Perceptions, knowledge, and practices related to oral health in a group of pregnant women: A qualitative study.

BACKGROUND: It is well known that the prevalence of dental caries and periodontal disease is increasing in pregnant women. Dental care is mostly sufficient to prevent oral diseases and perform timely interventions. However, few pregnant women go to the dental office during this period due to a lack of knowledge. The perceptions, knowledge, and oral health practices of pregnant women have been scarcely explored and should be taken into account to propose positive interventions in this population. OBJECTIVES: To identify and explore the perceptions, knowledge, and practices of oral health in a group of pregnant women in Colombia. MATERIAL AND METHODS: Twenty-four semistructured interviews were conducted in different areas of Colombia. The interviews were conducted via telephone, and the calls were recorded with the consent of the participants. The recordings were transcribed in Word® and checked for typing and transcription errors. The transcripts were analyzed using a hybrid approach combining inductive and deductive coding. The information was organized and encoded using NVivo12 ®software. We followed the Standards for Reporting Qualitative Research (SRQR) checklist. RESULTS: Pregnant women reported having good oral health. One barrier mentioned for occupation (Job) was pregnancy. The appearance of the oral cavity has not negatively affected the relationships of pregnant women. CONCLUSIONS: The pregnant women had good oral hygiene habits but did not receive dental check-ups. Knowledge in this group was limited and diverse. The information given by health professionals should be standardized, and some beliefs should be demystified. RELEVANCE TO CLINICAL PRACTICE: In general, few pregnant women were aware of bleeding gums during pregnancy. Empower pregnant women to take care of themselves through regular dental check-ups with the aim of preventing and treating oral diseases. Oral hygiene education and healthy nutritional habits should be intensified during this stage. PATIENT OR PUBLIC CONTRIBUTION: The participation in the study included a semistructured interview by telephone with the prior consent of the pregnant woman authorizing her involvement and the recording of the interview.

Prevalence and social determinants of periodontal disease in Colombian pregnant women.

OBJECTIVE: The objective of the study was to identify the prevalence of periodontal disease in pregnant women in the Colombian population and its association with social determinants and medical history based on data from the Fourth National Oral Health Survey (ENSAB IV). METHODS: A total of 1012 pregnant women from different areas of Colombia were evaluated. A periodontal evaluation was performed using a North Carolina periodontal probe. The following data were recorded: number of teeth, probing depth (PD), the position of the gingival margin (GM) and clinical attachment level (CAL). An ordinal logistic regression analysis was performed for the association between social determinants and the Centers for Disease Control and Prevention and the American Academy of Periodontology (CDC/AAP) classification and logistic regression between social determinants and the European Federation of Periodontology (EFP) classification. RESULTS: The prevalence of periodontitis was 37.1% using the CDC/AAP criteria and 41.2% according to the criteria of EFP distributed in sensitive (40.2%) and specific cases (0.9%). Age, belonging to a subsidized regime, living in a rural area, having an intermittent water supply and bleeding in medical records were found to be positively associated with periodontitis (mild, moderate, severe). CONCLUSIONS: The findings of this national study of pregnant women show a high prevalence of periodontitis-using the CDC/AAP and EFP criteria-associated with age, living in rural areas, subsidized regime, intermittent water supply and bleeding in medical records.

Prevalence of dental caries in pregnant Colombian women and its associated factors.

OBJECTIVE: To identify the prevalence of dental caries in pregnant women in the Colombian population and its association with the medical history and social determinants, based on data from the fourth National Oral Health Survey (ENSAB IV). MATERIALS AND METHODS: A total of 1,047 pregnant women from different areas of Colombia were evaluated. A dental evaluation was performed using a flat oral mirror and blunt-tipped probe (World Health Organization, 2007). For diagnosis of the dental condition, the DMFT index was used. A negative binomial regression analysis was performed to evaluate the association between social determinants and the DMFT index. RESULTS: The results of this national study show a 59% prevalence of caries in this population. Regarding the experience of caries, 89.9% of pregnant women showed having had caries. CONCLUSIONS: The results of this national study on pregnant women show a high prevalence of dental caries. The women's level of education is an important factor associated with dental caries and filled teeth, so the role of oral health education and dental check-ups are important. CLINICAL RELEVANCE: The findings of this study show the oral health situation of pregnant women, with a high prevalence of dental caries. This leads to the development and strengthening of oral health education strategies that empower pregnant women in their care. In addition, dental checkups during pregnancy should be implemented and reinforced to prevent and treat oral pathologies and thus prevent complications during this stage.

Neuromuscular exercise in children with Down Syndrome: a systematic review.

The effects and the prescription parameters of therapeutic exercise are not clear. For this reason, is needed to determine the effect of neuromuscular exercise on balance, muscle strength and flexibility specifying the parameters and characteristics of effective interventions in children between 6 and 12 years and adolescent between 13 and 18 years with Down Syndrome. The present study is a systematic review of effectiveness outcomes balance, muscle strength and flexibility in this population. The databases of PubMed, PEDro, EMBASE, SCIELO, Lilacs, Cochrane library were searched from May to December 2021. We recruited randomized controlled trials (RCTs) which met the inclusion criteria in our study. Ten studies were included. The interventions included mechanotherapy, vibration, and use of different unstable surfaces. The exercise frequency ranged from 3 to 5 days a week, and the duration of each session was between six and 15 min. The frequency was between two and three times a week for 6 and 12 weeks and the intensity were between 60 and 80% of maximal voluntary contraction. Neuromuscular exercise in different modes of application was associated with increases in chest and lower limb muscle strength mean 8.51, CI [2.35-14.67] kg and (21.54 [1.64, 41.43]) kg. Balance also improved when the mode of application was isokinetic training and core stability exercises (- 0.20 [- 0.29, - 0.12]) evaluated with stability index. Neuromuscular exercise appears to be effective for the improvement of both lower limb and chest muscle strength and balance in children over 8 years. No evidence was found in children under 8 years.

