Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Comportamiento epidemiológico de la sífilis gestacional y congénita en usuarios de una E.P.S en córdoba durante el periodo 2015-2017

Introducción: En 2017, Córdoba notificó al SIVIGILA, 49 casos de sífilis gestacional y 14 de congénita, con lo cual se activan las alarmas ante este grave problema de salud pública; en esta investigación se realiza un análisis comparativo del comportamiento de la sífilis gestacional y congénita durante los últimos 3 años. Materiales y métodos: estudio epidemiológico descriptivo, retrospectivo, con enfoque cuantitativo. Se analizó la información contenida en la base de datos de una de las EPS con mayor cobertura del departamento de Córdoba, en la cual se registra un total de 98 casos de sífilis gestacional y 32 de sífilis congénita desde el año 2015 al 2017. Resultados: la ciudad de Montería, registra el mayor número de reportes de sífilis gestacional, el cual ha ido en aumento en los últimos años, los más afectados por esta gran problemática en salud, siguen siendo la población adolescente en edades entre los 14 y 18 años, así mismo mujeres en edades entre los 19 y 30 años. La población neonatal sifilítica más afectada se registra en edades entre 1 y 5 días de nacimiento, y un porcentaje significativo hasta 20 días de nacimiento, lo cual se convierte en una detección tardía de la enfermedad.Pregrad

La salud de la mujer en condiciones de vulnerabilidad, pobreza y desigualdad social en Córdoba, Colombia

El hecho de analizar la salud de la mujer en una región con altos índices de pobreza, desigualdad social e inequidad, como el Departamento de Córdoba (1,2), obliga a determinar no solo la concepción que se asume frente a la vida, los padecimientos y su relación con las condiciones de existencia o el entorno social, económico y político, sino, también, la forma en que los hombres y mujeres entienden, sienten y reaccionan ante su propio proceso de salud-enfermedad. En otras palabras, se trata de comprender las distintas realidades de cada persona; de forma tal que puedan ser valoradas con una mirada de alteridad, desde las circunstancias y situaciones que vive y experimenta el otro.AGRADECIMIENTOS..................................................9PRESENTACIÓN..............................................10INTRODUCCIÓN..........................................................12CAPÍTULO 1: FACTORES SOCIALES Y EMBARAZO ADOLESCENTE EN UNA POBLACIÓN DESPLAZADA DE MONTERÍA, CÓRDOBA, COLOMBIA................................25INTRODUCCIÓN .........................................................26OBJETIVO...............................................................31BASES TEÓRICAS..........................................................31MATERIALES Y MÉTODOS .................................................39RESULTADOS.....................................................................42DISCUSIÓN.............................................................................53CONCLUSIONES.....................................................................54REFERENCIAS..................................................................56CAPÍTULO 2: EMBARAZO EN LA ADOLESCENCIA: EFECTO DE LOS DETERMINANTES SOCIALES DE LA SALUD........................................................................................................................................63INTRODUCCIÓN......................................................64MATERIALES Y MÉTODOS.............................................................73RESULTADOS Y ANÁLISIS........................................................80DISCUSIÓN........................................................................................................98CONCLUSIONES.................................................................................102REFERENCIAS........................................................................................104CAPÍTULO 3: CREENCIAS EN SALUD ORAL DE UN GRUPO DE GESTANTES DE MONTERÍA, DEPARTAMENTO DE CÓRDOBA, COLOMBIA ................................................................112INTRODUCCIÓN............................................113OBJETIVO..............................................................115BASES TEÓRICAS.............................................116RUTA METODOLÓGICA.....................................................124RESULTADOS Y DISCUSIÓN.............................................127CONCLUSIONES..............................................................145REFERENCIAS.............................................147CAPÍTULO 4: TUVE QUE VIVIR UN VERDADERO VIACRUCIS PARA PODER RESIGNIFICAR MI FUTURO REPRODUCTIVO...............................................................................156INTRODUCCIÓN.........................................................157OBJETIVO.............................................................159RUTA METODOLÓGICA...............................................159RESULTADOS.....................................................................165DISCUSIÓN............................................................................173CONCLUSIONES...................................................179REFERENCIAS..............................................................181CAPÍTULO 5: LA CONFIGURACIÓN SOCIAL DE LA SÍFILIS CONSTRUIDA POR GESTANTES DE MONTERÍA, DEPARTAMENTO DE CÓRDOBA, COLOMBIA...................190INTRODUCCIÓN..............................................................191OBJETIVO................................................................194BASES TEÓRICAS............................................................194RUTA METODOLÓGICA............................................202RESULTADOS...................................................206DISCUSIÓN................................................................212CONCLUSIONES...............................................................217REFERENCIAS...................................................................217CAPÍTULO 6: TRAZOS SOCIODEMOGRÁFICOS DE LA SÍFILIS GESTACIONAL EN CÓRDOBA........................................224INTRODUCCIÓN...................................................225MATERIAL Y MÉTODO.....................................................228RESULTADOS............................................................230CONCLUSIONES.................................................................235REFERENCIAS................................................................236CAPÍTULO 7: LAS VOCES DE LAS MUJERES QUE LOGRAN SALIR DEL CICLO DE LA VIOLENCIA DE PAREJA ÍNTIMA.......................................................................................................240CAPÍTULO 7: LAS VOCES DE LAS MUJERES QUE LOGRAN SALIR DEL CICLO DE LA VIOLENCIA DE PAREJA ÍNTIMA.......................................................................................................240INTRODUCCIÓN.........................................................................241BASES TEÓRICAS.......................................................................244RUTA METODOLÓGICA..............................................247DISCUSIÓN..........................................................................264CONCLUSIÓN...................................................................269REFERENCIAS........................................................................269CAPÍTULO 8: ESTRATEGIAS DE AFRONTAMIENTO Y PERCEPCIONES DE CALIDAD DE VIDA DE MUJERES CON DIAGNÓSTICO DE CÁNCER DE MAMA EN EL DEPARTAMENTO DE CÓRDOBA EN EL PERIODO 2013-2017..................................................................................................275INTRODUCCIÓN...................................................276OBJETIVO..............................................................................279BASES TEÓRICAS..........................................................279MATERIALES Y MÉTODOS...........................................286RESULTADOS Y ANÁLISIS................................................289DISCUSIÓN..............................................................................301CONCLUSIONES..............................................................................304REFERENCIAS.................................................................................306CAPÍTULO 9: FUNCIONALIDAD FAMILIAR EN MUJERES QUE HAN PADECIDO CÁNCER DE MAMA....311INTRODUCCIÓN...............................................................312BASES TEÓRICAS...............................................................316MATERIALES Y MÉTODOS...............................................323RESULTADOS..............................................................................328DISCUSIÓN.......................................................................333CONCLUSIONES............................................................334REFERENCIAS..................................................................33

