[Multicenter study of adherence to guidelines on surgical prophylaxis and the determinants of non-adherence in ArgentinaEstudo multicêntrico sobre a adesão a diretrizes de profilaxia cirúrgica e seus determinantes na Argentina]. / Estudio multicéntrico de adherencia a guías de profilaxis quirúrgica y sus determinantes en Argentina.

OBJECTIVE: Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence. METHODS: Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used. RESULTS: A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were: incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. According to population (maternal and child, pediatric, specific pathologies, and general pathologies), adherence was 97.9%, 97.2%, 89.4%, and 63.2%, respectively; p < 0.001. Adherence was highest in neurosurgery (91.1%), obstetrics (82.4%), and cardiovascular surgery (72.9%), and lowest in otorhinolaryngology (47.8%), ophthalmology (50%), and urology (55.9%) (p < 0.001). The adjusted analysis showed the highest adherence to guidelines in persons under 18 (odds ratio [OR]: 4.97; 95% confidence interval [CI 95]: 1.13-21.80); emergency surgery (OR: 2.18; CI 95: 1.11-4.26); and public, private, and community facilities (OR: 9.35; CI 95: 3.85-22.70). Adherence was also higher in facilities for maternal and child care and specific pathologies (OR: 10.52; CI 95, 1.30-85.12), cardiovascular surgery, neurosurgery, obstetrics (OR: 2.73; CI 95: 1.55-4.78), and facilities with programs to optimize the use of antimicrobial drugs (OR 1.95; CI 95, 1.10-3.45). CONCLUSIONS: Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.

OBJETIVO: Avaliar o nível de adesão às diretrizes (AD) de profilaxia cirúrgica em instituições de saúde da Argentina e os determinantes da não adesão (NA). MÉTODOS: Estudo multicêntrico transversal realizado em 35 centros na Argentina. Determinamos o nível de AD e as formas de NA, comparados segundo as características das seguintes variáveis: indicação antibiótica, anestesista, cirurgia, instituição e idade do paciente. Aplicamos um modelo de regressão logística ajustado. RESULTADOS: Revisamos um total de 1083 procedimentos cirúrgicos. A taxa de AD foi de 67%. As formas mais frequentes de NA foram: antibiótico incorreto (28,9%), profilaxia desnecessária (25,5%) e profilaxia prolongada (24,4%). A AD foi mais elevada em pacientes com menos de 18 anos (84,9% vs. 65,5%, p<0,001); também houve variações segundo o tipo de instituição (instituição de seguridade social, privada, pública ou comunitária, com adesão de 33,3%, 64,4%, 78,8% e 83,3%, respectivamente; p<0,001) e segundo a população (materno-infantil, pediátrica, com patologia específica ou geral, com adesão de 97,9%, 97,2%, 89,4% e 63,2%, respectivamente; p<0,001). A AD foi maior em neurocirurgia (91,1%), obstetrícia (82,4%) e cirurgia cardiovascular (72,9%) e menor em otorrinolaringologia (47,8%), oftalmologia (50%) e urologia (55,9%) (p<0,001). A análise ajustada mostrou uma AD mais elevada em pacientes com menos de 18 anos (odds ratio [OR]: 4,97, intervalo de confiança de 95% [IC95%]: 1,13-21,80), em cirurgias de emergência (OR: 2,18, IC95%: 1,11-4,26) e em instituições públicas, privadas ou comunitárias (OR: 9,35, IC95%: 3,85-22,70). A AD também foi superior em instituições para população materno-infantil ou para populações específicas (OR: 10,52; IC95%: 1,30-85,12), cirurgia cardiovascular, neurocirurgia, obstetrícia (OR: 2,73; IC95%: 1,55-4,78) e em instituições com programas para a otimização do uso de antimicrobianos (OR: 1,95; IC95%: 1,10-3,45). CONCLUSÕES: A AD foi de 67%; as formas mais frequentes de NA foram o uso incorreto, desnecessário e prolongado de antibióticos. A AD foi maior em pacientes mais jovens, em instituições com programas para a otimização do uso de antimicrobianos, em instituições privadas ou públicas e em populações pediátricas ou específicas, nos procedimentos cirúrgicos de emergência e em certas especialidades.

