An interactive web-based dashboard to track COVID-19 in Colombia. Case study: five main cities / Aplicativo web para el seguimiento del COVID-19 en Colombia. Estudio de caso: cinco ciudades principales

ABSTRACT Objective Design and implement an interactive web-based dashboard to track COVID-19 in Colombia Methods A tool was designed and implemented to analyze the data of Covid-19 positive cases in Colombia and published by the Instituto Nacional de Salud. The tool is based on the implementation of business intelligence methods with which you can understand the behavior of the pandemic in Colombia and generate structured data for decision-making by government levels. The tool displays, on a single screen, information on the number of cases, patient status, age ranges, city, location department, and gender. This information can be dynamically filtered and focus analyzes on the national, departmental, or municipal order. Additionally, methods are implemented for trend analysis, both on a linear and semi-log scale, as well as for calculating the case fatality rate in each of the municipalities. Results A web-based data analysis dashboard is implemented for semi-continuous monitoring of the COVID-19 pandemic in Colombia. With the use of the tool, a situational analysis is carried out for five of the most important cities in Colombia. Conclusions The application is effective, flexible, and easy to use. The situational analysis reflects that public policies for the control of the disease have been favorable for Medellín, but for Cartagena, Bogotá, Barranquilla, and Cali, complementary measures are required.(AU)

RESUMEN Objetivo Diseñar e implementar una herramienta dinámica web para el seguimiento de la COVID-19 en Colombia. Métodos Se diseña e implementa una herramienta para el análisis de los datos de los casos positivos de COVID-19 en Colombia y publicados por el Instituto Nacional de Salud. La herramienta se basa en la implementación de métodos de inteligencia empresarial con los que se pueda entender el comportamiento de la pandemia en Colombia y generar datos estructurados para la toma de decisiones por parte de los estamentos gubernamentales. La herramienta despliega, en una sola pantalla, información sobre número de casos, estado de los pacientes, rangos de edad, ciudad y departamento de ubicación y género. Esta información puede ser filtrada de forma dinámica y enfocar los análisis en el orden nacional, departamental o municipal. Adicionalmente, se implementan métodos para el análisis de tendencia, tanto en escala lineal como en escala semilogarítmica, así como para el cálculo de la tasa de letalidad en cada uno de los municipios. Resultados Se implementó una herramienta de análisis de datos basado en la web para el seguimiento semicontinuo de la pandemia de la COVID-19 en Colombia. A partir de la herramienta se realiza un análisis situacional para cinco de las ciudades más importantes de Colombia. Conclusiones El aplicativo es eficaz, flexible y de fácil manejo. El análisis situacional refleja que las políticas públicas para el control de la enfermedad han sido efectivas para Medellín, pero, para Cartagena, Bogotá, Barranquilla y Cali, se requieren medidas complementarias.(AU)

Morbilidad global asociada a ileostomías en asa temporales / Morbidity associated to ileostomies

Introduction: The main indications for a loop ileostomy are to protect a distal anastomosis or to management of an anastomotic leak. However, it is a procedure with complications arising from its confection, function or closure. There are sparse local data on this topic. Objective: To describe the global morbidity from loop ileostomies. Method: Patients who underwent a loop ileostomy between January 2009 and January 2012 were retrospectively included. Demographics, indications, complications from the making, function and closure of the ileostomy was recorded. Results: The series consists of 64 patients. The total percentage of complications was 40.3 percent. Complications arising from the confection, function and closure were 4.7 percent, 18.7 percent and 16.9 percent respectively. Two patients were readmitted for dehydration with a total of 4 readmissions. Four patients were reoperated for morbidity of ileostomy closure, two intestinal obstructions, one leak and one enterotomy. Conclusion: In this study, loop ileostomy complications are present in a substantial proportion of patients. It should be take in consideration at the moment of making it.

