Metabolically Unhealthy Normal Weight: Prevalence and Associated Factors in an Adult Population from Northwest Colombia.

Background and Aim: Individuals with a normal weight may have metabolic alterations at risk for chronic non-communicable diseases. The prevalence of this condition and associated factors have not been reported in Latin American populations. We aimed to estimate the presence and associated factors of Metabolically Unhealthy Normal Weight (MUNW) in adults from a public program for the control and prevention of chronic diseases in Medellín, Colombia. Methods: Cross-sectional study. Overweight and normal weight were characterized according to the absence or presence of one or more components of the metabolic syndrome, obtaining four phenotypes: Metabolically Healthy Normal Weight (MHNW), MUNW (phenotype of interest), Metabolically Healthy Overweight (MHO), and Metabolically Unhealthy Overweight (MUO). The association of these phenotypes with sociodemographic variables of lifestyles and increased waist circumference was conducted by using logistic regression. Results: In 37,558 individuals (72.7% women), the prevalence of MUNW was 23.3%. Among the additional phenotypes, MUO was found to be more prevalent (71.6%), while MHNW and MHO were very slightly common, 2% and 3.1%, respectively. In a multiple model, the factors associated with MUNW were age over 60 years (trend [OR 1.56 95% CI 0.97-2.52] p-value = 0.066), living in a rural area ([OR 1.58 95% CI 1.09-2.29] p-value = 0.015), and increased waist circumference ([OR 1.68 95% CI 1.45-1.95] p-value < 0.001). Male gender was inversely associated with all phenotypes (P < 0.05). Conclusion: Almost a quarter of the analyzed population presented MUNW. People living in a rural area and over 60 years old were more likely to present MUNW. Men were less likely to present the weight phenotypes studied, although they could have been underrepresented.

[Intrathyroidal thymus can cause confusion in the diagnosis of a thyroid mass. A case report]. / Timo intratiroideo: una causa de confusión en el diagnóstico de masas tiroideas infantiles. Reporte de caso.

Intrathyroidal thymus tissue (ITTT) is a rare, benign condition; its diagnosis can prove challenging due to unfamiliarity with this entity. However, it has ultrasonographical and cytological characteristics which can suggest its presence and thus should be considered in the differential diagnosis of thyroid nodules. Presently, immunohistochemistry can be used with fine needle aspiration (FNA) cytology, thus decreasing the need for unnecessary surgery. We discuss the usefulness of immunohistochemistry in thyroid cytology, with reference to a case of a 10-year-old patient, who underwent partial thyroidectomy for a suspicious thyroid nodule which was eventually diagnosed as ITTT by the histopathology of the surgical specimen.

Analysis of the Metabolic Response of Planktonic Cells and Biofilms of Klebsiella pneumoniae to Sublethal Disinfection with Sodium Hypochlorite Measured by NMR.

Klebsiella pneumoniae is a pathogenic agent able to form biofilms on water storage tanks and pipe walls. This opportunistic pathogen can generate a thick layer as one of its essential virulence factors, enabling the bacteria to survive disinfection processes and thus develop drug resistance. Understanding the metabolic differences between biofilm and planktonic cells of the K. pneumoniae response to NaClO is key to developing strategies to control its spread. In this study, we performed an NMR metabolic profile analysis to compare the response to a sublethal concentration of sodium hypochlorite of biofilm and planktonic cells of K. pneumoniae cultured inside silicone tubing. Metabolic profiles revealed changes in the metabolism of planktonic cells after a contact time of 10 min with 7 mg L-1 of sodium hypochlorite. A decrease in the production of metabolites such as lactate, acetate, ethanol, and succinate in this cell type was observed, thus indicating a disruption of glucose intake. In contrast, the biofilms displayed a high metabolic heterogeneity, and the treatment did not affect their metabolic signature.

Research Trends on Pillared Interlayered Clays (PILCs) Used as Catalysts in Environmental and Chemical Processes: Bibliometric Analysis.

