Desensitizing the autonomic nervous system to mitigate anti-GD2 monoclonal antibody side effects.

Background: Anti-GD2 monoclonal antibodies (mAbs) have shown to improve the overall survival of patients with high-risk neuroblastoma (HR-NB). Serious adverse events (AEs), including pain, within hours of antibody infusion, have limited the development of these therapies. In this study, we provide evidence of Autonomic Nervous System (ANS) activation as the mechanism to explain the main side effects of anti-GD2 mAbs. Methods: Through confocal microscopy and computational super-resolution microscopy experiments we explored GD2 expression in postnatal nerves of infants. In patients we assessed the ANS using the Sympathetic Skin Response (SSR) test. To exploit tachyphylaxis, a novel infusion protocol (the Step-Up) was mathematically modelled and tested. Results: Through confocal microscopy, GD2 expression is clearly visible in the perineurium surrounding the nuclei of nerve cells. By computational super-resolution microscopy experiments we showed the selective expression of GD2 on the cell membranes of human Schwann cells in peripheral nerves (PNs) significantly lower than on NB. In patients, changes in the SSR were observed 4 minutes into the anti-GD2 mAb naxitamab infusion. SSR latency quickly shortened followed by gradual decrease in the amplitude before disappearance. SSR response did not recover for 24 hours consistent with tachyphylaxis and absence of side effects in the clinic. The Step-Up protocol dissociated on-target off-tumor side effects while maintaining serum drug exposure. Conclusion: We provide first evidence of the ANS as the principal non-tumor target of anti-GD2 mAbs in humans. We describe the development and modeling of the Step-Up protocol exploiting the tachyphylaxis phenomenon we demonstrate in patients using the SSR test.

Human skin processing affects clinical outcome in allograft recipients.

Skin allografts represent a milestone in burn patient treatment. However, skin procurement is still burdened by high rates of contamination, and validation procedures have not yet been standardized. In addition, it is not clear if tissue viability affects allograft skin outcomes. In 2120 skin samples from 610 donors, a retrospective analysis was performed to identify donor and procurement variables associated with bacterial contamination and tissue viability. Post-processing contamination was associated significantly with the donor type, cause of death, length of hospitalization, procurement site, surgeon, interval between procurement and banking, and decontamination method. Tissue viability appeared to be negatively associated with freezing. In two series of skin allograft recipients (155 and 195 patients), we evaluated the role of skin characteristics and procurement variables on clinical outcomes. We found that the length of hospitalization was associated significantly with donor age. Procalcitonin and PCR values in allograft recipients were correlated with the decontamination method. No significant associations were observed between tissue viability and clinical outcomes (length of hospitalization, cause of donor death, or inflammatory parameters) after allograft transplantation. In these large case series, we identified donor and procurement variables that may affect allograft skin recipients. The decontamination method appeared to be a critical step for skin allograft requiring better standardization.

Bioactive Attributes and Analysis of Electronic Nose Feature Signals of Colombian Stingless Bees Propolis.

The volatile and non-volatile chemical composition and bioactivity of propolis from the species Apis mellifera has been widely studied, but there is very little knowledge regarding propolis of other bee species, which ultimately hinders their differentiation and potential use. In this work, 53 propolis samples of A. mellifera and four stingless bee species (Frieseomielitta sp., Melipona eburnea, Melipona sp., and Trigona sp.) were collected in Colombia. An electronic nose with 10 metal oxide semiconductor sensors (MOS) was used to generate a pattern of the representative volatile compounds of the samples. Ethanolic extracts were obtained to assess their antioxidant activity towards DPPH radical and ABTS radical cation, total phenolics, and color (CIELAB space). The results showed an overall similarity of the aromatic profiles between species. The antioxidant activity of Frieseomielitta sp. propolis was higher than that of A. mellifera and the other species, in correspondence with a higher phenolic content. CIELAB color parameter b* was the most differentiating variable among samples, indicating a variation of propolis colors between red and yellow. By combining the data from physico-chemical analysis and aromatic profile, it was possible to differentiate the propolis from each bee species, with the exception of those from Melipona sp. and Trigona sp., indicating their similarity. These results have practical significance since they are a starting point to recognizing and valuing native stingless bee propolis and their bioactive potential, which, in addition to geographical differentiation and further quality parameters evaluation, will enhance their commercial exploitation.

Ozanimod as a novel oral small molecule therapy for the treatment of Crohn's disease: The YELLOWSTONE clinical trial program.

