Impact of the COVID-19 pandemic on excess maternal deaths in Brazil: A two-year assessment.

BACKGROUND: Accurate estimates of the COVID-19 pandemic's indirect impacts are crucial, especially in low- and middle-income countries. This study aims to update estimates of excess maternal deaths in Brazil during the first two years of the COVID-19 pandemic. METHODS: This was an exploratory mixed ecological study using the counterfactual approach. The observed maternal deaths were gathered from the Mortality Information System (SIM) for the period between March 2015 and February 2022. Expected deaths from March 2020 to February 2022 were estimated using quasipoisson generalized additive models, considering quadrimester, age group, and their interaction as predictor variables. Analyses were performed in R version 4.1.2, RStudio, version 2023.03.1+446 and carried out with support from the "mgcv" and "plot_model" libraries. RESULTS: A total of 5,040 maternal deaths were reported, with varying excess mortality across regions and age groups, resulting in 69% excess maternal mortality throughout Brazil during the first two years of the pandemic. The Southeast region had 50% excess mortality throughout the first two years and 76% excess in the second year. The North region had 69% excess mortality, increasing in the second year, particularly among women aged 20-34. The Northeast region showed 80% excess mortality, with a significant increase in the second year, especially among women aged 35-49. The Central-West region had 75% excess mortality, higher in the second year and statistically significant among women aged 35-49. The South region showed 117% excess mortality, reaching 203% in the second year among women aged 20-34, but no excess mortality in the 10-19 age category. CONCLUSIONS: Over two years, Brazil saw a significant impact on maternal excess deaths, regardless of region and pandemic year. The highest peak occurred between March and June 2021, emphasizing the importance of timely and effective epidemic responses to prevent avoidable deaths and prepare for new crises.

Efficacy and safety of four COVID-19 vaccines in preventing SARS-CoV-2 infection: A rapid review. / Eficacia y seguridad de cuatro COVID-19 vacunas para prevenir la infección por SARS-CoV-2: una revisión rápida

INTRODUCTION: Since the emergence of the SARS-CoV-2, there have been efforts to develop vaccines to control the COVID-19 pandemic. OBJECTIVE: The present study assessed the efficacy and safety of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-Vac rAd26-S/rAd5-S vaccines against the SARS-CoV-2. MATERIALS AND METHODS: We searched PubMed/MEDLINE, Google Scholar, Cochrane, and the WHO International Clinical Trials Registry Platform on March 15, 2021. The search terms used were: "vaccine" OR "vaccination" AND "covid19" OR "coronavirus" OR "sarscov2" AND "bnt162b2" OR "chadox1-S" OR "azd1222" OR "sputnik" OR "Gam-COVID-Vac" OR "mrna" OR "mRNA-1273" . We measured the risk of bias of the studies and the quality of the evidence using GRADE profiles. A qualitative and quantitative analysis of the results of clinical trials is presented. RESULTS: Of the 74 identified studies, 4 were finally included in this review. The efficacies of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-VacrAd26-S/rAd5-S vaccines against symptomatic COVID-19 were 95,0% (CI95% 90,3-97,6), 94,1% (CI95% 89,3-96,8), 66,7% (CI95% 57,4-74,0), and 91,1% (CI95% 83,8-95,1), respectively. There was moderate certainty of the evidence due to serious indirectness, when we measured the risk of bias of the studies and the quality of the evidence using GRADE profile. The safety profiles were acceptable, and data on serious adverse events (summary RR=0,93; CI95% 0,77-1,12; p=0,16) and deaths from all causes (summary RR=0,70; CI95% 0,33-1,50; p=0,90) showed no significant differences. CONCLUSION: The results of this review support the level of evidence for the efficacy and safety of the COVID-19 vaccines analysed.

Introducción. Desde que surgió el virus SARS-CoV-2, se han realizado esfuerzos para desarrollar vacunas para controlar la pandemia por COVID-19. Objetivo. Evaluar los datos de la eficacia y seguridad de las vacunas BNT162b2, mRNA-1273, ChAdOx1/AZD1222 y Gam-COVID-Vac rAd26-S/rAd5-S contra el SARS-CoV-2. Materiales y métodos. Se realizaron búsquedas en PubMed/MEDLINE, Google Scholar, Cochrane y la Plataforma de Registro Internacional de Ensayos Clínicos de la OMS el 15 de marzo de 2021. Los términos usados fueron: "vaccine" OR "vaccination" AND "covid19" OR "coronavirus" OR "sarscov2" AND "bnt162b2" OR "chadox1-S" OR "azd1222" OR "sputnik" OR "Gam-COVID-Vac" OR "mrna" OR "mRNA-1273". Se midió el riesgo de sesgo de los estudios y la calidad de la información por medio de los perfiles GRADE. Se presenta un análisis cualitativo y cuantitativo de los resultados de los estudios clínicos. Resultados. Se identificaron 74 estudios y se incluyeron 4 en la revisión. La eficacia de las vacunas BNT162b2, mRNA-1273, ChAdOx1/AZD1222 y Gam-COVID-VacrAd26-S/rAd5-S contra la COVID-19 sintomática fue del 95,0 % (IC95% 90,3-97,6), 94,1 % (IC95% 89,3-96,8), 66,7 % (IC95% 57,4-74,0) y 91,1 % (IC95% 83,8-95,1), respectivamente, y hubo una certeza moderada de la información debido a la falta de evidencia directa. Los perfiles de seguridad fueron aceptables, y los eventos adversos graves (RR resumido=0,93; IC95% 0,77-1,12; p=0,16) y muerte por todas las causas (RR resumido=0,70; IC95% 0,33-1,50; p=0,90) no mostraron diferencias significativas. Conclusión. Los resultados de esta revisión respaldan el nivel de evidencia de la eficacia y seguridad de las vacunas COVID-19 que fueron analizadas.