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease

Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study

Background Results from retrospective studies suggest that use of neuromuscular blocking agents during general anaesthesia might be linked to postoperative pulmonary complications. We therefore aimed to assess whether the use of neuromuscular blocking agents is associated with postoperative pulmonary complications. Methods We did a multicentre, prospective observational cohort study. Patients were recruited from 211 hospitals in 28 European countries. We included patients (aged ≥18 years) who received general anaesthesia for any in-hospital procedure except cardiac surgery. Patient characteristics, surgical and anaesthetic details, and chart review at discharge were prospectively collected over 2 weeks. Additionally, each patient underwent postoperative physical examination within 3 days of surgery to check for adverse pulmonary events. The study outcome was the incidence of postoperative pulmonary complications from the end of surgery up to postoperative day 28. Logistic regression analyses were adjusted for surgical factors and patients’ preoperative physical status, providing adjusted odds ratios (ORadj) and adjusted absolute risk reduction (ARRadj). This study is registered with ClinicalTrials.gov, number NCT01865513. Findings Between June 16, 2014, and April 29, 2015, data from 22803 patients were collected. The use of neuromuscular blocking agents was associated with an increased incidence of postoperative pulmonary complications in patients who had undergone general anaesthesia (1658 [7·6%] of 21694); ORadj 1·86, 95% CI 1·53–2·26; ARRadj –4·4%, 95% CI –5·5 to –3·2). Only 2·3% of high-risk surgical patients and those with adverse respiratory profiles were anaesthetised without neuromuscular blocking agents. The use of neuromuscular monitoring (ORadj 1·31, 95% CI 1·15–1·49; ARRadj –2·6%, 95% CI –3·9 to –1·4) and the administration of reversal agents (1·23, 1·07–1·41; –1·9%, –3·2 to –0·7) were not associated with a decreased risk of postoperative pulmonary complications. Neither the choice of sugammadex instead of neostigmine for reversal (ORadj 1·03, 95% CI 0·85–1·25; ARRadj –0·3%, 95% CI –2·4 to 1·5) nor extubation at a train-of-four ratio of 0·9 or more (1·03, 0·82–1·31; –0·4%, –3·5 to 2·2) was associated with better pulmonary outcomes. Interpretation We showed that the use of neuromuscular blocking drugs in general anaesthesia is associated with an increased risk of postoperative pulmonary complications. Anaesthetists must balance the potential benefits of neuromuscular blockade against the increased risk of postoperative pulmonary complications

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions