Drug dealing and drug using behaviors among people who inject drugs in Colombia: A cross-sectional study.

INTRODUCTION: People who inject drugs (PWID) are highly exposed to drug-dealing networks. In Colombia, a recent dramatic increase in drug consumption has been reported. However, involvement of PWID in drug dealing, their demographics, and drug using behaviors has not been studied. METHODS: A cross-sectional study involving 1,099 PWID recruited by Respondent Driven-Sampling in five Colombian cities was conducted in 2014. Correlates of demographic characteristics, drug dealing, and injection behaviors were examined by multivariate analysis, and a binary logistic regression model. RESULTS: Drug-dealing PWID were predominantly male (86%) with a mean age of 26 years. 56% of participants-of whom 64% had low familial socioeconomic status-had been involved in drug dealing in the previous six months. Compared to non-drug-dealing PWID, drug-dealing PWID reported higher daily injection rate (AOR: 1.3), higher odds of injection equipment confiscation by the police (AOR: 1.4), and were less likely to pay for the drugs they injected (AOR: 0.6). CONCLUSIONS: Involvement of Colombian PWID in drug dealing was higher than previously reported, and drug-dealing PWID presented sociodemographic vulnerabilities and risky injection practices. Addressing these findings may lead to effective policy design and implementation, decreased drug-dealing involvement, harm reduction, and consumption prevention.

House-Level Risk Factors for Aedes aegypti Infestation in the Urban Center of Castilla la Nueva, Meta State, Colombia.

Aedes aegypti is the main vector of the dengue virus in Colombia. Some factors have been associated with its presence; however, in the local context, it has not been sufficiently evaluated. The present study seeks to identify the socioeconomic, environmental, and behavioral factors associated with the presence and abundance of A. aegypti in urban dwellings in the municipality of Castilla la Nueva. A cross-sectional cohort study was conducted in houses in the urban area of the municipality of Castilla la Nueva, where 307 houses were sampled by systematic random sampling during May 2018. A multifactorial survey was used to measure the socioeconomic, environmental, and behavioral factors as explanatory variables. The infestation and relative abundance were established by the presence of larval stages and ovitraps. The associated factors for the presence and abundance of A. aegypti were identified using negative binomial and logistic regression models. A positive housing infestation of 33.2% was identified by direct inspection and 78.5% with ovitraps. The main factors positively associated with the presence and abundance of A. aegypti were one-story homes (PR = 2.26; 95% CI: 1.31-3.87), the storage of water for domestic use (PR = 1.91; 95% CI: 1.18-3.09), and local conditions such as disorganized backyard (PR = 79.95; 95% CI: 10.96-583.24) and the proportion of shade greater than 50% of the backyard (PR = 62.32; 95% CI: 6.47-600.32). And, it is negatively associated with residential gas service (PR = 0.3; 95% CI: 0.16-0.58) and self-administered internal fumigation (PR = 0.37; 95% CI: 0.2-0.69). The presence and abundance of A. aegypti were explained by interrelated socioeconomic, environmental, and behavioral factors where local conditions and habits such as the organization of the patio, knowledge about vector biology, and cleaning containers are identified as main topics for future prevention strategies for the transmission of dengue in the local and national context.

Factors associated with the perception of HIV vulnerability among transgender women in three Colombian cities. / Factores asociados a la percepción de vulnerabilidad al VIH en mujeres transgénero de tres ciudades de Colombia.

OBJECTIVE: To describe the perception of vulnerability to HIV and its associated factors among transgender women (TW) in Bogotá, Medellín and Santiago de Cali, Colombia. MATERIALS AND METHODS: We conducted a cross-sectional study, using respondent-driven sampling (RDS) in which 620 TW participated. Sociodemographic aspects, sexual behavior, consumption of psychoactive substances and the perception of vulnerability to HIV were studied. We carried out a descriptive analysis, in which bivariate associations were evaluated using chi-square. We also conducted a multivariate analysis and built a model using Poisson regression. RESULTS: Of the participants, 63% were 35 years old or younger, had low income, started sexual relations at an early age and worked mainly as sex workers, webcam models and hairdressers; 84.7% of the participants had received money in exchange for sex at some point. The perception of vulnerability to HIV increased among those who were single, worked in prostitution, had sexually transmitted infections in the last year, avoided preventive health services and consumed cocaine during the six months before this survey. CONCLUSION: The perception of vulnerability to HIV among the TW participants in this study is high; therefore, effective interventions are required to improve the living conditions and sexual behavior of this population.

OBJETIVO: Describir la percepción de vulnerabilidad al VIH y sus factores asociados en mujeres transgénero (MT) en Bogotá, Medellín y Santiago de Cali, Colombia. MATERIALES Y MÉTODOS: Se llevó a cabo un estudio transversal, a partir de un muestreo dirigido por encuestados (RDS), en el que participaron 620 MT. Se investigaron aspectos sociodemográficos, conductas sexuales, consumo de sustancias psicoactivas y percepción de vulnerabilidad al VIH. Se realizó un análisis descriptivo, a través de asociaciones bivariadas, utilizando chi cuadrado. También se realizó el análisis multivariado y se construyó un modelo de regresión de Poisson. RESULTADOS: El 63% de las participantes son menores de 35 años, se desempeñan principalmente como trabajadoras sexuales, modelos web cam y estilistas, tienen bajos ingresos, iniciaron relaciones sexuales a temprana edad, y el 84,7% había recibido dinero a cambio de sexo alguna vez en la vida. La percepción de vulnerabilidad al VIH aumenta entre quienes ejercen la prostitución, antecedente de infecciones de transmisión sexual en el último año, son solteras, consumieron cocaína en los seis meses previos a la encuesta y evitan los servicios de prevención. CONCLUSIONES: La percepción de vulnerabilidad al VIH entre las MT participantes del estudio es alta, por lo cual se requieren intervenciones efectivas que mejoren sus condiciones de vida y comportamientos sexuales.

