Publications by authors named "Lena Barrera"

11 Publications

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Prevalence, awareness, treatment and control of high blood pressure in the elderly according to the ethnic group. Colombian survey.

Colomb Med (Cali) 2019 Jun 30;50(2):115-127. Epub 2019 Jun 30.

Universidad del Valle, Escuela de Salud Pública, Grupo epidemiología y salud poblacional (GESP), Cali, Colombia.

Introduction: High blood pressure (HBP) is the main cardiovascular risk factor, it is more prevalent in the older adult population, and the prevalence can vary between ethnic groups.

Objective: To estimate the prevalence of HBP, knowledge, treatment and control in population aged ≥60 years, resident in Colombia, according to their ethnic condition.

Methods: Population sample selected by multistage sampling. Ethnicity was defined based on skin color. HBP was defined as systolic blood pressure ≥140, and/or diastolic blood pressure ≥90 mm Hg, and/or the participants' self-report. Controlled HBP at a blood pressure value <140/90, knowledge and treatment were identified by self-report.

Results: 23,694 adults aged ≥ 60 years were included, of which 54.5%, 34.5% and 10.9% were respectively identified as having light, medium or dark skin color; 54.5% were women, and 78.1% resided in urban areas. The standardized prevalence of HBP, by age, was 57.7% (95% CI: 55.2 - 60.2); 51.4% (95% CI: 47.3-55. 5), in men; and 62.9% (60.9-64.9), in women. The standardized prevalence for light, medium and dark skin in men was 53.2% (95% CI: 48.7-57.7), 49.6% (44.5-54.7), and 49.4% (95% CI: 41.0-57.8) respectively; and in women was 62.5% (95% CI: 60.5-64 , 5), 61.7% (95% CI: 57.8-65.6), and 69.9% (95% CI: 63.6-76.2) respectively. 98% of the population received treatment, and 93.9% were aware of HBP diagnosis. 42.5% of men and 55.5% of women with HBP were under control. Only 21.8% performed regular physical activity.

Conclusion: Half of the adult population aged over 60 years suffers from HBP; the prevalence is higher in women particularly in dark-skinned women. It is necessary to develop policies to increase physical activity in the elderly.
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http://dx.doi.org/10.25100/cm.v50i2.4124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774579PMC
June 2019

High Blood Pressure prevention and control: from evidence to action.

Authors:
Lena Barrera

Colomb Med (Cali) 2018 Jun 30;49(2):137-138. Epub 2018 Jun 30.

Control and Prevention of Chronic Diseases research group. Departamento de Medicina Interna, Facultad de Salud, Universidad del Valle. Cali, Colombia.

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http://dx.doi.org/10.25100/cm.v49i2.3940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6084923PMC
June 2018

Comment on the 2017 ACC/AHA interventions for high blood pressure with particular reference to middle- and low-income countries.

Authors:
Lena Barrera

Eur J Prev Cardiol 2018 06 4;25(9):902-905. Epub 2018 May 4.

Department of Internal Medicine, School of Public Health, Faculty of Health, Universidad del Valle, Colombia.

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http://dx.doi.org/10.1177/2047487318775168DOI Listing
June 2018

Epidemiology of sepsis in Colombian intensive care units.

Biomedica 2014 Jan-Mar;34(1):40-7

Departamento de Cuidado Intensivo, Universidad de Antioquia.

Introduction: Currently, there is not enough data available concerning sepsis in developing countries, especially in Latin America.

Objective: We developed a study aimed at determining the frequency, clinical and epidemiological characteristics, and the consequences of sepsis in patients requiring admission to intensive care units in Colombia.

Materials And Methods: This was a secondary analysis of a prospective cohort study carried out over a six-month period, from September 1, 2007, to February 28, 2008, in ten medical/surgical intensive care units in four Colombian cities. Patients were considered eligible if they had a probable or confirmed diagnosis of infection according to medical records. We recorded demographic characteristics, first admission diagnosis and co-morbidities, clinical status, and sepsis, severe sepsis or septic shock.

