Cross-Cultural Validation of the TeamSTEPPS Teamwork Perceptions Questionnaire-Spanish in Colombia.

BACKGROUND: Teamwork influences health care quality and patient safety. Yet, validated instruments for assessing teamwork in Colombia are lacking. PURPOSE: The purpose of this study was to validate the Spanish version of the TeamSTEPPS-Teamwork Perceptions Questionnaire (T-TPQ-S) for the Colombian health care context. METHODS: The T-TPQ-S underwent translation, cultural adaptation, and comprehensive psychometric testing, including reliability and confirmatory factor analyses and item difficulty and discrimination analyses. RESULTS: The T-TPQ-S demonstrated high internal consistency and excellent fit to the theoretical model. Item discrimination was within expected ranges, with response thresholds displaying an ascending order. The tool better differentiated subjects with low and high teamwork perceptions. CONCLUSIONS: The T-TPQ-S is an effective, reliable, and valid instrument for assessing teamwork perception among Colombian health care workers.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study.

OBJECTIVE: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). METHODS: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. RESULTS: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. CONCLUSIONS: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Factors associated with the intensity of anxiety and depression symptoms in health workers of two centres of reference for COVID 19 patient care in Antioquia, Colombia - A latent class analysis.

OBJECTIVE: To classify the staff of two reference institutions for COVID-19 care in Antioquia according to the intensity of anxiety and depression symptoms, and to determine the factors associated with these classes. METHODS: Cross-sectional study in which the GAD-7, PHQ-9, fear of COVID-19, and the Copenhagen Burnout scale were used. Latent class analysis was performed to identify the classes, and the factors associated with these were determined using multinomial logistic regression. RESULTS: 486 people participated. The three-class model had the best fit: class I with low scores on the scales; class II with mild degrees of anxiety and depression, and intermediate levels of fear of COVID-19 and perceived stress; and class III with moderate and severe degrees of anxiety, depression, and perceived stress. The factors associated with belonging to class III were age (OR = 0.94; 95%CI, 0.91-0.96), change of residence to avoid exposing relatives (OR = 4.01; 95%CI, 1.99-8.09), and a history of depressive disorder (OR = 3.10; 95%CI, 1.27-7.56), and anxiety (OR = 5.5; 95%CI, 2.36-12.90). Factors associated with class II were age (OR = 0.97; 95%CI, 0.95-0.99), history of depressive disorder (OR = 3.41; 95%CI, 1.60-7.25), living with someone at risk of death from COVID-19 (OR = 1.86; 95%CI, 1.19-2.91), family member being healthcare staff (OR = 1.58; 95%CI, 1.01-2.47), and change of residence to avoid exposing relatives (OR = 1.99; 95%CI, 1.11-3.59). CONCLUSIONS: Three classes of participants were obtained, two of them with anxiety and depression symptoms. Younger age and a history of mental disorder were factors associated with the two classes of symptomatic patients; other factors may be causes or consequences of the symptoms.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Objetivo: Nuestro objetivo es determinar la prevalencia de trastornos mentales en hermanos de casos con TDAH y cómo los factores de adversidad psicosocial se relacionan con esta psicopatología en un país de ingresos bajos-medios (Colombia). Métodos: Se evaluó a sujetos con TDAH diagnosticado según los criterios del DSM-5, uno de sus padres y uno de sus hermanos (edades, 8-19 anos). Mediante la escala de calificación del TDAH y un conjunto de otros instrumentos se evaluó la presencia de trastornos mentales y adversidad psicosocial. Resultados: Se evaluó a 74 tríos formados por el caso índice con TDAH, un hermano y uno de los padres. Se halló que un 24,3% de los hermanos participantes también cumplían los criterios de TDAH y otro 24,3%, otros trastornos psiquiátricos. El riesgo de que estos hermanos tuvieran TDAH aumentó aún más cuando uno de los padres informó antecedentes de TDAH. También, que el 28,3% de las familias se enfrentaron a altos niveles de adversidad psicosocial según sus puntuaciones en el Índice de Adversidad de Rutter. Conclusiones: Los hermanos de sujetos con TDAH mostraron un significativo riesgo de TDAH y otros trastornos mentales. Ese riesgo aumenta si uno de los padres reporta antecedentes de TDAH y también cuando se presentan 2 o más factores de adversidad psicosocial. Este estudio respalda la importancia de la detección temprana con el fin de disminuir el riesgo para otros hermanos.

Is structural connectivity different in child and adolescent relatives of patients with bipolar disorder? A narrative review according to studies with DTI.