Excess maternal mortality in Brazil: Regional inequalities and trajectories during the COVID-19 epidemic.

BACKGROUND: The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. METHODS: This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. RESULTS: There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. CONCLUSIONS: Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.

Efficacy and safety of four COVID-19 vaccines in preventing SARS-CoV-2 infection: A rapid review / Eficacia y seguridad de cuatro vacunas COVID-19 para prevenir la infección por SARS-CoV-2: una revisión rápida

Introduction: Since the emergence of the SARS-CoV-2, there have been efforts to develop vaccines to control the COVID-19 pandemic. Objective: The present study assessed the efficacy and safety of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-Vac rAd26-S/rAd5-S vaccines against the SARS-CoV-2. Materials and methods: We searched PubMed/MEDLINE, Google Scholar, Cochrane, and the WHO International Clinical Trials Registry Platform on March 15, 2021. The search terms used were: "vaccine" OR "vaccination" AND "covid19" OR "coronavirus" OR "sarscov2" AND "bnt162b2" OR "chadox1-S" OR "azd1222" OR "sputnik" OR "Gam-COVID-Vac" OR "mrna" OR "mRNA-1273" . We measured the risk of bias of the studies and the quality of the evidence using GRADE profiles. A qualitative and quantitative analysis of the results of clinical trials is presented. Results: Of the 74 identified studies, 4 were finally included in this review. The efficacies of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-VacrAd26-S/rAd5-S vaccines against symptomatic COVID-19 were 95,0% (CI95% 90,3-97,6), 94,1% (CI95% 89,3-96,8), 66,7% (CI95% 57,4-74,0), and 91,1% (CI95% 83,8-95,1), respectively. There was moderate certainty of the evidence due to serious indirectness, when we measured the risk of bias of the studies and the quality of the evidence using GRADE profile. The safety profiles were acceptable, and data on serious adverse events (summary RR=0,93; CI95% 0,77-1,12; p=0,16) and deaths from all causes (summary RR=0,70; CI95% 0,33-1,50; p=0°90) showed no significant differences. Conclusion: The results of this review support the level of evidence for the efficacy and safety of the COVID-19 vaccines analysed.

Introducción. Desde que surgió el virus SARS-CoV-2, se han realizado esfuerzos para desarrollar vacunas para controlar la pandemia por COVID-19. Objetivo. Evaluar los datos de la eficacia y seguridad de las vacunas BNT162b2, mRNA-1273, ChAdOx1/AZD1222 y Gam-COVID-Vac rAd26-S/rAd5-S contra el SARS-CoV-2. Materiales y métodos. Se realizaron búsquedas en PubMed/MEDLINE, Google Scholar, Cochrane y la Plataforma de Registro Internacional de Ensayos Clínicos de la OMS el 15 de marzo de 2021. Los términos usados fueron: "vaccine" OR "vaccination" AND "covid19" OR "coronavirus" OR "sarscov2" AND "bnt162b2" OR "chadox1-S" OR "azd1222" OR "sputnik" OR "Gam-COVID-Vac" OR "mrna" OR "mRNA-1273'.' Se midió el riesgo de sesgo de los estudios y la calidad de la información por medio de los perfiles GRADE. Se presenta un análisis cualitativo y cuantitativo de los resultados de los estudios clínicos. Resultados. Se identificaron 74 estudios y se incluyeron 4 en la revisión. La eficacia de las vacunas BNT162b2, mRNA-1273, ChAdOx1/AZD1222 y Gam-COVID-VacrAd26-S/rAd5-S contra la COVID-19 sintomática fue del 95,0 % (IC95% 90,3-97,6), 94,1 % (IC95% 89,3-96,8), 66,7 % (IC95% 57,4-74,0) y 91,1 % (IC95% 83,8-95,1), respectivamente, y hubo una certeza moderada de la información debido a la falta de evidencia directa. Los perfiles de seguridad fueron aceptables, y los eventos adversos graves (RR resumido=0,93; IC95% 0,77-1,12; p=0,16) y muerte por todas las causas (RR resumido=0,70; IC95% 0,33-1,50; p=0,90) no mostraron diferencias significativas. Conclusión. Los resultados de esta revisión respaldan el nivel de evidencia de la eficacia y seguridad de las vacunas COVID-19 que fueron analizadas.

Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil.

