The public health challenges of female migration: the Venezuelan diaspora in Andean countries.

BACKGROUND: Venezuelan migration has experienced an unprecedented increase in the last decade, with approximately 7.7 million Venezuelan-born individuals residing in other countries as of 2024. Our study aims to identify the potential and actual demand for healthcare services (SRH) in the Venezuelan diaspora's four primary destinations within the Andean Countries: Colombia, Ecuador, Peru, and Chile. METHODS: Using official data from administrative records, censuses, and sample surveys reported by the host countries and international agencies, we estimate the annual evolution of Venezuelan-born women of reproductive age (WRA) and their offspring. Additionally, we conduct two case studies focusing on Colombia and Chile to analyse the groups most vulnerable to unmet health needs. RESULTS: The population of WRA has increased to between 5 and 6.8%, and births have risen to approximately 3-8% in host countries due to Venezuelan migration. Yet, we found a general decrease in health coverage for certain age groups of Venezuelan female migrants in host countries for the period 2017-2022, particularly in Chile. By 2022, an estimated 20% of healthcare needs remained unmet among children, girls, and younger Venezuelan women, contributing to greater health inequalities between Venezuelan-born adolescents and those from other countries of birth. CONCLUSIONS: Our findings highlight the escalating demand for and limited access to healthcare services among Venezuelan WRA in their destinations. Unmet healthcare needs are particularly prevalent among younger women by 2022, underscoring the urgency for health system to incorporate gender-responsive, equitable interventions and ensuring health rights for high-risk migrant groups such as infants, children, adolescents, and younger women. Addressing these challenges remains a critical task for the regional public health agenda in Latin America.

Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia.

BACKGROUND: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. OBJECTIVES: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. METHODS: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. RESULTS: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. CONCLUSIONS: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Descripción de un Programa de Telesalud Mental en el Marco de la Pandemia de COVID-19 en Colombia / Description of a Telehealth Mental Health Programme in the Framework of the COVID-19 Pandemic in Colombia

RESUMEN Introducción: En el LivingLab de la Facultad de Medicina de la Universidad de Antioquia se diseñó un programa de telesalud mental. Objetivo: Describir el desarrollo y el funcionamiento del programa y evaluar la satisfacción de los pacientes atendidos en 2020 y 2021 durante la pandemia de COVID-19. Métodos: Estudio descriptivo que detalla el desarrollo del programa. Se extrajeron los datos de las historias clínicas para describir a los pacientes atendidos. Se aplicó una escala de satisfacción a una muestra aleatoria y se resumieron los datos con estadística descriptiva. Resultados: Durante marzo de 2020 y agosto de 2021, se atendió a 10.229 pacientes con 20.276 atenciones por telepsicología y 4.164 por psiquiatría, 1.808 en la modalidad de telepsiquiatría y 2.356 en la de teleexperticia, con un total de 6.312 atenciones. Los diagnósticos más frecuentes fueron trastornos depresivos (36,8%), ansiosos (12,0%) y psicóticos (10,8%). Los encuestados se mostraron satisfechos, al punto de que más del 93% recomendaría el programa a otra persona. Conclusiones: El programa de telesalud mental del LivingLab permitió la atención de pacientes de Antioquia con problemas y trastornos mentales durante los primeros 2 años de la pandemia de COVID-19 y los beneficiarios mostraron un alto grado de satisfacción, por lo que podría adoptarse para la atención en salud mental.

ABSTRACT Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. Results: In March 2020 and August 2021,10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Invarianza factorial del cuestionario How I Think en adolescentes peruanos según el sexo / Factorial invariance according to sex of the How I Think Questionnaire in Peruvian adolescents

Resumen Desde el surgimiento de la psicología cognitiva, las cogniciones han tomado gran relevancia para explicar una gran variedad de fenómenos psicológicos. Un constructo que ha sido empleado en el ámbito clínico y forense es el de las distorsiones cognitivas que tiene poder predictivo sobre la conducta violenta. Las distorsiones cognitivas se definen como cogniciones irracionales y negativas: pensamiento egocéntrico, culpar a los demás, minimización y asumir lo peor. Para evaluar las distorsiones cognitivas se ha empleado el cuestionario How I Think ("Cómo pienso"), que ha sido validado para población hispanoparlante, pero no contaba con una versión validada en Perú. La presente investigación tuvo como objetivo analizar las propiedades psicométricas de una prueba que evalúa las distorsiones cognitivas en una muestra de adolescentes de la ciudad de Arequipa, Perú. Se evaluó a 2803 estudiantes nivel secundario (48.9 % mujeres y 51.1 % varones) entre 13 y 19 años, a través del cuestionario How I Think de Barriga y Gibbs (1996). El procesamiento psicométrico implicó el análisis de la validez por medio del análisis factorial confirmatorio, la confiabilidad por el método de consistencia interna y la invarianza factorial según el sexo. Los resultados psicométricos indican que la prueba tiene validez de constructo con tres factores: culpar a los demás/asumir lo peor, la minimización y el egocentrismo. También tiene índices de confiabilidad adecuados y no presenta sesgos entre varones o mujeres. Se concluye que el cuestionario How I Think es un instrumento válido y confiable para evaluar a los adolescentes peruanos, aunque presenta variaciones con respecto a su estructura original.

