Clinical Characteristics and Outcomes of a High-grade Endometrial Cancer Cohort Treated at Instituto Nacional de Câncer, Brazil / Características clínicas e desfechos de uma coorte de câncer endometrial de alto grau tratada no Instituto Nacional de Câncer, Brasil

Abstract Objective To analyze the outcomes of a cohort of patients with high-risk histologies of endometrial cancer (EC) treated at Instituto Nacional de Câncer (National Cancer Institute, INCA, in Portuguese), in Brazil. Materials and Methods We reviewed the medical records of patients with high-risk histologies of EC in any stage registered at INCA between 2010 and 2016 to perform a clinical and demographic descriptive analysis and to evaluate the outcomes in terms of recurrence and survival. Results From 2010 to 2016, 2,145 EC patients were registered and treated at INCA, and 466 had high-grade histologies that met the inclusion criteria. The mean age of the patients was 65 years, 44.6% were Caucasian, and 90% had a performance status of 0 or 1. The most common histology was high-grade endometrioid (31.1%), followed by serous carcinoma (25.3%), mixed (20.0%), carcinosarcoma (13.5%), and clear cell carcinoma (9.4%). Considering the 2018 Fédération Internationale de Gynécologie et d'Obstétrique (International Federation of Gynecology and Obstetrics, FIGO, in French) staging system, 44.8%, 12.4%, 29.8%, and 12.9% of the patient were in stages I, II, III or IV respectively. Age (> 60 years), more than 50% of myoinvasion, higher stage, poor performance status, serous and carcinosarcoma histologies, and adjuvant treatment were independent factors associated with recurrence-free survival (RFS) and overall survival (OS) in the multivariate analysis. Conclusion The current findings reinforced the international data showing poor outcomes of these tumors, especially for serous and carcinosarcomas and tumors with advanced stages, with shorter survival and high recurrence rates in distant sites, independently of the FIGO stage. Adjuvant therapy was associated with better survival.

Resumo Objetivo Analisar os desfechos de uma coorte de pacientes com câncer de endométrio (CE) e histologias de alto risco atendida no Instituto Nacional do Câncer (INCA) entre 2010 e 2016. Materiais e Métodos Foram revisados prontuários de pacientes com histologias de alto risco de CE em qualquer estágio cadastradas no INCA entre 2010 e 2016 para realizar uma análise descritiva clínica e demográfica e avaliar os resultados em termos de recorrência e sobrevida. Resultados De 2010 a 2016, 2.145 pacientes com CE foram cadastradas e atendidas no INCA, e 466 tinham histologias de alto grau e atendiam aos critérios de inclusão. A média de idade das pacientes foi de 65 anos, 44,6% eram brancas, e 90% tinham performance status de 0 ou 1. A histologia mais comum foi endometrioide de alto grau (31,1%), seguida de carcinoma seroso (25,3%), misto (20,0%), carcinossarcoma (13,5%) e carcinoma de células claras (9,4%). Considerando o estadiamento da Fédération Internationale de Gynécologie et d'Obstétrique (Federação Internacional de Ginecologia e Obstetrícia, FIGO, em francês) de 2018, 44,8%, 12,4%, 29,8% e 12,9% apresentaram estágios I, II, III ou IV, respectivamente. Idade (> 60 anos), mais de 50% de mioinvasão, estágio avançado, performance status ruim, histologias serosas e carcinossarcoma, e tratamento adjuvante foram fatores independentes associados à sobrevida livre de recorrência e sobrevida global na análise multivariada. Conclusão Os achados atuais reforçam os dados internacionais que demonstram o prognóstico ruim desses tumores, principalmente para as histologias serosas e carcinossarcomas e para estágios avançados, com menor sobrevida e altas taxas de recorrência à distância, independentemente do estágio da FIGO. A terapia adjuvante foi associada a melhor sobrevida.

Two Years of Evolutionary Dynamics of SARS-CoV-2 in Mexico, With Emphasis on the Variants of Concern.

Background: The advance of the COVID-19 pandemic and spread of SARS-CoV-2 around the world has generated the emergence of new genomic variants. Those variants with possible clinical and therapeutic implications have been classified as variants of concern (VOCs) and variants of interest (VOIs). Objective: This study aims to describe the COVID-19 pandemic and build the evolutionary and demographic dynamics of SARS-CoV-2 populations in Mexico, with emphasis on VOCs. Methods: 30,645 complete genomes of SARS-CoV-2 from Mexico were obtained from GISAID databases up to January 25, 2022. A lineage assignment and phylogenetic analysis was completed, and demographic history for Alpha, Gamma, Delta and Omicron VOCs, and the Mexican variant (B.1.1.519) was performed. Results: 148 variants were detected among the 30,645 genomes analyzed with the Delta variant being the most prevalent in the country, representing 49.7% of all genomes. Conclusion: The COVID-19 pandemic in Mexico was caused by several introductions of SARS-CoV-2, mainly from the United States of America and Europe, followed by local transmission. Regional molecular epidemiological surveillance must implement to detect emergence, introductions and spread of new variants with biologically important mutations.

Transição da morbimortalidade no Brasil: um desafio aos 30 anos de SUS / Transition of morbidity and mortality in Brazil: a challenge on the thirtieth anniversary of the SUS

Resumo Em 2020, completamos 30 anos desde a publicação das Leis Orgânicas do Sistema Único de Saúde. Desde então, a mudança no perfil de morbimortalidade tem desafiado a gestão, para que o serviço de saúde consiga atender à grande heterogeneidade dos quase seis mil municípios. Para isso, é necessário monitorar os principais indicadores do país. O objetivo do presente estudo foi apresentar uma visão geral das tendências de mortalidade e morbidade no Brasil entre 1990 e 2019. Utilizamos os dados do Estudo de Carga Global de Doenças para descrever a morbimortalidade pelos grandes grupos (doenças infecciosas, doenças crônicas e causas externas), segundo sexo e grupos etários. Há redução da morbimortalidade no período, independente do grupo de causa ou faixa etária, com variada diferença entre sexo de acordo com o grupo de causas. A contribuição das doenças crônicas é crescente com a progressão da idade, com diferença substancial segundo o sexo. As curvas de mortalidade e de anos perdidos por incapacidade possuem padrão típico, com destaque ao padrão diferenciado para curvas de homens por causas externas, com marcada sobremortalidade em idades jovens. A tendência ratifica o declínio dos indicadores de forma linear no período.