BACKGROUND: Inadequate antenatal care (ANC) has been associated with adverse pregnancy outcomes. ANC quality is considered a key component of the right to health and a route to equity and dignity for women and their children. Although ANC coverage is relatively high in Brazil, there are revealed some health disparities when coverage is examined by socio-demographic determinants. In this study we evaluated ANC quality and its socio-demographic determinants using data from the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil. METHODS: This study is part of the 2015 Pelotas population-based birth cohort (n = 3923 pregnant women) conducted in southern Brazil. ANC quality was assessed through 19 content and service utilization indicators recommended by the Brazilian Ministry of Health. Descriptive analyses and associations of each of the ANC indicators and independent variables were performed using the chi-square and linear trend test. ANC indicators were analyzed individually and aggregated as a score. Associations between ANC score quality and socio-demographic variables were assessed with ordinal regressions. Mediation analysis with G-computation was performed to estimate direct and indirect effect of mother's level of education on ANC quality mediated by the number of consultations and timing of ANC initiation. Base and post confounders were included. RESULTS: The results showed that except for breast examination, height measurement, tetanus toxoid vaccination and ANC starting at the first trimester, all ANC indicators showed more than 80% coverage during ANC visits. In the adjusted analysis, inadequate quality ANC was associated with lower maternal education level, not having a partner, being multiparous, being attended by a private provider and by the same professional in all consultations. In the mediation analyses, 6.8% of the association between ANC quality and mother's education was mediated by the trimester in which ANC started, while 12.8% was mediated by the number of ANC visits. CONCLUSIONS: ANC quality is associated with pregnant women's socio-demographic characteristics. Significant efforts are needed to improve the quality of facility-based maternity care.

Agreement of antenatal care indicators from self-reported questionnaire and the antenatal care card of women in the 2015 Pelotas birth cohort, Rio Grande do Sul, Brazil.

BACKGROUND: Studies of healthcare service use during the pregnancy-postpartum cycle often rely on self-reported data. The reliability of self-reported information is often questioned as administrative data or medical records, such as antenatal care cards, are usually preferred. In this study, we measured the agreement of antenatal care indicators from self-reported information and antenatal care cards of pregnant women in the 2015 Pelotas Birth Cohort, Brazil. METHODS: In a sample of 3923 mothers, indicator agreement strengths were estimated from Kappa and prevalence-and-bias-adjusted Kappa (PABAK) coefficients. Maternal characteristics associated with indicator agreements were assessed with heterogeneity chi-squared tests. RESULTS: The self-reported questionnaire and the antenatal care card showed a moderate to high agreement in 10 of 21 (48%) antenatal care indicators that assessed care service use, clinical examination and diseases during pregnancy. Counseling indicators performed poorly. Self-reported information presented a higher frequency data and a higher sensitivity but slightly lower specificity when compared to the antenatal card. Factors associated with higher agreement between both data sources included lower maternal age, higher level of education, primiparous status, and being a recipient of health care in the public sector. CONCLUSIONS: Self-reported questionnaire and antenatal care cards provided substantially different information on indicator performance. Reliance on only one source of data to assess antenatal care quality may be questionable for some indicators. From a public health perspective, it is recommended that antenatal care programs use multiple data sources to estimate quality and effectiveness of health promotion and disease prevention in pregnant women and their offspring.

Quality assessment indicators in antenatal care worldwide: a systematic review.

PURPOSE: To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES: Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION: Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION: Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS: Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION: Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.

Implante de audífono de conducción ósea osteointegrado: experiencia del Hospital Universitario de la Samaritana, Bogotá, D. C. / Bone anchored hearing aid: the Hospital Universitario de la Samaritana's experience, Bogotá, D. C.

Objetivo: Describir y comparar los resultados audiológicos pre y postquirúrgicos de los pacientes que fueron sometidos a implante de conducción ósea osteointegrado en el Hospital Universitario de la Samaritana, Bogotá D.C. Diseño: Estudio tipo Cohorte descriptiva. Métodos: Se evaluaron los resultados audiológicos pre y postquirúrgicos de 36 pacientes sometidos a Implante de audífono de conducción ósea osteointegrado. Resultados: Se observó una disminución estadísticamente significativa entre el valor de PTA pre y postquirúrgico (Diferencia = 36.94 dB; IC95% 35.2 a 38.7; p<0.001) Mejoría en la brecha Ósea ­ Aérea con una diferencia entre el valor previo y posterior a la intervención de 35.93 dB (IC95% 33.23 a 38.63; p<0.001). La diferencia entre el porcentaje de discriminación verbal antes y después del procedimiento quirúrgico fue de 6.67% (IC95% 1.41 a 11.92; p=0.008), con una reducción en los niveles de intensidad de sonido en la discriminación que fue de 32.26 dB (IC95% 29.21 a 35.32; p<0.001). Conclusión: Los resultados audiológicos esperados en pacientes con hipoacusia conductiva, mixta o neurosensorial unilateral que fueron sometidos a implante de audífono de conducción ósea osteointegrado muestran que el sistema ofrece un alto porcentaje de éxito y bajas tasas de complicaciones.

