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Familism is a multidimensional construct that includes familial support. However, limited research examines whether the sub-components of familism equally contribute to mental health and whether familism protects against depression beyond social support. To address these gaps, we test associations between the multidimensional components of familism (familial support, familial obligations, family as referents) and social support with depressive symptoms among immigrant Dominican women in New York City. We tested associations between the multidimensional components of familism, specifically, familial support, familial obligations, and family as referents (Sabogal et al., 1987), as well as social support, with depressive symptoms among 419 women. Multiple regression analysis indicated that whereas familial support predicted decreases in depressive symptoms (ß = - 0.15), family obligations, and family as referents did not. However, only social support predicted decreased depressive symptoms (ß= - 0.18) when accounting for covariates and familism subscales. Controlling for covariates, age predicted decreased depressive symptoms (ß = - 0.19), whereas self-rated poor health exhibited the inverse effect (ß = 0.17). These findings highlight the need for a nuanced understanding of familism, social support, and the association of cultural and demographic values on Latina mental health. These results illustrate the need for further analysis of social support and the multiple components of the familism construct.
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The repellent capacity against Sitophilus zeamais and the in vitro inhibition on AChE of 11 essential oils, isolated from six plants of the northern region of Colombia, were assessed using a modified tunnel-type device and the Ellman colorimetric method, respectively. The results were as follows: (i) the degree of repellency (DR) of the EOs against S. zeamais was 20-68% (2 h) and 28-74% (4 h); (ii) the IC50 values on AChE were 5-36 µg/mL; likewise, the %inh. on AChE (1 µg/cm3 per EO) did not show any effect in 91% of the EO tested; (iii) six EOs (Bursera graveolens-bark, B. graveolens-leaves, B. simaruba-bark, Peperomia pellucida-leaves, Piper holtonii (1b*)-leaves, and P. reticulatum-leaves) exhibited a DR (53-74%) ≥ C+ (chlorpyrifos-61%), while all EOs were less active (8-60-fold) on AChE compared to chlorpyrifos (IC50 of 0.59 µg/mL). Based on the ANOVA/linear regression and multivariate analysis of data, some differences/similarities could be established, as well as identifying the most active EOs (five: B. simaruba-bark, Pep. Pellucida-leaves, P. holtonii (1b*)-leaves, B. graveolens-bark, and B. graveolens-leaves). Finally, these EOs were constituted by spathulenol (24%)/ß-selinene (18%)/caryophyllene oxide (10%)-B. simaruba; carotol (44%)/dillapiole (21%)-Pep. pellucida; dillapiole (81% confirmed by 1H-/13C-NMR)-P. holtonii; mint furanone derivative (14%)/mint furanone (14%)-B. graveolens-bark; limonene (17%)/carvone (10%)-B. graveolens-leaves.
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Inibidores da Colinesterase , Repelentes de Insetos , Óleos Voláteis , Sesquiterpenos Policíclicos , Animais , Acetilcolinesterase/metabolismo , Inibidores da Colinesterase/farmacologia , Inibidores da Colinesterase/química , Colômbia , Repelentes de Insetos/farmacologia , Repelentes de Insetos/química , Óleos Voláteis/farmacologia , Óleos Voláteis/química , Piper/química , Óleos de Plantas/farmacologia , Óleos de Plantas/química , Sesquiterpenos Policíclicos/química , Sesquiterpenos Policíclicos/farmacologia , Gorgulhos/enzimologia , Gorgulhos/efeitos dos fármacos , Sesquiterpenos de Eudesmano/química , Sesquiterpenos de Eudesmano/farmacologia , Sesquiterpenos/química , Sesquiterpenos/farmacologiaRESUMO
Latinos have high rates of type 2 diabetes mellitus (T2DM) yet are characterized as having health-promoting social networks. The impacts of COVID-19 on personal networks were complex, especially in urban areas with high proportion of immigrants such as the Bronx in NYC. Our objective was to test the extent to which network characteristics increase vulnerability or resiliency for glycemic control based on data gathered from Mexican-origin Bronx dwellers. We used two-wave panel study analyzing self-reported personal social networks (n=30participants; 600network members) and HbA1c levels via dried blood spots in 2019, before the COVID-19 pandemic, and in 2021, a time after initial lockdowns and when the pandemic was still ravaging the community of study. Regression models adjusted for individual-level variables including sociodemographic and health indicators (i.e., physical health including COVID-19 and mental health). We found that an increase in the proportion of network members with diabetes predicted an increase in participant's HbA1c levels from 2019 to 2021 (ß=0.044, p < 0.05). Also, a greater proportion of network members consuming "an American diet" in 2019 predicted a decrease in participant's HbA1c levels (ß=-0.028, p < 0.01), while a greater proportion of network members that encouraged participants' health in 2019 predicted an increase in participant's HbA1c levels (ß=0.033, p < 0.05). Our study sheds light on specific social network characteristics relevant to individual diabetes outcomes, including potential longitudinal mechanistic effects that played out at the peak of the COVID-19 crisis.