Abstract In 2020, the 30th anniversary of the publication of the Organic Laws of the Unified Health System was celebrated. Since then, the change in the profile of morbidity and mortality has been a challenge to management to ensure that the health services can attend the significant heterogeneity of approximately 6,000 municipalities. To achieve this, it is necessary to monitor the leading indicators of the country. The scope of this study was to present an overview of trends in mortality and morbidity in Brazil between 1990 and 2019. Data from the Study on the Global Burden of Disease was used to describe morbidity and mortality by major groupings (infectious diseases, chronic diseases, and external causes), according to gender and age groups. There was a reduction in morbidity and mortality in the period, irrespective of the cause or age group, albeit with a varied difference between the sexes depending on the cause. The contribution of chronic diseases increases with age, with a marked difference according to gender. The curves for mortality and years lost due to disability have a typical profile, with a different pattern of curves for men due to external causes, with marked excess mortality at young ages. The trend confirms the decline of indicators in a linear manner over the period.

Demographic and Comorbidities Data Description of Population in Mexico with SARS-CoV-2 Infected Patients(COVID19): An Online Tool Analysis.

The Word Health Organization (WHO) declared in March 2020 that we are facing a pandemic designated as COVID-19, which is the acronym of coronavirus disease 2019, caused by a new virus know as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Mexico, the first cases of COVID-19, was reported by the Secretary of Health on 28 February 2020. More than sixteen thousand cases and more than fifteen thousand deaths have been reported in Mexico, and it continues to rise; therefore, this article proposes two online visualization tools (a web platform) that allow the analysis of demographic data and comorbidities of the Mexican population. The objective of these tools is to provide graphic information, fast and updated, based on dataset obtained directly from National Governments Health Secretary (Secretaría de Salud, SSA) which is daily refreshed with the information related to SARS-CoV-2. To allow a dynamical update and friendly interface, and approach with R-project, a well-known Open Source language and environment for statistical computing and Shiny package, were implemented. The dataset is loaded automatically from the latest version released by the federal government of Mexico. Users can choose to study particular groups determined by gender, entity, type of result (positive, negative, pending outcome) and comorbidity. The image results are plots that can be instantly interpreted and supported by the text summary. This tool, in addition to being a consultation for the general public, is useful in Public Health to facilitate the visualization of the data, allowing its timely interpretation due to the changing nature of COVID-19, it can even be used for decision-making by leaders, for the benefit of the health of the community.

Una aproximación al quehacer del personal de salud que trabaja con adultos con discapacidad intelectual / An approach to the work of health personnel working with adults with intellectual disabilities

Objetivo: conocer las percepciones del personal de salud en el contexto institucional motivacional, ocupacional y su nivel de satisfacción laboral en el trabajo con adultos con discapacidad intelectual. Materiales y métodos: estudio con enfoque cuantitativo, alcance descriptivo y diseño no experimental-transaccional. Se utilizó una ficha sociodemográfica y laboral (ad hoc) que incluye hábitos y estilo de vida. Para analizar los resultados se utilizó el SPSS 21. Resultados: participaron 12 trabajadores, el 83% mujeres con promedio de 34,5 años de edad; el 67% trabaja más de 40 horas a la semana. El 50% reportó experimentar inseguridad laboral con distintos niveles de frecuencia. El 66,7% disfruta trabajar con personas con discapacidad. El 42% cree prioritarios cambios en la "conducción" y el 17% "mejorar la comunicación". Conclusiones: estos resultados permiten diseñar propuestas de formación y programas para la promoción de su salud y prevención de la enfermedad..Au

Objectives: to know the perceptions of health personnel in relation to the institutional context, their level of job satisfaction and aspects related to motivational dimension. Materials and methods: study with a quantitative approach, with a descriptive scope, with a non-experimental, transactional design. A sociodemographic and labor file was used, which includes sociodemographic and labor data (ad hoc), as well as aspects related to lifestyle habits. The institutional context, the level of worker satisfaction and other aspects related to the motivational dimension are investigated. SPSS 21 was used for the analysis of the results. Results: 12 employees participated; these were women (83%) with an average age of 34.5 years, 67% work more than 40 hours per week. A 50% reported experiencing a certain level of occupational insecurity with different frequencies. The 66.7% enjoy working with people with disabilities. A 42% believe priority changes are needed in "leadership" and a 17% in the "improvement in communication". Conclusions: it is considered convenient to know the reality of these workers to design training proposals and to plan programs for the promotion of their health..Au

Métodos para estimação da subenumeração do grupo etário de 0 a 4 anos no Censo Demográfico brasileiro de 2000 / Methods for estimation of subenumeration of the 0-4 year old in the 2000 Brazilian Demographic Census / Métodos para la estimación de la subenumeración del grupo cero a cuatro años en el Censo Demográfico Brasileño del año 2000

O objetivo deste trabalho é discutir a aplicação de técnicas que contribuam para identificar e corrigir a subenumeração censitária para o grupo etário de 0 a 4 anos, utilizando, como população base, aquela enumerada no Censo Demográfico de 2000. Frequentemente, esse grupo possui baixa enumeração, se comparada àquela de faixas etárias da população adulta. Foram aplicadas cinco técnicas para a estimação do grupo de 0 a 4 anos e os resultados indicam que, não obstante o fato de técnicas já comumente usadas oferecerem resultados satisfatórios, formas alternativas têm grande potencial a ser explorado.

Our aim is to apply techniques which contribute to identify and correct the census underenumeration for people aged 0-4 years old, using population enumerated in the 2000 Brazilian census as reference for estimations. Usually, this group has lower enumeration than others, such as adult population. Five techniques were applied to the 0-4 year old group estimation and results indicate that, although usual techniques have offered satisfactory results, alternative forms have great potential to be explored.