Risk of infection in patients undergoing urologic surgery based on the presence of asymptomatic bacteriuria: A prospective study.

BACKGROUND: Treatment of asymptomatic bacteriuria (ASB) is recommended in pregnant women and prior to urologic procedures with anticipated mucosal disruption. However, there is still insufficient evidence of the usefulness of treating ASB prior to urologic procedures. Therefore, the aim of this study was to ascertain the risk of infections in patients undergoing urologic surgery based on the presence of ASB. METHODS: We conducted a cohort study among patients undergoing urologic surgery at a single center located in Medellín, Colombia. All patients were screened for ASB prior to their procedures. Patients were evaluated for the development of any postoperative infectious complications for up to 30 days after the procedure. RESULTS: A total of 149 patients were included in this cohort. Incidence of ASB was 14.8%. Thirteen patients (8.72%) developed infectious complications: 3 (13.64%) with ASB and 10 (7.87%) without ABS. Factors associated with postoperative infectious complications included urologic cancers (hazard ratio [HR], 5.26; 95% confidence intervals [CI], 1.24-22.37), urologic interventions in the preceding 3 months (HR, 3.72; 95% CI, 1.02-13.51), and use of antibiotics 3 months prior to surgery (HR, 3.83; 95% CI, 1.01-15.49). Presence of ASB was not associated with postsurgical infectious complications (HR, 1.02; 95% CI, 0.26-3.96). CONCLUSIONS: There was no association between ASB and postoperative infectious complications. There were other factors associated with infectious complications, such as urologic cancer, previous history of urologic manipulation, and antibiotic use.

Factors associated with multidrug-resistant bacteria in a cohort of patients with asymptomatic bacteriuria who underwent urological surgery.

BACKGROUND: Although the factors associated to bacterial resistance in patients with asymptomatic bacteriuria (ASB) have been studied in pregnant, fertile age women, patients with spinal cord injury, and those with urogynecological disorders, nothing is known about the factors associated with multidrug-resistant (MDR) bacteria in patients with ASB and planned urological procedures. This study therefore sought to identify the sociodemographic and clinical factors associated with MDR bacteria in a cohort of patients with ASB scheduled for urological procedures. METHODS: We conducted a nested case-control study on a cohort of patients with ASB and planned urological procedures at 3 Colombian medical centers. Cases were patients with MDR bacteria and controls were patients without MDR bacteria. RESULTS: A total of 184 patients were included, 41.8% (n = 77) of whom presented ASB with MDR bacteria. The factors linking ASB with MDR bacteria were: advanced age (odds ratio, 1.03; 95% confidence interval, 1.01-1.06) and hospitalization within the 3-month period before surgery (odds ratio, 2.35; 95% confidence interval, 1.08-5.21). CONCLUSIONS: Bacterial resistance is frequent among patients with ASB and planned urological procedures. Advanced age and prior hospitalization should be borne in mind for patients with planned urological procedures because they are factors associated with the presence of MDR bacteria.

Prevalence of hepatitis C virus in young people who inject drugs in four Colombian cities: A cross-sectional study using Respondent Driven Sampling.

BACKGROUND: Colombia has a growing population of young people who inject drugs (PWID). Despite the previously reported association of injection drug use with hepatitis c virus (HCV) in other countries, studies on HCV prevalence in PWID in Colombia are lacking. The objective of this study is to determine the prevalence, demographics, and correlations of risky injection behaviours in HCV seropositive PWID in four Colombian cities (Armenia, Bogotá, Cúcuta and Pereira). METHODS: This was a cross-sectional study carried out between January and June of 2014 that included 918 PWID from four Colombian cities, recruited by Respondent Driven Sampling. A survey was administered to each participant, and blood samples were collected. Binary logistic regression and multivariate analyses for each city were conducted. RESULTS: Average participant age was 26 years (SD 6.5). Of all participants, 27.3% of PWID were HCV seropositive, of which 52% were 25 years old or younger. In Pereira, increased risk of HCV infection was found for PWID that: had a history of injection drug use of 5 years or more (AOR: 3.0, CI: 1.7-7.8); were between 25 and 28 years of age (AOR: 5.2, CI: 1.0-26.3); had higher injection frequency (AOR: 2.5, CI: 1.4-4.2), and daily use of gifted, sold, or rented needles or syringes (AOR: 4.5, CI: 1.0-7.1). Additionally, in Cucuta, being HIV seropositive appeared to be greatly associated with risk of HCV seropositivity (AOR: 16.9, CI: 3.5-81.5). CONCLUSION: Although prevalence of HCV in PWID in Colombia is lower than that reported for other countries, the described demographic characteristics and diverse risky injection behaviors on each city, in the context of a young PWID population with a short injection drug use history, should be taken into account in order to guide efforts towards preventing and reducing risk of HCV infection in PWID in Colombia.

Exposición intrauterina a disruptores endocrinos (ftalatos): fuentes de exposición y cuantificación de metabolitos urinarios / Intrauterine exposure to endocrine disruptors (phthalates): sources of exposure and quantification of urinary metabolites

Introducción: Los ftalatos son disruptores endocrinos usados en la fabricación de múltiples productos de la industria, principalmente plásticos. El periodo fetal representa la principal ventana de vulnerabilidad, y la exposición a ftalatos en esta etapa de vida genera efectos adversos fetales y postnatales. El biomarcador más fiable para medición de ftalatos es la orina. Objetivo: Caracterizar las diferentes fuentes de exposición a disruptores endocrinos y cuantificar la concentración urinaria de ftalatos en gestantes. Materiales y métodos: Estudio transversal, observacional y descriptivo que incluye 400 gestantes que asistieron a control prenatal en las instituciones de salud Génesis y Metrosalud (Medellín-Colombia). Se caracterizaron fuentes de exposición, se recolectó muestras de orina de todas las gestantes, y cuantificó la concentración de ftalatos de 38 mujeres. Resultados: Las medias geométricas de ftalato Di(2-ethylhexyl)phthalate(DEHP), Mono-n-butyl phthalate(MnBP), Mono-2-ethyl-5-hydroxyhexyl phthalate(MEHHP) y Mono-2-ethyl-5-oxohexyl phthalate(MEOHP) fueron 162,72µg/L, 58,5 µg/L, 33,93µg/L y 31,63µg/L respectivamente. Conclusiones: La mayoría de las gestantes evaluadas han estado expuestas a lo largo de su vida a fuentes potenciales de disruptores endocrinos, presentes en químicos domésticos, tabaco y uso frecuente de cosméticos faciales y corporales. Las concentraciones de MnBP, MEHHP y MEOHP en orina de las participantes, fueron superiores a los hallazgos a nivel mundial.

