Zika virus knowledge, attitudes and prevention behaviors among pregnant women in the ZEN cohort study, Colombia, 2017-2018.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause severe birth defects in the fetus and is associated with neurodevelopmental abnormalities in childhood. Our objective was to describe ZIKV knowledge and attitudes among pregnant women in Colombia while ZIKV was circulating and whether they predicted the adoption of behaviors to prevent ZIKV mosquito-borne and sexual transmission. METHODS: We used self-reported data from Zika en Embarazadas y Niños (ZEN), a cohort study of women in early pregnancy across three regions of Colombia during 2017-2018. We used Poisson regression to estimate associations between knowledge, attitudes and previous experience with mosquito-borne infection and preventative behaviors. RESULTS: Among 1519 women, knowledge of mosquito-borne transmission was high (1480; 97.8%) and 1275 (85.5%) participants were worried about ZIKV infection during pregnancy. The most common preventive behavior was wearing long pants (1355; 89.4%). Regular mosquito repellent use was uncommon (257; 17.0%). While ZIKV knowledge and attitudes were not associated with the adoption of ZIKV prevention behaviors, previous mosquito-borne infection was associated with increased condom use (prevalence ratio 1.4, 95% CI 1.1 to 1.7). CONCLUSIONS: Participants were well informed about ZIKV transmission and its health consequences. However, whether this knowledge resulted in behavior change is less certain.

Pregnancy, Birth, Infant, and Early Childhood Neurodevelopmental Outcomes among a Cohort of Women with Symptoms of Zika Virus Disease during Pregnancy in Three Surveillance Sites, Project Vigilancia de Embarazadas con Zika (VEZ), Colombia, 2016-2018.

Project Vigilancia de Embarazadas con Zika (VEZ), an intensified surveillance of pregnant women with symptoms of the Zika virus disease (ZVD) in Colombia, aimed to evaluate the relationship between symptoms of ZVD during pregnancy and adverse pregnancy, birth, and infant outcomes and early childhood neurodevelopmental outcomes. During May-November 2016, pregnant women in three Colombian cities who were reported with symptoms of ZVD to the national surveillance system, or with symptoms of ZVD visiting participating clinics, were enrolled in Project VEZ. Data from maternal and pediatric (up to two years of age) medical records were abstracted. Available maternal specimens were tested for the presence of the Zika virus ribonucleic acid and/or anti-Zika virus immunoglobulin antibodies. Of 1213 enrolled pregnant women with symptoms of ZVD, 1180 had a known pregnancy outcome. Results of the Zika virus laboratory testing were available for 569 (48.2%) pregnancies with a known pregnancy outcome though testing timing varied and was often distal to the timing of symptoms; 254 (21.5% of the whole cohort; 44.6% of those with testing results) were confirmed or presumptive positive for the Zika virus infection. Of pregnancies with a known outcome, 50 (4.2%) fetuses/infants had Zika-associated brain or eye defects, which included microcephaly at birth. Early childhood adverse neurodevelopmental outcomes were more common among those with Zika-associated birth defects than among those without and more common among those with laboratory evidence of a Zika virus infection compared with the full cohort. The proportion of fetuses/infants with any Zika-associated brain or eye defect was consistent with the proportion seen in other studies. Enhancements to Colombia's existing national surveillance enabled the assessment of adverse outcomes associated with ZVD in pregnancy.

Epidemiology of cytomegalovirus Infection among mothers and infants in Colombia.

We assessed maternal and infant cytomegalovirus (CMV) infection in Colombia. Maternal serum was tested for CMV immunoglobulin G antibodies at a median of 10 (interquartile range: 8-12) weeks gestation (n = 1501). CMV DNA polymerase chain reaction was performed on infant urine to diagnose congenital (≤21 days of life) and postnatal (>21 days) infection. Maternal CMV seroprevalence was 98.1% (95% confidence interval [CI]: 97.5%-98.8%). Congenital CMV prevalence was 8.4 (95% CI: 3.9%-18.3%; 6/711) per 1000 live births. Among 472 infants without confirmed congenital CMV infection subsequently tested at age 6 months, 258 (54.7%, 95% CI: 50.2%-59.1%) had postnatal infection.