Estudio multicéntrico de adherencia a guías de profilaxis quirúrgica y sus determinantes en Argentina

[RESUMEN]. Objetivo. Evaluar el nivel de adherencia a las guías de profilaxis quirúrgica (AG) en instituciones de salud de Argentina y los determinantes de la falta de adherencia (NA). Métodos. Estudio multicéntrico de corte transversal en 35 centros de Argentina. Se determinaron el nivel de AG y las formas de NA y se comparó según características de la indicación antibiótica, anestesista, cirugía, institución y edad del paciente. Se ajustó un modelo de regresión logística. Resultados. Se revisaron 1 083 procedimientos quirúrgicos (PQ). La AG fue de 67%. Las formas más frecuentes de NA fueron: antibiótico incorrecto (28,9%), profilaxis innecesaria (25,5%) y profilaxis prolongada (24,4%). La AG fue mayor en menores de 18 años (84,9% frente a 65,5%, P < 0,001); según la dependencia (obra social, privada, pública o comunitaria) fue de 33,3%, 64,4%, 78,8% y 83,3%, respectivamente; P < 0,001) y según la población (maternoinfantil, pediátrica, con patología específica y general) fue de 97,9%, 97,2%, 89,4% y 63,2%, respectivamente; P < 0,001). La AG fue mayor en neurocirugía (91,1%), obstetricia (82,4%) y cirugía cardiovascular (CCV) (72,9%) y menor en otorrinolaringología (ORL) (47,8%), oftalmología (50%) y urología (55,9%) (P < 0,001). El análisis ajustado mostró mayor AG en menores de 18 años (odds ratio [OR]: 4,97; intervalo de confianza de 95% [IC95]: 1,13-21,80), cirugía de urgencia (OR: 2,18; IC95: 1,11-4,26) e institución pública, privada o de comunidad (OR: 9,35; IC95: 3,85-22,70). La AG también fue mayor en instituciones para población maternoinfantil o específica (OR: 10,52; IC95, 1,30-85,12), CCV, neurocirugía, obstetricia (OR: 2,73; IC95: 1,55-4,78) e instituciones con programas para la optimización del uso de antimicrobianos (PROA) (OR 1,95; IC95, 1,10-3,45). Conclusiones. LA AG fue de 67%; el uso incorrecto, innecesario y prolongado del antibiótico fueron las formas más frecuentes de NA. La AG fue mayor con menor edad, PROA, dependencia privada o pública y población pediátrica o específica, PQ de urgencia y ciertas especialidades.

[ABSTRACT]. Objective. Evaluate the level of adherence to guidelines on surgical prophylaxis in health facilities in Argentina and the determinants of non-adherence. Methods. Cross-sectional multicenter study in 35 centers in Argentina. The level of adherence to guidelines and the forms of non-adherence were determined and these were compared based on the characteristics of the indicated antibiotic, anesthesiologist, surgery, and facility, as well as patient age. An adjusted logistic regression model was used. Results. A total of 1,083 surgical procedures were reviewed. Adherence to guidelines was 67%. The most frequent forms of non-adherence were: incorrect antibiotic (28.9%), unnecessary prophylaxis (25.5%), and prolonged prophylaxis (24.4%). Adherence to guidelines was higher in persons under 18 years of age (84.9% compared to 65.5%, p < 0.001). According to the type of health coverage (social welfare, private insurance, public coverage, or community coverage), adherence was 33.3%, 64.4%, 78.8%, and 83.3%, respectively; p < 0.001. According to population (maternal and child, pediatric, specific pathologies, and general pathologies), adherence was 97.9%, 97.2%, 89.4%, and 63.2%, respectively; p < 0.001. Adherence was highest in neurosurgery (91.1%), obstetrics (82.4%), and cardiovascular surgery (72.9%), and lowest in otorhinolaryngology (47.8%), ophthalmology (50%), and urology (55.9%) (p < 0.001). The adjusted analysis showed the highest adherence to guidelines in persons under 18 (odds ratio [OR]: 4.97; 95% confidence interval [CI 95]: 1.13-21.80); emergency surgery (OR: 2.18; CI 95: 1.11-4.26); and public, private, and community facilities (OR: 9.35; CI 95: 3.85-22.70). Adherence was also higher in facilities for maternal and child care and specific pathologies (OR: 10.52; CI 95, 1.30-85.12), cardiovascular surgery, neurosurgery, obstetrics (OR: 2.73; CI 95: 1.55-4.78), and facilities with programs to optimize the use of antimicrobial drugs (OR 1.95; CI 95, 1.10-3.45). Conclusions. Adherence to guidelines was 67%. Incorrect, unnecessary, and prolonged use of antibiotics were the most frequent forms of non-adherence. Adherence was higher with younger patients, where programs exist to optimize the use of antimicrobial drugs, where there is private or public health coverage, with the pediatric population, for specific pathologies, in emergency surgery, and in certain specialties.