Introducción: Las principales indicaciones de ileostomías en asa son proteger una anastomosis distal de alto riesgo o el manejo de una complicación séptica derivada de una filtración. Sin embargo, es un procedimiento que no está exento de complicaciones derivadas de la confección, función o cierre. En este contexto, existen escasas publicaciones que incluyen la morbilidad sumatoria. Objetivo: Describir la morbilidad global derivada de las ileostomías en asa. Método: Se incluyó en forma retrospectiva los pacientes a quienes se les practicó una ileostomía en asa de protección de una anastomosis distal entre enero de 2009 y enero de 2012. Se registraron datos demográficos, indicaciones y complicaciones derivadas de la confección, función y cierre de la ostomía. Resultados: La serie consta de 64 pacientes. Un 40,3 por ciento de los pacientes tuvieron una o más complicaciones. Complicaciones derivadas de la confección, función y cierre de la ileostomía fueron 4,7 por ciento, 18,7 por ciento y 16,9 por ciento respectivamente. Se rehospitalizaron por deshidratación 2 pacientes con un total de 4 rehospitalizaciones. Se reoperaron 4 pacientes por morbilidad del cierre de la ileostomía, 2 por obstrucción intestinal, 1 filtración y 1 enterotomía inadvertida. Conclusión: Las ileostomías en asa presentan complicaciones en un importante porcentaje de los pacientes, lo que debe ser tomado en cuenta al decidir su confección.

Comportamiento eefractario de probetas de morteos conformadas con diatomitas ccomo agregado mineral / Refractaric ehavvior of mortar probes conformed with diatomite as minerals aggregtte

El objetivo de este trabajo es el estudio de las propiedades puzolánicas de algunos minerales, como las diatomitas, que potencialmente pueden reaccionar con la portlandita contenida en las pastas y morteros de cemento Portland. También se estudia si estas adiciones minerales pueden incrementar la resistencia térmica y la refractariedad de los morteros. En el comportamiento de estos agregados se sigue midiendo como parámetro el comportamiento puzolánico de las diatomitas en las pastas de cemento Portland, y las variaciones de la resistencia mecánica de probetas estandarizadas construidas con y sin agregado de diatomitas. El desarrollo experimental programado consta de tratamientos térmicos a las diatomitas, reducción de tamaño hasta compatibilidad con la granulometría del cemento Portland, ensayos de DRX, análisis de puzolanidad, construcción de probetas de morteros con y sin agregado, y finalmente la medición de sus propiedades mecánicas residuales después de haber sido sometidas a elevadas temperaturas. Del análisis de los resultados experimentales se puede informar que las diatomitas estudiadas si le confieren propiedades puzolánicas al cemento Portland, y como consecuencia mejoran la resistencia mecánica residual de las probetas de mortero cuando son sometidas a altas temperaturas.

On the search of new applications for regional mining resources the aim of this work is to study the pozzolanic properties of some minerals which may potentially react with the protlandite contained in Portland cement pastes and mortars. The possibility that these mineral additions may also increase thermal resistance and refractarity is also studied by measuring, as a parameter, the mechanical strength variations of standardized probe. In this search, natural silico-aluminates minerals resources (diatomites) are selected and chemical compositions of which are very similar to the natural pozzolanes, referred to as "active" in the literature. The programmed experimental development consists in thermal treatment of the mineral and size reduction so that it became compatible with cement grain size, pozzolanity analysis, construction of mortar probes. Mechanical residual properties of the probes are measured after exposure to high temperature. By analyzing the experimental results it may be concluded that the aggregate under study certainly shows pozzolanic properties and in addition, it improves the residual mechanical resistance of the probes.

Granulomatosis de Wegener. A propósito de un caso de difícil diagnóstico / Wegener's granulomatosis. Apropos of a case

Presentamos un paciente de 77 años, que debutó con un cuadro de falla respiratoria severa y lesiones cutáneas en dorso nasal y labio superior. Luego de varias dificultades se arribó al diagnóstico de Granulomatosis de Wegener (GW), una vasculitis necrotizante autoinmune que se presenta con lesiones en cualquier sector del tracto respiratorio y participación renal variable. La presentación típica en cabeza y cuello son las erosiones sinonasales costrosas, siendo comunes los hallazgos otológicos, faríngeos y laríngeos. Ocasionalmente se encuentran lesiones poco características que contribuyen al dilema diagnóstico. Dada la variabilidad de la presentación clinica de la GW en cabeza y cuello el otorrinolaringólogo debe mantener un alto índice de sospecha para ésta entidad en lesiones del tracto respiratorio. (AU) ##

Cuba en la Zona II de la Oficina Sanitaria Panamericana, México DF / Cuba in the Zone II of the Pan American Health Organization

