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SARS-CoV-2 transmission is largely driven by heterogeneous dynamics at a local scale, leaving local health departments to design interventions with limited information. We analyzed SARS-CoV-2 genomes sampled between February 2020 and March 2022 jointly with epidemiological and cell phone mobility data to investigate fine scale spatiotemporal SARS-CoV-2 transmission dynamics in King County, Washington, a diverse, metropolitan US county. We applied an approximate structured coalescent approach to model transmission within and between North King County and South King County alongside the rate of outside introductions into the county. Our phylodynamic analyses reveal that following stay-at-home orders, the epidemic trajectories of North and South King County began to diverge. We find that South King County consistently had more reported and estimated cases, COVID-19 hospitalizations, and longer persistence of local viral transmission when compared to North King County, where viral importations from outside drove a larger proportion of new cases. Using mobility and demographic data, we also find that South King County experienced a more modest and less sustained reduction in mobility following stay-at-home orders than North King County, while also bearing more socioeconomic inequities that might contribute to a disproportionate burden of SARS-CoV-2 transmission. Overall, our findings suggest a role for local-scale phylodynamics in understanding the heterogeneous transmission landscape.
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COVID-19 , Epidemias , Humanos , SARS-CoV-2/genética , COVID-19/epidemiologia , Washington/epidemiologiaRESUMO
BACKGROUND: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. METHODS: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. RESULTS: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. CONCLUSION: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care.
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Análise Custo-Benefício , Cuidados Paliativos , Humanos , Colômbia , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Análise Custo-Benefício/métodos , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , Estudos Retrospectivos , Idoso , Inquéritos e Questionários , Qualidade de Vida/psicologia , Adulto , Idoso de 80 Anos ou maisRESUMO
Pathogen genomics can provide insights into disease transmission patterns, but new methods are needed to handle modern large-scale pathogen genome datasets. Genetically proximal viruses indicate epidemiological linkage and are informative about transmission events. Here, we leverage pairs of identical sequences using 114,298 SARS-CoV-2 genomes collected via sentinel surveillance from March 2021 to December 2022 in Washington State, USA, with linked age and residence information to characterize fine-scale transmission. The location of pairs of identical sequences is highly consistent with expectations from mobility and social contact data. Outliers in the relationship between genetic and mobility data can be explained by SARS-CoV-2 transmission between postal codes with male prisons, consistent with transmission between prison facilities. Transmission patterns between age groups vary across spatial scales. Finally, we use the timing of sequence collection to understand the age groups driving transmission. This work improves our ability to characterize transmission from large pathogen genome datasets.
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Fluorescent organotin compounds are useful in sensing, optoelectronic devices, and in vitro bioimaging. Although in vitro fluorescence bioimaging shows low resolution at room temperature, a better resolution is possible at cryotemperatures. Therefore, the search for new cryoluminescent materials with potential application in high-resolution fluorescence bioimaging remains a great challenge. Herein, we report the cryoluminescence properties of two fluorescent bis-organotin compounds, namely, BisNTHySnBu2 (5) and BisNTHySnPh2 (6), synthesized via microwave irradiation. All compounds were fully characterized using 1H, 13C, and 119Sn NMR spectroscopy, Raman spectroscopy, IR spectroscopy, and HR-MS. The 119Sn δ and 3J(1H,119Sn) of 5 and 6 indicate that two Sn-ligands are chemically and electronically equivalent, as confirmed by cyclic voltammetry. The crystal structure of 6 showed pentacoordinate tin atoms with skeleton ligands. The study of self-assembled monolayers of both Sn-complexes via STM microscopy revealed a similar supramolecular packing in lamella-like patterns, adopting a face-on arrangement, where molecules stay flat lying on HOPG in accordance with the height profile of closely packed monolayers on graphite of about 0.33 nm thickness. However, only the Sn complex 6, which bears phenyls, covers large surface areas. The photophysical properties of bis-organotin compounds were also investigated in solution (room and low temperatures) and in the solid state. Good luminescence properties in solutions with fluorescence quantum yields (Φ) of approximately 35% and 50% were found. Despite this, Φ is quenched in the solid state because of aggregation, as supported by solvent/non solvent fluorescence studies, which is in agreement with STM and AFM investigation.
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Many studies have used mobile device location data to model SARS-CoV-2 dynamics, yet relationships between mobility behavior and endemic respiratory pathogens are less understood. We studied the effects of population mobility on the transmission of 17 endemic viruses and SARS-CoV-2 in Seattle over a 4-year period, 2018-2022. Before 2020, visits to schools and daycares, within-city mixing, and visitor inflow preceded or coincided with seasonal outbreaks of endemic viruses. Pathogen circulation dropped substantially after the initiation of COVID-19 stay-at-home orders in March 2020. During this period, mobility was a positive, leading indicator of transmission of all endemic viruses and lagging and negatively correlated with SARS-CoV-2 activity. Mobility was briefly predictive of SARS-CoV-2 transmission when restrictions relaxed but associations weakened in subsequent waves. The rebound of endemic viruses was heterogeneously timed but exhibited stronger, longer-lasting relationships with mobility than SARS-CoV-2. Overall, mobility is most predictive of respiratory virus transmission during periods of dramatic behavioral change and at the beginning of epidemic waves.
