Knowledge, Attitudes, and Practices of Hygiene and the Prevention of Trachoma in the Indigenous Population of the Colombian Amazon Vaupés Department.

The Colombian program to end trachoma implements the component F of the SAFE strategy in the Vaupés department of the Amazon rainforest. Cultural, linguistic, and geographical barriers and the coexistence of an ancestral medical system demand the technical and sociocultural adaptation of this component. A cross-sectional survey combined with focus-group discussions to understand the knowledge, attitudes, and practices of the indigenous population related to trachoma was conducted in 2015. Of the 357 heads of households that participated, 45.1% associated trachoma with a lack of hygiene, and 94.7% associated the concept of hygiene with taking one or more body baths per day, using commercial or handcrafted soap. In total, 93% reported cleaning their children's faces and eyes more often when they have conjunctivitis, but 66.1% also did this with clothes or towels in use, and 52.7% of people shared towels; in total, 32.8% indicated that they would use ancestral medicine to prevent and treat trachoma. The SAFE strategy in Vaupés requires an intercultural approach to facilitate stakeholder support and participation to promote general and facial hygiene, washing clothes with soap, and not sharing towels and clothes to dry and clean children's faces for effective and sustainable elimination of trachoma as a public health problem. This qualitative assessment facilitated an intercultural approach locally and in other Amazonian locations.

C-reactive protein, interleukin-6 and pre-eclampsia: large-scale evidence from the GenPE case-control study.

Multiple small studies have suggested that women with pre-eclampsia present elevated levels of C-reactive protein (CRP) and interleukin-6 (IL-6). However, little is known regarding the source of this CRP and IL-6 increase. Therefore, the aim of this study was to evaluate the relationship between CRP and IL-6 levels with pre-eclampsia considering different confounding factors. Using data from a large Colombian case-control study (3,590 cases of pre-eclampsia and 4,564 normotensive controls), CRP and IL-6 levels were measured in 914 cases and 1297 controls. The association between maternal serum levels of CRP and IL-6 with pre-eclampsia risk was evaluated using adjusted logistic regression models. Pre-eclampsia was defined as presence of blood pressure ≥140/90 mmHg and proteinuria ≥300mg/24 h (or ≥1 + dipstick). There was no evidence of association between high levels of CRP and IL-6 with pre-eclampsia after adjusting for the following factors: maternal and gestational age, ethnicity, place and year of recruitment, multiple-pregnancy, socio-economic position, smoking, and presence of infections during pregnancy. The adjusted OR for 1SD increase in log-CRP and log-IL-6 was 0.96 (95%CI 0.85, 1.08) and 1.09 (95%CI 0.97, 1.22), respectively. Although previous reports have suggested an association between high CRP and IL-6 levels with pre-eclampsia, sample size may lack the sufficient power to draw robust conclusions, and this association is likely to be explained by unaccounted biases. Our results, the largest case-control study reported up to date, demonstrate that there is not a causal association between elevated levels of CRP and IL-6 and the presence of pre-eclampsia.

Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia.

OBJECTIVES: The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. METHODOLOGY: Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). RESULTS: The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9). CONCLUSIONS: Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations.

Antibiotic treatment for ocular toxoplasmosis: a systematic review and meta-analysis: study protocol.

BACKGROUND: Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis, leading to visual impairment in a high proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual impairment by reducing the size of the retinochoroidal scar, the risk of recurrence, and the severity and duration of acute symptoms. Although OT is a very common cause of infectious posterior uveitis, its treatment remains controversial. Through our systematic review and meta-analysis, we aim to provide the best possible evidence-based information on the safety and effectiveness of the different antibiotic regimes for OT. METHODS: This systematic review protocol has been developed based on PRISMA-P guidelines for reporting systematic reviews evaluating health care interventions. We will include all published and unpublished randomized controlled trials (RCTs) comparing different antibiotics used for the treatment of OT. We will consider changes in visual acuity, number of recurrences, improvement or worsening of ocular inflammation, size of lesion, and adverse effects as our outcomes. Screening, data extraction, and quality assessment will be undertaken by two reviewers with disagreements resolved through discussion. Studies that compared antibiotics with placebo will be excluded. The reviews will be assessed for quality and relevance. We will assess the risk of bias in five domains according to Cochrane group's tool. The type of data will dictate measures of treatment effect. We will use a random-effects model to calculate our meta-analysis, as eligible studies represent clinically varied populations of participants. DISCUSSION: The strength of our study will lie in the exhaustive and systematic nature of the literature search, as well as in its methods for assessing quality and analyzing RCT data. Considering the controversial efficacy of the treatment for OT, our study will contribute to improving the existing evidence on the effectiveness of different antibiotics. Future studies may be conducted to increase physicians' awareness of antibiotic therapies, improving the health of patients with OT. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018085468.