Abstract Since the consolidation of the cognitive psychology and its diffusion around the world, the cognitions have taken a place of great relevance in order to explain a large variety of psychological events and phenomena. Nowadays the cognitive psychology is the dominant paradigm in the wide world of psychology, including obviously the Ibero-american countries. One construct that had been used in the field of clinical and forensic psychology is related to cognitive distortions, which have predictive power over the violent and aggressive behavior in children, adolescents, and adult people (Peña & Andreu, 2012). The cognitive distortions can be defined as a kind of negative and irrational cognitions (Ellis, 1999) that are used to explain or justify the aggressive behavior, and they are also linked to delinquent behavior (Roncero et al., 2016). Cognitive distortions can be classified in two types: self-serving and self-debasing cognitive distortions. In the first case, there are four types of self-serving cognitive distortions: Self-centered, Blaming others, Minimizing/Mislabeling, and Assuming the worst. In the second case, there are also four self-debasing cognitive distortions: Catastrophizing, Overgeneralizing, Personalizing, and Selective abstraction. Both types have great influence in people's beliefs, emotions, attitudes, and behaviors (Barriga et al., 2008). Several instruments have been applied to measure cognitive distortions. Some of them are orientated to measure the self-serving cognitive distortions and some others are orientated to measure the self-debasing type, such as The Cognitive Errors Questionnaire or The Automatic Thoughts Questionnaire. One of the most used tests to assess the self-serving cognitive distortions is the How I Think Questionnaire, that has been validated in Spanish-speaking population such as Spain, with adequate goodness of fit indexes and reliability; but there is not a validated version in Peru (Rojas et al., 2019). The present research pretends to analyze the psychometrical properties of the How I Think Questionnaire, a mental test that measures the cognitive distortions. Following that aim, this instrument was applied in a sample of adolescents from Arequipa (Peru), comprised of 2 803 middle and upper High School students (48.9 % female and 51.1 % male) between 13 and 19 years old. The version used of the How I Think Questionnaire was the one developed and validated by Barriga and Gibbs (1996), which has 54 items with five levels of Likert's scale response. The psychometrical process implies the analysis of validity by confirmatory factor analysis, reliability by the internal consistency method, and factorial invariance according to the sex of the adolescents that participated in the sample. The psychometrical results indicate that the How I Think Questionnaire possesses construct validity with three factors: Blaming others/Assuming the worst (which contains two factors from the original version), Minimizing and Self-Centered. It also has adequate reliability indexes, estimated by McDonald's Omega Test, and there are no trends to male or female scores according to the factorial invariance applied, taking sex as a comparison criterion. It is concluded that the How I Think Questionnaire is a valid and reliable instrument to assess Peruvian adolescents who live in Arequipa, although it presents some variations compared to its original structure. And the How I Think Questionnaire can be applied in male and female adolescents from Arequipa without the risk of biased scores. However, it is recommendable to perform new psychometric studies that include adolescent's samples from all of Peru to obtain a standardized version for the Peruvian population that could be used in several fields of psychological work. The version presented in this research is a useful instrument to assess cognitive distortions in educational, social, and forensic psychology, by mental health specialists in Arequipa Metropolitan City.

Invarianza factorial según sexo del Cuestionario de Agresión Proactiva y Reactiva en adolescentes peruanos / Reactive Proactive Aggression Questionnaire and its factorial invariance according to sex in Peruvian adolescents

Introducción: en esta investigación se analiza la validez, confiabilidad e invarianza del Cuestionario de Agresión Reactiva/Proactiva. Método: el estudio fue de tipo instrumental. Se evaluó a 2803 adolescentes, de los cuales 48.9% fueron mujeres 51.1% varones de la ciudad de Arequipa. Se aplicó el Cuestionario de Agresión Reactiva Proactiva (RPQ). Resultados: la prueba obtuvo índices de bondad de ajuste adecuados y se confirmó la estructura bifactorial mediante el análisis factorial confirmatorio. La prueba presentó invarianza escalar y estricta en función al sexo de los estudiantes evaluados, de modo que los varones muestran una mayor agresividad reactiva y proactiva que las mujeres. Las medidas de confiabilidadfueron satisfactorias. Conclusión: el RPQ es válido con una estructura de dos factores, además es invariante en función al sexo de los evaluados.

