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Heart failure is a common condition associated with significant mortality. Objective: to determine the prescription patterns of medications for the treatment of heart failure in a cohort of patients from Colombia. This was a retrospective study based on the clinical records of patients diagnosed with heart failure between 2019 and 2020. Sociodemographic, clinical, paraclinical, and pharmacological variables and the specialty of the treating physician were identified. Patients were classified according to functional class, stage, and left ventricular ejection fraction (LVEF). A total of 4742 patients were evaluated, with a mean age of 68.2 ± 13.8 years and a male predominance (61.3%). A total of 92.0% were classified as stage C and 54.8% as functional class I, the mean LVEF was 42.9 ± 14.8%, and 32.53% had reduced LVEF. 30.7% did not have LVEF data. The most common causes were ischemic heart disease (44.0%) and arterial hypertension (29.7%). A total of 5.2% had hospitalizations for heart failure in the last year, and 75.6% were attended by a general practitioner. These patients were treated with β-blockers (88.3%), renin-angiotensin-aldosterone system inhibitors (RAASis) (83.1%), loop diuretics (46.8%), and mineralocorticoid receptor antagonists (MRAs) (46.5%). Triple therapy with RAASis + β-blockers+MRAs was received by 56.4% of patients with reduced LVEF, 32.8% with mildly reduced LVEF and19.5% with preserved LVEF, while quadruple therapy adding a sodium-glucose cotransporter-2 inhibitor (SGLT2i) was given just to 4.6% with reduced LVEF. The treatment that patients with heart failure with preserved LVEF is relatively simpler and is closer to the recommendations, while the proportion of indicated therapies according to guidelines is lower among those with reduced LVEF.

Hemophilia A and B are disorders associated with the deficit of coagulation factors VIII and IX. Was to determine the incidence of complications in a cohort of patients diagnosed with moderate and severe hemophilia A or B under treatment in a specialized institution. A retrospective study of a cohort of patients with replacement therapy for hemophilia A or B, evaluating treatment and complications between January/2012 and July/2019. Sociodemographic, clinical and disease management-related variables were extracted from the medical records. Time to inhibitor development and rate associated with bleeding and hospitalizations were evaluated. A total of 159 male patients were identified with hemophilia A (n = 140; 88.1%) and B (n = 19; 11.9%) with a mean follow-up of 5.9±2.3 years. The mean age was 23.6±16.1 years, hemophilia was reported as severe in 125 patients in hemophilia A (89.3%) and 13 patients in hemophilia B (68.4%). Primary prophylaxis was registered in 17.0% of patients, 44.7% secondary, and 38.3% tertiary, with recombinant factors (n = 84; 52.8%) followed by plasma derived factors (n = 75; 47.2%). The incidence of inhibitor development was 0.3 per 100 patients/year, with mean time to event of 509 days. The incidence of bleeding was 192 per 100 patients/year, especially at the joint (n = 99; 62.3%) and muscle (n = 25; 15.7%) level. The incidence of hospitalization was 3.7 per 100 patients/year. The most common complication was joint bleeding which was expected in this type of patients. Low proportion of patients developed factor inhibitors during the follow up.

The objective of this article is to present the common knowldge of boys and girls about the working life of adults,visible in a primary school in Foz de Iguazú,Brazil,in the border with Paraguay. In the introduction, I circumscribe the context of ethnography from theoretical-methodological considerations. First,I present the paradoxical presentation of the border of the Brazilian State-nation in the school experience,second,the moral grammar of illegal work seen as legitimate, and,third, I present the knowledge of boys and girls of the school in relation to that work, explained by them through the scenes of a short film projected in the classrooms.

