Search

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.

An epidemiological study was performed in Santafé de Bogotá, Colombia, with a total of 306 women enrolled, including 153 incident BC cases and 153 age-matched controls. The objective of this study was to evaluate the association between BC risk and serum dichlorodiphenyl-dichloroethene (DDE) levels. Sociodemographic and reproductive data, diet, and past exposure to pesticides were obtained through a structured questionnaire. Chemical analysis of samples was performed by high resolution gas chromatography-ECD. Likelihood of developing BC by exposure to these substances was evaluated through odds ratios (OR) adjusted for: first-child breast-feeding, family BC history, body mass index (BMI), parity, and menopausal status. Data analysis was performed by conditional logistic regression techniques. Adjusted OR for exposure to serum DDE and BC suggests an increase risk of BC in the higher category of DDE exposure (OR = 1.95; CI 1.10-3.52). The test for trend was not statistically significant (p = 0.09). We confirm that serum DDE levels bear a positive association to risk of BC and could support the association between risk of BC and burden of DDE exposure.

AimThis study seeks to build upon a prior investigation into the impact of the COVID-19 pandemic and to evaluate the prevalence of anxiety among Brazilian children, along with its associated factors, one year after the commencement of the pandemic.DesignA cross-sectional study.MethodsA survey was conducted from April–May 2021 in Brazil. Children aged 6–12 and their guardians from five Brazilian regions were included. The Children’s Anxiety Questionnaire (CAQ; scores 4–12) and Numerical Rating Scale (NRS; scores 0–10) were used to measure anxiety.ResultsOf the 906 children, 53.3% were girls (average age = 8.79 ± 2.05 years). Mothers responded for 87.1% of the children, and 70.9% were from the Southeast region. Based on a CAQ score of ≥9 and an NRS score of ≥8, the anxiety prevalence was 24.9 and 34.9%, respectively. Using logistic regression, a CAQ ≥9 score was associated with older children and children with chronic disease or disability. An NRS score of ≥8 was associated with reduced family income during the pandemic, the person caring for the children, and with children with chronic disease or disability.ConclusionThese findings suggest the need to implement public health actions aimed at children with chronic diseases and disabilities and their parents to guide them regarding the warning signs and negative emotions. This study contributes to characterizing the evolution of the pandemic in Brazil and provides a basis for comparison with the literature from other countries.

Abstract Background Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People – eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals. Methods The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019–05364, Dnr 2020–03550, Dnr 2021–03255). Discussion The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location. Trial registration ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.

Objetive: To determine the expressions of the bone surface marker CD44 in samples of alveolar bone previously regenerated with allograft, xenograft, and mixed, using the technique of guided bone regeneration. Material and Methods: This exploratory study was approved by the institutional research and ethics committee. By means of intentional sampling and after obtaining informed consent for tissue donation, 20 samples of alveolar bone previously regenerated with guided bone regeneration therapy with particulate bone graft and membrane were taken during implant placement. The samples were stained with hematoxylin-eosin for histological analysis, and by immunohistochemistry for the detection of CD44. Results: Sections with hematoxylin-eosin showed bone tissue with the presence of osteoid matrix and mature bone matrix of usual appearance. Of the CD44+ samples, 80% were allograft and 20% xenograft. The samples with allograft-xenograft were negative. There were no differences in the intensity of CD44 expression between the positive samples. The marker was expressed in osteocytes, stromal cells, mononuclear infiltrate, and some histiocytes. Eighty percent of the CD44+ samples and 100% of the samples in which 60 or more cells were labelled corresponded to allografts (p=0.000). A total of 67% of the samples from the anterior sector, and 40% from the posterior sector were CD44+ (p=0.689). Conclusion: This study shows for the first time that guided bone regeneration using allografts is more efficient for the generation of mature bone determined by the expression of CD44, compared to the use of xenografts and mixed allograft-xenograft, regardless of the regenerated anatomical area.