El objetivo de este trabajo es la aplicación de técnicas que contribuyen en la identificación y corrección de la subenumeración censal del grupo etario de cero a cuatro años de edad, sobre la base de la población enumerada en el Censo Demográfico de 2000. Frecuentemente, este grupo posee baja enumeración, si se lo compara con la de otros grupos etarios de la población adulta. Para cumplir el objetivo, fueron aplicadas cinco técnicas para la estimación del grupo de cero a cuatro años, y los resultados señalan que, pese a que las técnicas comúnmente usadas ofrecen resultados satisfactorios, algunas formas alternativas también muestran gran potencial a ser explorado.

Health transition in Brazil: regional variations and divergence/convergence in mortality / A transição da saúde no Brasil: variações regionais e divergência/convergência na mortalidade / La transición de la salud en Brasil: variaciones regionales y divergencia/convergencia en la mortalidad

Abstract: This study analyzes the main characteristics of the health transition in Brazil and its five major regions, using a framework that accounts for regional inequalities in mortality trends. The regional mortality divergence/convergence process is described and discussed by considering the specific contributions of age groups and causes of death in life expectancy variations. Results show that mortality change in Brazil has follow the epidemiologic transition theory to some extent during the period under analysis - for instance, the sharp decline in infant mortality in all regions (first from infectious and parasitic diseases and then from causes associated with the perinatal period) and the increase in the participation of chronic and degenerative diseases as the main cause of death. However, some features of Brazilian transition have not followed the linear and unidirectional pattern proposed by the epidemiologic transition theory, which helps to understand the periods of regional divergence in life expectancy, despite the long-term trends showing reducing regional inequalities. The emergence of HIV/AIDS, the persistence of relatively high levels of other infections and parasitic diseases, the regional differences in the unexpected mortality improvements from cardiovascular diseases, and the rapid and strong variations in mortality from external causes are some of the examples.

Resumo: O estudo analisa as principais características da transição da saúde no Brasil como um todo e nas cinco macrorregiões, utilizando um referencial que leva em conta as desigualdades regionais nas tendências de mortalidade. O artigo descreve e discute o processo de divergência/convergência regional da mortalidade, ao considerar as contribuições específicas dos grupos etários e as causas de óbito para as variações na expectativa de vida. De acordo com os resultados, em certa medida a mudança na mortalidade no Brasil segue a teoria da transição epidemiológica durante o período de estudo - por exemplo, com a importante queda na mortalidade infantil em todas as regiões do Brasil (primeiro pelas doenças infecto-parasitárias, e depois pelas causas associadas ao período perinatal) e o aumento da participação das doenças crônicas e degenerativas como a principal causa de mortalidade. Entretanto, algumas características da transição brasileira não confirmaram o padrão linear e unidirecional proposto pela teoria da transição epidemiológica, o que ajuda a entender os períodos de divergência regional na expectativa de vida (apesar das tendências, no longo prazo, de redução das desigualdades regionais). Alguns exemplos incluem a epidemia de HIV/AIDS, a persistência de níveis relativamente altos de outras doenças infecciosas e parasitárias, as diferenças regionais na melhoria inesperada nas taxas de mortalidade por doenças cardiovasculares e as variações rápidas e acentuadas na mortalidade por causas externas.

Resumen: El estudio analiza las principales características de la transición de la salud en Brasil, como un todo y en las cinco macrorregiones, utilizando un marco de referencia que tiene en consideración las desigualdades regionales en las tendencias de mortalidad. El artículo describe y discute el proceso de divergencia/convergencia regional de la mortalidad, al considerar las contribuciones específicas de los grupos etarios y las causas de muerte para las variaciones en la esperanza de vida. De acuerdo con los resultados, en cierta medida el cambio en la mortalidad en Brasil sigue la teoría de la transición epidemiológica durante el período de estudio -por ejemplo, con una importante caída en la mortalidad infantil en todas las regiones de Brasil (primero por las enfermedades infecto-parasitarias, y después por las causas asociadas al período perinatal) y el aumento de la ocurrencia de enfermedades crónicas y degenerativas como la principal causa de mortalidad. Sin embargo, algunas características de la transición brasileña no confirmaron el padrón lineal y unidireccional propuesto por la teoría de la transición epidemiológica, lo que ayuda a entender los períodos de divergencia regional en la esperanza de vida (a pesar de las tendencias, a largo plazo, de reducción de las desigualdades regionales). Algunos ejemplos incluyen la epidemia de VIH/SIDA, la persistencia de niveles relativamente altos de otras enfermedades infecciosas y parasitarias, las diferencias regionales en la mejora inesperada en las tasas de mortalidad por enfermedades cardiovasculares y las variaciones rápidas y acentuadas en la mortalidad por causas externas.

Sobrecarga en cuidadores primarios de pacientes con glaucoma avanzado / Overload in primary caregivers of patients with advanced glaucoma

