Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm.

BACKGROUND: Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. OBJECTIVES: To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. METHODS: We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. RESULTS: Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. CONCLUSIONS: We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.

[Validation of the Spanish version of the Primary Care Assessment Survey questionnaire]. / Validación de la versión en español del cuestionario PCAS para evaluar la atención primaria de salud.

OBJECTIVE: Adapt the Primary Care Assessment Survey (PCAS) questionnaire to the Spanish language and determine its validity and reliability in identifying strengths and weaknesses in primary health care (PHC). METHODS: Study of the adaptation and validation of a questionnaire-survey. The suitable sample selected was 244 users of PHC services. The users were over 18 years of age and had had at least two institutional visits prior to being included in the study. The variables used were access, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment, and trust. Participation was confirmed through analysis of the distribution of responses; participation and patterns of nonresponse; the construct, through exploratory factorial analysis, using principal component analysis and the varimax rotation; the criterion, through the Pearson product-moment correlation coefficient; and reliability using Cronbach's alfa and the intraclass correlation coefficient. RESULTS: The exploratory factorial analysis obtained 11 factors that explain 68.38% of the original variability. The criterion validity showed a sufficient correlation between the summary measure of the scale and the ad hoc variables Q33b (value of r x1x2 = 0.569; P = 0.01) and Q32 (value of r x1x2 = 0.600; P = 0.01). The scale obtained a coefficient of Cronbach's alfa of 0.94. The test-retest reliability (F [1 140] = 0.155 [P = 0.694]) demonstrated that the scale is stable over time. CONCLUSIONS: The psychometric properties of the adapted version of the PCAS questionnaire make it possible to state that it is a valid and reliable scale to evaluate primary care from a standpoint of ongoing care based on the physician-patient relationship.

Impact of health-related quality of life on pediatric patients who underwent hematopoietic stem cell transplantation in a Colombian institution / Impacto de la calidad de vida relacionada a la salud en pacientes pediátricos con trasplante de progenitores hematopoyéticos en una institución colombiana.

Introduction: Hematopoietic stem cell transplantation is the curative option for some diseases and is increasing patient survival. The health-related quality of life in these patients is not systematically evaluated. Objectives: The present study sought to describe the health-related quality of life and complications in children who underwent hematopoietic stem cell transplantation. Materials and methods: A cross-sectional study was conducted on pediatric transplanted survivors. Health-related quality of life was measured using the KIDSCREEN-27 scale and Short Form-12 (SF-12) in patients between 8 and 14 years of age and those over 14 years, respectively. Statistical analysis was performed using STATA 12 software. We used the Rasch model person parameter estimates translated into T-values to score the questionnaire. Results: A total of 42 children answered the questionnaires. The most frequent adverse events were chronic graft Vs. host disease and endocrine complications. According to European norm data in the KIDSCREEN-12 scale, scores for the school dimension and social and peer support were below the 50th. percentile. The group administered immunosuppressants had lower scores on the physical component of the SF-12™ scale. Conclusions: In general, the KIDSCREEN-27 does appear to suggest some quality-of-life deficit in younger children. The scales showed reliability in this population.

Introducción. El trasplante de células madre hematopoyéticas es la opción curativa para algunas enfermedades y está aumentando el tiempo de supervivencia de los pacientes. La calidad de vida relacionada con la salud en estos pacientes no se evalúa de manera sistemática. Objetivos. Describir la calidad de vida relacionada con la salud y las complicaciones en niños con trasplante de células madre hematopoyéticas. Materiales y métodos. Es un estudio transversal en pacientes pediátricos sobrevivientes al trasplante. Se midió la calidad de vida relacionada con la salud, utilizando el cuestionario KIDSCREEN-27 en pacientes entre 8 y 14 años y la SF-12™ (Short Form-12) en pacientes mayores de 14 años. El análisis estadístico se realizó en el software Stata 12. Utilizamos el modelo de Rasch, trasladando estimación de parámetros a valores t para obtener el resultado de los cuestionarios. Resultados. En total, 42 pacientes respondieron alguno de los cuestionarios. Los eventos adversos más frecuentes fueron "enfermedad crónica de injerto Vs. contra huésped" y "complicaciones endocrinas". De acuerdo con la normalidad de datos del KIDSCREEN-27, los puntajes de las dimensiones "ambiente escolar" y "soporte social y pares" fueron inferiores al percentil 50. En el cuestionario SF-12™, el grupo que utilizaba inmunosupresores tuvo un menor puntaje en el componente físico. Conclusiones. En general, los resultados del KIDSCREEN-27 sugieren un cierto déficit de calidad de vida en pacientes entre 8 y 14 años. Los cuestionarios mostraron confiabilidad en la muestra.