Assuntos
COVID-19 , SARS-CoV-2 , Humanos , COVID-19/transmissão , COVID-19/epidemiologia , SARS-CoV-2/isolamento & purificação , Washington/epidemiologia , Pandemias , Cidades/epidemiologia , Estações do Ano , Viagem/estatística & dados numéricosRESUMO
Resumen OBJETIVO: Evaluar la utilidad preventiva de la hemorragia posparto mediante la ligadura bilateral de las arterias uterinas en pacientes con factores de riesgo. MATERIALES Y MÉTODOS: Estudio prospectivo, experimental, aleatorizado no probabilístico, por conveniencia, de casos y controles, longitudinal, comparativo al que se incluyeron pacientes con factores de riesgo de hemorragia posparto que finalizaron el embarazo mediante cesárea de urgencia. Se integraron dos grupos: experimental, en quienes se aplicó la técnica de ligadura bilateral de arterias uterinas y el grupo control: solo con cesárea. Antes y después del procedimiento quirúrgico se estimaron la pérdida de sangre, los parámetros de hemoglobina y hematocrito y se compararon con el grupo de control. RESULTADOS: Se estudiaron 91 pacientes: 45 en el grupo experimental y 46 de solo cesárea. Se observaron diferencias significativas en la pérdida de sangre del grupo experimental (345.56 ± 64.69 mL) en comparación con el grupo control (426.06 ± 125.49 mL; p = 0.000247), en los parámetros de hemoglobina (grupo experimental: 11:13 ± 1.62 g/dL; grupo control: 10.49 ± 1.32 g/dL, p = 0.037) y hematocrito (grupo experimental: 33.86%; grupo control: 31.87%; p = 0.017). CONCLUSIÓN: La ligadura bilateral de las arterias uterinas a pacientes con factores de riesgo de hemorragia poscesárea es una medida preventiva eficaz que ayuda a disminuir la pérdida sanguínea. Al complementarla con los uterotónicos reduce el volumen de sangrado.
Abstract OBJECTIVE: Evaluation of the benefits and harms of bilateral uterine artery ligation for prevention of postpartum hemorrhage in patients with risk factors. MATERIALS AND METHODS: Prospective, experimental, randomized, case-control, longitudinal, comparative study conducted during 2022, which included patients with risk factors for postpartum hemorrhage who terminated pregnancy by emergency cesarean section. Two groups were included: the experimental group, in which the technique of bilateral uterine artery ligation was applied, and the control group, in which only cesarean section was performed. Before and after the surgical procedure, blood loss, hemoglobin and hematocrit parameters were estimated and compared with the control group. RESULTS: Ninety-one patients were studied: 45 in the experimental group and 46 in the cesarean only group. Significant differences were observed in blood loss in the experimental group (345.56 ± 64.69 mL) compared to the control group (426.06 ± 125.49 mL; p = 0.000247), in hemoglobin (experimental group: 11:13 ± 1.62 g/dL; control group: 10.49 ± 1.32 g/dL, p = 0.037) and hematocrit (experimental group: 33.86%; control group: 31.87%; p = 0.017). CONCLUSION: Bilateral uterine artery ligation in patients with risk factors for post-cesarean hemorrhage is an effective preventive measure that helps to reduce blood loss. When combined with uterotonics, it reduces the volume of bleeding.
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Introducción: Se exponen los resultados de la atención anestesiológica en un Centro de Carácter Provincial, destinado a la cirugía obstétrica de pacientes gestantes tributarias de cesárea y enfermas por la COVID-19. Objetivo: Mostrar los resultados de una etapa de trabajo, bajo situación epidemiológica excepcional y durante la existencia de más de una cepa circulante de SARS-CoV 2. Métodos: Se realizó una investigación descriptiva, longitudinal, prospectiva; se incluyeron 70 embarazadas diagnosticadas con la COVID-19 y diverso grado de afectación pulmonar y sistémica. Resultados: Se consideraron graves 49 (85,96 %), se empleó la anestesia general orotraqueal en 54 (97,73 %), resultaron fallecidas en el posoperatorio 14 (26,31 %) y en el transoperatorio 1 (1,75 %). Del total arribaron ventiladas a la Unidad Quirúrgica 33 (57,89 %) y 49 (85,96 %) presentaron hipoxemia severa al arribo del quirófano. Se logró extubar al final de la intervención solo a 21 (36,84 %), únicamente se efectuaron tres anestesias regionales. El distrés respiratorio en 39 (68,42 %) casos, el fallo circulatorio en 17 (29,82 %) y la presencia de derrames pericárdicos en 13 (22,80 %) casos, fueron los hallazgos asociados. El tiempo entre diagnóstico y decisión de cesárea en beneficio materno fue de 2 días promedio. Conclusiones: Se mostraron los resultados de una etapa de trabajo, bajo situación epidemiológica excepcional, durante la existencia de más de una cepa circulante de SARS-CoV 2. La mayoría de las pacientes atendidas requirieron ventilación invasiva, la anestesia general fue la técnica a emplear, la disfunción pulmonar asociado a la falla cardiocirculatoria fueron condiciones presentes y determinantes del resultado, el cumplimiento de las medidas de bioseguridad evitó el contagio del personal durante todo el período(AU)
Introduction: The results of anesthesiological care are presented as it was provided in a provincial center for obstetric surgery of pregnant patients candidates for a cesarean section and who were ill with COVID-19. Objective: To show the results of a working stage, under an exceptional epidemiological situation and during the existence of more than one circulating strain of SARS-CoV-2. Methods: A descriptive, longitudinal and prospective study was carried out. Seventy pregnant women diagnosed with COVID-19 and varying degrees of pulmonary and systemic involvement were included. Results: Forty-nine (85.96 %) were considered as severe cases, orotracheal general anesthesia was used in 54 (97.73 %), 14 (26.31 %) died postoperatively and one (1.75 %) died during surgery. Of the total, 33 (57.89 %) were ventilated on arrival to the surgical unit and 49 (85.96 %) presented severe hypoxemia on arrival to the operating room. Only 21 (36.84 %) were extubated at the end of the operation and only three regional anesthetic procedures were performed. Respiratory distress in 39 (68.42 %) cases, circulatory failure in 17 (29.82 %) cases and the presence of pericardial effusions in 13 (22.80 %) cases were the associated findings. The time between diagnosis and decision for a cesarean section based on maternal benefit was two days on average. Conclusions: The results of a working stage under an exceptional epidemiological situation and during the existence of more than one circulating strain of SARS-CoV-2 were shown. Most of the attended patients required invasive ventilation. General anesthesia was the technique to be used. Pulmonary dysfunction in association with cardiocirculatory failure were present conditions that determined the results. Compliance with biosafety measures prevented the staff contagion during the entire period(AU)
