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Background Umbilical cord (UC) abnormalities are related to neurological outcome and death; specific molecular factors that might be involved are, as yet, unknown; however, protein-coding genes insulin-like growth factor 2 (IGF2) and cyclin-dependent kinase inhibitor 1C (CDKN1C) have been identified as potential candidates. Methods An analytical observational study was carried out. Newborn UCs were collected, along with their clinical and morphological features. Immunohistochemical analysis was made on paraffin-embedded sections and quantitative reverse transcription polymerase chain reaction (qRT-PCR) was performed in fresh UC tissue for the assessment of gene expression. Results A total of 100 newborns were included. A significant association was found between long UC and prematurity [odds ratio (OR) 9] and long UC and respiratory distress (OR 4.04). Gestational diabetes (OR 8.55) and hypertensive disorders of pregnancy (HDP) (OR 4.71) were found to be related to short UCs. The frequency for abnormal UC length was higher than expected. UC length was positively correlated with maternal, newborn and placental weight. No statistical association was found between IGF2 and CDKN1C (p57) expression and UC length; however, there was a tendency for higher CDKN1C expression in short UCs, while, on the contrary, higher IGF2 expression for long UCs. Conclusion UC length was observed to be associated with maternal and newborn complications. Protein expression, messenger RNA (mRNA) activity and the activity of said genes seem to be related to UC length.

Resumen Los registros de cáncer de base poblacional (RCBP) son los responsables del reporte de incidencia, mortalidad y supervivencia de los pacientes con cáncer para sus respectivas poblaciones. Los RCBP del país son definidos por la legislación colombiana como fuentes de información de los registros nacionales de cáncer para adultos y niños, pero carecen de un soporte jurídico que permita el acceso a las fuentes oficiales de información nacional y enfrentan restricciones dadas por la ley para el tratamiento de datos personales que impide la transferencia de información de los registros nacionales de cáncer y todas sus fuentes hacia los RCBP. Se analizarán los problemas de acceso a la información de estadísticas vitales del país, así como las consecuencias de estas barreras de acceso para los RCBP, y se presentarán argumentos que sustenten la necesidad de que los RCBP puedan acceder a la información necesaria para poder cumplir su objetivo. Abstract Population-based cancer registries (PBCR) are responsible for reporting incidence, mortality and survival for cancer patients in their respective populations. Colombian legislation assigned the PBCR as sources of information for the national observatory on cancer. However, the PBCR lack legal support that officially assures access to official sources of national vital statistics and information on healthcare consumption; they face restrictions provided by law for the processing of personal data that prevents the transfer of information from national cancer databases and all their sources to the PBCR. We provide analysis of the problems of access to information on vital statistics of the country and the consequences of these access barriers for the PBCR, the presented arguments illustrate the need for the PBCR to have a smooth access to such information to be able to comply with their objectives.

Introduction: Aging of the population and the accompanying increase in prevalence of chronic illnesses mean that more people will need palliative care. This need has not been extensively quantified in middle-income countries to policy planning and expanding health care. Objective: Provide an estimate of the need of palliative care services in Colombia and compare these needs with the current available offer. Methods: Cross-sectional study based on mortality statistics for Colombia for the period 2012 to 2016. We calculated age-specific and sex-specific numbers of deaths and mortality rates from death certificate for defined chronic illnesses to estimate the prevalence of palliative care need in Colombia, and contrasted this information with the current offer according to the Colombian Observatory of Palliative Care. Results: The numbers of deaths requiring palliative care increased from 107,065 in 2012 to 128,670 in 2016 (61.2% of total deaths). The causes of these deaths vary by age group, with a clearly more important proportion of heart and cerebrovascular diseases and dementia in advances ages, and HIV/AIDS in young ages. In all age groups, malignant neoplasms are an important part of the causes of deaths of those requiring palliative care (31.3% of all deaths in 2016). Contrasting this needs, in most areas there is no or very limited offer of palliative care services. Conclusion: A real palliative care policy, including a vast increase in training opportunities in the field and regulation allowing a wide range of health practitioners to be involved in palliative care, is necessary in Colombia to improve the palliative care offer. Resumen Introducción: El envejecimiento de la población y el consecuente aumento en la prevalencia de enfermedades crónicas implica que habrá más personas que necesitarán cuidados paliativos. Esta necesidad no se ha cuantificado mayormente en los países de medianos ingresos con miras a la planificación de políticas y a la ampliación de la atención en salud. Objetivo: Ofrecer un estimado de la necesidad de servicios de cuidados paliativos en Colombia y comparar dichas necesidades con la oferta disponible en la actualidad. Métodos: Estudio transversal basado en estadísticas de mortalidad en Colombia para el periodo comprendido entre 2012-2016. Calculamos las cifras de muertes y tasas de mortalidad específicas por edad y sexo a partir de los certificados de defunción correspondientes a enfermedades crónicas definidas, a _n de estimar la prevalencia de la necesidad de cuidados paliativos en Colombia, y se comparó dicha información con la oferta actual, de acuerdo con el Observatorio Colombiano de Cuidados Paliativos. Resultados: Las cifras correspondientes a muertes que requirieron cuidados paliativos aumentaron de 107 065 en el 2012 a 128 670 en el 2016 (61.2% del total de muertes). Las causas de estas muertes varían según el grupo etario, con un porcentaje evidentemente mayor de enfermedades cardiacas, cerebrovasculares y demencia en edades avanzadas, y VIH/SIDA en los grupos más jóvenes. En todos los grupos etarios, las neoplasias malignas son una parte importante de las causas de muerte de quienes requieren cuidados paliativos (31.3% de todas las muertes en el 2016). Estas necesidades contrastan con el hecho de que en la mayoría de las áreas no existen servicios de cuidados paliativos, o su oferta es muy limitada. Conclusiones: En Colombia se necesita una verdadera política de cuidados paliativos, incluyendo un aumento significativo de las oportunidades de capacitación en el área, así como un marco regulatorio que permita que una amplia gama de profesionales de la salud participen en cuidados paliativos, a in de mejorar la oferta de estos servicios.