Coinfections and differential diagnosis in immunocompetent patients with uveitis of infectious origin.

BACKGROUND: Making a definite diagnosis of infectious uveitis is a challenging task because many other infectious, and non-infectious uveitis, may have similar non-specific symptoms and overlapping clinical appearances. Co-infections in immunocompetent patients are not frequently proved with traditional serologic-diagnostic tools. METHODS: Descriptive transversal study, in a Uveitis Service of an Ophthalmology Reference Center, in Bogotá, Colombia, from July 2014 to February 2016. Aqueous humor (AH) and/or vitreous fluid, blood and serum samples were collected from consecutive patients suspected of having infectious uveitis. The diagnosis of ocular toxoplasmosis (OT) was confirmed by the Goldmann-Witmer coefficient (GWC) and by polymerase chain reaction (PCR). Differential diagnosis by PCR in AH was done for viral origin such as Cytomegalovirus (CMV), Herpes simplex virus type 1 (HSV1), Herpes simplex virus type 2 (HSV2), Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and Mycobacterium tuberculosis. RESULTS: In 66 Colombian patients with uveitis of presumed infectious origin: 22 (33.3%) were confirmed as OT, 16 (24.2%) as undetermined OT, five (7.5%) as co-infections and 23 (34.8%) as other uveitis. Toxoplasma coinfection with M. tuberculosis was identified in one case by PCR and in four cases with HSV by GWC. The initial clinical diagnosis changed, after laboratory examination, in 21 cases (31.8%). CONCLUSIONS: Clinical diagnosis can be changed by laboratory examination in a significant proportion of cases of uveitis. Diagnosis of OT should combine the use of PCR and GWC to reach the maximum of confirmation of cases. The use of multiple laboratory methods is necessary to identify co-infections and viral infections that can mimic OT in immunocompetent patients.

Association of pre-eclampsia risk with maternal levels of folate, homocysteine and vitamin B12 in Colombia: A case-control study.

BACKGROUND: Maternal serum concentrations of folate, homocysteine, and vitamin B12 have been associated with pre-eclampsia. Nevertheless, reported studies involve limited number of cases to reliably assess the nature of these associations. Our aim was to examine the relation of these three biomarkers with pre-eclampsia risk in a large Colombian population. MATERIALS AND METHODS: Design: A case-control study. Setting: Cases of pre-eclampsia and healthy pregnant controls were recruited at the time of delivery from eight different Colombian cities between 2000 and 2012. Population or Sample: 2978 cases and 4096 controls were studied. Maternal serum concentrations of folate, homocysteine, and vitamin B12 were determined in 1148 (43.6%) cases and 1300 (31.7%) controls. Also, self-reported folic acid supplementation was recorded for 2563 (84%) cases and 3155 (84%) controls. Analysis: Adjusted odds ratios (OR) for pre-eclampsia were estimated for one standard deviation (1SD) increase in log-transformed biomarkers. Furthermore, we conducted analyses to compare women that reported taking folic acid supplementation for different periods during pregnancy. Main Outcomes Measures: Odds ratio for pre-eclampsia. RESULTS: After adjusting for potential confounders in logistic regression models, the OR for pre-eclampsia was 0.80 (95% CI: 0.72, 0.90) for 1SD increase in log-folate, 1.16 (95%CI: 1.05, 1.27) for 1SD increase in log-homocysteine, and 1.10 (95%CI: 0.99, 1.22) for 1SD increase in log-vitamin B12. No interactions among the biomarkers were identified. Women who self-reported consumption of folic acid (1 mg/day) throughout their pregnancy had an adjusted OR for pre-eclampsia of 0.86 (95%CI: 0.67, 1.09) compared to women that reported no consumption of folic acid at any point during pregnancy. CONCLUSIONS: Maternal serum concentrations of folate were associated as a protective factor for pre-eclampsia while concentrations of homocysteine were associated as a risk factor. No association between maternal vitamin B12 concentrations and preeclampsia was found.

Toxoplasmosis ocular en Colombia: 10 años de aportes investigativos / Ocular toxoplasmosis in Colombia: 10 years of research contributions