Objective: To describe and compare pre and postoperative audiological results in patients who received a bone conduction hearing aid implant and the Hospital Universitario de la Samaritana, Bogotá D.C. Design: A descriptive cohort study. Methods: A descriptive cohort study was conducted. We evaluated audiological results before and after the bone conduction hearing aid implant procedure in 36 patients. Results: A statistically significant decrease in the PTA value was observed after the implant procedure (difference= 36.94 dB; 95CI% 35.2 - 38.7; p<0.001) The bone-air gap also presented improvement after the intervention with a decrease of 35.93 dB (95%CI 33.23 - 38.63; p<0.001). The difference in verbal discrimination percentage after the surgical procedure was 6.67% (95%CI 1.41 - 11.92; p=0.008), with a decrease in sound intensity discrimination levels of 32.26 db (95%CI 29.21 - 35.32; p<0.001). Conclusion: The audiological results in patients with conductive, mixed or unilateral sensorineural hearing loss that received a bone conduction hearing aid implant show that this intervention offers a high success rate and low postoperative complications.

Efectividad a corto plazo de la vacuna antipertusis en adolescentes: revisión sistemática / Short term effectiveness of acellular pertussis vaccine in teenagers: A systematic review

Introducción: La incidencia de la tosferina ha mostrado un incremento en los últimos años, afectando predominantemente a los niños menores de un año, adolescentes y adultos. En el 2005, el Comité Asesor de Prácticas en Inmunización de los Estados Unidos (Advisory Committee on Immunization Practices ACIP) recomendó administrar una dosis de refuerzo de la vacuna con un componente acelular antipertusis a los adolescentes, estrategia que ha sido adoptada por distintos países. Nuestro objetivo fue realizar una revisión sistemática que evaluara la efectividad a corto plazo de esta medida de prevención primaria, la cual no ha sido realizada hasta el momento. Métodos: Revisión sistemática de la literatura en inglés y español de artículos acerca de la efectividad a corto plazo de la administración de la vacuna de difteria, tétanos, pertusis acelular de contenido antigénico reducido (Tdap) como dosis de refuerzo en adolescentes, entre enero de 1990 y diciembre de 2012. Resultados: La búsqueda inicial arrojó un total de 121 resultados; de 26 artículos preseleccionados, solo 4 cumplieron los criterios de selección. La evidencia disponible fue clasificada como Ib. En los artículos se evaluó la inmunogenicidad generada contra tétanos y difteria por la vacuna Tdap versus tétanos, difteria reducida (Td) con resultados significativos y similares. Se documentó que la respuesta inmunológica protectora generada por la Tdap contra tétanos, difteria y Bordetella pertussis es apropiada. La reactogenicidad de la vacuna acelular fue baja, y el dolor en el sitio de administración fue el evento más común. Conclusión: La evidencia disponible indica que se puede recomendar la vacuna Tdap como dosis de refuerzo en adolescentes entre los 10 y los 18 años de edad por su baja reactogenicidad y adecuada inmunogenicidad contra tétanos, difteria y Bordetella pertussis.

Concordancia de presión sistólica pulmonar estimada por ultrasonografía y cateterismo cardíaco derecho en pacientes candidatos a trasplante cardíaco / Concordance of pulmonary systolic pressure estimated by ultrasonography and right heart catheterization in patients candidates for heart transplantation / Concordância de pressão sistólica pulmonar estimada por ultrassonografia e cateterismo cardíaco direito em pacientes candidatos a transplante cardíaco

Introducción: a los pacientes con Insuficiencia Cardíaca estadio D, candidatos a trasplante cardiaco, se les realiza la determinación de las presiones de la arteria pulmonar por CCD, considerada como Prueba de Oro, Sin embargo, existen métodos no invasivos como la ECO TT. Métodos: estudio retrospectivo. Se recolectó información sobre pacientes que fueron receptores de un trasplante cardiaco en la FCI-IC para el periodo 2005-2013, y se determinó la concordancia entre la presión sistólica pulmonar evaluado por ECO TT y CCD. Resultados: se incluyeron 46 pacientes. La PSAP estimada por CCD fue 48,3 ±13,1 mmHg Vs 45,1 ± 12,1 mmHg por ECO TT. La concordancia de la PSAPdeterminada por ambos métodos fue 0,475 (I,C: 0.256 - 0.694), el coeficiente de correlación intraclase fue de 0,090, indicando baja concordancia. Conclusión: la determinación de las presiones pulmonares determinada por ECO TT tiene mala concordancia con las obtenidas por CCD.

Introduction: patients with heart failure Stage D, candidates for heart transplantation were performed to determine the pressure in the pulmonary artery by CCD,considered the gold standard test. However, there are non invasive methods such asthe ECO TT.Methods: retrospective study. The information about patients who were receivinga heart transplant in the FCI-IC between 2005-2013, and the correlation between systolic pulmonary evaluated by ECO TT and CCD was determined. Results: 46 patients were included. The estimated PSAP CCD was 48.3 ± 13.1mmHg vs. 45.1 ± 12.1 mmHg ECO TT. The concordance of the PSAP determinedby both methods was 0.475 (I, C: 0256-0694), the intraclass correlation coefficient was 0.090, indicating low concordance. Conclusion: the determination of pulmonary pressures determined by ECO TT haspoor agreement with those obtained by CCD.