Results: During the study period, 826 patients were admitted to the intensive care units. From these patients, 421 (51%) developed sepsis in the community, 361 (44%) in the ICU, and 44 (5%) during hospitalization in the general ward. Two hundred and fifty three patients (30.6%) had involvement of one organ system: 20% had respiratory involvement, followed by kidney and central nervous system involvement with 3.4% and 2.7%, respectively.

Conclusions: In our cohort of septic patients, the prevalence of sepsis treated in ICU is similar to that reported in other studies, as well as the overall mortality.
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http://dx.doi.org/10.1590/S0120-41572014000100007DOI Listing
March 2015

Impact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: a longitudinal study.

BMC Health Serv Res 2014 Feb 25;14:87. Epub 2014 Feb 25.

Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.

Background: In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription.

Methods: A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period.

Results: From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12-0.21) and older non-black patients (OR 0.49, 95% CI 0.37-0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19-1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17-1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46-0.74).

Conclusion: The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.
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http://dx.doi.org/10.1186/1472-6963-14-87DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3943578PMC
February 2014

Clinical course of sepsis, severe sepsis, and septic shock in a cohort of infected patients from ten Colombian hospitals.

BMC Infect Dis 2013 Jul 24;13:345. Epub 2013 Jul 24.

Universidad de Antioquia, Medellín, Colombia.

Background: Sepsis has several clinical stages, and mortality rates are different for each stage. Our goal was to establish the evolution and the determinants of the progression of clinical stages, from infection to septic shock, over the first week, as well as their relationship to 7-day and 28-day mortality.

Methods: This is a secondary analysis of a multicenter cohort of inpatients hospitalized in general wards or intensive care units (ICUs). The general estimating equations (GEE) model was used to estimate the risk of progression and the determinants of stages of infection over the first week. Cox regression with time-dependent covariates and fixed covariates was used to determine the factors related with 7-day and 28-day mortality, respectively.

Results: In 2681 patients we show that progression to severe sepsis and septic shock increases with intraabdominal and respiratory sources of infection [OR = 1,32; 95%IC = 1,20-1,46 and OR = 1.21, 95%CI = 1,11-1,33 respectively], as well as according to Acute Physiology and Chronic Health Evaluation II (APACHE II) [OR = 1,03; 95%CI = 1,02-1,03] and Sequential Organ Failure Assessment (SOFA) [OR = 1,16; 95%CI = 1,14-1,17] scores. The variables related with first-week mortality were progression to severe sepsis [HR = 2,13; 95%CI = 1,13-4,03] and septic shock [HR = 3,00; 95%CI = 1,50-5.98], respiratory source of infection [HR = 1,76; 95%IC = 1,12-2,77], APACHE II [HR = 1,07; 95% CI = 1,04-1,10] and SOFA [HR = 1,09; 95%IC = 1,04-1,15] scores.

Conclusions: Intraabdominal and respiratory sources of infection, independently of SOFA and APACHE II scores, increase the risk of clinical progression to more severe stages of sepsis; and these factors, together with progression of the infection itself, are the main determinants of 7-day and 28-day mortality.
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http://dx.doi.org/10.1186/1471-2334-13-345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727953PMC
July 2013

Differences in the classification of hypertensive controlled patient in primary care: Cross sectional study.

JRSM Short Rep 2012 Oct 18;3(10):72. Epub 2012 Oct 18.

Department of Primary Care & Public Health, School of Public Health, Imperial College , Charing Cross Campus, London W6 8RP , UK ; Department of Internal Medicine Universidad del Valle , Calle 5 No. 36-08 Puiso 2, Cali , Colombia.

Objectives: To examine differences in blood pressure control using the 2006 National Institute for Health and Clinical Excellence (NICE) guidelines and the 2007 Quality and Outcome Framework (QOF) standards.

Design: Cross-sectional study.

Setting: 28 general practices located in Wandsworth, London.

Participants: Hypertensive patients aged 17 years and over.