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HumanosRESUMO
Los retos que enfrentó el profesorado durante el confinamiento causado por la covid-19 se acrecentaron para quienes atienden a estudiantes con necesidades educativas especiales o barreras para el aprendizaje, a causa de la escasez de herramientas tecnológicas especializadas y el incipiente desarrollo de competencias digitales. El objetivo de este artículo es analizar las condiciones en las que este profesorado que labora en educación básica y media superior en México trabajó durante el período abril 2020-diciembre 2021. Se realizó una investigación atributiva estructural de alcance explicativo que empleó la encuesta como técnica de recuperación de información. Participaron 140 docentes cuyas respuestas fueron analizadas estadísticamente y cartografíadas utilizando el Sistema de Información Geográfica y el programa ArcGIS, con la finalidad de destacar diferencias y carencias regionales. Los resultados se centran en dos ejes del Marco Común de Competencia Digital Docente (Creación de contenidos y Seguridad), y evidencian la persistencia de brechas socioeducativas, siendo docentes de zonas urbanas quienes expresan haber desarrollado estas competencias, destacando quienes tienen menos años de servicio, mayores grados académicos y buscan estabilidad laboral, lo que lleva a concluir en la necesidad de fortalecer procesos formativos diferenciados que respondan a las necesidades específicas de los contextos educativos. (AU)
The challenges faced by teachers during the confinement caused by Covid-19 were more severe for those who look after students with special needs or learning barriers, particularly in a context marked by the scarcity of specialized technological tools and an incipient development of digital skills among both teachers and students. The paper analyzes the conditions in which teachers who work in basic and upper secondary education in Mexico carried out their jobs from April 2020 - December 2021. The analysis is based upon a structural attributive research of explanatory scope that retrieved information through a survey. 140 teachers participated in the process; their responses were statistically analyzed and mapped out using the Geographic Information System and the ArcGIS program, in order to highlight regional differences and shortcomings. The results presented focus on two axes of the Common Framework for Digital Teaching Competence (Content Creation and Security) and show the persistence of socio-educational gaps. Those who express that to have developed these competences are teachers from urban areas, particularly those who have less years of service, higher academic degrees, and are in the seek of job stability. This leads to the conclusion that there is a need to strengthen differentiated training processes that respond to the specific needs of educational contexts. (AU)
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Humanos , Pandemias , Infecções por Coronavirus/epidemiologia , Tecnologia Educacional , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , México/epidemiologia , Quarentena , Docentes , Inquéritos e QuestionáriosRESUMO
Introducción: Se exponen los resultados de la intervención anestesiológica de pacientes sospechosos o confirmados con COVID-19 (enfermedad por el nuevo coronavirus), atendidos en un hospital clínico quirúrgico designado para la atención de pacientes en el curso de la pandemia. Objetivo: Presentar las experiencias del manejo de los pacientes quirúrgicos afectados o sospechosos de contagio por el nuevo coronavirus (COVID-19). Métodos: Se recogieron los datos de todos los casos atendidos en el Hospital Militar Central Dr. Luis Díaz Soto fueran obstétricos (cesárea) o de otras especialidades (cirugía, ortopedia, urología). Resultados: Se realizaron 49 intervenciones anestésico-quirúrgicas, de ellas 13 cesáreas, 9 traqueostomías, 7 apendicectomías, 7 salpingectomías, 3 fracturas de cadera, y 1 amputaciones, 1 trepanación de cráneo, 2 drenajes de abscesos y 1 necrectomia, 1 nefrostomía, 1 nefrectomía, 1 cura y 2 laparotomías. Se realizaron las cesáreas con anestesia neuroaxialepidural (inyección única 13-26,5 por ciento) el resto de los procederes se realizaron con anestesia general orotraqueal (32-65,30 por ciento) y general endovenosa (4-8,16 por ciento). Fueron confirmados a la COVID-19 el 38,77 por ciento (19). Se egresaron a terapia intensiva 18 pacientes (36 por ciento), de ellos ventilados 12 (24 por ciento). Fueron casos sospechosos a la COVID-19, 30 casos para el 61,2 por ciento. Conclusiones: No ocurrieron accidentes anestésicos, o fallas en el control de la vía aérea, y no ocurrieron muertes perioperatorias. No existió personal contagiado con la COVID 19; el alto número de sospechosos constituyen un riesgo potencial de contagio(AU)
Introduction: The results are presented regarding anesthesiological intervention of patients suspected of or confirmed with COVID-19 (the disease caused by the new coronavirus), treated in a clinical surgical hospital designated for the care of patients during the pandemic. Objectives: To present the experiences regarding management of surgical patients affected by or suspected of infection by the new coronavirus (COVID-19). Methods: The data of all the cases treated in Hospital Militar Central Dr. Luis Díaz Soto were collected, regardless if they were obstetric cases (by cesarean section) or corresponding to other specialties (surgery, orthopedics, urology). Results: Forty-nine anesthetic-surgical interventions were performed, including thirteen caesarean sections, nine tracheostomies, seven appendectomies, the same number of salpingectomies, three hip fracture surgeries, and one amputation, one skull trepanation, two abscess drains and one necrectomy, one nephrostomy, one nephrectomy, one cure and two laparotomies. Cesarean sections were performed under neuraxial (epidural) anesthesia (thirteen single injections, accounting for 26.5 percent of cases). The rest of the procedures were performed under general orotracheal anesthesia (32 single injections, accounting for 65.30 percent of cases) and general intravenous anesthesia (4 single injections, accounting for 8.16 percent of cases). 