RESUMO
INTRODUCTION: Carbapenems resistance is a growing phenomenon and a threat to public health because of the reduced therapeutic options for resistant infections. METHODS: A retrospective case-control study was conducted in 2 tertiary-care hospitals in Medellín, Colombia. Fifty patients infected with ertapenem-resistant enterobacteriaceae were compared with a control group consisting of 100 patients with infections caused by ertapenem susceptible enterobacteriaceae. A multivariate logistic regression model was used to identify factors that best explain ertapenem-resistant enterobacteriaceae infections. RESULTS: The factors associated with ertapenem-resistant enterobacteriaceae infections were prior exposure to carbapenems (adjusted OR 3.43; 95% IC 1.08-10.87) and prior exposure to cefepime (adjusted OR 6.46; 95% IC 1.08-38.38). CONCLUSION: Prior exposure to antibiotics is the factor that best explains the ertapenem-resistant enterobacteriaceae infection in this population, highlighting the importance of antimicrobial stewardship programs in hospitals.
Assuntos
Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Ertapenem/farmacologia , Centros de Atenção Terciária/estatística & dados numéricos , Resistência beta-Lactâmica , Idoso , Gestão de Antimicrobianos , Carbapenêmicos/uso terapêutico , Estudos de Casos e Controles , Cefepima/uso terapêutico , Colômbia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Grupos Diagnósticos Relacionados , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Objetivo: Se estableció la seroprevalencia de brucelosis canina en perros domésticos de 11 comunas de la ciudad de Medellín y se realizó una encuesta de factores de riesgo a los propietarios. Materiales y Métodos: Fueron analizados por inmunoensayo cromatográfico 441 muestras de suero de caninos cuyos dueños aceptaron responder a una encuesta epidemiológica para explorar factores de riesgo de transmisión de brucelosis canina a la población humana. Resultados: La seroprevalencia de brucelosis fue 2,76 % (IC: 1,11 %- 4,42 %) siendo mayor para las comunas Buenos Aires (6,9 %) y Villa Hermosa (5,7 %). La mayor seroprevalencia fue en machos (4,6 %), caninos criollos (4,8 %), menores de un año (3,7 %), caninos de viviendas con fuentes de agua cercanas (4,5 %), y en aquellos que han permanecido con el dueño por más de 5 meses (3,1 %). La raza presentó asociación con la presencia de anticuerpos (p < 0,05). La seroprevalencia aumentó a 7,5 % cuando la vivienda era compartida con otros animales domésticos. Se encontró mayor seroprevalencia entre los caninos que habitaban en viviendas sin suministro de agua potable (6,7 %) y sin conexión de acueducto y alcantarillado (7,7 %). Para ninguna de estas variables se encontró asociación con la presencia de anticuerpos. Conclusión: El riesgo de transmisión a los humanos de esta zoonosis emergente en circunstancias diferentes a las de índole ocupacional, como son los ambientes domésticos, puede considerarse en aumento si persisten o se incrementan los factores de riesgo que se exploraron en este estudio.
Objective: Determining Brucella canis prevalence in domestic dogs (pets) from 11 districts in Medellín. A survey of risk factors was also carried out. Materials and Methods: Immunoassay was used for analysing441 dog serum samples and several risk factors regarding their owners and some related to the immediate environment were established. Results: Brucellosis prevalence was 2.76 % (1.11-4.42 95 %CI), being highestin the Buenos Aires (6.9 %) and Villa Hermosa districts (5.7%). Seroprevalence was higher in male dogs (4.6 %),mongrels (4.8 %),dogs less than one year old (3.7 %), in homes having nearby water sources (4.5 %) andindogs living with their owners for more than five months (3.1 %).The dogs’ breed was associated with antibody presence (p<0.05). Seroprevalence became increased to 7.5 % when the home was shared with other pets. Higher prevalence was found when the dogs lived in homes without drinking water (6.7 %) and homes lacking a fixed water supply or sewerage connection (7.7 %). No association was found for any of the aforementioned variables with the presence of antibodies. Conclusion: Apart from cases involving occupational risk, the risk ofBrucella canistransmission to humans in domestic settings may increase if the aforementioned risk factors continue increasing in urban areas, such as those explored in this study.
Assuntos
Animais , Cães , Feminino , Masculino , Brucelose/veterinária , Doenças do Cão/epidemiologia , Doenças do Cão/microbiologia , Anticorpos Antibacterianos/sangue , Brucelose/sangue , Brucelose/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , Doenças do Cão/sangue , Animais de Estimação , Fatores de Risco , Estudos Soroepidemiológicos , Saúde da População UrbanaRESUMO
OBJECTIVE: Determining Brucella canis prevalence in domestic dogs (pets) from 11 districts in Medellín. A survey of risk factors was also carried out. MATERIALS AND METHODS: Immunoassay was used for analysing 441 dog serum samples and several risk factors regarding their owners and some related to the immediate environment were established. RESULTS: Brucellosis prevalence was 2.76 % (1.11-4.42 95 %CI), being highest in the Buenos Aires (6.9 %) and Villa Hermosa districts (5.7%). Seroprevalence was higher in male dogs (4.6 %),mongrels (4.8 %),dogs less than one year old (3.7 %), in homes having nearby water sources (4.5 %) and in dogs living with their owners for more than five months (3.1 %).The dogs' breed was associated with antibody presence (p<0.05). Seroprevalence became increased to 7.5 % when the home was shared with other pets. Higher prevalence was found when the dogs lived in homes without drinking water (6.7 %) and homes lacking a fixed water supply or sewerage connection (7.7 %). No association was found for any of the aforementioned variables with the presence of antibodies. CONCLUSION: Apart from cases involving occupational risk, the risk of Brucella canis transmission to humans in domestic settings may increase if the aforementioned risk factors continue increasing in urban areas, such as those explored in this study.