[RESUMO]. Objetivo. Avaliar o nível de adesão às diretrizes (AD) de profilaxia cirúrgica em instituições de saúde da Argentina e os determinantes da não adesão (NA). Métodos. Estudo multicêntrico transversal realizado em 35 centros na Argentina. Determinamos o nível de AD e as formas de NA, comparados segundo as características das seguintes variáveis: indicação antibiótica, anestesista, cirurgia, instituição e idade do paciente. Aplicamos um modelo de regressão logística ajustado. Resultados. Revisamos um total de 1083 procedimentos cirúrgicos. A taxa de AD foi de 67%. As formas mais frequentes de NA foram: antibiótico incorreto (28,9%), profilaxia desnecessária (25,5%) e profilaxia prolongada (24,4%). A AD foi mais elevada em pacientes com menos de 18 anos (84,9% vs. 65,5%, p<0,001); também houve variações segundo o tipo de instituição (instituição de seguridade social, privada, pública ou comunitária, com adesão de 33,3%, 64,4%, 78,8% e 83,3%, respectivamente; p<0,001) e segundo a população (materno-infantil, pediátrica, com patologia específica ou geral, com adesão de 97,9%, 97,2%, 89,4% e 63,2%, respectivamente; p<0,001). A AD foi maior em neurocirurgia (91,1%), obstetrícia (82,4%) e cirurgia cardiovascular (72,9%) e menor em otorrinolaringologia (47,8%), oftalmologia (50%) e urologia (55,9%) (p<0,001). A análise ajustada mostrou uma AD mais elevada em pacientes com menos de 18 anos (odds ratio [OR]: 4,97, intervalo de confiança de 95% [IC95%]: 1,13-21,80), em cirurgias de emergência (OR: 2,18, IC95%: 1,11-4,26) e em instituições públicas, privadas ou comunitárias (OR: 9,35, IC95%: 3,85-22,70). A AD também foi superior em instituições para população materno-infantil ou para populações específicas (OR: 10,52; IC95%: 1,30-85,12), cirurgia cardiovascular, neurocirurgia, obstetrícia (OR: 2,73; IC95%: 1,55-4,78) e em instituições com programas para a otimização do uso de antimicrobianos (OR: 1,95; IC95%: 1,10-3,45). Conclusões. A AD foi de 67%; as formas mais frequentes de NA foram o uso incorreto, desnecessário e prolongado de antibióticos. A AD foi maior em pacientes mais jovens, em instituições com programas para a otimização do uso de antimicrobianos, em instituições privadas ou públicas e em populações pediátricas ou específicas, nos procedimentos cirúrgicos de emergência e em certas especialidades.

'Adiós Bacteriemias': a multi-country quality improvement collaborative project to reduce the incidence of CLABSI in Latin American ICUs.

QUALITY PROBLEM: The incidence of central line-associated bloodstream infections (CLABSI) in Latin America has been estimated at 4.9 episodes per 1000 central line (CL) days, compared to a pooled incidence of 0.9 in the United States. CLABSI usually result from not adhering to standardized health procedures and can be prevented using evidence-based practices. INITIAL ASSESSMENT: The first phase of the 'Adiós Bacteriemias' Collaborative was implemented in 39 intensive care units (ICUs) from Latin America from September 2012 to September 2013 with a 56% overall reduction in the incidence of CLABSI. CHOICE OF SOLUTION: Bundles of care for the processes of insertion and maintenance of CLs have proven to be effective in the reduction of CLABSI across different settings. IMPLEMENTATION: Building on the results of the first phase, we implemented a second phase of the 'Adiós Bacteriemias' Collaborative between June 2014-July 2015. We adapted the Breakthrough Series (BTS) Collaborative model to guide the adoption of bundles of care for CLABSI prevention through virtual learning sessions and continuous feedback. EVALUATION: Eighty-three ICUs from five Latin American countries actively reported process and outcome measures. The overall reduction in the CLABSI incidence rate was 22% (incidence rate 0.78; 95% CI 0.65, 0.95), from 2.58 episodes per 1000 CL days at baseline to 2.02 episodes per 1000 CL days (P < 0.01) during the intervention period. LESSONS LEARNED: Adiós Bacteriemias was effective in reducing the incidence of CLABSI and improving the adherence to good practices for CL insertion and maintenance processes in participating ICUs in Latin America.