Se comenta la actuación en Cuba de los representantes viajeros de la Oficina Sanitaria Panamericana de 1923 a 1952, como paso previo de la aplicación del principio de zonificación sanitaria. Se destaca la labor principalmente de los doctores John D. Long, Maurice A. Roe y John R. Murdock. Se destaca que desde la creación de la Oficina de Zona II de la Oficina Sanitaria Panamericana, con sede en México DF, el 26 de agosto de 1952, Cuba formó parte de ella junto a México, Haití y República Dominicana. Se describen brevemente, los programas llevados a cabo hasta 1965 en que se nombró al primer representante permanente en La Habana

Comments are made on the performance of the traveling representatives of the Health Pan American Organization in Cuba from 1923 to 1952 as a previous step to the application of the principle of health zoning. It is stressed the work done by doctors John D. Long, Maurice A. Roe and Hohn R. Murdock. It is underlined that since the establishment of the Office of the Zone II of the Health Pan American Organization, with its headquarters in Mexico FD, on August 26, 1952, Cuba was part of it together with Mexico, Haiti and the Dominican Republic. The programs implemented until 1965 when the first permanent representative to Havana was appointed, are briefly described.

Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux

Infants with gastroesophageal reflux disease (GERD) who are breastfed have significantly shorter clinical episodes of the condition than artificially fed infants. The purpose of this study was to identify the knowledge about the benefits of breastfeeding in mothers of babies 0-12 months of age with gastroesophageal reflux. A non-probabilistic sample was taken among patients from various private radiological centers. Sixty mothers completed a self-administered questionnaire, with a median age of 26 years and an educational level of 14 years. Seventy one percent breastfed their last baby, but only 18.6 practiced exclusive breastfeeding. The pediatrician suggested formula to 53.3 of the mothers, and 64 of the mothers were told to combine breast milk with vegetables as treatment for the GERD. Inadequate knowledge about the benefits of breastfeeding was exhibited by 27 of the mothers. Mothers of infants with GERD need education on the importance of breastfeeding. Further research is necessary on the factors which impact the duration of breastfeeding in this population.

Profile of calls to a breastfeeding clinic information and help telephone line

Breastfeeding mothers need orientation and help in order to succeed with breastfeeding. Lack of support from health professionals and societal barriers result in a median duration of breastfeeding in Puerto Rico of only 3 weeks. A telephone warm line at our breastfeeding clinic tries to provide some much-needed support and orientation. The purpose of this study was to determine the principal reasons for calls to the warm line and the action taken by the counselor. Five hundred and thirty three calls were received in a 4-month period. They were handled by certified lactation educators who gathered demographic and feeding information from the mother and registered the action taken. Descriptive analysis was used with crosstabs tables and multi-response analysis; chi-square test was used to establish the association between variables. 78.7 of callers were breastfeeding fully, while 21.3 were breastfeeding partially or formula feeding, 62.8 of the babies were 2 months old or less. 68.8 of the calls originated in the metropolitan San Juan area. The source of the referral was family/friend in 64.2 of calls, while only 9.8 of the callers were referred by a physician, 3.0 by hospital personnel and 2.0 by other health care providers. Significant differences between full breastfeeders and partial or artificial feeders were found in calls related to position (p = 0.01), engorgement (p = 0.04), breast refusal (p = 0.001), product information (p = 0.02), medications (p = 0.009), breastmilk management and storage (p = 0.001), and relactation (p = 0.02). Actions taken by the counselor included orientation, referral to breastfeeding specialist physician and referral to breastfeeding support groups or classes. Results indicate that more active promotion of referral to breastfeeding support groups or classes is warranted since this action was taken in only 14.5 of fully breastfeeding mothers and 12.6 of partial breastfeeding or formula users. Promotion of the warm line among physicians, hospitals and other health care professionals is also needed.