38.77 percent (19) of cases were confirmed to COVID-19. Eighteen patients (36 percent) were discharged from the intensive care unit, twelve of which had been ventilated, a figure accounting for 24 percent of cases. There were thirty positive cases of COVID-19, accounting for 61.2 percent. Conclusions: There were no anesthetic accidents, failures in the airway control nor perioperative deaths. There were no personnel infected with COVID-19. The high number of suspects constitute a potential risk of contagion(AU)
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Humanos , Cuidados Críticos , Pandemias , COVID-19 , Unidades de Terapia Intensiva , Anestesia IntravenosaRESUMO
Resumen Introducción y objetivo: la severidad de la fluorosis dental refleja exposición a fluoruros durante el desarrollo del esmalte. Recientemente se han reportado asociaciones entre la exposición prenatal y postnatal a fluoruros y efectos negativos en el neurodesarrollo. El objetivo de este estudio fue describir y comparar la severidad y el patrón de distribución de la fluorosis en las denticiones primaria y permanente, como base para discutir la temporalidad de la exposición en niños viviendo en áreas endémicas en el departamento del Huila. Materiales y métodos: odontólogos entrenados diagnosticaron fluorosis en 840 niños (preescolares y escolares) de cuatro municipios usando el índice de Thylstrup & Fejerskov. Para estimar la prevalencia de las diferentes severidades, cada niño se clasifico de acuerdo con la severidad más alta en boca. La distribución de la prevalencia de severidades por grupo etario y tipo de dentición se reportan como tasas de prevalencia (%). Resultados: la prevalencia en preescolares y escolares fue de 97.2% y 99.9%, respectivamente y la fluorosis moderada la más prevalente (75.6% y 63.5%, respectivamente). En ambas denticiones, la fluorosis leve fue más prevalente en los dientes anteriores que en posteriores. Las severidades moderada y severa tuvieron mayor prevalencia en dientes posteriores que en anteriores. Conclusiones: el patrón de distribución de la severidad de la fluorosis sugiere exposición prenatal y postnatal a fluoruros, por encima de los niveles recomendados. Este estudio resalta la importancia de la alidación de la fluorosis del dental como un potencial biomarcador histórico de exposición a luoruros en momentos críticos para el neurodesarrollo.
Resumo Introdução e objetivo: a severidade da fluorose dentária reflete a exposição a fluoretos durante o desenvolvimento do esmalte. Recentemente, associações entre a exposição pré-natal e pós-natal ao fluoretos e efeitos negativos no desenvolvimento neurológico foram relatadas. O objetivo deste estudo é descrever e comparar o padrão de severidade e distribuição da fluorose na dentição decídua e permanente, como intuito para a discussão sobre a temporalidade da exposição em crianças moradoras em áreas endêmicas de fluorose no departamento de Huila, Colômbia. Materiais e métodos: Cirurgiões-dentistas treinados diagnosticaram fluorose em 840 crianças (pré-escolares e escolares) de quatro municípios, utilizando o índice de Thylstrup & Fejerskov. Para estimar a prevalência dos diferentes estágios de severidade, cada criança foi classificada de acordo com o escore mais severo da boca. A distribuição da prevalência de fluorose nos diferentes estágios de severidade por faixa etária e tipo de dentição é apresentada como taxa de prevalência (%). Resultados: a prevalência de fluorose em pré-escolares foi de 97,2% e em escolares de 99,9%. Fluorose moderada foi a mais prevalente (75,6% e 63,5%, respectivamente). Em ambas as dentições, a fluorose leve foi mais prevalente nos dentes anteriores do que nos posteriores. Porém, tanto fluorose moderada como severa foram mais prevalentes nos dentes posteriores do que nos anteriores. Conclusões: o padrão de distribuição da severidade da fluorose sugere uma exposição pré- e pós-natal a fluoretos acima de níveis recomendados. Este estudo salienta a importância da validação da fluorose dentária como um potencial biomarcador histórico da exposição ao fluoretos durante momentos críticos para o neurodesenvolvimento.
Abstract Introduction and objective: dental fluorosis severity reflects fluoride exposure during dental enamel development. Recently, prenatal and postnatal exposure to fluoride has been associated with negative neurodevelopmental outcomes. The aim of this study was to describe and compare the severity and distribution pattern of dental fluorosis in the primary and permanent dentition, as a basis to discuss the timing and extent of fluoride exposure of children living in endemic areas of fluorosis in the department of Huila. Materials and methods: 840 children (preschoolers and schoolchildren) from four municipalities of the Huila Department were examined by trained dentists for dental fluorosis using the Thylstrup & Fejerskov Index. To estimate the prevalence of severities of fluorosis, each child was classified according to the most severe score. The distribution of the prevalence of enamel fluorosis severity by age-group and type of dentition were reported as prevalence rates (%). Results: Prevalence of dental fluorosis in preschoolers was of 97.2% and in schoolers of 99.9%. For both preschoolers and schoolers moderate fluorosis was the most prevalent (75.6% and 63.5%, respectively). For both primary and permanent teeth, mild fluorosis was more prevalent in anterior teeth than in posterior teeth. Moderate and severe fluorosis were more prevalent in posterior teeth than in anterior teeth. Conclusions: the distribution pattern of the severity of dental fluorosis suggests both prenatal and postnatal exposure to fluoride above recommended levels. This study raises the importance of the validation of dental fluorosis as a potential historical biomarker of fluoride exposure at moments that are critical for neurodevelopment.
