Medical decisions concerning the end of life for cancer patients in three Colombian hospitals - a survey study.

BACKGROUND: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. METHODS: Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient's death. RESULTS: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. CONCLUSIONS: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients' wishes, and availability of palliative care should be further investigated.

Peritoneal Dialysis Modality Failure in a Middle-Income Country: A Retrospective Cohort Study.

RATIONALE & OBJECTIVE: Technique failure in peritoneal dialysis (PD) remains one of the most critical challenges of this therapy and is associated with a significant increase in costs and morbidity. Our objective was to estimate the frequency of PD technique failure and identify factors associated with technique failure. STUDY DESIGN: A retrospective multicenter observational cohort study. SETTING & PARTICIPANTS: All adult patients initiating PD between January 1, 2010, and December 31, 2015, with follow-up until December 31, 2018, at the Renal Therapy Services network in Colombia. EXPOSURE & PREDICTORS: PD modality (continuous ambulatory PD and automated PD) and demographic and clinical characteristics. OUTCOMES: Technique failure, defined as a switch to hemodialysis lasting at least 30 days. ANALYTICAL APPROACH: Sociodemographic and clinical characteristics of all patients were summarized descriptively according to modality. We estimated the cumulative incidence of technique failure, and a flexible parametric survival model with competing risks was used to evaluate factors associated with this outcome. RESULTS: Among 6,452 patients meeting inclusion criteria, 67% were treated with continuous ambulatory PD. The cumulative incidence of technique failure within 1 year of PD initiation adjusting for competing risks was 6.9% (95% CI, 6.3%-7.6%); within 2 years, technique failure was 13.5% (95% CI, 12.6%-14.4%); and within 3 years, 19.6% (95% CI, 18.5%-20.7%). Female sex, larger center size, and higher Kt/V were associated with lower risk for modality change, whereas diabetes, history of major abdominal surgery, catheter implant technique (laparotomy and percutaneous techniques), obesity, and peritonitis were associated with a higher likelihood of technique failure. LIMITATIONS: Variables of distance to the center, use of icodextrin, and measures of outcomes reported by patients were not included. CONCLUSIONS: Technique failure is relatively uncommon in Colombia; catheter-related problems are the most frequent cause of technique failure. Best practices in catheter insertion could minimize the risk for this outcome.

Clinical and economic outcomes associated with malnutrition in hospitalized patients.

BACKGROUND & AIMS: Hospitalized patients show a high rate of malnutrition, which is associated with poor patient outcomes and high healthcare costs. However, relatively few studies have investigated the association between clinical and economic outcomes and malnutrition in hospitalized patients, particularly those with cardiac and pulmonary conditions. METHODS: This multicenter prospective observational cohort study included 800 patients hospitalized at four Colombian hospitals with a diagnosis of congestive heart failure, acute myocardial infarction, community-acquired pneumonia, or chronic obstructive pulmonary disease. All patients were screened for malnutrition using the Malnutrition Screening Tool (MST). A descriptive analysis of baseline variables was followed by multivariate analysis and inverse probability weighting (IPW) to compare the clinical outcomes, i.e., length of stay (LOS), mortality, and readmission, and hospital costs associated with a positive MST result. RESULTS: The prevalence of a positive MST result was 24.62% (n = 197) and was more common in patients with older age and greater comorbidities. Multivariate analysis controlling for age, gender, healthcare plan, university degree, hospitalization, entrance disease and Charlson co-morbidity index showed that a positive MST result was associated with increased LOS (1.43 ± 0.61 days) and both in-hospital mortality (odds ratio, 2.39) and global mortality (odds ratio, 2.52). IPW analysis confirmed the association between a positive MST result and increased hospital LOS and 30-day mortality, as well as a relative increase of 30.13% in the average cost associated with hospitalization. CONCLUSIONS: This study of hospital inpatients demonstrated a high burden of malnutrition at the time of hospital admission, which negatively impacted LOS and mortality and increased the costs of hospitalization. These findings underscore the need for improved diagnosis and treatment of hospital malnutrition to improve patient outcomes and reduce healthcare costs.

Housing index, urbanisation level and lifetime prevalence of depressive and anxiety disorders: a cross-sectional analysis of the Colombian national mental health survey.

