Maltrato en el adulto mayor en Bogotá

Resumen: El maltrato al adulto mayor es un área en investigación, con pocos datos disponibles en nuestra población. Decidimos hacer este estudio para documentar su prevalencia y factores de riesgo. Objetivo: Documentar la prevalencia y los factores de riesgo del maltrato en el adulto mayor en Bogotá Métodos: Se realizó un estudio observacional de tipo corte transversal, se analizaron datos de la Encuesta Nacional de Salud, Bienestar y Envejecimiento (SABE), se analizaron la variable de maltrato con las variables: sexo, edad, estrato económico, tipo de familia, dependencia, depresión, deterioro cognoscitivo y tipo de seguridad social. Resultados: Se identificaron 676 personas con maltrato de 2000 encuestados, que corresponde al 33.8%, con factores de riesgo dados por edad: 37% vs 29%, estrato socio económico: 36% vs 9.5%, tipo de familia: 42% vs 32%, depresión: 50% vs 28% y tipo de seguridad social: 45.7% vs 28.7%. Conclusiones: En este trabajo, realizado en Bogotá, encontramos que la prevalencia de maltrato es del 33.8% con factores de riesgo dados por la edad entre 60 y 70 años, estratos 1,2 y 3, familia unipersonal, presencia de depresión, y pertenecer al régimen subsidiado de salud, siendo todos estadísticamente significativos.Summary: Elder abuse is an area of research, with few data available in our population. We decided to do this study to document its prevalence and risk factors. Objective: Document the prevalence and risk factors of abuse in the elderly in Bogota Methods: An observational cross-sectional study was conducted, data from the National Health, Welfare and Aging Survey (SABE) were analyzed, the abuse variable was analyzed with the variables: sex, age, economic stratum, family type, dependence, depression, cognitive deterioration and type of social security. Results: 676 people were identified with abuse of 2000 respondents, corresponding to 33.8%, with risk factors given by age: 37% vs. 29%, socioeconomic stratum: 36% vs. 9.5%, family type: 42% vs. 32%, Depression: 50% vs. 28% and social security type: 45.7% vs. 28.7%. Conclusions: In this work, conducted in Bogota, we found that the prevalence of abuse is 33.8% with risk factors given by the age between 60 and 70 years, strata 1,2 and 3, single-person family, presence of depression, and belonging to the regime subsidized health, all being statistically significant

Acute Myocardial Injury in Association with Metformin Toxicity

Metformin is one of the most commonly used oral hypoglycemic agents in the treatment of type 2 diabetes mellitus. Toxicity related to accidental or intentional ingestion of metformin is well reported in the pediatric literature. We report a case of transient acute myocardial injury documented by biochemical and electrophysiological evidences in an adolescent male who presented with intentional ingestion of a large dose of metformin. To our knowledge, this is the first such case of documented reversible myocardial injury in relation to metformin toxicity to be reported in the pediatric literature

Association between Sleep Disorders and Attention Deficit and Hyperactivity in Pediatrics

El déficit de atención e hiperactividad (TDAH) es uno de los trastornos del comportamiento más frecuentes en pediatría, que genera conductas maladaptativas inconsistentes con la edad y el desarrollo del niño. Recientemente ha despertado gran interés la alta coexistencia de este con trastornos de sueño, al igual que una posible causa bidireccional entre las alteraciones de la arquitectura del sueño y los síntomas principales del TDAH. El objetivo de esta revisión es encontrar la asociación entre el TDAH y los trastornos del sueño en la población pediátrica, evaluando a profundidad los documentos, con el fin de encontrar nivel de evidencia, para ampliar a futuro la intervención sobre el TDAH y optimizar la calidad de vida de estos pacientes, a corto y largo plazos. Se realizó la búsqueda en Pubmed, Cochrane y Fabumed, escogiendo estudios en niños, con menos de 10 años de publicación, en inglés o español, con acceso completo. Se escogieron 52 estudios basándose en su calidad y nivel de evidencia.Artículo de revisión183-199Attention deficit and hyperactive disorder (ADHD) is one of the most frequent behavioral disorders seen in the pediatric population that generates maladaptive conducts, which are inconsistent with the age and development of the child. The high coexistence between ADHD and sleep disorders, as well as the possible bidirectional cause between architectural alterations of sleep and the main symptoms of ADHD, have sparked a great interest as a topic of research. In order to find a better level of evidence, and to expand the future of interventions for ADHD to be able to optimize the quality of life in the long term for the patients, these new associations were revised more in depth in this document. The search was performed in Pubmed, Cochrane, and Fabumed, choosing studies on children, with less than ten years of publication, language in English or Spanish, and free access to the article. Fifty-two articles were chosen based on their quality and level of evidence

Asociación de las alteraciones del sueño con el déficit de atención e hiperactividad en pediatría

