Examinando por Autor "Hernández Vásquez, Akram"
  • Artículo
    Adverse Effects of Pharmacologic Treatments of Major Depression in Older Adults
    (Blackwell Publishing Inc., 2019) Sobieraj, Diana M. ; Martinez, Brandon K. ; Hernández Vásquez, Akram ; Ross, Joseph S. ; Berg, Karina M. ; Steffens, David C. ; Baker, William L.
    OBJECTIVES To assess adverse effects of pharmacologic antidepressants for treatment of major depressive disorder (MDD) in adults 65 years of age or older. DESIGN Systematic review and meta‐analysis. SETTING Specialist or generalist outpatient setting, rehabilitation facility, and nursing facilities. PARTICIPANTS Persons 65 years and older with MDD. INTERVENTION Selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), bupropion, mirtazapine, trazodone, vilazodone, or vortioxetine compared with another antidepressant, placebo, or nonpharmacologic therapy. MEASUREMENTS Adverse events, arrhythmias, cognitive impairment, falls, fractures, hospitalization, mortality, QTc prolongation, serious adverse events, and withdrawals due to adverse events.
  • Artículo
    Purchase of medications without prescription in Peru: a cross-sectional population-based study
    (F1000 Research Ltd., 2019-02) Hernández Vásquez, Akram ; Alarcon Ruiz, Christoper A. ; Díaz Seijas, Deysi ; Rosselli, Diego
    Background: Low availability of medicines in health services, self-medication, inadequate use of medicines, and inadequate dispensing practices in pharmacies are frequent problems in Peru. We aimed to evaluate how frequent the purchase of medications without medical prescription is in Peru, and which factors are associated with this practice. Methods: We conducted a secondary analysis of the 2016 ENSUSALUD national survey data. Purchase of medicines that require a prescription was measured as a dichotomous coded as bought one or more medicines that requires medical prescription or bought medicines that do not require a prescription. Crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI) were calculated using Poisson regressions model with robust variance to assess the association of purchasing of medicines that require prescriptions with sociodemographic factors. Results: There were 3858 participants in the dataset. The prevalence of purchasing medications without prescriptions was 47.2%. History of having previously consumed the same medication (31.6%), and the delay in receiving an appointment at health facilities (26.9%) were the main reasons to buy medications without a prescription. Regarding the recommendation of the medication purchased, the advice of the pharmacy, and remembering a previous old prescription, were the most frequent reasons (38.3%, and 25.9%, respectively). On the multivariable analysis, users that buy medications without prescription were more likely to be of aged 24-45; reside in the Amazon and Highlands regions; and self-consumption of the purchase. Individuals with Seguro Integral de Salud (Comprehensive Health Insurance) were less likely to buy medications without prescription. Conclusions: There is a high prevalence of prescription requiring medication being bought without one from pharmacies in Peru. It is necessary to include the evaluation of consumer patterns to develop strategies with the aim to regulate the consumption of prescription drugs in the Peruvian population.
  • Artículo
    Safe and Efficacious Use of 1-Month Triple Therapy in Patients with Atrial Fibrillation and High Bleeding Risk Undergoing PCI
    (Kluwer Academic Publishers, 2019) Sambola, Antonia ; Bueno, Héctor ; Miranda, Berta ; Hernández Vásquez, Akram ; Limeres, Javier ; García del Blanco, Bruno ; García Dorado, David
    Background: The impact of short or prolonged use of triple therapy (TT) on outcomes in patients with atrial fibrillation (AF) and high risk of bleeding undergoing percutaneous coronary intervention (PCI) is unclear. We compared clinical outcomes according to the duration of TT in patients with AF and HAS-BLED ≥ 3 at 1 year of follow-up. Methods: A prospective observational cohort enrolled 735 patients with AF between 2010 and 2015. Of these, 521 (70.9%) had HAS-BLED ≥ 3 and 380 (72.9%) were discharged on TT. TT was prescribed for 1 month in 233 patients (61.3%). The primary endpoint was the incidence of Bleeding Academic Research Consortium (BARC ≥ 3). The secondary endpoint was the occurrence of ischemic events (cardiac death, MI, stroke, or stent thrombosis). Results: Patients on 1-month TT had a higher median HAS-BLED. Intracraneal hemorrhage was twofold more frequently in patients on > 1-month TT but without statistical significance (0.9% vs 2.1%, p = 0.20). Rates of the primary endpoint (bleeding BARC ≥ 3) were 8.2% vs 10.9% and did not differ between groups, while secondary endpoint did not occur more frequently in the 1-month TT group compared with the > 1-month TT group (26.6% vs 23.1%). In adjusted multivariate analyses, patients receiving 1-month TT had a similar risk of the primary endpoint compared to those with > 1-month TT (HR 1.47; 95% CI 0.48–4.47, p = 0.50). No difference was found in the secondary ischemic endpoint (HR 1.24; 95% CI 0.77–2.00, p = 0.38).
