Luz Helena Lugo

Validación del cuestionario KIDSCREEN-27 de calidad de vida relacionada con la salud en niños y adolescentes de Medellín, Colombia

Resumen Objetivo Validar el cuestionario de calidad de vida (CV) KIDSCREEN-27 en el area metropolitana de Medellin (Colombia). Materiales y metodos Estudio de validacion de una escala de CV para ninos y adolescentes entre 8 y 18 anos, sanos y con enfermedades agudas o cronicas. Se evaluo la validez de constructo y de contenido, la consistencia interna, la fiabilidad interobservador e intraobservador y la sensibilidad al cambio. Se encuestaron 161 ninos y adolescentes sanos de 3 instituciones educativas y 160 ninos y adolescentes enfermos, 81 con enfermedades de menos de 3 meses de evolucion y 79 de mas de 3 meses de evolucion, hospitalizados o ambulatorios, de 3 instituciones de salud, 2 privadas y 1 publica. Resultados La CV en todas las dimensiones fue menor en los ninos y adolescentes enfermos y aun peor en los hospitalizados y en los ninos que en las ninas; en los adolescentes fue similar en ambos generos. Para la validez de constructo las medias de cada uno de los grupos fueron diferentes en todas las dimensiones. En el analisis factorial exploratorio se encontraron 6 categorias, validadas en el analisis factorial confirmatorio. La consistencia interna fue mayor a 0,7 en todas las dimensiones. En todos los dominios el coeficiente de correlacion intraclase fue superior a 0,87 en la fiabilidad interobservador y mayor a 0,8 en la fiabilidad intraobservador. Conclusion El KIDSCREEN-27 se puede usar en poblacion de ninos y adolescentes del area metropolitana de Medellin ya que mostro adecuadas propiedades psicometricas de fiabilidad y validez.

Out-patient rehabilitation programme for spinal cord injured patients: Evaluation of the results on motor FIM score

Purpose. The aim of this study was to evaluate an out-patient attention programme based on a short in-patient phase followed by an out-patient interdisciplinary rehabilitation programme. Methods. A prospective quasi-experimental before-and-after study was carried out; a phase 2 trial. The study population consisted of 42 patients who met the inclusion criteria. The Functional Independence Measurement (FIM) was the main outcome, and the American Spinal Injury Association (ASIA) motor scores and morbidity the secondary ones. The intervention was a two-phase goal-based interdisciplinary programme which consisted of a hospital and an ambulatory phase. After an evaluation upon admission to hospital, follow-up was carried out 1, 3, 6, 12 and 18 months later. Results. Initially, 208 patients were evaluated and only 42 completed the study. The in-patient phase was short (average: 13.5 days) and the out-patient phase lasted 18 months. Motor FIM scores progressively increased from 25/91 up to 69/91 (p < 0.01). Some 25% of the patients had pressure sores at 1 month, and 11.9% still had them after 18 months. Pain was the most frequent complication, in 80% of patients by the third month. Urinary and fecal continence improved during follow-up (74% at 18 months and 81.1% at 12 months, respectively). Conclusions. Good functional evolution of SCI patients and low morbidity can be obtained with a low-cost out-patient rehabilitation programme. Such a programme must emphasize patient and family education concerning self-care and possible SCI complications.

Efficacy of early treatment with carbamazepine in prevention of neuropathic pain in patients with spinal cord injury.

Objective The aim of this study was to evaluate whether early treatment with carbamazepine decreases the incidence of neuropathic pain (NP) or its intensity in patients with spinal cord injury. Design This study was a randomized, double-blind, placebo-controlled clinical trial at a third-level university hospital involving patients older than 18 yrs with a diagnosis of spinal cord injury sustained within 2 wks before enrollment and without evidence of NP. The patients received either carbamazepine up to 600 mg/day or placebo for 1 mo. Pain intensity was measured with a 10-cm visual analog scale and the SF-36 bodily pain subscale; quality-of-life, with the Short Form 36 (SF-36) Scale; and depression, with the Zung Self-Rating Depression Scale. Measurements were carried out at the start of the randomized trial and at the 1-, 3-, and 6-month follow-up assessments. Results Twenty-one of 46 patients developed NP. At the 1-, 3-, and 6-month follow-up assessments, NP was present in 4, 11, and 10 patients of the carbamazepine group and in 8, 9, and 8 patients of the placebo group, respectively. At 1 mo, two patients in the carbamazepine group vs. eight patients in the placebo group reported moderate/intense pain (visual analog scale, ≥4.0; P = 0.024). At the 3- and 6-month follow-up appointments, moderate/intense pain was reported by eight vs. six (P = 0.498) and six vs. eight patients (P = 0.298), carbamazepine and placebo group, respectively. There was no difference in the depression ratings or in any of the SF-36 scales. Conclusions Early intervention with carbamazepine decreased NP incidence at the 1-month but not at the 3- and 6-month follow-ups in the group of patients with acquired spinal cord injury.