Las personas dedicadas al cuidado de los pacientes con enfermedades avanzadas como el glaucoma pueden presentar sobrecarga física o emocional, esta es a menudo menospreciada por el paciente, el sistema de salud, la familia y el propio cuidador. El glaucoma avanzado es una patología que puede conducir a la ceguera y que generan dependencia del paciente frente a su cuidador primario. Consideramos relevante cuantificar el nivel de esta sobrecarga en personas dedicadas al cuidado de pacientes con glaucoma avanzado. Materiales y Métodos: para el estudio se utilizó una escala de sobrecarga internacional, validada en la ciudad de Medellín: la escala de Bedard de Cribado (abreviada de la escala de Zarit). Se aplicó vía telefónica - previo consentimiento informado - acompañada de un cuestionario corto en el cual se incluyeron datos sociodemográficos, a los cuidadores de pacientes con daño glaucomatoso avanzado. Resultados: se evaluaron en total 30 cuidadores, de estos 24 (80%) eran mujeres. El promedio± (DE) de la edad del cuidador fue 57.63 ± 12.48 años (R=33 - 93) años. El estado civil más frecuente fue casado 17 (56,7%). Diecisiete (56,7%) de los evaluados eran hijos, 9 (30%) cónyuge y 4 (13%) madre del paciente con glaucoma. El promedio ± (DE) del tiempo que llevaban a cargo del paciente era 10.37 ± (9.87) años (R=2 - 36) años. Además 17 (56,7%) tenían estudios de básica primaria, 10 (33,3%) de bachillerato, 2 (6,7%) técnica o tecnología y 1 (3,3%) universitarios. La mitad de los cuidadores 15 (50%) pertenecían al estrato socioeconómico 3 y solo cuatro (13,3%) al estrato 5 o 6. Asumiendo como punto de corte 8 puntos en la Escala de Bedard de Cribado encontramos sobrecarga en 5 de los 30 cuidadores (16,7%). Conclusiones: se puede concluir que el cuidador del paciente con glaucoma avanzado suele ser una mujer mayor, casada e hija del paciente. En su mayoría se trata de personas con estudios de primaria y que pertenece al estrato socioeconómico 3. Menos de una quinta parte de los encuestados mostraron sobrecarga en la escala actual, lo cual puede ser explicado por la edad, el sexo y el parentesco del cuidador.

The patient, family, system or the caregiver often underestimates the physic or emotional caregiver burden associated with chronic illnesses. Advanced glaucoma could lead to blindness and generate a great caregiver dependence. We tried to quantify the burden level in the primary caregivers of patients with advanced glaucoma. Methods. We performed a short standardized telephonic survey on the caregivers of advanced glaucoma patients, after verbal explanation and informed consent. We utilized a validated international Scale (Short or screening version of the Zarit Burden Scale). Results. We enrolled 30 caregivers, 24 (80%) were women. The Mean ± (SD) of the caregiver age was 57.63± 12.48 years (R=33-93). The majority of the evaluated were married 17 (56,7%). Seventeen (56,7%) were the patient's daughter, 9 (30%) wife or husband and 4 (13%) mother of the glaucoma patient. The mean ± (SD) of the time taking care of the patient was 10,37 ± (9.87) years range (R=2 -36). Additionally, 17 (56,7%) had elementary school, 10 (33,3%) high school, 2 (6,7%) technic or technology and 1 (3,3%) college degrees. Half the caregivers 15 (50%) were in the 3rd socioeconomic level and only four (13,3%) in the 5th or 6th level. Assuming an 8 point cut off level in the screening scale, we found burden in 5 of the 30 caregivers (16,7%) Conclusions We conclude that the caregiver of the glaucoma patient in our city is usually a married older woman, frequently the daughter of the patient. Mostly they have elementary school degrees and belong to the 3rd socioeconomic level. Less than a half of the caregivers showed burden using this scale. The authors' hypothesis is that these results could be explained by the age, the sex and the relationship of the caregiver.

Contexto sociodemográfico de los homicidios en México D.F.: un análisis espacial / Sociodemographic context of homicide in Mexico City: a spatial analysis

OBJETIVO:Investigar el patrón de distribución espacial de la tasa de homicidios y su relación con las características sociodemográficas en las delegaciones de Benito Juárez, Coyoacán y Cuauhtémoc de la Ciudad de México en el año 2010. MÉTODOS: Estudio inferencial de corte transversal que usa métodos de análisis espacial para estudiar la asociación espacial de la tasa de homicidios y las características demográficas. La asociación espacial fue determinada a través del cociente de localización, análisis de regresión múltiple y el uso de la regresión geográficamente ponderada. RESULTADOS: Los homicidios muestran un patrón de localización heterogéneo con altas tasas en zonas con uso del suelo no residencial, con baja densidad de población y baja marginación. CONCLUSIONES: El uso de herramientas de análisis espacial son instrumentos poderosos para el diseño de políticas de seguridad pública preventiva y recreativa que busquen reducir la mortalidad por causas externas como homicidios.

OBJECTIVE:Investigate the spatial distribution pattern of the homicide rate and its relation to sociodemographic features in the Benito Juárez, Coyoacán, and Cuauhtémoc districts of Mexico City in 2010. METHODS: Inferential cross-sectional study that uses spatial analysis methods to study the spatial association of the homicide rate and demographic features. Spatial association was determined through the location quotient, multiple regression analysis, and the use of geographically weighted regression. RESULTS: Homicides show a heterogeneous location pattern with high rates in areas with non-residential land use, low population density, and low marginalization. CONCLUSIONS: Spatial analysis tools are powerful instruments for the design of prevention- and recreation-focused public safety policies that aim to reduce mortality from external causes such as homicides.

Salud percibida por las personas mayores en España en función del tipo de demanda de actividad física / Saúde percebida pelas pessoas mais velhas na Espanha de acordo com o tipo de demanda para a atividade física / Health perceived by older people in Spain regarding the type of physical activity demand

Actualmente asistimos a un lento e inevitable proceso de envejecimiento de la población. Este hecho convierte a las personas mayores en un grupo poblacional de excepcional interés para las investigaciones científicas. Uno de los objetivos mas presentes en la literatura es el de mejorar su salud y su calidad de vida, logrando un envejecimiento activo. Por ello, el objetivo principal de la presente investigación es conocer cómo perciben las personas mayores su salud en función del grupo de demanda de actividad física en el que se encuentran, estableciéndose, además, relaciones con las variables sociodemográficas. La metodología ha consistido en una encuesta seccional aplicada a una muestra estadísticamente representativa de personas mayores de 64 años en España. Los resultados muestran que las personas físicamente activas perciben mejor su estado de salud y que las diferencias sociodemográficas se reducen o invierten en este grupo.

We witness a slow and inevitable process of demographic aging of the population, which makes the elderly a population group of particular interest in our field of research. Literature focuses on improving their health and quality of life through active aging. For that reason, the main goal of this research was to learn how the elderly perceive their health regarding the different types of demand for physical activity, relating them to socio-demographic variables. The methodology consisted in a sectional survey applied to a statistically representative sample of over-64 seniors in Spain. The results suggest that physically active people have better perception of their health. Furthermore, socio-demographic differences were reduced or reverted in that group.

