The aim of this study was to investigate the total weekly exposure to leisure noise among university students and to assess its association with self-reported symptoms of hypoacusis.This is a cross-sectional survey. An online questionnaire based on the “Noise Exposure Questionnaire”, plus 11 questions regarding hearing loss were sent to 730 randomly selected students. Participants self-reported time spent on different leisure noise activities and their subjective evaluation of the loudness of these activities, converted into equivalent noise levels, were used to estimate weekly noise exposure levels that were compared to occupational noise limits (> 85 dBA = hazardous). Inference statistics was applied to relate hearing symptoms and “likely or having some degree of hearing loss” with hazardous weekly leisure noise exposure levels.Ninety-three percent of the participants reported at least one hypoacusis symptom. The most frequent sound-related ear symptom was tinnitus (72%). Fifty-five percent of the individuals presented weekly exposure to noise >85 dBA. Symptoms of hearing loss were more prevalent in those exposed to weekly noise levels >85 dBA.This study suggests that there may be hearing loss caused by exposure to high levels of leisure noise in a large part of the study population. Health promotion of hearing conservation should be emphasized at university level. Objective repeated measurement of hearing acuity should be part of integral health services for the youth population. There is evidence of the negative impact of hearing loss on people's quality of life, causing social isolation, depression, changes in cognitive performance, and low self-esteem -4. According to recent estimates of the World Health Organization (WHO), approximately 466 million people worldwide suffer from disabling hearing loss. By 2050, one in 10 people will suffer from disabling hearing loss. Likewise, 1,100 million young people aged 12-35 years are at risk of suffering hearing loss as a result of exposure to noise in recreational contexts .Hearing disorders constitute an important public health problem because of their increasing prevalence in the world order and the economic impact they generate on health care systems and the economy in general .In Colombia, according to estimates of 2016, 17% of the population had hearing problems, with a marked upward trend in the age groups of 19-26 and 6-9 years. Among individuals aged 25-50 years, the prevalence of hearing loss was 14%, and only three out of 10 people have sought specialized assistance -7. A study highlighted the use of personal audio devices, for longer periods and at a very loud volume, among the Hispanic population of adults and adolescents .Consumption of tobacco, alcohol or psychoactive substances, environmental pollution, high level of noise in urbanized areas, and exposure to environmental or occupational toxins and recreational noise are preventable causes of hearing damage in the population. In young people, exposure to recreational noise predominates because of prolonged and frequent use of sound reproducing speakers, personal audio and multimedia content devices, and headphones, as well as a result of attendance to places with excessive noise, such as discos and concerts -13, and its consequences on hearing impairment in later life are already evident in the Eurotrak 2009-2015 study  and, more recently, in the EuroTrack 2020 report, carried out jointly by the European Federation of Hard of Hearing People (EFHOH), European Association of Hearing Aid (AEA), and European Hearing Instrument Manufacturers Association (EHIMA). According to estimates from the latest report, the average self-reported hearing loss is 11.1% for Europe as a whole, where 20% of the population is ≥64 years old. Furthermore, it is noted that 40% of the people who stated that they use headphones as a method for reproducing audiovisual content present hearing impairment .The association between recreational noise and hearing loss in young people has been studied in various regions of the world . Noise-induced sensorineural hearing loss is usually accompanied by symptoms such as tinnitus, decreased discrimination capacity, and sound distortion , which are manifestations that can be evaluated by subjective methods.It is known that the degree and extent of hearing damage are closely related to the sound pressure level, its frequency and duration, as well as with individual genetic susceptibility . Under these guidelines, this study investigated the participation of undergraduate students in noise-producing leisure activities in order to analyze the relationship between levels of weekly exposure to recreational noise and self-reported hearing loss symptoms in university students in the city of Barranquilla, Colombia.Despite the relevance of the previously discussed topics, exposure to leisure noise has not been sufficiently studied in the young adult university populations in Latin American cities. Colombia has had defined policy guidelines for the promotion and comprehensive management of hearing and communicative health since 2014, with programs that emphasize actions for health promotion, primary prevention, early detection, and treatment This study was approved by the Health Research Ethics Committee of “Universidad del Norte” according to act no. 177 of August 30, 2018. All participants signed an Informed Consent Form (ICF) prior to study commencement.A cross-sectional, observational study was carried out to assess the recreational factors of exposure to noise and their association with the report of hearing loss symptoms in university students aged 18 to 29 years enrolled in undergraduate programs at a university in the city of Barranquilla during the first semester of 2019. The covariates studied were sex and living in a noisy residential area., a precision of ±3, a confidence level of 95%, and a design effect of 1.2. To the estimated number of 692, 5% was added to provide for eventual need to discard questionnaires because of the previous existence of a basic hearing problem, and thus the total sample was composed of 730 students. Individuals were randomly selected, stratified by academic department and the courses they were enrolled. An invitation message with the link to the online questionnaire was sent to students and academic program coordinators in order to stimulate participation.The sample was calculated from a total eligible population of 13,431 students, with an estimated proportion of hearing loss in young people of 17% The questionnaire, developed in Google Forms, was structured in several sections. The first showed the terms of the ICF followed by a question and an approval box, which if not verified, prevented the student from continuing to the questionnaire. There was also a question about previously diagnosed hearing impairments (study exclusion criterion) and some related to general data ., validated by expert judgment . The NEQ is composed of two parts: Part A, which recorded the participation in leisure activities, the daily time and the number of days per week dedicated to each of them, and the subjective perception of noise on a scale from 1 “very quiet” to 5 ”very noisy “; Part B, which inquired about symptoms .The second section included the “Noise Exposure Questionnaire” (NEQ) - a translated version adapted to Spanish from its original version in English ® (available at https://www.yumpu.com/es/document/read/25302942/cuestionario-auditivo-phonak) for the self-assessment of the possible presence and degree of severity of hearing loss.The third section of the questionnaire includes the 11 items of the auditory questionnaire developed by the company Phonak for the transformation of the subjective assessment of respondents on the noise level of the activities evaluated in the questionnaire, the equivalent continuous sound level (LAeq dB) established in the international literature was considered . After counting the total number of affirmative responses to questions per participant, two groups were formed: group “with probable hearing loss” of some degree (4 or more points) and group “without suspicion of hearing loss” (0-3 points).vs. “<85 dB”) was evaluated using the odds ratio, the 95% confidence interval, and the statistical significance established at p<0.05, using the Chi-squared test (2X ). The analysis was carried out in the Epi-info 7.2 software.The association between the symptoms of hearing loss from the NEQ questionnaire and the possible degree of hearing loss with the equivalent recreational noise exposure level (“>85 dB” p>0.05). 25.2% were from Engineering programs, 18.3% from Health Sciences, 18.1% from Humanities, 14.8% from Business school, 12.29% from Law and Political Sciences, 5.3% from Architecture, 3.7% from Basic Sciences, 1.2% from Education, and 0.7% from Music. 