National and regional population attributable fractions for anemia risk factors (iron, folate, and vitamin B12) in Belize: potential impact of fortification.

Objective: To estimate the national and regional population attributable fraction (PAF) and potential number of preventable anemia cases for three nutritional risk factors (iron, red blood cell folate [RBCF], and vitamin B12 deficiencies) among women of childbearing age in Belize. Methods: A national probability-based household and micronutrient survey capturing sociodemographic and health information was conducted among 937 nonpregnant Belizean women aged 15-49 years. Blood samples were collected to determine hemoglobin, ferritin, alpha-1-glycoprotein (AGP), RBCF, and vitamin B12 status. All analyses used sample weights and design variables to reflect a complex sample survey. Logistic regression was used to determine adjusted prevalence risk (aPR) ratios, which were then used to estimate national and regional PAF for anemia. Results: The overall prevalence of anemia (hemoglobin <12 g/dL) was 21.2% (95% CI [18.7, 25.3]). The prevalence of anemia was significantly greater among women with iron deficiency (59.5%, 95% CI [48.7, 69.5]) compared to women without iron deficiency (15.2%, 95% CI [12.2, 18.3]; aPR 3.9, 95% CI [2.9, 5.1]). The three nutritional deficiencies examined contributed to 34.6% (95% CI [22.1, 47.1]) of the anemia cases. If all these nutritional deficiencies could be eliminated, then an estimated 5 953 (95% CI [3 807, 8 114]) anemia cases could be prevented. Conclusions: This study suggests that among women of child-bearing age in Belize, anemia cases might be reduced by a third if three modifiable nutritional risk factors (iron, RBCF, and vitamin B12 deficiencies) could be eliminated. Fortification is one potential strategy to improve nutritional status and reduce the burden of anemia in this population.

Newborn care in Indonesia, Lao People's Democratic Republic and the Philippines: a comprehensive needs assessment.

BACKGROUND: Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People's Democratic Republic (PDR) and the Philippines. METHODS: We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns' health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. MAIN FINDINGS: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. CONCLUSIONS: Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.

The Role of Documentation Status Concerns, Perceived Discrimination, and Social Support on Latinx Adults' Physical and Mental Health.

There is a growing number of immigrants arriving in the USA, with the majority being of Latinx descent. Coupled with this increase, there has also been growing anti-immigration legislation which impacts the experiences this group faces and creates additional concerns for those who are residing in this country without documentation. Experiences of overt and covert discrimination and marginalization have been shown to relate to poorer mental and physical health outcomes. Drawing from Menjivar and Abrego's Legal Violence Framework, this paper explores the impact of perceived discrimination and social support on the mental and physical health of Latinx adults. We further observe whether these relationships differ based on participants' concerns about their documentation status. This data comes from a community-based participatory study conducted in a Midwestern County. Our analytic sample was comprised of 487 Latinx adults. We found social support to be related to fewer self-reported days of mental health symptoms for all participants regardless of documentation status concern. Perceived discrimination was found to be related to worse physical health for participants with concerns about their status. These findings point to the pernicious role of discrimination for Latinx's physical health and the importance of social support as an asset beneficial for their mental health.

Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals.

OBJECTIVES: Racial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non-Hispanic White children undergo drug testing less often than children from other groups. METHODS: We conducted a retrospective cohort study of emergency department (ED)-only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self-harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non-Hispanic) Asian, (non-Hispanic) Black, Hispanic, and (non-Hispanic) White children overall, by condition and patient cohort (ED-only vs. hospitalized) and across hospitals. RESULTS: Among 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05-1.33) than White children. Black-White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18-1.69) but not among ED-only encounters (aOR: 1.07; 0.92-1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals. CONCLUSIONS: Hospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.

Corrigendum: D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: a multi-national case series from different waves.

[This corrects the article DOI: 10.3389/fmed.2023.1103842.].

D-dimer trends elaborate the heterogeneity of risk in hospitalized patients with COVID-19: A multi-national case series from different waves.