OBJECTIVES: To study socioeconomic inequalities in mental health in rural and urban Colombia, a country with a history of internal conflict and large socioeconomic inequalities. Recent survey data are available to study this understudied topic in a middle-income country. METHODS: Using data from 9656 respondents from the 2015 Colombian Mental Health survey, we investigated the association between lifetime prevalence of depressive and anxiety disorders and quality of dwellings and access to public services housing score (HS). We calculated the relative index of inequality (RII) and slope index of inequality (SII) for HS in urban and rural areas, adjusting for potential confounders and mediating factors. OUTCOMES: The lifetime prevalence of anxiety and depression (combined) was 9.6% in urban versus 6.9% in rural areas (p<0.001). HS was not associated with prevalence of anxiety and depression in urban settings, whereas a higher HS (poorer housing quality) was associated with fewer mental disorders in rural areas in both univariate and multivariate models (multivariate RIIurban0.96 (95% CI 0.51 to 1.81); RIIrural0.11 (95% CI 0.04 to 0.32)). In rural areas, the prevalence of mental health problems was 12% points lower in persons living in the poorest quality dwellings than in those living in high-quality dwellings (SII -0.12 (95% CI -0.18 to -0.06)). Interestingly, within rural areas, persons living in 'populated centres' (small towns, villages) had a higher lifetime prevalence of any mental health disorder (9.8% (95% CI 6.9 to 13.6)) compared with those living in more isolated, dispersed areas (6.0% (95% CI 4.6 to 7.7)). INTERPRETATION: In rural Colombia, those living in the poorest houses and in dispersed areas had a lower prevalence of mental health problems. Further understanding of this phenomenon of a seemingly inverse association of prevalence of mental disorders with poverty and/or urbanisation in rural areas is needed. Particularly, considering the progressive urbanisation process in Colombia, it is important to monitor mental health in populations migrating to the cities.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America.

OBJECTIVE: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. DESIGN: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. METHODS: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. RESULTS: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. CONCLUSIONS: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

Quality measurers of therapeutic communities for substance dependence: an international collaborative study survey in Latin America.

BACKGROUND: In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. METHODS: Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. RESULTS: Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were "Requesting a professional qualification to former addicts that belonged to the program" and "Work as part of the therapeutic program". Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. CONCLUSION: The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

Epidemiologic characteristics of death by burn injury from 2000 to 2009 in Colombia, South America: a population-based study.

BACKGROUND: Burns are one of the most severe traumas that an individual can suffer. The World Health Organization (WHO) affirms that injuries related to burns are a global public health problem mainly in low- and middle-income countries. The first step towards reducing any preventable injury is based on accurate information. In Colombia, the basic epidemiological characteristics of burn injuries are unknown. The objectives were establishing the causes, high-risk populations, mortality rate, and tendencies of burn deaths. METHODS: Observational, analytical, population-based study based on official death certificate occurred between 2000 and 2009. All codes of the International Classification of Diseases-10th Revision (ICD-10) related to burns were included. The mortality rates were standardized using the WHO world average age weights 2000-2025. To determine the tendency, an average annual percent change (AACP) was calculated. RESULTS: A total of 5448 deaths due to burns were identified; 78.4 % were men. The crude and adjusted burn mortality rate was 1.270 and 1.302 per 100,000, respectively. The AACP was -5.25 %. Electrical injury caused the greatest number of deaths (49.5 %), followed by fire and lightning injuries. A total of 1197 (22.1 %) children were under 15 years old. The causes of deaths were different among age groups. 59.4 % deaths occurred outside health institutions. CONCLUSIONS: This study is a first step in identifying the main causes of death and groups with higher mortality rates. Electricity is the main cause of deaths due to burn injury. Further research is required in order to generate awareness among government and community for reducing the number of injuries and burn deaths in our country.

[Methodological Aspects of the Sampling Design for the 2015 National Mental Health Survey]. / Aspectos metodológicos del diseño de muestra para la Encuesta Nacional de Salud Mental 2015.

