ABSTRACT: Objective: To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua. Methods: The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated. Results: Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence. Conclusion: We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.

RESUMO: Objetivo: Identificar os fatores ambientais presentes em áreas com alta densidade de acidentes de trânsito rodoviário (ATR) em León, Nicarágua. Métodos: Foram incluídos na análise todos os acidentes registrados pelo Departamento de Polícia da cidade de León de janeiro a junho de 2017. Georreferenciamos todos os acidentes e coletamos dados dos elementos ambientais em um perímetro de 20 metros do local até os acidentes ocorridos por meio de um instrumento de coleta de dados pré-testado. Foi especificado um modelo de regressão de Poisson para estimar as razões das taxas de incidência (TI) e intervalos de confiança de 95% (IC95%) para determinar os fatores ambientais associados à incidência do evento. Para identificar áreas com alta, média e baixa ocorrência de acidentes, estimamos a densidade do núcleo em torno dos pontos onde o ATR ocorreu. Resultados: Dos 667 acidentes registrados, 90% envolveram homens com idades entre 15 e 40 anos, e os acidentes de motocicleta representaram 60% dos ferimentos ou mortes. Os fatores ambientais que foram associados positivamente aos ATR incluíram boas condições da estrada (TI ajustada = 1,36; IC95% 1,13 - 1,63) e a existência de ciclovias (TI ajustada = 1,64; IC95% 1,29 - 2,10). Características ambientais associadas a velocidades mais altas e acidentes mais pesados podem aumentar a incidência deles. Conclusão: Constatamos que os centros comerciais ou turísticos com tráfego intenso são três áreas com alta densidade de acidentes. As autoridades locais podem usar essas descobertas para promover medidas de segurança no trânsito em áreas de alta incidência na cidade de León.

RESUMO: Objetivo: Identificar os fatores ambientais presentes em áreas com alta densidade de acidentes de trânsito rodoviário (ATR) em León, Nicarágua. Métodos: Foram incluídos na análise todos os acidentes registrados pelo Departamento de Polícia da cidade de León de janeiro a junho de 2017. Georreferenciamos todos os acidentes e coletamos dados dos elementos ambientais em um perímetro de 20 metros do local até os acidentes ocorridos por meio de um instrumento de coleta de dados pré-testado. Foi especificado um modelo de regressão de Poisson para estimar as razões das taxas de incidência (TI) e intervalos de confiança de 95% (IC95%) para determinar os fatores ambientais associados à incidência do evento. Para identificar áreas com alta, média e baixa ocorrência de acidentes, estimamos a densidade do núcleo em torno dos pontos onde o ATR ocorreu. Resultados: Dos 667 acidentes registrados, 90% envolveram homens com idades entre 15 e 40 anos, e os acidentes de motocicleta representaram 60% dos ferimentos ou mortes. Os fatores ambientais que foram associados positivamente aos ATR incluíram boas condições da estrada (TI ajustada = 1,36; IC95% 1,13 - 1,63) e a existência de ciclovias (TI ajustada = 1,64; IC95% 1,29 - 2,10). Características ambientais associadas a velocidades mais altas e acidentes mais pesados podem aumentar a incidência deles. Conclusão: Constatamos que os centros comerciais ou turísticos com tráfego intenso são três áreas com alta densidade de acidentes. As autoridades locais podem usar essas descobertas para promover medidas de segurança no trânsito em áreas de alta incidência na cidade de León.

ABSTRACT: Objective: To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua. Methods: The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated. Results: Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence. Conclusion: We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.

