Andrés Fandiño-Losada

The establishment of injury surveillance systems in Colombia, El Salvador, and Nicaragua (2000-2006)

La Organizacion Panamericana de la Salud (OPS), en colaboracion con los Centros para el Control y la Prevencion de Enfermedades (CDC) de los Estados Unidos de America, establecio en 2000 sistemas para la vigilancia de lesiones en Colombia, El Salvador y Nicaragua. Estos sistemas, basados en los servicios hospitalarios de emergencia, formaron parte de un proyecto piloto fundamentado en las guias para la vigilancia de lesiones, desarrolladas por la Organizacion Mundial de la Salud (OMS) y los CDC. Los objetivos de este proyecto eran evaluar la utilidad de las guias de la OMS/CDC, crear mecanismos apropiados para la vigilancia de lesiones en los tres paises, promover intervenciones preventivas adecuadas e integrar la prevencion y el control de lesiones en proyectos nacionales de salud publica. En este articulo se describe el proyecto piloto de la OPS/CDC y se resaltan los principios mas importantes y las lecciones aprendidas durante sus seis anos de funcionamiento (2000-2006). Entre las principales recomendaciones se encuentran la integracion de la vigilancia de las lesiones en las unidades de epidemiologia e informacion existentes en los ministerios de salud, la recogida de los datos importantes exclusivamente, la garantia de monitoreos y evaluaciones adecuados y la adopcion de las practicas que han demostrado ser mas efectivas para el entrenamiento de personal y la diseminacion de informacion.

Path analysis of the chronicity of depression using the comprehensive developmental model framework.

Abstract Background Depressive disorder is recognized as recurrent or chronic in the majority of affected individuals; but literature is not consistent about determinants of the disorder course. Aims To analyse the relationships between familial, personal and environmental characteristics in different life phases and their effects on the chronicity of depression in a population-based sample. Methods It was a longitudinal panel study with three waves (W1–W3) for 651 adult men and women with diagnosis of minor/major depression or dysthymia at W1 of the Swedish PART (mental health, work and relations) study. Risk factors and co-morbidities were assessed with questionnaires. The main outcome was an episode of minor/major depression or dysthymia at 10–12 years of follow-up (W3). Liability for depressive episodes was determined using exploratory structural equation modelling (SEM), following a path approach with step-wise specification searches. Results Most of the risk factors determined, directly or indirectly, depression severity at W3. Somatic trait anxiety, partner loss and other negative life events at W1, depressive symptoms at W2, and life difficulties and other dependent life events at W3 had direct effects on the outcome. Conclusions SEM model revealed complex and intertwined psychopathological pathways leading to chronicity of depression, given previous episodes, which could be assembled in two main mechanisms: a depressive-internalizing path and an adversity path comprised of life events. Pathways are simpler than those of depression occurrence, emphasizing the relevance of personality factors as depression determinants, and excluding disability levels, co-morbidities and social support. These novel findings need to be replicated in future studies.

Influence of serotonin transporter promoter variation on the effects of separation from parent/partner on depression.

BACKGROUND Loss of parent during childhood or loss of partner has been associated with adulthood depression. The serotonin transporter polymorphism (5-HTTLPR) has been reported to moderate stress sensitivity reflected for example in the relationship between childhood maltreatment and depression. Therefore, the effect of 5-HTT promoter variation on the relationship between the loss of parent or partner and depression was examined. METHOD 411 depressive cases and 1347 control subjects from a large well-characterized longitudinal population-based sample of adult Swedes with data on life history and life situation, including psychiatric diagnostic instruments, were studied. Their DNA was genotyped for the mini-haplotype 5-HTTLPR-rs25531. RESULTS Individuals with low 5-HTT activity variants had an increased risk of depression given loss of partner last year compared to those with high activity variants. Conversely, 5-HTT activity variation appeared not to strongly influence the risk of depression given loss of parent during childhood. LIMITATION Small sample size for those with losses of both parent and partner. Limited power to detect small interaction effects. CONCLUSION The increased risk of depression given last year loss of partner appeared to be influenced by genetic variation regulating 5-HTT activity. This adds to previous findings of 5-HTT x stressful life events interactions on depression and is in agreement with stronger GxE effects when using objective environmental measures.

