Supervivencia y factores asociados en pacientes con cáncer cervicouterino atendidas por el Seguro Popular en México.

 Objetivo. Estimar la supervivencia a cinco años por cáncer cervicouterino y sus factores asociados en pacientes mexica-nas, cuya atención fue financiada por el Fondo de Protección contra Gastos Catastróficos (FPGC) del Seguro Popular durante el periodo 2006-2014. Material y métodos. Se analizó la base de datos de las pacientes mencionadas y se vinculó con el Subsistema Epidemiológico y Estadístico de Defunciones. Se hizo un análisis de supervivencia a cinco años por etapa clínica y factores asociados, mediante el método de Kaplan-Meier y los modelos de riesgos proporcionales de Cox. Resultados. La supervivencia global por cáncer cervicouterino a los cinco años fue de 68.5%. Los factores asociados fueron la etapa clínica (locoregional [HR=2.8 IC95% HR: 2.6,3.0] y metastásica [HR=5.4 IC95% HR: 4.9,5.9]) com-parada con la etapa temprana y la edad (HR=1.003 IC95% HR:1.001,1.004). Conclusiones. Las mujeres que lograron el acceso a la atención del cáncer cervical financiadas por el FPGC tuvieron una supervivencia ligeramente superior a las reportadas en otros estudios.

[Construction of a development index for young people aged 14 - 26 in Medellín, Colombia]. / Construcción de un índice de desarrollo para jóvenes de 14 a 26 años, Medellín, Colombia.

OBJECTIVE: To construct and validate a Medellín youth development index (IDJM, for its Spanish acronym) covering young people aged 14 - 26 residing in the city's comunas and corregimientos, thus contributing scientific evidence for the development of intervention strategies. METHODS: A cross-sectional study of a random representative sample of 8 001 young people residing in Medellín, Colombia, was conducted, to whom a validated instrument was applied whose dimensions provide information on youth development. The Prinqual method for processing qualitative variables through optimal quantification was used. The first main component, the IDJM, was selected by means of a categorical analysis of the main components. The index was validated and disaggregated by sex, age group, and each dimension studied. RESULTS: The average IDJM score was 74.4 (SD=9.8; CI95%: 74.2 - 74.6). The 14 - 17-year-old age group had the highest score, with females exhibiting slightly higher scores than their male counterparts. The analysis likewise showed that scores increased with socioeconomic level and decreased as the age of the study population increased. Education was the dimension that contributed the most to the index, followed by Goods and Services, while Democracy and Participation and Labor contributed the least across all age groups. CONCLUSIONS: A Medellín youth development index was constructed and validated. It should prove to be a very useful tool, especially for decision-making regarding public policies that target young people. It is essential that the IDJM be updated regularly to ensure accurate assessment of the interventions' impact, especially in the dimensions that contributed lower scores.

Burden of disease in Colombian Orinoquia Region, 2017.

Background: Population health diagnoses are a fundamental tool to guide health policies and programs, and consequently, public health requirements. In this perspective, the burden of disease in inhabitants of Colombian Orinoquia is quantified for the first time. Methods: A descriptive population-based study that was based on secondary sources was carried out, which aimed at measuring the burden of the disease in the Colombian region of Orinoquia, using the simplified synthetic indicator of disability-adjusted life years (DALYs) of the global health estimation methodology. We used mortality records from the National Administrative Department of Statistics (DANE) and service provision records from the Ministry of Health and Social Protection of Colombia, both records from the year 2017, available on the Integrated Social Protection Information System. Results: 288,740.2 DALYs occurred (95% UI 210,714.6-382,948.8), with higher reports for men (59%); group of non-communicable diseases accounted for 62.3% of DALYs (179,993.6, 95% UI, 115,030.2-268,405.0), followed by external cause injuries group which contributed 24.6% (71,000.0, 95% UI, 25,638.1-134,013.1), and group of communicable, maternal, neonatal, and nutritional disorders which contributed 13.1% (37,746.0, 95% UI, 28,048.0-50,239.7). Interpersonal violence was the primary cause specific of DALYs with 9.8% of the burden, (28,290.0, 95% UI, 7,365.1-64,208.1). Conclusions: Most DALYs in Orinoquia are produced by non-communicable diseases (NCD), largely caused by neoplasms and cardiovascular disease, which increased with age. However, when considered by specific cause of illness or injury, interpersonal violence is indicated as the main cause of DALYs, affecting mainly young men, possibly as an expression of social inequality, substance use, criminality, and insecurity. It is important to highlight that this region has been recognized as an area of armed conflict, drug trafficking, and poverty.

Effectiveness of tailored intervention with a salutogenic approach to improve adherence in adults with hypertension: a non-randomized trial.

AIMS: Hypertension (HTN) is a chronic long-term, slowly progressing disease. For HTN control, management, and prevention of associated complications, adequate adherence to treatment is required. It has been proposed that tailored interventions to individual needs are required to address the phenomenon of adherence to treatment. However, studies evaluating the effects of tailored interventions to improve adherence are still scarce. The aim of this study is to evaluate the effectiveness of a tailored intervention using a salutogenic approach, to improve adherence in patients with HTN. METHODS AND RESULTS: A non-randomized trial design was used in this study. Adult patients with HTN were allocated in two groups: tailored intervention (n = 75) and standard care (n = 78). The content of the tailored intervention was based on personal resources and elaboration of an action plan with objectives in agreement with the patients. Patient outcomes (treatment adherence, blood pressure) were assessed both at the beginning of the study and at the 4-week follow-up for the intervention group and the standard care group. The Treatment Adherence Questionnaire for Patients with Hypertension was used to measure adherence. The results of this study showed that the total score and each dimension of the adherence questionnaire (medications, diet, physical activity, weight control, stimulation, and stress relief) increased significantly in the experimental group compared with the control group (P < 0.05). For the group assigned to tailored intervention, the delta score of the total adherence score increased in the final evaluation to 9.4 (95% CI = 8.60-10.28). CONCLUSION: A tailored intervention with a salutogenic approach appears to be effective for improving adherence in patients with HTN. Randomized controlled trials are required to confirm the effect of tailored interventions in this type of population.

Loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin, 2012 to 2015.

OBJECTIVE: Determine the loss of years of healthy life due to road incidents of motorcyclists in the city of Medellin from 2012 to 2015. METHODS: Descriptive study with data on health care of injured motorcyclists and deaths adjusted with the Preston and Coale method, and OPS proportional distribution for the period 2012-2015. The years of life lost due to premature death (YLLs), years lived with disability (YLDs), and the disability-adjusted life years (DALYs) were calculated according to the new methodology designed for that purpose. RESULTS: The loss of years of healthy life due to road incidents of motorcyclists in the four-year period was 80,046 DALYs (823.8 per 100,000 inhabitants), with a higher proportion in men (81.3% and a ratio of 5 to 1 compared to women); the YLDs was 66.6% with marked differences in favor of men. There was nearly a 38% difference in the ages of 15 to 19 as well as a 19% difference from 30 to 49, compared to women. Premature death (YLLs) contributed to 33.4% of DALYs, with significant presentation in the above-mentioned age groups. CONCLUSIONS: The greatest loss of years of healthy life due to road incidents of motorcyclists in Medellin was due to non-fatal injuries and was concentrated in young men. If the trend of motorcycle road incidents continues, both local and national road safety plans will fail to accomplish the expected results, especially among motorcycle users.

Local attributable burden disease to PM 2.5 ambient air pollution in Medellín, Colombia, 2010-2016.

Background: Exposure to 2.5-micron diameter air pollutants (PM 2.5) has been associated with an increased risk of illness and death worldwide; however, in Latin American health impacts assessment of this risk factor is scarce. Medellín is one of the most polluted cities in the region, with a population growth rate that is twice as high as that of other Colombian cities, which implies a growing population at risk. Methods: A descriptive study of the disease burden was carried out using the city as the unit of observation. Health events were selected based on epidemiologic evidence and the availability of the population attributable fraction associated with PM 2.5. The mortality records were taken from the module of deceased of the Single Registry of Affiliates of the Health System; the morbidity records were taken from the Individual Health Services Registries. For the estimation of the burden of disease, the current Global Burden of Disease guidelines were followed. Results: Attributable disability-adjusted life years to exposure to ambient PM 2.5 pollution (DALYs PM2.5) constituted 13.8% of total burden of the city. Males showed the greatest loss of DALYs PM2.5 due to acute events, while in women the greatest loss was due to chronic events. Ischemic heart disease, chronic diseases of the lower respiratory tract, and influenza and pneumonia were the events that contributed the most to DALYs PM2.5. 71.4% of the DALYs PM2.5 corresponded to mortality, mainly in the population over 65 years of age. Regarding attributable morbidity, acute events were more prevalent in both sexes, especially due to respiratory diseases Conclusion: Premature death among the elderly population has the greatest weight on burden of disease attributable to ambient PM 2.5 pollution, mainly due to respiratory and cardiovascular diseases, without significant differences according to gender.

[Quality of life and associated factors in women with breast cancer in Antioquia, Colombia]. / Calidad de vida y factores asociados en mujeres con cáncer de mama en Antioquia, Colombia.

OBJECTIVE: To determine the quality of life and some associated factors in women diagnosed with breast cancer enrolled in cancer treatment programs in a Colombian province. METHODS: In a cross-sectional study, the WHOQOL BREF domains related to the quality of life of 220 women with breast cancer who were in treatment were analyzed. First, a descriptive analysis was done of the sociodemographic variables included in the study. This was followed by an analysis of the quality-of-life scores of the patients in terms of their demographic, clinical, and social characteristics. Finally, some characteristics were identified that, in combination, explained the patients' quality of life. RESULTS: The quality of life was better for women with more schooling, those who were beneficiaries of the contributory health system, those who received support from family members, those from high-income groups, and those whose personal beliefs (religious and spiritual) helped them cope with the disease. Belonging to a lower-income group and having a skeptical attitude constituted risk factors for obtaining lower quality-of-life scores. CONCLUSIONS: The quality of life of breast cancer patients was poorer, both in general and in the physical, psychological, social, and environmental domains, in those who came from more humble levels of society. Psychosocial intervention, through patient-centered methods, is proposed as a strategy that can improve patients' quality of life, especially that of lower-income women. It is necessary to strengthen strategies that enable patients to cope with the disease, relying on the moral, social, and spiritual support of their environment as the main resource.

Disability-Adjusted Life Years Due to Mental Disorders and Diseases of the Nervous System in the Population of Medellin, 2006-2012. / Años de vida saludable perdidos a causa de trastornos mentales y enfermedades del sistema nervioso de la población de Medellín, 2006-2012.

OBJECTIVE: To determine the healthy life years (HLY) lost as a result of mental disorders and nervous system diseases in Medellin from 2006 to 2012. METHODS: Descriptive study using a secondary information source according to the Global Burden of Disease (GBD) framework. To calculate the years of potential life lost (YPLL), we used vital statistics data; to calculate disability-adjusted life years (DALY), we used morbidity data from individual records managed by health service providers, outpatient clinics and other research studies. HLY are the sum of YPLL and DALY. RESULTS: In Medellin, from 2006 to 2012, out of 1,242,407 HLY related to mental disorders and nervous system diseases, the vast majority (99.39%) were due to disability. Most HLY were found in females (70.22%) and 81% were found in people aged 15 to 59. The disorders representing the greatest burden were unipolar depressive disorder (81%), Alzheimer's disease and other types of dementia (4.82%), schizophrenia (3.5%) and drug use disorders (2.78%). CONCLUSIONS: Our results indicate a significant increase in the disease burden due to mental disorders and nervous system diseases. Public policy decision-makers in the city of Medellin should take note, as health problems of this type can result in a substantial rise in healthcare costs.

[Completeness of mortality reports in the vital statistics system in the Colombian Orinoquia, 2017]. / Completitud de los reportes de mortalidad en el sistema de estadísticas vitales en la Orinoquía colombiana, 2017.

