Peru's System Research Articles

Employer Branding and Its Relationship with Organizational Commitment: A Case Study in Peru

The study’s main purpose was to determine the association between employer branding and organizational commitment in a company specializing in technological solutions for payment systems in Peru. The research was characterized by having a quantitative approach, being basic and with a non-experimental – transversal design and a correlational scope. We worked with a census sample of 85 employees of the company studied, to which two questionnaires were applied, the first to measure the employer branding variable with 28 items, and the second to measure the organizational commitment variable with 26 items. Both instruments reported high reliability, evidenced by Cronbach’s coefficients of 0.967 and 0.925, respectively. The results showed a statistically significant association (r=0.690; p<0.001) between both variables, indicating a moderate-magnitude positive relationship. In conclusion, it is inferred that an adequate employer branding strategy is related to high levels of organizational commitment.

Financial Model Construction and Identification of Abnormal Activities in Mobile Networks for e-commerce Platform Using Machine Learning Algorithm

The advancement of informatization has significantly affected many sectors due to e-commerce, rendering the existing Financial Model (FM) inadequate for e-commerce customers. Artificial Intelligence (AI) substantially enhances the financial accounting capabilities and resource integration of systems using mobile networks. The insufficient FM of e-commerce tools and issues such as the administration of funds have significantly obstructed the advancement of standardized financial procedures, as the FM structure impacts managers' statistical evaluation of financial information. This research examines the financial hazards, management issues, and underlying causes of these issues inside e-commerce systems, subsequently employing AI to assess the FM operations of these websites in Peru. This research uses a Machine Learning (ML) approach to examine the clustering centers of FM information as well as the privacy aspect of the FM. This study ultimately presents ways for optimizing and constructing FMs to enhance data security and capital administration in e-commerce financing, hence fostering the continued growth of e-commerce systems using mobile networks. The experimental findings indicate that the FM’s classification value and security aspect for e-commerce systems progressively enhance under the ML. The average classification value is 1.23, whereas the average risk factor is around 1.41. AI and ML improve financial accounting requirements and the long-term growth of e-commerce systems in Peru.

Local food system resilience in the context of shocks and crises: vulnerabilities and responses of agroecology-based farmers in Peru, Germany, and the United States

ABSTRACT Multiple crises have disrupted food systems around the world. The shocks induced by the COVID-19 pandemic, coupled with increased energy prices and shortages of fertilizers and agricultural inputs, have affected farmers everywhere. By applying inductive, qualitative, and comparative research approaches, we investigate the impact of shocks and crises on diverse food systems. Using mixed qualitative methods, we integrate the voices of (n = 25) farmers belonging to agroecology-based local food systems in Peru, Germany, and the United States with the aims of: (i) understanding the different crisis scenarios; (ii) determining the vulnerabilities induced in farmers; and (iii) identifying the responses and coping mechanisms that farmers deploy in response to shocks. The results illustrate how farmers are affected by the combined effects of labor shortages, rising input costs, high energy prices, and climate change. Farmers’ responses to stressors are then analyzed and compared using attributes of food system resilience. Based on our results, we argue that resilience-building is determined not only by the environment in which agroecology is embedded, but also by the responsive capacities of farmers. We emphasize the need for more proactive policies aimed at promoting agroecological and localized production to enhance the resilience of food systems against recurrent shocks and crises.

Electronic Health Record Interoperability System in Peru Using Blockchain

In Peru, there is currently no integrated electronic health record (EHR) system that can be automatically shared between healthcare facilities. This leads to increased service costs due to duplicated examinations and records, as well as additional time required to manage patients’ clinical information. One alternative for ensuring the secure interoperability of EHRs while preserving data privacy is the use of blockchain technology. However, existing works consider a pre-established format for exchanging EHRs, which is not applicable when systems have different formats, as is the case in Peru. This work proposes an architecture and a web application for exchanging EHRs in heterogeneous systems. The proposed system includes the homologation of an EHR with rapid interoperability resources for medical attention using FHIR HL7, and vice versa, to achieve interoperability. Additionally, it utilizes blockchain technology to ensure data security and privacy. The web application was tested using a case simulation to demonstrate EHR interoperability between clinics in a clear, secure, and efficient manner. In addition, a survey was conducted with 30 patients regarding adoption, and another survey was conducted with 10 doctors from a public hospital in Peru regarding usability. The results demonstrate a very high level of adoption and usability for them all. Unlike other studies, the proposal does not necessitate alterations to existing EHR systems for interoperability. In other words, the proposal presents a feasible and cost-effective alternative to addressing the EHR interoperability issue in clinics and hospitals in Peru.

Determinants of financial inclusion in households in Peru.