Introduction: Phthalates are endocrine disruptors used in the manufacture of various industrial products, mainly plastics. The fetal period represents the principal window of vulnerability, and the exposure to Phthalates in this stage of life generates adverse fetal and post-natal effects. The most reliable biomarker for the assessment of Phthalates is urine. Objective: To characterize the different exposure sources of endocrine disruptors and quantify the urinary concentration of Phthalates in pregnant women. Materials and methods: A cross-sectional, observational, and descriptive study which included 400 pregnant women who received prenatal care in the Genesis and Metrosalud health institutions (Medellín-Colombia). Exposure sources were characterized and urine samples were collected from all pregnant women and the Phthalate concentration was quantified in 38 women. Results: The geometric measures of Phthalate Di(2-ethylhexyl)phthalate(DEHP), Mono-n-butyl phthalate(MnBP), Mono-2-ethyl-5-hydroxyhexyl phthalate(MEHHP) and Mono-2-ethyl-5-oxohexyl phthalate(MEOHP) were 162.72µg/L, 58.5 µg/L, 33.93µg/L and 31.63µg/L respectively. Conclusions: The majority of pregnant women that were evaluated were exposed to potential sources of endocrine disruptors throughout their life, which are present in household chemicals, tobacco, and frequent use of facial and body cosmetics. The concentrations of MnBP, MEHHP y MEOHP in urine of participants were higher than those found worldwide.

Factores asociados a la percepción de vulnerabilidad al VIH en mujeres transgénero de tres ciudades de Colombia / Factors associated with the perception of HIV vulnerability among transgender women in three Colombian cities

Objetivo: Describir la percepción de vulnerabilidad al VIH y sus factores asociados en mujeres transgénero (MT) en Bogotá, Medellín y Santiago de Cali, Colombia. Materiales y métodos: Se llevó a cabo un estudio transversal, a partir de un muestreo dirigido por encuestados (RDS), en el que participaron 620 MT. Se investigaron aspectos sociodemográficos, conductas sexuales, consumo de sustancias psicoactivas y percepción de vulnerabilidad al VIH. Se realizó un análisis descriptivo, a través de asociaciones bivariadas, utilizando chi cuadrado. También se realizó el análisis multivariado y se construyó un modelo de regresión de Poisson. Resultados: El 63% de las participantes son menores de 35 años, se desempeñan principalmente como trabajadoras sexuales, modelos web cam y estilistas, tienen bajos ingresos, iniciaron relaciones sexuales a temprana edad, y el 84,7% había recibido dinero a cambio de sexo alguna vez en la vida. La percepción de vulnerabilidad al VIH aumenta entre quienes ejercen la prostitución, antecedente de infecciones de transmisión sexual en el último año, son solteras, consumieron cocaína en los seis meses previos a la encuesta y evitan los servicios de prevención. Conclusiones: La percepción de vulnerabilidad al VIH entre las MT participantes del estudio es alta, por lo cual se requieren intervenciones efectivas que mejoren sus condiciones de vida y comportamientos sexuales.

Objective: To describe the perception of vulnerability to HIV and its associated factors among transgender women (TW) in Bogotá, Medellín and Santiago de Cali, Colombia. Materials and methods: We conducted a cross-sectional study, using respondent-driven sampling (RDS) in which 620 TW participated. Sociodemographic aspects, sexual behavior, consumption of psychoactive substances and the perception of vulnerability to HIV were studied. We carried out a descriptive analysis, in which bivariate associations were evaluated using chi-square. We also conducted a multivariate analysis and built a model using Poisson regression. Results: Of the participants, 63% were 35 years old or younger, had low income, started sexual relations at an early age and worked mainly as sex workers, webcam models and hairdressers; 84.7% of the participants had received money in exchange for sex at some point. The perception of vulnerability to HIV increased among those who were single, worked in prostitution, had sexually transmitted infections in the last year, avoided preventive health services and consumed cocaine during the six months before this survey. Conclusion: The perception of vulnerability to HIV among the TW participants in this study is high; therefore, effective interventions are required to improve the living conditions and sexual behavior of this population.

[Psychoactive substance use and violent behavior 11-18 year-old students. Itagüí, Colombia]. / Consumo de sustancias psicoactivas y comportamientos violentos en estudiantes de 11 a 18 años. Itagüí, Colombia.

