Typologies of Intimate Partner Violence Against Women in Five Latin-American Countries: A Latent Class Analysis.

Objectives: To estimate typologies of Intimate Partner Violence against women in some Latin-American countries. Methods: Multistage sampling survey included women aged 15 to 49 (n = 63,321). Latent class analysis was estimated, including psychological, physical, and sexual violence and control. Results: The three-class model had a better fit. 1) The high-level IPV class (23%) comprised those suffering high levels of violence. They had higher education and wealth index, lived in urban settings, and their husbands used alcohol more. 2) The middle-level IPV class (45%) suffered high levels of control but low levels of other violence. They justified IPV more than other classes and this group had a high proportion of women without education. 3) Women in the non-IPV class (32%) did not report IPV. Conclusion: Three typologies of IPV were found: high-level, middle-level, and non-IPV. Policies should create screening, early prevention strategies, and programs based on these typologies. The high-level IPV group can benefit from intense legal and mental health interventions, including alcohol reduction and women's empowerment. The middle-level IPV group could benefit from interventions to reduce violence justification and increase women's education.

Measurement of stigma and associated characteristics in people with tuberculosis in Medellín, Colombia: a cross-sectional study.

BACKGROUND: Stigma towards tuberculosis (TB) delays diagnosis and compromises adherence to treatment. We measured the degree of stigma and identified the sociodemographic and clinical characteristics that were associated with a higher degree of stigma in patients with pulmonary and extrapulmonary TB in Colombia. METHODS: We conducted a cross-sectional study with 232 participants included in the TB control program in 2017. Sociodemographic and clinical variables were measured. The stigma component was measured through a validated scale and a multiple linear regression was used. RESULTS: The study analysed 232 patients, of which 52.2% were men, 53.5% were between 27 and 59 y of age and 66.8% had a basic-medium education level. Two characteristics were significantly related to a higher stigma score: the basic-medium education level and homeless status. Homeless status increased the stigma score by 0.27. In contrast, the adjusted stigma score decreased by 0.07 if the patient's health status was perceived as 'healthy'. CONCLUSION: Stigma is maximized in homeless patients and patients with a low education level. It is minimized in patients who perceive their state of health as 'healthy'.

Delays in diagnosing pulmonary tuberculosis within a context of medium incidence, Medellín, Colombia, 2017: an operational research.

BACKGROUND: Delay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year. METHODS: A retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox's proportional hazards model was carried out to identify the variables associated with the delays. RESULTS: The study included 183 patients. The total delay median was 101 days (IQR: 64-163). Patient delay was of 35 days (IQR: 14-84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7-89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HRa = 0.69; 95% CI (0.49-0.97)] and having a TB home contact [HRa = 0.68; 95% CI (0.48-0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HRa = 0.64; 95% CI (0.45-0.92)] and more than two consultations before the diagnosis [HRa = 0.33; 95% CI (0.22-0.49)] was associated with greater health care system delay. CONCLUSIONS: Data from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.

Effect of maternal immunization against pertussis in Medellin and the metropolitan area, Colombia, 2016-2017.

BACKGROUND: In 2013, pertussis immunization (Tdap) for pregnant women was implemented in Colombia to protect newborns in response to increased pertussis incidence. OBJECTIVE: To assess the effect of Tdap maternal immunization on the concentration of mother/umbilical cord antibodies and the occurrence of pertussis in infants during their first six months of life. METHODS: A cohort study in eight randomly selected hospitals in Medellin and metropolitan area of Antioquia, Colombia was conducted in 2015-2016. IgG PT antibody levels in paired maternal and umbilical cord sera were measured from 805 mothers immunized recruited during labor and 200 mothers recruited during the prenatal care before immunization and followed until delivery. Antibodies were analyzed by commercial ELISA kits. 896 infants were followed to detect acute respiratory infections and paroxysms of coughing, inspiratory whoop, apnea, cyanosis or post-tussive vomiting. For laboratory confirmation, B. pertussis- specific real time PCR was performed. RESULTS: We observed a high prevalence of titers >100 IU/mL (mother: 18.40% [95% CI 16-21%]; umbilical cord: 23.1% [95% CI 19.2-27.4%]), positive correlation of umbilical cord and maternal antibodies, higher antibody concentration in vaccinated than in non-vaccinated mothers and significant difference in antibody levels before and after vaccination (Wilcoxon test p = 0.000). The trans placental transport ratio was higher if the mother was vaccinated between 26 and 30 weeks of pregnancy and maximum eight weeks before delivery. Two cases of pertussis were confirmed in infants (incidence of 1.99 per 1000). CONCLUSION: The expected effect of Tdap maternal vaccination against pertussis was observed.

