Molecular testing dynamics is reactive to COVID-19 incidence: Observations from the colombian experience

There was a positive correlation between molecular tests conducted and COVID-19 incidence and death rate (r = 0.79, p < 0.01 and r = 0.64, p < 0.01, respectively). The cointegration (ADF) test revealed a statistically significant and closely time-dependent stochastic structure between daily COVID-19 cases and number of molecular tests (ADF, -3.50; p < 0.01)

Health care resource utilization in patients with spondyloarthritis: A single setting analysis in Colombia

The aim of this study was to estimate the health care resource utilization in patients with spondylitis from a rheumatology care center located in Bogotá, D.C. Colombi

Prevalence of anemia and iron deficiency in pregnant women living in Cartagena, Colombia

According to the World Health Organization, anemia affects more than 40% of pregnant women worldwide. Iron-deficiency anemia is the most common type of anemia, and has been shown to have a direct impact on health and quality of life of both mother and child.Ferritin, and iron binding protein, can be used to assess the body’s stored iron and support diagnosis. This study assessed the prevalence of anemia and iron deficiency amongst pregnant women in the ESE Clinica Maternidad Rafael Calvo, a reference maternity unit in the department of Bolivar, Colombia

Burden of disease in young population of a colombian health insurance company

To estimate the burden of disease of population between 10-24 years old enrolled in the SER JOVEN program of a Colombian insurance company using disability-adjusted life-years (DALYs). Incidences were estimated from the administrative claims data of Mutual SER EPS. The ICD-10 codes of the main diagnosis were identified and regrouped according to the categories of diseases reported in the global burden of disease (GBD) study. To estimate the years of life lost (YLL), the difference between the age of death and the life expectancy at that age was obtained in a reference mortality population. The years lived with disability (YLD) were obtained by multiplying the estimated morbidity and the disability weights of the GBD 2017. DALYs were calculated by adding YLD and YLLs. We used the information of 512 patients insured to Mutual SER-EPS between 10-24 years, who died during January 2015 to December 2017 from all causes, and the healthcare registers of young people aged 10-24 years residing in 21 municipalities where Mutual SER EPS has presence. In the studied population, premature deaths and disability produced 5,355 DALYs, for 2017. Of these, 67.1% (3,591) of the burden of disease was due to non-communicable causes; followed by communicable, maternal, neonatal, and nutritional diseases (15.9%). The remaining 17% were due to unintentional and vital injuries and unclassified causes. The specific causes with the highest reported burden were substance use disorders and mental disorders, and this relationship remained constant between 2015-2017. In both sexes the first cause was non-communicable diseases; in men, injuries; and in women, communicable, maternal, neonatal diseases. In the analyzed population there was a considerable burden of disease associated with mental disorders and substance use. It is recommended to implement effective strategies that allow prioritizing the diseases that generate the greatest burden

Adherence to long-acting reversible contraceptive methods in low- income young women from the caribbean region of Colombia

Adolescent pregnancies are more likely to occur in poor communities, commonly driven by lack of education and employment opportunities. We aimed to estimate the subdermal implant discontinuation rate and to establish the factors associated with the discontinuation of long-acting reversible contraceptive (LARC) methods in a cohort of poor women in the Caribbean region of Colombia. A retrospective cohort study of LARC method use through review of administrative record data was conducted. A population of 2,192 adolescents and young women between 10-24 years old enrolled in the “SER JOVEN” program and who received subdermal implants between 2015-2018 was considered for eligibility. This program is for young people affiliated to a health care company in the Caribbean region of Colombia. We realized a follow-up time-person of the retrospective cohort, and we estimated the incidence of discontinuation of the subdermal implant at six months, one year, two years, and three years. Kaplan-Meier estimator for survival curves, and Cox proportional hazard model were used to ascertain factors associated with method discontinuation risk. A p-value <0.050 was considered significant. A total of 2,192 women were selected with a mean (standard deviation -SD) age of 19.4 (2.8) years and a mean duration of use of subdermal implant of 2.6 (0.8) years. We estimated the subdermal implant discontinuation rate at six months in 0.7% [CI95% 0.3-1.1], a year later in 1.5% [CI95% 1-2], two years later in 2.1% [CI95% 1.5-2.7] and finally at three years in 2.2% [CI95% 1.6-2.8]. Women who stated they have children at baseline were about 70% less risk to discontinue subdermal implants (HR: 0.3 [CI95% 0.1 – 0.8]). Adolescent pregnancy is a public health problem, and it is an important cause of poverty and illness. Then, the use of subdermal implants is an effective alternative to prevent unintended pregnancies