Introduction: Variable D-dimer trends during hospitalization reportedly result in distinct in-hospital mortality. In this multinational case series from the first and second waves, we show the universality of such D-dimer trends. Methods: We reviewed 405 patients with COVID-19 during the first wave admitted to three institutions in the United States, Italy, and Colombia, and 111 patients admitted to the U.S. site during the second wave and 55 patients during the third wave. D-dimer was serially followed during hospitalization. Results: During the first wave, 66 (15%) patients had a persistently-low pattern, 33 (8%) had early-peaking, 70 (16%) had mid-peaking, 94 (22%) had fluctuating, 30 (7%) had late-peaking, and 112 (26%) had a persistently-high pattern. During the second and third waves, similar patterns were observed. D-dimer patterns were significantly different in terms of in-hospital mortality similarly in all waves. Patterns were then classified into low-risk patterns (persistently-low and early-peaking), where no deaths were observed in both waves, high-risk patterns (mid-peaking and fluctuating), and malignant patterns (late-peaking and persistently-high). Overall, D-dimer trends were associated with an increased risk for in-hospital mortality in the first wave (overall: HR: 1.73) and stayed the same during the second (HR: 1.67, p < 0.001) and the third (HR: 4.4, p = 0.001) waves. Conclusion: D-dimer behavior during COVID-19 hospitalization yielded universal categories with distinct mortality risks that persisted throughout all studied waves of infection. Monitoring D-dimer behavior may be useful in the management of these patients.

Carcinoma de tiroides: Descripción de 634 pacientes atendidos en el Hospital Universitario San Ignacio, Bogotá, D. C., Colombia / Thyroid carcinoma: Description of 634 patients treated at the Hospital Universitario San Ignacio, Bogotá, D. C., Colombia

Introducción. La incidencia del carcinoma de tiroides ha aumentado a nivel mundial, probablemente relacionado con el sobre diagnóstico de nódulos tiroideos asintomáticos. La alta sobrevida del carcinoma diferenciado de tiroides ha permitido posibilidades de manejo quirúrgico menos radicales, o inclusive, la vigilancia activa de tumores seleccionados. Existen reportes de características clínico-patológicas del carcinoma de tiroides de nuestro país distintas a las reportadas en la literatura internacional. Métodos. Estudio observacional descriptivo de una cohorte retrospectiva de pacientes con carcinoma de tiroides atendidos en un hospital universitario entre 2015 y 2020. Resultados. Se identificaron 634 pacientes, el 83,4 % de sexo femenino. La tiroidectomía total con vaciamiento central fue el procedimiento más realizado (86,7 %). De 613 carcinomas diferenciados de tiroides, el 94,2 % corresponden al tipo papilar, seguido por el carcinoma de células de Hürtle (1,6 %); el 26,2 % presentaron subtipos histológicos agresivos y el 28,4 % compromiso tumoral bilateral. En los vaciamientos centrales se encontró 58,7 % de enfermedad metastásica; que fue de 49 % en los pacientes con microcarcinomas papilares (19 %). De las 68 lesiones del nervio laríngeo recurrente, 47 % fueron por secciones oncológicas. Discusión. En nuestra serie, la proporción de pacientes con carcinoma papilar de tiroides y de sus variantes histológicas agresivas, así como el compromiso tumoral bilateral es mayor a lo reportado en la literatura científica. Conclusión. El comportamiento biológico del carcinoma de tiroides es variable y puede tener características diferentes entre regiones; el manejo en nuestro medio debería considerar las características propias de nuestra población.

Introduction. The incidence of thyroid carcinoma has increased worldwide, probably related to the overdiagnosis of asymptomatic thyroid nodules. The high survival of differentiated thyroid carcinoma has allowed less radical surgical resection or even active surveillance for selected tumors. There are reports of clinicopathological features of thyroid carcinoma in our country that are different from those reported in the international literature. Methods. Retrospective observational study of a cohort of patients with thyroid carcinoma treated at a university hospital between 2015 and 2020. Results. 634 patients were identified; 83.4% were female. Total thyroidectomy with central dissection was the most performed procedure (86.7%). Of the 613 differentiated thyroid carcinomas, 94.2% were papillary type, followed by Hürtle cell carcinoma with 1.6%; 26.2% presented aggressive histological subtypes and 28.4% had bilateral tumor involvement. Metastatic disease was found in 58.7% of the central dissections performed, which was 49% in patients with papillary microcarcinomas (19%). Of the 68 recurrent laryngeal nerve injuries, 47% were due to oncological involvement. Discussion. In our series, the rate of patients with papillary thyroid carcinoma and its aggressive histological subtypes as well as bilateral tumor involvement is higher than that reported in the scientific literature. Conclusion: The biological behavior of thyroid carcinoma is variable and may have different characteristics between regions; the management in our country should consider our population's characteristics.

