by ELISA for HBsAg, anti-HBs, and anti-HBc. None of 2,111 sera obtained in the survey of jungle residents was positive for anti-HCV by immunoblot assay. Twelve of 16 HIV-1 antibody positive hemophiliacs, one of 103 HIV-1 antibody positive homosexuals, and three of 602 HIV-1 negative registered female prostitutes were positive for anti-HCV. A high prevalence of total markers of hepatitis B infection was found in all subjects, especially in older subjects and groups at high risk of parenterally and sexually transmitted diseases. The findings of this study indicate that seropositivity for hepatitis C virus antibody is uncommon in Peru except in high risk groups and suggest that the epidemiology of hepatitis C differs substantially from hepatitis B.
This article discusses three aspects of the history of astrology in seventeenth-century Peru that are of larger interest for the history of science in Latin America: Creole concerns about indigenous idolatry, the impact of the Inquisition on natural philosophy, and communication between scholars within the Spanish colonies and the transatlantic world. Drawing mainly on the scholars Antonio de la Calancha, Juan de Figueroa, and Ruiz de Lozano, along with several Jesuits, the article analyzes how natural and medical astrology took shape in Peru and how they fostered astronomical investigations of the southern skies. While natural and medical astrology, showing New and Old World influences, oscillated between orthodoxy and heterodoxy, and between scholasticism and new science, judicial astrology remained undeveloped. Toward the end of the seventeenth century the discourse about astrology took an unexpected turn, reflecting a newly invigorated moral and Christian reading of the heavens that was in part a response to a deep-rooted dissatisfaction with the failure of the extirpation of idolatry campaigns. Inscribing divine and cardinal virtues, the Virgin Mary, Christian saints, and Greco-Roman allegories into the heavens was considered a way to finally solve the problem of idolatry and to convey Creole greatness.
Bussmann, Rainer W; Sharon, Douglas
This paper examines the traditional use of medicinal plants in Northern Peru, with special focus on the Departments of Piura, Lambayeque, La Libertad, Cajamarca, and San Martin. Northern Peru represents the center of the old Central Andean "Health Axis," stretching from Ecuador to Bolivia. The roots of traditional healing practices in this region go at least as far back as the Moche period (AC 100–800). Although about 50% of the plants in use reported in the colonial period have disappeared from the popular pharmacopoeia, the plant knowledge of the population is much more extensive than in other parts of the Andean region. 510 plant species used for medicinal purposes were collected, identified and their vernacular names, traditional uses and applications recorded. The families best represented were Asteraceae with 69 species, Fabaceae (35), Lamiaceae (25), and Solanaceae (21). Euphorbiaceae had twelve species, and Apiaceae and Poaceae 11 species. The highest number of species was used for the treatment of "magical/ritual" ailments (207 species), followed by respiratory disorders (95), problems of the urinary tract (85), infections of female organs (66), liver ailments (61), inflammations (59), stomach problems (51) and rheumatism (45). Most of the plants used (83%) were native to Peru. Fresh plants, often collected wild, were used in two thirds of all cases, and the most common applications included the ingestion of herb decoctions or the application of plant material as poultices. PMID:17090303
Full Text Available Abstract This paper examines the traditional use of medicinal plants in Northern Peru, with special focus on the Departments of Piura, Lambayeque, La Libertad, Cajamarca, and San Martin. Northern Peru represents the center of the old Central Andean "Health Axis," stretching from Ecuador to Bolivia. The roots of traditional healing practices in this region go at least as far back as the Moche period (AC 100–800. Although about 50% of the plants in use reported in the colonial period have disappeared from the popular pharmacopoeia, the plant knowledge of the population is much more extensive than in other parts of the Andean region. 510 plant species used for medicinal purposes were collected, identified and their vernacular names, traditional uses and applications recorded. The families best represented were Asteraceae with 69 species, Fabaceae (35, Lamiaceae (25, and Solanaceae (21. Euphorbiaceae had twelve species, and Apiaceae and Poaceae 11 species. The highest number of species was used for the treatment of "magical/ritual" ailments (207 species, followed by respiratory disorders (95, problems of the urinary tract (85, infections of female organs (66, liver ailments (61, inflammations (59, stomach problems (51 and rheumatism (45. Most of the plants used (83% were native to Peru. Fresh plants, often collected wild, were used in two thirds of all cases, and the most common applications included the ingestion of herb decoctions or the application of plant material as poultices.
Bussmann, Rainer W; Sharon, Douglas
This paper examines the traditional use of medicinal plants in Northern Peru, with special focus on the Departments of Piura, Lambayeque, La Libertad, Cajamarca, and San Martin. Northern Peru represents the center of the old Central Andean "Health Axis," stretching from Ecuador to Bolivia. The roots of traditional healing practices in this region go at least as far back as the Moche period (AC 100-800). Although about 50% of the plants in use reported in the colonial period have disappeared from the popular pharmacopoeia, the plant knowledge of the population is much more extensive than in other parts of the Andean region. 510 plant species used for medicinal purposes were collected, identified and their vernacular names, traditional uses and applications recorded. The families best represented were Asteraceae with 69 species, Fabaceae (35), Lamiaceae (25), and Solanaceae (21). Euphorbiaceae had twelve species, and Apiaceae and Poaceae 11 species. The highest number of species was used for the treatment of "magical/ritual" ailments (207 species), followed by respiratory disorders (95), problems of the urinary tract (85), infections of female organs (66), liver ailments (61), inflammations (59), stomach problems (51) and rheumatism (45). Most of the plants used (83%) were native to Peru. Fresh plants, often collected wild, were used in two thirds of all cases, and the most common applications included the ingestion of herb decoctions or the application of plant material as poultices.
Duggan, Catherine; Dvaladze, Allison L; Tsu, Vivien; Jeronimo, Jose; Constant, Tara K Hayes; Romanoff, Anya; Scheel, John R; Patel, Shilpen; Gralow, Julie R; Anderson, Benjamin O
Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country. Copyright © 2017 Elsevier Ltd. All rights reserved.
Loret de Mola, Christian; Quispe, Renato; Valle, Giancarlo A; Poterico, Julio A
Rapid urbanization, increase in food availability, and changes in diet and lifestyle patterns have been changing nutritional profiles in developing nations. We aimed to describe nutritional changes in children under 5 years and women of reproductive age in Peru, during a 15-year period of rapid economic development and social policy enhancement. Trend analyses of anthropometric measures in children of preschool age and women between 15-49 years, using the Peruvian National Demographic and Family Health Surveys (DHS) from 1996 to 2011. WHO growth curves were used to define stunting, underweight, wasting and overweight in children 19 years, body mass index (BMI) was analyzed both categorically and as a continuous variable. To statistically analyze the trends, we used regression models: Linear and Poisson for continuous and binary outcomes, respectively. We analyzed data from 123 642 women and 64 135 children, from 1996 to 2011. Decreases over time were evidenced for underweight (pAnemia decreased in children and women (pPeru shows different patterns for urban and rural populations. Public policies should emphasize targeting both malnutrition conditions--undernutrition/stunting, overweight/obesity and anemia--considering age and place of residence in rapid developing societies like Peru.
Cnossen, Maryse C; Huijben, Jilske A; van der Jagt, Mathieu
BACKGROUND: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management......, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. RESULTS: The survey was completed by 66 centers (97% response rate). Centers were mainly academic....... There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas...
Fitri, Fanny; Aldila, Dipo
Malaria is a kind of a vector-borne disease. That means this disease needs a vector (in this case, the anopheles mosquito) to spread. In this article, a mathematical model for malaria disease spread will be discussed. The model is constructed as a seven-dimensional of a non-linear ordinary differential equation. The interventions of treatment for infected humans and use of repellent are included in the model to see how these interventions could be considered as alternative ways to control the spread of malaria. Analysis will be made of the disease-free equilibrium point along with its local stability criteria, construction of the next generation matrix which followed with the sensitivity analysis of basic reproduction number. We found that both medical treatment and repellent intervention succeeded in reducing the basic reproduction number as the endemic indicator of the model. Finally, some numerical simulations are given to give a better interpretation of the analytical results.
Full Text Available Allergic rhinitis, bronchial asthma, chronic idiopathic nettle rash, atopic dermatitis have been characterized by a stable growth in the prevalence of the allergic pathology over the last several decades. A similar pathogenesis of allergic diseases makes it possible to regard them as different manifestations of a systemic allergic inflammation. Histamine is one of the main mediators of an allergic inflammation, therefore first-line medications (drug of choice in the treatment of an allergic pathology, first of all, rhinitis and chronic nettle rash, are second-generation blockers of Н1-receptors. The proposed article discusses the issues connected with the use of antihistamines for children.Key words: allergic rhinitis, bronchial asthma, nettle rash, atopic dermatitis, treatment, antihistamines, children.
Tarimo, D S; Minjas, J N; Bygbjerg, I C
Prior to policy change from chloroquine (CQ) to sulphadoxine/pyrimethamine (S/P; Fansidar) we assessed the perception of CQ efficacy and the alternative treatment options for malaria in children among parents/guardians (N=527) of under-fives attending first level health facilities on account...... of fever. It was hypothesized that the long experience with CQ and its antipyretic effect (lacking in S/P) might impede acceptance of S/P for wider use as first-line drug. Malarial fevers in children were most commonly treated with CQ (92.8%), followed by quinine (60.7%) and S/P (28.7%). A 63.2% knew...
Kateb, Babak; Chiu, Katherine; Black, Keith L; Yamamoto, Vicky; Khalsa, Bhavraj; Ljubimova, Julia Y; Ding, Hui; Patil, Rameshwar; Portilla-Arias, Jose Antonio; Modo, Mike; Moore, David F; Farahani, Keyvan; Okun, Michael S; Prakash, Neal; Neman, Josh; Ahdoot, Daniel; Grundfest, Warren; Nikzad, Shouleh; Heiss, John D
Nanotechnology is the design and assembly of submicroscopic devices called nanoparticles, which are 1-100 nm in diameter. Nanomedicine is the application of nanotechnology for the diagnosis and treatment of human disease. Disease-specific receptors on the surface of cells provide useful targets for nanoparticles. Because nanoparticles can be engineered from components that (1) recognize disease at the cellular level, (2) are visible on imaging studies, and (3) deliver therapeutic compounds, nanotechnology is well suited for the diagnosis and treatment of a variety of diseases. Nanotechnology will enable earlier detection and treatment of diseases that are best treated in their initial stages, such as cancer. Advances in nanotechnology will also spur the discovery of new methods for delivery of therapeutic compounds, including genes and proteins, to diseased tissue. A myriad of nanostructured drugs with effective site-targeting can be developed by combining a diverse selection of targeting, diagnostic, and therapeutic components. Incorporating immune target specificity with nanostructures introduces a new type of treatment modality, nano-immunochemotherapy, for patients with cancer. In this review, we will discuss the development and potential applications of nanoscale platforms in medical diagnosis and treatment. To impact the care of patients with neurological diseases, advances in nanotechnology will require accelerated translation to the fields of brain mapping, CNS imaging, and nanoneurosurgery. Advances in nanoplatform, nano-imaging, and nano-drug delivery will drive the future development of nanomedicine, personalized medicine, and targeted therapy. We believe that the formation of a science, technology, medicine law-healthcare policy (STML) hub/center, which encourages collaboration among universities, medical centers, US government, industry, patient advocacy groups, charitable foundations, and philanthropists, could significantly facilitate such
Full Text Available Introduction: The phenomenon of obesity has nowadays become an epidemic, as it seems to greatly affect the populations of both developed and developing countries. General issues involving the evaluation of the phenomenon, its consequences and the health policies that can be used to confront it, are discussed.Objectives: The objectives of this paper were to critically discuss and analyze the relation between obesity and major diseases of the western societies such as cancers and diabetes mellitus. Furthermore its aim was to demonstrate the direct relation between various prevention strategies and the reduction of the phenomenon.Method: An online search in Medline, Pumed and the Cochrane Database of peer-reviewed Systematic Reviews and meta-analysis was conducted. Retrieved studies were screened to meet certain inclusion criteria, i.e. relevance, significant meanings in correspondence with this paper’s objectives and of interest to an international health-professional readership.Results: There is a clear demonstration of the direct relation between obesity and a series of diseases such as cancer, diabetes and coronary disease. Obesity also seems to be directly related to an increased incidence of caesarian sections and gestational diabetes mellitus. Reduced smoking rates during pregnancy and an increased time of breastfeeding seem to have a protective role. The importance of physical training, of a “healthy nutritional model” adopted by the parents, and of the Mediterranean diet are shown to be fundamental in the confrontation of the phenomenon. Additionally, family doctor interventions, cognitivebehavioral therapy and internet-mediated actions seem to sufficiently aid in its prevention.Conclusion: There is a clear proof that certain primary and secondary prevention strategies along with the the increase of health-concience in communities may lead to the decrease in the rates of obesity and its undoubtfully harmful consequences.
Full Text Available Abstract Background Patterns of decreasing malaria transmission intensity make presumptive treatment of malaria an unjustifiable approach in many African settings. The controlled use of anti-malarials after laboratory confirmed diagnosis is preferable in low endemic areas. Diagnosis may be facilitated by malaria rapid diagnostic tests (RDTs. In this study, the impact of a government policy change, comprising the provision of RDTs and advice to restrict anti-malarial treatment to RDT-positive individuals, was assessed by describing diagnostic behaviour and treatment decision-making in febrile outpatients Methods Prospective data from Biharamulo and Rubya Designated District Hospital (DDH were collected before and after policy change, in Sumve DDH no new policy was implemented. Diagnosis of malaria was confirmed by RDT; transmission intensity was evaluated by a serological marker of malaria exposure in hospital attendees. Results Prior to policy change, there was no evident association between the actual level of transmission intensity and drug-prescribing behaviour. After policy change, there was a substantial decrease in anti-malarial prescription and an increase in prescription of antibiotics. The proportion of parasite-negative individuals who received anti-malarials decreased from 89.1% (244/274 to 38.7% (46/119 in Biharamulo and from 76.9% (190/247 to 10.0% (48/479 in Rubya after policy change. Conclusion This study shows that an official policy change, where RDTs were provided and healthcare providers were advised to adhere to RDT results in prescribing drugs can be followed by more rational drug-prescribing behaviour. The current findings are promising for improving treatment policy in Tanzanian hospitals.
Buckner, Julia D.; Jeffries, Emily R.; Terlecki, Meredith A.; Ecker, Anthony H.
Students referred to treatment after violating campus drug policies represent a high-risk\\ud group. Identification of factors related to these students’ cannabis use could inform prevention\\ud and treatment efforts. Distress tolerance (DT) is negatively related to substance-related\\ud behaviors and may be related to high-risk cannabis use vulnerability factors that can impact\\ud treatment outcome. Thus, the current study tested whether DT was related to cannabis use\\ud frequency, cannabis-rel...
Due to its nature, it is very hard to measure tobacco illicit trade in any product. In the case of Latin American countries, there is scant information on the magnitude and characteristics of this trade in the case of cigarettes. The goal of this article is to provide estimates on the evolution of the illicit cigarette trade in five South American countries: Argentina, Brazil, Chile, Colombia and Peru. Gap analysis estimates for cigarette tax evasion/avoidance (a comparison on the evolution of the difference between registered cigarette sales and measured population consumption) is developed for Argentina, Brazil, Chile, Colombia and Peru. Nationally representative surveys, conducted regularly, are used to measure population consumption. Confidence intervals constructed by bootstrapping sample estimates are generated in order to statistically evaluate the evolution of the gap. Cigarette illicit trade has increased as a percentage of total sales in Brazil in recent years. In the case of Argentina, after a relative decrease between 2005 and 2009 it seems to have stabilized. There is no statistical evidence to argue that there has been an increase of cigarette illicit trade in Chile, Colombia and Peru, despite substantial price increases in Chile and tax increase in both Colombia and Peru. Using simple statistical methods, it is possible to assess the trend in tobacco illicit trend over time to better inform policy-makers. Getting reliable and regular population consumption surveys can also help to track tobacco illicit trade. Claims by tobacco industry of a positive association between price/tax changes and illicit trade are unsubstantiated. Evolution of cigarette illicit trade in five Latin American countries show different trajectories, not in line with tobacco industry estimates, which highlight the importance of producing solid, independent estimates. There are inexpensive methodologies that can provide estimates of the evolution of the relative importance of
expenditure or academic status. When compared to GHG emissions computed in the literature for developed nations, where the average caloric intake is substantially higher, diet-related emissions in Peru were in the low range. Our results could be used as a baseline for policy support to align nutritional and health policies in Peru with the need to reduce the environmental impacts linked to food production.
Vázquez-Rowe, Ian; Larrea-Gallegos, Gustavo; Villanueva-Rey, Pedro; Gilardino, Alessandro
status. When compared to GHG emissions computed in the literature for developed nations, where the average caloric intake is substantially higher, diet-related emissions in Peru were in the low range. Our results could be used as a baseline for policy support to align nutritional and health policies in Peru with the need to reduce the environmental impacts linked to food production.
Raising taxes in Latin America presents a unique opportunity to improve ... interactions between and among institutions can affect developing countries' ... limited support granted to science, technology and innovation (STI) activities in Peru.
More Decent Jobs in Peru: Strengthening Research and Policymaking Capacities. Despite ... In turn, such understanding requires appropriate data. Currently ... Call for new OWSD Fellowships for Early Career Women Scientists now open.
Wise, Mary Ruth
In the Amazonian jungle of Peru 240 Indian leaders representing 20 different South American Indian language groups are successfully teaching their own people to read and write, first in their mother tongue and then in Spanish. (Author/EB)
Moro, Pedro L; Shah, Jyotsna; Li, Olga; Gilman, Robert H; Harris, Nick; Moro, Manuel H
A serosurvey for human ehrlichiosis caused by Ehrlichia chaffeensis and Anaplasma phagocytophilum was performed in different regions of Peru by using indirect immunofluorescence assays (IFAs). Regions included an urban community in a shantytown in Lima (Pampas) and three rural communities located on the northern coast of Peru (Cura Mori), in the southern Peruvian Andes (Cochapata), and in the Peruvian jungle region (Santo Tomas). An overall E. chaffeensis seroprevalence of 13% (21 of 160) was found by IFA. Seroprevalences in females and males was 15% (16 of 106) and 9% (5 of 53), respectively. Seroprevalences in Cura Mori, Cochapata, Pampas, and Santo Tomas were 25% (10 of 40), 23% (9 of 40), 3% (1 of 40), and 3% (1 of 40), respectively. Seroprevalences in Cura Mori and Cochapata were significantly higher than in Santo Tomas or Pampas (P Peru. Further studies are needed to characterize Ehrlichia species in Peru, their vectors and their clinical significance.