INTRODUCTION: Bipolar disorder (BD) has been associated with a decrease in white matter integrity. Diffusion tensor imaging (DTI) studies have enabled these changes to be elucidated with higher quality. Due to BD's high heritability, some studies have been conducted in relatives of BD patients looking at white matter integrity, and have found that structural connectivity may also be affected. This alteration has been proposed as a potential BD biomarker of vulnerability. However, there are few studies in children and adolescents. OBJECTIVE: To conduct a review of the literature on changes in white matter integrity determined by DTI in high-risk children and adolescents. RESULTS: Brain structural connectivity in the paediatric population is described in studies using DTI. Changes in the myelination process from its evolution within normal neurodevelopment to the findings in fractional anisotropy (FA) in BD patients and their high-risk relatives are also described. CONCLUSIONS: Studies show that both BD patients and their at-risk relatives present a decrease in FA in specific brain regions. Studies in children and adolescents with a high risk of BD, indicate a reduced FA in axonal tracts involved in emotional and cognitive functions. Decreased FA can be considered as a vulnerability biomarker for BD.

¿Es diferente la conectividad estructural en niños y adolescentes familiares de pacientes con trastorno bipolar? Una revisión narrativa según estudios con DTI

Introducción: El trastorno afectivo bipolar (TAB) se ha asociado con una disminución de la integridad de la sustancia blanca. Los estudios con imágenes con tensor de difusión (DTI) han permitido elucidar con una mayor calidad estos cambios. Debido a la gran heredabilidad del TAB, se han realizado estudios en familiares de pacientes con TAB acerca de la integridad de la sustancia blanca, y se ha encontrado que la conectividad estructural también puede estar afectada. Dicha alteración se ha propuesto como un potencial biomarcador de vulnerabilidad a este trastorno. Sin embargo, los estudios en niños y adolescentes son pocos. Objetivo: Revisar la literatura sobre los cambios en la integridad de la sustancia blanca determinados mediante DTI en niños y adolescentes con alto riesgo. Resultados: Se describe la conectividad estructural cerebral en la población pediátrica en estudios que utilizaron DTI. Se describen los cambios en el proceso de mielinización desde su evolución dentro del neurodesarrollo normal hasta los hallazgos en la anisotropía fraccional (AF) en pacientes con TAB y los familiares en alto riesgo. Conclusiones: Los estudios demuestran que tanto pacientes con TAB como sus familiares en riesgo presentan disminución de la AF en regiones cerebrales específicas. Los estudios en niños y adolescentes con riesgo familiar de TAB señalan una AF reducida en tractos axonales implicados en funciones emocionales y cognitivas. La disminución de la AF puede considerarse como un biomarcador de vulnerabilidad al TAB.

Introduction: Bipolar disorder (BD) has been associated with a decrease in white matter integrity. Diffusion tensor imaging (DTI) studies have enabled these changes to be elucidated with higher quality. Due to BD's high heritability, some studies have been conducted in relatives of BD patients looking at white matter integrity, and have found that structural connectivity may also be affected. This alteration has been proposed as a potential BD biomarker of vulnerability. However, there are few studies in children and adolescents. Objective: To conduct a review of the literature on changes in white matter integrity determined by DTI in high-risk children and adolescents. Results: Brain structural connectivity in the paediatric population is described in studies using DTI. Changes in the myelination process from its evolution within normal neurodevelopment to the findings in fractional anisotropy (FA) in BD patients and their high-risk relatives are also described. Conclusions: Studies show that both BD patients and their at-risk relatives present a decrease in FA in specific brain regions. Studies in children and adolescents with a high risk of BD, indicate a reduced FA in axonal tracts involved in emotional and cognitive functions. Decreased FA can be considered as a vulnerability biomarker for BD.

Neuropsychological aspects of bipolar disorder.

Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and aprevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in this review.

Situación del suicidio en Antioquia-Colombia durante los años 2016 y 2017: Resultados de los datos de vigilancia epidemiológica