Main Outcomes Measures: Percentage of hypertensive patients classified as a hypertensive controlled patient (HCP) by each standard.

Results: 79.5% of patients were classified as a HCP by the QOF target and 60.7% by the NICE target. 93% and 14% of practices had more than 70% of patients classified as a HPC by using the QOF and NICE targets respectively. By applying the QOF target, men aged 45-64 years and 65 years and over had significantly higher probability of being classified as a HCP compared to those aged 17-44 years, OR 1.34 (1.08-.165) and OR 2.15 (1.61-2.87) respectively. Regardless of the target, for men the probability of being classified as a HCP increased with age.

Conclusion: Better achievement of blood pressure control targets is present when the less stringent QOF target is used. Men aged 65 years and over were more likely to be classified as a HCP. Greater consistency is needed between the clinical targets in QOF and NICE guidance.
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http://dx.doi.org/10.1258/shorts.2012.012008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3499957PMC
October 2012

[Serum lactate in the emergency department as a prognostic factor in patients with sepsis without hypotension].

Med Clin (Barc) 2013 Sep 30;141(6):246-51. Epub 2012 Jul 30.

Departamento de Medicina Interna, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

Background And Objective: The relationship between lactate and mortality in patients without hypotension has not been appropriately explored. Our aim was to determine the usefulness of serum lactate as a prognostic factor of 28-day mortality in patients admitted to the Emergency Department with clinical diagnosis of sepsis without septic shock.

Patients And Methods: We performed a secondary analysis of the study The epidemiology of sepsis in Colombia, a prospective cohort of patients from 10 general hospitals in 4 Colombian cities. We analyzed patients without hypotension with serum lactate available and admitted with community-acquired infections, which were confirmed according to the Centers for Disease Control and Prevention CDC criteria. A logistical regression was performed adjusting for age, sex, comorbidities and severity scores.

Results: We included 961 patients aged 57.2 ± 21.0 years, 54.2% were females, mean SOFA score was 3.0 ± 2.3 and APACHE score was 11.1±6.4. We observed a linear relationship between serum lactate and the odds of death, and after adjustment there was a significant and independent association between lactate and mortality (odds ratio 1,16, 95% confidence interval 1.02-1.33).

Conclusion: Serum lactate is independently and significantly associated with 28-day mortality among patients with infection who present to the Emergency Department without hypotension. Besides, mortality increases in a linear way with serum lactate from any detectable value.
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http://dx.doi.org/10.1016/j.medcli.2012.05.033DOI Listing
September 2013

The epidemiology of sepsis in Colombia: a prospective multicenter cohort study in ten university hospitals.

Crit Care Med 2011 Jul;39(7):1675-82

Universidad de Antioquia, Medellín, Colombia.

Objective: Our aim was to determine the frequency and the clinical and epidemiologic characteristics of sepsis in a hospital-based population in Colombia.

Design: Prospective cohort.

Setting: Ten general hospitals in the four main cities of Colombia.

Patients: Consecutive patients admitted in emergency rooms, intensive care units, and general wards from September 1, 2007, to February 29, 2008, with confirmation of infection according to the Centers for Disease Control and Prevention definitions.

Interventions: None.

Measurements And Main Results: The following information was recorded: demographic, clinical, and microbiologic characteristics; Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores; requirement for intensive care unit; length of stay; and 28-day all-cause mortality. During a period of 6 months, 2,681 patients were recruited: 69% and 31% with community-acquired and hospital-acquired infections, respectively. The mean age was 55 yrs (SD = 21), 51% were female, and the median length of stay was 10 days (interquartile range, 5-19). The mean Acute Physiology and Chronic Health Evaluation score was 11.5 (SD = 7) and the mean Sequential Organ Failure Assessment score was 3.8 (SD = 3). A total of 422 patients with community-acquired infections (16%) were admitted to the intensive care unit as a consequence of their infection and the median length of stay was 4.5 days in the intensive care unit. At admission, 2516 patients (94%) met at least one sepsis criterion and 1,658 (62%) met at least one criterion for severe sepsis. Overall, the 28-day mortality rates of patients with infection without sepsis, sepsis without organ dysfunction, severe sepsis without shock, and septic shock were 3%, 7.3%, 21.9%, and 45.6%, respectively. In community-acquired infections, the most frequent diagnosis was urinary tract infection in 28.6% followed by pneumonia in 22.8% and soft tissue infections in 21.8%. Within hospital-acquired infections, pneumonia was the most frequent diagnosis in 26.6% followed by urinary tract infection in 20.4% and soft tissue infections in 17.4%.