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The aim of this study was to assess whether caries risk, nutritional status, access to dental care and sociobehavioral factors are associated to two caries experience outcome variables using the Epidemiologic International Caries Detection and Assessment System (ICDASepi), which includes initial enamel caries lesions: 1The presence of ICDASepi caries experience (dmfICDASepi ≥ 1), and 2Having an ICDASepi caries experience (dmftICDASepi) higher than national figures for the same age. The sample included 316 eightto 71monthold children from the municipality of Anapoima, Colombia. Assessments included: prevalence and mean of caries experience using the ICDASepi system without compressed airdrying of teeth surfaces (dmfICDASepi), caries risk and nutritional status. Caregivers completed an elevenitem questionnaire assessing oral healthrelated social determinants, practices and quality of life (OHRQoL), and children's access to dental care. Data were analysed using the Wilcoxonranksum test, the test, the Fisherexact test, and bivariatelinear and nonconditioned logisticmultivariate regression models. Prevalence and mean number of teeth with dmftICDASepi were 65.2% and 3.5±4.13, respectively. Nutritional status outside the normal status, lower educational level of caregivers and age were significantly associated with dmfICDASepi≥ 1. OHRQoL, access barriers to miss and to attend dental care, operativetreatment or emergency being the reason to attend dental care, high caries risk, and age were significantly associated with a higherthannational dmftICDASepi. The significant associations found between early childhood caries experience and other variables represent oralhealth inequalities in early childhood in Anapoima, Colombia (AU)
El objetivo de este estudio fue evaluar en la primera infancia la asociación entre el riesgo de caries, el estado nutricional, el acceso a la consulta odontológica y los factores sociocomporta mentales y dos variables de desenlace de experiencia de caries usando el Sistema epidemiológico Internacional de Detección y Valoración de Caries (ICDASepi), que incluye lesiones de caries en el esmalte: 1La presencia de experiencia de caries ICDASepi (ceodICDASepi ≥ 1) y, 2Tener una experiencia de caries ICDASepi (ceodICDASepi) mayor que los datos nacionales correspondientes para la misma edad.La muestra fue de 316 niños del municipio de Anapoima, Colombia, de 8 a 71 meses de edad. Las valoraciones incluyeron: prevalencia y promedio de experiencia de caries usando el sistema ICDASepi sin secado de las superficies de los dientes con aire comprimido (dmfICDASepi) ; riesgo de caries y estado nutricional. Los cuidadores respondieron un cuestionario de once ítems que valoraba en relación con salud oral, determinantes sociales, prácticas y calidad de vida y, el acceso de los niños a la consulta odontológica. Los datos fueron analizados con la prueba de suma de rangos de Wilcoxon, la prueba de χ2, la prueba exacta de Fisher y, modelos de regresión logística multivariada tipos bivariantelineal y no condicionada. La prevalencia de experiencia de caries (ceodICDASepi) fue de 65.18% y el promedio de dientes con ceodICDASepi de 3.5 ± 4.13. El estado nutricional por fuera de rangos de normalidad, el bajo nivel educativo de los cuidadores y la edad se asociaron significativamente con ceoICDASepi ≥ 1. Se encontró asociación estadísticamente significativa entre tener un ceodICDASepi mayor que el promedio nacional y, calidad de vida relacionada con salud oral, barreras de acceso para perder y asistir a consulta odontológica, tratamiento operatorio o urgencia como motivo de consulta odontológica, alto riesgo de caries y edad. Las asociaciones estadísticamente significativas encontradas en este estudio entre la experiencia de caries de infancia temprana y demás variables representan inequidades en salud oral en la primera infancia en Anapoima, Colombia (AU)
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Índice CPO , Estado Nutricional , Fatores de Risco , Assistência Odontológica para Crianças , Cárie Dentária , Suscetibilidade à Cárie Dentária , Qualidade de Vida , Fatores Socioeconômicos , Estudos Transversais , Interpretação Estatística de Dados , Inquéritos e Questionários , Fatores Etários , Colômbia , Acessibilidade aos Serviços de SaúdeRESUMO
Abstract A caries-epidemiological study using the ICDASepi-merged system was conducted in Colombian young children. This study aimed at associating the time needed for the clinical examination of caries and caries risk in 1 to 5-year-old children according to age and caries risk, and to assess behavior and child pain self-perception during examination according to age. After IRB approval and given parents/caregivers' informed consent, seven trained examiners assessed 1 to 5-year olds in kindergartens under local field conditions. ICDASepi-merged caries experience (depiMEmf) was assessed as follows: Initial-depi (ICDAS 1/2 without air-drying); Moderate-dM (ICDAS 3,4); Extensive-dE (ICDAS 5,6) lesions; due-to-caries fillings-f and missing-m surfaces/teeth. Caries risk was assessed with Cariogram®. Child's behavior (Frankl-Behavior-Rating-Scale) and self-perceived pain (Visual-Analogue-Scale-of-Faces) during examination were evaluated. Clinical examination time was recorded with a stopwatch. A total of 592 children participated (1-yr.: n=31; 2-yrs.: n=96; 3-yrs.: n=155; 4-yrs.: n=209, 5-yrs.: n=101). The depiMEmfs prevalence was of 79.9% and the mean 8.4±10.4. Most were high-caries-risk children (68.9%). The majority (58.9%) showed ≥ positive-behavior and ≤ light-pain self-perception (88.4%). Mean clinical examination time was around 3.5 minutes (216.9±133.9 seconds). For 5-yr. olds it corresponded to 4 minutes (240.4±145.0 seconds) vs. 2 minutes (122.8±80.1 seconds) for 1-yr. olds (Kruskal-Wallis; p=0.00). For high- and low-caries risk children it was around 4.3 minutes (255.7±118.5 seconds) and 3.3 minutes (201.3±129.4 seconds), respectively (ANOVA; p=0.01). This study demonstrates using the ICDAS system in young children is feasible, taking less than 4 minutes for the clinical examination without children behavior/pain self-perception issues.