  • Artículo
    Sistemas de información geográfica: Aplicación práctica para el estudio de atropellos en el cercado de Lima, Perú
    (Instituto Nacional de Salud, 2016-12) Hernández Vásquez, Akram ; Azañedo, Diego ; Bendezú Quispe, Guido ; Pacheco Mendoza, Josmel ; Chaparro, R. Martín
    El objetivo del estudio fue explorar geoespacialmente los patrones de ocurrencia de atropellos en el Cercado de Lima, Perú. Se describieron y georreferenciaron los atropellos registrados en el Censo Nacional de Comisarías 2015 del Instituto Nacional de Estadística e Informática. Posteriormente, se realizó un análisis Kernel Density para localizar áreas con alta, mediana y baja densidad de eventos. Se estudiaron 171 registros de atropellos, los tipos de vehículo involucrados fueron automóvil (56,7%) y vehículos menores (22,8%). El mayor porcentaje de atropellos (38,6%) ocurrió entre las 12.00-17.00 horas. Se encontraron dos zonas de alta densidad y dos de densidad intermedia para atropellos, coincidiendo con ubicaciones reportadas previamente como críticas por sus deficiencias y mayor probabilidad de accidentes de tránsito. El empleo de sistemas de información geográfica ofrece una visión rápida y general de los patrones de ocurrencia de atropellos, permitiendo realizar comparaciones y facilitaría la implementación de respuestas a nivel local.
  • Artículo
    Socio-economic inequalities in smoking prevalence and involuntary exposure to tobacco smoke in Argentina: Analysis of three cross-sectional nationally representative surveys in 2005, 2009 and 2013
    (Public Library of Science, 2019-06) Hernández Vásquez, Akram ; Santero, Marilina ; Melendi, Santiago ; Irazola, Vilma Edith
    Background Understanding patterns of socio-economic inequalities in tobacco consumption is key to design targeted public health policies for tobacco control. This study examines socio-economic inequalities in smoking and involuntary exposure to tobacco smoke between 2005 and 2013. Methods Data were derived from the Argentine National Risk Factors Surveys, conducted in 2005, 2009, and 2013. Two inequality measures were calculated: the age-adjusted prevalence ratio (PR) and the disparity index (DI). Educational level, household income per consumer unit and employment status were used as proxies for socio-economic status (SES). Generalized linear models were used in the analysis. Results Prevalence of smoking decreased from 29.7% to 25.1% between 2005 and 2013, mainly in women (p<0.001). Despite the overall prevalence reduction, socio-economic inequalities in smoking persisted. For both men and women, the DI was moderately high for smoking (14.47%-33.06%) across the three surveys. In men, the PR indicated a higher smoking prevalence for lower educational levels and lower household income throughout the analyzed period. In women, unlike previous years, the 2013 survey showed disparity related to unemployment. Involuntary exposure to tobacco smoke in 2013 was associated with educational level and household income, with lower involuntary exposure among those with higher SES. Conclusions While overall smoking rates have decreased in Argentina, socio-economic disparities related to tobacco smoking persist. Comprehensive tobacco control programs targeted to address these inequalities are essential in developing strategies to reduce health disparities in tobacco-related diseases.
  • Artículo
    Use of oral health care services in Peru: Trends of socio-economic inequalities before and after the implementation of Universal Health Assurance
    (BioMed Central Ltd., 2019-03) Hernández Vásquez, Akram ; Bendezú Quispe, Guido ; Azañedo, Diego ; Santero, Marilina
    Background: Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS). Methods: Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI). Results: We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.