Introdução: aos pacientes com Insuficiência Cardíaca estádio D, candidatos atransplante cardíaco, se lhes realiza a determinação das pressões da artéria pulmonarpor CCD, considerada como Prova de Ouro. Mas, existem métodos não invasivoscomo a ECO TT.Métodos: estudo retrospectivo. Recolheu-se informação sobre pacientes que foramreceptores de um transplante cardíaco na FCI-IC para o período 2005-2013, e sedeterminou a concordância entre a pressão sistólica pulmonar avaliada por ECOTT e CCD.Resultados: incluíram-se 46 pacientes. A PSAP estimada por CCD foi 48,3 ± 13,1mmHg Vs 45,1 ± 12,1 mmHg por ECO TT. A concordância da PSAP determinadapor ambos métodos foi 0,475 (I,C: 0.256 - 0.694), o coeficiente de correlação extraclassefoi de 0,090, indicando baixa concordância.Conclusão: a determinação das pressões pulmonares determinada por ECO TT temmá concordância com as obtidas por CCD.

Factores relacionados a timpanoplastia fallida en el Hospital Universitario de La Samaritana / Factors related to failure in tympanoplasty in the University Hospital of La Samaritana

La perforación timpánica es un problema común que puede causar secuelas como hipoacusia e infecciones recurrentes del oído; requiere de intervención quirúrgica, timpanoplastia, para mejorar la audición y otras funciones, siendo la causa más común de fracaso la reperforación. Objetivo: Describir los factores asociados a las fallas de timpanoplastia en el Hospital Universitario de la Samaritana enre Enero 2005 a Diciembre 2012. Diseño: Estudio observacional analítico tipo cohorte histórica. Métodos: Revisión retrospectiva de 177 historias de pacientes sometidos a timpanoplastia primaria; se dividieron los pacientes en éxito y falla, analizando cada una de las variables buscando relación entre ellas. Se aceptó un valor de 0.05 como máximo error tipo I permitido. El análisis estadístico de los datos fue realizado con el software SPSS versión 20 para Windows. Resultados: Se incluyeron 141 historias, se encontró ganancia auditiva media de 14,83; éxito del procedimiento de 53,9% y asociaciones estadísticamente significativas con: Sexo, exposición al humo de leña, estado del oído en el momento del procedimiento, causa de la perforación, tipo de injerto utilizado y localización de la perforación. Conclusión: Se encontró un bajo porcentaje de éxito en la timpanoplastia, comparado con la literatura mundial y nacional; según las asociaciones encontradas podemos relacionarlo con reperforación; infección crónica, grandes perforaciones, exposición al humo de leña, localización inferior y a que parte de los procedimiento fueron realizados por residentes en entrenamiento. Se considera que la modificación de factores en la técnica y los posoperatorios mejorará la tasa de éxito...

The tympanic perforation is a common problem that can cause sequelae such as hearing loss and recurrent ear infections; it requires surgery, tympanoplasty, to improve hearing and other functions, the most common cause of recurrent failure is perforation. Objective: To analyze the factors associated with tympanoplasty in the Hospital Universitario de la Samaritana from January 2005 to December 2012. Design: Historical cohort study. Methods: An observational historic cohort study, retrospectively review 177 primary tympanoplasty for medical and statistical variables of patients who underwent tympanoplasty, between January 2005 and December 2012 at the Hospital Universitario de la Samaritana. We separated patients according to result, success or failure. Type I error of 0.05 value was accepted. All statistical analyses were performed using statistical software SPSS 20 for Windows. Results: 141 charts were included with a main hearing average improvement of 14,83, successful rate of 53,9%, statistical significant association with gender, exposure to wood smoke, infection of the ear at the surgery, cause of the perforation, and localization of the perforation. Conclusion: It was found a lower tympanoplasty success rate compared with the global literature, according to the associations that were found it can be related with the principal cause of tympanic perforation, chronic ear infection, a bigger size of perforation, the wood smoke exposure, localization at the inferior quadrant, and some parts of the procedures were performed by residents in training. Modifications of these factors can improve the succesful rate...

Risk factors for adolescent pregnancy in Bogotá, Colombia, 2010: a case-control study.

OBJECTIVE: To identify risk factors for adolescent pregnancy among female students in Bogotá, Colombia. METHODS: This was a retrospective study of cases and controls matched by age, identified by means of a survey on the sexual behavior of adolescent students in Bogotá (Encuesta sobre el Comportamiento Sexual de los Adolescentes Escolarizados en Bogotá) conducted in the first semester of 2010. All 272 cases and 544 randomly-selected controls were taken from 39 044 total records. Variables considered were sociodemographics, household structure, and family environment; sexual relationships and pregnancy; and knowledge of sexual and reproductive health. Matching and conditional logistic regression were used to adjust for possible confounding factors. RESULTS: The factors associated with increased risk of adolescent pregnancy based on multivariate analyses were: attending public school (odds ratio [OR]=2.25; 95% confidence interval [95% CI]: 1.45-3.51); history of siblings with adolescent pregnancy (OR =1.98; 95% CI: 1.55-2.76); early first sexual intercourse (12 years of age or less) (OR =2.34; 95% CI: 1.01-5.40); having a self-reported low- or average-level of contraceptive knowledge (OR =3.92; 95% CI: 1.96-7.83); previous pregnancy (OR =14.09; 95% CI: 8.74- 22.70); and not living with both parents (OR 3.58; 95% CI: 2.10-6.16). CONCLUSIONS: Factors related to individual, family, and social environments that influence the incidence of adolescent pregnancy must be considered and addressed when designing interventions. The existing sex education curriculum is an important component in preventing adolescent pregnancy, however, parent/caregiver participation is required for success.