Reducing Unnecessary Imaging for Patients With Constipation in the Pediatric Emergency Department.

OBJECTIVES: Constipation is a common diagnosis in the pediatric emergency department (ED). Children diagnosed with constipation may undergo an abdominal radiograph (AXR) as part of their diagnostic workup despite studies that suggest that an AXR in a patient suspected of being constipated is unnecessary and potentially misleading. We aimed to decrease the percentage of low-acuity patients aged between 6 months and 18 years diagnosed with constipation who undergo an AXR in our pediatric ED from 60% to 20% over 12 months. METHODS: We conducted an interventional improvement project at a large, urban pediatric ED by using the Institute for Healthcare Improvement's Model for Improvement. The primary outcome was the proportion of patients ultimately diagnosed with constipation who had an AXR during their ED visit. Analysis was performed by using rational subgrouping and stratification on statistical process control (SPC) charts. RESULTS: Process analysis was performed by using a cause-and-effect diagram. Four plan-do-study-act cycles were completed over 9 months. Interventions included holding Grand Rounds on constipation, sharing best practices, metrics reporting, and academic detailing. Rational subgrouping and stratification on SPC charts were used to target the interventions to different ED provider groups. Over 12 months, we observed a significant and sustained decrease from a mean rate of 62% to a mean rate of 24% in the utilization of AXRs in the ED for patients with constipation. CONCLUSIONS: The use of rational subgrouping and stratification on SPC charts to study different ED provider groups resulted in a substantial and sustained reduction in the rate of AXRs for constipation.

Cambio en la mortalidad intrahospitalaria durante el primer pico por SARS- COV-2 en Bogotá, Colombia / Change of in-hospital mortality during the first SARS-COV-2 surge in Bogotá, Colombia

Resumen Introducción: La mortalidad por SARS-COV-2 ha disminuido en diferentes países, pero no se ha evaluado si es igual en Colombia, o si se relaciona con las carac terísticas de los pacientes y tratamientos utilizados. Objetivo: Comparar la mortalidad por SARS-COV-2, en dos periodos de tiempo controlando por factores de riesgo asociados con mortalidad. Metodología: Estudio observacional, basado en una cohorte retrospectiva de pacientes con SARS-COV-2 atendidos en el Hospital Universitario San Ignacio, Bogotá (Colombia), desde el 19 de marzo al 12 de noviembre, 2020. Se comparó la tasa de mortalidad intrahospitalaria de los pacientes egresados antes y después del 21 de agosto de 2020 (primer pico de mortalidad en Colombia) y se analizó el impacto del momento de atención controlando por comorbilidades, severidad al ingreso y tratamiento recibido, usando un modelo de regresión logística. Resultados: 1399 pacientes (944 antes y 455 después del primer pico de mortalidad) fueron analizados. La tasa de mortalidad intrahospitalaria global fue similar en ambos periodos (17.6% vs 16.3%, p=0.539). En el análisis multivariado se encontró que la atención en el segundo periodo de tiempo se asoció a menor mortalidad (OR 0.66 IC95% 0.47; 0.93, p=0.018), a diferencia del aumento de la misma asociado a la edad (OR 1.06 IC95% 1.05; 1.07, p<0.001), sexo masculino (OR 1.84 IC95% 1.33; 2.54 p<0.001), cirrosis (OR 1.89 IC95% 1.24; 2.88, p=0.003), enfermedad renal (OR 1.36 IC95% 1.00; 1.83, p=0.043) y el uso de dexametasona (OR 1.53 IC95% 1.03; 2.28, p=0.031). Conclusiones: La tasa de mortalidad intrahospitalaria se redujo después del 21 de agosto durante la primera ola de la pandemia en Bogotá, posiblemente asociado a la mejoría en la capacidad de respuesta del sistema de salud en ese momento, o a un menor inoculo viral de los pacientes infectados. Estos hallazgos pueden cambiar con la saturación del sistema de salud.