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COVID-19 , Diabetes Mellitus Tipo 2 , Resiliência Psicológica , Humanos , Estados Unidos , Diabetes Mellitus Tipo 2/epidemiologia , Hemoglobinas Glicadas , Pandemias , Controle de Doenças TransmissíveisRESUMO
INTRODUCTION: The prevalence of type 2 Diabetes Mellitus (T2DM) is 2-3 times greater among Mexican Americans than non-Latino whites, and Mexican Americans are more likely to develop T2DM at younger ages and experience higher rates of complications. Social networks might play a crucial role in both T2DM etiology and management through social support, access to resources, social engagement, and health behavioral norms. OBJECTIVE: To quantitatively identify the social network features associated with glycated hemoglobin (HbA1c) in a community sample of Mexican immigrants residing in New York City, and to explore the extent to which these quantitative findings converge with qualitative narratives of their lived experiences. METHODS: This study used a convergent mixed methods design. To collect personal network data, we used EgoWeb, and obtained 1,400 personal network ties from 81 participants. HbA1c readings were collected using dried blood spots and categorized according to the laboratory criteria of the American Diabetes Association. Additional survey data were collected using Qualtrics software. To investigate the significance of the network-level factors after accounting for the socioeconomic and demographic individual-level factors that the literature indicates to be associated with T2DM, we used a multiple regression model on quantitative data sources. For the qualitative portion of the study, we selected a subset of individuals who participated in the quantitative portion, which represented 500 personal network ties from 25 participants. We conducted in-depth interviews guided by the visualization of these ties to explore who was helpful or difficult in managing their health and health behaviors. RESULTS: Individual-level indicators associated with lower HbA1c scores were body mass index (ß = -0.07, p<0.05), and healthy eating index scores (ß = -0.03, p<0.02). The network-level predictor associated with higher HbA1c levels was the percentage of diabetic alters in the network (ß = 0.08, p <0.001, with a 25% increase in the percentages associated 2.0 change in HbA1c levels. The qualitative data highlighted that most of the diabetes-related information diffused through the social networks of our participants was related to dietary practices, such as reducing sugar and red meat consumption, eating out less, and reducing portion sizes. Notably, even among those with elevated levels and diabetes-related health complications, HbA1c was not considered a part of the lay descriptions of good health since they were not "suffering." Participants regarded doctors as the ultimate authority in diabetes care, even if they had supportive members in their personal networks. CONCLUSION: Our study provides quantitative evidence for the significant role of diabetic network members in the etiology and management of T2DM among Mexican Americans. Our qualitative findings suggest important ley terms for T2DM management and the importance of physicians, which could be included in in future social networks studies seeking to diffuse diabetes-related health information for T2DM prevention and management efforts in this population.
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Complicações do Diabetes , Diabetes Mellitus Tipo 2 , Adulto , Humanos , Hemoglobinas Glicadas , Americanos Mexicanos , Cidade de Nova Iorque/epidemiologiaRESUMO
BACKGROUND: Evidence from Latin America suggests that children embedded in South-to-North migrant networks (i.e. relatives who live abroad, typically in the United States) are at increased risk of excess weight. It is unclear if the same findings apply to children embedded in Latin American intraregional migration or South-to-South migration networks. OBJECTIVE: To compare excess weight among Colombian children embedded in South-to-South migration networks (n = 334) to children with non-migrant parents (n = 4272) using Colombia's 2015 National Survey of the Nutritional Situation. METHODS: Prevalence ratios (PRs) for excess weight (BMI z-score ≥1) by parent migration history were estimated using weighted multivariable logistic regression adjusting for demographics, child behaviours, community and household indicators, including household food insecurity. RESULTS: Most migrant parents returned to Colombia from Venezuela (84%) and reported higher household food insecurity rates than non-migrant parents (59% versus 32%). Models excluding household food insecurity showed that excess weight among children with migrant parents was 51% lower (PR = 0.49; 95% CI 0.25, 0.98) than among children with non-migrant parents. After adjustment for household food insecurity, no statistically significant differences were found. CONCLUSION: Colombian children with return migrant parents from Venezuela experienced less excess weight than children with non-migrant parents, but higher rates of food insecurity in migrant households might partially explain this difference. This study calls attention to two serious public health concerns for Colombian children-those who have excess weight and those who lack sufficient food, particularly among migrant returnees (a situation that may have worsened since the COVID-19 pandemic).