50.28% (358/712) lived in a noisy residential area.All students invited to participate answered the questionnaire. Of the 730 surveys, 18 were excluded due to report of previous hearing problems, thus 712 individuals were included in the analysis. Just over half of the respondents were female (59.6%) and there was predominance of the 18 to 27-year age group (87%) for both sexes, with no significant differences in the distribution by age and sex , TV watching (10.3 h), and going to discos (2.2 h) . The lei, which reveals significant differences (p<0.05).The weekly exposure to noise calculated for the total sample, in relation to all the activities, the time devoted to each of them, and the estimated noise intensity for each activity show that the median exposure was 87 dBA. When analyzing the distribution of exposure by sex , it was p<0.05).Of the symptoms investigated in the NEQ questionnaire, ringing in the ears was the most reported (72%), followed by earache (44%), and temporary hearing loss (23%). The classification of the estimated degree of probable hearing loss, according to the number of symptoms , shows tp>0.05). Likewise, “living in a noisy residential area” was not associated with the possibility of having probable hearing loss (p>0.05)  .Students who were exposed to weekly levels of recreational noise above the permissible limit had a 1.57-time (95% CI = 1.16-2.11) greater chance of having four or more hearing loss symptoms; that is, probable hearing loss of some degree . This asTo the best of our knowledge, this is the first study addressing the prevalence of self-reported hearing loss symptoms in relation to exposure to recreational and environmental noise conducted with undergraduate college students aged 18-29 in a capital city of the Colombian Caribbean region.,18-19, Asia , the United States , and Latin America ,22.A relevant finding of the study is the time spent weekly in noise-producing recreational activities, in particular, the use of personal audio devices and television, which is similar to that reported for young people in Europe -13,23. However, only half of the young university students investigated perceive this activity as very noisy or not very noisy, in contrast to what was reported by young Asians .It has been reported that personal audio devices generate sound pressure levels as high as 124 dBA , but also because of the possibility of having been underestimated in the study, once the NEQ questionnaire inquires about weekly attendance, but not for longer periods.Likewise, the attendance to nightclubs for 2.3 h a week, declared by the participants, constitutes a very important noise exposure factor in the environment, not only because it generates higher intensity levels -19, exposure related to playing in a music group was infrequent in the university population surveyed, probably because music students were underrepresented in this study, as this was a recently opened program at the university where the study was conducted.Unlike young Europeans  and 2 dBA higher than that estimated for Spanish adolescents . Just over half of the population studied is exposed to a level of recreational noise above the internationally established risk limit, which implies a risk of suffering from hearing loss in the short, medium or long term. This frequency is lower than that found in studies conducted in Germany (25%) using a subjective measurement and audiometry as the objective method . However, it coincides with those reported in previous studies conducted with adolescents aged up to 19 years , young Finnish adults , and Spanish adolescents  that used the same methodology. Likewise, it is consistent with the WHO global estimates for adolescents and young people aged 12-35 years . The high percentage of exposure to dangerous levels of recreational noise in different countries suggests that the programs to promote hearing health present deficiencies, despite the existing regulations.The median total weekly exposure to noise in this study (87 dBA) was 14 dBA higher than that registered for the Nordic adult population .The high proportion of university students with probable hearing loss of some degree found in this study could be explained, in part, by the accumulation of exposure to recreational noise during adolescence. In all cases, the most reported activities (listening to music in audio devices and watching television in high volume) are habits that tend to remain or even increase during life. According to a 4-year follow-up audiological study carried out with adolescents in the city of Córdoba, Argentina, the average hearing threshold level tends to increase over time, in parallel with the increase in participation in musical recreational activities and attendance to discos and concerts . The findings of a systematic review  indicate that there is controversy in the effects of tinnitus on working memory and attention, as well as a high probability of bias in published studies. However, these functions are of paramount importance in the academic performance of university students and, therefore, they should be addressed in future research.Tinnitus, identified by the perception of ringing in the ears, was the most reported auditory annoyance in the present study, and thus deserves particular attention, as hearing impairment is its main risk factor .The analysis of factors associated with the presence of isolated hearing loss symptoms and simultaneous presence of several symptoms suggestive of probable hearing loss of some degree indicates that there were no significant differences in the presence of these hearing loss symptoms among the participants who declared to be exposed and not exposed to residential areas near construction sites or heavy traffic. This finding may be explained by the noise pollution described in the city of Barranquilla, caused by various sources of noise “one that incorporates health promotion into its educational and work project in order to foster human development and improve the quality of life of those who study or work there and, at the same time, train them to act as models or promoters of healthy behaviors at the level of their families, in their future work environments, and society in general”, and the latter action, based on the national guidelines for the promotion and comprehensive management of hearing and communicative health .This study provides new evidence of the risk posed by exposure to recreational noise levels above the 85 dBA limit for the young university population by observing that this population has a greater chance of simultaneously presenting several symptoms suggestive of probable hearing loss of some degree. These findings urge the need for the academy to implement promotion and prevention actions. At the university level, these actions are framed in recommendations of international and national policies for health care and promotion. The former action, based on the concept of a healthy or health-promoting university, defined as ; therefore, they are insufficient to accurately identify hearing-impaired individuals. However, the questions presented in the auditory questionnaire allow, from the academic setting, knowledge about the different symptoms that could be related to such changes. In particular, questions about difficulty in understanding conversation in noisy environments assist in detecting possible hidden hearing loss or cochlear synaptopathy, which may go unnoticed on an audiogram . Another limitation to this study is the failure to assess the frequency of hearing loss symptoms.A limitation to this study is the ignorance of the true hearing capacity of the participants due to the subjective measurement used. According to reviews on the reliability of self-reported hearing loss surveys, subjective measurements present inaccuracies: they underestimate the presence of hearing loss in older adults and tend to overestimate it in younger adults According to the literature review carried out by these authors, there is a lack of publications addressing hearing loss in the university population in Colombia - a situation that limited the possibility of comparing the results obtained in Barranquilla with those of other important cities of the country. In this sense, this study is useful as a precedent for future research where hearing acuity is established by subjective and objective assessment methods and correlated with environmental, recreational and behavioral characteristics. Additionally, it serves as a basis for the development of awareness and education programs in hearing health that promote the adoption of protective behaviors against possible hearing problems in university settings. This study also recommends the screening of hearing through medical examination in students who have just entered university, as well as corrective behaviors to prevent hearing problems.The subjective estimation of the intensity of exposure to noise and the symptoms of hearing loss in university students serves as screening for the early identification of hearing problems and provides population-based information for decision-making. The high prevalence of auditory symptoms reported in this study reflects the relevance of this problem. Although the university students surveyed identified the loudest recreational and environmental activities, they declared that the use of portable audio devices and going to discos are among their preferred daily activities, which expose them to average intensity levels >85 dB, and thus entails a risk of severe hearing impairment.This study provides new evidence on the association between prevalence of auditory symptoms and continuous exposure to average noise levels >85 dB in university students. It is necessary to incorporate or intensify the promotion of hearing health in university settings and raise awareness of the behaviors that predispose the development of hearing loss or worsen its basic condition. Simultaneously, it is recommended that more objective early detection programs be carried out through the university welfare services, in coordination with the health services network. In this way, continuity in the care of young people at risk of hearing loss can be facilitated, guaranteeing timely treatment and limiting the damage. -2.Las alteraciones auditivas hacen parte del grupo