Estudios de cohortes: 1a parte: descripción, metodología y aplicaciones / Cohort studies: 1st part: description, methodology and applications

Resumen Los estudio de cohortes (EC), son estudios de carácter longitudinal, observacional y analíticos. Corresponden a uno de los diseños más utilizados en investigación clínica, aportando altos niveles de evidencia, según el tipo de escenario en los que se aplique. Los EC tienen como objetivos, determinar asociación entre un factor de exposición y el desarrollo de alguna enfermedad o evento de interés, a partir de la estimación de riesgos; conocer la historia natural o el curso clínico de una enfermedad o de un evento de interés; determinar supervivencia; estudiar factores protectores y pronósticos. Los EC tienen diversas aplicaciones, por ejemplo: investigación de brotes epidemiológicos, estudios de causalidad, evaluación de intervenciones educacionales, etc. Teóricamente, la mejor aproximación es mediante un estudio de cohortes prospectivas; sin embargo, suelen exigir largos períodos de tiempo de seguimiento para obtener resultados útiles; por lo tanto, se puede recurrir a otras estrategias, como a los estudios retrospectivos y otros, que pueden resultar más factibles respecto de recursos y tiempos de seguimiento. El objetivo de este manuscrito fue generar un documento de estudio referente a descripción, metodología y aplicaciones de los EC en ciencias de la salud.

Cohort studies (CS) are longitudinal, observational and analytical studies. As one of the most utilized designs in clinical research, CS provides high levels of evidence, depending on the type of scenario in which they are applied. The objectives of CS are to determine the association between an exposure factor and the development of a disease or event of interest, based on the estimation of risks. Additionally, CS aim to provide insight into the natural history or the clinical course of an event of interest as well as generate results with regard to determine survival; study protective studies and prognostic factors. CS have various applications, for example: epidemiological outbreak research, causality studies, evaluation of educational interventions, etc. Theoretically, the method to generate the best approximations is through the use of a prospective CS; however, these usually require long periods of time performing follow-up to obtain useful results; therefore, it is possible to use other strategies, such as retrospective CS among others, which may be more feasible with respect to resources and monitoring times. The aim of this manuscript was to generate a document with reference to the description, methodology and applications of the CS in health sciences

Assessment of hematological parameters in workers exposed to organophosphorus pesticides, carbamates and pyrethroids in Cundinamarca 2016-2017 / Evaluación de parámetros hematológicos en trabajadores expuestos a pesticidas organofosforados, carbamatos y piretroides, Cundinamarca 2016-2017

ABSTRACT Objective To establish hematotoxic alterations through clinical and paraclinical exploration in workers who are exposed to organophosphorus pesticides, carbamates and pyrethroids (OPCP) due to their work in production, packaging, distribution and fumigation processes in Cundinamarca-Colombia between 2016 and 2017. Materials and Methods A cross-sectional descriptive epidemiological study was carried out on a sample of 92 workers from six companies, mostly aged between 18 and 30 years, of which 61 % were males and 39 % females, and 71 % were workers in the operational area and 29 % in the administrative area. Univariate, bivariate and multivariate analyses were performed. Results Clinical exploration reported findings in 17 % of the sample group, of which only 2 % presented with erythrocyte cholinesterase outside the reference range. The values of hematological parameters such as peripheral blood smear (PBS) and complete blood count (CBC) were outside the range in 15 % and 47 % of the sample, respectively. Discussion The results suggest that there are hematological alterations in this group that could possibly be associated with chronic exposure to OPCP.

RESUMEN Objetivo Determinar las alteraciones hematotóxicas a través de una exploración clínica y paraclínica, en trabajadores que por su oficio se exponen a pesticidas organofosforados, carbamatos y piretroides (POCP), en procesos de producción, envase, distribución y fumigación, en el departamento de Cundinamarca Colombia. Metodología Se realizó un estudio epidemiológico descriptivo de corte transversal. Se realizó un análisis univariado, bivariado y multivariado. La muestra se conforma por 92 trabajadores de seis empresas, la mayoría entre los 18 y 30 años, de los cuales el 61 % son hombres y el 39 % mujeres, 71 % se desempeñan en el área operativa y 29 % en el área administrativa. Resultados Es de resaltar que se tienen hallazgos en la exploración clínica en el 17 % del grupo participante, solo el 2 % presenta la colinesterasa eritrocitaria por fuera del rango de referencia. Los parámetros hematológicos como el frotis de sangre periférica (FSP) presentan valores por fuera de los rangos en el 15 % y el cuadro hemático (CH) tiene valores por fuera de los rangos en el 47 % de las personas. Discusión Los resultados sugieren que existen alteraciones hematológicas en este grupo y que posiblemente podrían estar asociadas con la exposición crónica a POCP.