Resumo Um estudo epidemiológico de cárie usando o sistema ICDAS foi realizado em crianças pequenas colombianas. O objetivo deste estudo foi associar o tempo necessário para o exame clínico da cárie e o risco de cárie em crianças de 1 a 5 anos de acordo com a idade e o risco de cárie e avaliar a autopercepção do comportamento e da dor na criança durante o exame, de acordo com a idade. Após a aprovação do comitê de ética e do consentimento informado dos pais/responsáveis, sete examinadores treinados avaliaram crianças de 1 a 5 anos em creches em condições locais de campo. A experiência de cárie do ICDAS (depiMEmf) foi avaliada da seguinte forma: Epi-depi inicial (ICDAS 1/2 sem secagem ao ar); Moderado-dM (ICDAS 3,4); lesões extensas de dE (ICDAS 5,6); restaurações devido a cárie -f e superfícies/dentes ausentes-m. O risco de cárie foi avaliado com Cariogram®. O comportamento de crianças (Frankl-Behavior-Rating-Scale) e a autopercepção de dor (Escala Visual-Analógica-de-Rostos) durante o exame foram avaliados. O tempo de exame clínico foi registrado com um cronômetro. 592 crianças participaram (1 ano: n = 31; 2 anos: n = 96; 3 anos: n = 155; 4 anos: n = 209, 5 anos: n = 101 ). A prevalência do depiMEmfs foi de 79,9% e a média de 8,4 ± 10,4. A maioria era de crianças com alto risco de cárie (68,9%). A maioria (58,9%) apresentou ≥ comportamento positivo e ≤ autopercepção de dor leve (88,4%). O tempo médio de exame clínico foi em torno de 3,5 min (216,9 ± 133,9 s). Para crianças de 5 anos, correspondeu a 4 min (240,4 ± 145,0 s) vs. 2 min (122,8 ± 80,1 s) para crianças de 1 ano de idade (Kruskal-Wallis; p = 0,00). Para crianças com alto e baixo risco de cárie, foi em torno de 4,3 min (255,7 ± 118,5 s) e 3,3 min (201,3 ± 129,4 s), respectivamente (ANOVA; p = 0,01). Este estudo demonstra que a utilização do sistema ICDAS em crianças pequenas é viável, levando menos de 4 min para o exame clínico sem problemas de autopercepção de comportamento/ dor em crianças.
Assuntos
Humanos , Lactente , Pré-Escolar , Cárie Dentária/diagnóstico , Dor/etiologia , Comportamento Infantil , Prevalência , Fatores de Risco , Colômbia/epidemiologia , Cárie Dentária/complicações , Cárie Dentária/epidemiologiaRESUMO
OBJECTIVE: To examine the effect of prenatal care (PNC) on the level and distribution of child stunting in three Andean countries-Bolivia, Colombia, and Peru-where expanding access to such care has been an explicit policy intervention to tackle child malnutrition in utero and during early childhood. METHODS: An econometric analysis of cross-sectional Demographic and Health Survey (DHS) data was conducted. The analysis included ordinary least-squares (OLS) regressions, estimates of concentration curves, and decompositions of a concentration index. RESULTS: The analysis shows that the use of PNC in Bolivia, Colombia, and Peru is only weakly associated with a reduction in the level of child malnutrition. CONCLUSIONS: Further expansion of PNC programs is unlikely to play a large role in reducing inequalities in malnutrition.
OBJETIVO: Analizar el efecto de la atención prenatal sobre el nivel y la distribución del retraso del crecimiento infantil en tres países andinos (Bolivia, Colombia y Perú) donde la ampliación del acceso a este tipo de atención ha constituido una intervención política explícita con objeto de afrontar la desnutrición intrauterina y durante la primera infancia. MÉTODOS: Se llevó a cabo un análisis econométrico de la Encuesta de Demografía y Salud, de carácter transversal. Este análisis incluyó regresiones ordinarias de mínimos cuadrados, cálculos de curvas de concentración y descomposiciones de un índice de concentración. RESULTADOS: El análisis demuestra que la atención prenatal en Bolivia, Colombia y Perú se asocia solo débilmente con una reducción del nivel de desnutrición infantil. CONCLUSIONES: Es poco probable que una mayor extensión de los programas de atención prenatal tenga un amplio efecto en la reducción de las desigualdades en materia de desnutrición.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Lactente , Pré-Escolar , Adulto , Transtornos da Nutrição Infantil/epidemiologia , Cuidado Pré-Natal/normas , Bolívia/epidemiologia , Colômbia/epidemiologia , Insuficiência de Crescimento/epidemiologia , Disparidades nos Níveis de Saúde , Peru/epidemiologia , PrevalênciaRESUMO
Objetivo Evaluar la variabilidad de VNTR (variable-number tandem repeat) de Mycobacterium leprae de pacientes colombianos con y sin tratamiento previo para identificar posibles fuentes de infección y entender los patrones de transmisión de la enfermedad. Metodología Estudio transversal descriptivo, en donde mediante un muestreo electivo a conveniencia se tomaron 161 biopsias de pacientes multibacilares de lepra, que habían sido solicitadas para diagnóstico y seguimiento de la enfermedad, de las cuales se realizó extracción de ADN de M. leprae y usando la técnica de PCR para VNTRs de M. leprae estandarizada, se establecieron los genotipos y los diferentes clusters mediante el agrupamiento apareado UPGMA. Resultados En las 161 muestras totales se hallaron 22 genotipos VNTRs diferentes, de las cuales 100 muestras (62,1 por ciento) pertenecían al genotipo único VNTRU, y de los genotipos restantes, los mayoritarios, es decir los que dieron lugar a formación de grupos o clusters fueron VNTR17 (5,6 por ciento), VNTR20 (4,3 por ciento), VNTR18 (4,3 por ciento), VNTR14 (4,3 por ciento) y VNTR13 (3,7 por ciento). Conclusión En este estudio se evidencia por análisis de agrupamiento que se pueden detectar clones con diferente grado de virulencia/agresividad, lo cual implica la necesidad de incrementar varias de las actividades del programa de control que darán como resultado la verdadera disminución de la transmisión del microorganismo.
