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Objetivo: determinar propiedades psicométricas de los instrumentos desarrollados por la OPS para evaluar  la calidad y la efectividad potencial de material educativo. Materiales y métodos: se utilizaron instrumentos  diseñados por la OPS para evaluar la calidad de material educativo en salud, diseñado durante el primer  semestre del 2010. La evaluación fue realizada por grupos de usuarios del material, así: para material  audiovisual, n=74; material impreso, n=116; material sonoro, n=37; material visual: n=71. Para cada  instrumento se evaluó la factoriabilidad mediante las pruebas de Kaiser-Meyer-Olkin y de esfericidad de  Bartlett. Posteriormente, se determinó la consistencia interna y estructura factorial del instrumento  mediante la estimación del alfa de Cronbach, y el análisis factorial por el método de extracción de  componentes principales. Resultados: todos los instrumentos fueron factorizables. El alfa de Cronbach para  material audiovisual fue 0,687; la extracción de ejes principales reportó cuatro factores. Para material  impreso: alfa de Cronbach de 0,83; la extracción de componentes principales arrojó un solo factor  Cronbach  = 0,73 y se extrajeron tres componentes principales. Para el material visual se encuentra alfa de Cronbach =  0,66 con tres componentes principales. Conclusiones: los instrumentos diseñados por la OPS para evaluar  material educativo constituyen una herramienta confiable para evaluar los criterios de atracción,  entendimiento, identificación y aceptación; se hace necesario profundizar en el análisis estructural de estos;  no evalúan el criterio de inducción a la acción que otros autores referencian.Objective: to determine psychometric properties of the instruments developed by PAHO to assess quality  and potential effectiveness of educational material. Materials and methods: instruments designed by PAHO  to assess the quality of health educational materials designed during the first semester 2010 were used. The  evaluation was carried out through materials user groups as follows: audiovisual material, n = 74; printed  material, n = 116; audio recordings, n = 37; visual material, n = 71. Factorability was evaluated for each one of  the instruments by using Kaiser -Meyer-Olkin`s test and sphericity was evaluated with Bartlett’s test. Internal  consistency and factorial structure of the instrument were determined later using Cronbach’s alpha estimate  and the factorial analysis was carried out using the main components extraction method. Results: all  instruments were factorable. Cronbach’s alpha for audiovisual material was 0.687; extraction of principal  axes reported 4 factors. For printed material: 0.83Cronbach’s alpha; the extraction of principal components  showed a single factor which explains 45.1% of the variance. In the audio material it was found 0.73  Cronbach`s alpha and three major components were extracted. For visual material Cronbach’s alpha is = 0.66  with three main components. Conclusions: the instruments designed by PAHO to assess educational  materials are a reliable tool for assessing the attraction, understanding, identifying and accepting criteria;  however, it is necessary to go deeper in their structural analysis. The do not assess the induction to action  criterion referenced by other authors

Risk factors associated with Trypanosoma cruziexposure in domestic dogs from a rural community in Panama

Chagas disease, caused by Trypanosoma cruzi infection, is a zoonosis of humans, wild and domestic mammals,including dogs. In Panama, the main T. cruzi vector is Rhodnius pallescens, a triatomine bug whose main naturalhabitat is the royal palm, Attalea butyracea. In this paper, we present results from three T. cruzi serological tests(immunochromatographic dipstick, indirect immunofluorescence and ELISA) performed in 51 dogs from 24 housesin Trinidad de Las Minas, western Panama. We found that nine dogs were seropositive (17.6% prevalence). Dogswere 1.6 times more likely to become T. cruzi seropositive with each year of age and 11.6 times if royal palms wherepresent in the peridomiciliary area of the dog’s household or its two nearest neighbours. Mouse-baited-adhesivetraps were employed to evaluate 12 peridomestic royal palms. All palms were found infested with R. pallescens withan average of 25.50 triatomines captured per palm. Of 35 adult bugs analysed, 88.6% showed protozoa flagellates intheir intestinal contents. In addition, dogs were five times more likely to be infected by the presence of an additionaldomestic animal species in the dog’s peridomiciliary environment. Our results suggest that interventions focused onroyal palms might reduce the exposure to T. cruzi infection

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Defunciones en niños a principios de los siglos xx y xxi en boyacá-colombia