Vaccination of the population seems to be an important strategy in halting the COVID-19 pandemic in both local and global society. The aim of this study was to explore Swedish adolescents’ willingness to be vaccinated against COVID-19 and its association with sociodemographic and other possible factors. A survey was distributed in Sweden between 7 July and 8 November 2020. The main qualitative question concerned adolescents’ thoughts on vaccination against COVID-19 and evaluated whether the adolescents would like to be vaccinated when a COVID-19 vaccine is made available. In total, 702 adolescents aged between 15 and 19 responded to the questionnaire. A convergent parallel mixed-methods design was used. The results showed that nearly one in three adolescents had not decided if they wanted to get a COVID-19 vaccine, i.e. 30.5%: n = 214. Of the participants 54.3% (n = 381) were willing to be vaccinated. Girls had higher levels of anxiety about the vaccine compared to boys. In addition, high levels of anxiety impacted on the participants’ willingness to be vaccinated. One reason for being undecided about the vaccine was that participants felt they did not know enough about it. Practising social distancing increased willingness to be vaccinated, as reflected in the qualitative results which showed participants wanted to be vaccinated to protect others. The results impart important knowledge to healthcare professionals and contribute to their communication with adolescents about vaccine hesitancy.

Introdução: durante o exame de pediatria, genética, ecográ co ou de anatomia patológica de fetos de gestações gemelares, costumam aparecer interrogantes no diagnóstico diferencial, especialmente quando os casos se associam com maceração, com malformações ou com duplicação de estruturas. Objetivo: propor um algoritmo para o enfoque da autopsia perinatal em gestações múltiplas de difícil diagnóstico. Materiais e Métodos: estudo observacional descritivo do universo de gestações gemelares vistas no Departamento de Patologia do Hospital Universitário San Ignacio (husi) entre 2007 e 2013. De nimos como “gestação múltipla de difícil diagnóstico” aquela na que o exame do(s) feto(s) apresentou um dos diagnósticos diferenciais: feto macerado/evanescente, gêmeo siamês, fetus in fetu, feto acárdico ou teratoma congênito. Realizou-se o estudo anatomopatológico e junto com a literatura revisada, os gêmeos se analisaram e classificaram segundo o algoritmo proposto. Resultados: houve 59 casos de gestações gemelares nas que pelo menos um dos fetos requereu autopsia perinatal. As principais causas de morte foram as infeções ascendentes seguidas da síndrome de transfusão feto-fetal. Como gestações múltiplas de difícil diagnóstico observamos três fetos acárdicos e oito fetos macerados. Aplicouse o algoritmo proposto neste artigo. Conclusões: o diagnóstico nas gestações gemelares pode ser em ocasiões difícil. Identificamos os aspectos mais importantes a ter em conta da história clínica e da autopsia perinatal para chegar ao diagnóstico definitivo; desenvolvemos um algoritmo para ser aplicado nestas circunstâncias durante as autopsias perinatais.

Objetivo: determinar mediante reacción en cadena de la polimerasa (PCR) la infección por el virus del papiloma humano de alto riesgo (DNA-HPV-H) y la presencia de cambio morfológico con atipia en la citología de mujeres que laboran en un hospital y un ente educativo. Métodos: serie de casos de muestras cérvico uterinas con citologías convencional y en base líquida, y PCR para DNA-HPV-H; se incluyeron las pacientes que tuvieron uno o más resultados positivos en citología (ASC-US y LSIL). Resultados: la tipificación de DNA-HPV-H fue positiva en 12 de 41 casos. Se observó un mayor número de citologías con atipia celular en el rango de mujeres jóvenes (22-49 años), comparado con las mayores (50-72 años). Los casos positivos para DNA-HPV-H tanto en citología convencional como en base líquida fue similar. Hubo 11 con infección simple y uno múltiple positivo para alto riesgo (HPV-H y HPV-16). Conclusiones: la PCR identificó 12 pacientes infectadas con HPV de alto riesgo, 11 con infección simple y una múltiple; el grupo que predominó fue el HPV-H (9 casos), seguido del subtipo HPV-18 (5) y por HPV-16 (1). Abreviaturas: ASC-US atipia indeterminada de células escamosas; ASC-H, atipia que no descarta alto grado; HPV, virus del papiloma humano; LSIL, lesión escamosa intraepitelial de bajo grado; HSIL, lesión escamosa intraepitelial de alto grado.

