Fundamento y generalidades de la construcción de modelos estadísticos multinivel en el ámbito de la investigación en salud

Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

Construction of multilevel statistical models in health research: Foundations and generalities / Fundamento y generalidades de la construcción de modelos estadísticos multinivel en el ámbito de la investigación en salud

This topic review aims to present a global vision of multilevel analysis models' applicability to health research, explaining its theoretical, methodological, and statistical foundations. We describe the basic steps to build these models and examples of their application according to the data hierarchical structure. It ir worth noticing that before using these models, researchers must have a rationale for needing them, and a statistical evaluation accounting for the variance percentage explained by the observations grouping effect. The requirements to conduct this type of analysis depends on special conditions such as the type of variables, the number of units per level, or the type of hierarchical structure. We conclude that multilevel analysis models are a useful tool to integrate information, considering the complexity of the relationships and interactions involved in most health conditions, including the loss of independence between observation units.

Este trabajo tiene como objetivo presentar una mirada global de la aplicabilidad de los modelos de análisis multinivel en el ámbito de la investigación sanitaria. Ofrece información sobre los fundamentos teóricos, metodológicos y estadísticos y, además, menciona los pasos básicos para la construcción de estos modelos, y da ejemplos de su uso, según la estructura jerárquica de los datos. Cabe resaltar que, antes de utilizar estos modelos, se requiere contar con un soporte teórico sobre la necesidad de uso y una valoración estadística que dé cuenta del porcentaje de varianza explicada por el efecto de agrupación de las observaciones. Los requisitos para llevar a cabo este tipo de análisis dependen de condiciones especiales como el tipo de variables, la cantidad de unidades por nivel o el tipo de estructura jerárquica. Se concluye que los modelos de análisis multinivel son una herramienta útil para lograr la integración de información, dadas la complejidad de las relaciones y las interacciones que determinan la mayoría de las condiciones de salud, incluida la pérdida de independencia entre las unidades de observación.

HIV infection prevalence and associated risk factors in people who inject drugs in Medellin / Prevalencia de infección por VIH y factores de riesgo asociados, en personas que se inyectan drogas en la ciudad de Medellín

Introduction: the availability of high purity and low-cost drugs has increased the use of intravenous substances, which makes it a public health problem due to its association with HIV infection. Objective: to identify the factors associated with HIV infection in people who inject drugs. Materials and methods: a cross-sectional descriptive study was carried out between December 2017 and January 2018 in Medellin, Colombia. We use the sampling conducted by the respondent (RDS). Results: They have recruited 224 subjects, 86.2% were men, 82.0% were single and 67.0% belonged to the subsidized or linked health system. The prevalence of HIV infection was 3.6%. This study found that 38.8% of consumers have shared needles and syringes with up to three people, representing a risk of infection of 5.07 times, compared to those who do not share (RPc = 5.07 95% CI: 1.19-21.55), and if this practice is carried out with a close friend, the probability increases to almost double (10.69) (RPc = 10.69 IC 95%: 2.26-50.61) (p <0.05). Conclusion: Given the low prevalence of HIV, it is vital to develop and implement public policies whose objective is to create prevention programs that ultimately lead to the reduction of infection in this population.

Introducción: La disponibilidad de drogas con una alta pureza y un bajo costo, ha aumentado el consumo de sustancias por vía intravenosa; llevándolo a ser considerado como un problema de salud pública, por su asociación con la presencia de infección por VIH. Se estima que existen aproximadamente 16 millones de consumidores de drogas intravenosas en el mundo y en Colombia, 15.000. Objetivo: identificar los factores asociados con la infección por VIH en personas que se inyectan drogas. Materiales y métodos: estudio descriptivo transversal, realizado (diciembre 2017/ enero 2018) Medellín - Colombia, se utilizó la metodología Respondent Driven Sampling (RDS). Resultados: Fueron reclutados 224 participantes, un 86,2% fueron hombres, el 82,0% eran solteros, el (67,0%) pertenecía al régimen de salud subsidiado o vinculado. Con relación a la prevalencia de infección por VIH esta fue del 3,6%. Este estudio encontró que el 38,8% de los consumidores había compartido agujas y jeringas con hasta tres personas, lo cual representa una probabilidad de 5,07 veces de contraer la infección comparado con aquellos que no comparten (RPc=5,07 CI95% 1,19-21,55), si esta práctica se hace con un amigo cercano dicha probabilidad aumenta a casi el doble 10,69 (RPc= 10,69 CI95% 2,26-50,61), (p<0,05). Conclusión: Ante la baja prevalencia de VIH, es necesario, el desarrollo e implementación de políticas públicas que tengan como objetivo la creación de programas de prevención que finalmente, lleven a la reducción de la infección en esta población.

Liraglutide vs. lixisenatide in obese type 2 diabetes mellitus patients: What effect should we expect in routine clinical practice?

