Consumo de alcohol en estudiantes de Licenciatura de Medicina UNIBE Costa Rica. Febrero-Marzo, 2015 / Alcohol consumption in bachelor´s students of medicine at UNIBE Costa Rica. February-March, 2015

Resumen Español: El objetivo general de esta investigación consistió en estimar la prevalencia y los patrones de consumo de alcohol en universitarios de licenciatura de medicina de la UNIBE entre febrero-marzo 2015. La población en estudio correspondió con 231 estudiantes de licenciatura matriculados en la carrera de medicina en el periodo de febrero a marzo del año 2015 en la Universidad Iberoamericana (UNIBE). Para este cálculo se consideró un intervalo de confianza del 95%, una prevalencia esperada del 20% y nivel alfa del 5 %. La estimación de la muestra fue de n= 120 individuos. La selección se hizo por muestreo sistemático. Con el presente trabajo se logró estimar la prevalencia del consumo de alcohol en estudiantes de licenciatura UNIBE, que corresponde con un 68.9%. De acuerdo con los resultados del presente estudio es posible afirmar que la prevalencia de consumo de alcohol es alta en la población universitaria estudiada. Además se halló que los patrones de consumo que tienen los estudiantes incluyen: 1) frecuencia de consumo corresponde con menos de 1 vez al mes, 2) la edad de inicio más frecuente corresponde con 18 años o incluso menos, 3) ocasiones de consumo la principal razón corresponde con momentos especiales y 4) bebida más consumida corresponde con la cerveza y no existen diferencias significativas entre sexos. Dentro de los desafíos futuros que nacen a partir de este estudio se encuentran: la búsqueda de intervenciones destinadas a disminuir la dependencia alcohólica y potenciar el consumo de alcohol responsable, en estudiantes de medicina.

Inglés The main objective of this investigation was to estimate the prevalence and consumption pattterns of alcohol in bachelor´s students of medicine at UNIBE between the months of January and March 2015. The population consisted of 231 bachelor students enrolled in the career of medicine between February and March at Iberoamerican University (UNIBE). For this calculation a confidence interval of 95% and an estimated prevalence of 20% were used, with an alpha level of 5%. The estimation of the sample was n= 120 individuals. The selection was made with systematic sampling. With this investigation it was possible to estimate the prevalence of alcohol consumption in the population of bachelor medical students at UNIBE, which corresponds with 68.9%, which show that the alcohol prevalence is high in this population. Also it was found that the consumption patterns of alcohol among students include:1) frequency of consumption at least once a month, 2) the age of onset which was more frequent was 18 years or less, 3) the main reason of consumption was special occasions, and 4) the beverage mostly consumed corresponds with beer and there were no significant differences between sexes. Within the future challeges that come out of this investigation is the search of interventions destined to reduce the alcoholic dependence and potentiate the responsible consumption of alcohol amongst medical students.

Fetal risk associated with rubella vaccination during pregnancy.

BACKGROUND: Costa Rica implemented a nationwide measles-rubella vaccination campaign among men and women (15-39 years old) in May 2001. A protocol was developed to follow-up the vaccinated women who were unknowingly pregnant, to determine the risk of congenital rubella syndrome (CRS) or congenital rubella infection only associated with the administration of the rubella vaccine RA27/3 during pregnancy. METHODS: To classify the prevaccination maternal immune status, a serum sample was taken at the initial evaluation to detect IgM and IgG rubella antibodies (enzyme-linked immunosorbent assay). All pregnancies were followed up and all newborns were evaluated. A cord serum sample of their children was taken at birth. We calculated odds ratio, OR (95% confidence interval, 95% CI) associated with miscarriage, stillbirth, prematurity, low birth weight, and the presence of defects compatible with CRS. RESULTS: The prevaccination immune status was established in 797 women and 1191 mother and child pairs were analyzed. Adjusted OR for miscarriage (OR = 0.60, 95% CI = 0.26-1.39), stillbirth (OR = 1.32, 95% CI = 0.10-16.81), prematurity (OR = 0.25, 95% CI = 0.03-2.39), low birth weight (OR = 0.25, 95% CI = 0.03-2.23) and defects compatible with CRS (OR = 1.09, 95% CI = 0.34-3.54) showed no association between immune and susceptible maternal status. There were no cases of CRS and no children were IgM positive. CONCLUSIONS: No adverse pregnancy outcome such as miscarriages or CRS was documented in women who were vaccinated and unknowingly pregnant. These results support RA27/3 rubella vaccine safety.