Tobacco use among school enrolled and no enrolled adolescent in Medellin, Colombia. A population survey.

BACKGROUND: Tobacco use among adolescents is a problematic risk behavior with early age of onset and consequences in health outcomes in adulthood. OBJECTIVES: Estimate the prevalence of tobacco use among adolescents at school and off school. METHODS: A community-base cross sectional study was conducted during 2007 to estimate the prevalence of tobacco consumption in adolescents aged 12-15 (n=1.998), school and off school. A multistage probability sampling was conducted. RESULTS: Life prevalence of tobacco consumption was 26.8% and currently use tobacco was 6%, the age onset was 11 years; non-enrolled in school adolescents had higher smoking rates. Majority of current smokers were able to buy cigarettes. CONCLUSION: Non-enrolled adolescents have more risk to tobacco use. Public policies should generate strategies to intervene this population. It is important to conduct the Global Youth Tobacco Survey in a national sample of adolescents including of school adolescents and establish an epidemiological surveillance system of risk behaviors based on surveys conducted periodically.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence.

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Aggressors and resilient youths in Medellin, Colombia: the need for a paradigm shift in order to overcome violence / Agresores y resilientes en Medellín, Colombia: necesidad de un cambio de paradigma para superar la violencia / Agressores e resilientes em Medellín, Colômbia: necessidade de uma mudança de paradigma, a fim de superar a violência

The objective of this study was to estimate the ratio of resilient youth and compare this to youth with aggressive behavior, and to youth who also exhibit sexually risky behavior and drug use. A cross-section study of a representative sample of people between aged between 12 and 60 who are residents of Medellin, Colombia, and its metropolitan area (N = 4,654) was employed using probabilistic multi-stage sampling. Youth between 14 and 26 years old were selected for the present analysis (n = 1,780). The proportion of resilient youth is 22.9%, of aggressors is 11.3%, and that of youth with other risky conduct is 65.8%. The high ratio of resilient youth calls for a reorientation of public policy toward prevention and control of violence, prioritizing the promotion of resilient behavior instead of continuing with tertiary prevention actions.

Los objetivos fueron estimar la proporción de jóvenes resilientes y comparar dicha proporción con la de jóvenes con conductas agresivas y con otras conductas de riesgo. Estudio transversal en una muestra representativa de personas entre los 12 a 60 años, habitantes de Medellín, Colombia, y el área metropolitana (N = 4.654). Muestreo probabilístico polietápico. Se seleccionaron los jóvenes entre 14-26 años para el presente análisis (n = 1.780). La proporción de jóvenes resilientes es de un 22,9%, la de agresores un 11,3%, la de jóvenes con otras conductas de riesgo es de un 65,8%. La alta proporción de jóvenes resilientes obliga a reorientar las políticas públicas de la prevención terciaria y el control de la violencia a la promoción de las conductas resilientes y al desarrollo positivo de los niños y jóvenes en la sociedad.

Os objetivos foram estimar a proporção de jovens resistentes e compará-la com jovens com condutas agressivas, e jovens que também apresentam comportamento sexual de risco e uso de drogas. Estudo transversal de uma amostra representativa de pessoas com idades entre 12 e 60 anos, habitantes de Medellín e sua área metropolitana, na Colômbia (N = 4.654), foi utilizado a partir de amostragem probabilística multiestágio. Jovens entre 14 e 26 anos foram selecionados para a presente análise (n = 1.780). A proporção de jovens resistentes foi de 22,9%, de agressores 11,3%, e de jovens com conduta de risco foi de 65,8%. A alta proporção de jovens resistentes força uma reorientação das políticas públicas para a prevenção e controle da violência, privilegiando a promoção de condutas de resistência ao invés de continuar com ações de prevenção terciária.

[An immunoenzymatic test for IgG antibody levels against 10 serotypes of Streptococcus pneumoniae]. / Estandarización en Colombia de una prueba ELISA para la evaluación de los niveles séricos de anticuerpos IgG contra diez serotipos de Streptococcus pneumoniae.