AIM: Liraglutide and lixisenatide improved glycemic control, weight and cardiovascular risk factors (CVRF) in type 2 diabetes mellitus (T2DM) patients. Our objective was to analyze clinical efficacy and safety differences in routine clinical practice. METHODS: A 24-week prospective observational study to compare the effect of liraglutide versus lixisenatide in obese T2DM patients in routine clinical practice. The main objective was to analyze between-group glycosylated hemoglobin (HbA1c) differences at the end of the study. Secondary objectives included differences in body weight, other CVRF, changes in medication, side effects, satisfaction and safety. RESULTS: A total of 100 patients (50 liraglutide, 50 lixisenatide) were included. Both groups experienced a decrease in HbA1c values (liraglutide, -1.4%, CI 95% -2, -0.8, P < 0.001 vs. lixisenatide, -0.8%, 95% CI -1.2, -0.5, P < 0.001). No differences were found in final HbA1c values between both groups (liraglutide 7.3 ±â€¯0.9% vs. lixisenatide 7.2 ±â€¯1.5%, P = 0.7). We did not detect between groups differences in anthropometric variables or CVRF at the study end. A lower proportion of patients received treatment with a maximum dose of liraglutide compared with lixisenatide (27% vs. 95%, P < 0.001). In contrast, a greater percentage of patients in the lixisenatide group than in liraglutide group (29% vs. 9%, P = 0.026) intensified treatment by the addition of sodium-glucose transporter type 2 inhibitors. Adverse events were less frequently reported in liraglutide treated patients compared with lixisentatide (80% vs. 96%, P = 0.014). No serious adverse events were detected. CONCLUSIONS: These results confirm the efficacy and safety of liraglutide and lixisenatide in routine clinical practice. Moreover, a different therapeutic effect between liraglutide and lixisenatide was detected.

Vaccination adherence to influenza, pneumococcal and hepatitis B virus in adult type 1 diabetes mellitus patients.

AIM: To document adherence to influenza, pneumococcal and hepatitis B virus (HBV) vaccination programme in adult type 1 diabetes mellitus (T1DM) patients. MATERIALS AND METHODS: Observational retrospective study using data obtained from computerized clinical records. We contacted all adult T1DM registered in our database from a tertiary diabetes care hospital. Primary efficacy outcome was to describe influenza, pneumococcal and HBV vaccination status. RESULTS: Three hundred patients were analyzed (male 53%). Mean age was 40.0±14.4years and T1DM duration was 19.7±11.8years. Thirty-five percent of the patients had complementary indications for studied vaccines. Adherence to vaccination program for influenza, pneumococcal and HBV was achieved by 55%, 18% and 17% of the patients, respectively. Only 3% of the subjects were vaccinated against the three microorganisms. Predictor of correct vaccination were: age, shorter diabetes duration, insulin pump treatment, better diabetes control and being a health professional. We detected 17 sick leaves, 127 lost working days and 3 hospitalizations due to flue during the follow-up. CONCLUSIONS: The uptake of recommended vaccinations against influenza, pneumococcal and HBV in adult T1DM patients was below desirable levels. A special effort is required to all health professionals to implement immunization among adult people with T1DM. Clinical Trials NCT03478254.

[Ovitraps evaluation for surveillance and control of Aedes aegypti in two urban settlements of Urabá, Antioquia]. / Evaluación de ovitrampas para vigilancia y control de Aedes aegypti en dos centros urbanos del Urabá antioqueño.

INTRODUCTION: Aedes (Stegomyia) aegypti is the main vector of dengue. Chemical insecticides have been used to control the mosquito and it has developed resistance. It is necessary to evaluate alternative strategies that are efficient, economical and easy to apply, such as ovitraps with Bacillus thuringiesis israeliensis . OBJECTIVE: To evaluate the impact of ovitraps loaded with B. t. israeliensis on traditional indexes, as strategies for surveillance and control of A. aegypti . MATERIALS AND METHODS: We selected eight neighborhoods from the municipalities of Apartadó and Carepa. Two neighborhoods in each municipality were chosen for intervention and two for control. The intervention consisted in the installation of ovitraps with B. t. israeliensis in every house. The traps were visited each month between September, 2009, and March, 2010. Traditional indexes were obtained and compared among the neighborhoods. Ovitrap positivity index and egg density index were calculated and we generated density maps. RESULTS: Five hundred and nineteen ovitraps were placed monthly; 3,114 samples were obtained, from which 76.4% were positive. We collected 501,425 eggs. In Apartadó, statistically significant differences were observed in the house, container and Breteau indexes. The ovitrap positivity index showed high risk of A. aegypti infestation and traditional indexes showed medium and low risk levels. CONCLUSIONS: Ovitraps had an impact on traditional indexes and proved to be useful strategies for surveillance and control of A. aegypti in Urabá, Antioquia.

Evaluación de ovitrampas para vigilancia y control de Aedes aegypti en dos centros urbanos del Urabá antioqueño / Ovitraps evaluation for surveillance and control of Aedes aegypti in two urban settlements of Urabá, Antioquia

Introducción. Aedes ( Stegomyia ) aegypti es el principal vector del dengue. En el control del mosquito se han usado insecticidas químicos contra los cuales ha desarrollado resistencia. Es necesaria la evaluación de estrategias alternativas que sean eficientes, económicas y de fácil aplicación, como las ovitrampas con Bacillus thuringiesis var. israeliensis. Objetivo. Evaluar el impacto de ovitrampas con B. thuringiesis var. israeliensis sobre los índices aédicos tradicionales, como estrategia para la vigilancia y el control de A. aegypti . Materiales y métodos. Se seleccionaron ocho barrios de los municipios de Apartadó y Carepa, Antioquia, de los cuales se escogieron dos barrios para la intervención y dos para el control en cada municipio. La intervención consistió en la instalación de una ovitrampa con B. thuringiesis var. israeliensis en cada una de las viviendas. Las ovitrampas se visitaron mensualmente entre septiembre de 2009 y marzo de 2010. Se obtuvieron los índices aédicos tradicionales y se hicieron comparaciones entre los barrios. Se calculó el índice de ovitrampas positivas y el de densidad de huevos, y se generaron los mapas de densidad. Resultados. Se colocaron 519 ovitrampas muestreadas mensualmente. Se hicieron 3.114 muestreos, con un porcentaje de registros positivos de 76,4 %. Se recolectaron 501.425 huevos. En Apartadó se observaron diferencias significativas entre el índice de infestación de viviendas, el índice de infestación de depósitos y el índice de Breteau en los barrios intervenidos comparados con los barrios de control. El índice de ovitrampas positivas evidenció un alto riesgo de infestación por A. aegypti y, los índices tradicionales, niveles de riesgo medio y bajo. Conclusiones. Las ovitrampas tuvieron impacto sobre los índices tradicionales y demostraron ser estrategias útiles en la vigilancia de A. aegypti en el Urabá antioqueño.