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Alimentos , Pandemias , Criança , Humanos , Estados Unidos , Colômbia/epidemiologia , Estudos Transversais , Aumento de Peso , Abastecimento de AlimentosRESUMO
BACKGROUND: Latinos in the United States (U.S.) represent a heterogeneous minority population disproportionally impacted by obesity. Colombians in the U.S. are routinely combined with other South Americans in most obesity studies. Moreover, most studies among Latino immigrants in the U.S. solely focus on factors in the destination context, which largely ignores the prevalence of obesity and contextual factors in their country of origin, and warrant transnational investigations. METHODS: Using 2013-17 data from the New York City Community Health Survey (NYC CHS, U.S.) and the National Survey of the Nutritional Situation (ENSIN, Colombia), Colombians that immigrated to the U.S. and are living in NYC (n = 503) were compared to nonimmigrant Colombians living in their home country (n = 98,829). Prevalence ratios (PR) for obesity (BMI ≥ 30 kg/m2) by place of residence were estimated using multivariable logistic regression adjusting for socio-demographic characteristics and daily consumption of sugar-sweetened beverages. RESULTS: The prevalence of obesity was 49% greater for immigrant Colombians living in NYC when compared to nonimmigrant Colombians living in in their home country (PR = 1.49; 95% CI 1.08, 2.07). Colombian immigrant men in NYC were 72% more likely to have obesity compared to nonimmigrant men living in their home country (PR = 1.72; 95% CI 1.03, 2.87). No significant differences were found in the adjusted models among women. CONCLUSIONS: Colombian immigrants in NYC exhibit a higher prevalence of obesity compared to their nonimmigrant counterparts back home and sex strengthens this relationship. More obesity research is needed to understand the immigration experience of Colombians in the U.S. and the underlying mechanisms for sex difference. Public health action focused on women in Colombia and both Colombian men and women immigrants in the U.S. is warranted to avert the long-term consequences of obesity.
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Emigrantes e Imigrantes , Obesidade , Feminino , Humanos , Masculino , Colômbia/epidemiologia , Colômbia/etnologia , Estudos Transversais , Emigrantes e Imigrantes/estatística & dados numéricos , Obesidade/epidemiologia , Obesidade/etnologia , Estados Unidos/epidemiologia , Cidade de Nova Iorque/epidemiologia , Fatores SexuaisRESUMO
Objective: This study examines the association between acculturative stress and psychological distress among Mexican immigrants living in New York City. It takes account factors such as language barriers, legal status, fear of deportation, and avoidance of social health and human services, and how these factors are implicated in the mental health status of the study population. Design: Study draws from a community-based sample of Mexican American adults from the Social Network of Mexican Americans study recruited from a church-based community center in the Bronx, New York. Eighty Mexican immigrants were included in this analysis. Descriptive statistics were used to display participants' characteristics. Pearson correlation and multiple regressions were run to determine the relationship between acculturative stress and psychological distress, and also with each of the items from the acculturative stress scale. Both scales have been validated among Spanish-speaking Latino immigrants. Results: A significant moderate positive relationship was found between acculturative stress and psychological distress. Within the acculturative stress scale, those items related to language discrimination, evasion of health services, and feeling guilty for leaving family/friends in home country had significant associations with increased psychological distress. Conclusion: The findings support the need for interventions that account for the major stressors associated with being a Mexican immigrant in the United States to prevent psychological distress, especially given the anti-immigration policies.