US Agency for International Development — Save the Children is implementing Leer Juntos, a USAID-funded three-year project targeting rural, indigenous communities in Guatemala and Peru with the objective of...
All projects related to peru. Keyword ... Local practices pertaining to biodiversity conservation, crop improvement and natural resource management are under stress. ... Creating Global Citizens : Impact of Volunteer and Work Abroad Programs.
Marcel Fortuna Biato
Full Text Available Abstract The 1998 Brasilia Peace Agreement ended a territorial dispute between Ecuador and Peru that, due to the size and location of the contested area, had remained a source of regional instability and continental tensions for decades. This paper examines the circumstances that finally allowed negotiations, beginning in 1995, to overcome an almost two-centuries-old conflict, long after almost all territorial disputes in South America had been laid to rest. It will focus in particular on the diplomatic endeavours by the guarantor countries of the 1942 Rio de Janeiro Protocol, which involved a unique set of negotiations, and the setting up of the first effective multilateral peace operation in South America. It also suggests that the peace agreement benefited from the dynamics of economic integration underway since the 1980s. Finally, it considers the implications for regional security arrangements, as well as Brazil’s leadership credentials in South America.
Revoredo Iparraguirre, José Francisco; Cavalcanti Oscátegui, Jessica
Analyze the process for implementation of health provider information systems in Peru. A qualitative study was conducted on implementation of a health provider information system in coastal, mountain, and jungle regions of Peru. Factors were identified that hinder and that facilitate the implementation process. Critical success factors included planning of implementation, executive commitment, commitment of the implementation leader, organizational culture, and human resources capacity. Implementation processes for provider information systems demonstrate various difficulties associated primarily with human barriers.
Tueros-Cuadros, E.; Otiniano, L.; Chirinos, J.; Soncco, C.; Guevara-Day, W.
The Large Aperture GRBs Observatory is a continental-wide observatory devised to detect high energy (around 100 GeV) component of Gamma Ray Bursts (GRBs), by using the single particle technique in arrays of Water Cherenkov Detectors (WCDs) at high mountain sites of Argentina, Bolivia, Colombia, Guatemala, Mexico, Venezuela and Peru. Details of the instalation and operation of the detectors in Marcapomacocha in Peru at 4550 m.a.s.l. are given. The detector calibration method will also be shown.
Moore, Stephanie Carol
This study analyzes the integration of the Japanese into the politics of race and nation in Peru during the period from 1899 to 1942. The first generation of Japanese immigrants arrived in Peru at the apex of debates on national racial identity and popular challenges to the white oligarchy's exclusive hold on national political and economic power. This dissertation examines how not only elites, but also working- and middle-class movements advocated the exclusion of the Japanese as a way of st...
2011, American Society for Microbiology. All Rights Reserved. Antin1icrobial Susceptibility of Brucella melitensis Isolates in Peru 9 Ryan C. Maves,1...48 human Brucella melitensis biotype 1 strains from Peru between 2000 and 2006. MICs of isolates to doxycycline, azithromycin, gentamicin, rifampin...of testing. Relapses did nut appear to be related tu drug resistance. Infection by Brucella species is a major cause of zoonotic disease
Talleri, Andres Velarde; Llinas-Audet, Xavier; Escardibul, Josep-Oriol
Peru is in the central, western part of South America. It is the third largest country in South America and number 20 in the world. It is the country with the fourth highest population in South America. In 2010, the gross domestic product (GDP) of Peru was 154 billion USD, and its rate of growth was 8.8% (higher than the average for the region for…
This paper assesses empirically the motives and effectiveness of forex interventions in Peru. While the central bank of Peru states that its forex interventions aim only at containing excessive exchange rate volatility, the results of this paper show that, in practice, the interventions seem to have aimed at “leaning against the wind” as well. The results also show that forex sales, but not forex purchases, react to volatility, indicating asymmetry in the central bank’s reactions to episodes ...
Kondili, Loreta A; Romano, Federica; Rolli, Francesca Romana; Ruggeri, Matteo; Rosato, Stefano; Brunetto, Maurizia Rossana; Zignego, Anna Linda; Ciancio, Alessia; Di Leo, Alfredo; Raimondo, Giovanni; Ferrari, Carlo; Taliani, Gloria; Borgia, Guglielmo; Santantonio, Teresa Antonia; Blanc, Pierluigi; Gaeta, Giovanni Battista; Gasbarrini, Antonio; Chessa, Luchino; Erne, Elke Maria; Villa, Erica; Ieluzzi, Donatella; Russo, Francesco Paolo; Andreone, Pietro; Vinci, Maria; Coppola, Carmine; Chemello, Liliana; Madonia, Salvatore; Verucchi, Gabriella; Persico, Marcello; Zuin, Massimo; Puoti, Massimo; Alberti, Alfredo; Nardone, Gerardo; Massari, Marco; Montalto, Giuseppe; Foti, Giuseppe; Rumi, Maria Grazia; Quaranta, Maria Giovanna; Cicchetti, Americo; Craxì, Antonio; Vella, Stefano
We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus-infected patients: policy 1, "universal," treat all patients, regardless of fibrosis stage; policy 2, treat only "prioritized" patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus-infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies' cost-effectiveness. The patients' age and fibrosis stage, assumed DAA treatment cost of €15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of €30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was €8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was €19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post-sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (€15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases
Schwartz, Robert; Haji, Farzana; Babayan, Alexey; Longo, Christopher; Ferrence, Roberta
Insurance coverage for evidence-based smoking cessation treatments (SCTs) promotes uptake and reduces smoking rates. Published studies in this area are based in the US where employers are the primary source of health insurance. In Ontario, Canada, publicly funded healthcare does not cover SCTs, but it can be supplemented with employer-sponsored benefit plans. This study explores factors affecting the inclusion/exclusion of smoking cessation (SC) benefits. In total, 17 interviews were conducted with eight employers (auto, retail, banking, municipal and university industries), four health insurers, two government representatives and three advisors/consultants. Overall, SCT coverage varied among industries; it was inconsistently restrictive and SCT differed by coverage amount and length of use. Barriers impeding coverage included the lack of the following: Canadian-specific return on investment (ROI), SC cost information, employer demand, government regulations/incentives and employee awareness of and demand. A Canadian evidence-based calculation of ROI for SC coupled with government incentives and public education may be needed to promote uptake of SCT coverage by employers. Copyright © 2017 Longwoods Publishing.
Nicholson, Thomas; Admay, Catherine; Shakow, Aaron; Keshavjee, Salmaan
The human rights arguments that underpinned the fight against HIV over the last three decades were poised, but ultimately failed, to provide a similar foundation for success against multidrug-resistant TB (MDR-TB) and other diseases of the poor. With more than 1.5 million deaths since 2000 attributed to strains of MDR-TB, and with half a million new, and mostly untreated, MDR-TB cases in the world each year, the stakes could not be higher. The World Health Organization (WHO), whose mandate is to champion the attainment by all peoples of the highest possible level of health, recommended unsound medical treatment for MDR-TB patients in resource-poor settings from 1993-2002. Citing cost considerations, WHO did not recommend the available standard of care that had been successfully used to contain and defeat MDR-TB in rich countries. By acting as a strategic gatekeeper in its technical advisory role to donor agencies and countries, it also facilitated the global implementation of a double standard for TB care in low- and middle-income countries (LMICs), upending important legal and scientific priorities. This raises serious questions about whether the organization violated international human rights standards and those established in its own constitution. While calling for additional analysis and discussion on this topic, the authors propose that policymakers should reject double standards of this kind and instead embrace the challenge of implementing the highest standard of care on a global level.
The medical duty of confidentiality represents a key element for the provision of reproductive and sexual health services. In some Latin American countries, such as Argentina and Peru, the legal systems impose—or are interpreted as imposing—on health professionals the duty of confidentiality, but also the duty to report the commission of a public order offense that they know about owing to the practicing of their profession. In these countries, the conflicting duties and the criminalization of abortion cause severe public health and human rights problems when health professionals assist their patients for post-abortion treatment. Typically, patients are deterred from seeking prompt medical care, and their privacy, autonomy, and dignity are violated. A 2010 ruling from the Supreme Court of Argentina and a 2004 ruling from the Inter-American Court of Human Rights emerge as important instruments that grant a more adequate protection of medical confidentiality. © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Full Text Available Background: In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma registry to sustainably improve trauma healthcare in this region. Methods: All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation. Results: From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%, motor vehicle collisions (23.3%, and blunt assault (10.5%. Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P < 0.001 and oxygen saturation (26 to 92%, P < 0.001 documentation was observed. Conclusion: A trauma registry is possible to implement in a resource-poor setting. Future efforts will focus on analysis of data to enhance prevention and treatment of injuries in Iquitos.
This thesis examines counternarcotics strategies of interdiction, eradication, and alternative development used in Peru during the 199Os to determine if Peru's success can provide the recipe for success in Colombia...
This paper explores how teachers' beliefs and practices create spaces for the contestation and innovation of bilingual intercultural education (BIE) policy, a policy of indigenous culture and language revitalization in Peru. Based on ethnographic research, there are two central arguments developed throughout this paper. First, the author argues…
Hornberger, Nancy H.
Discusses bilingual education policy and reform in the context of indigenous languages of Peru, Ecuador, and Bolivia, exploring the ideological paradox inherent in transforming a standardizing education into a diversifying one and in constructing a multilingual, multicultural national identity. Data come from policy documents and practitioner…
Grünwaldt, J M; Castellaro, G; Flores, E R; Morales-Nieto, C R; Valdez-Cepeda, R D; Guevera, J C; Grünwaldt, E G
This article discusses various aspects of pastoralism in the Latin American countries with the largest dryland areas. The topics covered include: social, economic and institutional issues; grasslands and their carrying capacity; production systems and productivity rates; competition for forage resources between domestic livestock and wildlife; and the health status of livestock and wildlife. Most grasslands exhibit some degree of degradation. The percentage of offspring reaching weaning age is low: 47-66% of calves and 40-80% of lambs. Some pastoralists adopt patterns of transhumance. In the main, pastoralists experience a high poverty rate and have poor access to social services. For many pastoralists, wildlife is a source of food and by-products. Argentina, Chile, Mexico and Peru have animal health control agencies, are members of the World Organisation for Animal Health (OIE) and have signed the United Nations Convention to Combat Desertification. Pastoral systems subsist mainly on income unrelated to pastoral farming. The OIE recognises all four countries as free from infection with peste des petits ruminants virus, and from rinderpest and African horse sickness. It is difficult to predict the future of pastoralism in Latin America because the situation differs from country to country. For instance, pastoralism is more important in Peru than in Argentina, where it is a more marginal activity. In the future, lack of promotion and protection policies could lead to a decline in pastoralism or to an adverse environmental impact on drylands.
Gross, Rainer; Lechtig, Aarón; López de Romaña, Daniel
Because of the rapid growth of the urban population in Peru, food and nutrition insecurity will occur increasingly in this population. For appropriate policy setting and programming, the food and nutrition situation of the urban poor requires better understanding. To gain information about the nature, magnitude, severity, and causes of the nutritional problems of the population in low-income areas of the city of Chiclayo, Peru. A cross-sectional nutrition survey was conducted in 1,604 households, covering children under 5 years of age and their parents. The prevalence rates of stunting, wasting, overweight. and anemia in children were 15.4%, 1.3%, 4.6%, and 65.7%, respectively; one third of adults were overweight, and one tenth were obese; 2.1% of the mothers were underweight; and 34.3% of mothers and 12.2% of fathers had anemia. Governmental feeding programs did not address these problems adequately. Interventions must have adequate targeting; address appropriate responses at the household, community, and national levels; and reduce stunting, obesity, and iron-deficiency anemia.
Hilton S. Nascimento
Full Text Available The Brazil-Peru border is inhabited by the second largest concentration of peoples in voluntary isolation of the world. These societies maintain a high degree of autonomy and avoid permanent contact with the surrounding societies. Since 2000, this region has been the target of policies aimed to favor the access to world markets (timber, oil, hydroelectric project, and the construction of infrastructure within the frame of the regional integration project IIRSA. This paper analyzes this situation, which threatens the survival of the isolated peoples who live in the region and has led to migratory processes of some of them from Peru into Brazil, and the reordering of the indigenous territories in this border region. These migrations often result in tense situations that can lead to conflicts between isolated and contacted groups. This calls for new strategies by the Brazilian and Peruvian organizations responsible for the protection and safeguarding of their rights, and for a greater integration between the institutions of both countries.
This address by the Peruvian delegation to the Third Preparatory Committee Meeting for the International Conference on Population and Development focuses on four points in the proposed Plan of Action that might require further development. First, the link between drug trafficking and environmental degradation should be recognized. Cultivation of narcotic plants contributes to deforestation of the tropical forest and contamination of rivers, and along with terrorism has caused considerable population movement in Peru. The second point is that widespread poverty, limited investment in human capital, insufficient institutional capacity, and the external debt burden of the developing countries are clearly interrelated with sociodemographic processes and decisively affect the capacity of the nation to implement population policies and programs as a function of current and future international commitments. The third point is that, in the area of information, education, and communication, attention should be given to the entire life cycle and the entirety of themes related to population. Finally, coordinated programs between public and private institutions and nongovernmental organizations at the national level, and between the U.N. Population Fund, the Population Commission, and the Commission on Sustainable Development at the international level, should be organized to assure effective follow-up on Plan of Action proposals and agreements. Peru has participated in a wide variety of international conferences and activities related to population, and was a major participant in the subregional preparatory conference of the Andean nations.
Goicolea, Isabel; Coe, Anna-Britt; San Sebastián, Miguel; Hurtig, Anna-Karin
Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries - Peru and Ecuador - introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities' transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.
Anthony D. Harries
Full Text Available Abstract The scale-up of antiretroviral therapy (ART in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.
Harries, Anthony D; Ford, Nathan; Jahn, Andreas; Schouten, Erik J; Libamba, Edwin; Chimbwandira, Frank; Maher, Dermot
The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO) in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.
Mariño, Rodrigo J; Fajardo, Jorge; Arana, Ana; Garcia, Carlos; Pachas, Flor
This article models the cost-effectiveness, from a societal viewpoint, of a dental caries prevention program using salt fluoridation for children 12 years of age, compared with non-intervention (or status quo) in Arequipa, Peru. Standard cost-effectiveness analysis methods were used. The costs associated with implementing and operating the salt-fluoridation program were identified and measured using 2009 prices. Health outcomes were measured as dental caries averted over a 6-year period. Clinical effectiveness data was taken from published data. Costs were measured as direct treatment costs, programs costs and costs of productivity losses as a result of dental treatments. The incremental cost-effectiveness ratio was calculated. A hypothetical population of 25,000 12-year-olds living in Arequipa, Peru was used in this analysis. Two-way sensitivity analyses were conducted over a range of values for key parameters. Our primary analysis estimated that if a dental caries prevention program using salt-fluoridation was available for 25,000 6-year-old children for 6 years, the net saving from a societal perspective would total S/. 11.95 [1 US$ = S/. (2009) 3.01] per diseased tooth averted when compared with the status quo group. That is, after 6 years, an investment of S/.0.32 per annum per child would result in a net saving of S/.11.95 per decayed/missing/filled teeth prevented. While the analysis has inherent limitations as a result of its reliance on a range of assumptions, the findings indicate that for the situations prevailing in Peru, there are significant health and economic benefits to be gained from the use of salt fluoridation.
Aldridge, Robert W; Iglesias, David; Cáceres, Carlos F; Miranda, J Jaime
Background The HIV epidemic in Peru is still regarded as concentrated - sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. Methods HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. Results Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to $US 5,928 (per DALY averted) for prevention of mother to child transmission. Conclusion The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country plans to amplify its
Cáceres Carlos F
Full Text Available Abstract Background The HIV epidemic in Peru is still regarded as concentrated - sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. Methods HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. Results Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to $US 5,928 (per DALY averted for prevention of mother to child transmission. Conclusion The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country
Huarcaya, Erick; Maguiña, Ciro; Torres, Rita; Rupay, Joan; Fuentes, Luis
Bartonellosis, or Carrion's Disease, is an endemic and reemerging disease in Peru and Ecuador. Carrion's Disease constitutes a health problem in Peru because its epidemiology has been changing, and it is affecting new areas between the highland and the jungle. During the latest outbreaks, and previously in endemic areas, the pediatric population has been the most commonly affected. In the pediatric population, the acute phase symptoms are fever, anorexia, malaise, nausea and/or vomiting. The main signs are pallor, hepatomegaly, lymphadenopathies, cardiac murmur, and jaundice. Arthralgias and weight loss have also commonly been described. The morbidity and mortality of the acute phase is variable, and it is due mainly to superimposed infections or associated respiratory, cardiovascular, neurological or gastrointestinal complications. The eruptive phase, also known as Peruvian Wart, is characterized by eruptive nodes (which commonly bleed) and arthralgias. The mortality of the eruptive phase is currently extremely low. The diagnosis is still based on blood culture and direct observation of the bacilli in a blood smear. In the chronic phase, the diagnosis is based on biopsy or serologic assays. There are nationally standardized treatments for the acute phase, which consist of ciprofloxacin, and alternatively chloramphenicol plus penicillin G. However, most of the treatments are based on evidence from reported cases. During the eruptive phase the recommended treatment is rifampin, and alternatively, azithromycin or erythromycin.
Full Text Available Bartonellosis, or Carrion's Disease, is an endemic and reemerging disease in Peru and Ecuador. Carrion's Disease constitutes a health problem in Peru because its epidemiology has been changing, and it is affecting new areas between the highland and the jungle. During the latest outbreaks, and previously in endemic areas, the pediatric population has been the most commonly affected. In the pediatric population, the acute phase symptoms are fever, anorexia, malaise, nausea and/or vomiting. The main signs are pallor, hepatomegaly, lymphadenopathies, cardiac murmur, and jaundice. Arthralgias and weight loss have also commonly been described. The morbidity and mortality of the acute phase is variable, and it is due mainly to superimposed infections or associated respiratory, cardiovascular, neurological or gastrointestinal complications. The eruptive phase, also known as Peruvian Wart, is characterized by eruptive nodes (which commonly bleed and arthralgias. The mortality of the eruptive phase is currently extremely low. The diagnosis is still based on blood culture and direct observation of the bacilli in a blood smear. In the chronic phase, the diagnosis is based on biopsy or serologic assays. There are nationally standardized treatments for the acute phase, which consist of ciprofloxacin, and alternatively chloramphenicol plus penicillin G. However, most of the treatments are based on evidence from reported cases. During the eruptive phase the recommended treatment is rifampin, and alternatively, azithromycin or erythromycin.
