Quality assessment indicators in antenatal care worldwide: a systematic review.

PURPOSE: To describe indicators used for the assessment of antenatal care (ANC) quality worldwide under the World Health Organization (WHO) framework and based on a systematic review of the literature. DATA SOURCES: Searches were performed in MEDLINE, SciELO, BIREME and Web of Science for eligible studies published between January 2002 and September 2016. STUDY SELECTION: Original articles describing women who had received ANC, any ANC model and, any ANC quality indicators were included. DATA EXTRACTION: Publication date, study design and ANC process indicators were extracted. RESULTS OF DATA SYNTHESIS: Of the total studies included, 69 evaluated at least one type of ANC process indicator. According to WHO ANC guidelines, 8.7% of the articles reported healthy eating counseling and 52.2% iron and folic acid supplementation. The evaluation indicators on maternal and fetal interventions were: syphilis testing (55.1%), HIV testing (47.8%), gestational diabetes mellitus screening (40.6%) and ultrasound (27.5%). Essential ANC activities assessment ranged from 26.1% report of fetal heart sound, 50.7% of maternal weight and 63.8% of blood pressure. Regarding preventive measures recommended by WHO, tetanus vaccine was reported in 60.9% of the articles. Interventions performed by health services to improve use and quality of ANC care, promotion of maternal and fetal health, and the number of visits to the ANC were evaluated in 65.2% of the studies. CONCLUSION: Numerous ANC content indicators are being used to assess ANC quality. However, there is a need to use standardized indicators across countries and efforts to improve quality evaluation.

Diagnostic tools for alzheimer's disease dementia and other dementias: an overview of diagnostic test accuracy (DTA) systematic reviews.

BACKGROUND: Dementia includes a group of neurodegenerative disorders characterized by progressive loss of cognitive function and a decrease in the ability to perform activities of daily living. Systematic reviews of diagnostic test accuracy (DTA) focus on how well the index test detects patients with the disease in terms of figures such as sensitivity and specificity. Although DTA reviews about dementia are essential, at present there is no information about their quantity and quality. METHODS: We searched for DTA reviews in MEDLINE (1966-2013), EMBASE (1980-2013), The Cochrane Library (from its inception until December 2013) and the Database of Abstracts of Reviews of Effects (DARE). Two reviewers independently assessed the methodological quality of the reviews using the AMSTAR measurement tool, and the quality of the reporting using the PRISMA checklist. We describe the main characteristics of these reviews, including basic characteristics, type of dementia, and diagnostic test evaluated, and we summarize the AMSTAR and PRISMA scores. RESULTS: We selected 24 DTA systematic reviews. Only 10 reviews (41.6%), assessed the bias of included studies and few (33%) used this information to report the review results or to develop their conclusions Only one review (4%) reported all methodological items suggested by the PRISMA tool. Assessing methodology quality by means of the AMSTAR tool, we found that six DTA reviews (25%) pooled primary data with the aid of methods that are used for intervention reviews, such as Mantel-Haenszel and separate random-effects models (25%), while five reviews (20.8%) assessed publication bias by means of funnel plots and/or Egger's Test. CONCLUSIONS: Our assessment of these DTA reviews reveals that their quality, both in terms of methodology and reporting, is far from optimal. Assessing the quality of diagnostic evidence is fundamental to determining the validity of the operating characteristics of the index test and its usefulness in specific settings. The development of high quality DTA systematic reviews about dementia continues to be a challenge.

Practice makes the expert: The importance of training volunteers in the generation of phenological data from photographs of biodiversity observation platforms.

Phenology studies the time at which events in the life cycle of a species occur sand how they are related to environmental cues. Patterns of change in phenology at different scales can be used as an indicator of ecosystem changes and climate change, but the data necessary to detect these changes can be difficult to obtain due to their temporal and regional dimensions. Citizen science can contribute to generate large amounts of data on phenological changes at wide geographical scales that would be almost impossible for professional scientists to generate, but the quality and reliability of these data are often questioned. The objective of this study was to evaluate the use of a biodiversity observation citizen science platform based on photographic information as a potential source of large-scale phenological information, and to identify the key benefits and limitations of this type of information source. We used the Naturalista photographic databases for two invasive species in a tropical region: Leonotis nepetifolia and Nicotiana glauca. The photographs were classified into different phenophases (initial growth, immature flower, mature flower, dry fruit) by three groups of volunteers: a group of experts, a trained group with information on the biology and phenology of both species, and an untrained group. The degree of reliability of the phenological classifications was estimated for each group of volunteers and each phenophase. The degree of reliability of the phenological classification of the untrained group was generally very low for all phenophases. The group of trained volunteers showed accuracy levels for the reproductive phenophases that equaled the degree of reliability among the expert group, regardless of species, and was consistent across phenophases. We conclude that volunteer classification of photographic information contained in biodiversity observation platforms can provide phenological information with high geographic coverage and an increasing temporal coverage on general phenological patterns of species with wide distributions but has limited applicability in the identification of exact start and end dates. and peaks of the different phenophases.

Efficacy and safety of intravenous immunoglobulin in patients with lupus nephritis: A systematic review of the literature.

