Social determinants of health associated with vitamin A deficiency and infections in children aged 1 to 4 years. ENSIN 2015

La deficiencia de vitamina A (DVA) en población infantil de 1 a 4 años representa un problema severo de salud pública en Colombia. Esto propicia un ciclo donde la falta de esta vitamina hace vulnerable a padecer infecciones y a su vez, los procesos infecciosos generan desnutrición por DVA. Objetivo: Analizar la asociación entre los determinantes sociales de la salud, la DVA y la presencia de infección en población infantil de 1 a 4 años. Metodología: Estudio transversal analítico a partir de 6371 registros provenientes de la ENSIN 2015. Resultados: Los determinantes asociados a la DVA fueron: vivir en la región Atlántica, que aumentó la probabilidad de DVA en 32% (I.C.= 29 – 34%; p= 0,000) y residir en la región Pacífica que aumentó la probabilidad de padecer esta deficiencia en un 28% (I.C.= 24 – 32%; p= 0,018). Pertenecer a la etnia afrocolombiana aumentó la probabilidad de presentar DVA en 34% (I.C.= 29 – 39%; p= 0,004) y pertenecer a un hogar ubicado en el cuartil más bajo de riqueza aumentó en 30% más la probabilidad de presentar DVA (I.C= 28 – 33%; p= 0.003); se observó que los niños con valores séricos de Proteína C Reactiva (PCR) superior a 0,5mg/dl tenían 52% más de probabilidad de presentar la deficiencia de esta vitamina. Los determinantes que se asociaron a la coexistencia DVA-infección fueron pertenecer a la etnia afrocolombiana, vivir en la región Atlántico y en Bogotá; se evidenció la escolaridad materna como un determinante que modifica algunas de las asociaciones observadas.Vitamin A deficiency in children ages 1-4 years represents a public health problem in Colombia. Vitamin A deficiency contributes to a cycle where the lack of this vitamin makes children more vulnerable to infection and, in turn prolonging the infectious state and the associated malnutrition. Objective: To analyze the association between the social determinants of health, Vitamin A deficiency, and the presence of infection in children ages 1-4 years. Methodology: Analytical cross-sectional study based on 6371 records from ENSIN 2015. Results: The social determinants associated with Vitamin A deficiency (DVA) were living in the Atlantic region increased the probability of DVA by 32% (CI = 29 - 34%; p = 0.000) while residing in the Pacific region increased the probability of DVA by 28% (CI = 24 - 32%; p = 0.018). Belonging to the Afro-Colombian ethnicity increased the probability of DVA by 34% (CI = 29 - 39%; p = 0.004) and residing within a household income located in the lowest quartile of wealth increased the probability of DVA by 30% (CI = 28 - 33%; p = 0.003). Increased CRP (infection marker) was also associated with DVA, where it was observed that these children were 52% more likely to suffer from DVA Conclusion: Coexistence of Vitamin A deficiency and the state of infection were more evident in Afro-Colombian children and residing in the Atlantic region and Bogotá. These social-economic criteria are determined by the maternal educational level as observed in the interaction analysis carried out

Influencia del clima organizacional en la ocurrencia de accidentes y enfermedades de origen laboral en la compañía Amcor Rigid Packaging planta in House Tocancipá.

No aplicaCon la presente investigación se buscó identificar si el clima laboral en que trabajan los empleados de la empresa Amcor Rigid Packaging planta In House de Tocancipá, pueden tener injerencia en la ocurrencia de accidentes y enfermedades laborales dentro de la empresa y cuáles son los aspectos presentados que tienen mayor impacto a la tranquilidad emocional, para lo cual se realizó una encuesta a los empleados de la compañía, donde se busca identificar cuáles son las condiciones emocionales de los trabajadores y qué escenarios se evidenciaron al momento de sufrir o presenciar un accidente laboral para con ello dar respuesta a la pregunta de investigación sobre el impacto del clima organizacional en la ocurrencia de los accidentes y enfermedades de origen laboral la cual nos permite evidenciar que las condiciones psicosociales de los trabajadores tienen un alto grado de impacto en la ocurrencia de los accidentes, ya que, aunque la empresa tiene un alto compromiso con la seguridad y toma las medidas pertinentes para lograr su objetivo de cero accidentes, los empleados perciben un alto riesgo de ocurrencia de un accidente debido a las condiciones emocionales con las que ellos y sus compañeros asisten al trabajo.With the present investigation, we sought to identify if the work environment in which the employees of the Amcor Rigid Packaging company, Tocancipá In House plant, may have an influence on the occurrence of accidents and occupational diseases within the company and what are the aspects presented that have a greater impact on emotional tranquility, for which a survey of the company's employees was carried out, which seeks to identify the emotional conditions of the workers and what scenarios were evidenced at the time of suffering or witnessing a work accident for This gives an answer to the research question about the impact of the organizational climate on the occurrence of work-related accidents and illnesses, which allows us to show that the psychosocial conditions of workers have a high degree of impact on the occurrence of accidents, since, although the company has a high commitment to safety and takes the pertinent measures to achieve its goal of zero accidents, employees perceive a high risk of an accident due to the emotional conditions with which they and their colleagues attend work

