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Resumen El Síndrome de apnea - hipopnea obstructiva del sueño es una enfermedad con compromiso multisistémico, con especial repercusión en el sistema cardiovascular y por tanto con alto impacto en la morbimortalidad general. Se han demostrado múltiples mecanismos fisiopatológicos que explican y sugieren una asociación directa y proporcional al daño generado por esta entidad, en especial para las taquiarritmias, específicamente para fibrilación auricular y también para las bradiarrimias, con mejoría demostrada tras el tratamiento con presión positiva continua de la vía aérea. La asociación con aleteo auricular y arritmias ventriculares ha mostrado resultados contradictorios en algunos estudios, por lo que aún no es tan clara.

Abstract Obstructive sleep apnoea / hypopnoea syndrome is a disease of multisystemic involvement, with particular repercussions on the cardiovascular system, and thus a high impact on morbidity and mortality. Several pathophysiological mechanisms have been demonstrated that explain and suggest a direct and proportional relationship to the damaged caused by the condition, especially for tachyarrhythmias, specifically for atrial fibrillation, and also for bradyarrhythmias, with a demonstrated improvement with continuous positive airway pressure. As the association with atrial flutter and ventricular arrhythmias has shown contradictory results in some studies, the relationship is still not clear.

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ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad¼ y «grupos de encuentro entre residentes¼ fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

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To summarize evidence concerning the articular examination needed to determine rheumatoid arthritis (RA) activity (follow-up or control) via a systematic review. A search of Medline, Embase, Lilacs, SciELO, the Web of Science, the National Technical Reports Library, and the reference lists of relevant studies through March 2017 was conducted using a systematic methodology to identify studies of patients with RA older than 18 years in which a detailed description of the physical examination or a description of the components of the articular examination was provided. Of 8322 references, 74 studies were included according to the selection criteria, and 6 references were ultimately included at the end of the review. Most of the included studies (n = 5) were associated with a moderate risk of bias. There was great variability among the studies and the articular examination methods used. Some studies presented the examination with a complete specification of the technique (n = 2), the consensus of rheumatologists (n = 2), or training through audiovisual materials and face-to-face courses (n = 2), but none of the studies explicitly showed the technique by which the physical examination was performed. Despite the importance of the clinical evaluation and physical examination of patients with RA for diagnosis, prognosis, clinimetrics, and follow-up, evidence concerning how to perform the articular examination is scarce.

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BACKGROUND: In Latin America, substance related disorders are highly prevalent and one of the treatment strategies is the Therapeutic Communities (TCs), however, in Latin America there is scarce data about this treatment strategies, their quality, drop-out rates and patient satisfaction. METHODS: Based on a previous study in 5 Latin American countries, the TCs who had a score equal or higher than 9 according to the De Leon criteria which are some fundamental items that the TCs should meet, were selected to carry out a descriptive and retrospective study of qualitative and quantitative characteristics of the TCs. RESULTS: Data from 58 TCs in 5 countries were included, with a sample of 1414 patients interviewed, of which most were single men, with no hospitalization history in a therapeutic community. Marijuana was the most commonly substance used in the 30 days prior to hospitalization, with 78% of interviewees referring alcohol consumption in the last 6 months and an average onset of psychoactive substances at 16 years of age. A 79% of the patients interviewed perceived some improvement during their stay in the TCs. The less fulfilled Quality Indicators by the TCs were "Requesting a professional qualification to former addicts that belonged to the program" and "Work as part of the therapeutic program". Among the reasons for discharge found in the database, 44% were due to therapeutic discharge with fulfillment of the treatment plan and 44% withdraws. CONCLUSION: The user satisfaction with TCs, in terms of infrastructure and quality are quite high, as the fulfillment of essential quality items, however, the follow up information to evaluate effectiveness of the treatment is poor or in some cases unknown.

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Introducción: el sistema nervioso central es uno de los órganos afectados, de manera directa e indirecta, por el VIH; adicionalmente, los trastornos psiquiátricos son más frecuentes en esta población. Objetivo: comprender la patogénesis, las manifestaciones clínicas y el manejo de las enfermedades neuropsiquiátricas en la población con VIH. Métodos: se realizó una búsqueda en las bases de datos Medline, Embase, SciELO, LILACS y Psychlnfo utilizando término libres y MeSH. Resultados: los trastornos neuropsiquiátricos generan un impacto negativo en el tratamiento y seguimiento de los pacientes con VIH, lo cual disminuye su adherencia al tratamiento y aumenta las dificultades en su manejo integral. Llamativamente, existe una falta de estudios latinoamericanos en esta área.