[Depressive Symptoms and Psychosocial Risk Factors in High Complexity Obstetric Patients Admitted to a Critical Care Obstetric Unit in Cali, Colombia]. / Detección de síntomas depresivos en mujeres gestantes de alta complejidad obstétrica y factores correlacionados.

Depression is the main cause of years lossed due to disability in the world, and it affects 50% more women 50% than men. Perinatal depression has been linked with more anxiety, a chronic course, and disability than depression in other life stages. In spite of its high prevalence and serious health effects on both mother and foetus, it is frequently under-diagnosed. This study was performed on all high risk obstetric patients admitted to a critical care obstetric unit in Cali, Colombia, from January to June, 2014. Depressive symptoms and psychosocial risk factors were screened by means of a survey and the Edinburgh Prenatal Depression Scale (EPDS). A total of 695 women were included, of whom 30.2% had depressive symptoms on the EPDS, and 3.6% reported having self-injury thoughts in the last 7 days. Our findings are consistent with previous reports on a history of child abuse and family depression as risk factors. It was also suggested that lower socio-economic status is associated with more vulnerability. Early screening is needed to ensure timely detection and treatment.

Impacto de la calidad de vida relacionada a la salud en pacientes pediátricos con trasplante de progenitores hematopoyéticos en una institución colombiana / Impact of health-related quality of life on pediatric patients who underwent hematopoietic stem cell transplantation in a Colombian institution

Introducción. El trasplante de células madre hematopoyéticas es la opción curativa para algunas enfermedades y está aumentando el tiempo de supervivencia de los pacientes. La calidad de vida relacionada con la salud en estos pacientes no se evalúa de manera sistemática. Objetivos. Describir la calidad de vida relacionada con la salud y las complicaciones en niños con trasplante de células madre hematopoyéticas. Materiales y métodos. Es un estudio transversal en pacientes pediátricos sobrevivientes al trasplante. Se midió la calidad de vida relacionada con la salud, utilizando el cuestionario KIDSCREEN-27 en pacientes entre 8 y 14 años y la SF-12™ (Short Form-12) en pacientes mayores de 14 años. El análisis estadístico se realizó en el software Stata 12. Utilizamos el modelo de Rasch, trasladando estimación de parámetros a valores t para obtener el resultado de los cuestionarios. Resultados. En total, 42 pacientes respondieron alguno de los cuestionarios. Los eventos adversos más frecuentes fueron "enfermedad crónica de injerto Vs. contra huésped" y "complicaciones endocrinas". De acuerdo con la normalidad de datos del KIDSCREEN-27, los puntajes de las dimensiones "ambiente escolar" y "soporte social y pares" fueron inferiores al percentil 50. En el cuestionario SF-12™, el grupo que utilizaba inmunosupresores tuvo un menor puntaje en el componente físico. Conclusiones. En general, los resultados del KIDSCREEN-27 sugieren un cierto déficit de calidad de vida en pacientes entre 8 y 14 años. Los cuestionarios mostraron confiabilidad en la muestra.

