Neuroprotective effect of hormone replacement therapy: a review of the literature.

OBJECTIVE: Menopause is a physiological period characterized by the cessation of ovarian activity. Sequential changes during this transition affect multiple systems, including the brain. Sixty percent of women experience cognitive impairment. The objective of this review is to show the neuroprotective effect of hormone replacement therapy (HRT) through the different scales and whether there is a benefit of this in women. METHOD: A search was conducted in six databases. Eligibility criteria included women within 10 years of menopause, receiving HRT controlled with placebo, studies lasting more than 6 months and women without a history of chronic underlying pathology. RESULTS: A total of nine randomized controlled trials met the inclusion criteria. Regarding memory, two studies reported better performance of HRT with a significant odds ratio (OR) of 0.67; regarding attention, one study reported potential improvement in women receiving HRT with a significant OR of 0.87; and neuroimaging assessment found an increase in ventricular volume compared to placebo over a 3-year period. CONCLUSIONS: The early initiation of menopausal HRT in healthy women appears to yield a positive effect on certain cognitive aspects, such as attention and cortical volume in the central nervous system. These findings should be confirmed through future prospective studies.

Long-term survival in venous thromboembolic disease: rivaroxaban vs. warfarin - propensity score matching study.

BACKGROUND: Venous thromboembolic disease (VTE) is characterized by obstruction of venous blood flow by a thrombus. Survival data, frequency of disease recurrence, and bleeding rate in patients on anticoagulant therapy with warfarin compared to rivaroxaban in the Latin American population are limited in VTE. METHODS: A retrospective cohort study with propensity score matching analysis was conducted in patients with pulmonary embolism and/or deep vein thrombosis anticoagulated with warfarin or rivaroxaban treated. Survival analysis was performed using a Kaplan-Meier curve for each of the intervention groups, and it was compared using a Log Rank test. RESULTS: Of 2193 potentially eligible patients with a suspected diagnosis of VTE, 505 patients entered the analysis; of these, 285 subjects were managed with warfarin and 220 anticoagulated with rivaroxaban. Major bleeding at 12 months occurred in 2.7% (6/220) of patients treated with Rivaroxaban, compared to 10.2% (29/285) in the Warfarin group in the unmatched population (p = 0.001). In the matched population, bleeding at 12 months occurred in 2.9% (6/209) of patients on Rivaroxaban and in 11.0% (23/209) of patients on Warfarin (p = 0.001). The survival rates at 6 months were 97.1% for Rivaroxaban and 97.6% for Warfarin (p = 0.76). At 12 months, the survival rates were 94.7% for Rivaroxaban and 95.7% for Warfarin (p = 0.61). CONCLUSION: In the treatment of VTE, there is no differences on 6 and 12-month survival or a reduction in the occurrence of new thromboembolic events when comparing rivaroxaban to warfarin. However, a lower risk of major bleeding is observed at 12 months with Rivaroxaban.

Conocimiento del parto humanizado en Colombia en residentes y ginecólogos / Knowledge of humanized childbirth in Colombian residents and gynecologists

Resumen OBJETIVO: Identificar, mediante una encuesta, el conocimiento de especialistas y residentes de Ginecología y Obstetricia de los beneficios de la atención respetuosa y digna a la paciente en el momento del parto. MATERIALES Y MÉTODOS: Estudio observacional, descriptivo, transversal y prospectivo efectuado en una muestra de ginecoobstetras y residentes de diferentes universidades e instituciones de Colombia a quienes se aplicó, entre los meses de diciembre de 2021 a agosto de 2022, un instrumento estructurado de manera individual, presencial o virtual. RESULTADOS: Se obtuvieron 343 respuestas. El 51% de la muestra fue de especialistas con más de dos años de experiencia. El 37.2% de los residentes cursaba el tercer y 20.2% el segundo año. Más de la mitad de los encuestados no recibió ni recibe educación del tema. Se identificó un vacío en el conocimiento y su implementación. La totalidad de la muestra no reconoció algún beneficio materno o neonatal. El 86.3% consideró que no existe contraindicación para la implementación del parto digno y respetuoso y el 94.8% manifestó una correlación entre la desinformación y su baja implementación. El 69.4% de la muestra conocía y ponía en práctica el plan de parto en su práctica diaria. CONCLUSIONES: De la muestra analizada se concluye que hay desinformación acerca de los beneficios maternos y neonatales del parto digno y respetuoso por parte de residentes y especialistas de Ginecología y Obstetricia. Por lo tanto, es necesario aumentar los contenidos del tema a los programas de educación. Además, estandarizar los protocolos ajustados que faciliten su ejecución e implementación.

Abstract OBJECTIVE: To identify, by means of a survey, the knowledge of specialists and residents in Gynaecology and Obstetrics of the benefits of respectful and dignified care for the patient at the time of delivery. MATERIALSAND METHODS: Observational, descriptive, cross-sectional, and prospective study carried out on a sample of obstetrician-gynecologists and residents from different universities and institutions in Colombia to whom a structured instrument was applied individually, in person or online, between December 2021 and August 2022. RESULTS: 343 responses were obtained. Fifty-one percent of the sample were specialists with more than two years of experience. 37.2% of the residents were in their third year and 20.2% were in their second year. More than half of the respondents did not and do not receive any education on the subject. A gap in knowledge and implementation were identified. The entire sample did not recognize any maternal or neonatal benefit. 86.3% considered that there is no contraindication to the implementation of respectful and dignified childbirth and 94.8% expressed a correlation between misinformation and low implementation of respectful and dignified childbirth. 69.4% of the sample were aware of and implemented the birth plan in their daily practice. CONCLUSIONS: From the sample analyzed, it is concluded that there is misinformation about the maternal and neonatal benefits of dignified and respectful childbirth on the part of Gynaecology and Obstetrics residents and specialists. Therefore, it is necessary to increase the content of the subject in education programs. In addition, it is necessary to standardize adjusted protocols that facilitate their execution and implementation.