Objetivo: Describir aportes investigativos en Toxoplasmosis ocular, realizados en Colombia. Método: Revisión narrativa de la literatura entre 2007 y 2017 en Toxoplasmosis Ocular (TO) en Colombia, sobre aspectos relacionados con el parásito y con el hospedero. Se incluyeron las revisiones publicadas, así como todos los artículos originales relacionados con diversos temas: epidemiológicos, inmunológicos, clínicos, diagnósticos y terapéuticos a través de PubMed usando los términos MeSH, con la siguiente sintaxis: "(((Colombia[Affiliation]) OR colombia[MeSHTerms]) OR south america[MeSH Terms]) AND "toxoplasmosis, ocular"[MeSH Terms] AND ("2007/01/01"[PDAT] : "2017/12/31"[PDAT]). Adicionalmente se realizaron búsquedas manuales. Resultados: En la búsqueda de la literatura con los términos MESH mencionados, se encontraron 36 artículos, distribuidos en el territorio con 10 en Colombia y 26 en el resto de Suramérica. Se encontraron diferencias importantes relacionadas con el parásito y con el hospedero, al comparar Colombia con el mundo. Las cepas en Colombia son más virulentas (Tipo I/III y atípicas). Se encontró una alta prevalencia de títulos positivos y desarrollo de TO en el país, presentándose el agua y los productos cárnicos como uno de los principales medios de contagio. Se determinó la importancia de péptidos que activan la respuesta inmune humoral en pacientes. Se encontraron diferencias significativas en la severidad clínica (tamaño de las lesiones, grado de inflamación, compromiso macular, compromiso bilateral y recurrencias, siendo mayores para los pacientes colombianos) relacionada con la respuesta inflamatoria producida en el hospedero, asociada con una disminución de los niveles intraoculares de IFN-γ /IL-17 y un aumento de IL-6/Il-13. En los pacientes colombianos el citoquinoma ocular está relacionado con las características clínicas, presentando una respuestaTh 2 relacionada con un compromiso severo ocular. Conclusión: Los aportes investigativos que Colombia ha realizado en TO, han sido de importancia mundial, permitiendo conocer más acerca del tipo de parásito, la epidemiología, la presentación clínica y la respuesta inmune.

Purpose: To describe research contributions in ocular toxoplasmosis performed in Colombia. Method: We conducted a narrative review of the literature on ocular toxoplasmosis (OT) in Colombia between 2007 and 2017 on aspects related to the parasite and to the host. Published reviews were included, as well as all the original articles related to various topics: epidemiological, immunological, clinical, diagnostic and therapeutic through PubMed using the MeSH terms, with the following syntax: "(((Colombia [Affi liation]) OR colombia [MeSH Terms]) OR south america [MeSH Terms]) AND "toxoplasmosis, ocular" [MeSH Terms] AND ("2007/01/01" [PDAT]: "2017/12/31" [PDAT]). Hand searches were also conducted. Results: In the literature search with the MESH terms, 36 articles were found, distributed in the territory with 10 in Colombia and 26 in the rest of South America. Important diff erences were found in the relationship between the parasite and the host when comparing Colombia with the rest of the world. The strains in Colombia are more virulent (Type I / III and atypical) and we found a high prevalence of positive titers and development of OT in the country, with water and meat products as one of the main means of contagion. The importance of peptides that triggered the humoral immune response in patients was determined. Significant differences were found in the clinical severity (with Colombian patients experiencing a greater size of lesions, degree of infl ammation, macular involvement, bilateral involvement, and recurrences) related to the infl ammatory response produced in the host, associated with a decrease in intraocular levels of IFN-γ / IL-17 and an increase of IL-6 / Il-13. In Colombian patients, ocular cytokinome is related to clinical features, presenting a Th 2 response related to severe ocular involvement. Conclusion: Research contributions of OT in Colombia have been of global importance, allowing to know more about the type of parasite, the epidemiology, the clinical presentation, the immune response.

Blended Learning y estilos de aprendizaje en estudiantes universitarios del área de la salud / Blended learning and learning styles in university students of the health areas

El presente artículo describe el desarrollo de un proceso de investigación que dio cuenta del favorecimiento de los estilos de aprendizaje como consecuencia de la interacción de estudiantes universitarios pertenecientes al área de la salud, a través de un ambiente blended learning diseñado desde una perspectiva de aprendizaje experiencial. La investigación se llevó a cabo en dos fases con un enfoque mixto. La primera, a través de una aproximación cuantitativa con un diseño descriptivo y transversal, cuyo propósito fue identificar los estilos de aprendizaje y su correlación con el rendimiento académico. La segunda fase, de corte cualitativo se desarrolló como un estudio de caso, cuyo objetivo fue analizar la percepción de satisfacción y las dificultades de los estudiantes con relación a la estrategia blended learning diseñada. Las conclusiones de la investigación hacen especial énfasis en las relaciones entre estilos de aprendizaje, rendimiento académico, satisfacción y factores que limitan el aprendizaje.

This article described the development of a research study that revealed the encouragement of learning styles as a result of the interaction among university students from a health area, through the blended learning environment designed from an experiential learning perspective. This research study had two phases: the first one was a quantitative approach based on a descriptive cross-sectional design to identify the learning styles and their correlation with academic performance. The second one was qualitative-oriented and developed as a case study to analyze the perception of satisfaction of and the difficulties faced by the students in relation to this blended learning strategy. The final conclusions made special emphasis on the relationships among the learning styles, the academic performance, the level of satisfaction and the factors restricting the learning process.