Introducción: la vigilancia epidemiológica del suicidio en una región permite identificar los patrones, la distribución y las características con que ocurre y sentar las bases de intervenciones para prevenirlo. Objetivo: describir la situación del suicidio en Antioquia para el periodo 2016-2017. Métodos: estudio descriptivo basado en datos del Sistema de Vigilancia Epidemiológica de Lesiones de Causa Externa del Instituto Nacional de Medicina Legal y Ciencias forenses. Se calcularon las tasas de suicidio y los años de vida potencialmente perdidos (AVPP) y se describieron las circunstancias del evento. Resultados: hubo 425 suicidios en 2016 y 419 en el 2017, con una tasa de suicidio de 6,50 y 6,34 por 100.000 habitantes/año respectivamente, y 16.446,8 AVPP para 2016 y 16.019,94 para 2017. La mayor parte de los suicidios se presentó en el sexo masculino, en los grupos de edad jóvenes, residentes en área urbana y estado civil soltero. Con respecto a las características del suicidio, el mecanismo más frecuentemente utilizado fue la asfixia mecánica seguido por el envenenamiento, en cerca del 40% de los casos se estableció un evento vital desencadenante como los conflictos de pareja, y se presentaron con mayor frecuencia los días domingo y lunes y en la noche y madrugada. Conclusión: las tasas de suicidio en Antioquia se han incrementado en 2016 y 2017 con respecto a años anteriores. Es más frecuente en hombres y en edades económicamente productivas, lo que explica los altos AVPP. La descripción de las características del suicidio podría facilitar la discusión de intervenciones preventivas.

Summary Background: Identifying the patterns, distribution, and characteristics of suicide in a region is possible with epidemiological surveillance which may lay the foundations for suicide prevention. Objective: To describe the situation of suicide in Antioquia during the period 2016-2017. Methods: Descriptive study based on data from the Epidemiological Surveillance System for External Cause Injuries of the National Institute of Legal Medicine and Forensic Sciences. Suicides rates and Years of Life Lost (YLL) were calculated and the circumstances of the event were described. Results: There were 425 suicides in 2016 and 419 in 2017, with a suicides rate of 6.50 and 6.34 per 100,000 inhabitants/year respectively, and 16,446.8 YLL for 2016 and 16,019.94 YLL for 2017. Most of the suicides occurred in males, in young age groups, urban residents and single marital status. Regarding the characteristics of suicide, the most frequently used mechanism was mechanical asphyxia followed by poisoning, in about 40% of cases a triggering life event was established, such as partner conflicts, and were more frequent on Sunday and Monday and at night and early morning. Conclusion: The incidence of suicide in Antioquia increased in 2016 and 2017 compared to previous years. It was more frequent in economically productive ages, which explains the high YLL. The description of the characteristics of suicide may facilitate the discussion of preventive interventions.

Aspectos neuropsicológicos del trastorno afectivo bipolar / Neuropsychological Aspects of Bipolar Disorder

RESUMEN El trastorno afectivo bipolar (TAB) es una entidad crónica con graves efectos para la salud y la funcionalidad de los pacientes que la sufren, con una alta carga de heredabilidad y segregabilidad y una prevalencia que oscila entre el 1 y el 2%. Las alteraciones neuropsicológicas son características importantes relacionadas con su pronóstico, por lo cual se hizo una revisión narrativa sobre estas alteraciones, los factores asociados y sus consecuencias funcionales. Se ha determinado que la presencia de alteraciones neuropsicológicas puede variar en los pacientes con TAB según la fase anímica en que se encuentren, con una gran influencia de los síntomas depresivos en la variabilidad cognitiva de los pacientes respecto a la población general y diferencias respecto a los pacientes en fase maniaca. En pacientes eutímicos, los dominios cognitivos más afectados son los de memoria, atención y función ejecutiva, asociados con una enfermedad más grave, factores sociodemográficos de vulne rabilidad y sin interacción con el tiempo de evolución. Se ha encontrado una relación entre el mal rendimiento cognitivo, especialmente la disfunción ejecutiva y el déficit funcional objetivo; además, se han perfilado diferencias cognitivas entre el TAB y otras enfermedades mentales graves que se describen en la revisión.

ABSTRACT Bipolar disorder (BD) is a chronic condition with serious consequences on the health and functionality of patients who suffer from it, with a high heritability and segregation, and a prevalence of between 1% and 2%. Neuropsychological deficits have been implicated as a very important issue related to BD prognosis, so a review was conducted of these deficits, the related factors and their functional consequences. It has been determined that the presence of neuropsychological deficits can vary in patients with BD according to their mood state, with a great influence of depressive symptoms on the cognitive variability of patients with respect to the general population and differences with respect to patients in the manic phase. In euthymic patients, the most affected cognitive domains are those of memory, attention, and executive function, associated with a more severe disease, sociodemographic vulnerability factors, and stable over time. A relationship has been found between poor cognitive performance, especially executive dysfunction, and objective functional deficit. Furthermore, cognitive differences have been outlined between BD and other serious mental illnesses that are described in the review.