INTRODUCTION: The WHO has encouraged the development, implementation and evaluation of policies related to mental health all over the world. In Colombia, within this framework and promoted by the Ministry of Health and Social Protection, as well as being supported by Colciencias, the fourth National Mental Health Survey (NMHST) was conducted using a observational cross sectional study. According to the context and following the guidelines and sampling design, a summary of the methodology used for this sampling process is presented. The fourth NMHST used the Homes Master Sample for Studies in Health from the National System of Studies and Population Surveys for Health to calculate its sample. This Master Sample was developed and implemented in the year 2013 by the Ministry of Social Protection. METHODS: This study included non-institutionalised civilian population divided into four age groups: children 7-11 years, adolescent 12-17 years, 18-44 years and 44 years old or older. The sample size calculation was based on the reported prevalences in other studies for the outcomes of mental disorders, depression, suicide, associated morbidity, and alcohol use. A probabilistic, cluster, stratified and multistage selection process was used. Expansions factors to the total population were calculated. RESULTS: A total of 15,351 completed surveys were collected and were distributed according to the age groups: 2727, 7-11 years, 1754, 12-17 years, 5889, 18-44 years, and 4981, ≥45 years. All the surveys were distributed in five regions: Atlantic, Oriental, Bogotá, Central and Pacific. CONCLUSIONS: A sufficient number of surveys were collected in this study to obtain a more precise approximation of the mental problems and disorders at the regional and national level.

Therapeutic Communities In Latin America: An International Descriptive Study In Different Countries Across Latin America / Comunidades terapéuticas en Latinoamérica: un estudio descriptivo en varios países de Latinoamérica

ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad¼ y «grupos de encuentro entre residentes¼ fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

Aspectos metodológicos del diseño de muestra para la Encuesta Nacional de Salud Mental 2015 / Methodological Aspects of the Sampling Design for the 2015 National Mental Health Survey

Resumen Introducción: La OMS ha incentivado la creación, implementación y evaluación de políticas relacionadas con la salud mental en todo el mundo. En Colombia, en ese marco e impulsada por el Ministerio de Salud y Protección Social y financiada por Colciencias, se realizó la cuarta Encuesta Nacional de Salud Mental (ENSM IV) usando un diseño observacional de corte transversal. En ese contexto, y de acuerdo con los lineamientos y el diseño demuestra proporcionado por el Ministerio de la Protección Social, se presenta a continuación un resumen de la metodología usada para el diseño muestral. La ENSM IV tuvo como base para su diseño muestral la Muestra Maestra de Hogares para Estudios en Salud del Sistema Nacional de Estudios y Encuestas Poblacionales para Salud, desarrollada e implementada en el año 2013 por el Ministerio de la Protección Social. Métodos: Para este estudio, se incluyó a la población civil no institucionalizada del país. Se consideraron cuatro grupos etarios de interés: niños de 7 a 11 años, adolescentes de 12 a 17 años, personas entre 18 y 44 años y mayores de 44 años. El cálculo del tamaño demuestra se basó en las prevalencias reportadas en otros estudios para los desenlaces de trastornos mentales, depresión, suicidio, morbilidad sentida y uso de alcohol. La selección fue de tipo probabilístico por conglomerados, estratificada y polietápica. Se calcularon los factores de expansión al total poblacional. Resultados: En este estudio se recolectaron 15.351 encuestas completas distribuidas según grupos de edad: 2.727 de 7-11 años; 1.754 de 12-17; 5.889 de 18-44 y 4.981 de = 45 años distribuidos en las 5 regiones: Atlántica, Oriental, Bogotá, Central y Pacífica. Conclusiones: En este estudio, se recolectó un número de encuestas completas suficiente para tener una aproximación bastante precisa a escalas nacional y regional de la salud mental y algunos trastornos y problemas mentales de la población colombiana.