Introduction: Aedes (Stegomyia) aegypti is the main vector of dengue. Chemical insecticides have been used to control the mosquito and it has developed resistance. It is necessary to evaluate alternative strategies that are efficient, economical and easy to apply, such as ovitraps with Bacillus thuringiesis israeliensis . Objective: To evaluate the impact of ovitraps loaded with B. t. israeliensis on traditional indexes, as strategies for surveillance and control of A. aegypti . Materials and methods: We selected eight neighborhoods from the municipalities of Apartadó and Carepa. Two neighborhoods in each municipality were chosen for intervention and two for control. The intervention consisted in the installation of ovitraps with B. t. israeliensis in every house. The traps were visited each month between September, 2009, and March, 2010. Traditional indexes were obtained and compared among the neighborhoods. Ovitrap positivity index and egg density index were calculated and we generated density maps. Results: Five hundred and nineteen ovitraps were placed monthly; 3,114 samples were obtained, from which 76.4% were positive. We collected 501,425 eggs. In Apartadó, statistically significant differences were observed in the house, container and Breteau indexes. The ovitrap positivity index showed high risk of A. aegypti infestation and traditional indexes showed medium and low risk levels. Conclusions: Ovitraps had an impact on traditional indexes and proved to be useful strategies for surveillance and control of A. aegypti in Urabá, Antioquia.

Homicidios y suicidios en jóvenes de 15 a 24 años, Colombia, 1998-2008 / Homicide and suicide in 15 to 24 year-old people in Colombia, 1998-2008

Introducción. Los comportamientos psicosociales son objeto de indiferencia, lo que ha llevado a un incremento generalizado de actitudes favorables a la violencia, que comprometen personas jóvenes, como víctimas o victimarios. Objetivo. Describir el comportamiento de la mortalidad por homicidio y suicidios en población de 15 a 24 años, en los departamentos de Colombia, entre 1998 y 2008. Materiales y métodos. Se llevó a cabo un estudio descriptivo de fuente secundaria, usando los 150.433 registros de defunción por homicidio y suicidio, en población de 15 a 24 años de Colombia, en el período de 1998 a 2008. Se calculó un índice de condiciones propicias para la violencia, según variables económicas, sociales y educativas. Resultados. La tasa de mortalidad fue de 95,6 defunciones por 100.000 personas en este rango de edad para homicidio y, de 10,1, para suicidio. Los hombres presentaron mayor riesgo que las mujeres, con una exceso de mortalidad masculina de 12,3 en homicidios y de 1,2 en suicidios, lo que evidencia cómo la violencia cobra vidas productivas y reproductivas, lo que a largo plazo afectará la estructura por edad y sexo, y disminuirá la ventana de oportunidades, con mayor riesgo en unos departamentos que en otros. Conclusión. Según el índice de condiciones para la violencia, los departamentos de Vaupés, Guaviare, Arauca y Guainía son los que presentan condiciones más propicias para que se aumente el riesgo de morir por homicidio y suicidio en personas de 15 a 24 años de edad, aunque otros departamentos registren mayores tasas de mortalidad.

Introduction: Psychosocial behaviors are the object of indifference, which has lead to a generalized increase in attitudes favoring violence. Among these, we can find young people as victims or killers. Objective: To describe the behavior of mortality due to homicide and suicide in young population between 15 and 24 years old in the departments of Colombia from 1998 to 2008. Materials and methods: This was a descriptive study form a secondary source. We used 150,433 death certificates with homicide or suicide as cause of death in 15 to 24 years old population in Colombia during the period 1998-2008. We calculated an index for favorable conditions for violence according to economical, social and educational variables. Results: Mortality rate was 95.6 deaths/100,000 people in this age range for homicide, and 10.1 for suicide. Men showed greater risk than women, with it being 12.3 higher for homicide and 1.2 for suicide. This evidences the way in which violence takes productive and reproductive lives, thus affecting the structure by sex and age and decreasing the opportunity window, but having a higher risk in some departments more than in others. Conclusion: According to the index for conditions for violence, the departments of Vaupés, Guaviare, Arauca and Guainía are the ones with more favorable conditions for an increased risk of dying by homicide and suicide in people from 15 to 24 years old, regardless of other departments having higher deaths rates.