The issue of financial inclusion considers access to and use of quality financial services by household members and different types of companies around the world, allowing us to reach the opportunities that the globalized world offers us. The objective of this research was to identify the socioeconomic factors that determined the inclusion of households in the financial system in Peru in the period of 2021. A quantitative approach was considered, which was non-experimental with a descriptive and correlational design and in which 81,441 pieces of data were obtained from the National Household Survey (ENAHO) of the National Institute of Statistics and Informatics, applying a logit binomial regression. It was determined that 47.02% of households were included in the financial system; 61.93% of those surveyed had their residence in the urban area; on average, respondents had incomplete secondary education; the age of the respondents on average was from 25 to 44 years; the average economic income of the household was less than $251 per month; 72.18% were represented by men as heads of the household and the rest by women; most of the respondents had a cohabiting marital status; the social conditions showed that 23.82% were in the group of being poor; and the majority of households did not have a property title. The determinants of financial inclusion in Peruvian households for 2021 were the area of residence, educational level, age of the respondent, economic income, gender of the respondent, marital status, social status, and property title.

Cost-sharing and associated factors in the Peruvian private health care system.

The costs associated with healthcare are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on healthcare costs in low- and middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health insurance and its financing models have received less research attention. We aimed to analyse user cost-sharing and associated factors within the private healthcare system. Our study was cross-sectional, using open data from the Electronic Transaction Model of Standardized Billing Data-TEDEF-SUSALUD, between 2021-2022. Our unit of analysis is the user's medical bills. We considered the total amount of cost-sharing, proportion of total payments as cost-sharing, and cost-sharing as a proportion of minimum salaries. We use a multiple regression model to perform the analyses. Our study included 5,286,556 health services provided to users of the private health insurance in Peru. We found a significant difference was observed in the cost-sharing for hospitalization-related services, with an average of 419.64 soles per day (95% CI: 413.44 to 425.85). Also, we identified that for hospitalization-related services per day is, on average, 0.41 (95% CI: 0.41 to 0.41) minimum salaries more expensive than outpatient care, although cost-sharing per day of hospitalization represent on average only 14% of the total amount submitted. Our study provides a detailed overview of cost-sharing in the private healthcare system in Peru and the factors associated with them. Policymakers can use the study's finding that higher cost-sharing for inpatient hospitalization compared to outpatient care in private insurance can create inequities in access to healthcare to design policies aimed at reducing these costs and promoting a more equitable and accessible healthcare system in Peru.

Causes of death among international travellers in Peru, 2017 to 2021.

The wellbeing and safety of international tourists is a paramount concern for governments and stakeholders. Mortality among travellers and the causes of death serve as a significant metric of destination safety. We describe the epidemiology and causes of death among international travellers in Peru. Data retrieved from the Peruvian government's deaths certificates registry included all non-residents who died between January 2017 and December 2021. We analysed the national incidence and causes of death among international travellers in Peru. Causes of death were classified into non-communicable diseases (NCD), communicable diseases and injuries. We classified fatalities according to the existence of preventive measures that could be provided during the travel medicine consultation to decrease the risk. We obtained records from 1514 deaths among international travellers (973 males, 64%). The incidence increased from 0.2 deaths per 10 000 travellers in 2017 to 9.9 in 2021. NCDs were the most common causes of death (n = 560, 37%), followed by communicable diseases (n=487, 32%), and injuries (n=321, 21%). Causes of death were unknown in 9.7% of the records. The leading causes of death in these categories were cancer, cardiovascular disease, COVID-19 and trauma. We found similar sex distribution of NCDs in travellers aged >50years and higher rates of communicable diseases among males across all ages. Injury-associated deaths were significantly higher among males aged 18-29years (P < 0.001) compared with other sex-age groups. We estimated that for 57.7% of deaths risk could have been decreased through pre-travel advice. Rates of deaths among travellers to Peru increased over time. Most deaths were due to NCDs, followed by communicable diseases and injuries. Pre-travel medical optimization and effective advice focused on age-sex and destination specific risks could reduce risk among travellers. Increased awareness among travel medicine practitioners and improvement of emergency medical response systems in Peru could decrease mortality.

Proposal for initial management of uncomplicated ST elevation myocardial infarction in centers without percutaneous coronary intervention capacity in Peru

ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.