Objective To determine the association between consumption of psychoactive substances (PAS) and violent behavior in middle and high school students (grades 6 to 11) in the municipality of Itagui, Colombia. Method Cross-sectional study with a random sample of 646 middle and high school students. Participants volunteered to fill out the survey independently and consent was provided. Participants' identity was kept anonymous. The survey contained questions regarding socio-demographic characteristics, PAS consumption and violent behavior. For these variables a descriptive analysis was conducted. In addition, prevalence ratios and 95 % confidence intervals were calculated. Lastly, a multivariate analysis was performed to determine association and risk factors. Results 646 students satisfactorily answered the survey. The median age was 15 years [Rq 3]. From this sample, 45.6 % (295) were male and 54.3 % (351) were female; 59.3 % (383) had a low socio-economic status, 38.9 % (251) have a medium socio-economic status, and 0.8 % (5) have a high socio-economic status. Regarding PAS consumption, 53.4% (345) of the participants reported to have consumed at least one PAS; 46.9 % (162/345) reported to have consumed alcohol within the last year; 15.3 % (53/345) reported to have consumed marihuana. All consumed substances were found to be associated with and were identified as a risk factor for violent behavior. Conclusions SPA consumption is associated with youth violent behavior and represents a risk factor to perform such behavior. Substances such as heroin, cocaine, and ecstasy, represent greater risk when compared to other analyzed PAS. When the other variables were adjusted, cigarettes and inhalants consumption, among others, were no longer a risk factor.

Incidencia y determinantes demográficos de la leucemia linfoide aguda en pacientes con cáncer pediátrico, Antioquia / Incidence and demographic determinants of lymphocytic leukemia in pediatric patients with cancer, Antioquia

Introducción: En el mundo las leucemias agudas son los tumores más frecuentes en la edad pediátrica, de gran interés por sus implicaciones en el niño y su familia. Objetivo: Identificar la incidencia de leucemia linfoide aguda y su asociación con determinantes demográficos en pacientes con cáncer pediátrico, Antioquia, 2017. Materiales y métodos: Estudio observacional, descriptivo, transversal, retrospectivo con intención analítica, sobre la incidencia de leucemia linfoide aguda (LLA) y su asociación con determinantes demográficos no causales de pacientes con cáncer infantil, en 190 registros del Sistema de Vigilancia en Salud Pública (SIVIGILA). Resultados: Las tasas de incidencia de cáncer infantil y LLA fueron 10 casos y 4 casos por cada 100.000 habitantes ≤18 años respectivamente. Las variables asociadas a LLA son: ser hombre (RPa: 1,02 IC95%: 0,52 - 2,02), residencia rural (RPa: 1,59 IC95%: 0,55 - 4,56), afiliación al régimen subsidiado (RPa: 1,41 IC95%: 0,68 - 2,92), edad ≥ 9 años (RPa: 0,76 IC95%: 0,38 - 1,50) y oportunidad diagnóstica confirmatoria ≥ 16 días (RPa: 0,34 IC95%: 0,10 - 1,15). Conclusiones: Ser hombre, vivir en zona rural y estar afiliado al régimen subsidiado, está relacionado con la incidencia de leucemia linfoide aguda.

Introduction: Acute leukemias are the most frequent pediatric malignancies worldwide that have led to a great interest due to their implications for children and their families. Objective: To identify the incidence of acute lymphocytic leukemia and its association with demographic determinants in pediatric cancer patients from Antioquia (Colombia) in 2017. Materials and methods: An observational, descriptive, cross-sectional, retrospective study was carried out with an analytical approach to identify the incidence of acute lymphocytic leukemia (ALL) and its association with non-causal demographic determinants in patients with pediatric cancer. 190 records from the Public Health Surveillance System (SIVIGILA) were analyzed. Results: The incidence rates of childhood cancer and ALL were 10 and 4 cases per 100,000 inhabitants ≤18 years of age, respectively. The variables associated with ALL are: being male (APR: 1.02 95% CI: 0.52 - 2.02); living in rural areas (APR: 1.59 95% CI: 0.55 - 4.56); being affiliated to the subsidized regime (APR: 1.41 95% CI: 0.68 - 2.92); being ≥ 9 years of age (APR: 0.76 95% CI: 0.38 - 1.50); and having a confirmatory diagnosis after 16 days (APR: 0.34 95% CI: 0.10 - 1.15). Conclusions: The variables related to acute lymphocytic leukemia are: being a man; living in rural areas; and being affiliated to the subsidized regime.

Patient safety climate in operating rooms at Colombian hospitals: differences by profession and type of contract / Clima de seguridad del paciente en unidades quirúrgicas de hospitales colombianos: diferencias por profesión y tipo de contratación

Abstract Introduction: The safety climate (SC) measurement in the hospitals, is essential for the development of a patient safety policy (PSP). Information about SC in the operating rooms is scarce. Objective: To measure the dimensions of SC in Colombian Operating Rooms according to characteristics of surgical staff. Methods: Cross-sectional study. The Hospital Survey on Patient Safety and an additional module for operating rooms were administered to healthcare workers in 6 high-complexity hospitals in the Metropolitan Area of Medellín (Colombia). The positive responses percentage for each dimension was measured. Differences by profession and type of contract were analyzed. Results: A total of442 participants were included. The workers in the operating rooms perceive a weak SC in terms of non-punitive response to error and workload (49.4% and 59.3% positive responses, respectively). Differences were found between physicians and nurses with lower scores in nursing for dimensions related to patient care. Anesthesiologists present low scores in events reporting. There are also differences by the type of work contract. Conclusion: Despite the PSP, the perception of a punitive culture to error, with a high workload. Recognizing differences between the groups within the surgical units helps to focus interventions strengthening the patient safety.

Resumen Introducción: La medición del clima de seguridad (CS) en las instituciones de salud es parte fundamental del desarrollo de una política de seguridad del paciente (PSP). Existe poca información acerca de la medición de clima de seguridad en las unidades quirúrgicas. Objetivo: Medir las dimensiones del CS en las unidades quirúrgicas de seis instituciones de salud colombianas según las características del personal. Métodos: Estudio de corte transversal. El cuestionario sobre seguridad del paciente en los hospitales (HSOPS) más la adición de un módulo para unidades quirúrgicas se aplicó al personal de seis hospitales de III nivel de Medellín (Colombia). Se midió el porcentaje de respuestas positivas para cada dimensión del CS. Se analizaron las diferencias por profesión y tipo de contratación. Resultados: Se incluyeron 442 participantes. El personal de las unidades quirúrgicas percibe un CS débil en respuesta no punitiva al error y carga de trabajo (49,4 % y 59,3 % de respuestas positivas respectivamente). Se encontraron diferencias entre personal médico y de enfermería con puntajes más bajos de percepción de CS en enfermería para aquellas dimensiones relacionadas con cuidado del paciente. Los anestesiólogos presentan puntajes bajos en el reporte de eventos. Existen además diferencias según el tipo de contrato de trabajo. Conclusiones: A pesar de la implementación de políticas de seguridad del paciente, persiste la percepción de una cultura punitiva frente al error, con una carga de trabajo elevado. El reconocimiento de las diferencias entre los grupos en las unidades quirúrgicas permitirá focalizar intervenciones que fortalezcan la seguridad del paciente.