Objective Assessing VNTR (variable-number tandem repeat) variability of Mycobacterium leprae from Colombian patients with and without prior treatment to identify potential sources of infection and to understand the patterns of disease transmission. Methodology This was a descriptive cross-sectional study where a convenience sample of biopsies was taken from 161 multibacillary leprosy patients; diagnosis and monitoring of the disease had been requested for these patients. DNA was extracted from M. leprae and standardised using the PCR technique for M. leprae VNTR, genotypes were established and different clusters grouped by unweighted pair group method with arithmetic mean (UPGMA). Results 22 different VNTR genotypes were found from 161 samples, of which 100 samples (62.1 percent) had a single u-VNTR genotype and the remaining genotypes were VNTR 17 (5.6 percent), VNTR 20 (4.3 percent), VNTR 18 (4.3 percent), VNTR 14 (4.3 percent) and VNTR 13 (3.7 percent), namely those forming groups or clusters. Conclusion This study showed that clones can be detected with varying degrees of virulence / aggressiveness by cluster analysis, implying the need for more monitoring programme activities which will result in a real decline in microorganism transmission.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Hanseníase/microbiologia , Hanseníase/transmissão , Mycobacterium leprae/classificação , Mycobacterium leprae/genética , Colômbia , Estudos Transversais , Genótipo , Sequências de Repetição em Tandem , Adulto JovemRESUMO
BACKGROUND: "To err is human" (Institute of Medicine, 1999) begun the Patients' Safety movement worldwide. We undertook this study to determine the frequency of patient complaints related to adverse events in the National Health Services. METHODS: The National Commission of Medical Arbitration and the Vice-Ministry for Innovation and Quality has the aim of determining the frequency of real adverse events as a reason for complaints by patients and relatives against healthcare professionals and health services. RESULTS: The Emergency Department registered the highest number of events. Negligence and absence of protocols account for more than half of the adverse events. CONCLUSIONS: Management protocols in emergency departments are areas of opportunity for improvement that must be considered.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Erros Médicos/estatística & dados numéricos , Estudos Transversais , México , Estudos RetrospectivosRESUMO
La prevención de la infección por el VIH en las comunidades escolares y universitarias adquiere una importancia transcedental entre los adolescentes y adultos jóvenes donde el riesgo de infección es por edad, ocupacion y ubicación, agregándose el factor de convivencia con otros grupos de alto índice de infección omo lo son los maestros y los trabajadores. Se requieren estrategias adecuadas para grupos específicos. En este trabajo se da a conocer la estrategia de la UNAM a través de una programa de tabajo realizado por un equipo de salud inter y multidisciplinario integrado en una comisión de prevención y control del SIDA que ha realizado acciones de información en la comunidad estudantil, detección, atención médica y psicológica, seguimiento y derivación. Los esfuerzos se han orientado también a la educación para la salud a través de la información y adiestramiento a profesores para que incluyan en sus clases tópicos preventivos del mismo. Consideramos importante la acción inmediata en la prevención de la infección por el VIH en adolescentes y adultos jóvenes por medio de acciones específicas y organizadas a cargo de personal de salud competente y las organizaciones comuntarias
The prevention of VIH infection in school and universitary communities acquires great importance in adolescents and young adults where the risk of HIV infection is caused by age, occupation, location, and also adjoining relations with other groups of high incidence of of infection, such as teachers and administrative employees. Adequate strategies for specific groups are needed. This paper focuses on the strategies developed at the National Autonomous University, of Mexico. An interdisciplinary health com- mission for the prevention and control of ADS was established to infonn the student body. Other activities per- fonned by this commission include providing medical and psychological attention for ~ms victims, as well as detecting and carring out follow-up studies of infected students. Eflorts in health education have also been mude by trainning profesors to include preventive memures against this disease as part of their subject matter. Specific, organized, and immediate action must be talten by health personnel and commwaity organizatons in order to prevent HIV infection in adolescents and young adults.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Infecções por Deltaretrovirus/prevenção & controle , México , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Síndrome da Imunodeficiência Adquirida/psicologia , Sistemas de Informação/educação , Sistemas de Informação/tendênciasRESUMO
Describe el desarrollo de la dentición permanente (Nolla), la frecuencia de agenesias/supernumerarios en radiografías panorex de niños con/sin labio-paladar-fisurado. Evalúa la asociación de riesgo entre agenesias y labio-paladar-fisurado. Se evaluaron 153-radiografías panorámicas de niños de 6-8-años sin historia de exodoncias, 53 con labio-paladar-fisurado (59.6 porciento-hombres-40.4 por ciento-mujeres) 37 con fisura-unilateral (13 derechos / 24-izquierdos), 16 con fisura-bilateral y 100 controles-sin-fisura. Los resultados se expresaron en distribución de frecuencias. Para detectar diferencias en el desarrollo de la dentición entre dientes pares se utilizó la prueba t-pareada y para evaluar riesgo de agenesias el Odds Ratio-(IC 95 por ciento). El número de dientes erupcionados y sin erupcionar mostró una distribución similar en ambos grupos (p=0.964); el desarrollo de la dentición-Nolla se encontró simétrico y acorde con la edad excepto en el par 11-21-(p=0.025) y 37-47-(p=0.02) del grupo sin-hendidura y en 11-21-(p=0.018) del grupo con hendidura-unilateral-derecha donde se observó un desarrollo diferente entre pares. La agenesia y supernumerarios se encontraron más en el grupo con-hendidura-(p menor que 0.05)-con 55 por ciento-9 por ciento respectivamente; el diente comprometido con mayor frecuencia fue el lateral superior. Se pudo establecer asociación de riesgo entre agenesia dental y fisura-unilateral (derecha OR=45/izquierda OR=32) y agenesia dental con hendidura-bilateral-(OR=19). Los resultados evidencian que la hendidura es un factor de riesgo significativo para presentar anormalidades en la formación dental como agenesia dental.