OBJECTIVE: Estimate the integrity, in terms of completeness, of the mortality records in the vital statistics information system of the Orinoquia and its departments. METHODOLOGY: A descriptive study was carried out, with a secondary source of information, from the records of non-fetal deaths reported in the vital statistics systems of each department, using methods of distribution of the mortality of Brass, Preston-Coale, Hill and Bennet-Hourichi to estimate the integrity of the records. RESULTS: Completeness was found in the mortality records of women and men (≥95%) in Meta, and in the men of Orinoquia and Arauca (≥95%), in contrast to the records of the rest of the territorial units, where under-registration is presented. CONCLUSIONS: Both demographic dynamics and migration influenced the results obtained from the integrity of the mortality records, therefore, also in the selection of the most appropriate method to estimate integrity; when the population is neither stable nor closed, methods based on two censuses with specific growth rates and migration adjustment should be applied; if there is no information on migration, the Hill method is recommended.

OBJETIVO: Estimar la integridad, en términos de completitud, de los registros de mortalidad en el sistema de información de estadísticas vitales de la Orinoquía colombiana y sus departamentos. METODOLOGÍA: Se realizó un estudio descriptivo, con fuente de información secundaria, procedente de los registros de defunciones no fetales reportados en los sistemas de estadísticas vitales de cada departamento. Se usaron métodos de distribución de la mortalidad de Brass, de Preston Coale, de Hill y de Bennet-Hourichi para estimar la integridad de los registros. RESULTADOS: Se encontró completitud en los registros de mortalidad de mujeres y hombres (≥95%) en Meta, y en los hombres de la Orinoquía y Arauca (≥95%), en contraste con los registros del resto de unidades territoriales, donde se presenta subregistro. CONCLUSIONES: Tanto la dinámica demográfica como la migración influyeron en los resultados obtenidos en la integridad de los registros de mortalidad y, por ende, también en la selección del método más adecuado para estimar la integridad; cuando la población no es estable, ni cerrada, se deben aplicar métodos basados en dos censos con tasas de crecimiento específica y ajuste por migración; si no existe información sobre migración, es recomendable el método de Hill.

Relación de PM2, 5 y Enfermedad Respiratoria Aguda en un territorio de Colombia: Modelos Aditivos Generalizados / Relationship between PM2. 5 and Acute Respiratory Disease in a Colombian region: Generalized Additive Models

Introducción: El efecto deletéreo de material particulado fino exterior sobre la salud respiratoria de la población de niños y de adultos mayores, es de interés en salud pública. Objetivo: Establecer el efecto de la contaminación por Material Particulado de menos de 2,5 μm de diámetro (PM2,5), sobre la Enfermedad Respiratoria Aguda (ERA) en los menores de 5 y personas de mínimo 65 años, ajustado por variables meteorológicas y climáticas, en los municipios del Área Metropolitana del Valle de Aburrá (Colombia), 2008 a 2015. Materiales y métodos: Estudio ecológico con información de la red de vigilancia de calidad del aire y de registros de prestación de servicios de salud. Se construyeron Modelos Aditivos Generalizados con función de enlace Poisson y suavización spline. Para cada rezago distribuido se calculó la medida de la asociación e intervalo de confianza. Resultados: Los casos de ERA aumentaron significativamente en los menores de 5 años en Envigado y Caldas (43,3% vs 29,6%) y en los de 65 y más años, en Medellín (13,2%) por cada incremento de 10 µg/m3 en PM2,5 al día quince a partir de la exposición. Conclusiones: Los eventos diarios respiratorios tuvieron especial frecuencia en Medellín y en municipios de la zona sur.

Introduction: The harmful effect of fine particulate matter on the respiratory health of child and elderly populations is a concern for public health. Objective: To establish the effect of pollution by less than 2.5 μm in diameter (PM2.5) particulate matter on Acute Respiratory Disease (ARD) during 2008-2015 in children younger than 5 and adults older than 65 from the Metropolitan Area of the Aburrá Valley (Colombia), adjusting for meteorological and climate variables. Materials and methods: Ecological study with information from the air quality surveillance network and individual records of health providers. Generalized Additive Models were developed using smoothing spline Poisson models. The assessment of the association and confidence intervals were calculated for each distributed lag. Results: For each 10 µg/m3 increment in PM2,5 and the day 15 post-exposure, ARD cases increased significantly in populations who are younger than 5 and older than 65 in Envigado and Caldas (43.3% vs. 29.6%) and Medellín (13.2%), respectively. Conclusions: Daily respiratory events had a special frequency in Medellín and the municipalities of the southern region.

Supervivencia y factores asociados en pacientes con cáncer cervicouterino atendidas por el Seguro Popular en México / Survival analysis and associated factors in patients with cervical cancer financed by the Seguro Popular in Mexico

Resumen: Objetivo: Estimar la supervivencia a cinco años por cáncer cervicouterino y sus factores asociados en pacientes mexicanas, cuya atención fue financiada por el Fondo de Protección contra Gastos Catastróficos (FPGC) del Seguro Popular durante el periodo 2006-2014. Material y métodos: Se analizó la base de datos de las pacientes mencionadas y se vinculó con el Subsistema Epidemiológico y Estadístico de Defunciones. Se hizo un análisis de supervivencia a cinco años por etapa clínica y factores asociados, mediante el método de Kaplan-Meier y los modelos de riesgos proporcionales de Cox. Resultados: La supervivencia global por cáncer cervicouterino a los cinco años fue de 68.5%. Los factores asociados fueron la etapa clínica (locoregional [HR=2.8 IC95% HR: 2.6,3.0] y metastásica [HR=5.4 IC95% HR: 4.9,5.9]) comparada con la etapa temprana y la edad (HR=1.003 IC95% HR:1.001,1.004). Conclusiones: Las mujeres que lograron el acceso a la atención del cáncer cervical financiadas por el FPGC tuvieron una supervivencia ligeramente superior a las reportadas en otros estudios.