Assistimos atualmente a um processo lento e inevitável do envelhecimento da população no mundo. Esse fato converte as pessoas mais velhas em um grupo populacional de excepcional interesse para as investigações científicas. Um dos objetivos mais discutidos na literatura científica é procurar melhorar a saúde e a qualidade de vida, para assim obter um envelhecimento ativo. Então, o objetivo principal desta pesquisa é conhecer como as pessoas mais velhas percebem sua saúde de acordo com a demanda do grupo da atividade física que elas participam, além de estabelecer relações com as variáveis sócio-demográficas. A metodologia constituiu-se em um estudo seccional aplicado a uma amostra estatisticamente representativa de pessoas com mais de 64 anos na Espanha. Os resultados mostraram que as pessoas fisicamente ativas percebem melhor seu estado de saúde e as diferenças sócio-demográficas são reduzidas ou revertidas neste grupo.

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test / Desempenho de uma amostra de adultos Brasileiros no Traill making test e Stroop Test

OBJECTIVE: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. METHODS: We recruited 1447 healthy subjects aged ?18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. RESULTS: Among the participants, mean intellectual efficiency was 103.20 (SD:12.0), age 41.0 (SD:16.4) years and education 11.9 (SD:5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. CONCLUSION: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

OBJETIVO: Os testes de atenção Trail Making Test (TMT) e Stroop Test (ST) são largamente usados na prática clínica e em pesquisas. O objetivo deste estudo foi fornecer informação normativa para a população brasileira de adultos e estudar a interferência de gênero, idade e educação no TMT parte A e B e no ST cartão A, B e C. MÉTODOS: Recrutamos 1447 sujeitos saudáveis com idade ?18 anos, nível educacional de 0-25 anos, falantes nativos do Português (Brasil). Os sujeitos foram avaliados pelos subtestes do Wechsler Adult Intelligence Scale-III Raciocínio Matricial e Vocabulários, além do TMTA, TMTB e ST A, B e C. RESULTADOS: Entre os participantes a média de eficiência intelectual foi de 103,20 (SD:12,0), de idade 41,0 (SD:16,4) anos e de escolaridade 11,9 (SD: 5,6) anos. Houve diferenças significantes por gênero em TMTA (p=0,002), TMTB (p=0,017) e STC (p=0,024). Idade se correlacionou de modo positivo com todos os testes de atenção, enquanto a escolaridade correlacionou-se de modo negativo. Após o modelo de regressão linear múltipla o gênero não manteve correlação significativa, mas idade e escolaridade mantiveram sua interferência. CONCLUSÃO: O gênero não mostrou grande impacto nas tarefas atencionais como a idade e escolaridade que devem, portanto, ser consideradas na estratificação de amostras normativas.

Performance of an adult Brazilian sample on the Trail Making Test and Stroop Test.

OBJECTIVE: The Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C. METHODS: We recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C. RESULTS: Among the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference. CONCLUSION: Gender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

OBJETIVO: Os testes de atenção Trail Making Test (TMT) e Stroop Test (ST) são largamente usados na prática clínica e em pesquisas. O objetivo deste estudo foi fornecer informação normativa para a população brasileira de adultos e estudar a interferência de gênero, idade e educação no TMT parte A e B e no ST cartão A, B e C. MÉTODOS: Recrutamos 1447 sujeitos saudáveis com idade ≥18 anos, nível educacional de 0-25 anos, falantes nativos do Português (Brasil). Os sujeitos foram avaliados pelos subtestes do Wechsler Adult Intelligence Scale-III Raciocínio Matricial e Vocabulários, além do TMTA, TMTB e ST A, B e C. RESULTADOS: Entre os participantes a média de eficiência intelectual foi de 103,20 (SD: 12,0), de idade 41,0 (SD: 16,4) anos e de escolaridade 11,9 (SD: 5,6) anos. Houve diferenças significantes por gênero em TMTA (p=0,002), TMTB (p=0,017) e STC (p=0,024). Idade se correlacionou de modo positivo com todos os testes de atenção, enquanto a escolaridade correlacionou-se de modo negativo. Após o modelo de regressão linear múltipla o gênero não manteve correlação significativa, mas idade e escolaridade mantiveram sua interferência. CONCLUSÃO: O gênero não mostrou grande impacto nas tarefas atencionais como a idade e escolaridade que devem, portanto, ser consideradas na estratificação de amostras normativas.

Factores laborales asociados al riesgo de estrés postraumático en uniformados de un sector de Medellín / Labour factors associated with post-traumatic stress in uniformed workers in Medellín

Objetivo Determinar los factores laborales asociados al riesgo del trastorno de estrés postraumático en un grupo de uniformados de un sector de Medellín. Método Estudio transversal en 124 uniformados entre los 20 y 48 años. Se diligenció el instrumento que incluyó el Test de estrés postraumático para adultos, validado para la ciudad de Medellín. Análisis estadístico univariado, bivariado y multivariado. Resultados La prevalencia de riesgo de estrés postraumático fue del 52,2 %. El análisis multivariado indicó que las situaciones de mayor riesgo de estrés postraumático fueron las relacionadas con el diagnóstico de salud mental (RP=7,67), tiempo de jornada laboral (RP=4,24), haber sido víctimas de algún evento violento (RP=3,59) y las relaciones con la comunidad (RP=2,73). Conclusiones La situación laboral parece ser un factor de riesgo que predispone para desarrollar estrés postraumático en la población estudiada.

Objective Determining the labor factors associated with post-traumatic stress in uniformed workers in Medellin. Method A cross-sectional study was made of 124 uniformed workers aged 20 to 48 years-old. A survey was made using an adults' post-traumatic stress instrument which had been validated in Medellin. Statistical analysis was carried out. Results Post-traumatic stress disorder risk prevalence was 52.2 %. Multivariate analysis showed that the highest risk situations were those related to previous mental health diagnosis (PR=7.67), working schedule (4.24), violent episodes (PR=3.59) and community relationships (PR=2.73). Conclusions A person's current labor situation seemed to be a risk factor for developing post-traumatic stress in the target population.