[Risky sexual behavior regarding HIV in a college population]. / Las prácticas sexuales de riesgo al VIH en población universitaria.

OBJECTIVE: The study addressed risky sexual behavior regarding HIV infection in students attending Fundación Universitaria Luis Amigó (FUNLAM) in Medellin during the last six months. METHOD: This was a descriptive cross-sectional study involving a representative sample of 680 students who were surveyed using a questionnaire containing 65 qualitative and quantitative questions in line with sociodemographic variables and risky sexual behavior regarding HIV infection. RESULTS: For each man who had had sexual contact during the past six months there were 0.50 women [PR 0.50: 0.32-0.76 CI] and regarding age there were 0.43 less than or equal to 20 year old students for each college student aged over 20 years old [PR 0.43: 0.29-0.64 CI]. Statistically significant differences were found when comparing psychology students to engineering students [PR 0.32: 0.15-0.69 CI] and when comparing tenth semester students to first, second and fourth semester students [PR 0.11: 0.01-0.88 CI; PR 0.07: 0.00-0.53 CI; PR 0.11: 0.14-0.86 CI, respectively]. CONCLUSION: Sexual practice during the last six months was related to gender and age rather than other demographic variables showing the need to work with young people of both sexes, not just college students, for designing public health prevention and promotion action aimed at minimizing the risk of sexually transmitted HIV infection.

[The social vulnerability index regarding Medellín's disabled population]. / Índice de vulnerabilidad de la población en situación de discapacidad en Medellín.

OBJECTIVE: Constructing a social vulnerability index (SVI) for Medellín's disabled population during 2008 aimed at determining areas which were reducing opportunities for this population to use their tangible and intangible assets, thus impairing their quality of life. METHODS: This descriptive cross-sectional study drew on a source of secondary information regarding people having some kind of limitation recorded in the Quality of Life Survey, 2008. Physical, human and social variables were grouped when constructing the SVI; the models were run in principal component analysis to determine their degree of vulnerability, defined by the number of negative factors identified (high category=4 or 5, medium=2 or 3 and low=1 or none). Such classification led to identifying non-causal relationships with demographic variables through Mann-Whitney, Chi-square and Kruskal-Wallis tests (5.0 % statistical significance level); multinomial logistic regression was used for calculating adjusted measures for epidemiological measurement, such as opportunity ratios and confidence intervals. RESULTS: A degree of medium vulnerability predominated in disabled people living in Medellín (60.3 %) followed by low vulnerability (28.7 %) and high vulnerability populations (11.0 %). CONCLUSIONS: The proposed ISV classified the city's communes according to high, medium or low vulnerability, supported by the use of statistical and spatial location techniques.

Construcción y análisis de un índice de vulnerabilidad social en la población joven / Construction and analysis of a social vulnerability index in young population / Construção e análise do índice de vulnerabilidade social na população jovem

Resumen (analítico): En esta investigación nos trazamos como objetivo explorar la vulnerabilidad social en la población entre los 15 y 24 años de edad, en Medellín; para ello diseñamos un índice usando la técnica de análisis factorial con variables contenidas en la Encuesta de Calidad de Vida de la ciudad, en el año 2014. Encontramos que la población joven con alta vulnerabilidad, en su mayoría es población masculina, con educación básica, conformada por mestizos, indígenas o raizales que viven en estrato socioeconómico 2 (bajo). El estudio cuenta con limitaciones para inferir los resultados a toda la población joven de la ciudad de Medellín; sin embargo, aporta información útil para identificar las características de los individuos jóvenes altamente vulnerables. Palabra clave autores: construcción de índice.

Abstract (analytical): The research aimed to explore the social vulnerability in the population between 15 and 24 years old; an index was designed using a factorial analysis technique with variables included in the Quality of Life Survey of the Municipality of Medellín, in 2014. It was identified that young people with high vulnerability were a primarily male population with a basic education level, identified as mestizos, indigenous or from afro-descendent and raizal communities and living at a socioeconomic level 2 (low). The study has limitations in inferring the results to cover all young people in the city of Medellín; however, it does provide useful information to identify the characteristics of highly vulnerable young people. Authors key word: construction of index.

Resumo (analítico): O objetivo da pesquisa foi explorar a vulnerabilidade social na população numa faixa etária de15 a 24 anos, para isso foi desenhado um índice utilizando a técnica de análises fatorial com variáveis contidas no questionário de qualidade de vida da cidade de Medellín no ano 2014. Encontrou-se que a população jovem com alta vulnerabilidade foi principalmente a população masculina, com ensino fundamental, identificados como mestiços, indígenas ou nativos que viviam em nível socioeconómico 2 (baixo). O estudo tem as limitações para deduzir os resultados para toda a população jovem da cidade de Medellín, mesmo assim, fornece informação útil para identificar as características dos jovens com alta vulnerabilidade. Palavras-chave do autor: construção de índice.

[Labour factors associated with post-traumatic stress in uniformed workers in Medellín]. / Factores laborales asociados al riesgo de estrés postraumático en uniformados de un sector de Medellín.