Abstract Objective To evaluate the global productivity regarding original articles on maternal near-miss (MNM). Methods We conducted a bibliometric analysis of original articles published from 2008 to November 2019 in the journals indexed in the Scopus database. The averages of the number of articles by author, of the number of authors by article, of the number of citations by article, and the total number of documents with one or more authors were obtained. An analysis of the co-citation of authors and a co-occurrence analysis of the terms included in the titles and abstracts were performed and were presented as network visualization maps. Results A total of 326 original articles were analyzed. There was an increase in the number of articles (p < 0.001; average annual growth rate = 12.54%;). A total of 1,399 authors, an average number of articles per author of 4.29, with an index of authors per document of 0.23, and an index of co-authors per document of 8.16 were identified. A total of 85 countries contributed with original articles on MNM. Among the top ten countries regarding the contribution of articles, five were low and middle-income countries (LMICs). Brazil had the highest volume of production (31.1%;), followed by the US (11.5%;). Terms related to countries and the measurement of the rates and cases of MNM and the associated factors were found in recent years in the analysis of the co-occurrence of terms. Conclusion There was an increase in the production of original articles on MNM, with a significant participation of authors and institutions from LMICs, which reveals a growing interest in the use of MNM indicators to improve the quality of maternal health care.

Objetivo: determinar la oferta global de Massive Open Online Courses (MOOCs) en salud y enfermería, y conocer las características de su contenido, para la educación continua de profesionales de enfermería en Perú. Método: estudio exploratorio se llevó a cabo en sitios web Coursera, edX, FutureLearn, XuetangX y Udacity, Class Central y MOOC List. Los cursos se clasificaron según las cinco áreas de enfermería reconocidas por el Colegio de Enfermeros del Perú (CEP). De cada curso se recopilaron datos sobre institución y país de origen, horas por semana y duración total en semanas, idioma de audio y de subtítulos. Resultados: se encontró un total de 654 cursos en esta modalidad en salud, que abarcaron las cinco áreas contempladas por el Colegio de Enfermeros del Perú. Catorce cursos fueron elaborados específicamente para enfermería con una duración promedio de cinco semanas (3,2 horas semanales de actividades). Once procedían de instituciones anglosajonas, con contenido en inglés. Solo dos se ofrecieron en español y uno en turco. Conclusión: Massive Open Online Courses es una herramienta útil para la educación continua del enfermero peruano dada la amplia oferta, incluyendo algunos específicamente para enfermeros, en las distintas áreas de la enfermería. El contenido de los cursos se ofrecen mayoritariamente en inglés. Ampliar la oferta de idiomas o subtítulos facilitaría la participación de un mayor público.

Objetivo: determinar a oferta global de Massive Open Online Courses (MOOCs) em saúde e enfermagem e conhecer as características de seu conteúdo para a educação continuada em profissionais de enfermagem. Método: estudo exploratório realizado nos sites Coursera, edX, FutureLearn, XuetangX e Udacity, Class Central e MOOC List. Os cursos foram classificados de acordo com as cinco áreas de enfermagem reconhecidas pelo Colégio Peruano de Enfermeiros (Colegio de Enfermeros del Perú, CEP). Para cada curso foram coletadas as variáveis instituição e país de origem, horas semanais e duração total em semanas, idioma do áudio e das legendas. Resultados: foram encontrados 654 cursos nessa modalidade em saúde, cobrindo as cinco áreas contempladas pelo Colégio Peruano de Enfermeiros. Quatorze cursos foram desenvolvidos especificamente para enfermagem, com duração média de cinco semanas (3,2 horas por semana de atividades). Onze procediam de instituições anglo-saxônicas, com conteúdo em inglês. Apenas dois cursos foram oferecidos em espanhol e um em turco. Conclusão: Massive Open Online Courses é uma ferramenta útil para a educação continuada do enfermeiro peruano, dada a ampla oferta, incluindo alguns especificamente para enfermeiros, nas diferentes áreas da enfermagem. O seu conteúdo é oferecido principalmente em inglês. Expandir a variedade de idiomas ou incluir legendas facilitaria a participação de um público maior.