Over the last four decades, a large number of studies have been published on pillared interlayered clays (PILCs) used as adsorbent materials and catalysts or supports for transition metals in heterogeneous catalysis. Particularly, PILCs have been used for water treatment through advanced oxidation processes (AOPs) to remove organic pollutants. They have also been studied in various chemical and environmental processes. Because of the growing interest in PILCs, this article is focused on analyzing scientific publications such as research/review articles and book chapters from the last four decades (from 1980 to 2019) through a bibliometric analysis (BA) to visualize and describe research trends on PILCs. By narrowing the bibliographic search to titles, keywords, and abstracts of publications related to PILCs, using Scopus and Web of Science (WoS) (the two scientific databases), a total of 3425 documents have been retrieved. The bibliometric dataset was analyzed by VantagePoint®. The main research trends identified in the last four decades were the use of PILCs in environmental processes (34.4% of total publications) along with chemical processes (petrochemical reactions 17.5%, SCR NOx 10.8%, and decomposition 8.2%). In environmental processes, PILCs have been used in photo-oxidation (32%), CWPO (21.1%), and heterogeneous catalysis (19.4%). Phenols, dyes, and VOCs have been the main pollutants studied using PILCs as catalysts. Fe, Ti, Zr, Cu, and Co are the most supported active phases in PILCs. Other research trends grouped by characterization techniques, countries, research areas, institutes, scientific journals that have published the most on this topic, number of publications per 5-year period, and most frequently used keywords through the last four decades have been identified. It was determined that the number of publications on PILCs has increased since 1980 and the countries with the highest number of publications are China, Spain, and The United States of America.

A critical review on N-modified TiO2 limits to treat chemical and biological contaminants in water. Evidence that enhanced visible light absorption does not lead to higher degradation rates under whole solar light.

Intensive research has been focused on the synthesis of N-modified TiO2 materials having visible light absorption in order to get higher solar photocatalytic degradation rates of pollutants in water. However, an exhaustive revision of the topic underlines several controversial issues related to N-modified TiO2 materials; these issues concern (a) the methodology used for preparation, (b) the assessment of the structural characteristics, (c) the mechanistic action modes and (d) the raisons argued to explain the limited performances of the prepared materials for organic and biological targets photodegradation in water. Taking advantage of last year's progress in analytical chemistry and in material characterization methods, the authors show, for example, that some works in the literature controversially attribute the term nitrogen doping without enough analytical evidence. Additionally, some papers describe N-modified TiO2 photocatalysts as being able to generate holes with enough oxidative potential to form hydroxyl radicals under visible light. This last assertion often derives from a no pertinent use of illumination sources, light filters, or targets or a limited understanding of the thermodynamic aspects of the studied systems. None of N-containing materials prepared by herein presented methods leads, under solar light, to a significant enhancement in pollutants degradation and microorganism's inactivation kinetics.

Resistance and induction of viable but non culturable states (VBNC) during inactivation of E. coli and Klebsiella pneumoniae by addition of H2O2 to natural well water under simulated solar irradiation.

Inactivation of E. coli and Klebsiella pneumoniae by addition of H2O2 10 mg L-1 into natural well water samples containing natural total iron concentrations (around 0.3 mg L-1) under simulated solar light was followed by bacterial culturability (plate count) and viability (DVC-FISH). Results showed that culturability of both bacteria was totally reduced while viability was only completely depleted for E. coli in well water samples depending of total iron concentration. Post-irradiation effects in presence of residual H2O2 showed that viability of both bacteria kept dropping being totally reduced for E. coli cells while K. pneumoniae decreased only 1-log. SEM micrographs showed that E. coli and K. pneumoniae cells underwent morphological changes and size reduction according to VBNC states. Different dark and photo-induced processes where physical-chemical features of groundwater samples play an important role could be responsible of bacteria abatement.

Associations of History of Displacement, Food Insecurity, and Stress With Maternal-Fetal Health in a Conflict Zone: A Case Study.