Driving under the influence of alcohol in Cali, Colombia: prevalence and consumption patterns, 2013

This studys goal was to establish the prevalence of driving under the influence of alcohol (DUI) and alcohol consumption patterns among drivers in Cali, Colombia, in 2013. A cross-sectional study based on a roadside survey using a stratified and multi-stage sampling design was developed. Thirty-two sites were chosen randomly for the selection of drivers who were then tested for blood alcohol concentration (BAC) and asked to participate in the survey. The prevalence of DUI was 0.88% (95% confidence intervals [95% CI] 0.26%–1.49%) with a lower prevalence when BAC was increasing. In addition, a higher prevalence was found during non-typical checkpoint hours (1.28, 95% CI −0.001%–0.03%). The overall prevalence is considered high, given the low alcohol consumption and vehicles per capita. Prevention measures are needed to reduce DUI during non-typical checkpoints and ongoing studies are required to monitor the trends and enable the assessment of interventions.

Sistema de indicadores comparables de convivencia y seguridad ciudadana: un consenso de países

The Region of the Americas, with a homicide rate of 16.4 per 100,000 population (2004), is the second most violent region in the world, but public policy-making for the prevention of violence and crime is hampered by the absence of reliable and comparable data on the problems various manifestations. This paper describes a 14-country initiative, sponsored by the Inter-American Development Bank in partnership with other regional agencies, to develop-collectively and by consensus- indicators for peaceful coexistence and citizen security that permit comparisons among countries, systematization of methods for the production and collection of pertinent data, the development of regional policies, and the dissemination and sharing of good practices. The selected indicators were homicide, death from road traffic injuries, suicide, death by firearm, sexual crime, family violence, child abuse, robbery, theft, vehicle theft and robbery, abduction, traffic offenses committed while under the influence of alcohol, general victimization, victimization by theft, victimization by robbery, perception of insecurity, perception of fear, confidence in institutions, and justification of the use of violence. For each indicator, agreement was reached on the type of measurement and the minimum variables that should be taken into account to have appropriate criteria for comparison.

Genetic cluster of fragile X syndrome in a Colombian district

Background:Fragile X syndrome (FXS) is the most common cause of inherited intellectual disabilities and autism. The reported prevalence of the full mutation (FM) gene FMR1 in the general population is 0.2–0.4 per 1000 males and 0.125–0.4 per 1000 females.Population screening for FMR1 expanded alleles has been performed in newborns and in an adult population. However, it has never been carried out in an entire town.Ricaurte is a Colombian district with 1186 habitants, with a high prevalence of FXS, which was first described by cytogenetic techniques in 1999.Methods:Using a PCR-based approach, screening for FXS was performed on blood spot samples obtained from 926 (502 males and 424 females) inhabitants from Ricaurte, accounting for 78% of total population.Results:A high prevalence of carriers of the expanded allele was observed in all FXS mutation categories. Using the Bayesian methods the carrier frequency of FM was 48.2 (95% Credibility Region CR: 36.3–61.5) per 1000 males and 20.5 (95% CR:13.5–28.6) per 1000 females; the frequency of premutation carrier was 14.1 (95% RC: 8.0–21.7) per 1000 males (95% RC: 8.0–21.7 per 1000 males) and 35.9 (95% RC: 26.5–46.2) per 1000 for females (95% RC: 26.5–46.2 per 1000 females), and gray zone carrier was 13.4 (95% RC: 7.4–20.7) per 1000 males (95% RC: 7.4–20.7 per 1000 males) and 42.2 (95% RC: 32.2–53.8) per 1000 for females (95% RC: 32.2–53.8 per 1000 females). Differences in carrier frequencies were observed for premutation and FM alleles between natives and non-natives.Conclusions:This study shows that in Ricaurte the carrier frequencies of FMR1 expanded alleles (premutations and FMs) are higher than those reported in the literature, suggesting that Ricaurte constitutes a genetic cluster of FXS.