Utilidad del índice UDT-65 en adultos con dolor torácico y electrocardiograma normal o no diagnóstico / Usefulness of the CPU-65 index in adults with chest pain and normal or non-diagnostic electrocardiogram

Resumen Objetivo: Evaluar la utilidad del índice UDT-65 para la estratificación del dolor torácico en urgencias en una población colombiana en la que se sospecha enfermedad coronaria. Método: Se condujo la validación externa del índice UDT-65 en una cohorte concurrente que incluyó pacientes que ingresaron a urgencias de una clínica cardiovascular en Bogotá con dolor torácico no traumático, y electrocardiograma normal o no diagnóstico. Se evaluaron 1320 pacientes de 18 o más años y se determinó la utilidad del índice en términos de calibración (uso de gráfico, ji al cuadrado para datos agrupados y prueba de bondad de ajuste de Hosmer-Lemeshow) y de capacidad de discriminación del modelo (curva de características operativas del receptor [ROC] y área bajo ella [AUC]). Resultados: El índice UDT-65 en esta población suministró evidencia de su utilidad en términos de calibración y capacidad de discriminación, para efectuar una buena aplicación de él en aquellos pacientes que consulten al servicio de urgencias de una clínica cardiovascular por dolor torácico no traumático de posible origen coronario. La capacidad de discriminación del índice UDT-65 fue adecuada, pues con un área bajo la curva ROC de 0.867 (IC 95% 0-847-0.885), que se acerca al valor obtenido (AUC 0.87) en la población española en que se desarrolló el índice. Conclusiones: Se necesitan más estudios similares en otras instituciones, dado el buen resultado, en beneficio de más pacientes.

Abstract Objective: To evaluate the clinical usefulness, in the emergency service, of the UDT-65 index for chest pain stratification in colombian population with suspected coronary disease. Method: The external validation of the UDT-65 index was conducted in a concurrent cohort that included patients admitted to the emergency service of the cardiovascular clinic in Bogotá with non-traumatic chest pain and normal or non-diagnostic electrocardiogram. 1320 patients were evaluated and the usefulness of this instrument was determined in terms of calibration (use of graph, Chi-square test for group data and the Hosmer-Lemeshow goodness-of-fit test) and discrimination capacity of the model (curve of receiver operating characteristics [ROC] and by finding the area under the curve [AUC]). Results: The UDT-65 index in the population under study, provided evidence of its usefulness in terms of calibration and discrimination capacity; this, in pursuance of a good application of the instrument in those patients who consult the Emergency Department of the cardiovascular clinic for non-traumatic chest pain of possible coronary origin. The discrimination capacity of the UDT65 index was adequate, with an area under the ROC curve of 0.867 (95 % CI 0.847-0.885), which is close in value to the one obtained (AUC 0.87) in the Spanish population where the original index was developed. Conclusions: More similar studies are needed in other institutions, due to the excellent and beneficial outcomes.

Factores asociados al reconocimiento de trastornos y problemas mentales en adolescentes en la Encuesta Nacional de Salud Mental, Colombia / Associated factors for recognition of mental problems and disorders in adolescents in the Colombian National Mental Health Survey

RESUMEN Introducción: Los problemas y los trastornos mentales son prevalentes en la población adolescente. Se calcula que alrededor de un 10% de los adolescentes sufren trastornos mentales que requieren atención y, en general, no se reconocen como tales. El objetivo es determinar potenciales factores asociados con que se reconozcan o no los trastornos y problemas mentales en la población colombiana. Métodos: De la Encuesta Nacional de Salud Mental (ENSM) del 2015 realizada en Colombia, se recogió a los adolescentes de 12-17 arios que respondieron a si algún profesional los había diagnosticado un problema o trastorno de salud mental y se los comparó con los que puntuaron positivo en trastornos mentales medidos por el CIDI 3.0 o en problemas mentales detectados por el SRQ-20. Resultados: Se obtuvo una muestra de 1.754 adolescentes, de los que el 7,3% (n = 129) tenían trastornos y el 22,6% (n = 396) tenían problemas. Del total con trastornos y problemas, reconocen que los tienen el 13,9% (n = 18) de las personas con trastornos y el 8,3% (n = 33) de aquellos con problemas. Se realizaron análisis bivariables con posibles variables relacionadas y, con los resultados, se construyó un modelo multivariable de regresión que evidenció factores asociados con el reconocimiento de trastornos o problemas, como disfunción familiar (OR = 2,5; IC del 95%, 1,3-4,5) y acudir a familiar en caso de problemas económicos (OR = 2,7; IC del 95%, 1,0-7,2). Conclusiones: El reconocimiento es de gran relevancia para que los adolescentes inicien el acceso a la asistencia. Los resultados proveen variables asociadas que permiten planear intervenciones que promuevan la detección de trastornos y problemas en esta población.

ABSTRACT Introduction: Mental problems and disorders are prevalent in the adolescent population. It is estimated that around 10% of adolescents have mental disorders that require attention and are generally not recognised as such. The aim was to determine potential factors associated with whether or not mental disorders and problems are recognised in the Colombian population. Methods: Adolescents aged 12 to 17 who said they had been diagnosed with a mental health problem or disorder by a healthcare professional were identified from the National Mental Health Survey conducted in Colombia in 2015. This group was compared with those who scored positive for mental disorders measured by CIDI 3.0 or mental problems detected by SRQ-20. Results: A sample of 1,754 adolescents was obtained, of whom 7.3% (n = 129) had disorders and 22.6% (n = 396) had problems. Of the total with disorders and problems, 13.9% (n = 18) of people with disorders and 8.3% (n = 33) with problems knew they had them. Bivariate analyses were performed with the possible related variables, and with the results we constructed a multivariate regression model that identified factors associated with the recognition of disorders or problems, such as family dysfunction (OR = 2.5; 95% CI, 1.3-4.5) or counting on family when having financial problems (OR = 2.7; 95% CI, 1.0-7.2). Conclusions: Recognition is of great importance for initiating access to care by adolescents. The results provide associated variables which can aid planning of interventions to improve the detection of disorders and problems in this population.