Single-Use Devices in Argentina: Cost Comparison Analysis of a "Re-Use" versus a "Single-Use" Policy for Trocars, Endocutters, Linear Cutters, and Harmonic Scalpels.

BACKGROUND: Re-use of medical devices labeled and marketed for single use only is a current practice around the world. OBJECTIVES: To estimate the average difference per surgery in device-related costs (DRCs) when performed with single-use devices under a single-use policy (SUP) instead of a re-use policy (RP) from the perspective of the private health sector of Argentina. METHODS: An analytical model was developed in Microsoft Excel and populated with data from a literature review, a Delphi-like panel, and local cost estimations. Four single-use devices were selected for analysis: plastic trocars, endocutters, linear cutters, and harmonic scalpels. DRCs were expressed in 2012 US dollars and divided into four cost categories: devices, adverse events, device failure, and surgical time extension. Outputs were expressed as DRCs per surgery under a SUP, under a RP, the difference between them expressed in US dollars (Diff_$), and the difference between them expressed as a percentage of surgery costs (Diff_%S). Deterministic and probabilistic sensitivity analyses were performed to analyze the impact of uncertainty on results. RESULTS: Expected DRCs per surgery were as follows: for trocars: SUP, US $424.6; RP, US $244.2; Diff_$, US $-180.4; and Diff_%S, -3.8%; for endocutters: SUP, US $1667.4; RP, US $1102.3; Diff_$, US $-565.1; and Diff_%S, -11.1%; for linear cutters: SUP, US $1228.1; RP, US $1045.9; Diff_$, US $-182.2; and Diff_%S, -3.4%; and for harmonic scalpels: SUP, US $1040.9; RP, US $292.4; Diff_$, US $-748.5; and Diff_%S, -14.8%. Sensitivity analyses showed results to be robust. CONCLUSIONS: RP was shown to be less costly in all devices and scenarios considered. Nevertheless, the real frequency of adverse events and their cost implications are still uncertain. More research is needed to assess the effectiveness and safety of these off-label policies.

Calidad de vida relacionada con salud en la población Colombiana: ¿cómo valoran los colombianos su estado de salud? / Quality of life related to health in the Colombian population: how do Colombians perceive their health condition?

RESUMEN Objetivo Determinar la percepción sobre la calidad de vida relacionada con salud (CVrS) que tiene la población adulta en Colombia. Métodos Encuesta poblacional en una muestra representativa de la población rural y urbana, de 18 y más años. Se midió la CVrS con el instrumento EQ5D-3L y la escala visual análoga, como parte de la cuarta Encuesta Nacional de Salud Mental. Las estimaciones fueron ajustadas por el diseño de muestreo y se acompañan de intervalos de confianza al 95 %. Resultados 1 0867 personas completaron la medición; 69,7 % (IC95 % 66,9 a 68,9) de la población reporto estar en "salud completa"; la mayor proporción de personas valoraron su salud por encima de 80 puntos. La presencia de "moderado dolor o malestar", seguida de estar "moderadamente angustiado o deprimido" fueron las alteraciones más frecuentes. Los adultos jóvenes tienden a valorar mejor su salud que los adultos mayores. No hay diferencias en la percepción de la salud entre regiones del país. Conclusiones La calidad de vida relacionada con salud en la población colombiana es mayor de 80 puntos en una escala de 1 a 100. Las alteraciones como angustia y depresión y la percepción del dolor, fueron las más comúnmente reportadas por los colombianos. La situación de pobreza y el bajo nivel educacional son determinantes de la valoración que hacen los colombianos de su CVrS.(AU)

ABSTRACT Objective To determine the perception about quality of life related to health in the adult population of Colombia. Methods Population-based survey applied on a representative sample of the Colombian rural and urban population, aged 18 years or more. Quality of life related to health was measured using the generic EQ5D instrument and the analogue visual scale as part of the fourth National Mental Health Survey. Estimates were accompanied by 95 % confidence intervals and were adjusted by the sampling design. Results 10 867 people aged 18 years or older completed the measurement. 69.7 % (CI95 %; 66.9-68.9) of the population reported being "completely healthy". Most of the population rated their health condition above 80 points. The presence of "moderate pain or discomfort", followed by being "moderately distressed or depressed" were the most frequent alterations. Young adults tend to perceive their health better than older adults. There is no difference in the perception of health between regions of the country. Conclusions Quality of life related to health in the Colombian population is greater than 80 points on a scale of 1 to 100. Alterations such as angst and depression and the perception of pain were the most frequently reported by Colombians. Poverty and a low level of education are determinants of the perception of Colombians regarding their quality of life related to health.(AU)

[Quality of life related to health in the Colombian population: how do Colombians perceive their health condition?] / Calidad de vida relacionada con salud en la población Colombiana: ¿cómo valoran los colombianos su estado de salud?