Abstract Introduction: The WHO has encouraged the development, implementation and evaluation of policies related to mental health all over the world. In Colombia, within this framework and promoted by the Ministry of Health and Social Protection, as well as being supported by Colciencias, the fourth National Mental Health Survey (NMHST) was conducted using a observational cross sectional study. According to the context and following the guidelines and sampling design, a summary of the methodology used for this sampling process is presented. The fourth NMHST used the Homes Master Sample for Studies in Health from the National System of Studies and Population Surveys for Health to calculate its sample. This Master Sample was developed and implemented in the year 2013 by the Ministry of Social Protection. Methods: This study included non-institutionalised civilian population divided into four age groups: children 7-11 years, adolescent 12-17 years, 18-44 years and 44 years old or older. The sample size calculation was based on the reported prevalences in other studies for the outcomes of mental disorders, depression, suicide, associated morbidity, and alcohol use. A probabilistic, cluster, stratified and multistage selection process was used. Expansions factors to the total population were calculated. Results: A total of 15,351 completed surveys were collected and were distributed according to the age groups: 2727, 7-11 years, 1754, 12-17 years, 5889, 18-44 years, and 4981, ≥45 years. All the surveys were distributed in five regions: Atlantic, Oriental, Bogotá, Central and Pacific. Conclusions: A sufficient number of surveys were collected in this study to obtain a more precise approximation of the mental problems and disorders at the regional and national level.

[Effects of aerial applications of the herbicide glyphosate and insecticides on human health]. / Evaluación de los efectos del glifosato y otros plaguicidas en la salud humana en zonas objeto del programa de erradicación de cultivos ilícitos.

INTRODUCTION: The herbicide glyphosate is administered aerially by the Program to Eradicate Illicit Crops Program and is undertaken in rigorous compliance with the Environmental Management Plan. OBJECTIVE: The effects of the glyphosate herbicide and other aerially applied insecticides were measured to determine possible impact on human health. MATERIALS AND METHODS: In 2006-2006, a survey was taken of 112 individuals living in herbicide-treated areas of the Colombian provinces of Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena and La Guajira. Samples of blood were examined for presence of acetylcholinesterase and organochlorine insecticides; urine was analyzed for glyphosate and its metabolites. RESULTS: Fifty percent (50%) of the individuals sampled acknowledged the use of control chemicals as part of their work. The mean exposure time to the chemicals was 84.4 months, with a mean daily exposure of 5.6 hours. The most commonly used pesticides were of category I--extremely hazardous. In individuals sampled for glyphosate (39.6% of the total), 64.3% indicated the use of this herbicide at ground level in agricultural work. A statistically significative relationship was found between the use of glyphosate at ground level, and the concentration levels of glyphosate in the urine samples (odds ratio=2.54, 95% CI: 1.08 to 6.8). CONCLUSION: These data did not show a relationship between the aerial sprayings of glyphosate for illicit crops eradication and an impact on human health, nor with occupational exposure to this and other chemicals (insecticides) with a high levels of toxicity.

Fracturas osteoporóticas vertebrales en laproyección lateral de tórax / Osteoporotic vertebral fractures in the lateral thorax projection

Objetivo: Este estudio se realizó para determinar el porcentaje de cambios morfológicos,considerados fracturas vertebrales por osteoporosis en la proyección lateral de tórax, depacientes mayores de 50 anos ˜ atendidos por razones médicas distintas a problemas decolumna, en un hospital de tercer nivel.Método: Tres investigadores evaluaron 237 radiografías digitales de tórax de pacientes conuna edad media de 66,86 anos ˜ (rango 50-90), usando de manera secuencial y estandarizadalos métodos Algorithm-Base Qualitative approach (ABQ) y de Genant. Cada evaluador contócon una pantalla de similar resolución y evaluó las radiografías de forma independiente.Resultados: De los casos, 152 fueron del sexo femenino y 85 del masculino. La edad promedio para las fracturas grado 1 (17 casos) fue 72,17 anos ˜ con rango de 60-90(DE 8,96) y para las de grado 2 (6 casos) de 74 anos ˜ con rango de 68-87 anos ˜ (DE 6,72).Conclusiones: El porcentaje de cambios morfológicos considerados fracturas osteoporóticasdorsales fue del 9,7% (23 fracturas), el cual resultó más bajo con respecto a lo reportado en la literatura. La distribución de las lesiones por sexo fue similar en ambos grupos yla concordancia inter e intraobservador, usando los 2 métodos de manera conjunta, fueexcelente...