Revisión de la demografía sanitaria del departamento de Risaralda, Colombia, 2012 / Review of sanitary demography of the department of Risaralda, Colombia, 2012

Introducción/Métodos: Se realizó un análisis descriptivo de una serie de indicadores demográficos calculados con información secundaria del Departamento Administrativo Nacional de Estadísticas DANE, el Registro Único de Afiliados RUAF y el Sistema de Vigilancia Epidemiológica SIVIGILA. Resultados: Se encontró que el departamento de Risaralda cuenta con una población joven, que está viviendo una transición demográfica caracterizada por un aumento en la expectativa de vida y disminución en la natalidad. Risaralda es un departamento donde la mayoría de personas se encuentran ubicadas en el Área Metropolitana, el 78% de los Nacimientos se presenta en las cabeceras municipales, sin embargo se presenta mayor tasa de natalidad en la zona rural sobre todo en los municipios con altas necesidades básicas insatisfechas. El 25% de los nacimientos se presentaron en mujeres menores de 19 años. Si bien el índice de masculinidad es de 94,98, se presentan más nacimientos de hombres y dicho índice va disminuyendo con los años. El 75% de la Población económicamente activa se encuentra en el Área Metropolitana, el índice de dependencia es de 49,8%. El 56% de las defunciones se presentaron en hombres. La tasa de mortalidad infantil fue de 9,99 por cada 1000 Nacidos Vivos. La mayor tasa de mortalidad fue en el municipio de Pueblo Rico donde murieron 6,32 personas por cada 1000 habitantes. En el departamento la expectativa de vida para los nacidos en el 2011 fue de 75.9 años, 73.8 para hombres y 77.9 para mujeres. Discusión: Preocupa la situación del Municipio de Pueblo Rico, donde los indicadores de mortalidad, necesidades básicas insatisfechas, natalidad y expectativa de vida entre otros son los más deficientes del departamento. Este trabajo sirve como fuente de información para la toma de decisiones y planeación de políticas públicas en el Departamento.

Introduction/Methods: A descriptive analysis was performed with a series of demographic indicators calculated with secondary information of Department Administrative of Statistics National DANE, of Registry of Affiliates RUAF and SIVIGILA Surveillance Epidemiology System. Results: It was found that Risaralda is a department with young population, which is experiencing a demographic transition, characterized by an increased life expectancy and decreased fertility. Risaralda is a department where most people are located in the metropolitan area, 78% of births happens in the cities, in contrast, the highest birth rate are given in rural municipalities, especially where exist high unsatisfied basic needs. The 25% of births occurred in women under age 19. While the Index of masculinity is 94.98, There were more men’s births and this rate decreases with age. 75% of the economically active people are in the metropolitan area, the dependency ratio is 49.8%. 56% of deaths occurred in men. The infant mortality rate was 9.99 per 1000 live births. The highest mortality rate was in the town of Pueblo Rico where they died 6.32 people per 1000 habitants. In the department, life expectancy in 2011 was 75.9 years, 73.8 for men and 77.9 for women. Discussion: Is worrying the situation the municipality of Pueblo Rico, where mortality indicators, basic needs, fertility and life expectancy are the lowest of the department. This work serves as a source of information for decision-making and public policy planning at the Department.

Características de profesionales y auxiliares de enfermería del Huila. 2010 / Characteristics of Professionals and Nursing Assistants from Huila. 2010 / Características dos profissionais e auxiliares de enfermagem de Huila. 2010

Objetivo: describir y analizar las características sociodemográficas y laborales de los profesionales y auxiliares de enfermería que laboran en el Huila. Metodología: Estudio descriptivo, de corte transversal, muestra conformada por 308 enfermeras (os) y 1025 auxiliares de enfermería distribuidos en los 37 municipios del departamento. Se utilizó el método directo y un cuestionario autodiligenciado. La información se procesó con Epi Info 6.04 D y Excel 2000. Resultados: características sociodemográficas: la mayoría son mujeres, ubicados en los estratos 1, 2, 3, residen desde hace más de diez años en Huila. Los profesionales están concentrados en la capital del departamento y en los municipios más habitados; 70 % egresó de la Universidad Surcolombiana, 27 % tiene posgrado y menos del 20 % se especializó en el componente disciplinar. Las auxiliares de enfermería, terminaron en escuelas de Neiva. Caracterización laboral: cerca del 60 % se dedica a la atención curativa; menos del 35 % trabajan en empresas sociales del Estado (ESE) de primer nivel. El 33 % de los profesionales son empleados de planta y dos terceras partes tienen menos de cinco años de vinculación a la empresa actual, el 29,6 % de auxiliares de enfermería son empleados de planta. Más del 60 % de profesionales devengan, en promedio, $1.600.000 y solo el 2,6 % recibe más de $3.090.000; el 73,4 % de auxiliares ganan entre uno y dos salarios mínimos.

Objective: Describe and analyze social-demographic and labor characteristics of nursing professionals and assistants who work in Huila. Methodology: Transversal descriptive study of a population of 308 nurses and 1025 nursing assistants distributed in the 37 municipalities of the department. Direct method and a self-managed questionnaire were used. The information was processed with Epi Info 6.04 D and Excel 2000. Results: Social and demographic characteristics: most of the population was women within class 1, 2 and 3 residing in Huila from over ten years. Professionals are concentrated in the capital of the department and in the most populated municipalities; 70 % graduated from the Universidad Surcolombiana, 27% has a master's degree and less than 20 % specialized in the disciplinary component. Nursing assistants ended up in schools of Neiva, work characteristics: about 60% works in healing assistance, less than 35 % work in first level Social State Companies (ESE). 33 % of professionals are part of the staff and two thirds have less than five years working in their current company, and 29.6 % of the nursing assistants are part of the staff. Over 60 % of professionals earn an average of $1,600,000 and only 2.6 % earn more than $3,090,000; el 73.4 % of assistants earn from one to two minimum wages.