INTRODUCTION AND OBJECTIVE: Intravenous immunoglobulin (IVIg) is an anti-inflammatory drug with an unclear role in the treatment of patients with lupus nephritis (LN). This systematic review evaluates the evidence for IVIg in the care of patients with LN. METHODOLOGY: A systematic search was done in the PubMed, EMBASE, BVS and OVID databases - All EBM Reviews following the PRISMA methodology (registration in PROSPERO CRD42021236662). The variables were extracted: indications for use, dosage, partial or complete response, adverse reactions, initiation of renal replacement therapy, reduction of proteinuria, and mortality. The quality assessment was done with the "The Joanna Briggs Institute (JBI) Critical Appraisal tools for use in Systematic Reviews Checklist". In addition, synthesis reports were prepared through the Synthesis Without Meta-analysis - SWiM guide. RESULTS: A total of 2328 articles were obtained (28 were considered for inclusion). When the studies were evaluated, IVIg therapy was found to be between 60% to 70% effective (except for patients with class V LN) with overall responses (complete + partial) even for patients who are refractory to first line treatment. Normalization (<0.5 g) of nephrotic proteinuria occurred in 24% of cases with infrequent adverse events and a mortality plus dialysis composite of 11.5% and 24.1% (most representative study). CONCLUSION: In patients with LN refractory to conventional treatment or co-infection situations, the reported data seem to demonstrate effectiveness of IVIg therapy. There are few adverse reactions and caution is exercised when using it on patients with class V NL. However, given the lack of controlled studies with long-term follow-up, these data should be interpreted cautiously thus encouraging the development of high-quality RCTs.

VII Encuentro Nacional de Semilleros de Investigación en Ciencias de la Salud de Investigación en Ciencias de la Salud (ENSI (ENSI 77 ). 26 y 27 de octubre de 2023 ). 26 y 27 de octubre de 2023 ¡Oportunidad para el reencuentro, la discusión y ¡Oportunidad para el reencuentro, la discusión y la controversia juveniles!la controversia juveniles! / Seventh national meeting of health sciences research incubators (ENSI incubators (ENSI 77). October 26 and 27, 2023 ). October 26 and 27, 2023 An opportunity for a youth encounter, discussion and An opportunity for a youth encounter, discussion and controversy!controversy!

It is known that, through its mission objectives, the FUCS is committed to teaching, research and social projection, in turn aligned with very long-term purposes present in various policies and plans in health, education, science, technology and Colombian research. On October 26 and 27, 2023, the seventh edition of the National Meeting of Health Research Seedbeds (ENSI) will be held, an occasion marked by the return to face-to-face events, but also by the possibility of a reunion after the forced separation and relative isolation due to the COVID-19 pandemic, whose character of international public health emergency was extended for 3 years, 3 months and 3 days until May 5, 2023.

[Burden of disease by external causes of injury in Casanare-Colombia, 2008-2012]. / Carga de enfermedad por lesiones de causa externa en Casanare, Colombia, 2008-2012.

OBJECTIVE: To estimate the burden of disease for external causes of injury in the department of Casanare during the 2008-2012 period. MATERIALS AND METHODS: Retrospective descriptive study on the records of the events grouped as external causes of injury notified to SIVIGILA and the events reported to the Epidemiological Surveillance System of External Causes (SIVELCE). Analysis of time, place, and person variables through descriptive statistics, using templates available via WHO in Microsoft Office® Excel 2013 and Epi-Info® 7.1.3. RESULTS: Between 2008 and 2012, 5 829 cases grouped as external causes of injury were notified to SIVIGILA: 751 ophidic accidents (12.9%), 3 774 rabies attacks (64.7%), 1 231 poisoning cases (21.1%), 32 gunpowder injuries (0.5%), and 41 cases of violence (0.7%), with a male/female ratio of 1:1, average age of 25±19,3 (r=0.01-92), and 821 disability-adjusted life years (DALYs) (2. 5 years per 1 000 inhabitants). In turn, SIVELCE received 15 539 reports: 12 834 intentional injuries (82.6%) and 2 704 unintentional injuries (17.4%), with a male/female ratio of 1:1, average age of 28±14.1 (r=0.03-90), correlation between dying by intentional injuries vs. unintentional injuries with an odds ratio of OR=0.12 (X2=1 060.56 1 g.l; p value=0.0), and DALY of 18 179 (55.8/1 000). CONCLUSIONS: The external causes of injury affect men and women equally; DALYs occur at the expense of morbidity. All external causes of injury are preventable; therefore, it is necessary to strengthen surveillance, prevention and control actions.

OBJETIVO: Estimar la carga de enfermedad por lesiones de causa externa (LCE) en el departamento de Casanare durante 2008-2012. MÉTODOS: Estudio descriptivo retrospectivo desde los registros de la notificación al Sivigila de los eventos agrupados como LCE y los eventos reportados al Sistema de Vigilancia Epidemiológica de Lesiones de Causa Externa (SIVELCE). Análisis de variables en tiempo-lugar-persona mediante estadística descriptiva, con plantillas disponibles vía OMS en Microsoft Office® Excel 2013 y Epi-Info® 7.1.3. RESULTADOS: Entre 2008-2012 fueron notificados al Sistema de Salud Pública (SIVI-GILA) 5 829 casos agrupados como LCE: accidente ofídico 751(12,9%), agresiones por rabia 3 774(64,7%), intoxicaciones 1 231(21,1%), lesiones por pólvora 32(0,5%) y violencia 41(0,7%), razón hombre/mujer 1:1, edad promedio 25±19,3(r=0,01-92) años, años de vida ajustados por discapacidad (AVAD) 821(2,5 años por 1 000 habitantes); y, al SIVELCE 15 539 reportes: lesiones intencionales 12 834(82,6%) y lesiones no intencionales 2 704(17,4%), razón hombre/mujer 1:1, edad promedio 28±14,1(r=0,03-90) años, relación entre morir por lesiones intencionales vs lesiones no intencionales tuvo una razón de disparidad OR=0,12 (X2=1 060,56 1 g.l, valor-p=0,0), AVAD 18 179(55,8/1 000). CONCLUSIONES: Las LCE afectan por igual a hombres y mujeres, los AVAD ocurren a expensas de la morbilidad. Todas las LCE son prevenibles, por tanto, es necesario fortalecer las respectivas acciones de vigilancia, prevención y control.