OBJECTIVE: Determining the labor factors associated with post-traumatic stress in uniformed workers in Medellin. METHOD: A cross-sectional study was made of 124 uniformed workers aged 20 to 48 years-old. A survey was made using an adults' post-traumatic stress instrument which had been validated in Medellin. Statistical analysis was carried out. RESULTS: Post-traumatic stress disorder risk prevalence was 52.2 %. Multivariate analysis showed that the highest risk situations were those related to previous mental health diagnosis (PR=7.67), working schedule (4.24), violent episodes (PR=3.59) and community relationships (PR=2.73). CONCLUSIONS: A person's current labor situation seemed to be a risk factor for developing post-traumatic stress in the target population.

Exposición a Bisfenol A (BPA) en mujeres embarazadas y su relación con la obesidad en sus hijos: Revisión Sistemática / Pregnant Women's Exposure to Bisphenol A (BPA) and its Relation to their Children's Obesity: A systematic Review / Exposição ao bisfenol a (BPA) em mulheres engravidadas e a sua relação com a obesidade em seus filhos: uma revisão sistemática

Resumen Introducción: El bisfenol A (BPA) es un contaminante químico no persistente que altera el funcionamiento normal del sistema endocrino. Se sugiere que la exposición prenatal a BPA se asocia con la obesidad en la descendencia. Objetivo: Revisar la literatura sobre la exposición al BPA en mujeres embarazadas y su relación con la obesidad en sus hijos. Metodología: Revisión sistemática de acuerdo a la guía PRISMA, donde se realizaron búsquedas en las bases de datos Pubmed, ScienceDirect, Clinical Key, Medline, Ebsco y Scielo y el motor de búsqueda Google Scholar hasta 30 de abril de 2017 por dos investigadores independientes que utilizaron iguales términos de búsqueda. Se incluyeron estudios prospectivos de cohorte realizados que midieron el BPA en la orina materna. Resultados: Se incluyeron 5 estudios con tamaños de muestra que varían entre 297 y 757 binomios madre e hijo, se encontró asociación positiva entre la exposición prenatal a BPA con la circunferencia de cintura en niños de cuatro años β: 0.28 (IC95%:0.01 a 0.57) y el índice de masa grasa β: 0.31 (IC95%: 0.01 a 0.60) en dos de los estudios. Además, se observaron asociaciones positivas y/o negativas no significativas con índice de masa corporal y su puntaje Z, porcentaje de grasa, sobrepeso/obesidad, peso y talla al nacer, porcentaje de masa grasa. Conclusión: Los resultados del cuerpo existente de estudios epidemiológicos de cohorte, limita las afirmaciones sobre un vínculo causal entre la exposición prenatal BPA y la obesidad postnatal.

Abstract Introduction: Bisphenol A (BPA) is a non-persistent chemical pollutant which alters the normal functioning of the endocrine system. It is suggested that prenatal exposure is related to descendant obesity. Objective: Review literature on pregnant women's exposure to BPA and the relation to their children's obesity. Methodology: Systematic review in accordance with PRISMA guidelines. Searches were conducted on databases including Pubmed, ScienceDirect, Clinical Key, Medline, Ebsco and Scielo and Google Scholar search engine until April 30, 2017 by two independent researchers that used the same search terms. Prospective cohort conducted studies were included because they measured BPA in maternal urine. Results: Five studies were included with sample sizes ranging from 297 to 757 mother-child binomials. The review found a positive association between prenatal BPA exposure with 4-year-old children's waist circumference β: 0.28 (95% CI :0.01 to 0.57) and the fat mass index β: 0.31 (95%CI: 0.01 to 0.60) in two of the studies. non-significant positive and/or negative associations where observed with body mass index z-scores, overweight/ obesity, weight and size at birth, body mass percentage. Conclusion: The results of cohort epidemiological studies constrain statements regarding a causal link between prenatal BPA exposure and postnatal obesity.

Resumo Introdução: O bisfenol A (BPA) é um contaminante químico não persistente que altera o funcionamento normal do sistema endócrino. Se sugere que a exposição pré-natal se associa com a obesidade na descendência. Objetivo: Revisar a literatura sobre a exposição ao BPA em mulheres engravidadas e a sua relação com a obesidade em seus filhos. Metodologia: Revisão sistemática de acordo com a guia PRISMA. Se realizaram pesquisas nas bases de dados Pubmed, ScienceDirect, Clinical Key, Medline, Ebsco e Scielo e o motor de pesquisa Google Scholar até o 30 de Abril de 2017 por dois investigadores independentes que utilizaram os mesmos termos de busca. Se incluíram estudos prospectivos de coorte realizados que calcularam o BPA na urina materna. Resultados: Se incluíram 5 estudos com tamanhos de amostra entre 297 e 757 binômios mãe e filho, se encontrou associação positiva entre a exposição pré-natal a BPA com a circunferência de cintura em meninos de quatro anos β: 0.28 (IC95%:0.01 a 0.57) e o índice de massa de gordura β: 0.31 (IC95%: 0.01 a 0.60) em dois dos estudos. Se enxergaram associações positivas e/ou negativas não significativas com índice de massa corporal e a sua pontuação Z, porcentagem de gordura, sobrepeso/obesidade, peso e dimensão ao nascer, porcentagem de massa de gordura. Conclusão: Os resultados de estudos epidemiológicos de coorte, limita as afirmações sobre um vínculo causal entre a exposição pré-natal BPA e a obesidade pós-natal.