Montalvan Castilla, Johana Evelyn
Measurements of learning outcomes have found that too many children in Peru are graduating from primary school without having achieved competency in literacy or numeracy (Barrett, 2009). Results show that seven out of ten elementary school pupils cannot understand what they read and about nine out of ten struggle doing mathematics at the expected level. In order to raise school performance, state policies have largely focused on improving schools' infrastructures, changing curricular designs ...
Zorrilla, Victor; Vásquez, Gissella; Espada, Liz; Ramírez, Pablo
Among approximately 190 species of Lutzomyia in Peru, only a small number have been identified as vectors of tegumentary leishmaniasis in Western and inter-Andean valleys. These include L. peruensis, L. verrucarum, L. tejadai, L. ayacuchensis, and L. pescei. In the Amazon region, L. yuilli yuilli, L. chagasi, L. davisi, and L. auraensis are naturally infected, among the subgenera Leishmania and Viannia. L. auraensis is newly reported as a potential vector of leishmaniasis in neotropical regions. Among the primary and most widely distributed vectors of human bartonellosis or Carrión's disease, L. verrucarum and L. peruensis are predominant in the Andean regions of northern, central, and southern Peru. Other potential vectors of Carrion's disease are L. serrana in the Monzon Valley, Huamalies, and Huanuco; L. pescei in Apurímac and Cusco; and L. robusta and L. maranonensis in Jaén, San Ignacio, and Utcubamba provinces, and the high forests of Peru. Because of the high prevalence of leishmaniasis and bartonellosis outside of known endemic areas in Peru, it is necessary to update data and distribution maps of these disease vectors. This may improve both prevention and control measures. Existing information about sandfly vectors in Peru is also provided in this article.
Laboratorio Gastrolab, Lima, Peru 9 Hospital Apoyo de Iquitos, Iquitos, Peru 10 Hospital Regional, Iquitos, Peru 11 Facultad de Medicina ...index.html: [cited 2012 May 10]. 40. El Peruano – Normas Legales . Decreto Supremo Nº 015-98-AG: Reglamento de Registro, Control y Comercialización
...-AG31 Defense Federal Acquisition Regulation Supplement; Trade Agreements--Costa Rica and Peru (DFARS... respect to Costa Rica, and the United States-Peru Trade Promotion Agreement. The trade agreements waive... States Free Trade Agreement with respect to Costa Rica and the United States-Peru Trade Promotion...
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Alves, Isis Campos; Gouvêa, Paulo F. M.; Silva, Paulo S.C.
The growing demand for complementary medicine practices has led to research related to mud therapy that is the use of peloid for therapeutic treatment. In Brazil, this practice is used in the city of Peruíbe for the application of Peruíbe's Black Lama (LNP) for cutaneous and rheumatic conditions. The LNP deposit was studied in this work with the objective of verifying its homogeneity regarding elemental chemical composition, since it is collected at different points of the deposit for application in patients. The results showed that the differences between the several sampling points and between the in natura and maturate sludge are small and not significant, thus, it can be considered that the LNP deposit is homogeneous with respect to its elemental composition
This paper reports that Peru's government is stepping up efforts to attract more foreign investment in its oil and gas sector. Since taking over in July 1990, the government of President Alberto Fujimori has taken a number of steps to privatize the oil sector, improve the fiscal regime for oil investment, and streamline regulations on oil and gas investment. In the most dramatic step, the Fujimori administration ended state oil company Petroleos del Peru's monopoly on downstream operations as well as imports and exports of oil and gas as part of sweeping new oil and gas legislation. In addition, officials of the Fujimori administration have been traveling to key oil centers around the world with a presentation on Peru's hydrocarbon potential, trying to spark interest in E and D investment there
Donaires, Luis F; Céspedes, Manuel; Valencia, Pedro; Salas, Juan Carlos; Luna, María E; Castañeda, Alex; Peralta, Víctor; Cabezas, César; Pachas, Paul E
Pneumonic plague is one of the clinical forms of plague, of low frequency and high mortality, transmitted by direct inhalation of Yersinia pestis coming from an animal or from person to person. To describe the clinical and epidemiological characteristics of the cases of primary pneumonic plague in an outbreak in the north of Peru. The clinical records of the confirmed cases of primary pneumonic plague presenting in an outbreak occurring in La Libertad, in July 2010, were reviewed, also the search and contact investigation was performed. The index case was identified, as well as three additional cases, out of these, two were nosocomial infections related to the index case. The initial clinical presentation was characterized by sudden onset of fever, chills, myalgia and chest pain, which in less than 24 hours evolved to hypotension and cyanosis. The initiation of specific treatment varied from 2 to 12 days, and cases with prompt initiation of treatment had a better clinical outcome. The lethality was 50% (2/4). Nosocomial transmission of pneumonic plague in Peru is evidenced, with severe clinical manifestations and high lethality.
Mispireta, Monica L
Obesity in children at school age is an increasing problem in Peru. It concentrates in urban areas, mainly in Lima where one out of three children is overweight. An initial study in 80 schools in Lima showed that the lack of physical activity would have a greater impact on overweight and obesity in school children than the amount of food intake. More detailed studies are required. In spite of the limited information available regarding its determining factors, it is necessary to implement culturally-sensitive measures to fight this problem as part of the current nutritional policies, and prevent the problem from spreading, making sure the sustainability of the health system is not affected.
Chowell, G; Torre, C A; Munayco-Escate, C; Suárez-Ognio, L; López-Cruz, R; Hyman, J M; Castillo-Chavez, C
SUMMARYThe weekly number of dengue cases in Peru, South America, stratified by province for the period 1994-2006 were analysed in conjunction with associated demographic, geographic and climatological data. Estimates of the reproduction number, moderately correlated with population size (Spearman rho=0.28, P=0.03), had a median of 1.76 (IQR 0.83-4.46). The distributions of dengue attack rates and epidemic durations follow power-law (Pareto) distributions (coefficient of determination >85%, Pjungle areas. Our findings suggest a hierarchy of transmission events during the large 2000-2001 epidemic from large to small population areas when serotypes DEN-3 and DEN-4 were first identified (Spearman rho=-0.43, P=0.03). The need for spatial and temporal dengue epidemic data with a high degree of resolution not only increases our understanding of the dynamics of dengue but will also generate new hypotheses and provide a platform for testing innovative control policies.
In developing countries, height and weight are good indicators of children's health and nutritional status. Maternal education has been accepted as one of the most important influences on child health. Using the 2000 Demographic and Health Survey of Peru, however, I find that the effect of maternal education varies as a function of region. In the most prosperous urban region, maternal education is less important for child health than in poor rural areas, and a higher level of education has a greater effect in rural areas. Multilevel analysis shows that a significant part of the observed correlation between maternal education and child health is moderated by regional differences and community characteristics. The finding suggests that Peruvian public policy should emphasize resource redistribution as well as women's education, and that investment in maternal education should be considered within regional contexts to enhance child health in rural areas.
Militares Peru-Chile no Se Han Afectado por Diferendo,” El Comercio , April 6, 2008. 329 Chile/Peru: Tensions Flare on Maritime Border Change.” 330 “FF...Relaciones Militares Peru-Chile no Se Han Afectado por Diferendo.” El Comercio , April 6, 2008. “Relations Falter for Peru, Chile.” Chicago Tribune...América Latina y el Mediterráneo (Centro de Estudios e Investigaciones Militares: Santiago, 2000), 82. 129 “A. P. Bureau Chief in Peru is Ordered out of
Maco, Vicente; Maco, Vicente P.; Gotuzzo, Eduardo
Tungiasis is a neglected ectoparasitism of impoverished areas in South America and sub-Saharan Africa. The sand flea Tunga spp. preferably infests the soles and the periungueal and interdigital regions of the feet. Ectopic tungiasis is rare, even in highly endemic areas. We describe a case of an indigenous patient in Peru who presented with a nodular lesion in the extensor aspect of the knee and whose biopsy was compatible with Tunga spp. This is the first documented case of knee tungiasis in an endemic country. The historical, clinical, histological, and current epidemiological aspects of tungiasis in Peru are discussed here. PMID:20519602
Weitzel, Thomas; Labarca, Jaime; Cortes, Claudia P; Rosas, Reinaldo; Balcells, M Elvira; Perret, Cecilia
We report a cluster of imported vivax malaria in three of five Chilean travelers returning from Peru in March 2015. The cluster highlights the high risk of malaria in the Loreto region in northern Peru, which includes popular destinations for international nature and adventure tourism. According to local surveillance data, Plasmodium vivax is predominating, but Plasmodium falciparum is also present, and the incidence of both species has increased during recent years. Travelers visiting this region should be counseled about the prevention of malaria and the options for chemoprophylaxis. © 2015 International Society of Travel Medicine.
Full Text Available We examine the occurrence of the tribe Phanaeini (Coleoptera: Scarabaeidae: Scarabaeinae in Peru based on the collection at Museo de Historia Natural of the Universidad Nacional Mayor de San Marcos and on data provided in literature. Each species is presented with citations of its diagnosis, distribution and related comments. Peruvian Phanaeini includes 30 species in nine genera: Coprophanaeus, Dendropaemon, Gromphas, Oruscatus, Oxysternon, Phanaeus, Sulcophanaeus, Tetramereia and Megatharsis. Oruscatus davus is the only species distributed in the high Andes; Phanaeus lunaris and P. achilles occur in the northern arid zone shared by Peru and Ecuador; the remaining species are Amazonian.
Wagner, Monika; Khoury, Hanane; Willet, Jacob; Rindress, Donna; Goetghebeur, Mireille
The multiplicity of issues, including uncertainty and ethical dilemmas, and policies involved in appraising interventions for rare diseases suggests that multicriteria decision analysis (MCDA) based on a holistic definition of value is uniquely suited for this purpose. The objective of this study was to analyze and further develop a comprehensive MCDA framework (EVIDEM) to address rare disease issues and policies, while maintaining its applicability across disease areas. Specific issues and policies for rare diseases were identified through literature review. Ethical and methodological foundations of the EVIDEM framework v3.0 were systematically analyzed from the perspective of these issues, and policies and modifications of the framework were performed accordingly to ensure their integration. Analysis showed that the framework integrates ethical dilemmas and issues inherent to appraising interventions for rare diseases but required further integration of specific aspects. Modification thus included the addition of subcriteria to further differentiate disease severity, disease-specific treatment outcomes, and economic consequences of interventions for rare diseases. Scoring scales were further developed to include negative scales for all comparative criteria. A methodology was established to incorporate context-specific population priorities and policies, such as those for rare diseases, into the quantitative part of the framework. This design allows making more explicit trade-offs between competing ethical positions of fairness (prioritization of those who are worst off), the goal of benefiting as many people as possible, the imperative to help, and wise use of knowledge and resources. It also allows addressing variability in institutional policies regarding prioritization of specific disease areas, in addition to existing uncertainty analysis available from EVIDEM. The adapted framework measures value in its widest sense, while being responsive to rare disease
Torres, Julio; Sardón, Victoria; Soto, Mirtha G; Anicama, Rolado; Arroyo-Hernández, Hugo; Munayco, César V
We describe the evolution and features of a cluster of Multidrug-resistant tuberculosis (MDR TB) cases that occurred in 2001, in a school located in a sub-urban area of the district of Ica, Peru. We identified 15 students related before becoming infected with tuberculosis. The mean age of the cluster was 15 years. A total of 12 students were MDR-TB cases and 7 were drug-resistant to 5 first-line drugs (RHEZS). Five out of the 15 cases received at least 3 different anti-tuberculosis treatment schemes. The average treatment duration was 37 months (minimum 21 and maximum 59 months). A total of 13 cases recovered and 2 died. This study describes a cluster of MDR -TB cases in an educational facility, which due to the epidemiological link and time presentation, is probably an outbreak of MDR TB with a satisfactory outcome after prolonged treatment.
Calvelo Rios, J M
Peru developed its first use of video for training and education in rural areas over a decade ago. On completion of the project in 1986, over 400,000 peasants had attended video courses lasting from 5-20 days. The courses included rural health, family planning, reforestation, agriculture, animal husbandry, housing, nutrition, and water sanitation. There were 125 course packages made and 1,260 video programs from 10-18 minutes in length. There were 780 additional video programs created on human resource development, socioeconomic diagnostics and culture. 160 specialists were trained to produce audiovisual materials and run the programs. Also, 70 trainers from other countries were trained. The results showed many used the training in practical applications. To promote rural development 2 things are needed , capital and physical inputs, such as equipment, fertilizers, pesticides, etc. The video project provided peasants an additional input that would help them manage the financial and physical inputs more efficiently. Video was used because many farmers are illiterate or speak a language different from the official one. Printed guides that contained many illustrations and few words served as memory aids and group discussions reinforced practical learning. By seeing, hearing, and doing, the training was effective. There were 46% women which made fertility and family planning subjects more easily communicated. The production of teaching modules included field investigations, academic research, field recording, tape editing, and experimental application in the field. An agreement with the peasants was initiated before a course began to help insure full participation and to also make sure resources were available to use the knowledge gained. The courses were limited to 30 and the cost per participant was $34 per course.
Arning, E T; Birgel, D; Brunner, B; Peckmann, J
Authigenic phosphatic laminites enclosed in phosphorite crusts from the shelf off Peru (10 degrees 01' S and 10 degrees 24' S) consist of carbonate fluorapatite layers, which contain abundant sulfide minerals including pyrite (FeS(2)) and sphalerite (ZnS). Low delta(34)S(pyrite) values (average -28.8 per thousand) agree with bacterial sulfate reduction and subsequent pyrite formation. Stable sulfur isotopic compositions of sulfate bound in carbonate fluorapatite are lower than that of sulfate from ambient sea water, suggesting bacterial reoxidation of sulfide by sulfide-oxidizing bacteria. The release of phosphorus and subsequent formation of the autochthonous phosphatic laminites are apparently caused by the activity of sulfate-reducing bacteria and associated sulfide-oxidizing bacteria. Following an extraction-phosphorite dissolution-extraction procedure, molecular fossils of sulfate-reducing bacteria (mono-O-alkyl glycerol ethers, di-O-alkyl glycerol ethers, as well as the short-chain branched fatty acids i/ai-C(15:0), i/ai-C(17:0) and 10MeC(16:0)) are found to be among the most abundant compounds. The fact that these molecular fossils of sulfate-reducing bacteria are distinctly more abundant after dissolution of the phosphatic laminite reveals that the lipids are tightly bound to the mineral lattice of carbonate fluorapatite. Moreover, compared with the autochthonous laminite, molecular fossils of sulfate-reducing bacteria are: (1) significantly less abundant and (2) not as tightly bound to the mineral lattice in the other, allochthonous facies of the Peruvian crusts consisting of phosphatic coated grains. These observations confirm the importance of sulfate-reducing bacteria in the formation of the phosphatic laminite. Model calculations highlight that organic matter degradation by sulfate-reducing bacteria has the potential to liberate sufficient phosphorus for phosphogenesis.
Sabi, Stella C; Rieker, Mark
The diagnosis of AIDS in 1982 in South Africa was followed by a rapid rise in the number of people living with the virus and dying from AIDS-related illnesses. The 2016 report by the Statistics South Africa indicated that about 7.03 million South Africans were infected with HIV/AIDS - the highest rate in the world. Despite the emergence of effective drugs in the mid-1990s, medical treatment remained unavailable in South Africa, particularly in public hospitals. This prompted civil society groups to establish platforms to discuss health policy change in South Africa. Prominent among these was the Treatment Action Campaign (TAC), formed in 1998, which aimed to advocate for improved HIV/AIDS health service delivery. The efforts succeeded in shaping the current HIV/AIDS policy through various initiatives such as the use of constitutional law in legal action against profiteering drug companies. This paper examines the role of civil society, and particularly the TAC engagement with the state in health policy making, and the subsequent implementation of health policy on HIV/AIDS in post-apartheid South Africa.
The aim of this study was to compare the efficacy of three types of treatments in the periarthritis of the shoulder: corticosteroid injections, Low Level Laser Therapy (LLLT) or wait-and-see-policy. BACKGROUND DATA: Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. METHODS: Patients, suffering from periarthritis of the shoulder of at least 6 weeks' duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3,6, 12, 26, 52 weeks. RESULTS: We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (84%) for wait-and-see policy. LLLT had better results than a wait-and-see policy, but differences were not significant ( p disadvantages of the treatment options for the periarthritis of the shoulder. The decision to treat with LLLT or to adopt a wait-and-see policy
García, Patricia J.; Cárcamo, César P.; Chiappe, Marina; Valderrama, Maria; La Rosa, Sayda; Holmes, King K.; Mabey, David C. W.; Peeling, Rosanna W.
Objectives Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. Methods The study was implemented from September 2009–November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. Results Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the “two for one strategy”, offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. Conclusions Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV
Patricia J García
Full Text Available Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening.The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability.Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%.Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1 engaging the authorities; (2 dissipating tensions between providers and identifying champions; (3 training according to the needs; (4 providing monitoring, supervision, support and recognition; (5 sharing results and discussing actions together; (6 consulting and obtaining feedback from users; and (7 integrating with other services such as with rapid HIV testing.
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Christian Loret de Mola
Full Text Available BACKGROUND: Rapid urbanization, increase in food availability, and changes in diet and lifestyle patterns have been changing nutritional profiles in developing nations. We aimed to describe nutritional changes in children under 5 years and women of reproductive age in Peru, during a 15-year period of rapid economic development and social policy enhancement. MATERIALS AND METHODS: Trend analyses of anthropometric measures in children of preschool age and women between 15-49 years, using the Peruvian National Demographic and Family Health Surveys (DHS from 1996 to 2011. WHO growth curves were used to define stunting, underweight, wasting and overweight in children 19 years, body mass index (BMI was analyzed both categorically and as a continuous variable. To statistically analyze the trends, we used regression models: Linear and Poisson for continuous and binary outcomes, respectively. RESULTS: We analyzed data from 123 642 women and 64 135 children, from 1996 to 2011. Decreases over time were evidenced for underweight (p<0.001, wasting (p<0.001, and stunting (p<0.001 in children under 5 y. This effect was particularly noted in urban settings. Overweight levels in children reduced (p<0.001, however this reduction stopped, in urban settings, since 2005 (∼12%. Anemia decreased in children and women (p<0.001; with higher reduction in urban (↓43% than in rural children (↓24%. BMI in women aged 15-19 years increased (p<0.001 across time, with noticeable BMI-curve shift in women older than 30 years. Moreover, obesity doubled during this period in women more than 19 y. CONCLUSION: Nutrition transition in Peru shows different patterns for urban and rural populations. Public policies should emphasize targeting both malnutrition conditions--undernutrition/stunting, overweight/obesity and anemia--considering age and place of residence in rapid developing societies like Peru.