[Public Resistance to Vaccination During Epidemics: The Example of COVID-19Resistência da população à vacinação em tempos de epidemias: sobre a COVID-19]. / Resistencia de la población hacia la vacunación en época de epidemias: a propósito de la COVID-19.

Objective: This article presents the findings of a review of the literature on public resistance to vaccines and the main factors that have influenced their decisions about immunoprevention, with a focus on the COVID-19 pandemic. Methods: We searched the literature using the terms DeCs/MeSH, anti-vaccination movement, vaccination refusal, epidemics, COVID-19, and impacts on health, using the Boolean operators OR and AND in Google Scholar, Medline, Lilacs, and Ibecs. Documents from official sources were also considered. Results: Throughout history, since vaccination began, people have had controversial perceptions of the procedure: some accept what the health authorities recommend, and others allege hidden intentions behind immunization. The COVID-19 vaccine against SARS-CoV-2 has been no exception. Conclusions: Vaccination has been one of the greatest scientific achievements in public health. However, despite its benefits, it has raised fear, uncertainty, and suspicion in the population. For this reason, it is important to increase health education actions in the population-with clear, concise, understandable information that is based on reliable and truthful sources-in order to reduce resistance to vaccination and address preventable diseases.

Objetivo: Este artigo busca apresentar os achados de uma revisão da literatura sobre a resistência da população às vacinas e os principais motivos que influenciaram suas decisões em relação à imunoprevenção, com foco na pandemia de COVID-19. Métodos: Foi realizada uma busca na literatura utilizando os termos DeCs/MeSH anti-vaccination movement, vaccination refusal, epidemics, COVID-19 e impacts on health, relacionados entre si pelos operadores booleanos OR e AND, no Google Scholar, MEDLINE, LILACS e IBECS. Documentos de fontes oficiais também foram levados em consideração. Resultados: Ao longo da história, desde o início da vacinação, a percepção das pessoas em relação a esse procedimento foi controversa. Há quem aceite o que as autoridades de saúde recomendam e quem alegue intenções ocultas por trás da imunização. A vacina contra o SARS-CoV-2, que causa a COVID-19, não foi exceção. Conclusões: A vacinação tem sido uma das maiores conquistas científicas em termos de saúde pública ­ um avanço que, apesar de seus benefícios, tem causado medo, incerteza e desconfiança na população. Por isso, é importante aumentar as ações de educação em saúde para a população, com informações claras, concisas e compreensíveis, baseadas em fontes confiáveis e verídicas, a fim de diminuir a resistência à vacinação e evitar doenças preveníveis.

Resistencia de la población hacia la vacunación en época de epidemias: a propósito de la COVID-19

[RESUMEN]. Objetivo. El presente artículo busca exponer los hallazgos de una revisión de la literatura sobre la resistencia de la población frente a las vacunas y las principales razones que han influido en sus decisiones hacia a la inmunoprevención, con foco en la pandemia de la COVID-19. Métodos. Se realizó una búsqueda en la literatura utilizando los términos DeCs/MeSH, Anti-Vaccination Movement, Vaccination refusal, Epidemics, COVID-19, Impacts on health, relacionados entre ellos por los operadores booleanos OR y AND en Google Scholar, Medline, Lilacs e Ibecs; también se tuvieron en cuenta documentos de fuentes oficiales. Resultados. A lo largo de la historia, desde el inicio de la vacunación, la percepción de las personas hacia este procedimiento ha sido controversial, hay quienes aceptan lo que las autoridades sanitarias recomiendan y quienes alegan intenciones ocultas detrás de la inmunización; la vacuna contra el SARS-CoV-2 causante de la COVID-19 no ha sido la excepción. Conclusiones. La vacunación ha sido uno de los mayores logros científicos en términos de salud pública, un avance que, a pesar de sus beneficios, ha causado miedo, incertidumbre y suspicacias en la población. Por esta razón, resulta importante incrementar las acciones de educación para la salud en la población, con infor- mación clara, concisa y comprensible, y sustentada en fuentes confiables y verídicas, con el fin de disminuir la resistencia a la vacunación y evitar las enfermedades prevenibles.

[ABSTRACT]. Objective. This article presents the findings of a review of the literature on public resistance to vaccines and the main factors that have influenced their decisions about immunoprevention, with a focus on the COVID-19 pandemic. Methods. We searched the literature using the terms DeCs/MeSH, anti-vaccination movement, vaccination refusal, epidemics, COVID-19, and impacts on health, using the Boolean operators OR and AND in Google Scholar, Medline, Lilacs, and Ibecs. Documents from official sources were also considered. Results. Throughout history, since vaccination began, people have had controversial perceptions of the pro- cedure: some accept what the health authorities recommend, and others allege hidden intentions behind immunization. The COVID-19 vaccine against SARS-CoV-2 has been no exception. Conclusions. Vaccination has been one of the greatest scientific achievements in public health. However, despite its benefits, it has raised fear, uncertainty, and suspicion in the population. For this reason, it is import- ant to increase health education actions in the population—with clear, concise, understandable information that is based on reliable and truthful sources—in order to reduce resistance to vaccination and address pre- ventable diseases.