[Direct costs and clinical aspects of adverse drug reactions in patients admitted to a level 3 hospital internal medicine ward]. / Costos directos y aspectos clínicos de las reacciones adversas a medicamentos en pacientes hospitalizados en el servicio de medicina interna de una institución de tercer nivel de Bogotá.

INTRODUCTION: Adverse drug reactions (ADRs) occur frequently in hospitals and increase costs of health care; however, few studies have quantified the clinical and economic impact of ADRs in Colombia. OBJECTIVES: These impacts were evaluated by calculating costs associated with ADRs in patients hospitalized in the internal medicine ward of a Level 3 hospital located in Bogotá, Colombia. In addition, salient clinical features of ADRs were identified and characterized. MATERIAL AND METHODS: Intensive follow-ups for a cohort of patients were conducted for a five month period in order to detect ADRs; different ways to classify them, according to literature, were considered as well. Information was collected using the INVIMA reporting format, and causal probability was evaluated with the Naranjo algorithm. Direct costs were calculated from the perspective of payer, based on the following costs: additional hospital stay, medications, paraclinical tests, additional procedures, patient displacement to intermediate or intensive care units, and other costs. RESULTS: Of 836 patients admitted to the service, 268 adverse drug reactions were detected in 208 patients (incidence proportion 25.1%, occurence rate 0.32). About the ADRs found, 74.3% were classified as probable, 92.5% were type A, and 81.3% were moderate. The body system most often affected was the circulatory system (33.9%). Drugs acting on the blood were most frequently those ones associated with adverse reactions (37.6%). The costs resulting from medical care of adverse drug reactions varied from COL dollar 93,633,422 (USD dollar 35,014.92) to COL dollar 122,155,406 (USD dollar 45,680.94), according to insurance type, during the study period. CONCLUSIONS: Adverse drug reactions have a significant negative health and financial impact on patient welfare. Because of the substantial resources required for their medical care and the significant proportion of preventable adverse reactions, active programs of institutional pharmacovigilance are highly recommended.

Perspectiva global y acción local para un programa doctoral en ciencias de la salud / Global perspective and local actions for a doctoral program in health sciences

Con el objeto de ponderar las condiciones actuales requeridas para un programa doctoral en Ciencias de la Salud en Colombia, se elaboró un documento base y de posición para explorar su viabilidad y factibilidad de desarrollo. Mediante una estrategia de revisión teórica, discusión de expertos y definición de categorías, se establecieron temas centrales para el estudio y comprensión de la situación. A través de un proceso heurístico, se definieron cinco categorías clave; "historia de los doctorados", "perspectiva global", "situación nacional", "elementos en la FUCS" y "prospectiva", que muestran un panorama mundial de sobreoferta y precariedad laboral versus la necesidad y la posibilidad de generar localmente desarrollos e innovaciones en salud, a condición que un doctorado respete condiciones de excelencia, integralidad y protección del estudiante y del talento humano formado. La conclusión fundamental es que un programa PhD en Ciencias de la Salud es viable en la medida de la factibilidad y la fortaleza de factores tales como unos proyectos bien planteados y ejecutados, un equipo de supervisores y codirectores expertos y competentes, y un conjunto de capacidades administrativa, financiera y estructural, todo lo cual implica, al final, voluntades políticas y directivas.

A base and position document was designed with the objective of considering the current conditions required to conceptualize a doctorate program in health sciences in Colombia, and explore its viability and feasibility. Some central topics were established by means of a theoretical review, expert discussion and defining categories in order to gain a better understanding of the situation. Five key categories were defined by an heuristic process, that is, "history of doctorates"; "global perspective"; "situation at the national level"; "elements available in the FUCS"; and "prospective", which show a global panorama of excess offer and job insecurity versus the need and the possibility to generate local health care developments and innovations to conduct a doctorate program respecting excellence, integrity and students and trained human talent. The fundamental conclusion was that a PhD program in health sciences depends on how feasible and strong some factors such as well formulated and implemented projects, a team of expert and competent supervisors and co-directors and a set of administrative, financial and structural capabilities are, all ultimately implying political and directive will

[Evaluation of medication side-effects from an economic perspective]. / Las reacciones adversas a medicamentos: una aproximación desde el punto de vista económico.

Pharmacovigilance is a health sciences discipline devoted to the data collection, data analysis and decision-making related to adverse drug reactions (ADR). It has played an expanded theoretical and practical role since the 1960's. However, few studies have made a careful analysis of the decision-making costs in evaluating ADRs. Herein, the relevant literature is reviewed concerning the costs generated due to the attention of the drug adverse events in medical practice. Examples are taken from international literature which offer by extrapolation of the potential future costs of ADR in Colombia. The objective is to sensitize and generate insights about the need for implementation and development of a national pharmacovigilance system.

[Burnout : concepts and implications affecting public health]. / Agotamiento profesional: concepciones e implicaciones en la salud pública.