McRobie, Ellen; Matovu, Fred; Nanyiti, Aisha; Nonvignon, Justice; Abankwah, Daniel Nana Yaw; Case, Kelsey K; Hallett, Timothy B; Hanefeld, Johanna; Conteh, Lesong
Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, programme and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Programme on HIV/AIDS set 'ambitious' treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by programme, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to '90-90-90'. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in programme-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analysed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh's policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of programme activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation
Levinson, Kimberly L; Abuelo, Carolina; Chyung, Eunice; Salmeron, Jorge; Belinson, Suzanne E; Sologuren, Carlos Vallejos; Ortiz, Carlos Santos; Vallejos, Maria Jose; Belinson, Jerome L
Cervical cancer is a preventable disease which causes significant morbidity and mortality, particularly in developing countries. Although technology for early detection continues to improve, prevention programs suffer from significant barriers. Community-based participatory research is an approach to research which focuses on collaboration with the community to surmount these barriers. The objective of this study was to evaluate the utility of community-based participatory research techniques in a mother-child screen/treat and vaccinate program for cervical cancer prevention in Manchay, Peru. Human papillomavirus (HPV) self-sampling and cryotherapy were used for the screen/treat intervention, and the Gardasil vaccine was used for the vaccine intervention. Community health workers from Manchay participated in a 3-day educational course, designed by the research team. The community health workers then decided how to implement the interventions in their community. The success of the program was measured by (1) the ability of the community health workers to determine an implementation plan, (2) the successful use of research forms provided, (3) participation and retention rates, and (4) satisfaction of the participants. (1) The community health workers used a door-to-door approach through which participants were successfully registered and both interventions were successfully carried out; (2) registration forms, consent forms, and result forms were used correctly with minimal error; (3) screen/treat intervention: 97% of registered participants gave an HPV sample, 94% of HPV-positive women were treated, and 90% returned for 6-month follow-up; vaccine intervention: 95% of registered girls received the first vaccine, 97% of those received the second vaccine, and 93% the third; (4) 96% of participants in the screen/treat intervention reported high satisfaction. Community-based participatory research techniques successfully helped to implement a screen/treat and vaccinate
Zeno F. Levy
Full Text Available Up to 850 billion gallons of untreated combined sewer overflow (CSO is discharged into waters of the United States each year. Recent changes in CSO management policy support green infrastructure (GI technologies as “front of the pipe” approaches to discharge mitigation by detention/reduction of urban stormwater runoff. Constructed wetlands for CSO treatment have been considered among suites of GI solutions. However, these wetlands differ fundamentally from other GI technologies in that they are “end of the pipe” treatment systems that discharge from a point source, and are therefore regulated in the U.S. under the National Pollution Discharge Elimination System (NPDES. We use a comparative regulatory analysis to examine the U.S. policy framework for CSO treatment wetlands. We find in all cases that permitting authorities have used best professional judgment to determine effluent limits and compliance monitoring requirements, referencing technology and water quality-based standards originally developed for traditional “grey” treatment systems. A qualitative comparison with Europe shows less stringent regulatory requirements, perhaps due to institutionalized design parameters. We recommend that permitting authorities develop technical guidance documents for evaluation of “green” CSO treatment systems that account for their unique operational concerns and benefits with respect to sustainable development.
Guadagnolo, B Ashleigh; Dohan, Daniel; Raich, Peter
Racial and ethnic minorities as well as other vulnerable populations experience disparate cancer-related health outcomes. Patient navigation is an emerging health care delivery innovation that offers promise in improving quality of cancer care delivery to these patients who experience unique health-access barriers. Metrics are needed to evaluate whether patient navigation can improve quality of care delivery, health outcomes, and overall value in health care during diagnosis and treatment of cancer. Information regarding the current state of the science examining patient navigation interventions was gathered via search of the published scientific literature. A focus group of providers, patient navigators, and health-policy experts was convened as part of the Patient Navigation Leadership Summit sponsored by the American Cancer Society. Key metrics were identified for assessing the efficacy of patient navigation in cancer diagnosis and treatment. Patient navigation data exist for all stages of cancer care; however, the literature is more robust for its implementation during prevention, screening, and early diagnostic workup of cancer. Relatively fewer data are reported for outcomes and efficacy of patient navigation during cancer treatment. Metrics are proposed for a policy-relevant research agenda to evaluate the efficacy of patient navigation in cancer diagnosis and treatment. Patient navigation is understudied with respect to its use in cancer diagnosis and treatment. Core metrics are defined to evaluate its efficacy in improving outcomes and mitigating health-access barriers. Copyright © 2011 American Cancer Society.
Jan 20, 2017 ... ... technology to improve the health-care system's efficiency could one day ... Women in Ventanilla, Peru, connect with life-saving information on their ... was recognized for its efforts to improve health service provision and the ...
Cueto, Santiago; Chinen, Marjorie
In this paper, we present data from an evaluation of the educational impact of a school breakfast program implemented in rural schools in Peru. The results showed positive effects on school attendance and dropout rates, and a differential effect of the breakfast program on multiple-grade and full-grade schools. Particularly in multiple-grade…
McDonald, Jane; Lammert, Jill
The purpose of this article is to examine a nationwide effort of educational reform in Peru. Specifically, the authors take a close look at the nation's efforts to change secondary education through the implementation of a 2-year postsecondary learning opportunity called the "bachillerato." First, the authors briefly present the…
Helpdesk for Spanish Speaking Telecentre Communities in Peru and Latin America. IDRC's telecentre.org supports various efforts to strengthen the capacity of people working in telecentres across the world through knowledge-sharing, collaboration and networking. Through these efforts, strong telecentre networks in Africa ...
Health systems in sub-Saharan Africa face a “triple” burden: a high prevalence of childhood malnutrition, an increase in diet-related chronic diseases, and an HIV epidemic that disproportionately affects women. Start Date: June 30, 2009. End Date: July 1, 2014. Topic: Gender. Region: Ghana, Peru, Canada. Program: ...
Gage, Anastasia J.; Silvestre, Eva A.
Objectives: This study examined whether mothers' experience of violence was a risk factor for physical punishment. Methods: Data were derived from the nationally representative 2000 Peru Demographic and Family Health Survey. Participants were 12,601 currently married women who were living with biological children aged 0-17 years and were…
The U.S. National Cancer Institute and the Republic of Peru signed a statement of intent to share an interest in fostering collaborative biomedical research in oncology and a common goal in educating and training the next generation of cancer research sci
Alva-Urcia, Carlos; Aguilar-Luis, Miguel Angel; Palomares-Reyes, Carlos; Silva-Caso, Wilmer; Suarez-Ognio, Luis; Weilg, Pablo; Manrique, Carlos; Vasquez-Achaya, Fernando; Del Valle, Luis J; Del Valle-Mendoza, Juana
Arboviral diseases are one of the most common causes of acute febrile illness (AFI) and a significant health problem in South America. In Peru, laboratory etiologic identification of these infections occurs in less than 50% of cases, leading to underdiagnoses of important emerging arboviruses. To assess the prevalence of the Dengue (DENV), Oropouche (OROV), Chikungunya (CHIKV), Mayaro (MAYV) and Zika (ZIKV) viruses in patients with acute febrile illness from Puerto Maldonado (Peru). Serum samples were obtained from patients with AFI during January 2016 to March 2016. A total of 139 specimens were analyzed for the presence of DENV, OROV, CHIKV, MAYV, and ZIKV using polymerase chain reaction (PCR). CHIKV in 9.4% and OROV in 8.6% were the most prevalent arboviruses, followed by DENV and ZIKV, with a prevalence of 6.5% and 5%, respectively. Among all patients, the most common symptoms accompanying fever were headaches 79.9%, muscle pain 65.5% and joint pain 63.3%. During this short 3-month period, 4 arboviruses were detected by PCR, CHIKV and OROV being the most common arboviruses in Puerto Maldonado (Peru). Thus, it is crucial to include OROV detection in the national health surveillance. Furthermore, the etiologic clinical diagnosis of arboviral infections is not possible due to the low specificity of symptoms; therefore an increase of cases confirmed by molecular diagnostic methods will enhance arboviral surveillance in Peru.
Manley, Marilyn S.
This article qualitatively and quantitatively investigates the Quechua language attitudes and maintenance practices of the members of two non-profit, non-governmental agencies in Cuzco, Peru. Within their respective agency/community contexts, the members of both groups claim to have significantly more positive attitudes toward Quechua and exhibit…
In early 1916, the legendary Yale University archaeologist Hiram Bingham III completed his third and final expedition in southern Peru. He shipped home 74 boxes of artifacts from Machu Picchu, a spectacular site in the Andes that is believed to have been the last major settlement of the Inca empire. Those boxes were supposed to be on temporary…
Angelo B. M. Machado
Full Text Available Philogenia nemesioi, a new damselfly from Peru (Odonata, Megapodagrionidae. Philogenia nemesioi sp. nov. is described and illustrated based on one male specimen collected on forests of the eastern slope of the Peruvian Andes at 900 m. It belongs to the cristalina group, but differs from other species of the group by the structure of the anal appendage.
Olivos Rossini, L.M.
This research contributes to the disciplines of information systems, management science in particular the field of management education and cross-cultural studies. It further proposes a model to understand technology-supported multicultural learning in Peru. In addition, the model examines intercultural competence as an outcome of both intervening variables of ICT and the training methods used by experts.
Olivos Rossini, L.M.
This research contributes to the disciplines of information systems, management science in particular the field of management education and cross-cultural studies. It further proposes a model to understand technology-supported multicultural learning in Peru. In addition, the model examines
John F. Merkel
Full Text Available Between AD 900 and 1100 in northern Peru, high-status members of the Middle Siccin culture were buried in large tombs accompanied by elaborate grave goods that included gold, silver and copper objects, and also pieces of sheet metal known as naipes. Metallurgical study of naipes at the Institute supports the view that they were a form of "primitive money".
Montesinos, D.B.; Cleef, A.M.; Sykora, K.V.
A syntaxonomic overview of shrubland vegetation in the southern Andean regions of Peru is presented. For each plant community, information is given on physiognomy, floristic diversity, ecology and geographical distribution. The shrub vegetation on the slopes of the upper Tambo river valley includes
Iwami, Michiyo; Petchey, Roland
In 1994 Peru embarked on a programme of health service reform, which combined primary care development and community participation through Local Committees for Health Administration (CLAS). They are responsible for carrying out local health needs assessments and identifying unmet health needs through regular household surveys. These enable them to determine local health provision and tailor services to local requirements. CLAS build on grassroots self-help circles that developed during the economic and political crises of the 1980s, and in which women have been prominent. However, they function under a 3 year contract with the Ministry of Health and within a framework of centrally determined guidelines and regulations. These reforms were implemented in the context of neo-liberal economic policies, which stressed financial deregulation and fiscal and monetary restraint, and were aimed at reducing foreign indebtedness and inflation. We evaluate the achievements of the CLAS and analyse the relationship between health and economic policy in Peru, with the aid of two contrasting models of the role of the state - 'agency' and 'stewardship'. We argue that Peru's experience holds valuable lessons for other countries seeking to foster community involvement. These include the need for community capacity building and partnership between community organizations and state (and other civil) agencies.
Valencia-Garcia, Dellanira; Starks, Helene; Strick, Lara; Simoni, Jane M
Despite increasing rates of HIV infection among heterosexual women in Peru, married women remain virtually invisible as a group at risk of HIV or requiring treatment. This study analyzed the intersections of HIV with machismo and marianismo, the dominant discourses in Latin America that prescribe gender roles for men and women. Data sources include recent literature on machismo and marianismo and interviews conducted with 14 HIV-positive women in Lima, Peru. Findings indicate how the stigma associated with HIV constructs a discourse that restricts the identities of HIV-positive women to those of 'fallen women' whether or not they adhere to social codes that shape and inform their identities as faithful wives and devoted mothers. Lack of public discourse concerning HIV-positive marianas silences women as wives and disenfranchises them as mothers, leaving them little room to negotiate identities that allow them to maintain their respected social positions. Efforts must be aimed at expanding the discourse of acceptable gender roles and behaviour for both men and women within the context of machismo and marianismo so that there can be better recognition of all persons at risk of, and living with, HIV infection.
Campos, Betty; Cerrate, Amelia; Montjoy, Enrique; Dulanto Gomero, Víctor; Gonzales, César; Tecse, Aldo; Pariamachi, Andrés; Lansingh, Van C; Dulanto Reinoso, Víctor; Minaya Barba, Jean; Silva, Juan Carlos; Limburg, Hans
To estimate the prevalence of blindness and visual impairment among adults in Peru and to determine their causes, to evaluate the coverage and quality of the cataract surgical services and to investigate the barriers that inhibit access to these services. A cross-sectional population study with two-stage random cluster sampling of individuals of ≥ 50 years old, representative of the entire country, using the standard methodology of the Rapid Assessment of Avoidable Blindness. Visual acuity was assessed and the condition of the lens and posterior pole examined by direct ophthalmoscopy. Cataract surgical coverage was calculated. Its quality, as well as the causes of visual acuity glaucoma (13.7%) and age-related macular degeneration (11.5%). Uncorrected refraction errors were the principal cause of moderate visual impairment (67.2%). Cataract surgical coverage was 66.9%. 60.5% of the eyes operated for cataracts achieved a visual acuity ≥ 20/60 with available correction. The main barriers to cataract surgery were the high cost (25.9%) and people being unaware that treatment was possible (23.8%). The prevalence of blindness and visual impairment in Peru is similar to that of other Latin American countries. Given the low cataract surgical coverage and the aging of the population, access to the services could be improved by increasing the population education on eye health and the response capacity of the ophthalmological and cataract surgical services, and by reducing the costs of the latter.
Carnero, Andres M; Mayta-Tristan, Percy; Konda, Kelika A; Mezones-Holguin, Edward; Bernabe-Ortiz, Antonio; Alvarado, German F; Canelo-Aybar, Carlos; Maguiña, Jorge L; Segura, Eddy R; Quispe, Antonio M; Smith, Edward S; Bayer, Angela M; Lescano, Andres G
Plagiarism is a serious, yet widespread type of research misconduct, and is often neglected in developing countries. Despite its far-reaching implications, plagiarism is poorly acknowledged and discussed in the academic setting, and insufficient evidence exists in Latin America and developing countries to inform the development of preventive strategies. In this context, we present a longitudinal case study of seven instances of plagiarism and cheating arising in four consecutive classes (2011-2014) of an Epidemiology Masters program in Lima, Peru, and describes the implementation and outcomes of a multifaceted, "zero-tolerance" policy aimed at introducing research integrity. Two cases involved cheating in graded assignments, and five cases correspond to plagiarism in the thesis protocol. Cases revealed poor awareness of high tolerance to plagiarism, poor academic performance, and widespread writing deficiencies, compensated with patchwriting and copy-pasting. Depending on the events' severity, penalties included course failure (6/7) and separation from the program (3/7). Students at fault did not engage in further plagiarism. Between 2011 and 2013, the Masters program sequentially introduced a preventive policy consisting of: (i) intensified research integrity and scientific writing education, (ii) a stepwise, cumulative writing process; (iii) honor codes; (iv) active search for plagiarism in all academic products; and (v) a "zero-tolerance" policy in response to documented cases. No cases were detected in 2014. In conclusion, plagiarism seems to be widespread in resource-limited settings and a greater response with educational and zero-tolerance components is needed to prevent it.
Full Text Available Traditional coca uses have taken place in Peru and Bolivia from three thousand years. International organizations have urged the implementation of “zero-coca” growing policies in those countries, although without tangible results. Supply-side harm reduction strategies are currently being implemented in Bolivia, which rely on social control to limit, although not totally abolish coca growing. In this article, the different motivations for traditional coca growing are extensively reviewed, and the data from a survey conducted with 496 farmers in an indigenous community is examined, in order to provide a comprehensive overview of the coca-growing problem and to evaluate if social control could potentially influence the scale of coca growing in Peru. The results suggest that social control variables, such as attachment, involvement, and beliefs, seem to limit coca-growing areas. Those factors have been largely overlooked and may offer an opportunity to reduce coca areas if explicitly considered in anti-drug policy design.
This article examines the socio-economic implications of the US-Peru Trade Promotion Agreement for the governance of Peruvian labour relations. It is argued that the trade agreement aims to lock-in the neoliberal market reforms carried out since the 1990s, which have given rise to an export-oriented
Montesinos-Tubée, D.B.; Sýkora, K.V.; Quipuscoa-Silvestre, V.; Cleef, A.M.
We present a phytosociological overview of the arid and semi-arid montane vegetation of the province of Arequipa in southern Peru. The xerophytic vegetation was studied after extreme rainfall had promoted exceptionally lush vegetation and a high aboveground floristic diversity. We used TWINSPAN for
Watsierah Carren A
Full Text Available Abstract Background Due to widespread anti-malarial drug resistance in many countries, Kenya included, artemisinin-based Combination Therapy (ACT has been adopted as the most effective treatment option against malaria. Artemether-lumefantrine (AL is the first-line ACT for treatment of uncomplicated malaria in Kenya, while quinine is preferred for complicated and severe malaria. Information on the providers’ knowledge and practices prior to or during AL and quinine implementation is scanty. The current study evaluated providers’ knowledge and practices of treatment policy and dosing regimens with AL and quinine in the public, private and not-for-profit drug outlets. Methods A cross-sectional survey using three-stage sampling of 288 (126 public, 96 private and 66 not-for-profits providers in drug outlets was conducted in western Kenya in two Plasmodium falciparum-endemic regions with varying malarial risk. Information on provider in-service training, knowledge (qualification, treatment policy, dosing regimen, recently banned anti-malarials and on practices (request for written prescription, prescription of AL, selling partial packs and advice given to patients after prescription, was collected. Results Only 15.6% of providers in private outlets had received any in-service training on AL use. All (100% in public and majority (98.4% in not-for-profit outlets mentioned AL as first line-treatment drug. Quinine was mentioned as second-line drug by 47.9% in private outlets. A total of 92.0% in public, 57.3% in private and 78.8% in not-for-profit outlets stated correct AL dose for adults. A total of 85.7% of providers in public, 30.2% in private and 41.0% in not-for-profit outlets were aware that SP recommendations changed from treatment for mild malaria to IPTp in high risk areas. In-service training influenced treatment regimen for uncomplicated malaria (P = 0.039 and P = 0.039 and severe malaria (P P = 0.002 in children and adults
The confusingly structured and in many areas corrupt health system in Peru even today provides only a fragmentary and insufficient medical treatment especially for the indigenous population (mainly Quechua Indians). Since October 2007 the Diospi Suyana missionary hospital in Curahuasi (State of Apurímac) has provided an affordable medical treatment at a high level mainly for these indigenous people of Peru; however, so far the hospital could only insufficiently meet the traumatological needs of the region. The establishment of a surgical trauma department aims to meet those needs but is also encumbered by special problems and challenges. Some patients, for example only present at the hospital after the fractures have already incorrectly healed, sometimes many weeks or even months after the trauma either due to a long journey through the country to different hospitals where treatment was not possible or they could not pay for the treatment and sometimes because of inadequate prior treatment, for example by traditional healers. Cultural and infrastructural particularities of the country must be included in the process of choosing the right method of treatment.