de enfermedades crónicas por su lenta evolución y larga duración. Existe evidencia del impacto negativo de la pérdida de la audición en la calidad de vida de las personas, al causar aislamiento social, depresión, alteraciones en el desempeño cognitivo y baja autoestima-4. Según estimaciones recientes de la OMS: alrededor de 466 millones de personas en todo el mundo padecen pérdida de audición discapacitante; en 2050, 1 de cada 10 personas, sufrirá una pérdida de audición discapacitante; asimismo 1100 millones de jóvenes, entre los 12 y 35 años, están en riesgo de padecer pérdida de audición por su exposición al ruido en contextos recreativos.Los trastornos de la audición constituyen un problema importante de salud pública debido a su creciente prevalencia en el orden mundial y al impacto económico que generan en los sistemas de atención salud y en la economía en general .En Colombia, según estimaciones realizadas en 2016, el 17% de la población presentaba problemas de audición, con una marcada tendencia al incremento en los grupos etarios de 19-26 años y de 6-9 años. Entre el grupo de 25-50 años, la prevalencia de pérdida de la audición fue del 14%, y solo 3 de cada 10 personas recurrían a la ayuda de un especialista en el tema-7. Un estudio destaca el uso de dispositivos personales de audio, por periodos más largos de tiempo y a un volumen muy alto, entre la población hispana de adultos y adolescentes  .El consumo de tabaco, alcohol o sustancias psicoactivas, la contaminación ambiental, el alto nivel de ruido en las áreas urbanizadas, la exposición a tóxicos ambientales u ocupacionales y el ruido recreativo son causas prevenibles de daño auditivo en la población. En los jóvenes, predomina la exposición al ruido recreativo, debido al uso prolongado y frecuente de parlantes reproductores de sonido, dispositivos personales de audio y contenido multimedia y auriculares; también por la concurrencia a sitios con exceso de ruido, tales como discotecas y conciertos. -13 y sus consecuencias en el deterioro de la audición, en etapas posteriores de la vida, son ya evidentes en el estudio Eurotrak 2009-2015  y más recientemente, en el reporte EuroTrack 2020, realizado en conjunción por las asociaciones Hard of Hearing People (EFHOH), Hearing Aid Professionals (AEA) and Hearing Instrument Manufacturers (EHIMA). Según estimaciones del último informe, el promedio de auto-reporte de pérdida auditiva es de 11.1% para toda Europa, donde el 20% de la población es ≥ 64 años; además, se señala que 40% de las personas que manifestaron usar auriculares como método para reproducción del contenido audiovisual presentan deterioro auditivo .La asociación entre el ruido recreativo y la pérdida auditiva en jóvenes ha sido estudiada en diversas regiones del mundo . La hipoacusia neurosensorial inducida por ruido, por lo regular, está acompañada de síntomas tales como acúfenos, disminución de la capacidad de discriminación y distorsión de los sonidos, manifestaciones susceptibles de ser evaluadas por métodos subjetivos.Se conoce que el grado y extensión del daño auditivo está estrechamente relacionado con el nivel de presión sonora, su frecuencia, la duración y también con la susceptibilidad genética individual . Bajo estos lineamientos, este estudio investigó la participación de estudiantes de pregrado en actividades de ocio productoras de ruido con el fin de analizar la relación entre los niveles de exposición semanal al ruido recreacional y los síntomas de hipoacusia auto reportados, en jóvenes universitarios, en la ciudad de Barranquilla, Colombia.A pesar de la relevancia de los temas expuestos anteriormente, la exposición al ruido de ocio no ha sido estudiada suficientemente en población adulta joven universitaria en ciudades de Latinoamérica. Colombia definió lineamientos de política para la promoción y gestión integral de la salud auditiva y comunicativa, desde 2014, con programas que enfatizan las acciones de promoción de la salud, prevención primaria, detección precoz y tratamiento El estudio tuvo aprobación del Comité de Ética en Investigación en el área de la Salud de la Universidad del Norte, según el acta No. 177 del 30 de agosto de 2018. Todos los participantes recibieron y aprobaron los términos del consentimiento informado.Se realizó un estudio observacional transversal para estudiar los factores recreacionales de exposición a ruido y su asociación con el reporte de síntomas de hipoacusia en jóvenes universitarios de 18 a 29 años, matriculados en programas de pregrado de una universidad en la ciudad de Barranquilla, durante el primer semestre de 2019. Las covariables estudiadas fueron sexo y vivir en zona residencial ruidosa., una precisión de ± 3, un nivel de confianza del 95% y un efecto de diseño de 1.2. Al número estimado de 692 se adicionó un 5% por la eventual necesidad de descartar cuestionarios debido a la existencia previa de un problema auditivo de base, para un total de 730 estudiantes. Los sujetos se seleccionaron de forma aleatoria, estratificada por división académica, a partir de los cursos matriculados. Se envió mensaje de invitación con el enlace al cuestionario online a los estudiantes y a los coordinadores de los programas académicos con el fin de estimular la participación.La muestra se calculó sobre una población total elegible de 13.431 estudiantes, con una proporción estimada de hipoacusia en jóvenes del 17% Google Forms, se estructuró en varias secciones. La primera, mostraba los términos del consentimiento informado seguido de un pregunta y casilla de aprobación, que en caso de no ser verificada impedía al estudiante continuar con el cuestionario. Había también una pregunta que indagaba el padecimiento de una alteración de la audición diagnosticada previamente (criterio de exclusión del estudio) y las relacionadas con los datos generales .El cuestionario, elaborado en , validada mediante juicio de expertos. El CER comprendía a su vez dos partes: Parte A, que registraba la participación en actividades de ocio, el tiempo diario dedicado a cada una de ellas, el número de días por semana y la percepción subjetiva del ruido en una escala de 1 “muy silenciosa” a 5 “muy ruidosa”. Parte B, que indagaba por síntomas .La segunda sección incluía el “Cuestionario de Exposición al Ruido” (CER), versión traducida y adaptada al idioma castellano, desde su versión original en inglésPhonak® (disponible en: https://www.yumpu.com/es/document/read/25302942/cuestionario-auditivo-phonak) para la autovaloración de la posible presencia y grado de severidad de pérdida auditiva.La tercera sección del cuestionario contenía los 11 ítems del cuestionario auditivo desarrollado por la empresa , para la transformación de la valoración subjetiva de los encuestados sobre el nivel de ruido de las actividades evaluadas en el cuestionario, en estimaciones objetivas de la exposición al ruido recreativo se utilizó el nivel de ruido continuo equivalente máximo (LAeq dB) establecido en la literatura internacional . Luego del conteo del total de preguntas afirmativas por participante, se conformaron dos grupos: Grupo “con probable pérdida auditiva” de algún grado (4 o más puntos) y grupo “sin sospecha de pérdida auditiva” (0-3 puntos).odds ratio, el intervalo de confianza al 95% y la significancia estadística establecida en p < 0.05, mediante la prueba de Chi cuadrado (2X ). El análisis se realizó en Epi-info versión 7.2La asociación entre los síntomas de hipoacusia del cuestionario CER y el posible grado de pérdida auditiva con el nivel de exposición al ruido recreativo equivalente  se evaluó mediante el Todos estudiantes invitados a participar respondieron el cuestionario. De las 730 encuestas, se excluyeron 18 debido al reporte de problemas auditivos previos, para un total de 712 sujetos incluidos en el análisis. Poco más de la mitad de los encuestados era de sexo femenino  y en ambos sexos el grupo de edad predominante fue el de 18 a 21 años (87%), sin diferencias significativas en la distribución por edad y sexo (p>0.05). El 25,2% eran de los programas de Ingenierías, 18,3% de Ciencias de la Salud, 18.1% de Humanidades, 14.8% de la Escuela de Negocios, 12,29% de Derecho y Ciencias Políticas, 5,3% de Arquitectura, 3,7% de Ciencias Básicas, 1,2% de Educación y solo 0,7% de Música. El 50,28% (358/712) vivía en zona residencial ruidosa.Las actividades recreativas evaluadas a las que los encuestados dedicaban más tiempo por semana fueron: uso de dispositivos portátiles (18 h), escuchar TV  y asistencia a discotecas  a la semana . Las act lo que revela diferencias significativas .La exposición semanal al ruido calculada a partir del total de la muestra, en relación con todas las actividades, el tiempo dedicado a cada una de ellas y la intensidad del ruido estimado para cada actividad muestra que la mediana de exposición fue de 87 dBA. Al analizar la distribución de la exposición por sexo  se enconDe los síntomas indagados en el cuestionario CER, el zumbido en los oídos fue el más referido (72%), seguido por el dolor de oídos (44%), y la pérdida temporal de la audición (23%). La En la La clasificación del grado estimado de probable pérdida de la audición, según el número de síntomas  muestra Aunque las mujeres presentaron 1,3 veces más chance de tener probable pérdida auditiva que los hombres, no se encontró una asociación significativa . Asimismo, el “vivir en zona residencial ruidosa” tampoco se asoció con la posibilidad de tener probable pérdida auditiva , 95% = 1,16-2,11) veces más chance de tener 4 o más síntomas de hipoacusia; es decir, probable pérdida auditiva de algún grado .Los estudiantes que estaban expuestos a niveles semanales de ruido recreativo por encima del límite permisible presentaron 1,57  debido a que en este país además de la medición subjetiva se utilizó la audiometría como método objetivo; mientras que sí coinciden con los reportado en estudios anteriores para adolescentes hasta los 19 años  y adultos jóvenes finlandeses y para adolescentes españoles, que utilizaron la misma metodología. Asimismo, es consistente con las estimaciones globales de la OMS para adolescentes y jóvenes de 12-35 años. El alto porcentaje de exposición a niveles peligrosos de ruido recreativo en distintos países sugiere deficiencias en los programas de promoción de la salud auditiva, a pesar de la normatividad existente.La mediana de exposición total semanal al ruido en este estudio (87 dBA) estuvo 14 dBA por encima de la registrada para población adulta nórdica.La alta proporción de jóvenes universitarios con probable hipoacusia de algún grado encontrada en este estudio podría ser explicada, en parte, por la acumulación de exposiciones al ruido recreativo, durante la etapa previa de adolescencia, toda vez, las actividades más reportadas  son hábitos que suelen permanecer durante la vida o inclusive llegar a incrementarse. Según el estudio audiológico de seguimiento a 4 años en adolescentes, realizado en la ciudad de Córdoba, Argentina, el nivel umbral auditivo promedio tiende a incrementarse en el tiempo, en paralelo al incremento de su participación en actividades recreativas musicales, asistencia a discotecas y a conciertos. Los hallazgos de una revisión sistemática indican que existe controversia en los efectos del tinnitus en la memoria de trabajo y en la atención y además señalan una alta probabilidad de sesgo en los estudios publicados; no obstante, estas funciones son de capital importancia en el desempeño académico de los universitarios, por lo que deberán ser estudiados en futuras investigaciones.El tinnitus, identificado por la percepción de zumbido en los oídos, fue la molestia auditiva más reportada en el presente estudio y merece particular atención, al ser el deterioro auditivo su principal factor de riesgo.El análisis de los factores asociados con la presencia de síntomas de hipoacusia aislados y el tener varios síntomas simultáneamente sugestivos de probable pérdida auditiva de algún grado, indica que no hubo diferencias significativas en presencia de estos síntomas de hipoacusia entre los participantes que declararon estar expuestos y no expuestos a zonas residenciales cercanas a sitios de construcción o mucho tráfico; posiblemente este hallazgo se explica por la contaminación auditiva descritos en la ciudad de Barranquilla, ocasionadas por diversas fuentes de ruidoaquélla que incorpora la promoción de la salud, a su proyecto educativo y laboral, con el fin de propiciar el desarrollo humano y mejorar la calidad de vida de quienes allí estudian o trabajan y, a la vez, formarlos para que actúen como modelos o promotores de conductas saludables a nivel de sus familias, en sus futuros entornos laborales y en la sociedad en general”  y las segundas, a partir de los lineamientos nacionales para la promoción y gestión integral de la salud auditiva y comunicativa.Este estudio aporta nueva evidencia del riesgo que supone la exposición a niveles de ruido recreativo por encima del límite de 85 dBA para la población joven universitaria, al observarse un mayor chance de presentar, simultáneamente, varios síntomas sugestivos de probable pérdida auditiva de algún grado. Estos hallazgos urgen la necesidad implementación de acciones de promoción y prevención desde la academia. En el ámbito universitario, estas acciones se enmarcan en recomendaciones de políticas internacionales y nacionales para la promoción y cuidado de la salud. Las primeras, fundamentadas en el concepto de universidad saludable o universidad promotora de salud, definida como “; por lo tanto, es insuficiente para identificar con exactitud a los individuos con déficit auditivo. Sin embargo, las preguntas expuestas en el cuestionario auditivo permiten, desde el escenario académico, conocer los diferentes síntomas que podrían relacionarse con tales alteraciones. En particular, las preguntas acerca de la dificultad para entender una conversación en ambientes ruidosos son útiles para detectar una posible pérdida auditiva oculta o sinaptopatía coclear, que puede pasar desapercibida en un audiograma. Otra limitante del estudio fue la no evaluación de la frecuencia de los síntomas de hipoacusia.Una limitante de este estudio es el desconocimiento de la verdadera capacidad auditiva de los participantes, debido a la medición subjetiva realizada. Según señalan revisiones acerca de la confiabilidad de las encuestas de pérdida auditiva auto reportada, la medición subjetiva tiene sus imprecisiones: subestima la presencia de pérdida auditiva en los adultos mayores, y tiende a sobrestimarla en los más jóvenesSegún la revisión de la literatura realizada por los autores, existe un vacío de publicaciones de estudios sobre hipoacusia en población universitaria en Colombia, situación que limitó la posibilidad de comparación de los resultados obtenidos en Barranquilla con la situación en otras ciudades capitales del país. En este sentido, este estudio es útil como precedente para futuras investigaciones en donde se establezca la agudeza auditiva por métodos de evaluación subjetivos y objetivos y se correlacione con las características ambientales, recreacionales y del comportamiento. Adicionalmente, sirve de base para la elaboración de programas de sensibilización y educación en salud auditiva que fomenten la adopción de conductas protectoras ante posibles problemas auditivos en escenarios universitarios y se recomienda el tamizaje de la audición en el examen médico a los estudiantes que entran por mi primera vez a la universidad, así como conductas correctivas ante problemas de audición instaurados.La estimación subjetiva de la intensidad de exposición al ruido y los síntomas de hipoacusia en jóvenes universitarios sirve de tamizaje para la identificación temprana de problemas auditivos y provee información de base poblacional para la toma de decisiones. La gran prevalencia de síntomas auditivos reportados en este estudio refleja la relevancia del problema. Si bien los universitarios encuestados identifican las actividades recreativas y ambientales más ruidosas declaran entre sus actividades diarias preferidas el uso de dispositivos portátiles de audio y la asistencia a discotecas, que los exponen a niveles de intensidad promedio superiores a los 85 dB, lo que conlleva un riesgo de padecer trastornos auditivos severos.Este estudio provee nueva evidencia de la asociación entre la prevalencia de síntomas auditivos y la exposición continua a niveles de ruido promedios mayores a 85 dB en jóvenes universitarios. Es preciso incorporar o intensificar la promoción de la salud auditiva, en ambientes universitarios, que sensibilicen sobre las conductas que predisponen al desarrollo de la hipoacusia o empeoran su condición de base. Simultáneamente, se recomienda realizar programas de detección temprana más objetivos, a través de los servicios de bienestar universitario, en articulación con la red de servicios de salud. De esta forma, se podrá facilitar la continuidad en la atención de los jóvenes en riesgo de hipoacusia, que garantice el tratamiento oportuno, limitando el daño.


It will be interesting to see what the fall holds, as more of the population becomes fully vaccinated. Working as an academic librarian at Queen’s University in Kingston during the Covid-19 era, September marks a planned return to campus after a year and a half of working remotely.Your JCHLA editorial team recently took time to discuss ways to streamline and improve the journal’s workflow process for current and future editors. We met three times in June to review and update editor position guides and workflow documentation. The Journal will also be trialing extended terms for the Copyeditor and Production Editor positions, to allow for a 4-month  overlap period to help onboard new volunteers. A big thanks to our current Copyeditor and outgoing Production Editor, Amanda Caputo and Rachel Couban, for agreeing to extend their lengths of terms for this purpose.The August issue marks the third and final issue that the Editor-in-Chief oversees, and the near end of their 3-year term on the editorial team. Participating on the JCHLA editorial team has been one of most rewarding learning experiences I’ve had in my professional career to date. I am grateful for all the wonderful colleagues that I’ve had the chance to meet and work with during this time, and I am proud of the work we have been able to accomplish as journal editors, working group members (JCHLA Data Sharing Policy), and CHLA Board members.In September, the Journal’s leadership transitions to the very capable hands of Alanna Campbell (Northern Ontario School of Medicine) as the new Editor-in-Chief, and Colleen Pawliuk  as the new Senior Editor. With the pandemic impacting the ability of so many to take on volunteer positions like this, we are very grateful to Megan Kennedy (University of Alberta) for stepping into a 3-year term beginning as the new Junior Editor, and to Courtney Ellsworth  for joining the team as our new Production Editor.The August 2021 issue of the Journal includes two articles about library support for knowledge synthesis research, including the program description: “Flipping it online: re-imagining teaching searching for knowledge syntheses”, and the