INTRODUCTION: Streptococcus pneumoniae is a major cause of morbi-mortality in early childhood and elderly. However, a test to measure the antibody responses after specific vaccination is not available in Colombia. OBJECTIVE: An immunoenzymatic test was standardized for the measurement of serum IgG levels against 10 serotypes of S. pneumoniae in response to the specific vaccination. MATERIAL AND METHODS: Capsular polysaccharides 1, 3, 4, 5, 6B, 9V, 14, 18, 19F, 23F of S. pneumoniae were used as antigens in a solid-phase ELISA. These responses were characterized in a randomized selected healthy individuals from a Colombian population. RESULTS: The reference and control sera showed great reactivity against all the polysaccharides evaluated, especially against polysaccharide 14 and 19F. The lowest reactivity in these two sera was observed against polysaccharide 3 and 4. Among the children evaluated, polysaccharide 5/19F showed the highes pre-vaccination reactivity, and polysaccharide 14/19F showed the highest post-vaccination reactivity. Among the adults, polysaccharides 14 and 19F showed the greatest reactivity pre- and post-vaccination. For all the polysaccharides (excepting polysaccharide 5), an inverse association among high polysaccharide-specific pre-vaccination- and the increase of post-vaccination-IgG levels was observed. CONCLUSION: This ELISA test reliably quantifies the serum levels of specific IgG against 10 serotypes of S. pneumoniae. According to the responses by healthy individuals, the current study validates parameters used internationally as an adequate the response to the 23-valent pneumococcal vaccine.

Estandarización en Colombia de una prueba ELISA para la evaluación de los niveles séricos de anticuerpos IgG contra diez serotipos de Streptococcus pneumoniae / An immunoenzymatic test for IgG antibody levels against 10 serotypes of Streptococcus pneumoniae

Introducción. Streptococcus pneumoniae es causante de gran morbimortalidad en niños pequeños y ancianos. Sin embargo, en Colombia no está disponible una prueba que evalúe la respuesta humoral a la vacunación específica contra este microorganismo Objetivo. Estandarizar en Colombia un ensayo inmunoenzimático para evaluar los niveles séricos de anticuerpos IgG contra diez serotipos de S. pneumoniae en respuesta a la vacunación específica y caracterizar esta respuesta en individuos sanos de nuestra población. Materiales y métodos. Se hizo un ELISA en fase sólida utilizando como antígenos los polisacáridos capsulares 1, 3, 4, 5, 6B, 9V, 14, 18, 19F y 23F de S. pneumoniae. Resultados. Los sueros de referencia y control reaccionaron fuertemente contra los polisacáridos evaluados, especialmente contra 14 y 19F. En los cinco niños sanos evaluados, los polisacáridos 5 y 19F presentaron los mayores títulos antes de la vacunación. Antes de la vacunación en los niños, y antes y después de la vacunación en los adultos, los polisacáridos 14 y 19F reaccionaron fuertemente. Para todos los polisacáridos, excepto para el 5, existe una relación inversa entre títulos altos de anticuerpos IgG antes de la vacunación y la razón de incremento de los títulos después de la misma. Conclusión. Esta prueba ELISA cuantifica de forma confiable los niveles de IgG sérica contra diez serotipos de S. pneumoniae y, de acuerdo con los resultados obtenidos en individuos sanos de nuestra población, en este trabajo se validan los parámetros internacionales para considerar adecuada la respuesta a la vacuna 23-valente contra este microorganismo.