Aplication of authenticity criteria in mitochondrial studies on archaic bone remains from a prehispanic Muisca population / Aplicación de criterios de autenticidad en estudios mitocondriales en restos óseos de un grupo poblacional muisca prehispánico

Introduction: Ancient DNA (aDNA)studies can support hypotheses regarding ancient populations; molecular studies can analyze the local population’s genetic composition, minimizing biases introduced by later migrations, demographic expansions, mutations, and bottleneck effects. These analyses must be performed with special care because of the low DNA concentrations and contamination risk; therefore, it is necessary to establish protocols to guarantee the reproducibility and veracity of results. Objective: The present study aims to establish a protocol to obtain ancient DNA from 16 pre-Columbian bone samples found in an excavation performed in the area ®Candelaria La Nueva¼ in Bogota, Colombia, dated in the period ®Muisca Tardio¼. Methods: Four founder mitochondrial DNA Amerindian haplotypes were analyzed by high resolution restriction enzyme analyses, obtaining fragments between 121 and 186 base pairs (bp). Different analyses were performed following a strict control of authenticity criteria regarding laboratory conditions, including: positive and negative controls, reproducibility of results, and verification of particular characteristics present in ancient DNA. Results: Results obtained from the bone samples showed the exclusive presence of haplogroup A in the population studied. This data support the statement of the archaeologists of a single biological population in space and time. The distribution of this haplogroup in a 100% frequency supports the hypothesis of Chibcha genetic affiliation. Conclusion: The present study is a contribution to the study of genetic diversity in archaic American populations, allowing the integration of geographic and historic data with genetic characterization techniques associated with linguistic, ethnographic, and glottochronology patterns. Following the protocol proposed in the present study allows fulfilling authenticity criteria for ancient samples with the available techniques.

Introducción: Los estudios de ADN arcaico (aADN) pueden verificar hipótesis sobre las poblaciones del pasado, permiten analizar la composición genética, pudiéndose así soslayar sesgos introducidos por migraciones, expansiones demográficas, mutaciones y cuellos de botella acontecidos con posterioridad. Los métodos de análisis son objeto de cuidadoso procedimiento debido a la dificultad de recuperación y a la posibilidad de contaminación, por lo tanto es necesario establecer protocolos que garanticen la reproducibilidad y veracidad de los resultados. Objetivo: El presente estudio tiene como fin establecer un protocolo para la obtención de ADN arcaico en 16 muestras óseas precolombinas encontradas en una excavación del sector de Candelaria La Nueva, Bogotá, Colombia, fechadas dentro del período Muisca Tardío. Métodos: Se estudiaron 4 haplogrupos fundadores amerindios presentes en el ADN mitocondrial arcaico, mediante enzimas de restricción con base en estudios de alta resolución obteniendo fragmentos de tamaños entre 121 y 186 pares de bases (pb). Los distintos análisis se realizaron observando un estricto control de los criterios de autenticidad en relación con las condiciones de laboratorio, incluyendo el uso de controles y blancos, la reproducibilidad de resultados y la verificación de las características particulares que presenta el ADN arcaico. Resultados: Los resultados obtenidos de las muestras óseas arcaicas establecieron la presencia única del haplogrupo ®A¼ en la población estudiada. Estos datos apoyan la afirmación de los arqueólogos en cuanto a que se trata de una misma población biológica tanto espacial como temporalmente. La distribución de este haplogrupo en una frecuencia del 100% soporta la filiación genética con los grupos chibcha.

Nueva metodología para probar el sistema nervioso autónomo en individuos hipertensos / A new methodology by testing the autonomic system activity in hypertensive individuals

Introducción y objetivo: Actualmente el Sistema Nervioso Autónomo está siendo apuntado como un factor importante en la génesis y desarrollo de la hipertensión arterial sistémica. Por esto, objetivamos estudiar el Sistema Nervioso Autónomo en esta patología, a través de una nueva metodología que utilice la frecuencia cardiaca Metodología: 45 sujetos fueron seleccionados (12 hipertensos y 33 sanos) para verificación de la presión arterial y frecuencia cardiaca a cada latido (2,5 min en reposo y 2,5 min después del ortostatismo). Falsos valores fueron retirados de las series temporales para posterior interpolación, debido a la falta de periodicidad de los latidos cardiacos. Posterior submuestro a 10Hz fue realizado y un filtro que respeta la frecuencia cardiaca fue aplicado. Análisis espectral en las series temporales fue realizado para posterior estimación de medianas y cuartiles. Finalmente, test de hipótesis con Wilcoxon rank sum test para verificar diferencias estadísticas entre grupos fue realizado. Resultados: Las medianas de las potencias porcentuales en las altas frecuencias, pre y post maniobra, de sanos fueron ligeramente inferiores pero no estadísticamente significativas al compararlas con los hipertensos (sanos: 42,69 y 32,39, hipertensos: 46,91 y 33,99). De otro lado, el mismo estimador en las bajas frecuencias fue levemente superior en sanos (sanos: 57,30 y 67,60 e hipertensos: 53,09 y 66). Adicionalmente, la diferencia en la respuesta autonómica de los hipertensos no fue significativa (p>0,01) mientras que en los sanos esto si ocurrió. Conclusiones: El método ha demostrado potencial para identificar disfunción del autónomo en hipertensión. También se confirma una activación del simpático disminuida en sujetos hipertensos cuando se realiza una maniobra ortostática.