[RESUMO]. Objetivo. Este artigo busca apresentar os achados de uma revisão da literatura sobre a resistência da popu- lação às vacinas e os principais motivos que influenciaram suas decisões em relação à imunoprevenção, com foco na pandemia de COVID-19. Métodos. Foi realizada uma busca na literatura utilizando os termos DeCs/MeSH anti-vaccination movement, vaccination refusal, epidemics, COVID-19 e impacts on health, relacionados entre si pelos operadores bool- eanos OR e AND, no Google Scholar, MEDLINE, LILACS e IBECS. Documentos de fontes oficiais também foram levados em consideração. Resultados. Ao longo da história, desde o início da vacinação, a percepção das pessoas em relação a esse procedimento foi controversa. Há quem aceite o que as autoridades de saúde recomendam e quem alegue intenções ocultas por trás da imunização. A vacina contra o SARS-CoV-2, que causa a COVID-19, não foi exceção. Conclusões. A vacinação tem sido uma das maiores conquistas científicas em termos de saúde pública um avanço que, apesar de seus benefícios, tem causado medo, incerteza e desconfiança na população. Por isso, é importante aumentar as ações de educação em saúde para a população, com informações claras, concisas e compreensíveis, baseadas em fontes confiáveis e verídicas, a fim de diminuir a resistência à vacinação e evitar doenças preveníveis.

Quality of life at 3 and 6 months in military personnel with a history of thoracic trauma suffered in combat.

OBJECTIVE: To measure the score and variation in the SF-36 quality of life questionnaire at 3 and 6 months of evaluation in military personnel with a history of chest trauma in combat. METHOD: Comparative study between military with chest trauma and healthy military personnel from 2011 to 2016, evaluating the SF-36 quality of life questionnaire. RESULTS: 45 subjects were analyzed, 25 with a history of chest trauma and 10 healthy controls with combat experience. 25 of the cases were evaluated at 3 months and 11 at 6 months. The average age was 28.2 years (standard deviation: 7.22), and 76% had projectile wounds with a high-speed firearm. 44 % (11/25) of the subjects with chest trauma at three months of assessment presented a lot of limitation for the performance of moderate activities (p < 0.001) and only 5% (1/20) of the controls reported a lot of limitation (p < 0.001). CONCLUSIONS: There is significant deterioration in the quality of life in all domains through the SF-36 questionnaire in patients with chest trauma at 3 and 6 months after the evaluation.

OBJETIVO: Medir el puntaje y la variación en el cuestionario de calidad de vida SF-36 a los 3 y 6 meses de valoración en militares con antecedente de trauma de tórax en combate. MÉTODO: Estudio comparativo entre militares con trauma de tórax y militares sanos entre los años 2011 y 2016, evaluando el cuestionario de calidad de vida SF-36. RESULTADOS: Se analizaron 45 sujetos, 25 con antecedente de trauma de tórax y 10 controles sanos con experiencia en combate. De los sujetos con trauma, 25 se evaluaron a los 3 meses y 11 a los 6 meses. El promedio de edad fue de 28.2 años (desviación estándar: 7.22). El 76% tuvieron heridas por proyectil con arma de fuego de alta velocidad. El 44% (11/25) de los sujetos con trauma de tórax, a los 3 meses de valoración, presentaba mucha limitación para la realización de actividades moderadas (p < 0.001) y solo el 5% (1/20) de los controles referían mucha limitación (p < 0.001). CONCLUSIONES: Hay un deterioro significativo en la calidad de vida en todos los dominios del cuestionario SF-36 en pacientes con trauma de tórax a los 3 y 6 meses de la valoración.

Resistencia de la población hacia la vacunación en época de epidemias: a propósito de la COVID-19 / Public Resistance to Vaccination During Epidemics: The Example of COVID-19 / Resistência da população à vacinação em tempos de epidemias: sobre a COVID-19

RESUMEN Objetivo. El presente artículo busca exponer los hallazgos de una revisión de la literatura sobre la resistencia de la población frente a las vacunas y las principales razones que han influido en sus decisiones hacia a la inmunoprevención, con foco en la pandemia de la COVID-19. Métodos. Se realizó una búsqueda en la literatura utilizando los términos DeCs/MeSH, Anti-Vaccination Movement, Vaccination refusal, Epidemics, COVID-19, Impacts on health, relacionados entre ellos por los operadores booleanos OR y AND en Google Scholar, Medline, Lilacs e Ibecs; también se tuvieron en cuenta documentos de fuentes oficiales. Resultados. A lo largo de la historia, desde el inicio de la vacunación, la percepción de las personas hacia este procedimiento ha sido controversial, hay quienes aceptan lo que las autoridades sanitarias recomiendan y quienes alegan intenciones ocultas detrás de la inmunización; la vacuna contra el SARS-CoV-2 causante de la COVID-19 no ha sido la excepción. Conclusiones. La vacunación ha sido uno de los mayores logros científicos en términos de salud pública, un avance que, a pesar de sus beneficios, ha causado miedo, incertidumbre y suspicacias en la población. Por esta razón, resulta importante incrementar las acciones de educación para la salud en la población, con información clara, concisa y comprensible, y sustentada en fuentes confiables y verídicas, con el fin de disminuir la resistencia a la vacunación y evitar las enfermedades prevenibles.