BACKGROUND: Ozanimod, an oral sphingosine 1-phosphate receptor modulator currently approved for the treatment of moderately to severely active ulcerative colitis and relapsing multiple sclerosis, showed clinical, endoscopic, and histological benefit in the phase 2 STEPSTONE trial for Crohn's disease (CD). We aim to describe the trial design of the YELLOWSTONE phase 3 program evaluating the safety and efficacy of ozanimod in patients with moderately to severely active CD. METHODS: The YELLOWSTONE program consists of phase 3, randomized, double-blind, placebo-controlled induction (NCT03440372 and NCT03440385) and maintenance (NCT03464097) trials and an open-label extension (OLE) study (NCT03467958). Patients with inadequate response or intolerance to ≥1 CD treatment are randomized to receive daily ozanimod 0.92 mg (equivalent to ozanimod HCl 1 mg) or placebo for 12 weeks during induction. Those who respond to ozanimod are rerandomized to continue ozanimod or placebo maintenance therapy for 52 weeks. Patients who do not meet criteria for maintenance, experience relapse during maintenance, or complete maintenance or ≥ 1 year of STEPSTONE are eligible for open-label treatment for up to 234 weeks. Efficacy endpoints include clinical, endoscopic, and histologic outcomes. RESULTS: Expected 2023 (induction studies), 2024 (maintenance study), and 2026 (OLE). CONCLUSION: YELLOWSTONE will provide pivotal phase 3 data on the safety and efficacy of ozanimod in patients with moderately to severely active CD using state-of-the-art methods, including centrally read endoscopic and histologic measurements, along with subjective assessments of symptom control based on the Crohn's Disease Activity Index. These studies could enable approval of ozanimod as a new CD therapy. CLINICAL TRIAL REGISTRATION NUMBERS: NCT03440372, NCT03440385, NCT03464097, NCT03467958.

Regenerative Medicine to Improve Outcomes of Ventral Hernia Reconstruction (REPAIR Study) Phase 1: Find the Best Decellularization Protocol for the Human Dermis.

Background: Tissue regeneration is a complex process that allows wounds to heal. Many options are currently available to help human skin repair and to reduce the recurrence of hernias. The aim of this study is to analyze the best decellularization protocol for allogenic human dermal tissues. Methods: Dermal flaps from donors were used and compared with a control group. Each flap was subjected to seven different decellularization protocols and washed with a sequence of five solutions. The samples were then subjected to four control tests (such as Nile Red), and long-term contacts were analyzed to assess whether the decellularized dermis samples could support the growth of human fibroblasts. Results: All the samples had an average residual viability of 60%. Except for one sample, the decellularization treatments were able to reduce cell viability significantly. The Nile Red test showed a significant reduction in phospholipid content (mean 90%, p-value < 0.05) in all treatments. The cell growth increased in a linear manner. As described in the literature, sodium-dodecyl-sulfate (SDS) caused an interference between the test and the detergent. Conclusions: This paper shows the first step to finding the best decellularization protocol for allografting human dermal tissues. Further biocompatibility tests and DNA quantification are necessary.

Effects of Solar Drying on the Structural and Thermodynamic Characteristics of Bee Pollen / Efectos del secado solar sobre las características estructurales y termodinámicas del polen apícola

Background: Bee pollen is a natural product collected and transformed by bees, intended for human consumption, given its nutritional and bioactive richness. The fundamental operation of adequacy is drying, which allows its preservation, avoiding chemical or microbiological degradation, typically using tray dryers with hot air that use electricity or fuel for heat generation. Solar drying is an alternative that uses radiation as an energy source. However, it should be ensured that this type of process guarantees the quality of the product while not degrading its properties and, therefore, maintaining its morphological integrity. Objective: to establish the effect of solar drying on bee pollen structure compared to the conventional cabin dehydration process. Methods: Bee pollen was dehydrated using two types of dryers: a solar dryer and a forced convection oven. The solar dryer operating conditions were an average temperature of 19-35 °C with a maximum of 38 °C and average relative humidity (RH) of 55 %. Cabin dryer operating conditions were a set point temperature of 55 ± 2 °C and 10 % RH average humidity. The morphologic and thermodynamic properties of dried bee pollen, such as phase transition enthalpy through Differential Scanning Calorimetry (DSC), porosity and surface area through surface area analysis, and microscopic surface appearance by Scanning Electron Microscopy (SEM), were measured. Results: The results showed dry bee pollen, both in the cabin dryer and solar dryer, did not suffer morphological changes seen through SEM compared to fresh bee pollen. Moreover, surface area analysis indicated the absence of porosity in the microscopic or macroscopic structure, demonstrating that solar or cabin drying processes did not affect the specific surface area concerning fresh bee pollen. Additionally, Differential Scanning Calorimetry (DSC) and Thermo Gravimetric Analysis (TGA) showed that endothermic phase transitions for dried bee pollen by cabin or solar dryer were at 145 °C and 160 °C, respectively. This can be mostly associated with free water loss due to the morphological structure preservation of the material compared to fresh bee pollen. Conclusion: These results demonstrate that solar drying is a reliable alternative to bee pollen dehydration as there were no effects that compromised its structural integrity