El déficit de atención e hiperactividad (TDAH) es uno de los trastornos del comportamiento más frecuentes en pediatría, que genera conductas maladaptativas inconsistentes con la edad y el desarrollo del niño. Recientemente ha despertado gran interés la alta coexistencia de este con trastornos de sueño, al igual que una posible causa bidireccional entre las alteraciones de la arquitectura del sueño y los síntomas principales del TDAH. El objetivo de esta revisión es encontrar la asociación entre el TDAH y los trastornos del sueño en la población pediátrica, evaluando a profundidad los documentos, con el fin de encontrar nivel de evidencia, para ampliar a futuro la intervención sobre el TDAH y optimizar la calidad de vida de estos pacientes, a corto y largo plazos. Se realizó la búsqueda en Pubmed, Cochrane y Fabumed, escogiendo estudios en niños, con menos de 10 años de publicación, en inglés o español, con acceso completo. Se escogieron 52 estudios basándose en su calidad y nivel de evidencia.Attention deficit and hyperactive disorder (ADHD) is one of the most frequent behavioral disorders seen in the pediatric population that generates maladaptive conducts, which are inconsistent with the age and development of the child. The high coexistence between ADHD and sleep disorders, as well as the possible bidirectional cause between architectural alterations of sleep and the main symptoms of ADHD, have sparked a great interest as a topic of research. In order to find a better level of evidence, and to expand the future of interventions for ADHD to be able to optimize the quality of life in the long term for the patients, these new associations were revised more in depth in this document. The search was performed in Pubmed, Cochrane, and Fabumed, choosing studies on children, with less than ten years of publication, language in English or Spanish, and free access to the article. Fifty-two articles were chosen based on their quality and level of evidence

Asociación de las alteraciones del sueño con el déficit de atención e hiperactividad en pediatría

El déficit de atención e hiperactividad (TDAH) es uno de los trastornos del comportamiento más frecuentes en pediatría, que genera conductas maladaptativas inconsistentes con la edad y el desarrollo del niño. Recientemente ha despertado gran interés la alta coexistencia de este con trastornos de sueño, al igual que una posible causa bidireccional entre las alteraciones de la arquitectura del sueño y los síntomas principales del TDAH. El objetivo de esta revisión es encontrar la asociación entre el TDAH y los trastornos del sueño en la población pediátrica, evaluando a profundidad los documentos, con el fin de encontrar nivel de evidencia, para ampliar a futuro la intervención sobre el TDAH y optimizar la calidad de vida de estos pacientes, a corto y largo plazos. Se realizó la búsqueda en Pubmed, Cochrane y Fabumed, escogiendo estudios en niños, con menos de 10 años de publicación, en inglés o español, con acceso completo. Se escogieron 52 estudios basándose en su calidad y nivel de evidencia.Attention deficit and hyperactive disorder (ADHD) is one of the most frequent behavioral disorders seen in the pediatric population that generates maladaptive conducts, which are inconsistent with the age and development of the child. The high coexistence between ADHD and sleep disorders, as well as the possible bidirectional cause between architectural alterations of sleep and the main symptoms of ADHD, have sparked a great interest as a topic of research. In order to find a better level of evidence, and to expand the future of interventions for ADHD to be able to optimize the quality of life in the long term for the patients, these new associations were revised more in depth in this document. The search was performed in Pubmed, Cochrane, and Fabumed, choosing studies on children, with less than ten years of publication, language in English or Spanish, and free access to the article. Fifty-two articles were chosen based on their quality and level of evidence

Ibero-American Cases and Dialogues on International Criminal Law, International Humanitarian Law, and Transitional Justice

Este libro es producto de la investigación de diversas inquietudes, de veintidós investigadores de diez países iberoamericanos, en torno a los desarrollos jurisprudenciales y los debates contemporáneos del derecho internacional en materia derecho internacional penal, derecho internacional humanitario, justicia transicional y las necesidades cambiantes de su protección y desarrollo en el contexto de la globalización. Esta investigación se instala en el contexto de una comunidad epistémica que se ha ido consolidando alrededor de las mesas temáticas que anualmente se reúnen en el Congreso Nacional de Derecho Internacional de la Facultad de Jurisprudencia de la Universidad del Rosario que, con el apoyo del Anuario Colombiano de Derecho Internacional, el Anuario Iberoamericano de Derecho Internacional Penal, el Instituto Iberoamericano de La Haya, la Red Latinoamericana de Revistas de Derecho Internacional, la Red de Investigación Perspectivas Ibero-Americanas sobre la Justicia y el Colegio de Abogados Rosaristas, se ha consolidado como el epicentro de grandes debates y promotor de investigaciones en favor del desarrollo hemisférico del derecho internacional.This book is the result of the investigation of matters of interest by twenty-two researchers from ten Ibero-American countries regarding the jurisprudential developments of international law and contemporary debates on international criminal law, international humanitarian law, transitional justice, and the changing needs of their protection and development in the context of globalization. This research takes place within an epistemic community that has slowly become established around the annual thematic tables of the National Conference on International Law organized by the Faculty of Jurisprudence at the Universidad del Rosario. With the support of the Anuario Colombiano de Derecho Internacional, the Anuario Iberoamericano de Derecho Internacional Penal, the Ibero-American Institute of The Hague, the Latin American Network of International Law Journals, the Ibero-American Perspectives on Justice Research Network, and the Universidad del Rosario Bar Association, this conference has consolidated itself as the epicenter of great debates and promoter of research in favor of the development of international law in the hemisphere

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