Carga económica de la Enfermedad Renal Crónica en Colombia

Objetivo: Estimar la carga económica asociada a la Enfermedad Renal Crónica (ERC) en Colombia, para el periodo 2015-2016. Materiales y métodos: Se estimó la carga económica de la ERC en Colombia, a partir de datos de terceros pagadores. Se realizó un costeo de los estadios de la ERC mediante la técnica de macro-costeo o top-down, con el fin de conocer el impacto económico de cada estadio en la carga global de la enfermedad. Se construyó un modelo de Markov que simulara la historia natural de la enfermedad. Se utilizó una tasa de descuento del 5% y ciclos anuales. A cada estado de la ERC, se le asignó un costo relacionado con la atención, obteniendo un estimado del costo y de la carga de enfermedad de todos los pacientes con ERC. Resultados: Al final de los ciclos de todos los pacientes desde el estadio 1-5 e incluyendo el trasplante, se estimó una carga económica que asciende a $10.5 billones de pesos (IC 95$8.7-$14.4). En el escenario con tasa de descuento del 5$7.8 billones de pesos. Conclusión: La ERC representa una alta carga económica al sistema de salud colombiano, que oscila entre $8.7 -$14.4 billones de pesos que representarían entre el 1,6% y el 2,7% del Producto Interno Bruto de Colombia, 2015

Inverse relationship between anemia in the third trimester of pregnancy and low birth weight in a reference maternity unit of a carribean region of Colombia

Anemia is common amongst women in developing countries. Although a relationship has been established between gestational anemia and negative perinatal outcomes, it remains a controversial debate as opposite associations have been found. This study assessed the relationship between gestational anemia in the third trimester and low birth weight (LBW) in the ESE Clinica Maternidad Rafael Calvo, a reference maternity unit in the department of Bolivar, Colombia

A comprehensive care program achieves high remission rates in rheumatoid arthritis in a middle-income setting. Experience of a center of excellence in Colombia

Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patient-centered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58–71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28

Precisión diagnóstica de tres pruebas moleculares para detectar la tuberculosis multirresistente

Introduction: Multi-drug resistant (MDR-TB) and extensively drug-resistant (XDR-TB) tuberculoses are a global public health problem. Their timely detection might reduce the burden of the disease and the economic impact on health systems worldwide.Objective: To conduct a literature review of the diagnostic accuracy of three molecular tests to detect multi-drug resistant and extensively drug-resistant tuberculoses. Materials and methods: A systematic literature review following Cochrane methodology was carried out to study the diagnostic accuracy of three molecular tests to detect MDR-TB and XDR-TB in previous studies among immunocompetent population. Articles indexed in Medline and Embase were reviewed starting in 2007. Diagnostic accuracy was reported by sensitivity, specificity, and positive and negative predictive values of each test.Results: In total, 8, 12 and 13 studies were included to assess the diagnostic accuracy of GeneXpert MTB/RIF®, GenoType MTBDRplus® and GenoType MTBDRsl®, respectively. The specificity of GeneXpert MTB/RIF® ranged between 91 and 100%, and its sensitivity between 33.3 and 100%. The sensitivity of GenoType® MTBDRplus® ranged between 88 and 100%. The sensitivity and specificity of GenoType MTBDRsl® to evaluate drug resistance ranged between 56 and 100% and 21 and 100%, respectively.Conclusion: The three diagnostic tests evaluated have shown an adequate diagnostic accuracy to detect MDR and XDR tuberculoses.Introducción. La tuberculosis multirresistente (TB-MDR) y la extremadamente resistente (TB-XDR) constituyen un problema de salud pública a nivel mundial. Su detección oportuna permitiría reducir la carga de la enfermedad y su impacto económico en los sistemas de salud.Objetivo. Revisar sistemáticamente la información relacionada con la precisión diagnóstica de tres pruebas moleculares para detectar la tuberculosis multirresistente y la extremadamente resistente.Materiales y métodos. Se hizo una revisión sistemática de la literatura, según los lineamientos de Cochrane, de los estudios en población inmunocompetente relacionados con la precisión diagnóstica de tres pruebas moleculares para detectar la tuberculosis multirresistente y la extremadamente resistente. La búsqueda de los estudios publicados a partir del 2007 se hizo en Medline y Embase. La precisión diagnóstica de las pruebas se estableció con base en los valores máximos y mínimos de sensibilidad y especificidad, y en los valores predictivos positivos y negativos.Resultados. Se detectaron ocho estudios sobre la precisión diagnóstica de la prueba GeneXpert MTB/RIF®, 12 sobre la de GenoType MTBDRplus® y 13 sobre la de GenoType MTBDRsl®. La especificidad de GeneXpert MTB/RIF® osciló entre 91 y 100 % y su sensibilidad, entre 33,3 y 100 %. La sensibilidad de GenoType MTBDRplus® varió entre 82 y 100 %, en tanto que la sensibilidad y la especificidad de GenoType® MTBDRsl fluctuaron entre 56 y 100 % y 21 y 100 %, respectivamente.Conclusión. Según los estudios consultados, los tres métodos de diagnóstico evaluados presentaban una adecuada eficacia diagnóstica para detectar la tuberculosis multirresistente y la extremadamente resistente