Introduction: in this research, we analyze the validity, reliability and invariance of the Reactive/Proactive Aggression Questionnaire. Method: the study was an instrumental sort of. We assessed 2803 adolescents, 48.9% female and 51.1% male from Arequipa City. The Reactive/Proactive Aggression Questionnaire (RPQ) was applied. Results: the test obtained adequate levels of goodness of fit and the bifactorial structure was confirmed by a confirmatory factor analysis. The test presented scalar and strict invariance based on the sex of the evaluated students, so men showed greater reactive and proactive aggressiveness than women. Reliability measures were satisfactory. Conclusion: the RPQ is valid with a two-factor structure; it is also invariant depending on the sex of those evaluated.

Barriers to Access to Palliative Care in Colombia: A Social Mapping Approach Involving Stakeholder Participation.

This study aimed to identify barriers to access to palliative care through a social mapping approach. In Colombia, the barriers to access to palliative care denote an enormous geographic disparity of resources and health needs, making it necessary to conduct community-based participatory research using an approach such as social mapping. A qualitative research design was used. Stakeholders from health insurance companies, regulatory authorities, regional health secretariats, health care professionals, patient and caregiver organizations, scientific societies, and medical journalists from 7 Colombian regions participated. It involved 3 stages. Stage 1: Semi-structured, audio-recorded interviews were conducted with 36 stakeholders and were subsequently transcribed and analyzed. Stage 2: An electronic survey was conducted to obtain feedback on the first outline of the map and the categories that emerged from stage 1. Stage 3: The nominal group technique was used to analyze and validate the barriers to access to palliative care included in the final map. The COREQ checklist was used. Twenty-seven barriers to access to palliative care related to limited availability of medications, stakeholders' poor knowledge of regulations, limited formal education in palliative care, few patients' support networks, patient care fragmentation, few specialized programs of palliative care, and mistaken beliefs about palliative care were identified. Stakeholders' diverse perspectives and opinions were crucial to understanding the development of palliative care in Colombia and its challenges. Better knowledge about palliative care can open opportunities to overcome the barriers identified in this study, directly impacting access to palliative care.

[Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia]. / Descripción de un programa de telesalud mental en el marco de la pandemia de COVID-19 en Colombia.

Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.Results: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.

Substance Use-Related Cognitive Decline in Families with Autosomal Dominant Alzheimer's Disease: A Cohort Study.

BACKGROUND: Cigarette smoking is a known risk factor for Alzheimer's disease (AD). However, the association between neurodegeneration and other substances has not been fully determined. It is of vital importance to evaluate this relationship in populations at high risk of dementia. Since substance use possibly modifies the progression rate of cognitive decline, we studied this association in a unique and well-phenotyped cohort from the University of Antioquia: carriers of the PSEN1-E280A genetic variant. OBJECTIVE: To determine the association between substance use and cognitive decline in carriers of the PSEN1-E280A genetic variant. METHODS: A retrospective cohort study was conducted with 94 carriers and 69 noncarriers recruited between January 2019 and April 2020. A psychiatrist interviewed the participants using the Consumption of Alcohol, Cigarettes and other Substances questionnaire. The participants were also submitted to cognitive evaluation. The relationship between cognitive decline and substance use was explored through a mixed effects regression model. RESULTS: There was an association between cigarettes and better performance on tasks related to perceptual organization, verbal fluency, and memory in carriers. Alcohol had a positive or negative effect on memory according to the type of alcoholic beverage. Results on marijuana use were no conclusive. Coffee was associated with progressive improvements in executive function and verbal fluency. CONCLUSION: Cigarette and alcohol were associated with an improvement of some cognitive assessments, possibly by a survival bias. In addition, coffee was related to improvements in executive function and language; therefore, its short-term neuroprotective potential should be studied.

An Integrated View of Virus-Triggered Cellular Plasticity Using Boolean Networks.

Virus-related mortality and morbidity are due to cell/tissue damage caused by replicative pressure and resource exhaustion, e.g., HBV or HIV; exaggerated immune responses, e.g., SARS-CoV-2; and cancer, e.g., EBV or HPV. In this context, oncogenic and other types of viruses drive genetic and epigenetic changes that expand the tumorigenic program, including modifications to the ability of cancer cells to migrate. The best-characterized group of changes is collectively known as the epithelial-mesenchymal transition, or EMT. This is a complex phenomenon classically described using biochemistry, cell biology and genetics. However, these methods require enormous, often slow, efforts to identify and validate novel therapeutic targets. Systems biology can complement and accelerate discoveries in this field. One example of such an approach is Boolean networks, which make complex biological problems tractable by modeling data ("nodes") connected by logical operators. Here, we focus on virus-induced cellular plasticity and cell reprogramming in mammals, and how Boolean networks could provide novel insights into the ability of some viruses to trigger uncontrolled cell proliferation and EMT, two key hallmarks of cancer.