Introduction: HIV is the infectious disease with the biggest worldwide impact in the last decades. For this reason, the control of this disease was induded in the millennium objectives of the UN. There has been a long time interest for studying the psychiatric comorbidities in these patients due to its impact in survival. Níethods: A research in the data bases Medline, Embase, SciELO, LILACS, and Psychlnfo was made using free terms and MeSH terms. Results: The neuropsychiatric disorders have a negative impact in the treatment and control of HIV positive patients, reducing their adherence and increasing the difficulties in the comprehensive treatment. There is a déficit in studies that could clear up this relationship in Colombian population.

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INTRODUCTION: Poverty has been associated in some studies with poorer outcomes in mental problems and disorders. A circular relationship has been considered in which poverty fosters the appearance of mental illness and this facilitates greater poverty. There are no studies in Colombia on this subject. OBJECTIVE: To describe the association between mental problems and disorders and poverty according to the Multidimensional Poverty Index (MPI) in Colombia. MATERIAL AND METHODS: Using the 2015 National Mental Health Survey, adjusted with the expansion factors for the population. The prevalences of mental problems and disorders obtained through semi-structured interviews employing the instruments SRQ-20, AUDIT C and A, modified PCL, familiar APGAR and CIDI CAPI. The poverty status was determined by the MPI. RESULTS: A total of 13,200 households were interviewed, of which 13.5% were classified as in a poverty condition, 6.3% of the adolescents of poor households reported a life-time prevalence of any mental disorder, and 4.6% in the last 12 months. On the other hand, the prevalences for the same age group not in a poverty condition were 7.2% and 3.3%, respectively. For adults in poverty, the prevalence of life-time mental disorders were 9.2%, with 4.3% in the last year, while those not considered poor showed prevalences of 9.1% and 3.9% for the same time periods. CONCLUSIONS: For the population of Colombia, there is a relationship between not being able to access the basic basket of goods and the presence of mental diseases, although there does not seems to be an association between an increase in poverty and the deterioration of mental health.

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Resumen Introducción: La pobreza se ha relacionado en algunos estudios con peores desenlaces en problemas y trastornos mentales. Se lo considera un círculo en el cual la pobreza favorece la aparición de la enfermedad mental y esta a su vez conduce a mayor pobreza. En Colombia no existen estudios al respecto. Objetivo: Describir la asociación en Colombia entre problemas y trastornos mentales y la condición de pobreza según el Índice de Pobreza Multidimensional (IPM). Material y métodos: Empleando la muestra de la Encuesta Nacional de Salud Mental 2015, ponderada por los factores de expansión para la población, mediante entrevistas semiestructuradas se emplearon los instrumentos SRQ-20, AUDIT C y A, PCL-modificado, APGAR familiar y CIDI-CAPI, para establecer la prevalencia de problemas y trastornos mentales, clasificando entre pobres y no pobres según el IPM. Resultados: Se entrevistó en total a 13.200 hogares, el 13,5% de ellos en condición de pobreza; en estos, el 6,2% de la población adolescente reportó algún trastorno a lo largo de la vida y el 4,6% en los últimos 12 meses; en contraste, en el mismo grupo de edad, pero no en condición de pobreza, las tasas fueron del 7,2 y el 3,3% respectivamente. En adultos en pobreza, la prevalencia de trastornos a lo largo de la vida fue del 9,2 y el 4,3% en el último año; los no pobres mostraron prevalencias del 9,1 y el 3,9 respectivamente. Conclusiones: Existe una relación entre no acceder de manera suficiente a la canasta de bienes básica y la presencia de afecciones mentales en la población colombiana; no obstante, no parece que haya asociación entre la exacerbación de la pobreza y un mayor deterioro de la salud mental.

Abstract Introduction: Poverty has been associated in some studies with poorer outcomes in mental problems and disorders.Acircular relationship has been considered in which poverty fosters the appearance of mental illness and this facilitates greater poverty. There are no studies in Colombia on this subject. Objective: To describe the association between mental problems and disorders and poverty according to the Multidimensional Poverty Index (MPI) in Colombia. Material and methods: Using the 2015 National Mental Health Survey, adjusted with the expansion factors for the population. The prevalences of mental problems and disorders obtained through semi-structured interviews employing the instruments SRQ-20, AUDIT C and A, modified PCL, familiar APGAR and CIDI CAPI. The poverty status was determined by the MPI. Results: A total of 13,200 households were interviewed, of which 13.5% were classified as in a poverty condition, 6.3% of the adolescents of poor households reported a life-time prevalence of any mental disorder, and 4.6% in the last 12 months. On the other hand, the prevalences for the same age group not in a poverty condition were 7.2% and 3.3%, respectively. For adults in poverty, the prevalence of life-time mental disorders were 9.2%, with 4.3% in the last year, while those not considered poor showed prevalences of 9.1% and 3.9% for the same time periods. Conclusions: For the population of Colombia, there is a relationship between not being able to access the basic basket of goods and the presence of mental diseases, although there does not seems to be an association between an increase in poverty and the deterioration of mental health.