Epidermólisis bullosa en el perú: estudio clínico y epidemiológico de pacientes atendidos en un hospital pediátrico de referencia nacional, 1993-2015 / Epidermolysis bullosa in peru: clinical and epidemiological study of patients treated in a national reference pediatric hospital, 1993-2015

RESUMEN Objetivos Describir las características clínicas y epidemiológicas de los pacientes diagnosticados con epidermólisis bullosa (EB), en el Instituto Nacional de Salud del Niño (INSN) en Lima, Perú; centro de referencia nacional para esta enfermedad. Material y métodos Estudio observacional, descriptivo y transversal. Se revisaron las historias clínicas y exámenes de laboratorio de los pacientes diagnosticados de EB atendidos en el INSN desde 1993 al 2015. Resultados Fueron registrados 93 pacientes. La edad promedio fue de 7,9 ± 5,6 años; el 53,8% (n=50) fueron hombres. Las formas clínicas correspondieron a EB distrófica con 41 (44,1%) casos, EB simple con 39 (41,9%) casos, EB de la unión con 8 (8,6%) y al síndrome de Kindler con 4 (4,3%) casos. No se pudo identificar la forma clínica en un caso. Procedían de Lima y Callao 48 casos (51,6%) y 45 casos (48,4%) de otras provincias del país. Entre las manifestaciones extracutáneas se registraron compromiso gastrointestinal (44,1%), ocular (37,6%), odontogénico (87,1%), nutricional (79,6%), además de pseudosindactilia (16,1%). Se halló desnutrición crónica (71,6%), desnutrición aguda (17,6%) y anemia en (62,4%). La mortalidad correspondió a 6 casos (6,5%). Conclusiones Se reportan 93 casos de EB en el INSN, la presentación clínica predominante fue la forma distrófica.

ABSTRACT Objectives To describe the clinical and epidemiological characteristics of patients diagnosed with epidermolysis bullosa (EB) at the Instituto Nacional de Salud (INSN) in Lima, Peru; a National Reference Center for this disease. Materials and methods Observational, descriptive and transversal study. We reviewed the clinical histories and laboratory tests of patients diagnosed with EB treated in INSN from 1993 to 2015. Results 93 patients were registered. The average age was 7.9 ± 5.6 years; 53.8% (n = 50) were boys. Clinical forms corresponded to dystrophic EB with 41 (44.1%) cases, simple EB with 39 (41.9%), union EB cases with 8 (8.6%) and Kindler syndrome with 4 (4.3%) cases. The clinical form could not be identified in a case. A total of 48 cases (51.6%) came from Lima and Callao, and 45 cases (48.4%) from other provinces of the country. Extracutaneous manifestations involved gastrointestinal (44.1%), ocular (37.6%), odontogenic (87.1%), and nutritional (79.6%) involvement, as well as pseudosindactilia (16.1%). Chronic malnutrition (71.6%), acute malnutrition (17.6%) and anemia (62.4%) were found. Mortality corresponded to 6 cases (6.5%). Conclusions 93 cases of EB were reported in INSN, the predominant clinical presentation was the dystrophic form.

Los estudios económicos en enfermedades crónicas de alta prevalencia / Economic studies in high prevalence chronic diseases

