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It is important to determine whether these lower avoidable hospitalization rates reflect an adequate level of accessibility and quality of primary care health services for rural populations or, in the contrary, they reveal access barriers to hospital care.

OBJECTIVE: To report the design, methodology and initial results of the National Socioeconomic Survey of Access to Health of the EsSalud Insured. RESULTS: There were interviews in 25,000 homes, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. RESULTS: The 25,000 homes were interviewed, surveying 79,874 people, of which 62,659 were affiliated to EsSalud. The insured people are mainly males (50.6%) with a higher technical education level (39.7%). The insured population has mostly independent (95.0%) and own (68.1%) home. Only 34.5% of the insured practice some sport or physical exercise; 14.0% of the population suffers from a chronic disease; 3.5% have diabetes; and 7.1%, arterial hypertension. In the last three months, 35.4% of the members needed medical attention; of these, only 73.1% received health care and the remaining 10.9% were treated in pharmacies or non-formal health care services. CONCLUSIONS: This survey is the first performed in the population of EsSalud affiliates, applied at the national level, and has socio-economic and demographic data of the insured, their distribution, risk factors of health, prevalence of health problems and the degree of access to health services.

Although women in Spain have incorporated mammography into their preventive healthcare regimen, inequalities in its use persist in some groups of women such those with primary caregiving responsibilities for disabled family members.

and the ease of work with the medication administration process after implementation of a bedside bar-coded medication administration system and a medication dispensing system in an intensive care unit (ICU) at a tertiary hospital. METHODS: A prospective cohort study was conducted to compare medication administration time before and after these two interventions using a pre-validated instrument. The bedside bar-coded medication administration system was implemented in 2008 and the medication dispensing system was implemented in 2009. Perception of nurses regarding timeliness of completion, documentation burden, administration burden, and ease of detection of medication errors during the medication administration process were measured using a 5 point Likert scale -from 1 (Strongly Disagree) to 5 (Strongly Agree). Descriptive and comparative (t test) analyses were conducted using SAS 9.2® to evaluate the impact of technological intervention on the nurses' perception. RESULTS: A total of 99 pre-intervention and 109 post-intervention responses were recorded for every medication administration process. Mean (Ϯ SD) perception score regarding timeliness of completion has been significantly (pϽ0.05) reduced from the pre-intervention period (2.8 Ϯ2.1) to the post intervention period (1.6Ϯ2.2). Similarly, mean scores for documentation (pre: 3.2Ϯ1.9 vs. post: 1.6Ϯ2.2) and administration (pre: 2.8Ϯ2.2 vs. post: 1.6Ϯ2.2) burden also improved significantly (pϽ0.05) after the intervention. There was no significant change in the perception score regarding ease of detection of medication errors (pre: 2.3Ϯ2.3 vs. post: 1.7Ϯ2.3). CONCLUSIONS: Nurses perceived less documentation and administration burden after the implementation of the technological intervention. These opinions help validate the role of health technology assessment in improving performance. OBJECTIVES:To evaluate the current national trends in Vitamin D prescribing among the elderly seeking care in office-based physician provider settings. METHODS: Cross-sectional study was conducted using the National Ambulatory Medical Care Survey (NAMCS) data from 2000 to 2009. All ambulatory office visits made by the elderly aged Ն65 years of age were included in the study. Bivariate associations between vitamin D and study variables such as patient demographics, region, physician's specialty, insurance status, and osteoporosis diagnosis were evaluated using chi square tests. Logistic regression analyses were conducted to determine the predictive factors associated with a vitamin D. All analyses were performed with SAS statistical software, version 9.1, at an alpha of 0.05. RESULTS: Of the 279,819 office-based physician visits made by the NAMCS participants from 2000 through 2009, there were 74,904(26.7%) visits that met the inclusion criteria. This estimate represented 2.4 billion physician-office visits from the elderly in the United States during the 10-year period. Of the included visits, 1,112 (1.91%) were associated with a vitamin D. Race was a significant predictor in bot...

El objetivo del estudio fue explorar las percepciones sobre la estrategia de Atención Integrada a las Enfermedades Prevalentes en la Infancia (AIEPI) de gestores de salud y facilitadores de la estrategia. Se realizó una investigación de tipo cualitativo mediante entrevistas semiestructuradas. Se llevaron a cabo 14 entrevistas entre mayo y junio del 2011, ocho en el Estado de Ceará-Brasil y seis en el Perú. En general los profesionales manifestaron una buena percepción de la estrategia AIEPI, observándose una predominancia del componente clínico, en comparación con el componente comunitario y de servicios de salud. A diferencia de Brasil, en el Perú hubo una promoción gubernamental para la adopción estrategia. En conclusión, este estudio muestra una intervención compleja de la estrategia AIEPI, con predominancia del componente clínico poniendo en evidencia las limitaciones en la integración de los componentes de la estrategia.

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a Médico pediatría, especialista en Medicina Preventiva y Salud Pública, magíster en Salud Pública; b médico gastroenterólogo pediatra, magíster en Gerencia en Servicios de Salud; c médico cirujano, magister en Salud Pública; d médico infectólogo. * El estudio se realizó cuando los autores fueron trabajadores de la institución señalada.Recibido:El objetivo del estudio fue determinar el cumplimiento de la vacunación contra el virus de la hepatitis B (VHB) en recién nacidos de Lima y Callao. Estudio de diseño descriptivo, transversal y multicéntrico, realizado en hospitales de alto nivel, públicos y privados. La información sobre la vacunación corresponde a recién nacidos durante una semana del 2015, y fue obtenida mediante consultas a los padres y revisión de reporte de los servicios de salud. El estudio se realizó en 12 establecimientos de salud incluyéndose a 935 madres y recién nacidos. La cobertura de vacunación dentro de las 24 horas de vida fue de 85,1% según el reporte de padres y 88,7% según el reporte de los servicios de salud. Se concluye que la cobertura la vacunación contra el VHB en recién nacidos dentro de las 24 horas de vida fue importante, pero aún alejada de metas ideales propuestas por el Ministerio de Salud y la Organización Mundial de la Salud. ABSTRACTThe objective of the study was to determine compliance with hepatitis-B virus (HBV) in newborns in Lima and Callao. A descriptive, cross-sectional, multicenter-design study was conducted in high level public and private hospitals. Information on vaccination corresponds to newborns during one week of 2015 and was obtained through consultations with parents and review of health service reports. The study was conducted in 12 health facilities including 935 mothers and newborns. Vaccination coverage within 24 hours of life was 85.1%, according to the parents' report; and 88.7%, according to the health services' report. It is concluded that the coverage of HBV vaccination in newborns within 24 hours of life was important, but still far from the ideal goals proposed by the Ministry of Health and the World Health Organization.