Clúster de síntomas en insuficiencia cardiaca avanzada: una revisión sistemática / Symptom Cluster among Patients with Advanced Heart Failure: A Systematic Review / Grupo de sintomas em insuficiência cardíaca avançada: uma revisão sistemática

Resumen Introducción La Insuficiencia cardiaca avanzada genera deterioro clínico y funcional marcado en el paciente. A través del tiempo se han desarrollado investigaciones para evaluar síntomas y aliviar el sufrimiento. El presente artículo tiene como objetivo identificar los clúster de síntomas en pacientes con insuficiencia cardiaca avanzada, que puedan contribuir en la consolidación del conocimiento. Materiales y Métodos Una estrategia PICO estableció la pregunta clave de revisión desarrollada, mediante PRISMA, con búsquedas en: Scopus, Pubmed, Embase y Google Scholar. Se incluyeron artículos de fuente primaria, insuficiencia cardiaca avanzada, publicados 2010 - 2019 en inglés y español, se excluye población pediátrica. Se realizaron análisis descriptivos de los síntomas encontrados. Resultados De 8000 estudios, fueron incluidos 11 para revisión completa, la mayoría de corte transversal, cuyas características de la muestra corresponde 50% hombres, entre 56 y 83 años. Se identificaron en el clúster físico síntomas: fatiga, dificultad para dormir, disnea; en el cluster emocional se identifican: Depresión, deterioro cognitivo y preocupación, además se encontró evaluación de síntomas por región geográfica. Discusión Existe un consenso en la clasificación de síntomas en grupos denominados físico y emocional, llama la atención que el edema en algunos casos no está incluido en ellos. Limitaciones Se incluyeron dos estudios del mismo autor en diferente año de publicación, población y los clúster son los mismos, pero con análisis de variables como calidad de vida y estado funcional. Conclusión Diversidad de poblaciones, tipos de estudio y métodos de análisis, no permiten un único enfoque para agrupación de los síntomas más frecuentes en pacientes con insuficiencia cardiaca avanzada.

Abstract Introduction Advanced heart failure leads to severe clinical and functional deterioration in patients. Over the years, research has been focused on the evaluation of symptoms and alleviation of suffering. This study aims to identify symptom clusters among patients with advanced heart failure in order to contribute towards knowledge consolidation. Materials and Methods The PICO strategy helps define the key review question developed through PRISMA, involving searches in Scopus, PubMed, Embase and Google Scholar. Primary source articles on advanced heart failure which had been published between 2010 and 2019 in English and Spanish, excluding the pediatric population, were considered for this review. We carried out a descriptive analysis of the symptoms found in the articles. Results A total of 11 out of 8000 studies were selected for a complete review, most of them are cross-sectional studies in which sample characterization corresponds to 50% of men aged 56 to 83 years. Fatigue, sleeping difficulty and dyspnea were some of the symptoms found in the physical symptom cluster, while depression, cognitive deterioration and concern were found in the emotional symptom cluster. Evaluations of symptoms by geographic region were also found. Discussion There is a general consensus about the classification of symptoms in physical and emotional clusters. However, it is surprising to find out that edema is not included in any of them. Limitations Two studies from the same author but published in different years were included in the review as the population and clusters were the same but different variables such as quality of life and functional status were studied. Conclusion Having diverse populations, study types and analysis methods do not allow applying a single approach to grouping the most frequent symptoms in patients with advanced heart failure.

Resumo Introdução A insuficiência cardíaca avançada gera deterioração clínica e funcional marcado no paciente. Foi desenvolvida ao longo do tempo pesquisas para avaliar os sintomas e aliviar o sofrimento. O presente artigo tem como objetivo identificar os agrupamentos de sintomas em pacientes com insuficiência cardíaca avançada, que podem contribuir para a consolidação do conhecimento. Materiais e Métodos Uma estratégia PICO estabeleceu a questão-chave de revisão desenvolvida, usando PRISMA, com buscas em: Scopus, Pubmed, Embase e Google Scholar. Artigos de uma fonte primária foram incluídos, insuficiência cardíaca avançada, publicados em 2010 - 2019 em inglês e espanhol, a população pediátrica é excluída. Foram realizadas análises descritivas dos sintomas encontrados. Resultados Dos 8.000 estudos, 11 foram incluídos para revisão completa, a maioria de corte transversal, cujas características da amostra correspondem a 50% de homens, entre 56 e 83 anos. Foram identificados no agrupamento físico os sintomas: cansaço, dificuldade para dormir, dispneia; no agrupamento emocional, foram identificados: Depressão, deterioração cognitiva e preocupação, assim como foi encontrada uma avaliação dos sintomas por região geográfica. Discussão Existe um consenso na classificação dos sintomas em grupos denominados físico e emocional, chama a atenção que o edema em alguns casos não está incluído neles. Limitações Foram incluídos dois estudos do mesmo autor em diferentes anos de publicação, a população e os agrupamentos são os mesmos, mas com análise de variáveis como qualidade de vida e estado funcional. Conclusão A diversidade de populações, tipos de estudos e métodos de análise não permitem uma abordagem única para agrupar os sintomas mais frequentes em pacientes com insuficiência cardíaca avançada.