Objetivo Comparar y analizar las Tasas Brutas de Mortalidad (TBM), la Mortalidad en Menores (MN) de 5 años por mil Nacidos Vivos (NV) y la Mortalidad Infantil (MI) en el departamento de Boyacá-Colombia, a comienzos de los siglos XX y XXI.Métodos Estudio descriptivo comparativo con enfoque histórico epidemiológico. Se utilizaron dos fuentes de datos, para las defunciones: registros parroquiales de 1912-1927 y el Boletín epidemiológico de Boyacá 2007; para la población los censos DANE 1912-1918-1927 y 2005. Se almacenaron y analizaron en Mysql®. Se calcula­ron tasas brutas, específicas por edad e infantil, proporciones de mortalidad y morta­lidad por causas.Resultados Entre 1912-1927 se registra una media de 7 958 muertes, en compara­ción con 5 813 en el siglo XXI; la TBM pasó de 150 muertes a 42 por 10 mil habi­tantes; la TMI se redujo considerablemente pasando de 231 a 17 por cada 1 000 NV; aunque se pueden comparar las tasas especificas en menores de 8 años con las de menores de 5, existe variabilidad en el rango y en la construcción de la TM especi­fica y la definida por OMS- UNICEF.Conclusiones Existe un impacto en la reducción de mortalidad, mayor en el siglo XXI, debido a las políticas nacionales e internacionales de control de enfermedades inmunoprevenibles y muerte materna. La pandemia de gripa de 1918-19 afectó con­siderablemente la mortalidad en todos los grupos de población; las causas violentas ocupan lugares importantes en la mortalidad infantil en el siglo XXI

Crecimiento poblacional y políticas públicas

La población humana del planeta, alrededor de 6,500 millones de habitantes en los inicios del siglo XXI, no ha sido constante, ha cambiado a través de la historia, crece a distintos ritmos con variaciones en diversos espacios geográficos. El artículo explora la relación entre crecimiento poblacional y políticas públicas. Con el enfoque histórico-hermenéutico se revisaron textos, artículos y publicaciones demográficas, históricas y de políticas de salud en medio físico y en la Web. Vincula el crecimiento poblacional como factor determinante del aumento de la pobreza, hambre y deterioro de la salud; el propósito es generar inquietud, de cara a la reforma estructural del Estado, a partir del análisis de la explosión demográfica y las crisis ambiental, social, política y económica. La revisión permite concluir la importancia que tiene la demografía desde su génesis histórica con respecto a la planificación de los estados

PROPIEDADES PSICOMÉTRICAS DE INSTRUMENTOS UTILIZADOS PARA EVALUAR MATERIAL EDUCATIVO EN SALUD PROPIEDADES PSICOMETRICAS DE INSTRUMENTOS UTILIZADOS PARA AVALIAR MATERIAL EDUCATIVO EM SAÚDE PSYCHOMETRIC PROPERTIES OF INSTRUMENTS USED TO EVALUATE HEALTH EDUCATIONAL MATERIAL

Objetivo: determinar propiedades psicométricas de los instrumentos desarrollados por la OPS para evaluar la calidad y la efectividad potencial de material educativo. Materiales y métodos: se utilizaron instrumentos diseñados por la OPS para evaluar la calidad de material educativo en salud, diseñado durante el primer semestre del 2010. La evaluación fue realizada por grupos de usuarios del material, así: para material audiovisual, n = 74; material impreso, n = 116; material sonoro, n = 37; material visual: n = 71. Para cada instrumento se evaluó la factoriabilidad mediante las pruebas de Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Posteriormente, se determinó la consistencia interna y estructura factorial del instrumento mediante la estimación del alfa de Cronbach, y el análisis factorial por el método de extracción de componentes principales. Resultados: todos los instrumentos fueron factorizables. El alfa de Cronbach para material audiovisual fue 0,687; la extracción de ejes principales reportó cuatro factores. Para material impreso: alfa de Cronbach de 0,83; la extracción de componentes principales arrojó un solo factor que explica el 45,1% de la varianza. En el material sonoro se encontró alfa de Cronbach = 0,73 y se extrajeron tres componentes principales. Para el material visual se encuentra alfa de Cronbach = 0,66 con tres componentes principales. Conclusiones: los instrumentos diseñados por la OPS para evaluar material educativo constituyen una herramienta confiable para evaluar los criterios de atracción, entendimiento, identificación y aceptación; se hace necesario profundizar en el análisis estructural de estos; no evalúan el criterio de inducción a la acción que otros autores referencian.<br>Objetivo: determinar propriedades psicométricas (é utilizada na psicologia para medir quais são os atributos que representam melhor às pessoas) dos instrumentos desenvolvidos pela OPS para avaliar a qualidade e a efetividade potencial de material educativo. Materiais e métodos: se utilizam instrumentos desenhados pela OPS para avaliar a qualidade de material educativo em sua saúde, desenhado durante o primeiro semestre de 2010. A avaliação foi realizada por grupos de usuários do material, assim: para material audiovisual, n = 74; material impresso, n=116; material sonoro, n = 37; material visual: n = 71. Para cada instrumento se avalio na fatoriabilidade mediante as probas de Kaiser-Meyer-Olkin e de esfericidade de Bartlett. Posteriormente, se determinou a consistência interna e estrutura fatorial do instrumento mediante a estimulação do alfa de Cronbach, e o analise fatorial pelo método de extração de componentes principais. Resultados: Todos os instrumentos foram fatorizavéis. O alfa de Cronbach para material audiovisuais foi 0,687; a extração de eixos principais reportou quatro fatores. Para material impresso: alfa de Cronbach de 0,83; a extração de componentes principais atirou um só fator que explica o 45,1% da variância. No material sonoro se encontrou alfa de Cronbach = 0,73 e se extraíram três componentes principais. Para o material visual se encontra alfa de Cronbach = 0,66 com três componentes principais. Conclusões: os instrumentos desenhados pela OPS para avaliar material educativo constituem uma ferramenta confiável para avaliar os critérios de atração, entendendo, identificação e aceitação; se faz necessária profundeza no analise estrutural destes; não avaliam o critério de introdução à ação que outros autores referenciam.<br>Objective: to determine psychometric properties of the instruments developed by PAHO to assess quality and potential effectiveness of educational material. Materials and methods: instruments designed by PAHO to assess the quality of health educational materials designed during the first semester 2010 were used. The evaluation was carried out through materials user groups as follows: audiovisual material, n = 74; printed material, n = 116; audio recordings, n = 37; visual material, n = 71. Factorability was evaluated for each one of the instruments by using Kaiser -Meyer-Olkin&#39;s test and sphericity was evaluated with Bartlett&#39;s test. Internal consistency and factorial structure of the instrument were determined later using Cronbach&#39;s alpha estimate and the factorial analysis was carried out using the main components extraction method. Results: all instruments were factorable. Cronbach&#39;s alpha for audiovisual material was 0.687; extraction of principal axes reported 4 factors. For printed material: 0.83 Cronbach&#39;s alpha; the extraction of principal components showed a single factor which explains 45.1% of the variance. In the audio material it was found 0.73 Cronbach&#39;s alpha and three major components were extracted. For visual material Cronbach&#39;s alpha is = 0.66 with three main components. Conclusions: the instruments designed by PAHO to assess educational materials are a reliable tool for assessing the attraction, understanding, identifying and accepting criteria; however, it is necessary to go deeper in their structural analysis. The do not assess the induction to action criterion referenced by other authors

