Violent delinquency in a Brazilian birth cohort: the roles of breast feeding, early poverty and demographic factors.

We investigated the association between breast feeding, economic factors and conviction for violent delinquency by age 25 years among subjects of the 1982 Birth Cohort from Pelotas, Southern Brazil. Information on breast-feeding pattern and duration was collected in childhood, during the 1983, 1984 and 1986 follow-ups. Information on socio-economic and family characteristics was also obtained between 1982 and 1996. Of the 5914 livebirths enrolled in the cohort, 5228 had obtained an identification document within the state of Rio Grande do Sul, and could thus be identified in judiciary databases. The outcome studied was conviction due to a violent act between ages 12 and 25 years. A total of 106 young people had been convicted at least once (3.0% of men and 1.0% of women). Subjects born to black or mixed mothers and coming from low-income families were at higher risk of having been convicted. Neither crude nor adjusted analyses showed any association between breast feeding and conviction for violent delinquency. Violent delinquency apparently depends more on social factors than on individual factors such as breast feeding.

Enfermedad ósea de Paget: reporte de caso / Paget's disease of bone: case report

La enfermedad ósea de Paget es una alteración metabólica generada por un disbalance entre la actividad osteoclástica y osteoblástica, llevando a un proceso de remodelación inadecuado que genera cambios en la estructura ósea. Aunque en muchos casos puede ser asintomática, se asocia a complicaciones severas como posibles fracturas, deformidades esqueléticas, neoplasias óseas y síntomas por compresión de estructuras nerviosas a nivel de cráneo y columna vertebral. Esta patología se presenta más frecuentemente pacientes de sexo masculino y en el Reino Unido, así como en países de población inmigrante británica, sin embargo es muy infrecuente en países latinoamericanos. Se presenta el caso de una paciente de 72 años, diagnosticada con enfermedad de Paget de acuerdo con hallazgos de imágenes y laboratorio, tratada con ácido zoledrónico para manejo sintomático.

Paget's disease of bone is a metabolic alteration generated by an imbalance between osteoclastic and osteoblastic activity, leading to an inadequate remodeling process that generates changes in the bone structure. Although in many cases it can be asymptomatic, it is associated with severe complications such as possible fractures, skeletal deformities, bone neoplasms and symptoms due to compression of nervous structures at the level of the skull and spine. This pathology occurs more frequently in male patients and in the United Kingdom, as well as in countries with a British immigrant population, however it is very rare in Latin American countries. The case of a 72-year-old patient is presented, diagnosed with Paget's disease according to imaging and laboratory findings, treated with zoledronic acid for symptomatic management.

[Self-rated health in adults: influence of poverty and income inequality in the area of residence]. / Salud autorreferida: influencia de la pobreza y la desigualdad del área de residencia.

OBJECTIVE: To evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents. METHODS: The study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals=level1, locations=level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex. RESULTS: The prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality. CONCLUSIONS: In Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels.

The role of the neighborhood, family and peers regarding Colombian adolescents' social context and aggressive behavior.

OBJECTIVE: Examining neighborhood conditions, parenting and peer affiliations' association with adolescents' aggressive behavior. Testing various mechanisms through which neighborhood conditions influence two adolescent outcomes, both directly and indirectly (via their impact on parenting and peer-affiliation): aggression and delinquency. METHOD: Data regarding adolescents was taken from a self-reporting survey of 1,686 Colombian adolescents living in 103 neighborhoods of Medellin. Neighborhood-related data was taken from official government datasets, as well as two separate community surveys. Both multilevel modeling and multilevel structural equation modeling were used in the analysis. RESULTS: The probability of an adolescent engaging in aggression in Medellin was 7.0 % and becoming involved in delinquency 0.3 %. There was also significant variation for both forms of aggressive behavior at neighborhood-level (7.0 % aggression and 14 % regarding the delinquency scale). No neighborhood condition had a direct association with adolescents' aggressive behavior; however; the neighborhood exerted an indirect influence on adolescent behavior which was mainly transmitted through families and the quality of friends within a particular community. CONCLUSIONS: Residing in disadvantaged neighborhoods did have an adverse effect on adolescents' aggressive behavior, mainly because of a lack of effective parenting strategies thereby facilitating affiliations being made with deviant peers. More efficient intervention for reducing adolescents' aggressive behavior should thus target areas having high odds of aggressive behavior and focus on improving community resources and, more importantly, on controlling adolescent peer groups, the lack of parental monitoring and inconsistent discipline.