Background Inherited mutations in the breast cancer susceptibility genes BRCA1 and BRCA2 (BRCA1/2) confer high risks of breast and ovarian cancer. In Colombian Hispanic families, four common BRCA1/2 founder mutations have previously been identified. Because nothing is known about the contribution of BRCA1/2 germline mutations to early-onset and hereditary breast and/or ovarian cancer in Afro-Colombians, we conducted the first study on 60 patients with early-onset and familial breast cancer in this population. Materials and Methods Screening for the four Colombian founder mutations BRCA1/c.3331_3334delCAAG, BRCA1/c.5123C>A, BRCA2/c.2806_2809delAAAC, and BRCA2/c.1763_1766delATAA was performed using mismatch polymerase chain reaction (PCR) analysis, PCR-based restriction fragment length polymorphism analysis, and qualitative real-time PCR. Mutations were confirmed by direct DNA sequencing. Results The BRCA1 founder mutation c.5123C>A was identified in one family with breast and ovarian cancer (1/60, 1.7%). Three women were diagnosed with breast cancer, including one with bilateral disease, at the ages of 30, 30/33, and 52 years, and one woman was diagnosed with ovarian cancer at the age of 60 years. Conclusion Our data showed a low prevalence of the BRCA1/2 founder mutations in Colombians of African descent, implying that these mutations should not be recommended for genetic screening programs in the Afro-Colombian population.

Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50–69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3–99.3) and 99.4% (95%CI 99.2–99.6). CBE sensitivity was 39.1% (95%CI 37.9–40.3) and specificity 83.4% (95%CI 82.6–84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.

Introduction: Umbilical cord (UC) abnormalities and their clinical relations in 434 newborns were analyzed. We had previously reported on clinical associations of long and short UCs with any kind of malformation. This study focuses on other UC features (insertion, vessels, entanglements, coiling, and knots) and their associations with clinical characteristics and neonatal prognosis. Methods: An observational analytic study was performed on placentas from consecutive deliveries. Ordered logistic regression with bivariate and multivariate analysis was performed to evaluate the relationship between variables of interest concerning UC abnormalities. Results: A total of 434 placentas made up the study. UC abnormalities were abnormal insertion, 82 (18.86%); coiling (hypo and hypercoiled), 177 (40.78%); single umbilical artery (SUA), 4 (0.92%); entanglements, 8 (1.84%); true knots, 3 (0.69%); webs in UC base, 9 (2.07%); and right twist, 68 (15.67%). After analyzing maternal and fetal complications during pregnancy, multivariate analysis confirmed the recognized association between malformations and SUA and male gender; further confirmation was also made between hypertensive disorders of pregnancy and true knots. Discussion: UC abnormalities associated with undesirable outcomes are varied and should be recognized and described. Clinical factors associated with anatomical UC abnormalities are not completely understood and justify forthcoming studies. © 2018, Society for Pediatric Pathology All rights reserved. Pontificia Universidad Javeriana ubiquitin, 60267-61-0 The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study makes up part of the research project entitled, ‘‘Factors that determine umbilical cord length,’’ (ID PPTA 00005140) financed by the Pontificia Universidad Javeriana and its Hospital Universitario San Ignacio, Bogota, Colombia.

OBJECTIVE The aim of the present study was to evaluate the effectiveness of an educational tool for general physicians, based on rheumatological clinical simulation, for the diagnosis of rheumatoid arthritis and osteoarthritis. METHODS A randomized clinical study was carried out, in which the physician research subjects were assigned to one of two groups: the experimental group (educational intervention for rheumatoid arthritis with clinical simulation) or the control group (educational intervention for the basic aspects of the diagnosis and treatment of osteoporosis). Four weeks after the educational intervention, the members of both groups completed an examination that included four clinical cases with real patients, two clinical cases with two clinical simulation models and six virtual clinical cases. In this examination, the participants noted clinical findings, established a diagnosis and defined the complementary tests they would request, if necessary, to corroborate their diagnosis. RESULTS A total of 160 doctors participated (80 in the active educational intervention for rheumatoid arthritis and 80 in the control group), of whom 89 were women (56%). The mean age was 35 (standard deviation 7.7) years. Success was defined as a physician correctly diagnosing at least 10 of the 12 cases presented. A significant difference of 81.3% (95% confidence interval 72-90%; p < 0.001) in success was found in favour of the active group (88.8% versus 7.5%). A greater number of correct answers was found in the active group compared with the control group in the detection of clinical findings and in the number of complementary tests requested (p < 0.001). CONCLUSIONS The study showed the effectiveness of an educational intervention based on clinical simulation to improve the diagnostic approach to rheumatoid arthritis and osteoarthritis. The results open a new horizon in the teaching of rheumatology.

Fetal hepatic calcifications can be caused by infections, chromosomal disorders, thrombotic events, ischemic hepatic necrosis and subcapsular hematomas among others events. Its features and clinical significance are still not well known. We performed an observational study to describe fetal hepatic calcifications and its association with main clinical and histopathological findings from the fetal autopsy database, between 2007 and 2014. Raw odds ratio analysis was performed. We reviewed 591 fetal autopsies: 14 cases with hepatic calcifications, 102 fetuses with chromosomal disorders; 13 with diagnosis of TORSCH (toxoplasma, rubella, syphilis, cytomegalovirus, herpes virus 1 and 2, and others) and 207 with any abnormality in the umbilical cord (UC). The relation between hepatic calcifications and chromosomal disorders in our series had significance. It is known that hepatic calcifications are common in chromosomal disorders, transplacental infections and UC abnormalities, those conditions are risk factor for hepatic calcifications formation; we suggest hepatic calcifications should alert the pathologists in order to consider these etiologies in first instance.