Objective: to determine the global offer of Massive Open Online Courses (MOOCs) in health and nursing, and to know the characteristics of its content, for continuing education in nursing professionals in Peru. Method: exploratory study was carried out on the websites: Coursera, edX, FutureLearn, XuetangX and Udacity, Class Central and MOOC List. The courses were classified according to the five nursing areas recognized by the Peruvian College of Nurses (Colegio de Enfermeros del Perú, CEP). From each course, data was collected on institution and country of origin, hours per week and total duration in weeks, audio and subtitle language. Results: a total of 654 courses in this modality are offered in health were found, covering the five areas contemplated by the Peruvian College of Nurses. Fourteen courses were specifically developed for nursing with an average duration of five weeks (3.2 hours per week of activities). Eleven came from Anglo-Saxon institutions, with content in English. Only two courses were offered in Spanish and one in Turkish. Conclusion: Massive Open Online Courses would be a useful tool for the continuing education of the Peruvian nurse given the wide offer, including some specifically for nurses, in the different areas of nursing. The content of the course is mostly in English. Expanding the range of languages or subtitles would facilitate the participation of a larger audience.

RESUMEN Análisis secundario de los datos de 41 330 niños de uno a 11 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se reportó la frecuencia de cepillado y el uso de pasta dental según el nivel de flúor (no cepillado, adecuado, inadecuado, no mostró/no usa pasta, e ilegible), según variables socioeconómicas y geográficas. Un 7,8% de los niños evaluados no se cepillaba los dientes, se evidenció diferencias porcentuales significativas (p <0,001) en el uso de pasta dental con concentración inadecuada de flúor entre las categorías extremas de las variables edad (12,3%), uso de servicios odontológicos (7,7%), nivel educativo del responsable (20,4%), índice de riqueza (17,8%), dominio geográfico (11,3%) y área de residencia (9,1%). Un porcentaje considerable de niños peruanos no se cepilla los dientes; además, un gran número de niños que se cepillan emplean pastas dentales con contenidos de flúor sin efecto preventivo.

ABSTRACT Secondary analysis of data on 41,330 children aged one to 11 from the Demographic and Family Health Survey (ENDES) carried out in 2018. The frequency of brushing and the use of toothpaste were reported according to the level of fluoride (no brushing, adequate, inadequate, did not show/did not use toothpaste, and illegible), according to socioeconomic and geographical variables. The evaluation showed that 7.8% of children did not brush their teeth; there were significant percentage differences (p <0.001) in the use of toothpaste with inadequate fluoride concentration between the extreme categories of the variables: age (12.3%), use of dental services (7.7%), educational level of the person responsible (20.4%), wealth index (17.8%), geographical domain (11.3%), and area of residence (9.1%). A considerable percentage of Peruvian children do not brush their teeth; in addition, a large number of children who brush use toothpastes with a fluoride content that has no preventive effect.

RESUMEN Objetivo. Estimar la prevalencia y determinar los factores asociados a la no utilización de instituciones prestadoras de servicios de salud (NUIPSS) en inmigrantes adultos venezolanos en Perú. Materiales y métodos. Estudio transversal analítico de la «Encuesta Dirigida a la Población Venezolana que Reside en el País» 2018. Se calculó la proporción de inmigrantes con NUIPSS (inmigrantes con algún síntoma o malestar, enfermedad, recaída de enfermedad crónica, accidente y molestia o problema como depresión, miedo, enojo, ansiedad, estrés y que consideraron que no era tan grave o necesario acudir a una institución prestadora de servicios de salud). Se estimaron razones de prevalencia (RP) crudas y ajustadas (RPa) de presentar NUIPSS usando modelos lineales generalizados. Resultados . Se incluyeron 2144 venezolanos inmigrantes. El 57,2% presentó NUIPSS, reportando motivos como: no contar con dinero (64,5%), carecer de seguro de salud (24,3%), automedicación (12,8%) y no disponer de tiempo (8,4%). Residir en Arequipa (Rpa:0,69; IC95%: 0,57-0,83) o Trujillo (Rpa: 0,87; IC95%: 0,76-0,99), padecer una enfermedad crónica (Rpa: 0,83; IC95%: 0,71-0,97) y estar afiliado al Seguro Integral de Salud (SIS) (Rpa: 0,28; IC95%: 0,13-0,61) se asoció con una menor probabilidad de NUIPSS. Ser de un grupo etario más joven al de 60 a más años se asoció con una mayor probabilidad de NUIPSS. Conclusiones. Uno de cada dos venezolanos inmigrantes en Perú presenta NUIPSS. Contar con SIS incrementa la probabilidad de acudir a atención médica en inmigrantes venezolanos en territorio peruano. Incrementar el aseguramiento público en salud de esta población, que actualmente es bajo, podría incrementar el uso de servicios de salud.

