Abstract Introduction The place of death is recognized as a proxy for the quality and equity of end-of-life care. Understanding where people die provides insights into health system performance, social inequalities, and the availability of palliative services. In Peru, evidence on this topic remains scarce, and national patterns and determinants have not been previously characterized. Methods We conducted a cross-sectional analytical study including all deaths registered in SINADEF from January 2017 to April 2024. Deaths were categorized as occurring at home, in a healthcare facility, or elsewhere. Sociodemographic, geographic, and contextual variables were analyzed, and the need for palliative care was estimated using the methodology of The Lancet Commission on Global Access to Palliative Care and Pain Relief. Associations were assessed using Poisson regression models with robust variance to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs). Results A total of 1,093,463 deaths were analyzed. Overall, 53.1% occurred in healthcare facilities, 41.3% at home, and 5.6% elsewhere. The proportion of home deaths increased over the study period (p < 0.001). Older age, lack of health insurance, lower educational level, lower socioeconomic status, Indigenous ethnicity, and residence outside Metropolitan Lima were associated with higher prevalence of home death. In contrast, individuals with estimated palliative care needs were less likely to die at home (aPR = 0.66; 95% CI: 0.65 to 0.66). Marked regional heterogeneity was observed, with home deaths ranging from 23.5% in Madre de Dios to 62.3% in Puno. Conclusions More than four in ten deaths in Peru occur at home, with increasing trends over time and wide regional and social disparities. The findings suggest that dying at home often reflects structural inequities and limited access to institutional or palliative care rather than preference. Strengthening community- and home-based palliative services is crucial to ensure that end-of-life care aligns with patients’ needs and values.
Background:Resin-modified glass ionomer cements are considered bioactive materials due to their sustained fluoride release, which has supported their continued use in clinical practice. Although some of these materials have been available on the market for many years and continue to be widely used in restorative dentistry, the scientific evidence regarding their mechanical properties remains limited and, in many cases, based on older or insufficiently updated studies. This situation highlights the need to generate new and updated scientific evidence to better understand the behavior of these materials under conditions that simulate long-term clinical use. The aim of this study was to evaluate and compare the surface microhardness of three resin-modified glass ionomer cements after an artificial aging process simulating two years of clinical use. Materials and Methods:Thirty-six discs (10 mm × 2 mm) were fabricated and distributed into three experimental groups (n = 12), corresponding to three commercial resin-modified glass ionomer cements: Gold Label 2 LC, Riva LC, and Vitremer. All specimens were prepared strictly according to the manufacturers' instructions. Surface microhardness was evaluated using the Vickers method with a calibrated microhardness tester, performing three indentations per specimen. Measurements were carried out at three experimental time points: baseline, after 10,000 cycles, and after 20,000 thermocycles. Data were analyzed using descriptive statistics, analysis of variance, and a linear mixed-effects model, considering a significance level of = 0.05. Results:All evaluated materials showed a progressive decrease in surface microhardness after artificial aging. Statistically significant differences were observed among the resin-modified glass ionomer cements (p < 0.05). Gold Label 2 LC exhibited the highest surface microhardness values and the greatest stability throughout the aging process, followed by Riva LC, whereas Vitremer showed the lowest microhardness values after aging. Conclusions:After artificial aging, all resin-modified glass ionomer cements showed a progressive decrease in surface microhardness. Gold Label 2 LC exhibited the highest stability, followed by Riva LC, whereas Vitremer showed the least favorable performance.