OBJECTIVE: To determine the perception about quality of life related to health in the adult population of Colombia. METHODS: Population-based survey applied on a representative sample of the Colombian rural and urban population, aged 18 years or more. Quality of life related to health was measured using the generic EQ5D instrument and the analogue visual scale as part of the fourth National Mental Health Survey. Estimates were accompanied by 95 % confidence intervals and were adjusted by the sampling design. RESULTS: 10 867 people aged 18 years or older completed the measurement. 69.7 % (CI95 %; 66.9-68.9) of the population reported being "completely healthy". Most of the population rated their health condition above 80 points. The presence of "moderate pain or discomfort", followed by being "moderately distressed or depressed" were the most frequent alterations. Young adults tend to perceive their health better than older adults. There is no difference in the perception of health between regions of the country. CONCLUSIONS: Quality of life related to health in the Colombian population is greater than 80 points on a scale of 1 to 100. Alterations such as angst and depression and the perception of pain were the most frequently reported by Colombians. Poverty and a low level of education are determinants of the perception of Colombians regarding their quality of life related to health.

OBJETIVO: Determinar la percepción sobre la calidad de vida relacionada con salud (CVrS) que tiene la población adulta en Colombia. MÉTODOS: Encuesta poblacional en una muestra representativa de la población rural y urbana, de 18 y más años. Se midió la CVrS con el instrumento EQ5D-3L y la escala visual análoga, como parte de la cuarta Encuesta Nacional de Salud Mental. Las estimaciones fueron ajustadas por el diseño de muestreo y se acompañan de intervalos de confianza al 95 %. RESULTADOS: 1 0867 personas completaron la medición; 69,7 % (IC95 % 66,9 a 68,9) de la población reporto estar en "salud completa"; la mayor proporción de personas valoraron su salud por encima de 80 puntos. La presencia de "moderado dolor o malestar", seguida de estar "moderadamente angustiado o deprimido" fueron las alteraciones más frecuentes. Los adultos jóvenes tienden a valorar mejor su salud que los adultos mayores. No hay diferencias en la percepción de la salud entre regiones del país. CONCLUSIONES: La calidad de vida relacionada con salud en la población colombiana es mayor de 80 puntos en una escala de 1 a 100. Las alteraciones como angustia y depresión y la percepción del dolor, fueron las más comúnmente reportadas por los colombianos. La situación de pobreza y el bajo nivel educacional son determinantes de la valoración que hacen los colombianos de su CVrS.

[Colombia 2015 National Mental Health Survey. Study Protocol]. / Encuesta Nacional de Salud Mental Colombia 2015. Protocolo del estudio.

INTRODUCTION: The 2015 National Mental Health Survey (NMHS) is the fourth mental survey conducted in Colombia, and is part of the National System of Surveys and Population Studies for health. METHODS: A narrative description is used to explain the background, references, the preparation, and characteristics of the 2015 NMHS. The 2015 NMHS and its protocol emerge from the requirements that support the national and international policies related to mental health. Together with the Ministry of Health and Social Protection, the objectives, the collection tools, the sample, and the operational plan are defined. The main objective was to obtain updated information about the mental health, mental problems and disorders, accessibility to health services, and an evaluation of health conditions. Participants were inhabitants from both urban and rural areas, over 7 years old, and in whom the comprehension of social determinants and equity were privileged. An observational cross-sectional design with national, regional and age group representativity, was used. The age groups selected were 7-11, 12-17, and over 18 years old. The regions considered were Central, Orient, Atlantic, Pacific, and Bogota. The calculated sample had a minimum of 12,080 and a maximum of 14,496 participants. CONCLUSIONS: A brief summary of the protocol of the 2015 NMHS is presented. The full document with all the collection tools can be consulted on the Health Ministry webpage.