Resumen Introduccion La Encuesta Nacional de Salud Mental (ENSM) de 2015 busca profundizar en la realidad de la situacion mental de los menores de edad de Colombia, teniendo en cuenta la carga de enfermedad que representan y que algunos trastornos mentales del adulto tienen su origen en la ninez o en la adolescencia, lo cual exige un mayor conocimiento del problema para disenar intervenciones oportunas y disminuir las complicaciones a largo plazo. Objetivo Determinar la prevalencia y los factores asociados de los trastornos en los ultimos 30 dias y los ultimos 12 meses. Metodos Se aplico la entrevista estructurada Diagnostic Interview Schedule for Children (DISC-P), que provee diagnosticos del DSM- IV a los cuidadores de ninos no institucionalizados de 7–11 anos. Se evaluaron los siguientes trastornos: depresion mayor, distimia, ansiedad generalizada, ansiedad de separacion, deficit de atencion e hiperactividad en sus tres presentaciones (mixto, inatento e hiperactivo), negativista desafiante y de conducta. El instrumento fue asistido por computador. Resultados Se presentan las prevalencias de los trastornos tanto en los ultimos 30 dias como en los ultimos 12 meses. En general se observa una prevalencia de cualquiera de los trastornos medidos del 3% (intervalo de confianza del 95% [IC95%], 2,2%-4,0%) en los ultimos 30 dias y del 4,7% (IC95%, 3,6%-6,2%) en los ultimos 12 meses. Son mas frecuentes en las mujeres. El trastorno por deficit de atencion e hiperactividad es el mas frecuente (el 2,3 y el 3,0%). Ademas, los trastornos de la conducta de inicio habitual en la infancia son los mas frecuentes en este grupo etario, con prevalencias del 2,5% en los ultimos 30 dias y el 3,2% en el ultimo ano. Se presentan factores de riesgo asociados. Conclusiones La ENSM de 2015 provee una informacion sobre la realidad de la situacion mental de los ninos de 7–11 anos de Colombia que permitira disenar estrategias de prevencion, diagnostico y tratamiento mas apropiados y precisos.

Aim The aim of this study was to assess the discriminative ability of the Infant Neurological International Battery (INFANIB), applied at 3, 6 and 9 months of corrected age (CA), on neurological outcomes at 1 year of CA. Method An observational analytic study was conducted on a cohort of 5857 infants, followed up to 1 year of CA in a Kangaroo Mother Care programme from 1993 to 2010 in Bogota, Colombia. Infants were included if they had two complete INFANIB results at 3 or 6 or 9 months of CA and at 12 months of CA, including the Griffiths Scale. The outcome was defined as the presence of a neurological abnormality, as evidenced by the results of both the INFANIB and Griffiths Scale. Results The sensitivity of the INFANIB at 3 months was 62.2%, and specificity was 76.1%, with a receiver operating characteristic (ROC) area of 0.69. At 6 months, the results were 77.5% for sensitivity and 74.4% for specificity (ROC 0.76), and at 9 months, they were 77.2% for sensitivity and 91.1% for specificity (ROC 0.84). Conclusion The INFANIB was an appropriate neurological screening test with regard to determining which Colombian infants would benefit from a timely intervention for neuromotor disorders.

In Latin America and the Caribbean, hypertensive pregnancy disorders are responsible for almost 26% of all maternal deaths [1] and, in Colombia, they account for 59% of all severe maternal morbidity (SMM) cases, and 59.7% of all SMM cases in adolescents [2]. One of the most important hypertensive pregnancy disorders is preeclampsia (PE). Lives can be saved, if PE is prevented, or detected early and properly managed. Prevention and detection depend on identifying the risk factors associated with PE, and, as these have been shown vary by population, they should be determined on a population-by-population basis. The following study utilized the nested case-control model to evaluate 45 potential PE risk factors of a cohort in Bogotá, Colombia, making it perhaps the most comprehensive study of its kind in Colombia. It found PE to have a statistically significant association with 7 of the 45 factors evaluated: 1) pre-gestational BMI >30 kg/m2, 2) pregnancy weight gain >12 kg, 3) previous history preeclampsia/eclampsia, 4) previous history of IUGR-SGA (Intrauterine Growth Restriction-Small for Gestational Age), 5) maternal age

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) represent a major clinical problem in Colombia. The aim of this study was to evaluate the risk factors associated with MRSA SSTI in Colombia. Methods: A multicenter cohort study with nested case–control design was performed. Patients with an SSTI with at least 48 h of inpatient care were included. Patients with an MRSA SSTI were considered the case group and patients with either a non-MRSA SSTI or with an Methicillin-susceptible S. aureus (MSSA) SSTI were the control groups. A multivariate logistic regression approach was used to evaluate risk factors associated with MRSA SSTI with two different statistical models. Results: A total 1134 patients were included. Cultures were positive for 498 patients, of which 52% (n = 259) were Staphylococcus aureus. MRSA was confirmed in 68.3% of the S. aureus cultures. In the first model, independent risk factors for MRSA SSTI were identified as the presence of abscess (P

Pathogenic BRCA1/2 germline mutations confer high risks of breast and ovarian cancer to women of European ancestry. Characterization of BRCA1/2 mutations in other ethnic groups is also medically important. We comprehensively screened 68 Colombian breast/ovarian cancer families for small-range mutations, 221 families for large-genomic rearrangements, and 1,022 unselected breast cancer cases for Colombian founder mutations in BRCA1/2. The risk of cancer among relatives of mutation carriers and the mutation penetrance were estimated by survival analysis. Identified BRCA2 mutations included 6310delGA and the recurrent 1991del4 mutations. A novel large BRCA2 deletion was found in 0.9% of the screened families. Among unselected breast cancer cases, 3.3% tested positive for BRCA1/3450del4, 2.2% for BRCA1/A1708E, 1.1% for BRCA2/3034del4, and 0.4% for BRCA2/1991del4. Female relatives of carriers of BRCA1/2 founder mutations showed a 5.90 times higher risk of breast cancer, when the woman herself carried a BRCA1 mutation compared to a non-carrier (95% CI 2.01–17.3). The estimated cumulative risk of breast cancer by age 70 years for BRCA1 mutations carriers was 14% (95% CI 5–38) compared to 3% for the general Colombian population (relative risk of breast cancer 4.05). Together with known founder mutations, reported novel variants may ease a cost-effective BRCA1/2 screening in women with Colombian ancestry.