A Learning Health-Care System for Improving Renal Health Services in Peru Using Data Analytics

The health sector around the world faces the continuous challenge of improving the services provided to patients. Therefore, digital transformation in health services plays a key role in integrating new technologies such as artificial intelligence. However, the health system in Peru has not yet taken the big step towards digitising its services, currently ranking 71st according to the World Health Organisation (WHO). This article proposes a learning health system for the management and monitoring of private health services in Peru based on the three key components of intelligent health care: (1) a health data platform (HDP); (2) intelligent technologies (IT); and (3) an intelligent health care suite (HIS). The solution consists of four layers: (1) data source, (2) data warehousing, (3) data analytics, and (4) visualization. In layer 1, all data sources are selected to create a database. The proposed learning health system is built, and the data storage is executed through the extract, transform and load (ETL) process in layer 2. In layer 3, the Kaggle dataset and the decision tree (DT) and random forest (RF) algorithms are used to predict the diagnosis of disease, resulting in the RF algorithm having the best performance. Finally, in layer 4, the intelligent health-care suite dashboards and interfaces are designed. The proposed system was applied in a clinic focused on preventing chronic kidney disease. A total of 100 patients and six kidney health experts participated. The results proved that the diagnosis of chronic kidney disease by the learning health system had a low error rate in positive diagnoses (err = 1.12%). Additionally, it was demonstrated that experts were “satisfied” with the dashboards and interfaces of the intelligent health-care suite as well as the quality of the learning health system.

Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru.

The COVID-19 pandemic forced the government to rapidly modify its legal framework to adopt telemedicine and promote the implementation of telehealth services to meet the healthcare needs of patients in Peru. In this paper, we aim to review the main changes to the regulatory framework and describe selected initiatives to promote the telehealth framework that emerged in Peru during the COVID-19 pandemic. In addition, we discuss the challenges to integrate telehealth services for strengthening health systems in Peru. The Peruvian telehealth regulatory framework began in 2005, and in subsequent years, laws and regulations were established that sought to progressively implement a national telehealth network. However, mainly local initiatives were deployed. In this sense, significant challenges remain to be addressed, such as infrastructure in healthcare centers, including high-speed Internet connectivity; infostructure of health-information systems, including interoperability with electronic medical records; monitoring and evaluation of the national agenda for the health sector in 2020-2025; expanding the healthcare workforce in terms of digital health; and developing the capacities of healthcare users on health literacy, including digital aspects. In addition, there is enormous potential for telemedicine as a key strategy to deal with the COVID-19 pandemic and to improve access to rural and hard-to-reach areas and populations. There is thus an urgent need to effectively implement an integrated national telehealth system to address sociocultural issues and strengthen the competencies of human resources in telehealth and digital health in Peru.

Can the privatization of prisons solve the crisis of the prison system in Peru?

Can the privatization of prisons solve the crisis of the prison system in Peru?

Rainfall thresholds estimation for shallow landslides in Peru from gridded daily data

Abstract. This work aims to generate and evaluate regional rainfall thresholds obtained from a combination of high-resolution gridded rainfall data, developed by the National Service of Meteorology and Hydrology of Peru, and information from observed shallow landslide events. The landslide data were associated with rainfall data, determining triggering and non-triggering rainfall events with rainfall properties from which rainfall thresholds are determined. The validation of the performance of the thresholds is carried out with events that occurred during 2020 and focuses on evaluating the operability of these thresholds in landslide warning systems in Peru. The thresholds are determined for 11 rainfall regions. The method of determining the thresholds is based on an empirical–statistical approach, and the predictive performance of the thresholds is evaluated with true skill statistics. The best predictive performance is the mean daily intensity–duration (Imean−D) threshold curve, followed by accumulated rainfall E. This work is the first estimation of regional thresholds on a country scale to better understand landslides in Peru, and the results obtained reveal the potential of using thresholds in the monitoring and forecasting of shallow landslides caused by intense rainfall and in supporting the actions of disaster risk management.

Genetic Analysis of Infectious Bronchitis Virus S1 Gene Reveals Novel Amino Acid Changes in the GI-16 Lineage in Peru

Infectious bronchitis is a highly contagious viral disease that represents an economic threat for poultry despite the wide use of vaccination. To characterize the virus circulating in Peru, we analyzed 200 samples, including nasopharyngeal swabs and multiple tissues collected from animals suspected of being infected with infectious bronchitis virus (IBV) between January and August in 2015. All animals had at least one positive sample for IBV by RT-PCR. Out of these positive samples, eighteen (18) were selected for viral isolation and a partial S1 sequencing. Phylogenetic analysis showed that sixteen isolates clustered with members of GI-16 lineage, also known as Q1, with nucleotide homology ranging from 93% to 98%. The two remaining isolates grouped with members of the GI-1 lineage. Our study reveals circulation of GI-16 lineage during this period in poultry systems in Peru, along with GI-1 lineage (vaccine-derived). Moreover, those IBV GI-16 isolates showed unique nucleotide and amino acid changes compared to their closest relatives. Altogether, these findings reveal the circulation of GI-16 lineage while describing changes at key regions of the S protein that might be of relevance for vaccine evasion. These results highlight the importance of genetic surveillance for improving vaccination strategies against infectious bronchitis.