Burnout was originally described as a mental condition characterized by reduced work performance, impotence, frustration and lack of capability to reach objectives or goals while performing a job. For some authors, burnout is a poorly defined mixture of symptoms and signs, while other professionals think of it as a disease and a potential threat to public health. Worldwide, it has been observed that the most afflicted professionals and technicians are those who work providing services or assistance to other people, especially those dedicated to health care. This paper focuses on the idea that burnout should be considered a disease more than a syndrome. On the other hand, definitions of health and disease have changed with time, as well as theoretical and methodological references about burnout. In addition, burnout remains a condition that is being discussed in various scientific areas, with radically opposing positions; these approaches are discussed in this article. After presenting different conceptions regarding burnout, the essay concludes with an exploration of its implications and the identification of possible treatments, especially for health workers, among whom it is more common depending on their predisposing conditions and environments.

Productos de tabaco calentado. Concepciones e Implicaciones para la Salud Pública / Products of heated tobacco. Conceptions and Implications for Public Health / Produits de tabac chauffé. Conceptions et Implications pour la santé publique / Produtos de tabaco aquecido. Conceções e Implicações para a Saúde Pública

Resumen: Objetivo: Explorar necesidades de conocimiento y posibles líneas futuras de investigación sobre los Productos de Tabaco Calentado, PTC (Heat-not-bum tobacco products), desde la literatura científica publicada y las fuentes en internet para el público. Métodos: Estudio mixto cualitativo/cuantitativo paralelo bajo tipología de revisiones de literatura por Grant & Booth y Pinto, y diseño de estudios de mapeo según Cooper. Exploración de bases de datos en motores de búsqueda, cotejo de títulos/resúmenes en cuatro idiomas de 2016-12-01 a 2017-12-31. Textos guardados en formatos MHT y PDF, acopiados en Dropbox y gestionados con Endnote X8. Definición de categorías agrupadas en cuatro dimensiones. Información analizada con Microsoft® Excel 2016 y Epi-INFO ® 7.2.2. Resultados: Cotejadas 46 páginas web, 63 referencias científicas, 99% en inglés; dos manuscritos con nota de retirada. En D1 (sumario): presentación del producto vs. aspectos toxicológicos o evaluativos de PTC. 48 artículos (76,2%) en digital o impreso (2017); por país: EUA: páginas web 23 (50%), 20 artículos (32%); Suiza: 22 artículos (35%), tres páginas web (7%). D2 (comercial): financiación por Phillip Morris International (PMI, 22; 33%) o universidades con fondos propios/gubernamentales (19, 30%); en páginas web predominaron PMI (60%), British American Tobacco y Japan Tobacco International (40%); relación con PMI ausente en 41 manuscritos (65%) y 36 páginas web (80%). D3 (metodológica): nivel de evidencia "experimental", laboratorial (26; 41,2%) o en humanos (4; 6,3%); investigación independiente en 36 (57%). D4 (interpretativa): principal interrogante en páginas web fue el carácter dañino o no de los PTC; en artículos científicos, los efectos de micro/nanopartículas de los PTC a mediano/largo plazo. Conclusiones: Se precisa que la comunidad científica complete los respectivos estudios de toxicidad y reducción del daño (harm reduction) relativos a los PTC y resuelva junto con el público y las autoridades, preguntas relativas a su seguridad a mediano y largo plazo.

Summary: Object: To explore knowledge gaps and possible future research line on Heat-not-burn tobacco products (HBT) from the published scientific literature and internet sources available to the population. Methods: Mixed methods qualitative/quantitative study under typology of literature reviews by Grant & Booth and Pinto, and mapping review study design by Cooper. Database search and check-in of titles/abstracts in 4 languages from 2016-12-01 to 2017-12-31. Texts saved in MHT and PDF formats, located in Dropbox and managed with Endnote X8. Category definitions grouped in 4 dimensions. Information analyzed with Microsoft® Excel 2016 and Epi-INFO® 7.2.2 Results: 46 webpages and 63 papers located, 99% in English; 2 manuscripts had withdrawal notes. In D1 (summary): product advertisement vs toxicological or evaluative aspects of the HBT. 48 papers (76,2%) in digital or printed (2017); by country, USA: webpages 23 (50%), 20 papers (32%); Switzertland: 22 papers (35%), 3 webpages (7%). D2 (commercial): financing by Phillip Morris International (PMI, 22, 33%) or universities with own or government funds (19, 30%); on webpages PMI (60%), British American Tobacco and Japan Tobacco International (40%); relation with PMI absent in 41 papers (65%) and 36 webpages (80%). D3 (methodological): evidence level "experimental", laboratory (26; 41,2%) or humans (4, 6,3%); independent research in 36 (57%). D4 (interpretative): main question on webpages was whether HBT products were harmful or not; on papers, the effects of HBT micro/nanoparticles at medium/long term. Conclusion: It is required from scientific community to finish their respective toxicity and harm reduction studies on HBT and to guide and solve questions related to HBT safety in medium/long term alongside population and authorities.