Tendencias de la mortalidad por fiebre amarilla, Colombia, 1998-2009 / Trends in yellow fever mortality in Colombia, 1998-2009

Introducción. La fiebre amarilla es una enfermedad tropical desatendida, razón por la cual el conocer las tendencias de mortalidad por fiebre amarilla en Colombia, constituye una importante fuente de información para la toma de decisiones y las intervenciones en salud pública. Objetivo. Analizar las tendencias de mortalidad fiebre amarilla en Colombia (1998-2009) y las diferencias que presentan las fuentes de información de morbilidad y mortalidad en el país, que afectan indicadores como el de letalidad . Materiales y métodos. Es un estudio descriptivo de las muertes por fiebre amarilla, según el Departamento Administrativo Nacional de Estadística, y de la incidencia de la enfermedad, según el Instituto Nacional de Salud. Se usaron fuentes secundarias de información en el cálculo de proporciones de las características sociodemográficas de los fallecidos y las medidas epidemiológicas de letalidad, incidencia y mortalidad por fiebre amarilla, por departamento de residencia de los fallecidos. Resultados. Las muertes por fiebre amarilla se presentan principalmente en hombres, en edad de trabajar, residentes en zonas rurales dispersas, afiliados al régimen vinculado, residentes en las zonas oriental, suroriental, norte y central del país. Se observaron inconsistencias en los informes reportados que afectan el análisis comparativo. Conclusión. Los habitantes de los departamentos ubicados en los territorios nacionales y en Norte de Santander presentan mayor riesgo de enfermar y de morir por fiebre amarilla, pero esta información pudiera estar subestimada, según la fuente de información utilizada en su cálculo.

Introduction: Yellow fever is a neglected tropical disease, thus, knowing the trends in mortality from this disease in Colombia is an important source of information for decision making and identifying public health interventions. Objective: To analyze trends in yellow fever mortality in Colombia during the 1998-2009 period and the differences in the morbidity and mortality information sources for the country, which affect indicators such as the lethality one. Materials and methods: This is a descriptive study of deaths by yellow fever according to the Departamento Administrativo Nacional de Estadística and the incidence of the disease according to the Instituto Nacional de Salud . We used secondary sources of information in the calculation of proportions of socio-demographic characteristics of the deceased and epidemiological measures of lethality, incidence and mortality from yellow fever by department of residence of the deceased. Results: Yellow fever deaths occur primarily in men of working age residing in scattered rural areas, who were members of the regimen vinculado, and who were living in the eastern, southeastern, northern and central zones in the country. We observed inconsistencies in the reports that affect the comparative analysis. Conclusion: The inhabitants of the departments located in national territories and Norte de Santander have an increased risk of illness and death from yellow fever, but this information could be underestimated, according to the source of information used for its calculation.

[Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections]. / Valoración de la satisfación y calidad de vida en pacientes con diabetes mellitus tipo 1 en tratamiento con infusión subcutánea continua de insulina comparado con multidosis de insulina.

OBJECTIVE: To assess the quality of life (QOL) and satisfaction (SF) in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI). METHOD: A descriptive study was conducted to assess the QOL and SF of 68 patients on CSII or MDI treatment (1:2). The instruments used were, the Spanish version of the Diabetes Quality of Life (EsDQOL) specific for diabetes related QOL, SF-36 for general QOL, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for SF evaluation. RESULTS: The EsDQOL scores for patients on CSII therapy were similar to those treated with MDI (87.20±21.11 vs 86.83±20.7, P=.86), with lower scores in the SF-36 questionnaire (66.91±15.76 vs 75.90±14.56, P=.03) except in Health Transition section, where patients treated with CSII showed higher scores (68.75±19.66 vs 57.93±17.18, p=.02). The values obtained in the DTSQ questionnaire were higher in CSII patients compared with the MDI group in last weeks (31.50±4.66 vs 27.83±6.06, p=.01) and last three months periods (13.2±6.73 vs 8.77±7.40, p=.01). CONCLUSIONS: Patients with T1DM on CSII therapy showed a poorer global QOL, although they felt more satisfied with their treatment than those treated with MDI. No differences in diabetes related QOL were detected between groups.

Valoración de la satisfación y calidad de vida en pacientes con diabetes mellitus tipo 1 en tratamiento con infusión subcutánea continua de insulina comparado con multidosis de insulina / Satisfaction and quality of life evaluation in patients with type 1 diabetes mellitus treated using continuous subcutaneous insulin infusion compared with multiple daily injections

Valorar la calidad de vida ( CV ) y satisfacción (SF) de los pacientes con diabetes mellitus tipo 1 (DM1) en terapia con infusión subcutánea continua de insulina (ISCI) comparado con los pacientes tratados con multidosis diarias de insulina (MDI). Método Estudio descriptivo valorando la CV y SF de 68 pacientes en tratamiento con ISCI o MDI (1:2). Los instrumentos utilizados fueron la versión española del cuestionario de CV relacionado con diabetes (Diabetes Quality of Life [EsDQOL]) y el cuestionario general de CV SF-36, junto con el test de SF con el tratamiento recibido (Diabetes Treatment Satisfaction Questionnaire [DTSQ]). Resultado sLos pacientes en terapia ISCI obtuvieron una puntuación similar a los tratados con MDI en el cuestionario EsDQOL (87,20 ± 21,11 y 86,83 ± 20,78, p = 0,86, respectivamente), aunque mostraron resultados menores en el test SF-36 (66,91 ± 15,76 y 75,90 ± 14,56 p = 0,03, respectivamente) salvo en el apartado transición de salud de este último, que resultó mayor (68,75 ± 19,66 y 57,93 ± 17,18 p = 0,02, respectivamente). Los valores conseguidos en el cuestionario DTSQ fueron mayores en el grupo ISCI frente a MDI en las últimas semanas (31,50 ± 4,66 y 27,83 ± 6,06, p = 0,01, respectivamente) y en los últimos 3 meses (13,20 ± 6,73 y 8,77 ± 7,40, p = 0,01, respectivamente). Conclusiones Los pacientes con DM1 en terapia ISCI mostraron peor CV general aunque se sienten más satisfechos con su tratamiento que los tratados con MDI. No detectamos diferencias en la CV relacionada con diabetes entre ambos grupos de tratamiento (AU)