Abstract: Objective: Estimate five-year survival from cervical cancer and associated factors in Mexican patients financed by Seguro Popular during the period 2006-2014. Materials and methods: We analyzed the database of patients financed by the Catastrophic Expenses Protection Fund and linked it to the Statistical and Epidemiological System of mortality. We performed a five-year survival analysis by clinical stage and associated factors, using the Kaplan-Meier method and Cox proportional hazards models. Results: Overall survival for cervical cancer at five years was 68.5%. The associated factors were the clinical stage: locoregional (HR=2.8 CI95% HR: 2.6,3.0) and metastatic (HR=5.4 CI95% HR: 4.9,5.9) compared to early stage and age (HR=1.003 CI95% HR:1.001,1.004). Conclusions: Women who gained access to Catastrophic Expenses Protection Fund cervical cancer care had similar survival than that reported in other studies.

Distribución espacial de la morbimortalidad atribuible a la contaminación del aire por PM2.5 en Medellín (Colombia), 2010-2016

Objetivo: Esta investigación buscó establecer la distribución espacial de la morbimortalidad atribuible a la contaminación del aire ambiental por materia particulada (particulate matter 2.5) (PM2.5) en Medellín entre 2010 y 2016. Metodología: Se planteó un estudio ecológico. Se estandarizaron las direcciones de residencia de los pacientes atendidos y las defunciones por eventos de interés. Se emplearon mapas de calor, mediante el análisis de densidad de Kernel, por núcleos domiciliarios para áreas de 10 000 m2. Resultados: Se encontraron 45 487 y 2743 casos y defunciones, respectivamente, atribuibles a la contaminación del aire ambiental por PM2.5 con datos de localización geográfica. La zona suroccidental de la ciudad presentó las mayores densidades de eventos atribuibles por todas las causas estudiadas y por grupo de eventos, con algunas áreas pequeñas en otros lugares. Por su parte, la zona suroriental, con las mejores condiciones socioeconómicas, manifestó la menor concentración de eventos atribuibles. Conclusión: La información geocodificada de la morbimortalidad por núcleos domiciliarios posibilitó establecer la distribución de casos y muertes atribuibles a la contaminación ambiental del aire por PM2.5 en Medellín, con mayor concentración al suroccidente de la ciudad, lo que permite evidenciar la presencia de disparidades territoriales de este fenómeno.

Objective: This research aimed to establish the spatial distribution of morbidity and mortality attributable to particulate matter (pm2.5) air pollution in Medellín between 2010 and 2016. Methodology: An ecological study was proposed. Addresses of patients treated and deceased due to events of interest were standardized. Heat maps were used, through Kernel density analysis per residential units for areas of 10,000 m2. Results: 45,487 cases and 2,743 deaths attributable to pm2.5 air pollution with geographic location data were found. The southwestern area of the city presented the highest event densities attributable to all causes studied and by group of events, with some small areas in other places. On the other hand, the southeastern area, with the best socio-economic conditions, showed the lowest concentration of attributable events. Conclusion: Geocoded information of morbidity and mortality by residential units made it possible to establish the distribution of cases and deaths attributable to pm2.5 air pollution in Medellín, with a greater concentration in the southwestern part of the city, which makes the presence of territorial disparities in this phenomenon observable.

Objetivo: Esta pesquisa procurou estabelecer a distribuição espacial da morbimortalidade atribuível à poluição do ar ambiental por matéria particulada (particulate matter 2.5) (PM2.5) em Medellín entre 2010 e 2016. Metodologia: Propôs-se uma abordagem ecológica. Padronizaram-se os endereços de residência dos pacientes atendidos e as mortes por eventos de interesse. Empregaram-se mapas de calor, por meio da análise de densidade de Kernel, por núcleos domiciliários para áreas de 10000 m2. Resultados: Acharam-se 45487 e 2743 casos e mortes, respectivamente, atribuíveis à poluição do ar ambiental por PM2.5 com dados de localização geográfica. A zona do sudoeste da cidade apresentou as maiores densidades de eventos atribuíveis por todas as causas estudadas e por grupo de eventos, com algumas áreas pequenas em outros lugares. Por sua parte, a zona do sudeste, com as melhores condições socioeconômicas, manifestou a menor concentração de eventos atribuíveis. Conclusão: A informação geocodificada da morbimortalidade por núcleos domiciliários possibilitou estabelecer a distribuição de casos e mortes atribuíveis à poluição ambiental do ar por PM2.5 em Medellín, com maior concentração no sudoeste da cidade, o que permite evidenciar a presença de disparidades territoriais deste fenômeno

Prevalencia de no resiliencia y factores asociados en escolares de un municipio colombiano, 2019

Objetivo: Determinar la prevalencia de no resiliencia y los factores demográficos, escolares y familiares asociados, en escolares de un municipio colombiano, en el año 2019. Metodología: Estudio trasversal, con muestreo probabilístico estratificado bietápico, con una muestra de 2958 escolares, a los que se les aplicó el cuestionario JJ46. Se calculó la prevalencia de no resiliencia y se relacionó con los factores indicados, mediante intervalos de confianza del 95 %. Además, se construyó una regresión binomial para la no resiliencia, teniendo presente el control de aquellas variables independientes que podrían confundir la relación con el desenlace. Resultados: Se encontró una prevalencia de no resiliencia del 58,4 %, siendo mayor en los hombres, de la zona urbana, que cursaban grado séptimo y que habían vivido algún evento vulnerable, en el 22,0, 29,0, 73,0 y 40,0 % respectivamente, con respecto a las mujeres, de la zona rural, que estaban en grado noveno y que no habían vivido eventos vulnerables. La prevalencia de no resiliencia en los hombres excedió en un 20 % el de las mujeres; y con respecto a la persona que le daba más cariño al escolar, en el 88 % de los casos eran otros familiares distintos a ambos padres. Conclusiones: Urge la necesidad de implementar talleres en los programas educativos sobre la promoción de la resiliencia y realizar una valoración periódica de la misma.

Objective: To determine the prevalence of non-resilience and associated demographic, school, and family factors in schoolchildren in a Colombian municipality in 2019. Methodology: This is a cross-sectional study with twostage stratified probability sampling on a sample of 2,958 schoolchildren to whom the JJ46 questionnaire was administered. We calculated the prevalence of non-resilience and related it to the selected factors using 95% confidence intervals. Moreover, we constructed a binomial regression for non-resilience while controlling the independent variables that could potentially misidentify the relationship with the outcome. Results: A 58.4% prevalence of non-resilience was found, being higher in males (22.0%), from the urban area (29.0%), in the seventh grade (73.0%), and who had experienced some vulnerable event (40.0%), compared to females, from the rural area, in the ninth grade, and who had not experienced vulnerable events. The prevalence of non-resilience in males exceeded that of females by 20%. In 88% of cases, the most affectionate person to the schoolchild was another relative other than the parents. Conclusions: There is an urgent need to implement workshops in school programs for the promotion of resilience and to conduct a periodic assessment of resilience.