Introduction. Streptococcus pneumoniae is a major cause of morbi-mortality in early childhood and elderly. However, a test to measure the antibody responses after specific vaccination is not available in Colombia. Objective. An immunoenzymatic test was standardized for the measurement of serum IgG levels against 10 serotypes of S. pneumoniae in response to the specific vaccination. Material and methods. Capsular polysaccharides 1, 3, 4, 5, 6B, 9V, 14, 18, 19F, 23F of S. pneumoniae were used as antigens in a solid-phase ELISA. These responses were characterized in a randomized selected healthy individuals from a Colombian population. Results. The reference and control sera showed great reactivity against all the polysaccharides evaluated, especially against polysaccharide 14 and 19F. The lowest reactivity in these two sera was observed against polysaccharide 3 and 4. Among the children evaluated, polysaccharide 5/19F showed the highes pre-vaccination reactivity, and polysaccharide 14/19F showed the highest post-vaccination reactivity. Among the adults, polysaccharides 14 and 19F showed the greatest reactivity pre- and post-vaccination. For all the polysaccharides (excepting polysaccharide 5), an inverse association among high polysaccharide-specific pre-vaccination- and the increase of post-vaccination-IgG levels was observed. Conclusion. This ELISA test reliably quantifies the serum levels of specific IgG against 10 serotypes of S. pneumoniae. According to the responses by healthy individuals, the current study validates parameters used internationally as an adequate the response to the 23-valent pneumococcal vaccine.

Predicting resilient adolescents and youths: validation of a screening test in Colombia.

BACKGROUND: This article presents the validation of the Child and Youth Resilience Measure-58 (CYRM-58) in the Colombian context and in Spanish language. METHODS: CYRM-58 has 58 questions and was developed by an international team of researchers coordinated by the Resilience Research Centre (Dalhousie University, Canada). Simplified CYRM Colombia is a test that uses 7 questions of CYRM-58; for its validation we tested reproducibility in 22 persons aged 14 to 23 years. RESULTS: We validated content and internal consistency in 39 resilients, 43 youth with deviant behaviors, and 66 controls matched by age and sex. We estimated internal consistency by non-parametric factorial analysis, and we assessed content validity by means of the Mann-Whitney test, bootstrap regression and logistic regression. The reproducibility was found to be in the range of 75-86%. Correlation between measurements was 75%. CONCLUSION: The best predictive model or Simplified CYRM Colombia was found to have seven questions (sensitivity = 96%, specificity = 76%, power = 80%).

Violence witnessing, perpetrating and victimization in Medellín, Colombia: a random population survey.

BACKGROUND: The burden of injury from violence and the costs attributable to violence are extremely high in Colombia. Despite a dramatic decline in homicides over the last ten years, homicide rate in Medellin, Colombia second largest city continues to rank among the highest of cities in Latin America. This study aims to estimate the prevalence and distribution of witnesses, victims and perpetrators of different forms of interpersonal violence in a representative sample of the general population in Medellin in 2007. METHODS: A face-to-face survey was carried out on a random selected, non-institutionalized population aged 12 to 60 years, with a response rate of 91% yielding 2,095 interview responses. RESULTS: We present the rates of prevalence for having been a witness, victim, or perpetrator for different forms of violence standardized using the WHO truncated population pyramid to allow for cross-national comparison. We also present data on verbal aggression, fraud and deception, yelling and heavy pranks, unarmed aggression during last year, and armed threat, other severe threats, robbery, armed physical aggression, and sexual aggression during the lifetime, by age, sex, marital and socioeconomic status, and education. Men reported the highest prevalence of being victims, perpetrators and witnesses in all forms of violence, except for robbery and sexual violence. The number of victims per perpetrator was positively correlated with the severity of the type of violence. The highest victimization proportions over the previous twelve months occurred among minors. Perpetrators are typically young unmarried males from lower socio-economic strata. CONCLUSIONS: Due to very low proportion of victimization report to authorities, periodic surveys should be included in systems for epidemiological monitoring of violence, not only of victimization but also for perpetrators. Victimization information allows quantifying the magnitude of different forms of violence, while data on factors associated with aggression and perpetrators are necessary to estimate risk and protective factors that are essential to sound policies for violence prevention formulation.

La violencia doméstica en Medellín y demás municipios del Valle de Aburrá, 2003-2004 / Domestic violence in Medellín and other municipalities of Aburrá Valley 2003-2004