Objective To assess the quality of life (QOL) and satisfaction (SF) in patients with type 1 diabetes mellitus (T1DM) treated with continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin injections (MDI).MethodA descriptive study was conducted to assess the QOL and SF of 68 patients on CSII or MDI treatment (1:2). The instruments used were, the Spanish version of the Diabetes Quality of Life (EsDQOL) specific for diabetes related QOL, SF-36 for general QOL, and the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for SF evaluation. Results The Es DQOL scores for patients on CSII therapy were similar to those treated with MDI (87.20 ± 21.11 vs 86.83 ± 20.7, P = .86), with lower scores in the SF-36 questionnaire (66.91 ± 15.76 vs 75.90 ± 14.56, P = .03) except in Health Transition section, where patients treated with CSII showed higher scores (68.75 ± 19.66 vs 57.93 ± 17.18, p = .02). The values obtained in the DTSQ questionnaire were higher in CSII patients compared with the MDI group in last weeks (31.50 ± 4.66 vs 27.83 ± 6.06, p = .01) and last three months periods (13.2 ± 6.73 vs 8.77 ± 7.40, p = .01). Conclusions Patients with T1DM on CSII therapy showed a poorer global QOL, although they felt more satisfied with their treatment than those treated with MDI. No differences in diabetes related QOL were detected between groups (AU)

[Homicide and suicide in 15 to 24 year-old people in Colombia, 1998-2008]. / Homicidios y suicidios en jóvenes de 15 a 24 años, Colombia, 1998-2008.

INTRODUCTION: Psychosocial behaviors are the object of indifference, which has lead to a generalized increase in attitudes favoring violence. Among these, we can find young people as victims or killers. OBJECTIVE: To describe the behavior of mortality due to homicide and suicide in young population between 15 and 24 years old in the departments of Colombia from 1998 to 2008. MATERIALS AND METHODS: This was a descriptive study form a secondary source. We used 150,433 death certificates with homicide or suicide as cause of death in 15 to 24 years old population in Colombia during the period 1998-2008. We calculated an index for favorable conditions for violence according to economical, social and educational variables. RESULTS: Mortality rate was 95.6 deaths/100,000 people in this age range for homicide, and 10.1 for suicide. Men showed greater risk than women, with it being 12.3 higher for homicide and 1.2 for suicide. This evidences the way in which violence takes productive and reproductive lives, thus affecting the structure by sex and age and decreasing the opportunity window, but having a higher risk in some departments more than in others. CONCLUSION: According to the index for conditions for violence, the departments of Vaupés, Guaviare, Arauca and Guainía are the ones with more favorable conditions for an increased risk of dying by homicide and suicide in people from 15 to 24 years old, regardless of other departments having higher deaths rates.

[Trends in yellow fever mortality in Colombia, 1998-2009]. / Tendencias de la mortalidad por fiebre amarilla, Colombia, 1998-2009.

INTRODUCTION: Yellow fever is a neglected tropical disease, thus, knowing the trends in mortality from this disease in Colombia is an important source of information for decision making and identifying public health interventions. OBJECTIVE: To analyze trends in yellow fever mortality in Colombia during the 1998-2009 period and the differences in the morbidity and mortality information sources for the country, which affect indicators such as the lethality one. MATERIALS AND METHODS: This is a descriptive study of deaths by yellow fever according to the Departamento Administrativo Nacional de Estadística and the incidence of the disease according to the Instituto Nacional de Salud . We used secondary sources of information in the calculation of proportions of socio-demographic characteristics of the deceased and epidemiological measures of lethality, incidence and mortality from yellow fever by department of residence of the deceased. RESULTS: Yellow fever deaths occur primarily in men of working age residing in scattered rural areas, who were members of the regimen vinculado, and who were living in the eastern, southeastern, northern and central zones in the country. We observed inconsistencies in the reports that affect the comparative analysis. CONCLUSION: The inhabitants of the departments located in national territories and Norte de Santander have an increased risk of illness and death from yellow fever, but this information could be underestimated, according to the source of information used for its calculation.

Calidad de vida de los adultos mayores de Medellín / Quality of life in institutionalized elderly people of Medellín

Introducción. Varios aspectos en el adulto mayor deterioran su calidad de vida, como son las relaciones familiares y de amigos, la soledad e, incluso, el mismo centro geriátrico. Objetivo. Explorar las condiciones asociadas con la calidad de vida de los ancianos en hogares geriátricos. Materiales y métodos. Estudio transversal de 276 ancianos de 39 Centros de Bienestar del Anciano de Medellín. Se excluyeron aquellos con grave deterioro cognitivo y los que no residían de forma permanente en la institución. La calidad de vida se evaluó mediante el World Health OrganizationQuality of Life of Older Adults (WHOQOL-OLD) de la Organización Mundial de la Salud; se utilizaron la escala de depresión de Yesavage, la de ansiedad de Goldberg, la de funcionalidad de Pfeffer, la minivaloración nutricional y, además, se evaluaron aspectos demográficos y sociales. La información se analizó con pruebas U de Mann-Whitney, Kruskal-Wallis, la correlación de Pearson y un modelo de regresión lineal múltiple. Resultados. El 59,4 % eran mujeres, la edad promedio fue de 79,2 ± 8,0 años, 71 % se consideraron independientes para realizar actividades de la vida diaria, 45,7 % presentaba sintomatología depresiva y 33 % mostraron riesgo de ansiedad, 28,3 % deterioro funcional y, 54,3 %, posible malnutrición. Se encontró una asociación negativa con la calidad de vida el ser mujer, presentar diabetes, altos puntaje sen las escalas de capacidad funcional, depresión y ansiedad; el ir voluntariamente a la institución mostró una asociación positiva. Conclusión. Se halló deterioro en la calidad de vida cuando las condiciones de funcionalidad y autonomía limitaban la realización de actividades de la vida diaria, agravado por el hecho de ser mujer, tener sintomatología depresiva y de ansiedad, y sentirse maltratado por sus familiares.