Utilidad de la triangulación en salud / Usefulness of health triangulation / Utilidade da triangulação na saúde

Los inicios de la triangulación como estrategia metodológica en investigación se dan a partir de la segunda mitad del siglo XX, específicamente, en investigación cualitativa cuando fue empleada como una estrategia para corroborar los hallazgos provenientes de dos fuentes de información diferentes. Posteriormente se empezó a utilizar como una estrategia para lograr completitud del fenómeno bajo estudio. La utilidad de la triangulación radica en que esta proporciona una mayor flexibilidad en la interpretación de los datos debido a que con el empleo de diferentes fuentes se estará buscando obtener una imagen más completa del problema. La triangulación puede darse en diversos niveles, no solo en los métodos y puede emplear un amplio rango de técnicas. El proceso de triangulación es una tarea ardua debido a que se tratan de mediar las diferencias entre dos o más fuentes de información, enfoques metodológicos, diseños, perspectivas teóricas, investigadores y análisis de datos para compensar las debilidades de una sola estrategia con el fin de lograr integridad o confirmación de los hallazgos

The beginnings of triangulation as a methodological strategy in research ocurred in the second half of the 20th century, specifically, in qualitative research when it was used as a strategy to corroborate the findings from two different sources of information. Subsequently, it began to be used as a strategy to achieve completeness of the phenomenon under study. The usefulness of triangulation is that it provides greater flexibility in the interpretation of the data because with the use of different sources a more complete picture of the problem is obtained. Triangulation can occur at various levels, not only in the methods and can use a wide range of techniques. The triangulation process is an arduous task because it tries to mediate the differences between two or more sources of information, methodological approaches, designs, theoretical perspectives, researchers and data analysis to compensate the weaknesses of a single strategy to achieve integrity or confirmation of the findings

O início da triangulação como estratégia metodológica na pesquisa ocorre na segunda metade do século XX, especificamente na pesquisa qualitativa, quando foi utilizado como estratégia para corroborar os achados de duas fontes diferentes de informação. Posteriormente, passou a ser utilizado como estratégia para alcançar a integridade do fenômeno em estudo. A utilidade da triangulação é que ela fornece maior flexibilidade na interpretação dos dados, porque diferentes fontes são usadas para obter uma imagem mais completa do problema. A triangulação pode ocorrer em vários níveis, não apenas em métodos e pode usar uma ampla gama de técnicas. O processo de triangulação é uma tarefa árdua porque tenta mediar as diferenças entre duas ou mais fontes de informação, abordagens metodológicas, projetos, perspectivas teóricas, pesquisadores e análise de dados para compensar os pontos fracos de uma única estratégia para obter integridade ou confirmação dos resultados

Evaluación de conocimientos sobre oxigenoterapia y lectura del flujómetro en el personal de salud de pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia / Knowledge Evaluation of Oxygen Therapy and Flowmeter's Reading among Health Workers in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia

Introducción: el oxígeno (O2) es un medicamento que puede generar efectos adversos. Discrepancias en la lectura del flujómetro y metas de saturación de oxígeno (SpC>2) pueden repercutir en la toma de decisiones clínicas, paraclínicas y estancia hospitalaria de pacientes pediátricos. Objetivo: evaluar conocimientos sobre SpO2, efectos adversos del O2 y lectura del flujómetro en el personal de salud del Departamento de Pediatría del Hospital Universitario San Ignacio, Bogotá, Colombia. Métodos: estudio transversal, mediante encuesta autodiligenciada en una muestra por conveniencia durante diciembre de 2016 y enero de 2017. Evaluación de conocimientos sobre oxigenoterapia, SpC>2, efectos adversos y lectura del flujómetro mediante fotografías de flujómetros del hospital con diferente fracción inspirada de oxígeno (FiC>2). Resultados: de 259 personas, el 77% respondió la encuesta. El 22% de los participantes respondió que la SpC>2 aumenta o se mantiene igual cuando el niño duerme; el 78% sabía de complicaciones del uso prolongado de O2, y el 67%, las relacionadas con la administración de una FiC>2 mayor a la necesaria. Con relación a la población neonatal, el 10% consideró que se deben buscar metas de SpO2 iguales o superiores al 96%; entre el 9% y el 19% de las lecturas en las diferentes fotografías de flujómetros fueron respuestas incorrectas. Discusión: es necesario reforzar conceptos actualizados sobre oxigenoterapia, con énfasis en metas de saturación, efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Introduction: Supplemental oxygen is considerad a pharmaceutical drug; therafora, it can produce adverse effects. Lack of consensus regarding the reading of oxygen flowmeters and peripheral oxygen saturation (SpC>2) goals can influence clinical and paraclinical decisions and hospital stay length. Objective: To assess knowledge on oxygen therapy, adverse effects, SpC>2 goals and oxygen flowmeter's reading among personnel in the Pediatric Unit at Hospital Universitario San Ignacio, Bogotá, Colombia. Methodology: Cross-sectional study derived from convenience sampling through a self-applied poli between December 2016 and January 2017. The poli evaluated topics on supplemental oxygen therapy fundamentáis and adverse effects, SpC>2 goals and flowmeter readings through flowmeters photographs indicating a specific ffaction of inspirad oxygen (FÍO2). Results: Response rate was 77% from 259 subjects. 22% considered that the oxygen saturation either increases or remains the same during sleep periods in children. 78% participants knew at least one complication associated to prolonged oxygen therapy and 67% due to supplementary oxygen concentration greater than required amounts. In neonatal population, 10% considered oxygen saturation efectos adversos y lectura de flujómetro mediante campañas educativas periódicas.

Prostaglandins for management of retained placenta.