Clúster de síntomas en insuficiencia cardiaca avanzada: una revisión sistemática / Symptom Cluster among Patients with Advanced Heart Failure: A Systematic Review

Introducción: La Insuficiencia cardiaca avanzada genera deterioro clínico y funcional marcado en el paciente. A través del tiempo se han desarrollado investigaciones para evaluar síntomas y aliviar el sufrimiento. El presente artículo tiene como objetivo identificar los clúster de síntomas en pacientes con insuficiencia cardiaca avanzada, que puedan contribuir en la consolidación del conocimiento. Materiales y Métodos: Una estrategia PICO estableció la pregunta clave de revisión desarrollada, mediante PRISMA, con búsquedas en: Scopus, Pubmed, Embase y Google Scholar. Se incluyeron artículos de fuente primaria, insuficiencia cardiaca avanzada, publicados 2010 ­ 2019 en inglés y español, se excluye población pediátrica. Se realizaron análisis descriptivos de los síntomas encontrados. Resultados: De 8000 estudios, fueron incluidos 11 para revisión completa, la mayoría de corte transversal, cuyas características de la muestra corresponde 50% hombres, entre 56 y 83 años. Se identificaron en el clúster físico síntomas: fatiga, dificultad para dormir, disnea; en el cluster emocional se identifican: Depresión, deterioro cognitivo y preocupación, además se encontró evaluación de síntomas por región geográfica. Discusión: Existe un consenso en la clasificación de síntomas en grupos denominados físico y emocional, llama la atención que el edema en algunos casos no está incluido en ellos. Limitaciones: Se incluyeron dos estudios del mismo autor en diferente año de publicación, población y los clúster son los mismos, pero con análisis de variables como calidad de vida y estado funcional. Conclusión: Diversidad de poblaciones, tipos de estudio y métodos de análisis, no permiten un único enfoque para agrupación de los síntomas más frecuentes en pacientes con insuficiencia cardiaca avanzada.

Introduction: Advanced heart failure leads to severe clinical and functional deterioration in patients. Over the years, research has been focused on the evaluation of symptoms and alleviation of suffering. This study aims to identify symptom clusters among patients with advanced heart failure in order to contribute towards knowledge consolidation. Materials and Methods: The PICO strategy helps define the key review question developed through PRISMA, involving searches in Scopus, PubMed, Embase and Google Scholar. Primary source articles on advanced heart failure which had been published between 2010 and 2019 in English and Spanish, excluding the pediatric population, were considered for this review. We carried out a descriptive analysis of the symptoms found in the articles. Results: A total of 11 out of 8000 studies were selected for a complete review, most of them are cross-sectional studies in which sample characterization corresponds to 50% of men aged 56 to 83 years. Fatigue, sleeping difficulty and dyspnea were some of the symptoms found in the physical symptom cluster, while depression, cognitive deterioration and concern were found in the emotional symptom cluster. Evaluations of symptoms by geographic region were also found. Discussion: There is a general consensus about the classification of symptoms in physical and emotional clusters. However, it is surprising to find out that edema is not included in any of them. Limitations: Two studies from the same author but published in different years were included in the review as the population and clusters were the same but different variables such as quality of life and functional status were studied. Conclusion: Having diverse populations, study types and analysis methods do not allow applying a single approach to grouping the most frequent symptoms in patients with advanced heart failure.

Introdução: A insuficiência cardíaca avançada gera deterioração clínica e funcional marcado no paciente. Foi desenvolvida ao longo do tempo pesquisas para avaliar os sintomas e aliviar o sofrimento. O presente artigo tem como objetivo identificar os agrupamentos de sintomas em pacientes com insuficiência cardíaca avançada, que podem contribuir para a consolidação do conhecimento. Materiais e Métodos: Uma estratégia PICO estabeleceu a questão-chave de revisão desenvolvida, usando PRISMA, com buscas em: Scopus, Pubmed, Embase e Google Scholar. Artigos de uma fonte primária foram incluídos, insuficiência cardíaca avançada, publicados em 2010 ­ 2019 em inglês e espanhol, a população pediátrica é excluída. Foram realizadas análises descritivas dos sintomas encontrados. Resultados: Dos 8.000 estudos, 11 foram incluídos para revisão completa, a maioria de corte transversal, cujas características da amostra correspondem a 50% de homens, entre 56 e 83 anos. Foram identificados no agrupamento físico os sintomas: cansaço, dificuldade para dormir, dispneia; no agrupamento emocional, foram identificados: Depressão, deterioração cognitiva e preocupação, assim como foi encontrada uma avaliação dos sintomas por região geográfica. Discussão: Existe um consenso na classificação dos sintomas em grupos denominados físico e emocional, chama a atenção que o edema em alguns casos não está incluído neles. Limitações: Foram incluídos dois estudos do mesmo autor em diferentes anos de publicação, a população e os agrupamentos são os mesmos, mas com análise de variáveis ​​como qualidade de vida e estado funcional. Conclusão: A diversidade de populações, tipos de estudos e métodos de análise não permitem uma abordagem única para agrupar os sintomas mais frequentes em pacientes com insuficiência cardíaca avançada.