ABSTRACT Objective. To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

RESUMEN Objetivos. Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. Materiales y métodos. Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. Resultados. Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno». Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. Conclusiones. Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

ABSTRACT Objectives. To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. Materials and Methods. Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. Results. The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. Conclusions. Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

Secondary analysis of data on 41,330 children aged one to 11 from the Demographic and Family Health Survey (ENDES) carried out in 2018. The frequency of brushing and the use of toothpaste were reported according to the level of fluoride (no brushing, adequate, inadequate, did not show/did not use toothpaste, and illegible), according to socioeconomic and geographical variables. The evaluation showed that 7.8% of children did not brush their teeth; there were significant percentage differences (p <0.001) in the use of toothpaste with inadequate fluoride concentration between the extreme categories of the variables: age (12.3%), use of dental services (7.7%), educational level of the person responsible (20.4%), wealth index (17.8%), geographical domain (11.3%), and area of residence (9.1%). A considerable percentage of Peruvian children do not brush their teeth; in addition, a large number of children who brush use toothpastes with a fluoride content that has no preventive effect.

Análisis secundario de los datos de 41 330 niños de uno a 11 años de la Encuesta Demográfica y de Salud Familiar (ENDES) 2018. Se reportó la frecuencia de cepillado y el uso de pasta dental según el nivel de flúor (no cepillado, adecuado, inadecuado, no mostró/no usa pasta, e ilegible), según variables socioeconómicas y geográficas. Un 7,8% de los niños evaluados no se cepillaba los dientes, se evidenció diferencias porcentuales significativas (p <0,001) en el uso de pasta dental con concentración inadecuada de flúor entre las categorías extremas de las variables edad (12,3%), uso de servicios odontológicos (7,7%), nivel educativo del responsable (20,4%), índice de riqueza (17,8%), dominio geográfico (11,3%) y área de residencia (9,1%). Un porcentaje considerable de niños peruanos no se cepilla los dientes; además, un gran número de niños que se cepillan emplean pastas dentales con contenidos de flúor sin efecto preventivo.

Objective.To estimate the prevalence and determine the factors associated with the non-utilization of healthcare facilities (NUHCF) among adult Venezuelan migrants in Peru. Materials and Methods. An analytical cross-sectional study of the "Survey of the Venezuelan Population Residing in Peru" 2018. We calculated the proportion of immigrants with NUHCF (immigrants with some symptom or malaise, illness, relapse of chronic illness, accident and discomfort, or other problem such as depression, fear, anger, anxiety, and stress, and who did not consider that it was serious or that they needed to visit a healthcare facility). Raw and adjusted (PRa) prevalence ratios (PR) for presenting NUHCF were estimated using generalized linear models. Results. The study included 2,144 Venezuelan migrants: 57.2% presented NUHCF, reporting reasons such as: not having money (64.5%), lack of health insurance (24.3%), self-medication (12.8%), and not having time (8.4%). Living in Arequipa (PRa: 0.69; 95% CI: 0.57-0.83) or Trujillo (PRa: 0.87; 95% CI: 0.76-0.99), suffering from a chronic disease (PRa: 0.83; 95% CI: 0.71-0.97), and being enrolled in the Seguro Integral de Salud (SIS) insurance (PRa: 0.28; 95% CI: 0.13-0.61) was associated with a lower probability of NUHCF. Belonging to an age group under 60 years was associated with a higher probability of NUHCF. Conclusions. One out of two Venezuelan migrants in Peru presents NUHCF. Having SIS increases the likelihood of Venezuelan migrants in Peruvian territory seeking medical attention. Increasing public health insurance for this population, which is currently low, could increase the utilization of health services.