Abstract Introduction: Mortality secondary to SARS-COV 2 has decreases around the world, however this has not been evaluated in Colombia neither has the correlation between patient characteristics or treatments. Objective: To compare the mortality due to SARS-COV-2, in two periods of time, controlling risk factors associated with mortality. Methodology: Observational retrospective cohort study of patients with SARS- COV-2 treated at the San Ignacio University Hospital in Bogotá (Colombia), from March 19 to November 12, 2020. The in-hospital mortality rate of patients discharged before and after August 21, 2020 (surge mortality in Colombia) was com pared. The impact of the moment of attention was analyzed controlled by comorbidities, severity at admission and treatment received using a bivariate and multivariate logistic regression model. Results: 1399 patients (944 before and 455 after August 21) were analyzed. The overall in-hospital mortality rate was similar at both times (17.6%vs16.3percentage, p=0.539). In the multivariate analysis, it was found that the moment of attention was associated with lower mortality (OR 0.66 95% CI0.47;0.93,p=0.018), in contrast to its increase associated with age (OR 1.06 95% CI 1.05;1.07,p=<0.001), male sex (OR 1.84 95%CI 1.33;2.54,p=<0.001), cirrhosis (OR1.89 95%CI 1.24;2.88, p=0.003), kidney disease (OR 1.36 95% CI1.00;1.83,p=0.043) and the use of dexamethasone (OR1.53 95%CI 1.03;2.28,p=0.031). Conclusions: The in-hospital mortality rate fell after August 21 during the first wave of the pandemic in Bogotá-Colombia, possibly associated with an improvement in response capacity, or a lower viral inoculum of infected patients. These findings may change with the saturation of the health system

Diseno del trabajo, bienestar y salud mental: Revision de literatura / Work Design, Well-being, and Mental Health: Literature Review

Resumen. El presente texto aporta al conocimiento sobre la relación entre diseno del trabajo, bienestar y salud mental. Realizamos una revisión de las publicaciones más recientes en relación con las variables estudiadas para ofrecer una sintesis de los principales conceptos, modelos teóricos y la evidencia empirica que explican la relación. Efectuamos la búsqueda en cuatro bases de datos: Web of Science, Springer, Ebsco y Pro-Quest en las que identificamos N = 11,878 artículos sobre Work design (N = 4,332), Job Desgin (N = 4,854) y Job Demands-Resources (N = 2,692). Destacamos los modelos de características del trabajo y de demandas-recursos laborales, para promover el bienestar y salud mental de los trabajadores. Analizamos la importancia de integrar las variables a nivel práctico, en relación con las unidades de análisis individual, grupal y organizacional; así como la necesidad de tener en cuenta la variedad de ocupaciones, cargos y la forma en que sus empleados se interrelacionan.

Abstract. This text contributes to the knowledge about the relationship between work design, well-being and mental health. We review the most recent publications concerning the variables studied to offer a synthesis of the main concepts, theoretical models and the empirical evidence that explain the relationship. We searched four databases: Web of Science, Springer, Ebsco and Pro-Quest, in which we identified N = 11,878 articles on Work design (N = 4,332), Job design (N = 4,854) and Job Demands-Resources (N = 2,692). We highlight the models of job characteristics and job-demand resources, to promote the well-being and mental health of workers. We discuss the importance of integrating the variables at a practical level, about the individual, group and organizational units of analysis; as well as the need to take into account the variety of occupations, positions and how their employees interact.

Enhanced auditory arousal increases intake of less palatable and healthier foods.

Two experiments were conducted to test a prediction of the arousal hypothesis that increased arousal will increase intake of less palatable and healthy foods. In both experiments, arousal was manipulated by adjusting the volume of a movie (soft, loud volume) while participants consumed foods. In Experiment 1, participants ate fresh (palatable) or stale (less palatable) popcorn during a 9-minute movie played at a soft or loud volume. Experiment 2 used the same procedures with healthier foods (carrot sticks and apple slices). Partial support for the arousal hypothesis in Experiment 1 showed that participants consumed more stale but not fresh popcorn in the loud (high arousal) versus soft (low arousal) volume group. These findings suggest that low but not high palatable foods are susceptible to manipulations of arousal. Consistent with this interpretation, Experiment 2 showed that high but not low environmental arousal increased intake of the fruits and vegetables, which are typically rated as lower in palatability compared to high fat foods. These results show that high arousal in an eating-typical environment increases intake of less palatable foods, and healthy foods (i.e., fruits and vegetables). Increasing the availability of healthier foods in a loud food environment can have a positive impact on increasing intake of fruits and vegetables in that environment.