BACKGROUND: Retained placenta affects 0.5% to 3% of women following delivery and it is a major cause of maternal death due to postpartum haemorrhage. Usually, retained placenta has been managed by manual removal or curettage under anaesthesia, which may be associated with haemorrhage, infection and uterine perforation. Medical management to facilitate the delivery of the retained placenta could be a safe alternative avoiding surgical intervention. OBJECTIVES: To assess the effectiveness and safety of prostaglandins for the management of retained placenta. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013), LILACS (1982 to 1 December 2013), SciELO (1998 to 1 December 2013), Web of Science (2001 to 1 December 2013), openSIGLE (1997 to 1 December 2013), World Health Organization International Clinical Trials Registry Platform (ICTRP) (1 December 2013) and the metaRegister of Controlled Trials (mRCT) (1 December 2013). We also contacted authors of included studies and reviewed the reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled clinical trials comparing the use of prostaglandins (or prostaglandin analogues) with placebo, expectant management, tocolytic drugs, any other prostaglandins or surgical interventions for the management of retained placenta after vaginal delivery of singleton live infants of 20 or more weeks of gestation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. Any disagreements were resolved through consensus or consultation with a third review author when required. Authors of the included studies were contacted for additional information. MAIN RESULTS: We included three trials, involving 244 women. The studies were considered to be at high risk of bias.The prostaglandins used were PG E2 analogue (sulprostone) in 50 participants and PG E1 analogue (misoprostol) in 194 participants at a dose of 250 mcg and 800 mcg respectively. The prostaglandins compared with placebo, were not superior in reducing the rate of manual removal of placenta (average risk ratio (RR) 0.82; 95% confidence interval (CI) 0.54 to 1.27), severe postpartum haemorrhage (RR 0.80; 95% CI 0.55 to 1.15), need for blood transfusion (RR 0.72; 95% CI 0.43 to 1.22), mean blood loss (mean difference (MD) -205.26 mL; 95% CI -536.31 to 125.79, random-effects) and the mean time from injection to placental removal (MD -7.00 minutes; 95% CI -21.20 to 7.20). Side-effects were no different between groups (vomiting, headache, pain and nausea between injection and discharge from the labour ward), with the exception of shivering, which was more frequent in women receiving prostaglandins (RR 10.00; 95% CI 1.40 to 71.49). We did not obtain any data for the primary outcomes of maternal mortality and the need to add another therapeutic uterotonic. AUTHORS' CONCLUSIONS: Currently there is limited, very low-quality evidence relating to the effectiveness and the safety using prostaglandins for the management of retained placenta. Use of prostaglandins resulted in less need for manual removal of placenta, severe postpartum haemorrhage and blood transfusion but none of the differences reached statistical significance. Much larger, adequately powered studies are needed to confirm that these clinically important beneficial effects are not just chance findings.Similarly, no differences were detected between prostaglandins and placebo in mean blood loss or the mean time from injection to placental removal (minutes) or side-effects (vomiting, headache, pain and nausea between injection and discharge from the labour ward) except for 'shivering' which was more frequent in women who received prostaglandin. The included studies were of poor quality and there is little confidence in the effect estimates; the true effect is likely to be substantially different. We can not make any recommendations about changes to clinical practice. More high-quality research in this area is needed.

Factores asociados con intento de suicidio y comportamientos de autolesión no suicida en pacientes con trastornos del comportamiento alimentario / Factors Associated With Suicide Attempts and Nonsuicidal Self-Injurious Behaviors in Patients With Eating Disorders

El intento de suicidio (IS) y los comportamientos de autolesión no suicida (CALNS) se han descrito en pacientes con trastornos del comportamiento alimentario (TCA) y se relacionan con una mayor morbilidad y peor pronóstico. Objetivos: Explorar la presentación de IS y CALNS en pacientes consultantes a un programa de tratamiento ambulatorio para TCA, evaluar las variables asociadas y explorar la correlación entre ambos tipos de comportamientos. Materiales y métodos: Se estudiaron 908 pacientes de ambos sexos que consultaron el Programa Equilibrio, de Bogotá. El antecedente de IS y CALNS fue explorado sistemática-mente en la elaboración de la historia clínica mediante preguntas estructuradas directas y corroboradas durante las entrevistas con la familia. Además, se estudiaron variables sociodemográficas y clínicas, y antecedentes de experiencias traumáticas. Se calcularon frecuencias simples, se realizó un análisis bivariado entre el IS y el CALNS, y las otras variables de estudio. Finalmente, para el análisis multivariado se construyeron 2 modelos de asociación con las variables de importancia clínica y significación estadística. Resultados: El 13% de los pacientes reportaron IS en algún momento de su vida y el 26%, CALNS. Las variables asociadas con IS fueron trastorno bipolar (OR: 3,86; IC 95% 2,4-6,1), personalidad limítrofe, subtipo purgativo del TCA y autolesiones. Con los CALNS se encontró asociado abuso sexual (OR: 3,48; IC 95% 2,2-5,4), trastorno bipolar, tricotilomanía e intento de suicidio. Conclusión: El IS y los CALNS son frecuentes en pacientes con TCA con múltiples comorbilidades, mayor impulsividad y desregulación emocional, y deben ser explorados y tratados.

Suicide attempt (SA) and non-suicidal self-injurious behaviors (NSSI) have been described in patients with eating disorders (ED), and they have been associated with increased morbidity and poor prognosis. Objectives: To explore the presence of SA and NSSI in patients attending an outpatient ED program, as well as to evaluate the associated variables and the correlation between both types of behaviors. Materials and methods: A total of 908 patients of both sexes attending the Equilibrio outpatient program in Bogotá were studied. The histories of SA and NSSI were systematically examined in the development of medical history by direct and structured questions to the patient, and then validated during interviews with the family. Sociodemographic and clinical variables, as well as history of traumatic experiences, were also studied. Simple frequencies were calculated, and a bivariate analysis was performed between SA, NSSI, and the other variables of the study. Finally, two models of association were designed for the multivariate analysis, using variables of clinical importance and statistical significance. Results: SA sometime in their lives was reported by 13% of the patients, and 26% of them reported NSSI. The variables associated with SA were bipolar disorder (OR: 3.86, 95% CI; 2.4-6.1), borderline personality, purgative subtype of ED, and self-injury. Sexual abuse was associated with NSSI (OR: 3.48, 95%CI; 2.2-5.4), as well as bipolar disorder, trichotillomania, and suicide attempt. Conclusion: SA and NSSI are frequent in patients with eating disorders with multiple comorbidities, increased impulsivity and emotional dysregulation, and they should be explored and treated.