Objetivo. Estimar la prevalencia y determinar los factores asociados a la no utilización de instituciones prestadoras de servicios de salud (NUIPSS) en inmigrantes adultos venezolanos en Perú. Materiales y métodos. Estudio transversal analítico de la «Encuesta Dirigida a la Población Venezolana que Reside en el País» 2018. Se calculó la proporción de inmigrantes con NUIPSS (inmigrantes con algún síntoma o malestar, enfermedad, recaída de enfermedad crónica, accidente y molestia o problema como depresión, miedo, enojo, ansiedad, estrés y que consideraron que no era tan grave o necesario acudir a una institución prestadora de servicios de salud). Se estimaron razones de prevalencia (RP) crudas y ajustadas (RPa) de presentar NUIPSS usando modelos lineales generalizados. Resultados. Se incluyeron 2144 venezolanos inmigrantes. El 57,2% presentó NUIPSS, reportando motivos como: no contar con dinero (64,5%), carecer de seguro de salud (24,3%), automedicación (12,8%) y no disponer de tiempo (8,4%). Residir en Arequipa (Rpa:0,69; IC95%: 0,57-0,83) o Trujillo (Rpa: 0,87; IC95%: 0,76-0,99), padecer una enfermedad crónica (Rpa: 0,83; IC95%: 0,71-0,97) y estar afiliado al Seguro Integral de Salud (SIS) (Rpa: 0,28; IC95%: 0,13-0,61) se asoció con una menor probabilidad de NUIPSS. Ser de un grupo etario más joven al de 60 a más años se asoció con una mayor probabilidad de NUIPSS. Conclusiones. Uno de cada dos venezolanos inmigrantes en Perú presenta NUIPSS. Contar con SIS incrementa la probabilidad de acudir a atención médica en inmigrantes venezolanos en territorio peruano. Incrementar el aseguramiento público en salud de esta población, que actualmente es bajo, podría incrementar el uso de servicios de salud.

Objectives. To estimate satisfaction with the healthcare received at facilities of the Ministry of Health (MINSA) of Peru and determine its associated factors in Peruvian adults. Materials and Methods. Analytical cross-sectional study using data from the National Household Survey on Living Conditions and Poverty (ENAHO) 2018. Satisfaction with healthcare received was rated as very bad, bad, good, and very good. The characteristics of the study population were described using weighted frequencies and proportions. To determine the factors associated with satisfaction with the care received, a generalized ordinal logistic model was estimated. Results. The study included a total of 14,206 adults (expanded population: 7,684,602) who reported having been treated at a MINSA healthcare facility. At the national level, 74.3% of users reported satisfaction with the service received as "good or very good". Having a chronic illness, having a native mother tongue, or living in a population with agglomerations of more than 2000 people were associated with lower satisfaction with the care received. Living in the jungle area was associated with a report of greater satisfaction with the care. Conclusions. Three out of four external users rate the care received at MINSA facilities as good or very good. There are population subgroups with less satisfaction with the care received. Improving the satisfaction of these users would improve the quality of care at the facilities of MINSA, the largest health provider in Peru.

Objetivos. Estimar la satisfacción con la atención en salud recibida en los establecimientos del Ministerio de Salud (MINSA) en el Perú y determinar sus factores asociados en adultos peruanos. Materiales y métodos. Estudio analítico de corte transversal empleando datos de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza (ENAHO) 2018. La satisfacción con la atención en salud recibida fue calificada como: muy mala, mala, buena, y muy buena. Se describieron las características de la población en estudio mediante frecuencias y proporciones ponderadas. Para determinar los factores asociados a la satisfacción con la atención recibida, se estimó un modelo logístico ordinal generalizado. Resultados. Se incluyó un total de 14 206 adultos (población expandida: 7 684 602) que reportaron haber sido atendidos en algún establecimiento de salud del MINSA. A nivel nacional, el 74,3% de usuarios reportó una satisfacción con el servicio recibido como «bueno o muy bueno». Padecer una enfermedad crónica, tener una lengua materna nativa o vivir en aglomeraciones poblacionales mayores a 2000 personas se asoció con una menor satisfacción con la atención recibida. Vivir en la selva se asoció con un reporte de mayor satisfacción con la atención. Conclusiones. Tres de cada cuatro usuarios externos califican como buena o muy buena la atención recibida en establecimientos del MINSA. Existen subgrupos poblacionales con una menor satisfacción de la atención recibida. Incidir en la mejora de la satisfacción de estos usuarios mejoraría la calidad de la atención en el MINSA, el mayor prestador en salud en Perú.