Resumo Nesta revisão objetivou-se investigar e sintetizar o que há na literatura científica sobre as relações entre as masculinidades e as pessoas moradoras de rua, com enfoque em relações sociais, trajetória e processo saúde-doença. Foi feita uma busca sistemática em dez bases de dados com os descritores: “Masculinities”, “Hegemonic Masculinities”, “Gender Identity” e “Homeless Persons”, “Homeless, Roofless” e “Houseless”. Obteve-se 2.459 resultados, com 25 referências finais após aplicação dos critérios de inclusão e exclusão, compostas em grande parte por estudos internacionais. Identificou-se seis temas-chave: Masculinidade enquanto prática performativa nas ruas, Masculinidades e relações de violência nas ruas, Masculinidades entre homens moradores de rua: percepções de liberdade e encarceramento, Paternidade dos homens moradores de rua, Estigmas e deságios no processo de busca pela masculinidade hegemônica nas ruas e Masculinidades como determinante social de saúde nas ruas. A revisão aborda as influências das masculinidades entre a População Moradora de Rua (PMR), destacando sua transversalidade nas vivências e atitudes do grupo, e explora a relação entre masculinidades e violência, os desafios na paternidade e os estigmas ligados à condição de vida nas ruas e impactos na saúde. Conclui-se que as normas sociais relacionadas ao masculino atuam como uma forma de se adaptar as vidas nas ruas, mas influenciam negativamente no processo saúde-doença da PMR, em especial dos homens. Abstract This study aimed to investigate and synthesize the scientific literature regarding the relationships between masculinities and individuals experiencing homelessness by focusing on social relationships, life trajectories, and the health-disease process. A systematic search was conducted in 10 databases using the following descriptors: “Masculinities,” “Hegemonic Masculinities,” “Gender Identity,” “Homeless Persons,” “Homeless, Roofless,” and “Houseless.” In total, 2459 results were retrieved. Overall, 25 studies remained after the application of inclusion and exclusion criteria, most of which were international studies. This study identified six key themes: 1) Masculinity as a performative practice on the streets, 2) Masculinities and relationships of violence on the streets, 3) Masculinities among men experiencing homelessness: perceptions of freedom and imprisonment, 4) Fatherhood among men experiencing homelessness, 5) Stigmas and challenges in the pursuit of hegemonic masculinity on the streets, and 6) Masculinities as a social determinant of health on the streets. This review addresses the influences of masculinities on individuals experiencing homelessness, emphasizing the cross-cutting nature of these ideals in the experiences and attitudes of this group. It explores the relationship between masculinities and violence, as well as addressing challenges in fatherhood. It highlights stigmas linked to the condition of being homeless that impact health and quality of life. It is concluded that social norms related to masculinity act negatively as social determinants of health for the homeless population, especially men.

Objetivo: el uso de anticonceptivos hormonales ha crecido progresivamente en muchos países del mundo. Se trazó el objetivo de determinar los patrones de utilización de anticonceptivos hormonales en mujeres mayores de 15 años afiliadas al Sistema de Salud de Colombia. Materiales y métodos: Estudio de corte, que incluyó datos de mujeres mayores de 15 años con prescripciones y dispensaciones de algún anticonceptivo hormonal durante al menos tres meses continuos (abril- a junio-2016). Se creó una base de datos con información sociodemográfica, farmacológica (tipo de anticonceptivos, dosis, comedicaciones y comorbilidades. Se realizaron análisis descriptivos y multivariados buscando identificar factores asociados con comedicaciones de riesgo. Resultados: Se identificaron 34309 mujeres que recibieron anticonceptivos hormonales, con edad media de 27,2±7,0 años (rango:13-60,8 años). Los anticonceptivos más utilizados fueron inyectables de aplicación mensual (63,0%), inyectables de aplicación trimestral (19,1%), de administración oral (12,1%), los implantes subdérmicos (7,4%) y finalmente los dispositivos intrauterinos hormonales con 0,4%. El 5,7% de las pacientes (n=1957), estaban recibiendo alguna comedicación, especialmente con antihipertensivos (2,9%) y antimigrañosos (1,9%). Ser mayor de 45 años (OR:2,3; IC95%:1,7-3,0), utilizar dispositivo intrauterino hormonal (OR:2,4; IC95%:1,4-4,1) y anticonceptivo inyectable trimestral (OR: 1,7; IC95%:1,3-2,3) se asociaron con mayor probabilidad de recibir comedicaciones. Conclusiones. Las mujeres colombianas que acceden a anticonceptivos hormonales a través del Sistema de Salud están empleando principalmente presentaciones inyectables, con muy baja frecuencia de las orales, y en general tienen pocas comorbilidades que requieran tratamiento farmacológico, pese a que algunas tienen condiciones cardiovasculares que pueden implicar un potencial riesgo de eventos trombóticos.