Aislamiento de Microsporum canis y Microsporum gypseum en gatos asintomáticos del área metropolitana de Asunción / Isolation of Microsporum canis and Microsporum gypseum in asymptomatic cats from the metropolitan area of Asunción-Paraguay

Introducción: las mascotas generalmente son reservorios y diseminadores de hongos causantes de tiñas en humanos. Objetivo: aislar e identificar hongos dermatofitos en el pelaje de gatos asintomáticos del área metropolitana de Asunción. Materiales y métodos: se incluyeron 68 gatos asintomáticos del área metropolitana de Asunción, cuyas edades estaban entre 1 mes y 14 años. Las muestras de pelos fueron obtenidas por el método del tapete de Mariat y Tapia, se cultivaron en Agar Sabouraud con cloramfenicol y cicloheximida (agar Mycosel) y se incubaron 21 días a 28 ºC. La identificación se basó en las características macroscópicas y microscópicas de las colonias. Resultados: se aislaron hongos dermatofitos en 13 gatos: 10 (14,7%) tenían Microsporum canis y 3 (4,4%) Microsporum gypseum. No se encontró diferencias significativas en cuanto a la presencia del hongo y las variables sexo, edad, hábitat y contacto con otros animales. Conclusión: en gatos de Asunción se aislaron Microsporun canis (14,7%) y Microscporum gypseum (4,4%).

Introduction: pets are generally reservoirs and disseminators of fungi causing "tinea" in humans. Objective: to isolate and identify dermatophyte fungi in hair of asymptomatic cats of the metropolitan area of Asunción. Materials and methods: 68 asymptomatic cats were included from the metropolitan area of Asunción, whose ages were between 1 month and 14 years. The hair samples were obtained by the Mariat and Tapia mat method, they were cultivated in Sabouraud Agar with chloramphenicol and cycloheximide (Mycosel agar) and incubated 21 days at 28 ºC. The identification was based on the macroscopic and microscopic characteristics of the colonies. Results: dermatophyte fungi were isolated in 13 cats: 10 (14.7%) had Microsporum canis and 3 (4.4%) Microsporum gypseum. No significant differences were found regarding the presence of the fungus and the variables sex, age, habitat and contact with other animals. Conclusion: Microsporum canis (14.7%) and Microscporum gypseum (4.4%) were isolated of Asunción cats.

Comparison of UHPLC and HPLC methods for the assay of prostanoids: "are the methods equivalent in terms of accuracy and precision?".

BACKGROUND: As new methods are developed to increase efficiency and higher analytical performance, it is necessary to evaluate their quality in comparison to standard methods. To understand how the analytical performance changes between methods, it is common to compare the validation parameters; sensitivity, linearity, accuracy and precision. Here, we compare an UHPLC-UV method to the HPLC-UV method (reference method) for the simultaneous determination of seven prostanoids. Though the basic chromatography theory is the same for HPLC and UHPLC, the instrumentation has been modified to accommodate higher pressures, lower flow rates and smaller sample size. The differences in analytical instrumentation and procedures can give rise to method inequivalencies. Our approach evaluates the UHPLC and HPLC methods and poses the question: are the methods equivalent? To answer this question a statistical comparison of the analytical performance and method parameters is necessary. RESULTS: Statistical comparisons were performed using the t-test, F-test, regression analyses (ordinary linear regression and Deming regression) and Bland-Altman analyses. Statistical comparison of the results, suggested that the precision (amount of variability) is different (p < 0.05) for the HPLC and UHPLC methods. Whereas, the accuracy (method bias and the means) is similar (p > 0.05) for 8-isoprostane, 11-dehydro TXB2, PGE2 PGF(2α), PGD2 and 15-deoxy Δ¹²,¹4 PGJ2. DISCUSSION: Ordinary linear regression shows that the methods are well correlated for all compounds. The Deming regression, which assumes error in both the methods, suggests the existence of a proportional and constant bias for 11-dehydro TXB2 and only proportional bias for 8-isoprostane, PGF(2α), PGD2 and 15-deoxy Δ(12,14) PGJ2 between the two methods. According to Deming regression, the two methods are statistically similar for 6-keto PGF(1α) and PGE2. The Bland-Altman analyses indicate the two methods are commutable.