RESUMEN Objetivo. Estimar la proporción de mujeres peruanas que recibieron un control prenatal (CPN) de calidad para el último parto de los últimos cinco años y determinar sus factores asociados. Materiales y métodos. Estudio transversal analítico de la Encuesta Demográfica y de Salud Familiar 2017. Se calculó la proporción de CPN de calidad según número de CPN. Se estimaron razones de prevalencia crudas y ajustadas (RPa) de presentar un CPN de calidad. Resultados. Se analizaron datos de 18 156 mujeres, el 56,1% recibió un CPN de calidad. Recibir más CPN incrementó la probabilidad de recibir un CPN de calidad (49,6% y 59,9% para seis y ocho controles, respectivamente). Ser de la sierra (RPa=0,85; IC 95%: 0,80-0,91), vivir en la zona rural (RPa=0,94; IC 95%: 0,89-0,99) y pertenecer a una etnia nativa (RPa=0,72; IC 95%: 0,66-0,79) se asoció con un menor probabilidad de recibir un CPN de calidad. Tener educación secundaria (RPa=1,16; IC 95%: 1,10-1,22) y superior (RPa=1,15; IC 95%: 1,07-1,23), ser del quintil de riqueza 2 (RPa=1,15; IC 95%: 1,08-1,22), quintil 3 (RPa=1,18; IC 95%: 1,09-1,27), quintil 4 (RPa=1,16; IC 95%: 1,07-1,26) y quintil 5 (RPa=1,16; IC 95%: 1,05-1,28), ser del resto de la Costa (RPa=1,06; IC 95%: 1,00-1,12) y Selva (RPa=1,31; IC 95%: 1,24-1,39), tener una afiliación a un seguro de salud (RPa=1,24; IC 95%: 1,18-1,30), orden de nacimiento 2 a 3 (RPa=1,10; IC 95%:1,06-1,15) o ≥4 (RPa = 1,20; IC 95%:1,14-1,27) y haber recibido un CPN en el primer trimestre (RPa=1,20; IC 95%: 1,14-1,26) se relacionaba a una mayor probabilidad de recibir un CPN de calidad. Conclusiones. Cuatro de cada diez mujeres no recibieron un CPN de calidad. Ser mujer de etnia nativa o de la sierra o zona rural estuvo asociado a una mala calidad del CPN, requiriéndose priorización de estos grupos en las estrategias de salud materna.

ABSTRACT Objective . To estimate the proportion of Peruvian women who received quality prenatal care (PNC) for their last childbirth in the last five years and to determine its associated factors. Materials and Methods. Analytical cross-sectional study of the 2017 Demographic and Family Health Survey. The proportion of quality PNC was calculated based on the number of PNC control visits. Bivariate and adjusted prevalence ratios (PRa) of quality PNC were estimated. Results. Data from 18,156 women were analyzed; 56.1% received quality PNC. Receiving more PNC visits increased the likelihood of receiving quality PNC (49.6% and 59.9% for six and eight control visits, respectively). Being from the highlands (PRa=0.85; 95% CI: 0.80-0.91), living in rural areas (PRa=0.94; 95% CI: 0.89-0.99), and belonging to a native ethnic group (PRa=0.72; 95% CI: 0.66-0.79) was associated with a lower likelihood of receiving quality PNC. Having completed high-school (PRa=1.16; 95% CI: 1.10-1.22) and higher education (PRa=1.15; 95% CI: 1.07-1.23), being from the 2nd wealth quintile (PRa=1.15; 95% CI: 1.08-1.22), 3rd quintile (PRa=1.18; 95% CI: 1.09-1.27), 4th quintile (PRa=1.16; 95% CI: 1.07-1.26), and 5th quintile (PRa=1.16; 95% CI: 1.05-1.28); being from the rest of the Coast (PRa=1.06; 95% CI: 1.00-1.12) and Jungle (PRa=1.31; 95% CI: 1.24-1.39); being enrolled in health insurance (PRa=1.24; 95% CI: 1.18-1.30); birth order 2-3 (PRa=1.10; 95% CI: 1.06-1.15) or ≥4 (PRa=1.20; 95% CI: 1.14-1.27), and having received PNC in the first trimester (PRa=1.20, 95% CI: 1.14-1.26) was related to an increased likelihood of receiving quality PNC. Conclusions . Four out of ten women did not receive quality PNC, especially in women of native ethnicity or residents of the highlands or rural areas, groups that would require prioritization in maternal health strategies.

Objective: To assess and identify changes in the temporal trend in mortality from alcohol-attributable gastrointestinal diseases and their disease burden based on years of life lost (YLL) in Peru. Materials and methods: An ecological study of the death records of the Ministry of Health of Peru was conducted from 2003-2016. A gastrointestinal death attributable to alcohol was considered if the basic, intermediate, or final cause of death included ICD-10 codes: K70, K700-4, K709, K292, K852, and K860. Crude and age-adjusted mortality rates were calculated for the general population aged 15 or older and by sex, and YLL. Joinpoint regression analysis was performed to evaluate trends in mortality. Results: There were 11 148 deaths by alcohol-attributable gastrointestinal diseases, being more frequent in males (74.89%), in adults aged 45 years and above (83.67%), living in urban area (69.87%) and the Andes region (60.0%), and in subjects with liver disease (85.98%). Adjusted mortality rates varied from 6.21 (95% CI: 5.78- 6.63) in 2003 to 3.95 (95% CI: 3.67-4.22) in 2016. The trend of mortality decreased in the general population (APC: -6.17, 95% CI: -9.9 to -2.2, p=0.007) during the period 2008-2016. Deaths from the causes studied generated 224 545 YLL. Conclusions: A declining trend was found in gastrointestinal deaths attributable to alcohol in the period 2008-2016. The highest mortality occurred in males, individuals aged 45 years and above, living in urban areas and the Andes region.

Objetivo: Evaluar e identificar los cambios en la tendencia temporal en mortalidad debida a las enfermedades gastrointestinal causadas por el alcohol y su carga de enfermedad basada en años de vida potencialmente perdidos (AVPP) en Perú. Material y métodos: Un estudio ecológico de los reportes de muerte del Ministerio de Salud del Perú entre 2013 a 2016. Se consideró una enfermedad gastrointestinal asociada al alcohol si la causa final o básica o intermedia de la muerta incluía los códigos CIE 10: K70, K700-4 K709 K292 K852 y K860. Los índices de mortalidad bruta y ajustada a la edad se calcularon para población general mayor de 15 años y por sexo y AVPP. Se realizaron análisis de regresión joinpoint para evaluar las tendencias en mortalidad. Resultados: Hubieron 11 148 muertes por enfermedades gastrointestinal atribuidas al uso de alcohol, siendo más frecuente en hombres (74,89%), en personas de 45 a más años de edad (83,67%), pobladores de área urbana (69,87%), en la región de los Andes (60,0%) y en sujetos con enfermedad hepática (85,98%). La tasa de mortalidad ajustada varió de 6,21 (95% IC 5,78 - 6,63) en 2003 a 3,95 (95% IC 3,67 - 4,22) en el 2016. La tendencia de la mortalidad disminuyó en la población general (APC: -6,17, 95% IC: -9,9 a -2,2, p=0,007) durante el periodo 2008-2016. Las muertes debidas a las causas estudiadas generaron 224 545 años perdidos. Conclusiones: Se encontró una tendencia decreciente en las muertes por enfermedades gastrointestinal atribuidas al alcohol en el periodo 2008-2016. La mortalidad más alta ocurrió en hombres, personas de 45 a más años, procedentes de áreas urbanas y de la región de los Andes.