Perspectivas teóricas y metodológicas para el estudio del ambiente como determinante de la salud / Theoretical and methodological perspectives for studying the environment as a determinant of health / Perspectivas teóricas e metodológicas para o estudo do ambiente como determinante da saúde

RESUMEN Objetivo: Describir algunas de las perspectivas teóricas y metodológicas del ambiente como determinante de la salud, como un aporte desde lo conceptual a este complejo campo en constante construcción y deconstrucción. Metodología: Revisión de tema con un análisis de la literatura previa detección y consulta de documentos oficiales y artículos científicos que permitieron la estructuración del texto alrededor del tema. Resultados y discusión: A lo largo de la historia y en los diferentes discursos, vivencias individuales y colectivas, el ambiente ha estado presente en el continuo del proceso salud - enfermedad. La higiene y el saneamiento resuelven el problema en un escenario donde hay riesgos y peligros que deben ser identificados para controlarse o eliminarse. Sin embargo, desde las últimas décadas del siglo XX por intereses económicos, necesidad de conservar la salud, por los daños, problemas ambientales globales y locales, se ha dado lugar, al menos desde lo teórico y metodológico, al entendimiento del ambiente como un determinante de la salud, concepción que implica pasar del dominio y control del hombre sobre la naturaleza a entenderse como parte de ella misma. Conclusiones: A través del tiempo se ha observado y vivenciado que las intervenciones antrópicas del hombre sobre la naturaleza han sido poco respetuosas y ha pasado sistemáticamente de ser victimario de su ambiente y su entorno a ser víctima de los ambientes construidos. Los modelos de salud ambiental construidos con una mirada más desde la salud deben integrarse con otras disciplinas, para el análisis de situaciones complejas en salud ambiental.

ABSTRACT Objective: To describe some of the theoretical and methodological perspectives of the environment as a health determinant, this is a contribution from the conceptual standpoint to this complex field in constant construction and deconstruction. Methodology: The subject was reviewed through an analysis of the literature performed after finding and reading official documents and scientific papers that made it possible to structure the text around the subject. Results y discussion: Throughout history, in various discourses and in individual and collective experiences, the environment has been present in the continuum of the health-disease process. Hygiene and sanitation solve the problem in a scenario where there are risks and hazards that should be identified in order to be controlled or removed. However, since the last decades of the twentieth century, the economic interests, along with the global and local environmental damage and the need to preserve health, have caused the environment to be understood, at least theoretically and methodologically, as a determinant of health. This conception in turn implies considering mankind not as the master of nature but as part of it. Conclusions: Throughout time it has been observed and experienced that the anthropic interventions of humankind over nature have been disrespectful and have led it to consistently move from the status of victimizer of its surrounding to that of victim of the constructed environments. Environmental health models built with a stronger focus on health should be integrated with other disciplines for the analysis of complex situations in environmental health.

RESUMO Objetivo: Descrever algumas das perspectivas teóricas e metodológicas do ambiente como determinante da saúde, como um aporte desde o conceptual a este complexo campo em constante construção e desconstrução. Metodologia: Revisão de tema com uma análise da literatura previa detecção e consulta de documentos oficiais e artículos científicos que permitiram a estruturação do texto ao redor do tema. Resultados e discussão: Ao longo da historia e nos diferentes discursos, vivencias individuais e coletivas, o ambiente tem estado presente no continuo do processo saúde - doença. A higiene e o saneamento resolvem o problema num cenário onde ha riscos e perigos que devem ser identificados para controlar-se ou eliminar-se. Mas, desde as últimas décadas do século XX por interesses econômicos, necessidade de conservar a saúde, pelos danos, problemas ambientais globais e locais, se tem dado lugar, ao menos desde o teórico e metodológico, ao entendimento do ambiente como um determinante da saúde, conceição que implica passar do domínio e controle do homem sobre a natureza ao entender-se como parte dela mesma. Conclusões: A través do tempo se tem observado e vivenciado que as intervenções antrópicas do homem sobre a natureza tem sido pouco respeitosas e tem passado sistematicamente de ser carrasco do seu ambiente e o seu entorno pra ser vítima dos ambientes construídos. Os modelos de saúde ambiental construídos com una olhada mais desde a saúde devem integrar-se com outras disciplinas, para o análise de situações complexas em saúde ambiental.

Factores asociados a la hipertensión arterial en el adulto mayor según la subregión / Factors associated to arterial hypertension in older adults according to subregión

Resumen Introducción: El envejecimiento de la población y la hipertensión arterial presentaron una tendencia al aumento en las subregiones del Departamento de Antioquia. Objetivo: Determinar los factores asociados a la hipertensión arterial en el adulto mayor, según las subregiones del Departamento de Antioquia en el segundo semestre del año 2012. Método: Estudio observacional, descriptivo, transversal y retrospectivo donde se caracterizaron los factores asociados a la hipertensión arterial. Se usó una fuente secundaria de información utilizando la base de datos del estudio ''Situación de salud y condiciones de vida del adulto mayor, Departamento de Antioquia, 2012''. Resultado: Se analizaron 4.248 encuestas diligenciadas por los adultos mayores, el 65,5% fueron mujeres hipertensas, el 64,1% adultos mayor joven (60 a 74 años de edad), la subregión de Oriente (RP = 1,67, IC al 95%: 1,27-2,19), la pobreza se asocia con la enfermedad, el estrato socioeconómico cero (RP = 2,54, IC al 95%: 0,85-7,57), se encontró asociación con los hábitos como: el consumo de alcohol, el tabaco y el estado nutricional. El 21,8% presentó prevalencia de la diabetes y el 28,3% de los adultos hipertensos manifestó que empeorará mucho la calidad de vida. Conclusiones: La condición de ser: adulto mayor viejo, sexo femenino, afrocolombiano, residir en estrato cero y presentar un estado nutricional moderado, diabetes, problemas del corazón y cerebro, se asocia con la hipertensión arterial. Se requiere la implementación de las siete P (7 P) de la salud pública: las políticas públicas, la planeación en salud, la población vulnerable, la promoción de la salud, la prevención del riesgo, la participación comunitaria y los principios éticos.