Antecedentes: El polen apícola es un producto natural recolectado y transformado por las abejas. La operación fundamental de adecuación del polen es el secado, lo que permite su conservación, evitando su degradación química o microbiológica, típicamente se utilizan secadores de bandejas con aire caliente que emplean electricidad o combustibles para la generación de calor. El secado solar es una alternativa que utiliza la radiación solar como fuente de energía. Sin embargo, se debe garantizar que este tipo de proceso asegure la calidad del producto a la vez que no degrade sus propiedades, manteniendo su integridad morfológica. Objetivo: Establecer el efecto del secado solar sobre la estructura del polen apícola en comparación al proceso convencional de deshidratación en cabina. Métodos: El polen de abeja se deshidrató utilizando dos tipos de secadores: secador solar y horno de convención forzada. Las condiciones de operación del secador solar fueron una temperatura promedio de 19-45 °C con un máximo de 38 °C y una humedad relativa (HR) promedio de 55 %. Las condiciones de operación del secador de cabina fueron una temperatura de referencia de 55 ± 2 °C y una humedad promedio de 10 % HR. Se midieron las propiedades morfológicas y termodinámicas del polen de abeja desecado, como la entalpía de transición de fase mediante calorimetría diferencial de barrido (DSC), la porosidad y el área superficial mediante análisis de área superficial y el aspecto microscópico de la superficie mediante microscopía electrónica de barrido (SEM). Resultados: Los resultados mostraron que el polen seco tanto en el secador de cabina como en el secador solar muestra que no sufrió cambios morfológicos vistos a través de Microscopía Electrónica de Barrido y en comparación con el polen fresco de abeja, además un análisis de sortometría indicó la ausencia de porosidad en la estructura microscópica y macroscópica, lo que indica que los procesos de secado solar o en cabina no tuvieron efectos sobre el área superficial específica con respecto al polen fresco de las abejas. En adición, los resultados de calorimetría diferencial de barrido (DSC) y análisis termogravimétrico (TGA) muestran que las transiciones de fase endotérmicas para el polen seco tanto en secado de cabina como solar fueron a 145 °C y 160 °C, que puede asociarse mayormente a la pérdida de agua libre, debido a la conservación de la estructura morfológica del material y en comparación al polen fresco. Conclusión: Estos resultados demuestran que el secado solar es una alternativa viable para la deshidratación del polen al no existir efectos que comprometan su integridad estructural

Trazas de ADN y su implicancia en la obtención de perfiles genéticos: revisión bibliográfica / Trace DNA and its implication in obtaining genetic profiles: bibliographic review

Introducción: El aumento en la sensibilidad de las técnicas empleadas ha permitido la obtención de perfiles genéticos a partir de trazas de ADN que se hayan depositado mediante contacto antes, durante o después de la comisión de los hechos investigados. Por otro lado, la contaminación accidental de los indicios biológicos, con la consecuente interpretación errónea de los resultados genéticos, tienen importantes consecuencias en el proceso judicial. Debido a ello, minimizar las contaminaciones que se pueden generar durante algunas de las fases de recolección o análisis genético, como así también la detección de estos eventos, es una prioridad para los laboratorios forenses. Objetivo: analizar las publicaciones más relevantes respecto a las trazas de ADN, los diferentes tipos de transferencia y contaminación que se pueden obtener en una evidencia. Metodología: se realizó la búsqueda en PubMed, del Instituto Nacional de Salud (NIH), y Google Académico usando las palabras clave en español e inglés: ADN de toque, Transferencia de ADN, Contaminación, Trazas, DNA-TTPR, Persistencia del ADN, Perfiles genéticos contaminados. Resultados: se encontraron más de 500 trabajos relacionados a la temática propuesta en esta revisión. El criterio de selección fue el número de citas, el enfoque y el impacto de estos. Se analizaron 71 artículos donde evaluaron la composición de las muestras de contacto y el origen del material genético que contienen. Además, de las metodologías de recolección, análisis de dichas muestras, la importancia que tiene la transferencia y contaminación del ADN en distintos escenarios posibles. Conclusión: existe riesgo de transferencia de ADN que puede conducir a resultados erróneos, por lo tanto es importante asegurar la actualización de los procedimientos de la práctica y brindar la capacitación adecuada para garantizar que el personal policial y del que recolecta indicios sea consciente de los riesgos de contaminación y de los diferentes mecanismos de transferencia de material genético...(AU)

P037 Effect of Ozanimod Treatment and Discontinuation on Absolute Lymphocyte Count in Moderate-to-Severe Ulcerative Colitis: Results from a Phase 3 Trial.