Interobserver Variability in Assessing Pathologic Response to Preoperative Treatment in Rectal Cancer: Standardization of an Evaluation Method and Comparisons Between Published Scales.

BACKGROUND: Evaluating tumor response of rectal cancer to preoperative chemoradiotherapy (NCRT) has a prognostic value on overall survival; however, grading tumor response is a controversial issue due to lack of reproducibility and the lack of information about the standardization of the evaluation. METHODS: We performed this study to examine the variability between observers' assessment of the pathological responses to NCRT using a systematic quantitative grading system based on a percentage of tumor response against the proportion of residual tumor burden. As a secondary aim, we classified the tumor response according to six published systems to determine the correlation between the observers into each grading system. RESULTS: From 70 cases, the mean age was 60.6 ± 11.78 years, 36 (51.47%) patients were female, the pathological T stage was pT3 in 48.6% of cases, pT2 in 32.9%, pT1 in 11.4% and 7.1% in pT4, whereas 40% had lymph node metastasis. The median lymph node count was ten lymph nodes (range 6-43). Our method of tumor regression evaluation has a good intraclass correlation (ICC) value. From the scales compared regarding interobserver agreement, the Ryan's and Royal College of Pathologists showed fair agreement (but good ICC); the scales from Dworak, Becker, and Rizk showed substantial agreement (and good to excellent ICC values); and the scale from Rödel showed almost-perfect agreement. RESULTS: All the evaluated systems showed good interobserver agreement, but the best interobserver agreement was reached with the Rödel's scale.

Hepatitis A / Hepatitis A

Resumen El virus de la hepatitis A ha estado clásicamente relacionado con el mecanismo de transmisión fecal-oral, característica de países endémicos. El aumento de las condiciones higiénicas en nuestro entorno había supuesto una importante disminución de los casos de infección por estos patógenos. Sin embargo, en la actualidad, su epidemiología esta cambiando debido a nuevas vías de contagio en Europa. En el caso de la hepatitis A, están aumentando los casos debidos a la transmisión por vía sexual, especialmente en hombres que tienen sexo con hombres. Los cambios descritos deberían promover la implantación de nuevas estrategias de diagnóstico, manejo y prevención. La hepatitis aguda por virus de hepatitis A usualmente sigue un curso corto, benigno y autolimitado sin ocasionar una hepatitis crónica, sin embargo en algunos casos puede manifestarse mediante formas atípicas.

Abstract Hepatitis A virus has been classically linked to the fecal-oral transmission mechanism, characteristic of endemic countries. The increase in hygiene conditions in our environment had led to a significant decrease in cases of infection by these pathogens. However, the epidemiology of these infections is currently changing due to new routes of transmission in Europe. In the case of hepatitis A, cases due to sexual transmission are increasing, especially among men who have sex with men. The changes described should promote the implementation of new strategies for the diagnosis, management and prevention of these diseases. Acute hepatitis due to the hepatitis A virus usually has a short, benign and self-limited course, without causing chronic hepatitis. However, some cases have an atypical presentation.

Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease.

BACKGROUND: There are forms of Alzheimer's disease (AD) that have an autosomal dominant inheritance pattern; one of them is caused by the E280A mutation in the gene that codes for Presenilin-1 (PSEN1). Studying families of people with this mutation allows the evaluation of characteristics of the subjects before cognitive decline begins. OBJECTIVE: To determine whether having the mutation E280A in PSEN1 increases the risk of presenting mental disorders in adults under 30 years old who are in the preclinical stage of AD and may be eligible for primary prevention studies of AD. METHODS: A psychiatric evaluation was made to 120 people belonging to families with a history of early onset AD. Of these, 62 carried the E280A mutation in PSEN1. The occurrence of mental disorders between carriers and non-carriers of the mutation was compared. RESULTS: No statistically significant differences were found in the frequency of any mental disorder between the group of carriers and non-carriers of the mutation (Hazard Ratio: 0.80, 95% CI 0.49 to 1.31); nor were differences observed when evaluating specific disorders. CONCLUSION: The E280A mutation does not increase the risk of mental disorders before the age of 30 in the relatives of people affected by familial AD. Studies with larger sample sizes are required to assess the risk of low incidence mental disorders.

Validation of the sixth version of the Addiction Severity Index (ASI-6) for patients in a clinical population of Colombia / Validación de la sexta edición del Addiction Severity Index (ASI-6) (ISA-6) en población clínica de Colombia.