Introducción: feto acárdico es, un feto con ausencia de estructura cardiaca (completa o remanente primitivo) 1,2. La incidencia de fetos acárdicos es 1/35.000 nacimientos y 1% de embarazos de gemelos monocigotos1. Reporte de casos: caso 1: producto de embarazo gemelar de 23 semanas, diagnóstico prenatal de feto acárdico y hermano gemelo muerto con involución, se realiza aborto terapéutico, se obtiene acárdico Anceps y hermano sin malformación. Caso 2: producto de embarazo a término. Hallazgo inesperado en placenta durante parto. Hermano no malformado sano. diagnóstico: acárdico Acéfalo. Caso 3: producto embarazo gemelar a término. Cesárea por ausencia movimientos fetales. Se obtiene feto acárdico y gemelo sin malformación con RCUI muerto. diagnóstico:acárdico Anceps. Caso 4: Producto embarazo gemelar, a término, evidencia feto acárdico por eco prenatal. Se obtiene por cesárea masa amorfa y hermano sin malformación. Patología confirma presencia estructura axial en acárdico. Diagnóstico: Acárdico amorfo. Discusión: la etiología se debe al desarrollo de anastomosis vasculares (arteriales y venosas) entre arterias y venas umbilicales de gemelos monocigotos1, 2. Existen 2 teorías acerca de su patogenia2: Desarrollo vasculatura placentaria anormal que lleva a una secuencia de perfusión arterial reversa entre los gemelos con posterior desarrollo de feto acárdico (TRAP) y la embriogénesis cardiaca anormal como evento primario por cromosomopatía y/o factores ambientales en el feto acárdico. Morfológicamente se clasifica en: - Acárdico acéfalo: se caracteriza por ausencia de cabeza y órganos torácicos. -Acárdico anceps: se caracteriza por presencia de cabeza y cara parcialmente formadas y presencia de extremidades superiores parcialmente formadas. -Acárdio acormus: sólo desarrollo cabeza, poco frecuente. -Acárdico amorfo: Es una masa que conserva su estructura axial. Las complicaciones asociadas son: amenaza del bienestar de gemelo "bomba" por secuestro vascular de feto acárdico2, 3, riesgo de parto pretérmino del gemelo "bomba", retardo de crecimiento intrauterino y muerte en 35 - 55% casos2. El diagnóstico diferencial debe hacerse con: teratoma placentario o de cordón umbilical, feto in feto y muerte intrauterina de gemelo moncorial severamente malformado.

• A comprehensive systematic review on person-centered care. • A consensus about the crucial components of person-centered care for older people. • A guide to support policymakers and health care professionals in implementing person-centered care. • A guide to improve the quality of care for older people, particularly for those with complex health care needs. • The crucial components of person-centered care based on Ricœur's philosophy and ethics. of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciencias de la Salud is the property of Colegio Mayor de Nuestra Senora del Rosario and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

An epidemiological study was performed in Santafé de Bogotá, Colombia, with a total of 306 women enrolled, including 153 incident BC cases and 153 age-matched controls. The objective of this study was to evaluate the association between BC risk and serum dichlorodiphenyl-dichloroethene (DDE) levels. Sociodemographic and reproductive data, diet, and past exposure to pesticides were obtained through a structured questionnaire. Chemical analysis of samples was performed by high resolution gas chromatography-ECD. Likelihood of developing BC by exposure to these substances was evaluated through odds ratios (OR) adjusted for: first-child breast-feeding, family BC history, body mass index (BMI), parity, and menopausal status. Data analysis was performed by conditional logistic regression techniques. Adjusted OR for exposure to serum DDE and BC suggests an increase risk of BC in the higher category of DDE exposure (OR = 1.95; CI 1.10-3.52). The test for trend was not statistically significant (p = 0.09). We confirm that serum DDE levels bear a positive association to risk of BC and could support the association between risk of BC and burden of DDE exposure.