Puerto Rican health teachers: attitudes towards breastfeeding

OBJECTIVE: The purpose of the study was to identify attitudes towards breastfeeding and support for breastfeeding in public in a group of health teachers in the Department of Education. METHOD: The study design was correlational descriptive. A self-administered questionnaire was used (Cronbach's alpha = 0.83) for 125 health teachers. Descriptive and inferential statistics (chi square and t test) were used for data analysis. RESULTS: 89.6 were women, 47.1 had 39 years of age or less, 76.4 were married, the median of years in the profession was 12.5. Only 8.8 had breastfed exclusively, 46.1 used artificial feedings exclusively, and 45.1 combined artificial milk and breast milk. A moderate/negative attitude towards breastfeeding was shown by 53.1. 60.3 stated they agreed or totally agreed that in order to breastfeed the mother must follow a specific diet, 36.0 agreed or totally agreed that breast milk should alternate with artificial milk, and 100 of participants do not support breastfeeding in public. No significant difference was found in the attitude scale towards breastfeeding and the gender, the age, years in the profession, and the type of milk given their children. CONCLUSIONS: We must train teachers in the Department of Education, on a priority basis, in the field of human lactation in view of their importance for health promotion.

The management of labor and delivery and its implications for breastfeeding

The main professional organizations of obstetrical and pediatric care providers in the United States and Puerto Rico have issued official position papers in favor of breastfeeding. Routine labor and delivery practices, however, constitute frequent barriers for the initiation, type and duration of breastfeeding. Many of these practices, moreover, lack the scientific basis to justify their routine use. We analyze in this article some of the most common obstetrical practices and their impact on breastfeeding.

Política pública para la promoción de la lactancia materna en las instituiciones hospitalarias / Public policy for the promotion of maternal lactation in hospitals

The policy for Breastfeeding Promotion in Puerto Rico includes as one of its goals, that all hospital in the island become Baby Friendly Hospitals. The authors present a hospital policy model which can be adopted and recommendations for the implementation of this policy are given.

Aspectos éticos en la promoción de la lactancia jumana y el amamantamiento / Ethical aspects of human lactation and breastfeeding

Breastfeeding has experienced a surge in Puerto Rico thanks to the efforts of many women, as well as governmental, non-governmental and private organizations. Among the aspects which can affect the initiation, establishment and maintenance of successful breastfeeding one finds potential ethical conflicts among health professionals as well as the financial interests of the companies which produce and market artificial milks. These companies dedicate great marketing efforts and enormous sums of money in the sale of their products, in detriment of breastfeeding. The profit motive of these companies is in open contradiction to public health and to breastfeeding promotion. The international community has carried out efforts for more than two decades in the creation of structures which protect the rights of women and their children to ideal nutrition practices, free from commercial pressures, through breastfeeding. Possible ethical conflicts related to the new industry of breastfeeding paraphernalia are discussed, especially when these are marketed exclusively for profit. Recommendations are presented for health professionals in order for them to be able to face and respond to the unethical strategies practiced by the manufacturers of artificial milks in utilizing these professionals for legitimating and marketing their products.

Obstetras y pediatras: Experiencia con la lactancia materna en sus programas de residencia / Obstetricians and pediatricians: experience with breastfeeding in their residency programs

A prior study had the objective of identifying knowledge and experience on breastfeeding of obstetricians and pediatricians in two private hospitals of the Metropolitan Area of San Juan, Puerto Rico. This study presents the experience of those physicians regarding breastfeeding education during their residency training. An exploratory research design was used, the sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals during June, 1997. The studied sample included 29 pediatricians and 26 obstetricians. Descriptive statistics and crosstab tables were used to describe the results. It was found that participating physicians had little or no exposition to breastfeeding related topics during their respective residency programs. They are aware of the importance of their role in the achievement of successful breastfeeding. They perceive themselves as effective in stimulating breastfeeding although they recognize that they should have received better training on the subject. This attitude is worrisome in face of the fact that this same group presented significant deficiencies in a previous study with regards to knowledge in the management of breastfeeding.

Análisis sobre las funciones de los proveedores de cuidado en lactancia humana y amamantamiento / Analysis of the role of caregivers in human lactation and breastfeeding

The provision of care and support in breastfeeding and human lactation is a function of health professionals as well as of the members of the community. These functions must be appropriately defined so that the importance and degree of responsibility of health professionals and of the community be understood. The legal aspects of the practice of Lactation Consultant are discussed. The training course for Lactation Educator offered by the Maternal and Child Health Program in the Graduate School of Public Health is presented as an alternative in basic training and service. The scope of the practice of the Lactation Educator should be determined by the basic role of the graduate within the system of care for the breastfeeding mother and her infant.