Objetivo: Determinar a prevalência de não resiliência e os fatores demográficos, escolares e familiares associados, em escolares de um município colombiano, no ano 2019. Metodologia: Estudo transversal, com amostragem probabilística estratificada bietápica, com uma amostra de 2958 escolares, aos que se aplicou o questionário JJ46. Foi calculada a prevalência de não resiliência e associada com os fatores indicados, por meio de intervalos de confiança do 95%. Além disso, construiu-se uma regressão binomial para a não resiliência, considerando o controle daquelas variáveis independentes que poderiam confundir a relação com o desenlace. Resultados: Achouse uma prevalência de não resiliência de 58,4%, sendo maior nos homens, da zona urbana, que cursavam sétimo grau e que tinham vivido algum evento vulnerável, de 22,0, 29,0, 73,0 e 40,0% respectivamente, em relação com as mulheres, da zona rural, que estavam em nono grau e que não tinham vivido eventos vulneráveis. A prevalência de não resiliência nos homens excedeu em um 20% à das mulheres; e no que tange à pessoa que dava mais carinho ao escolar, 88% dos casos eram outros familiares diferentes a ambos os pais. Conclusões: Urge a necessidade de implementar oficinas nos programas educativos sobre a promoção da resiliência e realizar uma valoração periódica da mesma.

Valoración de la resiliencia en escolarizados: línea base para programas de intervención, Antioquia, 2018 / Assessment of resilience in schoolchildren: baseline for intervention programs, Antioquia, 2018 / Valoração da resiliência em escolarizados: línea base para programas de intervenção, Antioquia, 2018

Resumen Objetivo: determinar los niveles de resiliencia en los estudiantes de 12 a 17 años de las instituciones públicas urbanas de las subregiones del departamento de Antioquia, Colombia. Método: transversal en 2185 estudiantes y en muestras independientes por subregión, a quienes se les aplicó un cuestionario de valoración de la resiliencia en adolescentes, el JJ46. Se calcularon los niveles de resiliencia y se analizó la relación entre estos con características demográfico-familiares y de vulnerabilidad social. Resultados: en Antioquia predominó la resiliencia media, 53,9%. Los escolarizados de las subregiones Oriente, Suroeste y Norte fueron los que obtuvieron los puntajes más altos de resiliencia, con 57,1%, 53,9% y 50,6%, respectivamente, y los de las subregiones Magdalena Medio, Urabá y Bajo Cauca los menores. En el Valle de Aburrá la resiliencia fue media: 44,2%. Conclusiones: diseñar intervenciones en los escolarizados de los municipios de las subregiones con niveles de resiliencia media e inferior.

Abstract Objective: To determine the levels of resilience in students aged 12 to 17 years of urban public institutions in the subregions of the department of Antioquia, Colombia. Method: Cross-sectional study with 2185 students in independent samples by sub-region to whom the JJ46 questionnaire for assessing resilience in adolescents was applied. Resilience levels were calculated and the relationship between these and demographic-family characteristics and social vulnerability was analyzed. Results: the average resilience, 53.9%, prevailed in the Department of Antioquia. Schoolchildren from the East, Southwest and North subregions obtained the highest resilience scores, with 57.1%, 53.9% and 50.6% respectively, and those from the subregions of Magdalena Medio, Urabá and Bajo Cauca obtained the lower scores. In the Aburrá Valley, resilience was average, 44.2%. Conclusions: There is a need to design interventions in schoolchildren of the municipalities of the subregions with medium and lower levels of resilience.

Resumo Objetivo: determinar os níveis de resiliência nos estudantes de 12 a 17 anos das instituições públicas urbanas das sub-regiões do departamento de Antioquia, Colômbia. Método: transversal em 2185 estudantes e em amostras independentes por sub-região, a quem se lhes aplicou um questionario de valoração da resiliência em adolescentes, o JJ46. Calcularam-se os níveis de resiliência e se analisou a relação entre estes com características demográficofamiliares e de vulnerabilidade social. Resultados: em Antioquia predominou a resiliência media, 53,9%. Os escolarizados das sub-regiões Oriente, Sul-oeste e Norte foram os que obtiveram as pontuações mais altas de resiliência, com 57,1%, 53,9% e 50,6%, respectivamente, e os das sub-regiões Magdalena Médio, Urabá e Baixo Cauca os menores. No Vale de Aburrá a resiliência foi media: 44,2%. Conclusões: desenhar intervenções nos escolarizados dos municípios das sub-regiões com níveis de resiliência media e inferior.

Años de vida saludable perdidos a causa de trastornos mentales y enfermedades del sistema nervioso de la población de Medellín, 2006-2012 / Disability-Adjusted Life Years Due to Mental Disorders and Diseases of the Nervous System in the Population of Medellin, 2006-2012

RESUMEN Objetivo: Determinar la pérdida de años de vida saludables (AVISA) por trastornos mentales y enfermedades del sistema nervioso en Medellín, de 2006 a 2012. Métodos: Estudio descriptivo, con fuente de información secundaria bajo lineamientos teóricos del Estudio la Carga Global de la Enfermedad (CGE). Para calcular los Años Potenciales de Vida Perdidos (APVP), se empleó información de las estadísticas vitales; para los Años de Vida Ajustados por Discapacidad (AVD), la de morbilidad de los Registros Individuales de Prestación de Servicios de Salud (RIPS), de consulta externa y otras investigaciones. Los AVISA se obtuvieron de sumar los APVP y AVD. Resultados: En Medellín, durante el septenio, de 1.242.407 AVISA por trastornos mentales y enfermedades del sistema nervioso, la mayor carga se debió a discapacidad (99,39%). Las mujeres aportaron más AVISA (70,22%). El 81% de los AVISA se concentraron en el grupo de 15 a 59 años. Los trastornos que mayor carga representaron fueron, en este orden, el trastorno depresivo unipolar (81%), el Alzheimer y otras demencias (4,82%), la esquizofrenia (3,45%) y los trastornos por consumo de drogas (2,78%). Conclusiones: Se sustenta un importante incremento de la carga de la enfermedad por trastornos mentales y enfermedades del sistema nervioso, lo que debe llamar la atención de los tomadores de decisiones sobre la política pública del municipio, ya que estos problemas de salud pueden significar un gran aumento en los costos de atención en salud.