Objective The Montreal Cognitive Assessment (MoCA) was developed as a simple screening tool for cognitive impairment. This study is the first validation in Latin America of the MoCA in Spanish (MoCA-S), which was developed in Colombia (South America). Methods Aiming to perform the first validation of the MoCA-S, we developed a study of concordance by conformity to assess the MoCA-S compared with diagnostic consensus by interdisciplinary assessment in the Memory Clinic (the best diagnostic method available) and to evaluate the psychometric properties of the MoCA-S. A total of 193 subjects were evaluated, 109 of whom were patients, including 26 who met the mild cognitive impairment (MCI) clinical criteria, based on neuropsychological testing, and 83 who had mild dementia (MD). The remaining 84 participants were healthy subjects from the community. Results The psychometric evaluation of the MoCA-S was appropriate. Using a cutoff score of ≥23, the MoCA had sensitivities of 76.0% to detect MCI and 92.7% to detect MD and a specificity of 79.8%. The percentage of patients clearly labeled by the MoCA-S was 85%. Conclusion The MoCA-S is a valid screening tool and is useful for identifying MCI and MD in Colombia. The MoCA-S is valid and adequate for application in Colombia with good internal consistency, inter-observer reliability, and content validity. However, the average educational level was high in this study; thus, caution should be exercised when extrapolating these results to individuals with lower educational levels. Copyright © 2014 John Wiley & Sons, Ltd.

Introducción: Los resultados de las pruebas SABER PRO de medicina tienen un alto impacto en la comunidad académica a nivel de estudiante y de universidad, y son empleados como indicadores de fortalezas y debilidades de los procesos de formación. La amplia variabilidad de los resultados entre universidades y entre estudiantes dentro de las universidades hace necesario estudiar qué posibles variables están asociadas con el desempeño en estas pruebas. Objetivo: Analizarla relación entre las variables a nivel de las universidades y las variables a nivel de estudiante de medicina con el desempeño en las pruebas SABER PRO de estudiantes de medicina. Materiales y métodos: Se empleó la información de 4498 estudiantes de medicina evaluados en las pruebas SABER PRO 2009 y de las 40 facultades de medicina a las que pertenecían; mediante el uso de modelos jerárquicos de dos niveles se evaluó la asociación de las características de estudiantes y universidades con el puntaje obtenido en la prueba. Resultados: El puntaje promedio por universidades de la prueba SABER PRO 2009 para estudiantes de medicina fue 100,4, con un rango entre 84,3 y 110,8 puntos. La variabilidad de los puntajes en la prueba fue explicada en un 29% por las diferencias entre universidades. Conclusiones: Las universidades oficiales y las facultades de medicina que cuentan con hospitales universitarios propios tienen en promedio mejores desempeños. Sin embargo, la oferta de programas de especialización médica se asocia con menores puntajes. Introduction: The results of the SABER PRO medical test have considerable impact on theaca-demic community. They are used as indicators of strengths and weaknesses of the education processes for both the student and the university. The wide variability of the results among different universities and students within the same university requires an analysis of the potential variables associated with the performance in these tests. Objective: To analyze the relationship of the inter-university variables and the inter-medical students variables against the performance on the SABER PRO tests. Materials and Methods: The information used was from 4498 medical students evaluated through the SABER PRO 2009 tests and of 40 schools of medicine the students belonged to. The association between the characteristics of the students and universities and the test scores obtained were evaluated using two-level hierarchical models. Results: The average score in the SABER PRO test per university for medical students was 100.4, with a range between 84.3 and 110.8 points. The variability of the test scores was accounted for in 29% of the cases by the inter-university differences. Conclusions: The public universities and the schools of medicine that have their own teaching hospital have better performance in average. However, the offer of medical specialization programs is associated with lower scores.

ResumenIntroducciónLos resultados de las pruebas SABER PRO de medicina tienen un alto impacto en la comunidad académica a nivel de estudiante y de universidad, y son empleados como indicadores de fortalezas y debilidades de los procesos de formación. La amplia variabilidad de los resultados entre universidades y entre estudiantes dentro de las universidades hace necesario estudiar qué posibles variables están asociadas con el desempeño en estas pruebas.ObjetivoAnalizar la relación entre las variables a nivel de las universidades y las variables a nivel de estudiante de medicina con el desempeño en las pruebas SABER PRO de estudiantes de medicina.Materiales y métodosSe empleó la información de 4498estudiantes de medicina evaluados en las pruebas SABER PRO 2009 y de las 40facultades de medicina a las que pertenecían; mediante el uso de modelos jerárquicos de dosniveles se evaluó la asociación de las características de estudiantes y universidades con el puntaje obtenido en la prueba.ResultadosEl puntaje promedio por universidades de la prueba SABER PRO 2009 para estudiantes de medicina fue 100,4, con un rango entre 84,3 y 110,8 puntos. La variabilidad de los puntajes en la prueba fue explicada en un 29% por las diferencias entre universidades.ConclusionesLas universidades oficiales y las facultades de medicina que cuentan con hospitales universitarios propios tienen en promedio mejores desempeños. Sin embargo, la oferta de programas de especialización médica se asocia con menores puntajes.AbstractIntroductionThe results of the SABER PRO medical test have considerable impact on theacademic community. They are used as indicators of strengths and weaknesses of the education processes for both the student and the university. The wide variability of the results among different universities and students within the same university requires an analysis of the potential variables associated with the performance in these tests.ObjectiveTo analyze the relationship of the inter-university variables and the inter-medical students variables against the performance on the SABER PRO tests.Materials and MethodsThe information used was from 4498 medical students evaluated through the SABER PRO 2009 tests and of 40 schools of medicine the students belonged to. The association between the characteristics of the students and universities and the test scores obtained were evaluated using two-level hierarchical models.ResultsThe average score in the SABER PRO test per university for medical students was 100.4, with a range between 84.3 and 110.8 points. The variability of the test scores was accounted for in 29% of the cases by the inter-university differences.ConclusionsThe public universities and the schools of medicine that have their own teaching hospital have better performance in average. However, the offer of medical specialization programs is associated with lower scores.