Estimating the burden of congenital rubella syndrome in Costa Rica, 1996-2001.

BACKGROUND: The epidemiology of rubella in Costa Rica changed during recent decades, shifting the susceptible groups to the reproductive age. This study estimates the burden of congenital rubella syndrome (CRS) from 1996 to 2001 in this country. METHODS: Three methods to calculate CRS incidence were used. A retrospective search ("Observed cases") was conducted using hospital discharge records of children born from 1996 to 2001 with selected codes of ICD9 and ICD10 consistent with CRS and children <3 months of age with a positive serologic test for rubella IgM antibody at the National Children's Hospital (NCH). Cases were classified as either suspected, compatible or confirmed CRS and congenital rubella infection. "Expected" incidence of CRS was calculated using reported cases of rubella (women 15-45 years of age) and fertility rates, assuming CRS probability of 0.9 during the first trimester of pregnancy and 0.5 of asymptomatic rubella cases. "Estimated" CRS cases were calculated using incidence rates reported from modeling analysis during epidemic and endemic years. RESULTS: Of the 577 discharge charts reviewed and the 66 children reported as rubella IgM(+), 40 compatible CRS cases, 45 confirmed, and 4 with congenital rubella infection cases were identified. The range of annual incidence rate of CRS (per 1000 live births) was as follows: "Observed" = 0.00-0.33, "Expected" = 0.00-0.35 and "Estimated" = 0.5-1.5. Compared with the estimated number of CRS cases, only 27.2% of CRS cases were detected from the retrospective search and 10.1% would be expected when calculated using rubella reported cases. CONCLUSIONS: The under-detection of CRS cases using rubella reported cases in women of reproductive age and retrospective search of CRS reinforces the importance of suspecting CRS in the presence of a single compatible manifestation. Laboratory confirmation is indispensable to implement CRS elimination strategies and should be done in every suspected case.

Human rabies: a reemerging disease in Costa Rica?

Two human rabies cases caused by a bat-associated virus variant were identified in September 2001 in Costa Rica, after a 31-year absence of the disease in humans. Both patients lived in a rural area where cattle had a high risk for bat bites, but neither person had a definitive history of being bitten by a rabid animal. Characterization of the rabies viruses from the patients showed that the reservoir was the hematophagous Vampire Bat, Desmodus rotundus, and that a sick cat was the vector.

Accelerated rubella control and congenital rubella syndrome prevention strengthen measles eradication: the Costa Rican experience.

In 2000, Costa Rica set a goal for accelerated rubella control and congenital rubella syndrome (CRS) prevention in conjunction with its established measles eradication goal. To achieve this goal, a National Plan of Action for the integration of a measles-rubella (MR) vaccination strategy was implemented. The components of the national plan included conducting a national vaccination campaign with a single dose of MR vaccine for men and women aged 15-39 years, establishing routine postpartum MR vaccination of all previously unvaccinated women, maintaining high coverage among children with two doses of measles-mumps-rubella vaccine, strengthening the integrated measles and rubella surveillance system, and developing a CRS surveillance system. This report summarizes the results of a successful adult campaign. Targeting MR vaccination appropriately and using the opportunity to strengthen surveillance for rash illness has benefits beyond accelerated rubella control and CRS prevention, including strengthening of the measles eradication program.