Background: In populations with a history of conflict, early identification of pregnant women who are at risk of adverse pregnancy outcomes is challenging, especially if sonography is not available. We evaluated the performance of symphysis-fundal height (SFH) for identification of high-risk pregnancies and investigated if food security and diet quality, clinical biomarkers, and stress were associated with SFH and two known indicators of maternal-fetal well-being, sonography-estimated fetal weight and amniotic fluid index (AFI). Methods: For this cross-sectional study, 61 women with high-risk pregnancies were recruited after referral to the obstetrics and gynecology unit at San José Hospital in Popayán, Colombia. Multiple stepwise linear and ordered logistic regressions were used to identify associations of SFH, sonography-estimated fetal weight and AFI classification with history of displacement, food insecurity, post-traumatic stress symptoms as well as biopsychosocial risk evaluated through the Colombian risk scale. Results: History of displacement was associated with lower SFH Z-scores, but higher hemoglobin, taking iron supplements and a higher diastolic blood pressure were associated with higher SFH Z-scores. SFH was also associated with AFI but not with sonography-estimated fetal weight. Stress indicators were associated with a higher AFI. In contrast family support, an element of the Colombian biopsychosocial risk assessment, was associated with a higher sonography-estimated fetal weight, whereas more hours of sleep/day were associated with lower sonography-estimated fetal weight. Conclusion: SFH was not only associated with biological factors known to affect maternal/fetal health but also with history of displacement, thus validating its use in conflict areas for pregnancy assessment. Associations of biopsychosocial stressors with maternal-fetal outcomes highlight the need for a systematic assessment of stress in pregnant women from conflict zones.

Photo-Fenton process at natural conditions of pH, iron, ions, and humic acids for degradation of diuron and amoxicillin.

Effect of ferric ions at concentrations typically found in natural waters (0.05 to 1.06 mg L-1) and low H2O2 concentrations (between 0.5 and 17.9 mg L-1) on simulated sunlight-induced (300 W m-2) photo-Fenton degradation at initial neutral pH (7.0) of amoxicillin and diuron in Milli-Q water was studied using an rotatable central composite experimental design 22 with a central and two axial points. H2O2 concentration was the parameter playing the key role on the degradation of both pollutants. Despite that initial pH was 7.0 in Milli-Q water, this latter decreased rapidly in the first minutes, reaching values of 3.5 and 5.0 for diuron and amoxicillin respectively after 15 min of simulated sunlight irradiation. In contrast, in presence of bicarbonate/carbonate (HCO3-/CO3=), fluoride (F-), and humic acids (HAs) at concentrations found often in surface and well waters with ferric ion and H2O2 concentrations of 0.3 and 9.7 and 15.2 mg L-1 respectively, both pollutants exhibited a strong degradation keeping the circumneutral pH. Amoxicillin and diuron degradation byproducts found by HPLC/MS were compatible with HO• and/or CO3-• radical attack. Several photo-induced processes such as photo-Fenton (by dissolved ferric-HA complexes), heterogeneous photocatalysis (by colloidal iron), UV-B H2O2 photolysis, irradiated-dissolved organic matter, and their reactions with pollutants would be the main oxidative route responsible of degradations. These findings demonstrated that it could be possible using iron concentrations often found in natural waters to oxidize via photo-Fenton processes among other events, organic pollutants at natural pH conditions.

Abatement of 2,4-D by H2O2 solar photolysis and solar photo-Fenton-like process with minute Fe(III) concentrations.

The Photo-Fenton-like (PF-like) process with minute Fe(III) concentrations and the Hydrogen Peroxide Photolysis (HPP), using Xe-lamp or solar light as sources of irradiation, were efficiently applied to eliminate the herbicide 2,4-D from water. PF-like experiments concerning ferric and H2O2 concentrations of 0.6 mg L-1 and 20 mg L-1 respectively, using Xenon lamps (Xe-lamps) as a source of irradiation and 2,4-D concentrations of 10 mg L-1 at pH 3.6, exhibited complete 2,4-D degradation and 77% dissolved organic carbon (DOC) removal after 30 min and 6 h of irradiation respectively whereas HPP (in absence of ferric ions) experiments showed a 2,4-D reduction and DOC removal of 90% and 7% respectively after 6 h of irradiation. At pH 7.0, HPP process achieved a 2,4-D abatement of approximately 75% and a DOC removal of 4% after 6 h. PF-like exhibited slightly improved 2,4-D and DOC removals (80% and 12% respectively) after the same irradiation time probably due to the low pH reduction (from 7.0 to 5.6). Several chlorinated-aromatic intermediates were identified by HPLC-MS. These by-products were efficiently removed by PF at pH 3.6, whereas at neutral PF-like and acid or neutral HPP, they were not efficiently degraded. With natural solar light irradiation, 10 and 1 mg L-1 of 2,4-D were abated using minor H2O2 concentrations (3, 6, 10 and 20 mg L-1) and iron at 0.6 mg L-1 in Milli-Q water. Similar results to Xe-lamp experiments were obtained, where solar UV-B + A light H2O2 photolysis (HPSP) and solar photo-Fenton-like (SPF-like) played an important role and even at low H2O2 and ferric concentrations of 3 and 0.6 mg L-1 respectively, 2,4-D was efficiently removed at pH 3.6. Simulated surface water at pH 3.6 containing 1 mg L-1 2,4-D, 20 mg L-1 H2O2 and 0.6 mg L-1 Fe(III) under natural sunlight irradiation efficiently removed the herbicide and its main metabolite 2,4-DCP after 30 min of treatment while at neutral pH, 40% of herbicide degradation was achieved. In the case of very low iron concentrations (0.05 mg L-1) at acid pH, 150 min of solar treatment was required to remove 2,4-D.