Causas de Muerte Poco Útiles en el Hospital de Atención Integral del Adulto Mayor, Quito 2018 / Mortality Garbage Codes use in Hospital de Atención Integral del Adulto Mayor, 2018

INTRODUCCIÓN: En este trabajo, se analiza la situación y principales características de las causas de muerte "poco útiles" del Hospital de Atención Integral del Adulto Mayor (HAIAM). Se proceso la base de datos sobre defunción de enero a julio del 2018, que se encuentra validada según los criterios vigentes para identificación y análisis de la exactitud de la información sobre las causas básicas de muerte. METODOLOGÍA: Estudio descriptivo, cuantitativo, transversal. El universo son los registros de defunciones totales ocurridas de enero a julio del 2018. Se calcula el porcentaje de las causas de muerte "poco útiles" en el total de defunciones del HAIAM, incluye muertes de más y menos de 48 horas. RESULTADOS: 3 de cada 10 muertes registradas corresponde a causas "poco útiles" durante el período analizado, con un 24% de causas poco útiles. Dentro de estos el más alto porcentaje (50%) corresponde a causas sin suficiente especificación.  El 47% corresponde a causas intermedias de muerte, y un 3% como causas de defunción mal definidas. CONCLUSIÓN: La importancia de verificar la calidad de la información en relación a mortalidad aplicando los códigos garbage para validar las causas de muerte representa un aporte importante en relación a la calidad de información. Las causas de muerte mal definidas alteran el análisis de la información clínica y epidemiológica.(au)

BACKGROUND: this article analyzes the use and the main characteristics of mortality garbage codes in Hospital de Atención Integral del Adulto Mayor (HAIAM). The death database was processed from January to July 2018, which was validated according to the current criteria for the identification and analysis of the accuracy of the information on the basic causes of death. METHODS: Descriptive, quantitative, cross-sectional study. The universe is the total of deaths that occurred from January to July 2018. The percentage of mortality garbage codes in from total deaths of HAIAM was calculated, including deaths of more and less than 48 hours. RESULTS: 3 out of every 10 deaths registered correspond to "garbage codes" during the analyzed period, corresponding to 24% of garbage codes. The highest percentage (50%) were death causes with poor specification. 47% where intermediate causes of death and 3% poorly defined causes of death. CONCLUSION: The importance of verifying the quality of information about mortality, using garbage codes to validate death causes, is an important contribution. Garbage codes alter the appropriate analysis of clinical and epidemiological information.(au)

Actuar político para el control del cáncer en Colombia / Political Acting to Control the Cancer in Colombia / Agindo politicamente para o controlo do câncer na Colômbia

Resumen El cáncer es un tema de interés en salud pública, debido al progresivo aumento del número de casos, los altos costos para los sistemas de salud y el número de muertes. Para controlarlo, no es suficiente con promover la salud, puesto que la implementación de estilos de vida saludables no solo requiere voluntad individual, sino también creación de políticas, leyes, programas, planes, entre otros, que favorezcan cambios de comportamiento en individuos hacia estos estilos, que además posicionen las opciones saludables como iniciativas atractivas que tomar. Colombia ha entendido el cáncer como tema de atención prioritaria y como tal estableció un marco normativo que busca su control desde la prevención y la detección temprana, pasando por el tratamiento integral hasta la rehabilitación e incorporación a la vida laboral. Esta revisión pretende hacer un acercamiento a la normatividad y reglamentación colombiana para el control del cáncer, registrando su evolución histórica y destacando sus posibles alcances e inconvenientes.

Abstract Cancer is a topic of interest in public health due to the gradual increase in the number of cases, high costs to the health systems and the number of deaths. Health promotion is not enough to control it, since the implementation of healthy lifestyles not only requires the individual willingness but also the making of policies, laws, programs, plans, and so on, to favor the individual's behavioral changes into the healthy lifestyles that would, in turn, position the healthy options as appealing initiatives to follow. Colombia has understood the cancer as a priority issue. therefore, the country has set a regulatory framework aiming to control the cancer based on the early detection and prevention as well as the comprehensive treatment including both the rehabilitation and resuming to the labor life. this review seeks to approach to the Colombian legal and regulatory system concerning the cancer control, by outlining its historic evolution and underlining the potential inconveniences and scope.