Introduction and objective: Currently the Autonomous Nervous System has been considered as an important factor in the genesis and the development of Arterial Systemic Hypertension. Because of that, aimed to study the Autonomous Nervous Sistem in this pathology through a new methodology which uses heart rate. Methodology: 45 subjects were selected (12 hypertensive and 31 healthy) to check the arterial pressure and heart rate beat by beat (2.5 min in rest and 2.5 min after the orthostatism) spurious values were retired from temporal series for interpolation because the lack of heart rate periodicity. Then, sub sampling in 10Hz was realized and a filter that respect the heart rate was applied. Spectral analysis in the temporal series was realized by posterior median and quartile estimation. Finally, hypothesis test with Wilcoxon rank sum test to check statistical differences between groups was performed. Results: The medians of the percentage powers by the high frequencies, pre and post maneuver, in healthy individuals were a few inferior but not with statistical significance when are compared with hypertensive individuals (healthy:42.69 and 32.39; hypertensive:46.91 and 33.99). On the other hand, the same estimator by the low frequencies was a few superior in healthy individuals (healthy: 57.30 and 67.60; hypertensive: 53.09 and 66). Additionally, the difference in the autonomic response between hypertensive individuals was not significative (p>0.01) meanwhile in healthy individuals do. Conclusions: The methodology had demonstrated potential to identify autonomic disfunction in hypertensive. Also, it confirms a lower sympathetic activation in hypertensive individuals when the orthostatic maneuver is done.

Factores de riesgo de los trastornos de la conducta alimentaria en jóvenes escolarizados en Cundinamarca (Colombia) / Risk factors for eating disorders among school-aged young people in Cundinamarca (Colombia)

Introducción: El diagnóstico precoz de un trastorno de la conducta alimentaria (TCA) es determinante para evitar complicaciones graves a lo largo de la vida. Pocos estudios en Colombia han examinado sus características clínicas y comorbilidad en la población escolar. Objetivo: Determinar la frecuencia de TCA, sus factores de inicio y mantenimiento, así como sus subtipos clínicos y comorbilidad en una población escolarizada. Método: Estudio de base comunitaria y corte transversal con 937 estudiantes entre 12 y 20 años de edad, de Bogotá y la sabana centro de Cundinamarca, que respondieron la EAT-26, encuesta de factores de inicio y mantenimiento de TCA, y la Zung de ansiedad y depresión. Los casos probables fueron contactados para entrevista clínica psiquiátrica. Resultados: Se detectaron 141 casos probables de TCA, la mayoría en mujeres (p<0,01). El 38,3% de ellos aceptó entrevista psiquiátrica. Se realizó diagnóstico clínico de TCA en el 53,7% de los entrevistados, sin diferencias por estrato socioeconómico ni grupos de edad. El subtipo no especificado estuvo presente en el 93%. Se encontró comorbilidad con trastornos depresivos y ansiosos, así como conductas suicidas más frecuentes en adolescentes con diagnóstico clínico de TCA que en aquellos sin diagnóstico psiquiátrico y con otros trastornos (p=0,019). Conclusión: Los TCA ocurren desde edades tempranas. Existe una alta tasa de comorbilidad con trastornos afectivos y conductas suicidas...

Introduction: The early diagnosis of Eating Disorders (ED) is decisive in order to prevent serious complications during lifetime. In Colombia, few studies have assessed the clinical characteristics and comorbidity of ED in students. Objective: To determine the frecuency of ED, its onset and maintenance factors, as well as its clinical subtypes and comorbidity in student population. Method: Cross sectional and community based study with 937 students, ages 10 to 12, from Bogotá and Sabana Centro-Cundinamarca, who answered the EAT- 26, a survey on onset and maintenance factors for ED, and the Zung depression and anxiety scales. Results: 141 probable cases of ED were detected, predominantly among women (p<0.01). 38.3% of them accepted clinical psychiatric evaluation. ED was clinically diagnosed in 53.7% of the cases, without significant differences regarding socioeconomic level or age groups; subtype not otherwise specified in 93%. Comorbidity with depression and anxiety disorders was also found; similarly, suicidal behaviors were more frequent in adolescents with clinical diagnosis of ED than in those without psychiatric diagnosis or in those with other psychiatric disorders (p=0.019). Conclusions: ED occurs since early ages. Comorbidity with affective disorders and suicidality is high...