Addition of Hydrogen Peroxide to Groundwater with Natural Iron Induces Water Disinfection by Photo-Fenton at Circumneutral pH and other Photochemical Events.

Samples of natural groundwater (with low turbidity, neutral pH and 0.3 mg L-1 iron concentration) inoculated with Escherichia coli K-12 were exposed to simulated solar light both in the presence and in the absence 10 mg L-1 of H2 O2. Results demonstrated that the viability of E. coli (by DVC-FISH) was grounded to zero after 360 min of irradiation. This abatement could be caused by the oxidative stress induced by ·OH radicals or another photo-induced reactive oxygen species. Two 23 factorial experimental designs enabled the evaluation of the effects of chemical factors on the inactivation of E. coli. The first experimental design considered the pH, iron and H2 O2 , while the second evaluated the ions fluoride, carbonate and phosphate found in groundwater. pH was found to play a key role in the inactivation of E. coli. The best reduction in viability was obtained at the lower pH (6.75), while a nonsignificant effect was observed when iron or H2 O2 concentrations were raised. At higher concentrations, anions, such as carbonate and phosphate, negatively affected the E. coli abatement. However, a higher concentration of fluoride accelerated it. In all experiments, the pH was observed to rise to values higher than 8.0 units after 360 min of treatment.

2,4-D abatement from groundwater samples by photo-Fenton processes at circumneutral pH using naturally iron present. Effect of inorganic ions.

This study evaluated, at laboratory scale, if the using iron naturally present (0.3 mg L-1) and adding 10 mg L-1 of hydrogen peroxide was effective to remove 24.3 mgL-1 of 2,4-dichlorophenoxyacetic acid (2,4-D) from groundwater samples by simulated solar irradiation (global intensity = 300 W m-2). Under these conditions, the degradation of 2,4-D reached 75.2 % and the apparition of its main oxidation byproduct 2,4-dichlorophenol (DCP) was observed. On the other hand, pH exhibited an increasing from 7.0 to 8.3 during the experiment. Experiments using Milli-Q water at pH 7.0, iron, and H2O2 concentrations of 0.3 and 10 mg L-1, respectively, were carried out in order to study the effect of ions such as carbonate species, phosphate, and fluoride in typical concentrations often found in groundwater. Ion concentrations were combined by using a factorial experimental design 23. Results showed that carbonates and fluoride did not produce a detrimental effect on the 2,4-D degradation, while phosphate inhibited the process. In this case, the pH increased also from 7.0 to 7.95 and 8.99. Effect of parameters such as pH, iron concentration, and hydrogen peroxide concentration on the 2,4-D degradation by the photo-Fenton process in groundwater was evaluated by using a factorial experimental design 23. Results showed that the pH was the main parameter affecting the process. This study shows for the first time that using the photo-Fenton process at circumneutral pH and iron naturally present seems to be a promising process to remove pesticides from groundwater.

Reduction of maternal mortality due to preeclampsia in Colombia--an interrupted time-series analysis.