Résumé: Objectif: Explorer les besoins en connaissances et les éventuelles futures lignes de recherche sur les Produits de Tabac Chauffé, PTC (Heat- not-burn tobacco products), á partir de la littérature scientifique publiée et de sources Internet destinées au public. Méthodes: Étude mixte, qualitative / quantitative en paralléle, selon le tipe de revue de littérature proposé par Grant & Booth et Pinto, et conception d'études de cartographie selon Cooper. Exploration de bases de données á partir de moteurs de recherche, révision de titres / résumés en quatre langues du 01-12-2016 au 31-12-2017. Textes enregistrés aux formats MHT et PDF, stockés dans Dropbox et gérés avec Endnote X8. Définition de catégories regroupées en quatre dimensions. Information analysée avec Microsoft® Excel 2016 et Epi-INFO ® 7.2.2. Résultats: 46 pages Web révisées, 63 références scientifiques dont 99% en anglais; deux manuscrits avec acte de retrait. En D1 (résumé): présentation du produit vs aspects toxicologiques ou évaluatifs des PTC. 48 articles (76,2%) en version numérique ou imprimée (2017); par pays: États-Unis: 23 pages Web (50%), 20 articles (32%); Suisse: 22 articles (35%), trois pages Web (7%). D2 (commercial): financement par Phillip Morris International (PMI, 22, 33%) ou par des universités disposant de fonds propres/publics (19, 30%); dans les pages Web, ont prédominé PMI (60%), British American Tobacco et Japan Tobacco International (40%); la relation avec PMI était absente dans 41 manuscrits (65%) et 36 pages Web (80%). D3 (méthodologique): niveau de preuve «expérimental¼, de laboratoire (26, 41,2%) ou avec des humains (4, 6,3%); 36 recherches indépendantes (57%). D4 (interprétative): le principal questionnement dans les pages Web portait sur la nocivité ou non des PTC; dans les articles scientifiques, il portait sur les effets des micro/nanoparticules des PTC á moyen/long terme Conclusions: II est nécessaire que la communauté scientifique compléte les études respectives sur la toxicité et al.

Resumo: Objetivo: Explorar as necessidades de conhecimento e possíveis futuras linhas de investigação sobre os produtos de tabaco aquecido, PTC (Heat-not-burn tabaco), a partir da literatura científica publicada e fontes da Internet para o público. Métodos: Estudo misto qualitativo/quantitativo baseado na tipologia de revisao da literatura de Grant & Booth e Pinto, e no desenho de estudos de mapeamento de Cooper. A exploração de bases de dados em motores de busca realizou-se pelos títulos/resumos em quatro idiomas de 2016-12-01 a 2017-12-31. Os textos foram guardados em formatos MHT e PDF, armazenados no Dropbox e geridos com o Endnote X8. As categorias foram agrupadas em quatro dimensões. A informação foi analisada com o Microsoft® Excel 2016 e Epi-INFO ® 7.2.2. Resultados: Foram agrupados em 46 páginas web, 63 referências científicas, 99% em inglês; dois manuscritos com notas. Em D1 (resumo): verifica-se a apresentação do produto versus aspetos toxicológicos ou avaliativos do PTC. 48 artigos (76,2%) em formato digital ou em suporte papel (2017); por país: EUA: páginas da Web 23 (50%), 20 artigos (32%); Suíça: 22 artigos (35%), três páginas da web (7%). D2 (comercial): financiamento pela Phillip Morris International (PMI, 22, 33%) ou universidades com fundos próprios/governamentais (19, 30%); nas páginas web predominaram as PMI (60%), British American Tobacco e Japan Tobacco International (40%); a relação com PMI está ausente em 41 manuscritos (65%) e 36 páginas na web (80%). D3 (metodológico): nível de evidência "experimental", laboratorial (26, 41,2%) ou em humanos (4, 6,3%); pesquisa independente em 36 (57%). D4 (interpretativa): a principal questão nas páginas web foi a natureza nociva ou não do PTC; em artigos científicos, os efeitos das micro/nanopartículas do PTC no médio / longo prazo. Conclusoes: É necessário que a comunidade científica complemente os respetivos estudos de toxicidade e redução de danos (harm reduction) relacionados com o PTC e resolva, em conjunto com o público e as autoridades, questões relativas à sua segurança a médio e longo prazo.

Fukushima: lecciones japonesas para la Salud Pública colombiana. Reporte de caso / Fukushima: japanese lessons to colombian Public Health

Resumen Introducción: Durante el 21o. Congreso Mundial de Epidemiología, organizado por la Asociación Internacional de Epidemiología (IEA) en Saitama-Japón en agosto de 2017, se aceptó invitación de los organizadores para visitar la Planta Nuclear # 1 de Fukushima. Objetivo: Explorar la situación operacional y de salud pública en el área de la prefectura de Fukushima y su planta nuclear #1, sitio afectado por el terremoto y tsunami de 2011. Métodos: Salida de inspección de campo (Inspection Tour) y encuentro con representantes de TEPCO (Tokyo Energy Power Company) en área de control; explicación didáctica de antecedentes y situación actual zonal, e instrucciones (briefing) para acceso. Visita con explicación de zonas de atención de salud y trabajos realizados. Recorrido en autobús especialmente adaptado al perímetro de cada reactor, portando dosímetro individual. Reunión final para resolución de dudas e inquietudes y lecciones del caso. Resultados: Visita y reuniones ejecutadas; exposición personal = 0,01 mSv/h. Radiación por zonas de reactor: central=230 mSv/h; paredes=40 mSv/h; planta=0,26 mSv/h, periferia=0,26 mSv/h. Zona de exclusión=20 km. Políticas de salubridad basadas en limpieza y remoción de fuentes de contaminación; aislamiento de aguas y bombeo de fuentes subterráneas; prevención y contención de escapes. Conclusión: La prevención lo es todo en asuntos industriales, sean nucleares o no; la colaboración interpersonal e interagencias es esencial en el manejo a muy largo plazo de desastres similares; debe evitarse incorporar técnicas o tecnologías industriales desconocidas o foráneas sin antes valorar su costo, alcance y posibles riesgos de salud individual, pública o medio-ambiental.