Introduction: The Addiction Severity Index (ASI-6) is recommended for identifying the needs of addicted patients and assessing the effectiveness of a program. Objective: To develop a version of the ASI-6 suitable for Colombia and trans-linguistically and trans-culturally equivalent to the original. Additionally, this study also sought to assess the reliability and construct validity of the resulting version. Materials and methods: The study included Colombian adults with harmful substance use or dependence syndrome who were being treated at drug addiction centers. The original English version underwent a cultural adaptation process. The scale was translated and back-translated to assess its equivalence. Reliability was assessed in terms of internal consistency and interrater and test-retest reliability. The convergent aspect of the construct validity was assessed via the correlation of the instrument with other scales measuring similar underlying constructs. Results: We found an adequate internal consistency for the subscales of the ASI-6 for its Cronbach´s alpha coefficient was above 0.7 with the exception of the social problems subscale (α=0.66). In addition, interrater and test-retest reliability was high, since their intraclass correlation coefficient (ICC) was above 0.7 for all the subscales. Construct validity was demonstrated by a Spearman correlation coefficient ranging from 0.53 to 0.88 between the ASI-6 subscales and other similar scales. Conclusion: The version of the ASI-6 adapted to the Colombian context was found to have good reliability and validity, thus it can be introduced into clinical practice. However, additional studies are needed to evaluate its responsiveness and structural validity.

Introducción. Se recomienda el uso del Addicition Severity Index en su sexta versión (ASI-6) para establecer las necesidades del paciente con adicciones y evaluar la efectividad de los programas. Objetivo. Desarrollar una versión para Colombia del ASI-6 garantizando la equivalencia translingüística y transcultural, y evaluar su confiabilidad y la validez de constructo. Materiales y métodos. En el estudio se incluyeron adultos con trastornos debidos al uso de sustancias bajo tratamiento en centros de atención de la drogodependencia. Se adaptó la versión en español con base en la original en inglés y, posteriormente, se tradujo al inglés la versión así adaptada para determinar su equivalencia. Se evaluó la confiabilidad en cuanto a la consistencia interna, así como la reproducibilidad prueba-reprueba y la confiabilidad interevaluador. La validez convergente del constructo se comprobó mediante la correlación con cuestionarios que miden constructos similares a los subyacentes a cada subescala del ISA-6. Resultados. Se encontró una consistencia interna adecuada, con un alfa de Cronbach por encima de 0,7 en todas las subescalas, excepto la "Social" (α=0,66). La confiabilidad entre evaluadores y de la prueba-reprueba fueron altas, con coeficientes de correlación intraclase mayores de 0,7 en todas las subescalas. El aspecto convergente de la validez de constructo se demostró al obtener coeficientes de correlación de Spearman entre 0,53 y 0,88 en las subescalas del ISA-6 comparadas con cuestionarios que miden constructos similares. Conclusión. La versión del ISA-6 adaptada al contexto colombiano evidenció una confiabilidad y una validez de constructo adecuadas, por lo que puede introducirse en la clínica, aunque se requieren estudios para conocer su sensibilidad al cambio y su validez estructural.

WITHDRAWN: Mental Disorders in Young Adults from Families with the Presenilin-1 Gene Mutation E280A in the Preclinical Stage of Alzheimer's Disease.

Ahead of Print article withdrawn by publisher.

Validación de la sexta edición del Addiction Severity Index (ASI-6) (ISA-6) en población clínica de Colombia / Validation of the sixth version of the Addiction Severity Index (ASI-6) for patients in a clinical population of Colombia

Resumen Introducción. Se recomienda el uso del Addicition Severity Index en su sexta versión (ASI- 6) para establecer las necesidades del paciente con adicciones y evaluar la efectividad de los programas. Objetivo. Desarrollar una versión para Colombia del ASI-6 garantizando la equivalencia translingüística y transcultural, y evaluar su confiabilidad y la validez de constructo. Materiales y métodos. En el estudio se incluyeron adultos con trastornos debidos al uso de sustancias bajo tratamiento en centros de atención de la drogodependencia. Se adaptó la versión en español con base en la original en inglés y, posteriormente, se tradujo al inglés la versión así adaptada para determinar su equivalencia. Se evaluó la confiabilidad en cuanto a la consistencia interna, así como la reproducibilidad prueba-reprueba y la confiabilidad interevaluador. La validez convergente del constructo se comprobó mediante la correlación con cuestionarios que miden constructos similares a los subyacentes a cada subescala del ISA-6. Resultados. Se encontró una consistencia interna adecuada, con un alfa de Cronbach por encima de 0,7 en todas las subescalas, excepto la "Social" (α=0,66). La confiabilidad entre evaluadores y de la prueba-reprueba fueron altas, con coeficientes de correlación intraclase mayores de 0,7 en todas las subescalas. El aspecto convergente de la validez de constructo se demostró al obtener coeficientes de correlación de Spearman entre 0,53 y 0,88 en las subescalas del ISA-6 comparadas con cuestionarios que miden constructos similares. Conclusión. La versión del ISA-6 adaptada al contexto colombiano evidenció una confiabilidad y una validez de constructo adecuadas, por lo que puede introducirse en la clínica, aunque se requieren estudios para conocer su sensibilidad al cambio y su validez estructural.