[Factors Associated With Suicide Attempts and Nonsuicidal Self-Injurious Behaviors in Patients With Eating Disorders]. / Factores asociados con intento de suicidio y comportamientos de autolesión no suicida en pacientes con trastornos del comportamiento alimentario.

UNLABELLED: Suicide attempt (SA) and non-suicidal self-injurious behaviors (NSSI) have been described in patients with eating disorders (ED), and they have been associated with increased morbidity and poor prognosis. OBJECTIVES: To explore the presence of SA and NSSI in patients attending an outpatient ED program, as well as to evaluate the associated variables and the correlation between both types of behaviors. MATERIALS AND METHODS: A total of 908 patients of both sexes attending the Equilibrio outpatient program in Bogotá were studied. The histories of SA and NSSI were systematically examined in the development of medical history by direct and structured questions to the patient, and then validated during interviews with the family. Sociodemographic and clinical variables, as well as history of traumatic experiences, were also studied. Simple frequencies were calculated, and a bivariate analysis was performed between SA, NSSI, and the other variables of the study. Finally, two models of association were designed for the multivariate analysis, using variables of clinical importance and statistical significance. RESULTS: SA sometime in their lives was reported by 13% of the patients, and 26% of them reported NSSI. The variables associated with SA were bipolar disorder (OR: 3.86, 95% CI; 2.4-6.1), borderline personality, purgative subtype of ED, and self-injury. Sexual abuse was associated with NSSI (OR: 3.48, 95%CI; 2.2-5.4), as well as bipolar disorder, trichotillomania, and suicide attempt. CONCLUSION: SA and NSSI are frequent in patients with eating disorders with multiple comorbidities, increased impulsivity and emotional dysregulation, and they should be explored and treated.

[Assessing the force of hepatitis A virus infection in Colombia by applying catalytic models]. / Estimación de la fuerza de infección de Hepatitis A en Colombia, aplicando modelos catalíticos.

AIMS: Estimating the force of hepatitis A virus (HAV) infection concerning a 1- to 15-year-old child population being attended at six healthcare centres in Colombia by applying catalytic models. METHODS: Anti-HAV seroprevalence was estimated in 2,152 patients attending six health centres in 5 Colombian cities; based on such estimation, the force of infection and average age of infection were obtained for each region. RESULTS: The 1- to 4-year-old age group's force of infection was 0.15 in Barranquilla; for the other cities the force of infection was 0.02 in Bogotá for the 5- to 15-year-old age group and 0.06 in Medellin for the 1- to 9-year-old age group. Average infection age in Bogotá, Bucaramanga, Cali and Medellin was 10.68 to 11.97 years-old. CONCLUSION: There was high anti-HAV prevalence in the young-adult population, average infection age being 10.69 to 11.97 years-old, thereby presenting a similar pattern to that of developing regions having intermediate level of endemicity.

Prevalencia y factores asociados a la infección por C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans, sífilis, VIH y vaginosis bacteriana en mujeres con síntomas de infección vaginal en tres sitios de atención de Bogotá, Colombia, 2010 / The prevalence of and factors associated with C. trachomatis, N. gonorrheae, t. vaginalis, C. albicans infection, syphilis, Hiv and bacterial vaginosis in females suffering lower genital tract infection symptoms in three healthcare attention sites in bogotá, colombia, 2010

Objetivo: estimar la prevalencia y etiología de las infecciones de transmisión sexual, y de las infecciones endógenas en mujeres en edad reproductiva con síntomas de infección del tracto genital inferior sintomáticas, y describir los factores asociados.Materiales y métodos: estudio de corte transversal en tres centros de atención en Bogotá. Se realizó el diagnóstico etiológico mediante puntaje de Nugent para vaginosis bacteriana (VB), cultivo para Candida, y frotis en fresco para trichomonas. En un subgrupo de pacientes se realizó cultivo In Pouch TM para T. vaginalis (TV), PCR para C. trachomatis (CT) y N. gonorroheae (NG), y pruebas serológicas para sífilis y VIH. Los factores de riesgo fueron evaluados comparando los dos grupos por medio del Odds Ratio (OR) y el intervalo de confianza del 95 por ciento. Resultados: 1385 mujeres fueron incluidas, de ellas 115 (8,3 por ciento) eran trabajadoras sexuales. Se confirmó la presencia de alguna infección del tracto genital (ITG) en 731 (52,7 por ciento) de las mujeres; 560 (40,4 por ciento) presentaron infecciones endógenas y 170 (12,3 por ciento) infecciones de transmisión sexual (ITS). La etiología más frecuente fue la VB en 549 (39,6 por ciento), seguida por candidiasis en 153 (11 por ciento). CT fue detectada en 134 (9,7 por ciento y NG en 19 (1,4 por ciento). TV fue detectada por frotis en fresco en 11 (0,8 por ciento) y por cultivo en 8 de 634 (1,2 por ciento), sífilis en 12 (0,8 por ciento) y VIH en 1 (0,07 por ciento). Las mujeres trabajadoras sexuales tuvieron mayor riesgo de presentar cualquier ITS (OR: 2,0; IC 95 por ciento 1,2-3,3). Las mujeres con ITS tuvieron una edad promedio de 27,9 (± 7,8), y aquellas que no tenían ITS de 31,9 (± 8,9) años. El consumo de licor con frecuencia entre diaria y semanal fue mayor en las mujeres con ITS (OR: 2,6; IC 95 por ciento: 1,4-4,5). Conclusiones: se identificó la etiología en el 52,7 por ciento de las mujeres que consultaron por síntomas de infección del tracto genital inferior. La infección más frecuente fue vaginosis bacteriana, y clamidia dentro de la infecciones de transmisión sexual. No se identificó ninguna etiología infecciosa específica en el 47,3 por ciento de las mujeres aun cuando se utilizó el patrón de oro diagnóstico para los diferentes microorganismos.