ABSTRACT Objective. This article presents the findings of a review of the literature on public resistance to vaccines and the main factors that have influenced their decisions about immunoprevention, with a focus on the COVID-19 pandemic. Methods. We searched the literature using the terms DeCs/MeSH, anti-vaccination movement, vaccination refusal, epidemics, COVID-19, and impacts on health, using the Boolean operators OR and AND in Google Scholar, Medline, Lilacs, and Ibecs. Documents from official sources were also considered. Results. Throughout history, since vaccination began, people have had controversial perceptions of the procedure: some accept what the health authorities recommend, and others allege hidden intentions behind immunization. The COVID-19 vaccine against SARS-CoV-2 has been no exception. Conclusions. Vaccination has been one of the greatest scientific achievements in public health. However, despite its benefits, it has raised fear, uncertainty, and suspicion in the population. For this reason, it is important to increase health education actions in the population—with clear, concise, understandable information that is based on reliable and truthful sources—in order to reduce resistance to vaccination and address preventable diseases.

RESUMO Objetivo. Este artigo busca apresentar os achados de uma revisão da literatura sobre a resistência da população às vacinas e os principais motivos que influenciaram suas decisões em relação à imunoprevenção, com foco na pandemia de COVID-19. Métodos. Foi realizada uma busca na literatura utilizando os termos DeCs/MeSH anti-vaccination movement, vaccination refusal, epidemics, COVID-19 e impacts on health, relacionados entre si pelos operadores booleanos OR e AND, no Google Scholar, MEDLINE, LILACS e IBECS. Documentos de fontes oficiais também foram levados em consideração. Resultados. Ao longo da história, desde o início da vacinação, a percepção das pessoas em relação a esse procedimento foi controversa. Há quem aceite o que as autoridades de saúde recomendam e quem alegue intenções ocultas por trás da imunização. A vacina contra o SARS-CoV-2, que causa a COVID-19, não foi exceção. Conclusões. A vacinação tem sido uma das maiores conquistas científicas em termos de saúde pública - um avanço que, apesar de seus benefícios, tem causado medo, incerteza e desconfiança na população. Por isso, é importante aumentar as ações de educação em saúde para a população, com informações claras, concisas e compreensíveis, baseadas em fontes confiáveis e verídicas, a fim de diminuir a resistência à vacinação e evitar doenças preveníveis.

Intervenciones de rehabilitación en una corte transversal de pacientes diagnosticados con COVID- 9 en Chía, Colombia / Rehabilitation interventions in a cross-section of patients diagnosed with COVID-19 in Chía, Colombia

Introducción. La infección por SARS CoV-2 se caracteriza por una afección multisistémica que en la etapa aguda impacta de forma negativa la funcionalidad de los pacientes. Aunque en otros países existen programas de rehabilitación para tratar pacientes con COVID-19, los cuales se basan en la prevención y manejo de complica-ciones agudas, en Colombia existen pocos datos respecto a la epidemiología de esta población. Objetivos. Describir las intervenciones médicas y de rehabilitación que se ofrecieron a los pacientes adultos con COVID-19 que requirieron manejo intrahospitalario en la Clínica Universidad de La Sabana de Chía, Colombia, y definir las características sociodemográficas de esta población. Métodos. Se realizó un análisis descriptivo de las variables establecidas a través de la revisión de las historias clínicas de 96 pacientes atendidos entre julio y diciembre del 2020 en la Clínica Universidad de La Sabana. Resultados. La mayoría de los pacientes eran hombres (62,5%) y la comorbilidad más prevalente fue la hipertensión arterial (47,9%). De los pacientes que tuvieron que ingresarse a la unidad de cuidados intensivos (UCI), 45% requirieron soporte ventilatorio invasivo. La valoración por fisiatría se realizó en promedio a los 9,29 días desde el inicio de hospitalización y el 95,8% de los pacientes recibieron intervención por alguna modalidad terapéutica Conclusiones. Se encontró una alta prevalencia de pacientes masculinos adultos mayores con comorbilidades y procedentes de Chía. En cuanto a la intervención integral de rehabilitación, fisioterapia fue la más prescrita en un 79,5% de la población y el diagnostico más frecuente fue síndrome de desacondicionamiento físico.

Introduction. SARS CoV-2 infection is characterized by a multisystemic condition that in the acute stage has a negative impact on the functionality of patients. Although in other countries there are rehabilitation programs to treat patients with CoVID-19, which are based on the prevention and management of acute complications, in Colombia there are few data regarding the epidemiology of this population. Objectives. To describe the medical and rehabilitation interventions offered to adult patients with COVID-19 who required in-hospital management at the Clínica Universidad de La Sabana in Chía, Colombia, and to define the sociodemographic characteristics of this population. Methods. A descriptive analysis of the variables established through the review of the medical records of 96 patients attended between July and December 2020 at the Clínica Universidad de La Sabana was performed. Results. Most patients were men (62.5%) and the most prevalent comorbidity was arterial hypertension (47.9%). Of the patients who had to be admitted to the intensive care unit (ICU), 45% required invasive ventilatory support. Physiatry assessment was performed on average 9.29 days after hospitalization and 95.8% of the patients received intervention by some therapeutic modality. Conclusions. A high prevalence of older male patients with comorbidities and from Chía was found. Regarding the integral rehabilitation intervention, physiotherapy was the most prescribed in 79.5% of the population and the most frequent diangosto was physical deconditioning syndrome.