Risk factors for adolescent pregnancy in Bogotá, Colombia, 2010: a case-control study / Factores de riesgo de embarazo adolescente en Bogotá, Colombia, 2010: estudio de casos y testigos

OBJECTIVE: To identify risk factors for adolescent pregnancy among female students in Bogotá, Colombia METHODS: This was a retrospective study of cases and controls matched by age, identified by means of a survey on the sexual behavior of adolescent students in Bogotá (Encuesta sobre el Comportamiento Sexual de los Adolescentes Escolarizados en Bogotá) conducted in the first semester of 2010. All 272 cases and 544 randomly-selected controls were taken from 39 044 total records. Variables considered were sociodemographics, household structure, and family environment; sexual relationships and pregnancy; and knowledge of sexual and reproductive health. Matching and conditional logistic regression were used to adjust for possible confounding factors RESULTS: The factors associated with increased risk of adolescent pregnancy based on multivariate analyses were: attending public school (odds ratio [OR]=2.25; 95% confidence interval [95% CI]: 1.45-3.51); history of siblings with adolescent pregnancy (OR =1.98; 95% CI: 1.55-2.76); early first sexual intercourse (12 years of age or less) (OR =2.34; 95% CI: 1.01-5.40); having a self-reported low- or average-level of contraceptive knowledge (OR =3.92; 95% CI: 1.96-7.83); previous pregnancy (OR =14.09; 95% CI: 8.74- 22.70); and not living with both parents (OR 3.58; 95% CI: 2.10-6.16 CONCLUSIONS: Factors related to individual, family, and social environments that influence the incidence of adolescent pregnancy must be considered and addressed when designing interventions. The existing sex education curriculum is an important component in preventing adolescent pregnancy, however, parent/caregiver participation is required for success.

OBJETIVO: Identificar los factores de riesgo de embarazo adolescente entre las estudiantes de Bogotá, Colombia MÉTODOS: Estudio retrospectivo de casos y testigos pareados por edad e identificados por medio de una encuesta sobre el comportamiento sexual de los adolescentes escolarizados en Bogotá (Encuesta sobre el Comportamiento Sexual de los Adolescentes Escolarizados en Bogotá) realizada el primer trimestre del 2010. Los 272 casos y 544 testigos seleccionados aleatoriamente se tomaron de un total de 39 044 registros. Se consideraron variables sociodemográficas, estructura de los hogares y entorno familiar; relaciones sexuales y embarazo, y conocimientos sobre salud sexual y reproductiva. Los métodos utilizados para el ajuste por posibles factores de confusión fueron pareamiento y regresión logística condicional RESULTADOS: Sobre la base de los análisis multifactoriales, los factores asociados con mayor riesgo de embarazo adolescente fueron: asistencia a una escuela pública (razón de posibilidades [OR]=2,25; intervalo de confianza [IC] 95%: 1,45-3,51); antecedentes de embarazo adolescente de una hermana (OR =1,98; IC 95%: 1,55-2,76); primera relación sexual a edad temprana (a los 12 años o antes) (OR =2,34; IC 95%: 1,01-5,40); nivel bajo o medio de conocimiento autoinformado sobre anticonceptivos (OR =3,92; IC 95%: 1,96-7,83); embarazo anterior (OR =14,09; IC 95%: 8,74-22,70), y hogar monoparental (OR=3,58; IC 95%: 2,10-6,16 CONCLUSIONES: Los factores relacionados con el entorno individual, familiar y social que influyen en la incidencia del embarazo adolescente se deben tomar en consideración y abordar cuando se diseñen intervenciones. La inclusión de la educación sexual en el programa de estudios es un componente importante para prevenir el embarazo adolescente; sin embargo, para lograr el éxito es necesaria la participación de los padres o cuidadores.