Objective: Determining the prevalence and aetiology of sexually-transmitted infections and endogenous infections in women of childbearing age having lower genital tract infection symptoms and describing the pertinent risk factors. Materials and methods: This cross-sectional study was carried out at three outpatient healthcare centres in Bogotá, Colombia. Etiologic diagnosis was made using Nugent’s criteria for bacterial vaginosis, blood agar culture for Candida and wet mount for T. vaginalis. The In-pouch culture technique was used for T. vaginalis, the polymerase chain reaction for C. trachomatis and N. gonorroheae and serological tests for syphilis (RPR, TPHA) and HIV on a sample of the afore mentioned population. Results: 1,385 females were recruited in 2010. 115 (8.3 percent) were sex workers. An LGTI was confirmed in 731 (52.7 percent); 560 (40.4 percent) had an endogenous infection and 170 (12.3 percent) a sexually-transmitted infection (STI). The most frequent aetiology were bacterial vaginosis (39.6 percent), candidiasis (11 percent), C. trachomatis (9.7 percent) and N. gonorroheae (1.4 percent); Trichomona was detected by wet mount (0.8 percent) and culture (1.2 percent), as were syphilis (0.8 percent) and HIV (1 case). Sex workers had a higher risk of having an STI (2.0 OR; 1.2-3.3 95 percent CI), as were younger females (28 ± 7.8 cf 32 ± 8.9) (p = 0.001) and alcohol users (2.6 OR; 1.4-4.5 95 percent CI). Conclusions: Aetiology was identified for 52.7 percent of the females who consulted for lower genital tract infection symptoms; bacterial vaginosis was the most common and Chlamydia the most frequent sexually-transmitted infection. No specific aetiology was identified in almost the same number of females (47.3 percent), even when using gold-standard diagnostic technology for each microorganism.

Pharmacological interventions for the prevention of allergic and febrile non-haemolytic transfusion reactions.

BACKGROUND: Allergic and febrile non-haemolytic transfusion reactions (NHTRs) are the two most common forms of transfusion reaction. Pretransfusion medication with anti-inflammatory drugs is used in NHTR prevention, however its efficacy and safety remains unclear. OBJECTIVES: To assess the clinical effects and safety of pharmacological interventions for preventing NHTR in patients with and without a history of transfusion reactions. SEARCH STRATEGY: The search strategy included The Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library (Issue 4, 2008), Cochrane Injuries Group's Specialised Register (December 17, 2008), MEDLINE (1950 to November (week 3) 2008), EMBASE (1988 to November (week 3) 2008), LILACS (1982 to January 12, 2009), CINAHL (1982 to December 2008), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED): 1970 to December 2008). There was no language restriction. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing the effectiveness of interventions for the prevention of NHTR. DATA COLLECTION AND ANALYSIS: Authors independently selected studies, assessed the risks of bias and extracted data. Relative risks (RR) were estimated in RCTs with parallel design (PD). Odds ratio (OR) was estimated for one RCT with crossover design (CD). No meta-analysis was attempted due to differences in the pharmacotherapy of pre-transfusion medication and methodology between the studies; a per-protocol analysis was used. MAIN RESULTS: This review includes three RCTs (two PD and one CD). The PD-RCTs employed disparate units of randomisation (UofR); patient or transfusion, while the CD-RCT applied the patient as the UofR. The PD-RCTs administered leukodepleted blood products. Both PD-RCTs compared acetaminophen plus diphenhydramine (ApD) at different regimens with placebo, while the CD-RCT contrasted hydrocortisone pharmacotherapy with diphenhydramine. Both PD-RCTs found no statistically significant difference in allergic reactions (RR 0.13, 95% confidence interval (CI) 0.01 to 2.39, RR 1.46, 95% CI 0.78 to 2.73) and febrile reactions (RR 0.52, 95% CI 0.22 to 1.26). The CD-RCT found a statistically significant difference in the odds of febrile reactions (OR 2.38, 95% CI 1.07 to 5.27). The trials did not report anaphylactic reactions, deaths related to transfusion reactions or other adverse events. AUTHORS' CONCLUSIONS: None of the three studies found that medication prior to transfusion reduces NHTR. This applied regardless of the patient's history of NHTR and the use of leukodepleted blood products in the transfusion. However, this conclusion is based on three trials of moderate to low quality. A better-powered RCT is necessary to evaluate the role of pretransfusion medication in the prevention of NHTR. Inclusion criteria should be restricted to patients at high risk of developing NHTR, with no restriction by age, history of transfusion reactions and type of blood products (leukodepleted or not).

Estimación de la fuerza de infección de Hepatitis A en Colombia, aplicando modelos catalíticos / Assessing the force of hepatitis A virus infection in Colombia by applying catalytic models

Objetivo Estimar la fuerza de infección de hepatitis A en la población de niños entre 1 a 15 años de edad que asistieron a seis centros de salud en Colombia entre el año 2007 y 2008, aplicando modelos catalíticos. Métodos En 2 152 pacientes de seis centros de salud en cinco ciudades de Colombia se estimó la seroprevalencia de anticuerpos contra el virus de la Hepatitis A (anti-VHA) por grupos de edad. Con base en esta estimación, se obtuvo la fuerza de infección y la edad promedio de infección para cada región ajustando modelos catalíticos. Resultados La fuerza de infección fue de 0,15 en el grupo de 1 a 4 años en Barranquilla. En el resto de ciudades la fuerza de infección tomó valores entre 0,02 para Bogotá en el grupo de 5 a 15 años, y 0,06 para Medellín en el grupo de 1 a 9 años. La edad promedio de infección en Bogotá, Bucaramanga, Cali y Medellín estuvo entre 10,7 y 12,0 años. Conclusión En Bogotá, Bucaramanga, Cali y Medellín se estimaron seroprevalencia de anti-VHA entre 26,3 % y 40,4 % en el grupo de 10 a 15 años, con una edad promedio de infección entre 10,7 y 12,0 años; comportamiento semejante a la de regiones en desarrollo con endemicidad intermedia.

