Investigación IComo elaborar una

propuesta de InvestigaciónLuz María Moyano Vidal. MSC MSc PhDc

Directora Médica

Centro de Salud Global

UPCH-Tumbes

Bienvenidos al primer modulo de Investigación• Se puede hacer investigación en el Perú?• Hay algún Centro de Investigación en Tumbes?.• Podemos organizar una buena idea para hacer investigación?• Quiero hacer mi Tesis como puedo hacerlo?

• La Idea de este módulo es que tengan recursos e ideas para desarrollar su propuesta de Tesis y poder publicar.

• El producto final de este módulo es armar una propuesta.• Este módulo va a tener certificación.

Location: in Tumbes , Perú

Location:3°32’50.05 S, 80°24’01.82 OElevation 21mAltitude: 437 MSNM.

Pop: 200, 000 inhabitants

Human HealthTeam

Every field worker is trained in:• Research ethics and

human subjects protection.

• Census• Biosafety guidelines

for collection, storage and transport of samples of urine, feces and blood of humans

• Appropiate application of Informed consents.

• Mass treatment with medication :antiparasitic, AED, etc

Animal HealthTeam

• Hand-made Maps• GPS• Porcine Census• Ear Tagging• Serological

surveys • Treatment with

Oxfendazole in porcine population

Animal HealthTeam

• Hand-made Maps• GPS• Porcine Census• Ear Tagging• Serological surveys • Treatment with

Oxfendazole in porcine population

DB LIMA

DB TUMBES

Data Management

data entry

MSQL-SERVER

Physical Records

Laboratory team

Mobil Lab: for Field Interventions

Clinical unit area

Ct Scan, somaton emotions(siemens) Video-EEG, easy III cadwell

Neurologist, physcians and students Young Nursing Staff

Objetivos

• Definir una buena PREGUNTA de investigación/Tesis y bosquejar algunos métodos

• Hospital Based-studies.• Analizar críticamente la lectura científica.

Pautas

• Si tienes dificultades, avísanos la idea es de que esta clase sea interactiva.

• Nota aprobatoria es 13.• Es posible no tener la certificación si faltan al 25% o más de las clases.• Ustedes tendrán el syllabus.• Si hay más dificultades que esas, sentemos a conversar

Componentes

• Problema de investigación• Preguntas de investigación• Redacción de una introducción• Redacción de una Justificación• Como hacer una búsqueda Bibliográfica• Bosquejos de como someter los documentos a un CIE

Ideas de investigación

• Title: Epidemiology of Epilepsy in a territory endemic for Taeniosis/cysticercosis: Socio-demographic characteristic, standard methodology and field work evolving wide scale interventions in advantage of a Cysticercosis Elimination Program, Peruvian experience since 2004-2013 .

• Short Title: Epidemiology of epilepsy in a region endemic for Cysticercosis. Peruvian experience since 2004-2013

Hipótesis:

• Hypothesis.• H1: Is neurocysticercosis one of the most frequent causes of

secondary epilepsy in the northern coastal of Peru?• H0: Neurocysticercosis is not one of the most frequent causes of

secondary epilepsy in the northern coastal of Peru.

Modelo de Introducción

• II. Introduction • 1. Anthropological aspects: Hallmarks in Peruvian Story about Epilepsy.• 2. Epidemiology of epilepsy in the world (systematic review, meta-analysis of Asia, Sub-Saharan Africa and

Latin America [1–4] ).• 2.1 Definition of Epilepsy (ILAE) 1993 [x]: Clinic criteria [definition] / Epidemiology criteria [definition]• 2.2 Epidemiology in Developed countries: prevalence, incidence, classification and methodology.[XX ] • 2.3 Epidemiology in Developing Countries: prevalence, incidence, classification and methodology.[3,5–11]• - WHO programs and declarations [12–14].• 3. Epilepsy and neurocysticercosis in the world with focus in Latin America countries (LAC) (socio-

demographic characteristic, educational context and sanitation in rural conditions as factor associate).[3,5]• 3.1 International Task Force for disease eradication from WHO (1993)[15].• 3.2 Epidemiology of Epilepsy in Peru and neighboring countries [6,11,16]

• -

Porque investigar? O porque hacer una Tesis?

Logros de la Clase ?