Copyright of Revista Colombiana de Obstetricia y Ginecologia is the property of Federacion Colombiana de Asociaciones de Obstetricia y Ginecologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Universitas Médica is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: Los trastornos cromosómicos son causa de alta mortalidad en el grupo de edad fetal y perinatal; sin embargo, los estudios citogenéticos o moleculares todavía no se realizan rutinariamente en el medio colombiano. Métodos: Estudio que caracteriza la morfología de pacientes sometidos a autopsia perinatal en el HUSI durante 2012 y 2013, con la impresión diagnóstica de trastorno cromosómico y se revisan las características clínicas prenatales. Resultados: Se incluyeron 42 casos; la mayoría contaba con placenta, correspondían al segundo trimestre de la gestación (mediana de 15,5 semanas) y las madres estaban entre los 18 y los 35 años. Los cambios morfológicos predominaron en cabeza, cuello y extremidades. Conclusiones: El conocimiento de los cambios morfológicos desde la autopsia perinatal es una herramienta que complementa el análisis de la mortalidad en este grupo de edad.

Introducción: La placenta tiene la misma información genética que el feto; dentro del útero hace la labor de varios de sus órganos y guarda información sobre la vasculatura de la madre y la del hijo, reacciona contra infecciones y es afectada por las enfermedades maternas y también tiene manifestaciones de las enfermedades fetales. Objetivo: complementar su estudio con la información necesaria sobre ambos en el posparto, pues ahora, sorprendentemente, puede ayudar a entender trastornos transgeneracionales. Conclusión: Su rápida revisión y selección en la sala de partos define la ruta de las placentas y determina si se requiere estudio anatomopatológico. Este artículo explica cómo hacer la selección de manera efectiva.

Introducción: La utilización de imágenes diagnósticas en autopsias clínicas y médicolegales es una práctica que viene llevándose a cabo en países diferentes al nuestro, en especial en autopsias de particular dificultad como las de fetos y neonatos. Es importante conocer la concordancia entre la resonancia magnética post mortem y la autopsia clínica para recomendar su uso rutinario en nuestro medio. Materiales y métodos: Se realizó autopsia a 20 fetos y neonatos y se tomó resonancia magnética corporal total, comparando los hallazgos por imágenes con los hallazgos de la autopsia. Se tabuló la información obtenida y se calculó el valor kappa nominal para determinar la concordancia entre los dos métodos diagnósticos. Resultados: Se calculó la concordancia entre la resonancia magnética y la autopsia clínica en la detección de malformaciones mayores por sistema, calculando un índice de kappa para malformaciones mayores en sistema nervioso central de 0,273, para cabeza y cuello de 0,459, para sistema respiratorio de 0, para sistema cardiovascular de 0,459, para tubo digestivo y abdomen de 0 y para sistema urinario de 0,643. Conclusiones: A pesar de la mala concordancia entre la resonancia magnética post mortem y la autopsia clínica en la detección de malformaciones mayores, se considera en este caso la autopsia clínica como un patrón de referencia imperfecto y se recomienda el uso de la resonancia como modalidad de estudio que puede servir de apoyo a la autopsia clínica en la detección de malformaciones mayores en casos difíciles en fetos y neonatos.

Introducción : Los defectos congénitos de la pared toracoabdominal del feto o del recién nacido presentan un reto diagnóstico en medicina perinatal. Algunas de las entidades se sobreponen, comparten segmentos alterados y pueden tener etiología semejante o no. Métodos : Se revisaron bases de datos en busca de criterios diagnósticos de entidades que involucran defectos congénitos en la pared toracoabdominal. Se ilustran con casos recibidos en el Hospital Universitario San Ignacio. Resultados : De la revisión se construyó una guía diagnóstica. Conclusiones : Dada la complejidad diagnóstica de los defectos de la pared toracoabdominal en fetos y recién nacidos por su tamaño, por los cambios por maceración o por las malformaciones asociadas, es indispensable conocer los criterios para el correcto dictamen.

