Showing papers by "J. Jaime Miranda published in 2010"

Physical activity and cardiovascular risk factors among rural and urban groups and rural-to-urban migrants in Peru: a cross-sectional study

Abstract: OBJECTIVE: To compare physical activity and sedentary behavior patterns of rural-to-urban migrants in Peru versus lifetime rural and urban residents and to determine any associations between low physical activity and four cardiovascular risk factors: obesity (body mass index > 30 kg/m²), systolic and diastolic blood pressure, hypertension, and metabolic syndrome. METHODS: The PERU MIGRANT (PEru's Rural to Urban MIGRANTs) cross-sectional study was designed to measure physical activity among rural, urban, and rural-to-urban migrants with the International Physical Activity Questionnaire (IPAQ). RESULTS: The World Health Organization (WHO) age-standardized prevalence of low physical activity was 2.2% in lifetime rural residents, 32.2% in rural-to-urban migrants, and 39.2% in lifetime urban residents. The adjusted odds ratios for low physical activity were 21.43 and 32.98 for migrant and urban groups respectively compared to the rural group. The adjusted odds ratio for being obese was 1.94 for those with low physical activity. There was no evidence of an association between low physical activity and blood pressure levels, hypertension, or metabolic syndrome. CONCLUSIONS: People living in a rural area had much higher levels of physical activity and lower risk of being overweight and obese compared to those living in an urban area of Lima. Study participants from the same rural area who had migrated to Lima had levels of physical inactivity and obesity similar to those who had always lived in Lima. Interventions aimed at maintaining higher levels of physical activity among rural-to-urban migrants may help reduce the epidemic of obesity in urban cities.

Exporting "failure": why research from rich countries may not benefit the developing world

Abstract: The '10/90 gap' was first highlighted by the Global Forum for Health Research. It refers to the finding that 90% of worldwide medical research expenditure is targeted at problems affecting only 10% of the world's population. Applying research results from the rich world to the problems of the poor may be a tempting, potentially easy and convenient solution for this gap. This paper had the objective of presenting arguments that such an approach runs the risk of exporting failure. Health interventions that are shown to be effective in the specific context of a Western industrialized setting will not necessarily work in the developing world.

Reduciendo el trauma y la mortalidad asociada a los accidentes de tránsito en los peatones en el Perú: intervenciones que pueden funcionar

Abstract: Pedestrians in Peru are the victims of the greatest proportion of road traffic fatalities in the world. In 2009, pedestrians were involved in 27% of road traffic incidents in Peru. This is a significant public health problem in Peru and it has important economic effects as well. We review the evidence for some of the solutions and interventions implemented in other countries that may work well in Peru to confront this problem via preventing pedestrian-vehicle incidents. Most importantly, deploying interventions such as area-wide traffic calming through speed bumps, roundabouts, better lighting, one-way streets, detours, and blocking some roads has the strongest evidence for reducing injuries and fatalities in pedestrians. Other interventions related to education and enforcement may have a role as well in very specific contexts, but overall designing and modifying the built environment is the most important intervention.

Migration surrogates and their association with obesity among within-country migrants.

Abstract: Limited studies have evaluated the link between acculturation and health outcomes of within-country migrants. The objective of this study was to evaluate whether well-known acculturation surrogates were associated with obesity among Peruvian rural-to-urban migrants. We performed a cross-sectional survey, the PERU MIGRANT study, using single-stage random sampling. Evaluation included weight, height, and waist circumference (WC) as well as acculturation surrogates. Obesity was assessed using BMI and WC. Length of residence, age at migration, language proficiency, and language preferences (Spanish or Quechua) were assessed in logistic regression models to calculate odd ratios and 95% confidence intervals adjusting for potential confounders. A total of 589 rural-to-urban migrants were enrolled. The mean age was 47.8 (s.d.: 11.7, range: 30-92), and 280 (47.5%) were men. Obesity prevalence assessed using BMI was 30.4% among women and 10.7% among men (P < 0.001), whereas abdominal obesity assessed using WC was 29.1% among women and 19.1% among men (P < 0.01). Obesity was associated with older age at first migration, language speaking proficiency, and language preferences. The association between obesity and acculturation surrogates is variable in this population. Thus, acculturation per se can explore positive channels associated with better health outcomes. The patterns shown in this report suggest a more complex association for these factors.

Traumatismos causados por el tránsito en países en desarrollo: agenda de investigación y de acción

Abstract: Road traffic injury (RTI) is the leading cause of death in persons aged 10-24 worldwide and accounts for about 15% of all male deaths. The burden of RTI is unevenly distributed amongst countries with over eighty-fold differences between the highest and lowest death rates. Thus the unequal risk of RTI occurring in the developing world, due to many reasons, including but not limited to rapid motorization and poor infrastructure, is a major global challenge. This editorial highlights a number of key issues that must inform programs designed to prevent RTI in the developing world, where the epidemic is all the more insidious. firstly, road safety is a development issue; secondly, road traffic injury is a major health issue; thirdly, road traffic injuries can be prevented by the implementation of scientific measures; fourthly, pre-hospital and hospital emergency care is needed; and fifthly, research on RTI is neglected in low-income and middle-income countries. The repercussion of such progress to Peru is also discussed.