INTRODUCTION: Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. METHODS: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. RESULTS: Five years after (2002 - 2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR=0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR=0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). CONCLUSIONS: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

INTRODUCCIÓN: La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. MÉTODOS: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. RESULTADOS: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR=0.77, CI 95% 0.71-0.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88), igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR=0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). CONCLUSIONES: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

Estado nutricional del hierro en gestantesadolescentes, MedellÝn, Colombia / Nutritional status of iron in pregnant adolescents, MedellÝn, Colombia

Objetivo: analizar el estado nutricional del hierro en gestantesadolescentes de tercer trimestre. MetodologÝa: estudioanalÝtico de corte transversal con 276 adolescentes entre 10 y19 a±os, en tercer trimestre de gestaci¾n de la Empresa Socialdel Estado (ese) Metrosalud (MedellÝn, 2011-2012), con datosde hemoglobina, volumen corpuscular medio, concentraci¾nde hemoglobina corpuscular media e ingesta de suplementode hierro. La ferritina sÚrica se analiz¾ en 178 gestantes,controlada por proteÝna C-reactiva. Se utilizaron medidas detendencia central, dispersi¾n, porcentajes y pruebas de Chi2,anova, Kruskal-Wallis y U de Mann-Whitney. Resultados:la prevalencia de anemia fue 17,1% en el tercer trimestrede gestaci¾n y por deficiencia de hierro, 51%. La medianade ferritina sÚrica fue 13,3 Ág/L (RQ: 7,7 Ág/L-17,9 Ág/L);s¾lo el 5,6% (n = 9) present¾ valores adecuados de ferritina.Las madres que tomaron suplemento de hierro diariamentepresentaron mejores concentraciones de hemoglobina yferritina, frente a aquellas que no lo hicieron, Hb 12,1g/dL vs.11,7 g/dL (p = 0,019) y ferritina sÚrica 14,6 Ág/L vs. 7,0 Ág/L(p = 0,000). Discusi¾n: hubo altas prevalencias de anemia yferropenia en las gestantes, asociadas con la no adherencia alsuplemento de hierro...

Objective: to analyze the nutritional status of iron in pregnantadolescents in their third trimester. Methodology: a crosssectionalanalytical study with 276 adolescents between theages of 10 and 19 in the third trimester of pregnancy fromthe ESE Metrosalud State Social Enterprise (MedellÝn 2011-2012). Data was collected for hemoglobin, mean corpuscularvolume, mean corpuscular concentration and the ingestionof iron supplements. Serum ferritin levels were analyzed in178 pregnant adolescents and were controlled by C-reactiveprotein. Central tendency measures, dispersion, percentagesand Chi 2, anova, Kruskal-Wallis and Mann-Witney U testswere employed. Results: anemia prevalence was 17.1% inthe third trimester, 51% because of iron deficiency. Medianserum ferritin was 13.3 Ág/L (RQ: 7.7 Ág/L-17.9 Ág/L); only5.6% (n=9) showed adequate ferritin levels. Mothers who tookdaily iron supplements exhibited greater concentrations ofhemoglobin and ferritin when compared with those who did nottake any supplement, Hb: 12.1g/dL vs 11.7 g/dL ( p = 0.019) andserum ferritin 14.6 Ág/L vs7.0 Ág/L (p = 0.000). Discussion:there was high prevalence of anemia and iron deficiency inthe expectant mothers, which was associated with a lack ofadherence to the iron supplement...

Reduction of maternal mortality due to preeclampsia in Colombia - an interrupted time-series analysis / Reducción de la mortalidad materna por preeclampsia en Colombia - un análisis de series de tiempo interrumpido