The purpose of this study was to explore the contexts that shape obese children’s engagement in physical activity (PA) focusing on children’s perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children’s neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

Las alteraciones cromosómicas son una importante causa de muerte en humanos. Su diagnóstico cuenta con nuevas herramientas que están cada vez más al alcance y permiten correlacionar los hallazgos de los estudios fetales y placentarios; sin embargo, no en todas las instituciones de salud colombianas se cuenta con tales recursos. Se reporta un caso de trisomía 13, corroborada por hibridación fluorescente in situ (FISH) y se analizan las manifestaciones histológicas encontradas en la placenta, la cual sí puede ser estudiada de manera rutinaria.

Patricia Olaya-Contreras1, Torgny Persson2, Jorma Styf11Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at The University of Gothenburg, Sweden; 2The Lundby Hospital, Gothenburg, SwedenBackground: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients.Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard.Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression.Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.Keywords: agreement, disability, underlying diagnoses

Las infecciones ocurridas durante la gestación son una importante preocupación, tanto por su incidencia como por las consecuencias de secuelas y muerte que pueden traer para el recién nacido. Sin embargo, la sospecha clínica de infección por citomegalovirus en obstetricia y en pediatría no se correlaciona con la baja confirmación que se hace de la enfermedad. En la placenta, la infección congénita por citomegalovirus (CMV) se refleja en la aparición de villitis crónica, la cual se caracteriza por infiltrado inflamatorio linfohistiocitario focal o difuso en las vellosidades. De estos casos, 80% son asintomáticos y los que tienen síntomas presentan graves déficits neurológicos, retardo del crecimiento intrauterino e, incluso, la muerte. En autopsias fetales, la presencia de inclusiones típicas por citomegalovirus hace el diagnóstico de infección por CMV. Se presenta el caso de un óbito fetal, producto del primer embarazo de una madre adolescente sin adecuado control prenatal, y en cuya autopsia se documentó villositis crónica y la presencia de inclusiones virales en múltiples órganos, tales como vías aéreas y páncreas, con confirmación por inmunohistoquímica.

Introducción: el cordón umbilical es una estructura incomprendida a pesar de transportar todo lo que un feto necesita para crecer y subsistir. Cada una de sus características es relevante, y la principal es la longitud, la cual, cuando está alterada, se relaciona con pobre pronóstico neurológico y muerte fetal. Materiales y métodos: con base en la revisión de principios físicos, se proponen fórmulas que podrían explicar la importancia de la longitud del cordón por sus repercusiones hemodinámicas. Resultados: se analizó la circulación fetal desde el corazón hasta la red capilar vellositaria en el plato placentario y, por medio de fórmulas físicas, se plantea la importancia de la longitud del cordón en la perfusión fetal. Conclusiones: las complicaciones clínicas conocidas para la excesiva longitud del cordón umbilical fueron analizadas desde el punto de vista de la física, dejando listas las fórmulas para ser alimentadas con datos reales provenientes de doppler fetales y mediciones del cordón umbilical.

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.

An epidemiological study was performed in Santafé de Bogotá, Colombia, with a total of 306 women enrolled, including 153 incident BC cases and 153 age-matched controls. The objective of this study was to evaluate the association between BC risk and serum dichlorodiphenyl-dichloroethene (DDE) levels. Sociodemographic and reproductive data, diet, and past exposure to pesticides were obtained through a structured questionnaire. Chemical analysis of samples was performed by high resolution gas chromatography-ECD. Likelihood of developing BC by exposure to these substances was evaluated through odds ratios (OR) adjusted for: first-child breast-feeding, family BC history, body mass index (BMI), parity, and menopausal status. Data analysis was performed by conditional logistic regression techniques. Adjusted OR for exposure to serum DDE and BC suggests an increase risk of BC in the higher category of DDE exposure (OR = 1.95; CI 1.10-3.52). The test for trend was not statistically significant (p = 0.09). We confirm that serum DDE levels bear a positive association to risk of BC and could support the association between risk of BC and burden of DDE exposure.Em estudo epidemiológico realizado em Santa Fé de Bogotá, Colômbia, 153 casos incidentes de câncer de mama (CM) foram comparados com 153 controles, pareados por idade. O objetivo deste estudo foi avaliar a associação entre o risco de CM e níveis séricos do pesticida DDT (DDE). Dados reprodutivos e sócio-demográficos, características da dieta e informação sobre exposição pregressa a pesticidas foram obtidos por meio de questionário. A análise química de amostras de sangue foi realizada através de cromatografia a gaz de alta resolução - ECD. A verossimelhança de desenvolver CM como decorrência de exposição a estas substâncias foi avaliada através de odds ratios (OR), obtidas por técnicas de regressão logística condicional, ajustadas para amamentação do primogênito, história familiar de CM, índice de massa corporal, paridade e presença de menopausa. As OR ajustadas sugerem um risco aumentado de CM no estrato de maior exposição a DDE (OR = 1,95; C.I. 1,10-3,52), embora o teste de tendência fosse estatisticamente não significativo (p = 0,09). Os resultados encontrados constataram que os níveis séricos de DDE estão positivamente associados com o risco de CM, e poderiam apoiar a hipótese desta associação.