Validez y confiabilidad de la Escala de Tinetti para población colombiana

Resumen Introduccion Las caidas, son el cuarto sindrome geriatrico con mayor prevalencia, incrementan la morbilidad y la mortalidad, disminuyen la funcionalidad, y aumentan prematuramente el ingreso a los hogares geriatricos. Las alteraciones de la marcha y el equilibrio son los principales factores que las generan, con un rango de valores ajustados de riesgo relativo entre 1.2–2.2 y 1.2–2.4, respectivamente. La escala de Tinetti de marcha y equilibrio ha demostrado ser una herramienta valida y confiable para la evaluacion de la movilidad (r 0.74–0.93), ademas, tiene una alta fiabilidad inter-observador (0.95). Objetivo Validar la Escala de Tinetti, a partir de su version original, para el uso en poblacion colombiana. Materiales y metodos La escala de Tinetti en su version en espanol fue aplicada por dos evaluadores a 90 adultos mayores, residentes de tres instituciones geriatricas de la ciudad de Medellin y dos municipios del Valle de Aburra con diferentes grados de funcionalidad en la marcha y en el equilibrio. Posteriormente, se realizo la validacion de contenido, constructo y criterio, asi como fiabilidad inter e intraobservador. Resultados La validez de contenido, sugiere la reestructuracion de los items del dominio del equilibrio con un alfa de Cronbach de 0.95 y una varianza de 13.89; en la validez de constructo, en 46 de las 48 respuestas de la escala se encontraron diferencias estadisticamente significativas en la capacidad de detectar cambios en un grupo sin alteraciones en la marcha y el equilibrio (sanos) comparado con el grupo con alteraciones (enfermos); la validez de criterio concurrente logro una alta correlacion r:-0.82 con el test “Timed up and go”. La fiabilidad inter e intraobservador obtuvo un Kappa ponderado de 0.4 a 0.6 y 0.6 a 0.8, respectivamente; el alpha de Cronbach fue de 0.91. Conclusiones La escala de Tinetti es valida y confiable para utilizarla en adultos mayores en Colombia.

Validez y confiabilidad del 'Cuestionario de calidad de vida KIDSCREEN-27' versión padres, en Medellín, Colombia

OBJECTIVE Validate the KIDSCREEN-27 for parents in the metropolitan area of Medellín, Colombia, including the Social Acceptance (SA) subscale of KIDSCREEN-52, as it evaluates the effect of bullying in Life Quality of children. METHODS The study population was made up by parents of children between 8 and 18, from Medellín and its metropolitan area. A sample of 1,150 parents was estimated according to the different psychometric properties to be measured. Construct validation was made by comparing the mean scores between groups of high and low socioeconomic conditions. The content validity and the measurement of reliability were verified by internal consistency and test-retest stability. The parent-child agreement was also measured. RESULTS The internal consistency was adequate (Cronbach alpha 0,76-0,83). Parents of children with better socio-economic status had higher scores in all dimensions (p<0,05). Scores were higher among healthy children. Women had lower scores than men, while children registered higher scores than adolescents. The intraclass correlation coefficient for the reliability assessment was above 0.7 in all dimensions, except in School Environment-SE- (ICC 0,6-0,92). The parent-child agreement reached moderate and good levels (ICC 0,49-0,69). The exploratory factorial analysis, including social acceptance subscale, registered eight dimensions, four of which in agreement with the original questionnaire: Physical activity, SE, Social Support, and SA subscale. CONCLUSIONS KIDSCREEN-27 for parents is a valid and reliable instrument to be used in the Colombian context.Objective Validate the KIDSCREEN-27 for parents in the metropolitan area of Medellin, Colombia, including the Social Acceptance (SA) subscale of KIDSCREEN-52, as it evaluates the effect of bullying in Life Quality of children.