ObjectiveThis study was performed to determine the percentage of morphological changes considered as vertebral fractures due to osteoporosis in the lateral thorax projection of patients older than 50 years old who were attended for different medical reasons for spine problems in a third level hospital.MethodThree investigators evaluated 237 digital radiographs of the thorax of patients with a median age of 66.86 years (range 50-90) using 2 standardized methods sequentially: the Algorithm-Base Qualitative approach (ABQ) method and the Genant method. Each examiner used a similar resolution screen and evaluated the radiographs independently.ResultsThe cases included 152 females and 85 males. There were 23 fractures where the distribution by Genant method was 10 (6.5%) of grade 1, and only one (0.6%) of grade 2 for a total of 11 (7.2%) in the female group. In the male group there were 7 (8.2%) of grade 1, and 5 (5.8%) of grade 2 fractures, for a total of 12 (14.1%). The total number of grade 1 fractures was 17 (7.17%) and 6 (2.53%) grade 2. The fractures identified by ABQ method were 11 (7.2%) in the female group and 12 (14.1%) in the male group.The interobserver agreement for the 3 evaluators using the Genant method had a Kappa value of 0.88 (Z of 23.59 with p > Z of 0.0) and 0.9237 (Z of 24.63 with p > Z of 0.0) by ABQ method. The agreement for each evaluator respect the consensus of them for each method had a Kappa of 0.929 for the first and second evaluators, and 0.954 for the third. Whilst using the Genant method it was 0.911, 0.886 and 0.907, respectively. Both of them with P < .005.The intraobserver agreement had a Kappa value of 0.83 and 1 for the first evaluator, 0.704 and 0.86 for the second; and, 1 and 1 for the third evaluator for ABQ and Genant methods, respectively, with P < .005.The median age for grade 1 fractures (17 cases) was 72.17 years with range 60-90 (SD of 8.96 years)...

Evaluación de los efectos del glifosato y otros plaguicidas en la salud humana en zonas objeto del programa de erradicación de cultivos ilícitos / Effects of aerial applications of the herbicide, glyphosate and insecticides on human health

Introducción. El Programa de Erradicación de Cultivos Ilícitos con Glifosato se ejecuta dando cumplimiento a lo establecido en el Plan de Manejo Ambiental. Objetivo. Explorar los posibles efectos del glifosato y otros plaguicidas sobre la salud humana como resultado de las aspersiones aéreas. Materiales y métodos. Se realizó un estudio descriptivo en 112 individuos procedentes de las áreas asperjadas de los departamentos de Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena y La Guajira, durante 2005 y 2006. Se aplicó una encuesta y se recolectaron muestras de orina para la determinación de glifosato, y de sangre, para la determinación de acetilcolinesterasa y organoclorados. Se llevó a cabo un análisis simple y se exploraron las posibles asociaciones. Resultados. El 50,0% (56 individuos) de la población manifestó el uso de plaguicidas en su trabajo. El tiempo que llevaban utilizando los plaguicidas fue de 84,8 meses y refirieron aplicar plaguicidas 5,6 horas al día. El predominio de los plaguicidas usados fue extremadamente tóxico. De 39,6% de los individuos a quienes se les cuantificó glifosato, 64,3% reportaron su uso en actividades agrícolas. Se encontró una relación estadísticamente significativa entre el uso de glifosato terrestre (manual) y los niveles de este herbicida en orina (OR=2,54; IC95% 1,08-6,08). Conclusión. No hubo hallazgos concluyentes entre la exposición a glifosato empleado en la erradicación de cultivos ilícitos y los efectos en la salud, debido a que se halló exposición ocupacional concomitante por la misma sustancia y por otras de mayor toxicidad que el glifosato.