Abstract Introduction. During the 21st. International Epidemiology Association (IEA) World Congress of Epidemiology at Saitama (Japan), celebrated in August 2017, an invitation from its organizers to visit Fukushima Nuclear Plant # 1 was accepted. Objective: To explore operational and public health situation at the area of the Fukushima Prefecture and its nuclear plant #1, place affected by the 2011 earthquake and tsunami. Methods. Inspection tour and appointment with representatives of TEPCO (Tokyo Energy Power Company) at the control area; explanation on background and actual situation, and briefing before access. Guided visit to areas dedicated to healthcare and workers' attention, and work done. Tour by specially adapted autobus to the perimeter of each reactor, using individual dosimeter. Final meeting to solve questions and lessons of this case. Results. Visit and meetings were executed; individual exposure = 0,01 mSv. Radioactivity by reactor zones: central (inside) =230 mSv/h; walls =40 mSv/h; plant =0,26 mSv/h, perimeter =0,26 mSv/h. Exclusion zone =20 km. Public Health policies in place based upon cleansing and removal of sources of contamination; water isolation and subterranean sources pumping; prevention and containment of leaks. Conclusion. About industrial issues, prevention is everything, whether they be nuclear or not; interpersonal / interagencies' cooperation is paramount when dealing with similar disasters at a very long term; unknown or poorly understood industrial techniques or technologies should be avoided before a proper evaluation of their risk/benefit balance, scope and possible health risks to subjects, communities or environment.

Carga de enfermedad por lesiones de causa externa en Casanare, Colombia, 2008-2012 / Burden of disease by external causes of injury in Casanare-Colombia, 2008-2012

RESUMEN Objetivo Estimar la carga de enfermedad por lesiones de causa externa (LCE) en el departamento de Casanare durante 2008-2012. Métodos Estudio descriptivo retrospectivo desde los registros de la notificación al Sivigila de los eventos agrupados como LCE y los eventos reportados al Sistema de Vigilancia Epidemiológica de Lesiones de Causa Externa (SIVELCE). Análisis de variables en tiempo-lugar-persona mediante estadística descriptiva, con plantillas disponibles vía OMS en Microsoft Office® Excel 2013 y Epi-Info® 7.1.3. Resultados Entre 2008-2012 fueron notificados al Sistema de Salud Pública (SIVI-GILA) 5 829 casos agrupados como LCE: accidente ofídico 751(12,9%), agresiones por rabia 3 774(64,7%), intoxicaciones 1 231(21,1%), lesiones por pólvora 32(0,5%) y violencia 41(0,7%), razón hombre/mujer 1:1, edad promedio 25±19,3(r=0,01-92) años, años de vida ajustados por discapacidad (AVAD) 821(2,5 años por 1 000 habitantes); y, al SIVELCE 15 539 reportes: lesiones intencionales 12 834(82,6%) y lesiones no intencionales 2 704(17,4%), razón hombre/mujer 1:1, edad promedio 28±14,1(r=0,03-90) años, relación entre morir por lesiones intencionales vs lesiones no intencionales tuvo una razón de disparidad OR=0,12 (X2=1 060,56 1 g.l, valor-p=0,0), AVAD 18 179(55,8/1 000). Conclusiones Las LCE afectan por igual a hombres y mujeres, los AVAD ocurren a expensas de la morbilidad. Todas las LCE son prevenibles, por tanto, es necesario fortalecer las respectivas acciones de vigilancia, prevención y control.(AU)

ABSTRACT Objective To estimate the burden of disease for external causes of injury in the department of Casanare during the 2008-2012 period. Materials and Methods Retrospective descriptive study on the records of the events grouped as external causes of injury notified to SIVIGILA and the events reported to the Epidemiological Surveillance System of External Causes (SIVELCE). Analysis of time, place, and person variables through descriptive statistics, using templates available via WHO in Microsoft Office® Excel 2013 and Epi-Info® 7.1.3. Results Between 2008 and 2012, 5 829 cases grouped as external causes of injury were notified to SIVIGILA: 751 ophidic accidents (12.9%), 3 774 rabies attacks (64.7%), 1 231 poisoning cases (21.1%), 32 gunpowder injuries (0.5%), and 41 cases of violence (0.7%), with a male/female ratio of 1:1, average age of 25±19,3 (r=0.01-92), and 821 disability-adjusted life years (DALYs) (2. 5 years per 1 000 inhabitants). In turn, SIVELCE received 15 539 reports: 12 834 intentional injuries (82.6%) and 2 704 unintentional injuries (17.4%), with a male/female ratio of 1:1, average age of 28±14.1 (r=0.03-90), correlation between dying by intentional injuries vs. unintentional injuries with an odds ratio of OR=0.12 (X2=1 060.56 1 g.l; p value=0.0), and DALY of 18 179 (55.8/1 000). Conclusions The external causes of injury affect men and women equally; DALYs occur at the expense of morbidity. All external causes of injury are preventable; therefore, it is necessary to strengthen surveillance, prevention and control actions.(AU)

Prevalencia de enfermedades crónicas no transmisibles, Trinidad-Casanare / Prevalence of chronic non-transmissible diseases in Trinidad - Casanare

Objetivo: establecer la prevalencia de las enfermedades crónicas no transmisibles (ECNT) en el municipio de Trinidad-Casanare durante 20122014. Métodos: estudio descriptivo, transversal, retrospectivo a partir de datos consignados en los Registros Individuales de Prestación de Servicios (RIPS). Análisis realizado mediante estadística descriptiva con Epi-Info 7.2.0. Resultados: el 11,6%(1.032/8.934) de registros fueron ECNT, en 2012(317; 30,7%), 2013(299; 29,0%) y 2014(416 (40,3%); área urbana 757(73,3%), rural 230(22,2%), sin datos 45(4,3%); hombres 466(45,2%) y mujeres 566(54,8%); edad promedio 40 ±25,8(rango=0,2-106); razón hombre/mujer 4:5. Prevalencia por sistema: respiratorio 301(29,1%), digestivo 253(24,5%), circulatorio 186(18,0%), endocrino 57(5,5%), genitourinario 155(15,0%), trastornos mentales/orgánicos 29(2,8%), osteomuscular/tejido conectivo 20(1,9%); hematológico/anemia 11(1,1%), nervioso 10(1,0%), oncológico/ neoplasias 6(0,6%), genético 4(0,4%). Conclusiones: se evidencia un incremento en el número de personas atendidas durante el período a estudio con predominio del sexo femenino. Se recomienda la vigilancia de estas condiciones en aras de definir prioridades a mediano y largo plazo para la Salud Pública local.