BACKGROUND: Ozanimod is an oral sphingosine 1-phosphate (S1P) receptor modulator selectively targeting S1P1 and S1P5, which reduces migration of lymphocytes involved in adaptive immunity from lymphoid tissues to blood and inflamed tissues while preserving components of the innate immune response. Ozanimod is approved in multiple countries for the treatment of relapsing forms of multiple sclerosis and in the US for the treatment of moderately-to-severely active ulcerative colitis (UC). The reduction of circulating lymphocytes is expected based on the mechanism of action of ozanimod and thought to be an important driver of efficacy. METHODS: We assessed absolute lymphocyte count (ALC) during ozanimod induction and maintenance, and after ozanimod discontinuation, per protocol, in adults with moderately-to-severely active UC to characterize the time course of ALC reduction and recovery. The analysis included patients who received ozanimod 0.92 mg (equivalent to ozanimod HCl 1 mg) or placebo once daily in True North, a phase 3 randomized trial (NCT02435992). During a 10-week induction period, patients were randomized 2:1 to double-blind treatment with ozanimod or placebo (Cohort 1) or received open-label ozanimod (Cohort 2). Patients from either cohort with a clinical response to ozanimod at week 10 were re-randomized 1:1 to double-blind treatment with ozanimod or placebo during maintenance through week 52. Placebo-treated patients with a clinical response at week 10 continued placebo during maintenance. ALC was assessed at baseline and at visits throughout induction and maintenance. RESULTS: A total of 69 patients received continuous placebo treatment, 230 received continuous ozanimod treatment, and 227 received ozanimod during induction and placebo during maintenance. In patients who received continuous placebo, mean ALC remained stable between 1.8‒2.1 x 109/L over time (normal range: 1.02‒3.36 x 109/L). In ozanimod-treated patients, mean ALC was reduced to 43%‒45% of baseline and 70%‒73% of patients had ALC shifts from normal at baseline to low (9/L) at week 10. In patients who continued ozanimod, mean ALC reductions were sustained at approximately the same level and ALC shifts from normal at baseline to low were maintained in 73%‒89% of patients during maintenance. In patients who received ozanimod induction therapy and then were re-randomized to placebo for maintenance, mean ALC recovered within 8 weeks to levels similar to baseline at induction and the proportion of patients with ALC shifts from normal at baseline to low decreased from 73% at week 10 to 6% at week 52. Fewer than 2% of ozanimod-treated patients had ALC 9/L during either induction or maintenance and ALC generally returned to ≥ 0.2 x 109/L while patients remained on ozanimod. Among those who switched from ozanimod induction to placebo maintenance, there were no occurrences of ALC 9/L at the end of maintenance. No patients with a serious/opportunistic infection had concurrent ALC 9/L. CONCLUSION: Consistent with the mechanism of action of ozanimod, ALC reductions occurred during ozanimod induction and were sustained during maintenance. Incidence of ALC 9/L was low. ALC recovered after switching to placebo and most patients did not require treatment discontinuation because of changes in ALC.

Communities on the move: community participation in health in rural territories of Buenaventura District in Colombia.

BACKGROUND: Social and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector. These policies contribute not only to overcoming inequity in the provision of this type of services but also to a reduction in social inequalities as a whole. Through a comparative analysis, this study aimed to explain the conditions through which ethnic-rural territories of the Colombian Pacific coast participate in health to contribute to the generation of policies and programs in territories with similar conditions. METHODS: The work was developed through the use of multiple techniques and strategies for information collection and analysis. These include several semi-structured interviews, multiple observation exercises and analysis based on a set theory, i.e., qualitative comparative analysis (QCA). The latter aims to develop a model that provides a count of the main causal combinations that allow high community participation in health. RESULTS: Key findings include how the trajectory of social mobilization and existence of a robust community social fabric became two critical conditions for community participation in the context of social exclusion. The presence of variables such as the implementation of PHC, guarantee of social rights, and trust in institutions, is underestimated as sufficient causal conditions for obtaining this result. Therefore, it is essential to recognize the existence, validity, and importance of processes, experiences, and resourcefulness of political natures, which aim at transforming the daily reality of the inhabitants of these communities. These also set a potential space and scenario for managing the communities' main problems, including health, in the absence of institutionality that guarantees access to their social rights. CONCLUSION: This study points out the importance of understanding community participation as a political activity, expanding exchange dynamics and dialogs between institutions, rulers, and communities to provide social responses in health and well-being to communities and to understand local realities and their own community dynamics.

In-vitro and ex-situ regional mass spectral analysis of phospholipids and glucose in the vitreous humor from diabetic and non-diabetic human donors.