Social determinants of health associated with vitamin A deficiency and infections in children aged 1 to 4 years. ENSIN 2015

La deficiencia de vitamina A (DVA) en población infantil de 1 a 4 años representa un problema severo de salud pública en Colombia. Esto propicia un ciclo donde la falta de esta vitamina hace vulnerable a padecer infecciones y a su vez, los procesos infecciosos generan desnutrición por DVA. Objetivo: Analizar la asociación entre los determinantes sociales de la salud, la DVA y la presencia de infección en población infantil de 1 a 4 años. Metodología: Estudio transversal analítico a partir de 6371 registros provenientes de la ENSIN 2015. Resultados: Los determinantes asociados a la DVA fueron: vivir en la región Atlántica, que aumentó la probabilidad de DVA en 32% (I.C.= 29 – 34%; p= 0,000) y residir en la región Pacífica que aumentó la probabilidad de padecer esta deficiencia en un 28% (I.C.= 24 – 32%; p= 0,018). Pertenecer a la etnia afrocolombiana aumentó la probabilidad de presentar DVA en 34% (I.C.= 29 – 39%; p= 0,004) y pertenecer a un hogar ubicado en el cuartil más bajo de riqueza aumentó en 30% más la probabilidad de presentar DVA (I.C= 28 – 33%; p= 0.003); se observó que los niños con valores séricos de Proteína C Reactiva (PCR) superior a 0,5mg/dl tenían 52% más de probabilidad de presentar la deficiencia de esta vitamina. Los determinantes que se asociaron a la coexistencia DVA-infección fueron pertenecer a la etnia afrocolombiana, vivir en la región Atlántico y en Bogotá; se evidenció la escolaridad materna como un determinante que modifica algunas de las asociaciones observadas.Vitamin A deficiency in children ages 1-4 years represents a public health problem in Colombia. Vitamin A deficiency contributes to a cycle where the lack of this vitamin makes children more vulnerable to infection and, in turn prolonging the infectious state and the associated malnutrition. Objective: To analyze the association between the social determinants of health, Vitamin A deficiency, and the presence of infection in children ages 1-4 years. Methodology: Analytical cross-sectional study based on 6371 records from ENSIN 2015. Results: The social determinants associated with Vitamin A deficiency (DVA) were living in the Atlantic region increased the probability of DVA by 32% (CI = 29 - 34%; p = 0.000) while residing in the Pacific region increased the probability of DVA by 28% (CI = 24 - 32%; p = 0.018). Belonging to the Afro-Colombian ethnicity increased the probability of DVA by 34% (CI = 29 - 39%; p = 0.004) and residing within a household income located in the lowest quartile of wealth increased the probability of DVA by 30% (CI = 28 - 33%; p = 0.003). Increased CRP (infection marker) was also associated with DVA, where it was observed that these children were 52% more likely to suffer from DVA Conclusion: Coexistence of Vitamin A deficiency and the state of infection were more evident in Afro-Colombian children and residing in the Atlantic region and Bogotá. These social-economic criteria are determined by the maternal educational level as observed in the interaction analysis carried out

Perjuicios inmateriales en la jurisdicción contencioso administrativo desde el año 2015 al 2019

Este ejercicio académico busca responder la pregunta ¿Cuál ha sido el desarrollo de la reparación de perjuicios inmateriales en la jurisdicción contenciosa administrativa en el periodo comprendido desde el año 2015 al 2019? Para ello se investigó exhaustivamente la jurisprudencia del Consejo de Estado y se documentó con la producción de doctrinantes destacados en el campo de la jurisdicción contenciosa administrativa. La monografía aborda los presupuestos conceptuales que se han desarrollado referente a los perjuicios inmateriales, cuales son o han sido los criterios indemnizatorios a cargo del Estado desde la perspectiva del Consejo de Estado y sus múltiples cambios. Se coloca de presente la evolución jurisprudencial del concepto de perjuicios inmateriales, los criterios que han quedado rezagados con el pasar del tiempo y los que se conservan en la actualidad.This project seeks to answer the question: What has been the development of the reparation of non-pecuniary damages in the contentious-administrative jurisdiction in the period from 2015 to 2019? For this, the jurisprudence of the Council of State was exhaustively investigated and it was also documented with the writings of many important doctrinants for the contentious administrative jurisdiction. This monograph wanted to establish which are the conceptual assumptions that have been developed regarding non-pecuniary damages in the jurisdiction of contentious-administrative matters. In addition, to identify what are or have been the State's criteria for reparation according to the decisions of the State Council. There have been innumerable changes that the contentious administrative jurisdiction has had regarding the issue of immateial damages imputed to the state. This work wants to show the changes and evolution that jurisprudence has had, what criteria have been remaining with the passage of time and what criteria have been used in order to determine which are the criteria that we currently have.Resumen. -- Introducción. -- 1. Planteamiento del problema. -- 2. Objetivos. -- 2.1 Objetivo general. -- 2.2 Objetivos específicos. -- 3. Marco teórico. -- 4. Metodología. -- 5. Los perjuicios inmateriales en la Jurisdicción de lo Contencioso Administrativo. -- 5.1 Nociones. -- 5.2 Evolución de los perjuicios inmateriales. -- 5.2.1 Daño moral. -- 5.2.2 Daño fisiológico. -- 5.2.3 Daño a la vida de relación. -- 5.2.4 Alteración de las condiciones de existencia. -- 5.2.5 Daño a la salud. -- 5.3 Reparación. -- 6. Conclusiones. -- Referencias