Abstract Introduction. Preeclampsia is the most important cause of maternal mortality in developing countries. A comprehensive prenatal care program including bio-psychosocial components was developed and introduced at a national level in Colombia. We report on the trends in maternal mortality rates and their related causes before and after implementation of this program. Methods: General and specific maternal mortality rates were monitored for nine years (1998-2006). An interrupted time-series analysis was performed with monthly data on cases of maternal mortality that compared trends and changes in national mortality rates and the impact of these changes attributable to the introduction of a bio-psychosocial model. Multivariate analyses were performed to evaluate correlations between the interventions. Results: Five years after (2002-2006) its introduction the general maternal mortality rate was significantly reduced to 23% (OR= 0.77, CI 95% 0.71-0.82).The implementation of BPSM also reduced the incidence of preeclampsia in 22% (OR= 0.78, CI 95% 0.67-0.88), as also the labor complications by hemorrhage in 25% (OR= 0.75, CI 95% 0.59-0.90) associated with the implementation of red code. The other causes of maternal mortality did not reveal significant changes. Biomedical, nutritional, psychosocial assessments, and other individual interventions in prenatal care were not correlated to maternal mortality (p= 0.112); however, together as a model we observed a significant association (p= 0.042). Conclusions: General maternal mortality was reduced after the implementation of a comprehensive national prenatal care program. Is important the evaluation of this program in others populations.

Resumen Introducción. La preeclampsia es la causa más importante de mortalidad materna en los países en desarrollo. Se desarrolló e introdujo en Colombia y a nivel nacional un programa de cuidado prenatal que incluyó componentes bio-psicosociales. Se muestran las tendencias de las tasas de mortalidad materna y las causas relacionadas antes y después de la implementación del programa. Métodos: Las tasas de mortalidad general y específica fueron monitoreadas durante 9 años (1998-2006). Un análisis de series de tiempo ininterrumpido se realizó con datos mensuales de casos de mortalidad materna y se compararon las tendencias de cambio en las tasas de mortalidad nacional y el impacto de los cambios atribuibles a la introducción del modelo. Se hizo un análisis multivariado para evaluar la asociación entre las intervenciones. Resultados: Cinco años después de la introducción del programa (2002-2006) la tasa de mortalidad maternal se redujo significativamente en 23% (OR= 0.77, CI 95% 0.710.82). La implementación del MBPS redujo la incidencia de la preeclampsia en 22% (OR= 0.78, CI 95% 0.67-0.88 , igual la mortalidad materna por complicación del parto por hemorragias en 25% (OR= 0.75, CI 95% 0.59-0.90). Otras causas de mortalidad materna no mostraron cambios significativos. No se correlacionó la mortalidad materna con intervenciones de cuidado prenatal individuales como las biomédicas, nutricionales y psicosociales (p= 0.112), sin embargo, ellas en conjunto como un modelo (biopsicosocial) si observaron una asociación significativa (p= 0.042). Conclusiones: La mortalidad maternal general se redujo después de la implementación de un programa nacional de cuidado prenatal. Es importante evaluar este programa en otras poblaciones.

Atención primaria y mortalidad materno-infantil en Iberoamérica / Primary care and maternal and infant mortality in Latin American countries

Introducción: La reducción de la mortalidad infantil es una meta del milenio. Los médicos de familia han demostrado ser coste-efectivos en la reducción de la mortalidad infantil en los países desarrollados; este efecto en los países en vías de desarrollo no se conoce. Métodos: Se realizó un estudio descriptivo en 11 países de Iberoamérica para observar sus indicadores de salud y la posible asociación entre la presencia de los médicos de familia en la atención primaria y las cifras de la mortalidad materno-infantil. Las asociaciones científicas nacionales de medicina de familia y comunitaria de la región reportaron la información para cada país. Se realizó un análisis estadístico centralizado. Resultados: Se observaron brechas entre los diferentes países con respecto a sus características sociodemográficas, a las desigualdades, a la inversión pública para la atención primaria, a la proporción de médicos de familia dentro del gremio médico y a los indicadores en salud. Los indicadores en salud estuvieron correlacionados con el nivel de desarrollo y con los recursos destinados para la salud en cada país. La mortalidad materna no se correlacionó con la presencia de los médicos de familia (R2: 0,003), tampoco su presencia en conjunto con la presencia de otras especialidades médicas (R2: 0,07), en contraste la razón de mortalidad infantil sí se correlacionó con la presencia de los médicos de familia (R2: 0,37; IC 95% 0,04-0,95; p < 0,05). Conclusión: La presencia de los médicos de familia en los países de Iberoamérica se asoció con las cifras de mortalidad infantil contribuyendo a su reducción dentro del cumplimiento de las metas del milenio (AU)