To describe, in infants aged 1-4 months old living at 3200 meters above sea level (MASL), oxygen saturation (SpO2), sleep apnea indices, and periodic breathing (PB) during sleep. Polysomnographies were done in 18 healthy infants.The median SpO2 was 87%, and the median PB was 7.2% for the total sleep time. The median central sleep apnea index was 30.5/hour, which decreased to 5.4/hour once sleep apneas associated with PB were excluded. The 5th percentile for SpO2 was 76% among awake infants, and 66% among asleep infants.The SpO2 was lower than that observed at sea level, whereas PB and the central sleep apnea index were higher, once sleep apneas associated with PB were excluded. The latter was similar to that observed at sea level. At 3200 MASL, different cut-off points are required for a normal SpO2, one for infants during the waking state and one for infants during sleep.Objetivos: describir, en niños de 1-4 meses, a 3200 m de altura, la saturación de oxígeno (SpO2 ), los índices de apnea y la respiración periódica (RP) durante el sueño. Se realizaron polisomnografías en 18 lactantes sanos. Resultados: las medianas fueron de 87% para la SpO2 y de 7,2% para la RP del tiempo total de sueño. El índice de apnea central tuvo una mediana de 30,5/hora, que disminuyó a 5,4/hora al descontar las apneas asociadas a RP. El p5 de la SpO2 para niños despiertos fue de 76% y, para niños dormidos, de 66%. Conclusiones: la SpO2 fue inferior a la del nivel del mar y la RP y el índice de apnea central, mayores; al descontar las apneas centrales asociadas a RP. Este último, fue similar a la del nivel del mar. A 3200 m, se requieren puntos diferentes para la SpO2 normal, uno para niños despiertos y otro si están dormidos.

Resumen Introduccion La ideacion suicida es un factor de mal pronostico en depresion por el riesgo de intento de suicidio y suicidio consumado; sin embargo, es un aspecto que no ha sido estudiado lo suficiente en la poblacion colombiana. Es importante conocer factores asociados para desarrollar estrategias adecuadas de tratamiento. Objetivo Identificar factores de riesgo para la ideacion suicida en pacientes con diagnostico de trastorno depresivo mayor entre los 18 y 65 anos, en 5 ciudades de Colombia. Metodo Se empleo la informacion de 295 pacientes con diagnostico de trastorno depresivo mayor que participaron en el Estudio de Carga Economica de la Depresion en Colombia. La asociacion de variables clinicas y psicosociales con la ideacion suicida se evaluo por medio de modelos multinivel. Resultados El sexo femenino fue un factor asociado con un menor riesgo de ideacion suicida. Los factores asociados con ideacion suicida incluyen desempleo, consumo de cigarrillo y de alcohol en los ultimos 30 dias, percepcion de la salud mental como regular o mala, diagnostico de depresion doble, tratamiento intrahospitalario, bajos ingresos y haber sufrido una gran crisis financiera en los ultimos 2 anos. Conclusiones La ideacion suicida es altamente prevalente en pacientes con trastorno depresivo mayor. Dentro de los factores de riesgo para ideacion suicida se identifican elementos de dominio tanto clinico como psicosocial que deben ser abordados con especial cuidado en pacientes con este diagnostico al momento de hacer una evaluacion de riesgo.

Resumen Introduccion El consumo de sustancias psicoactivas (SPA) es un problema mundial de salud publica. Los consumidores suelen utilizar los servicios de urgencias, mas que los no consumidores. Objetivo Determinar la prevalencia de consumo de seis sustancias psicoactivas en personas entre 18 y 65 anos, que acudieron al servicio de urgencias de un hospital universitario en Bogota e identificar sus caracteristicas demograficas. Metodo Estudio de corte transversal, con muestreo estratificado por grupos de edad y sexo de pacientes adultos que acudieron al servicio de urgencias por patologias no psiquiatricas, a quienes se les aplico un instrumento que indagaba datos demograficos, medicos, farmacologicos y toxicologicos. Luego se realizo un analisis toxicologico con el Breath Scan Test, para la deteccion de alcohol a partir de la exhalacion de aire, y el Screeners KO, para la deteccion en orina de cannabinoides, cocaina, benzodiacepinas, anfetaminas y opiaceos, en las ultimas seis horas. Resultados Se realizo el analisis en 473 personas. La prevalencia de consumo de cualquier sustancia fue de 7,8%. La sustancia mas detectada fue opiaceos, seguida por alcohol, cannabis, cocaina, benzodiacepinas y anfetaminas. El reporte verbal de consumo en las ultimas seis horas solo fue veraz para alcohol. Conclusiones La prevalencia de consumo de SPA en la poblacion general de urgencias es alta. De acuerdo con los resultados, ocho de cada cien personas que consultan a urgencias han consumido alguna SPA en las ultimas seis horas.

Resumen Introduccion La medicina complementaria y alternativa (MCA) esta adquieriendo un papel importante en el contexto de la atencion sanitaria en salud mental. Objetivo Describir el uso de las MCA en pacientes con trastorno afectivo bipolar (TAB), realizando una aproximacion al impacto que este tipo de medicinas puede generar en el diagnostico temprano de la enfermedad y la adherencia al tratamiento. Metodo Se recogio una muestra consecutiva de pacientes adultos con diagnostico de TAB, quienes asistian a tratamiento psiquiatrico en las instituciones participantes entre mayo del 2008 y mayo del 2009. Se administro una encuesta anonima, estructurada y autoaplicada. Resultados Se obtuvo informacion sobre 66 mujeres y 34 hombres; edad promedio, 45,5 anos (desviacion estandar 14,9 anos). El 29,3% reporto que desde el inicio de los sintomas del TAB hasta el diagnostico por un psiquiatra transcurrieron mas de 5 anos; el 31,6% referia haber recurrido a MCA como primera atencion sanitaria. Las consultas a sacerdotes y la asistencia a misas de sanacion constituyeron las practicas mas utilizadas, junto con la medicina homeopatica, la bioenergetica, las esencias florales, la acupuntura y el yoga. Discusion y conclusiones Aunque existen demoras en recibir un diagnostico adecuado y un tratamiento oportuno, y a su vez insatisfaccion con los servicios de la MC, este estudio permite un acercamiento al impacto de las MCA; sin embargo, se requiere mas investigacion orientada a conocer las expectativas y necesidades de los pacientes, que en lo posible integre los recursos terapeuticos disponibles para el tratamiento del TAB.