Encuesta Nacional de Salud Mental Colombia 2015. Protocolo del estudio / Colombia 2015 National Mental Health Survey. Study Protocol

Introducción: La Encuesta Nacional de Salud Mental 2015 (ENSM 2015) es la cuarta que se realiza en el país y se enmarca en el Sistema Nacional de Encuestas y estudios poblacionales para salud de Colombia. Métodos: Se presenta una descripción narrativa de los antecedentes, los referentes, el proceso de elaboración y las características del protocolo de la ENSM 2015. La ENSM 2015 y el protocolo parten de unos requisitos que dan soporte a las políticas nacionales en salud e internacionales relacionadas con salud mental. Para su elaboración se trabaja junto con el Ministerio de Salud y Protección Social para definir los objetivos, los instrumentos de recolección, la muestra y el plan operativo. Como objetivo principal se definió brindar información actualizada acerca de la salud mental, los problemas, los trastornos mentales, la accesibilidad de los servicios y la valoración de estados de salud, de la población colombiana rural y urbana mayor de 7 años de edad, en la que privilegió su comprensión desde los determinantes sociales y la equidad. Para ello se decidió realizar un estudio observacional de corte transversal en el ámbito nacional, con representatividad nacional, regional y por franjas de edad: 7-11, 12-17 y ≥ 18 años. Las regiones consideradas fueron: Central, Oriental, Atlántica, Pacífica y Bogotá, con un tamaño de muestra total calculado como mínimo de 12.080 sujetos y máximo de 14.496. Conclusiones: Se presenta un breve resumen del protocolo que puede ser consultado en su totalidad en la página web del MSPS que incluye los instrumentos de recolección.

Introduction: The 2015 National Mental Health Survey (NMHS) is the fourth mental survey conducted in Colombia, and is part of the National System of Surveys and Population Studies for health. Methods: A narrative description is used to explain the background, references, the preparation, and characteristics of the 2015 NMHS. The 2015 NMHS and its protocol emerge from the requirements that support the national and international policies related to mental health. Together with the Ministry of Health and Social Protection, the objectives, the collection tools, the sample, and the operational plan are defined. The main objective was to obtain updated information about the mental health, mental problems and disorders, accessibility to health services, and an evaluation of health conditions. Participants were inhabitants from both urban and rural areas, over 7 years old, and in whom the comprehension of social determinants and equity were privileged. An observational cross-sectional design with national, regional and age group representativity, was used. The age groups selected were 7-11, 12-17, and over 18 years old. The regions considered were Central, Orient, Atlantic, Pacific, and Bogota. The calculated sample had a minimum of 12,080 and a maximum of 14,496 participants. Conclusions: A brief summary of the protocol of the 2015 NMHS is presented. The full document with all the collection tools can be consulted on the Health Ministry webpage.

Costos ambulatorios y hospitalarios de la falla cardiaca en dos hospitales de Bogotá / Outpatient and inpatient costs of heart failure in two hospitals in Bogotá

Objetivo: realizar una aproximación a la determinación de costos directos de la falla cardiaca (FC) en el país, a través de la evaluación de costos asociados con el cuidado de pacientes atendidos en dos instituciones prestadoras de salud de Bogotá. Métodos: estudio de costos bajo la perspectiva del tercer pagador. La identificación de eventos generadores de costos en atención ambulatoria se realizó mediante revisión de historias clínicas de pacientes atendidos durante 2011 en la consulta externa especializada de una institución. Los costos de interconsultas y paraclínicos se determinaron según los valores del Acuerdo 256 de 2001, con adición de 30%. Los costos de la medicación se determinaron a partir del registro SISMED. La identificación de eventos generadores de costos en hospitalización se realizó mediante revisión de listados y facturas de pacientes atendidos entre 2009 y 2010 en dos instituciones. Los resultados se presentan resumidos por medidas de tendencia central y de dispersión, en pesos colombianos (COP) de 2011. Resultados: el costo mensual promedio del tratamiento ambulatorio de FC fue de 304.318 COP (D.E. 760.876), con una mediana de 45.280 COP (RIC 25.539 - 109.715); los medicamentos representaron la fuente principal de consumo de recursos (55,2%). El costo promedio de la hospitalización por descompensación de FC fue de 6.427.887 COP (D.E. 9.663.176); la estancia hospitalaria representó la mayor proporción del costo (29,1%). Conclusiones: los costos ambulatorios, y especialmente los hospitalarios, asociados con la FC en Colombia son sustanciales. La fuente principal de costos difiere dependiendo de si el manejo es hospitalario (estancia) o ambulatorio (medicamentos). (Acta Med Colomb 2013; 38: 208-212).