research article: “An environmental scan of librarian involvement in systematic reviews at Queen’s University: 2020 update”. This issue features the article: “Evolution-revolution-devolution: a short history of the provision of knowledge-based information services to Manitoba’s health professionals” and reviews the book “Meeting the Challenge of Teaching Information Literacy”. A big thanks to all of our authors and peer reviewers!Sincerely,Sandra McKeownJCHLA/JABSC Editor-in-Chiefeditor@chla-absc.caEmail: A nos lecteurs,J'espère que vous avez tous pu profiter des mois plus chauds en ce deuxième été de pandémie. Il sera intéressant de voir ce que l'automne nous réserve, alors qu'une plus grande partie de la population sera vaccinée. En tant que bibliothécaire universitaire à l'Université Queen's à Kingston, pendant l'ère Covid-19, le mois de septembre marquera un retour sur le campus, après un an et demi de télétravail.Votre équipe de rédaction du Journal de l’Association des bibliothèques de la santé du Canada (JABSC) a récemment pris le temps de discuter des moyens de rationaliser et d'améliorer le processus de révision pour les actuels et futurs éditeurs. Nous nous sommes réunies trois fois en juin pour examiner et mettre à jour les lignes directrices des éditeurs ainsi que la documentation afférente . La revue va également tester des mandats prolongés pour les postes de réviseur et d’éditeur de la production, afin d’allouer une période de chevauchement de quatre mois (un numéro de la revue), facilitant ainsi l'intégration des nouveaux bénévoles. Nous remercions chaleureusement Amanda Caputo et Rachel Couban, notre réviseure actuelle et notre éditrice de la production sortante, qui ont accepté de prolonger la durée de leur mandat à cette fin.Le numéro d'Août marque le troisième et dernier numéro supervisé par l’éditrice en chef, et la fin de son mandat de trois ans au sein de l'équipe de rédaction. Faire partie de l'équipe de rédaction du JABSC a été l'une des expériences d'apprentissage les plus enrichissantes que j'ai vécues jusqu'à présent, dans ma carrière professionnelle. Je suis reconnaissante envers tous les merveilleux collègues que j'ai eu la chance de rencontrer et avec lesquels j'ai travaillé pendant cette période. Je suis fière du travail que nous avons pu accomplir en tant qu’éditrices sr6u de la revue, membres du groupe de travail (politique de partage des données du JABSC) et membres du conseil d'administration de l'ABSC.En Septembre, la direction de la revue passera aux mains très compétentes d'Alanna Campbell (École de médecine du Nord de l'Ontario), nouvelle éditrice en chef, et de Colleen Pawliuk , nouvelle éditrice principale. Étant donné l’impact de la pandémie sur la capacité d'un grand nombre de personnes à occuper des postes bénévoles, nous sommes très reconnaissantes à Megan Kennedy (Université de l'Alberta) d'avoir accepté un mandat de trois ans en tant que nouvelle éditrice débutante, et à Courtney Ellsworth  de s'être jointe à l'équipe en tant que nouvelle éditrice de production.Le numéro d'Août 2021 comprend deux articles sur le soutien des bibliothèques pour la recherche sur la synthèse des connaissances, incluant la description du programme : “Flipping it online : re-imagining teaching searching for knowledge syntheses”, et l'article de recherche : “An environmental scan of librarian involvement in systematic reviews at Queen's University : 2020 update”. Ce numéro présente l'article : : “Evolution-revolution-devolution: a short history of the provision of knowledge-based information services to Manitoba’s health professionals” ainsi qu’une critique du livre “Meeting the Challenge of Teaching Information Literacy”. Un grand merci à tous nos auteurs et pairs réviseurs !Sincèrement,Sandra McKeownJCHLA/JABSC Rédactrice en chefeditor@chla-absc.caCourriel:


During the COVID-19 pandemic, healthcare services reduced the number of elective procedures performed. Vascular surgery patients are a group at risk of contracting severe forms of the infection, but are also susceptible to complications of their underlying diseases if they do not receive routine care. It is therefore necessary to understand the direct and indirect impacts and consequences of the pandemic on vascular patients.To assess the impact of 1 year of the pandemic on a vascular surgery service and changes to the profile of surgeries during the same period.An analysis was conducted of the medical records of patients who underwent elective and emergency surgery from 2019 to 2021. A review of the literature was also conducted, using the search terms “vascular surgery”, “COVID-19”, and “amputations”. Data were analyzed with Stata/SE v.14.1 .A total of 1,043 surgeries were identified during the study period, 51.6% conducted pre-pandemic and 48.4% performed during the pandemic. There was a reduction in the number of elective surgeries and an increase in the number of lower limb amputations and surgical debridements. Increases were also observed in the proportion of patients with peripheral arterial occlusive disease with advanced Rutherford classifications and in the number of cases of diabetic foot.The reduction in elective care and patients’ reluctance to seek health services during the pandemic are the probable causes of increased severity of patient status, with greater need for lower limb amputation and surgical debridement and changes to the profile of the surgery performed at the service. The first case in Brazil was confirmed on February 26, 2020, in São Paulo. One month later, cases of the disease had been notified by all of Brazil’s states.2-While there has been much discussion of the impacts of COVID-19 on healthcare systems, because of the severity of the disease and bed shortages, in Brazil little has been said about its impacts on diseases unrelated to the virus. The vascular surgery specialty treats a vast range of diseases, including arterial diseases and the diabetic foot. Epidemiologically, patients with these conditions are generally elderly and have multiple comorbidities, placing them in the group of people at risk of contracting severe forms of COVID-19.7It is therefore pertinent to assess and discuss the pandemic’s impacts on patients with vascular diseases, in addition to the harm caused by the respiratory disease itself, to enable a rethink of public health policies and find ways to avoid the same problems faced in this pandemic in a possible future situation of a global disease outbreak.The objectives of this study were to assess the impact of 1 year of the COVID-19 pandemic on a vascular surgery service at a teaching hospital in Brazil and to evaluate the changes to the profile of surgeries conducted during the same period.A retrospective study based on analysis of data from the medical records of patients admitted via the SUS and the private healthcare system who underwent elective, urgent, or emergency surgery from March 2019 to March 2021. Surgeries conducted during the period were analyzed, classifying those performed from March 2019 to March 2020 as pre-pandemic and those from March 2020 to March 2021 as during the pandemic. It should be understood that, throughout the text, whenever references are made to the pandemic period, the reference is only to the study period, since the pandemic is still ongoing at the time of article submission.The present study was approved by the Research Ethics Committee under protocol number 45138821.7.0000.0099, decision number 4.735.088.In the statistical analysis, ages are expressed as means, standard deviations, and minimums and maximums. For age, the null hypothesis tested was that mean patient age is equal for the two periods, versus the alternative hypothesis of different means. Categorical variables are expressed as frequencies and percentages. For each of the categorical variables, the null hypothesis tested was that distributions of variable categories are equal during the two periods, versus the alternative hypothesis that distributions are different.t test for independent samples was used to compare the periods before and during the pandemic in terms of age. Categorical variables were analyzed using Fisher’s exact test or the chi-square test.Student’s P values < 0.05 indicate statistical significance. Data were analyzed with Stata/SE v.14.1 .Finally, a review of the literature was also conducted using the search platforms PubMed, DynaMed, UpToDate, and Google Scholar. Search terms employed included “vascular surgery”, “COVID-19”, and “amputations”.A total of 1,043 admissions were identified for the vascular surgery specialty during the period from March 1, 2019 to March 17, 2021, 538 (51.6%) of which occurred before the pandemic  and 505 (48.4%) of which were during the pandemic . Some patients were treated in both periods and were included in analyses of both. Patients were assessed for age and main comorbidities during the periods considered pre-pandemic and during the pandemic, as a means of measuring changes to the profile of patients, as specified in Presence of comorbidities was heterogeneous, with greatest prevalence of hypertension (62.6% vs. 43.8%), diabetes (27.4% vs. 9.7%), and other comorbidities, such as dyslipidemia (51.8% vs. 29%), among patients seen during the pandemic and during the pre-pandemic period, respectively (p < 0.05). There was also a robust statistical difference in mean age between the two groups (p = 0.007), with a higher mean age for patients seen during the pandemic.Complications possibly related to COVID-19 were also analyzed for the pandemic period, as shown in ,4,The