Introduction. Many factors contribute to the deteriorating quality of life of elderly people living in care institutions. Some of these problems are a consequence of few contacts with relatives and friends, and being alone with a feeling of isolation. Objective. The conditions of quality of life are explored for elderly people living in care institutions. Materials and methods. In a cross sectional study, 276 subjects were selected from 39 long term institutions located in the city of Medellín, Colombia. The sex ratio was female: male 60:40% with a mean age of 79.2±8.0. Elderly subjects with cognitive problems or not living in the institution were excluded. The World Health Organization Quality of Life of Older Adults (WHOQOL-OLD) questionnaire was applied; in additional, capacity and cognitive functional scales of Pfeffer, the anxiety scale of Goldberg, and the Geriatric Depression Scale of Yesavage were administered. Mininutritional assessment scalesand complementary questionnaires about demographics, health perception, social support system were also included. The information was analyzed using the Mann Whitney U test, Kruskal Wallis test, Pearson correlation and multiple linear regression method. Results. Most (71%) considered themselves autonomous for undertaking daily, habitual activities. Other statistics included the following: 45.7% with depression, 33.0% with anxiety, 28.3% with functional problems, and 54.3% at risk of malnutrition. A negative quality-of-life assessment was associated with the following factors: female, diabetes, depression, anxiety and high functional capacity. A positive quality-of-life assessment was associated with individuals who voluntarily came to the institution. Conclusion. Quality of life for elderly people living in care institutions can become deteriorated when they are not capable to do the usual activities necessary for daily living. Exacerbating factors included sex, symptoms of depression, anxiety, or perceived mistreatment by their families.

Supervivencia de implantes realizados en la Clínica CES Sabaneta 2000-2007 / Implant survival in a clinical teaching setting, CES Sabaneta 2000-2007

Introducción y Objetivo: El éxito se define comúnmente como Supervivencia los factores significativos que la influencian.estan relacionados con el paciente, con el implante o con la restauración. El propósito del este estudio fue evaluar la supervivencia de los implantes colocados en la clínica CES Sabaneta entre el 2000 y el2007. Materiales y Métodos: Se tomaron datos de las historias clínicas, se reclutaron el mayor número de pacientes y se evaluaron clínica y radiográficamente Resultados: Entre 2000 y el 2007 se colocaron en la institución 144 implantes en 81 pacientes el (63,9%) fueron mujeres tres casas comerciales principalmente, Nobel Biocare (38,9%), 3i (32,6%) y Lifecore (22,9%). Dado que hubo un alto número de pacientes que no pudieron ser contactados, se asumió el tiempo hasta la fecha de última revisión del implante, como tiempo de supervivencia del mismo y se estableció la diferencia en tiempo de uperviviencia de los implantes en estos pacientes con respecto a la supervivencia de los implantes en los pacientes contactados, no se encontraron diferencias estadísticamente significativas en el promedio del tiempo de supervivencia de los implantes. El promedio en el tiempo desde la colocación de los implantes hasta el análisis fue de 5 años aproximadamente, el éxito fue del 89,6%, es decir de los 144 implantes colocados se presentaron 15 fracasos. Conclusión: La supervivencia de los implantes colocados en la Clínica CES Sabaneta, está de acuerdo a los reportes en la literatura tanto de instituciones educativas como privadas.

Introduction and Objetive: The success of dental implants is commonly defined as survival and there are significant factors that influence it. Some of these are related to the patient, others with the implant and finally with the restoration. Materials and Methods: The purpose of this study was to evaluate the survival of implants placed in the CES University Dental Clinics between 2000 and 2007. Results: Data was collected from the medical records of as many patients possible and found that during this period 144 implants in 81 patients were placed. Most patients were female (63,9%), Implants placed corresponded to Nobel Biocare (38,9%), 3i (32,6%) and Lifecore (22,9%), and the remaining percentage from other commercial brands. Conclusions: Average time from implant placement until the analysis was approximately 5 years with a success rate of 89,6%, which means that out of 144 implants presented 15 were missing. It can be concluded that the survival of implants placed at CES University Dental Clinics coincides with reports in the literature as well as private educational institutions.