Administration and Therapeutic Drug Monitoring of ß-lactams and Vancomycin in Critical Care Units in Colombia: The ANTIBIOCOL Study.

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of ß-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06-0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Agreement between surgical and histopathological findings in patients with acute appendicitis at a level III hospital in Bogotá, Colombia / Concordancia entre los hallazgos quirúrgicos e histopatológicos en pacientes con apendicitis aguda en un hospital de tercer nivel deBogotá, Colombia

Introduction. Currently surgical findings dictate the post-operative treatment of patients with acute appendicitis; however, this relies only on the judgement of the surgeon during the appendectomy. This study aimed to determine the inter-rater reliability between surgeons and pathologists at a tertiary hospital.Methods. This was a cross-sectional retrospective study conducted between October 2015 and October 2016 at the Central Military Hospital in Bogotá. Patients who underwent appendectomy due to suspected acute appendicitis and had histopathological with their respective surgical findings were included. Our aim was to determine the agreement between surgical and pathology reports. Results. During the study period, we identified 418 patients who underwent appendectomy. Surgeons assessed 32 (7.77%) appendix as negative, 78 (18.93%) as inflamed, 110 (26.7%) as suppurative, 137 (33.25%) gangrenous and 55 (13.35%) as perforated. Highest agreement was observed in patients with suppurative appendicitis (82/110; 74.5%). Overall Kappa indicated a poor-fair agreement between the pathologist and surgeons (Kappa = 0.2950, 95% CI 0.2384-035.17, p < 0.0001).Conclusion. There is a poor concordance between surgical and pathologic findings in our study, which is similar to previous articles. As a take home message, surgeons and pathologist should revise the definition of the clinical and the histopathological criteria to better describe the findings and reach a better agreement

Introducción. Los hallazgos quirúrgicos actuales dictan el tratamiento postoperatorio de los pacientes con apendicitis aguda; sin embargo, esto se basa únicamente en el juicio del cirujano durante la apendicectomía. Este estudio tuvo como objetivo determinar la correlación de la evaluación entre cirujanos y patólogos en un hospital de tercer nivel. Métodos. Estudio transversal retrospectivo realizado entre octubre de 2015 y octubre de 2016 en el Hospital Militar Central de Bogotá. Se incluyeron pacientes que se sometieron a apendicectomía debido a sospecha de apendicitis aguda y tenían histopatología con sus respectivos hallazgos quirúrgicos. Nuestro objetivo fue determinar la concordancia entre el informe quirúrgico y el de patología.Resultados. Durante el período de estudio, identificamos a 418 pacientes que se sometieron a apendicectomía. Los cirujanos evaluaron 32 (7,77%) apéndices como negativos, 78 (18,93%) como inflamados, 110 (26,7%) como supurativos, 137 (33,25%) gangrenosos y 55 (13,35%) como perforados. La mayor concordancia se observó en pacientes con apendicitis supurativa (82/110; 74.5%). En general, Kappa indicó un acuerdo poco equitativo entre el patólogo y los cirujanos (Kappa = 0.2950, IC 95% 0.2384-035.17, p <0.0001).Conclusión. Hay una pobre concordancia entre los hallazgos quirúrgicos y patológicos en nuestro estudio, similar a los documentos médicos anteriores. Como mensaje, los cirujanos y el patólogo deben revisar la definición de los criterios clínicos e histopatológicos para describir mejor los hallazgos y llegar a un mejor acuerdo

The pursuit of healthier communities through a community health medical education program.

BACKGROUND: Distinct periods in the community health undergraduate medical program at the University of La Sabana (Colombia) were identified in its evolution from 1999 to 2013. We describe each period and explain the succesion of changes toward improvement. METHODS: An ordered review of the community health program was constructed based on the retrospective recollection, classification, and analysis of information from document archives and interviews with participants. The review of the experience reconstructs periods of the program, organizing the evolution of its learned lessons and identified changes across the development of community health projects (CHPs) and the phases followed in their implementation. RESULTS: Two principal stages were identified, the first when students' CHPs involved only schools, and the second when students worked in a broader array of community settings. Identified phases of the community health cycle leading to identifying changes across the program timeline were focus of the community-campus partnership; development of relationships among participants; health and health determinants' assessment; defining project goals and objectives; devising a project activity plan; implementing and gathering results; disseminating project achievements; and building sustainability of program activities. Periods were bounded by important new characteristics introduced in the pursuit of healthier communities. DISCUSSION: Understanding the evolution of the program revealed the key concepts and practices in setting community health apprenticeship scenarios for the various participants. Overall, trust and commitment from stakeholders requires competent facilitators able to build meaningful and sustainable collaborations that can translate the purpose of community health practice into an effective teaching-learning experience. Institutional capacity building and collaborative practice contribute to improvements in the community health program and its ability to be flexible to adapt to different contexts. Periods reflecting improvement in this school's programs over time can help others identify key elements that need to be integrated into a community health medical education program.

Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study.

OBJECTIVE: To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia. MATERIALS AND METHODS: An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. RESULTS: The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (ß = -0.021; 95%CI -0031 to -0.01 and ß 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (ß = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. DISCUSSION: The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

Relación entre factores sociodemográficos y el bajo peso al nacer en una clínica universitaria en Cundinamarca (Colombia) / Relationship between sociodemographic factors and low birth weight in a university clinic in Cundinamarca (Colombia)

Resumen Objetivos: Explorar la relación entre las variables sociodemográficas presentes en la madre y en la familia con el bajo peso al nacer en los recién nacidos atendidos en una clínica universitaria en Chía (Cundinamarca, Colombia). Métodos: Estudio de corte transversal. Se incluyó a 301 recién nacidos de la Clínica Universidad de La Sabana entre el 1° de julio y 31 de diciembre de 2015. Se midieron variables sociodemográficos y factores de la madre y del recién nacido. Se realizó un análisis bivariado para determinar la relación entre las variables de exposición y bajo peso; para este se aplicó la prueba de chi2 o de Fisher. Posteriormente se realizó un modelo de regresión logística para explorar la asociación entre las variables de exposición y el bajo peso al nacer. Resultados: La frecuencia de bajo peso al nacer fue del 18.27 %. Se halló asociación entre el bajo peso al nacer y el nivel educativo bajo de la madre (OR 2.65; IC 95 %: 1.17 - 5.97). Como factor protector para el bajo peso al nacer se encontró el asistir a 4 o más controles prenatales (OR 0.34; IC 95 %: 0.14 - .084). Conclusiones: La frecuencia de bajo peso al nacer en la población estudiada está por encima del promedio nacional y regional. Se encontró como factor de riesgo el nivel educativo bajo, y como factor protector, el número de controles prenatales. Es importante continuar con el adecuado control social en las madres y familias de estratos bajos como factor preventivo primario del bajo peso al nacer.

Abstract Objectives: To explore the relationship between sociodemographic variables present in the mother and in the family with low birth weight infants attended at a university clinic in Chia, Colombia. Methods: Cross-sectional study. 301 newborns from the Clinica Universidad de La Sabana were included between July 1 and December 31, 2015. Socio-demographic variables and maternal and newborn factors were analyzed. A bivariate analysis was performed to determine the relationship between the variables and low-birth weight, the chi2 or Fisher test was applied. A logistic regression model was performed to explore the association between exposure variables and low birth weight. Results: The frequency of low birth weight was 18.27 %. We found an association between low birth weight and low maternal education (OR 2.65,95 % CI: 1.17 - 5.97). As a protective factor for birth weight was found to attend four or more prenatal controls (OR 0.34, 95 % CI: 0.14 - .084). Conclusions: The frequency of low birth weight is above the national and regional average. The low educational level was found as a risk factor and as a protective factor the number of prenatal controls. It is important to continue with adequate social control in low-income mothers and families as a primary preventive factor of low birth weight.

Association of early childhood caries with risk factors in community homes of Instituto Colombiano de Bienestar Familiar in Zipaquirá, Colombia / Asociación de caries de infancia temprana con factores de riesgo en hogares comunitarios del Instituto Colombiano de Bienestar Familiar en Zipaquirá, Colombia

ABSTRACT Introduction: the goal of this study was to establish the association of social and biological risk factors with early childhood caries (ECC) in children from community homes of Instituto Colombiano de Bienestar Familiar (ICBF) in Zipaquirá, Colombia. Methods: descriptive cross-sectional study conducted by universities in 546 children aged 24 to 60 months. The following conditions were identified: socio-demographic variables, hygiene habits, O'Leary index and DMFT index, anthropometric variables, and psychomotor development. To evaluate the association of early childhood caries and severe caries to the variables under study, the Pearson's Chi-squared test was used for categorical variables, and the Spearman's correlation coefficient test was used for ordinal variables. Results: prevalence of ECC of 64.3% (95% CI 60.3%-68,3%) and severe ECC of 54% (95% CI 49.8%-58,2%). There was statistically significant association between the presence of ECC and inadequate brushing, visits to the dentist, dental treatment, the presence of malnutrition and the consumption of food at night after brushing; and severe ECC was associated with visits to the dentist, dental treatment, bottle feeding during the evening, the use of sweeteners in baby bottles, the habit of sleeping with the bottle, and food intake in the evening after brushing. Conclusions: the prevalence of EEC is high. The results of this study help validate the need for a comprehensive approach to children's health care, incorporating ECC to the spectrum of childhood diseases prevalent in the studied population.