Objetivo: estimar la magnitud y distribución por sexo de la violencia doméstica (de pareja, de padres a hijos y entre hermanos) en Medellín y los otros nueve municipios del Valle de Aburrá 2003-2004. Métodos: encuesta cara a cara en una muestra multietápica representativa de la población de 12 a 60 años, no institucionalizada, del área urbana de cada municipio. Resultados: en miembros de la pareja se encontró agresión y victimización verbal o sicológica (64 y 61%); física sin lesión (17 y 14%); física con lesión (2 y 3%). Se observan proporciones de agresión y victimización similares en hombres y en mujeres. La agresión verbal y física a hijos por sus padres es cercana a 60% y la que deja lesiones físicas es de 10%. En 55% de las familias hubo peleas entre hermanos y en 3%, secuelas de lesión física. En Medellín se presentan mayores proporciones de violencia doméstica que en los demás municipios agrupados. La proporción de no denuncia es muy alta (80 a 95%) y es significativamente mayor entre los hombres. Conclusiones: no es aconsejable fincar las políticas públicas y programas de prevención y control de la violencia doméstica en las estadísticas de las cuales dispone el Estado; se recomienda realizar encuestas periódicas en muestras poblacionales completas (hombres y mujeres). Se sugiere tener dos tipos de programas: unos de prevención de la violencia doméstica, considerando a la familia como una unidad total, y otros de rehabilitación de agresores crónicos y severos.

Objective: To estimate the magnitude and distribution by sex of domestic or family violence (between partners, siblings, and from parents to children) in Medellin, Colombia and nine surrounding municipalities (Medellin metropolitan area), 2003-2004. Methods: Household survey to a representative multistage sample to non institutionalized population, within 12 and 60 years of age, in the urban area of each municipality. Results: Verbal or psychological aggression and victimization: 64% and 61%, physical violence without physical injury: 17% and 14%, physical violence with physical injury: 2% and 3% between intimate partners. Intimate partners’ aggression and victimization do no differentiate by sex. Verbal, psychological and physical aggression from parents toward children is 60%, and physical aggression with physical injury is near 10%. 55% of families reported fights among siblings, and 3% with physical injury. Medellin has the highest rates of family or domestic violence compared with the other municipalities of Aburra Valley. Domestic violence charge is very low (5-20%), and masculine victims rather prefer not to report. Conclusions: We suggest not to ground public policies on current statistics, but to establish a system of periodic surveys, representative of general population or families. It seems important to have two different types of interventions: domestic or family violence prevention considering family as a unit that interaCTS with the surrounding; and rehabilitation of chronic and severe domestic aggressors.

Conductas socialmente indeseables asociadas a agresores y resilientes. Un estudio de casos y controles en Medellín, Colombia. 2003 - 2005 / Deviant behaviors associated with aggressors and resilient subjects. A case-control study in Medellin, Colombia. 2003-2005

Con base en un estudio de casos y controles realizado en Medellín, Colombia, entre 2003 y 2005 con el fin de estimar los factores asociados a formas severas de agresión y delincuencia, así como los factores de resiliencia frente a ellas, se estimaron las conductas socialmente indeseables o anómicas vinculadas a cada uno de los grupos estudiados. Metodología: Se estudiaron cinco grupos: agresores severos (n=62), agresores principalmente de riñas graves (n=81), miembros de las Autodefensas Unidas de Colombia (AUC) no reinsertados, comúnmente denominados paramilitares (n=72), resilientes (n=59) y controles comunitarios (n=103). A todos se les hizo una encuesta, respondida personalmente en las comunidades donde residen, para ello se los identificó y contactó por medio de entidades y personas de las comunidades que les merecieran respeto y confianza. Resultados: La magnitud de la prevalencia y el número de las conductas de agresión abierta, de agresión encubierta, de oposición y el consumo de sicoactivos es mayor entre los miembros de las AUC, los agresores severos y los agresores de riñas que entre los controles y resilientes. Los resilientes presentan menor número de conductas socialmente anómalas que los controles comunitarios y con una proporción de prevalencia menor. El grupo de AUC no se diferencia de los agresores más severos en cuanto a las conductas que están frecuentemente asociadas a cada uno de estos grupos.

Concurrent risky or deviant behaviors of serious offenders, resilient men and community controls were estimated through a case-control study carried out in Medellin, Colombia between 2003 and 2005. Methodology: Cases: serious offenders (n=62), men involved in violent quarrels or brawls (n=81), and members of Autodefensas Unidas de Colombia -Colombian paramilitary army- (AUC), also known as paramilitaries (n=72) were compared to resilient men (n=59) and community controls (n=103). All were interviewed face to face in their communities. Cases were interviewed at the site, day and hour agreed with the group leader. Controls and resilient men were referred by respected and trusted persons of the community and interviewed in their own communities in a place chosen by them. Results: Antecedents of overt and covert aggression, deviant behaviors and oppositional behaviors, and substance abuse was higher among AUC members (paramilitaries), serious offenders and men involved in quarrels than among community controls and resilient men. Resilient men report a smaller number of concurrent deviant and risky behaviors compared to community controls. AUC members (paramilitaries) are not different from serious offenders in their reports of concurrent risky and deviant behaviors.