Investigating neighbourhood effects on health: using community-survey data for developing neighbourhood-related constructs.

OBJECTIVE: Structural and social neighbourhood constructs have been developed for studying a neighbourhood's influence on a variety of health outcomes; community surveys are being increasingly used for capturing such information. This paper has proposed a six-fold approach which integrates existing methodologies (i.e. multilevel factor analysis, ecometrics, multilevel spatial multiple membership models and multilevel latent class analysis) for estimating reliable and valid measurement of neighbourhood conditions. METHODS: The proposed approach used seven demographic and socio-economic variables reported in a community survey by 20,413 individuals residing in 244 neighbourhoods in Medellin, Colombia, to measure structural neighbourhood conditions. RESULTS: The set of variables reliably measured one neighbourhood construct: the deprivation index; this showed significant variation between neighbourhoods as well as significant spatial clustering across the city. CONCLUSIONS: The approach presented here should enable public health researchers to better estimate neighbourhood indicators and may result in more accurate assessment of the relationship between neighbourhood characteristics and individual-level health outcomes.

Salud autorreferida: influencia de la pobreza y la desigualdad del área de residencia / Self-rated health in adults: influence of poverty and income inequality in the area of residence

Objetivo: Evaluar la influencia de la desigualdad de ingresos y de la pobreza de las localidades de Bogotá-Colombia sobre la percepción de mala salud de sus residentes. Métodos: El estudio se basó en la encuesta multipropósito aplicada en Bogotá-Colombia. Se utilizó la estructura jerárquica de los datos (individuos=nivel 1, localidades=nivel 2) para definir un modelo logístico multinivel de tipo logit. La variable dependiente fue la percepción de mala salud, y las variables de localidad fueron la desigualdad de ingresos y la pobreza. Todos los análisis se controlaron por variables sociodemográficas y se estratificaron por sexo. Resultados: La prevalencia de reportar regular o mala salud en la población estudiada fue del 23,2%. Las mujeres mostraron mayor riesgo de mala salud, así como también los hombres y mujeres de bajo nivel educativo, con edad avanzada, sin trabajo en la última semana y afiliados al régimen subsidiado de salud. Los mayores niveles de pobreza en la localidad incrementan el riesgo de mala salud. Las interacciones transnivel mostraron que mujeres jóvenes y hombres con bajo nivel educativo son los más afectados por la desigualdad de ingresos de la localidad. Conclusiones: En Bogotá existen diferencias geográficas en la percepción de la salud, y mayores porcentajes de pobreza y desigualdad de ingreso se mostraron asociados a un mayor riesgo de mala salud. Destacan grandes inequidades de salud entre individuos y entre localidades (AU)

Objective: To evaluate the influence of income inequality and poverty in the towns of Bogotá, Colombia, on poor self-rated health among their residents. Methods: The study was based on a multipurpose survey applied in Bogotá-Colombia. A hierarchical data structure (individuals=level1, locations=level 2) was used to define a logit-type multilevel logistic model. The dependent variable was self-perceived poor health, and local variables were income inequality and poverty. All analyses were controlled for socio-demographic variables and stratified by sex. Results: The prevalence of self-reported fair or poor health in the study population was 23.2%. Women showed a greater risk of ill health, as well as men and women with a low educational level, older persons, those without work in the last week and persons affiliated to the subsidized health system. The highest levels of poverty in the city increased the risk of poor health. Cross-level interactions showed that young women and men with a low education level were the most affected by income inequality in the locality. Conclusions: In Bogotá, there are geographical differences in the perception of health. Higher rates of poverty and income inequality were associated with an increased risk of self-perceived poor health. Notable findings were the large health inequalities at the individual and local levels (AU)

Prevalencia y factores asociados al VIH en habitante de calle de la ciudad de Medellín Colombia / Prevalence and factors associated with HIV among the street dwellers of Medellin, Colombia / Prevalência e fatores associados ao HIV em moradores de rua da cidade de Medellín-Colômbia