Proceso de eliminación del Tétanos neonatal en Colombia 1989-2005 / The process of eliminating neonatal Tetanus in Colombia, 1989-2005

Objetivo Describir los avances de Colombia en la eliminación del tétanos neonatal a partir de la información ofrecida por la vigilancia epidemiológica. Métodos Estudio descriptivo retrospectivo de la vigilancia epidemiológica del tétanos neonatal en Colombia para el período 1989-2005. Se consultó la información disponible de la notificación de este evento de interés en salud pública. Resultados En el periodo estudiado se notificaron en total 830 casos de tétanos neonatal. En 1989 la tasa del tétanos neonatal era del 0,22 por 1 000 nacidos vivos. En el 2005 se redujo a 0,01 por 1 000 nacidos vivos, es decir una disminución cercana al 94% de los casos. Conclusiones Teniendo en cuenta la información aportada por la vigilancia epidemiológica, el país ha logrado la meta de mantener una tasa <1 caso por 1 000 nacidos vivos. A pesar de esto es necesario considerar tan solo un caso en cualquier sitio del país como una falla del sistema de atención en salud.(AU)

Objective To describe the country's progress in eliminating neonatal tetanus based on the information obtained from epidemiologic surveillance. Material and Methods A retrospective descriptive study of the epidemiological surveillance of neonatal tetanus in Colombia in the period ranging from 1989 to 2005. Available information was consulted regarding confirmations of this event of interest for Public Health. Results During the study period, a total of 830 cases of neonatal tetanus were reported. In 1989, the rate of neonatal tetanusinColombiawas0.22 per1000live births. In 2005, this value was reduced to 0.01 cases per1000live births; a reduction of nearly 94 %. Conclusions Given the information provided by epidemiological surveillance, Colombia has achieved the goal of maintaininga rate<1 case per 1000live births. Nevertheless, even one case anywhere in the country should be considered a failure of the healthcare system.(AU)

[The process of eliminating neonatal Tetanus in Colombia, 1989-2005]. / Proceso de eliminación del Tétanos neonatal en Colombia 1989-2005.

OBJECTIVE: To describe the country's progress in eliminating neonatal tetanus based on the information obtained from epidemiologic surveillance. MATERIAL AND METHODS: A retrospective descriptive study of the epidemiological surveillance of neonatal tetanus in Colombia in the period ranging from 1989 to 2005. Available information was consulted regarding confirmations of this event of interest for Public Health. RESULTS: During the study period, a total of 830 cases of neonatal tetanus were reported. In 1989, the rate of neonatal tetanus in Colombia was 0.22 per 1000 live births. In 2005, this value was reduced to 0.01 cases per 1000 live births; a reduction of nearly 94 %. CONCLUSIONS: Given the information provided by epidemiological surveillance, Colombia has achieved the goal of maintaining a rate<1 case per 1000 live births. Nevertheless, even one case anywhere in the country should be considered a failure of the healthcare system.

[Central venous catheter-related complications in critically ill children]. / Complicaciones relacionadas con catéteres venosos centrales en niños críticamente enfermos.

OBJECTIVE: Placing central venous catheters is essential when managing critically ill children. This paper was thus aimed at identifying the major complications involved in this and determining the incidence of mechanical and infection-related complications associated with central venous catheterization in critically ill children. MATERIAL AND METHODS: A descriptive study was undertaken between October 2011 and March 2012 of all new central venous catheters inserted in critically ill children. The definition of central venous catheter infection was based on CDC criteria. RESULTS: During the study period 200 central venous catheters were placed, 51 % in male patients, mostly infants; 71 % required mechanical ventilation and 56.5 % medication for hemodynamic support. Respiratory tract infections were the leading diagnosis on admission in 33 % of the cases. Complications were reported in 8.5 % of the children (52 % of these being due to mechanical complication and 48 % to infection). Mechanical complication incidence was 4.5% and eight central venous catheters fulfilled CDC criteria for central line associated blood stream infection (4 % incidence, i.e. 5 per 1,000 catheter/day rate). CONCLUSIONS: Despite some complications arising from its use, central venous catheter placement is a safe procedure. Mechanical and infection incidence associated with central venous catheter placement should be known, not only because it differs from that regarding adult patients but also because this can help to establish preventative measures for reducing such complications and improving the care of critically ill children.

[Epidemiological surveillance of measles and Germán measles (rubella) within the context of the elimination plan: Colombia, 1995-2009]. / La vigilancia epidemiológica de sarampión y rubéola en el marco del plan de eliminación: Colombia 1995-2009.

OBJECTIVE: Describing the behavior of epidemiologic surveillance regarding measles and German measles (rubella) to provide evidence about the interruption of the endemic circulation of tríese viruses in Colombia. METHODS: This was a retrospective descriptive study of epidemiological surveillance for measles and German measles in Colombia from 1995 to 2009 by reviewing available notification information from the measles elimination surveillance system (MESS), the Colombian Public Health Surveillance System (SIVIGILA) and the Colombian Statistics Department (DANE) for population projections. Surveillance quality was evaluated by using the indicators proposed for integrated measles and German measles surveillance. RESULTS: 28,732 suspicious cases were notified during the study period (66.15 % concerned measles and 33.8 % German measles). The greatest number of notified cases occurred in 2002 (22.4 %); this was detected in the 6-11 month and 2-4 year-old groups. Confirmed measles cases amounted to 495 (1995-2002) and German measles to 946 (for the whole period). The cumulative average for indicators was as follows: timely research had a pattern below 80.5 %, weekly notification was above 80 %, suitable sampling was 93.7 % on average and sample reception was 65.2 % for 1995-2006 and 83.3 % for 2007-2009. CONCLUSIONS: According to the information compiled regarding epidemiological surveillance, Colombia complied with 4 of the 7 proposed indicators for quality evaluation; these showed active surveillance having suitable indicator performance regarding laboratory and notification rate. They demonstrated interrupted endemic circulation of measles and German measles in Colombia.