Genética de la preeclampsia / Genetics of preclampsia

La preeclampsia es un trastorno hipertensivo específico del embarazo y es una de las principales causas de morbilidad y mortalidad materna y neonatal en todo el mundo, afectando 5 a 7% de todos los embarazos. En Colombia es la primera causa de morbilidad y mortalidad materna, siendo un problema de salud pública. Muchas investigaciones coinciden en que su origen se relaciona con la interacción entre factores genéticos y ambientales. Múltiples estudios han explorado factores genéticos tratando de identificar regiones cromosómicas y genes candidatos cuyas variantes se relacionen con una mayor susceptibilidad a la enfermedad. La presente revisión ofrece una visión general de los factores genéticos asociados a la preeclampsia.

Preeclampsia is a hypertensive disorder that occurs only during pregnancy and is one of the main causes of maternal and neonatal morbidity and mortality, affecting 5-7% of pregnancies. In Colombia it is the primary cause of maternal morbidity and mortality, and an important public health issue. Many investigations agree that its origin is related to the interaction of genetic and environmental factors. Numerous studies have explored genetic factors in attempt to identify chromosomal regions and candidate genes, variants of which are related with increased susceptibility to the disease. This review offers a general vision of the genetic factors associated with preeclampsia.

Validez y confiabilidad de la versión en español del instrumento Escala de medición del proceso de afrontamiento y adaptación de Callista Roy / Validity and Confidence Level of the Spanish Version Instrument of Callista Roy Coping Adaptation Processing Scale

El objetivo del presente estudio fue determinar, mediante una investigación metodológica, la validez facial y la confiabilidad (consistencia interna y estabilidad) de la versión en español del instrumento Escala de Medición del Proceso de Afrontamiento y Adaptación (ESCAPS) de Callista Roy, con el fin de evaluar su comportamiento y dominio.La escala, denominada en inglés Coping Adaptation Processing Scale (CAPS), fue diseñada por Callista Roy en el año 2004 (1), con el fin de identificar las estrategias de afrontamiento y adaptación que la persona utiliza para hacer frente a situaciones difíciles o críticas. Está integrada por 47 ítems agrupados en cinco factores, con una calificación Likert de cuatro puntosPara establecer la validez facial se utilizaron dos métodos; el primero correspondió a un panel de expertos, quienes evaluaron el instrumento considerando tres criterios de calificación: claridad, precisión, comprensión; al respecto se encontró que 45 (96 por ciento) del total de los 47 ítems del instrumento cumplieron estos criterios. El segundo correspondió a cinco sujetos de estudio quienes evaluaron el instrumento en su totalidad, determinando su comprensión. De esta forma se estableció que el instrumento aparenta tener validez facial.Para establecer la confiabilidad del instrumento, éste se aplicó a una muestra de 417 sujetos mayores de cincuenta años, con una función mental intacta, procedentes del municipio de Chía y la ciudad de Bogotá, durante el periodo comprendido entre agosto de 2005 a marzo de 2006, quienes fueron escogidos mediante un muestreo aleatorio por conveniencia. La confiabilidad se evaluó a través de la consistencia interna, con un Alta de Cronbach de 0,88, y la estabilidad se midió a través del coeficiente de correlación de Spearman (r = 0,94) para el total del instrumento y un Anova con un valor de probabilidad (p=NS) estadísticamente no significativo, confirmando la estabilidad de los puntajes obtenidos a través del tiempo.Los res...

Angiotensin-converting enzyme I/D polymorphism and preeclampsia risk: evidence of small-study bias.

BACKGROUND: Inappropriate activation of the renin-angiotensin system may play a part in the development of preeclampsia. An insertion/deletion polymorphism within the angiotensin-I converting enzyme gene (ACE-I/D) has shown to be reliably associated with differences in angiotensin-converting enzyme (ACE) activity. However, previous studies of the ACE-I/D variant and preeclampsia have been individually underpowered to detect plausible genotypic risks. METHODS AND FINDINGS: A prospective case-control study was conducted in 1,711 unrelated young pregnant women (665 preeclamptic and 1,046 healthy pregnant controls) recruited from five Colombian cities. Maternal blood was obtained to genotype for the ACE-I/D polymorphism. Crude and adjusted odds ratio (OR) and 95% confidence interval (CI) using logistic regression models were obtained to evaluate the strength of the association between ACE-I/D variant and preeclampsia risk. A meta-analysis was then undertaken of all published studies to February 2006 evaluating the ACE-I/D variant in preeclampsia. An additive model (per-D-allele) revealed a null association between the ACE-I/D variant and preeclampsia risk (crude OR = 0.95 [95% CI, 0.81-1.10]) in the new case-control study. Similar results were obtained after adjusting for confounders (adjusted per-allele OR = 0.90 [95% CI, 0.77-1.06]) and using other genetic models of inheritance. A meta-analysis (2,596 cases and 3,828 controls from 22 studies) showed a per-allele OR of 1.26 (95% CI, 1.07-1.49). An analysis stratified by study size showed an attenuated OR toward the null as study size increased. CONCLUSIONS: It is highly likely that the observed small nominal increase in risk of preeclampsia associated with the ACE D-allele is due to small-study bias, similar to that observed in cardiovascular disease. Reliable assessment of the origins of preeclampsia using a genetic approach may require the establishment of a collaborating consortium to generate a dataset of adequate size.