Introduction. The herbicide glyphosate is administered aerially by the Program to Eradicate Illicit Crops Program and is undertaken in rigorous compliance with the Environmental Management Plan. Objective. The effects of the glyphosate herbicide and other aerially applied insecticides were measured to determine possible impact on human health. Materials and methods. In 2005-2006, a survey was taken of 112 individuals living in herbicide-treated areas of the Colombian provinces of Huila, Tolima, Putumayo, Guaviare, Santander, Antioquia, Magdalena and La Guajira. Samples of blood were examined for presence of acetylcholinesterase and organochlorine insecticides; urine was analyzed for glyphosate and its metabolites. Results. Fifty percent (50%) of the individuals sampled acknowledged the use of control chemicals as part of their work. The mean exposure time to the chemicals was 84.4 months, with a mean daily exposure of 5.6 hours. The most commonly used pesticides were of category I--extremely hazardous. In individuals sampled for glyphosate (39.6% of the total), 64.3% indicated the use of this herbicide at ground level in agricultural work. A statistically significative relationship was found between the use of glyphosate at ground level, and the concentration levels of glyphosate in the urine samples (odds ratio=2.54, 95% CI: 1.08 to 6.8). Conclusion. These data did not show a relationship between the aerial sprayings of glyphosate for illicit crops eradication and an impact on human health, nor with occupational exposure to this and other chemicals (insecticides) with a high levels of toxicity.

Factores asociados al intento de suicidio en la poblacion colombiana / Associated factors in suicide attempts in colombian people

Objetivos: describir y analizar el perfil epidemiológico y los factores asociados al intento de suicidio en una muestra de la población Colombiana. Diseño: análisis secundario de la base de datos de la Primera encuesta nacional de salud mental y consumo de sustancias psicoactivas. Muestra: 25.135 personas fueron encuestadas. Se escogieron 21.988 personas de ambos sexos con edades entre 16 y 60 años, a quienes se les aplicó la escala de Zung para ansiedad y depresión. Se midieron 240 variables independientes. Medida de desenlace principal: reporte de intentos de suicidio en el último año y en la vida. Resultados: la prevalencia para intentos de suicidio en el último año y a través de toda la vida fue de 1,2 por ciento (IC 95 por ciento: 1,06-1,34) y 4,25 por ciento (IC 95 por ciento: 4,25-4,81) respectivamente. Con la técnica de regresión logística para variables policótomas, los intentos de suicidio en el último año estaban asociados con: edades de 16 a 21 años OR = 2,5 (IC 95 por ciento 1,5-4,2), depresión grave OR = 11,8 (5,1-27,3), moderada OR = 5,3 (3,1-9,0) y leve OR = 3,6 (2,4-5,8), niveles moderados y graves de ansiedad OR = 3,4 (1,8-6,7). Se encontraron resultados similares cuando se consideraron los intentos de suicidio a lo largo de la vida. Conclusiones: el intento de suicidio en Colombia tiene una prevalencia similar a la de otros países, la población con mayor riesgo tiene entre 16 y 21 años, presenta depresión o ansiedad, consulta al médico por 'nervios', es objeto de abuso verbal (particularmente en las mujeres) o tiene diferentes valores morales a los de su familia

Suicidio y lesiones autoinflingidas Colombia, 1973-1996 / Suicide and selfinjuries Colombia 1973-1996

Objetivos: (1) describir la mortalidad por suicidio y lesiones autoinfligidas desde 1973 hasta 1996, basándonos en los datos emanados del certificado de defunción del DAÑE. (2) Establecer los factores asociados al suicidio en la población colombiana, utilizando modelos de regresión logística. Diseño: análisis secundario de los registros de defunción del DAÑE (1973- 1996). Resultados: entre las variables sociodemográfícas estudiadas para el lapso 1973-1996 encontramos que la mayor proporción de muertes causadas por suicidio se presentó dentro del grupo de 15 a 24 años, para las mujeres, y mayores de 60 años, para los hombres. La tasa de suicidio fue de 2-4/100.000 para ambos géneros y para todos los grupos de edad durante estos años, y osciló entre 4-6/100.000 para hombres y de 1-3/100.000 para mujeres. Las cifras aumentan a 4-5/100.000 para personas mayores de 15 años. Se presentan los modelos de asociación para 3 años (1985, 1993 y 1996), en los cuales se observó durante 1996 un OR = 54,4 (IC 95 por ciento: 38,4-77,1, p> 0,05) para el grupo de 15 a 24 años, y de 8,7 (6,1-12,3) para aquellos de 25 a 59 años. Para los hombres se calculó un OR = 3,1(2,7-3,6), así como un OR = 0,4 (0,3-0,5) para la zona urbana. Igualmente, se describen otras proporciones y asociaciones de importancia