Resumo O câncer é um tema de interesse em saúde pública, devido ao progressivo aumento do número de casos, os altos custos para os sistemas de saúde e o número de óbitos. Para controlá-lo, não é suficiente com promover a saúde, pois a implementação de estilos de vida saudáveis não apenas requer vontade individual, mas também criação de políticas, leis, programas, planos, dentre outros, a favorecer mudanças no comportamento em indivíduos para esses estilos que, aliás, posicionarem as opções saudáveis como iniciativas atrativas a serem tomadas. A Colômbia entendeu o câncer como tema de atendimento prioritário e como tal estabeleceu um quadro normativo que procura seu controle desde a prevenção e detecção precoce, a passar pelo tratamento abrangente até a reabilitação e incorporação à vida laboral. Essa revisão visa fazer aproximação da normatividade e regulamentações colombianas para o controle do câncer, registrando sua evolução histórica e destacando possíveis escopos e desvantages.

Papel de la interculturalidad en el control del cáncer en pueblos indígenas

Pese a su importancia, la población indígena se caracteriza por tener mayor pobreza, menor acceso a educación y a salud, lo que conlleva a reducir su expectativa de vida. Otros aspectos como el elevado nivel de desempleo, la precariedad de servicios sociales, la vulneración de Derechos Humanos y la degradación del ambiente, configuran un desfavorable escenario de discriminación, marginación y exclusión. Aunque es bien conocida la necesidad de ofrecer servicios de salud diferenciales, esto aún no logra materializarse, lo que sumado a la ausencia de información y estrategias apropiadas, lleva a la falta de goce efectivo de la población indígena de los servicios para el control del cáncer que son accesibles al resto de la población. Dado lo anterior, es indispensable la reflexión respecto al estado y papel de la interculturalidad en el control del cáncer.

Despite its importance, the indigenous population is characterized by greater poverty, less access to education and health services, which leads to reduced life expectancy. Other facts such as the high rate of unemployment, the precarious social services, the violation of Human Rights and the environment degradation, constitute an unfortunate scenario of discrimination, marginalization and exclusion. Although the need to offer differential health services is well known, this has not yet materialized, in addition, the lack of information and appropriate strategies, leads to indigenous population unable to enjoy effectively the cancer control services. which are accessible to the rest of the population. According to the above mentioned, it is essential to reflect on the condition and role of interculturality in cancer control.

Apesar de sua importância, a população indígena é caracterizada por maior pobreza, menor acesso à educação e à saúde, o que leva a uma redução da expectativa de vida. Outros aspectos, como o alto nível de desemprego, a precariedade dos serviços sociais, a violação dos direitos humanos e a degradação do meio ambiente, constituem um cenário desfavorável de discriminação, marginalização e exclusão. Embora a necessidade de oferecer serviços diferenciais de saúde seja bem conhecida, isso ainda não é uma realidade, o que, somado à falta de informações e estratégias adequadas, leva à falta de aproveitamento efetivo dos serviços de controle de câncer por parte da população indígena, embora tais serviços são acessíveis para o resto da população. Diante do exposto, é essencial refletir sobre o status e o papel da interculturalidade no controle do câncer.

Aproximación desde las ciencias de la complejidad y la historia de la acción institucional en salud pública para el control del cáncer / Approach from the science of complexity and history of institutional action in public health for cancer control / Aproximação desde as ciências da complexidade e a história do agir institucional em saúde pública a respeito do controle do câncer

Diversas políticas, planes, programas y proyectos en salud pública se han desarrollado a lo largo de la historia. Con el ánimo de comprender estas acciones institucionales se revisaron los enfoques que hasta la actualidad han dado respuesta a las necesidades en salud, incluyendo una visión desde la complejidad. Para resaltar estas acciones se requiere su abordaje y formulación desde este último paradigma epistemológico, buscando se descifren las necesidades sentidas de la población en sus particularidades, se reconozca el territorio en el que están inmersos y su contexto, sin olvidar la orientación del sector salud a obtener resultados efectivos. En conclusión, esto llevará a pensar la Salud Pública como un evento colectivo; el proceso salud-enfermedad como un fenómeno complejo visto desde la simbiosis de la dimensión individual y colectiva y a entender la calidad de vida como dinámica abierta, en la que emergen múltiples elementos que pueden interaccionar y retroaccionar de manera sinérgica, antagónica o complementaria para producirla y transformarla permanentemente.