Perez-Brumer, Amaya G; Reisner, Sari L; McLean, Sarah A; Silva-Santisteban, Alfonso; Huerta, Leyla; Mayer, Kenneth H; Sanchez, Jorge; Clark, Jesse L; Mimiaga, Matthew J; Lama, Javier R
In Peru, transgender women (TW) experience unique vulnerabilities for HIV infection due to factors that limit access to, and quality of, HIV prevention, treatment and care services. Yet, despite recent advances in understanding factors associated with HIV vulnerability among TW globally, limited scholarship has examined how Peruvian TW cope with this reality and how existing community-level resilience strategies are enacted despite pervasive social and economic exclusion facing the community. Addressing this need, our study applies the understanding of social capital as a social determinant of health and examines its relationship to HIV vulnerabilities to TW in Peru. Using qualitative methodology to provide an in-depth portrait, we assessed (1) intersections between social marginalization, social capital and HIV vulnerabilities; and (2) community-level resilience strategies employed by TW to buffer against social marginalization and to link to needed HIV-related services in Peru. Between January and February 2015, 48 TW participated (mean age = 29, range = 18-44) in this study that included focus group discussions and demographic surveys. Analyses were guided by an immersion crystallization approach and all coding was conducted using Dedoose Version 6.1.18. Themes associated with HIV vulnerability included experiences of multilevel stigma and limited occupational opportunities that placed TW at risk for, and limited their engagement with, existing HIV services. Emergent resiliency-based strategies included peer-to-peer and intergenerational knowledge sharing, supportive clinical services (e.g. group-based clinic attendance) and emotional support through social cohesion (i.e. feeling part of a community). This study highlights the importance of TW communities as support structures that create and deploy social resiliency-based strategies aimed at deterring and mitigating the impact of social vulnerabilities to discrimination, marginalization and HIV risk for
Bolívar Murcia, María Paula; Cruz González, Joan Paola; Rodríguez Bello, Luz Angélica
Evaluate the change over time of psychosocial risk management for the nursing personnel of an intermediate complexity clinic of Bogota (Colombia). Descriptive and correlational research performed under the approach of risk management (identification, analysis, assessment and treatment). The psychosocial risk of the nursing personnel was studied through 10-year system dynamics models (with and without the implementation of the policy of good practices on the risk treatment) in two scenarios: when the nursing personnel works shifts of 6 hours (morning or afternoon) and when they work over 12 hours (double shift or night shift). When implementing a policy of good practices on the risk treatment, the double shift scenario shows an improvement among 25% to 88% in the variables of: health, labor motivation, burnout, service level and productivity; as well as in the variables of the organization associated to number of patients, nursing personnel and profit. Likewise, the single shift scenario with good practices improves in all the above-mentioned variables and generates stability on the variables of absenteeism and resignations. The best scenario is the single shift scenario with the application of good practices of risk treatment in comparison with the double shift scenario with good practices, which allows concluding that the good practices have a positive effect on the variables of nursing personnel and on those associated to the organization. Copyright© by the Universidad de Antioquia.
Full Text Available Based on Life Cycle Assessment (LCA and Eco-indicator 99 method, a LCA model was applied to conduct environmental impact and end-of-life treatment policy analysis for secondary batteries. This model evaluated the cycle, recycle and waste treatment stages of secondary batteries. Nickel-Metal Hydride (Ni-MH batteries and Lithium ion (Li-ion batteries were chosen as the typical secondary batteries in this study. Through this research, the following results were found: (1 A basic number of cycles should be defined. A minimum cycle number of 200 would result in an obvious decline of environmental loads for both battery types. Batteries with high energy density and long life expectancy have small environmental loads. Products and technology that help increase energy density and life expectancy should be encouraged. (2 Secondary batteries should be sorted out from municipal garbage. Meanwhile, different types of discarded batteries should be treated separately under policies and regulations. (3 The incineration rate has obvious impact on the Eco-indicator points of Nickel-Metal Hydride (Ni-MH batteries. The influence of recycle rate on Lithium ion (Li-ion batteries is more obvious. These findings indicate that recycling is the most promising direction for reducing secondary batteries’ environmental loads. The model proposed here can be used to evaluate environmental loads of other secondary batteries and it can be useful for proposing policies and countermeasures to reduce the environmental impact of secondary batteries.
Yu, Yajuan; Chen, Bo; Huang, Kai; Wang, Xiang; Wang, Dong
Based on Life Cycle Assessment (LCA) and Eco-indicator 99 method, a LCA model was applied to conduct environmental impact and end-of-life treatment policy analysis for secondary batteries. This model evaluated the cycle, recycle and waste treatment stages of secondary batteries. Nickel-Metal Hydride (Ni-MH) batteries and Lithium ion (Li-ion) batteries were chosen as the typical secondary batteries in this study. Through this research, the following results were found: (1) A basic number of cycles should be defined. A minimum cycle number of 200 would result in an obvious decline of environmental loads for both battery types. Batteries with high energy density and long life expectancy have small environmental loads. Products and technology that help increase energy density and life expectancy should be encouraged. (2) Secondary batteries should be sorted out from municipal garbage. Meanwhile, different types of discarded batteries should be treated separately under policies and regulations. (3) The incineration rate has obvious impact on the Eco-indicator points of Nickel-Metal Hydride (Ni-MH) batteries. The influence of recycle rate on Lithium ion (Li-ion) batteries is more obvious. These findings indicate that recycling is the most promising direction for reducing secondary batteries’ environmental loads. The model proposed here can be used to evaluate environmental loads of other secondary batteries and it can be useful for proposing policies and countermeasures to reduce the environmental impact of secondary batteries. PMID:24646862
Yu, Yajuan; Chen, Bo; Huang, Kai; Wang, Xiang; Wang, Dong
Based on Life Cycle Assessment (LCA) and Eco-indicator 99 method, a LCA model was applied to conduct environmental impact and end-of-life treatment policy analysis for secondary batteries. This model evaluated the cycle, recycle and waste treatment stages of secondary batteries. Nickel-Metal Hydride (Ni-MH) batteries and Lithium ion (Li-ion) batteries were chosen as the typical secondary batteries in this study. Through this research, the following results were found: (1) A basic number of cycles should be defined. A minimum cycle number of 200 would result in an obvious decline of environmental loads for both battery types. Batteries with high energy density and long life expectancy have small environmental loads. Products and technology that help increase energy density and life expectancy should be encouraged. (2) Secondary batteries should be sorted out from municipal garbage. Meanwhile, different types of discarded batteries should be treated separately under policies and regulations. (3) The incineration rate has obvious impact on the Eco-indicator points of Nickel-Metal Hydride (Ni-MH) batteries. The influence of recycle rate on Lithium ion (Li-ion) batteries is more obvious. These findings indicate that recycling is the most promising direction for reducing secondary batteries' environmental loads. The model proposed here can be used to evaluate environmental loads of other secondary batteries and it can be useful for proposing policies and countermeasures to reduce the environmental impact of secondary batteries.
Jemima A. Frimpong
Full Text Available Abstract Background To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. Methods We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS. Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. Results The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. Conclusions Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.
Andres Quintero, Julian; Ruth Felix, Erika; Eduardo Rincón, Luis; Crisspín, Marianella; Fernandez Baca, Jaime; Khwaja, Yasmeen; Cardona, Carlos Ariel
Peru has introduced a law to promote the use of biofuels with the objective to increase employment, strengthening agriculture development, providing an economic alternative to illegal drug production. In this work, the costs of biodiesel production from oil palm and Jatropha were analyzed under different scenarios. They include the participation of associations of smallholders and commercial producers as raw material provides in biodiesel business in Peru. The scenarios considered have a strong social dimension in which they explicitly consider how productions' costs change when smallholders supply a proportion of the feedstock to the industry. Production cost profiles were generated using the chemical process simulation and economical evaluation software packages provided by Aspen Technology. Total production cost found for oil palm biodiesel production ranged between 0.23 and 0.31 USD/L and Jatropha biodiesel production costs were between 0.84 and 0.87 USD/L. These production costs were analyzed and compared to biodiesel ex-factory prices and diesel fuel production cost factors. The results suggest that including smallholders in the supply chain can be under some conditions competitive with liquid biofuel production systems that are purely large scale. - Highlights: ► We design and simulate biodiesel production schemes based on oil palm and Jatropha. ► Scenarios consider smallholders and commercial producers combinations. ► Inclusion of by-product selling allows a reduction of 30% in total biodiesel production cost. ► Major inclusion of smallholders requires a strong government policy to improve their technical production conditions.
Full Text Available Robust evidence on interventions to improve the shortage of health workers in rural areas is needed. We assessed stated factors that would attract short-term contract nurses and midwives to work in a rural area of Peru.A discrete choice experiment (DCE was conducted to evaluate the job preferences of nurses and midwives currently working on a short-term contract in the public sector in Ayacucho, Peru. Job attributes, and their levels, were based on literature review, qualitative interviews and focus groups of local health personnel and policy makers. A labelled design with two choices, rural community or Ayacucho city, was used. Job attributes were tailored to these settings. Multiple conditional logistic regressions were used to assess the determinants of job preferences. Then we used the best-fitting estimated model to predict the impact of potential policy incentives on the probability of choosing a rural job or a job in Ayacucho city. We studied 205 nurses and midwives. The odds of choosing an urban post was 14.74 times than that of choosing a rural one. Salary increase, health center-type of facility and scholarship for specialization were preferred attributes for choosing a rural job. Increased number of years before securing a permanent contract acted as a disincentive for both rural and urban jobs. Policy simulations showed that the most effective attraction package to uptake a rural job included a 75% increase in salary plus scholarship for a specialization, which would increase the proportion of health workers taking a rural job from 36.4% up to 60%.Urban jobs were more strongly preferred than rural ones. However, combined financial and non-financial incentives could almost double rural job uptake by nurses and midwifes. These packages may provide meaningful attraction strategies to rural areas and should be considered by policy makers for implementation.
A report has recently been published which describes the findings of the International Uranium Resources Evaluation Project (TUREP) Mission to Peru. The IUREP Orientation Phase Mission to Peru estimates that the Speculative Resources of that country fall within the range of 6 000 to 11 000 tonnes uranium. The majority of this potential is expected to be located in Late Tertiary ignimbrites and associated sediments in the high Andes of southern Peru. Other favourable geological environments include calcretes, developed from Tertiary volcanogenic sources over the Precambrian in the Pacific Coastal desert in southern Peru, and Hercynian subvolcanic granites in the eastern Cordillera of southern Peru. The Mission recommends that over a period of five years approximately U.S. $10 million be spent on exploration in Peru. The majority of this would be spent on drilling ($5 million) and tunnelling ($2 million) with an additional $3 million on surface and airborne radiometric surveys. (author)
Full Text Available The decision by the Constitutional Court in Karlsruhe of placing restrictions on the right to an abortion will profoundly affect German women's right to choose. This decision is a culmination of efforts to errode the right to choose for West as well as East German women. In the former GDR, even though liberal abortion laws allowed women access to free abortions, for ideological reasons, the government devised policies that discouraged abortions as a means of birth control. This policy becomes particularly apparent in the early 1980s when the East German government, confronted with a declining birth rate, faced the dilemma of how to leave the existing liberal abortion law intact while discouraging women from aborting their fetuses. To accomplish this task officials persuaded writers to produce literary works that promoted a three-child family policy where abortion was relegated to an inappropriate option. The article analyzes several literary works written in the early 1980s within the context of this renewed effort to encourage women to produce more children at the expense of their personal choice, and concludes that, in spite of the liberal abortion rights in the former GDR, the conditions for exercising these rights proved to be far less favorable.
García Herrera, Ricardo; Díaz, H. F.; García, R. R.; Prieto, M. R.; Barriopedro Cepero, David; Moyano, R.; Hernández Martín, Emiliano
The authors present a chronology of El Niño (EN) events based on documentary records from northern Peru. The chronology, which covers the period 1550-1900, is constructed mainly from primary sources from the city of Trujillo (Peru), the Archivo General de Indias in Seville (Spain), and the Archivo General de la Nacion in Lima (Peru), supplemented by a reassessment of documentary evidence included in previously published literature. The archive in Trujillo has never been systematically evaluat...
Fisher, A A
Hjorth in his classic monogram "Eczematous Allergy to Balsams" emphasized that sensitization to balsam of Peru is most important since secondary allergens such as "fragrances" are ubiquitous. The application of a topical medication containing balsam of Peru to the skin of an infant, particularly in the occluded diaper area, seems a great way to sensitize the infant not only to balsam of Peru but also to our fragrant environment.
Cancino-Espinoza, Eduardo; Vázquez-Rowe, Ian; Quispe, Isabel
Quinoa is a plant that is cultivated in the Andean highlands across Peru and Bolivia. It is increasingly popular due to its high nutritive value and protein content. In particular, the cultivation of organic quinoa has grown substantially in recent years since it is the most demanded type of quinoa in the foreign market. Nevertheless, despite the interest that quinoa has generated in terms of its nutritional properties, little is known regarding the environmental profile of its production and processing. Therefore, the main objective of this study was to analyze the environmental impacts that are linked to the production and distribution of organic quinoa to the main export destinations through the application of the Life Cycle Assessment (LCA) methodology. An attributional LCA perspective was conducted including data from approximately 55 ha of land used for quinoa production in the regions of Huancavelica and Ayacucho, in southern-central Peru. IPCC, 2013 and ReCiPe 2008 were the two assessment methods selected to estimate the environmental impact results using the SimaPro 8.3 software. Results, which were calculated for one 500 g package of organic quinoa, showed that GHG emissions are in the upper range of other organic agricultural products. However, when compared to other high protein content food products, especially those from animal origin, considerably low environmental impacts are obtained. For instance, if 20% of the average annual beef consumption in Peru is substituted by organic quinoa, each Peruvian would mitigate 31 kg CO 2 eq/year in their diet. Moreover, when the edible protein energy return on investment (i.e., ep-EROI) is computed, a ratio of 0.38 is obtained, in the higher range of protein rich food products. However, future research should delve into the environmental and food policy implications of agricultural land expansion to produce an increasing amount of quinoa for a growing global demand. Copyright © 2018 Elsevier B.V. All
Full Text Available We describe the current distribution of the European hare, Lepus europaeus, in Peru which currently covers the highlands, Andean valleys, surrounding areas of the Titicaca Lake and coastal irrigations; in Arequipa, Cusco, Moquegua, Puno and Tacna departments. Based on its current distribution we developed models of potential distribution of this species, which would forecast this species in northern Peru. We make recommendations on the main issues that should be studied in Peru, and the possible consequences of their invasive process of in Peru.
Full Text Available Abstract Background Accurate prevalence data on cocaine use, that points to where problems exist and the extent of these problems, is necessary to guide the formulation of effective substance abuse policy and practice. The purpose of this study was to provide surveillance information about the nature and extent of problematic cocaine use in South Africa. Methods Data were collected between January 1997 and December 2006 on admissions for drug abuse treatment through a regular monitoring system involving 56 drug treatment centres and programmes in Cape Town, Gauteng Province (Johannesburg and Pretoria and the Eastern Cape every six months as part of the South African Community Epidemiology Network on Drug Use (SACENDU. A one-page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance, and information on prior treatment. Results Treatment indicators point to a significant increase in cocaine related admissions over time in all sites, but with substantial inter-site variation, particularly in recent years. The data indicate high levels of crack cocaine use and high levels of daily usage among patients, most of whom were first time admissions. Patients with cocaine related problems continue to be predominantly male, with a mean age of around 30 years. Substantial changes in the racial profile of patients have occurred over time. Poly drug use is high with cocaine often used with alcohol, cannabis and other drugs. Conclusion These trends point to the possibility of cocaine use becoming a serious health and social issue in South Africa and demonstrate the utility of continued monitoring of cocaine treatment admissions in the future. They also highlight the need to address cocaine use in national and provincial policy planning and intervention efforts. In terms of treatment, the findings highlight the need to ensure that
Oliveros Donohue, A A
Plans are described for the implementation of 40 small plants to be used for cheese production. As a start, a demonstration plant has been built in San Juan de Chuquibambilla-Puno, Peru. Design and testing of a flat plate solar collector, to be used for water heating purposes, are described. The cheese making process is discussed. Essentially two pots are required, one at 32/sup 0/C and one at 80/sup 0/. Two flat plate collectors (1.12 m/sup 2/ each) are connected to a 150 l storage tank. Instrumentation and results are discussed. Total efficiency of the process is given as 40%. It is concluded that future installations should consider using biogas digesters and wind driven water pumps in addition to the solar collectors. A brief discussion of the climate, population distribution, and economy of Peru is given. (MJJ)
Fritz, Hermann M.; Kalligeris, Nikos; Borrero, Jose C.; Broncano, Pablo; Ortega, Erick
On 15 August 2007 an earthquake with moment magnitude (Mw) of 8.0 centered off the coast of central Peru, generated a tsunami with locally focused runup heights of up to10 m. A reconnaissance team was deployed two weeks after the event and investigated the tsunami effects at 51 sites. Three tsunami fatalities were reported south of the Paracas Peninsula in a sparsely populated desert area where the largest tsunami runup heights were measured. Numerical modeling of the earthquake source and tsunami suggest that a region of high slip near the coastline was primarily responsible for the extreme runup heights. The town of Pisco was spared by the Paracas Peninsula, which blocked tsunami waves from propagating northward from the high slip region. The coast of Peru has experienced numerous deadly and destructive tsunamis throughout history, which highlights the importance of ongoing tsunami awareness and education efforts to ensure successful self-evacuation.
Fairley Jr., Jerry P.
Agriculture in the arid and semi-arid regions that comprise much of present-day Peru, Bolivia, and Northern Chile is heavily dependent on irrigation; however, obtaining a dependable water supply in these areas is often difficult. The precolumbian peoples of Andean South America adapted to this situation by devising many strategies for transporting, storing, and retrieving water to insure consistent supply. I propose that the ''elaborated springs'' found at several Inka sites near Cuzco, Peru, are the visible expression of a simple and effective system of groundwater control and storage. I call this system ''geologic water storage'' because the water is stored in the pore spaces of sands, soils, and other near-surface geologic materials. I present two examples of sites in the Cuzco area that use this technology (Tambomachay and Tipon) and discuss the potential for identification of similar systems developed by other ancient Latin American cultures.
policy to make suggestions for the lexicographical presentation and treatment of a number of ... phers of the last 250 years have underrated themselves. ... item policy as stem, e.g. educational policy, children's policy, women's policy, envi- .... Page 5 ... In the domain of language policy one in reality finds, with the exception of.
