Knowledge and attitudes regarding contraceptive methods and sex education in students and parents of eight Colombian schools 2020-2021: a mixed methods study.

Background: In Colombia, the average age of first sexual intercourse is between 14 and 15, and it has one of the highest fertility rates among adolescents in Latin America, which reflects poor access to health services and a lack of knowledge about contraception. Some laws support comprehensive sex education as a learning process that families and schools should provide. The objective of this work was to assess the frequency of adequate knowledge and attitudes of acceptance towards contraception in students, their associated factors, sexual behaviours in sexually active students, and experiences with sex education. Methods: Mixed methods study consisting of an analytical cross-sectional study and a qualitative hermeneutic phenomenological study. The former included students who completed a questionnaire with sociodemographic variables, surveys on knowledge and attitudes toward contraception, and questions about sexual behaviour. Focus groups were used in the qualitative study to evaluate students' and parents' sex education experiences. Findings: 827 students were surveyed, of whom 52.3% had adequate knowledge about contraceptives and 80.1% had attitudes of acceptance. Talking with parents about sex education, receiving sex education, and being in the eleventh grade increased the likelihood of having adequate knowledge. Each year of age, being male, being a victim of forced displacement, and studying in a public school were associated with lower possibilities of attitudes of acceptance. Using condoms, compared to other contraceptives, was associated with less adequate knowledge and attitudes of acceptance (p < 0.05). Experiences with sex education, contraception, and sexual and reproductive rights were three emerging categories in the focus groups. Interpretation: In a group of Colombian high school students, half of them had adequate knowledge, eight out of 10 had attitudes of acceptance about contraception, and both were associated with having received sex education. Nevertheless, different types of barriers to sexual education were identified at home and in schools. The results will allow the generation of educational policies that modify the educational model as well as new strategies by health professionals to raise awareness about responsible sexuality. Funding: This project was financed by internal research of the Fundación Universitaria de Ciencias de la Salud-FUCS (DI-I-0392-20).

Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: a situational analysis.

BACKGROUND: Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. METHODS: Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. FINDINGS: In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690-3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48-0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. INTERPRETATION: We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. FUNDING: Zoll Medical.

Diagnóstico y manejo de la obesidad en perros: una revisión / Diagnosis and management of obesity in dogs: a review / Diagnóstico e manejo da obesidade em cães: revisão

La obesidad es definida como la acumulación excesiva de grasa en el tejido adiposo del cuerpo, que se corresponde con un consumo inadecuado de energía y proteína lo que ocasiona un balance positivo de energía. El sobrepeso y la obesidad afectan a cerca del 25% de los perros, su presentación puede variar entre el 20 y 45% de la población canina que visita los centros y clínicas veterinarias de varios países occidentales y de Australia y, por lo tanto, se leconsidera una enfermedad nutricional común en los animales de compañía (perros y gatos). Los factores de riesgorelacionados con la obesidad incluyen la genética, la raza, la edad, la actividad física, el tipo de alimento consumidoy la castración, entre otros. El objetivo de esta revisión es realizar una aproximación al problema de la obesidadde los perros y gatos, sus factores de riesgo y su manejo integral, además de proponer un método sencillo paraestablecer la cantidad de alimento a suministrar a cada paciente de acuerdo con su estado fisiológico.

Obesity is defined as an excessive accumulation of fat in the adipose tissue of the body which results froman inappropriate consumption of energy and protein leading to a positive energy balance. Excess weight andobesity affect about 25% of dogs, a percentage that may vary between 20 and 45% of the dog populationpresenting for consultation in centers and veterinary clinics in several Western countries and Australia. Obesityis thus considered a nutritional disease common in companion animals (dogs and cats). Risk factors associatedwith obesity include genetics, breed, age, physical activity, the type of food consumed, and castration, amongstothers. This review intends to address the problem of obesity, its risk factors in dogs and cats and theircomprehensive management. Additionally, a simple procedure is proposed for establishing the precise quantity of daily food to be provided to each patient according to their physiological condition.

A obesidade é definida como acúmulo excessivo de gordura no tecido adiposo do corpo que resulta de um consumoinadequado de energia e proteína levando a um balanço energético positivo. O excesso de peso e a obesidade afetam cerca de 25% dos cães, sua apresentação pode variar entre 20 e 45% da população canina que visitam os centros eclínicas veterinárias em vários países ocidentais e na Austrália, por tanto, é considerada um desordem nutricionalcomum em animais de companhia (cães e gatos). Fatores de risco associados à obesidade incluem genética, raça,idade, atividade física, o tipo de alimento consumido, a castração, entre outros. O objetivo desta revisão é abordar o problema da obesidade em cães e gatos, seus fatores de risco e sua gestão integrada, além de propor um método simples para estabelecer a quantidade exata de alimento a ser oferecida para cada paciente de acordo com sua condição fisiológica.

Abscesos profundos de cuello. Diez años de experiencia en el Instituto Nacional de Pediatría / Deep neck abscess. ten years of experience in Instituto Nacional de Pediatria

Se trataron 107 casos de absceso profundo de cuello en el Instituto Nacional de Pediatría del 1o. de enero de 1985 al 15 de septiembre de 1995. Evolucionaron satisfactoriamente excepto dos: uno falleció por complicaciones propias de esta patología y otro pidió alta voluntaria. Algunos pacientes presentaron trismo, tortícolis y rigidez de cuello; disfagia, odinofagia y disfonía según el sitio de localización del absceso. Los síntomas principales y signos generales fueron: debilidad, malestar, fiebre de 38 a 40 ºC, pulso filiforme, leucocitosis y en unos casos anemia. El diagnóstico clínico se corroboró con estudios de laboratorio y gabinete como cultivos de secreción, ultrasonido y tomografía computarizada. Los pacientes se manejaron como urgencias con hospitalización inmediata y administración de antibióticos por vía intravenosa a dosis elevadas; algunos requirieron drenaje del absceso para evitar complicaciones mortales debidas al manejo inadecuado y tardío