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Background: The Geriatric Depression Scale (GDS) is a widely used instrument to assess depression in older adults. The short GDS versions that have four (GDS-4) and five items (GDS-5) represent alternatives for depression screening in limited-resource settings. However, their accuracy remains uncertain. Objective: To assess the accuracy of the GDS-4 and GDS-5 versions for depression screening in older adults. Methods: Until May 2020, we systematically searched PubMed, PsycINFO, Scopus, and Google Scholar; for studies that have assessed the sensitivity and specificity of GDS-4 and GDS-5 for depression screening in older adults. We conducted meta-analyses of the sensitivity and specificity of those studies that used the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Diseases-10 (ICD-10) as reference standard. Study quality was assessed with the QUADAS-2 tool. We performed bivariate random-effects meta-analyses to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI) at each reported common cut-off. For the overall meta-analyses, we evaluated each GDS-4 version or GDS-5 version separately by each cut-off, and for investigations of heterogeneity, we assessed altogether across similar GDS versions by each cut-off. Also, we assessed the certainty of evidence using the GRADE methodology. Results: Twenty-three studies were included and meta-analyzed, assessing eleven different GDS versions. The number of participants included was 5048. When including all versions together, at a cut-off 2, GDS-4 had a pooled sensitivity of 0.77 (95% CI: 0.70–0.82) and a pooled specificity of 0.75 (0.68–0.81); while GDS-5 had a pooled sensitivity of 0.85 (0.80–0.90) and a pooled specificity of 0.75 (0.69–0.81). We found results for more than one GDS-4 version at cut-off points 1, 2, and 3; and for more than one GDS-5 version at cut-off points 1, 2, 3, and 4. Mostly, significant subgroup differences at different test thresholds across versions were found. The accuracy of the different GDS-4 and GDS-5 versions showed a high heterogeneity. There was high risk of bias in the index test domain. Also, the certainty of the evidence was low or very low for most of the GDS versions. Conclusions: We found several GDS-4 and GDS-5 versions that showed great heterogeneity in estimates of sensitivity and specificity, mostly with a low or very low certainty of the evidence. Altogether, our results indicate the need for more well-designed studies that compare different GDS versions. [ABSTRACT FROM AUTHOR]

• This is the first systematic review to compare the efficacy of adding omega-3 supplementation to the continuous sertraline therapy vs. not adding it. • We did not find essential reductions in depression or anxiety scales. • It may be better not to provide omega-3 supplementation to the continuous sertraline therapy in patients with coronary disease. We aimed to synthesize the evidence from randomized controlled trials (RCTs) that determined the efficacy of adding omega-3 supplementation to the continuous sertraline therapy in adults with depression. Meta-analyses were performed using random effects. We used the Revised Cochrane risk of bias tool for randomized trials version 2.0. to assess the risk of bias. Four RCTs were included. The follow-up ranged from eight to 12 weeks. Regarding the Beck Depression Inventory, the pooled SMD was 0.50 (95% CI: -0.51, 1.50; I2: 94.1%). A subgroup analysis was performed regarding the presence of coronary disease: SMD -0.17 (95% CI: -0.41, 0.07; I2: 0.0%). Regarding the Beck Anxiety Inventory, the pooled MD was 0.03 (95% CI: -2.22, 2.28; I2: 0.0%). Regarding the Hamilton Depression Rating Scale, the pooled MD was 0.42 (95% CI: -1.44, 2.29; I2: 35.7%). All pooled outcomes presented a very low certainty of the evidence. Three RCTs presented a low risk of bias in all domains; however, one study presented some concerns in two domains. No essential reductions in the outcomes were found. A subgroup analysis suggested that may be better not to provide the supplementation in patients with coronary disease. The evidence is not enough to make recommendations. [ABSTRACT FROM AUTHOR]

Background & Aims: Vasoactive agents with endoscopic therapy are used to treat acute variceal bleeding (AVB). There are two main groups of vasoactive agents: terlipressin and vasopressin (T-V), and octreotide and somatostatin (O-S). However, the benefit/harm balance is unclear. Our aim was to assess the efficacy and safety of T-V versus O-S for the management of AVB. Methods: We performed a systematic search for randomized controlled trials (RCTs) in PubMed, Scopus, and CENTRAL. Our main outcomes were mortality and adverse events. Secondary outcomes were bleeding control, rebleeding, blood transfusion, hospital stay. We evaluated the certainty of evidence using GRADE methodology. Results: We included 21 RCTs. The risk of mortality (RR: 1.01; 95%CI: 0.83-1.22), bleeding control (RR: 0.96; 95%CI: 0.91-1.02; I2=53%), early rebleeding (RR: 0.91; 95%CI: 0.66-1.24: I2=0%), late rebleeding (RR: 0.94; 95 CI: 0.56-1.60; I2=0%), blood transfusion (MD: 0.04; 95%CI: -0.31-0.39; I2=68%) and hospital stay (MD: -1.06; 95%CI: -2.80-0.69; I2=0%) were similar between T-V and O-S groups. Only 15 studies reported adverse events, which were significantly higher in the T-V compared to the O-S group (RR 2.39; 95%CI: 1.58-3.63; I2=57%). The certainty of evidence was moderate for the main outcomes, and low or very low for others. Conclusions: In cirrhotic patients with AVB, those treated with T-V had similar mortality risk compared to O-S. However, the use of T-V showed an increased risk of adverse events compared to O-S. [ABSTRACT FROM AUTHOR]