INTRODUCCIÓN: El cáncer de mama desde 1992 ha sido la segunda causa de muerte femenina en Colombia (tasa promedio anual de 4,5*100.000 hab.) y se reporta una tendencia ascendente por este tipo de neoplasia, y la información sobre los potenciales factores de riesgo del cáncer de la mama en los países Latinoamericanos es escasa. Los objetivos del trabajo fueron probar la protección ofrecida por la lactancia materna, y establecer los factores reproductivos asociados al cáncer de mama en Colombia. MÉTODOS: Se realizó un estudio de casos y controles hospitalarios pareados por edad (+ 2 años) de Julio 1995 a Marzo 1996 en Bogotá. La población de estudio quedó constituída por 171 casos histopatológicamente definidos y 171 controles. La historia reproductiva y sociodemográfica fué recolectada a través de un cuestionario y se utilizó la técnica de regresión logística condicionada para el análisis estadístico de la información. RESULTADOS: Se encontraron como factores de riesgo: la nuliparidad , al contrario de las mujeres con paridades mayores de 3 hijos (OR=3,35 IC 1,4 - 8,0), la edad al primer nacimiento (>20 años vs. menores de 20. OR= 1,83 IC 0,7 - 4,8), el antecedente familiar de cáncer de mama y la lactancia al primer hijo (OR=0,09 IC 0,01-0,64 de 1-11 meses y OR= 0,01 IC 0,00-0,14 para los 12 meses) y la lactancia acumulada por encima de los 24 meses (p=0,001 prueba de tendencia) como principales factores protectores de la enfermedad. CONCLUSIONES: El estudio confirma la importancia de enfocarse en la promoción de la lactancia prolongada y ratifica que el nivel socioeconómico puede determinar los estilos de vida y los eventos reproductivos de las mujeres, explicando el aumento en la mortalidad por cáncer de mama en los países Latinoamericanos, con perfiles de fecundidad y factores de riesgo para el cáncer de mama, similares a los de los países desarrollados.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: Family members provide the majority of informal care for older adults in Sweden. Nevertheless, by providing a range of assistance, peers often emerge as a central to counter social isolation among older adults. Therefore, there is a need to know more about what informal care provision by older adults to their peers means for different groups of older adults., Aim: This study investigated the types of informal care and support that older adults provide to their peers in Sweden, and how these types of care and support are associated with demographic characteristics and social isolation. We also compared older adults who provide informal care and support with those who do not., Method: For this purpose, we used a national online survey named "Involuntary loneliness among senior citizens" answered by 10,044 older adults enrolled in the Swedish Citizen Panel. We adopted a mixed-method design to analyse the survey data, including free-text options (n = 2155) and numerical data. Social isolation was assessed using a score built from the social loneliness items of the UCLA Loneliness Scale., Results: In our population, 21.5% of the older adults were providing informal care and support to their peers. Practical/instrumental help was frequently offered by younger participants (<75 years), men and respondents who were less socially isolated. On a general level, the factors that were positively associated with giving informal care and support to peers were older age, being male, retired, married/living in a relationship, living in an urban area/big city and exhibiting greater isolation. Focusing specifically on social support shows that older participants (>80) and those experiencing less social isolation (score < 24) were more engaged in social activities.  CONCLUSION: This paper is unique in exploring the informal peer-caregiver's perceptions of isolation. Data were collected during the COVID-19 pandemic; this highlights the need to recognise informal care and support between older adults and to acknowledge their contributions as an essential component of Swedish civil society, especially during a societal crisis., (© 2021 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness: the University of Gothenburg Centre for Person-Centred Care (GPCC). The GPCC steering committee formulated a position paper with three 'simple routines' to initiate, implement, and safeguard PCC in daily clinical practice. The EJCN accepted this position paper for publication in 2011. This brief review seeks to present how PCC, as defined in the position paper, has been used in research and published in EJCN during the past 5 years (2016-20). Clinical implications and future research in PCC are also suggested., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)