Validity based on content: A challenge in health measurement scales.

Content-based validity can be defined as the evidence of the degree to which the items of an instrument represent the construct to be inferred. It is the initial and unavoidable step for evaluating other sources of validity. However, it is one of the least reported psychometric properties in development of health measurement scales. That is why it is considered a challenge that must be overcome with the recognition of its value. In this narrative review, the concept of content as evidence of validity is revised and methods for evaluation are synthesized with an algorithm.

High risk for psychiatric disorders in bipolar offspring. A four years prospective study / Riesgo elevado de trastornos psiquiátricos en hijos de padres con trastorno bipolar. Estudio prospectivo de cuatro años de duración

ABSTRACT Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. Objective: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. Methods: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). Results: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. Conclusion: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.

RESUMEN El trastorno bipolar (TB) tiene un gran componente hereditario. Es un trastorno que comienza en la edad adulta temprana, pero acerca del cual se ha descrito un período premórbido que precede al inicio de TB. Durante esta expresión heraldo, pueden aparecer trastornos y síntomas psiquiátricos, como depresivos, maníacos, psicóticos, ansiosos y otros. Objetivo: Determinar el perfil psicopatológico de un grupo de hijos de padres con TB (BO) en comparación con el grupo de hijos de padres control de la misma comunidad (CCO), y su evolución en el tiempo. Los síntomas subumbrales y los trastornos mentales serán incluidos. Métodos: Nosotros llevamos a cabo un estudio observacional mixto de cohorte, con diseño prospectivo. Incluimos sujetos de seis a 30 anos de edad, de la región de Antioquia, Colombia. Un total de 131 sujetos del grupo de riesgo BO y 150 sujetos del grupo CCO fueron evaluados a través de entrevistas de diagnóstico psiquiátricas validadas (K-SADS-PL y DIGS), al inicio yalos4anos de seguimiento. Todas las entrevistas se llevaron a cabo por personal ciego a los diagnósticos de los padres. La evaluación de seguimiento se completó en el 72% de la descendencia. Cuarenta y dos sujetos fueron excluidos ya que superaron la edad de 30 anos, y solo 46 sujetos no fueron seguidos (cambio de dirección o no dieron su consentimiento para participar). Resultados: En comparación con el grupo CCO, el grupo BO tuvo una mayor frecuencia de trastorno afectivo, el trastorno psicótico, los trastornos de externalización y el uso de las sustancias psicoactivas durante ambas evaluaciones en los tiempos 1 y 2. La magnitud de las diferencias entre los grupos aumentó cuando alcanzaron el tiempo 2. El grupo BO tuvo un mayor riesgo de presentar síntomas subumbrales y trastornos psiquiátricos definitivos, tales como trastornos afectivos, trastornos psicóticos y trastornos de externalización. Además, el grupo BO tuvo una edad de comienzo más baja para el consumo de sustancias psicoactivas. Conclusión: Durante el período de seguimiento, el grupo BO tuvo un mayor riesgo de presentar trastornos mentales en comparación con el grupo CCO. Los síntomas y trastornos más importantes que preceden al inicio del TB fueron: depresivo, bipolar no especificado de otra manera, psicóticos y el uso de sustancias.

High risk for psychiatric disorders in bipolar offspring. A four years prospective study.

Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. OBJECTIVE: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. METHODS: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). RESULTS: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. CONCLUSION: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.

Risk factors for perioperative complications in transurethral prostate resection in patients at a Colombian institution. / Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de Colombia.

OBJECTIVE: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolar transurethral resection of the prostate at a complex care institution in Colombia. MATERIALS AND METHODS: A mixed cohort study was conducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolar transurethral resection of the prostate between 2012 and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate of complications determined up to 30 postoperative days. RESULTS: A total of 67 patients (19.45%) presented perioperative complications of which 17 (25.37%) were previously hospitalized. According to the Clavien Dindo classification, 14.79% were grade I - II: secondary hematuria was the most reported complication and was present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The risk factors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 - 4.39), INR (RR: 7.59, IC95%:4.63 - 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 - 1.42) and urethral catheter use (RR: 1.04, CI95%: 1.02 - 1.05). CONCLUSIONS: In this study, the complication rate after bipolar transurethral resection of the prostate was less than 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. The risk factors that were found are modifiable, which could reduce postoperative morbidity.