Introduction: Hematopoietic stem cell transplantation is the curative option for some diseases and is increasing patient survival. The health-related quality of life in these patients is not systematically evaluated. Objectives: The present study sought to describe the health-related quality of life and complications in children who underwent hematopoietic stem cell transplantation. Materials and methods: A cross-sectional study was conducted on pediatric transplanted survivors. Health-related quality of life was measured using the KIDSCREEN-27 scale and Short Form-12 (SF-12) in patients between 8 and 14 years of age and those over 14 years, respectively. Statistical analysis was performed using STATA 12 software. We used the Rasch model person parameter estimates translated into T-values to score the questionnaire. Results: A total of 42 children answered the questionnaires. The most frequent adverse events were chronic graft Vs. host disease and endocrine complications. According to European norm data in the KIDSCREEN-12 scale, scores for the school dimension and social and peer support were below the 50th. percentile. The group administered immunosuppressants had lower scores on the physical component of the SF-12™ scale. Conclusions: In general, the KIDSCREEN-27 does appear to suggest some quality-of-life deficit in younger children. The scales showed reliability in this population.

Prevalência de depresión mayor en pacientes con preeclampsia en una clínica de cuarto nivel en Cali, Colombia / Prevalence of mayor depression in patients with preeclampsia in a fourth level clinic in Cali, Colombia

Resumen Objetivo: Determinar la frecuencia de episodio de depresión mayor y caracterizar la funcionalidad familiar y apoyo social en embarazadas con diagnóstico de preeclampsia y hospitalizadas en la unidad de alto riesgo obstétrico de la Clínica Valle del Lili, desde diciembre de 2015 hasta mayo de 2016. Materiales y métodos: Estudio descriptivo transversal en 50 pacientes hospitalizadas. Se utilizó la Escala de depresión postnatal de Edimburgo para evaluar la presencia de síntomas depresivos y se tomó como valor de referencia 13 o más puntos, y la Mini Entrevista Neuropsiquiatrica Internacional en su apartado de "episodio depresivo mayor" para hacer el diagnóstico de episodio de depresión mayor. Resultados: La media de edad fue de 28,1 ± 6,7 años y edad gestacional promedio de 34 semanas. La prevalencia de síntomas depresivos fue del 26 % y de depresión mayor fue del 20 %. El 66 % de las pacientes cursó con preeclampsia severa. Conclusiones: Una de cada cinco pacientes presentó episodio depresivo mayor. Los hallazgos concuerdan con lo reportado en la literatura y sugieren que es una condición frecuente en esta población.

Abstract Objective: To determine the frequency of episodes of major depression and to characterize family functionality and social support in pregnant women diagnosed with preeclampsia hospitalized in the unit of high obstetric risk in Clinica Valle del Lili in Cali - Colombia, from December 2015 to May 2016. Materials and methods: Cross-sectional descriptive study in 50 hospitalized patients. The Postnatal Depression Scale of Edinburgh was used to evaluate the presence of depressive symptoms and 13 or more points were taken as a reference value, and the Mini International Neuropsychiatric Interview in its section of major depressive episode to make the diagnosis of major depression episode. Results: Mean age was 28.1 ± 6.7 years and average gestational age was 34 weeks. The prevalence of depressive symptoms was 26% and major depression was 20%. 66% of the patients had severe preeclampsia. Conclusions: one in five patients presented major depressive episode. The findings agree with what is reported in the literature and suggest that it is a frequent condition in this population.

Detección de síntomas depresivos en mujeres gestantes de alta complejidad obstétrica y factores correlacionados / Depressive Symptoms and Psychosocial Risk Factors in High Complexity Obstetric Patients Admitted to a Critical Care Obstetric Unit in Cali, Colombia

RESUMEN La depresión es la principal causa de arios perdidos por discapacidad en el mundo, y en mujeres la carga de la enfermedad es un 50% mayor que en varones. La depresión perinatal tiene mayor asociación con ansiedad, cronicidad y discapacidad que en otras etapas de la vida y es poco reconocida a pesar de su alta prevalencia y sus graves efectos en la salud de la madre y el feto. Se realizó un estudio en pacientes ingresadas y valoradas en una unidad de alto riesgo obstétrico en el proceso de implementación del programa durante los meses de enero a junio de 2014; se utilizaron la Edinburgh Prenatal Depression Scale (EPDS) y un cuestionario previamente desarrollado para identificar la presencia de síntomas depresivos y factores de riesgo psicosocial. Se evaluó sistemáticamente a más de 600 mujeres, y se encontró que el 30,2% de las mujeres evaluadas tenían síntomas depresivos según la EPDS y el 3,6% había tenido ideas de autolesión en los últimos 7 días. Los factores relacionados evaluados indican una condición de vulnerabilidad de las mujeres con menor nivel socioeconómico. Los datos encontrados reiteran la importancia de detectar factores que tradicionalmente el personal de salud no identifica ni interviene a lo largo de la vida y particularmente durante la gestación.