Medio familiar y entorno escolar: detonantes y antídotos de las conductas agresivas en niños en edad escolar / Medio familiar y entorno escolar: detonantes y antídotos de las conductas agresivas en niños en edad escolar

Se realizó una investigación-acción participativa en 32 niños en edad escolar, con conductas agresivas, del Colegio General Santander de Chía, para observar cómo influye el medio familiar y escolar en las conductas agresivas de los niños, y plantear alternativas para modular dichas conductas. El estudio indagó, en niños y padres de familia, factores determinantes de las conductas agresivas. Se evaluaron el tipo de estructura familiar, las personas responsables del cuidado de los niños, las condiciones de vivienda, el hacinamiento, el nivel de escolaridad, la situación laboral, los métodos correctivos y el consumo de alcohol por parte de los padres o cuidadores, como variables determinantes del medio familiar. Se encontró que los determinantes que influyeron en las manifestaciones agresivas de los niños, en este caso, fueron: el tipo de estructura familiar, el bajo nivel de escolaridad de los padres, y las personas responsables de la educación y cuidado de los niños; y en relación con el medio escolar, la fuente de imitación de conductas agresivas.

Medio familiar y entorno escolar: detoantes y antídotos de las conductas agresivas en niños en edad escolar / Average relative and scholastic surroundings: detonating and antidotes of the aggressive conducts in children in scholastic age

Se realizó una investigación-acción participativa en 32 niños en edad escolar, con conductas agresivas, del Colegio General Santander de Chía, para observar cómo influye el medio familiar y escolar en las conductas agresivas de los niños, y plantear alternativas para modular dichas conductas. El estudio indagó, en niños y padres de familia, factores determinantes de las conductas agresivas. Se evaluaron el tipo de estructura familiar, las personas responsables del cuidado de los niños, las condiciones de vivienda, el hacinamiento, el nivel de escolaridad, la situación laboral, los métodos correctivos y el consumo de alcohol por parte de los padres o cuidadores, como variables determinantes del medio familiar. Se encontró que los determinantes que influyeron en las manifestaciones agresivas de los niños, en este caso, fueron: el tipo de estructura familiar, el bajo nivel de escolaridad de los padres, y las personas responsables de la educación y cuidado de los niños; y en relación con el medio escolar, la fuente de imitación de conductas agresivas

Endothelial NO synthase genotype and risk of preeclampsia: a multicenter case-control study.

Polymorphisms in the endothelial NO synthase (eNOS) gene have been evaluated as risk factors for preeclampsia. However, data from small studies are conflicting. We assessed whether eNOS genotypes alter the risk of preeclampsia in a population in which the incidence of this disorder is high. A total of 844 young pregnant women (322 preeclamptic and 522 controls) were recruited from 5 cities. Genotyping for the Glu298Asp, intron-4 and -786T-->C polymorphisms in the eNOS gene was conducted. Multivariate odds ratios (ORs) were obtained to estimate the association of individual polymorphisms and haplotypes with preeclampsia risk. No increase in the risk of preeclampsia for the intron-4 or -786T-->C polymorphisms was observed under any model of inheritance. In contrast, in women homozygous for the Asp298 allele, the adjusted OR for preeclampsia was 4.60 (95% confidence interval [CI], 1.73 to 12.22) compared with carriers of the Glu298 allele. After a multivariate analysis, carriage of the "Asp298-786C-4b" haplotype was also associated with increased risk of preeclampsia (OR, 2.11 [95% CI, 1.33 to 3.34]) compared with carriers of the "Glu298-786T-4b" haplotype. The eNOS Glu298Asp polymorphism and the Asp298-786C-4b haplotype are risk factors for preeclampsia.