OBJETIVO: Determinar la tasa de complicaciones y los factores de riesgo para complicaciones perioperatorias tempranas de la Resección Transuretral de Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. MATERIALES Y MÉTODOS: Se realizó un estudio de cohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna (HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las características basales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. RESULTADOS: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%) fueron intrahospitalarias. Según la clasificación Clavien Dindo el 14,79% fueron complicaciones grado I y II: la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tracto urinario (4,64%) y disfunción de la sonda uretrovesical (1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 ­ 4,39), aumento del valor del INR por unidad (RR: 7,59, IC95%: 4,63 ­ 12,44) y cada día adicional de irrigación vesical (RR: 1,32, IC95%:1,22 ­ 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02­ 1,05). CONCLUSIONES: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de meno rdel 20%, siendo las complicaciones grados I y II las más frecuentes. Los factores de riesgo encontrados son modificables lo que podría reducir la morbilidad postoperatoria.

Factores de riesgo para complicaciones perioperatorias en la resección transuretral de próstata en pacientes de una institución de colombia / Risk factors for perioperative complications in transurethral resection of the prostate in patients from a Colombian institution

Objetivo: Determinar la tasa de complicaciones y los factores de riesgo para complicacionesperioperatorias tempranas de la Resección Transuretralde Próstata con bipolar (RTUP-B) en una institución prestadora de servicios de salud de Colombia. Materiales y métodos: Se realizó un estudio decohortes mixta en el cual se incluyeron 340 pacientes con diagnóstico de Hiperplasia Prostática Benigna(HPB) que fueron llevados a RTUP-B entre el año 2012y 2019. Se recolectaron datos sobre las característicasbasales y perioperatorias y se determinó la tasa de complicaciones hasta los 30 días postoperatorio. Resultados: 67 pacientes (19,45%) presentaron complicaciones perioperatorias de las cuales 17 (25,37%)fueron intrahospitalarias. Según la clasificación ClavienDindo el 14,79% fueron complicaciones grado I y II:la hematuria secundaria fue la complicación más reportada en (5,22%), seguida de infecciones del tractourinario (4,64%) y disfunción de la sonda uretrovesical(1,76%). Los factores de riesgo fueron: estancia hospitalaria previo a la cirugía por cualquier causa (RR:2,23, IC95%: 1,14 – 4,39), aumento del valor del INRpor unidad (RR: 7,59, IC95%: 4,63 – 12,44) y cadadía adicional de irrigación vesical (RR: 1,32, IC95%:1,22 – 1,42) y sonda vesical (RR: 1,04, IC95%: 1,02– 1,05). Conclusiones: En este estudio, la tasa de complicaciones después de la RTUP con bipolar fue de menordel 20%, siendo las complicaciones grados I y II lasmás frecuentes. Los factores de riesgo encontrados sonmodificables lo que podría reducir la morbilidad postoperatoria.(AU)

Objetive: Determining the complications rate and the risk factors associated with early operative and postoperative complications with a bipolartransurethral resection of the prostate at a complex careinstitution in Colombia. Material and methods: A mixed cohort study wasconducted involving 340 patients diagnosed with benign prostatic hyperplasia who were taken to bipolartransurethral resection of the prostate between 2012and 2019. Data based on the baseline and perioperative characteristics were collected, and the rate ofcomplications determined up to 30 postoperative days. Results: A total of 67 patients (19.45%) presentedperioperative complications of which 17 (25.37%)were previously hospitalized. According to the ClavienDindo classification, 14.79% were grade I – II: secondary hematuria was the most reported complication andwas present in 18 patients (5.22%), followed by complicated urinary tract infections in 16 (4.64%) and dysfunction of the ureterovesical catheter in 6 (1.76%). The riskfactors found were surgery during hospitalization (RR:2.23, 95% CI: 1.14 – 4.39), INR (RR: 7.59, IC95%:4.63 – 12.44), duration in days of cysto/irrigation (RR:1.32, CI95%: 1.22 – 1.42) and urethral catheter use(RR: 1.04, CI95%: 1.02 – 1.05). Conclusions: In this study, the complication rate after bipolar transurethral resection of the prostate was lessthan 20%. The most frequent complications were grade Iand II according to the Clavien Dindo classification. Therisk factors that were found are modifiable, which couldreduce postoperative morbidity.(AU)

[Predictors of biochemical recurrence after radical prostatectomy at an oncology reference center in Colombia.] / Factores predictores de recaída bioquímica después de prostatectomía radical en un centro oncológico colombiano.