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BACKGROUND: Research on negative dietary acculturation among Mexican-Americans has mostly focused on individual-level processes and has largely ignored the role of social networks. METHODS: This mixed-method study used an egocentric network approach and derived 1620 personal ties of self-identified Mexican adults in New York. 24-hour dietary recalls were used to derive a total Healthy Eating Index (HEI) and subscores. The qualitative portion generated narratives around who helps or hinders their efforts to eat healthfully. RESULTS: At the individual level, age at which participants migrated to the U.S. was negatively associated with total HEI (ß = -0.39, p < .01). An annual income below $30,000 was positively associated with total HEI (ß = 0.25, p < .05) and with HEI fruit subscores (ß = 0.25, p < .05). Acculturative stress was negatively associated with HEI fruit (ß = -0.29, p < .05) and refined grain subscores (ß = -0.34, p < .01). At the network level, the proportion of network members who consumed traditional Latino diets was negatively associated with total HEI and HEI refined grains subscores (ß = -0.39, p < .001; and ß = -0.23, p < .05; respectively). In contrast, the proportion of alters who lived in another country was positively associated with HEI dairy subscores (ß = 0.25, p < .05). Juxtaposing qualitative participants' visual representation of their total HEI scores with their lay interpretations of healthy and unhealthy eating matched public health messages of reducing sugar, red meat intake, and processed foods. However, participants felt that this could only be achieved through restriction rather than balance. Qualitative narratives also elucidated how dietary acculturation and income could help shape dietary quality in unexpected ways. CONCLUSIONS: This study found evidence of negative dietary acculturation and showcases the complex ways in which both individual- and network-level processes help shape dietary choices for Mexican-Americans.
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Aculturação , Dieta Saudável , Americanos Mexicanos , Adulto , Humanos , Dieta , Cidade de Nova IorqueRESUMO
Introducción. La evaluación de la calidad de vida es un resultado de salud que comúnmente se asocia con la eficacia de los tratamientos derivados a los pacientes con enfermedad de las arterias coronarias. Específicamente, la literatura no es clara con respecto al papel de la rehabilitación cardíaca sobre la calidad de vida en población sometida a revascularización coronaria. Objetivo. Determinar si existen diferencias en la percepción de calidad de vida relacionada con la salud, después de asistir a un programa de rehabilitación cardiaca de 8 semanas comparado con uno de 12 semanas en personas post revascularización percutánea. Métodos. Ensayo clínico controlado aleatorizado, conformado por personas que asisten a rehabilitación cardíaca, divididas en dos grupos de estudio (8 y 12 semanas), quienes se evaluaron a través del Cuestionario SF-36.Resultados. La muestra estuvo conformada por 17 personas, con edad promedio de 63.1±6.9 años. Al comparar la evaluación pre y posttratamiento en cada grupo, se encontraron diferencias significativas en los dominios función física y rol físico en el grupo de 8 semanas; al realizar la comparación entre grupos hubo diferencias en el dominio emocional. Conclusión. Los resultados del estudio no evidenciaron diferencias en cuanto a la calidad de vida relacionada con la salud entre los grupos de estudio en el resultado global del cuestionario SF-36. Sin embargo, al comparar las dos intervenciones, el grupo de 8 semanas demostró mejores valores sobre el rol emocional
Introduction. The evaluation of quality of life is a health outcome that is commonly associated with the efficacy of treatments derived from patients with coronary artery disease. The literature is unclear regarding the role of cardiac rehabilitation on quality of life in the population undergoing coronary revascularization.Aim. To determine if there are differences in perception of health-related quality of life after attending an 8-week cardiac rehabilitation program compared to a 12-week program in people after coronary angioplasty. Methods. Randomized controlled clinical trial that included people with coronary angioplasty, who attended a cardiac rehabilitation program, divided in two groups (8 and 12 weeks), who were evaluated through the 8 domains of Short Form-36 Health Survey (SF-36). Results. The sample was made up of 17 people, with an average age of 63.1 ± 6.9 years. When comparing the evaluation before and after treatment in each group, sta-tistical differences were found in the physical-functioning and role-physical in 8 weeks group. Comparation between group show differences in role-emotional. Conclusion. The results of the present study did not show differences between the global score on health-related quality of life. However, when comparing the two in-terventions, the 8-week group showed better values on the role-emotional.