Abstract Objectiv: to determine prevalence of chronic non-transmissible diseases (CNTD) at the municipality of Trinidad-Casanare during 2012-2014. Methods: cross-sectional study on data from the Service Provision Individual Registries (SPIR). Analysis through descriptive statistics using Epi-Info 7.2.0. Results: of all SPIRs, 11,6% (1.032/8.934) were CNTD; by year, 2012 (317; 30,7%), 2013 (299; 29,0%) and 2014(416 (40,3%); by city área, urban 757 (73,3%), rural 230 (22,2%), without data 45 (4,3%); by sex, men 466 (45,2%), women 566 (54,8%). Mean age was 40±25,8 (range=0,2-106); ratio male/ female was 4:5. Prevalence by bodily system: respiratory 301 (29,1%), digestive 253 (24,5%), circulatory 186 (18,0%), endocrine 57 (5,5%), genitourinary 155 (15,0%), mental/psychiatric 29 (2,8%), ostheomuscular/connective tissue 20 (1,9%); hematologic 11 (1,1%), nervous system 10(1,0%), oncologic 6(0,6%), genetic 4(0,4%). Conclusions: this study found out an increase in outpatients attended during the period under study; females were predominant. Surveillance of this conditions is recommended in order to set both medium and long-term priorities for the local Public Health.

Conocimientos, actitudes y prácticas frente al control del vector Aedes aegypti, Villanueva-Casanare, Colombia, 2016 / Knowledges, attitudes and practices in front the control of the vector Aedes aegypti, Villanueva-Casanare, Colombia, 2016

Objetivo. Identificar, para Villanueva, los conocimientos, actitudes y prácticas (CAP) de la comunidad frente a enfermedades transmitidas por Aedes aegypti sus factores de riesgo, signos, síntomas asociados con las enfermedades y, medidas de prevención. Métodos. Estudio transversal. Muestreo aleatorio por conglomerados. Análisis realizado mediante estadística descriptiva con Epi-Info 7.2.0. Resultados. 211 encuestas diligenciadas; mujeres 155(73,5%). Edad promedio 34,2±17,2(rango 10-85) años, tiempo medio de permanencia en el municipio 19,2±16,8(rango 1-78) años. Conocimiento sobre rol transmisor del mosquito osciló entre 76,8%-90,5%; desconocimiento sobre signos y síntomas causados por estas enfermedades osciló entre 90%-100. Se encontró bajo conocimiento (8,5%-28,0%) y bajo uso (4,7%-27,0%) de medidas de control basadas en acciones individuales/colectivas. La medida estatal/gubernamental de control más recordada fue fumigación (42,2%). Conclusiones. Existe un conocimiento somero sobre el vector y las enfermedades. Se precisan acciones decididas a través de la movilización social, un acompañamiento intensivo de las comunidades.

Objective. To dentify in Villanueva’s people their knowledges, attitudes and practices (KAP) about diseases transmitted by Aedes aegypti - Dengue, Chikungunya and Zika viruses, their risk factors, disease-associated signs and symptoms, and individual or collective measures against them. Methods. Cross-sectional. Analysis performed using descriptive statistics with Epi-Info 7.2.0. Results. 211 forms completed; women 155(73.5%), mean age 34,2±17,2 years (range 10-85). Mean residence time in the municipality 19.2±16.8 years (range 1-78). Knowledge about the transmission role of the mosquito oscillates between 76.8%-90.5%; ignorance about their signs and symptoms goes between 90%-100%. We found low knowledge (8.5%-28.0%) and low use (4.7%-27.0%) of prevention/control measures based upon individual or collective actions; 57.8% were not visited by a health worker in the last six months. Most remembered Public Health control measure by respondents was fumigation (42.2%). Conclusions. There is lack of knowledge about both vector and its related diseases. Strong, focused actions by health authority are needed through social mobilization, intensive communities’ support and empowerment.

Epidemiología social y economía política: la UCI como punto de encuentro / Social epidemiology and political economy: ICU as point of convergence / Epidemiologia social e economia política: a UTI como ponto de encontro

Las interrogantes acerca de epidemiología, economía y cuidado crítico suelen estar en la mente de casi cualquier profesional de la salud. Sin embargo, casi nunca se tiene presente que la epidemiología y la economía pueden converger -a pesar de ser campos de estudio aparentemente separados- y que lo pueden hacer para explicar la situación actual o las tendencias futuras de un servicio hospitalario o de salud pública. Este ensayo presenta brevemente el devenir de la epidemiología social y de la economía política y cómo ambas actividades académicas pueden encontrar intereses comunes a propósito de la Unidad de Cuidado Intensivo (UCI), en particular para generar interrogantes, posibles áreas de investigación y alternativas hacia el desarrollo de servicios de salud más eficientes, más efectivos y más humanos.