OBJECTIVE: To determine predictors of BCR in patients with localized PCa undergoing RP at an oncology reference center in Colombia. MATERIALS AND METHODS: A retrospective analytical study was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml. For the bivariate analysis we used Kaplan-Meier, and Cox proportional risk analysis to estimate the hazard ratio as well as to determine variables independently associated with the outcome. RESULTS: 280 patients were included. The medianage was 65.3 years, with a median follow up of 52.2 months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis, high risk [HR 2.07 (95% CI 1.11 - 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 - 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 - 4.01)] were identified as independent variables associated significantly with BCR. Limitations include retrospective design and sample size. CONCLUSIONS: High risk, positive surgical margins and the presence of tertiary Gleason pattern are the predictive factors of BCR after RP in the Colombian population.

OBJETIVO: Determinar los predictores de recaída bioquímica en pacientes con cáncer de próstata localizado llevados a prostatectomía radical en un centro oncológico de referencia en Colombia.MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo analítico en pacientes con cáncer de próstata localizado que fueron llevados a prostatectomía radical y que tuvieran al menos un factor patológico adverso para recaída bioquímica. Las variables analizadas fueron la edad, el riesgo, el estadio pT, el estadio pN, la densidad ganglionar, los márgenes quirúrgicos, el grupo grado de Gleason y el patrón terciario del Gleason. Consideramos recaída bioquímica como 2 elevaciones consecutivas del PSA después de la prostatectomía radical, mayor a 0,2 ng/ml. Para el análisis bivariado usamos Kaplan-Meier y el análisis de riesgo proporcional de Cox para estimar el HR así como para determinarlas variables independientemente asociadas con el desenlace. RESULTADOS: Se incluyeron 280 pacientes. La edad promedio fue de 65,3 años, con una media de seguimiento de 52,2 meses. La recaída bioquímica ocurrió en el 39% de los pacientes, con una media de tiempo hasta la recaída bioquímica de 24,8 meses. En el análisis multivariado, el riesgo alto [HR 2,07 (IC95% 1,11­ 3,86)], los márgenes quirúrgicos positivos [HR 2,79 (IC95% 1,66 ­ 4,69)] y el patrón terciario del Gleason [HR 2,16 (IC 95% 1,16 ­ 4,01)] fueron identificados como variables independientes asociadas significativamente con recaída bioquímica. Las limitaciones incluyen el diseño retrospectivo del estudio y el tamaño de la muestra. CONCLUSIONES: El riesgo alto, los márgenes quirúrgicos positivos y la presencia de patrón terciario de Gleason son las variables predictoras de recaída bioquímica después de prostatectomía radical en la población colombiana.

Calidad de vida en adultos con hemofilia afiliados a un programa de salud en Medellín, Colombia

Objetivo: determinar la calidad de vida relacionada con la salud en adultos con hemofilia afiliados a un programa de coagulopatía y explorar su asociación con factores clínicos y demográficos. Diseño: estudio observacional de corte transversal descriptivo y exploratorio. Se aplicó a todos los pacientes con hemofilia de una clínica especializada de Medellín (Colombia) el cuestionario de calidad de vida específico para hemofilia en Latinoamérica (Hemolatin-QoL). Se usaron medidas de estadística descriptiva y se evaluaron los factores asociados con las distintas dimensiones de la calidad de vida usando Kruskall-Wallis y correlación de Spearman. Resultados: se incluyeron 48 adultos con una mediana de edad de 32 años (RI: 23,2-40,7). La población varió en la gravedad de la hemofilia (leve 16,7 %, moderada 12,5 % y grave 70,8 %) y en el tratamiento (75,0 % profilaxis, 22,9 % demanda y 2,1 % inmunotolerancia). El 37,5 % tenía movilidad reducida y el 16,7 % comorbilidad. El puntaje total del Hemolatin-QoL fue 81,5. Los factores asociados con una menor calidad de vida fueron una mayor edad, número de comorbilidades, nivel socioeconómico bajo, presencia de artropatía y movilidad reducida. Conclusiones: la calidad de vida obtuvo puntuaciones cercanas a la máxima posible del cuestionario. Los factores asociados con la calidad de vida son similares a los encontrados en otras poblaciones y están relacionados con dificultades económicas, otras enfermedades y discapacidad. Es necesario realizar estudios posteriores y longitudinales con una muestra mayor para establecer asociaciones causales.