Introduction: Family physicians, as leaders of primary healthcare teams, have demonstrated to be cost-effective in reducing infant mortality in developed nations, but their effect in developing nations is yet unknown. Methods: A descriptive study was conducted in 11 Latin American countries to observe their health indicators, and the possible association of the presence and actions of their family physicians regarding achieving a reduction in maternal and infant mortality. National scientific associations of family and community medicine in the region provided information for each country; a centralized statistical analysis was made. Results: There was a wide variation between the different countries, as regards their socio-demographic characteristics, inequalities, public investment in primary care, the proportion of family physicians within the medical profession, healthcare indicators, those relating to the level of development, and to the resources assigned to healthcare in each country. Maternal mortality was not associated to the presence and actions of family physicians in each country (R2: 0.003) nor together with other medical specialties (R2: 0.07); in contrast, infant mortality was associated with the presence and actions of family physicians (R2: 0.37; 95% CI 0.04-0.95; P<0.05). Conclusion: The presence and actions of family physicians in primary healthcare in Latin America was associated to a reduction of infant mortality, with the Millenium challenges contributing to this reduction (AU)

[Primary care and maternal and infant mortality in Latin American countries]. / Atención primaria y mortalidad materno-infantil en Iberoamérica.

INTRODUCTION: Family physicians, as leaders of primary healthcare teams, have demonstrated to be cost-effective in reducing infant mortality in developed nations, but their effect in developing nations is yet unknown. METHODS: A descriptive study was conducted in 11 Latin American countries to observe their health indicators, and the possible association of the presence and actions of their family physicians regarding achieving a reduction in maternal and infant mortality. National scientific associations of family and community medicine in the region provided information for each country; a centralized statistical analysis was made. RESULTS: There was a wide variation between the different countries, as regards their socio-demographic characteristics, inequalities, public investment in primary care, the proportion of family physicians within the medical profession, healthcare indicators, those relating to the level of development, and to the resources assigned to healthcare in each country. Maternal mortality was not associated to the presence and actions of family physicians in each country (R(2): 0.003) nor together with other medical specialties (R(2): 0.07); in contrast, infant mortality was associated with the presence and actions of family physicians (R(2): 0.37; 95% CI 0.04-0.95; P<0.05). CONCLUSION: The presence and actions of family physicians in primary healthcare in Latin America was associated to a reduction of infant mortality, with the Millenium challenges contributing to this reduction.

[Effect of periodontal therapy on the subgingival microbiota in preeclamptic patients]. / Efecto del tratamiento periodontal sobre la microbiota subgingival en pacientes con preeclampsia.

INTRODUCTION: Few studies have described subgingival microbiota in pregnant women with mild preeclampsia. OBJECTIVE: Clinical periodontal and subgingival microbiota changes were identified in pregnant women with mild preeclampsia after periodontal treatment. MATERIALS AND METHODS: In a secondary analysis of a randomized clinical trial, 57 preeclamptic women were studied at Hospital Universitario del Valle in Cali, Colombia. Thirty one women were randomized to the periodontal intervention group (subgingival scaling and planing ultrasonic and manual) during pregnancy and 26 to the control group (supragingival prophylaxis). Periodontal clinical parameters and subgingival microbiota were characterized at the time of acceptance into the study and again at postpartum. Eight periodontopathic bacteria and 2 herpesviruses were assessed by polymerase chain reaction. Chi-square, McNemar or Student's t tests were used, with a significance level of p≤0.05. RESULTS: Both groups were comparable in the clinical and microbiological variables at baseline. Periodontal treatment reduced the average pocket depth in the intervention group from 2.4±0.3 to 2.3±0.2 mm (p<0.001) and in control group 2.6±0.4 to 2.44±0.4 mm, (p<0.001) and bleeding index 16.4±1.5% to 7.9±0.7% in the intervention group(p<0.001) and 17.1±1.8% to 10±0.9% in the control group (p=0.002). The frequency of detection of microorganisms did not differ significantly between groups. CONCLUSION: Scaling/root planning and supragingival prophylaxis significantly reduced the probing depth and gingival bleeding index. Periodontal treatment was not more effective than prophylaxis in reducing periodontopathic organisms or herpesvirus.