La pandemia de gripe de 1918-1919 en Bogotá y Boyacá, 91 a&os después The influenza pandemic of 1918-1919 in Bogotá and Boyacá, 91 years later

Introducción. La pandemia de gripa de 1918-1919 causó la mayor mortalidad en la historia en corto tiempo. Se estima que entre 20 millones y 50 millones de personas fallecieron en menos de un año. Los historiadores de Europa y Estados Unidos registran tres oleadas, con mayor impacto en octubre y noviembre (80% de la mortalidad), que afectaron la población económicamente activa. La gripa nos ha acompañado en América desde el segundo viaje de Colón, probablemente asociada a la importación de cerdos y caballos infectados. Materiales y métodos. Se describen las condiciones sociales y de salud en Bogotá y Boyacá, a partir de fuentes documentales de la época. Las tasas de mortalidad se calcularon a partir de los registros de la Iglesia. Resultados. Las condiciones de pobreza y hacinamiento acentuaron la letalidad. La iniciativa privada asumió el control y la atención de las víctimas, dada la ineficiencia de las autoridades. Se recolectaron 106.484 registros de defunción del periodo 1912-1927, 9,5% (10.123 muertes) por gripa. Entre octubre y noviembre de 1918, hubo 2.019 muertes en Boyacá, con una tasa de 4,8 por 1.000 habitantes, y predominio en menores de 5 años y en ancianos; no se observaron oleadas. La mayor altura sobre el nivel del mar resultó ser un factor de riesgo para la muerte por gripa. Discusión. Las condiciones actuales favorecen una nueva pandemia. Los nuevos medios de transporte podrían aumentar la velocidad de transmisión de la infección. Se hace necesario conocer el pasado y las implicaciones en la mortalidad para evitar repetir los errores en el futuro.<br>Introduction: The pandemic Flu of 1918-19 was the cause of the greatest mortality in history, in a very short period of time. An estimated mortality between 20 and 50 million deaths/year was calculated. The European and American researchers registered three different epidemic peaks, with a special impact between October and November (80% mortality), affecting a large proportion of the economically active population. Since Colombo’s second travel, the Flu has been within us, probably associated with the presence infected pigs and horses, brought by the Spaniards. Materials and methods: We describe the social and health conditions in Bogotá and Boyacá, from documentary sources of the time. Mortality rates were estimated from Church records. Results: Poverty and overcrowding conditions increased the epidemic lethality. As a result of the inefficiency of the authorities of that time, the control and care of victims were assumed by private organizations. We collected 106,484 records from death certificates, since 1912 until 1927; 9.5% (10,123 deaths) were caused by flu. The mortality rate attributed to the Flu was 4.8 per 1,000 people (2,019 deaths) between October and November of 1918. Children under 5 years and the elder people were mainly affected by Flu. The highest altitude above sea level was a risk factor for Flu mortality and non epidemic waves were observed. Discussion: Due to current general conditions, a new epidemic is possible. New means of transportation may increase its transmission rate. Lessons from the past can lead us to avoid repeating same mistakes in the future