Similitudes y diferencias entre miembros de las Autodefensas Unidas de Colombia, agresores severos y controles comunitarios en Medellín / Similarities and differences among paramilitaries, severe aggressors and communal control, a case-control study in Medellín, Colombia

Con base en un estudio de casos y controles llevado a cabo entre 2003 y 2005 en Medellín, Colombia, se compararon las características de agresores severos o delincuentes mayores con las de miembros de las Autodefensas Unidas de Colombia (AUC), comúnmente llamados paramilitares, y las de controles comunitarios. Los agresores severos y paramilitares tienen un menor nivel educativo que los controles, provienen en menor proporción de familias biparentales, en sus familias de origen había más problemas de consumo de drogas y abuso de alcohol y tuvieron en mayor grado desplazamiento forzado y asesinato de miembros de la familia. No hubo diferencias en cuanto al tiempo de residencia en la ciudad y en el barrio ni en cuanto a la forma de tenencia de la vivienda en la familia de origen, tampoco en cuanto a estresores en la familia actual. Tampoco las hubo en cuanto a la creencia en Dios, la práctica religiosa ni los motivos para practicar la religión. No hubo diferencias entre agresores severos y paramilitares con respecto a las anteriores variables. Los paramilitares indicaron haber padecido condiciones de extrema pobreza en su niñez en mayor grado que los agresores severos y los controles. Se exploró también la percepción de oportunidades de progreso en la sociedad.

A case-control study was performed in Medellín during 2003- 2004 to compare characteristics of severe aggressors, members of Colombian United Selfdefense Forces members (AUC), otherwise named paramilitaries, and communal control. Severe aggressors and paramilitaries have lower educational level than communal control; their families were biparental in a lower proportion, and experienced drug and alcohol abuse in a higher proportion than in the case of families of communal control. Severe aggressors and paramilitaries’ families suffered forced displacement and assassination of one of its members in a higher proportion than those of controls. There were no differences relating time of residence in Medellín or current neighborhood, or current family socioeconomic stressors. No differences were found regarding believing in God, religious practice and reasons for practicing religion. There were no significant differences for all mentioned variables between severe aggressors and paramilitaries. Paramilitaries did inform having suffered extreme poverty conditions during childhood in a higher proportion than severe aggressors and controls. Progress opportunities perception was also explored.

Reporte de hechos violentos en los municipios del Valle de Aburrá / Crime report in the cities of Aburra Valley metropolitan area

Este artículo analiza el reporte de hechos violentos en los municipios del Valle de Aburrá con base en la encuesta sobre magnitud, distribución y factores asociados a la violencia realizada entre 2003 y 2004 en el área urbana de los diez municipios del Valle de Aburrá. Prácticamente no se denuncian las formas de agresión menos severas y más del 75% de las víctimas de agresión severa no denuncian el hecho ante las autoridades. Se concluye que con estos niveles de subregistro no es posible apoyar políticas públicas que impacten estos hechos.

This article analyzes crime report in Valle de Aburrá cities, based on a household survey of a representative sample of subjects between 12 and 60 years old, interviewed in 2003-2004. Actually, there is almost no report of non severe aggressions and over 75% of victims of severe aggression do not report to authorities. Sexual aggression is almost no reported by men. According to these high rates of no reporting, it is not advisable to support public policies on such statistical reports.