Desigualdades en la mortalidad debidas a la infección respiratoria aguda en niños: análisis de la situación en Colombia

Introduction: Acute respiratory infections (ARI) are a leading public health issue worldwide. Objective: To explore the inequalities in ARI mortality rates in under-5, according to socioeconomic characteristics. Materials and methods: We conducted an ecological analysis to study inequalities at municipal level due to ARI mortality in children under 5 years. The data were obtained from official death records of the Departamento Administrativo Nacional de Estadística. The analysis of inequalities in the under-5 mortality rate (U5MR) included: 1) Classification of the population in different socio-economic strata, and 2) measurement of the degree of inequality. We used the ARI-U5MR as an outcome measurement. The mortality rates were estimated at national and municipal levels for the years 2000, 2005, 2010, and 2013. Rate ratios, rates differences, and concentration curves were calculated to observe the inequalities. Results: A total of 18,012 children under 5 years died by ARI in Colombia from 2000 to 2013. ARIU5MR was greater in boys than in girls. During this period, an increase in the infant mortality relative gap in both boys and girls was observed. In 2013, the U5MR evidenced that for boys from municipalities with the highest poverty had a 1.6-fold risk to die than those in municipalities with the lowest poverty (low tercile). In girls, the ARI-U5MR for 2005 and 2013 in the poorest tercile was 1.5 and 2 times greater than in the first tercile, respectively. Conclusion: Colombian inequalities in the ARI mortality rate among the poorest municipalities compared to the richest ones continue to be a major challenge in public health.Introducción. Las infecciones respiratorias agudas (IRA) son un importante problema de salud pública a nivel mundial. Objetivo. Explorar las desigualdades de la tasa de mortalidad debida a IRA en niños menores de 5 años según las variables socioeconómicas. Materiales y métodos. Se hizo un análisis ecológico para estudiar las desigualdades a nivel municipal de las tasas de mortalidad por IRA en menores de 5 años. Los datos se obtuvieron a partir de los registros de muertes del Departamento Administrativo Nacional de Estadística. El análisis de desigualdades incluyó la clasificación de la población por estatus socioeconómico y la medición del grado de desigualdad. Como resultado en salud se utilizó la tasa de mortalidad por IRA en menores de 5 años. Se estimaron tasas a nivel nacional y municipal para 2000, 2005, 2010 y 2013. Se calcularon razones y diferencias de tasas y curvas de concentración para observar las desigualdades. Resultados. Entre 2000 y 2013 murieron por IRA en Colombia 18.012 menores de 5 años. La tasa de mortalidad por ARI fue mayor en niños que en niñas. En el periodo, se observó un incremento en la brecha de mortalidad infantil en ambos sexos. En el 2013, la tasa de niños que murieron en municipios con mayor pobreza fue 1,6 veces mayor que la de niños en aquellos con menos pobreza. En niñas, en el 2005 y el 2013, la tasa en el tercil más pobre fue 1,5 y 2 veces mayor que la del primer tercil, respectivamente. Conclusión. Las desigualdades en la tasa de mortalidad por IRA de los municipios más pobres en comparación con la de los más ricos, continúan siendo un reto importante en salud pública