ABSTRACT Depression is the main cause of years lossed due to disability in the world, and it affects 50% more women 50% than men. Perinatal depression has been linked with more anxiety, a chronic course, and disability than depression in other life stages. In spite of its high prevalence and serious health effects on both mother and foetus, it is frequently under-diagnosed. This study was performed on all high risk obstetric patients admitted to a critical care obstetric unit in Cali, Colombia, from January to June, 2014. Depressive symptoms and psychosocial risk factors were screened by means of a survey and the Edinburgh Prenatal Depression Scale (EPDS). A total of 695 women were included, of whom 30.2% had depressive symptoms on the EPDS, and 3.6% reported having self-injury thoughts in the last 7 days. Our findings are consistent with previous reports on a history of child abuse and family depression as risk factors. It was also suggested that lower socio-economic status is associated with more vulnerability. Early screening is needed to ensure timely detection and treatment.

Factores relacionados con la carga de discapacidad en personas con intento de suicidio, atendidas en la red pública de servicios de salud de Santiago de Cali / Factors related to the disability burden in people with suicidal attempts attended in the public health care service network of Santiago de Cali

Introducción: Según la Organización Mundial de la Salud, las secuelas del intento de suicidio constituyen la sexta causa de mala salud y discapacidad en el mundo. Objetivo: Establecer los grados de discapacidad y sus factores relacionados, en términos de restricciones en la participación y limitaciones en la actividad, en personas con intento de suicidio entre septiembre del 2009 y junio del 2010, atendidas en la Red Pública de Servicios de Salud de Santiago de Cali. Método: Estudio observacional de corte transversal en 126 personas con intento de suicidio, con edades entre 15 y 65 años. Se empleó la versión en español de la Escala de Evaluación de Discapacidad de la Organización Mundial de la Salud. Resultados: Se calcularon 30 años de vida ajustados en función de la discapacidad (AVAD), se estimó una prevalencia del 95,3 % de discapacidad. El 4,6 % de la muestra no presenta discapacidad; el 41,27 %, discapacidad leve; el 38,1 %, discapacidad moderada, y el 15,87 %, discapacidad severa. Los factores relacionados con discapacidad fueron: edad, ocupación, presencia de enfermedad mental, presencia de síntomas depresivos actuales, métodos fatales, consumo de medicamentos psiquiátricos, limitaciones en la actividad, restricciones en la participación y no práctica religiosa. Conclusiones: La prevalencia de discapacidad en personas con intento de suicidio atendidas en la Red Pública de Servicios de Salud de Santiago de Cali fue del 95,3 %. Los resultados son acordes con el estudio de carga mundial de enfermedad que establece una alta carga para trastornos mentales asociados a intento de suicidio. La presencia de una deficiencia posterior al intento de suicidio incrementa la carga de discapacidad.

Introduction: According to the World Health Organization (WHO), the aftermaths of suicide attempts are the sixth leading cause of poor health and disability in the world. Object: Establish the level of disability and related factors in terms of restrictions regarding participation and activity limitations in cases of suicidal attempts attended by the Public Service Network Health of Santiago de Cali, from September 2009 to June 2010. Methodology: A cross-section, observational study was applied to 126 people between 15 and 65 who had attempted suicide and were treated at the Public Health Service in Santiago de Cali. A Spanish version of the Disability Assessment Scale of the World Health Organization Results: 30 disability-adjusted life years (DALYs) were calculated together with a disability prevalence of 95.3%. 4.6% of the sample did not show disability while 41.27% had mild disability, 38.1%, moderate disability, and 15.87%, severe disability. Factors related with disability were: Age, occupation, presence of mental illness, current depressive symptoms, lethal methods, use of psychiatric drugs, activity limitations, participation restrictions and lack of religious practice. Conclusions: The prevalence of disability in people who have committed suicidal attempts treated at the public health services in Santiago de Cali, was 95.3%. The results are consistent with the study of global burden of disease that establishes a high score for mental disorders in suicidal attempts. The presence of a deficiency after the suicide attempt increases the burden of disability.