Objetivo: descrever e analisar as características sociodemográficas e de trabalho dos profissionais e auxiliares de enfermagem que trabalham em Huila. Metodologia: Estudo descritivo de corte transversal com uma amostra conformada por 308 enfermeiras(os) e 1025 auxiliares de enfermagem distribuídos nos 37 municípios do departamento. Utilizou-se um método direto e um questionário de autopreenchimento. A informação foi processada com Epi Info 6.04 D e Excel 2000. Resultados: características sociodemográficas: a maioria são mulheres dos estratos sociais 1, 2 e 3 que moram desde há mais de dez anos em Huila. Os profissionais estão concentrados na capital do departamento e nos municípios mais habitados; 70 % é formado da Universidade Surcolombiana, 27 % tem estudos de pós-graduação e menos de 20 % tem alguma especialização no componente disciplinar. As auxiliares de enfermagem terminaram em escolas de Neiva, com uma caracterização laboral de perto de 60% dedicado à atenção curativa e menos de 35 % trabalhando em empresas sociais do Estado (ESE) de primeiro nível. Trinta e três por cento dos profissionais são funcionários fixos e duas terceiras partes têm menos de cinco anos de vinculação com a empresa atual, 29,6 % dos auxiliares de enfermagem são funcionários fixos. Mais de 60 % dos profissionais ganham uma média de $1.600.000 e só 2,6 % recebe mais de $3.090.000; 73,4 % dos auxiliares ganham entre um e dois salários mínimos.

Sobrevivência e reprodução de Synthesiomyia nudiseta (Diptera, Muscidae)

The reproduction and survival of Synthesiomyia nudiseta (Wulp, 1883) were studied between 22 and 28ºC, 70% R.H. and 12h photoperiod. The raw data were analyzed based on age-class, sex life table, Weibull distribution and entropy curve (H). The intrinsic rate of increase (r m), finite rate of increase (lambda), net reproduction rate (R0) and mean generation time (T) were 0.534, 1.7, 59.439 and 7.65 respectively, suggesting fast population growth in these conditions. That is caused by the high fecundity that was confirmed for this species with mean number of eggs/female of 266 and mean preoviposition period of 10.25 days. The Weibull survival model showed that the survival was not constant throughout the adults life: the mortality rate was more pronounced after the fourth and fifth week because both sexes had H values intermediate to those theoretically expected (0.0-0.5), showing that the survival curve is rectangular (with more impact of mortality on the fourth and fifth week from pupal emergence). The presented results can be considered as base for detailed studies on dynamics and population growth of this species in natural habitats.

A reprodução e a sobrevivência de Synthesiomyia nudiseta (Wulp, 1883) foram estudadas entre 22 e 28ºC, UR de 70% e fotoperíodo de 12h. Os dados foram analisados através de classes de idade, tabelas de vida de fecundidade, análise de sobrevivência pela distribuição de Weibull e análise das curvas de sobrevivência através do conceito de entropia (H). A taxa intrínseca de aumento natural (r m), taxa finita de aumento (lambda), taxa de reprodução líquida (R0) e tempo médio de uma geração (T) foram 0,534; 1,7; 59,439 e 7,65 respectivamente, sugerindo rápido crescimento populacional nestas condições. Isso foi causado pela alta fecundidade, confirmando o que ocorre para esta espécie, com média de 266 ovos/fêmea e período de pré-oviposição de 10,25 dias. O modelo de Weibull demonstrou que a sobrevivência não foi constante ao longo da vida de adultos, com mortalidade pronunciada depois da quarta e quinta semanas e valores de H intermediários aos valores teóricos esperados (0,0-0,5) para os ambos sexos, demonstrando que a curva de sobrevivência é retangular (com maior impacto da mortalidade na quarta e quinta semanas após a emergência). Os resultados apresentados podem ser considerados como base para estudos pormenorizados da dinâmica e do crescimento populacional desta espécie em hábitats naturais.

Sobrevivência e reprodução de Synthesiomyia nudiseta (Diptera, Muscidae)

The reproduction and survival of Synthesiomyia nudiseta (Wulp, 1883) were studied between 22 and 28ºC, 70% R.H. and 12h photoperiod. The raw data were analyzed based on age-class, sex life table, Weibull distribution and entropy curve (H). The intrinsic rate of increase (r m), finite rate of increase (lambda), net reproduction rate (R0) and mean generation time (T) were 0.534, 1.7, 59.439 and 7.65 respectively, suggesting fast population growth in these conditions. That is caused by the high fecundity that was confirmed for this species with mean number of eggs/female of 266 and mean preoviposition period of 10.25 days. The Weibull survival model showed that the survival was not constant throughout the adults life: the mortality rate was more pronounced after the fourth and fifth week because both sexes had H values intermediate to those theoretically expected (0.0-0.5), showing that the survival curve is rectangular (with more impact of mortality on the fourth and fifth week from pupal emergence). The presented results can be considered as base for detailed studies on dynamics and population growth of this species in natural habitats.

A reprodução e a sobrevivência de Synthesiomyia nudiseta (Wulp, 1883) foram estudadas entre 22 e 28ºC, UR de 70% e fotoperíodo de 12h. Os dados foram analisados através de classes de idade, tabelas de vida de fecundidade, análise de sobrevivência pela distribuição de Weibull e análise das curvas de sobrevivência através do conceito de entropia (H). A taxa intrínseca de aumento natural (r m), taxa finita de aumento (lambda), taxa de reprodução líquida (R0) e tempo médio de uma geração (T) foram 0,534; 1,7; 59,439 e 7,65 respectivamente, sugerindo rápido crescimento populacional nestas condições. Isso foi causado pela alta fecundidade, confirmando o que ocorre para esta espécie, com média de 266 ovos/fêmea e período de pré-oviposição de 10,25 dias. O modelo de Weibull demonstrou que a sobrevivência não foi constante ao longo da vida de adultos, com mortalidade pronunciada depois da quarta e quinta semanas e valores de H intermediários aos valores teóricos esperados (0,0-0,5) para os ambos sexos, demonstrando que a curva de sobrevivência é retangular (com maior impacto da mortalidade na quarta e quinta semanas após a emergência). Os resultados apresentados podem ser considerados como base para estudos pormenorizados da dinâmica e do crescimento populacional desta espécie em hábitats naturais.