Different policies, plans, programs and projects in public health have been developed throughout history. With the aim to understand these institutional actions, the approaches that until now have provided answers to the populations’ health needs were revised, including a glance of complexity. To understand these actions, the approaches and formu- lations from the latter epistemological paradigm are required. Their identification involve the deciphering of the populations’ needs and its particularities, the recognition of the territory and context in which they are embedded and the guidance of the health sector to obtain effective results. In conclusion, this will lead to think of public health as a collective event and the process of health-disease as a complex phenomenon seen in the perspective of indivi- dual and collective dimensions. Furthermore, the quality of life will be perceived as dynamic and open, in which multiple elements that may interact synergistically, anta- gonistically or complementary emerge in such a manner to produce and permanently transform the understanding of the concept of public health on population basis.

Ao longo da história tem se desenvolvido diversas políticas, planos, projetos e programas de saúde pública. O presente artigo visa compreender tais ações institucionais a partir de uma revisão dos principais enfoques que tem dado resposta às necessidades de saúde. Isto inclui o enfoque do paradigma próprio das ciências da complexidade, cuja abordagem permite decifrar as necessidades de cada população particular, reconhecer seu território e contexto, sem esquecer a orientação a resultados próprio do setor da saúde. Este paradigma epistemológico permite pensar a Saúde pública como sendo um evento coletivo, mesmo assim, permite pensar o processo saúde-doença em termos de fenômeno complexo com implicações individuais e coletivas. Trata-se de um enfoque que propicia a compreensão da qualidade de vida como sendo dinâmica, graças à emergência de elementos que entram em interação e retroação, seja sinérgica, antagónica ou complementária.

Cardiac surgery after mediastinal radiation: extent of exposure influences outcome.

OBJECTIVES: Mediastinal radiation for thoracic malignancies uses multiple treatment fields and doses. We investigated whether more extensive radiation exposure is associated with more hospital complications and worse survival after cardiac surgery. METHODS: From January 2000 to January 2005, 230 patients underwent cardiac surgery after 3 levels of mediastinal radiation: extensive (Hodgkin disease, thymoma, and testicular cancer; n = 70), variable (eg, non-Hodgkin lymphoma and lung cancer; n = 35); and tangential (breast cancer; n = 125). Hospital complications were recorded prospectively, and time-related survival was assessed by patient follow-up (mean follow-up, 2.2 +/- 1.4 years). RESULTS: Patients receiving extensive exposure were youngest (51 vs 64 vs 72 years), with the longest radiation-to-operation interval (25 vs 13 vs 14 years), and had the most diastolic dysfunction, left main stenosis of greater than 70% (21% vs 9% vs 8%), and aortic regurgitation (79% vs 54% vs 50%). Patients receiving extensive and variable exposure had the poorest pulmonary function (percent predicted forced expiratory volume in 1 second, 57% vs 54% vs 67%; percent predicted forced vital capacity, 56% vs 63% vs 66%). All groups received a similar mix of cardiac procedures. Hospital deaths (13% vs 8.6% vs 2.4%) and respiratory complications (24% vs 20% vs 9.6%) were higher after more extensive radiation, and survival was poorer (4-year survival, 64% vs 57% vs 80%) than for patients receiving tangential radiation exposure, and it deviated more from expected matched-population life tables. CONCLUSIONS: Among patients undergoing cardiac surgery after thoracic radiation, radiation exposure is heterogeneous, and therefore these patients cannot be managed and assessed as a single uniform cohort. Extensively irradiated patients are more likely to develop radiation heart disease, which increases perioperative morbidity and decreases short- and long-term survival.