Abstract Introduction: Ageing population and arterial hypertension showed a rising trend in the subregions of the Antioquia department. Objective: To determine factors associated to arterial hypertension in old adults according to the subregion of the Antioquia department during the second semester of the year 2012. Method: Cross-sectional, descriptive, observational, retrospective study where factors associated to arterial hypertension were identified. A secondary source of information was used, with the database of the study Health situation and living conditions of old adults, Antioquia department, 2012 (''Situación de salud y condiciones de vida del adulto mayor, Departamento de Antioquia, 2012''). Results: 4,248 surveys completed by old adults were analysed, 65.5% were hypertensive women, 64.1% were young elderly (between 60 and 74 years old), Oriente subregion (OR = 1.67, CI 95%): 1.27-2.19), poverty is associated to illness, zero socioeconomic status (OR = 2.54, CI 95%: 0.85- 7.57), an association was found with alcohol and tobacco consumption and nutritional status. 21.8% showed diabetes prevalence and 28.3% of hypertensive adults expressed that it worsened their quality of life. Conclusions: Being an older adult, female, of Afro-Colombian origin, living in status zero and showing a moderate nutritional status, diabetes, cardiac or brain problems are associated with arterial hypertension. Implementing the 7 public health indications is required: public policies, health planning, vulnerable population, health promotion, risk prevention, Community participation and ethical principles.

Consumo de sustancias psicoactivas y comportamientos violentos en estudiantes de 11 a 18 años. Itagüí, Colombia / Psychoactive substance use and violent behavior 11-18 year-old students. Itagüí, Colombia

Objetivo Determinar la asociación entre el consumo de sustancias psicoactivas (SPA) y los comportamientos violentos en los escolarizados del municipio de Itagüí, 2011. Método Estudio analítico transversal con una muestra probabilística de 646 estudiantes de las instituciones educativas. Los estudiantes diligenciaron de manera individual, anónima y voluntaria un cuestionario con preguntas sobre características socio demográficas, consumo de SPA y comportamientos violentos. Se realizó un análisis descriptivo para estas variables. Se estimaron razones de prevalencia (RP) y los intervalos de confianza del 95 % (IC95 %); se realizó un análisis multivariado para determinar asociación y estimación de riesgo. Resultados 646 estudiantes contestaron satisfactoriamente la encuesta. La mediana de la edad fue 15 años (Rq3). El 45,6 % son hombres y el 54,3 % mujeres; el 59,3 % pertenecen a estrato socioeconómico bajo, el 38,9 % medio y el 0,8 % estrato alto; el 53,4 % manifestó haber consumido alguna SPA; el 46,9 % dice consumir bebidas alcohólicas durante el último año; el 15,3 % marihuana. Todas las sustancias consumidas se asociaron y al ajustar variables, la mayoría representaron riesgo para el joven ser autor de comportamientos violentos. Conclusiones El consumo de SPA, se asocia con los comportamientos violentos del joven y representa un factor de riesgo para serlo. la heroína, la cocaína y éxtasis representan mayor riesgo que las demás SPA analizadas. Al ajustar con las demás variables, el cigarrillo, los inhalables entre otras dejaron de ser FR.(AU)

Objective To determine the association between consumption of psychoactive substances (PAS) and violent behavior in middle and high school students (grades 6 to 11) in the municipality of Itagui, Colombia. Method Cross-sectional study with a random sample of 646 middle and high school students. Participants volunteered to fill out the survey independently and consent was provided. Participants' identity was kept anonymous. The survey contained questions regarding socio-demographic characteristics, PAS consumption and violent behavior. For these variables a descriptive analysis was conducted. In addition, prevalence ratios and 95 % confidence intervals were calculated. Lastly, a multivariate analysis was performed to determine association and risk factors. Results 646 students satisfactorily answered the survey. The median age was 15 years [Rq 3]. From this sample, 45.6 % (295) were male and 54.3 % (351) were female; 59.3 % (383) had a low socio-economic status, 38.9 % (251) have a medium socio-economic status, and 0.8 % (5) have a high socio-economic status. Regarding PAS consumption, 53.4% (345) of the participants reported to have consumed at least one PAS; 46.9 % (162/345) reported to have consumed alcohol within the last year; 15.3 % (53/345) reported to have consumed marihuana. All consumed substances were found to be associated with and were identified as a risk factor for violent behavior. Conclusions SPA consumption is associated with youth violent behavior and represents a risk factor to perform such behavior. Substances such as heroin, cocaine, and ecstasy, represent greater risk when compared to other analyzed PAS. When the other variables were adjusted, cigarettes and inhalants consumption, among others, were no longer a risk factor.(AU)

[Dignified social support for elderly institutionalised adults in Medellín, 2008]. / Apoyo social dignificante del adulto mayor institucionalizado. Medellín, 2008.

OBJECTIVE: Analysing the social support provided for elderly institutionalised adults being cared for in Elderly Welfare Centres (Centros de Bienestar del Anciano de Medellín) in Medellin during 2008. MATERIALS: This was a cross-sectional descriptive study (primary information source) which addressed some characteristics related to the social support being received by 273 elderly people institutionalised in 37 social welfare centres. Univariate and bivariate analysis was applied to the data. RESULTS: The institutionalised people were mostly single or widowed women aged between 65 and 84 who had received primary and secondary education; most were affiliated to the contributory health regimen. Loneliness, health problems and family decision were the main causes for them having become institutionalised. They were visited by their children and other relatives and such support was rated as being satisfactory; however, more than half of them had feelings of loneliness and one sixth claimed to be humiliated and insulted by their loved ones. It should be noted that a few of them reported being mistreated by their caregivers. Institutionalised elderly adults performed recreational activities, were satisfied with the support received from friends, with cohabitation and the pertinent institution. CONCLUSIONS: Social support networks were strong within the institution (i.e. Elderly Welfare Centres); the elderly seemed to receive greater abuse from family members and cohabitants than institutional caregivers. Loneliness generally leads elderly adults to become institutionalised; however, once having entered an institution (being partly motivated by little family contact and average satisfaction with friends and the institution itself) their neglect and social vulnerability becomes evident.