Full Text Available This paper reflects on the significance of the legal treatment of sexual violence in contexts of armed conflict. What are the physical and emotional effects of the widespread use of rape as a weapon of war? In what way are women objectified and how are the implications of this projected into the social reference group? In order to answer these questions, first, a review is made of the international standards of legal protection against sexual violence. Then two case studies are analysed: Sepur Zarco in Guatemala and Manta and Vilca in Peru. In these cases,for the first time, national legal systems, based on international humanitarian law, have established a legal basis to punish sexual violence crimes within armed conflict contexts as crimes against humanity.
Bazán Zender, Carlos; Reyes Coloma, Luis; León Cueto, José Luis; Revoredo Palacios, Giancarlo; Arias Stella Castillo, Javier; Pezo, Alonso
The heterotopic pancreas (HP) is a rare condition in the pediatric population. HP cases involving an ileal intussusception are rare in children and very rarely reported, usually presenting with symptoms of intestinal obstruction. We report the case of a one year old male patient with a chronic history of anorexia, irritability, abdominal pain, accompanied by intermittent episodes of "currant jelly" stools that evolved to rectal bleeding. The patient presented a concomitant diagnosis of allergic colitis, which prolonged the effective surgical treatment at an external health center. In the abdominal CT scan, the classic "target" sign was found. In the exploratory laparotomy an ileoileal intussusception was confirmed, a mass was found that the histopathology laboratory confirmed as HP. To our knowledge, it is the first case of pediatric intussusception by HP reported in Peru.
García, P J
In designing an effective national response to sexually transmitted infections (STIs), one must incorporate a historical perspective of previous efforts that have addressed different aspects of STIs. One must understand who have been the key players, what aspects of STIs were the focus of efforts (prevention, treatment or control), and which, if any, societal subgroups were targeted (i.e. sex workers, military, men who have sex with men [MSM], etc.). In addition, one must consider historical and modern attitudes towards sex, sexuality and STIs, especially in terms of taboos and stigmas that may be attached to each. Most importantly, one must recognize which efforts have succeeded, which have failed, and why. This paper presents a historical overview of the perceptions of and responses to STIs at different points in Peru's history, and discusses current efforts to build upon past successes and avoid repeating previous failures that could be helpful for other countries in the Latin American region.
Barriga, L. E.; Zaharia, M.; Pinillos, L.; Moscol, A.; Heredia, A.; Sarria, G.; Marquina, J.; Barriga, O.; Picon, C.
Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990's: one patient exposed to a radiotherapy 60 Co source in Arequipa, the other patient to a 192 Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients. (authors)
Miñán, Erick; Lavalle, Carlos; Díaz-Puente, José M.
In a context of mass higher education, it is necessary to ensure not only quality but also the relevance of engineering master's programs, namely the appropriateness of the objectives and outcomes to the needs and interests of the program beneficiaries. After a literature review we analyzed the evaluation models of three organizations in Peru: the Board of Evaluation, Accreditation and Certification of the University Education Quality CONEAU, the Institute of Quality and Accreditation of Comp...
Peru is the one of the most important exporters of asparagus in the world. Its export volume of fresh asparagus is ranked number one, and its export volume of preserved asparagus number two, globally. The objective of this paper is to provide an overview of the recent trends in asparagus production and exports around the world and to analyze factors in the development of the Peruvian asparagus industry. The production of asparagus has spread geographically. The center of its production used t...
Beuermann, Diether W.; McKelvey, Christopher; Vakis, Renos
We estimate the effects of mobile phone coverage on different measures of economic development. We exploit the timing of mobile coverage at the village level merging it with a village-level panel dataset for rural Peru. The main findings suggest that mobile phone expansion has increased household real consumption by 11 per cent, reduced poverty incidence by 8 percentage points and decreased extreme poverty by 5.4 percentage points. Moreover, those benefits appear to be shared by all covered h...
Lucas, C M; Franke, E D; Cachay, M I; Tejada, A; Cruz, M E; Kreutzer, R D; Barker, D C; McCann, S H; Watts, D M
Studies were conducted from 1986 through 1993 to further define the geographic distribution and relative importance of different species of Leishmania as a cause of leishmaniasis in Peru. Patients with a clinical diagnosis of cutaneous and/or mucosal or diffuse cutaneous leishmaniasis were enrolled at the Naval Medical Research Institute Detachment (NAMRID) Laboratory in Lima, the Tropical Disease Clinic at San Marcos University Daniel A. Carrión, the Central Military Hospital, and a Ministry of Health hospital in Cusco, Peru. Clinical features, lesion aspirates, and biopsy tissue were obtained from each patient. All specimens were collected and assayed separately, including multiple specimens from some of the same patients for Leishmania parasites by inoculating aliquots of either aspirates or biopsy tissue suspensions onto Senekji's blood agar medium. Stocks of Leishmania isolates were used to prepare promastigotes to produce extracts for identifying the Leishmania species by the cellulose acetate electrophoresis enzyme technique. A total of 351 isolates of Leishmania were obtained from 350 patients who were infected primarily in the low and high jungle of at least 15 different Departments of Peru. Of the 351 isolates, 79% were identified as L. (V.) braziliensis, 7% as L. (V.) guyanensis, 10% as L. (V.) peruviana, 2% as L. (V.) lainsoni, and 1.7% as L. (L.) amazonensis. The clinical form of disease varied depending on the species of Leishmania, with L. (V.) braziliensis being associated most frequently with cutaneous, mucosal ulcers and mixed cutaneous and mucosal disease, and L. (V) peruviana, L. (V.) guyanensis, L. (V.) lainsoni with cutaneous lesions. Leishmania (L.) amazonensis was isolated from six patients, three with cutaneous lesions, one with mucosal lesions, and two with diffuse cutaneous lesions. Among all of the leishmaniasis cases, males were affected more frequently, and cases occurred among patients less than 10 to more than 51 years of age. These
Burrai, Elisa.; Mostafanezhad, Mary.; Hannam, Kevin.
In this paper, we develop a conceptual approach from which to examine the moral landscape of volunteer tourism development in Cusco, Peru. Drawing from recent work on assemblage theory in geography and tourism studies, we explore how assemblage thinking can facilitate new understandings of volunteer tourism development. Using assemblage as an analytical framework allows us to understand volunteer tourism as a series of relational, processual, unequal and mobile practices. These practices, we ...
Les régimes à teneur élevée en sel sont une cause majeure de l'hypertension artérielle et un facteur prédominant des décès, et comptent pour près des deux tiers des accidents vasculaires cérébraux et de la moitié des incidents de maladie cardiaque dans le monde. Région: Argentina, Brazil, Costa Rica, Paraguay, Peru.
The main task of this bachelor's thesis is to approach and describe the draft of microfinance and microfinancial institutions including its composition. The first part introduce microfinance theory, general principles and history. The next part is focused on specific application microfinance in Peru and description of concrete organizations that work here. Conclusion will be valorization efficiency existence of microfinancial institutions and they have influence to improvement life situation ...
Abundio Sagástegui Alva
Full Text Available Ophryosporus marchii Sagást. & E. Rodr. is described as a new species of Ophryosporus Meyen (Eupatorieae: Asteraceae from the Department of Cajamarca, Peru. This new species is apparently endemic to the province of Contumaza and closest relative to O. sagasteguii H. Rob. It is critically compared with this species and data on its geographical distribution, ecology and conservation status are provided.
Medina, Edwin; Bel, Elvira; Suñé, Josep María
To consolidate and assess information on counterfeit medicines subject to pharmaceutical alerts issued by the Peruvian Medicines Regulatory Authority over 18 years (1997-2014) of health monitoring and enforcement. A retrospective review of drug alerts. A search of the website of the General Directorate of Medicines, Supplies and Drugs (DIGEMID) of the Ministry of Health of Peru for drug alerts issued between 1997 and 2014. Drug alerts related to counterfeit medicines. A total of 669 DIGEMID alerts were issued during the study period, 354 (52.91%) of which cover 1738 cases of counterfeit medicines (many alerts deal with several cases at a time). 1010 cases (58.11%) involved pharmaceutical establishments and 349 (20.08%) involved non-pharmaceutical commercial outlets. In 126 cases (7.25%), counterfeit medicines were seized in an unauthorised trade (without any marketing authorisation); in 253 cases (14.56%) the type of establishment or business associated with the seized product was not identified. Counterfeit medicines are a serious public health problem in Peru. A review of the data cannot determine whether counterfeit medicines in Peru increased during the study period, or if monitoring by different government health agencies highlighted the magnitude of the problem by providing more evidence. The problem is clearly structural, since the majority of cases (58.11% of the total) were detected in legitimate supply chains. Most counterfeit medicines involve staple pharmaceutical products and common dosage forms. Considerable work remains to be done to control the serious problem of counterfeit medicines in Peru. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Joel Vásquez Bardales
Full Text Available This work reports the food plants utilized by 19 species of butterflies from Allpahuayo-Mishana Research Center and the Community of San Rafael, Loreto, Peru. We report 23 plant species and one hybrid of angiosperms used by the butterflies. Larval host plants were 21 species and five were adult nectar sources. Two species were both host plant and nectar source: Passiflora coccinea Aubl. and Passiflora edulis Sims. The most frequently used plant families were Solanaceae, Passifloraceae, Fabaceae and Aristolochiaceae.
WU, S.; Notaro, M.; Vavrus, S. J.; Mortensen, E.; Block, P. J.; Montgomery, R. J.; De Pierola, J. N.; Sanchez, C.
The central Andes receive over 50% of annual climatological rainfall during the short period of January-March. This summertime rainfall exhibits strong interannual and decadal variability, including severe drought events that incur devastating societal impacts and cause agricultural communities and mining facilities to compete for limited water resources. An improved seasonal prediction skill of summertime rainfall would aid in water resource planning and allocation across the water-limited southern Peru. While various underlying mechanisms have been proposed by past studies for the drivers of interannual variability in summertime rainfall across southern Peru, such as the El Niño-Southern Oscillation (ENSO), Madden Julian Oscillation (MJO), and extratropical forcings, operational forecasts continue to be largely based on rudimentary ENSO-based indices, such as NINO3.4, justifying further exploration of predictive skill. In order to bridge this gap between the understanding of driving mechanisms and the operational forecast, we performed systematic studies on the predictability and prediction skill of southern Peru summertime rainfall by constructing statistical forecast models using best available weather station and reanalysis datasets. At first, by assuming the first two empirical orthogonal functions (EOFs) of summertime rainfall are predictable, the potential predictability skill was evaluated for southern Peru. Then, we constructed a simple regression model, based on the time series of tropical Pacific sea-surface temperatures (SSTs), and a more advanced Linear Inverse Model (LIM), based on the EOFs of tropical ocean SSTs and large-scale atmosphere variables from reanalysis. Our results show that the LIM model consistently outperforms the more rudimentary regression models on the forecast skill of domain averaged precipitation index and individual station indices. The improvement of forecast correlation skill ranges from 10% to over 200% for different
about health in six Latin American countries, 1973- 1992. Rev Panam Salud Publica 1: 23–34. 3. Cowan G, 2000. Rickettsial diseases: the typhus group of...Leonardo Mendoza Instituto Nacional de Salud , Capac Yupanqui No. 1400, Jesús Maria, Lima 11, Peru, Telephone: 51-1-471-9920. Allen L. Richards, Viral and...Colli C, 1997. Leptospira interrogans in a canine population of greater Bue- nos Aires: variables associated with seropositivity. Rev Panam Salud
Yves M. Zinngrebe
In a second step, a comparative analysis of the dominant and diverging political perspectives is made. I argue that by deconstructing underlying premises and ideologies, common ground and possible opportunities for collaboration can be identified. Moreover, although the presented results can serve as a discussion scaffold to organize conservation debates in Peru, this example demonstrates how the terms biodiversity and sustainability are operationalized in conservation narratives.
Llamoza, Javier; Químico Farmacéutico, Acción Internacional para la Salud, Lima, Perú.
Through Free Trade Agreements, the economies of the United States of America (USA) and the European Union (EU) have been achieving a higher standard of protection of the intellectual property rights. This increases unduly the monopolist rights of the industry, restricting competition and limiting the access of new generic drugs. Peru has not been the exception to this process, subscribing a free trade agreement with the USA called Agreement of Commercial Promotion (APC) that involved the ...
This paper reports the results of behavioral economic experiments conducted in Peru to examine the relationship amongst risk preferences, loan take-up, and insurance purchase decisions. This area-based yield insurance can help reduce people's vulnerability to large scale covariate shocks, and can also lower the loan default probability under extreme negative covariate shocks. In a context of collateralized formal credit markets, we provide suggestive evidence that insurance may help reduce th...
Cerrate V, A.; Manrique Chavez, A.; Camarena, F.M.; Nakaodo Nakaodo, J.; Del Carpio R, G.
Mutagenesis of Lupinus mutabilis was started at the UNA LM (Peru) to obtain mutants with low alkaloid content and early germination. Varieties SCG 25 and Lib 020 were irradiated with gamma radiation. The optimum dose for the SCG 25 variety was 15 Krad and for Lib 020 15 to 20 Krad. The relation between the plant height and radiation dose fits the quadratic polynomial model
Edmonston, B; Andes, N
Data from the national Peru Fertility Survey are used to estimate infant and childhood mortality ratios, 1968--77, for 124 Peruvian communities, ranging from small Indian hamlets in the Andes to larger cities on the Pacific coast. Significant mortality variations are found: mortality is inversely related to community population size and is higher in the mountains than in the jungle or coast. Multivariate analysis is then used to assess the influence of community population size, average femal...
Efficacy of sulfadoxine-pyrimethamine and mefloquine for the treatment of uncomplicated Plasmodium falciparum malaria in the Amazon basin of Peru Eficácia da sulfadoxina-pirimetamina e mefloquina no tratamento de malária não-complicada por Plasmodium falciparum na bacia amazônica peruana
Alan J. Magill
Full Text Available In vivo antimalarial drug efficacy studies of uncomplicated Plasmodium falciparum malaria at an isolated site in the Amazon basin of Peru bordering Brazil and Colombia showed >50% RII/RIII resistance to sulfadoxine-pyrimethamine but no evidence of resistance to mefloquine.Testes in vivo foram realizados para avaliar resistência a drogas antimalária, em pessoas com malária não complicada, causada por Plasmodium falciparum, numa região isolada da Bacia Amazônica, na fronteira com o Brasil e a Colômbia. Os testes mostraram resistência >50% RII/RIII a sulfadoxina-pirimetamina, mas não evidenciaram resistência a mefloquina.
Russell, Jill; Swinglehurst, Deborah; Greenhalgh, Trisha
In England the National Health Service (NHS) is not allowed to impose 'blanket bans' on treatments, but local commissioners produce lists of 'low value' procedures that they will normally not fund. Breast surgery is one example. However, evidence suggests that some breast surgery is clinically effective, with significant health gain. National guidelines indicate the circumstances under which breast surgery should be made available on the NHS, but there is widespread variation in their implementation.The purpose of this study was to explore the work practices of 'individual funding request' (IFR) panels, as they considered 'one-off' funding requests for breast surgery; examine how the notion of 'value' is dialogically constructed, and how decisions about who is deserving of NHS funding and who is not are accomplished in practice. We undertook ethnographic exploration of three IFR panels. We extracted all (22) breast surgery cases considered by these panels from our data set and progressively focused on three case discussions, one from each panel, covering the three main breast procedures.We undertook a microanalysis of the talk and texts arising from these cases, within a conceptual framework of interpretive policy analysis. Through an exploration of the symbolic artefacts (language, objects and acts) that are significant carriers of policy meaning, we identified the ways in which IFR panels create their own 'interpretive communities', within which deliberations about the funding of breast surgery are differently framed, and local decisions come to be justified. In particular, we demonstrated how each decision was contingent on [a] the evaluative accent given to certain words, [b] the work that documentary objects achieve in foregrounding particular concerns, and [c] the act of categorising. Meaning was constructed dialogically through local interaction and broader socio-cultural discourses about breasts and 'cosmetic' surgery. Despite the appeal of calls to tackle
Maroye, Stephane; Aerssens, Andre [Tractebel Engineering, Lima (Peru)
In May 2002, Suez-Tractebel was awarded by the government of Peru a 30-year concession for the construction and operation of the gas distribution network in Lima, Peru. On 10 July, 2004, first gas was delivered to Lima, 1 month ahead of the official date. This gas distribution network, operated by GNLC (Gas Natural de Lima y Callao), delivers gas to some of the largest industries and power generators in and around Lima and the harbour area of Callao. Gas delivered in Lima comes through a 700 km HP gas pipeline from Camisea fields. This pipeline is operated by TGP (Transportadora de Gas del Peru). A City Gate is located at Lurin, on the southern side of the city. The gas distribution network is made of a 62 km main pipeline (20') with 25 km laterals. The main pipeline is operated at 50 bar, as the main customer, the Etevensa power plant, is located on the northern side of the city. Due to this high operating pressure combined to the surroundings, specific design philosophies were adopted to meet the extreme safety requirements. This paper highlights the specific measures taken during construction phase and the experience of the first months of operation of this challenging project. (author)
Kontschán, Jenő; Friedrich, Stefan
Soil dwelling Uropodina mites were collected from a primary lowland rainforest in Amazonian Peru. The species found belong to three different families. A new diagnosis and the type genus of Tetrasejaspidae fam. nov. are given, and the family is recorded from Peru for the first time on the basis of Tetrasejaspis sellnicki Hirschmann, 1973. Two rotundabaloghid mites were collected (Rotundabaloghia (Circobaloghia) magna Hirschmann, 1992 and Rotundabaloghia (Circobaloghia) iquitosensis Hirschmann, 1992), both already reported from Peru. A new species (Origmatrachys peruensis sp. nov.) from the family Trachyuropodidae was collected in large numbers from soil, and is described on the basis of females, males, nymphs and larvae. This is the first description of the protonymphs and larvae of Origmatrachys. The new species differs from the previously described ones in the basis of sculptural pattern of dorsal, ventral, sternal shields and the length of the setae in the central part of the dorsal shield. A new key to the known adults and deutonymphs of Origmatrachys is given.