Assuntos
Brucelose/veterinária , Doenças do Cão/epidemiologia , Doenças do Cão/microbiologia , Animais , Anticorpos Antibacterianos/sangue , Brucelose/sangue , Brucelose/epidemiologia , Colômbia/epidemiologia , Estudos Transversais , Doenças do Cão/sangue , Cães , Feminino , Masculino , Animais de Estimação , Fatores de Risco , Estudos Soroepidemiológicos , Saúde da População UrbanaRESUMO
Objective: To explore some factors associated to stunted growth in children below 11 years of age in the Department of Antioquia. Methodology: Cross-sectional study using the databases of alimentary and nutritional profiles in homes of Antioquia in 2004, based on a representative random sample of homes in the department (95% reliability and error margin of 3%). For this study, 100% of the records of children below 11 years of age were used. A model of generalized equations estimation was constructed for stunted growth classified by a Z score smaller than -2 standard deviation with respect to p 50 of the 1978 NCHS (Centro Nacional de Estadísticas de la Salud - National Center for Health Statistics). Data were analyzed using the GLIMMIX Procedure: SAS version 9.1. Results: We found 18.6% of the children with stunted growth, 75% of the homes with male head of household, 70% of heads of household with maximum 5 years of schooling; 47% of homes were nucleated bi-parental, and 40% extensive with a 5-member median per home; 56.4% poor per unsatisfied basic needs, and 80% in alimentary insecurity. The factors associated to stunted growth were: female gender, 1-5 years of age, head of household with less than 6 years of schooling, more than 5 people in the home, more than two household members under 7 years of age, coming from a poor home per unsatisfied basic needs, belonging to a sub-region different from Medellin, food availability of less than 30 different foods per week, no production of food, and head of household under 40 years of age. Conclusions: Herein, we show evidence of the magnitude of poverty and association of precarious socioeconomic conditions with stunted growth in Antioquia. The study shows the importance of considering the correlated nature of the data for the construction of the model.
Objetivo: Explorar algunos factores asociados con el retraso del crecimiento en menores de 11 años en Antioquia, Colombia. Metodología: Estudio de corte transversal utilizando las bases de datos del perfil alimentario y nutricional de los hogares de Antioquia en el año 2004. Muestra representativa aleatoria de hogares por subregión del departamento (95% de confianza y error del 3%). Se tomó 100% de los registros de los menores de 11 años. Se construyó un modelo de estimación de ecuaciones generalizadas para el retraso del crecimiento clasificado por puntaje Z menor de -2 desviaciones estándar, con respecto al p 50 de la NCHS (Centro Nacional de Estadísticas de la Salud) 1978. Los datos se analizaron usando el procedimiento GLIMMIX: SAS versión 9.1. Resultados: Del total de niños, 18.6% tenían retraso del crecimiento, 75% de hogares con jefatura masculina, 70% de jefes con máximo 5 años de escolaridad; 47% de hogares nucleados biparental y 40% extensos, mediana de 5 integrantes por hogar; 56.4% pobres por necesidades básicas insatisfechas y 80% en inseguridad alimentaria. Los factores asociados con el retraso del crecimiento fueron: sexo femenino, edad entre 1 y 5 años, jefe con escolaridad menor de 6 años, más de 5 personas en el hogar, más de dos menores de 7 años en el hogar, provenir de un hogar pobre por necesidades básicas insatisfechas, pertenecer a una subregión diferente a Medellín, disponibilidad menor a 30 alimentos diferentes por semana, no producir alimentos y jefe de hogar menor de 40 años. Conclusiones: Se evidenció la magnitud de la pobreza y la asociación de condiciones socioeconómicas precarias con el retraso del crecimiento en Antioquia. Se demostró la importancia de considerar la naturaleza correlacionada de los datos para la construcción del modelo.