OBJETIVO: determinar la prevalencia de VIH y explorar su relación con características sociales y demográficas de habitantes de calle de la ciudad de Medellín en el año 2014. METODOLOGIA: se realizó un estudio descriptivo-transversal para determinar la seroprevalencia de VIH y se exploraron factores sociales y demográficos asociados a la infección por VIH en habitantes de calle de la ciudad de Medellín en el año 2014. El procesamiento de datos fue realizado en el software SPSS 21.0. Los análisis incluyeron descripción univariada y bivariada, se utilizó la prueba estadística de Chi cuadrado; razón de prevalencia (RP) intervalos de confianza del 95% asumiendo un nivel de significación estadística menor del 5%. RESULTADOS: se encuestaron 184 habitantes de calle, el 80% eran hombres, con un promedio de edad de 40 (DE 11,4 años). Se identificó una prevalencia de VIH del 8,2%; para los hombres esta prevalencia fue de 6,1% y para las mujeres fue de 16,2%. Las mujeres tuvieron tres veces el riesgo de VIH comparado con los hombres; y las personas casadas y en unión libre cinco veces el riesgo de tener VIH comparado con los solteros, separados y divorciados. CONCLUSION: la prevalencia mayor del 5% en la población habitante de calle, muestra que la infección por VIH en Colombia está concentrada en poblaciones clave (alta prevalencia y vulnerables) y se requieren acciones focalizadas hacia grupos específicos.

OBJECTIVE:To determine the prevalence of HIV and describe the social and demographic characteristics of street dwellers Medellin in 2014. METHODOLOGY: A descriptive cross-sectional study where the authors determined the seroprevalence of HIV and explored the social and demographic factors associated with HIV infection among street dwellers of the city of Medellin in 2014. The data were processed using the SPSS 21.0 software. Analyses included univariate and bivariate descriptions, and the statistical Chi-square test was used. Prevalence ratio (PR) confidence interval 95% assuming a statistical significance level of less than 5%. RESULTS: a total of 184 street dwellers were surveyed, 80% were male, with an average age of 40 (SD 11.4 years). An HIV prevalence of 8.2% was found; for men, this prevalence was 6.1% and for women 16.2%. Women had three times the risk of HIV compared to men; those who were cohabiting and married had five times the risk of having HIV compared to single, separated and divorced individuals. CONCLUSION: The higher prevalence amounting to 5% for the street dwellers shows that HIV infection in Colombia is concentrated in key groups (i.e. those having high prevalence and vulnerability) requiring actions focusing on specific of groups.

OBJETIVO: determinar a prevalência de HIV e explorar a sua relação com características sociais e demográficas de moradores de rua da cidade de Medellín no ano 2014. METODOLOGIA: Realizou-se um estudo descritivo-transversal no qual se determinou a seroprevalência de HIV e se exploraram fatores sociais e demográficos associados à infecção por HIV em habitantes de rua da cidade de Medellín no ano 2014. O processamento dos dados foi realizado no software SPSS 21.0. As análises incluíram descrição univariada e bivariada, utilizou-se a prova estatística de Chi-quadrado; razão de prevalência (RP) intervalos de confiança de 95% atingindo um nível de significação estatística menor de 5%. RESULTADOS: foram inquiridos 184 moradores de rua, 80% eram homens, com uma média de idade de 40 (DE 11,4 anos).Foi identificada uma prevalência de HIV de 8,2%; para os homens esta prevalência foi de 6,1% e para as mulheres de 16,2%. As mulheres tiveram três vezes o risco de HIV comparado com os homens; e as pessoas casadas e em união livre cinco vezes o risco de ter HIV comparado com os solteiros, separados e divorciados. CONCLUSÃO: a prevalência maior de 5% na população moradora de rua, mostra que a infecção por HIV na Colômbia está concentrada em populações chave (alta prevalência e vulneráveis) e são requeridas ações visando grupos específicos.