impacts of social distancing measures and the consequent reduction in healthcare provision have been investigated in several different countries, demonstrating that, since access to medical consultations in general was restricted, compounded by reluctance to seek care at hospitals that also treat COVID-19 cases, fewer patients sought medical attention.2In the present study, important statistically significant changes were observed in the profile of patients during the pandemic. During this period, there was a predominance of male patients and an increase in the proportion of patients admitted with other comorbidities, including systemic arterial hypertension (SAH), diabetes mellitus (DM), and other comorbidities.,2,3,9,In addition to the change in the profile of the patients, an important change was also observed in the types of surgeries conducted during the pandemic period, in particular a sharp drop in the number of varicose veins surgeries. This was expected since these surgeries are elective and elective procedures were prohibited during the pandemic. There was also a considerable increase in the numbers of amputations and debridements. Similar data were reported at other centers, where sharp drops were seen in the number of elective surgeries7,Analyzing the increase in the number of amputations, explanations for this observation include the increased severity with which patients arrived at hospital, primarily because of loss of control of comorbidities and reluctance to seek health services early. One possible cause of the increase may have been the attempt to minimize exposure of patients to COVID-19, avoiding long hospital stays, and also to increase the number of beds available for more severe cases. Given that amputations require a shorter length of hospital stay and need less intensive care unit (ICU) care than lower limb revascularization surgery, amputations may have been considered earlier by the vascular surgeon and even by the patient.2When patients with PAOD were analyzed in isolation, it was observed that there was a statistically significant increase in the number of admissions of patients at Rutherford classes 4, 5, and 6, even though the number of revascularization surgery procedures (angioplasty and bypasses) had fallen during the period. A study conducted in Holland also demonstrated an important increase in patients with Rutherford classifications over 5.Admissions due to complications of diabetic foot also increased sharply, with statistical significance, during the period analyzed. During the pandemic period, the greater severity of the patients treated increased the likelihood of diabetic patients undergoing amputations to 10.8 times greater than during the pre-pandemic period, with a higher probability of major amputations than minor ones.Many vascular surgery services around the world reported important increases in the occurrence of cases of acute arterial occlusion requiring surgical treatment. In Italy, for example, approximately 60% of cases of acute arterial occlusion occurred in patients positive for COVID-19.Despite the concern with relation to the possibility of vascular patients contracting the virus and developing severe cases of the disease, just 3.4% of the patients admitted via our service contracted the disease. Over the entire pandemic period analyzed, seven vascular surgeries were performed because of COVID-19, accounting for just 1.6% of the vascular surgeries performed during the pandemic period.In Singapore, teleconsultations were used as a way to reduce the impact of suspension of consultations and elective surgeries, providing a means for screening patients to determine which patients could be managed with guidance only and which patients required assessment by specialists, in settings with no suspected cases.Since this study assessed just one pandemic period and only considered patients admitted to a single hospital in the city, the possibility of even more devastating consequences for this specific group of patients cannot be ruled out. The elevated number of amputations will have immeasurable future consequences not only for the individuals involved, but also for healthcare services and expenditure in general. In the future, methods for assessing and providing care to patients of this degree of complexity during periods in which isolation is required will be essential to prevent consequences of lack of access to medical attention that are even more devastating than the disease itself.The reduction in consultations and patients’ reluctance to attend health services during the first year of the pandemic had a negative effect on care for vascular patients. This was the result of a considerable increase in the severity of patients who were admitted and changes to the profile of surgery conducted at the service, with increased numbers of debridements and amputations and reduced numbers of varicose veins surgeries. -A covid-19, doença causada pelo coronavírus 2 da síndrome respiratória aguda grave (SARS-CoV-2), foi declarada como pandemia pela Organização Mundial de Saúde (OMS) no dia 11 de março de 2020. O primeiro caso no Brasil foi confirmado em 26 de fevereiro de 2020, na cidade de São Paulo. Após 1 mês, todos os estados brasileiros já haviam notificado casos da doença2-versus o risco de o paciente evoluir com complicações devastadoras de suas doenças vasculares de baseApesar de muito se discutir sobre os impactos da covid-19 nos sistemas de saúde, devido à gravidade da doença e à falta de leitos, pouco se fala, no Brasil, sobre os seus impactos em doenças não relacionadas com o vírus. A especialidade de cirurgia vascular inclui tratamento de uma vasta variedade de doenças, entre elas, as doenças arteriais e o pé diabético. Epidemiologicamente, os portadores dessas enfermidades geralmente são idosos, que apresentam múltiplas comorbidades, o que os coloca no grupo de risco para adquirir as formas graves da covid-197Sendo assim, são válidas a avaliação e a discussão dos impactos que a pandemia trouxe para os pacientes portadores de doenças vasculares, além dos malefícios causados pela própria doença respiratória, para que seja possível repensar as políticas de saúde pública e encontrar formas de evitar os mesmos problemas enfrentados nesta pandemia em uma possível nova situação de doença de acometimento mundial.O objetivo deste estudo foi avaliar o impacto de 1 ano de pandemia de covid-19 em um serviço de Cirurgia Vascular de um hospital-escola no Brasil, assim como avaliar a mudança do perfil de cirurgias durante o mesmo período.Estudo retrospectivo, realizado a partir da análise de dados de prontuários de pacientes internados, do SUS e do sistema privado, submetidos a cirurgias eletivas, de urgência e emergência, no período de março de 2019 a março de 2021. Foram avaliadas as cirurgias realizadas no período, sendo que as cirurgias entre março de 2019 e março de 2020 foram consideradas pré-pandemia, e as cirurgias entre março de 2020 e março de 2021 foram consideradas como pandemia. Entende-se que, durante o texto, sempre que nos referirmos ao período de pandemia, este consiste apenas no período do estudo, uma vez que a pandemia ainda está em vigência na data da submissão deste artigo.O presente estudo foi aprovado pelo Comitê de Ética em Pesquisa sob o número 45138821.7.0000.0099, número do parecer 4.735.088.versus a hipótese alternativa de médias diferentes. Variáveis categóricas foram descritas por frequência e percentual. Para cada uma das variáveis categóricas, testou-se a hipótese nula de que as distribuições sobre as classificações da variável são iguais para os dois períodos versus a hipótese alternativa de distribuições diferentes.Na análise estatística, as descrições da idade foram apresentadas por meio de média, desvio padrão, mínimo e máximo. Para idade, testou-se a hipótese nula de que as médias dos pacientes são iguais nos dois períodos t de Student para amostras independentes. Variáveis categóricas foram analisadas, usando-se o teste exato de Fisher ou o teste de qui-quadrado.Para a comparação dos períodos antes e durante a pandemia, em relação à idade, foi usado o teste Valores de p < 0,05 indicaram significância estatística. Os dados foram analisados com o programa computacional Stata/SE v.14.1 .Por fim, em conjunto, foi realizada uma revisão de literatura com base nas plataformas de pesquisa PubMed, DynaMed, UpToDate e Google Scholar. Os temas pesquisados envolveram as palavras-chave “cirurgia vascular”, “covid-19” e “amputações”.Foram identificados 1.043 internamentos para a especialidade de cirurgia vascular no período de 01/03/2019 a 17/03/2021, sendo 538  antes da pandemia (de 01/03/19 a 20/03/20) e 505  durante a pandemia (24/03/20 a 17/03/21). Alguns pacientes tiveram atendimento nos dois períodos e foram incluídos em ambos. Os pacientes foram avaliados quanto à idade e às principais comorbidades no período considerado pré e durante a pandemia, como forma de mensurar mudanças no perfil dos pacientes conforme especificado na A presença de comorbidades foi bastante heterogênea, com maior prevalência de hipertensão , diabetes  e outras comorbidades, como dislipidemia , nos pacientes atendidos durante a pandemia, quando comparados aos pacientes atendidos no período pré-pandemia . Com relação à média de idade, também foi observada uma importante diferença estatística entre os dois grupos , com a maior média de idade observada em pacientes atendidos durante a pandemia.Na versus menores . Há, também, evidência de maior número de pacientes diagnosticados com pé diabético, com complicações, no