Relación entre las características de los cuidadores familiares de pacientes con discapacidad y la percepción de su estado de salud / The relation between the characteristics of the family caretakers of disable patients and the perception of their current state of health

En este artículo se presentan los resultados de la investigación Relación entre las características de los cuidadores familiares de pacientes con discapacidad y la percepción de su estado de salud, cuyo propósito fue establecer la relación que existe entre la percepción de la salud física, emocional y los estresores del cuidado y las características de un grupo de cuidadores de pacientes que se habían vinculado recientemente al programa de rehabilitación integral de la Clínica Universitaria Teletón. Los hallazgos revelan en esta primera fase del tratamiento, que los cuidadores en su mayoría identifican un compromiso ligero de su estado de salud física y emocional, los cuales no se correlacionan en forma significativa con su edad. Llama la atención que se encuentra un compromiso importante en estresores del cuidado, como son las condiciones de salud del paciente, la modificación del trabajo y del rol habitual, la falta de actividades recreativas y trastornos del sueño. Estos resultados muestran la necesidad de establecer programas de promoción y prevención dirigidos a los cuidadores, que deben iniciarse simultáneamente con el programa de rehabilitación del paciente, para evitar los sentimientos de sobrecarga y alteración de la salud que puedan sobrevenir más adelante.

This article presents the research results of the Relation between the characteristics of the family caretakers of disable patients and the perception of their current state of health. The purpose was to establish the relationship that exists between the perception of physical and emotional health, and the care stress factors, as well as the characteristics of a group of caretakers that have joined recently the integral Rehabilitation Program at the Teletón University Clinic. The findings reveal that in the first stages of treatment, most caretakers show a slight compromise regarding their physical and emotional health, which do not correlate significantly with their age. It draws one's attention...

Evaluación de un modelo de educación continuada para médicos generales y de urgencias de la Secretaría Distrital de Salud de Bogotá D.C. / Evaluation of a continuing education model for general and emergency physicians of the Secretaría Distrital de Salud de Bogotá D.C. (District Health Secretariat of Bogotá D.C.)

Introducción: la educación continuada permite de manera simultánea la motivación de la persona y la actualización del conocimiento médico, partiendo del concepto de que el conocimiento comparte al mismo tiempo información y estructura mental de significados que le dan sentido (1). Objetivos: desarrollar y evaluar un modelo de educación continuada para médicos generales de consulta externa y urgencias que laboran en instituciones prestadoras de servicios de salud del I y II nivel de complejidad correspondientes a la red centro oriente del Distrito Capital. Metodología: el método utilizado fue el de intervención observacional antes-después, lo cual permitió determinar la diferencia en el nivel de conocimientos, aplicación de los mismos a casos clínicos y el nivel de motivación, antes y después de las 56 sesiones educativas realizadas con base en el modelo diseñado por la Fundación Universitaria Ciencias de la Salud, en el cual se integran el aprendizaje significativo, la evidencia científica y la educación de adultos. El universo estaba conformado por 96 médicos y la muestra fue seleccionada teniendo como criterios de inclusión la participación voluntaria, realizar evaluaciones anónimas y asistir por lo menos al 80% de las sesiones, lo cual fue cumplido por 50 médicos. Resultados: el análisis de los resultados muestra que las diferencias entre el pretest y el postest en los conocimientos son estadísticamente significativas excepto en cinco de los 56 temas. Con relación a la motivación los participantes manifestaron que la metodología fue apropiada y el 96.2% de los asistentes reportó que el curso aumenta sus perspectivas de desarrollo profesional y los estimula para la lectura y la aplicación de la evidencia científica a la práctica médica reafirmando lo manifestado por Erazo (1) cuando expresa que "El quehacer educativo presupone una concepción del hombre y de la sociedad que conjuntamente con la psicológica, explique lo relacionado con el aprendizaje y la formación de intereses para el desarrollo de la personalidad".

Introduction: continuing education allows simultaneously the motivation of the person and the updating of medical knowledge, based on the concept that knowledge shares at the same time information and mental structure of meanings that give it meaning (1). Objectives: to develop and evaluate a continuing education model for outpatient and emergency general practitioners working in institutions providing health services at the first and second level of complexity corresponding to the central-eastern network of the Capital District. Methodology: the method used was the before-after observational intervention, which allowed determining the difference in the level of knowledge, its application to clinical cases and the level of motivation, before and after the 56 educational sessions carried out based on the model designed by the Fundación Universitaria Ciencias de la Salud, which integrates significant learning, scientific evidence and adult education. The universe was made up of 96 physicians and the sample was selected based on the inclusion criteria of voluntary participation, anonymous evaluations and attendance to at least 80% of the sessions, which was met by 50 physicians. Results: the analysis of the results shows that the differences between pretest and posttest in knowledge are statistically significant except in five of the 56 subjects. Regarding motivation, the participants stated that the methodology was appropriate and 96.2% of the attendees reported that the course increased their professional development perspectives and stimulated them to read and apply scientific evidence to medical practice, reaffirming Erazo's (1) statement that "the educational task presupposes a conception of man and society which, together with the psychological one, explains what is related to learning and the formation of interests for the development of the personality".