Prevalence of traffic rule infractions in Cali, Colombia, at sites where injury crashes occurred.

This study aim to determine the proportion of traffic rule infractions in Cali, Colombia, in places where a road traffic injury (RTI) occurred. Description of videotaping of sites where a person was injured in an RTI in 2009. Counts of road users and infractions were established for each road user group and were compared using a Z-test. They were found 13,491 users, distributed as follow: 8.9% were pedestrians, 4.6% cyclists, 24.6% motorcyclists, and 61.8% were automobile drivers. The most frequent traffic violation among motorcyclists was transiting on lines designated for other vehicles (55.2%). Among cyclists, the most frequent violations were transiting without a helmet (99.2%) and not wearing the designated vest (100%). Among pedestrians, crossing streets at prohibited places (77.3%), even at sites where a pedestrian bridge was present (72.7%), represented two common violations. Vulnerable road users committed more traffic infractions than automobile drivers (p < 0.001). High rates of traffic rule infractions among vulnerable road users were observed. Studies to better understand the occurrence of these behaviours and the promotion of effective interventions are warranted.

Inequidades en el diagnóstico de anomalías congénitas mayores en recién nacidos en Cali, Colombia

SUMMARY Background: Major Congenital Anomalies (MCA) are present in 2-3% of live births. Most of these are diagnosable by prenatal ultrasound (PNUS). Developing countries have inequities in access to this screening test. Objectives: To determine existing inequities access to PNUS in mothers of newborns (NB) with MCA hospitalized in two neonatal intensive care units (NICU) and to identify inequities in the diagnosis of MCA among mothers to whom it was made at least one PNUS. Methods: Cross-sectional study in NB with MCA diagnosable by PNUS hospitalized in two NICUs of Cali, Colombia, between 2005 and 2009. The index of agreement (kappa) between prenatal diagnosis and definitive MCA was calculated. It was

Psychosocial experiences among female and male primary care patients with and without pain

Abstract Objective: The study examined the psychosocial characteristics and experiences of female and male primary care patients with and without pain with particular interest in gender differences and whether females were more vulnerable to pain than males. Patients and methods: A total of 1122 primary care patients from 20 randomly selected primary care centres in Stockholm were assessed cross-sectionally on various variables during 15 consecutive days. The data were examined with chi-square tests, ANOVAs, Dunn–Bonferroni tests and multivariate logistic/linear regression analyses. Results: Pain patients compared to pain-free patients reported more depression, burn-out, job demands, less job control, more job strain, and financial problems, with no gender differences in general. These constructs were associated with pain in the regressions and some of them were inter-related. Factors such as sick-leave were also important. Female pain patients had a more severe clinical profile (e.g. pain intensity) than...

Tremor-Ataxia Syndrome and Primary Ovarian Insufficiency in an FMR1 Premutation Carrier

Abstract Introduction: The FMR1 gene has four allelic variants according to the number of repeats of the CGG triplet. Premutation carriers with between 55 and 200 repeats are susceptible to developing pathologies such as tremor and ataxia syndrome (FXTAS) and fragile X-associated primary ovarian insufficiency (FXPOI) syndrome. Case description: The patient was a 53-year-old female farmer with severe tremor in the upper limbs at rest that worsens with movement, tremor in the jaw and tongue, and generalized cerebral atrophy. She is a carrier of the FMR1 premutation diagnosed by PCR and Southern Blot, complying with the clinical and radiological criteria of FXTAS, and in addition, has a history of vagal symptoms suggestive of ovarian failure and menstrual cycle disorders that led to hysterectomy at age 33 and was subsequently diagnosed with FXPOI. Conclusion: An unusual case of FXTAS and FXPOI complying with clinical and radiological criteria is reported in a premutation carrier of the FMR1 gene.