Objective. To estimate the proportion of Peruvian women who received quality prenatal care (PNC) for their last childbirth in the last five years and to determine its associated factors. Materials and Methods. Analytical cross-sectional study of the 2017 Demographic and Family Health Survey. The proportion of quality PNC was calculated based on the number of PNC control visits. Bivariate and adjusted prevalence ratios (PRa) of quality PNC were estimated. Results. Data from 18,156 women were analyzed; 56.1% received quality PNC. Receiving more PNC visits increased the likelihood of receiving quality PNC (49.6% and 59.9% for six and eight control visits, respectively). Being from the highlands (PRa=0.85; 95% CI: 0.80-0.91), living in rural areas (PRa=0.94; 95% CI: 0.89-0.99), and belonging to a native ethnic group (PRa=0.72; 95% CI: 0.66-0.79) was associated with a lower likelihood of receiving quality PNC. Having completed high-school (PRa=1.16; 95% CI: 1.10-1.22) and higher education (PRa=1.15; 95% CI: 1.07-1.23), being from the 2nd wealth quintile (PRa=1.15; 95% CI: 1.08-1.22), 3rd quintile (PRa=1.18; 95% CI: 1.09-1.27), 4th quintile (PRa=1.16; 95% CI: 1.07-1.26), and 5th quintile (PRa=1.16; 95% CI: 1.05-1.28); being from the rest of the Coast (PRa=1.06; 95% CI: 1.00-1.12) and Jungle (PRa=1.31; 95% CI: 1.24-1.39); being enrolled in health insurance (PRa=1.24; 95% CI: 1.18-1.30); birth order 2-3 (PRa=1.10; 95% CI: 1.06-1.15) or ≥4 (PRa=1.20; 95% CI: 1.14-1.27), and having received PNC in the first trimester (PRa=1.20, 95% CI: 1.14-1.26) was related to an increased likelihood of receiving quality PNC. Conclusions. Four out of ten women did not receive quality PNC, especially in women of native ethnicity or residents of the highlands or rural areas, groups that would require prioritization in maternal health strategies.

Objetivo. Estimar la proporción de mujeres peruanas que recibieron un control prenatal (CPN) de calidad para el último parto de los últimos cinco años y determinar sus factores asociados. Materiales y métodos. Estudio transversal analítico de la Encuesta Demográfica y de Salud Familiar 2017. Se calculó la proporción de CPN de calidad según número de CPN. Se estimaron razones de prevalencia crudas y ajustadas (RPa) de presentar un CPN de calidad. Resultados. Se analizaron datos de 18 156 mujeres, el 56,1% recibió un CPN de calidad. Recibir más CPN incrementó la probabilidad de recibir un CPN de calidad (49,6% y 59,9% para seis y ocho controles, respectivamente). Ser de la sierra (RPa=0,85; IC 95%: 0,80-0,91), vivir en la zona rural (RPa=0,94; IC 95%: 0,89-0,99) y pertenecer a una etnia nativa (RPa=0,72; IC 95%: 0,66-0,79) se asoció con un menor probabilidad de recibir un CPN de calidad. Tener educación secundaria (RPa=1,16; IC 95%: 1,10-1,22) y superior (RPa=1,15; IC 95%: 1,07-1,23), ser del quintil de riqueza 2 (RPa=1,15; IC 95%: 1,08-1,22), quintil 3 (RPa=1,18; IC 95%: 1,09-1,27), quintil 4 (RPa=1,16; IC 95%: 1,07-1,26) y quintil 5 (RPa=1,16; IC 95%: 1,05-1,28), ser del resto de la Costa (RPa=1,06; IC 95%: 1,00-1,12) y Selva (RPa=1,31; IC 95%: 1,24-1,39), tener una afiliación a un seguro de salud (RPa=1,24; IC 95%: 1,18-1,30), orden de nacimiento 2 a 3 (RPa=1,10; IC 95%:1,06-1,15) o ≥4 (RPa = 1,20; IC 95%:1,14-1,27) y haber recibido un CPN en el primer trimestre (RPa=1,20; IC 95%: 1,14-1,26) se relacionaba a una mayor probabilidad de recibir un CPN de calidad. Conclusiones. Cuatro de cada diez mujeres no recibieron un CPN de calidad. Ser mujer de etnia nativa o de la sierra o zona rural estuvo asociado a una mala calidad del CPN, requiriéndose priorización de estos grupos en las estrategias de salud materna.