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In forensic science, the information that teeth provide to the age estimation process is very important. In adults, one of the most widely used indicators of skeletal age is the Root Dentin Translucency (RDT), mainly through the Lamendin technique, which is used in various Latin American contexts. Recently, Parra et al. (2020) have developed a Bayesian regression model using the Lamendin technique to establish standardized criteria for estimating age-at-death in adults in various forensic contexts. In this study, we evaluate the applicability of this proposal together with the proposal by Lamendin et al. (1992) and Prince and Ubelaker (2002) in Latin American contexts. A sample of single-rooted teeth belonging to 805 individuals from six Latin American countries was used. The results of the three proposals considered were analyzed taking into account factors such as age, sex, origin, and the tooth surface on which the variables were surveyed. Of the factors that would affect the estimates, it was found that the age of the individuals had the greatest influence. However, it was confirmed that the sex and surface of the teeth on which the measurements were taken did not influence the final result. On the other hand, as we expected, the application of the analyzed proposals would also be possible in other forensic contexts, as shown by the results obtained according to the origin. This research expands the FIDB with more information on Latino contexts.
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Determinação da Idade pelos Dentes/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Odontologia Legal/métodos , Retração Gengival/patologia , Humanos , América Latina , Luz , Masculino , Pessoa de Meia-Idade , Raiz Dentária/anatomia & histologia , Adulto JovemRESUMO
ABSTRACT Introduction: Achondroplasia is an autoso-mal dominant congenital condition caused by a mutation of the fibroblast growth encoding gene, which affects endochondral ossification. It is the most common cause of disproportionate short stature, generating physical disability. In the presence of disability, adapted sport emerges as a strategy designed to generate inclusion and, thereby, improve the quality of life of disabled people. The aim was to develop a physical therapy plan that included recommendations to minimize the risk of injury and prevent loss of functionality as a consequence of sports practice. Case presentation: This is the case of a 27-year-old Colombian athlete diagnosed with achondroplasia who competes in the para-powerlifting and swimming modalities. Physiotherapeutic and physical fitness evaluations were carried out, finding obesity and postural and gait pattern alterations. The available literature does not recommend practicing these sports in this type of patient; however, a training program and recommendations were designed to preserve her functionality and improve her sports performance. The plan was put into practice and tolerated adequately by the athlete. Conclusions: Training plans that promote the maintenance of optimal physical condition in adapted sports participants allow them to continue practicing their sport without compromising their life expectancy or functionality. The analysis of the present case illustrates how physical therapists play a key role in this population to minimize the possible complications derived from training and competitions.
RESUMEN Introducción. La acondroplasia es una condición congênita causada por una mutación del gen codificador de crecimiento del fibroblasto que afecta la osificación endocondral y genera discapacidad estructural; además, es la causa más común de talla baja desproporcionada. Por su parte, el deporte adaptado es una disciplina deportiva que se ajusta al colectivo de personas con discapacidad y una estrategia diseñada para generar inclusión y mejorar la calidad de vida de sus participantes. Se presenta el caso de una paciente con acondroplasia a quien se le diseñó un plan fisioterapéutico de intervención enfocado a minimizar el riesgo de lesiones y prevenir la pérdida de funcionalidad como consecuencia de la práctica deportiva. Presentación del caso. Paciente femenina de 27 años diagnosticada con acondroplasia y practicante de levantamiento de potencia adaptado y natación paralímpica, a quien mediante valoración fisioterapéutica y de la aptitud física se le encontraron alteraciones posturales y en el patrón de marcha. Dado que por su condición de base no es recomendable que practique los deportes en los cuales compite, se le diseñó un programa de entrenamiento y recomendaciones dirigido a preservar su funcionalidad y mejorar su desempeño en la práctica deportiva. El plan fue puesto en práctica y tolerado de forma adecuada por la deportista. Conclusiones. Los planes de entrenamiento que favorezcan el mantenimiento de la condición física óptima de los participantes de deportes adaptados les permiten a estos deportistas realizar su práctica sin afectar su expectativa de vida ni su funcionalidad. El análisis del presente caso muestra cómo el fisioterapeuta desempeña un rol importante en esta población, pues los puede ayudar a disminuir las posibles complicaciones que se deriven de entrenamientos y competencias.