The causes of vitreous humor (VH) liquefaction remain unclear. Diabetes accelerates this process and other ocular diseases. The weakening of the blood-retina barrier observed with diabetes could enhance the rate of transfer of relatively small molecules such as glucose (Glu) and phospholipids (PLs) from the retina to the VH. Glucose and PLs have been detected previously in VH but their regional distributions are not known. The mapping of Glu and PLs in VHs from subjects with and without diabetes could reveal the roles of these molecules in VH liquefaction. Diabetic and non-diabetic human eyes were acquired from the Kentucky Lions Eye Bank and frozen immediately. Each VH was removed and halved along the sagittal plane. One half was stamped on a matrix assisted laser desorption ionization (MALDI) plate. Either p-Nitroanaline (26 mg/mL MeOH:CHCl3) or 2,5-dihydroxybenzoic acid (20 mg/mL H2O:acetonitrile) was used as matrix. Glu and PLs were extracted from the remaining sections and analyzed. Data were acquired using a MALDI-mass spectrometer. The levels of Glu and PLs were significantly greater in VH from diabetics (VHd) compared with VH from non-diabetics (VHnd). VHds showed the highest relative levels of PLs in the posterior VH, followed by the anterior and central regions. Throughout the entire VH, the most abundant PLs were phosphatidylcholines followed by sphingomyelins. For Glu, the relative intensities were ~3 times higher in the posterior region of VHd (12 ± 1.3) compared with VHnd (6.5 ± 0.7) VHs. Regional studies showed that relative to the posterior VHd, the Glu levels were lower in the anterior (8.1 ± 1.0) and central (6.7 ± 0.8) regions. For the VHnds, the values for the central and anterior regions were 5.9 ± 1.2 and 4.7 ± 0.9, respectively. PLs and Glu are most abundant in the posterior region relative to the central and anterior zones of VHs. This trend was observed in VHd and VHnd, but PLs and Glu levels were significantly higher in VHds. These results support the possibility that higher levels of Glu and PLs accelerate VH liquefaction in diabetic patients. As liquefaction begins in the posterior region, the higher abundance of PLs and Glu in this zone also suggests that they may play a role in liquefaction. The specific molecular interactions affected by Glu and PLs in the collagen/hyaluronan/water network need to be examined.

Violencia sexual en niños y adolescentes varones en el mundo: una revisión integrativa / Sexual violence in male children and adolescents worldwide: An integrative review / Violência sexual em crianças e adolescentes do sexo masculino no mundo: uma revisão integrativa

Objetivo: recopilar, resumir y analizar la producción científica actual sobre la violencia sexual infantil (VSI) en niños y adolescentes varones en el mundo entre el 2014 y el 2019. Método: se realizó una revisión integrativa de literatura mediante una búsqueda sistemática de estudios publicados entre el 2014 y el 2019 en PubMed, LILACS e IBECS. Resultados: se identificaron 990 referencias, de las cuales se seleccionaron 31 artículos para la revisión. La mayoría se realizaron en EE. UU. (n = 18) y otros países desarrollados; solo cinco provienen de países en desarrollo (Brasil, China, India, Jamaica y Suráfrica). Dieciocho estudios usaron metodologías cuantitativas; quince, de tipo transversal. Dos trabajos abordaron menores de 16 años como su población objetivo. Respecto a los objetivos y hallazgos principales, se identificaron cuatro temas recurrentes: caracterización de la VSI, efectos en salud de la VSI (salud mental, salud sexual, comportamientos de riesgo y violencia), revelación de la VSI y análisis de intervenciones terapéuticas. Entre los hallazgos más sobresalientes se refirió que la divulgación del evento constituye un factor protector en el fortalecimiento de la resiliencia frente al abuso. Conclusiones: la VSI genera un impacto negativo en diferentes dimensiones de la salud de la víctima, que trascienden a lo largo de su vida y se profundizan en la medida en que se prolonga el momento de la revelación de los hechos. Más investigaciones son necesarias, principalmente en regiones y países en vías de desarrollo.

Objective: Collect, summarize, and analyze current scientific publications on Child Sexual Violence (CSV) in male children and adolescents worldwide between 2014 and 2019. Method: An integrative review was conducted using a systematic search of studies published between 2014 and 2019 in PubMed, LILACS, and IBECS. Results: Nine hundred and ninety references were identified, from which thirty-one articles were selected for the review. Most of the studies were conducted in the USA (n=18) and other developed countries; only five were conducted in developing countries (Brazil, China, India, Jamaica, and South Africa). Eighteen studies used quantitative methodologies; fifteen were cross-sectional. In two articles, children under 16 years were chosen as the target population. Regarding the main objectives and findings, four recurrent themes were identified: CSV characteristics, effects of CSV on health (mental health, sexual health, risk behaviors, and violence), CSV disclosure, and analysis of therapeutic interventions. Among the findings, the most outstanding was that the disclosure of the event is a protective factor for strengthening resilience against abuse. Conclusions: CSV has a negative impact on different dimensions of the victim's health that transcends throughout his life, and it deepens as the moment of disclosure is delayed. Further research is needed, especially in regions of developing countries.