Describes permanent dentition development (Nolla-criteria), the frequence of congenitally missing/supernumerary teeth in panorex-x-rays (radiographies) of children with/without cleft-lip-plate. Evaluates the risk-association between congenitally missing teeth and cleft-lip-plate. 153 panoramic- x-rays (radiographies) of 6-8 years old children without history of exodontias were evaluated; 53 with cleft-lift-palate (59.6-male, 40.4 per cent-female): 37-unilateral-cleft (13-right/24-left), 16-bilateral-cleft, and 100 control individuals without cleft-lip-palate. Results were expressed in frequence-distribution. Paired T-test was used to detect development differences between pair-teeth, and Odds Ratio (IC 95 per cent) to evaluate the risk of congenitally missing teeth. The number of erupted and no-erupted teeth showed a similar distribution in both groups (p=0.964); dental development (Nolla) was found symmetrical and corresponding to age except in pairs 11-2 (p=0.025) and 37-47 (p=0.02) of the group without cleft, and in 11-21 (p=0.018) of the group with unilateral ûright-cleft where different development among pairs is observed. Congenitally missing teeth and supernumeraries were more common in the group with cleft-lip-palate (p less than 0.05) with 55 per cent-9 per cent respectively; the tooth more frequently involved was the upper lateral incisor. Risk association between congenitally-missing-teeth and unilateral-cleft (right OR=45/left OR=32), and cleft-lip-palate is a significant risk factor to present dental development abnormalities like congenitally missing teeth.
Assuntos
Humanos , Masculino , Feminino , Criança , Anodontia , Dentição , Dente Supranumerário , Fissura Palatina , ColômbiaRESUMO
OBJETIVO: Describir algunas características sociodemográficas, clínicas y epidemiológicas de los casos nuevos de lepra y sus convivientes de nueve municipios endémicos y uno no endémico para lepra en Colombia. METODOLOGíA: Se realizó un análisis descriptivo, a partir de la información de los casos nuevos de lepra ingresados al Programa de Control y Eliminación de Lepra de los municipios participantes en el estudio de noviembre de 2002 a octubre de 2003 RESULTADOS: El 62,2 por ciento de los casos presentó la forma multibacilar y el 63 por ciento correspondía al género masculino, la mediana de edad fue de 46.5 años. El 55,6 por ciento de los casos nuevos tenía en el momento del diagnóstico discapacidades grado 1 y 2, mayor al reportado a escala nacional (37,5 por ciento) para el año 2003. Se observó una correlación positiva entre el porcentaje de Necesidades Básicas Insatisfechas por municipio y la incidencia de la enfermedad (r=0,69, p=0,0180). CONCLUSIONES: Nuestros hallazgos resaltan la poca respuesta del Programa de Control de Lepra en algunos municipios para realizar la detección activa y oportuna de los enfermos, además de evidenciar la asociación que históricamente esta enfermedad ha tenido con la pobreza.(AU)
OBJECTIVE: To describe some socio-demographical, clinical and epidemiological characteristics of the new cases of leprosy and household reported from 9 endemic and 1 non-endemic towns in Colombia. METHODOLOGY: A descriptive analysis was made from the information of the new leprosy cases included in the leprosy control and elimination program of the participant towns in the study carried out between November 2002 and October 2003. RESULTS: 62.2 % of the cases presented the multibacillary form and 63 % of them were males; the median age was 46.5 years. 55.6 % of the new cases had first or second level impairments at the moment of diagnosis. This percentage is higher than the one reported in 2003 at a nationwide level, 37.5 %. A positive correlation was observed between the Unsatisfied Basic Needs Index (NBI) and the disease incidence by town (r=0.69, p=0.0180). CONCLUSIONS: Our findings highlight the little response of the Leprosy Control Program in some towns to carry out the active and timely detection of the diseased people, besides making evide nt the historical relationship that this disease has had with poverty.(AU)
Assuntos
Humanos , Doenças Endêmicas , Hanseníase/epidemiologia , Demografia , Estudos Transversais/instrumentação , Colômbia/epidemiologiaRESUMO
La lepra, enfermedad producida por Mycobacteríum leprae, es una de las causas más frecuentes y más antiguas de afección neural periférica. Posee un espectro clínico en piel y en nervio que va desde las formas paucibacilares (tuberculoide) hasta las formas multibacilares (lepromatosa) pasando por una forma intermedia (dimorfa). El diagnóstico se realiza por la historia y la presentación clínica del paciente, sumado a las baciloscopias y hallazgos de biopsias de piel. La biopsia de nervio periférico es un método diagnóstico de alta morbilidad que se utiliza sólo en casos muy seleccionados. La detección precoz del compromiso neurológico en la enfermedad de Hansen sumado a una adecuada terapia farmacológica e interdisciplinaria para el manejo de sus discapacidades hace la diferencia en el pronóstico y calidad de vida de los pacientes afectados
Assuntos
HanseníaseRESUMO
Este trabajo presenta los resultados, separados por sexo y edad, de una encuesta sobre el consumo de sustancias tóxicas (alcohol, tabaco y drogas) entre los alumnos de primer ingreso a la UNAM. La información se obtuvo por medio del examen médico computarizado. Esta información es necesaria para planear programas de educación para la salud, acciones preventivas y terapéuticas relacionadas con el abuso de dichas sustancias, en los planteles con mayor consumo