Access to mental health services by people with mental disorders has traditionally been limited, and is associated with attitudinal, social, and structural variables.To analyse the factors that determine access to mental health services by the adult population (18-44 years old) in Colombia, from the results obtained in the 2015 National Mental Health Survey.Analysis of variables of access to attention in mental health care for adults. The reasons for not consulting were classified as barriers of behavioural supply and demand. To analyse the factors associated with access to mental health services in the Colombian adult population, the use of health services in the last 12 months for emotional, nervous or mental health problems was taken into account, as well as associated variables such as demographic characteristics, occupational activity, affiliation to social security, and health status variables. The relationships between these variables were estimated using bivariate multinomial logistic regression models.Rural residence, being married, and having a chronic disease were associated with the decision to consult or not to consult the doctor.Further studies should be conducted to evaluate the situation as regards mental health care access, as well as to determine the potential factors associated with these limitations.

The WHO has encouraged the development, implementation and evaluation of policies related to mental health all over the world. In Colombia, within this framework and promoted by the Ministry of Health and Social Protection, as well as being supported by Colciencias, the fourth National Mental Health Survey (NMHST) was conducted using a observational cross sectional study. According to the context and following the guidelines and sampling design, a summary of the methodology used for this sampling process is presented. The fourth NMHST used the Homes Master Sample for Studies in Health from the National System of Studies and Population Surveys for Health to calculate its sample. This Master Sample was developed and implemented in the year 2013 by the Ministry of Social Protection.This study included non-institutionalised civilian population divided into four age groups: children 7-11 years, adolescent 12-17 years, 18-44 years and 44 years old or older. The sample size calculation was based on the reported prevalences in other studies for the outcomes of mental disorders, depression, suicide, associated morbidity, and alcohol use. A probabilistic, cluster, stratified and multistage selection process was used. Expansions factors to the total population were calculated.A total of 15,351 completed surveys were collected and were distributed according to the age groups: 2727, 7-11 years, 1754, 12-17 years, 5889, 18-44 years, and 4981, ≥45 years. All the surveys were distributed in five regions: Atlantic, Oriental, Bogotá, Central and Pacific.A sufficient number of surveys were collected in this study to obtain a more precise approximation of the mental problems and disorders at the regional and national level.

The 2015 National Mental Health Survey aimed to expand our knowledge about the real mental state of children in Colombia, taking into account the fact that most mental disorders in adults begin during childhood or adolescence. It is essential to have an improved knowledge of the magnitude of this issue and to design timely interventions that reduce long term complications.The aim of the study was to determine the prevalence of the disorders in the last 12 months and 30 days according to the DSM-IV, as well as to collect data about social and demographic variables.The structured Diagnostic Interview Schedule for Children (DISC-P), which provides DSM-IV diagnoses, was applied to carers of non-institutionalised children between 7 and 11 years old. The disorders evaluated included: major depressive disorder, dysthymia, generalised anxiety disorder, separation anxiety disorder, attention deficit hyperactivity disorder in its three kinds (mixed, inattentive, and hyperactive), oppositional defiant disorder, and conduct disorder. The instrumentation was computer-assisted.Prevalences of the disorders are present both in the last 30 days and in the last 12 months. In general, there is a prevalence of any of the disorders of 3% (95% CI, 2.2-4.0) in the last 30 days, and 4.7% (95% CI, 3.6-6.2) in the last 12 months. When evaluated individually, attention deficit hyperactivity disorder is the most frequent disorder, with a prevalence of 2.3% and 3.0% in the last 30 days and the last 12 months, respectively. In addition, the disorders that are known to frequently begin during childhood are the most common disorders in the age group studied, with a prevalence of 2.5% in the last 30 days and 3.2% in the last year.The 2015 National Mental Health Survey provides precise information about the real mental situation in children between the ages of 7 and 11 years in Colombia, compared with past epidemiological studies in the country, which were restricted to specific populations. By improving the reliability on knowledge about mental disorders in children, it will be possible to design more appropriate and precise strategies for prevention, diagnosis, and treatment.

Background: oxygen saturation (SpO2) during sleep in infants 1-4 months at altitudes 2,200-2,800 m is not established, nor have respiratory periodic breathing (PB) or apnea indexes (AI). Objectives: to describe SpO2 and PB and AI and their correlation with SpO2 during sleep in infants 1-4 months living at 2,560 m. Methods: polysomnography was performed in 35 healthy infants 1-4 months in Cuenca (Ecuador) at 2,560 m. To look for a correlation between SpO2 and PB, the ratio of the time during which the infant had a SpO2 ≥92% and the time when the SpO2 was less than 92%, was used. This number was called sleep saturation ratio (SSR). Results: No correlation was found between PB and SpO2. Conclusions: SpO2 was lower than the values at sea level and PB was higher. The absence of correlation between PB and SpO2 suggests that low SpO2 is attributable mainly to the decreased pressure oxygen in high altitudes. The decision to supply oxygen should be based on SpO2 and not on PB or other values.

There are few data in the literature related to polysomnography in infants in altitudes from 2,200 m to 2,800 m. The main objective of this investigation was to describe oxygen saturation (SpO 2 ) levels during sleep in infants aged between 1 and 4 months living at an altitude of 2,560 m. The secondary objectives were the description of periodic breathing (PB) and apnea indexes. Polysomnography was performed in 35 healthy infants 1-4 months in Cuenca (Ecuador) at 2,560 m. The median for SpO 2 was 92% and 4.9% for PB. The median for the central apnea index was 23.7/hour and 15.4/hour when related to PB. No correlation was found between PB and SpO 2 . Conclusion: SpO 2 was lower than the values at sea level and PB and central apnea indexwere higher. When apneas associated with PB were not considered, the central apnea indexwas similar to that found at sea level.