Full Text Available The genus Solanum is among the most species-rich genera both of the Peruvian flora and of the tropical Andes in general. The present revised checklist treats 276 species of Solanum L., of which 253 are native, while 23 are introduced and/or cultivated. A total of 74 Solanum species (29% of native species are endemic to Peru. Additional 58 species occur only in small number of populations outside Peru, and these species are here labelled as near-endemics to highlight the role Peru playes in their future protection. Species diversity is observed to peak between 2500 – 3000 m elevation, but endemic species diversity is highest between 3000 – 3500 m elevation. Cajamarca has the highest number of endemic (29 spp. and total species (130 spp., even when considering the effect of area. Centers of endemic species diversity are observed in provinces of Cajamarca (Cajamarca, Huaraz and Carhuaz (Ancash, and Canta and Huarochirí (Lima. Secondary centres of endemism with high concentrations of both endemics and near-endemics are found in San Ignacio and Cutervo (Cajamarca, Santiago de Chuco (La Libertad, Oxapampa (Pasco, and Cusco (Cusco. Current diversity patterns are highly correlated with collection densities, and further collecting is needed across all areas, especially from Arequipa, Ayacucho, Puno, Ancash, Huánuco, Amazonas and Cajamarca, where high levels of species diversity and endemism are indicated but only a few collections of many species are known.
Cabrera, Rufino; Del Pilar, María; Altamirano, Trillo
The purpose of this review is to show the experimental studies carried out on the biological cycle, culture, pathogenicity of the anisakidae nematode larvae and to disseminate the information regarding current epidemy and the probable emergence of anisakidosis in Peru, and in addition, to propose measures of prevention and control, as well as the perspective and need for investigation. The studies of experimental pathogenicity in cats, dos, and hamsters are incomplete. Eight cases of acute human anisakidosis have been reported (5 confirmed and 3 unconfirmed). It is probable that it emerges during the "El Niño" Weather Phenomenon; however, during normal conditions it is probably due to the increase of raw fish consumption and other factors. In the coast of Peru, five and four fishes of direct human consumption are parasited by the Anisakis simplex and Anisakis physeteris larva, respectively, and two fishes are parasited by the Pseudoterranova decipiens. The main host for the Anisakis simplex is the dolphin (Delphinus delphia), but the Contracaecum osculatum is hosted by the sea lion: Otaria byronia and Arctocephalus australis, P. decipiens parasita a O. byronia. Eviscerating the fish would be most adequate prevention method to lessen the risk of human infection. There is evidence that anisakidosis is an underestimated zoonosis in Peru, and that it is probably and emerging disease. Therefore, its presence is to be suspected in patients with the prototype clinical syndrome.
Verano, John W
Several forms of mummified human trophy heads were produced by prehistoric and historic native groups in South America. This paper describes the diagnostic features of trophy heads produced by the Nasca culture of ancient Peru. A growing interest in these mummified heads among collectors of Pre-Columbian art and antiquities has led to their illegal exportation from Peru, in violation of national and international antiquities laws. Requests from the Peruvian government to protect its cultural patrimony led the United States in 1997 to declare these heads as items subject to U.S. import restriction, along with six other categories of human remains. Despite such restrictions, Nasca trophy heads continue to reach private collectors outside of Peru and thus may be encountered by local, state, or federal law enforcement officials unfamiliar with their characteristic features and origin. The objective of this paper is to describe the features that allow Nasca trophy heads to be identified and distinguished from other archaeological and forensic specimens that may be submitted to a forensic anthropologist for identification.
Salazar-Morales, Diego Alonso
This article explains how after 43 years of unsatisfactory outcomes, the Ministry of Education of Peru (MoE) suddenly ranked at the top of governmental performance tables. To do so, this study relies on implementation and major discussions of policy instrument theories to provide a comprehensive explanation of the reasons underlying the MoE's…
Tinoco, Yeny O; Azziz-Baumgartner, Eduardo; Rázuri, Hugo; Kasper, Matthew R; Romero, Candice; Ortiz, Ernesto; Gomez, Jorge; Widdowson, Marc-Alain; Uyeki, Timothy M; Gilman, Robert H; Bausch, Daniel G; Montgomery, Joel M
Influenza disease burden and economic impact data are needed to assess the potential value of interventions. Such information is limited from resource-limited settings. We therefore studied the cost of influenza in Peru. We used data collected during June 2009-December 2010 from laboratory-confirmed influenza cases identified through a household cohort in Peru. We determined the self-reported direct and indirect costs of self-treatment, outpatient care, emergency ward care, and hospitalizations through standardized questionnaires. We recorded costs accrued 15-day from illness onset. Direct costs represented medication, consultation, diagnostic fees, and health-related expenses such as transportation and phone calls. Indirect costs represented lost productivity during days of illness by both cases and caregivers. We estimated the annual economic cost and the impact of a case of influenza on a household. There were 1321 confirmed influenza cases, of which 47% sought health care. Participants with confirmed influenza illness paid a median of $13 [interquartile range (IQR) 5-26] for self-treatment, $19 (IQR 9-34) for ambulatory non-medical attended illness, $29 (IQR 14-51) for ambulatory medical attended illness, and $171 (IQR 113-258) for hospitalizations. Overall, the projected national cost of an influenza illness was $83-$85 millions. Costs per influenza illness represented 14% of the monthly household income of the lowest income quartile (compared to 3% of the highest quartile). Influenza virus infection causes an important economic burden, particularly among the poorest families and those hospitalized. Prevention strategies such as annual influenza vaccination program targeting SAGE population at risk could reduce the overall economic impact of seasonal influenza. © 2015 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.
Chabrol, Fanny; David, Pierre-Marie; Krikorian, Gaëlle
New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity. Copyright © 2017. Published by Elsevier Ltd.
Zúñiga Palomino, Mario
This article analyzes the reasons for the so-called “network neutrality” and its regulation in Peru (including the laws regulating as a proffer recently presented by OSIPTEL); consisting primarily of equal treatment of all traffic, content or application by internet service providers. From Economic Analysis of Law’sperspective, it has been concluded that the Internet access does not present market failures that justify regulating the conditions of service provision. The author explains why ne...
Are pharmacological properties of anticoagulants reflected in pharmaceutical pricing and reimbursement policy? Out-patient treatment of venous thromboembolism and utilization of anticoagulants in Poland.
Bochenek, T; Czarnogorski, M; Nizankowski, R; Pilc, A
Pharmacotherapy with vitamin K antagonists (VKA) and low-molecular-weight heparins (LMWH) is a major cost driver in the treatment of venous thromboembolism (VTE). Major representatives of anticoagulants in Europe include: acenocoumarol and warfarin (VKA), enoxaparin, dalteparin, nadroparin, reviparin, parnaparin and bemiparin (LMWH). Aim of this report is to measure and critically assess the utilization of anticoagulants and other resources used in the out-patient treatment of VTE in Poland. To confront the findings with available scientific evidence on pharmacological and clinical properties of anticoagulants. The perspectives of the National Health Fund (NHF) and the patients were adopted, descriptive statistics methods were used. The data were gathered at the NHF and the clinic specialized in treatment of coagulation disorders. Non-pharmacological costs of treatment were for the NHF 1.6 times higher with VKA than with LMWH. Daily cost of pharmacotherapy with LMWH turned out higher than with VKA (234 times for the NHF, 42 times per patient). Within both LMWH and VKA the reimbursement due for the daily doses of a particular medication altered in the manner inversely proportional to the level of patient co-payment. Utilization of long-marketed and cheap VKA was dominated by LMWH, when assessed both through the monetary measures and by the actual volume of sales. Pharmaceutical reimbursement policy favored the more expensive equivalents among VKA and LMWH, whereas in the financial terms the patients were far better off when remaining on a more expensive alternative. The pharmaceutical pricing and reimbursement policy of the state should be more closely related to the pharmacological properties of anticoagulants.
J Jaime Miranda
Full Text Available Doctors' scarcity in rural areas remains a serious problem in Latin America and Peru. Few studies have explored job preferences of doctors working in underserved areas. We aimed to investigate doctors' stated preferences for rural jobs.A labelled discrete choice experiment (DCE was performed in Ayacucho, an underserved department of Peru. Preferences were assessed for three locations: rural community, Ayacucho city (Ayacucho's capital and other provincial capital city. Policy simulations were run to assess the effect of job attributes on uptake of a rural post. Multiple conditional logistic regressions were used to assess the relative importance of job attributes and of individual characteristics. A total of 102 doctors participated. They were five times more likely to choose a job post in Ayacucho city over a rural community (OR 4.97, 95%CI 1.2; 20.54. Salary increases and bonus points for specialization acted as incentives to choose a rural area, while increase in the number of years needed to get a permanent post acted as a disincentive. Being male and working in a hospital reduced considerably chances of choosing a rural job, while not living with a partner increased them. Policy simulations showed that a package of 75% salary increase, getting a permanent contract after two years in rural settings, and getting bonus points for further specialisation increased rural job uptake from 21% to 77%. A package of 50% salary increase plus bonus points for further specialisation would also increase the rural uptake from 21% to 52%.Doctors are five times more likely to favour a job in urban areas over rural settings. This strong preference needs to be overcome by future policies aimed at improving the scarcity of rural doctors. Some incentives, alone or combined, seem feasible and sustainable, whilst others may pose a high fiscal burden.
Pajuelo-Ramírez, Jaime; Sánchez-Abanto, José; Alvarez-Dongo, Doris; Tarqui-Mamani, Carolina; Agüero-Zamora, Rosa
To determine the prevalence of overweight, obesity and chronic malnutrition in 6- to 9-year-old children in Peru. A cross-cutting study based on the 2009-2010 National Household Survey. The size/age ratio was analyzed with references of the National Center for Health Statistic (NCSH) and the World Health Organization (WHO), considering less than two standard deviations for chronic malnutrition (CM); and the Must and WHO reference tables to measure the body mass index with 85 to 95 percentile values for overweight and above 95 for obesity. With Must as reference, overweight was 12.1% and obesity 9.4%, and according to WHO overweight and obesity were 10.2 and 11.3% respectively. The prevalence of CM according to NCSH and WHO is 15.4 and 17.8% respectively. The highest prevalence of CM is in the north (25.2%), center (22.9%) and south of (19%) the Highland, while obesity is more present in the south coast (28%), Metropolitan Lima (22.8%) and the central Coast (22.5%). Of all the children with CM, 6.5% has overweight and 1.2% obesity. CM is decreasing because size averages have improved, however obesity has doubled. The presence of CM and obesity in children aged 6 to 9 years old in different regions of Peru poses a challenge in the planning of food and nutrition policies.
Bohra, Tasneem; Benmarhnia, Tarik; McKinnon, Britt; Kaufman, Jay S
Previous studies of inequality in health and mortality have largely focused on income-based inequality. Maternal education plays an important role in determining access to water and sanitation, and inequalities in child mortality arising due to differential access, especially in low- and middle-income countries such as Peru. This article aims to explain education-related inequalities in child mortality in Peru using a regression-based decomposition of the concentration index of child mortality. The analysis combines a concentration index created along a cumulative distribution of the Demographic and Health Surveys sample ranked according to maternal education, and decomposition measures the contribution of water and sanitation to educational inequalities in child mortality. We observed a large education-related inequality in child mortality and access to water and sanitation. There is a need for programs and policies in child health to focus on ensuring equity and to consider the educational stratification of the population to target the most disadvantaged segments of the population. © The American Society of Tropical Medicine and Hygiene.
Full Text Available The article describes the experience gained in Ji’an County (Ji’an Prefecture-Level City, Jiangxi Province on the implementation of policies aimed to alleviate poverty through the implementation of the “Four-One” Industry Targeted Poverty Alleviation Project including 1 “Pomelo of One Mu for One Household”, 2 “Hengjiang Grape of One Mu for One Household”, 3 “One Chicken Coop for One Household”, and 4 “One Post in the Park for One Household”. It is proved that households that implement such projects can get out of poverty. The goal of the study is to help people living in poverty get out of it, and to help the poor county become richer. The author relies on the idea that is developing in modern social science and that deals with the structural poverty typical of different historical eras and economic paradigms. In this case, the following types of structural poverty are distinguished: pre-industrial, industrial and post-industrial poverty. The preindustrial type accompanies pre-capitalist development of society. Industrial poverty is typical of the countries that are at the stage of industrial development, it is caused by excess supply of low and semi-skilled labor. A common way to alleviate industrial poverty is to stimulate the creation of highly skilled jobs with the help of investment and tax policy, education and advanced training systems available to general public. The post-industrial type of poverty is different from the industrial type in a way that this poverty is also formed with participation of the labor market, but this market is not so much local as global. The economic basis of post-industrial poverty is structural changes in the global economy and the increase in competition for jobs in the international framework
... Threatened Wildlife and Plants; Listing Foreign Bird Species in Peru and Bolivia as Endangered Throughout... Plants; Listing Foreign Bird Species in Peru and Bolivia as Endangered Throughout Their Range AGENCY...)-- all native to Peru. The ash-breasted tit-tyrant and royal cinclodes are also native to Bolivia. This...
Salas, A.R.; Spooner, D.M.; Huamán, Z.; Torres Maita, R.V.; Hoekstra, R.; Schüler, K.; Hijmans, R.J.
Peru contains about half of the described wild potato taxa, and many of these are not yet preserved in genebanks. This paper reports results of the second of a series of five planned collecting expeditions to Peru. Collections were made in the central Peruvian departments of Ancash, Huancavelica, La
Loyola, Steev; Flores-Mendoza, Carmen; Torre, Armando; Kocher, Claudine; Melendrez, Melanie; Luce-Fedrow, Alison; Maina, Alice N; Richards, Allen L; Leguia, Mariana
While studying rickettsial infections in Peru, we detected Rickettsia asembonensis in fleas from domestic animals. We characterized 5 complete genomic regions (17kDa, gltA, ompA, ompB, and sca4) and conducted multilocus sequence typing and phylogenetic analyses. The molecular isolate from Peru is distinct from the original R. asembonensis strain from Kenya.
Sujet: URBAN COMMUNITIES, NUTRITION, COMMUNITY SERVICES, PERU, LOW INCOME GROUPS, Disease control. Région: Peru, South America, North and Central America. Programme: Alimentation, environnement et santé. Financement total : CA$ 302,700.00. Examen des liens entre la télévision et les mauvaises ...
Long, N.; Roberts, B.
This volume traces the development of the central highlands, one of Peru's major mining regions. It draws on extensive fieldwork carried out in Peru between 1970 and 1982, spanning a reforming military government, reaction and a return to civilian politics under Belaunde. Through historical material
Gaps persist despite growth Poverty has declined substantially in Peru, but continues to affect 20% of the population. ... Economic growth has failed to reduce gaps in opportunities for the country's ... This project will support collaboration among researchers, central and regional governments, and the private sector in Peru.
Full Text Available A new species of Teagueia (Luer Luer (Orchidaceae: Pleurothallidinae from the highlands of Northern Peru is described and illustrated with a black and white drawing. This species is the first record of genus Teagueia (Luer Luer in Peru.
Pérez-Lu, José E; Cárcamo, Cesar; Nandi, Arijit; Kaufman, Jay S
In some countries, conditional cash transfer (CCT) programmes show an impact on maternal and child health. Juntos, the CCT programme in Peru, has been evaluated several times operationally, but seldom for maternal and child health outcomes. The objective of this study is to evaluate the impact of Juntos on children under 6 years, pregnant women and mothers of children under 17 years. Outcomes evaluated included (1) anaemia in women and children; (2) acute malnutrition in children; (3) post-partum complications in mothers; and (4) underweight and overweight in mothers. We identified Juntos eligible respondents from the Demographic and Health Surveys of Peru for years 2007 to 2013. Propensity score matching was used to identify comparable treatment and control groups, including eligible respondents enrolled in Juntos vs. those not enrolled in Juntos (individual-level analysis), as well as eligible respondents living in Juntos districts vs. those not residing in Juntos districts (district-level analysis). We then used generalized linear models to estimate prevalence ratios. Individual level analysis showed that Juntos reduced underweight in women (PR:0.39, 95%CI:0.18 - 0.85) and anaemia in children (PR:0.93, 95%CI:0.86 - 1.00). In the district level analysis, the programme was associated with a reduction of overweight in women (PR:0.94, 95%CI:0.90 - 0.98) and acute malnutrition in children (PR:0.49, 95%CI:0.32 - 0.73), but an increase in the prevalence of anaemia in children (PR:1.09, 95%CI:1.01 - 1.17). We found that Juntos had an effect on maternal and child health indicators, but further studies are required to overcome some limitations encountered here. © 2016 John Wiley & Sons Ltd.
Ramírez Soto, Max C
The clinical and epidemiologic characteristics of pediatric sporotrichosis are poorly understood. To describe the incidence and clinical characteristics of cases of sporotrichosis in children 14 years of age and younger reported in Abancay from 2004 to 2011, stratified according to age. We performed a retrospective review of pediatric patients 14 years of age and younger who were diagnosed with sporotrichosis in a referral center at Abancay, a poor area located in the south central highlands of Peru, to estimate the incidence rates (per 100,000 person-years) according to age and sporotrichosis type (lymphocutaneous and fixed), and clinical characteristics of these patients. Of the 240 pediatric cases identified, 131 (54.6%) were male. The median age at baseline was 6 years. The mean incidence rate was 81.4 cases per 100,000 person-years for the period from 2004 to 2011, and was highest among children ranging in age from 5-9 years. The incidence of lymphocutaneous sporotrichosis and fixed sporotrichosis was 55 and 27 cases per 100,000 person-years, respectively, and the face was the most commonly affected anatomic site. Ninety-six of the 240 patients (40%) reported previous contact with cats, and 46 (19.2%) had a clear history of traumatic inoculation with plant material. The therapeutic response to treatment with potassium iodide was satisfactory. In this retrospective study, we described a high incidence of sporotrichosis in children in the south central highlands of Peru, which increased with age. Lymphocutaneous sporotrichosis was the more common type with an incidence rate twice that of the fixed type. The face was the most commonly affected anatomic site, and infection appeared to be acquired predominantly through contact with cats. © 2017 The International Society of Dermatology.