Frecuencia y factores asociados a caídas en adultos mayores atendidos en Consulta Externa en el Servicio de Geriatría del Hospital Almanzor Aguinaga Asenjo. 2013 / Frequency and associated factors with falls in aged treated in outpatient Service in Geriatric Department at the Hospital Almanzor Aguinaga Asenjo. 2013

Objetivo: Determinar la frecuencia y los factores asociados a caídas en adultos mayores atendidos en consulta externa en el Servicio de Geriatría del Hospital Almanzor Aguinaga Asenjo en el año 2013. Material y Métodos: Se realizó un estudio descriptivo-transversal. La muestra estuvo formada por 301 personas, elegidos por un muestreo aleatorio simple. Se tomaron datos generales, patologías y consumo de fármacos registrados en su historia clínica. Asimismo, realizó una entrevista en el consultorio, donde se aplicaron múltiples escalas validadas para valorar los factores asociados a caídas. Resultados: La frecuencia de caídas en los adultos mayores fue de 60,42%; de los cuales, 104 mujeres (57,14%) y 78 (42,86%) varones presentaron caídas en el último año. La edad promedio de los pacientes incluidos en el estudio fue de 77,8 años en las mujeres y 74,95 años en los varones. La mayoría de las caídas ocurrió en la casa (59,9%) y vía pública (41,1%). Entre los factores asociados a caídas se encontraron: edad mayor de 80 años (RP=1,51; [IC 95%=1,26-1,82]), alteración cognitiva (RP=1,84; [IC 95%=1,51-2,25]), alteración del equilibrio y la marcha (RP=2,25; [IC 95%=1,44-3,49]), miedo a caer (RP=2,11; [IC 95%=1,81-2,47]), depresión (RP=1,87; [IC 95%=1,53-2,28]), polifarmacia (RP=1,27 ; [IC 95%=1,05-1,53]), diabetes (RP=1,46 ; [IC 95%=1,24-1,73]), cataratas (RP=1,44 ; [IC 95%=1,21-1,70]) y accidentes cerebrovasculares (RP=1,53 ; [IC 95%=1,27-1,84]). Conclusiones: Las caídas son eventos frecuentes en la población adulta mayor, incrementándose el riesgo en el sexo femenino y mayores de 80 años.

Objective: Determine the prevalence and factors associated with falls in aged treated in outpatient Geriatric Department at the Almanzor Aguinaga Asenjo Hospital in 2013. Material and methods: Adescriptive-transversal study where the sample was formed by 301 patients, chosen by a random simple sampling. General information, pathologies and consumption of medicaments registered in his clinical history were studied. In addition, an interview in the doctor's office wasdone, where multiple validated scales were applied for evaluating the factors associated with falls. Results: The frequency of falls in the aged was 60.42%; of which, 104 women (57.14%) and 78 (42.86%) males presented falls in the last year. The average age of the patients included in the study was 77.8 years in the women and 74.95 years in the males. Mostfalls happened in the house (59.9%)and thoroughfare (41.1%).Factors associated with falls are: age older than 80 years (PR=1.51; [CI 95%=1.26-1.82]), cognitive alteration (PR=1.84; [CI 95%=1.51-2.25), march balance alteration (PR=2.25; [CI 95%=1.44-3.49]), fear of falling down(PR=2.11;[CI95%=1.81-2.47]),depression (PR=1.87;[CI95%=1.53-2.28]),polypharmacy (PR=1.27; [CI 95%=1.05-1.53]), diabetes (PR=1.46; [CI 95%=1.24-1.73]),cataracts(PR=1.44;[CI95%=1.21-1.70]) and stroke (PR: 1,53 ; [CI 95%: 1,27-1,84]). Conclusions: Falls are frequent events in the elderly population, increasing the risk in women and older than 80 years.