Diseño y metodología de la Encuesta Nacional de Salud 2000 / National Health Survey 2000: design and methodology

OBJETIVO: Como parte del Sistema de Encuestas Nacionales de Salud, durante los últimos meses de 1999 y los primeros tres del año 2000 se realizó la Encuesta Nacional de Salud de México (ENSA 2000). Se estudió la accesibilidad, calidad, utilización y cobertura de los Servicios de Salud; de modo adicional se actualizaron los marcadores serológicos de enfermedades infecciosas prevenibles por vacunación, infecciones de transmisión sexual y hepatitis. MATERIAL Y MÉTODOS: Para la ENSA 2000 se seleccionaron tres grupos etarios y a los utilizadores de los servicios de salud. Se captó la información mediante entrevista directa y se tomaron muestras biológicas para análisis clínicos y medidas de parámetros biológicos y somatométricos. El diseño muestral de la ENSA 2000 fue probabilístico, polietápico, estratificado y de conglomerados. El tamaño de la muestra fue de 1 470 viviendas por estado, para un total de 47 040 viviendas a nivel nacional; los factores de expansión se modificaron por la falta de respuesta y la posestratificación. El personal operativo se capacitó y estandarizó para mantener una alta respuesta, en especial para las muestras de sangre. RESULTADOS: En total se obtuvieron 83 157 muestras de sangre de las 94 000 esperadas (respuesta de 88 por ciento) que se mantuvieron refrigeradas en tanto se ubicaron en el laboratorio del Instituto Nacional de Salud Pública donde se prepararon cuatro alícuotas y se congelaron a -150° C hasta el análisis.

OBJECTIVE: The 2000 Mexican National Health Survey (NHS) was created as part of the System for National Health Surveys conducted during the last months of 1999 and the first three of 2000. The 2000 NHS is a probabilistic survey of households from which users of health services were selected according to three age groups. Information was gathered through direct interviews with appropriate informants. Biological samples were taken for clinical tests as well as for measuring biological and somatometric parameters. MATERIAL AND METHODS: The sample design of the 2000 NHS was stratified and clustered. Sample size was 1 470 households per state for a total of 47 040 households nationwide (there are 32 states in México). Sample weights were calculated and modified according to the non-response and post-stratified to calibrate for population distribution. Interviewers were trained in order to maintain a high response rate, especially for biological samples. RESULTS: A total of 83 157 blood samples were collected from the 94 000 expected (88 percent response rate). All samples were refrigerated immediately after collection and divided in four vials for storage at the National Institute for Public Health's laboratory. Samples were frozen at -150° Celsius until further analysis.

[Legalization and dissolution of consensual unions: an example of log-linear models used to estimate models of competing risk]. / Legalizacion y disolucion de uniones consensuales: un ejemplo del uso de modelos log-lineales para estimar modelos de riesgos en competencia.

PIP: "This is a mainly methodological work: a generalization of the so-called proportional risk models to cases of multiple and competing risks.... Proportional risk models are an extension of the methodology implied in calculating mortality tables, where the risk function is made to depend on some variables (covariables), as in a regression model.... Life-table methodology has been...an essential instrument in demographic calculus and analysis." The author uses the proposed methods to analyze the determinants of the legalization and dissolution of consensual unions in Mexico. (EXCERPT)^ieng

Decline of tuberculosis mortality in an urban Mexican-origin population, 1935-1984.

Through a series of life table analyses, this paper describes the natural history of tuberculosis mortality in a Mexican-origin community over five decades (1935-84) during which the disease underwent a transition from a major underlying cause of death to a disease conditioned mentioned more often on death certificates as contributing to death than causing death. The decline in death rates from 1940 to 1950 was especially remarkable. Successive birth cohorts of Mexican Americans, separated by as little as five years of age, experienced distinctly lower risk of death from tuberculosis as they entered young adulthood. There was a rapid convergence in age-specific patterns of tuberculosis death rates in Mexican Americans toward those of non-Hispanic whites, so that by 1960 tuberculosis was primarily a cause of death in old age rather than young adulthood. The impact of changing environment, both through improvements of conditions within neighborhoods and through residential mobility, on birth cohorts at risk of tuberculosis needs to be examined in further research.

PIP: This study examines the history of tuberculosis mortality during 1935-84 among a Mexican-origin community in Bexar County, Texas. Data were obtained from death records of the San Antonio Metropolitan Health District. Data coding accounted for the shift in 1949 in formatting underlying cause and primary cause of death. Deaths are estimated from multiple decrement life tables for deaths by age and underlying cause in a hypothetical cohort of 100,000 newborns followed to their deaths. Cause-eliminated life tables show the distributions of deaths if tuberculosis were eliminated. Findings indicate that life expectancy of Mexican-origin people in Bexar County during 1938-42 was about 47 years for males and females. Life expectancy for Anglos was higher but still lower than the national average. By 1980, differences in life expectancies by ethnic group converged. The rapid increases in life expectancy occurred during the 1940s: 12.7 years for Mexican-origin women and 10.3 years for Mexican-origin men. The 1940 risk of tuberculosis death among Mexican-origin people was 5-7 times that of Anglos. Among the 1940s Mexican-origin population, tuberculosis caused heavy fatalities in early adulthood between the ages of 15 and 35 years. By 1960, it was a cause only in old age, as it was among Anglos. Cohort comparisons reveal that the cohort reaching the age of 15 years in 1945 had a mortality probability that was only half as great to age 20 in 1950. The mortality probability declined to near zero by age 25 in 1955. The life table proportion of deaths due to tuberculosis declined linearly and added to life expectancy until 1980. Tuberculosis was the underlying cause of death among 96% of Mexican-origin people in 1938-42 and 41% in 1983-85. Tuberculosis morbidity declined during the 1940s and 1950s due to major housing renewal, slum clearance, code enforcement, and residential mobility.