Introduction: This article summarizes the clinical practice guideline (CPG) for the prevention and management of acute kidney injury in the Social Security of Peru (EsSalud). Objective: Provide clinical recommendations based on evidence for the prevention and management of acute kidney injury in EsSalud. Methods: A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 6 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant-primary studies were carried out in PubMed during 2022. Evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In regular work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding flowcharts. Finally, the CPG was approved with Resolution No. 099-IETSI-ESSALUD-2022. Results: This CPG addressed 6 clinical questions on prevention, diagnosis and management (fluid therapy). Based on these questions, 5 recommendations (3 strong and 2 conditional), 2 BPCs, and 2 flowcharts were formulated. Conclusion: This article summarizes the methodology and evidence-based conclusions of the CPG for the prevention and management of acute kidney injury in EsSalud. [ABSTRACT FROM AUTHOR]

Objective: Determine the institutional expectations and motivations of the first-semester medical students who entered to the Universidad Nacional Mayor de San Marcos for the first time in 2017. Methodology: Quantitative and qualitative, descriptive, cross-sectional study that explores expectations and institutional motivations of medical students who entered to a university for the first time and attended the first semester at the School of Medicine "San Fernando" during 2017. The informed consent was requested. A previously validated questionnaire was applied to all the students who met the inclusion criteria. Results: Of the 158 students surveyed, 100 (63.3%) entered a university for the first time. Their institutional expectations varied from GOOD to REGULAR in relation to the different services that the university should provide them. About motivations, the students considered their family motivations and personal medical history decisive for the choice of career; however, many of these students do not consider economic motivations relevant. On the other hand, there was ignorance about Public Health in this student group. Conclusions: First-year medical students enter with certain expectations and motivations about the university, which are influenced by some factors, such as family or knowledge about the subjects. The university should know the expectations and motivations of students to improve the educational services offered. [ABSTRACT FROM AUTHOR]

Background: Coronary disease (CD) is the main cause of mortality worldwide. Data about trends and geographical variation in CD mortality is available in some American countries. This information varies among countries since CD risk factors frequencies vary. Objective: To describe the trend and geographical variation of coronary disease (CD) mortality in Peru, 2005–2017. Methods: Analysis of secondary data of the Peruvian Ministry of Health's registry of deaths. We analyzed CD mortality. We described the absolute and relative frequency of deaths and age-standardized mortality rate (ASMR) by natural regions, departments, age, sex, and year. We also described the change of ASMR between two periods (2005–2010 vs. 2011–2017). Results: There were 64,721 CD deaths between 2005 and 2017 (4.12% among all deaths). The absolute frequency of CD deaths was 5,665 and 6,565 in 2005 and 2017, respectively. CD mortality was more frequent in men and older adults. The ASMR varied among natural regions, being higher in the Coast (19.61 per 100,000 inhabitants). The change between the two periods revealed that almost all departments reduced their ASMRs, except for Callao, Lambayeque, and Madre de Dios. Conclusion: CD mortality has increased in Peru. Mortality was higher in men and older adults, and it varied among departments. More political efforts are needed to reduce these trends. [ABSTRACT FROM AUTHOR]

Objectives. To evaluate the relationship between having a medical specialty and the monthly income of Peruvian doctors, and to compare the economic incomes among areas with greater and lower density of medical doctors in Peru. Materials and methods. We analyzed the data of the National Satisfaction Survey of Health Users (in Spanish: ENSUSALUD) carried out in Peru in the year 2015. This survey with national inference was made to physicians working in health facilities in Peru. Economic income was assessed considering all paid activities of the physician. Crude and adjusted prevalence ratios (PR and aPR) and their confidence intervals to 95% (CI 95%) were calculated through Poisson regression models with robust variance, taking into account the complex sampling of the survey. Results. Out of 2 219 Physicians surveyed, 2 154 (97.0%) observations were analyzed. The frequency of earning > S/5 000 (1 572.3 USD) per month was 29.1% for general practitioners; 65.6% for specialists; 63.0% in clinical specialists; 70.5% in surgeons and 55.7% in other specialties. Compared to general practitioners, physicians with clinical, surgical and other specialties were more likely to earn > S/5 000 per month (aPR=1.44, 1.49 and 1.26, respectively). The probability of earning > S/5 000 was higher in those working in departments with low medical density. Conclusions. Economic incomes were higher in specialist physicians than in non-specialists. Economic incomes were higher in lower-density departments of physicians, which may encourage physicians to work in these departments. [ABSTRACT FROM AUTHOR]