ABSTRACT Objective: To determine the healthy life years (HLY) lost as a result of mental disorders and nervous system diseases in Medellin from 2006 to 2012. Methods: Descriptive study using a secondary information source according to the Global Burden of Disease (GBD) framework. To calculate the years of potential life lost (YPLL), we used vital statistics data; to calculate disability-adjusted life years (DALY), we used morbidity data from individual records managed by health service providers, outpatient clinics and other research studies. HLY are the sum of YPLL and DALY. Results: In Medellin, from 2006 to 2012, out of 1,242,407 HLY related to mental disorders and nervous system diseases, the vast majority (99.39%) were due to disability. Most HLY were found in females (70.22%) and 81% were found in people aged 15 to 59. The disorders representing the greatest burden were unipolar depressive disorder (81%), Alzheimer's disease and other types of dementia (4.82%), schizophrenia (3.5%) and drug use disorders (2.78%). Conclusions: Our results indicate a significant increase in the disease burden due to mental disorders and nervous system diseases. Public policy decision-makers in the city of Medellin should take note, as health problems of this type can result in a substantial rise in healthcare costs.

Calidad de vida relacionada con la salud en niños, niñas y adolescentes, municipios El Líbano y Honda (Tolima), 2018 / Quality of life in relation to health in children and adolescents, El Líbano and Honda (Tolima) municipalities, 2018 / Qualidade de vida relacionada com a saúde de crianças e adolescentes, municípios El Líbano e Honda (Tolima), 2018

Resumen Objetivo: Determinar la calidad de vida relacionada con la salud (cvrs) en niñas, niños y adolescentes entre 8 y 18 años, vinculados a la modalidad hogar sustituto-vulneración, en los municipios de El Líbano y Honda, del departamento de Tolima. Metodología: Estudio de corte, en una muestra no aleatoria de 77 niñas, niños y adolescentes, de 35 hogares sustitutos, a quienes se les aplicó el kidscreen-52, constituido por ocho dimensiones que puntúan en sentido positivo (autopercepción, autonomía, relación con los padres y vida familiar, sentimientos, recursos económicos, actividad física y salud, amigos y apoyo social, y entorno escolar) y dos con sentido negativo (estado de ánimo y aceptación social). Para la estimación del índice global de cvrs (igcvrs), se utilizó el kidscreen-10. Resultados: La media del igcvrs fue de 69,9 puntos (desviación estándar = 18,2). Cuando se cotejó el puntaje promedio del igcvrs con el de las dimensiones, la "aceptación social", los "sentimientos", el "entorno escolar" y la "autopercepción" alcanzaron, como mínimo, el puntaje promedio del igcvrs, en contraste con los puntajes de las dimensiones "actividad física y salud", "vida familiar", "estado de ánimo", "amigos", "autonomía" y "dinero". El 46,8 % valoró excelente su estado de salud, y el 9,1 %, regular. Conclusión: Es útil implementar una valoración basada en el perfil de vulnerabilidad-generatividad familiar y elaborar un perfil de la niña, del niño o de la o el adolescente, teniendo en cuenta sus dificultades y problemáticas psicosociales, lo que mejorará los procesos de autonomía, estado de ánimo, vida familiar, autopercepción y apoyo social.

Abstract Objective: To determine the quality of life related to health (CVRS) in girls, boys and adolescents between 8 and 18 years old, linked to home substitution-violation, in the municipalities of El Líbano and Honda in the department of Tolima. Methodology: A cross-sectional study in a non-random sample of 77 girls, boys and adolescents from 35 foster homes, to whom KIDSCREEN-52 was applied, consisting of eight dimensions that score positively (self-perception, autonomy, relationship with parents and family life, feelings, financial resources, physical activity and health, friends and social support, and school environment) and two negatively (mood and social acceptance). The KIDSCREEN-10 was used for the estimation of the overall CVRS index (IGCVRS). Results: The mean of the IGCVRS was 69.9 points (standard deviation = 18.2). When the average IGCVRS score was compared with that of the dimensions, "social acceptance", "feelings", "school environment" and "self-perception" reached, as a minimum, the average IGCVRS score, in contrast to the scores of the "physical activity and health", "family life", "state of mind", "friends", "autonomy" and "money" dimensions. 46.8% rated their health status as excellent, and 9.1%, fair. Conclusion: It is useful to implement assessment based on the family vulnerability-generativity profile and create a profile for the girl, boy or adolescent, taking into account their psychosocial difficulties and problems, which will improve the processes of autonomy, state of encouragement, family life, self-perception and social support.

Resumo Objetivo: Determinar a qualidade de vida relacionada com a saúde (CVRS) em crianças e adolescentes entre 8 e 18 anos, vinculados à modalidade lar substituto-vulnerabilidade, nos municípios de El Líbano e Honda, no estado de Tolima. Metodologia: Estudo de corte, numa amostra não aleatória de 77 crianças e adolescentes de 35 lares substitutos, a qual foi aplicada o KIDSCREEN-52, constituído por oito dimensões que marcam em sentido positivo (autopercepção, autonomia, relação com os pais e a vida familiar, sentimentos, recursos econômicos, atividade física e saúde, amigos e apoio social e ambiente escolar) e duas com sentido negativo (estado de ânimo e aceitação social). Para a estimativa do índice global de CRVS (IGCVRS) utilizou-se o KIDSCREEN-10. Resultados: A média do IGCVRS foi de 69,9% pontos (desvio padrão = 18,2). Quando a pontuação média do IGCVRS foi verificada com a pontuação das dimensões, (aceitação social, sentimentos, ambiente escolar e autopercepção), atingiram como mínimo a pontuação média do IGCVRS, contrastando com as pontuações das dimensões (atividade física e saúde, vida familiar, estado de ânimo, amigos, autonomia e dinheiro). Um total de 46,8% avaliou como excelente seu estado de saúde e 9,1% como regular. Conclusão: É útil programar uma avaliação baseada no perfil de vulnerabilidade-geratividade familiar e elaborar um perfil da criança ou do adolescente, considerando suas dificuldades e problemas psicossociais, o que pode melhorar os processos de autonomia, estado de ânimo, vida familiar, autopercepção e apoio social.