Objetivo: coletar, resumir e analisar a produção científica atual sobre violência sexual infantil (VSI) em crianças e adolescentes do sexo masculino no mundo entre 2014 e 2019. Método: foi realizada uma revisão integrativa da literatura por meio de uma busca sistemática de estudos publicados entre 2014 e 2019 no PubMed, LILACS e IBECS. Resultados: foram identificadas 990 referências, das quais 31 artigos foram selecionados para a revisão. A maioria foi conduzida nos Estados Unidos (n = 18) e em outros países desenvolvidos; apenas cinco provém de países em desenvolvimento (Brasil, China, Índia, Jamaica e África do Sul). Dezoito estudos utilizaram metodologias quantitativas; quinze, tipo transversal. Dois estudos abordaram crianças menores de 16 anos como população-alvo. Em relação aos objetivos e principais achados foram identificados quatro temas recorrentes: caracterização da VSI, efeitos da VSI na saúde (saúde mental, saúde sexual, comportamentos de risco e violência), revelação da VSI e análise das intervenções terapêuticas. Entre os achados mais destacados, foi colocado que a divulgação do evento constitui um fator de proteção no fortalecimento da resiliência contra o abuso. Conclusões: a VSI gera impacto negativo em diferentes dimensões da saúde da vítima, que transcendem ao longo de sua vida e se aprofundam à medida que se prolonga o momento da revelação dos fatos. Mais pesquisas são necessárias, principalmente em países e regiões em desenvolvimento

An assessment of infant mortality rates in Colombia, 1980-2009 / Una evaluación de las tasas de mortalidad infantil en Colombia, 1980-2009

Abstract Purpose: The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. Methods: The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. Results: The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. Conclusions: The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.

Resumen Propósito: La Tasa de Mortalidad Infantil es un indicador clave del bienestar y desarrollo humano. Sin embargo, en Colombia el Departamento Administrativo Nacional de Estadística reporta una tasa de mortalidad infantil registrada para 2009 de 13.69 por cada 1,000 nacidos vivos, mientras que, la tasa estimada es de 20.13 para el mismo año, como en muchas economías de transición, lo que sugiere la presencia de datos inconsistentes. El objetivo fue determinar la tasa de mortalidad infantil de Colombia desde 1980 a 2009, con los datos disponibles y publicados recientemente. Métodos: El estudio analiza 8 636 510 de registros individuales de nacidos vivos (1998-2009) y 443 338 registros individuales de mortalidad (1979-2009). Además, se incluyen todas las fuentes disponibles: nacimientos y defunciones registrados del Departamento Administrativo Nacional de Estadística (DANE), datos censales, y la Encuesta Nacional de Demografía y Salud (ENDS) de Profamilia Colombia. En primer lugar, tras un análisis descriptivo, se utilizó una función exponencial para estimar las tasas de mortalidad infantil en Colombia para 1980-2009 mientras se resuelven las incoherencias internas en los datos de todas las fuentes, con el objetivo de evaluar la tasa de mortalidad infantil en Colombia 1980-2009. Resultados: El análisis mostró que las tasas registradas y estimadas para 2009 eran incompatibles, debido a que la tasa de descenso de los nacimientos y las defunciones a lo largo del tiempo también eran inconsistentes. Si bien la tasa registrada de 13.69, estaba subestimada frente a la situación real, la tasa estimada de 20.13, parecía estar demasiado sobreestimada. Los análisis basados en otras fuentes muestran que la tasa de mortalidad infantil se encuentra entre 15.81 y 17.58 en 2009, con tasas de descenso anual entre un 3.0 y el 5.0 por ciento, para el período 1980-2009. Conclusiones: El estudio concluye que, durante el período 1980-2009 la tasa de mortalidad infantil para Colombia se redujo de 54 a 17 muertes por mil nacidos vivos, lo que sugiere una tasa anual de descenso aproximada para el período de 4.0 por ciento.

Calcio de 28 mg/dl en paciente de 4 días de vida. Tratamiento urgente y seguimiento posterior / Calcium of 28 mg/dL in patient of 4 days of life. Urgent treatment and follow-up

No disponible

Early adolescent childbearing in Colombia: time-trends and consequences.

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

Impact of desertification and land degradation on Colombian children.

OBJECTIVES: Desertification affected more than 24% of Colombia's land mass in 2012. The study aims to establish the singular impact of desertification on under-five mortality in Colombia. METHODS: Descriptive statistics and multivariate logit regressions are applied to the population of live births and under-five deaths in Colombia 2008-2011. RESULTS: Children have a higher probability to die in rural communities and among mothers with low education who also have inferior health insurance. Controlling for those, desertification below about 50% of the land, lowers child mortality and increases it after that percentage. The impact of extraction of hydrocarbons is 12.45, metals 5.73 and others 4.91 times higher in municipalities with more than 50% of desertification territory. Rural areas with high desertification have 2.25 times higher risk of mortality due to malnutrition. CONCLUSIONS: In the short term, when mines have less or no effect on desertification, living conditions may improve and reduce child mortality. In the long term, however, as desertification intensifies affecting the ecosystem, child mortality increases. More research is needed, and policy formulated accordingly.

An assessment of infant mortality rates in Colombia, 1980-2009.