La vigilancia epidemiológica de sarampión y rubéola en el marco del plan de eliminación: Colombia 1995-2009 / Epidemiological surveillance of measles and Germán measles (rubella) within the context of the elimination plan: Colombia, 1995-2009

Objetivo Describir el comportamiento de la vigilancia epidemiológica, con el fin de aportar evidencias sobre la interrupción de la circulación endémica de los virus del sarampión y la rubéola en el país. Métodos Estudio descriptivo retrospectivo de la vigilancia epidemiológica del sarampión y rubéola en Colombia para el período 1995-2009, a través de la consulta de información disponible de notificación en el aplicativo Measles Elimination Surveillance System (MESS), Sistema Nacional de Vigilancia en Salud Pública (SIVIGILA) y el Departamento Nacional de Estadísticas (DANE) para proyecciones poblacionales. La evaluación de la calidad de la vigilancia se hizo mediante los indicadores propuestos para la vigilancia integrada de sarampión y rubéola. Resultados En el período a estudio se notificaron 28 732 casos sospechosos, 66,15 % de sarampión y 33,8 % de rubéola, mayor número de casos notificados en 2002 (22,4 %); total de casos confirmados de sarampión entre 1995-2002 (n=495) y de rubéola (n=946) en todo el período. El promedio acumulado de los indicadores fue investigación oportuna con un comportamiento por debajo de 80,5 %, notificación semanal por encima de 80 %, toma de muestra adecuada en 93,7 %, y para recepción de muestra de 65,2 % para 1995-2006 y de 83,3 % para el periodo 2007-2009. Conclusiones De acuerdo con la información aportada por la vigilancia epidemiológica, el país cumple con 4 de los 7 indicadores propuestos para evaluar su calidad. Se evidencia que la circulación endémica de los virus de sarampión y rubéola en Colombia se encuentra interrumpida.

Objective Describing the behavior of epidemiologic surveillance regarding measles and German measles (rubella) to provide evidence about the interruption of the endemic circulation of tríese viruses in Colombia. Methods This was a retrospective descriptive study of epidemiological surveillance for measles and German measles in Colombia from 1995 to 2009 by reviewing available notification information from the measles elimination surveillance system (MESS), the Colombian Public Health Surveillance System (SIVIGILA) and the Colombian Statistics Department (DANE) for population projections. Surveillance quality was evaluated by using the indicators proposed for integrated measles and German measles surveillance. Results 28,732 suspicious cases were notified during the study period (66.15 % concerned measles and 33.8 % German measles). The greatest number of notified cases occurred in 2002 (22.4 %); this was detected in the 6-11 month and 2-4 year-old groups. Confirmed measles cases amounted to 495 (1995-2002) and German measles to 946 (for the whole period). The cumulative average for indicators was as follows: timely research had a pattern below 80.5 %, weekly notification was above 80 %, suitable sampling was 93.7 % on average and sample reception was 65.2 % for 1995-2006 and 83.3 % for 2007-2009. Conclusions According to the information compiled regarding epidemiological surveillance, Colombia complied with 4 of the 7 proposed indicators for quality evaluation; these showed active surveillance having suitable indicator performance regarding laboratory and notification rate. They demonstrated interrupted endemic circulation of measles and German measles in Colombia.

[A rapid evaluation of vaccination coverage in Bogotá, 2006]. / Evaluación rápida de coberturas vacunales en Bogotá, 2006.

OBJECTIVE: Evaluating vaccination coverage in the infant population aged 0-23 months by cluster (locality) in Bogotá and identifying reasons for the lack of vaccination coverage. MATERIALS AND METHODS: This was a descriptive, retrospective study. Sample size was calculated on target population (children aged 0-23 months), further divided into 0-1, 2-6, 7-11 and 12-23 month sub-groups by tri-stage sampling to ascertain newborn vaccination status, evaluate opportune oral polio vaccine (OPV) and pentavalent vaccine third dose vaccination and opportune measles, mumps and rubella (MMR) vaccination. RESULTS: 5,845 children were surveyed; 96.7% had immunisation cards, 75.3% were registered in the Social Protection System and 12.6% (713 out of 5,845) had not been vaccinated. Vaccination coverage by biological products was as follows: 99.1% BCG, 93.0% pentavalent vaccine, 93.2% OPV, 85% MMR. Vaccination opportunity was 5,328 for BCG (94.3%), 1 256 for OPV (88.6%), 1 112 for pentavalent (88.5%) and 1,702 for MMR (69.5%) with 33 vaccination errors (1.3%). Among the identified reasons for non-vaccination were confused health service logistics and coordination (59.2%), misguided parental beliefs (27.9%) and unregistered children (12.8%). CONCLUSIONS: Useful and timely vaccine coverage was evident with BCG; there were difficulties regarding recording pentavalent vaccination. Information, education and mass communication strategies must be developed to counteract reasons given for non-vaccination and to educate parents and tutors in its opportune application to increase triple-viral vaccine coverage.