La lactancia materna en Puerto Rico: patrones tradicionales, tendencias nacionales e estrategias para el futuro / Breast feeding in Puerto Rico: traditional patterns, national trends and future strategies

The Puerto Rican society has gone through profound transformations during the past 50 years. Industrialization and the incorporation of women into the labor force have been accompanied by medicalization of the reproductive process and a progressive reduction in the prevalence of breastfeeding as the cultural norm for nutrition of infants. The data base for 1990 places Puerto Rico significantly below Latin America and the United States in the percentage of reastfed infants. The authors report their experience in the promotion of reastfeeding during the last 5 years. The principal negative factors which inder the beginning and maintenance of successful breastfeeding are of a social nature. The orientation of physicians towards technology underrates the benefits of breastfeeding. The marketing strategies of the corporations which manufacture artificial milk continuously violate the International Code for Marketing of breast Milk Substitutes and disfigure the community's perception on the benefits of breastfeeding. The lack of social and legal support for the breastfeeding working mother frequently prevents her from carrying out successful breastfeeding for the recommended period of time. Strategies are presented for the overturn of the existent barriers which have reduced breastfeeding in Puerto Rico to the present precarious levels

Creencias Hacia la lactancia materna y la actud hacia apoyar la lactancia en público de un grupo de estudiantes de salud de una escuela superior de la Región Educativa de Caguas / Knowledge about breast feeding and attitude to breast feeding in public of a group of high school students in the Caguas Educational Region

The objective of this study was to identify the knowledge and attitudes towards breastfeeding and towards breastfeeding in public of a group of high school students in the Caguas Educational Region. The study design was a descriptive survey. The sample consisted of 101 students gistered in the Health Course. A self administered questionnaire was used to ther the information. Descriptive and inferential statistics (chi quare and t test) were used for data analysis. We found that the majority of the participants have the intention of breastfeeding or supporting breastfeeding for their children. We found, nevertheless, that there were misconceptions regarding breastfeeding hich could develop into barriers for effective breastfeeding. It was also observed that support for breastfeeding varied depending on the location where it took place. Support was greater if it was done in non-public places. In inclusion, it became evident that there is a need for educational programs with correct information on breastfeeding and the importance of breastfeeding in public

Factores asociados al inicio, tipo y duración de la lactancia materna entre participantes y no participantes a charla prenatal de educación en lactancia materna de una institución hospitalaria / Factors related to initiation, type and length of breast feeding among participants and non-participants in prenatal breast feeding education at a local hospital

The objective of this study was to determine the factors associated to initiation, type and duration of breastfeeding among participants and non-participants in prenatal breastfeeding classes at a local hospital (n = 153). Pre-experimental study design was used. The participants of the study were selected by simple systematic random sampling. Median age of participants was 28 years and 85 percent were married at the moment of the interview. 88.9 percent began to breast feed at some time and of these 32 percent breastfed for six months. Average number of school years completed by participants was 15.1 with a standard deviation of 1.9 years. The inferential results reflected statistical association between participation in prenatal breastfeeding classes and the initiation, type and duration of breastfeeding. Multiple regression results indicate a positive relationship between duration of breastfeeding and participation in breastfeeding support groups, after controlling for all factors of the conceptual model. The results of this study give support for hospital and community initiatives for increasing the incidence of breastfeeding and for extending the duration of breastfeeding. It is further recommended that continued education courses be offered to health professionals on breastfeeding techniques

Ginecólogos-obstetras y pediatras: conocimientos y experiencia hacia la lactancia materna / Gynecologists-obstetricians and pediatricians: knowledge and experience concerning breast feeding

The objective of this study was to identify the level of knowledge and the experience towards breastfeeding of medical personnel (obstetricians and pediatricians) in two private hospitals in Metropolitan San Juan, Puerto Rico. An exploratory research design was used for the study. The studied population consisted of obstetricians and pediatricians practicing in those hospitals. The sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals in June 1997. The sample was made up of 55 physicians (29 pediatricians and 26 obstetricians). Descriptive statistics, crosstab tables, chi square and Fisher Exact tests were used to establish association between the physician's specialty and his/her knowledge and experience on breastfeeding. It was found that both the pediatricians and the obstetricians studied had lack of knowledge in areas related to breastfeeding and little practical experience in the management of breastfeeding