Investigating neighbourhood effects on health: Using community-survey data for developing neighbourhood-related constructs / Efectos del barrio sobre la salud: Metodología para construir variables del barrio utilizando datos de encuestas poblacionales

Objective Structural and social neighbourhood constructs have been developed for studying a neighbourhood's influence on a variety of health outcomes; community surveys are being increasingly used for capturing such information. This paper has proposed a six-fold approach which integrates existing methodologies (i.e. multilevel factor analysis, ecometrics, multilevel spatial multiple membership models and multilevel latent class analysis) for estimating reliable and valid measurement of neighbourhood conditions. Methods The proposed approach used seven demographic and socio-economic variables reported in a community survey by 20,413 individuals residing in 244 neighbourhoods in Medellin, Colombia, to measure structural neighbourhood conditions. Results The set of variables reliably measured one neighbourhood construct: the deprivation index; this showed significant variation between neighbourhoods as well as significant spatial clustering across the city. Conclusions The approach presented here should enable public health researchers to better estimate neighbourhood indicators and may result in more accurate assessment of the relationship between neighbourhood characteristics and individual-level health outcomes.

Objetivo Múltiples variables que describen las características físicas y sociales de los barrios han sido desarrolladas para investigar los efectos del barrio sobre la salud. Las encuestas poblacionales son cada vez más utilizadas para capturar dicha información. Este artículo propone una metodología que integra diferentes técnicas estadísticas, tales como análisis factorial multinivel, ecometría, modelo espacial multinivel y modelo de clases latentes multinivel, para explorar datos derivados de encuestas poblacionales y estimar variables que describan las características de los barrios de manera precisa y confiable. Métodos Este artículo demuestra la aplicación del método propuesto para caracterizar condiciones estructurales de los barrios de Medellín-Colombia. Para esto se analizaron siete variables demográficas y socio-económicas reportadas por 20 413 individuos residentes de 244 barrios de la ciudad. Resultados Los resultados mostraron que el conjunto de variables miden de manera confiable un índice de privación económica para cada barrio, el cual mostró variaciones significativas entre los barrios, y agrupaciones espaciales en diferentes áreas de la ciudad. Conclusiones Se espera que el método propuesto sirva a los investigadores en salud pública para estimar indicadores del barrio más precisos, lo que ha de traducirse en estimaciones más confiables de los efectos del barrio sobre la salud individual.

The role of the neighborhood, family and peers regarding Colombian adolescents' social context and aggressive behavior / Contexto social y comportamiento agresivo en adolescentes Colombianos: el rol del barrio, la familia y los amigos

Objective Examining neighborhood conditions, parenting and peer affiliations' association with adolescents' aggressive behavior. Testing various mechanisms through which neighborhood conditions influence two adolescent outcomes, both directly and indirectly (via their impact on parenting and peer-affiliation): aggression and delinquency. Method Data regarding adolescents was taken from a self-reporting survey of 1,686 Colombian adolescents living in 103 neighborhoods of Medellin. Neighborhood-related data was taken from official government datasets, as well as two separate community surveys. Both multilevel modeling and multilevel structural equation modeling were used in the analysis. Results The probability of an adolescent engaging in aggression in Medellin was 7.0 % and becoming involved in delinquency 0.3 %. There was also significant variation for both forms of aggressive behavior at neighborhood-level (7.0 % aggression and 14 % regarding the delinquency scale). No neighborhood condition had a direct association with adolescents' aggressive behavior; however; the neighborhood exerted an indirect influence on adolescent behavior which was mainly transmitted through families and the quality of friends within a particular community. Conclusions Residing in disadvantaged neighborhoods did have an adverse effect on adolescents' aggressive behavior, mainly because of a lack of effective parenting strategies thereby facilitating affiliations being made with deviant peers. More efficient intervention for reducing adolescents' aggressive behavior should thus target areas having high odds of aggressive behavior and focus on improving community resources and, more importantly, on controlling adolescent peer groups, the lack of parental monitoring and inconsistent discipline.

