Estado del arte del proyecto

El objetivo de este proyecto de investigación es realizar evaluaciones económicas de intervenciones sanitarias y estudios de resultados en salud que permitan aumentar la evidencia científica que informa las decisiones en salud, tanto a nivel micro como macro en las áreas de economía de la salud, epidemiología, salud pública y la gestión sanitaria y de servicios de salud. Este proyecto de investigación se sustenta en la medida que valora la intención de materializar en artículos científicos diversas investigaciones que se vienen adelantando al interior de nuestros grupos de investigación de la Universidad de la Costa-CUC. Existen diferentes aproximaciones metodológicas desde donde se pueden diseñar y ejecutar las investigaciones que planteamos. Como grupos de análisis intentaremos abordar el mayor espectro posible de las enfermedades crónicas no transmisibles y las enfermedades infecciosas. Este proyecto será de gran utilidad para aumentar la cantidad y calidad de la evidencia en el área de las evaluaciones económicas de intervenciones sanitarias y los estudios de resultados en salud. El número de publicaciones que se esperan obtener con este proyecto impactarán positivamente en los estándares investigativos del programa al que pertenecemos, la facultad y la Universidad, así como en la clasificación de nosotros como investigadores y de los grupos de investigación en donde se articularán estos trabajos. Las publicaciones serán mayormente sometidas a revistas Q1, así también como a Q2 y Q3. Se espera que las investigaciones llevadas a cabo generen un número importante de artículos científicos, artículos cortos y presentaciones en congresos científicos

Global, Regional, And National Cancer Incidence, Mortality, Years Of Life Lost, Years Lived With Disability, And Disability-Adjusted Life-Years For 29 Cancer Groups, 1990 To 2016: A Systematic Analysis For The Global Burden Of Disease Study

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined

Characteristics and monetary compensation of caregivers for patients with rheumatic conditions

Musculoskeletal disorders (MD) are highly prevalent conditions that affect quality of life. MD cause physical and psychological dependence. Usually, the care of a patient with MD is assumed by a caregiver. The aim of this study was to describe the sociodemographic characteristics and the monetary remuneration associated to the care of a patient with MD. A cross sectional study was carried out in order to estimate the monetary remuneration related to the health care of patients with MD. A survey was applied to caregivers of patients with MD. Demographic data was collected. We asked about the relationship with the patient, the time as a caregiver and all data related to the monetary compensation. Descriptive epidemiology was done. We reported monetary data in American Dollars (USD) using the average exchange rate for 2018. We surveyed 132 caregivers. Mean age was 52 years [standard deviation 19], 72% were women, 78% were taking care of a patient with rheumatoid arthritis, 12% osteoarthrosis 2% lupus, and 2% osteoporosis. The remaining 6% were caregivers of patients with ankylosing spondylitis, fibromyalgia and Sjogren syndrome. Regarding the time as a caregiver, 48% had less than a year, 16% between two and three years, 18% more than three years, 13% more than four years, and 5% were temporarily caregivers. In our study, 85% of caregivers were a family member, while 15% a nurse or a non-related person. Regarding the compensation, 97% did not receive any salary or payment for being caregiver, the remaining 3% received between 265 and 530 USD per month. Our study demonstrated that the care for patients with MD is mainly assumed by family members. Our results agree with other studies in chronic conditions where only a small proportion of caregivers is paid. Caregivers should be considered for the health system

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

Costos del conflicto armado en Colombia : una revisión sistemática.

The aim of this paper was to review systematically the literature related to the quantification and estimation of the economic costs due to armed conflict in Colombia. We conduct a systematic review and an analysis of the scientific literature on published documents describing the costs related to the conflict in Colombia. The studies presented constitute relevant evidence in terms of estimating the direct and indirect costs, the destruction of physical and human capital and the effects on economic growth of the Colombian armed conflict.El objetivo del presente artículo fue revisar la literatura relacionada con la cuantificación y estimación de los costos económicos del conflicto armado en Colombia. Se realizó una revisión sistemática de literatura científica sobre documentos cientificos publicados que describieran los costos relacionados con el conflicto armado en Colombia y se hizo un análisis de los costos obtenidos. Los estudios presentados constituyen evidencia relevante con relación a la estimación de costos directos e indirectos, la destrucción de capital físico, humano y de los efectos en el crecimiento del Producto Interno Bruto del conflicto armado