Los estudios económicos han ido ganando importancia en el mundo de las publicaciones científicas. De apenas quinientos estudios registrados en la base de datos de PubMed en 2000 con el descriptor "Costos y Análisis de Costo ("Costs and Cost Analysis"[Mesh]), se ha pasado a nueve mil publicaciones en 2014. Para nadie es un secreto que el costo de una terapia debe entrar en la fórmula, junto a su efectividad y su seguridad, al momento de tomar una decisión clínica. Muchos de los estudios se concentran en enfermedades de alto costo, como el cáncer, que registra 771 estudios publicados en el lapso 2013-2014. Pero también son de interés las enfermedades de alta prevalencia, así el costo del tratamiento del paciente individual no sea tan elevado. Es el caso de la depresión, con 602 estudios económicos en el mismo lapso.Este número de Acta Médica Colombiana presenta los resultados de la "Evaluación económica de las principales intervenciones farmacológicas como monoterapia para el tratamiento de la hipertensión arterial leve a moderada recién diagnosticada" adelantada por el equipo que lideró Rodolfo Dennis, de la Fundación Cardioinfantil de Bogotá (1). Su conclusión es que, en el paciente hipotético de 65 años que inicia terapia antihipertensiva, la monoterapia con diuréticos, al ser similar en efectividad a las terapias con inhibidores de enzima convertidora, bloqueadores del receptor de angiotensina o calcio antagonistas, resulta ser la opción más adecuada, al repre-sentar un ahorro para el sistema de salud de entre seis y veinte millones de pesos de 2011 por paciente, en valor presente, y considerando toda la vida del paciente.

Barriers and facilitators to bicycle use in adults: a systematic review / Barreiras e facilitadores para o uso de bicicleta em adultos: uma revisão sistemática

The aim of this systematic review was to summarize the evidence on the barriers and facilitators to the use of bicycles in adults. Search terms were defined using Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH) and evidence was searched in the following databases: Lilacs, SciELO, PubMed, Web of Science and Science Direct. A total of seven studies met the inclusion criteria and showed that the main barriers and facilitators to the use of bicycles are related to the physical, social and natural environment characteristics and individual characteristics (cognitive, psychological and emotional aspects). Interventions in the area of public health should consider these features to increase the use of bicycles in adults.

O objetivo desta revisão sistemática foi sintetizar as evidências sobre as barreiras e os facilitadores para o uso de bicicleta em adultos. Foram utilizados termos de busca padronizados pelos Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH) para localizar as evidências nas bases Lilacs, SciELO, PubMed, Web of Science e Science Direct. Sete estudos atenderam os critérios de inclusão e mostraram que as principais barreiras e facilitadores para o uso da bicicleta guardam relação com características do ambiente físico, social e natural, além de características individuais e aspectos cognitivos, psicológicos e emocionais. Intervenções na área da saúde pública poderiam considerar estas características para aumentar o uso de bicicleta em adultos.

Effectiveness of Nursing Management Information Systems: A Systematic Review / 대한의료정보학회지

OBJECTIVES: The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. METHODS: For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag* and admin*, and nurs* were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. RESULTS: Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. CONCLUSIONS: The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs.

Variáveis individuais, ambientais e sociais associadas com o uso de espaços públicos abertos para a prática de atividade física: uma revisão sistemática / Individual, environmental and social variables associated with the use of public open spaces for physical activity practices: a systematic review

Os objetivos desta revisão foram sintetizar as evidências e identificar as variáveis associadas com o uso de espaços públicos abertos para a prática de atividade física. A revisão sistemática foi realizada em periódicos revisados por pares e indexados nas bases de dados Lilacs, SciELO, PubMed e Web of Science utilizando descritores padronizados pelo Medical Subject Headings (MeSH) e Descritores em Ciências da Saúde (DeCS). Foram incluídos estudos originais, quantitativos, publicados a partir de 1998 e realizados com adultos. Quinze estudos atenderam os critérios de inclusão e, no total, 42 variáveis individuais, sociais e ambientais foram testadas. Idade mais jovem e prática de atividade física foram consistentemente associadas com o uso dos locais, enquanto sexo masculino e proximidade da residência apresentaram possível associação positiva. Estes resultados podem auxiliar profissionais a focarem as intervenções para aumentar o uso dos locais em grupos específicos da população.

The aims of this review were to summarize the evidence and to identify the variables associated with the use of public open spaces for physical activity (POSPA). A systematic review was conducted in peer-reviewed journals and indexed in the databases Lilacs, SciELO, PubMed and Web of Science, according to descriptors from Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Only empirical quantitative studies, published since 1998 and conducted with adults were included. Fifteen studies met the inclusion criteria and 42 individual, social and environmental variables were identified. Younger age and physical activity practices were consistently associated with the use of POSPA, while males and proximity of residence showed possible positive association. These results can help practitioners to target interventions to specific population groups to increase the use POSPA.