Completitud de los reportes de mortalidad en el sistema de estadísticas vitales en la Orinoquía colombiana, 2017 / Completeness of mortality reports in the vital statistics system in the Colombian Orinoquia, 2017

RESUMEN Objetivo Estimar la integridad, en términos de completitud, de los registros de mortalidad en el sistema de información de estadísticas vitales de la Orinoquía colombiana y sus departamentos. Metodología Se realizó un estudio descriptivo, con fuente de información secundaria, procedente de los registros de defunciones no fetales reportados en los sistemas de estadísticas vitales de cada departamento. Se usaron métodos de distribución de la mortalidad de Brass, de Preston Coale, de Hill y de Bennet-Hourichi para estimar la integridad de los registros. Resultados Se encontró completitud en los registros de mortalidad de mujeres y hombres (≥95%) en Meta, y en los hombres de la Orinoquía y Arauca (≥95%), en contraste con los registros del resto de unidades territoriales, donde se presenta subregistro. Conclusiones Tanto la dinámica demográfica como la migración influyeron en los resultados obtenidos en la integridad de los registros de mortalidad y, por ende, también en la selección del método más adecuado para estimar la integridad; cuando la población no es estable, ni cerrada, se deben aplicar métodos basados en dos censos con tasas de crecimiento específica y ajuste por migración; si no existe información sobre migración, es recomendable el método de Hill.(AU)

ABSTRACT Objective Estimate the integrity, in terms of completeness, of the mortality records in the vital statistics information system of the Orinoquia and its departments. Methodology A descriptive study was carried out, with a secondary source of information, from the records of non-fetal deaths reported in the vital statistics systems of each department, using methods of distribution of the mortality of Brass, Preston-Coale, Hill and Bennet-Hourichi to estimate the integrity of the records. Results Completeness was found in the mortality records of women and men (≥95%) in Meta, and in the men of Orinoquia and Arauca (≥95%), in contrast to the records of the rest of the territorial units, where under-registration is presented. Conclusions Both demographic dynamics and migration influenced the results obtained from the integrity of the mortality records, therefore, also in the selection of the most appropriate method to estimate integrity; when the population is neither stable nor closed, methods based on two censuses with specific growth rates and migration adjustment should be applied; if there is no information on migration, the Hill method is recommended.(AU)

Prevalencia de depresión en soldados regulares de un batallón de una ciudad colombiana, 2017 / Depression prevalence in regular soldiers in a Colombian infantry battalion in 2017

Resumen Objetivo: Determinar la prevalencia de depresión y de sus dimensiones en soldados de un batallón colombiano. Métodos: Estudio transversal en 410 soldados a quienes se les aplicó un cuestionario de depresión. Se calcularon las prevalencias para cada dominio y para la depresión en general y la asociación con factores de interés. Resultados: La prevalencia de depresión fue del 8,8%; las prevalencias de los dominios fueron: 11,7% para la autoestima negativa, 24,6% para la ideación suicida, 56,8% para pobre imagen social, 26,3% para afecto negativo, 23,4% para desesperanza y 19,3% para evitación. Conclusión: Refinar los procedimientos de tamizaje en salud mental en el proceso de selección de los jóvenes soldados, para que sean desacuartelados aquellos aspirantes propensos a la depresión.

Abstract Objective: To determine the prevalence of depression and its dimensions in soldiers in a Colombian battalion. Method: This cross-sectional study was conducted to 410 soldiers; a questionnaire about depression issues was used to interview them. The prevalence of depression was analyzed in general and specific terms. Addiotionally, some factors of interest that are associated with it were studied too. Result: In general terms, the depression prevalence was 8,8%. On the other hand, the prevalence of the depression dimensions was: 11,7% for negative self-esteem, 24,6% for suicidal thoughts, 56,8% for poor social image perception, 26,3% for negative affect, 23, 4% for helplessness, and 19,3% for avoidance tendencies. Conclusion: To conclude, it is necessary to improve the selection criteria in order to analyze the soldiers' mental health and, in this way, not to choose the candidates with depressive tendencies.

Prevalencia del consumo de sustancias psicoactivas y factores relacionados en soldados regulares adscritos a un batallón de una ciudad colombiana

Objetivo: Calcular la prevalência del consumo de Sustancias Psicoactivas (SPA y su relación con factores personales, demográficas, lúdicas y familiares en soldados adscritos a un batallón de una ciudad colombiana. Método: Estudio cross sectional en una muestra de 384 soldados a los cuales se aplicó el instrumento ASSIST. Se realizó un análisis descriptivo y se calculó la prevalencia de SPA en la vida y a los tres meses, con sus respectivos intervalos de confianza (IC) del 95 %. Se determinó la asociación del desenlace con factores plausibles, por medio de la razón de prevalencias y sus respectivos IC del 95 %. Se construyeron modelos de regresión binomial simple y múltiple y regresión binomial negativos (cálculo de índice-Rate Rations (IRR)) y se calculó la prueba exacta de Fisher. Para determinar las variables candidatas a ingresar al modelo ajustado, se aplicó el criterio de Hosmer-Lemeshow. Resultados: La prevalencia de consumo de SPA en la vida fue del 73,7 % con predominio del consumo de bebidas alcohólicas 58,6 %, del tabaco, 47,9 %, cannabis, 41,1 %, y cocaína, 16,4 %. La prevalencia de consumo de SPA en los últimos tres meses fue del 48,4 %, con hegemonía del tabaquismo, 33,1 %. Conclusiones: El consumo de sustancias psicoactivas es una problemática que debe abordarse desde el factor humano y la gestión social en cualquier organización en general y en particular en el ejército colombiano. Se deben revisar los protocolos de inserción de los soldados regulares que conduzcan a minimizar la incorporación de ciudadanos que consuman sustancias psicoactivas.