Construcción y validación de una escala para evaluar salud sexual y reproductiva en adolescentes mujeres de la Región Caribe Colombiana / The Development and Validation of a scale to measure Reproductive and Sexual Health of young women in the Colombian Caribbean region

El presente estudio tuvo como objetivo el diseño y validez de una escala para evaluar salud sexual y reproductiva. Participaron 919 estudiantes mujeres entre 11 a 19 años quienes respondieron el cuestionario, que evalúa actitudes y normas subjetivas, basado en planteamientos de la teoría de comportamiento planeado. Con el objetivo de comprobar la fiabilidad y validez del instrumento, se realizó un análisis factorial exploratorio y un análisis de componentes principales con rotación VARIMAX. Esta investigación incluye dos estudios independientes, en el estudio 1 (prueba piloto) la versión del pilotaje inicialmente constaba de 172 ítems y disminuyó a 78 en la muestra final. Para el estudio 2, en la escala de actitud se reporta una media de 3.68 (D.E. = 1.21) y un a= 0.91. Se extrajeron dos factores agrupados en dos dimensiones que explican un 67.10%; en la escala de normas subjetivas se obtuvo media de 3.80 (D.E. = 1.10) y un a= 0.97. Los ítems se adecuan a la matriz factorial. Se extrajeron 11 factores de los cuales son interpretables 9 y se explican en un 75.89%. En conclusión, el instrumento confirma una confiabilidad adecuada y estabilidad estructural de gran utilidad para la comprensión e implementación de estrategias de acción en sexualidad reproductiva en mujeres adolescentes.

This article describes the design and validation of a scale for evaluating reproductive and sexual health. 919 young females from 11 to 19 years in five Caribbean- Colombian cities were administered the questionnaire that assesses attitudes and subjective norms about the reproductive sexuality, based on the planned behavior theory (Ajzen & Fishbein, 2000). The reliability and validity of the instrument was analyzed through exploratory factorial analysis with principal components and VARIMAX rotation. The methodology includes two independent studies; in study 1 (pilot test) the first questionnaire consisted of 172 items and decreased to 78 in the final sample. For study 2, the attitude scale reported (Mean = 3.68, ED = 1.21) and Cronbach's alpha reliability was 0.91. Two factors were extracted and grouped into two dimensions that explain 67.10% of the variance. For the subjective norms scale (Mean = 3.8, ED = 1.1) Cronbach's alpha reliability was 0.97 and eleven factors were extracted and grouped into nine dimensions, which explain 75.89% of the variance. The scale showed good reliability and structural stability for the analysis and design of programs for sexual and reproductive health in adolescent girls.

Correlación entre la personalidad y los factores de la teoría del comportamiento planeado (TCP) en adolescentes escolarizados de 11-19 años del caribe colombiano / Correlation between personality and the factors of the theory of planned behavior, in school enrolled adolescents from 11-19 years old in the Colombian Caribbean

La creciente tasa de embarazos en adolescentes y la alta incidencia de las infecciones de transmisión sexual (entre ellas el VIH/SIDA), son temáticas en torno a la salud y en especial la salud sexual y reproductiva, que han recibido gran atención por parte de investigadores y de la opinión pública en general. Recientemente, se ha encontrado que los adolescentes llevan a cabo con facilidad comportamientos de riesgo para su salud sexual y reproductiva y aquellos que no han presentado dichos comportamientos también muestran altos niveles de intención para llevarlos a cabo. Se ha hipotetizado que además de variables cognitivas como las actitudes, normas subjetivas, control conductual percibido y la intención, la personalidad de los jóvenes es un aspecto que juega un papel importante en su salud sexual y reproductiva. Se encontraron correlaciones significativas entre las variables de la TCP y las características de personalidad y los resultados sugieren que la direccionalidad de estas correlaciones se encuentra asociada con el tipo específico de comportamiento o situación que se está evaluando.

The increasing rate of pregnancies in teenagers and the high incident of the infections of sexual transmission (HIV/ AIDS, for example), these are health related issues (and especially the sexual and reproductive health), which have received great attention on the part of investigators and of the public opinion in general. Recently, there has been evidenced that teenagers carry out very easily risk sexual behaviors, and those who have not presented the above mentioned behaviors also show high levels of intention to carry out them. There is the hypothesis that besides cognitive variables such as attitudes, subjective norms, perceived behavioral control and intention, the personality of the young persons is an aspect that plays an important paper in their sexual and reproductive health. Significant correlations were found between the variales of the TPB and the personality traits; the results suggest that the direction of these correlations is associated with the specific type of behavior or situation that is assessed.