SUMMARY Objective: To determine the quality of life related to health in adults with hemophilia affiliated with a coagulopathic disorders program and to explore its association with clinical and demographic factors. Design: A cross sectional and descriptive study was performed. The hemophilia-specific quality of life questionnaire in Latin America (Hemolatin-QoL) was applied to all hemophilia patients at a specialized clinic in Medellín (Colombia). Descriptive statistical measures were used, and the factors associated with the different dimensions of quality of life were evaluated using the Kruskall-Wallis test and the Spearman correlation coefficient. Results: Forty-eight adults were included, with a median age of 32 years old (RI: 23.2-40.7). The population varied in the severity of hemophilia (16.7% mild, 12.5% moderate, and 70.8% severe) and in treatment (75% prophylaxis, 22.9% demand and 2.1% immuno-tolerance.), 37.5% had reduced mobility, while 16.7% suffered from comorbidity. The total Hemolatin-Qol score was 81.5. The factors associated with lower quality of life were: older age, number of comorbidities, low socioeconomic level, presence of arthropathy and reduced mobility. Conclusions: The quality-of-life scores obtained by the study were close to the maximum possible score of the questionnaire. The factors associated with quality of life are similar to those found in other populations and are related to economic difficulties, other diseases and disability. Further longitudinal studies with a larger sample are necessary to establish causal associations.

Factores predictores de recaída bioquímica después de prostatectomía radical en un centro oncológico colombiano / Predictive factors of biochemical relapse after radical prostatectomy in a Colombian cancer center

Objetivo: Determinar los predictores derecaída bioquímica en pacientes con cáncer de próstata localizado llevados a prostatectomía radical en uncentro oncológico de referencia en Colombia.Materiales y métodos: Se realizó un estudio retrospectivo analítico en pacientes con cáncer de próstatalocalizado que fueron llevados a prostatectomía radicaly que tuvieran al menos un factor patológico adversopara recaída bioquímica. Las variables analizadas fueron la edad, el riesgo, el estadio pT, el estadio pN, ladensidad ganglionar, los márgenes quirúrgicos, el grupo grado de Gleason y el patrón terciario del Gleason. Consideramos recaída bioquímica como 2 elevacionesconsecutivas del PSA después de la prostatectomía radical, mayor a 0,2 ng/ml. Para el análisis bivariado usamos Kaplan-Meier y el análisis de riesgo proporcionalde Cox para estimar el HR así como para determinarlas variables independientemente asociadas con el desenlace.Rresultados: Se incluyeron 280 pacientes. La edadpromedio fue de 65,3 años, con una media de seguimiento de 52,2 meses. La recaída bioquímica ocurrióen el 39% de los pacientes, con una media de tiempohasta la recaída bioquímica de 24,8 meses. En el análisis multivariado, el riesgo alto [HR 2,07 (IC95% 1,11– 3,86)], los márgenes quirúrgicos positivos [HR 2,79(IC95% 1,66 – 4,69)] y el patrón terciario del Gleason[HR 2,16 (IC 95% 1,16 – 4,01)] fueron identificadoscomo variables independientes asociadas significativamente con recaída bioquímica. Las limitaciones incluyenel diseño retrospectivo del estudio y el tamaño de lamuestra.Conclusiones: El riesgo alto, los márgenes quirúrgicos positivos y la presencia de patrón terciario deGleason son las variables predictoras de recaída bioquímica después de prostatectomía radical en la población colombiana.(AU)

Objetive: To determine predictors ofBCR in patients with localized PCa undergoing RP at anoncology reference center in Colombia.Materiales ymethods: A retrospective analyticalstudy was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml.For the bivariate analysis we used Kaplan-Meier, andCox proportional risk analysis to estimate the hazardratio as well as to determine variables independentlyassociated with the outcome.Results: 280 patients were included. The medianage was 65.3 years, with a median follow up of 52.2months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis,high risk [HR 2.07 (95% CI 1.11 – 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 – 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 – 4.01)were identified as independent variables associatedsignificantly with BCR. Limitations include retrospectivedesign and sample size.Conclusions: High risk, positive surgical marginsand the presence of tertiary Gleason pattern are thepredictive factors of BCR after RP in the Colombian population.(AU)

Is Structural Connectivity Different in Child and Adolescent Relatives of Patients with Bipolar Disorder? A Narrative Review According to Studies with DTI. / ¿Es diferente la conectividad estructural en niños y adolescentes familiares de pacientes con trastorno bipolar? Una revisión narrativa según estudios con DTI.