Conclusions: In a general inpatient population of Colombia, the rates of severe sepsis and septic shock are higher than those reported in the literature. The observed mortality is higher than the predicted by the Acute Physiology and Chronic Health Evaluation II score.
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http://dx.doi.org/10.1097/CCM.0b013e318218a35eDOI Listing
July 2011

Effectiveness of a hand hygiene promotion strategy using alcohol-based handrub in 6 intensive care units in Colombia.

Am J Infect Control 2011 Oct 2;39(8):633-639. Epub 2011 Jun 2.

Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; World Health Organization Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

Background: Hand hygiene is an effective strategy for the prevention of health care-associated infection (HAI). We investigated the effect of a hand hygiene promotion strategy introducing alcohol-based handrub (AHBR) on the incidence of HAI in a university hospital in Colombia.

Methods: A Prospective cohort study was performed in 6 intensive care units from January 2001 to December 2005. HAI were identified using standard US Centers for Disease Control and Prevention definitions. Alcohol-based handrub dispensers were installed between February and June 2002.

Results: Total ABHR consumption was 5,794 L (mean, 28.9 L per 1,000 patient-days) and significantly increased over time (+9.2% per year; P < .001). Of 14,516 patients cumulating 166,498 patient-days, 2,398 (16.5%) acquired a total of 3,490 HAI episodes (20.9 per 1,000 patient-days). Incidence densities for central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and urinary tract infections were 7.7, 10.6, and 3.6 episodes per 1,000 device-days, respectively. A significant decrease was observed for CLABSI (-12.7% per year; P < .001) with low nurse-to-patient ratio independently associated with infection (odds ratio, 1.11; 95% confidence interval: 1.07-1.16; P < .001).

Conclusion: Improved hand hygiene measured by increased ABHR consumption resulted in CLABSI reduction. Low nurse-to-patient ratio is independently associated with HAI in an upper-middle income country.
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http://dx.doi.org/10.1016/j.ajic.2010.11.004DOI Listing
October 2011

Surveillance and screening of American cutaneous leishmaniasis by Colombian primary health care workers using a clinical prediction rule.

Trans R Soc Trop Med Hyg 2002 Jul-Aug;96(4):405-10

Centro Internacional de Entrenamiento e Investigaciones Médicas, CIDEIM, AA 5390, Cali, Colombia.

Confirmed cases of American cutaneous leishmaniasis (ACL) and other dermatological diseases were evaluated in Colombia with a clinical prediction rule independently by 3 types of evaluators: community health volunteer (CHV), practical nurse (PN) and programme physician (PP). The adapted prediction rule included 6 variables based upon clinical-historical information. The screening instrument was a rotating tower of coloured squares, one colour for each variable. A score ranging from 0 to 7, and a cutoff point of > or = 4 was selected for ACL classification (sensitivity 94.3%, specificity 53.3% and efficiency 80.3%). Disease classification, total score, and variable-specific score obtained by CHVs and PNs were compared to those obtained by a PP. The impact on case detection in the study area was assessed. Both types of primary health worker had a high agreement with the PP (sensitivity) on the classification of patients with ACL by score, CHV (92.3%) and PN (93.3%). Case detection of ACL increased 3-fold over that observed one year earlier. This screening instrument and prediction rule, when incorporated into a community surveillance programme for ACL, can facilitate greater case detection and appropriate referral for more-specific diagnostic procedures.
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http://dx.doi.org/10.1016/s0035-9203(02)90375-5DOI Listing
March 2003