RESUMEN. Introducción: el objetivo del presente estudio consistió en determinar la asociación de factores de riesgo sociales y biológicos con caries de infancia temprana (CIT) en los niños de hogares comunitarios del Instituto Colombiano de Bienestar Familiar (ICBF) en Zipaquirá, Colombia. Métodos: estudio descriptivo transversal, desarrollado por instituciones universitarias en 546 niños con edades entre los 24 y 60 meses. Se identificaron variables sociodemográficas, hábitos de higiene, los índices O'Leary y CEO, y variables antropométricas y de desarrollo psicomotriz. Para evaluar la asociación de caries de infancia temprana y caries severa con las variables evaluadas se aplicó la prueba χ² de Pearson en el caso de variables categóricas, y el coeficiente de correlación de rangos de Spearman en el caso de variables ordinales. Resultados: prevalencia de CIT del 64,3% (IC 95% 60,3%-68,3%) y de CIT severa del 54% (IC 95% 49,8%-58,2%). Se encontró asociación estadísticamente significativa entre la presencia de CIT y el cepillado inadecuado, la visita al odontólogo, el tratamiento odontológico, la presencia de desnutrición y el consumo de alimentos en la noche después de cepillarse; y de CIT severa con la visita al odontólogo, el tratamiento odontológico, la succión de biberón en la noche, el uso de endulzantes en el biberón, la costumbre de dormir con el biberón y el consumo de alimentos en la noche después de cepillarse. Conclusiones: la prevalencia de CIT es alta. Los resultados de este trabajo permiten evidenciar la necesidad de ofrecer un abordaje integral al cuidado de la salud de la infancia, incorporando la CIT al espectro de las enfermedades prevalentes de la infancia en la población estudiada.

Frecuencia de asistencia a la consulta odontológica en el control prenatal y factores asociados en un hospital público de Bogotá, Colombia, 2011-2012 / Frequency of attendance to the dental clinic as part of prenatal care, and associated factors in a public hospital in Bogotá, Colombia, 2011-2012

Objetivo: Determinar la frecuencia de asistencia a la consulta odontológica durante el embarazo de las mujeres que asisten al primer control neonatal y que tuvieron su parto en la misma institución, y explorar asociaciones entre hábitos de higiene oral, hábitos de salud, conocimientos y creencias, y la asistencia a la consulta odontológica. Materiales y métodos: Estudio de corte transversal descriptivo. Se incluyeron 682 mujeres que asistieron al primer control neonatal y cuyo parto fue atendido en la misma institución entre los años 2011 y 2012, en un hospital de segundo nivel de complejidad, ubicado en una localidad de ingreso socioeconómico bajo en la ciudad de Bogotá. Se midieron variables sociodemográficas, factores relacionados con comportamientos de salud oral, estilos de vida, conocimientos sobre la salud oral y el embarazo; se exploró el conocimiento sobre el efecto del embarazo en la salud oral y sobre el efecto de una pobre salud oral en el desenlace del embarazo. Se realizó un modelo de regresión logística para explorar asociaciones entre hábitos de higiene oral, hábitos de salud, conocimientos y creencias, y la asistencia a la consulta odontológica. Resultados: La prevalencia de asistencia al odontólogo fue 75,9 %; la variable que más asociación positiva tuvo, respecto a la asistencia a la consulta odontológica, fue remisión al odontólogo (OR = 25,90; IC 95 %: 14,60-45,96). La variable que tuvo mayor asociación negativa fue desconocimiento sobre el efecto de la enfermedad periodontal en los resultados perinatales (OR= 0,61; IC 95 %: 0,38-0,97) y la no asistencia regular al odontólogo antes del embarazo (OR= 0,49; IC 95 %: 0,29-0,82). Conclusiones: La prevalencia de asistencia a la consulta odontológica durante el embarazo fue elevada. Es importante educar a la paciente sobre las posibles consecuencias de la mala salud oral sobre el buen curso del embarazo.

Objective: To determine the frequency of attendance to the dental care clinic during pregnancy in women coming to their first neonatal follow-up visit in the same institution where they were delivered, and to explore associations between oral hygiene habits, health habits, knowledge and beliefs, and attendance to dental care appointments. Materials and methods: Descriptive, cross-sectional study that included 682 women coming to the first neonatal follow-up visit and who were delivered in the same Level II institution located in a low-income area in Bogotá, during 2011 and 2012. The variables measured included social and demographic factors, factors associated with oral health, life-style, knowledge about oral health and pregnancy. The knowledge about the effect of pregnancy on oral health and about the effect of poor oral health on the outcome of pregnancy was explored. A logistic regression model was used to explore associations between oral hygiene habits, health habits, knowledge and beliefs, and attendance to the dental care clinic. Results: Prevalence of attendance to the dental care clinic was 75.9 %. The variable with the highest positive association with attendance to the dental clinic was referral to the dentist (OR = 25,90; 95 % CI: 14.60-45.96). The variable with the highest negative association was lack of knowledge of the impact of periodontal disease on perinatal outcomes (OR= 0.61; 95 % CI: 0.38-0.97) and failure to visit the dentist regularly before pregnancy (OR= 0.49; 95 % CI: 0.29-0.82). Conclusions: The prevalence of attendance to the dental care clinic during pregnancy was high. It is important to educate patients regarding the potential consequences of poor oral health for the good course of the pregnancy.