PURPOSE: The infant mortality rate is a key indicator of human welfare and development. However, in Colombia, the Departamento Administrativo Nacional de Estadística has set the registered rate for 2009 as 13.69 per 1,000 live births, while the estimated rate is 20.13, suggesting the presence of inconsistencies in the data, as in many other transitional economies. Objective: To set the record straight on Colombia's Infant mortality rate reporting since 1980 by using all available data that have recently become public. METHODS: . The study analyzes 8,636,510 records of live births (1998-2009) and 443,338 records of deaths (1979-2009), and considers information from all available sources: births and death registries, census data, Departamento Administrativo Nacional de Estadística, and Profamilia surveys. First, following a descriptive analysis, an exponential function is used to estimate the Infant mortality rates in Colombia for 1980-2009 while resolving internal inconsistencies in the data from all sources. The objective is to evaluate the infant mortality rate in Colombia, 1980-2009. RESULTS: The analysis demonstrates that the registered and the estimated rates for 2009 are incompatible since they follow inconsistent long-term rates of decline in Infant mortality rate. While the registered rate underestimates the real situation, the estimated rate appears to grossly overestimate it. Analyses, based on other sources, put the Infant mortality rate between 15.81 and 17.58 in 2009, with rates of decline between 3.0 and 5.0 percent for the period 1980-2009. CONCLUSIONS: The study concludes that during the period 1980-2009, the Infant mortality rate for Colombia on average fell from about 54 to about 17, suggesting a long-term annual rate of decline of about 4.0 percent.

Early adolescent childbearing in Colombia: time-trends and consequences / Maternidad prematura adolescente en Colombia: tendencias temporales y consecuencias / Gravidez precoce na adolescência na Colômbia: tendências temporais e consequências

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

La maternidad prematura se ha visto incrementada, especialmente entre niñas con edades comprendidas entre los 10 a 14 años, aminorando mejoras en la salud pública y propagando la marginalización social. El objetivo de este artículo es estudiar los embarazos adolescentes en Colombia y sugerir posibles políticas de intervención. El estudio abarca análisis univariados y multivariados que examinan tendencias y correlacionan el parto en la adolescencia y la mortalidad infantil relacionada, en Colombia, durante el periodo de 2001 a 2011, usando estadísticas vitales completas. El estudio compara, también, mediante un análisis de riesgos relativos, a dos grupos de madres adolescentes, con edades de 10 a 14 y edades de 15 a 19 años, con un grupo de referencia, madres con edades de 20 a 34. Durante el período de estudio, la media anual de la tasa de natalidad se incrementó un 2,6% y un 0,8% en madres con edades de 10 a 14 años, y edades de 15 a 19 años, respectivamente, mientras que decreció a una tasa media de 0,2% anualmente en madres con 20-35 años de edad. Simultáneamente, mientras disminuía en general, la tasa de mortalidad infantil (TMI) del grupo más joven fue consistentemente más alta durante todo el período que la TMI de los grupos con mayor edad. Comparadas con otros grupos, las madres con edades entre 10 a 14 años eran más propensas a no estar casadas, ser procedentes del ámbito rural, indígenas o afro-mulatas, y contar con menor acceso a servicios de salud. El estudio demuestra que la maternidad prematura en adolescentes es un desafío creciente, al menos en Colombia. Estas madres tienen un riesgo más alto de perder a sus bebés mientras están en situación de pobreza. El estudio indica la necesidad de políticas que tengan como objetivo una educación apropiada y cuidados de salud, dirigidos a niñas pobres, desde una edad tan temprana como los 10 años o incluso más jóvenes.

A gravidez na adolescência tem crescido, especialmente na faixa etária de 10 a 14 anos, freando avanços na saúde pública e impulsionando a marginalização social. O objetivo deste artigo é estudar a gravidez na adolescência na Colômbia e sugerir possíveis intervenções de políticas públicas. O estudo consiste em análises univariadas e multivariadas que examinam tendências e correlativos da gravidez na adolescência e da mortalidade infantil associada na Colômbia no período de 2001 a 2011 usando estatísticas vitais completas. O estudo compara, também por meio de análise de risco relativo, dois grupos de mães adolescentes, com idade entre 10 e 14 anos e entre 15 e 19 anos, com um grupo de referência, mães com idade entre 20 e 34 anos. Durante o período do estudo, as taxas médias anuais de natalidade aumentaram em 2,6% e 0,8% entre as mães com idade entre 10 e 14 e entre 15 e 19 anos, respectivamente, ao mesmo tempo em que sofreram uma redução, a uma taxa média anual de 0,2%, entre as mães com idade entre 20 e 35 anos. Ao mesmo tempo, a taxa de mortalidade infantil (TMI) do grupo mais jovem foi consistentemente mais alta do que a dos grupos mais velhos, ainda que tenha sofrido uma redução. Quando comparadas aos outros grupos, mães com idade entre 10 e 14 anos tinham maior probabilidade de serem solteiras, indígenas ou Afro-mulatas, viverem em áreas rurais e terem menos acesso a serviços de saúde. Este estudo demonstra que a gravidez precoce na adolescência é um desafio crescente, pelo menos na Colômbia. Essas mães têm risco maior de perderem seus bebês e, simultaneamente, de serem e permanecerem pobres. O estudo sugere a necessidade de políticas dirigidas à educação e serviços de saúde apropriados para meninas pobres a partir dos 10 anos e até mais jovens.