Estudio descriptivo del programa de rehabilitación cardiaca de la Clínica Las Américas

Estudio descriptivo de antes y despues que demuestra la eficacia y seguridad del Programa de Rehabilitacion Cardiaca de la Clinica Las Americas, con base en un seguimiento a 77 pacientes, en el que se evidencio mejoria de la capacidad funcional asi como disminucion del perimetro abdominal y de las cifras basales de presion arterial sistolica y diastolica sin complicaciones severas, en todos los tipos de paciente, independientemente de la fraccion de eyeccion o las variables demograficas. De igual forma, se describen las caracteristicas epidemiologicas de la poblacion y de los factores de riesgo cardio-cerebro-vascular.

Cost-Effectiveness Analysis of the Use of a Prophylactic Antibiotic for Patients Undergoing Lower Limb Amputation due to Diabetes or Vascular Illness in Colombia

BACKGROUND The use of a prophylactic antibiotic in an amputation surgery is a key element for the successful recovery of the patient. We aim to determine, from the perspective of the Colombian health system, the cost-effectiveness of administering a prophylactic antibiotic among patients undergoing lower limb amputation due to diabetes or vascular illness in Colombia. METHODS A decision tree was constructed to compare the use and nonuse of a prophylactic antibiotic. The probabilities of transition were obtained from studies identified from a systematic review of the clinical literature. The chosen health outcome was reduction in mortality due to prevention of infection. The costs were measured by expert consensus using the standard case methodology, and the resource valuation was carried out using national-level pricing manuals. Deterministic sensitivity, scenarios, and probabilistic analyses were conducted. RESULTS In the base case, the use of a prophylactic antibiotic compared with nonuse was a dominant strategy. This result was consistent when considering different types of medications and when modifying most of the variables in the model. The use of a prophylactic antibiotic ceases to be dominant when the probability of infection is greater than 48%. CONCLUSIONS The administration of a prophylactic antibiotic was a dominant strategy, which is a conclusion that holds in most cases examined; therefore, it is unlikely that the uncertainty around the estimation of costs and benefits change the results. We recommend creating policies oriented toward promoting the use of a prophylactic antibiotic during amputation surgery in Colombia.

Cost-Effectiveness Analysis of Diagnosis of Duchenne/Becker Muscular Dystrophy in Colombia

OBJECTIVES To determine the cost-effectiveness ratio of different courses of action for the diagnosis of Duchenne or Becker muscular dystrophy in Colombia. METHODS The cost-effectiveness analysis was performed from the Colombian health system perspective. Decision trees were constructed, and different courses of action were compared considering the following tests: immunohistochemistry (IHC), Western blot (WB), multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification (MLPA), and the complete sequencing of the dystrophin gene. The time horizon matched the duration of sample extraction and analysis. Transition probabilities were obtained from a systematic review. Costs were constructed with a type-case methodology using the consensus of experts and the valuation of resources from consulting laboratories and the 2001 Social Security Institute cost manual. Deterministic sensitivity and scenario analyses were performed with one or more unavailable alternatives. Costs were converted from Colombian pesos to US dollars using the 2014 exchange rate. RESULTS In the base case, WB was the dominant strategy, with a cost of US

P233 How Confident Are You In The Results Given Only One Rct? Ticagrelor Vs Clopidogrel: Case Report By Clinical Guideline On Acute Coronary Syndrome In Colombia

419.07 and a sensitivity of 100%. This approach remains the dominant strategy down to a 98.2% sensitivity and while costs do not exceed US

Effects of an Exercise Program on the Rehabilitation of Patients With Spinal Cord Injury

837.38. If WB was not available, IHC had the best cost-effectiveness ratio, followed by MLPA and sequencing. CONCLUSIONS WB is a cost-effective alternative for the diagnosis of patients suspected of having Duchenne or Becker muscular dystrophy in the Colombian health system. The IHC test is rated as the second-best detection method. If these tests are not available, MLPA followed by sequencing would be the most cost-effective alternative.