The repercussions of the COVID-19 pandemic on children's lives deserve attention. This study aimed to assess the prevalence of anxiety among Brazilian children and its associated factors during social distancing during COVID-19. We used a cross-sectional design with an online survey from April to May 2020 in Brazil. We included children aged 6-12 years and their guardians. The Children's Anxiety Questionnaire (CAQ; scores 4-12) and the Numerical Rating Scale (NRS; scores 0-10) were used to measure anxiety. We enrolled 157 girls and 132 boys, with a mean age of 8.84 (±2.05) years; 88.9% of respondents were mothers. Based on CAQ ≥ 9, the prevalence of anxiety was 19.4% (n = 56), and higher among children with parents with essential jobs and those who were social distancing without parents. In logistic regression, the following variables were associated with higher CAQ scores: social distancing without parents; more persons living together in home; and education level of guardians. Based on NRS > 7, the prevalence of anxiety was 21.8% (n = 63); however, no associations with NRS scores were found with the investigated variables. These findings suggest the necessity of implementing public health actions targeting these parents and their children at the population level.

Objective: The prevalence of type 2 diabetes (T2D) among Iraqi immigrants to Sweden is high and partly related to sedentary physical activity and calorie dense food. The aim of the present study was to explore perceptions, experiences and barriers concerning lifestyle modifications (LSM) in Iraqi immigrants to Sweden at risk for T2D., Design: A qualitative thematic analysis was conducted on data collected from gender-specific focus group interviews which took place during a culturally adapted randomised controlled intervention study addressing motivation to lifestyle change, self-empowerment, behavioural modifications and sociocultural barriers to LSM. Seven focus groups were held, with an interval of 1-4 weeks between January and May of 2015; each session lasted approximately 1.5 hours., Setting: The city of Malmö, Sweden., Participants: Out of 27 women and 23 men assigned to the intervention group, 19 women and 14 men who attended at least one focus group session were included in the study., Results: Participants expressed awareness of the content of healthy lifestyle practices. They also expressed numerous social and cultural barriers to LSM connected to irregular meals, overeating, food and drinking preferences and family expectations. Overeating was described as a consequence of social and cultural norms and expectations and of poor mental well-being. Facilitators for reaching successful LSM were connected to family involvement and support., Conclusion: Our study reports that facilitators for LSM are connected to presence of family support. Preventive actions addressing family involvement may benefit Middle Eastern immigrants at high risk for T2D to consider healthier lifestyles practices. Identification of sociocultural barriers and facilitators for LSM are crucial for successful health promotion in minority populations at risk for T2D., Trial Registration: Trial registration number: NCT01420198 for the MEDIM-study; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