Fonoaudiologia educacional: reflexões acerca da medicalização da educação / Educational Speech, Language Pathology and Audiology: considerations on the medicalization of education / Fonoaudiologia educativa: Reflexiones acerca de la medicalización de la educación

Introdução: Ao longo dos últimos anos, práticas fonoaudiológicas educacionais têm sido direcionadas para identificar alterações de linguagem e aprendizagem do aluno. Diversos profissionais têm debatido esse contexto que, em última instância, se reflete no fracasso escolar. Objetivo: refletir sobre o papel da fonoaudiologia educacional e o processo de medicalização na educação. Método: Pesquisa bibliográfica com uso das palavras chaves: fonoaudiologia educacional e medicalização da educação. Resultados: A escola é considerada promotora de oportunidades para a melhoria na qualidade de vida do cidadão. Para o aluno que não apresenta o desenvolvimento esperado resta o fracasso escolar cujas causas têm sido diagnosticadas por profissionais da saúde vistos como capazes de solucionar o problema. Conclusão: Ao longo dos últimos anos, trabalhos e publicações da área, apesar de uma proposta institucional, continuam a assinalar forte tendência de manter o olhar clínico na Escola. Iniciativas procuram incentivar outras possibilidades de atuação, com vistas a uma parceria junto aos professores e famílias, com ênfase na singularidade do processo de aprendizagem e no papel que a Escola exerce como instituição formadora de cidadãos, tanto na rede regular de ensino, como na educação especial. A atuação do fonoaudiólogo educacional requer conhecimento do contexto educacional e das particularidades da instituição onde está inserido. Só assim as ações a serem desenvolvidas poderão favorecer a cidadania e reverter benefícios para toda comunidade. Essa é a meta daqueles que pensam a Educação para além dos muros da Escola.

Introduction: Over the last few years educational speech-language pathology and audiology practices have been addressed to students to identify any impairment in their language and learning. Several professionals have been debating about this context, which, in the long run, reflects in school failure. Objective: to make considerations about the role of educational speech-language pathology and audiology and of the medicalization process in education. Method: Bibliographical research using the key words: educational speech-language pathology and audiology and medicalization of education. Results: School is considered a promoter of opportunities for improvement of the citizens' quality of life. For the student who does not present the expected development, school failure is what is left and its causes must be diagnosed by health professionals, as they are seen as capable of solving the problem. The performance of the educational speech-language pathologist requires knowledge about the educational context as well as about the specific features of the institution where he is inserted. This is the only way to develop citizenship and to offer benefits to the community as a whole. This is the goal of those who consider Education belongs beyond School walls. Conclusion: Over the last few years research and publications in this area continue to indicate strong tendency to maintain a clinical view of the School, despite institutional proposals. Initiatives seek to urge other possibilities of action, namely partnership with teachers and families, emphasizing the uniqueness of the learning process and the role the School plays preparing citizens, both in the regular education network and in special education.

Introduccion: A lo largo de los últimos años prácticas fonoaudiológicas educativas han sido dirigidas a identificar alteraciones de lenguaje y aprendizaje del alumno. Diversos profesionales debatieron ese contexto que, en última instancia, se refleja en el fracaso escolar. Objetivo: reflexionar el papel de la fonoaudiología educativa y proceso de medicalización en la educación. Método: Investigación bibliográfica con uso de palabras claves: fonoaudiología educativa y medicalización de la educación. Resultados: Escuela considerada promotora de oportunidades para la mejora en la calidad de vida del ciudadano. Para el alumno que no presenta el desarrollo esperado queda el fracaso escolar cuyas causas han sido diagnosticadas por profesionales de la salud vistos como capaces de solucionar el problema. Conclusión: A lo largo de los últimos años trabajos y publicaciones del área, a pesar de una propuesta institucional, siguen señalando fuerte tendencia a mantener mirada clínica en la Escuela. Iniciativas buscan incentivar otras posibilidades educativas, con miras a una asociación con profesores y familias, con énfasis en la singularidad del proceso de aprendizaje y en el papel que la Escuela ejerce como institución formadora de ciudadanos tanto en la red de enseñanza general como en la enseñanza especial. La actuación del fonoaudiólogo educativo requiere conocimiento del contexto educativo y de las particularidades de la institución donde está inserto. Sólo así las acciones a desarrollar podrán favorecer la ciudadanía y revertir beneficios para la comunidad. Esta es la meta de aquellos que piensan la Educación más allá de los muros de la Escuela.