The Situation of the Health System in Peru to 2021 and the Pending Agenda

This descriptive research seeks to identify and present the situation of the Peruvian health system in 2021, as well as to propose the schedule pending for the sector, proposing the contrast of the evolution of health spending with the previous periods, comparatively with other countries of the Latin American and European region. The problem of human resources in the sector is analyzed, and finally, the infrastructure gap of the first level of care is identified. It is concluded that the health sector needs a sustained increase in a greater proportion of the general budget of the republic, as well as the decentralization of the PNA.

Tree diversity in agroforestry systems of native fine-aroma cacao, Amazonas, Peru.

Cocoa cultivation is of considerable economic and social importance to the Amazonas region and is commonly associated with forest species in the region. However, the diversification level and composition of cacao agroforestry systems in Peru are poorly understood. The objective of this study is, therefore, to describe the diversity of tree species in cocoa AFS by plantation age. Accordingly, the number of species of 15 plots covering a total of 1.5 hectares was recorded. Moderately low levels of tree species diversity were reported (H´ ranged 0.89-1.45). In total 17 species were reported throughout the study area. The most abundant botanical family was represented by a single Musa sp. species. The dissimilarity indices show a moderate similarity between the age ranges evaluated (over 62%). Additionally, the IVI indicates that the most important species are used for food and timber apart from providing shade, additionally major of this species are introduced intentionally for the farmers. Based on the observations, it may be concluded that the farmer's interest in obtaining further benefits from the plot, mostly economic benefits affect the diversification of cocoa agroforestry systems.

Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study.

BackgroundA computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user’s perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate.ObjectiveThe aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death.MethodsThis study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95% was chosen to support a significant association.ResultsIn this study, 272 physicians responded to the survey; 184 (67.6%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as “using SINADEF avoids falsifying a death certificate” (P<.001), “using SINADEF reduces the risk of errors” (P<.001), and “using SINADEF allows for filling out a certificate in less time” (P<.001); and (2) perceived ease of use, expressed as “I think SINADEF is easy to use” (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF.ConclusionsThe behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates.

CHILD PARTICIPATION IN FAMILY AND CHILD PROTECTION MATTERS IN PERU

The paper is part of a collaborative research organized by the International Association of Youth and Family Judges and Magistrates (AIMJF/IAYFJM) on child participation in family and protection matters. The article explains the legal, institutional and procedural aspects of child participation in the Justice System in Peru.

Re-tracing urban landscape lines

&#x0D; &#x0D; &#x0D; &#x0D; As designers, we should question ourselves on how we relate to the ground. In this article, we would re-trace urban landscape lines of the Qhapaq Ñan, the Inca Andean Road system in Peru, to reveal the primeval pattern that a city extends; we shall explore it through a series of conceptual layers. We inhabit a territory that is facing big changes, and this is taking us towards to the dispel of ecological and archaeological vestiges which are information layers that can lead us to explore the territory. We seek to re-trace a multidimensional system of lines and points, adopting an exploratory and descriptive approach that responses to different strata that allow us to become aware of the landscape. Within observing the systems revealed, we can understand and appreciate the natural and urban landscapes intertwined in a city morphology to operate upon it, for us to propose new alternatives to integrate our heritage to the existent urban landscape.&#x0D; &#x0D; &#x0D; &#x0D;

Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study.

BackgroundThere is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability.ObjectiveWe presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru.MethodsWe collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design.ResultsIn the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws.ConclusionsThe CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting.

Embedding circularity into the transition towards sustainable agroforestry systems in Peru

Peru is promoting the adoption of agroforestry systems with the aim to halt the deforestation of tropical forests caused by smallholder farmers. However, deficient soil conservation practices and nutrient management are common among the targeted smallholders, hampering the success of this strategy. In this study, we explore the potential of valorizing municipal biowaste as compost to be used as soil amendment in coffee agroforestry systems and in silvopastoral systems. The analysis was concentrated in four Peruvian regions and the most populous city in each of them. For lands with coffee production, it was assumed that 90 kg N ha−1 (i.e., 50% of the N requirements) should come from compost, while for pastures, the requirement was 40 kg P ha−1. We found that composting could lead to large greenhouse gas (GHG) reductions compared with the current waste disposal methods (i.e., deep dumping and landfilling), as it only emits 5–10% of the GHG emissions produced with the other methods. Nonetheless, the area of agroforestry and silvopastoral systems that could be fertilized with compost obtained from the main city of each region is limited and insufficient. If all compost were to be used for the coffee agroforestry system, less than 3% of the coffee agroforestry area could be fertilized, while in the case of pastures, only 4% would be attained. Large amounts of compost could be obtained from Lima, the most populated city; however, its transportation to the agroforestry areas would increase compost GHG emissions by 15–60%. Although composting municipal food waste and loss may bring GHG benefits and should be promoted, its use as a fertilizer requires mixing with N-rich sources to improve its nutrient quality.