Questions around epidemiology, economics and critical care are often in the mind of almost any healthcare professional. However, it is seldom realized that epidemiology and economymay converge -in spite of being apparently separated fields of study- in order to explain the present situation or future trends of a hospital or public health service. This essay briefly depictshow social epidemiology and political economy have developed and how both academic activities may find a common ground about the Intensive Care Unit (ICU), particularly to pose questions, to create possible research lines and feasible alternatives towards more efficient, effective and humane health services.

As interrogantes sobre de epidemiologia, economia e cuidado crítico acostumam estar na mente de quase qualquer professional da saúde. Porém, quase nunca se tem presente que a epidemiologia e a economia podem convergir -apesar de ser campos de estudo aparentemente separados- e que o podem fazer para explicar a situação atual ou as tendências futuras de um serviço hospitalar ou de saúde pública. Este ensaio apresenta brevemente o devir da epidemiologia social e da economia política e como ambas atividades acadêmicas podem encontrar interesses comuns a propósito da Unidade de Tratamento Intensivo (UTI), em particular para gerar interrogantes, possíveis áreas de investigação e alternativas para o desenvolvimento de serviços de saúde mais eficientes, maisefetivos e mais humanos.

Agotamiento profesional: hacia una epidemiología social de la unidad de cuidado intensivo / Burnout: Towards a social epidemiology of the intensive care unit

Resumen Algunos autores dentro de la epidemiología social proponen el estudio del balance salud-enfermedad a partir de la noción de sistemas sociales interrelacionados por niveles jerárquicos; tal proposición trasciende lo probabilístico y lo cuantitativo al abordar diferentes niveles de la realidad de lo individual a lo global o del continuo espacio -tiempo-ubicación e historicidad. La unidad de cuidado intensivo puede verse como uno de estos sistemas sociales, pues cuenta con instalación médica de alta complejidad científica y tecnológica para vigilancia, soporte, cuidado y terapéutica de pacientes críticos y propensos a una muerte evitable. Esta tarea puede ser tan exigente para los médicos intensivistas que los agobia más allá del mero cansancio físico, originándose el llamado agotamiento profesional o burnout, un problema de salud pública que permanece en la sombra por diversas razones. Se proponen aquí las nociones de configuración y de sistema social, expresadas en cuatro categorías básicas (las "cuatro E": especialidad, equipamiento, edificio y entorno), como elementos susceptibles de investigación integral y se concluye con algunas ventajas de la aplicación de esta alternativa, las cuales se dan a través de un enfoque investigativo mixto cualicuantitativo en enfermedades no transmisibles que puedan afectar, en este caso particular, al cuerpo de profesionales y técnicos de salud hospitalarios.

Abstract Some social epidemiology authors propose studying the health-disease balance based on the notion of social systems interconnected by hierarchical levels; this proposition transcends the quantitative and probabilistic aspects by addressing different levels of reality, from the individual to the global, or based on the space-time-location continuum and historicity. The intensive care unit can be seen as one of these social systems, since it requires a high scientific and technologically complex medical facility for monitoring, support, care and treatment of critical and prone to preventable death patients. This task can be so challenging for intensive care doctors who can feel overwhelmed beyond simple physical fatigue, resulting in the so-called burnout, a public health issue that remains in the shade for several reasons. Configuration and social system notions are proposed here and are expressed in four basic categories: specialty, equipment, building and environment, which act as elements susceptible of comprehensive research. The conclusions include some advantages of applying this alternative, which are generated through a qualitative- quantitative research approach to non-communicable diseases that may affect, in this particular case, the body of professionals and hospital health technicians.

[Knowledge, attitudes and community practice during an outbreak of dengue in a town in Colombia, 2010]. / Conocimientos, actitudes y prácticas comunitarias en un brote de Dengue en un municipio de Colombia, 2010.

OBJECTIVE: 17 cases of dengue were reported from the town of El Playón (7°28'15"-N/73°12'00"-W/altitude 510 masl) during epidemiological study weeks 5-6 and 12-13/2010. The Santander Department's Health Secretariat sought outbreak investigation and community knowledge-attitudes-practice (KAP) assessment on 16-4-2010 concerning a dengue fever outbreak in the town after an epidemiological surveillance committee had met; this was to strengthen local action regarding Aedes aegypti vector promotion-prevention-control. METHODS: This was a descriptive outbreak investigation study using an active search for cases having clinical manifestations of dengue according to protocol definitions, an entomological survey and a KAP survey of 47 people selected by simple-random-sampling. Data was systematised and analysed using Epi-INFO (3.5.1) with measures of central tendency-male ratio, in-house Aegypti (IA), water-storage (WI) and Breatau (BI) indexes. RESULTS: 4,774 clinical records were examined. There were 67 records compatible with dengue, 24 cases were notified (75 % town-25 % department), 15 (63 %) being women and 9 (38 %) men. 20 (83 %) cases occurred in the urban area and 4 (17 %) in rural areas. Attack rate/cumulated incidence: initial=0.3 % (17/6 303), final=0.4 % (24/6 303), male ratio=1.5. 47 houses and 142 water-storage items proved positive: low water-stores=8.7 %(4/46), rubber tyres=8.3 %(1/12), others=4.4 %(2/45), plants=2.9 %(1/34). IA=5 %, WI=6%, BI=17%, taxonomy confirmed=15 %(7/47). 47 KAP, 36 (77 %) women, 11 (23 %) men; knowledge on disease, symptoms and signs 44 (94 %), eliminating larvae deposits 32(68 %), asked about dengue 3(6 %), informed about responsibilities related to control 25(53 %). CONCLUSIONS: The local community knows about risk factors and is aware of its responsibility regarding vector control. Community participation should be promoted using the ecosystem as a strategy for mosquito and dengue transmission control.