• Identificar un problema de Investigación.• Reconocer las fuentes de información• Aprender a formular los tipos de pregunta de investigación usando la

formula o propuesta PICO/PECO• Evaluar propuestas de investigación usando FINER

Fuentes de información

• Experiencia personal o laboral.• Manuscritos o investigaciones previas• Consultar a expertos• Prioridades en Salud a nivel Nacional o Regional ( Tumbes) ?• Nuevas tendencias : Neglected Tropicla Diseases, Outbreaks, etc

Experiencia Personal

• Conocemos mejor el problema ????• Ejemplo:• Cual es la prevalencia de Epilepsia a Nivel Nacional : • Ventajas de un estudio basado en la comunidad vs estudios basados

en los hospitales.• Residencia vs logros académicos ( maestria PhD)• Quienes son mejores los que leen más ?• Quienes son los que tiene más éxito los migrantes vs los que se

quedan a hacer sus estudios en Perú?

Investigaciones Previas

• Epilepsia en el Perú ………………….casi nada

• Objectives:To determine, in a cysticercosis-endemic , the frequency of 1) epileptic seizures, 2) serum antibodies to Taenia solium, 3) NCC-compatible findings on brain CT

• Results: Pop. 903 residents. The overall prevalence of epilepsy was 32.1 per 1,000 and that of active epilepsy was 16.6 per 1,000. Seroprevalence was 24.2% (200/825). Seroprevalence was associated with seizures (odds ratio 2.14; p = 0.026). Brain CT abnormalities compatible with NCC were more frequent in individuals with seizures and in those seropositive.

Neurology. 2005 Jul 26;65(2):229-33.

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• Objectives:To determine the incidence in a cysticercosis endemic region.• Results: The cohort study comprised 817 individuals.The overall epilepsy

incidence rate was 162.3/100,000 person-year, and for epileptic seizure 216.6/100,000 person-year.Out of the 8 individuals, who had epileptic seizure, 4 had markers of NCC.

Neuroepidemiology 2009;33:25–31

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Objectives : To determine in a rural population : Prevalence of active and non active epilepsy, Frequency of antibodies to cysticercosis (western blot) in people with epilepsy, Frequency of CT images compatible with NCC in people with epilepsy.

Figure 1. Diagram of intervention Figure 2. validated survey

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Paper 1

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Map of Tumbes

Table 1. Prevalence’s of epilepsy and seizures in the studied populations

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Paper 1

EITB for cysticercosis: Seroprevalence in PWE was aproximately 40% in both studies.• Serological results Region A (2006), 169 consenting out of 180,

seroprevalence of PWE was 71/169(42.01%), in general population was 344/959(35.87%). However proportion presenting strong antibody reactions was higher in PWE (15/169,8.87% versus 16/959,1.65% OR 5.74; 95%CI :2.8 – 11.9, p<0.001).

• Serological results Region B (2007), 116 consenting out of 121, seroprevalence of PWE was 47/116(40.5%), in general population was 656/2808,(23.4%), significally higher (OR 2.2; 95%CI :1.52 – 3.27, p<0.001). The proportion presenting strong antibody reactions was higher in PWE (4/121,3.31% versus 22/2808,0.78% OR 4.33; 95%CI :1.5 – 12.7, p=0.004).

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Paper 1

Brain CT Scan and serology.• The proportion of CT-positives findings was significally higher in PWE

than reported in general population of similar villages (109/282 [39%] vs.26/111[23%]; OR:2.05; 95%CI :1.25 – 3.39, p=0.004).

• 279 PWE had had been both CT scan and serology, 115/279 (41.21%) were seropositive; NCC images were present in 62/115(53.91%) of the seropositives and 47/164(33.56%) of the seronegatives (OR 2.82,95% IC 1.72 to 4.65, p=<0.001).

• In subgroup, 53.91% (62/115) of seropositives PWE had evidence of NCC on CT scan, compare to 35%(18/53) in general population positive (OR 2.27,95% IC 1.15 to 4.47, p=0.016).

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Paper 1

Consulta a Expertos

Como los encuentras:• Publicaciones• Personas que lidian todos los días con el tema.• Esa persona que tanto sabe de mi problema de investigación?• La Dirección que le estoy dando es la correcta?• Que nuevos temas hay actualmente?• Voy a poder trabajar con ellos?

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Prioridades de investigación• DIRESAS• DISAS• HOSPITALES REGIONALES• CONCYTEC• ISN• BUSQUEN PRIORIDADES EN SALUD EN EL PERU.

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nuevas TENDENCIAS

Áreas poco desarrolladas en el Perú:• Epigenetica.• Salud Ocupacional• Salud Ambiental• Salud Sexual• Informatica Médica• Uso de redes sociales en medicina.• Uso de herramientas como : Ipad, Iphone, Apple watch.

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Merci Beaucoup !!!!

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Merci Beaucoup!!!!!