Validación de la versión en español del cuestionario PCAS para evaluar la atención primaria de salud / Validation of the Spanish version of the Primary Care Assessment Survey questionnaire

OBJETIVO: Adaptar el cuestionario PCAS (del inglés Primary Care Assessment Survey) al idioma español y determinar su validez y su fiabilidad cuando se trata de identificar las debilidades y las fortalezas que se observan en la atención primaria de salud (APS). MÉTODOS: Estudio de adaptación y validación de un cuestionario-encuesta. Se seleccionó una muestra por conveniencia de 244 usuarios de servicios de APS, mayores de 18 años y con al menos dos visitas institucionales al momento de ser incluidos en el estudio. Se utilizaron las variables: accesibilidad, continuidad, integralidad, integración, interacción clínica, trato interpersonal y confianza. Se validaron la apariencia, mediante análisis de distribución de las respuestas, análisis de participación y patrones de no respuesta; el constructo, mediante análisis factorial exploratorio usando el método de componentes principales y rotación Varimax; el criterio, mediante el coeficiente de correlación de Pearson, y la fiabilidad, usando el alfa de Cronbach y el coeficiente de correlación intraclase. RESULTADOS: En el análisis factorial exploratorio se obtuvieron 11 factores que explicaron 68,38 por ciento de la variabilidad original. La validez de criterio mostró una correlación adecuada entre la medida resumen de la escala y las variables "ad hoc" Q33b (valor de r×1×2 = 0,569; P = 0,01) y Q32 (valor de r×1×2 = 0,600; P = 0,01). La escala obtuvo un coeficiente de alfa de Cronbach de 0,94. La fiabilidad test-retest (F [1,140] = 0,155 [P = 0,694]) demostró que la escala es estable en el tiempo. CONCLUSIONES: Las propiedades psicométricas de la versión adaptada del cuestionario PCAS permiten afirmar que se trata de una escala válida y fiable para evaluar la atención primaria desde un enfoque de continuidad asistencial basada en la relación médico-paciente.

OBJECTIVE: Adapt the Primary Care Assessment Survey (PCAS) questionnaire to the Spanish language and determine its validity and reliability in identifying strengths and weaknesses in primary health care (PHC). METHODS: Study of the adaptation and validation of a questionnaire-survey. The suitable sample selected was 244 users of PHC services. The users were over 18 years of age and had had at least two institutional visits prior to being included in the study. The variables used were access, continuity, comprehensiveness, integration, clinical interaction, interpersonal treatment, and trust. Participation was confirmed through analysis of the distribution of responses; participation and patterns of nonresponse; the construct, through exploratory factorial analysis, using principal component analysis and the varimax rotation; the criterion, through the Pearson product-moment correlation coefficient; and reliability using Cronbach's alfa and the intraclass correlation coefficient. RESULTS: The exploratory factorial analysis obtained 11 factors that explain 68.38 percent of the original variability. The criterion validity showed a sufficient correlation between the summary measure of the scale and the ad hoc variables Q33b (value of r x1x2 = 0.569; P = 0.01) and Q32 (value of r x1x2 = 0.600; P = 0.01). The scale obtained a coefficient of Cronbach's alfa of 0.94. The test-retest reliability (F [1 140] = 0.155 [P = 0.694]) demonstrated that the scale is stable over time. CONCLUSIONS: The psychometric properties of the adapted version of the PCAS questionnaire make it possible to state that it is a valid and reliable scale to evaluate primary care from a standpoint of ongoing care based on the physician-patient relationship.