Severity factors of Acquired Pneumonia Community in a children's hospital in the Colombian Caribbean

Objective: Identify predisposing factors to develop severe pneumonia in hospitalized children diagnosed with community-acquired pneumonia hospitalized in Cartagena´s Napoleón Franco Pareja children´s Hospital.Methods: Analytical observational cross-sectional study performed in patients under 18 years. Data from surveys and records were analyzed. Univariate and bivariate analysis was performed. The variables are grouped according to the presence or absence of complications and analyzed by ji-square test. We were calculating OR of each of the dummy variables to evaluate their association with complications was performed. A P &amp;lt; 0.05 was considered statistically significant for all analyzes.Results: 301 patients with severe pneumonia were included. Risk factors related to severity: age less than 3 months (OR: 4.86; CI 95%: 1,5 - 14.3; p = 0.004); exclusive breastfeeding for less than 6 months (CI:95% 7,7- 1,4; p = 0.0019); heart disease (OR: 5.37; CI 95%: 1,28- 19,88, p = 0.010); prematurity (OR: 1.62, CI 95%: 0.93- 6.69, p = 0.034); Incomplete vaccination (OR: 2.32; CI: 95% 1.07 - 5.10; p = 0.015).Conclusions: It was found increased severity risk, statistical significantly, in patients less than 6 months breastfeeding, prematurity, heart disease, incomplete vaccination scheme, and positive blood culture with Sp. pneumoni

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

Direct medical costs related to COVID-19 in Colombia

We studied 113 patients hospitalized by COVID-19, 51.3% men. On average, the hospital length of stay for COVID-19 hospitalized patient was 7,3 (± 6,2) days with a median cost of $1,688 (IQR 788-2,523). In women, the median direct medical cost of hospitalization was$1,328 (IQR $463-$2,098), while in men was 1.4 times greater. Being 60 years of age or older triggers hospitalization costs almost twice as high as those under this age ($1,813 vs.$2,994), and when the cost is compared by type of hospitalization, this difference is more than three times (ICU: 4,118; general ward: $1,312)

Policies and processes for human papillomavirus vaccination in Latin America and the Caribbean

e124Objectives. Three highly effective vaccines are available to prevent human papillomavirus (HPV) infection, and they have been introduced in many countries around the world. This article describes advances and challenges in introducing HPV vaccines in the Expanded Program of Immunization (EPI) of countries in Latin America and the Caribbean (LAC). Methods. We reviewed national and regional sources of information to identify LAC countries with and without universal HPV vaccination, along with the year of introduction, type of HPV vaccine, vaccination scheme, age groups targeted, and coverage level reached. Incidence rates of cervical cancer were compared across countries with and without an HPV vaccination program, in order to identify inequities in access to HPV vaccines. Results. So far, 10 LAC countries have supplied data on their vaccination policies and vaccination coverage rates to the Pan America Health Organization. The majority of those 10 started their vaccination programs using quadrivalent vaccine. Only Chile, Ecuador, and Mexico started their programs using a two-dose scheme. However, by the end of 2016, most of the other countries had switched from a three-dose to a two-dose scheme. Different age groups are targeted in the various programs. Some countries vaccinate one-year birth cohorts, while others vaccinate multiple-year birth cohorts. By the end of 2014, coverage with at least two doses ranged from a low of 2% to a high of 86%. With the exception of Venezuela, the LAC countries with the largest populations introduced universal HPV vaccination between 2010 and 2014. Despite the progress that has occurred in some LAC countries, there are still 10 LAC nations with cervical cancer rates above the LAC average (21.2 cases per 100 000) that have not introduced an HPV vaccine in their EPI. Conclusions. With several key adjustments, HPV vaccination programs across Latin America and the Caribbean could be substantially strengthened. Ongoing monitoring of HPV infection outcomes is needed in order to assess the impact of different vaccination policies