Aims Estimating the force of hepatitis A virus (HAV) infection concerning a 1- to 15-year-old child population being attended at six healthcare centres in Colombia by applying catalytic models. Methods Anti-HAV seroprevalence was estimated in 2,152 patients attending six health centres in 5 Colombian cities; based on such estimation, the force of infection and average age of infection were obtained for each region. Results The 1- to 4-year-old age group’s force of infection was 0.15 in Barranquilla; for the other cities the force of infection was 0.02 in Bogotá for the 5- to 15-year-old age group and 0.06 in Medellin for the 1- to 9-year-old age group. Average infection age in Bogotá, Bucaramanga, Cali and Medellin was 10.68 to 11.97 years-old. Conclusion There was high anti-HAV prevalence in the young-adult population, average infection age being 10.69 to 11.97 years-old, thereby presenting a similar pattern to that of developing regions having intermediate level of endemicity.

[Incidence and preventability of adverse events in patients hospitalised in three Colombian hospitals during 2006]. / Incidencia y Evitabilidad de Eventos Adversos en Pacientes Hospitalizados en tres Instituciones Hospitalarias en Colombia, 2006.

OBJECTIVE: Determining adverse event (AE) incidence, preventability, classification and impact for establishing their importance as a public health problem within the Colombian Social Security System. METHODOLOGY: This was a study of a prospective inpatient cohort from three Colombian general-practice institutions. INCLUSION CRITERIA: at least 12 hours' length of hospital stay during 2006. EXCLUSION CRITERIA: suffering psychiatric disorders and AE which had occurred before hospitalisation indexing. The sample consisted of 6 557 patients. SOURCE OF INFORMATION: clinical charts. Being a three-phase design, the first phase consisted of translating and standardising screening and causation formats, phase II of actively monitoring screening criteria and phase III of evaluating causation regarding the care being provided, based on specialist committee concept on a 0-6 scale. The variables measured were age, gender, social security affiliation, cumulative AE incidence, temporality, preventability of AE and disability resulting from them. RESULTS: 6,688 patients were evaluated; 505 of them fulfilled positive screening criteria (95 % CI=7,9;7,3-8,6), 310 presented at least one AE during their hospitalisation (95 %CI for accumulated incidence=4,6; 4,1-5,1). AE were considered to have been preventable in 189 cases (95 % CI=61;55-66) and permanent disability occurred in 1,3 % of them. AE-associated mortality was 6,4 % (20/310). Hospitalisation became increased to 1 072 days as a direct consequence of AE. CONCLUSIONS: This study revealed an important incidence of AE in three Colombian hospitals, these being mainly preventable. Their ongoing monitoring as a part of risk management systems could reduce costs and AE-associated morbidity and mortality.

Concordancia entre la estimación visual y la medición del volumen recolectado en una bolsa del sangrado intraparto en mujeres con parto normal en Bogotá, Colombia, 2006 / Agreement between visual estimation and the objective determination of the volume of intrapartum blood loss in a collecting bag in women undergoing vaginal delivery. Bogotá, Colombia, 2006

Objetivos: establecer la concordancia entre la estimación visual y la medición del volumen recolectado en una bolsa del sangrado intraparto, según las características del personal encargado de la atención del parto en un hospital universitario de mediana complejidad y la correlación entre el volumen recolectado y el cambio en la hemoglobina y el hematocrito posparto.Materiales y métodos: se realizó un estudio de concordancia en una cohorte de 168 embarazadas atendidas por parto normal, en un hospital general de nivel medio de complejidad ubicado en Bogotá, Colombia. Se evaluó la concordancia por observadores simultáneos de niveles crecientes de formación y experiencia, mediante el coeficiente de correlación concordancia (CCC Lin), límites de acuerdo del 95 por ciento y la correlación entre el cambio en la hemoglobina y hematocrito con el volumen recolectado mediante el coeficiente de Pearson.Resultados: la mediana del volumen recolectado fue 494 mL (p5 = 110, p95 = 1.320), la de la caída del hematocrito de 3,8 por ciento y de hemoglobina de 1,2 g/dL. La concordancia global fue aceptable [CCC = 0,72 IC 95 por ciento: 0,67-0,76)] con una subestimación visual media de 110,2 mL (límites de acuerdo 95 por ciento = -562,1 mL y 341,8 mL). La subestimación y la pérdida de la confiabilidad fueron crecientes a mayor volumen recolectado para todas las categorías de evaluadores. La correlación entre volumen recolectado y el cambio en hemoglobina y hematocrito fue 0,55 y 0,53.Conclusiones: la confiabilidad de la estimación visual es aceptable para volúmenes pequeños y disminuye al aumentar el volumen recolectado. Se deben introducir instrumentos y educación continuada que permitan mejorar la confiabilidad de la estimación del sangrado intraparto para prevenir la hemorragia posparto.