Full Text Available Abstract Background The World Health Organization (WHO recommends injectable artesunate given either intravenously or by the intramuscular route for definitive treatment for severe malaria and recommends a single intramuscular dose of intramuscular artesunate or intramuscular artemether or intramuscular quinine, in that order of preference as pre-referral treatment when definitive treatment is not possible. Where intramuscular injections are not available, children under 6 years may be administered a single dose of rectal artesunate. Although the current malaria treatment guidelines in Ethiopia recommend intra-rectal artesunate or alternatively intramuscular artemether or intramuscular quinine as pre-referral treatment for severe malaria at the health posts, there are currently no WHO prequalified suppliers of intra-rectal artesunate and when available, its use is limited to children under 6 years of age leaving a gap for the older age groups. Intramuscular artesunate is not part of the drugs recommended for pre-referral treatment in Ethiopia. This study assessed the perspectives of health workers, and policy-makers on the use of intramuscular artesunate as a pre-referral and definitive treatment for severe malaria at the health post level. Methods In-depth interviews were held with 101 individuals including health workers, malaria focal persons, and Regional Health Bureaus from Oromia and southern nations, nationalities, and peoples’ region, as well as participants from the Federal Ministry of Health and development partners. An interview guide was used in the data collection and thematic content analysis was employed for analysis. Results Key findings from this study are: (1 provision of intramuscular artesunate as pre-referral and definitive treatment for severe malaria at health posts could be lifesaving; (2 with adequate training, and provision of facilities including beds, health posts can provide definitive treatment for severe
Bustamante, Maria Jose; Konda, Kelika A; Joseph Davey, Dvora; León, Segundo R; Calvo, Gino M; Salvatierra, Javier; Brown, Brandon; Caceres, Carlos F; Klausner, Jeffrey D
HIV status awareness is key to prevention, linkage-to-care and treatment. Our study evaluated the accessibility and potential willingness of HIV self-testing among men who have sex with men (MSM) and transgender women in Peru. We surveyed four pharmacy chains in Peru to ascertain the commercial availability of the oral HIV self-test. The pharmacies surveyed confirmed that HIV self-test kits were available; however, those available were not intended for individual use, but for clinician use. We interviewed 147 MSM and 45 transgender women; nearly all (82%) reported willingness to perform the oral HIV self-test. However, only 55% of participants would definitely seek a confirmatory test in a clinic after an HIV-positive test result. Further, price may be a barrier, as HIV self-test kits were available for 18 USD, and MSM and transgender women were only willing to pay an average of 5 USD. HIV self-testing may facilitate increased access to HIV testing among some MSM/transgender women in Peru. However, price may prevent use, and poor uptake of confirmatory testing may limit linkage to HIV treatment and care.
Wu, Yu-Ting; Chen, Shou-Tung; Chen, Chih-Jung; Kuo, Yao-Lung; Tseng, Ling-Ming; Chen, Dar-Ren; Kuo, Shou-Jen; Lai, Hung-Wen
Breast cancer arising within a fibroadenoma (BcaFad) is rare; the rate varies from 0.002% to 0.125% in fibroadenoma specimens. Owing to its rarity, the clinicopathologic feature and treatment principle of BcaFad is still not clear. Therefore, the aim of this study was to perform a collective analysis of case reports in the literature to identify the characteristics and optimal treatment for BcaFad. We analyzed an aggregated sample of 30 patients with BcaFad from case reports in the literature (n=24 cases) and our present study (n=6 cases). We collected and analyzed the clinicopathologic features and prognoses of patients with BcaFad, as well as treatments they received. The patients' mean age at diagnosis was 46.9 years. Twenty BcaFad patients (66.7%) received breast-conserving surgery (BCS), and nine other patients (30.0%) were treated with mastectomy. The rate of lymph node metastasis in BcaFad patients was 23.8%. The breakdown of the histological types of BcaFad was invasive ductal carcinoma (53.3%), followed by ductal carcinoma in situ (23.3%), lobular carcinoma in situ (16.7%) and invasive lobular carcinoma (13.3%). More than half of patients with positive hormone receptor status received hormone therapy. Most BcaFad patients with lymph node metastases received chemotherapy, and 20.0% of BcaFad patients treated with BCS received further radiotherapy. Only one patient had recurrence after surgery, and another had lung metastasis when diagnosed with BcaFad. Most BcaFad patients could be managed by BCS. Adjuvant radiotherapy could be performed, but was not mandatory. Chemotherapy should be considered as a treatment option in the presence of lymph node metastasis.
First chapter contains geographical and political characteristics of Peru and its history. Second part of the thesis includes economic characteristics of Peru and structure of foreign trade. Next chapter focuses on future development of Peru. Last chapter contains key characteristics of role of Peru within the latinamerican region.
Li, Jinhui; Dong, Qingyin; Liu, Lili; Song, Qingbin
Waste Electrical and Electronic Equipment (WEEE) volume is increasing, worldwide. In 2011, the Chinese government issued new regulations on WEEE recycling and disposal, establishing a WEEE treatment subsidy funded by a levy on producers of electrical and electronic equipment. In order to evaluate WEEE recycling treatment costs and revenue possibilities under the new regulations, and to propose suggestions for cost-effective WEEE management, a comprehensive revenue-expenditure model (REM), were established for this study, including 7 types of costs, 4 types of fees, and one type of revenue. Since TV sets dominated the volume of WEEE treated from 2013 to 2014, with a contribution rate of 87.3%, TV sets were taken as a representative case. Results showed that the treatment cost varied from 46.4RMB/unit to 82.5RMB/unit, with a treatment quantity of 130,000 units to 1,200,000 units per year in China. Collection cost accounted for the largest portion (about 70.0%), while taxes and fees (about 11.0 %) and labor cost (about 7.0 %) contributed less. The average costs for disposal, sales, and taxes had no influence on treatment quantity (TQ). TQ might have an adverse effect on average labor and management costs; while average collection and purchase fees, and financing costs, would vary with purchase price, and the average sales fees and taxes would vary with the sales of dismantled materials and other recycled products. Recycling enterprises could reduce their costs by setting up online and offline collection platforms, cooperating with individual collectors, creating door-to-door collection channels, improving production efficiency and reducing administrative expenditures. The government could provide economic incentives-such as subsidies, low-cost loans, tax cuts and credits-and could also raise public awareness of waste management and environmental protection, in order to capture some of the WEEE currently discarded into the general waste stream. Foreign companies with
Azétsop, Jacquineau; Diop, Blondin A
Universal access to antiretroviral treatment (ART) in Chad was officially declared in December 2006. This presidential initiative was and is still funded 100% by the country's budget and external donors' financial support. Many factors have triggered the spread of AIDS. Some of these factors include the existence of norms and beliefs that create or increase exposure, the low-level education that precludes access to health information, social unrest, and population migration to areas of high economic opportunities and gender-based discrimination. Social forces that influence the distribution of dimensions of well-being and shape risks for infection also determine the persistence of access barriers to ART. The universal access policy is quite revolutionary but should be informed by the systemic barriers to access so as to promote equity. It is not enough to distribute ARVs and provide health services when health systems are poorly organized and managed. Comprehensive access to ART raises many organizational, ethical and policy problems that need to be solved to achieve equity in access. This paper argues that the persistence of access barriers is due to weak health systems and a poor public health leadership. AIDS has challenged health systems in a manner that is essentially different from other health problems.
Huo, Michael; Panizza, Benedict; Bernard, Anne; Porceddu, Sandro V
To determine the rate of subsequent primary site failure in patients with head and neck squamous cell carcinoma of unknown primary (UKP HNSCC) in a region with a high prevalence of cutaneous squamous cell carcinoma, according to a pre-determined institutional policy. Secondary aims included regional and distant control, and overall survival. Patients presenting between April 2005 and June 2016 to the Princess Alexandra Hospital Head and Neck Multidisciplinary Meeting with UKP HNSCC from either presumed mucosal or cutaneous sites treated with curative intent were eligible. Patients with presumed mucosal origin were treated with radiation therapy (RT) with or without chemotherapy, while patients with presumed cutaneous SCC were treated with surgery and post-operative RT with or without chemotherapy. A total of 63 patients met the inclusion criteria. Median follow up duration was 3.9 years (IQR 2.07-5.14). There were no subsequent primary site failures. The rate of nodal failure among presumed mucosal patients was 11.5%, and 8.1% among presumed cutaneous patients. The rate of distant metastatic failure was 11.1% among all patients. The estimated 5 year overall survival was 71.2% (95% CI 59.2-85.7%). Treatment according to our pre-defined institutional policy for UKP HNSCC in a region with a high prevalence of cutaneous SCC appears to be safe and effective with low rates of mucosal primary emergence and nodal failure. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Studies about mass media framing have found divergent levels of influence on public opinion; moreover, the evidence suggests that issue attributes can contribute to this difference. In the case of climate change, studies have focused exclusively on developed countries, suggesting that media influence perceptions about the issue. This study presents one of the first studies of media coverage in a developing country. It examines newspapers' reporting in Peru during the Fifth Latin America, Caribbean and European Union Summit in May 2008. The study focuses on the frames and the sources to provide an initial exploratory assessment of the coverage. The results show that the media relied mostly on government sources, giving limited access to dissenting voices such as environmentalists. Additionally, a prominence of "solutions" and "effects" frames was found, while "policy" and "science" frames were limited. The results could serve as a reference point for more comprehensive studies.
Park, Soojin; Steiner, Peter M; Kaplan, David
Considering that causal mechanisms unfold over time, it is important to investigate the mechanisms over time, taking into account the time-varying features of treatments and mediators. However, identification of the average causal mediation effect in the presence of time-varying treatments and mediators is often complicated by time-varying confounding. This article aims to provide a novel approach to uncovering causal mechanisms in time-varying treatments and mediators in the presence of time-varying confounding. We provide different strategies for identification and sensitivity analysis under homogeneous and heterogeneous effects. Homogeneous effects are those in which each individual experiences the same effect, and heterogeneous effects are those in which the effects vary over individuals. Most importantly, we provide an alternative definition of average causal mediation effects that evaluates a partial mediation effect; the effect that is mediated by paths other than through an intermediate confounding variable. We argue that this alternative definition allows us to better assess at least a part of the mediated effect and provides meaningful and unique interpretations. A case study using ECLS-K data that evaluates kindergarten retention policy is offered to illustrate our proposed approach.
Watts, Nathaniel S; Pajuelo, Monica; Clark, Taryn; Loader, Maria-Cristina I; Verastegui, Manuela R; Sterling, Charles; Friedland, Jon S; Garcia, Hector H; Gilman, Robert H
Neurocysticercosis is a leading cause of seizures and epilepsy in most of the world, and it occurs when Taenia solium larval cysts infect the central nervous system. T. solium tapeworm infection is endemic in much of Peru, but there are scarce data on the prevalence in many rural highland communities where it is likely to be hyper-endemic. Peace Corps Volunteers live and work in these communities; however, to our knowledge, they have not been used to facilitate public health research. We utilized Peace Corps Volunteers to estimate the prevalence of T. solium tapeworm infection in seven rural communities in northern Peru. A convenience non-random sampling frame was used. Peace Corps Volunteers facilitated the collection of stool samples (N = 2,328), which were analyzed by sedimentation and microscopy. Niclosamide treatment and purgation preceded species identification, which was done by PCR-REA. Taenia sp. egg-positive stool samples were found in three of the seven communities we surveyed. The overall prevalence of Taenia sp. egg positivity was 2.1% (49/2,328) (95% CI = 1.6-2.8%) with prevalence up to 4.3% (42/977) (95% CI = 3.1-5.8%) by community. All 34 of the specimens tested by PCR-REA were T. solium. The overall prevalence of T. solium tapeworm infection was 1.5% (34/2,328) (95% CI = 1.0-2.0%). Prevalence up to 2.9% (28/977) (95% CI = 1.9-4.1%) by community was observed. This study recorded high T. solium tapeworm prevalence, and identified hyper-endemic rural communities. It demonstrates that synergy between researchers and Peace Corps Volunteers can be an effective means to conducting large-scale, community-based studies in remote areas of Peru.
Watts, Nathaniel S.; Pajuelo, Monica; Clark, Taryn; Loader, Maria-Cristina I.; Verastegui, Manuela R.; Sterling, Charles; Friedland, Jon S.; Garcia, Hector H.; Gilman, Robert H.
Background Neurocysticercosis is a leading cause of seizures and epilepsy in most of the world, and it occurs when Taenia solium larval cysts infect the central nervous system. T. solium tapeworm infection is endemic in much of Peru, but there are scarce data on the prevalence in many rural highland communities where it is likely to be hyper-endemic. Peace Corps Volunteers live and work in these communities; however, to our knowledge, they have not been used to facilitate public health research. Materials and Methods We utilized Peace Corps Volunteers to estimate the prevalence of T. solium tapeworm infection in seven rural communities in northern Peru. A convenience non-random sampling frame was used. Peace Corps Volunteers facilitated the collection of stool samples (N = 2,328), which were analyzed by sedimentation and microscopy. Niclosamide treatment and purgation preceded species identification, which was done by PCR-REA. Results Taenia sp. egg-positive stool samples were found in three of the seven communities we surveyed. The overall prevalence of Taenia sp. egg positivity was 2.1% (49/2,328) (95% CI = 1.6–2.8%) with prevalence up to 4.3% (42/977) (95% CI = 3.1–5.8%) by community. All 34 of the specimens tested by PCR-REA were T. solium. The overall prevalence of T. solium tapeworm infection was 1.5% (34/2,328) (95% CI = 1.0–2.0%). Prevalence up to 2.9% (28/977) (95% CI = 1.9–4.1%) by community was observed. Conclusion/Significance This study recorded high T. solium tapeworm prevalence, and identified hyper-endemic rural communities. It demonstrates that synergy between researchers and Peace Corps Volunteers can be an effective means to conducting large-scale, community-based studies in remote areas of Peru. PMID:25469506
Guillén-Mendoza, Daniel; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú.; Quiroga de Michelena, María; Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. Genética. Instituto de Medicina Genética. Lima, Perú.
Alkaptonuria is an inborn error of metabolism caused by deficiency of homogentisate 1,2-dioxygenase (HGD) which produces an excess of homogentisic acid (HGA). A case is presented of a 57 year old woman whose urine has turned black since birth. For 9 years she presented a greenish pigmentation in her nail beds that did not improve with antifungal treatments, and in the last 9 months she showed worsening large joint osteoarthritis. This situation forced her to use a wheelchair due to the intens...
Mbonye, Anthony K; Bygbjerg, Ib; Magnussen, Pascal
The impact of intermittent preventive treatment (IPT) on malaria in pregnancy is well known. In countries where this policy is implemented, poor access and low compliance to this intervention has been widely reported. A study was designed to assess a new approach to deliver IPT to pregnant women...... through traditional birth attendants (TBAs), drug-shop vendors (DSVs), community reproductive health workers (CRHWs) and adolescent peer mobilisers (APMs); and compared this approach with IPT at health units. We evaluated this approach to assess user perceptions, its acceptability and sustainability....... Results show that the new approach increased access and compliance to IPT. Mean gestational age at first dose of IPT was 21.0 weeks with the community approaches versus 23.1 weeks at health units, P>0.0001. Health units accessed a high proportion of adolescents, 28.4%, versus 25.0% at the new approaches...
Hernández-Vásquez, Akram; Azañedo, Diego; Antiporta, Daniel A; Cortés, Sandra
To establish regional prevalences of anemia in pregnant women receiving care at public clinics in Peru in 2015 and identify high-prevalence district conglomerates. An ecological study was carried out on data from pregnant women with anemia registered on the Nutritional Status Information System (SIEN) who received care in 7703 public clinics in 2015. Regional and district prevalences of gestational anemia were calculated. District conglomerates with a high prevalence of gestational anemia were identified using the Moran Index. Information was gathered from 311,521 pregnant women distributed in 1638 districts in Peru. The national prevalence of anemia was 24.2% (95% confidence interval [95% CI]: 24.0-24.3%), the rural prevalence was 30.5%, and the urban prevalence was 22.0%. The regions of Huancavelica (45.5%; 95% CI: 44.2-46.7%), Puno (42.8%; 95% CI: 41.9-43.7%), Pasco (38.5%; 95% CI: 36.9-40.0%), Cusco (36.0%; 95% CI: 35.3-36.8%), and Apurímac (32.0%; 95% CI: 30.8-33.1%) had the highest prevalences of anemia. The local Moran Index identified 202 high-priority districts (hot spots) (12.3% of total; 44 urban and 158 rural) located in Ancash, Apurímac, Arequipa, Ayacucho, Cajamarca, Cusco, Huancavelica, Huánuco, Junín, La Libertad, Lima, Pasco, and Puno containing high-prevalence district conglomerates. Gestational anemia in Peru has its highest prevalence rates in rural and southern mountainous areas. The district conglomerates with high prevalence rates of gestational anemia coincide with the areas of high regional prevalence.
Full Text Available Peru has historically been among the Latin-American countries with a low rural electrification rate. Aiming to improve this situation, the country conducted several electrification efforts in the last few decades that included off-grid photovoltaic (PV solutions for remote areas (where the grid expansion was unviable. More recently, the government has also sponsored a ‘massive program’ that aims to deploy a minimum of 150,000 off-grid PV solutions in the upcoming years. In this paper, we assess the sustainability of rural electrification programs in Peru, paying special attention to the ongoing “massive program”. Our assessment considers four dimensions of sustainability (institutional, economic, environmental, and socio-cultural and is based on an exhaustive qualitative document analysis complemented by semi-structured expert interviews. We found that the lack of strong formal institutions with a flexible and decentralized structure seriously compromises the sustainability of rural electrification efforts in Peru. Staff rotation and overlapping competences have caused disturbing changes and inhibited following a strategic line, while widespread outsourcing combined with weak controls have often affected the reliability of the deployed systems. Although cross subsidies have made off-grid PV systems affordable for users, systems often fell short of energy demand. Notably, we found that Peruvian officials appear to be unaware of the importance of local participation, and there is a significant mistrust between the government and the rural population (especially in areas where mining is extensive. As a consequence, most of the projects are still designed without the participation and engagement of the communities, which has frequently led to project failures, payment defaults, and inhibited seizing opportunities regarding productive uses of off-grid PV systems. We expect that our findings may help Peruvian institutions to address the most
McClellan, Sean R.
Objectives. We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California’s Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Methods. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997–2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. Results. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Conclusions. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services. PMID:23865663
Snowden, Lonnie R; McClellan, Sean R
We investigated the extent to which implementing language assistance programming through contracting with community-based organizations improved the accessibility of mental health care under Medi-Cal (California's Medicaid program) for Spanish-speaking persons with limited English proficiency, and whether it reduced language-based treatment access disparities. Using a time series nonequivalent control group design, we studied county-level penetration of language assistance programming over 10 years (1997-2006) for Spanish-speaking persons with limited English proficiency covered under Medi-Cal. We used linear regression with county fixed effects to control for ongoing trends and other influences. When county mental health plans contracted with community-based organizations, those implementing language assistance programming increased penetration rates of Spanish-language mental health services under Medi-Cal more than other plans (0.28 percentage points, a 25% increase on average; P language-related disparities. Mental health treatment programs operated by community-based organizations may have moderately improved access after implementing required language assistance programming, but the programming did not reduce entrenched disparities in the accessibility of mental health services.
Violence in three Latin American cities: A comparative study between Bogota, Lima, ... ENVIRONMENTAL POLICY, SURVEYS, INTERVIEWS, CASE STUDIES, POLICY ... GROUPS, CONSUMER BEHAVIOUR, SOCIAL BEHAVIOUR, Social Policy, ... Topic: OCCUPATIONAL STRUCTURE, LABOUR MARKET, ACCESS TO ...