período da pandemia .Na Foram avaliadas, também, possíveis complicações relacionadas com a covid-19 durante o período da pandemia, como demonstrado na ,4,Os impactos das medidas de distanciamento social e, consequentemente, da diminuição dos atendimentos em saúde foram avaliados em diversos países, demonstrando que, uma vez que os acessos aos atendimentos médicos em geral estavam restritos, em conjunto com o receio de buscar atendimento em hospitais que também atendiam casos de covid-19, menos pacientes procuraram atendimento médico2No presente estudo, foi possível observar, com significância estatística, uma importante mudança de perfil dos pacientes durante a pandemia. Durante esse período, foi observada predominância de pacientes do sexo masculino, assim como aumento de pacientes internados que possuíam outras comorbidades, entre elas hipertensão arterial sistêmica (HAS), diabetes melitos (DM) e outras comorbidades.,2,3,9,Além de alteração no perfil dos pacientes, foi possível observar também uma importante mudança nos tipos de cirurgias realizadas no período da pandemia, com destaque para importante diminuição de cirurgias de varizes. Isso era esperado, dado o fato de ser uma cirurgia de cunho eletivo, cuja realização foi proibida durante a pandemia. Notou-se, também, um importante aumento do número de amputações e desbridamentos. Tais dados igualmente foram observados em outros centros, onde foi possível verificar importante queda do número de cirurgias eletivas7,Quando analisamos o aumento do número de amputações, algumas justificativas encontradas para tal fato são a maior gravidade com que os pacientes chegaram ao hospital, principalmente pelo descontrole de comorbidades e pelo receio de procurar os serviços de saúde precocemente. Outra possível causa para o aumento pode ter sido a tentativa de minimizar a exposição dos pacientes à covid-19, evitando internamentos prolongados, bem como visando aumentar o número de leitos para pacientes de maior gravidade. Dado que as amputações possuem menor tempo de internamento e menor necessidade de unidade de terapia intensiva (UTI) do que cirurgias de revascularização de membros inferiores, as amputações podem ter sido consideradas de forma mais precoce pelo médico cirurgião vascular e até mesmo pelo paciente2lockdown, o número daqueles com Rutherford estágio maior que 4 aumentouQuando avaliados os pacientes com DAOP isoladamente, foi possível observar, com significância estatística, um aumento no número de internações de pacientes com classes 4,5 e 6 de Rutherford, apesar de o número de cirurgias de revascularização (angioplastia e pontes) ter diminuído no período. Um estudo conduzido na Holanda também demonstrou importante aumento de pacientes com classificações de Rutherford maior que 5lockdown, estimando um aumento da hemoglobina glicada de 2,26% para 30 dias e 3,68% para 45 dias de isolamento. Além do aumento da hemoglobina com lockdown de 30 dias, foi estimado um aumento de 10% nos casos de amputação em 1 ano, sendo essa porcentagem progressiva quanto maior o tempo de isolamentoOs internamentos por complicações de pé diabético também tiveram expressiva mudança, com significância estatística, durante o período avaliado. Durante o período da pandemia, devido à maior gravidade dos pacientes, as chances de pacientes diabéticos evoluírem para amputações foi 10,8 vezes maior do que no período pré-pandemia, com ainda maior probabilidade de evoluir para amputações maiores do que menoresMuitos serviços de cirurgia vascular ao redor do mundo reportaram um aumento importante na ocorrência de casos de oclusão arterial aguda com necessidade de tratamento cirúrgico. Na Itália, por exemplo, aproximadamente 60% dos casos de oclusão arterial aguda ocorreram em pacientes positivos para covid-19Apesar de todo o receio quanto à possibilidade de os pacientes vasculares adquirirem o vírus e evoluírem para doenças graves, apenas 3,4% dos pacientes internados no nosso serviço contraíram a doença. Durante todo o período de pandemia avaliado, foram realizadas sete cirurgias vasculares devido à covid-19, representando apenas 1,6% das cirurgias vasculares realizadas na pandemia.Em Singapura, como uma forma de minimizar os impactos da suspensão dos atendimentos e cirurgias eletivas, a realização de teleconsultas funcionou como uma forma de triagem daqueles que poderiam ser acompanhados apenas com orientações e daqueles que necessitavam ser avaliados por especialistas, fora do ambiente dos casos suspeitosComo este estudo avaliou apenas um período da pandemia e considerou apenas os pacientes internados em um único hospital da cidade, não é possível descartar consequências ainda mais devastadoras para esse grupo de pacientes especificamente. O número elevado de amputações trará futuramente consequências imensuráveis não só para esses indivíduos, mas também para os serviços e custos de saúde em geral. No futuro, formas de atendimento e assistência à saúde para pacientes dessa complexidade, em períodos de necessidade de isolamento, serão essenciais para que as consequências da falta de acesso ao atendimento médico não sejam ainda mais devastadoras do que a própria doença.A diminuição dos atendimentos e o receio dos pacientes em procurar os serviços de saúde durante o período de 1 ano de pandemia promoveram efeito negativo no cuidado do paciente vascular. Isso aconteceu porque houve aumento considerável da gravidade dos pacientes internados, assim como mudança no perfil cirúrgico do serviço, o que evidenciou aumento do número de desbridamentos e amputações, além de diminuição das cirurgias de varizes.


Measuring the health and wellbeing of the population is the first step in visualizing the real needs of the population in order to promote healthy habits, as well as effective health and social policy responses.Several goals of United Nations’ 2030 Agenda for Sustainable Development are related to reducing the risks of being unhealthy and socially vulnerable. Recently, we have experienced that, under the shock of a pandemic, these goals are scarcely fulfilled, even in developed countries.This Special Issue contains 11 contributions from diverse research lines, representing different geographies, such as America, Asia or Europe. Some of them are related to elderly or disabled populations ,3,4), wh,4, wh3,4Irene Albarrán Lozano, Pablo J. Alonso-González and José Javier Núñez-Velázquez  estimateJulia Córdoba and María José Bagnato  study thThe study presented by Aurea Grané, Irene Albarrán and David E. Merchán  is focusMauricio Matus-López and Alexander Chaverri-Carvajal  present J. Iñaki De La Peña, M. Cristina Fernández-Ramos and Asier Garayeta  study hoAna Debón, Steven Haberman, Francisco Montes and Eduardo Otranto  evaluateThe work by Pu Liao, Zhihong Dou and Xingxing Guo  is focusIwona Bonikowska, Katarzyna Szwamel and Izabella Uchmanowicz  investigFederica Cugnata, Silvia Salini and Elena Siletti  use a BaMartínez-Urbistondo et al.  study thFinally, James Ming Chen, Mira Zovko, Nika Šimurina and Vatroslav Zovko  focus th


O emprego do escore de cálcio no auxílio da estratificação de risco cardiovascular pode ser ferramenta com melhor custo-efetividade em comparação à estratégia convencional.Avaliação da custo-efetividade do emprego do escore de cálcio na orientação terapêutica para a prevenção primária cardiovascular.Modelo de microssimulação para avaliar as consequências clínicas e econômicas da doença cardiovascular aterosclerótica, comparando-se a estratégia de prevenção pelo uso do escore de cálcio e a estratégia convencional.Resultados obtidos demonstram melhor custo-efetividade da estratégia terapêutica guiada pelo escore de cálcio, por meio da redução do custo incremental, e aumento nos anos de vida ajustados por qualidade (QALY), que corresponde, em número, ao benefício incorporado à qualidade de vida do indivíduo.O emprego do escore de cálcio mostrou-se mais custo-efetivo que a estratégia convencional tanto em custo como em QALY, na maioria dos cenários estudados. Por consequência, muitos dos indivíduos elegíveis à terapia farmacológica poderiam se beneficiar marginalmente dessa terapêutica em longo prazo, uma vez que o benefício acumulado do tratamento é diretamente proporcional ao risco de base.7Nesse cenário, o escore de cálcio coronariano (ECC), realizado por meio da tomografia computadorizada para quantificar a carga aterosclerótica dos indivíduos, pode ser útil para reclassificar o paciente intermediário para baixo ou alto risco de eventos, evitando ou, eventualmente, até intensificando a necessidade da terapia hipolipemiante nessa população.Dessa forma, é relevante a avaliação da efetividade e da custo-efetividade dessa ferramenta em comparação a outros mecanismos de estratificação de risco da população, com o objetivo de orientar a prática clínica, bem como direcionar estrategicamente os esforços e recursos da saúde.11 Entre eles, Nasir et al.5 estudaram a custo-efetividade do emprego do ECC e compararam-na com a estratificação guiada apenas pelo escore de risco de eventos cardiovasculares. Essa análise utilizou os dados e os custos previstos nos Estados Unidos e teve como base os dados populacionais do Multi-Ethnic Study of Atherosclerosis (MESA), uma coorte composta de 6.814 participantes de diversos centros de estudos do país.12 Neste artigo, usamos como referência o estudo citado anteriormente, com a mesma base populacional citada, adaptando os custos para a realidade brasileira, a fim de verificar a reprodutibilidade do método no Brasil.Diversos estudos de custo-efetividade compararam o emprego do ECC à