In South America, a high proportion of the population is of Hispanic origin with an important representation in Colombia. Since nothing is known about the contribution of BRCA1 and BRCA2 germline mutations to hereditary breast/ovarian cancer in the Hispanic population from Colombia, we conducted the first study of 53 breast/ovarian cancer families from this country. Comprehensive BRCA mutation screening was performed using a range of techniques, including DHPLC, SSCP, and PTT, followed by DNA sequencing analysis. Thirteen deleterious germline mutations (24.5%) were identified in 53 families, comprising eight in BRCA1 and five in BRCA2. The two recurrent BRCA1 mutations, 3450 delCAAG and A1708E, accounted for 100% of all BRCA1 mutations identified in this cohort and the recurrent 3034 delACAA BRCA2 mutation for 40% of all BRCA2 mutations. Haplotype analyses suggested that each of these mutations has arisen from a common ancestor. The prevalence of BRCA1 or BRCA2 mutations was 50% in multiple case breast cancer families, and was 33% for the breast-ovarian cancer families. Our findings show that BRCA mutations account for a substantial proportion of hereditary breast/ovarian cancer in Colombia. The spectrum of mutations differed completely to that previously reported in Hispanic families of predominantly Mexican origin from Southern California [1] suggesting that specific genetic risk assessment strategies for the different Hispanic populations in South America and in the United States need to be developed.

Bacteremia due to Pseudomonas aeruginosa resistant to carbapenems is a public health problem due to the limitations it places on therapeutic options, as well as the increased time patients must spend in hospital, costs and the risk of mortality. To evaluate the risk factors for presentation of bacteremia due to carbapenem-resistant P. aeruginosa acquired in the Hospital Universitario San Ignacio between January 2008 and June 2014. This was a case control study in which the case patients presented bacteremia due to P. aeruginosa resistant to carbapenems and the control group included patients with P. aeruginosa susceptible to this group of antibiotics. Variables such as the previous use of meropenem and ertapenem, immunosuppression and neoplasia were measured. Mortality and duration of hospital were also described. In all, 168 patients were evaluated, of which 42 were cases and 126 controls. Using a multivariate model, the risk factors related to bacteremia due to carbapenem-resistant P. aeruginosa acquired in hospital were the following: use of parenteral nutrition (OR=8.28; 95% CI: 2.56-26.79; p=0); use of meropenem (OR=1.15; 95% CI: 1.03-1.28; p=0.01); and use of ciprofloxacin (OR=81.99; 95% CI: 1.14-5884; p=0.043). In order to prevent the emergence of carbapenem-resistant P. aeruginosa, antimicrobial control programs should be strengthened by promoting the prudent administration of carbapenems and quinolones. The correct use of parenteral nutrition should also be monitored.

Alcohol misuse has been recognized as a public health problem in universities. It is possible to achieve a preventive approach if early identification of people with risky and harmful drinking patterns is achieved. There are multiple screening instruments with acceptable sensitivity. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has recommended the use of a simple question to screen hazardous and harmful alcohol consumption in primary care and their incorporation into routine clinical practice.To determine the discriminative ability of a simple question as a screening in a student health service.We applied this question to 303 patients treated at a university medical service, followed by the AUDIT.Using AUDIT as a reference, the sensitivity and specificity of the simple question to detect hazardous and harmful alcohol consumption was 0.90 (95% CI: 0.68-0.98) and 0.76 (95% CI: 0.70-0.80), respectively, with a negative predictive value of 99.1%.The simple question can timely detect people with risky and harmful alcohol consumption in a university medical service. This requires implementing a systematic approach to timely identify and intervene in this problem.

Unhealthy behaviors of medical students influence their attitudes toward preventive counseling. The burden of chronic diseases is continually growing in developing countries, emphasizing the need for the increased role of general practitioners in preventive counseling. The objective of this study was to describe the effect of medical training on the risk profiles and attitudes of medical students toward preventive counseling in a Colombian university. Students in their first and fifth years of training were surveyed using the “Healthy Doctor = Healthy Patient” questionnaire to assess counseling attitudes; personal practices, such as risky drinking, smoking, inadequate nutrition, and non-compliance with physical activity recommendations; and the university environment. The association among these components was estimated, as well as the effect of the university environment. Risky drinking and smoking decreased from first to fifth year (59.3% vs. 37.1%, P = 0.021 and 31.5% vs. 25.9%, P = 0.51, respectively), whereas inadequate nutrition and non-compliance with physical activity recommendations increased. Physical activity (PA) was associated with positive counseling attitude (ORs: nutrition 7.6; alcohol 5.2; PA 10.6). Areas governed by institutional policies that are emphasized in the curriculum positively affected student practices. PA promoted preventive counseling and healthy lifestyles most effectively. Universities should therefore strengthen their preventive medicine curricula and modify social determinants.

The Montreal Cognitive Assessment (MoCA) was developed as a simple screening tool for cognitive impairment. This study is the first validation in Latin America of the MoCA in Spanish (MoCA-S), which was developed in Colombia (South America).Aiming to perform the first validation of the MoCA-S, we developed a study of concordance by conformity to assess the MoCA-S compared with diagnostic consensus by interdisciplinary assessment in the Memory Clinic (the best diagnostic method available) and to evaluate the psychometric properties of the MoCA-S. A total of 193 subjects were evaluated, 109 of whom were patients, including 26 who met the mild cognitive impairment (MCI) clinical criteria, based on neuropsychological testing, and 83 who had mild dementia (MD). The remaining 84 participants were healthy subjects from the community.The psychometric evaluation of the MoCA-S was appropriate. Using a cutoff score of ≥ 23, the MoCA had sensitivities of 76.0% to detect MCI and 92.7% to detect MD and a specificity of 79.8%. The percentage of patients clearly labeled by the MoCA-S was 85%.The MoCA-S is a valid screening tool and is useful for identifying MCI and MD in Colombia. The MoCA-S is valid and adequate for application in Colombia with good internal consistency, inter-observer reliability, and content validity. However, the average educational level was high in this study; thus, caution should be exercised when extrapolating these results to individuals with lower educational levels.