Heart failure is a common condition associated with significant mortality. Objective: to determine the prescription patterns of medications for the treatment of heart failure in a cohort of patients from Colombia. This was a retrospective study based on the clinical records of patients diagnosed with heart failure between 2019 and 2020. Sociodemographic, clinical, paraclinical, and pharmacological variables and the specialty of the treating physician were identified. Patients were classified according to functional class, stage, and left ventricular ejection fraction (LVEF). A total of 4742 patients were evaluated, with a mean age of 68.2 ± 13.8 years and a male predominance (61.3%). A total of 92.0% were classified as stage C and 54.8% as functional class I, the mean LVEF was 42.9 ± 14.8%, and 32.53% had reduced LVEF. 30.7% did not have LVEF data. The most common causes were ischemic heart disease (44.0%) and arterial hypertension (29.7%). A total of 5.2% had hospitalizations for heart failure in the last year, and 75.6% were attended by a general practitioner. These patients were treated with [beta]-blockers (88.3%), renin-angiotensin-aldosterone system inhibitors (RAASis) (83.1%), loop diuretics (46.8%), and mineralocorticoid receptor antagonists (MRAs) (46.5%). Triple therapy with RAASis + [beta]-blockers+MRAs was received by 56.4% of patients with reduced LVEF, 32.8% with mildly reduced LVEF and19.5% with preserved LVEF, while quadruple therapy adding a sodium-glucose cotransporter-2 inhibitor (SGLT2i) was given just to 4.6% with reduced LVEF. The treatment that patients with heart failure with preserved LVEF is relatively simpler and is closer to the recommendations, while the proportion of indicated therapies according to guidelines is lower among those with reduced LVEF.

In-hospital falls are multicausal in older hospitalized patients. Drugs with anticholinergic load and psychotropic effects can increase the risk of falling. This study aimed to determine the associations between fall risk-increasing drugs (FRIDs) and the anticholinergic risk score (ARS) with falls in hospitalized older hospitalized patients. This was a case‒control study of patients ≥65 years of age of either sex treated in four clinics in Colombia between 2018 and 2020. Each patient who suffered a fall during hospitalization was matched with four hospitalized patients who did not. Sociodemographic, clinical, and pharmacologic variables and the use of the ARS and FRIDs were evaluated. The risk associated with FRIDs was estimated using conditional logistic regression. There were 250 patients and 1,000 controls (ratio of 1:4), with a mean age of 77.4 ± 7.4 years and a predominance of men ( = 800, 64.0%). The majority of falls occurred during hospitalization ( = 192 patients, 76.8%). Polypharmacy, calcium channel blockers, antiepileptics, antipsychotics, sodium-glucose cotransporter type 2 inhibitors, and nonsteroidal anti-inflammatory drugs were associated with falls during hospitalization. With an ARS score of 3, the probability of falling during the hospital stay increased (aOR: 2.34; 95% CI: 1.64-3.32). There is an association between suffering a fall and the use of drugs with anticholinergic load or FRIDs in hospitalized adults more than 65 years of age in Colombia.

Introduction Pulmonary hypertension (PH) is a chronic disease characterized by a progressive rise in pulmonary artery blood pressure. The objective was to describe the treatment patterns among ambulatory patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) in a real‐world setting. Methods This is a longitudinal cohort follow‐up study characterizing the treatment patterns of patients diagnosed with PAH or CTEPH, with secondary data from a population‐based drug‐dispensing database between 2022 and 2023, which includes sociodemographic, diagnosis, prescribing specialty, and treatment (drugs, persistence of use, and concomitant medications). Results In total, 1045 patients with a diagnosis of PH were identified, with mean age of 62.9 ± 18.2 years, and 72.3% of females; of which 947 (90.6%) received monotherapy, and 98 (9.4%) received combination therapy at the beginning of follow‐up. The most frequently used drugs for the treatment of PH were calcium channel blockers (58.1%), followed by phosphodiesterase 5 inhibitors (41.1%), endothelin receptor antagonist (32.5%), and guanylate cyclase stimulants (9.7%). The schemes used most frequently were monotherapy with amlodipine (31.0%), sildenafil (19.2%), or nifedipine (10.0%), but the main combination were sildenafil with nifedipine (2.5%). The mean of persistence of use was 161 ± 123 days during 1 year of follow‐up. Conclusions This group of patients with PH from Colombia were treated predominantly with monotherapy of calcium channel blockers and phosphodiesterase 5 inhibitors. However, current clinical practice guidelines recommend the use of combined therapy. The average persistence of the use of drugs for treatment for less than 6 months may be associated with difficulties in follow‐up, adherence, effectiveness, tolerability, and access. This study describes the treatment patterns among ambulatory patients with pulmonary hypertension (PH) in Colombia, from a population‐based drug‐dispensing database between 2022 and 2023. It found that patients with PH from Colombia were treated predominantly with monotherapy of calcium channel blockers and phosphodiesterase 5 inhibitors, with an average persistence of less than 6 months.