Factors associated with stunted growth in children below 11 years of age in Antioquia, Colombia, 2004 / Factores asociados con el retraso del crecimiento en menores de 11 años en Antioquia, Colombia, 2004

Objective: To explore some factors associated to stunted growth in children below 11 years of age in the Department of Antioquia. Methodology: Cross-sectional study using the databases of alimentary and nutritional profiles in homes of Antioquia in 2004, based on a representative random sample of homes in the department (95% reliability and error margin of 3%). For this study, 100% of the records of children below 11 years of age were used. A model of generalized equations estimation was constructed for stunted growth classified by a Z score smaller than -2 standard deviation with respect to p 50 of the 1978 NCHS (Centro Nacional de Estadísticas de la Salud - National Center for Health Statistics). Data were analyzed using the GLIMMIX Procedure: SAS version 9.1. Results: We found 18.6% of the children with stunted growth, 75% of the homes with male head of household, 70% of heads of household with maximum 5 years of schooling; 47% of homes were nucleated bi-parental, and 40% extensive with a 5-member median per home; 56.4% poor per unsatisfied basic needs, and 80% in alimentary insecurity. The factors associated to stunted growth were: female gender, 1-5 years of age, head of household with less than 6 years of schooling, more than 5 people in the home, more than two household members under 7 years of age, coming from a poor home per unsatisfied basic needs, belonging to a sub-region different from Medellin, food availability of less than 30 different foods per week, no production of food, and head of household under 40 years of age. Conclusions: Herein, we show evidence of the magnitude of poverty and association of precarious socioeconomic conditions with stunted growth in Antioquia. The study shows the importance of considering the correlated nature of the data for the construction of the model.

Objetivo: Explorar algunos factores asociados con el retraso del crecimiento en menores de 11 años en Antioquia, Colombia. Metodología: Estudio de corte transversal utilizando las bases de datos del perfil alimentario y nutricional de los hogares de Antioquia en el año 2004. Muestra representativa aleatoria de hogares por subregión del departamento (95% de confianza y error del 3%). Se tomó 100% de los registros de los menores de 11 años. Se construyó un modelo de estimación de ecuaciones generalizadas para el retraso del crecimiento clasificado por puntaje Z menor de -2 desviaciones estándar, con respecto al p 50 de la NCHS (Centro Nacional de Estadísticas de la Salud) 1978. Los datos se analizaron usando el procedimiento GLIMMIX: SAS versión 9.1. Resultados: Del total de niños, 18.6% tenían retraso del crecimiento, 75% de hogares con jefatura masculina, 70% de jefes con máximo 5 años de escolaridad; 47% de hogares nucleados biparental y 40% extensos, mediana de 5 integrantes por hogar; 56.4% pobres por necesidades básicas insatisfechas y 80% en inseguridad alimentaria. Los factores asociados con el retraso del crecimiento fueron: sexo femenino, edad entre 1 y 5 años, jefe con escolaridad menor de 6 años, más de 5 personas en el hogar, más de dos menores de 7 años en el hogar, provenir de un hogar pobre por necesidades básicas insatisfechas, pertenecer a una subregión diferente a Medellín, disponibilidad menor a 30 alimentos diferentes por semana, no producir alimentos y jefe de hogar menor de 40 años. Conclusiones: Se evidenció la magnitud de la pobreza y la asociación de condiciones socioeconómicas precarias con el retraso del crecimiento en Antioquia. Se demostró la importancia de considerar la naturaleza correlacionada de los datos para la construcción del modelo.

[Quality of life in institutionalized elderly people of Medellín]. / Calidad de vida de los adultos mayores de Medellín.

INTRODUCTION: Many factors contribute to the deteriorating quality of life of elderly people living in care institutions. Some of these problems are a consequence of few contacts with relatives and friends, and being alone with a feeling of isolation. OBJECTIVE: The conditions of quality of life are explored for elderly people living in care institutions. MATERIALS AND METHODS: In a cross sectional study, 276 subjects were selected from 39 long term institutions located in the city of Medellín, Colombia. The sex ratio was female: male 60:40% with a mean age of 79.2 ± 8.0. Elderly subjects with cognitive problems or not living in the institution were excluded. The World Health Organization Quality of Life of Older Adults (WHOQOL-OLD) questionnaire was applied; in additional, capacity and cognitive functional scales of Pfeffer, the anxiety scale of Goldberg, and the Geriatric Depression Scale of Yesavage were administered. Mininutritional assessment scales and complementary questionnaires about demographics, health perception, social support system were also included. The information was analyzed using the Mann Whitney U test, Kruskal Wallis test, Pearson correlation and multiple linear regression method. RESULTS: Most (71%) considered themselves autonomous for undertaking daily, habitual activities. Other statistics included the following: 45.7% with depression, 33.0% with anxiety, 28.3% with functional problems, and 54.3% at risk of malnutrition. A negative quality-of-life assessment was associated with the following factors: female, diabetes, depression, anxiety and high functional capacity. A positive quality-of-life assessment was associated with individuals who voluntarily came to the institution. CONCLUSION: Quality of life for elderly people living in care institutions can become deteriorated when they are not capable to do the usual activities necessary for daily living. Exacerbating factors included sex, symptoms of depression, anxiety, or perceived mistreatment by their families.

Un diseño de muestreo complejo en el anßlisis de la calidad de vida de la población adulta. Medellín, 2005 / A complex design sampling in the analysis of the quality of life among the MedellínÆs adult population. 2005

Introducción: La calidad de vida es un concepto que ha evolucionado a través del tiempo, pues pasa del bienestar al nivel de vida, según las condiciones sociales y culturales de la época; su definición es imprecisa y adopta distintos significados según la percepción, contexto y escala de valores, por ello toma elementos de diversas disciplinas para su conceptualización y puede medirse de forma general o a través de sus componentes sociales, económicos, personales, de salud y seguridad social. Objetivo: Describir la percepción sobre diferentes aspectos de la calidad de vida de los hombres y las mujeres de 20 a 64 a±os, residentes en Medellín en 2005, mediante un dise±o de muestreo complejo, con el fin de aportar al estado del arte del constructo. Materiales y métodos: Se dise±ó un estudio poblacional descriptivo transversal, con fuente de información primaria constituida por dos muestras: 659 hombres y 683 mujeres, que representaron a 523,705 y 651,704, respectivamente, según factores de expansión poblacional; seleccionados con muestreo complejo probabilístico, estratificado por estrato socioeconómico, por conglomerados de manzanas, y polietßpico. Se tomaron cinco personas por manzana y una sola por vivienda, se les aplicó una encuesta dise±ada por los investigadores tomando como referencia escalas genéricas y la aplicaron encuestadores contratados por la Universidad de Antioquia.