INTRODUCTION: Bipolar disorder (BD) has been associated with a decrease in white matter integrity. Diffusion tensor imaging (DTI) studies have enabled these changes to be elucidated with higher quality. Due to BD's high heritability, some studies have been conducted in relatives of BD patients looking at white matter integrity, and have found that structural connectivity may also be affected. This alteration has been proposed as a potential BD biomarker of vulnerability. However, there are few studies in children and adolescents. OBJECTIVE: To conduct a review of the literature on changes in white matter integrity determined by DTI in high-risk children and adolescents. RESULTS: Brain structural connectivity in the paediatric population is described in studies using DTI. Changes in the myelination process from its evolution within normal neurodevelopment to the findings in fractional anisotropy (FA) in BD patients and their high-risk relatives are also described. CONCLUSIONS: Studies show that both BD patients and their at-risk relatives present a decrease in FA in specific brain regions. Studies in children and adolescents with a high risk of BD, indicate a reduced FA in axonal tracts involved in emotional and cognitive functions. Decreased FA can be considered as a vulnerability biomarker for BD.

Psychopathological Risk in Siblings of Subjects with Attention-Deficit/Hyperactivity Disorder: A cross-Sectional Study.

OBJECTIVE: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia). METHODS: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity. RESULTS: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index. CONCLUSIONS: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings.

Validación de la escala de Autoestigma por Búsqueda de Ayuda (ABA) en una población de estudiantes de Medicina de Colombia / Validation of the Self Stigma of Seeking Help (SSOSH) Scale in a Population of Colombian Medical Students

RESUMEN Objetivo: Validar la escala de Autoestigma por Búsqueda de Ayuda (ABA), conocida en inglés como Self-Stigma of Seeking Help (SSOSH), en una población de estudiantes de una facultad de Medicina para su uso en Colombia. Método: Se incluyó a 384 estudiantes de Medicina de la ciudad de Medellín. Se realizaron 2 traducciones directas, 2 en sentido inverso y 1 prueba piloto. Luego se evaluó la consistencia interna, la reproducibilidad prueba-reprueba y la validez del constructo estructural, convergente, divergente y discriminativa. Resultados: Se obtuvo una versión en español de fácil comprensión y diligenciamiento. La consistencia interna de la escala fue adecuada (alfa de Cronbach = 0,80; IC95%, 0,77-0,83) al igual que la reproducibilidad prueba-reprueba (CCI = 0,77; IC95%, 0,63-0,86). El análisis factorial confirmatorio mostró un buen ajuste con la estructura unidimensional (RMSEA = 0,073; IC90%, 0,056-0,089; CFI = 0,968; TLI = 0,977; WRMR = 0,844). La validez convergente se mantuvo con la correlación con las escalas de estigma público (p = 0,39) y de actitudes hacia la búsqueda de ayuda (p = -0,50) y la validez divergente con la escala de deseabilidad social (p = -0,05). Al examinar la validez discriminativa, se encontraron diferencias significativas entre las puntuaciones de quienes estarían dispuestos a buscar ayuda profesional en caso de tener un problema de salud mental y quienes probablemente no lo harían (diferencia de medias, 4,9; IC95%, 2,99-6,83). Conclusiones: La versión colombiana de la ABA es válida, confiable y útil para la medición del autoestigma asociado con la búsqueda de ayuda profesional en población universitaria del área de la salud de Colombia. Se debe investigar sus propiedades psicométricas en poblaciones de otros programas y no universitarias.

ABSTRACT Objective: Validate the Self Stigma Of Seeking Help (SSOSH) scale in a population of students of a medical school for its use in Colombia. Methods: We included 384 medical students from the city of Medellín. Initially, two direct translations were made, two back translation and one pilot test. The internal consistency, test-retest repeatability and structural, convergent, divergent and discriminative construct validity were then evaluated. Results: A easy-to-understand and to fill out Spanish version was obtained. The internal consistency of the scale was adequate (Cronbach's alpha = .80; 95%CI, .77-.83) as well as the test-retest repeatability (CCI = .77; 95%CI, .63-.86). The Confirmatory Factor Analysis showed a good fit with the one-dimensional structure (RMSEA = .073; IC90%, .056-.089; CFI = .968; TLI = .977; WRMR= .844). The convergent validity was supported by the correlation with the Public Stigma scales (p=.39) and Attitudes towards Seeking Help (p= -0.50) and the divergent validity with the Social Desirability scale (p=-0,05). When examining the discriminative validity, differences were found between the scores of those who would be willing to seek professional help when having a mental health problem and those who probably would not (Difference of means = 4.9; 95%CI, 2.99-6.83). Conclusions: The Colombian version of the SSOSH is valid, reliable and useful for the measurement of the Self-stigma associated with seeking professional help in the university population of the Colombian health sector. Its psychometric properties must be investigated in populations of other programs and outside universities.