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Resumen: Objetivo: Determinar la precisión del dimorfismo sexual a través del análisis morfométrico de bóvedas palatinas en cráneos procedentes del Laboratorio de Investigación Forense del Equipo Forense Especializado (EFE) de Ayacucho del Ministerio Público - Perú. Materiales y métodos: Diseño transversal, constituido con una muestra de 43 cráneos con sexo biológico preestablecido, (24=masculino y 19=femenino). La estimación del dimorfismo sexual se estableció a través del método propuesto por Meera Jacob y cols., basado en las mediciones de la longitud y ancho palatino, posteriormente se calculó el índice palatino, estableciéndose la precisión y exactitud del método. El análisis inferencial se realizó con un nivel de significancia del 5% a través de la prueba T student, Shapiro Wilk y el coeficiente de Pearson. Resultados: Se estableció que el ancho palatino presenta una media de 3,43 (+0,31) cm. para el sexo masculino y 3,62 (+0,25) cm. para el femenino, en la longitud palatina la media fue de 5,07 (+0,44) cm. para masculino y 4,79 (+0,41) cm. en el femenino; en el índice palatino, el 100% de los cráneos de sexo masculino corresponden al paladar duro estrecho y en el femenino un 73,7% al estrecho, un 21% al intermedio y un 5,3% al ancho. Además, se determinó que existió diferencias estadísticamente significativas entre los parámetros del ancho y longitud de la bóveda palatina entre ambos sexos y se planteó una fórmula de análisis discriminante. Conclusión: El análisis morfométrico de bóvedas palatinas establece una precisión de 83.72% en la estimación del dimorfismo sexual.
Abstracts: Objective: Determine sexual dimorphism precision via palatal vault morphometric analysis in craniums sourced from the Laboratorio de Investigación Forense del Equipo Forense Especializado (EFE) de Ayacucho del Ministerio Público- Perú. Materials and Methods: Cross-sectional design consisting of a sample of 43 skulls with pre-established biological gender, (24 males and 19 females). Sexual dimorphism was established by means of the method proposed by Meera Jacob and co., based on palatal width and length measurements, after which the palatal index was calculated, establishing the method's precision and accuracy. The inferential analysis was made with a level of significance of 5% through the T student test, Shapiro Wilk and Pearson's coefficient. Results: Palatal width had a mean of 3.43 (+0.31cm) for males and 3.62 (+0.25) for females and in palatal length a mean of 5.07 (+0.44) cm. for males and 4.79 (+0.41) cm. for females is established; on palatal index, 100% of the male skulls correspond to hard narrow palate and on females 73.7% to narrow, 21% to intermediate and 5.3% to wide. Furthermore, it was determined that there were statistically significant differences between width and length of palatal vault for both genders, and a discriminating analysis formula was proposed. Conclusion: Morphometric analyses of palatal vaults establish an 83.72% precision on the estimation of sexual dimorphism.
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Humanos , Caracteres Sexuais , Palato Duro/anatomia & histologia , Peru , Crescimento e DesenvolvimentoRESUMO
Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury. Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables. Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05. Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%. Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.
Introducción. El trauma craneoencefálico es una de las principales causas de muerte y discapacidad en adultos jóvenes. Su gravedad se define según la escala de coma de Glasgow. Sin embargo, el deterioro neurológico agudo no siempre concuerda con la gravedad inicial indicada por la escala, lo que implica una subestimación de la magnitud real de la lesión. Objetivo. Estudiar la correlación entre la gravedad inicial del trauma craneoencefálico según la escala de coma de Glasgow y la condición final del paciente, en el contexto de diferentes variables clínicas y de los hallazgos de la tomografía. Materiales y métodos. Se analizó una cohorte retrospectiva de 490 pacientes con trauma craneoencefálico cerrado que requirieron atención en la unidad de cuidados intensivos de dos centros de tercer nivel de Barranquilla. La estimación del riesgo se estableció con la razón de momios (odds ratio, OR) y un intervalo de confianza (IC) del 95 %. Se utilizó un alfa de 0,05 como nivel de significación. Resultados. El 41,0 % de los pacientes requirió intubación endotraqueal; el 51,2 % había presentado traumas inicialmente clasificados como moderados y, el 6,0 %, como leves. El retraso en la implementación de un tratamiento agresivo afectó principalmente a aquellos con trauma craneoencefálico moderado, en quienes la letalidad aumentó al 100 % cuando no se detectó a tiempo el deterioro neurológico y, por lo tanto, el tratamiento agresivo se demoró más de 4 a 8 horas. Por el contrario, la letalidad fue de menos de 20 % cuando se brindó el tratamiento agresivo en el curso de la primera hora después del trauma. Conclusiones. El riesgo de letalidad del trauma craneoencefálico aumentó cuando el deterioro neurológico se detectó tardíamente y el tratamiento agresivo se inició después de transcurrida la primera hora a partir del trauma.