Introduction: Quality of life is a concept that has evolved through time, happening of the well-being to the standard of life, in accordance with the social and cultural conditions of the time; its different definition is vague and adopts several meanings following the perception, context and scale of values, for this reason it takes elements from different disciplines for its conceptualization and can be moderate of general form or through their social, economic, personal components, of health and social security. Objective: To describe the perception on different aspects of life quality among men and women from 20 to 64 y.o., resident in Medellín in 2005, with a design of complex sampling, and the purpose of contributing to the state of the art. Materials and methods: A cross-sectional descriptive population study was designed, with primary source of information constituted by two samples: 659 men and 683 women, who represented 523,705 and 651,704, respectively, according to factors of population expansion; selected with probabilistic complex sampling, stratified by socioeconomic level, cluster sampling. Five people by cluster and only one person by house were considered, to them a survey designed by the investigators was applied, taking as reference generic scales and applied by inquirer personnel hired by Universidad de Antioquia. Results: Adult population valued over 75% personal, social perception, state of health and house conditions; the economic situation reached 39% and the attention in health 64%, the best one described by both sexes was the personal life with 80% and the present quality of life with 77% obtaining a higher valuation among men.

[Trends of tuberculosis related mortality and hospital discharges before and after the implementation of the health sector reform, Colombia, 1985-1999]. / Tendencia de la mortalidad y los egresos hospitalarios por tuberculosis, antes y durante la implementación de la reforma del sector salud, Colombia, 1985-1999.

We describe the changes that have been presented in the tendencies of mortality and hospital discharges by tuberculosis (TB) between 1985-1999, period before and during the implementation of the Health Sector Reform (HSR) in Colombia. For it, we carried out an exploratory descriptive study with analysis of time series of hospital discharges and mortality rates of TB in Colombia. It was found that although starting from 1991 the Series approach stabilized, their tendencies showed a significant descent diminishing both in 30% between 1985 and 1990. The steady trend registered from 1991 to 1999, could be explained by deterioration of the primary care during this period, also due to other complex social processes occurred in Colombia during this decade, which barred the continuing the descent trend in hospital discharges and mortality due to TB previously registered. Due to the study design limitations we cannot establish causal relationships between these trends and the health sector reform in the country; we recommend the improvement the health sector performance about public health problems such as TB in order to avoid unnecessary hospitalizations and deaths due to causes responsive to health sector interventions.

Tendencia de la mortalidad y los egresos hospitalarios por tuberculosis, antes y durante la implementación de la reforma del sector salud, Colombia, 1985-1999

Se describen los cambios que se han presentado en las tendencias de mortalidad y egresos hospitalarios por tuberculosis entre 1985 y 1999, que corresponde al periodo antes y durante la implementación de la Reforma del Sector Salud en Colombia. Se realizó un estudio descriptivo exploratorio con análisis de series de tiempo de los egresos hospitalarios y de las tasas de mortalidad por tuberculosis en el país durante el período de estudio. Se encontró que, aunque a partir de 1991 las tasas de hospitalización y mortalidad se estabilizaron, se había registrado un significativo descenso en el país tanto en egresos hospitalarios como en mortalidad entre 1985 y 1990; disminuyeron, aproximadamente, en una tercera parte. El estancamiento en las tasas entre 1991 y 1999 en comparación con el período anterior pudiera estar indicando un deterioro en la prestación de servicios de salud en el nivel primario de atención, además, de otros procesos sociales complejos vividos en el país durante la década que no han permitido que tanto la hospitalización como la mortalidad por tuberculosis hayan continuado la trayectoria descendente que traía en los años anteriores. Si bien por el tipo de estudio realizado no se pueden establecer relaciones causales con el proceso de reforma, sí se recomienda mejorar el desempeño del sistema de salud en torno a problemas de importancia en salud pública, ya que la tuberculosis es una enfermedad vulnerable a las acciones del sector y se pueden evitar hospitalizaciones y muertes innecesarias.

Trends of tuberculosis related mortality and hospital discharges before and after the implementation of the health sector reform, Colombia, 1985-1999 We describe the changes that have been presented in the tendencies of mortality and hospital discharges by tuberculosis (TB) between 1985-1999, period before and during the implementation of the Health Sector Reform (HSR) in Colombia. For it, we carried out an exploratory descriptive study with analysis of time series of hospital discharges and mortality rates of TB in Colombia. It was found that although starting from 1991 the series approach stabilized, their tendencies showed a significant descent diminishing both in 30% between 1985 and 1990. The steady trend registered from 1991 to 1999, could be explained by deterioration of the primary care during this period, also due to other complex social processes occurred in Colombia during this decade, which barred the continuing the descent trend in hospital discharges and mortality due to TB previously registered. Due to the study design limitations we cannot establish causal relationships between these trends and the health sector reform in the country; we recommend the improvement the health sector performance about public health problems such as TB in order to avoid unnecessary hospitalizations and deaths due to causes responsive to health sector interventions.