Religiosity may be linked to psychological functioning, particularly in terms of coping strategies, emotional regulation and the development of cognitive-behavioural patterns. This study examined the relationship between dimensions of religiosity and early maladaptive schemas (EMS) using a quantitative, cross-sectional, descriptive-correlational design. The study involved 360 secondary school students from an educational institution in southern Peru, with a mean age of 15.6 years (SD = 1.05), selected using purposive non-probabilistic sampling. The Young Schema Questionnaire–Short Form (YSQ-SF) and the Age Universal I-E 12 Scale were used. Analyses were conducted using Spearman’s rho. Intrinsic religiosity was negatively correlated with vulnerability to harm and illness (ρ = -0.452; p < 0.001) and entitlement/ grandiosity (ρ = -0.151; p = 0.004), but not with abandonment (ρ = -0.095; p = 0.071). Extrinsic-social religiosity was positively associated with insufficient self-control/discipline (ρ = 0.220; p < 0.001), self-sacrifice (ρ = 0.240; p < 0.001), inflexible standards 2 (ρ = 0.153; p = 0.004) and emotional inhibition (ρ = 0.113; p = 0.032), and negatively with vulnerability to harm and illness (ρ = -0.206; p < 0.001). Extrinsic-personal religiosity was negatively correlated with mistrust/abuse (ρ = -0.114; p = 0.031), vulnerability to harm and illness (ρ = -0.220; p < 0.001) and inflexible standards 1 (ρ = -0.121; p = 0.022), and positively with self-sacrifice (ρ = 0.133; p = 0.011). These findings suggest that religiosity is differentially related to certain EMS, although due to the cross-sectional design it is not possible to establish causal relationships. It is recommended that religiosity be considered as a contextual factor in psychological assessment and educational guidance programmes.
The objective of this study is to identify the determinants of social media advertising and its influence on purchase intention (PI). Four key factors such as information (IN), entertainment (EN), interactivity (IT) and privacy concern (PC) are investigated. Using a quantitative approach and structural equation modeling (SEM), data were collected from a sample of 213 participants. The results reveal that interactivity β = 0.30 is the factor with the greatest positive influence on purchase intention, followed by information and privacy concerns with β = 0.22 value for each. Although entertainment also has a positive influence on purchase intention β = 0.15, its influence is lower. In addition, it is highlighted that proper privacy management can increase consumer confidence and thus their willingness to buy. The proposed SEM model explained 37
Background: Antimicrobial resistance complicates the selection of appropriate regimens for urinary tract infections (UTIs), even when susceptibility data are available, particularly where infectious disease (ID) expertise is scarce. Machine learning clinical decision support systems (CDSS) may support prescribing, but evidence from Latin America is limited. The goal of this study was to evaluate the concordance between antimicrobial regimens selected by physicians and those recommended by a machine-learning-with-human-in-the-loop (ML-HITL) CDSS (OneChoice®), and to assess CDSS appropriateness against an independent, blinded expert reference standard. Methods: In this cross-sectional, survey-based concordance study conducted in Lima, Peru, 194 verified physicians contributed 224 eligible evaluations across 42 real UTI case codes with complete culture and antimicrobial susceptibility data. Of the 224 evaluations, 70 were contributed by infectious disease specialists and 154 by non-ID physicians. Participants selected OneChoice® and alternative antimicrobial regimens. Responses were compared with CDSS recommendations under three concordance definitions. Discordances were adjudicated by an external panel blinded to the source of the recommendation. Non-independence was addressed using cluster-robust methods. Results: First-choice, alternative, and general concordance were 50.9%, 40.6%, and 62.5%, respectively. ID specialists showed higher concordance than non-ID physicians (65.7% vs. 44.2%; 51.4% vs. 35.7%; 72.9% vs. 57.8%; all p ≤ 0.034). ID specialty was independently associated with concordance (adjusted OR 2.19–2.68; p ≤ 0.016). Among discordant evaluations, the external panel judged the CDSS recommendation to be preferable in 90.5–93.2% of cases. Physician–CDSS concordance was moderate and higher among ID specialists. The external adjudication findings indicate that the CDSS recommendations were frequently aligned with expert assessment when physician and CDSS recommendations differed; however, the study did not evaluate comparative clinical effectiveness or patient outcomes. Conclusions: Physician–CDSS concordance was moderate and higher among ID specialists, yet discordances overwhelmingly favored the CDSS on independent adjudication. These findings suggest the CDSS aligns with expert reasoning and may support antimicrobial selection in high-resistance settings.