Systemic lupus erythematosus is an autoimmune disease associated with serious complications and high costs. The aim was to describe the clinical characteristics and health care resource utilization of a Colombian systemic lupus erythematosus outpatient cohort. This was a retrospective descriptive study. Clinical records and claims data for systemic lupus erythematosus patients from ten specialized care centers in Colombia were reviewed for up to 12 months. Baseline clinical variables, Systemic Lupus Erythematosus Disease Activity Index, drug use, and direct costs were measured. Descriptive statistics were analyzed using SPSS. A total of 413 patients were included; 361 (87.4%) were female, and the mean age was 42 ± 14 years. The mean disease evolution was 8.9 ± 6.0 years; 174 patients (42.1%) had a systemic manifestation at baseline, mostly lupus nephritis (105; 25.4%). A total of 334 patients (80.9%) had at least one comorbidity, mainly antiphospholipid syndrome (90; 21.8%) and hypertension (76; 18.4%). The baseline Systemic Lupus Erythematosus Disease Activity Index score was 0 in 215 patients (52.0%), 1-5 in 154 (37.3%), 6-10 in 41 (9.9%) and 11+ in 3 (0.7%). All patients received pharmacological therapy, and the most common treatment was corticosteroids (293; 70.9%), followed by antimalarials (chloroquine 52.5%, hydroxychloroquine 31.0%), immunosuppressants (azathioprine 45.3%, methotrexate 21.5%, mycophenolate mofetil 20.1%, cyclosporine 8.0%, cyclophosphamide 6.8%, leflunomide 4.8%) and biologicals (10.9%). The mean annual costs were USD1954 per patient/year, USD1555 for antirheumatic drugs (USD10,487 for those with biologicals), USD86 for medical visits, USD235 for drug infusions and USD199 for laboratory tests. Systemic lupus erythematosus generates an important economic and morbidity burden for the Colombian health system. Systemic lupus erythematosus outpatient attention costs in the observation year were mainly determined by drug therapy (especially biologics), medical visits and laboratory tests. New studies addressing the rate of exacerbations, long-term follow-up or costs related to hospital care are recommended.

Background Type 2 diabetes mellitus is one of the most common causes of chronic kidney disease (CKD) worldwide and prevalence of 1.75 per 100 inhabitants in Colombia. The aim of this study was to describe the treatment patterns of a group of patients with type 2 diabetes mellitus and CKD in an outpatient setting from Colombia. Methods A cross-sectional study in adult patients with type 2 diabetes mellitus and CKD identified in the Audifarma S.A. administrative healthcare database between April 2019 and March 2020 was performed. Sociodemographic, clinical and pharmacological variables were considered and analyzed. Results A total of 14,722 patients with type 2 diabetes mellitus and CKD were identified, predominantly male (51%), with a mean age of 74.7 years. The most common treatment patterns of type 2 diabetes mellitus included the use of metformin monotherapy (20.5%), followed by the combination of metformin + dipeptidyl peptidase-4 inhibitor (13.4%). Regarding the use of drugs with nephroprotective properties, the most prescribed treatments were angiotensin receptor blockers (67.2%), angiotensin converting enzyme inhibitors (15.8%), sodium glucose cotransporter 2 inhibitors (SGLT2i) (17.0%) and glucagon-like peptide-1 analogs (GLP1a) (5.2%). Conclusion In Colombia, the majority of patients with type 2 diabetes mellitus and CKD identified in this study were treated with antidiabetic and protective medications to ensure adequate metabolic, cardiovascular, and renal control. The management of type 2 diabetes mellitus and CKD may be improved if the beneficial properties of new groups of antidiabetics (SGLT2i, GLP1a), as well as novel mineralocorticoid receptor antagonists, are considered.