Magnitud y distribución de diferentes formas de violencia en Medellín, 2003-2004 / Magnitude and distribution of different forms of violence in Medellin, 2003-2004

Objetivo: estimar la magnitud y distribución del hecho de haber sido testigo, víctima o agresor de diferentes tipos de violencia. Métodos: estudio de corte en muestra representativa de la población (12-60 años) de Medellín. La información se recolectó por encuestas domiciliarias en 2003-2004. Resultados: los hombres reportan las mayores proporciones como victimas, agresores y testigos por todas las formas de violencia excepto agresor sin arma y victima de desplazamiento forzado y de violencia sexual. El número de víctimas por agresor aumenta con la gravedad del tipo de violencia. Mas de 75 por ciento ha sido testigo de amenazas graves y asalto armado, 46 por ciento de robo y 10 por ciento de violencia sexual. Cerca de 40 por ciento ha sido victima de amenzas graves, robo y agresion armada; y el 6 por ciento, de violencia sexual. La mayor victimización en los últimos doce meses se presento en los menores de edad. El 10 por ciento de los menores de edad, 7 por ciento de 18 a 35 años han robado en sus vidas y el 4 por ciento de 18 a 54 años agradieron con arma. Aproximadamente una cuarta parte percibe que en su barrio hay problemas de peleas entre vecinos a entre pandillas y robos. Se presentan la probabilidad de ser agresor, victima y testigo en las 16 comunas urbanas de Medellín.

Decentralización del sector salud en Colombia análisis de 91 Municipios / Health sector decentralization in Colombia: analysis of 91 cities

Objetivo: analizar la capacidad institucional y la participación comunitaria del sector salud de los municipios de los departamentos de Antioquia, Caldas y Risaralda, segun su categoría socioeconómica. Métodos: Se realizó una encuesta por correo a todos los municipios (164)de los departamentos de Antioquia, Caldas y Risaralda, de los cuales respondió el 56 por ciento. Se realizó un análisis descriptivos de los datos, análisis de componente principal y finalmente, análisis de correlaciones.Resultados: se encontró que el nivel de desarrollo institucional del sector salud de los municipios no está acorde con su categoría socio-económica; tampoco los municipios tienen un desarrollo integral de los diferentes aspectos de su capacidad institucional. Algunos municipios pequeños y con bajo nvel socioeconómico presentan desarrollos similares y aún mejores que municipios de mayor nivel socioeconómico.

Prediccion de la grasa corporal en adultos sin la confusion generada por la edad / Prediction of fat body in adults

Introducción: Las ecuaciones para estimar la grasa corporal incorporan la edad como factor predictor. Esto obliga a los clínicos a aceptar que las personas engordarán a través de los años aunque sus pliegues de grasa permanezcan estables o incluso aunque disminuyan. Esta situación sin sentido se examina en el presente estudio para esclarecer ¿qué es lo que realmente pasa? ¿cómo fue que la confusión afectó los instrumentos analíticos que hoy manejamos? Y también ¿cómo pueden corregirse los equívocos? Objetivo: Identificar el factor determinante del incremento de grasa con la edad y establecer los correctivos necesarios para una correcta evaluación de la composición corporal en el adulto. Métodos: 1.725 adultos entre 18 y 79 años de edad fueron evaluados con diversas mediciones corporales y analizadas en su composición corporal siguiendo los lineamientos de control de calidad y estandarización propuestos por Habitch, Malina, Lohman, Roche y Martorell. Por correlación y regresión lineal se analiza la tendencia de incremento de la grasa con la edad, controlando por variables categóricas para comparar las pendientes y sus intervalos de confianza al 95 por ciento. Por regresión múltiple se genera la ecuación lineal única para el cálculo preciso de grasa corporal en hombres y mujeres. Se elaboran tablas mejoradas para el análisis de composición corporal en el adulto. Resultados: Diversos indicadores de acumulación de grasa corporal aumentan con la edad: grasa total .150 ka/año, pliegue de grasa promedio .106 mm/año, área interna abdominal 4.33 cm2 perímetro abdominal .35 cm/año. Estos incrementos son signiñcativos tanto para hombres como para mujeres. La grasa aumenta a través de la edad en personas sedentarias, pero no aumenta significativamente en personas activas. La grasa se asocia con la edad en la población general (r.45), pero la asociación desaparece en grupos activos (r -.01). El área interna del abdomen correlaciona bien con el perímetro abdominal (r.98) y ambos reflejan la acumulación de grasa interna. Se ofrecen tablas mejoradas para la estimación de grasa corporal en adultos, a partir de grasa externa y grasa interna. Se genera una ecuación lineal de predicción con mejoramientos en validez, simplicidad y precisión. por ciento G = .2467S+.12A] -2.18 en hombres + 4.98 en mujeres S=suma 4 pliegues: bíceps, tríceps, subescapular, suprailiaco...