Efectividad de los trabajadores comunitarios en medidas preventivas para salud maternal e infantil en países de bajos y medianos ingresos: revisión sistemática de la literatura / Effectiveness of community workers on preventive measures to maternal and child health in low and middle income countries: systematic review of the literature

Objetivo: Evaluar y sintetizar la evidencia científica que presente información sobre la efectividad de las intervenciones preventivas realizadas por los trabajadores comunitarios en salud materna y salud infantil a nivel hogar. Metodología: Se realizó una revisión sistemática de la literatura. La búsqueda se realizó desde 1966 a 2014 en las diferentes bases de datos: Medline, Embase, Lilacs, Cochrane, CINHAL, OMS series y google schollar. Se incluyeron estudios tipo experimental o cuasi experimentales que abordaran la incorporación de trabajadores comunitarios en intervenciones de prevención primaria para salud materna e infantil. Se realizó una síntesis narrativa de los resultados. Resultados: se identificó un total de 12 560 referencias; de estas se tamizaron 6234. Se incluyeron en esta revisión, posterior a una evaluación de calidad metodológica, 19 estudios. De estos se identificaron diseños como ensayos clínicos controlados, ensayos por conglomerados, estudios de antes y después, estudios observacionales analíticos tipo casos y controles y estudios de corte transversal. Se identificaron actividades de promoción y prevención para malaria, adherencia a la lactancia materna, cuidados del recién nacido, cuidados y soporte para el momento del parto. En todos los escenarios se demostró efectividad de la inclusión del trabajador comunitario en los desenlaces de adherencia y reducción de mortalidad materna e infantil. Conclusiones: La inclusión de los trabajadores comunitarios es efectiva en la reducción de la mortalidad materna e infantil en países de bajos y medianos ingresos. Además de ello, mejora el acceso y la cobertura a los servicios de salud de poblaciones vulnerables.

Objective: To evaluate and synthesize scientific evidence that reports on the effectiveness of preventive interventions by community workers in maternal and child health at the household level. Methods: A systematic literature review was conducted. The search was conducted from 1966-2014 in different databases: Medline, Embase, Lilacs, Cochrane, CINAHL, WHO and google Schollar series. Experimental or quasi-experimental studies that addressed the incorporation of community workers in primary prevention interventions for maternal and child health were included. A narrative summary of the results was performed. Results: A total of 12 560 references were identified, of these 6234 references were screened. They were included in this review, after an assessment of methodological quality, 19 studies. Of these 19 studies designs as controlled clinical trials, cluster tests, before and after studies, analytical observational case-control studies and cross-sectional studies we were identified. Advocacy and malaria prevention, adherence to breastfeeding, newborn care, care and support during childbirth were identified. In all scenarios, including the effectiveness of Community worker in the outcomes of adherence and reduction of maternal and infant mortality it was demonstrated. Conclusions: Inclusion of community workers is effective in reducing maternal and infant mortality in low- and middle-income. Moreover it is improving access and coverage of health services to vulnerable populations.

Avances en la comprensión de la transición nutricional colombiana / Avanços na compreensão da transição nutricional colombiana / Advances in understanding Colombia´s nutrition transition

Objetivo: describir la presencia y las características relacionadas con la transición nutricional colombiana, a partir de datos antropométricos y sociodemográficos. Métodos: se estimó el estado nutricional de mujeres en edad fértil y niños menores de cinco años, con base en la información registrada en las bases de datos de la Encuesta Nacional de Demografía y Salud de Colombia delos años 1995, 2000, 2005 y 2010. Se evaluó la asociación entre el estado nutricional de los dos subgrupos y las características sociodemográficas, como también con marcadores potencialesde actividad física sedentaria. Resultados y conclusiones: se encontraron distintas expresionesde la transición nutricional en Colombia: mayor prevalencia de sobrepeso y obesidad en ambos subgrupos respecto a desnutrición, una prevalencia creciente y acelerada de obesidad en el grupo de mujeres en edad fértil, asociación del estado nutricional con marcadores potenciales de actividadfísica sedentaria y estado nutricional relacionado con algunas variables sociodemográficas...

Objective: to describe the presence and characteristics related to the Colombian nutrition transition by analyzing anthropometric and sociodemographic data. Methods: the nutritional conditionof women in childbearing age and of children under 5 years was estimated based on information from the Colombian 1995, 2000, 2005 and 2010 Demographic Health Surveys. Association between the nutritional condition of the two subgroups with sociodemographic characteristicsand potential markers of sedentary physical activity was evaluated. Results and Conclusions: different expressions of the nutritional transition in Colombia were observed: Higher prevalenceof overweight and obesity in both population subgroups as compared to undernutrition, an increasing and accelerated prevalence of obesity of women in childbearing age, associationof the nutritional condition with potential markers of sedentary physical activity in households and nutritional condition related to some sociodemographic variables...

Objetivo: Descrever a presencia e características relacionadas com a transição nutricional colombianaa partir de dados antropométricos e sociodemográficos. Métodos: Estimou-se o estado nutricional de mulheres em idade fértil e crianças menores de 5 anos com base na informação registrada nas bases de dados do Inquérito Nacional de Demografia e Saúde de Colômbia dos anos 1995, 2000, 2005 e 2010. Avaliou-se a associação entre estado nutricional dos dois subgrupos e características sociodemográficas mesmo com marcadores potenciais de atividade física sedentária. Resultados e conclusões: Encontraram-se diferentes expressões da transição nutricional na Colômbia: Maior prevalência de sobrepeso e obesidade em ambos os subgrupos respeito à desnutrição, prevalência crescente e acelerada de obesidade no grupo de mulheresem idade fértil, associação do estado nutricional com marcadores potenciais de atividade física sedentária e estado nutricional relacionado com variáveis sociodemográficas...