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Introducción: La pobreza se ha relacionado en algunos estudios con peores desenlaces en problemas y trastornos mentales. Se lo considera un círculo en el cual la pobreza favorece la aparición de la enfermedad mental y esta a su vez conduce a mayor pobreza. En Colombia no existen estudios al respecto. Objetivo: Describir la asociación en Colombia entre problemas y trastornos mentales y la condición de pobreza según el Índice de Pobreza Multidimensional (IPM). Material y métodos: Empleando la muestra de la Encuesta Nacional de Salud Mental 2015, ponderada por los factores de expansión para la población, mediante entrevistas semiestructuradas se emplearon los instrumentos SRQ-20, AUDIT C y A, PCL-modificado, APGAR familiar y CIDI-CAPI, para establecer la prevalencia de problemas y trastornos mentales, clasificando entre pobres y no pobres según el IPM. Resultados: Se entrevistó en total a 13.200 hogares, el 13,5% de ellos en condición de pobreza; en estos, el 6,2% de la población adolescente reportó algún trastorno a lo largo de la vida y el 4,6% en los últimos 12 meses; en contraste, en el mismo grupo de edad, pero no en condición de pobreza, las tasas fueron del 7,2 y el 3,3% respectivamente. En adultos en pobreza, la prevalencia de trastornos a lo largo de la vida fue del 9,2 y el 4,3% en el último año; los no pobres mostraron prevalencias del 9,1 y el 3,9 respectivamente. Conclusiones: Existe una relación entre no acceder de manera suficiente a la canasta de bienes básica y la presencia de afecciones mentales en la población colombiana; no obstante, no parece que haya asociación entre la exacerbación de la pobreza y un mayor deterioro de la salud mental.

Introduction: Poverty has been associated in some studies with poorer outcomes in mental problems and disorders.Acircular relationship has been considered in which poverty fosters the appearance of mental illness and this facilitates greater poverty. There are no studies in Colombia on this subject. Objective: To describe the association between mental problems and disorders and poverty according to the Multidimensional Poverty Index (MPI) in Colombia. Material and methods: Using the 2015 National Mental Health Survey, adjusted with the expansion factors for the population. The prevalences of mental problems and disorders obtained through semi-structured interviews employing the instruments SRQ-20, AUDIT C and A, modified PCL, familiar APGAR and CIDI CAPI. The poverty status was determined by the MPI. Results: A total of 13,200 households were interviewed, of which 13.5% were classified as in a poverty condition, 6.3% of the adolescents of poor households reported a life-time prevalence of any mental disorder, and 4.6% in the last 12 months. On the other hand, the prevalences for the same age group not in a poverty condition were 7.2% and 3.3%, respectively. For adults in poverty, the prevalence of life-time mental disorders were 9.2%, with 4.3% in the last year, while those not considered poor showed prevalences of 9.1% and 3.9% for the same time periods. Conclusions: For the population of Colombia, there is a relationship between not being able to access the basic basket of goods and the presence of mental diseases, although there does not seems to be an association between an increase in poverty and the deterioration of mental health.

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BACKGROUND: Parkinson disease (PD) is a chronic multifaceted neurodegenerative disorder of adult onset that affects quality of life and places a burden on patients, caregivers, and society. In early disease, dopaminergic therapy improves motor symptoms, but as the disease progresses, symptoms tend to increase in frequency and severity, even with best medical treatment (BMT). Deep brain stimulation (DBS) becomes an option for certain patients, but cost becomes an important issue. OBJECTIVE: We performed a systematic review of the literature of economic studies of the use of DBS in patients with PD, including costs studies or economic evaluations expressed as cost per improvement in quality life, decrease in dose of pharmacological treatments, and the decrease of caregiver burden. METHODS: We reviewed the following databases: Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, LILACS, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform ICTRP portal and ClinicalTrials.gov from 1980 to 2015. Costs have been converted or adjusted to 2016 US dollars (US$). RESULTS: Nine studies were identified. The average cost of DBS for a patient with PD in 5 years is US$186,244. The quality-adjusted life year was higher in DBS compared with BMT after at least 2 years of treatment, with an average incremental cost utility ratio of US$41,932 per additional quality-adjusted life year gained. Costs in the first year are higher with DBS because of direct costs related to the surgical procedure, the device, and the more frequent controls. Studies show better results with a longer time horizon (up to 5 years). CONCLUSION: DBS is a cost-effective intervention for patients with advanced PD, but it has a high initial cost compared with BMT. However, DBS reduces pharmacologic treatment costs and should also reduce direct, indirect, and social costs of PD on the long term.

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