Incidencia y Evitabilidad de Eventos Adversos en Pacientes Hospitalizados en tres Instituciones Hospitalarias en Colombia, 2006 / Incidence and preventability of adverse events in patients hospitalised in three Colombian hospitals during 2006

Objetivo Determinar incidencia, clasificación, evitabilidad e impacto de los Eventos Adversos (EA) para establecer su importancia como problema en algunos hospitales en Colombia. Metodología Cohorte prospectiva de pacientes hospitalizados al menos 12 horas en 3 instituciones generales en Colombia. Se excluyeron pacientes psiquiátricos, presencia del EA antes del ingreso a la hospitalización índice. Con una diferencia estimada del 1 por ciento (complejidad alta y media), significancia: 0,05 por ciento, poder: 80 por ciento relación 2:1 se requerían mínimo 6 557 pacientes. Fuente de información: historia clínica Fase I: traducción y adaptación de formularios. Fase II: vigilancia activa de eventos de tamización. Fase III: evaluación de la asociación del EA con el cuidado proveído, por un comité de especialistas, Variables: edad, género y tipo de afiliación al sistema de seguridad social, incidencia acumulada de EA, temporalidad, evitabilidad y discapacidad resultante naturaleza del EA. Resultados Fueron evaluados 6 688 sujetos durante el periodo de vigilancia. Se detectaron 505 pacientes con eventos de tamización positivos (7,9 por ciento IC95 por ciento 7,3-8,6). Un total de 310 sujetos presentaron al menos un evento adverso; Incidencia acumulada: (4,6 por ciento IC95 por ciento 4,1-5,1) durante la hospitalización. De estos se consideró evitable el evento adverso en 189 sujetos (61 por ciento, IC95 por ciento 55-66). Ocurrió discapacidad permanente en 1,3 por ciento. La mortalidad asociada al evento adverso fue de 6,4 por ciento (20/310). Se incrementó la hospitalización como consecuencia del EA un total de 1 072 días. Conclusiones La incidencia de eventos adversos evitables fue relevante en los tres hospitales de Colombia.

Objective Determining adverse event (AE) incidence, preventability, classification and impact for establishing their importance as a public health problem within the Colombian Social Security System. Methodology This was a study of a prospective inpatient cohort from three Colombian general-practice institutions. Inclusion criteria: at least 12 hours' length of hospital stay during 2006. Exclusion criteria: suffering psychiatric disorders and AE which had occurred before hospitalisation indexing. The sample consisted of 6 557 patients. Source of information: clinical charts. Being a three-phase design, the first phase consisted of translating and standardising screening and causation formats, phase II of actively monitoring screening criteria and phase III of evaluating causation regarding the care being provided, based on specialist committee concept on a 0-6 scale. The variables measured were age, gender, social security affiliation, cumulative AE incidence, temporality, preventability of AE and disability resulting from them. Results 6 688 patients were evaluated; 505 of them fulfilled positive screening criteria (95 percent CI=7,9;7,3-8,6), 310 presented at least one AE during their hospitalisation (95 percentCI for accumulated incidence=4,6; 4,1-5,1). AE were considered to have been preventable in 189 cases (95 percent CI=61;55-66) and permanent disability occurred in 1,3 percent of them. AE-associated mortality was 6,4 percent (20/310). Hospitalisation became increased to 1 072 days as a direct consequence of AE. Conclusions This study revealed an important incidence of AE in three Colombian hospitals, these being mainly preventable. Their ongoing monitoring as a part of risk management systems could reduce costs and AE-associated morbidity and mortality.

Factores de riesgo asociados al síndrome depresivo en la población colombiana / Factors of risk associated with the depressive syndrome in the population of Colombia

Objetivos: Describir y determinarlos factores de riesgo asociados con el Síndrome Depresivo en la población colombiana. Diseño: Estudio de corte transversal en la población colombiana. Análisis secundario de la base de datos del Primer Estudio Nacional de Salud Mental y Abuso de Sustancias. Participantes: 25.134 personas, éntrelos 12y 60 años de edad fueron incluidos, 52. 7% mujeres y 42.8 96 hombres. Principal medida desenlace: Depresión, medida por la Escala de Zung en personas de 16 a 60 años (N-21.274). La información para todas/as variables fue recolectada en forma estandarizada por entrevistadores no médicos entrenados. Fueron medidas 240 variables independientes. Resultados: 84.2% de la población no presentó depresión, 11.8% presentó depresión leve, 3.4% moderada y 0.6% depresión severa. El análisis bivariado encontró que la edad, estrato social, ansiedad, percepción familiar, percepción de la salud, percepción general de sí mismo, sexo e intentos de suicidio estaban asociados con depresión. Con el modo de regresión logística ordinal encontramos asociación entre depresión y los siguientes factores .-percepción dé la salud como mala, baja cohesión familiar, baja ansiedad, intento de suicidio en toda la vida, en el último año y baja satisfacción con los logros personales. Conclusiones: La depresión es una importante y prevalente enfermedad mental en Colombia. Ansiedad, intentos de suicidio, satisfacción con los logros, percepción de la familia y de sí mismo con importantes factores asociados que deben ser estudiados en nuestro país con el propósito de mejorar el manejo de esta enfermedad e implementar campañas de prevención...

Objective: To describe and determine the risk factors associated with depressive syndrome among Colombian population. Depression has became one ofthe most important andprevalent mental health problems in Colombia. Design: Cross-Sectional survey among Colombian population. Secondary analysis ofa data set fromthe First National Mental Health and Substance Abuse. Paríicipants: 25134 persons, aged 12to60years were included, 57.2% females and 42.8% males. Main Outcome Measure: Depression measuredbyZung Sale in persons 16 to 60years(N-21.274). Information aboutall variables was collectedon standardizedform bytrainedno medical interviewers. 240 independent variables were measured. Results: 84.2% ofthe population didnot present depression, 11.896 has mild depression, 3.4% modérate and 0.6% severe depression. Bivariate analysis foundthat age, stratum, anxiety, family perception, health perception, general selfperception, sex and suicide attempts were associated with depression. With ordinallogístíc regression technique we foundassociation of health perception asbad, low family cohesión, low anxiety, suicide attempt in the wholelife, in the lastyear and low satisfaction with achievements with levéis of depression. Conclusions: Depression is a prevalent and important mental health problem in Colombia. Anxiety, suicide attempts, satisfaction with achievements, family and self perception may be important associated factors to be studied in our country in order to improve management and implement prevention campaigns...