Inequities in diagnosis of Fragile X syndrome in Colombia.

BACKGROUND: Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and autism spectrum disorder (ASD). In Colombia, there are no screening or testing protocols established for the diagnosis of FXS. In this study, we aimed to describe the diagnostic trends of FXS in Colombia. METHODS: Data were included on 1322 individuals obtained based on data from the only 2 databases available. Sociodemographic information and data related to the diagnostic process were obtained and included in this study. RESULTS: The average age at the time of diagnosis for individuals with the full mutation (FM) was of 26.9 ± 2.57 years and was strongly dependent on sex and socioeconomic status. Most individuals with a molecular diagnosis were from the main cities. CONCLUSION: The overall age of diagnosis of FXS is later in life than reports from other countries. Restricted access to molecular testing through the national health system might explain this discrepancy in Colombia.

Association of Health Insurance Status and Vaccination Coverage among Adolescents 13-17 Years of Age.

OBJECTIVE: To assess selected vaccination coverage among adolescents by health insurance status and other access-to-care characteristics. STUDY DESIGN: The 2015 National Immunization Survey-Teen data were used to assess vaccination coverage disparities among adolescents by health insurance status and other access-to-care variables. Multivariable logistic regression analysis and a predictive marginal modeling were conducted to evaluate associations between health insurance status and vaccination coverage. RESULTS: Overall, vaccination coverage was significantly lower among uninsured compared with insured adolescents for all vaccines assessed for except ≥3 doses of human papillomavirus vaccine (HPV) among male adolescents. Among adolescents 13-17 years of age, vaccination of uninsured compared with insured adolescents, respectively, for tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine was 77.4% vs 86.8%; for ≥1 dose of meningococcal conjugate vaccine was 72.9% vs 81.7%; for ≥1 dose of HPV was 38.8% vs 50.2% among male and 42.9% vs 63.8% among female adolescents; for 3 doses of HPV was 24.9% vs 42.8% among female adolescents. In addition, vaccination coverage differed by the following: type of insurance among insured adolescents, having a well-child visit at 11-12 years of age, and number of healthcare provider contacts in the past year. Uninsured were less likely than insured adolescents to be vaccinated for HPV (female: ≥1 dose and 3 doses; and male: ≥1 doses) after adjusting for confounding variables. CONCLUSIONS: Overall, vaccination coverage was lower among uninsured adolescents. HPV vaccination coverage was lower than tetanus toxoid, reduced content diphtheria toxoid, and acellular pertussis vaccine Tdap and meningococcal conjugate vaccine in both insured and uninsured adolescents. Wider implementation of effective evidence-based strategies is needed to help improve vaccination coverage among adolescents, particularly for those who are uninsured. Limitation of current federally funded vaccination programs or access to healthcare would be expected to erode vaccine coverage of adolescents.

Factores asociados a la perforación apendicular en pacientes con apendicitis aguda. Experiencia en el Nuevo Sanatorio Durango / Delay in the request for health care and other factors associated with appendix perforation in patients with acute appendicitis

Antecedentes: La complicación más grave de la apendicitis aguda es la perforación debido a su alta morbilidad y mortalidad. Se ha señalado que la probabilidad de perforación pudiera relacionarse al tiempo de demanda de atención, medicamentos previos a la atención médica y tipo de seguro del paciente. Objetivo: Establecer los factores asociados a la perforación apendicular en pacientes con apendicitis aguda atendidos en el Centro Hospitalario Nuevo Sanatorio Durango entre enero del 2008 y octubre del 2012. Material y métodos: Se estudió a pacientes sometidos a cirugía por apendicitis aguda. Se agruparon según la presencia o no de perforación apendicular al momento del procedimiento quirúrgico. Se analizó el tiempo en horas de evolución hasta su ingreso a nuestra unidad, además de las características de sexo, edad, tipo de seguro (individual o empresarial) y comorbilidad de los pacientes. Se preguntó además si hubo medicación prehospitalaria. Resultados: Se analizó un total de 189 expedientes, de los cuales, en 69 (36%) se presentó perforación apendicular. Los pacientes con perforación apendicular tuvieron 2 horas más en promedio de evolución previo a su atención (26 frente 24 horas, p < 0.001), lo cual significó 2% más de riesgo (RM) por hora transcurrida (IC 95% de 0.2 a 4%, p = 0.03). Otros factores asociados fueron la medicación previa (RM = 23, IC 95%, 9 a 57), el tener un seguro empresarial (RM = 3.3, IC 95% 1.6 a 10). Conclusiones: Los factores asociados a la perforación apaendicular son el retraso en la atención médica, la medicación previa y el tipo de seguro del paciente.

Background: Appendiceal rupture is the most severe complication of acute appendicitis, since it has high morbidity and mortality rates. It has been suggested that the risk of appendiceal rupture is related to the time the patient takes to ask for medical help, previous medication, and te patient's type of insurance. Objective: To establish the factors related to the appendiceal rupture in patients with acute appendicitis who attended the Centro Hospitalario Nuevo Sanatorio Durango from January 2008 to October 2012. Material and metodology: Patients who had undergone appendectomy for acute appendicitis were studied and 2 groups were formed: Appendiceal rupture group and Nonappendiceal rupture group. The time of evolution (in hours) until admittance to the hospital, as well as age, sex, type o insurance (personal, company), comorbidity, and if the patient had taken any medication before looking for medical help, were the patient's features assessed. Results: From 189 patients who underwent appendectomy for acute appendicitis, 69 (36%) presented appendiceal rupture. These patients had two more hours of evolution (26 vs 24 horas, p<0.001) on average before receiving medical help; which meant 2% higher risk per hour (IC 95% de 0.2% a 4%, p = 0.03). Other factors associated were previous medication (RM = 23, IC 95% 9 a 57), having company insurance (RM = 3.3, IC 95% 1.6 a 10). Conclusions: the factors associated with appendiceal perforation were delay in medical attention, previous medication, and the type of insurance owned by the patient.