Suicidal ideation is a poor prognostic factor in patients with depression, due to the risk of suicide attempt or completed suicide. However, it is a relatively unexplored aspect in the Colombian population. It is important to identify the associated factors in order to develop appropriate treatment strategies.To identify risk factors for suicidal ideation in patients with major depressive disorder between 18 and 65 years in 5 Colombian cities.Data from 295 patients diagnosed with major depressive disorder were used from the Study of the Economic Burden of Depression in Colombia. The association between the clinical and psychosocial variables with the presence of suicidal ideation was assessed using two-level hierarchical models.Female sex was a factor associated with a lower risk of suicidal ideation. Factors associated with the presence of suicidal ideation include unemployment, smoking and alcohol use in the past 30 days, mental health perceived as fair or poor, diagnosis of double depression, inpatient treatment, low income, unemployment, and a major financial crisis in the last 2 years.Suicidal ideation is highly prevalent in patients with major depressive disorder. Risk factors associated with both the clinical and psychosocial domain must be carefully evaluated during risk assessment of patients with this diagnosis.

Objective The aim of this study was to determine the differences in the efficacy and efficiency in providing critical care to hospitalized patients in teaching vs nonteaching intensive care units (ICUs) in Colombia. Methods A prospective cohort observational study was conducted. Location This study was conducted in 11 teaching and 8 nonteaching ICUs. From June 1 until December 31, 2005, data on 826 patients admitted consecutively to teaching ICUs and 825 patients admitted to nonteaching ICUs were analyzed. Measurements Acute Physiology and Chronic Health Evaluation II, Simplified Therapeutic Intervention Scoring System, ICU discharge status (dead or alive) and ICU length of stay, and standardized mortality ratios were considered in this study. A logistic regression and robust linear regression were performed. Results There were no differences in mortality (P = .25). Standardized mortality was less than 1 for both types of units. The teaching ICUs length of stay was 1 day longer (P < .01). Resource use is 25% higher in teaching units (P = .01). When the Simplified Therapeutic Intervention Scoring System score on the last day was from 21 to 35, a higher ratio of patients from the nonteaching ICUs was observed going floor or home when discharged from the ICU (P < .01). Conclusions Nonteaching ICUs discharge patients earlier than do teaching ICUs, but the effect of it remains to be clarified with further studies addressing questions as what happens after ICU discharge.

Estimating the prevalence of cardiovascular and chronic disease risk factors in a Colombian coffee-growing population.This cross-sectional study was carried out from February to November 2007. Multistage conglomerate sampling of 55 rural areas in 13 municipalities led to 516 people being surveyed. The questionnaires used were recommended by PAHO (anthropometric and biochemical measurements). The resulting data was subjected to univariate and bivariate descriptive analysis using 95 % CI, significance tests and comparison with previous studies.There was 21.1 % (19.2-23.3 95 %CI) current smoker prevalence, 31.2 % sedentarism (27.8-32.6 95 % CI), 86.3 % people consumed less than 5 portions of fruit and vegetables per day (84.4-87.9 95 % CI), 2.2 % had high alcohol consumption level (1.6-3.2 95 %CI), 26.2 % suffered from hypertension (23.9-28.6 95 % CI), 4.6 % diabetes (3.6-5.8 95 % CI), 62.1 % hyperlipidaemia (59.5-64.7 95 % CI) and 42.9 % (40.4-45.5 95 % CI) were overweight or obese. 85 % had at least 2 or more risk factors simultaneously. Sedentarism, diabetes, hyperlipidaemia and being overweight /obese was greater in females (p0.001). Alcohol consumption and smoking were greater in males (p0.001). Age, civil state, education, income and health system were related to the risk factors being studied.The study provided fresh knowledge concerning the lack of available information regarding rural Latin-American populations. Compared to the second Colombian study of chronic disease risk factors (ENFREC II), no important advances were found regarding a reduction of the prevalence of risk factors. Further studies are required for going deeper into social determinants and health systems explaining this study's findings.

Diabetes mellitus is a common disorder worldwide that produces significant morbi-mortality that could be reduced with proper glycemic control.Estimate the prevalence of glycemic control in type-2 diabetic patients and explore its association with personal, clinical and familial factors.We conducted a cross-sectional study with 150 type-2 diabetic patients from a chronic diseases program at the Hospital Universitario San Ignacio in Bogota. Clinical and family (type and lifecycle) information was obtained. Adherence to treatment and family function (family-APGAR) were assessed. The prevalence of glycemic control (HbA1C7%) was estimated and its association with determinant factors was calculated using crude and adjusted odds ratios (OR's).The prevalence of glycemic control was 49% (HbA1C7%) and 63% when we included a different goal for patients over 71 years or with a disease lasting longer than 11 years (HbA1c 7-7.9%). Age, family function, type and adherence to treatment showed significant differences between controlled and uncontrolled patients (p0.04). Only family function (OR 1.3 and 7.0 for mild dysfunction and moderate/severe dysfunction respectively) and type of treatment (OR 7.2 for oral therapy and 17.8 for any therapy including insulin) showed an association with glycemic control.Family function and treatment type are relevant factors for glycemic control. A comprehensive approach for diabetes mellitus type-2 is essential to plan effective preventive and therapeutic interventions.

Frecuentemente los resultados de una investigación provienen del análisis de una muestra, y es necesario generalizar esta información sobre el total de elementos que conforman la población de estudio. Diversas metodologías para este fin están disponibles a través de procedimientos estadísticos, como las pruebas de hipótesis y los intervalos de confianza. Sin embargo, especialmente en los últimos treinta años, las publicaciones científicas médicas han visto la creciente necesidad de acompañar los resultados publicados con medidas que permitan determinar su grado de precisión e incertidumbre, cuando son generalizados sobre la población. De esta forma, la estimación de los intervalos de confianza se convierte en la metodología estadística más ampliamente usada y la que responde a esta creciente necesidad. El presente artículo ilustra la filosofía que se maneja en la construcción de los intervalos de confianza, presenta y discute los elementos que los componen y explica la forma correcta de interpretación que se debe hacer de ellos. Research findings frequently rise from analysis of a sample and it is necessary to infer the conclusions for the population where the sample elements come from. Statistical methods such as confidence intervals and hypothesis testing allow inferences to be made from a sample to a specific population. Notably over the last 30 years, medical scientific publications have increasingly needed to report research results using measures that specify the degree of precision and uncertainty when conclusions are generalized to a population. Thus, confidence intervals have become the most common methodology used to report scientific results. This paper shows the philosophy behind the construction of confidence intervals as well as the presentation and discussion of their elements beside an explanation of the correct way to interpret them.