The prevalence of angina symptoms and association with cardiovascular risk factors, among rural, urban and rural to urban migrant populations in Peru

Abstract: Rural-to-urban migration in low- and middle-income countries causes an increase in individual cardiovascular risk. Cost-effective interventions at early stages of the natural history of coronary disease such as angina may stem an epidemic of premature coronary deaths in these countries. However, there are few data on the prevalence of angina in developing countries, whilst the understanding the aetiology of angina is complicated by the difficulty in measuring it across differing populations. The PERU MIGRANT study was designed to investigate differences between rural-to-urban migrant and non-migrant groups in specific cardiovascular disease risk factors. Mass-migration seen in Peru from 1980s onwards was largely driven by politically motivated violence resulting in less 'healthy migrant' selection bias. The Rose angina questionnaire was used to record chest pain, which was classified definite, possible and non-exertional. Mental health was measured using the General Health Questionnaire (GHQ-12). Mantel-Haenszel odds ratios (adjusted for age, sex, cardiovascular disease risk factors and mental health) were used to assess the risk of chest pain in the migrant and urban groups compared to the rural group, and further to assess the relationship (age and sex-adjusted) between risk factors, mental health and chest pain. Compared to the urban group, rural dwellers had a greatly increased likelihood of possible/definite angina (multi-adjusted OR 2.82 (1.68- 4.73)). Urban and migrant groups had higher levels of risk factors (e.g. smoking - 20.1% urban, 5.5% rural). No diabetes was seen in the rural dwellers who complained of possible/definite angina. Rural dwellers had a higher prevalence of mood disorder and the presence of a mood disorder was associated with possible/definite angina in all three groups, but not consistently with non-exertional chest pain. Rural groups had a higher prevalence of angina as measured by Rose questionnaire than migrants and urban dwellers, and a higher prevalence of mood disorder. The presence of a mood disorder was associated with angina. The Rose angina questionnaire may not be of relevance to rural populations in developing countries with a low pre-test probability of coronary disease and poor mental health.

Evaluación situacional, estructura, dinámica y monitoreo de los sistemas de información en accidentes de tránsito en el Perú - 2009

Abstract: RESUMEN Ojetivo: Con el objetivo de elaborar un diagnostico situacional de las fuentes de informacion existentes relacionadas con el registro de accidentes de transito, asi como conocer su estructura, dinamica y monitoreo, se realizo una investigacion en las ciudades de Lima, Huamanga y Pucallpa. Materiales y metodos. Como poblacion de estudio fueron considerados funcionarios y responsables de los sistemas de informacion de diversas instituciones. Se realizaron 50 entrevistas en profundidad. El instrumento usado tuvo en consideracion estandares y recomendaciones internacionales de sistemas de informacion. Resultados. Se identificaron seis sistemas de informacion; algunos cuentan con sistemas operativos que permiten recolectar, procesar, consolidar y analizar los datos de forma automatica. Estos sistemas son considerados valiosos por distintos actores, pues les permiten tener datos organizados. Se observo que existe un bajo nivel de colaboracion e intercambio de datos entre las instituciones en las distintas fases del levantamiento y procesamiento de informacion, y el uso de los mismos. A nivel operativo existen alianzas formales entre las instituciones vinculadas con el tema que permitirian un trabajo conjunto. Existe un interes por parte de las instituciones de conformar un sistema integrado de informacion por la necesidad de contar con informacion con mayor detalle y fiable empleando la menor cantidad d e recursos. Conclusiones. Existen limitaciones en los sistemas de informacion en accidentes de transito existentes. La utilidad y uso de la informacion es limitada para la toma de decisiones en materia de prevencion de los accidentes de transito a nivel nacional.

Cobertura real de la ley de atención de emergencia y del Seguro Obligatorio contra Accidentes de Tránsito (SOAT)

Abstract: (74% en Pucallpa, 34% en Ayacucho y 26% en Lima: p<0,001). De los que contaban con un seguro (SOAT u otro), pero cuya atencion no fue cubierta por este, la mayoria estuvo en Lima (70%), seguido de Ayacucho (30%) y ninguno en Pucallpa. La mayoria (94%) procedio de establecimientos publicos. Las razones incluyeron problemas administrativos (25%), vencimiento del seguro o morosidad en el pago (21%), invalidez del seguro en el establecimiento (18%), no disponibilidad de la poliza (18%), o no cobertura de las lesiones por el seguro (9%). En estos casos, los gastos fueron asumidos por el mismo paciente, familiares o parientes, el chofer o dueno del vehiculo, el servicio social del EESS, u otras personas o instituciones. Conclusiones. En este estudio se observo un gran desconocimiento de la Ley de Atencion de Emergencia, y una cobertura de atencion muy deficiente, pues casi la mitad de atenciones no fueron brindadas de acuerdo a uno o mas puntos establecidos por dicha norma. Los costos de atencion generados por el accidente de transito no fueron cubiertos por un seguro en una de cada tres victimas. Es urgente mejorar la informacion de los ciudadanos sobre sus derechos y el cumplimiento efectivo de las leyes, para lograr una cobertura universal y mas equitativa en la atencion de las victimas de accidentes de transito.

Traumatismos causados por el tránsito en el Perú. ¿Dónde estamos y hacia dónde vamos?

Abstract: MIRANDA, Jaime J. y HUICHO, Luis. Traumatismos causados por el transito en el Peru : ?Donde estamos y hacia donde vamos?. Revista Peruana de Medicina Experimental y Salud Publica. [en linea]. 2010, vol. 27, no. 2. p. 157-161. ISSN 1726-4642.