Objetivo Evaluar la asociación entre las condiciones del barrio, las pautas de crianza y las relaciones con amigos con el comportamiento agresivo. Además analiza diferentes mecanismos por los cuales las condiciones del barrio pueden influir directa e indirectamente (vía su impacto sobre las pautas de crianza y las relaciones con amigos) dos tipos de comportamiento: agresión y delincuencia. Método Datos sobre comportamiento agresivo son tomados de una encuesta aplicada a 1 686 adolescentes residentes de 103 barrios de Medellín-Colombia. Datos sobre el barrio son tomados de bases de datos gubernamentales y de dos encuestas poblacionales. Para el análisis se utilizaron modelos multinivel y de ecuaciones estructurales. Resultados En Medellín, la probabilidad de agresión de un adolescente es del 7,0 % y de delincuencia de 0,3 %. Dichas probabilidades varían significativamente entre los barrios. Aunque ninguna de las características del barrio mostró un efecto directo sobre el comportamiento agresivo, las condiciones estructurales afectan indirectamente los adolescentes influyendo las pautas de crianza y la calidad de los amigos con quienes se relacionan. Conclusiones La pobreza en el barrio afecta el comportamiento agresivo de los adolescentes impactando las pautas de crianza y la calidad de las relaciones dentro del barrio. Intervenciones para controlar y prevenir el comportamiento agresivo deben desarrollarse en barrios con alta probabilidad de comportamiento agresivo y enfocarse no solamente en el mejoramiento físico de los barrios, sino en el fortalecimiento de las pautas de crianza y la calidad de los amigos de los adolescentes.

[Lessons learned from an early intervention violence prevention program in Medellín, Colombia]. / Lecciones del programa de prevención temprana de la violencia, Medellín, Colombia.

OBJECTIVE: To describe the components and development of the Early Prevention of Violence Program in the city of Medellín, Colombia, and to evaluate the results of its first phase, three years after implementation. METHODS: A before (2001) and after (2004) study of four variables--direct aggression, indirect aggression, prosocial behavior, and scholastic achievement--was conducted among a convenience sample of 339 program participants and their families. RESULTS: Several program benefits were noted. Decreases in both direct and indirect aggression were observed, though the latter was reduced only in girls and in those over 12 years old. Prosocial behavior increased among children of all ages and both genders, including those who exhibited low levels of prosocial behavior in 2001. In addition, improved school performance was seen in the group as a whole. Results may have been affected by some changes to the prevention program's implementation and by the dangerous nature of the neighborhood, which limited the home visits. CONCLUSIONS: The program seems to be an effective intervention for highly aggressive children, among whom a decline in direct aggression was observed. It also offers preventive benefits, as evidenced by the rise of prosocial behaviors in less aggressive children.

Sistema de vigilancia epidemiológica de la violencia para los municipios colombianos / Epidemiological survellice system of violence in Colombian municipalities

Se analizan los diferentes sistemas de vigilancia epidemiológica sobre lesiones y violencia propuestos por organismos nacionales e internacionales; se hace énfasis en que ellos no tienen suficiente información sobre lesiones no fatales, características de los agresores ni factores de protección y de riesgo de las diferentes formas de violencia. Se propone un sistema que utilice información que, por norma legal deba ser recolectada a escala local y que tenga un bajo suregistro (muertes violentas y por accidentes de transito) y lesiones no fatales y, además, un sistema de encuestas periódicas, con diferentes formatos, que puedan aplicarse según la capacidad del respectivo municipio. Por medio de las encuestas se monitorea la magnitud y distribución de diferentes formas de violencia y de otros comportamientos de riesgo, por lo general asociados a ella, así como los factores de protección y de riesgo. Se indica que el sistema propuesto complementa y enriquece, mas no remplaza, los sistemas de vigilancia epidemiológica vigentes hoy por norma legal en el país.

The different systems of epidemiological surveillance of injuries and violence proposed by Colombian and international institutions are analyzed. The fact that those systems do not provide enough information on non fatal injuries, characteristics of the aggressors nor protection factors of the different forms of violence is emphasized. A system based on information which should be gathered at a small scale according to legal rules is proposed. This information should also be underreported (violent deaths, suicide, deaths due to traffic accidents, and non fatal injuries). The implementation of periodic and systematic community surveys is also suggested, designed in different formats according to the local circumstances of the municipalities. The magnitude and distribution of the different forms of violence and other risky factors are all monitored through the surveys mentioned above. The system proposed here does not replace the surveillance systems legally adopted by Colombian norms, but it does reinforce and complement them.