Objective: To calculate the prevalence of Psychoactive Substances Abuse and its relationship with personal, demographic, recreational, and family factors in soldiers assigned to a battalion of a Colombian city. Method: Cross-sectional study in a sample of 384 soldiers who were applied the ASSIST test. A descriptive analysis was performed, and the prevalence of PAS was calculated in life and at three months, with their respective 95% confidence intervals (CI). The association of the outcome with plausible factors was determined, using the prevalence ratio and their respective 95% CI. Simple and multiple binomial regression models and negative binomial regression were constructed (calculation of the Index-Rate Rations (IRR)) and the Fisher's exact test was calculated. To determine the variables to adjust the model, the Hosmer-Lemeshow criterion was applied. Results: The prevalence of PAS use in life was 73.7% with a predominance of drug use or alcoholic beverages 58.6%, tobacco 47.9%, cannabis 41.1%, and cocaine 16.4%. The prevalence of PAS use in the last three months was 48.4%, with the prevalence of smoking being 33.1%. Conclusions: The consumption of psychoactive substances is a problem that must be approached from the human factor and social management in any organization, in general, and, particularly, in the Colombian army. The insertion protocols of regular soldiers should be reviewed to minimize the incorporation of citizens who consume psychoactive substances.

Prevalencia del consumo de sustancias psicoactivas y factores relacionados en soldados regulares adscritos a un batallón de una ciudad colombiana / Prevalence of psychoactive substance use and related factors in regular soldiers attached to a battalion in a Colombian city / Prevalência do consumo de substâncias psicoactivas e factores relacionados em soldados regulares afectos a um batalhão numa cidade colombiana

Objetivo: Calcular la prevalencia del consumo de Sustancias Psicoactivas (SPA y su relación con factores personales, demográficas, lúdicas y familiares en soldados adscritos a un batallón de una ciudad colombiana. Método: estudio cross sectional en una muestra de 384 soldados a los cuales se aplicó el instrumento ASSIST. Se realizó un análisis descriptivo y se calculó la prevalencia de SPA en la vida y a los tres meses, con sus respectivos intervalos de confianza (IC) del 95%, se determinó la asociación del desenlace con factores plausibles, por medio de la razón de prevalencias y sus respectivos IC del 95%, se construyeron modelos de regresión binomial simple y múltiple y regresión binomial negativos (cálculo de índice-Rate Rations (IRR)) y se calculó la prueba exacta de Fisher. Para determinar las variables candidatas a ingresar al modelo ajustado se aplicó el criterio de Hosmer-Lemeshow. Resultados: La prevalencia de consumo de SPA en la vida fue del 73,7% con predominio del consumo de bebidas alcohólicas 58,6%, del tabaco, 47,9%, cannabis, 41,1%, y la cocaína, 16,4%. La prevalencia de consumo de SPA en los últimos tres meses fue del 48,4%, con hegemonía del tabaquismo, 33,1%. Conclusiones: la alta prevalencia en el consumo de SPA se convierte en una preocupación exclusiva del ejército nacional, donde se contempla que el consumo de drogas ayuda a resistir las difíciles condiciones que se afrontan en medio del conflicto, y que los principales factores de riesgo son tener amigos o superiores que consumen y la disfuncionalidad familiar.

Objective: To calculate the prevalence of Psychoactive Substances (PAS) use and its relationship with personal, demographic, recreational and family factors in soldiers attached to a battalion in a Colombian city. Method: cross sectional study in a sample of 384 soldiers to whom the ASSIST instrument was applied. A descriptive analysis was carried out and the prevalence of PAS in life and at three months was calculated, with their respective 95% confidence intervals (CI), the association of the outcome with plausible factors was determined by means of the prevalence ratio and their respective 95% CI, simple and multiple binomial regression and negative binomial regression models were constructed (calculation of the index-Rate Rations (IRR)) and Fisher's exact test was calculated. The Hosmer-Lemeshow criterion was applied to determine the candidate variables to be included in the adjusted model. Results: Lifetime prevalence of PAS use was 73.7%, with a predominance of alcoholic beverages (58.6%), tobacco (47.9%), cannabis (41.1%), and cocaine (16.4%). The prevalence of PAS consumption in the last three months was 48.4%, with smoking predominating, 33.1%. Conclusions: the high prevalence of PAS consumption becomes an exclusive concern of the national army, where it is considered that drug consumption helps to resist the difficult conditions faced in the midst of the conflict, and that the main risk factors are to have

Objetivo: Calcular a prevalência do consumo de Substâncias Psicoactivas (SPA) e a sua relação com factores pessoais, demográficos, recreativos e familiares em militares afectos a um batalhão de uma cidade colombiana. Método: estudo transversal numa amostra de 384 militares aos quais foi aplicado o instrumento ASSIST. Realizou-se uma análise descritiva e calculou-se a prevalência de PAS na vida e aos três meses, com os respectivos intervalos de confiança (IC) a 95%, determinou-se a associação do desfecho com factores plausíveis através da razão de prevalência e respectivos IC a 95%, construíram-se modelos de regressão binomial simples e múltipla e de regressão binomial negativa (cálculo das Razões de Taxa de Indexação (IRR)) e calculou-se o teste exato de Fisher. O critério de Hosmer-Lemeshow foi aplicado para determinar as variáveis candidatas a entrar no modelo ajustado. Resultados: A prevalência de uso de SPA na vida foi de 73,7%, com predomínio de bebidas alcoólicas 58,6%, tabaco 47,9%, cannabis 41,1% e cocaína 16,4%. A prevalência do uso de SPA nos últimos três meses foi de 48,4%, com predomínio do tabagismo, 33,1%. Conclusões: A elevada prevalência do consumo de SPA tornou-se uma preocupação exclusiva do exército nacional, onde se considera que o consumo de drogas ajuda a suportar as difíceis condições enfrentadas no meio do conflito e que os principais factores de risco são ter