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Lesões Encefálicas Traumáticas/complicações , Transtornos da Consciência/etiologia , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/terapia , Criança , Colômbia/epidemiologia , Coma/etiologia , Terapia Combinada , Intervalos de Confiança , Craniectomia Descompressiva , Feminino , Fundações , Escala de Coma de Glasgow , Hospitais Universitários , Humanos , Soluções Hipertônicas/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Hemorragia Subaracnoídea Traumática/complicações , Hemorragia Subaracnoídea Traumática/mortalidade , Hemorragia Subaracnoídea Traumática/terapia , Adulto JovemRESUMO
Introducción. El trauma craneoencefálico es una de las principales causas de muerte y discapacidad en adultos jóvenes. Su gravedad se define según la escala de coma de Glasgow. Sin embargo, el deterioro neurológico agudo no siempre concuerda con la gravedad inicial indicada por la escala, lo que implica una subestimación de la magnitud real de la lesión. Objetivo. Estudiar la correlación entre la gravedad inicial del trauma craneoencefálico según la escala de coma de Glasgow y la condición final del paciente, en el contexto de diferentes variables clínicas y de los hallazgos de la tomografía. Materiales y métodos. Se analizó una cohorte retrospectiva de 490 pacientes con trauma craneoencefálico cerrado que requirieron atención en la unidad de cuidados intensivos de dos centros de tercer nivel de Barranquilla. La estimación del riesgo se estableció con la razón de momios (odds ratio, OR) y un intervalo de confianza (IC) del 95 %. Se utilizó un alfa de 0,05 como nivel de significación. Resultados. El 41,0 % de los pacientes requirió intubación endotraqueal; el 51,2 % había presentado traumas inicialmente clasificados como moderados y, el 6,0 %, como leves. El retraso en la implementación de un tratamiento agresivo afectó principalmente a aquellos con trauma craneoencefálico moderado, en quienes la letalidad aumentó al 100 % cuando no se detectó a tiempo el deterioro neurológico y, por lo tanto, el tratamiento agresivo se demoró más de 4 a 8 horas. Por el contrario, la letalidad fue de menos de 20 % cuando se brindó el tratamiento agresivo en el curso de la primera hora después del trauma. Conclusiones. El riesgo de letalidad del trauma craneoencefálico aumentó cuando el deterioro neurológico se detectó tardíamente y el tratamiento agresivo se inició después de transcurrida la primera hora a partir del trauma.
Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury. Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables. Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05. Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%. Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.
Assuntos
Traumatismos Craniocerebrais , Prognóstico , Acidentes de Trânsito , Escala de Coma de Glasgow , Mortalidade , Resultados de Cuidados CríticosRESUMO
Low level of physical activity is a risk factor for chronic non-communicable diseases. Specifically, people at risk of Type 2 Diabetes (T2D) have shown to benefit from being physically active. The objective of this study was to explore what factors were associated with low physical activity in people at high risk of T2D living in Bogota and Barranquilla, Colombia. Methodology: Cross-sectional study using baseline data from a quasi-experimental clinical trial (PREDICOL Project). The study included 1,135 participants of Bogota and Barranquilla that presented a high risk of developing T2D according to the Finnish Diabetes Risk Score (>12 points) and who underwent an oral glucose tolerance test. The main outcome variable was the level of physical activity assessed by the International Physical Activity Questionnaire. Unadjusted and adjusted logistic regression analysis were used to calculate odds ratios (OR) and the corresponding 95% confidence intervals (CI). Results: In total, 72.5% of the study participants had low level of physical activity. Participants in the age group between 45 and 54 years showed 74% greater odds of having low physical activity compared with the youngest age group (OR 1.74, 95% CI 1.1 -2.8). People living in Barranquilla were eight times more likely to have low physical activity compared with those in Bogotá D.C. (OR 8.1, 95% CI 5.7 to 11.4). Conclusion: A large proportion of the population at risk of developing D2T in two large cities of Colombia have a sedentary lifestyle. Interventions should be designed and implemented in order to increase physical activity in these populations.