Lecciones del programa de prevención temprana de la violencia, Medellín, Colombia / Lessons learned from an early intervention violence prevention program in Medellín, Colombia

OBJETIVO: Describir las características y la evolución del Programa de Prevención Temprana de la Violencia del Municipio de Medellín, Colombia, y evaluar los resultados de la primera etapa tres años después de su implementación. MÉTODOS: Se llevó a cabo un análisis anterior (año 2001) y posterior (año 2004) de cinco variables -síntomas de agresión directa, síntomas de agresión indirecta, síntomas de prosocialidad y rendimiento escolar- en una muestra por conveniencia de 339 niños y sus familias que habían participado en el programa. RESULTADOS: Se evidenciaron varios efectos positivos del programa. Se observó una disminución de los síntomas de agresión directa y de los de agresión indirecta, pero en este último caso sólo en niñas y en mayores de 12 años. Se evidenció asimismo un aumento en la prosocialidad en niños de todas las edades y de ambos sexos, incluso en los que presentaban menor grado de prosocialidad en 2001. También se observó en todo el grupo una mejora del rendimiento escolar. Estos resultados pueden haber sido afectados por algunas modificaciones en la implementación del programa de prevención y por la gran peligrosidad del barrio, que ocasionó una disminución de la frecuencia de las visitas domiciliarias a las familias. CONCLUSIONES: El programa parece tener efectos preventivos, puesto que se observa una disminución de la agresión directa en los niños con mayor nivel de agresión, y un efecto protector en el aumento de la prosocialidad en los niños menos agresivos.

OBJECTIVE: To describe the components and development of the Early Prevention of Violence Program in the city of Medellín, Colombia, and to evaluate the results of its first phase, three years after implementation. METHODS: A before (2001) and after (2004) study of four variables-direct aggression, indirect aggression, prosocial behavior, and scholastic achievement-was conducted among a convenience sample of 339 program participants and their families. RESULTS: Several program benefits were noted. Decreases in both direct and indirect aggression were observed, though the latter was reduced only in girls and in those over 12 years old. Prosocial behavior increased among children of all ages and both genders, including those who exhibited low levels of prosocial behavior in 2001. In addition, improved school performance was seen in the group as a whole. Results may have been affected by some changes to the prevention programÆs implementation and by the dangerous nature of the neighborhood, which limited the home visits. CONCLUSIONS: The program seems to be an effective intervention for highly aggressive children, among whom a decline in direct aggression was observed. It also offers preventive benefits, as evidenced by the rise of prosocial behaviors in less aggressive children.

Causas de mortalidad en jóvenes y su contribución al cambio en la esperanza de vida: Cali, 1989-1999 / Mortality causes in young people and their contribution to change of life expectancy: Cali, 1989-1999

Antecedentes: La situación de salud de los jóvenes es un aspecto a tener en cuenta en las estrategias sanitarias. Los cambios en las condiciones socioeconómicas y culturales exigen mayor atención a este grupo. Objetivo: Estimar la mortalidad juvenil en Cali entre 1989 y 1999 y la contribución de las causas de muerte al cambio en la esperanza de vida. Métodos: La información fue proporcionada por el Departamento Nacional de Estadística (DANE) y se analizó mediante los programas Excel y SPSS v. 11.0. Las causas de mortalidad se agruparon según la lista 6/67 de la Organización Panamericana de la Salud (OPS): signos, síntomas y afecciones mal definidas, enfermedades transmisibles, tumores, ciertas afecciones en el período perinatal, enfermedades del sistema circulatorio, causas externas y todas las demás enfermedades. Se calcularon las tasas de mortalidad por edad, sexo y causa que permitieron la construcción de las tablas de vida, que fueron el soporte para la aplicación del Método de Pollard. Este permitió establecer las causas de muerte que generaron pérdida o ganancia en la esperanza de vida de los jóvenes. Resultados: En la mortalidad de los jóvenes hubo predominio de las causas externas, las enfermedades transmisibles y los tumores. Se observó una ganancia total en la esperanza de vida de 4.49 años. Se presentó una pérdida en la esperanza de vida juvenil debida al grupo de enfermedades transmisibles y al de tumores, 0.07 y 0.28 años respectivamente, mientras que los grupos de causas externas y del sistema circulatorio se asociaron con una ganancia en la esperanza de vida juvenil de 0.52 y 0.002 años respectivamente. Conclusión: Se señalan dos características importantes de los problemas de salud y muerte de los jóvenes: la mayoría son prevenibles y además multidimensionales, lo que trae como consecuencia la búsqueda de soluciones con un enfoque multidisciplinario y sectorial. Se sugiere políticas de prevención de la violencia, promoción de estilos de vida sanos y estímulos que mejoren las condiciones de vida de la población joven