Revisión sistemática de estudios epidemiológicos sobre la infección por el virus linfotrópico de células T humanas I/II en el Perú / Systematic review of epidemiological research about human T-cel lymphotropic virus type I/II infection in Perú

Objetivo: El virus linfotrópico de células T humanas (HTLV) fue el primer retrovirus humano descubierto en 1979, sin embargo actualmente no se tiene un estimado real a nivel mundial y nacional de su prevalencia en población general. Métodos: Se realizó una búsqueda sistemática en Medline, LILACS y en 4 revistas biomédicas peruanas usando los términos DeCS/Mesh: ôHTLV-Iõ, ôHTLV-I infectionõ, ôHuman T-lymphotropic virus Iõ, ôHTLV-IIõ, ôHTLV-II infectionõ y ôPeruõ. Se determinó la prevalencia en grupos vulnerables y en grupos seleccionados de población general. Resultados: En la búsqueda en Medline y LILACS un total de 50 artículos fueron publicados entre 1988 y 2010; de los cuales sólo 19 (38%) de ellos fueron estudios epidemiológicos de HTLV en el Perú. Adicionalmente, en las cuatro revistas biomédicas peruanas analizadas, cinco estudios fueron observacionales de tipo transversal. Los estudios analizados incluyeron 20805 participantes, de los cuales 846 tuvieron serología positiva para HTLV I/II. La prevalencia promedio de HTLV I/II en los grupos seleccionados de población general fue de 4.85% (IC95%: 2.84-7.36) y 5.11% (IC95%: 2.28-8.99) en grupos vulnerables. Conclusiones: En el Perú no existe información sobre la prevalencia de HTLV I/II en la población general. En base a los estudios analizados, Perú es un país endémico de HTLV-I, en grupos seleccionados de población general y en grupos de vulnerables para infecciones de transmisión sexual. En base a estas conclusiones es necesario implementar políticas de salud preventivas como tamizaje prenatal de HTLV y recomendación de lactancia materna hasta el sexto mes o el tamizaje neonatal.

Human T-cel Lymphotropic virus type I (HTLV-I) was the first human retrovirus discovered at 1979, however currently do not have a real estimate global and national prevalence in general population. Methods: We realized a systemic research in Medline, LILACS and four Peruvian biomedical journals using DeCS/Mesh terms: ôHTLV-Iõ, ôHTLV-I infectionõ, ôHTLV-IIõ, ôHTLV-II infectionõ and ôPeruõ. We determinate the prevalence in vulnerable groups and in selected groups of general population. Results: In the search in Medline and LILACS a total of 50 articles were published between 1988 and 2010. Of these, only 19 (38%) were epidemiological studies in Peru. Additionally, in the four Peruvian biomedical journals analyzed, 5 studies were cross sectional studies. The studies analyzed included 20 805 participants, of whom 846 had tested positive for HTLV I / II. The average prevalence of HTLV I/II in selected groups of general population was 4.85% (95% CI: 2.84-7.36) and 5.11% (95% CI: 2.28-8.99) in vulnerable groups. Conclusions: In Peru, there is no information about prevalence of HTLV I/II in general population. Based on the studies reviewed, Peru is an endemic country for HTLV-I in selected groups of general population and vulnerable groups for sexually transmitted infection. Based on these findings is necessary to develop preventive health as HTLV antenatal screening and recommendation of breastfeeding until the sixth month or neonatal screening.

Cuestionamientos y requerimientos en la investigación de la calidad de vida en oncología / Questions and Requirements of Quality of Life Research in Oncology

Introducción: Durante las dos últimas décadas ha habido una explosión de estudios de evaluación de la calidad de vida. En este estudio se abordaron las principales estrategias metodológicas, entre ellas la elección del instrumento óptimo, propiedades psicométricas básicas y tiempos de evaluación de la calidad de vida. Objetivos: Proporcionar definiciones fundamentales útiles, describir las herramientas existentes y enunciar los desafíos en la interpretación de estudios de calidad de vida. Método: Se realizó una búsqueda narrativa de la literatura con la siguiente estrategia de búsqueda: “(‘Quality of Life’[MeSH] AND (‘Research’[MeSH] OR ‘Epidemiologic Research Design’[MeSH] OR ‘Health Services Research’[MeSH])) AND (‘Oncology Service, Hospital’[MeSH] OR ‘Medical Oncology’[MeSH])”. La indagación contempló el período comprendido entre 1966 y 2007. La estrategia de búsqueda fue adaptada a cada una de las bases de datos consultadas: Medline, Cochrane, LILACS y SciELO. Resultados: Se encontraron, por título y resumen, 189 artículos, a criterio de los autores, de los cuales fueron seleccionados 54 para esta revisión. No se obtuvieron cuatro artículos, por no tener acceso a los correspondientes journals. Conclusiones: La calidad de vida se ha convertido en un tema de interés para muchos investigadores en oncología, ya que no es suficiente con aumentar el tiempo de sobrevida, sino garantizar un estándar de calidad de vida generado a partir del tratamiento médico...