Objective: to make an approach to the determination of direct costs of heart failure (HF) in the country through the evaluation of costs associated with the care of patients seen in two health institutions in Bogota. Methods: low cost third-party payer perspective. Identification of cost generating events in ambulatory care was performed by review of medical records of patients seen during 2011 in the specialized outpatient clinic of an institution. Interconsultations and paraclinical costs were determined according to the 256 Agreement of 2001, with addition of 30%. Medication costs were determined from the SISMED register. Identification of events that generate costs in hospitalization was conducted by reviewing lists and bills of patients treated between 2009 and 2010 in two institutions. The results are presented summarized by measures of central tendency and dispersion, in Colombian pesos (COP) of 2011. Results: the average monthly cost for outpatient treatment of HF was 304,318 COP (D.E. 760 876), with a median of 45,280 COP (RIC 25,539-109,715); drugs represented the main source of resource consumption (55.2%). The average cost of hospitalization for decompensated HF was 6,427,887 COP (D.E. 9.663.176); hospital stay accounted for the largest proportion of the cost (29.1%). Conclusions: outpatient costs, and especially the inpatient ones associated with HF in Colombia are substantial. The main source of costs differs depending on whether the management is hospitable (stay) or outpatient (drugs). (Acta Med Colomb 2013; 38: 208-212).

Frecuencia de discapacidad en estudiantes que presentan la prueba estandarizada de acceso a la educación superior (Saber 11) en Colombia y caracterización de su rendimiento / The frequency of disability amongst highschool students taking the standardised Colombian highschool leaving test (Saber 11) and a characterisation of their performance

Introducción. El examen nacional de acceso a la educación superior en Colombia (prueba Saber 11), es obligatorio para obtener el título de bachiller y ha realizado adaptaciones que permiten evaluar a personas con discapacidad física, auditiva y visual. Objetivo. Describir las características y el rendimiento en la prueba Saber 11 de las personas con discapacidad (PCD) en 2009. Materiales y métodos. Análisis secundario de tipo descriptivo de los resultados del examen nacional de acceso a la educación superior (prueba Saber 11), presentado por PCD en el ano 2009. La certificación de discapacidades realizada previa al examen durante la inscripción a la prueba. Se describen las características de dicha población, junto con los puntajes en la prueba. Resultados. 529.651 estudiantes presentaron la prueba por primera vez, de los cuales el 0,2% (842) afirmaron durante la inscripción tener algún tipo de discapacidad. Del total de PCD, el 35,0% presentó una discapacidad motora, el 34,9% presentó una discapacidad auditiva y requirieron intérprete en la prueba, 19,1% presentó una discapacidad visual y un 11,5% presentó discapacidad auditiva, pero no requirieron intérprete. La mayoría de sus puntajes están en categorización media, y, en promedio, las personas con discapacidad visual tuvieron resultados mejores en las áreas básicas al compararlos con otras discapacidades. Conclusión. Este estudio sugiere que son pocas las PCD que se presentan a la prueba Saber 11. No existe forma de evidenciar discapacidad cognitiva en la prueba.

Background. Taking the standardised Colombian highschool leaving test (Saber 11) is obligatory for students to graduate from high school and is also used for rating students applying to Colombian universities; it has been adapted for evaluating young people having hearing physical, visual and auditory disabilities. Objectives. Describing and characterising the profile of students suffering from disability (SWD) who presented the standardised Colombian highschool leaving test in 2009. Methods. A descriptive secondary analysis was made of the standardised Colombian highschool leaving test database concerning SWD who took the test in 2009. A disability certificate must have been obtained beforehand and presented during registration for the test. The prevalence of SWD taking the test was calculated, their scores were recorded and univariate statistics were used for the social, demographic and economic characterisation of their profile. Results. 529,651 students took the test for the first time in 2009; 0.2% (842) of these students claimed to have some type of disability during registration. 35.0% (295) of these had a motor disability, 34.9% (294) had a hearing disability and were assisted by a sign language interpreter, 19.1% (161) were visually impaired and 11.5% (97) had a hearing disability but did not receive assistance from a sign language interpreter. Most SWD achieved midranging scores; the visuallyimpaired scored higher points than the rest of the SWD. Conclusion. This study suggested that very few SWD were presenting the standardised Colombian highschool leaving test. Cognitive impairment could not be measured by this type of standardised test.