Assuntos
Diabetes Mellitus Tipo 2 , Cidades , Colômbia/epidemiologia , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Exercício Físico , Humanos , América Latina/epidemiologia , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: The objective of the demonstration project for type 2 diabetes prevention in the Barranquilla and Juan Mina (DEMOJUAN) study was to investigate the extent to which it is possible to reach normal glucose metabolism with early lifestyle interventions in people at high risk of type 2 diabetes (prediabetes), compared with those who receive standard usual care. METHODS: DEMOJUAN was a randomized controlled trial conducted in Juan Mina and Barranquilla, Northern Colombia. Eligible participants were randomized into one of three groups (control group, initial nutritional intervention, and initial physical activity intervention). The duration of the intervention was 24 months. The main study outcome in the present analysis was reversion to normoglycemia. Relative risks and their corresponding 95% confidence intervals were calculated for reversal to normoglycemia and T2D incidence. RESULTS: There was no statistically significant association between the intervention groups and reversion to normoglycemia. The relative risk of reversion to normoglycemia was 0.88 (95% CI 0.70-1.12) for the initial nutritional intervention group participants and 0.95 (95% CI 0.75-1.20) for the initial physical activity intervention group participants. CONCLUSIONS: Our study did not find any statistically significant differences in reversion to normoglycemia or the development of type 2 diabetes between the intervention groups and the control group in this population.
Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Intolerância à Glucose , Estilo de Vida , Colômbia/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Exercício Físico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-IdadeRESUMO
With the marked increase of the Latino population in the United States during the past 20 years, there has been growing interest in the social, cultural, and structural factors that may impede breast cancer screening among Latino women, especially among those subgroups that have been understudied. Acculturation and fatalism are central cultural constructs in these growing fields of research. However, there is great debate on the extent to which acculturation and fatalism affect breast cancer screening among Latinas relative to other social or structural factors or logistical barriers. Moreover, little theoretical work specifies or tests pathways between social, structural, and cultural determinants of screening. This study tests a theoretical model of social and structural (socioeconomic status and access to health care) and cultural factors (acculturation and fatalism) as correlates of mammography screening among Dominican Latinas, a group that has been understudied. The study expands prior work by examining other factors identified as potential impediments to mammography screening, specifically psychosocial (e.g., embarrassment, pain) and logistical (e.g., not knowing how to get a mammogram, cost) barriers. Interview-administered surveys were conducted with 318 Latinas from the Dominican Republic aged 40 years or older. Fatalistic beliefs were not associated with mammogram screening. Greater acculturation assessed as language use was associated with decreased screening. The strongest predictor of decreased screening was perceived barriers. Results highlight the importance of assessing various self-reported psychosocial and logistical barriers to screening. Possible avenues for screening interventions include intensifying public health campaigns and use of personalized messages to address barriers to screening. Results add to a limited body of research on Dominicans, who constitute the fifth largest Latino group in the United States.
Assuntos
Aculturação , Neoplasias da Mama/etnologia , Detecção Precoce de Câncer , Hispânico ou Latino/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Idoso , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , República Dominicana/etnologia , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Mamografia/psicologia , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Classe Social , Estados UnidosAssuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Obesidade/etnologia , Adulto , Idoso , Feminino , Humanos , Masculino , México/etnologia , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: A growing literature on Latino's beliefs about cancer focuses on the concept of fatalismo (fatalism), despite numerous conceptual ambiguities concerning its meaning, definition, and measurement. This study explored Latina women's views on breast cancer and screening within a cultural framework of destino ("destiny"), or the notion that both personal agency and external forces can influence health and life events. METHODS: Semi-structured interviews were conducted with 25 Latinas from the Dominican Republic aged 40 or over. RESULTS: Respondents reported complex notions of health locus of control that encompassed both internal (e.g., individual action) and external (e.g., the will of God) forces shaping breast cancer prevention efforts. Furthermore, women actively participated in screening because they believed that cancer could become a death sentence if diagnosed late or left untreated. DISCUSSION: In contrast to simplistic notions of "fatalism", our analysis suggests complex strategies and beliefs regarding breast cancer and cancer screening that speak of resiliency rather than hopelessness.