Uso de dispositivos de micronebulización en adultos mayores en un programa de hospitalización domiciliaria

Home health care is a strategy that allows avoiding infections associated with health care of individuals with immune deficiencies such as older adults. A descriptive-longitudinal investigation was conducted, which took into account conditions related to the micro-nebulization equipment device such as: its time of use, cleansing, and storage. With respect to the therapist, it was taken into account: hand washing and implementation of the protocol of cleaning and disinfection. Two different samples were taken to seventeen individual micro-nebulization equipment devices of older adults be-longing to the program of home hospitalization of Forging Companies Ltd., after fifteen and thirty days of use after the delivery of the device in two times: before and after the respiratory procedure.Eight microorganisms were identified in the first portion of the sample that were classified as transitory flora and nineteen microorganisms in the second one, where resident, transient, and potentially pathogenic flora was found. In relation to the protocol of cleaning and disinfection carried out by the therapists. Changes to the protocol established by Forging Companies Ltd. were observed; however, this protocol does not include the washing of hands, which is a vital point for patient care. It is necessary to provide patients, family members and/or caregivers with timely information about the proper storage of the device in order to avoid the presence of microorganisms that can affect the health of older adults.La atención médica domiciliaria es una estrategia que permite evitar infecciones asociadas al cuidado de la salud en individuos con deficiencias inmunológicas como los adultos mayores. Se realizó una investigación de tipo descriptivo-longitudinal, en la que se tuvieron en cuenta condiciones relacionadas con el dispositivo de micronebulización como: el tiempo de uso, el lavado del dispositivo y su almacenamiento. Con respecto al terapeuta se tuvo en cuenta: lavado de manos y aplicación del protocolo de limpieza y desinfección. Se realizaron dos tomas de muestra a diecisiete dispositivos de micronebulización individual de adultos mayores pertenecientes al programa de hospitalización domiciliaria de Forja Empresas Ltda, a los quince y treinta días de uso después de la entrega del dispositivo en dos momentos: antes y después del procedimiento de la terapia respiratoria.Se identificaron ocho microorganismos en la primera toma de muestra que se clasificaron como flora transitoria y diecinueve microorganismos en la segunda, en la que se encontró flora residente, transitoria y potencialmente patógena. En relación al protocolo de limpieza y desinfección, realizado por los terapeutas, se observó modificaciones al protocolo establecido por Forja Empresas Ltda, sin embargo dicho protocolo no incluye el lavado de manos, punto indispensable para la atención del paciente. Se hace necesario brindarles información oportuna a los pacientes, familiares y/o cuidadores sobre el almacenamiento adecuado del dispositivo con el fin de evitar presencia de microorganismos que pueden afectar la salud de los adultos mayores

A Pharmacogenetic Study of CYP2C19 in Acute Coronary Syndrome Patients of Colombian Origin Reveals New Polymorphisms Potentially Related to Clopidogrel Therapy

Clopidogrel, an oral platelet P2Y12 receptor blocker, is used in the treatment of acute coronary syndrome. Interindividual variability in treatment response and the occurrence of adverse effects has been attributed to genetic variants in CYP2C19. The analysis of relevant pharmacogenes in ethnically heterogeneous and poorly studied populations contributes to the implementation of personalized medicine. We analyzed the coding and regulatory regions of CYP2C19 in 166 patients with acute coronary syndrome (ACS) treated with clopidogrel. The allele frequencies of CYP2C19 alleles *1, *2, *4, *17, *27 and *33 alleles were 86.1%, 7.2%, 0.3%, 10.2%, 0.3% and 0.3%, respectively. A new potentially pathogenic mutation (p.L15H) and five intronic variants with potential splicing effects were detected. In 14.4% of the patients, a new haplotype in strong linkage disequilibrium was identified. The clinical outcome indicated that 13.5% of the patients presented adverse drugs reactions with a predominance of bleeding while 25% of these patients were carriers of at least one polymorphic allele. We propose that new regulatory single-nucleotide variants (SNVs) might potentially influence the response to clopidogrel in Colombian individuals

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

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

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: 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. Funding: National Institute for Health and Care Research