Abstract Introduction: The Addiction Severity Index (ASI-6) is recommended for identifying the needs of addicted patients and assessing the effectiveness of a program. Objective: To develop a version of the ASI-6 suitable for Colombia and trans-linguistically and trans-culturally equivalent to the original. Additionally, this study also sought to assess the reliability and construct validity of the resulting version. Materials and methods: The study included Colombian adults with harmful substance use or dependence syndrome who were being treated at drug addiction centers. The original English version underwent a cultural adaptation process. The scale was translated and back-translated to assess its equivalence. Reliability was assessed in terms of internal consistency and interrater and test-retest reliability. The convergent aspect of the construct validity was assessed via the correlation of the instrument with other scales measuring similar underlying constructs. Results: We found an adequate internal consistency for the subscales of the ASI-6 for its Cronbach´s alpha coefficient was above 0.7 with the exception of the social problems subscale (α=0.66). In addition, interrater and test-retest reliability was high, since their intraclass correlation coefficient (ICC) was above 0.7 for all the subscales. Construct validity was demonstrated by a Spearman correlation coefficient ranging from 0.53 to 0.88 between the ASI-6 subscales and other similar scales. Conclusion: The version of the ASI-6 adapted to the Colombian context was found to have good reliability and validity, thus it can be introduced into clinical practice. However, additional studies are needed to evaluate its responsiveness and structural validity.

Stage I-III colon cancer patients with tumor deposits behave similarly to stage IV patients. Cross-section analysis of 392 patients.

BACKGROUND AND OBJECTIVES: Tumor deposits (TDs) are associated with adverse prognostic factors and decreased survival in colorectal cancer. However, controversy exists regarding their definition, evaluation, and staging categories. This study aimed to determine the survival and recurrence impact of the TD in colon adenocarcinomas; and to determine if TD patients behave similarly to stage IV patients. METHODS: Cross-section study from 392 patients with colon adenocarcinoma from 2005 to 2012. We performed survival analysis and further stratified patients considering TD patients as a "stage IV-TD" to demonstrate if they behave similarly than stage IV patients. RESULTS: From 392 patients, 204 (52%) were men, the mean age was 57.4 ± 13.9 years and 11.5% of cases had TD. In a multivariate analysis, TD failed to predict mortality and recurrence. Considering cases with TD as stage IV-TD, their mean survival was similar to stage IV patients (69.3 and 64.6 months, respectively) and different to those in stage III (110.5 months), II (135.7 months), and I (114.9 months) (P < 0.001). CONCLUSIONS: TD failed to predict mortality and recurrence. Patients with TD in stage I-III shows similar mortality than stage IV patients; then, we suggest putting them into a substage IV category instead of the N1c category.

The impact of violence on Venezuelan life expectancy and lifespan inequality.

BACKGROUND: Venezuela is one of the most violent countries in the world. According to the United Nations, homicide rates in the country increased from 32.9 to 61.9 per 100 000 people between 2000 and 2014. This upsurge coincided with a slowdown in life expectancy improvements. We estimate mortality trends and quantify the impact of violence-related deaths and other causes of death on life expectancy and lifespan inequality in Venezuela. METHODS: Life tables were computed with corrected age-specific mortality rates from 1996 to 2013. From these, changes in life expectancy and lifespan inequality were decomposed by age and cause of death using a continuous-change model. Lifespan inequality, or variation in age at death, is measured by the standard deviation of the age-at-death distribution. RESULTS: From 1996 to 2013 in Venezuela, female life expectancy rose 3.57 [95% confidence interval (CI): 3.08-4.09] years [from 75.79 (75.98-76.10) to 79.36 (78.97-79.68)], and lifespan inequality fell 1.03 (-2.96 to 1.26) years [from 18.44 (18.01-19.00) to 17.41 (17.30-18.27)]. Male life expectancy increased 1.64 (1.09-2.25) years [from 69.36 (68.89-59.70) to 71.00 (70.53-71.39)], but lifespan inequality increased 0.95 (-0.80 to 2.89) years [from 20.70 (20.24-21.08) to 21.65 (21.34-22.12)]. If violence-related death rates had not risen over this period, male life expectancy would have increased an additional 1.55 years, and lifespan inequality would have declined slightly (-0.31 years). CONCLUSIONS: As increases in violence-related deaths among young men (ages 15-39) have slowed gains in male life expectancy and increased lifespan inequality, Venezuelan males face more uncertainty about their age at death. There is an urgent need for more accurate mortality estimates in Venezuela.