The purpose of this study was to explore the contexts that shape obese children's engagement in physical activity (PA) focusing on children's perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children's neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time., Competing Interests: Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Disability due to acute low back pain (ALBP) runs parallel with distress and physical inactivity. If low back pain persists, this may lead to long-term sick leave and chronic back pain. This prospective randomized study evaluated the effect on physical activity and on the course of ALBP of two different treatment advices provided in routine care., Methods: Ninety-nine patients with acute severe LBP examined within 48 h after pain onset were randomized to the treatment advices "Stay active in spite of pain" (stay active group) or "Adjust activity to the pain" (adjust activity group). Pedometer step count and pain intensity (Numeric Rating Scale, NRS, 0-10) were followed daily during seven days. Linear mixed modeling were employed for statistical analyses., Results: The step count change trajectory showed a curvilinear shape with a steep initial increase reaching a plateau after day 3 in both groups, followed by an additional increase to day 7 in the stay active group only. At day 1, the step count was 4560 in the stay active group compared to 4317 in adjust activity group (p = 0.76). Although there were no statistical differences between the two groups in the parameters describing the change trajectory for step count, the increase in step count was larger in the stay active group. At day 7 the step count was 9865 in the stay active group compared to 6609 in the adjust activity group (p = 0.008). The pain intensity (NRS) trajectory was similar in the two groups. Between day 1 and day 7 it decreased linearly from 5.0 to 2.8 in the stay active group (p < 0.001), and from 4.8 to 2.3 in the adjust activity group (p < 0.001)., Conclusions: Patients with acute severe LBP advised to stay active in spite of the pain exhibited a considerable more active behavior compared to patients adjusting their activity to pain. This result confirms compliance to the treatment advice as well as the utility of the stay active advice to promote additional physical activity for more health benefits in patients with ALBP. There was minimal effect of the treatment advice on the course of ALBP., Trial Registration: ClinicalTrials.gov (NCT02517762).

Aims: The aim of this study is to investigate associations of screen-time and physical activity (PA) with self-efficacy for PA, intrinsic motivation to PA and health-related quality of life (HRQoL) in Colombian schoolchildren from socioeconomically disadvantaged neighborhoods, and to compare these variables among children with normal-weight (NW), overweight (OW) and obesity (OB)., Methods: In 678 schoolchildren (age 10-14 years) screen-time (TV, video games, computer) and number of days being physically active ≥ 60 minutes were self-reported. Multi-item scales were used to assess self-efficacy to PA and intrinsic motivation to PA. The KIDSCREEN-27 was used to assess HRQoL., Results: Screen-time was associated with HRQoL in the school/learning environment dimension. Number of days being physically active was associated with self-efficacy for PA, intrinsic motivation for PA and with HRQoL concerning physical well-being, autonomy/parent relation and social support/peers. Group differences were found for days being physically active (OW = 2.8 and OB = 2.7 vs. NW = 3.3) but not for screen-time (NW = 5.0, OW = 4.7 and OB = 5.7 hrs·d-1). OW and OB scored lower on intrinsic motivation to PA than NW (OW = 19.2 and OB = 17.9 versus NW = 20.1). All 3 groups differed in physical well-being scores (NW = 50.3, OW = 48.1, OB = 40.6, P < .001)., Conclusions: Schoolchildren with overweight and obesity from socioeconomically disadvantaged neighborhoods need additional motivational support to perform health-enhancing PA to experience higher physical well-being.

Aims: To study the prevalence of somatic and mental health comorbidity and the use of opioid medication among patients on long-term sick-leave due to chronic musculoskeletal pain (CMP); to compare an orthopaedic-based assessment of ability to work with a team assessment; to investigate the relationship between intensity of pain and psychosocial characteristics in this group., Methods: A cross-sectional study was carried out with 174 consecutive patients on sick-leave for a mean of 21 months. All were referred from the Social Insurance Office for orthopaedic evaluation and assessment of the ability to work. Of them, only 83/174 patients were referred by the Office for psychiatric evaluation., Results: Neck pain was the main cause of disability. Patients with neck pain often suffered pain in more than two sites, and greater intensity of pain. Thirty-four percent of all participants had been prescribed opioid medication before consultation. Degrees of disability, unemployment, low degree of education and to be an immigrant were related to intensity of pain. Unrecognized psychiatric disorders changed the main cause of inability to work in 69% of patients who underwent both orthopaedic and psychiatric evaluation., Conclusions: An evaluation based on biopsychosocial function is valuable in reaching an accurate assessment of the patient's diagnosis, and ability to work in CMP. Ability to work and degree of sick-leave in patients on long-term sick-leave is determined to a large extent by undiagnosed mental health comorbidities, and not solely somatic complaints.

Background: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients., Methods and Patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient's diagnoses and capacity to work. The mean age was 45 (23-61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard., Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression., Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.