terapia guiada por escores de risco ou outros métodos de classificação.version 2016 — Williamstown, Massachusetts). O modelo simula as consequências clínicas e econômicas da doença cardiovascular aterosclerótica, no contexto da prevenção primária em paciente de moderado risco cardiovascular. As estratégias comparadas nesta análise são : pacientes não realizaram ECC e foram submetidos à terapia farmacológica com estatina de moderada potência.Estratégia 2 (ECC): pacientes realizaram um ECC, e o tratamento foi guiado pelo resultado. Indivíduos com ECC 1–100 foram submetidos ao tratamento com estatina de moderada intensidade.Com valor de ECC superior a 100, era iniciado tratamento com estatina de alta potência. Contudo, se ECC:0, não era iniciado tratamento medicamentoso.13 As demais medicações de uso contínuo, caso indicadas, não sofreram modificações após a reclassificação de risco.A intensidade do tratamento com estatinas, classificada em baixa, moderada e alta potência, segue os critérios contidos na diretriz da AHA e da Sociedade Brasileira de Cardiologia (SBC).quality-adjusted life years — QALY) como medida de benefício. A QALY é uma medida de resultado de saúde, que combina em um índice numérico a quantidade  e a qualidade (morbidade) de vida da população, sendo útil para comparar e analisar o resultado comparativo entre as estratégias 1 e 2.A análise comparativa do estudo de custo-efetividade é baseada nos anos de vida ajustados por qualidade .Ao compararmos a custo-efetividade do emprego do ECC como ferramenta de auxílio na estratificação do risco em pacientes em prevenção primária e risco moderado de eventos cardiovasculares, compreendemos os seus reais benefícios e sua aplicabilidade na prática clínica. Os fatores que respaldam esta análise são: 1) a redução do custo incremental de cada estratégia; e 2) o aumento no QALY, que corresponde, em número, ao benefício incorporado à qualidade de vida do indivíduo.O resultado encontrado nesta pesquisa está de acordo com a literatura, mesmo após o ajuste dos custos para a realidade brasileira. Dessa maneira, estratificar indivíduos de risco moderado para eventos cardiovasculares com o ECC e, com base no resultado obtido, decidir entre o uso ou não da estatina comprova ser vantajoso se comparado à estratégia conservadora.Dessa forma, restringe-se o número de indivíduos elegíveis ao tratamento medicamentoso e, por consequência, a possibilidade de efeitos adversos relacionados à droga. Ao mesmo tempo, inicia-se o tratamento do indivíduo com real benefício de seu uso e, portanto, podem-se prevenir eventos cardiovasculares associados à aterosclerose. Fica, portanto, evidente a custo-efetividade da estratégia que inclui a utilização do ECC na estratificação desses indivíduos, como ferramenta de extrema importância quando implementada em larga escala. 2 As an example of these changes, the 2018 dyslipidemia management and 2019 cardiovascular prevention guidelines of the American Heart Association (AHA) and American College of Cardiology (ACC) suggest the use of a cardiovascular risk score  to estimate the risk of cardiovascular events related to atherosclerosis over a period of ten years.4 This score classifies the individual, according to modifiable and non-modifiable variables, as being at high risk (>20% of events in ten years); moderate risk (7.5–20% of events in ten years); borderline (5–7.5% of events in ten years) and low risk (<5% of events in ten years).4Thanks to new ways of classifying the risk of cardiovascular events in primary prevention, which are recommended by the guidelines of the main cardiology societies in the world, there is a significant increase in the population eligible for the use of statins.5However, it is possible to note that this classification unites a heterogeneous cardiovascular risk population, since a portion of individuals who are candidates for statin use do not show symptoms or signs of overt atherosclerotic disease. Consequently, many individuals eligible for pharmacological therapy could marginally benefit from this therapy in the long term, since the accumulated benefit of the treatment is directly proportional to the baseline risk.7In this scenario, the coronary artery calcium score (CAC), performed by means of computed tomography to quantify the atherosclerotic burden of individuals, may be useful to reclassify the intermediate patient to low or high risk of events, avoiding or eventually even intensifying the need for lipid-lowering therapy in this population.Thus, it is important to evaluate the therapeutic effectiveness and cost-effectiveness of this tool in comparison to other mechanisms of risk stratification of the population, with the objective of guiding clinical practice, as well as strategically directing health efforts and resources.11 Among them, Nasir et al. studied the cost-effectiveness of using CAC and compared it with stratification guided only by the risk score for cardiovascular events. This analysis used data and expected costs in the United States and was based on population data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort composed of 6,814 participants from different study centers in the country.12Several cost-effectiveness studies have compared the use of CAC to therapy guided by risk scores or other classification methods.Here, we used the aforementioned study as a reference, with the same population base mentioned, adapting the costs to the Brazilian reality, to determine the reproducibility of the method in Brazil.In this analysis, the methods were replicated from the article published by Nasir et al., using a microsimulation model . The model simulates the clinical and economic consequences on the basis of atherosclerotic cardiovascular disease, in the context of primary prevention in patients with moderate cardiovascular risk. The strategies compared in this analysis are  explaineStrategy 1 : patients did not undergo CAC and were submitted to pharmacological therapy with moderate-intensity statin.Strategy 2 .The comparative analysis of the cost-effectiveness study was based on quality-adjusted life years (QALY) as a measure of benefit. QALY is a health outcome measure, which combines the population's quantity  and quality (morbidity) of life in a numerical index, being useful to compare and analyze the comparative result between strategies 1 and 2.The population of this analysis, as mentioned, is based on the MESA study, and the population characteristics and distribution of the calcium score according to cardiovascular risk, based on the ACC/AHA scores, are shown in In this investigation, patients were run through the model until they had a cardiovascular event or death from other causes, and the number of years of statin use or cardiovascular event was searched for each patient. The time horizon was updated with one-year cycles. All costs and results were discounted at 3% per year.As a limitation of our study, we emphasize that the analysis of the assumptions was not performed, since in this case, the results are extensions of studies carried out previously.As previously mentioned, the costs were adapted to the Brazilian reality. The values are shown in 14It is important to note that the cost of CAC was added to the model only once, as the test is not repeated frequently. In the literature, the warrant time, that is, CAC guarantee time for individuals with CAC=0, is relatively long in addition to being individualized, taking into account several aspects such as age, sex and the presence of risk factors, including diabetes. Therefore, in case of a zero calcium score, the indication of its repetition is variable and may be indicated at intervals of three to seven years.The rest of the clinical parameters, including probabilistic multiparameter sensitivity analyses, were used as described in the previous publication.When comparing the cost-effectiveness of using CAC in the cardiovascular stratification of primary prevention of individuals with moderate cardiovascular risk between strategies 1 and 2, we observed that when considering the median cost of all statins and the CAC, there was a statistically significant reduction of R$ 672.00 in accumulated costs in favor of the group in which CAC was determined .When comparing the cost-effectiveness of using the CAC as a tool to aid in risk stratification in patients undergoing primary prevention and moderate risk of cardiovascular events, we understand its real benefits and its applicability in clinical practice. The factors that support this analysis are: 1) the reduction of the incremental cost of each strategy; and 2) the increase in QALY, which corresponds, in number, to the benefit incorporated into the individual's quality of life.The results obtained in this study are in agreement with the literature, even after adjusting the costs to the Brazilian reality. Thus, stratifying individuals at moderate risk for cardiovascular events with CAC and on the basis of the results obtained, deciding whether or not to use a statin proves to be advantageous compared to the conservative strategy.Thus, the number of individuals eligible for drug treatment is limited and consequently the possibility of adverse drug-related effects. At the same time, treatment of the individual is initiated with real benefit from its use, and therefore, cardiovascular events associated with atherosclerosis can be prevented. Therefore, the cost-effectiveness of the strategy that includes the use of CAC in the stratification of these individuals is evident, as an extremely important tool when implemented on a large scale.