Assuntos
Humanos , Abastecimento de Alimentos , Desnutrição , Pobreza , Fatores SocioeconômicosRESUMO
INTRODUCTION: The prevalence of female sexual dysfunction (FSD) in Colombia has not been adequately studied. A reliable estimate of the prevalence of FSD can be helpful for the adequate planning of reproductive health and research activities. AIM: Measure the prevalence of female sexual complaints in a sample of sexually active women aged 18-40 years in a city of Colombia. METHODS: A self-administered validated questionnaire, the Female Sexual Function Index (FSFI), was administered to 410 sexually active women at different focal groups. A cutoff value of 26.5 was used to define female sexual complaint. Ten questions on age, educational level, socioeconomic status, marital status, cohabitation, depressive feelings, use of antidepressive drugs, menstrual cycle, offspring, and contraception were included. MAIN OUTCOME MEASURES: The primary end point was the percentage of women having a score equal or less than 26.5. RESULTS: In the study group, 117 of 391 women scored less than 26.5 for a prevalence of sexual complaints of 30%. The independent variables associated with sexual complaints were low educational level, the feelings of depression, and the use of antidepressive drugs. CONCLUSION: The present study found a low FSFI score in 30% of sexually active women aged 18-40 years in the city of Medellin, Colombia, which could be indicative of sexual complaints.
Assuntos
Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Psicogênicas/epidemiologia , Adolescente , Adulto , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Colômbia/epidemiologia , Comorbidade , Comportamento Contraceptivo , Comparação Transcultural , Estudos Transversais , Transtorno Depressivo/epidemiologia , Escolaridade , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Estado Civil , Análise Multivariada , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
La tuberculosis continúa siendo una de las enfermedades con mayor impacto sobre la salud pública, el cual ha aumentado mediante la coinfección con el virus de inmunodeficiencia adquirida. El papel preventivo de la terapia antirretroviral altamente efectiva (HAART), para que ocurra la tuberculosis activa, se considera insuficiente si no se brinda de una manera regular y con un nivel de adherencia por parte de los pacientes. Desde la implementación mundial de esta terapia HAART, la morbilidad por la coinfección tuberculosa ha disminuido de manera importante, pero no es el único factor para controlar la TB en este grupo de alto riesgo. Objetivos: determinar la tendencia de la enfermedad tuberculosa en pacientes VIH positivos durante los años de implementación del tratamiento antirretroviral en dos cohortes de pacientes VIH positivos provenientes de diferentes centros de salud de la ciudad de Medellín. Metodología: estudio descriptivo basado en los registros de la base de datos del programa de atención para VIH en un programa de referencia para manejo de pacientes con VIH/sida de diferentes instituciones de salud durante los años 1996 a 2002 y una cohorte retrospectiva conformada para evaluar la incidencia de la TB, en comparación con pacientes que recibían quimioprofilaxis en un estudio realizado durante los años 2003 a 2005. Resultados: se encontró una tendencia progresiva al aumento de la proporción de terapia HAART en el período de estudio, con suministro irregular de esta terapia de 60% entre los años 2003-2005. Se presentó una incidencia anual de TB entre 0,1 y 5,1%. La proporción de casos de TB entre quienes no recibieron HAART fue significativamente mayor: 29,5% en el período 1996-2001. El nivel de efectividad contra la tuberculosis de esta terapia fue de 60% (RR = 0,4). Conclusión: se debe garantizar una terapia altamente efectiva a los pacientes con VIH/sida en el momento en que se les indique por el alto riesgo de desarrollar TB. ...
Tuberculosis (TB) is still an important disease with public health impact. Which has increased since HIV epidemic emergence. The preventive role of highly effective antiretroviral (HAART) against TB disease is not enough to control TB because it requires regular administration and adherence to therapy. Since HAART implementation around the world, de TB, co morbidity has decreased, but is no the only factor to control it. Objectives: to determine TB trend in HIV infected patients, during HAART implementation in two patient cohorts coming from different health centers of Medellín. Methods: a descriptive study was conducted based on registries and data bases from a referral program to care HIV/AIDS patiens in different health centers in the city during 1996 to 2002, and a retrospective cohort of HIV patients with data from clinical registries which was comprised in order to compare TB risk in a prophylaxis study during 2003-2005. Results: we report an increasing trend of HAART therapy use during the period of study, with 60% of HIV patients with irregular therapy during the last period (2003-2005). The annual TB incidence was between 0.1 to 5.1%. The TB proportion among the HIV patients who did not received haart effectiviness was 60% (RR=0.4). Conclusion: HAART therapy must be administered at each HIV/AIDS patients when the risk of developing TB is high, according to this results, HAART therapy is effective but is not the only factor to control TB in this population.
Assuntos
TuberculoseRESUMO
Objetivo: Determinar em que grau as informaçoes dadas pelos médicos aos pacientes sobre sua doença e orientaçao terapêutica influenciam o seu prognóstico e sua qualidade de vida. Métodos: Foi elaborado, na Disciplina de Reumatologia, um questionário a ser preenchido pelos doentes, enquanto se encontravam na sala de espera, para ser entregue à enfermeira-chefe do ambulatório, sendo esta a responsável por qualquer esclarecimento necessário. Foram avaliados cinco itens: 1) nível de explicaçao da doença fornecido pelo médico; 2) significado da doença para o paciente; 3) diagnóstico feito pelo médico; 4) uso de medicina alternativa pelo paciente; 5) confiança do paciente na conduta médica. Resultados: A grande maioria dos pacientes (91,7 por cento) nao recebeu qualquer informaçao sobre sua doença dada pelos médicos que os atenderam. Conclusao: Esta falta de informaçao resultou em baixa confiança na conduta prescrita pelo médico (28,8 por cento)