Introduction: During the last two decades, there has been an explosion of studies assessing the quality of life. Main methodological strategies have been addressed, including the optimal choice of instrument, basic psychometric properties and times of evaluation of quality of life. Objectives: To provide basic definitions and tools, to describe the existing tools, and to articulate the challenges of interpreting studies of quality of life. Methods: We conducted a narrative literature search with the following search strategy “(‘Quality of Life’[MeSH] AND (‘Research’[MeSH] OR ‘Epidemiologic Research Design’[MeSH] OR ‘Health Services Research’[MeSH])) AND (‘Oncology Service, Hospital’[MeSH] OR ‘Medical Oncology’ [MeSH]). The search comprised the period between 1966 and 2007. The search strategy was adapted to each of the searchable databases: Medline, Cochrane, LILACS and SciELO. Results: 189 articles were found by title and abstract, of which 54 were selected for this review. Four articles were not obtained for not having access to relevant journals. Conclusions: The quality of life has become a topic of interest to many researchers in oncology since it is not enough to increase survival time, inasmuch as a standard quality of life must ensue from the medical treatment as well...

[Helicobacter pylori and gastric adenocarcinoma]

Accumulating evidence for considering HP as a causal factor for gastric cancer comes from recent epidemiologic studies, the advent of an animal model of gastric cancer and from new insights in to the biological mechanisms for gastric carcinogenesis. The purpose of this review is to analyze recent data from the literature on this relationship and try to define what kinds of preventive measures could be proposed. We conducted a review of the literature through the interrogation of the MEDLINE database using a query documentary by combining the Boolean [AND] keywords [MeSH] as follows: Helicobacter pylori, stomach neoplasms. HP infection, host genetic background, food regimen are known to be involved in this cancer. There is no definite clinical evidence of the benefit of eradication on cancer risk in humans due to the lack of randomized controlled studies in large populations. Therefore HP should be eradicated in selected patients, such as patients' relatives with documented gastric cancer as well as patients having another gastrointestinal cancer

Micropouch vertical banded gastroplasty - new technique evaluation

In this study, 500 patients underwent the micropouch vertical banded gastroplasty [VBG], the median age was 35 years with a median preoperative BMI of 70 kg/m. The micropouch was constructed using single TLH55 stapler through a mini incision. The outlet of the tubular micropouch was banded with a prolene mesh. 98% of the patients showed a good control of their weight within five years and 2% started to gain weight after the first year. The mean operating time was 35 minutes. The use of small single stapler allowed the procedure through a mini incision. The incidence of intraoperative gastroesophageal perforation was 0.6%. The incidence of postoperative leak was 0.2%. Thirty patients were complaining of solid food intolerance. The mortality rate was 0.6%

Traumatic diaphragmatic injuries

Traumatic diaphragmatic injury is a potentially serious complication, which can be overlooked at the time of presentation. 1 present 15 cases of blunt [14] and penetrating [one] injuries of the diaphragm encountered during surgical practice in 4 years time. Most of the injuries were on the left side [12 cases], 2 on the right side and only one case with bilateral injury. Rupture was correctly diagnosed or suspected in 12 cases. High suspicion index is required to diagnose such cases. 1 failed to diagnose 3 cases. The diaphragmatic injuries are almost always associated with other injuries and prognosis depends upon presence of such associated injuries. Chest X-rays proved to be of great value in diagnosing diaphragmatic injuries and other diagnostic aids are occasionally needed. All cases treated surgically using polypropylene mesh and very good results obtained except for little morbidities unrelated to the diaphragmatic injury itself and one recorded mortality due to severe head injury