Assessment of adrenal function by measurement of salivary steroids in response to corticotrophin in patients infected with human immunodeficiency virus.

OBJECTIVE: Adrenal insufficiency has been reported among critically ill HIV-infected patients. This is the first study that attempts to detect subclinical hypoadrenal states in non-critical HIV patients through salivary steroids in response to intramuscular low-dose ACTH injection. PATIENTS AND METHODS: We studied 21 ambulatory adult HIV-infected patients without specific clinical signs or symptoms of adrenal insufficiency. Normal salivary flow-rate and salivary alpha-amylase activity confirmed adequate salivary gland function. Salivary cortisol (SAF) and salivary aldosterone (SAL) were obtained at baseline and 30 min after the injection of 25 microg of ACTH in the deltoid muscle (LDT(s)). Assessment of salivary steroids after stimulation with 250 microg of intramuscular ACTH (HDT(s)) was performed on those who hyporesponded to LDT(s). Basal blood samples were drawn for steroids, renin and ACTH measurements. RESULTS: At baseline SAF and SAL correlated significantly (p=0.0001) with basal serum cortisol and aldosterone (r=0.70 and 0.91, respectively). Plasma ACTH and renin concentrations were within the normal range in all patients. Eight of the twenty-one HIV(+) patients were LDT(s) hyporesponders in either SAF (n:1) or SAL (n:7). LDT(s) repeated in six cases after a year reconfirmed the impairment of aldosterone secretion. LDT(s) hyporesponders had normal steroid responses to HDT(s). CONCLUSIONS: LDT(s) is a simple, safe, well-accepted and non-invasive approach to assess adrenal function in HIV-infected ambulatory patients. It revealed subnormal cortisol (5%) and aldosterone responses (33%) when HDT(s) results were normal.

Modelo de control de malaria en el Departamento de Antioquia: estudio de casos / The malaria control model in the Department of Antioquia: a case study

OBJETIVOS: El trabajo se orientó hacia la descripción del modelo de control de la malaria en el contexto del Sistema General de Seguridad Social en Salud-SGSSS, buscando contribuir a un mejor entendimiento de las problemáticas actuales. MÉTODOS: Se realizó un estudio de casos múltiples, descriptivo y evaluativo, en el cual se obtuvo información cuantitativa y cualitativa, de fuentes primarias y secundarias. La recolección de la información se realizó en Septiembre de 2003. RESULTADOS: Se encontró una tendencia creciente de la morbilidad, acentuada en la década de los noventa, pero con una disminución significativa en la mortalidad. Se identifico la estructura bajo la cual opera el programa en el marco de la descentralización y la reforma a partir de la Ley 100 de 1993; y su influencia sobre el modelo en su totalidad. Se conocieron las percepciones de los actores y las debilidades y fortalezas del modelo. CONCLUSIONES: Los hallazgos sugieren que el modelo de control cuenta con algunos logros importantes y también presenta debilidades en las políticas publicas sectoriales e intersectoriales. No ha logrado hacer frente de manera integral y eficaz a la enfermedad en su contexto social y político. De otra parte, la participación social y comunitaria no ha alcanzado sus potencialidades. El modelo de control de la malaria se encuentra fragmentado e inmerso en los procesos, tensiones y situaciones que genera el conflicto armado en algunas de las regiones agrarias, lo que a su vez dificulta la operación del SGSSS.(AU)

OBJECTIVE: This study was oriented towards describing the malaria control model within the context of the General Health Social Security System (SGSSS), with the aim of contributing to a better understanding of its current problems. METHODS: A descriptive and evaluative study of multiple cases was carried out, in which both qualitative and quantitative information was obtained from primary and secondary sources. The collection of information was carried out during September 2003. RESULTS: The long-term malaria trends indicate a fall in the mortality caused by malaria and an increase in the morbidity, particularly since 1990. The department has been decentralized, which influences the structure of the malaria control program. Malaria and vector-borne diseases control programs exist both at the department level and in the municipalities where diagnostic and treatment activities are carried out. The control model presents a set of weaknesses and strengths. CONCLUSIONS:The findings suggest that the control model has some important achievements and also some weaknesses in the sectorial and intersectorial public policies. The program has not managed the disease in an integral and effective way, in its social and political context. On the other hand, the social and community participation has not reached its potential. The malaria control model is fragmented and immersed within the processes, tensions and situations generated by the armed conflict in some agricultural regions, which in turn hampers the operation of the SGSSS.(AU)